A New N-staging System for Predicting Postoperative Survival of M0 Stage Inflammatory Breast Cancer / 肿瘤防治研究

Objective To establish a new N-stage system combining the number of metastatic lymph nodes and the ratio of metastatic lymph nodes for postoperative M0 stage inflammatory breast cancer patients. Methods Based on the data of inflammatory breast cancer patients in the SEER database, the number of metastatic lymph nodes and the ratio of metastatic lymph nodes were calculated.A new N-staging system was established and compared with the 8th edition of AJCC TNM staging system of breast cancer.The nomograph prognostic model was constructed and validated. Results The prediction performance of the new N-staging system for postoperative survival of M0 inflammatory breast cancer patients was better than the traditional N-staging system.The nomograph prognostic model showed an excellent clinical efficacy with a consistency index of 0.711. Conclusion The new N-staging system has good predictive performance for postoperative survival of M0 inflammatory breast cancer patients and can accurately reflect the prognosis.

Caracterización del cáncer de mama triple negativo / Characterization of Triple Negative Breast Cancer

RESUMEN Fundamento: el cáncer de mama triple negativo constituye un problema de salud pública, por su elevada morbilidad y mortalidad. Objetivo: caracterizar las pacientes diagnosticadas con cáncer de mama triple negativo atendidas en el Servicio de Oncología del Hospital Universitario Docente Celestino Hernández Robau en el período 2015- 2016. Método: se realizó un estudio descriptivo de corte transversal. El universo correspondió a 59 pacientes diagnosticadas con cáncer de mama triple negativo con confirmación histológica. Se consideraron las variables: edad, color de la piel, variante histológica, tamaño tumoral, estado ganglionar, invasión vascular y linfática, grado histológico y nuclear, etapas clínicas, tratamiento, tipo y tiempo de aparición de las metástasis. La información recopilada se procesó por medio del programa estadístico IBM SPSS versión 21. Fueron utilizados de la estadística descriptiva las distribuciones de frecuencia y porcentaje. Los resultados fueron expresados mediante tablas. Resultados: el grupo etáreo predominante fue el de 60 y más años, el color de la piel blanca, el diagnóstico histológico más frecuente fue el carcinoma ductal infiltrante, prevaleció la etapa clínica II, predominó la no afectación de ganglios axilares y la no invasión vascular y linfática, las metástasis diagnosticadas que predominaron fueron las viscerales. Conclusiones: predominó la edad de 60 años y más y el carcinoma ductal infiltrante, el tamaño del tumor, grado histológico y grado nuclear constituyen factores pronósticos importantes para el diagnóstico y tratamiento del cáncer de mama triple negativo. Al término del estudio el 55,9 % de las pacientes estaban vivas.

ABSTRACT Background: triple negative breast cancer constitutes a public health problem due to its high morbidity and mortality. Objective: to characterize the patients diagnosed with triple negative breast cancer treated at the Oncology Service of the Celestino Hernández Robau University Hospital in the period 2015-2016. Method: a descriptive cross-sectional study was carried out. The universe corresponded to 59 patients diagnosed with histological confirmed triple negative breast cancer. The variables were considered: age, skin color, histological variant, tumor size, lymph node status, vascular and lymphatic invasion, histological grade and clinical nucleo-stages, treatment, type and time of appearance of metastases. The information collected was processed through the statistical program IBM SPSS version 21. The frequency and percentage distributions were used from descriptive statistics. The results were expressed by charts. Results: the predominant age group was 60 and over, white skin color, the most frequent histological diagnosis was infiltrating ductal carcinoma, clinical stage II prevailed, there was no involvement of axillary lymph nodes or vascular and lymphatic invasion, the diagnosed metastases that the visceral ones predominated. Conclusions: the age of 60 years and older prevailed and infiltrating ductal carcinoma, tumor size, histological grade and nuclear grade are important prognostic factors for the diagnosis and treatment of triple negative breast cancer. At the end of the study, the 55,9 % of the patients were alive.

Single vertical incision thoracoabdominal flap for chest wall reconstruction following mastectomy of locally advanced breast cancer

PURPOSE: Skin grafts have been widely used in managing extensive chest wall defects after mastectomy for advanced breast cancer. However, their durability and tolerability to radiotherapy is still controversial. A thoracoabdominal (TA) flap with a few technical refinements can safely transfer a larger flap while minimizing complications. METHODS: From January 2007 to February 2018, a retrospective review was performed to compare 2 groups after wide breast excision: skin graft group (group 1) and lateral-based, single vertical incision rotation-advancement TA flap (group 2). Patients' demographics, operative details, complications, hospital stay, postoperative outpatient visits, cost, and start of adjuvant therapy were analyzed between the 2 groups. RESULTS: During the study period, 34 patients received skin graft and 41 patients received TA flap. group 2 had a shorter hospital stay (6.41 ± 2.64 days vs. 12.62 ± 4.60 days, P 1 year was observed in 4 patients in only group 1 (43.90% vs. 38.24%, P = 0.613). CONCLUSION: TA flap has a simple design that minimizes concerns involving the donor site. Moreover, it does not require complicated procedures and allows for re-elevation whenever necessary. Finally, it guarantees faster wound recovery than skin graft with fewer complications.

