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1.
Medicine (Baltimore) ; 98(51): e18511, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861038

RESUMO

BACKGROUND: Peri-prosthetic seroma after implant insertion for breast reconstruction is a common but difficult-to-manage complication. This study aimed to compare peri-prosthetic seroma duration and the number of aspirations associated with intravenous cannula with those associated with conventional needle. METHODS: Seventy-one patients who underwent skin- or nipple-sparing mastectomy and implant insertion were treated for peri-prosthetic seroma. When peri-prosthetic seroma was detected, ultrasound-guided aspiration was performed either by using an intravenous cannula (n = 35) or a conventional needle (n = 36); however, the method adopted was randomly selected. We analyzed the participants' clinicopathologic factors after medical record review. RESULTS: There were no significant intergroup differences in mean age (P = .052), mean body mass index (P = .601), total clinical tumor size (P = .107), pathologic tumor size (P = .269), specimen weight (P = .147), implant size (P = .313), or operation time (P = .595). However, the mean total peri-prosthetic seroma volume was significantly higher (105.80 vs 88.58, P = .015) but the number of aspirations was lower (4.48 vs 5.80, P = .043) in the intravenous cannula group than in the conventional needle group. Mean peri-prosthetic seroma volume per aspiration was nonsignificantly higher in the intravenous cannula group (26.92 vs 19.14, P = .291). CONCLUSION: Ultrasound-guided aspiration performed using an intravenous cannula was comparable to the procedure performed using a conventional needle. Furthermore, the former method can be safer and effective alternative to manage peri-prosthetic seroma.


Assuntos
Doenças Mamárias/cirurgia , Implante Mamário/efeitos adversos , Seroma/cirurgia , Ultrassonografia de Intervenção/instrumentação , Adulto , Doenças Mamárias/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Seroma/etiologia , Sucção/instrumentação , Sucção/métodos
2.
Rev Col Bras Cir ; 46(5): e20192286, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31859725

RESUMO

OBJECTIVE: to evaluate the safety profile and aesthetic results of 2-octyl-cyanoacrylate versus intradermal nylon suture in breast surgeries. METHODS: an open-label, randomized, clinical trial evaluating the occurrence of complications, such as dehiscence, hematoma, infection, and allergic reactions after the use of 2-octyl-cyanoacrylate or nylon thread. The size of the incisions, skin closure time, and total surgical time were also analyzed. The aesthetic outcome was evaluated at 40 and 180 days after surgery, by means of the average width of the surgical wound and by subjective conceptual assessment (optimal, good, reasonable, or poor). RESULTS: 79 patients were included: 37 in the 2-octyl-cyanoacrylate group and 42 in the nylon suture group. The study was stopped before the end of patient recruitment due to the occurrence of a greater number of dehiscences in the adhesive group (OR: 11.42; 95%CI: 1.36-96.02; p=0.007). Regarding the other analyzed complications, the surgical duration and postoperative aesthetic result, no significant differences were observed between the groups. The mean operative wound size was greater in the adhesive group than in the suture group, but there was no correlation between wound size and the largest number of dehiscences. CONCLUSION: while the cosmetic outcomes with the two techniques were similar, there was a greater risk of dehiscence with the use of 2-octyl-cyanoacrylate compared to intradermal suturing.


Assuntos
Doenças Mamárias/cirurgia , Cianoacrilatos/uso terapêutico , Nylons , Técnicas de Sutura/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente , Ferida Cirúrgica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
Korean J Parasitol ; 57(2): 179-184, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31104411

RESUMO

Sparganosis is a parasitic infestation caused by sparganum, a plerocercoid tapeworm larva of the genus Spirometra. Since the first case of human sparganosis reported in 1908, sparganosis has been a global disease, and is common in China, Japan, and Southeast Asian countries. Consumption of raw snakes, frogs, fish, or drinking contaminated beverages are sources of human infections. Human sparganosis usually manifests in subcutaneous fat in areas such as the abdomen, genitourinary tract, and limbs. Breast sparganosis cases are rare, representing less than 2% of total cases of human infections. Complete surgical extraction of the sparganum is the treatment of choice. Because of the rarity of the disease, clinical suspicion is vital to reach the diagnosis of breast sparganosis. Here we report 2 rare cases of breast sparganosis presenting with a painless breast lump, both treated with surgical excision and sparganum extraction.


