Impact of invasive lobular carcinoma on long-term outcomes in Mexican breast cancer patients.

PURPOSE: The aim of this study was to compare the difference in disease-free survival (DFS) and overall survival (OS) between invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) in our Hispanic population with breast cancer (BC). METHODS: We retrospectively analyzed a database of 4533 non-metastatic BC patients treated for BC at the National Cancer Institute in Mexico (INCan) between 2006 and 2016. We compared clinical characteristics, treatment and survival between women with invasive ductal and invasive lobular BC. We evaluated differences between survival curves with the log-rank test and used Cox's proportional hazards model for the multivariate analysis. RESULTS: Median follow-up time was 42.13 months (IQ25 25.2-IQ75 72.06). The median age was 50.9 years (IQ25 43.5-IQ75 59.8). DFS at 5 years was 80.8% for IDC versus 76.2% for ILC. 5 years OS was 88.7% for IDC versus 84.3% for ILC. Multivariate analysis showed that factors that negatively affected the 5-year DFS include: clinical stage III [hazard ratio (HR) 4.2, 95% CI 3.36-5.35; p < 0.001], triple negative phenotype (HR 1.4, 95% CI 1.08-1.81; p = 0.009), Ki67 ≥ 18 (HR 1.6, 95% CI 1.28-2.11; p < 0.001), and lobular histological type (HR 1.6, 95% CI 1.09-2.49; p = 0.017). Factors associated with a negative impact on OS were: clinical stage III (HR 4.5, 95% CI 3.15-6.54; p < 0.001), triple negative phenotype (HR 2.4, 95% CI 1.69-3.48; p < 0.001), and Ki67 ≥ 18% (HR 1.9, 95% CI 1.27-2.92; p = 0.02). CONCLUSION: Our results highlight the different biology of ILC and show that long-term prognosis in terms of DFS is not as favorable as previously reported.

Association of the IL-10 gene rs1800872 (-592 C>A) polymorphism with breast cancer in a Mexican population.

PURPOSE: Interleukin 10 (IL-10) gene polymorphisms are associated with different types of cancer, but these associations are inconsistent. The purpose of this study was to determine the frequency and association of the rs1800872 IL-10 gene polymorphism in Mexican women with breast cancer (BC). METHODS: The rs1800872 polymorphism was genotyped in 368 BC patients and 320 control women using the polymerase chain reaction (PCR). RESULTS: The rs1800872 polymorphism was a risk factor for BC compared to controls and BC patients with genotypes CA (p=0.004) and AA, and in the recessive model (p=0.0002), dominant model (CA+AA; p=0.0001), and allele A ( p=0.0001). Additionally, differences were observed in BC patients with the CA and CAAA genotypes who had chemotherapy gastric and hematological toxicity (p=0.022) and tumor stage IV (p=0.013) as a risk factor. Genotypes were CA in breastfeeding (p=0.017), AA in gastric toxicity (p=0.048), and CAAA in tumor stage I-II (p=0.019) as protective risk factors. In BC carriers of: 1) CAAA genotype with tumor stage I-II and breast feeding (≥6 months), 2) CA genotype BC Luminal A with tumor stage I-II, 3) CA genotype BC Luminal B with breastfeeding (≥6 months), and 4) CAAA genotypes in BC HER2 with indices of cellular proliferation (Ki-67) that were elevated (≥20%), were considered to be protective factors in BC patients. CONCLUSION: The IL-10 gene rs1800872 polymorphism was associated with BC susceptibility in this sample from the Mexican population.

Incidence, mortality and receptor status of breast cancer in African Caribbean women: Data from the cancer registry of Guadeloupe.

