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Introduction Breast sarcomas are tumors of a mesenchymal origin, with an incidence of less than 1% of the total breast tumors. The diagnosis of this disease is a challenge for pathologists, radiologists, and breast surgeons. Aim To describe the diagnostic, therapeutic, and outcomes approach of patients with breast sarcoma treated at the National Cancer Institute (NCI) in Bogota, Colombia. Materials and methods It is a descriptive and retrospective case series study of patients diagnosed with breast sarcoma treated at the NCI during the period between August 1, 2016 and March 30, 2019. Results We identified 14 patients diagnosed with breast sarcoma, 10 (71.4%) patients with primary breast sarcomas, and four (28.6%) with sarcomas associated with radiotherapy. The most frequent histological subtype in both, primary and secondary sarcomas, was angiosarcoma (n = 5, 35.7%). 100% (n = 14) of patients received surgical management as primary treatment. Eight (57.1%) patients presented recurrence (disease-free survival (DFS) follow-up of 5.95 months). A total of five deaths were recorded, representing 35.7% of patients (overall survival (OS) follow-up of 23.5 months). Conclusion Breast sarcomas are characterized by aggressive clinical behavior, which is why it is important to make a precise histological diagnosis and thus provide patients with radical surgical procedures that ensure local control of the disease and improve DFS.
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BACKGROUND: The majority of patients with breast cancer in Colombia are admitted into oncological centers at locally advanced stages of the disease (53.9%). The aim of this study was to describe the pathological response obtained with neoadjuvant chemotherapy (NACT) according to the molecular classification of breast cancer in patients with locally advanced tumors treated within the National Cancer Institute (NCI) Functional Breast Cancer Unit (FBCU) in Bogotá, Colombia. MATERIALS AND METHODS: This was an observational, descriptive, historical cohort study of patients with locally advanced breast cancer treated within the NCI FBCU. RESULTS: We included 414 patients who received NACT and surgical management. Most patients had luminal B HER2-negative tumors (n = 134, 32.4%). The overall rate of pathological complete response (pCR) ypT0/ypN0 was 15.2% (n = 63). Tumors that presented the highest rate of pCR were pure HER2, at 40.5% (n = 15; odds ratio [OR], 6.7); however, with a follow-up of 60 months, only the triple negative tumors presented a statistically significant difference for event-free survival (EFS; median recurrence time, 18 months; range, 1-46) and overall survival (OS; median follow-up, 31 months; range 10-57). The molecular subtype that most recurrences presented was luminal B HER2 negative, at 38.3% (n = 28). The majority of recurrences (93.2 %; n = 68; OR, 5.9) occurred in patients in whom no pathological response was obtained (Chevallier 3 and 4). CONCLUSION: Pathological response in locally advanced tumors is related to the molecular subtype of breast cancer, finding higher pCR rates in pure HER2 and triple-negative tumors. A direct relationship was found between disease recurrences and the pathological response, evidencing greater tumor recurrence in patients who did not respond to NACT (Chevallier 3 and 4). EFS and OS were greater in patients with pCR, with statistical significance only in triple-negative tumors. IMPLICATIONS FOR PRACTICE: This research article is of scientific interest, because it describes the clinical and pathological features and analyzes the correlation between pathological response to neoadjuvant chemotherapy and the molecular classification of locally advanced breast cancer in patients treated in the National Cancer Institute in Bogotá, Colombia. It was found that pathological response is related to the molecular subtype of breast cancer. In addition, there is a direct relationship between disease recurrences and pathological response. The survival results were greater in patients with pathological complete response.
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Neoplasias da Mama/classificação , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Introducción: La frecuencia de malignidad en presencia de un reporte mamográfico BI-RADS 4A no es conocida en el medio colombiano. Objetivo: Describir la frecuencia de patología maligna en las pacientes que acudieron a la consulta de seno con mamografía BI-RADS 4A en el Hospital de San José, en el periodo 2008-2010. Métodos: Estudio descriptivo de serie de casos. Ingresaron todas las pacientes con reporte de mamografía BI-RADS 4A tomada con intención diagnóstica o de tamizaje de oportunidad que fueron valoradas por los servicios de cirugía general y ginecología. Todas las pacientes fueron llevadas a biopsia. Los casos positivos siguieron el protocolo del manejo del servicio. Resultados: Se identificaron 51 casos con mamografía BI-RADS 4A, de las cuales completaron el estudio para diagnóstico 49 pacientes. La edad media fue 54,2 años (DE: 9,2). Se indicaron para tamizaje 22 mamografías (44,9) y hubo 27 con intención diagnóstica (55,1). Seis pacientes presentaron patología maligna (12,2): tres casos con carcinoma ductal infiltrante, dos con carcinoma ductal in situ y una con carcinoma tubular. En la población con hallazgos benignos, cuatro presentaron hiperplasia sin atipias. Conclusiones: Ante el hallazgo mamográfico BI-RADS 4A, se deben continuar esfuerzos en la búsqueda de malignidad.
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Biópsia , Neoplasias da Mama , MamografiaRESUMO
Estudio descriptivo de corte transversal para determinar la prevalencia de patología maligna en mujeres mayores de 14 años que consultaron por masa sólida palpable en mama al servicio de cirugía general del Hospital de San José, de Bogotá D.C. durante el período marzo 2009 a febrero de 2010. Esta prevalencia fue de 18,1%. El promedio de edad fue 60.1 años, el de la menopausia 50 años, la edad del primer parto 25.8 años y el promedio de hijos 1.7. El tiempo de lactancia materna fue 10.5 meses, no había antecedentes personales de cáncer de mama y sólo 13,3% presentaron antecedente familiar de esta malignidad. El 78,3% (65) de las masas sólidas palpables fueron detectadas por autoexamen de seno. El tiempo de aparición fue en promedio de 14.1 meses (DE: 17 meses) y como manifestación clínica asociada se reportó dolor en la mayoría. La clasificación de BIRADS predominante para ecografía y mamografía en mujeres con patología maligna fue el tipo 4. Entre los diagnósticos por biopsia predominó el carcinoma ductal infiltrante (80%) y en patología benigna el fibroadenoma (56%). El tratamiento más frecuente fue quirúrgico.
This is a descriptive cross sectional study conducted to determine the prevalence of breast malignant pathology in women more than 14 years old who consulted for a palpable solid mass in the breast to the General Surgery Department at Hospital de San José, Bogotá DC. between March 2009 and February 2010. The prevalence rate was 18.1%. Mean age was 60.1 years. Average age at onset of menopause was 50 years, age at first birth 25.8 years and number of children 1.7. Average period of time they breast fed their children was 10.5 months. There were no personal antecedents of breast cancer, and family history of this malignancy was found in 13.3% only. Sixty-five (78.3%) of the palpable solid masses were detected by self-exam. The mean time of appearance was 14.1 months (SD: 17 months) and the majority of patients reported pain as associated clinical manifestation. The predominant BIRADS classification for ultrasound and mammography in women with malignancy was type 4. The predominant result in biopsies was, infiltrating ductal carcinoma (80%), and fibroadenoma (56%), a benign condition. Surgery was the most frequently used therapeutic intervention.
