Evaluation of the AJCC Eighth-Edition Prognostic Staging System for Breast Cancer in a Latin American Cohort.

BACKGROUND: The staging of breast cancer has been based on tumor size, lymph node involvement, and presence or absence of distant metastases. The American Joint Committee on Cancer (AJCC) staging system in its eighth edition incorporates hormone receptors, human epidermal growth factor receptor 2 (HER2), and histologic grade due to their prognostic importance. In Latin America, however, the impact of the new edition is unknown. This article evaluates the performance of the AJCC eighth-edition staging system in a cohort of patients with breast cancer at a reference center in Colombia. METHODS: The study investigated a descriptive cohort of 912 patients who received complete treatment for non-metastatic invasive breast cancer and had information on the anatomic stage and biologic factors,. All the patients were restaged using the AJCC eighth-edition classification. Changes in clinical stages and differences between the two classifications were compared. RESULTS: The study enrolled 912 patients. Changes in staging occurred for 54.82% (downstaging for 40.3% and upstaging for 14.47%) of these patients. For recurrence-free survival, the C-Index of the eighth-edition AJCC was 0.726, and the AIC was 1323.7, whereas the C-Index of the seventh-edition AJCC was 0.731, and the AIC was 1314.3 (p = 0.99). CONCLUSIONS: The seventh and eighth editions of the AJCC staging system have similar predictive values in our population for recurrence-free survival. Future studies are necessary to evaluate the performance of the AJCC eighth-edition staging system in predicting overall survival.

When is Sentinel Lymph Node Biopsy Useful in Ductal Carcinoma In Situ? The Experience at a Latin American Cancer Center.

Introduction Ductal carcinoma in situ (DCIS) accounts for 15% of breast cancers. Surgery is the main treatment, and the use of sentinel node biopsy (SLNB) is restricted to patients at risk of infiltration, which is estimated to be around 26%. Materials and methods Aimed at evaluating the benefit of SLNB in patients with DCIS at the Breast and Soft Tissue Functional Unit of the National Cancer Institute (INC for its initials in Spanish), a descriptive observational study of a retrospective cases series was conducted between August 1, 2013, and September 30, 2018. Results A total of 40 patients with a median age of 57 years were included in the study; 62.5% of them underwent mastectomy with SLNB, and the remaining 37.5% underwent conservative surgery with SLNB. 100% of sentinel nodes were identified, by using lymphoscintigraphy in 95%. Sentinel node was positive in four patients (10%), three of whom had infiltration in the surgical specimen reported. With a follow-up of 49 months, only one patient had a local relapse. None of the patients had axillary or distant recurrence. Conclusions SLNB in DCIS should be limited to patients with risk factors for infiltration (tumor size greater than 3 cm, comedo-type histology, and high-grade DCIS), and patients with an indication for mastectomy. Its percentage of complications is low, and a high identification percentage in surgical groups with adequate training.

El ejemplo, la única manera de enseñar / Examples, the only way to teach

Introducción La Universidad de La Sabana conserva una colección de recetas médicas empleadas durante el siglo XVIII en la Nueva Granada; una de estas integra agentes fitoterapéuticos para aliviar síntomas generados por infecciones de la glándula mamaria. Objetivo Exponer una receta utilizada para el tratamiento del absceso mamario y definir si los componentes de esta tenían efectos beneficiosos en la enfermedad. Material y métodos Se realizó una búsqueda en El Archivo Histórico de la Biblioteca Octavio Arizmendi Posada en la Universidad de La Sabana, donde se encuentra la receta «apostema en los pechos de mujeres», y posteriormente se hizo una recopilación de datos y revisión de la literatura sobre este método en las bases de datos de PubMed, Google Académico y SciELO. Resultados Se encontró que plantas como Luffa cylindrica y Lonicera japonica tienen propiedades galactogogas, analgésicas y antiinflamatorias, pudiendo prevenir el desarrollo del absceso mamario. Por otro lado, la hoja de col tiene un rol importante en el alivio del dolor una vez se tiene el absceso dadas sus propiedades analgésicas. Conclusión A través de la revisión de textos originales de la época se encuentra una receta médica colonial; se revisaron efectos fitoterapéuticos de sus componentes y se destacan beneficios galactogogos, analgésicos y antiinflamatorios. Permitiendo contrastar desde la evidencia médica actual algunos de los métodos de origen natural empleados para los abscesos mamarios en la Nueva Granada durante los siglos XVIII y XIX. (AU)

