Validación ecológica del programa FORT (Fear of Cancer Recurrence Therapy): una adaptación del español mexicano al español castellano: reporte preliminar / Ecological validation of Fear of Cancer Recurrence Therapy from Mexican to european Spanish for breast cancer patients: Preliminary repor

Introducción: El miedo a la recaída es uno de los problemas psicológicos en los pacientes con cáncer, más específicos. El aumento en la esperanza de vida en el paciente oncológico, y la supervivencia, hace que cada vez más conozcamos las consecuencias emocionales, y vivir con el llamado Síndrome de la Espada de Damocles es sin duda una de las más importantes. Este miedo a la recaída puede llegar a ser invalidante y por ello cada vez más se elaboran programas terapéuticos para poderlo combatir. Uno de los más conocidos es el FORT (Fear of Recurrence Therapy) elaborado por Maheu y Lebel y que en este momento está siendo adaptado a otros lenguajes y culturas. Una de ellas es la adaptación de Gálvez en México. Objetivo: Nuestro objetivo en el presente trabajo preliminar es presentar los primeros datos de adaptación de esta terapia del español mexicano al europeo. Método: El procedimiento seguido es la validación ecológica propuesta por Bernal en base al consenso de dos psicooncólogas expertas. Resultados: Después de valorar el cambio de diferentes conceptos y terminologías, se han valorado de forma independiente por parte de ambas psicooncólogas, las 8 dimensiones de Bernal con un alto índice Kappa (de 0,8 a 1). Conclusiones: Este es un estudio preliminar al que le va a seguir los mismos pasos para el manual de la paciente por parte de profesionales y de pacientes con cáncer de mama (AU)

Introduction: Fear of recurrence is one of the most specific psychological problems faced by cancer patients. Their increase in life expectancy, and survival, makes them increasingly aware of the emotional consequences, and living with the so-called Sword of Damocles Syndrome is undoubtedly one of the most important. Fear of recurrence can become disabling and affect their emotional well-being, leading to the development of therapeutic programs like FORT (Fear of Recurrence Therapy) developed by Maheu and Lebel. This therapy is being adapted to different languages and cultures, including Mexican Spanish by Gálvez. Objective: In this preliminary work, we aim to present the first data on adapting FORT from Mexican Spanish to European Spanish. Methods: The procedure used was to follow the ecological validation method proposed by Bernal, by two skilled psychooncologists. Results: The assessment of different concepts and terminologies by the two psychooncologists in an independent way, the analysis yielded a high Kappa index (from 0.8 to 1) for the 8 dimensions of Bernal. Conclusions: This preliminary study will be followed by a similar process for the patient manual by professionals and breast cancer patients (AU)

Predicting the evolution of COVID-19 mortality risk: A Recurrent Neural Network approach.

Background: In December 2020, the COVID-19 disease was confirmed in 1,665,775 patients and caused 45,784 deaths in Spain. At that time, health decision support systems were identified as crucial against the pandemic. Methods: This study applies Deep Learning techniques for mortality prediction of COVID-19 patients. Two datasets with clinical information were used. They included 2,307 and 3,870 COVID-19 infected patients admitted to two Spanish hospitals. Firstly, we built a sequence of temporal events gathering all the clinical information for each patient, comparing different data representation methods. Next, we used the sequences to train a Recurrent Neural Network (RNN) model with an attention mechanism exploring interpretability. We conducted an extensive hyperparameter search and cross-validation. Finally, we ensembled the resulting RNNs to enhance sensitivity. Results: We assessed the performance of our models by averaging the performance across all the days in the sequences. Additionally, we evaluated day-by-day predictions starting from both the hospital admission day and the outcome day. We compared our models with two strong baselines, Support Vector Classifier and Random Forest, and in all cases our models were superior. Furthermore, we implemented an ensemble model that substantially increased the system's sensitivity while producing more stable predictions. Conclusions: We have shown the feasibility of our approach to predicting the clinical outcome of patients. The result is an RNN-based model that can support decision-making in healthcare systems aiming at interpretability. The system is robust enough to deal with real-world data and can overcome the problems derived from the sparsity and heterogeneity of data.

PharmacoNER Tagger: a deep learning-based tool for automatically finding chemicals and drugs in Spanish medical texts.

