背景:Lipomoodelling(LM)是一种越来越多地用于重建或纠正与物质损失有关的美学缺陷的技术。在法国,HAS于2015年和2020年发布了有关在治疗和对侧乳房上使用LM的建议.这些似乎被不一致地遵循。
方法:法国妇科医生和妇产科学院(法国妇科医生和妇产科医师学院)的十二名Senology委员会成员回顾了LM的癌症安全性以及乳腺癌手术后患者的临床和放射学随访,基于法国和国际的建议和文献综述。书目搜索于2015年至2022年通过Medline进行,选择法语和英语的文章并应用PRISMA指南。
结果:共有14项关于LM肿瘤安全性的研究,保留了5项随访研究和7项指南。14项研究(6项回顾性研究,2项前瞻性分析和6项荟萃分析)具有异质性纳入标准和可变随访,从38到120个月不等。大多数显示LM后局部或远处复发的风险没有增加。一项回顾性病例对照研究(464名LMs和3100名对照)显示,在80个月没有复发的患者中,在管腔A癌病例中,LM后无复发生存率的随后降低,强调失去随访的数量(超过2/3的腔A癌)。关于LM后的随访,5系列显示了临床肿块和放射学图像LM后的高频(在1/4病例中),最常对应于细胞脂肪坏死。大多数指南都强调了LM肿瘤安全性的不确定性,由于缺乏前瞻性数据和长期随访。
■参议员委员会成员同意HAS工作组的结论,特别是通过对LM\“没有警告期\”的建议,过度,或者在复发风险很高的情况下,并建议明确,在接受LM之前向患者提供详细信息,以及术后随访的必要性。建立国家登记册可以解决有关该程序的肿瘤安全性和患者随访方式的大多数问题。
Lipomodelling (LM) is an increasingly used technique to reconstruct or correct an aesthetic defect linked to a loss of substance. In France, the Haute Autorité de santé (HAS) published recommendations in 2015 and 2020 concerning the conditions of use of LM on the treated and contralateral breast. These appear to be inconsistently followed.
Twelve members of the Senology Commission of the Collège national des gynécologues-obstétriciens français (French College of Gynecologists and Obstetricians) reviewed the carcinological safety of LM and the clinical and radiological follow-up of patients after breast cancer surgery, based on French and international recommendations and a review of the literature. The bibliographic search was conducted via Medline from 2015 to 2022, selecting articles in French and English and applying PRISMA
guidelines.
A total of 14 studies on the oncological safety of LM, 5 studies on follow-up and 7
guidelines were retained. The 14 studies (6 retrospective, 2 prospective and 6 meta-analyses) had heterogeneous inclusion criteria and variable follow-up, ranging from 38 to 120 months. Most have shown no increased risk of locoregional or distant recurrence after LM. A retrospective case-control study (464 LMs and 3100 controls) showed, in patients who had no recurrence at 80 months, a subsequent reduction in recurrence-free survival after LM in cases of luminal A cancer, highlighting the number of lost to follow-up (more than 2/3 of luminal A cancers). About follow-up after LM, the 5 series showed the high frequency after LM of clinical mass and radiological images (in ¼ of cases), most often corresponding to cytosteatonecrosis. Most of the
guidelines highlighted the uncertainties concerning oncological safety of LM, due to the lack of prospective data and long-term follow-up.
The members of the Senology Commission agree with the conclusions of the HAS working group, in particular by advising against LM \"without cautionary periods\", excessively, or in cases of high risk of relapse, and recommend clear, detailed information to patients before undergoing LM, and the need for postoperative follow-up. The creation of a national registry could address most questions regarding both the oncological safety of this procedure and the modalities of patient follow-up.