Surgery improves survival in elderly with breast cancer. A study of 465 patients in a single institution.

INTRODUCTION: Breast cancer treatment in elderly patients is controversial. This single-centre study was conducted to review the treatment and outcomes for octogenarian women treated for breast cancer. METHODS: Data from all patients aged 80 years or more with primary breast cancer treated at our institution between 1995 and 2012 were included. Patients with carcinoma in-situ (stage 0) and advanced breast cancer (stage IV) were excluded. RESULTS: The study population consisted of 369 patients (median age 84 years). A total of 277 (75%) patients underwent surgical treatment (PST) and 92 (25%) received primary endocrine treatment (PET). Prognostic factors (HER-2, tumour grade, lymphovascular invasion and subsequent adjuvant therapy) were homogeneously distributed in both groups. PST and PET were stratified according to stage: 273 (66%) patients with early stage disease (I, IIA, IIB) and 96 (34%) with locally advanced disease (IIIA, IIIB, IIIC). Patients were followed-up for a median of 63 months. In patients with early stage disease, the mean breast cancer-specific survival (BCSS) was 109 months (95% CI = 101-115) in PST patients, and 50 months (95% CI = 40-60) in PET patients (P < 0.01). Conversely, for patients with locally advanced breast cancer, there was no significant difference in BCSS between the surgical and non-surgical groups. In the PST group, BCSS and disease-free survival were significantly better among patients who underwent standard surgical treatment than among those who received suboptimal treatment. There were no differences in the Charlson comorbidity index scores between the PST and PET groups. CONCLUSION: In women ≥80 years with early-stage breast cancer, standard surgical treatment was associated with a better BCSS when compared with PET.

The superparamagnetic iron oxide is equivalent to the Tc99 radiotracer method for identifying the sentinel lymph node in breast cancer.

BACKGROUND: Preoperative injection of Tc99 is standardly performed before sentinel lymph node biopsy (SLN) for breast cancer. Multiple questions have arisen concerning appropriate technique for SLNBs including site of injection, timing and injection material. The aim of this study was to assess the concordance between a new method, superparamagnetic iron oxide (SPIO) and the Tc99 radiotracer to identify the SLN in early breast cancer. MATERIAL AND METHODS: Between July 2013 and March 2014, 120 patients with clinically node negative early breast cancer were included in the study. Patients were injected the day before the radiotracer for lymphoscintigraphy and injected the SPIO subareolar intraoperatively. SLN was excised if it was radioactive, magnetic or palpable. Patients signed an inform consent. RESULTS: There was no drainage by either technique in 2 patients, so this leaves 118 patients for further analysis. Detection rate by Tc 99 was successful in 113 (95.7%%) patients and by SPIO in 116 (98.3%). Concordance rates per patient between techniques was 98.2%. The SLN was positive in 36 (30%) patients. Of this, SLN positivity was detected by both techniques in 32 patients. Mean number of SLNs by 99Tc and SPIO were 1.9 and 2.21 respectively (p = 0.001). DISCUSSION: Detection of SLNs with SPIO allows for easy identification of axillary nodes, at a frequency not inferior to the radiotracer. It is an oncologically safe procedure, facilitates patients and operative room management and can be used to reliably identify SLNs in breast cancer.

Breast conservative surgery after neoadjuvant chemotherapy in breast cancer patients: comparison of two tumor localization methods.

AIMS: The key to surgical planning for breast conservative treatment (BCT) after neoadjuvant chemotherapy (NAC) is tumor localization. Tumor marking can be performed using either skin tattoo or metallic marker. The objective of this study is to compare both types of tumor localization markers and to assess which techniques improve BCT in achieving a complete resection without compromise margins. METHODS: 149 patients between 1999 and 2009 were eligible for the study. The skin tattoo group (TG) included 118 patients and the metallic marker group (MG) included 31 patients. Both markers were placed before starting NAC. RESULTS: Median clinical tumor volume was 10.3 cm(3) in the TG and 22.4 cm(3) in the MG (p = 0.051). After NAC treatment, there were no significant statistically differences in both groups regarding complete clinical response, partial clinical response, and complete and partial pathological response. Median pathological tumor volume was: 0.8 cm(3) in the TG and 0.69 cm(3) in the MG (p = 0.8). Lumpectomy volume was bigger in the TG (268 cm(3)) than MG (143 cm(3)); p < 0.004. There were no statistically significant differences when comparing margin status. CONCLUSIONS: Lumpectomy guided with metallic marker after NAC allows lower excision of breast tissue without compromising margins. Having similar pathologic response between groups, skin tattoo leads to excise larger volume of tissue adding no benefits to the surgery. With the increasing pathologic complete responses to NAC, patients who are candidates for BCT after NAC will benefit from marking the tumor with metallic markers.

