Total versus inhaled intravenous anesthesia methods for prognosis of patients with lung, breast, or esophageal cancer: A cohort study.

Objective: To explore the influences of total intravenous anesthesia (TIVA) and inhaled-intravenous anesthesia on the prognosis of patients with lung, breast, or esophageal cancer. Methods: In this retrospective cohort study, patients with lung, breast, or esophageal cancer who underwent surgical treatments at Beijing Shijitan Hospital between January 2010 and December 2019 were included. The patients were categorized into the TIVA group and inhaled-intravenous anesthesia group, according to the anesthesia methods used for the patients for surgery of the primary cancer. The primary outcome of this study included overall survival (OS) and recurrence/metastasis. Results: Totally, 336 patients were included in this study, 119 in the TIVA group and 217 in the inhaled-intravenous anesthesia group. The OS of patients in the TIVA group was higher than in the inhaled-intravenous anesthesia group (P = 0.042). There were no significant differences in the recurrence/metastasis-free survival between the two groups (P = 0.296). Inhaled-intravenous anesthesia (HR = 1.88, 95%CI: 1.15-3.07, P = 0.012), stage III cancer (HR = 5.88, 95%CI: 2.57-13.43, P < 0.001), and stage IV cancer (HR = 22.60, 95%CI: 8.97-56.95, P < 0.001) were independently associated with recurrence/ metastasis. Comorbidities (HR = 1.75, 95%CI: 1.05-2.92, P = 0.033), the use of ephedrine, noradrenaline or phenylephrine during surgery (HR = 2.12, 95%CI: 1.11-4.06, P = 0.024), stage II cancer (HR = 3.24, 95%CI: 1.08-9.68, P = 0.035), stage III cancer (HR = 7.60, 95%CI: 2.64-21.86, P < 0.001), and stage IV cancer (HR = 26.61, 95%CI: 8.57-82.64, P < 0.001) were independently associated with OS. Conclusion: In patients with breast, lung, or esophageal cancer, TIVA is preferable than inhaled-intravenous anesthesia group for longer OS,, but TIVA was not associated with the recurrence/metastasis-free survival of patients.

Anestesia total intravenosa en la cirugía oncológica de mama / Total intravenous anesthesia in oncologist breast surgery

Introducción: El cáncer es la principal causa de muerte. Cada año se diagnostican millones de mujeres con cáncer de mama que necesitan tratamiento quirúrgico, para lo cual la anestesia total intravenosa parece ser una excelente opción. Objetivo: Describir los resultados de la aplicación de la anestesia total intravenosa en las pacientes a las que se les efectuó cirugía oncológica de mama. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal, prospectivo, en el Servicio de Anestesiología del Hospital General Docente "Abel Santamaría Cuadrado" en el período comprendido entre enero de 2013 y enero de 2015. Se estudió una población accesible de 111 pacientes seleccionados mediante criterios de inclusión y exclusión. Para el análisis estadístico se utilizaron distribuciones de frecuencias, cálculo de medidas de tendencia central y de dispersión. Algunas de las variables fueron tensión arterial, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación, respuesta analgésica. Resultados: Se logró gran estabilidad hemodinámica en más del 95 por ciento de las pacientes. Se detectó superficialidad anestésica en 1,80 por ciento de los casos. El 92,80 por ciento de los casos se recuperaron entre 10 y 20 min. Se presentó sedación adecuada en 106 pacientes. Las principales complicaciones fueron las náuseas y los vómitos en 9,01 por ciento. Existió una adecuada respuesta analgésica en 93,69 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía oncológica de mama arrojó resultados muy satisfactorios como método anestésico(AU)

Introduction: Cancer is the leading cause of death worldwide. Every year millions of women are diagnosed with breast cancer and they need surgical treatment, for which total intravenous anesthesia seems to be an excellent option. Objective: Describe the results of the application of total intravenous anesthesia in patients undergoing oncological breast surgery. Methods: An observational, descriptive, longitudinal, prospective study was conducted in the Anesthesiology Service of "Abel Santamaría Cuadrado" Hospital in the period between January 2013 and January 2015. An accessible population of 111 patients selected using inclusion and exclusion criteria was studied. For the statistical analysis, frequency distributions, calculation of measures of central tendency and dispersion were used. Some of the variables were blood pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, analgesic response. Results: High hemodynamic stability was achieved in more than 95 percent of the patients. Anesthetic superficiality was detected in 1.80 percent of cases. 92.80 percent of the cases recovered after 10 to 20 minutes. Adequate sedation was present in 106 patients. The main complications were nausea and vomiting in 9.01 percent There was an adequate analgesic response in 93.69 percent of the cases. Conclusions: The application of total intravenous anesthesia for oncological breast surgery yielded very satisfactory results as an anesthetic method(AU)

