Breast-Conserving Surgery Guided with Magnetic Seeds vs. Wires: A Single-Institution Experience.

PURPOSE: The aim of this study is to describe our initial experience using magnetic seeds (Magseed®) to guide breast-conserving surgery in non-palpable breast lesions and compare the use of magnetic seed with wires to guide breast-conserving surgery in terms of clinical and pathological characteristics. METHODS: We performed a retrospective study including all breast-conserving surgeries for non-palpable breast lesions under 16 mm from June 2018 to May 2021. We compared breast-conserving surgeries guided with magnetic seeds (Magseed®) to those guided with wires, analyzing tumor and patient characteristics, surgical time, and pathological results of the surgical specimens. RESULTS: Data from 225 cases were collected, including 149 cases guided by magnetic seeds and 76 cases guided by wires. The breast lesion was localized in every case. Both cohorts were similar regarding clinical and pathological characteristics. We found significant statistical differences (p < 0.02) in terms of the median volume (cm3) of the excised specimen, which was lower (29.3%) in the magnetic seed group compared with the wire group (32.5 [20.5-60.0]/46.0 [20.3-118.7]). We did not find significant differences regarding surgical time (min) or the affected or close margins. CONCLUSION: In our experience, the use of magnetic seed (Magseed®) is a feasible option to guide breast-conserving surgery of non-palpable lesions and enabled us to resect less breast tissue.

Surgical Interest of an Accurate Real-World Prediction of Primary Systemic Therapy Response in HER2 Breast Cancers.

Human epidermal growth factor receptor 2 (HER2)-enriched breast cancers (BC) present the highest rates of pathological response to primary systemic therapy (PST), but they are also the ones that tend to be larger at diagnosis, with microcalcifications and, often, with axillary involvement. If we do not have a reliable method to predict the degree of response, we may not be able to transfer the benefits of PST to surgery. The post-PST surgery planning is guided by the findings in the magnetic resonance imaging (MRI), whose predictive capacity, although high, is far from optimal. Thus, it seems interesting to find other variables to improve it. A retrospective observational study including women with HER2 BC treated with PST and further surgery was conducted. Information regarding clinical, radiological, and histopathological variables was gathered from a total of 132 patients included. Radiological complete response (rCR) was achieved in 65.9% of the sample, and pathological complete response (pCR), according to Miller and Payne criteria, in 58.3% of cases. A higher Ki67 value, the absence of Hormonal Receptors expression, and an rCR was significantly related to a pCR finding. This information impacts directly in surgery planning, as it permits adjustment of the breast resection volume.

EMD-based data augmentation method applied to handwriting data for the diagnosis of Essential Tremor using LSTM networks.

The increasing capacity of today's technology represents great advances in diagnosing diseases using standard procedures supported by computer science. Deep learning techniques are able to extract the characteristics of temporal signals to study their patterns and diagnose diseases such as essential tremor. However, these techniques require a large amount of data to train the neural network and achieve good results, and the more data the network has, the more accurate the final model implemented. In this work we propose the use of a data augmentation technique to improve the accuracy of a Long short-term memory system in the diagnosis of essential tremor. For this purpose, the multivariate Empirical Mode Decomposition method will be used to decompose the original temporal signals collected from control subjects and patients with essential tremor. The time series obtained from the decomposition, covering different frequency ranges, will be randomly shuffled and combined to generate new artificial samples for each group. Then, both the generated artificial samples and part of the real samples will be used to train the LSTM network, and the remaining original samples will be used to test the model. The experimental results demonstrate the capability of the proposed method, which is compared to a set of 10 different data augmentation methods, and in all cases outperforms all other methods. In the best case, the proposed method increases the accuracy of the classifier from 83.20% to almost 93% when artificial samples are generated, which is a promising result when only small databases are available.

[The impact of the first wave of the COVID-19 pandemic on oncological patients in a tertiary hospital]. / Impacto de la primera ola de la pandemia de COVID-19 en la atención a pacientes oncológicos en un hospital terciario.