Automatically detecting mentions of pharmaceutical drugs and chemical substances is key for the subsequent extraction of relations of chemicals with other biomedical entities such as genes, proteins, diseases, adverse reactions or symptoms. The identification of drug mentions is also a prior step for complex event types such as drug dosage recognition, duration of medical treatments or drug repurposing. Formally, this task is known as named entity recognition (NER), meaning automatically identifying mentions of predefined entities of interest in running text. In the domain of medical texts, for chemical entity recognition (CER), techniques based on hand-crafted rules and graph-based models can provide adequate performance. In the recent years, the field of natural language processing has mainly pivoted to deep learning and state-of-the-art results for most tasks involving natural language are usually obtained with artificial neural networks. Competitive resources for drug name recognition in English medical texts are already available and heavily used, while for other languages such as Spanish these tools, although clearly needed were missing. In this work, we adapt an existing neural NER system, NeuroNER, to the particular domain of Spanish clinical case texts, and extend the neural network to be able to take into account additional features apart from the plain text. NeuroNER can be considered a competitive baseline system for Spanish drug and CER promoted by the Spanish national plan for the advancement of language technologies (Plan TL). PharmacoNER Tagger can be accessed at https://github.com/PlanTL-SANIDAD/PharmacoNER.

Why are we still detecting food-related Salmonella outbreaks in Spain? / ¿Por qué estamos detectando aún brotes de Salmonella relacionados con la alimentación en España?

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[Molecular diagnostic methods of respiratory infections. Has the scheme diagnosis changed?]. / Métodos moleculares de diagnóstico de infecciones respiratorias. ¿Ha cambiado el esquema diagnóstico?

Lower respiratory tract infections remain one of the most common causes of mortality worldwide, which is why early diagnosis is crucial. Traditionally the microbiological diagnosis of these infections has been based on conventional methods including culture on artificial media for isolation of bacteria and fungi and cell cultures for virus and antibody or antigen detection using antigen-antibody reactions. The main drawback of the above mentioned methods is the time needed for an etiological diagnosis of the infection. The techniques based on molecular biology have drawn much attention in recent decades as tools for rapid diagnosis of infections. Some techniques are very expensive, especially those that can detect various microorganisms in the same reaction, therefore the question that arises is whether the cost of such testing is justified by the information obtained and by the clinical impact that its implementation will determine. In this article we make a review of the various techniques of molecular biology applied to the diagnosis of pneumonia and focus primarily on analysing the impact they may have on the management of patients with acute respiratory tract infections.

Métodos moleculares de diagnóstico de infecciones respiratorias. ¿Ha cambiado el esquema diagnóstico? / Molecular diagnostic methods of respiratory infections. Has the scheme diagnosis changed?

Las infecciones respiratorias bajas siguen siendo una de las causas más frecuentes de mortalidad en todo el mundo, de ahí que el diagnóstico precoz sea fundamental. Tradicionalmente, el diagnóstico microbiológico de este tipo de infecciones se ha basado en métodos convencionales que incluyen cultivos en medios artificiales para aislamiento de bacterias y hongos y cultivos celulares para virus, así como en la detección antigénica o de anticuerpos mediante reacciones antígeno-anticuerpo. El principal inconveniente de las metodologías anteriormente citadas es el tiempo necesario para obtener un diagnóstico etiológico de la infección. Las técnicas basadas en la biología molecular han irrumpido con fuerza en las últimas décadas como herramientas de diagnóstico rápido de las infecciones. Algunas de estas técnicas -sobre todo aquellas que pueden detectar diversos microorganismos en la misma reacción- acostumbran a ser caras, por lo que la cuestión que se plantea es si el gasto de tales ensayos se ve justificado por la información obtenida y por el impacto clínico que su implementación determina. En este artículo se pretende hacer una revisión de las diversas técnicas de biología molecular aplicadas al diagnóstico de las infecciones respiratorias, centrándose fundamentalmente en la neumonía, y analizar el impacto que pueden tener en el manejo del paciente con infección respiratoria aguda

Lower respiratory tract infections remain one of the most common causes of mortality worldwide, which is why early diagnosis is crucial. Traditionally the microbiological diagnosis of these infections has been based on conventional methods including culture on artificial media for isolation of bacteria and fungi and cell cultures for virus and antibody or antigen detection using antigen-antibody reactions. The main drawback of the above mentioned methods is the time needed for an etiological diagnosis of the infection. The techniques based on molecular biology have drawn much attention in recent decades as tools for rapid diagnosis of infections. Some techniques are very expensive, especially those that can detect various microorganisms in the same reaction, therefore the question that arises is whether the cost of such testing is justified by the information obtained and by the clinical impact that its implementation will determine. In this article we make a review of the various techniques of molecular biology applied to the diagnosis of pneumonia and focus primarily on analysing the impact they may have on the management of patients with acute respiratory tract infections

Structural and functional evaluation of the palindromic alanine-rich antimicrobial peptide Pa-MAP2.