BACKGROUND: Geographical disparities in breast cancer incidence and outcomes are reported worldwide. Women of African descent show lower incidence, higher mortality rates and earlier age of onset. We analyzed data from the cancer registry of Guadeloupe for the period 2008-2013. METHODS: We describe breast cancer characteristics by molecular subtype, as well as estimated observed and net survival. We used Cox proportional hazard models to determine associations between cancer subtypes and death rate, adjusted for variables of interest. RESULTS: Overall, 1275 cases were recorded with a mean age at diagnosis of 57(±14) years. World standardized incidence and mortality were respectively 71.9/100,000 and 14.1/100,000 person-years. Age-specific incidence rates were comparable to European and US populations below the age of 45, and higher in Guadeloupean women aged between 45 and 55 years. Overall, 65.1% of patients were hormone receptor (HR)+ and 20.1% were HR-. Triple negative breast cancers (TNBC) accounted for 14% of all cases, and were more frequent in patients under 40 (21.6% vs. 13.4%, p=0.02). Five-year net survival was 84.9% [81.4-88.6]. It was higher for HR+/Her2+ and HR+/Her2- subtypes, and lower for HR-/Her2+ and TNBC patients. CONCLUSION: We found high age-specific incidence rates of breast cancer in women aged 45 to 55 years, which warrants further investigation in our population. However, this population of mainly African descent had good overall survival rates, and data according to subtypes are consistent with those reported internationally. These results may suggest that poorer survival in other African descent populations may not be an inherent feature of the disease but may be amenable to improvement.

[Clinical and pathological features of breast cancer in a population of Mexico]. / Características clinicopatológicas del cáncer de mama en una población de mujeres en México.

BACKGROUND: Breast cancer is the most common among women in our country, and its treatment is based on prognostic factors to categorize patients into different risk groups. In this study, the clinical and pathological features that play a role as a prognostic factor in a representative population with breast cancer in México are described. MATERIAL AND METHODS: A descriptive analysis of the clinical and pathological features of women diagnosed with breast cancer, in a period from June 2005 to May 2014; registered in a database and calculated by simple frequencies. RESULTS: A total of 4,411 patients were included, the average age at diagnosis was 53 years, 19.7% were diagnosed by mammography screening program and 80.3% derived from any signs or symptoms. Regarding the stages at diagnosis, 6.8% were carcinoma in situ, 36% at early stages (I and IIA), 45% locally advanced (IIB to IIIC), 7.7% metastatic and 3.9% unclassifiable. A 79% were ductal histology, lobular 7.8% and the rest, other types. Of ductal carcinomas, 9.1% were grade I, 54.1% grade II, and 34.6% grade III. Regarding the biological subtypes, 65.7% were luminal, 10.9% luminal Her positive, 8.7% pure Her 2 positive and 14.6% triple negative. CONCLUSION: In the present study, we described the clinical and pathologic features of a group of Mexican women with breast cancer that might reflect a national landscape, and represent the prognostic factors to determine groups of risk and treatment decisions.

Mammographic Screening of Women Attending a Reference Service Center in Southern Brazil.

BACKGROUND: To investigate the prevalence of and factors associated with performance of annual mammography by women above 40 years of age. MATERIALS AND METHODS: This cross-sectional retrospective study was conducted at an oncology reference service in Southern Brazil from October 2013 to October 2014 with 525 women aged 40 years or older. RESULTS: The prevalence of annual mammography was 54.1%; annual mammographic screening was performed for women without private medical insurance, who were under hormone replacement therapy and who had used contraception in the past. An association was found between non-performance of breast clinical and self-examination and non-performance of mammographic screening. CONCLUSIONS: Use of mammography for breast cancer screening in the public health care setting proved to be accessible; nevertheless, the proportion of screened women was low, and they exhibited poor adherence to the basic measures of care recommended for breast assessment. Thus, control of breast cancer requires implementing actions targeting the population most vulnerable to non-adherence to screening in addition to continuously monitoring and assessing that population to reduce the prevalence of this disease.

[Breast cancer in Mexican women under 40]. / Cancer de mama en mujeres mexicanas menores de 40 años.

BACKGROUND: Breast cancer is the leading cause of death from malignancy in women. The incidence increases with age, but the relationship between age and survival of breast cancer patients is not well defined. It is observed that young women with breast cancer have patterns more aggressive biological. OBJECTIVE: To determine the frequency, sociodemographic, clinical and histopathological features of breast cancer in women under 40 years attending a specialist breast unit in Mexico City. PATIENTS AND METHOD: Transversal, descriptive and retrospective study of patients under 40 years of age with breast cancer treated between 2005 and 2010. RESULTS: 1430 cases were diagnosed with breast cancer five years with a mean age of 53.64 +/- 11.87 years (range 23 to 93 years), 142 cases were women under 40 years of age (10%). The auto-detection of a breast lump was the most frequent clinical manifestation (50%). CONCLUSION: The prevalence of clinical stage III in this age group suggests the difficulty of diagnosis, the high breast density, which is one factor limiting studies of screening with mammography, it diminishes their effectiveness in early detection of breast cancer.

