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PURPOSE We evaluated the impact of 21-gene test results on treatment decisions for patients with early-stage breast cancer treated under the public health care system in Brazil, Sistema Único de Saúde. METHODS Eligible patients treated at Hospital Pérola Byington and Santa Casa de Misericórdia de São Paulo in Brazil were required to have the following characteristics: postsurgery with hormone receptor–positive, human epidermal growth factor 2–negative, node-negative and node-positive, and T1/T2 breast cancer and patients with these characteristics were candidates for adjuvant systemic therapy. Treatment recommendations, chemotherapy plus hormonal therapy (CT + HT) or HT alone, were captured before and after 21-gene test results. RESULTS From August 2018 to April 2019, 179 women were enrolled. The mean age was 58 years (29-86 years), 135 (76%) were postmenopausal, and 58 (32%) had node-positive breast cancer. Most patients (61%) had a tumor > 2 cm, including 7% with tumors > 4 cm. Using Recurrence Score (RS) result cut points on the basis of the TAILORx trial, 40 (22%) had RS 0-10, 91 (51%) had RS 11-25, and 48 (27%) had RS 26-100. Before 21-gene testing, 162 of 179 (91%) patients were recommended for CT. After testing, 117 of 179 patients (65%) had changes in CT recommendation: 112 (63%) who were initially recommended CT received HT alone and five (3%) who were initially recommended HT alone received CT + HT. After 21-gene testing, 99% of physicians reported strong confidence in their treatment recommendations. CONCLUSION The change in clinical practice at these public hospitals was greater than expected: 66% of initial treatment recommendations were changed to omit CT with 21-gene test results. Clinicopathologic features did not correlate well with 21-gene test results and did not adequately identify those most likely to benefit from CT.

To assess quality of life and climacteric symptoms for post-menopausal women receiving hormone therapy for breast cancer.A prospective observational study of women treated at the Mastology Outpatient Clinic of the Department of Obstetrics and Gynecology was conducted between 2015 and 2019. Post-menopausal patients who had been diagnosed with breast cancer and who were experiencing climacteric symptoms were selected. These patients had undergone surgery, radiotherapy, and/or chemotherapy more than one year prior and were receiving tamoxifen or an aromatase inhibitor. A total of 57 women were recruited and during visits completed a sociodemographic questionnaire, the Blatt-Kupperman Menopausal Index (KI), and the World Health Organization Quality of Life version-bref (WHOQOL-bref) scale. Repeated measures ANOVA, and Friedman and Pearson tests were conducted.Patients had a mean age of 54.4 ± 5.9 years, 86% had ductal carcinoma, 98% had undergone surgery, 70% had received chemotherapy, and 96% had received radiotherapy. Scores on the KI (P0.001) and WHOQOL-bref scale (P0.046) had improved by the 6-month follow-up. Correlation of the KI and WHOQOL-bref scales showed that less intense climacteric symptoms were associated with higher scores on quality of life domains, and these results were statistically significant (P0.001).The correlation of the scales showed that reduction in climacteric symptoms is associated with significant improvements in quality of life measures.

Background and objectives To report on the outcomes and evolution of an oncoplastic mammaplasty referred to as geometric compensation mammaplasty. Methods Seventy-three patients with malignant tumours were operated on and followed up in five centres in two countries. Preoperative markings were performed using a Wise pattern. The resection of affected skin was geometrically compensated using another area of preserved skin. Results Mean pathological tumour size was 30.42 ± 21.98 mm. Twenty tumours (30.77%) were locally advanced and 15 (20.55%) were multicentric. Twenty-two patients (34.38%) were submitted to neoadjuvant chemotherapy. Cosmetic results were considered good or excellent in 59 cases (80.82%). Margins were positive in two cases (2.74%). Complications were partial wound dehiscence (n = 11; 15.07%), fat necrosis (n = 9; 12.33%), skin necrosis (n = 5; 6.85%), seromas (n = 5; 6.85%), enlarged scars (n = 7; 9.59%) and infection (n = 2; 2.74%). There were three cases of local recurrence (4.29%), two of bone metastasis (2.86%) and three of metachronous contralateral breast cancer (4.35%). No deaths were recorded within a mean follow-up of 35.33 ± 28.21 months. Conclusions The technique allowed breast conservation in situations requiring a large resection of skin in difficult positions, with a high rate of free margins, correction of ptosis, satisfactory symmetry and few complications.

Invasive lobular carcinoma represents 5%–15% of breast carcinomas, presenting in many cases as multicentric and bilateral tumors with low mammographic detection. The most common breast cancer metastases are the bones, lungs, brain, and liver. However, the disease can also spread to abdominal cavity, ovaries, and skin. The orbit is an infrequent site of tumor metastasis, ranging from 1% to 13% among all orbital tumors, and breast, lung, and prostate are among the most common primary sites. We report the case of a 73-year-old female patient who presented with a palpable mass in the left orbital rim, whose incisional biopsy revealed a pattern compatible with invasive breast carcinoma with lobular characteristics and E-cadherin overexpression, luminal molecular subtype B. She denied breast complaints and palpable nodules, but on clinical examination she showed a tumor in the inferolateral quadrant of the left breast measuring 6 cm and a left axilla with lymph node enlargement suspected of lymph node involvement. Mammography identified suspicious nodulation in this topography, confirmed by ultrasound. The diagnosis made through core biopsy was an invasive breast carcinoma with lobular characteristics, and the immunohistochemical profile showed luminal molecular subtype B. Systemic staging revealed involvement of the retroperitoneum, left ovarian annex, vertebral bodies, pelvis, right femur, and left iliac suspected for secondary involvement. The patient is currently undergoing adjuvant systemic treatment.

