Association of coffee intake and its polyphenols with mammographic findings in women who visited the Brazilian Public Health Service / Asociación de la ingesta de café y sus polifenoles con hallazgos mamográficos en mujeres atendidas en el Servicio de Salud Pública de Brasil

Objective: this study aimed to evaluate if there is an association of intake of coffee and its polyphenols with mammographic findings in women treated at a breast care service unit of the Unified Health System (SUS), Brazil. Research methods and procedures: this was a cross-sectional study with 532 women treated at a health service. The participants were divided according to their mammographic reports into two groups: without and with altered findings. Two 24-h dietary recalls were applied and coffee consumption was categorized into three groups (less than 1 cup, 1 to 3 cups, and more than 3 cups). Phenolic acids were determined using the Phenol Explorer program. The intake of polyphenols was calculated by adding the values obtained from the total amount of coffee consumed during the day. The Multiple Source Method (MSM) was applied to analyze the usual intake. Results: of the 532 women, 178 (33.5 %) had altered mammographic findings. The participants' average daily coffee intake was 193.4 mL. No significant association was found between coffee consumption and mammographic findings. However, it was found that the second tertile of polyphenols was a protective factor for breast changes. Conclusion: Coffee polyphenols are protective against breast changes in the group evaluated and, thus, can help prevent breast cancer. (AU)

Objetivo: este estudio tuvo como objetivo evaluar si existe una asociación de la ingesta de café y sus polifenoles con los hallazgos mamográficos de mujeres tratadas en una unidad de patología mamaria del Sistema Unificado de Salud (SUS), Brasil. Métodos y procedimientos de investigación: este fue un estudio transversal con 532 mujeres tratadas en un servicio de salud. Las participantes se dividieron de acuerdo con sus informes mamográficos en dos grupos: sin y con hallazgos alterados. Se aplicaron dos registros dietéticos de 24 horas y el consumo de café se clasificó en tres grupos (menos de 1 taza, 1 a 3 tazas y más de 3 tazas). Los ácidos fenólicos se determinaron utilizando el programa Phenol Explorer. La ingesta de polifenoles se calculó sumando los valores obtenidos de la cantidad total de café consumido durante el día. Se aplicó el método de fuentes múltiples (MSM) para analizar la ingesta habitual. Resultados: de las 532 mujeres, 178 (33,5 %) tenían hallazgos mamográficos alterados. La ingesta diaria promedio de café de los participantes fue de 193,4 ml. No se encontró una asociación significativa entre el consumo de café y los hallazgos mamográficos. Sin embargo, se encontró que el segundo tercil de polifenoles era un factor protector para los cambios mamarios. Conclusión: los polifenoles del café son protectores contra los cambios mamarios en el grupo evaluado y, por lo tanto, podrían ayudar a prevenir el cáncer de mama. (AU)

Association of coffee intake and its polyphenols with mammographic findings in women who visited the Brazilian Public Health Service.

Introduction: Objective: this study aimed to evaluate if there is an association of intake of coffee and its polyphenols with mammographic findings in women treated at a breast care service unit of the Unified Health System (SUS), Brazil. Research methods and procedures: this was a cross-sectional study with 532 women treated at a health service. The participants were divided according to their mammographic reports into two groups: without and with altered findings. Two 24-h dietary recalls were applied and coffee consumption was categorized into three groups (less than 1 cup, 1 to 3 cups, and more than 3 cups). Phenolic acids were determined using the Phenol Explorer program. The intake of polyphenols was calculated by adding the values obtained from the total amount of coffee consumed during the day. The Multiple Source Method (MSM) was applied to analyze the usual intake. Results: of the 532 women, 178 (33.5 %) had altered mammographic findings. The participants' average daily coffee intake was 193.4 mL. No significant association was found between coffee consumption and mammographic findings. However, it was found that the second tertile of polyphenols was a protective factor for breast changes. Conclusion: Coffee polyphenols are protective against breast changes in the group evaluated and, thus, can help prevent breast cancer.

