Comparative study of surgical and oncological outcomes in oncoplastic versus non oncoplastic breast-conserving surgery for breast cancer treatment.

BACKGROUND: Oncoplastic surgery has been increasingly used in breast cancer treatment and allows the performance of breast-conserving surgery in cases of larger tumors with unfavorable location or tumor-breast disproportion. PURPOSE: To compare surgical and oncological outcomes of patients undergoing oncoplastic and nononcoplastic breast-conserving surgery. METHODS: Retrospective cohort study with convenience sampling of 866 patients who consecutively underwent breast-conserving surgery from 2011 to 2015. RESULTS: The mean follow-up was 50.4 months. Nononcoplastic breast conservation surgery was performed on 768 (88.7%) patients and oncoplastic surgery on 98 (11.3%) patients. Patients in the oncoplastic group were younger (p<0.0001) and most were premenopausal (p<0.0001). Comorbidities such as diabetes (p=0.003) and hypertension (p=0.0001) were less frequent in this population. Invasive carcinoma >2 cm (p<0.0001), multifocality (p=0.004), ductal in situ carcinoma (p=0.0007), clinically positive axilla (p=0.004), and greater weight of surgical specimens (p<0.0001) were more frequent in the oncoplastic group. A second surgery for margin re-excision was more frequently performed in the nononcoplastic group (p=0.027). There was more scar dehiscence in the oncoplastic group (p<0.001), but there was no difference in early major complications (p=0.854), conversion to mastectomy (p=0.92), or local recurrence (p=0.889). CONCLUSION: Although used for the treatment of larger and multifocal tumors, surgical re-excisions were performed less often in the oncoplastic group, and there was no increase in conversion to mastectomy or local recurrence. In spite of the higher rate of overall complications in the oncoplastic group, major complications were similar in both groups.

Sexual transmission of SARS-CoV-2 virus and its role in the spread of COVID-19: A living systematic review protocol.

OBJECTIVE: To provide a review of the literature on the presence of SARS-CoV-2 in the sexual fluids of patients with COVID-19 and to observe its possible sexual transmission in a timely, rigorous, and continuously updated manner. DATA SOURCES: We will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature, and a centralized repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal. ELIGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We adapted an already published standard protocol for multiple parallel systematic reviews to the specificities of this question. We will include randomized trials evaluating the sexual transmission of the SARS-CoV-2 virus. Randomized trials evaluating the sexual transmission of other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 will be searched if no direct evidence from randomized trials is found or if the direct evidence provides a low to a very low level of certainty for critical outcomes. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will perform random-effects meta-analyses and use GRADE to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit the review if the conclusions change or if there are substantial updates. PROSPERO REGISTRATION: (CRD42020189368).

OBJETIVO: Proporcionar una revisión de la literatura sobre la presencia de SARS-CoV-2 en los fluidos sexuales de pacientes con COVID-19 y su posible transmisión sexual de manera oportuna, rigurosa y continuamente actualizada. FUENTES DE DATOS: Realizaremos búsquedas en PubMed / Medline, Embase, Registro Cochrane Central de Ensayos Controlados (CENTRAL), literatura gris y en un repositorio centralizado en L · OVE (Living OVerview of Evidence). L · OVE es una plataforma que mapea las preguntas PICO a la evidencia de la base de datos Epistemonikos. En respuesta a la emergencia de COVID-19, L · OVE se adaptó para ampliar el rango de evidencia que cubre y se personalizó para agrupar todas las pruebas de COVID-19 en un solo lugar. La búsqueda cubrirá el período hasta el día anterior al envío a una revista. CRITERIOS DE ELEGIBILIDAD PARA LA SELECCIÓN DE ESTUDIOS Y MÉTODOS: Adaptamos un protocolo común ya publicado para múltiples revisiones sistemáticas paralelas a las especificidades de esta pregunta. Incluiremos ensayos aleatorios que evalúen la transmisión sexual del virus SARS-CoV-2. Se buscarán ensayos aleatorizados que evalúen la transmisión sexual de otros coronavirus, como MERS-CoV y SARS-CoV, y estudios no aleatorizados en COVID-19 en caso de que no se encuentre evidencia directa de ensayos aleatorizados, o si la evidencia directa proporciona una - o certeza muy baja para resultados críticos. Dos revisores evaluarán de forma independiente la elegibilidad de cada estudio, extraerán datos y evaluarán el riesgo de sesgo. Realizaremos metanálisis de efectos aleatorios y utilizaremos GRADE para evaluar la certeza de la evidencia para cada resultado. Una versión viva basada en la web de esta revisión estará disponible abiertamente durante la pandemia de COVID-19. Lo volveremos a enviar si las conclusiones cambian o hay actualizaciones sustanciales. REGISTRO PROSPERO: (CRD42020189368).

