Tumor amiloide de mama / Amyloid tumour of the breast

La amiloidosis primaria de afectación mamaria es una dolencia infrecuente, por lo que, ante su aparición, debemos descartar la existencia de otras enfermedades o la amiloidosis visceral difusa. Presentamos el caso de una paciente en cuya mamografía de control se identifican 2 nódulos con microcalcificaciones en la mama derecha. Las biopsias muestran alteraciones compatibles con depósito de amiloide. Se procede a la resección de las mismas, cuyo análisis de anatomía patológica confirma que se trata de un tumor amiloide. En los controles posteriores no ha presentado ninguna alteración local ni sistémica, lo que nos lleva a pensar que se trata de una amiloidosis primaria. Es de gran relevancia mantener revisiones periódicas para permitirnos diagnosticar precozmente la aparición de otras lesiones (AU)

Primary amyloid tumour of the breast is an unusual disease and consequently, when suspected, the presence of other illnesses or systemic amyloidosis must be excluded. We report the case of a woman in whom mammography revealed 2 nodes with microcalcifications in the right breast. Biopsies showed amyloid deposits. The lesions were resected and the diagnosis of amyloid tumour was confirmed by pathological analysis. Subsequently, the patient has shown no local or systemic alterations, leading us to believe that the lesions were primary amyloid tumours. It is essential to conduct frequent follow-up visits to rapidly diagnose the appearance of other lesions (AU)

Cirugía guiada con radiotrazadores de lesiones de mama no palpables y del ganglio centinela / Radioguided localization with radiotracer of non palpable breast lesions and sentinel node

Objetivo. Evaluar nuestra experiencia en el procedimiento de localización prequirúrgica de lesiones de mama no palpables (LMNP) y del ganglio centinela (GC) con radiotrazadores. Material y métodos. Se incluyeron las LMNP localizadas prequirúrgicamente durante el período comprendido desde enero de 2001 a diciembre de 2011. La inyección del radiotrazador se realizó guiada con ecografía o mamografía. Se obtuvo comprobación con gammagrafía prequirúrgica en todos los casos. El cirujano localizaba en quirófano las LMNP y el GC axilar con una sonda detectora portátil. El estudio histológico del GC se realizó intraoperatorio para evitar reintervenciones si estaba indicada la linfadenectomía axilar. Resultados. Se incluyeron 881 pacientes, de las cuales 226 presentaban lesiones benignas en las que estaba indicada la tumorectomía, y 655 presentaban lesiones malignas en las que estaba indicado el tratamiento quirúrgico conservador. La tasa de detección de las LMNP fue del 99,4%, consiguiendo reducir las reintervenciones por bordes afectos hasta un 7,4%. Conclusión. En nuestra experiencia la cirugía radioguiada de LMNP con radiotrazadores es una técnica sencilla y rápida que permite la extirpación con márgenes quirúrgicos suficientes y resultado estético óptimo, así como la biopsia del GC en la misma intervención ((AU)

Objective. To evaluate our experience with preoperative localization of non-palpable breast lesions (NPBL) with the injection of a radiotracer, or radioguided occult lesion localization technique, and with localization of NPBL and sentinel node (SN) with a single injection of radiotracer, or SN and occult lesion localization technique. Material and methods. We included NPBL in which excision was indicated during the period from January 2001 to December 2011. The radiotracer was injected under stereotactic or ultrasound guidance. Scintigraphy was carried out in all patients before surgery. The surgeon in the operating room had a hand-held gamma probe to locate the lesions in the breast and in the axilla. Intraoperative pathological examination of the SN was done to avoid reinterventions if there were indications for axillary lymphadenectomy. Results. We included 881 patients: 226 benign lesions were localized in patients with indications for lumpectomy and 655 malignant lesions in patients scheduled for breast conserving treatment. The detection rate of NPBL was 99.4%. Reoperations were reduced to 7.4%. Conclusion. In our experience, radioguided surgery of NPBL with radioguided occult lesion localization-SN and occult lesion localization is a quick and simple technique that allows tumor excision with adequate surgical margins and optimal cosmetic results, as well as SN biopsy during the same operation ((AU)

