OSNA Total Tumor Load for the Prediction of Axillary Involvement in Breast Cancer Patients: Should We use Different Thresholds According to the Intrinsic Molecular Subtype? MOTTO Study.

Aims: To assess the impact of the molecular subtype (MS) on the total number of CK19 mRNA copies in all positive SLN (TTL) threshold, to predict non-SLN affectation, and to compare 5 years progression-free survival (PFS) according to the risk of recurrence (ROR) group by PAM50. Methods: Cohort with infiltrating breast cancer with intra-operative metastatic SLN detected by one-step nucleic acid amplification (OSNA) assay who underwent subsequent ALND. Logistic regression was used to assess a possible interaction between TTL and MS(Triple Negative, Her-2-Enriched, Luminal A, or Luminal B), or hormone receptors (HR: positive or negative) by immunohistochemistry (IMH). Cox regression was used to compare PFS and OS in the 3 ROR groups (high, medium, or low). Results: TTL was predictive of non-SLN affectation in both univariate (OR [95% CI]: 1.72 [1.43, 2.05], P < .001) and multivariate (1.55 [95% CI: 1.04, 2.32], P = .030) models, but MS-IMH or HR-IMH, and their interactions with TTL were not (best multivariate model: HR + main effect OR 1.16 [95% CI: 0.18, 7.64], P = .874; interaction OR: 1.04 [0.7, 1.55], P = .835; univariate model: HR + main effect OR: 1.44 [95% CI: 0.85, 2.44], P = .180). PFS was lower in the high-risk ROR group (81.1%) than in the low-risk group (93.9%) (HR: 3.68 [95 CI: 1.70, 7.94], P < .001). Conclusions: our results do not provide evidence to support the utilization of subtype-specific thresholds for TTL values to make therapeutic decisions on the axilla. The ROR group was predictive of 5 years-PFS.

Human Papillomavirus in the region of La Ribera-Valencia: Present and future.

OBJECTIVE: Human Papillomavirus (HPV) is the main cause of cervical cancer. The etiology and effects derived from this infection are set by molecular techniques and cytological diagnosis, respectively. In the present study, data obtained by an opportunist screening of cervical cancer in La Ribera region are revised and related statistically. METHODS: Data considering different variables such as age, degree of lesion, HPV type detected and number of virus in coinfection were collected from 1,372 HPV positive cytology samples. HPV detection was carried out by means of three molecular techniques and the degree of lesion was analyzed by cytological diagnosis (Bethesda). In order to determine the relationship between different selected variables, several statistical analyses were performed. RESULTS: Only degree of lesion variable showed a direct relationship with the rest of variables, increasing with aging process, viral oncogenicity, presence of at least one high-risk virus and with the fact of being mono-infected. The probability of presenting a higher-level degree of lesion multiplied by 28.4 when high-risk HPV was detected in mono-infection. CONCLUSIONS: HPV molecular detection is the most suitable technique to perform a cervix cancer primary screening for the management of women with negative cytological diagnose. The number of detected types is statistically related to the degree of lesion. The establishment of a properly regulated screening to identify HPV infection, and therefore, of cervical cancer risk, is essential.

Elaboration of a nomogram to predict non sentinel node status in breast cancer patients with positive sentinel node, intra-operatively assessed with one step nucleic acid amplification method.

BACKGROUNDS: Tumor-positive sentinel node(SLN) biopsy results in a risk of nonsentinel node metastases in case of micro and macro metastases ranging from 20 to 50 %, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. Thus, the development of a mathematical model for predicting patient-specific risk of non sentinel node(NSLN) metastases is strongly warranted. METHODS: The following parameters were recorded: CLINICAL: hospital, age, medical record number Bio-pathological: tumor (T) size, grading (G), multifocality, histological type, LVI, ER-PR status, HER-2, ki67, molecular classification (luminal A, luminal B, HER2 like, triple negative) Sentinel and nonsentinel lymph node related: number of removed SLNs, number of positive and negative SLNs, copy number of positive sentinel nodes, ratio: number of positive SLNs to number of removed SLNs, number of removed and number of positive nodes after ALND. A total of 2460 patients have been included in the database. All the patients have been provided by the authors of this paper. RESULTS: Multivariate logistic regression analysis demonstrated that only the number of a CK19 mRNA copies (p < 0.0001), T size (p < 0.0001) and LVI (p < 0.0001) were associated with NSN metastases. The discrimination of the model, quantified with the area under the receiver operating characteristics curve, was 0.71 (95 %, C.I. 0.69-0.73), thus confirming a good level of reliability. CONCLUSIONS: The nomogram may be employed by the surgeon as a decision making tool on whether to perform an intraoperative axillary lymph node dissection on breast cancer patients with SLN positive. The large population employed and the standardized method of measuring the value of CK19 mRNA copies are appropiate prerequisites for a reliable nomogram.

