Persistent seroma after intraoperative placement of mammosite for accelerated partial breast irradiation: Incidence, pathologic anatomy, and contributing factors
Persistent seroma after intraoperative placement of mammosite for accelerated partial breast irradiation: Incidence, pathologic anatomy, and contributing factors
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DOI：
10.1016/j.ijrobp.2005.12.045
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发表时间：
2006-06-01
影响因子：
7
通讯作者：
Wazer, David E.
中科院分区：
文献类型：
--
作者：
Evans, Suzanne B.;Kaufman, Seth A.;Wazer, David E.
目的：探讨术中放置乳腺导管加速部分乳房照射后血清肿的发生率及可能的相关因素。方法和材料：本研究评估了38例在乳房肿瘤切除术或再切除术中进行术中乳腺导管放置的患者，随后进行了10次34 Gy的部分乳房加速照射。收集有关剂量学参数的数据，包括100%、150%和200%等剂量外壳所包围的体积或组织、剂量均匀性指数和涂药器表面的最大剂量。分析临床和治疗相关因素，包括患者年龄、体重、糖尿病和吸烟史、再次切除的使用、手术和放疗的间隔时间、导管放置的总时间、切除的总标本体积以及术后感染的存在与否。血清瘤经临床检查、乳房x光检查和/或超声检查证实。持续性血肿定义为放疗结束后6个月临床可检测到的血肿。结果：中位随访17个月后，血清瘤总检出率为76.3%。38例患者中有26例（68.4%）出现持续性血清肿（6个月），其中46%的患者在随访期间的某个时间点至少有中度不适。在这些有症状的患者中，3例需要活检或完全切除腔，发现鳞状化生，异物巨细胞反应，成纤维细胞和活跃的胶原沉积。在分析的剂量学、临床和治疗相关变量中，只有体重与血肿形成风险呈正相关（p = 0.04）。术后感染与血清肿形成风险降低显著相关（p = 0.05）。血清肿与次优美容结果相关，因为有血清肿的妇女中有61.5%获得优分，而无血清肿的妇女中有83%获得优分。结论：术中放置乳腺导管加速部分乳房照射与临床可检出的高血清肿率相关，这对美容效果有不利影响。血肿风险与体重呈正相关，与术后感染呈负相关。(c) 2006爱思唯尔公司
Purpose: To investigate the incidence of, and possible factors associated with, seroma formation after intraoperative placement of the MammoSite catheter for accelerated partial breast irradiation.Methods and Materials: This study evaluated 38 patients who had undergone intraoperative MammoSite catheter placement at lumpectomy or reexcision followed by accelerated partial breast irradiation with 34 Gy in 10 fractions. Data were collected regarding dosimetric parameters, including the volume or tissue enclosed by the 100%, 150%, and 200% isodose shells, dose homogeneity index, and maximal dose at the surface of the applicator. Clinical and treatment-related factors were analyzed, including patient age, patient weight, history of diabetes and smoking, use of reexcision, interval between surgery and radiotherapy, total duration of catheter placement, total excised specimen volume, and presence or absence of postprocedural infection. Seroma was verified by clinical examination, mammography, and/or ultrasonography. Persistent seroma was defined as seroma that was clinically detectable > 6 months after radiotherapy completion.Results: After a median follow-up of 17 months, the overall rate of any detectable seroma was 76.3%. Persistent seroma (> 6 months) occurred in 26 (68.4%) of 38 patients, of whom 46% experienced at least modest discomfort at some point during follow-up. Of these symptomatic patients, 3 required biopsy or complete cavity excision, revealing squamous metaplasia, foreign body giant cell reaction, fibroblasts, and active collagen deposition. Of the analyzed dosimetric, clinical, and treatment-related variables, only body weight correlated positively with the risk of seroma formation (p = 0.04). Postprocedural infection correlated significantly (p = 0.05) with a reduced risk of seroma formation. Seroma was associated with a suboptimal cosmetic outcome, because excellent scores were achieved in 61.5% of women with seroma compared with 83% without seroma.Conclusion: Intraoperative placement of the MammoSite catheter for accelerated partial breast irradiation is associated with a high rate of clinically detectable seroma that adversely affects the cosmetic outcome. The seroma risk was positively associated with body weight and negatively associated with postprocedural infection. (c) 2006 Elsevier Inc.