Padilla Daniela Bresciani, Tsai Jacqueline, Beck Amanda Sutherland, Wapnir Irene L
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive H3625, Stanford, CA, 94305, USA.
Breast Cancer Res Treat. 2025 May;211(1):51-58. doi: 10.1007/s10549-025-07621-w. Epub 2025 Feb 10.
Breast-conserving surgery for larger ductal carcinoma in situ (DCIS) remains limited. We compare the attempted use and success rates of lumpectomy surgery in patients with DCIS measuring ≥ 4 cm versus < 4 cm.
A retrospective review was conducted using the institutional tumor registry to identify cases of pure DCIS that were surgically treated from 2015 to 2022. Clinical-pathological data were abstracted from electronic medical records. Pathologic tumor size on initial surgery was used to define the two cohorts. Comparisons of variables were made using Chi-square and ANOVA tests.
A total of 669 patients, 84% (562) with tumors measuring < 4 cm and 16% (107) ≥ 4 cm were identified. Lumpectomy was the initial surgery performed for 89% of women with lesions measuring < 4 cm on preoperative imaging studies compared to 64% of those ≥ 4 cm. Overall, 461 (92.9%) of 496 in the < 4 cm succeeded at lumpectomy compared to 36 (56.3%) of 64 in the ≥ 4 cm group. Re-excision lumpectomies or mastectomy were performed in 27% and 44% of the < 4 cm and ≥ 4 cm subgroups. Lumpectomy was achieved for 70% of women with tumors in the 4 to 5.9 cm range compared to 33% in the 6-7.9 cm and the ≥ 8 cm groups. There were no local recurrences in the ≥ 4 cm group at an average of 4.4 years follow-up.
Lumpectomy is a viable option for many patients with DCIS ≥ 4 cm, especially those measuring < 6 cm, though repeat re-excisions may be required after initial attempt.
对于较大的导管原位癌（DCIS），保乳手术的应用仍然有限。我们比较了肿瘤大小≥4 cm与＜4 cm的DCIS患者行乳房肿块切除术的尝试率和成功率。
使用机构肿瘤登记处进行回顾性研究，以确定2015年至2022年接受手术治疗的纯DCIS病例。从电子病历中提取临床病理数据。首次手术时的病理肿瘤大小用于定义两个队列。使用卡方检验和方差分析对变量进行比较。
共确定669例患者，其中84%（562例）肿瘤大小＜4 cm，16%（107例）≥4 cm。在术前影像学检查中，89%肿瘤大小＜4 cm的女性首次手术为乳房肿块切除术，而肿瘤大小≥4 cm的女性这一比例为64%。总体而言，＜4 cm组496例中有461例（92.9%）乳房肿块切除术成功，而≥4 cm组64例中有36例（56.3%）成功。＜4 cm和≥4 cm亚组分别有27%和44%的患者进行了再次切除乳房肿块切除术或乳房切除术。肿瘤大小在4至5.9 cm范围内的女性，70%实现了乳房肿块切除术，而在6 - 7.9 cm组和≥8 cm组中这一比例为33%。在平均4.4年的随访中，≥4 cm组无局部复发。
对于许多肿瘤大小≥4 cm，尤其是＜6 cm的DCIS患者，乳房肿块切除术是一种可行的选择，尽管初次尝试后可能需要再次切除。
