Metástasis cerebral de cáncer epitelial de ovario: estudio de un caso / Cerebral metastasis of ovarian epithelial cancer: case study

Caso: mujer de 50 años de edad, diagnosticada y tratada de un carcinoma epitelial de ovario en 1996. Se realizó cirugía citorreductora óptima y quimioterapia adyuvante. Nueve años más tarde, desarrolló una lesión metastásica cerebral tratada con cirugía y radioterapia holocraneal. Cuatro años después del tratamiento sigue sin evidencia de enfermedad. Conclusión: estas pacientes tienen un pronóstico pobre, con estudios que reportan una supervivencia media de 12 meses. Sin embargo, nuestra paciente se mantiene libre de la enfermedad, por lo que en pacientes con metástasis única, la cirugia y la radioterapia son la mejor opción de tratamiento (AU)

Case: 50-year-old woman diagnosed and treated for primary ovarian cancer in 1996. She underwent optimal cytoreductive surgery and adjuvant chemotherapy. Nine years later, she developed brain metastatic lesion, and was treated with both surgery and whole-brain radiotherapy. She is currently 4 years post-treatment of her brain metastases without evidence of disease-free. Conclusion: These patients have a poor prognosis, with studies reporting a mean survival of 12 months. However, the patient in this report remains disease-free since her treatment for metastatic disease. Aggressive surgical and radiation treatment for patients with isolated central nervous system metastases can be a reasonable option in selected patients (AU)

Breast-conservative surgery followed by radiofrequency ablation of margins decreases the need for a second surgical procedure for close or positive margins.

BACKGROUND: Excision of breast cancer followed by radiofrequency ablation (eRFA) is a technique designed to increase negative margins in breast-conservative surgical procedures. The objective of this study is to analyze the impact of eRFA in avoiding a second surgical procedure for close or positive margins after a breast-conservative surgical procedure. MATERIAL AND METHODS: From February 2008 to May 2010, 20 patients were included. After lumpectomy, the eRFA was performed in the lumpectomy cavity, and biopsies from each margin from the radial ablated cavity walls were obtained. Biopsy samples were assessed for tumor viability. RESULTS: eRFA was successful in 19 of 20 patients. In all patients, the devitalized tissue extended beyond a 5- to 10-mm radial depth of the biopsy sample. Overall, 6 patients (31%) had margins < 2 mm, 4 of them with < 1 mm margin. All 6 of these patients had no tumor viability according to analysis of biopsy samples stained with 2,3,5-triphenyltetrazolium chloride. At a median follow-up of 46 months, no local recurrence had been found. CONCLUSION: This study supports the feasibility of eRFA treatment. In our study, the eRFA method has spared 31% of patients from undergoing a re-excision surgical procedure, and it may, in the long-term, reduce local recurrences.

Detection of sentinel lymph node in breast cancer recurrence may change adjuvant treatment decision in patients with breast cancer recurrence and previous axillary surgery.

Use of sentinel lymph node dissection in patients with ipsilateral breast cancer recurrence is still controversial. The objective of this study is to evaluate the feasibility of the sentinel lymph node in breast cancer recurrence (SLNBR) and whether the positivity had impact in the adjuvant treatment. Between 2008 and 2012 we performed SLNBR in patients with ipsilateral breast tumor recurrence. We included 53 patients in a prospective study. Forty-three patients (81%) had a previous axillary lymph node dissection (ALND) and ten (19%) had a previous sentinel lymph node biopsy (SLNB). Identification rate after SLNB was 50% and after ALND was 60.5% (p = 0.4). Nine patients (26%) had a positive SLNBR. Adjuvant systemic treatment was given to all the patients with a positive SLNBR and to 23 (85%) with a negative SLNBR (p = 0.29). Six patients (66%) with positive SLNBR and 4 patients (14%) with negative SLNBR underwent radiation therapy (p < 0.01). As conclusions of our study we conclude that sentinel lymph node biopsy in breast tumor recurrence is feasible and significant differences were found in the use of radiation therapy in patients with a positive SLNBR.

Situación de las unidades de patología cervical en España. Resultados de una encuesta nacional / Cervical pathology units in Spain today. Results of a national survey

Objetivos. Conocer el grado de implementación de las Unidades de Patología Cervical (UPC) en los hospitales españoles. Describir su organización asistencial y volumen de trabajo, así como sus necesidades formativas, de protocolización y control de calidad, como base para la elaboración de un proyecto conjunto de la Sociedad Española de Ginecología y Obstetricia (SEGO) y la Asociación Española de Patología Cervical y Colposcopia (AEPCC) de Acreditación de UPC. Material y métodos. Análisis descriptivo de los resultados de una encuesta dirigida a los Servicios de Ginecología de los hospitales españoles, entre noviembre del 2012 y enero del 2013. De las 220 encuestas enviadas, se obtuvo respuesta en 128 (58%), representando a todas las comunidades autónomas españolas. Resultados. El 70% de los hospitales encuestados disponen de UPC. La media de ginecólogos que trabajan a tiempo completo en la UPC es de 3 y a tiempo parcial, de 20. El promedio de actividad anual reportada fue de 178 nuevos diagnósticos, 79 casos de neoplasia intraepitelial de cérvix 2 positivas y 87 cirugías de conización cervical. El 60% de los hospitales disponen de registros de complicaciones y de correlaciones citológicas, colposcópicas e histológicas. Un 90% sigue las recomendaciones de AEPCC y SEGO para la prevención primaria y secundaria del cáncer de cérvix. Más del 90% de los médicos consultados considerarían adecuado que la AEPCC y la SEGO promoviesen la acreditación de las UPC. Conclusiones. La situación global de las UPC en España es buena pero mejorable en algunos aspectos. La mayoría de los centros ven adecuada la existencia de una acreditación para las UPC (AU)

Objectives. To determine the extent to which Cervical Pathology Units (CPU) are implemented in Spanish hospitals and to describe their organization and workload and requirements for training, standardization, and quality assurance, as a basis for a joint project of the Spanish Society of Obstetrics and Gynecology (SEGO) and the Spanish Association of Cervical Pathology and Colposcopy (AEPCC) for CPU accreditation. Material and methods. We performed a descriptive analysis of the results of a survey of Gynecology Services at Spanish hospitals between November 2012 and January 2013. A total of 220 surveys were sent and replies were received from 128 services (58%) representing all the Spanish regions. Results. A total of 70% of the hospitals in the survey had a CPU. There was an average of 3 full-time gynecologists and 20 part-time gynecologists at each CPU. The mean annual reported activity was 178 new cases, 79 cervical intraepithelial lesions 2 positive, and 87 conizations. Sixty percent of the hospitals had a register of complications and cytological, colposcopic and histological correlations. Ninety percent followed the recommendations of the AEPCC and the SEGO for primary and secondary prevention of cervical cancer. More than 90% of the gynecologists believed it would be appropriate for the AEPCC and the SEGO to promote CPU accreditation. Conclusions. The overall situation of CPU in Spain is good but could be improved. Most hospitals in the survey believe that implementing the accreditation process would not be difficult (AU)

Variation among Spanish teaching hospitals in ductal carcinoma in situ treatment: results of a national survey.

