Accuracy of sentinel node mapping in patients with biopsy-proven metastatic axillary lymph nodes and upfront surgery: preliminary results of the Multimodal Targeted Axillary Surgery (MUTAS) trial.

Background: Some studies suggested that the patients included in the Z0011 trial may represent patients with ultrasound-negative axillary nodes and axillary invasion diagnosed by sentinel node (SN) biopsy. Nevertheless, the National Comprehensive Cancer Network (NCCN) guidelines recommend SN mapping if 1 or 2 suspicious lymph nodes are identified on axillary ultrasound (AU). The aim of this preliminary phase of the Multimodal Targeted Axillary Surgery (MUTAS) trial was to establish the accuracy of SN mapping in patients with axillary involvement undergoing upfront surgery. Methods: Between September 2019 and March 2022, we recruited patients with biopsy-proven metastatic axillary nodes and upfront surgery from a single center. We performed SN mapping in these patients before the surgical intervention, which included axillary lymph node dissection. The biopsy-proven metastatic node, SNs and the remaining axillary nodes were excised separately. SN status was considered representative of the status of the remaining axillary nodes. We calculated the sensitivity, specificity, negative predictive value and positive predictive value of the SN, overall and in patients with palpable nodes, in those with non-palpable nodes and an AU leading to diagnosis of axillary involvement, in those with 1 or 2 suspicious nodes on AU, and in patients with a single suspicious node on AU. We evaluated clinical, imaging and pathology features as predictors of the status of the remaining axillary nodes, false-negatives, and false-positives. Results: We included 25 patients in this phase. The false-negative rate of SN mapping was 28% overall, 21.42% for patients with palpable nodes, 36.36% for patients with non-palpable nodes and an AU diagnosis of axillary involvement, 28.75% for those with 1 or 2 suspicious nodes on AU, and 15.38% in patients with a single suspicious node on AU. The negative predictive value was highest in patients with a single suspicious node on AU (75%). The only significant predictive factor was that FN showed a higher Ki67 index score. Conclusions: In this study, SN mapping was not reliable in patients with biopsy-proven metastatic axillary nodes and upfront surgery for any of the subgroups studied. Further research should elucidate the best staging pathways in these patients to avoid premature de-escalation.

Autoimmune/inflammatory syndrome induced by mineral oil: a health problem.

Autoimmune/inflammatory syndrome induced by adjuvant (ASIA) includes the following conditions: siliconosis, Gulf War syndrome, macrophagic myofasciitis syndrome, and post-vaccination phenomena. Afterward, other syndromes have been recognized, such as in ASIA by mineral oil (ASIA-MO). These conditions are triggered by adjuvants and they are the result of the interplay of genetic and environmental factors. ASIA-MO is defined as the infiltration of oily type modeling substances for cosmetic purposes. It has been reported in many countries and used surreptitiously. Pathogenesis of ASIA-MO is not clear, but is characterized by chronic granulomatous inflammation, like the pristane model in mice, with increase of proinflammatory cytokines: type I interferons (IFNα and IFNß), systemic lupus erythematosus (SLE), and erosive arthritis. In humans, an increase of interleukin 1 (IL-1) has been found. Clinical spectrum of ASIA-MO is heterogeneous, varying from mild to severe and being local and systemic. The systemic manifestations can be non-specific and specific, meeting criteria for any autoimmune disease (AID), i.e., SLE, rheumatoid arthritis, and systemic sclerosis, among others. The areas of the body where the mineral oil is mostly applied include the following: buttocks (38-72%), breasts (12-16%), lower extremities (18-22%), and face (6-10%). The penis augmentation is also common. Treatment is focused on local and systemic manifestations and requires medical and surgical management representing a challenge for the physician.

Análisis de las cofras de ácido lactico en el líquido cefalorraquideo en pacientes con síndrome neurológico infeccioso / Analysis of lactic acid figures in the cerebrospinal fluid of patients with infectious neurologic syndrome

Se realizó la determinación de lactato en todos los líquidos cefalorraquídeos (LCR) que se obtuvieron por punción lumbar a los pacientes que acudieron al Cuerpo Guardia con síntomas sospechosos de infección del sistema nervioso central (SNC) en el período comprendido entre el 15 de febrero al 30 de abril de 1985; se analizaron un total de 177 LCR. Los resultados obtenidos fueron los siguientes: en pacientes sin infección del SNC los valores del lactato fluctuaron de 1,0 a 2,44 mmol/L y en los pacientes con meningoencefalitis viral de 1,1 a 2,77 mmol/L. Estas cifras contrastan con las encontradas en pacientes con infección del SNC bacteriana, donde encontramos valores de 2,2 a 5,11 mmol/L, por lo que se concluye que no se constatan prácticamente diferencias entre las cifras de ácido láctico en el LCR de pacientes sin infección del SNC y en los que tienen infección viral del SNC; se observa que las cifras de lactato en el LCR son más elevadas en las meningoencefalitis bacterianas que en las virales; por tanto, se considera que dicha investigación resulta de utilidad para establecer el diagnóstico diferencial entre las infecciones bacteriana y virales del SNC. Se sugiere la posibilidad de que esta investigación pueda ser útil para establecer criterios de pronóstico