Indicaciones y resultados de la biopsia del ganglio centinela en el cáncer de mama: cambios observados en el año 2018 respecto al año 2012 / Indications and results of Sentinel Lymph Node Biopsy in breast cancer: changes observed in 2018 compared to 2012

Antecedentes y objetivo Durante los últimos 15 años se han sucedido múltiples cambios en el tratamiento del cáncer de mama (CM) y, en especial, en las indicaciones de la biopsia del ganglio centinela (BGC) y las actitudes ante su resultado. Valorando estos avances, nuestro objetivo es comparar los resultados de las BGC realizadas en nuestro centro en 2012, año a partir del cual se dejó de practicar linfadenectomía axilar (LA) ante el hallazgo de micrometástasis en la BGC, con aquellas llevadas a cabo en 2018, cuando empezaron a aplicarse los criterios Z0011. Material y métodos Hemos desarrollado un estudio retrospectivo observacional comparativo entre la población de pacientes con CM cN0 a las que se les hizo una BGC en el año 2012 y aquellas a las que se les practicó este procedimiento en 2018. Resultados Al analizar los 2 grupos, 174 pacientes de 2012 y 165 de 2018, se hallaron algunas diferencias significativas: en 2018 hubo mayor tasa de BGC, menor número de cánceres lobulillares (14/28; p<0,05), el tamaño medio anatomopatológico fue menor (p<0,001), la representación de tumores Her2 y triple negativos fue mayor (28/49; p<0,01), así como la proporción de tratamiento neoadyuvante (6,6 vs. 42,5%; p<0,001). Al valorar los resultados del estudio axilar, en 2018 hubo un descenso tanto en la positividad de la BGC, que descendió a casi la mitad que en 2012 (42,4 vs. 24,1%; p<0,0001), como en el porcentaje de LA (21,2 vs. 12,6%; p<0,05), así como el de LA con resultado negativo (74,3 vs. 59,1%; p=ns). Conclusión En el grupo de estudio de 2018 se halló una mayor tasa de BGC, con menor tasa de resultado positivo y de LA en blanco, pese a tratarse de una población con tumores más agresivos. Este hecho podría justificarse con la mejora en el filtro radiológico mediante ecografía al diagnóstico, así como con el aumento en el uso de la terapia neoadyuvante (AU)

Background and objective Over the last 15 years, breast cancer (BC) treatment has undergone numerous changes, which have also affected the indications for sentinel lymph node biopsy (SLNB) as well as the procedures depending on its outcome. The aim of this study is to compare the results of the SLNB carried out at our center during 2012, when we stopped performing an axillary lymph node dissection (ALND) after the finding of a micrometastasis, with those conducted in 2018, when we started applying Z011 criteria. Materials and methods We have performed a comparative retrospective observational study, including cN0 BC patients that underwent a SLNB in 2012 versus those that underwent this procedure in 2018. Results A total of 174 patients from 2012 and 165 from 2018 were studied. We found significant differences between the 2groups: in 2018 there were fewer lobular invasive cancers (14 vs. 28) (P<0.05), a smaller mean pathological size(P<0.001), a higher proportion of HER2 and triple negative tumors (28 vs. 49; P<0.01) and, finally, an increase in use of neoadjuvant treatments (42.0 vs. 6.7%). Regarding axillary involvement, we observed a decrease in both the presence of a positive sentinel node (24.1% in 2018 vs. 42.4% in 2012; P<0.0001) as well as in the proportion of ALND performed (12.6% in 2018 vs. 21.2% in 2012) and the presence of positive non sentinel nodes after a ALND (59.1% vs. 74.3%; P=ns). Conclusion Although the 2018 cohort that underwent SLNB had more aggressive tumors, there were fewer positive SN and ALND performed. This is probably due to a more accurate radiological diagnosis with ultrasound, that enables to detect cN1 cases before surgery, and to the increasing use of neoadjuvant treatments that may downstage the axilla (AU)

Indications and results of sentinel lymph node biopsy in breast cancer: Changes observed in 2018 compared to 2012.

BACKGROUND AND OBJECTIVE: Over the last 15 years, breast cancer (BC) treatment has undergone numerous changes, which have also affected the indications for Sentinel Lymph Node Biopsy (SLNB) as well as the procedures depending on its outcome. The aim of this study is to compare the results of the SLNB carried out at our Center during 2012, when we stopped performing an axillary lymph node dissection (ALND) after the finding of a micrometastasis, with those conducted in 2018, when we started applying Z011 criteria. MATERIALS AND METHODS: We have performed a comparative retrospective observational study, including cN0 BC patients that underwent a SLNB in 2012 versus those that underwent this procedure in 2018. RESULTS: 174 patients from 2012 and 165 from 2018 were studied. We found significant differences between the two groups: in 2018 there were fewer lobular invasive cancers (14 vs 28) (P < .05), a smaller mean pathological size (P < .001), a higher proportion of HER2 and triple negative tumors (28 vs 49) (P < .01) and, finally, an increase in use of neoadjuvant treatments (42.0% vs 6.7%). Regarding axillary involvement, we observed a decrease in both the presence of a positive sentinel node (24.1% in 2018 vs 42.4% in 2012) (P < .0001) as well as in the proportion of ALND performed (12.6% in 2018 vs 21.2% in 2012) and the presence of positive non sentinel nodes after a ALND (59.1% vs74.3%) (ns) CONCLUSION: Although the 2018 cohort that underwent SLNB had more aggressive tumors, there were fewer positive SN and ALND performed. This is probably due to a more accurate radiological diagnosis with ultrasound, that enables to detect cN1 cases before surgery, and to the increasing use of neoadjuvant treatments that may downstage the axilla.

Gammagrafía peritoneal con 99mTc-MAA en las comunicaciones pleuroperitoneales en pacientes en diálisis peritoneal / 99mTc-MAA peritoneal scintigraphy in pleuroperitoneal comunication in peritoneal dialysis patients

La diálisis peritoneal (DP) constituye una alternativa plenamente contrastada en el tratamiento de la insuficiencia renal crónica, aunque no está exenta de complicaciones. Entre las más frecuentes se encuentran la peritonitis y las infecciones de la zona de acceso. El derrame pleural secundario a comunicación pleuroperitoneal (CPP) es una complicación grave y poco frecuente en estos pacientes.Presentamos el caso de un varón de 50 años diagnosticado de insuficiencia renal crónica en tratamiento con diálisis peritoneal que presentó disnea progresiva y derrame pleural derecho. La gammagrafía peritoneal con 99mTc permitió confirmar el paso de líquido de diálisis intraperitoneal a cavidad pleural(AU)

Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients.We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with 99mTc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity(AU)

[99mTc-MAA peritoneal scintigraphy in pleuroperitoneal comunication in peritoneal dialysis patients]. / Gammagrafía peritoneal con 99mTc-MAA en las comunicaciones pleuroperitoneales en pacientes en diálisis peritoneal.

Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity.