Evolución de los sarcomas primarios de la mama: nuestra experiencia / Evolution of primary sarcomas of the breast: our experience

Resumen: Los sarcomas primarios de la mama son una rara entidad, representan menos del 1% de los tumores malignos de la mama. La bibliografía reporta pequeñas series, lo cual no proporciona la suficiente información para entender la evolución natural de estos tumores, sin existir consenso definitivo acerca del tratamiento adecuado. Se estudiaron retrospectivamente 13 sarcomas puros de la mama en el Servicio de Ginecología del Hospital Nacional de Clínicas de Córdoba entre marzo 1989 y agosto del 2012. A 12 pacientes se les realizó tratamiento quirúrgico primario y a 1 caso quimioterapia primaria neoadyuvante (en otra institución). Se analizaron edad de los pacientes, diagnóstico preoperatorio, cirugía realizada, diagnóstico definitivo mediante técnicas de inmunohistoquímica (IHQ), tamaño tumoral, características histológicas y terapias adyuvantes realizadas. Nueve de nuestros pacientes recibieron terapia radiante adyuvante y un caso quimioterapia adyuvante específica para tejidos blandos, debido al mal pronóstico tumoral. A la fecha se encuentran 6 pacientes vivos en seguimiento oncológico. Se concluye que los principales inconvenientes serían: Para el diagnóstico correcto definitivo se necesita de la IHQ en casos con problemas. El manejo quirúrgico con márgenes amplios y la utilización de terapias adyuvantes en casos de mal pronóstico son la base del tratamiento. Necesidad de estudios prospectivos multicéntricos para consenso en la toma de conductas terapéuticas definidas.

Utility of 18F-FDG PET/CT in follow-up of patients with low-grade serous carcinoma of the ovary.

OBJECTIVE: Ovarian low-grade serous carcinoma (LGSC) is a rare and indolent tumor. The utility of 18F-FDG PET/CT in monitoring patients with LGSC has not been established. We assessed the accuracy and clinical impact of 18F-FDG PET/CT in patients with ovarian LGSC after initial treatment. METHODS: A retrospective analysis was performed on patients with ovarian LGSC who had undergone 18F-FDG PET/CT scans during follow-up after primary treatment. The impact of 18F-FDG PET/CT on the management plan was assessed. The sensitivity, specificity, and accuracy of 18F-FDG PET/CT findings in the detection of recurrence were calculated. Total lesion glycolysis (TLG) was determined to assess metabolic activity of tumors. Potential prognostic factors for disease-free and overall survival after recurrence were assessed. RESULTS: Forty-eight patients were included in the analysis, 39 with recurrent disease and 9 without recurrence. A total of 91 18F-FDG PET/CT scans were performed, and 30% of these (27/91) had an impact on the management plan. Sensitivity, specificity, and accuracy in the detection of LGSC recurrence were 94%, 100%, and 97%, respectively, for 18F-FDG PET/CT; 89%, 95%, and 93%,respectively, for CT; and 68%, 89%, and 73%, respectively, for serum CA-125. There was no significant difference in sensitivity between PET/CT and CT. Survival after recurrence was poorer in patients with a TLG value greater than 67.7g. CONCLUSIONS: 18F-FDG PET/CT may provide useful information during the follow-up of patients with LGSC after initial treatment. TLG may be a predictor of survival after recurrence.