Localización con semilla radioactiva (LSR) de lesiones no palpables de la mama- Desarrollo e implementación del programa en la República Argentina

Resumen

El intervencionismo en mama se inició con la localización preoperatoria de lesiones no palpables.

En una segunda etapa, el desarrollo de técnicas de biopsias en las tres modalidades (mamografía, ultrasonido y resonancia magnética), reforzaron las indicaciones de localización de lesiones con histología ya confirmada.

La técnica de localización en Argentina se basó casi exclusivamente en la inserción de alambres con arpones e inyección de carbón.

A partir del año 2001, se ofreció como alternativa a las localizaciones con arpones la inserción de semilla de Iodo-125, considerando las ventajas para la paciente, el cirujano y el sistema hospitalario al desacoplar los turnos de quirófano y servicios de imágenes, otorgando acceso a cualquier cuadrante con incisiones cosméticas.

La provisión del isótopo es la clave para instalar y atender la demanda de los usuarios, una vez que han conocido los méritos del procedimiento.

En todos los ámbitos y distintos países, se verificó una lenta incorporación a la rutina de localización de lesiones con material radioactivo, primariamente por las regulaciones fundamentales y justificadas para la adquisición del isótopo.

En nuestro medio y en una labor conjunta con la Autoridad Regulatoria Nuclear (ARN), logramos finalmente, en el año 2017, el reconocimiento de la práctica.

Revisamos la bibliografía, describimos la técnica y la logística para lograr autorización de aquellos centros interesados en aplicar un procedimiento universalmente adoptado por sus ventajas respecto a los métodos tradicionales.

Abstract

Diagnostic intervention in breast disease started with preoperative localization of non-palpable lesions.

Later, with the histological diagnosis obtained through biopsy techniques in mammography, ultrasound and magnetic resonance imaging, the localization of lesions has become a must.

Traditionally, in Argentina, the localization technique was exclusively based on the insertion of harpoon-shaped guided wires and carbon suspension.

Since 2001, the iodine-125 radioactive seed localization has emerged as a reliable and advantageous alternative for the patient, the surgeon and the hospital system, reducing scheduling conflicts between the breast imaging department and the surgical department, and allowing access to any quadrant with cosmetic incisions.

The isotope provision is the key to satisfying the users demand, once they have known the merits of the procedure.

The implementation of radioactive material for the localization of lesions has been tardy in all fields and in different countries, mainly due to justified regulations related to the acquisition of the isotope.

As a result of joint efforts with the Autoridad Regulatoria Nuclear (Nuclear Regulatory Authority), the practice finally gained its deserved recognition in 2017.

We conducted a review of the existing literature and described the technique and the logistics to obtain the approval of the sites that were interested in the deployment of a widely used procedure that has proved to be more advantageous than traditional methods.

Palabras clave

cáncer de mama/diagnóstico por imágenes - cáncer de mama/patología - cáncer de mama/cirugía - medicina nuclear/procedimientos - ultrasonografía/procedimientos

Keywords

breast neoplasms/diagnostic imaging - breast neoplasms /pathology - breast - neoplasms/surgery - radionuclide imaging/methods - ultrasonography/methods

Responsabilidades éticas

Protección de personas y animales. Los autores declaran que para esta investigación no se han realizado experimentos en seres humanos ni en animales.

Confidencialidad de los datos. Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicación de datos de pacientes.

Derecho a la privacidad y consentimiento informado. Los autores declaran que en este artículo no aparecen datos de pacientes.

• Bibliografía

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