ABSTRACT
INTRODUCTION: The purpose of this study was to evaluate the utility of performing a selective intraoperative sentinel lymph node biopsy (SLNB) in breast cancer patients. PATIENTS AND METHODS: Patients in this prospective study were women with breast cancer seen at our hospital in 2014. These patients were divided into 2 groups on the basis of the clinical criteria age, tumor size, and molecular subtype: (1) Group A: women with clinical criteria indicative of the need to perform an intraoperative analysis of the sentinel lymph node (SLN); and (2) Group B: women in whom postoperative analysis of the SLN was performed. The final anatomopathologic findings obtained for the SLNs were analyzed and the sensitivity, specificity, positive predictive value, and negative predictive value of the clinical criteria used to decide between intraoperative or postoperative analysis of the SLN were estimated. RESULTS: A total of 170 patients were included: 106 in group A and 64 in group B. The number of positive SLNs was 29 (22 in group A and 7 in group B; P = .09). The sensitivity of our clinical criteria for establishing the indication to perform an axillary SLNB was 75.86% (95% confidence interval [CI], 56.05%-88.98%), the specificity was 40.43% (95% CI, 32.35%-49.03%), the positive predictive value was 20.75% (95% CI, 13.73%-29.95%), and the negative predictive value was 89.06% (95% CI, 78.16%-95.12%). CONCLUSIONS: The clinical findings used to decide whether or not to perform an SLNB exhibit low sensitivity and specificity and must therefore not be used to decide the need for an intraoperative SLNB.
Subject(s)
Breast Neoplasms/pathology , Clinical Decision-Making/methods , Intraoperative Care/methods , Postoperative Care/methods , Sentinel Lymph Node Biopsy/methods , Age Factors , Axilla , Breast Neoplasms/surgery , Female , Humans , Lymphatic Metastasis , Mastectomy , Middle Aged , Neoplasm Staging , Practice Guidelines as Topic , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Sentinel Lymph Node/pathologyABSTRACT
Objetivo. Analizar las discordancias entre la estadificación pre- y posquirúrgica en los cánceres de endometrio operados en nuestro servicio. Material y método. Estudio retrospectivo de los cánceres de endometrio operados por vía laparoscópica entre el 1 de enero de 2005 y el 31 de agosto de 2014. Se han calculado la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo de la resonancia nuclear magnética y la biopsia de endometrio realizadas antes de la intervención quirúrgica, así como el porcentaje de mujeres que podrían haber sido infra- y sobretratadas en el caso de no haber realizado biopsia intraoperatoria de la pieza de histerectomía. Resultados. Hemos operado 174 cánceres de endometrio. La sensibilidad de la resonancia nuclear magnética para el diagnóstico de tumores en estadio I fue del 95,09%, la especificidad de 63,33%, el valor predictivo positivo de 93,37% y el valor predictivo negativo de 70,37%. Para la biopsia preoperatoria la sensibilidad para detectar tumores de grado 1 fue del 90,91%, la especificidad del 65,38%, el valor predictivo positivo de 74,77% y el valor predictivo negativo de 86,44. De no haber realizado biopsia intraoperatoria 21 mujeres (12,65%) de las 166 en estadio I hubiesen sido infratratadas y un 3,61% hubiesen sido sobretratadas. Conclusión. En los estadios iniciales del cáncer de endometrio la biopsia intraoperatoria de la pieza quirúrgica resulta imprescindible para evitar sobre e infratratamientos (AU)
Objectives. To analyse differences between preoperative and postoperative staging in a series of patients with endometrial cancer who underwent surgery in our department. Material and methods. We conducted a retrospective study of malignant endometrial tumours treated by laparoscopic surgery between January 1st 2005 and August 31st 2014. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of magnetic resonance imaging and biopsy performed before the intervention. We estimated the percentage of women at risk of over- and under-treatment if intraoperative biopsy had not been performed. Results. We included 174 malignant endometrial tumours. The sensitivity, specificity, positive predictive value and negative predictive value of magnetic resonance imaging was 95.09, 63.33, 93.37 and 70.37%, respectively. For preoperative biopsy, the results were sensitivity (90.91%), specificity (65.38%), positive predictive value (74.77%) and negative predictive value. (86.44%). If intraoperative biopsy had not been performed, 12 of 166 (12.65%) women in stage 1 would have been undertreated and 3.61% would have been overtreated. Conclusion. Intraoperative biopsy should be mandatory in the early the stages of endometrial cancer to avoid under- and over-treatment (AU)
