Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA.
Arch Pathol Lab Med. 2010 Jan;134(1):109-14. doi: 10.5858/2008-0676-OAR1.1.
Margin status of lumpectomy specimens is related to frequency of local recurrence. Optimal surgical technique requires microscopic margins free of carcinoma by at least 2 mm. Recurrence following lumpectomy is associated with residual carcinoma secondary to inadequate resection.
To review our series of breast excisions to determine the frequency of residual carcinoma for positive, close, and negative margins.
We reviewed lumpectomies and excisional biopsies for invasive ductal carcinoma that had subsequent reexcisions. Margin status of specimens was recorded as positive, less than 1 mm, 1 to 2 mm, or greater than 2 mm.
A total of 123 lumpectomies and excisional biopsies of invasive ductal carcinoma with reexcision were reviewed. Residual invasive carcinoma was found in 44% (17), 25% (6), 28% (8), and 16% (5) of cases with positive, less than 1 mm, 1 to 2 mm, and greater than 2 mm margins, respectively. Residual invasive carcinomas were found in 57% (8), 100% (5), 67% (2), and 100% (2) of mastectomies with positive, less than 1 mm, 1 to 2 mm, and greater than 2 mm margins, respectively, in the initial lumpectomy or excisional biopsy.
Frequency of residual invasive carcinoma was related to margin status of the original lumpectomy/biopsy. Even when margins were positive, most reexcisions were free of carcinoma. Residual invasive carcinoma was found in greater than 25% of patients with margins less than 2 mm, supporting reexcision for patients with margins of less than 2 mm. Sixteen percent of cases with margins greater than 2 mm harbored residual invasive carcinoma. Evaluation of margin status was complicated by tissue distortion and fragmentation.
保乳手术标本的切缘状态与局部复发的频率有关。最佳手术技术要求显微镜下切缘无癌，至少 2mm 以上。保乳手术后的复发与因切除不足而残留的继发癌有关。
回顾我们的乳腺切除术系列，以确定阳性、接近和阴性切缘的残留癌的频率。
我们回顾了有后续再次切除术的浸润性导管癌的保乳术和切除术活检。标本的切缘状态记录为阳性、小于 1mm、1 至 2mm 或大于 2mm。
共回顾了 123 例浸润性导管癌的保乳术和切除术活检，并有再次切除术。在阳性、小于 1mm、1 至 2mm 和大于 2mm 切缘的病例中，分别发现残留浸润性癌 44%（17 例）、25%（6 例）、28%（8 例）和 16%（5 例）。在初始保乳术或切除术活检中，阳性、小于 1mm、1 至 2mm 和大于 2mm 切缘的乳房切除术的残留浸润性癌分别为 57%（8 例）、100%（5 例）、67%（2 例）和 100%（2 例）。
残留浸润性癌的频率与原始保乳术/活检的切缘状态有关。即使切缘阳性，大多数再次切除术仍无癌。在切缘小于 2mm 的患者中，有大于 25%的患者发现残留浸润性癌，支持对切缘小于 2mm 的患者进行再次切除。在切缘大于 2mm 的病例中，有 16%的患者存在残留浸润性癌。切缘状态的评估受到组织变形和碎裂的影响。