Introducción: Objetivo: este estudio tuvo como objetivo evaluar si existe una asociación de la ingesta de café y sus polifenoles con los hallazgos mamográficos de mujeres tratadas en una unidad de patología mamaria del Sistema Unificado de Salud (SUS), Brasil. Métodos y procedimientos de investigación: este fue un estudio transversal con 532 mujeres tratadas en un servicio de salud. Las participantes se dividieron de acuerdo con sus informes mamográficos en dos grupos: sin y con hallazgos alterados. Se aplicaron dos registros dietéticos de 24 horas y el consumo de café se clasificó en tres grupos (menos de 1 taza, 1 a 3 tazas y más de 3 tazas). Los ácidos fenólicos se determinaron utilizando el programa Phenol Explorer. La ingesta de polifenoles se calculó sumando los valores obtenidos de la cantidad total de café consumido durante el día. Se aplicó el método de fuentes múltiples (MSM) para analizar la ingesta habitual. Resultados: de las 532 mujeres, 178 (33,5 %) tenían hallazgos mamográficos alterados. La ingesta diaria promedio de café de los participantes fue de 193,4 ml. No se encontró una asociación significativa entre el consumo de café y los hallazgos mamográficos. Sin embargo, se encontró que el segundo tercil de polifenoles era un factor protector para los cambios mamarios. Conclusión: los polifenoles del café son protectores contra los cambios mamarios en el grupo evaluado y, por lo tanto, podrían ayudar a prevenir el cáncer de mama.

Association between dietary patterns and alteredmammographic findings / Asociación entre patrones dietéticos y hallazgos mamográficos alterados

Introduction: Breast cancer is one of the main types ofcancer in women. Previous studies assessed the relationshipbetween diet and breast cancer risk, however, studies thatevaluate the relationship between diet and mammographicfindings are scarce. Aim: To evaluate the association between dietary patternsand mammographic findings of women monitored by a mas-tology service of the Brazilian Unified Health System. Materials and Methods: Cross-sectional study that eval-uated data from 504 women. Two 24-hour dietary recallswere applied and dietary patterns were identified by principalcomponent factor analysis. The mammography reports wereclassified into normal and altered mammographic findings. Logistic regression models were applied to evaluate the asso-ciation between dietary patterns and mammographic findings.The analyses were performed in the software Stata and R andconsidered significant values of p <0.05. Results: Three dietary patterns was identified: “traditionalBrazilian” (rice, beans, red meat, breads, oils and fats andcoffees and teas), “Western” (sugar sweetened beverages, eggs, cakes, pies and cookies, fast-food snacks and, sweetsand desserts) and “prudent” (whole grains, fruits, vegetables,tubers and their products, dairy and chicken). Women withless adherence (OR 0.54 CI 95% 0.30:0.95) to the “traditionalBrazilian” dietary pattern had 46% lower odds for having al-tered mammographic findings. No associations were foundbetween “Western” and “prudent” dietary patterns with mam-mographic findings.(AU)

Higher carbohydrate quality index is associated with better adequate micronutrient consumption in Brazilian women.

Introduction: Introduction: inadequate consumption of micronutrients is an emerging public health problem that can compromise health. Objectives: to assess whether the quality of dietary carbohydrates is associated with the consumption of 13 micronutrients in a sample of women monitored by the Brazilian Unified Health System. Methods: this cross-sectional study included 648 women monitored by the Brazilian Unified Health System. The association between quality of dietary carbohydrates and adequacy of consumption of 13 micronutrients was investigated using logistic regression models adjusted for potential confounding variables. Results: the consumption of micronutrients increased as the quality of carbohydrates improved. The micronutrients with the highest prevalence of inadequate intake were vitamin A, magnesium, manganese, and thiamine. After adjustments using logistic regression models, women in the third tertile of the carbohydrate quality index were less likely to have an inadequate consumption of magnesium (odds ratio (OR), 0.29; 95 % confidence interval (CI), 0.14-0.59), manganese (OR, 0.32; 95% CI, 0.21-0.49), and copper (OR, 0.22; 95% CI, 0.12-0.37). Conclusions: intake of a higher quality of dietary carbohydrates is associated with improved adequacy in consumption of most micronutrients in women monitored by the Brazilian Unified Health System, especially magnesium, manganese, and copper, after adjustment using regression models.

Introducción: Introducción: el consumo inadecuado de micronutrientes es un problema de salud pública emergente que puede comprometer la salud. Objetivo: evaluar si la calidad de los carbohidratos de la dieta está asociada con el consumo de 13 micronutrientes en una muestra de mujeres monitoreadas por el Sistema Único de Salud de Brasil. Métodos: este estudio transversal incluyó a 648 mujeres monitoreadas por el Sistema Único de Salud de Brasil. La asociación entre la calidad de los carbohidratos de la dieta y la adecuación del consumo de 13 micronutrientes se investigó mediante modelos de regresión logística ajustados por posibles variables de confusión. Resultados: el consumo de micronutrientes aumentó a medida que mejoraba la calidad de los carbohidratos. Los micronutrientes con mayor prevalencia de ingesta inadecuada fueron: vitamina A, magnesio, manganeso y tiamina. Después de los ajustes mediante modelos de regresión logística, las mujeres del tercer tercil del índice de calidad de carbohidratos tenían menos probabilidades de tener un consumo inadecuado de magnesio (odds ratio (OR): 0,29; intervalo de confianza (IC) del 95 %: 0,14-0,59), manganeso (OR: 0,32 ; IC del 95 %: 0,21 a 0,49) y cobre (OR: 0,22; IC del 95 %: 0,12 a 0,37). Conclusiones: la ingesta de una mayor calidad de carbohidratos en la dieta se asocia con una mejor adecuación en el consumo de la mayoría de los micronutrientes en mujeres monitoreadas por el Sistema Único de Salud de Brasil, especialmente magnesio, manganeso y cobre, después del ajuste mediante modelos de regresión.

