2007, Number 10
<< Back Next >>
Ginecol Obstet Mex 2007; 75 (10)
Identification of surgical margins by intraoperative mammography of quadrantectomys specimens for breast cancer and histopathological comparison
Peña AAR, Mainero RFE, Vargas SJM, Buenrostro PMA, Bernechea MA, Burgos PI, Aguilar GUI, Balcázar RJ
Language: Spanish
References: 15
Page: 588-602
PDF size: 400.10 Kb.
ABSTRACT
Background: Wide surgical margins are prognostic indicators to prevent recurrences after conservative surgery in breast cancer; type of surgery and histopathological analysis are key factors too.
Objectives: To evaluate tumoral size and surgical margins of quadrantectomy specimens utilizing mammography and histopathology, and decide if mammography of quadrantectomy specimens are useful for close margins prediction.
Materials and methods: Prospective, observational and descriptive study based on the findings of specimen projections of two mammography quadrantectomies, and histopathological data. Ten patients with breast cancer were evaluated from May to November 2006. Surgical margins of quadrantectomys were marked with radiopaque material.
Results: Tumoral size was similar in mammography and histopathological analysis of quadrantectomys, however there was a tendency to report a larger size in mammography. With mammography only one case was reported as close superficial margin, the rest of patients has adequate margins (1 cm or higer). Five cases were close by histopathology (3 in the deep margin, one superior and one more in the superior and inferior margins), and five had adequate margins. Four additional surgical procedures where practiced (3 re-excisions and one mastectomy), in one of them additional surgery was unnecessary.
Conclusions: Mammography evaluation was useful to identify peripheral margins (superior, inferior medial and lateral) as well as tumoral size, but useless to identify close borders (deep and superficial areas). It is necessary to evaluate more cases to improve this technique and to establish a common language between specialists.
REFERENCES
Rodríguez-Cuevas SA, Capurro-García M. Epidemiología del cáncer de mama. Ginecol Obstet Mex 2006;74:585-93.
Fernández-Cid A, Fernández-Cid M. Diccionario de mastología enciclopédico ilustrado. 1ª ed. Barcelona: Masson, 1988;pp:91-98, 116-7, 363-6.
Bland KI, Copeland EM. The breast. Comprehensive management of bening and malignant diseases. 2a. ed. Philadelphia: WB Saunders, 1998.
Hernández-Muñoz G, Bernardillo ETL, Aristodemo-Pinotti J, Barros AC. Tratamiento conservador en cáncer de mama. Bogotá: McGraw-Hill Interamericana, 2001;pp:156-63.
Katz JF, Homer MJ, Graham RA, Rothschild JG. Metallic fragments on mammography after intraoperative deployment of radiopaque clips. Am J Roentgeno 2000;175:1591-3.
Rosen PT. Patología mamaria de Rosen. 2a. ed. Madrid: Amolca, 2005;pp:931-90.
Neuman L, Querer H. Advances in breast conservation therapy. J Clin Oncol 2005;23:1685-97.
Di Filippo EB, Miranda HH, Luján CP, Serrano MJ, et al. Manejo conservador del cáncer mamario. Experiencia en el servicio de oncología del Hospital General de México. GAMO 2004;3:59-63.
Moreno-de Miguel LF, Pérez-Braojo I, Sánchez-Varela I, Rodríguez-Díaz R. Cirugía conservadora más radioterapia en el cáncer temprano de mama en el INOR. Rev Cuba Oncol 1998;14:143-8.
Veronesi U, Luini A, Vechio M, Greco M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 1993;328:1587-91.
Alberro Adúriz J. Tratamiento quirúrgico del cáncer de mama: Mastectomía. Indicaciones, técnicas y complicaciones. Tratamiento conservador en el cáncer de mama. Ponencia. Congreso Nacional de Senología y Patología Mamaria. 1995 octubre.
Pinotti JA, Carvalho FM. Intraoperative pathological monitorization of surgical margins: a method to reduce recurrences after conservative treatment for breast cancer. Eur J Gynaecol Oncol 2002;23:11-16.
Mainero Ratchelous FE. Tratado de cirugía general: tratamiento quirúrgico del cáncer de mama. 1ª ed. México: El Manual Moderno, 2003;pp:1399-415.
Moore MM, Borrosa G, Imbrie JZ, Fechner RE, et al. Association of infiltrating lobular carcinoma with positive surgical margins after breast-conservation therapy. Ann Surg 2000;231:877-82.
McCormick JT, Keleher AJ, Tikhomirov VB, Budway RJ, Caushaj PF. Analysis of the use of specimen mammography in breast conservation therapy. Am J Surg 2004;188:433-6.