Breast cancer after thoracic radiotherapy in young patients: what does the radiologist need to know?

Radiation-induced secondary tumors constitute a rare complication of radiation therapy and typically occur in or near the irradiated area. Women who undergo thoracic radiotherapy before 30 years of age have a significantly greater lifetime risk of developing breast cancer than do those in the general population. It is recommended that a patient who has previously received thoracic radiotherapy with a radiation dose ≥ 10 Gy subsequently undergo annual screening with mammography and magnetic resonance imaging, beginning eight years after the initial treatment or when the patient has reached 25 years of age (whichever comes later). The treatment of secondary breast cancer in this population should be individualized and should be discussed with a multidisciplinary team to avoid toxicity related to the treatment of the primary cancer.

Os cânceres secundários induzidos por radiação são complicações raras da radioterapia e geralmente ocorrem na área tratada ou próximo a ela. Mulheres com menos de 30 anos de idade tratadas com radioterapia torácica têm risco significativamente aumentado de desenvolver câncer de mama ao longo da vida, em comparação com a população em geral. Para as pacientes tratadas com irradiação torácica com dose igual ou superior a 10 Gy é recomendado rastreamento anual com mamografia e ressonância magnética iniciando oito anos após o tratamento, desde que este início seja após 25 anos de idade. O tratamento do câncer de mama secundário nessa população deve ser individualizado e discutido com equipe multidisciplinar, para evitar toxicidade relacionada ao tratamento do câncer primário.

Breast cancer after thoracic radiotherapy in young patients: what does the radiologist need to know? / Câncer de mama após radioterapia torácica em pacientes jovens: o que o radiologista precisa saber?

Abstract Radiation-induced secondary tumors constitute a rare complication of radiation therapy and typically occur in or near the irradiated area. Women who undergo thoracic radiotherapy before 30 years of age have a significantly greater lifetime risk of developing breast cancer than do those in the general population. It is recommended that a patient who has previously received thoracic radiotherapy with a radiation dose ≥ 10 Gy subsequently undergo annual screening with mammography and magnetic resonance imaging, beginning eight years after the initial treatment or when the patient has reached 25 years of age (whichever comes later). The treatment of secondary breast cancer in this population should be individualized and should be discussed with a multidisciplinary team to avoid toxicity related to the treatment of the primary cancer.

Resumo Os cânceres secundários induzidos por radiação são complicações raras da radioterapia e geralmente ocorrem na área tratada ou próximo a ela. Mulheres com menos de 30 anos de idade tratadas com radioterapia torácica têm risco significativamente aumentado de desenvolver câncer de mama ao longo da vida, em comparação com a população em geral. Para as pacientes tratadas com irradiação torácica com dose igual ou superior a 10 Gy é recomendado rastreamento anual com mamografia e ressonância magnética iniciando oito anos após o tratamento, desde que este início seja após 25 anos de idade. O tratamento do câncer de mama secundário nessa população deve ser individualizado e discutido com equipe multidisciplinar, para evitar toxicidade relacionada ao tratamento do câncer primário.

Postmastectomy Radiation Therapy Bolus Associated Complications in Patients Who Underwent 2-stage Breast Reconstruction.

