RESUMEN
OBJECTIVE: This study aimed to perform a meta-analysis to investigate the diagnostic safety and accuracy of Ultrasound-Guided Core Needle Biopsy (US-CNB) Axillary Lymph Nodes (ALNs) region in patients with Breast Cancer (BC). METHODS: The authors searched the electronic databases PubMed, Scopus, Embase, and Web of Science for clinical trials about US-CNB for the detection of ALNs in breast cancer patients. The authors extracted and pooled raw data from the included studies and performed statistical analyses using Meta-DiSc 1.4 and Review Manager 5.3 software. A random effects model was used to calculate the data. At the same time, data from the Ultrasound-guided Fine-Needle Aspiration (US-FNA) were introduced for comparison with the US-CNB. In addition, the subgroup was performed to explore the causes of heterogeneity. (PROSPERO ID: CRD42022369491). RESULTS: In total, 18 articles with 2521 patients were assessed as meeting the study criteria. The overall sensitivity was 0.90 (95% CI [Confidence Interval], 0.87â0.91; p = 0.00), the overall specificity was 0.99 (95% CI 0.98â1.00; p = 0.62), the overall area under the curve (AUC) was 0.98. Next, in the comparison of US-CNB and US-FNA, US-CNB is better than US-FNA in the diagnosis of ALNs metastases. The sensitivity was 0.88 (95% CI 0.84â0.91; p = 0.12) vs. 0.73 (95% CI 0.69â0.76; p = 0.91), the specificity was 1.00 (95% CI 0.99â1.00; p = 1.00) vs. 0.99 (95% CI 0.67â0.74; p = 0.92), and the AUC was 0.99 vs. 0.98. Subgroup analysis showed that heterogeneity may be related to preoperative Neoadjuvant Chemotherapy (NAC) treatment, region, size of tumor diameter, and the number of punctures. CONCLUSION: US-CNB has a satisfactory diagnostic performance with good specificity and sensitivity in the preoperative diagnosis of ALNs in BC patients.
Asunto(s)
Neoplasias de la Mama , Humanos , Femenino , Metástasis Linfática/patología , Neoplasias de la Mama/patología , Biopsia con Aguja Gruesa , Axila/patología , Sensibilidad y Especificidad , Ganglios Linfáticos/diagnóstico por imagen , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Ultrasonografía Intervencional , Estudios RetrospectivosRESUMEN
OBJECTIVE: Tumor-to-skin distance is known to have an effect on axillary lymph node metastasis but has no clinical use with nomograms. This study aimed to investigate the effect of tumor-to-skin distance on axillary lymph node metastasis alone and in combination with nomogram for clinical use. METHODS: A total of 145 patients who underwent surgery for breast cancer (T1-T2 stage) and whose axillary lymph nodes were evaluated (axillary dissection or sentinel lymph node biopsy) between January 2010 and December 2020 were included in the study. Tumor-to-skin distance and other pathological data of the patients were evaluated. RESULTS: Of the 145 patients, 83 (57.2%) had metastatic lymph nodes in the axilla. Tumor-to-skin distance was different in terms of lymph node metastasis (p=0.045). In the receiver operating characteristic curve for tumor-to-skin distance, area under curve was 0.597 (95%CI 0.513-0.678, p=0.046), area under curve of the nomogram was 0.740 (95%CI 0.660-0.809), p<0.001) and nomogram+tumor-to-skin distance was 0.753 (95%CI 0.674-0.820), p<0.001). No statistical difference was found for axillary lymph node metastasis between the nomogram+tumor-to-skin distance and the nomogram alone (p=0.433). CONCLUSION: Although tumor-to-skin distance demonstrated a significant difference in axillary lymph node metastasis, it had a poor association with an area under curve value of 0.597 and did not produce a significant improvement in predicting lymph node metastasis when combined with the nomogram. The tumor-to-skin distance may be unlikely to enter clinical practice.
