RADIOGUIDED PLACEMENT IN BREAST CANCER PATIENTS WITH IODINE-125 IMPLANTS IN BREAST AND AXILLARY TUMOR BEDS.

Mendes S. (Real e Benemérita Sociedade Beneficência Portugues), Rodrigues C. (Real e Benemérita Sociedade Beneficência Portugues), Gabure L. (Real e Benemérita Sociedade Beneficência Portugues), Rostelato M. E. C. M. (Real e Benemérita Sociedade Beneficên

Real e Benemérita Sociedade Beneficência Portuguesa de São PauloObjective: In our midst we still have women with advanced breast cancer (T3≥ and / or ≥ 2) or minor lesions T2 but with unfavorable breast / tumor, the mode of the surgical treatment would be mastectomy. With the advent of new drugs adjuvant chemotherapy (QTN) was now used in these cases with 80% of significant response and 40% with complete clinical response. For diagnostic tests tumors, regardless of whether the breasts or axilla should be submitted to biopsy (Core, Paaf, or mamotomy) and marking with a metallic clip to start QTN treatment. After termination of the QTN treatment the patient should be submitted to the surgical treatment of the breasts and axilla will be sent to the location of the lesions that may be by (ROLL) Technique-99 specific intratumoral radioguided technique (phytate), or the technique of location by introduction Of wire made by USG, MMG, or Magnetic Resonance (MRI). In cases of suspected initial non-palpable lesions after having undergone biopsy such as core, mamotomy, and placement of a metal clip, they will also undergo the same preoperative localization technique. The proposal is to implant a seed enriched with iodine -125 immediately in the biopsy of the initial lesions of the breast, in the advanced tumors pre-chemotherapy, and in the axils with lymph nodes that were diagnosed positive by biopsy or suspected by USG. These seeds being enriched with material Can be identified months after its implantation without causing any morbidity to the patient.Methods: seed consists of a small titanium capsule of 0.8mm external diameter 0.05 wall thickness and 4.5mm length. In its interior there is a silver wire of 0.5mm in diameter and 3mm in length, material to which the Iodine-125 is absorbed, is a gamma emitter with average energy of 29Kev, has half physical life 59.4days. The introduction of the radioactive seed will be in suspected early or advanced axillary and breast lesions through USG guided biopsy, or stereotactic via 18 gauge needle or equivalent. Immediately after the implant, imaging is performed to confirm the implant. For the detection of the seed will be used intra-operative gamma-probe equipmentResults: Thirty patients were implanted and ten patients with a non-palpable lesion were implanted in a bilateral lesion that obtained a 100% lesion location, allowing centralization of the seed in the operative part, facilitating the study of margins and in relation to the sensitivity of the probe compared to phytate and seed Was 0.5 cms against 2.0 to 2.5 cms of phytate. In twenty QTN patients received the seed, eleven ongoing nine operated five received breasts and axilla seeds and four only breasts. Those that implanted seeds in the armpit were also submitted to research of the sentinel lymph node with phytate and two were phytophore and seed in the same lymph nodeCONCLUSIONS: Radioactive seed implantation in breast lesions is economical, feasible, fast learning curve, safe, decreases the number of procedures for the patient, and can be detected months after implantationbreast cancer, radioactive seed, non-palpable breast lesion

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