Assuntos
Doenças Mamárias/diagnóstico , Doenças Mamárias/patologia , Mama/patologia , Mama/parasitologia , Esparganose/diagnóstico , Esparganose/patologia , Plerocercoide/isolamento & purificação , Idoso , Animais , Doenças Mamárias/parasitologia , Doenças Mamárias/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Esparganose/parasitologia , Esparganose/cirurgia , Resultado do Tratamento
7.
Breast J ; 25(4): 712-715, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31079421

RESUMO

The authors report the case of a 56-year-old woman with mammary sparganosis due to infection with a plerocercoid tapeworm larva of Spirometra mansoni. Magnetic resonance imaging revealed an area of heterogeneous density in outer upper quadrant of the right breast, with a high likelihood of malignancy. During surgery for the removal of a granuloma, the parasite was discovered and excised. The authors review the pathological and imaging features of mammary sparganosis.


Assuntos
Doenças Mamárias/parasitologia , Doenças Mamárias/cirurgia , Esparganose/parasitologia , Esparganose/cirurgia , Spirometra/patogenicidade , Animais , Doenças Mamárias/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Esparganose/diagnóstico por imagem , Ultrassonografia Mamária
8.
Breast J ; 25(3): 393-400, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30945398

RESUMO

Benign papillary and sclerosing lesions of the breast (intraductal papillomas, complex sclerosing lesions, radial scars) are considered high-risk lesions due to the potential for upgrade to carcinoma on subsequent surgical excision. Optimal clinical management of such lesions remains unclear due to variable reported upgrade rates. Apocrine metaplasia is a common finding in breast tissue and its role in MRI enhancing lesions is increasingly being recognized. The purpose of this study was to investigate the MRI features of papillary and sclerosing lesions of the breast, evaluate the clinical management and upgrade rate of such lesions, and examine the contribution of apocrine metaplasia to the imaging findings. A 13-year retrospective review of MRI-guided biopsies identified 70 MRI-detected and -biopsied papillary and sclerosing lesions. Sixteen lesions without atypia underwent surgical excision; only one case (6%) was upgraded to pleomorphic lobular carcinoma in situ. The majority (64%) of biopsies contained apocrine metaplasia either within or adjacent to the targeted lesion. We found that half of MRI-detected lesions had T2 hyperintense foci (2-5 mm) or masses (>5 mm) adjacent to the lesion. Histologic correlation showed apocrine cysts were likely responsible for this imaging finding in 56% of these cases.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Feminino , Seguimentos , Humanos , Biópsia Guiada por Imagem , Imagem por Ressonância Magnética , Glândulas Mamárias Humanas/diagnóstico por imagem , Glândulas Mamárias Humanas/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Esclerose
9.
Turkiye Parazitol Derg ; 43(1): 47-49, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30938140

RESUMO

Hydatid cyst is a helminthic infection caused by Echinococcus granulosus that we encounter in various organs, especially in the liver and the lungs. Hydatid cyst of the breast is seen very rarely even in regions where the disease is endemic. In this article, we aimed to present a female patient who presented with complaints of a mass in her right breast, was diagnosed as having hydatid cyst as a result of physical examination and radiological imaging methods, and was treated.