Recently, several peptides have been studied regarding the defence process against pathogenic microorganisms, which are able to act against different targets, with the purpose of developing novel bioactive compounds. The present work focuses on the structural and functional evaluation of the palindromic antimicrobial peptide Pa-MAP2, designed based on the peptide Pa-MAP from Pleuronectes americanus. For a better structural understanding, molecular modelling analyses were carried out, together with molecular dynamics and circular dichroism, in different media. Antibacterial activity against Gram-negative and positive bacteria was evaluated, as well as cytotoxicity against human erythrocytes, RAW 264.7, Vero and L6 cells. In silico docking experiments, lipid vesicle studies, and atomic force microscopy (AFM) imaging were carried out to explore the activity of the peptide. In vivo studies on infected mice were also done. The palindromic primary sequence favoured an α-helix structure that was pH dependent, only present on alkaline environment, with dynamic N- and C-terminals that are stabilized in anionic media. Pa-MAP2 only showed activity against Gram-negative bacteria, with a MIC of 3.2 µM, and without any cytotoxic effect. In silico, lipid vesicles and AFM studies confirm the preference for anionic lipids (POPG, POPS, DPPE, DPPG and LPS), with the positively charged lysine residues being essential for the initial electrostatic interaction. In vivo studies showed that Pa-MAP2 increases to 100% the survival rate of mice infected with Escherichia coli. Data here reported indicated that palindromic Pa-MAP2 could be an alternative candidate for use in therapeutics against Gram-negative bacterial infections.

Evaluation of a new, rapid, simple test for the detection of influenza virus.

BACKGROUND: Influenza virus infections are responsible for significant morbidity and mortality in both pediatric and adult populations worldwide. Rapid and accurate diagnosis of influenza is necessary for appropriate patient management during the influenza season and for optimal utilization of anti-influenza therapy. We prospectively tested the accuracy of a simple and rapid diagnostic method. METHODS: Ninety-eight samples (nasal and pharyngeal swabs) from patients with upper respiratory tract infection symptoms who presented to primary healthcare centres in Barcelona (Spain) were prospectively analyzed. The samples were collected as part of influenza surveillance program. Samples that had enough volume to make the new test after aliquoting the amount needed to perform routine tests were included. None of the samples were pre-selected as a result of their status in relation to influenza virus. Samples were analyzed by in-house real-time PCR and Alere i Influenza A & B (Alere i), which uses isothermal amplification of nucleic acids for the qualitative detection of influenza A and B in nasal swabs transported in viral transport media. The two techniques were compared by positive percent agreement (PPA) and negative percent agreement (NPA). Statistical analysis was performed with Stata. RESULTS: Of the 98 samples analysed 90 were concordant; 46 (46.9%) were positive and 44 (44.9%) were negative. Five samples showed invalid results with the Alere i test and could be not re-tested due to insufficient sample volume and were not included in the final statistical analysis. In the 93 remaining samples, the Alere i test showed 97% of accuracy having correctly classified 90 samples. We obtained discordant results in 3 samples (3%). The PPA was 93.8% for influenza A and 94.1% for influenza B, and NPA was 100% for influenza A and influenza B virus. In addition, the Alere i was very rapid (15 minutes or less) and extremely easy to use. CONCLUSIONS: The Alere i test provided a good correlation compared to the real-time PCR test for the diagnosis of influenza. Since this method can be performed in minutes, it allows immediate, accurate clinical decisions to prescribe appropriate antiviral treatment or isolation of patients.

Uso de internet para evaluar el distrés psicológico en pacientes con cáncer de mama / Use of internet to assess psychological distress in breast cancer patients

Objetivo: El objetivo de este estudio es determinar la prevalencia de síntomas de distrés y la estrategia de adaptación entre una amplia muestra de pacientes de habla hispana con cáncer de mama mediante el uso de internet. Métodos: Se diseñó un estudio transversal con pacientes con cáncer de mama (n = 434) reclutadas a través de Internet (http://www.cancermama.org). Las participantes completaron un cuestionario demográfico y médico, y también se usaron cuestionarios de evaluación psicológica ampliamente utilizados en Psicooncología, la HADs (Escala de Ansiedad y Depresión Hospitalaria) y la escala MAC (La Escala de Ajuste Mental al Cáncer), en su versión reducida de 29 ítems (Mini-MAC). Resultados: En nuestro estudio el resultado global de la HADs como medida de distrés en línea es confiable en nuestro estudio. La tasa de prevalencia general de distrés para nuestra muestra fue del 50%, sin diferencias según nivel socio-demográfico o variables médicas. En cuanto a puntuación de ansiedad 66,2% y 34% alcanzaron nivel clínico de ansiedad y depresión, respectivamente. Estos resultados se relacionaron con los de la Mini-MAC según lo esperado. Conclusiones: Estos resultados dan apoyo al uso de Internet como herramienta válida para la evaluación de los trastornos psicológicos en pacientes con cáncer de mama. Internet nos brinda la posibilidad de identificar pacientes de alto riesgo a través de screening psicológico con el fin de realizar intervenciones tempranas, y las puntuaciones globales de distrés pueden ser una herramienta precisa. Sin embargo se necesitan más estudios para analizar la situación de consulta en internet como un estímulo provocador de ansiedad

Objective: The object of this study is to determine the prevalence of distress symptoms and coping strategy among a large sample of Spanish-speaking breast cancer patients recruited on-line. Methods: We designed a cross-sectional study with breast cancer survivors (n=434) that were accrued via Internet (http://www.cancermama.org). Participants completed a demographic and medical questionnaire, and they were also evaluated using self-reporting measures of psychological distress and adjustment to cancer; the 14-item Hospital Anxiety and Depression Scale (HADS) and the 29-item version of the Mental Adjustment to Cancer Scale (Mini-MAC), respectively. Results: Global HAD as a measure of distress on-line is reliable in our study. The overall prevalence rate of distress for our sample was 50%, with no differences for socio-demographics or medical status variables. Concerning to anxiety punctuation 66.2% were clinical cases and 34.5% reached the clinical level for depression. These results were associated with Mini-MAC scales as expected. Conclusions: These results offer support for the use of Internet as valid tool for the psychological distress assessment in patients with breast cancer Spanish-speaking patients. Internet brings us the possibility to identify high-risk patients through psychological screening in order to provide early interventions, and Global HAD punctuation may be an accurate tool. However more studies are needed to analyze internet illness consulting situation as an anxious provoking space

Brotes epidémicos causados por Escherichia coli diarreagénicas / Outbreaks caused by diarrheagenic Escherichiacoli

Escherichia coli es una bacteria ubicua de una gran variedad de ecosistemas, incluido el tracto gastrointestinal del ser humano y de los animales de sangre caliente. Puede actuar como bacteria oportunista causando una gran variedad de procesos infecciosos como sepsis, infecciones del tracto urinario, meningitis, infecciones de heridas y muchas otras. Además, puede actuar también como patógeno primario en el tracto intestinal. Existen diversos tipos de E. coli causantes de enteritis, de algunos de estos patotipos de E. coli se han descrito casos esporádicos, así como brotes epidémicos. En el presente trabajo se revisarán la patogenia y epidemiología de las enteritis ocasionadas por dichos patotipos de E. coli, así como algunos ejemplos de brotes epidémicos descritos en la literatura científica y las medidas necesarias para evitarlos (AU)

Escherichia coli are ubiquitous bacteria from a wide variety of ecosystems including the gastrointestinal tract of humans and warm-blooded animals. E. coli can play a role as an opportunistic bacteria causing a variety of infectious diseases including, among many others, sepsis, urinary tract infections, meningitis, and wound infections. Moreover, these bacteria can also act as primary pathogens in the intestinal tract. There are several pathotypes of E. coli that cause enteritis, and both sporadic cases and outbreaks have been reported. In this article, we review the pathogenicity and epidemiology of enteritis caused by these E. coli pathotypes, and provide some examples of outbreaks described in the scientific literature and the measures required to prevent them (AU)

[Outbreaks caused by diarrheagenic Escherichia coli]. / Brotes epidémicos causados por Escherichia coli diarreagénicas.

