Afonso Celso Pinto Nazário

Linfonodos axilares em pacientes com câncer de mama: avaliação ultrassonográfica

Axillary staging of patients with early-stage breast cancer is essential in the treatment planning. Currently such staging is intraoperatively performed, but there is a tendency to seek a preoperative and less invasive technique to detect lymph node metastasis. Ultrasonography is widely utilized for this purpose, many times in association with fine-needle aspiration biopsy or core needle biopsy. However, the sonographic criteria for determining malignancy in axillary lymph nodes do not present significant predictive values, producing discrepant results in studies evaluating the sensitivity and specificity of this method. The present study was aimed at reviewing the literature approaching the utilization of ultrasonography in the axillary staging as well as the main morphological features of metastatic lymph nodes.Axillary staging of patients with early-stage breast cancer is essential in the treatment planning. Currently such staging is intraoperatively performed, but there is a tendency to seek a preoperative and less invasive technique to detect lymph node metastasis. Ultrasonography is widely utilized for this purpose, many times in association with fine-needle aspiration biopsy or core needle biopsy. However, the sonographic criteria for determining malignancy in axillary lymph nodes do not present significant predictive values, producing discrepant results in studies evaluating the sensitivity and specificity of this method. The present study was aimed at reviewing the literature approaching the utilization of ultrasonography in the axillary staging as well as the main morphological features of metastatic lymph nodes.

Effect of Combined Oral Contraceptives on Breast Epithelial Proliferation in Young Women

Abstract:  The mammary gland undergoes morphologic changes during the menstrual cycle. Proliferation of normal breast epithelium is most extensive during the natural luteal phase. To determine the impact of one cycle of a combined oral contraceptive (COC) on breast homeostasis, we evaluated the proliferation index (PI), determined by KI‐67 expression, in normal human mammary epithelial cells and correlated it with cellular proliferation in spontaneous menstrual cycles during the same period. Normal breast tissue samples were obtained from 82 patients randomized in two groups. Forty‐two women in group A received one cycle of a COC (30 μg ethinyl estradiol and 150 μg levonorgestrel) administrated daily for 21 days, beginning on the first day of the menstrual cycle. Group B patients (n = 40) experienced a natural menstrual cycle. Menstrual cycle phase characterization was based on the date of the last period and subsequent menses and on progesterone serum levels obtained at the time of biopsy. The PI (number of Ki‐67‐positive nuclei per 1,000 epithelial cells), was significantly larger in group A (5.47 ± 3.87), than in group B (3.27 ± 3.24), p < 0.01. A cyclical variation of PI was observed in COC cycles. The rise in PI in the first week of the COC cycles was significantly higher than in the natural cycle (COC = 7.02 ± 4.94; non‐COC = 1.10 ± 0.67; p < 0.0011). There was no significant difference between the two groups during the other weeks. Additionally, there was an inverse correlation between proliferation and chronological age, irrespective of the stage of the cycle. The PI of COC (p = 0.175) and natural cycles (p = 0.466) were not statistically different in younger patients. COC users have increased proliferative activity at the beginning of the menstrual cycle. This alteration in the pattern of proliferative activity may relate to the increased risk of breast cancer that has been associated with COCs.

Association between estrogen receptor gene polymorphisms and breast density in postmenopausal women

Objectives The aim of this study was to evaluate the association between clinical characteristics and polymorphisms HaeIII, MspI and XbaI of the estrogen receptor gene α with postmenopausal mammographic density. Methods A prospective study was performed with 120 women who were not users of hormones and had no identified breast lesions. All of them underwent bilateral mammography; the radiological density was determined by three independent observers, with two subjective evaluations based on the ACR-BIRADS® classification of mammographic patterns, 2003, and one computerized evaluation using the gray-scale histogram tool of the Adobe Photoshop® 7.0 software. Peripheral blood samples were obtained for DNA extraction, performed according to the GFX® Kit protocol (Amersham-Pharmacia). Polymerase chain reaction restriction fragment length polymorphism was carried out for an analysis of the polymorphisms present in intron 1 (HaeIII and XbaI) and in exon 1 (MspI) of the estrogen receptor gene. Results There was a high degree of concordance among the observers in the determination of mammary density (Kappa, Pearson and Spearman, p < 0.001). The associations of clinical characteristics with mammary density were: age (p = 0.04), body mass index (p < 0.0001) and age at menarche (p = 0.02). The relationship between the allele distribution of the polymorphisms and density was: XbaI (p = 0.02), HaeIII (p = 0.65) and MspI (p = 0.65). Conclusions Our data suggested that the polymorphism XbaI may be strongly related to mammographic density.

