Trabalhos Originais Archives - Page 2 of 51 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):491-499
DOI 10.1590/S0100-72032003000700005
PURPOSE: to investigate whether rectally administered misoprostol is an effective method for induction of labor in patients with premature ruptured membranes at term. METHODS: a pilot trial was conducted, enrolling 32 women with alive, singleton, cephalic fetus and ruptured membranes between 36 and 41 weeks of pregnancy, with Bishop score <6 and without evidence of labor. They received rectal misoprostol (tablets of 50 mg) every 4 h until active labor was diagnosed. Patients with ruptured membranes for >18 h received antibiotics (crystalline penicillin) for prophylaxis of streptococcal infeccion. Outcomes included time from induction to labor and induction to delivery, incidence of tachysystole, mode of delivery, incidence of chorioamnionitis and neonatal outcome. Statistical analysis was performed using the public domain software Epi-Info 2002. Means and standard deviations were calculated, as well as frequency distributions. Survival analysis was performed to determine percent of deliveries according to time (hours) since the administration of the first tablet. RESULTS: the mean (±SD) induction-to-labor and induction-to-delivery intervals were 299.8±199.9 and 681±340.5 min, respectively. The frequency of tachysystole was 9.4%. About 72% of patients achieved vaginal delivery. Chorioamnionitis was diagnosed in 12.5% of the patients. Median Apgar scores at 1st and 5th min were 8 and 9, respectively. There was no case of Apgar <7 at the 5th min. Neonatal sepsis occurred in 12.5% of the neonates. CONCLUSION: induction of labor with rectal misoprostol in the setting of premature rupture of membranes was effective, with 72% of vaginal deliveries and a low rate of chorioamnionitis. These findings must be confirmed by large randomized controlled trials.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):491-499
DOI 10.1590/S0100-72032003000700005
PURPOSE: to investigate whether rectally administered misoprostol is an effective method for induction of labor in patients with premature ruptured membranes at term. METHODS: a pilot trial was conducted, enrolling 32 women with alive, singleton, cephalic fetus and ruptured membranes between 36 and 41 weeks of pregnancy, with Bishop score <6 and without evidence of labor. They received rectal misoprostol (tablets of 50 mg) every 4 h until active labor was diagnosed. Patients with ruptured membranes for >18 h received antibiotics (crystalline penicillin) for prophylaxis of streptococcal infeccion. Outcomes included time from induction to labor and induction to delivery, incidence of tachysystole, mode of delivery, incidence of chorioamnionitis and neonatal outcome. Statistical analysis was performed using the public domain software Epi-Info 2002. Means and standard deviations were calculated, as well as frequency distributions. Survival analysis was performed to determine percent of deliveries according to time (hours) since the administration of the first tablet. RESULTS: the mean (±SD) induction-to-labor and induction-to-delivery intervals were 299.8±199.9 and 681±340.5 min, respectively. The frequency of tachysystole was 9.4%. About 72% of patients achieved vaginal delivery. Chorioamnionitis was diagnosed in 12.5% of the patients. Median Apgar scores at 1st and 5th min were 8 and 9, respectively. There was no case of Apgar <7 at the 5th min. Neonatal sepsis occurred in 12.5% of the neonates. CONCLUSION: induction of labor with rectal misoprostol in the setting of premature rupture of membranes was effective, with 72% of vaginal deliveries and a low rate of chorioamnionitis. These findings must be confirmed by large randomized controlled trials.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):501-505
DOI 10.1590/S0100-72032003000700006