Escherichia coli are ubiquitous bacteria from a wide variety of ecosystems including the gastrointestinal tract of humans and warm-blooded animals. E. coli can play a role as an opportunistic bacteria causing a variety of infectious diseases including, among many others, sepsis, urinary tract infections, meningitis, and wound infections. Moreover, these bacteria can also act as primary pathogens in the intestinal tract. There are several pathotypes of E. coli that cause enteritis, and both sporadic cases and outbreaks have been reported. In this article, we review the pathogenicity and epidemiology of enteritis caused by these E. coli pathotypes, and provide some examples of outbreaks described in the scientific literature and the measures required to prevent them.

Impact of adjuvant chemotherapy in the long-term outcome of patients with resected gastric cancer.

BACKGROUND AND OBJECTIVES: We analyzed in a retrospective analysis whether adjuvant chemotherapy with mitomycin (MMC) alone or with Tegafur (TG) is associated with long-term survival benefit in resected gastric cancer. Other prognostic factors are compared. METHODS: From 1977 to 1998, 314 consecutive totally resected gastric adenocarcinoma patients have been included in a survival study. In 151 patients no adjuvant therapy was given. In 163 patients, four courses of adjuvant chemotherapy was given, 109 of them with MMC, 10-20 mg/m(2) i.v. every 6 weeks and the other 54 with MMC plus TG, 500 mg/m(2) p.o. day for 42 consecutive days. Univariate and multivariate survival analyses were performed. RESULTS: Survival benefit was seen in patients who had received adjuvant chemotherapy compared with the controls (52% vs. 30% alive at the end of the study, relative risk = 0.46, 95% CI: 0.33-0.62, P < 0.0001), women (52% vs. 35%, RR = 0.83, 95% CI: 0.71-0.98, P = 0.0342) and increment of staging IB, II, IIIA, or IIIB (80, 56, 24 vs. 13%, respectively, RR = 1.83, 95% CI: 1.42-2.35, P < 0.0001). Better prognosis of node-negative patients was observed only in univariate analysis. CONCLUSIONS: After curative surgery, adjuvant chemotherapy with mitomycin C, both alone or combined with Tegafur, improved the long-term cure rate over no postoperative chemotherapy in locally advanced gastric cancer patients. This benefit was not influenced by other prognostic factors.

Cancer knowledge among Spanish women participating in literacy schemes.

Access to information on cancer prevention and treatment is often difficult for ethnic or low socio-economic groups. This study aimed to ascertain level of knowledge about cancer, and breast cancer in particular, in Spanish women from low socio-economic groups participating in literacy schemes. A study specific questionnaire was administered to 541 women All participants were married with a median of 2 children, and a total family income of less than 10,000 euros per year. The main themes covered: understanding of and access to screening, knowledge about cancer risk, diagnosis and prognosis. The majority of these women (66%) feel they have no control over getting cancer and 26% report that it can be caught from others. Most believe that a mammogram is the best method of diagnosis (87%) but a minority (14%) agree with the statement that breast cancer can be caused by breast feeding. In general, younger women are better informed and more optimistic about prognosis. In Spain there are problems in disseminating information about cancer to lower social-economic groups. These results confirm that more cancer education needs to be directed to low income and socially deprived groups.

Multidisciplinary approach in advanced cancer of the oral cavity: outcome with neoadjuvant chemotherapy according to intention-to-treat local therapy. A phase II study.

