Eficacia de la biopsia con aguja gruesa en lesiones palpables de mama realizadas por médicos especialistas en ginecología

Abstract

Introduction: Analysis of the BAG performed by gynecologists, who are experts in ultrasound imaging on palpable breast lesions suspected of malignancy in the Gynecology Service of the Hospital Universitario de Guadalajara in order to assess the adaptation of the circuits of this hospital in the nodule suspicious of breast cancer to improve care for women with this pathology. Objective: The main objective of the study is to evaluate the efficacy of BAG, aiming at the sensitivity and specificity of this technique to justify its use on the hands of these professionals. The secondary objectives pursue to analyze the characteristics of the patients affected by breast cancer in whom a BAG was performed, and to evaluate the complications of the diagnostic process, as well as the similarity between these complications and those described in the literature in the BAG performed by radiology specialists. Additionally, it is intended to define the current agreement between the ultrasound suspicion of breast cancer and the definitive pathological anatomy and to quantify the waiting times between consultation, diagnosis and treatment. Material and methods: an observational, descriptive and retrospective study was carried out with a total of 229 BAG cases collected from September 2009 to December 2017. For this purpose, 66 variables are analyzed, highlighting among them age, parity, the BIRADs in mammography, tumor size at diagnosis in the ultrasound and in the surgical specimen, the pathology of the BAG and of the surgery, the administration of neoadjuvant treatment, the type of surgery performed, including the analysis of the sentinel node; as well as the need to perform axillary lymphadenectomy, the type of adjuvants after surgery, as well as the need for second surgeries. A concordance analysis was performed to evaluate and justify the use of this technique by gynecologists specialized in ultrasound. Results: it is observed that breast cancer cases in the study are a sample that can be extrapolated to reality, finding a distribution similar to the literature in terms of demographic characteristics (predominance in 99% of the cases in the female sex, age around at age 60, predominance in menopause) and breast pathology (involvement of the upper-left quadrant of the left breast by luminal infiltrating ductal carcinomas smaller than 3 centimeters). There was a median waiting period for AGB of 1 day and a median waiting time for surgery after cancer diagnosis of 27 days. A good concordance with a substantial kappa was observed between the immunohistochemical tests of the BAG and the surgical pieces, achieving statistical significance with (p<0.001) in this and also in the degree of agreement in the estrogen receptors, progesterone and oncoprotein study Her2 between the pieces of the BAG and the definitive surgery. A good concordance was evidenced with (p<0.001) between the estimated size in ultrasound and the definitive one in the surgical piece; without being able to demonstrate a good concordance between the pre- and post-surgical TNM staging, due to an underestimation of the staging in the initial stages, especially in lymph node involvement. The complication rate is low (less than 2%) and similar to that described in the literature when the technique is performed by radiologists. It was an evidence that the larger the tumor, the greater the risk of requiring an axillary lymphadenectomy due to involvement at this level (p=0.046). Conclusions: The high sensitivity and specificity of BAG in the study justifies the use of this technique on the hands of gynecologists who are experts in ultrasound. There is good agreement between the tumor size estimated by ultrasound and the final size of the surgical piece, as well as a good agreement between the pathological anatomy of the BAG and the surgical piece, which demonstrates a good diagnostic yield. The delay time for carrying out the BAG has a median of one day, achieving an excellent quality standard.