Mastopatía diabética: clínica, hallazgos radiológicos y anatomopatológicos y tratamiento / Diabetic mastopathy: clinical presentation, imaging and histologic findings, and treatment

Objetivo. La mastopatía diabética (MD) es una complicación infrecuente de la diabetes mellitus de larga evolución, que plantea el diagnóstico diferencial con el cáncer de mama. Se estudian la presentación clínica y evolución de la MD, los hallazgos radiológicos, la histología y el tratamiento en los pacientes diagnosticados en nuestro hospital. Material y métodos. Se incluyen 6 pacientes diabéticos insulinodependientes con MD, 5 mujeres y un varón, diagnosticados en un periodo de 11 años. El estudio radiológico se realiza con mamografía, ecografía y resonancia magnética (RM). Se obtiene en todos los casos un diagnóstico anatomopatológico definitivo con biopsia con aguja gruesa o quirúrgica. No se recurre en ningún caso a punción-aspiración con aguja fina. Se lleva a cabo un seguimiento clínico en un periodo medio de 7 años. Resultados. La presentación clínica más frecuente es el nódulo palpable (67%). Los hallazgos radiológicos son: en la mamografía, la asimetría de densidad (50%), en la ecografía un nódulo/masa sólido, hipoecoico, de 1-5cm, mal definido, con sombra acústica y sin señal Doppler (50%) y en la RM el realce tras la administración de contraste (66%). El hallazgo anatomopatológico más frecuente es la mastitis linfocítica en estadios iniciales (83%). Se realiza un tratamiento quirúrgico en todos los pacientes (100%). Conclusiones. La MD es una enfermedad poco frecuente que plantea el diagnóstico diferencial con el cáncer de mama. Su diagnóstico es complejo, pues requiere el conocimiento de los antecedentes personales del paciente, la clínica, la exploración física y los hallazgos radiológicos e histológicos. El tratamiento quirúrgico conservador es de elección, porque no se obtiene respuesta con el tratamiento médico (AU)

Objective. Diabetic mastopathy is an uncommon complication of longstanding diabetes mellitus that must be considered in the differential diagnosis with breast cancer. We report the clinical presentation and course, the imaging and histologic findings, and the treatment of the patients diagnosed with diabetic mastopathy at our hospital. Material and methods. In an 11-year period, we studied six insulin-dependent diabetic patients (five women and one man) with diabetic mastopathy. Imaging studies included mammography, ultrasonography, and magnetic resonance imaging. A definitive histologic diagnosis was reached after core needle or surgical biopsy in all cases. Fine-needle aspiration cytology was not used in any of the cases. The mean follow-up period was 7years. Results. The most common clinical presentation was a palpable nodule (67%). The imaging findings were a) at mammography: asymmetrical density (50%), b) at ultrasonography: a solid, hypoechoic nodule measuring between 1cm and 5cm in diameter, with ill-defined margins, acoustic shadowing, and no Doppler signal (50%), and c) at MRI: enhancement after the administration of contrast media (66%). The most common histologic finding was lymphocytic mastitis in the initial stages (83%). All patients underwent surgical treatment (100%). Conclusions. Diabetic mastopathy is an uncommon disease that should be included in the differential diagnosis with breast cancer in diabetic patients. The diagnosis is complex because it requires knowledge of the patient's history, clinical presentation, and the imaging and histologic findings, Conservative surgery is the treatment of choice because the condition does not respond to medical treatment (AU)

[Diabetic mastopathy: clinical presentation, imaging and histologic findings, and treatment]. / Mastopatía diabética: clínica, hallazgos radiológicos y anatomopatológicos y tratamiento.

OBJECTIVE: Diabetic mastopathy is an uncommon complication of longstanding diabetes mellitus that must be considered in the differential diagnosis with breast cancer. We report the clinical presentation and course, the imaging and histologic findings, and the treatment of the patients diagnosed with diabetic mastopathy at our hospital. MATERIAL AND METHODS: In an 11-year period, we studied six insulin-dependent diabetic patients (five women and one man) with diabetic mastopathy. Imaging studies included mammography, ultrasonography, and magnetic resonance imaging. A definitive histologic diagnosis was reached after core needle or surgical biopsy in all cases. Fine-needle aspiration cytology was not used in any of the cases. The mean follow-up period was 7 years. RESULTS: The most common clinical presentation was a palpable nodule (67%). The imaging findings were a) at mammography: asymmetrical density (50%), b) at ultrasonography: a solid, hypoechoic nodule measuring between 1cm and 5cm in diameter, with ill-defined margins, acoustic shadowing, and no Doppler signal (50%), and c) at MRI: enhancement after the administration of contrast media (66%). The most common histologic finding was lymphocytic mastitis in the initial stages (83%). All patients underwent surgical treatment (100%). CONCLUSIONS: Diabetic mastopathy is an uncommon disease that should be included in the differential diagnosis with breast cancer in diabetic patients. The diagnosis is complex because it requires knowledge of the patient's history, clinical presentation, and the imaging and histologic findings, Conservative surgery is the treatment of choice because the condition does not respond to medical treatment.

