Locally advanced breast cancer: breast-conserving surgery and other factors linked to overall survival after neoadjuvant treatment.

Background: Recent data suggest that breast-conserving surgery (BCS) may positively impact overall survival (OS) in early breast cancer. However, the role of BCS in locally advanced breast cancer (LABC) following neoadjuvant therapy (NAT) remains uncertain. Methods: We conducted a retrospective cohort study involving 530 LABC patients who underwent surgery after NAT between 2010 and 2015. Outcomes examined included OS, distant recurrence rates (DRR), and loco-regional recurrence rates (LRRs). Results: Among the 927 breast cancer patients who received NAT, 530 were eligible for our study. Of these, 24.6% underwent BCS, while 75.4% underwent mastectomy (MS). The median follow-up duration was 79 months. BCS patients exhibited a higher pathological complete response (PCR) rate compared to those who underwent MS (22.3% vs. 10%, p < 0.001). The 6-year OS rates for BCS and MS were 81.5% and 62%, respectively (p < 0.000). In multivariate OS analysis, MS was associated with worse outcomes (OR 1.678; 95% CI 1.069-2.635; p = 0.024), as was body mass index (BMI) (OR 1.031; 95% CI 1.006-1.058; p = 0.017), and stage IIIB or IIIC (OR 2.450; 95% CI 1.561-3.846; p < 0.000). Conversely, PCR (OR 0.42; 95% CI 0.220-0.801; p = 0.008) was associated with improved survival. DRR was significantly lower in BCS (15.4%) compared to MS (36.8%) (OR 0.298; 95% CI 0.177-0.504). LRRs were comparable between BCS (9.2%) and MS (9.5%) (OR 0.693; 95% CI 0.347-1.383). Conclusion: Our findings suggest that BCS is oncologically safe, even for patients with large lesions, and is associated with superior OS rates compared to MS. Additionally, lower BMI, lower pretreatment stage, and achieving PCR were associated with improved survival outcomes.

Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: randomized controlled trial (BREAST-MRI trial).

BACKGROUND: Breast magnetic resonance imaging (MRI) has high sensitivity in detecting invasive neoplasms. Controversy remains about its impact on the preoperative staging of breast cancer surgery. This study evaluated survival and surgical outcomes of preoperative MRI in conservative breast cancer surgery. METHODS: A phase III, randomized, open-label, single-center trial including female breast cancer participants, stage 0-III disease, and eligible for breast-conserving surgery. We compared the role of including MRI in preoperative evaluation versus radiologic exam routine with mammography and ultrasound in breast cancer conservative candidates. The primary outcome was local relapse-free survival (LRFS), and secondary outcomes were overall survival (OS), mastectomy rate, and reoperation rate. RESULTS: 524 were randomized to preoperative MRI group (n = 257) or control group (n = 267). The survival analysis showed a 5.9-years LRFS of 99.2% in MRI group versus 98.9% in control group (HR = 0.72; 95% CI 0.12-4.28; p = 0.7) and an OS of 95.3% in the MRI group versus 96.3% in the control group (HR = 1.37 95% CI 0.59-3.19; p = 0.8). Surgical management changed in 21 ipsilateral breasts in the MRI group; 21 (8.3%) had mastectomies versus one in the control group. No difference was found in reoperation rates, 22 (8.7%) in the MRI group versus 23 (8.7%) in the control group (RR = 1.002; 95% CI 0.57-1.75; p = 0.85). CONCLUSION: Preoperative MRI increased the mastectomy rates by 8%. The use of preoperative MRI did not influence local relapse-free survival, overall survival, or reoperation rates.

Avaliação da sensibilidade dolorosa e fatores envolvidos na qualidade da amostra citológica do fluxo papilar: resultados preliminares da utilização de sistema automatizado de coleta / Assessment of pain sensitivity and factors involved in the quality of the sample fluid cytologic papillary: preliminary results from the use of automated collection