Transmisión sexual del virus SARS-CoV-2 y su rol en la propagación de COVID-19: protocolo de una revisión sistemática viva / Sexual transmission of SARS-CoV-2 virus and its role in the spread of COVID-19: a living systematic review protocol

Objetivo Proporcionar una revisión de la literatura sobre la presencia de SARS-CoV-2 en los fluidos sexuales de pacientes con COVID-19 y su posible transmisión sexual de manera oportuna, rigurosa y continuamente actualizada. Fuentes de datos Realizaremos búsquedas en PubMed / Medline, Embase, Registro Cochrane Central de Ensayos Controlados (CENTRAL), literatura gris y en un repositorio centralizado en L · OVE (Living OVerview of Evidence). L · OVE es una plataforma que mapea las preguntas PICO a la evidencia de la base de datos Epistemonikos. En respuesta a la emergencia de COVID-19, L · OVE se adaptó para ampliar el rango de evidencia que cubre y se personalizó para agrupar todas las pruebas de COVID-19 en un solo lugar. La búsqueda cubrirá el período hasta el día anterior al envío a una revista. Criterios de elegibilidad para la selección de estudios y métodos Adaptamos un protocolo común ya publicado para múltiples revisiones sistemáticas paralelas a las especificidades de esta pregunta. Incluiremos ensayos aleatorios que evalúen la transmisión sexual del virus SARS-CoV-2. Se buscarán ensayos aleatorizados que evalúen la transmisión sexual de otros coronavirus, como MERS-CoV y SARS-CoV, y estudios no aleatorizados en COVID-19 en caso de que no se encuentre evidencia directa de ensayos aleatorizados, o si la evidencia directa proporciona una - o certeza muy baja para resultados críticos. Dos revisores evaluarán de forma independiente la elegibilidad de cada estudio, extraerán datos y evaluarán el riesgo de sesgo. Realizaremos metanálisis de efectos aleatorios y utilizaremos GRADE para evaluar la certeza de la evidencia para cada resultado. Una versión viva basada en la web de esta revisión estará disponible abiertamente durante la pandemia de COVID-19. Lo volveremos a enviar si las conclusiones cambian o hay actualizaciones sustanciales Registro PROSPERO (CRD42020189368).

Road traffic accidents of the elderly in Chile between the years 2008-2017: A register-based descriptive study. / Siniestros de tránsito de las personas mayores en Chile entre los años 2008 y 2017: estudio descriptivo.

Objective: To determine whether Chilean elderly persons have higher rates of traffic incidents, resulting in death or injury, compared to non-older adults between 2008 and 2017. Method: The databases of the National Traffic Safety Commission of the last ten years and the data of inhabitants according to the projections made by the National Statistics Institute were used. Effect measures and 95% confidence intervals were calculated. Results: Older adults in Chile had 0.5 times the rate of suffering a traffic accident, 0.6 times the rate of injury, and 1.3 times the rate of dying in a traffic accident when compared against non-elderly adults. Antofagasta and Arica were the regions with the lowest and highest occurrence of death for the elderly, respectively. The leading causes of traffic accidents were the imprudence of the driver and pedestrian, which presented 1.6 and 2.6 times the death rate when compared against non-elderly adults. Of the main types of traffic accidents, only when the pedestrian was hit by a vehicle, the elderly had a higher occurrence of death (rate ratio: 2.4). Conclusions: The elderly presented greater vulnerability to die in a traffic accident. Substantial differences are seen across different regions. Future research should address the characteristics of the users, the strategies that could help them to have better interaction, and promote health with a focus on road safety in the elderly.

