[Immunohistochemical characterisation of breast cancer: towards a new clasification?]. / Características inmunohistoquímicas del cáncer de mama: hacia una nueva clasificación?

BACKGROUND: The aim of this paper is to determine the possible association between five different profiles of immunohistochemical expression related to clinical, histopathological and immunohistochemical known prognostic value variables for breast cancer. MATERIAL AND METHOD: A total of 194 breast carcinoma tumour samples were studied. In this study five groups or immunohistochemical profiles were defined, based on expression of hormone receptors (oestrogen or progesterone) and/or Her2/neu (luminal-type A, luminal-type B, mixed profile, Her2/neu profile and triple-negative-type profile) and we studied whether there are differences between them with regard to clinical, histopathological and immunohistochemical variables that have a known prognostic significance. RESULTS: In the series we found 134 (69%) cases corresponding to a luminal immunophenotype, of which 98 (50.5%) were from the luminal A group and 36 (18.6%) from luminal B. Twenty-nine cases (15.9%) were triple-negative, 18 (9.3%) mixed and 13 (6.7%) Her2/neu type. It is worth noting the relationship between the triple-negative and Her2/neu immunophenotypes and the more poorly differentiated histological forms (62% and 60%, respectively) and between the luminal A group and well-differentiated tumours (p = 0.008). Expression of ki67 was high in the triple-negative group (73.9%) and low in the luminal A group (26.3%; p = 0.001). The expression of p53 was also greater for the Her2/neu (55.5%) and triple-negative (60.8%) groups (p = 0.0005) than for the others. CONCLUSIONS: The subgroups without hormone receptor expression, with Her2/neu overexpression or without (triple-negative group), have characteristics associated with variables of a poorer prognosis. The lack of progesterone receptor expression also seems to be associated with these.

Características inmunohistoquímicas del cáncer de mama: ¿hacia una nueva clasificación? / Immunohistochemical characterisation of breast cancer: towards a new classification?

Introducción. El objetivo de este trabajo es determinarla posible asociación de cinco perfiles diferentes de expresión inmunohistoquímica con variables clínicas, histopatológicas e inmunohistoquímicas de conocido valor pronóstico en el cáncer de mama. Material y método. Se estudiaron 194 muestras de carcinoma ductal infiltrante de mama. Se definieron 5perfiles inmunohistoquímicos basados en la expresión de receptores hormonales (estrogénicos o de progesterona)y/o Her2neu (luminal A, luminal B, mixto,Her2neu y triple negativo) y se estudió si había diferencias entre ellos en relación con variables clínicas, histopatológicas e inmunohistoquímicas de conocido valor pronóstico. Resultados. En la serie se encontraron 134 (69%) casos correspondientes a un inmunofenotipo luminal, de los que 98 (50,5%) fueron del grupo luminal A y 36(18,6%) del luminal B; 29 (15,9%) casos fueron triples negativos, en 18 (9,3%) se daba un tipo mixto y en 13(6,7%), del tipo Her2neu. Destaca la relación entre los inmunofenotipos triple negativos y Her2neu con formas histológicas peor diferenciadas (el 62 y el 60%,respectivamente) y del grupo luminal A con tumores bien diferenciados (p = 0,008). La expresión de ki67fue mayor en el grupo triple negativo (73,9%) y baja en el luminal A (26,3%) (p = 0,001). La expresión de p53también fue mayor para los grupos Her2neu (55,5%) y triple negativo (60,8%) (p = 0,0005) respecto a los otros. Conclusiones. Los subgrupos sin expresión de receptores hormonales, con sobreexpresión de Her2neuo sin ella (triple negativo) presentan características asociadas con variables de peor pronóstico. La pérdida de expresión de receptores a progesterona también parece asociarse con ellas (AU)

Background. The aim of this paper is to determine the possible association between five different profiles of immunohistochemical expression related to clinical, histopathological and immunohistochemical known prognostic value variables for breast cancer. Material and method. A total of 194 breast carcinomatumour samples were studied. In this study five groups or immunohistochemical profiles were defined, based on expression of hormone receptors (oestrogenor progesterone) and/or Her2/neu (luminaltypeA, luminal-type B, mixed profile, Her2/neu profile and triple-negative-type profile) and we studied whether there are differences between them with regard to (..) (AU)

[Technical features of interest in lymphatic basin localization in breast cancer sentinel lymph node biopsy]. / Aspectos técnicos de interés en la localización de drenajes linfáticos en la biopsia del ganglio centinela del cáncer de mama.

OBJECTIVES: The sentinel node is defined as the node with the highest probability of being involved in the case of lymphatic spread from a tumor. Accurate identification and biopsy of this node can avoid unnecessary lymphadenectomies. The aim of this study was to determine if there are differences in the number of isolated sentinel lymph nodes in breast cancer according to whether a mixed technique (vital dye plus isotopic tracer) or radiotracer alone is used and if there are differences in the detection of more than one lymphatic basin and in the number of lymphatic nodes depending on the site of tracer injection. PATIENTS AND METHOD: A total of 173 sentinel lymph node biopsies in 173 women with breast cancer were studied taking into account the technique (mixed [n = 109] or radiotracer alone [n = 64]) and the location of tracer injection (periareolar [n = 81], intra and/or peritumoral [n = 92]). The number of lymphatic basins and the number of sentinel nodes were compared among the distinct groups resulting from the combination of the 2 parameters. RESULTS: Simultaneous drainage to both the axilla and internal mammary chain was more frequent with the intra-periareolar technique. The number of identified nodes was significantly higher when mixed techniques were compared, and was higher with periareolar injection than with the intra-peritumoral route. CONCLUSIONS: In breast cancer sentinel lymph node biopsy, the number of identified nodes is not influenced by the use of a mixed technique or radiotracer alone. However, the number of identified nodes is higher with the periareolar route than with the intra-peritumoral route. Intra-peritumoral injection of the tracer shows a higher frequency of internal mammary chain drainage than periareolar injection, although this difference was not statistically significant.

Aspectos técnicos de interés en la localización de drenajes linfáticos en la biopsia del ganglio centinela del cáncer de mama / Technical features of interest in lymphatic basin localization in breast cancer sentinel lymph node biopsy

Objetivos. El ganglio centinela es el que tiene más probabilidad de afectarse en caso de extensión linfática de un tumor. Su identificación y biopsia correctas pueden evitar linfadenectomías innecesarias. El objetivo de este trabajo es estudiar si hay diferencias en el número de ganglios centinelas aislados en el cáncer de mama dependiendo de que se utilice la técnica mixta (colorante más trazador isotópico) o únicamente isótopo como trazador, y si las hay en la aparición de más de un drenaje linfático y en el número de ganglios centinela, dependiendo de la localización de la inyección del trazador. Pacientes y método. Se han estudiado de forma prospectiva 173 biopsias selectivas del ganglio centinela en 173 mujeres con carcinoma de mama, considerando la técnica usada (mixta, 109; isótopo, 64) y la localización de la inyección del trazador (periareolar [n = 81], intratumoral y/o peritumoral [n = 92]). Se comparó el número de drenajes y el número de ganglios centinela entre los distintos grupos resultantes de combinar los dos parámetros. Resultados. El drenaje simultáneo a axila y a cadena mamaria interna fue más frecuente en los casos de inyección intratumoral y peritumoral. Con relación al número de ganglios identificados, encontramos que fue significativamente mayor al comparar las técnicas mixtas entre sí, y fue mayor el número de ganglios con la técnica de inyección periareolar que con la intratumoral y peritumoral. Conclusiones. En la biopsia selectiva del ganglio centinela para el cáncer de mama, el número de ganglios centinelas identificados no depende de usar una técnica mixta o sólo isótopo como trazador; sin embargo, es mayor cuando se usa la vía periareolar que la intratumoral y peritumoral. La inyección intratumoral y peritumoral muestra una mayor frecuencia de drenajes hacia la cadena mamaria interna que la periareolar, aunque esta diferencia no es estadísticamente significativa (AU)

Objectives. The sentinel node is defined as the node with the highest probability of being involved in the case of lymphatic spread from a tumor. Accurate identification and biopsy of this node can avoid unnecessary lymphadenectomies. The aim of this study was to determine if there are differences in the number of isolated sentinel lymph nodes in breast cancer according to whether a mixed technique (vital dye plus isotopic tracer) or radiotracer alone is used and if there are differences in the detection of more than one lymphatic basin and in the number of lymphatic nodes depending on the site of tracer injection. Patients and method. A total of 173 sentinel lymph node biopsies in 173 women with breast cancer were studied taking into account the technique (mixed [n = 109] or radiotracer alone [n = 64]) and the location of tracer injection (periareolar [n = 81], intra and/or peritumoral [n = 92]). The number of lymphatic basins and the number of sentinel nodes were compared among the distinct groups resulting from the combination of the 2 parameters. Results. Simultaneous drainage to both the axilla and internal mammary chain was more frequent with the intra-periareolar technique. The number of identified nodes was significantly higher when mixed techniques were compared, and was higher with periareolar injection than with the intra-peritumoral route. Conclusions. In breast cancer sentinel lymph node biopsy, the number of identified nodes is not influenced by the use of a mixed technique or radiotracer alone. However, the number of identified nodes is higher with the periareolar route than with the intra-peritumoral route. Intra-peritumoral injection of the tracer shows a higher frequency of internal mammary chain drainage than periareolar injection, although this difference was not statistically significant (AU)

Tumor filodes de mama maligno, unilateral y multicéntrico / Unilateral and multicentric malignant phylloides tumor of the breast

El tumor filodes es un tumor mamario infrecuente, de estirpe fibroepitelial, que tiene generalmente un comportamiento biológico benigno. En el presente trabajo presentamos un caso clínico de tumor filodes maligno multicéntrico y unilateral (AU)