Biopsia selectiva de ganglio centinela en cáncer de mama, ¿está justificada la espera al resultado intraoperatorio? / Intraoperative sentinel node biopsy, is it worth the wait?

Objetivo: En nuestro centro, el estudio de la biopsia selectiva del ganglio centinela (BSGC) se realiza de forma intraoperatoria. El objetivo principal del presente trabajo es conocer qué proporción de pacientes se beneficia de la espera intraoperatoria al resultado de la BSGC. Material y métodos: Se ha realizado un análisis retrospectivo de pacientes intervenidas en nuestro centro entre el 1 de enero de 2018 y el 30 de junio de 2019. Se incluyeron mujeres con tumores T1-T2, tratadas mediante tumorectomía y BSGC estudiado mediante método one-step nucleic acid amplification (OSNA). Resultados: Se incluyeron 149 mujeres en el estudio. No se encontraron diferencias estadísticamente significativas en cuestión de datos demográficos entre el grupo tratado mediante linfadenectomía axilar (LA) y el grupo tratado exclusivamente con BSGC. Se realizaron 18 LA tras el análisis del GC estudiado de forma intraoperatoria. Solo en seis de los casos se extrajeron tres o más GC. La localización por cuadrante de la lesión, permeación linfovascular y carga tumoral total muestran diferencias estadísticamente significativas entre los grupos. En el análisis multivariante, únicamente la carga tumoral total (TTL) se establece como variable independiente de necesidad de LA. Conclusiones: La obtención del resultado de la BSGC de forma diferida permite disminuir el tiempo de anestesia de las pacientes y tiempo de ocupación de quirófano, ya que en el momento actual no se realiza ningún procedimiento adicional en un elevado porcentaje de casos. (AU)

Introduction: In our institution, the study of selective sentinel node biopsy (SLNB) is performed intraoperatively. The main objective of our study is to know the proportion of patients who benefits from the waiting of the results of SLNB. Methods: A retrospective analysis of patients operated on our center between January 1 st, 2018 and June 30, 2019 was carried out. We included women diagnosed with T1–T2 tumors, treated by lumpectomy and SLNB studied using OSNA method. Results: Our study included 149 women. There were not statistically significant differences in terms of demographic data between the group treated with axillary lymph node dissection (ALND) and exclusively SLNB group. After analysis of SLN intraoperatively, there were performed 18 axillary lymphadenectomies. Only in six of these 18 cases, three or more sentinel nodes were founded. The location of the tumor, the presence of lymphovascular permeation and the total tumor load (TTL) showed statistically significant differences between groups. Only the TTL was established as the independent factor of the need for ALND. Conclusions: Obtaining a deferred result of the SLNB allowed reducing the time of anesthesia and occupation of the operating room, since in a high percentage of cases an additional procedure is not performed. (AU)

Intraoperative sentinel node biopsy, is it worth the wait?

INTRODUCTION: In our institution, the study of selective sentinel node biopsy (SLNB) is performed intraoperatively. The main objective of our study is to know the proportion of patients who benefits from the waiting of the results of SLNB. METHODS: A retrospective analysis of patients operated on our center between January 1st, 2018 and June 30, 2019 was carried out. We included women diagnosed with T1-T2 tumors, treated by lumpectomy and SLNB studied using OSNA method. RESULTS: Our study included 149 women. There were not statistically significant differences in terms of demographic data between the group treated with axillary lymph node dissection (ALND) and exclusively SLNB group. After analysis of SLN intraoperatively, there were performed 18 axillary lymphadenectomies. Only in six of this 18 cases, three or more sentinel nodes were founded. The location of the tumor, the presence of lymphovascular permeation and the total tumor load (TTL) showed statistically significant differences between groups. Only the TTL was established as the independent factor of the need for ALND. DISCUSSION: Obtaining a deferred result of the SLNB allowed reducing the time of anesthesia and occupation of the operating room, since in a high percentage of cases an additional procedure is not performed.

Myofibroblastoma of the male breast: A case report / Miofibroblastoma en la mama de un varón, descripción de un caso clínico

Myofibroblastoma (MFB) is a rare spindle stromal tumour of the breast that predominates in 60–80 years-old adult males. Its imaging features are nonspecific, leading to misdiagnosis. Thus, core biopsy is needed for definitive diagnosis. Macroscopically, MFB is usually a well-circumscribed, firm and rubbery, unencapsulated, pale white to grey round mass. Microscopically, it consists on spindle cells arranged in haphazardly intersecting fascicles or clusters, thick hyalinized collagen bundles and low mitotic activity with a lack of myoepithelial component and necrosis. Immunohistochemistry shows consistently positive immunoreactivity to vimentin and CD34, while expression of desmin, SMA, bcl-2 and CD99 varies. Oestrogen, progesterone and androgen receptors are usually expressed. They are constantly negative to cytokeratins, EMA, S100 protein, HMB-45 and c-kit (CD117). These differentiate them from fibroadenoma, phyllodes tumour, round pattern gynecomastia, carcinoma and sarcoma, since they present infiltrative growth and are negative to CD34. Wide local excision is curative, with no need of sentinel lymph node biopsy, since local recurrence is extremely low and has been reported to be less than 1.5%. No distant metastases have been described on the literature. We report a rare case MFB on a 73-year-old male attended at our institution presenting with a nodule on the right breast. (AU)

El miofibroblastoma (MFB) es un tumour estromal de células fusiformes que aparece en varones de 60-80 años. Las características radiológicas son inespecíficas, por lo que es necesaria la realización de biopsia para el diagnóstico definitivo. Macroscópicamente se trata de una lesión bien circunscrita, firme, no encapsulada. Microscópicamente consiste en células fusiformes organizadas en fascículos entremezclados con bandas de colágeno hialino, con baja actividad mitótica y ausencia de componente mioepitelial y necrosis. La inmunohistoquímica muestra la expresión constante de vimentina y CD34, con expresión variable de desmina, AML, bcl-2 y CD99. Los receptores de estrógenos, progesterona y andrógenos normalmente son positivos, mientras que la expresión de citoqueratinas, EMA, S100, HMB-45 y c-kit (CD117) es negativa. Estas características lo diferencian del fibroadenoma, tumour filodes, ginecomastia, carcinoma y sarcoma, ya que la mayoría de ellos se caracterizan por ser negativos para CD34 y presentar crecimiento infiltrativo. La tumorectomía es considerada curativa, sin necesidad de realizar biopsia selectiva de ganglio centinela, dado que la recurrencia local es baja (menos del 1,5%). No se ha descrito la presencia de metástasis a distancia en la literatura. Presentamos el caso de MFB en un varón de 73 años que debutó con un nódulo en la mama derecha. (AU)

Influencia del COVID-19, el estado de alarma y el confinamiento en la epidemiología y gravedad de la apendicitis aguda / Influence of the COVID-19 state of alarm and lockdown on the epidemiology and severity of acute appendicitis

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