[Costs of intravenous vs. subcutaneous administration of trastuzumab in peruvian patients with HER2-positive breast cancer - An observational analysis of direct and indirect costs]. / Costos de la administración intravenosa vs. subcutánea del trastuzumab en pacientes peruanas con cáncer de mama HER2 positivo. Un análisis observacional de los costos directos e indirectos.

ANTECEDENT AND OBJECTIVE: In Peru, the presentation of TZM-IV and TZM-SC is carried out. But there is no comparative cost data by route of administration. The objective of our study was to know the costs of patients with breast cancer, comparing the routes of administration in a regional cancer center in Peru. MATERIAL AND METHODS: In 2020, patients who were prescribed TZM treatment were prospectively recorded clinical, demographic and transport data, and medical costs were obtained from medical history and pharmacy records. With these data, the simulation was performed in 100 patients who received 18 cycles of the drug. RESULTS: The main contributor to the cost of the difference was the cost of the drug itself, being S/. 4,711.11 (1,323.35 USD) and S/. 4,680.30 (1,314.69 USD) for TZM-IV and TZM-SC, respectively. The administration costs to treat 100 patients with complete cycles of TZM-IV and TZM-SC were S/. 334,488.53 (93,957.45 USD) and S/.207,455.33 (58,873.97 USD), respectively. Indirect costs indicate that patients lost in total, S/. 1,123.28 (315.53 USD) and S/. 1,148.60 (322.64 USD) in TZM-IV and TZMSC per patient, respectively. CONCLUSIONS: The use of TZM-SC is recommended, in the scenario of a lower cost of the drug and a shorter duration of administration time. Especially in a country with low funding, which only allows subsidizing the direct costs of cancer treatment.

Spindle Cell Metaplastic Breast Carcinoma.

INTRODUCTION: Metaplastic breast carcinoma is an uncommon malignancy that constitutes < 5% of all breast cancers. There are 5 subtypes which are spindle cell, squamous cell, carcinosarcoma, matrix-producing and metaplastic with osteoclastic giant cells. Spindle cell carcinoma represents approximately <0.3% of invasive breast carcinomas. It is typically a triple-negative cancer with distinct pathological characteristics, but relatively a non-conclusive on imaging findings. CASE REPORT: An elderly lady presented with an enlarging painful left breast lump for one year. Palpable left breast lump was found on clinical examination. Mammography demonstrated a high density, oval lesion with a partially indistinct margin. Corresponding ultrasound showed a large irregular heterogeneous lesion with solid-cystic areas. Histopathology showed atypical spindle-shaped cells that stained positive for cytokeratins and negative for hormone and human epidermal growth factor receptors, which favoured spindle cell metaplastic carcinoma. Left mastectomy and axillary dissection were performed, and the final diagnosis was consistent with metaplastic spindle cell carcinoma. CONCLUSION: Spindle cell carcinoma of the breast is a rare and aggressive histological type of carcinoma, which may present with benign features on imaging. Tissue diagnosis is essential for prompt diagnosis with multidisciplinary team discussion to guide management and improve patient's outcomes.

The Heparan Sulfate Binding Peptide in Tumor Progression of Triple-Negative Breast Cancer.

Angiogenesis is the formation of new vessels from pre-existing vasculature. The heparan sulfate chains from endothelial cell proteoglycans interact with the major angiogenic factors, regulating blood vessels´ formation. Since the FDA´s first approval, anti-angiogenic therapy has shown tumor progression inhibition and increased patient survival. Previous work in our group has selected an HS-binding peptide using a phage display system. Therefore, we investigated the effect of the selected peptide in angiogenesis and tumor progression. The HS-binding peptide showed a higher affinity for heparin N-sulfated. The HS-binding peptide was able to inhibit the proliferation of human endothelial umbilical cord cells (HUVEC) by modulation of FGF-2. It was verified a significant decrease in the tube formation of human endothelial cells and capillary formation of mice aorta treated with HS-binding peptide. HS-binding peptide also inhibited the formation of sub-intestinal blood vessels in zebrafish embryos. Additionally, in zebrafish embryos, the tumor size decreased after treatment with HS-binding peptide.

