USE OF DYE IN THE PREOPERATIVE MARKING OF NONPALPABLE BREAST LESIONS LITERATURE REVIEW / Uso de corantes na marcação pré-cirúrgica de lesões impalpáveis de mama: revisão de literatura

Objective: To evaluate and compare the use of different dyes in the marking of nonpalpable breast lesions indicated for surgical resection. Method: We analyzed the following variables: number of cases, types of dye, technique used for marking (patent blue, indocyanine green, or methylene blue), associated techniques (guidewire or Tc-99m), free margins of the surgical specimen (when the diagnosis was cancer), pain during the marking, and allergic events. The main results of the articles were organized in tables, using the software Microsoft Excel 2011. Results: We selected 11 articles for analysis. A total of 510 women had 516 nonpalpable breast lesions marked with dyes. The main dyes used were patent blue, methylene blue, and indocyanine green. The rate of free margins in cancer cases was 95%. Methylene blue was superior to other dyes in obtaining free margins. Out of the 11 articles selected, three associated dye with radioactive materials, and two with guidewire. Two studies analyzed the pain during the marking and revealed that 75% of the patients classified it as moderate or minimal, with mammography being the method most associated with pain. No allergic event was reported. Conclusion: The use of dyes in the preoperative marking of nonpalpable breast lesions is a viable, safe, and cheap technique. The initial results of several groups indicate significant advantages compared to the methods currently available. Methylene blue has a lower rate of positive margins than other dyes. Prospective randomized studies are still necessary to verify the superiority of the technique in comparison to others

Objetivo: Avaliar e comparar o uso de diferentes corantes na marcação de lesões não palpáveis de mama que possuem indicação para ressecção cirúrgica. Método: Foram analisadas as seguintes variáveis: número de casos, tipos de corante, técnica utilizada na marcação (azul patente, indocianina verde ou azul de metileno), técnicas associadas (fio-guia ou TC-99), margens livres do espécime cirúrgico (quando o diagnóstico era câncer), dor durante a marcação e eventos alérgicos. Organizou-se os principais resultados dos artigos em tabelas, utilizando o programa Microsoft Excel 2011. Resultados: Foram selecionados 11 artigos para análise. Ao todo, 510 mulheres realizaram marcação com corantes em 516 lesões impalpáveis de mama. Os principais corantes utilizados foram azul patente, azul de metileno e indocianina verde. A taxa de margens livres em casos de câncer foi de 95%. O azul de metileno foi superior aos demais corantes na obtenção de margens livres. Dos 11 artigos selecionados, em três foi feita a associação do corante com materiais radioativos, e em dois, com o fio guia. A dor durante a marcação foi analisada por dois estudos e classificada como moderada ou mínima por 75% das pacientes, sendo a mamografia o método mais associado à dor. Não foram reportados eventos alérgicos. Conclusão: O uso de corantes na marcação pré-operatória de lesões impalpáveis de mama é uma técnica viável, segura e mais barata. Os resultados iniciais de diversos grupos apontam vantagens significativas em relação aos métodos disponíveis atualmente. O azul de metileno apresenta menor taxa de margens comprometidas em relação aos demais corantes. Estudos prospectivos randomizados ainda são necessários para atestar a superioridade da técnica em relação às demais.

Use of the Patent Blue and Air in the Preoperative Marking of Impalpable Breast Lesions.

OBJECTIVE: The goal of this study is to analyze the applicability of the patent blue dye and air in the preoperative marking of impalpable mammary lesions with indication of surgical resection. MATERIALS AND METHODS: A prospective cohort study was performed. We selected 49 patients with detection of impalpable lesions on a breast mammography or breast ultrasonography. The patients received the dye injection as close to their surgery time as possible. The criteria analyzed included: 1) complete marking and identification of the lesion; 2) complete removal of the lesion; 3) in cases of malignant lesions, presence of free margins for successful surgery; 4) occurrence of allergic events; 5) necessity of reoperation; and 6) difficulty in locating lesions. RESULTS: All lesions were marked, and they were successfully excised. In cases of malignancy, free margins were obtained in 100% of the cases. There were no allergic events or reoperations. Only 8.9% of the lesions were difficult to locate. CONCLUSION: The marking with patent blue and air is an effective alternative for the labeling of impalpable breast lesions, and it has satisfactory surgical oncology results. All lesions were resected, 91.1% of them were performed with no difficulties, and free margins were obtained in 100% of cases of malignancy.

Surgical correction of polymastia and polytelia with an uncommon presentation / Correção cirúrgica de polimastia e politelia com apresentação incomum

Polymastia is a rare condition that is present in 1 to 5% of the population. Clinically, it is characterized by the presence of two or more breasts, which can occur in males or females. The condition may appear with or without the presence of extra nipples, which is termed polythelia. Bilateral presentation is uncommon. Here we report a case of a patient who had more than one pair of breasts and extra nipples which were surgically corrected

Polimastia é uma condição rara presente em 1 a 5% da população. Clinicamente se caracteriza pela presença de duas ou mais mamas e pode ocorrer em homens ou mulheres. Essa condição pode se apresentar com ou sem a presença de mamilos extras, ou seja, politelia. A apresentação bilateral é incomum. Aqui apresentamos um caso de uma paciente que tinha mais de um par de mamas e mamilos extras que foram removidos cirurgicamente