Prevalencia de micrometástasis y células aisladas en el ganglio centinela en estadios iniciales del cáncer de mama / Prevalence of micrometastases and isolated tumor cells in the sentinel node at early stage breast cancer

Objetivo. Estudiar la prevalencia de células tumorales aisladas (CTA) y micrometástasis en el ganglio centinela del cáncer de mama en estadios iniciales. Material y métodos. Estudiamos 234 enfermas con cáncer de mama estadios T1 o T2, sin afectación axilar clínica ni con ecografía-PAAF. El ganglio centinela fue identificado mediante linfogammagrafía y extraído en el quirófano. Posteriormente se estudió mediante cortes seriados y tinciones inmunohistoquímicas, y catalogados como negativo (GC−), negativo con CTA (GC−CTA), positivo por micrometástasis (Mic) y positivo con macrometástasis (GC+mac). Se realizó linfadenectomía axilar completa cuando se hallaron micro o macrometástasis en el ganglio centinela, siendo catalogada en el primer caso como negativa (LAC−), positiva con micrometástasis (LAC+mic) y positivo con macrometástasis (LAC+mac) el resto. El período de seguimiento fue de entre 6 y 71 meses. Resultados. Se detectaron CTA en el ganglio centinela en 12 enfermas (5,1%), y micrometástasis en otras 24 (10,3%). Por tanto, un total de 36 pacientes se vieron afectadas por alguna de estas dos entidades (15,4%). Por su parte la LAC en el grupo con micrometástasis fue LAC− en 19/24 (79,1%), positivo LAC+mic en 2 (8,3%) y LAC+mac en 3 (12,5%). No existen recaídas axilares hasta la fecha. Conclusiones. La infiltración del ganglio centinela por CTA o micrometástasis en estadios iniciales del cáncer de mama afecta a un porcentaje significativo de enfermas. La escasa frecuencia de LAC+ en los GC+ mic invita a plantear la posibilidad de evitar la LAC en favor de otros tratamientos adyuvantes (quimioterapia, radioterapia)(AU)

Aim. To analyze the prevalence of isolated tumor cells (ITC) and micrometastases in the sentinel node of early stage breast cancer. Material and methods. A total of 234 patients diagnosed of breast cancer, stages T1 or T2, with no axillary involvement detected by palpation or ultrasound-FNA, were studied. The sentinel node (SN) was identified by lymphoscintigraphy and removed in the operating room. Serial sections and immunohistochemical staining were then performed, classifying them as negative (SN−), negative with ITC (SN-ITC), positive with micrometastases (SN+mic) and positive with macrometastases (SN+mac). A complete axillary lymphadenectomy (CAL) was carried out in those cases with micro- or macrometastases, the former being classified as negative (CAL−), positive with micrometatases (CAL+mic), and positive with macrometastases (CAL+mac). The follow-up ranged from 6-71 months. Results. ITC were found in 12 patients (5.1%) and micrometastases in 24 (10.3%). Thus, a total of 36 patients were affected by some of these conditions (15.4%). In the group with micrometastases, the result of CAL was CAL− in 19/24 (79.1%), CAL+mic in 2 (8.3%) and CAL+mac in 3 (12.5%). No axillary recurrences have occurred up to date. Conclusions. ITC and micrometastases were found in the sentinel node in a significant percentage of patients in the early stages of breast cancer. The low percentage of further axillary invasion in the group of micrometastases may open up the possibility of avoiding CAL in favor of other adjuvant treatments (chemotherapy, radiotherapy)(AU)

[Prevalence of micrometastases and isolated tumor cells in the sentinel node at early stage breast cancer]. / Prevalencia de micrometástasis y células aisladas en el ganglio centinela en estadios iniciales del cáncer de mama.