PURPOSE: to identify Listeria monocytogenes (Lm) in human placentas by immunohistochemistry (IHC) and relate its presence to the histological alterations found on conventional examination, to the pregnancy trimester, age of pregnant women, cases of abortion and premature delivery, and to the occurrence of habitual abortion. METHODS: a retrospective study was carried out at the pathology service of a teaching hospital in the city of Porto Alegre in 2000. The paraffin blocks of 254 placentas, obtained from abortion, premature delivery and full-term birth, were analyzed by conventional histology using hematoxylin and eosin (HE) staining. The IHC assay consisted of a rabbit anti-listeria polyclonal antibody B65420R (Biodesign®) diluted 1:1000, in addition to the avidin-biotin-streptavidin complex; 148 placentas revealed inflammatory disorders, hemorrhage, necrosis and thrombosis. The c² test was used for statistical analysis. RESULTS: Listeria monocytogenes was detected in 33.78% of the placentas analyzed by IHC. Chorioamnionitis and villitis showed significant statistical difference in the positive placentas. Lm occurred in the 1st, 2nd and 3rd trimester of pregnancy. The age of pregnant women, the cases of abortion and/or premature births were not statistically different as to the presence or absence of Lm in the placentas. Habitual abortions occurred in patients with or without Lm in the placental tissue. CONCLUSION: Immunohistochemistry may be used to confirm the histopathological diagnosis of listeriosis in all trimesters of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):501-505
DOI 10.1590/S0100-72032003000700006
PURPOSE: to identify Listeria monocytogenes (Lm) in human placentas by immunohistochemistry (IHC) and relate its presence to the histological alterations found on conventional examination, to the pregnancy trimester, age of pregnant women, cases of abortion and premature delivery, and to the occurrence of habitual abortion. METHODS: a retrospective study was carried out at the pathology service of a teaching hospital in the city of Porto Alegre in 2000. The paraffin blocks of 254 placentas, obtained from abortion, premature delivery and full-term birth, were analyzed by conventional histology using hematoxylin and eosin (HE) staining. The IHC assay consisted of a rabbit anti-listeria polyclonal antibody B65420R (Biodesign®) diluted 1:1000, in addition to the avidin-biotin-streptavidin complex; 148 placentas revealed inflammatory disorders, hemorrhage, necrosis and thrombosis. The c² test was used for statistical analysis. RESULTS: Listeria monocytogenes was detected in 33.78% of the placentas analyzed by IHC. Chorioamnionitis and villitis showed significant statistical difference in the positive placentas. Lm occurred in the 1st, 2nd and 3rd trimester of pregnancy. The age of pregnant women, the cases of abortion and/or premature births were not statistically different as to the presence or absence of Lm in the placentas. Habitual abortions occurred in patients with or without Lm in the placental tissue. CONCLUSION: Immunohistochemistry may be used to confirm the histopathological diagnosis of listeriosis in all trimesters of pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):507-512
DOI 10.1590/S0100-72032003000700007
PURPOSE: to evaluate the prevalence of osteoporosis in climacteric women and analyze the influence of general and reproductive risk factors on bone mineral density. METHODS: a cross-sectional study with the evaluation of the 473 hospital records of climacteric women followed up at the Menopause Outpatient Facility of CAISM/Unicamp, between 03/28/2000 and 04/17/2001. These women were at least 12 months in amenorrhea and presented the results of a bone densitometry study performed at the Nuclear Medicine Department of HC/Unicamp. The following variables were evaluated: age, color, body mass index, level of education, smoking, use of medication, age at menopause, parity, use and length of hormone replacement therapy and its effect on bone mineral density. Statistical analyses were performed using logistic regression ajusted by age and hormone replacement therapy use. RESULTS: the mean age of the studied women was 53.9 years (± 7.1 SD) with mean age at menopause being 45.9 years (± 6.9 SD). Osteoporosis occurred in 14.7% and osteopenia in 38% of the cases in the lumbar vertebrae (L2-L4 interspace) and in 3.8 and 32.7% in the femur, respectively. Logistic regression adjusted to age and hormone therapy showed an association between the following variables: level of education, age at menopause and body mass index. CONCLUSION: there was a high prevalence of osteoporosis and osteopenia in the studied population. Advanced age, lower level of education, late menarche, early menopause and lower body mass index were identified as risk factors for developing decreased bone mass in the studied population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):507-512
DOI 10.1590/S0100-72032003000700007
