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Barco I, García-Font M, García-Fdez A, Fraile M, Vallejo E, Vidal MC, González S, González C, Mitru CB, Porta O, Sanz CC. Strict versus Liberal Use of Sentinel Node Biopsy in Breast Cancer Surgery: Any Clinical Outcome Differences? A 20-Year Clinical Experience. Breast Care (Basel) 2024; 19:18-26. [PMID: 38384490 PMCID: PMC10878707 DOI: 10.1159/000533731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/20/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction As applied to early breast cancer (BC) patients, sentinel node biopsy (SNB) has undergone major changes over the years, especially concerning the widening of indication criteria or skipping systematic axillary lymph node dissection (ALND) after a positive SN. We aimed to ascertain whether a strict versus a more liberal use of SNB resulted in different clinical outcomes in our clinical experience. Methods We studied consecutive BC patients undergoing SNB between January 1, 2000, and March 31, 2020. There were 1,587 patients and 1,634 SNB procedures. Cases were divided into two study groups: the "strict" SNB group (unifocal tumors up to 35 mm in which ALND was always performed for a positive SN, amounting to 1,183 SNBs), and the "liberal" SNB group (extended tumor size up to selected T3 cases, as well as multifocal or bilateral disease, and patients with previous contralateral BC, not always followed by ALND after a positive SN, amounting to 451 SNBs). Patients were closely followed up to the end of the study. Results Clinico-pathological variables were strikingly different between study groups, with the liberal group showing a higher risk profile. Cox regression analysis for disease recurrence did not show significant differences in axillary, lymph node, or locoregional recurrence rates or distant relapse. There were no differences in survival between groups. Conclusion It seems reasonable to adopt the liberal SNB approach, as the goal of surgical management in early BC patients must be attaining optimal locoregional disease control, no matter the differences in distant metastatic spread rates across different BC risk profiles.
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Affiliation(s)
- Israel Barco
- Breast Unit Department of Gynecology, Research Foundation Mútua Terrassa/University of Barcelona/Hospital of Mútua Terrassa, Terrassa, Barcelona, Spain
| | | | - Antonio García-Fdez
- Breast Unit Department of Gynecology, Research Foundation Mútua Terrassa/University of Barcelona/Hospital of Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Manel Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa and University Hospital German Trias i Pujol, Barcelona, Spain
| | - Elena Vallejo
- Breast Unit Department of Gynecology, Research Foundation Mútua Terrassa/University of Barcelona/Hospital of Mútua Terrassa, Terrassa, Barcelona, Spain
| | - MCarmen Vidal
- Department of Breastfeeding, Sexual and Reproductive Health Care Program, Catalan Institute of Health, Barcelona, Spain
| | - Sonia González
- Breast Unit Department of Gynecology, Research Foundation Mútua Terrassa/University of Barcelona/Hospital of Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Clarisa González
- Department of Pathology, Research Foundation Mútua Terrassa/University of Barcelona/Hospital of Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Claudia Beatriz Mitru
- Breast Unit Department of Surgery, Research Foundation Mútua Terrassa/University of Barcelona/Hospital of Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Oriol Porta
- Breast Unit Department of Gynecology, Research Foundation Mútua Terrassa/University of Barcelona/Hospital of Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Carolina Chabrera Sanz
- Tecnocampus, Universitat Pompeu Fabra, Research Group in Attention to Chronicity and Innovation in Health (GRACIS), Barcelona, Spain
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Barco I, Chabrera C, García-Fernández A, Fraile M, Vidal C, Mitru CB, Porta O, García-Font M. COVID-19 Incidence and Mortality in Patients Operated on for Breast Cancer. Comparison with the General Population. Clin Breast Cancer 2023; 23:135-142. [PMID: 36503687 PMCID: PMC9671614 DOI: 10.1016/j.clbc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breast Cancer (BC) remains the most diagnosed malignancy and the most common cause of cancer-related mortality in women worldwide. Covid-19 mortality in BC patients has been linked to comorbid conditions rather than to cancer treatment itself, although this was not confirmed by a meta-analysis. Also, during Covid-19 outbreaks, a great deal of health care resources is reassigned to critical Covid-19 patients. PATIENTS AND METHODS During 5 consecutive trimesters (from 1/12/2020 to 31/3/2021) 2511 BC patients older than 20 years from our institution were surveyed. 1043 of them had received a Covid test and these made our study group, which was conveniently compared with the Covid-19 tested background feminine Catalan population. RESULTS 13.1% of our patients presented with a positive Covid-19 test, whereas confirmed COVID-19 infection amounted to 7.1% of the feminine Catalan tested population. The COVID-19-specific mortality rate was 11.7% (16/137) in the study group, which compares with a 4.7% rate for the overall population. Most deaths occurred in patients over 70. CONCLUSION Three clinical factors were significantly associated with Covid-19 mortality in BC, namely lack of hormone therapy, distant metastases, and BC dwelling in nursing homes. BC patients are at a higher risk of Covid-19 infection and mortality in comparison with the reference group without BC.
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Affiliation(s)
- Israel Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Carolina Chabrera
- Tecnocampus, Universitat Pompeu Fabra, Research Group in Attention to Chronicity and Innovation in Health (GRACIS), Mataró, Barcelona, Spain.
| | - Antonio García-Fernández
- Head emeritus Breast Cancer Screening Vallés Occidental West, Barcelona, Breast Unit University Hospital Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Manel Fraile
- Head emeritus Nuclear Medicine Department, University Hospital Mútua Terrassa and University Hospital German Trias i Pujol, Barcelona, Spain
| | - Carmen Vidal
- Department of nursing, Breastfeeding Consultant, Institut Català de la salut, Barcelona Spain
| | - Claudia Beatriz Mitru
- Breast Unit, Department of surgery University Hospital Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Oriol Porta
- Departament of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
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Barco I, García-Fdez A, Vallejo E, Tarroch X, Ysamat M, Báez CJ, Fraile M. Intraoperative Sentinel Node Fine-Needle Aspiration Biopsy as a Substitute for Whole Sentinel Node Excisional Biopsy in Breast Cancer Patients. Initial Report. Clin Breast Cancer 2022; 22:e877-e880. [PMID: 36127248 DOI: 10.1016/j.clbc.2022.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Sentinel Node Biopsy (SNB) is the choice procedure for axillary staging in Breast Cancer. Following the ACOSOG Z11 trial, axillary dissection is advised only in patients with more than 2 positive SNs. We aimed at exploring palpation-guided, intraoperative fine-needle aspiration biopsy of the SN as a replacement for whole SN excision in node-negative BC patients to minimize side-effects. PATIENTS AND METHODS We included 80 patients with BC undergoing SNB between December 2020 and May 2022. After identification of the SN, the breast surgeon performed SN-FNAB. Results were compared with definitive pathological assessment. ResultsDiagnostic yield was 80%, including a "learning curve." 58 of 64 patients with suitable samples tested negative. In this group, the Negative Predictive Value was 77.6% (IC 64.7%-87.5 %). If micro metastasis is disregarded, the NPV would increase to 86.2% (IC 74.6%-93.9%). If we accept the Z11 criterion for axillary dissection, the NPV would rise to 100%. Six patients had a positive SN-FNAB. They were all confirmed as having macro metastatic-positive SNs at the final pathological assessment, and 3 of them also displayed extra nodal extension (ENE). CONCLUSION We believe that intraoperative SN-FNAB is highly accurate for swiftly depicting both low axillary tumor burden/negative cases, in whom axillary dissection is to be omitted, as well as high axillary tumor burden cases.
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Affiliation(s)
- Israel Barco
- Breast Unit, Department of Gynecology. Hospital Universitari Mútua Terrassa. Universitat de Barcelona. Terrassa. Spain.
| | - Antonio García-Fdez
- Breast Unit, Department of Gynecology. Hospital Universitari Mútua Terrassa. Universitat de Barcelona. Terrassa. Spain
| | - Elena Vallejo
- Breast Unit, Department of Gynecology. Hospital Universitari Mútua Terrassa. Universitat de Barcelona. Terrassa. Spain
| | - Xavier Tarroch
- Breast Unit, Department of Pathology. Hospital Universitari Mútua Terrassa. Universitat de Barcelona. Terrassa. Spain
| | - Montse Ysamat
- Breast Unit, Department of Nuclear Medicine. Hospital Universitari Mútua Terrassa. Universitat de Barcelona. Terrassa. Spain
| | - Cinthya J Báez
- Breast Unit, Department of Pathology. Hospital Universitari Mútua Terrassa. Universitat de Barcelona. Terrassa. Spain
| | - Manel Fraile
- Breast Unit, Department of Nuclear Medicine. Hospital Universitari Mútua Terrassa. Universitat de Barcelona. Terrassa. Spain
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Barco I, Vallejo E, Muntañola A, García Fdez A, Vidal MC, Luizaga LA, Carrillo EM, Fraile M. ADVANCED-STAGE BREAST IMPLANT-ASSOCIATED LARGE CELL ANAPLASTIC LYMPHOMA. A RARE CASE OF MASS-LIKE BILATERAL DISEASE WITH AXILLARY INVOLVEMENT. Current Problems in Cancer: Case Reports 2022. [DOI: 10.1016/j.cpccr.2022.100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Barco I, Chabrera C, García-Fernández A, Fraile M, Giménez N, Vallejo E, Zarco P, González S, González C, Larrañaga I, Garcia-Font M. Clinico-pathologic factors associated with the occurrence of early and late metastatic spread in a cohort of breast cancer patients. Breast Dis 2022; 41:365-372. [PMID: 36057813 DOI: 10.3233/bd-210086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Distant metastatic spread in breast cancer patients is a complex phenomenon involving several prognostic factors. We focused our analysis on early metastatic breast cancer (EMBC) (occurring during the first 36 months) versus late metastatic breast cancer (LMBC) (occurring beyond 3 years) in order to ascertain their possible differential predictive factors. METHODS diagnostic, surgical, and follow-up data were assessed for consecutive patients with breast cancer undergoing surgery between 1997 and 2019. We analysed the predictive factors for distant metastasis using both univariate and multivariate analysis. RESULTS The median follow-up for this cohort of 2708 patients was 89 months. The median metastasis-free interval (FMI) for metastasis patients was 38 months (17 months for EMBC group and 76 months for LMBC group). Distant metastases developed in 12.9% (350/2708); 48% (168/350) of them as EMBC and 52% (182/350) as LMBC. Loco-regional recurrence and nodal extracapsular extension were the only common predictors for both. CONCLUSIONS EMBC and LMBC appeared as two separate conditions, with a different outcome. In the EMBC group, tumour proliferation related factors were significant (histological grade, tumour size, body mass index), whereas for LMBC, other slow-acting factors seemed to be involved (screening program, tumour burden, bilateral tumour).
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Affiliation(s)
- Israel Barco
- Breast Unit, Department of Gynaecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Carol Chabrera
- Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Barcelona, Spain
| | - Antonio García-Fernández
- Breast Unit, Department of Gynaecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Manel Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Nuria Giménez
- Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Vallejo
- Breast Unit, Department of Gynaecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Patricia Zarco
- Breast Unit, Department of Gynaecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Sonia González
- Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Clarisa González
- Department of Pathology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Itziar Larrañaga
- Department of Surgery, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
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Sánchez García C, Osorio I, Bernar J, Fraile M, Villarejo P, Salido S. Body Mass Index impact on Extended Total Extraperitoneal Ventral Hernia Repair: a comparative study. Hernia 2022; 26:1605-1610. [PMID: 35274208 DOI: 10.1007/s10029-022-02581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Obesity is a risk factor for developing abdominal wall hernias and is associated with major postoperative complications, such as surgical site infection, delayed wound healing and recurrent hernia. Therefore, treating incisional hernia in this patient subgroup is a challenge. METHODS We conducted a comparative, prospective study on patients who underwent primary ventral hernia surgery or incisional hernia surgery through the extended totally extraperitoneal pathway, with body mass indices (BMIs) ≤ 30 (no obesity) and BMI > 30 (with obesity). We collected demographic data, preoperative and intraoperative variables, complication and recurrence rate, hospital stay and follow-up as postoperative data. RESULTS From May 2018 to December 2020, 74 patients underwent this surgery, 38 patients without obesity and 36 with obesity. The median area of the hernia defect measured by CT was 57 cm2 and 93 cm2 in patients without and with obesity, respectively (p = 0.012). The median follow-up was 16 months. One patient without obesity experienced some postoperative complication compared with four patients with obesity (p > 0.05). No patient without obesity had recurrent hernia compared with two patients with obesity (p > 0.05). CONCLUSIONS There were statistically significant differences between patients with and without obesity in the size of the hernia defect. However, there were no significant differences in terms of complications, hospital stay, postoperative pain or relapses. Therefore, the minimally invasive completely extraperitoneal approach for patients with obesity appears to be a safe procedure despite our study limitations. Studies with longer follow-ups and a greater number of patients are needed.
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Affiliation(s)
- C Sánchez García
- Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, 2, 28040, Madrid, Spain.
| | - I Osorio
- Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - J Bernar
- Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Villalba General Hospital, Madrid, Spain
| | - M Fraile
- Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Villalba General Hospital, Madrid, Spain
| | - P Villarejo
- Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - S Salido
- Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, 2, 28040, Madrid, Spain
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Barco I, Garcia-Font M, García-Fernández A, Fraile M, Giménez N, González S, Vallejo E, Zarco P, González C, Itziar L, Chabrera C. Breast cancer patients developing distant metastasis at follow-up: Mortality-related factors. Breast J 2021; 27:291-293. [PMID: 33482685 DOI: 10.1111/tbj.14159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Israel Barco
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Marc Garcia-Font
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | | | - Manel Fraile
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Nuria Giménez
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Sonia González
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Elena Vallejo
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Patricia Zarco
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Clarisa González
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Larrañaga Itziar
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
| | - Carol Chabrera
- Breast Unit, Universitari Hospital Mútua Terrassa, Terrassa, Spain
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Barco I, Fraile M, Vidal MC, Cambra MJ, Vallejo E, Deu J, González S, Giménez N, Pessarrodona A, García-Fernández A. Tamoxifen induced radiation recall dermatitis in a breast cancer patient. Breast J 2018. [PMID: 29517150 DOI: 10.1111/tbj.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Israel Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Manel Fraile
- Department of Nuclear Medicine, CTD, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - MCarmen Vidal
- Department of Nursing, Breastfeeding Promotion Programme, ASSIR Mollet, InstitutCatalà de la Salut, Barcelona, Spain
| | - Maria Jose Cambra
- Department of Radiation Oncology, Hospital General de Catalunya, Barcelona, Spain
| | - Elena Vallejo
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Jordi Deu
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Sonia González
- Department of Oncology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Antonio García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
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Barco I, Vidal MC, Fraile M, Masferrer E, Barco L, Barco D, Baez CJ, Giménez N, Pessarrodona A, García-Fernández A. MOHS micrographic surgery for treating erosive adenoma of the nipple: a case report and review of the literature. Int J Dermatol 2017; 56:1451-1454. [PMID: 28960299 DOI: 10.1111/ijd.13747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Erosive adenoma of the nipple (EAN) is a benign condition that involves major ducts of the nipple. Its clinical presentation may resemble other disorders. Complete removal of the nipple is often suggested because of frequent relapse. However, adverse cosmetic and functional results have prompted clinicians to look for other more conservative options. AIMS To present a case of EAN successfully treated using Mohs micrographic surgery (MMS) and summarize differential diagnosis and treatment. MATERIALS AND METHODS A 40-year-old woman with EAN was diagnosed by immunohistochemical markers after clinical suspicion. We have reviewed other cases treated with MMS in the literature. RESULTS In this patient, lesion size was 0.8 cm and the margin specimen was 1 × 0.9 × 0.2 cm, with EAN as histopathologic diagnosis. No atypia or malignancy was reported. Final esthetic outcome was reached with only one session, under local anesthesia and on an outpatient basis. DISCUSSION Dermatologic lesions appearing on the nipple's surface should be closely followed. Paget's disease, carcinoma or proliferative lesions like EAN have to be considered, and such conditions require different surgical approaches. Traditional complete removal of the nipple is performed in many cases, but it may result in over-treatment and unfavorable cosmetic outcome. MMS is frequently used in dermatologic surgery to treat malignant lesions with a high cure rate, avoiding excess tissue excision and leading to better patient satisfaction. CONCLUSION EAN can be successfully treated by minimal resection, especially if early diagnosis is done. MMS offers a better aesthetic outcome than traditional total excision.
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Affiliation(s)
- Israel Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - MCarmen Vidal
- Department of Nursing, Breastfeeding Promotion Programme, ASSIR Mollet, Institut Català de la Salut, Barcelona, Spain
| | - Manel Fraile
- Department of Nuclear Medicine, CTD, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Emili Masferrer
- Department of Dermatology, University Hospital of Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - Leo Barco
- Dermatologist, Centro Médico Bayyana, Almeria, Spain
| | - Didac Barco
- Dermatologist, Centre Mèdic Teknon, Barcelona, Spain
| | - Cinthya J Baez
- Department of Pathology, University Hospital of Mútua terrassa, University of Barcelona, Barcelona, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Antonio García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
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Milà M, Bechini J, Vázquez A, Vallejos V, Tenesa M, Espinal A, Fraile M, Monreal M. Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option? Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Milà M, Bechini J, Vázquez A, Vallejos V, Tenesa M, Espinal A, Fraile M, Monreal M. Acute pulmonary embolism detection with ventilation/perfusion SPECT combined with full dose CT: What is the best option? Rev Esp Med Nucl Imagen Mol 2017; 36:139-145. [PMID: 28185782 DOI: 10.1016/j.remn.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/16/2022]
Abstract
AIM To compare diagnostic accuracy of Ventilation/Perfusion (V/P) single-photon emission computed tomography (SPECT) combined with simultaneous full-dose CT with a hybrid SPECT/CT scanner versus planar ventilation/perfusion (V/P) SPECT and CT angiography (CTA) in patients suspected with acute pulmonary embolism (PE). METHODS Between 2009 and 2011, consecutive patients suspected of acute PE were referred for V/P SPECT/CT (reviewed board approved study). A contrast agent was administered to patients who had no contraindications. Non-contrast V/P SPECT/CT was performed on the remaining patients. All patients were followed-up for at least 3 months. RESULTS A total of 314 patients were available during the study period, with the diagnosis of PE confirmed in 70 (22.29%) of them. The overall population sensitivity and specificity was 90.91% and 92.44%, respectively for V/P SPECT, 80% and 99.15%, respectively, for CTA, and 95.52% and 97.08% for V/P SPECT/CT. SPECT/CT performed better than V/P SPECT (AUC differences=0.0419, P=0.0043, 95% CI; 0.0131-0.0706) and CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259)). Comparing imaging modalities when contrast agent could be administered, sensitivity and specificity increased and V/P SPECT/CT was significantly better than CTA (AUC differences=0.0681, P=0.0208, 95% CI; 0.0103-0.1259) and V/P SPECT (AUC differences=0.0659, P=0.0052, 95% CI; 0.0197-0.1121). In case of non-contrast enhancement, there was non-significant increase of specificity. Secondary findings on CT impacted patient management in 14.65% of cases. CONCLUSION Our study shows that combined V/P SPECT/CT scanning has a higher diagnostic accuracy for detecting acute PE than V/P SPECT and CTA alone. When feasible, V/P SPECT/CT with contrast enhancement is the best option.
