Brazilian Society of Surgical Oncology consensus on fertility-sparing surgery for cervical cancer.

OBJECTIVE: Several controversies remain on conservative management of cervical cancer. Our aim was to develop a consensus recommendation on important and novel topics of fertility-sparing treatment of cervical cancer. METHODS: The consensus was sponsored by the Brazilian Society of Surgical Oncology (BSSO) from March 2020 to September 2020 and included a multidisciplinary team of 55 specialists. A total of 21 questions were addressed and they were assigned to specialists' groups that reviewed the literature and drafted preliminary recommendations. Further, the coordinators evaluated the recommendations that were classified by the level of evidence, and finally, they were voted by all participants. RESULTS: The questions included controversial topics on tumor assessment, surgical treatment, and surveillance in conservative management of cervical cancer. The two topics with lower agreement rates were the role of minimally invasive approach in radical trachelectomy and parametrial preservation. Additionally, only three recommendations had <90% of agreement (fertility preservation in Stage Ib2, anti-stenosis device, and uterine transposition). CONCLUSIONS: As very few clinical trials have been developed in surgery for cervical cancer, most recommendations were supported by low levels of evidence. We addressed important and novel topics in conservative management of cervical cancer and our study may contribute to literature.

Prospective study evaluating oncological safety of axillary reverse mapping.

BACKGROUND: Axillary reverse mapping (ARM) is a new technique developed with the aim of reducing lymphedema rates by preserving lymphatic drainage of the upper limbs during sentinel lymph node biopsy and axillary lymph node dissection (ALND). However, it is unclear whether preservation of these lymph nodes affects oncological risk. The present study evaluated the presence of metastases in ARM nodes. METHODS: A total of 45 patients underwent ARM during ALND. Blue dye was used for ARM nodes localization. All axillary lymph nodes, including ARM nodes, were removed and sent separately for pathological evaluation of metastases. RESULTS: ARM identification was achieved in 40/45 patients (88.9 %). The average number of removed ARM nodes was 1.9. ARM nodes metastasis occurred in 10 of 40 patients (25 %). Patients with an axilla extensively affected by cancer had an elevated risk of metastasis to the arm's lymph nodes (p < 0.001). CONCLUSIONS: The rate of arm lymph nodes compromised by metastases calls into question the viability of the ARM technique. Larger studies may point to particular patient profiles for which ARM can be safely use.

Comparação de aspectos anatomopatológicos entre ROLL e carvão / Comparison of anatomopathological aspects between ROLL and Carbon localization

Objetivo: Vários métodos são descritos para a localização pré-operatória de lesões de mama clinicamente ocultas que necessitam de estudo histológico. A marcação com ROLL (localização radioguiada de lesões ocultas) utiliza injeção de radiofármaco na lesão oculta e localização intra-operatória com sonda de captação de radiação. A técnica de marcação com carvão consiste na injeção de solução de carvão ativado na lesão e localização visual. Ambas apresentam vantagens e desvantagens. O objetivo desse estudo foi comparar a eficácia entre as técnicas de carvão e ROLL para localização de lesões não palpáveis em relação aos aspectos anatomopatológicos, considerando as variáveis: peso e volume dos espécimes cirúrgicos excisados e alterações morfológicas quanto à resposta inflamatória. Método: Foram avaliados 84 casos mediante revisão retrospectiva de laudos anatomopatológicos e suas respectivas lâminas, 42 casos marcados com técnica ROLL e 42 com a técnica de carvão. As variáveis acima descritas foram comparadas por meio de testes estatísticos, assumindo nível de significância estatística de 5%. Resultados: Peso e volume dos espécimes cirúrgicos foram significativamente menores com a técnica do carvão (p=0,002 para peso e p<0,001 para volume). Quanto à reação inflamatória, observou-se presença de reação inflamatória aguda ou crônica na totalidade dos casos do grupo carvão, enquanto que em um caso do grupo ROLL foi demonstrada infiltração linfocítica (p<0,001). Conclusão: O carvãomostrou-se um marcador eficaz para localização de lesões não palpáveis da mama. Na comparação com a técnica do ROLL permitiu obtenção de espécimes cirúrgicos de menor peso e volume, estando associado à maior reação inflamatória.

Objective: Several methods are described for the preoperatively localization of clinically occult breast lesions that need to be defined histologically. The ROLL technique (radioguided occult lesion localization) uses radiotracer injection in hidden lesion and intraoperative localization with a gamma probe. The carbon marking is the injection of activated carbon in the lesion and visual localization. Both methods have advantages and disadvantages. The objective was to compare the efficacy of carbon marking and ROLL for locating non-palpable lesions by pathological aspects, considering the following variables: weight and volume of surgical specimens and morphological changes as the inflammatory response. Methods: 84 cases were assessed by a retrospective review of pathology reports and their histological H/E stained slides, 42 cases with ROLL and 42 with carbon marking. The variables described above were compared with Fisher exact test and Mann-Whitney test, assuming significance level of 5 %. Results: Weight and volume of surgical specimens were significantly lower with carbon marking (p=0.002 for weight and p<0.001 for volume). In relation of the inflammatory reaction, the presence of acute or chronic inflammatory reaction was observed in all cases of the carbon group, while in only one case of the ROLL group was demonstrated lymphocytic infiltration. Conclusion: The carbon marking is effective marker for locating nonpalpable breast lesions. In comparison with ROLL, allowed obtaining surgical specimens of lower weight and volume, but is associated with the presence of inflammatory reaction.