Clough Krishna B, Gouveia Pedro F, Benyahi Djazia, Massey Eleanore J D, Russ Elisabeth, Sarfati Isabelle, Nos Claude
L'Institut du Sein - Paris Breast Center, Paris, France.
Ann Surg Oncol. 2015 Dec;22(13):4247-53. doi: 10.1245/s10434-015-4514-3. Epub 2015 Apr 18.
Oncoplastic techniques applied to breast-conserving surgery (BCS) allow large-volume resections without compromising cosmetic results. Level II oncoplastic techniques are based on mammoplasties. When required, they allow resection of more than 20 % of the breast volume; however, a subgroup of these patients will still have positive margins. The clinical management of positive margins after level II oncoplastic surgery (OPS) is a challenge.
All patients who had undergone level II oncoplastic techniques at The Paris Breast Center between 2004 and 2013 were reviewed. The choice of the optimal mammoplasty technique was based on the tumor location and the 'quadrant per quadrant atlas'.
A total of 277 level II oncoplastic techniques were performed on 272 patients. The mean tumor size was 26 mm (range 2-160 mm), with a mean resected weight of 175 g (range 50-1540 g). The rate of positive margins was 11.9 %. Risk factors for positive margins identified in univariate analysis were histologic subgroup, tumor size, T stage and grade. In multivariate analysis, only patients with invasive lobular carcinoma had a significantly higher risk of positive margins. A second operation was required in 33 cases, and a third operation was required in three cases because of positive margins. Final breast conservation rate was 91 %.
Level II OPS results in a low positive margin rate despite large tumor size. Patients with involved margins can be offered a second BCS if the remaining volume allows this.
应用于保乳手术（BCS）的肿瘤整形技术可实现大体积切除，且不影响美容效果。二级肿瘤整形技术基于乳房整形术。在必要时，它们可切除超过20%的乳房体积；然而，这些患者中有一部分仍会有切缘阳性。二级肿瘤整形手术（OPS）后切缘阳性的临床处理是一项挑战。
回顾了2004年至2013年期间在巴黎乳腺中心接受二级肿瘤整形技术治疗的所有患者。最佳乳房整形技术的选择基于肿瘤位置和“象限象限图谱”。
共对272例患者实施了277次二级肿瘤整形技术。平均肿瘤大小为26毫米（范围2 - 160毫米），平均切除重量为175克（范围50 - 1540克）。切缘阳性率为11.9%。单因素分析确定的切缘阳性危险因素为组织学亚组、肿瘤大小、T分期和分级。多因素分析显示，只有浸润性小叶癌患者切缘阳性风险显著更高。33例患者因切缘阳性需要二次手术，3例患者需要三次手术。最终保乳率为91%。
尽管肿瘤体积大，但二级OPS导致切缘阳性率较低。如果剩余体积允许，切缘受累的患者可接受二次BCS。
