Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition).

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

Metástasis cutánea como primera manifestación de un carcinoma papilar capsulado de mama / Cutaneous metastasis as the first manifestation of an encapsulated papillary carcinoma of the breast

Introducción La mama es el órgano interno que con más frecuencia produce metástasis en la piel en las mujeres. Puede ser un signo de enfermedad sistémica avanzada o ser la primera manifestación de un cáncer asintomático. No se han descrito hasta la fecha metástasis cutáneas por carcinomas papilares capsulados de mama. Caso clínico Mujer de 76 años, con elevada comorbilidad y mastectomía radical modificada izquierda 25 años antes por carcinoma ductal infiltrante. Acudió al servicio de Dermatología por una lesión tumoral vascularizada, sangrante y dolorosa de 0,8cm de diámetro localizada en zona retroauricular mastoidea izquierda. Se realizó biopsia escisional de la lesión que, tras estudio anatomopatológico, fue diagnosticada de metástasis cutánea de cáncer de mama. La mamografía derecha y la ultrasonografía demostraron la presencia de un nódulo de 38mm, bien delimitado. La pieza de tumorectomía demostró la presencia de un carcinoma papilar capsulado, antes conocido también como intraquístico. El estudio de extensión resultó negativo para otras metástasis. Conclusión La mama es el origen más frecuente de las metástasis cutáneas de neoplasias internas. Las formas de presentación son variadas y el clínico debe mantener un alto índice de sospecha para poder realizar un diagnóstico adecuado y precoz. (AU)

Introduction The breast is the internal organ that most often produces skin metastasis in women. Metastasis can be a sign of advanced systemic disease or the first manifestation of asymptomatic cancer. To date, there have been no descriptions of cutaneous metastases from papillary carcinomas encapsulated in the breast. Clinical case We report the case of a 76-year-old woman with high comorbidity and a modified radical mastectomy 25 years previously due to infiltrating ductal carcinoma. The patient attended the dermatology department due to a painful, vascularized, bleeding 0.8cm tumor located in the left mastoid retroauricular area. An excisional biopsy of the lesion was performed, which, after pathological study, was diagnosed as cutaneous metastasis from breast cancer. The presence of a well-defined 38mm nodule was confirmed by mammography and ultrasonography. The tumorectomy specimen demonstrated the presence of an encapsulated papillary carcinoma, previously also known as intracystic carcinoma. The extension study was negative for other metastases. Conclusion The breast is the most frequent origin of cutaneous metastases from internal neoplasms. The forms of presentation are varied and clinicians must maintain a high index of suspicion in order to make an accurate and early diagnosis. (AU)

Análisis del impacto de la cirugía bariátrica en el gasto farmacológico a medio plazo / Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure

Introducción: La obesidad y las enfermedades asociadas a ella suponen un importante problema, y no solo sanitario, sino también económico, ya que muchas de esas patologías son subsidiarias de tratamiento farmacológico de por vida. La cirugía bariátrica y metabólica, a priori, disminuye la demanda de medicamentos de estos pacientes, pero puede condicionar otro tipo de necesidades farmacológicas. El objetivo del estudio es demostrar si existe un descenso real del gasto farmacológico tras la cirugía bariátrica. Material y métodos: Análisis retrospectivo transversal de los pacientes intervenidos en nuestro centro entre 2012 y 2016, comparando las distintas comorbilidades y los gastos farmacológicos asociados a ellas un mes antes y a los 2años de la cirugía. Resultados: Fueron intervenidos 400 pacientes. Se presentaron los resultados mostrando para cada una de las técnicas quirúrgicas estudiadas las diferencias entre la resolución de las distintas comorbilidades y el ahorro farmacológico generado. La comorbilidad más coste-efectiva del estudio fue la diabetes mellitus tipo2 (DM2). La técnica quirúrgica con mejores resultados fue el bypass metabólico, presentando una diferencia de costes tras la cirugía de 507euros mensuales (p<0,001). Conclusiones: En un seguimiento de 2años tras la cirugía bariátrica se produce un descenso en la prevalencia de las enfermedades asociadas a la obesidad y del gasto farmacológico asociado a ellas, lo que demuestra que este tipo de intervención resulta eficiente a medio plazo. (AU)

Introduction: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. Material and methods: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2years after surgery. Results: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507euros per month (P<.001). Conclusions: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term. (AU)

Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure.

