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1.
Radiographics ; 42(2): 321-339, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35179983

RESUMO

Nipple-sparing mastectomy (NSM) is increasingly offered to patients undergoing treatment of breast cancer and prophylaxis treatment for reduction of breast cancer risk. NSM is considered oncologically safe for appropriately selected patients and is associated with improved cosmetic outcomes and quality of life. Accepted indications for NSM have expanded in recent years, and currently only inflammatory breast cancer or malignancy involving the nipple is considered an absolute contraindication. Neoplasms close to and involving the nipple areolar complex are common, and cancer of the lactiferous ducts can spread to the nipple. Therefore, accurate determination of nipple involvement at imaging examinations is critical to identifying appropriate candidates for NSM and preventing local recurrence. Multiple imaging features have been described as predictors of nipple involvement, with tumor to nipple distance, enhancement between the index malignancy and the nipple, and nipple retraction demonstrating the highest predictive values. These features can be assessed at multimodality breast imaging, particularly at breast MRI, which demonstrates high specificity and negative predictive value for determining nipple involvement in malignancy. Online supplemental material is available for this article. ©RSNA, 2022.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia/métodos , Mamilos/diagnóstico por imagem , Mamilos/patologia , Mamilos/cirurgia , Qualidade de Vida , Radiologistas , Estudos Retrospectivos
2.
World J Surg ; 46(4): 829-835, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34994838

RESUMO

BACKGROUND: Sentinel lymph node biopsy is the gold standard for axillary assessment of patients with clinically node negative breast cancer. The current internationally accepted methods comprise of the usage of either a radioactive tracer, vital stains or the combination of both. However, in developing countries radioactive tracer is not widely used due to its high cost and limited availability. In addition, the classic retro-areolar blue dye injection has a high failure rate. OBJECTIVE: Our study aimed to assess the efficacy of patent blue dye injection in the upper outer quadrant of the breast after validation by concurrent usage of radioactive nanocolloid, in comparison with the classic retro-areolar injection in identifying the sentinel node. METHODS: A randomized control study involving 279 patients randomly divided into two groups. In group A lateral injection of 1% patent blue dye (validated by radioactive nanocolloid) was used, while subdermal patent blue dye injection in the retro-areolar space was performed in group B. RESULTS: The new technique showed the promising results with lower failure rate (3.4%) in comparison with the classic retro-areolar patent blue injection (13.7%). CONCLUSIONS: The lateral injection technique can be result in comparable results to the combination technique with the added benefit of being widely available and a cheaper option especially in developing countries.


Assuntos
Neoplasias da Mama , Linfadenopatia , Linfonodo Sentinela , Axila/patologia , Neoplasias da Mama/patologia , Corantes , Egito , Feminino , Humanos , Linfonodos/patologia , Linfadenopatia/patologia , Metástase Linfática/patologia , Mamilos/patologia , Traçadores Radioativos , Compostos Radiofarmacêuticos , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos
3.
Isr Med Assoc J ; 24(1): 20-24, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35077041

RESUMO

BACKGROUND: The purpose of mastectomy for the transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique. A holistic and surgical approach to transgender men includes our experience-based classification system for selecting the correct surgical technique. OBJECTIVES: To present and discuss the Transgender Standard of Care and our personal experience. METHODS: Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003-2019. Pictures of the patients were also analyzed. RESULTS: Until May 2021, 342 mastectomies were performed by the senior author on 171 patients. The 220 mastectomies performed on 110 patients until November 2019 were included in our cohort. Patient age was 13.5 to 50 years (mean 22.5 ± 6.1). The excision averaged 443 grams per breast (range 85-2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple-areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple-areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple-areola complex graft in 56 (50.9%). Complications included two hypertrophic scars, six hematomas requiring revision surgery, three wound dehiscences, and three cases of partial nipple necrosis. CONCLUSIONS: A holistic approach to transgender healthcare is presented based on the World Professional Association for Transgender Health standard of care. Analysis of the data led to Wolf's classification for female-to-male transgender mastectomy based on skin excess and the distance between the original and the planned position of the nipple-areola complex.


