ABSTRACT
Introducción: Las lesiones inflamatorias mamarias precisan con frecuencia de estudio histopatológico por su capacidad de imitar a los tumores mamarios malignos. El objetivo es proponer una secuencia diagnóstica de las inflamaciones mamarias benignas crónicas. Material y método: Se han revisado en la literatura los métodos y algoritmos diagnósticos de las mastitis crónicas. Resultados: Se propone un algoritmo diagnóstico para los procesos inflamatorios crónicos mamarios. Requiere determinar el patrón histopatológico inflamatorio y su localización, así como un estudio microbiológico apropiado. Posteriormente puede precisar de nuevas pruebas bioquímicas y serológicas orientadas por una correlación clinicopatológica para establecer un diagnóstico específico. Discusión: No se han identificado en la literatura otros algoritmos diagnósticos avalados por estudios de alto nivel de evidencia. Los patrones histopatológicos no son uniformes. Conclusiones: El diagnóstico etiológico precisa identificar patrones histopatológicos inflamatorios benignos y su localización, un estudio microbiológico y pruebas orientadas por correlación clinicopatológica. Se precisan estudios de investigación con niveles de evidencia altos
Introduction: Inflammatory breast lesions require histopathological study due to their ability to clinically and radiologically mimic malignant mammary tumours. The objective is to propose a diagnostic technique for benign chronic inflammatory processes of the breast. Material and methods: We reviewed the literature on the diagnostic methods used in chronic mastitis. Results: We propose a diagnostic algorithm for chronic inflammatory processes of the breast. The aetiological diagnosis requires identifying benign inflammatory histopathologic patterns and locations, and microbiological study. New biochemical and serological tests oriented by clinicopathological correlation may then be required to establish a specific diagnosis. Discussion: No diagnostic algorithms based on studies with a high level of evidence have been identified. No uniformity in histopathologic patterns has been described. Conclusions: The etiologic diagnosis requires identifying benign inflammatory histopathologic patterns and locations, microbiological study and tests oriented by clinicopathological correlation. There is a lack of studies with a high level of evidence
Subject(s)
Humans , Female , Mastitis/etiology , Algorithms , Granuloma/diagnosis , Erythema Nodosum/etiology , Neoplasms, Glandular and Epithelial/physiopathology , Mastitis/pathology , Mastitis/diagnosis , Necrosis/classification , Necrosis/diagnosis , Infections/complicationsABSTRACT
INTRODUCTION: In breast IMRT simultaneous integrated boost (SIB) treatment and accelerated partial breast irradiation (APBI), proper delineation of the tumor bed is necessary. Conservative oncoplastic surgery causes changes in peritumoral breast tissue that complicates locating the site of the tumor. Nevertheless, there are still centers that do not use surgical clips to delineate the site. This study aims to show how the lack of clips affects the techniques of SIB and APBI in terms of dose distribution and safety margins in the tumor bed. MATERIALS AND METHODS: On 30 patients, the defining of the tumor bed obtained from the pre-surgery CT scan to that outlined on the basis of clips on the post-surgery CT was compared. Tumor bed deviation from the original tumor site was quantified. In addition, the margins to the original tumor site necessary to guarantee the coverage of the tumor bed were calculated. RESULTS: Variations were detected in the distances between geometric centers of the PTV (minimum 0.5-maximum 3 cm). The maximum margin necessary to include the entire tumor bed was 4.5 cm. Lesions located in the upper outer quadrant required the widest margins. If margins are not added, the tumor bed volume defined with clips will be underdosed. CONCLUSIONS: The definition of the tumor bed based on studies before surgery does not have the necessary accuracy. Clips need to be placed in the surgical bed to identify the changes occurring after the restorative mammoplasty. Without clips, SIB and APBI are not safe (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Breast/pathology , Breast/radiation effects , Breast/surgery , Mastectomy, Segmental/methods , Radiotherapy Planning, Computer-Assisted , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Prospective Studies , RadiotherapyABSTRACT
INTRODUCTION: The indication and extent of axillary lymph node dissection in breast cancer remains open to controversy. MATERIALS AND METHOD: In this context, a 20-year survival study has been made of 1600 breast cancer patients subjected during surgical treatment to systematic dissection of the acromiothoracic vascular pedicle together with the accompanying lymph nodes (Rotter and Grossman interpectoral lymph node groups). An anatomical study of these nodes was also conducted in 100 necropsies, with the evaluation of 200 acromiothoracic vascular pedicles. RESULTS: The interpectoral lymph nodes were anatomically present in 42% of the necropsies and in 35.1% of the patients subjected to surgery. The prognosis was much worse in cases of neoplastic infiltration of the interpectoral lymph nodes (Kaplan-Meier survival study), regardless of the influence of other prognostic factors. CONCLUSIONS: In view of the results obtained, the designation of grade N3 of the TNM classification is proposed for malignancies with positive interpectoral lymph node infiltration.
Subject(s)
Breast Neoplasms/mortality , Lymphatic Metastasis , Adolescent , Adult , Aged , Aged, 80 and over , Autopsy/methods , Beclomethasone , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Child , Child, Preschool , Dissection/methods , Female , Genetic Variation , Humans , Infant , Life Tables , Lymph Node Excision , Lymph Nodes/anatomy & histology , Middle Aged , Neoplasm Staging , Organ Specificity , Prognosis , Retrospective Studies , Survival Analysis , Thorax/anatomy & histologyABSTRACT
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Introduction. The indication and extent of axillarylymph node dissection in breast cancer remainsopen to controversy.Materials and method. In this context, a 20-yearsurvival study has been made of 1600 breast cancerpatients subjected during surgical treatment to systematicdissection of the acromiothoracic vascularpedicle together with the accompanying lymphnodes (Rotter and Grossman interpectoral lymphnode groups). An anatomical study of these nodeswas also conducted in 100 necropsies, with the evaluationof 200 acromiothoracic vascular pedicles.Results. The interpectoral lymph nodes were anatomicallypresent in 42% of the necropsies and in35.1% of the patients subjected to surgery. The prognosiswas much worse in cases of neoplastic infiltrationof the interpectoral lymph nodes (Kaplan-Meier survival study), regardless of the influence ofother prognostic factors.Conclusions. In view of the results obtained, thedesignation of grade N3 of the TNM classification isproposed for malignancies with positive interpectorallymph node infiltration
Subject(s)
Female , Humans , Lymph Nodes/pathology , Breast Neoplasms/pathology , Lymphatic Metastasis/pathology , Autopsy , Lymph Node Excision , Pectoralis Muscles/pathology , Neoplasm StagingABSTRACT
The authors study the 5 and 10 years survival of 1.058 cases of breast carcinoma treated between 1963 and 1981, classified according to the pTNM system. They suggest the convenience of eliminating some of the combinations in order to obtain a good correlation with prognostic criteria. The authors propose a modification of the TNM system with closer clinical significance.