OBJECTIVES: To determine outcomes in local-regional control and overall survival in patients with squamous locally advanced cancer of the oral cavity, based on intention-to-treat with neoadjuvant chemotherapy followed by surgery or radiation therapy. METHODS: Two hundred and four out of 1,089 patients analyzed met the defined criteria. All had squamous cell carcinomas of the oral cavity in stage III or in nonmetastatic stage IV and were selected for surgery or radiation therapy (if located in the tonsils or in the base of the tongue). Chemotherapy was based on cisplatin 120 mg/m(2) i.v. day 1 plus bleomycin 20 mg/m(2) days 1-5 in continuous i.v. perfusion or plus 5-fluorouracil 1,000 mg/m(2) days 1-5 in continuous i.v. perfusion. A total of 418 cycles were given to 204 patients (mean 2.049 per patient). Definitive surgery (n = 73; plus adjuvant radiation therapy) or definitive radiation therapy (n = 131) was performed. RESULTS: One hundred thirty-five out of 204 (66%) patients were chemotherapy responders, 16% complete and 50% partial. One hundred ninety-four patients (95%) completed 2 courses of chemotherapy. After neoadjuvant chemotherapy, 34 out of 46 patients considered inoperable initially (74%) obtained a disease-free status with surgery. Eighty-three percent of surgical patients obtained a disease-free status (initial tumor control) versus 72% of radiation therapy patients. Disease-free survival rates at 5 years were 26 and 22%, respectively. A better prognosis was observed in stage III over IV (p = 0.02); primary tumor in the retromolar trigone, palate or buccal mucosa over tongue, tonsil or floor of the mouth (p = 0.0085); negative cervical nodes over positive (p = 0.0186); responders to chemotherapy over nonresponders (p = 0.0003); and adjuvant postsurgical radiation therapy (p = 0.0013). Causes of death were relapses in local area (86%), regional nodes (10.5%) or distant metastases (3.5%). Eleven patients (5%) died of a second primary. The main toxic effects were vomiting in 9% of patients and hemolytic-uremic syndrome in 3% of the patients treated with bleomycin. CONCLUSIONS: In locally advanced squamous cell carcinoma of the oral cavity, neoadjuvant chemotherapy induces a high response rate that may facilitate definitive surgery or radiotherapy. In this study, patients have an acceptable long-term survival.

Tyrosinase mRNA in blood of patients with melanoma treated with adjuvant interferon.

PURPOSE: To evaluate the clinical significance of the detection of circulating melanoma cells in patients treated with adjuvant interferon and to determine their potential value as a marker of interferon response. PATIENTS AND METHODS: We prospectively analyzed 616 peripheral-blood samples from 120 melanoma patients with stage IIA (n = 33), IIB (n = 22), III (n = 50), or IV (surgically resected) (n = 15) disease receiving adjuvant interferon alfa-2b therapy. Tyrosinase mRNA was assayed by reverse transcriptase polymerase chain reaction (RT-PCR) as a marker of circulating melanoma cells before the start of interferon and every 2 to 3 months thereafter. RESULTS: With a median follow-up time of 32.3 months (range, 7.1 to 77.5 months), 47 patients (39.8%) relapsed and 31 (26%) died. During adjuvant interferon treatment, 76 patients (64%) had undetected circulating melanoma cells and 44 patients (36%) had a positive RT-PCR result in at least one sample. Actuarial 5-year disease-free survival was 62% in patients with persistently negative RT-PCR during interferon treatment and 38% for patients with positive RT-PCR during interferon (P =.02). Actuarial 5-year overall survival was 75% and 50%, respectively (P =.03). CONCLUSION: Patients with melanoma and tyrosinase mRNA detected in the blood during adjuvant interferon therapy had a worse prognosis compared with patients with undetected tyrosinase mRNA during treatment. Further investigation into the detection of circulating melanoma cells as a surrogate marker of response to adjuvant interferon therapy is warranted.

Detection of occult breast cancer cells by amplification of CK19 mRNA by reverse transcriptase-polymerase chain reaction: role of surgical manipulation.

BACKGROUND: To assess if surgical manipulation increases peripheral blood cancer cells dissemination in early stage (I and II) breast cancer patients. PATIENTS AND METHODS: We analyzed 64 patients using RT-PCR for cytokeratin-19 as a marker for peripheral blood breast cancer cell dissemination. Peripheral blood was obtained at 4 different time-points (24 hours before and after surgery, one week and one month later). RESULTS: RT-PCR was positive in 14 (24%) out of 59 evaluable patients. Circulating cells were detected in 4 out of 14 patients before surgery (7%) while in the remaining 10, the positivity was observed after surgery (17%). The percentage of patients with occult breast cancer cells increased significantly after surgery (p = 0.01). CONCLUSION: 1) 7% of early breast cancer patients had circulating tumor cells before surgery. 2) After surgery tumor cells were detected in 17% of patients. 3) Surgery significantly increased the presence of occult breast cancer cells. 4) The clinical significance of occult breast cancer cells should be tested within a larger clinical trial trying to assess their role as an independent prognostic factor.