Estadificación ganglionar tras terapia sistémica primaria en mujeres con cáncer de mama y afectación ganglionar al diagnóstico / Lymph node staging after primary systemic therapy in women with breast cancer and lymph node involvement at diagnosis

Objetivo: El objetivo principal de este estudio es analizar la eficacia del marcaje ganglionar combinado (clip y biopsia de ganglio centinela (BGC)) para la estadificación axilar en pacientes con tratamiento sistémico primario (TSP) y cáncer de mama con ganglios positivos confirmados patológicamente en el momento del diagnóstico. El objetivo secundario es determinar el impacto del marcaje ganglionar en la supresión de la linfadenectomía axilar (LA) en el grupo a estudio. Métodos: Estudio prospectivo en el que se realizó la estadificación ganglionar mediante la localización con alambre metálico (arpón) de los ganglios afectados y una BGC con doble trazador. Todas las pacientes sin afectación metastásica del ganglio centinela (GC) o del ganglio marcado con clip/alambre no realizaron una LA. El comité multidisciplinar acordó el tratamiento axilar de las pacientes con afectación ganglionar. Resultados: Ochenta y un pacientes cumplieron los criterios de inclusión. Identificamos y extirpamos el ganglio marcado con clip/alambre en 80 de 81 pacientes (98,8%), y la BGC se realizó con éxito en el 88,9% de los pacientes. El GC y el nódulo marcado con arpón coincidieron en el 78,9% de las pacientes. El 76,2% de las pacientes no se sometieron a LA. Conclusiones: El marcaje axilar combinado (clip y BGC) en pacientes con ganglios metastásicos al diagnóstico y TSP ofrece una alta tasa de identificación (98,8%) y una alta correlación entre el ganglio marcado con arpón y el GC (78,8%). Este procedimiento ha permitido la supresión de la LA en el 76,2% de las pacientes incluidas en el estudio. (AU)

Objective: The main objective of this study is to analyze the efficacy of combined axillary marking (lymph node clipping and sentinel lymph node biopsy (SLNB)) for axillary staging in patients with primary systemic treatment (PST) and pathologically confirmed node-positive breast cancer at diagnosis. The secondary objective is to determine the impact of lymph node marking in the suppression of axillary lymph node dissection (ALND) in the study group. Methods: We conducted a prospective study in which lymph node staging was performed using wire localization of positive lymph nodes and a SLNB with dual tracer. All patients who presented no metastatic involvement of the sentinel lymph node (SLN) or clip/wire-marked lymph node were spared an ALND. The multidisciplinary committee agreed on axillary treatment for patients with lymph node involvement. Results: Eighty one patients met the inclusion criteria. We identified and extirpated the clip/wire-marked node in 80 of 81 patients (98.8%), with SLNB performed successfully in 88,9% of patients. The SLN and wire-marked node matched in 78.9% of patients; 76.2% of patients did not undergo ALND. Conclusions: The combined axillary marking (clip and SLNB) in patients with metastatic lymph node at diagnosis and PST offers a high identification rate (98.8%%) and a high correlation between the wire-marked lymph node and the SLN (78.9%%). This procedure has enabled the suppression of ALND in 76.2% of patients. (AU)

Precisión diagnóstica de la mamografía con contraste vs RM en la valoración de la respuesta del cáncer de mama tratado con quimioterapia neoadyuvante / Diagnostic accuracy of contrast-enhanced mammography vs MRI in evaluating the response of breast cancer treated with neoadjuvant chemotherapy

