Saarela A O, Paloneva T K, Rissanen T J, Kiviniemi H O
Department of Surgery, Oulu University Hospital, Finland.
J Surg Oncol. 1997 Dec;66(4):248-53. doi: 10.1002/(sici)1096-9098(199712)66:4<248::aid-jso5>3.0.co;2-b.
Removal of the entire tumor by breast-conserving surgery is important, but the determinants of adequate excision have not been established.
A prospective study of 55 consecutive lumpectomies for early breast cancer was performed to study the correlation between touch preparation cytology and histologic margins and the determinants of positive histologic margins and residual disease after the initial excision.
The correlation between touch preparation cytology and histologic margins was poor: sensitivity and specificity were 37.5% and 85.1%, respectively. The histologic margins were positive in 8 cases (14.5%) and were related to the presence of intraductal carcinoma and to the large pathologic size of the index tumor. Re-excision specimen of the tumor bed (34 of 55 cases) contained residual cancer in seven cases (20.6%). Multifocal and nonpalpable index tumors predicted residual cancer. Residual disease was found in 37.5% of the cases (3 of 8) with positive and in 15.4% of the cases (4 of 26) with negative histologic margins.
Touch preparation cytology cannot be recommended as a method of assessing lumpectomy margins for early breast cancer. Histologic margins are misleading in predicting residual cancer in re-excision specimens. To minimize the risk of residual cancer, wide excision or mastectomy should be considered in the management of multifocal and nonpalpable tumors.
通过保乳手术完整切除肿瘤很重要，但充分切除的决定因素尚未明确。
对55例连续的早期乳腺癌肿块切除术进行前瞻性研究，以探讨术中印片细胞学检查与组织学切缘之间的相关性，以及初次切除后组织学切缘阳性和残留疾病的决定因素。
术中印片细胞学检查与组织学切缘之间的相关性较差：敏感性和特异性分别为37.5%和85.1%。8例（14.5%）组织学切缘阳性，与导管内癌的存在及索引肿瘤的较大病理大小有关。肿瘤床的再次切除标本（55例中的34例）中有7例（20.6%）含有残留癌。多灶性和不可触及的索引肿瘤预示有残留癌。在组织学切缘阳性的病例中，37.5%（8例中的3例）发现有残留疾病；在组织学切缘阴性的病例中，15.4%（26例中的4例）发现有残留疾病。
术中印片细胞学检查不能作为评估早期乳腺癌肿块切除切缘的方法。组织学切缘在预测再次切除标本中的残留癌方面具有误导性。为将残留癌风险降至最低，对于多灶性和不可触及的肿瘤，在治疗时应考虑广泛切除或乳房切除术。