BLACKGROUND: The COVID-19 pandemic has over-burdened the Spanish health service and, as a result, affected the treatment and management of oncological patients. The aim of this study is to make a descriptive analysis of the management of oncological patients and the functioning of the tumour committees in the University Hospital La Paz (Madrid) during the first wave of the pandemic. MATERIALS AND METHODS: A descriptive analysis was made, based on the results of a questionnaire given to all 18 adult tumour committees and 3 paediatric tumour committees in the University Hospital La Paz. Further information was obtained from all the hospital services involved in the diagnosis and treatment of oncological patients. RESULTS: During the first wave of the pandemic, there was a significant decrease in diagnostic tests. For many weeks, the majority of oncological surgical procedures were delayed or referred to other hospitals. Highly beneficial systemic and radiotherapeutic treatments were maintained and preoperative treatment was increased. The diagnosis and treatment of paediatric tumours was unaltered. Tumour committees were affected but each one adjusted in a different way. All the departments involved in the diagnosis and treatment of oncological patients made contingency plans to minimalize the effect on patients. CONCLUSION: This study shows how the management of oncological patients and the functioning of tumour committees was affected during the COVID-19 pandemic.

The Clinical Impact of Neoadjuvant Endocrine Treatment on Luminal-like Breast Cancers and Its Prognostic Significance: Results from a Single-Institution Prospective Cohort Study.

Purpose: Neoadjuvant endocrine treatment (NET) has become a useful tool for the downstaging of luminal-like breast cancers in postmenopausal patients. It enables us to increase breast- conserving surgery (BCS) rates, provides an opportunity for us to assess in vivo NET effectiveness, and allows us to study any biological changes that may act as valid biomarkers. The purpose of this study was to evaluate the safety and effectiveness of NET, and to assess the role of Ki67 proliferation rate changes as an indicator of endocrine responsiveness. Methods: From 2016 to 2020, a single-institution cohort of patients, treated with NET and further surgery, was evaluated. In patients with Ki67 ≥ 10%, a second core biopsy was performed after four weeks. Information regarding histopathological and clinical changes was gathered. Results: A total of 115 estrogen receptor-positive (ER+)/HER2-negative patients were included. The median treatment duration was 5.0 months (IQR: 2.0−6.0). The median maximum size in the surgical sample was 40% smaller than the pretreatment size measured by ultrasound (p < 0.0001). The median pretreatment Ki67 expression was 20.0% (IQR: 12.0−30.0), and was reduced to 5.0% (IQR: 1.8−10.0) after four weeks, and to 2.0% (IQR: 1.0−8.0) in the surgical sample (p < 0.0001). BCS was performed on 98 patients (85.2%). No pathological complete responses were recorded. A larger Ki67 fold change after four weeks was significantly related to a PEPI score of zero (p < 0.002). No differences were observed between luminal A- and B-like tumors, with regard to fold change and PEPI score. Conclusions: In our cohort, NET was proven to be effective for tumor size and Ki67 downstaging. This resulted in a higher rate of conservative surgery, aided in therapeutic decision making, provided prognostic information, and constituted a safe and well-tolerated approach.

Impacto de la primera ola de la pandemia de COVID-19 en la atención a pacientes oncológicos en un hospital terciario / The impact of the first wave of the COVID-19 pandemic on oncological patients in a tertiary hospital

Introducción: La pandemia de COVID-19 ha puesto en una situación de sobrecarga al sistema sanitario español y, como consecuencia, la atención al paciente oncológico se ha visto afectada. El objetivo de este estudio es realizar un análisis descriptivo de la atención al paciente oncológico y del funcionamiento de los Comités de Tumores en el Hospital Universitario la Paz durante la primera ola de la pandemia. Material y métodos: Análisis descriptivo basado en los resultados obtenidos a través de una encuesta realizada a los 18 comités de tumores del adulto y a los tres comités de tumores infantiles del Hospital Universitario La Paz. El estudio se completó con la información obtenida a partir de los servicios implicados en el diagnóstico y tratamiento de pacientes oncológicos. Resultados: Durante la primera ola se disminuyó significativamente la realización de técnicas diagnósticas. Se suspendió la cirugía de la mayoría de tumores en el hospital durante varias semanas, retrasándose o derivándose a otro centro. Se mantuvieron los tratamientos sistémicos y radioterápicos asociados a un mayor beneficio, incrementándose la frecuencia de la administración preoperatoria. Sin embargo, el diagnóstico y tratamiento de los tumores infantiles no sufrió alteraciones. El funcionamiento de los comités de tumores se vio afectado, y cada uno de ellos llevó a cabo ajustes diferentes. Los diferentes servicios implicados realizaron planes de contingencia para minimizar el impacto sobre los pacientes. Conclusión: Este estudio muestra cómo la atención al paciente oncológico y el funcionamiento de los comités de tumores se vio afectado de forma generalizada durante la pandemia por COVID-19.(AU)