Objetivo: Determinar si las personas mayores tienen mayor tasa de sufrir siniestros de tránsito, de fallecer o de lesionarse en estos, en comparación con personas adultas en Chile entre los años 2008 y 2017. Método: Se utilizaron las bases de datos de la Comisión Nacional de Seguridad de Tránsito de los últimos 10 años y los datos de habitantes según las proyecciones realizadas por el Instituto Nacional de Estadística. Se calcularon las medidas de efecto e intervalos de confianza del 95%. Resultados: Las personas mayores en Chile tuvieron 0,5 veces la tasa de sufrir un siniestro de tránsito; 0,6 veces la tasa de lesionar y 1,3 veces la tasa de fallecer en un siniestro de tránsito que presentan las personas adultas. Antofagasta y Arica fueron las regiones con menor y mayor ocurrencia de fallecimientos de personas mayores. Las principales causas de siniestro fueron la imprudencia del conductor y peatón, las que a su vez presentaron 1,6 y 2,6 veces la tasa de fallecimiento en personas adultas. De los principales tipos de siniestros, sólo en los atropellos las personas mayores tuvieron mayor ocurrencia de muerte (razón de tasas 2,4). Conclusiones: Confirma la mayor vulnerabilidad a fallecer en un siniestro de tránsito de las personas mayores. Se aprecian grandes diferencias a través de las diversas regiones del país. Las futuras investigaciones deben abordar las características de los usuarios, las estrategias que podrían ayudar a estos a tener una mejor interacción y promover la salud con foco en la seguridad vial en las personas mayores.

Siniestros de tránsito de las personas mayores en Chile entre los años 2008 y 2017: estudio descriptivo / Road traffic accidents of the elderly in Chile between the years 2008-2017: a register-based descriptive study

OBJETIVO: Determinar si las personas mayores tienen mayor tasa de sufrir siniestros de tránsito, de fallecer o de lesionarse en estos, en comparación con personas adultas en Chile entre los años 2008 y 2017. MÉTODO: Se utilizaron las bases de datos de la Comisión Nacional de Seguridad de Tránsito de los últimos 10 años y los datos de habitantes según las proyecciones realizadas por el Instituto Nacional de Estadística. Se calcularon las medidas de efecto e intervalos de confianza del 95%. RESULTADOS: Las personas mayores en Chile tuvieron 0,5 veces la tasa de sufrir un siniestro de tránsito; 0,6 veces la tasa de lesionar y 1,3 veces la tasa de fallecer en un siniestro de tránsito que presentan las personas adultas. Antofagasta y Arica fueron las regiones con menor y mayor ocurrencia de fallecimientos de personas mayores. Las principales causas de siniestro fueron la imprudencia del conductor y peatón, las que a su vez presentaron 1,6 y 2,6 veces la tasa de fallecimiento en personas adultas. De los principales tipos de siniestros, sólo en los atropellos las personas mayores tuvieron mayor ocurrencia de muerte (razón de tasas 2,4). CONCLUSIONES: Confirma la mayor vulnerabilidad a fallecer en un siniestro de tránsito de las personas mayores. Se aprecian grandes diferencias a través de las diversas regiones del país. Las futuras investigaciones deben abordar las características de los usuarios, las estrategias que podrían ayudar a estos a tener una mejor interacción y promover la salud con foco en la seguridad vial en las personas mayores.

OBJECTIVE: To determine if older adults in Chile have higher rates of traffic incidents, resulting in death or injury when compared to younger adults between 2008 and 2017. METHODS: The databases of the National Traffic Safety Commission of the last ten years and the data of inhabitants according to the projections made by the National Statistics Institute were used. Effect measures and 95% confidence intervals were calculated. RESULTS: The elderly in Chile had 0.5 times the rate of suffering a traffic accident, 0.6 times the rate of injury, and 1.3 times the rate of dying in a traffic accident when compared against non-elderly adults. Antofagasta and Arica were the regions with the lowest and highest occurrence of death for older adults, respectively. The leading causes of traffic accidents were the imprudence of the driver and pedestrian, which presented 1.6 and 2.6 times the death rate when compared against non-elderly adults. Of the main types of traffic accidents, only when the pedestrian was hit by a vehicle, the elderly had a higher occurrence of death (rate ratio 2.4). CONCLUSIONS: Older adults presented a greater vulnerability to death by traffic accidents. Substantial differences are seen across different regions. Future research should address the characteristics of the users, the strategies that could help them to have better interaction, and promote health with a focus on road safety for older people.

Effectiveness of digital interventions based on mobile phones for the prevention of sexually transmitted infections: A systematic review protocol. / Efectividad de las intervenciones digitales basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual: protocolo de revisión sistemática.