Asunto(s)
Neoplasias de la Mama , Humanos , Femenino , Metástasis Linfática/patología , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Axila/patología , Biopsia del Ganglio Linfático Centinela , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Escisión del Ganglio Linfático , Curva ROC , Estudios RetrospectivosRESUMEN
BACKGROUND: The use of neoadjuvant chemotherapy (NAC) in less aggressive breast cancer (BC) is controversial. OBJECTIVE: To investigate the effect of neoadjuvant chemotherapy in HER2 negative luminal B breast cancer. PATIENTS AND METHODS: Patients between January 2016 and December 2021 were retrospectively evaluated. RESULTS: A total of 128 patients were included in the study. Patients with pathological complete response (pCR) were younger and had higher ki67 levels. Cutoff levels for ki67 based on pCR and ypT status were ≤ 40% and ≤ 35%, respectively. According to pre-NAC magnetic resonance imaging findings, only mastectomy was viable in 90 patients, but after NAC breast-conserving surgery (BCS) was possible in 29 (32%). Moreover, 68.5% became eligible for sentinel lymph node biopsy (SLNB) after NAC. Since SLNB was positive in 45 (54.2%), axillary lymph node dissection (ALND) was performed and the remainder, 38 (31.4%), avoided ALND. CONCLUSION: In patients with Luminal B, HER2(-) BC a low pCR rate should not discourage the use of NAC. The ki67 level is a guide for individualizing treatment. Especially in young patients with high ki67 levels, NAC increases the chance of breast-conserving surgery and may spare patients from ALND.
ANTECEDENTES: El uso de quimioterapia neoadyuvante (QTN) en cáncer de mama (CB) menos agresivo es controversial. OBJETIVO: Investigar el efecto de la quimioterapia neoadyuvante en el cáncer de mama HER2 negativo luminal B. MÉTODO: Se evaluaron retrospectivamente pacientes entre enero de 2016 y diciembre de 2021. RESULTADOS: Se incluyeron 128 pacientes. Los valores de corte para ki67 basados en el estado de respuesta patológica completa y el estadio tumoral tras la quimioterapia neoadyuvante fueron ≤ 40% y ≤ 35%, respectivamente. Según los hallazgos de la resonancia magnética previa a la quimioterapia neoadyuvante, la mastectomía solo fue viable en 90 pacientes, pero después de la quimioterapia neoadyuvante la cirugía conservadora de la mama fue posible en 29 (32%). Además, el 68.5% se volvieron elegibles para biopsia del ganglio linfático centinela después de la quimioterapia neoadyuvante, y se evitó la disección de ganglios linfáticos axilares en 38 pacientes (31.4%). CONCLUSIONES: En las pacientes con cáncer de mama HER2 negativo luminal B, una tasa baja de respuesta patológica completa no debe desalentar el uso de quimioterapia neoadyuvante. En especial en pacientes jóvenes con niveles altos de ki67, la quimioterapia neoadyuvante aumenta la posibilidad de una cirugía conservadora de la mama y puede evitar que las pacientes sufran disección de ganglios linfáticos axilares.
Asunto(s)
Neoplasias de la Mama , Terapia Neoadyuvante , Femenino , Humanos , Axila/patología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Antígeno Ki-67 , Escisión del Ganglio Linfático , Metástasis Linfática , Mastectomía , Estudios Retrospectivos , Biopsia del Ganglio Linfático Centinela/métodosRESUMEN
OBJECTIVE: The aim of this study was to determine the role of positron emission tomography/computed tomography in the decision to perform axillary surgery by comparing positron emission tomography/computed tomography findings with pathology consistency after neoadjuvant chemotherapy. METHODS: Patients who were diagnosed for T1-4, cN1/2 breast cancer receiving neoadjuvant chemotherapy in our clinic between January 2016 and February 2021 were evaluated. Clinical and radiological responses, axillary surgery, and histopathological results after neoadjuvant chemotherapy were evaluated. RESULTS: Axillary involvement was not detected in positron emission tomography/computed tomography after neoadjuvant chemotherapy in 140 (60.6%) of 231 node-positive patients. In total, 88 (62.8%) of these patients underwent sentinel lymph node biopsy, and axillary lymph node dissection was performed in 29 (33%) of these patients upon detection of 1 or 2 positive lymph nodes. The other 52 (37.1%) patients underwent direct axillary lymph node dissection, and no metastatic lymph nodes were detected in 33 (63.4%) patients. No metastatic lymph node was found pathologically in a total of 92 patients without involvement in positron emission tomography/computed tomography, and the negative predictive value was calculated as 65.7%. Axillary lymph node dissection was performed in 91 (39.4%) patients with axillary involvement in positron emission tomography/computed tomography after neoadjuvant chemotherapy. Metastatic lymph nodes were found pathologically in 83 of these patients, and the positive predictive value was calculated as 91.2%. CONCLUSION: Positron emission tomography/computed tomography was found to be useful in the evaluation of clinical response, but it was not sufficient enough to predict a complete pathological response. When planning axillary surgery, axillary lymph node dissection should not be decided only with a positive positron emission tomography/computed tomography. Other radiological images should also be evaluated, and a positive sentinel lymph node biopsy should be the determinant of axillary lymph node dissection.