OBJECTIVE: To investigate current management of ductal carcinoma in situ (DCIS) of the breast in Spanish teaching hospitals and to evaluate prognostic factors for recurrence. STUDY DESIGN: To allow follow-up of 5 years or more, cases diagnosed and treated during 2004 were considered, in order to evaluate the recurrence and death rates due to the disease. Data were reported corresponding to 473 cases, which represents 9.8% of all diagnosed breast carcinomas in the 23 participating centers. Only 425 could be ultimately evaluated, corresponding to approximately 27% of all incident in situ breast carcinoma cases in Spain during 2004. RESULTS: About two-thirds of patients were surgically treated by lumpectomy, and one-third by mastectomy. A strikingly high number of patients had their axillary lymph nodes studied, by means of either sentinel node biopsy (21.9%) or lymphadenectomy (19.3%). Five-year global survival was 99.5%, and disease-free survival 96.9%. The only factor significantly associated with tumor recurrence was tumor microinvasion (p=0.05). In a second, restricted model stratified by microinvasion, the only factor emerging as significantly associated with a better outcome was having received hormonal therapy (p=0.03), but only in the group of pure in situ carcinomas, without microinvasion. CONCLUSIONS: Prospective randomized trials are mandatory to achieve an agreement about the best treatment for DCIS. As long as the current discrepancy exists, we should probably err on the conservative side, and not subject our patients to unnecessary therapeutic aggressiveness.

Surgery improves breast cancer-specific survival in octogenarians with early-stage breast cancer.

INTRODUCTION: No consensus exists on optimum therapy for older cancer patients. This singlecentre study was conducted to review the treatment and outcomes for octogenarian women treated for breast cancer. METHODS: Data of all elderly breast cancer patients (≥80 years) with primary breast cancer treated at out institution between 1990 and 2009. Patients with carcinoma in-situ (stage 0) and advanced breast cancer (stage IV) were excluded. Breast cancer-specific survival and disease-free survival for the different patient groups were analysed according to the Kaplan-Meier method. RESULTS: The study population consisted of 259 patients (median age 84 years). There were 189 (73%) patients with early stage disease (I, IIA, IIB) and 70 (27%) with locally advanced disease (IIIA, IIIB, IIIC). A total of 175 (67.7%) patients underwent surgical treatment and 84 (32.4%) received primary endocrine treatment. Patients were followed for a median of 65 months. In patients with early stages, the mean breast cancer-specific survival was 108 months (95% CI 101-115) in the surgical group and 50 months (95% CI 39-61) in the non-surgical group (P < 0.01), whereas patients with locally advanced breast cancer breast cancer-specific survival was similar for the surgical and non-surgical groups. Breast cancer-specific survival and disease-free survival were significantly better among patients who underwent standard surgical treatment than among those with suboptimal surgery. CONCLUSION: In women ≥80 years with early-stage breast cancer, standard surgical treatment as compared with non-surgical therapy was associated with a better breast cancer-specific.

Molecular diagnosis of endometrial cancer from uterine aspirates.

Rapid and reliable diagnosis of endometrial cancer (EC) in uterine aspirates is highly desirable. Current sensitivity and failure rate of histological diagnosis limit the success of this method and subsequent hysteroscopy is often necessary. Using quantitative reverse transcriptase-polymerase chain reaction on RNA from uterine aspirates samples, we measured the expression level of 20 previously identified genes involved in EC pathology, created five algorithms based on combinations of five genes and evaluated their ability to diagnose EC. The algorithms were tested in a prospective, double-blind, multicenter study. We enlisted 514 patients who presented with abnormal uterine bleeding. EC was diagnosed in 60 of the 514 patients (12%). Molecular analysis was performed on the remnants of aspirates and results were compared to the final histological diagnoses obtained through biopsies acquired by aspiration or guided by hysteroscopy, or from the specimens resected by hysterectomy. Algorithm 5 was the best performing molecular diagnostic classifier in the case-control and validation study. The molecular test had a sensitivity of 81%, specificity of 96%, positive predictive value (PPV) of 75% and negative predictive value (NPV) of 97%. A combination of the molecular and histological diagnosis had a sensitivity of 91%, specificity of 97%, PPV of 79% and NPV of 99% and the cases that could be diagnosed on uterine aspirate rose from 76 to 93% when combined with the molecular test. Incorporation of the molecular diagnosis increases the reliability of a negative diagnosis, reduces the need for hysteroscopies and helps to identify additional cases.

Nerve sparing technique in robotic-assisted radical hysterectomy: results.