Percepção dos internos de uma faculdade de medicina sobre o câncer de mama e reconstrução mamária / Perception of breast cancer and breast reconstruction in medical school students

Introdução: O câncer de mama é o tipo mais comum entre as mulheres no mundo e no Brasil, depois do câncer de pele não melanoma. O objetivo é avaliar a percepção dos estudantes de medicina sobre o câncer de mama e reconstrução mamária. Métodos: Trata-se de estudo transversal piloto composto por alunos do 5º e 6º ano de curso de medicina, realizado de maio de 2016. Resultados: Foi questionado se há possibilidade de reconstrução mamária após a mastectomia, sendo que de forma unânime 100% foi sim. Para melhor caracterização, foi perguntado se a reconstrução pode ser feita no mesmo momento da mastectomia, 69 (57,5%) estudantes marcaram sim e 51 (42,5%) negaram. Em análise aos conhecimentos cirúrgicos, foi perguntado se os mesmos conhecem alguma técnica de reconstrução mamária, sendo que 49 (40,83%) responderam que sim e 71 (59,16%) negaram conhecer. Em relação ao encaminhamento à especialidade médica mais preparada para acompanhar e realizar a reconstrução mamária, 93 (77,5%) discentes elegeram a cirurgia plástica e 26 (21,66%) a mastologia. Quanto à possibilidade de reconstrução de mama em pacientes que farão radioterapia adjuvante, 66 (55%) responderam sim, 51 (42,5%) não e 3 (2,5%) não souberam responder. Quanto a esta possibilidade mesmo em pacientes com implantes de silicone, 59 (49,16%) responderam sim, 3 (2,5%) responderam não e 58 (48,33%) afirmaram não saber sobre o assunto. Conclusão: Observou-se que a Mastologia vem ganhando espaço na reconstrução de mama, inclusive no meio acadêmico, devido ao alto percentual de resposta de que a mesma seria mais preparada do que a Cirurgia Plástica para reconstrução mamária.

Introduction: Breast cancer is the most common type of cancer among women in the world and in Brazil, after non-melanoma skin cancer. Our objective was to evaluate the medical students' perception of breast cancer and breast reconstruction. Methods: This is a cross-sectional pilot study composed of students from the fifth and sixth year of medical school, in May 2016. Results: We questioned whether there is a possibility of breast reconstruction after mastectomy, and the response was unanimous (100%). For a better characterization, we asked if the reconstruction could be done at the same time as the mastectomy, and 69 (57.5%) students said yes and 51 (42.5%) denied. In the analysis of surgical knowledge, we asked whether they knew any breast reconstruction technique, and 49 (40.83%) answered yes and 71 (59.16%) denied knowing. With regard to referral to a medical specialist who was better prepared to follow and perform breast reconstruction, 93 (77.5%) students chose plastic surgery and 26 (21.66%) chose mastology. Regarding the possibility of breast reconstruction in patients who need to undergo adjuvant radiotherapy, 66 (55%) answered yes, 51 (42.5%) did not answer, and three (2.5%) did not know how to respond. Regarding this possibility in patients with silicone implants, 59 (49.16%) answered yes, three (2.5%) answered no, and 58 (48.33%) said they did not know about the subject. Conclusion: We conclude that mastology has been gaining immense interest in the field of breast reconstruction, including in the academic world, based on the high percentage of respondents who stated that they are better prepared for this procedure than for plastic surgery for breast reconstruction.

Dermoscopy of inflammatory breast cancer

Abstract: Inflammatory breast cancer is an aggressive and infiltrative malignancy that is often misdiagnosed as an infection because of its symptoms and signs of inflammation, delaying proper diagnosis and treatment. We report a case of inflammatory breast cancer showing correlation between dermoscopic and histopathological diagnoses. We highlight the utility of dermoscopy for skin biopsy site selection.

