Filariasis mamaria / Breast filariasis

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Biopsia selectiva del ganglio centinela tras quimioterapia neoadyuvante en el cáncer de mama: resultados del estudio GEICAM 2005-07 / Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study

INTRODUCCIÓN: La utilidad de la biopsia selectiva del ganglio centinela (BSGC) en pacientes con cáncer de mama que precisan quimioterapia neoadyuvante (QTN) es controvertida. Nuestro objetivo es analizar la tasa de detección (TD) y de falsos negativos (FN) de la BSGC tras QTN así como la influencia de la afectación ganglionar inicial y de los protocolos aplicados. MÉTODOS: Estudio prospectivo observacional multicéntrico con mujeres con cáncer de mama tratadas con QTN y a las que se les realizó BSGC tras recibir la QTN y linfadenectomía posterior. Se calcularon las TD y las tasas de FN, tanto globales como dependientes de la afectación ganglionar inicial o del uso de protocolos de diagnóstico pre-BSGC. RESULTADOS: No se demostraron diferencias en la TD entre los casos sin afectación ganglionar inicial y los que sí la tuvieron (89,8 vs. 84,4%; p = 0,437). Sí se encontraron diferencias significativas (94,1 vs. 56,5%; p = 0,002) en el valor predictivo negativo, menor cuando existía afectación ganglionar inicial, y mayor tasa de FN, aunque no de forma significativa (18,2 vs. 43,5%; p = 0,252) en ese mismo supuesto. Un estudio de la axila antes de indicar la BSGC y tras la QTN disminuyó significativamente la tasa de FN en los casos en los que existía afectación inicial (55,6 vs. 12,5; p = 0,009). CONCLUSIONES: La QTN da lugar a una menor TD y a una mayor tasa de FN en la BSGC posterior, sobre todo si hay afectación ganglionar inicial. Los protocolos para la evaluación axilar después de administrar la QTN y antes de la BSGC disminuyen la tasa de FN en estas pacientes

INTRODUCTION: A controversial aspect of breast cancer management is the use of sentinellymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS: Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS: No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P= 0,002) inthe negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS: NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients

Selective sentinel lymph node biopsy after neoadjuvant chemotherapy in breast cancer: results of the GEICAM 2005-07 study.

INTRODUCTION: A controversial aspect of breast cancer management is the use of sentinel lymph node biopsy (SLNB) in patients requiring neoadjuvant chemotherapy (NCT). This paper discusses the detection rate (DT) and false negatives (FN) of SLNB after NCT to investigate the influence of initial nodal disease and the protocols applied. METHODS: Prospective observational multicenter study in women with breast cancer, treated with NCT and SLNB post-NCT with subsequent lymphadenectomy. DT and FN rates were calculated, both overall and depending on the initial nodal status or the use of diagnostic protocols pre-SLNB. RESULTS: No differences in DT between initial node-negative cases and positive cases were found (89.8 vs. 84.4%, P=.437). Significant differences were found (94.1 vs. 56.5%, P=0,002) in the negative predictive value, which was lower when there was initial lymph node positivity, and a higher rate of FN, not significant (18.2 vs. 43.5%, P=.252) in the same cases. The axillary study before SLNB and after the NCT, significantly decreased the rate of FN in patients with initial involvement (55.6 vs 12.5, P=0,009). CONCLUSIONS: NCT means less DT and a higher rate of FN in subsequent SLNB, especially if there is initial nodal involvement. The use of protocols in axillary evaluation after administering the NCT and before BSGC, decreases the FN rate in these patients.

Mixofibrosarcoma de bajo grado en la mama: una localización inusual / Low-grade myxofibrosarcoma of the breast: an unusual localization

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Carcinoma invasivo mioblastomatoide (histiocitoide). Presentación de 2 casos y revisión de la literatura / Myoblastomatoid invasive carcinoma (histiocytoid). Report of two cases and review of the literature

El carcinoma histiocitoide de mama es una variante rarade cáncer mamario cuya existencia como entidad distinta deotros tipos ha sido muy debatida, siendo un frecuente problemadiagnóstico debido a la similitud histológica con otrostipos de cáncer mamario, así como al escaso número decasos publicados. Es considerado por algunos autores comouna variante de carcinoma lobulillar infiltrante y suele confundirsefácilmente con condiciones benignas, u otros tumoresmamarios compuestos por células de citoplasma eosinofílicogranular o espumoso y núcleo excéntrico. Con objetode estudiar su incidencia en nuestro medio se han revisado925 carcinomas de mama existentes en nuestro hospital desde1996, encontrándose sólo 7 casos diagnosticados comocarcinoma histiocitoide, 5 de los cuales se han reubicadocomo carcinomas lobulillares pleomórficos con cambiosapocrinos, quedando solo 2 casos que cumplan todos los criterioshistológicos, y citológicos del carcinoma histiocitoide (AU)

Histiocytoid carcinoma of the breast is a rare variant ofbreast cancer, discussed as different subtype from other breastlesions, being a frequent diagnostic problem due to itshystologic similarity with other types of breast cancer, andbecause of the few number of cases in literature. Histiocytoidcarcinoma is considered by some authors as a subtypeof lobular infiltrating carcinoma, easily confused withbenign conditions or other mammary lesions composed ofcells with a pink granular to foamy cytoplasm and eccentricnucleus. We have reviewed 925 cases from our hospital filessince 1996, in order to study the incidence in our area, finding7 cases diagnosed as histiocytoid carcinoma, 5 of themhave been re-classified as pleomorphic lobular carcinomawith apocrine changes, and only two cases were classifiedas histiocytoid carcinoma upon histological, cytological andimmunochemical criteria (AU)