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Affiliation(s)
- M Milà
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | - J Bechini
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A Vázquez
- Applied Statistics Service, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Vallejos
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Tenesa
- Department of Radiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - A Espinal
- Applied Statistics Service, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Fraile
- Department of Nuclear Medicine (ICS-IDI), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - M Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Barco I, Chabrera C, García-Fernández A, Fraile M, González S, Canales L, Lain JM, González C, Vidal MC, Vallejo E, Deu J, Pessarrodona A, Giménez N, García Font M. Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients. Clin Transl Oncol 2016; 19:704-710. [PMID: 27896640 DOI: 10.1007/s12094-016-1589-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/18/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement. METHODS/PATIENTS Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required. RESULTS 1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%. CONCLUSION We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.
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Affiliation(s)
- I Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain
| | - C Chabrera
- Department of Nursing, School of Health Science, TecnoCampus Mataró-Maresme, Barcelona, Spain
| | - A García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain.
| | - M Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - S González
- Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - L Canales
- Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - J M Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain
| | - C González
- Department of Pathology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - M C Vidal
- Department of Nursing, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain
| | - E Vallejo
- Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - J Deu
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/Sant Antoni, 21, 08221, Terrassa, Spain
| | - A Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - N Giménez
- University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M García Font
- University International of Catalunya, Barcelona, Spain
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Barco I, Chabrera C, García-Fernández A, Fraile M, Vidal MC, González S, Lain JM, Reñé A, Canales L, Vallejo E, Deu J, Pessarrodona A, Giménez N, García-Font M. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease. Eur J Radiol 2016; 85:1786-1793. [DOI: 10.1016/j.ejrad.2016.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 01/22/2023]
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Barco Nebreda I, Vidal MC, Fraile M, Canales L, González C, Giménez N, García-Fernández A. Lactating Adenoma of the Breast. J Hum Lact 2016; 32:559-62. [PMID: 27197575 DOI: 10.1177/0890334416646564] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 04/04/2016] [Indexed: 11/17/2022]
Abstract
Lactating adenoma is an uncommon breast palpable lesion occurring in pregnancy or lactation. Although it is a benign condition, it often requires core biopsy or even surgery to exclude malignancy. As with other solid lesions in pregnancy and lactation, lactating adenoma needs an accurate evaluation in order to ensure its benign nature. Work-up must include both imaging and histologic findings. Ultrasound evaluation remains the first step in assessing the features of the lesion. Some authors consider magnetic resonance imaging as a useful tool in cases of inconclusive evaluation after ultrasound and histologic exam in an attempt to avoid surgery. Most lactating adenomas resolve spontaneously, whereas others persist or even increase in size and must be removed. The authors present a case of a 35-year-old woman at 6 months postpartum with a lactating adenoma in her right breast. After surgical removal, breastfeeding was perfectly continued within the next 24 hours, which highlights the fact that breast surgery is most often compatible with breastfeeding.
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Affiliation(s)
- Israel Barco Nebreda
- Breast Unit, Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - M Carmen Vidal
- Department of Nursing, Breastfeeding Consultant, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain
| | - Manel Fraile
- Nuclear Medicine Department, CTD, Hospital Universitari Mútua Terrassa, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Lydia Canales
- Breast Unit, Department of Radiology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Clarisa González
- Breast Unit, Department of Pathology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio García-Fernández
- Breast Unit, Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
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García-Fernández A, Barco I, Fraile M, Lain JM, Carmona A, Gonzalez S, Pessarrodona A, Giménez N, García-Font M. Factors predictive of mortality in a cohort of women surgically treated for breast cancer from 1997 to 2014. Int J Gynaecol Obstet 2016; 134:212-6. [PMID: 27233816 DOI: 10.1016/j.ijgo.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/05/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether previously reported factors predictive of breast cancer mortality are effectively linked with mortality, particularly breast-cancer-specific mortality. METHODS In a prospective study, clinical, surgical, and follow-up data were assessed for consecutive patients with breast cancer who underwent surgery between 1997 and 2014 at two centers in Barcelona, Spain. Predictors of mortality were assessed by multivariate analysis. RESULTS Overall, 2134 patients were treated for 2206 breast tumors. Overall mortality was 15.0% (n=319), and breast-cancer-specific mortality was 9.0% (n=191). On multivariate analysis, the most significant factors associated with breast-cancer-specific mortality were clinical stage, inmunohistochemical profile, locoregional relapse, and lymphovascular invasion (all P<0.001). Age at onset, participation in the mass-screening program, histologic grade, and multicentricity were not significant. Patients with three or more positive axillary nodes sustained a specific mortality significantly higher than did node-negative patients or those with fewer than three positive nodes. CONCLUSION Factors predictive of breast cancer mortality were clinical stage, locoregional relapse, molecular classification, lymphovascular invasion, and neoadjuvant chemotherapy. As a single factor, nodal disease becomes relevant only when three or more lymph nodes are involved.
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Affiliation(s)
- Antonio García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.
| | - Israel Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Manel Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - José M Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain
| | - Ana Carmona
- Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Sonia Gonzalez
- Department of Hemato-Oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Antoni Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Solà M, Recaj M, Castellà E, Puig P, Gubern JM, Julian JF, Fraile M. Sentinel Node Biopsy in Special Histologic Types of Invasive Breast Cancer. J Breast Health 2016; 12:78-82. [PMID: 28331738 DOI: 10.5152/tjbh.2016.2929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/07/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the feasibility of sentinel node biopsy (SNB) in ductal and lobular invasive breast cancer, a group of tumors known as special histologic type (SHT) of breast cancer. MATERIALS AND METHODS Between January 1997 and July 2008, 2253 patients from 6 affiliated hospitals underwent SNB who had early breast cancer and clinically negative axilla. The patients' data were collected in a multicenter database. For lymphatic mapping, all patients received an intralesional dose of radiocolloid Tc-99m (4mCi in 0.4 mL saline), at least two hours before the surgical procedure. SNB was performed by physicians from the same nuclear medicine department in all cases. RESULTS Of the 2253 patients in the database, the SN identification rate was 94.5% (no radiotracer migration in 123 patients), and positive sentinel node prevalence was 22%. SHT was reported in 144 patients (6.4%) of the whole series. In this subgroup, migration of radiotracer was unsuccessful in 8 patients (identification rate was 94.4%) and SNs were positive in 7.4%. SN positivity prevalence in these tumors was variable across the subtypes. Higher probability of lymphatic spread seemed to be related to tumor invasiveness (20% of positivity in micropapillary, 15% in cribriform subtypes, and 0% in adenoid-cystic). CONCLUSION Sentinel node biopsy is feasible in special histologic subtypes of breast carcinoma with a good identification rate. Lower migration rates, however, might be associated with special histologic features (colloid subtype). Complete axillary dissection after a positive sentinel node cannot be omitted in patients with SHT breast cancer because they can be associated with further axillary disease; the reported very low incidence of axillary metastases would justify avoiding axillary dissection only in the adenoid-cystic subtype.