INTRODUCTION: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2 years after surgery. RESULTS: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type 2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507 euros per month (P < 0.001). CONCLUSIONS: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.

Mastopatía diabética. Revisión sistemática con 93 pacientes / Diabetic mastopathy. A systematic review of 93 patients

Introducción La mastopatía diabética (MD) es una afectación benigna de la mama que aparece en pacientes diabéticas con mal control glucémico de larga evolución. La enfermedad se caracteriza por la aparición de nódulos fibrosos que pueden simular tanto clínica como radiológicamente un cáncer de mama. Su diagnóstico debe realizarse con biopsia con aguja gruesa (BAG) y el tratamiento debe evitar resecciones quirúrgicas. El objetivo de este trabajo es caracterizar con más exactitud esta enfermedad y sus características aportando claridad en su diagnóstico diferencial. Material y métodos Se ha realizado una revisión sistemática de los artículos publicados en los últimos 5 años en las principales bases de datos médicas usando para ello los términos «Mastopatía diabética» y «Diabetic mastopathy». Se incluyeron todo tipo de artículos científicos que aportasen datos sobre la MD, excluyendo aquellos que incluyeran otras enfermedades inflamatorias de la mama. Se seleccionaron finalmente 28 artículos. Para el análisis estadístico se dividió a las pacientes en 2 grupos, diabetes mellitus (DM) tipo 1 (DM1) y DM tipo 2 (DM2), y se compararon la media y la proporción de las diferentes variables analizadas utilizando para ello la prueba t de Student. Se utilizó el programa STATA para realizar el análisis estadístico. Resultados Se analizaron 28 artículos, con un total de 93 pacientes incluidas. En los artículos analizados todos los pacientes eran mujeres. La mayoría de las pacientes presentaron DM1 y el tiempo medio de evolución de la diabetes fue de 20 años. La lesión asociada a la DM que se observó con mayor frecuencia fue la retinopatía diabética (34%). La lesión palpable fue la forma de manifestación más frecuente (53%). Respecto al diagnóstico el hallazgo mamográfico más habitual, fue la hiperdensidad asimétrica y en la ecografía la lesión hipoecoica de bordes irregulares y sombra acústica posterior. El tratamiento más habitual fue conservador. Conclusión ... (AU)

Introduction Diabetic mastopathy is a benign disease of the breast that develops in patients with long-standing diabetes and poor glycemic control. The disease is characterised by fibrous nodules that can be confused with breast cancer both clinically and radiologically. Diagnosis should be made with core needle biopsy (CNB) and treatment should avoid surgical resections. The main objective of this study was to characterise this rare disease in order to improve its differential diagnosis and treatment. Material and methods A systematic review was conducted, including articles published in the last 5 years in the main medical databases using the terms “Mastopatía diabética” and “Diabetic mastopathy”. We included all types of scientific articles providing data on diabetic mastopathy. We excluded articles including other inflammatory breast diseases. Finally 28 articles were selected. For the statistical analysis, patients were divided in 2groups: DM1 patients and DM2 patients. The mean and proportion of the different variables were analysed with the Student t-test. The statistical analysis was performed with the STATA programme. Results We analysed 28 articles, with 93 patients. None of the included articles reported male patients. Most patients had type 1 diabetes and diabetic mastopathy developed at a mean of 20 years after diabetes onset. The most frequent complication of diabetes was diabetic retinopathy (34%). The most common manifestation was a palpable nodule (53%). Regarding diagnosis, the most common mammographic finding was asymmetric hyperdensity and the most common ultrasound finding was a hypoechoic lesion with irregular edges and posterior acoustic shadow. The most frequent treatment was conservative. Conclusion... (AU)

Bull horn injuries. A 40-year retrospective study with 572 patients.

