5 research outputs found
ΠΠΠ’ΠΠΠΠΠΠΠΠ― Π ΠΠ‘Π§ΠΠ’Π ΠΠΠΠ©ΠΠΠ ΠΠΠΠΠΠ¬ΠΠΠΠ ΠΠ’ΠΠΠ ΠΠΠΠ ΠΠ Π Π ΠΠΠ ΠΠΠΠΠ§ΠΠΠ ΠΠΠΠΠΠ«
Breast cancer with skin involvement is one of the least studied and at the same time difficult to treat forms of cancer. Despite the achievements of modern diagnostics, many issues related to skin edema severity evaluation and quantitative assessment of changes associated with neoadjuvant drug therapy often cause a number of difficulties. In turn, this can lead to both incorrect staging and Β«overtreatmentΒ» of patients, as well as subjectivity in assessing the response to the treatment. Various approaches have been proposed to calculate the severity of edema, but they have not been widely accepted. This article presents our method developed for determining the area of skin edema, which in the future will allow individualizing approaches to treatment.Π Π°ΠΊ ΠΌΠΎΠ»ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ Ρ Π²ΠΎΠ²Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΊΠΎΠΆΠΈ β ΠΎΠ΄Π½Π° ΠΈΠ· Π½Π°ΠΈΠΌΠ΅Π½Π΅Π΅ ΠΈΠ·ΡΡΠ΅Π½Π½ΡΡ
ΠΈ, Π² ΡΠΎ ΠΆΠ΅ Π²ΡΠ΅ΠΌΡ, ΡΠ»ΠΎΠΆΠ½ΠΎ ΠΏΠΎΠ΄Π΄Π°ΡΡΠΈΡ
ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠΎΡΠΌ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ, ΠΌΠ½ΠΎΠ³ΠΈΠ΅ Π²ΠΎΠΏΡΠΎΡΡ, ΠΊΠ°ΡΠ°ΡΡΠΈΠ΅ΡΡ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΡ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΠΎΡΠ΅ΠΊΠ° ΠΊΠΎΠΆΠΈ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠΈ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π½Π° ΡΠΎΠ½Π΅ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π·Π°ΡΠ°ΡΡΡΡ Π²ΡΠ·ΡΠ²Π°ΡΡ ΡΡΠ΄ ΡΠ»ΠΎΠΆΠ½ΠΎΡΡΠ΅ΠΉ. Π ΡΠ²ΠΎΡ ΠΎΡΠ΅ΡΠ΅Π΄Ρ, ΡΡΠΎ ΠΌΠΎΠΆΠ΅Ρ ΠΏΡΠΈΠ²Π΅ΡΡΠΈ ΠΊΠ°ΠΊ ΠΊ Π½Π΅ΠΏΡΠ°Π²ΠΈΠ»ΡΠ½ΠΎΠΌΡ ΡΡΠ°Π΄ΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ Β«ΠΏΠ΅ΡΠ΅Π»Π΅ΡΠΈΠ²Π°Π½ΠΈΡΒ» ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΡΠ°ΠΊ ΠΈ ΠΊ ΡΡΠ±ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π² ΠΎΡΠ΅Π½ΠΊΠ΅ ΠΎΡΠ²Π΅ΡΠ° Π½Π° ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠΌΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅. Π Π°Π½Π΅Π΅ Π±ΡΠ»ΠΈ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠ΅ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ Π΄Π»Ρ ΡΠ°ΡΡΠ΅ΡΠ° ΡΡΠ΅ΠΏΠ΅Π½ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΠΎΡΠ΅ΠΊΠ°, ΠΎΠ΄Π½Π°ΠΊΠΎ ΡΠΈΡΠΎΠΊΠΎΠ³ΠΎ ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΡ ΠΎΠ½ΠΈ Π½Π΅ ΠΏΠΎΠ»ΡΡΠΈΠ»ΠΈ. Π Π΄Π°Π½Π½ΠΎΠΉ ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ°Π½Π½ΡΠΉ Π½Π°ΠΌΠΈ ΠΌΠ΅ΡΠΎΠ΄, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠΈΠΉ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΠΏΠ»ΠΎΡΠ°Π΄Ρ ΠΎΡΠ΅ΠΊΠ° ΠΊΠΎΠΆΠΈ, ΠΊΠΎΡΠΎΡΡΠΉ Π² Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅ΠΌ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Ρ ΠΊ Π»Π΅ΡΠ΅Π½ΠΈΡ
ΠΡΠ±ΠΎΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π²Π°ΡΠΈΠ°Π½ΡΠ° ΡΠ°Π·ΠΌΠ΅ΡΠΊΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ ΡΠ·Π»ΠΎΠ² Ρ Π±ΠΎΠ»ΡΠ½ΡΡ ΡΠ°ΠΊΠΎΠΌ ΠΌΠΎΠ»ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ
Often, neoadjuvant treatment in patients with locally advanced breast cancer leads to complete clinical and pathomorphological regression of not only the primary tumor, but metastatic lymph nodes also. Currently, discussions are ongoing regarding the optimal volume of surgical intervention on regional lymph nodes in this category of patients. As a de-escalation of classical lymphadenectomy, a method of targeted axillary dissection (TAD) is used, which presumes a biopsy of sentinel lymph nodes (SLN) with the removal of a previously marked metastatic lymph node. Our study is aimed at choosing the most optimal method for labeling a metastatic lymph node. The study included 63 patients diagnosed with stage T1β3N1M0 breast cancer, all divided into two comparison groups: 29 patients had a radiopaque label placed in the metastatic lymph node before neoadjuvant therapy, and 33 patients had a radioisotope label (with I125).After the neoadjuvant treatment completion, all patients with complete clinical response in the lymph nodes underwent targeted axillary lymphadenectomy. We evaluated the time of the surgical intervention, the length of the skin incision, the presence of complications when using one or another type of marking. Based on the results of statistical analysis, we propose a variant with a radioisotope label for implementation into the clinical practice. This method, in our opinion, presented the best qualities, reliability and convenience for the surgeon, comfort for the patient.ΠΠ΅ΡΠ΅Π΄ΠΊΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠΊ Ρ ΠΌΠ΅ΡΡΠ½ΠΎ-ΡΠ°ΡΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π½ΠΎΠΉ ΡΠΎΡΠΌΠΎΠΉ ΡΠ°ΠΊΠ° ΠΌΠΎΠ»ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΠΏΠΎΠ»Π½ΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅Π³ΡΠ΅ΡΡΠΈΠΈ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΡΠ°ΠΌΠΎΠΉ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ ΠΎΠΏΡΡ
ΠΎΠ»ΠΈ, Π½ΠΎ ΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π»ΠΈΠΌΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ·Π»ΠΎΠ². Π Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠ°ΡΡΡΡ Π΄ΠΈΡΠΊΡΡΡΠΈΠΈ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΠΌΠ° Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π½Π° ΡΠ΅Π³ΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ
Π»ΠΈΠΌΡΠΎΡΠ·Π»Π°Ρ
Ρ ΡΡΠΎΠΉ ΠΊΠ°ΡΠ΅Π³ΠΎΡΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
. Π ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ Π΄Π΅ΡΡΠΊΠ°Π»Π°ΡΠΈΠΈ ΠΊΠ»Π°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π»ΠΈΠΌΡΠ°Π΄Π΅Π½ΡΠΊΡΠΎΠΌΠΈΠΈ ΠΏΡΠΈΠΌΠ΅Π½ΡΠ΅ΡΡΡ ΡΠ°ΠΊΠΎΠΉ ΠΌΠ΅ΡΠΎΠ΄, ΠΊΠ°ΠΊ ΡΠ°ΡΠ³Π΅ΡΠ½Π°Ρ Π°ΠΊΡΠΈΠ»Π»ΡΡΠ½Π°Ρ Π΄ΠΈΡΡΠ΅ΠΊΡΠΈΡ (Π’ΠΠ), Π° ΠΈΠΌΠ΅Π½Π½ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π±ΠΈΠΎΠΏΡΠΈΠΈ Β«ΡΡΠΎΡΠΎΠΆΠ΅Π²ΡΡ
Β» Π»ΠΈΠΌΡΠΎΡΠ·Π»ΠΎΠ² (ΠΠ‘ΠΠ£) Ρ ΡΠ΄Π°Π»Π΅Π½ΠΈΠ΅ΠΌ ΡΠ°Π½Π΅Π΅ ΡΠ°Π·ΠΌΠ΅ΡΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»ΠΈΠΌΡΠΎΡΠ·Π»Π°. ΠΠ°ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π½Π°ΡΠ΅Π»Π΅Π½ΠΎ Π½Π° Π²ΡΠ±ΠΎΡ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠΎΡΠΎΠ±Π° ΠΌΠ°ΡΠΊΠΈΡΠΎΠ²ΠΊΠΈ ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»ΠΈΠΌΡΠΎΡΠ·Π»Π°. Π ΡΠ°Π±ΠΎΡΡ Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 63 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ Ρ Π΄ΠΈΠ°Π³Π½ΠΎΠ·ΠΎΠΌ ΡΠ°ΠΊ ΠΌΠΎΠ»ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ T1β3N1Π0 ΡΡΠ°Π΄ΠΈΠΈ, Π²ΡΠ΅ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ ΡΡΠ°Π²Π½Π΅Π½ΠΈΡ: 29 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ°ΠΌ Π΄ΠΎ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ Π½Π΅ΠΎΠ°Π΄ΡΡΠ²Π°Π½ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π² ΠΌΠ΅ΡΠ°ΡΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π»ΠΈΠΌΡΠΎΡΠ·Π΅Π» Π±ΡΠ»Π° ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π° ΡΠ΅Π½ΡΠ³Π΅Π½ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½Π°Ρ ΠΌΠ΅ΡΠΊΠ°, Π° 33 Π±ΠΎΠ»ΡΠ½ΡΠΌ β ΡΠ°Π΄ΠΈΠΎΠΈΠ·ΠΎΡΠΎΠΏΠ½Π°Ρ ΠΌΠ΅ΡΠΊΠ° (Ρ I125). ΠΠΎΡΠ»Π΅ ΠΎΠΊΠΎΠ½ΡΠ°Π½ΠΈΡ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π²ΡΠ΅ΠΌ Π±ΠΎΠ»ΡΠ½ΡΠΌ Ρ ΠΏΠΎΠ»Π½ΡΠΌ Π»Π΅ΡΠ΅Π±Π½ΡΠΌ ΠΏΠ°ΡΠΎΠΌΠΎΡΡΠΎΠ·ΠΎΠΌ Π½Π° Π»ΠΈΠΌΡΠΎΡΠ·Π»Π°Ρ
Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° ΡΠ°ΡΠ³Π΅ΡΠ½Π°Ρ Π°ΠΊΡΠΈΠ»Π»ΡΡΠ½Π°Ρ Π»ΠΈΠΌΡΠ°Π΄Π΅Π½ΡΠΊΡΠΎΠΌΠΈΡ. Π ΡΠ°Π±ΠΎΡΠ΅ ΡΡΠΈΡΡΠ²Π°Π»ΠΎΡΡ Π²ΡΠ΅ΠΌΡ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°, Π΄Π»ΠΈΠ½Π° ΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΡΠ°Π·ΡΠ΅Π·Π°, Π½Π°Π»ΠΈΡΠΈΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ ΡΠΎΠ³ΠΎ ΠΈΠ»ΠΈ ΠΈΠ½ΠΎΠ³ΠΎ Π²ΠΈΠ΄Π° ΡΠ°Π·ΠΌΠ΅ΡΠΊΠΈ. ΠΠΏΠΈΡΠ°ΡΡΡ Π½Π° ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°Π½Π°Π»ΠΈΠ·Π°, Π΄Π»Ρ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΡ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΡΡ ΠΏΡΠ°ΠΊΡΠΈΠΊΡ ΠΌΡ ΠΏΡΠ΅Π΄Π»Π°Π³Π°Π΅ΠΌ Π²Π°ΡΠΈΠ°Π½Ρ Ρ ΡΠ°Π΄ΠΈΠΎΠΈΠ·ΠΎΡΠΎΠΏΠ½ΠΎΠΉ ΠΌΠ΅ΡΠΊΠΎΠΉ. ΠΠΌΠ΅Π½Π½ΠΎ ΡΡΠΎΡ ΠΌΠ΅ΡΠΎΠ΄, Π½Π° Π½Π°Ρ Π²Π·Π³Π»ΡΠ΄, ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΠΈΠ» Π½Π°ΠΈΠ»ΡΡΡΠΈΠ΅ ΠΊΠ°ΡΠ΅ΡΡΠ²Π°, Π° ΠΈΠΌΠ΅Π½Π½ΠΎ Π½Π°Π΄Π΅ΠΆΠ½ΠΎΡΡΡ ΠΈ ΡΠ΄ΠΎΠ±ΡΡΠ²ΠΎ Π΄Π»Ρ Π²ΡΠ°ΡΠ°-Ρ
ΠΈΡΡΡΠ³Π°, ΠΊΠΎΠΌΡΠΎΡΡ Π΄Π»Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°
Choice of a way to verify space-occupying lesions of the breast at a preoperative stage
Preoperative verification of breast cancer (BC) is a necessary stage of diagnosis. The main method for obtaining materials is fine-needle aspiration biopsy that is of low informative value in a number of cases. Histological biopsy of nonpalpable breast masses extends the verification capabilities of accurate diagnosis and determines the choice and tactics of combination and complex treatments in patients with BC just at a preoperative stage, and, in case of detection of a benign tumor, enables one to abandon sector resection with an urgent histological study
Capabilities of percutaneous biopsy methods to preoperatively verify breast microcalcinates
Information on the morphological type of a tumor is of crucial importance for successfully planning the treatment of patients with breast cancer (BC). Technological progress in the past decade has led to quality improvement in the diagnosis of particularly nonpalpable BC, one of whose manifestations is microcalcinates. Adequate use of mini-invasive procedures for obtaining materials for morphological analysis is favorable for extending the capabilities of accurate preoperative diagnosis verification to effectively plan a patient treatment and rehabilitation program