Avaliação do tecido glandular e neoplasia residual no retalho cutâneo após mastectomia com preservação de pele por câncer de mama / Evaluation of glandular tissue and residual tumor in the skin flap after slin-parking mastectomies due breast cancer

RESUMO

O objetivo do trabalho foi avaliar a prevalência de tecido glandular e neoplasia residual no retalho cutâneo de pacientes submetidas à mastectomia com preservação de pele (MPP). Quarenta e duas mulheres portadoras de carcinoma de mama, estadio 0 a III, foram submetidas à MPP entre junho de 2003 e janeiro de 2004. Antes da cirurgia, foram desenhadas duas linhas na pele da mama, representando as incisões da MPP e da mastectomia convencional. Após a cirurgia, o retalho cutâneo que permaneceria após a MPP foi retirado. Neste, foram avaliadas a presença de tecido glandular mamário, através da identificação de unidades ducto tubulares alveolares (UDTL), assim como, a presença de neoplasia residual, por microscopia óptica. Estes dados foram correlacionados com outros parâmetros clínicos e patológicos, através de teste exato de Fisher e curva ROC. Em 25/42 (59,5%) dos casos havia UDTL remanescente, associada significativamente com espessura do retalho cutâneo > 5 mm. Em 4/42 das pacientes havia neoplasia residual na pele, associada à espessura > 5mm e presença de UDTL. A curva ROC mostrou que conforme a espessura do retalho cutâneo diminui, também diminui a prevalência de UDTL. Foi concluído que alta prevalência de UDTL e de neoplasia residual estiveram associadas a espessuras de retalhos cutâneos > que 5 mm.

ABSTRACT

The objective of the study was to evaluate the prevalence of glandular tissue and residual tumor in the skin flap after skin-sparing mastectomies (SSM). Forty-two breast cancer female patients, stage 0 - III, without clinical skin involvement, underwent SSM from June 2003 to January 2004. Before surgery, two lines were drawn on the breast skin, representing SSM and conventional mastectomy incisions. After surgery, the skin flap that would remain after SSM was removed and immediate breast reconstruction was begun. The presence and amount of remaining glandular breast tissues were histologically evaluated in the skin flap, identifying terminal duct-lobular units (TDLU) under an optical microscope, as well as the presence of residual disease. These data were correlated with other clinical and pathological parameters, using the Fisher exact test and ROC curve. The prevalence of residual breast tissue in the sample was 59,5% (25/42) and the presence of TDLU was significantly associated with skin flaps thicker than 5mm. Residual disease was found in 9,5% (4/42) of the women and associated with skin flaps > 5mm thick and presence of TDLU. The ROC curve showed that, as skin flaps reduces in thickness, the presence of TDLU also decreases. It was concluded that a high prevalence of glandular breast tissue and residual disease in the skin flap were associated with skin flaps thickness > 5mm.