Incidental Findings in Reduction Mammoplasty Specimens in Patients with No Prior History of Breast Cancer. An Analysis of 783 Specimens.

Breast reduction surgery is a common procedure and the rate of incidental findings in the removed specimens varies between 0% and 4.6%. There are no guidelines about pathological evaluation of breast reduction surgery. We reviewed all pathology reports of patients undergoing breast reduction surgery in a single tertiary institution in Brazil from January 2008 to August 2014. Exclusion criteria were a personal history of breast cancer, unclear reason for mastectomy and incomplete data on the pathology report. We considered "relevant findings" flat epithelial atypia, atypical hyperplasia, carcinomas in situ and invasive carcinoma. Of 1672 specimens from breast reduction surgery, 783 met inclusion criteria. Median patient age was 40 (8-77), 91% underwent bilateral mastectomy and 57% of the specimens weighted less than 200 g. In 55% of cases, 4 or more paraffin blocks were sampled. There were 40 (5.1%) relevant findings and the most common was atypical lobular hyperplasia (16-2%). There were 3 invasive carcinomas (0.38%). In multivariate analysis, the only variables associated with a higher odds of relevant pathological findings were patient age ≥ 40 (OR 4.73 CI95% 1.98-11.3 p < 0.001) and sampling of ≥4 paraffin blocks from each specimen (OR 6.69 95% CI 2.25-19.9 p < 0.001). The incidence of pre-malignant and malignant lesions in specimens from breast reduction surgery is around 5%, but this risk is significantly higher for patients older than 40 years-old. Sampling at least 4 paraffin blocks from each specimen significantly increases detection rates.

A logistic regression model predicting high axillary tumour burden in early breast cancer patients.

PURPOSE: As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. METHODS/PATIENTS: Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. RESULTS: Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. CONCLUSIONS: Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.

Core Breast Biopsies Showing Lobular Carcinoma In Situ Should Be Excised and Surveillance Is Reasonable for Atypical Lobular Hyperplasia.

OBJECTIVE: The purpose of this article is to determine the upgrade rate to ductal carcinoma in situ (DCIS) or invasive carcinoma at excision at the same site after percutaneous breast biopsy findings of atypical lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS) using current imaging and strict pathologic criteria. MATERIALS AND METHODS: From January 2006 through September 2013, 32,960 breast core biopsies were performed; 1084 (3.3%) core biopsies found ALH or classic LCIS. For 447 lesions in 433 women, this was the only high-risk lesion at that site, with no ipsilateral malignancy, and results of excision were available. RESULTS: Among the 447 lesions, 22 (4.9%) were malignant at excision, including 10 invasive carcinomas (two grade 2 and eight grade 1; all node negative) and 12 DCIS. The upgrade rate of LCIS was 9.3% (10/108; 95% CI, 5.1-16.2%) and that of ALH was 3.5% (12/339; 95% CI, 2.0-6.1%; p = 0.02). After excluding five cases with radiologic-pathologic discordance and reclassifying one core from ALH to LCIS at review, the upgrade rate for LCIS remained higher (8.4%; 9/107; 95% CI, 4.5-15.2%) than that for ALH (2.4%; 8/335; 95% CI, 1.2-4.6%; p = 0.01). CONCLUSION: Excision is recommended for LCIS on core biopsy because of its 8.4-9.3% upgrade rate. Excluding discordant cases, patients with other high-risk lesions or concurrent malignancy, the risk of upgrade of ALH was 2.4%. Surveillance at 6, 12, and 24 months can be performed in lieu of excision because a short delay in diagnosis of the few malignancies is not expected to cause harm.

Assessing Surgical and Medical Complications in Bilateral Abdomen-Based Free Flap Breast Reconstructions Compared With Unilateral Free Flap Breast Reconstructions.