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Affiliation(s)
- Montserrat Solà
- Germans Trias Pujol Hospital, Nuclear Medicine, Badalona, Spain
| | | | - Eva Castellà
- Germans Trias Pujol H, Pathology, Badalona, Spain
| | - Pere Puig
- Sant Jaume Calella H, Surgery, Calella, Spain
| | | | | | - Manel Fraile
- Germans Trias Pujol Hospital, Nuclear Medicine, Badalona, Spain
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Barco I, Vidal MC, Fraile M, Vallejo E, Giménez N, García-Fernández A. Advanced breast cancer following alternative medicine. Int J Gynaecol Obstet 2016; 133:378-9. [PMID: 26969146 DOI: 10.1016/j.ijgo.2015.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/06/2015] [Accepted: 01/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Israel Barco
- Breast Unit, Department of Obstetrics and Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain..
| | - M Carmen Vidal
- Department of Nursing, Breastfeeding Consultant, Promotion and Supporting Program, Institut Català de la Salut, ASSIR Mollet, Barcelona, Spain
| | - Manel Fraile
- Department of Nuclear Medicine, Diagnostic Technology Center (CTD), Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Spain
| | - Elena Vallejo
- Breast Unit, Department of Obstetrics and Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Laboratory of Toxicology, Autonomous University of Barcelona, Barcelona, Spain
| | - Antonio García-Fernández
- Breast Unit, Department of Gynaecology, Hospital Universitari Mútua Terrassa, Research Foundation Mútua Terrassa, Universitat de Barcelona, Spain
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18
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Barco I, García-Fernández A, Chabrera C, Fraile M, Vallejo E, Lain JM, Deu J, González S, González C, Veloso E, Torres J, Torras M, Cirera L, Pessarrodona A, Giménez N, García-Font M. The appropriate axillary procedure after a positive sentinel node in breast cancer patients: the "Hôpital Tenon" score revisited. A two-institution study. Clin Transl Oncol 2016; 18:1098-1105. [PMID: 26920150 DOI: 10.1007/s12094-016-1487-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/13/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Until recently, completion ALND has been considered the standard of care after a positive SN in breast cancer patients. However, most patients will not display further axillary involvement. The Tenon score is a simple nomogram that can be used intraoperatively to avoid completion ALND in low-risk patients. We aimed at validating the Tenon score on a SN-positive patient sample that had been preoperatively selected using axillary US examination. PATIENTS AND METHOD We used a retrospective analysis of our bicentric database that included 246 breast cancer patients with a positive SN. We calculated sensitivity, specificity, as well as positive and negative predictive values for each cut-off point. ROCs were constructed and corresponding AUC values were calculated as a measure of discriminative capacity. RESULTS At least one non-SN was positive in 52 patients (21.1 %). 118 patients (48 %) had a score up to 5. Among them, three had at least one positive non-SN. NPV was 97.5 %. Using that threshold, the ROCs analysis showed an AUC of 0.822 (95 % CI 0.764-0.880). CONCLUSION Use of preoperative axillary US examination led to a modification of the proposed Tenon cut-off value from 3.5 to 5 to attain good predictive power for non-SN status. Straightforward intraoperative use of the Tenon score may be considered an advantage over other available nomograms.
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Affiliation(s)
- I Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain
| | - A García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain.
| | - C Chabrera
- Department of Nursing, School of Health Science, TecnoCampus Mataró-Maresme, Mataró, Spain
| | - M Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - E Vallejo
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain
| | - J M Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain
| | - J Deu
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain
| | - S González
- Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - C González
- Breast Unit, Department of Pathology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - E Veloso
- Breast Unit, Department of Surgery, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - J Torres
- Breast Unit, Department of Radiology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - M Torras
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain
| | - L Cirera
- Breast Unit, Department of Hemato-oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain
| | - A Pessarrodona
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, C/ Sant Antoni, 21, 08221, Terrassa, Spain
| | - N Giménez
- University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M García-Font
- University International of Catalunya, Barcelona, Spain
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García-Fernández A, Lain JM, Chabrera C, García Font M, Fraile M, Barco I, Torras M, Reñe A, González S, González C, Piqueras M, Veloso E, Cirera L, Pessarrodona A, Giménez N. Comparative Long-term Study of a Large Series of Patients with Invasive Ductal Carcinoma and Invasive Lobular Carcinoma. Loco-Regional Recurrence, Metastasis, and Survival. Breast J 2015; 21:533-7. [PMID: 26190560 DOI: 10.1111/tbj.12455] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Our aim was to compare histologic and immunohistochemical features, surgical treatment and clinical course, including disease recurrence, distant metastases, and mortality between patients with invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC). We included 1,745 patients operated for 1,789 breast tumors, with 1,639 IDC (1,600 patients) and 145 patients with ILC and 150 breast tumors. The median follow-up was 76 months. ILC was significantly more likely to be associated with a favorable phenotype. Prevalence of contralateral breast cancer was slightly higher for ILC patients than for IDC patients (4.0% versus 3.2%; p = n.s). ILC was more likely multifocal, estrogen receptor positive, Human Epidermal Growth Factor Receptor-2 (HER2) negative, and with lower proliferative index compared to IDC. Considering conservative surgery, ILC patients required more frequently re-excision and/or mastectomy. Prevalence of stage IIB and III stages were significantly more frequent in ILC patients than in IDC patients (37.4% versus 25.3%, p = 0.006). Positive nodes were significantly more frequent in the ILC patients (44.6% versus 37.0%, p = 0.04). After adjustment for tumor size and nodal status, frequencies of recurrence/metastasis, disease-free and specific survival were similar among patients with IDC and patients with ILC. In conclusion, women with ILC do not have worse clinical outcomes than their counterparts with IDC. Management decisions should be based on individual patient and tumor biologic characteristics rather than on lobular versus ductal histology.
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Affiliation(s)
- Antonio García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Josep María Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Terrassa, Spain
| | - Carol Chabrera
- Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme, Barcelona, Spain
| | | | - Manel Fraile
- Nuclear Medicine Department-CTD, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Israel Barco
- Breast Unit, Department of Gynecology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Merçe Torras
- Breast Unit, Department of Gynecology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Asumpta Reñe
- Department of Radiology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Sonia González
- Department of Hemato-Oncology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Clarissa González
- Department of Pathology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Mercedes Piqueras
- Breast Unit, Department of Gynecology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Enrique Veloso
- Department of Surgery, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Lluís Cirera
- Department of Hemato-Oncology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Antoni Pessarrodona
- Department of Gynecology, University Hospital of MútuaTerrassa, University of Barcelona, Barcelona, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation MútuaTerrassa, University of Barcelona, Barcelona, Spain.,Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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20
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Barco I, Chabrera C, García Font M, Gimenez N, Fraile M, Lain JM, Piqueras M, Vidal MC, Torras M, González S, Pessarrodona A, Barco J, Cassadó J, García Fernández A. Comparison of Screened and Nonscreened Breast Cancer Patients in Relation to Age: A 2-Institution Study. Clin Breast Cancer 2015; 15:482-9. [PMID: 25986958 DOI: 10.1016/j.clbc.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/02/2015] [Accepted: 04/16/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Screening programs for breast cancer aim to allow early diagnosis, and thus reduce mortality. The aim of this study was to assess the effect of a population screening program in a sample of women aged between 50 and 69 years in terms of recurrence, metastasis, biological profiles, and survival, and to compare their results with those of women of a wider age range who did not participate on the screening program. PATIENTS AND METHODS A prospective multicenter study in which 1821 patients with 1873 breast tumors who received surgery between 1999 and 2014 at MútuaTerrassa University Hospital and the Hospital of Terrassa in Barcelona were analyzed. A comparison was performed in the 50- to 69-year-old age group between those who participated on the screening program and those who did not. RESULTS The mean age of patients was 58 years. The mean follow-up was 72 months, and median follow-up 59 months. The screened group showed significantly better results in all prognostic factors and in specific mortality than all nonscreened groups. The specific mortality rate in the screened patients was 2.4% (12/496), local recurrence 2.8% (14/496), and metastasis at 10 years 3.6% (18/496). In the nonscreened group, younger women presented a higher rate of metastasis (16.4% [81/493]) and a shorter disease-free period (77.1% [380/493]). The age group older than 70 years had the highest number of T4 tumors (7.5% [30/403]) and the highest proportion of radical surgery (50.4% [203/403]). CONCLUSION Patients in the screening program presented improved survival. We speculate that extending breast cancer screening programs to women younger than 50 and older than 70 years could bring about mortality benefits.
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Affiliation(s)
- Israel Barco
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Carol Chabrera
- Department of Nursing, School of Health Science Tecnocampus Mataró-Maresme, Barcelona, Spain
| | | | - Nuria Gimenez
- Research Unit, Research Foundation Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Manel Fraile
- Department of Nuclear Medicine (CTD), Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Josep María Lain
- Breast Unit, Department of Gynaecology, Hospital de Terrassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Merce Piqueras
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - M Carmen Vidal
- Department of Nursing, Breastfeeding Promotion Programme, ASSIR Mollet, Institut Català de la Salut, Barcelona, Spain
| | - Merce Torras
- Department of Nursing, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Sonia González
- Department of Oncology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Pessarrodona
- Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Josep Barco
- Department of Gynaecology and Obstetrics, Clínica Sant Josep, Manresa, Spain
| | - Jordi Cassadó
- Department of Gynaecology, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain
| | - Antonio García Fernández
- Department of Gynaecology, Breast Unit, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Barcelona, Spain; Breast Cancer Screening Unit, Vallès Occidental, Institut Català de la Salut, Terrassa, Barcelona, Spain
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García Fernández A, Chabrera C, García Font M, Fraile M, Lain JM, Gónzalez S, Corral C, Torras M, Torres J, Teixido M, Barco I, López R, Gónzalez C, Pessarrodona A, Giménez N. Mortality and recurrence patterns of breast cancer patients diagnosed under a screening programme versus comparable non-screened breast cancer patients from the same population: analytical survey from 2002 to 2012. Tumour Biol 2013; 35:1945-53. [PMID: 24114015 DOI: 10.1007/s13277-013-1260-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/25/2013] [Indexed: 11/30/2022] Open
Abstract
Breast cancer screening programmes seem to bring about significant benefits, including decreased mortality, although they may also have some drawbacks such as false-negative and false-positive results. This study aims to compare the clinical outcome of a group of patients undergoing a breast cancer screening programme with that of a synchronous non-screened group of patients matched for age and follow-up period. We studied basic characteristics of epidemiology, immunohistochemistry, loco-regional relapse, distant metastases, disease-free interval and overall and specific mortality. We compared 510 patients in the screened group with 394 non-screened patients, along the period of 2002-2012. Screening was applied on a target population of 49,847 and was based on double-projection, double-read mammograms. Two years were allowed per round. Overall participation for the five rounds considered was 75.2%, with 86.5% coverage, and a total cumulative population of 123,445. The non-participant women amounted 40,794. Tumour detection rate for the screened women was 3.8 per thousand (475/123,445), while the corresponding rate for non-participants was 9.4 per thousand (382/40,797). Incidence of luminal A subtype was 15% higher in screened than that in non-screened patients (95% confidence interval (CI) 8-22%). Conversely, the triple-negative subtype was 6% higher in the non-screened group (95% CI 2-10%). Incidence of breast conservative treatments and sentinel node biopsies was significantly higher in the screened group. Overall mortality was 2.6 times higher in non-screened than that in screened group (95% CI 1.2-5.6) After 10 years of experience with our own screening programme, we believe that included patients receive a benefit versus comparable non-screened breast cancer patients, with acceptable benefit-risk relation.