Women with Abnormal Mammographic Findings and High Neutrophil-to-Lymphocyte Ratio have the Worst Dietary Carbohydrate Quality Index.

INTRODUCTION: There are gaps in knowledge in breast cancer prevention studies focusing on interactions among mammographic findings, inflammation, and diet, especially those related to carbohydrates. OBJECTIVE: We aimed to verify the association among mammographic findings, inflammatory markers, and carbohydrate quality index (CQI) in women. METHODOLOGY: This was a cross-sectional study of 532 women assisted in a healthcare service. The enrolled women were divided into two groups according to their mammographic findings: those without and those with abnormal mammographic findings. Two 24-hour dietary reminders were applied, and CQI was determined based on four components: fibers, glycemic index, ratio between whole and total grains, and ratio between solid and total carbohydrates. The neutrophil-to-lymphocyte ratio (NLR) was calculated as an inflammatory marker. RESULTS: There were 178 (33.5%) women with abnormal mammographic findings, and 20 (3.8%) had NLR. There was no association between CQI and mammographic findings and NLR. Women with abnormal mammographic findings and high NLR had lower CQI (p = 0.039) and lower whole total ratio (p = 0.024). CONCLUSION: Women with abnormal findings and high NLR had worse CQI and worse overall total grain ratio.

Impact of the COVID-19 pandemic on breast cancer diagnosis

Introduction: In 2020, a total of 2,510 new cases of breast cancer were estimated in Ceará State, 14% above the figures of 2019. In the context of the COVID-19 pandemic, postponing screening and assessing the risks and benefits of elective procedures was needed, rescheduled until after their control. Objective: We sought to identify the impact of the COVID-19 pandemic in the care of a Reference Service for Breast Cancer Diagnosis. Methods: Time series study, with analysis of the production of the consultations carried out from March to June of the current year in a service located in Fortaleza City, Ceará State. Results: There was a reduction of up to 84% in the services offered, with emphasis on mammography and ultrasound procedures, with 95 and 100%, respectively. The diagnosis of new cases and the performance of surgeries reduced by up to 60 and 56%, respectively. The months with the greatest impact were April and May, with a progressive resumption in June. Conclusion: The study evaluated a reference service of relevance in the state reality. Considering that many cases are identified during screening, postponing mammograms contributed to a delayed diagnosis. The findings are believed to pose severe consequences, considering the annual increase in the incidence of the disease, the low screening coverage, the high number of cases in advanced staging, the ascending mortality, and the low supply of diagnostic services. Diverting attention exclusively to the pandemic represents a worldwide challenge, but cancer is an important cause of morbidity and mortality, and cannot be neglected. There is concern that delaying screening, diagnosis, and treatment of breast cancer may cost more lives than COVID-19 itself. Post-pandemic requires planning to promote harm reduction resulting from the delay in the diagnosis and treatment of the repressed demand, in a disaggregated and overloaded system.

Invasive ductal carcinoma: relationship between pathological characteristics and the presence of axillary metastasis in 220 cases.

Objective: to analyze the relation of anatomopathological features and axillary involvement in cases of invasive ductal carcinoma. Methods: this is a cross-sectional study of 220 breast cancer patients submitted to radical mastectomy or quadrantectomy with axilar emptying, from the Mastology Service of the Assis Chateaubriand Maternity School, Ceará, Brazil. We submitted the tumors to histological processing and determined the histological (HG), tubular (TG) and nuclear (NG) grades, and the mitotic index (MI) by the classification of Scarff-Bloom-Richadson, verified the presence of angiolymphatic invasion (AI) and measured the largest tumor diameter (TD). We then correlated these variables with the presence of axillary metastases. Results: the mean patients'age was 56.81 years ± 13.28. Tumor size ranged from 0.13 to 22 cm, with an average of 2.23cm ± 2.79. HG3, TG3 and NG3 prevailed, respectively 107 (48.6%), 160 (72.7%) and 107 (48.6%). Mitotic indexes 1, 2 and 3 presented a homogeneous distribution, respectively 82 (37.2%), 68 (31%) and 70 (31.8%). We observed no relation between the HG, TG and NG with the occurrence of axillary metastases (p=0.07, p=0.22 and p=0.21, respectively). Mitotic indices 2 and 3 were related with the occurrence of axillary metastases (p=0.03). Tumors larger than 2cm and cases that presented angiolymphatic invasion had a higher index of axillary metastases (p=0.0003 and p<0.0001). Conclusion: elevated mitotic indexes, tumors with a diameter greater than 2cm and the presence of angiolymphatic invasion were individuallyassociatedwith the occurrence of axillary metastases.