BACKGROUND: Although bullfighting festivals were traditionally attributed to the cultural idiosyncrasies of the Ibero-American people, they also exist world-wide. METHODS: A retrospective study was conducted, reviewing the medical records of patients treated on our service for bull horn injuries between January 1978 and December 2019. RESULTS: There were 572 admissions due to bull horn injuries. 54 of these patients had multiple injuries. The average annual admission was 13.6 patients. The most frequent injuries were located in the lower extremities, perineum, and abdomen. Forty-seven laparotomies were performed, revealing intra-abdominal visceral impairment on 39 occasions. The most frequently injured organs were the intestine and liver. The most frequent complications were skin devitalisation, infection and post-operative eventration. The recorded mortality was 0.87%. CONCLUSION: We wish to highlight the importance of injuries caused by bull horns worldwide. These are high-impact injuries with specific intrinsic characteristics that require regulated medical and surgical care.

Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure. / Análisis del impacto de la cirugía bariátrica en el gasto farmacológico a medio plazo.

INTRODUCTION: Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS: Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2years after surgery. RESULTS: 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507euros per month (P<.001). CONCLUSIONS: In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.

Mammary Paget's disease. Conservative mastectomy / Enfermedad de paget mamaria. Mastectomía conservadora

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Cáncer de mama en pacientes transgénero. Revisión de la literatura / Breast cancer in transgender patients. A review

El término «transgénero» hace referencia a las personas que experimentan su identidad de género de manera diferente del género asignado en el nacimiento. La glándula mamaria representa un claro signo de feminidad e identidad corporal, por lo que su tratamiento adquiere especial relevancia tanto en varones como en mujeres transgénero. Los tratamientos de reasignación de género (hormonales o quirúrgicos) afectarán directamente al tejido glandular mamario, lo que puede afectar al riesgo de presentar un cáncer de mama y modificar así los procesos diagnósticos y terapéuticos. Se realiza en este estudio una revisión y resumen de la literatura científica más relevante sobre este campo, abordando los aspectos clínicos referentes al diagnóstico y el tratamiento de la enfermedad mamaria en pacientes transgénero

The term "transgender" refers to people who experience their gender identity differently from the gender assigned at birth. The mammary gland represents a clear sign of femininity and body identity, so its treatment acquires special relevance in transgender men and women. Gender reassignment treatments (hormonal or surgical) will directly affect the mammary glandular tissue, which may affect the risk of presenting breast cancer and thus modify the diagnostic and therapeutic processes. A review and summary of the most relevant scientific literature on this field is carried out in this study, addressing the clinical aspects related to the diagnosis and treatment of mammary pathology in transgender patients

Tumor de células granulares. Abrikossoff de la mama, presentación de un caso tratado en nuestro centro / Granular cell tumour. Abrikossof tumour of the breast. Report of a case treated in our centre

El presente artículo describe nuestra experiencia en el diagnóstico y tratamiento de un paciente varón de 42 años diagnosticado de un tumor de células granulares en la mama y pretende llamar la atención sobre esta entidad, que puede simular un carcinoma de mama, debiéndose tener en cuenta en el diagnóstico diferencial de la enfermedad nodular mamaria

This article describes our experience in the diagnosis and treatment of a 42-year-old male patient diagnosed with a granular cell tumour in the breast and draws attention to this entity, which can simulate a breast carcinoma. This should be taken into account in the differential diagnosis of nodular breast disease

Microbiota biliar en pacientes colecistectomizados: revisión de la antibioterapia empírica / Biliary microbiote in cholecystectomized PATIENTS: review of empirical antibiotherapy

