乳腺癌保留乳房手术切除范围的探讨

Study of Lumpectomy Range of Breast Cancer for Conservative Surgery

目的:探讨合适的乳腺癌保留乳房手术切除范围。方法:对104例乳腺癌根治手术患者的切除标本进行观察研究。每一患者标本分为“癌肿区”、“近癌区”和“远癌区”。以肿瘤切除活检标本或肉眼可见肿瘤及其周围0.5cm区域为“癌肿区”;“癌肿区”边缘向外1cm～3cm区域为“近癌区”;3cm～5cm区域为“远癌区”。对三个区域乳腺组织非典型增生和c-erbB-2、p53基因蛋白异常表达发生情况分别进行研究。结果:104例乳腺癌手术标本中,“近癌区”和“远癌区”发生非典型增生率分别为56.7%、32.7%,其中Ⅱ、Ⅲ级非典型增生率“近癌区”明显高于“远癌区”。49例c-erbB-2阳性乳腺癌中,“近癌区”亦发现有c-erbB-2阳性表达者26例(53.6%),“远癌区”阳性表达者8例(16.3%)。两组比较均P<0.01。25例p53阳性者中,“近癌区”及“远癌区”检测均阴性。结论:提示在行保留乳房手术时,一并切除近癌组织是必要的。

Objective:To study the optimal lumpectomy range of breast cancer for conser-vative surgery.Methods:A study of pathological and immunohistochemical assay measuring the epithelial atypical hyperplasia and overexpression of c-erbB-2and p53was performed in104breast cancer specimens.Results:It showed that the rate of epithelial atypical hyperplasia in″nearer-tumor region″(1-3cm from the tumor margin)was much higher than that of″farther-tumor region″(3～5cm from the tumor margin)(56.7%and32.7%respectively,P<0.01).There were more gradeⅡandⅢepithelial atypical hyperplasia in the″nearer-tumor region″than in the″far-ther-tumor region″(62.7%and31.4%respectively,P<0.01).Also there were more overexpression of c-erbB-2protein in the″nearer-tumor region″of cerbB-2positive breast cancer than that in the″farther-tumor region″.While there was no overexpression of p53in either″nearer-tumor re-gion″or″farther-tumor region″of p53positive breast cancer.Conclusion:On the basis of this study,the″nearer-tumor region may need to be resected with the tumor together in conservative surgery of breast cancer.