乳腺癌保乳手术切缘安全范围的分子病理学研究

Safety Scope of Breast-conserving Surgery in Breast Cancer:Molecular Pathological Study

目的通过检测肿瘤周边浸润及周围组织的癌变规律,找出病理检查难以发现的隐性癌灶范围,为临床医生决策保乳手术切除边缘得出依据。方法各手术部位切除标本分别行HE染色、分子生物学检测和免疫组化。结果癌旁1cm及2cm处阳性因素比例高于3cm处(P<0.05),lcm与2cm处之间差异无统计学意义(P>0.05)。结论原发性乳腺癌C-erbB-2扩增和P53突变患者行保乳手术应扩大切除范围>2cm,以减少局部复发的危险。

Objective To find out the pathologic elusive hidden cancerous focirange by detecting carcinogenesis regular pattern of the tumor surrounding invasion and surrounding tissue in an attempt to provide evidence for the surgical marginal distance from tumor edge in clinical breast-conserving operation. Methods The specimens were detected by using routine pathological examination of HE staining, immunohistochemistry and molecular biology. Results The positive rates of risk factors at lcm and 2cm surrounding tumor was significantly higher than the positive rate of 3 cm （P〈0.05）, with no significant difference between 1 cm and 2 cm （P〉0.05）. Risk factors still existed in 3 cases（4.8%） at 3 cm from tumor, and the examination results of PCNA, C-erbB-2 and P53 of their primary tumors showed that at least two indicators were positive. Conclusion The resection should be extended up to more than 2era in breast-conserving surgery for those with primary breast cancer C-erhB-2 amplification and P53 mutation to reduce the risk of local recurrence.