Aplicación de sellantes de fibrina (Tissucol(R) frente a Tachosil(R)) para la prevención del seroma tras linfadenectomía axilar en cirugía del cáncer de mama. Estudio prospectivo y aleatorizado / Application of fibrin sealants (Tissucol(R) versus Tachosil(R)) for seroma prevention after axillary lymphadenectomy in breast cancer surgery. A prospective randomised study

Introducción: Los objetivos del estudio fueron valorar la utilidad de sellantes de fibrina para evitar seromas postoperatorios tras linfadenectomía axilar y comparar la incidencia de seroma axilar en 3 grupos de estudio (Tachosil(R), Tissucol(R) y control). Así mismo analizar posibles factores relacionados con la aparición del seroma. Métodos: Entre los años 2012 y 2015 se realizó un estudio prospectivo y aleatorizado en nuestro centro. Se incluyeron 110 pacientes consecutivas operadas de cáncer de mama que requirieron linfadenectomía axilar. Las pacientes fueron aleatorizadas en 3 grupos: Tachosil(R) (38 pacientes), Tissucol(R) (35) y control (37). Las variables estudio fueron: edad, peso, talla e índice de masa corporal, estadificación TNM del tumor, tipo histológico e inmunohistoquímico, número de ganglios extirpados, afectos, y uso de quimioterapia neoadyuvante. Las variables resultado fueron: débito obtenido por el drenaje desde el día 1 postoperatorio hasta la retirada del mismo, volumen total del drenaje axilar, aparición de seroma que precisara punción evacuación, volumen del seroma postoperatorio drenado y número de punciones evacuadoras hasta su resolución clínica. Resultados: No existieron diferencias significativas en el porcentaje de seromas, volumen y número de punciones evacuadoras necesarias para su resolución, ni tampoco respecto al débito a través del drenaje antes de su retirada entre los grupos de estudio. Los valores pronósticos para desarrollar seroma fueron: edad >56 años y débito al 6.° día posquirúrgico >70ml. Conclusiones: No se evidenciaron ventajas al aplicar sellantes de fibrina en relación con el volumen seroso drenado y con la formación de seroma axilar posquirúrgico

Introduction: The objectives of our study were to evaluate the usefulness of fibrin sealants in preventing the appearance of seromas after axillary lymphadenectomy and to compare the incidence of axillary seroma in three groups (Tachosil(R), Tissucol(R) and control). We also analysed the possible factors related to the development of seroma. Methods: Between 2012 and 2015, we carried out a prospective, randomised study at our centre including 110 consecutive patients undergoing breast cancer surgery who required axillary lymphadenectomy. Patients were randomised into 3 groups: Tachosil(R) (38 patients), Tissucol(R) (35) and control (37). Study variables consisted of age, weight, height and body mass index (BMI), tumour-node-metastases (TNM) stage, histological and immunohistochemical type, application of neoadjuvant chemotherapy, and the number of excised and metastasised lymph nodes. Outcome variables consisted of daily output from postoperative day 1 to the withdrawal of drainage, the total volume of axillary drainage, the appearance of postoperative seromas requiring puncture evacuation, the volume of the postoperative seroma drained and the number of seroma puncture evacuations required until clinical resolution. Results: There were no significant differences in the percentage of seromas, volume, number of puncture evacuations needed for resolution of the seroma or total flow through the drainage tubes prior to withdrawal in the 3 study groups. Prognostic values for the development of axillary seroma were age >56 years and a drained volume >70ml by the 6th postoperative day. Conclusions: We did not identify any advantages in applying fibrin sealants in relation to the serous volume drained or the incidence of postoperative axillary seroma

Manejo diagnóstico y terapéutico de la filariasis mamaria / Diagnostic and therapeutic management to breast filariasis

La filariasis es una enfermedad parasitaria benigna poco frecuente en los países occidentales, sobre todo la afectación mamaria es inusual. Sin embargo, aumenta la frecuencia de casos de filariasis mamaria en nuestro medio debido a las corrientes migratorias y el turismo a zonas endémicas. Nuestro objetivo es incidir en el manejo diagnóstico y terapéutico de la filariasis mamaria a propósito de un caso clínico

Filariasis is a benign parasitic disease that is unusual in western countries, especially filariasis of the breast. However, cases of breast filariasis are increasing in our environment due to greater immigration and tourism to endemic areas. We report a case of breast filariasis to describe the diagnostic and therapeutic management of this disease

Factors associated with health-related quality of life in a cohort of Spanish breast cancer patients.

