Taner YİĞİT, Ünsal COŞKUN, Mentes Oner, Cengizhan YİĞİTLER, Güleç BÜLENT, Müjdat BALKAN, Orhan KOZAK, Tufan TURGUT

The role of contrasted dynamic multi-detector computerized tomography imaging on surgical decision making in breast cancer

Giriş: Meme kanserinin cerrahi tedavisinin başarısı temel olarak hastalık tekrarının önlenmesi prensibine dayanmaktadır. Günümüzde manyetik rezonans görüntüleme meme kanserinin tanısında yoğun olarak kullanılmaktadır. Buna karşın kapalı alan korkusu olan hastalara bu tetkikin uygulanmasında güçlükler ve kolay ulaşılabilirliğin kısıtlı olması manyetik rezonans görüntülemenin uygulanabilirliğinin sınırlamaları olarak karşımıza çıkmaktadır. Bu çalışmada bölgesel hastalık tekrarı gelişiminde önemli etkenlerden olan tümörün çevre yapılarla olan ilişkisi ve uydu tümör odaklarının varlığının incelenmesinde kontrastlı dinamik çok detektörlü tomografinin manyetik rezonans görüntülemeye alternatif olarak kullanılabilirliğini araştırdık. Materyal-metod: 18 aylık dönem içinde meme kanseri tanısı konmuş ve meme koruyucu cerrahi planlanan toplam 30 hastaya kontrastlı dinamik çok detektörlü tomografi uygulandı. Sonuçlar: İki hastada (10%) tümörün pektoral kas kılıfına çok yakın sonlandığı, üç hastada (15%) uydu tümör odağı varlığı tespit edildi. Bu hastaların birinde ise uydu tümör odağına ilave olarak pektoral kas kılıfına yakın sonlanma tespit edildi. Hastaların dördüne de aydınlatılmış onamları alınarak meme koruyucu cerrahi yerine modifiye radikal mastektomi ameliyatı uygulandı. Tartışma: Kontrastlı dinamik çok detektörlü tomografi, seçilmiş vakalarda manyetik rezonans görüntülemeye iyi bir alternatiftir. Kontrastlı dinamik çok detektörlü tomografi ile ana tümörün pektoral kas kılıfına ile olan ilişkisi ve uydu tümör odakları hakkında yararlı veriler elde edilebilmektedir.

Meme kanserli hastalarda cerrahi tedavinin pşanlanmasında konstraslı dinamik multi-dedektör tomografi görüntülemenin rolü

Background:. The success of surgical treatment of breast carcinoma depends mainly on prevention of local recurrence. Nowadays magnetic resonance imaging is being intensively used for the diagnosis of breast lesions. In this study we investigated the effect of the multi-detector computed tomography as an alternative to magnetic resonance in the evaluation of satellite breast cancer and the relation of the tumor margins with surrounding tissue, which plays an important role in local recurrence. Methods: In an 18 months' period 30 patients with breast cancer, for whom a breast-conserving surgery was planned, were given a multi-detector computed tomography in the preoperative period. Results: In two (10%) patients a very close correlation between the tumor and pectoral fascia was found; in three (15%) patients a satellite tumor focus was detected. It was also reported that one of these patients had both satellite lesions and a primary tumor-pectoral fascia connection. Four patients received a modified radical mastectomy in accordance with their informed consent. Conclusion: multi-detector computed tomography is a good alternative for magnetic resonance imaging in some cases and provides useful data in the determination of satellite tumor focus and the relation of the primary tumor to the pectoral fascia.

