¿Son los colgajos toracoabdominales una herramienta útil en el tratamiento del carcinoma de mama avanzado? / Are thoracoabdominal flaps an effective tool in the treatment of advanced breast cancer?

A pesar de los avances en el tratamiento del cáncer de mama existen casos en los que la enfermedad se presenta en estadios avanzados y precisa tratamientos quirúrgicos agresivos que originan grandes defectos en la pared torácica. Dentro de las diferentes técnicas comprendidas en la cirugía oncoplástica, los colgajos toracoabdominales, incluidos en el grupo de colgajos de rotación, se han postulado como una técnica atractiva para cubrir los amplios defectos que resultan de estas cirugías tan extensas, con el fin de comenzar precozmente el tratamiento adyuvante y mejorar la supervivencia sin aumentar la morbilidad. Es importante establecer una correcta indicación y el exhaustivo conocimiento de la anatomía con el objetivo de conseguir un cierre simple del defecto con una buena cobertura cutánea. (AU)

Despite advances in the treatment of breast cancer, there are cases in which the disease occurs in advanced stages and requires aggressive surgical treatments that cause large defects in the chest wall. Within the different techniques included in oncoplastic surgery, the thoracoabdominal flaps, included in the group of rotation flaps, have been postulated as an attractive technique to cover the wide defects resulting from these extensive surgeries, in order to start adjuvant treatment earlier and improve survival without increasing morbidity. It is important to establish a correct indication and an exhaustive knowledge of the anatomy in order to achieve a simple closure of the defect with good skin coverage. (AU)

Is Axillary Assessment of Ductal Carcinoma In Situ of the Breast Necessary in All Cases?

BACKGROUND: Staging of the axilla in women with ductal carcinoma in situ (DCIS) is a point of controversy. We aimed to assess whether there is a group of patients in whom axillary assessment can be avoided and whether the likelihood of underdiagnosis of infiltrating carcinoma is sufficient to justify this evaluation. MATERIALS AND METHODS: This was a multicenter, prospective, observational study of patients who were operated on between 2008 and 2018 in three Spanish hospitals, with a diagnosis by radiological or excisional biopsy of DCIS and clinically and radiologically negative axilla. RESULTS: A total of 530 patients with a preoperative diagnosis of DCIS were studied. An axillary assessment was performed in 77% of the patients. In 397 patients, selective sentinel lymph node biopsy was performed. Axillary involvement was found in 7.2% of all patients, which dropped to 2.15% if we only included DCIS diagnosed after a definitive anatomical pathology analysis. Underdiagnosis was correlated with the type of biopsy performed: the risk was 1.34 times as high if the biopsy was performed with a core needle. The risk of lymph node metastasis was higher when there was lymphovascular invasion and when mastectomy was performed. CONCLUSIONS: We propose an axilla management algorithm in patients with a preoperative diagnosis of DCIS. The patients who would benefit from sentinel lymph node biopsy would be those who are not candidates for breast-conserving surgery, those with a BIRADS 5 lesion biopsied by core-needle biopsy, and those whose definitive diagnosis is lymphovascular invasion.

Sentinel lymph node BIOPSY after neoadjuvant therapy in breast cancer patients with lymph node involvement at diagnosis. Could wire localization of clipped node improve our results?

