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Previous issue date: 2016-05-30 / The Nipple-areolar Complex-sparing Mastectomy (NSM) enables rebuild a symmetrical and quite natural breast body. This technique can be a safe alternative to Modified Radical Mastectomy in patients with well-selected breast cancer and cause less impact on quality of life. However, NSM has its oncological safety questioned by the theoretical risk of persistence of breast fibroglandular tissue (BFT) along with the skin envelope and the nipple-areolar complex, which could increase the risk of recurrence. The objective of this study was to develop a methodology for determining the remaining BFT volume after NSM surgery using magnetic resonance imaging and through it, to evaluate the presence and the residual BFT volume of a group of patients. Descriptive statistical analysis of frequency, mean, standard deviation and confidence interval for the mean volume of BFT was performed using SPSS 17 program. Initially it was verified if that there was a difference between the results obtained on different hardware / manufacturers. It was tested whether there was a correlation between the resulting volume method and variables. For this sample we used the Shapiro-Wilk test and a significance level of 5%. The method developed in this paper for targeting the BFT used semi-automatic segmentation tools, based on level set and live wire, and other features available in MIPAV software. The methodology starts by pre-processing the images and the withdrawal of all tissues that do not constitute the BFT, called Regions of No-Interest (RNI). These tissues are excluded from the image and constitute the following regions: the breast implant (RNI-1), the skin (RNI-2), the fatty tissue (RNI-3) and the pectoralis muscle (RNI-4). The residual BFT volume was calculated in a sample of 18 breasts, with an mean volume of 1.47 ? 1.69 cm 3 (at least 0.12 cm3 and 7.11 cm3 maximum). The mean proportion of residual BFT volume in relation to the estimated total volume of the breast was 0.419 ? 0.328%. In spite of all patients show some amount of residual BFT, the proportion of the residual volume BFT in patients relative to the total volume of the breast was extremely low and could justify oncological safety of NSM demonstrated in previous retrospective studies. / A cirurgia de mastectomia preservadora de pele e de complexo ar?olo-papilar (MPPCAP) possibilita reconstruir um corpo mam?rio sim?trico e bastante natural. Esta t?cnica pode ser uma alternativa segura ? Mastectomia Radical Modificada em pacientes com C?ncer de Mama bem selecionadas, al?m de causar menor impacto na qualidade de vida. Contudo, a MPCCAP tem sua seguran?a oncol?gica questionada pelo risco te?rico de perman?ncia de tecido fibroglandular mam?rio (TFG), juntamente com o envelope cut?neo e o complexo ar?olo-papilar, o que poderia aumentar o risco de recidivas. O objetivo deste estudo foi desenvolver um m?todo para a determina??o do volume de TFG remanescente, ap?s cirurgia de MPPCAP, a partir de imagem por resson?ncia magn?tica e, atrav?s desta metodologia, avaliar a presen?a e o volume de TFG residual de um grupo de pacientes submetidas ? cirurgia de MPPCAP. A an?lise estat?stica descritiva de frequ?ncia, m?dia, desvio padr?o e intervalo de confian?a para o volume m?dio de TFG foi realizada atrav?s do programa SPSS 17. Inicialmente foi verificado se havia diferen?a entre os resultados obtidos em distintos equipamentos/fabricantes. Foi verificado se havia correla??es entre o volume resultante do m?todo e as vari?veis. Foi utilizado o teste de Shapiro-Wilk e um n?vel de signific?ncia de 5%. O m?todo desenvolvido, neste trabalho, para a segmenta??o do TFG utilizou ferramentas de segmenta??o semiautom?tica, baseadas nas ferramentas level set e live wire, al?m de outros recursos dispon?veis no software MIPAV. A metodologia inicia pelo pr?-processamento das imagens e pela retirada de todos os tecidos que n?o constituem o TFG, denominadas Regi?es de N?o Interesse (RNI). Esses tecidos s?o exclu?dos da imagem e constituem-se nas seguintes regi?es: a pr?tese mam?ria (RNI-1), a pele (RNI-2), o tecido gorduroso (RNI-3) e o m?sculo peitoral (RNI-4). O volume do TFG residual foi calculado em uma amostra de 18 mamas, com um volume m?dio de 1,47 ? 1,69 cm3 (m?nimo 0,12 cm3 e o m?ximo 7,11 cm3). A m?dia da propor??o do volume de TFG residual em rela??o ao volume total estimado da mama foi de 0,419 ? 0,328%, (m?nimo 0,0268% e m?ximo 1,067%). Apesar da totalidade das pacientes demonstrarem alguma quantidade de TFG residual, a propor??o do volume de TFG residual nas pacientes, relativa ao volume total da mama, foi extremamente baixo e poderia justificar a seguran?a oncol?gica da MPPCP demonstrada nos estudos retrospectivos anteriores.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/7067 |
| Date | 30 May 2016 |
| Creators | Zardo, Bianca Ceratti |
| Contributors | Silva, Ana Maria Marques da, Frasson, Ant?nio |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Gerontologia Biom?dica, PUCRS, Brasil, Instituto de Geriatria e Gerontologia |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 4438661476953179033, 600, 600, 600, 2296420844541114010, -969369452308786627 |
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