Clinical quality assurance in breast cancer screening and diagnosis: a warning regarding mammographic positioning

This study aimed to evaluate the clinical image quality of mammograms performed in users of the Brazilian Unified Health System (SUS) referred to a tertiary hospital. Methods: A prospective study assessed mammograms from women referred to a specialist breast center in Goiânia, Goiás, Brazil, between May and October 2017. Scans performed in the preceding 6 months, either screening or diagnostic, were included in the study. Clinical quality was determined from 40 variables related to patient identification, technical performance, the equipment, radiological findings, reporting of results, and breast positioning. Scans performed in the public and private healthcare networks were compared regarding mammographic positioning. Results: Overall, 4,560 variables associated with the clinical quality of the images were evaluated in scans from 114 women with a mean age of 50.6 years. A total of 660 (14.47%) inadequacies were found, 443 (67.12%) of which were related to breast positioning. The most common errors were as follows: pectoral muscle could not be seen in 86.8% of scans in the craniocaudal view and inframammary angle could not be seen in 79.8% of scans in the mediolateral oblique view. Considering the breast-positioning criteria evaluated in the mediolateral oblique view, there was a greater risk of the breast not being centrally positioned with the nipple in profile (RR 4.66; 95%CI 1.05−20.62; p=0.02) and of nonvisualization of the retro-areolar area (RR 4.14; 95%CI 0.92−18.66; p=0.04) in the exams performed in the private compared to the public network.

Real-world data on metastatic breast cancer in Goiânia, Brazil: a 17-year analysis (1995­2011)

Introduction: Most of the data on metastatic breast cancer (MBC) originate from hospital-based studies or controlled trials involving specific populations and controlled treatments. In this respect, few population-based studies have analyzed the profile of MBC in low- and middle-income countries. Objective: To describe the epidemiological profile of women with de novo MBC using data from a population-based cancer registry (PBCR). Methods: An ecological study conducted in a PBCR in Goiânia, Brazil, for the 1995­2011 period. Women with MBC at diagnosis were included and the standardized incidence rate and annual percent change (APC) over the period were calculated. The women's clinical and demographic characteristics and data on diagnosis and treatment were analyzed. Results: Overall, 5,289 cases of breast cancer were registered in the Goiânia PBCR, 277 (5.2%) at metastatic stage. The adjusted incidence was 8.9/100,000 in 1995 and 6.04/100,000 in 2011 (APC: 1.1; p=0.6). Most of the patients (70.3%) were receiving care within the public healthcare system and the mean age at diagnosis was 54.7±14.5 years. Additional data for a subpopulation of 156 patients were identified at the city's two main treatment centers. According to immunohistochemistry, 53 women (67.1%) had hormone receptor-positive cancer. Of these, 14.0% (6/43) received endocrine therapy as first-line systemic treatment and 48.5% (17/35) as second-line treatment. A comparison of clinical data between the 1995­2003 and 2004­2011 periods revealed no significant differences in age, histological grade, locoregional staging, the presence of symptoms at diagnosis, or in treatment. Conclusion: This study population of women with MBC consisted predominantly of locally advanced tumors and the luminal-like subtype. The incidence rate of MBC in Goiânia did not change over the 17-year period. Most cases received chemotherapy as firstline systemic treatment irrespective of the tumor phenotype.

Knowledge of basic attention professionals about prevention and early detection of breast cancer in the state of Goiás

The role of Basic Health Care (BHC) professionals is essential in the primary and secondary prevention of breast cancer. The aim of this study was to characterize BHC professionals in the Health Regions of a federative unit and to assess their knowledge about breast cancer. This was a prospective study carried out with BHC professionals from the state of Goiás. Phase 1 ­ Preparation of material and training of the team. Phase 2 ­ Agreement of actions between executing team and coordination of health regions. Phase 3 ­ Presentation of project at the collegiate meeting. Phase 4 ­ Qualification of BHC professionals with different learning methods and application of questionnaires, evaluating the contribution of the action. A total of 1,133 professionals were included; mean age was 36.3 years, and they were predominantly women (87.6%), working as community health agents (59.2%) and at public service (76.3%). Only 53.8% of professionals identified the female sex as a risk factor for breast cancer, while 90% identified family history as an important factor for the development of the disease. Important changes in physical examination that can occur in patients with the disease, such as skin retraction, skin bulging and nipple injury, were mentioned as a risk factor only by 35.3%, 31.3% and 39.7%, respectively. BHC professionals who participated in the project had less than ten years of professional experience and significant restrictions of knowledge about primary and secondary prevention of breast cancer. They still experience difficulties in accessing mammography and specialized care.

