Histología e inmunohistoquímica de los carcinomas de mama en pacientes intervenidas de más de 70 años de edad

Objective

We retrospectively analyzed tumoral characteristics (histology and immunohistochemistry) in a group of elderly patients (≥ 70 years old) after surgery between 2003 and 2005, and compared these characteristics with those of younger patients.

Material and methods

We studied the characteristics of 483 breast carcinomas diagnosed sfrom 2003 to 2005 in the Gynecology Service of the 12 de Octubre Hospital in Madrid. Of these, 153 (31.7%) corresponded to patients aged 70 years old or older. Data were analyzed using the SPSS 12.0 program, and the groups were compared using chi-square analysis (or Fisher’s test when required). Quantitative data were expressed as mean ± standard deviation and median with interquartile range.

Results

In our patients aged 70 years or older, diagnosis after mammography was less frequent. In situ and microinvasive carcinomas were less frequent and the mean size of invasive carcinomas was larger. These findings can be explained by the lack of mammographic screening. No other histological or immuno-histochemical differences were found in comparison with younger patients and no differences were found in axillary lymph node involvement in women with axillary dissection.

Conclusions

Treatment in elderly patients should be individually tailored according to the biological characteristics of the tumor, comorbidity, and life expectancy. Age per se should not be considered a predictive factor of worse outcome.     

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.     

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.     

Factores pronóstico en la supervivencia del cáncer epitelial de ovario invasivo en el área sanitaria de León

Objective

We studied survival and associated prognostic factors in invasive epithelial ovarian cancer in women from the health area of León between 1991 and 2001.

Subjects and method

There were 236 patients with a histological diagnosis of invasive epithelial ovarian cancer, but only 221 were included in the survival study due to losses to follow-up. Univariate analysis of overall survival was performed and the distinct clinical factors were compared by means of the Log-Rank test or the Mantle-Haenszel test. Variables that were significant (p < 0.05) in univariate analysis were submitted to multivariate analysis using Cox multiple regression and variables that remained significant in this analysis were considered to be predictive factors of the disease.

Results

The over all survival at 1, 5 and 10 years was 69.1%, 37.9% and 24.7%, respectively. The variables modifying survival were FIGO stage (p ≤ 0.001), histological type (p ≤ 0.001), age at diagnosis (p ≤ 0.001), hormonal status (p ≤ 0.001), serum CA-125 marker (p = 0.034), degree of tumor differentiation (p = 0.004), type of primary surgery carried out (p ≤ 0.001), type of chemotherapy administered (p ≤ 0.001), and disease recurrence (p = 0.054). Variables that remained significant after Cox regression were FIGO stage (p = 0.002), histological type(p = 0.008), and age at diagnosis (p = 0.004). For stage I and II tumors, the only variable thatmodified prognosis was disease recurrence (p ≤ 0.001). For advanced tumoral stages (III and IV), significant variables in the univariate analysis were age (p = 0.001), histological type(p = 0.023), hormonal status (p = 0.036), serum CA-125 marker (p ≤ 0.001), the type of primary surgery performed (p < 0.001), type of chemotherapy administered (p ≤ 0.001), and disease recurrence (p ≤ 0.001). The variables that remained significant after multivariate analysis were histological type (p = 0.006) and the type of surgery performed (p = 0.037).

Conclusions

In our study, the prognostic factors that modified survival in patients with invasive epithelial ovarian cancer in the health area of León were tumoral stage, age, and histological type.     

Márgenes histológicos de los carcinomas de mama diagnosticados mediante biopsia con arpón

Objectives

We analyzed the characteristics of carcinomas that could influence margin status and the existence of residual tumor in reexcisons.

Material and methods

We retrospectively studied the characteristics of 133 breast carcinomas diagnosed by mammographic wire-guided biopsy.

Results

In 37.59% biopsy was the only surgery in the breast. A total of 31.6% of margins were clear (more than 3 mm.), 20.3% were close (equal to or less than 3 mm) and 48.1% showed tumoral involvement. The mean tumor size of carcinomas with clear margins was statistically smaller than those with involved margins. Histological grade was related to margin status in ductal carcinomas in situ (DCIS) and to higher positive reexcision rates (grades II and III) in infiltrating ductal carcinomas (IDC). The overall residual tumor rate was 50%, but this percentage was higher in reexcisions of infiltrating lobular carcinomas (ILC) (85.71%), DCIS (70.53%), and in carcinomas with axillary lymph node involvement. A second reexcision was required in 13.79% of DCIS.

Conclusions

Reexcision is recommended in patients with ILC, DCIS and IDC (especially histological grades II and III in both cases) in which margins of more than 3 mm have not been achieved, regardless other characteristics. Clear margins are sometimes difficult to obtain in DCIS.     

Cribado del cáncer cervicouterino en colectivos de mujeres asintomáticas con factores de riesgo

Objectives

To determine the rates of cervical and vaginal disease in groups of asymptomatic women with risk factors and their degree of adhesion to the screening program.

Patients and methods

269 asimptomatic women attended during 1 year (1998) were interrogated in relation to risk practices; they underwent pap smear, colposcopy-biopsy of the cervix and determination of antibodies for VIH. A follow-up was made during 5 years.

Results

The prevalence of intaepithelial lesions was 26.8% and the accumulated incidence was 10.4%; 62.5% of the women never returned to revision more, whereas 37.6% returned at least once.

Conclusions

The women of the studied groups show high rates of cervical-vaginal pathology and high risk of developing cervical cancer. The adhesion of these women to the screening program is very low. Because of the low precision of the citology, this women must undergo a second screening test.     

Es posible aplicar protocolos de cribado de cáncer de cérvix en la práctica diaria

Objective

To evaluate whether screening protocols for cervical cancer can be implemented without delaying the diagnosis of cancer and whether this practice is well accepted by patients.

Subjects and methods

In 2005, we developed a protocol for the early diagnosis of cervical cancer based on carrying out cervical smears every 3 years in women over the age of 30 with three previous normal smears. We studied 300 patients who had attended an appointment in 2006 and another 300 in 2008. We reviewed our records to determine whether we had performed a smear and, if one was indicated, whether we had recommended attendance at a follow-up visit 3 years later, and whether the women had returned earlier. Adherence to the protocol in cancers diagnosed from 2005 was also reviewed.

Results

The number of smears decreased by 32% in 2008 compared with 2004, the year prior to screening. In 2008, 21% of women were recommended to attend the next review 3 years later and 3% returned earlier. Of 17 cancers diagnosed since 2005, only one woman with adenocarcinoma had undergone screening.

Conclusions

The overuse of cytology/smears in daily clinical practice can be avoided.     

Factor de crecimiento de hepatocitos plasmático en preeclampsia y eclampsia

Objective

To compare plasma hepatocyte growth factor concentrations in eclamptic, preeclamptic and normotensive pregnant women.

Materials and method

We included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). A control group of 30 healthy pregnant women (group D) was selected with a similar age and body mass index to participants in the study groups. Only nulliparous patients were included. Blood samples were collected for plasma hepatocyte growth factor determination in all patients before delivery and in the study groups immediately after diagnosis.

Results

Plasma hepatocyte growth factor values were highest in eclamptic patients and in severe preeclamptic patients and were lowest in mild preeclamptic patients. Hepatocyte growth factor values were significantly higher in the study groups than in controls (P<.05). Linear regression analysis revealed that 24-hour proteinuria significantly affected plasma hepatocyte growth factor concentrations (P<.05).

Conclusion

The findings of this research showed that plasma hepatocyte growth factor concentrations were higher in eclamptic and preeclamptic patients than in normotensive pregnant women.     

Evolución clínica y paraclínica de 9 embarazos en 4 pacientes con enfermedad de Gaucher tipo 1 en el servicio de hematología de un hospital docente asistencial

Objectives

To describe the clinical presentation and course in a group of pregnant women with Gaucher disease type 1.

Subjects and methods

Pregnant women admitted to our hematology service with a medical diagnosis of Gaucher disease type 1.

Results

All patients were classified as high risk. We describe 9 pregnancies in 4 patients: 7 were on enzyme replacement therapy before the pregnancy and continued to receive this therapy throughout the pregnancy; 1 patient discontinued therapy 8 months previously and had a hematological exacerbation.

Conclusions

Pregnancy should not be contraindicated in patients with stable disease. Enzyme replacement therapy should not be interrupted or suspended because it decreases complications.     

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.     

Estudio prospectivo sobre la efectividad de una minibanda suburetral en el tratamiento de la incontinencia urinaria de esfuerzo

Objectives

To assess the efficacy of the tension-free vaginal tape mini-sling (TVT-S) to treat stress urinary incontinence (SUI) in women.

Material and method

We performed a prospective study of 170 patients who underwent TVT-S insertion and who were followed-up for at least 24 months. Both the objective and subjective cure rate were evaluated using clinical examination and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF).