Asunto(s)
Neoplasias de la Mama , Humanos , Femenino , Neoplasias de la Mama/cirugía , Terapia Neoadyuvante , Biopsia del Ganglio Linfático Centinela/métodos , Ganglios Linfáticos/patología , Escisión del Ganglio Linfático , Tomografía Computarizada por Tomografía de Emisión de Positrones , Axila/patología , Estadificación de NeoplasiasRESUMEN
We retrospectively reviewed the data from patients ≥ 70 years old treated between January 2012 and January 2017. Axillary staging was scarcely used in the therapeutic algorithm but arm lymphedema was significantly associated to axillar dissection (p=0.04) and regional nodal irradiation (p = 0.02). Aggressive management of axilla did not provide relevant information for deciding chemotherapy but added morbidity.
Asunto(s)
Neoplasias de la Mama , Anciano , Axila/patología , Neoplasias de la Mama/patología , Disección , Femenino , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Estadificación de Neoplasias , Estudios Retrospectivos , Biopsia del Ganglio Linfático CentinelaRESUMEN
To evaluate overall survival and locoregional recurrence between patients with invasive breast tumours and sentinel node metastasis undergoing sentinel lymph node dissection (SLND) alone and those undergoing complete axillary lymph node dissection (ALND). In this retrospective cohort study, we reviewed the medical records of patients with invasive breast carcinoma who underwent lumpectomy at a public university hospital in Brazil between 2008 and 2018. We evaluated the overall survival and the locoregional recurrence using Kaplan-Meier and Cox regression analyses, respectively. Overall, 97 participants who underwent lumpectomy were enroled; 41 in the ALND group, and 56 in the SLND group, according to Z0011 criteria. Only 17% of the patients in the ALND group had an additional biopsy-proven axillary disease, and 83% were treated with complete dissection unnecessarily. The 5-year survival rates were 80.1% and 87.5% for SLND and ALND, respectively (p = 0.376). Locoregional recurrence was rare (1.7% and 7.3% in the SLND and ALND, respectively; p = 0.3075). Overall survival and locoregional recurrence were similar between the two groups. The de-escalation of ALND to SLND in women with metastasis in the sentinel lymph node treated with conservative surgery and radiotherapy that meet the Z0011 criteria is feasible even in developing countries.
Asunto(s)
Axila/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/mortalidad , Ganglio Linfático Centinela/patología , Anciano , Algoritmos , Biomarcadores de Tumor , Neoplasias de la Mama/etiología , Neoplasias de la Mama/terapia , Toma de Decisiones Clínicas , Manejo de la Enfermedad , Femenino , Humanos , Inmunohistoquímica , Metástasis Linfática , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Modelos de Riesgos Proporcionales , Recurrencia , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Winged scapula (WS) is a critical complication of axillary surgery in patients treated for breast cancer, and is associated with pain, impairment of the upper extremity's function and poor performance in daily activities. SOURCES OF DATA: A systematic review and meta-analysis were performed following the PRISMA guidelines. Two independent reviewers searched PubMed, Embase and Virtual Health Library databases from January 1, 2000 to December 1, 2020. Clinical studies evaluating the diagnosis and epidemiology of WS among breast cancer surgery (BCS) patients were included. AREAS OF AGREEMENT: The diagnosis of WS relies almost entirely on physical assessment. Studies have suggested a high variability in the report of the incidence of WS given the subjectivity of its diagnosis, and the different criteria used during clinical assessment. AREAS OF CONTROVERSY: The diagnosis of WS in BCS patients remains a challenge given the lack of standardized diagnostic protocols. Physical examination cannot rely on one manoeuvre only, as it may overlook patients with subtle injuries or overweight and contributing to the underreporting of its incidence. GROWING POINTS: BCS patients undergoing axillary lymph node dissection experience a significantly higher incidence of WS than those undergoing sentinel lymph node dissection. The global incidence of WS after BCS is 16.79%. Additionally, the anterior flexion test and the push-up test are the most commonly performed diagnostic manoeuvers. AREAS TIMELY FOR DEVELOPING RESEARCH: Further studies should aim for objective diagnostic tests, especially when the condition is not evident.
Asunto(s)
Neoplasias de la Mama , Axila/patología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Incidencia , Escisión del Ganglio Linfático/efectos adversos , Escisión del Ganglio Linfático/métodos , Escápula/patología , Biopsia del Ganglio Linfático Centinela/efectos adversos , Biopsia del Ganglio Linfático Centinela/métodosRESUMEN
Abstract Objective To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. Methods A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. Results A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded fromthe study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes andmet the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). Conclusion The ACOSOG Z0011 trial criteria can be applied to a select group of SLNpositive patients, reducing the costs and morbidities of breast cancer surgery.
Resumo Objetivo Avaliar o número de pacientes com câncer de mama em estágio inicial que se beneficiariam da omissão da linfadenectomia axilar segundo o protocolo Z0011 da Alliance for Clinical Trials in Oncology (ACOSOG). Métodos Estudo de coorte retrospectiva conduzido no Hospital da Mulher da Universidade Estadual de Campinas. Foram incluídas mulheres diagnosticadas com carcinoma invasivo de mama em estágio inicial, com axila clinicamente negativa, tratadas com cirurgia conservadora e biópsia do linfonodo sentinela, radioterapia, quimioterapia e/ou hormonioterapia, de janeiro de 2005 a dezembro de 2010. Os critérios do estudo da ACOSOG Z0011 foram aplicados a essas mulheres e foi realizada uma análise estatística que comparou ambas as populações dos estudos. Resultados Foram estudadas 384 mulheres submetidas a cirurgia conservadora de mama e biópsia do linfonodo sentinela. Entre elas, 86 mulheres foram submetidas a linfadenectomia axilar por metástase presente no linfonodo sentinela. Uma paciente foi submetida a linfadenectomia axilar por ter um linfonodo palpável suspeito no intraoperatório, não incluída no estudo. Entre essas 86 pacientes, 82 (95,3%) tiveram de 1 a 2 linfonodos sentinela comprometidos e seriam elegíveis para omissão da linfadenectomia axilar pelos critérios do ACOSOG Z0011. Entre as 82 pacientes elegíveis, apenas 13 (15,9%) delas apresentaram tumores com invasão angiolinfática, e 62 (75,6%) dos tumores mediram até 2 cm (T1). Conclusão Os critérios do estudo ACOZOG Z0011 podem ser aplicados a um seleto grupo de pacientes com linfonodo sentinela positivo reduzindo os custos e a morbidade cirúrgica do tratamento do câncer de mama.
Asunto(s)
Humanos , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Mastectomía Segmentaria , Escisión del Ganglio Linfático , Axila/patología , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Quimioterapia Adyuvante , Radioterapia Adyuvante , Biopsia del Ganglio Linfático Centinela , Ganglios Linfáticos/patología , Metástasis Linfática , Persona de Mediana Edad , Estadificación de NeoplasiasRESUMEN
OBJECTIVE: To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. METHODS: A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. RESULTS: A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded from the study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes and met the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). CONCLUSION: The ACOSOG Z0011 trial criteria can be applied to a select group of SLN-positive patients, reducing the costs and morbidities of breast cancer surgery.
OBJETIVO: Avaliar o número de pacientes com câncer de mama em estágio inicial que se beneficiariam da omissão da linfadenectomia axilar segundo o protocolo Z0011 da Alliance for Clinical Trials in Oncology (ACOSOG). MéTODOS: Estudo de coorte retrospectiva conduzido no Hospital da Mulher da Universidade Estadual de Campinas. Foram incluídas mulheres diagnosticadas com carcinoma invasivo de mama em estágio inicial, com axila clinicamente negativa, tratadas com cirurgia conservadora e biópsia do linfonodo sentinela, radioterapia, quimioterapia e/ou hormonioterapia, de janeiro de 2005 a dezembro de 2010. Os critérios do estudo da ACOSOG Z0011 foram aplicados a essas mulheres e foi realizada uma análise estatística que comparou ambas as populações dos estudos. RESULTADOS: Foram estudadas 384 mulheres submetidas a cirurgia conservadora de mama e biópsia do linfonodo sentinela. Entre elas, 86 mulheres foram submetidas a linfadenectomia axilar por metástase presente no linfonodo sentinela. Uma paciente foi submetida a linfadenectomia axilar por ter um linfonodo palpável suspeito no intraoperatório, não incluída no estudo. Entre essas 86 pacientes, 82 (95,3%) tiveram de 1 a 2 linfonodos sentinela comprometidos e seriam elegíveis para omissão da linfadenectomia axilar pelos critérios do ACOSOG Z0011. Entre as 82 pacientes elegíveis, apenas 13 (15,9%) delas apresentaram tumores com invasão angiolinfática, e 62 (75,6%) dos tumores mediram até 2 cm (T1). CONCLUSãO: Os critérios do estudo ACOZOG Z0011 podem ser aplicados a um seleto grupo de pacientes com linfonodo sentinela positivo reduzindo os custos e a morbidade cirúrgica do tratamento do câncer de mama.