Assuntos
Cicatriz , Hematoma , Mastectomia , Complicações Pós-Operatórias , Procedimentos de Readequação Sexual , Deiscência da Ferida Operatória , Pessoas Transgênero , Adulto , Contorno Corporal/métodos , Contorno Corporal/psicologia , Imagem Corporal/psicologia , Cicatriz/etiologia , Cicatriz/psicologia , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Mastectomia/efeitos adversos , Mastectomia/métodos , Mamilos/patologia , Mamilos/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Satisfação do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Procedimentos de Readequação Sexual/efeitos adversos , Procedimentos de Readequação Sexual/métodos , Procedimentos de Readequação Sexual/psicologia , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/cirurgia , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos
5.
J Obstet Gynecol Neonatal Nurs ; 51(1): 83-88, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34762834

RESUMO

The formation of a milk bleb during breastfeeding is frequently associated with nipple pain that may affect the breastfeeding success of the mother-infant dyad. Early cessation of breastfeeding may occur when pain is ongoing. Timely evaluation and diagnosis and effective management are imperative to prevent tissue damage and lingering symptoms. In this case report, we evaluate the unique challenges of the diagnosis and management of milk blebs, including nonpharmacologic and pharmacologic treatment.


Assuntos
Vesícula , Aleitamento Materno , Vesícula/diagnóstico , Vesícula/etiologia , Vesícula/terapia , Feminino , Humanos , Lactente , Leite Humano , Mães , Mamilos/patologia
6.
Ann R Coll Surg Engl ; 104(3): e60-e63, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34821523

RESUMO

A glomus tumour is a benign mesenchymal tumour. It is extremely rare in the breast. We report a case of glomus tumour of the nipple in a 54-year-old man. To the best of the authors' knowledge, this is the first case report of a glomus tumour of the nipple. We describe the different presenting symptoms, method of diagnosis and treatment.


Assuntos
Neoplasias da Mama Masculina , Tumor Glômico , Neoplasias da Mama Masculina/diagnóstico , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia , Tumor Glômico/diagnóstico , Tumor Glômico/patologia , Tumor Glômico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mamilos/patologia
7.
Ann Surg Oncol ; 29(3): 1774-1786, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34839426

RESUMO

BACKGROUND: Nipple discharge is the third most frequent complaint of women attending rapid diagnostic breast clinics. Nipple smear cytology remains the single most used diagnostic method for investigating fluid content. This study aimed to conduct a systematic review and meta-analysis of the diagnostic accuracy of nipple discharge fluid assessment. METHODS: The study incorporated searches for studies interrogating the diagnostic data of nipple discharge fluid cytology compared with the histopathology gold standard. Data from studies published from 1956 to 2019 were analyzed. The analysis included 8648 cytology samples of women with a presenting complaint of nipple discharge. Both hierarchical and bivariate models for diagnostic meta-analysis were used to attain overall pooled sensitivity and specificity. RESULTS: Of 837 studies retrieved, 45 fulfilled the criteria for inclusion. The diagnostic accuracy of the meta-analysis examining nipple discharge fluid had a sensitivity of 75 % (95 % confidence interval [CI], 0.74-0.77) and a specificity of 87 % (95 % CI, 0.86-0.87) for benign breast disease. For breast cancer, it had a sensitivity of 62 % (95 % CI, 0.53-0.71) and a specificity 71 % (95 % CI, 0.57-0.81). Furthermore, patients presenting with blood-stained discharge yielded an overall malignancy rate of 58 % (95 % CI, 0.54-0.60) with a positive predictive value (PPV) of 27 % (95 % CI, 0.17-0.36). CONCLUSIONS: Pooled data from studies encompassing nipple discharge fluid assessment suggest that nipple smear cytology is of limited diagnostic accuracy. The authors recommend that a tailored approach to diagnosis be required given the variable sensitivities of currently available tests.