Introducción: la resonancia magnética es el método diagnóstico más preciso en la evaluación de la enfermedad residual en el cáncer de mama tratado con quimioterapia neoadyuvante. La mamografía con contraste puede ser una alternativa eficaz a la resonancia en la evaluación de tumor residual. Esta técnica disminuiría los costes significativamente, mejoraría el flujo de pacientes y apenas tiene contraindicaciones. Métodos: hemos realizado un estudio observacional y prospectivo en 43 pacientes con cáncer de mama tratadas con quimioterapia neoadyuvante. El estudio prequirúrgico incluyó tanto la mamografía con inyección de contraste como la resonancia magnética. Se correlacionó el tamaño tumoral residual por imagen con el estudio anatomopatológico posquirúrgico. Resultados: la MC presenta un coeficiente de correlación interclase superior al de la RM (0,9 vs. 0,7). Los valores de sensibilidad y especificidad de la MC (83,9 y 83,3%) son altos y equiparables a los de la RM (74,2 y 91,6%). Además, el valor predictivo negativo de la MC es mayor que el de la RM (66,7 vs. 57,9%) y VPP es muy similar (92,9 vs. 95,8%). Conclusión: la mamografía con contraste es una prueba equiparable a la resonancia magnética para la evaluación de la respuesta tumoral posneoadyuvancia en las pacientes con cáncer de mama. También es una prueba válida para la visualización de lesiones adicionales en la misma mama o en la contralateral. (AU)

Introduction: Magnetic resonance imaging is the most accurate diagnostic method for evaluating residual disease in breast cancer treated with neoadjuvant chemotherapy. Contrast-enhanced mammography can be an effective alternative to MRI in the evaluation of residual tumor. This technique would significantly reduce costs, improve patient flow and hardly has any contraindications. Methods: We have carried out an observational and prospective study in 43 patients with breast cancer treated with neoadjuvant chemotherapy. The pre-surgical study included both mammography with contrast injection and magnetic resonance imaging. Residual tumor size by imaging was correlated with the postoperative pathology study. Results: The CM presents a higher interclass correlation coefficient than the RM (0.9 vs. 0.7). The sensitivity and specificity values of CM (83.9% and 83.3%) are high and comparable to those of MRI (74.2% and 91.6%). Furthermore, the negative predictive value of CM is greater than that of MRI (66.7% vs 57.9%) and PPV is very similar (92.9% vs 95.8%). Conclusion: Contrast-enhanced mammography is a test comparable to magnetic resonance imaging for the evaluation of post-neoadjuvant tumor response in patients with breast cancer. It is also a valid test in visualizing additional lesions in the same or contralateral breast. (AU)

Lymph node staging after primary systemic therapy in women with breast cancer and lymph node involvement at diagnosis.

OBJECTIVE: The main objective of this study is to analyze the efficacy of combined axillary marking (lymph node clipping and sentinel lymph node biopsy (SLNB)) for axillary staging in patients with primary systemic treatment (PST) and pathologically confirmed node-positive breast cancer at diagnosis. The secondary objective is to determine the impact of lymph node marking in the suppression of axillary lymph node dissection (ALND) in the study group. METHODS: We conducted a prospective study in which lymph node staging was performed using wire localization of positive lymph nodes and a SLNB with dual tracer. All patients who presented no metastatic involvement of the sentinel lymph node (SLN) or clip/wire-marked lymph node were spared an ALND. The multidisciplinary committee agreed on axillary treatment for patients with lymph node involvement. RESULTS: Eighty one patients met the inclusion criteria. We identified and extirpated the clip/ wire-marked node in 80 of 81 patients (98.8%), with SLNB performed successfully in 88,9% of patients. The SLN and wire-marked node matched in 78.9% of patients; 76.2% of patients did not undergo ALND. CONCLUSIONS: The combined axillary marking (clip and SLNB) in patients with metastatic lymph node at diagnosis and PST offers a high identification rate (98.8%) and a high correlation between the wire-marked lymph node and the SLN (78.9%). This procedure has enabled the suppression of ALND in 76.2% of patients.