BACKGROUND: This work assessed the role of robotic-assisted lapararoscopic radical hysterectomy in the treatment of early invasive cervical cancer with special regard to nerve sparing technique. METHODS: Between October 2009 and June 2011, a total of 14 non-consecutive patients underwent early cervical cancer surgery at the authors' institution. Patients with FIGO stage IA2 or IB1 with a tumor size less than or equal to 2 cm underwent radical hysterectomy type B1 and patients with FIGO stage IB1 with a tumor mass bigger than 2 cm underwent a radical hysterectomy using a C1 type technique. RESULTS: Three type B1 and 11 type C1 radical hysterectomies with robotic-assisted laparoscopy were performed using Da Vinci®. The median operation time was 260 min (range 150-300 min). The median follow-up after surgery was 13.7 months (range 1-23 months). During this time, three patients reported anorectal dysfunction while none reported sexual or bladder dysfunction. All patients remain without evidence of disease except one with high risk factors for recurrence. They all are alive. CONCLUSIONS: Laparoscopic robotic-assisted radical hysterectomy with nerve sparing technique is an attractive surgical approach for early invasive cervical cancer. Robotic technology allows a stereoscopic visualization of blood vessels and autonomic nerve supplies (sympathetic and parasympathetic branches) to the bladder and rectum making nerve sparing a safe and feasible procedure.

Situación actual: docencia en patología del tracto genital inferior y colposcopia en España / Current scenario: teaching of lower genital tract pathology and colposcopy in Spain

Objetivo. Evaluar el impacto que una intervención educativa en patología de tracto genital inferior (TGI) emprendida por la Asociación Española de Patología Cervical y Colposcopia (AEPCC) y la Sociedad Española de Ginecología y Obstetricia (SEGO) ha tenido en la asistencia de los hospitales docentes españoles y en los conocimientos y habilidades de los residentes españoles de la especialidad. Sujetos y métodos. Estudio observacional descriptivo transversal, basado en una encuesta de 15 preguntas contestadas voluntariamente por residentes españoles de ginecología y obstetricia. Resultados. Comparado con una encuesta previa de 2006, se detecta un sustancial incremento en la proporción de hospitales docentes españoles que disponen de unidad de TGI (40% vs 80%). Se dobla el porcentaje de residentes que declara tener conocimientos medio/altos sobre esta patología; persiste baja la capacidad de manejo de la patología vulvar. Conclusiones. Se confirma la utilidad del plan de actuación sobre la formación continuada en TGI emprendido por la AEPCC y la SEGO(AU)

To evaluate the impact of an educational intervention in lower genital tract pathology (LGTP) on the knowledge and skills acquired by Spanish resident physicians. The intervention was carried out by the Spanish Association of Colposcopy and Cervical Pathology and the Spanish Society of Obstetrics and Gynecology. Subjects and methods. We performed an observational, descriptive and cross-sectional study, based on a 15-item questionnaire voluntarily completed by Spanish Obstetrics and Gynecology trainees. Results. Compared with a previous survey in 2006, the proportion of Spanish teaching hospitals with a LGTP unit substantially increased (40% vs 80%), while the percentage of residents who reported fair to good knowledge of this field doubled. However, knowledge of the management of some vulvar diseases remains poor. Conclusiones. Se confirma la utilidad del plan de actuación sobre la formación continuada en TGI emprendido por la AEPCC y la SEGO. Conclusions. This study confirms the usefulness of the continuing education in LGTP carried out by Spanish Scientific Societies(AU)

Current situation: lower genital tract pathology and colposcopy training in spanish gynecology and obstetrics residents.

