Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study.

The objective was to determine the 10-year oncological safety of nipple-sparing mastectomy (NSM) in patients diagnosed with ductal carcinoma in situ (DCIS). The use of NSM preserves the nipple-areola complex (NAC). As residual fibroglandular breast tissue can remain behind the spared NAC, its use for patient with breast cancer is controversial. The oncologic outcomes and complication rates after performing NSM compared to other techniques are still under debate and a concern when treating patients with breast cancer. We retrospectively reviewed 69 consecutive NSM patients diagnosed with DCIS during 1984-2016 at the Valencia Institute of Oncology, Valencia, Spain. 13 of 82 reviewed cases were excluded from the analysis owing to the presence of invasive tumor in the final pathologic report. All 69 patients who underwent NSM due to DCIS were included and analyzed. The indications were as follows: unfavorable correlation between tumor size and breast size in 53 patients, 10 patients with multifocal or multicentric tumors and breast cancer recurrence after breast-conserving surgery in six patients. The reconstruction was performed using a prosthetic implant: saline-filled implant 33 (47.8%) or tissue expander 36 (52.2%). No frozen section was performed in the patients included in our study. The presence of DCIS was confirmed in 60 patients and in the other nine patients we found no tumor in the mastectomy specimen (removed due to excisional biopsy procedure). High risk features were: tumor grade 3 in 27 (39.2%) cases and comedonecrosis in 32 (46.4%) cases. In 27 patients surgical axillary staging was performed and no residual disease in the axilla was observed. After a mean follow-up period of 142.6 ± 70.7 months no nipple necrosis was observed. In 15 patients (21.7%) an additional surgical procedure was performed. 48 patients (69.6%) did not receive any adjuvant treatment. Adjuvant hormone therapy was given to 20 patients (29%) and one patients received radiation therapy (1.4%). Eight patients showed a local relapse (11.6%). One patient developed a recurrence within the nipple-areola region presented as Paget's disease (1.4%). One patient presented a thorax wall relapse after 42 months of disease-free survival and died because of metastatic dissemination of the tumor. The DFS rate was 88.4% and the overall survival rate was 98.6%. In patients with DCIS that are not candidates to breast-conserving therapy, NSM is a realistic option of treatment. No case of nipple necrosis was observed. A low rate of nipple relapse (1.4%) and a good survival rate (98.5%) were observed after a median follow-up of 142.6 months.

Tumoral load quantification of positive sentinel lymph nodes in breast cancer to predict more than two involved nodes.

AIM: One-Step Nucleic Acid Amplification (OSNA) can detect isolated tumour loads in axillary lymph nodes of breast cancer patients. We investigated the predictability of the non-sentinel lymph node (SLN) metastatic involvement (MI) based on the OSNA SLN assessment in surgical invasive breast cancer. METHODS: We studied surgical breast invasive carcinoma patients, not taking neoadjuvant chemotherapy, having SLN positive by OSNA and having received axillary lymphadenectomy. Age, basic histopathological, immunohistochemical, SLN biopsy and lymphadenectomy data were compared between patients with or without MI of more than 2 non-SLN in both univariate and multivariate analyses. The discriminating capacity of the multivariate model was characterized by the ROC AUC. RESULTS: 726 patients from 23 centers in Spain aged 55.3 ± 12.2 years were analysed. The univariate analysis comparing patients with or without MI of more than 2 non-SLN detected statistically significant differences in primary tumour size, multifocality, presence of lymphovascular infiltration, positive proliferation index with ki67, immunophenotype and logTTL (Tumour Total Load). The multivariate logistic analyses (OR (95% CI)) confirmed multifocality (2.16 (1.13-4.13), p = 0.019), lymphovascular infiltration (4.36 (2.43-7.82), p < 0.001) and logTTL (1.22 (1.10-1.35), p < 0.001) as independent predictors, and exhibit an AUC (95% CI) of 0.78 (0.72-0.83) with an overall fit (Hosmer-Lemeshow test) of 0.359. A change in the slope of both sensitivity and specificity is observed at about 10,000 copies/µL, without relevant changes in the Negative Predictive Values. CONCLUSIONS: Using OSNA technique, the MI of more than 2 non-SLN can be reliably predicted.

Cirugía reconstructiva tram / Reconstructive surgery tram

Se incluye en el concepto de reconstrucción postmastectomía (RPM), la agrupación de técnicas quirúrgicas que posibilitan la restitución de la mama, a las pacientes a las que fue extirpada, durante el proceso terapéutico de su cáncer, La mama, tiene en la actualidad un sentido muy distinto, de cuando su fin último era el de ser un órgano imprescindible para la reproducción humana. El estilo de vida actual, ha dadoal busto femenino, un significado del más alto gradoen la vida de la relación, por lo que su extirpación repercute de manera importante en la calidad de vida de las pacientes. El cáncer y su tratamiento producen una disrupción en la vida física, emocional, social y sexual, y aunque como se ha afirmado en algunos medios de comunicación, el que la mujer no sólo es el pecho, hay que añadir que también lo es. Actualmente la cirugía sigue siendo el mejor método de tratamiento del cáncer en general, y especialmente en el mama. Además de la mejora de su diagnóstico en las fases iniciales, por la mamografía, se ha logrado una buena integración multimodal terapéutica en el tratamiento con los métodos radioterápicos y farmacológicos