ABSTRACT
INTRODUCTION: Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. METHODS: An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. RESULTS: SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. CONCLUSION: The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique.
Subject(s)
Breast Neoplasms/pathology , Breast Neoplasms/surgery , Lymph Node Excision , Sentinel Lymph Node Biopsy , Axilla , Female , Humans , Middle Aged , Retrospective StudiesABSTRACT
Clásicamente se han descrito los carcinomas papilares de tiroides (CPT) como tumores de comportamiento benigno; especialmente, aquellos con lesiones menores a 1 cm y cada vez mas, se encuentran pacientes con enfermedad agresiva que recaen local, regionalmente y/o a distancia. Recientemente se propuso incluir en la clasificación patológica el término microtumor papilar de tiroides (PMiT), que corresponde a una lesión menor a 1 cm, y que no tiene factores de riesgo histopatológicos, anteriormente denominado microcarcinoma papilar (MCPT). En el Instituto Nacional de Cancerología de Colombia (INC) fue atendido un paciente masculino de 49 años, quien consultó por fractura patológica del fémur izquierdo. Con biopsia del hueso se le confirmó carcinoma papilar metastásico de origen tiroideo, por lo cual se procedió a tiroidectomía total. Su diagnóstico final fue de MCPT. Por tratarse de un caso poco común, se reporta en el presente trabajo, y, a la vez, se comenta la nueva clasificación de tumores papilares de tiroides.
The classic description of papillary thyroid carcinoma (PTC) is that it is benign; particularly in lesions less than 1 cm. However, it is often observed that patients with aggressive diseases suffer from local, regional, and/or distant relapse. A recent proposal for pathology classification is the term papillary thyroid micro tumor (PMiT), which corresponds to a lesion less than 1 cm. and which does not have histopathological risk factors previously designated as papillary thyroid microcarcinoma (PTMC). A 49-year-old male patient sought treatment at the National Cancer Institute (NCI) for pathological fracture in the left femur. Bone biopsy confirmed metastatic papillary carcinoma of thyroid origin; thus leading to total thyroidectomy. His final diagnosis was PTMC. Due to the fact that this was a rare case, it is the subject of this report which also focuses on the new classification for papillary thyroid tumors.