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Mastectomía Segmentaria , Axila/patología , Quimioterapia Adyuvante , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Persona de Mediana Edad , Estadificación de Neoplasias , Radioterapia Adyuvante , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Retrospectivos , Biopsia del Ganglio Linfático CentinelaRESUMEN
BACKGROUND: Erdheim-Chester disease (ECD) is a non-Langerhans histiocytosis that results in multi-organ disease involving the skin, bones, lungs and kidneys. Central nervous system (CNS) involvement occurs in about 50 % of patients, and diabetes insipidus, visual disturbances, and cerebellar ataxia are the most frequent neurological signs. We report a case of Erdheim-Chester disease with central nervous system involvement in the form of enhancing intracranial mass lesions with massive edema. CASE PRESENTATION: The patient presented with vertigo, ataxia, encephalopathy and pyramidal signs. Diagnosis was suggested by xanthomatous skin lesions and a biopsy was compatible with Erdheim-Chester disease demonstrating xanthogranulomas CD68 positive (clone KP1) and CD1a and S100 negative. Testing for BRAF mutation was negative, which precluded treatment with Vemurafenib. Treatment with steroids and interferon resulted in improvement of neurological signs and regression of edema on MRI. CONCLUSIONS: The diagnosis of Erdheim-Chester disease should be considered in intracranial mass lesions. Xanthomatous skin lesions are a clue to the diagnosis.
Asunto(s)
Encefalopatías/etiología , Enfermedad de Erdheim-Chester/complicaciones , Enfermedad de Erdheim-Chester/diagnóstico , Enfermedad de Erdheim-Chester/patología , Enfermedades de la Piel/etiología , Adulto , Axila/patología , Biopsia , Encefalopatías/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Enfermedades de la Piel/patologíaRESUMEN
PURPOSE: The role of sentinel lymph node biopsy (SLNB) in breast cancer patients who undergo neoadjuvant chemotherapy (NAC) remains controversial. This study aims to investigate if axillary lymph node dissection (ALND) could be safely omitted after a negative SLNB in cN1/2 patients who become cN0 after NAC. METHODS: We retrospectively assessed T1-4, cN1/2 patients who were submitted to NAC between 2010 and 2016. T1-T3 patients who achieved complete axillary clinical response underwent SLNB. Those whose SLNs were negative were not subjected to additional ALND. The oncological outcomes of the patients were analyzed. RESULTS: Fifty-nine T1-T3 patients (45.0%) achieved a complete axillary response (cN0), and were selected to undergo SLNB. SLNs were detected in 55 of them (93.2%). Seventeen of those patients (30.9%) had SLN metastases detected and subsequently underwent ALND. In contrast, 38 patients (69.1%) had no nodal metastases detected and were managed without complementary ALND. After a mean follow-up of 55.8 months, only one patient (2.6%) submitted to SLNB without a complementary ALND had axillary recurrence as compared with three patients (3.2%) in the ALND group (p = 0.71). Distant recurrence occurred more frequently among patients submitted to ALND (92.1%) than among those only submitted to SLNB (7.9%) (p < 0.0006). Overall survival and disease-free survival were significantly better in patients who were not submitted to ALND. CONCLUSION: SLNB could be successfully used in guiding a more selective axillary approach in cN+ patients that became cN0 after NAC. Omitting ALND in CN0 patients with negative SLNs did not seem to compromise disease control and oncological outcomes.
