Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer.

BACKGROUND: This study analysed the correlation between [(18)F]fluorodeoxyglucose (FDG) uptake assessed by positron emission tomography (PET) in breast tumours, and histopathological and inmunohistochemical prognostic factors. METHODS: FDG-PET was performed before surgery in 275 women with primary breast cancer. The standarized uptake value (SUV) was compared with histopathological findings after surgery. RESULTS: A positive relationship was found between the SUV and tumour size (r = 0.46, P < 0.001), axillary lymph node status (P < 0.001), histological type (P < 0.001), histological grade (P < 0.001), oestrogen receptor status (P < 0.001), p53 (P < 0.001) and Ki-67 (P < 0.001) expression. Multivariable linear regression showed that tumour size, histological grade, Ki-67 expression, oestrogen receptor status and histological type were significantly related to the SUV. CONCLUSION: The SUV is a preoperative and non-invasive metabolic factor that relates to some prognostic factors in breast cancer.

[New developments in the surgical treatment of breast cancer]. / Novedades en el tratamiento quirúrgico del cáncer de mama.

Adecuate surgical treatment is mandatory in order to achieve cure in patients with breast cancer. Breast surgeons have to choice the best surgical technique over the breast and over the axillary nodes. Two new surgical aproaches have been implemented in the last decade: oncoplastic conservative surgery and sentinel lymph node biopsy. Oncoplastic surgery provides oncologic safety results and good cosmetic outcome. In this paper the technical steps and indications of different oncoplastic techniques in conservative breast surgery are review. Concerning to axillary surgery sentinel lymph node biopsy is the gold standard. However there are several controversial points in sentinel node biopsy referring to indications, identification and histological findings.

Novedades en el tratamiento quirúrgicodel cáncer de mama / New developments in the Surgical Treatment of Breast Cancer

Un tratamiento quirúrgico correcto es imprescindible para conseguir lacuración de las pacientes con cáncer de mama. El cirujano debe elegirla mejor cirugía tanto en la mama como en los ganglios axilares. Enla última década se han incorporado dos nuevas técnicas quirúrgicas:la cirugía oncoplástica conservadora y la biopsia de ganglio centinela.La cirugía oncoplástica aporta seguridad oncológica y buen resultadoestético. En este trabajo se revisan los pasos técnicos y las indicacionesde las diferentes técnicas oncoplásticas que se emplean en cirugía conservadorade mama. Respecto a la cirugía axilar, la biopsia de gangliocentinela es la técnica de elección actual. Sin embargo existen aspectoscontrovertidos en la biopsia del ganglio centinela respecto a indicaciones,técnicas de identifi cación y hallazgos histológicos (AU)

Adecuate surgical treatment is mandatory in order to achieve cure inpatients with breast cancer. Breast surgeons have to choice the bestsurgical technique over the breast and over the axillary nodes. Two newsurgical aproaches have been implemented in the last decade: oncoplasticconservative surgery and sentinel lymph node biopsy. Oncoplasticsurgery provides oncologic safety results and good cosmetic outcome.In this paper the technical steps and indications of different oncoplastictechniques in conservative breast surgery are review. Concerning to axillarysurgery sentinel lymph node biopsy is the gold standard. Howeverthere are several controversial points in sentinel node biopsy referringto indications, identifi cation and histological fi ndings (AU)

Novedades en el tratamiento quirúrgico del cáncer de mama / No disponible

Un tratamiento quirúrgico correcto es imprescindible para conseguir lacuración de las pacientes con cáncer de mama. El cirujano debe elegirla mejor cirugía tanto en la mama como en los ganglios axilares. Enla última década se han incorporado dos nuevas técnicas quirúrgicas:la cirugía oncoplástica conservadora y la biopsia de ganglio centinela.La cirugía oncoplástica aporta seguridad oncológica y buen resultadoestético. En este trabajo se revisan los pasos técnicos y las indicacionesde las diferentes técnicas oncoplásticas que se emplean en cirugía conservadorade mama. Respecto a la cirugía axilar, la biopsia de gangliocentinela es la técnica de elección actual. Sin embargo existen aspectoscontrovertidos en la biopsia del ganglio centinela respecto a indicaciones,técnicas de identifi cación y hallazgos histológicos(AU)

