Is using the Gail model to calculate the risk of breast cancer in the Venezuelan population justified?

Objective: To evaluate the accuracy of the Gail model (GM) in women who already have a diagnosis of breast cancer (BC) from the Breast Pathology Service, Hospital Oncology Department of the Venezuelan Social Security Institute (SOH-IVSS) in the period 2004-2014. To compare the accuracy of the GM in women aged above and below 40 years with a diagnosis of BC. Method: Descriptive, retrospective, cross-sectional, 830 records of patients diagnosed with BC were reviewed between 2004 and 2014. Results: The mean age for diagnosis of the disease was 46 ± 13 years; menarche age was 13 years ± 2; age at first birth 22 ± 5 years, with a history of biopsy 32 ± 11, the percentage of relatives with a primary history of BC reported (PHBC) 9.3%. Only 41% of women with a diagnosis of BC reported Gail >1.67 (positive Gail). In the dichotomous logistic regression that related positive Gail with the independent variables, it was observed: greater probability of positive Gail if menarche age <11 years (p < 0.036), PHBC (p = 0.005), previous biopsy (p = 0.007), age at first birth 25-29 years (p = 0.019). When stratifying by age, unlike the bivariate analysis, women over 40 years of age are more likely to have a positive Gail in menarche age <11 years (p = 0.008), PHBC (p = 0.001), previous biopsy (p = 0.025) when compared with younger women, the age at first birth between 25 and 29 years was statistically significant for both groups; however, the probability was higher in younger women (p = 0.008). Conclusion: There is no conclusive evidence to consider that the GM is applicable to Venezuelan women due to its low precision since it only identified 41% of the patients who had BC as high risk; however, when the factors are analysed separately, we found a higher probability of a positive Gail with statistical significance in EM <11 years, PHBC, previous biopsy and age at first birth 25-29 years; When stratifying by age, we observed that the age at first birth 25-29 years in women aged 40 or less increases the probability of a positive Gail. It is necessary to develop new risk assessment models that are adapted to our female population.

Do breast cancer patients have a gender preference when choosing a breast surgeon?

Introduction: There is a paucity of data on breast cancer (BC) patients' gender preferences when it comes to choosing their surgeon, unlike in other specialties like gynaecology and obstetrics, where women tend to prefer a female physician. The aim of this trial was to examine if there are any gender preferences in women with BC at the time of choosing their breast surgeon. Material and methods: A cross-sectional, observational and descriptive study with 528 patients, older than 18 years, at the Breast Department 'Servicio Oncológico Hospitalario del Instituto Venezolano de los Seguros Sociales', from January to June 2022. We applied an anonymous questionnaire to evaluate patients' gender preferences when it comes to choosing their breast surgeon. Results: The average age of the patients was 56 ± 11 years. 89.4% did not have gender preferences, whereas 6.5% and 4.1% chose to be treated by female surgeons and male surgeons, respectively. The most important characteristics chosen by the patients when they decided to choose their breast surgeon were experience (75%), knowledge (54%) and hospital-based (41%). Conclusion: Personal and professional skills are the most important factors when it comes to patients choosing their breast surgeon, gender does not have any impact on expertise or competence.

Experiencia en la utilización del perfil genético de 70 genes mammaprint / Experience in the utilization of 70 gen test mammaprint

Estudio prospectivo para evaluar la técnica, utilidad de la plataforma genética de 70 genes mammaprint, para de clasificar pacientes con cáncer de mama en alto y bajo riesgo para recaída a distancia a 10 años, comparar resultados con factores de riesgo pronósticos y predictivos tradicionales. El mammaprint fue evaluado en muestras de piezas quirúrgicas en fresco de 16 pacientes tratadas entre mayo-octubre 2011, con diagnóstico de cáncer de mama estadios I-II. La muestra en fresco es tomada por los patólogos, enviada y procesada en Holanda. Grupo etario más frecuente: 61-70 años. 98,34% de éxito en toma de muestras, las cuales fueron satisfactorias para practicar técnica genética. El 80% de los casos fueron cirugías conservadoras de mama, 40% pacientes con tumores menores de 2 cm y menos de 3 ganglios positivos (86,6%). Pacientes con bajo riesgo y ganglios negativos fue el 26,66%, alto riesgo tenían de 1 a 3 ganglios positivos en un 40%. El subtipo molecular más frecuente 73% fue el luminal, correspondiendo al 53,33% de los pacientes de bajo riesgo. La técnica del perfil genético de 70 genes es una herramienta que puede ser realizada en nuestros centros, permite conocer el riesgo de recaída, identificar el subtipo molecular y disponer de una segunda opinión a los resultados de inmunhistoquímica de receptores hormonales y erb 2 neu, e individualizar el tratamiento de los pacientes con cáncer de mama.