Transcriptome and genome evolution during HER2-amplified breast neoplasia.

BACKGROUND: The acquisition of oncogenic drivers is a critical feature of cancer progression. For some carcinomas, it is clear that certain genetic drivers occur early in neoplasia and others late. Why these drivers are selected and how these changes alter the neoplasia's fitness is less understood. METHODS: Here we use spatially oriented genomic approaches to identify transcriptomic and genetic changes at the single-duct level within precursor neoplasia associated with invasive breast cancer. We study HER2 amplification in ductal carcinoma in situ (DCIS) as an event that can be both quantified and spatially located via fluorescence in situ hybridization (FISH) and immunohistochemistry on fixed paraffin-embedded tissue. RESULTS: By combining the HER2-FISH with the laser capture microdissection (LCM) Smart-3SEQ method, we found that HER2 amplification in DCIS alters the transcriptomic profiles and increases diversity of copy number variations (CNVs). Particularly, interferon signaling pathway is activated by HER2 amplification in DCIS, which may provide a prolonged interferon signaling activation in HER2-positive breast cancer. Multiple subclones of HER2-amplified DCIS with distinct CNV profiles are observed, suggesting that multiple events occurred for the acquisition of HER2 amplification. Notably, DCIS acquires key transcriptomic changes and CNV events prior to HER2 amplification, suggesting that pre-amplified DCIS may create a cellular state primed to gain HER2 amplification for growth advantage. CONCLUSION: By using genomic methods that are spatially oriented, this study identifies several features that appear to generate insights into neoplastic progression in precancer lesions at a single-duct level.

Pain mapping and characteristics in breast cancer survivors during task-oriented training: analysis at 3, 6, and 9 months.

PURPOSE: To evaluate the frequency and characteristics of trunk and upper limb pain in women diagnosed with breast cancer, in different movement planes, during task-oriented training (TOT) 3, 6, and 9 months after surgery. METHODS: A prospective cohort study with 20 women. The body pain diagram (BPD), VAS, and McGill questionnaire were used. The TOT consisted of 20 exercises based on the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) questionnaire. BPD overlay was performed in GIMP® image editor. The chi-square test was applied to the relationship between population characteristics and pain. Freedman's ANOVA and the Cochran's Q test were used in the comparison of pain site frequencies and intensity over time. RESULTS: In total, 297 BPDs were generated, which identified the affected upper limb as the body area with the highest frequency of pain at the three moments. However, at 9 months, the unaffected upper limb presented the same frequency as the affected limb. Radiotherapy presented a statistically significant relationship (p < 0.05) with pain at 9 months. The pain was characterized as moderate at the three moments, affective at 3 and 6 months, and sensory at 9 months. CONCLUSION: The most frequent area of pain at 3 and 6 months was the affected upper limb however, at 9 months, the unaffected upper limb presented the same frequency of pain as the affected upper limb. Pain was characterized as moderate at the three evaluation moments.

Mouse Mammary Tumor Virus (MMTV)-Like env Sequence in Brazilian Breast Cancer Samples: Implications in Clinicopathological Parameters in Molecular Subtypes.

Background: Breast cancer (BC) is a complex disease in which susceptibility and clinical course depend on multiple factors. Evidence suggests that a mouse mammary tumor virus (MMTV)-homolog may be present in human BCs; however, little is known about its clinical implications. Methods: MMTV-like env nucleotide-sequence was searched in tumor and tumor-adjacent tissues from 217 Brazilian BC patients through nested-PCR and confirmed through PCR-sequencing. Blood samples were also tested for patients with MMTV-like env gene-positive tumors. Correlations with clinicopathological parameters were evaluated. Results: MMTV-like env sequence was detected in tumor and tumor-adjacent tissue samples from 41/217 and 30/196 patients, respectively. In blood, MMTV-like was detected in 17/32 patients. In Luminal-B tumors, MMTV-like in tumor tissue was negatively correlated with tumor size and disease stage, whereas in HER2 tumors it anti-correlated with lymph node metastasis (LNM) and disease stage. Considering blood, MMTV-like env gene positivity negatively correlated with age in general BC, while in Luminal-A tumors it positively correlated with Ki67 but negatively correlated with age and LNM. The associations with decreased LNM frequency were independent of other prognostic factors. Conclusion: MMTV-like env positivity is associated with better prognostic parameters in BC subtypes, which might be explainable by its anti-metastatic potential and by putative activation of immune milieu.

