Significance of target volume delineation of tumor bed according to metal clips or seroma in determing tumor bed position during radiotherapy after breast-conserving surgery for breast cancer / 肿瘤研究与临床

Objective:To investigate the differences between the mental clips placed intraoperatively and the tumor bed's target volume delineation of seroma based on CT scanning during radiotherapy for breast cancer patients who received breast-conserving surgery in the persuit of a better solution to determine the tumor bed position.Methods:The clinical data of 13 patients with early breast cancer who received postoperative radiotherapy after breast-conserving surgery at Beijing Shijingshan Hospital and Beijing Shijitan Hospital of Capital Medical University from December 2020 to January 2022 were retrospectively analyzed. They all had surgical clips implanted during the surgery. The following methods were used to delineate the target volume of tumor bed, including gross target volume delineation of tumor bed based on the mental clips (GTVtb-Clip), the tumor bed's gross target volume delineation of seroma based on CT scanning (GTVtb-Seroma), and the combination of both (GTVtb-C+S). The volume, diameter on three coordinate axis, neutral point displacement and conformability of these delineation methods were compared.Results:The volume of GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S was (25±10) cm 3, (38±17) cm 3, (49±20) cm 3, and the differences were statistically significant (all P<0.05). The diameter on X axis was (4.7±1.2) cm, (5.3±1.4) cm, (5.7±1.6) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Y axis was (4.6±1.7) cm, (5.0±1.6) cm, (5.7±1.7) cm, respectively in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S; the diameter on Z axis was (4.4±1.5) cm, (5.2±1.4) cm, (5.6±1.4) cm in GTVtb-Clip, GTVtb-Seroma and GTVtb-C+S. The differences in the diameter of GTVtb-Clip and GTVtb-C+S on X,Y, Z axis were statistically significant (all P<0.05); the differences in the diameter of GTVtb-Seroma and GTVtb-C+S on X, Z axis were statistically significant (all P<0.05); the difference in the diameter of GTVtb-Clip and GTVtb-Seroma on X axis was statistically significant ( P<0.05) .Neutral point displacement was (5.8±1.6) cm, (5.5±1.9) cm, (6.0±1.7) cm, respectively of GTVtb-Clip, GTVtb-Seroma, GTVtb-C+S, and the difference was not statistically significant ( P>0.05). Conformability of GTVtb-Clip and GTVtb-Seroma, GTVtb-Clip and GTVtb-C+S, GTVtb-Seroma and GTVtb-C+S was 0.412±0.112, 0.525±0.095, 0.774±0.112,respectively, and the differences were statistically significant (all P<0.05). Conclusions:During radiotherapy after breast-conserving surgery for breast cancer, compared with the single method, the combination of GTVtb-Clip and GTVtb-Seroma can better cover the real tumor bed, thus reducing the omission of tumor bed and recurrence rate. CT position should better take place at 4 to 8 weeks for patients receiving radiotherapy after breast-conserving surgery, and target volume of tumor bed will be delineated based on the postoperative changes of both mental clips and seroma.

Publications, by different surgical specialties, on patient-reported outcomes of oncoplastic surgery

Summary OBJECTIVE: This study aimed to compare the publications authored by plastic surgeons with those from other specialties' surgeons on patient-reported outcomes of oncoplastic surgery. METHODS: A review was carried out on the Medline database, emcompassing five years (2015-2020). Studies about partial breast reconstruction after conservative treatment, immediate or delayed, by any technique, which presented patient-reported outcomes, were included. RESULTS: We found 292 articles, from which 142 met the eligibility criteria. Publications were stratified into groups 1 (plastic surgeons) and 2 (other surgical specialties), and also into groups A (only plastic surgeons), B (only other specialties) and C (both), and compared statistically. Most publications (60.6%) were attributed to specialties other than plastic surgery. Nineteen percent had only plastic surgeons as authors, 50% only other specialties' surgeons, and 31% had both. There was no difference between groups regarding the impact factor of the journals in any of the stratifications, and the majority was published in journals with impact factor ≤2. CONCLUSION: In the last years, surgeons from specialties other than plastic surgery published more about the results of the oncoplastic surgery reported by the patients. There was no statistical difference between the groups regarding the impact factor of the journals.