Avance en el tratamiento de la mastitis granulomatosa idiopática: utilidad de micofenolato de mofetilo / Breakthrough in treatment of the idiopathic granulomatous mastitis: Use of mycophenolate mofetil

Objetivos: La mastitis granulomatosa idiopática (MGI) es una patología inflamatoria inusual de la mama, con un curso insidioso, incluso recurrente que afecta a mujeres premenopáusicas. Es muy importante su reconocimiento y diagnóstico precoz con el fin de evitar tratamientos ineficaces, demostrando en nuestra casuística la eficacia del tratamiento micofenolato mofetilo (MFM).Materiales y método: Realizamos un estudio con los ocho casos de MGI en nuestro centro desde el año 2012 que fueron refractarios a los tratamientos usuales (antibióticos, limpieza quirúrgica, esteroides, metotrexato), valorando la evolución con el tratamiento a base de MFM.Resultados: La respuesta fue buena tanto radiológica como clínicamente al uso de MFM, con desaparición de las lesiones tras el uso de MFM sin que fueran necesarios tratamientos más invasivos ni hubiera tasas de recidiva significativa.Conclusiones:El uso de MFM como tratamiento parece exitoso tanto en la recurrencia como la desaparición de la enfermedad. Dado su diagnóstico diferencial y su curso benigno, el papel de las técnicas de imagen para reconocer esta enfermedad lo más pronto posible puede llevar a un mejor resultado clínico y evitar sobretratamiento innecesario. (AU)

Objective: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast with persistent course, even recurrent, that frequently affects parous premenopausal women. It can mimic the appearance of breast cancer, so its diagnosis is of great help to avoid irreversible surgical endeavours. Although multiple treatments have been tried for its management, none have been truly successful and no consensus exists as which the best therapeutic option is.Methods: We conducted a study with the eight cases of IGM in our institution since 2012 that were refractory to the used treatments for IGM (antibiotics, steroids, methotrexate or observation) seeing their evolution after the use of mycophenolate mofetil.Results: They responded well radiologically as well as clinically to the use of mycophenolate mofetil, not needing more invasive course of treatment.Conclusión: IGM is a rare inflammatory condition of the breast. The use of MMF as treatment is successful in the recurrence and disappearance of this disease. Given its differential diagnosis and its benign course, the role of multimodal imaging in recognizing this entity as soon as possible can lead to an improved patient outcome and help preventing any unnecessary overtreatment. (AU)

Combining Wire Localization of Clipped Nodes with Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer: Preliminary Results from a Prospective Study.

BACKGROUND: The ideal technique for lymph node staging for patients with pathologically confirmed node-positive breast cancer at diagnosis and neoadjuvant chemotherapy (NAC) is unclear. OBJECTIVE: The aim of this study was to analyze the feasibility of wire/clip localization and sentinel lymph node biopsy (SLNB) for the axillary staging of these patients. METHODS: We conducted a prospective study in which lymph node staging was performed using wire localization of positive lymph nodes and an SLNB with dual tracer. All patients who presented no metastatic involvement of the sentinel lymph node (SLN) or clip/wire-marked lymph node were spared an axillary lymph node dissection (ALND). The multidisciplinary committee agreed on axillary treatment for patients with lymph node involvement. RESULTS: Forty-two patients met the inclusion criteria. We identified and extirpated the clip/wire-marked node in all patients (100%), with SLNB performed successfully in 95.3% of patients. The SLN and wire-marked node matched in 80% of patients; 73.8% of patients did not undergo ALND. DISCUSSION AND CONCLUSIONS: Several studies have evaluated the efficacy of various procedures for lymph node marking for women with prechemotherapy lymph node involvement. Most of the studies reported high identification rates (> 94.8%), with false negative rates of < 7%. Similarly, our study allows us to conclude that combined axillary marking (clip and SLNB) in patients with metastatic lymph node at diagnosis and NAC offers a high identification rate (100%) and a high correlation between the wire-marked lymph node and the SLN (80%). This procedure has enabled the suppression of ALND for a significant number of patients (73%).