Prospective study to evaluate the technical usefulness of the platform 70-gene mammaprint gene, in order to classify the breast cancer patients with high and low risk for relapse at 10 years distance, compare the results with prognostic risk factors and traditional predictors. The mammaprint was tested in samples from fresh surgical specimens of 16 patients treated in the period May to October 2011, service SOH-IVSS breast disease, diagnosed with breast cancer stages I-II. Fresh sample is taken by pathologists, then sent and processed in the Netherlands. Age group most frequently between 61 and 70 years of age. We obtained a 98.34% success in taking the samples, which were satisfactory for practicing genetic engineering. 80% of cases were breast-conserving surgeries, 40% of patients with tumors less than 2 cm and less than 3 positive nodes, 86.6% of cases. Patients with low-risk node-negative was 26.66%, high risk had 1 to 3 positive nodes in 40%. The most common molecular subtype was luminal 73%, corresponding to 53,33% of patients at low risk. The technique of the genetic profile of 70 genes or Mammaprintis a tool that can be performed in our centers, to understand the risk of relapse, identify the molecular subtype and havea second opinion as to the results of immunohistochemistry for hormone receptors and erb 2 neu, and individualize the treatment of patients with breast cancer.

Cistosarcoma phyllodes bilateral: un raro caso / Bilateral cystosarcoma phyllodes: a rare case

El cistosarcoma phyllodes es un tumor mixto poco frecuente de la mama, que contiene elementos de tejido epitelial y conectivo. Los cistosarcomas phyllodes bilaterales son raros y solo existen 7 casos publicados en la literatura. A continuación se reporta el caso de una paciente de 48 años con cistosarcoma phyllodes bilateral.

The cystosarcoma phyllodes is a less frequent breast mixed tumor, that containing both: the epithelial and the connective tissue elements. The bilateral cystosarcoma phyllodes tumors are rare and only 7 cases are recorded in the literature. We report a case of a 48 years old female patient with bilateral cystosarcoma phyllodes.

Tumor neuroectodérmico primitivo renal: sarcoma de Ewing extraóseo: presentación de un caso / Primitive neuroectodermal renal tumor: Ewing sarcoma extra osseous: presentation of a case

El sarcoma de Ewing o también llamado tumor neuroectodérmico primitivo es una entidad muy rara, cuyo diagnóstico se realiza con la utilización de estudios de inmunohistoquímica, su comportamiento es muy agresivo con una supervivencia limitada. Se presenta el caso de un paciente masculino de 18 años de edad que consultó por presentar un tumor renal, se le realizó nefrectomía radical con diagnóstico definitivo de sarcoma de Ewing extra esquelético. Esta es una patología quirúrgica poco frecuente, lo que nos motivó a su presentación y a la revisión de la literatura.

The Ewing sarcoma is also denominated primitive neuroectodermic tumor and is considered how a rare entity, the diagnostic is realize with the utilization of immunohistochemestry study’s, his clinical curse is very aggressive with a limite superlife. We presented and study a clinical case of a sex male patient of 18 years old which consult us for present a renal tumor. He underwent a radical nefrectomy with a definitive diagnostic of extra osseous Ewing sarcoma. This is a less frequent surgical pathology, we motive us to present and review the literature.

Identificación de recidiva de cáncer colorrectal: con tomografía de emisión de positrones: a propósito de 2 casos / Identification colorectal cancer recidivate with emission positron tomography: study of two cases

La principal indicación actual del CT-PET en el cáncer colorrectal es el estadiaje, reestadiaje y la detección de recurrencias. El valor del FDG-PET en la detección de la recurrencia está bien establecido, con meta análisis recientes que demuestran su alta sensibilidad para del CT-PET en la evaluación del carcinoma colorrectal, aunque su utilización se discute por su alto costo. Estudio descriptivo de 2 casos clínicos del Servicio de Cirugía I Hospital Vargas de Caracas revisión de la literatura de pacientes con diagnóstico previo de cáncer colorrectal, con niveles elevados de marcadores tumorales y estudios imaginológicos y de extensión negativos, donde la realización de CT-PET permitió la constatación y localización de enfermedad. A diferencia de la tomografía computarizada y la resonancia magnética, que sólo muestra los detalles anatómicos, el CT-PET muestra los fenómenos químicos y fisiológicos celulares cuya utilidad en oncología se basa en la observación hecha hace 75 años de que las células malignas tienen más altas tasas de glicólisis anaeróbica, que el tejido sano. Entre las ventajas del CTPET resaltan su alta precisión para detectar las lesiones subclínicas, diferenciar fibrosis, inflamación y células neoplásicas y complementar el seguimiento de los pacientes con alto riesgo de recidiva o en el caso de estudios de extensión negativos y niveles séricos de marcadores tumorales elevados. A pesar de su elevado costo, el CT-PET es una herramienta versátil y de gran utilidad para la detección de recidivas de cáncer colorrectal.