AIM: To analyze the prevalence of isolated tumor cells (ITC) and micrometastases in the sentinel node of early stage breast cancer. MATERIAL AND METHODS: A total of 234 patients diagnosed of breast cancer, stages T1 or T2, with no axillary involvement detected by palpation or ultrasound-FNA, were studied. The sentinel node (SN) was identified by lymphoscintigraphy and removed in the operating room. Serial sections and immunohistochemical staining were then performed, classifying them as negative (SN-), negative with ITC (SN-ITC), positive with micrometastases (SN+mic) and positive with macrometastases (SN+mac). A complete axillary lymphadenectomy (CAL) was carried out in those cases with micro- or macrometastases, the former being classified as negative (CAL-), positive with micrometatases (CAL+mic), and positive with macrometastases (CAL+mac). The follow-up ranged from 6-71 months. RESULTS: ITC were found in 12 patients (5.1%) and micrometastases in 24 (10.3%). Thus, a total of 36 patients were affected by some of these conditions (15.4%). In the group with micrometastases, the result of CAL was CAL- in 19/24 (79.1%), CAL+mic in 2 (8.3%) and CAL+mac in 3 (12.5%). No axillary recurrences have occurred up to date. CONCLUSIONS: ITC and micrometastases were found in the sentinel node in a significant percentage of patients in the early stages of breast cancer. The low percentage of further axillary invasion in the group of micrometastases may open up the possibility of avoiding CAL in favor of other adjuvant treatments (chemotherapy, radiotherapy).

Micrometástasis en el ganglio centinela y macrometástasis ganglionares axilares en el cáncer de mama / Micrometastasis in the sentinel node and axillary lymph node macrometastasis in breast cancer

ObjetivoEl estudio del ganglio centinela ha permitido tener un conocimiento más preciso del grado de afectación axilar en el cáncer de mama, disminuyendo a su vez la morbilidad quirúrgica asociada a la exploración de la axila. El uso sistemático de técnicas inmunohistoquímicas y de biología molecular permite detectar la presencia de micrometástasis o de células aisladas en un porcentaje relevante de casos, como único signo de extensión linfática de la enfermedad. Actualmente, se plantea la posibilidad de evitar la linfadenectomía axilar completa en aquellas enfermas que solo presentan micrometástasis, dada la baja incidencia de afectación en el resto de los ganglios axilares.Material y métodoSe incluyeron 159 enfermas con cáncer de mama en estadio T1 o T2, en las que se identificó mediante gammagrafía y se localizó intraoperatoriamente el ganglio centinela, practicándoseles una linfadenectomía axilar completa en el caso de observarse afectación por micro o macrometástasis, con el fin de determinar el grado de extensión axilar.ResultadosUn total de 40 enfermas (25%) mostraron afectación del ganglio centinela, siendo en 17 de ellas (10,7%) invasión sólo por micrometástasis. De entre estas 17 enfermas, solo 2 (11,8%) mostraron invasión por macrometástasis en la linfadenectomía, no modificándose en el resto la estadificación alcanzada tras el estudio del ganglio centinela.ConclusiónCabe conjeturar que en el futuro pueda evitarse la disección axilar en las enfermas con afectación por micrometástasis, a la espera de los resultados que arrojen los estudios multicéntricos actualmente en marcha(AU)

AimThe study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes.Material and method159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement.ResultsA total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macrometastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified.ConclusionIt is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies(AU)

[Micrometastasis in the sentinel node and axillary lymph node macro-metastasis in breast cancer]. / Micrometástasis en el ganglio centinela y macrometástasis ganglionares axilares en el cáncer de mama.

AIM: The study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes. MATERIAL AND METHOD: 159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement. RESULTS: A total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macro-metastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified. CONCLUSION: It is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies.

Gasless laparoscopic cholecystectomy is not more time-consuming.

BACKGROUND: Although abdominal wall retraction is said to be advantageous in laparoscopic cholecystectomy (LC), many surgeons have found that, when this option is chosen, more time is needed to prepare for and carry out the surgical procedure. Our aim was to determine the time required for surgical preparation and operation in patients undergoing LC with carbon dioxide (CO2) pneumoperitoneum (CO2 PP) vs abdominal wall retraction (AWR). METHODS: We performed a prospective randomized study of a CO2 PP LC group (n = 19) vs an AWR LC group (n = 15). Demographic data were collected preoperatively. LC was performed with either CO2 PP (12 mmHg) or AWR (6-10 kps). Two phases were considered: (a) time employed to create the surgical field (phase 1) and (b) operating time (phase 2). The chi-square test was used to compare the medians of the two groups. RESULTS: The two groups were homogeneous. Phase 1 required 35 min in the CO2 PP group vs 25 min in the AWR group (p = 0.24). Phase 2 required 60 min in both groups (p = 0.76). CONCLUSION: We found no statistically significant difference between the PP CO2 and AWR groups in either time spent to create the surgical field or actual operating time.