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Meme Koruyucu Cerrahide İntraoperatif Ultrason ve Frozen Patoloji Kullanımının Güvenli Cerrahi Sınır Üzerindeki Etkinliği

Year 2023, Volume: 20 Issue: 2, 352 - 356, 31.08.2023
https://doi.org/10.35440/hutfd.1297280

Abstract

Amaç: Meme kanseri 40 yaş üstü kadınlarda en sık görülen kanserdir. Yaşam boyu risk %12 civarındadır. Günümüzde tarama programları sayesinde meme kanseri hastalarına erken tanı konulmakta ve bu sayede ölüm oranları %25-30 civarına düşmektedir. Meme Koruyucu Cerrahi'de cerrahi sınırların pozitifliği veya yakınlığı %5-60 arasında değişmektedir. İleride tekrar meme kanseri oluşmasını önlemek, tekrarlayan ameliyatları önlemek ve ek tedavilerin önüne geçmek için cerrahi sınırların negatifliği çok önemlidir.
Bu çalışmada Meme Koruyucu Cerrahi ile tedavi edilen meme kanserlerinde intraoperatif ultrasonografi ve frozen kesit kullanımının güvenli cerrahi sınır elde etmede ve postoperatif kozmetik açıdan etkinliğini araştırmayı amaçladık.
Materyal ve Metod: Bu çalışma, Ocak 2015 ile Ocak 2019 tarihleri arasında meme kanseri tanısı alan ve Meme Koruyucu Cerrahi ile tedavi edilen 150 hastayı içermektedir. Memelerde uzak metastaz varlığı ve multifokal ya da santral yerleşimli tümör tutulumu araştırıldı. Tüm hastalarda tümörün lokalizasyonu preoperatif ultrasonografi ile anatomik olarak işaretlendi. Tümör tamamen eksize edildi ve altta yatan kas fasyası da dahil olmak üzere ameliyat öncesi işaretli alanda deri de dahil olmak üzere tümörün çevresinde en az 1 cm sağlam doku bırakıldı. Medial ve superior sınırlar ip ile işaretlendi. Eksize edilen bu doku bloğu intraoperatif ultrasonografi ile incelendi.
Bulgular: Hastaların yaş ortalaması 48,3± 9,7 idi. Tümör hastaların 83 (%55,3)'ünde sağ memede yerleşirken, 67 (%44,7) hastada sol memede yerleşmişti. Tümör 67 (%44,7) hastada üst dış kadranda, 53 (%35,3) hastada üst iç kadranda, 30 (%20) hastada alt dış kadranda yerleşmişti. Hastaların 21'ine (%14) sentinel lenf nodu pozitifliği nedeniyle aksiller diseksiyon uygulandı. Histolojik tiplendirmede 141 (%94) hasta duktal karsinom ve 9 (%6) hasta lobüler karsinomdu.
Sonuç: Çalışmamız ve literatür taraması sonucunda intraoperatif ultrasonografi ile birlikte frozen incelemenin Meme Koruyucu Cerrahi'de güvenli cerrahi sınırı belirlemede basit, kolay uygulanabilir ve kozmetik açıdan iyi bir yöntem olduğunu düşünüyoruz.

