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1.
Oncol. (Guayaquil) ; 31(1): 66-73, Abril 30, 2021.
Article in Spanish | LILACS | ID: biblio-1222460

ABSTRACT

Introducción: El cáncer de mama afecta cada vez más a las mujeres a nivel mundial. Los tipos de tratamiento quirúrgico y quimioterápico han evolucionado, consecuentemente es necesaria la correc-ta evaluación del tumor primario y los ganglios linfáticos implicados por ser un importante factor pronóstico y tratamiento. La técnica de ganglio centinela evalúa al primer ganglio en recibir el drenaje linfático del tumor. Métodos: el objetivo fue determinar el impacto en pacientes con cáncer de mama en un estudio cuantitativo, observacional no experimental, correlacional de recolección retrospectiva, de tipo cohorte histórico. Se recuperó 153 pacientes en dos grupos de estudio, los que se sometieron a la técnica de ganglio centinela y los que se realizaron linfadenectomía axilar. Resultados: el tipo histológico de cáncer de mama más frecuente fue el ductal infiltrante de grado histológico 2, un 76.4% y 73.6% de pacientes tuvieron receptores de estrógeno y progesterona positivo respectivamente mientras el receptor 2 de factor de crecimiento epidérmico humano fue positivo en 16.9%. La mediana del número de ganglios metastásicos fue semejante en los dos grupos, no así el número de ganglios libres 3 vs. 14 respectivamente (P < 0.001). En el estudio se evidenció morbilidad en 23.1% de pacientes que se biopsiaron el Ganglio Centinela, en contraste con 45.5% de en quienes no se efectuó dicho procedimiento (P = 0.025), la morbilidad más frecuentemente asociada fue el edema de la extremidad (27%). Conclusiones: se demostró que la linfadenectomía expone tres veces a desarrollar morbilidades en comparación con la técnica de ganglio centinela.


Introduction: Breast cancer affects more and more women worldwide. The types of surgical and chemotherapeutic treatment have evolved, consequently the correct evaluation of the primary tumor and the involved lymph nodes is necessary because it is an important prognostic factor and treatment. The sentinel lymph node technique evaluates the first node in receiving the lymphatic drainage of the tumor. Methods: the objective was to determine its impact in patients with breast cancer in a quantitative, observational, non-experimental, correlational, retrospective, historical cohort study. We recovered 153 patients in two study groups, those who underwent the sentinel lymph node technique and those who underwent axillary lymphadenectomy. Results: the most frequent histological type of breast cancer was the infiltrative ductal of histologi-cal grade 2, 76.4% and 73.6% of patients had positive estrogen and progesterone receptors respec-tively while the receptor 2 of human epidermal growth factor was positive in 16.9 %. The median number of metastatic lymph nodes was similar in the two groups, but not the number of free nodes 3. 14 respectively (P <0.001). In the study, morbidity was evidenced in 23.1% of patients who were sentinel lymph node biopsies, in contrast to 45.5% of those who did not undergo the procedure (P= 0.025), the most frequently associated morbidity was the edema of the extremity (27%). Conclusions: lymphadenectomy was shown three times to develop morbidities compared to the sentinel lymph node technique.


Subject(s)
Breast Neoplasms , Morbidity , Sentinel Lymph Node Biopsy , Sentinel Lymph Node , Lymph Node Excision
2.
Rev. colomb. cir ; 36(2): 268-274, 20210000. fig, tab
Article in Spanish | LILACS | ID: biblio-1223966

ABSTRACT

Introducción. El arco de Langer es una entidad infrecuente, cuya prevalencia depende de la técnica quirúrgica utilizada y usualmente no se asocia con síntomas de compresión vascular o neuronal. El objetivo de este estudio fue describir las características clínicas y morfológicas, y la proporción de síntomas de compresión neurovascular del arco de Langer, en mujeres con cáncer de mama llevadas a cirugía axilar. Métodos. Estudio descriptivo del arco de Langer en mujeres con cáncer de mama, llevadas a cirugía axilar en el registro personal de un cirujano, en Medellín, Colombia, entre el 1 enero de 2017 y el 15 agosto de 2020. Se evaluaron características clínicas, morfológicas y síntomas de compresión neurovascular. Las variables categóricas se agruparon según su frecuencia como porcentajes, y para las variables continuas se calculó la mediana y su rango intercuartílico. Resultados. Entre el 1 enero de 2017 y el 15 agosto de 2020 se realizaron 725 cirugías axilares, 479 biopsias de ganglio centinela y 246 linfadenectomías, encontrando 17 casos de arco de Langer, para una frecuencia de 2,3 %. Fue más frecuente encontrarlo en el curso de una linfadenectomía (n=11, 64,7 %). En 15 (88,2 %) casos se presentó riesgo de ocultamiento ganglionar y en 14 (82,3 %) generó dificultad quirúrgica. No hubo casos con síntomas de compresión vascular o neuronal. En ningún caso se realizó el diagnostico imagenológico prequirúrgico. La conducta quirúrgica predominante fue sección, en 88,2 %, sin presentar complicaciones quirúrgicas asociadas. Discusión. Es importante para el cirujano el conocimiento del arco axilar como una variante anatómica de la axila, que puede ocultar los ganglios o dificultar la disección axilar, por lo que la conducta más usada es la sección


