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Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(1):67-73
, , , , , To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy.
A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords (radial scar OR complex sclerosing lesion, breast cancer, anatomopathological percutaneous biopsy AND/OR surgical biopsy).
Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed.
A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions.
The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%.
The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical andmalignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(1):67-73
, , , , , To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy.
A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords (radial scar OR complex sclerosing lesion, breast cancer, anatomopathological percutaneous biopsy AND/OR surgical biopsy).
Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed.
A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions.
The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%.
The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical andmalignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(10):512-517
Triple-negative breast carcinomas (TNBCs) represent a heterogeneous group of neoplasias, even though they generally exhibit a clinically more aggressive phenotype, and are more prevalent in young women. To date, targeted therapies for this group of tumors have not been defined. The aim of this study was to evaluate the frequency of the apocrine subtype in TBNCs from premenopausal patients as defined by the immunohistochemical expression of the androgen receptor (AR) and its association with: histological type; tumor grade; proliferative activity; epidermal growth factor receptor (EGFR) expression; and a basal-like phenotype.
A total of 118 tumor samples from patients aged 45 years or younger were selected and reviewed according to histological type and grade. Ki-67 expression was also evaluated. Immunohistochemical expression of the AR, basal cytokeratin ⅚, and EGFR expression were analyzed in tissue microarrays. The apocrine subset was defined by AR-positive expression. The basal-like phenotype was characterized by cytokeratin ⅚ and/or EGFR expression.
An apocrine profile was identified in 6/118 (5.1%) cases. This subset of cases also exhibited a lower rate of Ki-67 expression (17.5% versus 70.0%, p= 0.02), and a trend toward a lower histological grade (66.7% versus 27.9%, p= 0.06).
The apocrine subtype of TNBCs is rare among premenopausal women, and it tends to present as carcinomas of lower grade and lower proliferative activity, suggesting a less aggressive biological phenotype.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(10):512-517
Triple-negative breast carcinomas (TNBCs) represent a heterogeneous group of neoplasias, even though they generally exhibit a clinically more aggressive phenotype, and are more prevalent in young women. To date, targeted therapies for this group of tumors have not been defined. The aim of this study was to evaluate the frequency of the apocrine subtype in TBNCs from premenopausal patients as defined by the immunohistochemical expression of the androgen receptor (AR) and its association with: histological type; tumor grade; proliferative activity; epidermal growth factor receptor (EGFR) expression; and a basal-like phenotype.
A total of 118 tumor samples from patients aged 45 years or younger were selected and reviewed according to histological type and grade. Ki-67 expression was also evaluated. Immunohistochemical expression of the AR, basal cytokeratin ⅚, and EGFR expression were analyzed in tissue microarrays. The apocrine subset was defined by AR-positive expression. The basal-like phenotype was characterized by cytokeratin ⅚ and/or EGFR expression.
An apocrine profile was identified in 6/118 (5.1%) cases. This subset of cases also exhibited a lower rate of Ki-67 expression (17.5% versus 70.0%, p= 0.02), and a trend toward a lower histological grade (66.7% versus 27.9%, p= 0.06).
The apocrine subtype of TNBCs is rare among premenopausal women, and it tends to present as carcinomas of lower grade and lower proliferative activity, suggesting a less aggressive biological phenotype.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(6):280-286
Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer. However, some tumors will not respond to this treatment due to histological and molecular features. The protein EZH2 (enhancer of zest homolog 2) is a histone methyltransferase that is correlated with poorly differentiated breast carcinomas and aggressive tumor behavior.
The present study evaluated the association between EZH2 expression and response to NAC, and its correlation with HER2 overexpression, estrogen and progesterone receptors (ER, PR) and Ki-67 proliferation index.
A total of 60 patients with locally advanced breast cancer treated with NAC were selected for this study. Twenty-three paraffin blocks had not enough material for tissue resection, and were not evaluated. A tissue microarray based in immunohistochemistry (IHC) analysis of EZH2 was performed for the remaining 37 specimens. Patients were divided into two groups based on response to NAC.
EZH2 expression was significantly associated with markers of poor prognosis such as ER negativity (p = 0.001), PR negativity (p = 0.042) and high Ki-67 proliferation index (p = 0.002). High EZH2 expression was not correlated with the response to NAC.
