Kikuyama Mizuho, Akashi-Tanaka Sadako, Hojo Takashi, Kinoshita Takayuki, Ogawa Toshihisa, Seto Yasuyuki, Tsuda Hitoshi
Department of Metabolic Care and Endocrine Surgery, Graduate School of Medicine, University of Tokyo, Tokyo Department of Breast Surgery, National Cancer Center Hospital, Tokyo Department of Breast Surgery, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo.
Department of Breast Surgery, National Cancer Center Hospital, Tokyo Breast Surgical Oncology Department, Showa University, School of Medicine, Tokyo.
Jpn J Clin Oncol. 2015 Jan;45(1):19-25. doi: 10.1093/jjco/hyu158. Epub 2014 Oct 15.
In patients who underwent breast-conserving surgery, we attempted to identify the histological characteristics of margin-exposed tumor components on intraoperative frozen section examinations that were predictive of residual tumor components in additionally resected specimens.
Of 1835 patients who underwent breast-conserving surgery, we identified 220 patients who had positive surgical margins determined by intraoperative frozen section examinations and who had undergone immediate additional resections. Two observers (M.K., H.T.) reviewed the slides of frozen sections and confirmed the presence of tumor components.
In additionally resected specimens, residual tumors were detected in 115 cases (52.3%) but not in 105 cases (47.7%). The primary tumor characteristics of extensive intraductal component (+), younger age, invasive lobular carcinoma and pathological T3 classification were significantly associated with the residual tumor components. The margin-exposed tumor components of the maximum diameter, number of positive margins and histological type were correlated with the residual tumors. Multivariate analysis showed that the maximum tumor diameter was an independent risk factor for residual tumors.
Diagnosis of positive margins by intraoperative frozen section examinations was useful for predicting residual tumors, and three histological properties of the margin-exposed tumor components were correlated with the status of residual tumor components. Although it was impossible to clearly identify the single main factor for predicting patients for whom additional resections were not necessary, it may be possible to consider stratification of additional surgical therapy according to the characteristics of margin-exposed tumor components on intraoperative frozen section examinations.
在接受保乳手术的患者中，我们试图确定术中冰冻切片检查时切缘暴露的肿瘤成分的组织学特征，这些特征可预测再次切除标本中是否存在残留肿瘤成分。
在1835例接受保乳手术的患者中，我们确定了220例术中冰冻切片检查显示手术切缘阳性且随后立即接受再次切除的患者。两名观察者（M.K.，H.T.）复查了冰冻切片玻片并确认肿瘤成分的存在。
在再次切除的标本中，115例（52.3%）检测到残留肿瘤，105例（47.7%）未检测到残留肿瘤。广泛导管内成分（+）、较年轻、浸润性小叶癌和病理T3分期等原发肿瘤特征与残留肿瘤成分显著相关。切缘暴露肿瘤成分的最大直径、阳性切缘数量和组织学类型与残留肿瘤相关。多因素分析显示，肿瘤最大直径是残留肿瘤的独立危险因素。
术中冰冻切片检查诊断切缘阳性有助于预测残留肿瘤，切缘暴露肿瘤成分的三种组织学特征与残留肿瘤成分状态相关。虽然不可能明确确定预测无需再次切除患者的单一主要因素，但根据术中冰冻切片检查时切缘暴露肿瘤成分的特征考虑对再次手术治疗进行分层可能是可行的。