Evaluación de la percepción preoperatoria de la calidad de vida y satisfacción de la mujer con cáncer de mama mediante el cuestionario BREAST-Q™ / Evaluation of the preoperative perception of quality of life and satisfaction of women with breast cancer using the BREAST-Q™ questionnaire

INTRODUCCIÓN: Cerca del 40% de las mujeres intervenidas por un carcinoma mamario refieren estar insatisfechas con la toma de decisiones y con el resultado cosmético de la cirugía. El objetivo del estudio es demostrar la utilidad del cuestionario prequirúrgico BREAST-Q™ para evaluar la satisfacción y calidad de vida de las mujeres con cáncer de mama en un estado basal previo a la cirugía e identificar perfiles de satisfacción. MÉTODOS: Estudio observacional de una corte prospectiva en mujeres con carcinoma de mama donde se evaluó la calidad de vida antes y después de la intervención propuesta mediante el cuestionario prequirúrgico BREAST-Q™. Se presentan los resultados preliminares del estudio, con el análisis de la fase prequirúrgica. Se calcularon los percentiles para cada dominio del cuestionario y se evaluaron las características físicas basales para su posterior análisis. RESULTADOS: La satisfacción media de las pacientes con sus mamas fue de 58,9 ± 16,9. La media de bienestar psicosocial prequirúrgico fue de 70,5 ± 16,1. A las pacientes que se les propuso una cirugía conservadora presentaron una media de bienestar físico de 80,7 ± 18,5 y a las pacientes que se les propuso una mastectomía con reconstrucción fue de 79,9 ± 17,7. La media de score para el bienestar sexual fue de 63,2 ± 20,7. No se encontraron diferencias estadísticamente significativas entre el grupo de mujeres con score bajo y el grupo con score medio o alto en cuanto a las características clinicoepidemiológicas de las pacientes. CONCLUSIONES: La evaluación preoperatoria de las pacientes con cáncer de mama permite una correcta valoración del impacto de la cirugía sobre la satisfacción y calidad de vida, siendo de utilidad para orientar el proceso informativo acerca de las expectativas de los resultados postoperatorios

INTRODUCTION: Almost 40% of women who undergo breast surgery are dissatisfied with the decision-making process as well as cosmetic results. Our objective was to demonstrate the usefulness of the BREAST-Q™ preoperative questionnaire to evaluate the satisfaction and health-related quality of life in women with diagnosis of breast cancer prior to surgery, as well as identifying satisfaction profiles. METHODS: Prospective cohort observational study in women with breast cancer, evaluating preoperative quality of life using the BREAST-Q™ questionnaire. Percentile measures for each domain and baseline physical characteristics were assessed for posterior analysis. RESULTS: The average score in the breast satisfaction domain was 58.9±16.9. The average score in the preoperative psychosocial well-being domain was 70.5±16.1. Patients who were offered conservative surgery had a mean physical well-being score of 80.7±18.5, and those who were offered mastectomy had an average score of 79.9±17.7. The sexual well-being average score was 63.2±20.7. No statistically significant differences were found between low-score and high-score groups regarding epidemiological and clinical characteristics. CONCLUSIONS: Preoperative evaluation in breast cancer patients provides correct assessment of the effect of surgical treatment on patient satisfaction and quality of life. This information is useful for communicating with patients about their expectations and postoperative results

Evaluation of the preoperative perception of quality of life and satisfaction of women with breast cancer using the BREAST-Q™ questionnaire. / Evaluación de la percepción preoperatoria de la calidad de vida y satisfacción de la mujer con cáncer de mama mediante el cuestionario BREAST-Q™.

INTRODUCTION: Almost 40% of women who undergo breast surgery are dissatisfied with the decision-making process as well as cosmetic results. Our objective was to demonstrate the usefulness of the BREAST-Q™ preoperative questionnaire to evaluate the satisfaction and health-related quality of life in women with diagnosis of breast cancer prior to surgery, as well as identifying satisfaction profiles. METHODS: Prospective cohort observational study in women with breast cancer, evaluating preoperative quality of life using the BREAST-Q™ questionnaire. Percentile measures for each domain and baseline physical characteristics were assessed for posterior analysis. RESULTS: The average score in the breast satisfaction domain was 58.9±16.9. The average score in the preoperative psychosocial well-being domain was 70.5±16.1. Patients who were offered conservative surgery had a mean physical well-being score of 80.7±18.5, and those who were offered mastectomy had an average score of 79.9±17.7. The sexual well-being average score was 63.2±20.7. No statistically significant differences were found between low-score and high-score groups regarding epidemiological and clinical characteristics CONCLUSIONS: Preoperative evaluation in breast cancer patients provides correct assessment of the effect of surgical treatment on patient satisfaction and quality of life. This information is useful for communicating with patients about their expectations and postoperative results.