PURPOSE: to evaluate the prevalence of osteoporosis in climacteric women and analyze the influence of general and reproductive risk factors on bone mineral density. METHODS: a cross-sectional study with the evaluation of the 473 hospital records of climacteric women followed up at the Menopause Outpatient Facility of CAISM/Unicamp, between 03/28/2000 and 04/17/2001. These women were at least 12 months in amenorrhea and presented the results of a bone densitometry study performed at the Nuclear Medicine Department of HC/Unicamp. The following variables were evaluated: age, color, body mass index, level of education, smoking, use of medication, age at menopause, parity, use and length of hormone replacement therapy and its effect on bone mineral density. Statistical analyses were performed using logistic regression ajusted by age and hormone replacement therapy use. RESULTS: the mean age of the studied women was 53.9 years (± 7.1 SD) with mean age at menopause being 45.9 years (± 6.9 SD). Osteoporosis occurred in 14.7% and osteopenia in 38% of the cases in the lumbar vertebrae (L2-L4 interspace) and in 3.8 and 32.7% in the femur, respectively. Logistic regression adjusted to age and hormone therapy showed an association between the following variables: level of education, age at menopause and body mass index. CONCLUSION: there was a high prevalence of osteoporosis and osteopenia in the studied population. Advanced age, lower level of education, late menarche, early menopause and lower body mass index were identified as risk factors for developing decreased bone mass in the studied population.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):513-516
DOI 10.1590/S0100-72032003000700008
PURPOSE: to evaluate the usefulness of the in vitro maturation technique of human oocyte and subsequent fertilization. METHODS: this is a prospective nonrandomized, descriptive study, carried out during the period of November 1999 to March 2001, with 20 cycles of in vitro fertilization of 15 patients with tubal infertility. All signed the written informed consent before the beginning of the study. The selected patients were at least 18 and at most 32 years of age, with only tubal infertility, and body mass index less than 25 kg/m². The patients received 300 UI of recombinant follicle stimulating hormone (FSH) by intramuscular injection at the second day of the cycle and additional doses of 150 IU at the fourth and sixth days of cycle. The oocyte retrieval was performed at the seventh day of the cycle. Those oocytes classified as immature were cultured in tissue culture medium 199 (TCM-199) with antibiotics, pyruvate, FSH, human chorionic gonadotropin (hCG) and serum (serum substitute supplement - Irvine Scientific®). After 48 h of culture, the oocytes that achieved metaphase II stage were inseminated, and the fertilized ones were transferred. RESULTS: one hundred and forty-four follicles were aspirated. There were 67 (46.5%) immature retrieved oocytes and 43 (64.2%) reached the metaphase II stage and were inseminated. Thirty fertilized oocytes and 25 embryos were transferred to 10 patients. There was one pregnancy with a baby born. CONCLUSION: we conclude that to mature human oocytes in vitro before in vitro fertilization is a procedure able to achieve pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):513-516
DOI 10.1590/S0100-72032003000700008
PURPOSE: to evaluate the usefulness of the in vitro maturation technique of human oocyte and subsequent fertilization. METHODS: this is a prospective nonrandomized, descriptive study, carried out during the period of November 1999 to March 2001, with 20 cycles of in vitro fertilization of 15 patients with tubal infertility. All signed the written informed consent before the beginning of the study. The selected patients were at least 18 and at most 32 years of age, with only tubal infertility, and body mass index less than 25 kg/m². The patients received 300 UI of recombinant follicle stimulating hormone (FSH) by intramuscular injection at the second day of the cycle and additional doses of 150 IU at the fourth and sixth days of cycle. The oocyte retrieval was performed at the seventh day of the cycle. Those oocytes classified as immature were cultured in tissue culture medium 199 (TCM-199) with antibiotics, pyruvate, FSH, human chorionic gonadotropin (hCG) and serum (serum substitute supplement - Irvine Scientific®). After 48 h of culture, the oocytes that achieved metaphase II stage were inseminated, and the fertilized ones were transferred. RESULTS: one hundred and forty-four follicles were aspirated. There were 67 (46.5%) immature retrieved oocytes and 43 (64.2%) reached the metaphase II stage and were inseminated. Thirty fertilized oocytes and 25 embryos were transferred to 10 patients. There was one pregnancy with a baby born. CONCLUSION: we conclude that to mature human oocytes in vitro before in vitro fertilization is a procedure able to achieve pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):519-523
