Estetik Amacı ile Yapılan Mammoplasti Spesmenlerinde Saptanan İnsidental Proliferatif Non-Proliferatif Lezyonların Değerlendirilmesi

Year 2024, Volume: 26 Issue: 2, 95 - 99, 30.08.2024

Nazlı Sena Seker , Osman Furkan Mülkem , Yakup Karabağlı Aydan Köse

https://doi.org/10.18678/dtfd.1397306

Abstract

Amaç: Redüksiyon mammoplasti (RM) operasyonları sıklıkla meme küçültme ve asimetri düzeltilmesi için yapılmaktadır. İnvaziv meme karsinomu (İMK) gelişme riski yüksek hastalarda bu materyallerin değerlendirmesi prekanseröz lezyonların ya da kansere eşlik edebilecek lezyonların saptanması açısından önemlidir. Bu çalışmada RM materyallerinde görülen proliferatif ve non-proliferatif lezyonların histopatolojik ve klinik özelliklerinin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu çalışmaya 2020 ve 2023 yılları arasında Eskişehir Osmangazi Üniversitesi hastanesinde estetik amaçlı (jinekomasti hariç) olarak opere edilmiş olan, 214 RM olgusu (402 örnek) dahil edildi. Olguların yaşları, lezyonların lokalizasyonu ve bilateralitesi ve proliferatif ve non-proliferatif lezyonlar değerlendirildi.
Bulgular: RM olgularının yaş ortalaması 38,5±10,9 yıl idi. RM materyallerinde en sık rastlanan lezyon apokrin metaplazi idi. Tüm RM olgularının %24,8 (n=53)’inde proliferatif ve non-proliferatif lezyonlar bilateral olarak saptandı. En çok bilateralite gösteren lezyon intraduktal papillom, çoğunlukla unilateral olan lezyon ise duktal ektazi idi. %0,2 (n=1) duktal karsinoma in situ olgusu ve %0,9 (n=4) lobüler karsinoma in situ olgusu saptandı.
Sonuç: Yüksek riskli lezyonların tespiti uygun klinik takip için önemlidir. Bu çalışmada RM olgularında önemli oranda yüksek riskli proliferatif lezyonlar saptanmıştır. Yüksek riskli proliferatif lezyon saptanan hastaların gelecekte kanser riski açısından daha sıkı takip edilmesi gerekmektedir. Ayrıca estetik amaçlı yapılan mamoplasti operasyonlarında bu lezyonların gözden kaçırılmaması amacı ile makroskopik incelemenin dikkatli yapılması büyük önem taşımaktadır.

Keywords

Duktal karsinoma in situ, meme neoplazileri, mammoplasti

Evaluation of Incidental Proliferative Non-Proliferative Lesions Detected in Mammoplasty Specimens Performed for Aesthetic Purposes

Abstract

Aim: Reduction mammoplasty (RM) operations are frequently performed for breast reduction and asymmetry correction. Evaluation of these materials is important in patients at high risk of developing invasive breast carcinoma (IBC) to detect precancerous lesions or lesions that may accompany cancer. This study aimed to evaluate the histopathologic and clinical features of proliferative and non-proliferative lesions in RM materials.
Material and Methods: In this study, 214 cases (402 specimens) of RM operated for aesthetic purposes (except gynecomastia) at Eskişehir Osmangazi University Hospital between the years 2020 and 2023 were included. The age of cases, location and bilaterality of the lesions, and proliferative and non-proliferative lesions were evaluated.
Results: The mean age of RM cases was 38.5±10.9 years. The most common lesion was apocrine metaplasia in RM materials. Proliferative and non-proliferative lesions were found bilaterally in 24.8% (n=53) of all RM cases. The most common bilaterality was intraductal papilloma and the most common unilateral lesion was ductal ectasia. 0.2% (n=1) case of ductal carcinoma in situ and 0.9% (n=4) cases of lobular carcinoma in situ was found.
Conclusion: Detection of high-risk lesions is important for appropriate clinical follow-up. In this study, high-risk proliferative lesions were found considerably in RM cases. Patients with high-risk proliferative lesions should be followed up more closely in terms of cancer risk in the future. In addition, it is crucial to perform a careful macroscopic examination in mammoplasty operations performed for aesthetic purposes to avoid missing these lesions.