Breast cancer staging in population-based registries: an alert to the quality of information

Objective: To discuss the practical difficulties associated with breast cancer staging, especially in the context of populationbased cancer registries (PBCR). Methods: This is a short communication that discusses the importance and temporal evolution of breast cancer staging, as well as the limitations and new challenges associated with this process. Results: This study discusses the importance and temporal evolution of breast cancer staging, as well as the limitations and new challenges associated with this process. Minimal divergences in physical examination and disagreements in imaging tests can classify the patient in a higher or lower stage of the disease. In some population-based registries, up to 20% of the information regarding the clinical stage of breast cancer may be mistaken. Conclusion: We highlight the necessity for continuing education and constant training for all professionals involved in the breast cancer epidemiological context. The utilization of new technologies can help standardize the information and reduce the divergences related to cancer staging registry.

Nipple-sparing mastectomy in normal breast: consequence of simulation and disease anxiety

Diagnosis in psychiatry is a thorough and potentially artificial process. In this letter, we discuss this diagnostic process in the context of a young patient who underwent nipple-sparing mastectomy after falsifying a breast biopsy report revealing invasive ductal carcinoma. The secondary pathology revision was also forged by the patient and confirmed the diagnosis. The patient was summoned by the Service's board and admitted the falsification of breast cancer reports. After evaluation at the Psychiatric Service, changes in vital mood, psychosis, delusional activity and obsessive-compulsive symptoms were ruled out. In view of the growing demand for prophylactic mastectomy observed worldwide, similar cases may become more frequent.

Evaluation of ionizing radiation as a risk factor for the incidence of breast cancer: long-term analysis after the cesium-137 accident in Goiânia, Brazil. An ecological study

ABSTRACT BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. OBJECTIVE: To evaluate the association between breast cancer incidence and ionizing radiation levels. DESIGN AND SETTING: Ecological study among residents of the city of Goiânia, Brazil. METHODS: The central region of Goiânia, with seven major sources of contamination from cesium-137, was defined as the study area. The addresses of women diagnosed with breast cancer were identified between 2001 and 2010. The data were geographically referenced and, using census data, the annual averages of crude incidence rates were estimated. The existence of clusters of new cases was ascertained by means of the Moran index. Correlations of radiometric measurements with the incidence were assessed using unconditional linear regression. RESULTS: A total of 4,105 new cases were identified, of which 2,233 were in the study area, and of these, 1,286 (57.59%) were georeferenced. The gross rates of total and referenced cases were 102.91 and 71.86/100,000 women, respectively. These were close to the average for Brazilian state capitals, which is 79.37/100,000 women. The cluster analysis showed slight correlations in three small sets of census tracts, but these were far from the sources of contamination. The scatter plot of points and the R2 value close to zero indicated that there was no association between the variables. CONCLUSION: This study reinforces the hypothesis that the ionizing radiation levels to which women living in Goiânia are now exposed to are not associated with the onset of new cases of breast cancer.

Publication rate of abstracts on breast cancer presented at different scientific events in Brazil

Introduction: Medical congresses allow scientific production to be appropriately disseminated and discussed. However, most of the scientific papers presented at medical congresses do not go on to be published in indexed journals. The present study aimed to characterize the abstracts presented at three different congresses on breast cancer held in Brazil, and to determine the publication rate of these three events. Methods: Observational, retrospective study, where the observation unit consisted of the scientific papers presented at the Brazilian Congress of Mastology (CBM), Jornada Paulista de Mastologia (JPM) and Brazilian Breast Cancer Symposium (BBCS) in 2017. Initially, we recorded all the abstracts of works presented at the event. Subsequently, the works were searched in digital databases (BIREME/LILACS and MEDLINE/PubMed) and in the respective resumes of the authors on the Lattes platform. Results: The study included 266 abstracts of scientific papers presented in the three selected events, of which 21 (7.9%) were published in an indexed journal. Most of these studies were conducted predominantly in public institutions (71.1%), located in the State of São Paulo (30.5%) and were presented in the form of a poster (77.8%). The publication rate from the BBCS, CBM and JPM was 13.4, 5.4 and 3.4%, respectively (p = 0.03). Considering the published articles, there was no difference in journal impact factor between the congresses (p = 0.49). "Mastology" was the journal that received the largest number of publications (n = 8; 38.1%). Conclusion: In 2017, less than 10% of the abstracts on breast cancer presented at Brazilian congresses were published in an indexed journal. Among the main specialty events in the country, the Brazilian Breast Cancer Symposium has a significantly higher publication rate.

Vitiligo as a Köebner phenomenon after oncoplastic breast surgery

The Köebner phenomenon is characterized by the appearance of several types of dermatological lesions after traumatic stimulation. The triggering of this phenomenon after breast surgery is uncommon and usually associated with psoriatic lesions. The aim of this study was to describe two cases of vitiligo as the initial manifestation of Köebner phenomenon after breast oncoplastic surgery. Case 1: female, 41 years old, no history of dermatological pathologies, presenting with tubular carcinoma in the right breast. Quadrantectomy and sentinel lymph node biopsy were performed, followed by reconstruction with mammoplasty. Later, the patient started on tamoxifen and underwent radiotherapy, without complications. Thirty days after treatment, the patient presented progressive depigmentation of the areola-papillary complex. Topical treatment was started with dermatological ointment tacrolimus monohydrate and, after one year, the condition was completely resolved. Case 2: 52-yearold woman with previous history of vitiligo on the face, with complete clinical response after dermatological treatment. She was diagnosed with ductal carcinoma in situ on the left breast and underwent quadrantectomy, by means of mammoplasty using the round block technique. Afterwards, she underwent radiotherapy and started tamoxifen. Four years after the surgery, she developed dyschromia in the ipsilateral periareolar region and was diagnosed with vitiligo. Local dermopigmentation was offered, but the patient opted for an expectant conduct and clinical follow-up. To our knowledge, this is the first description of Köebner phenomenon after breast oncoplastic surgery. In these cases, the therapeutic approach must be multidisciplinary and count on the assessment of multiple clinical and individual parameters.

The cosmetic outcome of breast reconstruction: reproducibility of different methods assessed by different professionals / Resultado estético após reconstrução mamária: reprodutibilidade de diferentes métodos avaliados por diferentes profissionais

Objective: To compare the reproducibility of different methods for assessing the cosmetic outcome of breast reconstruction, which was assessed by different health professionals. Methods: Photographs of 270 breast cancer patients who had been submitted to breast reconstruction of some type were included. A plastic surgeon, a resident in plastic surgery, two mastologists, two residents in mastology, and two psychologists performed the evaluation. The modified Garbay and Harvard scales and the objective BCCT. core software program were used. Cohen's Kappa and Spearman correlation coefficients were calculated. Results: The mean age of the patients was 55.7 (±11.1) years. Overall, 145 women (53.7%) underwent partial breast reconstruction and 125 (46.3%), total breast reconstruction. The mean follow-up time was 63.7±45.6 months. By applying the Harvard scale, the interobserver reproducibility among the different professionals was minimal; whereas the Garbay scale had no agreement. The correlations between the BCCT.core software program and the Harvard and modified Garbay scales were moderate. Conclusion: Correlations between both the modified Garbay scale and the Harvard scale and the objective (BCCT.core) test were moderate. There was less interobserver variability with the Harvard scale compared to the modified Garbay scale.

Objetivo: Comparar a reprodutibilidade de métodos diferentes de avaliação dos resultados estéticos de cirurgias reconstrutivas da mama, por avaliadores distintos. Métodos: Foram incluídas fotografias de 270 pacientes portadoras de neoplasia da mama que passaram por cirurgias reconstrutivas da mama. As notas da avaliação foram dadas por um cirurgião plástico, um residente em cirurgia plástica, dois mastologistas, dois residentes em mastologia e dois psicólogos. Foram utilizadas as escalas de Harvard e Garbay modificada e a nota objetiva do programa BCCT.core. Foram calculados os índice Kappa de concordância interobservador e de correlação de Spearman. Resultados: A média de idade das pacientes foi de 55,7 anos (±11,1). No geral, 145 (53,7%) mulheres foram submetidas a tratamento conservador com cirurgia oncoplástica e 125 (46,3%) passaram por mastectomia e reconstrução total. A média de tempo de seguimento foi de 63,7±45,6 meses. Para a escala de Harvard, houve uma reprodutibilidade interobservador razoável para os diferentes profissionais, enquanto na escala de Garbay, a reprodutibilidade foi pobre entre os profissionais. De forma geral, a nota dada pelo programa BCCT.core correlacionou-se moderadamente com a escala de Harvard e a de Garbay modificada. Conclusão: As escalas de Harvard e de Garbay modificada correlacionam-se igualmente de forma moderada com o teste objetivo (BCCT.core). A escala de Harvard tem menor variabilidade interobservador, se comparada com a escala de Garbay.

