RESUMO
OBJETIVO: Presentar nuestra experiencia inicial en el procedimiento combinado de detección intraoperatoria del ganglio axilar positivo biopsiado marcado con semilla de 125I (GM) y biopsia del ganglio centinela (GC) después de quimioterapia neoadyuvante, en pacientes con cáncer de mama. MATERIAL Y MÉTODOS: Estudio prospectivo, enero de 2017 - marzo de 2019, 16 pacientes con cáncer de mama T1-3N1. Estadio TNM: II-A: 3, II-B: 10, III-A: 3. Tipo histológico ductal infiltrante: 14. Subtipos moleculares: luminal-A: 3, luminal-B: 9, HER2: 3, triple negativo: 1. El GM se marcó 227+/-36 días antes de iniciar la quimioterapia neoadyuvante (n: 10), o 1-6 días antes de la cirugía, sobre el ganglio previamente identificado con un marcador ecovisible tipo hidrogel (n: 3) o tridimensional-3D (n: 3). En 10 pacientes se realizó linfadenectomía axilar. RESULTADOS: GM y GC se identificaron en la cirugía en el 93,7% (15/16) de los casos, en 33,3% (5/15) GM no se encontraba entre los GC, y solo en una enferma (1/5) existió discrepancia entre el resultado de GM y GC (macrometástasis y negativo 0/2). Número medio ganglios GC: 2,2+/-0,9 (rango 1-3) y linfadenectomía axilar: 13,5+/-5,2 (rango 7-23). En todos los casos, el análisis anatomopatológico del GM, con semilla de 125I y/o marcador, predijo correctamente el estatus axilar posneoadyuvancia. En todas las pacientes se recuperó la semilla radiactiva de 125I. CONCLUSIONES: La colocación de semillas de 125I es una técnica factible para la localización intraoperatoria del ganglio positivo biopsiado en combinación con la biopsia del ganglio centinela. El resultado anatomopatológico del GM permite determinar el estatus axilar posneoadyuvancia
OBJECTIVE: To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with 125I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients. MATERIAL AND METHODS: Prospective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227+/-36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients. RESULTS: ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2+/-0.9 (range 1-3) and AD: 13.5+/-5.2 (range 7-23). In all cases, histopathological analysis of ML, 125I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the 125I radioactive seed was recovered. CONCLUSIONS: Placing of 125I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Radioisótopos do Iodo , Biópsia de Linfonodo Sentinela , Linfonodo Sentinela/diagnóstico por imagem , Axila , Mama/patologia , Neoplasias da Mama/química , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/química , Carcinoma Ductal de Mama/patologia , Radioisótopos do Iodo/administração & dosagem , Excisão de Linfonodo , Terapia Neoadjuvante , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Estudos Prospectivos , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Linfonodo Sentinela/patologiaRESUMO
OBJECTIVE: To present our initial experience in the combined procedure of intraoperative detection of axillary positive node marked with 125I seed (ML) and sentinel node biopsy (SLN) after neoadjuvant chemotherapy (NACT), in breast cancer patients. MATERIAL AND METHODS: Prospective study, January 2017 - March 2019, 16 breast cancer patients T1-3N1. TNM stage: IIA: 3, IIB: 10, IIIA: 3. Histological type ductal invasive: 14. Molecular subtype: luminal A: 3, luminal B: 9, HER2: 3, basal like: 1. The ML was marked 227±36 days before neoadjuvant chemotherapy (n: 10), or 1-6 days before surgery, on previously identified node by ultrasound visibility marker, hydrogel (n: 3) or three dimensional-3D (n: 3). Axillary lymphadenectomy was undertaken in 10 patients. RESULTS: ML and SLN were identified in the surgery in 93.7% (15/16) of the cases, in 33.3% (5/15) ML was not among SLN, and in only one patient (1/5) was there a discrepancy between the result of ML and SLN (macrometastases vs. negative 0/2). Median number of lymph nodes SLN: 2.2±0.9 (range 1-3) and AD: 13.5±5.2 (range 7-23). In all cases, histopathological analysis of ML, 125I seed and/or marker within, correctly predicted axillary status after neoadjuvant chemotherapy. In all patients the 125I radioactive seed was recovered. CONCLUSIONS: Placing of 125I seeds is a feasible technique for intraoperative location of axillary positive node combined with SLN. The histopathological result of ML allows the axillary status to be determined after neoadjuvant chemotherapy.
