Intraoperative assessment of sentinel lymph node by one-step nucleic acid amplification in breast cancer patients after neoadjuvant treatment reduces the need for a second surgery for axillary lymph node dissection.

PURPOSE: Sentinel lymph node (SLN) biopsy has been shown to be both accurate and feasible for women who receive neoadjuvant chemotherapy (NAC). Intraoperative assessment of SLN by frozen sections can produce false negative results. The aim of this study was to compare two different techniques of intraoperative assessment of SLN in breast cancer patients treated with NAC: frozen section (FS) and molecular assay (OSNA). METHODS: A multicenter cohort of 320 consecutive breast cancer patients treated with NAC between 2010 and 2014 was analyzed. FS was performed intraoperatively in 166 patients (H&E cohort) and OSNA in 154 patients (OSNA cohort). RESULTS: A mean of 2.15 SLNs by FS and 1.22 SLNs by OSNA was assessed (p = 0.03). SLN metastasis was found in 44 patients (26.5%) by FS and in 48 (31.2%) by OSNA (p = 0.4). There was no statistical significance in rates of macrometastasis (75%), micrometastasis (20.5%) or ITCs (4.5%) when assessed by FS compared to OSNA (52.3%, 36.3% and 11.4%, respectively) (p = 0.06). There were 10 patients in the H&E cohort with positive-SLN in the definitive pathology assessment with negative intraoperative FS. When OSNA and definitive pathology were compared, there were no differences in rates of macrometastasis (61.1%), micrometastasis (33.3%) nor ITCs (5.6%) (p = 0.5). Fifty-four patients in the H&E cohort and 44 in the OSNA cohort had ALND after positive-SLNs. ALND was performed in a second surgery in 10 patients (18.5%) in the H&E cohort for intraoperative FS false negative results, 90% being micrometastasis. 42 out of 44 patients (95.5%) in the OSNA cohort had an ALND in the same surgery (p = 0.03). CONCLUSIONS: OSNA assay detects SLNs metastases as accurately as conventional pathology in the NAC setting. Intraoperative definitive assessment of the SLN by OSNA reduces the need for a second surgery for ALND in 18.5% of breast cancer patients with a positive-SLN after NAC.

Biopsia selectiva del ganglio centinela tras quimioterapia neoadyuvante en el cáncer de mama: resultados del estudio GEICAM 2005-07 / Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study

INTRODUCCIÓN: La utilidad de la biopsia selectiva del ganglio centinela (BSGC) en pacientes con cáncer de mama que precisan quimioterapia neoadyuvante (QTN) es controvertida. Nuestro objetivo es analizar la tasa de detección (TD) y de falsos negativos (FN) de la BSGC tras QTN así como la influencia de la afectación ganglionar inicial y de los protocolos aplicados. MÉTODOS: Estudio prospectivo observacional multicéntrico con mujeres con cáncer de mama tratadas con QTN y a las que se les realizó BSGC tras recibir la QTN y linfadenectomía posterior. Se calcularon las TD y las tasas de FN, tanto globales como dependientes de la afectación ganglionar inicial o del uso de protocolos de diagnóstico pre-BSGC. RESULTADOS: No se demostraron diferencias en la TD entre los casos sin afectación ganglionar inicial y los que sí la tuvieron (89,8 vs. 84,4%; p = 0,437). Sí se encontraron diferencias significativas (94,1 vs. 56,5%; p = 0,002) en el valor predictivo negativo, menor cuando existía afectación ganglionar inicial, y mayor tasa de FN, aunque no de forma significativa (18,2 vs. 43,5%; p = 0,252) en ese mismo supuesto. Un estudio de la axila antes de indicar la BSGC y tras la QTN disminuyó significativamente la tasa de FN en los casos en los que existía afectación inicial (55,6 vs. 12,5; p = 0,009). CONCLUSIONES: La QTN da lugar a una menor TD y a una mayor tasa de FN en la BSGC posterior, sobre todo si hay afectación ganglionar inicial. Los protocolos para la evaluación axilar después de administrar la QTN y antes de la BSGC disminuyen la tasa de FN en estas pacientes

INTRODUCTION: A controversial aspect of breast cancer management is the use of sentinellymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS: Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS: No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P= 0,002) inthe negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS: NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients

Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study.

