Risk of locoregional recurrence in patients with false-negative frozen section or close margins of retroareolar specimen in nipple-sparing mastectomy.

BACKGROUND: Our purpose was to evaluate the locoregional recurrence (LRR) of patients with false-negative, frozen-section or close margins of retroareolar specimen in nipple-sparing mastectomy (NSM) procedure. METHODS: From 2002-2008, we recruited patients who had atypia or presence of cancer cells in definitive histology of retroareolar tissue despite of absence of tumor cell in intraoperative retroareolar frozen section. We also included the close margin cases defined as the presence of tumor cells at the first frozen section, but after deeper core out of retroareolar tissue were revealed free of malignancy. The incidence of LRR and NAC recurrence were reported, and the factors associated were analyzed. RESULTS: Of 948 NSM procedures, there were 88 false-negative, frozen-sections and 10 close margin cases. The 5-year cumulative incidence of LRR and NAC recurrence was 11.2 % (10/98 patients) and 2.4 % (2/98 patients), respectively. Analyzing the definitive results of retroareolar tissue, the 5-year cumulative incidence of LRR was 42.9 % (n = 4) for atypia, 10 % (n = 2) for lobular carcinoma in situ (LCIS), 10 % (n = 1) for close margins, 8.7 % (n = 3) for ductal carcinoma in situ (DCIS), and 0 % for invasive carcinoma. In situ carcinoma as a primary tumor was a significant predictor of NAC recurrence (P < 0.01). CONCLUSIONS: Despite a high reliability of frozen section, there is still a minority of false-negative results. Nevertheless, the LRR is considerably low. This fact suggests the possibility of preservation of the NAC after discussion with the patient.

Analysis of neonatal morbidity and mortality in late-preterm newborn infants.

OBJECTIVE: To compare mortality and the principal intercurrent clinical conditions suffered by late-preterm newborn infants born with gestational ages of 34 full weeks to 36 weeks and 6 days, and full term newborns. METHODS: This was a cross-sectional study of all preterm newborn infants born at a public hospital from August 2010 to August 2011. The study sample comprised late-preterm infants (cases) and a group of full term newborns (controls). Three controls were enrolled for each case. Maternal, gestational and neonatal variables were analyzed. Means and standard deviations were used to compare numerical variables between case and control groups using Student's t test and the Mann-Whitney test; Pearson's chi-square was used for categorical variables. Odds ratios and 95% confidence intervals were calculated to estimate risk. RESULTS: The study sample comprised 239 late-preterm infants and 698 full term newborns. Mothers aged over 35 years and/or with a history of previous premature deliveries had a higher proportion of late-preterm children. The following gestational variables were associated with late-preterm delivery: hypertension, infectious diseases, rupture of membranes more than 18 hours previously and multiple pregnancies. When compared with full term newborns, late-preterms were statistically more likely to be subject to hypothermia/hyperthermia, hypoglycemia, respiratory pathologies, resuscitation in the delivery room, phototherapy, supplementary feeding, mechanical ventilation, venous infusions, antibiotics and admission to the neonatal intensive care unit, resulting in a nine times greater neonatal mortality rate. Intercurrent conditions were inversely related to gestational age. CONCLUSION: Late-preterm newborn infants had a mortality rate nine times that of full term infants and were exposed to a greater risk of intercurrent conditions during the neonatal period. These intercurrent conditions were inversely related to gestational age.

Análise da morbiletalidade neonatal em recém-nascidos pré-termo tardios / Analysis of neonatal morbidity and mortality in late-preterm newborn infants

OBJETIVO: Comparar as taxas de óbito e as principais intercorrências clínicas entre recém-nascidos pré-termo tardios nascidos com idade gestacional entre 34 semanas completas e 36 semanas e 6 dias e recém-nascidos a termo. MÉTODOS: Estudo transversal envolvendo todos os recém-nascidos pré-termo tardios nascidos entre agosto de 2010 e agosto de 2011. A população do estudo foi constituída pelos recém-nascidos pré-termo tardios (casos) e um grupo de recém-nascidos a termo (controles), sendo selecionados três controles para cada caso. Foram analisadas variáveis maternas, da gestação e neonatais. Na análise estatística, utilizaram-se médias, desvios padrão e testes t de Student e de Mann-Whitney para variáveis numéricas, o qui-quadrado de Pearson para variáveis categóricas e estimativa de risco pela odds ratio com intervalo de confiança de 95%. RESULTADOS: A população do estudo foi constituída por 239 recém-nascidos pré-termo tardios e 698 recém-nascidos a termo. As gestantes com mais de 35 anos e/ou história de prematuros prévios tiveram um número maior de pré-termo tardios. As variáveis da gestação relacionadas com o pré-termo tardio foram a hipertensão, doenças infecciosas, ruptura de membrana há mais de 18 horas e gravidez gemelar. Os recém-nascidos pré-termo, em comparação com os recém-nascidos a termo, apresentaram estatisticamente mais hipo/hipertermia, hipoglicemia, patologias respiratórias, necessidade de reanimação em sala de parto, necessidade de fototerapia, uso de complemento alimentar, necessidade de ventilação mecânica, infusão venosa, uso de antibiótico e internação em unidade de tratamento intensivo neonatal, sendo a sua taxa de óbito neonatal nove vezes maior. As intercorrências se mostraram inversamente relacionadas à idade gestacional. CONCLUSÃO: Os recém-nascidos pré-termo tardios apresentaram uma taxa de óbito nove vezes maior do que os recém-nascidos a termo e maior risco de intercorrências no período neonatal, sendo estas inversamente relacionadas com a idade gestacional.

OBJECTIVE: To compare mortality and the principal intercurrent clinical conditions suffered by late-preterm newborn infants born with gestational ages of 34 full weeks to 36 weeks and 6 days, and full term newborns. METHODS: This was a cross-sectional study of all preterm newborn infants born at a public hospital from August 2010 to August 2011. The study sample comprised late-preterm infants (cases) and a group of full term newborns (controls). Three controls were enrolled for each case. Maternal, gestational and neonatal variables were analyzed. Means and standard deviations were used to compare numerical variables between case and control groups using Student's t test and the Mann-Whitney test; Pearson's chi-square was used for categorical variables. Odds ratios and 95% confidence intervals were calculated to estimate risk. RESULTS: The study sample comprised 239 late-preterm infants and 698 full term newborns. Mothers aged over 35 years and/or with a history of previous premature deliveries had a higher proportion of late-preterm children. The following gestational variables were associated with late-preterm delivery: hypertension, infectious diseases, rupture of membranes more than 18 hours previously and multiple pregnancies. When compared with full term newborns, late-preterms were statistically more likely to be subject to hypothermia/hyperthermia, hypoglycemia, respiratory pathologies, resuscitation in the delivery room, phototherapy, supplementary feeding, mechanical ventilation, venous infusions, antibiotics and admission to the neonatal intensive care unit, resulting in a nine times greater neonatal mortality rate. Intercurrent conditions were inversely related to gestational age. CONCLUSIONS: Late-preterm newborn infants had a mortality rate nine times that of full term infants and were exposed to a greater risk of intercurrent conditions during the neonatal period. These intercurrent conditions were inversely related to gestational age.