Adecuate surgical treatment is mandatory in order to achieve cure inpatients with breast cancer. Breast surgeons have to choice the bestsurgical technique over the breast and over the axillary nodes. Two newsurgical aproaches have been implemented in the last decade: oncoplasticconservative surgery and sentinel lymph node biopsy. Oncoplasticsurgery provides oncologic safety results and good cosmetic outcome.In this paper the technical steps and indications of different oncoplastictechniques in conservative breast surgery are review. Concerning to axillarysurgery sentinel lymph node biopsy is the gold standard. Howeverthere are several controversial points in sentinel node biopsy referringto indications, identifi cation and histological fi ndings(AU)

Carcinoma intraductal de mama con microinvasión (T1mic): revisión a propósito de 53 nuevos casos / No disponible

Introducción: El desarrollo de las campañas de diagnósticoprecoz del cáncer de mama está determinando un incrementoen el hallazgo de carcinomas intraductales, en ocasiones confocos de microinfiltración (T1mic). En la bibliografía ha existidodisparidad en los criterios para su definición, y en consecuenciaen la valoración de su incidencia, índice de afectaciónaxilar y actitud terapéutica.Material y métodos: De un total de 225 carcinomas intraductalesse han seleccionado 53 por cumplir los criterios paraser definidos como T1mic en la Clasificación TNM (1997). Seanalizan algunas características clínicas, morfológicas y biológicas,así como su tratamiento y seguimiento.Resultados: El 77,4% de los casos fueron hallazgo de unchequeo mamográfico. El subtipo comedo fue la variante másfrecuente (52%) sobre la que asentó la microinfiltración. En el49,1% de los casos se encontró dos o más focos de microinfiltración,hallazgo más frecuente sobre el subtipo comedo(60,7%). Se practicó cirugía conservadora en 24 casos y mastectomíaen 29 (15 de ellos con reconstrucción inmediata). Enninguna caso se encontró afectación axilar y tras un seguimientomedio de 70 meses todas están vivas (una con metástasisa distancia).Conclusiones: Es necesario unificar los criterios que defineneste estadio tumoral y seguir los propuestos por la clasificaciónTNM en su versión AJCC-1997. Aceptando estos criterios,el tratamiento será el mismo al indicado para elcarcinoma intraductal, y dado el bajo índice de afectación axilarse recomienda recurrir al estudio del ganglio centinela sóloen los casos en que el comedo sea el subtipo dominante o elcarcinoma intraductal muy extenso(AU)

Introduction: The development of screening campaignsfor breast cancer is producing an increment in the incidence ofintraductal carcinomas (DCIS) with foci of microinvasion(T1mic). However, there is a degree of inconsistency in the literaturewith respect to defining these carcinomas and as aconsequence, there is no consensus regarding the incidence ofaxillar involvement and the appropriate treatment for these tumours.Material and Methods: Of 225 patients with intraductalcarcinomas, 53 cases were selected that complied with the requisitesfor defining microinvasive carcinomas, according tothe TNM cancer staging criteria laid down in 1997 (T1mic < 1mm). The morphological and biological characteristics of thecarcinomas were analysed, as were the results of the treatmentfollowed.Results: Referral to our department was provoked by the resultsof a screening study in 78% of the cases. The comedosubtype was the most frequent DCIS variant found and it waspresent in 52,8% of the cases studied. In 26 cases (49,1%), 2 ormore foci of microinvasion were observed, this occurring morefrequently among the comedo variants (60,7%). Conservativesurgery was performed in 24 cases and mastectomy was carriedout in 29 cases (in 15 of which immediate breast reconstructionwas performed). Involvement of the axillary lymph nodes wasnot observed and after a mean period of 70 months, all the patientswere alive (one with a distant metastasis).Conclusions: In order to be able to reach definitive conclusionsregarding this type of carcinoma, it is necessary to unifythe criteria of definition according to those proposal by theAJCC in 1997. In accepting these criteria, the therapeutic recommendationsare the same as those followed for intraductalcarcinoma...(AU)