Objetivo: analisar a relação das características anatomopatológicas com o comprometimento axilar em casos de carcinoma ductal invasor. Métodos: estudo transversal de 220 pacientes com câncer de mama, submetidas à mastectomia radical ou quadrantectomia com esvaziamento axilar, oriundos do Serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil. Os tumores foram submetidos a processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN), índice mitótico (IM) pela classificação de Scarff-Bloom-Richadson, verificada a presença de invasão angiolinfática (IA) e mensurado o maior diâmetro do tumor (DT). Tais variáveis foram correlacionadas com a presença de metástases axilares. Resultados: a média de idade das pacientes foi 56,81 anos ± 13,28. O tamanho do tumor variou de 0,13 a 22 cm, com média de 2,23cm ± 2,79. Os GH3, GT3 e GN3 prevaleceram: n=107 (48,6%), n=160 (72,7%) e n=107 (48,6%), respectivamente. Os índices mitóticos 1, 2 e 3 apresentaram distribuição homogênea: n=82 (37,2%), n=68 (31%) e n=70 (31,8%), respectivamente. Não foi evidenciada relação do GH, GT e GN com a ocorrência de metástases axilares (p=0,07; p=0,22 e p=0,21). Índices mitóticos 2 e 3 apresentaram relação com a o ocorrência de metástases axilares (p=0,03). Tumores maiores do que 2cm e casos com invasão angiolinfática apresentaram maior índice de metástases axilares (p=0,0003 e p<0,0001). Conclusão: índices mitóticos elevados, tumores com diâmetro maior do que 2cm e presença de invasão angiolinfática apresentaram isoladamente relação com a ocorrência de metástases axilares.

Invasive ductal carcinoma: relationship between pathological characteristics and the presence of axillary metastasis in 220 cases / Carcinoma ductal invasor: relação de características anatomopatológicas com a presença de metástases axilares em 220 casos

ABSTRACT Objective: to analyze the relation of anatomopathological features and axillary involvement in cases of invasive ductal carcinoma. Methods: this is a cross-sectional study of 220 breast cancer patients submitted to radical mastectomy or quadrantectomy with axilar emptying, from the Mastology Service of the Assis Chateaubriand Maternity School, Ceará, Brazil. We submitted the tumors to histological processing and determined the histological (HG), tubular (TG) and nuclear (NG) grades, and the mitotic index (MI) by the classification of Scarff-Bloom-Richadson, verified the presence of angiolymphatic invasion (AI) and measured the largest tumor diameter (TD). We then correlated these variables with the presence of axillary metastases. Results: the mean patients'age was 56.81 years ± 13.28. Tumor size ranged from 0.13 to 22 cm, with an average of 2.23cm ± 2.79. HG3, TG3 and NG3 prevailed, respectively 107 (48.6%), 160 (72.7%) and 107 (48.6%). Mitotic indexes 1, 2 and 3 presented a homogeneous distribution, respectively 82 (37.2%), 68 (31%) and 70 (31.8%). We observed no relation between the HG, TG and NG with the occurrence of axillary metastases (p=0.07, p=0.22 and p=0.21, respectively). Mitotic indices 2 and 3 were related with the occurrence of axillary metastases (p=0.03). Tumors larger than 2cm and cases that presented angiolymphatic invasion had a higher index of axillary metastases (p=0.0003 and p<0.0001). Conclusion: elevated mitotic indexes, tumors with a diameter greater than 2cm and the presence of angiolymphatic invasion were individuallyassociatedwith the occurrence of axillary metastases.