Our data suggested that EZH2 protein expression may not correlate with the clinical response to NAC. Other studies with more patients are needed to confirm this observation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(6):280-286
Neoadjuvant chemotherapy (NAC) is the standard treatment for locally advanced breast cancer. However, some tumors will not respond to this treatment due to histological and molecular features. The protein EZH2 (enhancer of zest homolog 2) is a histone methyltransferase that is correlated with poorly differentiated breast carcinomas and aggressive tumor behavior.
The present study evaluated the association between EZH2 expression and response to NAC, and its correlation with HER2 overexpression, estrogen and progesterone receptors (ER, PR) and Ki-67 proliferation index.
A total of 60 patients with locally advanced breast cancer treated with NAC were selected for this study. Twenty-three paraffin blocks had not enough material for tissue resection, and were not evaluated. A tissue microarray based in immunohistochemistry (IHC) analysis of EZH2 was performed for the remaining 37 specimens. Patients were divided into two groups based on response to NAC.
EZH2 expression was significantly associated with markers of poor prognosis such as ER negativity (p = 0.001), PR negativity (p = 0.042) and high Ki-67 proliferation index (p = 0.002). High EZH2 expression was not correlated with the response to NAC.
Our data suggested that EZH2 protein expression may not correlate with the clinical response to NAC. Other studies with more patients are needed to confirm this observation.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):308-313
DOI 10.1590/S0100-720320150005343
To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors.
A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis.
Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size.
The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):308-313
DOI 10.1590/S0100-720320150005343
To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors.
A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis.
Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size.
The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):503-508
DOI 10.1590/S0100-720320140005081
To evaluate variations in the body mass index in patients undergoing adjuvant chemotherapy for breast cancer, and to associate these changes with patient's age and adjuvant chemotherapy regimen.
We performed a retrospective cohort study in order to correlate any variation in the body mass index before and after adjuvant chemotherapy with patient's age and adjuvant chemotherapy regimen. Patients who received any form of prior hormone therapy, such as tamoxifen or aromatase inhibitors, were excluded. We selected data for 196 patients with stage I to III breast cancer who were treated by radical or conservative surgery and received adjuvant chemotherapy at the Cancer Institute of the State of São Paulo, Brazil.
Before adjuvant chemotherapy, 67.8% of patients were classified as overweight or obese according to their body mass indices. Around 66.3% (95% CI 59.7–73.0) of the patients exhibited an increase in the body mass index after adjuvant chemotherapy. The average age of all patients was 56.3±11.3 years. Participants whose body mass index increased were younger than those with no increase (54.7±11.1 versus 59.3±11.2 years; p=0.007). Patients were treated with the following adjuvant chemotherapy regimens: doxorubicin, cyclophosphamide, and paclitaxel (AC-T, 129 patients, 65.8%); 5-fluoracil, doxorubicin, and cyclophosphamide (36 patients, 18.4%); cyclophosphamide, methotrexate, and 5-fluoracil (16 patients, 8.2%); docetaxel and cyclophosphamide (7 patients, 3.6%); and other regimen (8 patients, 4.1%). The AC-T regimen showed a statistically significant association with increase in the body mass index (p<0.001 by ANOVA).
Most patients with breast cancer showed an increase in the body mass index after adjuvant chemotherapy, especially after the AC-T chemotherapy regimen.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(11):503-508
DOI 10.1590/S0100-720320140005081
To evaluate variations in the body mass index in patients undergoing adjuvant chemotherapy for breast cancer, and to associate these changes with patient's age and adjuvant chemotherapy regimen.
We performed a retrospective cohort study in order to correlate any variation in the body mass index before and after adjuvant chemotherapy with patient's age and adjuvant chemotherapy regimen. Patients who received any form of prior hormone therapy, such as tamoxifen or aromatase inhibitors, were excluded. We selected data for 196 patients with stage I to III breast cancer who were treated by radical or conservative surgery and received adjuvant chemotherapy at the Cancer Institute of the State of São Paulo, Brazil.