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References

  • 1. Shah C, Al-Hilli Z, Schwarz G. Oncoplastic Surgery in Breast Cancer: Don’t forget the Boost. Ann Surg Oncol. 2018; 25: 2509-11.
  • 2. Fisher B, Anderson S, Bryant J, Margolese R.G, Deutsch M, Fisher E.R et al. Twenty-year follow-up of a randomi-zed trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233–1241.
  • 3. Xin Hu, Si Li, Yi Jiang, Wei W, Ji Y, Li Q et.al. Intraoperative ultrasoundguided lumpectomy versus wire-guided exci-sion for nonpalpable breast cancer. Journal of Internatio-nal Medical Research 2020; 48(1) 1-12.
  • 4. Pleijhuis R G, Graafland M, de Vries J, Bart J, de Jong J.S, van Dam G.M. Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions. Ann Surg Oncol. 2009;16:2717–2730.
  • 5. Lovrics PJ, Cornacchi SD, Vora R, Goldsmith CH, Kahnamoui K. Systematic review of radioguided Surgery for non-palpable breast cancer. Eur J Surg Oncol 2011; 37: 388–397.
  • 6. Wang PS, Wang R, Shen J, X T Gao X.T, Zhou J. Clinical analysis of 137 cases of ultrasound-guided positioning for resection of non-palpable breast masses. Eur J Gynaecol Oncol 2016;37: 388–390.
  • 7. Haloua MH, Krekel NM, Coupe VM, Bosmans JE, Lopes Cardozo AM, Meijer S. et al. Ultrasound-guided surgery for palpable breast cancer is cost-saving: results of a cost-benefit analysis. Breast. 2013;22:238–43.
  • 8. Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5:257–61.
  • 9. Kaufmann M, Morrow M, von Minckwitz G, Harris J.R. Locoregional treatment of primary breast cancer: consen-sus recommendations from an international expert panel. Cancer 2010; 116: 1184–1191.
  • 10. Morrow M. Trends in the surgical treatment of breast cancer. Breast J 2010; 16 (Suppl. 1): S17–19.
  • 11. Eggemann H, Ignatov T, Beni A, Costa S.D, Ortmann O, Ignatov A. Intraoperative Ultrasound in the Treatment of Breast Cancer. Geburtsh Frauenheilk 2013; 73: 1028–1034.
  • 12. Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US – diag-nostic yield and tumor characteristics. Radiology 1998; 207: 191–199.
  • 13. Schwartz GF, Goldberg BB, Rifkin MD, D’Orazio SE. Ultra-sonography: an alternative to x-ray-guided needle localiza-tion of nonpalpable breast masses. Surgery 1988; 104: 870–873.
  • 14. Krekel NM, Haloua MH, Lopes Cardozo AM, de Wit RH, Bosch AM, de Widt-Levert LM, et al. Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial. Lancet Oncol 2013; 14: 48–54.
  • 15. Max H. Haloua, Jose´ H. Volders, Krekel NM Cardozo AMFL, de Roos WK, de Widt-Levert LM. et.al. Intraopera-tive Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Re-sults of a Multicenter Randomized Controlled Trial (CO-BALT). Ann Surg Oncol (2016) 23:30–37.
  • 16. Hill-Kayser CE, Chacko D, Hwang WT, Vapiwala N, Solin LJ. Long-term clinical and cosmetic outcomes after breast conservation treatment for women with early-stage bre-ast carcinoma according to the type of breast boost. Int J Radiat Oncol Biol.Phys. 2011;79:1048–54.
  • 17. Hau E, Browne LH, Khanna S, Cail S, Cert G, Chin Y et al. Radiotherapy breast boost with reduced whole-breast do-se is associated with improved cosmesis: the results of a comprehensive assessment from the St. George and Wol-longong randomized breast boost trial. Int J Radiat Oncol Biol Phys. 2012;82:682–689.
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  • 20. Esbona K, Li Z, Wilke LG. Intraoperative imprint citology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Annals of Surgical Oncology. 19(10):3236–3245.
  • 21. Eggemann H, Ignatov T, Costa SD, Ignatov A. Accuracy of ultrasound-guided breast conserving surgery in the de-termination of adequate surgical margins. Breast Cancer Res Treat 2014; 145: 129–136.
  • 22. Olsha O, Shemesh D, Carmon M, Sibirsky O, Dalo R.A, Rivkin L et al. Resection margins in ultrasound guided bre-ast conserving surgery. Ann Surg Oncol 2011; 18: 447–452.
  • 23. Krekel N, Zonderhuis B, Muller S, Bril H, van Slooten H-J, de Klerk E.L et al. Excessive resections in breast conserving surgery: a retrospective multicentre study. Breast J 2011; 17: 602–609
  • 24. Moore MM, Whitney LA, Cerilli L, Imbrie J.Z, Bunch M, Simpson V.B et al. Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg 2001; 233: 761–768
  • 25. Bani MR, Lux MP, Heusinger K, Wenkel E, Magener A, Schulz-Wendtland R et al. Factors correlating with reexci-sion after breast-conserving therapy. Eur J Surg Oncol 2009; 35: 32–37
  • 26. Ko S.S, Chun Y.K, Kang S.S, Hur M.H. The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery. J Bre-ast Cancer. 2017 Jun;20(2):176-182.
  • 27. Osako T, Nishimura R, Nishiyama Y, Okumura Y, Tashima R,Nakano M et al. Efficacy of intraoperative entire-circumferential frozen section analysis of lumpectomy margins during breast-conserving surgery for breast can-cer. Int J Clin Oncol. 2015 Dec;20(6):1093-101.