Incisões cirúrgicas mamárias tratadas com 2-octilcianoacrilato versus sutura intradérmica com fio de nylon: ensaio clínico randomizado / Surgical breast incisions treated with 2-octyl-cyanoacrylate versus intradermal nylon suture: a randomized clinical trial

RESUMO Objetivo: avaliar o perfil de segurança e os resultados estéticos do 2-octilcianoacrilato versus sutura intradérmica com fio de nylon em cirurgias mamárias. Métodos: ensaio clínico randomizado, aberto, que avaliou a ocorrência de complicações, como deiscência, hematoma, infecção e reações alérgicas após o uso do 2-octilcianoacrilato ou do fio de nylon. Também foi analisado o tamanho das incisões, o tempo de fechamento da pele e o tempo cirúrgico total. O resultado estético foi avaliado após 40 e 180 dias da cirurgia, por meio da largura média da ferida operatória e por avaliação subjetiva conceitual (ótimo, bom, razoável ou ruim). Resultados: foram incluídas 79 pacientes, sendo 37 no grupo 2-octilcianoacrilato e 42 no grupo de sutura com fio de nylon. O estudo foi interrompido antes do término do recrutamento dos pacientes pela ocorrência de maior número de deiscências no grupo do adesivo (OR: 11,42; IC95%: 1,36-96,02; p=0,007). Em relação às demais complicações analisadas, ao tempo cirúrgico e ao resultado estético no pós-operatório, não se observaram diferenças significativas entre os grupos. A média do tamanho da ferida operatória foi maior no grupo do adesivo em relação ao grupo da sutura, mas não houve correlação entre o tamanho da ferida e o maior número de deiscências. Conclusão: o 2-octilcianoacrilato apresentou maior risco de deiscência em relação à sutura intradérmica, com resultados estéticos equivalentes.

ABSTRACT Objective: to evaluate the safety profile and aesthetic results of 2-octyl-cyanoacrylate versus intradermal nylon suture in breast surgeries. Methods: an open-label, randomized, clinical trial evaluating the occurrence of complications, such as dehiscence, hematoma, infection, and allergic reactions after the use of 2-octyl-cyanoacrylate or nylon thread. The size of the incisions, skin closure time, and total surgical time were also analyzed. The aesthetic outcome was evaluated at 40 and 180 days after surgery, by means of the average width of the surgical wound and by subjective conceptual assessment (optimal, good, reasonable, or poor). Results: 79 patients were included: 37 in the 2-octyl-cyanoacrylate group and 42 in the nylon suture group. The study was stopped before the end of patient recruitment due to the occurrence of a greater number of dehiscences in the adhesive group (OR: 11.42; 95%CI: 1.36-96.02; p=0.007). Regarding the other analyzed complications, the surgical duration and postoperative aesthetic result, no significant differences were observed between the groups. The mean operative wound size was greater in the adhesive group than in the suture group, but there was no correlation between wound size and the largest number of dehiscences. Conclusion: while the cosmetic outcomes with the two techniques were similar, there was a greater risk of dehiscence with the use of 2-octyl-cyanoacrylate compared to intradermal suturing.

Foreign body in the breast: multiple sewing needles / Corpo estranho no parênquima mamário: múltiplas agulhas

Needles embedded in the breast are an unusual situation. It is reported the possibility of developing an abscess and the risk of migration of the needles. We report the case of a 38 year old woman with approximately 25 needles inserted in her breasts, bilaterally. According to the patient, the insertion occurred during the episode of a recent physical aggression; however, the hypothesis of self-mutilation could not be ruled out. She also referred the withdrawal of some needles at home and tried a surgical resection of others. Physical examination of the breasts revealed bilateral bruising, located in the upper inner quadrant of the left breast and diffusely in the right breast. Ultrasound examination showed needles in both breasts, associated with a hyperechoic area between 5 and 6h of the right breast, corresponding to palpable clinical area. An X-ray and chest tomography also revealed the presence of several needles in the breasts. At mammography, multiple intra-mammary needles and lymph nodes were diffusely distributed through the parenchyma, bilaterally. After discussing with the patient about the diagnosis and therapeutic options, we opted for clinical follow-up. Currently, the patient has moderate acyclic mastalgia, and is on clinical follow up for 55 months

