Multiple foreign body granulomas after mastectomy with intraoperative application of tissue adhesive vs. surgical drainage – sonographic finding

Abstract

Purpose The use of tissue adhesive instead of a drain following mastectomy was a point of interest for many breast surgeons. Postoperative formation of multiple unusual sonographic lesions was observed in patients that underwent mastectomy with TissuGlu. The aim of this study was to describe the sonographic features of these lesions and, when possible, to examine them histologically.

Materials and Methods This study includes 98 patients, 49 underwent mastectomy with the application of TissuGlu and 49 with drain insertion. Unusual postoperative sonographic findings were thoroughly described. A histological examination was carried out according to the guideline recommendations.

Results Unusual sonographic findings were detected in 87.8% of patients in the TissuGlu group and in only 4% of the patients in the drain group. These lesions were detectable between 6 and 59 months postoperatively. 47 breasts of the TissuGlu group were classified as category 3, while only 2 breasts as category 4. Lesions were on average 7.5 mm in diameter, echogenic or isoechoic with posterior shadowing, an irregular and ill circumscribed marginal contour, and a horizontal axis. All histologically examined lesions (n=29) were benign. Granulomatous tissue was histologically proven in 63% of those lesions (n=17), while residual adhesive material could be detected in 18.5% of lesions (n=5).

Conclusion The use of TissuGlu adhesive after mastectomy may cause the formation of unusual palpable granulomas, with or without residual adhesive materials. Sonographic description of lesions will help physicians to differentiate between granulomas and local relapse.

Zusammenfassung

Ziel Um nach Mastektomie die Seromproduktion zu verringern, wurden in den letzten Jahren u.a. Gewebekleber verwendet. Bei Patientinnen, bei denen intraoperativ TissuGlu zur Anwendung kam, wurde die postoperative Bildung multipler ungewöhnlicher sonografischer Herdbefunde beobachtet. Ziel dieser Studie war es, die sonografischen Kriterien dieser Herdbefunde zu beschreiben und, wenn möglich, histologisch zu untersuchen.

Material and Methode 98 Patientinnen wurden eingeschlossen. 49 erhielten eine Mastektomie mit TissuGlu und 49 eine Mastektomie mit Drainagen-Einlage. Bei der postoperativen Kontrolle wurden ungewöhnliche sonografische Herdbefunde beschrieben und histologisch gesichert.

Ergebnisse Suspekte sonografische Herdbefunde kamen bei 87,8% der Patientinnen in der TissuGlu-Gruppe, allerdings nur bei 4% der Patientinnen in der Drainage-Gruppe zur Darstellung. Die Herdbefunde hatten durchschnittlich einen Durchmesser von 7,5mm. Diese Herdbefunde waren echoarm bis echogleich, mit dorsaler Schallauslöschung, einer nicht umschriebenen Randkontur und einer horizontalen Achse. Alle histologisch untersuchten Herdbefunde (n=29) waren gutartig. Eine granulomatöse Fremdkörper-Reaktion wurde histologisch in 63% der gesicherten Herdbefunde (n=17) nachgewiesen, und in 18,5% der Herdbefunde (n=5) zusätzlich Reste des adhäsiven Materials.

Schlussfolgerungen Diese Studie konnte zeigen, dass die Verwendung von TissuGlu-Gewebekleber bei Mastektomie zur Bildung von Fremdkörper-Granulomen führen kann, teilweise auch mit Rückständen von Klebermaterial. Die beschriebenen sonografischen Kriterien dieser Herdbefunde werden Ärzten helfen, besser zwischen Granulomen und lokalen Rezidiven zu unterscheiden.

Keywords

local recurrence - tissue adhesive - Tissuglu - AREAS, STRUCTURES & SYSTEMS - breast - granuloma

Publication History

Received: 31 July 2023

Accepted after revision: 28 February 2024

Article published online:
27 March 2024

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