Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, CT, USA.
Ann Surg Oncol. 2014 Mar;21(3):704-16. doi: 10.1245/s10434-014-3481-4. Epub 2014 Feb 10.
Controversy exists regarding the optimal margin width in breast-conserving surgery for invasive breast cancer.
A multidisciplinary consensus panel used a meta-analysis of margin width and ipsilateral breast tumor recurrence (IBTR) from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus.
Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a two-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component.
The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.
在保乳手术治疗浸润性乳腺癌中，对于最佳切缘宽度存在争议。
一个多学科共识小组使用了一项荟萃分析，该分析基于对 33 项研究的系统评价，其中包括 28162 名患者的切缘宽度和同侧乳房肿瘤复发（IBTR）数据，作为共识的主要证据基础。
与阴性切缘相比，阳性切缘（浸润性癌或原位导管癌上的墨水）与 IBTR 风险增加两倍相关。这种风险增加不能通过有利的生物学、内分泌治疗或放射增敏来减轻。与没有肿瘤上的墨水相比，更广泛的清晰切缘并不能显著降低 IBTR 率。没有证据表明更广泛的清晰切缘可降低年轻患者或生物学不良、小叶癌或具有广泛管内成分的癌症患者的 IBTR 率。
在多学科治疗时代，将肿瘤上没有墨水作为浸润性癌充分切缘的标准，与低复发率相关，并有可能降低再次切除率，改善美容效果，降低医疗成本。