[Epidemiological characterization and evolution of breast cancer patients in the Arica and Parinacota region in Chile, 1997-2007]. / Caracterización epidemiológica y evolución del cáncer de mama en Arica y Parinacota, Chile 1997-2007.

OBJECTIVE: Epidemiologically characterizing breast cancer in the Arica and Parinacota region in Chile and its evolution during 1997-2007. METHOD: A descriptive, cross-sectional study was performed. All clinical histories for 306 cases of breast cancer were reviewed. All patients were detected through the Arica Juan Noé Crevani Hospital's Oncological Mammary Polyclinic from 1997 to 2007. A descriptive data analysis was made, followed by a tendency analysis. RESULTS: 51.3 % of the 306 cases studied were aged 46 to 65 years, 13.9 % being of Aymara ethnic origin. 70.2 % of the women involved in the study were climacteric, 98.4 % being without hormonal treatment. 12 % referred to having a family background of cancer, the sister being the most frequently referred to relative. 84.1 % had a histological diagnosis of infiltrating ductal carcinoma, stage IIA being the most frequently occurring one (32.8 %). 31.6 % presented multiple metastases, 74.7 % of this group being aged 56 to 94. Time series analysis indicated an increasing incidence rate and decreasing mortality rate. CONCLUSIONS: The Arica and Parinacota region of Chile presented an increasing tendency for new cases of breast cancer during the period being studied which was concentrated during the early stages of evolution. These findings could be explained by the early detection of breast cancer and the implementation of public health policy.

Lobular neoplasia: frequency and association with other breast lesions.

BACKGROUND: Using new molecular biology techniques, recent studies have implicated a common evolutionary pathway between lobular neoplasia, lobular carcinomas, and columnar cell lesions. Our aims were to assess the frequency of lobular neoplasia in a series of breast biopsies that were performed and examined in the same institution and to analyze the association between subtypes of lobular neoplasia and benign and malignant breast lesions. METHODS: Cases were selected after reviewing archived pathological reports in the Breast Pathology Laboratory, School of Medicine of Federal University of Minas Gerais (1999-2008). Cases of lobular neoplasia were reviewed and classified as atypical lobular hyperplasia, ductal involvement by cells of atypical lobular hyperplasia, lobular carcinoma in situ, and pleomorphic lobular carcinoma in situ. Coexistence of lobular neoplasia with other breast lesions, including columnar cell lesions, invasive ductal carcinoma and invasive lobular carcinoma, was evaluated. The association between lobular neoplasia and breast lesions was analyzed by Fisher's exact test and chi-square test for linear trend. RESULTS: We analyzed 5650 breast specimens, selecting 135 breast specimens (2.4%) that had a diagnosis of lobular neoplasia, corresponding to 106 patients. Hematoxylin and eosin-stained slides were available for 84 cases, 5 of which were excluded because they contained only "indeterminate" in situ lesions. Of the 79 remaining cases, columnar cell lesions were present in 78.5%, primarily with columnar cell changes without atypia (67.7%). Invasive carcinoma was present in 45.6% of cases of lobular neoplasia--a similar frequency (47.2%) as invasive ductal carcinoma and invasive lobular carcinoma. We noted a significant linear trend (p < 0.03) of a higher frequency of invasive carcinomas that were concomitant with lobular carcinoma in situ compared with atypical lobular hyperplasia. Invasive lobular carcinomas were associated with lobular carcinoma in situ in 33% of cases, compared with 2.8% of atypical lobular hyperplasia cases. CONCLUSIONS: Our findings confirm a frequent association between lobular neoplasia and columnar cell lesions, the majority of which lacked atypia. We also observed a greater frequency of invasive carcinoma, more commonly invasive lobular carcinoma, associated with more developed forms of lobular neoplasia (lobular carcinoma in situ).