INTRODUCTION: Sexually transmitted infections, including HIV, are an important public health problem. Every day, over one million persons become infected with a sexually transmitted infection (STI). Health systems are searching for solutions to improve sex education and change the sexual behavior of people in order to prevent them. In public health, digital interventions based on mobile health technologies (M-health), especially those based on mobile phones, might be a crucial tool for the prevention of STIs and HIV. This systematic will review and summarize the evidence on the effectiveness of mobile phone-based interventions for the prevention of STIs and HIV. METHODS AND ANALYSIS: The protocol was designed and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The protocol will include randomized controlled trials that assess the effect of interventions based on mobile phones for the prevention of STIs/HIV. The interventions of interest will be those targeting mobile phone users and should consist of providing information by mobile phone through any function or application that can be used or sent to, and that has been designed to educate, promote or modify sexual behaviors and prevent STIs, including HIV. The data sources to identify these studies will be the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE and MEDLINE. The risk of bias will be assessed using the tool recommended by Cochrane. Finally, a meta-analysis will be done and data will be presented following the GRADE method. ETHICS AND DISSEMINATION: This research was exempted by the Ethics Committee of Pontificia Universidad Católica de Chile (ID 171128002). TRIAL REGISTRATION NUMBER: CRD42018099008.

INTRODUCCIÓN: Las infecciones de transmisión sexual, incluida el VIH, son un importante problema de salud pública. Cada día más de un millón de personas contraen una infección de transmisión sexual. Los sistemas de salud están buscando soluciones para mejorar la educación y lograr cambios en el comportamiento de las personas para prevenir infecciones de transmisión sexual. Las intervenciones digitales basadas en tecnologías móviles en salud (M-health), en especial las basadas en teléfonos móviles, podrían ser una importante herramienta en salud pública para la prevención de infecciones de transmisión sexual/VIH. Esta revisión sistemática resume la evidencia sobre la efectividad de las intervenciones basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual/VIH. MÉTODOS Y ANÁLISIS: El protocolo fue diseñado y será reportado en concordancia con la directriz "Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)". Se incluirán ensayos controlados aleatorizados que evalúen el efecto de las intervenciones basadas en teléfonos móviles para la prevención de infecciones de transmisión sexual/VIH. Las intervenciones de interés serán aquellas dirigidas a usuarios de teléfonos móviles, basada en cualquier función o aplicación que pueda usarse o enviarse y que hayan sido diseñadas para educar, promocionar o modificar conductas para reducir comportamiento sexual de riesgo y prevención de infecciones de transmisión sexual incluyendo VIH. La búsqueda electrónica para identificar los estudios se realizará en el Registro Cochrane Central de ensayos controlados (CENTRAL), en EMBASE y MEDLINE/PubMed. Se evaluará el riesgo de sesgo utilizando la herramienta recomendada por la colaboración Cochrane. Se realizará metanálisis y se presentarán los datos mediante el método GRADE. ÉTICA Y DIFUSIÓN: Esta investigación fue inscrita en el comité de ética de la Pontificia Universidad Católica de Chile, aceptada y cuenta con certificado de resolución exenta de revisión (ID 171128002). NÚMERO DE REGISTRO: CRD42018099008.

Claudin-4 Expression Is Associated With Disease-Free Survival in Breast Carcinoma-in-Situ: Mean Follow-up of 8.2 Years.

INTRODUCTION: Claudins are tight junctions associated with breast cancer prognosis. The claudin-low intrinsic subtype of invasive carcinoma is associated with high-grade carcinoma, low junction molecule expression, and worse response to chemotherapy. However, it is not known whether the expression of claudins may provide clues as to carcinoma-in-situ (CIS) prognosis. The aim of this study was evaluate claudin-4 expression in CIS and its association with disease-free survival and histologic type of local recurrence (in situ or invasive). METHODS: A tissue microarray block, constructed from 137 pure CIS paraffin blocks, was submitted to immunohistochemical staining for claudin-4, ß-catenin, E-cadherin, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki-67. A claudin-4 score categorized samples as claudin-4-low or -high. Clinical and treatment data were obtained from medical records. RESULTS: Claudin-4 expression was evaluated in 86 samples; 88.4% were high and 11.6% low. Mean follow-up was 98.4 months, and the local recurrence rate was 10.4%. There was a significant difference in disease-free survival between claudin-4-high and -low (4.9 and 1.9 years, respectively, P = .02); however, there was no difference between them in histologic type of recurrence (invasive or in situ) (P = .44). CONCLUSION: In our samples, high claudin-4 expression in CIS was more frequent than low expression. Claudin-4-low expression had a worse prognosis in CIS (inferior disease-free survival), but it was similar to high claudin-4 in histologic type of local recurrence.

