Nasrinossadat Alavi, Ladan Fonooni, Fereshte Ensani, Asieh Olfatbakhsh, Reza Chaman, Akramossadat Sadjadian, Golshan Mehra
Iranian Center for Breast Cancer, Academic Center for Education, Culture and Research,Tehran, Iran.
Asian Pac J Cancer Prev. 2011;12(5):1189-92.
The widespread use of improved mammographic techniques has led to increased detection of nonpalpable breast masses. Preoperative localization is important for reducing false negative results and decreasing the size of tissue resection needed and the resulting breast deformity. We used ultrasound guided methylen blue injection in the mass for localization of breast masses that were clinically nonpalpable but detectable by ultrasound.
57 masses from 51 patients were marked 20 to 180 minutes before surgery with 0.4-0.7 cc methylene blue and resection was done in operating room under local or general anesthesia . success of radiologist for localization and success of surgeon for complete resection and pathology results were reviwed and fallow up ultrasound was done 3-5 month after surgery for patients whom pathology report was non specific (such as FCC) to confirm complete resection.
57 masses were excised successfully by the surgeon , localization was successful in all patients but injection in the mass was not feasible in 4 patients and dye was injected on the surface of the mass and led to successful excision .Only one mass was not found at surgery because dye washed out before surgery, and the mass was resected by use of intra operative ultrasound. 5.3% patients reported the procedure was painful and 28% reported tolerable pain during injection and 66.7 % of patients said that the injection was painless or with minimal discomfort. Allergic reaction was not seen in any patient and no interference was reported by the pathologist in slide preparation or diagnoses and IHC study.
Marking with blue dye injection is a safe and low cost method for localization of non palpable breast lesions that are detectable by Ultrasound. In one patient failure to find the mass was because of location of the mass that was in axillary tail of breast and time of surgery that was 100 minutes after injection that led to absorption of blue dye before surgery and it is advised to do surgery as soon as possible after blue dye injection especially in peripheral and deeply located masses.
改良乳腺钼靶技术的广泛应用使得不可触及乳腺肿块的检出率增加。术前定位对于减少假阴性结果、缩小所需组织切除范围以及减轻由此导致的乳房畸形至关重要。我们采用超声引导下向肿块内注射亚甲蓝的方法对临床不可触及但超声可检测到的乳腺肿块进行定位。
51例患者的57个肿块在手术前20至180分钟用0.4 - 0.7毫升亚甲蓝进行标记，然后在局部或全身麻醉下于手术室进行切除。回顾放射科医生的定位成功率、外科医生的完整切除成功率及病理结果，并对病理报告不明确（如纤维囊性改变）的患者在术后3至5个月进行超声随访以确认是否完整切除。
外科医生成功切除了57个肿块，所有患者的定位均成功，但有4例患者无法向肿块内注射，而是将染料注射在了肿块表面，最终成功切除。仅1个肿块在手术时未找到，原因是手术前染料被冲洗掉，该肿块通过术中超声切除。5.3%的患者称该操作疼痛，28%的患者称注射时疼痛可耐受，66.7%的患者表示注射无痛或仅有轻微不适。未观察到任何患者出现过敏反应，病理学家在制片、诊断及免疫组化研究中均未报告有干扰情况。
注射蓝色染料标记是一种安全且低成本的方法，用于定位超声可检测到的不可触及乳腺病变。有1例患者未找到肿块是因为肿块位于乳腺腋尾部且手术时间是在注射后100分钟，导致手术前蓝色染料被吸收，建议在注射蓝色染料后尽快进行手术，尤其是对于周边及深部的肿块。
