Osteen R T, Connolly J L, Recht A, Silver B, Schnitt S J, Harris J R
Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115.
Arch Surg. 1987 Nov;122(11):1248-52. doi: 10.1001/archsurg.1987.01400230034005.
The extent of excision prior to radiation for breast cancer is controversial. Three hundred evaluable patients with invasive ductal carcinoma received radiation therapy after gross tumor excision. The median follow-up was 70 months. Local recurrence was related to the presence of an extensive intraductal component (EIC) in addition to the invasive ductal carcinoma. From operative notes and pathology reports, patients with an EIC were categorized as having discrete masses with the extent of disease confirmed histologically or as having one of five criteria in which the final pathologic findings revealed more intraductal disease than was evident grossly or by frozen section. After ten years of follow-up, the local failure rate of patients without an EIC (193) was 3% compared with 35% for those with an EIC (107). Eight-year recurrence rates were 18% for clearly defined tumors and 71% for tumors in which the intraductal component was detectable only histologically.
乳腺癌放疗前的切除范围存在争议。300例可评估的浸润性导管癌患者在肿瘤大体切除后接受了放射治疗。中位随访时间为70个月。除浸润性导管癌外，局部复发与广泛导管内成分（EIC）的存在有关。根据手术记录和病理报告，有EIC的患者被分类为具有经组织学证实疾病范围的离散肿块，或具有五个标准之一，其中最终病理结果显示导管内疾病比大体或冰冻切片明显更多。经过十年的随访，无EIC患者（193例）的局部失败率为3%，而有EIC患者（107例）为35%。明确界定肿瘤的八年复发率为18%，仅在组织学上可检测到导管内成分的肿瘤复发率为71%。