Assuntos
Doenças Mamárias/diagnóstico , Equinococose/diagnóstico , Echinococcus granulosus/isolamento & purificação , Animais , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/parasitologia , Doenças Mamárias/cirurgia , Diagnóstico Diferencial , Equinococose/diagnóstico por imagem , Equinococose/parasitologia , Equinococose/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade
10.
Am J Case Rep ; 20: 580-586, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31015391

RESUMO

BACKGROUND Epidermal inclusion cysts rarely develop in the breast. The cysts that do develop within the breast typically present as cutaneous or subcutaneous cysts. They more rarely present in a subareolar location or in a ruptured state. Thus far, 5 cases of ruptured epidermal inclusion cysts in subareolar locations have been reported in the English literature. Furthermore, clinical presentation of nipple discharge is rare in epidermal inclusion cysts of the breast; only 4 such cases has been reported. CASE REPORT A 58-year-old female presented with a 1-month history of bloody discharge from her left nipple. Mammography showed focal asymmetry in the left subareolar region; sonography showed a left subareolar mass with irregular shape, indistinct margin, heterogeneous echogenicity, and posterior enhancement. The mass was surgically excised; a pathological diagnosis of ruptured epidermal inclusion cyst with foreign body reaction and abscess formation was established. In this case, the clinical presentation of bloody nipple discharge was peculiar; furthermore, mammographic and sonographic features were indistinguishable from breast malignancy or typical breast abscess. CONCLUSIONS A ruptured epidermal inclusion cyst can present in an unusual subareolar location, combined with bloody nipple discharge; importantly, this can radiologically resemble breast malignancy.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Cisto Epidérmico/diagnóstico por imagem , Reação a Corpo Estranho/diagnóstico por imagem , Mamilos/cirurgia , Biópsia por Agulha , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Reação a Corpo Estranho/cirurgia , Humanos , Imuno-Histoquímica , Mamografia/métodos , Pessoa de Meia-Idade , Mamilos/diagnóstico por imagem , Mamilos/patologia , Doenças Raras , Medição de Risco , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler em Cores
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(3): 341-344, 2019 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-30874393

RESUMO

Objective: To explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy. Methods: Between January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m 2, with an average of 30.8 kg/m 2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g). Results: The skin flap necrosis at the "T" trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15). Conclusion: For severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.


Assuntos
Doenças Mamárias , Mamoplastia , Adulto , Doenças Mamárias/cirurgia , Cicatriz , Humanos , Hipertrofia , Pessoa de Meia-Idade , Mamilos , Estudos Retrospectivos , Adulto Jovem
13.
J Obstet Gynaecol Res ; 45(7): 1398-1403, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30916459

RESUMO

Mayer-Rokitansky-Küster-Hauser syndrome is characterized by aplasia of the uterus and the upper ⅔ of the vagina, with normal female genotype (46,XX) and the development of secondary sexual characters. One of the most popular surgical treatment is the McIndoe procedure, which major drawbacks are the scar of split thickness skin graft (STSG)harvesting, and risk of vaginal stenosis for graft retraction. We report the case of a patient, operated modifying the McIndoe technique, by harvesting a full thickness skin grafts (FTSG) from patient's breasts, undergone simultaneous reduction mammoplasty. The FTSG provided a complete lining of the reconstructed neovagina. At 6 months, we observed complete mucinous metaplasia of the vaginal walls and 1 year after surgery no sign of stenosis, without the use of the mold. The advantages of this technique are reduced donor site morbidity, when compared with traditional McIndoe technique, and reduced risk of neovagina retraction ensured by FTSG, compared with STSG. If future patients' series confirm the good results achieved, we could consider it as a first-line option in patients undergoing neovagina reconstruction, seeking breasts or body contouring surgery.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Doenças Mamárias/cirurgia , Anormalidades Congênitas/cirurgia , Ductos Paramesonéfricos/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Vagina/anormalidades , Transtornos 46, XX do Desenvolvimento Sexual/complicações , Transtornos 46, XX do Desenvolvimento Sexual/patologia , Doenças Mamárias/congênito , Doenças Mamárias/patologia , Terapia Combinada , Anormalidades Congênitas/genética , Anormalidades Congênitas/patologia , Estética , Feminino , Humanos , Hipertrofia , Ductos Paramesonéfricos/patologia , Ductos Paramesonéfricos/cirurgia , Vagina/cirurgia , Adulto Jovem
14.
Medicine (Baltimore) ; 98(10): e14713, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855464

RESUMO

BACKGROUND: Breast disease has been a global serious health problem, among women. Surgery is the main treatment for the patients suffering from breast disease. Postoperative nausea and vomiting are still disturbing. Acupoint stimulation, an effective treatment of traditional Chinese medicine, has been used to reduce postoperative nausea and vomiting. Recently, non-needle acupoint stimulation becomes a new intervention. Though several clinical trials have been done, there is still no final conclusion on the efficacy. This Meta-Analysis aims at evaluating the efficacy of non-needle acupoint stimulation for prevention of nausea and vomiting after breast surgery. METHODS: Systematic searches were conducted in PubMed, Embase, Cochrane, and Wanfang Med Online databases for studies. The review period covered from the inception of databases to December 31, 2017. The outcome measures of interest were frequency of nausea, frequency of vomiting, frequency of PONV, verbal rating scale of nausea, and use of rescue antiemetic. Data extraction and risks of bias evaluation were accomplished by 2 independent reviewers using the Cochrane Collaboration Review Manager software (RevMan 5.3.5). RESULTS: Fourteen randomized controlled trials with a total of 1009 female participants in the non-needle acupoint stimulation group and control group met the inclusion criteria. Although the therapeutically effect on vomiting within postoperative 2 hours was not obvious, non-needle acupoint stimulation still had an important role in reducing nausea and vomiting within postoperative 48 hours. According to Jadad scale, there was moderate quality evidence for the pooled analysis results in this study. In addition, stimulating acupoint by wristband acupressure was more likely to cause adverse reactions. CONCLUSION: Non-needle acupoint stimulation can be used for female patients undergoing breast surgery to reduce postoperative nausea and vomiting. Into consideration, we recommend transcutaneous acupoint electrical stimulation on PC6 from 30 minutes before induction of anesthesia to the end of surgery for application. This non-pharmaceutical approach may be promising to promote the recovery of patients after breast surgery.


Assuntos
Pontos de Acupuntura , Doenças Mamárias/cirurgia , Náusea e Vômito Pós-Operatórios , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Estimulação Elétrica Nervosa Transcutânea/métodos , Feminino , Humanos , Náusea e Vômito Pós-Operatórios/etiologia , Náusea e Vômito Pós-Operatórios/prevenção & controle , Resultado do Tratamento
15.
Cir. plást. ibero-latinoam ; 45(1): 27-36, ene.-mar. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182675

RESUMO

Introducción y Objetivo: La mama tuberosa es una anomalía congénita que se evidencia en la pubertad con un alto índice de presentación. Se caracteriza por alteraciones en la forma y estructura de la mama, con mayor afectación del polo inferior. Presentamos nuestra experiencia de 3 años en corrección de la mama tuberosa con la técnica de doble plano invertido con colgajo de pectoral mayor y evaluamos los resultados obtenidos. Material y Método: Estudio prospectivo de 3 años sobre 12 pacientes intervenidas quirúrgicamente utilizando como alternativa de tratamiento un colgajo publicado por nosotros que utiliza el músculo pectoral mayor en su porción distal, irrigado por las perforantes internas (doble plano invertido), que proporciona mayor cobertura del implante en la zona problema. Resultados: Obtuvimos un porcentaje de satisfacción del 83% de las pacientes intervenidas, evaluado mediante tabla de satisfacción a los 8 meses de postoperatorio. Conclusiones: En nuestra experiencia, la técnica de doble plano invertido con colgajo de pectoral mayor para la plastia de mamas tuberosas otorga mayor cobertura en el polo inferior por utilizar cobertura muscular, con una anatomía constante, segura y conocida


