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Schnittränder beim duktalen Carcinoma in situ und beim Mammakarzinom

Wieviel Sicherheit brauchen wir?

Surgical margins in ductal carcinoma in situ and in breast cancer

How much safety do we need?

  • Gynäkologie aktuell
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Tumorbefallene Resektionsränder beim Mammakarzinom und beim duktalen Carcinoma in situ (DCIS) haben einen negativen Effekt auf die Prognose und gehen nachweislich mit einem erhöhten Lokalrezidivrisiko einher, sodass tumorfreie Resektionsränder eingefordert werden müssen. Ein mikroskopisch freier Schnittrand bei invasiven Karzinomen – „no cells on ink“ – auch mit begleitendem DCIS wird inzwischen als ausreichend angesehen. Dies gilt für alle Tumortypen und ist unabhängig vom Alter der Patientin. Die Voraussetzung stellt eine leitliniengerechte adjuvante Strahlen- und Systemtherapie dar. Dieses Vorgehen wird in den amerikanischen Leitlinien sowie von der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) bereits empfohlen, ist in der aktuell gültigen deutschen S3-Leitlinie von 2012 jedoch noch nicht verankert. Beim reinen DCIS sollte aktuell noch ein tumorfreier Schnittrand von 2 mm erreicht werden, wenn nach brusterhaltender Operation nachbestrahlt wird.

Abstract

Tumor affected surgical margins in breast cancer and ductal carcinoma in situ (DCIS) have a negative prognostic effect and are associated with an increased risk of local recurrence so that tumor-free resection margins are strongly recommended. A microscopically free resection margin in invasive breast carcinomas—“no cells on ink”—also with accompanying DCIS is currently considered sufficient. This refers to any tumor biology and is independent of the age of the patient. Postoperative guideline-recommended adjuvant radiotherapy and systemic therapy is required. This approach is already recommended in the American guidelines as well as in the recommendations of the German Arbeitsgemeinschaft Gynäkologische Onkologie (AGO). In the currently valid German S3 guideline from 2012 these recommendations are still missing. For DCIS only, a tumor-free resection margin of 2 mm should be achieved if radiotherapy is planned after breast-conserving surgery.

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Literatur

  1. McCahill LE, Single RM, Aiello Bowles EJ et al (2012) Variability in reexcision following breast conservation surgery. JAMA 307:467–475

    Article  PubMed  Google Scholar 

  2. Tafra L, Fine R, Whitworth P et al (2006) Prospective randomized study comparing cryo-assisted and needle-wire localization of ultrasound visible breast tumors. Am J Surg 192:462–470

    Article  PubMed  Google Scholar 

  3. Kreienberg R, Jonat W, Volm T et al (2006) Management des Mammakarzinoms, 3. Aufl. Springer Medizin Verlag, Heidelberg

    Book  Google Scholar 

  4. Patey DH, Dyson WH (1948) The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer 2(1):7–13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Veronesi U, Zurrida S (1995) Surgery of the breast: 100 years after Halsted. Chir Ital 47(4):1–4

    CAS  PubMed  Google Scholar 

  6. Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. Eng J Med 347(16):1233–1241

    Article  Google Scholar 

  7. Houssami N, Macaskill P, Marinovich ML et al (2010) Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer 46(18):3219–3232

    Article  PubMed  Google Scholar 

  8. Huston TL, Simmons RM (2005) Locally recurrent breast cancer after conservation therapy. Am J Surg 189:229–235

    Article  PubMed  Google Scholar 

  9. Wöckel A, Wolters R, Wiegel T et al (2014) The impact of adjuvant radiotherapy on the survival of primary breast cancer patients: a retrospective multicenter cohort study of 8935 subjects. Ann Oncol 25(3):628–632

    Article  PubMed  PubMed Central  Google Scholar 

  10. Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347(16):1227–1232

    Article  PubMed  Google Scholar 

  11. Houssami N, Macaskill P, Marinovich ML et al (2014) The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 21(3):717–730

    Article  PubMed  Google Scholar 

  12. Lowery AJ, Kell MR, Glynn RW et al (2012) Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat 133(3):831–841

    Article  PubMed  Google Scholar 

  13. Pilewskie M, Ho A, Orell E et al (2014) Effect of margin width on local recurrence in triple-negative breast cancer patients treated with breast-conserving therapy. Ann Surg Oncol 21(4):1209–1214

    Article  PubMed  Google Scholar 

  14. Kreienberg R, Volm T, Möbus V et al (2002) Management des Mammakarzinoms, 2. Aufl. Springer Medizin Verlag, Heidelberg

    Book  Google Scholar 

  15. Dunne C, Burke JP, Morrow M et al (2009) Effect of margin status on local recurrence after breast conservation and radiation therapy for ductal carcinoma in situ. J Clin Oncol 27(10):1615–1620

    Article  PubMed  Google Scholar 

  16. Wang SY, Chu H, Shamliyan T (2012) Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst 104(7):507–516

    Article  PubMed  PubMed Central  Google Scholar 

  17. Coopey SB, Buckley JM, Smith BL et al (2011) Lumpectomy cavity shaved margins do not impact re-excision rates in breast cancer patients. Ann Surg Oncol 18(11):3036–3040

    Article  PubMed  Google Scholar 

  18. Smitt MC, Horst K (2007) Association of clinical and pathologic variables with lumpectomy surgical margin status after preoperative diagnosis or excisional biopsy of invasive breast cancer. Ann Surg Oncol 14(3):1040–1044

    Article  PubMed  Google Scholar 

  19. Guidroz JA, Larrieux G, Liao J et al (2011) Sampling of secondary margins decreases the need for re-excision after partial mastectomy. Surgery 150(4):802–809

    Article  PubMed  Google Scholar 

  20. Holland R, Veling SH (1985) Histologic multifocality of Tis, T1–2. Cancer 56(5):979–990

    Article  CAS  PubMed  Google Scholar 

  21. Graham RA, Homer MJ, Katz J et al (2002) The pancake phenomen contributes to the inaccuracy of margin assessment in patients with breast cancer. Am J Surg 184(2):89–93

    Article  PubMed  Google Scholar 

  22. Pappo I, Spector R, Schindel A et al (2010) Diagnostic performance of a novel device for real-time margin assessment in lumpectomy specimens. J Surg Res 160(2):277–281

    Article  PubMed  Google Scholar 

  23. Karni T, Pappo I, Sandbank J et al (2007) A device for real-time, intraoperative margin assessment in breast-conservation surgery. Am J Surg 194:467–473

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Universitätsfrauenklinik Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland

    I. Bekes, V. Fink, L. Schwentner, E. Leinert & W. Janni

  2. Institut für Pathologie, Universitätsklinikums Ulm, Ulm, Deutschland

    K. Koretz

Authors
  1. I. Bekes
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  2. V. Fink
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  3. L. Schwentner
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  4. E. Leinert
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  5. K. Koretz
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  6. W. Janni
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Corresponding author

Correspondence to I. Bekes.

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Interessenkonflikt

I. Bekes, V. Fink, L. Schwentner, E. Leinert, K. Koretz und W. Janni geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

T. Fehm, Düsseldorf

W. Janni, Ulm

R. Kimmig, Essen

N. Maass, Kiel

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Bekes, I., Fink, V., Schwentner, L. et al. Schnittränder beim duktalen Carcinoma in situ und beim Mammakarzinom. Gynäkologe 49, 701–705 (2016). https://doi.org/10.1007/s00129-016-3934-x

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  • DOI: https://doi.org/10.1007/s00129-016-3934-x

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