Before adjuvant chemotherapy, 67.8% of patients were classified as overweight or obese according to their body mass indices. Around 66.3% (95% CI 59.7–73.0) of the patients exhibited an increase in the body mass index after adjuvant chemotherapy. The average age of all patients was 56.3±11.3 years. Participants whose body mass index increased were younger than those with no increase (54.7±11.1 versus 59.3±11.2 years; p=0.007). Patients were treated with the following adjuvant chemotherapy regimens: doxorubicin, cyclophosphamide, and paclitaxel (AC-T, 129 patients, 65.8%); 5-fluoracil, doxorubicin, and cyclophosphamide (36 patients, 18.4%); cyclophosphamide, methotrexate, and 5-fluoracil (16 patients, 8.2%); docetaxel and cyclophosphamide (7 patients, 3.6%); and other regimen (8 patients, 4.1%). The AC-T regimen showed a statistically significant association with increase in the body mass index (p<0.001 by ANOVA).
Most patients with breast cancer showed an increase in the body mass index after adjuvant chemotherapy, especially after the AC-T chemotherapy regimen.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):27-30
DOI 10.1590/S0100-72032011000100004
PURPOSE: to evaluate the concordance rate of ultrasound-guided core needle biopsy followed by excisional biopsy in palpable breast lumps, suggestive of fibroepithelial tumors. METHOD: a retrospective study included 70 biopsies with a histological diagnosis of fibroepithelial tumor in 67 out of 531 patients with breast lesions submitted to ultrasound-guided core needle biopsy with a high frequency (7.5 MHz) linear transducer, using an automatic Bard-Magnum gun and a 14-gauge needle. Cases with a diagnosis of fibroepithelial tumor by core needle biopsy or excisional biopsy and with a diagnosis of fibrosclerosis were included in the study. The agreement between the two biopsy methods was assessed using the Kappa coefficient. RESULTS: excisional biopsy revealed 40 cases of fibroadenoma (57.1%), 19 cases of phyllodes tumor (27.2%), and 11 cases of fibrosclerosis (15.7%). The concordance rate for fibroadenoma was substantial (k = 0.68, 95%CI = 0.45 - 0.91), almost perfect for the phyllodes tumor (k = 0.81, 95%CI = 0.57 - 1.0), and moderate for fibrosclerosis (k = 0.58, 95%CI = 0.36 - 0.90). CONCLUSIONS: the core needle biopsy is a minimally invasive method that has "substantial" to "almost perfect" concordance rate with excisional biopsy. Fibrosclerosis should be considered in the differential diagnosis of fibroepithelial tumors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2011;33(1):27-30
DOI 10.1590/S0100-72032011000100004
PURPOSE: to evaluate the concordance rate of ultrasound-guided core needle biopsy followed by excisional biopsy in palpable breast lumps, suggestive of fibroepithelial tumors. METHOD: a retrospective study included 70 biopsies with a histological diagnosis of fibroepithelial tumor in 67 out of 531 patients with breast lesions submitted to ultrasound-guided core needle biopsy with a high frequency (7.5 MHz) linear transducer, using an automatic Bard-Magnum gun and a 14-gauge needle. Cases with a diagnosis of fibroepithelial tumor by core needle biopsy or excisional biopsy and with a diagnosis of fibrosclerosis were included in the study. The agreement between the two biopsy methods was assessed using the Kappa coefficient. RESULTS: excisional biopsy revealed 40 cases of fibroadenoma (57.1%), 19 cases of phyllodes tumor (27.2%), and 11 cases of fibrosclerosis (15.7%). The concordance rate for fibroadenoma was substantial (k = 0.68, 95%CI = 0.45 - 0.91), almost perfect for the phyllodes tumor (k = 0.81, 95%CI = 0.57 - 1.0), and moderate for fibrosclerosis (k = 0.58, 95%CI = 0.36 - 0.90). CONCLUSIONS: the core needle biopsy is a minimally invasive method that has "substantial" to "almost perfect" concordance rate with excisional biopsy. Fibrosclerosis should be considered in the differential diagnosis of fibroepithelial tumors.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(10):491-496
DOI 10.1590/S0100-72032010001000004
