Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial.

OBJECTIVE:: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS:: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS:: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION:: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

Prevalence of paresthesia, fatigue, edema and pain after treatment for breast cancer

Objective: To investigate the prevalence of chronic symptoms among patients who underwent breast cancer treatment, and to determine the factors that might be related to these symptoms. Material and Methods: A questionnaire was applied to 87 patients undergoing breast cancer follow-up. It evaluated the length of time since treatment, therapeutic procedure (type of surgery, chemotherapy, radiotherapy and/or endocrine therapy), use of analgesic medication, location and intensity of pain and presence of paresthesia, fatigue and upper-limb edema. Results: The patients’ mean age was 54.46 years; the mean interval between locoregional treatment and the interview was 52.95 months. The prevalence of paresthesia symptoms was 65.5 percent; fatigue, 49.4 percent; edema, 31 percent; and pain, 31 percent. From multivariate analysis, we observed that fatigue was influenced by mastectomy (OR = 2.680; 95 percent CI = 1.127 - 6.373), radiotherapy (OR = 3.028; 95 percent CI = 1.142 - 8.030) and chemotherapy (OR = 5.271; 95 percent CI = 1.067 - 26.034), and was lower among patients who underwent endocrine therapy (OR = 0.407; 95 percent CI = 0.171 - 0.967). Paresthesia, edema and pain were not influenced by any of the therapeutic types. Conclusions: There was high prevalence of complaints among the patients who had undergone breast cancer treatment. Fatigue was the only symptom influenced by the different treatments.

A new chest wall reconstruction: a three-layer technique

Soft tissue sarcomas are rare tumors that represents less than 1% of all neoplasms and only 5.3% of these tumors arises in the chest wall. After resection of these tumors, the defects generated by radical surgery especially when sternum or three or more ribs are resected represent a challenge to the surgeons because of the defect itself and pulmonary physiology alterations. The authors describe a new three-layer technique for chest wall reconstruction, based upon steel stitches, polypropylene mesh and myocutaneous flaps performed in six consecutive patients.

Modified radical mastectomy sparing one or both pectoral muscles in the treatment of breast cancer: intra and postoperative complications.

CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS: The patients demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (+/- 29.9) and 102 minutes (+/- 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (+/- 7.6) for Patey and 19.8 (+/- 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon's discretion.

Modified radical mastectomy sparing one or both pectoral muscles in the treatment of breast cancer: intra and postoperative complications / Mastectomia radical modificada com conservação de um ou de ambos músculos peitorais no tratamento do câncer de mama: complicações intra e pós-operatórias

CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS: The patients' demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (± 29.9) and 102 minutes (± 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (± 7.6) for Patey and 19.8 (± 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon's discretion.

CONTEXTO E OBJETIVO: A mastectomia radical modificada continua a ser amplamente usada para o tratamento de câncer de mama. Porém, até agora, a preservação do músculo peitoral secundário (técnica de Madden) não foi prospectivamente comparada à técnica de Patey. O objetivo deste trabalho foi comparar as duas técnicas de mastectomias radicais modificadas, analisando o grau de dificuldade e as complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado, realizado na Unidade de Mama do Hospital Araújo Jorge, Faculdade de Medicina da Universidade Federal de Goiás, Goiás, Brazil. MÉTODOS: 430 pacientes portadoras de câncer de mama com indicação de mastectomia radical modificada foram incluídas no programa. Foram disponíveis para análise 426 pacientes, das quais 225 alocadas no grupo Patey e 201 no grupo Madden. A análise foi feita por intenção de tratamento, usando-se o Qui-quadrado ou o teste t de Student, quando aplicáveis. RESULTADOS: A distribuição das características demográficas pacientes foi semelhante entre os grupos. A duração média da cirurgia foi de 105 minutos (DP ± 29.9) e 102 (DP ± 33) para o grupo Patey e Madden, respectivamente (p = 0,6). O tempo de internação foi de 2,3 dias para ambos os grupos. A média de linfonodos ressecados foi de 20,3 (DP ± 7,6) para Patey e 19,8 (DP ± 8,1) para Madden (p = 0,5). Não houve diferenças entre as complicações vasculares, nervosas, hematomas, infecções, bem quanto à dificuldade relatada pelo cirurgião. CONCLUSÃO: A retirada do músculo pequeno peitoral não influenciou nenhuma das variáveis estudadas. As técnicas de mastectomias radicais modificadas, Patey e Madden, foram semelhantes em todos os critérios observados, podendo ser executadas de acordo com a preferência do cirurgião.