PDF

___

1) Alberg AJ, Visvanathan K, Helzisouer K.J. Epidemiology, prevention, and early detection of breast cancer. Curr Opin Oncol 1998; 10: 492-497.
2) Espie M. Treatment of breast cancer. Presse Med 1998; 27: 1332-5.
3) Gairard B, Mathelin C, Schaffer P, Brettes JP. Breast cancer: epidemiology, risk factors, screening. Rev Prat 1998; 48: 21-27
4) Mettlin C, Smart CR. Breast cancer detection guidelines for women aged 40 to 49 years: rationale for the American Cancer Society reaffirmation of recommendations. American Cancer Society. CA Cancer J Clin 1994; 44: 248-255
5) Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996; 14: 1558-1564.
6) Blichert-Toft M, Rose C, Andersen JA, Overgaard M, Axelsson CK, Andersen KW, Mouridsen HT. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr 1992; 11: 19-25
7) Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med 1995; 333: 1444-1445
8) Borger J, Kemperman H, Hart A, Peterse H, van Dongen J, Bartelink H. Risk factors in breast-conservation therapy. J Clin Oncol 1994;12: 653-60
9) Soran A, Vogel V. Optimal Management of Primary Breast Cancer. Breast J 1999; 5: 81-93
10) Vezeridis MP, Bland KI. Surgical and medical management of in situ and early stage breast carcinoma. In: Singletary SE, ed. Breast cancer. New York: Springer, 1999: 132-148
11) Kurtz JM, Jacquemier J, Torhorst J, et al. Conservation therapy for breast cancers other than infiltrating ductal carcinoma. Cancer 1989; 63: 1630-5
12) Dalberg K, Mattsson A, Rutqvist LE, Johansson U, Riddez L, Sandelin K. Breast conserving surgery for invasive breast cancer: risk factors for ipsilateral breast tumor recurrences. Breast Cancer Res Treat 1997; 43: 73-86
13) Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333: 1456-1461
14) Veronesi U, Luini A, Galimberti V, Zurrida S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg 1994; 18: 70-75
15) McKee MD, Cropp MD, Hyland A, Watroba N, McKinley B, Edge SB. Provider case volume and outcome in the evaluation and treatment of patients with mammogram-detected breast carcinoma. Cancer 2002; 95:704-712
16) Wolmark N, Wang J, Mamounas E, Bryant J, Fisher B. Preoperative chemotherapy in patients with operable breast cancer: nine-year results from National Surgical Adjuvant Breast and Bowel Project B-18. J Natl Cancer Inst Monogr 2001;30:96-102
17) Meric-Bernstam F. Breast conservation in breast cancer: surgical and adjuvant considerations. Curr Op Obst Gynecol 2004;16:31-36
18) Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK. MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. Am J. Roentgenol 2003; 180:901-910
19) Edeiken S. Mammography in the symptomatic woman. Cancer 1989;63:1412-1414.
20) Jackson VP. What is the role of sonographic breast imaging for detecting occult cancer in a patient with a strong family history of breast cancer and mammographically dense breasts without obvious masses? AJR American Journal of Roentgenology 1995; 165:1004
21) Noguchi S, Koyama H, Kasugai T, et al. A case-control study on risk factors for local recurrences or distant metastases in breast cancer patients treated with breast-conserving surgery. Oncology 1997:54:468-474
22) Smitt MC, Nowels KW, Zdeblick MJ. The importance of the lumpectomy surgical margins status in long term results of breast conservation. Cancer 1995; 76:259-261
23) Solin LJ, Fowble BL, Schultz DJ, et al. The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer. Int J Radiat Oncol Biol Phys 1991; 21: 279-287
24) Spivack B, Khanna MM, Tafra L, et al. Margin status and local recurrence after breast-conserving surgery. Arch Surg 1994; 129: 952-957.
25) Schmidt-Ullrich R, Wazer DE, Tercilla O, et al. Tumor margin assessment as a guide to optimal conservation surgery and irradiation in early stage breast carcinoma. Int J Radiat Oncol Biol Phys. 1989;17:733-8
26) Mokbel K, Ahmed M, Nash A, Sacks N. Re-excision in non-palpable breast cancer, J Surg Oncol. 1995;58:225-228
27) Silverstein MJ. Ductal carcinoma in situ of the breast: controversial issues. Oncologist, 1998;3:94-103
28) Veronesi U, Luini A, Del Vecchio M, et al. Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med. 1993;328:1587-1591
29) Heywang SH, Wolf A, Pruss E. MRI of the breast with Gd-DTPA: use and limitations. Radiology 1989;171:95-103
30) Heywang-Kobrunner SH, Beck R. Contrast-enhanced MRI of the breast. 2nd ed. Berlin: Springer-Verlag, 1995
31) Kaiser WA, Hahn D. Multifocality of breast cancer detected with dynamic MR mammography. In: Abstracts book 8th European Congress of Radiology. Berlin: Springer International, 1993:152.
32) Melani E, Sardanelli F, Ottonello C. Magnetic resonance mammography in suspected tumor recurrences. Radiol Med 1995;3:219-224
33) Sardanelli F, Calabrese M, Zandrino F, et al. Dynamic helical CT of breast tumors. J Comput Assist Tomogr 1998;22:398-407
34) Van Gelderen WF. Computed tomography of the breast: a valuable adjunct to mammography in selected cases. Australas Radiol. 1995;39:176-178
35) Spillane RM, Whitman GJ, Me Carthy KA, Hulka CA, Hall DA, Kopans DB. Computed tomography-guided needle localization of nonpalpable breast lesions: review of 24 cases. Acad Radiol 1996;3:115-120
36) Evans SH, Davis R, Cooke J, Anderson W. A comparison of radiation doses to the breast in computed tomographic chest examinations for two scanning protocols. Clin Radiol 1989;40:45-46
37) Boone JM, Nelson TR, Lindfors KK, Seibert JA. Dedicated breast CT:radiation dose and image quality evaluation; Radiology.2001 Dec;221(3) :657-667