Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study.

The clinical value of sentinel lymph node (SLN) biopsy in thick melanoma patients (Breslow >4 mm) has not been sufficiently studied. The aim of the study is to evaluate whether SLN biopsy increases survival in patients with thick cutaneous melanoma, and, as a secondary objective, to investigate correlations between survival and lymph node status. We included 1,211 consecutive patients with thick melanomas (>4 mm) registered in the participating hospitals' melanoma databases between 1997 and 2015. Median follow-up was 40 months. Of these patients, 752 were matched into pairs by propensity scores based on sex, age, tumor location, histologic features of melanoma, year of diagnosis, hospital and adjuvant interferon therapy. The SLN biopsy vs. observation was associated with better DFS [adjusted hazard ratio (AHR), 0.74; 95% confidence interval (CI) 0.61-0.90); p = 0.002] and OS (AHR, 0.75; 95% CI, 0.60-0.94; p = 0.013) but not MSS (AHR, 0.84; 95% CI, 0.65-1.08; p = 0.165). SLN-negative patients had better 5- and 10-year MSS compared with SLN-positive patients (65.4 vs. 51.9% and 48.3 vs. 38.8%; p = 0.01, respectively). As a conclusion, SLN biopsy was associated with better DFS but not MSS in thick melanoma patients after adjustment for classic prognostic factors. SLN biopsy is useful for stratifying these patients into different prognostic groups.

Ganglio secundario como indicador de linfadenectomía axilar en pacientes afectas de cáncer de mama / Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients

Introducción: En la actualidad no existe consenso en cuanto a la necesidad de realizar linfadenectomía axilar (LA) en los casos en que se detectan macrometástasis en el ganglio centinela (GC). En este estudio se presenta la utilidad del ganglio secundario (GS), una nueva técnica diagnóstica, como factor predictor de afectación axilar. Métodos: Se diseñó un estudio observacional, retrospectivo y multicéntrico con el objetivo de validar la técnica del GS, entendido como tal el siguiente ganglio a nivel anatómico y de difusión linfogammagráfica tras el GC, como predictor de la afectación axilar. Sobre un total de 2.273 pacientes afectas de cáncer de mama se obtuvo una muestra válida de 283 pacientes a las que se había analizado el estado del GS de forma adicional. Las variables principales del estudio fueron el estado histológico del GC, del GS y del vaciamiento axilar y se valoró la sensibilidad, especificidad y exactitud de la prueba. Resultados: La prueba del GS, con GC positivo, presenta una sensibilidad del 61,1%, una especificidad del 78,7%, un valor predictivo positivo del 45,8% y un valor predictivo negativo del 87,3%, con una exactitud del 74,7%. Conclusión: El estudio del GS junto con la técnica del GC permite realizar una estadificación más precisa del estado axilar, en pacientes con cáncer de mama, en comparación con el estudio único del GC (AU)

Introduction: Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. Methods: An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. Results: SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. Conclusion: The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique (AU)

Secondary node analysis as an indicator for axillary lymphadenectomy in breast cancer patients. / Ganglio secundario como indicador de linfadenectomía axilar en pacientes afectas de cáncer de mama.

INTRODUCTION: Currently, there is no agreement regarding if it would be necessary to perform an axillary lymph node dissection (ALND) in patients who have macrometastases in the sentinel lymph node (SLN). We studied the utility of the secondary node analysis (SN), defined as the following node after the SLN in an anatomical and lymphatic pathway, as a sign of malignant axillary involvement. METHODS: An observational, retrospective and multicentre study was designed to assess the utility of the SN as a sign of axillary involvement. Among 2273 patients with breast cancer, a valid sample of 283 was obtained representing those who had the SN studied. Main endpoints of our study were: the SLN, the SN and the ALND histological pattern. Sensitivity, specificity and precision of the test were also calculated. RESULTS: SN test, in cases with positive SLN, has a sensitivity of 61.1%, a specificity of 78.7%, a positive predictive value of 45.8% and a negative predictive value of 87.3% with a precision of 74.7%. CONCLUSION: The study of the SN together with the technique of the SLN allows a more precise staging of the axillary involvement, in patients with breast cancer, than just the SLN technique.

Reconstruccion de la mama con gel de plaquetas en la cirugia conservadora del cancer / Use of platelet gel in breast reconstruction after breast-conserving cancer surgery

Introducción: Con la finalidad de disminuir las deformidades de la mama después de la cirugía conservadora del cáncer, presentamos una nueva técnica de reconstrucción mamaria mediante la restitución del volumen mamario con gel de plaquetas. Pacientes y métodos Estudio piloto de 20 pacientes con cáncer de mama sometidas a tumorectomía a las que se aplicó en el espacio residual el gel obtenido por plaquetoaféresis de donante alogénico sano. A las pacientes se les realizó un seguimiento clínico, iconográfico e histológico, así como una valoración del resultado estético. Resultados La edad media fue de 50,5±8,65 años (rango 42-70 años) y la mediana del índice de comorbilidad de Charlson fue de 1,15±1,27 (rango 0-5). El volumen medio de la tumorectomía fue de 63,1±31,1ml (rango 30-160ml) y el volumen de restitución con el gel de plaquetas fue de 111,5±60,9ml (rango 40-250ml). Después de una mediana de seguimiento de medio de 17 meses, el 80% de las pacientes preservaron el volumen mamario y no fueron necesarias reintervenciones por afectación de los márgenes quirúrgicos ni se observaron recidivas. Conclusiones El gel de plaquetas permite restituir el volumen mamario ajustado al volumen de la tumorectomía, minimizando las retracciones y deformidades habituales de la cirugía conservadora, lo que permite realizar resecciones amplias con márgenes oncológicos de seguridad (AU)

Introduction: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. Patients and method: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by platelet pheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. Results: The mean age was 50.5 8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1 1.2 (range 0-5). The mean tumour volume was 63.1 31.1 ml(range 30-160 ml) and the mean restitution volume with platelet gel was 111.5 60.9 ml (range40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. Conclusions: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins (AU)

[Use of platelet gel in breast reconstruction after breast-conserving cancer surgery]. / Reconstrucción de la mama con gel de plaquetas en la cirugía conservadora del cáncer.

INTRODUCTION: With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. PATIENTS AND METHOD: A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by plateletpheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. RESULTS: The mean age was 50.5±8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1±1.2 (range 0-5). The mean tumour volume was 63.1±31.1 ml (range 30-160 ml) and the mean restitution volume with platelet gel was 111.5±60.9 ml (range 40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. CONCLUSIONS: Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins.