[DIEP flap reconstruction after palliative curettage mastectomy in locally advanced breast cancer]. / Colgajo DIEP de cobertura tras mastectomía de limpieza paliativa en cáncer de mama localmente avanzado.

BACKGROUND: Curettage mastectomy is indicated as a palliative treatment in locally advanced breast cancer. We present our experience with the use of a DIEP flap reconstruction following extensive mastectomy. METHODS: We report the case of a patient with very advanced local breast cancer that was subsidiary to aggressive palliative surgery after chemotherapy. RESULTS: It was considered that the closure that could be performed with the latissimus dorsi muscle was unsuitable, therefore a DIEP flap was performed. The patient was discharged uneventfully. CONCLUSION: The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment.

Colgajo DIEP de cobertura tras mastectomía de limpieza paliativa en cáncer de mama localmente avanzado / DIEP flap reconstruction after palliative curettage mastectomy in locally advanced breast cancer

Fundamento. La mastectomía de limpieza está indicada con carácter paliativo en el cáncer de mama localmente avanzado. Para cerrar el defecto cutáneo puede ser necesario el empleo de un injerto. Mostramos nuestra experiencia con el uso de un colgajo DIEP (Deep Inferior Epigastric artery Perforators) de cobertura tras la realización de una mastectomía de gran extensión. Material y métodos. Se muestra el caso de una paciente con un tumor de mama muy avanzado localmente, que era subsidiaria de un tratamiento quirúrgico agresivo tras la administración de quimioterapia. Resultados. Se consideró que el cierre que puede ofrecer un colgajo realizado con el músculo dorsal ancho esta insuficiente, por lo que se realizó un DIEP. La paciente presentó una evolución postoperatoria satisfactoria. Conclusiones. El colgajo DIEP de cobertura ofrece una gran extensión cutánea. Puede ser un recurso en casos muy seleccionados de tumores de mama localmente avanzados, en los que la cirugía se convierte en la principal arma terapéutica (AU)

Background. Curettage mastectomy is indicated as a palliative treatment in locally advanced breast cancer. We present our experience with the use of a DIEP flap reconstruction following extensive mastectomy. Methods. We report the case of a patient with very advanced local breast cancer that was subsidiary to aggressive palliative surgery after chemotherapy. Results. It was considered that the closure that could be performed with the latissimus dorsi muscle was unsuitable, therefore a DIEP flap was performed. The patient was discharged uneventfully. Conclusion. The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment (AU)

Morbidity, mortality, and pathological response in patients with gastric cancer preoperatively treated with chemotherapy or chemoradiotherapy.

BACKGROUND: Significant tumor downstaging has been achieved in patients with localized gastric adenocarcinoma by preoperative chemoradiotherapy (ChRT) or induction chemotherapy (Ch). However the influence of ChRT and Ch on postoperative outcomes has not yet been clarified, with very few studies examining this issue. We retrospectively analyzed the efficacy in terms of pathological response and early postoperative complications of two protocols of preoperative ChRT and Ch for locally advanced gastric cancer. METHODS: Between 2000 and 2008, 72 patients with operable locally advanced gastric cancer (cT3-4/N+) were treated with preoperative treatment: 1-patients receiving induction Ch or 2-neoadjuvant Ch followed by concurrent ChRT. Postoperative histopathological regression and surgical complications were investigated including variables related to patients, surgical variables, preoperative treatment, and tumor. RESULTS: There were no differences in the incidence of complications between the ChRT and Ch groups (30.9% vs. 33.3%). The most frequent complications were nonspecific surgical complications (pneumonia [12.5%] and infection from intravenous catheters [9.7%]). Risk factors for complications were high-body mass index (BMI > 25 kg/m(2) ) and extension of surgery to the pancreas and spleen. A major pathological response was observed in 33.3% of patients, being more frequent in the ChRT group (47.6% vs. 13.3%; χ(2) , P = 0.0024). CONCLUSIONS: Preoperative treatment with Ch or ChRT for locally advanced gastric cancer can be performed safely with an acceptable operative morbidity and low operative mortality rate with careful consideration of the added risk associated with BMI and surgical resection of the pancreas and spleen. Ch and ChRT is feasible and effective in terms of pathological response and R0 resection.

