000			07421namaa22004451i 4500
003			OSt
005			20250723130152.0
008			250610s2024 ua a|||frm||| 000 0 eng d
040			_aEG-GICUC _beng _cEG-GICUC _dEG-GICUC _erda
041	0		_aeng _beng _bara
049			_aDeposit
082	0	4	_a616.99449059
092			_a616.99449059 _221
097			_aPh.D
099			_aCai01.19.04.Ph.D.2024.Mi.I
100	0		_aMichael Farid Fouad Abdelmalik, _epreparation.
245	1	0	_aImage-guided breast conserving surgery : _bA Randomized Controlled Trial / _cby Michael Farid Fouad Abdelmalik ; Supervisors Prof. Sherif Naguib, Prof. Ahmed Farahat, Dr. Tarek Hashim, Dr. Amira Hamed Radwan.
246	1	5	_aالاستئصال التحفظي للثدي عن طريق الأشعة
264		0	_c2024.
300			_a80 pages : _billustrations ; _c25 cm. + _eCD.
336			_atext _2rda content
337			_aUnmediated _2rdamedia
338			_avolume _2rdacarrier
502			_aThesis (Ph.D)-Cairo University, 2024.
504			_aBibliography: pages 61-80.
520	3		_aBackground: Breast-conserving surgery (BCS) has gained wide acceptance as the treatment of choice for early-stage breast cancer. One of the primary goals of BCS is to obtain tumor-free resection margins. In practice, the excision of a palpable breast carcinoma is guided by preoperative diagnostic images and the intraoperative tactile skills of the surgeon. The somewhat ‘blind’ approach of using palpation-guided surgery is known to be highly inaccurate, with studies worldwide reporting positive resection margins in up to 41% of patients. In recent years, ultrasonography has emerged as an effective guidance tool during surgery and ultrasound-guided surgery has been introduced into breast cancer surgery as a method of excising nonpalpable breast cancer. In light of the advantages when applied to nonpalpable masses, ultrasound-guided surgery for palpable breast cancer should similarly decrease margin positivity and excision volumes. Objective: The aim of this study is comparing ultrasound-guided vs palpation-guided conservative breast surgery in obtaining tumor-free resection margins and achieving a satisfactory cosmetic outcome. Methods: This study was a prospective randomized controlled clinical trial where patients with early breast cancer (T1-T2) and eligible for breast conserving surgery are randomly assigned (1:1) into two arms. Arm A: included the patients who will undergo ultrasound-guided breast conserving surgery. Arm B: included the patients who will undergo the conventional palpation-guided breast conserving surgery. Results: Overall, 142 patients undergoing breast conserving surgery were enrolled: 71 were allocated to the Ultrasound-guided (US) group (Arm A) and 71 to the Palpation-guided (PG) group (Arm B). Patient and tumor characteristics were comparable between the two groups. Age, Body mass index, tumor laterality, tumor location and tumor stage were comparable in both groups and statistically insignificant. Despite that the final tumor size was comparable between both groups, IOUS significantly reduced the main specimen volume and the least negative margin width (p<0.001). The median operative time was significantly longer in the US group bey around 27 min than in the PG group and this was statistically significant in favor of the PG surgery (p<0.001). The involved resection margin rate was significantly higher in the PG group and thus the need for reoperation (p<0.001). Postoperative complications rate was also comparable between the US group and the PG group. As regards the cosmetic results, patients filled out a self-evaluation questionnaire and the data was interpreted using BCCT.core software. The results were highly in favour of the US group with more patient satisfaction and better results than in the PG group (p<0.001). Conclusion: IOUS is the only method allowing a true real-time visualization and continuous control of resection margins during all phases of BCS. In our single-institution study, IOUS demonstrated clear superiority over palpation-guided surgery in both oncological and surgical outcomes except for the operative time (smaller excision volume yet, with optimum resection margins and better cosmetic outcome). IOUs provides much better tumor localization in small breasts with dense fibroadenosis. Since all the other available localization techniques (including palpation) limit the surgeon’s visual guidance during BCS, IOUS could be regarded as one of the most significant modern technological innovations in the field of breast cancer surgery, restoring sight to the breast surgeon. Our findings strongly suggests that the integration of IOUS in breast conserving surgery could be regarded as a highly beneficial surgical approach.
520	3		_aاكتسبت الجراحة التحفظية للثدي قبولًا واسعًا باعتبارها العلاج المفضل لسرطان الثدي في المراحل المبكرة على مدى العقود الماضية، تم تحقيق تقدم في التشخيص المبكر من خلال زيادة وعي المريض، وتصوير الثدي بالأشعة السينية على نطاق واسع وتقنيات التصوير المحسنة. وقد أدى ذلك إلى زيادة في معدل الاستئصال التحفظي للثدي ويمكن الآن تقديم هذه الإجراءات بأمان لمعظم مرضى سرطان. الثدي. أحد الاهداف الرئيسية للاستئصال التحفظي للثدي هو الحصول على حواف امان خالية من الورم. ومن الاهداف الثانوية المهمة هو تحقيق نتيجة تجميلية مرضية. حظيت النتيجة التجميلية للجراحة التحفظية للثدي باهتمام متزايد في السنوات الأخيرة. بسبب العلاقة الوثيقة مع رفاهية المريض ونوعية الحياة. سيتم تصميم هذه الدراسة لمقارنة فعالية الجراحة الموجهة عن طريق الموجات الصوتيه في سرطان الثدي الغازي الملموس مع الجراحة المعيارية الموجهه بالجس بما في ذلك النتائج الرئيسية لحواف الامان المرتبطة بالورم وكميه الانسجة السليمة المستأصلة مع الورم. وكذلك الأهداف الثانوية من تقييم النتيجة التجميلية للجراحة باستخدام كل من التقييم الذاتي للمريض والتقييم عن طريق برنامج BCCT.Core.
530			_aIssues also as CD.
546			_aText in English and abstract in Arabic & English.
650		0	_abreast surgery
653		1	_abreast cancer _aimage _aguided _asurgical margin _apalpation-guided _abreast _aconserving _afrozen _acosmetic outcome
700	0		_aSherif Naguib _ethesis advisor.
700	0		_aAhmed Farahat _ethesis advisor.
700	0		_aTarek Hashim _ethesis advisor.
700	0		_aAmira Hamed Radwan _ethesis advisor.
900			_b01-01-2024 _cSherif Naguib _cAhmed Farahat _cTarek Hashim _cAmira Hamed Radwan _UCairo University _FNational Cancer Institute _DDepartment of surgical oncology
905			_aShimaa _eEman Ghareb
942			_2ddc _cTH _e21 _n0
999			_c172484