RESUMO
Abstract Introduction: Core needle biopsy (CNB) is the gold standard for histopathological diagnosis of breast masses. However, rare complications may occur after undergoing CNB, including hematoma and pseudoaneurysm (PA) of the breast. Cases presentation: Case 1: 66-year-old woman with a mass in the left breast who underwent CNB without complications. After approximately eleven months, she noticed a palpable and pulsatile mass in her left breast. She was diagnosed with a PA (1.6x1.3cm) by means of a Doppler ultrasound (US) and breast magnetic resonance imaging, which was surgically resected without any complication using local anesthesia. Case 2: 44-year-old woman with a mass in the left breast. After undergoing CNB, she developed ecchymosis and a palpable and pulsatile mass in her left breast. A Doppler US showed a 1.4x0.7cm cystic lesion suggestive of a breast PA. The mass was surgically resected without complications using local anesthesia and sedation. Conclusion: Breast PA is an extremely rare complication of CNB, with only 17 cases reported in PubMed to date. However, it should be highly suspected in the presence of warning signs such as bleeding, hematoma, and a palpable and/or pulsatile breast mass after undergoing CNB.
Resumen Introducción. La biopsia por punción con aguja gruesa (CNB, por su sigla en inglés) es el estándar de oro para el diagnóstico histopatológico de las masas mamarias. No obstante, complicaciones raras como hematomas y pseudoaneurisma (PA) de la mama pueden ocurrir después de este procedimiento. Presentación de los casos. Caso 1: mujer de 66 años con una masa mamaria izquierda y a la que se le realizó una CNB sin complicaciones. Aproximadamente 11 meses después la paciente notó una masa pulsátil palpable en el seno izquierdo. Mediante ecografía Doppler y resonancia magnética de las mamas se diagnosticó un PA (1.6x1.3cm). La masa fue extirpada quirúrgicamente sin complicaciones bajo anestesia local. Caso 2: mujer de 44 años con una masa mamaria izquierda. Después de realizarse una CNB, la paciente desarrolló equimosis y una masa pulsátil palpable en su mama izquierda. Mediante una ecografía Doppler se observó una lesión cística de 1.4x0.7cm sugestiva de PA mamario. La masa fue extirpada quirúrgicamente sin complicaciones bajo anestesia local y sedación. Conclusión. El PA mamario es una complicación extremadamente rara de la CNB; tan solo 17 casos han sido reportados en PubMed hasta la fecha. Sin embargo, esta entidad debe ser altamente sospechada ante la presencia de signos de alarma como dolor, sangrado, hematoma y una masa mamaria palpable y/o pulsátil tras la realización de una CNB.
RESUMO
PURPOSE: Residual breast tissue (RBT) after mastectomy represents an unknown risk for local recurrence or development of a new cancer and affects decisions regarding adjuvant radiation therapy. This study used breast magnetic resonance imaging to evaluate the frequency of RBT and provide average thickness skin flap measurements in patients with total mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy (NSM) followed by breast reconstruction. METHODS AND MATERIALS: We carried out a retrospective analysis of 7432 consecutive postoperative breast magnetic resonance imaging examinations performed between August 2008 and July 2013, selecting 367 women (mean ± standard deviation age, 46.7 ± 8.7 years) who had undergone therapeutic or prophylactic mastectomy with reconstruction, for a total of 501 cases. The variables analyzed included fibroglandular tissue presence, skin flap thickness at 11 pre-established points, age, weight, height, body mass index, laterality, surgical indication, surgery type, reconstruction type, adjuvant therapy, and cancer treatment history. Statistical analyses were descriptive and comparative and included logistic regression models (P < .05). RESULTS: At 9 of the 11 points of measure, the median thickness of the flap exceeded 5.5 mm. Excluding the areolar region, RBT was identified in 29.9% of the cases: 21.3% of the therapeutic mastectomy cases and 51% of the NSM cases. The variables independently associated with the presence of RBT were flap thickness (P < .001), patient height (P < .03), mastectomy indication (P < .001), mastectomy type (P < .012 for skin-sparing mastectomy and P < .001 for NSM and total mastectomy), and breast reconstruction with flap (P < .019). CONCLUSIONS: All forms of mastectomy leave RBT. Our study has demonstrated that the RBT amount can be variable and quite prevalent. Because of the low quality of the evidence to ensure the oncological safety of sparing mastectomies, we suggest that knowledge of the extent of the remaining breast tissue is important for guiding additional surveillance and therapeutic interventions, including radiation therapy.