Background: The COVID-19 pandemic has over-burdened the Spanish health service and, as a result, affected the treatment and management of oncological patients. The aim of this study is to make a descriptive analysis of the management of oncological patients and the functioning of the tumour committees in the University Hospital La Paz (Madrid) during the first wave of the pandemic. Materials and methods: A descriptive analysis was made, based on the results of a questionnaire given to all 18 adult tumour committees and 3 paediatric tumour committees in the University Hospital La Paz. Further information was obtained from all the hospital services involved in the diagnosis and treatment of oncological patients. Results: During the first wave of the pandemic, there was a significant decrease in diagnostic tests. For many weeks, the majority of oncological surgical procedures were delayed or referred to other hospitals. Highly beneficial systemic and radiotherapeutic treatments were maintained and preoperative treatment was increased. The diagnosis and treatment of paediatric tumours was unaltered. Tumour committees were affected but each one adjusted in a different way. All the departments involved in the diagnosis and treatment of oncological patients made contingency plans to minimalize the effect on patients. Conclusion: This study shows how the management of oncological patients and the functioning of tumour committees was affected during the COVID-19 pandemic.(AU)

Analysis of Fine Motor Skills in Essential Tremor: Combining Neuroimaging and Handwriting Biomarkers for Early Management.

Essential tremor (ET) is a highly prevalent neurological disorder characterized by action-induced tremors involving the hand, voice, head, and/or face. Importantly, hand tremor is present in nearly all forms of ET, resulting in impaired fine motor skills and diminished quality of life. To advance early diagnostic approaches for ET, automated handwriting tasks and magnetic resonance imaging (MRI) offer an opportunity to develop early essential clinical biomarkers. In this study, we present a novel approach for the early clinical diagnosis and monitoring of ET based on integrating handwriting and neuroimaging analysis. We demonstrate how the analysis of fine motor skills, as measured by an automated Archimedes' spiral task, is correlated with neuroimaging biomarkers for ET. Together, we present a novel modeling approach that can serve as a complementary and promising support tool for the clinical diagnosis of ET and a large range of tremors.

The Present and Future of Neoadjuvant Endocrine Therapy for Breast Cancer Treatment.

Endocrine therapy (ET) has established itself as an efficacious treatment for estrogen receptor-positive (ER+) breast cancers, with a reduction in recurrence rates and increased survival rates. The pre-surgical approach with chemotherapy (NCT) has become a common form of management for large, locally advanced, or high-risk tumors. However, a good response to NCT is not usually expected in ER+ tumors. Good results with primary ET, mainly in elderly women, have encouraged studies in other stages of life, and nowadays neoadjuvant endocrine treatment (NET) has become a useful approach to many ER+ breast cancers. The aim of this review is to provide an update on the current state of art regarding the present and the future role of NET.

External validation of a prognostic model based on total tumor load of sentinel lymph node for early breast cancer patients.

BACKGROUND: A prognostic model based on the results of molecular analysis of sentinel lymph nodes (SLN) is needed to replace the information that staging the entire axilla provided. The aim of the study is to conduct an external validation of a previously developed model for the prediction of 5-year DFS in a group of breast cancer patients that had undergone SLN biopsy assessed by the One Step Nucleic Acid Amplification (OSNA) method. METHODS: We collected retrospective data of 889 patients with breast cancer, who had not received systemic treatment before surgery, and who underwent SLN biopsy and evaluation of all SLN by OSNA. The discrimination ability of the model was assessed by the area under the ROC curve (AUC ROC), and its calibration by comparing 5-years DFS Kaplan-Meier estimates in quartile groups of model predicted probabilities (MPP). RESULTS: The AUC ROC ranged from 0.78 (at 2 years) to 0.73 (at 5 years) in the training set, and from 0.78 to 0.71, respectively, in the validation set. The MPP allowed to distinguish four groups of patients with heterogeneous DFS (log-rank test p < 0.0001). In the highest risk group, the HR were 6.04 [95% CI 2.70, 13.48] in the training set and 4.79 [2.310, 9.93] in the validation set. CONCLUSIONS: The model for the prediction of 5-year DFS was successfully validated using the most stringent form of validation, in centers different from those involved in the development of the model. The external validation of the model confirms its utility for the prediction of 5-year DFS and the usefulness of the TTL value as a prognostic variable.