INTRODUCCIÓN: La colecistitis constituye una importante causa de ingreso hospitalario. En colecistitis moderada o severa, el retraso en el tratamiento puede acarrear complicaciones graves. Nuestro objetivo es analizar los microorganismos aislados en bilis de pacientes colecistectomizados y su patrón de sensibilidad para evaluar el tratamiento empírico en aquellos casos en que la extirpación quirúrgica de la vesícula deba demorarse. PACIENTES Y MÉTODOS: Estudio descriptivo prospectivo de los cultivos biliares de pacientes sometidos a colecistectomía desde mayo de 2013 hasta febrero de 2015, en el Servicio de Cirugía del Hospital General Universitario de Castellón. RESULTADOS: Se estudiaron 196 pacientes, 83 mujeres (42,3%) y 113 hombres (57,7%), con una media de edad de 61,5 años. Los antibióticos más utilizados como tratamiento empírico fueron piperacilina/tazobactam (77,8%) y amoxicilina/clavulánico (14,8%). En el 46,4% de los pacientes (91/196) los cultivos de bilis fueron positivos. Se aislaron un total de 165 microorganismos. La mayoría eran bacilos gramnegativos (60,5%), principalmente Enterobacterales (91/54,5%), siendo Escherichia coli el microorganismo más frecuente (24%) seguido de Klebsiella spp. (12,5%). Se aislaron 3 E. coli productoras de betalactamasa de espectro extendido (BLEE) y 1 Klebsiella pneumoniae BLEE. No se aislaron microorganismos productores de carbapenemasa ni Staphylococcus aureus resistente a meticilina. CONCLUSIÓN: La microbiota biliar, con predominio de Enterobacterales, es similar a la encontrada en estudios europeos

INTRODUCTION: Cholecystitis is an important cause of hospital admission. In moderate or severe cholecystitis, the delay in treatment can lead to serious complications. Our objective is to analyze the microorganisms isolated in bile from cholecystectomized patients and their sensitivity pattern, to evaluate the empirical treatment in those cases in which the surgical removal of the gallbladder should be delayed. PATIENTS AND METHODS: Prospective descriptive study of biliary cultures of patients undergoing cholecystectomy from May 2013 to February 2015, in the Surgery Department of the Hospital General Universitari de Castelló. RESULTS: We studied 196 patients, 83 women (42.3%) and 113 men (57.7%), with an average age of 61.5 years. The most used antibiotics as empiric treatment were piperacillin/tazobactam (77.8%) and amoxicillin/clavulanic (14.8%). In 46.4% of patients (91/196) bile cultures were positive.165 microorganisms were isolated. The majority were Gram-negative bacilli (60.5%), mainly of the Enterobacterales order (91/54.5%), with Escherichia coli being the most frequent microorganism (24%) followed by Klebsiella spp. (12.5%).3 E. coli with extended-spectrum beta-lactamase (ESBL) and 1 K. pneumoniae with ESBL were isolated. Microorganisms producing carbapenemase and methicillin-resistant Staphylococcus aureus were not isolated. CONCLUSION: The bile microbiota, with a predominance of Enterobacterales is similar to that found in european studies

Síndrome de la mama fantasma posmastectomía. Estudio de prevalencia y características clínicas en un hospital de tercer nivel / Post-mastectomy phantom breast syndrome. Study of prevalence and clinical characteristics in a tertiary hospital