The Efficacy of Using Intraoperative Ultrasound and Frozen Pathology in Breast Conserving Surgery on Safe Surgical Boundary

Year 2023, Volume: 20 Issue: 2, 352 - 356, 31.08.2023
https://doi.org/10.35440/hutfd.1297280

Abstract

Background: Breast cancer is the most common cancer in women over the age of 40. The lifetime risk is around 12%. Today, breast cancer patients are diagnosed at an early stage thanks to screening programs, and thus mortality has decreased to around 25-30%. The positivity or closeness of surgical margins in breast conserving surgery varies between 5-60%. Negativity of surgical margins is very important to prevent future recurrent breast cancer, to pre-vent recurrent surgeries, and to prevent additional treatments. In this study, we aimed to investigate the efficacy of intraoperative ultrasonography and frozen section use in breast cancers treated with breast conserving surgery in obtaining safe surgical margins and in postoperative cosmetic terms.
Materials and Methods: This study includes 150 patients diagnosed with breast cancer and treated with breast con-serving surgery in between January 2015 and January 2019. The presence of distant metastases and multifocal or centrally located tumor involvement in the breasts were investigated. The localization of the tumor was marked anatomically by preoperative ultrasonography in all patients. The operation was started 15 minutes after the injec-tion. The tumor was completely excised, leaving at least 1 cm of intact tissue around the tumor, including the skin, on the preoperatively marked area, including the underlying muscle fascia. Medial and superior borders were marked with string. This excised tissue block was examined with intraoperative ultrasonography.
Results: The mean age of the patients was 48,3± 9.7 years. While the tumor was located in the right breast in 83 (55.3%) of the patients, it was located in the left breast in 67 (44.7%) patients. The tumor was located in the upper outer quadrant in 67 (44.7%) patients, in the upper inner quadrant in 53 (35.3%) patients, and in the lower outer quadrant in 30 (20%) patients. Axillary dissection was performed in 21 (14 %) of the patients because sentinel lymph node was positive. In histological typing, 141 (94 %) patients were ductal carcinoma and 9 (6 %) patients were lobular carcinoma.
Conclusions: As a result of our study and literature review, we think that frozen examination together with intraope-rative ultrasonography is a simple, easily applicable and cosmetically good method to determine the safe surgical margin in breast conserving surgery.