PURPOSE: to evaluate painful sensitivity and factors involved in producing papillary fluid suitable for cytological analysis by means of automated collection. METHODS: we selected 50 asymptomatic women without a personal or family history of breast cancer, outside the pregnancy and childbirth cycle in order to collect papillary fluid by the automated system. We recorded and related to the production of papillary fluid patient age, smoking habit, previous breast surgery, parity, breastfeeding, menopausal status and age at menarche. All material collected was fixed in appropriate place, and sent separately for cytological analysis. The painful sensitivity of the collection procedure was assessed using the Borg Category-Ratio Scale (CR10 Scale). RESULTS: patient age ranged from 22 to 59 years, mean 41.6±8.6 years. Of the 50 patients, 20 (40%) showed no papillary fluid suitable for analysis in the breasts. In those patients from whom appropriate fluid was obtained for analysis of papillary cytology, parity was inversely related to the ability to obtain suitable cell samples with a level of statistical significance of p=0.035, OR=0.0032 (95%CI=0.0001-0.1388). Regarding soreness, the exam was well tolerated. CONCLUSIONS: the automated method of fluid collection for analysis of papillary cytology was well tolerated by the women; thus producing analyzable material in 60% of cases, a rate was inversely related to parity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2010;32(10):491-496
DOI 10.1590/S0100-72032010001000004
PURPOSE: to evaluate painful sensitivity and factors involved in producing papillary fluid suitable for cytological analysis by means of automated collection. METHODS: we selected 50 asymptomatic women without a personal or family history of breast cancer, outside the pregnancy and childbirth cycle in order to collect papillary fluid by the automated system. We recorded and related to the production of papillary fluid patient age, smoking habit, previous breast surgery, parity, breastfeeding, menopausal status and age at menarche. All material collected was fixed in appropriate place, and sent separately for cytological analysis. The painful sensitivity of the collection procedure was assessed using the Borg Category-Ratio Scale (CR10 Scale). RESULTS: patient age ranged from 22 to 59 years, mean 41.6±8.6 years. Of the 50 patients, 20 (40%) showed no papillary fluid suitable for analysis in the breasts. In those patients from whom appropriate fluid was obtained for analysis of papillary cytology, parity was inversely related to the ability to obtain suitable cell samples with a level of statistical significance of p=0.035, OR=0.0032 (95%CI=0.0001-0.1388). Regarding soreness, the exam was well tolerated. CONCLUSIONS: the automated method of fluid collection for analysis of papillary cytology was well tolerated by the women; thus producing analyzable material in 60% of cases, a rate was inversely related to parity.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):735-739
DOI 10.1590/S0100-72032004000900010
PURPOSE: to describe the use of a superior labial flap for the treatment of labia minora hypertrophy. METHODS: from May, 1998 to July, 2002 10 patients with labia minora hypertrophy were submitted to reduction of the labial excess through the resection of the inferior segment by an L-shaped incision. The transversal incision was done starting on the labial external border towards the hymenal caruncles, and the longitudinal incision, from that point until near the furcula. The border of the superior flap was then lowered to eliminate the defect caused by the inferior resection. RESULTS: within an average period of 45 days after surgery, the patients were satisfied with its esthetical and functional aspects. The local sensibility did not change. Only two cases presented complications: one case with perineal ecchymosis and the other with partial, early unilateral dehiscense. Infection, necrosis and late dehiscense were not observed. CONCLUSION: the utilization of the superior flap in the correction of labia minora hypertrophy produces a satisfactory esthetical and functional result with few complications and easy resolution.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(9):735-739
DOI 10.1590/S0100-72032004000900010
PURPOSE: to describe the use of a superior labial flap for the treatment of labia minora hypertrophy. METHODS: from May, 1998 to July, 2002 10 patients with labia minora hypertrophy were submitted to reduction of the labial excess through the resection of the inferior segment by an L-shaped incision. The transversal incision was done starting on the labial external border towards the hymenal caruncles, and the longitudinal incision, from that point until near the furcula. The border of the superior flap was then lowered to eliminate the defect caused by the inferior resection. RESULTS: within an average period of 45 days after surgery, the patients were satisfied with its esthetical and functional aspects. The local sensibility did not change. Only two cases presented complications: one case with perineal ecchymosis and the other with partial, early unilateral dehiscense. Infection, necrosis and late dehiscense were not observed. CONCLUSION: the utilization of the superior flap in the correction of labia minora hypertrophy produces a satisfactory esthetical and functional result with few complications and easy resolution.