OBJETIVO: avaliar a sensibilidade dolorosa e os fatores envolvidos na produção de fluido papilar adequado para análise de citologia oncótica, por meio de sistema automatizado de coleta. MÉTODOS: foram selecionadas 50 mulheres assintomáticas, sem antecedente pessoal ou familiar de câncer de mama, fora do ciclo gravídico-puerperal para coleta de fluido papilar por meio de sistema automatizado. Foram registradas e relacionadas com a produção de fluido papilar a idade da paciente, tabagismo, antecedente de cirurgia mamária, paridade, amamentação, estado menopausal e idade da menarca. Todo o material coletado foi fixado em meio apropriado, e encaminhado separadamente para análise de citologia oncótica. A sensibilidade dolorosa do procedimento de coleta foi avaliada por meio da Escala Category-Ratio Scale (CR10) de Borg. RESULTADOS: a idade variou de 22 a 59 anos, média de 41,6±8,6 anos. Das 50 pacientes, 20 (40 por cento) não apresentaram fluido papilar adequado para análise em nenhuma das mamas. Naquelas pacientes que se obteve fluido papilar adequado para análise de citologia oncótica, a paridade esteve inversamente relacionada com a capacidade de obter amostra celular adequada, nível de significância estatística (p=0,035), OR=0,0032 (IC 95 por cento=0,0001-0,1388). Em relação à sensibilidade dolorosa, o exame foi bem tolerado. CONCLUSÕES: o método automatizado de coleta de fluido papilar para análise de citologia oncótica foi bem tolerado pelas mulheres tendo produzido material analisável em 60 por cento dos casos, esteve inversamente relacionado com a paridade.

PURPOSE: to evaluate painful sensitivity and factors involved in producing papillary fluid suitable for cytological analysis by means of automated collection. METHODS: we selected 50 asymptomatic women without a personal or family history of breast cancer, outside the pregnancy and childbirth cycle in order to collect papillary fluid by the automated system. We recorded and related to the production of papillary fluid patient age, smoking habit, previous breast surgery, parity, breastfeeding, menopausal status and age at menarche. All material collected was fixed in appropriate place, and sent separately for cytological analysis. The painful sensitivity of the collection procedure was assessed using the Borg Category-Ratio Scale (CR10 Scale). RESULTS: patient age ranged from 22 to 59 years, mean 41.6±8.6 years. Of the 50 patients, 20 (40 percent) showed no papillary fluid suitable for analysis in the breasts. In those patients from whom appropriate fluid was obtained for analysis of papillary cytology, parity was inversely related to the ability to obtain suitable cell samples with a level of statistical significance of p=0.035, OR=0.0032 (95 percentCI=0.0001-0.1388). Regarding soreness, the exam was well tolerated. CONCLUSIONS: the automated method of fluid collection for analysis of papillary cytology was well tolerated by the women; thus producing analyzable material in 60 percent of cases, a rate was inversely related to parity.

[Assessment of pain sensitivity and factors involved in the quality of the sample fluid cytologic papillary: preliminary results from the use of automated collection]. / Avaliação da sensibilidade dolorosa e fatores envolvidos na qualidade da amostra citológica do fluxo papilar: resultados preliminares da utilização de sistema automatizado de coleta.

PURPOSE: to evaluate painful sensitivity and factors involved in producing papillary fluid suitable for cytological analysis by means of automated collection. METHODS: we selected 50 asymptomatic women without a personal or family history of breast cancer, outside the pregnancy and childbirth cycle in order to collect papillary fluid by the automated system. We recorded and related to the production of papillary fluid patient age, smoking habit, previous breast surgery, parity, breastfeeding, menopausal status and age at menarche. All material collected was fixed in appropriate place, and sent separately for cytological analysis. The painful sensitivity of the collection procedure was assessed using the Borg Category-Ratio Scale (CR10 Scale). RESULTS: patient age ranged from 22 to 59 years, mean 41.6 ± 8.6 years. Of the 50 patients, 20 (40%) showed no papillary fluid suitable for analysis in the breasts. In those patients from whom appropriate fluid was obtained for analysis of papillary cytology, parity was inversely related to the ability to obtain suitable cell samples with a level of statistical significance of p=0.035, OR=0.0032 (95%CI=0.0001-0.1388). Regarding soreness, the exam was well tolerated. CONCLUSIONS: the automated method of fluid collection for analysis of papillary cytology was well tolerated by the women; thus producing analyzable material in 60% of cases, a rate was inversely related to parity.

Manejo da pancreatite aguda da gravidez: o papel coadjuvante da nutriçäo parenteral / Management of acute pancreatitis in pregnancy: coadjuvant role of parenteral nutrition

A pancreatite aguda da gravidez é uma eventualidade freqüente, poucas centenas de casos tendo sido publicados na literatura. Seu diagnóstico pode ser dificultado por manifestaçöes próprias da gestaçäo e pelo retardo na solicitaçäo de exames subsidiários. Estes fatos parecem contribuir para o prognóstico grave desta afecçäo, que no passado atingia até 20% de mortalidade. O tratamento recomendado é conservador e, a menos que haja complicaçöes exigindo correçäo cirúrgica imediata, as operaçöes para eventualitíase biliar devem ser postergadas para depois do parto. A nutriçäo parenteral pode colaborar para melhor evoluçäo, auxiliando no repouso da glândula e na melhora das condiçöes nutritivas maternas e fetais