References

  • 1. Shah C, Al-Hilli Z, Schwarz G. Oncoplastic Surgery in Breast Cancer: Don’t forget the Boost. Ann Surg Oncol. 2018; 25: 2509-11.
  • 2. Fisher B, Anderson S, Bryant J, Margolese R.G, Deutsch M, Fisher E.R et al. Twenty-year follow-up of a randomi-zed trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233–1241.
  • 3. Xin Hu, Si Li, Yi Jiang, Wei W, Ji Y, Li Q et.al. Intraoperative ultrasoundguided lumpectomy versus wire-guided exci-sion for nonpalpable breast cancer. Journal of Internatio-nal Medical Research 2020; 48(1) 1-12.
  • 4. Pleijhuis R G, Graafland M, de Vries J, Bart J, de Jong J.S, van Dam G.M. Obtaining adequate surgical margins in breast-conserving therapy for patients with early-stage breast cancer: current modalities and future directions. Ann Surg Oncol. 2009;16:2717–2730.
  • 5. Lovrics PJ, Cornacchi SD, Vora R, Goldsmith CH, Kahnamoui K. Systematic review of radioguided Surgery for non-palpable breast cancer. Eur J Surg Oncol 2011; 37: 388–397.
  • 6. Wang PS, Wang R, Shen J, X T Gao X.T, Zhou J. Clinical analysis of 137 cases of ultrasound-guided positioning for resection of non-palpable breast masses. Eur J Gynaecol Oncol 2016;37: 388–390.
  • 7. Haloua MH, Krekel NM, Coupe VM, Bosmans JE, Lopes Cardozo AM, Meijer S. et al. Ultrasound-guided surgery for palpable breast cancer is cost-saving: results of a cost-benefit analysis. Breast. 2013;22:238–43.
  • 8. Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5:257–61.
  • 9. Kaufmann M, Morrow M, von Minckwitz G, Harris J.R. Locoregional treatment of primary breast cancer: consen-sus recommendations from an international expert panel. Cancer 2010; 116: 1184–1191.
  • 10. Morrow M. Trends in the surgical treatment of breast cancer. Breast J 2010; 16 (Suppl. 1): S17–19.
  • 11. Eggemann H, Ignatov T, Beni A, Costa S.D, Ortmann O, Ignatov A. Intraoperative Ultrasound in the Treatment of Breast Cancer. Geburtsh Frauenheilk 2013; 73: 1028–1034.
  • 12. Kolb TM, Lichy J, Newhouse JH. Occult cancer in women with dense breasts: detection with screening US – diag-nostic yield and tumor characteristics. Radiology 1998; 207: 191–199.
  • 13. Schwartz GF, Goldberg BB, Rifkin MD, D’Orazio SE. Ultra-sonography: an alternative to x-ray-guided needle localiza-tion of nonpalpable breast masses. Surgery 1988; 104: 870–873.
  • 14. Krekel NM, Haloua MH, Lopes Cardozo AM, de Wit RH, Bosch AM, de Widt-Levert LM, et al. Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial. Lancet Oncol 2013; 14: 48–54.
  • 15. Max H. Haloua, Jose´ H. Volders, Krekel NM Cardozo AMFL, de Roos WK, de Widt-Levert LM. et.al. Intraopera-tive Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Re-sults of a Multicenter Randomized Controlled Trial (CO-BALT). Ann Surg Oncol (2016) 23:30–37.
  • 16. Hill-Kayser CE, Chacko D, Hwang WT, Vapiwala N, Solin LJ. Long-term clinical and cosmetic outcomes after breast conservation treatment for women with early-stage bre-ast carcinoma according to the type of breast boost. Int J Radiat Oncol Biol.Phys. 2011;79:1048–54.
  • 17. Hau E, Browne LH, Khanna S, Cail S, Cert G, Chin Y et al. Radiotherapy breast boost with reduced whole-breast do-se is associated with improved cosmesis: the results of a comprehensive assessment from the St. George and Wol-longong randomized breast boost trial. Int J Radiat Oncol Biol Phys. 2012;82:682–689.
  • 18. Corsi F, Sorrentino L, Bossi D, Sartani A, Foschi D. Preopera-tive Localization and Surgical Margins in Conservative Bre-ast Surgery. International Journal of Surgical Oncology. 2013; 2013: 1-9
  • 19. Bennett IC, Greenslade J, Chiam H. Intraoperative ultraso-und-guided excision of nonpalpable breast lesions. World Journal of Surgery. 2005;29(3):369–374.
  • 20. Esbona K, Li Z, Wilke LG. Intraoperative imprint citology and frozen section pathology for margin assessment in breast conservation surgery: a systematic review. Annals of Surgical Oncology. 19(10):3236–3245.
  • 21. Eggemann H, Ignatov T, Costa SD, Ignatov A. Accuracy of ultrasound-guided breast conserving surgery in the de-termination of adequate surgical margins. Breast Cancer Res Treat 2014; 145: 129–136.
  • 22. Olsha O, Shemesh D, Carmon M, Sibirsky O, Dalo R.A, Rivkin L et al. Resection margins in ultrasound guided bre-ast conserving surgery. Ann Surg Oncol 2011; 18: 447–452.
  • 23. Krekel N, Zonderhuis B, Muller S, Bril H, van Slooten H-J, de Klerk E.L et al. Excessive resections in breast conserving surgery: a retrospective multicentre study. Breast J 2011; 17: 602–609
  • 24. Moore MM, Whitney LA, Cerilli L, Imbrie J.Z, Bunch M, Simpson V.B et al. Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg 2001; 233: 761–768
  • 25. Bani MR, Lux MP, Heusinger K, Wenkel E, Magener A, Schulz-Wendtland R et al. Factors correlating with reexci-sion after breast-conserving therapy. Eur J Surg Oncol 2009; 35: 32–37
  • 26. Ko S.S, Chun Y.K, Kang S.S, Hur M.H. The Usefulness of Intraoperative Circumferential Frozen-Section Analysis of Lumpectomy Margins in Breast-Conserving Surgery. J Bre-ast Cancer. 2017 Jun;20(2):176-182.
  • 27. Osako T, Nishimura R, Nishiyama Y, Okumura Y, Tashima R,Nakano M et al. Efficacy of intraoperative entire-circumferential frozen section analysis of lumpectomy margins during breast-conserving surgery for breast can-cer. Int J Clin Oncol. 2015 Dec;20(6):1093-101.
There are 27 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Abidin Tüzün 0000-0002-4953-6602

Erkan Dalbaşı 0000-0002-4652-1747

Ercan Gedik 0000-0002-5812-6998

Early Pub Date August 18, 2023
Publication Date August 31, 2023
Submission Date May 15, 2023
Acceptance Date June 1, 2023
Published in Issue Year 2023 Volume: 20 Issue: 2

Cite

Vancouver Tüzün A, Dalbaşı E, Gedik E. The Efficacy of Using Intraoperative Ultrasound and Frozen Pathology in Breast Conserving Surgery on Safe Surgical Boundary. Harran Üniversitesi Tıp Fakültesi Dergisi. 2023;20(2):352-6.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty