The Breast Unit, Elizabeth Garrett Anderson Wing, University College Hospital, London, United Kingdom.
Breast J. 2010 May-Jun;16(3):222-32. doi: 10.1111/j.1524-4741.2010.00917.x.
Conventional indications for mastectomy (MX) reflect circumstances where breast conserving therapy (BCT) could compromise oncological or cosmetic outcome. MX continues to be recommended for the majority of women with multiple lesions within the same breast. In this article, we review the oncological safety and aesthetic considerations of BCT in the context of multifocal (MF) or multicentric (MC) breast cancer. Literature review facilitated by Medline and PubMed databases. Published studies have reported divergent results regarding the oncological adequacy of BCT in the management of MF or MC disease. Earlier studies demonstrated high rates of local recurrence (LR) for BCT. More recent series have found BCT to be comparable to MX in terms of LR, distant failure, disease free and overall survival. Few studies have adequately evaluated cosmetic outcomes following BCT for MF or MC breast cancer. Contemporary oncoplastic techniques have extended the clinical utility of BCT and are of particular relevance to breast conservation in the context of MF or MC lesions. Appropriate case selection, preoperative oncological and aesthetic planning, satisfactory clearance of the surgical margins and adjuvant radiotherapy are of paramount importance. In the absence of level-1 guidance concerning the management of women with MF or MC disease, each case requires discussion with regard to tumor and patient related factors in the context of the multidisciplinary team. In selected patients with MF or MC disease, BCT is oncologically safe and cosmetically acceptable. Uniformity of practice and the establishment of a standard of care will require an evidence-base from prospective studies.
保乳手术（MX）的传统适应证反映了保乳治疗（BCT）可能影响肿瘤学或美容效果的情况。对于同一乳房内有多个病变的大多数女性，仍然推荐 MX。在本文中，我们将回顾多灶性（MF）或多中心（MC）乳腺癌中 BCT 的肿瘤安全性和美容学考虑因素。通过 Medline 和 PubMed 数据库进行文献复习。已发表的研究报告了 BCT 治疗 MF 或 MC 疾病的肿瘤学充分性的结果存在差异。早期研究表明，BCT 的局部复发（LR）率较高。最近的系列研究发现，BCT 在 LR、远处失败、无病生存和总生存方面与 MX 相当。很少有研究充分评估了 MF 或 MC 乳腺癌 BCT 后的美容效果。当代的肿瘤整形技术扩展了 BCT 的临床应用，并特别适用于 MF 或 MC 病变的保乳。适当的病例选择、术前肿瘤学和美容学规划、满意的手术切缘清除和辅助放疗至关重要。在缺乏关于 MF 或 MC 疾病女性管理的 1 级指南的情况下，每个病例都需要根据多学科团队中肿瘤和患者相关因素进行讨论。在 MF 或 MC 疾病的选定患者中，BCT 在肿瘤学上是安全的，美容上是可以接受的。一致性的实践和护理标准的建立将需要来自前瞻性研究的证据基础。
