Dokument: Einflussfaktoren für Restdrüsenparenchym der Mamma nach risikoreduzierender Mastektomie bei genetisch Disponierten, detektiert durch MRT Mammographie: Ergebnisse einer monozentrischen Studie
| Titel: | Einflussfaktoren für Restdrüsenparenchym der Mamma nach risikoreduzierender Mastektomie bei genetisch Disponierten, detektiert durch MRT Mammographie: Ergebnisse einer monozentrischen Studie | |||||||
| Weiterer Titel: | Influencing factors for residual glandular tissue of the breast after risk-reducing mastectomy in genetically predisposed patients, detected by MRI Mammography: Results of a monocentric study | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=64086 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20231113-111634-1 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Kolberg, Leoni Kristin [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. med. Fehm, Tanja N. [Gutachter] Prof. Dr. med. Antoch, Gerald [Gutachter] | |||||||
| Dokumententyp (erweitert): | Dissertation | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Restdrüsenparenchym (engl. Residual glandular tissue, RGT) der Mamma nach risikoreduzierender
Mastektomie ist für Patientinnen mit familiärer Disposition mit einem nicht exakt bestimmbaren Mammakarzinomrisiko behaftet. Da diese Patientinnen nicht mehr in intensivierte Früherkennungsprogramme inkludiert werden, sollte das Restrisiko für ein Rezidiv bestmöglich abschätzbar sein. Unsere monozentrische Studie untersucht Einflussfaktoren für postoperatives Restdrüsenparenchym mit besonderem Augenmerk auf der Operationsmethode. Genutzt wurden Mamma-MRT-Aufnahmen von 2006 bis 2022. Die Erfassung des verbliebenen Hautmantels erfolgte mittels Abstandsmessungen an 8 gleichverteilten, uhrzeigersinnigen Punkten sowie retromamillär, weiterhin anhand von Volumetrien jeder Mamma. Vorhandenes RGT wurde ebenfalls volumetriert. Darüber hinaus wurden patientinnenbezogene Kovariablen erfasst und deren Einfluss auf postoperatives Restdrüsenparenchym sowie den Hautmantel uni- und multivariat untersucht. Analysiert wurden 117 Mammae, davon 63 links und 54 rechts aus einer Kohorte von 81 Patientinnen mit uni- (n = 36) oder bilateraler (n = 45) risikoreduzierender Mastektomie, allesamt Trägerinnen einer pathogenen Mutation (BRCA1 (n = 49), BRCA2 (n = 24), andere pathogene Mutation (n = 9)). Die Testung erfolgte entweder im Zentrum Familiärer Brust- und Eierstockkrebs des Universitätsklinikum Düsseldorf, oder im Vorhinein an einem anderen Standort und die Ergebnisse der dortigen Testung wurden mit Einverständnis der jeweiligen Patientin übermittelt. Die Patientinnen waren durchschnittlich 40,12 Jahre alt, das Follow-Up war im Mittelwert 61,3 Monate lang. 99 Mammae (84,6 %) wurden als Nipple-Sparing Mastektomie (NSM) operiert, davon 72 (61,5 %) mittels Inframammärschnitt. Skin-Sparing Mastektomien wurden bei 18 Beobachtungen (15,4 %) durchgeführt. Bei 50 Beobachtungen (42,74 %) konnte Restdrüsenparenchym detektiert werden. Die größte Menge, die volumetrisch erfasst wurde, war 5,5 ml, die kleinste 0,1 ml, der Mittelwert 1,58 ml. Alle Fälle postoperativen Restdrüsenparenchyms traten bei Nipple-Sparing Mastektomien auf. Eine hohe Brustdichte, große postoperative Hautmanteldurchmesser, die Operationsmethode Inframammärschnitt-NSM, kleine Brustvolumina sowie eine geringe Erfahrung des/ der OperateurIn führten zu mehr RGT. Aufgrund des starken Effekts des Hautmantels auf RGT, wurden auch Einflussfaktoren hierfür untersucht. Große Brustvolumina, eine niedrige Brustdichte sowie eine geringe Erfahrung des/ der OperateurIn führten zu breiteren Hautmanteldurchmessern.Residual glandular tissue of the breast after risk-reducing mastectomy is associated with an imprecisely determinable risk of breast cancer for patients with familial predisposition. Since these patients are no longer included in intensified screening programs, the residual risk should be determined as best as possible. Our monocentric study in-vestigates factors influencing postoperative residual glandular tissue with special regard to surgical method. Breast MR images (MRI) from 2006 to 2022 were used to assess the remaining skin flap thickness by distance measurements at 8 equally distributed, clockwise points and retro-mamillary, as well as by volumetrics of each mamma. Residual glandular tissue was also volumetrized. In addition, patient-related covariates were recorded and their influence on postoperative residual glandular tissue and skin flap thickness was analysed by uni- and multivariate regression. Analysed were 117 breast MRIs, 63 left and 54 right, from a cohort of 81 patients with unilateral (n = 36) or bilateral (n = 45) risk-reducing mastectomy, all carriers of a pathogenic mutation (BRCA1 (n = 49), BRCA2 (n = 24), or further mutation (n = 9)). Testing was performed either at the Familial Breast and Ovarian Cancer Center of the Universitätsklinikum Düsseldorf, or in advance at another site and the test results were transmitted with the consent of the respective patient. Patients were on average 40,12 years of age, with a mean follow-up of 61,3 months. In ninety-nine (84,6 %) cases, the surgery was performed as nipple-sparing mastectomies (NSM), 72 (61,5 %) of them by inframammary incision. Skin-sparing mastectomies (SSM) were performed in 18 cases (15,4 %). Residual glandular tissue was detected in 50 cases (42,74 %). The largest amount of residual glandular tissue, detected volumetrically, was 5.5 ml, the smallest was 0.1 ml, and the mean was 1.58 ml. All cases of residual glandular tissue occurred after nipple-sparing mastectomies. High breast density, large postoperative skin flaps, the surgical method inframammary fold incision NSM, small breast volumes, and low surgical experience led to more RGT. Because of the strong effect of skin flap thickness on RGT, factors influencing this were also investigated. Large breast volumes, low breast density, and low surgical experience resulted in larger skin flap diameters. | |||||||
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| Lizenz: |  Dieses Werk ist lizenziert unter einer Creative Commons Namensnennung 4.0 International Lizenz | |||||||
| Bezug: | 2021-2023 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 13.11.2023 | |||||||
| Dateien geändert am: | 13.11.2023 | |||||||
| Promotionsantrag am: | 09.06.2023 | |||||||
| Datum der Promotion: | 07.11.2023 |