Carcinoma tubular de mama: revisión de una serie de 38 casos / No disponible

Introducción: El carcinoma tubular de mama (CTM) representaun subtipo de carcinoma infiltrante, bien diferenciado,poco frecuente, de diagnóstico diferencial en ocasiones difícil.Material y métodos: Estudio retrospectivo de 38 casos queanaliza algunas de sus características clínicas y biológicas, asícomo del tratamiento utilizado.Resultados: Edad media de 51,5 años, el motivo diagnósticomás común fue la presencia de una tumoración palpable(50%), y otro 50% resultado de un chequeo mamario. En trescasos se presentó un carcinoma bilateral (uno de ellos sincrónico).Tamaño tumoral medio de 1,4 cm; el 81,8% fueron pT1.Afectación ganglionar axilar en el 13,1% de los casos (todosCTM mixtos). Se observó alto índice de tumores RE positivos,bajo índice proliferativo (Ki67) y muy baja expresión de p53 yc-erbB2. En el 79% de los casos se practicó cirugía conservadoracon vaciamiento axilar. La supervivencia a 10 años fuedel 97,4%.Conclusiones: Carcinoma poco frecuente, cuyo hallazgoes cada vez más resultado de estudios de screening. Se presentacomo una imagen estelar que obliga al diagnóstico diferencialcon algunas lesiones benignas.Su habitual pequeño tamaño y buena diferenciación histológica,permiten el tratamiento conservador en la mayoría delos casos, siendo excepcional la afectación ganglionar axilar.Dado su buen pronóstico, se discute la utilidad/necesidadde tratamiento adyuvante e incluso la cirugía axilar en los detamaño < 1 cm, especialmente en las formas puras(AU)

Introduction: Tubular carcinoma (TC) is a rare and well-differentiatedhistological variant of all breast cancer. The diagnosisof TC is some occasions difficult.Material and methods: We conducted a retrospectivestudy that analyzes 38 cases of TC (it supposes 1,6% of BreastCancer treated in our Breast Unit).The clinical and biological features and the treatment areanalyzed.Results: The medium average age was of 51,5 years. Themore frequent consultation was the presence of a palpablebreast mass followed by the screening. In three patients weobserved a bilateral cancer (1 out of 3 were synchronous tumour).The size half size tumour was of 1,4 cm and 81,8% theywere tumours pT1. Metastatic axillary disease was observed in13,1% of cases. We found a high rate of tumours was with positivehormonal receivers, low KI-67) and very low expressionof p53 and c-erb-2. The 79% of patient were treated with breastconservation therapy. With a median follow-up of 10 yearsthe survival was 97,4%.Discusion: TC is a rare breast cancer that can be discoveredin screening. TC can appear in mammography as a spiculatedabnormality and therefore it can be difficult to distinguishfrom radial scar or sclerosing adenosis. TC usually presents asa small tumour that can be treated with conservative surgery.Maxillary nodal metastases are uncommon. Because it is goodprognosis, adjuvant postoperative treatment and even any axillarysurgical procedure are controversial in TC(AU)

Metastases to the breast: a review of 33 cases.

The aim of the study was to show the clinical and radiological manifestations of metastases to the breast (MB). From 1987 to 2006, 33 patients with MB were diagnosed at our institution. Their clinical and radiological features were retrospectively evaluated. Of the 33 cases, 31 presented as a palpable breast lump. On mammography, their findings were classified as follows: well-circumscribed masses (11 cases), ill-circumscribed masses (five), focal asymmetric densities (one) and inflammatory skin changes (six). Mammograms were normal in six cases (all of them showed dense breast tissue). Four CT scans showed two well-circumscribed masses and two ill-circumscribed masses. Ultrasonography was available in 18 cases: hypoechoic lesions (15 cases) were more frequent than hyperechoic (one) or isoechoic lesions (two). The appearance on magnetic resonance was similar to primary breast cancer (one case). The most common primary tumours causing MB were haematological malignancies (nine cases) and melanomas (seven). Metastases to the breast showed a wide range of mammographic and ultrasonographic appearances, resembling both benign and malignant lesions. Any patient who presents with a breast lump with a history of cancer should undergo a core-needle biopsy in order to determine the histology of the lump.

[Mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy]. / Hallazgos mamográficos en las microcalcificaciones asociadas a cáncer de mama tras quimioterapia neoadyuvante.

OBJECTIVE: To evaluate the mammographic findings in microcalcifications associated with breast cancer after neoadjuvant chemotherapy. MATERIAL AND METHODS: From January 2000 to May 2005, a total of 99 breast cancer patients underwent neoadjuvant chemotherapy. Ten patients had microcalcifications on mammograms prior to treatment. We evaluated the evolution of the tumor and of the microcalcifications, correlating the imaging findings with the clinical and histological manifestations. RESULTS: Four different patterns of evolution were observed for the microcalcifications: the number of particles increased in two cases, remained stable in three, decreased in four, and in one patient the microcalcifications disappeared. The size of the tumor decreased in all cases. CONCLUSIONS: After neoadjuvant chemotherapy microcalcifications can evolve unpredictably and independently of tumor response.

Influencia del estudio intraoperatorio de los márgenes de resección sobre la recidiva local en la cirugía conservadora del cáncer de mama / No disponible

Introducción: la cirugía conservadora del cáncer de mamaes en la actualidad la técnica estándar en los tumores de pequeñotamaño; no obstante precisa generalmente de radioterapiacomplementaria y tiene el riesgo de presentar recidivastumorales en la misma mama. Se analizan las posibles ventajasdel estudio intraoperatorio de los bordes de resección parala reducción de las posibles reintervenciones y de las recidivaslocales tras cirugía conservadora.Material y métodos: analizamos retrospectivamente 1.010casos de cáncer de mama tratados mediante cirugía conservadora(resección segmentaria y linfadenectomía axilar), complementadacon radioterapia. En todos los casos se efectuó estudiointraoperatorio de los bordes de resección mediante cortespor congelación. Con un seguimiento medio de 6 años se valorande las recidivas locales y su significado.Resultados: con una media de edad de 52,2 años, el71,4% fueron tumores pT1, observándose afectación axilaren el 29,5%. El estudio intraoperatorio evidenció afectaciónde bordes en 251 casos (24,8%) obligando a su ampliación enel mismo acto operatorio; en 21 casos fue necesaria mas deuna ampliación. De esta forma en el estudio definitivo en parafinase confirmó un 97% de casos con bordes de resecciónlibres de tumor.Tras 6 años de seguimiento medio se han observado 24 recidivaslocales (2,4%), 12 de ellas en el área de tumorectomíaprevia y otras 12 en otro cuadrante.Conclusiones: en la cirugía conservadora, la obtención deunos márgenes quirúrgicos libres de tumor, y suficientementeamplios, constituye un factor importante para la reducción delas recidivas locales. El estudio intraoperatorio de los márgenes,es una técnica que permite lograr este objetivo a la vezque reduce la necesidad de reintervenciones diferidas(AU)

Introduction: breast-conserving therapy (BCT) is the standardtechnique for early-stage breast cancer; nevertheless BCTusually requires postoperative radiotherapy and has the risk oflocal recurrence in the same breast. We analyzed in this studythe need for intraoperative frozen section study of resectionmargins in order to reduce the reoperations and local recurrenceafter BCT.Material and methods: we conducted a retrospective studywith 1010 cases of Breast cancer treated with BCT (segmentalresection and axillary lymphadenectomy), followed by radiotherapy.In all cases intraoperative frozen section study of resectionmargin was made We analyzed the local recurrencerate with a mediam follow-up of 6 years.Results: the average age was 52.2 year-old age. 71.4%were pT1 tumors, and axillary nodes metastasis was found in29.5%. The intraoperative frozen section showed affectedmargins in 251 cases (24.8%) prompting re-resection. Provisionof additional tissue in two o more occasions was neededin 21 cases. Following this protocol, we found 97% of caseswith free resection margins on permanent paraffin embeddedsamples.With a median follow-up of 6 years, 24 local recurrenceswere observed (2.4%): 12 localized at the site of originalbreast tumor (true local recurrence), and 12 localized in a differentsite (most likely a second primary).Conclusions: during BCT, is very import to achieve freeresection margins in order to reduce the local recurrencerate. Intraoperative frozen section study contributes to reducelocal recurrence and provides information for reoperations(AU)