Caracterización epidemiológica y evolución del cáncer de mama en Arica y Parinacota, Chile 1997-2007 / Epidemiological characterization and evolution of breast cancer patients in the Arica and Parinacota region in Chile, 1997-2007

Objetivo Caracterizar epidemiológicamente el cáncer de mama y su evolución en la Región de Arica y Parinacota para el decenio 1997- 2007, Chile Método Se realizó un estudio descriptivo de tendencia. Se revisaron las historias clínicas de 306 casos pesquisados, consultantes del Policlínico de Oncología Mamaria del Hospital en Red Dr. Juan Noé Crevani. Se realizó un análisis descriptivo univariado de cada variable estudiada y se evaluó la tendencia de la incidencia y mortalidad de cáncer de mama. Resultados De los 306 casos estudiados durante el periodo, el 51,3 por ciento tuvo entre 46 y 65 años de edad, siendo el 13,9 por ciento de origen Aymara. El 70,2 por ciento de las pacientes eran menopáusicas, 98,4 por ciento sin tratamiento hormonal. El 12 por ciento refirió tener antecedentes familiares, de los cuales la hermana fue lo más frecuente. El 84,1 por ciento tuvo el diagnostico de carcinoma ductal infiltrante, un 32,8 por ciento de estos en etapa IIA. De todos los casos, el 31,6 por ciento presentó metástasis múltiple, con 74,7 por ciento en un rango de edad entre of 56 a 94 años. El análisis de la serie indica una tendencia creciente de nuevos casos y una moderada tendencia a la diminución de la tasa de mortalidad. Conclusiones La Región de Arica y Parinacota de Chile, muestra una tendencia creciente absoluta y relativa de nuevos casos de cáncer de mama durante el decenio estudiado. Por otra parte, la tasa mortalidad tendió a la disminución en el periodo. Ambos situaciones se explicarían en parte por el diagnóstico precoz y las políticas de salud implementados.

Objective Epidemiologically characterizing breast cancer in the Arica and Parinacota region in Chile and its evolution during 1997-2007. Method A descriptive, cross-sectional study was performed. All clinical histories for 306 cases of breast cancer were reviewed. All patients were detected through the Arica Juan Noé Crevani Hospital's Oncological Mammary Polyclinic from 1997 to 2007. A descriptive data analysis was made, followed by a tendency analysis. Results 51.3 percent of the 306 cases studied were aged 46 to 65 years, 13.9 percent being of Aymara ethnic origin. 70.2 percent of the women involved in the study were climacteric, 98.4 percent being without hormonal treatment. 12 percent referred to having a family background of cancer, the sister being the most frequently referred to relative. 84.1 percent had a histological diagnosis of infiltrating ductal carcinoma, stage IIA being the most frequently occurring one (32.8 percent). 31.6 percent presented multiple metastases, 74.7 percent of this group being aged 56 to 94. Time series analysis indicated an increasing incidence rate and decreasing mortality rate. Conclusions The Arica and Parinacota region of Chile presented an increasing tendency for new cases of breast cancer during the period being studied which was concentrated during the early stages of evolution. These findings could be explained by the early detection of breast cancer and the implementation of public health policy.

[Breast cancer screening: have there been any changes during the last decade? A study in a Spanish unit].

BACKGROUND: Breast screening programs in Spain cover almost 100% of population. The objective of the present study was to analyze if there have been any changes during the last decade in our breast screening unit (Unidad de Prevención del Cáncer de Mama de Castellón) that can also be extrapolated to other breast screening units. METHODS: We conducted a retrospective and descriptive analysis reviewing patients seen in our breast screening unit between January 1, 2000 and December 31, 2009. Patients with a final diagnosis of carcinoma, year of diagnosis, age, histological type, infiltration, surgical procedure and tumor extension were analyzed. RESULTS: A total of 311 breast cancers were diagnosed among 90,010 women who were seen at our breast screening unit. Mean age of the patients was 56 years. A progressive increase of the target population was seen (24,004 persons in 2000 and 31,950 in 2009). Histological type, percentage of infiltrative tumors and lymph node involvement did not show significant differences by year. Differences were observed for tumor size (pT category of TNM classification) and breast conservation surgery. CONCLUSIONS: Tumor stage in cancers diagnosed in breast screening units progressively decreased when the program was being implemented. There is a maximum level among which tumor characteristics remain constant. Changes in screening programs can modify these characteristics.

