ABSTRACT
Introduction Given the high rate of complete nodal response, the role of axillary lymph node dissection on staging the axilla has been questioned. This survey, addressed to breast cancer surgeons in Spain, has the objective of assessing current clinical trends on axillary staging of cN + patients treated with NAC. Methods An online survey was conducted among breast surgeons from the Spanish Society of Surgery (AEC), Spanish Surgical Oncology Society (SEOQ), Spanish Breast Cancer Surgeons Society (AECIMA) and Spanish Gynecology and Obstetrics Society (SEGO). It was structured in 5 sections: general information and clinical practice, knowledge of clinical trials, diagnosis work-up and nodal marking, axillary staging, and axillary treatment. Results 150 breast cancer surgeons completed the full survey (96.7%). 81.8% of respondents performed SLNB or targeted axillary dissection in cN1 patients treated with NAC. Radiological axillary response was the preferred parameter guiding the surgical strategy. The excision of the clipped node (92.0%), use of dual tracer (73.2%), and axillary US (65.9%) after treatment were the most important variables considered by respondents, to increase the accuracy of SLNB in cN + patients. Conclusion This survey confirms a trend toward a less invasive approach for axillary staging in cN + patients treated with NAC among breast cancer surgeons in Spain. While there is widespread agreement in less invasive approaches to axillary staging, there is, however, a lack of consensus around treatment strategy. Further, it shows a wide heterogeneity in their clinical practice. This study highlights the need for clear evidence concerning less invasive staging procedures and their oncological safety, to ensure consistent recommendations in surgical practice (AU)
Subject(s)
Humans , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Practice Patterns, Physicians' , Lymph Node Excision , Neoadjuvant Therapy , Sentinel Lymph Node , Neoplasm Staging , Spain , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Given the high rate of complete nodal response, the role of axillary lymph node dissection on staging the axilla has been questioned. This survey, addressed to breast cancer surgeons in Spain, has the objective of assessing current clinical trends on axillary staging of cN + patients treated with NAC. METHODS: An online survey was conducted among breast surgeons from the Spanish Society of Surgery (AEC), Spanish Surgical Oncology Society (SEOQ), Spanish Breast Cancer Surgeons Society (AECIMA) and Spanish Gynecology and Obstetrics Society (SEGO). It was structured in 5 sections: general information and clinical practice, knowledge of clinical trials, diagnosis work-up and nodal marking, axillary staging, and axillary treatment. RESULTS: 150 breast cancer surgeons completed the full survey (96.7%). 81.8% of respondents performed SLNB or targeted axillary dissection in cN1 patients treated with NAC. Radiological axillary response was the preferred parameter guiding the surgical strategy. The excision of the clipped node (92.0%), use of dual tracer (73.2%), and axillary US (65.9%) after treatment were the most important variables considered by respondents, to increase the accuracy of SLNB in cN + patients. CONCLUSION: This survey confirms a trend toward a less invasive approach for axillary staging in cN + patients treated with NAC among breast cancer surgeons in Spain. While there is widespread agreement in less invasive approaches to axillary staging, there is, however, a lack of consensus around treatment strategy. Further, it shows a wide heterogeneity in their clinical practice. This study highlights the need for clear evidence concerning less invasive staging procedures and their oncological safety, to ensure consistent recommendations in surgical practice.
