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Advisor(s)
Abstract(s)
A maximização do potencial da abordagem cirúrgica conservadora da axila para o
cancro da mama, como um método minimamente invasivo para a avaliação de
metastização axilar, visando diminuir a morbilidade associada ao esvaziamento axilar
completo, requer um método preciso para avaliação patológica intraoperatória. Esse
método não foi ainda estabelecido. Imprints e corte de congelação do gânglio sentinela são
os procedimentos comummente utilizados, apesar de uma sensibilidade e especificidade
inferior à desejada. Actualmente, novas técnicas estão a ser desenvolvidas, que apesar da
sua optimização, ainda não ultrapassam os resultados das utilizadas.
Um total de 138 mulheres com cancro da mama, submetidas a cirurgia mamária por
abordagem conservadora da axila, cuja utilização de imprints e cortes de congelação foram
os métodos de avaliação intraoperatória do gânglio sentinela. Os diagnósticos dados pela
observação dos cortes dos fragmentos do exame extemporâneo foram comparados com os
obtidos nos cortes histológicos definitivos dos fragmentos fixados em formol e incluídos
em parafina. Os resultados obtidos da avaliação do exame extemporâneo demonstraram
sensibilidade de 79,1%, especificidade de 96,9%, com uma precisão de 91,4%. Não se
obteve correlação entre os resultados do extemporâneo e os parâmetros de caracterização
do exame extemporâneo e tumores.
Os métodos, imprints e cortes de congelação, actualmente utilizados na nossa
instituição apresentam bons resultados, mas a adopção de apenas um ou outro necessita de
uma análise mais aprofundada dos dados relativos à metodologia utilizada nos
extemporâneos, de forma a verificar a especificidade e sensibilidade individualizadas dos
imprints e dos cortes de congelação. Se os imprints se revelarem semelhantes aos cortes de
congelação, a sua utilização é preferencial uma vez que acarreta menores custos e são
menos morosos. A implementação de novas técnicas será uma metodologia adoptar, pelos
benefícios acrescidos, porém mais estudos e a optimização
Maximization of the potential of conservative axillary surgical approach to breast cancer, as a minimally invasive method for the evaluation of axillary metastasis and in order to reduce the morbidity associated with complete axillary dissection requires a method to evaluate intraoperative pathological need. This method has not been established yet. Imprints and frozen section of sentinel node are commonly used procedures, although sensitivity and specificity are less than desirable. Currently, new techniques are being developed, which despite its optimization, the results do not overcome those which are currently used. An amount of 138 women with breast cancer undergone to conservative breast surgery in the armpit conservation approach, whose use of imprints and frozen sections were the methods of intraoperative assessment of sentinel node. The extemporaneous diagnoses were compared to those of permanent histological cuts. The results of sentinel lymph node evaluation shown an sensibility of 79,1%, specificity of 96,9% and an accuracy de 91,4%. It was not shown relation between sentinel lymph node results and the tumors characteristics. The methods, imprints and frozen sections, currently used at our institution had good results, but the adoption of only one requires a deeper analysis of data concerning the methodology used in the extemporaneous, to verify the individual specificity and sensitivity of imprints and frozen sections. If imprints prove similar to frozen sections, its use is preferred since it entails lower costs and less time consuming. The implementation of new techniques is a methodology to be adopted by the added benefits, but further studies and optimization of these techniques are necessary in order to overcome the limitations that still exist.
Maximization of the potential of conservative axillary surgical approach to breast cancer, as a minimally invasive method for the evaluation of axillary metastasis and in order to reduce the morbidity associated with complete axillary dissection requires a method to evaluate intraoperative pathological need. This method has not been established yet. Imprints and frozen section of sentinel node are commonly used procedures, although sensitivity and specificity are less than desirable. Currently, new techniques are being developed, which despite its optimization, the results do not overcome those which are currently used. An amount of 138 women with breast cancer undergone to conservative breast surgery in the armpit conservation approach, whose use of imprints and frozen sections were the methods of intraoperative assessment of sentinel node. The extemporaneous diagnoses were compared to those of permanent histological cuts. The results of sentinel lymph node evaluation shown an sensibility of 79,1%, specificity of 96,9% and an accuracy de 91,4%. It was not shown relation between sentinel lymph node results and the tumors characteristics. The methods, imprints and frozen sections, currently used at our institution had good results, but the adoption of only one requires a deeper analysis of data concerning the methodology used in the extemporaneous, to verify the individual specificity and sensitivity of imprints and frozen sections. If imprints prove similar to frozen sections, its use is preferred since it entails lower costs and less time consuming. The implementation of new techniques is a methodology to be adopted by the added benefits, but further studies and optimization of these techniques are necessary in order to overcome the limitations that still exist.
Description
Keywords
Cancro da mama Gânglio sentinela Exame extemporâneo Cortes de congelação Imprints Breast cancer Sentinel node Intraoperative Frozen sections
Citation
Publisher
Instituto Politécnico do Porto. Escola Superior de Tecnologia da Saúde do Porto