1
|
Dhami A, Rutland CD, Momeni A, Waheed U. Acellular Dermal Matrix: Imaging Features With Histopathology Correlation. JOURNAL OF BREAST IMAGING 2024:wbae054. [PMID: 39248808 DOI: 10.1093/jbi/wbae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Indexed: 09/10/2024]
Abstract
Acellular dermal matrix (ADM) is an immunologically inert graft, typically from cadaveric skin, often used in postmastectomy breast reconstruction. Created from decellularized dermal tissues that have been treated to remove DNA and antigenic donor cells (leaving extracellular matrix), ADM is often used as a structural scaffold or sling to reinforce and support the structure and position of a breast implant during postoperative integration in implant-based breast reconstruction; ADM can also be used to fill cosmetic defects. Advantages of ADM use include improved cosmesis and reduced capsular contracture rates. On US, ADM can be seen as a subtle band with variable echogenicity adjacent to the implant. When folded on itself or redundant, ADM may present as a palpable oval mass with indistinct or circumscribed margins and variable echogenicity. On mammography, ADM can be seen as a circumscribed oval equal density mass when redundant and folded on itself; a layered appearance may be evident on tomosynthesis. On MRI, presence and absence of enhancement have been documented. Imaging findings likely vary depending on the degree of host tissue remodeling and incorporation, and when biopsied, histopathologically, ADM may be difficult to distinguish from scarring. Successful imaging diagnosis of ADM is aided by clinical knowledge of the intraoperative use and configuration of ADM, which may help differentiate ADM from new or recurrent malignancy and avoid unnecessary biopsy.
Collapse
Affiliation(s)
- Alysha Dhami
- Breast Imaging Division, Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| | - Cooper D Rutland
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - Arash Momeni
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Uzma Waheed
- Breast Imaging Division, Department of Radiology, Stanford University Medical Center, Stanford, CA, USA
| |
Collapse
|
2
|
Durando M, Ferrando PM, Dianzani C, Galioto F, Mariscotti G, Regini E, Bartoli G, Malan F, Bogetti P, Fonio P. Acellular dermal matrix imaging features in breast reconstructive surgery: a pictorial review. Br J Radiol 2024; 97:505-512. [PMID: 38419148 DOI: 10.1093/bjr/tqad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/29/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
Acellular dermal matrices (ADMs) are biological engineered tissues, which may provide an immunologically inert scaffold in breast reconstruction. Since the literature on imaging features of ADMs is limited, radiologists must be aware of the common imaging appearances of ADM, to differentiate normal conformation from residual or recurrent disease. Our purpose is to review the current role of ADMs in implant-based breast reconstruction, describing the normal imaging findings at ultrasound, mammography, and MRI also considering the possible changes over time. In this pictorial essay, we reviewed imaging features of ADMs described in the literature and we reported our experience in patients who underwent reconstructive surgery with human or animal ADM for newly diagnosed breast cancer.
Collapse
Affiliation(s)
- Manuela Durando
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Pietro Maria Ferrando
- Plastic Surgery Department; Presidio ospedaliero CTO - A. O. U. Città della Salute e della Scienza di Torino; Via Zuretti, 29, Torino, 10126, Italy
| | - Chiara Dianzani
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Francesca Galioto
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Giovanna Mariscotti
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Elisa Regini
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Germana Bartoli
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| | - Fabrizio Malan
- Plastic Surgery Department; Presidio ospedaliero CTO - A. O. U. Città della Salute e della Scienza di Torino; Via Zuretti, 29, Torino, 10126, Italy
| | - Paolo Bogetti
- Structure of Reconstructive and Aesthetic Plastic Surgery - University of Turin; Department of Surgical Sciences; Presidio Ospedaliero Molinette - A.O.U. Città della Salute e della Scienza di Torino; Torino, 10126, Italy
| | - Paolo Fonio
- Radiology - University of Turin; Department of Diagnostic Imaging and Interventional Radiology; Presidio Ospedaliero Molinette - A. O. U. Città della Salute e della Scienza di Torino; Via Genova 3, Torino, 10126, Italy
| |
Collapse
|
3
|
Breast Reconstruction after Mastectomy with the Use of an Implant and Serratus Anterior Fascia Flap-Initial Clinical Evaluation. J Pers Med 2021; 11:jpm11111142. [PMID: 34834494 PMCID: PMC8623064 DOI: 10.3390/jpm11111142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Prosthesis-based techniques are the predominant form of breast reconstruction worldwide. The most performed surgical technique involves the placement of the expander in a partial submuscular plane. The coverage of the implant remains a difficult management problem that can lead to complications and poor outcomes. The use of the serratus fascia flap may be the best choice to create a subpectoral pocket for the placement of a tissue expander, with excellent results in terms of morbidity and cost-effectiveness. A total of 20 breast reconstructions with the inferolateral coverage with the serratus fascia were performed. Patients demonstrated a low overall complication rate (9.5%), such as seroma and infection, with complete resolution during the follow-up and no major complications. The US examination of the soft tissues over the implant reported thickness measurements that demonstrated a good coverage over the inferolateral area. Our study shows that using the serratus fascia flap to create a pocket with the pectoralis major for the placement of the tissue expander is an effective technique during two-stage breast reconstruction. The resulting low rate of morbidity and the US findings collected reveal the safety of this procedure. Its success relies on appropriate patient selection and specific intraoperative technique principles.