Iniquidade social e câncer de mama feminino: análise da mortalidade / Social iniquity and breast cancer in women: mortality analysis

Resumo Introdução Apesar das ações para prevenção, o câncer de mama (CAM) no Brasil apresenta elevada mortalidade, provavelmente devido à identificação do tumor em estádios avançados. Objetivo Analisar a mortalidade por CAM nas microrregiões de saúde de Minas Gerais (MG), de 2013 a 2017 e sua possível associação com a desigualdade social. Método Estudo ecológico, cuja unidade de análise foram as microrregiões de saúde de MG. Dados de mortalidade, sociodemográficos e de saúde foram extraídos do SIM, IBGE, PROADESS e DATASUS. Foram calculadas taxas de mortalidade específicas e padronizadas por idade, construídos mapas temáticos e realizadas análises estatísticas utilizando o Índice de Moran e a regressão simples e múltipla. Resultados De 2013 a 2017, ocorreram em MG 7.571 óbitos por CAM. As microrregiões com maior mortalidade estão localizadas no Centro e Leste e, com menor, no Norte e Nordeste. A maioria das variáveis apresentaram alto coeficiente de variação e foram significativas no modelo de regressão linear simples. Nos modelos múltiplos distal e proximais, somente o grau de urbanização foi significativa. Todas as variáveis apresentaram autocorrelação espacial significativa e dependência espacial. Conclusão Altas taxas de mortalidade nas microrregiões mais urbanizadas podem ser explicadas por fatores reprodutivos, comportamentais e distribuição dos recursos de saúde, presentes nos grandes centros urbanos.

Abstract Introduction Despite the preventive actions, breast cancer (BC) in Brazil has a high mortality, probably due to the identification of the tumor in advanced stages. Objective To analyze mortality from BC in the health micro-regions of Minas Gerais (MG), 2013-2017, and its possible association with social inequality. Method Ecological study, whose unit of analysis was the health micro-regions of MG. Mortality, sociodemographic and health data were extracted from SIM, IBGE, PROADESS, and DATASUS. Specific and age-standardized mortality rates were calculated, thematic maps were constructed, and statistical analyzes were performed using the Moran Index and multiple simple regression. Results From 2013-2017 there were 7,571 deaths from BC in MG. The deadliest microregions are in the Center and East; the smallest in the North and Northeast. Most variables had a high coefficient of variation and were significant in the simple linear regression model. In the multiple distal and proximal models, only the degree of urbanization was significant. All variables showed significant spatial autocorrelation and spatial dependence. Conclusion High mortality rates in the most urbanized micro-regions can be explained by reproductive, behavioral factors and the distribution of health resources, present in large urban centers.

Proprioceptive neuromuscular facilitation in the functionality and lymphatic circulation of the upper limb of women undergoing breast cancer treatment.

BACKGROUND: With the increase in survival of women treated for breast cancer, it is necessary to evaluate the effect of therapeutic resources on co-morbidities resulting from the surgical treatment of the disease. The aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation on the functionality and lymphatic circulation of the upper limb involved in the treatment of breast cancer. METHODS: The study was conducted according to randomized clinical trial design. Thirty-two women at a mean age of 52.20 (±8.32) years, submitted to breast cancer treatment, divided into two groups, control - women submitted to standard breast cancer treatment, and treated group, composed of women who underwent breast cancer treatment and rehabilitation with the proprioceptive neuromuscular facilitation technique. Palmar grip strength with dynamometer and shoulder range of motion with goniometer were evaluated. Lymphatic circulation analysis was performed in a computerized scintillation chamber, before and after therapeutic intervention. FINDINGS: In the results obtained, a significant increase (p < 0.05) of palmar grip strength was observed, a significant increase in range of motion of flexion (p < 0.001), extension (p < 0.0012), abduction (p < 0.0001), external rotation (p < 0.0001), internal rotation (p < 0.0001), and not significant for lymphatic flow (p > 0.05). INTERPRETATION: The results obtained in this study allow us to conclude that proprioceptive neuromuscular facilitation favors an increase in muscle strength, range of motion, but not in lymphatic flow, in women undergoing surgical treatment for breast cancer.