BACKGROUND: Prophylactic mastectomy is more common, with many patients seeking reconstruction. Bilateral free flap reconstructions subject patients to 2 flaps and longer operations, potentially increasing their risk for complications. We hypothesized that bilateral abdomen-based free flap reconstruction patients are a unique patient population with a higher rate of perioperative complications. METHODS: A retrospective chart review compared all 444 bilateral abdomen-based free flap breast reconstructions (in 222 patients) and 367 unilateral free flap breast reconstructions, performed at a single institution between March 2005 and July 2011. Patient and surgical characteristics and complications were studied. RESULTS: Bilateral reconstruction patients were slightly younger and heavier (mean, 49.2 years and 77.7 kg) and more likely to be white. Bilateral reconstructions were more often immediate reconstructions and less likely to have postoperative radiation therapy. These patients had longer surgical times and higher rates of intraoperative arterial thrombosis, but there were no significant differences in postoperative thrombosis or flap loss rates between the groups. The bilateral reconstruction patients, however, did have higher rates of minor surgical and medical complications, including a higher rate of lower extremity deep venous thrombosis (1.8% vs 0.3%, P = 0.045). CONCLUSIONS: We find that bilateral abdomen-based free flap breast reconstruction patients do not have higher rates of major postsurgical complications such as flap loss or postoperative thrombosis. However, higher rates of minor surgical and postoperative medical complications, including significantly more cases of lower extremity deep venous thrombosis, are seen. These findings are important for patient counseling and perioperative management.

Positive margins following breast cancer tumorectomy. Can we predict the occurrence of residual disease?

AIMS AND BACKGROUND: In conservative early stage breast cancer surgery, the sample's margins are directly related to relapse, and positive or close margins indicate the need for additional surgery. Since the range of residual disease in secondary surgeries and the related pathological factors are highly variable, we intended to evaluate the number of additional surgeries due to compromised margins and identify the percentage of residual disease and factors related to it. METHODS: We retrospectively analyzed the clinical records of 659 tumorectomy or needle localization surgery patients with breast carcinoma at the Hospital Universitario Austral in Buenos Aires, Argentina, between December 2000 and December 2012. The variables considered were age, type of surgery, type of margin, tumor size, histological grade, extensive intraductal component and immunohistochemical profile. We investigated how they related to the presence of residual disease. RESULTS: We identified 68 patients (10%) who were reoperated because of positive (75%) or close (25%) margins. Residual disease was identified in 68% of them; the positive (66%) and close (70%) margin ratio was similar. The individual analysis of variables was statistically significant only for tumors larger than 3 cm (Pearson's chi square [1] = 6.7194; P = 0.0095; relative risk = 1.56 [95% CI 1.09-2.21]) with an association between age and tumor size: Pearson's chi square (1) = 3.8984; P = 0.0483; relative risk = 1.56 (95% CI 1.09-2.21). CONCLUSIONS: The need for second surgery due to compromised margins is not common, with variable residual tumor identifying ranges. Some pathological factors can predict the persistence of residual disease. In our series, tumor size >3 cm was the variable identified as an independent predictor.

Prospective study evaluating oncological safety of axillary reverse mapping.

BACKGROUND: Axillary reverse mapping (ARM) is a new technique developed with the aim of reducing lymphedema rates by preserving lymphatic drainage of the upper limbs during sentinel lymph node biopsy and axillary lymph node dissection (ALND). However, it is unclear whether preservation of these lymph nodes affects oncological risk. The present study evaluated the presence of metastases in ARM nodes. METHODS: A total of 45 patients underwent ARM during ALND. Blue dye was used for ARM nodes localization. All axillary lymph nodes, including ARM nodes, were removed and sent separately for pathological evaluation of metastases. RESULTS: ARM identification was achieved in 40/45 patients (88.9 %). The average number of removed ARM nodes was 1.9. ARM nodes metastasis occurred in 10 of 40 patients (25 %). Patients with an axilla extensively affected by cancer had an elevated risk of metastasis to the arm's lymph nodes (p < 0.001). CONCLUSIONS: The rate of arm lymph nodes compromised by metastases calls into question the viability of the ARM technique. Larger studies may point to particular patient profiles for which ARM can be safely use.