Molecular analysis of sentinel lymph nodes and search for molecular signatures of the metastatic potential of breast cancer.

Molecular assays are a new and invaluable tool in the assessment of axillary lymph node status and metastatic potential of breast cancer. Many protocols for assessing the sentinel lymph node (SLN) status have been developed based on cytology and/or histology, showing that the rate of detection of metastasis increases with the number of histologic sections examined and with use of immunohistochemical staining in addition to conventional Hematoxylin & Eosin staining. However, full standardization of protocols for this procedure has not been achieved. Further attempts to increase sensitivity and specificity of sentinel node analysis include molecular biology-based techniques such as the real-time polymerase chain reaction (RT-PCR) and, more recently, one step nucleic acid amplification (OSNA). The latter technique, that has sensitivity close to 100% and extremely high specificity along with good reproducibility, allows analysis of the SLN in full with an intraoperative procedure in approximately 30 minutes. This highly standardized method permits to compare results between groups and predicts the probability of involvement of the remaining axillary lymph nodes based on the total tumor load of the SLN(s). Results of multicenter clinical trials suggest that OSNA allows a better personalization of patients' care based on the results of SLN analysis, because it offers criteria to select patient with metastatic SLN who will not receive additional benefit from axillary clearance. Due to the current controversy on the best treatment of the axilla after a positive SLN, the SLN copy number of CK19 mRNA can have a high impact on therapeutic decisions in this group of patients. Breast cancer is a highly heterogeneous group of diseases, characterized by remarkable differences in the histopathological features, response to treatment and clinical outcome. Most of the clinical and translational research efforts during the last decades aimed at identifying markers that would allow to predict the metastatic potential of early breast cancer, and hence to assess accurately its prognosis and to inform the choice of adjuvant systemic treatments. It is now clear that neoplastic transformation, tumor progression and response to treatment are driven and accompanied by the deregulated expression of hundred or thousand genes, whose status cannot be assessed by the currently established histopathological and immunohistochemical approach. The new molecular assays have elicited a great deal of expectations, and for the most part they have been enthusiastically welcomed as potentially offering new chances for a better and more personalized care of the patients. Many, however, are still reluctant to consider these assays ready for use in the clinical practice, and keep waiting for a confirmatory evidence of their utility when the results of ongoing clinical trials will be mature.

Debut sexual y conocimientos sobre el usode anticonceptivos en una población adolescente. Programa Forma Joven / No disponible

Es labor importante dentro de la cartera de Atención Primaria la promoción y protección de la salud, especialmente en los sectores depoblación más vulnerables. Entre este colectivo se encuentran los jóvenes adolescentes en la fase educativa ESO y Bachillerato. El ProgramaForma Joven pone en marcha herramientas que, a través de las enfermeras de Atención Primaria, contribuye a proteger la salud y potenciarlos hábitos saludables. Gracias a este programa las enfermeras tenemos ocasión de contactar con la población juvenil y pulsar sus inquietudesy tendencias, analizando situaciones que nos pueden ayudar en nuestra práctica asistencial. Recogemos en este trabajo una seriede elementos que nos ponen en antecedentes sobre el comportamiento sexual de un grupo de jóvenes y sobre los conocimientos quetienen de los anticonceptivos habituales y de urgencia (píldora poscoital). Estos datos tienen una repercusión directa sobre nuestro trabajoen el Programa ya que nos ayudan a aportar conocimientos donde existen lagunas o a enderezar situaciones que detectamos están desviadaspor desconocimiento o información errónea (AU)

Summary: In primary care it is an important task to promote and protect health, especially among those population who are more vulnerable.In this group, there are young teens en the educative period of secondary education. Young shape program provides tools that,through nurses of primary care, helps to protect health and to promote healthy habits. Thanks to that program, nurses have the chanceto establish contact with young population and deal with their worries and tendencies, analyzing actions that can help in our clinical practice.We compile in this study different elements that inform us about sexual behabiours of a group of teens and about the information thatthey have about usual/urgency contraceptives (morning-after pill). These data has direct impact about our work in the Program as theyhelp us to know where there are gaps or to improve situations that are risky because of ignorance or mistaken information (AU)