Keywords

Breast Carcinoma In Situ, Breast Neoplasms, Mammoplasty

References

• Ishag MT, Bashinsky DY, Beliaeva IV, Niemann TH, Marsh WL Jr. Pathologic findings in reduction mammaplasty specimens. Am J Clin Pathol. 2003;120(3):377-80.
• Dreifuss, SE, Landfair AS, De La Cruz C. A risk-stratified comparison of high-risk findings in reduction mammoplasty. Ann Plast Surg. 2018;81(1):36-8.
• Colwell AS, Kukreja J, Breuing KH, Lester S, Orgill DP. Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg. 2004;113(7):1984-8.
• Hassan FE, Pacifico MD. Should we be analyzing breast reduction specimens? A systematic analysis of over 1,000 consecutive cases. Aesthetic Plast Surg. 2012;36(5):1105-13.
• Li Z, Fadare O, Hameed O, Zhao C, Desouki MM. Incidental atypical proliferative lesions in reduction mammoplasty specimens in patients with a history of breast cancer. Hum Pathol. 2014;45(1):104-9.
• Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985;312(3):146-51.
• Trentham-Dietz A, Chapman CH, Jayasekera J, Lowry KP, Heckman-Stoddard BM, Hampton JM, et al. Collaborative modeling to compare different breast cancer screening strategies: A decision analysis for the US Preventive Services Task Force. JAMA. 2024;331(22):1947-60.
• Berg WA. USPSTF breast cancer screening guidelines do not go far enough. JAMA Oncol. 2024;10(6):706-8.
• Ahern TP, Sprague BL, Bissell MCS, Miglioretti DL, Buist DSM, Braithwaite D, et al. Family history of breast cancer, breast density, and breast cancer risk in a US Breast Cancer Screening Population. Cancer Epidemiol Biomarkers Prev. 2017;26(6):938-44.
• Tozbikian G, Brogi E, Vallejo CE, Giri D, Murray M, Catalano J, et al. Atypical ductal hyperplasia bordering on ductal carcinoma in situ. Int J Surg Pathol. 2017;25(2):100-7.
• Nergiz D, Süren D, Alikanoğlu AS, Yıldırım HT, Altun ZA, Uslu A. Rate of incidental pathological lesions in reduction mammoplasty specimens and incidence of invasive breast carcinoma following breast reduction operation. Aesthetic Plast Surg. 2022;46(1):83-90.
• Kakagia D, Fragia K, Grekou A, Tsoutsos D. Reduction mammaplasty specimens and occult breast carcinomas. Eur J Surg Oncol. 2005;31(1):19-21.
• Tadler M, Vlastos G, Pelte MF, Tille JC, Bouchardy C, Usel M, et al. Breast lesions in reduction mammaplasty specimens: a histopathological pattern in 534 patients. Br J Cancer. 2014;110(3):788-91.
• Arslan R. Clinical significance of pathologically detected lesions in reduction mammoplasty. J Surg Med. 2022;6(5):573-6.
• Akintayo RM, Rosenkranz KM, Wells WA, Ridgway EB. Reviewing the evidence to guide clinical care: proliferative breast lesions in breast reduction specimens. Ann Plast Surg. 2017;79(4):410-4.
• Ambaye AB, Goodwin AJ, MacLennan SE, Naud S, Weaver DL. Recommendations for pathologic evaluation of reduction mammoplasty specimens: A prospective study with systematic tissue sampling. Arch Pathol Lab Med. 2017;141(11):1523-8.
• Bas S, Oner C, Aydin AC, Ucak R, Sirvan SS, Karsidag S. Discussion of histopathological findings of 954 breast reduction specimens. Sisli Etfal Hastan Tip Bul. 2021;55(1):42-8.
• Strickland S, Turashvili G. Are columnar cell lesions the earliest non-obligate precursor in the low-grade breast neoplasia pathway? Curr Oncol. 2022;29(8):5664-81.