High-risk human papillomavirus in mammary gland carcinomas and non-neoplastic tissues of Mexican women: no evidence supporting a cause and effect relationship.

Human papillomavirus (HPV) has been implicated in breast carcinogenesis. Consecutive and non-selected mastectomy specimens from Mexican patients harboring breast carcinomas were sampled in order to look for the presence of HPV DNA. HPV-16 was detected in 6 (10%) of 60 breast carcinomas. Two of these also had HPV genome in adjacent non-neoplastic mammary-tissues. Seven cases had HPV DNA only in non-neoplastic tissue specimens. HPV DNA was also detected in 4 (25%) of 10 tumor-bed specimens without residual neoplastic lesions that were obtained from patients who underwent neoadjuvant chemotherapy or neoadjuvant chemotherapy/radiotherapy. HPV-positive tumors tended to be smaller in size, than HPV-negative tumors (p=0.047). Histological distributions of HPV-positive and -negative cases showed no significant difference. Although all the HPV-16 DNA were found integrated, its low viral load rendered it difficult to incriminate this virus in breast carcinogenesis. However, the possibility that HPV infection occurred during carcinoma development cannot be ruled out.

Quimioterapia no carcinoma lobular invasivo: qual a evidência? / Chemotherapy in lobular invasive breast cancer: is there an evidence?

O carcinoma lobular invasivo é o segundo tipo histológico mais freqüente de câncer de mama, e sua incidência parece estar aumentando. O carcinoma lobular invasivo apresenta características clínicas, biológicas e moleculares distintas das do carcinoma ductal, sendo freqüentemente de baixo grau e quase sempre positivo para receptores de estrógeno. A taxa de resposta à quimioterapia neo-adjuvante do carcinoma lobular invasivo é mais baixa que a do carcinoma ductal invasivo. Apesar disso, a quimioterapia adjuvante é rotineiramente indicada para pacientes com carcinoma lobular invasivo, com base nos mesmos critérios utilizados para carcinoma ductal invasivo. Neste artigo, revisaram-se os estudos randomizados de quimioterapia em câncer de mama localizado e não se encontraram dados suficientes para alicerçar ou banir o uso de quimioterapia em pacientes com carcinoma lobular invasivo. O benefício da quimioterapia sistêmica para pacientes com carcinoma lobular invasivo precoce está pouco claro na literatura. O carcinoma lobular invasivo é uma classe clínica e molecularmente distinta dos cânceres de mama, que deve ser investigada separadamente em estudos prospectivos, para que se possa oferecer o tratamento ideal para pacientes com essa doença.

Invasive lobular carcinoma is the second most frequent histological type of breast cancer, and on whose incidence seems to be increasing. Invasive lobular carcinoma displays unique clinical and biological features, when compared with invasive ductal carcinoma, and a significantly lower response rate to neoadjuvant chemotherapy. However, adjuvant chemotherapy is indicated for patients with invasive lobular carcinoma using the same criteria utilized for invasive ductal carcinoma. In this article, we provide an overview of the randomized trials of neoadjuvant and adjuvant chemotheraphy; at the present time, there is little evidence to support or to withhold chemotherapy for patients with early-stage, invasive lobular carcinoma. We thus suggest that the role of systemic chemotherapy for such patients is currently unclear, and an issue well deserving of more thorough investigation in future trials.

Evidence for an association of TP53 codon 72 polymorphism with breast cancer risk.

