Beck N E, Bradburn M J, Vincenti A C, Rainsbury R M
Breast Unit, Royal Hampshire County Hospital, Winchester, UK.
Br J Surg. 1998 Sep;85(9):1273-6. doi: 10.1046/j.1365-2168.1998.00876.x.
Assessment of completeness of tumour excision has become an integral part of breast-conserving surgery, but the accuracy of margin analysis has been questioned. This study compared the results of resection margin analysis with an examination of tumour bed biopsies and of the excised cavity wall.
One hundred and forty-four patients underwent breast-conserving surgery for T1-2 N0-1 breast cancer. Following wide local excision, four bed biopsies were taken from the cavity wall which was then completely excised. The presence of invasive and in situ disease at the inked resection margin (IRM) and in the adjacent bed biopsies and cavity wall was recorded.
Positive margins and/or residual disease in either the bed biopsies or cavity wall was found in 62 (43 per cent) of 144 cases. Residual disease (invasive or in situ) was present at the IRM in 39 specimens (27 per cent) and was present in 25 bed biopsy (17 per cent) and 39 cavity wall (27 per cent) specimens. These comprised different but overlapping groups of patients.
Margin analysis of wide local excision specimens is a poor predictor of completeness of excision. Routine resection and examination of the entire cavity wall increases the detection of residual disease compared with examination of bed biopsies alone and is a useful adjuvant to conventional margin evaluation.
评估肿瘤切除的完整性已成为保乳手术不可或缺的一部分，但切缘分析的准确性受到质疑。本研究比较了切除切缘分析结果与肿瘤床活检及切除腔壁检查的结果。
144例T1-2 N0-1期乳腺癌患者接受了保乳手术。在广泛局部切除后，从腔壁取4块床旁活检组织，然后将腔壁完整切除。记录标记切除边缘（IRM）、相邻床旁活检组织和腔壁中浸润性疾病和原位疾病的存在情况。
144例患者中有62例（43%）在床旁活检组织或腔壁中发现切缘阳性和/或残留疾病。39个标本（27%）的IRM存在残留疾病（浸润性或原位），25个床旁活检组织（17%）和39个腔壁标本（27%）存在残留疾病。这些患者群体不同但有重叠。
广泛局部切除标本的切缘分析对切除完整性的预测能力较差。与仅检查床旁活检组织相比，常规切除并检查整个腔壁可增加残留疾病的检出率，是传统切缘评估的有用辅助手段。
