Underestimation of invasive breast carcinoma in patients with initial diagnosis of ductal carcinoma in situ: Size matters.

BACKGROUND: The aim of our study was to identify those patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) and high risk of upstaging to invasive breast carcinoma (IBC), in whom sentinel lymph node biopsy (SLNB) should be considered. MATERIALS AND METHODS: One-hundred and five DCIS patients treated with breast-conserving surgery (BCS) or mastectomy were studied. Preoperative features of the tumours were analyzed to investigate its association with underestimation of IBC on final pathology. RESULTS: Overall, the underestimation rate of IBC was 16.2%. The underestimation rate was highest in lesions with initial size >2 cm compared with those with size ≤2 cm (26.8% vs. 4.1%, respectively; p < 0.003). Eighty-eight patients (83.8%) underwent concurrent SLNB and only one case had lymph node involvement (1.1%). CONCLUSIONS: SLNB should be considered in DCIS patients receiving BCS with lesions greater than 2 cm since approximately one in four will harbour an IBC.

Infraestimación de carcinoma infiltrante de mama en pacientes con diagnóstico inicial de carcinoma ductal in situ: el tamaño importa / Underestimation of invasive breast carcinoma in patients with initial diagnosis of ductal carcinoma in situ: Size matters

Introducción: El objetivo de nuestro estudio consistió en identificar aquellas pacientes con diagnóstico preoperatorio de carcinoma ductal in situ (CDIS) y alto riesgo de presentar un carcinoma infiltrante en la lesión, en las que se debería considerar realizar una biopsia selectiva de ganglio centinela (BSGC). Métodos: Se estudiaron 105 pacientes con CDIS tratadas mediante cirugía conservadora o mastectomía. Se analizaron las características preoperatorias de los tumores para investigar su asociación con la infraestimación de carcinoma infiltrante. Resultados: El porcentaje global de infraestimación de carcinoma infiltrante fue del 16,2%. El porcentaje de infraestimación fue mayor en las lesiones con un tamaño inicial superior a 2 cm en comparación con las lesiones con un tamaño igual o menor a 2 cm (26,8% vs. 4,1%, respectivamente; p < 0,003). Se realizó la BSGC en 88 pacientes (83,8%), encontrándose afectación ganglionar en un solo caso (1,1%). Conclusiones: En pacientes con diagnóstico inicial de CDIS tratadas mediante cirugía conservadora, se debería considerar realizar una BSGC cuando el tamaño de la lesión es superior a 2 cm, ya que uno de cada cuatro casos albergará la presencia de un carcinoma infiltrante. (AU)

Introduction: The aim of our study was to identify those patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) and high risk of upstaging to invasive breast carcinoma (IBC), in whom sentinel lymph node biopsy (SLNB) should be considered. Methods: One-hundred and five DCIS patients treated with breast-conserving surgery (BCS) or mastectomy were studied. Preoperative features of the tumors were analyzed to investigate its association with underestimation of IBC on final pathology. Results: Overall, the underestimation rate of IBC was 16.2%. The underestimation rate was highest in lesions with initial size >2 cm compared with those with size ≤2 cm (26.8% vs. 4.1%, respectively; p < 0.003). Eighty-eight patients (83.8%) underwent concurrent SLNB and only one case had lymph node involvement (1.1%). Conclusions: SLNB should be considered in DCIS patients receiving BCS with lesions greater than 2 cm since approximately one in four will harbor an IBC. (AU)

Sutura laparoscópica mecanizada con FlexDex Surgical System® para ubicaciones anatómicamente difíciles / Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture

El campo de la cirugía laparoscópica ha experimentado un crecimiento exponencial en los últimos años. A pesar de los grandes avances en este campo, las herramientas laparoscópicas estándar no han logrado su desarrollo óptimo, presentando ciertas deficiencias en lo que a movilidad y ergonomía se refiere. La cirugía robótica ha intentado aportar soluciones a estos problemas, sin embargo, existen inconvenientes, entre los que se encuentran su elevado coste, escasa disponibilidad y la necesidad de capacitación específica, lo que condiciona su rentabilidad y generalización de uso. Presentamos los resultados de una serie clínica prospectiva de 20 casos, en los que se ha testado la seguridad, eficacia y ergonomía de FlexDex® para la realización de suturas intracorpóreas laparoscópicas. El resultado muestra una herramienta segura y funcional que ofrece control y precisión en su manejo, además de mejorar la ergonomía del cirujano. Este dispositivo supone una alternativa que combina la precisión y el rango de movimientos de la cirugía robótica, con la mayor disponibilidad de la laparoscopia convencional. (AU)

The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy. (AU)

Underestimation of invasive breast carcinoma in patients with initial diagnosis of ductal carcinoma in situ: Size matters. / Infraestimación de carcinoma infiltrante de mama en pacientes con diagnóstico inicial de carcinoma ductal in situ: el tamaño importa.

INTRODUCTION: The aim of our study was to identify those patients with preoperative diagnosis of ductal carcinoma in situ (DCIS) and high risk of upstaging to invasive breast carcinoma (IBC), in whom sentinel lymph node biopsy (SLNB) should be considered. METHODS: One-hundred and five DCIS patients treated with breast-conserving surgery (BCS) or mastectomy were studied. Preoperative features of the tumors were analyzed to investigate its association with underestimation of IBC on final pathology. RESULTS: Overall, the underestimation rate of IBC was 16.2%. The underestimation rate was highest in lesions with initial size >2 cm compared with those with size ≤2 cm (26.8% vs. 4.1%, respectively; p < 0.003). Eighty-eight patients (83.8%) underwent concurrent SLNB and only one case had lymph node involvement (1.1%). CONCLUSIONS: SLNB should be considered in DCIS patients receiving BCS with lesions greater than 2 cm since approximately one in four will harbor an IBC.

Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture. / Sutura laparoscópica mecanizada con FlexDex Surgical System® para ubicaciones anatómicamente difíciles.

The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy.

Trombosis del tronco celíaco como presentación de la arteritis de Takayasu / Celiac trunk thrombosis as a presentation of Takayasu arteritis

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