Séquelles thérapeutiques du sein après traitement conservateur du cancer du sein

详细信息	查看全文 | 推荐本文 |

• 作者：E. Delay ; J. Gosset ; G. Toussoun ; T. Delaporte ; M. Delbaere
• 关键词：Breast cancer ; Conservative treatment sequelae ; Plastic surgery ; Reconstructive surgery
• 刊名：Annales de chirurgie plastique esthetique
• 出版年：2008
• 期刊代码：11_02941260
• 类别：med
• 出版时间：April 2008
• 卷：53
• 期：2
• 页码：135-152
• 文件大小：2134 K

摘要

In our unit, breast cancer patients suffering mild sequelae of conservative cancer treatment receive fat transfer (lipomodelling), following a precise protocol, based on mammographic and ultrasound examinations and MRI. Available data do not seem to indicate any deleterious impact on patient outcome, notably in view of radiological images, but recurrence (or rather occurrence of new ipsilateral or contralateral cancer) is frequent. The correlation between new or recurrent breast cancer and lipomodelling is high; misinterpretations are possible and frequently arise. The present paper is a description of five complex clinical cases and a discussion of the medicolegal issues that may possibly arise; it also provides tentative expert evaluation of the cases. Clinical findings are reported and analyzed. The second step is a discussion of the radiological impact of lipomodelling, and of the problems caused by the transfer of potentially malignant cells when no preoperative diagnosis of recurrence is made; the morphological and esthetic benefits of the method are described, as well as the potential beneficial impact of fat transfer, notably associated with lower breast density and injections of fat stem cells. Our conclusion is that specialized radiologists, as well as plastic surgery and oncology experts should address the question of fat transfer in operated breast cancer patients and give their reasoned opinion about potentially litigious cases. This would help minimize or solve the conflicts between patients, doctors and experts. Establishing common ground between the different stakeholders would allow the development of the technique, as lipomodelling is, according to our experience, a tremendous advance in the treatment of sequelae from conservative breast cancer surgery.

ss="infobubble" id="infobubble_3" onMouseOver="InfoBubble.show('infobubble_3','mlktLink_3')" onMouseOut="InfoBubble.timeout()">spacing=0 width=100%>

style="float:right; padding-left:5px">src="/scidirimg/btn_xclose.gif" alt="Close" title="Close" onmouseover="javascript:this.src='/scidirimg/btn_xclose_hov.gif';" onmouseout="javascript:this.src='/scidirimg/btn_xclose.gif';"> src="/scidirimg/sci_dir/jrn_sub.gif" alt="You are entitled to access the full text of this document" title="You are entitled to access the full text of this document" width=12 height=14"> sciencedirect.com/science?_ob=ArticleURL&_udi=B6W8M-4R8PNPT-2&_user=2795313&_coverDate=04%2F30%2F2008&_rdoc=1&_fmt=high&_orig=article&_cdi=6658&_sort=v&_docanchor=&view=c&_ct=1640&_acct=C000058823&_version=1&_urlVersion=0&_userid=2795313&md5=6d1952982d8b6405d10a0cbe788409af">Aspects radiologiques des seins trait&#xe9;s par lipomodelage apr&#xe8;s s&#xe9;quelles du traitement conservateur du cancer du sein Annales de Chirurgie Plastique Esth&#xe9;tique, Volume 53, Issue 2, April 2008, Pages 178-189 J. Gosset, N. Guerin, G. Toussoun, T. Delaporte, E. Delay Abstract ss="mlktScroll"> style="line-height:150%"> ss="h3">R&#xe9;sum&#xe9; Nous utilisons depuis 2002 le lipomodelage pour la correction des s&#xe9;quelles du traitement conservateur du cancer du sein. Les r&#xe9;sultats morphologiques sont tr&#xe8;s int&#xe9;ressants et cette technique est amen&#xe9;e &#xe0; se d&#xe9;velopper de fa&#xe7;on consid&#xe9;rable. Cependant, la critique des transferts graisseux au niveau des seins avait &#xe9;t&#xe9; principalement le possible retentissement radiologique d&#xe9;l&#xe9;t&#xe8;re de ces transferts graisseux. Aussi, le but de ce travail est d’&#xe9;valuer l’aspect radiologique des seins conserv&#xe9;s, reconstruits par lipomodelage gr&#xe2;ce &#xe0; une &#xe9;tude comportant 21 patientes ayant b&#xe9;n&#xe9;fici&#xe9; d’une &#xe9;chographie, d’une mammographie et d’une IRM avant et un an apr&#xe8;s le lipomodelage. Nous avons conclu &#xe0; l’apparition de 19 %de microcalcifications d’allure b&#xe9;nigne en mammographie, 57 %de kystes huileux infracentim&#xe9;triques, 19 %de kystes complexes en &#xe9;chographie et 47 %d’images de cytost&#xe9;aton&#xe9;crose en IRM. À la suite de cette &#xe9;tude, nous avons pu conclure, que m&#xea;me si la fr&#xe9;quence de ces images peut para&#xee;tre &#xe9;lev&#xe9;e, elle est proche de celle des images observ&#xe9;es apr&#xe8;s tout autre type de chirurgie mammaire et il est ais&#xe9; pour le radiologue d’affirmer la b&#xe9;nignit&#xe9; de ces images. Nous concluons dans ce travail que les images observ&#xe9;es apr&#xe8;s lipomodelage ne pr&#xea;tent en aucun cas &#xe0; confusion avec une &#xe9;ventuelle r&#xe9;cidive de n&#xe9;oplasie mammaire. Elles sont sans cons&#xe9;quence sur le suivi radiologique mais leurs aspects doivent &#xea;tre connus des radiologues et des experts. ss="h3">Summary Breast lipomodelling has been used in our unit since 2002 to correct the sequelae of conservative treatment of cancer. Morphologically, satisfactory results have been recorded and the method is likely to develop considerably. However, the technique has also been questioned because of the possible deleterious radiological impact of injecting fat into the breast. The present work investigated the radiological aspect of conserved breast reconstructed by lipomodelling in a series of 21 patients undergoing ultrasound examination, mammography and MRI, before and after the procedure. Benign-looking microcalcifications were detected on 19%of the mammographies, small (<1 cm) oily cysts and complex cysts were visible on respectively 57 and 19%of ultrasound images, whereas 47%of the MRI scans indicated cytosteatonecrotic lesions. Even though multiple events could be observed, their frequency is close to that observed following other conventional breast surgery. Besides, there is clear radiological evidence of benignity. The conclusion of the study is that images obtained after lipomodelling are satisfactory and in no way suggestive of recurrence of breast cancer. Provided that radiologists and experts are aware of this pattern, there is no impact on the radiological follow-up of the patients. sciencedirect.com/science?_ob=MImg&_imagekey=B6W8M-4R8PNPT-2-K&_cdi=6658&_user=2795313&_orig=article&_coverDate=04%2F30%2F2008&_sk=999469997&view=c&wchp=dGLbVtz-zSkzS&md5=82443a30cdd8a58bea676654877cb4dd&ie=/sdarticle.pdf" target="newPdfWin" onClick="var newWidth=((document.body.clientWidth*90)/100); var newHeight=document.body.clientHeight; var pdfWin; pdfWin=window.open('','newPdfWin','width='+newWidth+',height='+newHeight+',resizable=yes, left=50, top=50');pdfWin.focus()">style="vertical-align:absmiddle;" border="0" src="http://www.sciencedirect.com/scidirimg/icon_pdf.gif" alt=""> PDF (1336 K)

ss="articleTitle">

Séquelles thérapeutiques du sein après traitement conservateur du cancer du sein