Objective: The aim of this study was to assess the knowledge and attitudes of members of the Brazilian Society of Mastology (SBM) about the systemic treatment of triple-negative breast cancer (TNBC). Methods: All 1,400 SBM members were invited to answer a survey with 44 objective questions. An expert meeting was held in December 2021, with the participation of 27 experts and 3 ad hoc consultants. Panelists responded to the survey before and after the meeting (brainstorm). Responses that reached 70% agreement were considered consensual. Results: There was consensus regarding the indications of neoadjuvant chemotherapy and the addition of platinum in this context, unlike immunotherapy, which was only recommended among experts after brainstorming. The presence of germline BRCA mutations does not interfere with the recommendation of neoadjuvant treatment with immunotherapy (double consensus). In contrast, 70.6% of mastologists consider the status of PD-L1 for the indication of neoadjuvant immunotherapy. Faced with the combination of chemotherapy and neoadjuvant immunotherapy, about 75% of respondents recommend that anthracyclines be used in a dose- -dense regimen (double consensus). After the brainstorm, this agreement was reversed. In adjuvant therapy, controversies remain regarding the maintenance of immunotherapy and the combination of immunotherapy and capecitabine/olaparib in relevant cases. Conclusion: Consensus among experts was reached on more than 70% of the questions, and agreement between panelists and associates was moderate. As verified in the brainstorm, the educational intervention about the systemic treatment of breast cancer influenced the mastologist’s decision-making in 60% of the questions. This theme should be explored, intensively and systematically, in continuing education actions aimed at mastologist professionals.

Dermatofibrosarcoma (DFS) is a rare low-grade fibroblastic mesenchymal tumor derived from the dermis. The lesion accounts for approximately 1% of all soft-tissue sarcomas and less than 0.1% of all malignancies, with an annual incidence of 4.2–4.5 cases per million. It occurs most frequently between the second and fifth decades of life and usually appears in the dermis and subcutaneous tissue. DFS occurs more commonly in the trunk (42%–72%), and breast involvement is uncommon and occurs due to the infiltration of previous dermal involvement. We report a case of a 40-year-old female patient with a history of a violaceous nodulation that was hardened and not adhered to deep planes measuring approximately 5 cm in the inferomedial quadrant of the left breast, whose biopsy was performed in an external unit revealing a DFS. Magnetic resonance imaging of the breast showed a nodule with thickening of the adjacent skin in the aforementioned topography, measuring 3.1×3×2.9 cm, in addition to another nodular image with similar characteristics, compatible with multifocal involvement. She underwent quadrantectomy and immediate reconstruction with a myocutaneous flap of the fat-grafted latissimus dorsi muscle. A surgical specimen containing two nodules, measuring 2.8 and 2.5 cm, respectively, with a result compatible with a DFS with free surgical margins was analyzed. Immunohistochemistry revealed native estrogen and progesterone receptors, positive CD34 in tumor cells, and positive Ki67 in less than 5% of cells. The patient remains under clinical follow-up at our service, with no evidence of recurrence of the lesion, currently with annual consultations for physical examination and checking of breast ultrasound and bilateral mammography examinations.

Objective: The aim of this study was to evaluate the knowledge and attitudes of the members of the Brazilian Society of Mastology (SBM) about the locoregional treatment of triple-negative breast cancer (TNBC). Methods: All 1,400 SBM members were invited to answer a survey of 44 objective questions. An expert meeting was held in December 2021, with the participation of 27 experts and 3 ad hoc consultants. Panelists responded to the survey before and after the meeting (brainstorm). Responses that reached 70% agreement were considered consensual. Results: In a patient undergoing conservative surgery after neoadjuvant therapy, with a compromised sentinel lymph node (SLNB), there was a double consensus on the indication of lymphadenectomy (ALND). In patients undergoing upfront surgery, with compromised SLNB, there was a double consensus on the indication of radiotherapy for locoregional control. However, 22% of breast specialists still indicate ALND in patients eligible for the ACOSOG Z0011 study. In women with TNBC who tested negative for pathogenic mutations, 100% of the panelists disagreed with the unrestricted indication of bilateral mastectomy. In women with a positive test, almost 100% of the respondents stated that the possibility of bilateral mastectomy should be considered. The panel reaffirmed the concept of “no ink on tumor” as adequate margins, regardless of initial treatment. Conclusion: Consensus among experts was reached on more than 70% of the questions, and agreement between panelists and associates was moderate. In view of the differences observed in some points already consolidated in the literature, it is suggested that the locoregional treatment of TNBC be explored, in an intense and systematic way, in continuing education actions aimed at the mastologist.

Purpose: An Expert Panel on Breast Cancer and COVID-19 was convened to address the impact of the COVID-19 pandemic for early breast cancer management. Methods: In order to ensure the most clinically relevant information was addressed, essential information was drawn from several of the latest national and international guidelines and another technical document. The Expert Panel met in five virtual closed sessions from November 2020 to May 2021 to consult on the relevant data from evidence-based results. The data gathered were discussed on an online platform (Within3 ®). Results: This paper reports the Expert Panel’s highlights of these meetings’ discussions. In addition, it provides practical recommendations covering topics regarding diagnosis, treatment, and management of breast cancer patients in clinical settings routinely encountered by HCPs amid the COVID-19 pandemic. Conclusions: It was provided guidance on several topics regarding eBC management amid the COVID-19 pandemics to inform safer care practices.

To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020. A survey of members of the Brazilian Society of Mastology. Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old. This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.

Objective The aim of this study was to describe a variation of the breast reconstruction technique with myocutaneous flap of the fat-grafted latissimus dorsi muscle and its outcomes and evaluation of patient satisfaction. Method This prospective cohort study included 18 patients and 19 reconstructed breasts, with 1 bilateral case. There were 7 cases of late reconstruction and 11 cases of immediate reconstruction. The flap was prepared with fat at the time of surgery, which was injected before its preparation. The evaluation of the results regarding shape, volume, and symmetry was performed through a satisfaction scale completed by patients and 2 physicians from 12 to 18 months after reconstruction. Results On average, 171.31 mL of fat was injected (100-275 mL); the average time of unilateral surgery was 3 hours 42 minutes (3 hours to 4 hours 30 minutes). After a mean follow-up of 26.38 months (13-38 months), we did not observe complications of this new technique. In the evaluation performed by patients regarding the shape, volume, and symmetry, more than 80% rated the outcome as excellent and good, and the evaluations by the medical team were also satisfactory. In the comparative analysis between immediate and late reconstruction, patients who underwent immediate reconstruction were more satisfied. Conclusions This reconstruction technique with autologous fat injection was effective, with satisfactory and long-lasting results, and without the requirement for implants to set breast shape and volume.

