ABSTRACT
Resumen Introducción: El melanoma ocasiona el 75% de las muertes por cáncer de piel. Según GLOBOCAN, en 2018 se presentaron 287.723 casos nuevos de melanoma, con una mortalidad de 60.712 casos, que equivale al 20% del total de los casos incidentes. Las alternativas para el tratamiento del melanoma se fundamentan en la estatificación de la enfermedad, y en las características moleculares de la enfermedad. Objetivo: Consensuar, por común acuerdo de expertos, sugerencias para el diagnóstico y manejo de melanoma temprano basadas en la evidencia y ajustadas al contexto colombiano. Métodos: Se llevó a cabo un consenso de expertos multidisciplinario, constituido por 19 oncólogos clínicos, 2 cirujanos de mama y tejidos blandos, 2 dermatólogos, 2 patólogos y 2 radioterapeutas, miembros activos de la Asociación Colombiana de Hemato Oncología (ACHO). Este consenso se realizó en 4 etapas: 1. Estructuración de 29 preguntas, que se calificaron de 1 a 9. 2. Reenvío de las preguntas no consensuadas. 3. Análisis y discusión de las respuestas. 4. Las respuestas no consensuadas se llevaron a un consenso nominal. Resultados: Se discutieron 29 preguntas relacionadas con el diagnóstico y tratamiento de melanoma temprano, se construyeron sugerencias basadas en evidencia utilizada por los expertos y en guías de manejo de oncología reconocidas internacionalmente, adaptadas al contexto y realidad colombianos. Conclusiones: Se presentan sugerencias multidisciplinarias para el diagnóstico y tratamiento de melanoma temprano, las cuales debe considerarse para orientar la toma de decisiones y homogenizar la práctica clínica de acuerdo al contexto colombiano y a las características propias del sistema de salud del país. Este es un documento académico y no regulatorio.
Abstract Introduction: Melanoma causes 75% of deaths from skin cancer. In 2018, according to GLOBOCAN, 287,723 new melanoma cases were registered, with a mortality of 60,712 cases, which is equivalent to 20% of all incident cases. Alternatives for the treatment of melanoma are based on disease staging and the molecular characteristics of the disease. Objective: To establish a consensus by common agreement of experts and construct suggestions for the diagnosis and management of early-stage melanoma based on evidence and adjusted to the Colombian context. Methods: A multidisciplinary expert consensus was established, wth the participation of 19 clinical oncologists, 2 soft tissue surgeons, 2 dermatologists, 2 pathologists, and 2 radiotherapists, active members of the Colombian Association of Hemato-Oncology (ACHO). This consensus was carried out in four stages: 1) Structuring of 29 questions, which were scored from 1 to 9; 2) Resubmission of non-consensual questions; 3) Analysis and discussion of responses; and 4) Validation of non-consensual responses by nominal consensus. Results: Twenty-nine questions related to the diagnosis and treatment of early-stage melanoma were discussed in order to construct suggestions based on evidence proven by experts, as well as on internationally recognized oncology management guidelines adapted to the Colombian context and reality. Conclusions: Multidisciplinary suggestions are offered for the diagnosis and treatment of early-stage melanoma, which should be considered in order to guide decision-making and homogenize clinical practice according to the Colombian context and the characteristics of the Colombian health care system. This is an academic and non-regulatory document.
