乳腺癌的生物学特征对保乳手术切除范围的影响  

The influence of biological characteristics of breast cancer on the extent of breast conserving surgery

作　　者：赵凯华[1] 谭政帅[1] 方堃[1] 李培莹[1] 李振凤[1] 宫磊[1] 刘松岭[1] 王炳高[1] 颜政[1] ZHAO Kaihua;TAN Zhengshuai;FANG Kun;LI Peiying;LI Zhenfeng;GONG Lei;LIU Songling;WANG Binggao;YAN Zheng(Department of Breast Surgery,the Second Clinical Medical College of Qingdao University,Qingdao Central Hospital,Qingdao 266042,China)

机构地区：[1]青岛大学第二临床医学院青岛市中心医院乳腺病诊疗中心,山东青岛266042

出　　处：《临床肿瘤学杂志》2019年第1期76-80,共5页Chinese Clinical Oncology

摘　　要：目的探讨乳腺癌的生物学特征与保乳手术切除范围的关系。方法 303例Ⅰ～Ⅱ期可扪及肿块、非特殊类型乳腺癌患者按分子分型分为Luminal A组、Luminal B组、Luminal-HER-2组、HER-2过表达型组和三阴性乳腺癌组。钼靶影像征像采用BI-RADS分类标准,分为肿块、钙化、结构扭曲、不对称致密和毛刺征。患者术前钼靶标记切除病灶范围,术中快速病理确定初始切缘状态,石蜡病理证实切缘状态及肿瘤分型,结合钼靶影像征象及征象种类,分析影响乳腺癌保乳手术切除范围的因素。结果 33例患者切缘阳性。乳腺癌分子亚型与钼靶影像下生长方式呈正相关(P <0. 001)。保乳手术切缘状态与钼靶影像征象、边缘毛刺征象、分子分型无关(P> 0. 05),而与钼靶影像下生长方式、边缘钙化征象有关(P <0. 05)。结论对非特殊型乳腺癌患者,在行保乳手术时可以结合钼靶影像征象特征(生长方式、边缘征象)确定个体化的切除范围,以降低手术再切除率。Objective To investigate the relationship between the biological characteristics of breast cancer and the extent of breast conserving surgery. Methods Three hundred and three patients with stage I-II palpable masses and non-special breast cancer were divided into Luminal A group, Luminal B group, Luminal-HER-2 group, HER-2 overexpression group and triple negative breast cancer group according to molecular classification. Mammography images were characterized by mass,calcification,structural distortion,asymmetrical density and spicule sign with BI-RADS classification standard. Preoperative molybdenum target labeling was used to determine the extent of the lesion, the initial state of the incision margin was determined by intraoperative rapid pathology, and paraffin pathology was used to confirm the state of the incision margin and the classification of the tumors. The factors affecting the extent of breast conserving surgery were analyzed in combination with molybdenum target imaging signs and types of signs. Results Thirty-three patients had positive margin of incision. The molecular subtypes of breast cancer were positively correlated with the growth pattern in molybdenum target images ( P <0.001). The incision margin of breast conserving surgery was not related to molybdenum target image, marginal burr sign and molecular typing ( P >0.05), but to the growth pattern in molybdenum target images and marginal calcification sign ( P <0.05). Conclusion For non-special breast cancer patients, mammography features (growth pattern, margin signs) and molecular subtypes can be combined to determine the individual resection range in order to reduce the probability of re-excision.

关 键 词：乳腺癌 手术切缘 生物学特征 钼靶征象 保乳手术 

分 类 号：R737.9[医药卫生—肿瘤]