Introduction The COVID-19 pandemic has changed health systems across the world, both in general hospitals and in oncology institutes or centres.For cancer specialists, particularly breast cancer (BC), the COVID-19 pandemic represents a combination of challenges since the hospital resources and staff have become more limited; this has obliged oncology specialists to seek a consensus and establish which patients with BC require more urgent attention and which patients can wait until there is a better control of this pandemic. The health system in Latin America has some special characteristics; in some of the countries, there are shortages which limit access to several specialities (surgery, clinical oncology and radiotherapy) in some regions. Objective After a systematic review of the most recent literature regarding the management of BC during the COVID-19 pandemic, the main objective is to understand the position of the different Latin American Societies of Mastology in terms of available alternatives for the treatment of BC. Methods After carrying out a comprehensive and exhaustive search of the most recent guides on the management of BC during the COVID-19 pandemic, the board members of the Latin American Federation of Mastology invited, via email, different specialists, all experts in BC care, to complete an anonymous survey online.The survey was distributed between 30 and 10 May 2020. The survey included 27 questions on four topics: demographic information, consultations, imaging and treatment of BC.The questionnaire was sent and then distributed to various health specialists including breast surgeons, clinical oncologists, radiation oncologists and radiologists via the Presidents of the different Latin American Societies of Mastology in 18 countries. The results are summarised as tallies based on the number of responses to each question. Results A total of 499 responses were received. The majority of the respondents were males (275 (55.11%)); 290 participants were over 45 years (58.11%).The questionnaire presented those surveyed with three possible answers (agree, disagree and neither agree nor disagree). The results reflect that there was consensus in the majority of situations presented. Only seven questions revealed disagreement among those responding. The results are presented as recommendations. Conclusion The management of patients with BC presents unique challenges during the current world health situation produced by COVID-19 pandemic. Breast care specialists (surgical oncologists, breast care clinicians, clinical oncologists, radiation oncologists and radiologists) from 18 countries in Central and South America submitted through their responses and recommendations for the treatment of BC during the COVID-19 pandemic.

Conservative surgery followed by radiation therapy is considered the method of choice for the treatment of breast cancer. In some cases, even though conservative surgery adequately treats cancer, it results in breast mutilation levels whose deleterious esthetic effects are very important, and thus, the partial reconstruction of the breast, also called oncoplasty gains space. The Round Block periareolar technique was reported in 1988 by Benelli (Rev Fr Chir Esthet 13:7–11, 1988) and differed from the periareolar mammoplasty techniques used until then, since with certain details of the new technique, the indications for periareolar mammoplasty were no longer limited to small volume breasts and those with a small degree of ptosis. Another advantage of the new technique was the lower incidence of enlargement and distortion of the scar caused by suture tension. With the development of oncoplastic surgery, periareolar techniques gained space in breast oncologic and repair treatment. A combination of techniques enabled access to tumors in different topographies in addition to breast remodeling, correction of ptosis, and breast hypertrophy.

Purpose: Evaluation of the performance of a computer-aided diagnosis (CAD) system based on the quantified color distribution in strain elastography imaging to evaluate the malignancy of breast tumors. Methods: The database consisted of 31 malignant and 52 benign lesions. A radiologist who was blinded to the diagnosis performed the visual analysis of the lesions. After six months with no eye contact on the breast images, the same radiologist and other two radiologists manually drew the contour of the lesions in B-mode ultrasound, which was masked in the elastography image. In order to measure the amount of hard tissue in a lesion, we developed a CAD system able to identify the amount of hard tissue, represented by red color, and quantify its predominance in a lesion, allowing classification as soft, intermediate, or hard. The data obtained with the CAD system were compared with the visual analysis. We calculated the sensitivity, specificity, and area under the curve (AUC) for the classification using the CAD system from the manual delineation of the contour by each radiologist. Results: The performance of the CAD system for the most experienced radiologist achieved sensitivity of 70.97%, specificity of 88.46%, and AUC of 0.853. The system presented better performance compared with his visual diagnosis, whose sensitivity, specificity, and AUC were 61.29%, 88.46%, and 0.829, respectively. The system obtained sensitivity, specificity, and AUC of 67.70%, 84.60%, and 0.783, respectively, for images segmented by Radiologist 2, and 51.60%, 92.30%, and 0.771, respectively, for those segmented by the Resident. The intra-class correlation coefficient was 0.748. The inter-observer agreement of the CAD system with the different contours was good in all comparisons. Conclusions: The proposed CAD system can improve the radiologist performance for classifying breast masses, with excellent inter-observer agreement. It could be a promising tool for clinical use.

Objectives: To determine the applicability of a computer-aided diagnostic system strain elastography system for the classification of breast masses diagnosed by ultrasound and scored using the criteria proposed by the breast imaging and reporting data system ultrasound lexicon and to determine the diagnostic accuracy and interobserver variability. Methods: This prospective study was conducted between March 1, 2016, and May 30, 2016. A total of 83 breast masses subjected to percutaneous biopsy were included. Ultrasound elastography images before biopsy were interpreted by 3 radiologists with and without the aid of computer-aided diagnostic system for strain elastography. The parameters evaluated by each radiologist results were sensitivity, specificity, and diagnostic accuracy, with and without computer-aided diagnostic system for strain elastography. Interobserver variability was assessed using a weighted κ test and an intraclass correlation coefficient. The areas under the receiver operating characteristic curves were also calculated. Results: The areas under the receiver operating characteristic curve were 0.835, 0.801, and 0.765 for readers 1, 2, and 3, respectively, without computer-aided diagnostic system for strain elastography, and 0.900, 0.926, and 0.868, respectively, with computer-aided diagnostic system for strain elastography. The intraclass correlation coefficient between the 3 readers was 0.6713 without computer-aided diagnostic system for strain elastography and 0.811 with computer-aided diagnostic system for strain elastography. Conclusion: The proposed computer-aided diagnostic system for strain elastography system has the potential to improve the diagnostic performance of radiologists in breast examination using ultrasound associated with elastography.

Background: To determine whether there is correlation between magnetic resonance imaging (MRI) findings and breast elastography to differentiate seroma/hematoma from silicone-induced granuloma of breast implant capsule (SIGBIC). Methods: Prospective study of 99 patients with breast implants submitted to breast MRI during the period from February 1 to May 1, 2017. Patients who present MRI findings of seroma/hematoma or SIGBIC were submitted to a complementary ultrasound elastography study to evaluate the correlation of the results. The criteria adopted for the diagnosis of granuloma by MRI were heterogeneous hypersignal in the T2-weighted sequences, late contrast enhancement, and black drop sign. Lesions that did not enhance after the use of contrast were considered as seroma/hematoma. By elastography, the results were considered positive for granuloma when presented as hard lesions, whereas seroma/hematoma presented as soft lesions. Results: Of the 99 patients evaluated, 15 were included in the study. Of the 15 patients, 9 had solid intracapsular MRI masses, whereas 6 presented collections without contrast enhancement. The complementary elastography study showed correlation with MRI results in all cases of SIGBIC and seroma/hematoma, being elastography able to differentiate lesions from solid to cystic. Conclusions: Elastography of intracapsular masses in breast implants presented results compatible with those found by MRI to differentiate solid lesions from collections.

Made available in DSpace on 2018-12-11T16:38:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-08-01 Background: Lumpectomy may result in major deformities and asymmetries in approximately one-third of patients. Although oncoplastic surgery (OP) could be a useful alternative to avoid them, lack of strong data is causing some debate. The purpose of this study was to compare aesthetic outcomes in patients undergoing OP versus lumpectomy using three different assessment methods. Methods: A total of 122 patients were included in this cross-sectional multicentric study; 57 underwent OP (46.7 %), and 65 underwent lumpectomy (53.3 %). Two breast surgeons and two plastic surgeons from different institutions using the Garbay scale independently evaluated aesthetic outcomes. BCCT.core software was applied in both groups, and the patients evaluated their aesthetic outcomes answering a questionnaire about their satisfaction rate. Results: OP group had a higher proportion of excellent aesthetic results according to the BCCT.core software analysis (p = 0.028) and the specialists (p = 0.002). Multifactorial analyses showed that age ≥70 years (RP = 6.02; 95 % confidence interval [CI] 1.73–21.0; p = 0.005), tumors in the medial, inferior, and central quadrants (RP = 4.21; 95 % CI 1.88–9.44; p

Breast elastography is a new sonographic technique that provides additional information to evaluate tissue stiffness. However, interpreting breast elastography images can vary depending on the radiologist. In order to provide quantitative and less subjective data regarding the stiffness of a lesion, we developed a tool to measure the amount of hard area in a lesion from the 2D image. The database consisted of 78 patients with 83 breast lesions (31 malignant and 52 benign). Two radiologists and one resident manually drew the contour of the lesions in B-mode ultrasound images and the contour was mapped in the elastography image. By using the system proposed, the radiologists obtained a very good diagnostic agreement among themselves (kappa = 0.86), achieving the same sensitivity and specificity (80.7 and 88.5, respectively), and an AUC of 0.883 for Radiologist 1 and 0.892 for Radiologist 2. The Resident had less interobserver agreement, as well as lower specificity and AUC, which may be related to less experience. Furthermore, the radiologists had an agreement with the tool used in the automatic method higher than 90%. Thus, the method developed was useful in aiding the diagnosis of breast lesions in strain elastography, minimizing its subjectivity.

Objective:Todescribeatechniqueofoncoplasticmammaplasty,referredtoasgeometriccompensation,whichissuitablefortumorsclosetotheskin in areas not included in the classic preoperative drawings for mammaplasty. Materials and Methods: Seventeen patients with malignant tumors were included. Preoperative markings followed the “Wise‐pattern” technique. The resection of affected skin was geometrically compensated with another area of preserved skin. Results:Themeanageofthepatientswas52.88 � 12.14years.Meanpathologicaltumorsizewas43.82 � 31.39mm.Therewere7(41.18%)locally advanced tumors. Six patients (35.29%) were submitted to neoadjuvant and the remainder to adjuvant chemotherapy. Radiotherapy was indicated in allcases.Fifteenpatients(88.24%)receivedhormonetherapy.Ptosiswascorrectedinallcases.Theaestheticresultwasratedexcellentinsevencases (41.18%), good in 7 (41.18%), and fair in three cases (17.65%). Surgical margins were free. A seroma developed in one case (5.88%), small fat necrosis in three (17.65%), and enlarged scar in one (5.88%). There were no recurrences within 28.24 � 18.02 months. Conclusions: The technique allowed breast conservation in situations requiring large resection of affected skin, with free surgical margins, correction of ptosis, satisfactory symmetry, and few complications. J. Surg. Oncol. . 2014 Wiley Periodicals, Inc.