Accuracy of frozen section, imprint cytology, and permanent histology of sub-nipple tissue for predicting occult nipple involvement in patients with breast carcinoma.

The sub-nipple tissue (SNT) examination has been used by surgeons to preserve, or not, the nipple in nipple-sparing mastectomy. However, it is uncertain whether SNT evaluation can predict nipple involvement. The aim of this study was to evaluate the accuracy, sensitivity, specificity, PPV, and NPV of the intraoperative frozen section and imprint cytology, and permanent histology of SNT to predict the involvement of the nipple in breast carcinoma and to compare the three exams. A prospective study was performed with 68 consecutive breast carcinoma women who had undergone mastectomy or central segmentectomy (removing nipple-areolar complex). After surgery, the nipple-areolar complex was dissected simulating a nipple-sparing flap (ex vivo). The SNT was subsequently removed and submitted to frozen section, imprint cytology, and permanent histology. The nipple was examined separately by paraffin histopathology and was considered the gold standard. The occult nipple involvement rate was 11.7 %. The frozen section, cytology, and permanent histology of SNT presented accuracy 86.8, 76.5, and 86.8 %; sensitivity 50, 37.5, and 62.5 %; specificity 91.7, 81.7, and 90 %; PPV 44.4, 21.4, and 45.5 %; and NPV 93.2, 90.7, and 94.7 %, respectively. The accuracy of the frozen section was similar to that of permanent histology (p = 0.77) and both were better than cytology (p = 0.01). False negative rates were 6.8 % for frozen section, 9.3 % for cytology and 5.3 % for paraffin. SNT evaluation is a good method for predicting occult nipple involvement; the outcomes showed a good accuracy and low false negative rate for the frozen section, cytology, and permanent histology exams. When we compared the exams, the frozen section was similar to permanent histology and more accurate than imprint cytology.

Case report and review of the literature: secretory breast cancer in a 13-year-old boy--10 years of follow up.

Carcinoma of the breast is very rare in childhood, accounting for less than 1% of all childhood malignancies and is especially rare in boys. Delay in diagnosis and treatment in children with breast cancer may occur because surgeons are very reluctant to perform biopsies on the developing breast, since these can cause future deformity. We report a case of male secretory breast carcinoma in a 13-year-old boy. Radical mastectomy was performed followed by chemotherapy. The patient is free of disease after 10 years. Secretory breast carcinoma (SBC) is the commonest type of breast carcinoma in children. In this article, we discuss the diagnosis and treatment options for breast cancer among children as well as features of SBC, based on a literature review.

Severe phenytoin-induced gingival enlargement associated with periodontitis: rational model for its clinical management

This case report documented a severe gingival enlargement associated with periodontitis in a patient under antiepileptic therapy and provided a rational model for its clinical management. Initially, full-mouth scaling and root planing, oral hygiene instructions and phenyto in with drawal were performed. However, clinical results demonstrated just partial resolution of upper jaw gingival hyperplasia after non-surgical therapy. Subsequently, surgical therapy was indicated for the upper jaw teeth. After the surgical therapy, complete reduction of gingival enlargement was observed. This report described the challenges faced by the oral and medical health practitioners in developing appropriate prevention and treatment for antiepileptic drug users, particularly for periodontal patients.

O presente relato documentou o aumento gengival induzido por fenitoína associado com periodontite apresentado por uma paciente sob terapia antiepiléptica, e propôs um modelo adequado para o manejamento clínico do caso. Inicialmente, realizou-se raspagem e aplainamento radicular completos, instruções de higiene bucal e substituição da fenitoína. Mas os resultados clínicos demonstraram resolução incompleta da hiperplasia do arco superior após a terapia não cirúrgica. Por isso, subseqüentemente, foi indicada para o arco superior a terapia periodontal cirúrgica, que acarretou em resolução completa do aumento gengival. Este relato de caso descreveu as dificuldades encontradas por profissionais médicos e odontológicos para o desenvolvimento de métodos preventivos e terapêuticos adequados para usuários de drogas antiepilépticas, particularmente pacientes com doença periodontal.