Objetivo: Conocer la prevalencia y características del síndrome de la mama fantasma en nuestro entorno. Pacientes y métodos: Se realizó una encuesta telefónica a 50 mujeres mastectomizadas entre los años 2002 y 2009 en el Hospital General Universitario de Castellón. Se preguntó sobre la presencia de dolor antes del diagnóstico de la enfermedad y de la cirugía, del síndrome de dolor posmastectomía y del síndrome de la mama fantasma, ampliando el interrogatorio en caso de respuesta afirmativa para conocer las características de la sintomatología, el momento de aparición, la frecuencia de aparición, la duración de la clínica y la necesidad o no de tratamiento farmacológico específico en cada síndrome. Se realizó un análisis descriptivo de los datos obtenidos. Resultados: El 76% de las mujeres interrogadas presentaron algún tipo de sensación extraña o dolorosa en la zona de la cicatriz mamaria, de las cuales el 65,8% presentó sensaciones no dolorosas y el 34,2% dolorosas. El síndrome de la mama fantasma apareció en el 38% de las mujeres interrogadas, y en muchos de los casos (31,6%) de las que respondieron afirmativamente se expresaba en forma de picor en el pezón ausente. Conclusiones: El síndrome de dolor posmastectomía y el síndrome de la mama fantasma son entidades poco conocidas, aunque prevalentes en nuestro medio. Tienen un carácter complejo y multifactorial, por lo que es importante conocerlas para conseguir un correcto tratamiento de las pacientes afectas, y así mejorar su calidad de vida

Objective: To determine the prevalence of post-mastectomy pain syndrome and phantom breast syndrome in our environment. Patients and methods: We performed a telephone survey of 50 women who underwent mastectomy between 2002 and 2009 in the General Hospital of Castellon (Spain). The women were asked about the presence of pain before diagnosis of the disease and surgery, post-mastectomy pain syndrome, and phantom breast syndrome. Women with symptoms were asked about their characteristics, time of onset, frequency, duration, and whether or not a specific pharmacological treatment was needed for each syndrome. A descriptive analysis was performed of the data obtained. Results: A total of 76% of the women surveyed had some kind of strange or painful sensation in the breast scar, 65.8% of whom had painless sensations and 34.2% had painful sensations. Phantom breast syndrome appeared in 38% of the surveyed women and manifested as an itch in the absent nipple in 31.6% of the women. Conclusions: Post-mastectomy pain syndrome and phantom breast syndrome are little known entities, although they prevalent in our environment. These syndromes are complex and multifactorial; therefore, familiarity with their characteristics is essential to provide affected women with proper treatment and improve their quality of life

Idiopathic granulomatous mastitis: A systematic review of 3060 patients.

Idiopathic granulomatous mastitis is a rare benign breast disease. A systematic review was designed. Clinical and therapeutic characteristics were analyzed. Human Development Index (HDI) was used to define two groups of study: group A (very high and high HDI) and group B (medium and low HDI). Corticosteroid therapy was done in 69% group A and 78% group B. Surgery was done in 63% in group A and 83% in group B. Antibiotics were used in 68% group A and 88% group B. There is no consensus about optimal treatment for granulomatous mastitis.

Mastitis granulomatosa idiopática. Análisis descriptivo de 10 casos en una unidad de referencia española / Idiopatic granulomatous mastitis. A descriptive analysis of 10 cases in a Spanish unit of reference

Introducción La mastitis granulomatosa es unaenfermedad infrecuente caracterizada por una inflamación granulomatosa crónica de los lobulillos mamarios. Las opciones de tratamiento siguen siendo controvertidas. Objetivo El objetivo del presente estudio fue analizar nuestra experiencia en el diagnóstico y tratamiento de las pacientes con mastitis granulomatosas, valorando la conveniencia de tratamientos quirúrgicos o tratamientos más conservadores. Material y método Se presenta un estudio retrospectivo y descriptivo de las pacientes diagnosticadas y tratadas en nuestro centro desde enero de 2010 hasta diciembre de 2018. Se analizaron las características clínicas y radiológicas de cada una, así como el tratamiento y su evolución. Resultados Los resultados del estudio fueron los siguientes: • El número de pacientes fue 10; el tiempo medio de seguimiento fue de 10,5 meses (rango 2-49 meses); la mediana de edad fue de 44,5 años (rango 31-81 años);ocho pacientes (80%)se manifestaron como tumoración palpable; el tiempo medio de duración de los síntomas fue de 6,8 meses (rango 2-24 meses); el tamaño medio de la lesión alcanzó los 23,6 mm (rango 12-40); una paciente se clasificó como bi-rads 2, 1 paciente como bi-rads 3, 1 paciente como bi-rads 4y 3 pacientes como bi-rads 5. • El tratamiento fue quirúrgico en 6 ocasiones (4 resecciones y 2 drenajes con biopsia) y médico en 4 ocasiones. Siete de las pacientes (70%) se curaron con el tratamiento efectuado (5 con cirugía y 2 con tratamiento conservador). Tres pacientes presentaron recurrencia o persistencia (1 con cirugía y 2 con tratamiento conservador). Conclusiones La mastitis granulomatosa es una enfermedad infrecuente y de causa desconocida, con tendencia a la recurrencia y cronicidad, cuyo tratamiento es todavía motivo de controversia

