保乳手术标本定位全部取材病理检查的意义

目的探讨保证保乳手术标本切缘阴性的病理取材诊断方法及意义。方法（1）术中对145例保乳手术标本进行定位全切片检查,79例进行选择性取材检查;（2）术后对84例保乳手术标本进行定位全切片检查,226例进行选择性取材检查;（3）对两组手术病例进行随访观察。结果（1）术中定位全切片取材切缘阳性检出率（24．1％,35／145）明显高于选择性取材（6．3％,5／79）,差异具有统计学意义（P〈0．01）;（2）术后定位全切片取材切缘阳性检出率（29／84,34．5％）亦明显高于选择性取材（12．0％,27／226）,差异具有统计学意义（P〈0．01）;（3）经2～46个月随访,保乳手术标本选择性取材病例中有3例分别于术后6、15、28个月局部复发,定位全切片取材病例无复发。结论定位全切片取材和诊断可以降低保乳手术标本切缘阳性的漏诊率,并能够定位切缘阳性的部位,对减小二次手术和术后复发的风险,保证保乳手术的成功具有重要作用。

Evaluation of efficacy of stereoscopic location and whole serial sections of margin status in breast conservation therapy specimens

OBJECTIVE: To evaluate the efficacy of different methods in pathologic assessment of margin status in breast conservation therapy specimens. METHODS: Assessment of margin status in breast conservation therapy specimens by stereoscopic location and whole serial sections (SLWS) and selective margin sections (SMS) was compared. The margin status was evaluated with intraoperative frozen sections either by SLWS (145 cases) or SMS (79 cases). On the other hand, with formalin-fixed specimens, the margin status of 84 cases was assessed by SLWS and that of another 226 cases by SMS. Follow-up data of all patients were analyzed. RESULTS: The rate of detection of positive margin by SLWS (24.1%, 35/145) was significantly higher than that by SMS (6.3%, 5/79) during frozen section setting. Similarly, the rate of detection of positive margin by SLWS (34.5%, 29/84) was also higher than that by SMS (12.0%, 27/226) when applied in formalin-fixed specimens. The duration of follow-up ranged from 2 to 46 months. None of the patients with margin status assessed by SLWS developed local recurrence. This was in contrast to 3 cases with tumor recurrence (6 months, 15 months and 28 months after the operation respectively) in SMS group. CONCLUSIONS: Assessment of margin status by SLWS in breast conservation therapy specimens can reduce the chance of missing underlying minute foci of margin involvement and help to localize the exact site of positive margin. It thus reduces the overall risk of local recurrence and the need of a second operation.