中国实用外科杂志

中国实用外科杂志

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早期乳腺癌病人保乳手术标本病理切缘评价临床价值研究

程元甲a，陈晶晶a，张    虹b，张    爽b，叶京明a，徐    玲a，段学宁a，李    挺b，刘荫华a   

  1. 北京大学第一医院  a.乳腺疾病中心  b.病理科，北京 100034
  • 出版日期:2019-12-01 发布日期:2019-12-23

  • Online:2019-12-01 Published:2019-12-23

摘要： 目的    探讨早期乳腺癌保乳手术标本病理切缘评价的临床价值。方法    回顾性分析2013-01-01—2017-12-31北京大学第一医院乳腺疾病中心接受保乳手术的早期乳腺癌病人资料，探讨病理切缘范围与预后的关系，以及术中冰冻病理与术后石蜡病理对于保乳手术切缘评价的一致性。结果    共474例保乳病例纳入研究，总体复发转移发生率为3.4%，局部复发率（LRR）1.5%，5年无病存活率（DFS）95.7%，5年总存活率（OS）96.8%。术后石蜡与术中冰冻病理学检查对于保乳切缘评价的符合率为100%，首次切缘阳性与阴性相比，局部复发率差异无统计学意义（χ2=1.371，P=0.242）。切缘阴性病人不同切缘宽度的无病存活率和总存活率差异均无统计学意义（χ2=0.123，P=0.726；χ2=0.077，P=0.781），局部复发率差异也无统计学意义（χ2=1.808，P=0.613）。结论    术中冰冻与术后石蜡病理学检查评价保乳手术切缘符合率高，不同宽度阴性切缘病人的无病存活率和局部复发率差异无统计学意义。

关键词: 乳腺癌, 保乳手术, 切缘

Abstract: A retrospective study of pathological margin evaluation in breast-conserving surgery specimens of patients with early breast cancer        CHENG Yuan-jia*, CHEN Jing-jing, ZHANG Hong,et al. *Breast Disease Center, Peking University First Hospital, Beijing 100034, China
Corresponding author：LIU Yin-hua，E-mail：liuyinhua7520@163.com
Abstract    Objective    To explore the clinical value of pathological evaluation of incision margin of breast-conserving operation specimens for early breast cancer. Methods    The clinical data of early breast cancer patients undergone breast-conserving surgery in the Breast Disease Center of the Peking University First Hospital from January 1，2013 to December 31，2017 were analyzed  retrospectively. The consistency of intraoperative frozen pathology with postoperative paraffin pathology and the relationship between pathological margin and prognosis were discussed. Results    A total of 474 breast-conserving cases were included in the study. The overall recurrence and metastasis rate was 3.4%; the local recurrence rate（LRR） was 1.5%; the 5-year disease-free survival rate（DFS）was 95.7%，and the 5-year overall survival rate（OS）was 96.8%. The coincidence rate of paraffin pathology and intraoperative frozen pathology in evaluating the breast-conserving margin was 100%. There was no significant difference in local recurrence rate between positive and negative first margin （χ2=1.371，P=0.242）. There was no significant difference in disease-free survival rate and overall survival rate among patients with negative margin width（χ2=0.123，P=0.726；χ2=0.077，P=0.781），and no significant difference in local recurrence rate（χ2=1.808，P=0.613）. Conclusion    Rapid frozen pathological examination is safe and reliable in evaluating the incision margin of breast-conserving surgery. On the premise of the negative incision margin，there is no significant difference in disease-free survival rate and local recurrence rate among different incision margin widths.

Key words: breast cancer, breast-conserving surgery, margin