Carcinoma de mama triple negativo. Heterogeneidad inmunofenotípica y en el comportamiento farmacocinético / Triple-negative breast carcinoma: heterogeneity in immunophenotypes and pharmacokinetic behavior

Objetivos. Valorar, mediante resonancia magnética (RM), las características morfocinéticas, farmacocinéticas y de difusión de las neoplasias de mama con fenotipo triple negativo y analizar si hay relación entre estos parámetros y el tiempo hasta la progresión. Material y métodos. Estudio retrospectivo y observacional de una serie consecutiva de 100 pacientes con diagnóstico histológico de cáncer de mama, fenotipo triple negativo, entre enero de 2005 y diciembre de 2010 en nuestro centro. Se revisaron los estudios de RM de extensión locorregional y se recogieron las características anatomopatológicas y el seguimiento de las pacientes hasta agosto de 2014. Resultados. Las características más frecuentes por RM de estos tumores fueron: lesiones tipo masa de morfología redondeada (47,3%), bordes bien delimitados (53,7%), patrón de captación 'en anillo' (46,2%), curvas de tipo 3 (50,5%), hiperintensidad de señal intratumoral en las secuencias potenciadas en T2, valores altos de ADC (coeficiente de difusión aparente) (1,04 × 10−3 mm2/s) y una permeabilidad capilar aumentada (Kep) (0,94 min−1). No se evidenció ninguna relación estadísticamente significativa entre las características morfocinéticas o farmacocinéticas y el tiempo hasta la progresión. Se halló elevada presencia del componente in situ en las piezas quirúrgicas, aunque su representación era baja. En el seguimiento, un 25% presentaron metástasis, con predilección por órganos viscerales y baja supervivencia. Conclusión. Las neoplasias con fenotipo triple negativo mostraron mayoritariamente en la RM lesiones de tipo masa, de morfología redondeada, bordes bien delimitados y patrón de captación "en anillo". No se evidenció ninguna relación estadísticamente significativa entre las características morfocinéticas o farmacocinéticas y el tiempo hasta la progresión (AU)

Objectives. To evaluate the morphokinetic, pharmacokinetic, and diffusion characteristics of triple-negative breast cancers on magnetic resonance (MR) imaging and to analyze whether there is a relation between these parameters and the time to progression. Material and methods. This was a retrospective observational study of a consecutive series of 100 patients with histologically confirmed triple-negative breast cancer studied at our center between January 2005 and December 2010. We reviewed the findings on MR locoregional extension studies, the histological findings, and the follow-up of patients until August 2014. Results. The most common MR findings for these tumors were a rounded mass (47.3%), well-defined borders (53.7%), ring enhancement (46.2%), type 3 curves (50.5%), hyperintensity within the tumor on T2-weighted sequences, high ADC values (1.04 × 10-3 mm2/s), and increased capillary permeability (Kep) (0.94 min-1). No significant association was observed between the morphokinetic or pharmacokinetic characteristics and the time to progression. The in situ component in the surgical specimens was high, although its expression was low. During follow-up, 25% of patients had metastases, with a predilection for the visceral organs, and survival was low. Conclusion. Tumors with the triple-negative phenotype mostly presented in MR as rounded tumors with well-defined borders and ring enhancement. We found no significant association between the morphokinetic or pharmacokinetic characteristics and the time to progression (AU)

Triple-negative breast carcinoma: heterogeneity in immunophenotypes and pharmacokinetic behavior.

OBJECTIVES: To evaluate the morphokinetic, pharmacokinetic, and diffusion characteristics of triple-negative breast cancers on magnetic resonance (MR) imaging and to analyze whether there is a relation between these parameters and the time to progression. MATERIAL AND METHODS: This was a retrospective observational study of a consecutive series of 100 patients with histologically confirmed triple-negative breast cancer studied at our center between January 2005 and December 2010. We reviewed the findings on MR locoregional extension studies, the histological findings, and the follow-up of patients until August 2014. RESULTS: The most common MR findings for these tumors were a rounded mass (47.3%), well-defined borders (53.7%), ring enhancement (46.2%), type 3 curves (50.5%), hyperintensity within the tumor on T2-weighted sequences, high ADC values (1.04 × 10(-3) mm2/s), and increased capillary permeability (Kep) (0.94 min(-1)). No significant association was observed between the morphokinetic or pharmacokinetic characteristics and the time to progression. The in situ component in the surgical specimens was high, although its expression was low. During follow-up, 25% of patients had metastases, with a predilection for the visceral organs, and survival was low. CONCLUSION: Tumors with the triple-negative phenotype mostly presented in MR as rounded tumors with well-defined borders and ring enhancement. We found no significant association between the morphokinetic or pharmacokinetic characteristics and the time to progression.

Sobrediagnóstico en cribado de cáncer / Overdiagnosis in cancer screening

En los programas de diagnóstico precoz, se considera sobrediagnóstico al diagnóstico de una enfermedad que sin cribado nunca se hubiera diagnosticado, y como se espera que dicho diagnóstico no cause la muerte, se trata innecesariamente. El sobrediagnóstico es un sesgo del propio cribado y un efecto no deseado de la prevención secundaria y de la mejora de la sensibilidad de las técnicas diagnósticas. A priori es difícil de discriminar qué diagnósticos son los clínicamente relevantes y en cuáles se podría evitar el tratamiento. Para minimizar el efecto de sobrediagnóstico, el cribado debe dirigirse a población considerada de riesgo (AU)

In screening programs, overdiagnosis is defined as the detection of a disease that would have gone undetected without screening when that disease would not have resulted in morbimortality and was treated unnecessarily. Overdiagnosis is a bias inherent in screening and an undesired effect of secondary prevention and improved sensitivity of diagnostic techniques. It is difficult to discriminate a priori between clinically relevant diagnoses and those in which treatment is unnecessary. To minimize the effects of overdiagnosis, screening should be done in patients at risk (AU)

[Overdiagnosis in cancer screening]. / Sobrediagnóstico en cribado de cáncer.

In screening programs, overdiagnosis is defined as the detection of a disease that would have gone undetected without screening when that disease would not have resulted in morbimortality and was treated unnecessarily. Overdiagnosis is a bias inherent in screening and an undesired effect of secondary prevention and improved sensitivity of diagnostic techniques. It is difficult to discriminate a priori between clinically relevant diagnoses and those in which treatment is unnecessary. To minimize the effects of overdiagnosis, screening should be done in patients at risk.

Diagnóstico por imagen. Organización por Órganos/sistemas / Diagnosis through Images. Organisation by organs/systems

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Evaluation of the regular practice of breast cancer screening in a health area.

Breast cancer screening has proved to be efficacious only in clinical trials or structured programs. However, little is known of its effectiveness as a regular practice. This study is an assessment of breast cancer screening in regular practice in a Spanish area of 350,000 inhabitants through analysis of existing sources of information. It is evident that this screening is insufficient, inefficient, very variable, nonspecific, and probably ineffective, although there is insufficient information to prove it. The immediate implementation of a well-structured and accredited screening program is essential to overcome the current limitations.

[Massive hemoptysis secondary to mycotic aortic aneurysm]. / Hemoptisis masiva secundaria a aneurisma micótico aórtico.

A case of aortic aneurysms caused by fungus, following a sepsis of prostatic origin which produced the death of the patient after a massive hemoptysis, is presented. The postmortem study showed an aortic-pulmonary fistula as the cause of massive hemoptysis. We comment on the clinical features and the etiology of the different types of mycotic aneurysms. The advances in diagnosis techniques, the suspicion and the medical-surgical therapy are the factors which improved the prognosis of this serious disease.