A pesquisa do linfonodo sentinela para o câncer de mama na prática clínica do ginecologista brasileiro / The sentinel lymph node biopsy in breast cancer in the practice of the Brazilian gynecologist: a revision

O estudo histopatológico dos linfonodos axilares continua sendo o melhor parâmetro para a avaliação do prognóstico do câncer de mama. No entanto, como em cerca de 80 por cento das pacientes com tumores de até 2 cm os linfonodos não apresentam comprometimento neoplásico, foi proposta, há alguns anos, a dissecção do linfonodo sentinela, reduzindo a morbidade cirúrgica nas pacientes com resultado negativo. Recentemente, esta técnica cirúrgica disseminou-se no Brasil, mas existem duas questões importantes: qual a probabilidade de resultado falso-negativo, ou seja, deixar de identificar um linfonodo comprometido pelo câncer, e se o subestadiamento pelo resultado falso-negativo exporia a paciente ao risco de recidiva axilar ou mesmo metástase a distância, pela utilização de terapia cirúrgica e adjuvante menos agressiva. A revisão da literatura mostra que a taxa de falsos-negativos varia de 5 a 10 por cento, sendo o principal fator associado à falta de experiência do cirurgião. Embora as recidivas axilares sejam raras, não é ainda possível avaliar o efeito a longo prazo de deixar de retirar linfonodos comprometidos, devido ao curto período de seguimento. Portanto, a recomendação é que o linfonodo sentinela só seja realizado por cirurgiões com experiência comprovada pela pequena taxa de resultados falso-negativos.

Axillary nodal metastasis is still the most important breast cancer prognostic factor. As in approximately 80 percent of the patients with tumors measuring less than 2 cm the axillary lymph nodes are negative, it has been proposed sentinel lymph node biopsy, reducing surgical morbidity in the patients with negative result. Recently, this technique has been widely used in Brazil, but there are two questions that need to be answered: what is the probability of a false-negative result (not diagnosing a positive lymph node) and if the understaging by false-negative result exposes the patient to the risk of axillary recurrence or even distant metastases, due to less effective surgical and adjuvant therapy. The literature shows that the false-negative rate varies from 5 to 10 percent, being the surgeon's experience the major factor that contributes to improved results. Although axillary relapse is rare, it is not yet possible to evaluate the long term effect of not removing positive lymph nodes, due to short follow-up. The recommendation is that sentinel lymph node biopsy should only be performed by surgeons with experience confirmed by a low false-negative rate.

Randomized clinical trial comparing conjugated equine estrogens and isoflavones in postmenopausal women: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the effects of isoflavone on the climacteric symptoms (Kupperman Menopausal index), vaginal pH, vaginal cytology (vaginal maturation index) and endometrium (evaluated by ultrasound and biopsy) in postmenopausal women. METHODS: It was a single-center, 6-month, randomized, double-blind, estrogen-controlled trial. Seventy-nine women were randomly assigned to one of the two treatment groups: isoflavone (n=40): 300 mg of the standardized soy extract with a medium dose of 120 mg isoflavones/day as glycoside and aglycone (60 mg twice a day), or estrogen (n=39): one capsule of 0.625 mg conjugated equine estrogens and other capsule with glucose 0.625 mg (placebo). RESULTS: After treatment, there was a decrease in the symptomatology in both estrogen and isoflavone groups. There was a significant decrease in vaginal pH, an increase in superficial vaginal cells and endometrium proliferation after 3 and 6 months of treatment in the estrogen group, but no differences were observed in the isoflavone group for these variables. CONCLUSIONS: We concluded that the daily standardized soy extract with 120 mg isoflavones' effect on symptoms was similar to that from estrogen. Soy isoflavone has no effect on endometrium and vaginal mucosa during the treatment.

Estado atual da cirurgia conservadora no cancer de mama / Actual state of conservative surgery of breast cancer

O tratamento do cancer de mama,ate 1950,baseou-se nas consideraçoes de que esta doenca, ao menos em primeira instancia, era localizada e,como tal, restrita a mama, disseminando-se posteriormente, primeiro aos linfonodos regionais e depois a distancia. A conviccao desta propagacao locorregional motivou o desenvolvimento de tecnicas cirurgicas radicais e ultra-radicais, complementadas ou nao pela radioterapia.