Subject(s)
Breast Neoplasms , Surgeons , Humans , Female , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Sentinel Lymph Node Biopsy/methods , Neoadjuvant Therapy/methods , Spain , Axilla , Neoplasm Staging , Lymph Node Excision/methods , Surveys and Questionnaires , Lymph Nodes/surgery , Lymph Nodes/pathologyABSTRACT
PURPOSE: To determine whether the metabolic features of breast tumours differ among molecular subtypes. METHODS: This prospective study included 168 women diagnosed with locally advanced breast cancer. PET/CT was requested in the initial staging before neoadjuvant treatment (multicentre study, FISCAM grant). All patients underwent an ¹8F-FDG PET/CT scan with a dual time-point acquisition. Both examinations (PET-1 and PET-2) were evaluated qualitatively and semiquantitatively with calculation of SUVmax (SUV-1 and SUV-2, respectively), and the percentage variation in the SUVs and retention indexes (RI) between PET-1 and PET-2 in the breast tumour were calculated. Biological prognostic parameters, including the steroid receptor status, HER-2 expression, proliferation rate (Ki-67) and grading, were determined from primary tumour tissue. Tumour subtypes were classified following the recommendations of the 12th International Breast Conference, by immunohistochemical surrogates as luminal A, luminal B-HER2(-), luminal B-HER2(+), HER2(+) or basal. Metabolic semiquantitative parameters and molecular subtypes were correlated. RESULTS: Of the 168 tumours, 151 were classified: 16 were luminal A, 53 were luminal B-HER2(-), 29 were luminal B-HER2(+), 18 were HER2(+) and 35 were basal. There were significant differences between SUV-1 and SUV-2 and the different subtypes, with higher SUVs in HER2(+) and basal tumours. No significant differences were found with respect to RI. CONCLUSION: Semiquantitative metabolic parameters showed statistically significant differences among the molecular subtypes of the tumours evaluated. Therefore, there seems to be a relationship between molecular and glycolytic phenotypes.
Subject(s)
Breast Neoplasms/diagnosis , Carcinoma/diagnosis , Ki-67 Antigen/metabolism , Multimodal Imaging , Positron-Emission Tomography , Receptor, ErbB-2/metabolism , Tomography, X-Ray Computed , Adult , Aged , Breast Neoplasms/classification , Breast Neoplasms/metabolism , Carcinoma/classification , Carcinoma/metabolism , Female , Fluorodeoxyglucose F18 , Humans , Ki-67 Antigen/genetics , Mammography , Middle Aged , Neoplasm Staging , Radiopharmaceuticals , Receptor, ErbB-2/genetics , Ultrasonography, MammaryABSTRACT
PURPOSE: The aim of this study was to analyse the correlation between dual-time-point (18)F-2-deoxy-2-fluoro-D-glucose (FDG) uptakes in lymph nodes assessed by positron emission tomography (PET)/CT and histopathological and immunohistochemical prognostic factors. METHODS: Seventy-five women with locally advanced breast cancer were prospectively evaluated. PET/CT was requested in the initial staging previous to adjuvant chemotherapy (multicentre study). All of the patients underwent (18)F-FDG PET/CT with a dual-time-point acquisition. Both examinations were evaluated qualitatively and semi-quantitatively with calculation of maximum standardized uptake values (SUV(max)) in PET-1 (SUV-1) and in PET-2 (SUV-2) and the percentage variation of the SUV or retention index (RI) between PET-1 and PET-2 in lymph nodes with the greater (18)F-FDG uptake. The biological prognostic parameters such as the steroid receptor status, p53 and HER2 expression, proliferation rate (Ki-67) and grading were determined from tissue of the primary tumour. Metabolic and biological parameters were correlated using Spearman's rank-order correlation coefficient and Mann-Whitney U and Kruskal-Wallis tests. RESULTS: Negative receptor status was correlated with higher SUV-1, SUV-2 and RI in lymph nodes. The results were significant for progesterone receptor status. p53 over-expression and triple-negative status were associated with greater semi-quantitative parameters in lymph nodes. Higher tumoural grades were related with greater semi-quantitative parameters (p > 0.05). CONCLUSION: Biological factors of bad prognosis were correlated with higher semi-quantitative metabolic values in lymph nodes. Therefore these results appear to reveal biological significance of lymph node (18)F-FDG accumulation.
