Intraoperative imprint cytology versus histological diagnosis for the detection of sentinel lymph nodes in breast cancer treated with neoadjuvant chemotherapy

OBJECTIVES: To compare imprint cytology and paraffin section histology for sentinel lymph node detection in women with breast cancer treated with neoadjuvant chemotherapy. METHOD: A cross-sectional study and report of the sentinel lymph node statuses of 64 patients with breast cancer who underwent intraoperative imprint cytology and neoadjuvant chemotherapy in a referral cancer institute in Rio de Janeiro, Brazil, between 2014 and 2016. RESULTS: The mean age was 51 years. The most common histological type was invasive ductal carcinoma (93.75%), and the most common differentiation grade was 2 (62.5%). Overall, 153 lymph nodes were identified, with a mean of 2.39/case. Thirty-four lymph nodes tested positive for malignancy by imprint cytology, and 55 tested positive by histology. Of the 55 positive lymph nodes, 41 (74.5%) involved macrometastases, and 14 (25.5%) involved micrometastases. There were 21 false negatives with imprint cytology, namely, 7 for macrometastases and 14 for micrometastases, resulting in a rate of 17.6%. The sensitivity of imprint cytology was 61.8%, with a specificity and positive predictive value of 100%, a negative predictive value of 82.4% and an accuracy of 86.3%. The method presented null sensitivity for the identification of micrometastases. CONCLUSIONS: The false-negative rate with imprint cytology was associated with the number of sentinel lymph nodes obtained. The rate found for complete response to neoadjuvant chemotherapy was comparable to the rates reported in the literature. The accuracy of imprint cytology was good, and its specificity was excellent for sentinel lymph node detection; however, the method was unable to detect lymph node micrometastases.

Convulsión afebril benigna asociada a gastroenteritis por rotavirus / Afebrile benign seizures associated to rotavirus gastroenteritis

Introducción: el rotavirus, es la principal causa de gastroenteritis en niños menores de 3 años de edad. Se han publicado reportes en los cuales describen estas gastroenteritis asociadas a convulsiones generalizadas, afebriles, benignas. Esta convulsión se presenta con deshidratación leve y sin desequilibrio hidroelectrolítico. Es una entidad bien conocida en Asia pero muy poco reportada en el resto del mundo.Caso clínico: lactante varón de 1 año y 2 meses de edad que acude por presentar convulsión tónica asociado a una gastroenteritis por rotavirus. La crisis fue autolimitada y de evolución benigna.Conclusión: la entidad no se presenta exclusivamente en Asia y es probable que en nuestro medio sea mas frecuente pero subdiagnosticada.

Introduction: Rotavirus is the main cause of gastroenteritis in children under 3 years of age. Some reports have been published, describing cases of gastroenteritis associated to afebrile benign generalized seizures. These seizures occurring with mild dehydration and with no hydroelectrolytic imbalance have been frequently described in Asia, but they have rarely been reported in the rest of the world.Case report: A 1-year and two-months old male infant presented with tonic seizures associated with rotavirus gastroenteritis. The episode was self-limited and with a good outcome up to now. This condition is not exclusive to Asia and it may even be more frequent in our environment but misdiagnosed. Conclusion: to organization one does not appear exclusively in Asia and it is probable that in our means but frequent but it is subdiagnosed.