Micrometastases in the sentinel node after neoadjuvant therapy. Is axillary dissection still required?

The present review intends to discuss the controversies and strengths in clinically node-positive patients with axillary nodal status ypN i+ / mi after neoadjuvant chemotherapy. Over the past 20 years, a de-escalation approach toward axillary surgery has been observed in patients with breast cancer. The worldwide use of sentinel node biopsy in the upfront setting and after primary systemic therapy substantially reduced surgical complications or late sequelae and eventually improving quality of life of patients. However, the role of axillary dissection is still unclear in patients with low residual disease post-chemotherapy, namely those with micrometastases in the sentinel node, and its prognostic role is still not very clear. The aim of the present narrative review is to report the available evidence on this topic, discussing the pros and cons of performing axillary lymph node dissection in the infrequent finding of micrometastases in the sentinel node after neoadjuvant chemotherapy. We will also describe the ongoing prospective studies which are expected to shed light and guide future decisions.

[Quality of life and related factors among climacteric women from south Brazil]. / Qualidade de vida e fatores asociados em mulheres climatéricas residentes na região sul do Brasil.

OBJECTIVE: This study aimed to evaluate the quality of life in climacteric and associated factor among women from Southeast Brazil. PATIENTS AND METHOD: A cross-section study of 506 women aged between 45 and 60 years old attended at a university climacteric clinic from South Brazil from June to October 2002. Hysterectomized women, as well as hormonal therapy or hormonal contraceptive users were excluded. The quality of life was evaluated by the Women's Health Questionnaire (WHQ). Statistical analysis was performed with multiple linear regression analysis. RESULTS: The average of the age among the studied women was 51.3 (+/- 4.5) years old. About 15.4% were premenopausal, 34.4% perimenopausal and 50.2% postmenopausal women. The quality of life showed up deteriorated among the studied women. The factors related with quality of life were: the educational level (p < 0.01), the confirmation of smoking in the last year (p < 0.01), regular physical activity (p < 0.01), the confirmation of previous co-morbidities (p < 0.01) and the menopausal status (p < 0.01). A higher educational level, as well as the confirmation of regular physical activity led to a significant increase on their life quality. Smoking and previous clinical co-morbidities were responsible for the lower scores of quality of life. The pre-menopause was associated with a higher life quality level if compared to peri and post menopause. No differences in relation to the scores of life were identified among the perimenopausal and postmenopausal women. CONCLUSIONS: Nevertheless the menopausal status showed up associated to the quality of life, the results of the study pointed out that the climacteric is not just influenced by biological factors, but also by psychosocial and cultural factors.