Surgical marker navigation system in breast conserving surgery and excision of non-palpable lesions: first Spanish single-center experience.

BACKGROUND: Due to the establishment of screening mammography for breast cancer detection, the number of non-palpable lesions has increased. Thus, an optimal localization system is mandatory for the excision of non-palpable breast tumors. OBJECTIVE: The aim of the study is to report the feasibility Surgical Marker Navigation (SMN) system Sirius Pintuition® for the excision of non-palpable breast tumors and non-palpable axillary lymph nodes. METHODS: A retrospective observational study of patients undergoing breast-conserving surgery and lymph node excision guided by SMN between December 2022 and May 2023 was performed. RESULTS: A total of 84 patients underwent excision of non-palpable breast tumors (77; 91.7%) or non-palpable axillary lymph-nodes (7; 8.3%) using SMN. In total, 94 markers were placed, in 74 patients (88.1%) only one marker was placed, whereas in 10 patients (11.9%) two markers were placed to correctly localize the lesion in the operating room. Most markers were placed using ultrasonographic guidance (69; 82.1%). Seventy-seven patients underwent breast-conserving surgery (91.7%) and 7 (8.3%) lymph node excision. In 10 cases (11.9%), the marker was accidentally displaced during surgery due to the use of magnetized instruments, although the specimen could be removed. In sum, all the markers were removed from the patients, although the marker retrieval rate, as we defined it (percentage of patients in whom the initial excised specimen contained the marker divided by the total number of patients), was 88.1%. CONCLUSION: The use of Sirius Pintuition® SMN for non-palpable breast tumors and non-palpable lymph nodes is feasible, with a retrieval rate of 88.1%.

Breast metastases from non-primary breast malignancies: What should we know?

BACKGROUND: Metastases from extramammary malignant neoplasms are very rare, accounting for less than 2% of all breast malignancies. OBJECTIVE: The aim of this study is to describe the clinicopathological features and prognosis of breast metastases from non-primary breast malignancies at our institution. METHODS: We performed a retrospective observational study, obtaining data from electronic medical records and pathology databases between January 1985 and December 2020 for patients diagnosed with breast metastasis from non-primary breast malignancies. Only patients diagnosed by biopsy were included. RESULTS: Fifteen patients diagnosed with breast metastases from non-primary breast malignancies were included, 13 women (86,67%) and 2 men (13,33%). The median age at time of initial diagnosis was 56 years (IQR 21-68). The most frequent primary malignancy was melanoma (9/15; 60%). The median time to diagnosis of breast metastases was 65 months (IQR 13-106). The most common diagnostic modality was CT-scan (10/15; 66,67%). The median follow-up was 96 months (IQR 29-136). Eight patients underwent surgery (53,3%), being the most common surgical intervention breast-conserving surgery (5/8; 62,5%). Mortality at the end of follow-up was 53,3% (8/15). On the survival analysis, we found no differences between patients undergoing surgery and those only receiving systemic treatment [41,5 months (IQR 17,5-57,5) versus 14 months (IQR 2-24), respectively; p = 0,161]. CONCLUSIONS: Breast metastases from non-primary breast malignancies are extremely rare and represent a diagnostic and therapeutic challenge, due to the poor prognosis of these patients. Thus, arriving at the correct diagnosis is crucial to avoid unnecessary treatment in this population.

Biopsia selectiva de ganglio centinela en cáncer de mama, ¿está justificada la espera al resultado intraoperatorio? / Intraoperative sentinel node biopsy, is it worth the wait?

Objetivo: En nuestro centro, el estudio de la biopsia selectiva del ganglio centinela (BSGC) se realiza de forma intraoperatoria. El objetivo principal del presente trabajo es conocer qué proporción de pacientes se beneficia de la espera intraoperatoria al resultado de la BSGC. Material y métodos: Se ha realizado un análisis retrospectivo de pacientes intervenidas en nuestro centro entre el 1 de enero de 2018 y el 30 de junio de 2019. Se incluyeron mujeres con tumores T1-T2, tratadas mediante tumorectomía y BSGC estudiado mediante método one-step nucleic acid amplification (OSNA). Resultados: Se incluyeron 149 mujeres en el estudio. No se encontraron diferencias estadísticamente significativas en cuestión de datos demográficos entre el grupo tratado mediante linfadenectomía axilar (LA) y el grupo tratado exclusivamente con BSGC. Se realizaron 18 LA tras el análisis del GC estudiado de forma intraoperatoria. Solo en seis de los casos se extrajeron tres o más GC. La localización por cuadrante de la lesión, permeación linfovascular y carga tumoral total muestran diferencias estadísticamente significativas entre los grupos. En el análisis multivariante, únicamente la carga tumoral total (TTL) se establece como variable independiente de necesidad de LA. Conclusiones: La obtención del resultado de la BSGC de forma diferida permite disminuir el tiempo de anestesia de las pacientes y tiempo de ocupación de quirófano, ya que en el momento actual no se realiza ningún procedimiento adicional en un elevado porcentaje de casos. (AU)

