Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer.

INTRODUCTION: In this prospective ex vivo study, we propose a new technique for the intraoperative examination of retroareolar tissue and describe both surgical excision and pathological methods. We performed a nipple-sparing mastectomy simulation in patients selected to total mastectomy, in order to evaluate the accuracy of these new technique. MATERIALS AND METHODS: A total of 158 total mastectomy specimens from patients affected by ductal carcinoma in situ (n = 15) or invasive ductal carcinoma (stages I, II, or IIIA) (n = 143) were examined. To obtain the entire sample area, the terminal retroareolar milk duct bunch was isolated. Fragments approximately 1.5 cm in length were excised and sectioned in parallel at the base of the nipple using a cold bistoury. Three transverse histological sections (4 µm each) at 200 µm intervals that included the entire isolated fragments were subjected to frozen section examination. The sections were stained with hematoxylin-eosin and were evaluated. The remainder of each fragment was embedded in paraffin and 4 µm sections were subsequently stained with hematoxylin-eosin and examined. RESULTS: There were two false-negative (1.3%) and five false-positive (3.1%) findings among the frozen and paraffin sections analyzed. A statistical analysis of the frozen section examinations showed a sensitivity of 92.0%, a specificity of 96.2%, a positive predictive value of 82.1%, a negative predictive value of 98.4%, and an accuracy of 95.4%. CONCLUSION: The frozen section examination technique described here detected nipple involvement in breast cancer with greater accuracy than the frozen section usually performed by most surgeons.

Evaluation of frozen-section analysis of surgical margins in the treatment of breast cancer.

OBJECTIVE: To evaluate surgical margins in cases of ductal carcinoma through a histopathological exam using frozen sections. MATERIALS AND METHODS: Retrospective study encompassing 242 conservative surgeries, 179 of which included intraoperative frozen-section histopathology and 63 intraoperative nonfreezing techniques (macroscopy/gross examination and cytology). The results of such analyses were compared with those of the histology processing following paraffin embedment and hematoxylin and eosin (H & E) staining. A margin was deemed free when the distance between the tumor and the surgical border was equal to or greater than two millimeters. The factors given consideration for possibly affecting the results were: age, surgical aspects (skin removal and widening of surgical margins), histopathological findings (size, affected lymph nodes, and angiolymphatic invasion), and extensive intraductal and immunohistochemical components (estrogen, progesterone, Ki-67, and HER-2 receptors). In the statistical analyses, the chi-square test was used and negative predictive values were calculated. RESULTS: The negative predictive values were 87.1% and 79.3% for frozen and nonfrozen sections, respectively. There was no significant difference between the two groups (p = 0.14). The factors under consideration had no influence on the results of the intraoperative exam of the margins. CONCLUSION: The present study allowed to conclude that the intraoperative exam of the surgical margins by frozen section is not superior to a macroscopy and/or cytology exam.

Treatment of carcinoma in situ of the cervix experience at the Faculty of Medicine, University of São Paulo.

The authors studied a total of 334 cases of carcinoma in situ of the cervix (1975-1990). The patients were 19 to 61 years old (mean age, 36.6 years). The following procedures were performed: cervical amputation in 54.5% of cases, cervical enlarged amputation with resection of the adjacent vaginal mucosa in 23.3%, abdominal hysterectomy in 15.3%, electrocauterization in 3.6%, simple conization in 2.4%, and vaginal hysterectomy in 0.9%. Recurrence rates were: 9.8% after cervical amputation, 1.3% after cervical enlarged amputation, 25% after simple conization, 5.8% after abdominal hysterectomy, and 33% after electrocauterization. Recurrences were detected before the 18th month after treatment and none of them was of the invasive type. The treatment procedure with the highest rate of complications was cervical enlarged amputation (16%), followed by simple conization (12%), total abdominal hysterectomy (3.9%), and cervical amputation (2.9%). The authors conclude that, although cervical enlarged amputation was followed by the lowest recurrence rate, it was also the treatment followed by the largest number of complications. On this basis, they recommend cervical amputation or hysterectomy. For young women who wish to have children, simple conization is recommended.

Teste da estimulacao sonica: correlacao entre a resposta cardiaca fetal e o seu equilibrio acido-basico ao nascer / Sound stimulation test: correlation between fetal cardiac response and base-acid balance values at the birth

Os autores estudaram um grupo de 41 gestantes de alto risco com o objetivo de comparar os resultados do Teste de Estimulacao Sonica (TES) com os resultados da gasometria do sangue dos vasos do cordao umbilical imediatamente ao nascimento. O TES foi executado no mesmo dia do parto que ocorreu por operacao cesariana antes do inicio do trabalho de parto. Este teste foi classificado baseando-se nos componentes amplitude e duracao da resposta cardiaca fetal. Foram considerados fetos REATIVOS aqueles que exibiram resposta minima de 2,5 por cento e 5 por cento da populacao estudada; HIPORREATIVO aqueles que exibiram resposta inferior a esses niveis e NAO-REATIVOS aqueles que nao exibiram resposta. A correlacao dos tres grupos assim constituidos com os resultados gasometricos permitiu discerni-los em NORMAIS os fetos REATIVOS e ANORMAIS os fetos HIPORREATIVOS e NAO-REATIVOS.

Estudo clinico e laboratorial de pacientes climatericas (fase pos-menopausica) submetidas ao LIR-1660. / Clinical and laboratorial study of climacteric patients (post-menopausal phase) submitted to LIR 1660

Trinta pacientes na pos-menopausa fisiologica foram tratadas com LIR-1660 na dosagem de 100 mg/dia durante 20 dias. Atraves do indice menopausal de Kupperman, da dosagem de FSH, LH prolactina, estradiol e da colpocitologia hormonal observaram-se as modificacoes apos o tratamento. Pode-se concluir ser a droga eficaz no controle dos sintomas neurovegetativos, mas nao determina alteracoes nas concentracoes sanguineas dos hormonios estudados e na colpocitologia hormonal. Em nenhum caso foi observado efeitos colaterais e galactorreia

Nova medicacao nao estrogenica no tratamento da sindrome climaterica. / A new non-hormonal steroid drug in the treatment of climacteric syndrome

Os autores avaliaram, em 20 pacientes menopausadas, uma nova medicacao a base de ciclofenil e diazepam. O criterio de diagnostico da sindrome climaterica e do controle de eficacia foi feito atraves do indice de Kuppermann no pre e pos-tratamento. Devido aos excelentes resultados obtidos os autores concluem que a nova medicacao representa uma opcao eficaz para o adequado controle da sintomatologia climaterica

Ensaio clinico de um novo creme vaginal na terapeutica das colpites. / Clinical trial of a new vaginal cream in colpitis therapy

Os autores avaliaram a eficacia e a tolerabilidade de um novo creme vaginal em 32 pacientes portadoras de vaginitis por monilia e/ou tricomonas e/ou bacterias. A avaliacao da eficacia e da tolerancia foi feita baseada nos dados obtidos por ocasiao dos exames ginecologicos e complementares (bacterioscopia a fresco e apos coloracao pelo Gram), realizados 15 dias apos o final do tratamento. A eficacia foi considerada excelente e boa em 90,91% dos casos avaliados. Nao houve referencias a nenhum efeito colateral. Os autores concluem pela otima eficacia e excelente tolerabilidade deste novo creme vaginal, destacando-se pelo largo espectro de atividade em relacao aos diversos tipos de colpites