Single-Incision Approach for Breast-Conserving Surgery: Effectiveness, Complications and Quality of Life.

OBJECTIVE: The aim of this study was to assess the success of tumor resection and its postoperative complications, satisfaction, and quality of life using a single-incision approach for breast-conserving surgery. MATERIALS AND METHODS: This was an observational, prospective study conducted between 2015 and 2018. The study group consisted of patients in whom tumor extirpation and lymph node (LN) staging was performed using a single incision, while the control group consisted of patients who underwent a breast-conserving procedure with independent incisions. All patients were given the preoperative and postoperative module of the Breast-Q™ questionnaire. RESULTS: Overall, 226 patients met the study's inclusion criteria, 152 of whom successfully underwent breast and LN removal using a single-incision approach (98.7% overall success). There were no significant differences in postoperative complications, although there was a greater tendency towards breast seroma in the study group and axillary neuralgia in the control group. Both groups presented a similar rate of breast and axillary salvage surgery. The postoperative Breast-Q™ questionnaire showed that the study group had greater satisfaction with both the breast and the information provided by the surgeon. CONCLUSION: The single-incision approach is as effective as standard surgery, with custom incisions in terms of breast resection, LN staging, and complications. There was greater satisfaction with both the breast and the information provided.

El declive de la linfadenectomía axilar en el cáncer de mama. Evolución de su indicación durante los últimos 20 años / The decline of axillary lymph node dissection in breast cancer. Evolution of its indication over the last 20 years

Introducción: En los últimos 20 años los procedimientos de estadificación ganglionar en el cáncer de mama se han modificado. El objetivo de este estudio es describir la evolución de estos procedimientos en nuestro centro. Métodos: Estudio prospectivo observacional que incluye a las mujeres con cáncer de mama intervenidas entre el 2001 y el 2017. Se identificaron 4 grupos según el esquema terapéutico utilizado y 3 periodos a estudio definidos por las indicaciones de la linfadenectomía. Resultados: Mil trescientos diecinueve pacientes cumplieron los criterios de inclusión. La cirugía conservadora primaria fue el esquema terapéutico más frecuente (54,13%) y se realizaron 615 linfadenectomías axilares (46,62%) durante los 20 años estudiados. El porcentaje de linfadenectomías axilares disminuyó progresivamente en el tiempo, pasando del 91% en el primer periodo al 34% en el último periodo. Las linfadenectomías axilares fútiles descendieron al 6,6% en el último año. En la cirugía conservadora primaria no se realizó ninguna linfadenectomía axilar fútil los 2 últimos años. Conclusión: La introducción de la biopsia de ganglio centinela en 2001 y de los criterios ACOSOG Z0011 han modificado la indicación de la linfadenectomía axilar. Así, se han disminuido las linfadenectomías axilares sin afectación, evitando la morbilidad que asocia este procedimiento, especialmente linfedema. El estudio refleja el descenso progresivo de la indicación de la linfadenectomía en los diferentes grupos a estudio, similar a lo expuesto por otros autores. En diversos ensayos clínicos se ha descrito que estos cambios no han impactado negativamente en supervivencia

Introduction: In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital. Methods: A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection. Results: 1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years. Conclusion: The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival

The decline of axillary lymph node dissection in breast cancer. Evolution of its indication over the last 20 years. / El declive de la linfadenectomía axilar en el cáncer de mama. Evolución de su indicación durante los últimos 20 años.