Subject(s)
Humans , Therapeutics , Melanoma , Skin Neoplasms , Decision MakingABSTRACT
In the last decades, surgical treatment of breast cancer has enormously changed. As a result, nipple-sparing mastectomy (NSM) has evolved as an oncologically safe and cosmetic approach. NSM includes a subareolar frozen section to evaluate malignancy. We determined the accuracy of subareolar frozen section diagnosis, analyzed the discrepancy factor, and estimated the interobserver agreement of frozen section in NSM. A retrospective review of all NSMs at our institution from 2009 to 2015 was performed. Frozen sections were compared to the final diagnoses to analyze the accuracy of subareolar frozen sections. Discordant results were rigorously evaluated to identify discrepancy factors. Some cases were randomly chosen to assess the interobserver agreement (kappa) among pathologists. The agreement results were evaluated with and without knowledge of the tumor morphology. Among 34 NSMs, the frozen section false-negative and false-positive rate was 5.9% and 8.8%, respectively. The sensitivity and specificity was 77.8% and 88.0%, respectively. Sampling errors and diathermy artifacts explained our false-negative diagnoses. Freezing artifacts and an intraductal papilloma explained our false-positive diagnoses. The interobserver agreement between breast and general pathologists was 0.87 (p<0.0001) and 0.31 (p=0.0001), respectively. The interobserver agreement increased to 0.35 (p<0.0001) in general pathologists with knowledge of the tumor morphology. Subareolar frozen section showed to be a specific test with moderate sensitivity. Papillary lesions can mimic atypical cells and influence the frozen section interpretation. Frozen section in NSM had a better performance in breast pathologists (almost perfect) versus general pathologists (fair). Interobserver agreement may improve with knowledge of tumor morphology.
Subject(s)
Breast Neoplasms/pathology , Frozen Sections , Nipples/pathology , Adult , Aged , Carcinoma, Intraductal, Noninfiltrating , Female , Frozen Sections/methods , Humans , Male , Mastectomy, Subcutaneous/methods , Middle Aged , Observer Variation , Retrospective StudiesABSTRACT
El cáncer de mama es uno de los principales problemas de salud y, aproximadamente, 10% de los casos son de origen genético. En un estudio previo realizado por nosotros, se encontraron mutaciones fundadoras en los genes BRCA1 y BRCA2; esto permite trazar estrategias de detección temprana para personas con alta susceptibilidad en Colombia e implementar medidas profilácticas. El objetivo de este estudio fue estimar el componente genético del cáncer de mama en Colombia, mediante el estudio de la frecuencia y penetrancia de las mutaciones germinales en BRCA1 y BRCA2. Se estudiaron 766 pacientes que cumplieron el criterio de habérseles diagnosticado cáncer de mama después de 2004 y se realizaron estudios moleculares para las mutaciones fundadoras. Se entregaron los resultados a las pacientes y se analizaron los datos para frecuencia y penetrancia. La frecuencia total para mutaciones fundadoras para BRCA1 y BRCA2 fue de 4,2% (IC95% 2,9-5,8), y la penetrancia a los 50 años fue de 33,3 (IC95% 15,2-63,1) para BRCA1 y de 32 (IC95%11,8-70,9) para BRCA2 La alta frecuencia de mutaciones justifica la necesidad de ofrecer este tipo de examen a mujeres con cáncer de mama, independientemente de los antecedentes.Es necesario ampliar los estudios para realizar cálculos de penetrancia a los 70 años...
Breast cancer is one of the main public health problems, approximately 10% are genetic. In a previous study carried out by our group, founder mutations in BRCA1 and BRCA2 genes were detected; this will allow early testing and detection of patients with high breast and ovarian cancer susceptibility in Colombia, and to implement prophylactic strategies. The aim of this study was to estimate the genetic component of breast cancer in Colombia, testing for the frequency and penetrance of germinal mutations in BRCA1 and BRCA2. 766 patients fulfilling the criteria of breast cancer diagnosis after 2004 were studied for founder mutations. The results were reported to the patients; frequency and penetrance were tested. Total frequency for founder mutations in BRCA1 and BRCA2 was 4.2% (CI 95%: 2.9-5.8), and penetrance at 50 years was 33, 3(CI 95%: 15.2 - 63.1) for BRCA1 and 32(CI 95%:11.8 - 70.9) for BRCA2. The high frequency of the mutations supports the need to implement genetic testing policy for patients with breast cancer independently of family history or age. It is necessary to continue the study to perform penetrance testing at the 70 year limit...