OBJECTIVE: This study aimed to evaluate the impact of an educational intervention in lower genital tract pathology (LGTP) on the knowledge and skills acquired by the Spanish specialist residents. This didactic change was carried out under the auspices of the Asociación Española de Patología Cervical y Colposcopia and the Sociedad Española Ginecología y Obstetricia and its Resident Section. STUDY DESIGN: This is an observational, descriptive, and cross-sectional study. The survey was composed of 15 questions voluntarily answered by Spanish gynecology and obstetrics trainees. RESULTS: Compared with a previous survey, a substantial increase in the proportion of Spanish teaching hospitals with an LGTP unit (9/42 vs 47/59) has been detected while doubling the percentage of residents who acknowledge medium to high knowledge on this pathology. The same cannot be said about the handling capacity of vulvodynia registering a great improvement. CONCLUSIONS: Spanish scientific societies, concerned in the quality of LGTP training gained by their residents, have focused on the necessity of LGTP units. Our study confirms the usefulness of this performance in the new continued LGTP education.

Multidisciplinary approach to breast cancer diagnosed during pregnancy: maternal and neonatal outcomes.

AIM: We assessed maternal and neonatal outcome in women diagnosed with breast cancer during pregnancy. PATIENTS AND METHODS: Retrospective single-centre cohort study of 25 consecutive pregnant women (mean age 36 years) diagnosed and treated for breast cancer between 2000 and 2011. Management was individualized according to type of tumor and time of gestation at diagnosis. RESULTS: Twelve patients were diagnosed during the second trimester. BI-RADS category <3 mammographic lesions were diagnosed in 7 patients. A suspicious area was detected by ultrasound in 20 of 21 women who underwent ultrasound studies. Nineteen patients had positive hormone receptors and 7 sobreexpressed HER2. One patient was in stage 0, 8 in stage I, 8 in stage II, 3 in stage III and 5 in stage IV. Four patients decided voluntarily to legally terminate their pregnancies, one had a spontaneous miscarriage and in three patients, pregnancy was interrupted at the end of the third trimester before oncological treatment. Eleven patients were treated with chemotherapy during pregnancy after the second trimester using anthracycline-based regimens. In five patients the pregnancy was ended before 34 weeks of gestation. Nine patients had gestation-related complications, including preterm labor, pneumonia, increase in velocity of the middle cerebral artery, oligohydramnios, preeclampsia, extreme prematurity, intrauterine growth restriction, dyspnea, spontaneous miscarriage and chemotherapy-related granulocytopenia. Betamethasone to stimulate fetal lung maturation was used in 6 patients. CONCLUSION: Breast cancer women diagnosed during pregnancy presented a high number of complications unrelated to antineoplastic treatment. A multidisciplinary team approach is necessary for satisfactory neonatal results.

The EMT signaling pathways in endometrial carcinoma.

Endometrial cancer (EC) is the most common gynecologic malignancy of the female genital tract and the fourth most common neoplasia in women. In EC, myometrial invasion is considered one of the most important prognostic factors. For this process to occur, epithelial tumor cells need to undergo an epithelial to mesenchymal transition (EMT), either transiently or stably, and to differing degrees. This process has been extensively described in other types of cancer but has been poorly studied in EC. In this review, several features of EMT and the main molecular pathways responsible for triggering this process are investigated in relation to EC. The most common hallmarks of EMT have been found in EC, either at the level of E-cadherin loss or at the induction of its repressors, as well as other molecular alterations consistent with the mesenchymal phenotype-like L1CAM and BMI-1 up-regulation. Pathways including progesterone receptor, TGFß, ETV5 and microRNAs are deeply related to the EMT process in EC.

Encuesta sobre el uso en España de la prueba para la determinación del virus del papiloma humano / Survey on the use of tests for the detection of human papilloma virus in Spain