Câncer de Mama Multifocal: Relato de Caso / Multifocal Breast Cancer: Case Report / Cáncer de Mama Multifocal: Relato de caso

Introdução: O câncer de mama é a neoplasia que mais acomete o sexo feminino, sendo a primeira causa de morte por câncer em mulheres.O carcinoma mamário representa um grupo heterogêneo de doenças. Casos individuais diferem uns dos outros na morfologia, fenótipo e prognóstico. As patologias malignas das mamas podem se manifestar como tumores unifocais, multifocais e/ou multicêntricos. A incidência de tumores multifocais e multicêntricos no câncer de mama varia de 13% a 70%. Relato do caso: Paciente L.C., sexo feminino, 65 anos, com relato de nódulo palpável em mama direita em setembro de 2015. O estudo anatomopatológicodo nódulo mostrou carcinoma intraductal. Realizada quadrantectomia, com anatomopatológico que identificou carcinoma papilífero bem diferenciado intracístico e invasivo damama, associado a componente intraductal cribriforme e papilar, com margens e linfonodo sentinela livres e imuno-histoquímica compatível com perfil triplo-negativo. Em fevereiro de 2019, apresentou duas novas lesões em mama contralateral, identificadas como carcinoma ductal invasivo multifocal com papiloma intraductal associado, e carcinoma ductal invasivo associado a componente intraductal in situ dos tipos papilar, sólido e cribriforme, com imuno-histoquímica com perfis moleculares distintos entre si, sendo uma lesão do tipo luminal A e a outra, luminal híbrido. Conclusão: Este estudo relata um caso de uma paciente que apresentou lesões neoplásicas em ambas as mamas, em tempos distintos e com perfis histológicos e imuno-histoquímicos diferentes. Dessa forma, destacam-se a raridade do caso e a relevância da terapia dirigida a alvos específicos, uma vez que a paciente apresentava lesões com perfis moleculares distintos.

Introduction: Breast cancer is the neoplasm that most affects females, being the first cause of death by cancer in women. Breast carcinoma is a heterogeneous group of diseases. Individual cases differ from each other in morphology, phenotype and prognosis. Malignant breast pathologies can manifest as single, multifocal and/or multicentric tumors. The incidence of multifocal and multicentric tumors in breast cancer varies from 13% to 70%. Case report: Patient L.C., female, 65 years old, with a palpable nodule in the right breast in September 2015. The anatomopathological study of the nodule showed intraductal carcinoma. She underwent quadrantectomy, with anatomopathological examination that identified well-differentiated intracystic and invasive papillary carcinoma of the breast, associated with a cribriform and papillary intraductal component, with free sentinel lymph node and margins and immunohistochemistry compatible with triple negative profile. In February 2019, she presented two new lesions in contralateral breast, identified as invasive multifocal ductal carcinoma, with associated intraductal papilloma, and invasive ductal carcinoma, associated with an in situ intraductal component of the papillary, solid and cribriform types, with immunohistochemistry with different molecular profiles, being one lesion classified as luminal A and the other, hybrid luminal. Conclusion: This study reports a case of a patient who had neoplastic lesions in both breasts, at different times and with distinctive histological and immunohistochemical profiles. Thus, the rarity of the case and the relevance of the therapy aimed at specific targets are highlighted, since the patient presented lesions with different molecular profiles.

Introducción: El cáncer de mama es la neoplasia que más afecta a las mujeres, siendo la primera causa de muerte por cáncer en las mujeres. El carcinoma de mama representa un grupo heterogéneo de enfermedades. Los casos individuales difieren entre sí en morfología, fenotipo y pronóstico. Las patologías mamarias malignas pueden manifestarse como tumores únicos, multifocales y/o multicéntricos. La incidencia de tumores multifocales y multicéntricos en el cáncer de mama varía del 13% al 70%. Relato del caso: Paciente L.C., mujer, 65 años, con un nódulo palpable en el seno derecho en septiembre de 2015. El estudio anatomopatológico de la lesión mostró carcinoma intraductal. La paciente se sometió a una cuadrantectomía, con un examen anatomopatológico que identificó un carcinoma papilar invasivo e intraquístico bien diferenciado de mama, asociado con un componente intraductal cribiforme y papilar, con ganglio linfático y márgens libres y inmunohistoquímica compatible con perfil triple negativo. En febrero de 2019, presentó dos nuevas lesiones en el seno contralateral, identificadas como carcinoma ductal multifocal invasivo, con papiloma intraductal asociado y carcinoma ductal invasivo, asociado con un componente intraductal in situ de los tipos papilar, sólido y cribiforme, con inmunohistoquímica con diferentes perfiles moleculares, siendo una lesión del tipo luminal A y la otra, luminal híbrida. Conclusión: Este estudio reporta un caso de una paciente que tenía lesiones neoplásicas en ambos senos, en diferentes momentos y con diferentes perfiles histológicos e inmunohistoquímicos. Por lo tanto, se destaca la rareza del caso y la relevancia de la terapia dirigida a objetivos específicos, una vez que la paciente presentó lesiones con diferentes perfiles moleculares.