Empleo actual de la hormonoterapia neoadyuvante en cáncer de mama: resultados de una encuesta realizada en España / Current use of neoadjuvant endocrine treatment for breast cancer: results of a survey conducted in Spain

OBJETIVO: Establecer el estado actual del empleo de hormonoterapia en neoadyuvancia (HTNA) en las distintas unidades de patología mamaria del territorio nacional. MATERIAL Y MÉTODOS: Se confeccionó una encuesta electrónica de 14 preguntas que se envió a los socios de la Sociedad Española de Senología y Patología Mamaria (SESPM) así como a miembros de otros centros del ámbito público y privado. RESULTADOS: Se obtuvieron 79 respuestas. El 74,7% correspondían a centros del ámbito público. El 77,2% afirman emplear HTNA, si bien la mayoría (44,3%) solo en caso de mujeres ancianas pluripatológicas. El seguimiento de las pacientes corre a cargo del oncólogo médico en el 62,0% de los casos, siendo la exploración (64,7%), la resonancia (55,9%) y la ecografía los métodos más empleados en el seguimiento. El fármaco más utilizado es el letrozol (45,5%) y la duración habitual del tratamiento es de 3-6meses en casi de la mitad de los casos (43,0%). El 82,2% de los encuestados afirman realizar HTNA en caso de axila positiva, si bien casi la mitad (47,6%) la restringen al caso de mujer anciana con comorbilidad. La alternativa en caso de no respuesta es la cirugía en el 78,5% de los casos. El 72,2% de los encuestados creen que la posibilidad de realizar una plataforma genómica en la biopsia inicial les animaría a emplear más la HTNA. CONCLUSIONES: La HTNA es un método empleado por las unidades de mama de forma habitual, si bien su uso queda relegado por lo general a mujeres ancianas con comorbilidades

OBJECTIVES: To establish the current state of the use of neoadjuvant endocrine treatment (NET) for breast cancer in breast cancer units (BCU) in Spain. MATERIAL AND METHODS: A 14-question electronic survey was designed and sent on-line to members of the Spanish Society of Senology and Breast Disease (SESPM) as well as to other breast cancer units in public and private healthcare centres in Spain. RESULTS: A total of 79 surveys were completed. Nearly three quarters (74.7%) of respondents worked in public centres, and 77.2% used NET, although most (44.3%) only used it in elderly or frail women. Follow-up was carried out by a medical oncologist in 62.0% of the cases. The preferred follow-up methods were clinical examination (64.7%), MRI (55.9%) and ultrasound (48.5%). Letrozole was the chosen drug in 45.5%, and 43.0% maintained treatment for 3-6months. Most (82.2%) respondents used NET when there were axillary-positive nodes but, of these, 47.6% restricted it to frail elderly women. Surgery was the alternative treatment in 78.5% of non-responders. In all, 72.2% of the respondents believed that the possibility of performing a genomic profile in the core biopsy would increase the chances of NET use. CONCLUSIONS: NET is a frequently employed method in BCUs in Spain, although its use is usually relegated to elderly or frail women

Modelo predictivo de metástasis en ganglios axilares no centinela en cáncer de mama. Variables emergentes. Estudio MOTTO, parte I / Predictive model of breast cancer metastasis in axillary non-sentinel lymph nodes. Emergent variables. The MOTTO study, part I

INTRODUCCIÓN: La carga tumoral total (CTT) obtenida del estudio OSNA de cada uno de los ganglios centinela ha sido identificada como el predictor más potente de metástasis en ganglios linfáticos axilares no centinela. Por otra parte, los distintos subtipos moleculares (SM) de cáncer de mama difieren entre ellos de forma significativa no solo en términos de incidencia, pronóstico y tratamiento, sino también respecto al patrón de afectación metastásica axilar. Nuestra hipótesis consiste en que la predicción de enfermedad metastásica en la linfadenectomía axilar puede mejorar aplicando un modelo predictivo basado en la CTT y el subtipo intrínseco del tumor. OBJETIVO: Evaluar el impacto del SM subrogado inmunohistoquímicamente en la predicción metastásica de los ganglios axilares no centinela con base en la CTT. MATERIAL Y MÉTODOS: Estudio retrospectivo, multicéntrico europeo, que incluye 683 pacientes procedentes de 9 hospitales. RESULTADOS: El análisis univariante identificó 6 variables independientes que correlacionan significativamente con la afectación metastásica axilar no centinela. De ellas, las variables valor logarítmico de la CTT, diámetro tumoral y SM diagnosticado por inmunohistoquímica fueron seleccionadas para el modelo multivariante. Las odds ratio estimadas por el modelo fueron valor logarítmico de la CTT 1.527 (IC 95% 1.299-1.796), diámetro tumoral 1.503 (IC 95% 1.062-2.129) y SM 2.195 (IC 95% 1.246-3.867). CONCLUSIONES: El SM, la CTT y el diámetro tumoral son los predictores más potentes de afectación axilar y deben ser incluidos en los algoritmos diagnósticos como variables esenciales para la toma de decisiones terapéuticas sobre la axila