BACKGROUND: A common Arg/Pro polymorphism at codon 72 of the TP53 gene has been investigated as a risk factor for cancer in different populations. So far, the results have been controversial. Our purpose was to investigate the association of this polymorphism with breast carcinoma in women from Southern Brazil, a high-risk area for breast cancer. METHODS: Blood samples collected from 118 women with primary breast carcinoma and from 202 female blood donors were analyzed through polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing. RESULTS: The relative frequency of each allele was 0.75 for Arg and 0.25 for Pro in patients with cancer, and 0.62 for Arg and 0.38 for Pro in normal controls (P < 0.001). The Arg/Arg genotype was significantly associated with an increased risk for breast cancer (OR 2.9; 95% CI 1.43-3.6; P < 0.002). No correlation between the genotype distribution and specific prognostic predictors for the disease outcome was observed. DISCUSSION: TP53 codon 72 polymorphism might be implicated in breast carcinogenesis, with the Arg/Arg genotype being associated with an increased susceptibility for this malignancy.

Cáncer de mama: experiencia del Centro Integral de la Mama de Clínica Las Condes 1996-2005 / Breast Cancer: Centro Integral de la Mama de Clínica Las Condes experience

Se presenta la experiencia del Centro Integral de la Mama (CIM) de Clínica Las Condes en diagnóstico y tratamiento del cáncer de mama, a diez años de su formación; y se evalúa si la intervención multidisciplinaria impacta en las posibilidades de conservar la mama y aumentar la sobrevivencia. Se busca establecer el impacto favorable del trabajo multidisciplinario sobre el cáncer de mama, principalmente en su etapa diagnóstica, aumentando los porcentajes de tumores menores de 2 cms, lo que permite incrementar los índices de cirugía conservadora de la mama, así como obtener una supervivencia global del 95 por ciento a cinco años.

[Fine needle aspiration biopsy of breast lesions: institutional experience]. / Biopsia por aspiración con aguja fina en lesiones mamarias: experiencia institucional.

BACKGROUND: With the advent of new diagnostic technologies and the fear of low diagnostic accuracy, there has been a reduction in the use of fine needle aspiration (FNA) for diagnosis of breast lesions. The objectives of the present study were to establish the diagnostic accuracy and complications associated with FNA of breast lesions. MATERIAL AND METHODS: We retrospectively reviewed FNA of breast lesions done in a tertiary referral center in Mexico City from 1999 through 2001. We analyzed demographic, radiologic and pathological variables in order to establish diagnostic accuracy of FNA. The gold standard was considered the histopathologic study of the specimen or the clinical follow-up of benign lesions. Categorical variables were analyzed with the X2 method and statistical significance was considered at p < 0.05. RESULTS: We identified 300 patients with a mean age of 50 years (range, 20-86). Fifty-three percent were postmenopausal. In ninety-three percent of patients, FNA was performed in the outpatient clinic. Nonpalpable lesions were aspirated under ultrasound guidance. Mean size of the lesion was 2.27 cm (range 0.7-10 cm). Thirty-one percent of patients had definite diagnosis of malignancy. The only variables associated with cancer diagnosis were the BI-RADS category and the presence of palpable adenopathy. Cancer was diagnosed in 6.5% of lesions categorized as BI-RADS 0-3 compared to 56.2% for lesions BI-RADS 4-5 (p < 0.0001). Positive predictive value and specificity of FNA were 100%. Sensitivity, negative predictive value and accuracy were 82.6%, 92.8% and 94.7%, respectively. The most common diagnosis of false negative lesions were lobular and papillary carcinomas. There were no significant complications associated with FNA. CONCLUSIONS: Diagnostic accuracy of FNA for breast lesions is very high with minimal complications. Positive predictive value of 100% allows to establish therapy based on its results.

Biopsia por aspiración con aguja fina en lesiones mamarias: experiencia institucional / Fine needle aspiration biopsy of breast lesions: institutional experience