Mammography correlates to better survival rates in breast cancer patients: a 20-year experience in a University health institution.

Breast cancer (BC) is the most common malignancy in women. We retrieved medical records from >2,000 Chilean BC patients over the 1997-2018 period. The objective was to assess changes in clinical presentation or prognosis of our patients throughout these 20 years of practice. Although most variables did not display significant variations, we observed a progressive increase in stage IV BC over this period. Our data showed that tumour stage III/IV or HER2-enriched subtype tumours were associated with poorer prognosis. In contrast, we found that patients diagnosed by mammography had better overall survival. We speculate that better screenings and more sensitive imaging could explain the unexpected rise in stage IV cases. Our results support mammography screenings as an effective measure to reduce BC-related mortality.

Educational Case: Invasive Ductal Carcinoma of the Breast.

The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.

Regenerated oxidised cellulose versus calcium alginate in controlling bleeding from malignant breast cancer wounds: randomised control trial study protocol.

OBJECTIVE: Malignant wounds due to breast cancer can present with recurrent episodes of bleeding in the tumour tissue. This study will compare the efficacy of a calcium alginate dressing (Biatain, Coloplast A/S, Denmark) and a regenerated oxidised cellulose dressing (Surgicel, Ethicon, LLC, Puerto Rico). PROTOCOL: A total of 24 patients with breast cancer and bleeding, malignant wounds will be enrolled in the randomised, controlled, open study, conducted at a hospital specialising in breast cancer treatment and at another hospital specialising in palliative care. Patients over 18 years old, with bleeding and willing to undergo venipuncture for blood collection will be included. All enrolled patients will be randomised for allocation to an experimental group (regenerated oxidised cellulose dressing) or a control group (calcium alginate dressing). The main intervention will consist of the application of the haemostatic product, assessment of digital pressure and estimation of the time required for haemostasis. OUTCOMES: Key outcome measures will be the percentage of patients with haemostasis within 20 minutes, observation of haemostasis after three, five and 10 minutes, in addition to recurrence of bleeding and the quantity of product used. DISCUSSION: To our knowledge, this is the first study to evaluate the effectiveness of haemostatic products in malignant wounds. This type of wound is poorly explored in the literature and, among its signs and symptoms, bleeding is poorly studied. The completion of this study will provide a more robust rationale for clinical decision-making related to the control of bleeding in malignant breast cancer wounds in the context of evidence-based nursing practices.

Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials.

OBJECTIVE: The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched. METHODS: Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45-2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4-2.4). CONCLUSION: Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.

Cosmesis in patients with breast neoplasia submitted to the hypofractionated radiotherapy with of intensity-modulated beam

SUMMARY OBJECTIVE: To assess the cosmetic satisfaction of patients diagnosed with breast cancer submitted to the hypofractionated radiotherapy with IMRT (hIMRT) technique and its correlation with dosimetric data of the radiotherapy planning. MATERIALS AND METHODS: The retrospective cohort study that assessed women with a diagnosis of malignant breast neoplasia submitted to the conservative treatment or radical mastectomy and treated with hIMRT. In the period between August 2007 to December 2014, in a philanthropic / private institution, 170 records were selected. The cosmetic assessment was carried out by means of the Harvard/RTOG/NSABP scale with one-year minimum range after treatment. The collected dosimetric data were: breast / chest wall volume, volume that received 95% (V95%) and 107% (V107%) of the prescribed dose. RESULTS: The volume of the treated breasts ranged from 169 to 2.103 ml (median = 702; IQR: 535 to 914 ml). Median V95% was 86.7% (54.6-96.6%; IQR: 80.0% to 90.6%); eight (5.7%) patients had V95% higher than 95%. Median V107% was 0% (0%-16.3%; IQR: 0.0% to 0.3% and 13); 9.3% patients had V107% higher than 2%. One hundred and thirty-three (78.2%) patients responded to the cosmetic assessment: 99 (74.4%) considered the cosmetic results excellent. Significant associations between cosmetic assessment and breast volume (p=0.875), V95% (p=0.294) e V107% (p=0.301) were not found. CONCLUSION: The cosmetic results showed favorable when using hIMRT, and the lack of correlation with usual the dosimetric data illustrates the capacity of hIMRT to minimize the heterogeneity of the dose in this endpoint, even in voluminous breasts.

