ABSTRACT
Since extended mastectomy after Urban involves an unjustifiably high level of trauma, this method has limited application. We have evolved a procedure of video-assisted thoracoscopic parasternal lymphadenectomy (VATPL). On completion of the experimental part using cadavers to work out the rationale for extent of surgery, clinical trials started. A total of 120 operations in patients aged 27-73 were performed (left-sided--64, right-sided--56), with the number of lymph nodes removed in each case ranging 1-10. Metastases were detected in 23 (19.2%), isolated lesions (metastases to parasternal lymph nodes alone)--6 (5.0%). With volume of removed tissue being identical, the findings on level of pain, amount of narcotic analgetics, hospital stay duration, intra- and postoperative complication incidence and cardiointervalography and pneumotachometry for VATPL patients were significantly better than for those treated by traditional (open-chest) procedure. It is concluded that VATPL is a highly effective and low-traumatizing diagnostic method. It may be recommended as an operation of choice for parasternal lymph collector involvement of central or medial localization.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Lymph Node Excision/methods , Lymphatic Metastasis , Thoracic Surgery, Video-Assisted , Adult , Aged , Analgesics, Opioid/administration & dosage , Female , Humans , Length of Stay , Lymphatic Metastasis/diagnosis , Middle Aged , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Sternum , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methods , Thoracotomy/adverse effects , Treatment OutcomeABSTRACT
The study was concerned with application of the stereotactic automated surgical biopsy breast with the ABBI (USSC) device for verification of non-palpable breast lumps. It included 13 females, aged 34-72 (mean age--54) and lasted 6 months (1999). Microcalcinates were detected in 3 (22.8%), local cordlike tissue structures--3 (22.8%), focal shadows--7 (53.2%). Lesion size: (5 mm (16%), 5.1-10 mm (25%) and 10.1-20 mm (59%). Malignancy was diagnosed in 3 cases (22.8%), dia. 7-10 mm; atypical ductal hyperplasia--2 (8.3%), and miscellaneous benign pathology--53.2%. Adequate removal of lesions was histologically confirmed in all cases. The procedure was carried out with ambulatory monitoring, under local anesthesia, and lasted 1.5 hrs. No complications were reported. The cosmetic results were good; no analgetics were dispensed. The ABBI system proved an effective means of stereotactic surgical biopsy of the breast because it removed the entire radiologically-suspicious site as a complete tissue preparation. It provided all histological data without crushing or segmenting the preparation. Since tissue texture and, particularly, the preparation edges remained intact, the latter could be examined too, if needed. All this ruled out inaccurate interpretation, repeat biopsy and unjustified lumpectomies.
Subject(s)
Biopsy/methods , Breast Diseases/diagnosis , Stereotaxic Techniques/instrumentation , Adult , Aged , Ambulatory Surgical Procedures , Anesthesia, Local , Breast Diseases/surgery , Breast Neoplasms/diagnosis , Calcinosis/diagnosis , Diagnosis, Differential , Female , Humans , Middle AgedABSTRACT
14 biopsies were performed in patients with non-palpable tumors of the breast with stereotaxic automated system (ABBI) and disposable "pistol-needle" ("Auto-Suture") whose needle-harpoon penetrates into pathologic focus under local anesthesia (four fold digital stereotaxic control guarantees the precision of biopsy). Non-palpable breast cancer in the tissue areas of 4, 7 and 11 mm in horizontal section was diagnosed in 3 patients. Biopsy was performed outpatiently, there were no complications. The procedure is like a diagnostic sectoral resection of the breast.