RESUMO Objetivo: analisar a relação das características anatomopatológicas com o comprometimento axilar em casos de carcinoma ductal invasor. Métodos: estudo transversal de 220 pacientes com câncer de mama, submetidas à mastectomia radical ou quadrantectomia com esvaziamento axilar, oriundos do Serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil. Os tumores foram submetidos a processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN), índice mitótico (IM) pela classificação de Scarff-Bloom-Richadson, verificada a presença de invasão angiolinfática (IA) e mensurado o maior diâmetro do tumor (DT). Tais variáveis foram correlacionadas com a presença de metástases axilares. Resultados: a média de idade das pacientes foi 56,81 anos ± 13,28. O tamanho do tumor variou de 0,13 a 22 cm, com média de 2,23cm ± 2,79. Os GH3, GT3 e GN3 prevaleceram: n=107 (48,6%), n=160 (72,7%) e n=107 (48,6%), respectivamente. Os índices mitóticos 1, 2 e 3 apresentaram distribuição homogênea: n=82 (37,2%), n=68 (31%) e n=70 (31,8%), respectivamente. Não foi evidenciada relação do GH, GT e GN com a ocorrência de metástases axilares (p=0,07; p=0,22 e p=0,21). Índices mitóticos 2 e 3 apresentaram relação com a o ocorrência de metástases axilares (p=0,03). Tumores maiores do que 2cm e casos com invasão angiolinfática apresentaram maior índice de metástases axilares (p=0,0003 e p<0,0001). Conclusão: índices mitóticos elevados, tumores com diâmetro maior do que 2cm e presença de invasão angiolinfática apresentaram isoladamente relação com a ocorrência de metástases axilares.

Carcinoma ductal invasor: comparação dosgraus histológicos entre tumor primário e metástase axilar / Invasive ductal carcinoma: comparison of histological gradebetween primary tumor and axillary metastasis

Objetivo: Estabelecer o grau histológico das metástases axilares em casos de câncer de mama do tipo ductal invasor e comparar com os achados do tumor primário. Métodos: Estudo transversal de envolvendo 69 casos de câncer de mama do tipo ductal invasivo, oriundos do serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil, com suas respectivas metástases axilares. Os tumores primários da mama e os linfonodos metastáticos foram submetidos ao processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN) e índice mitótico (IM) na mama e na axila pela classificação de Scarff-Bloom-Richadson. Resultados: Os GH mais elevados predominaram entre os tumores primários, sendo 52,2% classificados como GH 3. Quando comparadas ao tumor primário, as metástases axilares evidenciaram uma frequência maior de GH 3 (66,7%), GT 3 (85,5%), GN 3 (58%) e GM 2 (58%). A formação tubular foi menor nas metástases axilares (p=0,04). Conclusão: Os implantes axilares apresentaram morfologia tecidual mais desorganizada formando menos túbulos quando comparados aos tumores primários da mama. Entretanto, não houve diferença significativa do GH entre o tumor primário e a metástase axilar em nossa amostra.

Objective: To establish the histological grade of the axillary metastases in invasive ductal breast cancer cases and to compare it with the findings from the primary tumor. Methods: Cross-sectional study involving 69 cases of invasive ductal breast cancer from the mastology service of Assis Chateaubriand Maternity School, Ceará, Brazil, and their respective axillary metastases. The breast primary tumors and metastatic lymph nodes were subjected to histological processing and the histological grade (HG), tubular grade (TG), nuclear grade (NG) and mitotic index (MI) of the breast and axilla were subsequently determined by the Scarff-Bloom-Richardson grading system. Results: The highest HG prevailed among the primary tumors, with 52,2% classified as HG 3. When compared to the primary tumor, the axillary metastases showed a higher frequency of HG 3 (66,7%), TG 3 (85,5%), NG 3 (58%) and MI 2 (58%). Conclusion: The axillary implants revealed a more disorganized tissue morphology, which formed a lower number of tubules when compared to the breast primary tumors. However, there was no significant difference in the HG between the primary tumor and axillary metastasis in this sample.

Comparação da hemossiderina com o tecnécio-99 na identificação do linfonodo sentinela do câncer de mama. /Paulo Henrique Diógenes Vasques

INTRODUÇÃO E OBJETIVO: Atualmente, a Biopsia do Linfonodo Sentinela (BLS) substitui oesvaziamento axilar no estadiamento do câncer de mama inicial com axila clinicamentenegativa. O tecnécio 99 (Tc99) é o padrão ouro para identificação do Linfonodo Sentinela(LS) da mama. Os corantes azuis são uma opção menos onerosa e mais difundida no Brasil.Estes corantes são responsáveis pelas reações adversas e de hipersensibilidade que, emborararas, podem pôr em risco à vida dos pacientes. Há interesse na descoberta de novassubstâncias equivalentes e com menores efeitos colaterais às usadas na BLS. Aqui se avaliama segurança e a equivalência do uso da hemossiderina, em comparação ao tecnécio 99 (Tc99)na BLS no câncer de mama. A hemossiderina é um derivado da hemoglobina, identificada emestudo pré-clínico, que se mostrou eficaz na BLS da mama da cadela. O objetivo destapesquisa é avaliar a segurança e a potencial equivalência do uso da hemossiderina emcomparação com o Tc99 na BLS da mama humana...

