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Introduction: Breast cancer treatment in elderly patients is controversial. This single-centre study was conducted to review the treatment and outcomes for octogenarian women treated for breast cancer., Methods: Data from all patients aged 80 years or more with primary breast cancer treated at our institution between 1995 and 2012 were included. Patients with carcinoma in-situ (stage 0) and advanced breast cancer (stage IV) were excluded., Results: The study population consisted of 369 patients (median age 84 years). A total of 277 (75%) patients underwent surgical treatment (PST) and 92 (25%) received primary endocrine treatment (PET). Prognostic factors (HER-2, tumour grade, lymphovascular invasion and subsequent adjuvant therapy) were homogeneously distributed in both groups. PST and PET were stratified according to stage: 273 (66%) patients with early stage disease (I, IIA, IIB) and 96 (34%) with locally advanced disease (IIIA, IIIB, IIIC). Patients were followed-up for a median of 63 months. In patients with early stage disease, the mean breast cancer-specific survival (BCSS) was 109 months (95% CI = 101-115) in PST patients, and 50 months (95% CI = 40-60) in PET patients (P < 0.01). Conversely, for patients with locally advanced breast cancer, there was no significant difference in BCSS between the surgical and non-surgical groups. In the PST group, BCSS and disease-free survival were significantly better among patients who underwent standard surgical treatment than among those who received suboptimal treatment. There were no differences in the Charlson comorbidity index scores between the PST and PET groups., Conclusion: In women ≥80 years with early-stage breast cancer, standard surgical treatment was associated with a better BCSS when compared with PET., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Excision of breast cancer followed by radiofrequency ablation (eRFA) is a technique designed to increase negative margins in breast-conservative surgical procedures. The objective of this study is to analyze the impact of eRFA in avoiding a second surgical procedure for close or positive margins after a breast-conservative surgical procedure., Material and Methods: From February 2008 to May 2010, 20 patients were included. After lumpectomy, the eRFA was performed in the lumpectomy cavity, and biopsies from each margin from the radial ablated cavity walls were obtained. Biopsy samples were assessed for tumor viability., Results: eRFA was successful in 19 of 20 patients. In all patients, the devitalized tissue extended beyond a 5- to 10-mm radial depth of the biopsy sample. Overall, 6 patients (31%) had margins < 2 mm, 4 of them with < 1 mm margin. All 6 of these patients had no tumor viability according to analysis of biopsy samples stained with 2,3,5-triphenyltetrazolium chloride. At a median follow-up of 46 months, no local recurrence had been found., Conclusion: This study supports the feasibility of eRFA treatment. In our study, the eRFA method has spared 31% of patients from undergoing a re-excision surgical procedure, and it may, in the long-term, reduce local recurrences., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Use of sentinel lymph node dissection in patients with ipsilateral breast cancer recurrence is still controversial. The objective of this study is to evaluate the feasibility of the sentinel lymph node in breast cancer recurrence (SLNBR) and whether the positivity had impact in the adjuvant treatment. Between 2008 and 2012 we performed SLNBR in patients with ipsilateral breast tumor recurrence. We included 53 patients in a prospective study. Forty-three patients (81%) had a previous axillary lymph node dissection (ALND) and ten (19%) had a previous sentinel lymph node biopsy (SLNB). Identification rate after SLNB was 50% and after ALND was 60.5% (p = 0.4). Nine patients (26%) had a positive SLNBR. Adjuvant systemic treatment was given to all the patients with a positive SLNBR and to 23 (85%) with a negative SLNBR (p = 0.29). Six patients (66%) with positive SLNBR and 4 patients (14%) with negative SLNBR underwent radiation therapy (p < 0.01). As conclusions of our study we conclude that sentinel lymph node biopsy in breast tumor recurrence is feasible and significant differences were found in the use of radiation therapy in patients with a positive SLNBR., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: To investigate current management of ductal carcinoma in situ (DCIS) of the breast in Spanish teaching hospitals and to evaluate prognostic factors for recurrence., Study Design: To allow follow-up of 5 years or more, cases diagnosed and treated during 2004 were considered, in order to evaluate the recurrence and death rates due to the disease. Data were reported corresponding to 473 cases, which represents 9.8% of all diagnosed breast carcinomas in the 23 participating centers. Only 425 could be ultimately evaluated, corresponding to approximately 27% of all incident in situ breast carcinoma cases in Spain during 2004., Results: About two-thirds of patients were surgically treated by lumpectomy, and one-third by mastectomy. A strikingly high number of patients had their axillary lymph nodes studied, by means of either sentinel node biopsy (21.9%) or lymphadenectomy (19.3%). Five-year global survival was 99.5%, and disease-free survival 96.9%. The only factor significantly associated with tumor recurrence was tumor microinvasion (p=0.05). In a second, restricted model stratified by microinvasion, the only factor emerging as significantly associated with a better outcome was having received hormonal therapy (p=0.03), but only in the group of pure in situ carcinomas, without microinvasion., Conclusions: Prospective randomized trials are mandatory to achieve an agreement about the best treatment for DCIS. As long as the current discrepancy exists, we should probably err on the conservative side, and not subject our patients to unnecessary therapeutic aggressiveness., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Aim: We assessed maternal and neonatal outcome in women diagnosed with breast cancer during pregnancy., Patients and Methods: Retrospective