Prospective study: Impact of breast magnetic resonance imaging on oncoplastic surgery and on indications of mastectomy in patients who were previously candidates to breast conserving surgery.

Background: Routine use of magnetic resonance imaging (MRI) in the staging of patients with early breast cancer is still controversial. Oncoplastic surgery (OP) allows for wider resections without compromising the aesthetic results. This study aimed to assess the impact of preoperative MRI on surgical planning and on indications of mastectomy. Methods: Prospective study including T1-T2 breast cancer patients treated between January 2019 and December 2020 in the Breast Unit of the Hospital Nossa Senhora das Graças in Curitiba, Brazil. All patients had indication for breast conserving surgery (BCS) with OP and did a breast MRI after conventional imaging. Results: 131 patients were selected. Indication for BCS was based on clinical examination and conventional imaging (mammography and ultrasound) findings. After undergoing breast MRI, 110 patients (84.0%) underwent BCS with OP and 21 (16.0%) had their surgical procedure changed to mastectomy. Breast MRI revealed additional findings in 52 of 131 patients (38%). Of these additional findings, 47 (90.4%) were confirmed as invasive carcinoma. Of the 21 patients who underwent mastectomies, the mean tumor size was 2.9 cm (± 1,7cm), with all having additional findings on breast MRI (100% of the mastectomies group vs 28.2% of the OP, p<0.01). Of the 110 patients submitted to OP, the mean tumor size was 1,6cm (± 0,8cm), with only 6 (5.4%) presenting positive margins at the final pathology assessment. Conclusion: Preoperative breast MRI has an impact on the OP scenario, bringing additional information that may help surgical planning. It allowed selecting the group with additional tumor foci or greater extension to convert to mastectomy, with a consequent low reoperation rate of 5.4% in the BCS group. This is the first study to assess the impact of breast MRI in the preoperative planning of patients undergoing OP for the treatment of breast cancer.

Marking axillary nodes with 4% carbon microparticle suspension before neoadjuvant chemotherapy improves sentinel node identification rate and axillary staging.

BACKGROUND AND OBJECTIVES: Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate. METHODS: A prospective study of patients with cT1-T4, cN1-N2 breast cancer who underwent US-guided fine-needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected. RESULTS: Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02). CONCLUSION: The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC.

Intervenções para tratamento da obesidade: revisão sistemática / Interventions in obesity treatments: a systematic review / Intervenciones para el tratamiento de la obesidad: una revisión sistemática

Objetivo: fazer uma revisão sistemática para avaliar a efetividade e segurança dos métodos para redução de peso, sendo eles: cirúrgico, farmacológico e mudanças do estilo de vida (MEV), que incluem exercícios físicos e dietas. Os resultados clínicos de interesse foram a perda de peso e sua manutenção pelo prazo mínimo de 1 ano. Método: foi feita uma busca de artigos nas bases de dados PUBMED, Scielo e Biblioteca do Cochrane, com as palavras-chave weight loss maintenance e obesity treatment. A busca incluiu artigos em português, inglês e espanhol publicados até outubro de 2011. Foram incluídos revisões sistemáticas, metanálises e ensaios clínicos randomizados que tivessem um período de seguimento maior ou igual a um ano. Os estudos deveriam ter como participantes: adultos obesos (maior que 18 anos e com índice de massa corpórea ­ IMC maior que 30) e que comparassem intervenções distintas para o tratamento da obesidade. Resultados: foram selecionados 5 artigos que contemplaram os critérios de inclusão, sendo que cada um desses estudaram isoladamente, comparados com MEV, a eficácia do Orlistat, Sibutramina, Pramlintide e gastroplastia. A gastroplastia teve um resultado significativo (p < 0,05) para evitar o total reganho de peso. O Orlistat produziu uma perda de peso significativa durante o primeiro ano de tratamento e o ganho de peso foi diminuído com seu uso no segundo ano de tratamento (p < 0,001). A Sibutramina se mostrou eficaz na manutenção do peso após um período de perda com dieta de grande restrição calórica. O Pramlintide mostrou efetividade na perda de peso e redução da circunferência abdominal. Conclusões: As intervenções farmacológicas e cirúrgicas se mostraram mais efetivas quando comparadas à MEV em relação à perda de peso e a sua manutenção a longo prazo, porém é necessária a realização de mais estudos que analisem a comparação entre as diferentes intervenções disponíveis para o tratamento da obesidade.

Objective: to make a systematic review to evaluate the effectiveness and safety of methods to reduce weight, as follows: surgical, pharmacological and changes in lifestyle, which include exercise and diet. Clinical outcomes of interest were weight loss and long-term loss maintenance. Methods: a search for the keywords "weight loss maintenance" and "obesity treatment" in articles from PubMed, Scielo and Cochrane Library database was performed. The search included articles in English, Portuguese and Spanish published until October 2011. Systematic reviews, meta-analysis and randomized clinical trials that had a follow-up period greater or equal to one year were included. The studies should have obese adults (over 18 years with body mass index greater than 30) as participants and compare different interventions to the treatment of obesity. Results: five articles that fulfill the inclusion criteria were selected, and each of these articles separately studied the effectiveness of Orlistat, Sibutramine, Pramlintide and gastroplasty, in comparison to changes in lifestyle. Gastroplasty presented significant results (p < 0.05) to avoid the total weight regain. Orlistat produced significant weight loss during the first year of treatment and weight gain was reduced with its use in the second year of treatment (p < 0.001). Sibutramine was effective in maintaining weight loss after a weight loss diet with high caloric restriction. Pramlintide showed effectiveness in weight loss and reduction in waist circumference. Conclusions: Pharmacological and surgical interventions were more effective compared to changes in lifestyle regarding weight loss and maintenance in the long term, but further studies need to be carried out to examine the comparison between the different interventions available for the treatment of obesity.

Objetivo: Realizar una revisión sistemática para evaluar la eficacia y la seguridad de los siguientes métodos para reducción de peso: cirugía, medicación y cambio de estilo de vida (CEV), incluyendo el ejercicio y la dieta. Los resultados clínicos evaluados fueron la pérdida de peso y su manutención por el plazo mínimo de un año. Métodos: Se buscaron artículos en las base de datos PubMed, Scielo y en la Biblioteca Cochrane con las palabras-clave "mantenimiento de la pérdida de peso" y "tratamiento de la obesidad". La búsqueda incluyó artículos en Inglés, Portugués y Español publicados hasta octubre de 2011. Se incluyeron revisiones sistemáticas, meta-análisis y ensayos clínicos aleatorizados que tuviesen un período de seguimiento mayor o igual a un año. Los estudios debían tener como participantes: adultos obesos (mayores de 18 años y con índice de masa corporal mayor que 30) y que comparasen diferentes intervenciones para el tratamiento de la obesidad. Resultados: Se seleccionaron cinco artículos que contemplaron los criterios de inclusión, cada uno de ellos fue estudiado por separado con relación al CEV, la eficacia del Orlistat, la Sibutramina, la Pramlintida, y la gastroplastia. La gastroplastia tuvo un resultado significativo (p < 0,05) para evitar la recuperación del peso total. El Orlistat produjo una pérdida significativa de peso durante el primer año de tratamiento y su uso disminuyó el aumento de peso en el segundo año de tratamiento (p < 0,001). La Sibutramina fue eficaz en el mantenimiento de peso después de un período de pérdida con una dieta de gran restricción calórica. La Pramlintida mostró eficacia en la pérdida de peso y reducción de la circunferencia abdominal. Conclusiones: Las intervenciones farmacológicas y quirúrgicas fueron más efectivas en comparación con el CEV en relación con la pérdida de peso y su mantenimiento a largo plazo, pero es necesario llevar a cabo más estudios que analicen la comparación entre las diferentes intervenciones disponibles para el tratamiento de la obesidad.