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.

Plano de cuidados para sobreviventes de câncer de mama: tradução e validação / Plan de cuidados para sobrevivientes de cáncer de mama: traducción y validación / Care plan for breast cancer survivors: translation and validation

Resumo Objetivo Traduzir, adaptar transculturalmente e validar o conteúdo do Treatment Summary and Survivorship Care Plan (TSSCP-S) para sobreviventes brasileiras de câncer de mama. Métodos Estudo metodológico, quantitativo, executado de acordo com as etapas de tradução, compatibilização e retrotradução, construção de consenso de opiniões de um grupo de especialistas para a validação de conteúdo, de acordo com a Técnica Delphi e avaliação do usuário. Resultados O plano traduzido e adaptado transculturalmente foi avaliado por 10 profissionais, entre estes, enfermeiros, médicos, psicológos, nutricionista e fisioterapeuta, possuidores de titulação, produção científica, conhecimento e tempo de atuação na temática e o consenso foi obtido em duas rodadas. O instrumento apresentou coeficiente de validade de conteúdo de 83,3% na segunda rodada da Delphi. Na avaliação dos domínios conteúdo, clareza, utilidade, responsividade cultural e socioecológica, a concordância foi de 93,3%. O perfil sóciodemográfico e clínico das usuárias foi heterogêneo, contribuindo para os ajustes culturais necessários, com consenso final de 93,9%. Conclusão O plano de cuidados foi traduzido para o português do Brasil, adaptado transculturalmente e seus conteúdos foram validados, considerando as políticas de saúde nacionais.

Resumen Objetivo Traducir, adaptar transculturalmente y validar el contenido del Treatment Summary and Survivorship Care Plan (TSSCP-S) para sobrevivientes brasileñas de cáncer de mama. Métodos Estudio metodológico, cuantitativo, ejecutado de acuerdo con las etapas de traducción, compatibilización y retrotraducción, construcción de consenso de opiniones de un grupo de especialistas para la validación de contenido, de acuerdo con el método Delphi y evaluación del usuario. Resultados El plan traducido y adaptado transculturalmente fue evaluado por diez profesionales, entre ellos enfermeros, médicos, psicólogos, nutricionista y fisioterapeuta, con titulación académica, producción científica, conocimiento y tiempo de actuación en la temática, y el consenso se obtuvo en dos rondas. El instrumento presentó un coeficiente de validez de contenido del 83,3 % en la segunda ronda de Delphi. En la evaluación de los dominios contenido, claridad, utilidad, responsividad cultural y socioecológica, la concordancia fue del 93,3 %. El perfil sociodemográfico y clínico de las usuarias fue heterogéneo, lo que contribuye a los ajustes culturales necesarios, con consenso final del 93,9 %. Conclusión El plan de cuidados fue traducido al portugués de Brasil, adaptado transculturalmente y sus contenidos fueron validados, considerando las políticas sanitarias nacionales.

Abstract Objective To translate, cross-culturally adapt and validate the content of the Treatment Summary and Survivorship Care Plan (TSSCP-S) for Brazilian breast cancer survivors. Methods Methodological, quantitative study performed according to the steps of translation, compatibility and back-translation, construction of consensus of opinions in a group of experts for content validation, according to the Delphi technique and user evaluation. Results The translated and cross-culturally adapted plan was evaluated by ten professionals, including nurses, physicians, psychologists, nutritionists and physical therapists with a degree, scientific production, knowledge and time working on the subject. Consensus was obtained in two rounds. The instrument presented a content validity coefficient of 83.3% in the second round of Delphi. In the evaluation of content, clarity, usefulness, cultural and socioecological responsiveness domains, agreement was 93.3%. The sociodemographic and clinical profile of users was heterogeneous, contributing to the necessary cultural adjustments, with a final consensus of 93.9%. Conclusion The care plan was translated into Brazilian Portuguese, cross-culturally adapted and its contents were validated considering national health policies.

Computed tomography assessment of body composition in patients with nonmetastatic breast cancer: what are the best prognostic markers?