single-centre cohort study of 25 consecutive pregnant women (mean age 36 years) diagnosed and treated for breast cancer between 2000 and 2011. Management was individualized according to type of tumor and time of gestation at diagnosis., Results: Twelve patients were diagnosed during the second trimester. BI-RADS category <3 mammographic lesions were diagnosed in 7 patients. A suspicious area was detected by ultrasound in 20 of 21 women who underwent ultrasound studies. Nineteen patients had positive hormone receptors and 7 sobreexpressed HER2. One patient was in stage 0, 8 in stage I, 8 in stage II, 3 in stage III and 5 in stage IV. Four patients decided voluntarily to legally terminate their pregnancies, one had a spontaneous miscarriage and in three patients, pregnancy was interrupted at the end of the third trimester before oncological treatment. Eleven patients were treated with chemotherapy during pregnancy after the second trimester using anthracycline-based regimens. In five patients the pregnancy was ended before 34 weeks of gestation. Nine patients had gestation-related complications, including preterm labor, pneumonia, increase in velocity of the middle cerebral artery, oligohydramnios, preeclampsia, extreme prematurity, intrauterine growth restriction, dyspnea, spontaneous miscarriage and chemotherapy-related granulocytopenia. Betamethasone to stimulate fetal lung maturation was used in 6 patients., Conclusion: Breast cancer women diagnosed during pregnancy presented a high number of complications unrelated to antineoplastic treatment. A multidisciplinary team approach is necessary for satisfactory neonatal results., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: The one-step nucleic acid amplification (OSNA) is a molecular procedure that yields a semiquantitative result for detection of nodal metastasis. Size of metastasis in the sentinel lymph node (SLN) by conventional histology has been described as a predictive factor for additional axillary metastasis. The objective of this study is to quantify intraoperatively the total tumoral load (TTL) in the positive SLNs assessed by OSNA and to determine whether this TTL predicts non-SLN metastasis in patients with clinically node negative early stage breast cancer., Methods: 306 patients with cT1-3N0 invasive breast cancer who had undergone intraoperative SLN evaluation by OSNA were included. TTL was defined as the addition of CK19 mRNA copies of each positive SLN (copies/μL)., Results: TTL was a predictive factor of additional non-SLN metastasis in the complete axillary lymph node dissection (cALND) (OR, 1.67; 95% CI, 1.18-2.35). In the multivariate analysis, the TTL was a predictor of non-SLN metastasis in HR positive patients (OR, 1.69; 95% CI, 1.19-2.41). In our cohort of patients, with a TTL ≤1.2 × 10(5) copies/μL, there was a specificity of 85.3% and negative predictive value (NPV) of 80%. If we consider only the HR positive patients, with a TTL ≤5 × 10(5) copies/μL there was a specificity of 86.7% and NPV of 83.7%., Conclusions: TTL assessed by OSNA assay predicts for additional non-SLN metastasis and this intraoperative tool can help guiding decisions on performing a cALND in breast cancer patients., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: No consensus exists on optimum therapy for older cancer patients. This singlecentre study was conducted to review the treatment and outcomes for octogenarian women treated for breast cancer., Methods: Data of all elderly breast cancer patients (≥80 years) with primary breast cancer treated at out institution between 1990 and 2009. Patients with carcinoma in-situ (stage 0) and advanced breast cancer (stage IV) were excluded. Breast cancer-specific survival and disease-free survival for the different patient groups were analysed according to the Kaplan-Meier method., Results: The study population consisted of 259 patients (median age 84 years). There were 189 (73%) patients with early stage disease (I, IIA, IIB) and 70 (27%) with locally advanced disease (IIIA, IIIB, IIIC). A total of 175 (67.7%) patients underwent surgical treatment and 84 (32.4%) received primary endocrine treatment. Patients were followed for a median of 65 months. In patients with early stages, the mean breast cancer-specific survival was 108 months (95% CI 101-115) in the surgical group and 50 months (95% CI 39-61) in the non-surgical group (P < 0.01), whereas patients with locally advanced breast cancer breast cancer-specific survival was similar for the surgical and non-surgical groups. Breast cancer-specific survival and disease-free survival were significantly better among patients who underwent standard surgical treatment than among those with suboptimal surgery., Conclusion: In women ≥80 years with early-stage breast cancer, standard surgical treatment as compared with non-surgical therapy was associated with a better breast cancer-specific., (Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The axillary reverse mapping (ARM) technique has been proposed to prevent arm lymphedema. We conducted this study to assess the feasibility of the technique and the outcomes of patients with neoadjuvant chemotherapy (NAC)., Methods: From July 2009 to May 2010, a prospective study was performed in 36 patients with breast cancer undergoing an ALND. The ARM technique was performed injecting 3 cm(3) of Patent Blue in the ipsilateral arm. Of the 36 patients, 29 patients received NAC previously to the ARM and 7 patients had an ALND and ARM performed as first treatment for positive axillary nodes., Results: The identification rate of blue nodes was 83.3% (30 patients). Sentinel lymph node (SLN) was performed in 15 of 29 (42%) patients in the NAC group. Of these 15, two patients (13%) had a concordance between the blue and the hot node. Blue nodes were positive in 4 (13%) of the 30 patients., Conclusions: The ARM technique is feasible in patients undergoing NAC. Patients with extensive nodal involvement have increased risk of having positive blue nodes. More studies are needed to assess the subgroup of patients with positive axilla that may have the blue node spared without compromising the oncological treatment., (Copyright © 2012 Wiley Periodicals, Inc.)

We assessed whether pregnancy after breast cancer in patients younger than 36 years of age affects the prognosis. Of 115 women with breast cancer followed for a mean of 6 years, 18 became pregnant (median time between diagnosis and the first pregnancy 44.5 months). Voluntary interruption of pregnancy was decided by 8 (44.4%) women. Significant differences in prognostic factors between pregnant and non-pregnant women were not observed. Pregnant women showed a lower frequency of positive estrogen receptors (41%) than non-pregnant (64%) (P=0.06). At 5 years of follow-up, 100% of women in the pregnant group and 80% in the non-pregnant group were alive. The percentages of disease-free women were 94% and 64%, respectively (P=0.009). Breast cancer patients presented a high number of unwanted pregnancies. Pregnancy after breast cancer not only did not adversely affect prognosis of the neoplasm but also may have a protective effect., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Aims: The key to surgical planning for breast conservative treatment (BCT) after neoadjuvant chemotherapy (NAC) is tumor localization. Tumor marking can be performed using either skin tattoo or metallic marker. The objective of this study is to compare both types of tumor localization markers and to assess which techniques improve BCT in achieving a complete resection without compromise margins., Methods: 149 patients between 1999 and 2009 were eligible for the study. The skin tattoo group (TG) included 118 patients and the metallic marker group (MG) included 31 patients. Both markers were placed before starting NAC., Results: Median clinical tumor volume was 10.3 cm(3) in the TG and 22.4 cm(3) in the MG (p = 0.051). After NAC treatment, there were no significant statistically differences in both groups regarding complete clinical response, partial clinical response, and complete and partial pathological response. Median pathological tumor volume was: 0.8 cm(3) in the TG and 0.69 cm(3) in the MG (p = 0.8). Lumpectomy volume was bigger in the TG (268 cm(3)) than MG (143 cm(3)); p < 0.004. There were no statistically significant differences when comparing margin status., Conclusions: Lumpectomy guided with metallic marker after NAC allows lower excision of breast tissue without compromising margins. Having similar pathologic response between groups, skin tattoo leads to excise larger volume of tissue adding no benefits to the surgery. With the increasing pathologic complete responses to NAC, patients who are candidates for BCT after NAC will benefit from marking the tumor with metallic markers., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

We assessed whether axillary dissection using the electrothermal bipolar vessel sealing system (LigaSure) improved perioperative outcome when compared with conventional axillary dissection, in a prospective randomized study of 100 women with breast cancer. Those needing axillary dissection were randomized to the use of LigaSure or to conventional axillary dissection (with 50 patients in each group, all of whom had a closed suction drain in the axilla). The LigaSure patients had less intraoperative blood loss (exceeding 199 mL in 30.8% vs. 69.2%, P < 0.001), quicker axillary dissection (mean 48 vs. 63.2 min, P = 0.004), fewer days of suction drainage (4.3 vs. 5.7 days, P = 0.012), and shorter hospitalization (5.1 vs. 6.5 days, P = 0.021). No difference was found in the rate of hematomas, reoperations or infection. The use of LigaSure in axillary surgery reduced the surgical time and length of hospital stay, favoring early drain removal without increasing postoperative complications., (Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

We describe the case of a pregnant woman diagnosed with breast cancer at 26 weeks' gestation. The tumor was positive for estrogen and progesterone receptors and negative for overexpression of c-erbB-2 protein. Neoadjuvant FAC (fluorouracil, adriamycin, cytoxan) chemotherapy was started at 29 weeks' gestation. At 37 weeks, delivery was induced and the patient gave born to a healthy female baby weighing 2350 g, after which she was given a further cycle of chemotherapy and weekly paclitaxel. Clinical and radiological remission was achieved. Resection of the breast tissue showed complete pathological response and negative lymph nodes. This case illustrates how the integrated work of different specialists can obtain excellent oncological and obstetrical results in the care of pregnant women with breast cancer.

Objective: Clinico-pathologic data on microinvasive carcinoma of the breast (MICB) as defined by the 2003 TNM criteria (T1mic

Background: One of the benefits of neoadjuvant chemotherapy (NAC) is its ability to convert patients ineligible for breast conservative treatment (BCT) to be candidates for this treatment, although questions have been raised regarding the effectiveness of BCT in terms of loco-regional recurrence (LRR). The objective of this study is to evaluate LRR in this group and the influence of tumor characteristics in recurrence., Material and Methods: Between 1996 and 2007, 137 patients were treated with BCT after NAC at our Service. After completion of NAC a multidisciplinary team evaluated the cases eligible for BCT. All patients treated with BCT had negative margins and received radiation therapy. Risk factors associated with local recurrence were analyzed using Kaplan-Meier survival curves and long-rang test., Results: Information was obtained in 121 patients. Median age was 54 years old (SD: 12 years). At a median follow-up of 35 months (range, 18-87 months), 6 (4.95%) patients developed an LRR, with an accumulative incidence at 5 years of 7.3% (95% CI: 0.4-14.1%) and at 10 years of 11.5% (95% CI: 2.8-20.1%). Overall survival at 5 and 10 years was 94.8% (95% CI: 90.9-98.6%) and 82.3% (95% CI: 67.3-97.2%) respectively. Tumor size (T3) (p < 0.001) and pathological stage (Stage III) (p = 0.001) after surgery were strongly associated with LRR., Conclusions: The results of this study confirm that BCT is an effective treatment in patients with NAC. Tumor size and pathological stage after systemic treatment influence loco-regional recurrence in patients with BCT.

Background: Sentinel lymph node (SLN) biopsy has been shown to be both accurate and feasible for women who receive neoadjuvant chemotherapy (NAC). This study was designed to evaluate the ability of intraoperative assessment to predict metastasis in the sentinel node after NAC and to compare it with patients not treated with NAC., Methods: Thirty-seven patients with invasive breast cancer and SLN biopsy after NAC and 461 patients with invasive breast cancer not treated with NAC were included in the study. The SLN was identified by the gamma probe and sent to pathology for frozen (FS) and H&E paraffin-sections. If the SLN was negative by H&E paraffin-sections, then immunohistochemistry was performed., Results: The sensitivity of FS in the NAC group ranged from 78.5% for micro and isolated tumor cells to 100% for macrometastasis. The sensitivity of FS in the non-NAC group ranged from 82% for micro and isolated tumor cells to 97.4% for macrometastasis. There were no statistically differences between the sensitivities of FS in the two groups. Nine (64.2%) of the 14 patients in the NAC group with metastasis to the SLN had other non-SLN metastasis., Conclusions: After NAC, FS is an effective method for detecting macrometastasis in the SLN. As in the adjuvant setting, the sensitivity of FS is lower for SLN micro and sub-micrometastasis. Intraoperative FS of the SLN after NAC is indicated to avoid a second surgery because 60% of patients with a positive SLN will have additional positive axillary nodes.