Tumor filodes de la mama: experiencia en el diagnóstico, tratamiento y seguimiento de 28 casos en Colombia / Phyllodes tumor of the breast: experience in the diagnosis, treatment and follow-up of 28 cases in Colombia

Resumen: OBJETIVO: Describir la experiencia en el diagnóstico, tratamiento y seguimiento de pacientes con tumor filodes que consultaron en dos instituciones de Bogotá, en un periodo de 6 años. MATERIALES Y MÉTODOS: Estudio descriptivo, de serie de casos. Se revisaron las historias clínicas y los reportes de patología quirúrgica de pacientes con diagnóstico de tumor filodes que asistieron a la consulta de Mastología del Hospital de San José y Hospital Infantil Universitario de San José entre los meses de enero de 2013 a junio de 2019. Se analizaron los estudios imagenológicos, biopsias preoperatorias, tratamiento quirúrgico, reporte final de Patología y el seguimiento posterior al tratamiento. Toda la información se guardó en una base de datos con las características sociodemográficas y clínicas de interés. RESULTADOS: Se reportaron 15 de 28 casos benignos, 7 de 28 malignos y 6 de 28 fronterizos; la mediana de edad fue de 49.3 años (rango intercuartil: 43.5 -57), la biopsia trucut identificó a 18 de 28 casos con tumor filodes. Los estudios ecográficos se reportaron como BI-RADS 4 en 18 de 28 pacientes. El tratamiento quirúrgico fue cuadrantectomía y mastectomía, según el tamaño de la lesión. No se reportaron muertes. CONCLUSIONES: El tumor filodes es de crecimiento rápido, baja incidencia, frecuente en mujeres entre la quinta y sexta décadas de la vida, aunque se registran casos en edades extremas (15 y 74 años). El síntoma principal es una masa palpable; en estudios de imágenes se manifiesta como lesión sugerente de malignidad (BI-RADS 4). El tratamiento quirúrgico es la base de la conducta terapéutica.

Abstract: OBJECTIVE: Describe the experience of diagnosis, treatment and follow-up of patients with phyllodes tumor who consulted in two institutions in Bogotá, in a period of 6 years. MATERIALS AND METHODS: A descriptive case series study was carried out, where clinical histories and reports of surgical pathology of patients with a diagnosis of PT who attended a mastology consultation at the San José Hospital and San José University Children's Hospital in January were reviewed. from 2013 to June 2019. Imaging studies, preoperative biopsies, surgical management, final pathology report and post-treatment follow-up were analyzed. A database with sociodemographic and clinical characteristics of interest was tabulated. RESULTS: 15 of 28 benign cases, 7 of 28 malignant cases and 6 of 28 borderline cases were reported, the median age was 49.3 years (RIC 43.5 -57), Trucut biopsy identified 18/28 of phyllodes tumor. Ultrasound studies were reported as BIRADS 4 in 18/28. The surgical management was quadrantectomy and mastectomy according to the size of the lesion. No deaths were reported. CONCLUSIONS: Phyllodes tumor is a tumor of rapid growth, low incidence, frequent in the fifth and sixth decade of life, however, cases are recorded at extreme ages (15-74 years). Its main symptom is palpable mass and in imaging studies it manifests itself as suggestive lesions of malignancy (BIRADS 4). Surgical management is considered as the treatment pillar.

Cáncer de mama en mujeres pinareñas menores de 45 años, serie cronológica de 23 años / Breast cancer in Pinar del Río on women under 45 years old: chronological series of 23 years

RESUMEN Introducción: el cáncer de mama es un problema de salud mundial, constituye la primera causa de muerte por tumor maligno en féminas. En los últimos años se ha apreciado un descenso en la edad de presentación de la enfermedad, y la necesidad de disponer de una investigación que la reporte en la provincia. Objetivo: caracterizar el cáncer de mama en mujeres menores de 45 años atendidas en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río en el período 1995-2018. Métodos: se realizó un estudio, observacional, descriptivo, longitudinal y retrospectivo en mujeres menores de 45 años operadas por cáncer de mama. Universo 1 223 mujeres, el muestreo fue intencional (n=256). Se aplicaron métodos de estadística descriptiva, los datos fueron obtenidos de la base de datos de la consulta central de mama del hospital. Resultados: el 21,48 % tenían antecedente familiar de cáncer, la mama derecha fue la más afecta (57,42 %), el estadio clínico más frecuente fue IIA, (31,25 %), la técnica quirúrgica frecuente fue la cirugía conservadora (69,14 %), el carcinoma ductal con sus diferentes variables fue el tipo histológico predominante (56,64 %). Conclusiones: el cáncer de mama es un problema de salud pública, cada año aparece en pacientes más jóvenes y con antecedentes familiares de cáncer, el diagnostico se realiza precoz en la mayoría de los casos y las técnicas quirúrgicas conservadoras fueron las empleadas.

ABSTRACT Introduction: breast cancer is a worldwide health problem; it is the leading cause of death from malignant tumor in female gender. In recent years there has been a decrease in the age of onset of this disease, and it is a need for the province to carry out research works regarding this entity. Objective: to characterize breast cancer in women under the age of 45 treated at Abel Santamaría Cuadrado General Teaching Hospital in Pinar del Río during in the period 1995 - 2018. Methods: an observational, descriptive, longitudinal and retrospective study was conducted including women less than 45 years old operated on breast cancer. The target group comprised 1223 women, the sampling was intentional (n=256). Methods of descriptive statistics were applied; data were obtained from the central database of the clinic of breast cancer. Results: 21,48 % had a family history of cancer, the right breast was the most affected (57,42 %), the most frequent clinical stage was IIA (31,25 %), conservative surgery was the most frequent surgical technique applied (69,14 %); duct carcinoma with its different variables was the predominant histological type (56,64 %). Conclusions: breast cancer is a public health problem, each year it emerges in younger patients with a family history of cancer, diagnosis is early made in most cases and conservative surgical procedures were the ones applied.