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Affiliation(s)
- A García Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Barcelona, Spain,
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García Fernández A, Chabrera C, García Font M, Fraile M, Lain J, Barco I, González C, Gónzalez S, Reñe A, Veloso E, Cassadó J, Pessarrodona A, Giménez N. Positive versus negative sentinel nodes in early breast cancer patients: Axillary or loco-regional relapse and survival. A study spanning 2000–2012. Breast 2013; 22:902-7. [DOI: 10.1016/j.breast.2013.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/09/2013] [Accepted: 04/17/2013] [Indexed: 11/15/2022] Open
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Fraile M, Martín Ÿ, Deodato D, Rodriguez-Rojo S, Nogueira I, Simplício A, Cocero M, Duarte C. Production of new hybrid systems for drug delivery by PGSS (Particles from Gas Saturated Solutions) process. J Supercrit Fluids 2013. [DOI: 10.1016/j.supflu.2013.06.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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García Fernández A, Chabrera C, García Font M, Fraile M, Gónzalez S, Barco I, González C, Cirera L, Veloso E, Lain JM, Pessarrodona A, Giménez N. Differential survival and recurrence patterns of patients operated for breast cancer according to the new immunohistochemical classification: analytical survey from 1997 to 2012. Tumour Biol 2013; 34:2349-55. [DOI: 10.1007/s13277-013-0782-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/27/2013] [Indexed: 02/07/2023] Open
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García Fernández A, Giménez N, Fraile M, González S, Chabrera C, Torras M, González C, Salas A, Barco I, Cirera L, Cambra M, Veloso E, Pessarrodona A. Survival and clinicopathological characteristics of breast cancer patient according to different tumour subtypes as determined by hormone receptor and Her2 immunohistochemistry. A single institution survey spanning 1998 to 2010. Breast 2012; 21:366-73. [DOI: 10.1016/j.breast.2012.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 03/06/2012] [Accepted: 03/13/2012] [Indexed: 11/30/2022] Open
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Recal-Gutierrez M, Sola M, Fraile M. 590 Neither Ductal Nor Lobular Invasive Breast Cancer and Sentinel Node. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Solá M, Pérez R, Cuadras P, Díaz R, Holgado S, Puyalto P, Iborra M, Fraile M. Value of bone SPECT-CT to predict chronic pain relief after percutaneous vertebroplasty in vertebral fractures. Spine J 2011; 11:1102-7. [PMID: 22208854 DOI: 10.1016/j.spinee.2011.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 09/12/2011] [Accepted: 11/15/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Longer life span has resulted in increased risk of vertebral osteoporotic fractures. Among minimally invasive procedures, percutaneous vertebroplasty (PV) has shown excellent results in the treatment of chronic vertebral pain. The role of preintervention bone single photon emission computed tomography-computed tomography (SPECT-CT) has not been clearly established for the management of these patients. PURPOSE To determine the value of bone SPECT-CT in patient selection, treatment planning, and prediction of response to PV. A comparison with magnetic resonance imaging (MRI) was also aimed. STUDY DESIGN Prospective consecutive series. PATIENT SAMPLE We studied the performance of bone SPECT-CT on 33 consecutive patients with chronic pain because of vertebral fracture intended for PV. OUTCOME MEASURES Improvement of clinical status was based on comparison of preprocedure and postprocedure outcome measurements of pain, mobility, and analgesic use. METHODS Bone SPECT was done using a dual-detector variable-angle gamma camera coupled with a two-slice CT scanner (Symbia T2 System; Siemens, Munich, Germany). Magnetic resonance imaging was done using a magnet of 1.5 T (Giroscan System ACS NT Intera; Philips, Amsterdam, The Netherlands). RESULTS Of the 33 patients, 24 finally underwent PV. Positive SPECT-CT images predicted clinical improvement in 91% (21 of 23) of them. Agreement between SPECT-CT and MRI was 80% (20 of 25). Single photon emission computed tomography-computed tomography images showed an alternative cause of pain in some cases, such as new fractures or multiple coexisting fractures, persisting bone remodeling in a previous cemented vertebra, and facet or discal degenerative disease. Single photon emission computed tomography-computed tomography was mandatory in eight patients that could no receive MRI, all of whom improved after PV. CONCLUSIONS Positive bone SPECT-CT seems a good predictor of postprocedural response. It also adds valuable information as to the cause of back pain and facilitates complete patient evaluation in patients that can not receive MRI.
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Affiliation(s)
- Montserrat Solá
- Department of Nuclear Medicine, Hospital Universitari Germans Trias i Pujol. Carretera del Canyet, Badalona, Barcelona, Spain.
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García J, Fraile M, Soler M, Bechini J, Ayuso J, Lomeña F. PET/CT-guided salvage surgery protocol. Results with ROLL technique and PET probe. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.remngl.2011.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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García JR, Fraile M, Soler M, Bechini J, Ayuso JR, Lomeña F. [PET/CT-guided salvage surgery protocol. Results with ROLL Technique and PET probe]. ACTA ACUST UNITED AC 2011; 30:217-22. [PMID: 21514975 DOI: 10.1016/j.remn.2011.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 02/03/2011] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To assess the value of intraoperatory radioguided probe detection to guide surgical resection of malignant lesions previously detected by (18)F-FDG PET-CT. MATERIAL Twelve consecutive patients with suspected tumor recurrence detected by (18)F-FDG PET-CT considered resectable were enrolled in the study. Ultrasound guided fine needle aspiration (FNA) before surgery was performed in 6 patients and CT guided biopsy was performed in 1 patient. In 5 patients with accessible lesions, a radioguided occult lesion localization (ROLL) technique was performed after injection of (99m)Tc-colloid (1.7-2.4 mCi) inside the lesion under ultrasound or CT guidance, pre-operatively. Radioguided surgical detection was then carried out 19-24 hours afterwards using the gamma probe. In 7 patients with non-accessible needle lesions or multiple lesions, 9.5-10.5 mCi of (18)F-FDG were injected 3-5 hours before radioguided surgery using a PET-dedicated probe (Gamma locator DXI-GF&E). RESULTS ROLL technique: All lesions injected with nanocolloid were resected (6 lesions in 5 patients, 1 patient with 2 lesions), and recurrence was histologically confirmed. PET probe: Fourteen out of 16 hypermetabolic lesions detected on the PET-CT were resected. One cervical and one mediastinal lymph node in different patients could not be excised. Histological recurrence was confirmed in 12 out of 14 lesions. In one patient, the 2 lymph nodes excised were inflammatory. CONCLUSIONS (18)F-FDG PET-CT can be key in deciding surgical approach and appropriate radioguided protocol. When lesions are solitary and easily accessible, ROLL technique seems the method of choice. PET probe is more adequate for less accessible lesions.
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Affiliation(s)
- J R García
- CETIR Unidad PET/TC, Esplugues de Llobregat, Barcelona, Spain
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García Fernández A, Fraile M, Giménez N, Reñe A, Torras M, Canales L, Torres J, Barco I, González S, Veloso E, González C, Cirera L, Pessarrodona A. Use of axillary ultrasound, ultrasound-fine needle aspiration biopsy and magnetic resonance imaging in the preoperative triage of breast cancer patients considered for sentinel node biopsy. Ultrasound Med Biol 2011; 37:16-22. [PMID: 21144955 DOI: 10.1016/j.ultrasmedbio.2010.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 09/24/2010] [Accepted: 10/09/2010] [Indexed: 05/10/2023]
Abstract
We assessed the diagnostic yield of axillary ultrasound, alone or in combination with fine-needle aspiration axillary biopsy and magnetic resonance imaging in patients with invasive breast carcinoma compared with final axillary histology by sentinel node biopsy or by axillary lymph node dissection. From January 2003 to March 2009, 520 axillary ultrasound examinations and 105 axillary magnetic resonance imaging studies were included. Compared with final axillary histology, ultrasound fine-needle aspiration showed positive predictive value of 87%, negative predictive value of 82%, sensitivity of 53% and specificity of 100%. In cases of negative ultrasound, the rate of positive nodes was 17% (micro-metastases excluded). Ultrasound examination of the axilla, combined with fine-needle aspiration as appropriate must be included in the preoperative work-up of patients considered for sentinel node biopsy to definitively establish such an indication while minimizing the risk of false-negative sentinel node. Axillary magnetic resonance imaging did not improve the preoperative work-up.