Asunto(s)
Neoplasias de la Mama , Ganglio Linfático Centinela , Axila/patología , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Femenino , Humanos , Escisión del Ganglio Linfático , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Estudios Retrospectivos , Ganglio Linfático Centinela/patología , Biopsia del Ganglio Linfático CentinelaRESUMEN
Describir la técnica quirúrgica de la disección axilar dirigida (DAD) usando carbón vegetal como marcador del ganglio linfático axilar metastásico al momento del diagnóstico conjuntamente con la biopsia del ganglio centinela en paciente con cáncer de mama tratada con quimioterapia neoadyuvante con respuesta completa clínica y ecográficamente, demostrando su seguridad y eficacia. Material y Métodos: Estudio retrospectivo y descriptivo. Paciente con cáncer de mama y ganglio linfático metastásico en axila ipsilateral marcado con carbón vegetal al confirmarse ese diagnóstico y tratada con quimioterapia neoadyuvante con posterior negativización tanto clínica como ecográfica del ganglio linfático metastásico. Se planificó para disección axilar dirigida (extirpación del ganglio marcado con carbón vegetal y biopsia de ganglio centinela) con el fin de demostrar la eficacia del marcador utilizado y su relación o no con el ganglio centinela. Resultados: Se comprobó la identificación certera del ganglio afectado marcado con carbón vegetal el cual no presentó migración del colorante o reacción inflamatoria local coincidiendo además con dos ganglios centinelas todos con respuesta patológica completa. El carbón permaneció 153 días desde su administración hasta la cirugía axilar. Conclusión: Esta experiencia admite el marcaje con carbón vegetal del ganglio axilar metastásico al momento de su diagnóstico como un método seguro, sencillo, económico y accesible en relación a otros métodos de marcaje, además su asociación con la biopsia del ganglio centinela nos permite prescindir de la disección axilar en caso de respuesta patológica completa, sin embargo, es importante resaltar que se necesitan evaluar más casos para obtener conclusiones determinantes(AU)
To describe the surgical technique of targeted axillary dissection using charcoal marking of the metastatic lymph node at the time of diagnosis together with sentinel node biopsy in a breast cancer patient who received neoadjuvant chemotherapy with complete clinical and sonographical response, demonstrating its safety and efficacy. Material and Methods: Retrospective and descriptive study. Patient with breast cancer and metastatic lymph node in the ipsilateral axilla which was marked with charcoal upon confirmation of this diagnosis and treated with neoadjuvant chemotherapy with subsequent clinical and sonographical negativization of the metastatic lymph node. It was planned for targeted axillary dissection (removal of charcoal-marked lymph node and sentinel node biopsy) in order to demonstrate the efficacy of the marker used and its relationship or not with the sentinel node. Results: The correct identification of the affected lymph node marked with charcoal was verified, which did not present dye migration or local inflammatory reaction, also coinciding with two sentinel nodes, all of them with a complete pathological response. The charcoal remained 153 days from its administration until the axillary surgery. Conclusion: This experience supports charcoal marking of the metastatic lymph node at the time of diagnosis as a safe, simple, inexpensive and accessible method in relation to other marking methods, in addition its association with sentinel node biopsy allows us to dispense with axillary dissection in case of complete pathological response, however it is important to highlight that more cases need to be evaluated to obtain decisive conclusions(AU)
Asunto(s)
Femenino , Persona de Mediana Edad , Axila/patología , Biopsia del Ganglio Linfático Centinela , Ganglio Linfático Centinela , Neoplasias de la Mama , Carbón Orgánico , Quimioterapia , Ganglios LinfáticosRESUMEN
The asymmetric periflexural exanthema of childhood is an underdiagnosed entity of unknown etiology that affects, most commonly, girls around two years of age. Clinically, it affects only one side of the body and it eventually disappears without the need of any specific treatment. We report two cases of this entity. The first case is a 14-month-old female patient with an erythematosus papular eruption that initiates near the axilla and progresses, in a period of seven days, towards the ipsilateral upper limb and hemithorax, with no other alterations. The second case is a 24-month-old female with a pruriginous erythematosus papular exanthema that begins on the left lower extremity and extends throughout the left hemibody. Due to the characteristics of the exanthema and the age range of the patients, they were diagnosed with asymmetric periflexural exanthema. They both received symptomatic treatment with spontaneous resolution of the condition.
El exantema periflexural asimétrico de la infancia es una entidad subdiagnosticada, de etiología incierta, que afecta, predominantemente, a niñas alrededor de los dos años de edad. Se caracteriza por ser un exantema que solo afecta a un hemicuerpo y que se resuelve sin tratamiento específico. Se reportan dos casos clínicos acerca de esta entidad. El primero, referente a una niña de 14 meses con exantema papuloeritematoso de inicio en la axila siete días antes y extensión a la extremidad superior y el hemitronco ipsilateral sin otras alteraciones. El segundo, referente a una niña de 24 meses de edad con exantema papuloeritematoso pruriginoso de inicio en la extremidad inferior izquierda y la posterior extensión por el hemicuerpo izquierdo. Dadas las características del exantema y la edad de las pacientes, se diagnosticó exantema periflexural asimétrico y recibió tratamiento sintomático, con resolución del cuadro de forma espontánea.
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Axila/patología , Exantema/diagnóstico , Preescolar , Progresión de la Enfermedad , Exantema/patología , Exantema/terapia , Femenino , Humanos , LactanteRESUMEN
PURPOSE: In this study, we investigated the circulating levels of 25-hydroxyvitamin D (25[OH]D) in Brazilian women with breast cancer in samples collected at diagnosis, and correlated these with clinicopathological parameters relevant to disease prognosis. METHODS: This study involved 147 women diagnosed with infiltrative ductal carcinoma whose peripheral blood samples were collected, to have 25(OH)D levels measured in plasma. RESULTS: Our findings indicated that circulating 25(OH)D levels at diagnosis were insufficient in patients with breast cancer. Further, 25(OH)D reduced plasmatic levels at diagnosis correlated significantly with poor prognosis parameters, including axillar positivity, chemoresistance and metastasis. Patients bearing triple-negative tumors also presented reduced 25(OH)D in plasma when compared to those who carried Luminal tumors. Our data suggest relevant correlations when 25(OH)D is reduced in plasma at diagnosis, such as advanced disease with axillar positivity, chemoresistance with advanced disease, early age at diagnosis with high histological grade and dead with axilla positivity. CONCLUSIONS: Altogether, our findings reinforce that 25(OH)D reduction can be a plausible marker of disease prognosis in breast cancer.
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Axila/patología , Neoplasias de la Mama/complicaciones , Vitamina D/análogos & derivados , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/fisiopatología , Resistencia a Antineoplásicos , Femenino , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Metástasis de la Neoplasia , Pronóstico , Vitamina D/sangreRESUMEN
Background: Sweat gland carcinomas divide into eccrine, apocrine, mixed origin (eccrine and apocrine). Eccrine carcinoma(EC) is a rare malignant neoplasm of the sweat glands that can affect dogs, cats, and humans. EC can present itself as asolitary swelling in the pads, digits, or distal limbs. EC is more common in elder animals, and exhibits no predispositionaccording to breed. In humans, EC is more frequent in the head and neck, and is more likely to occur in mid-aged people;metastases can develop in any site of the body. A diagnosis of this type of tumor can be determined by histopathologicalexamination. Apocrine carcinomas occur most frequently in the axillary areas even though they may occur in other regionsof the body, and affect mainly elder animals.Case: A 13-year-old male mongrel dog with a history of presence of smooth reddish infiltrative nodule in the skin of thethorax, but with no history of progression, was examined. After running complementary tests, a fragment of the skin onthe thorax was taken for biopsy. The second animal was an 8-year-old female Golden Retriever, which was presented witha history of presence of a nodule on the right digital pad. After running complementary tests, a fragment of this nodulewas collected. In both cases, the excised fragments were placed in 10% buffered formalin and routinely processed forthe preparation of histological slides, which were stained with hematoxylin and eosin, and subjected to histopathologicalevaluation. Light microscopy analysis revealed, in both cases, the presence of a poorly delimited, non-encapsulated massinfiltrating the muscle and adipose tissue. Necrotic areas, and presence of eosinophilic material in the nucleus were observed.Additionally, the samples from both cases were subjected to immunohistochemical staining for cytokeratin (CK Pan).Discussion: A definitive diagnosis of sweat gland carcinoma...(AU)
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Animales , Masculino , Perros , Carcinoma/veterinaria , Acrospiroma/veterinaria , Glándulas Sudoríparas/patología , Axila/patología , BiopsiaRESUMEN
Resumen Introducción El tejido mamario ectópico es consecuencia de la involución incompleta de la cresta mamaria. Su localización más frecuente es axilar siendo más común en el sexo femenino. Nuestro objetivo fue presentar el caso de una patología infrecuente en su localización. Materiales y Método Se presenta el caso de una paciente de 39 años, con diagnóstico de cáncer de mama ectópica en la región axilar izquierda. Resultados Presentamos el estudio y la resolución quirúrgica de una paciente con cáncer de mama ectópica. Discusión La presencia de tejido mamario ectópico ocurre en el 2%-6% de la población general. Este tejido sufre cambios fisiopatológicos similares a los de la mama normal, entre los cuales se encuentra la malignización. El carcinoma primario de este tejido es infrecuente y su manifestación más común es el tumor palpable. Conclusiones La incidencia de carcinoma en tejido ectópico es de 0,3% de todos los cánceres de mama. El tratamiento debe seguir las mismas recomendaciones que el cáncer de mama normotópico, con igual estadio TNM.