INTRODUCTION: The total tumour load (TTL) obtained from OSNA study in each of the sentinel lymph nodes has been identified as the most powerful predictor of axillary non-sentinel lymph node metastasis. In addition, the distinct molecular subtypes (MS) of breast cancer differ significantly not only in terms of incidence, prognosis and treatment but also in terms of the pattern of axillary metastatic involvement. We hypothesised that the prediction of metastatic disease in axillary lymphadenectomy could be enhanced by applying a predictive model based on the TTL and the intrinsic tumour subtype. OBJECTIVE: To evaluate the impact of the MS identified by immunohistochemistry on prediction of metastatic disease in axillary non-sentinel lymph nodes based on TTL. MATERIAL AND METHODS: Retrospective, European multicenter study including 683 patients from 9 hospitals. RESULTS: Univariate analysis identified 6 variables that were significantly correlated with axillary non-sentinel metastasis. Of these, the variables logarithmic value of the TTL, tumour diameter and MS diagnosed by immunohistochemistry were selected for multivariate analysis. The odds ratio estimated by the model were: logarithmic value of the TTL 1.527 (95% CI: 1.299-1.796), tumour diameter 1.503 (95% CI: 1.062-2.129) and MS 2.195 (95% CI: 1.246-3.867). CONCLUSIONS: The strongest predictors of axillary involvement were MS, TTL and tumour diameter. These variables should be included in diagnostic algorithms as essential parameters for therapeutic decision-making on the axilla

Fibromatosis mamaria. Reporte de dos casos clínicos y revisión bibliogáfica / Mammary fibromatosis. Two case report and review of literatura

RESUMEN Introducción y objetivos: La fibromatosis produce tumores benignos pero localmente agresivos, que afectan a los tejidos blandos. A nivel mamario, representa tan sólo el 0.2% de las neoplasias de la mama. Nuestro objetivo con el presente artículo es profundizar en el conocimiento de la fibromatosis mamaria, a través del estudio de dos casos clínicos, mostrando sus características clínico-radiológicas e histológicas, e intentar establecer un protocolo de actuación adecuado. Métodos: Estudio retrospectivo de dos casos clínicos de fibromatosis mamaria diagnosticados en el Hospital Universitario La Paz entre los años 2018 y 2019. Resultados: Presentaremos dos pacientes con diagnóstico de fibromatosis mamaria, ambas debutaron con la autopalpación de un nódulo mamario. Al realizarles una ecografía, se visualizó un nódulo sólido, mal definido y axila ecográficamente negativa, que precisó de biopsia-aspiración con aguja gruesa. En los dos casos, se decidió resección quirúrgica de la lesión. Seguimiento mediante exploración mamaria y pruebas de imagen periódicas. Conclusiones: Aunque se trata de una entidad benigna, la fibromatosis mamaria puede simular un proceso maligno, tanto clínica como radiológicamente, por lo que precisa de un estudio histológico. A pesar de que la diseminación metastásica es muy poco frecuente, no se debe olvidar el carácter agresivo a nivel local de esta patología, y sus altas tasas de recurrencia. Como tratamiento, se debe realizar una resección quirúrgica, aunque recientemente se ha contemplado la opción de vigilancia estrecha sin tratamiento. No existe evidencia científica que justifique la utilización de otros tratamientos como la radioterapia o el tratamiento hormonal.

