ABSTRACT
Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple?sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and Methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow?up of 42.82 (19�) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM
ABSTRACT
Objective:Occult breast cancer (OBC) accounts for 0.3%-1.0%of all breast cancers. Because of the rarity of this dis-ease, its treatment and prognosis remain unclear. Our study evaluated the treatment outcomes and prognostic factors associated with OBC. Methods:A total of 82 patients diagnosed with OBC based on available criteria were treated at the Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China, between January 1968 and June 2014. Except for 16 patients who were treated by needle biopsy or excisional biopsy only and were subsequently excluded, all of the cases reported were included in the study. Of the remaining 66 patients, one was male. Patient data, tumor characteristics, and treatment and outcome variables were evaluated. Overall survival (OS) and disease-free survival (DFS) were analyzed. A unicentric retrospective review of 66 patients with OBC was performed. Re-sults:The median follow-up was 75.5 months (7.0-328.0). No significant differences in OS and DFS were observed between patients who underwent mastectomy plus axillary lymph node dissection (Mast+ALND) and those who underwent breast conservation surgery (P>0.05). Univariate analysis revealed that nodal status is a significant prognosis factor of DFS (P=0.031). Conclusion:No significant difference in treatment outcomes between mastectomy+ALND and breast conservation surgery was observed. Nodal status may be an independent predictor of poor outcomes in OBC patients.
ABSTRACT
Objetivo: Rever o estado de arte relativo a: conceito, diagnóstico, tratamento e prognóstico do carcinoma oculto da mama. Método: Procedeu-se a revisão das publicações do período de 2002 a 2007, nas bases de dados MedLine, BIREME, LILACS e Cochrane, que incluíssem conceito, diagnósticos provável e definitivo, tratamento e prognóstico de carcinoma oculto da mama. Entre os 72 artigos localizados, 43 foram excluídos por falta de pelo menos um dos critérios de inclusão. Desenvolvimento: O carcinoma oculto da mama caracteriza-se por ser uma entidade clínica rara, não detectável aos exames físico e radiológico da mama, que se apresenta como linfadenopatia axilar. Seu diagnóstico definitivo, de exclusão, exige: conhecimento dos diagnósticos diferenciais, imagem por ressonância magnética, histopatologia e imunoistoquímica de material de linfadenectomia com pesquisa dos fatores de crescimento endotelial vascular C e D, positivos em 75% e 81,9%, respectivamente. Mais recentemente, a cintimamografia tem sido empregada para localização do tumor e a tomografia por emissão de pósitrons ainda não é indicada. O tratamento deve ser individualizado segundo análise dos fatores de risco e do painel prognóstico. Inclui linfadenectomia associada à radioterapia e à adjuvância, podendo ser empregada mastectomia radical com ou sem reconstrução imediata. A sobrevida em 10 anos varia de 50% a 71%, segundo o painel prognóstico.
Objective: To revue current trends in the definition, diagnosis, treatment and prognosis of occult breast carcinoma. Method: Publications from 2002 and 2007, on MedLine, BIREME, LILACS and Cochrane databases were reviewed, according to inclusion criteria of definition, probable diagnosis and definitive diagnosis, treatment and prognosis of occult breast carcinoma. Amongst 72 localized articles, 43 were excluded due to absence of at least one inclusion criterium. Development: Occult breast carcinoma is characterized as a rare clinical entity, undetectable by physical and radiological exams, with first symptoms consisting on axillary limphadepathy. Its definitive diagnosis, determined by exclusion, requires: knowledge of differential diagnosis, magnetic resonance images, histopathology and immune histochemistry analyzes of sample obtained by limphadenectomy, including research of endothelial vascular growth factors C and D, because they are positive for 75% and 81.9% of cases, respectively. Recently, cintimamography has been used for tumor localization, but positron tomography is not yet indicated. Treatment must be individualized according to risk factor analyzes and prognostic panel. It includes lymphadenectomy associated to radiotherapy and adjuvancy, but radical mastectomy with or without immediate reconstruction may be used. The 10 years survey varies from 50% and 71%, according to prognostic panel.