EVALUATION OF LOCAL RECURRENCE OF BREAST CONSERVATION SURGERY AT THE CEARÁ INSTITUTE OF CANCER / Avaliação da recidiva local da cirurgia conservadora de mama no Instituto do Câncer do Ceará

Introduction: Breast cancer is the most common malignant tumor in the world, with the exception of cases of non-melanoma skin cancer. In Brazil, more than 56,000 cases were estimated for 2016. The expected mortality rate remains high because of late diagnosis. Nowadays, conservative surgery is the gold standard treatment. Objective: To evaluate the locoregional recurrence of conservative surgery practiced at the Ceará Institute of Cancer, between 2002 and 2012. Method: A cross ­ sectional study with a descriptive approach using secondary data obtained from the medical records of patients with breast cancer operated at the Ceará Institute of Cancer. Results: The study population consisted of 360 patients. Invasive ductal carcinoma was the most common type (72.8%), followed by ductal carcinoma in situ (16.4%) and invasive lobular carcinoma (4.7%). The other histological types represent 6.4% (cribriform, 0.5%, medullary, 0.6%, micro invasive, 0.3%, mucinous, 1.1%, papillary, 3.1% 8%; and tubular, 0.8%). In the sample, 25 patients had some type of recurrence: 13/360 (3.6%), local or locoregional; and 12/360 (3.3%), distant recurrence. Conclusion: From the data analysis, we can conclude that the conservative surgery practiced at the Ceará Institute of Cancer showed data on recurrence compatible with the international literature

Introdução: O câncer de mama é o tumor maligno que mais acomete mulheres em todo o mundo, excetuando-se os casos de pele não melanoma. No Brasil, estimavam-se mais de 56.000 casos para 2016. A mortalidade esperada ainda é alta devido ao diagnóstico tardio. Na atualidade, a cirurgia conservadora é o padrão-ouro. Objetivo: Avaliar a recidiva locorregional da cirurgia conservadora praticada no Instituto do Câncer do Ceará, no período entre 2002 a 2012. Método: Estudo transversal e descritivo, utilizando dados secundários obtidos nos prontuários médicos de pacientes com câncer de mama operadas no Instituto do Câncer do Ceará. Resultados: A população em estudo foi de 360 pacientes. O carcinoma ductal invasivo foi o tipo mais comum (72,8%), seguido do carcinoma ductal in situ (16,4%) e do carcinoma lobular invasivo (4,7%). Os outros tipos histológicos representam 6,4% (cribiforme, 0,5%; medular, 0,6%; microinvasor, 0,3%; mucinosos, 1,1%; papilífero, 3,1%; e tubular, 0,8%). Na amostra, 25 pacientes tiveram algum tipo de recidiva: 13/360 (3,6%), local ou locorregional; e 12/360 (3,3%), recidiva a distância. Conclusão: Da análise dos dados, podemos concluir que a cirurgia conservadora praticada no Instituto do Câncer do Ceará tem dados de recorrência compatíveis com a literatura internacional

Potential Benefits of Neoadjuvant Chemotherapy in Clinically Node-Positive Luminal Subtype⁻ Breast Cancer / 한국유방암학회지

PURPOSE: Neoadjuvant chemotherapy (NAC) is less effective for luminal breast cancer because luminal breast cancer has a lower rate of pathological complete response (pCR) after NAC than human epidermal growth factor receptor 2 (HER2)-type and triple-negative breast cancer (TNBC). We investigated the efficacy of NAC and the predictive factors of a better response in luminal breast cancer. METHODS: Between 2010 and 2016, we retrieved data of 244 patients with clinically node-positive breast cancer who were treated with NAC followed by surgery from a prospectively collected database. We classified breast cancer into luminal HER2⁻ and non-luminal HER2⁻ breast cancer (luminal HER2⁺, HER2⁺, and TNBC types). We analyzed each subtype with respect to surgical outcomes, response to NAC, and determined variables associated with surgical outcomes and response in patients with luminal HER2⁻ breast cancer. RESULTS: The total, breast, and axillary pCR rates were significantly lower in 114 patients with luminal HER2⁻ breast cancer than in those with other subtypes (7.9%, 12.3%, and 22.8%, respectively). However, breast-conserving surgery (BCS) conversion and tumor response rates did not significantly differ between patients with luminal HER2⁻ and those with non-luminal HER2⁻ breast cancer (p = 0.836 and p = 0.180, respectively). In the multivariate analysis, high tumor response rate (≥ 46.4%) was significantly associated with an increased BCS conversion rate. In the subgroup analysis of luminal HER2⁻ breast cancer, the multivariate analysis showed that higher Ki67 expression and axilla pCR and BCS conversion rates were significantly associated with tumor response to NAC. CONCLUSION: Despite the low pCR rate, the tumor response and BCS conversion rates after NAC of luminal HER2⁻ breast cancer were similar to those of other subtypes. NAC has the potential benefit of reducing the size of breast cancer, thereby increasing the BCS conversion rate in luminal HER2⁻ breast cancer.

