Hiperplasia ductal atípica de mama: correlación de la biopsia percutánea y los resultados de la biopsia quirúrgica

Objetive

The purpose was to evaluate the prevalence of carcinoma found at surgical biopsy of llesions identified as atypical ductal hyperplasia by percutaneous breast biopsy.

Methods

We performed a retrospective study of all asymptomatic patients with a result of atypical ductal hyperplasia on percutaneous breast biopsy and who underwent surgical excision from January 2002 to December 2010.

Results

Sixty-eight patients were found to have atypical ductal hyperplasia at percutaneous breast biopsy and were evaluated with surgical biopsy. Seventeen patients (25%) had carcinoma at surgical excision, 10 had ductal carcinoma in situ, and 7 patients had invasive carcinoma. The mammographic characteristics associated with malignancy were analyzed.

Conclusions

A finding of atypical ductal hyperplasia at percutaneous breast biopsy frequently corresponds to cancer and is therefore an indication for surgical excision.     

Evolución del cáncer de mama en Aragón (España). Proyecciones a 15 años

Objective

The aim of this study was to determine the trend in breast cancer in Aragon by projecting the incidence rates, prevalence and mortality over a 15-year period from 2008 to 2022.

Material and methods

Data were obtained from the National Institute of Statistics and the program used was the MIAMOD.

Results

We estimated that from 2008 to 2022, the incidence rate of breast cancer in Aragon will decrease from 53.06 to 45.56 (adjusted from 31.66 to 25.22). Mortality will decline gradually from 15.6 in 2008 to 12.9 (adjusted from 8.13 to 6.37) and the prevalence will decrease from 568.33 to 522.17 (adjusted from 322.15 to 271.32).

Conclusions

These projections indicate that the incidence, mortality and prevalence of breast cancer in Aragon will decrease, although only the reduction in the incidence rate will be statistically significant.     

Criterios de calidad en el manejo del cáncer de mama en Castilla y León,mejorando nuestra eficiencia

Objectives

To assess the quality of care provided to breast cancer patients in the public hospitals of Castile-Leon.

Material and methods

Data collection was carried out through a survey on quality criteria endorsed by the European Society of Breast Cancer Specialists (EUSOMA), which was sent to the public hospitals in Castile-Leon. A total of 1235 patients diagnosed with breast cancer in 2011 participated in the survey.

Results

A total of 81.81% of criteria were achieved. Ninety percent of patients received treatment within 6 weeks of diagnosis. Surgical, radiotherapeutic, and systemic treatment complied with quality criteria. However, too many surgical excisions were performed in benign disease. The cases of 87% of cancer patients were discussed by a multidisciplinary team. There was excessive follow-up in asymptomatic patients and excessive study of tumoral extension.

Conclusion

Although the healthcare provided exceeded most quality criteria, we identified areas that could be improved to achieve more efficient resource use.     

Influencia de las características tumorales del cáncer de mama en mujeres menores de 35 años en el pronóstico de la enfermedad

Background and objective

Two per cent of breast cancers develop in women aged 35 years old or younger. The aim of this study was to analyze the influence of the histological characteristics of the tumor and axillary involvement on the prognosis of the disease.

Methods

We performed a retrospective study of 71 women aged 35 years old or younger diagnosed with breast cancer in the 12 de Octubre Hospital from 1983 to 2000. A survival curve was designed using the Kaplan-Meier method.

Results

The most important prognostic factor was tumoral extension at diagnosis. A total of 66.7% of the patients in initial stage IV died within 5 years of follow-up. For stages 0 and I, 92.3% and 100% of the patients, respectively, were alive and had no evidence of disease. The most frequent histological type was infiltrating ductal carcinoma. Outcome was not influenced by tumoral type or histological grade. Recurrence was more frequent in patients with positive receptors than in those with negative receptors. One of the most important prognostic factors was axillary involvement. Recurrence occurred in 71.4% of the patients with nodal involvement compared with 31.4% of those without nodal invasion. The greater the number of affected nodes, the higher the risk of recurrence. Alteration of P53 and c-erb 2 were poor prognostic factors.

Conclusions

Tumoral size and stage, axillary involvement and the number of affected nodes were associated with a higher risk of recurrence and worse 5-year outcome. The presence of positive receptors was also related to an unfavorable outcome. Fifty percent of women lived for more than 15 years.     

Resultados de la aplicación de la técnica SNOLL versus tumorectomía guiada con arpón en el cáncer de mama

Objective

To compare the results of the SNOLL technique with those of wire-guided lumpectomy in the treatment of breast cancer.

