Comprehensive Breast Program, Moffitt Cancer Center Tampa, FL, USA.
The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Breast. 2020 Jun;51:29-33. doi: 10.1016/j.breast.2020.02.013. Epub 2020 Mar 6.
A 2014 consensus statement from the Society of Surgical Oncology and American Society for Radiation Oncology supported "no ink on tumor" as an adequate margin for breast conserving therapy (BCT). This study evaluates this statement in a multi-institution cohort.
A retrospective review of BCT cases at 3 comprehensive cancer centers was performed. Women age >18 receiving BCT for T1-2 breast cancer from 2008-2012 were included. Pre-2014, all sites considered 2 mm adequate. Estimated re-excision rates using the 2014 guidelines were calculated and factors predictive of re-excision were analyzed.
542 patients (545 lumpectomies) were eligible. Using a ≥2 mm margin standard, 32.8% of patients underwent re-excision compared to 14.1% after 2014 (p < 0.0001). Tumor size (p= 0.003), grade (p=0.015), and lymphovascular invasion (p=0.021) were predictive of re-excision. Patients with additional intraoperative margins excised were less likely to require reoperation (p=0.002). Local recurrence was unaffected by re-excision after mean followup of 66 months.
The 2014 margin guidelines markedly reduce re-excision rates. There is no difference in local recurrence for patients after re-excision for a close margin versus without Powered.
2014 年外科肿瘤学会和美国放射肿瘤学会的共识声明支持“无肿瘤墨水”作为保乳治疗（BCT）的充分切缘。本研究在多机构队列中评估了这一说法。
对 3 个综合癌症中心的 BCT 病例进行了回顾性审查。纳入年龄>18 岁、2008-2012 年间接受 T1-2 期乳腺癌 BCT 的女性。2014 年前，所有部位均认为 2mm 是足够的。使用 2014 年指南计算了估计的再次切除率，并分析了预测再次切除的因素。
542 例患者（545 例乳房切除术）符合条件。使用≥2mm 切缘标准，32.8%的患者需要再次切除，而 2014 年后为 14.1%（p<0.0001）。肿瘤大小（p=0.003）、分级（p=0.015）和脉管侵犯（p=0.021）是再次切除的预测因素。术中额外切除边缘的患者再次手术的可能性较小（p=0.002）。在平均随访 66 个月后，局部复发与再次切除无关。
2014 年切缘指南显著降低了再次切除率。对于切缘接近而无需再次切除的患者，局部复发率无差异。