Thoracic interfascial plane block for multimodal analgesia after breast lumpectomy

BACKGROUND: Thoracic interfascial plane block is useful as a component of multimodal analgesia in patients undergoing mastectomy. However, multimodal analgesia tends not to be provided during lumpectomy as it is one of the less aggressive procedures among breast cancer surgeries. Therefore, we investigated the effects of thoracic interfascial plane block as more effective analgesia after breast lumpectomy. METHODS: Forty six patients (20–80 years old, female) with breast cancer scheduled to undergo lumpectomy were randomly assigned to two groups. Postoperative pain control in the control group consisted only of intravenous patient-controlled analgesia (PCA). In the block group, intravenous PCA was used after serratus intercostal fascial plane block and pecto-intercostal fascial plane block. The primary outcome was the 24 h cumulative postoperative fentanyl consumption. Pain severity, additional rescue analgesic requirement, side effects, and patient satisfaction were also evaluated. RESULTS: Postoperative fentanyl consumption in the block group was significantly reduced compared with the control group (median, 88.8 [interquartile range, 48.0, 167.6] vs. 155.2 [88.8, 249.2], P = 0.022). The pain score was significantly lower in the block group only in the post-anesthesia care unit (2.9 ± 1.8 vs. 4.3 ± 2.3, P = 0.022). There were no differences in the incidence of postoperative nausea and vomiting and the requirement for additional analgesics between the groups. The satisfaction score was significantly higher in the block group. CONCLUSIONS: Thoracic interfascial plane block after lumpectomy reduces opioid usage and increases patient satisfaction with postoperative pain control. Thoracic interfascial plane block is useful for multimodal analgesia after lumpectomy.

A consensus statement on the breast-conserving surgery of early-stage breast cancer (2019) / 中华外科杂志

To facilitate the progress of the standardization of performing breast-conserving therapy in China, the Chinese Association of Breast Surgery organized the Chinese experts to discuss the latest domestic and international breast surgical treatment guidelines and reached a consensus about breast-conserving surgery of early-stage breast cancer based on the actual clinical situation of China. The contents include recommendations about the indication and contraindications of breast-conserving surgery, preoperative imaging examinations, and standardized techniques of breast-conserving surgery. Meanwhile, the panel also discussed cutting-edges topics that lack of high-level evidence or consensus.

A consensus statement on the breast-conserving surgery of early-stage breast cancer (2019) / 中华外科杂志

To facilitate the progress of the standardization of performing breast-conserving therapy in China, the Chinese Association of Breast Surgery organized the Chinese experts to discuss the latest domestic and international breast surgical treatment guidelines and reached a consensus about breast-conserving surgery of early-stage breast cancer based on the actual clinical situation of China. The contents include recommendations about the indication and contraindications of breast-conserving surgery, preoperative imaging examinations, and standardized techniques of breast-conserving surgery. Meanwhile, the panel also discussed cutting-edges topics that lack of high-level evidence or consensus.

ONCOPLASTIC MAMMOPLASTY WITH GEOMETRIC COMPENSATION TECHNIQUE IN AN OLDER ADULT PATIENT / Mamoplastia oncoplástica com técnica de compensação geométrica em paciente idosa

Breast cancer is a neoplasm of high incidence in women, which has been increasingly affecting older adult patients. Conservative breast surgery has changed the history of Mastology. Oncoplastic techniques and breast reconstruction are used in pursuit of better harmony between oncological treatment and cosmetic results. This study reports the case of an older adult patient submitted to oncological mammoplasty with geometric compensation technique

O câncer de mama é uma neoplasia de grande incidência nas mulheres e cada vez mais tem se apresentado em pacientes idosas. A cirurgia conservadora de mama alterou definitivamente a história da mastologia. As técnicas de oncoplastia e reconstrução mamária são utilizadas buscando uma maior sintonia entre o tratamento oncológico e o resultado estético. Este estudo relata o caso de paciente idosa submetida à mamoplastia oncológica com técnica de compensação geométrica.

