IMPROVEMENT OF SURGICAL TREATMENT TACTICS OF EARLY FORMS OF BREAST CANCER IN WOMEN IN ORDER TO PREVENT THE DEVELOPMENT OF CONGENITAL LYMPHOMA
About the author:
Savenkov O. Yu., Romanukha K. H., Khomenko A. V.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
The article addresses the problem of breast cancer (BC), which ranks first in the structure of cancer incidence and mortality of the female population in Ukraine. It is known that the leading method of treatment of stage I-II breast cancer is surgical. To improve the search results for sentinel lymph nodes, the world’s leading clinics recommend the use of contrast-enhanced fluorescent technology – green indocyanin (ICG) and ICG camera, which improves the accuracy of regional lymph nodes diagnosis by up to 97% and is currently optimal. On the positive result of urgent (intraoperative) histological examination of the sentinel lymph node, a decision is made to perform complete regional lymph node dissection, with lymph node-negative variant lymphadenectomy is not performed, which allows to prevent the development of complications in the future. Therefore, the aim of the study is to improve the methods of detection and identification of sentinel lymph node using ICG technology to stage the disease intraoperatively and determine the feasibility of lymph node dissection in early forms of breast cancer in women. In the first stage, all patients underwent a complete examination, which included: physical examination, mammography, radiography of the chest, ultrasound of the breast and regional lymph nodes, abdominal organs, retroperitoneal space and pelvis, small-needle biopsy or trepan-biopsy of a tumor with cytology, morphological and immunohistochemical (ER, PgR, HER-2/neu, Ki-67) studies, cytological examination of excretions from the nipple and ulcerative tumors. It is shown that according to the pathohistological study most tumors had ductal or combined (lobular-ductal) type – 85.7% and 93.3% respectively (p> 0.05), with moderate differentiation – 90.5% and 90% (p> 0.05). The histological inspection of the sentinel lymph node during its intraoperative imaging using ICG technology showed a metastatic decrease in 9 out of 21 cases (42.9%) in the main group. These patients were required to undergo full regional lymph node dissection along with breast surgery. In the other 12 cases, the patient’s lymphatic collector was stored. It is established that the development of secondary lymphedema in early forms of breast cancer is probably associated with the performance of regional lymph node dissection (correlation coefficient r = 0.29; p <0.05) and does not depend on the incidence of oncological process. Among other factors that determine the development of SL after surgical treatment of early forms of breast cancer, a significant correlation is found only with the body mass index (r = 0.45; p = 0.004), which is consistent with the literature. Thus, given the statistical comparison of the study groups on the basic parameters of the oncological process, it can be stated that the use of intraoperative imaging of the sentinel lymph node method using ICG technology leads to a decrease in the frequency of development of secondary lymphedema and other complications in the postoperative period, shortening acceleration of social and labor rehabilitation of patients and improvement of their quality of life.
breast cancer, surgical tactics, sentinel lymph node, ICG technology.
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 200-203 pages, index UDK 618.19–006.6–055.2–06-084-089