Introduction: In our institution, the study of selective sentinel node biopsy (SLNB) is performed intraoperatively. The main objective of our study is to know the proportion of patients who benefits from the waiting of the results of SLNB. Methods: A retrospective analysis of patients operated on our center between January 1 st, 2018 and June 30, 2019 was carried out. We included women diagnosed with T1–T2 tumors, treated by lumpectomy and SLNB studied using OSNA method. Results: Our study included 149 women. There were not statistically significant differences in terms of demographic data between the group treated with axillary lymph node dissection (ALND) and exclusively SLNB group. After analysis of SLN intraoperatively, there were performed 18 axillary lymphadenectomies. Only in six of these 18 cases, three or more sentinel nodes were founded. The location of the tumor, the presence of lymphovascular permeation and the total tumor load (TTL) showed statistically significant differences between groups. Only the TTL was established as the independent factor of the need for ALND. Conclusions: Obtaining a deferred result of the SLNB allowed reducing the time of anesthesia and occupation of the operating room, since in a high percentage of cases an additional procedure is not performed. (AU)

Intraoperative sentinel node biopsy, is it worth the wait?

INTRODUCTION: In our institution, the study of selective sentinel node biopsy (SLNB) is performed intraoperatively. The main objective of our study is to know the proportion of patients who benefits from the waiting of the results of SLNB. METHODS: A retrospective analysis of patients operated on our center between January 1st, 2018 and June 30, 2019 was carried out. We included women diagnosed with T1-T2 tumors, treated by lumpectomy and SLNB studied using OSNA method. RESULTS: Our study included 149 women. There were not statistically significant differences in terms of demographic data between the group treated with axillary lymph node dissection (ALND) and exclusively SLNB group. After analysis of SLN intraoperatively, there were performed 18 axillary lymphadenectomies. Only in six of this 18 cases, three or more sentinel nodes were founded. The location of the tumor, the presence of lymphovascular permeation and the total tumor load (TTL) showed statistically significant differences between groups. Only the TTL was established as the independent factor of the need for ALND. DISCUSSION: Obtaining a deferred result of the SLNB allowed reducing the time of anesthesia and occupation of the operating room, since in a high percentage of cases an additional procedure is not performed.

CHARACTERIZING COVID-19-RELATED RETINAL VASCULAR OCCLUSIONS: A Case Series and Review of the Literature.

PURPOSE: To describe clinical and ophthalmologic features and outcomes of patients with coronavirus disease-19 with retinal vascular occlusions. METHODS: Retrospective multicenter case series and PubMed review of cases reported from March 2020 to September 2021. Outcome measures are as follows: type of occlusion, treatments, best-corrected visual acuity, and central macular thickness on optical coherence tomography. RESULTS: Thirty-nine patients were identified. Fifteen patients with a median age of 39 (30-67) years were included in the multicenter study. Vascular occlusions included central retinal vein occlusion (12 eyes), branch retinal vein occlusion (4 eyes), and central retinal artery occlusion (2 eyes). Three cases were bilateral. Baseline best-corrected visual acuity was 20/45 (no light perception-20/20). Baseline central macular thickness was 348.64 (±83) µm. Nine eyes received anti-vascular endothelial growth factor agents, dexamethasone intravitreal implant, or both. Final best-corrected visual acuity was 20/25 (no light perception-20/20), and central macular thickness was 273.7 ± 68 µm (follow-up of 19.6 ± 6 weeks). Among the 24 cases from the literature review, retinal vein occlusion was the predominant lesion. Clinical characteristics and outcomes were similar to those found in our series. CONCLUSION: Coronavirus disease-19-associated retinal vascular occlusions tend to occur in individuals younger than 60 years. Retinal vein occlusion is the most frequent occlusive event, and outcomes are favorable in most cases.