BACKGROUND: Several factors can modify health-related quality of life (HRQOL) of breast cancer survivors. The objective of the current study was to analyse the associations between HRQOL scores 1 year after breast cancer surgery and sociodemographic and clinical factors. METHODS: This was an observational, multicentre and prospective study of a cohort of patients who underwent oncological breast cancer surgery and which was followed up for 1 year. The HRQOL was assessed at 1 year after surgery using three questionnaires: EuroQol-5D, EORTC QLQ-C30 and its breast-specific module BR-23. RESULTS: A total of 364 patients participated in the study. Some factors were associated with better HRQOL 1 year after surgery: age between 60 and 69 years and under 50 years, being single or a housewife, stage I-II, invasive papillary carcinoma, breast-conserving surgery (BCS) or lack of axillary dissection. However, only the following were independent predictive factors: being single or a housewife, BCS, invasive papillary carcinoma, coming from an outpatient clinic or not receiving radiotherapy. Further, some factors were independent predictors of a worse HRQOL: age over 70 years, being married, separated or widowed, stage III or not receiving adjuvant chemotherapy. CONCLUSIONS: Demographic and clinical factors can influence HRQOL, some of them independently.

¿Mejora la cirugía mamaria la supervivencia del cáncer oculto de mama? / Does surgery improve survival in occult breast cancer?

Introducción. El cáncer oculto de mama (COM), con una incidencia del 0,3-1%, aún plantea retos diagnósticos y terapéuticos. El objetivo del trabajo fue determinar las características patológicas de nuestra serie de COM, evaluar los resultados de las técnicas diagnósticas y terapéuticas empleadas (cirugía mamaria con linfadenectomía axilar o solo linfadenectomía axilar) y la supervivencia global. Pacientes y métodos. Análisis retrospectivo de 21 pacientes con metástasis ganglionares de cáncer mamario con mamografía y ecografía mamaria negativas. Desde 2003 se incluyó la resonancia magnética nuclear (RMN) en el protocolo de estudio. Se valoró la supervivencia en 2 grupos; grupo A: pacientes con COM tratadas con cirugía mamaria (15 casos), bien mastectomía radical (10 pacientes) bien cirugía conservadora (5 casos), y grupo B: 4 pacientes tratadas quirúrgicamente con linfadenectomía axilar niveles i y ii de Berg. Se asoció radioterapia sobre la mama tras cirugía conservadora (50 Gy) y sobre la axila si > 3 adenopatías axilares tumorales. Resultados. En 9 pacientes (7 de las mastectomías y 2 de las cirugías conservadoras) se identificó histológicamente un carcinoma de mama, de tipo ductal infiltrante en 8 casos y un carcinoma medular. La RMN (6 casos) demostró en 2 pacientes tumor mamario con confirmación histológica de carcinoma. Con una mediana de seguimiento de 87 meses, la supervivencia global fue de 101,2 meses (rango: 12-235 meses) con una supervivencia a 5 años del 69%. La supervivencia media en el grupo A fue de 120 meses, superior a los 41 meses del grupo B (p = 0,05). Conclusiones. En nuestra serie el tratamiento quirúrgico sobre la mama mejora la supervivencia global respecto al grupo tratado solo con linfadenectomía axilar. La RMN ha sido útil para evidenciar nódulos tumorales ante un supuesto COM y permite seleccionar a pacientes para realizar cirugía conservadora de la mama(AU)

Introduction. Occult breast cancer (OBC) has an incidence of 0.3-1% but nevertheless represents a diagnostic and therapeutic challenge. The aim of our study was to determine the pathologic characteristics of patients in our OBC series, compare the results of the different diagnostic and therapeutic techniques available (breast surgery with axillary lymphadenectomy or axillary lymphadenectomy alone), and overall survival. Patients and methods. A retrospective analysis was carried out in 21 patients with axillary lymph node metastases and negative mammography and breast ultrasonography. From 2003 onward, our group included magnetic resonance imaging (MRI) in the study protocol of OBC. Overall survival was determined and 2 groups were compared: Group A consisted of patients with OBC treated with breast surgery (n = 15), either with radical breast mastectomy (n = 10) or breast-conserving surgery (n = 5); and group B consisted of patients (n = 4) treated surgically with Berg level i or ii axillary lymphadenectomy. We added breast radiotherapy (50 Gy) in patients treated with breast-conserving therapy and axillary radiotherapy when there were more than 3 metastatic axillary nodes. Results. In 9 patients (7 mastectomies, 2 breast-conserving interventions), one breast carcinoma, 8 infiltrating ductal carcinomas and one medullar carcinoma were identified by histology. Two breast carcinomas were detected by MRI in 6 patients, which were later confirmed by histologic study. The median follow-up was 87 months, with an overall survival of 101.2 months (range: 12-235 months) and a 5-year survival of 69%. The mean survival was 120 months in group A and 41 months in group B (P = .05). Conclusions. In our series, surgical treatment of OBC improved overall survival compared with lymphadenectomy alone. MRI was useful in the identification of malignant tumors in suspected OBC and allowed patient selection for breast-conserving surgery(AU)

Evolution of Health-Related Quality of Life in Breast Cancer Patients during the First Year of Follow-Up.