Introduction. Langer's arch is an infrequent entity, the prevalence of which depends on the surgical technique used and is usually not associated with symptoms of vascular or neuronal compression. The objective of this study was to describe the clinical and morphological characteristics, and the proportion of symptoms of neurovascular compression of Langer's arch, in women with breast cancer who underwent axillary surgery.Methods. Descriptive study of Langer's arch in women with breast cancer, who underwent axillary surgery in the personal registry of a surgeon, in Medellín, Colombia, between January 1, 2017 and August 15, 2020. Clinical, morphological and clinical characteristics were evaluated for symptoms of neurovascular compression. Categorical variables were grouped according to their frequency as percentages, and the median and interquartile range were calculated for continuous variables.Results. Between January 1, 2017 and August 15, 2020, 725 axillary surgeries, 479 sentinel node biopsies, and 246 lymphadenectomies were performed, finding 17 cases of Langer's arch, for a frequency of 2.3%. It was more frequently found in the course of lymphadenectomy (n= 11; 64.7%). In 15 (88.2%) cases there was a risk of lymph node concealment and in 14 (82.3%) it generated surgical difficulty. There were no cases with symptoms of vas-cular or neuronal compression. In no case was the pre-surgical imaging diagnosis made. The predominant surgical approach was section, in 88.2%, without presenting associated surgical complications.Discussion. Knowledge of the axillary arch as an anatomical variant of the axilla is important for the surgeon, which can hide the lymph nodes or make axillary dissection difficult, so the most commonly used approach is to cut it


Subject(s)
Humans , Axilla , Breast Neoplasms , Sentinel Lymph Node Biopsy , Lymph Node Excision
3.
Chinese Medical Journal ; (24): 318-325, 2021.
Article in English | WPRIM | ID: wpr-878045

ABSTRACT

BACKGROUND@#Methylene blue is the most commonly used tracer for sentinel lymph node (SLN) biopsy (SLNB) in China. This study aimed to investigate the feasibility of clinical application of SLNB using methylene blue dye (MBD) for early breast cancer and the prognosis of patients with different SLN and non-SLN statuses.@*METHODS@#We retrospectively analyzed the clinicopathological data of patients with early breast cancer treated at the Peking University First Hospital between 2013 and 2018. We calculated the SLN identification rate (IR) in SLNB with MBD and the false-negative rate (FNR), and analyzed the prognosis of patients with different SLN and non-SLN statuses using Kaplan-Meier curves.@*RESULTS@#Between January 2013 and December 2018, 1603 patients with early breast cancer underwent SLNB with MBD. The SLN IR was 95.8% (1536/1603). Two SLNs (median) were detected per patient. There were significant differences in FNR between patients with SLN micrometastasis and macrometastasis (19.0% vs. 4.5%, χ2 = 12.771, P < 0.001). Chi-square test showed that there were significant differences in SLN successful detection rates among patients with different vascular tumor embolism status (96.3% vs. 90.8%, χ2 = 9.013, P = 0.003) and tumor (T) stages (96.6% vs. 94.1%, χ2 = 5.189, P = 0.023). Multivariate analysis showed that vascular tumor embolism was the only independent factor for SLN successful detection (odds ratio: 0.440, 95% confidence interval: 0.224-0.862, P = 0.017). Survival analysis showed a significant difference in disease-free survival (DFS) between patients with non-SLN metastasis and patients without non-SLN metastasis (P = 0.006).@*CONCLUSION@#Our single-center data show that, as a commonly used tracer in SLNB in China, MBD has an acceptable SLN IR and a low FNR in frozen sections. This finding is consistent with reports of dual tracer-guided SLNB. Positive SLNs with non-SLN metastasis are associated with DFS.


Subject(s)
Breast Neoplasms/surgery , China , Humans , Lymph Nodes , Methylene Blue , Retrospective Studies , Sentinel Lymph Node Biopsy
4.
Article in English | WPRIM | ID: wpr-880661

ABSTRACT

The preliminary screening of oral cancer mostly depends on the experience of clinicians, The surgical margin of tumor is mostly based on physical examination and preoperative imaging examination. It lacks real-time and objective intraoperative evaluation methods. Indocyanine green (ICG), as a safe and pollution-free organic fluorescent pigments, combined with near-infrared fluorescence imaging can be applied in the screening of early oral cancer, the determination of tumor resection margins, sentinel lymph node biopsy, cervical lymph node dissection, targeted chemotherapy, and other aspects. Near-infrared fluorescence imaging may become a key link in the early diagnosis and accurate treatment for oral cancer in the future.


Subject(s)
Humans , Indocyanine Green , Lymph Nodes , Mouth Neoplasms/therapy , Optical Imaging , Sentinel Lymph Node Biopsy
5.
Autops. Case Rep ; 11: e2020227, 2021. tab, graf
Article in English | LILACS | ID: biblio-1142414

ABSTRACT

Secretory carcinoma of the breast (SBC) is a rare breast neoplasm. Most of the patients present at an early stage with a relatively indolent clinical course. Lymph node and distant metastasis are also very infrequent. The histomorphological features of the secretory breast carcinoma are quite characteristic. Predominantly three histological patterns, solid, microcystic, and tubular, have been noted with copious amounts of intra and extracellular secretory material. Most commonly, no positivity for estrogen receptor (ER), progesterone receptor (PR) and ERBB2(HER2/neu) is observed in SBCs. As SBC can occasionally be hormone receptor-positive, they should not be categorized in the triple-negative breast carcinoma (TNBC) group in general. A very characteristic genetic translocation t (12;15) has been noted in this rare tumor, resulting in a fusion between ETV6 and NTRK3 proteins. We present a case of a 60-year-old lady who presented with right breast lump of 1-month duration and was managed by lumpectomy and sentinel lymph node dissection. Axillary dissection was not performed because the sentinel lymph node biopsy was negative. Postoperative radiotherapy was given to the right breast with a boost to the tumor bed. No adjuvant chemotherapy was given No recurrence has been noted even after a year of the completion of treatment


Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms/pathology , Carcinoma/pathology , Translocation, Genetic , Secretory Component , Sentinel Lymph Node Biopsy
6.
Rev. venez. cir ; 74(1): 407-411, 2021. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1283702

ABSTRACT

Describir la técnica quirúrgica de la disección axilar dirigida (DAD) usando carbón vegetal como marcador del ganglio linfático axilar metastásico al momento del diagnóstico conjuntamente con la biopsia del ganglio centinela en paciente con cáncer de mama tratada con quimioterapia neoadyuvante con respuesta completa clínica y ecográficamente, demostrando su seguridad y eficacia. Material y Métodos: Estudio retrospectivo y descriptivo. Paciente con cáncer de mama y ganglio linfático metastásico en axila ipsilateral marcado con carbón vegetal al confirmarse ese diagnóstico y tratada con quimioterapia neoadyuvante con posterior negativización tanto clínica como ecográfica del ganglio linfático metastásico. Se planificó para disección axilar dirigida (extirpación del ganglio marcado con carbón vegetal y biopsia de ganglio centinela) con el fin de demostrar la eficacia del marcador utilizado y su relación o no con el ganglio centinela. Resultados: Se comprobó la identificación certera del ganglio afectado marcado con carbón vegetal el cual no presentó migración del colorante o reacción inflamatoria local coincidiendo además con dos ganglios centinelas todos con respuesta patológica completa. El carbón permaneció 153 días desde su administración hasta la cirugía axilar. Conclusión: Esta experiencia admite el marcaje con carbón vegetal del ganglio axilar metastásico al momento de su diagnóstico como un método seguro, sencillo, económico y accesible en relación a otros métodos de marcaje, además su asociación con la biopsia del ganglio centinela nos permite prescindir de la disección axilar en caso de respuesta patológica completa, sin embargo, es importante resaltar que se necesitan evaluar más casos para obtener conclusiones determinantes(AU)


To describe the surgical technique of targeted axillary dissection using charcoal marking of the metastatic lymph node at the time of diagnosis together with sentinel node biopsy in a breast cancer patient who received neoadjuvant chemotherapy with complete clinical and sonographical response, demonstrating its safety and efficacy. Material and Methods: Retrospective and descriptive study. Patient with breast cancer and metastatic lymph node in the ipsilateral axilla which was marked with charcoal upon confirmation of this diagnosis and treated with neoadjuvant chemotherapy with subsequent clinical and sonographical negativization of the metastatic lymph node. It was planned for targeted axillary dissection (removal of charcoal-marked lymph node and sentinel node biopsy) in order to demonstrate the efficacy of the marker used and its relationship or not with the sentinel node. Results: The correct identification of the affected lymph node marked with charcoal was verified, which did not present dye migration or local inflammatory reaction, also coinciding with two sentinel nodes, all of them with a complete pathological response. The charcoal remained 153 days from its administration until the axillary surgery. Conclusion: This experience supports charcoal marking of the metastatic lymph node at the time of diagnosis as a safe, simple, inexpensive and accessible method in relation to other marking methods, in addition its association with sentinel node biopsy allows us to dispense with axillary dissection in case of complete pathological response, however it is important to highlight that more cases need to be evaluated to obtain decisive conclusions(AU)


Subject(s)
Female , Middle Aged , Axilla/pathology , Sentinel Lymph Node Biopsy , Sentinel Lymph Node , Breast Neoplasms , Charcoal , Drug Therapy , Lymph Nodes
7.
Rev. argent. cir ; 112(2): 157-164, 2020. tab
Article in English, Spanish | LILACS | ID: biblio-1125796

ABSTRACT

Antecedentes: los melanomas en cabeza y cuello (MCC) han sido asociados con factores pronósticos diferentes de aquellos en otras localizaciones. Objetivo: comparar características demográficas, clínicas y resultados del tratamiento quirúrgico de pacientes con MCC y pacientes con melanomas en tronco y extremidades (MTE). Material y métodos: se llevó a cabo una revisión retrospectiva de las historias clínicas de pacientes operados por melanoma entre enero de 2012 y diciembre de 2017. Quince pacientes (22,3%) tuvieron MCC y 52 (77,7%) MTE. Resultados: ambos grupos tuvieron edad similar (63,8 ± 21,1 versus 58,5 ± 16), pero los MCC mostraron una tendencia con predominio masculino (80% versus 61,3%). Los MCC tuvieron menor espesor tumoral que los MTE (2,07 versus 5,5 mm) y mayor porcentaje de melanoma in situ, 5 (33,3%) versus 8 (15,3%), pero requirieron vaciamientos ganglionares más a menudo (33% versus 25%) así como reconstrucción del defecto primario con colgajos locales y miocutáneos. Durante el seguimiento, en el grupo de MCC, dos pacientes desarrollaron recidivas locales que fueron extirpadas, y otros tres desarrollaron metástasis a distancia en pulmón, intestino delgado y abdomen y fallecieron por la enfermedad; en el grupo de MTE un paciente tuvo recidiva local y cinco fallecieron de metástasis sistémicas. El tamaño de la muestra no permitió aplicar pruebas de significación entre las diferencias encontradas. Conclusión: los MCC se presentan en un amplio rango de edad y estadios, y tuvieron algunas diferencias clínicas con el MTE. Los defectos producidos por la extirpación de la lesión primaria requieren procedimientos reconstructivos más complejos la mayoría de las veces y se aconseja un abordaje multidisciplinario.