ABSTRACT Introduction and objectives: Fibromatosis produces benign but locally aggressive tumours that affect soft tissues. At breast level, it represents only 0.2% of breast neoplasms. Our goal with this article is to increase knowledge on breast fibromatosis, through the study of two clinical cases; explaining their clinical-radiologic and histological characteristics. Additionally, try to establish an adequate protocol, for the management of the disease and for its subsequent monitoring. Methods: A retrospective study about two clinical cases of breast fibromatosis diagnosed in La Paz Hospital between 2018-2019. Results: both patients presented with clinical manifestations, autopalpation of a breast nodule. A breast ultrasound was performed and a solid nodule was visualized, with poorly defined edges and ecographically negative armpit. A core needle biopsy was performed to confirm the histological diagnosis. In both clinical cases, the treatment was surgical resection of the lesion. Periodic revisions are being performed in order to exclude recurrence. Conclusions: Although it is a benign disease, breast fibromatosis can simulate a malignancy, both in a clinical and radiological way, so histological study is mandatory in order to achieve an accurate diagnosis. Even metastatic dissemination is extremely rare, the local aggressive nature and high rates of recurrence for fibromatosis makes surgical excision, with wide free margins, the most important tool in treatment, although the possibility of close surveillance without treatment is recently being contemplated. There is no scientific evidence to justify the use of other treatments such as radiotherapy or hormonal treatment.

Necesidad de vaciamiento axilar en el cáncer de mama. Rigor en los métodos predictivos / Need for axillary lymphadenectomy in breast cancer. Rigour in predictive methods

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Discrete Cosine Transform for the Analysis of Essential Tremor.

Essential tremor (ET) is the most common movement disorder. In fact, its prevalence is about 20 times higher than that of Parkinson's disease. In addition, studies have shown that a high percentage of cases, between 50 and 70%, are estimated to be of genetic origin. The gold standard test for diagnosis, monitoring and to differentiate between both pathologies is based on the drawing of the Archimedes' spiral. Our major challenge is to develop the simplest system able to correctly classify Archimedes' spirals, therefore we will exclusively use the information of the x and y coordinates. This is the minimum information provided by any digitizing device. We explore the use of features from drawings related to the Discrete Cosine Transform as part of a wider cross-study for the diagnosis of essential tremor held at Biodonostia. We compare the performance of these features against other classic and already analyzed ones. We outperform previous results using a very simple system and a reduced set of features. Because the system is simple, it will be possible to implement it in a portable device (microcontroller), which will receive the x and y coordinates and will issue the classification result. This can be done in real time, and therefore without needing any extra job from the medical team. In future works these new drawing-biomarkers will be integrated with the ones obtained in the previous Biodonostia study. Undoubtedly, the use of this technology and user-friendly tools based on indirect measures could provide remarkable social and economic benefits.

Comparison of risk classification between EndoPredict and MammaPrint in ER-positive/HER2-negative primary invasive breast cancer.

PURPOSE: To compare the concordance in risk classification between the EndoPredict and the MammaPrint scores obtained for the same cancer samples on 40 estrogen-receptor positive/HER2-negative breast carcinomas. METHODS: Formalin-fixed, paraffin-embedded invasive breast carcinoma tissues that were previously analyzed with MammaPrint as part of routine care of the patients, and were classified as high-risk (20 patients) and low-risk (20 patients), were selected to be analyzed by the EndoPredict assay, a second generation gene expression test that combines expression of 8 genes (EP score) with two clinicopathological variables (tumor size and nodal status, EPclin score). RESULTS: The EP score classified 15 patients as low-risk and 25 patients as high-risk. EPclin re-classified 5 of the 25 EP high-risk patients into low-risk, resulting in a total of 20 high-risk and 20 low-risk tumors. EP score and MammaPrint score were significantly correlated (p = 0.008). Twelve of 20 samples classified as low-risk by MammaPrint were also low-risk by EP score (60%). 17 of 20 MammaPrint high-risk tumors were also high-risk by EP score. The overall concordance between EP score and MammaPrint was 72.5% (κ = 0.45, (95% CI, 0.182 to 0.718)). EPclin score also correlated with MammaPrint results (p = 0.004). Discrepancies between both tests occurred in 10 cases: 5 MammaPrint low-risk patients were classified as EPclin high-risk and 5 high-risk MammaPrint were classified as low-risk by EPclin and overall concordance of 75% (κ = 0.5, (95% CI, 0.232 to 0.768)). CONCLUSIONS: This pilot study demonstrates a limited concordance between MammaPrint and EndoPredict. Differences in results could be explained by the inclusion of different gene sets in each platform, the use of different methodology, and the inclusion of clinicopathological parameters, such as tumor size and nodal status, in the EndoPredict test.