Peutz-Jeghers syndrome and duodeno-jejunal adenocarcinoma--therapeutic implications.

The Peutz-Jeghers syndrome (PJS) is an autosomal dominant hamartomatous poliposis describred in 1921. Hemminki in 1997 described the presence of LKB-1 mutation tumor-suppressor gen.The patients with PJS develop a higher cumulative incidence of gastrointestinal, pancreas and extraintestinal tumors, being occasion of a renew interest on hamartomatous polyposis syndromes regarding the clinical care, cancer surveillance treatment and long term follow-up.We report the case of a 38 years old male, diagnosed of PJS who developed a multiple adenocarcinoma in duodenum and yeyunum. Surgically treated and with a long-term free disease survival of 11 years represents the sixth case reported in the spanish literature of PJS associated with a gastrointestinal tumor.A critical review, molecular alterations and the established criteria of tumor screening and surveillance are reviewed.

[New developments in the surgical treatment of breast cancer]. / Novedades en el tratamiento quirúrgico del cáncer de mama.

Adecuate surgical treatment is mandatory in order to achieve cure in patients with breast cancer. Breast surgeons have to choice the best surgical technique over the breast and over the axillary nodes. Two new surgical aproaches have been implemented in the last decade: oncoplastic conservative surgery and sentinel lymph node biopsy. Oncoplastic surgery provides oncologic safety results and good cosmetic outcome. In this paper the technical steps and indications of different oncoplastic techniques in conservative breast surgery are review. Concerning to axillary surgery sentinel lymph node biopsy is the gold standard. However there are several controversial points in sentinel node biopsy referring to indications, identification and histological findings.

Novedades en el tratamiento quirúrgico del cáncer de mama / No disponible

Un tratamiento quirúrgico correcto es imprescindible para conseguir lacuración de las pacientes con cáncer de mama. El cirujano debe elegirla mejor cirugía tanto en la mama como en los ganglios axilares. Enla última década se han incorporado dos nuevas técnicas quirúrgicas:la cirugía oncoplástica conservadora y la biopsia de ganglio centinela.La cirugía oncoplástica aporta seguridad oncológica y buen resultadoestético. En este trabajo se revisan los pasos técnicos y las indicacionesde las diferentes técnicas oncoplásticas que se emplean en cirugía conservadorade mama. Respecto a la cirugía axilar, la biopsia de gangliocentinela es la técnica de elección actual. Sin embargo existen aspectoscontrovertidos en la biopsia del ganglio centinela respecto a indicaciones,técnicas de identifi cación y hallazgos histológicos(AU)

Adecuate surgical treatment is mandatory in order to achieve cure inpatients with breast cancer. Breast surgeons have to choice the bestsurgical technique over the breast and over the axillary nodes. Two newsurgical aproaches have been implemented in the last decade: oncoplasticconservative surgery and sentinel lymph node biopsy. Oncoplasticsurgery provides oncologic safety results and good cosmetic outcome.In this paper the technical steps and indications of different oncoplastictechniques in conservative breast surgery are review. Concerning to axillarysurgery sentinel lymph node biopsy is the gold standard. Howeverthere are several controversial points in sentinel node biopsy referringto indications, identifi cation and histological fi ndings(AU)

Carcinoma intraductal de mama con microinvasión (T1mic): revisión a propósito de 53 nuevos casos / No disponible