Background and Objective: The tuberous breast is a congenital anomaly that can be evidenced throughout puberty with a high rate of presentation. It is characterized by alterations in form and structure, the lower pole being the most usual condition. We present our 3 year experience using the double inverted plane technique in the correction of tuberous breast and evaluate our results. Methods: Prospective 3 year study on 12 patients using as an alternative to the treatment an our authorship flap that uses the pectoralis major muscle in its distal portion, irrigated by the internal perforators (inverted dual plane), which provides greater coverage of the implant in the problem zone. Results: A 83% percentage of patients'satisfaction was obtanined with the proposed technique; results were evaluated by means of a satisfaction table at 8 months postoperative period. Conclusions: In our experience, the inverted double plane technique with pectoralis major flap for tuberous breast plasty, provides greater coverage in the lower pole by using muscle coverage, with a constant, safe and known anatomy


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Doenças Mamárias/cirurgia , Mama/anormalidades , Retalhos Cirúrgicos , Estudos Prospectivos , Músculos Peitorais/cirurgia , Satisfação do Paciente/métodos , Cuidados Pós-Operatórios/métodos , Implantes de Mama
16.
J Clin Pathol ; 72(6): 438-442, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30739079

RESUMO

Benign spindle cell lesions of the breast include neoplastic and reactive entities that are diagnostically challenging given their rarity and similar histomorphology. Accurate diagnosis on percutaneous core biopsy within this category is essential as some lesions require excision and surveillance, whereas others may be observed. We present three cases of rare benign spindle cell lesions of the breast that reflect the diversity of this group: solitary fibrous tumour, nodular pseudoangiomatous stromal hyperplasia and nodular fasciitis. Through these cases, we discuss the associated differential diagnosis and demonstrate how emerging ancillary studies can be integrated into a diagnostic approach. We highlight distinctive clinical and histopathological features and summarise recent updates to the clinical management of these lesions. An organised approach to the broad differential of spindle cell lesions is essential for appropriate diagnosis and treatment.


Assuntos
Angiomatose/diagnóstico , Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Fasciite/diagnóstico , Hiperplasia/diagnóstico , Tumores Fibrosos Solitários/diagnóstico , Adulto , Angiomatose/diagnóstico por imagem , Angiomatose/patologia , Angiomatose/cirurgia , Biópsia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Diagnóstico Diferencial , Fasciite/diagnóstico por imagem , Fasciite/patologia , Fasciite/cirurgia , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/patologia , Hiperplasia/cirurgia , Imuno-Histoquímica , Mastectomia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/patologia , Tumores Fibrosos Solitários/cirurgia , Resultado do Tratamento , Ultrassonografia Mamária
17.
Breast Cancer Res Treat ; 175(1): 165-170, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30689105

RESUMO

PURPOSE: Use of a wire to localize a non-palpable breast lesion for surgery is standard but archaic. We sought to evaluate a new radiofrequency localization system (RFLS) as an effective, non-radioactive alternative to the wire. METHODS: Patients who required surgical excision of a non-palpable breast lesion were consented for the study. Patients underwent localization with a radiofrequency Tag and surgical removal guided by the handheld LOCalizer probe. The primary study endpoint was successful placement and retrieval of the Tag, and secondary endpoints included marker migration; days prior to surgery of Tag insertion; patient, radiologist, and surgeon experience; distance of Tag from skin; and positive margin and re-excision rates for cancer. RESULTS: Fifty patients had successful placement and retrieval of the radiofrequency Tag. Likert questionnaire data revealed that most patients thought the procedure went smoothly and was easier than expected. Radiologists and surgeons thought that the Tag was as reliable as the wire. Of the 33 patients who had surgery for in situ or invasive cancer, one had a positive margin on final pathology (3%) and two underwent re-excision (6%). CONCLUSIONS: Data from this pilot study suggest that the RFLS is an effective localization system for non-palpable breast lesions intended for surgical removal. Unlike most other technologies, the LOCalizer probe detects distance from the Tag, and this unique feature may have contributed to the low positive margin rate seen in this study. The RFLS appears to offer advantages over current localization procedures and should be explored as an alternative to wire. ClinicalTrials.gov Identifier: NCT03202472.