DOI 10.1590/S0100-72032003000700009
PURPOSE: to analyze the accuracy of sonohysterography for the evaluation of the uterine cavity in patients with an implantation failure, at the first attempt of an in vitro fertilization cycle. METHODS: in a prospective double blind study, the authors analyzed patients previously submitted to at least one embryo transfer, who presented implantation failures. The patients were submitted to a sonohysterographic examination followed by a diagnostic hysteroscopic examination, carried out by different professionals each of whom was not aware of the results of the other. The results were recorded and only interpreted after the end of the trial. Sonohysterography was performed by the introduction of a urethral catheter 8 into the uterine cervix followed by infusion of physiological saline. The anechoic interface shown by the physiological saline can reveal abnormalities, like uterine polyps or submucosal myomas. Hysteroscopy was performed with a Karl Storz equipment, 4 mm 30º rigid telescope, and infusion of physiological saline for uterine cavity distention. RESULTS: twenty-eight of the 33 originally selected patients for this study were analyzed. Sonohysterography detected abnormalities in 8 patients, five with endometrial polyps (62.5%), two with endocervical polyps (25.0%), and one with submucosal myoma (12.5%). Hysteroscopy (gold standard) detected abnormalities in 7 patients, two with endometrial polyps (28.6%), two with cervical polyps (28.6%) and one with submucosal myoma (14.2%). Sonohysterography, when compared with diagnostic hysteroscopy, presented 71.4% sensibility, 85.7% specificity, 62.5% positive predictive value, and 90% negative predictive value of. CONCLUSION: due to its low positive predictive value, the authors suggest confirmation of the sonohysterography result by diagnostic hysteroscopy. Because sonohysterography presents a good level of specificity and a favorable low negative predictive value, the authors suggest that after a normal sonohysterography diagnostic hysteroscopy to evaluate the uterine cavity before in vitro fertlization is not necessary. This study leads to the conclusion that sonohysterography is a good screening method for the detection of polypoid lesions of the uterine cavity, which could be responsible for implantation failures in in vitro fertilization cycles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):519-523
DOI 10.1590/S0100-72032003000700009
PURPOSE: to analyze the accuracy of sonohysterography for the evaluation of the uterine cavity in patients with an implantation failure, at the first attempt of an in vitro fertilization cycle. METHODS: in a prospective double blind study, the authors analyzed patients previously submitted to at least one embryo transfer, who presented implantation failures. The patients were submitted to a sonohysterographic examination followed by a diagnostic hysteroscopic examination, carried out by different professionals each of whom was not aware of the results of the other. The results were recorded and only interpreted after the end of the trial. Sonohysterography was performed by the introduction of a urethral catheter 8 into the uterine cervix followed by infusion of physiological saline. The anechoic interface shown by the physiological saline can reveal abnormalities, like uterine polyps or submucosal myomas. Hysteroscopy was performed with a Karl Storz equipment, 4 mm 30º rigid telescope, and infusion of physiological saline for uterine cavity distention. RESULTS: twenty-eight of the 33 originally selected patients for this study were analyzed. Sonohysterography detected abnormalities in 8 patients, five with endometrial polyps (62.5%), two with endocervical polyps (25.0%), and one with submucosal myoma (12.5%). Hysteroscopy (gold standard) detected abnormalities in 7 patients, two with endometrial polyps (28.6%), two with cervical polyps (28.6%) and one with submucosal myoma (14.2%). Sonohysterography, when compared with diagnostic hysteroscopy, presented 71.4% sensibility, 85.7% specificity, 62.5% positive predictive value, and 90% negative predictive value of. CONCLUSION: due to its low positive predictive value, the authors suggest confirmation of the sonohysterography result by diagnostic hysteroscopy. Because sonohysterography presents a good level of specificity and a favorable low negative predictive value, the authors suggest that after a normal sonohysterography diagnostic hysteroscopy to evaluate the uterine cavity before in vitro fertlization is not necessary. This study leads to the conclusion that sonohysterography is a good screening method for the detection of polypoid lesions of the uterine cavity, which could be responsible for implantation failures in in vitro fertilization cycles.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):525-528
DOI 10.1590/S0100-72032003000700010
PURPOSE: to evaluate the results of the use of bovine pericardium in the pubovaginal sling procedure for treatment of stress urinary incontinence. METHODS: a prospective analysis of five patients who underwent pubovaginal sling with the use of bovine pericardium strip for stress urinary incontinence in the "Hospital das Clínicas of UFMG" from October/2001 to December/2001. The mean age was 48.2±11.5 years (33 to 69 years). RESULTS: the mean surgical time was 45±35.3 min and the mean hospital stay was 36±12.4 h (24 to 48 h). Complications in the periperative or immediate postoperative period did not occur. All patients initially presented satisfactory results with normal voiding and without stress incontinence. Postoperative complications occurred in the 5 patients (100%), with dehiscence of the vaginal wound and total expulsion of the strip in 2 patients (40%) and partial expulsion in 3 patients (60%). All patients presented stress urinary incontinence and were submitted to a new sling procedure using the rectus fascia. The patients then progressed without complications and with improvement of urinary continence in 4 patients (80%). CONCLUSIONS: pubovaginal sling with the use of bovine pericardium was associated with high rates of complications. Therefore, its use is not recommended in the treatment of stress urinary incontinence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(7):525-528
DOI 10.1590/S0100-72032003000700010
PURPOSE: to evaluate the results of the use of bovine pericardium in the pubovaginal sling procedure for treatment of stress urinary incontinence. METHODS: a prospective analysis of five patients who underwent pubovaginal sling with the use of bovine pericardium strip for stress urinary incontinence in the "Hospital das Clínicas of UFMG" from October/2001 to December/2001. The mean age was 48.2±11.5 years (33 to 69 years). RESULTS: the mean surgical time was 45±35.3 min and the mean hospital stay was 36±12.4 h (24 to 48 h). Complications in the periperative or immediate postoperative period did not occur. All patients initially presented satisfactory results with normal voiding and without stress incontinence. Postoperative complications occurred in the 5 patients (100%), with dehiscence of the vaginal wound and total expulsion of the strip in 2 patients (40%) and partial expulsion in 3 patients (60%). All patients presented stress urinary incontinence and were submitted to a new sling procedure using the rectus fascia. The patients then progressed without complications and with improvement of urinary continence in 4 patients (80%). CONCLUSIONS: pubovaginal sling with the use of bovine pericardium was associated with high rates of complications. Therefore, its use is not recommended in the treatment of stress urinary incontinence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):325-331
DOI 10.1590/S0100-72032000000600002
Purpose: to evaluate the efficacy of medroxyprogesterone acetate and megestrol acetate in endometrial hyperplasia. Patients and Methods: forty-seven patients with abnormal uterine bleeding were retrospectively evaluated. These patients were submitted to diagnostic uterine curettage and/or endometrial biopsy, with histopathological finding of endometrial hyperplasia. Patients with hyperplasia without atypia received 10 mg/day oral medroxyprogesterone acetate during 10 to 12 days a month. Those with hyperplasia with atypia received 160 mg/day oral megestrol acetate continuously. The length of treatment ranged from 3 to 18 months. Control endometrial biopsy and/or uterine curettage were performed 3 and 6 months from the beginning of treatment, and then periodically to evaluate whether or not regression of hyperplasia occurred. Results: forty-two patients with endometrial hyperplasia without