INTRODUCTION AND OBJECTIVE: Sentinel Lymph Node Biopsy (SLNB) has currently replaced axillary dissection in early - stage breast cancer in clinically tumor - free patients. Technetium - 99 ( 99 Tc) is the gold standard for the identification of Breast Sentinel Ly mph Node (SLN). Blue dyes are a less expensive and widely used option in Brazil. These dyes are responsible for several adverse and hypersensitivity reactions that – although rare – ’ v at risk. There is an interest in the discovery of new equivalent substances with less side effects than those used in SLNB. This research assesses the safety and equivalence of the use of hemosiderin in SLNB in breast cancer compared to technetium - 99 ( 99 Tc). Hemosiderin is a hemoglobin derivate identifie d in a preclinical trial that has proven to be effective in the SLNB f f ’. Th f h h h f y equivalence of the use of hemosiderin in SLNB in human breast compared to the 99 Tc...

Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer.

PURPOSE: To assess the safety and potential equivalence of the use of hemosiderin compared to the Technetium-99 in sentinel lymph node biopsy in human breast cancer. METHODS: Non-random sample of 14 volunteer women diagnosed with breast cancer with primary tumors (T1/T2) and clinically tumor-free axilla were submitted to the identification of sentinel lymph node using hemosiderin obtained from autologous blood injected in the periareolar region 24h before surgery on an outpatient basis. Patients received preoperative subareolar intradermal injection of Technetium-99 in the immediate preoperative period. Patients were submitted to sentinel lymph node biopsy, with incision in the axillary fold guided by Gamma-Probe, dissection by planes until the identification of the point of maximum uptake of Technetium-99, identifying the marked nodes and their colors. All surgical specimens were sent for pathological and immunohistochemical study. RESULTS: The results showed no evidence of side effects and/or allergic and non-allergic reactions in patients submitted to SLNB with hemosiderin. The SLN identification rate per patient was 100%. SLNB identification rate per patient with hemosiderin was the same as that of Technetium, with a concordance rate of 100% between the methods. CONCLUSION: Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy.

Comparison between hemosiderin and Technetium-99 in sentinel lymph node biopsy in human breast cancer

PURPOSE: To assess the safety and potential equivalence of the use of hemosiderin compared to the Technetium-99 in sentinel lymph node biopsy in human breast cancer. METHODS: Non-random sample of 14 volunteer women diagnosed with breast cancer with primary tumors (T1/T2) and clinically tumor-free axilla were submitted to the identification of sentinel lymph node using hemosiderin obtained from autologous blood injected in the periareolar region 24h before surgery on an outpatient basis. Patients received preoperative subareolar intradermal injection of Technetium-99 in the immediate preoperative period. Patients were submitted to sentinel lymph node biopsy, with incision in the axillary fold guided by Gamma-Probe, dissection by planes until the identification of the point of maximum uptake of Technetium-99, identifying the marked nodes and their colors. All surgical specimens were sent for pathological and immunohistochemical study. RESULTS: The results showed no evidence of side effects and/or allergic and non-allergic reactions in patients submitted to SLNB with hemosiderin. The SLN identification rate per patient was 100%. SLNB identification rate per patient with hemosiderin was the same as that of Technetium, with a concordance rate of 100% between the methods. CONCLUSION: Hemosiderin is a safe dye that is equivalent to Technetium in breast sentinel lymph node biopsy.

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye.

PURPOSE: This paper aims to study and define the experimental model of sentinel lymph node biopsy of the vulva in bitches. METHODS: 0.2 ml of 99mTc phytate was injected intradermally, using a fine gauge insulin needle in the anterior commissure of the vulva. Thirty minutes after 99mTc injection, the inguinal mapping was performed using a gamma probe. After this, 0.5 ml of blue dye (bleu patenté V Guerbet 2.5%) was injected in the same place. After 15 minutes, a 3 cm long inguinal incision was made at point maximum uptake followed by careful dissection, guided by visualization of a bluish afferent lymphatic system that points to the sentinel lymph node (SLN). RESULTS: It was observed that 88% of SLN were identified. It wasn't found a significant difference among the presence or not of sentinel lymph node in the sides, which is an indication of a good consistency. It was observed a high (88%) and significant (χ2=12.89 and p=0.0003) intercession between both methods (blue dye and radiation). CONCLUSION: The experimental model adopted is feasible, becoming advantageous in applying the association of Patent blue and 99mTc.