Introducción: El desarrollo de las campañas de diagnósticoprecoz del cáncer de mama está determinando un incrementoen el hallazgo de carcinomas intraductales, en ocasiones confocos de microinfiltración (T1mic). En la bibliografía ha existidodisparidad en los criterios para su definición, y en consecuenciaen la valoración de su incidencia, índice de afectaciónaxilar y actitud terapéutica.Material y métodos: De un total de 225 carcinomas intraductalesse han seleccionado 53 por cumplir los criterios paraser definidos como T1mic en la Clasificación TNM (1997). Seanalizan algunas características clínicas, morfológicas y biológicas,así como su tratamiento y seguimiento.Resultados: El 77,4% de los casos fueron hallazgo de unchequeo mamográfico. El subtipo comedo fue la variante másfrecuente (52%) sobre la que asentó la microinfiltración. En el49,1% de los casos se encontró dos o más focos de microinfiltración,hallazgo más frecuente sobre el subtipo comedo(60,7%). Se practicó cirugía conservadora en 24 casos y mastectomíaen 29 (15 de ellos con reconstrucción inmediata). Enninguna caso se encontró afectación axilar y tras un seguimientomedio de 70 meses todas están vivas (una con metástasisa distancia).Conclusiones: Es necesario unificar los criterios que defineneste estadio tumoral y seguir los propuestos por la clasificaciónTNM en su versión AJCC-1997. Aceptando estos criterios,el tratamiento será el mismo al indicado para elcarcinoma intraductal, y dado el bajo índice de afectación axilarse recomienda recurrir al estudio del ganglio centinela sóloen los casos en que el comedo sea el subtipo dominante o elcarcinoma intraductal muy extenso(AU)

Introduction: The development of screening campaignsfor breast cancer is producing an increment in the incidence ofintraductal carcinomas (DCIS) with foci of microinvasion(T1mic). However, there is a degree of inconsistency in the literaturewith respect to defining these carcinomas and as aconsequence, there is no consensus regarding the incidence ofaxillar involvement and the appropriate treatment for these tumours.Material and Methods: Of 225 patients with intraductalcarcinomas, 53 cases were selected that complied with the requisitesfor defining microinvasive carcinomas, according tothe TNM cancer staging criteria laid down in 1997 (T1mic < 1mm). The morphological and biological characteristics of thecarcinomas were analysed, as were the results of the treatmentfollowed.Results: Referral to our department was provoked by the resultsof a screening study in 78% of the cases. The comedosubtype was the most frequent DCIS variant found and it waspresent in 52,8% of the cases studied. In 26 cases (49,1%), 2 ormore foci of microinvasion were observed, this occurring morefrequently among the comedo variants (60,7%). Conservativesurgery was performed in 24 cases and mastectomy was carriedout in 29 cases (in 15 of which immediate breast reconstructionwas performed). Involvement of the axillary lymph nodes wasnot observed and after a mean period of 70 months, all the patientswere alive (one with a distant metastasis).Conclusions: In order to be able to reach definitive conclusionsregarding this type of carcinoma, it is necessary to unifythe criteria of definition according to those proposal by theAJCC in 1997. In accepting these criteria, the therapeutic recommendationsare the same as those followed for intraductalcarcinoma...(AU)

Carcinoma tubular de mama: revisión de una serie de 38 casos / No disponible

Introducción: El carcinoma tubular de mama (CTM) representaun subtipo de carcinoma infiltrante, bien diferenciado,poco frecuente, de diagnóstico diferencial en ocasiones difícil.Material y métodos: Estudio retrospectivo de 38 casos queanaliza algunas de sus características clínicas y biológicas, asícomo del tratamiento utilizado.Resultados: Edad media de 51,5 años, el motivo diagnósticomás común fue la presencia de una tumoración palpable(50%), y otro 50% resultado de un chequeo mamario. En trescasos se presentó un carcinoma bilateral (uno de ellos sincrónico).Tamaño tumoral medio de 1,4 cm; el 81,8% fueron pT1.Afectación ganglionar axilar en el 13,1% de los casos (todosCTM mixtos). Se observó alto índice de tumores RE positivos,bajo índice proliferativo (Ki67) y muy baja expresión de p53 yc-erbB2. En el 79% de los casos se practicó cirugía conservadoracon vaciamiento axilar. La supervivencia a 10 años fuedel 97,4%.Conclusiones: Carcinoma poco frecuente, cuyo hallazgoes cada vez más resultado de estudios de screening. Se presentacomo una imagen estelar que obliga al diagnóstico diferencialcon algunas lesiones benignas.Su habitual pequeño tamaño y buena diferenciación histológica,permiten el tratamiento conservador en la mayoría delos casos, siendo excepcional la afectación ganglionar axilar.Dado su buen pronóstico, se discute la utilidad/necesidadde tratamiento adyuvante e incluso la cirugía axilar en los detamaño < 1 cm, especialmente en las formas puras(AU)