Introduction Granulomatous mastitis is an infrequent disease characterized by a chronic granulomatous inflammation of mammary lobules. Treatment options remain controversial. Objective The aim of the present study was to analyze our experience in the diagnosis and treatment of patients with granulomatous mastitis, assessing the convenience of surgical treatments or more conservative treatments. Materials and method This is a retrospective and descriptive study of the patients diagnosed and treated in our center from January 2010 to December 2018. We analyzed the clinical and radiological characteristics of each one, as well as the treatment and its evolution. Results • Number of patients 10; mean time of follow-up 10.5 months (range 2-49 months); median of age 44.5 years (range 31-81 years); eight patients (80%) manifested as a palpable tumor;mean duration of symptoms was 6.8 months (range 2-24 months); mean lesion size of 23.6mm (range 12-40); one patient was classified as bi-rads 2, 1 patient as bi-rads 3, 1 patient as bi-rads 4 and 3 patients as bi-rads 5. • The treatment was surgical 6 times (4 resections and 2 drainages with biopsy) and doctor on 4 occasions. Seven of the patients (70%) were cured with the treatment performed (5 with surgery and 2 with conservative treatment). Three patients presented recurrence or persistence (1 with surgery and 2 with conservative treatment). Conclusions Granulomatous mastitis is an infrequent disease of unknown cause, with a tendency to recurrence and chronicity, whose treatment is still controversial

Modelling the probability of erroneous negative lymph node staging in patients with colon cancer.

BACKGROUND: Patients in who with insufficient number of analysed lymph nodes (LNs) are more likely to receive an incorrect LN staging. The ability to calculate the overall probability of undiagnosed LN involvement errors in these patients could be very useful for approximating the real patient prognosis and for giving possible indications for adjuvant treatments. The objective of this work was to establish the predictive capacity and prognostic discriminative ability of the final error probability (FEP) among patients with colon cancer and with a potentially incorrectly-staged LN-negative disease. METHODS: This was a retrospective multicentric population study carried out between January 2004 and December 2007. We used a mathematical model based on Bayes' theorem to calculate the probability of LN involvement given a FEP test result. Cumulative sum graphs were used to calculate risk groups and the survival rates were calculated, by month, using the Kaplan-Meier method. RESULTS: A total of 548 patients were analysed and classified into three risk groups according to their FEP score: low-risk (FEP < 2%), intermediate-risk (FEP 2%-15%), and high-risk (FEP > 15%). Patients with LN involvement had the lowest overall survival rate when compared to the three risk groups. This difference was statistically significant for the low- and intermediate-risk groups (P = 0.002 and P = 0.004, respectively), but high-risk group presented similar survival curves to pN+ group (P = 0.505). In terms of disease-free survival, the high-risk group presented similar curves to the intermediate-risk group until approximately 60 months' follow-up (P = 0.906). After 80 months' follow-up, the curve of high-risk group coincided with that of the pN+ group (P = 0.172). Finally, we summarized the FEP according to the number of analysed LNs and accompanied by a contour plot which represents its calculation graphically. CONCLUSIONS: The application of Bayes' theorem in the calculation of FEP is useful to delimit risk subgroups from among patients without LN involvement.