Experimental canine model for sentinel lymph node biopsy in the vulva using technetium and patent blue dye / Modelo canino experimental para a pesquisa do linfonodo sentinela na vulva usando tecnécio e azul patente

PURPOSE: This paper aims to study and define the experimental model of sentinel lymph node biopsy of the vulva in bitches. METHODS: 0.2 ml of 99mTc phytate was injected intradermally, using a fine gauge insulin needle in the anterior commissure of the vulva. Thirty minutes after 99mTc injection, the inguinal mapping was performed using a gamma probe. After this, 0.5 ml of blue dye (bleu patenté V Guerbet 2.5 percent) was injected in the same place. After 15 minutes, a 3 cm long inguinal incision was made at point maximum uptake followed by careful dissection, guided by visualization of a bluish afferent lymphatic system that points to the sentinel lymph node (SLN). RESULTS: It was observed that 88 percent of SLN were identified. It wasn´t found a significant difference among the presence or not of sentinel lymph node in the sides, which is an indication of a good consistency. It was observed a high (88 percent) and significant (χ2=12.89 and p=0.0003) intercession between both methods (blue dye and radiation). CONCLUSION: The experimental model adopted is feasible, becoming advantageous in applying the association of Patent blue and 99mTc.

OBJETIVO: Definir um modelo experimental para a pesquisa do linfonodo sentinela na vulva de cadelas. MÉTODOS: 0,2 ml de tecnécio diluído em fitato (99mTc) foi injetado por via intradérmica na comissura anterior da vulva. Trinta minutos após a injeção de 99mTc, o mapeamento inguinal foi realizada utilizando uma sonda gama. Após isto, 0,5 ml de corante azul (bleu Patente Guerbet V 2,5 por cento) foram injetados no mesmo lugar. Após 15 minutos, uma incisão inguinal de três centímetros foi feita no ponto de captação máxima seguido de dissecção cuidadosa, guiada através da visualização de um sistema linfático aferente corado em azul que apontava para o linfonodo sentinela (LS). RESULTADOS: Foi observado que em 88 por cento das vezes o LS foi identificado. Não foi encontrada diferença significativa entre a presença ou não de linfonodo sentinela nos lados direito e esquerdo, o que é uma indicação de uma boa consistência do método. Foi observada uma alta (88 por cento) e significativa (χ2 = 12,89 e p = 0,0003) intercessão entre os dois métodos (corante azul e radiação). CONCLUSÃO: O modelo experimental adotado é viável, tornando-se vantajoso na aplicação da associação de Azul Patente e 99mTc.

The impact of previous para-areolar incision in the upper outer quadrant of the breast on the localization of the sentinel lymph node in a canine model.

OBJECTIVES: This paper discusses the influence of a para-areolar incision in the upper outer quadrant of the breast on the location of the sentinel lymph node in a canine model. METHODS: The sentinel lymph node was marked with technetium-99, which was injected into the subareolar skin of the cranial breast. After the marker had migrated to the axilla, an arcuate para-areolar incision was performed 2 cm from the nipple in the upper outer quadrant. Patent blue dye was then injected above the upper border of the incision. At the marked site, an axillary incision was made, and the sentinel lymph node was identified by gamma probe and/or by direct visualization of the dye. The agreement between the two injection sites and the two sentinel lymph node identification methods was determined. Our sample group consisted of 40 cranial breasts of 23 adult females of the species Canis familiaris. The data were analyzed by using the McNemar test and by determining the kappa agreement coefficient. RESULT: Our findings showed that in 95% of the breasts, the sentinel lymph node was identified by the injection of technetium-99 m into the subareolar region, and in 82% of the cases, the sentinel lymph node was identified by the injection of patent blue dye above the upper border of the incision. The methods agreed 82% of the time. CONCLUSIONS: Previous para-areolar incisions in the upper outer quadrant did not interfere significantly with the biopsy when the dye was injected above the upper border of the incision.

The impact of previous para-areolar incision in the upper outer quadrant of the breast on the localization of the sentinel lymph node in a canine model

OBJECTIVES: This paper discusses the influence of a para-areolar incision in the upper outer quadrant of the breast on the location of the sentinel lymph node in a canine model. METHODS: The sentinel lymph node was marked with technetium-99, which was injected into the subareolar skin of the cranial breast. After the marker had migrated to the axilla, an arcuate para-areolar incision was performed 2 cm from the nipple in the upper outer quadrant. Patent blue dye was then injected above the upper border of the incision. At the marked site, an axillary incision was made, and the sentinel lymph node was identified by gamma probe and/or by direct visualization of the dye. The agreement between the two injection sites and the two sentinel lymph node identification methods was determined. Our sample group consisted of 40 cranial breasts of 23 adult females of the species Canis familiaris. The data were analyzed by using the McNemar test and by determining the kappa agreement coefficient. RESULT: Our findings showed that in 95 percent of the breasts, the sentinel lymph node was identified by the injection of technetium-99 m into the subareolar region, and in 82 percent of the cases, the sentinel lymph node was identified by the injection of patent blue dye above the upper border of the incision. The methods agreed 82 percent of the time. CONCLUSIONS: Previous para-areolar incisions in the upper outer quadrant did not interfere significantly with the biopsy when the dye was injected above the upper border of the incision.

