Antonio Esgueva

Electrothermal bipolar vessel sealing system in axillary dissection: A prospective randomized clinical study

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.

Extensive nodal involvement increases the positivity of blue nodes in the axillary reverse mapping procedure in patients with breast cancer.

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).

Detection of sentinel lymph node in breast cancer recurrence may change adjuvant treatment decision in patients with breast cancer recurrence and previous axillary surgery.

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.

Modeling anti-IL-6 therapy using breast cancer patient-derived xenografts

The pleiotropic cytokine IL-6 accelerates the progression of breast cancer in a variety of preclinical models through the activation of the STAT3 (signal transducer and activator of transcription 3) signaling pathway. However, the proportion of breast cancers sensitive to anti-IL-6 therapies is not known. This study evaluates the efficacy of anti-IL-6 therapies using breast cancer patient derived xenografts (PDXs). During the generation of our collection of PDXs, we showed that the successful engraftment of tumor tissue in immunodeficient mice correlates with bad prognosis. Four PDXs out of six were resistant to anti-IL-6 therapies and the expression of IL-6, its receptor or the levels of phospho-STAT3 (the active form of the signal transducer) did not correlate with sensitivity. Using cell cultures established from the PDXs as well as samples from in vivo treatments, we showed that only tumors in which the activation of STAT3 depends on IL-6 respond to the blocking antibodies. Our results indicate that only a fraction of breast tumors are responsive to anti-IL-6 therapies. In order to identify responsive tumors, a functional assay to determine the dependence of STAT3 activation on IL-6 should be performed.

Increased detection of sentinel nodes in breast cancer patients with the use of superparamagnetic iron oxide tracer.

100 Background: The use of superparamagnetic iron oxide (SPIO) tracer for sentinel node biopsy (SLN) has shown non inferiority compared with the radioisotope technique in early breast cancer. False negative rates of SLN biopsy after neoadjuvant treatment (NAC) have decreased with dual tracer (radioisotope/dye) and with the excision of > 2 SLNs. This study was designed to evaluate the outcome of SLN after NAC using a dual tracer (SPIO-Tc99) and to compare it with the SLN by same dual tracer in the adjuvant setting. METHODS Between July 2013 and March 2014, 30 patients with invasive breast cancer (IBC) and SLN biopsy after NAC (NAC- SLN), and 118 patients with IBC not treated with NAC (adjuvant SLN), whose SLN was traced by Tc99 and SPIO were included in the study. Patients were injected subareolar with Tc99 the day before surgery and with the SPIO intraoperatively. SLN was excised if it was radioactive, magnetic or palpable. Patients signed an inform consent. RESULTS Detection rate by Tc 99 was successful in 113 (95.7%) patients and by SPIO in 116 (98.3%) in the adjuvant SLN (P= 0.0833) while in the NAC-SLN group detection rate by Tc-99 was successful in 28 patients (93.3%) and by SPIO in 30 patients (100%) (P =0.1573). Concordance rates per patient in the adjuvant SLN between techniques was 98.2%, while in the NAC-SLN was 100%. (p = 0.4762) Mean number of SLNs excised by 99Tc and SPIO were 1.9 and 2.21 respectively in the adjuvant SLN, (p=0.001) while 1.533 and 2.60 respectively in the NAC-SLN group. (p=0.0016) In the adjuvant SLN, the SLN was positive in 36 patients (30%), and in the NAC-SLN in 9 patients (30%). In the adjuvant SLN, both techniques detected same number of positive nodes but in the NAC-SLN, 9 patients had a positive SLN by SPIO (> 2 SLNs by SPIO and 1 SLN by Tc99) and 7 patients had a positive SLN by Tc99. CONCLUSIONS Detection of SLNs with SPIO allows for easy identification of axillary nodes and can be used to reliably identify SLNs in breast cancer. Even though the small sample size in the NAC-SLN, the higher number of SLNs excised by the SPIO may optimize the success of SLN after NAC.

Percutaneous ultrasound guided vacuum-assisted excision of benign breast lesions: A learning curve to assess outcomes

OBJECTIVE: To evaluate the efficacy and learning curve of ultrasoundguided vacuum-assisted excision (US-VAE) of benign breast lesions, and to assess characteristics associated with residual lesion. METHODS: This was a retrospective study with institutional review board-approval. Sonographic and clinical follow-up were performed 6 months after intervention. Effectiveness and safety of the technique were analyzed. The cumulative summation (CUSUM) graphs were used to evaluate learning curves concerning complete excision and hematoma. RESULTS: 152 ultrasound-VAEs in 143 patients were included. Initial complete resection was achieved in 90.8 % (138 of 152). 6-month follow-up was completed for 143 (94%) of cases and complete resection was observed in 72 % (100 of 143). Mean maximum size without residual tumor was 16.9 mm, while with residual lesion it was 21.9 mm (p = < 0.001), with a volume of 1.53 and 3.39 cm3, respectively (p = < 0.001). Increase in lesion size and volume was associated with less effectiveness (p = 0.05), clinical control (p = 0.05), and higher risk of clinically significant hematoma (p = 0.05). Receiver operating characteristic analysis demonstrate a volume threshold of 2.6 cm3 (r = 0.71, specificity 84.5%) for leaving no residual lesion. Cumulative summation graphs demonstrate that, on average, 11 excisions were required to acquire skills to perform complete excision in more than 80% at the end of the ultrasound-VAE and 18 excisions at 6 months. CONCLUSION: Ultrasound-VAE is an effective treatment for benign breast lesions. Breast lesion volume should be considered when assessing for percutaneous treatment. ADVANCES IN KNOWLEDGE: A follow-up of the learning process of ultrasound-VAE will be a valuable tool to assess the efectiveness and safety of the technique i.