Background Although there are many reports on different techniques in breast reconstruction, there are few data regarding immediate breast reconstruction with definitive form-stable anatomical implants in terms of aesthetics and quality-of-life outcomes. Methods Ninety-four patients underwent mastectomy with immediate breast reconstruction using anatomical implants and contralateral symmetrization. Aesthetic results were evaluated by three different methods: the patient's self-report, the assessment of four independent specialists (two breast surgeons and two plastic surgeons from different institutions), and the BCCT.core software. Quality of life was evaluated by means of the BREAST-Q instrument. Results Average age ± SD was 52.1 ± 11.6 years. Most of patients had medium size breasts and T1 tumors. Patients had evaluated their aesthetic results better than did software and specialists. There was no significant difference in the comparison between software and specialist's evaluation. Multifactorial analysis showed that age older than 70 years and radiotherapy were significant risk factors for poor aesthetic outcomes after immediate breast reconstruction with implants. Considering quality of life, most of the patients were satisfied with their outcome and psychosocial and sexual well-being. Conclusion Immediate breast reconstruction with implants and contralateral symmetrization had a positive impact on the quality of life and showed satisfactory outcomes when evaluated by subjective and objective methods.

The objective of this study was to evaluate the correlation between cyclooxygenase-2 (COX-2) and markers of cell proliferation and apoptosis, including, Bcl-2, Bax, Ki-67 and the type I insulin-like growth factor (IGF) receptor (IGF1-R) in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC), present in the same surgical specimen. A total of 110 cases were evaluated using tissue microarrays. Cases were classified in scores from 0 to 3 according to pre-defined methods. The results showed that the positivity rates were COX-2 in 87% of cases in DCIS and IDC; Bcl-2 in 55% of cases in DCIS and IDC; Bax in 23% of cases in IDC and 19% in DCIS, IGF-1 in 24% of cases in DCIS and IDC; and Ki-67 in 81% of cases in DCIS and IDC. We also observed a positive correlation between the expression of COX-2 and IGF1-R (p=0.045). Our results demonstrate a positive correlation between the expression of COX-2 and IGF1-R in DCIS and IDC, demonstrating that they are involved in breast cancer carcinogenesis. Further studies are required to prove the effectiveness of COX-2 and IGF1-R inhibitors for the prevention and treatment of breast cancer, as well as to explain their mechanism of action.

CONTEXT AND OBJECTIVE: Cyclooxygenase-2 (COX-2) and human epidermal growth factor receptor type 2 (HER-2) are associated with tumorigenesis. Studies have shown that HER-2 can regulate COX-2 expression. The aim of this study was to evaluate the correlation between COX-2 and HER-2 expression in normal breast epithelium and in ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) present in the same breast. DESIGN AND SETTING: Cross-sectional study at the Mastology Unit of the Department of Gynecology and Obstetrics, Santa Casa de Misericórdia de São Paulo Hospital. METHODS: COX-2 and HER-2 were detected using immunohistochemistry on 100 tissue fragments. HER-2 > +2 was subjected to fluorescence in situ hybridization (FISH). RESULTS: COX-2 expression was detected in 87%, 85% and 75% of IDC, DCIS and normal epithelium, respectively. HER-2 expression was detected in 34% of IDC and 34% of DCIS. COX-2 in DCIS correlated with HER-2 in IDC (P = 0.049) and DCIS (P = 0.049). COX-2 in normal epithelium correlated with HER-2 in IDC (P = 0.046) and DCIS (P = 0.046). COX-2 in IDC was not associated with HER-2 (P = 0.235). Comparison between COX-2 and HER-2 in DCIS showed that there was a statistically significant difference with regard to nuclear grades II and III and presence of comedonecrosis (P < 0.001). In IDC, there was significant expression with nuclear grades II and III and histological grade II (P < 0.001). CONCLUSIONS: Our findings provide evidence that HER-2 and COX-2 regulate each other CONTEXTO E OBJETIVO: Ciclo-oxigenase (COX-2) e receptor tipo 2 do fator de crescimento epidérmico humano (HER-2) estão associados com tumorigênese. Estudos mostraram que HER-2 pode regular a expressão de COX-2. O objetivo deste estudo foi avaliar a correlação entre expressão da COX-2 e HER-2 no epitélio normal de mama, no carcinoma ductal in situ (DCIS) e carcinoma ductal invasivo (IDC) presentes na mesma mama. TIPO DE ESTUDO E LOCAL: Estudo transversal na clínica de Mastologia do Departamento de Obstetrícia e Ginecologia do Hospital da Santa Casa de Misericórdia de São Paulo. MÉTODOS: A detecção da COX-2 e HER-2 foi realizada por imunoistoquímica em 100 fragmentos teciduais. HER-2 > +2 foi submetido a hibridização fluorescente in situ (FISH). RESULTADOS: Expressão de COX-2 foi detectada em 87%, 85% e 75% dos IDC, DCIS e epitélio normal, respectivamente. Expressão de HER-2 foi detectada em 34% dos IDC e 34% de DCIS. COX-2 em DCIS correlacionou-se com HER-2 em IDC (P = 0,049) e DCIS (P = 0,049). COX-2 no epitélio normal correlacionou-se com HER-2 em IDC (P = 0,046) e DCIS (P = 0,046). COX-2 no IDC não foi associada com HER-2 (P = 0,235). Quando comparado COX-2 com HER-2 em DCIS houve diferença estatisticamente significante com relação ao grau nuclear II e III e presença de comedonecrose (P < 0,001) e no IDC, houve expressão significativa no grau nuclear II e III e histológico II (P < 0,001). CONCLUSÕES: Nossos achados mostram evidências que HER-2 e COX-2 se autorregulam.

