Radioguided surgery with 99mTc-sestamibi intravenous and magnetic resonance imaging for breast cancer / Cirurgia radioguiada com 99mTc-sestamibi intravenoso e ressonancia nuclear magnetica no cancer de mama

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Aims: To study the use of radioguided surgery with 99mTc-sestamibi, associated with magnetic resonance imaging (MRI), for breast cancer evaluation. For this, we developed two techniques: the first was dominated Radioguided Intraoperative Margins Evaluation (RIME), a technique that uses a radiopharmaceutical agent to distinguish normal and cancer tissue with a probe; the second was termed Magnetic Resonance Imaging and Scintimammography fusion (MRI/SM) to determine the extension of cancer. Thus, this study aims to assess the feasibility of techniques, the ability of RIME to obtain free margins and the ability of MRI/SM to determine the real tumor extension, in comparison to other examinations. Subjects and methods: A descriptive experimental study was carried out on 23 women with invasive ductal breast carcinoma, stages IIA to IIIA, programmed for mastectomy. Two to 10 days before the surgery, the patients were submitted to a scintimammography with 99mTc-sestamibi to localize the tumor and to estimate the optimal time to begin radioguided surgery, through a curve of radiation count per time. On the same day, 20 patients realized a MRI with gadolinium. At the moment of the surgery, the same dose of 99mTc-sestamibi was injected intravenously, after a previously-estimated optimal time a segmentectomy was performed with a probe that determined the resection margins. MRI was used to evaluate the compromising of the skin, deep fascia and the other tumor foci that were included in the segmentectomy, characterizing the RIME. All the patients were then submitted to mastectomy. The segmentectomy and residual breast were histopathologically examined. In parallel, software was developed in visual language to perform the MRI/SM fusion in 20 patients. The intersection area between the MRI and scintimammography was determined as tumor in MRI/SM and the tumor was measured and compared with the measurement in the pathological, MRI, mammography and clinical examination. The Fisher?s exact test, Student?s t-test, Wilcoxon?s test and linear regression were used for statistical analysis. Results: The RIME and MRI/SM techniques were successfully performed in all patients (feasibility of 100%). The principal tumor was removed by RIME and provided histologically-free margins in 19 patients (mean margins, 4.8mm). Additionally, 11 patients were without residual disease after segmentectomy. The mean size of residual carcinoma was 3.6mm and generally located near the tumor bed (<1.5cm in 10 patients). There was no significant association between presence of residual disease and tumor size or margin status. The MRI/SM cancer measurements correlated better with pathology than MRI, mammography and clinical examination in all diameters analyzed. Conclusions: The RIME and MRI/SM techniques are feasible. In general, RIME aids in tumor resection with free margins. MRI/SM seems to be better than MRI, mammography and clinical examination to determine the tumoral extension

ASSUNTO(S)

magnetic resonance imaging tecnecio tc99msestamibi cintilografia scintigraphy gadolinium 99m tc-sestamibi ressonancia magnetica nuclear neoplasias mamarias radioguided surgery cirurgia radioguiada breast cancer gadolineo

ACESSO AO ARTIGO

Documentos Relacionados