Barroso-Bravo S, Zarco-Espinosa G, Alvarado-Cabrero I, Valenzuela-Flores AG, Pichardo-Romero P, Rodríguez-Cuevas AS

Idioma: Español
Referencias bibliográficas: 39
Paginas: 437-441
Archivo PDF: 86.14 Kb.

RESUMEN

El objetivo de este estudio es evaluar técnica y factibilidad de la combinación de mapeo linfático con linfadenectomía del ganglio centinela, para evitar la disección axilar en pacientes con cáncer de mama incipiente. Se trató de mujeres que acudieron al Hospital de Oncología, Centro Médico Nacional Siglo XXI, del 1 de marzo de 2002 al 30 de abril de 2004. Se incluyeron mujeres con cáncer de mama y ganglios clínicamente negativos (N0), sin tratamiento ni biopsias previos. Todas fueron sometidas a mapeo linfático y linfadenectomía de los ganglios centinela, con azul patente o técnica doble azul y sonda gamma. Los ganglios centinela fueron evaluados con impronta transoperatoria y el resultado se tomó en cuenta para realizar la disección axilar. No se excluyó ningún caso. Se revisaron 60 mujeres con edad promedio de 51 años. El tamaño promedio del tumor primario fue de 1.9 cm; 9 % estaba en etapa EC-0, 33 % en EC-I y 58 % en EC-IIA. En todas las mujeres se encontró ganglio centinela. Se disecaron 95 ganglios centinela, para un promedio de 1.6 por procedimiento. En el informe histopatológico definitivo, 19 mujeres (32 %) resultaron con ganglios positivos a metástasis y 41 (68 %) con negativos. La correlación de los resultados de la impronta citológica transoperatoria con los resultados histopatológicos definitivos indicó un caso falso positivo y seis falsos negativos, para dar a la impronta citológica transoperatoria una sensibilidad de 68.4 %, especificidad de 97.5 %, valor predictivo positivo de 92.8 % y valor predictivo negativo de 86.9 %. La combinación de mapeo linfático, linfadenectomía del ganglio centinela e impronta citológica transoperatoria, permitió evitar la disección radical de axila en 68 % de las pacientes; únicamente en 10 % de la pacientes fue necesaria una segunda cirugía.

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