Mioepitelioma maligno recidivante de la mama, una evolución poco frecuente / Recurrent malignant myoepithelioma of the breast, an uncommon progression

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Evaluación de la respuesta patológica a la quimioterapia neoadyuvante en mama y axila según los fenotipos moleculares del cáncer de mama / Evaluation of pathological response to neoadjuvant chemotherapy in the breast and axilla according to molecular phenotypes of breast cancer

Objetivo. Evaluar la respuesta patológica a la quimioterapia neoadyuvante tanto en la mama como en la axila según los fenotipos moleculares de cáncer de mama. Pacientes y método. Estudio retrospectivo entre enero de 2011 y diciembre de 2014 que incluye a las pacientes con cáncer de mama infiltrante intervenidas tras tratamiento con quimioterapia neoadyuvante. Hemos considerado 5 fenotipos moleculares según los criterios de St. Gallen 2013. La respuesta patológica en mama y en axila se ha evaluado según los criterios de Sataloff. Resultados. Se recogen los datos de un total de 181 pacientes tratadas con quimioterapia neoadyuvante, de las que a 96 se les realizó linfadenectomía axilar. El 34,3% tenían un fenotipo molecular Her-2, 28,7% basal, 25,4% luminal B y 11,6% luminal A. En los luminal A, el 28,5% han tenido una respuesta patológica completa en la mama frente al 21,4% en la axila; en los luminal B, 34,7 frente al 13,7%; en los luminal B Her-2, 65 frente a 41,1%; en los Her-2, 95,4 frente a 70,5%; en los basales, 59,6 frente a 36,8%. Globalmente, la respuesta patológica completa en la mama ha sido del 55,2% frente al 35,4% en axila. Conclusiones. Los fenotipos moleculares Her-2 y basal presentan mayores tasas de respuesta patológica completa tras quimioterapia neoadyuvante. No existe correlación entre la respuesta patológica observada en la mama y en la axila. La respuesta axilar es, en términos generales, menor que en la mama (AU)

Objective. To evaluate pathological response to neoadjuvant chemotherapy in the breast and axilla according to the different molecular phenotypes of breast cancer. Patients and method. A retrospective study was performed between January 2011 and December 2014, including those patients with infiltrating carcinoma who underwent surgery after neoadjuvant chemotherapy. Five molecular phenotypes were considered according to St. Gallen's 2013 criteria. Pathological axillary and breast response were evaluated following the Sataloff system. Results. We analysed data from 181 patients treated with neoadjuvant chemotherapy. Of these, an axillary lymphadenectomy was performed in 96 patients. In total, 34.3% of the patients belonged to the Her-2 group, 28.7% to the basal group, 25.4% to the luminal B group and 11.6% to the luminal A group. In luminal A tumours, pathological complete response was observed in the breast in 28.5% of the patients and in the axilla in 21.4%; in luminal B group, 34.7 versus 13.7%; in luminal B-Her-2, 65 versus 41.1%; in Her-2 positive tumours, pathological complete response was observed in the breast in 95.4% of the patients versus 70.5% in the axilla; in the basal group, pathological complete response was achieved in the breast in 59.6% versus only 36.8% in the axilla. Overall, pathological complete response was observed in the breast in 55.2% compared with 35.4% in the axilla. Conclusions. Her-2 and basal phenotypes of breast cancer show better rates of complete pathological complete response after neoadjuvant chemotherapy. No correlation was found between pathological response in the breast and the axilla. Axillary response was worse than that found in the breast (AU)

[Co-expression of estrogen receptors and Her2/neu in breast cancer. Neoadjuvant chemotherapy sentinel lymph node and hormonotherapy]. / Cancer de mama con Her-2-neu y receptores hormonales positivos. Quimioterapia neoadyuvante, biopsia de ganglio centinela y tratamiento hormonal.

Neoadjuvant chemotherapy is an interesting option in the therapy of some breast cancer cases. Cases in which the timing for sentinel lymph node biopsy is controversial. Co-expression of estrogen receptors and Her2/neu (c-erbB-2) in breast cancer may imply hormone resistance, especially to tamoxifen. We present a clinic case with co-expression of estrogen receptors and Her2/neu that was treated with neoadjuvant chemotherapy and previous sentinel lymph node biopsy followed by breasttumorectomy with axillar lymphadenectomy, radiotherapy and hormonotherapy with letrozol, geserelina and trastuzumab. A good treatment response was found.