INTRODUCTION: In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital. METHODS: A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection. RESULTS: 1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years. CONCLUSION: The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival.

The Use of Antidotes for Calcium Gluconate Extravasation: An Experimental Study in Mice.

BACKGROUND: Calcium gluconate extravasation is a process that can cause serious lesions, such as necrosis and calcification of the soft tissues. The aim of the present study was to analyze the beneficial effects of four possible local antidotes for calcium gluconate extravasation: hyaluronidase, sodium thiosulfate, triamcinolone acetonide, and physiologic saline solution. METHODS: Seventy-four BALB/c mice were used in the study. The substances selected for use in this study were calcium gluconate (4.6 mEq/ml), hyaluronidase (1500 IU/ml), sodium thiosulfate (25%), triamcinolone acetonide (40 mg/ml 0.5 mg/kg), and saline solution 0.9%. Five minutes were allowed to lapse after the calcium gluconate infiltration, and then an antidote was infiltrated. After 3 weeks, a skin biopsy was performed and a radiographic and histologic study was carried out. RESULTS: Only in the group infiltrated with sodium thiosulfate did all skin lesions disappear after the 3-week period after infiltration. In the radiographic study, calcium deposits larger than 0.5 mm were observed in 40 percent of cases without an antidote, in 33 percent with triamcinolone acetonide, in 13 percent with a saline solution, and in none with thiosulfate and hyaluronidase. In the histologic study, calcium deposits were found in 53 percent of cases without antidote, 100 percent of cases with triamcinolone acetonide, 33 percent of cases with saline solution, and 13 percent of cases with sodium thiosulfate or hyaluronidase. CONCLUSION: Sodium thiosulfate and hyaluronidase prevent the development of calcium deposits after calcium gluconate extravasation.

The role of oncoplastic breast reduction in the conservative management of breast cancer: Complications, survival, and quality of life.

BACKGROUND AND OBJECTIVES: Reduction Mammaplasty (RM) in breast cancer allows mammary remodeling after wide excisions. We aimed to analyze the complications, survival, and quality of life after RM. METHODS: Retrospective study of women who underwent a surgical intervention for breast cancer between 2000 and 2016. Patients were divided into two groups: RM and tumorectomy. Postoperative complications, survival and quality of life were assessed using the Breast-Q questionnaire. RESULTS: A total of 801 patients were evaluated, with a mean follow up of 84 months. RM patients experienced a longer operating time and hospital stay, and a higher proportion of tissue necrosis compared to tumorectomy patients (P < 0.001). No significant differences were observed regarding rate of re-excision or rate of mastectomy, but the recurrence rate at 10 years was higher for RM patients (P < 0.03). Patients who underwent RM reported optimal satisfaction with the breast and a good quality of life. CONCLUSIONS: RM is a useful approach in breast cancer surgery, with a low rate of re-excision and mastectomy. Overall survival at 10 years is similar to that associated with tumorectomy, though with a higher rate of local recurrence. Patient satisfaction and quality of life appears to be good one year after radiotherapy.

Radioterapia axilar en la cirugía conservadora del cáncer de mama en estadio temprano (estadio I y II) / Axillary radiotherapy in conservative surgery for early-stage breast cancer (stage I and II)