RESUMO OBJETIVO: Avaliar a satisfação cosmética de pacientes diagnosticadas com câncer de mama submetidas à radioterapia hipofracionada com técnica IMRT (hIMRT) e sua correlação com dados dosimétricos do planejamento radioterápico. MATERIAIS E MÉTODOS: Estudo de coorte retrospectivo que avaliou mulheres com diagnóstico de neoplasia maligna de mama submetidas a tratamento conservador ou mastectomia radical e tratadas com hIMRT. No período de agosto de 2007 a dezembro de 2014, em uma instituição filantrópica/particular, foram selecionados 170 prontuários. A avaliação cosmética foi feita por meio da escala de Harvard/RTOG/NSABP com um intervalo mínimo de um ano após o tratamento. Dados dosimétricos coletados foram: volume da mama/plastrão, volume que recebeu 95% (V95%) e 107% (V107%) da dose prescrita. RESULTADOS: O volume das mamas tratadas variou de 169 a 2.103 ml (mediana = 702; IQR: 535 a 914 ml). O V95% mediano foi 86,7% (54,6-96,6%; IQR: 80,0% a 90,6%); oito (5,7%) pacientes tiveram o V95% superior a 95%. O V107% mediano foi 0% (0%-16,3%; IQR: 0,0% a 0,3% e 13); 9,3% pacientes tiveram o V107% superior a 2%. Cento e trinta e três (78,2%) pacientes responderam à avaliação cosmética: 99 (74,4%) consideraram o resultado cosmético excelente. Não foram encontradas associações significativas entre a avaliação cosmética e o volume da mama (p=0,875), V95% (p=0,294) e V107% (p=0,301). CONCLUSÕES: Os resultados cosméticos mostraram-se favoráveis com o uso de hIMRT, e a ausência de correlação com os dados dosimétricos usuais ilustra a capacidade do hIMRT em minimizar a heterogeneidade da dose neste desfecho, mesmo em mamas volumosas.

O Grupo de Suporte como espaço promotor de holding para mulheres com câncer de mama / The Suport Group as a holding promoter for women with breast cancer / Le Groupe de Soutien comme espace promoteur de holding pour des femmes ayant un cancer du sein / El Grupo de Apoyo como un espacio de promoción de sostén (holding) entre mujeres con cáncer de mama

Fundamentado na psicanálise e no conceito de suporte social, este trabalho busca explorar as repercussões psíquicas do adoecimento de mulheres com câncer de mama e o potencial de reintegração do Grupo de Suporte. Os resultados apontam para o fortalecimento das defesas psicossomáticas, através dos vínculos estabelecidos no Grupo, considerado um espaço promotor de holding, por propiciar suporte social, compartilhamento de sentimentos e melhor integração entre psíquico e somático, possibilitando a reinserção social e o enfrentamento da doença.

Anchored on psychoanalysis and on the concept of social support, this paper aims to explore the psychic repercussions of the illness of women with breast cancer and the reintegration potential by the Support Group. The results point to the strengthening of the women's psychosomatic defenses, by means of the ties created in the Group, regarded as a space that promotes holding, by providing social support, sharing of feelings and better psychological and somatic integration, making social reintegration and the confrontation of the disease possible.

Sur la base de la psychanalyse et du concept de soutien social, ce travail vise à explorer les répercussions psychologiques de la maladie des femmes atteintes du cancer du sein et de la réinsertion potentielle du Groupe de Soutien. Les résultats indiquent un renforcement des défenses psychosomatiques à travers des liens établis au sein du groupe, considéré comme un espace promoteur de maintien, pour apporter un soutien social, partage de sentiments et une meilleure intégration entre le psychique et le somatique, rendant ainsi possible la réinsertion sociale et la lutte contre la maladie.

Basado en el psicoanálisis y en el concepto de apoyo social, este trabajo pretende explorar las repercusiones psíquicas, entre las mujeres, repercusiones provenientes del diagnóstico de cáncer de mama, y el potencial de reintegración del Grupo de Apoyo. Los resultados apuntan al fortalecimiento de las defensas psicosomáticas de las mujeres, a través de los vínculos establecidos dentro del Grupo, que es considerado un espacio que promueve el sostén (holding) al proporcionar apoyo social, permitir compartir sentimientos y promover una mejor integración entre lo psíquico y lo somático, haciendo posible la reintegración social y el manejo de la enfermedad.

