在保乳手术中，肿块切除标本的切缘对于预测残留疾病并不可靠。
Lumpectomy specimen margins are not reliable in predicting residual disease in breast conserving surgery.
作者信息
Tang Rong, Coopey Suzanne B, Specht Michelle C, Lei Lan, Gadd Michele A, Hughes Kevin S, Brachtel Elena F, Smith Barbara L
机构信息
Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Division of Breast Surgery, Hunan Provincial Tumor Hospital, The Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha 410013, China.
Division of Surgical Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
出版信息
Am J Surg. 2015 Jul;210(1):93-8. doi: 10.1016/j.amjsurg.2014.09.029. Epub 2014 Dec 23.
BACKGROUND
In breast conserving surgery, the concordance between lumpectomy margin (LM) status and the status of the corresponding lumpectomy cavity remains uncertain.
METHODS
We analyzed pathology reports of lumpectomies from 2004 to 2006. We included those which contained both ink-directed LM and complete (≥4) separate corresponding shaved cavity margins (SCMs). SCM pathology was used as a surrogate for lumpectomy cavity status, to determine the predictive value of LM for residual disease.
RESULTS
Pathology from 1,201 pairs of LM and SCM from 242 patients was compared. LM status predicted corresponding lumpectomy cavity status with 50.9% sensitivity, 69.5% specificity, 35% positive predictive value, and 81.4% negative predictive value, giving an overall accuracy of 64.9%.
CONCLUSIONS
Oriented LMs are not reliable for predicting lumpectomy cavity status, and therefore not reliable for directing re-excision. Taking complete, oriented SCMs at the time of lumpectomy may improve accuracy compared with traditional LM assessment.
背景
在保乳手术中，肿块切除边缘（LM）状态与相应肿块切除腔状态之间的一致性仍不确定。
方法
我们分析了2004年至2006年肿块切除术的病理报告。我们纳入了那些包含墨水标记的LM和完整（≥4个）单独的相应刮除腔边缘（SCM）的报告。SCM病理被用作肿块切除腔状态的替代指标，以确定LM对残留疾病的预测价值。
结果
比较了242例患者的1201对LM和SCM的病理。LM状态预测相应肿块切除腔状态的灵敏度为50.9%，特异度为69.5%，阳性预测值为35%，阴性预测值为81.4%，总体准确率为64.9%。
结论
定向LM对于预测肿块切除腔状态不可靠，因此对于指导再次切除也不可靠。与传统的LM评估相比，在肿块切除时获取完整、定向的SCM可能会提高准确性。
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