Collapse
|
4
|
Dong YC, Bouché M, Uman S, Burdick JA, Cormode DP. Detecting and Monitoring Hydrogels with Medical Imaging. ACS Biomater Sci Eng 2021; 7:4027-4047. [PMID: 33979137 PMCID: PMC8440385 DOI: 10.1021/acsbiomaterials.0c01547] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hydrogels, water-swollen polymer networks, are being applied to numerous biomedical applications, such as drug delivery and tissue engineering, due to their potential tunable rheologic properties, injectability into tissues, and encapsulation and release of therapeutics. Despite their promise, it is challenging to assess their properties in vivo and crucial information such as hydrogel retention at the site of administration and in situ degradation kinetics are often lacking. To address this, technologies to evaluate and track hydrogels in vivo with various imaging techniques have been developed in recent years, including hydrogels functionalized with contrast generating material that can be imaged with methods such as X-ray computed tomography (CT), magnetic resonance imaging (MRI), optical imaging, and nuclear imaging systems. In this review, we will discuss emerging approaches to label hydrogels for imaging, review the advantages and limitations of these imaging techniques, and highlight examples where such techniques have been implemented in biomedical applications.
Collapse
Affiliation(s)
- Yuxi C Dong
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Mathilde Bouché
- Université de Lorraine, CNRS, L2CM UMR 7053, F-54000 Nancy, France
| | - Selen Uman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Jason A Burdick
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - David P Cormode
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| |
Collapse
|
5
|
Postsurgical Ultrasound Evaluation of Patients with Prosthesis in Acellular Dermal Matrix: Results from Monocentric Experience. Int J Surg Oncol 2019; 2019:7437324. [PMID: 31316828 PMCID: PMC6601478 DOI: 10.1155/2019/7437324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/23/2019] [Indexed: 11/18/2022] Open
Abstract
Mastectomy and breast prosthetic reconstruction is the most common surgical treatment for women diagnosed with breast cancer. In the last few years, breast prosthetic augmentation in acellular dermal matrix (ADM) has been introduced. The aim of this study is to present our single-center experience in evaluating the outcome of patients who underwent breast reconstruction in ADM, using ultrasound (US) examination. US follow-up allows evaluating both normal postoperative findings and changes and potential local complications, demonstrating that ADM is a safe option for women candidates for mastectomy.
Collapse
|
6
|
Zhang D, Tan QW, Luo JC, Lv Q. Evaluating the angiogenic potential of a novel temperature-sensitive gel scaffold derived from porcine skeletal muscle tissue. ACTA ACUST UNITED AC 2018; 13:055003. [PMID: 29724961 DOI: 10.1088/1748-605x/aac275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our previous study fabricated decellularized porcine muscle tissues (DPMTs) and demonstrated that DPMTs with few cell residues possess highly preserved protein components and good biocompatibility. In the physical state, skeletal muscle equips an abundant vascular network due to the vast demand of energy from aerobic metabolism. Vascular bioactive factors which are rich in skeletal muscle tissues may contribute to the angiogenic effect of DPMTs. However, implanting DPMTs in vivo in a less invasive way is unfeasible. Hence, the purpose of this study was to fabricate DPMTs into hydrogel and investigate the effects of DPMT gel on promoting neovessel formation in vitro and in vivo. The results demonstrated that the surface topographies of the DPMT gel were looser and more homogeneous than the DPMTs. The rates of retained VEGF, bFGF, and PDGF-BB in DPMT gel were almost half of the corresponding content in fresh skeletal muscle tissues. Human umbilical endothelial cells displayed better proliferation ability and enhanced the formation of neovascular loops when seeded on DPMT gel compared to small intestinal submucosa gels at the same concentration of 2% (W/V). Furthermore, the increased neovessel formation was detected after subcutaneous injection of DPMT gel. Taken together, these findings suggested that DPMT gel may possess the potential of promoting neovascular formation.