Objetivo. Conocer el conocimiento de las recomendaciones españolas para el cribado del cáncer de cuello uterino (CCU) y evaluar la utilización por los ginecólogos en España de las pruebas de detección del virus del papiloma humano (VPH). Sujetos y métodos. Encuesta dirigida a ginecólogos de la Sociedad Española de Ginecología y Obstetricia y la Asociación Española de Patología Cervical y Colposcopia. Se recogieron los datos aportados por 141 especialistas. Resultados. Participó el 30% de la población objeto de estudio. El 95,6% conocía las recomendaciones. El 93,5% utilizaba habitualmente la técnica de detección del VPH (el 77,7% como cribado de CCU). Los criterios de uso variaron considerablemente entre participantes. El principal motivo para no usar la técnica fue su falta de disponibilidad. Conclusiones. Es necesario reforzar la formación e información sobre las recomendaciones disponibles acerca de las nuevas estrategias de cribado y, en particular, del uso clínico de la determinación del VPH (AU)

Objective. To determine knowledge of the Spanish guidelines for cervical cancer screening, and to evaluate the use of tests for the detection of human papilloma virus (HPV) by Spanish gynecologists. Subjects and methods. The survey focused on gynecologists who were members of the Spanish Society of Gynecology and Obstetrics and the Spanish Association of Cervical Pathology and Colposcopy. One hundred forty-one specialists completed the questionnaire. Results. Thirty percent of the target population participated. A total of 95.6% were aware of the recommendations and 93.5% routinely used the test for the detection of the HPV (77.7% for cervical cancer screening). The criteria for the use of the test varied considerably among participants. The main reason for not using the technique was its unavailability. Conclusions. Training and information on the available recommendations for the new screening strategies and, particularly, on the clinical use of HPV determination should be reinforced (AU)

Conocimientos y adherencia a las nuevas recomendaciones de la SEGO para la prevención del cáncer de cuello de útero, por parte de los ginecólogos españoles en la práctica diaria / Knowledge and adherence to SEGO recommendations for the prevention of cervical cancer by Spanish gynecologists in daily practice

Objetivo. Valorar el grado de conocimiento y la aplicación en la práctica clínica de las nuevas recomendaciones auspiciadas por la Sociedad Española de Ginecología y Obstetricia (SEGO), para la prevención del cáncer de cuello de útero y la vacunación frente al virus del papiloma humano (VPH), por parte de los ginecólogos españoles. Métodos. Estudio transversal (desde noviembre de 2010 a marzo de 2011) en el que a través de una plataforma on line los participantes cumplimentaron una encuesta de conocimientos y de práctica clínica real sobre la epidemiología de la infección por el VPH, cribado del cáncer de cuello uterino y la vacuna frente al VPH, desarrollada previamente por el Comité Científico Nacional. Resultados. Un total de 454 ginecólogos participaron en el estudio. Se observó un buen conocimiento sobre la transmisibilidad del VPH, volumen de enfermedad relacionado con VPH, mortalidad por cáncer de cuello de útero, demostración de memoria inmune, seguridad y eficiencia de las vacunas frente a VPH y espectro de protección de la vacuna tetravalente. Los conocimientos sobre la tasa de mujeres sexualmente activas positivas al VPH a los 5 años, diferencia entre eficacia y eficiencia del cribado citológico e intervalos de control seguros en mujeres con doble test negativo (citología y VPH) fueron deficientes. Asimismo, la actitud proactiva de la vacunación frente al VPH en el segmento de edad prioritario (<27 años) fue pobre, con una tasa de encuestados del 63% recomendando la vacunación. Sorprendentemente, un 4% recomendaba la vacuna en mujeres mayores de 45 años. El 15% manifestaba no disponer de tiempo para explicar que el control trienal citológico es seguro y el 27% lo consideraba inseguro. El 35% declaró no tener disponible el test de VPH en su medio. En un 12% de los casos, la colposcopia se usaba como complemento de la citología en la revisión inicial. Conclusiones. Aunque los conocimientos de la epidemiología y vacunas frente al VPH eran adecuados, la actitud proactiva de vacunación en el grupo etario preferente fue pobre. Solo un 38% de los participantes demostró un seguimiento completo de las recomendaciones de la SEGO. Es indispensable diseñar e implementar estrategias a nivel nacional para difundir y mejorar la aplicación clínica de dichas recomendaciones (AU)

