East of Scotland Breast Service, Ninewells Hospital, Dundee DD1 9SY, UK.
Eur J Surg Oncol. 2012 Apr;38(4):302-6. doi: 10.1016/j.ejso.2012.01.004. Epub 2012 Jan 27.
Complete tumour excision in breast conserving surgery (BCS) is critical for successful outcome; involved circumferential resection margins are associated with increased disease recurrence. However, the importance of an involved anterior margin (IAM) is less clear. The purpose of this study was to review an aggressive approach to IAM and hence assess whether anterior margin re-excision (RE) yields clinical benefit.
A review of prospectively collected clinical and pathology data was performed for all patients who underwent BCS between 2006 and 2010 through a single cancer centre. An involved margin was defined as < 1 mm clearance of invasive or in-situ breast cancer.
1667 patients underwent BCS for invasive and/or in-situ disease, of whom 114 underwent RE. A total of 170 involved margins were identified: most commonly the anterior (52 margins) followed by the posterior (39 margins) and inferior (31 margins) margin. Patients with IAM were more likely to have grade 3 invasive disease (p = 0.0323) but less likely to have residual disease found at re-excision (2/49 vs. 32/101 margins, p = 0.0033); there were no differences when in-situ characteristics were compared.
RE of IAM after BCS rarely yields further disease; multi-disciplinary teams should consider whether further therapy for an IAM is required on a patient by patient basis.
保乳手术（BCS）中完全切除肿瘤对于获得成功的结果至关重要；受累的环形切缘与疾病复发增加有关。然而，受累的前切缘（IAM）的重要性尚不清楚。本研究的目的是回顾一种积极的 IAM 处理方法，从而评估前切缘再次切除（RE）是否能带来临床获益。
对 2006 年至 2010 年期间通过单一癌症中心接受 BCS 的所有患者的前瞻性收集的临床和病理数据进行了回顾。受累的切缘定义为浸润性或原位乳腺癌的清除<1 毫米。
1667 例患者接受了浸润性和/或原位疾病的 BCS，其中 114 例接受了 RE。共发现 170 个受累的切缘：最常见的是前切缘（52 个），其次是后切缘（39 个）和下切缘（31 个）。IAM 患者更有可能患有 3 级浸润性疾病（p = 0.0323），但在再次切除时发现残留疾病的可能性较小（2/49 与 32/101 个切缘，p = 0.0033）；当比较原位特征时，没有差异。
BCS 后对 IAM 的 RE 很少产生进一步的疾病；多学科团队应根据患者的具体情况考虑是否需要对 IAM 进行进一步的治疗。