Alternativa técnica para tratamento de esteatonecrose em mama: descrição e resultados / Alternative technique for the treatment of osteonecrosis in breasts: description and results

Introdução: Este trabalho descreve e apresenta os resultados de uma técnica alternativa para tratamento da esteatonecrose, a lipoaspiração com cânula específica, com bons resultados observados no exame físico e de imagem. A esteatonecrose é uma complicação que ocorre com alguma frequência nas cirurgias mamárias, principalmente nas reconstruções mamárias, nas cirurgias conservadoras ou TRAM, caracterizando-se, inicialmente, por endurecimento de uma região, que evolui para uma nodulação de tamanhos variados, em qualquer região mamária, com cistos oleosos e fibrose, que traduz uma preocupação constante por parte das pacientes, do oncologista, do mastologista e do cirurgião plástico devido à ocorrência de recidiva tumoral. Método: Foi realizada uma revisão retrospectiva dos prontuários das pacientes submetidas a procedimentos nas mamas, seja reconstrução ou estética, e evoluíram com esteatonecrose, sendo submetidas ao tratamento com lipoaspiração, inspirada na técnica de perfuração óssea para tratamento de necrose óssea, realizado por ortopedistas. Resultados: No período englobado, 8 pacientes foram selecionadas. A idade média foi de 56 anos. Grande parte possuía alguma deformidade na mama acometida, sendo o cisto oleoso o mais comum - 5 pacientes (62,5%). 75% possuíam história de neoplasia mamária. Conclusão: A individualização do paciente é a chave para o sucesso do tratamento da esteatonecrose e uma ferramenta essencial para atender às expectativas e anseios da paciente após essa complicação. Cada técnica tem suas indicações, vantagens e limitações, que devem ser amplamente discutidas com o paciente visando o melhor resultado possível.

Introduction: This work describes and presents the results of an alternative technique for treating steatonecrosis by liposuction using a specific cannula, with good physical and imaging results. Steatonecrosis is a complication that frequently occurs during mammary surgeries, especially during mammary reconstructions and in conservative surgery or TRAM. Steatonecrosis is characterized initially by hardening of the tissue that may develop into nodules of different sizes in any mammary region with oily cysts and fibrosis; consequently, steatonecrosis is a constant concern for patients, oncologists, breast cancer specialists, and plastic surgeons due to the possibility of tumor recurrence. Method: A retrospective review of the medical records of the patients undergoing procedures related to the breast, either reconstructive or aesthetic, was performed. Patients who developed steatonecrosis and were treated by liposuction, similar to the bone drilling technique performed by orthopedic surgeons for the treatment of bone necrosis, were included in the study. Results: Eight patients from the study period reviewed were selected. The mean age was 56 years. Most of the patients showed deformity in the affected breast, with oily cysts, reported in 5 patients (62.5%), being the most common deformity. Breast cancer history was reported for 75% of the patients. Conclusion: The individualization of the patient is the key to successful treatment of steatonecrosis and an essential tool to satisfy the expectations and desires of the patient after this complication. Each technique has its indications, advantages and limitations, which should be thoroughly discussed with the patient to obtain the best possible result.

Caso Clínico: Carcinoma Papilar Sólido de Mama / Case Report: Breast Papillary Solid Carcinoma

INTRODUCCIÓN: El carcinoma papilar sólido de mama es un subtipo poco frecuente de carcinomas mamarios representando el 1 ­ 2 % y principalmente en mujeres postmenopáusicas. Su diagnóstico desde el punto de vista clínico, imagenológico y patológico es difícil. El tratamiento no está estandarizado por el bajo porcentaje de casos reportados, actualmente es aceptada la cirugía conservadora, la radioterapia, existiendo controversia en la hormonoterapia y el vaciamiento axilar, pues las metástasis ganglionares ascienden únicamente al 2 %. Su pronóstico es bueno y la complicación más común es la recidiva local. CASO CLÍNICO: Paciente femenina de 80 años, acudió a consulta por presentar una masa a nivel de mama izquierda al realizarse una autoexploración, donde identificó un nódulo de 2 cm aproximadamente. EVOLUCIÓN: Se realizó una mamografía, ecografía mamaria y la citología mamaria que dio como resultado un tumor, inicialmente se consideró como Phyllodes. Tras el diagnóstico se realizó una lumpectomía, y la patología de la pieza quirúrgica fue de un carcinoma papilar sólido, luego recibió radioterapia y vigilancia médica. CONCLUSIÓN: La autoexploración fue un pilar fundamental en el diagnóstico de este caso y alertó a la paciente a buscar valoración médica. Al tratarse de un caso poco frecuente el diagnóstico definitivo fue la patología.

BACKGROUND: Solid papillary carcinoma of the breast is a rare subtype of mammary carcinomas corresponding to 1 ­ 2 % and mainly in postmenopausal women. It is diagnosis from the clinical, imaging and pathological point of view is difficult. The treatment is not standardized due to the low percentage of cases reported, conservative surgery, radiotherapy is currently accepted, and controversy exists in hormone therapy and axillary emptying, as lymph node metastases amount to only 2 %. It is prognosis is good and the most common complication is local recurrence. CASE REPORT: An 80-year-old female patient attended the consultation by presented a mass at the level of the left breast when performing the self-examination, where identified a 2 cm nodule. EVOLUTION: Mammography, mammary ultrasound and mammary cytology outcome in a tumor, was initially considered as Phyllodes. After the diagnosis a lumpectomy was performed, and the pathology of the surgical piece was of a solid papillary carcinoma, then received radiotherapy and surveillance. CONCLUSIONS: Self-examination was a fundamental pillar in the diagnosis of this case and alerts the patient to seek medical assessment. Being a rare case, the definitive diagnosis was pathology.