Purpose: This study aimed to evaluate the association of bolus and 2-stage breast reconstruction complications, and whether the dosimetric advantage translates into improvements in local control. Methods and Materials: We retrospectively analyzed data from 2008 to 2019 of women who underwent a mastectomy and a planned 2-stage breast reconstruction, followed by adjuvant radiation therapy. We reviewed all data from medical records and radiation plans regarding patient characteristics, diagnoses, surgeries, complications, pathology, staging, systemic therapy, radiation therapy, and outcomes, and compared complication rates according to bolus usage. Results: A total of 288 women, age 25 to 71 years, were included in the study. Of these women, 6 were treated with daily bolus and 19 with alternate days bolus, totaling 25 of 288 patients (8.7%) in the bolus group. A total of 226 patients (78.5%) had the second stage performed. The median follow-up time was 61 months. The rates for 5-year overall survival and locoregional control were both 97%, and the metastasis-free rate was 83%. In the first stage, 6.25% of patients in the entire cohort had an infection and 4.2% had implant loss. Daily bolus significantly increased the risk of expander infection (hazard ratio [HR]: 10.3; 95% confidence interval [CI], 1.7-61.8) and loss (HR: 13.89; 95% CI, 2.24-85.98), but alternate-day bolus showed a nonsignificant increase for expander infection (HR: 1.14; 95% CI, 0.14-9.295) and loss (HR: 1.5; 95% CI, 0.19-12.87). Bolus was not associated with second-stage complications or local-regional failure. Local infection and implant loss were more frequent in the second than in the first stage (5.2% vs 10.2% and 4.2% vs 12.8%, respectively). Conclusions: Skin bolus significantly increased first-stage breast reconstruction complications (infection and reconstruction failure). Despite the small sample size and the need for future studies, these findings need to be taken into consideration when planning treatment and reconstruction, and recommendations should be individualized.

An introduction to male breast cancer for urologists: epidemiology, diagnosis, principles of treatment, and special situations

ABSTRACT Breast cancer (BC) is mainly considered a disease in women, but male BC (MaBC) accounts for approximately 1.0% of BC diagnoses and 0.5% of malignant neoplasms in the western population. The stigmatization of MaBC, the fact that men are less likely to undergo regular health screenings, and the limited knowledge of health professionals about MaBC contribute to men being diagnosed at more advanced stages. The aim of this article is to increase the visibility of MaBC among urologists, who have more contact with male patients. This review highlights key points about the disease, the risk factors associated with MaBC, and the options for treatment. Obesity and increased population longevity are among the important risk factors for MaBC, but published studies have identified family history as extremely relevant in these patients and associated with a high penetrance at any age. There is currently no screening for MaBC in the general population, but the possibility of screening in men at high risk for developing BC can be considered. The treatment of MaBC is multidisciplinary, and, because of its rarity, there are no robust clinical studies evaluating the role of systemic therapies in the management of both localized and metastatic disease. Therefore, in current clinical practice, treatment strategies for men with breast cancer are extrapolated from information arising from studies in female patients.

An introduction to male breast cancer for urologists: epidemiology, diagnosis, principles of treatment, and special situations.

Breast cancer (BC) is mainly considered a disease in women, but male BC (MaBC) accounts for approximately 1.0% of BC diagnoses and 0.5% of malignant neoplasms in the western population. The stigmatization of MaBC, the fact that men are less likely to undergo regular health screenings, and the limited knowledge of health professionals about MaBC contribute to men being diagnosed at more advanced stages. The aim of this article is to increase the visibility of MaBC among urologists, who have more contact with male patients. This review highlights key points about the disease, the risk factors associated with MaBC, and the options for treatment. Obesity and increased population longevity are among the important risk factors for MaBC, but published studies have identified family history as extremely relevant in these patients and associated with a high penetrance at any age. There is currently no screening for MaBC in the general population, but the possibility of screening in men at high risk for developing BC can be considered. The treatment of MaBC is multidisciplinary, and, because of its rarity, there are no robust clinical studies evaluating the role of systemic therapies in the management of both localized and metastatic disease. Therefore, in current clinical practice, treatment strategies for men with breast cancer are extrapolated from information arising from studies in female patients.

Benefits of a standardized protocol for axillary management after neoadjuvant chemotherapy in a single center

Introduction: The axillary lymph node status is one of the most important prognostic factors in breast cancer. For locally advanced tumors, neoadjuvant chemotherapy favors higher rates of breast lumpectomy and downstaging tumor burden of axilla. The aim of this study was to evaluate the use of a standardized image-guided protocol after neoadjuvant chemotherapy to enable sentinel node dissection in patients with axillary downstaging, avoiding axillary dissection. Methods: Retrospective cohort study of data collected from medical records of patients who underwent neoadjuvant chemotherapy in a single center, from January 2014 to December 2018. The protocol comprises the placement of a metal clip in positive axillary lymph node, in patients with up to two clinically abnormal lymph nodes presented on imaging. After neoadjuvant chemotherapy, and once a radiologic complete response was achieved, sentinel node dissection was performed using blue dye and radiotracer. Axillary dissection were avoided in patients whose clipped sentinel node were negative for metastasis and in patients with three identified and negative sentinel node dissection. Results: A total of 471 patients were analyzed for this study: 303 before and 165 after the implementation of the protocol; 3 cases were excluded. The rate of sentinel node dissection in clinical nodes positive patients was statistically higher in this group when compared to patients treated before the protocol implementation (22.8% vs. 40.8%; p=0.001). Patients with triple negative and HER2-positive tumors underwent sentinel node dissection more frequently when compared to luminal tumors (p=0.03). After multivariate analysis, the variables that were associated with a greater chance of performing sentinel node dissection were clinical staging, type of surgery performed and implementation of the axillary assessment protocol. Conclusions: The results showed that the use of an easily and accessible image-guided protocol can improve sentinel node dissection in selected patients, even if the lymph node was positive previously to neoadjuvant treatment.

Informed consent and a risk-based approach to oncologic surgery in a cancer center during the COVID-19 pandemic.

BACKGROUND: Cancer patients configure a risk group for complications or death by COVID-19. For many of them, postponing or replacing their surgical treatments is not recommended. During this pandemic, surgeons must discuss the risks and benefits of treatment, and patients should sign a specific comprehensive Informed consent (IC). OBJECTIVES: To report an IC and an algorithm developed for oncologic surgery during the COVID-19 outbreak. METHODS: We developed an IC and a process flowchart containing a preoperative symptoms questionnaire and a PCR SARS-CoV-2 test and described all perioperative steps of this program. RESULTS: Patients with negative questionnaires and tests go to surgery, those with positive ones must wait 21 days and undergo a second test before surgery is scheduled. The IC focused both on risks and benefits inherent each surgery and on the risks of perioperative SARS-CoV-2 infections or related complications. Also, the IC discusses the possibility of sudden replacement of medical staff member(s) due to the pandemic; the possibility of unexpected complications demanding emergency procedures that cannot be specifically discussed in advance is addressed. CONCLUSIONS: During the pandemic, specific tools must be developed to ensure safe experiences for surgical patients and prevent them from having misunderstandings concerning their care.

The use of telemedicine to maintain breast cancer follow-up and surveillance during the COVID-19 pandemic.

As a result from restricted economic activities and social distancing due to the coronavirus disease-2019 (COVID-19) pandemic, we observed a 49.4% decrease in outpatient appointments at our Institution. to minimize this impact on screening and oncological follow-up of breast cancer patients, telemedicine appointments were established. The authors demonstrate how a cancer center in the largest city in Brazil has managed outpatient appointments during the COVID-19 pandemic. This is a retrospective study of patients who had their appointments through telemedicine at the AC Camargo Cancer Center between June 2020 and October 2020, during the COVID-19 pandemic. Of the 77 patients who had telemedicine appointments, 36 (46.8%) accounted for breast cancer follow-up, 20 (26%) for breast cancer screening, 10 (13%) for benign breast disease evaluation, 7 (9%) for a second opinion, and 4 (5.2%) for general orientations. Routine surveillance/follow-up exams were requested for 45 (58.4%) patients and breast image exams and a request to return for a personal appointment for 30 (39%) patients. Two (2.6%) patients were requested to schedule a personal appointment immediately for a physical exam. In conclusion, telemedicine may be a feasible alternative to reduce personal outpatient appointments for cancer follow-up and breast cancer screening during the COVID-19 pandemic.

Pleomorphic adenoma of the breast

Pleomorphic adenoma (PA) is a common tumor of the salivary gland, but rarely occurs in the breast. PA of the breast is a benign tumor that usually presents as a periareolar nodule. Core-needle biopsies may yield misdiagnosis with complex fibroadenoma, phyllodes tumor and metaplastic breast cancer due to the mixture of stromal and epithelial elements. We present a case of PA of the breast suspected after core-needle biopsy, but confirmed after surgical excision. The importance to make a correct diagnosis consists in avoid extensive unnecessary surgery, such as mastectomy, since PA can be treated with local surgical resection.

