Central Department of Radiology Mustapha Bacha University Hospital Algiers Algeria 16000 6ème PAIRSHammametTunisavril2012 THE IMPACT OF INTERVENTIONNAL SENOLOGY IN SURGICAL MANAGEMENT ID: 1040527
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1. AB. BENDIB .m.H. MEKHILEFCentral Department of RadiologyMustapha Bacha University Hospital, Algiers, Algeria, 16000 6ème PAIRS-Hammamet-Tunis-avril2012THE IMPACT OF INTERVENTIONNAL SENOLOGY IN SURGICAL MANAGEMENT OF INFRACLINICAL LESIONS.L’IMPACT DE L’INTERVENTIONNEL EN SENOLOGIE SUR LA PRISE EN CHARGE CHIRURGICALE DES LESIONS INFRACLINIQUES.
2. INTRODUCTIONThe interest of the percutanious biopsy : -Histology -RH(RP/RO/HER2/KI67)The advent of percutaneous biopsy with its different modalities made a changement in the management of the infracliniques breast lesions.How ?
3. INDICATIONS OF BIOPSYALL lesions categorized as ACR5 histological type, HR , Pronostic , chemotherapy…ALL lesions categorized as ACR4 histology M/B.Some lesions categorized as ACR 3 with high risk (BRCA), anxiety …
4. PURPOSEEvaluate of the impact of the interventionnal in senology in surgical management of infraclinical lesions:The rate of surgery avoided.Surgery in one step/ sentinal node.
5. THE HISTORY OF THE INTERVENTIONNAL IN SENOLOGY 1986:FNA1990: Microbiopsy : 18 to 14 G1994:Microbiopsy with automatic pistol 14G on dedicated table PARKER1996: Parker et Burban mammotome with vacuum and 12 GAfter : 9-8-7 G.
6. THE INTERVENTIONAL TECHNICSMICROBIOPSY14Gsamples :1.6mmXX introductionsLARGE CORE BIOPSY12, 09 G samples 2-3.2mmOne introductionmarker
7. DIFFERENTS POSSIBILITIESMicrobiopsy under ultrasonographyLarge core biopsy under ultrasonographyLarge core biopsy stereotactic
8. I-MICROBIOPSY UNDER USINDICATIONS:All anomalies detectable under US as mass or distorsion.Size ≥5 mmDifficult case / experience :Target :movable ,deep, isoéchoic/fatty and larger breast. Breast : fibrous / introduction of the needle.
9. MICROBIOPSY UNDER USMATERIALS:144 microbiopsy realised in 136 patientesAge : 21 to 82 years old.Target : mass, distorsion, solido-cysticClassified using Bi-rads :20 cases as ACR379 cases as ACR445 cases as ACR5
10. MICROBIOPSY UNDER USMETHODChoose the acess, asepsis. Local anesthesia.05 samples, min 03 samples. Formol fixation.
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12. MICROBIOPSY UNDER USRESULTSSensibility: 96%.Malignant results + HR 49%.FN :2.2%.Technic failure: 0.7%.02 cases of atypia 1 case of IDC.02 cases of CIS underestimation of IDC.Evicton of surgery : 47%.
13. MICROBIOPSY UNDER USRESULTSSENSIBILITY : 92% to 98%FN : 1.7%*3.3%** 4.8%***FN in surgery: 2.5%****ann surg 2005* Liberman 1998** Derschaw 1996*** jackman radiology 1997****
14. II-LARGE CORE BIOPSY UNDER US INDICATIONSDiagnostic purposes:Very small mass <<5mm, in difficult situationFailure in microbiopsy.Excision purposes:Of mass no suspecte (papilloma, Adenofibroma)
15. LARGE CORE BIOPSY UNDER USMATERIALS16 biopsies realized in 14 patientes.Age : 26 to 62 years old.Background of breast cancer :3/14 cases.Targets were classified using bi-rads:ACR3: 03 casesACR4 :13 casesACR5: 00 cases
16. LARGE CORE BIOPSY UNDER USMETHODChoose the access, patient in DDLocal anesthesiaBiopsy under vacuum and continu control US.Put a clip.Take out the samples and fixed in formol.
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18. LARGE CORE BIOPSY UNDER USHISTOLOGICAL RESULTSBenign: ADF 09 / FCM : 05 / B Papilloma:01.Atypia : EAH 01 caseMalignant :00 Totale excision :…………………..80%Complications: hematoma……01 cases vagal shock…..01 casesFN:0%Rate of underestimation : 0%
19. LARGE CORE BIOPSY UNDER USRESULTSTotal excision size < 15 mmThe only complication : hemorrhagy <2%Rate of FN =0Rate of underestimation :0%* to 0.75%** *Plantade :Journal de Radiologie 2007 vol 86 – 20 ** Sebag ,Tourasse et Lebas : journal de radiologie vol 87-2006
20. III-LARGE CORE STEREOTACTIC BIOPSYINDICATIONSMicrocalcifications Distorsions without image in USMass in some difficult situations
21. LARGE CORE STEREOTACTIC BIOPSYMETHODMATERIALS:130 biopsies in 122 patientes Age : 33 to 82 years old
22. LARGE CORE STEREOTACTIC BIOPSYRESULTSMalignant in 39% surgeryAtypia in 9% surgery / follow upBenign in 53% eviction of surgery
23. CONCLUSION43% of malignant Dg TRT 53 % of eviction of surgery 4% of chirurgical biopsy with frozen