INTRODUCCIÓN: Diversos estudios clínicos analizan el tratamiento axilar en el cáncer de mama temprano debido a los cambios actuales en la indicación de la linfadenectomía axilar. El objetivo de este estudio fue analizar el impacto de la radioterapia axilar en la supervivencia global y libre de enfermedad en mujeres con un carcinoma de mama en estadio inicial tratadas mediante cirugía conservadora. MÉTODOS: Estudio retrospectivo en mujeres con un carcinoma infiltrante de mama en estadios iniciales tratadas mediante cirugía conservadora. Análisis comparativo de las mujeres con afectación ganglionar y factores de riesgo asociados que recibieron radioterapia axilar frente a un grupo con afectación ganglionar de bajo riesgo sin tratamiento radioterápico. Se utilizó una regresión logística para determinar los factores que influían en la supervivencia y en la aparición de linfedema. RESULTADOS: Se incluyó a 541 mujeres, 384 (71%) sin afectación de ganglios linfáticos axilares y 157 (29%) con afectación de 1-3 ganglios axilares. Las pacientes con radioterapia axilar tenían un mayor número de ganglios metastásicos respecto a las no irradiadas (1,6 ± 0,7 vs. 1,4 ± 0,6; p = 0,02). El grupo de mujeres con afectación ganglionar y radioterapia axilar tuvo una supervivencia global y libre de enfermedad a los 10 años similar a las pacientes sin irradiación de la axila (89,7 y 77,2%, respectivamente). La afectación de 3 ganglios incrementó 7 veces el riesgo de fallecer (HR = 7,20; IC 95%: 1,36-38,12). En el estudio multivariante, la linfadenectomía axilar fue el único factor de riesgo independiente de aparición de linfedema (HR = 22,22; IC 95%: 4,71-105,59; p < 0,001). CONCLUSIÓN: La recidiva axilar en el cáncer de mama en estadios I y II es un evento poco frecuente. En las enfermas con afectación axilar y factores de riesgo asociados, la radioterapia regional contribuye al control locorregional de la enfermedad con igual supervivencia global

INTRODUCTION: Several clinical studies analyze axillary treatment in women with early-stage breast cancer because of changes in the indication for axillary lymph node dissection. The aim of the study is to analyze the impact of axillary radiotherapy in disease-free and overall survival in women with early breast cancer treated with lumpectomy. METHODS: Retrospective study in women with initial stages of breast carcinoma treated by lumpectomy. A comparative analysis of high-risk women with axillary lymph node involvement who received axillary radiotherapy with the group of women with low risk without radiotherapy was performed. Logistic regression was used to determine factors influencing survival and lymphedema onset. RESULTS: A total of 541 women were included in the study: 384 patients (71%) without axillary lymph node involvement and 157 women (29%) with 1-3 axillary lymph node involvement. Patients with axillary radiotherapy had a higher number of metastatic lymph node compared to non-irradiated (1.6 ± 0.7 vs. 1.4 ± 0.6, P=.02). The group of women with axillary lymph node involvement and radiotherapy showed an overall and disease-free survival at 10 years similar to that obtained in patients without irradiation (89.7% and 77.2%, respectively). 3 lymph nodes involved multiplied by more than 7 times the risk of death (HR = 7.20; 95% CI: 1.36 to 38.12). The multivariate analysis showed axillary lymph node dissection as the only variable associated with the development of lymphedema. CONCLUSION: The incidence of axillary relapse on stage I and II breast cancer is rare. In these patients axillary radiotherapy does not improve overall survival, but contributes to regional control in those patients with risk factors

Axillary radiotherapy in conservative surgery for early-stage breast cancer (stage I and II). / Radioterapia axilar en la cirugía conservadora del cáncer de mama en estadio temprano (estadio I y II).

INTRODUCTION: Several clinical studies analyze axillary treatment in women with early-stage breast cancer because of changes in the indication for axillary lymph node dissection. The aim of the study is to analyze the impact of axillary radiotherapy in disease-free and overall survival in women with early breast cancer treated with lumpectomy. METHODS: Retrospective study in women with initial stages of breast carcinoma treated by lumpectomy. A comparative analysis of high-risk women with axillary lymph node involvement who received axillary radiotherapy with the group of women with low risk without radiotherapy was performed. Logistic regression was used to determine factors influencing survival and lymphedema onset. RESULTS: A total of 541 women were included in the study: 384 patients (71%) without axillary lymph node involvement and 157 women (29%) with 1-3 axillary lymph node involvement. Patients with axillary radiotherapy had a higher number of metastatic lymph node compared to non-irradiated (1.6±0.7 vs. 1.4±0.6, P=.02). The group of women with axillary lymph node involvement and radiotherapy showed an overall and disease-free survival at 10 years similar to that obtained in patients without irradiation (89.7% and 77.2%, respectively). 3 lymph nodes involved multiplied by more than 7 times the risk of death (HR=7.20; 95% CI: 1.36 to 38.12). The multivariate analysis showed axillary lymph node dissection as the only variable associated with the development of lymphedema. CONCLUSION: The incidence of axillary relapse on stage I and II breast cancer is rare. In these patients axillary radiotherapy does not improve overall survival, but contributes to regional control in those patients with risk factors.

