Necesidad de vaciamiento axilar en el cáncer de mama. Rigor en los métodos predictivos / Need for axillary lymph node dissection in breast cancer. Rigour in predictive methods

Introduccción: El objetivo es describir la validez diagnóstica y la seguridad de los métodos empleados en nuestro entorno para obviar el vaciamiento axilar en el tratamiento quirúrgico primario de mama en estadio inicial tras determinación de macrometástasis en el ganglio centinela. Métodos: Estudio observacional retrospectivo multicéntrico aprobado por el Comité de Ética. Determinación de sensibilidad, especificidad, valor predictivo positivo y negativo de los métodos: OSNA (punto de corte a 15.000 copias de ARN), score Tenon 5 (punto de corte en 5), perfil de alto riesgo (si no cumple T1G2RH+ HER-), criterios ACOSOG Z-11 y resultado de ganglio secundario. Se incluyó a pacientes con cáncer de mama dirigidas a tratamiento quirúrgico primario; tamaño T1-T2 y axila clínica y radiológicamente negativa; con resultado de ganglio centinela positivo para macrometástasis. Resultados: Se incluyó a 279 pacientes con macrometástasis en el ganglio centinela, de los cuales resultaron 69 (24,4%) linfadenectomías positivas. Los resultados de sensibilidad, especificidad, valor predictivo positivo y negativo fueron: OSNA (100%, 17%, 32%, 100%); Tenon 5 (91%, 34%, 31%, 92%); alto riesgo (82%, 32%, 28%, 85%), ACOSOG Z-11 (30%, 97%, 75%, 84%); ganglio secundario (86%, 76%, 55%, 94%). Conclusiones: El método más seguro, score Tenon 5, solo evitaría un tercio de linfadenectomías negativas. Un perfil de riesgo no ofrecería suficiente seguridad. La propuesta del grupo ACOSOG Z-11 sería el método menos seguro. La cuantificación de la macrometástasis por método OSNA no conseguiría validez diagnóstica. El análisis del ganglio secundario, siendo el método menos aplicado, sería el más válido, con mejor sensibilidad y especificidad conjunta. En nuestra valoración, ninguno de los métodos estudiados resultaría suficientemente riguroso pues no obtendrían resultados óptimos para permitir obviar la linfadenectomía

Introduction: The aim of this study was to describe the diagnostic validity and safety of the most commonly used methods to avoid axillary lymph node dissection (ALND) in the primary surgical treatment of initial-stage breast cancer after determination of sentinel node macrometastases. Methods: This multicenter, retrospective observational study was approved by the ethics committee and assessed the sensitivity, specificity, positive and negative predictive value of the following methods: OSNA (cut-off point of 15,000 RNA copies), Tenon 5 score (cut-off point 5), HIGH risk profile (RH+ HER-), ACOSOG Z-11 criteria and second-tier sentinel node outcome. We included patients with breast cancer undergoing primary surgical treatment, with T1-T2 tumours, clinically and radiologically negative axillae, and sentinel node macrometastases. Results: We included 279 patients, of whom 69 (24.4%) had a positive ALND. The results of sensitivity, specificity, positive predictive value and negative predictive value were as follows: OSNA (100%, 17%, 32%, 100%); Tenon 5 (91%, 34%, 31%, 92%); HIGH (82%, 32%, 28%, 85%), ACOSOG Z-11 (30%, 97%, 75%, 84%); SECOND (86%, 76%, 59%, 94%). Conclusions: The most accurate method, the Tenon score, would only avoid one-third of negative lymphadenectomies. Relying on a risk profile would not provide enough safety. The proposal of the ACOSOG Z-11 group was the least safe method. Quantification of macrometastases by OSNA would not be a valid diagnostic method. Second-tier sentinel node analysis, the least applied method, seems the most accurate, with the best sensitivity and specificity.In our analysis, none of the methods would be sufficiently rigorous to safely allow avoidance of ALND

Lactating Adenoma of the Breast.

Lactating adenoma is an uncommon breast palpable lesion occurring in pregnancy or lactation. Although it is a benign condition, it often requires core biopsy or even surgery to exclude malignancy. As with other solid lesions in pregnancy and lactation, lactating adenoma needs an accurate evaluation in order to ensure its benign nature. Work-up must include both imaging and histologic findings. Ultrasound evaluation remains the first step in assessing the features of the lesion. Some authors consider magnetic resonance imaging as a useful tool in cases of inconclusive evaluation after ultrasound and histologic exam in an attempt to avoid surgery. Most lactating adenomas resolve spontaneously, whereas others persist or even increase in size and must be removed. The authors present a case of a 35-year-old woman at 6 months postpartum with a lactating adenoma in her right breast. After surgical removal, breastfeeding was perfectly continued within the next 24 hours, which highlights the fact that breast surgery is most often compatible with breastfeeding.