Department of Pathology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
Oncology (Williston Park). 2011 Aug;25(9):852-6.
Utilizing routine histopathologic parameters obtained from appropriately handled lumpectomy and mastectomy specimens, a rational therapeutic plan based on epidemiologic and outcome-based data can be devised for any patient diagnosed with ductal carcinoma in situ (DCIS). In order to make a sound decision when weighing the current treatment options for DCIS--which include excision alone, excision plus radiation, and mastectomy--the following are mandatory: 1) assurance of an accurate diagnosis, 2) assessment of DCIS size and grade, and 3) careful margin evaluation. Accurate grading of DCIS is critical, since high nuclear grade and the presence of necrosis are highly predictive of the inability to achieve adequate margins, of local recurrence, and of the probability of missed areas of invasion. Margin status is the single most important determinant of local control following breast conservation for DCIS; numerous studies have shown that as the margin width increases, the risk of local failure decreases. The pros and cons of irradiating conservatively treated patients with DCIS should be carefully weighed on a case-by-case basis. Despite the 20-year-old dogma that all patients treated with breast conservation should receive postoperative radiation, a subset of patients who can be successfully treated by excision alone has been identified.
利用适当处理的保乳手术和乳房切除术标本获得的常规组织病理学参数，可以为任何诊断为导管原位癌（DCIS）的患者制定基于流行病学和基于结果的数据的合理治疗计划。为了在权衡 DCIS 的当前治疗选择时做出明智的决策——这些选择包括单纯切除、切除加放疗和乳房切除术——以下是强制性的：1）确保准确的诊断，2）评估 DCIS 的大小和分级，以及 3）仔细评估边缘。准确分级 DCIS 至关重要，因为核高级别和坏死的存在高度预测无法达到足够的边缘、局部复发和错过侵袭区域的概率。边缘状态是保乳治疗 DCIS 后局部控制的唯一最重要决定因素；许多研究表明，随着边缘宽度的增加，局部失败的风险降低。应根据具体情况仔细权衡对接受保守治疗的 DCIS 患者进行放疗的利弊。尽管存在 20 年的陈旧观念，即所有接受保乳治疗的患者都应接受术后放疗，但已经确定了一部分可以通过单纯切除成功治疗的患者。
