Burlington, Vt. From the Departments of Pathology and Plastic and Reconstructive Surgery and the Vermont Cancer Center, University of Vermont.
Plast Reconstr Surg. 2009 Nov;124(5):1386-1392. doi: 10.1097/PRS.0b013e3181b988da.
Reduction mammaplasty for symptomatic macromastia or correction of asymmetry is performed more than 100,000 times per year in the United States. The reported incidence of occult breast cancer in reduction mammaplasty ranges from 0.06 to 4.6 percent. No standard pathology assessment for reduction mammaplasty exists. The authors evaluated the incidence of occult carcinoma and atypical hyperplasia in reduction mammaplasty specimens and identified clinical risk factors. Systematic sampling of additional tissue sections was instituted to evaluate the hypothesis that increased sampling would identify more significant pathologic findings.
All reduction mammaplasty specimens over a 20-month period at a single institution were prospectively examined. All specimens had baseline gross and microscopic evaluations, and then each was subjected to systematic additional sampling. The incidence of significant pathologic findings (carcinoma and atypical hyperplasia) was tabulated. Variables such as age and preoperative mammogram were examined.
A total of 202 cases were evaluated. Significant pathologic findings (carcinoma and atypical hyperplasia) were present in 12.4 percent. The rate of carcinoma was 4 percent in all patients (6.2 percent in patients >or=40 years and 7.9 percent in patients >or=50 years).
A significantly higher rate (12.4 percent) of significant pathologic findings was identified in this prospective study compared with published literature. None of the lesions was identified on preoperative mammogram. Age was significantly associated with significant pathologic findings. Increased sampling was associated with significant pathologic findings only in patients 40 years or older, indicating the need for thorough sampling of reduction mammaplasty specimens in patients older than 40.
在美国，每年有超过 10 万例因症状性巨乳症或不对称性而进行的乳房缩小成形术。据报道，乳房缩小成形术中隐匿性乳腺癌的发病率为 0.06%至 4.6%。目前还没有针对乳房缩小成形术的标准病理学评估。作者评估了乳房缩小成形术标本中隐匿性癌和不典型增生的发生率，并确定了临床危险因素。系统地对额外的组织切片进行采样，以验证增加采样可以发现更多显著的病理发现的假设。
在一个机构的 20 个月期间，前瞻性地检查了所有的乳房缩小成形术标本。所有标本均进行了基线大体和显微镜评估，然后对每个标本进行了系统的额外采样。记录了显著的病理发现（癌和不典型增生）的发生率。还检查了年龄和术前乳房 X 线照片等变量。
共评估了 202 例病例。有 12.4%的病例存在显著的病理发现（癌和不典型增生）。所有患者的癌发生率为 4%（40 岁及以上患者为 6.2%，50 岁及以上患者为 7.9%）。
与已发表的文献相比，这项前瞻性研究发现显著的病理发现的比率明显更高（12.4%）。术前乳房 X 线照片未发现任何病变。年龄与显著的病理发现显著相关。仅在 40 岁及以上的患者中，增加采样与显著的病理发现相关，这表明需要对 40 岁以上患者的乳房缩小成形术标本进行彻底采样。