Postoperative complications following simultaneous therapeutic and contralateral prophylactic nipple-sparing mastectomy: a retrospective study

Introduction: Nipple-Sparing Mastectomy (NSM) is increasingly indicated for therapeutic and prophylactic purposes due to better cosmetic results with nipple maintenance. Postoperative complications have not been compared among patients who have undergone simultaneous therapeutic and contralateral prophylactic NSM. The aim of the present study was to evaluate the incidence and risk factors for postoperative complications in bilateral/unilateral NSMs, and therapeutic and/or prophylactic NSMs. Methods: Retrospective study of patients who underwent NSM between 2007 and 2017 at A.C. Camargo Cancer Center. Results: Among 290 patients, 367 NSMs were performed, 64 simultaneous therapeutic and contralateral prophylactic NSM. The latter were associated with more postoperative complications (OR=3.42; p=0.002), mainly skin flap necrosis (OR=3.79; p=0.004), hematoma (OR=7.1; p=0.002), wound infection (OR=3.45; p=0.012), and nipple-areola complex (NAC) loss (OR=9.63; p=0.003). Of the 367 NSMs, 213 were unilateral NSMs, which were associated with lower rates of postoperative complications (OR=0.44; p=0.003), especially skin flap necrosis (OR=0.32; p=0.001), hematoma (OR=0.29; p=0.008), wound infection (OR=0.22; p=0.0001), and reoperation (OR=0.38; p=0.008). Obesity was related to more postoperative complications (OR=2.55; p=0.01), mainly hematoma (OR=3.54; p=0.016), reoperation (OR=2.68; p=0.023), and NAC loss (OR=3.54; p=0.016). Patients' age (p=0.169), their smoking status (p=0.138), breast ptosis (0.189), previous chest radiotherapy (p 1), or previous breast surgery (p=0.338) were not related to higher chances of postoperative complications. Conclusions: Results suggest that performing therapeutic and contralateral prophylactic NSM as separated procedures may represent a good strategy for minimizing postoperative complications.

Cowden Syndrome: a single institution case series and literature review / Síndrome de Cowden: serie de casos de una única institución y revisión de la literatura

OBJECTIVE: Cowden Syndrome belongs to a group of disorders that are associated with germline mutations in the tumor suppressor gene, phosphatase and tensin homolog (PTEN). The prevalence has been estimated to be 1 in 200,000-250,000. However, this prevalence may be underestimated due to many factors. Better understand Cowden Syndrome among our local population to provide genetic counseling and appropriate screening for different types of neoplasms associated to Cowden Syndrome. MATERIAL AND METHODS: Case series analysis based on data maintained by the Breast Cancer and Hereditary Cancer Departments of the AC Camargo Cancer Center, a large specialized hospital in Brazil. RESULTS: Five cases are presented according to their diagnostic criteria, cancer rates, and outcomes for Cowden Syndrome. CONCLUSION: These cases highlight the need for a multi-institutional evaluation of Cowden Syndrome cases in order to better comprehend its prevalence in Brazil. To improve the outcome of patients with CS, a greater understanding of this syndrome is needed, as well as recognition of the value of periodic screening

OBJETIVO: El síndrome de Cowden (SC) pertenece a un grupo de trastornos asociados a las mutaciones germinales en el gen supresor del tumor, homólogo de fosfatasa y tensina (PTEN). La prevalencia ha sido estimada en uno por cada 200.000-250.000 sujetos. Sin embargo, esta prevalencia puede subestimarse debido a muchos factores. Nuestro objetivo es hacer que nuestra población local comprenda mejor el SC para proporcionar asesoramiento genético, así como un cribado adecuado para los diferentes tipos de neoplasias asociadas a dicho síndrome. MATERIAL Y MÉTODOS: Análisis de una serie de casos basado en los datos mantenidos por los Departamentos de Cáncer de Mama y Cáncer Hereditario del Centro para el Cáncer AC Camargo, un gran hospital especializado de Brasil. RESULTADOS: Se presentan 5 casos con arreglo a sus criterios diagnósticos, tasas de cáncer y resultados para el SC. CONCLUSIÓN: Estos casos subrayan la necesidad de realizar una evaluación multi-institucional de los casos del SC, a fin de comprender mejor su prevalencia en Brasil. Para mejorar el resultado de los pacientes con SC se necesita una mayor comprensión del mismo, así como el reconocimiento del valor del cribado periódico