PURPOSE: The objective of this study was to describe the evolution of health-related quality of life (HRQOL) in a cohort of breast cancer patients over 1 year after surgery and to analyse the predictive ability of HRQOL measurement instruments. METHODS: Observational, multicenter and prospective study of a cohort of breast cancer patients, assessing HRQOL at 1, 6, and 12 months after surgery using three questionnaires: EuroQol-5D-3L, EORTC QLQ-C30, and EORTC QLQ-BR23. RESULTS: A total of 364 women participated in the study. Visual Analogue Scale (VAS) scores from the EuroQol improved (1 month vs. 1 year: 70 vs. 80; p<0.0001); however, the EuroQol score showed no significant change (0.81 vs. 0.83; p=0.1323). In contrast, Global Health Status on the EORTC QLQ-C30 improved (66.67 vs. 100.00; p<0.0001), as did all of this instrument's scales and most of its independent items. The EORTC QLQ-BR23 dimensions showed improvement, except for sexual functioning (100.00 vs. 86.67; p=0.0030) and future perspective (33.33 vs. 66.67; p<0.0001). Patients with good HRQOL outcomes at 1 month showed improved levels of HRQOL at 1 year; HRQOL measured at 1 month was predictive of HRQOL at 1 year. CONCLUSION: HRQOL improved during the follow-up period. Likewise, HRQOL measurement instruments can predict early HRQOL.

Cáncer de mama y embarazo. Análisis de una serie de 27 pacientes / Breast cancer and pregnancy. Analysis of a series of 27 patients

Objetivo: Realizar un análisis descriptivo de la serie de pacientes con cáncer de mama (CM) y embarazo diagnosticadas en nuestro centro en relación con los métodos terapéuticos empleados y supervivencia global de la serie. Pacientes y métodos: Entre 1982 y 2009, de 5.906 pacientes diagnosticadas de CM, se trató a 27 pacientes con CM y embarazo (0,46%). Analizamos las características clínicas y anatomopatológicas, el diagnóstico, los tratamientos y la evolución de estas pacientes en nuestro centro. Resultados: La edad media al diagnóstico fue de 35 años. Durante la gestación se diagnosticó a 21 pacientes y en el posparto, a 6. El retraso medio diagnóstico desde el inicio de los síntomas fue de 4 meses. Respecto al perfil inmunohistoquímico determinado en 19 pacientes, 5 (26%) eran receptor 2 de factor de crecimiento epidérmico humano (HER2) positivo; otros 5 (26%), triple negativo; 3, luminal A, y en las 6 restantes, luminal B. Al diagnóstico, se clasificó a 5, 9, 11 y 2 pacientes en estadio I, II, III y IV, respectivamente. Histológicamente, 21 (78%) eran carcinomas ductales infiltrantes; 11 (41%), de alto grado histológico, y 4 casos (15%) presentaron características de carcinoma tipo inflamatorio al diagnóstico. Se pautó quimioterapia neoadyuvante en 16 pacientes (59%), sin que se detectaran complicaciones fetales. Se operó a todas las pacientes, y se realizó mastectomía radical modificada en 24 (89%), así como cirugía conservadora en 3. Con un tiempo medio de seguimiento de 60 meses, la supervivencia global fue del 70%. Cuatro pacientes (15%) presentaron recaída local y 13 (48%), recaída sistémica. Conclusiones: El carcinoma de mama durante el embarazo se asocia con un retraso diagnóstico, estadios avanzados y grados histológicos altos. El tratamiento quirúrgico conlleva un alto porcentaje de mastectomías radicales. La quimioterapia no produjo efectos adversos en el feto tras el primer trimestre de gestación. El pronóstico de CM durante el embarazo es similar al de las pacientes no gestantes de la misma edad y estadio tumoral (AU)

Objective: To perform a descriptive analysis of patients with breast cancer (BC) and pregnancy diagnosed in our centre, as regards the therapeutic methods used and the overall survival of the series. Patients and methods: Between 1982-2009, 5906 patients were diagnosed with BC, of whom 27 (0.46%) were treated for pregnancy-associated BC. We analysed the characteristics, diagnosis, treatments and outcome of these patients in our centre. Results: The mean age at diagnosis was 35 years. Twenty-one patients were diagnosed during pregnancy and six of them in the post-partum period. The mean diagnostic delay from the onset of symptoms was four months. In the immunohistochemical profile performed in 19 patients, 5 (26%) were HER2, 5 (26%) were triple-negative, luminal A in three patients, and luminal B in the other 6 cases. At diagnosis, 5, 9, 11 and 2 patients were classified into stages I, II, III and IV, respectively. Histologically, 21 (78%) were infiltrating ductal carcinomas, 11 (41%) were high grade carcinomas and 4 (15%) were inflammatory carcinomas at diagnosis. Neoadjuvant chemotherapy was prescribed in 16 patients (59%), with no foetal complications detected. All patients underwent surgery; 24 (89%) had modified radical mastectomy while three had conservative surgery. The mean follow-up time was 60 months, in which the overall survival was 70%. Four patients (15%) had local recurrence and 13 (48%) had systemic recurrence. Conclusions: Breast carcinoma during pregnancy is associated with diagnostic delay, advanced stages and high histological grades. Surgical treatment involves a high percentage of radical mastectomies. Chemotherapy did not produce adverse effects in the foetus after the first trimester. The prognosis for BC during pregnancy is similar to that of non-pregnant patients of the same age and tumour stage(AU)