Ganglio centinela en cáncer de mama: ¿histológico o molecular? Estudio diagnóstico comparativo multicéntrico español. Grupo de Estudios Senológicos / Nodisponible

Introducción: La biopsia del ganglio centinela (GC) estáaceptada como el procedimiento estándar para la cirugía conservadorade la axila en el cáncer de mama, pero la gran variabilidadexistente en los protocolos de estudio anatomopatológicoshan impedido una correcta estandarizacióndiagnóstica.Objetivo: Comparar los resultados de un nuevo métodomolecular (“One-step-Nucleic-Acid-Amplification”, OSNA)con los resultados de los procedimientos habituales y evaluar sies posible la implementación del OSNA como procedimientode elección para el diagnóstico intraoperatorio.Material y métodos: Se estudió una serie de 181 GC procedentesde seis hospitales. De cada ganglio, se realizaron seccionesde 2 mm de espesor hasta agotar el ganglio. Se incluyerontodas las secciones de manera alternativa “a” y “c” paraestudio histológico, y “b” y “d” para OSNA.Resultados: Se obtuvo un nivel de concordancia entre elprocedimiento histológico y el molecular del 99,45%.Conclusiones: El estudio multicéntrico demuestra que elOSNA es un procedimiento altamente sensible, específico yreproducible y que permite la estandarización del diagnósticointraoperatorio del GC en cáncer de mama(AU)

Background: The biopsy of the sentinel node (SN) hasbeen established as the standard procedure for conservativeaxillary surgery but its adequate diagnostic standardization hasnot yet been achieved since the protocols for histopathologicstudy have been highly variable.Objective: Our goal is to compare the results of this newmethod with the results of conventional histological tests, toevaluate the feasibility of this procedure for the intra-operativestudy of SN in breast cancer surgery and to evaluate it as away to standardize the sentinel node procedure.Material and methods: The study included 181 cases. Parallel,2 mm-thick sections were performed to drain the lymphnode which were then processed alternately for histologicalanalysis (“a” and “c”) and the others (“b” and d”) following theOSNA procedure.Results: A concordance level of 99.45% was found betweenthe histological and the molecular procedure.Conclusions: Our multicentric OSNA assay for sentinelnode in breast cancer demonstrates that this is a highly sensitive,specific and reproducible technique that allows the standardizationof the diagnostic procedure, a needed and up tonow unresolved question(AU)

Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon.

INTRODUCTION: sessile serrated adenoma (SSA) is a recently described lesion that may be related to the development of up to 15% of colorectal cancers (CRCs). OBJECTIVE: to determine the accuracy of morphological criteria for the diagnosis of SSA by assessing concordance between pathologists. MATERIAL AND METHODS: concordance between two pathologists in the diagnosis of serrated lesions of the colon was studied for 195 lesions (187 hyperplastic polyps and 7 serrated adenomas). Size, location, morphology, and sampling method were collected of each lesion. Both pathologists were unaware of the previous diagnosis, macroscopic characteristics, and location of lesions. Possible diagnoses were: SSA, traditional serrated adenoma (TSA), hyperplastic polyp (HP), serrated polyp, tubular adenoma, or mixed lesions. Diagnostic doubts had to be described. Concordance between both observers was assessed using the kappa index (ê). The influence of collected variables on concordance degree was also evaluated. RESULTS: overall agreement on the histological diagnosis was poor (ê = 0.14), and so was agreement on the diagnosis of SSA (ê = 0.23). Concordance in the diagnosis of SSA improved with size > 5 mm (ê = 0.64) and proximal location (ê = 0.43). CONCLUSION: in a real clinical setting, the existing morphological criteria for SSA identification may be difficult to use.

Evaluación de la reproducibilidad del diagnóstico microscópico del adenoma serrado de sésil de colon / Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon

Introducción: el adenoma serrado sésil (ASS) es una lesión descrita recientemente y que puede estar relacionada con el desarrollo de hasta un 15% de los cánceres colorrectales (CCR). Objetivo: determinar la eficacia de los criterios morfológicos para el diagnóstico del ASS evaluando el grado de acuerdo entre patólogos. Material y métodos: se estudió la concordancia entre dos patólogos para el diagnóstico de las lesiones serradas de colon en 195 lesiones (187 pólipos hiperplásicos y 7 adenomas serrados). De cada lesión se recogió el tamaño, la localización, la morfología y la forma de obtención de la muestra. Los dos patólogos eran desconocedores del diagnóstico inicial, las características macroscópicas y la localización de las lesiones. Los posibles diagnósticos fueron: ASS, adenoma serrado tradicional (AST), pólipo hiperplásico (PH), pólipo serrado, adenoma tubular o formas mixtas. Las dudas diagnósticas debían describirse. La concordancia entre los dos observadores se evaluó mediante el índice kappa (k). También se evaluó la influencia de las variables recogidas de las lesiones en el grado de acuerdo en el diagnóstico. Resultados: el acuerdo global para el diagnóstico histológico fue pobre (k = 0,14). También lo fue el acuerdo para el diagnóstico de ASS (k = 0,23). La concordancia para el diagnóstico de ASS mejoró con el tamaño > 5 mm (k = 0,64) y para la localización proximal (k = 0,43). Conclusión: en un contexto clínico real, los criterios morfológicos existentes para la identificación del ASS pueden ser de difícil aplicación(AU)

Introduction: sessile serrated adenoma (SSA) is a recently described lesion that may be related to the development of up to 15% of colorectal cancers (CRCs). Objective: to determine the accuracy of morphological criteria for the diagnosis of SSA by assessing concordance between pathologists. Material and methods: concordance between two pathologists in the diagnosis of serrated lesions of the colon was studied for 195 lesions (187 hyperplastic polyps and 7 serrated adenomas). Size, location, morphology, and sampling method were collected of each lesion. Both pathologists were unaware of the previous diagnosis, macroscopic characteristics, and location of lesions. Possible diagnoses were: SSA, traditional serrated adenoma (TSA), hyperplastic polyp (HP), serrated polyp, tubular adenoma, or mixed lesions. Diagnostic doubts had to be described. Concordance between both observers was assessed using the kappa index (k). The influence of collected variables on concordance degree was also evaluated. Results: overall agreement on the histological diagnosis was poor (k = 0.14), and so was agreement on the diagnosis of SSA (k = 0.23). Concordance in the diagnosis of SSA improved with size > 5 mm (k = 0.64) and proximal location (k = 0.43). Conclusion: in a real clinical setting, the existing morphological criteria for SSA identification may be difficult to use(AU)

Doxorubicin and cyclophosphamide followed by weekly docetaxel as neoadjuvant treatment of early breast cancer: analysis of biological markers in a GEICAM phase II study.

INTRODUCTION: To evaluate the sequential administration of doxorubicin (A) and cyclophosphamide (C) followed by weekly docetaxel in women with stage II to IIIA breast cancer. PATIENTS AND METHODS: Patients received 60 mg/m(2) of A and 600 mg/m(2) of C every three weeks for four cycles followed by 12 infusions of weekly docetaxel at a dose of 36 mg/m(2) and with a 2-week resting period. RESULTS: Sixty-three women were included. On an intention-to- treat basis, clinical response rate was 90% (95% CI: 83-98), with 46% complete responses. Breast-conserving surgery could be performed in 43 patients (68%). Complete pathological responses in the breast were confirmed in 17% of patients. No correlations between levels of expression of topoisomerase II alpha, survivin or p27 and the pathological response were detected. The study treatment was generally well tolerated. CONCLUSION: Neoadjuvant AC followed by weekly docetaxel is a feasible regimen for patients with early-stage breast cancer.

Doxorubicin and cyclophosphamide followed by weekly docetaxel as neoadjuvant treatment of early breast cancer: analysis of biological markers in a GEICAM phase II study

INTRODUCTION: To evaluate the sequential administration of doxorubicin (A) and cyclophosphamide (C) followed by weekly docetaxel in women with stage II to IIIA breast cancer. PATIENTS AND METHODS: Patients received 60 mg/m(2) of A and 600 mg/m(2) of C every three weeks for four cycles followed by 12 infusions of weekly docetaxel at a dose of 36 mg/m(2) and with a 2-week resting period. RESULTS: Sixty-three women were included. On an intention-to- treat basis, clinical response rate was 90% (95% CI: 83-98), with 46% complete responses. Breast-conserving surgery could be performed in 43 patients (68%). Complete pathological responses in the breast were confirmed in 17% of patients. No correlations between levels of expression of topoisomerase II alpha, survivin or p27 and the pathological response were detected. The study treatment was generally well tolerated. CONCLUSION: Neoadjuvant AC followed by weekly docetaxel is a feasible regimen for patients with early-stage breast cancer (AU)

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Utilidad de la resonancia magnética en la evaluación local del cáncer de mama: impacto en el cambio de actitud terapéutica en una serie prospectiva de 338 pacientes / No disponible

Introducción: la estadificación del cáncer de mama implicareunir información no sólo sobre el tamaño del tumor principal,sino también sobre la presencia de multifocalidad, multicentricidad,bilateralidad, componente intraductal extenso oextensión al complejo areola-pezón. El objetivo de nuestro estudioes validar la técnica en nuestro entorno asistencial y evaluarel impacto que la RM de mama con contraste ha tenido sobre338 pacientes consecutivas con diagnóstico de cáncer demama en el proceso de la toma de decisión del modelo de tratamiento.Como objetivo secundario se plantea la correlaciónde los hallazgos de la RM con los hallazgos histopatológicos.Material y métodos: estudiamos con RM a 338 pacientesconsecutivas con diagnóstico de cáncer de mama antes de decidircuál era el abordaje terapéutico más adecuado. La intenciónterapéutica se registró antes y después de cada estudio deRM. Se calculó la sensibilidad, la especificidad, el valor predictivopositivo y el valor predictivo negativo de la RM para lesionesadicionales, así como el coeficiente de correlación linealde Pearson para el diámetro del tumor índice o principal.Resultados: en 145 pacientes (42%) se identificaron 164lesiones adicionales, de las cuales 87 (53%) fueron malignas,28 (17%) fueron benignas, 35 (21,3%) se catalogaron comoprobablemente benignas, en 6 (3,6%) no se alcanzó un diagnósticofinal y 8 (4,9%) no quedaron incluidas en la pieza quirúrgicao bien desaparecieron tras la quimioterapia neoadyuvante.Estos hallazgos implicaron un cambio en la actitudterapéutica en 82 pacientes (24,2%). Este cambio se confirmócon los resultados de la anatomía patológica como correcto en69 paciente (20,4%) y como incorrecto o innecesario en 13pacientes (3,8%). El coeficiente de correlación de Pearson resultóser fuertemente positivo (r = 0,784) cuando se compararonlos resultados de la RM y la anatomía patológica...(AU)

Background: breast cancer staging implies gathering informationnot only on the size of the main tumour, but also onmultifocality, multicentricity, bilaterality, presence of an extensiveintraductal component and extension to the nipple-areolarcomplex. The objective of our study is to demonstrate thatbreast magnetic resonance (MR) is the modality of choice inthe staging of breast cancer patients due to the fact that it addsinformation capable of modifying the therapeutic approach inthese patients. A secondary objective is to validate our resultsin our clinical environment.Material and methods: 338 consecutive patients with abreast cancer diagnosis were studied with breast MR beforedeciding the most appropiate therapeutic approach. Therapeuticintention was registered before and after each MRstudy. Sensibility, specificity, postive predictive value (PPV)and negative predictive value (NPV) of MR for additional lesionswas calculated and Pearson's linear correlation coefficientwas calculated for the index lesion diameter.Results: 164 additional lesions were found in 145 patients(42%) of which 87 (53%) were malignant, 28 (17%) were benign,35 (21,3%) were probable benign, 6 (3,6%) had no diagnosisand 8 (4,9%) were not included in the surgical specimenor else dissappeared after neoadjuvant chemotherapy. Thesefindings implied change in therapeutic approach in 82 patients(24,2%). These change was pathologically validated ascorrect in 69 patients (20,4%) and as unnecessary or incorrectin 13 patients (3,8%). Pearson's linear correlation coefficientwas strongly positive (r = 0,784) when MR and pathology resultswere compared. Sensibility, specificity, PPV and NPV ofMR for additional lesions was 90,6, 55,2, 75,7 and 79,5%respectively...(AU)

Estudio por congelación del ganglio centinela en carcinoma de mama / No disponible

A pesar de que el estudio del ganglio centinela constituyeya un procedimiento de rutina en la estadificación del cáncerde mama, todavía no existe consenso acerca de cuál es el protocolomás eficiente para su estudio histopatológico.El objetivo fundamental de este estudio es describir nuestroprotocolo para el estudio histopatológico del ganglio centinela(GC), comparando los resultados del mismo cuando se realizaintraoperatoriamente o diferido y justificar la inclusión de la citoqueratinacomo parte necesaria del protocolo.La serie incluye 85 casos de los cuales 42 se estudiaron intraoperatoriamente,de los cuales el 45,2% mostró positividadpara células tumorales. De los 43 restantes, estudiados en diferido,mostró positividad para células tumorales el 34,8%. En10 de los 85 casos (28,5%), el diagnóstico sólo pudo realizarsesobre los cortes teñidos con citoqueratina (CK). No se observarondiferencias estadísticamente significativas entre losresultados de los grupos intraoperatorio y diferido.En conclusión, nuestros resultados apoyan este protocolocomo un método sensible y específico que permite realizar eltratamiento quirúrgico del cáncer de mama y su estadificaciónen un solo tiempo(AU)

In spite that the Sentinel Node (SN) procedure is admittedfor routine breast cancer staging, there is still no agreementon the most efficient histopathological protocol to evaluate it.The main aim of this study is to describe our histopathologicalwork up comparing intraoperative and deferred protocols,and to emphasize the use of Cytokeratin Immunostain asa desirable part of it.Out of 85 cases in our series, 42 were studied by intraoperativeprocedure and 45.2% of them showed positive tumourcells. Of the 43 remaining cases, studied by deferred procedure,34.8% were positive for tumour cells. In 10 out of 85 cases(28.5%) the diagnosis was reached by cytokeratin immunostain.There were not statistically significant differencesbetween the intraoperative and the deferred groups.We conclude that the results make our method is sensibleand specific enough to allow one step surgical treatment andstaging of breast cancer(AU)

Expresión de la proteína p53 desde displasia leve hasta adenocarcinoma en un paciente con esófago de Barrett: un estudio con inmunohistoquimia / p53 protein expresion from mild dysplasia to adenocarcinoma in a patient with Barrett s esophagus: an immunohistochemical study

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[Study of the sentinel node in breast cancer using lymphoscintigraphy and a fast method for cytokeratin]. / Estudio del ganglio centinela en el cáncer de mama mediante linfogammagrafía y citoqueratina por congelación.

INTRODUCTION: Histopathological examination of the axillary sentinel node (SN) is becoming a routine procedure in the surgical phase of infiltrating ductal carcinoma of the breast (IDC). The SN exam may yield false negative cases mainly due to identification failure of the SN but some of the false negative cases may be the result of the pathological examination procedure applied. MATERIAL AND METHODS: Sixty two (62) cases of clinically staged N0 IDC of the breast by TNM nomenclature were assigned to breast surgery along with conventional axillary node dissection. The identification technique included lymphoscintigraphy and intraoperative gamma-detecting probe after peritumoral injection of 99mTc-labeled colloids.The histological study of SN was performed with paired 4 microm slices and staining with hematoxylin-eosin and with a fast method of cytokeratins for freezing. RESULTS: In only two of the 62 patients, it was not possible to identify the SN. Eighteen of the remaining 60 had SN involvement by metastasis, having no metastases in the other nodes of the axillary dissection in 6 of them. Ten of those were micrometastasis (size of metastasis= or <0.2 cm). In two out of these last 10 cases, diagnosis of the micrometastasis was only possible using slices stained with CK. There were no false negative results. CONCLUSIONS: The lymphoscintigraphy, after peritumoral injection of small volumes and low dose of the tracer, makes it possible to obtain excellent results in the intraoperative detection of the SN in breast cancer. The study of this SN with a fast method for CK decreases the number of false negative results of the technique.

Estudio del ganglio centinela en el cáncer de mama mediante linfogammagrafía y citoqueratina por congelación / Study of the sentinel node in breast cancer using lymphoscintigraphy and a fast method for cytokeratin

Introducción: El estudio histológico del ganglio centinela axilar (GC) está estableciéndose como un procedimiento habitual en la cirugía del carcinoma infiltrante de mama. Los falsos negativos descritos son imputables tanto a la identificación del verdadero ganglio centinela como al protocolo aplicado para el estudio de dicho ganglio. Material y métodos: Estudiamos 62 enfermas de carcinoma infiltrante de mama, clínicamente N0 (TNM), subsidiarias de exéresis tumoral y vaciamiento axilar. En todas se practicó linfogammagrafía y detección intraoperatoria tras la administración peritumoral de 99mTc-nanocoloide de albúmina. El estudio histológico del GC se efectuó realizando pares de cortes de 4 y tinción mediante hematoxilina-eosina (H/E) y técnica rápida de citoqueratinas (CK) por congelación. Resultados: Del total de 62 enfermas, en dos no fue posible detectar el GC. De las 60 restantes, 18 presentaban metástasis en el GC, sin observarse afectación de otros ganglios en 6 de ellas. Diez de estas enfermas mostraron la presencia de micrometástasis exclusivamente (depósito tumoral 2 mm).En dos de estos diez últimos casos, el diagnóstico de las micrometástasis sólo fue posible a partir de los cortes teñidos con CK. No se obtuvo ningún resultado falso negativo. Conclusiones: La linfogammagrafía, previa inyección peritumoral de volúmenes pequeños y dosis bajas del radiotrazador, permite obtener excelentes resultados en la localización intraoperatoria del GC en el cáncer de mama. Su posterior estudio mediante CK rápida permite disminuir el número de falsos negativos de la técnica (AU)

Characterization of GIST/GIPACT tumors by inmunohistochemistry and exon 11 analysis of c-kit by PCR.

Gastrointestinal stromal tumors (GIST/GIPACT) are the most common mesenchymal tumors of the human gastrointestinal (GI) tract and are characterized by the constant immunohistochemical expression of CD117. In recent years, sporadic and germ line mutations in the c-kit gene have been described in GIST/GIPACT tumors, resulting in a constitutive activation of the gene. The most prevalent mutation is located in exon 11 of the c-kit gene, involved in the transcription of the juxta-membrane domain of the c-kit protein. There are conflicting reports with respect to the association between exon 11 mutations and the biological behavior of GIST/GIPACT tumors. This work studies eight patients with tumors diagnosed as GIST/GIPACT, both morphologically and immunohistochemically for CD117, CD34, a-smooth muscle actin, desmin and S-100 protein primary antibodies. The DNA of the eight cases was also studied by PCR for mutation of exon 11 of the c-kit gene. All cases were CD117 positive, but only two showed mutation of exon 11. These last two cases did not show morphological characteristics of malignancy. The most aggressive case, with early death of the patient, did not show the mutation. In conclusion, there was no correlation between the mutation of exon 11 of the c-kit gene and the malignant behavior of GIST/GIPACT tumors in our series.

Caracterización de tumores GIST/GIPACT mediante inmunohistoquimia y PCR para el análisis del exón 11 del gen c-kit / No disponible

Los tumores estromales gastrointestinales (GIST/GIPACT) son los tumores mesenquimales más frecuentes del tracto gastrointestinal humano y se caracterizan por su constante expresión inmunohistoquímica del CD117. En los últimos años, se han descrito mutaciones tanto esporádicas como somáticas del gen c-kit en los tumores GIST/GIPACT, resultando en una activación constitutiva del gen. La mutación más prevalente se localiza en el exón 11 del gen c-kit, implicado en la transcripción del dominio de yuxta-membrana de la proteína c-kit. Existe controversia acerca de la relación entre la mutación del exón 11 y el comportamiento biológico de los tumores GIST/GI- PACT. El objeto de este trabajo es estudiar ocho tumores diagnosticados como GIST/GIPACT, tanto morfológicamente como inmunohistoquímicamente con anticuerpos frente a las proteínas CD117, CD34, α-actina de músculo liso y S-100. Asimismo, estudiar ADN procedente de los 8 tumores mediante técnicas de PCR para la mutación del exón 11 del gen c-kit y evaluar su posible relación con la agresividad tumoral. Todos los casos fueron positivos para el CD117, pero sólo dos mostraron mutación para el exón 11. Ninguno de los casos que expresaron la mutación mostró características morfológicas de malignidad. El caso de comportamiento más agresivo, con fallecimiento precoz del paciente no presentaba la mutación. En conclusión, en nuestra serie no hay correlación entre la mutación del exón 11 del gen c-kit y la agresividad de los tumores GIST/GIPACT (AU)

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