Radicality effect of adding an interpectoral to a subpectoral approach for dissection of level III axillary lymph nodes in breast cancer.

AIMS AND BACKGROUND: The extent of axillary lymph node dissection for breast cancer treatment is tailored to each patient. When the surgeon assumes that full dissection, including level III, is needed, there are basically two ways for reaching the apical nodes while preserving the pectoralis muscles: a subpectoral approach, below the joined pectoralis muscles, and another that includes an additional interpectoral dissection between the muscles. We conducted a study to evaluate the radicality of dissection using these two approaches. METHODS: To determine whether the harvest of level III axillary lymph nodes is equivalent with the different approaches, we prospectively studied 75 patients with breast cancer. Careful axillary lymph node dissection was done to as radical an extent as possible, first below the lateral edge of the joined pectoralis muscles (subpectoral approach) and sequentially after opening the space between the muscles (additional interpectoral approach). The number of patients with extra level III nodes retrieved by the addition of an interpectoral dissection as well as the number of complementary nodes obtained in such patients were determined. RESULTS: We excised 1701 axillary lymph nodes in 75 patients (mean, 22.7). Using first the subpectoral approach, we resected 259 level III nodes in 68 patients (mean, 3.8); in 56 patients, we removed 132 additional level III nodes using the supplementary interpectoral approach (mean, 2.4). In 7 patients (9.3%), we found at least one metastatic node with the interpectoral approach. Two of these patients had positive level III nodes that were discovered only by addition of the interpectoral dissection. CONCLUSIONS: The dissection of level III axillary nodes is more radical when an additional interpectoral dissection is performed after a subpectoral approach has been used. The exclusive subpectoral approach frequently leaves residual nodes at the apex of the axilla.

Prophylactic mastectomy: is it worth it?

BACKGROUND: Breast cancer is the second mortality-related cancer and the leading cause of general mortality in women aged 40-55. Prophylactic mastectomy has proved to be effective in several clinical scenarios but is still a somewhat controversial procedure. METHODS: We performed a retrospective study by reviewing the records of all patients who underwent prophylactic mastectomy in a 25-year period. We evaluated the aesthetic and long-term oncologic outcomes, complications, and patient satisfaction. RESULTS: We had 52 patients, 40 of them unilateral cases (contralateral prophylactic mastectomy) and 12 bilateral (bilateral prophylactic mastectomy) for a total of 64 mastectomized breasts. We had 1 (1.56%) case of unexpected breast cancer in the mastectomy specimens. Forty-two (65.62%) cases had a subcutaneous prophylactic mastectomy and 22 (34.37%) cases had a simple total prophylactic mastectomy. Fifty-eight (90.62%) cases underwent reconstruction with alloplastics and 6 (9.37) cases with autologous tissue of which 5 (7.81%) cases received latissimus dorsi flaps with alloplastic implants and 1 (1.56%) case had a TRAM flap. The complications included 4 (6.25%) breasts that developed capsular contracture, 2 (3.12%) cases of hematoma, and 1 (1.56%) infection. Concerning patient satisfaction, 39 (75%) patients reported being highly satisfied, 10 (19.23%) partially satisfied, and 3 (5.76%) unsatisfied. When we performed the aesthetic evaluation according to our scale, we got an overall aesthetic index of 8.8. CONCLUSION: Prophylactic mastectomy is becoming an increasingly frequent procedure. Plastic surgeons should consider the aesthetic outcome when planning mastectomy and reconstruction. Our ability to predict the high-risk population has improved and it is that population who can get the best benefit from this intervention. The recommendation against subcutaneous prophylactic mastectomy lacks scientific evidence. There is plenty of evidence that prophylactic mastectomy lowers the risk of breast cancer in the high-risk population in at least 95%. Our experience with prophylactic mastectomy is extremely satisfactory, with an overall patient satisfaction rate of 94%, no mortality, and an oncologic long-term outcome of 0% of ulterior development of breast cancer. Our series, although relatively small, should provide some insight into the power of this technique and we think all plastic surgeons should have it in their surgical armamentarium and should share their experiences so that this procedure may become more widely accepted. We also think that plastic surgeons should strive for perfecting the technique to reduce the complication rate and therefore help the procedure gain acceptance by the medical community.

[Breast cancer in Mexican women under 40]. / Cancer de mama en mujeres mexicanas menores de 40 años.

BACKGROUND: Breast cancer is the leading cause of death from malignancy in women. The incidence increases with age, but the relationship between age and survival of breast cancer patients is not well defined. It is observed that young women with breast cancer have patterns more aggressive biological. OBJECTIVE: To determine the frequency, sociodemographic, clinical and histopathological features of breast cancer in women under 40 years attending a specialist breast unit in Mexico City. PATIENTS AND METHOD: Transversal, descriptive and retrospective study of patients under 40 years of age with breast cancer treated between 2005 and 2010. RESULTS: 1430 cases were diagnosed with breast cancer five years with a mean age of 53.64 +/- 11.87 years (range 23 to 93 years), 142 cases were women under 40 years of age (10%). The auto-detection of a breast lump was the most frequent clinical manifestation (50%). CONCLUSION: The prevalence of clinical stage III in this age group suggests the difficulty of diagnosis, the high breast density, which is one factor limiting studies of screening with mammography, it diminishes their effectiveness in early detection of breast cancer.

Thoracoscopic approach in the treatment of breast cancer relapse in the internal mammary lymph node.

Regional recurrence of breast cancer may involve the surgical site of mastectomy, axillary lymph nodes and the internal mammary lymphatic chain. Treatment of regional recurrent mammary cancer rarely requires thoracic surgery intervention, except in some selected cases of recurrence in the chest wall. Concerning lymphatic recurrence in breast cancer, the therapeutic choice rarely includes surgical lymph node excision. Exclusive videothoracoscopic (VTS) resection of recurrence in internal mammary lymph nodes has not as yet been reported in the literature. Due to the rare surgical exploration of this lymphatic chain, the thoracoscopic approach is described only in three published studies involving humans, furthermore, in these three descriptions, the operation was performed only for mere staging but not for the whole resection of the recurrent lymphatic structure. We present a case of recurrence of breast cancer in lymph nodes of the internal mammary chain that was treated with complete resection by pure VTS surgery.

Metástasis vulvar de carcinoma lobulillar de mama: reporte de un caso / Vulvar metastases of lobulillar carcinoma of breast: a case report

El objetivo del presente trabajo es el de presentar un caso de metástasis a vulva de primario de mama derecha carcinoma lobulillar estadio IIB, en paciente de 46 años con tratamiento quirúrgico y adyuvancia con quimioterapia, radioterapia y hormonoterapia, vista y tratada en el servicio de patología mamaria del Instituto de Oncología “Dr. Luis Razetti” Caracas, Venezuela. Se revisa la literatura. Se describe una lesión metastásica en labio mayor de hemivulva izquierda de 1,5 cm de diámetro en una paciente con carcinoma lobulillar de mama derecha estadio IIB con intervalo libre de enfermedad de 5 meses después de tratamiento quirúrgico y adyuvante completo. Las metástasis a vulva del cáncer de mama son infrecuentes. La vigilancia ginecológica cuidadosa en pacientes con cáncer de mama permite evidenciar sitios infrecuentes de metástasis, para poder ser diagnosticados precozmente y tratados apropiadamente.

The objective of this present work is to report a case of metastases to vulva of primary of right breast lobulillar carcinoma classified as stadium IIB, in 46 years old patient with surgical and adjuvant treatment with complete chemotherapy, radiotherapy and hormonal therapy she was seen and treated in breast pathology service of Oncology Institute “Dr. Luis Razetti”, Caracas, Venezuela. We review the literature. Describe a metastatic tumor in left lip bigger of the vulva of 1.5 cm primary of the right breast lobular cancer, stadium IIB, with 5 months interval free of illness, after surgical and adjuvant complete treatment. The metastases to vulva of breast cancer are less frequent. The careful gynecological surveillance in patient with breast cancer allows us to evidence an unusual place of metastasis, to be able to be diagnosed precociously and tried appropriately.

Optimizing the nipple-areola sparing mastectomy with double concentric periareolar incision and biodimensional expander-implant reconstruction: aesthetic and technical refinements.

Although the biodimensional anatomical expander-implant system (BEIS) is a reliable technique, little information has been available regarding outcome following nipple-areola sparing mastectomy (NSM). To perform the resection of glandular tissue, while improving the surgical access and maintaining the nipple-areola vascularization we have developed a new approach for NSM based on the double concentric periareolar incision (DCPI). The purpose of this study is to analyze the feasibility, surgical planning and its outcome following NSM. 18 patients underwent NSM reconstructions. Mean time of follow-up was 29 months. The technique was indicated in patients with small/moderate volume breasts. Flap complications were evaluated and information on aesthetic results and patient satisfaction were collected. 83.3% had tumors measuring 2cm or less (T1) and 72.1% were stage 0 and I. All patients presented peripherally tumors located (at least 5cm from the nipple). Skin complications occurred in 11.1%. One patient (5.5%) presented small skin necrosis and a wound dehiscence was observed in one patient (5.5%). The aesthetic result was good/very good in 94.4 percent and the majority of patients were very satisfied/satisfied. No local recurrences were observed. All complications except one were treated by a conservative approach. DCPI-BEIS is a simple and reliable technique for NSM reconstruction. The success depends on patient selection, coordinated planning with the oncologic surgeon and careful intra-operative and post-operative management.

Regression of the fibrous disease of the breast in a non-diabetic woman after pregnancy and breastfeeding

Fibrous mastopathy, also known as diabetic mastopathy and lymphocytic mastopathy, may mimic breast cancer at the physical examination, mammography, and ultrasound. We report a case of a woman who presented a non-tender mass clinically suggestive of breast carcinoma; however, the fine-needle aspiration cytology indicated atypia and the core needle biopsy revealed lymphocytic mastopathy. The magnetic resonance imaging of the breast showed a lesion with benign features. It was not demonstrated diabetics mellitus and autoimmune diseases. The patient got pregnant, breastfed, and it was observed the progressive regression of the lesion, with complete disappearance of the solid mass. Three years and three months later, there was no palpable mass at the clinical examination and ultrasound. In conclusion, fibrous mastopathy shall be considered for all breast lesions, regardless of the diagnosis of diabetes mellitus. Once a definitive diagnosis of this pathology is reached, it is recommended clinical, imaging studies and fine-needle aspiration biopsy follow-up of the patient, avoiding unnecessary surgical procedures.

A mastopatia fibrótica, também conhecida como mastopatia diabética e mastopatia linfocítica, pode, ao exame clínico, mamografia e ultra-som, simular um carcinoma mamário. Descrevemos o relato de uma mulher na qual o nódulo foi inicialmente suspeito de carcinoma mamário, mas o diagnóstico pela punção aspirativa com agulha fina foi de atipia, e o com biópsia com agulha grossa foi de mastopatia linfocítica. A ressonância magnética da mama mostrou a lesão com características de benignidade. Não foram demonstradas diabetes mellitus e doenças auto-imunes. A paciente engravidou, amamentou e foi observada regressão progressiva da lesão, com desaparecimento da mesma. A paciente persiste sem lesão na mama ao exame clínico e de ultra-som após acompanhamento de três anos e três meses. Em conclusão, a mastopatia fibrótica deve ser considerada para todas as lesões de mama, mesmo em pacientes sem diabetes mellitus. Quando o diagnóstico definitivo da patologia for realizado, é recomendável o acompanhamento da paciente com estudos clínicos e de imagem e biópsia com agulha fina, evitando-se procedimentos cirúrgicos desnecessários.

Perianal metastases from lobular breast carcinoma.

Breast cancer gastrointestinal and soft tissue metastases are extremely rare. We present the case of a woman with perianal metastases from a primary lobular breast carcinoma 11 years after mastectomy and local radiotherapy.

A 7 year experience with immediate breast reconstruction after skin sparing mastectomy for cancer.

Skin sparing mastectomy (SSM) is a procedure that has gained popularity for patients who elect to have a mastectomy as the treatment for carcinoma of the breast. Reconstruction of the breast after SSM yields the best aesthetic results since it preserves most of the skin envelope and the inframammary fold. The purpose of this study was to evaluate the oncologic safety and aesthetic results for SSM and immediate breast reconstruction. One hundred and five patients treated between April 1997 and December 2004 were reviewed. The mean age of the patients was 40 years. The mean follow up was for 48 months, considered from the time of SSM and reconstruction. Reconstructive techniques included pedicled transverse rectus abdominis muscle (TRAM) flap (n: 70 patients), tissue expanders and implants (n: 29 patients), latissimus dorsi flaps and implants (n: 6 patients). Aesthetic results were judged by an independent plastic surgeon and by the patient as excellent, good, fair or poor. The findings of this study demonstrate that SSM and immediate breast reconstruction can be safely performed. Detection and treatment of recurrences were not inhibited by the reconstructions. In this experience the best results were seen after TRAM flap reconstructions. The general level of satisfaction expressed by the patient was correlated with a good appearance of the reconstructed breast and the physical comfort.

Regression of the fibrous disease of the breast in a non-diabetic woman after pregnancy and breastfeeding.

Fibrous mastopathy, also known as diabetic mastopathy and lymphocytic mastopathy, may mimic breast cancer at the physical examination, mammography, and ultrasound. We report a case of a woman who presented a non-tender mass clinically suggestive of breast carcinoma; however, the fine-needle aspiration cytology indicated atypia and the core needle biopsy revealed lymphocytic mastopathy. The magnetic resonance imaging of the breast showed a lesion with benign features. It was not demonstrated diabetics mellitus and autoimmune diseases. The patient got pregnant, breastfed, and it was observed the progressive regression of the lesion, with complete disappearance of the solid mass. Three years and three months later, there was no palpable mass at the clinical examination and ultrasound. In conclusion, fibrous mastopathy shall be considered for all breast lesions, regardless of the diagnosis of diabetes mellitus. Once a definitive diagnosis of this pathology is reached, it is recommended clinical, imaging studies and fine-needle aspiration biopsy follow-up of the patient, avoiding unnecessary surgical procedures.

[Conservative management of the axillary nodes in operable breast cancer]. / Manejo conservador de la axila en cáncer de mama operable.

Over the years, the treatment of breast cancer has changed dramatically. We briefly describe those changes and also the different therapeutic approches to the axillary nodes. Over the last century, the primary goal was to avoid radical surgery of the breast. However, during the last decades, the interest was mainly focused on the possibility of treating the axila in a conservative way, in an effort to minimize the adverse effects of linfadenectomy. The sentinel node technique is of key importance, because nowadays it is possible to diagnose breast cancer at early stages when most of the times the axila is negative. The early diagnoses of breast cancer makes the sentinel node technique a relevant tool at the time of making therapeutic decisions. We believe that the sentinel node technique could predict in many cases the lymph node status without the need of a complete axillary dissection of the axila in patients with breast cancer.

Manejo conservador de la axila en cáncer de mama operable / Conservative management of the axillary nodes in operable breast cancer

El tratamiento del cáncer de mama (CM), tumor mas frecuente en la mujer, sufrió diferentes modificaciones a lo largo de los dos últimos siglos. Se describe una reseña de las mismas, como así también los cambios en el manejo de la terapéutica axilar. Durante el siglo pasado, se trabajó fundamentalmente en las opcionesterapéuticas para la conservación de la glándula mamaria. Recién en las últimas décadas comienza el planteo de conductas dirigidas al manejo conservador de la axila, sobre todo para minimizar los efectos adversos secundarios a la linfadenectomía axilar completa. La técnica del Ganglio Centinela cobra importancia ya que los canceres de mama, cada vez con mayor frecuencia, son diagnosticados en estadios iniciales, por lo que las probabilidades de tener ganglios axilares negativos son cada vez mayores. Concluimos que la información que brinda el conocimiento del estado de los ganglios axilares es muy importante en la toma de decisiones terapéuticas en pacientes con cáncer de mama, y que la técnica del ganglio centinela podría, en algunos casos, ser un test que predice el status ganglionar axilar, sin necesidad de realizar una linfadenectomía axilar clásica.

Over the years, the treatment of breast cancer has changed dramatically. We briefly describe those changes and also the different therapeutic approaches to the axillary nodes. Over the last century, the primary goal was to avoid radical surgery of the breast. However, during the last decades, the interest was mainly focused on the possibility of treating the axilla in a conservative way, in an effort to minimize the adverse effects of linfadenectomy. The sentinel node technique is of key importance, because nowadays it is possible to diagnose breast cancer at early stages when most of the times the axilla is negative. The early diagnoses of breast cancer make the sentinel node technique a relevant tool at the time of making therapeutic decisions. We believe that the sentinel node technique could predict in many cases the lymph node status without the need of a complete axillary dissection of the axilla in patients with breast cancer.

Manejo conservador de la axila en cáncer de mama operable / Conservative management of the axillary nodes in operable breast cancer

El tratamiento del cáncer de mama (CM), tumor mas frecuente en la mujer, sufrió diferentes modificaciones a lo largo de los dos últimos siglos. Se describe una reseña de las mismas, como así también los cambios en el manejo de la terapéutica axilar. Durante el siglo pasado, se trabajó fundamentalmente en las opcionesterapéuticas para la conservación de la glándula mamaria. Recién en las últimas décadas comienza el planteo de conductas dirigidas al manejo conservador de la axila, sobre todo para minimizar los efectos adversos secundarios a la linfadenectomía axilar completa. La técnica del Ganglio Centinela cobra importancia ya que los canceres de mama, cada vez con mayor frecuencia, son diagnosticados en estadios iniciales, por lo que las probabilidades de tener ganglios axilares negativos son cada vez mayores. Concluimos que la información que brinda el conocimiento del estado de los ganglios axilares es muy importante en la toma de decisiones terapéuticas en pacientes con cáncer de mama, y que la técnica del ganglio centinela podría, en algunos casos, ser un test que predice el status ganglionar axilar, sin necesidad de realizar una linfadenectomía axilar clásica.(AU)

Over the years, the treatment of breast cancer has changed dramatically. We briefly describe those changes and also the different therapeutic approaches to the axillary nodes. Over the last century, the primary goal was to avoid radical surgery of the breast. However, during the last decades, the interest was mainly focused on the possibility of treating the axilla in a conservative way, in an effort to minimize the adverse effects of linfadenectomy. The sentinel node technique is of key importance, because nowadays it is possible to diagnose breast cancer at early stages when most of the times the axilla is negative. The early diagnoses of breast cancer make the sentinel node technique a relevant tool at the time of making therapeutic decisions. We believe that the sentinel node technique could predict in many cases the lymph node status without the need of a complete axillary dissection of the axilla in patients with breast cancer.(AU)