Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, Genoa, Italy.
Breast Surgery Clinic, San Martino Policlinic Hospital, Genoa, Italy.
In Vivo. 2022 Mar-Apr;36(2):814-820. doi: 10.21873/invivo.12768.
BACKGROUND/AIM: Clinicopathological features of patients undergoing margin enlargement after lumpectomy for early breast cancer with positive/close excision margins were analyzed in order to define whether a re-operative procedure could have been avoided. Furthermore, a standardized protocol of specimen orientation was adopted in order to optimize both the widening procedure as well as the oncologic outcome.
A retrospective analysis was performed including pre-, peri-, and post-operative parameters, and a predictive score by means of a multivariate model was developed using all clinically and statistically significant variables associated with residual disease (RD).
RD was significantly related to positive tumor margins, hormone receptor negative, HER2-positive, and tumors with high Ki67 proliferation index (p<0.001); the corresponding contribution to the prognostic score was as follows: close margins, 3 points; hormone receptor positive disease, 2 points; low Ki67, 2 points; HER2 negativity, 1 point. In 102 patients with a score >3, only 2 patients (2.0%) had RD, while in 81 patients with a score ≤3, 55 patients (67.9%) had RD (p<0.001).
This predictive model might aid in clinical-decision making of patients with positive margins who actually require a widening procedure after intraoperative and/or definitive histology.
背景/目的：分析保乳术后切缘阳性/近切缘的早期乳腺癌患者扩大切缘的临床病理特征，以明确是否可以避免再次手术。此外，采用了标本定向的标准化方案，以优化扩大手术和肿瘤学结果。
进行了回顾性分析，包括术前、术中和术后参数，并通过多变量模型开发了预测评分，使用与残留疾病（RD）相关的所有临床和统计学上显著的变量。
RD 与肿瘤阳性切缘、激素受体阴性、HER2 阳性和 Ki67 增殖指数高的肿瘤显著相关（p<0.001）；对预后评分的相应贡献如下：切缘阳性，3 分；激素受体阳性疾病，2 分；Ki67 低，2 分；HER2 阴性，1 分。在评分>3 的 102 例患者中，仅 2 例（2.0%）有 RD，而在评分≤3 的 81 例患者中，55 例（67.9%）有 RD（p<0.001）。
该预测模型可能有助于指导切缘阳性的患者做出临床决策，这些患者实际上需要在术中及/或最终组织学检查后进行扩大手术。
