Surgical Oncology, VU University Medical Center, Amsterdam, The Netherlands.
Breast J. 2011 Nov-Dec;17(6):602-9. doi: 10.1111/j.1524-4741.2011.01198.x.
The main determinant of cosmetic outcomes following breast-conserving surgery (BCS) for breast cancer is the volume of resection. The importance of achieving optimal oncological control may lead to an unnecessarily large resection of breast tissue. The aim of this study is to evaluate excess resection volume in BCS for cancer by determining a calculated resection ratio (CRR). This retrospective study was conducted in four affiliated institutions and involved 726 consecutive patients with T1-T2 invasive breast cancer treated by BCS between January 2006 and 2009. The pathology reports were reviewed for tumor palpability, tumor size, surgical specimen size, and oncological margin status. The optimal resection volume (ORV) was defined as the spherical tumor volume with an added 1.0 cm margin of healthy breast tissue. The total resection volume (TRV) was defined as the ellipsoid volume of the surgical specimen. CRR was determined by dividing the TRV by the ORV. Of all tumors, 72% (525/726) were palpable, and 28% (201/726) were nonpalpable. The tumor stage was T1 in 492 patients (67.8%) and T2 in 234 patients (32.2%). The median CRR was 2.5 (0.01-42.93). Margin status was positive or focally positive in 153 patients (21.1%). Lower tumor stage was associated with a higher CRR (factor 0.61 [p < 0.0001] and a lower positive margin rate [p = 0.064]). Accordingly, the median CRR of the nonpalpable lesions was higher than that of the palpable lesions (3.1 and 2.2, respectively; p < 0.01), and the involved margin rate was lower (17.4% and 22.5%, respectively; p = 0.13). Of patients with a CRR >4.0, 10.7% still had tumor involved margins. This study clearly shows that BCS is associated with excessive resection of healthy breast tissue while clear margins are not assured. Surgical factors should be modified to improve surgical accuracy.
保乳手术后（BCS）乳腺癌美容效果的主要决定因素是切除体积。实现最佳肿瘤控制的重要性可能导致乳房组织的不必要的大量切除。本研究旨在通过确定计算切除比（CRR）来评估癌症保乳手术中的过度切除体积。这项回顾性研究在四家附属医院进行，涉及 2006 年 1 月至 2009 年间接受 BCS 治疗的 726 例 T1-T2 浸润性乳腺癌连续患者。对病理报告进行了肿瘤可触性、肿瘤大小、手术标本大小和肿瘤边缘状态的审查。最佳切除体积（ORV）定义为具有 1.0 cm 健康乳腺组织边缘的球形肿瘤体积。总切除体积（TRV）定义为手术标本的椭圆形体积。CRR 通过将 TRV 除以 ORV 来确定。在所有肿瘤中，72%（525/726）是可触的，28%（201/726）是不可触的。肿瘤分期为 T1 的患者 492 例（67.8%），T2 的患者 234 例（32.2%）。中位 CRR 为 2.5（0.01-42.93）。153 例（21.1%）边缘状态为阳性或局灶性阳性。较低的肿瘤分期与较高的 CRR 相关（因子 0.61 [p < 0.0001] 和较低的阳性边缘率 [p = 0.064]）。因此，不可触病变的中位 CRR 高于可触病变（分别为 3.1 和 2.2；p < 0.01），且受累边缘率较低（分别为 17.4%和 22.5%；p = 0.13）。CRR >4.0 的患者中有 10.7%仍有肿瘤累及边缘。本研究清楚地表明，BCS 与健康乳腺组织的过度切除有关，而不能保证明确的边缘。应修改手术因素以提高手术准确性。
