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Chirurgie conservatrice du cancer du sein: évaluation des berges d’exérèse lors de la chirurgie première

Surgical margins in conservative surgery for breast cancer

  • Synthèse / Review Article
  • Published:
Oncologie

Abstract

Conservative surgery is the actual gold standard for the management of low-stages (i.e. I and II) breast cancers. The completion of clearmargins isaprerequisite for a complete local treatment and a decrease of local recurrences. Atight collaboration between pathologists and surgeons is mandatory. There is no consensus for the definition of the cut of a clear margin. Different management processes have been reported through the literature, ranging fromgrossmanagement to cytologic or histopathologic methods for margin evaluation. Such approaches have to be correlated to the clinical and radiological setting. They have to be performed in line with tumor characteristics, and treatment plans. The perspectives are a better evaluation of surgical margins using nuclear medicine or molecular biology tools to decrease the number of second surgical procedures.

Résumé

Le traitement conservateur est actuellement la référence dans la prise en charge des cancers du sein de stades I et II. L’obtention de marges saines est un facteur primordial pour la diminution du taux de récidives locales. Elle ne fait l’objet d’aucun consensus tant pour la technique d’évaluation des berges chirurgicales que pour la valeur seuil limite d’une marge d’exérèse de sécurité. Diverses approches ont été évaluées dans la littérature, depuis la prise en charge macroscopique de la pièce à sa réception par le pathologiste à l’emploi de méthodes cytologiques et histologiques d’évaluation des berges. De telles pratiques sont évidemment à replacer dans un contexte radioclinique et doivent faire l’objet d’une collaboration étroite entre les différents spécialistes. Les perspectives sont une amélioration de l’évaluation des limites et/ou des marges tumorales à l’aide de techniques de médecine nucléaire, et/ou de biologie moléculaire afin de diminuer le nombre de reprises chirurgicales.

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Authors and Affiliations

  1. Département de pathologie, Centre de lutte contre le cancer d’Auvergne Jean-Perrin, 58, rue Montalembert, BP 392, F-63011, Clermont-Ferrand cedex 01, France

    P. Romero, M. -M. Dauplat, F. Mishellany & F. Penault-Llorca

  2. Département de chirurgie, Centre de lutte contre le cancer d’Auvergne Jean-Perrin, 58, rue Montalembert, BP 392, F-63011, Clermont-Ferrand cedex 01, France

    P. Gimbergues & G. Le Bouëdec

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  1. P. Romero
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  2. M. -M. Dauplat
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  3. F. Mishellany
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  4. P. Gimbergues
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  6. F. Penault-Llorca
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Correspondence to P. Romero.

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Romero, P., Dauplat, M.M., Mishellany, F. et al. Chirurgie conservatrice du cancer du sein: évaluation des berges d’exérèse lors de la chirurgie première. Oncologie 12, 19–23 (2010). https://doi.org/10.1007/s10269-009-1839-1

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  • DOI: https://doi.org/10.1007/s10269-009-1839-1

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