Assuntos
Doenças Mamárias/diagnóstico , Doenças Mamárias/etiologia , Mama/metabolismo , Adulto , Idoso , Mama/patologia , Doenças Mamárias/metabolismo , Doenças Mamárias/cirurgia , Diagnóstico por Imagem/métodos , Feminino , Humanos , Pessoa de Meia-Idade
19.
Br J Radiol ; 92(1094): 20180626, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30359092

RESUMO

OBJECTIVE:: To evaluate the efficacy and learning curve of ultrasoundguided vacuum-assisted excision (US-VAE) of benign breast lesions, and to assess characteristics associated with residual lesion. METHODS:: This was a retrospective study with institutional review board-approval. Sonographic and clinical follow-up were performed 6 months after intervention. Effectiveness and safety of the technique were analyzed. The cumulative summation (CUSUM) graphs were used to evaluate learning curves concerning complete excision and hematoma. RESULTS:: 152 ultrasound-VAEs in 143 patients were included. Initial complete resection was achieved in 90.8 % (138 of 152). 6-month follow-up was completed for 143 (94%) of cases and complete resection was observed in 72 % (100 of 143). Mean maximum size without residual tumor was 16.9 mm, while with residual lesion it was 21.9 mm (p = < 0.001), with a volume of 1.53 and 3.39 cm3, respectively (p = < 0.001). Increase in lesion size and volume was associated with less effectiveness (p = 0.05), clinical control (p = 0.05), and higher risk of clinically significant hematoma (p = 0.05). Receiver operating characteristic analysis demonstrate a volume threshold of 2.6 cm3 (r = 0.71, specificity 84.5%) for leaving no residual lesion. Cumulative summation graphs demonstrate that, on average, 11 excisions were required to acquire skills to perform complete excision in more than 80% at the end of the ultrasound-VAE and 18 excisions at 6 months. CONCLUSION:: Ultrasound-VAE is an effective treatment for benign breast lesions. Breast lesion volume should be considered when assessing for percutaneous treatment. ADVANCES IN KNOWLEDGE:: A follow-up of the learning process of ultrasound-VAE will be a valuable tool to assess the efectiveness and safety of the technique i.


Assuntos
Doenças Mamárias/cirurgia , Mama/cirurgia , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Biópsia por Agulha , Mama/diagnóstico por imagem , Mama/patologia , Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Curva de Aprendizado , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia Mamária , Vácuo , Adulto Jovem
20.
Breast J ; 25(1): 103-106, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30461129

RESUMO

Excision of high-risk breast lesions (HRL) continues to be standard of care. Previous studies have shown that HRLs can be upgraded to carcinoma in situ (CIS) or invasive carcinoma (IC) upon excision. A single institution retrospective review was conducted to determine the rate of upgrade of HRLs and ductal carcinoma in situ (DCIS) identified on image-guided biopsy upon excision. Eight hundred and fifty-seven patients who underwent core needle biopsy (CNB) following the detection of suspicious lesions (BI-RADS IV) on mammograms were identified. HRLs and DCIS warranting subsequent surgical excision were found in 129 of 857 patients (15.1%). Overall, 19.6% (10/51) of DCIS, 52.4% (11/21) of ADH, and 17.6% (3/17) of papillomas were upgraded on surgical excision. A statistically significant difference was found between the concordant and discordant groups regarding the number of cores obtained (P = 0.01) and the needle size used to retrieve specimens on CNB (P = 0.01). This study reveals an upgrade rate of 26.7% of HRLs and DCIS diagnosed by CNB on surgical excision and emphasizes the continued use of large bore needles with an adequate number of core specimens when investigating a suspicious breast lesion.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Idoso , Doenças Mamárias/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Biópsia Guiada por Imagem , Mamografia , Pessoa de Meia-Idade , Papiloma/diagnóstico por imagem , Papiloma/patologia
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