Singh Babu, Dorelles Adriana, Konnikov Nellie, Nguyen Bichchau M
*Department of Dermatology, Boston University Medical Center, Boston, Massachusetts; †Department of Economics, Arizona State University, Tempe, Arizona; ‡Department of Dermatology, VA Boston Healthcare System, Jamaica Plains Campus, Boston, Massachusetts; §Department of Dermatology, Tufts Medical Center, Boston, Massachusetts.
Dermatol Surg. 2017 Aug;43(8):1003-1011. doi: 10.1097/DSS.0000000000001146.
Histologic analysis of tumor debulks from Mohs micrographic surgery (MMS) or wide local excision may lead to the detection of adverse features missed on initial biopsy.
Determine the incidence of (1) high-risk features on debulk analysis compared with initial biopsy and (2) upstaging of tumors on debulk analysis according to the American Joint Committee of Cancer-7th Edition (AJCC-7) and the Brigham and Women's Alternative (BWH) staging criteria.
A comprehensive search strategy using PubMed/MEDLINE, Web of Science, and EMBASE was conducted to identify articles published from 1960 to present that detail histology of initial biopsy and debulked tumor.
Fourteen studies, encompassing 2,565 cases of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were included in the data extraction process. BCCs (30.9%) were reclassified from a low-risk histologic subtype to a high-risk subtype on debulk analysis (p < .001). Cases with perineural invasion (89.4%) were detected on debulk analysis. SCC tumors (9.1% and 11.1%) were upstaged according to the AJCC-7 and BWH Alternative criteria, respectively. Ninety percent of high-risk BWH T2b SCCs were inaccurately staged lower on initial biopsy.
Tumor debulk analysis in MMS may aid in the identification of additional high-risk features, thereby improving staging accuracy, treatment decisions and patient outcomes.
对莫氏显微外科手术（MMS）或广泛局部切除术后肿瘤标本进行组织学分析，可能会发现初次活检时遗漏的不良特征。
确定（1）与初次活检相比，肿瘤标本分析中高危特征的发生率，以及（2）根据美国癌症联合委员会第7版（AJCC-7）和布莱根妇女医院替代（BWH）分期标准，肿瘤标本分析中肿瘤分期上调的情况。
采用全面的检索策略，通过PubMed/MEDLINE、科学网和EMBASE数据库，检索1960年至今发表的详细描述初次活检和肿瘤标本组织学的文章。
数据提取过程纳入了14项研究，共2565例基底细胞癌（BCC）和鳞状细胞癌（SCC）病例。在肿瘤标本分析中，BCC（30.9%）从低危组织学亚型重新分类为高危亚型（p < 0.001）。在肿瘤标本分析中检测到神经周围浸润的病例（89.4%）。SCC肿瘤分别根据AJCC-7和BWH替代标准上调分期（分别为9.1%和11.1%）。90%的高危BWH T2b SCC在初次活检时分期不准确地降低。
MMS中的肿瘤标本分析可能有助于识别更多高危特征，从而提高分期准确性、治疗决策和患者预后。
