Haloua M H, Volders J H, Krekel N M A, Barbé E, Sietses C, Jóźwiak K, Meijer S, van den Tol M P
Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Department of Surgical Oncology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
Breast. 2016 Feb;25:14-21. doi: 10.1016/j.breast.2015.11.003. Epub 2015 Dec 11.
The current study aims to assess margin status in relation to amount of healthy breast tissue resected in breast-conserving surgery (BCS) on a nationwide scale.
Using PALGA (a nationwide network and registry of histology and cytopathology in the Netherlands), all patients who underwent BCS for primary invasive carcinoma in 2012-13 were selected (10,058 excerpts). 9276 pathology excerpts were analyzed for a range of criteria including oncological margin status and distance to closest margin, specimen weight/volume, greatest tumor diameter, and with or without localization method. Calculated resection ratios (CRR) were assessed to determine excess healthy breast tissue resection.
Margins for invasive carcinoma and in situ carcinoma combined were tumor-involved in 498 (5.4%) and focally involved in 1021 cases (11.0%) of cases. Unsatisfactory resections including (focally) involved margins and margins ≤ 1 mm were reported in 33.8% of patients. The median lumpectomy volume was 46 cc (range 1-807 cc; SD 49.18) and median CRR 2.32 (range 0.10-104.17; SD 3.23), indicating the excision of 2.3 the optimal resection volume.
The unacceptable rate of tumor-involved margins as well as margins ≤ 1 mm in one third of all patients is also achieved at the expense of healthy breast tissue resection, which may carry the drawback of high rates of cosmetic failure. These data clearly suggest the need for improvement in current breast conserving surgical procedures to decrease tumor-involved margin rates while reducing the amount of healthy breast tissue resected.
本研究旨在在全国范围内评估保乳手术（BCS）中切缘状态与切除的健康乳腺组织量之间的关系。
利用PALGA（荷兰全国性的组织学和细胞病理学网络及登记处），选取了2012 - 13年因原发性浸润性癌接受保乳手术的所有患者（10,058份摘录）。对9276份病理摘录进行了一系列标准分析，包括肿瘤切缘状态和距最近切缘的距离、标本重量/体积、最大肿瘤直径以及是否采用定位方法。计算切除率（CRR）以确定健康乳腺组织切除过量的情况。
浸润性癌和原位癌合并的切缘在498例（5.4%）病例中被肿瘤累及，在1021例（11.0%）病例中局灶性累及。33.8%的患者报告了不满意的切除情况，包括（局灶性）累及切缘和切缘≤1毫米。乳房肿块切除术的中位体积为46立方厘米（范围1 - 807立方厘米；标准差49.18），中位CRR为2.32（范围0.10 - 104.17；标准差3.23），表明切除了2.3倍的最佳切除体积。
三分之一的患者中出现不可接受的肿瘤累及切缘率以及切缘≤1毫米的情况，这也是以切除健康乳腺组织为代价的，这可能带来高美容失败率的缺点。这些数据清楚地表明，需要改进当前的保乳手术程序，以降低肿瘤累及切缘率，同时减少切除的健康乳腺组织量。