INTRODUCTION: Sentinel lymph node biopsy (SLNB) after neoadjuvant therapy (NAT) in node-positive (N+) breast cancer patients at diagnosis remains a controversial issue, with no consensus on implementation or safety. OBJECTIVES: We sought to assess the accuracy of SLNB after NAT in biopsy-proven N+ cases at diagnosis and the efficacy and accuracy of wire localization of the clipped node to improve results. MATERIAL AND METHODS: A cross-sectional diagnostic technique validation study in N+ patients following NAT was performed. The biopsy-proven affected lymph node was clipped at diagnosis. SLNB and axillary lymph node dissection (ALND) were performed in cases of clinical-radiological lymph node response after NAT. For the purposes of our study we added wire localization of the clipped node. RESULTS: 103 patients were included (mean age, 54.4 years [± 12.7]). Wire marking was performed in 28 cases. The overall identification rate (IR) of SLN was 81.6%. The median number of nodes removed was 2 (range 2). The overall false negative rate (FNR) was 6.1%. Sensitivity and overall accuracy were 93.9% and 95.2%, respectively (area under curve 0.97). In the double-marked (clip and wire) group the FNR decreased to 0% and accuracy was 100%. Axillary pathologic complete response was observed in 24.3% of cases. CONCLUSIONS: SLNB is useful in node-positive patients at diagnosis who respond to NAT. Combining this with preoperative wire localization of the biopsied lymph node reduces the FNR without increasing the number of complications.

Biopsia selectiva del ganglio centinela posneoadyuvancia como herramienta en la valoración de la axila / Sentinel lymph node biopsy after neoadjuvant therapy as a tool to evaluate axillary status

Objetivo. El objetivo de este estudio fue estimar la validez de la técnica de biopsia selectiva del ganglio centinela (BSGC) para el diagnóstico del estado de la axila en pacientes con cáncer de mama tras recibir tratamiento neoadyuvante. Material y métodos. Se realizó un estudio transversal de validación durante 2005-2011. Las pacientes fueron sometidas a tratamiento neoadyuvante, posteriormente se realizó la cirugía sobre la mama, BSGC y disección axilar. El ganglio centinela se detectó 24 h antes de la intervención. Resultados. Se incluyeron 66 pacientes con una edad media de 56 años. El 86% fueron carcinomas ductales infiltrantes. El 33,3% de las pacientes tenían axilas afectas al diagnóstico (cN1). La migración del Tc99m fue del 90%, y la no migración en la linfogammagrafía se relacionó en un 77,8% con afectación axilar. La tasa de identificación del ganglio centinela en quirófano fue del 98,3%, con un porcentaje de falsos negativos del 9,7%, y un área bajo la curva de 0,95. En las pacientes con axila sana al diagnóstico (cN0), se detectó el ganglio centinela en el 94%, (5,6% falsos negativos), con un área bajo la curva de 0,97; en cN1 la detección descendió al 87% (9% falsos negativos), con un área bajo la curva de 0,92. Conclusiones. La estadificación de la axila después de tratamiento neoadyuvante es posible con la BSGC, pudiendo evitar disecciones axilares innecesarias. En las pacientes con cN0 la técnica de la BSGC es similar a la de las pacientes con cánceres precoces. Si bien existe una disminución de la identificación en las pacientes con cN1, la exactitud de la prueba es adecuada (AU)

Objective. To estimate the validity of sentinel lymph node biopsy (SLNB) in the diagnosis of axillary status in patients with breast cancer after neoadjuvant therapy. Material and methods. We carried out a cross sectional validation study from 2005 to 2011. Patients were treated with neoadjuvant therapy with subsequent breast surgery, SLNB, and axillary dissection. Twenty four hours before the intervention, the sentinel lymph node was detected with radiocolloid injected through subareolar and peritumoral tissue. Results. We included 66 patients with a mean age of 56 years. A total of 86% had infiltrating ductal carcinoma, while 33.3% had axillary involvement at diagnosis (cN1). Migration of Tc99m was nearly 90%, and non-migration was related to axillary involvement in 77.8%. The sentinel lymph node identification rate was 98.3% in the operating room, with a false negative rate of 9.7%, and an area under the curve of 0.95. In patients with healthy axilla at diagnosis (cN0), the sentinel lymph node was detected in nearly 94% (false negative, 5.6%; area under the curve, 0.97); in cN1, sentinel lymph node detection decreased to 87% (false negative 9%; area under the curve of 0.92). Conclusions. Axillary staging with SLNB is feasible after neoadjuvant therapy and can avoid unnecessary axillary dissection. In patients with cN0, the SLNB technique is similar to that in patients with early breast cancer. Although sentinel lymph node identification decreases in patients with cN1, the accuracy of the technique is adequate (AU)

Phase II trial with letrozole to maximum response as primary systemic therapy in postmenopausal patients with ER/PgR[+] operable breast cancer.

PURPOSE: Letrozole is superior to tamoxifen in terms of response and breast preservation rates as primary systemic therapy (PST) in postmenopausal women with ER-positive early breast cancer. However, the optimum duration of endocrine PST remains uncertain. METHODS: A phase 2 multicentre, open-label trial was conducted to evaluate the efficacy of letrozole over a preoperative period of 4 months to 1 year. Seventy postmenopausal patients (over 65 years) were recruited in four centers. The primary endpoint was to establish the optimal duration of treatment defined as the time required to attain the maximum response by clinical palpation. RESULTS: The median age of the group was 79 years (66-91) and the median tumour size 35 mm (range 25-100 mm). No severe adverse events were reported. Fifty-six patients were evaluable for the primary objective. A total of 43 patients (76.8%) achieved an objective response; 29 (51.8%) being partial and 14 (25.0%) complete. The median time to objective response was 3.9 months (95% CI, 3.3-4.5) and the median time to maximum response was 4.2 months (95% CI, 4.0-4.5), although 20 (37.1%) patients achieved the maximal response within 6-12 months. CONCLUSIONS: Letrozole shows a high activity and excellent tolerability as neoadjuvant therapy in elderly patients with endocrine-dependent breast cancer. Four to six months of letrozole as PST is an optimum duration with modest benefits thereafter.

Metástasis coroideas y de cuero cabelludo en el cáncer de mama / Choroidal and scalp metastasis in breast cancer

No disponible

No disponible

Tratamiento quirúrgico tras quimioterapia neoadyuvante en el cáncer de mama operable: once años de experiencia / Surgical treatment after neoadjuvant chemotherapy in operable breast cancer: an eleven-year experience

Introducción. El objetivo del estudio ha sido evaluar el tratamiento conservador tras la quimioterapia de inducción y analizar los resultados obtenidos tras 11 años de experiencia con la neoadyuvancia en el cáncer de mama. Pacientes y método. Se administró quimioterapia de inducción a las pacientes con cáncer de mama no metastásico con tumores mayores de 3 cm. Se indicó tratamiento conservador en las pacientes con un tamaño tumoral 3 cm y en las que no existieran contraindicaciones. Resultados. Entre enero de 1990 y diciembre del 2000 se administró quimioterapia de inducción a 146 pacientes. El tamaño tumoral medio fue de 5,14 cm, que pasó a ser de 2,8 cm tras la inducción (p < 0,05).La respuesta a la quimioterapia fue completa en el 10 por ciento de las pacientes y parcial en el 75 por ciento; el 15 por ciento restante no respondió. Se realizó tratamiento quirúrgico conservador en el 31 por ciento de los casos (el 55 por ciento de los que estaban en estadio IIa, el 31 por ciento de los de estadio IIb, el 19 por ciento de los de estadio IIIa y el 3 por ciento de los de estadio IIIb). En los tumores menores de 5 cm sin afección ganglionar fue más factible el tratamiento conservador (p < 0,05). Tras un seguimiento medio de 44,4 meses, 34 pacientes (23 por ciento) desarrollaron metástasis y 4 (2,7 por ciento) recurrencia local. Las pacientes con tumores mayores de 5 cm y afección axilar tras la quimioterapia presentaron enfermedad metastásica con más frecuencia (p < 0,05). Conclusión. La quimioterapia preoperatoria reduce significativamente el tamaño tumoral y permite el tratamiento quirúrgico conservador con un riesgo bajo de recidiva local. La afección axilar y el tamaño tumoral tras la inducción son importantes factores de pronóstico (AU)