背景:对于接受保乳手术(BCS)的导管原位癌(DCIS)患者,指南建议边缘宽度至少为2毫米,研究表明,与狭窄的边缘相比,复发风险降低。然而,有限的数据存在,确定这个边缘在乳腺切除术中是否合适,特别适用于保留乳头的乳房切除术(NSM)。因此,我们评估了接受NSM的DCIS患者的切缘和由此产生的肿瘤学结局.
方法:对2010年4月至2021年12月接受NSM的DCIS或DCIS伴微侵(DCIS+MI)患者进行单机构回顾性研究。患者和肿瘤特征,边距状态,治疗,并收集结果信息。检查了边缘与局部区域(LRR)和远处复发(DR)之间的关联。
结果:纳入161例患者,包括284NSM(164治疗,120预防性)。153例患者有DCIS,8例患者有DCIS+MI。大多数患者对激素敏感,123(76.4%),和二级核,72(44.7%),疾病。总的来说,35例(21.7%)患者边缘阳性或<2mm。其中,21(60%)累及前缘。在中位随访45个月(范围0-151),2.5%(n=4)的LRR和.6%(n=1)的DR。复发的患者,只有2个有阳性或<2毫米的边缘,1人接受过内分泌治疗,没有人接受辅助放射.
结论:对于行NSM的DCIS或DCIS+MI患者,未发现与复发相关的特定切缘状态。复发风险很低。总的来说,这表明BCS中建议的DCIS边距不一定适用于NSM,其中<2mm的余量是可以接受的。
BACKGROUND: For patients with ductal carcinoma in situ (DCIS) undergoing breast conservation surgery (BCS), guidelines advise a margin width of at least 2 mm, with studies demonstrating decreased recurrence risk compared to narrower margins. However, limited data exist establishing if this margin is appropriate in mastectomies, and specifically for nipple-sparing mastectomy (NSM). Consequently, we evaluated the margins of DCIS patients undergoing NSM and resulting oncologic outcomes.
METHODS: A single-institution retrospective review was performed in patients with DCIS or DCIS with microinvasion (DCIS + MI) undergoing NSM from April 2010 to December 2021. Patient and tumor characteristics, margin status, treatment, and outcomes information were collected. The association between margins and local-regional (LRR) and distant recurrence (DR) were examined.
RESULTS: 161 patients were included, comprising 284 NSM (164 therapeutic, 120 prophylactic). 153 patients had DCIS and 8 had DCIS + MI. Most patients had hormone sensitive, 123 (76.4%), and nuclear grade 2, 72 (44.7%), disease. In total, 35 (21.7%) patients had positive or <2 mm margins. Of these, 21 (60%) involved the anterior margin. At a median follow-up of 45 months (range 0-151), 2.5% (n = 4) had a LRR and .6% (n = 1) had a DR. Of patients with a recurrence, only 2 had positive or <2 mm margins, 1 had received endocrine therapy, and none received adjuvant radiation.
CONCLUSIONS: No specific margin status was found to correlate with recurrence for patients with DCIS or DCIS + MI undergoing NSM, with an altogether low recurrence risk. Overall, this suggests that recommended DCIS margins in BCS doesn\'t necessarily apply in NSM, where margins of <2 mm may be acceptable.