ABSTRACT
Objetivo. Analizar la tasa de recurrencias axilares (RA) en pacientes con cáncer de mama en estadios iniciales y biopsia selectiva del ganglio centinela negativa (BSGC) sin linfadenectomía (LDN) posterior. Material y métodos. Se han incluido un total de 173 pacientes a quienes se aplicó la BSGC tras diagnóstico de cáncer de mama en estadios iniciales. En 32 pacientes la BSGC fue positiva y estas pacientes fueron sometidas a LDN. Se han seguido 141 pacientes con BSGC negativa sin LDN, por un periodo medio de 55 meses (rango 74-36). Resultados. La tasa de detección del GC fue del 99,42%. Después de un periodo de seguimiento medio de 4,5 años no se han detectado RA. Dos pacientes desarrollaron recidiva local, otras 2 desarrollaron metástasis a distancia y 4 desarrollaron un cáncer intercurrente. Se produjeron 4 muertes, ninguna de ellas asociadas al cáncer de mama. Conclusiones. Los resultados obtenidos apoyan la BSGC como una técnica exacta en la estadificación axilar de los pacientes con cáncer de mama en estadios iniciales, ofreciendo en los casos de BSGC negativa un control axilar seguro después de 4,5 años de seguimiento medio (AU)
Objective. To analyze the rate of axillary recurrences (AR) in patients with early breast cancer who had not undergone an axillary node dissection (ALND) because of a negative sentinel lymph node biopsy (SLNB). Material and methods. The study includes 173 patients operated on for breast cancer and selective node biopsy. In 32 patients the SLNB was positive and undergone subsequent ALND. We followed up 141 patients with negative SLNB without LDN, with a median follow up of 55 months (range 74-36). Results. The detection rate of SLN was of 99.42%. After a median follow-up of 4.5 years, there were no axillary recurrences. Two patients developed local recurrence, other two patients developed distant metastases and four patients developed a metachronous tumor. Four patients died, none of them because of breast cancer. Conclusions. The results obtained support the SLNB as an accurate technique in the axillary stratification of patients with breast cancer, offering in the cases of negative SLNB a safe axillary control after 4.5 year follow-up (AU)
Subject(s)
Humans , Female , Sentinel Lymph Node Biopsy/statistics & numerical data , Breast Neoplasms/pathology , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging , Lymph Node Excision , Disease-Free SurvivalABSTRACT
Objetivo: En la estadificación del cáncer de mama, el método del análisis intraoperatorio del ganglio centinela (GC) no ha sido todavía adecuadamente establecido. Hemos evaluado la validez diagnóstica y el impacto del análisis intraoperatorio mediante sección en congelación (SC) del GC. Material y métodos: Se ha realizado un estudio descriptivo de validez diagnóstica de la SC del GC en las pacientes con cáncer de mama a las que se realizó biopsia selectiva del ganglio centinela (BSGC) desde octubre de 2006 hasta octubre de 2012. Se evaluaron los índices de validez diagnóstica sensibilidad, especificidad, valores predictivos positivo y negativo y valor global. Se consideró patrón oro el estudio anatomopatológico definitivo de las biopsias. Resultados: Se estudiaron 370 pacientes. La sensibilidad y especificidad para la detección de metástasis mediante la SC en el GC ha sido del 67% y del 100%, y la validez diagnóstica global del 95%. Se encontró relación entre tamaño del tumor y detección de metástasis (p < 0,05). Doce de las 15 pacientes con micrometástasis se sometieron a linfadenectomía y no se hallaron ganglios metastáticos en ninguna de ellas. Conclusiones: El análisis intraoperatorio mediante SC del GC es un método útil y fiable para la estadificación de los ganglios linfáticos axilares en pacientes con cáncer de mama en estadios iniciales. La SC reduce la necesidad de realizar una segunda cirugía, al menos en la mayoría de los pacientes con cáncer de mama y evidencia inequívoca de GC positivo (AU)
Objective: The method for intraoperative sentinel lymph node (SLN) evaluation has still not been established in breast cancer staging. This study has evaluated the diagnostic validity and impact of intraoperative analysis using the frozen section (FS) of SLN. Material and methods: We performed a descriptive study of the diagnostic validity of the FS of the SLN in patients with breast cancer and selective sentinel node biopsy (SSNB) from October-2006 to October- 2012. The diagnostic validity indexes were evaluated using sensitivity, specificity, positive and negative predictive values and global value. Gold standard was considered as the final histopathological results of the biopsies. Results: A total of 370 patients were studied. Sensitivity and specificity for detection of metastasis by FS in the SLN were 67% and 100%, respectively. Global diagnostic validity was 95%. There was a correlation between detection of metastasis and tumor size (p < 0.05). Twelve of the 15 patients with SLN micrometastases underwent axillary lymph node dissection (ALND). Metastatic lymph nodes were not found in any of them. Conclusions: Intraoperative FS examination of the SLN is a useful and reliable predictor of axillary lymph node staging in patients with initial stages of breast cancer. FS reduces the need for second interventions, at least for most patients who have breast cancer with identifiable positive SLN and unequivocal evidence of positive lymph node disease (AU)
Subject(s)
Humans , Female , Sentinel Lymph Node Biopsy , Breast Neoplasms/surgery , Intraoperative Period , Lymphatic Metastasis/pathology , Sensitivity and Specificity , Reproducibility of ResultsABSTRACT
OBJECTIVE: To analyze the rate of axillary recurrences (AR) in patients with early breast cancer who had not undergone an axillary node dissection (ALND) because of a negative sentinel lymph node biopsy (SLNB). MATERIAL AND METHODS: The study includes 173 patients operated on for breast cancer and selective node biopsy. In 32 patients the SLNB was positive and undergone subsequent ALND. We followed up 141 patients with negative SLNB without LDN, with a median follow up of 55 months (range 74-36). RESULTS: The detection rate of SLN was of 99.42%. After a median follow-up of 4.5 years, there were no axillary recurrences. Two patients developed local recurrence, other two patients developed distant metastases and four patients developed a metachronous tumor. Four patients died, none of them because of breast cancer. CONCLUSIONS: The results obtained support the SLNB as an accurate technique in the axillary stratification of patients with breast cancer, offering in the cases of negative SLNB a safe axillary control after 4.5 year follow-up.