Assuntos
Neoplasias da Mama , Derrame Papilar , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Citodiagnóstico , Feminino , Humanos , Mamilos/patologia , Sensibilidade e Especificidade
9.
Arch Gynecol Obstet ; 305(1): 95-102, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34480228

RESUMO

PURPOSE: Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results. METHODS: Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q™), and breast volumetry based on 3D scans (Vectra® H2, Canfield Scientific). RESULTS: Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively. CONCLUSION: Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.


Assuntos
Mama , Mamoplastia , Satisfação do Paciente , Pesos e Medidas Corporais , Mama/anormalidades , Mama/patologia , Mama/cirurgia , Implantes de Mama/psicologia , Anormalidades Congênitas/patologia , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Mamoplastia/métodos , Mamoplastia/psicologia , Mamilos/patologia , Mamilos/cirurgia , Tamanho do Órgão , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
10.
Am J Clin Pathol ; 157(2): 266-272, 2022 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-34519762

RESUMO

OBJECTIVES: Subareolar tissue is examined during nipple-sparing mastectomy (NSM) to minimize the risk of occult malignancy within the preserved nipple. A positive subareolar tissue biopsy typically warrants subsequent nipple excision. We study the factors associated with a positive subareolar tissue biopsy, the rate of residual malignancy in subsequent nipple excisions, and the value of subareolar tissue biopsy intraoperative frozen section (IOF). METHODS: We identified 1,026 consecutive NSMs with separately submitted subareolar tissue biopsies over a 5.5-year period. Clinicopathologic data were reviewed. We examined concordance rates between subareolar tissue biopsy and subsequent nipple excisions as well as IOF diagnosis and permanent control diagnosis. RESULTS: Among cases of therapeutic NSM, the rate of a positive subareolar tissue biopsy was 7.2%. Multifocal/multicentric disease (P = .0005), presence of lymphovascular invasion (P = .033), and nodal involvement (P = .006) were significantly associated with a positive subareolar tissue biopsy. Thirty-nine of 41 cases with positive subareolar biopsies underwent subsequent nipple excision, with 20 (51%) showing residual carcinoma. Among all IOF samples, 9 (3.3%) showed a discrepancy between the IOF and permanent diagnoses, mostly because of false-negatives. CONCLUSIONS: A positive subareolar tissue biopsy predicts residual carcinoma in the excised nipples in 51% of cases. IOF is accurate and reliable.


Assuntos
Neoplasias da Mama , Carcinoma Intraductal não Infiltrante , Biópsia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/patologia , Feminino , Humanos , Mastectomia , Mamilos/patologia , Mamilos/cirurgia , Estudos Retrospectivos
11.
World J Surg ; 46(5): 1116-1121, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35076823

RESUMO

BACKGROUND: Nipple-areola complex (NAC) necrosis, which is caused by local ischemia, remains one of the complications associated with nipple-sparing mastectomy. Obesity, smoking, diabetes mellitus, and immediate breast reconstruction have been identified as risk factors of NAC necrosis. The current study examined the correlation between NAC necrosis and nipple volume. MATERIALS AND METHODS: A total of 83 patients who underwent NSM for primary breast cancer from January 2016 to December 2019 were retrospectively analyzed. Nipple volume was determined using the formula: volume (cc) = length × width × height (mm), with measurements determined using contrast-enhanced magnetic resonance imaging. Total and partial NAC necrosis was defined as full-thickness necrosis requiring surgical procedures and epidermal necrosis managing local wound care, respectively. RESULTS: NAC necrosis was observed in 30 patients (36%), with 3 and 27 patients having total and partial necrosis, respectively. Large nipple volume (56% vs. 24%, p = 0.006), as well as smoking and immediate breast reconstruction (57 vs. 28%, p = 0.017; 48% vs. 20%, p = 0.009, respectively), were significantly correlated with NAC necrosis. Multivariate analysis identified nipple volume as an independent risk factor for NAC necrosis (OR, 3.75; 95% CI, 1.23-11.44; p = 0.02). Smoking (OR, 4.68; 95% CI, 1.37-15.94; p = 0.014) and immediate breast reconstruction (OR, 3.43; 95% CI, 1.05-11.23; p = 0.042) were also independently associated with NAC necrosis. CONCLUSIONS: This study suggested that a large nipple volume could be one of the risk factors for NAC necrosis following NSM.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Mastectomia/métodos , Necrose/etiologia , Necrose/patologia , Mamilos/patologia , Mamilos/cirurgia , Estudos Retrospectivos , Fatores de Risco
12.
In Vivo ; 36(2): 839-847, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35241540