Micrometástasis del ganglio centinela en mujeres con carcinoma ductal in situ. Falsos positivos del método OSNA (One-step nucleic acid amplification)? / Micrometastasis in the sentinel node in women with in situ ductal carcinoma. False positives of the OSNA (One-step nucleic acid amplification) method?

No disponible

Repercusión de los criterios ACOSOG Z0011 sobre la indicación de la linfadenectomía axilar y el control locorregional en mujeres con ganglio centinela metastásico. Resultados preliminares tras cuatro años de aplicación clínica / Repercussion of the ACOSOG-Z0011 criteria for the indication of axillary lymph node dissection and locoregional control in women with metastatic sentinel lymph node. Preliminary results after four years of clinical application

Objetivo. Evaluar los cambios en la indicación de la linfadenectomía axilar (LA), su eficacia para eliminar enfermedad residual y control locorregional, tras la adopción de los criterios del estudio ACOSOG Z0011. Pacientes y método. Estudio observacional retrospectivo en mujeres con carcinoma infiltrante de mama tratadas quirúrgicamente, entre febrero 2010 y mayo de 2014. Todas las pacientes fueron valoradas según los criterios del ensayo clínico ACOSOG Z0011 para el manejo del ganglio centinela (GC) metastatizado. Resultados. Un total de 118 enfermas presentaron afectación del GC, y de ellas 53 (44,92% de las pacientes con GC metastásico) evitaron la LA por la aplicación de los criterios ACOSOG Z0011. La mayoría de estas mujeres (73,58%) presentaron afectación micrometastásica del GC. El grupo de enfermas con mayor beneficio fueron las pacientes con conservación mamaria, ya que el 58,23% de estas enfermas evitaron la LA. Se realizaron un total de 65 LA por afectación metastásica del GC sin que se evidenciase metástasis en la grasa axilar en 37 (55,2%) pacientes. Conclusiones. La adopción de los criterios ACOSOG Z0011 permite disminuir la indicación de la LA, especialmente en aquellas mujeres sometidas a un procedimiento conservador. A pesar de la introducción de estos criterios, existe un grupo significativo de mujeres (55%) en quienes la LA no demuestra afectación ganglionar de la grasa axilar y no obtienen ningún beneficio con la misma (AU)

Objective. To evaluate changes in the indication of axillary lymph node dissection (ALND), its effectiveness in eliminating residual disease, and locoregional control after the adoption of the ACOSOG Z0011 study criteria. Patients and methods. Retrospective study in women with invasive breast cancer treated surgically from February 2010 to May 2014. All women were evaluated according to the ACOSOG-Z0011 trial criteria for the management of metastasized sentinel lymph node (SLN). Results. A total of 118 women had SLN involvement. Application of the ACOSOG Z0011 criteria avoided ALND in 53 of the 118 patients (44.92% of the patients with metastatic SLN), most of them (73.58%) with micrometastases. The benefit was greater in women undergoing conservative surgery, because 58.23% of these women avoided ALND. A total of 65 ALND were performed for metastatic SLN, of which 37 (55.2%) showed no involvement of axillary fat. Conclusions. Adoption of the ACOSOG Z0011 criteria decreases the indication of ALND, especially in women undergoing conservative surgery. Despite the introduction of these criteria, there is a significant percentage of women (55%) in whom ALND shows no lymph node involvement in axillary fat and produces no benefit (AU)