Material and methods

A retrospective study conducted in the Breast Pathology Unit of the Vigo University Hospital from May 2010 to February 2012.

Results

We studied 73 patients. The SNOLL technique was used in 34 women and wire-guided lumpectomy in 39. In both groups, the most common histological type was infiltrating ductal carcinoma (94% and 64.1%, respectively, P=.005). In the intraoperative study, 55.3% of tumors in the SNOLL group and 44.7% of those in the wire-guided group were found to touch the surgical margin. The rate of margin extension in the same intervention was higher in the SNOLL group (P=.160). The reoperation rate for margin extension was 0% in the SNOLL group and 13% in the wire-guided group (P=.57). In the final surgical specimen, the mean disease-free margin was 7.21 mm in the SNOLL group and 4.66 mm in the wire-guided group (P=.01).

Conclusions

The re-excision rate was similar in the two groups. The SNOLL technique allows a greater margin of safety.     

Cáncer de mama en la mujer joven

Objective

To review the characteristics of breast cancer in young women.

Material and methods

The scientific literature was reviewed, indicating the etiological factors, diagnostic methods and treatment options, with special reference to the factors that can concur in young patients such as premature menopause, loss of fertility, pregnancy after breast cancer and breast cancer during pregnancy.

Results

Importantly, breast cancer in young women is very rare but is on the increase. Tumors are larger in young women and have positive margins, making the disease more aggressive and leading to higher mortality. Diagnosis is more difficult than in older women and the triple test (mammography, ultrasound and biopsy) is of great importance. Treatment options are the same as in older women.

Conclusions

Breast cancer in young women shows certain characteristics that differentiate it in some respects from breast cancer diagnosed in older women.     

Implementación de la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama tratadas en hospitales comarcales de la Comunidad Autónoma de Cantabria

Objective

To evaluate the results of sentinel lymph node (SLN) biopsy in women with breast cancer treated in hospitals without a nuclear medicine unit.

Subjects and methods

Eighty-eight patients with early-stage breast cancer treated in two district hospitals between February 2007 and July 2010 were included. The day before surgery a lymphoscintigraphy was performed in the specialized hospital. Intraoperative localization of the SLN was accomplished by the combined use of a hand-held gamma probe and a manual gamma-camera.

Results

Surgical localization of the SLN was successful in 97.7% of the patients. The mean number of lymph nodes excised by each procedure and each surgical team was 2.1±1.4 and 2.5±1.2. Axillary lymph node dissection was performed in 27.2% of the patients. There was one false-negative result and one false-positive result.

Conclusion

The implementation of SLN biopsy in district hospitals provides similar results to those obtained in the supervising hospital.     

Cáncer inflamatorio de mama. Factores pronósticos relacionados con la enfermedad

Objectives

To analyze the possible prognostic value of disease-related factors in inflammatory breast carcinomas (IBC) diagnosed and treated in our hospital.

Subjects and methods

This retrospective analysis included 40 patients with non-metastatic IBC diagnosed in our service between 1991 and 2004, with both clinical and pathological criteria of IBC.

Results

Treatment response was significantly better in tumors with positive hormone receptor status. Axillary invasion, involvement of more than 4 nodes, and lack of response to neoadjuvant chemotherapy were determinants of a high risk of recurrence.

Conclusions

Our data suggest that response to neoadjuvant chemotherapy is an important prognostic factor. Further studies are required to determine the most appropriate treatment of IBC.     

Cribado con resonancia magnética de la mama contralateral en pacientes con cáncer de mama

Case report

We report the case of a woman with an invasive carcinoma of the right breast, in whom magnetic resonance imaging (MRI) identified a ductal carcinoma in situ in the contralateral breast. This tumor had not been detected by other diagnostic tests.

Discussion

The authors review recent series that discuss the issue of MRI screening of the contralateral breast. The clinical impact of MRI screening is assessed.

Conclusions

MRI of the contralateral breast in breast cancer patients detects a small, but significant, number of breast cancers that would have been missed if MRI had not been performed. The effect of these findings on prognosis remains uncertain.     

Valor pronóstico de los receptores hormonales,receptor del factor de crecimiento epidérmico humano,ciclinas D1 y D2, B-Cell Lymphoma2 y ciclooxigenasa-2 en pacientes jóvenes con cáncer de mama

Objetive

To investigate the value of hormone receptor (HR) status, HER-2, cyclins D1 and D2, bcl-2 and cyclooxygenase-2 (COX-2) in predicting the outcome of very young breast cancer patients (below 35 years).

