Meena S. Moran, Yale University School of Medicine, New Haven, CT; Stuart J. Schnitt and Jay R. Harris, Harvard Medical School, Boston, MA; Armando E. Giuliano, Cedars Sinai Medical Center, Los Angeles, CA; Seema A. Khan, Northwestern University Feinberg School of Medicine, Chicago, IL; Janet Horton, Duke University Medical Center, Durham, NC; Suzanne Klimberg, University of Arkansas for Medical Sciences, Fayetteville, AR; Mariana Chavez-MacGregor, University of Texas MD Anderson Cancer Center, Houston, TX; Gary Freedman, University of Pennsylvania School of Medicine, Philadelphia, PA; Nehmat Houssami, School of Public Health, University of Sydney Medical School, Sydney, New South Wales, Australia; Peggy L. Johnson, Susan G. Komen Advocate in Science, Wichita, KS; and Monica Morrow, Memorial Sloan-Kettering Cancer Center, New York, NY.
J Clin Oncol. 2014 May 10;32(14):1507-15. doi: 10.1200/JCO.2013.53.3935. 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 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. J Clin Oncol 32. 2014 American Society of Clinical Oncology®, American Society for Radiation Oncology®, and Society of Surgical Oncology®. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology.
在保乳手术治疗浸润性乳腺癌中，最佳切缘宽度存在争议。
多学科共识小组使用来自 33 项研究的系统评价中关于切缘宽度和同侧乳房肿瘤复发（IBTR）的荟萃分析作为共识的主要证据基础，这些研究包括 28162 例患者。
与阴性切缘相比，阳性切缘（浸润性癌或导管原位癌上的墨水）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缓解。更广泛的清晰切缘与无肿瘤墨水相比，并不会显著降低 IBTR 发生率。没有证据表明更广泛的清晰切缘可降低年轻患者、生物学不良、小叶癌或具有广泛导管内成分的癌症患者的 IBTR 发生率。
在多学科治疗时代，将肿瘤上无墨水作为浸润性癌充分切缘的标准，与低复发率相关，并有潜力降低再次切除率、改善美容结果并降低医疗保健成本。J Clin Oncol 32. 2014 美国临床肿瘤学会、美国放射肿瘤学会和外科肿瘤学会。未经美国临床肿瘤学会、美国放射肿瘤学会和外科肿瘤学会书面许可，不得以任何形式或通过任何手段复制或传播本文档的任何部分，包括影印、录制或任何信息存储和检索系统。