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Affiliation(s)
- Antonio García Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Spain.
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Solá M, Julian F, Ballester B, Rojo R, Pericás I, Piñero A, García A, Vallejo V, De Pablo J, Fraile M. 307 Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastases. Interim analysis of the Spanish multicenter clinical trial. AATRM 048/13/2000. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Solá M, Margeli M, Castellà E, Gubern J, Culell P, Julian F, Vallejo V, Fraile M. 303 Sentinel lymph node biopsy and immunohistochemical examination of bone marrow for the detection of isolated tumour cells in early stage breast cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
Injection technique and radiocolloid size are two critical parameters that must be carefully selected according to patient presentation and lesion appearance for accurate sentinel node detection in breast cancer. Scintigraphic detection and intraoperative localization are dependent on these parameters. The present clinical case illustrates how much deep intralesional tracer injection bears on our capacity to detect extra-axillary sentinel nodes and how the use of smaller-size radiocolloids may sometimes facilitate sentinel node detection.
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Affiliation(s)
- M Solá
- Servicio de Medicina Nuclear, Hospital Universitari Trias i Pujol, Badalona, España.
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Solá M, Fraile M, Mariscal A, Julián F, Gubern J, Culell P, Puig P, Peñalva G, Deulofeu P, Janer J, Vallès A, Encinas X, Calvo E, Vallejos V, Milà M. Estudio comparativo de la técnica del ganglio centinela entre los casos de carcinoma de mama multifocal y unifocal. Radiología 2009; 51:140-7. [DOI: 10.1016/j.rx.2008.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 02/03/2008] [Indexed: 02/06/2023]
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Mariscal A, Balliu E, Solá M, Pérez de Tudela A, Fraile M, Julián J. Comparación entre la inyección intratumoral y peritumoral del radiotrazador para la localización y biopsia del ganglio centinela en cáncer de mama no palpable. Radiología 2008; 50:309-16. [DOI: 10.1016/s0033-8338(08)71990-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Culell P, Solernou L, Fraile M, Tarazona J, Miguel A, Villa V. Técnica del ganglio centinela en la cirugía del cáncer de mama en un hospital sin servicio de medicina nuclear. Cir Esp 2007; 81:126-9. [PMID: 17349235 DOI: 10.1016/s0009-739x(07)71282-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Knowledge of lymph node stage is the most important prognostic factor in breast cancer. The sentinel lymph node biopsy technique (SLNBT), initially developed to avoid unnecessary dissection in melanoma, has been shown to be able to predict the axillary stage of breast cancer. The difficulty of applying the SLNBT in hospitals without a nuclear medicine service has led to the existence of external teams that allow these hospitals to apply the technique. OBJECTIVE To test the application of the SLNBT in our hospital which has no nuclear medicine service. PATIENTS AND METHODS Coinciding with the validation of the SLNBT in the Germans Trias i Pujol Hospital in Badalona in November 1999, and with their help, the Centre Hospitalari de Manresa began to apply this technique. In 2002, the technique was used in all the hospitals of the ALTHAIA-Xarxa Assistencial de Manresa. From November 1999 to June 2005, the technique was applied in 163 patients. RESULTS Of the 163 patients, the technical success rate was 97.55%. In 98% of the patients, the sentinel lymph node was found in the axilla. In 10.7% of the patients, the node was found in the internal mammary basin. Twenty-six percent of the axillas had metastases of over 2 mm, and 16% had micrometastases. One hundred and five patients were spared axillary dissection. CONCLUSIONS The SLNBT can be performed in a hospital without a nuclear medicine service. This technique improves and simplifies the surgical technique and reduces length of hospital stay and morbidity.
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Affiliation(s)
- Pere Culell
- Unidad de Patología Mamaria, Fundació ALTHAIA-Xarxa Assistencial de Manresa, Manresa, Barcelona, España.
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Pacha-González MA, Oller-Sales B, Feliu E, Millá F, Xandri M, Troya J, Roca J, Riba J, Fraile M, Martínez-Cáceres EM, Rodríguez N, Martínez MJ, Pujol-Borrell R, Fernández-Llamazares J. [Evaluation of splenic function by dynamic gammagraphy, study of pitted erythrocytes and submembranous vacuoles in patients with slight and severe splenic trauma receiving conservative treatment or splenectomy]. Med Clin (Barc) 2007; 128:161-7; quiz 1 p following 200. [PMID: 17298776 DOI: 10.1157/13098389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The splenic function of patients followed by the Department of General and Digestive Surgery in the Hospital Universitari Germans Trias i Pujol (HUGTiP) from 1985 to 2003 for different degrees of splenic trauma according to the classification of the American Association for the Surgery of Trauma (AAST) 1994 was quantified and related to the treatment received (non surgical, total splenectomy with or without splenosis and splenectomy plus autotransplantation) to detect splenic dysfunction predisposing the development of postsplenectomy sepsis (PSS). PATIENTS AND METHOD 43 patients underwent an isotopic study with dynamic splenic gammagraphy and pitted erythrocytes (Normarsky optics) and submembranous vacuoles (transmission electron microscopy) were evaluated. RESULTS The non surgical group presented normal phagocytic and filtration function with the median speed of splenic enhancement being 3.46 Kcts/s2 (interval: 0.8-6.98). The percentage of pitted erythrocytes was 2% (0-8.8), the number of pits per erythrocyte was 0.03 (0-0.12) and the percentage of erythrocytes with 1, 2, 3 and 4 pits was 1.6%, 0.4%, 0% and 0%, respectively. The percentage of red cells with submembranous vacuoles was 2.55% (0-5.6), the number of vacuoles per red cell was 0.03 (0-0.06) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 2%, 0.2%, 0% and 0%, respectively. In the operated group, the splenic enhancement speed was 0.08 Kcts/s2 (0-1.75) (p < 0.0001). The percentage of pitted erythrocytes was 38% (0.2-64) (p < 0.0001), the number of pits per erythrocyte was 0.86 (0-1.8) (p < 0.0001) and the percentage of erythrocytes with 1,2,3 and 4 pits was 16.39%, 7.2%, 3.59% and 2.52%, respectively (p < 0.0001). The percentage of red cells with submembranous vacuoles was 11.2% (1.8-31.9) (p = 0.0006); the number of vacuoles per cell was 0.16 (p = 0.0022) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 6.51%, 1.73%, 0.4% and 0.2%, respectively (p = 0.0246, 0.0010, < 0.0001 and 0.0002, respectively). CONCLUSIONS Splenic function of patients with a history of splenic trauma receiving conservative treatment is normal, independently of the degree of the lesion, thereby reinforcing the use of this therapeutic approach to avoid the development of postsplenectomy sepsis. In the patients treated with splenectomy, with or without splenosis, splenic function was absent or very altered being partially conserved in cases treated with splenectomy plus autotransplantation.
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Affiliation(s)
- Miguel Angel Pacha-González
- Departamento de Cirugía, Hospital Universitari Germans Trias i Pujol, Facultad de Medicina, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
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Fraile M, Gubern JM, Rull M, Julián FJ, Serra C, Llatjós M, Culell P, Puig P, Solà M, Vallejos V, Mariscal A, Janer J, Deulofeu P, Fusté F. Is it possible to refine the indication for sentinel node biopsy in high-risk ductal carcinoma in situ? Nucl Med Commun 2006; 27:785-9. [PMID: 16969260 DOI: 10.1097/01.mnm.0000230074.39071.bf] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The indication for sentinel node biopsy (SNB) has not been fully established yet for patients with ductal carcinoma in situ (DCIS). AIM To relate the conversion rate to invasive carcinoma with sentinel node positivity in high risk DCIS, and to refine the clinical presentation analysis in order to better select patients for SNB. For this purpose, a risk score was devised. METHODS From 1998 to 2005, 151 high-risk DCIS patients from six clinical centres were included in a prospective sentinel node database. The conversion rate to invasive carcinoma was 39%. Ten of 142 (7%) successful SNBs showed a positive sentinel node (eight micrometastatic). The sentinel node was positive in 1% of pure DCIS, in 5.5% of DCIS with micro-invasion, and in 19.5% of invasive carcinoma. RESULTS Both clinical presentation and corresponding risk score were closely related to conversion to invasive carcinoma. The association of risk score and sentinel node positivity approached but did not reach statistical significance (P=0.06); therefore a subset of further selected higher risk patients could not be defined. CONCLUSION The relevance of SNB positivity cannot be overlooked in high-risk DCIS patients, however, because SNB is not free from morbidity and cost, more studies are needed to refine its final indication.
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Affiliation(s)
- Manel Fraile
- Medicina Nuclear, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.