Subjects and method

In this study HR, HER-2, cyclins D1 and D2, bcl-2 and COX-2 were determined for a second time by immunohistochemistry and tissue arrays in a cohort of 71 patients aged less than 35 years with known outcome. The prognostic influence of these factors was evaluated by the chi-square test and Kaplan Meier method.

Results

Expression of HR was detected in 67% of the patients, HER-2 in 48.6%, cyclins D1 and D2 in 59.1% and 59.7%, respectively, bcl-2 in 62.5% and COX-2 in 63.4% of breast tumors. HR and COX-2 overexpression were significantly correlated with a major risk of local relapse (OR: 4.6, P=.03 for HR and OR: 3.7, P=.02 for COX-2).

Conclusions

Increased expression of HR and COX-2 may play a role in the progression of primary breast carcinoma in very young patients. Overexpression of cyclins D1 and D2 and bcl-2 had no prognostic value.     

Hormonoterapia como primer tratamiento en pacientes no subsidiarias de cirugía en cáncer de mama

Objectives

To analyze the response to hormonotherapy and survival in non-surgical breast cancer patients.

Material and methods

We performed a retrospective study of 153 patients with inoperable breast carcinoma due to advanced disease, advanced age, severe comorbidity or refusal to accept conventional therapy, who were treated with hormonotherapy. Initial tumoral stage, response, overall survival and causes of death were evaluated.

Results

The mean age was 79 ± 7 years with a mean follow-up of 42.6 months (range: 0-180). At diagnosis, stage T4 tumors were found in 22%, clinical nodal involvement was found in 47% and metastasis in 16%. Tamoxifen was administered in 87.7% of the patients and aromatase inhibitors or megestrol in the remainder. Successive treatments were required in 22%. Complete response occurred in 5.8% and partial response in 31.8%. Of the remaining patients, 34.4% remained stable and 9.7% showed disease progression. The first event occurred at 35.7 ± 33 months of follow-up. Overall mortality was 68.7% and breast cancer mortality was 57.3%.

Conclusions

Because of its efficacy and scarce adverse effects, hormonotherapy may be an effective treatment in non-surgical patients with breast carcinoma.     

Casuística del carcinoma intraductal de mama en el Hospital Universitario Son Dureta

Objective

To determine the incidence rates and clinical presentation of ductal carcinoma in situ of the breast, as well as its pathologic characteristics, the forms of treatment used, and outcomes.

Subjects and method

We performed a retrospective study with review of 83 consecutive patients with a histopathological diagnosis of ductal carcinoma in situ (DCIS) of the breast from January 1st, 1990 to December 31st, 2004 in the Son Dureta University Hospital in Palma, Majorca.

Results

Breast DCIS accounted for 3.5% of all breast carcinomas identified in our hospital in the previous 15 years. The most frequent age at diagnosis ranged from 50 to 64 years. Seventy-two percent of the lesions were detected by mammography. Total mastectomy was performed in 57% of the patients, and treatment with breast preservation was carried out in 37%. The recurrence rate was 4%, with an overall survival rate of 100%.

Conclusions

Screening mammography identifies very small cancers. Involvement of the surgical margins is a determining factor for local treatment of breast cancer and is an accurate predictor of risk of recurrence. Disease-free survival is almost 100% in patients undergoing mastectomy, although the preferred therapy in cases of DCIS is local treatment with breast conservation.     

Valoración ecográfica del endometrio en pacientes tratadas con tamoxifeno

Objective

To measure endometrial thickness and characterize ultrasonographic endometrial images induced by tamoxifen, as well as to determine changes in ultrasonographic patterns throughout treatment.

Patients and methods

We analyzed 278 patients with breast cancer between 1995 and 2000 under adjuvant therapy with tamoxifen for 5 years. Annual ultrasonographic examination was performed. Endometrial thickness and the morphological endometrial patterns in stored ultrasonographic images were retrospectively analyzed.

Results

Endometrial thickness significantly increased during treatment from a mean of 7.84 mm in the first year to 16.67 mm in the fifth year. Five endometrial patterns were found on ultrasonography in patients receiving tamoxifen: linear, heterogeneous-hyperechoic, homogeneoushyperechoic, endometrial polyp, and suspicious for malignancy. The homogeneous-hyperechoic pattern predominated in the first year and the heterogeneous-hyperechoic pattern in the fifth year.

Conclusions

Tamoxifen increases endometrial thickness in the course of treatment and induces five ultrasonographic patterns which change year-by-year.     

Impacto psicológico de la mamografía de cribado en mujeres con resultados no concluyentes

Objective

To assess the impact of mammographic screening on anxiety, depression, and quality of life in women requiring a second mammogram 6 months after an inconclusive biennial screening mammogram.

