Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35249-7331, USA.
Hum Pathol. 2012 Jul;43(7):986-93. doi: 10.1016/j.humpath.2011.09.010. Epub 2012 Jan 4.
Breast-conserving surgery with radiation therapy has become a standard treatment option in women with localized ductal carcinoma in situ. Re-excision is common in breast-conserving surgery, partly due to lack of consensus on what might constitute an adequate margin. In this study, we aimed to identify potential predictive factors for presence/absence of residual disease after initial breast-conserving surgery. Of 232 cases with a diagnosis of ductal carcinoma in situ without invasive carcinoma at initial biopsy between 2005 and 2009, 108 patients underwent breast-conserving surgery, of which 46 had re-excisions due to close margins (≤ 2 mm). The notable features significantly associated with ductal carcinoma in situ residuum (19/46; 41%) on univariate logistic regression analysis included the number of close margins, the percentage of sections with ductal carcinoma in situ, and the number of duct spaces with ductal carcinoma in situ (no. of ductal carcinoma in situ ducts) at close margins. Only the percentage of sections with ductal carcinoma in situ remained a significant factor associated with outcomes on multivariate analysis, whereas the number of ductal carcinoma in situ ducts at close margins held borderline predictive value (P = .054). Furthermore, logistic regression and classification and regression tree analysis using the 10-fold cross validation method revealed optimal predicting accuracy by using the 3 significant factors in univariate analysis. The final decision tree was constructed by using the number of ductal carcinoma in situ ducts at close margins and the percentage of sections with ductal carcinoma in situ. Thus, these 2 factors represent the most powerful predictors for residual disease on re-excision. Optimal discriminatory power for prediction of absence of residual disease was achieved with cutoffs of 18 ductal carcinoma in situ ducts at close margins and 51.3% sections with ductal carcinoma in situ.
保乳手术联合放疗已成为局部导管原位癌女性的标准治疗选择。保乳手术后常需再次切除，这部分是由于对什么构成足够的切缘缺乏共识。在这项研究中，我们旨在确定初始保乳手术后残留疾病存在/缺失的潜在预测因素。在 2005 年至 2009 年间，232 例初始活检诊断为导管原位癌且无浸润性癌的患者中，有 108 例患者接受了保乳手术，其中 46 例因切缘接近（≤2mm）而再次切除。单因素逻辑回归分析表明，与导管原位癌残余物显著相关的显著特征包括：切缘接近的数量、有导管原位癌的切片百分比和有导管原位癌的导管数量（导管原位癌导管数）。仅在多因素分析中，有导管原位癌的切片百分比仍然是与结果相关的显著因素，而切缘接近的导管原位癌导管数具有边缘预测价值（P=0.054）。此外，使用 10 折交叉验证法的逻辑回归和分类回归树分析显示，使用单因素分析中的 3 个显著因素可以达到最佳预测准确性。最终决策树是使用切缘接近的导管原位癌导管数和有导管原位癌的切片百分比构建的。因此，这 2 个因素是切缘接近的导管原位癌残余物的最强预测因素。预测无残留疾病的最佳判别能力是切缘接近的导管原位癌导管数为 18 个，有导管原位癌的切片百分比为 51.3%。
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