ABSTRACT
Las metástasis ganglionares axilares contralaterales son un fenómeno poco frecuente en el cáncer de mama. Aunque se considera un estadio iv de la enfermedad, hay hipótesis que postulan que la diseminación de las células tumorales hasta los ganglios axilares contralaterales podría producirse mediante vía linfática y no por vía hematógena. Presentamos el caso de una paciente de 35 años, diagnosticada de carcinoma ductal infiltrante de mama en estadio iii y tratada con quimioterapia neoadyuvante, mastectomía radical modificada, radioterapia y hormonoterapia. Siete meses después del tratamiento quirúrgico la enfermedad progresó con metástasis axilares contralaterales, sin evidencia de otra afectación a distancia. Se trata de una evolución inusual del cáncer de mama, y por tanto su manejo no está estandarizado. Hemos realizado una revisión de la literatura para buscar la mejor opción terapéutica en pacientes que presentan esta situación clínica (AU)
Contralateral axillary lymph node metastases are a rare presentation in breast cancer. Although they are considered stage IV of the disease, it has been postulated that the spread of tumour cells to the contralateral axillary lymph nodes could occur through the lymph vessels and not through the bloodstream. We report the case of a 35-year-old woman who was diagnosed with a stage III invasive breast carcinoma and was treated with neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy and hormone therapy. Seven months after the surgery, the disease progressed, showing contralateral axillary lymph node metastases with no evidence of any other distant disease. This is an unusual progression of breast cancer and thus its management is not standardized. We reviewed the literature to search for evidence on how to treat this very special clinical situation (AU)
Subject(s)
Humans , Female , Adult , Breast Neoplasms/complications , Prognosis , Lymphatic Metastasis/pathology , Lymphatic Metastasis , Neoplasm Metastasis/pathology , Mammography/instrumentation , Mammography/methods , Mastectomy, Modified Radical/methods , Neoadjuvant Therapy/methods , Neoadjuvant Therapy , Axilla/pathology , Axilla , Mastectomy, Modified Radical , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/pathology , Mammography , Lymph Node Excision/methods , Follow-Up StudiesABSTRACT
The use of hormone replacement therapy (HRT) is currently a subject of debate because of the possibility of an increase in the incidence of breast cancer and difficulties associated with breast cancer detection. The objective of this study was to determine the influence of HRT on specificity and sensitivity in a breast cancer screening program. We found that although specificity was significantly lower in menopausal women who had ever used or were currently using HRT (93.3%) compared to HRT nonusers (94.8%) at the expense of a greater number of recalls (6.9% versus 5.6%), this difference seems to be clinically irrelevant. There were no significant differences with regard to the number of invasive procedures (2.5% in the HRT versus 2.1% in the control group). We conclude that the slight decrease in sensitivity of screening mammography in HRT users is not clinically significant in our setting, and in any case, false positives (recalled women) are diagnosed correctly with additional imaging studies without the need for invasive procedures. Most women given HRT are candidates to participate in population breast cancer screening campaigns.