Introduction: Tubular carcinoma (TC) is a rare and well-differentiatedhistological variant of all breast cancer. The diagnosisof TC is some occasions difficult.Material and methods: We conducted a retrospectivestudy that analyzes 38 cases of TC (it supposes 1,6% of BreastCancer treated in our Breast Unit).The clinical and biological features and the treatment areanalyzed.Results: The medium average age was of 51,5 years. Themore frequent consultation was the presence of a palpablebreast mass followed by the screening. In three patients weobserved a bilateral cancer (1 out of 3 were synchronous tumour).The size half size tumour was of 1,4 cm and 81,8% theywere tumours pT1. Metastatic axillary disease was observed in13,1% of cases. We found a high rate of tumours was with positivehormonal receivers, low KI-67) and very low expressionof p53 and c-erb-2. The 79% of patient were treated with breastconservation therapy. With a median follow-up of 10 yearsthe survival was 97,4%.Discusion: TC is a rare breast cancer that can be discoveredin screening. TC can appear in mammography as a spiculatedabnormality and therefore it can be difficult to distinguishfrom radial scar or sclerosing adenosis. TC usually presents asa small tumour that can be treated with conservative surgery.Maxillary nodal metastases are uncommon. Because it is goodprognosis, adjuvant postoperative treatment and even any axillarysurgical procedure are controversial in TC(AU)

Enfermedad de Paget de la mama: análisis de una serie de 27 casos / Paget's disease of the breast: analysis of a series of 27 patients

Objetivo: Analizar las características de una serie, con especial referencia a su histogénesis y las posibilidades de la cirugía conservadora. Material y métodos: Se revisó a 27 pacientes portadoras con cáncer de mama (CM) y afectación del pezón con características de enfermedad de Paget (EP). Resultados: Las pacientes tenían una media de 56,5 años, los motivos de consulta fueron: eccema de pezón (48,1%), presencia de tumor mamario (26%) y secreción por el pezón (18,5%). El examen físico advirtió la lesión eccematosa en 26/27 casos. En 11 casos la imagen mamográfica se localizó a nivel retroareolar, en 13 casos distal al pezón y en 3 casos la mamografía fue normal. En 15 casos correspondió a un carcinoma intraductal, y en los 12 restantes a carcinoma ductal infiltrante. En uno la EP fue hallazgo del estudio seriado de la pieza de mastectomía. Se practicó una cirugía conservadora en 5 casos y mastectomía en 22 (6 con reconstrucción inmediata). Tras 6,5 años de seguimiento medio, 2 pacientes presentaron diseminación a distancia y una de las pacientes sometida a cirugía conservadora presentó recidiva local. Conclusiones: La EP representa el 1,4 % de los CM en nuestra serie y el signo diagnóstico característico es el eccema de pezón-aréola. La mamografía muestra una baja sensibilidad diagnóstica; se puede recurrir a la resonancia magnética en los casos de EP sin patología mamográfica y se debe realizar biopsia de la lesión ante la menor duda diagnóstica. El tratamiento más utilizado fue la mastectomía, y se recurrió a la cirugía conservadora en casos seleccionados de EP limitada al pezón, o con lesión subareolar circunscrita, conociendo los riesgos de un tumor subyacente inadvertido

Objective: To analyze the characteristics of a series, with special reference to histogenesis and the possibilities of conservative surgery. Material and methods: We reviewed 27 patients with breast cancer, nipple involvement and characteristics of Paget's disease. Results: The mean age of the patients was 56.5 years. Reasons for consulting were eczema of the nipple (48.1%), breast tumor (26%), and nipple secretion (18.5%). Physical examination revealed an eczematous lesion in 26/27 patients. The mammographic image was localized in the retroareolar area in 11 patients, distal to the nipple in 13 patients and was normal in three patients. Intraductal carcinoma was found in 15 patients and invasive ductal carcinoma in the remaining 12 patients. In one patient, Paget's disease was detected on examination of serial sections of the mastectomy specimen. Conservative surgery was performed in five patients and mastectomy in 22 (six with immediate reconstruction). After a mean follow-up of 6.5 years, distant dissemination occurred in two patients and local recurrence occurred in one patient who underwent conservative surgery. Conclusions: Paget's disease represented 1.4% of breast carcinoma in our series and the characteristic diagnostic sign was eczema of the nipple-aureola. Mammography showed low diagnostic sensitivity. Magnetic resonance imaging should be used in patients with Paget's disease without breast abnormalities. Biopsy of the lesion should be performed when there is diagnostic doubt. The most common treatment was mastectomy. Conservative surgery can be used in selected patients with Paget's disease limited to the nipple or with a circumscribed subareolar lesion, although the risk of an underlying tumor must be taken into account