[US-guided localization of non-palpable breast cancer and sentinel node using 99mTechnetium-albumin colloid]. / Localización ecodirigida del cáncer de mama no palpable y del ganglio centinela con 99mtecnecio-coloide de albúmina.

OBJECTIVE: Surgery on non-palpable breast lesions is becoming increasingly common and new techniques for preoperative lesion localization have appeared. Radio-guided occult lesion localization (ROLL) enables malignant or probably malignant non-palpable breast lesions to be located and biopsy of the sentinel node to be performed (SNOLL: sentinel node and occult lesion localization). MATERIAL AND METHODS: Included were 118 patients with malignant or probably malignant non-palpable breast lesions visible on ultrasonography in whom radio-guided lesion resection and sentinel node biopsy were indicated. 99mTechnetium-albumin colloid was injected into the periphery of the lesion under ultrasonographic guidance and all patients underwent preoperative scintigraphy. RESULTS: From November 2001 to December 2004, 118 patients were included. All patients underwent conservative surgery, with the non-palpable lesion being located in all cases (100% lesion detection rate). The histological diagnoses were: 81 invasive ductal carcinomas (68.64%), 7 infiltrating lobular carcinomas (5.93%), 5 mixed-type carcinomas (4.24%), 17 carcinomas in situ (14.40%), and 8 other invasive carcinomas (6.78%). The sentinel node was detected in 98.41%. DISCUSSION AND CONCLUSIONS: Radio-guided ROLL surgery on non-palpable lesions located under ultrasonographic guidance is a simple, fast technique that enables the lesion to be safely excised. Both ROLL and SNOLL can be carried out in the same intervention with a single ultrasound-guided injection of 99mTechnetium-albumin colloid with satisfactory results.

Localización ecodirigida del cáncer de mama no palpable y del ganglio centinela con 99mtecnecio-coloide de albúmina / US-guided localization of non-palpable breast cancer and sentinel node using 99mtechnetium-albumin colloid

Objetivo. La cirugía de lesiones no palpables de mama va en aumento y han aparecido nuevas técnicas de localización preoperatoria. La técnica ecodirigida denominada ROLL (radioguided occult lesion localisation) permite localizar las lesiones de mama no palpables malignas o probablemente malignas y la biopsia del ganglio centinela (sentinel node and occult lesion localisation [SNOLL]).Material y métodos. Se incluyen 118 pacientes con lesiones de mama no palpables malignas o probablemente malignas visibles con ecografía, en las que está indicada la exéresis radioguiada de la lesión y la biopsia del ganglio centinela. Se inyecta con control ecográfico 99mtecnecio- coloide de albúmina en la periferia de la lesión y se realiza gammagrafía preoperatoria en todos los casos.Resultados. Desde noviembre del 2001 hasta diciembre del 2004 se incluyen 118 pacientes. En todas se realiza cirugía conservadora, localizando la lesión no palpable en todos los casos (tasa de detección de la lesión del 100%). El resultado anatomopatológico es: 81 carcinomas ductales infiltrantes (68,64%), 7 carcinomas lobulillares infiltrantes (5,93%), 5 carcinomas mixtos (4,24%), 17 carcinomas in situ (14,40%) y 8 otros carcinomas infiltrantes (6,78%). La detección del ganglio centinela es posible en un 98,41%.Discusión y conclusiones. La cirugía radioguiada ROLL de lesiones no palpables de mama localizadas con control ecográfico es una técnica sencilla y rápida que permite la exéresis de la lesión con seguridad. Se pueden realizar tanto ROLL como SNOLL en la misma intervención con una única inyección ecodirigida de 99mtecnecio-coloide de albúmina con resultados satisfactorios

Objective. Surgery on non-palpable breast lesions is becoming increasingly common and new techniques for preoperative lesion localization have appeared. Radio-guided occult lesion localization (ROLL) enables malignant or probably malignant non-palpable breast lesions to be located and biopsy of the sentinel node to be performed (SNOLL: sentinel node and occult lesion localization).Material and methods. Included were 118 patients with malignant or probably malignant non-palpable breast lesions visible on ultrasonography in whom radio-guided lesion resection and sentinel node biopsy were indicated. 99mTechnetium-albumin colloid was injected into the periphery of the lesion under ultrasonographic guidance and all patients underwent preoperative scintigraphy.Results. From November 2001 to December 2004, 118 patients were included. All patients underwent conservative surgery, with the non- lpable lesion being located in all cases (100% lesion detection rate). The histological diagnoses were: 81 invasive ductal carcinomas (68.64%), 7 infiltrating lobular carcinomas (5.93%), 5 mixed-type carcinomas (4.24%), 17 carcinomas in situ (14.40%), and 8 other invasive carcinomas (6.78%). The sentinel node was detected in 98.41%.Discussion and conclusions. Radio-guided ROLL surgery on nonpalpable lesions located under ultrasonographic guidance is a simple, fast technique that enables the lesion to be safely excised. Both ROLL and SNOLL can be carried out in the same intervention with a single ultrasound-guided injection of 99mTechnetium-albumin colloid with satisfactory results

Cirugía Radioguiada de lesiones no palpables de mama / Radio-guided surgery in non palpable breast lesions

Introducción: La cirugía de lesiones no palpables de mama va en aumento y han aparecido nuevas técnicas de localización preoperatoria. Presentamos nuestra experiencia con la cirugía radioguiada (ROLL, radioguided occult lesion localisation), los aspectos técnicos y los resultados de nuestra serie de pacientes.Matarial y métodos: Estudiamos un total de 144 pacientes con lesiones no palpables de mama que sean visibles por ecografía, divididas en dos grupos. Un primer grupo de 44 pacientes que corresponden a lesiones benignas y probablemente benignas para exéresis radioguiada de la lesión únicamente; se inyectan macroagregados de albúmina marcados con 99mTecnecio por vía intralesional. Un segundo grupo de 100 pacientes que son lesiones probablemente malignas y con diagnóstico preoperatorio de malignidad para exéresis radioguiada de la lesión y biopsia del ganglio centinela en el mismo acto quirúrgico (SNOLL: sentinel node and occult lesion localisation), en las cuales se inyecta 99mTecnecio-coloide de albúmina por vía perilesional. Gammagrafía preoperatoria en todos los casos. La cirugía se realiza bajo anestesia general y la detección con sonda modelo Navigator GPS® (Tyco).Resultados: En todas las 144 pacientes se ha podido localizar el punto de máxima captación con facilidad y rapidez. En el grupo de lesiones probablemente benignas el resultado definitivo ha sido 93,2% patología benigna y 6,8% patología maligna. En el grupo de lesiones con sospecha moderada o alta de malignidad el resultado ha sido 9% patología benigna y 91% patología maligna, en las cuales la biopsia del ganglio centinela se realizó con éxito en 85 pacientes (93,4%). Resultado global patología benigna/maligna de 1/ 1,9. Porcentaje de reintervenciones por márgenes afectos o insuficientes en patología maligna de 14,9%. Conclusiones: La cirugía radioguiada ROLL de lesiones no palpables de mama marcadas bajo control ecográfico es una técnica sencilla y rápida que permite la exéresis de las lesiones con seguridad y menores índices de márgenes afectos que los métodos tradicionales (arpón). En patología maligna se puede realizar de forma adecuada tanto la ROLL como la biopsia del ganglio centinela con una sola inyección de radiotrazador

Background: Occult breast lesions surgery are in increasing frecuency and new preoperative localization techniques have been reported. We present our experience in radioguided surgery (ROLL, radioguided occult lesion localisation), technical aspects and our results.Methods: 144 patients of occult breast lesions detected by ultrasounography were included in two groups. First group of 44 patients with benign or probably benign lesions for excision biopsy only; using macroaggregates of 99mTechnecium labelled human serum albumin injected into the center of the lesion. A second group of 100 patients with suspicious abnormalities suggestive of malignancy and preoperative diagnosed breast cancer were enrolled for simultaneous performance of ROLL and sentinel node identification (SNOLL: sentinel node and occult lesion localisation), with peritumoral injection of 99mTechnecium labelled human albumin microcolloid. Lymphoscintigraphy was always performed. General anesthesia was used in all patients and excision was performed using a gamma-detecting probe Navigator GPS® (Tyco).Results: In all 144 patients, the "hot spot" was located easily and quickly. In probably benign lesions, pathologic examination revealed 93,2% benign lesions and 6,8% breast cancer. In diagnosed breast cancers and moderate or high suspicious lesions, the histology revealed 9% benign lesions and 91% breast cancers, in which sentinel node biopsy was succesfull in 85 patinets (93,4%). Global histologic results revealed benign/ malignant ratio 1/1,9. In breast cancers additional excisions to ensure free margins were performed in 14,9%. Conclusions: Radioguided surgery ROLL for nonpalpable breast lesions labelled with ultrasonographic guidance is a feasible and quickly method that allows more accurate removal of nonpalpable breast lesions and a lower rate of insufficient margins than conventional localization techniques (wire). In breast cancer simultaneous performance of ROLL and sentinel lymph node biopsy are possible with a single radiotracer injection