Myofibroblastoma of the male breast: A case report / Miofibroblastoma en la mama de un varón, descripción de un caso clínico

Myofibroblastoma (MFB) is a rare spindle stromal tumour of the breast that predominates in 60–80 years-old adult males. Its imaging features are nonspecific, leading to misdiagnosis. Thus, core biopsy is needed for definitive diagnosis. Macroscopically, MFB is usually a well-circumscribed, firm and rubbery, unencapsulated, pale white to grey round mass. Microscopically, it consists on spindle cells arranged in haphazardly intersecting fascicles or clusters, thick hyalinized collagen bundles and low mitotic activity with a lack of myoepithelial component and necrosis. Immunohistochemistry shows consistently positive immunoreactivity to vimentin and CD34, while expression of desmin, SMA, bcl-2 and CD99 varies. Oestrogen, progesterone and androgen receptors are usually expressed. They are constantly negative to cytokeratins, EMA, S100 protein, HMB-45 and c-kit (CD117). These differentiate them from fibroadenoma, phyllodes tumour, round pattern gynecomastia, carcinoma and sarcoma, since they present infiltrative growth and are negative to CD34. Wide local excision is curative, with no need of sentinel lymph node biopsy, since local recurrence is extremely low and has been reported to be less than 1.5%. No distant metastases have been described on the literature. We report a rare case MFB on a 73-year-old male attended at our institution presenting with a nodule on the right breast. (AU)

El miofibroblastoma (MFB) es un tumour estromal de células fusiformes que aparece en varones de 60-80 años. Las características radiológicas son inespecíficas, por lo que es necesaria la realización de biopsia para el diagnóstico definitivo. Macroscópicamente se trata de una lesión bien circunscrita, firme, no encapsulada. Microscópicamente consiste en células fusiformes organizadas en fascículos entremezclados con bandas de colágeno hialino, con baja actividad mitótica y ausencia de componente mioepitelial y necrosis. La inmunohistoquímica muestra la expresión constante de vimentina y CD34, con expresión variable de desmina, AML, bcl-2 y CD99. Los receptores de estrógenos, progesterona y andrógenos normalmente son positivos, mientras que la expresión de citoqueratinas, EMA, S100, HMB-45 y c-kit (CD117) es negativa. Estas características lo diferencian del fibroadenoma, tumour filodes, ginecomastia, carcinoma y sarcoma, ya que la mayoría de ellos se caracterizan por ser negativos para CD34 y presentar crecimiento infiltrativo. La tumorectomía es considerada curativa, sin necesidad de realizar biopsia selectiva de ganglio centinela, dado que la recurrencia local es baja (menos del 1,5%). No se ha descrito la presencia de metástasis a distancia en la literatura. Presentamos el caso de MFB en un varón de 73 años que debutó con un nódulo en la mama derecha. (AU)

As (novas) tecnologias e o (velho) problema da determinação da responsabilidade penal nas equipas médicas / The (new) technologies and the (old) problem of the determination of criminal liability in medical teamwork / Las (nuevas) tecnologías y el (antiguo) problema de determinar la responsabilidad penal en equipos médicos

Objetivo: discutir a determinação da responsabilidade penal dos profissionais de saúde que atuam em equipa, convocando o princípio da divisão do trabalho e o princípio da confiança. Metodologia: utilizou-se o método dedutivo, em que se avaliou a validade do princípio da confiança no âmbito da divisão do trabalho nas equipas de saúde, analisando a seu enquadramento dogmático no Direito Penal. Resultados: a doutrina penal divide-se quanto ao modo de determinação da responsabilidade por negligência, em caso de pluralidade de agentes, sobretudo no âmbito da divisão de trabalho vertical. Conclusão: a partir do princípio da divisão do trabalho e do princípio da confiança, é possível determinar a responsabilidade penal de cada membro de uma equipa de saúde quando da atuação negligente resultar uma ofensa à integridade física ou mesmo a morte do paciente.

Objective: to discuss the determination of criminal liability of health professionals who work in teams, based on the principle of division of labor and the principle of trust. Methodology: the deductive method was used, in which the validity of the principle of trust in the scope of the division of labor in the health teams was evaluated, correlating it with the criminal aspects. Results: the penal doctrine is divided as to the way of determining liability for negligence in the case of plurality of agents, especially within the scope of the vertical division of labor. Conclusion: from the principle of division of labor and the principle of trust, it is possible to determine the criminal responsibility of each member of a health team when negligent performance results in an injury to the physical integrity or even the death of the patient.

Objetivo: este documento tiene como objetivo discutir la determinación de la responsabilidad penal de los profesionales de la salud que trabajan en equipo, con base en el principio de división del trabajo y el principio de confianza. Metodología: se utilizó el método deductivo, en el cual se evaluó la validez del principio de confianza en el alcance de la división del trabajo en los equipos de salud, analizando su marco dogmático en Derecho Penal. Resultados: la doctrina penal se divide en cuanto a la forma de determinar la responsabilidad por negligencia en el caso de la pluralidad de agentes, especialmente dentro del alcance de la división vertical del trabajo. Conclusión: desde el principio de división del trabajo y el principio de confianza, es posible determinar la responsabilidad penal de cada miembro de un equipo de salud cuando el desempeño negligente resulta en una lesión a la integridad física o incluso la muerte del paciente.