OBJECTIVE: This study intends to verify the expression levels and correlation of aromatase, matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9) and CD44 in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC) when both are found in the same breast. METHODS: One hundred and ten cases were evaluated by tissue microarray (TMA) and immunohistochemically screened with anti-aromatase polyclonal antibodies, anti-MMP-2 monoclonal antibodies, anti-MMP-9 policlonal antibodies and anti-CD44 monoclonal antibodies. RESULTS: Aromatase was expressed in IDC and DCIS in 63 (57.3%) and 60 (67%) of the cases respectively; MMP-2 was similarly expressed in IDC and DCIS in 15 (13.60%) cases; MMP-9 was positively expressed in IDC and DCIS in 83 (75.50%) and 82 (74.50%) cases, respectively; CD44 was positively expressed in IDC and DCIS in 49 (44.50%) and 48 (42.60%) of the cases, respectively; all of them were highly correlated (pOBJETIVO: O objetivo desse estudo é verificar as expressões e correlações da aromatase, metalloproteinase 2 da matriz (MMP2), metalloproteinase 9 da matriz (MMP-9) e CD44 no carcinoma ductal in situ (CDIS) e carcinoma ductal infiltrativo (CDI) quando ambos estão presentes simultaneamente na mesma mama. MÉTODOS: Foram avaliados 110 casos pelo método de tissue microarray (TMA) e através da utilização de anticorpos policlonais antiaromatase, anticorpos monoclonais anti-MMP-2, anticorpos policlonais anti-MMP-9 e anticorpos monoclonais anti-CD44. RESULTADOS: A aromatase estava expressa de forma positiva no CDI e CDIS em 63 (57,3%) e 60 (67%) casos, respectivamente. A expressão de MMP-2 estava expressa de forma positiva em 15 (13,6%) casos tanto no CDI, quanto no CDIS. A expressão da MMP-9 estava expressa de forma positiva em 83 (75,5%) e 82 (74,5%) casos de CDI e CDIS, respectivamente. A expressão de CD44 estava expressa de forma positiva em 49 (44,5%) e 48 (42,6%) casos de CDI e CDIS, respectivamente. Todos eles apresentando alta correlação (p

The current study compares the rates of overexpression of the HER2 protein in stage II ductal carcinoma of breast in patients with lymph-node involvement. The research material was tissue sections obtained from the primary tumor of 28 patients with lymph-node involvement. The technique used to detect the protein was immunohistochemistry. The overexpression of HER2 protein occurred in 33.3% of lymph node-positive patients. Subsequently, the lymph-node metastases population was divided into two subgroups: one subgroup having involvement of up to three lymph nodes and the second subgroup with the involvement of four or more lymph-nodes. In the first group the level of HER2 overexpression was 7.7% and in the second subgroup the HER2 overexpression was 63.6%. The difference was statistically significant.

OBJETIVO: Avaliar expressão da enzima aromatase nos carcinomas de mama ductais invasivos (CDI), in situ (CDIS), no epitélio e estromas adjacentes. MÉTODOS: Foram avaliados 45 espécimes cirúrgicos provenientes de mastectomias e quadrantectomias com CDI e CDIS concomitantes de pacientes com estadios clínicos I e II. A análise da expressão da enzima aromatase foi realizada por meio de anticorpos policlonais antiaromatase e categorização das amostras de acordo com intensidade e número de células coradas. RESULTADOS: Nos 45 casos de CDI a expressão da aromatase foi positiva em 32 espécimes (71%) e negativa em 13 (29%). Nos casos de CDIS, a positividade foi idêntica à observada no CDI, mostrando correlação positiva. No epitélio normal constatou-se expressão positiva em 19 casos (42,2%) e negativa nos outros 26 (57,8%), mostrando correlação positiva estatisticamente (pOBJECTIVE: to evaluate the expression of aromatase in simultaneously invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). METHODS: forty-five surgical samples were obtained from mastectomy and quadrantectomy with simultaneous IDC and DCIS of stage I and II patients. Aromatase was evaluated using antibodies anti-aromatase and the samples classified in accordance with the number and intensity of stained cells. RESULTS: Aromatase was expressed positively in 32(71%) and negatively in 13(29%) of the cases in the IDC. The same results were obtained in the DCIS showing a perfect positive correlation. In the normal epithelium,aromatase was positive in 19(42.2%) and negative in 26 (57.8%) and a positive correlation, statistically significant was obtained when compared with IDC and DCIS(p

OBJETIVO: Avaliar expressão da enzima aromatase nos carcinomas de mama ductais invasivos (CDI), in situ (CDIS), no epitélio e estromas adjacentes. MÉTODOS: Foram avaliados 45 espécimes cirúrgicos provenientes de mastectomias e quadrantectomias com CDI e CDIS concomitantes de pacientes com estadios clínicos I e II. A análise da expressão da enzima aromatase foi realizada por meio de anticorpos policlonais antiaromatase e categorização das amostras de acordo com intensidade e número de células coradas. RESULTADOS: Nos 45 casos de CDI a expressão da aromatase foi positiva em 32 espécimes (71%) e negativa em 13 (29%). Nos casos de CDIS, a positividade foi idêntica à observada no CDI, mostrando correlação positiva. No epitélio normal constatou-se expressão positiva em 19 casos (42,2%) e negativa nos outros 26 (57,8%), mostrando correlação positiva estatisticamente (p