Introduction: Patients with a diagnosis of breast ductal carcinoma in situ (DCIS) have a low risk of developing axillary metastases. The use of sentinel node biopsy in this group of patients is controversial. The objective of this study is to determine if the sentinel node biopsy benefits a subgroup of patients with DCIS., Patients and Method: Between April 2002 and December 2007, patients with a diagnosis of DCIS and who underwent a sentinel node biopsy were included in the study. In our centre the sentinel node biopsy was performed in patients with DCIS who required a mastectomy, high grade and >2cm DCIS and palpable DCIS., Results: Forty-seven patients were included in the study. In all cases the sentinel node was identified. Twenty-five (53.1%) patients underwent a mastectomy due to extensive DCIS; 14 of these (56%) with immediate reconstruction with implants. Twenty-five (53.1%) patients had high grade DCIS. In 7 (14.8%) patients the tumour was palpable. Fourteen patients (29.7%) were upgraded to invasive breast cancer in the definitive histology. In 2 (4.2%) patients who underwent a mastectomy a positive sentinel node was found., Conclusions: Performing sentinel node biopsy in this group of DCIS patients has lead us to identify 4% of patients with positive sentinel nodes. Furthermore, 29.7% of the patients have avoided a second invasive diagnostic procedure for definitive histology. For these reasons we consider it appropiate to perform sentinel node biopsy in this subgroup of patients with DCIS of the breast.

Objective: The aim of this study is to evaluate if it is necessary to remove all the radioactive sentinel lymph nodes (SLNs) not seen on lymphoscintigraphy in order to accurately stage breast cancer patients., Material and Methods: From March 1999 to March 2006, SLN biopsy was performed in 461 patients. All patients were only injected with radioisotope. Lymphoscintigraphy was performed in all the patients. The mean number of SLNs removed was 2.1 (range 1-15)., Results: The SLN was positive in 133 patients (28.8%). Lymphoscintigraphy accurately predicted the number of SLNs identified intraoperatively in 243 patients (52.7%). In 175 patients (37.9%) there were more SLNs identified intraoperatively than were seen on lymphos cintigraphy. In 11 (6.2%) of these 175 patients, additional SLNs identified intraoperatively harboured metastasis. Type of injection, need for a second injection, tumour location and age were not identified as statistically significantly associated with additional positive SLNs identified intraoperatively and not seen on lymphoscintigraphy., Conclusions: Lymphoscintigraphy does not accurately predict the number of SLNs identified intraoperatively, this number being underestimated. Surgeons should remove all radioactive SLNs to improve the detection of positive SLNs.

Primary or metastatic breast-like carcinoma of the vulva is a rare event. Because of the similarity with breast ductal carcinoma, we think that the same principles used for treatment of orthotopic breast cancer can be applied, as well as the use of sentinel lymph node technique, which is widely accepted in the management of early-stage breast cancer. We report a 49-old-year postmenopausal woman who was referred to our institution after small biopsy of a 3.5- x 3-cm right vulvar tumor. Histopathologically, infiltration of the vulvar dermis by a ductal carcinoma of mammary gland type was reported. At operation, the sentinel node technique revealed two sentinel nodes in the right inguinal area. Although these nodes proved negative for malignancy, the patient underwent wide local excision of tumor and complete ipsilateral inguinofemoral lymphadenectomy. The remaining excised nodes were negative. Surgical specimen proved estrogen- and progesterone-positive receptors, the reason for which the patient received tamoxifen adjuvant therapy. This report represents the first case in the world literature of primary breast carcinoma arising in the vulva in which sentinel lymph node identification has been possible. Because of the rarity of this condition, the pathologic similarity of this tumor along with currently accepted guidelines for the management of breast cancer supports the possibility of local excision and sentinel lymph node identification as a possible alternative to inguinofemoral lymphadenectomy.

Endometrial polyps and endometrial neoplasms are a recognized complication of chronic tamoxifen treatment. This study describes an endometrial carcinoma that developed in a woman receiving low-dose tamoxifen treatment for breast cancer. Little is known about steroid receptor status, somatic alterations in oncogenes and tumor suppressor genes, and inherited susceptibility in endometrial carcinomas associated with tamoxifen use. In the present case, the endometrial carcinoma was negative for estrogen receptors and weakly positive for progesterone receptors. In addition, analysis of K-ras, c-erbB2/neu, cyclin D1, and p53 status revealed a codon 12 point mutation in the K-ras oncogene. The patient was determined not to be a carrier of germ-line mutations in cytochrome P-450 1A1 (CYP1A1), an estrogen-metabolizing gene previously associated with enhanced endometrial cancer risk, but she was a carrier of a methylenetetrahydrofolate reductase gene variant related with putative alterations in DNA methylation.