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Fontseré N, Bonal J, Navarro M, Riba J, Fraile M, Torres F, Romero R. A Comparison of Prediction Equations for Estimating Glomerular Filtration Rate in Adult Patients with Chronic Kidney Disease Stages 4–5. ACTA ACUST UNITED AC 2006; 104:c160-8. [PMID: 16943683 DOI: 10.1159/000095476] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Accepted: 05/15/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The accuracy of prediction equations has not been validated in adult patients with chronic kidney disease (CKD) stages 4-5 in extreme situations of nutritional status and age. OBJECTIVE AND METHODS The significance of nutritional status, calculated with the creatinine production (CP) formula, and age (< or =64 years and >64 years) in the application of different prediction equations--modification of diet in renal disease (MDRD), simplified MDRD (sMDRD), Cockcroft-Gault (CG)--and the mean of urea and creatinine clearance (Cr-Ur) compared with the isotopic glomerular filtration rate (GFR) estimation calculated by 51Cr-EDTA was studied in 87 Caucasian adults with CKD stages 4-5 (GFR: 30-8 ml/min/1.73 m2). The Bland-Altman method and Lin's concordance coefficient (Rc) were used to study accuracy (bias) and precision. RESULTS The GFR calculated with 51Cr-EDTA in the study group was 22.2 +/- 6.9 ml/min/1.73 m2 (range: 8-30). CG and sMDRD were the best prediction equations with bias of -1.1 and -3.8 ml/min/1.73 m2 and Rc of 0.52-0.50. In this situation, the mean Cr-Ur proved the most inaccurate equation compared with the isotopic technique with bias of -5.4 ml/min/1.73 m2 and Rc of 0.32. In the analysis of patients with higher CP (> 0.90; n = 44), CG and sMDRD obtained the best bias of 1.2 and -2.7 ml/min/1.73 m2 and Rc of 0.54-0.53. In patients aged < or =64 (n = 44), these equations obtained a bias of 1.1 and -3.6 ml/min/1.73 m2 and Rc 0.50-0.49. Both in lower CP (< or =0.90; n = 43) and older age (>64 years; n = 43), all the equations underestimated the value obtained with isotopic GFR. In these situations, the results obtained with CG had a bias of -2.2 and -3.6 ml/min/1.73 m2 (Rc 0.29-0.56) and with sMDRD -4.0 and -4.1 ml/min/1.73 m2 (Rc 0.39-0.51). In these circumstances, Cr-Ur was the most inaccurate equation, obtaining a bias of -10.1 and -13.2 ml/min/1.73 m2 (Rc 0.14-0.16). CONCLUSIONS In the group with higher CP and age < or =64 years, results of the presented data yielded no evidence for superiority of the MDRD equation over CG formula in patients with advanced renal failure. On the basis of our results, we do not recommend the use of the Cr-Ur adjusted to 1.73 m(2) of body surface area, which was the most imprecise equation. Application of all the equations proved inaccurate in lower CP patients with or without advanced age, implying the premature start of substitution renal treatment. In these circumstances, ambulatory GFR determination by isotopic techniques would be indicated.
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Affiliation(s)
- Néstor Fontseré
- Department of Nephrology, University Hospital Germans Trias i Pujol, Badalona, Spain.
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Margelí M, Cirauqui B, Vallejos V, Sánchez C, Mariscal A, Castellà E, Rull M, Torrente A, Fraile M, Barnadas A. Monitorization of primary therapy (PT) by additional imaging methods in locally advanced breast cancer (LABC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10580 Introduction: The response of locally advanced breast cancer (LABC) to Primary therapy (PT) may be monitored clinically and by mammography (MG). Magnetic resonance (MR) and 99mTc-sestamibi scintimammography (SMM) are increasingly being used. The aim of this study was to determine whether MG, MR and SMM are accurate indicators of tumour response to PT and whether they are predictors of histological response. Patients and Methods: A prospective observational study was approved at our institution and 52 patients( p) with core biopsy diagnostic of LABC and written consent were enrolled (mean age 52 years, SD 13) All p had clinical, MG, MR, SM assessment pre- and post- PT. Primary chemotherapy based on anthracyclines was administered as follows: 19 p FEC, 17 p AC-Docetaxel, 8 p Gemcitabine- Doxorubicine- Paclitaxel, 1 p FEC- Docetaxel and 1 p Carboplatin- VP16. 6 p were treated with hormone-therapy. RECIST criteria were considered for clinical response assessment and the same criteria was adapted for imaging and pathologic response. Results: After PT 33 tumours were considered not suitable for breast-conserving surgery. Based on histopathological findings, 10 (19%) lesions showed complete pathologic response, 30 (58%) partial response, 12 (23%) stabilization. No progression was detected. Clinical assessment of tumour complete response agreed with pathology in 40 of 52 tumours (78%), and with MG in 39 (78%). Correlation between MG and pathological findings was observed in 42 p (84%). Correlation between MR and pathological findings was observed in 42 p (82%). Correlation between SMM and pathological findings was observed in 31 p (66%). Among patients with complete pathologic remission, 9 of ten patients achieve a complete response by MR and SMM. Conclusion: In conclusion, our results don’t show that MR and SMM add any benefit to the diagnostic arsenal for predicting histopathological complete response to PT. However these new diagnostic methods should be considered in selected cases. No significant financial relationships to disclose.
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Affiliation(s)
- M. Margelí
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - B. Cirauqui
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - V. Vallejos
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - C. Sánchez
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - A. Mariscal
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - E. Castellà
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - M. Rull
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - A. Torrente
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - M. Fraile
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
| | - A. Barnadas
- Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain; Hospital de la Sante Creu i Sant Pau, Barcelona, Spain
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García JR, Minoves M, Bassa P, Fraile M. [Bone scintigraphy and (111)In-octreotide in the diagnosis of bone metastasis of chemodectoma]. ACTA ACUST UNITED AC 2006; 25:204-5. [PMID: 16762278 DOI: 10.1157/13088420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mangas C, Hilari JM, Paradelo C, Rex J, Fernández-Figueras MT, Fraile M, Alastrue A, Ferrándiz C. Prognostic significance of molecular staging study of sentinel lymph nodes by reverse transcriptase-polymerase chain reaction for tyrosinase in melanoma patients. Ann Surg Oncol 2006; 13:910-8. [PMID: 16788751 DOI: 10.1245/aso.2006.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Accepted: 02/01/2006] [Indexed: 01/10/2023]
Abstract
BACKGROUND We performed this study to evaluate the clinical effect of microscopic and submicroscopic metastases in sentinel lymph nodes (SLNs) from patients with early-stage melanoma. METHODS Patients with confirmed cutaneous melanoma (American Joint Committee on Cancer stages I and II) underwent standard lymphoscintigraphy and SLN biopsy. Serial sections were divided between routine histopathology with hematoxylin and eosin plus immunohistochemistry for HMB-45 and molecular analysis by nested reverse transcriptase-polymerase chain reaction (RT-PCR) assay for tyrosinase (using beta-actin as a control). RESULTS Of 180 patients analyzed (318 SLNs), 38 (21%) patients had positive SLN(s) by routine hematoxylin and eosin and immunohistochemistry (microscopic disease; group 1), and 142 (79%) had negative histological results. Analysis by RT-PCR detected tyrosinase in at least 1 SLN from 124 (69%) patients. Among patients with histologically negative SLN(s), tyrosinase was detected in 86 (48%) patients (submicroscopic disease; group 2), whereas 40 (22%) patients had negative results by both histology and RT-PCR (group 3). Sixteen (9%) patients had histologically negative SLNs and ambiguous RT-PCR results (group 4). Among 138 patients in the analysis of recurrence (mean follow-up, 45 months), only 18 patients had a recurrence: 11 (31%) of 35 in group 1, 5 (10%) of 51 in group 2, and 2 (5%) of 37 in group 3. No recurrences were seen in group 4. Only group 1 had a significantly shorter disease-free survival and overall survival compared with the other groups. CONCLUSIONS After a long follow-up period, molecular upstaging by tyrosinase RT-PCR failed to detect a subgroup of patients with an increased probability of recurrence.
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Affiliation(s)
- Cristina Mangas
- Department of Dermatology, Hospital Universitario Germans Trias i Pujol, Carretera Canyet s/n., 08916, Badalona, Spain
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Rex J, Paradelo C, Mangas C, Hilari JM, Fernández-Figueras MT, Fraile M, Alastrué A, Ferrándiz C. Single-Institution Experience in the Management of Patients with Clinical Stage I and II Cutaneous Melanoma: Results of Sentinel Lymph Node Biopsy in 240 Cases. Dermatol Surg 2006; 31:1385-93. [PMID: 16416605 DOI: 10.2310/6350.2005.31202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lymphatic mapping and sentinel lymph node biopsy (SLNB) has been developed as a minimally invasive technique to determine the pathologic status of regional lymph nodes in patients without clinically palpable disease and incorporated in the latest version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma. OBJECTIVE To analyze the results of SLNB and the prognostic value of the micrometastases and the pattern of early recurrences in patients according to sentinel lymph node (SLN) status. METHOD Patients with cutaneous melanoma in stages I and II (AJCC 2002) who underwent lymphatic mapping and SLNB from 1997 to 2003 were included in a prospective database for analysis. RESULTS The rate of identification of the SLN was 100%. Micrometastases to SLN were found in 20.8% of patients. The rate of SLN micrometastases increased according to Breslow thickness and clinical stage. Breslow thickness of 0.99 mm was the optimal cutpoint for predicting the SLNB result. Twenty-four patients (12.3%) developed a locoregional or distant recurrence at a median follow-up of 31 months. Recurrences were more frequent in patients with a positive SLN. Among patients who had a recurrence, those with a positive SLN were more likely to have distant metastases than those with negative SLN. Nodal recurrences were more frequent in patients with a negative SLN compared with those with a positive SLN. CONCLUSIONS The status of the SLN provides accurate staging for identifying patients who may benefit from further therapy and is the most important prognostic factor of relapse-free survival.