Background. With the advent of new diagnostic technologies and the fear of low diagnostic accuracy, there has been a reduction in the use of fine needle aspiration (FNA) for diagnosis of breast lesions. The objectives of the present study were to establish the diagnostic accuracy and complications associated with FNA of breast lesions. Material and methods. We retrospectively reviewed FNA of breast lesions done in a tertiary referral center in Mexico City from 1999 through 2001. We analyzed demographic, radiologic and pathological variables in order to establish diagnostic accuracy of FNA. The gold standard was considered the histopathologic study of the specimen or the clinical follow-up of benign lesions. Categorical variables were analyzed with the method and statistical significance was considered at p < 0.05. Results. We identified 300 patients with a mean age of 50 years (range, 20-86). Fifty-three percent were postmenopausal. In ninety-three percent of patients, FNA was performed in the outpatient clinic. Nonpalpable lesions were aspirated under ultrasound guidance. Mean size of the lesion was 2.27 cm (range 0.7-10 cm). Thirty-one percent of patients had definite diagnosis of malignancy. The only variables associated with cancer diagnosis were the BTRADS category and the presence of palpable adenopathy. Cancer was diagnosed in 6.5% of lesions categorized as BTRADS 0-3 compared to 56.2% for lesions BTRADS 4-5 (p < 0.0001). Positive predictive value and specificity of FNA were 100%. Sensitivity, negative predictive value and accuracy were 82.6%, 92.8% and 94.7%, respectively. The most common diagnosis of false negative lesions were lobular and papillary carcinomas. There were no significant complications associated with FNA. Conclusions. Diagnostic accuracy of FNA for breast lesions is very high with minimal complications. Positive predictive value of 100% allows to establish therapy based on its results.

Antecedentes. El advenimiento de nuevas tecnologías diagnósticas, así como el temor a baja exactitud diagnóstica, han reducido el papel de la biopsia por aspiración con aguja fina (BAAF) en lesiones mamarias. El objetivo del presente estudio fue el establecer la exactitud diagnóstica y complicaciones de la BAAF en esta indicación. Material y métodos. Estudio retrospectivo de BAAF de lesiones mamarias realizadas en nuestra institución de 1999 a 2001. Se analizaron variables demográficas, radiológicas e histopatológicas para establecer la exactitud diagnóstica. Se definió como estándar diagnóstico al análisis histopatológico del tejido o bien al seguimiento clínico en caso de lesiones benignas dejadas para observación. Las variables categóricas se analizaron con la prueba de . Se estableció como significativa a una p < 0.05. Resultados. Fueron identificados 300 pacientes con una edad promedio de 50 años (20-86). Fueron posmenopáusicas 53.3%. En 93.3% de los casos se realizó BAAF de lesión clínicamente palpable y en el resto de una lesión visible por ultrasonido. El tamaño promedio de la lesión fue de 2.27 cm (0.7-10 cm). De las pacientes, 30.7% tuvieron diagnóstico definitivo de lesión maligna. Las únicas variables asociadas al diagnóstico de cáncer fueron la clasificación radiológica de BI-RADS y la presencia de adenomegalias palpables. La incidencia de cáncer en pacientes con BI-RADS de 0 a 3 fue de 6.5% vs. 56.2% en aquellas con BI-RADS 4 o 5 (p < 0.0001). Tanto el valor predictivo positivo como la especificidad de la BAAF fueron de 100%, con una sensibilidad de 82.6% y valor predictivo negativo de 92.8%, para una exactitud diagnóstica de 94.7%. Las causas más frecuentes de falsos negativos fueron el carcinoma lobulillar infiltrante y el carcinoma papilar. No se presentaron complicaciones significativas en ningún caso asociadas con la BAAF. Conclusiones. La exactitud diagnóstica de la BAAF en lesiones mamarias es muy elevada, con una incidencia mínima de complicaciones. Un valor predictivo positivo de 100% permite basar la terapéutica en sus resultados. El diagnóstico de benignidad por BAAF permite el seguimiento seguro de lesiones mamarias.

Carcinoma lobulillar infiltrante de la mama : tipos histológicos y riesgo de metástasis en 126 casos / Infiltrating lobular carcinoma of the breast : histologic types and metastatic risk in 126 cases