Background: Head and neck melanomas (HNMs) have been associated with prognostic factors different from those on other locations. Objective: The goal of the present study was to compare the demographic and clinical characteristics and the outcomes of surgical treatment between patients with HNM and those with trunk and extremity melanoma (TEM). Material and methods: The clinical records of patients undergoing surgery for melanoma between October 2014 and April 2018 were retrospectively reviewed. Fifteen patients (22.3%) had HNM and 52 (77.7) presented TEM. Results: There were no differences in age between both groups (63.8 ± 21.1 versus 58.5 ± 16), but there was a trend toward higher percentage of men in the HNM group (80% versus 61.3%). Patients with HNM had lower tumor thickness than those with TEM (2.07 versus 5.5 mm), higher incidence of melanoma in situ [5 (33.3%) versus 8 (15.3%)]; lymph node resection was more common (33% versus 25%) as well as reconstruction of the primary defect with local and musculocutaneous flaps. During follow-up, two patients in the HNM group developed local recurrences that were excised and three presented distant metastases in the lung, small bowel and abdomen and finally died due to the disease. In the TEM group, one patient had local recurrence and five died due to systemic metastases. The sample size was not sufficient to assess statistically significant differences. Conclusion: Head and neck melanomas occur in a wide age range and stages and has some clinical differences with TEM. The defects produced after the excision of the primary lesion often require more complex procedures and should be managed with a multidisciplinary approach.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Head and Neck Neoplasms/epidemiology , Melanoma/epidemiology , Cross-Sectional Studies , Retrospective Studies , Sentinel Lymph Node Biopsy , Extremities/pathology , Torso/pathology , Margins of Excision , Melanoma/surgery
8.
Dermatol. argent ; 26(1): 23-25, 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1146359

ABSTRACT

Antecedentes: En la octava edición del manual de estadificación del cáncer del American Joint Committee on Cancer (AJCC), se introdujeron cambios importantes en las categorías T, N y M. Al entrar en vigencia la octava guía de la AJCC, se modificó no solo el T, sino también la indicación de biopsia del ganglio centinela (BGC). Entre los cambios más significativos en la estadificación se encuentran: la exclusión del índice mitótico (IM) de la categoría T en los melanomas finos (de hasta 1 mm de espesor) y el cambio del punto de corte para el espesor tumoral para discriminar un T1a (< 0,8 mm sin ulceración) de un T1b (≥ 0,8 mm). Objetivo: Comparar la estadificación inicial de los melanomas finos según el criterio utilizado en la séptima edición, con la que tendrían de acuerdo con la perspectiva actual del AJCC, con especial atención en el índice mitótico. Diseño y métodos: Estudio observacional, de corte transversal, realizado mediante la recolección de datos de las historias clínicas desde el 1 de enero de 2000 hasta el 31 de diciembre de 2017. Resultados: De 131 melanomas finos incluidos, 28 tendrían cambios en su estadificación. Al considerar el nuevo punto de corte para el espesor tumoral, 22 melanomas T1a pasarían a T1b. Asimismo, se detectaron 20 melanomas con un IM ≥ 1 mitosis/mm2, de los cuales solo 6 tuvieron indicación de BGC por este criterio exclusivamente y serían clasificados como T1a en la actualidad. De estos, en 2 no se realizó la BGC por autodeterminación de los pacientes y en los 4 restantes el resultado fue negativo. Conclusiones: Veintiocho de nuestros pacientes tendrían hoy diferencias en la indicación de BGC: 22 serían considerados con mayor riesgo de metástasis ganglionares y serían candidatos a su pesquisa. Los otros 6 pacientes ya no tendrían indicación de ese estudio por la baja posibilidad de encontrar metástasis ocultas, lo cual coincide con el resultado negativo de la BGC en los 4 pacientes que se sometieron al procedimiento. (AU)


Background: In the 8th edition of the cancer staging manual of the American Joint Committee on Cancer (AJCC), important changes were made in the T, N and M categories. When the 8th guideline of the AJCC came into effect, not only was the T stage modified, but also the indication for sentinel lymph node biopsy (SLNB). The most significant changes in staging included: the exclusion of the mitotic index (MI) as a determinant of the T category and the change of the threshold of tumor thickness to discriminate a T1a (< 0.8 mm without ulceration) from a T1b (≥ 0.8 mm). Objective: To compare the initial staging of thin melanomas according to the criteria used in the 7th edition, with the one that would have been used according to the current AJCC recommendations, with special focus on MI. Design and methods: Observational, cross-sectional study, carried out through the collection of data from medical records from January 1, 2000 to December 31, 2017. Results: There were 131 thin melanomas included, 28 of which would have had changes in their staging. When considering the modified threshold for tumor thickness, 22 T1a melanomas would be classified as T1b. Among 20 thin melanomas with a MI ≥ 1, only 6 had an indication for SLNB solely due to the MI criterion and would be now classified as T1a. Two of these did not undergo SLNB because they rejected the procedure, and in the remaining 4, there were no SLN metastasis. Conclusions: Nowadays, 28 of our patients would have differences in the indication for SLNB: 22 would be considered to be at greater risk of lymph node metastasis and would be candidates for screening. The other 6 patients would no longer have an indication for this procedure due to the low probability of clinically occult metastases, which seems to concur with the negative result of SLNB in the 4 patients who underwent the procedure. (AU)


