Complications and local relapse after intraoperative low-voltage X-ray radiotherapy in breast cancer.

PURPOSE: To study those factors that influence the occurrence of surgical complications and local relapse in patients intervened for breast cancer and receiving intraoperative radiotherapy. METHODS: Observational study on patients intervened for breast cancer with conservative surgery and intraoperative radiotherapy with low-voltage X-ray energy source (INTRABEAM), from 2015 to 2017 with 24 months minimum follow-up. Variables possibly associated to the occurrence of postoperative complications were analyzed with the Student t-test and the Fisher exact test; P < 0.05 considered significant. Subsequently, the construction of multiple multivariate analysis models began, thus building a logistic regression analysis using the IBM SPSS Statistics ver. 23 software. Local relapse was described. RESULTS: The study included 102 patients, mean age of 61.2 years; mean global size of tumor, 12.2 mm. Complications occurred in 29.4%. Fibrosis was the most frequently observed complication, followed by postoperative seroma. Using a 45 mm or larger applicator were significantly associated with the occurrence of complications. Tumor size 2 cm or larger and reintervention showed borderline significant association. Only one case of local relapse was observed. CONCLUSION: Certain factors may increase the risk of complication after the use of intraoperative radiotherapy. Using external complementary radiotherapy does not seem to increase the rate of complications. Select patients and the involvement of a multidisciplinary team are essential for achieving good results.

Inverse radiotherapy planning in reconstructive surgery for breast cancer.

BACKGROUND: Post-mastectomy radiotherapy reduces the risk of local-regional relapse and distant disease, and increases global survival in women with axillary involvement. With the new reconstruction techniques and increasing use of directed external radiotherapy, immediate reconstruction can be performed with good cosmetic results and low complication rates. MATERIALS AND METHODS: Observational study with consecutive sampling conducted in patients undergoing reconstructive surgery for breast cancer, between 2010 and 2016, with a 12-months minimum follow-up period. A group of patients radiated after receiving an expander (RT-Expander) were compared with a control group of non-radiated patients (Non-RT), who had been treated with the same surgical technique. We compare general complications, reconstruction failure, aesthetic results and satisfaction degree with software IBM® SPSS® Statistics v. 21 and BREAST-Q scores. RESULTS: Reconstruction failure was observed in 15.6% of patients in a similar proportion in both groups. External radiotherapy was not an independent significant factor influencing the occurrence of general complications, capsular contracture grade ≥3 or reconstruction failure. The Kaplan-Meyer curve showed no differences in reconstruction survival between groups. Aesthetic results were excellent-very good in 78.1% of patients. Absence of a contralateral procedure for symmetrization, occurrence of general complications, occurrence of capsular contracture grade ≥3 and reconstruction failure were significantly associated to fair-poor cosmetic results. The satisfaction degree of operated patients was similar in both groups. CONCLUSIONS: The evolution of external radiotherapy towards more directed techniques, which modulate the dose administered to the mammary tissue and adjacent structures, allowed us to make immediate reconstruction a reality for most patients, with complication rates, cosmetic results and satisfaction degrees similar to those of non-radiated patients.

Factores predictores de la aparición de tumor residual en pacientes reintervenidas tras cirugía conservadora por cáncer de mama / Predictive factors in the development of residual tumor in patients undergoing reoperation after conservative surgery for breast cancer

Objetivos. Estudiar los factores predictores en la aparición de tumor residual en pacientes reintervenidas tras cirugía conservadora por cáncer de mama. Materiales y métodos. Durante los años 2012 y 2013 se intervinieron 301 pacientes con cirugía conservadora por cáncer de mama. Se valoraron las 58 reintervenciones por afectación de márgenes de resección y se estudiaron 16 variables relacionadas con la presencia de tumor residual. Resultados. Se reintervino a un 19% del total de pacientes operadas por cáncer de mama. Al 67% se le realizó ampliación de márgenes, mientras que en el 33% de los casos restantes se optó por la mastectomía. Cuando se realizó ampliación de márgenes solo en un 15% se objetivó tumor residual, mientras que cuando se realizó mastectomía, en un 79% de los casos se objetivó afectación variable de los bordes de reección por carcinoma. En el análisis multivariante solo la presencia de carcinoma in situ en la BAG y la afectación extensa del margen influyeron significativamente en la detección de tumor residual en la pieza quirúrgica tras la reintervención. Conclusiones. Existe un riesgo elevado de afectación del margen por tumor residual cuando la paciente presenta componente in situ y afectación extensa del borde. Además, el tamaño tumoral, la infiltración axilar y la afectación de más de 2 bordes son variables independientes con relación significativa para la aparición de márgenes afectos, por lo que también deberán ser tenidos en cuenta a la hora de planificar la intervención (AU)

Objectives. To identify the factors predicting the development of residual tumor in patients undergoing reoperation after conservative surgery for breast cancer. Materials and methods. A total of 301 patients underwent surgery for breast cancer between 2012 and 2013. We studied 58 reoperations for positive margins and 16 variables related to the presence of residual tumor. Results. Of the total number of patients who underwent surgery for breast cancer, 19% underwent reoperation because of positive margins. Among these patients, re-excision lumpectomy was performed in 67% and mastectomy in 33%. When re-excision lumpectomy was performed, residual tumor was observed in only 15%. When mastectomy was performed, a varying degree of carcinoma in the resection margins was observed in 79% of the patients. On multivariate analysis, the only factors predictive of residual tumor in the surgical specimen after the second surgery were the presence of in situ carcinoma and extensive margin involvement. Conclusions. The risk of residual tumor is high in patients with in situ carcinoma and extensive tumoral involvement of the resection margins. Other factors independently related to the occurrence of positive margins were tumoral size, axillary infiltration, and involvement of more than 2 margins. These factors should also be taken into account during surgical planning (AU)

Sobre un análisis incorrecto del concepto de ganglio centinela / On an incorrect analysis of the concept of sentinel node breast biopsy

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Utilidad y ventajas de la inyección subareolar única del trazador en la biopsia selectiva del ganglio centinela en el cáncer de mama / Utility and advantages of single tracer subareolar injection in sentinel lymph node biopsy in breast cancer

Introducción. La biopsia selectiva del ganglio centinela (BSGC) ha demostrado ser eficaz para determinar el estadio de los ganglios linfáticos en pacientes con cáncer de mama. Es un procedimiento mínimamente invasivo que permite evitar la linfadenectomía en pacientes sin afectación ganglionar. Presentamos el proceso de validación de la BSGC realizado con inyección subareolar única de 99mTc-nanocoloides. Material y método. Durante 2 años se estudió a 100 pacientes con cáncer de mama en estadios iniciales (T1 y T2). A todas ellas se les realizó, el mismo día de la intervención, una gammagrafía con inyección subareolar de 99mTc-nanocoloides para la localización del ganglio centinela (GC). Tras la visualización de los GC, y una vez realizado el marcaje en la piel, se procedió a la tumorectomía seguida de la BSGC utilizando una sonda detectora de rayos gamma. Una vez extirpado el GC se completó el vaciamiento axilar en todos los casos. En el análisis anatomopatológico del GC se utilizó la tinción con hematoxilina-eosina (HE), y con citoqueratinas (CK). Resultados. Se identificó el GC en todos los casos, y se extrajo una media de 1,95 ganglios por paciente. En 44 de ellas el GC presentaba metástasis, y en 15 de estos casos también se encontró extensión al resto de los ganglios axilares. En las 56 pacientes restantes el GC estaba libre de enfermedad, y tan sólo en 2 de ellos existía afectación ganglionar axilar (4,5% falsos negativos). La sensibilidad global de la técnica fue del 95,65% (44/46), y la especificidad del 100% (54/54), con un valor predictivo positivo de 100% y un valor predictivo negativo de 96,4% (54/56). Conclusiones. La BSGC en pacientes con cáncer de mama en estadios iniciales es un proceso seguro y eficaz que proporciona una estadificación al alza de la enfermedad y disminuye la morbilidad asociada a la cirugía axilar. La inyección subareolar presenta las siguientes ventajas: es única, no precisa otras técnicas de imagen para localizar el tumor, permite una rápida visualización del GC y evita la superposición de imágenes cuando el tumor está localizado cerca de la axila (AU)

