Cox C E, Pendas S, Ku N N, Reintgen D S, Greenberg H S, Nicosia S V
Department of Surgery, University of South Florida College of Medicine, H. Lee Moffitt Cancer Center, Tampa 33612, USA.
Am Surg. 1998 Jun;64(6):533-7; discussion 537-8.
Successful breast conservation therapy with optimal cosmesis requires adequate tumor excision and negative tumor margins. Therefore, more sensitive techniques are being developed to identify lumpectomy margins intraoperatively with greater accuracy. Unidentified microscopic disease is seemingly responsible for a local recurrence rate of up to 25 per cent 3 to 5 years after lumpectomy and radiotherapy for breast cancer patients. As a result, Moffitt Cancer Center has routinely used an intraoperative touch preparation cytology (TPC) protocol to evaluate the entire resected surface of all lumpectomies. In addition, resection margins were also evaluated by gross examination and by standard histology. In rare instances frozen sections were used to evaluate tumor margins. In this study 701 consecutive lumpectomy specimens were evaluated by TPC during the period of 9 years with a mean follow-up of 3.5 years. Local cancer recurrence was 2.7 per cent (mean recurrence, 2.53 years), in women whose lumpectomy margins were evaluated by TPC. Of interest, a local recurrence rate of 14.6 per cent was observed in patients who had referral lumpectomies evaluated by conventional histopathology. This study suggests that accurate margin assessment with TPC plays an important role in the control of local recurrence after breast conservation therapy. Therefore, we conclude the routine use of intraoperative TPC provides rapid, reliable, topographically accurate identification of residual microscopic disease at lumpectomy margins.
成功实施具有最佳美容效果的保乳治疗需要进行充分的肿瘤切除且切缘无肿瘤残留。因此，人们正在研发更灵敏的技术，以便在术中更准确地识别肿块切除的切缘。对于乳腺癌患者，在肿块切除及放疗后3至5年，局部复发率高达25%似乎是由未被发现的微小病灶所致。因此，莫菲特癌症中心常规采用术中触摸准备细胞学检查（TPC）方案来评估所有肿块切除标本的整个切除表面。此外，还通过大体检查和标准组织学检查来评估切除切缘。在极少数情况下，会使用冰冻切片来评估肿瘤切缘。在本研究中，在9年期间对701例连续的肿块切除标本进行了TPC评估，平均随访时间为3.5年。通过TPC评估肿块切除切缘的女性患者局部癌症复发率为2.7%（平均复发时间为2.53年）。有趣的是，在通过传统组织病理学评估转诊肿块切除标本的患者中，观察到局部复发率为14.6%。这项研究表明，通过TPC进行准确的切缘评估在保乳治疗后控制局部复发方面发挥着重要作用。因此，我们得出结论，术中常规使用TPC可快速、可靠且在地形学上准确地识别肿块切除切缘处残留的微小病灶。