Objective. To assess the degree of knowledge of the new recommendations of the Spanish Society of Obstetrics and Gynecology (Sociedad Española de Ginecología y Obstetricia [SEGO]) for the prevention of cervical cancer and vaccination against human papilloma virus (HPV) among Spanish gynecologists and implementation of these recommendations in daily clinical practice. Methods. A cross-sectional survey (from November 2010 to March 2011) was carried out, in which participants used an online platform to complete a questionnaire previously developed by the National Scientific Committee on knowledge of the epidemiology of HPV infection, cervical cancer screening and HPV vaccines, and activities related to these issues in daily clinical practice. Results. A total of 454 gynecologists participated in the study. The gynecologists showed good knowledge of HPV transmission, HPV disease load, mortality due to cervical cancer, demonstration of immune memory, safety and efficiency of HPV vaccines, and the spectrum of protection by the tetravalent vaccine. Knowledge of the rate of sexually-active HPV-positive women at 5 years, differences between the efficacy and efficiency of cytological screening, and safe screening intervals in women with a double negative test (cytology and HPV) was deficient. Proactive attitudes to HPV vaccination in the priority age group (<27 years) was poor, with 63% of the surveyed physicians recommending vaccination. Surprisingly, 4% recommended vaccination in women older than 45 years. Fifteen percent reported they lacked time to explain that cytological testing every 3 years was safe, and 27% considered this practice unsafe. Thirty-five percent reported that the HPV test was unavailable in his/her environment. In 12% of cases, colposcopy was used to complement cytology at the initial visit. Conclusions. Although knowledge of HPV epidemiology and vaccines was adequate, proactive attitudes to HPV vaccination in the preferential age group were scarce. Complete adherence to SEGO recommendations was found in only 38% of participants. Nationwide strategies should be designed and introduced to spread and improve the implementation of these recommendations in daily clinical practice (AU)

Extensive nodal involvement increases the positivity of blue nodes in the axillary reverse mapping procedure in patients with breast cancer.

BACKGROUND: The axillary reverse mapping (ARM) technique has been proposed to prevent arm lymphedema. We conducted this study to assess the feasibility of the technique and the outcomes of patients with neoadjuvant chemotherapy (NAC). METHODS: From July 2009 to May 2010, a prospective study was performed in 36 patients with breast cancer undergoing an ALND. The ARM technique was performed injecting 3 cm(3) of Patent Blue in the ipsilateral arm. Of the 36 patients, 29 patients received NAC previously to the ARM and 7 patients had an ALND and ARM performed as first treatment for positive axillary nodes. RESULTS: The identification rate of blue nodes was 83.3% (30 patients). Sentinel lymph node (SLN) was performed in 15 of 29 (42%) patients in the NAC group. Of these 15, two patients (13%) had a concordance between the blue and the hot node. Blue nodes were positive in 4 (13%) of the 30 patients. CONCLUSIONS: The ARM technique is feasible in patients undergoing NAC. Patients with extensive nodal involvement have increased risk of having positive blue nodes. More studies are needed to assess the subgroup of patients with positive axilla that may have the blue node spared without compromising the oncological treatment.

Risk factors for progression or persistence of squamous intraepithelial lesions diagnosed during pregnancy.