Collapse
Affiliation(s)
- Di Zhang
- Department of Breast Surgery, Clinical Research Center for Breast, West China Hospital, Sichuan University, Chengdu, People's Republic of China. Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | | | | | | |
Collapse
|
7
|
Lee CU, Bobr A, Torres-Mora J. Radiologic-Pathologic Correlation: Acellular Dermal Matrix (Alloderm ®) Used in Breast Reconstructive Surgery. J Clin Imaging Sci 2017; 7:13. [PMID: 28515964 PMCID: PMC5385699 DOI: 10.4103/jcis.jcis_7_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022] Open
Abstract
Acellular dermal matrix (ADM) such as Alloderm® is sometimes used in tissue reconstruction in primary and reconstructive breast surgeries. As ADM is incorporated into the native tissues, the evolving imaging findings that would correlate with varying degrees of host migration and neoangiogenesis into the matrix can be challenging to recognize. In the setting of a palpable or clinical area of concern after breast reconstructive surgery following breast cancer, confident diagnosis of a mass representing ADM rather than recurring or developing disease can be challenging. Such diagnostic imaging uncertainties generally result in short-term imaging and clinical follow-up, but occasionally, biopsy is performed for histopathological confirmation of benignity. A case of biopsy-proven Alloderm® is described. To the best of our knowledge, this is the first radiologic-pathologic correlation of ADM in the literature.
Collapse
Affiliation(s)
| | - Aleh Bobr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Wang Y, Fan W, Zhao S, Zhang K, Zhang L, Zhang P, Ma R. Qualitative, quantitative and combination score systems in differential diagnosis of breast lesions by contrast-enhanced ultrasound. Eur J Radiol 2015; 85:48-54. [PMID: 26724648 DOI: 10.1016/j.ejrad.2015.10.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/14/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the feasibility of score systems in differential diagnosis of breast lesions by contrast-enhanced ultrasound (CEUS). METHODS CEUS was performed in 121 patients with 127 breast lesions by Philips iU22 with Sonovue as contrast agent. Pearson Chi-square χ(2) test, binary logistic regression analysis and Student's t-test are used to identify significant CEUS parameters in differential diagnosis. Based on these significant CEUS parameters, qualitative, quantitative and combination score systems were built by scoring 1 for benign characteristic and scoring 2 for malignant characteristic. Receiver operating characteristic (ROC) curve was applied to evaluate the diagnostic efficacy of different analytical methods. RESULTS Pathological results showed 41 benign and 86 malignant lesions. Qualitative analysis and logistic regression analysis showed that there are significant differences in enhancement degree, enhancement order, internal homogeneity, enhancement margin, surrounding vessels and enlargement of diameters (P<0.05) between benign and malignant lesions. Quantitative analysis indicated that malignant lesions tended to show higher peak intensity (PI), larger area under the curve (AUC) and shorter time to peak (TTP) than benign ones (P<0.05). Qualitative score systems showed higher diagnostic efficacy than single quantitative CEUS parameters. The corresponding area under the ROC curve for qualitative, quantitative and combination score systems were 0.897, 0.716 and 0.903 respectively. Z test showed that area under the ROC curve of quantitative score system was statistically smaller than that of other score systems. CONCLUSIONS Quantitative score system helps little in improving the diagnostic efficacy of CEUS. While qualitative score system improves the performance of CEUS greatly in discrimination of benign and malignant breast lesions. The application of qualitative could develop the diagnostic performance of CEUS which is clinically promising.
Collapse
Affiliation(s)
- YongMei Wang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, China.
| | - Wei Fan
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China.
| | - Song Zhao
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, China.
| | - Kai Zhang
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, China.
| | - Li Zhang
- Department of Health Care Ultrasound, Qilu Hospital of Shandong University, Jinan, China.
| | - Ping Zhang
- Department of Health Care Ultrasound, Qilu Hospital of Shandong University, Jinan, China.
| | - Rong Ma
- Department of Breast Surgery, Qilu Hospital of Shandong University, Jinan, China.
| |
Collapse
|
9
|
Jacobs JM, Salzberg CA. Implant-based breast reconstruction with meshes and matrices: biological vs synthetic. Br J Hosp Med (Lond) 2015; 76:211-6. [PMID: 25853352 DOI: 10.12968/hmed.2015.76.4.211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article presents an overview of the different acellular dermal matrices and synthetic meshes used in modern-day primary and secondary implant-based breast reconstruction. Case examples are given, along with a description of the senior author's pioneering direct-to-implant reconstruction.
Collapse
Affiliation(s)
- Jordan Ms Jacobs
- Assistant Professor of Plastic Surgery, Mount Sinai Medical System, New York, NY, USA
| | | |
Collapse
|