Introduction Ectopic mammary tissue is consecuence of the incomplete involution of the mammary crest. The most frequent location is the axillary region and more common in women. Our gol was present the case of an infrequent pathology in its location. Materials and Method A case of a 39-year-old patient with a diagnosis of ectopic breast cancer in the left axillary region. Results We present the study and surgical resolution of a patient with ectopic breast cancer. Discussion Ectopic breast tissue occurs in 2-6% of the general population. This tissue undergoes pathophysiological changes similar to those of the normal breast, among which malignancy is found. The primary carcinoma of this tissue is infrequent and its most common manifestation is the palpable tumor. Conclussion The incidence of carcinoma in ectopic tissue is approximately 0.3% of all breast cancers. Treatment should follow the same recommendations as those for breast tumors with the same TNM stage.
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Humanos , Femenino , Adulto , Axila/cirugía , Axila/patología , Mama/patología , Neoplasias de la Mama/diagnóstico por imagen , Mastectomía/métodos , Neoplasias Primarias Desconocidas , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/complicaciones , MamografíaAsunto(s)
Síndrome del Nevo Displásico/patología , Nevo Pigmentado/patología , Nevo/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Axila/patología , Brasil/epidemiología , Mama/patología , Errores Diagnósticos/prevención & control , Femenino , Genitales/patología , Humanos , Rodilla/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Nevo/ultraestructura , Nevo Pigmentado/ultraestructura , Cuero Cabelludo/patología , Neoplasias Cutáneas/clasificación , Neoplasias Cutáneas/ultraestructura , Ombligo/patología , Organización Mundial de la Salud/organización & administraciónRESUMEN
Background: Sweat gland carcinomas divide into eccrine, apocrine, mixed origin (eccrine and apocrine). Eccrine carcinoma(EC) is a rare malignant neoplasm of the sweat glands that can affect dogs, cats, and humans. EC can present itself as asolitary swelling in the pads, digits, or distal limbs. EC is more common in elder animals, and exhibits no predispositionaccording to breed. In humans, EC is more frequent in the head and neck, and is more likely to occur in mid-aged people;metastases can develop in any site of the body. A diagnosis of this type of tumor can be determined by histopathologicalexamination. Apocrine carcinomas occur most frequently in the axillary areas even though they may occur in other regionsof the body, and affect mainly elder animals.Case: A 13-year-old male mongrel dog with a history of presence of smooth reddish infiltrative nodule in the skin of thethorax, but with no history of progression, was examined. After running complementary tests, a fragment of the skin onthe thorax was taken for biopsy. The second animal was an 8-year-old female Golden Retriever, which was presented witha history of presence of a nodule on the right digital pad. After running complementary tests, a fragment of this nodulewas collected. In both cases, the excised fragments were placed in 10% buffered formalin and routinely processed forthe preparation of histological slides, which were stained with hematoxylin and eosin, and subjected to histopathologicalevaluation. Light microscopy analysis revealed, in both cases, the presence of a poorly delimited, non-encapsulated massinfiltrating the muscle and adipose tissue. Necrotic areas, and presence of eosinophilic material in the nucleus were observed.Additionally, the samples from both cases were subjected to immunohistochemical staining for cytokeratin (CK Pan).Discussion: A definitive diagnosis of sweat gland carcinoma...
Asunto(s)
Masculino , Animales , Perros , Acrospiroma/veterinaria , Axila/patología , Carcinoma/veterinaria , Glándulas Sudoríparas/patología , BiopsiaRESUMEN
PURPOSE: Breast cancer (BC) is the most common cancer in women worldwide. The main treatment for BC is surgery, which involves an axillary procedure that associates with the development of axillary web syndrome (AWS). The incidence of AWS among Chilean women with BC and its possible predisposing factors are currently unknown. Thus, we aimed to (1) determine the incidence of AWS among Chilean women with BC after surgery and (2) identify possible predisposing factors. METHODS: Within 90 days post-surgery, patients were assessed for AWS, i.e., palpable or visible axillary cords in the axillary region extending down from the mid-axilla to the ipsilateral arm. We then computed the odds ratio with 95% confidence interval (OR [95% CI]) for having AWS considering the following predisposing factors: age, body mass index (BMI), number of lymph nodes removed, axillary procedure, days from surgery to the physical therapy assessment, hospital for the surgery, type of breast surgery, and neoadyuvant chemotherapy. RESULTS: AWS was present in 49 out of 107 patients (45.8%). Younger age and lower BMI appeared as the sole predisposing factors for AWS (age, 0.95 [0.91-0.99]; BMI, normal weight 1.00, overweight 0.35 [0.11-1.12], obesity 0.28 [0.08-0.97]). CONCLUSION: The incidence of AWS among Chilean women with BC was 45.8%. Our study also confirms data from previous reports showing that younger age and low BMI are associated with the development of AWS.