RESUMO
BACKGROUND: The dislocation of the malignant cells along the needle tract during breast cancer (BC) diagnosis has been demonstrated by several studies. However, the published experiences that relate the diagnostic technique with sentinel node (SN) involvement are few and controversial. The aim of our analysis was to evaluate the impact of different techniques for preoperative BC biopsy among prognostic factors of metastases occurrence in SN. MATERIALS AND METHODS: We reviewed the institutional clinical database of our Center. A total of 674 patients were diagnosed between February 1999 and December 2006 with invasive BC. SN metastases classification followed the 2002 American Joint Committee on Cancer (AJCC) TNM pathological staging: macrometastases, micrometastases, isolated tumor cells or negative. Only macrometastases and micrometastases were considered positive. Concerning fine-needle aspiration cytology, we used disposable needles of the size of 21-27 G. For percutaneous biopsy we used cutting needle type "tru-cut"; the Gauge needle ranged between 14 and 20. RESULTS: At univariate analysis of specific parameters using positive SN as outcome, percutaneous diagnostic technique did not affect significantly the SN positivity (p = 0.60). At multivariate models only central quadrant lesion (p = 0.005) and lymph vascular invasion (LVI) presence (p < 0.0001) maintained the statistical significance as risk factor for positive SN status. Polytomic logistics models showed that only LVI maintained the statistical significance both for prediction of micrometastases and macrometastases. CONCLUSIONS: Our analysis showed that different techniques used for BC diagnosis did not influence SN status.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/secundário , Micrometástase de Neoplasia/patologia , Inoculação de Neoplasia , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Biópsia por Agulha Fina/efeitos adversos , Biópsia por Agulha Fina/métodos , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/cirurgia , Distribuição de Qui-Quadrado , Estudos de Coortes , Bases de Dados Factuais , Equipamentos Descartáveis , Feminino , Humanos , Imuno-Histoquímica , Incidência , Linfonodos/patologia , Metástase Linfática , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Células Neoplásicas Circulantes/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de SobrevidaRESUMO
The aim of this work was to evaluate the accuracy of vacuum-assisted biopsy by comparing it with frozen biopsy. 141 stereotaxic biopsies were performed by Mammotome (Ethicon Endo-Surgery, Hamburg) from January 2000 to March 2001. Biopsies were performed for microcalcifications (n = 105, 74.5%), irregular opacities (n = 20, 14.2%), regular opacities (n = 6, 4.2%), stellate lesions (n = 10, 7.1%). Histological analysis showed 85 (60.3%) benign lesions, 46 (32.6%) malignant lesions including (21 cases of carcinoma in situ and 25 invasive carcinomas) and 10 (7.1%) atypical lesions. All malignant lesions were subjected to surgery. In three cases (1 in situ and 2 invasive), core biopsy was excisional and no residual lesion was observed. Two of the carcinomas in situ revealed invasive features on the surgical biopsy. One of the atypical lesions was underestimated and the final diagnosis was "well differentiated carcinoma in situ." Only three of benign lesions underwent surgery after Mammotome biopsy. Among the 55 frozen-section biopsies of mammographically detected breast lesions performed in the same period, were one false-positive and 3 false-negative cases, while in 4 cases the diagnosis was deferred after paraffin embedding. Our results confirmed Mammotome biopsy as an effective alternative and a more reliable method than frozen-section examination.
Assuntos
Biópsia por Agulha/instrumentação , Doenças Mamárias/patologia , Mama/patologia , Técnicas Estereotáxicas/instrumentação , Doenças Mamárias/diagnóstico , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/patologia , Carcinoma/diagnóstico , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Carcinoma/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Diagnóstico Diferencial , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Secções Congeladas , Humanos , Mamografia , Invasividade NeoplásicaRESUMO
One hundred morbidly obese patients underwent an elective bypass operation with an overall mortality of two per cent. Some pathophysiological features of gross obesity are discussed as well as the problems that this condition presents for both anesthesiologist and surgeon. Preoperative work-up, conduct of anesthesia, including Althesin as the primary anesthetic, and management in the recovery room are described. Good anesthetic care and careful monitoring are essential to success with the morbidly obese patient.