Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Breast J. 2010 Sep-Oct;16 Suppl 1:S49-52. doi: 10.1111/j.1524-4741.2010.01005.x.
Ductal carcinoma in situ (DCIS) is a heterogeneous and complex disorder that has changed greatly as an entity over the past few decades. Despite an overall favorable prognosis and evidence-based recommendations from randomized trials, the clinical management of DCIS varies considerably among surgeons. While the goal is to achieve maximal local control with minimal morbidity, surgeons at times both over- and undertreat these patients. Currently, the rates of mastectomy and contralateral prophylactic mastectomy have been dramatically rising without clear evidence of better control. Radiotherapy is omitted in about one- half of patients undergoing lumpectomy. Tools to help stratify patients at highest risk for DCIS or invasive recurrence may assist in determining appropriate therapy. This article reviews some of the areas of controversy in the surgical approach to DCIS, including breast conservation versus mastectomy, the use of radiotherapy, the appropriate extent of margins, and the criteria for including sentinel nodal biopsy.
导管原位癌（DCIS）是一种异质性和复杂性疾病，在过去几十年中作为一个实体发生了很大变化。尽管总体预后良好，且有随机试验的循证建议，但 DCIS 的临床管理在外科医生之间差异很大。虽然目标是通过最小的发病率实现最大的局部控制，但外科医生有时会过度治疗和治疗不足这些患者。目前，乳房切除术和对侧预防性乳房切除术的比率在没有明显更好控制证据的情况下急剧上升。约有一半接受保乳手术的患者未接受放疗。有助于分层 DCIS 或浸润性复发风险最高的患者的工具可能有助于确定适当的治疗方法。本文回顾了 DCIS 外科治疗方法中的一些争议领域，包括保乳与乳房切除术、放疗的应用、切缘的适当范围以及前哨淋巴结活检的标准。