Cirugía mamaria radioguiada. Evolución del uso de técnicas miniinvasivas y situación actual / Radioguided breast surgery. Evolution of the use of minimal-invasive technologies and current situation

El aumento en la detección de lesiones no palpables de mama ha permitido el desarrollo de métodos de localización mediante el uso de radiofármacos que nos permiten una óptima cirugía de extirpación “ahorradora” y, simultáneamente, la biopsia del ganglio centinela en los casos de cáncer mamario. Revisamos la bibliografía actual acerca del tema y se aprecia una eclosión de artículos sobre cirugía radioguiada en numerosos y destacados grupos de trabajo mundiales que reflejan la bondad del método, así como su eficacia y atractivo para unos cirujanos que apuestan cada vez más por la excelencia en su labor diaria. Aportamos también nuestra experiencia como grupo funcional que se extiende a 413 intervenciones sobre lesiones no palpables realizadas de forma radioguiada (ROLL) y en 229 casos de afección maligna (75%) ha sido posible simultanear con la biopsia del ganglio centinela (SNOLL). El interés que ha despertado la técnica no debe estar exento de un espíritu crítico pero innovador y reflexivo para poder analizar de forma correcta los resultados obtenidos por cada grupo, conscientes de que estamos ante métodos en que intervienen varias especialidades y cada una deberá aportar la máxima eficiencia (AU)

The increase in the detection of occult lesions has led to the development of new localisation methods using radiopharmaceutical products. The use of these products allows us to perform a “thrifty” (less-aggressive) surgical excision and, to simultaneously carry out the biopsy of the sentinel node in cases of breast cancer. On making a search for the most up to date references on this particular topic, we found many articles on radioguided surgery by many leading international work groups. These articles clearly show the advantages of the radioguided surgery method, its effectiveness and attractiveness to surgeons who are very much involved in the search for excellence in their daily work. We also contribute our experience as a functional group, with 413 interventions on occult lesions performed using the radioguided method (ROLL). In 229 cases out of these 413, we found a malignancy (75%); in all these 229 cases it was possible to perform the intervention simultaneously with the biopsy of the sentinel node (SNOLL), during the same surgical act. However the interest created by the new procedure, it is essential to keep a critical but innovative and reflexive mind on this issue, in order to accurately analyze the results obtained by each group. We must remember that these types of methods involve several clinical specialties and, therefore, each one will have to contribute with the highest efficiency

[Radioguided breast surgery. Evolution of the use of minimal-invasive technologies and current situation]. / Cirugía mamaria radioguiada. Evolución del uso de técnicas miniinvasivas y situación actual.

The increase in the detection of occult lesions has led to the development of new localisation methods using radiopharmaceutical products. The use of these products allows us to perform a "thrifty" (less-aggressive) surgical excision and, to simultaneously carry out the biopsy of the sentinel node in cases of breast cancer. On making a search for the most up to date references on this particular topic, we found many articles on radioguided surgery by many leading international work groups. These articles clearly show the advantages of the radioguided surgery method, its effectiveness and attractiveness to surgeons who are very much involved in the search for excellence in their daily work. We also contribute our experience as a functional group, with 413 interventions on occult lesions performed using the radioguided method (ROLL). In 229 cases out of these 413, we found a malignancy (75%); in all these 229 cases it was possible to perform the intervention simultaneously with the biopsy of the sentinel node (SNOLL), during the same surgical act. However the interest created by the new procedure, it is essential to keep a critical but innovative and reflexive mind on this issue, in order to accurately analyze the results obtained by each group. We must remember that these types of methods involve several clinical specialties and, therefore, each one will have to contribute with the highest efficiency.