OBJECTIVE: This study aimed to assess the risk of progression/persistence of squamous intraepithelial lesions (SILs) during pregnancy according to the age of the woman, the grade of the lesion, the type of human papillomavirus (HPV) infection, and the mode of delivery. MATERIALS AND METHODS: Eighty pregnant women with abnormal cytologic result at the first antenatal visit were evaluated. Postpartum cytologic and histologic findings were compared with the antepartum findings. RESULTS: There were 40 patients with low-grade SIL and 40 with high-grade SIL (HSIL). The overall regression rate was 32.5%. There were 19 patients 25 years or younger and 61 patients older than 25 years. The regression rate among younger patients was 52.6% versus 26.2% among those older than 25 years (relative risk [RR] = 2.01, 95% confidence interval [CI] = 1.10-3.66). The regression rate was 45% in the group of low-grade SIL and 20% in the group of HSIL (RR = 2.25, 95% CI = 1.11-4.57). In patients with HSIL, those older than 25 years had a 2-fold increased risk of progression/persistence than younger patients. High-risk HPV-positive samples were typed in 44 cases, 21 of which (47.7%) were positive for HPV-16. The regression rate was 9.5% for HPV-16-positive cases and 52.2% for HPV-16-negative cases (RR = 5.48, 95% CI = 1.39-21.68). The risk of progression or persistence of the lesion according to mode of delivery did not show significant differences (RR = 1.15, 95% CI = 0.82-1.63). CONCLUSIONS: Age of the patient older than 25 years, HSILs, and HPV type 16 infection are risk factors for the progression or persistence of intraepithelial lesions of the cervix in the postpartum period.

Generation and characterization of orthotopic murine models for endometrial cancer.

We describe the generation of two orthotopic murine models for endometrial cancer (EC).The first model is generated from endometrial Hec-1A cancer cells transfected with luciferase and injected directly into the uterus of female mice. This model allows a follow-up with bioluminescence imaging (BLI) along the experiment and generates abdominal dissemination and lymphatic and hematogenous metastases in high percentages, also detectables with BLI. The dissemination pattern of this model imitates the advanced stages of EC in patients, and its molecular profile corresponds to aggressive type 2 EC (p53 positive, hormone receptors negative, high percentage of Ki67 positive cells). The second model is derived from endometrioid human tissue collected from surgical pieces. By injecting this tissue inside the uterine cavity of a mouse we obtain orthotopic growth with pelvic dissemination and lymph node metastasis. The molecular pattern observed in human type 1 endometrioid EC (p53 negative, low Ki67 index, presence of hormone receptors) is conserved after the murine growth in orthotopic tumor and metastases. This model supposes a singular pre-clinical tool to study therapeutic agents, though it mimics clinical and molecular behavior of endometrioid EC, which is the most common histology in the patient.

Molecular bases of endometrial cancer: new roles for new actors in the diagnosis and the therapy of the disease.

Endometrial carcinoma (EC) is the most commonly diagnosed gynecologic malignancy in the western world. The majority of these cancers are curable, but a subset about 15-20% of endometrial tumors exhibits an aggressive phenotype. Based on clinic-pathological and molecular characteristics, EC has been classified into two groups: Type I estrogen-dependent adenocarcinomas, which have a good prognosis and an endometrioid histology, and Type II or non-estrogen-dependent EC associated with poor prognosis and non-endometrioid histology. EC develops as a result of a stepwise accumulation of alterations that seem to be specific of each histological type. However, more knowledge is needed to better understand the differences in the biology and the clinical outcome of EC. We would like to highlight the need to explore new potential biomarkers of EC as a tool for the detection and monitoring of aggressive endometrial tumors that, at the same time, will allow us to develop novel and more selective molecular targeted therapies against EC.

Pregnancy after treatment of breast cancer in young women does not adversely affect the prognosis.

We assessed whether pregnancy after breast cancer in patients younger than 36 years of age affects the prognosis. Of 115 women with breast cancer followed for a mean of 6 years, 18 became pregnant (median time between diagnosis and the first pregnancy 44.5 months). Voluntary interruption of pregnancy was decided by 8 (44.4%) women. Significant differences in prognostic factors between pregnant and non-pregnant women were not observed. Pregnant women showed a lower frequency of positive estrogen receptors (41%) than non-pregnant (64%) (P=0.06). At 5 years of follow-up, 100% of women in the pregnant group and 80% in the non-pregnant group were alive. The percentages of disease-free women were 94% and 64%, respectively (P=0.009). Breast cancer patients presented a high number of unwanted pregnancies. Pregnancy after breast cancer not only did not adversely affect prognosis of the neoplasm but also may have a protective effect.