Lesiones proliferativas intraductales: aspectos inmunohistoquímicos / No disponible

Introducción: la difusión de la mamografía de cribado ha incrementado el diagnóstico de lesiones proliferativas. Dado que algunas lesiones proliferativas aumentan el riesgo de desarrollar un cáncer de mama, se ha incrementado el interés en las mismas. El cáncer de mama es probablemente el resultado de sucesivos cambios genéticos (cada uno con su correlación histológica) en la secuencia hiperplasia ductal atípica (HDA) a carcinoma. El objetivo de este estudio es analizar la correlación entre las determinaciones inmunohistoquímicas (IHQ) de diferentes marcadores biológicos (receptores hormonales, Ki 67, p53, y c-erbB-2)y el diagnóstico de diferentes lesiones proliferativas ductales. Material y métodos: se estudian mediante técnicas de IHQ la expresión en tejido mamario de receptores de estrógeno(RE), proliferación celular (Ki67), p53 y c-erbB-2 en 228 pacientes portadoras de: hiperplasia ductal atípica (HDA) en 28casos, carcinoma intraductal CDIS en 60 casos, carcinoma intraductal con microinfiltración (T1mic) en 40 casos, carcinoma ductal infiltrante con CDIS extenso en 40 casos y CDI puro en60 casos. Las lesiones benignas fueron clasificadas de acuerdo a los criterios de Page. El carcinoma intraductal se clasificó segúnsu grado histológico (GH) y su patrón nuclear. Resultados: la expresión de RE fue del 100% en las HDAy decrece hasta el 70% en CDIS y CDI. No se observa expresión de p53 y c-erbB2 en la HDA, pero aumenta con el desarrollo del cáncer de mama, especialmente con la presencia de infiltración. Un alto GH se asoció a tumores con RE-, alto índice de proliferación y sobrexpresión de p53 y c-erbB-2. Conclusiones: en las etapas iniciales de la secuencia de lesiones proliferativas ductales no se observa expresión de p53ni c-erbB2. Ambos marcadores se incrementan en el cáncer de mama en relación con el GH...(AU)

Background: breast screening has greatly increased the number of women diagnosed with proliferative breast disease. Recent studies have shown an association between benign breast diseases and subsequent breast cancer, hence have focussed on benign proliferative lesions. Breast cancer is probably the result of a series of genetic events (each with its own histologic correlation and sequence) from atypical ductal hyperplasia(ADH) to carcinoma. The goal of this study was to determine the diagnostic value of immunohistochemical determinations of biological markers(hormonal receptors, Ki67, p53 and c-erbB-2 expresion) in this sequence. Methods: expression of estrogen receptors (ER), cellular proliferation (Ki67), p53 and c-erbB-2 were examined by immunohistochemistry in samples of breast tissue from 228 patients with varying mammary lesions: ADH (28 cases), ductal carcinoma in situ (60 cases), ductal carcinoma in situ with microinfiltration(40 cases), invasive ductal carcinoma with extensive CDIS (40 cases) and pure invasive ductal carcinoma (60cases). A paraffin block was selected for immuno histochemical studies. DCIS was classified according to the Page’s criteria and histologic grading of invasive carcinoma following criteria given by Scarff-Bloom-Richardson modified by Elston and Ellis. Results: the ER expresion was 100% in ADH but decreases down to 70% in DCIS and DCI. Expression for p53 andcerbB-2 was not observed in ADH; but appears with the development of breast cancer: was observed in 21.7% in DCIS, 42.5% in DCIS-mic and 41.5% in pure DCI. High histological grade has been associated with estrogen receptor negativity, cellular proliferation, p53 and c-erbB-2 over expression. Conclusions: a p53 and c-erb-2 over expression were not observed in the early stages of the sequence atypical hyperplasia-carcinoma...(AU)

Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer.

BACKGROUND: This study analysed the value of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting axillary lymph node involvement in women with breast cancer. METHODS: In the first 150 women in this prospective study, axillary lymph node dissection (ALND) was performed regardless of the PET results. In a second group (125 women) FDG-PET was complemented with sentinel lymph node biopsy (SLNB) only in those who did not have pathological axillary uptake. RESULTS: The sensitivity and specificity of FDG-PET in detecting axillary involvement was 84.5 and 98.5 per cent respectively in the whole series of 275 patients, with two false-positive and 22 false-negative results. False-negative results were associated with some intrinsic tumour characteristics. In 21 women, PET revealed pathological uptake, suggesting involvement of the internal mammary lymph node chain. Whole-body PET identified a second synchronous tumour in five asymptomatic patients and haematogenous metastases in two patients. CONCLUSION: The high positive predictive value of PET (98.4 per cent) suggests that FDG uptake in the axilla could be an indication for full ALND without previous SLNB.

[Imaging techniques for axillary lymph node staging in breast cancer]. / Técnicas de imagen para la valoración del estado ganglionar axilar en el cáncer de mama.

The axillary lymph node status is the most important prognostic factor in breast cancer, and the axillary dissection as the gold standar for staging. It requires radical surgery, which is accompanied by importants postoperaive problems. Axillary lymph nodes can be imaged with a wide variety of available diagnostic radiological test (ultrasonography, mammography, computed tomography and magnetic resonance imaging). In these anatomic imaging, the limph nodes whit metastatic disease appear dense, enlarged or spiculated. Difficulties arise, not in visualization of the axillary lymph nodes, but in reliably separating normal from those involved with metastatic disease. Radionucleide studies and positron emisión tomography provide biochemical information, but are limited by resolution constrains.

Técnicas de biopsia para el diagnóstico de lesiones mamarias no palpables / Biopsy techniques for the diagnosis of non-palpable mammary lesions

Ante una lesión mamaria no palpable que precise una biopsia diagnóstica debe valorarse el método de guiado idóneo para acceder a la misma. En la actualidad se emplean tres métodos: la estereotaxia (fundamentalmente en casos de microcalcificaciones), la ecografía (sobre todo en los nódulos) y la resonancia magnética (para lesiones no visibles mediante los anteriores sistemas). El siguiente paso es elegir la técnica de biopsia más adecuada. La técnica más clásica y fiable es la biopsia quirúrgica con marcaje previo con un arpón metálico, pero tiene los inconvenientes de ser una técnica agresiva para el diagnóstico de la patología benigna, además de presentar un alto coste. Como alternativas se han desarrollado múltiples sistemas de punción. La punción con aguja fina es de fácil realización técnica y puede dar buenos resultados en los nódulos mamarios, pero la existencia de resultados falsos positivos y negativos han limitado progresivamente su utilización. Como alternativa, los sistemas de biopsia con aguja gruesa han permitido la obtención de múltiples cilindros con gran fiabilidad diagnóstica, sobre todo en el caso de los nódulos mamarios. Sin embargo, su empleo en las microcalcificaciones continúa mostrando resultados falsos negativos. El advenimiento de los sistemas de biopsia asistida por vacío ha permitido la obtención de cilindros de mayor calidad, mejorando claramente los resultados de los sistemas anteriores, sobre todo en los casos de microcalcificaciones. Por último, los sistemas de biopsia escisional percutánea mediante cánulas de hasta 22 mm de diámetro consiguen la extracción completa de lesiones de tamaño inferior al de la cánula, con una fiabilidad similar al de la biopsia quirúrgica (AU)

18F-FDG PET complemented with sentinel lymph node biopsy in the detection of axillary involvement in breast cancer.

AIM: The presence of axillary involvement is the most important prognostic factor in breast cancer. This study analysis the value of 18F-FDG PET in the detection of the lymph node status. METHODS: This study includes 200 breast cancer patients. The PET scans were obtained after the injection of 370 MBq of 18F-FDG; the breast areas, axillary, supraclavicular and internal mammary lymph node chains were evaluated. In a subgroup of 100 patients the PET-FDG scan was complemented with the study of the sentinel node (SN) in those cases which did not demonstrate pathological lymph node uptake. The standardized uptake value (SUV) was related to the tumour characteristics of size, histological type, axillary status and histological grading. RESULTS: The sensitivity and specificity of PET-FDG in the detection of axillary involvement was 84.1 and 97.8%, respectively. Seventeen false negative cases were obtained, and were associated with low SUV in the mammary tumour. In 15 cases the PET-FDG scans revealed pathological uptake foci that suggested involvement of the internal mammary chain. CONCLUSIONS: The PET-FDG avoids routine SN study in those cases presenting axillary uptake, but it must be complemented by sentinel node study in those cases without pathological uptake. The association of PET-FDG and SN improves the sensitivity in the detection of axillary involvement. Its sensitivity and specificity in the analysis of axillary status can be extended to the evaluation of the internal mammary chain.

[Biopsy techniques for the diagnosis of non-palpable mammary lesions]. / Técnicas de biopsia para el diagnóstico de lesiones mamarias no palpables.

Facing a non-palpable mammary lesion requiring a diagnostic biopsy, consideration must be given to the most suitable guiding method for obtaining the latter. Three methods are employed at present: stereotaxy (basically in cases of microcalcifications), echography (above all in the nodules), and magnetic resonance (for lesions not made visible through the previous systems). The next step is to select the most suitable biopsy technique. The most classical and reliable technique is the surgical biopsy with prior marking using a metallic harpoon, but, besides its high cost, it has the drawback of being an aggressive technique for the diagnosis of a benign pathology. Numerous systems of puncture have been developed as alternatives. Puncture with a fine needle is technically simple to carry out and can provide good results in the mammary nodules, but the existence of positive and negative false results has progressively limited its use. As an alternative, the systems of biopsy with a broad needle have made it possible to obtain multiple cylinders with a high diagnostic reliability, above all in the case of mammary nodules. However, their use in microcalcifications continues to show negative false results. The arrival of systems of vacuum-assisted biopsy has made it possible to obtain cylinders of greater quality, above all in cases of microcalcifications. Finally, the systems of percutaneous resection biopsy by means of cannulas with a diameter of 22 mm make it possible to completely extract lesions of a size below that of the cannula, with a reliability similar to that of the surgical biopsy.

Cáncer de mama en España: algunos resultados de una encuesta multicéntrica / Breast cancer in Spain: some results from a multicenter survey

Mediante una encuesta remitida a los miembros de la Sociedad Española de Senología, se ha intentado analizar retrospectivamente las características de presentación, diagnóstico y tratamiento del cáncer de mama en España. Se recibió respuesta por parte de 7 socios, aportando en su conjunto datos sobre 10.858 cánceres de mama. Las series fueron muy variadas tanto en casuística aportada (rango 68-3.860) como en numero de casos tratados/año (rango 32-387).El análisis de estas serie mostró una máxima incidencia del cáncer de mama en la década 51-60 años, siendo el tumor palpable el motivo mas común de consulta, seguido del chequeo para diagnóstico precoz. El 10 por ciento de los casos fueron tumores no infiltrantes y en el 54,7 por ciento de la series no existió afectación ganglionar axilar. En más del 50 por ciento de casos se recurrió a cirugía conservadora, y para la estidificación inicial y posterior seguimiento, son muchos los centros que siguen protocolos clásicos, intensivos (AU)

Lesiones mamarias no palpables: experiencia inicial con la biopsia estereotáxica automatizada / Non-palpable breast lesions: initial experience with the automated stereotaxic biopsy

Analizamos retrospectivamente en nuestra experiencia la eficacia de los sistemas MIBB (minimally invased breast biopsy) y ABBI (advanced breast biopsy instrumentation) en el diagnóstico de las lesiones mamograficas sospechosas no palpables. Se realizaron 70 biopsias: 36 con el MIBB y 34 con el ABBI. Mediante el MIBB se obtuvieron varios cilindros por un único punto de punción, con la biopsia ABBI se obtuvo un único cilindro de 1-2 cm de diámetro. La biopsia se indicó por microcalcificaciones (n = 40) y nódulos (n = 30). Analizamos las complicaciones técnicas, postbiopsia y los resultados histológicos. La lesión sospechosa fue correctamente localizada y biopsiada en el 98,5 per cent (36 de 36 MIBB y 33 de 34 ABBI) comprobada por la radiografía de la pieza, las imágenes estereotáxicas y el análisis histológico. En 4 casos (5,7 per cent) se observaron complicaciones técnicas que no impidieron completar la biopsia. En 3 casos (4,3 per cent) se presentaron complicaciones postbiopsia: 2 hematomas post ABBI y un sincope vagal post MIBB. 27 lesiones fueron malignas (38,5 per cent); 10 biopsiadas por MIBB y 13 por ABBI. No se observó tumor residual en la tumorectomía posterior en 5 de los 10 ABBI malignos reintervenidos. Tres pacientes con carcinomas de mama con márgenes de resección negativos se extirparon con la cánula ABBI sin practicar una intervención posterior. Los sistemas MIBB y ABBI fueron métodos de biopsia mamaria seguros y precisos y evitaron la cirugía posterior en el 71,2 per cent de casos. La localización, tamaño y grado de sospecha de la lesión son muy importantes para decidir el tipo de biopsia. Las lesiones sospechosas de más de 1 cm o las multifocales deben biopsiarse con el sistema MIBB. Las lesiones únicas de menos de 1cm deben biopsiarse con el sistema ABBI. Tumores de mama de pequeño tamaño en casos seleccionados podrían extirparse por completo con el ABBI sin necesitar una posterior tumorectomía (AU)

An experience with the Advanced Breast Biopsy Instrumentation (ABBI) system in the management of non-palpable breast lesions.

Our objective was to evaluate our experience with the Advanced Breast Biopsy Instrumentation system (ABBI) in non-palpable breast lesions in a prospective study from July 1998 to November 2000. The ABBI system was included in a protocol for BIRADS 4 non-palpable, small (<15 mm) breast lesions. Digital radiographs of both specimen and biopsy cavity were obtained to validate the procedure. A total of 255 ABBI biopsies were performed in 254 patients. In 251 cases the lesions were successfully removed (98.4%). Mammographic lesions consisted of 176 cases of microcalcifications (69%), 51 cases of architectural distortions (20%) and 28 cases of nodules (11%). Seventy-two carcinomas were diagnosed (28.2%). Affected margins were found in 41 cases (56.9%). Residual tumour was seen in 31 patients (43%). Seventeen borderline results and 33 benign architectural distortions obviated further procedures. The complication rate in 10 cases was as follows: 3 wound infections; 4 haematomas; and 3 vasovagal reactions. The main utility of the ABBI system is to allow a reliable diagnosis in complex lesions, such as small clusters of microcalcifications and especially architectural distortions. Surgery can be avoided for borderline cases if the lesion is completely removed and free margins are obtained in the pathology study. Therapeutic use is controversial and can be applied only in selected cases.

Atypical evolution of a calcified lipid cyst presenting spontaneously as a suspicious cluster of microcalcifications.

We report an infrequent mammographic case in which a gross-calcified lipid cyst evolved spontaneously to form a cluster of pleomorphic microcalcifications which were indistinguishable from those seen in breast cancer. The biopsy performed was consistent with fat necrosis. Ultrasonography of the specimen showed a nodule with mixed echogenicity surrounded by a hypoechoic rim. To our knowledge, this behavior is extremely rare, with only one similar case reported in the literature.