[Knowledge on screening and diagnosis of breast cancer among gynecologists in Goiãs State (Brazil)]. / Conhecimento sobre o diagnóstico e rastreamento do câncer de mama entre os ginecologistas do estado de Goiãs (Brasil).

OBJECTIVES: To evaluate the knowledge level on the screening and diagnosis of breast cancer among the gynecologists of the State of Goiãs, Brazil. METHODS: Questionnaires containing professional information and questions on breast cancer screening were posted for all the 427 gynecologists associated to the Goiãs Society of Gynecology and Obstetrics, between May and July of 1999. RESULTS: Of the 427 questionnaires, 26 (6%) were returned because incorrect mailing address. Of the 401 doctors who received the questionnaire, 85 (21%) answered and returned them back. Of these, 28% were female; the average of the profession time was of 17 years. The medical residence was the highest title level for 70%. The average age of the doctors was 44 years. The rates of correct answers were: 94% for the knowledge of the most frequent sign of breast cancer, 75% for the best method for screening, 88% for the period of when the mammography begins, 93% for the periodicity of the mammography after the 50 years and 83% about the indication of the complementary ultrasound. The doctors who have studied in a program of medical residence was the only factor that influenced the rate of correct answers, if compared to those that did not cursed it. The professional's gender, the Title in Gynecology and Obstetrics Specialty (TEGO) holders and the city of work did not influence the rates of correct answers. CONCLUSION: The gynecologists of the State of Goiãs who answered the questionnaire have a good knowledge on the screening and diagnosis of breast cancer. Medical residence was the single factor that influenced the rate of correct answers.

Prevenção primária do câncer da mama: informações suficientes para indicá-la / Primary prevention of breast cancer: enough information to be recommended

O Câncer de mama representa grande problema social no nosso meio devido à sua crescente incidência. No presente trabalho são discutidos os fatores de risco para a neoplasia mamária e o enquadramento da paciente nos grupos de risco. É feita extensa revisão, mostrando que a prevenção primária do câncer de mama já é uma realidade, devendo ser indicada. Atividade física, alimentação, uso de moduladores seletivos dos receptores de estrogênio, mastectomia profilática bilateral e ooforectomia são opções que devem ser consideradas e oferecidas às mulheres, caso a caso, de acordo com o risco individual, ajustando o risco/benefício para cada mulher

Conhecimento sobre o diagnóstico e rastreamento do câncer de mama entre os ginecologistas do estado de Goiás (Brasil) / Knowledge on screening and diagnosis of breast cancer among gynecologists from Goiás State (Brazil)

OBJETIVOS: Avaliar o nível de conhecimento sobre o rastreamento e diagnóstico do câncer de mama entre os ginecologistas do Estado de Goiás, Brasil. MÉTODOS: Foi enviado um questionário contendo perguntas sobre a formaçäo profissional e sobre o diagnóstico do câncer de mama, para os 427 sócios da Sociedade Goiana de Ginecologia e Obstetrícia, entre maio e julho de 1999. RESULTADOS: Dos 427 questionários enviados, 26 (6 por cento) foram devolvidos por endereçamento incorreto. Dos 401 médicos que receberam o questionário, 85 (21 por cento) responderam e retornaram. Destes, 28 por cento eram do sexo feminino, a média do tempo de profissäo foi de 17 anos e 70 por cento possuía a residência médica como maior titularidade. A média de idade foi de 44 anos. As taxas de respostas corretas foram: 94 por cento sabiam o sinal mais freqüente do câncer de mama, 75 por cento o melhor método para rastreamento, 88 por cento o período de quando iniciar a mamografia, 93 por cento a periodicidade da mamografia após os 50 anos e 83 por cento sobre a indicaçäo da ultra-sonografia complementar. O fato de o profissional ter cursado um programa de Residência Médica foi o único fator que influenciou na taxa de respostas corretas, se comparado àqueles que näo cursaram. O sexo do profissional, portadores de Título de Especialista em ginecologia e obstetrícia (TEGO) e a cidade de atuaçäo näo influenciaram nas taxas de respostas corretas. CONCLUSÕES: Os ginecologistas do Estado de Goiás que responderam ao questionário têm um bom conhecimento sobre o rastreamento e diagnóstico do câncer de mama, sendo que apenas a Residência Médica influenciou na taxa de respostas corretas