Basierend auf die Psychoanalyse und auf das Konzept der sozialen Unterstützung, zielt diese Arbeit darauf ab, die psychischen Auswirkungen der Erkrankung bei Frauen mit Brustkrebs und das Wiedereingliederungspotential einer Unterstützungsgruppe zu erforschen. Die Ergebnisse deuten darauf hin, dass die psychosomatische Widerstandskraft der Frauen durch die in der Gruppe geknüpften Verhältnisse gestärkt wurde. Die Gruppe wird als Raum beschrieben, der das Holding fördert, da sie soziale Unterstützung leistet, es erlaubt Gefühle zu teilen, die Integration psychologischer und somatischer Aspekte fördert, die soziale Wiedereingliederung ermöglicht und den Patientinnen hilft, die Krankheit zu konfrontieren.

Precursor Lesions of the Low-Grade Breast Neoplasia Pathway.

The nonobligate precursor lesions columnar cell change/hyperplasia and flat epithelial atypia, atypical ductal hyperplasia and atypical lobular hyperplasia, lobular carcinoma in situ, and low-grade ductal carcinoma in situ share morphologic, immunophenotypic, and molecular features supporting the existence of a low-grade breast neoplasia pathway. The practical implication for pathologists is that the identification of one of these lesions should prompt careful search for others. From a clinical management perspective, however, their designation as "precursor lesions" should not be overemphasized, as the risk of progression among the earliest lesions is exceedingly low. Factors determining which lesions will progress remain unknown.

Changes in social function and body image in women diagnosed with breast cancer undergoing chemotherapy / Alterações na função social e imagem corporal de mulheres com câncer de mama em quimioterapia

The objective of this study was to investigate the impairment of social and emotional functions, body image and future perspective in women with breast cancer undergoing chemotherapeutic treatment. This is a longitudinal research conducted from October 2012 to October 2013 at the chemotherapy unit of a private institution of Oncology located in Curitiba, PR, Brazil. Sociodemographic and clinical questionnaires were applied, Quality of Life Questionnaire Core 30 e Quality of Life Questionnaire ­ Breast Cancer Module, to 48 women subjected for the first time to chemotherapy, in three different stages of the treatment. Analysis with Friedman`s, Spearman and Kruskal -Wallis nonparametric tests was performed. Changes were observed in social function and body image, which compromised quality of life significantly. Results can subsidize the planning of and adjustments to the care provided to these women by considering the perception about the impact of therapy on QL and their perspectives.

O objetivo deste estudo foi investigar o comprometimento da função social, emocional, imagem corporal e perspectiva futura de mulheres com câncer de mama submetidas ao tratamento quimioterápico. Pesquisa longitudinal, realizada em Outubro de 2012 a Outubro de 2013, na unidade de quimioterapia de instituição privada de Oncologia situada em Curitiba-PR, Brasil. Aplicaram-se questionários sociodemográfico e clínico, Quality of Life Questionnaire Core 30 e Quality of Life Questionnaire ­ Breast Cancer Module a 48 mulheres submetidas pela primeira vez à quimioterapia em três etapas diferentes do tratamento. Realizou-se análise com testes não paramétricos de Friedman, Spearman e Kruskal-Wallis. Alterações foram percebidas na função social e imagem corporal que comprometeram significativamente a qualidade de vida. Os resultados podem subsidiar o planejamento e ajustes no cuidado a essas mulheres ao considerar a percepção do impacto da terapêutica na QV nas suas perspectivas.

Estadiamento e grau de resiliência do sobrevivente ao câncer de mama / Staging and resilience degree in breast cancer survivors / Estadificación y grado de resiliencia del sobreviviente de cáncer de mama

Objective: To assess the resilience and staging degree relating to sociodemographic factors of breast cancer survivors followed up in an oncology service. Method: Quantitative study with 112 breast cancer survivors.The variables selected were: sociodemographic; clinical staging; survival time; and resilience scale. The analysis was performed using the Epi Info 6.04 software and Fisher’s exact test. The research was approved by the Ethics Committee of the Federal University of Pelotas School of Nursing under Opinion Nº 31/2009. Results: The average age was 46.2 years, there was 60.71% of stage IIcases, 81.25% were white, 40.18% had five-to eight-year schooling, 52.68% were married, 73.32% had lived in urban areas, 41.96% exhibited high resilience, and 48.21% were followed up from one to three years. Conclusion: Staging was not associated with the resilience degree, but rather with age and survival time, confirming the findings of other studies.