Objective: To correlate body composition measures, based on computed tomography (CT) analysis of muscle mass and adipose tissue, with disease-free survival in breast cancer patients. Materials and Methods: This single-center retrospective study included 262 female patients with nonmetastatic breast cancer. Body composition was assessed on a pretreatment CT scan (at the L3 level). The analysis included quantification of the areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle mass, as well as of the mean skeletal muscle density. The VAT/SAT ratio, skeletal mass index (SMI), and skeletal muscle gauge (SMG) were calculated. Results: Of the 262 patients evaluated, 175 (66.8%) were classified as overweight or obese on the basis of their body mass index. We observed low SMI in 35 patients (13.4%) and elevated VAT in 123 (46.9%). Disease-free survival was significantly shorter in the patients who underwent neoadjuvant chemotherapy (p = 0.044), in those with a low SMI (p = 0.006), in those with low SMG (p = 0.013), and in those with a low VAT/SAT ratio (p = 0.050). In a multivariate analysis, only SMG, the VAT/SAT ratio, and having undergone neoadjuvant chemotherapy retained their statistical significance. Conclusion: Our results confirm that low SMG and the VAT/SAT ratio can be used as imaging biomarkers to assess prognosis in patients with nonmetastatic breast cancer.

Objetivo: Correlacionar medidas de composição corporal baseadas na análise por tomografia computadorizada (TC) da massa muscular e tecido adiposo com a sobrevida livre de doença em pacientes com câncer de mama. Materiais e Métodos: Estudo retrospectivo unicêntrico que incluiu 262 mulheres com câncer de mama não metastático. Avaliação da composição corporal foi realizada na TC pré-tratamento (nível de L3), incluindo tecido adiposo subcutâneo (SAT) e tecido adiposo visceral (VAT), massa muscular esquelética e densidade do músculo esquelético. A relação VAT/SAT, o índice de massa esquelética (SMI) e o produto do músculo esquelético (SMG) foram calculados. Resultados: De acordo com o índice de massa corporal, 175 (66,8%) pacientes foram classificadas com sobrepeso ou obesidade. Baixo SMI foi observado em 35 (13,4%) pacientes e VAT elevado, em 123 (46,9%). Houve uma redução significativa na sobrevida livre de doença nas pacientes que realizaram quimioterapia neoadjuvante (p = 0,044), nas com baixo SMI (p = 0,006), baixo SMG (p = 0,013) e baixa relação VAT/SAT (p = 0,050). Na análise multivariada, apenas SMG, relação VAT/SAT e quimioterapia neoadjuvante confirmaram significância estatística. Conclusão: Nossos resultados confirmaram que SMG e relação VAT/SAT baixos podem ser usados como importantes biomarcadores de imagem para avaliar o prognóstico em pacientes com câncer de mama não metastático.

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.

Computed tomography assessment of body composition in patients with nonmetastatic breast cancer: what are the best prognostic markers? / Avaliação da composição corporal por tomografia computadorizada em pacientes com câncer de mama não metastático: quais os melhores marcadores de prognóstico?

Abstract Objective: To correlate body composition measures, based on computed tomography (CT) analysis of muscle mass and adipose tissue, with disease-free survival in breast cancer patients. Materials and Methods: This single-center retrospective study included 262 female patients with nonmetastatic breast cancer. Body composition was assessed on a pretreatment CT scan (at the L3 level). The analysis included quantification of the areas of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle mass, as well as of the mean skeletal muscle density. The VAT/SAT ratio, skeletal mass index (SMI), and skeletal muscle gauge (SMG) were calculated. Results: Of the 262 patients evaluated, 175 (66.8%) were classified as overweight or obese on the basis of their body mass index. We observed low SMI in 35 patients (13.4%) and elevated VAT in 123 (46.9%). Disease-free survival was significantly shorter in the patients who underwent neoadjuvant chemotherapy (p = 0.044), in those with a low SMI (p = 0.006), in those with low SMG (p = 0.013), and in those with a low VAT/SAT ratio (p = 0.050). In a multivariate analysis, only SMG, the VAT/SAT ratio, and having undergone neoadjuvant chemotherapy retained their statistical significance. Conclusion: Our results confirm that low SMG and the VAT/SAT ratio can be used as imaging biomarkers to assess prognosis in patients with nonmetastatic breast cancer.

Resumo Objetivo: Correlacionar medidas de composição corporal baseadas na análise por tomografia computadorizada (TC) da massa muscular e tecido adiposo com a sobrevida livre de doença em pacientes com câncer de mama. Materiais e Métodos: Estudo retrospectivo unicêntrico que incluiu 262 mulheres com câncer de mama não metastático. Avaliação da composição corporal foi realizada na TC pré-tratamento (nível de L3), incluindo tecido adiposo subcutâneo (SAT) e tecido adiposo visceral (VAT), massa muscular esquelética e densidade do músculo esquelético. A relação VAT/SAT, o índice de massa esquelética (SMI) e o produto do músculo esquelético (SMG) foram calculados. Resultados: De acordo com o índice de massa corporal, 175 (66,8%) pacientes foram classificadas com sobrepeso ou obesidade. Baixo SMI foi observado em 35 (13,4%) pacientes e VAT elevado, em 123 (46,9%). Houve uma redução significativa na sobrevida livre de doença nas pacientes que realizaram quimioterapia neoadjuvante (p = 0,044), nas com baixo SMI (p = 0,006), baixo SMG (p = 0,013) e baixa relação VAT/SAT (p = 0,050). Na análise multivariada, apenas SMG, relação VAT/SAT e quimioterapia neoadjuvante confirmaram significância estatística. Conclusão: Nossos resultados confirmaram que SMG e relação VAT/SAT baixos podem ser usados como importantes biomarcadores de imagem para avaliar o prognóstico em pacientes com câncer de mama não metastático.

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.

Radiation therapy with elective lymph node irradiation for breast cancer: dosimetric study and impact on cardiovascular risk and second neoplasms.

OBJECTIVE: The aim of this study was to perform dosimetric analysis of radiotherapy (RT) plans with or without elective nodal irradiation (ENI) and estimate whether the increase in mean doses (MDs) in the heart and lungs with ENI may lead to late side effects that may surpass the benefits of treatment. METHODS: The dosimetric analysis of 30 treatment plans was done with or without ENI. The planning and dose-volume histograms were analyzed, and the impact on the mortality of cardiovascular and lung cancer was estimated based on the correlation of the dosimetric data with data from population studies. RESULTS: RT with ENI increased the doses in the lungs and heterogeneity in the plans compared to breast-exclusive RT. When the increase in MDs is correlated with the increase of late side-effect risks, the most important effect of ENI is the increased risk of lung cancer, especially in patients who smoke (average increase in absolute risk=1.38%). The increase in the absolute risk of cardiovascular diseases was below 0.1% in the all the situations analyzed. CONCLUSIONS: ENI increases the heterogeneity and the doses at the lungs. When recommending ENI, the risks and benefits must be taken into account, considering the oncology factors and the plan of each patient. Special attention must be given to patients who smoke as ENI may lead to a significant increase in MD in the lung and the increased risk of radiation-induced lung cancer may surpass the benefits from this treatment.

Radiation therapy with elective lymph node irradiation for breast cancer: dosimetric study and impact on cardiovascular risk and second neoplasms

SUMMARY OBJECTIVE: The aim of this study was to perform dosimetric analysis of radiotherapy (RT) plans with or without elective nodal irradiation (ENI) and estimate whether the increase in mean doses (MDs) in the heart and lungs with ENI may lead to late side effects that may surpass the benefits of treatment. METHODS: The dosimetric analysis of 30 treatment plans was done with or without ENI. The planning and dose-volume histograms were analyzed, and the impact on the mortality of cardiovascular and lung cancer was estimated based on the correlation of the dosimetric data with data from population studies. RESULTS: RT with ENI increased the doses in the lungs and heterogeneity in the plans compared to breast-exclusive RT. When the increase in MDs is correlated with the increase of late side-effect risks, the most important effect of ENI is the increased risk of lung cancer, especially in patients who smoke (average increase in absolute risk=1.38%). The increase in the absolute risk of cardiovascular diseases was below 0.1% in the all the situations analyzed. CONCLUSIONS: ENI increases the heterogeneity and the doses at the lungs. When recommending ENI, the risks and benefits must be taken into account, considering the oncology factors and the plan of each patient. Special attention must be given to patients who smoke as ENI may lead to a significant increase in MD in the lung and the increased risk of radiation-induced lung cancer may surpass the benefits from this 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.