Accuracy of ultrasound-guided core-needle biopsy confronted with pathological findings and comparison of its costs with vacuum-assisted biopsy's costs

Introduction: Breast cancer screening has enhanced early­stage diagnosis by detection of impalpable tumors which require histopathological evaluation. Main percutaneous biopsy types are core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). CNB is less invasive and related to less bleeding and pain. VAB allows larger tissue samples and permits metal clip placement in biopsy bed for posterior localization in case of surgery. Access to VAB is restricted in Brazil due to its high costs. Objectives: To evaluate the agreement between pathological results of ultrasound (US) guided CNB with metal clip placement and surgery and settle false negative rates (FNR), sensibility, specificity, and accuracy of this method, for breast lesions < 20 mm. Methods: 388 US-guided CNB were retrospectively reviewed. Results: Surgical excision was performed in 317 patients. Overall FNR was 9.8%, (5.2% for lesions 10­20 mm), sensibility 90.2% (94.8% for lesions 10­20 mm), specificity 94.9% (94.1% for lesions 10­20 mm), and accuracy 91.1% (94.7% for lesions 10­20 mm). Cost of VAB varies from 2.2 to 12.5 times US-guided CNB. With metal clip placement, VAB costs 1.95 to 5.2 times US-guided CNB. Conclusions: For lesions that can be identified in US, CNB with metal clip placement has high sensitivity, specificity, and accuracy, as well as low FNR.

Accuracy of ultrasound-guided core-needle biopsy confronted with pathological findings and comparison of its costs with vacuum-assisted biopsy's costs

Introduction: Breast cancer screening has enhanced early­stage diagnosis by detection of impalpable tumors which require histopathological evaluation. Main percutaneous biopsy types are core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). CNB is less invasive and related to less bleeding and pain. VAB allows larger tissue samples and permits metal clip placement in biopsy bed for posterior localization in case of surgery. Access to VAB is restricted in Brazil due to its high costs. Objectives: To evaluate the agreement between pathological results of ultrasound (US) guided CNB with metal clip placement and surgery and settle false negative rates (FNR), sensibility, specificity, and accuracy of this method, for breast lesions < 20 mm. Methods: 388 US-guided CNB were retrospectively reviewed. Results: Surgical excision was performed in 317 patients. Overall FNR was 9.8%, (5.2% for lesions 10­20 mm), sensibility 90.2% (94.8% for lesions 10­20 mm), specificity 94.9% (94.1% for lesions 10­20 mm), and accuracy 91.1% (94.7% for lesions 10­20 mm). Cost of VAB varies from 2.2 to 12.5 times US-guided CNB. With metal clip placement, VAB costs 1.95 to 5.2 times US-guided CNB. Conclusions: For lesions that can be identified in US, CNB with metal clip placement has high sensitivity, specificity, and accuracy, as well as low FNR.

Intraoperative breast radiotherapy: survival, local control and risk factors for recurrence.

BACKGROUND: Whole breast irradiation reduces loco-regional recurrence and risk of death in patients submitted to breast-conserving treatment. Data show that radiation to the index quadrant alone may be enough in selected patients. AIM: To report the experience with intra-operative radiotherapy (IORT) with Electron-beam Cone in Linear Accelerator (ELIOT) and the results in overall survival, local control and late toxicity of patients submitted to this treatment. MATERIALS AND METHODS: 147 patients treated with a median follow up of 6.9 years (0.1â¿¿11.5 years). The actuarial local control and overall survival probabilities were estimated using the Kaplan Meier method. All tests were two-sided and p â¿¤ 0.05 was considered statistically significant. RESULTS: Overall survival of the cohort in 5 years, in the median follow up and in 10 years was of 98.3%, 95.1% and 95.1%, respectively, whereas local control in 5 years, in the median follow up and in 10 years was of 96%, 94.9% and 89.5%, respectively. Two risk groups were identified for local recurrence depending on the estrogen or progesterone receptors, axillary or margin status and lymphovascular invasion (LVI) (p = 0.016). CONCLUSIONS: IORT is a safe and effective treatment. Rigorous selection is important to achieve excellent local control results.