atypia and 5 with hyperplasia with atypia were included. The mean age of the patients was 49.5 ± 10.6 years (22 to 72 years), 70.2% aged over 45 years. Medroxy-progesterone acetate was effective in promoting regression of 83.2% (35/42) of hyperplasia without atypia, and megestrol acetate in 80% (4/5) of hyperplasia with atypia. Despite treatment, lesions persisted in 16.8% (7 cases) of hyperplasia with atypia and in 20% (1 case) of hyperplasia without atypia. No progression to endometrial cancer was seen during the follow-up period of 3 months to 9 years. During follow-up, we found that 18 patients (38.3%) showed amenorrhea, 12 (25.5%) menstrual cycle regulation, and 17 (36.2%) persistent abnormal uterine bleeding and underwent total abdominal hysterectomy. Histological examination of the uterus showed 8 patients with persistence of hyperplastic lesion, 4 with leiomyoma, 3 with adenomyosis, 1 with diffuse uterine myohypertrophy, and 1 with normal uterus, despite regression of the hyperplastic lesions in 9 of the 17 patients. Conclusions: the treatment of endometrial hyperplasia with medroxyprogesterone acetate and megestrol acetate can be a safe alternative for women who refuse to have their uterus removed or those at high risk for surgery. However, a careful monitoring of the endometrium is needed. This can be achieved with periodical endometrial biopsy, transvaginal ultrasonography, and evaluation of the symptoms.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):333-337
DOI 10.1590/S0100-72032000000600003
Purpose: to evaluate the efficacy of conservative axillary dissection (levels I and II) in the surgical treatment of stage I breast cancer. Methods: the results of 142 mastectomies performed from January/93 to December/98 in patients with clinical stage I breast cancer (T1NO) were evaluated. Removing the axillary lymph nodes present at levels I and II, with the preservation of the pectoralis muscles, the axillary lymph nodes were dissected by the author (LAGB), and subsequently one section of each lymph node was histopathologically evaluated. Quadrantectomy was performed in 138 cases and modified mastectomy (Patey), in 4 cases. The predominance of the T1c (130 cases) was observed. Results: a total of 3,282 lymph nodes were removed (2,456 at level I and 826 at level II), with an average of 23.1 nodes per axilla. Only 68 were histologically involved (2%). "Skip" metastasis was present only in one case (0.7%). Thirty-five false negative cases were observed (24.6%), with involvement of level I in 34 cases (97.1%) and of level II in 2 cases (5.7%). We observed 107 cases with negative axillary lymph nodes (75.4%). Conclusion: the axillary dissection of levels I and II is sufficient to treat the axilla in clinical stage I breast cancer. In clinical stage II and III of the disease, the complete axillary dissection including levels I, II and III is indicated. The interpectoral Rotter group will be removed if surgically suspicious.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(6):333-337
DOI 10.1590/S0100-72032000000600003
Purpose: to evaluate the efficacy of conservative axillary dissection (levels I and II) in the surgical treatment of stage I breast cancer. Methods: the results of 142 mastectomies performed from January/93 to December/98 in patients with clinical stage I breast cancer (T1NO) were evaluated. Removing the axillary lymph nodes present at levels I and II, with the preservation of the pectoralis muscles, the axillary lymph nodes were dissected by the author (LAGB), and subsequently one section of each lymph node was histopathologically evaluated. Quadrantectomy was performed in 138 cases and modified mastectomy (Patey), in 4 cases. The predominance of the T1c (130 cases) was observed. Results: a total of 3,282 lymph nodes were removed (2,456 at level I and 826 at level II), with an average of 23.1 nodes per axilla. Only 68 were histologically involved (2%). "Skip" metastasis was present only in one case (0.7%). Thirty-five false negative cases were observed (24.6%), with involvement of level I in 34 cases (97.1%) and of level II in 2 cases (5.7%). We observed 107 cases with negative axillary lymph nodes (75.4%). Conclusion: the axillary dissection of levels I and II is sufficient to treat the axilla in clinical stage I breast cancer. In clinical stage II and III of the disease, the complete axillary dissection including levels I, II and III is indicated. The interpectoral Rotter group will be removed if surgically suspicious.