Piper Merisa L, Wong Jasmine, Fahrner-Scott Kelly, Ewing Cheryl, Alvarado Michael, Esserman Laura J, Mukhtar Rita A
1Division of Plastic Surgery, Department of Surgery, University of California, San Francisco, CA USA.
2Division of General Surgery, Department of Surgery, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA USA.
NPJ Breast Cancer. 2019 Sep 6;5:29. doi: 10.1038/s41523-019-0125-7. eCollection 2019.
Rates of positive margins after surgical resection of invasive lobular carcinoma (ILC) are high (ranging from 18 to 60%), yet the efficacy of re-excision lumpReceptor subtypeectomy for clearing positive margins is unknown. Concerns about the diffuse nature of ILC may drive increased rates of completion mastectomy to treat positive margins, thus lowering breast conservation rates. We therefore determined the success rate of re-excision lumpectomy in women with ILC and positive margins after surgical resection. We identified 314 cases of stage I-III ILC treated with breast conserving surgery (BCS) at the University of California, San Francisco. Surgical procedures, pathology reports, and outcomes were analyzed using univariate and multivariate statistics and Cox-proportional hazards models. We evaluated outcomes before and after the year 2014, when new margin management consensus guidelines were published. Positive initial margins occurred in 118 (37.6%) cases. Of these, 62 (52.5%) underwent re-excision lumpectomy, which cleared the margin in 74.2%. On multivariate analysis, node negativity was significantly associated with successful re-excision (odds ratio [OR] 3.99, 95% CI 1.15-13.81, = 0.029). After 2014, we saw fewer initial positive margins (42.7% versus 25.5%, = 0.009), second surgeries (54.6% versus 20.2%, < 0.001), and completion mastectomies (27.7% versus 4.5%, < 0.001). In this large cohort of women with ILC, re-excision lumpectomy was highly successful at clearing positive margins. Additionally, positive margins and completion mastectomy rates significantly decreased over time. These findings highlight improvements in management of ILC, and suggest that completion mastectomy may not be required for those with positive margins after initial BCS.
浸润性小叶癌（ILC）手术切除后切缘阳性率较高（范围为18%至60%），然而再次切除肿块切除术清除切缘阳性的疗效尚不清楚。对ILC弥漫性特征的担忧可能导致为治疗切缘阳性而进行的全乳切除术比例增加，从而降低保乳率。因此，我们确定了ILC且手术切除后切缘阳性的女性患者再次切除肿块切除术的成功率。我们在加利福尼亚大学旧金山分校识别出314例接受保乳手术（BCS）治疗的I-III期ILC病例。使用单变量和多变量统计以及Cox比例风险模型分析手术过程、病理报告和结果。我们评估了2014年之前和之后的结果，2014年发布了新的切缘管理共识指南。118例（37.6%）出现初始切缘阳性。其中，62例（52.5%）接受了再次切除肿块切除术，74.2%的患者切缘得以清除。多变量分析显示，淋巴结阴性与再次切除成功显著相关（优势比[OR] 3.99，95%置信区间1.15-13.81，P = 0.029）。2014年之后，我们观察到初始切缘阳性病例减少（42.7%对25.5%，P = 0.009），二次手术减少（54.6%对20.2%，P < 0.001），以及全乳切除术减少（27.7%对4.5%，P < 0.001）。在这个大型ILC女性队列中，再次切除肿块切除术在清除切缘阳性方面非常成功。此外，切缘阳性率和全乳切除术率随时间显著下降。这些发现突出了ILC管理方面的改善，并表明对于初始BCS后切缘阳性的患者可能不需要进行全乳切除术。