INTRODUCTION: A controversial aspect of breast cancer management is the use of sentinel lymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS: Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS: No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P=0,002) in the negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS: NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients.

Gigantomastia gravídica asociada a tejido mamario ectópico vulvar / Gestational gigantomastia associated with a vulvar ectopic mammary adenoma

Presentamos el caso de una mujer primigesta, con el antecedente de una mamoplastia de reducción, que desarrolló una gigantomastia asociada a tumoraciones vulvares, que resultaron ser tejido ectópico mamario. A pesar de la baja frecuencia de esta patología, debemos conocerla por la gran repercusión que conlleva para la paciente y el equipo sanitario, con toma de decisiones importantes para la salud y, en ocasiones la vida, de la mujer y el feto (AU)

We report the case of a primigravida who had previously undergone breast reduction and who developed gigantomastia associated with a vulvar adenoma, diagnosed as an ectopic mammary adenoma. Despite its low frequency, physicians should be familiar with this entity due to its major effects on the patient and health team, requiring decisions with important repercussions on the health - and sometimes life - of the woman and fetus (AU)

[Skin-sparing mastectomy: an alternative to conventional mastectomy in breast cancer]. / La mastectomía ahorradora de piel como alternativa a la mastectomía estándar en el cáncer de mama.

Women who require or desire mastectomy for breast cancer one option should be immediate breast reconstruction. Skin-sparing mastectomy (SSM) describes the surgery that maximises breast skin and infra- mammary fold preservation, significantly improves the symmetry and natural appearance and a more satisfied patient. In multiple studies, SSM seems to be oncologically safe in patients undergoing mastectomy for invasive T1-T2 tumours, multicentric tumours, ductal carcinoma in situ or risk-reduction. However, the technique should be avoided in patients with inflammatory breast cancer or in those with extensive tumour involvement of the skin. SSM with nipple areola complex preservation appears to be oncologically safe, providing that the tumour is not close to the nipple and the retro-areolar tissue is free of tumour. Though adjuvant radiotherapy is not an absolute contraindication to SSM, it should be used with caution since it decreases the final cosmetic result.

La mastectomía ahorradora de piel como alternativa a la mastectomía estándar en el cáncer de mama / Skin-sparing mastectomy: an alternative to conventional mastectomy sparing mastectomy: an alternative to conventional mastectomy

En los casos de cáncer de mama donde se requiera o se desee una mastectomía, una opción es la reconstrucción inmediata. La mastectomía ahorradora de piel (MAP) es la que conserva la máxima cantidad de piel y el surco submamario; facilita la reconstrucción inmediata y se consigue mejor simetría, aspecto natural de la mama y mayor satisfacción de la paciente. En múltiples estudios se compara la mastectomía estándar con la MAP y parece que es oncológicamente segura en tumores invasivos (T1-T2), multicéntricos, carcinomas ductales in situ o para reducción de riesgo. Estaría contraindicada en tumores inflamatorios o con amplia afectación de la piel. La MAP con conservación del complejo areola-pezón también parece oncológicamente segura en tumores alejados del pezón y con tejido retroareolar libre de tumor. La radioterapia adyuvante no representa una contraindicación absoluta para la MAP, pero se debería tener precaución pues puede empeorar el resultado reconstructivo (AU)

Women who require or desire mastectomy for breast cancer one option should be immediate breast reconstruction. Skin-sparing mastectomy (SSM) describes the surgery that maximises breast skin and infra- mammary fold preservation, significantly improves the symmetry and natural appearance and a more satisfied patient. In multiple studies, SSM seems to be oncologically safe in patients undergoing mastectomy for invasive T1-T2 tumours, multicentric tumours, ductal carcinoma in situ or risk-reduction. However, the technique should be avoided in patients with inflammatory breast cancer or in those with extensive tumour involvement of the skin. SSM with nipple areola complex preservation appears to be oncologically safe, providing that the tumour is not close to the nipple and the retro-areolar tissue is free of tumour. Though adjuvant radiotherapy is not an absolute contraindication to SSM, it should be used with caution since it decreases the final cosmetic result (AU)

Adecuación de las unidades de mama españolas a los criterios de EUSOMA / EUSOMA requirements for breast cancer units in Spain

