EXAMEN INTRAOPERATORIO DEL GANGLIO CENTINELA MEDIANTE IMPRONTAS CITOLOGICAS Hospital Universitari...
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Transcript of EXAMEN INTRAOPERATORIO DEL GANGLIO CENTINELA MEDIANTE IMPRONTAS CITOLOGICAS Hospital Universitari...
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EXAMEN INTRAOPERATORIO DEL
GANGLIO CENTINELA MEDIANTE
IMPRONTAS CITOLOGICAS
Hospital Universitari Germans Trias i Pujol
Badalona Barcelona
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Unidad de Patologia MamariaH. U. Germans Trias i Pujol
Badalona
1997-2004
800 pacientes año
Dx de carcinoma en 23 %
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BSGC. CRITERIOS DE INCLUSION
• Pacientes con carcinoma
• Tamaño inferior a 3 cm
• Ganglios axilares clínicamente negativos
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BSGC. CRITERIOS DE EXCLUSION
• Carcinoma localmente avanzado
• Adenopatias axilares (PAAF+)
• Biopsia excisional previa
• Radioterapia o quimioterapia previas
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Sonda Isotópica Portátil
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10/1997 01/ 2004BGC 744 Casos
Octubre 1997 - Noviembre 1999 Validación132 casos
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25
17
6
77
2 5
VP VN FN No detec.
SóloSóloGCGC
SóloSóloGCGCMmetMmet
48%
48
Sentinel node biopsy as a practical alternative to axillarylymph node dissection in breast cancer patients: An approach to its validity
M Fraile et al
2000; 11:701
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FALSOS NEGATIVOS
• Invasión metastásica masiva del GC
• GC muy próxima al tumor primario
• Biopsia excisional previa
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Complete Metastatic Invasion
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Radioactive-Shine Through
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Previous Excisional Biopsy
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EXAMEN HISTOLOGICO DEFINITIVO
Fijación en formol 24 horas
Inclusión en parafina
secciones de 2mm
múltiples cortes seriados por bloque
tinción con H-E y CAM5.2
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Se acepta GC: pNx(sn)
Micromet (pN1mi)
Se descartan casos de CTA o de grupos celulares < 0,2 mm
N0
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Resultados de la intraoperatoria
C
I
T
O
L
O
G
I
A
HISTOLOGIA
VN
294
FN
66 (59mmet)
NEGATIVO
FP
0
VP
93 (14mmet)
POSITIVO
NEGATIVOPOSITIVO
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PARAMETROS DE EFICACIA
• SENSIBILIDAD 59%• ESPECIFICIDAD 100%• EXACTITUD DIAGNÓSTICA 85%• VALOR PREDICTIVO POSITIVO 100%
• VALOR PREDICTIVO NEGATIVO 81%• SENSIBILIDAD (macromet) 95%
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CONCLUSIONES
• Técnica viable
• Valoración intraoperatoria del GC
• Cirugía primaria en un solo tiempo
• No alarga el tiempo de la intervención
• Sensibilidad óptima
• Baja detección de micrometástasis
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RESULTADOS BGC POST-VALIDACION EN 490 PACIENTES RESULTADOS BGC POST-VALIDACION EN 490 PACIENTES CON CRITERIOS + RESULTADOS AP DEFINITIVOSCON CRITERIOS + RESULTADOS AP DEFINITIVOS
FN-BLOQ1%
VAX GC+31%
NOVAX68%