When breast-conserving surgery is used to remove the primary tumor, the distance between the margin and the tumor margin is very important, and the local recurrence after surgery is closely related to the surgical margin. It is generally believed that the margin is only 2cm away from the tumor margin, but the margin should be negative. The margin is 0.5 ~ 1.0 cm from the margin of the tumor, and only 5% is positive, but the tumor recurrence rate is still high. The results of NSABP and JCRT showed that the tumor margin was negative under microscope, and the local recurrence rate was 3% within 5 years. When the margin is 65438±0mm from the tumor margin, the 5-year recurrence rate is 2%.
The method of placing metal markers on the tumor bed was adopted to solve the problems of scar left after operation and the position of the tumor bed. It is necessary to explain the significance of placing metal markers to patients and their families before operation. After obtaining the consent, a silver clip was placed around the residual cavity where the tumor was removed, then the gland and subcutaneous tissue were sutured, and finally the skin was sutured. After the incision is healed, the radiation field of the focus area is located according to the metal mark under the simulator, and local radiotherapy is carried out to ensure the accuracy of the radiotherapy site.
SLN biopsy is negative, so axillary lymph node dissection is unnecessary. Generally, the number of axillary lymph node dissection is more than 10. However, axillary lymph node dissection has a series of complications (such as upper limb edema and lymphedema). ), and partial axillary lymph node dissection can not improve the survival rate of patients with axillary lymph node negative. The false negative rate of patients with negative axillary lymph node biopsy was 30%. Therefore, if a method can be found to judge whether axillary lymph nodes must be cleaned, so that those with negative axillary SLN can avoid axillary cleaning, while those with positive axillary SLN miss axillary cleaning, SLN biopsy can meet this requirement.
The axillary recurrence rate and complications of SLNB replacement axillary lymph node dissection in patients with SLN negative are very low. Therefore, it is proved that SLNB can safely replace axillary lymph node dissection in patients with SLN negative, and the recurrence rate is low. SLNB has replaced axillary dissection in most major medical centers in Europe, America and Australia. Prospective randomized experiments such as Pumshotham also confirmed that SLNB can significantly reduce complications and improve the quality of life of patients with negative lymph nodes, rather than axillary lymph node dissection.
After breast-conserving therapy for small tumors achieved satisfactory results, scholars began to try breast-conserving therapy for large tumors. Van Dongen et al reported a randomized clinical study of 868 patients, among which 696 (80.0%) patients had tumors of 2. 1 ~ 5.0 cm. The median follow-up was 65438 03.4 years, and the curative effect of breast-conserving plus radiotherapy was compared with that of modified radical operation. Although the local recurrence rate in breast-conserving group is high, these recurrences have no obvious effect on distant metastasis and overall survival rate.
Multiple breast cancer accounts for about 1.3% of breast cancer patients, which is generally considered as a contraindication to breast conservation, but these patients also have breast conservation requirements. After breast-conserving surgery, ensure that there is no tumor within 2mm of the postoperative specimen margin. As long as there is no tumor residue at the margin, supplemented by radiotherapy and systemic treatment, breast-conserving treatment for such patients is also feasible.