Utilidad del SPECT-CT en la biopsia del ganglio centinela tras quimioterapia neoadyuvante en cáncer de mama y axila positiva / The usefulness of SPECT-CT in sentinel lymph nodes identification after neoadjuvant chemotherapy in patients with breast cancer and axillary involvement

Objetivo Valorar la utilidad de los estudios híbridos SPECT-CT en la biopsia del ganglio centinela (BGC) post quimioterapia neoadyuvante (QNA) en pacientes cN+. Método Estudio transversal de los resultados obtenidos en un grupo de 25 pacientes tratadas en la Unidad Funcional de Mama del HUGTIP desde marzo de 1918 a septiembre de 2020. La metodología específica para este estudio incluye: 1)ecografía axilar y colocación de marcador ecovisible en el ganglio afecto antes de iniciar la QNA; 2)tras QNA, colocación de marcador ferromagnético (Magseed®) en ganglio marcado previamente (GM); 3)valoración del estado axilar tras la QNA, que incluye estudio linfogammagráfico axilar con SPECT-CT; BGC y exéresis del ganglio marcado (GM) si es distinto al ganglio centinela (GC), y vaciado ganglionar axilar (VGA). Resultados La valoración de los SPECT-CT permitió verificar la coincidencia entre el GM y el GC en 14 casos (56%). En 3 casos no se encontró GC y en 8 casos el marcador magnético no estaba en un GC. La biopsia selectiva de los ganglios (GC y/o GM) fue negativa en 12 pacientes (2 con VGA positivo) y positiva en 13 (4 con VGA positivo). Conclusión El estudio SPECT-CT aportó información adicional sobre la localización y la concordancia del ganglio marcado y el ganglio centinela previa a la cirugía, mejorando la planificación de la misma. (AU)

Objective To evaluate the usefulness of SPECT-CT hybrid studies in the biopsy of sentinel lymph node (SLNB) after neoadjuvant chemotherapy (NAC) in patients with axillary metastatic disease (N+). Methods Cross-sectional study of 25 patients treated in the HUGTIP Breast Functional Unit from March 2018 to September 2020. All patients included in the study were submitted to: (1)axillary ultrasound (US) and US visible marker placement in the affected node before starting the NAC; (2)placement of a ferromagnetic marker in the previously marked lymph node (MLN) after NAC; (3)assessment of axillary status after NAC: it includes SPECT-CT lymphoscintigraphy; SLNB and excision of the MLN whether different from the sentinel lymph node (SLN); and axillary lymph node dissection (ALND). Results In 14 patients (56%) the MLN corresponded with the SLN. In 3 cases it was not possible identify the SLN and in 8 cases the MLN was not a SLN. The biopsy of MLN and SLN was negative for metastasis in 12 patients (2 of them had a positive ALND) and was positive for metastasis in 13 patients (4 of them had a positive ALND). Conclusion The SPECT-CT study provided additional information about the identification and the concordance of the MLN and the SLN improving the surgical planning. (AU)

Advantages of preoperative localization and surgical resection of metastatic axillary lymph nodes using magnetic seeds after neoadjuvant chemotherapy in breast cancer.

PURPOSE: To assess the safety and effectiveness of magnetic seeds in preoperative localization and surgical dissection of metastatic axillary lymph nodes (LN+) in breast cancer patients with axillary involvement, after neoadjuvant chemotherapy (NAC). In addition, to assess the impact of targeted axillary dissection (TAD) in reducing the rate of false negatives (FN) in sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A cross-sectional prospective cohort study was conducted from April 2017 to September 2019, including breast cancer patients with axillary lymph node involvement treated with NAC. Prior to NAC, the LN+ were marked by ultrasound-guided clip insertion. After NAC, a magnetic seed (Magseed®) was inserted in the clip-marked lymph node (MLN). During surgery, the MLN was located and removed with the aid of a magnetic detection probe (Sentimag®) and the sentinel lymph node was removed. Axillary lymph node dissection (ALND) was used to determine the rate of FN for SLNB alone and the combination of SLNB and MLN dissection, called TAD. RESULTS: The study included 29 patients (mean age, 55; range, 30-78 years). Selective preoperative localization and surgical dissection were successful for all 30 MLNs (100%). The MLN corresponded to the SLN in 50% of cases. After ALND, there were 21.4% (3/14) FN with SLNB alone and 5.9% (1/17) with TAD. CONCLUSIONS: Following NAC, selective surgical removal of MLN by preoperative localization using magnetic seeds is a safe and effective procedure with a success rate of 100%. Adding TAD reduces the rate of FN associated with SLNB alone.

Pneumoendoscopic single port approach to breast cancer. How we do it?

Endoscopic procedures have not become the gold standard in breast surgery. In order to improve today's outcomes we have developed a pilot study in the Breast Pathology Unit of Hospital Germans Trias i Pujol. A surgical procedure was performed creating a pneumoendoscopic cavity by using a Single Incision Laparoscopic Surgery (Single port) approach with a follow up of four years. Four patients underwent pneumoendoscopic single-port breast surgery receiving skin-sparing quadrantectomy and axillary surgery requiring lymphadenectomy in all of them. All patients had immediate reconstruction with a Latisimus Dorsi flap. No perioperative complications appeared. Mean operative time was 290 min (range 240-315 min) and mean hospital stay was 3,2 days. Surgical margins of all cases were pathologically negative and all patients were disease free after four years of monitoring. All patients were satisfied with the cosmetic outcome in the immediate postoperative and during the follow up. Although all innovative techniques generate hesitation on their beginnings and are liable to improve, we believe that pneumoendoscopic single-port breast surgery can be suitable for breast cancer, offering better cosmetic outcomes with oncological safety.

Primary Hormone Therapy in Elderly Women with Hormone-Sensitive Locoregional Breast Cancer: Endocrine Therapy Alone Is a Reasonable Alternative in Selected Patients.

BACKGROUND: Treatment with aromatase inhibitors (AIs) followed by surgery is often recommended for women with locoregional hormone-sensitive breast cancer. However, no study has compared the efficacy of AIs alone versus AIs followed by surgery. METHODS: 33 postmenopausal breast cancer patients were treated with primary hormone therapy. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor type 2 receptor (HER2) expression levels were analyzed by immunohistochemistry. After hormone therapy, eligible patients underwent surgery, and those who were not candidates for surgery continued on hormone therapy. We retrospectively analyzed time to progression, overall survival, response, and impact of surgery on outcome. RESULTS: All patients were ER+. HER2 was successfully analyzed in 30 patients, all of whom were HER2-. The median time to progression was 94 months, and the median overall survival was not reached, while the mean overall survival was 123 months. The overall response rate was 63.6%, with 9.1% complete responses. No significant differences in time to progression or survival were observed between patients who underwent surgery and those who did not. CONCLUSIONS: Primary hormone therapy with AIs is effective in elderly breast cancer patients with high levels of hormone receptors and may provide a feasible and tolerable alternative to surgery in selected hormone-sensitive breast cancer patients.

Mastitis granulomatosa perilobulillar idiopática: aspectos diagnósticos y terapéuticos / Idiopathic perilobular granulomatous mastitis: Diagnostic and therapeutic considerations

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Radioguided localization of nonpalpable breast cancer lesions: randomized comparison with wire localization in patients undergoing conservative surgery and sentinel node biopsy.

OBJECTIVE: The aim of this investigation was to determine whether radioguided occult lesion localization and routine wire localization differ in respect to the effectiveness of complete excision of nonpalpable breast cancer lesions. SUBJECTS AND METHODS: This prospective randomized study included patients with breast cancer scheduled for conservative tumor excision and sentinel node biopsy. Patients were randomized to either radioguided localization or wire localization. Comparative radiologic, surgical, and pathologic data were collected and analyzed to establish the duration, ease of use, and accuracy of the two techniques for occult lesion localization. The effectiveness of sentinel node biopsy also was assessed. One radiologist and two surgeons participated in the study. RESULTS: Among 134 patients, 68 were treated with wire localization and 66 with radioguided localization. The mean duration of radiologic localization was significantly shorter for radioguided localization (p < 0.001). No statistical differences were found for the other parameters studied. Radiography of the surgical specimen showed 100% lesion excision with both techniques. Complete tumor excision with tumor-free margins was achieved in 89.4% of patients who underwent radioguided localization group and 82.4% of patients who underwent wire localization. Pathologic examination showed the excised tissue volume was slightly larger (p = 0.371) and lesion concentricity slightly less (p = 0.730) with radioguided localization. The sentinel node detection rate was 91% with radioguided localization and 84% with wire localization. CONCLUSION: The radioguided technique is as effective as the standard wire technique for localization and excision of nonpalpable breast cancer lesions and is somewhat faster and simpler to perform than wire localization.