Division of Plastic Reconstruction Surgery, European Institute of Oncology, Milan, Italy.
Ann Surg Oncol. 2012 Dec;19(13):4117-23. doi: 10.1245/s10434-012-2514-0. Epub 2012 Jul 21.
Our purpose was to evaluate the locoregional recurrence (LRR) of patients with false-negative, frozen-section or close margins of retroareolar specimen in nipple-sparing mastectomy (NSM) procedure.
From 2002-2008, we recruited patients who had atypia or presence of cancer cells in definitive histology of retroareolar tissue despite of absence of tumor cell in intraoperative retroareolar frozen section. We also included the close margin cases defined as the presence of tumor cells at the first frozen section, but after deeper core out of retroareolar tissue were revealed free of malignancy. The incidence of LRR and NAC recurrence were reported, and the factors associated were analyzed.
Of 948 NSM procedures, there were 88 false-negative, frozen-sections and 10 close margin cases. The 5-year cumulative incidence of LRR and NAC recurrence was 11.2 % (10/98 patients) and 2.4 % (2/98 patients), respectively. Analyzing the definitive results of retroareolar tissue, the 5-year cumulative incidence of LRR was 42.9 % (n = 4) for atypia, 10 % (n = 2) for lobular carcinoma in situ (LCIS), 10 % (n = 1) for close margins, 8.7 % (n = 3) for ductal carcinoma in situ (DCIS), and 0 % for invasive carcinoma. In situ carcinoma as a primary tumor was a significant predictor of NAC recurrence (P < 0.01).
Despite a high reliability of frozen section, there is still a minority of false-negative results. Nevertheless, the LRR is considerably low. This fact suggests the possibility of preservation of the NAC after discussion with the patient.
本研究旨在评估保乳乳房切除术（NSM）术中切缘为阴性、冷冻切片或接近乳晕后组织切缘的患者的局部区域复发（LRR）情况。
2002 年至 2008 年，我们招募了这样一组患者，尽管术中乳晕后组织的冷冻切片未发现肿瘤细胞，但最终的组织学检查显示乳晕后组织存在不典型增生或癌细胞。我们还包括切缘接近的病例，定义为首次冷冻切片发现肿瘤细胞，但进一步切除乳晕后组织的核心组织后证实无恶性肿瘤。报告了 LRR 和 NAC 复发的发生率，并分析了相关因素。
在 948 例 NSM 手术中，有 88 例为冷冻切片假阴性，10 例为切缘接近。LRR 和 NAC 复发的 5 年累积发生率分别为 11.2%（98 例患者中有 10 例）和 2.4%（98 例患者中有 2 例）。分析乳晕后组织的最终结果，不典型增生的 5 年 LRR 累积发生率为 42.9%（n=4），乳腺小叶原位癌（LCIS）为 10%（n=2），切缘接近为 10%（n=1），导管原位癌（DCIS）为 8.7%（n=3），浸润性癌为 0%。作为原发性肿瘤的原位癌是 NAC 复发的显著预测因素（P<0.01）。
尽管冷冻切片的可靠性很高，但仍有少数假阴性结果。然而，LRR 相当低。这一事实表明，在与患者讨论后，有可能保留 NAC。