RESUMO

BACKGROUND/AIM: The prediction of a sub-areolar tissue infiltration in breast cancer (BC) patients could be helpful in selecting the best functional outcome according to several reconstructive oncoplastic or radical techniques. This study aims to evaluate the diagnostic performance of preoperative ultrasound (US) guided sub-areolar biopsy (SAB) in detecting occult nipple involvement, in comparison with the definitive pathological examination of tissue after surgery. PATIENTS AND METHODS: We prospectively recorded clinical and pathological data of 46 consecutive patients scheduled for breast conserving surgery or nipple-areola sparing mastectomy. All cases underwent preoperative SAB and the results were compared with the histopathology of the dissected tumors and their biological characteristics. All parameters were correlated with nipple involvement by univariate and multivariate analysis. RESULTS: The sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of the SAB examination for nipple staging were 60%, 97.5%, 75% and 95.2%, respectively. According to the clinicopathological features, the bivariate analysis did not show a significant interaction between patient age, tumor size or type, lymph node status, lymphatic vascular invasion, histologic grade, ER, PR, Ki-67 status, HER2 amplification, multifocal or multicentric disease and positive NAC assessment (p>0.05). CONCLUSION: A preoperative sample of retroareolar tissue obtained by US-guided biopsy could be considered a reproducible, mini-invasive diagnostic procedure useful to facilitate immediate breast reconstruction with implants or through conservative oncoplastic approaches, thereby guiding clinical practice.


Assuntos
Neoplasias da Mama , Mamilos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Biópsia Guiada por Imagem , Mastectomia/métodos , Mamilos/patologia , Mamilos/cirurgia , Estudos Retrospectivos , Ultrassonografia de Intervenção
13.
Am J Surg ; 223(3): 447-451, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34955166

RESUMO

BACKGROUND: Mastectomy is the recommended treatment for ipsilateral breast tumor recurrence (IBTR) in patients who initially received breast conservation surgery (BCS) and radiation. We evaluated the 3 types of mastectomies performed for the surgical treatment of IBTR (nipple sparing (NSM), skin sparing (SSM) and total mastectomy (TM)) to assess surgical complications and local control outcomes among groups. METHODS: Patients who developed IBTR after BCS and received mastectomy from 2011 to 2019 were reviewed. Patient characteristics and treatment were analyzed. The incidence of postoperative complications and second breast cancer recurrence were compared. RESULTS: Mastectomy was performed in 113 patients presenting with isolated IBTR (17 NSM, 48 SSM and 48 TM). There was no difference in post-operative complications between groups. At 3-year follow-up, 5 (4%) patients had a second recurrence. Tumor size at IBTR was the only predictor for second recurrence and not mastectomy type or receipt of reconstruction. CONCLUSION: In patients initially treated with BCS who experienced an IBTR, NSM or SSM mastectomy with immediate reconstruction had low complication rates and no increase in local recurrence compared to the TM group.