Agulhas inseridas no parênquima mamário constituem uma situação incomum, podendo haver ocorrência de abscessos e o risco de migração das agulhas. Descrevemos o caso de uma paciente do sexo feminino, de 38 anos de idade, diagnosticada com aproximadamente 25 agulhas de costura em suas mamas, bilateralmente. Segundo a paciente, a inserção ocorreu durante episódio de agressão física recente; porém, a hipótese de automutilação não pôde ser descartada. A paciente também referiu a retirada domiciliar de algumas agulhas e a tentativa de retirada em outro Serviço. Ao exame físico das mamas, evidenciava-se equimose bilateral, localizada no quadrante súpero-medial da mama esquerda e difusamente na mama direita. O exame ultrassonográfico evidenciou agulhas em ambas as mamas, associadas à área hiperecoica entre 5 e 6h da mama direita, correspondente a área clínica palpável. A radiografia e a tomografia de tórax visibilizaram a presença de vários corpos estranhos nas mamas, de aspecto metálico, compatíveis com agulhas. Após discussão com a paciente acerca do diagnóstico e das opções terapêuticas, optou-se por conduta expectante. Após 55 meses, a paciente refere mastalgia acíclica moderada e mantém seguimento clínico no Serviço

Prognostic factors and overall survival of breast cancer in the city of Goiania, Brazil: a population-based study / Fatores prognósticos do câncer de mama e sobrevida global em cinco e dez anos na cidade de Goiânia, Brasil: estudo de base populacional

ABSTRACT Objective: to analyze the overall survival and prognostic factors of women with breast cancer in the city of Goiânia. Methods: this is a retrospective, cross-sectional, observational study that included women with malignant neoplasms of the breast identified by the Goiânia Population-based Cancer Registry. The variables studied were age at diagnosis, tumor size, staging, axillary lymph node involvement, tumor grade, disease extent, hormone receptors, and c-erb-B2 oncoprotein. We performed overall survival analyzes of five and ten years. Results: we included 2,273 patients in the study, with an overall survival of 72.1% in five years and 57.8% in ten years. In the multivariate analysis adjusted for tumor size, the factors that influenced the prognosis were axillary lymph nodes, histological grade, progesterone receptor, c erb B2, T staging and disease extension. Conclusion: overall survival in ten years is below that observed in other countries, and possibly reflects what happens with the majority of the Brazilian population. The prognostic factors found in this population follow the same international patterns.

RESUMO Objetivo: analisar a sobrevida global e os fatores prognósticos de mulheres com câncer de mama na cidade de Goiânia. Métodos: estudo observacional, retrospectivo, transversal, que incluiu mulheres portadoras de neoplasias malignas da mama identificadas pelo Registro de Câncer de Base Populacional de Goiânia. As variáveis estudadas foram: idade ao diagnóstico, tamanho do tumor, estadiamento, comprometimento dos linfonodos axilares, grau tumoral, extensão da doença, receptores hormonais e oncoproteína c-erb-B2. Foram realizadas análises de sobrevida global, de cinco e de dez anos. Resultados: foram incluídas no estudo 2273 pacientes, com sobrevida global em cinco anos de 72,1% e de 57,8% em dez anos. Na análise multivariada ajustada pelo tamanho do tumor, os fatores que influenciaram o prognóstico foram: linfonodos axilares, grau histológico, receptor de progesterona, c-erb-B2, estadiamento T e extensão da doença. Conclusão: a sobrevida global em dez anos está abaixo da observada em outros países, e possivelmente reflete o que acontece com a maioria da população brasileira. Os fatores prognósticos encontrados nesta população seguem o mesmo padrão internacional.

Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

Iniciação científica na graduação: experiência da Liga da Mama da Universidade Federal de Goiás / Scientific activities during undergraduate education: the experience of Breast League of the Federal University of Goiás

Objetivo: Descrever a experiência da Liga da Mama da Universidade Federal de Goiás no processo de iniciação científica na graduação e descrever a produção científica entre 2008 e 2015, com a participação direta dos acadêmicos dessa liga. Métodos: Trata-se de um estudo descritivo e retrospectivo que analisou a produção científica dos acadêmicos da Liga da Mama da Universidade Federal de Goiás entre 2008 e 2015. As seguintes variáveis foram analisadas: apresentações orais ou em pôster, em congressos científicos e estudantis e publicações em periódicos nacionais e internacionais. Resultados: Entre 2008 e 2015, aproximadamente 11 0 alunos de graduação participaram de algum projeto científico vinculado à Liga da Mama da Universidade Federal de Goiás. Nesse período, os acadêmicos da liga apresentaram 233 trabalhos em congressos científicos e estudantis, dos quais 196 (84,1%) foram em formato de pôster e 37 (15,9%) na forma de apresentação oral. Ainda, observou-se a publicação de 29 artigos científicos com participação direta de 1 ou mais discentes de graduação vinculados ao projeto. Conclusão: Na Universidade Federal de Goiás, os projetos de iniciação científica da Liga da Mama constituem uma oportunidade de desenvolvimento acadêmico para os discentes de graduação. As ligas acadêmicas, quando orientadas de forma adequada, podem contribuir para a produção científica nacional e a consolidação do currículo acadêmico.

Objective: To describe the experience of Breast League of the Federal University of Goiás, Brazil, in scientific research process in undergraduate and describe the scientific production between 2008 and 2015, with the direct participation of the students. Methods: This is a descriptive and retrospective study that analyzed the scientific production of Breast League of the Federal University of Goiás between 2008 and 2015. The following variables were analyzed: oral or poster presentations, scientific and student conferences and papers in national and international journals. Results: Between 2008 and 2015, about 110 undergraduate students participated in a scientific project linked to the Breast League of the Federal University of Goiás. During this period, the students of the league had presented 233 works in scientific conferences, of which 196 (84.1%) were in poster format and 37 (15.9%) were oral presentations. There was the publication of 29 scientific papers with direct participation of 1 or more undergraduate students linked to the project. Conclusion: At the Federal University of Goiás, the scientific projects of the Breast League are an academic development opportunity for undergraduate students. The academic leagues, when directed properly, can contribute to the national scientific production and the consolidation of the academic curriculum.

Is the combination of fat grafts and platelet rich plasma effective in rats?

ABSTRACT PURPOSE: To investigate if the association of fat grafts and platelet-rich plasma (PRP) improves graft viability in female rats. METHODS: This is an experimental, randomized and blinded study, which involved 47 rats. Fat was harvested from the inguinal region and grafted to the cranial region. The experimental group consisted of PRP-enriched fat grafts (n=22) whilst the control group consisted of fat graft only (n=25). After a 100-day period, the animals were euthanised and the fat grafts were analyzed using scores from 0 (absent) to 4 (abundant), in optical microscopy by two independent and blinded pathologists. RESULTS: Regarding fat graft cell viability, the PRP group scored moderate/abundant in 63% of cases and the fat graft only group scored absent/slight in 72% of cases (p=0.03). The PRP group also presented lower fat necrosis scores when compared to the fat graft only group (p=0.03). Tumors (dermoid cysts) within the fat grafts were observed in three animals in which the grafts were mixed with PRP. CONCLUSION: Platelet-rich plasma improves the viability and integration of fat grafts in rats, but more studies are needed to fully understand the exact mechanisms that lead to this improvement and assess the safety of the method for use in humans.

Adesão ao seguimento ambulatorial de pacientes com doença trofoblástica gestacional atendidas em um centro de referência / Adherence to follow­up in patients with gestational trophoblastic disease treated at a referral center

Objetivo Avaliar a adesão das pacientes com doença trofoblástica gestacional (DTG) ao seguimento ambulatorial pós­molar em um centro de referência na região Centro­Oeste do Brasil. Métodos Estudo observacional, retrospectivo, que incluiu todas as pacientes diagnosticadas com DTG na Maternidade­Escola da Universidade Federal de Goiás em um ano. Foram colhidos dados referentes a idade, paridade e valores de B­hCG. A adesão ao seguimento ambulatorial e o exame histopatológico do produto do esvaziamento uterino foram obtidos pela revisão de prontuários. Resultados Entre as 55 pacientes incluídas no estudo, apenas 27 (49%) prosseguiram com o tratamento de forma completa; das quais 11 (40,7%) tiveram indicação de quimioterapia segundo o protocolo do Serviço. Conclusão A taxa de adesão ao seguimento ambulatorial foi baixa. O alto índice de pacientes com necessidade de quimioterapia determina um cenário alarmante sobre o prognóstico das pacientes que não concluíram o seguimento pós­molar. Esse estudo aponta a necessidade de estratégias efetivas para o manejo e o controle da doença.

