Department of Surgery, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea.
Breast Cancer Res Treat. 2012 Aug;134(3):1115-23. doi: 10.1007/s10549-012-2124-3. Epub 2012 Jun 13.
A positive resection margin after breast-conserving surgery (BCS) is the most important risk factor for tumor recurrence. Re-excision after BCS often results in unnecessary wider excisions, or even mastectomies and poor cosmetic results, as well as increased medical costs and patients' anxiety. A nomogram for predicting positive resection margins may allow the surgeon to develop an individualized surgical plan. Data from 1,034 consecutive breast cancer patients with invasive or in situ breast cancer who initially underwent BCS between January 2008 and December 2009 were used to develop a nomogram for predicting positive resection margins. The nomogram was then validated independently using a cohort of 563 patients who underwent breast surgery in 2010. Multivariate logistic regression analysis showed that microcalcifications (OR 1.574, P = 0.034), grade 4 mammographic density (OR 4.515, P = 0.005), >0.5 cm difference in tumor size between magnetic resonance imaging and ultrasonography (OR 10.001, P < 0.0001), ductal carcinoma in situ (DCIS) on needle biopsy (OR 1.575, P = 0.044), and lobular component on needle biopsy (OR 3.985, P = 0.015) were independent predictors of positive resection margins. These significant variables were used to develop a nomogram for predicting positive resection margins after BCS; the AUCs of the study and the validation cohorts were 0.823 [95 % confidence interval (CI), 0.785-0.862] and 0.846 (95 % CI, 0.800-0.892), respectively. Our new nomogram using 5 variables that were determined before surgery to predict positive resection margins should aid the surgeon in developing individualized surgical plans for breast cancer patients who are scheduled for BCS.
保乳手术后（BCS）的阳性切缘是肿瘤复发的最重要危险因素。BCS 后再次切除通常会导致不必要的更广泛切除，甚至乳房切除术和较差的美容效果，以及增加医疗费用和患者焦虑。预测阳性切缘的列线图可以帮助外科医生制定个体化的手术计划。该列线图使用了 2008 年 1 月至 2009 年 12 月期间接受 BCS 的 1034 例浸润性或原位乳腺癌连续患者的数据进行开发，并在 2010 年接受乳房手术的 563 例患者中进行了独立验证。多变量逻辑回归分析显示，微钙化（OR 1.574，P = 0.034）、4 级乳腺密度（OR 4.515，P = 0.005）、磁共振成像和超声之间肿瘤大小差异>0.5cm（OR 10.001，P < 0.0001）、针活检中的导管原位癌（DCIS）（OR 1.575，P = 0.044）和针活检中的小叶成分（OR 3.985，P = 0.015）是阳性切缘的独立预测因素。这些显著变量用于开发预测 BCS 后阳性切缘的列线图；研究和验证队列的 AUC 分别为 0.823 [95%置信区间（CI），0.785-0.862]和 0.846（95%CI，0.800-0.892）。我们使用 5 个术前确定的变量开发的新列线图来预测阳性切缘，应该有助于外科医生为计划接受 BCS 的乳腺癌患者制定个体化的手术计划。