Hemosiderin: a new marker for sentinel lymph node identification.

PURPOSE: To evaluate and present our initial results of a new marker (hemosiderin) for mammary sentinel lymph node identification in an experimental model. METHODS: Skins mapped like a lymphatic duct draining to the axilla in patients submitted to breast biopsy, in our mastology service, stimulated us to try it in an animal model (female dogs). Our theory was that some blood derivate (hemosiderin) was captured by macrophages and accessed the lymphatic ducts in direction to the axilla. Six female dogs of no defined race were studied. We injected 0,2 ml of technetium on both superior mammary glands. After ten minutes, a 2,5 ml solution of hemolized blood (hemosiderin) from the own animal was injected in the subareolar lymphatic plexus on the left superior mammary gland and 2,5 ml of patent blue concomitantly and equally on the contralateral gland. Ten minutes after, incisions on both axillae were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. RESULTS: Seven brown sentinel lymph nodes were identified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. CONCLUSION: Preliminary studies of a potential new dye for sentinel lymph node identification are presented. It may be the change of the current use of the blue dyes and their severe side-effects on patients submitted to sentinel lymph node biopsies.

Hemosiderin: a new marker for sentinel lymph node identification / Hemossiderina: um novo marcador para identificação do linfonodo sentinela

PURPOSE: To evaluate and present our initial results of a new marker (hemosiderin) for mammary sentinel lymph node identification in an experimental model. METHODS: Skins mapped like a lymphatic duct draining to the axilla in patients submitted to breast biopsy, in our mastology service, stimulated us to try it in an animal model (female dogs). Our theory was that some blood derivate (hemosiderin) was captured by macrophages and accessed the lymphatic ducts in direction to the axilla. Six female dogs of no defined race were studied. We injected 0,2 ml of technetium on both superior mammary glands. After ten minutes, a 2,5 ml solution of hemolized blood (hemosiderin) from the own animal was injected in the subareolar lymphatic plexus on the left superior mammary gland and 2,5 ml of patent blue concomitantly and equally on the contralateral gland. Ten minutes after, incisions on both axilas were made to search, through the lymphatic mapping and a gamma probe, the sentinel lymph nodes. RESULTS: Seven brown sentinel lymph nodes were indentified and also radiomarked on the left axilla. Six blue sentinel lymph nodes were identified and also radiomarked on the right axilla. CONCLUSION: Preliminary studies of a potential new dye for sentinel lymph node identification are presented. It may be the change of the current use of the blue dyes and their severe side-effects on patients submitted to sentinel lymph node biopsies.

OBJETIVO: Avaliar e apresentar resultados preliminares de um novo marcador (hemossiderina) para a identificação de linfonodos sentinela mamários em um modelo experimental. MÉTODOS: Durante acompanhamento de dois casos de biópsias excisionais de tumores da mama, no nosso serviço de mastologia, observou-se trajeto pigmentado no quadrante inferior externo daquelas mamas, sugerindo ser marcação cutânea do ducto de drenagem linfática a partir da papila mamária em direção a axila homolateral. Levantamos a hipótese que um derivado sanguíneo (hemossiderina) foi capturado por macrófagos obtendo acesso aos ductos linfáticos em direção à axila. Seis cadelas sem raça definida foram estudadas. Injeção de 0,2 ml de tecnécio foi realizada em ambas as mamas superiores. Após 10 minutos, uma solução de 2,5 ml de sangue hemolizado (hemossiderina) do próprio animal foi injetado no plexo linfático subpapilar da mama esquerda e 2,5 ml de azul patente na mama contralateral concomitantemente e igualmente. Após mais 10 minutos, incisões axilares foram realizadas para a procura, pela coloração e com um gama probe, dos linfonodos sentinela. RESULTADOS: Sete linfonodos sentinela castanhos e radiomarcados foram identificados na axila esquerda. Seis linfonodos sentinela azuis e radiomarcados foram identificados na axila direita. CONCLUSÃO: São apresentados estudos preliminares de um potencial novo marcador para identificação do linfonodo sentinela. Este poderá mudar o uso dos corantes vitais e de seus efeitos adversos em pacientes submetidos à biópsia do linfonodo sentinela.