Hidir KİLİNC, Bilge Turk BİLEN, Omer ELMAS

Radiological and Histopathological Evaluation in Reduction Mammoplasty

Amaç: Mammografi ve Ultrasonografi (USG), redüksiyon mammoplasti öncesinde asemptomatik lezyonların tespit edilmesinde yardımcı tanı yöntemleridir. Ancak preoperatif radyolojik değerlendirme her zaman kesin sonuçlar vermemektedir. Bu nedenle premalign lezyonların veya sessiz kanser odaklarının tanısı amacıyla, preoperatif radyolojik inceleme ve postoperatif histopatolojik değerlendirme birlikte kullanıldı. Gereç ve Yöntemler: Kliniğimizde, 2007-2011 yılları arasında 135 hastada radüksiyon mammoplasti ameliyatı yapıldı. Hastaların yaşları 18 ile 67 arasında değişmekteydi (ortalama 44,6 yıl). Operasyondan önce tüm hastalarda USG ve 40 yaş üstündeki hastalarda ek olarak mammografi yapıldı. Çıkarılan tüm doku örnekleri histopatolojik olarak incelendi. Bulgular: Preoperatif olarak yapılan radyolojik incelemede; 96 hastada (%71,1) USG sonuçları normal olarak değerlendirildi. %8,1 Fibrokistik değişiklik, %0,7 lipoma, %4,4 fibroadenoma, %2,9 benign lenf nodu olduğu tespit edildi. Histopatolojik olarak yapılan incelemede; %7 hafif-orta epitelyal hiperplazi, %4,8 ağır epitelyal hiperplazi, %25,9 fibrokistik değişiklik, %16,2 fibrozis, %9,6 yağdan zengin meme dokusu, %7,7 apokrin metaplazi, %4,4 duktal ektazi, %3,7 fokal adenozis, %4,4 hafif-orta dereceli duktal hiperplazi, %3,7 fibroadenoma ve %12,2 normal meme dokusu olarak değerlendirildi. Sonuç: Bu çalışmada, meme dokusu örneklerinde %87,6 oranında non-proliferatif benign değişiklikler olduğu görüldü. Premalign veya malign lezyona rastlanmadı. Bu sonuçlar, preoperatif radyolojik değerlendirme ve postoperatif histopatolojik incelemenin, memenin benign, premalign veya sessiz malign lezyonlarının tanısındaki önemini göstermesi açısından anlamlı bulundu.

Redüksiyon Mammoplastide Radyolojik ve Histopatolojik Değerlendirme

Aim: Mammography and ultrasonography are helpful diagnostic methods for the detection of asymptomatic lesions prior to reduction mammoplasty operations. Preoperative radiological evaluation does not give accurate results all time. Consequently, preoperative radilological and postoperative histopathologic evaluation were used together in order to diagnose the premalignant and silent cancer foci. Material and Methods: In our clinic, 135 patients underwent reduction mammoplasty operation between 2007 and 2011. The age of the patients ranged from 18 to 67 (mean 44.6). Ultrasonography was performed for all the patients and mammography was performed additionally for the ones older than 40 years of age. The excised tissue samples were sent for histopathologic evaluation. Results: Preoperative radiologic evaluation, USG results were assessed as normal in 96 patients (71,1%) and, of the patients, % 8,1 had fibrocystic changes, 0,7% had lipoma, 4.4% had fibroadenoma and 2,9% had benign lymph node. In the histopathologic evaluation, 7% had mild epithelial hyperplasia, 4,8% had severe epithelial hyperplasia, 25,9% had fibrocystic changes, 16.2% had fibrosis, 9,6% had fatty breast tissue, 7,7% had apocrine metaplasia, 4,4% had ductal ectasia, 3,7% had focal adenosis, 4,4% had mild ductal hyperplasia, 3,7% had fibroadenoma and 12,2% had normal breast tissue. Conclusion: In this study, non-proliferative benign changes were seen in the 87,6% of the breast tissue samples. No premalignant or malignant lesions were detected. These results revealed that preoperative radiologic evaluation and postoperative histopathologic analysis were significant in terms of diagnosis of benign, premalignant or silent malignant lesions of the breast.

PDF

___

Clancy J. Clark, Susan Whang, Keith T. Paige. Incidence of precancerous lesions in breast reduction tissue: A pathologic review of 562. Plast Reconstr Surg 2009;124:1033.
Boice JD, Friis S, McLaughlin JK, et al. Cancer following breast reduction surgery in Denmark. Cancer Causes Control 1997;8:253-58.
Tang CL, Brown MH, Levine R, Sloan M, Chong N, Holowaty E. A follow-up study of 105 women with breast cancer following reduction mammaplasty. Plast Reconstr Surg 1999;103:1687-90.
Carter CL, Corle DK, Micozzi MS, Schatzkin A, Taylor PR. A prospective study of the development of breast cancer in 16,692 women with benign breast disease. Am J Epidemiol 1988;128:467-77.
Robbins, S. L. Pathologic Basis of Diseases, 4th Ed. Philadelphia: Saunders, 1989:1181-201.
Silverstein, M. J., Sartorious, W., and Zarem, H. A. Pathology of the breast for plastic and reconstruction surgeons. In R. M. Goldwyn (Ed.), Plastic and Reconstruction Surgery of the Breast, 1st Ed. Boston: Little, Brown, 1976:59-81.
Ahmed HG, Ali AS, Almobarak AO. Frequency of breast cancer among sudanese patients with breast palpable lumps. Indian J Cancer 2010;47:23-6.
Pitanguy, I., and Torres, E. Histopathological aspects of mammary gland tissue in cases of plastic surgery of breast. Br J Plast Surg 1964;17:297.
Pitanguy, I, Torres, E., and Zelicovich, R. Histopathological aspects of mammary gland tissue in cases of plastic surgery of breast. Br J Plast Surg 1964;17:297.
Bodian CA, Perzin KH, Lattes R, Hoffmann P, Abernathy TG. Prognostic significance of benign proliferative breast disease. Cancer 1993;71:3896-907.
Shannon J., King J.B., Lampe J.W., Gao D.L., Ray R.M, Lin M.G, Stalsberg H., Thomas D.B. Erythrocyte fatty acids and risk of proliferative and nonproliferative fibrocystic disease in women in Shanghai, China. Am J Clin Nutr 2009;89:265-76.
Wells CA, El-Ayat GA. Non-operative breast pathology: apocrine lesions. J Clin Pathol 2007;60:1313-20.
Wilson, R. W. Perspectives from a surgical oncologist: The history of breast cancer. In R. M. Goldwyn (Ed.), Plastic and Reconstruction Surgery of the Breast, 1st Ed. Boston: Little, Brown, 1976:431-40.
Silverstein, M. J, Sartorious, W, and Zarem, H. A. Pathology of the breast for plastic and reconstruction surgeons. In R. M. Goldwyn (Ed.), Plastic and Reconstruction Surgery of the Breast, 1st Ed. Boston: Little, Brown, 1976:59-81.
Andersen, J. A. Lobular carcinoma in situ: An approach to rational treatment. Cancer 1977;39:2597.
Dinner, M. I., and Artz, J. S. Carcinoma of the breast occurring in routine reduction mammaplasty. Plast Reconstr Surg 1989;83:1042-4.
Robbins, S. L. Pathologic Basis of Diseases, 4th Ed. Philadelphia: Saunders, 1989:1181-201.
Petit JY, Rietjens M, Contesso G, Bertin F, Gilles R. Contralateral mastoplasty for breast reconstruction: A good opportunity for glandular exploration and occult carcinomas diagnosis. Ann Surg Oncol 1997;4:511-5.
Miller CL, Feig SA, Fox JW. Mammographic changes after reduction mammoplasty. AJR Am J Roentgenol 1987;149:35-8.
Clark C.J., Susan Whang S., Paige K.T. Incidence of precancerous lesions in breast reduction tissue: A pathologic review of 562 consecutive patients. Plast Reconstr Surg 2009;124:1033-9.