Introduction. Sentinel lymph node (SLN) biopsy is a reliable technique for determining axillary status in patients with early breast cancer. This technique is a minimally invasive procedure that can avoid the use of lymphadenectomy in patients without axillary involvement. We present a validation study of SLN biopsy with subareolar injection of 99mTc-nanocolloids. Material and method. We studied 100 patients with early breast cancer (T1 and T2) over a 2-year period. All patients underwent deep subareolar-injection of 99mTc-nanocoloid for localization of the sentinel node. Images were obtained and when the sentinel node was seen, it was marked on the skin. All patients underwent tumor excision and radioguided SLN biopsy followed by complete lymphadenectomy. Histopathological analysis of sentinel nodes was performed by hematoxylin-eosin and immunohistochemistry with cytokeratins. Results. The sentinel node was identified in all patients, and a mean of 1.95 sentinel nodes per patient were found. Lymphatic metastases in the sentinel node were found in 44 patients and in 15 of these tumoral spread was also found in the remaining axillary nodes. In the 56 remaining patients the sentinel node was free of metastasis, but in two of them a non-sentinel node was found to be positive (4.5% false negative rate). Sensitivity was 95.7% (44/46), specificity was 100% (54/54), the positive predictive value was 100% and the negative predictive value was 96.4% (54/56). Conclusions. SLN biopsy is an accurate alternative to complete axillary lymph node dissection in patients with early-stage breast cancer. This technique improves the staging of these patients and decreases the morbidity associated with lymphadenectomy. The advantages of subareolar injection are that a single injection site is required, the tumor does not have to be located by other techniques, it allows rapid visualization of the sentinel node and avoids the "shine through phenomenon" when the tumor is located near the axilla (AU)

[Utility and advantages of single tracer subareolar injection in sentinel lymph node biopsy in breast cancer]. / Utilidad y ventajas de la inyección subareolar única del trazador en la biopsia selectiva del ganglio centinela en el cáncer de mama.

INTRODUCTION: Sentinel lymph node (SLN) biopsy is a reliable technique for determining axillary status in patients with early breast cancer. This technique is a minimally invasive procedure that can avoid the use of lymphadenectomy in patients without axillary involvement. We present a validation study of SLN biopsy with subareolar injection of 99mTc-nanocolloids. MATERIAL AND METHOD: We studied 100 patients with early breast cancer (T1 and T2) over a 2-year period. All patients underwent deep subareolar-injection of 99mTc-nanocoloid for localization of the sentinel node. Images were obtained and when the sentinel node was seen, it was marked on the skin. All patients underwent tumor excision and radioguided SLN biopsy followed by complete lymphadenectomy. Histopathological analysis of sentinel nodes was performed by hematoxylin-eosin and immunohistochemistry with cytokeratins. RESULTS: The sentinel node was identified in all patients, and a mean of 1.95 sentinel nodes per patient were found. Lymphatic metastases in the sentinel node were found in 44 patients and in 15 of these tumoral spread was also found in the remaining axillary nodes. In the 56 remaining patients the sentinel node was free of metastasis, but in two of them a non-sentinel node was found to be positive (4.5% false negative rate). Sensitivity was 95.7% (44/46), specificity was 100% (54/54), the positive predictive value was 100% and the negative predictive value was 96.4% (54/56). CONCLUSIONS: SLN biopsy is an accurate alternative to complete axillary lymph node dissection in patients with early-stage breast cancer. This technique improves the staging of these patients and decreases the morbidity associated with lymphadenectomy. The advantages of subareolar injection are that a single injection site is required, the tumor does not have to be located by other techniques, it allows rapid visualization of the sentinel node and avoids the "shine through phenomenon" when the tumor is located near the axilla.