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Rev. bras. mastologia ; 18(3): 107-113, jul.-set. 2008. tab
Article in Portuguese | LILACS | ID: lil-550143

ABSTRACT

Objetivo: Avaliar a concordância dos achados histopatológicos em linfonodos sentinela e axilares, após quimioterapia neoadjuvante para câncer de mama avançado. Método: Por estudo prospectivo, clínico, foram comparados histopatologicamente grupos de linfonodos de 21 mulheres, com câncer de mama em estádios III ou IV, submetidas a quimioterapia neoadjuvante, biópsia de linfonodo sentinela pelo azul patente e mastectomia radical, no Hospital Universitário Oswaldo Cruz, Recife, PE, de outubro de 2005 a outubro de 2006. Com o programa Statistical Package for Social Sciences 13.0, empregaram-se: teste exato de Fisher em nível de significância de 5%, teste Kappa e cálculos de concordânciaa, sensibilidade, especificidade, valores preditivos positivo e negativo, proporção de falso-negativos e positivos. Foram excluídas 7/28 (25%) pacientes por impossibilidade de identificar linfonodo sentinela. Resultados: O número de linfonodos sentinela excisados igualou-se a um (19/21; 90,5% pacientes) ou dois (2/21; 9,5% pacientes). As taxas de concordância, falso-negativos, falso-positivos, sensibilidade e especificidade de células neoplásicas em linfonodo sentinela, comparadas à dos axilares, foram: 71,4%, 38,5%, 12,5%, 61,5% e 87,5%, comparado a outros trabalhos, o presente estudo identificou menor taxa de concordância, maior de falso-negativos e igual taxa de identificação, com baixa sensibilidade, alta especificidade e grau de concordância significativo.


Objective: To evaluate the agreement of histopathologic findings on sentinel and axillary lymph nodes after neoadjuvant chemotherapy for advanced breast cancer. Methods: Within a prospective, clinical study, lymph node groups of 21 women, carries of breast cancer in stadium III or IV, submitted to neoadjuvant chemotherapy and radical mastectomy after lymph node biopsy by patent blue, at the Hospital Universitário Oswaldo Cruz, Recife, Pernambuco, Brazil, from October 2005 to October 2006, were histopathologically compared. Statistical Package for Social Sciencs 13.0 software was used to perform Fisher exact test, with significance level of 5%, kappa test and calculi of agreement, sensibility, specificity, positive and negative predictive values, false negatives and positives ratios. One excluded 7/28 (25%) patients due to the impossibility to identify sentinel lymph node. Results: Excised sentinel lymph nodes varied from one (19/21; 90.5% patients) to two (2/21; 9.5% of patients). Comparing sentinel to axillary lymph nodes for positivity of neoplasic cells, rates of agreement, false negatives and positives, sensibility and specificity were: 71.4%, 38.5%, 12.5%, 61.5% and 87.5%, respectively, with significant concordance degree (p = 0.027; k = 0.447). Conclusion: Related to other studies, one identified minor concordance rate, higher false negative rate and equal identification rate, associated to law sensibility, high specificity and a significant concordance degree.


Subject(s)
Humans , Female , Adult , Middle Aged , Sentinel Lymph Node Biopsy/methods , Lymph Node Excision , Lymph Nodes/pathology , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Chemotherapy, Adjuvant/adverse effects , Neoadjuvant Therapy/methods , Axilla , False Negative Reactions , False Positive Reactions , Prospective Studies , Sensitivity and Specificity , Sentinel Lymph Node Biopsy , Diagnostic Techniques and Procedures
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