Ultrasound Measurement of the Distance between the Breast Tumor and the Skin: A Cut-Off Value for Safe Skin Preservation - Diagnostic Accuracy Study.

Background: In superficial tumors of the breast, it is necessary to plan the thickness of surgical skin flaps, and whether skin can be preserved for esthetics results. This study aimed to find an ultrasound-measured cut-off distance between tumor and skin (TSD) that allows patients to have the skin over the tumor spared. Methods: This is a diagnostic accuracy study comparing preoperative ultrasound TSD with pathological TSD and the thickness of the skin flaps. We recruited all consecutive women diagnosed with breast cancer between January 2017 and December 2019 whose surgical planning allowed to have the tumor and overlying skin to be removed in bloc (reconstruction procedures, situations where skin removal would not lead to esthetic problems, and superficially located tumors). Measurements were made: preoperatively (by ultrasound), during surgery (using a metal caliper to obtain the thickness of surgical skin flap), and after surgery (pathological). A pathological tumor-skin distance greater than surgical skin flap thickness would indicate preservation of skin above the tumor. Results: We evaluated 95 consecutive patients with 102 lesions. The average surgical flap thickness was 5.5 mm (3-10 mm). The ultrasound-measured cut-off TSD of 2.1 mm obtained 96.0% accuracy in predicting free anterior margin, considering a 5-mm-thick surgical flap. Conclusion: In breast superficial tumors, a cut-off distance of 2.1 mm or more measured preoperatively by ultrasound allows safe preservation of the skin above the tumor. Future studies need to follow up for longer the women submitted to skin preservation surgeries, especially those not undergoing radiotherapy.

Breast cancer in the health insurance system of Jundiaí: data on 105 patients / Câncer de mama no sistema de saúde suplementar de Jundiaí: dados de 105 pacientes

Introduction: The data related to breast cancer's epidemiology in Brazil are heterogenous, reflecting the country's socioeconomic inequalities. Significant number of cases of this disease are attended through the health insurance system, but data on these cases is poorly disseminated. Objective: To evaluate epidemiological data on breast cancer from patients attended through the health insurance system in the municipality of Jundiaí, São Paulo. Methods: This was a retrospective study conducted through reviewing the medical files of 105 patients diagnosed with breast cancer, who were attended between January 2014 and December 2015. The information gathered included: age, clinical staging, histological type, immunohistochemical profile, surgical treatment and adjuvant treatment. Results: The study included 105 patients with breast cancer who were treated exclusively within the health insurance system of Jundiaí. The patients' mean age was 50.8 years. We observed that 13 patients (12.3%) were diagnosed with ductal carcinoma in situ (stage 0), 43 (40.9%) with stage I, 34 (32.3%) with stage II, 11 (10.4%) with stage III and 2 (1.9%) with stage IV. Conservative surgery was performed on 76 patients (72.3%), while 29 (27.7%) underwent mastectomy. Among the latter, immediate reconstruction was performed in 82.7% (24) of the cases. Conclusion: The high rates of early diagnosis and conservative surgery show that screening for breast cancer within the health insurance system of the municipality of Jundiaí, has been effective. Accessible mammography and the socioeconomic level of the population seem to be the main factors responsible for the obtained findings.

Introdução: Os dados referentes à epidemiologia do câncer de mama no Brasil são heterogêneos, reflexo da desigualdade socioeconômica do país. A medicina suplementar possui número relevante de casos da doença, porém estes são pouco divulgados. Objetivo: Avaliar os dados epidemiológicos do câncer de mama em pacientes atendidas pela saúde suplementar no município de Jundiaí, SP. Método: Estudo retrospectivo por meio da revisão do prontuário médico de 105 pacientes com diagnóstico de câncer de mama atendidas entre janeiro de 2014 e dezembro de 2015. As informações coletadas incluíram: idade, estadiamento clínico, tipo histológico, perfil imuno-histoquímico, tratamento cirúrgico e adjuvante. Resultados: O estudo incluiu 105 pacientes com câncer de mama, tratadas exclusivamente no sistema de saúde suplementar de Jundiaí. A idade média das pacientes foi de 50,8 anos. Observamos que 13 (12,3%) pacientes foram diagnosticadas com carcinoma ductal in situ (estádio 0), 43 (40,9%) no estádio I, 34 (32,3%) no estádio II, 11 (10,4%) no estádio III, e 2 (1,9%) no estádio IV. A cirurgia conservadora foi realizada em 76 (72,3%) pacientes, das quais 29 (27,7%) foram submetidas à mastectomia. Nessas pacientes, a reconstrução imediata foi realizada em 82,7% (24) dos casos. Conclusão: A elevada taxa de diagnósticos precoces, assim como de cirurgias conservadoras, revela rastreamento eficaz para o câncer de mama na saúde suplementar do município de Jundiaí. A acessibilidade à mamografia e o nível socioeconômico da população parecem ser os principais responsáveis pelos achados obtidos

Leiomyoma of the breast parenchyma: a case report and review of the literature

ABSTRACT INTRODUCTION: Benign tumors are often seen in breast screening examinations. However, the differential diagnosis is not always simple because of radiological similarity between the different benign lesions. CASE REPORT: We present a rare case report of leiomyoma of the breast parenchyma in a 68-year-old asymptomatic patient. The mammographic and ultrasonographic findings were similar to those observed in benign lesions. CONCLUSION: The histopathological diagnosis requires careful differentiation from lesions that have smooth muscle proliferation, especially leiomyosarcoma. The most commonly performed treatment is resection of the lesion with free margins. Although breast leiomyoma is rare, it should be considered among the differential diagnoses for breast nodules of benign appearance. Resection with safety margins proved to be the only treatment needed.

Leiomyoma of the breast parenchyma: a case report and review of the literature.

INTRODUCTION: Benign tumors are often seen in breast screening examinations. However, the differential diagnosis is not always simple because of radiological similarity between the different benign lesions. CASE REPORT: We present a rare case report of leiomyoma of the breast parenchyma in a 68-year-old asymptomatic patient. The mammographic and ultrasonographic findings were similar to those observed in benign lesions. CONCLUSION: The histopathological diagnosis requires careful differentiation from lesions that have smooth muscle proliferation, especially leiomyosarcoma. The most commonly performed treatment is resection of the lesion with free margins. Although breast leiomyoma is rare, it should be considered among the differential diagnoses for breast nodules of benign appearance. Resection with safety margins proved to be the only treatment needed.