A large number of prospective clinical trials have demonstrated: breast-conserving surgery plus radiation therapy can make breast cancer patients with radical surgery to achieve the same survival rate, and a good cosmetic effect. Do not lose the breast, this desire has been part of the breast cancer patients become a reality.
What can breast-conserving it? The current consensus is that: early breast cancer, single lesion, surgical margin negative pathological examination, breast, other parts of the non-suspicious micro-calcification can be conserving.
Breast-conserving surgery absolute contraindications are:
1, can not be a single incision to achieve cosmetic results of local resection of the multi-center lesion;
2, ipsilateral breast had radiotherapy;
3, gestational breast cancer;
4, breast X films showed diffuse suspicious or signs of malignant microcalcifications;
5, positive margin.
Breast-conserving surgery relative contraindications are:
1, while suffering from some collagen vascular diseases such as scleroderma, lupus erythematosus;
2, multi-center breast lesions were located in the same quadrant;
3, tumor surrounding the existence of unidentified calcification;
4 , tumor> 5cm;
5, tumors in the areola area.
2006 NCCN Breast Cancer Clinical Practice Guidelines recommends that: In addition to T0 phase of ductal carcinoma in situ; ≤ 2cm, axillary lymph node metastasis of breast cancer in stage â… , â…¡ and â…¢ A period of (T3N1M0) breast cancer can also choose to breast-conserving surgery, In other words, even if the tumor is too large, or axillary lymph node metastasis, may also consider breast-conserving. For these locally advanced breast cancer, NCCN guidelines advocate first neo-adjuvant chemotherapy (chemotherapy before surgery), tumor shrinkage after the line-conserving surgery, but it should be noted that the original edge of the tumor marker to determine the extent of resection. Tumor is too large, or axillary lymph node metastasis in locally advanced breast cancer, breast conserving surgery there is a high rate of local recurrence risk Patients should be informed.
To determine the suitability of a patient breast-conserving surgery should conduct a comprehensive assessment of the following factors:
1, there is invariably a history of radiotherapy for the disease;
2, breast size, tumor size and location;
3, preoperative imaging studies to understand the disease the extent of distribution;
4, cutting edge of breast-conserving resection of the pathological specimen examination (intraoperative frozen);
5, reaching the requirements of the scope of breast-conserving resection while preserving the breast can have a better look. Another important factor is the patient’s demands and aspirations, in particular, the tumor is too large or locally advanced breast cancer patients and their doctors should be breast-conserving therapy and radical resection of the advantages and disadvantages discussed.
In general, breast-conserving surgery is the surgical treatment of breast cancer in the mature technology, but at present there is no absolute indication for uniform standards, individual hospital breast conservation is not fully consistent with indications of certainty, even in a number of issues There is a certain controversy, to reach international consensus in 2006 NCCN Breast Cancer Clinical Practice Guidelines, although not a clear indication for thinning-conserving, but breast-conserving indication of certainty given the authority of evidence-based medicine recommendations. A single lesion in early breast cancer (tumor diameter ≤ 3cm, preoperative clinical examination of axillary lymph node metastasis) is the domestic and foreign scholars generally accepted indications. With the in-depth research and technological progress, in ensuring the efficacy under the premise of the scope of indications for breast-conserving surgery is expanding.