Removal of all radioactive sentinel nodes in breast cancer improves the detection of positive sentinel nodes.

OBJECTIVE: The aim of this study is to evaluate if it is necessary to remove all the radioactive sentinel lymph nodes (SLNs) not seen on lymphoscintigraphy in order to accurately stage breast cancer patients. MATERIAL AND METHODS: From March 1999 to March 2006, SLN biopsy was performed in 461 patients. All patients were only injected with radioisotope. Lymphoscintigraphy was performed in all the patients. The mean number of SLNs removed was 2.1 (range 1-15). RESULTS: The SLN was positive in 133 patients (28.8%). Lymphoscintigraphy accurately predicted the number of SLNs identified intraoperatively in 243 patients (52.7%). In 175 patients (37.9%) there were more SLNs identified intraoperatively than were seen on lymphos cintigraphy. In 11 (6.2%) of these 175 patients, additional SLNs identified intraoperatively harboured metastasis. Type of injection, need for a second injection, tumour location and age were not identified as statistically significantly associated with additional positive SLNs identified intraoperatively and not seen on lymphoscintigraphy. CONCLUSIONS: Lymphoscintigraphy does not accurately predict the number of SLNs identified intraoperatively, this number being underestimated. Surgeons should remove all radioactive SLNs to improve the detection of positive SLNs.

Removal of all radioactive sentinel nodes in breast cancer improves the detection of positive sentinel nodes

OBJECTIVE: The aim of this study is to evaluate if it is necessary to remove all the radioactive sentinel lymph nodes (SLNs) not seen on lymphoscintigraphy in order to accurately stage breast cancer patients. MATERIAL AND METHODS: From March 1999 to March 2006, SLN biopsy was performed in 461 patients. All patients were only injected with radioisotope. Lymphoscintigraphy was performed in all the patients. The mean number of SLNs removed was 2.1 (range 1-15). RESULTS: The SLN was positive in 133 patients (28.8%). Lymphoscintigraphy accurately predicted the number of SLNs identified intraoperatively in 243 patients (52.7%). In 175 patients (37.9%) there were more SLNs identified intraoperatively than were seen on lymphos cintigraphy. In 11 (6.2%) of these 175 patients, additional SLNs identified intraoperatively harboured metastasis. Type of injection, need for a second injection, tumour location and age were not identified as statistically significantly associated with additional positive SLNs identified intraoperatively and not seen on lymphoscintigraphy. CONCLUSIONS: Lymphoscintigraphy does not accurately predict the number of SLNs identified intraoperatively, this number being underestimated. Surgeons should remove all radioactive SLNs to improve the detection of positive SLNs (AU)

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Regional distribution of specific high affinity binding sites for 3H-imipramine and 3H-paroxetine in human brain.

The binding of 3H-paroxetine and 3H-imipramine has been compared in 17 different regions of 12 human control brains. Our findings reveal that the regional distribution is similar for both radioligands and their bindings tend to be parallel in the brain. The highest binding site density was found in basal ganglia (hypothalamus Bmax 780 +/- 102 fmol/mg protein for 3H-imipramine binding and Bmax 515 approximately 83 for 3H-paroxetine binding). The lowest values were found in cortical areas (cingulate cortex 191 +/- 18.5 fmol/mg for 3H-imipramine binding and 88 +/- 7.5 fmol/mg for 3H-paroxetine binding). The Kd values for 3H-paroxetine binding to neuronal membranes were similar in all brain regions (mean +/- s.d. Kd 0.07 +/- 0.007 nM) and also for 3H-imipramine binding (mean +/- s.d. Kd 1.05 +/- 0.12 nM). As these values are the same as in platelet membrane, the results obtained indicate that both binding sites are identical in neuronal and in platelet membranes. These findings suggest that both ligands are good markers of the 5HT transporter. However, the higher affinity of 3H-paroxetine confirms that this compound is a better radioligand for the 5HT uptake site.

Seasonal variability in blood platelet 3H-imipramine binding in healthy controls: age and gender effects.

Binding of 3H-imipramine to blood platelet membranes was determined four times (once each season) in 26 healthy volunteers (11 men and 15 women), over the course of 1 year to determine possible seasonal variations. Blood platelets were obtained in April-May, July-August, October-November, and January-February. Significant seasonal variations in the maximum number of binding sites were found in women but not in men, with circannual peak in summer and a nadir in spring. The pattern of seasonal variations was not the same in men and women. The present results highlight the importance of monitoring for gender and season in binding studies. We found no significant correlation between 3H-imipramine binding parameters and age.