Introducción. El planteamiento multidisciplinario del cáncer de mama en unidades especializadas se considera el más adecuado, tanto en el beneficio para la paciente como en el consumo más racional de recursos materiales. Con estas premisas se han elaborado las recomendaciones de la European Society of Mastology (EUSOMA) encaminadas a dotar a todos los países europeos de equipos multidisciplinarios de alta calidad. Material y método. En este trabajo se presentan y se analizan los resultados obtenidos de la encuesta sobre unidades de mama, promovida por la Sección de Patología de la Mama de la Asociación Española de Cirujanos, en 241 hospitales españoles. Resultados. Destaca la elevada implicación de los servicios de cirugía general (131 hospitales) en la atención de la patología mamaria, así como el gran interés por la formación continuada de los cirujanos españoles (el 41,2% de los servicios posee un título de posgrado). En 95 (73,6%) hospitales se planifica el proceso terapéutico, mediante reunión multidisciplinaria regular. Existen protocolos escritos sobre diagnóstico y tratamiento en 119 (90,8%) de los servicios que se dedican a la patología mamaria y se aplican medios para mantener un adecuado control de la calidad asistencial en 83 (63,4%) hospitales. Conclusiones. Resaltamos la necesidad de una normativa española sobre unidades de mama, preferiblemente adaptada a los criterios de EUSOMA, que son los admitidos por el comité encargado del Parlamento Europeo. La Asociación Española de Cirujanos, a través de la Sección de Patología de la Mama, debe ejercer un destacado papel a la hora de acreditar a los médicos de las unidades de mama y potenciar la formación continuada de éstos (AU)

Introduction. The optimal treatment of breast cancer consists of a multidisciplinary approach in specialized units, benefitting patients and leading to more rational resource use. Based on these premises, the European Society of Mastology (EUSOMA) drew up recommendations designed to provide all European countries with high-quality multidisciplinary teams. Material and method. We present and analyze the results obtained from a survey of breast cancer units in 241 Spanish hospitals performed by the Breast Diseases Group of the Spanish Association of Surgeons. Results. Breast disease was treated in general surgery departments in 131 hospitals and Spanish surgeons showed strong interest in continuing training (41.2% had a postgraduate degree in mastology). Multidisciplinary discussions at weekly intervals took place in 95 hospitals (73.6%) hospitals for planning a diagnostic and therapeutic course of action specific for each patient. Written protocols for diagnosis and treatment were used in 119 departments (90.8%) and quality control measures were applied in 83 (63.4%). Conclusions. We stress the need for mandatory requirements in Spain for breast cancer units, preferably adapted to the EUSOMA criteria, which are accepted by the relevant committee of the European Parliament. Through its Breast Diseases Group, the Spanish Association of Surgeons should be involved in accreditation standards for breast surgeons and should promote adequate specialization programs (AU)

[EUSOMA requirements for breast cancer units in Spain]. / Adecuación de las unidades de mama españolas a los criterios de EUSOMA.

INTRODUCTION: The optimal treatment of breast cancer consists of a multidisciplinary approach in specialized units, benefitting patients and leading to more rational resource use. Based on these premises, the European Society of Mastology (EUSOMA) drew up recommendations designed to provide all European countries with high-quality multidisciplinary teams. MATERIAL AND METHOD: We present and analyze the results obtained from a survey of breast cancer units in 241 Spanish hospitals performed by the Breast Diseases Group of the Spanish Association of Surgeons. RESULTS: Breast disease was treated in general surgery departments in 131 hospitals and Spanish surgeons showed strong interest in continuing training (41.2% had a postgraduate degree in mastology). Multidisciplinary discussions at weekly intervals took place in 95 hospitals (73.6%) hospitals for planning a diagnostic and therapeutic course of action specific for each patient. Written protocols for diagnosis and treatment were used in 119 departments (90.8%) and quality control measures were applied in 83 (63.4%). CONCLUSIONS: We stress the need for mandatory requirements in Spain for breast cancer units, preferably adapted to the EUSOMA criteria, which are accepted by the relevant committee of the European Parliament. Through its Breast Diseases Group, the Spanish Association of Surgeons should be involved in accreditation standards for breast surgeons and should promote adequate specialization programs.