Impact of breast magnetic resonance imaging on the locoregional staging and management of breast cancer.

OBJECTIVE: To assess the impact of magnetic resonance imaging (MRI) on the locoregional staging of breast cancer. MATERIALS AND METHODS: We evaluated 61 patients with breast cancer who underwent pre-treatment breast MRI, between August 2015 and April 2016. An experienced breast surgeon determined the surgical treatment, on the basis of the findings of conventional imaging examinations, and made a subsequent treatment recommendation based on the MRI findings, then determining whether the MRI changed the approach, as well as whether it had a positive or negative impact on the treatment. RESULTS: The mean age was 50.8 years (standard deviation, 12.0 years). The most common histological type was invasive breast carcinoma of no special type (in 68.9%), and the most common molecular subtype was luminal B (in 45.9%). Breast MRI modified the therapeutic management in 23.0% of the cases evaluated, having a positive impact in 82.7%. CONCLUSION: Breast MRI is an useful tool for the locoregional staging of breast cancer, because it provides useful information that can have a positive impact on patient treatment.

OBJETIVO: Avaliar o impacto do uso da ressonância magnética (RM) no estadiamento pré-operatório do câncer de mama. MATERIAIS E MÉTODOS: Foram avaliadas 61 pacientes com carcinoma mamário submetidas a RM das mamas, no período de agosto de 2015 a abril de 2016. Um mastologista foi questionado sobre a conduta terapêutica indicada diante dos dados da paciente e dos exames convencionais e, após realização da RM, foi novamente questionado sobre a conduta para determinar se houve mudança e impacto no tratamento. RESULTADOS: A média de idade das pacientes foi 50,8 anos (desvio-padrão: 12,0), o tipo histológico mais frequente foi carcinoma mamário invasivo tipo não especial (68,9%) e o imunofenótipo mais prevalente foi luminal B (45,9%). A RM das mamas mudou a conduta terapêutica em 23% dos casos, com impacto positivo em 82,7%. CONCLUSÃO: A RM das mamas é instrumento útil no estadiamento locorregional do câncer de mama, sendo capaz de adicionar informações que tenham impacto positivo no tratamento.

Impact of breast magnetic resonance imaging on the locoregional staging and management of breast cancer / Impacto da ressonância magnética das mamas no estadiamento locorregional e manejo do câncer de mama

Abstract Objective: To assess the impact of magnetic resonance imaging (MRI) on the locoregional staging of breast cancer. Materials and Methods: We evaluated 61 patients with breast cancer who underwent pre-treatment breast MRI, between August 2015 and April 2016. An experienced breast surgeon determined the surgical treatment, on the basis of the findings of conventional imaging examinations, and made a subsequent treatment recommendation based on the MRI findings, then determining whether the MRI changed the approach, as well as whether it had a positive or negative impact on the treatment. Results: The mean age was 50.8 years (standard deviation, 12.0 years). The most common histological type was invasive breast carcinoma of no special type (in 68.9%), and the most common molecular subtype was luminal B (in 45.9%). Breast MRI modified the therapeutic management in 23.0% of the cases evaluated, having a positive impact in 82.7%. Conclusion: Breast MRI is an useful tool for the locoregional staging of breast cancer, because it provides useful information that can have a positive impact on patient treatment.

