Tumour Bed Analysis and Local Recurrence After Breast-Conserving Surgery for Breast Cancer

Oncology, Surgery

Macmillan, Robert Douglas

University:University of Glasgow

关键词: Oncology, Surgery;   

Others  :  http://theses.gla.ac.uk/75897/1/13818634.pdf

来源: University of Glasgow

【 摘 要 】

This thesis is a study of the causes and significance of local recurrence after breast-conserving surgery for breast cancer. Relevant published literature is reviewed. The core study involved 300 patients with invasive breast cancer who underwent breast-conserving surgery. All patients had tumour bed analysis performed by pathological examination of a shaving taken from the cavity wall. This was excised after the surgeon had performed a wide macroscopic clearance of the tumour. Disease in the cavity shaving was found in 39.3% of cases (tumour bed positivity). Re-excision was performed selectively and all patients received postoperative radiotherapy. At 4.4 years mean follow-up the local recurrence rate was 2.2% for breast-conserved patients and the systemic recurrence rate for all patients was 10.4%. Tumour bed positivity was found to be significantly associated with higher tumour grade, presence of an extensive in-situ component, dense mammographic pattern, casting-type mammographic calcification and absence of mammographic nidus. Nonsignificant trends were observed between tumour bed positivity and smaller lumpectomy diameter, younger patient age and lobular carcinoma. Tumour bed positivity was found to be significantly associated with poor distant disease-free survival. The implications of these findings are discussed.