Assuntos
Neoplasias da Mama , Mastectomia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia Segmentar , Recidiva Local de Neoplasia/patologia , Mamilos/patologia , Mamilos/cirurgia , Estudos Retrospectivos
14.
Comput Math Methods Med ; 2022: 4066179, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35321201

RESUMO

Background: Axillary lymph node (ALN) staging is the most effective method to evaluate the condition of patients with breast cancer, their choice of treatment options, and prognosis. The sentinel lymph node (SLN) status assessment is the key to sentinel lymph node biopsy (SLNB) in patients with breast cancer. The choice of tracer and tracer injection sites affects SLNB. Objective: This study mainly analyzes the best tracer for SLNB and the best choice of tracer injection site. Methods: A total of 165 breast cancer patients who underwent SLNB were selected and injected with methylene blue or 99mTc-labeled sodium phytate or nanocarbon 20 min before biopsy. The number of SLNs detected by different tracers in different injection sites such as peritumoral tissue (PT) and subareolar area (SA) was counted, and the sensitivity, specificity, and positive/negative prediction rates were recorded and compared. Results: The detection success rate, average detection number of SLNs, and detection accuracy of the nanocarbon tracer were higher than the other two. The detection sensitivity, specificity, and positive and negative prediction rates of nanocarbon for SLNB were also higher than those of the other two tracers. When comparing the performance of tracers in different injection sites, it was found that the detection of three tracers injected in the SA was better than the injection in the PT. Conclusion: For women with early-stage breast cancer, nanocarbon can be used as the preferred tracer for SLNB to determine the status of the patient's ALNs, and the areola area can be used as the best injection site.


Assuntos
Neoplasias da Mama , Biópsia de Linfonodo Sentinela , Axila/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Linfonodos , Mamilos/patologia , Biópsia de Linfonodo Sentinela/métodos
15.
Breast J ; 27(12): 899-901, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34873794

RESUMO

Carney complex (CNC) is an extremely rare, autosomal dominant genetic syndrome consisting of pigmented skin and mucosal changes with multiple endocrine and nonendocrine tumors, including the breast. Breast tumors are typically multiple and benign and are most commonly reported as myxoid fibroadenomas and/or intraductal papillomas. We present a young female patient with known CNC who presented with copious bloody nipple discharge with multiple breast lumps and discuss the breast imaging features regarding this complex and often underrecognized genetic condition.


Assuntos
Neoplasias da Mama , Complexo de Carney , Fibroadenoma , Derrame Papilar , Papiloma Intraductal , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Complexo de Carney/diagnóstico , Complexo de Carney/genética , Complexo de Carney/patologia , Feminino , Fibroadenoma/patologia , Humanos , Mamilos/patologia , Papiloma Intraductal/patologia
17.
Pan Afr Med J ; 39: 178, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34584604

RESUMO

Sporadic neurofibromas of the nipple-areolar complexes are exceptional even in patients with neurofibromatosis. Diffuse neurofibroma is an uncommon subtype of neurofibroma that has received little attention in the imaging literature. As are most superficial lesions, it is often evaluated clinically and if biopsy is needed, it is usually performed without imaging. However the imaging data is quite characteristic with the aim of evaluating the extension in depth and detecting an underlying cancer. We report a case of women without a history of neurofibromatosis presenting a skin thickening disfiguring her left breast, related to diffuse neurofibroma of the nipple-areolar complexes confirmed histologically. We study echo-mammography and breast magnetic resonance imaging (MRI) findings in order to highlight its radiographics features.


Assuntos
Neurofibroma/diagnóstico por imagem , Neurofibromatoses/diagnóstico por imagem , Mamilos/diagnóstico por imagem , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Mamografia , Neurofibroma/patologia , Neurofibromatoses/patologia , Mamilos/patologia
19.
Radiology ; 301(1): 47-56, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34254854