Subject(s)
Humans , Skin Neoplasms/pathology , Practice Guidelines as Topic , Sentinel Lymph Node Biopsy , Melanoma/pathology , Mitotic Index , Neoplasm Staging/methods , Skin Neoplasms/diagnosis , Cross-Sectional Studies , Risk Factors , Lymphatic Metastasis , Melanoma/diagnosis
9.
Rev. argent. mastología ; 38(140): 82-99, dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1116280

ABSTRACT

Introducción Durante años, la correlación directa entre el tamaño tumoral y el compromiso ganglionar fue uno de los parámetros de mayor importancia a la hora del diagnóstico del cáncer de mama. La biopsia del ganglio centinela permite estadificar la axila en pacientes con cáncer de mama y axila clínicamente negativa. Mediante este procedimiento, se evita la linfadenectomía axilar en una proporción de pacientes. Se han identificado variables independientes de compromiso ganglionar, como la edad de la paciente, el tamaño y grado tumoral, la invasión vasculolinfática, el alto índice de proliferación (Ki67), el estado de los receptores de estrógeno (re), de receptores de progesterona (rp) y de her2. Objetivo El objetivo de nuestro estudio fue estimar si existe relación entre el compromiso del ganglio centinela y el fenotipo molecular. Material y método Este es un estudio observacional, retrospectivo, transversal y analítico, en el cual se incluyeron 1.034 mujeres con diagnóstico de cáncer de mama en estadio temprano tratadas entre junio de 2008 y junio 2016 en la Sección de Mastología del Servicio de Ginecología del Hospital de Agudos Dr. Ignacio Pirovano y del consultorio de práctica privada. Los datos clínicos y anatomopatológicos fueron recabados de la base de datos de ambos centros ingresados en el Registro de Cáncer de Mama de la Sociedad Argentina de Mastología (rcm). Resultados El análisis multivariado demostró correlación estadísticamente significativa entre el compromiso del ganglio centinela y los fenotipos Luminal B (or 1,546; ic 95%, 1,065 - 2,244; p=0,022), her2 (or 2,23; ic 95%, 1,060 - 4,691; p=0,035) y Triple Negativo (or 0,247; ic 95%, 0,055 - 1,098; p=0,066) con respecto a los Luminales A en cáncer de mama estadio temprano. A mayor tamaño tumoral mayor compromiso del ganglio centinela: en tumores pT1b: or 3,154 (ic 95%, 1,231- 8,078; p= 0,017); en tumores pT1c: or 4,973 (ic 95%, 2,086 - 11,856; p<0,05) y en tumores pT2: or 6,180 (ic 95%, 2,458 - 15,536; p<0,05) con respecto al pT1a. No hubo diferencias significativas con respecto a la invasión linfovascular en nuestra población. Conclusiones En el análisis de nuestro estudio podemos concluir que existe relación estadísticamente significativa entre el fenotipo molecular (Luminales, her2) y el compromiso del ganglio centinela


Introduction The relation between tumor size and nodal involvement was one of the most important parameters. The sentinel node biopsy allows staging the axilla in patients with breast cancer and clinically negative axilla. It is possible to avoid the axillary dissection in a proportion of patients. It´s has been identified independent variables of nodal involvement as age, size and tumor grade, vascular and lymphatic invasion, high proliferation index (Ki67), status of estrogen receptors (er), progesterone receptors (pr) and her2. Objective The aim of our study was to estimate the correlation between the involvement of the sentinel node and the molecular phenotype. Materials and method This is an observational, retrospective, transversal and analytical study, in which 1,034 women presented diagnosis of early stage breast cancer between June 2008 and June 2016 in the Mastology Section of Hospital Dr. Ignacio Pirovano and private practice. Clinical and pathological data were collected from the database of both centers entered in the Register of Breast Cancer of the Society of Argentina Mastology (rcm). Results Multivariate analysis showed statistically significant correlation between the involvement of sentinel node and phenotypes Luminal B (or 1.546; ci 95%, 1.065 - 2.244; p=0.022), her2 (or 2.23; ci 95%. 1.060 - 4.691; p=0.035) and Triple Negative Breast Cancer (tnbc) (or 0.247; ci 95%, 0.055 - 1.098; p=0.066) in comparison with Luminal A phenotype in early stage breast cancer. Furthermore, if the tumor size is bigger the chance of the involvement of the sentinel node is greater. With tumors pT1b: or 3,154 (95% ci, 1.231- 8.078; p = 0.017); pT1c: or 4,973 (95% ci, 2.086 to 1.856; p <0.05) and pT2: or 6,180 (95% ci, 2.458 to 15.536; p <0.05) in comparison with pT1a. There were no significant differences regarding lymphovascular invasion in our population. Conclusions In the analysis of our study we can conclude that there is a statistically significant relationship between the molecular phenotype (Luminal, her2) and the involvement of the sentinel node


Subject(s)
Breast Neoplasms , Sentinel Lymph Node Biopsy , Sentinel Lymph Node
11.
An. bras. dermatol ; 94(1): 47-51, Jan.-Feb. 2019. tab
Article in English | LILACS | ID: biblio-983750

