2014年美国外科肿瘤学会（SSO）与美国放射肿瘤学会（ASTRO）联合发布的指南下保乳手术后的再次切除率。
Re-excision rates after breast conserving surgery following the 2014 SSO-ASTRO guidelines.
作者信息
Heelan Gladden Alicia A, Sams Sharon, Gleisner Ana, Finlayson Christina, Kounalakis Nicole, Hosokawa Patrick, Brown Regina, Chong Tae, Mathes David, Murphy Colleen
机构信息
University of Colorado School of Medicine, Department of Surgery, Aurora, CO, USA.
University of Colorado School of Medicine, Department of Pathology, Aurora, CO, USA.
出版信息
Am J Surg. 2017 Dec;214(6):1104-1109. doi: 10.1016/j.amjsurg.2017.08.023. Epub 2017 Sep 20.
BACKGROUND
In 2014, SSO-ASTRO published guidelines which recommended "no ink on tumor" as adequate margins for patients undergoing breast conservation for invasive breast cancer. In 2016, new SSO-ASTRO-ASCO guidelines recommended 2 mm margins for DCIS. We evaluated whether these guidelines affected re-excision rates at our institution.
METHODS
Patients treated with breast conservation surgery from January 1, 2010-March 1, 2016 were identified. Re-excision rates, tumor characteristics, and presence of residual disease were recorded. The 2016 guidelines were retrospectively applied to the same cohort and expected re-excision rates calculated.
RESULTS
Re-excision rates did not significantly decline before and after 2014 guideline adoption (11.9% before, 10.9% after; p = 0.65) or when the 2016 guidelines were retrospectively applied (8.4%; p = 0.10).
CONCLUSIONS
The 2014 and 2016 guidelines had minimal impact on our re-excision rates, as most re-excisions were done for DCIS and 2016 guidelines supported our prior institutional practices of 2 mm margins for these patients.
背景
2014年，美国乳腺外科医师协会（SSO）与美国放射肿瘤学会（ASTRO）发布指南，推荐对接受保乳手术的浸润性乳腺癌患者采用“肿瘤无墨水残留”作为足够的切缘。2016年，SSO-ASTRO-美国临床肿瘤学会（ASCO）发布新指南，推荐对导管原位癌（DCIS）采用2毫米切缘。我们评估了这些指南是否影响了我们机构的再次切除率。
方法
确定2010年1月1日至2016年3月1日期间接受保乳手术治疗的患者。记录再次切除率、肿瘤特征和残留疾病情况。将2016年指南回顾性应用于同一队列，并计算预期再次切除率。
结果
2014年指南采用前后，再次切除率没有显著下降（之前为11.9%，之后为10.9%；p = 0.65），回顾性应用2016年指南时再次切除率也没有显著下降（8.4%；p = 0.10）。
结论
2014年和2016年的指南对我们的再次切除率影响极小，因为大多数再次切除是针对DCIS进行的，且2016年指南支持我们之前对这些患者采用2毫米切缘的机构做法。
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