Multiple Fremdkörper-Granulome nach Mastektomie und Anwendung eines Gewebeklebers vs. einer Drainage

Zusammenfassung

Ziel

Um nach Mastektomie die Seromproduktion zu verringern, wurden in den letzten Jahren u.a. Gewebekleber verwendet. Bei Patientinnen, bei denen intraoperativ TissuGlu zur Anwendung kam, wurde die postoperative Bildung multipler ungewöhnlicher sonografischer Herdbefunde beobachtet. Ziel dieser Studie war es, die sonografischen Kriterien dieser Herdbefunde zu beschreiben und, wenn möglich, histologisch zu untersuchen.

Material and Methode

98 Patientinnen wurden eingeschlossen. 49 erhielten eine Mastektomie mit TissuGlu und 49 eine Mastektomie mit Drainagen-Einlage. Bei der postoperativen Kontrolle wurden ungewöhnliche sonografische Herdbefunde beschrieben und histologisch gesichert.

Ergebnisse

Suspekte sonografische Herdbefunde kamen bei 87,8% der Patientinnen in der TissuGlu-Gruppe, allerdings nur bei 4% der Patientinnen in der Drainage-Gruppe zur Darstellung. Die Herdbefunde hatten durchschnittlich einen Durchmesser von 7,5 mm. Diese Herdbefunde waren echoarm bis echogleich, mit dorsaler Schallauslöschung, einer nicht umschriebenen Randkontur und einer horizontalen Achse. Alle histologisch untersuchten Herdbefunde (n = 29) waren gutartig. Eine granulomatöse Fremdkörper-Reaktion wurde histologisch in 63% der gesicherten Herdbefunde (n = 17) nachgewiesen, und in 18,5% der Herdbefunde (n = 5) zusätzlich Reste des adhäsiven Materials.

Schlussfolgerungen

Diese Studie konnte zeigen, dass die Verwendung von TissuGlu-Gewebekleber bei Mastektomie zur Bildung von Fremdkörper-Granulomen führen kann, teilweise auchmit Rückständen von Klebermaterial. Die beschriebenen sonografischen Kriterien dieser Herdbefunde werden Ärzten helfen, besser zwischen Granulomen und lokalen Rezidiven zu unterscheiden.

Abstract

Purpose

The use of tissue adhesive instead of a drain following mastectomy was a point of interest for many breast surgeons. Postoperative formation of multiple unusual sonographic lesions was observed in patients that underwent mastectomy with TissuGlu. The aim of this study was to describe the sonographic features of these lesions and, when possible, to examine them histologically.

Materials and Methods

This study includes 98 patients, 49 underwent mastectomy with the application of TissuGlu and 49 with drain insertion. Unusual postoperative sonographic findings were thoroughly described. A histological examination was carried out according to the guideline recommendations.

Results

Unusual sonographic findings were detected in 87.8% of patients in the TissuGlu group and in only 4% of the patients in the drain group. These lesions were detectable between 6 and 59 months postoperatively. 47 breasts of the TissuGlu group were classified as category 3, while only 2 breasts as category 4. Lesions were on average 7.5mm in diameter, echogenic or isoechoic with posterior shadowing, an irregular and ill circumscribed marginal contour, and a horizontal axis. All histologically examined lesions (n = 29) were benign. Granulomatous tissue was histologically proven in 63% of those lesions (n = 17), while residual adhesive material could be detected in 18.5% of lesions (n = 5).

Conclusion

The use of TissuGlu adhesive after mastectomy may cause the formation of unusual palpable granulomas, with or without residual adhesive materials. Sonographic description of lesions will help physicians to differentiate between granulomas and local relapse.

Schlüsselwörter

Lokalrezidiv - Gewebekleber - Tissuglu - AREAS, STRUCTURES & SYSTEMS - Brust - Granulom

Keywords

local recurrence - tissue adhesive - Tissuglu - AREAS, STRUCTURES & SYSTEMS - breast - granuloma