Influencia del estudio intraoperatorio de los márgenes de resección sobre la recidiva local en la cirugía conservadora del cáncer de mama / No disponible

Introducción: la cirugía conservadora del cáncer de mamaes en la actualidad la técnica estándar en los tumores de pequeñotamaño; no obstante precisa generalmente de radioterapiacomplementaria y tiene el riesgo de presentar recidivastumorales en la misma mama. Se analizan las posibles ventajasdel estudio intraoperatorio de los bordes de resección parala reducción de las posibles reintervenciones y de las recidivaslocales tras cirugía conservadora.Material y métodos: analizamos retrospectivamente 1.010casos de cáncer de mama tratados mediante cirugía conservadora(resección segmentaria y linfadenectomía axilar), complementadacon radioterapia. En todos los casos se efectuó estudiointraoperatorio de los bordes de resección mediante cortespor congelación. Con un seguimiento medio de 6 años se valorande las recidivas locales y su significado.Resultados: con una media de edad de 52,2 años, el71,4% fueron tumores pT1, observándose afectación axilaren el 29,5%. El estudio intraoperatorio evidenció afectaciónde bordes en 251 casos (24,8%) obligando a su ampliación enel mismo acto operatorio; en 21 casos fue necesaria mas deuna ampliación. De esta forma en el estudio definitivo en parafinase confirmó un 97% de casos con bordes de resecciónlibres de tumor.Tras 6 años de seguimiento medio se han observado 24 recidivaslocales (2,4%), 12 de ellas en el área de tumorectomíaprevia y otras 12 en otro cuadrante.Conclusiones: en la cirugía conservadora, la obtención deunos márgenes quirúrgicos libres de tumor, y suficientementeamplios, constituye un factor importante para la reducción delas recidivas locales. El estudio intraoperatorio de los márgenes,es una técnica que permite lograr este objetivo a la vezque reduce la necesidad de reintervenciones diferidas(AU)

Introduction: breast-conserving therapy (BCT) is the standardtechnique for early-stage breast cancer; nevertheless BCTusually requires postoperative radiotherapy and has the risk oflocal recurrence in the same breast. We analyzed in this studythe need for intraoperative frozen section study of resectionmargins in order to reduce the reoperations and local recurrenceafter BCT.Material and methods: we conducted a retrospective studywith 1010 cases of Breast cancer treated with BCT (segmentalresection and axillary lymphadenectomy), followed by radiotherapy.In all cases intraoperative frozen section study of resectionmargin was made We analyzed the local recurrencerate with a mediam follow-up of 6 years.Results: the average age was 52.2 year-old age. 71.4%were pT1 tumors, and axillary nodes metastasis was found in29.5%. The intraoperative frozen section showed affectedmargins in 251 cases (24.8%) prompting re-resection. Provisionof additional tissue in two o more occasions was neededin 21 cases. Following this protocol, we found 97% of caseswith free resection margins on permanent paraffin embeddedsamples.With a median follow-up of 6 years, 24 local recurrenceswere observed (2.4%): 12 localized at the site of originalbreast tumor (true local recurrence), and 12 localized in a differentsite (most likely a second primary).Conclusions: during BCT, is very import to achieve freeresection margins in order to reduce the local recurrencerate. Intraoperative frozen section study contributes to reducelocal recurrence and provides information for reoperations(AU)

Lesiones proliferativas intraductales: aspectos inmunohistoquímicos / No disponible

