Breast-Conserving Surgery Guided with Magnetic Seeds vs. Wires: A Single-Institution Experience.

PURPOSE: The aim of this study is to describe our initial experience using magnetic seeds (Magseed®) to guide breast-conserving surgery in non-palpable breast lesions and compare the use of magnetic seed with wires to guide breast-conserving surgery in terms of clinical and pathological characteristics. METHODS: We performed a retrospective study including all breast-conserving surgeries for non-palpable breast lesions under 16 mm from June 2018 to May 2021. We compared breast-conserving surgeries guided with magnetic seeds (Magseed®) to those guided with wires, analyzing tumor and patient characteristics, surgical time, and pathological results of the surgical specimens. RESULTS: Data from 225 cases were collected, including 149 cases guided by magnetic seeds and 76 cases guided by wires. The breast lesion was localized in every case. Both cohorts were similar regarding clinical and pathological characteristics. We found significant statistical differences (p < 0.02) in terms of the median volume (cm3) of the excised specimen, which was lower (29.3%) in the magnetic seed group compared with the wire group (32.5 [20.5-60.0]/46.0 [20.3-118.7]). We did not find significant differences regarding surgical time (min) or the affected or close margins. CONCLUSION: In our experience, the use of magnetic seed (Magseed®) is a feasible option to guide breast-conserving surgery of non-palpable lesions and enabled us to resect less breast tissue.

The Clinical Impact of Neoadjuvant Endocrine Treatment on Luminal-like Breast Cancers and Its Prognostic Significance: Results from a Single-Institution Prospective Cohort Study.

Purpose: Neoadjuvant endocrine treatment (NET) has become a useful tool for the downstaging of luminal-like breast cancers in postmenopausal patients. It enables us to increase breast- conserving surgery (BCS) rates, provides an opportunity for us to assess in vivo NET effectiveness, and allows us to study any biological changes that may act as valid biomarkers. The purpose of this study was to evaluate the safety and effectiveness of NET, and to assess the role of Ki67 proliferation rate changes as an indicator of endocrine responsiveness. Methods: From 2016 to 2020, a single-institution cohort of patients, treated with NET and further surgery, was evaluated. In patients with Ki67 ≥ 10%, a second core biopsy was performed after four weeks. Information regarding histopathological and clinical changes was gathered. Results: A total of 115 estrogen receptor-positive (ER+)/HER2-negative patients were included. The median treatment duration was 5.0 months (IQR: 2.0−6.0). The median maximum size in the surgical sample was 40% smaller than the pretreatment size measured by ultrasound (p < 0.0001). The median pretreatment Ki67 expression was 20.0% (IQR: 12.0−30.0), and was reduced to 5.0% (IQR: 1.8−10.0) after four weeks, and to 2.0% (IQR: 1.0−8.0) in the surgical sample (p < 0.0001). BCS was performed on 98 patients (85.2%). No pathological complete responses were recorded. A larger Ki67 fold change after four weeks was significantly related to a PEPI score of zero (p < 0.002). No differences were observed between luminal A- and B-like tumors, with regard to fold change and PEPI score. Conclusions: In our cohort, NET was proven to be effective for tumor size and Ki67 downstaging. This resulted in a higher rate of conservative surgery, aided in therapeutic decision making, provided prognostic information, and constituted a safe and well-tolerated approach.

Misdiagnosis of an extragastrointestinal stromal tumor in the rectovaginal septum.

INTRODUCTION: Gastrointestinal stromal tumors are very rare, representing 0.1% to 1% of gastrointestinal malignancies. Gastrointestinal stromal tumors outside the digestive tract comprise a very small fraction of all gastrointestinal stromal tumors, and their most common locations are the omentum, the mesentery, and, in few cases, the rectovaginal septum. Despite their low incidence, extragastrointestinal stromal tumors are potentially malignant tumors and they present a high rate of recurrences. This, added to the fact that they are often asymptomatic until advanced stages, determines an unfavorable prognosis. CASE REPORT: We report a case of gastrointestinal stromal tumor located in the rectovaginal septum, which recurred after local excision; hence, a reintervention was needed. CONCLUSIONS: A correct differential diagnosis between extragastrointestinal stromal tumors and other similar pathologies such as leiomyomas or schwannomas is imperative based on their histology and immunohistochemistry. The correct diagnosis of extragastrointestinal stromal tumors allows to start adequate treatment and follow-up, preventing recurrence that determines their poor prognosis.

Sarcoma de partes blandas: experiencia HOPM / Soft tissue sarcoma: experience HOPM

Se presenta un análisis retrospectivo de 89 casos de pacientes con el diagnóstico de Sarcoma de partes blandas, evaluados y tratados en el Hospital Oncológico Padre Machado entre enero de 1976 y mayo de 1988. Las variedades histológicas más frecuente fueron el rabdomiosarcoma (19,1 por ciento) y el fibrohistiositoma (15,7 por ciento). La ubicación más frecuente fue en miembros inferiores (62 por ciento). Más del 60 por ciento tenían criterios de mal pronóstico a su presentación. Para resultados de tratamiento, se analizaron 77 pacientes, 63 de los cuales tenían enfermedad localizada a su presentación. Se practicaron 20 amputaciones y 53 procedimientos quirurgicos preservadores. Se le administró Radioterapia postoperatoria a 37 pacientes. Recibieron quimioterapia 49 pacientes. La sobrevida a los 5 años en todos los estadios es el 62 por ciento. En los casos de sarcoma localizados, la sobrevida a los 5 años fue 72 por ciento; la SLE a los 5 años fue del 63 por ciento En los pacientes que tuvieron cirugia preservadora más radioterapia, con o sin quimioterapia, se observó una sobrevida a los 5 años del 70 por ciento. El control local en los pacientes tratados con cirugía preservadora más radioterapia, fue del 89,3 por ciento, 75 por ciento y 70,5 por ciento a los 2, 4 y 5 años respectivamente. En los pacientes amputados, el control local fue del 100 por ciento a los 5 años. El presente estudio muestra la importancia del tratamiento multidisciplinario de los SPB y la mayor tendencia a practicar cirugía preservadora y radioterapia adyuvante, obteniendo cifras de sobrevida y de control local, comparables a las informadas por otros centros