EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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Breast cancer (malignant breast neoplasm - MBN) is one of the leading causes of women’s death in most countries. Mass screening of females based on high sensitivity mammography allows detecting different tumor phases including саrcinoma in situ which can be cured with modern organ-preserving surgery.

There is a biopsy method consisting of lumpectomy and minimally invasive elimination of “small” breast tumors by way of dissecting skin a little, introducing under ultrasound control a device containing a stylet and trocar sleeve, then vacuum soaking and, finally, manifold excision of tissue fragments (device for breast biopsy named EnCore manufactured by American company SenoRx). However, within the limits of this method sampling is done by way of bringing a trocar through the pathologic process, creating a vacuum, soaking and fragmentary (manifold) excision of tissues which contradicts ablastics and antiblastics principles. In vacuum the biological material pollutes the expensive device.

Research Objective – to provide ablastics and completeness of minimally invasive elimination of breast tumors, to improve the adequacy of ultrasound visualization, to cut down expenses, to reduce surgical intervention.

Research Methods. One dissects skin up to 2 cm indepth, pulls apart the wound edges and introduces a device which allows to fix reliably a pathologic focus with a cryogenic stylet, to turn the focus into an “ice ball”, then to excise and remove it by way of retraction of the cryogenic stylet together with the “ice ball” into the cylinder with the help of a handle (Fig.1).

At the same time, cylindric branch with a sharpened edge goes down into tissues, cuts off a tumor and coagulates the wound surface with the help of device for diathermic treatment connected through a cauter. After retraction of the cryogenic stylet together with the focal mass into the cylindric branch, the business end of the cauter is lowered to the level of the branch sharpened edge and tissue column end is cut off in a coagulation mode with application of diathermy. The device is pulled out of the wound. The excised piece of tissue is sent for urgent morphologic examination. Hemostasis control. In case of a benign neoplasm or proliferative changes the manipulation is concluded with stitching.

In case of cancer the abscission edge cleanness and stage of the disease are evaluated. Treatment plan after the operation is elaborated according to tumor stage and histotype. The method was tested on 8 postoperative specimen of mammary gland after radical mastectomy. Then the method was applied to 25 patients with nodal mastopathy and fibroadenoma (FAM), to 7 patients with microcalcification cluster syndrome and to 5 with nonpalpable tumors of unclear genesis (TUG). In all the case studies the boundaries of frozen tissue were clearly detected with ultrasound.

No complications occurred after minimally invasive elimination of pathologic foci, neither did the problems in morphologic examinations. Average time needed for minimally invasive elimination of a focus (from skin dissection to stitching) made up 12±3,0 minutes, while analogous elimination of palpable abnormalities with the device EnCore manufactured by American company SenoRx takes up to one hour. The method offered is little traumatic, fixes pathologic focus in a reliable way, handy to work with and doesn’t require expensive disposable instruments.

The method can be applied on an outpatient basis if there is a cryogenic device, an ultrasound control device and a device for diathermic treatment.

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