Estimativa de custo do rastreamento mamográfico em mulheres no climatério

PURPOSE: to evaluate the cost of preventive mammographic screening in climacteric women, as compared to the cost of breast cancer treatment in more advanced stages. METHODS: one thousand and fourteen patients attended at the Climacteric outpatient service of the Gynecology Department, Federal University of Sao Paulo Paulista School of Medicine, were included in the study and submitted to mammographic test. All mammographic tests were analyzed by the same two physicians and classified according to the BI-RADS (Breast Imaging Reporting and Data System American College of Radiology) categories. The detected lesions were submitted to cytological and histological examination. RESULTS: the final diagnostic impression of the 1014 examinations, according to the classification of BI-RADS categories was: 1=261, 2=671, 3=59, 4=22 and 5=1. The invasive procedures were performed through a needle guided by ultrasound or stereotactic examinations: 33 fine-needle aspiration biopsies, 6 core biopsies guided by ultrasound and 20 core biopsies guided by stereotactic examination. Five cancer diagnoses were established. The total cost of this screening based on Brazilian procedure values was R

Leiomyoma of the breast: a case report

76,593.79 (25,534 dollars). Therefore, the cost of the diagnosis of the five cases of cancer in this screening was R

Nódulos benignos da mama: uma revisão dos diagnósticos diferenciais e conduta

15,318.75 (5,106 dollars) each. However, the average cost per patient screened was R

Morphometric Analysis of the Epithelium of Mammary Fibroadenomas During the Proliferative and Secretory Phases of the Menstrual Cycle

75.53 (25 dollars). CONCLUSIONS: considering that the total treatment cost of only one case of breast cancer in advanced stage including hospital costs, surgery, chemotherapy, radiotherapy and hormonal treatment is similar to the cost of 1,000 mammographic screenings in climacteric women, it may be concluded that the cost of the early cancer diagnosis program is worth it and should be included in the public health program, as a way of lowering the public health expense.

Genetic Association Study of Angiotensin II Receptor Types 1 (A168G) and 2 (T1247G and A5235G) Polymorphisms in Breast Carcinoma among Brazilian Women

A rare case of leiomyoma of the breast is reported, with a discussion of the clinical aspects and of the differential diagnosis. Excluding tumors originating from the areolar-papillary complex and the skin, this neoplasm is extremely rare, with only 11 cases reported so far. The histogenesis of the lesion is still controversial.

Application of a domicile-based exercise program for shoulder rehabilitation after breast cancer surgery

The benign mammary tumors are responsible for up to 80% of the clinical masses. Its differential diagnosis is wide, involving mammary cysts, fibroadenomas, phyllodes tumors, papillomas, hamartomas, and adenomas, among others. The fibroadenoma is the most common mammary neoplasia in patients under 35 years old, while the cysts are more frequent in the perimenopause. The differential diagnosis among solid or cystic nodules can be made through the fine-needle aspiration or by ultrasound, being therapeutic for the last ones. In this article, the differential diagnostic aspects will be revised between these tumors, as well as the new therapeutic approaches.

Malignant phyllodes tumor in the right breast and invasive lobular carcinoma within fibroadenoma in the other: case report

▪ Abstract: Fibroadenoma of the breast is a benign neoplasia with a mixture of glandular and mesenchymal elements of high incidence and is mainly present in young women. This aspect and the presence of estrogen and progesterone receptors reinforce its hormone dependency. Recent studies have demonstrated that the proliferative activity of the mammary epithelium is significantly increased during the luteal phase. In order to assess whether fibroadenomas behave like the normal breast under the cyclic action of hormones we counted the number of mitoses and calculated the nuclear volume of epithelial cells in both the proliferative and luteal phases. We selected 20 women with clinically diagnosed fibroadenomas, 10 in the proliferative phase and 10 in the secretory phase. Our results showed no significant differences in mitotic index or nuclear volume between the proliferative and the luteal phases of fibroadenomas. We therefore conclude that the epithelium of fibroadenomas behaves like a true neoplasia whose regulation may occur via paracrine mechanisms, which in turn would explain its self‐limited growth. ▪