OBJETIVO: Propor uma sistematização do estudo elastográfico para emprego na rotina ultrassonográfica. MÉTODOS: Avaliação de 308 pacientes encaminhadas ao serviço de intervenção mamária do CTC-Gênese no período de 1 de maio de 2007 a 1 de março de 2008 para a realização de biópsia mamária percutânea. Antes da realização da biópsia percutânea foi realizado o estudo ultrassonográfico e a elastografia. As lesões foram primeiramente analisadas e classificadas conforme o léxico Bi-Rads pelo ultrassom convencional (modo B). Posteriormente, a elastografia foi realizada e analisada conforme sistematização proposta pelos autores, por meio das imagens obtidas durante a compressão e após a descompressão da área de interesse. As lesões foram classificadas conforme escores criados pelos autores: os escores 1 e 2 foram considerados benignos, o escore 3 como provavelmente benigno e o 4 como suspeito para malignidade. Foram comparados os resultados obtidos entre os dois métodos com os resultados histológicos utilizando as áreas dentro das curvas ROC (curvas operadores dependentes). RESULTADOS: A área dentro da curva para a elastografia foi de 0.952 com intervalo de confidência entre 0.910 e 0.966, erro de 0.023, e de 0.867 com intervalo de confidência entre 0.823 e 0.903, erro de 0.0333, para o ultrassom. Quando comparadas as áreas observou-se diferença entre as curvas de 0.026, estatisticamente significativa. CONCLUSÃO: Este trabalho apresenta uma sistematização do estudo elastográfico utilizando as informações obtidas durante a compressão e após a descompressão da amostra ultrassonográfica, demonstrando que a elastografia pode incrementar a avaliação do risco de malignidade para lesões caracterizadas pelo ultrassom.OBJECTIVE: Proposal of systematization for the elastographic study in the ultrasound routine. METHODS: Evaluation was made of 308 patients forwarded to the breast intervention service in the CTC-Genesis from May 1, 2007 to March 1, 2008 to perform percutaneous breast biopsy. Prior to the percutaneous biopsy, an ultrasound study and an elastography were performed. Lesions were primarily analyzed and classified according to the Bi-Rads® lexicon criteria by the conventional ultrasound scan (B mode). The elastography was then performed and analyzed in accordance with the systematization proposed by the authors, using images obtained during compression and after decompression of the area of interest. Lesions were classified following the system developed by the authors using a four-point scale, where scores (1) and (2) were considered benign, score (3) probably benign and score (4) suspicion of malignancy. Results obtained by the two methods were compared with the histological results using the areas within the ROC (receiver operator curves) curves. RESULTS: The area within the curve for elastography was of 0.952 with a confidence interval between 0.910 and 0.966, error of 0.023, and of 0.867 with a confidence interval between 0.823 and 0.903, error of 0.0333 for the ultrasound. When the areas were compared, a difference between the curves of 0.026 was observed, which was statistically significant. CONCLUSION: This work shows the systematization of the elastographic study using information obtained during compression and after decompression of the ultrasound scan sample, thus showing that elastography might enhance the assessment of risk of malignancy for lesions characterized by the ultrasound.

OBJETIVO: Avaliar os valores preditivos positivo e negativo das categorias 3, 4 e 5 do sistema BI-RADS™ em lesões mamárias nodulares não-palpáveis avaliadas por mamografia, ultra-sonografia e ressonância magnética. MATERIAIS E MÉTODOS: Vinte e nove pacientes com achados mamográficos de lesões mamárias nodulares não-palpáveis, das classes 3, 4 e 5 do BI-RADS, que realizaram exames complementares de ultra-sonografia e ressonância magnética, além de biópsia excisional. Realizaram-se 30 biópsias e correlacionaram-se as lesões e suas respectivas classificações de 3 a 5 do BI-RADS com os resultados histopatológicos. O cálculo dos valores preditivos foi feito utilizando-se equações matemáticas específicas. RESULTADOS: O valor preditivo negativo da categoria 3 pela análise mamográfica foi de 69,23%, pela análise ultra-sonográfica foi de 70,58% e pela análise por ressonância magnética foi de 100%. O valor preditivo positivo da categoria 4 pela análise mamográfica foi de 63,63%, pela análise ultra-sonográfica foi de 50% e pela análise por ressonância magnética foi de 30,76%. O valor preditivo positivo da categoria 5 foi de 100% pelas análises mamográfica e ultra-sonográfica e de 92,85% pela análise por ressonância magnética. CONCLUSÃO: O valor preditivo negativo da categoria 3 foi elevado na análise pela ressonância magnética e os valores preditivos positivos foram moderados na categoria 4 e elevados na categoria 5 pelos três métodos.

OBJETIVO: Avaliar os valores preditivos positivo e negativo das categorias 3, 4 e 5 do sistema BI-RADS™ em lesões mamárias nodulares não-palpáveis avaliadas por mamografia, ultra-sonografia e ressonância magnética. MATERIAIS E MÉTODOS: Vinte e nove pacientes com achados mamográficos de lesões mamárias nodulares não-palpáveis, das classes 3, 4 e 5 do BI-RADS, que realizaram exames complementares de ultra-sonografia e ressonância magnética, além de biópsia excisional. Realizaram-se 30 biópsias e correlacionaram-se as lesões e suas respectivas classificações de 3 a 5 do BI-RADS com os resultados histopatológicos. O cálculo dos valores preditivos foi feito utilizando-se equações matemáticas específicas. RESULTADOS: O valor preditivo negativo da categoria 3 pela análise mamográfica foi de 69,23%, pela análise ultra-sonográfica foi de 70,58% e pela análise por ressonância magnética foi de 100%. O valor preditivo positivo da categoria 4 pela análise mamográfica foi de 63,63%, pela análise ultra-sonográfica foi de 50% e pela análise por ressonância magnética foi de 30,76%. O valor preditivo positivo da categoria 5 foi de 100% pelas análises mamográfica e ultra-sonográfica e de 92,85% pela análise por ressonância magnética. CONCLUSÃO: O valor preditivo negativo da categoria 3 foi elevado na análise pela ressonância magnética e os valores preditivos positivos foram moderados na categoria 4 e elevados na categoria 5 pelos três métodos.OBJECTIVE: To evaluate the predictive value of BI-RADS™ categories 3, 4 and 5 in non-palpable breast masses assessed by mammography, ultrasound and magnetic resonance imaging MATERIALS AND METHODS: Twenty-nine patients with BI-RADS categories 3, 4 and 5 nonpalpable breast masses identified by mammograms were submitted to complementary ultrasound and magnetic resonance imaging studies, besides excisional biopsy. In total, 30 biopsies were performed. The lesions as well as their respective BI-RADS classification into 3, 4 and 5 were correlated with the histopathological results. The predictive values calculation was made by means of specific mathematical equations. RESULTS: Negative predictive values for category 3 were: mammography, 69.23%; ultrasound, 70.58%; and magnetic resonance imaging, 100%. Positive predictive values for category 4 were: mammography, 63.63%; ultrasound, 50%; and magnetic resonance imaging, 30.76%. For category 5, positive predictive values were: mammography and ultrasound, 100%; and magnetic resonance imaging, 92.85%. CONCLUSION: For category 3, the negative predictive value of magnetic resonance imaging was high, and for categories 4 and 5, the positive predictive values of the three modalities were moderate.