Results

The final number of assessed women was 137. The objective cure rate was 84% and the subjective cure rate was 91.2%. There were 7 complications during the surgery and 5 cases of mesh exposure (3.6%) during the follow-up period.

Conclusions

In our experience, the TVT-S cure rate for SUI is acceptable but is lower than the published cure rate for tension-free transvaginal tape (TVT) and tension-free transvaginal tape obturator (TVT-O).     

Prevalencia de la infección por el virus del papiloma humano en mujeres con citologías anormales del cérvix uterino y factores de riesgo asociados a la infección

Objectives

To determine the prevalence of human papillomavirus (HPV) infection in women with an abnormal pap smear of the uterine cervix and to determine the risk factors associated with HPV infection.

Subjects and methods

Eighty-one women with a cytological result of atypical cells of unknown origin (ASCUS), low-grade squamous intraepithelial lesions (LG-SIL) or high-grade squamous intraepithelial lesions (HG-SIL) were referred for epidemiological questionnaire, HPV detection performed using the Hybrid Capture II^® test, histological study, and analysis of other sexuallytransmitted diseases.

Results

Cytologic study identified 16 women with ASCUS, 44 with LG-SIL and 21 with HG-SIL. The global prevalence of HPV infection was 67.9% (55 patients) and high-risk HPV (HR-HPV) infection was detected in 50 patients (61.8%). The percentages of HR-HPV infection in women with ASCUS, L-SIL and H-SIL were 31.2%, 63.6% and 80.9%, respectively. The number of sexual partners over a woman’s lifetime was significantly associated with HPV infection (χ² for trend: 4.187; p = 0.0407).

Conclusions

Women with ASCUS detected by cytology are those who could most benefit from HR-HPV detection techniques, because of the lower prevalence of the infection. The main risk factor associated with HPV infection was the number of sexual partners over a woman’s lifetime.     

Inseminación artificial intrauterina en mujeres con síndrome de ovario poliquístico resistentes al citrato de clomifeno

Objective

To evaluate the results of ovulation induction cycles with gonadotropins and intrauterine insemination (IUI) carried out in women with polycystic ovary syndrome (POS) resistant to clomiphene citrate.

Material and methods

We performed an observational retrospective study of 462 ovulation induction cycles with IUI in women with SOP and clomiphene citrate resistance.

Results

The clinical pregnancy rate was 11.9% per cycle initiated and 14.74% per insemination and 45.45% of the pregnancies terminated in abortion. The effective accumulative percentage of term pregnancies per cycle initiated was 8% for the first cycle and 10.23% for insemination, increasing to 26.15% from the fifth cycle and to 32.24% from the fifth insemination. A total of 19.26% of the cycles was cancelled.

Conclusions

IUI is a useful method in women with SOP who are resistant to clomiphene citrate, with similar results to those obtained with other indications. These patients have high abortion and cycle cancellation rates. The high abortion rate should prompt research into ways of reducing reproductive loss.     

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.     

Hemopatías malignas en el embarazo

Objective

To analyze the incidence of hematological malignancies, their obstetric and medical management, and maternal and perinatal outcomes in pregnant women.

Subjects and methods

Medical histories were reviewed, and all cases of women diagnosed with hematologic malignancies during pregnancy from 2000 to 2005 were analyzed.

Results

We found five cases (two leukemias and three lymphomas, two of which were Hodgkin's disease), in distinct trimesters of pregnancy. The women consulted mainly because of B symptoms. Blood tests and histological data were highly variable. In all patients, complete remission was achieved after proper staging and treatment.

Conclusions

Pregnancy does not alter the development of hematological malignancies. Long-term disease-free survival is similar in both pregnant and non-pregnant women with the same disease.     

Implantación de un sistema de gestión de riesgos en obstetricia: aprendiendo de los errores

Objective

To describe the implementation of a patient safety program in an obstetrics department and the results obtained.

Material and methods

The program was applied in all women admitted to the labor and delivery unit. To detect adverse events, a patient safety indicator system that allows monitoring over time was designed and an anonymous event reporting tool was activated.

Results

An adverse event occurred in 9.26% of hospitalized patients. Adverse events were more common in the puerperium (6.61%) and after cesarean delivery (16.04%) than in instrumental (10.63%) and vaginal delivery (7.40%). Most of the notifications concerned potential adverse events (near misses) and 72% led to improvements.

Conclusions

Our program detects adverse events and allows improvement measures to be designed. In obstetrics, safety is of great importance because of the potential effects to mother and child. Furthermore, childbirth is a frequent cause of hospitalization and litigation in obstetrics is common.