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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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(6):403-409
DOI 10.1590/S0100-72032003000600004
PURPOSE: to evaluate the local, regional and distant recurrence rate of a new surgical technique for the conservative treatment of the breast cancer in early stages. The technique is based on breast segmental resection with axillary dissection and skin sparing by a single periareolar incision. METHODS: one hundred and nineteen patients with breast cancer stages I and II constituted the present study. The study group comprised fifty-seven patients who were submitted to surgery by the proposed technique, while 62 patients submitted to the classic quadrantectomy constituted the control group. Postoperative radiotherapy and boost were perfomed in both groups. The average follow-up was 50.1 months for the study group and 51.2 months for the control group. The rates of recurrence, global survival and disease-free survival were analyzed and compared between the two groups. RESULTS: the rate of local recurrence in the period was 3.5% for the study group and 4.8% for the control group. There was no statistically significant difference between the groups as to disease-free survival and global survival rates. CONCLUSION: we demonstrated that the technique of segmental resection with axillary dissection by a single periareolar incision, preserving skin, did not show difference in relation to the classic quadrantectomy, regarding rates of recurrence, global survival and disease-free survival.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(6):403-409
DOI 10.1590/S0100-72032003000600004
PURPOSE: to evaluate the local, regional and distant recurrence rate of a new surgical technique for the conservative treatment of the breast cancer in early stages. The technique is based on breast segmental resection with axillary dissection and skin sparing by a single periareolar incision. METHODS: one hundred and nineteen patients with breast cancer stages I and II constituted the present study. The study group comprised fifty-seven patients who were submitted to surgery by the proposed technique, while 62 patients submitted to the classic quadrantectomy constituted the control group. Postoperative radiotherapy and boost were perfomed in both groups. The average follow-up was 50.1 months for the study group and 51.2 months for the control group. The rates of recurrence, global survival and disease-free survival were analyzed and compared between the two groups. RESULTS: the rate of local recurrence in the period was 3.5% for the study group and 4.8% for the control group. There was no statistically significant difference between the groups as to disease-free survival and global survival rates. CONCLUSION: we demonstrated that the technique of segmental resection with axillary dissection by a single periareolar incision, preserving skin, did not show difference in relation to the classic quadrantectomy, regarding rates of recurrence, global survival and disease-free survival.