Introduction The University of La Sabana preserves a collection of medical prescriptions used in the eighteenth century in New Granada; one of these contains phytotherapeutic agents to alleviate the symptoms caused by mammary gland infections. Objective To present a formula used to treat breast abscesses and to determine whether the components are effective in resolving this entity. Materials and methods We conducted a search in the Historical Archive of the Octavio Arizmendi Posada Library of the University of La Sabana, where we found the formula “abscess in women's breasts”. We also collected data and performed a literature search on this method in the PubMed, Google Scholar and SciELO databases. Results The use of plants such as Luffa cylindrica and Lonicera japonica could prevent the development of breast abscesses due to their galactagogue, analgesic and anti-inflammatory properties. Cabbage leaf also plays an important role in relieving pain in persons with abscesses, due to its analgesic properties. Conclusion Through the review of eighteenth century texts, we found a colonial medical prescription and reviewed the phytotherapeutic effects of its components, highlighting its galactagogue benefits. This allows a comparison between current medical evidence and some of the natural methods used for breast abscesses in New Granada during the eighteenth and nineteenth centuries. (AU)

Lesión vulvar y perineal secundaria a trauma pelviperineal complejo: presentación de un caso y revisión de la literatura / Vulvar and perineal injury secondary to complex pelvic and perineal trauma: case presentation and review of the literature

Hacer una revisión de la literatura orientada a describir la anatomía quirúrgica, el diagnóstico y el manejo de las lesiones vulvares y perineales secundarias a trauma genital y perineal de alto impacto.Materiales y métodos: se presenta el caso de una adolescente de 15 años de edad, que presentó fractura inestable de pelvis, desgarro rectal y trauma vulvar, con destrucción de la anatomía del piso pélvico, atendida en una clínica privada de referencia de la cuidad de Bogotá (Colombia). Se realizó reconstrucción del piso pélvico por parte del servicio de ginecología de forma inmediata y manejo conjunto de las otras lesiones con cirugía general y ortopedia. Se hizo una revisión de la literatura registrada con los siguientes términos MeSH: heridas y traumatismos, vulva, genitales femeninos, lesiones y ginecología, en las bases de datos Medline vía Pub-Med, desde el año 1940 hasta el 2015; además, en EBSCO y Lilacs se buscaron artículos de revisión y reportes de caso publicados en inglés y español.Resultados: inicialmente se seleccionaron 20 estudios, de los cuales se descartaron 6 artículos en los que el principal objetivo era el manejo del trauma obstétrico, trauma por prolapso o trauma con mayor compromiso abdominal; quedaron 14 estudios. Tres de los casos reportados se describen en pacientes prepúberes, 9 en mujeres en edad reproductiva y 2 en posmenopáusicas por diferentes mecanismos de trauma. El diagnóstico se basa en la historia clínica y la exploración física. Las imágenes diagnósticas podrían ayudar a establecer la magnitud del daño pélvico. Se considera una emergencia quirúrgica; se debe hacer reparación de los músculos y nervios, y ligadura de vasos sangrantes...

To review the literature focused on the description of the surgical anatomy, diagnosis and management of vulvar and perineal injuries secondary to high-impact genital and perineal trauma.Materials and methods: Case presentation of a 15-year old adolescent who sustained unstable pelvic fracture, rectal tear and vulvar trauma with destruction of the pelvic floor anatomy, seen at a clinic located in Bogota (Colombia). The pelvic floor was reconstructed immediately by the gynaecology service and the other injuries were managed jointly with the general and orthopaedic surgeons. A review of the published literature between 1940 and 2015 was conducted in the Medline database via Pubmed using the following MeSH terms: wounds and trauma, vulva, genitalia, female, injuries and gynaecology. Moreover, a search was conducted in EBSCO and LILACS of review articles and case reports published in English and Spanish.Results: Initially, 20 articles were selected but 6 that focused on the management of obstetric trauma, prolapse-related trauma or major trauma with abdominal compromise were discarded. A total of 14 articles were included. Of the total number of cases, 3 are described in pre-pubertal patients, 9 in women in childbearing age, and 2 in post-menopausal women, with different mechanisms of injury. The diagnosis is based on the clinical record and the physical exam. Diagnostic imaging could help determine the severity of the pelvic damage. This condition is considered a surgical emergency requiring the repair of muscles and nerves, and ligation of bleeding vessels...