RESUMO

Background Although nonmass enhancement (NME) extension to the nipple at preoperative MRI frequently leads to sacrifice of the nipple-areolar complex (NAC), its correlation with pathologically confirmed NAC involvement is unclear. Purpose To evaluate the diagnostic accuracy of using NME extension to the subareolar region at breast MRI to predict pathologic nipple involvement and the eligibility for nipple-sparing mastectomy. Materials and Methods From November 2017 to November 2019, the authors prospectively enrolled participants with breast cancer and NME within 2 cm of the nipple at breast MRI who underwent surgery that included removal of the NAC. The authors evaluated NME extensions that were ipsilateral and contiguous with the biopsy-proven tumor lesions on images acquired during the early contrast phases. Pathologic nipple involvement and the distance from the nipple to the nearest cancer cell were evaluated by using serial vertical sectioning of the area extending from the entire NAC to the tumor. The primary end point was the positive predictive value (PPV) of NME, which was calculated as follows: (number with pathologic nipple invasion and NME extension to the nipple at breast MRI/number with NME extension to the nipple at breast MRI) × 100. Results Of 64 women (mean age, 52 years ± 9.8 [standard deviation]), 49 (77%) had NME extension to the nipple at breast MRI. The PPV of NME extension to the nipple was 86% (42 of 49 women; 95% CI: 73, 94). Among the 15 participants without NME extension to the nipple, only one (7%) had pathologic nipple involvement. The diagnostic accuracy of using NME extension to the nipple was 88% (56 of 64 women; 95% CI: 77, 95). The radiologic distance correlated well with the pathologic distance (Spearman correlation coefficient = 0.71, P = .003). Conclusion Nonmass enhancement extension to the nipple base at preoperative MRI has a high positive predictive value for identifying tumor involvement of the nipple, a contraindication to nipple-sparing mastectomy. © RSNA, 2021 Online supplemental material is available for this article.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Imageamento por Ressonância Magnética/métodos , Mamilos/diagnóstico por imagem , Mamilos/patologia , Adulto , Idoso , Mama/diagnóstico por imagem , Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , República da Coreia
20.
Plast Reconstr Surg ; 148(1): 21-30, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181601

RESUMO

BACKGROUND: Previous breast surgery does not represent an absolute contraindication for nipple-sparing mastectomy, although it may negatively interfere with surgical outcomes. The aim of the authors' study was to confirm the feasibility of nipple-sparing mastectomy after previous breast surgery, focusing on skin incisions and risk factors, complications, and oncologic outcomes. METHODS: The authors retrospectively identified 368 patients who underwent 387 nipple-sparing mastectomies and reconstruction after previous surgery (quadrantectomy, breast resection, augmentation and reduction mammaplasty, mastopexy) at the European Institute of Oncology from January of 2003 to November of 2017. Patterns of skin incisions (i.e., radial, hemiperiareolar, periareolar, vertical pattern, inframammary fold, Wise-pattern, and round-block) for primary surgery and for mastectomy, type of reconstruction, and radiotherapy have been recorded. The authors collected data regarding early and late complications and further operations (implant change, fat grafting) performed within 2 years to improve cosmetic outcomes. Oncologic follow-up has been reported for in-breast recurrences. RESULTS: Complete and partial nipple-areola complex necrosis occurred, respectively, in 2.8 percent and in 5.4 percent of cases. The authors recorded 5.4 percent failures resulting in implant removal. The analysis of risk factors for complications or for the need for further operations showed no significant association with skin incision for first surgery and mastectomy, use of the same skin incision, previous radiotherapy, or type of primary surgery. Five-year overall survival and disease-free survival were 99.1 and 93.8 percent, respectively. No nipple recurrence was recorded. CONCLUSIONS: The authors' results confirm that nipple-sparing mastectomy can be a safe surgical procedure after previous breast surgery. Surgical planning should be tailored to each patient. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Neoplasias da Mama/terapia , Contraindicações de Procedimentos , Mastectomia Subcutânea/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Glândulas Mamárias Humanas/patologia , Glândulas Mamárias Humanas/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Mamilos/patologia , Mamilos/cirurgia , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/estatística & dados numéricos , Reoperação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco
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