Tafra L, Guenther J M, Giuliano A E
Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, St John's Hospital and Health Center, Santa Monica, Calif.
Arch Surg. 1993 Sep;128(9):1014-8; discussion 1018-20. doi: 10.1001/archsurg.1993.01420210078010.
Some surgeons consider excisional biopsy with gross negative margins to be adequate surgical therapy for breast carcinomas, if followed by axillary dissection and radiation. To test our hypothesis that breast carcinoma necessitates planned operation, we reviewed the incidence of residual cancer tissue (RCT) and the significance of positive margins following excisional breast biopsy and segmentectomy. SETTING, PATIENTS, AND INTERVENTION/OUTCOME MEASURES: Using the clinical database of our multidisciplinary cancer center, we examined the tumor status of segmentectomy specimens from 375 patients treated for breast carcinoma during the past 10 years. All patients underwent excisional biopsy of the tumor mass before definitive treatment with segmentectomy and axillary dissection. Median follow-up was 32 months.
The 284 patients (76%) whose segmentectomy specimens contained residual tumor (RCT-positive patients) had a larger median tumor diameter than RCT-negative patients (2 vs 1 cm, P < .01). Patients with tumor-positive axillary lymph nodes were more likely to be RCT positive (P < .001). Tumors of RCT-positive patients were more frequently identified by physical examination, whereas those of RCT-negative patients were more frequently identified by mammography (P < .001). Overall recurrence rate was 7% (26/384). Recurrence-free survival rates were statistically related to tumor status of the segmentectomy margins (P < .025) but not to RCT in the segmentectomy specimen.
Diagnostic breast biopsy is not a substitute for planned excision to remove all malignant tissue. Anything less than a preconceived surgical procedure may leave a significant amount of malignant tissue.
一些外科医生认为，对于乳腺癌患者，如果在切除活检后进行腋窝清扫和放疗，切缘大体阴性的切除活检即为充分的手术治疗。为验证我们关于乳腺癌需要进行计划性手术的假设，我们回顾了乳腺切除活检和节段切除术后残留癌组织（RCT）的发生率及切缘阳性的意义。研究地点、患者及干预/结果测量：利用我们多学科癌症中心的临床数据库，我们检查了过去10年中375例接受乳腺癌治疗患者的节段切除标本的肿瘤状态。所有患者在接受节段切除和腋窝清扫的确定性治疗前均接受了肿瘤块的切除活检。中位随访时间为32个月。
284例（76%）节段切除标本含有残留肿瘤的患者（RCT阳性患者）的肿瘤中位直径大于RCT阴性患者（2 cm对1 cm，P <.01）。腋窝淋巴结肿瘤阳性的患者更有可能RCT阳性（P <.001）。RCT阳性患者的肿瘤更常通过体格检查发现，而RCT阴性患者的肿瘤更常通过乳腺X线摄影发现（P <.001）。总体复发率为7%（26/384）。无复发生存率与节段切除切缘的肿瘤状态在统计学上相关（P <.025），但与节段切除标本中的RCT无关。
诊断性乳腺活检不能替代计划性切除以清除所有恶性组织。任何低于预先设定手术程序的操作都可能留下大量恶性组织。
