Browsing by Subject "yleiskirurgia"

Sort by: Order: Results:

Now showing items 1-1 of 1
  • Niinikoski, Laura (Helsingin yliopisto, 2020)
    Background: The aim of the thesis is to assess different surgical and biopsy techniques, which can help to treat breast cancer patients with less invasive methods. Material and methods: The thesis comprises four original retrospective studies. All study patients were treated at the Breast Surgery Unit of Helsinki University Hospital 2010-2016. Study I evaluated the feasibility of Breast Lesion Excision System (BLES) procedure in the treatment of breast lesions (n=80) with a needle biopsy –based suspicion of an intraductal papilloma. In studies II and III 1800 breast cancer patients underwent breast conserving surgery (BCS). Study II compared reoperations due to insufficient surgical margins and local recurrences (LR) after conventional or oncoplastic BCS and study III after BCS using radioguided occult lesion localization (ROLL) or radioactive seed localization (RSL). In study IV patients (n=507) with primary invasive breast cancer and axillary nodal metastasis preoperatively diagnosed by ultrasound (US)-guided needle biopsy underwent breast surgery and axillary lymph node dissection. The aim was to determine which factors were related to high nodal tumour burden in clinically node-positive breast cancer patients and to construct a predictive tool for evaluating the patient-specific risk of having >2 axillary lymph node metastases (LNM). Results: In study I, the BLES biopsy diagnosis was a benign intraductal papilloma or other benign in 61 lesions, 10 lesions were upgraded to high-risk tumours and five to malignancy. Four procedures failed, no major complications occurred. In study II, 1189 patients underwent conventional BCS and 611 oncoplastic BCS. Patients with oncoplastic BCS were younger, they had more often multifocal, larger and more aggressive tumours. There was no difference, however, in reoperation rates or in local recurrence-free survival (LRFS) between the groups during the follow-up. In study III, 318 patients underwent ROLL and 426 RSL. The reoperation rate or the 5-year LRFS was not different between these groups. In study IV, 153 patients had 1-2 LNM and 354 >2 LNMs. Patient’s age, larger size and lymphovascular invasion of the primary tumour, extracapsular extension of the LNMs, and morphology of the lymph nodes in US were the factors, which remained statistically significantly associated with >2 LNMs. These factors were included in the predictive model. Conclusions: The BLES procedure is an acceptable method for the management of small benign and high-risk breast lesions. Thus, a great amount of diagnostic surgical biopsies can be avoided. Oncoplastic BCS is as safe as conventional BCS, though it is used for larger, multifocal and more aggressive tumours. It enables BCS for patients who otherwise were candidates for mastectomy. Reoperation rates and LRFS were comparable for ROLL and RSL in patients with impalpable breast cancer treated with BCS. The 4th study provides a well performing patient-specific prediction model for evaluating the nodal tumour burden in clinically node-positive breast cancer patients. The prediction model could be helpful in the decision-making on the optimal axillary treatment in these patients.