Publikationsverlauf

Artikel online veröffentlicht:
10. März 2025

• Literatur

• 1 Kumar S, Lal B, Misra MC. Post-mastectomy seroma: a new look into the aetiology of an old problem. J R Coll Surg Edinb 1995; 40: 292-294
• 2 Ohlinger R, Gieron L, Rutkowski R. et al. The Use of TissuGlu® Surgical Adhesive for Mastectomy With or Without Lymphonodectomy. In Vivo 2018; 32: 625-631
• 3 Udén P, Aspegren K, Balldin G. et al. Fibrin adhesive in radical mastectomy. Eur J Surg 1993; 159: 263-265
• 4 Paepke S, Sauter V, Ohlinger R. et al. Selective tissue adhesion reducing seroma formation in extensive breast surgery: The application of TissuGlu® – Only problematic case solver or possible standard procedure?. European Journal of Surgical Oncology (EJSO) 2014; 40: 621
• 5 Unger J, Rutkowski R, Kohlmann T. et al. Potential Risk Factors Influencing the Formation of Postoperative Seroma After Breast Surgery – A Prospective Study. Anticancer Res 2021; 41: 859-867
• 6 Walgenbach KJ, Bannasch H, Kalthoff S. et al. Randomized, prospective study of TissuGlu® surgical adhesive in the management of wound drainage following abdominoplasty. Aesthetic Plast Surg 2012; 36: 491-496
• 7 Eichler C, Dahdouh F, Fischer P. et al. No-drain mastectomy – Preventing seroma using TissuGlu®: A small case series. Ann Med Surg (Lond) 2014; 3: 82-84
• 8 Eichler C, Dahdouh F, Sauerwald A. et al. Seroma suppression using TissuGlu® in a high-risk patient post-mastectomy: a case report. J Med Case Reports 2013; 7: 138
• 9 Ohlinger R, Rutkowski R, Kohlmann T. et al. Impact of the Lysine-urethane Adhesive TissuGlu® on Postoperative Complications and Interventions After Drain-free Mastectomy. Anticancer Res 2020; 40: 2801-2812
• 10 Drugs@FDA: FDA-Approved Drugs [cited 2021]. https://www.accessdata.fda.gov/scripts/cder/daf/
• 11 Foreign body granuloma | DermNet NZ [cited 2021]. https://dermnetnz.org/topics/foreign-body-granuloma/
• 12 Bader W, Vogel-Minea CM, Blohmer JU. et al. Best Practice Guideline – DEGUM Recommendations on Breast Ultrasound. Ultraschall in Med 2022; 43: 570-582
• 13 Vogel-Minea CM, Bader W, Blohmer JU. et al. Best Practice Guideline – Empfehlungen der DEGUM zur Durchführung und Beurteilung der Mammasonografie. Ultraschall in Med 2023; 44: 520-536
• 14 Chala LF, Barros N de, Camargo Moraes P de. et al. Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings. Curr Probl Diagn Radiol 2004; 33: 106-126
• 15 Günther-Tritsch K, Bojahr B, Ohlinger R. Diagnostic value of palpation and ultrasonography for diagnosing breast cancer recurrence after mastectomy--a comparison. Ultraschall in Med 2009; 30: 577-584
• 16 Kim SM, Park JM. Normal and Abnormal US Findings at the Mastectomy Site. RadioGraphics Radiological Society of North America; 2004; 24: 357-365
• 17 Kim HJ, Kwak JY, Choi JW. et al. Impact of US surveillance on detection of clinically occult locoregional recurrence after mastectomy for breast cancer. Ann Surg Oncol 2010; 17: 2670-2676
• 18 Kerridge WD, Kryvenko ON, Thompson A. et al. Fat Necrosis of the Breast: A Pictorial Review of the Mammographic, Ultrasound, CT, and MRI Findings with Histopathologic Correlation. Radiol Res Pract 2015; 2015: 613139
• 19 Lee JH, Kim EK, Oh JY. et al. US screening for detection of nonpalpable locoregional recurrence after mastectomy. Eur J Radiol 2013; 82: 485-489
• 20 Pryce C, Owen W. Palpable Masses after Mastectomy: Differentiating Benign Postoperative Findings from Recurrent Disease. Journal of Breast Imaging 2020; 2: 501-510
• 21 Riebe E, Günther K, Schulz K. et al. Recurrent disease after breast preserving therapy (BPT) and radiation therapy for breast cancer--diagnostic yield of palpation, mammography and ultrasonography. Ultraschall in Med 2007; 28: 394-400
• 22 Wang Y, Liu D, Wu Z. Ultrasound May Help Detect Chest Wall Recurrence After Mastectomy at an Early Stage. J Ultrasound Med 2020; 39: 2339-2349
• 23 Rissanen TJ, Mäkäräinen HP, Mattila SI. et al. Breast cancer recurrence after mastectomy: diagnosis with mammography and US. Radiology 1993; 188: 463-467