Translation and cultural adaptation of the Breast Cancer Treatment Outcome Scale (BCTOS) into Brazilian Portuguese

SUMMARY BACKGROUND: Breast conservative treatment (BCT) is safe when it is performed in association with radiotherapy. The number of referral for BCT has increased, and it has become an important treatment modality. Patients who undergo BCT present some characteristics that are associated with better quality of life compared with patients who undergo mastectomy without reconstruction. Instruments that measure the quality of life specifically used in cases of BCT are limited. One of these instruments is the Breast Cancer Treatment Outcome Scale (BCTOS), which has not yet been translated into Brazilian Portuguese. It contains 22 questions and four domains (functional, aesthetic, breast sensitivity and oedema). METHODS: We performed the translation and cultural adaptation process using Beaton's and EORTC translations process. In summary, the translation process is based on Portuguese translation, translation summary, reverse translation into English, expert committee, pre-test (10 patients), questionnaire review and test of the final version (6 patients). RESULTS: All 16 patients were submitted to quadrantectomy and mammary radiotherapy. Lymphedema was present in 4, altered strength in 5, and altered shoulder mobility in 6 patients. Considering the questionnaire, the reconciled version determined change in 2 items. Pre-test evaluation showed difficulties in 3 patients, but the questionnaire did not change. Test evaluation showed no problems. CONCLUSION: The translation of BCTOS into Portuguese will help us to evaluate the quality of life in BCT patients evaluating treatment-related sequelae and may be useful for oncoplastic surgery evaluation.

RESUMO INTRODUÇÃO: O tratamento conservador da mama (TCM), desde que associado à radioterapia, é seguro. As indicações inicialmente utilizadas para o TCM se elevaram, sendo importante modalidade de tratamento. Novas modalidades, como a oncoplastia associada ao TCM, tornam-se cada vez mais presentes no cotidiano. Pacientes submetidas ao TCM apresentam alguns parâmetros associados a uma melhor qualidade de vida em relação às pacientes mastectomizadas sem reconstrução. Há limitados instrumentos de qualidade de vida a serem utilizados específicamente no TCM, sendo um deles o Breast Cancer Treatment Outcome Scale (BCTOS), questionário este não traduzido e adaptado para a língua portuguesa/Brasil. O BCTOS contém 22 perguntas e quatro domínios (funcional, estético, sensibilidade mamária e oedema). MÉTODOS: Realizamos a tradução e adaptação cultural utilizando a metodologia proposta por Beaton e pelo EORTC. Em resumo, consiste de tradução para o português, resumo da tradução, tradução reversa para o inglês, comitê de especialistas, pré-teste (dez pacientes), revisão do questionário e teste da versão final (seis pacientes). RESULTADOS: As 16 pacientes foram submetidas a quadrantectomia e radioterapia. Linfedema esteve presente em quatro, alteração da força em cinco e alteração da mobilidade em seis pacientes. Avaliando o questionário, a versão de conciliação modificou dois itens. O pré-teste mostrou dificuldades em três pacientes, mas o questionário não se alterou, fato que não se observou no teste final. CONCLUSÃO: A tradução do BCTOS para o português nos ajudará a avaliar a qualidade de vida em pacientes submetidas a tratamento conservador da mama, avaliando as sequelas relacionadas ao tratamento, podendo ser útil na avaliação da cirurgia oncoplástica.

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.

Fatores preditivos de margens cirúrgicas comprometidas no tratamento do carcinoma ductal in situ da mama / Predictive factors of positive margins in the treatment of ductal carcinoma in situ

O objetivo deste estudo foi determinar, através de revisão da literatura, possíveis fatores que possam estar associados com margens cirúrgicas comprometidas em portadoras de carcinoma ductal in situ (CDIS). Foi empregado o banco de dados do Medical Literature Analysis and Retrieval System Online (MEDLINE®), utilizando as expressões: "Ductal carcinoma in situ", "in situ breast cancer" e "DCIS". Os termos adicionais incluídos foram "surgery" e "margin". O período de referência desses estudos foi de fevereiro de 2000 a fevereiro de 2015. Dos 438 artigos encontrados, 6 foram incluí- dos nessa revisão, com um total de 1.222 pacientes. A taxa de margens comprometidas nos estudos variou de 29 a 72%. As principais variáveis relacionadas com margem comprometida foram o grau histológico e o tamanho nal da lesão na para na (três estudos), multifocalidade (um estudo) e volume da peça cirúrgica ressecada (um estudo). Margens cirúrgicas representam, indubitavelmen- te, um dos mais importantes fatores de recorrência local no tratamento do CDIS. São necessários estudos mais amplos e com metodologias adequadas para se estrati car, com segurança, os fatores de risco associados ao comprometimento das margens cirúrgicas.