ABSTRACT

Abstract: Background: Sentinel lymph node biopsy in thin invasive primary cutaneous melanoma (up to 1mm thick) is a controversial subject. The presence of tumor-infiltrating lymphocytes could be a factor to be considered in the decision to perform this procedure. Objective: To evaluate the association between the presence of tumor-infiltrating lymphocytes and lymph node metastases caused by thin primary cutaneous melanoma. Methods: Cross-sectional study with 137 records of thin invasive primary cutaneous melanoma submitted to sentinel lymph node biopsy from 2003 to 2015. The clinical variables considered were age, sex and topography of the lesion. The histopathological variables assessed were: tumor-infiltrating lymphocytes, melanoma subtype, Breslow thickness, Clark levels, number of mitoses per mm2, ulceration, regression and satellitosis. Univariate analyzes and logistic regression tests were performed as well the odds ratio and statistical relevance was considered when p <0.05. Results: Among the 137 cases of thin primary cutaneous melanoma submitted to sentinel lymph node biopsy, 10 (7.3%) had metastatic involvement. Ulceration on histopathology was positively associated with the presence of metastatic lymph node, with odds ratio =12.8 (2.77-59.4 95% CI, p=0.001). The presence of moderate/marked tumor-infiltrating lymphocytes was shown to be a protective factor for the presence of metastatic lymph node, with OR=0.20 (0.05-0.72 95% CI, p=0.014). The other variables - clinical and histopathological - were not associated with the outcome. Study limitations: The relatively small number of positive sentinel lymph node biopsy may explain such an expressive association of ulceration with metastatization. Conclusions: In patients with thin invasive primary cutaneous melanoma, few or absent tumor-infiltrating lymphocytes, as well as ulceration, represent independent risk factors for lymph node metastasis.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Skin Neoplasms/pathology , Lymphocytes, Tumor-Infiltrating/pathology , Sentinel Lymph Node/pathology , Lymphatic Metastasis/pathology , Melanoma/pathology , Logistic Models , Cross-Sectional Studies , Multivariate Analysis , Risk Factors , ROC Curve , Sex Distribution , Statistics, Nonparametric , Risk Assessment , Sentinel Lymph Node Biopsy/methods
12.
S. Afr. j. surg. (Online) ; 57(1): 7-10, 2019. ilus
Article in English | AIM | ID: biblio-1271042

ABSTRACT

Background: Sentinel lymph node biopsy (SLNB) is the standard of care for women with node negative breast cancer. Tc99 nanocolloid is a popular tracer, facilitating preoperative lymphoscintigraphy to identify sentinel nodes. This study compares the number of sentinel lymph nodes identified at the time of surgery in women who had lymphoscintigraphy with those who did not.Method: All women with primary breast cancer undergoing a SLNB from 2003­2017 who were node negative and did not have neoadjuvant chemotherapy were retrospectively reviewed in this study.Results: 576 women who had Tc99 preoperative injection were included in the study. Three hundred patients (Group 1) underwent lymphoscintigraphy preoperatively and 276 (Group 2) had no lymphoscintigraphy. The mean age at diagnosis for Groups 1 and 2 were 56 and 58 years, respectively. Both groups were also found to be similar in terms of histological subtype, tumour location, size, and HER2- and Estrogen receptor (ER) status. The surgery for the breast primary was similar in groups 1 and 2. While both groups had a median number of 2 nodes identified, the mean number of nodes identified for Group 2 (2.12) was 10% higher than for Group 1 (1.92) (p = 0.0026).Conclusion: This is the largest series to show that a preoperative lymphoscintigram (scan) can safely be omitted when performing a SLNB. As newer tracers are being used (e.g. Iron Oxide), it is important to know that accuracy of SLNB is not compromised by omission of a scan


Subject(s)
Breast Neoplasms , Lymphoscintigraphy , Sentinel Lymph Node Biopsy , South Africa
13.
Article in English | WPRIM | ID: wpr-738415

ABSTRACT

PURPOSE: The Z0011 trial showed that axillary lymph node dissection (ALND) can be safely avoided in breast cancer patients with low nodal burden (LNB). ALND can be performed in patients with high nodal burden (HNB). We aimed to determine whether HNB in early breast cancer patients can be predicted preoperatively to avoid sentinel lymph node biopsy (SLNB). METHODS: Early invasive breast cancer patients (cT1-2cN0) were retrospectively reviewed. We excluded patients with neoadjuvant chemotherapy and incomplete data. The patients were divided into the following groups based on surgical histology: no positive (N0), LNB, and HNB, defined as 0, 1–2, and ≥ 3 metastatic lymph nodes (LNs), respectively. Of the patients with metastatic nodal disease, only those with ALND were included in the analysis. Clinical, radiological, and histological parameters were evaluated using logistic regression analysis as predictors of HNB versus LNB and N0 combined. RESULTS: Of the 1,298 included patients, 832 (64.1%), 286 (22.0%), and 180 (13.9%) had N0, LNB, and HNB, respectively. Univariate logistic regression analysis revealed that sonographic features of breast tumor size (p < 0.0001), number of abnormal LNs (p < 0.0001), cortical thickness (p = 0.0002), effacement of the fatty hilum (p < 0.0001), and needle biopsy being performed (p < 0.0001) were indicators of HNB. Breast tumor grade (p = 0.0001) and human epidermal growth factor receptor 2 status (p = 0.0262) were also statistically significant. Among these significant features, multivariable stepwise logistic regression showed that the number of abnormal LNs is the sole independent predictor of HNB (p < 0.0001, area under the curve = 0.774). The positive predictive value of HNB in patients with ≥ 4 abnormal LNs was 92.9%. CONCLUSION: The detection of ≥ 4 abnormal LNs on ultrasound can help to identify HNB patients who require upfront ALND and thus avoid SLNB.


Subject(s)
Biopsy, Needle , Breast Neoplasms , Breast , Drug Therapy , Humans , Logistic Models , Lymph Node Excision , Lymph Nodes , ErbB Receptors , Retrospective Studies , Sentinel Lymph Node Biopsy , Ultrasonography
14.
Article in English | WPRIM | ID: wpr-739378

ABSTRACT

Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipplesparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.