Resumo Objetivo: Avaliar o impacto do uso da ressonância magnética (RM) no estadiamento pré-operatório do câncer de mama. Materiais e Métodos: Foram avaliadas 61 pacientes com carcinoma mamário submetidas a RM das mamas, no período de agosto de 2015 a abril de 2016. Um mastologista foi questionado sobre a conduta terapêutica indicada diante dos dados da paciente e dos exames convencionais e, após realização da RM, foi novamente questionado sobre a conduta para determinar se houve mudança e impacto no tratamento. Resultados: A média de idade das pacientes foi 50,8 anos (desvio-padrão: 12,0), o tipo histológico mais frequente foi carcinoma mamário invasivo tipo não especial (68,9%) e o imunofenótipo mais prevalente foi luminal B (45,9%). A RM das mamas mudou a conduta terapêutica em 23% dos casos, com impacto positivo em 82,7%. Conclusão: A RM das mamas é instrumento útil no estadiamento locorregional do câncer de mama, sendo capaz de adicionar informações que tenham impacto positivo no tratamento.

Linfonodo sentinela em câncer de mama: situações especiais na prática clínica / Sentinel lymph node biopsy in breast cancer: special situations in clinical practice

A biópsia do linfonodo sentinela já é um procedimento consagrado tanto em nivel nacional quanto internacional para a avaliação da axila de pacientes com câncer de mama diagnosticado na sua fase inicial. Porém, ainda existem algumas situações que geram dúvidas tanto sobre a melhor abordagem, quanto o tratamento. Nos últimos anos, temos observado um crescente interesse em relação à biópsia do linfonodo sentinela (BLS) e na maneira como urilizá-la em algumas situações especiais como no carcinoma ductal in situ (CDIS), quando há drenagem para a mamária interna, câncer de mama na gravidez, mastectomia profilática e tratamento quimioterápico sistêmico pré-operatório (quimioterapia sistêmica neoadjuvante - QT neo). Existem diversos estudos prospectivos em andamento para se estabelecer a condura ideal. Porém, enquanto os resultados não são publicados, necessitamos nos atualizar com relação à melhor maneira de abordá-los. Este artigo tentou apresentar, de maneira clara e resumida, o que há de mais recente publicado em relação à essas situações.

The sentinel lymph node biopsy is an accepted procedure at a national and international level to study the axillary status of patients with early-stage breast cancer. However there are some special situations that create some doubts about the better way to diagnostic and to threat it. In the last years we have seen a greatest interest in sentinel lymph node biopsy (SINB) and in the manner how to use it in some special situations like ductal carcinoma in situ, when there is migration to internal mammary lymph nodes, breast cancer and pregnancy, during prophylactic mastectomy and systemic therapy before surgery (preoperative chemotherapy). There are several prospective studies going on, with the intent to determine the ideal treatment for these special situations. While these results are not published, we must be aware of the better way to treat them. This article tries to show, in an easy and clear way, what have been published recently about these situations.

Câncer de mama na gestação: relato de casos / Pregnancy-associated breast cancer: case reports

O câncer de mama na gestação vem se tomando uma realidade na medida em que a idade da primeira gestação das mulheres aumenta. Aproximadamente 3% dos tumores de mama são diagnosticados em mulheres grávidas entre os 23 e os 47 anos de idade (media de 33 anos). Por definição, o câncer de mama associado à gestação é todo câncer de mama diagnosticado durante a mesma ou até um ano após o parto. Em geral, o câncer de mama na gestação apresenta-se de forma avançada devido principalmente ao atraso no diagnóstico e no tratamento do que devido às características histológicas dos tumores. Na literatura, ainda não há um consenso sobre a melhor estratégia terapêutica a ser usada. São apresentados aqui três casos de câncer de mama durante a gestação bem como uma análise sobre aspectos patológicos, diagnósticos e terapêuticos, com base na experiência dos autores e no que há de mais recente na literatura.

Pregnancy-associated breast cancer is becoming a reality since women delay childbearing. Approximately 3% of breast cancers are diagnosed in pregnant woman between 23 to 47years (mean age 33 years). It is defined as any breast carcinoma diagnosed during pregnancy or during the first postpartum year. The pregnancy-associated breast cancer usually presents as an advanced stage, in part because of delay on diagnostic and treatment, than histological characteristics of the breast cancer. There is no consensus about the better treatment option that should being used. We report here three cases of pregnancy-associated breast cancer and discuss some clinical, histopathological, diagnostic and therapeutic aspects, showing our experience and the more recent we found in literature.