Целесообразность выполнения органосохраняющих операций при мультифокальном/мультицентричном раке молочной железы

Частота встречаемости мультифокальных (МФ) и мультицентричных (МЦ) карцином широко варьируется среди клинических исследований в зависимости от определений и методов морфологического исследования. Применение магнитно-резонансной томографии широко распространено в связи с возможностью точного распознания дополнительных скрытых опухолей. однако, ложноположительные поражения могут привести к некорректному выбору лечения. таким образом, необходимо проведение дооперационных биопсий во избежание неоправданного хирургического вмешательства. Большинство исследований продемонстрировали более высокие показатели поражения лимфатических узлов при МФ/МЦ опухолях по сравнению с унифокальными. однако, частота местного рецидива обычно ниже после проведения органосохраняющего лечения при МФ/МЦ опухолях. Предполагается, что органосохраняющее лечение является целесообразным при МФ/МЦ опухолях в случае с пациентами в возрасте 50-69 лет с небольшими опухолями и отсутствием обширной протоковой карциномы in situ. Согласно метаанализу, наблюдаются низкие показатели общей выживаемости при МФ/МЦ опухолях, однако данный факт остается под вопросом. Хирургическое вмешательство должно обеспечивать как должный косметический результат, так и гистологически чистые края резекции, что требует тщательного рентгенологического исследования и локализации поражений. Необходимо тщательно изучить особенности бустерного облучения, поскольку двойная доза облучения может привести к повышенной токсичности, в частности к развитию фиброза. В заключение, органосохраняющее лечение целесообразно в случае с определенной группой пациентов с МФ/ МЦ опухолями, однако решение относительно выбора хирургического вмешательства должно приниматься в рамках междисциплинарного взаимодействия рентгенолога, хирургов и специалистов по лучевой терапии.

мастэктомия, органосохраняющая хирургия, мультифокальные опухоли, мультицентричные опухоли, лучевая терапия, местный рецидив, рак молочной железы, выживаемость, Mastectomy, Breast conservative surgery, Multifocal tumors, Multicentric tumors, Radiotherapy, Local recurrence, Breast cancer, Survival

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