Subject(s)
Acellular Dermis , Arm , Breast Implants , Breast , Carcinoma, Ductal , Cicatrix , Contracture , Female , Freedom , Hematoma , Humans , Mammaplasty , Mastectomy , Necrosis , Robotic Surgical Procedures , Sentinel Lymph Node Biopsy , Seroma , Surgeons , Tissue Expansion Devices
15.
Cancer Research and Treatment ; : 1011-1021, 2019.
Article in English | WPRIM | ID: wpr-763178

ABSTRACT

PURPOSE: Axillary lymph node dissection (ALND) may be avoidable for breast cancer patients with 1-2 positive lymph nodes (LN) after breast-conserving therapy. However, the effects of ALND after mastectomy remain unclear because radiation is not routinely used. Herein, we compared the benefits of post-mastectomy ALND versus sentinel node biopsy (SNB) alone for breast cancer patients with 1-3 metastatic LNs. MATERIALS AND METHODS: A total of 1,697 patients with pN1 disease who underwent mastectomy during 2000-2015 were identified from an institutional database. Outcomes were compared using the inverse probability of treatment weighted method. RESULTS: Patients who underwent SNB tended to have smaller tumors, a lower histology grade, a lower number of positive LNs, and better immunohistochemical findings. After correcting all confounding factors regarding patient, tumor, and adjuvant treatment, the SNB and ALND groups did not differ in terms of overall survival (OS) and disease-free survival (DFS), distant metastasis and locoregional recurrence. The 10-year DFS and OS rates were 83% and 84%, respectively, during a median follow-up period of 93 months. CONCLUSION: ALND did not improve post-mastectomy survival outcomes among patients with N1 breast cancer, even after adjusting for all histopathologic and treatment-related factors.


Subject(s)
Biopsy , Breast Neoplasms , Breast , Disease-Free Survival , Follow-Up Studies , Humans , Lymph Node Excision , Lymph Nodes , Mastectomy , Methods , Neoplasm Metastasis , Recurrence , Sentinel Lymph Node Biopsy
16.
Article in English | WPRIM | ID: wpr-763146

ABSTRACT

PURPOSE: The purpose of this study was to detect the lymphatic drainage pattern of internal mammary area and verify the concept of internal mammary sentinel lymph node (IM-SLN) in breast. MATERIALS AND METHODS: A small particle radiotracer ((99m)Tc-Dextran 40) was prepared and tested. (99m)Tc-Dextran 40 was injected into intraparenchyma at the sound breast by a modified radiotracer injection technique. Subsequently, dynamic single-photon emission computed tomography (SPECT), computed tomography (CT), and SPECT/CT combination images were performed to identify the radioactive lymph vessels and internal mammary lymph nodes (IMLNs). The direction of lymph drainage and the location of the IMLNs were identified in the SPECT/CT imaging. RESULTS: The radiochemical purity of (99m)Tc-Dextran 40 was > 95%. (99m)Tc-Dextran 40 could drainage into first, second, and third lymph node and the radioactive lymph node could be detected by the γ detector in the animal experiment. After (99m)Tc-Dextran 40 injecting into intraparenchyma, 50.0% cases (15/30) were identified the drainage lymphatic vessels and radioactive IMLNs by SPECT. The drainage lymphatic vessel was found from injection point to the first IMLN (IM-SLN) after 10.5±0.35 minutes radiotracer injection, and then (99m)Tc-Dextran 40 was accumulated into the IM-SLN. The combination imaging of SPECT/CT showed the second IMLN received the lymph drainage from the IM-SLN. The lymphatic drainage was step by step in the internal mammary area. CONCLUSION: The lymph was identified to drain from different regions of the breast to IM-SLN, and then outward from IM-SLN to other IMLN consecutively. It demonstrated the concept of the IM-SLN and provided more evidences for the application of internal mammary sentinel lymph node biopsy.


Subject(s)
Animal Experimentation , Breast Neoplasms , Breast , Drainage , Lymph Nodes , Lymphatic Vessels , Sentinel Lymph Node Biopsy , Tomography, Emission-Computed , Tomography, Emission-Computed, Single-Photon
17.
Article in English | WPRIM | ID: wpr-762863

ABSTRACT

BACKGROUND: Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy affecting the skin, for which timely diagnosis and aggressive treatment are essential. MCC has most often been reported in Caucasians, and case reports in Asians are rare. This study presents our experiences with the surgical treatment and radiotherapy of MCC in Asian patients. METHODS: We retrospectively reviewed the records of seven MCC patients between 2000 and 2018 from a single institution, and analyzed patient characteristics, tumor characteristics, surgical treatment, sentinel lymph node evaluation, reconstruction, adjuvant radiation therapy, and prognosis. RESULTS: Eight MCC lesions occurred in seven patients, most commonly in the head and neck region. All patients underwent surgical excision with reconstruction. The final surgical margin was 1.0 cm in most cases, and reconstruction was most commonly performed with a split-thickness skin graft. Five patients received adjuvant radiotherapy, and two patients received sentinel lymph node biopsy. During the follow-up period, three patients remained well, two died from other causes, one experienced recurrence, and one was lost to follow-up. CONCLUSIONS: We treated seven Asian MCC patients and our series confirmed that MCC is a very dangerous cancer in Asians as well. Based on our experiences, thorough surgical excision of MCC with histopathological clearance should be considered, with sentinel lymph node evaluation if necessary, followed by appropriate reconstruction and careful postoperative observation. Adjuvant radiation therapy is also recommended for all Asian MCC patients. The results of this case series may provide guidance for the treatment of Asian MCC patients in the future.


