RESUMO
BACKGROUND: Breast cancer surgery has evolved towards minimizing morbidity, maximizing cure rates and stratifying treatments according to disease stage. Sentinel lymph node biopsy is becoming standard practice in most centres. However, no standard radiopharmaceutical exists. OBJECTIVES: To blindly compare 99mTc dextran 500 and 99mTc phytate in the scintigraphic detection of sentinel lymph nodes. Endpoints were the detection of axillary or internal mammary lymph nodes, number of lymph nodes detected, detectability in the first versus the second hour of evaluation and the relationship between rate of detection and age or body mass index. METHODS: Forty-six patients with histological diagnosis of early breast cancer, without previous surgical treatment, were enrolled in our study. Each patient underwent lymphoscintigraphy twice: on one day with 99mTc dextran 500 and on another day with 99mTc phytate. Images were acquired 1 h and 2 h after tracer administration. RESULTS: Eighty-eight lymphoscintigraphic studies were performed in 44 patients. On the first image (taken at 1 h), 34 patients from the 99mTc dextran group showed sentinel nodes compared with 28 positive examinations using 99mTc phytate (P = 0.113). On the second image (taken at 2 h) 39 patients from the 99mTc dextran group showed positive results compared to 30 positive examinations using 99mTc phytate (P = 0.036). There was no statistically significant correlation between the body mass index or age and the result of the lymphoscintigraphy. CONCLUSION: 99mTc dextran 500 is better than 99mTc phytate for use in a 2 h interval scintigraphic protocol because it demonstrates the sentinel node in a significantly higher number of patients and also showed more lymph nodes suitable for pathological examination.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Dextranos/farmacologia , Ácido Fítico/farmacologia , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela/métodos , Tecnécio/farmacologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Mama/patologia , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Apresentamos a experiencia de 21 anos no Servico de Mastologia da Santa Casa de Misericordia de Porto Alegre (Enfermaria 22), referente a patologia mamaria. Foi analisado o total de 28 casos de pacientes com Cystosarcoma Phyllodes (CP) nos quais se avaliaram os seguintes parametros: idade, tempo medio de evolucao da doenca, tamanho tumoral, manejo cirurgico, recidiva tumoral e mortalidade. Ocorreram l4% de CP maligno (CPM) (4 casos) com a idade media de 44,5 anos. Os pacientes com CP benignos (CPB) (24 casos) apresentaram idade media de 39,1 anos. O tamanho do tumor variou entre 1,5 a 30 cm. Os 4 casosde CPM mediam mais de 5 cm, e 12 dos 28 casos tinham tamanho maior que 10 cm. Ocorreram 25% de recidivas locais na dependencia da cirurgia que nao incluia a extirpacao local com margens livres em volta do tumor. A expectativa de metastases no CP esta em torno de 10%, porem e muito mais elevada se considerados so os casos de CPM. Ocorreu metastase pulmonar em duas pacientes com CPM e uma delas se encontra clinicamente bem, um ano apos a cirurgia (lobectomia).