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Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):287-293
DOI 10.1590/S0100-72032008000600004
PURPOSE: to analyze the expression of matrix metalloproteinase-9 (MMP-9) and of vascular endothelial growth factor (EVGF) in a group of patients with primary breast cancer, and correlate them to one another and with other prognostic indicators. METHODS: transversal study that has analyzed the expression of MMP-9 and of VEGF in 88 consecutive cases of primary breast tumors. The samples were obtained from patients with primary breast cancer, submitted to surgical treatment in the Clinical Hospital of Porto Alegre of the Universidade Federal do Rio Grande do Sul, from January 2000 to December 2004. An immunohistochemical technique has been applied, using the avidin-biotin-peroxidase complex to evaluate the antigen immunoreactions in the tumors. The qualitative expression of proteins has been assessed through the observation of the brownish stain intensity of antibodies in the cytoplasm of malignant cells, when at least one of the tumoral cells presented clear and unequivocal staining with each of those markers. To determine the qualitative score (0=absent, 1=weak, 2=average and 3=strong), the stronger cytoplasmatic staining intensity on the glass slide has been taken into consideration, independently of the stained cells. The quantitative expression was determined by the average percentage of stained cells, observed in at least ten microscopic fields. The MMP-9 and VEGF final quantification expression has been done by the application of the HSCORE=Σ[(I+1)]xPC, where I and PC represent the staining intensity and the percentage of stained cells, respectively. RESULTS: MMP-9 and VEGF presented a significant correlation in the tumors studied. The final expression has shown a median score of 180 and 190, respectively. When MMP-9 and VEGF expression were compared with the variables "age", "tumoral diameter", "histological type", "histological grade", "axillary lymph node" and "vascular invasion", it was impossible to find any significant correlation. Compared to one another, MMP-0 and VEGF have presented a positive correlation (rho=0.23; p=0.03). The axillary lymph node positivity has presented a positive correlation with the larger tumoral diameter (2.7±1.1 cm; p<0.01) and with the presence of vascular invasion (84.1%; p<0.01). CONCLUSIONS: The present results do not show correlation between the MMP-9 and VEGF with the selected prognostic indicators, but shown a significant correlation between one another.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(6):287-293
DOI 10.1590/S0100-72032008000600004
PURPOSE: to analyze the expression of matrix metalloproteinase-9 (MMP-9) and of vascular endothelial growth factor (EVGF) in a group of patients with primary breast cancer, and correlate them to one another and with other prognostic indicators. METHODS: transversal study that has analyzed the expression of MMP-9 and of VEGF in 88 consecutive cases of primary breast tumors. The samples were obtained from patients with primary breast cancer, submitted to surgical treatment in the Clinical Hospital of Porto Alegre of the Universidade Federal do Rio Grande do Sul, from January 2000 to December 2004. An immunohistochemical technique has been applied, using the avidin-biotin-peroxidase complex to evaluate the antigen immunoreactions in the tumors. The qualitative expression of proteins has been assessed through the observation of the brownish stain intensity of antibodies in the cytoplasm of malignant cells, when at least one of the tumoral cells presented clear and unequivocal staining with each of those markers. To determine the qualitative score (0=absent, 1=weak, 2=average and 3=strong), the stronger cytoplasmatic staining intensity on the glass slide has been taken into consideration, independently of the stained cells. The quantitative expression was determined by the average percentage of stained cells, observed in at least ten microscopic fields. The MMP-9 and VEGF final quantification expression has been done by the application of the HSCORE=Σ[(I+1)]xPC, where I and PC represent the staining intensity and the percentage of stained cells, respectively. RESULTS: MMP-9 and VEGF presented a significant correlation in the tumors studied. The final expression has shown a median score of 180 and 190, respectively. When MMP-9 and VEGF expression were compared with the variables "age", "tumoral diameter", "histological type", "histological grade", "axillary lymph node" and "vascular invasion", it was impossible to find any significant correlation. Compared to one another, MMP-0 and VEGF have presented a positive correlation (rho=0.23; p=0.03). The axillary lymph node positivity has presented a positive correlation with the larger tumoral diameter (2.7±1.1 cm; p<0.01) and with the presence of vascular invasion (84.1%; p<0.01). CONCLUSIONS: The present results do not show correlation between the MMP-9 and VEGF with the selected prognostic indicators, but shown a significant correlation between one another.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.