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Affiliation(s)
- Jordi Rex
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Badalona, Spain.
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Elola-Olaso AM, Gonzalez EM, Diaz JCM, Garcia García I, Usera MA, Romero J, Perez-Saborido B, Fraile M, Manrique A. Hepatic vein reconstruction in living donor liver transplantation. Transplant Proc 2006; 37:3891-2. [PMID: 16386575 DOI: 10.1016/j.transproceed.2005.10.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Living donor liver transplantation has emerged as a response to the cadaveric graft shortage, especially for adult recipients. Both right and left liver grafts are widely used, although some technical problems remain unresolved. Herein we describe our technique for reconstruction of the venous outflow in living donor liver transplantation. METHODS From April 1986 to September 2004, 1012 liver transplantations were performed including 30 living donor liver transplantations between April 1995 and September 2004. We have selected the first 28 cases to ensure a mean follow-up of 21.07 +/- 13.11 months. We transplanted 18 right lobe grafts, 7 left lobe grafts, and 3 left lateral segment grafts. A surgical technique is described herein. RESULTS No venous outflow obstruction developed among living donor liver transplantation recipients. CONCLUSION We recommend reconstruction of the hepatic veins in living donor liver transplantation including joining together the three hepatic veins in the recipient to avoid venous outflow obstruction.
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Affiliation(s)
- A Moreno Elola-Olaso
- Servicio de Cirugia General, Aparato Digestivo y Trasplante de Organos Abdominales, Hospital 12 de Octubre, Madrid, Spain.
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Moreno A, Meneu JC, Moreno E, Fraile M, García I, Loinaz C, Abradelo M, Jiménez C, Gomez R, García-Sesma A, Manrique A, Gimeno A. Liver transplantation and transjugular intrahepatic portosystemic shunt. Transplant Proc 2003; 35:1869-70. [PMID: 12962829 DOI: 10.1016/s0041-1345(03)00685-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Describe the results of liver transplantation after installing Transjugular Intrahepatic Portosystemic Shunt (TIPS) and compare them with those of a control group in a comparative, longitudinal, retrospective study. MATERIALS AND METHODS Between April 1986 and October 2002, we performed 875 liver transplantations. Between January 1996 and October 2002, 26 transplantations were performed on TIPS carriers. This group was compared with a control cohort of 50 randomly selected patients who underwent transplantation in this period (non-TIPS carriers). Both groups were homogeneous with no significant differences between age, sex United Network for Organ Sharing (UNOS) score, Child stage, or etiology. RESULTS Actuarial survival rates at 1 and 3 years: TIPS group 96.15% and 89.29% versus control cohort 87.8% and 81%, respectively. In 73.9%, the TIPS was clearly effective; in 88.9%, a postoperative Doppler revealed normal flow. There were no statistically significant differences compared with time on the waiting list for transplant, duration of the operation, ischemia times, intraoperative consumption of hemoderivates, vascular or nonvascular postoperative complications, duration of stay in the intensive care unit, hospital stay, or retransplantation rate. CONCLUSIONS In our experience, TIPS insertion does not affect either the intraoperative or postoperative evolution and is not associated with an increased time on the liver transplant waiting list.
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Affiliation(s)
- A Moreno
- Servicio de Cirugía General, Aparato Digestivo y Trasplante de Organos Abdominales, Hospital 12 de Octubre, Madrid, Spain
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Julián FJ, Fraile M, Llatjós M, Rull M, Fusté F, Castellà E, Vallejos V, Mariscal A, Barnadas A, Alastrué A. Internal mammary sentinel node metastases in an otherwise lymph-node negative breast cancer patient. Breast J 2002; 8:317-9. [PMID: 12199764 DOI: 10.1046/j.1524-4741.2002.08516.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 35 year old woman with biopsy proved breast cancer was submitted for sentinel node (SN) biopsy. Preoperative lymphoscintigraphy displayed both axillary and internal mammary (IM) uptake foci consistent with SNs. Full axillary dissection was completed because of a greater-than 2 cm primary lesion. Two axillary SNs were excised. An IM SN was also excised through the second intercostal space, with the aid of the gamma probe. Fourteen axillary nodes, including SNs, were negative, whereas the IM SN harbored several metastatic implants. Implications for staging, prognosis and further therapy of such IM-only positive sentinel nodes are discussed.
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Vallejos V, Balaña C, Fraile M, Roussos Y, Capellades J, Cuadras P, Ballester R, Ley A, Arellano A, Rosell R. Use of 201Tl SPECT imaging to assess the response to therapy in patients with high grade gliomas. J Neurooncol 2002; 59:81-90. [PMID: 12222842 DOI: 10.1023/a:1016389119399] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To assess the potential role of 201Tl single photon emission tomography (201-Thallium SPECT) when compared to other imaging modalities in the evaluation of the response to therapy in high grade gliomas. MATERIALS AND METHODS Twenty patients with histologically proved high grade glioma have been included: 15 with glioblastoma (GBM), 3 with anaplastic astrocytoma (AA) and 2 with anaplastic oligoastrocytoma (AOA). Patients were assessed by 201Tl SPECT, computed tomography (CT) and magnetic resonance imaging (MRI) at (a) either at the moment of maximum response to first line chemotherapy, or after the completion of radiotherapy and chemotherapy if post-surgical residual disease was present, and (b) after the completion of second line chemotherapy if disease persisted, or either a relapse or disease progression was confirmed. Final response was evaluated according to the McDonald criteria, and by comparing SPECT, CT and MRI results. RESULTS According to the McDonald criteria, clinical response after first line chemotherapy was 5 partial response, 7 stable disease and 8 progressive disease. Evaluation by 201Tl SPECT was in agreement with such criteria in nearly all patients (90%). MRI findings closely agreed with the clinical follow-up. CT findings clearly differed from those observed by SPECT and MRI. After second line therapy, 10 patients progressed, 3 had stable disease and 7 had partial response. 201Tl SPECT agreed with the clinical status in 89% cases, whereas MRI and, specially CT, fared significantly lower. CONCLUSION Compared to conventional neuroimaging, 201Tl SPECT added valuable information in the assessment of the response to therapy in our patient population; whenever findings were not conclusive and in the case of disagreement between CT and MRI findings.
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Affiliation(s)
- V Vallejos
- Department of Nuclear Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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Llatjós M, Castellà E, Fraile M, Rull M, Julián FJ, Fusté F, Rovira C, Fernández-Llamazares J. Intraoperative assessment of sentinel lymph nodes in patients with breast carcinoma: accuracy of rapid imprint cytology compared with definitive histologic workup. Cancer 2002; 96:150-6. [PMID: 12115303 DOI: 10.1002/cncr.10620] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND As sentinel lymph node biopsy (SNB) becomes a new surgical standard in the treatment of patients with breast carcinoma, there is an emergent need for a fast and accurate method with which to assess the SN intraoperatively, so a decision can be made regarding whether to perform axillary lymph node dissection during primary surgery. In the current study, the authors performed a prospective investigation of the relative merits of imprint cytology for that purpose. METHODS Seventy-six patients with T1-T2 breast carcinoma were included after undergoing successful SNB. SNs were freshly sectioned at 2-mm intervals and imprint smears were obtained from all cut surfaces. The smears were examined using a rapid May-Grünwald-Giemsa stain variation, and the SNs were judged to be positive or negative for metastases. SNs later were submitted for paraffin embedding and serial sectioning. Both hematoxylin and eosin stained and cytokeratin (CK) immunostained sections were examined. The postoperative evaluation of the SNs was taken as the gold standard. RESULTS Intraoperative cytology showed a sensitivity of 67.7%, a specificity of 100%, an accuracy of 86.8%, and a negative predictive value of 81.8%. The majority of false-negative cases (8 of 10 cases) were due to micrometastasis in the SNs that were discovered only after exhaustive examination with serial sectioning and CK immunostaining. CONCLUSIONS The results of the current study demonstrate that the accuracy of imprint cytology is high enough to warrant its use for intraoperative SN assessment. If the findings are negative, axillary lymph node dissection can be omitted. Only a few patients with SN micrometastasis may require reoperation.
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Affiliation(s)
- Mariona Llatjós
- Breast Disease Unit and the Department of Pathology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
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Fraile M. Lymphoscintigraphic detection and selective biopsy results of internal mammary sentinel nodes in breast cancer patients. Eur J Cancer 2002. [DOI: 10.1016/s0959-8049(02)80164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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