Introducción: la difusión de la mamografía de cribado ha incrementado el diagnóstico de lesiones proliferativas. Dado que algunas lesiones proliferativas aumentan el riesgo de desarrollar un cáncer de mama, se ha incrementado el interés en las mismas. El cáncer de mama es probablemente el resultado de sucesivos cambios genéticos (cada uno con su correlación histológica) en la secuencia hiperplasia ductal atípica (HDA) a carcinoma. El objetivo de este estudio es analizar la correlación entre las determinaciones inmunohistoquímicas (IHQ) de diferentes marcadores biológicos (receptores hormonales, Ki 67, p53, y c-erbB-2)y el diagnóstico de diferentes lesiones proliferativas ductales. Material y métodos: se estudian mediante técnicas de IHQ la expresión en tejido mamario de receptores de estrógeno(RE), proliferación celular (Ki67), p53 y c-erbB-2 en 228 pacientes portadoras de: hiperplasia ductal atípica (HDA) en 28casos, carcinoma intraductal CDIS en 60 casos, carcinoma intraductal con microinfiltración (T1mic) en 40 casos, carcinoma ductal infiltrante con CDIS extenso en 40 casos y CDI puro en60 casos. Las lesiones benignas fueron clasificadas de acuerdo a los criterios de Page. El carcinoma intraductal se clasificó segúnsu grado histológico (GH) y su patrón nuclear. Resultados: la expresión de RE fue del 100% en las HDAy decrece hasta el 70% en CDIS y CDI. No se observa expresión de p53 y c-erbB2 en la HDA, pero aumenta con el desarrollo del cáncer de mama, especialmente con la presencia de infiltración. Un alto GH se asoció a tumores con RE-, alto índice de proliferación y sobrexpresión de p53 y c-erbB-2. Conclusiones: en las etapas iniciales de la secuencia de lesiones proliferativas ductales no se observa expresión de p53ni c-erbB2. Ambos marcadores se incrementan en el cáncer de mama en relación con el GH...(AU)

Background: breast screening has greatly increased the number of women diagnosed with proliferative breast disease. Recent studies have shown an association between benign breast diseases and subsequent breast cancer, hence have focussed on benign proliferative lesions. Breast cancer is probably the result of a series of genetic events (each with its own histologic correlation and sequence) from atypical ductal hyperplasia(ADH) to carcinoma. The goal of this study was to determine the diagnostic value of immunohistochemical determinations of biological markers(hormonal receptors, Ki67, p53 and c-erbB-2 expresion) in this sequence. Methods: expression of estrogen receptors (ER), cellular proliferation (Ki67), p53 and c-erbB-2 were examined by immunohistochemistry in samples of breast tissue from 228 patients with varying mammary lesions: ADH (28 cases), ductal carcinoma in situ (60 cases), ductal carcinoma in situ with microinfiltration(40 cases), invasive ductal carcinoma with extensive CDIS (40 cases) and pure invasive ductal carcinoma (60cases). A paraffin block was selected for immuno histochemical studies. DCIS was classified according to the Page’s criteria and histologic grading of invasive carcinoma following criteria given by Scarff-Bloom-Richardson modified by Elston and Ellis. Results: the ER expresion was 100% in ADH but decreases down to 70% in DCIS and DCI. Expression for p53 andcerbB-2 was not observed in ADH; but appears with the development of breast cancer: was observed in 21.7% in DCIS, 42.5% in DCIS-mic and 41.5% in pure DCI. High histological grade has been associated with estrogen receptor negativity, cellular proliferation, p53 and c-erbB-2 over expression. Conclusions: a p53 and c-erb-2 over expression were not observed in the early stages of the sequence atypical hyperplasia-carcinoma...(AU)

Fluorodeoxyglucose positron emission tomography with sentinel lymph node biopsy for evaluation of axillary involvement in breast cancer.

BACKGROUND: This study analysed the value of [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) in detecting axillary lymph node involvement in women with breast cancer. METHODS: In the first 150 women in this prospective study, axillary lymph node dissection (ALND) was performed regardless of the PET results. In a second group (125 women) FDG-PET was complemented with sentinel lymph node biopsy (SLNB) only in those who did not have pathological axillary uptake. RESULTS: The sensitivity and specificity of FDG-PET in detecting axillary involvement was 84.5 and 98.5 per cent respectively in the whole series of 275 patients, with two false-positive and 22 false-negative results. False-negative results were associated with some intrinsic tumour characteristics. In 21 women, PET revealed pathological uptake, suggesting involvement of the internal mammary lymph node chain. Whole-body PET identified a second synchronous tumour in five asymptomatic patients and haematogenous metastases in two patients. CONCLUSION: The high positive predictive value of PET (98.4 per cent) suggests that FDG uptake in the axilla could be an indication for full ALND without previous SLNB.