Lesión extensa de pared torácica en una paciente con antecedentes de carcinoma de mama / Extensive thoracic skin lesion in a patient with history of breast cáncer

No disponible

Necrosis mamaria en paciente con linfoma no Hodgkin primario de células T / Breast necrosis in a patient with primary T-cell non-Hodgkin lymphoma

No disponible

Hidroadenocarcinoma de células claras de localización mamaria / Hydroadenocarcinoma of clear cells located in the breast

No disponible

Incidencia y seguimiento a 5 años de la recidiva locorregional durante 4 años consecutivos en una unidad multidisciplinar de patología mamaria / Incidence and 5-year follow-up of locoregional recurrence during 4 consecutive years in a multidisciplinary breast unit

Objetivos. Analizar la incidencia de recidiva locorregional y la evolución de las pacientes diagnosticadas de carcinoma infiltrante de mama con seguimiento de larga evolución. Métodos. Estudio retrospectivo de pacientes intervenidas por carcinoma infiltrante de mama entre enero de 2006 y diciembre de 2009. Criterios de inclusión: seguimiento mínimo de 24 meses, diagnóstico de recidiva locorregional de mama confirmado mediante biopsia. Se recogieron características diagnósticas y terapéuticas del tumor primario y la recidiva, la biología molecular, el tiempo libre de enfermedad y la supervivencia global a 5 años. Resultados. Cuatrocientas setenta y dos pacientes cumplieron los criterios de inclusión, con una mediana de seguimiento de 66 meses (47-85). Quince (3,2%) pacientes presentaron recaída locorregional. El diagnóstico fue carcinoma ductal infiltrante, la mediana del tamaño tumoral fue de 18 mm (12-30) y 16 mm en la recidiva (8-28). De las piezas analizadas, en 5 casos (2 luminal A, 2 luminal B y un HER2) la biopsia de la recidiva mostró un cambio histopatológico a triple negativo. Se observó un mayor índice de proliferación celular en la recidiva frente al tumor primario (45 vs. 30%; p = 0,068). La supervivencia libre de enfermedad en meses fue mayor en las pacientes con tumores que no eran triple negativo (33 vs. 28 meses; p = 0,199). Solo una paciente (6%) falleció a lo largo del periodo de seguimiento. Conclusiones. La incidencia de recidiva locorregional a 5 años permanece baja y dentro de los estándares actuales. La selección a triple negativo mostró peores tasas de supervivencia libre de enfermedad (AU)

Aims. To evaluate our results in locoregional recurrences in a cohort of patients with infiltrating breast cancer. Methods. A retrospective study was performed over patients with breast cancer who underwent surgery for breast cancer form January 2006 to December 2009 in Breast Surgery Unit of Fundación Jiménez Díaz University Hospital. Those with a minimum follow-up of 2 years and a locoregional recurrence confirmed by biopsy were selected. We analyzed patient and tumor's characteristics, time to recurrence confirmed by biopsy and long-term oncological outcomes. Results. 472 completed the inclusion criteria with a median follow-up of 66 months (47-85). Of them, 15 patients (3.2%) had a locoregional recurrence. A triple-negative breast cancer was found in 5 patients at the time of relapse (2 luminal A, 2 luminal B and one HER2), compared to one patient at the initial surgery. A higher cellular proliferation index was observed in recurrence tumors (45 vs. 30%; P = .068). Disease-free survival was higher in triple-negative non-selected patients (33 vs. 28 months; P = .199). During the follow-up period, one patient died (6%). Conclusions. In our experience, locoregional recurrence of breast cancer is low and similar to the existing standard guidelines. Patients with triple-negative selected tumors showed worst disease-free survival rates (AU)

Estómago de retención gigante por atracones bulímicos / Gigantic gastric retention due to bulimic binge eating

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Una fístula poco frecuente tras mastectomía / A rare leak after mastectomy

La fístula linfática es una complicación poco frecuente tras mastectomía. A continuación se presenta el caso clínico de una paciente con dicha complicación y se discuten las diferentes alternativas terapéuticas (AU)

Chylous leak is a rare complication after breast cancer surgery. We present the case of a patient with a chylous leak and discuss the management options (AU)

[A rare leak after mastectomy]. / Una fístula poco frecuente tras mastectomía.

Chylous leak is a rare complication after breast cancer surgery. We present the case of a patient with a chylous leak and discuss the management options.