UNILATERAL BREAST EDEMA DUE TO SUBCLAVIAN VEIN COMPRESSION / Edema mamário unilateral resultante de compressão da veia subclávia

Unilateral breast edema may have different causes that vary from malignant to benign diseases. The  knowledge of the main etiologies, associated to a detailed clinical examination and to radiological findings, is important in order to establish the correct diagnosis and determine the appropriate management of the patient. This article will report the case of a patient with lung cancer who developed unilateral breast edema; the main differential diagnoses will also be discussed.

O edema mamário unilateral pode ter diferentes causas, que variam desde doenças malignas até benignas. O conhecimento das principais etiologias, associado ao exame clínico detalhado e aos achados radiológicos, é importante para que se estabeleça o diagnóstico correto, e para que se determine o manejo adequado do paciente. Neste artigo, será relatado o caso de uma paciente com câncer de pulmão que desenvolveu edema mamário unilateral; também serão discutidos os principais diagnósticos diferenciais.

Inflammatory breast neoplasms: a systematic review

OVERVIEW: Inflammatory Breast Cancer (IBC) is a rare and very aggressive type of cancer that tends to develop at a younger age, compared with other subtypes of breast cancer. Because a distinct lump may not be noticeable, correct diagnosis takes longer and, therefore, successful treatment may hinder a patient's prognostics. This study aims to conduct a systematic review of research articles on IBC. METHODS: This is a systematic review of studies in the PubMed database to April 2013, which fit the eligibility criterion of "Inflammatory Breast Neoplasms" (MeSH Terms), filtered by Languages (English OR Portuguese OR Spanish). FINDINGS: Of the 119studies identified, 25 complied with the eligibility criterion for the disease, diagnostics, treatment and prognostics. FINAL CONSIDERATIONS: Despite methodological differences, findings evidence that although IBC presents particular features (lower survival rate and worse prognostics than most types of breast cancer), very few studies examine its epidemiology and specific risk factors in depth and use any other therapeutic approaches than those commonly used for other breast cancer subtypes. Therefore, further investigation of the disease's aggressiveness is still necessary.

Cáncer de mama inflamatorio: un reto diagnóstico y terapéutico / Inflammatory breast cancer: a diagnostic and therapeutic challenge

El cáncer de mama inflamatorio (IBC) es una rara enfermedad que afecta a mujeres a temprana edad. Actualmente a pesar de los esfuerzos para establecer criterios para el diagnóstico de IBC, es una entidad difícil de diagnosticar debido a su poca frecuencia de presentación, a los hallazgos clínicos, patológicos y radiológicos escasos, y a la carencia de estudios que describan el IBC por si solo y no como parte de cáncer de mama localmente avanzado (LABC). Por ende, usualmente es un diagnóstico tardío y debido a su agresividad, el pronóstico de IBC suele ser malo. El propósito de esta revisión es describir acerca del adecuado diagnóstico y los avances del manejo a través de los años, de esta frecuentemente olvidada enfermedad...

Inflammatory Breast Cancer (IBC) is a rare disease that affects women in an early age. Currently despite efforts to establish the criteria for IBC diagnosis, results a very difficult Cancer to diagnose because has no specific characteristic in clinical, pathological and image studies, in addition to the lack of investigations describing IBC itself and not as part of Locally Advanced Breast Cancer (LABC). Due to the motioned facts, IBC occurs as a delayed diagnosis, for this reason and its aggressiveness IBC has a poor survival. This review, pretends to describe the appropriate diagnose and new treatments of this often forgotten cancer...

Carcinoma inflamatorio de mama en una mujer de 62 años: presentación de un caso / Breast Inflammatory Carcinoma in a 62 Years Old Woman: Case Report

Son múltiples los espectros de presentación del cáncer de mama; uno de ellos es el carcinoma inflamatorio. En el presente artículo se expone el caso de una paciente de 62 años en quien se diagnostica carcinoma inflamatorio por medio de los hallazgos clínicos, ecográficos y mamográficos, y se corroboran mediante patología. La relevancia del caso radica en que es un caso típico de carcinoma inflamatorio, incluyendo clínica, patología y características imaginológicas. Se hace una revisión epidemiológica, de presentación histológica, clínica y por imágenes, con el fin de orientar a radiólogos y clínicos en el diagnóstico de tan importante, pero infrecuente entidad.

There are multiple spectra of breast cancer presentations, one of which is inflammatory carcinoma. This article describes the case of a 62 year old patient with inflammatory carcinoma, diagnosed by clinical, ultrasound and mammography findings confirmed by pathology. This case is relevant because it is a typical case of inflammatory carcinoma, including clinical, pathology and imaging features. An epidemiological revision is made, with a histological, clinical and imaging presentation in order to guide radiologists and clinicians in the diagnosis of this important but uncommon entity.