Objetivo: Investigar o grau de resiliência e de estadiamento frente aos fatores sociodemográficos dos sobreviventes ao câncer de mama em acompanhamento em um serviço de oncologia. Método: Estudo quantitativo com amostra de 112 sobreviventes ao câncer de mama. Foram selecionadas variáveis sociodemográficas, estadiamento clínico, tempo de sobrevida e escala de resiliência. A análise foi realizada utilizando o software Epi Info 6.04 e o teste exato de Fisher. A pesquisa foi aprovada pelo Comitê de Ética da Faculdade de Enfermagem da Universidade Federal de Pelotas sob o Parecer nº 31/2009. Resultados: A média de idade foi de 46,2 anos, houve 60,71% de estadiamento II, 81,25% eram brancos,40,18% tinham escolaridade entre cinco e oito anos, 52,68% eram casados,73,32% havia vivido em zona urbana, 41,96% apresentou alta resiliência e 48,21% mantinha-se em acompanhamento entre um e três anos.Conclusão: O estadiamento não esteve associado ao grau de resiliência,mas sim à idade e tempo de sobrevida, confirmando os achados em outros estudos.

Objetivo: Investigar el grado de resiliencia y estadificación en relación con factores sociodemográficos de sobrevivientes de cáncer de mama en seguimiento en un servicio de oncología. Método: Estudio cuantitativo con 112 sobrevivientes de cáncer de mama. Las variables seleccionadas fueron: sociodemográficas; estadificación clínica; tiempo de sobrevida; y escala de resistencia. El análisis se realizó utilizando el software EpiInfo 6.04 y el test exacto de Fisher. La investigación fue aprobada por el Comité de Ética de la Facultad de Enfermería de la Universidad Federal de Pelotas con el Dictamen Nº 31/2009. Resultados: La edad promedio fue de 46,2 años, 60.71% estaban en estadio II, 81.25% eran blancos, 40.18% tenían escolaridad entre cinco y ocho años, 52.68% eran casados, 73.32% habían vivido en zonas urbanas, 41.96% tuvieron alta resiliencia y el 48,21% estaban en seguimiento entre uno y tres años. Conclusión: La estadificación no estuvo asociada al grado de resiliencia, sino a la edad y tiempo de sobrevida, confirmando los hallazgos de otros estudios.

Breast reconstruction and risk of lymphedema after mastectomy: A prospective cohort study with 10 years of follow-up.

OBJECTIVE: The aim of this study is to assess the incidence and risk factors for lymphedema in women submitted to mastectomy, with or without breast reconstruction. METHODS: A cohort study was performed on women submitted to mastectomy with axillary lymphadenectomy in a single center. The follow-up included clinical evaluation and arm column measurements before surgery, at 30 days, 6 months, 5 years, and 10 years after surgery. For women subjected to late reconstruction, the time of occurrence of lymphedema (before or after reconstruction) was observed. RESULTS: We followed up on 622 patients submitted to mastectomy and axillary lymphadenectomy for an average period of 57 months after surgery. In total, 94 women were submitted to breast reconstruction, 47 (8%) of them immediate and 47 (8%) late reconstructions. Incidence of lymphedema in the whole group was 33% (n = 204). Among the patients submitted to reconstruction, 28% of them developed lymphedema, on average, 93 months (CI 95%, 88-98) after surgical treatment. In women not subjected to reconstruction, 179 (34%) developed lymphedema, on average, after 106 months (CI 95%, 96-116) (p = 0.03). Breast reconstruction reduced lymphedema risk in 36% (HR = 0.64, CI 96%, 0.42-0.98, p = 0.04). After adjustment for pathological staging and radiotherapy, this was not statistically significant (HR = 0.79, CI 95%, 0.52-1.21, p = 0.28). CONCLUSION: Breast reconstruction does not increase the risk of lymphedema in long-term follow-up.