[The present state of esophageal laparoscopic surgery]. / Estado actual de la cirugía laparoscópica esofágica.

Laparoscopic surgery has changed the therapeutic approach in the most frequent esophageal diseases. With the excellent results in the control of symptoms and the low associated morbidity, surgical treatment is increasingly indicated in benign esophageal pathology as a superior alternative to a chronic and less efficient medical treatment. For the hiatus hernia and gastroesophageal reflux, Nissen's fundoplication by laparoscopy is the technique of choice. The best results in the treatment of achalasia are obtained with Heller's laparoscopic myotomy. This growing experience includes the resection of tumours of the esophagus combining thoracoscopy and laparoscopy with similar results to those of open surgery.

18F-FDG PET complemented with sentinel lymph node biopsy in the detection of axillary involvement in breast cancer.

AIM: The presence of axillary involvement is the most important prognostic factor in breast cancer. This study analysis the value of 18F-FDG PET in the detection of the lymph node status. METHODS: This study includes 200 breast cancer patients. The PET scans were obtained after the injection of 370 MBq of 18F-FDG; the breast areas, axillary, supraclavicular and internal mammary lymph node chains were evaluated. In a subgroup of 100 patients the PET-FDG scan was complemented with the study of the sentinel node (SN) in those cases which did not demonstrate pathological lymph node uptake. The standardized uptake value (SUV) was related to the tumour characteristics of size, histological type, axillary status and histological grading. RESULTS: The sensitivity and specificity of PET-FDG in the detection of axillary involvement was 84.1 and 97.8%, respectively. Seventeen false negative cases were obtained, and were associated with low SUV in the mammary tumour. In 15 cases the PET-FDG scans revealed pathological uptake foci that suggested involvement of the internal mammary chain. CONCLUSIONS: The PET-FDG avoids routine SN study in those cases presenting axillary uptake, but it must be complemented by sentinel node study in those cases without pathological uptake. The association of PET-FDG and SN improves the sensitivity in the detection of axillary involvement. Its sensitivity and specificity in the analysis of axillary status can be extended to the evaluation of the internal mammary chain.

Comparison between two warm ischemic models in experimental liver transplantation in pigs.

BACKGROUND: Experimental models of warm ischemia in liver transplantation have been employed to study the mechanisms and treatment of ischemia reperfusion injury. METHODS: We compared a control group without (group A, n = 10) versus two models of warm ischemia of liver transplants in pigs: namely, occlusion of the hepatic artery and portal vein for 30 minutes (group B, n = 23) and extraction of the liver 60 minutes after cardiac arrest (group C, n = 5). Liver function tests, coagulation studies, and liver biopsies were performed during the first 24 hours post-liver transplant. RESULTS: Clamping of the hepatic vasculature in group B produced a significant liver injury compared with the control group: elevation of the ALT and an abnormal 1-hour post-revascularization biopsy similar to that observed in the cardiac arrest group C. The transaminase levels were lower among group A animals (P <.05). But the hepatic synthetic functions as reflected in the protrombin time (PT) were not affected in group B versus group A. The alteration in PT with respect to the initial value was similar among group A and group B animals, which were significantly less than that in group C (P <.05). CONCLUSIONS: Occlusion of the hepatic artery and portal vein, a simple surgical maneuver, causes moderate damage to a liver graft but less alteration of hepatic synthetic function. Clamping of the hepatic vasculture obtains more long-term survivors after OLT than cardiac arrest.

An experience with the Advanced Breast Biopsy Instrumentation (ABBI) system in the management of non-palpable breast lesions.