Subject(s)
Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Neoplasm Recurrence, Local/epidemiology , Sentinel Lymph Node Biopsy , Adult , Aged , Aged, 80 and over , Axilla , Breast Neoplasms/surgery , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Sentinel Lymph Node Biopsy/methods , Time FactorsABSTRACT
OBJECTIVE: The method for intraoperative sentinel lymph node (SLN) evaluation has still not been established in breast cancer staging. This study has evaluated the diagnostic validity and impact of intraoperative analysis using the frozen section (FS) of SLN. MATERIAL AND METHODS: We performed a descriptive study of the diagnostic validity of the FS of the SLN in patients with breast cancer and selective sentinel node biopsy (SSNB) from October-2006 to October-2012. The diagnostic validity indexes were evaluated using sensitivity, specificity, positive and negative predictive values and global value. Gold standard was considered as the final histopathological results of the biopsies. RESULTS: A total of 370 patients were studied. Sensitivity and specificity for detection of metastasis by FS in the SLN were 67% and 100%, respectively. Global diagnostic validity was 95%. There was a correlation between detection of metastasis and tumor size (p<0.05). Twelve of the 15 patients with SLN micro-metastases underwent axillary lymph node dissection (ALND). Metastatic lymph nodes were not found in any of them. CONCLUSIONS: Intraoperative FS examination of the SLN is a useful and reliable predictor of axillary lymph node staging in patients with initial stages of breast cancer. FS reduces the need for second interventions, at least for most patients who have breast cancer with identifiable positive SLN and unequivocal evidence of positive lymph node disease.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Frozen Sections , Lymph Nodes/pathology , Sentinel Lymph Node Biopsy , Adult , Aged , Aged, 80 and over , Female , Humans , Intraoperative Period , Lymphatic Metastasis , Middle Aged , Prospective Studies , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
La mastopatía diabética (MD) es una complicación de la diabetes mellitus (DM) de larga evolución. Consiste en la aparición de nódulos mamarios que clínicamente pueden simular un proceso maligno. Las pruebas de imagen son inespecíficas. La biopsia informa de fibrosis densa e infiltración linfocitaria sin signos de malignidad. No hay riesgo de malignización de las lesiones. Se trata el caso de una mujer de 32 años, con DM tipo 1 que presenta en la mama izquierda un nódulo retroareolar de 4 cm, móvil, mal delimitado, duro e irregular, sin signos inflamatorios. La ecografía y la mamografía muestran mamas densas sin signos de malignidad. El diagnóstico se realiza con biopsia percutánea y el manejo es conservador mediante revisiones periódicas, descartando la exéresis quirúgica. En conclusión, aunque clínicamente la MD simule un proceso maligno, siempre es benigna. Se diagnostica mediante core-biopsia y el manejo debe ser conservador; no precisa cirugía
Diabetic mastopathy is a complication of long-standing diabetes mellitus (DM). It consists of breast nodules that can mimic a malignant process. Imaging tests are nonspecific. Biopsy reveals dense fibrosis and lymphoid infiltrates without signs of malignant disease. There is no risk of malignant transformation of the lesions. A 32-year-old woman with DM type 1 presented with a 4-cm, hard, palpable mass in the subareolar region of the left breast. The nodule was mobile and irregularly shaped, without signs of inflammation. Diagnosis was based on percutaneous biopsy. Management was conservative through periodic follow-up visits and surgical resection was ruled out. In conclusion, although diabetic mastopathy can mimic cancer, it is always a benign process. Diagnosis must be made with core biopsy and treatment should avoid surgery