Methodology

A total of 105 women were interviewed after they had been informed of the BI-RADS results of their screening mammography. Of these women, 72 were interviewed for a second time, after they had received a negative result of the follow-up mammogram. The assessment scales used were the Hospital Anxiety and Depression Scale, and the Medical Outcomes Short-Form General Health Survey (SF-36). Anxiety and perceived physical comfort during the screening and follow-up mammograms were also evaluated through two questions specifically designed for this study.

Conclusions

Levels of anxiety and depression, quality of life and physical discomfort were satisfactory, with no differences between the two time points of measurement. Mammography screening does not cause emotional distress. These results should be emphasized by breast screening campaigns.     

Enfermedad residual después de cirugía conservadora por cáncer de mama

Objective

To evaluate which factors are related to the presence of residual tumor after lumpectomy for breast cancer with a view to determining the excisional biopsy margins that guarantee a complete excision.

Material and methods

The records of 118 women with invasive breast carcinoma who were treated with lumpectomy in our service between June 2004 and December 2006 were retrospectively reviewed. The parameters evaluated were age, palpability, diagnostic method, type of initial and definitive surgery, histologic type, tumor size, lymphovascular invasion, presence/absence of extensive intraductal component (EIC), estrogen receptors, surgical margins, reexcision, and the presence of residual tumor.

Results

Residual disease was found in 27%. In the univariate analysis, only margins (P=.015), EIC (P=.026) and size (P=.025) were significantly associated with the presence of residual tumor. With simple lineal regression analysis, only margins (P=.008) and EIC (P=.025) showed a significant association.

Conclusions

We believe that a minimum margin of 2 mm is enough to guarantee the absence of residual breast cancer if there is no EIC. In patients with margins ≤ 2 mm, the presence of EIC is an indication of high risk of residual disease.     

Ayuno vs. dieta líquida. Estudio aleatorizado controlado para evaluar la duración de la labor de parto,tasa de cesáreas y satisfacción con la labor

Aim

To evaluate the benefits of allowing oral intake of clear liquids in terms of labor duration, the cesarean section rate, and personal satisfaction.

Methods

A randomized controlled trial was carried out to assess the effects of a clear liquid diet in a low risk population. The primary outcome was labor duration. The secondary outcome was the incidence of cesarean section. A satisfaction survey was performed within the first 2 h after delivery to evaluate the patient's perception of labor.

Results

A total of 348 patients were randomized. The mean duration of labor was 257.75 min in the liquid diet group and 288.40 min in the fasting group (p = NS). There was no statistically significant difference (per-protocol analysis and intention-to-treat analysis) in the cesarean section rate.Patients reported greater satisfaction when allowed to drink during labor than when fasting.

Conclusion

A clear liquid diet during labor did not alter the duration of labor or the cesarean section rate. Allowing a liquid diet during labor was associated with a better perception of the birth process and a higher degree of satisfaction.     

Carcinoma adenoide quístico de mama: a propósito de un caso

Objective

To describe an unusual and infrequent type of breast carcinoma with specific defining characteristics.

Case report

We present the case of a woman with cystic adenoid carcinoma and review the literature published on this entity to date.

Results

The behavior of this tumor in relation to other breast tumors, and its clinical management and treatment are analyzed.

Conclusions

Cystic adenoma of the breast is a distinct clinicopathological entity from infiltrating ductal or lobular breast carcinoma. Its treatment is not based on parameters that are determinant in other breast cancers. Its outcome and biological behavior seem more favorable.     

Encuesta SEGO. Tratamiento de la amenaza de parto pretérmino en los hospitales españoles

Objective

To determine how threatened preterm labor is treated in Spanish hospitals.

Material and method

Under the aegis of the Spanish Society of Obstetrics and Gynecology, an Internet questionnaire on basic aspects of the treatment of threatened preterm labor was sent to 41 Spanish hospitals (37 public and four private hospitals).

Results

All hospitals use tocolysis in threatened preterm labor before 34th weeks. The most widely used tocolytic agent is atosiban (73,7%), followed by betamimetics (21.9%) and nifedipine (4.9%). Only 7.3% of the hospitals use tocolytics in threatened preterm labor after 34 weeks. All the hospitals use corticosteroids to accelerate lung maturation: 92.7% use betamethasone and 7.3% prefer dexamethasone. In 90% of the hospitals, steroid therapy is not repeated. In multiple pregnancies, the same steroid dose as that used in single pregnancies is administrated in all centers.

Conclusions

The most widely used tocolytic agent in Spanish hospitals is atosiban and the preferred corticosteroid is betamethasone.