Subject(s)
Asian Continental Ancestry Group , Carcinoma, Merkel Cell , Diagnosis , Follow-Up Studies , Head , Humans , Lost to Follow-Up , Lymph Nodes , Mohs Surgery , Neck , Prognosis , Radiotherapy , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Sentinel Lymph Node Biopsy , Skin , Transplants
18.
Article in English | WPRIM | ID: wpr-762762

ABSTRACT

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroectodermal carcinoma arising from mechanoreceptor Merkel cells. Multiple MCCs are even rarer. We report a case of two independent MCCs simultaneously present in the cheek of a patient, which were effectively and esthetically treated using a cheek flap. Punch biopsy performed in a 60-year-old woman admitted with a chief complaint of two skin-colored hard nodules in her left cheek, accompanied by an itching sensation, was suggestive of MCC. Accordingly, we performed sentinel lymph node biopsy through the modified Blair incision under general anesthesia, in cooperation with the head and neck surgery department. The defect was covered with a cheek flap by slightly extending the existing incision following wide excision with a safety margin of 1 cm. This paper is significant in that it introduces an effective reconstruction technique that maintains function using a cheek flap for the management of this rare case. In addition, this paper is the first to classify multiple MCCs according to the time of onset. We believe that this paper presents an effective alternative reconstruction technique with sentinel node biopsy through the modified Blair incision.


Subject(s)
Anesthesia, General , Biopsy , Carcinoma, Merkel Cell , Cheek , Female , Head , Humans , Mechanoreceptors , Merkel Cells , Middle Aged , Neck , Neural Plate , Pruritus , Sensation , Sentinel Lymph Node Biopsy , Surgical Flaps
19.
Article in English | WPRIM | ID: wpr-762691

ABSTRACT

PURPOSE: Sentinel lymph node (SLN) biopsy (SLNB) is widely performed for axillary staging in patients with breast cancer. Based on the results of frozen section examination (FSE), surgeons can decide to continue further axillary dissections. This study aimed to verify the accuracy of FSE for SLNs. METHODS: We reviewed the records of 4,219 patients who underwent SLNB for primary invasive breast cancer between 2007 and 2016 at the Severance Hospital. We evaluated factors associated with the false-negative results of FSE for SLNs using the Generalized Estimating Equations model. RESULTS: A total of 1,397 SLNs from 908 patients were confirmed to be metastatic. Seventy-one patients (1.7%) had confirmed pathologic N2 or N3 stage. Among metastatic SLNs, micrometastasis was found in 234 (16.8%). The overall accuracy of SLNB was 98.5%. The sensitivity and false-negative rate of FSE were 86.4% and 13.6%, respectively. Several clinicopathological factors, including the size of SLN metastases, suspicious preoperative axillary lymph nodes, and luminal B subtype, were associated with a higher rate of false-negative results. CONCLUSION: Most patients were not indicated for axillary lymph node dissection. Some patients may show transition in their permanent pathology due to the size of the metastatic node. However, the false-negative results of FSE for SLNs based on the size of the metastatic node did not change our practice. Therefore, intraoperative FSE for SLN should not be routinely performed for all breast cancer patients.


Subject(s)
Biopsy , Breast Neoplasms , Breast , False Negative Reactions , Frozen Sections , Humans , Lymph Node Excision , Lymph Nodes , Neoplasm Metastasis , Neoplasm Micrometastasis , Pathology , Phenobarbital , Sentinel Lymph Node Biopsy , Surgeons
20.
Article in English | WPRIM | ID: wpr-762684

ABSTRACT

PURPOSE: The combination of indocyanine green and methylene blue (ICG + MB) was reported to be an efficient tracer method in sentinel lymph node biopsy (SLNB). However, whether this method is superior to MB only or carbon nanoparticles (CN) is controversial. This study was to evaluate the efficacy of the three methods in SLNB for breast cancer, and to analyze its influencing factors. METHODS: One hundred eighty patients with early breast cancer were recruited and randomly divided into 3 groups. Each group comprising of 60 patients with SLNB using ICG + MB, MB, and CN, respectively. Then the 3 groups were compared in detection rate, mean number of SLNs, and the detection rates and number of metastatic sentinel lymph nodes (SLNs). RESULTS: The detection rate of SLNs was 100% (60 of 60) in ICG + MB group, 96.7% (58 of 60), and 98.3% (59 of 60) in MB and CN group, respectively, with no significant difference (P = 0.362). Totally, 204 SLNs (mean ± standard deviation [SD] [range], 3.4 ± 1.4 [2–8]) were detected in ICG + MB group, 102 (1.7 ± 0.7 [0–3]) and 145 (2.4 ± 0.7 [0–6]) in MB and CN group, indicating significant difference (P < 0.001). The detection rate of metastatic SLN was 23.3% (14 of 60) in ICG + MB group, which was higher than 18.3% (11 of 60) and 20% (11 of 60) in MB and CN group, respectively, but showed no statistical significance (P = 0.788). CONCLUSION: ICG + MB method was superior to MB only and CN only methods in the mean number of SLNs, thus predicting axillary lymph node metastasis more accurately. Therefore, in areas where the standard method is not available, ICG + MB may be more suitable as an alternative tracer for SLNB.


Subject(s)
Breast Neoplasms , Breast , Carbon , Humans , Indocyanine Green , Lymph Nodes , Methods , Methylene Blue , Nanoparticles , Neoplasm Metastasis , Sentinel Lymph Node Biopsy
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