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PURPOSE: This study aimed to validate the classification of breast cancer (BC) patients in progression risk groups based on total tumor load (TTL) value to predict lymph node (LN) affectation after neo-adjuvant systemic therapy (NAST) obtained in the NEOVATTL study. METHODS/PATIENTS: This was an observational, retrospective, international, multicenter study including patients with infiltrating BC who received NAST followed by sentinel lymph node biopsy (SLNB) analyzed with one-step nucleic acid amplification (OSNA) from nine Spanish and two Italian hospitals. Patients were classified into three groups according to the progression risk, measured as disease-free survival (DFS), based on TTL values (> 250, 250-25,000, and > 25,000 copies/µL). The previous (NEOVATTL study) Cox regression model for prognosis was validated using prognostic index (PI) and Log ratio test (LRT) analyses; the value of TTL for axillary non-SLN affectation was assessed using receiver operating characteristic (ROC) curves. RESULTS: We included 263 patients with a mean age of 51.4 (± SD 10.5) years. Patients with TTL > 25,000 copies/µL had a shorter DFS (HR 3.561 [95% CI 1.693-7.489], p = 0.0008 vs. TTL ≤ 25,000). PI and LRT analyses showed no differences between the two cohorts (p = 0.2553 and p = 0.226, respectively). ROC analysis showed concordance between TTL and non-SLN involvement (area under the curve 0.828), with 95.7% sensitivity and 92.9% specificity at a TTL cut-off of > 15,000 copies/µL. CONCLUSIONS: In BC patients who had received NAST and underwent SLNB analysis using OSNA, a TTL value of > 25,000 copies/µL was associated with a higher progression risk and > 15,000 copies/µL was predictive of non-SLN involvement.
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Assessment of HER2 biomarker in invasive breast carcinoma patients allows a specific therapeutic approach. Clinical guidelines indicate immunohistochemistry (IHC) and in situ hybridization (ISH) to test HER2, however both have drawbacks which results in low reproducibility of results especially in equivocal cases. Our main objective is to quantify inter-observer IHC reproducibility and cross it with the ISH result. Our series includes 205 invasive breast carcinoma cases sent for ISH retest from 14 hospitals, 5 observers to assess the IHC and 1 observer for ISH of each case. We found that the observers only achieve an absolute agreement for IHC in 1 out of 3 cases. The inter-observer concordance for IHC is low (0.2 ≤ k ≤ 0.4) or moderate (0.41 ≤ k ≤ 0.6). In ISH positive cases the concordance for IHC is higher than in the ISH negative cases. In conclusion, the study shows low and moderate IHC inter-observer concordance, finding the more worrying values among the ISH negative cases which are the most part of this particular sample. Subjective interpretation of the techniques, among other factors, has negative impact in HER2 evaluation. To offset this limitation we have checked that reaching a consensus from different observers for HER2 IHC assessment improves the results.
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Neoplasias de la Mama/metabolismo , Inmunohistoquímica/métodos , Hibridación in Situ/métodos , Receptor ErbB-2/metabolismo , Biomarcadores de Tumor/metabolismo , Neoplasias de la Mama/patología , Consenso , Femenino , Humanos , Invasividad Neoplásica/patología , Variaciones Dependientes del Observador , Reproducibilidad de los ResultadosRESUMEN
Axillary lymph node status at the time of diagnosis is the most important prognostic indicator for women with breast cancer, and may influence management decisions. However, at present its role is controversial, as some groups recommend avoiding axillary lymph node dissection (ALND) in cases with metastasis of any size in the sentinel lymph nodes. Molecular analysis allows full examination of the sentinel lymph nodes in a short time period, discriminatation between macrometastasis, micrometastasis and isolated tumor cells, and helps to predict the performance of ALND. ALND may be the treatment of choice in some patients, even in cases of low-volume metastasis, as chemotherapy does not control regional disease well. In addition, the collection of metastatic cells, as well as the local immune surveillance, is susceptible to further molecular studies that will offer prognostic and predictive information, which may have an impact on therapeutic decisions, so that individualized treatments can be adequately designed.
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Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Ensayos Clínicos como Asunto , Femenino , Humanos , Metástasis Linfática , Estadificación de Neoplasias , Pronóstico , Biopsia del Ganglio Linfático Centinela , Carga TumoralRESUMEN
Dieulafoy's lesion is an uncommon vascular anomaly causing massive gastrointestinal hemorrhage, characterized by bleeding from an arteriole that protrudes through a tiny mucosal defect. Although Dieulafoy's lesion was initially described in the stomach and upper gastrointestinal tract, cases have also been reported in the colon, rectum and anal canal. We report the first case of Dieulafoy's lesion in the gallbladder, which presented as massive peritoneal bleeding. We describe the clinical and pathological characteristics of this unusual entity, as well as the approach to its diagnosis and treatment.
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Arterias/anomalías , Vesícula Biliar/irrigación sanguínea , Hemobilia/etiología , Hemoperitoneo/etiología , Anciano , Humanos , MasculinoRESUMEN
The increase in the detection of occult lesions has led to the development of new localisation methods using radiopharmaceutical products. The use of these products allows us to perform a "thrifty" (less-aggressive) surgical excision and, to simultaneously carry out the biopsy of the sentinel node in cases of breast cancer. On making a search for the most up to date references on this particular topic, we found many articles on radioguided surgery by many leading international work groups. These articles clearly show the advantages of the radioguided surgery method, its effectiveness and attractiveness to surgeons who are very much involved in the search for excellence in their daily work. We also contribute our experience as a functional group, with 413 interventions on occult lesions performed using the radioguided method (ROLL). In 229 cases out of these 413, we found a malignancy (75%); in all these 229 cases it was possible to perform the intervention simultaneously with the biopsy of the sentinel node (SNOLL), during the same surgical act. However the interest created by the new procedure, it is essential to keep a critical but innovative and reflexive mind on this issue, in order to accurately analyze the results obtained by each group. We must remember that these types of methods involve several clinical specialties and, therefore, each one will have to contribute with the highest efficiency.