| Abstract | Cilj istraživanja. Željeli smo istražiti koja je metoda povoljnija (uspješnija) pri odstranjenju okultnih lezija dojke – intraoperativno ultrazvučno lociranje okultnih lezija ili lociranje okultnih lezija radioaktivnim navođenjem. Istodobno, proučavali smo poštednost prema zdravom tkivu dojke.
Ustroj istraživanja. Uspoređene su dvije dijagnostičko-terapijske metode: intraoperativno ultrazvučno lociranje okultnih lezija (prema engl. intraoperative ultrasound occult lesion localization) i ROLL – lociranje okultnih lezija radioaktivnim navođenjem (prema engl. radioguided occult lesion localization).
Mjesto istraživanja. Istraživanje je provedeno na povijestima bolesti iz pismohrane Klinike za kirurgiju Kliničkog bolničkog centra Split; Split; Hrvatska.
Pacijenti i postupci. Studija je provedena na 66 pacijentica (srednja dob 60.8 godina, SD ± 10.24) s okultnim tumorima dojke (tumori <12mm). Uz mentorovu pomod, analizirao sam i obradio podatke iz povijesti bolesti dobivenih uvidom u dokumentaciju pismohrane Klinike za kirurgiju Kliničkog bolničkog centra Split. U sklopu prijeoperacijske obrade sve su ispitanice obrađene klinički, laboratorijski, radiološki (ultrazvuk i/ili mamografija) i citološki. Ultrazvučni uređaj koji je bio korišten u našoj studiji je Toshiba sddr model (Toshiba Nemio, Tokyo, Japan) s longitudinalnom sondom frekvencije 7.5 MHz. Kao radiomarker korišten je radioaktivni izotop tehnecija 99 (Tc99m) koji je u količini od 2 MBq ispitanicama apliciran u rasponu od 4 do 8 sati prije zahvata. Njegovu smo radioaktivnost potom detektirali s pomodu ručne gama-sonde. Intraoperacijskim ultrazvukom navođenu biopsiju (IUSOLL) nadopunili bismo ekscizijom okolnoga ostatnog tkiva koje je radioaktivnošdu mjerilo do 30% od najviše izmjerene radioaktivnosti. Mjerenja volumena odstranjene lezije u odnosu na volumen i masu ukupno odstranjenog tkiva postupci su kojima smo objektivizirali rezultate.
Rezultati. Najvedi promjer okultne lezije određivan je u skladu s patohistološkim nalazom. Promjer najmanje okultne lezije u našoj studiji iznosio je 4 mm, dok je promjer najvede bio 12 mm. Prosječna masa tkiva dojke odstranjenog primjenom intraoperacijskog ultrazvuka je 31 g (23-39, ± 5,01). Kada smo biopsiju vođenu intraoperacijskim ultrazvukom nadopunili evakuacijom radioaktivnim tehnecijem (Tc-99m) u količini od 2 MBq obilježenog tkiva prosječna masa bioptičkog uzorka popela se na 45 g (36-54, ± 5,46) (m(ROLL) = 45 g : m(IUSOLL) = 31 g). Taj je rezultat statistički značajan (P<0.001). Uzorak odstranjem pri metodi IUSOLL bio je prosječno za 32% lakši od uzorka uzetog metodom ROLL. Slični podatci su dobiveni i za vrijednosti volumena uzetog tkiva. Uspješnost biopsije primjenom metode IUSOLL u našem je istraživanju apsolutna (100 %), tj. u svih 66 ispitanica okultna lezija je uspješno locirana i ekscidirana.
Zaključak. Svi analizirani parametri daju statistički značajnu prednost korištenju metode IUSOLL, zbog poštednosti zdravog tkiva dojke te zbog boljeg onkološkog i estetskog ishoda. Primjenjiva je u detekciji i odstranjivanju zlodudnih i dobrodudnih tumora. |
| Abstract (english) | Objective. The aim of our study was to compare the effectiveness of non-palpable breast lesion biopsy using intaoperative ultrasound in relation to biopsy cited radioactive technetium. Besides the success of the removal of occult lesions, the two methods we compared delt with the conservation of healthy breast tissue, so we compared the volume of the removed lesions in relation to the total volume and weight of the removed tissue.
Design. We compared the two diagnostic and therapeutic methods: intraoperative ultrasound occult lesion localization (IUSOLL) and radioactive occult lesion indicating (ROLL).
Settings. The study was conducted on the medical histories from the archives of the Surgical Clinic, Clinical Hospital Center Split; Split; Croatia.
Patients and methods. The study was conducted on 66 patients (average age 60.8 years, SD ± 10.24) with occult breast tumors (tumors <12 mm). With the mentor's supervision, I reviewed and analyzed data from the medical histories obtained by examining archives of the Surgical Clinic, Clinical Hospital Centre Split. In the preoperative treatment of all patients, they were treated with clinical methods, laboratory, radiology (ultrasound and / or mammography) and cytology. The ultrasonic device that was used in our study is the Toshiba sddr model (Toshiba Nemio, Tokyo, Japan) with longitudinal frequencies 7.5 MHz probe. As a radiomarker we used a radioactive isotope of technetium 99 (Tc99m) to a quantity of 2 MBq injected into the patients ranging from 4 to 8 hours before surgery. Its radioactivity was then detected using a handheld gamma probe. Guided by inoperative ultrasound biopsies, (IUSOLL) we complemented with excision of surrounding residual tissue which had radioactivity measured up to 30% of the maximum measured radioactivity.
Result. The largest diameter of occult lesions was determined in accordance with the histopathological findings. The diameter of the least occult lesions in our study was 4 mm, while the largest was 12 mm. Analyzing the mass and volume of excised breast tissue using a ROLL or IUSOLL biopsy method, we obtained the following results: The average weight of breast tissue removed by applying IUSOLL was 31 g (23-39, ± 5,01). The biopsy, guided by the intraoperative ultrasound, was supplemented by evacuation using a radioactive technetium (Tc-99m) in quantities of 2 MBq. Then the average mass of tissue biopsy sample rises to 45 g (36-54, ± 5,46) (m (ROLL) = 45g: m (IUSOLL) = 31g). The obtained result is statistically significant (P <0.001). Samples taken at the average method IUSOLL were 32% lighter than an average sample taken from the ROLL method. Similar data were obtained for the values of the volume of taken tissue. The success of the biopsy method IUSOLL in our study was absolute (100%), i.e., occult lesions in all 66 patients were successfully located and excised.
Conclusion. All analyzed parameters give statistically significant advantage of using method IUSOLL due to conservation of the healthy breast tissue, and due to improved oncologic and esthetic outcomes. Because of the absolute diagnostic-therapeutic effect, this method is applicable in both malignant and benign tumors with the same intensity of validity. |