Objective To evaluate the adherence to outpatient follow­up among patients with gestational trophoblastic disease (GTD) in a reference center in the Midwest region of Brazil. Methods This was an observational, retrospective study that included all patients diagnosed with GTD in the Maternity School of the Universidade Federal de Goiás in one year. Data were collected regarding age, parity and B­hCG values. Adherence to follow­up and histopathological examination of the uterine evacuation product were obtained by chart review. Results Among the 55 patients included in the study, only 27 (49%) continued with the treatment properly; of which 11 (40.7%) had chemotherapy indication by the protocol service. Conclusion The adherence rate to outpatient follow­up was low. The high rate of patients in need of chemotherapy determines an alarming scenario on the prognosis of patients who did not complete the follow­up. This study highlights the need for effective strategies for the management and control of the disease.

Doença de Paget da mama: experiência de um centro universitário / Paget's disease of the breast: experience of a university center

Objetivo: Determinar a prevalência de doença de Paget da mama (DPM) entre os casos de carcinomas ductais diagnosticados em um centro universitário, entre 2003 e 2007, descrever as características clínicas e analisar a sobrevida desses casos. Métodos: Estudo de coorte retrospectiva, por meio da revisão de prontuários médicos. Foi realizada análise de frequência para todas as variáveis e utilizada curva de Kaplan-Meier para a representação da sobrevida global. Resultados: De 278 casos de carcinomas ductais de mama, houve 14 casos de DPM, determinando prevalência de 5,0%. Um caso foi excluído da análise por apresentar dados incompletos. A média de idade ao diagnóstico foi de 57,1 (±11,2) anos. Dos casos analisados, 11 (84,6%) apresentavam tumor palpável, e 9 (69,3%), lesão do complexo aréolo-papilar (CAP). Apenas um caso não foi submetido à mastectomia, por óbito durante quimioterapia neoadjuvante. Radioterapia foi realizada em 6 casos (46,2%), quimioterapia, em 11 casos (84,6%), e endocrinoterapia, em 6 casos (46,2%). A imunoistoquímica identificou 5 casos (38,5%) com expressão de receptores hormonais e 12 casos (92,3%) com superexpressão de HER2. A sobrevida global das pacientes foi de 61,5 (±13,4) meses e não houve recidiva local após um tempo médio de seguimento de 75,8 meses. Conclusão: Observou-se prevalência de DPM associada a carcinomas invasores com estádio clínico avançado, o que possivelmente ocasionou sobrevida global inferior à observada em estudos prévios para a região.

Objective: To determine the prevalence of Paget's disease of the breast (PD) among cases of ductal carcinomas diagnosed in a university hospital between 2003 and 2007; describe clinical characteristics and analyze the survival of these cases. Methods: Retrospective cohort study, by reviewing medical records. Frequency analysis was performed for all variables and used Kaplan-Meier curve for the representation of overall survival. Results: In 278 cases of breast ductal carcinoma, 14 cases were PD determining prevalence of 5.0%. A case was excluded from analysis because of incomplete data. The mean age at diagnosis was 57.1 (±11.2) years. Of the cases analyzed, 11 (84.6%) had palpable tumor and 9 (69.3%) presented lesion of the nipple-areola complex. Only one case was not submitted to mastectomy because she died during neoadjuvant chemotherapy. Radiotherapy was performed in six cases (46.2%); chemotherapy in eleven cases (84.6%); endocrinoterapia in six cases (46.2%). Immunohistochemistry identified five cases (38.5%) with expression of hormone receptors and twelve patients (92.3%) with overexpression of HER2. The overall survival of patients was 61.5 (±13.4) months, and there was no local recurrence after a mean follow-up of 75.8 months. Conclusion: There was a prevalence of Paget's disease of the breast associated with invasive carcinomas with advanced clinical stages; which possibly resulted in overall survival rate lower than that observed in other studies for the region.

Mortalidade por câncer de mama feminino no Brasil de acordo com a cor / Female breast cancer mortality in Brazil according to color

Descrever a mortalidade por câncer de mama feminino no Brasil segundo a cor, nos anos de 2000 e 2010.

To describe the mortality of female breast cancer in Brazil according to color, in the years 2000 and 2010.