e purpose of this study was to determinate, through a literature review, possible factors related to positive margins in patients treated with surgery for ductal carcinoma in situ (DCIS). e Medical Literature Analysis and Retrieval System Online (MEDLINE®) database were used to search the articles, with the expressions: "Ductal carcinoma in situ" "in situ breast cancer" and "DCIS". Ad- ditional terms included were "surgery" and "margin". e reference period of these studies was from February 2000 to February 2015. A total of 438 articles were found, and six of them were included in this review, with a total of 1,222 patients. e rate of positive margins studies varied from 29 to 72%. e main variables related to positive margins were the histological grade and the nal size of the lesion in para n (three studies), multifocality (one study) and volume of the resected specimen (one study). Surgical margins represent, undoubtedly, one of the most important factors of local recurrence in the treatment of DCIS. Larger studies are needed, with adequate methodology, to safely stratify the risk factors associated with surgical margins involvement.

Current situation and problems of breast conserving surgery / 国际肿瘤学杂志

There is no difference between breast conserving surgery (BCS) combined with radiotherapy and radical surgery in outcomes.However, comparing with the radical surgery, BCS has little trauma, less bleeding and lower infection rate, which makes patients′ quality of life improved.In the practice of BCS, due to the disease, patients, physicians, socio-economic, clinical, security and many other factors, there are still many controversial issuesin the doctor-patient communication, socio-economic, aesthetic, margins width, precision operation procedures of BCS.At the same time, new surgical techniques such as plastic breast conserving surgery, and new intraoperative assessment equipment such as MarginProbe system and other new technology development has brought us new ideas to solve these problems.

Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer

BACKGROUND: Breast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation. METHODS: To date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study. RESULTS: We applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site. CONCLUSIONS: In our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.

Mamoplastia oncoplástica: técnica de round block / Oncoplastic mammoplasty: round block technique

A técnica oncoplástica de round block ou donut é utilizada para reconstrução imediata de segmen? tectomias ou quadrantectomias em pacientes com câncer de mama; a técnica foi inicialmente indicada para tratamentos de ptose e hipertrofias mamarias de baixo grau, até que evoluiu para o tratamento de câncer de mama localizado em qualquer quadrante da mama. Neste artigo apre? sentamos um caso clínico de uma mulher de 53 anos com carcinoma ductal invasivo do tipo não especial, sendo este luminal A. O tamanho do tumor foi classificado como estádio T1, a paciente apresentava uma mama de médio tamanho, ideal para esse tipo de técnica. O tumor foi ressecado com margens livres, obtendo, assim, um bom resultado oncológico e uma cicatriz periareolar, sendo esta menos aparente que uma cicatriz vertical, favorável para um bom resultado estético.

The round?block oncoplastic technique or Donut is used for immediate reconstruction for segmentec? tomy or quadrantectomies in patients with breast cancer, the technique was initially indicated for breast ptosis treatments and mammary hypertrophy until it evolved for the treatment of breast cancer located in any quadrant of the breast. In this article we present a case of a woman with 53 years old who present a ductal carcinoma luminal A type. Tumor size was classified as T1 stage, the patient had a medium size breast, ideal for this type of technique. The tumor was resected with clear margins, getting a good oncologic outcome and with good cosmetic results with a periareolar scar that is less apparent than a vertical one.

Application of volumet -displacement technique following breast conserving surgery in early breast cancer / 中国基层医药

Objective To explore the application and assess the cosmetic effect of mammaplasty with volume-displacement technique(VDT)following breast conserving surgery.Methods Breast conservation therapy(BCT) was performed in 77 patients of early breast cancer(EBC).Of the patients,42 cases received oncoplastic VDT (onco-plastic group)and 35 cases had only direct skin closure without treatment of the postresection defect (regular group) following BCT.The cosmetic results of the two groups were evaluated after operation and radiotherapy,respectively. Results All patients were followed up for 1 -36 months with median follow -up of 22.3 months,and no recurrence or metastasis occurred in one of the patients.1 month after surgery,the excellent or good cosmetic outcome were achieved in 31 cases (73.81%)in oncoplastic group and 17 cases (48.57%)in regular group respectively,and there was statistical difference between the two groups (χ2 =5.442,P =0.021);1 month after radiotherapy,the cos-metic excellent or good result were obtained in 27 cases (64.29%)in oncoplastic group and 6 cases (17.14%)in regular group respectively,and the difference between the two groups reached statistical significance (χ2 =9.045,P =0.008).Conclusion VDT can improve the cosmetic effect of mammaplasty following BCT in EBC and does not affect curative effect,it is worthy of promoting.