Biopsia mamaria asistida por vacío y guiada por estereotaxia. Correlación con la biopsia quirúrgica

Objective

To evaluate the efficiency of stereotactic vacuum-assisted core breast biopsy as an alternative to diagnostic surgical biopsy.

Material and methods

A retrospective study based on 250 stereotactic vacuum-assisted percutaneous biopsies was conducted from March 2006 to August 2010. The false-negative rate and underestimation of disease at percutaneous biopsy were determined in comparison with diagnostic surgical biopsy.

Results

The false-negative rate was 2% (1/63) and the positive predictive value was 100%. Surgical excision revealed carcinoma in 30% (3/10) of the patients with atypical ductal hyperplasia at core biopsy and in 33.3% (2/6) of those with lobular carcinoma in situ. Among 40 lesions diagnosed as ductal carcinoma in situ at vacuum-assisted biopsy, surgery revealed invasive carcinoma in four (10%).

Conclusions

Stereotactic core breast biopsy can be considered a valid alternative to diagnostic surgical biopsy, although diagnostic underestimation still occurs.     

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.     

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.     

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.     

Valor de la histeroscopia en la hiperplasia endometrial con atipias

Objective

To evaluate the utility of hysteroscopy in the diagnosis of atypical hyperplasia and its ability to identify concurrent endometrial cancer.

Subjects and methods

We describe the clinical activity from January 1, 1996 to December 31, 2002, in our hospital gynecology unit. All cases of atypical hyperplasia were collected. Diagnoses made by hysteroscopy combined with different techniques of endometrial biopsy and surgical specimen analysis after hysterectomy were evaluated. All these data were correlated to analyze their diagnostic capacity.

Results

A large percentage of endometrial cancers (11/18) was previously diagnosed exclusively by hysteroscopy, based on morphological approaches. Endometrial biopsy underestimated 22.7% of cases of adenocarcinoma and overestimated 46.8% of cases of atypical hyperplasia.

Conclusions

Hysteroscopy could be a highly useful diagnostic tool to identify endometrial cancer in women with a finding of atypical endometrial hyperplasia on biopsy. Studies with a sufficiently large number of patients to show statistical significance are required.     

Hiperplasia endometrial atípica en biopsia preoperatoria y resultado de la pieza de histerectomía

Objectives

The purpose of this study was to examine the relationship between diagnosis of atypical endometrial hyperplasia in a curettage sample and the final pathological result after hysterectomy.

Material and methods

There were 33 patients who fulfilled the criteria for inclusion in this study. Clinical records were reviewed to identify clinical, histopathological and treatment data.

Results

Adenocarcinoma was found in four (12.12%) of the 33 surgical specimens from hysterectomy. Endometrial hyperplasia was found in 28 specimens, although 12 (36.3%) of these specimens showed no atypia. No endometrial hyperplasia or signs of any other tumor were found in one specimen.

Conclusions

After pathological findings of atypical endometrial hyperplasia, the next step should be to perform hysterectomy. Given the major risks of delaying or not performing surgery for a possible concomitant endometrial cancer, which can be treated and cured, the risk of overtreating some patients is acceptable.     

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.     

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.     

Actualización en linfomas primarios de mama: serie de casos y revisión de la literatura

Introduction

Primary breast lymphomas (PBL) are a rare malignant disease of the breast that can be mistaken for breast carcinoma. Knowledge of PBL allows a correct diagnostic-therapeutic approach to this uncommon malignancy (0.04- 0.5% of breast cancers).

Material and methods

This update is based on an analytic retrospective study of a series of cases recorded at the Hospital Príncipe de Asturias and a comprehensive review of the oncologic and gynecologic literature available.

Discussion

PBL are virtually indistinguishable from breast carcinomas because of their similar age distribution, clinical presentation and imaging features. Diagnosis can only be confirmed by histology. The most effective treatment is combined therapy based on chemotherapy (the most widely used being the CHOP-R regimen). Surgery and radiotherapy play a secondary role. The course of PBL varies widely, from early dissemination to complete remission. Prognostic factors play an important role in PBL. Prompt diagnosis is essential to improve outcome.

Conclusion

Because of their low prevalence, PBL are a diagnostic-therapeutic challenge. There is no agreement on treatment regimens, and outcome is highly variable. New in-depth studies are required to unify criteria and knowledge of this entity.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

Aplicabilidad de la técnica de identificación y biopsia del ganglio centinela en el cáncer de vulva

Objectives

To assess the percentage detection of sentinel-lymph-node in vulval cancer, its sensitivity and negative predictive value (NPV). To ascertain the adverse effects of this technology and long term relapses of tumour.

Material and methods

Systematic review of literature and subsequent critical appraisal of the evidence.

Results

A total of 29 studies were selected, all of which were observational in nature. The sentinel lymph node was detected by Tc⁹⁹-colloid and combined technique in 98% of patients. The percentage of false negatives observed was less than 2%, the sensitivity values and NPV were over 95% and the lymph node relapse rate around 3%.

Conclusions

Sentinel-lymph-node technique would seem to be a reasonable alternative to inguinal lymphadenectomy in patients with early stages of vulval cancer. When it comes to implementing the technique, a series of factors must be borne in mind with respect to the work team, patient selection, detection technique, surgical and anatomopathological techniques and learning curve.