Antonio García-Fernández

Comparative Long-term Study of a Large Series of Patients with Invasive Ductal Carcinoma and Invasive Lobular Carcinoma. Loco-Regional Recurrence, Metastasis, and Survival

Our aim was to compare histologic and immunohistochemical features, surgical treatment and clinical course, including disease recurrence, distant metastases, and mortality between patients with invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC). We included 1,745 patients operated for 1,789 breast tumors, with 1,639 IDC (1,600 patients) and 145 patients with ILC and 150 breast tumors. The median follow‐up was 76 months. ILC was significantly more likely to be associated with a favorable phenotype. Prevalence of contralateral breast cancer was slightly higher for ILC patients than for IDC patients (4.0% versus 3.2%; p = n.s). ILC was more likely multifocal, estrogen receptor positive, Human Epidermal Growth Factor Receptor‐2 (HER2) negative, and with lower proliferative index compared to IDC. Considering conservative surgery, ILC patients required more frequently re‐excision and/or mastectomy. Prevalence of stage IIB and III stages were significantly more frequent in ILC patients than in IDC patients (37.4% versus 25.3%, p = 0.006). Positive nodes were significantly more frequent in the ILC patients (44.6% versus 37.0%, p = 0.04). After adjustment for tumor size and nodal status, frequencies of recurrence/metastasis, disease‐free and specific survival were similar among patients with IDC and patients with ILC. In conclusion, women with ILC do not have worse clinical outcomes than their counterparts with IDC. Management decisions should be based on individual patient and tumor biologic characteristics rather than on lobular versus ductal histology.

Role of axillary ultrasound, magnetic resonance imaging, and ultrasound-guided fine-needle aspiration biopsy in the preoperative triage of breast cancer patients.

PurposeRoughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement.Methods/patientsBetween January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required.Results1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%.ConclusionWe may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.

Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease.

OBJECTIVE The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. PATIENTS AND METHODS There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. RESULTS Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p=0.020) and lobular carcinomas (p=0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional foci diagnosed by MRI as a dependent variable. CONCLUSION Preoperative MRI seems to have a role in preoperative tumour staging for breast cancer patients, as it discloses additional disease foci in some patients, including contralateral involvement. However, given the lack of absolute accuracy, core-needle biopsy cannot be neglected in the diagnosis of such additional malignant foci, which could result in a change in surgical treatment.

Advanced breast cancer following alternative medicine

Universitari Mutua Terrassa, Placa Dr. Robert 5, Terrassa 08221, Barcelona, Spain. Tel.: +34 937 365 085; fax: +34 937 365 086. E-mail address: ibarco@mutuaterrassa.es (I. Barco). http://dx.doi.org/10.1016/j.ijgo.2015.10.014 0020-7292/© 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. conventional condom balloon tamponade; it provides a drainage port and replaces sterile thread with rings made out of the catheter material itself (Supplementarymaterial S2). The cost of the CGBalloon is nominal (approximately

Factors predictive of mortality in a cohort of women surgically treated for breast cancer from 1997 to 2014.

2) and, consequently, it has the potential to be a milestone in the management of PPH in low-resource settings. Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.ijgo.2015.10.014.

Tamoxifen induced radiation recall dermatitis in a breast cancer patient

To determine whether previously reported factors predictive of breast cancer mortality are effectively linked with mortality, particularly breast‐cancer‐specific mortality.

Atypical uterine cervix metastases from invasive lobular carcinoma of the breast

Breast Unit, Department of Gynecology, University Hospital of M utua Terrassa, University of Barcelona, Barcelona, Spain Department of Nuclear Medicine, CTD, University Hospital of M utua Terrassa, University of Barcelona, Barcelona, Spain Department of Nursing, Breastfeeding Promotion Programme, ASSIR Mollet, InstitutCatal a de la Salut, Barcelona, Spain Department of Radiation Oncology, Hospital General de Catalunya, Barcelona, Spain Department of Oncology, University Hospital of M utua Terrassa, University of Barcelona, Barcelona, Spain Research Unit, Research Foundation M utua Terrassa, University of Barcelona, Barcelona, Spain Laboratory of Toxicology, Universitat Aut onoma de Barcelona, Barcelona, Spain Department of Gynecology, University Hospital of M utua Terrassa, University of Barcelona, Barcelona, Spain

MOHS micrographic surgery for treating erosive adenoma of the nipple: a case report and review of the literature

Invasive lobular carcinoma (ILC) of the breast is the second most common histologic subtype of breast cancer, representing 10% of breast cancer occurrences. It differs from invasive ductal carcinoma in its epidemiology, clinical and radiological presentation, associated molecular changes, and the natural course of disease. Often, ILC presents at an advanced stage of onset in postmenopausal women [1]. This article is protected by copyright. All rights reserved.

A logistic regression model predicting high axillary tumour burden in early breast cancer patients

Erosive adenoma of the nipple (EAN) is a benign condition that involves major ducts of the nipple. Its clinical presentation may resemble other disorders. Complete removal of the nipple is often suggested because of frequent relapse. However, adverse cosmetic and functional results have prompted clinicians to look for other more conservative options.

Lactating Adenoma of the Breast

PurposeAs elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy.Methods/patientsBased on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis.ResultsOnly those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted.ConclusionsOur LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.