Summary
Revista Brasileira de Ginecologia e Obstetrícia. 06-24-2001;23(8):499-504
DOI 10.1590/S0100-72032001000800004
Purpose: to evaluate factors that might influence the results of nonphamacological treatment (verbal guidance) in women with clinical mastalgia. Methods: an uncontrolled study of the experimental type was conducted on a sample of 128 women with a clear history of clinical mastalgia treated with verbal guidance. A visual analogue scale for pain was used before and after treatment to evaluate pain intensity and mastalgia was classified into grade I (mild), grade II (moderate) and grade III (severe) according to pain intensity. The Cardiff Breast Score (CBS), modified, was also used to evaluate the clinical response to treatment. Data were analyzed statistically using the chi² test (Epi-Info 6.04). Results: we noted that factors such as parity, menarche, age at first term delivery and breast-feeding had no significant effect (p=0.19, p=0.31, p=0.80 and p=0.54, respectively) on the results of nonpharmacological treatment (verbal guidance). On the other hand, when age was taken into consideration, 26 patients (78.8%) aged 40 years or older were found to benefi more from verbal guidance, with a significant difference (p=0.01) when compared to younger women. Conclusion: reproductive factors such as parity, menarche, age at first term delivery and breast-feeding did not affect the results of nonpharmacological treatment (verbal guidance), whereas the age factor had a specific and significant effect on the results.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 02-13-2002;24(9):585-591
DOI 10.1590/S0100-72032002000900004
Purpose: to report 15 breast cancer cases associated with pregnancy and to compare to a control group with breast ductal infiltrating carcinoma, evaluating clinical staging, metastatic axillary lymph node involvement, histopathologic aspects related to nuclear grade, histology grade and estrogen and progesterone hormonal receptors. Method: a retrospective study of 15 cases of patients with breast cancer associated with pregnancy, attended at Mastology Department in the Woman Health Reference Center, Pérola Byington Hospital, São Paulo, was done between September 1996 and April 2001. The evaluation of clinical staging, time of diagnosis and involved axillary lymph nodes was the main study basis. Also age, parity, histologic type, applied treatment, histologic characteristics regarding nuclear grade and histologic grade and the presence of hormonal receptors in the tumors were analyzed. Results: we observed that 7 patients (46.7%) presented a locally advanced breast cancer (clinical stage IIIA and IIIB) and that 3 patients (20%) presented a disseminated disease at the moment of diagnosis. The patients presented on average 2.4 involved axillary lymph nodes and in only one patient the lymph nodes were free of disease (6.6%). Regarding time of diagnosis, 40% of the tumors were diagnosed during the lactational period, 46.7% during the second trimester and 13.3% during the third trimester. The pregnant patients were compared to a control group of non-pregnant patients in the same age range, all of them with infiltrating breast carcinoma, and clinical staging, axillary lymph node involvement, nuclear grade, histologic grade and estrogen and progesterone hormonal receptors were evaluated. There was a statistically significant difference (p=0.0022) regarding clinical staging and axillary lymph node involvement (p=0.0017), and no statistically significant difference as concerns the remaining parameters. Conclusion: breast cancer associated with pregnancy is a neoplasia with a bad prognosis. There is no difference when comparing pregnant patients with non-pregnant patients in the same age range, the advanced clinical staging at the moment of diagnosis being the determinant factor for survival.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 11-06-2002;24(7):447-452
DOI 10.1590/S0100-72032002000700004
Purpose: to compare the size of locally advanced breast tumors through clinical examination, mammography, and ultrasound, and describe the parameters of color Doppler ultrasound evaluated before and after primary chemotherapy. Methods: it was a prospective and descriptive clinical study. Eighteen women with the diagnosis of breast carcinoma, with clinical primary tumors of 50 mm or larger, were submitted to palpation, mammography, ultrasound and color Doppler ultrasound at the moment of diagnosis and after 3 cycles of chemotherapy. The response was considered present when there was a clinical decrease of 50% or more and an ultrasonographic decrease of 25% or more, and absent when there was a clinical decrease less than 50% and ultrasonographic decrease less than 25%. A descriptive statistical analysis and Wilcoxon test were used. Results: regarding the size of the tumors, the method whose results were closer to pathological examination was the clinical examination after chemotherapy, when compared with sizes on ultrasound and mammography. The mammography helped to evaluate 44% of the cases before chemotherapy (8/18). In the cases where the response was absent, the Doppler showed a significant increase of the flow and a decrease of resistance and pulsatility index. In the cases where the response was present (9 cases), the Doppler did not show any significant change regarding the studied parameters. Conclusion: clinical examination was the most efficient method to evaluate the decrease of the volume of tumors submitted to neoadjuvant chemotherapy when compared with ultrasound and mammographic examinations. Doppler showed increase of the flow in the cases of absent response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 07-10-2002;24(4):241-246
DOI 10.1590/S0100-72032002000400005
Purpose: to make a differential diagnosis in regard to breast carcinoma and to evaluate diagnostic and clinical methods in the treatment of breast tuberculosis and the follow-up after adequate treatment. Patients and Methods: three patients with breast tuberculosis were observed from March 2001 to March 2002; the first two were hospitalized at our Mastology Department and the third patient was treated at a private clinic. The clinical signs and symptoms, laboratory findings, response to therapy and follow-up were evaluated. Results: the average age of the patients was 40.6 years. The most frequent signs and symptoms were pain and breast tumor. In two patients the presumptive diagnosis was based on the clinical findings, on the histological findings (granulomatous inflammatory process), and on the therapeutic response to tuberculostatic drugs. Only one patient had a microbiological diagnosis, as Koch's bacillus was identified in a sample of her breast tissue. Treatment with a triple tuberculostatic regimen, including rifampin, isoniazid and pyrazinamide, led to the regression of the lesions. Conclusion: primary breast tuberculosis, a rare occurrence which may present clinically as a breast nodule and radiologically as carcinoma, should be taken into account when making the differential diagnosis of patients presenting with mammary mass.