乳腺浸润性小叶癌的临床病理特征及保乳切缘阳性的危险因素分析

Invasive Lobular Carcinoma of the Breast-Conserving Clinicopathological Features and Risk Factors Analysis for Positive Margin

目的探讨乳腺浸润性小叶癌的临床病理特征及保乳切缘阳性的危险因素分析。方法回顾我院2000年至2012年浸润性小叶癌病例资料,描述浸润性小叶癌临床病理特征,分析影响保乳切缘的临床病理因素。结果我院浸润性小叶癌手术患者78例,其中行保乳手术患者20例,一次手术保乳成功率为60%。单因素分析切检(P=0.009),超声/钼靶提示结构紊乱(P=0.009),超声/钼靶提示多中心或多灶性(P=0.006),术前核磁检查提示多中心或多灶性(P=0.002)与阳性切缘显著相关。Logistic回归表明术前核磁检查结果为影响保乳切缘的主要危险因素(P=0.025)。结论浸润性小叶癌可选择保乳的手术方式,术前核磁检查提示多中心或多灶性的患者保乳切缘阳性风险较大。保乳术前核磁检查应尤为重视。

Objective Discussion invasive lobular carcinoma clinicopathological features and conserving positive margin analysis of risk factors. Methods Clinicop athologic features of ILC patients between 2000 and 2012 were retrospectively reviewed to determine if specific clinical and pathologic factors influenced the margins status after breast conserving surgery. Results 78 cases of ILC were reviewed, 20 patients received breast conserving surgery（BCS） as their initial procedure. BCS was successful in 60% patients who received negative margin after 1 surgical procedure. An ultrasonographic/ mammography diagnosis of architectural distortion（P= 0.009）, an ultrasonographic or mammography diagnosis of mulifocality and multicentricity lesions（P= 0.002）, excisional biopsy（P= 0.009）, mulifocality and multicentricity findings by MRI（P= 0.002） were significantly associated with close of positive margins on univariate analysis. Multivariable logistic regression analysis, only MRI diagnosis retained statistical significance（P= 0.025）. Conclusion ILC was not a contradiction of breast conserving surgery. MRI diagnosis is a critical predictive factor of margin status after BCS. With appropriate patient selection, most patients can undergo successful BCS. Based on the currently available data, it is strongly recommended that preoperative MR imaging be conducted in all patients with ILC prior to therapy.