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首页> 外文期刊>International Journal of Surgical Oncology >Optimizing Surgical Margins in Breast Conservation
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Optimizing Surgical Margins in Breast Conservation

机译：优化乳房保护术的手术余量

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Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy,) include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.
机译：传统上，在乳腺癌的保乳手术中有足够的手术余量一直被认为是局部复发率的预测指标。关于什么构成适当的手术切缘仍未达成共识，但是很明显，在广泛清楚的切缘与可接受的美容性之间需要权衡。在适当的切缘范围内（在手术时以及在新辅助化疗后）计划切除范围的术前方法包括乳房X线检查，US和MRI。为了确保完全去除影像学发现并促进切缘清除，在术前术前病灶定位策略以及术中标本评估方面已有改进。术中准确评估肿瘤和腔边缘的术中策略包括腔体剃刮技术，以及用于边缘探针的新技术。包括射频消融以及术中放射在内的消融技术可用于扩大无肿瘤的边缘，而无需切除其他组织。肿瘤整形技术可在保持美容效果的同时进行更广泛的切除，并具有可接受的局部复发率，但是通常需要对侧乳房进行手术。随着乳腺癌的全身治疗的不断改善，目前尚不清楚手术切缘对局部控制率的重要性。

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