Specific reports have linked GPC3 with cancer. Its usefulness as a marker has been proved for hepatocarcinoma, melanoma and ovary carcinoma. However, there are no studies analyzing GPC3 usefulness as a biomarker in mammary tumors. The aim of this work was to analyze GPC3 expression in breast tissues and to determine whether it might be useful as a biomarker in breast cancer patients. Expression level of GPC3 mRNA in Brazilian and Argentine human breast tumor (n=121) and peritumoral "normal" tissue (n=77) samples was analyzed using qRT-PCR. GPC3 protein expression was analyzed from 69 breast cancer and 10 peritumoral samples using IHC. Statistical analyses were done to evaluate the clinical-pathological significance of GPC3 expression. We found that Brazilian and Argentine populations are statistically different regarding GPC3 mRNA expression. In Argentine patients a lower GPC3 mRNA expression was found in tumors as compared to peritumoral tissues. No association was found between GPC3 mRNA and protein expression and the clinical-pathological parameters. The Kaplan-Meier curves suggested that elevated levels of GPC3 mRNA are associated with relapse. Our results indicate differential expression of GPC3 in mammary tumors in comparasion to normal breast tissues. They also suggest the potential role of GPC3 as a biomarker and the importance of deepening the study.

Quimioprevenção é definida como o uso de agentes químicos naturais ou sintéticos para reverter, suprimir ou prevenir a progressão carcinogênica para carcinoma invasor. Os fármacos que agem como agentes quimiopreventivos contra o câncer de mama são divididos em dois grupos principais: os que previnem cânceres de mama receptor de estrogênio (RE) positivos, como os moduladores seletivos do receptor de estrogênio (SERM), inibidores de aromatase, agonistas de GnRH e fitoestrogênios; e os fármacos que previnem os cânceres RE-negativos, como os inibidores da ciclooxigenase-2 (COX-2), retinóides, as estatinas, os inibidores do receptor tirosina quinase, o anticorpo monoclonal contra HER-2 e os inbidores da telomerase. Resultados do estudo conduzido pelo NSABP que comparou o tamoxifeno com o raloxifeno (STAR), avaliando a eficácia na redução de risco, assim como a toxicidade desses dois SERMs em uma população similar e de alto risco para câncer de mama, demonstrou que o raloxifeno é tão efetivo quanto o tamoxifeno na redução de risco de câncer de mama invasor (p=0,83) e apresentou menor risco de eventos tromboembólicos e catarata; todavia, exibiu maior risco de carcinoma não invasor, porém sem significância estatística. Baseado nos dados promissores que revelaram diminuição de risco de câncer de mama contralateral em estudos de adjuvância, alguns inibidores de aromatase, incluindo o letrozol, anastrazol e exemestane, estão sendo incorporados em investigações para avaliar sua eficácia como agentes preventivos de alto risco em mulheres. Os inibidores de COX-2 demonstraram sua eficácia na prevenção do câncer de mama em estudos caso-controle e coorte, sendo necessários estudos aleatórios para atestar sua eficácia. O resultado positivo de alguns ensaios clínicos na prevenção do câncer de mama em populações de alto risco sugere que a quimioprevenção é uma estratégia racional e atraente.Chemoprevention is defined as the use of natural or synthetic chemical agents to reverse, suppress or prevent carcinogenic progression of invasive cancer. Drugs that act as chemoprevention agents for breast cancer are divided into two major groups: drugs that prevent Estrogen Receptor (ER) - positive breast cancers [selective estrogen receptor modulators (SERM), aromatase inhibitors GnKH agonists and phytoestrogens] and drugs that prevent ER - negative breast cancers [cyclooxygenase-2 (COX-2) inhibitors, retinoids, statins, receptor tyrosine, kinase inhibitors, monoclonal antibody against HER-2 and telomerase inhibitors]. Results from the NSABP Study of Tamoxifen and Raloxifene (STAR), which compared the risk-reducing efficacy as well as toxicity of these two SERMs in a similar high-risk for breast cancer population, showed that Raloxifene is as effective as Tamoxifen in reducing the risk of non-invasive breast cancer (p=.83). It has a statistically significant lower risk of thromboembolic events and cataracts, however a non- statistically significant higher risk of noninvasive breast cancer. Based on promising data involving reduction of contralateral breast cancer risk in adjuvant studies, several aromatase inhibitors, including letrozole, anastrozole and exemestane, are being included in trials to evaluate their efficacy in breast cancer prevention in both case-control and cohort studies As such randomized studies to confirm this efficacy are needed. Positive results of several recent clinical trials for preventing breast cancer in high-risk populations suggest that chemoprevention is a rational and attractive strategy.

The Enfermarias Zn-Pb(Ag, Sb, Au) prospect, located in the Moura-Ficalho region (Alentejo, Portugal), was intensively explored during 1980s. A drilling programme was successful, intersecting massive and disseminated sulphide mineralizations. The geological and geophysical data set available for Enfermarias is quite vast and comprises 13 borehole geological logs, as well as gravity, magnetic and resistivity data. In this paper, the dipole-dipole resistivity surveys are re-examined and interpreted using both 2D and 3D inversion to provide an interesting comparison of the two different approaches. Results from gravity data modelling and data from borehole logs are used as independent validity tests on the quality of the results. The 2D and 3D models indicate a conductive overburden covering more resistive bedrock, which appears at a depth of 70–100 m in the western part of the profiles. Results obtained from 3D inversion, however, show a very clear separation of the most resistive domains in the two different bodies, whereas this separation does not appear in the 2D models. The 3D model also shows a higher degree of spatial continuity than the partial 2D models, which are, in general, richer in shortwavelength anomalies, and show a higher variation from profile to profile. Comparison of the resistivity results with gravity in two coincident profiles reveals an excellent agreement between the main shallow features of both 2D and 3D models. This suggests that the resistivity model does indeed satisfy the main features of the available geological and geophysical data.