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Senologie - Zeitschrift für Mammadiagnostik und -therapie 2021; 18(02): 121-123
DOI: 10.1055/a-1327-6432
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Empfehlungen der Österreichischen Gesellschaft für Senologie zur Diagnostik und Therapie des duktalen Karzinoms in situ (= DCIS)

Michael Stierer
1   PK Döbling, Brustzentrum Wien
,
Angelika Reiner
2   Pathologisch-bakteriologisches Institut, Klinikum Donaustadt, Wien
,
Florian Fitzal
3   Universitätsklinik für Chirurgie, Medizinische Universität Wien/AKH, Comprehensive Cancer Center (CCC)
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Bildgebende Diagnostik

  1. Bestimmung der Ausdehnung der Läsion durch digitale Mammografieverfahren

  2. Ultraschall nur bei assoziierter Herdläsion und/oder Architekturstörung

  3. Präoperative MRT: a) bei bioptisch verifiziertem DCIS G2, 3 bei dichter Brust (ACR 3 und 4)

    • bei Verdacht auf Multizentrizität und Multifokalität [1].

  4. Clipmarkierung nach jeder Biopsie obligat!
    Vakuumbiopsie oder Corebiopsie (nur bei soliden Läsionen) [2] [3]

  5. Präoperative, bildgesteuerte Hakenmarkierung. Bei großen Läsionen (≥ 4 cm) und quardrantenüberragenden Läsionen Markierung der Tumorränder mit Haken an bis zu 3 Stellen empfohlen. Bildgebende Dokumentation der Lage der Haken

  6. Präparatradiografie zum Nachweis der kompletten Exzision von Mikroverkalkungen [4] – unmittelbare Nachexzision bei sehr knappem oder involviertem Schnittrand eventuell in Zusammenschau mit einem möglichen Gefrierschnitt vom verdächtigen Schnittrand

  7. Postoperative Kontrollmammografie bei Schnittrand ≤ 2 mm und ausgedehntem Mikrokalk – Verdacht auf Residualkalk (4 bis 6 Wochen postoperativ, Kompression der Brust bereits möglich) [5] [6].
    Postoperative MRT bei Schnittrand ≤ 2 mm und ausgedehntem non-mass enhancement im Rahmen eines präoperativen MRT (Verdacht auf Residualläsion)

  8. Jährliche Kontrollmammografie zum Ausschluss von Rezidiven und kontralateralem Karzinom.



Publication History

Article published online:
01 June 2021

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