Our objective was to evaluate our experience with the Advanced Breast Biopsy Instrumentation system (ABBI) in non-palpable breast lesions in a prospective study from July 1998 to November 2000. The ABBI system was included in a protocol for BIRADS 4 non-palpable, small (<15 mm) breast lesions. Digital radiographs of both specimen and biopsy cavity were obtained to validate the procedure. A total of 255 ABBI biopsies were performed in 254 patients. In 251 cases the lesions were successfully removed (98.4%). Mammographic lesions consisted of 176 cases of microcalcifications (69%), 51 cases of architectural distortions (20%) and 28 cases of nodules (11%). Seventy-two carcinomas were diagnosed (28.2%). Affected margins were found in 41 cases (56.9%). Residual tumour was seen in 31 patients (43%). Seventeen borderline results and 33 benign architectural distortions obviated further procedures. The complication rate in 10 cases was as follows: 3 wound infections; 4 haematomas; and 3 vasovagal reactions. The main utility of the ABBI system is to allow a reliable diagnosis in complex lesions, such as small clusters of microcalcifications and especially architectural distortions. Surgery can be avoided for borderline cases if the lesion is completely removed and free margins are obtained in the pathology study. Therapeutic use is controversial and can be applied only in selected cases.

Segundo tumor primario hallazgo de la tomografía por emisión de positrones (PET-18FDG) de estadificación neoplásica / Second primary tumor detected by positron emission tomography (PET-18FDG) in tumoral staging

La PET con 18FDG es una técnica que está adquiriendo un gran interés en la patología oncológica, al permitir la detección precoz de algunas neoplasias, su estadificación en el momento de diagnóstico inicial, y el descubrimiento de metástasis en el curso del seguimiento.La práctica de un estudio de cuerpo completo nos ha permitido detectar en 6 casos segundas neoplasias, que por ser asintomáticas y su localización no estar relacionada con el tumor inicial, podían haber pasado inadvertidas. (AU)

Valoración de la tomografía por emisión de positrones (PET-18FDG) en la estadificación del cáncer de mama* / Testing positron emission tomography (PET-18FDG) for breast cancer staging

El estado de los ganglios axilares es el factor pronóstico más importante en el cáncer de mama (CM) y sólo el análisis histológico permite en el momento actual conocer su estado de forma fiable. La tomografía por emisión de positrones (PET) se ha descrito como técnica útil en la valoración de algunos tumores, debiéndose analizar más ampliamente en el CM. Mediante PET con 18F-fluoro-2-desoxi-D-glucosa (18FDG), se estudian 100 casos de CM, analizando su depósito a nivel del tumor primario, cadenas ganglionares axilar y mamaria interna, así como en estudio de cuerpo entero. En 15 casos, tras una segunda inyección de 18FDG, se efectuó una nueva PET sobre los ganglios axilares extraídos e individualizados, previamente al análisis histológico. La PET confirmó el CM en todos los casos (sensibilidad: 100 por ciento), y una imagen sugestiva de multifocalidad en 7 casos (confirmada en 5). La sensibilidad en la detección del estado ganglionar axilar fue el 91 por ciento, con una especificidad del 100 por ciento. En 7 casos se apreciaron focos de captación a nivel de cadena mamaria interna, y en 3 casos carcinomas extramamarios, asintomáticos, desconocidos. La PET realizada sobre los ganglios axilares aislados mostró una sensibilidad del 100 por ciento. La PET-FDG muestra alta sensibilidad en el diagnóstico del CM. Puede permitir la detección de focos tumorales múltiples en la mama. Una PET sugestiva de afectación ganglionar axilar, es una indicación para la práctica de un vaciamiento axilar. Una PET que no evidencie afectación ganglionar axilar, no excluye la infiltración metastásica de alguno de los ganglios axilares (falso negativo: 9 por ciento); por ello, todavía hoy debe plantearse A. Zornoza y cols. - Valoración de la tomografía por emisión de positrones (PET-18FDG) en la estadificación del cáncer de mama a exploración quirúrgica axilar, que puede reducirse al estudio del ganglio centinela. Su especificidad (100 por ciento) en la valoración del estado ganglionar axilar, puede trasladarse a la cadena mamaria interna, y permitir catalogar como pN3 a aquellos casos en los que la PET muestre focos de captación en ese territorio. La PET-18FDG parece una técnica fiable en el estadiaje del CM. Los niveles de captación de glucosa, determinados por el SUV, están en relación con factores pronósticos bien conocidos como el tamaño tumoral, grado histológico, la ploidía y el Ki67 (AU)