Subject(s)
Breast Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Lymph Nodes/diagnostic imaging , Multimodal Imaging , Positron-Emission Tomography , Tomography, X-Ray Computed , Adult , Aged , Breast Neoplasms/chemistry , Breast Neoplasms/therapy , Cell Proliferation , Chemotherapy, Adjuvant , Female , Humans , Middle Aged , Neoplasm Staging , Prognosis , Receptor, ErbB-2/analysis , Receptors, Steroid/analysis , Statistics, Nonparametric , Tumor Suppressor Protein p53/analysisABSTRACT
Electrochemotherapy (ECT) is a therapeutical procedure based on the induction of cell membrane electroporation, by cell exposure to electric fields lasting a few microseconds, combined with the local or systemic administration of cytotoxic drugs, with an intracellular target and high intrinsic efficacy, but poor cell membrane permeability. ECT is an effective local therapy for any histological tumour that has been used clinically since 2005 and is currently in use in 83 centres all over Europe. In the literature, ECT as a local oncological treatment shows an objective response between 70 and 90% in mucocutaneous primary and metastatic lesions, is cost effective and has few local and systemic side effects. In this manuscript, we present an overview of the European experience in ECT, as well as our own experience in a specialised Spanish oncological centre and in a basic oncological unit in Nicaragua. The purpose is to reflect on the role that this procedure could have in the treatment of skin and mucosal cancer as part of a multidisciplinary approach.
Subject(s)
Combined Modality Therapy/classification , Combined Modality Therapy/trends , Electrochemotherapy/methods , Melanoma/drug therapy , Skin Neoplasms/drug therapy , Soft Tissue Neoplasms/drug therapy , Clinical Trials as Topic/methods , Clinical Trials as Topic/trends , Combined Modality Therapy/methods , Electrochemotherapy/classification , Humans , Treatment OutcomeABSTRACT
Merkel cell carcinoma (MCC) is an infrequent neuroendocrine tumor of the skin with a high potential for local recurrence, lymphatic dissemination and distant dissemination. We present a case of MCC in a male patient with chronic lymphocytic leukemia (CLL). The immunosuppression induced by the leukemia or by the chemotherapy could play a pathogenic role in the association of these diseases. Positron emission tomography (PET) was a useful staging technique in this patient, and made the differential diagnosis of the lymph node involvement from MMC and CLL possible.
Subject(s)
Carcinoma, Merkel Cell/pathology , Leukemia, Lymphocytic, Chronic, B-Cell , Neoplasms, Second Primary/pathology , Skin Neoplasms/pathology , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Merkel Cell/diagnostic imaging , Carcinoma, Merkel Cell/radiotherapy , Carcinoma, Merkel Cell/secondary , Carcinoma, Merkel Cell/surgery , Cyclophosphamide/adverse effects , Cyclophosphamide/therapeutic use , Diagnosis, Differential , Humans , Immunocompromised Host , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Leukemia, Lymphocytic, Chronic, B-Cell/immunology , Lymph Node Excision , Lymphatic Metastasis/radiotherapy , Male , Middle Aged , Neoplasms, Second Primary/diagnostic imaging , Neoplasms, Second Primary/radiotherapy , Neoplasms, Second Primary/surgery , Positron-Emission Tomography , Prednisone/adverse effects , Prednisone/therapeutic use , Radiotherapy, Adjuvant , Skin Neoplasms/diagnostic imaging , Skin Neoplasms/surgery , Vincristine/adverse effects , Vincristine/therapeutic useABSTRACT
El carcinoma de células de Merkel (CCM) es un tumor neuroendocrino cutáneo infrecuente con un elevado potencial de recurrencias locales, diseminación linfática y diseminación a distancia. Presentamos un caso de CCM en un paciente con leucemia linfática crónica (LLC). La inmunosupresión inducida por la leucemia o por la quimioterapia podría desempeñar un papel patogénico en la asociación de estas enfermedades. La tomografía por emisión de positrones (PET) es una técnica de estadiaje útil en este paciente, y permite el diagnóstico diferencial de la afectación ganglionar por CCM y LLC
Merkel cell carcinoma (MCC) is an infrequent neuroendocrine tumor of the skin with a high potential for local recurrence, lymphatic dissemination and distant dissemination. We present a case of MCC in a male patient with chronic lymphocytic leukemia (CLL). The immunosuppression induced by the leukemia or by the chemotherapy could play a pathogenic role in the association of these diseases. Positron emission tomography (PET) was a useful staging technique in this patient, and made the differential diagnosis of the lymph node involvement from MMC and CLL possible