Fusion of magnetic resonance and scintimammography images for breast cancer evaluation: a pilot study.

BACKGROUND: To achieve a more specific method to estimate the real size of breast cancer, we have developed a method to fuse magnetic resonance imaging (MRI) and scintimammography (SM) images. The aim of this study was to assess the feasibility of this method and to evaluate its accuracy to measure the size of breast cancer compared with MRI alone, mammography, and clinical examination, employing pathologic size as the gold standard. METHODS: Twenty consecutive breast cancer women at stages IIA-IIIA, scheduled for mastectomies, underwent SM with (99m)Tc-sestamibi and MRI with gadolinium 2-10 days before surgery. All patients had had recent mammographies and were examined clinically. Software was developed in visual language to perform the fusion between MRI and SM images and tumor measurements (MRI/SM). The tumor size, in 3 diameters (anteroposterior, longitudinal, and transverse), for each examination was correlated with pathological measurements using linear regression. RESULTS: The MRI/SM technique was successfully performed in all patients, and the principal tumor was measured by this method. The MRI/SM cancer measurements correlated better with pathology than MRI, mammography, and clinical exam in all diameters analyzed (r = 0.88, 0.81, 0.81; SE = 0.11, 0.14, 0.11 in anteroposterior, longitudinal, and transverse diameters, respectively). CONCLUSIONS: The MRI/SM is a feasible technique and appears to be more accurate than other examinations (MRI alone, mammography, and clinical exam) to measure breast cancer size.

Nonproliferative epithelial alteration and expression of estrogen receptor and Ki67 in the contralateral breast of women treated with tamoxifen for breast cancer.

The aim of study was to evaluate the frequency of nonproliferative epithelial alteration and expression of Ki67 and estrogen receptors (ER) in patients using tamoxifen. Forty-four women were selected who had been taking 20mg of tamoxifen daily for at least 12 months for adjuvant treatment of breast cancer. The women underwent core biopsy in the contralateral breast into an area of highest fibroglandular mammographic density. Fragments were analyzed by immunohistochemistry for monoclonal antibody Ki67 and ER, and histopathologic analysis. It was verified that 82% of the patients presented nonproliferative epithelial alteration, 70% were ER-negative, and all had low Ki67 expression. There was no association between duration of tamoxifen therapy, patient age, mammographic density, and presence of nonproliferative alteration (P>0.05). In conclusion, tamoxifen for more than a year showed a high frequency of nonproliferative epithelial alteration and low expression of Ki67 and ER in the normal breast tissue, consistent with low cell proliferation.

Radioguided surgery using intravenous 99mTc sestamibi associated with breast magnetic resonance imaging for guidance of breast cancer resection.

The purpose of this study was to evaluate the feasibility of surgery radioguided with intravenous (99m)Tc sestamibi associated with magnetic resonance imaging (MRI) of the breast to detect tumor extent and guide complete tumor resection. A descriptive experimental study was developed with 10 breast cancer patients (stage IIA-IIB) who underwent mastectomy. From 2 to 10 days before surgery, the patients underwent breast MRI with 0.1 mmol/kg of gadolinium and scintimammography with a 740 MBq of (99m)Tc sestamibi. A region of interest was drawn around the tumor image and an uptake curve as a function of time was plotted to calculate the optimal time to perform radioguided surgery. In the perioperative period, the same dose of (99m)Tc sestamibi was intravenously injected into the patients. Tumor resection was performed under the guidance of a gamma probe. MRI was used to evaluate the skin and deep fascia involvement and to detect occult tumor foci which were also excised. Subsequently a modified radical mastectomy was performed. Tumor and residual breast were histopathologically examined. In a series of 10 women, all demonstrated (99m)Tc sestamibi uptake in tumor cells. Eight patients showed no disease in the residual breast, one presented with one foci of invasive ductal carcinoma measuring 0.5 cm in diameter located 5 cm from the tumor bed, and one presented with one foci of ductal carcinoma in situ measuring 0.8 cm at the resection margin. The mean tumor size in the histopathologic assessment was 3.3 cm and in MRI was 5.0 cm. Radioguided surgery using (99m)Tc sestamibi associated with MRI is a feasible technique that can be employed in tumor resection.