A pesar del reconocimiento de diversas variantes histológicas, los factores pronóstico no están aún completamente definidos en el carcinoma lobulillar infiltrante (CLI) de la mama. Por otro lado, la prevalencia del CLI es muy variable en distintas series. Materiales y métodos : con el objeto de establecer la prevalencia del CLI y sus variantes, y de analizar los factores de riesgo de metástasis ganglionares (RMG), se estudiaron retrospectivamente todos los CLI en tres laboratorios de patología-Mar del Plata (MP), Bahía Blanca (BB) y tres Arroyos (TA)-entre el 1/8/92 y el 31/7/97. Se analizaron : edad, tamaño, bilateralidad, presencia de carcinoma lobulillar in situ (CLIS), tipo histológico, grado nuclear e índice micótico. Se investigó cuales de estas variables eran capaces de predecir el riesgo de metástasis ganglionares (RMG). Resultados : sobre un total de 1229 carcinomas mamarios infiltrantes, 736 correspondieron a MP, 408 a BB y 85 a TA. La incidencia general del CLI fue del 10 por ciento (n=126). La edad media fue de 59 años (35-87). Se halló CLIS en 49/ casos (38,8 por ciento). Seis casos (4,7 por ciento) mostraron bilateralidad (5 de ellos de la variante pleomórfica). 116 casos fueron grado nuclear 1 ó 2, y 20 casos grado nuclear 3. En 91 casos se extirparon ganglios axilares. El número de ganglios metastásicos osciló entre 1 y 18 (media 1,93; DS 4,42). En este grupo (n=91) se investigó la influencia de cada una de las variables en el RMG. La única variable estadísticamente significativa fue el tamaño tumoral (P<0,02). No se observaron diferencias significativas para desarrollar MG entre el tipo clásico y el resto de las variables consideradas en conjunto. Conclusión: la prevalencia de CLI en esta serie es del 10 por ciento y se halla en el centro del espectro de las ya publicadas. El tipo clásico representa el 60 por ciento, correspondiendo el 40 por ciento restante a las distintas variantes. El 15 por ciento de los casos corresponden a la variante pleomórfica. En los casos que aquí se analizan, la única variable significativa para predecir el riesgo de metástasis ganglionares fue el tamaño tumoral

Carcinoma lobulillar infiltrante de la mama : tipos histológicos y riesgo de metástasis en 126 casos / Infiltrating lobular carcinoma of the breast : histologic types and metastatic risk in 126 cases

A pesar del reconocimiento de diversas variantes histológicas, los factores pronóstico no están aún completamente definidos en el carcinoma lobulillar infiltrante (CLI) de la mama. Por otro lado, la prevalencia del CLI es muy variable en distintas series. Materiales y métodos : con el objeto de establecer la prevalencia del CLI y sus variantes, y de analizar los factores de riesgo de metástasis ganglionares (RMG), se estudiaron retrospectivamente todos los CLI en tres laboratorios de patología-Mar del Plata (MP), Bahía Blanca (BB) y tres Arroyos (TA)-entre el 1/8/92 y el 31/7/97. Se analizaron : edad, tamaño, bilateralidad, presencia de carcinoma lobulillar in situ (CLIS), tipo histológico, grado nuclear e índice micótico. Se investigó cuales de estas variables eran capaces de predecir el riesgo de metástasis ganglionares (RMG). Resultados : sobre un total de 1229 carcinomas mamarios infiltrantes, 736 correspondieron a MP, 408 a BB y 85 a TA. La incidencia general del CLI fue del 10 por ciento (n=126). La edad media fue de 59 años (35-87). Se halló CLIS en 49/ casos (38,8 por ciento). Seis casos (4,7 por ciento) mostraron bilateralidad (5 de ellos de la variante pleomórfica). 116 casos fueron grado nuclear 1 ó 2, y 20 casos grado nuclear 3. En 91 casos se extirparon ganglios axilares. El número de ganglios metastásicos osciló entre 1 y 18 (media 1,93; DS 4,42). En este grupo (n=91) se investigó la influencia de cada una de las variables en el RMG. La única variable estadísticamente significativa fue el tamaño tumoral (P<0,02). No se observaron diferencias significativas para desarrollar MG entre el tipo clásico y el resto de las variables consideradas en conjunto. Conclusión: la prevalencia de CLI en esta serie es del 10 por ciento y se halla en el centro del espectro de las ya publicadas. El tipo clásico representa el 60 por ciento, correspondiendo el 40 por ciento restante a las distintas variantes. El 15 por ciento de los casos corresponden a la variante pleomórfica. En los casos que aquí se analizan, la única variable significativa para predecir el riesgo de metástasis ganglionares fue el tamaño tumoral (AU)