Citometria de fluxo utilizando-se aspirados da PAAF nos tumores da mama / Flow citometry using FNAC aspirates in breast tumors

A citometria de fluxo(CF)tem sido utilizada como fator prognóstico para o câncer de mama; entretanto a confiabilidade do método utilizando-se aspirados obtidos de punção aspirativa por agulha fina(PAAF)permanece controversa. Objetivo: Comparar o coeficiente de variação(CV), o índice de DNA(DNA), a fase de síntese(fase S)e a aneuploidia utilizando-se aspirados provenientes de PAAF com o tecido histológico de peças cirúrgicas arquivado em parafina. Material e métodos: Foram utilizados 44 peças frescas contendo tumores mamários. Em cada peça ex vivo, procedeu-se a duas punções por agulha fina. Posteriormente as peças foram fixadas e incluídas em parafina. Tanto os aspirados quanto o material histológico, desparafinizado, foram preparados para a citometria de fluxo. O exame foi feito utilizando-se um aparelho BD FACScan, com leitura de 10 mil células por exame. Resultados: A média do CV para os aspirados foi de 6,05(+ ou - 1,60)e da peça foi de 6,96(+ ou - 2,13)(p < 0,05). A média do índice de DNA foi de 1,6(+ ou - 0,5)para os aspirados e de 1,49(+ ou - 0,42)para as peças cirúrgicas(NS). A média da fase-S foi de 7,2(+ ou - 6,34) e de 5,85(+ ou - 4,73)para a citologia e para o material histológico, respectivamente (NS). Quanto à aneuploidia, a média nos aspirados foi de 38,2(+ ou -24,7) e de 29,8(+ ou - 20)para a peça cirúrgica(NS). Conclusão: Os aspirados da PAAF são bastante confiáveis para a realização da citometria de fluxo, podendo ser ainda melhores que o material desparafinizado

Carcinoma espinocelular da mama: relato de um caso / Squamous cell carcinoma of the breast tissue: a case report

O carcinoma espinocelular do parênquima mamário é um tipo raro de neoplasia, representando menos de 1 por cento de todos os carcinomas mamários. Esse trabalho relata a conduçäo de um caso diagnosticado e tratado no Serviço de Ginecologia e Mama do Hospital Araújo Jorge/ACCG. Säo discutidos a apresentaçäo clínica, o diagnóstico e o prognóstico destes tumores

Análise da sobrevida de pacientes com câncer de mama localmente avançado submetidas à quimioterapia neo-adjuvante (FACV) / Analysis of the survival of patients with locally advanced breast neoplasm submitted to neoadjuvant chemotherapy (FACV)

Com o objetivo de avaliar a sobrevida de pacientes com câncer de mama localmente avançado, 71 pacientes com carcinoma de mama, estadio clínico III, foram submetidas à quimioterapia neo-adjuvante com o esquema FACV (ciclofosfamida 400 mg/m2, 5-fluorouracil 400 mg/m2, adriamicina 10 mg/m2 e vincristina 1 mg/m2). Foram realizados 6 ciclos, semanalmente, seguidos de mastectomia e mais 11 ciclos quinzenalmente. As curvas de sobrevida foram calculadas pelos estimadores de Kaplan e Meier. Como resultado, a mediana de seguimento das pacientes foi de 24 meses, variando de 1 a 93 meses. Aos 60 meses, a sobrevida livre de recidiva local foi de 60 por cento, a sobrevida livre de doença foi de 26 por cento e a sobrevida total foi de 52 por cento. A mediana de tempo para a recidiva local foi de 14 meses e a mediana de tempo para o aparecimento de metástases foi de 16 meses. Houve 8,5 por cento de abandono de tratamento pré-operatório. Assim, conclui-se que a quimioterapia neo-adjuvante, com o esquema proposto, mostrou ser uma boa alternativa no controle do câncer de mama, com alto índice de adesäo ao tratamento e um controle sistêmico satisfatório para pacientes diagnosticadas com doença localmente avançada.