Fernando Schuh

Sexual function and chemotherapy in postmenopausal women with breast cancer

BackgroundThis cross-sectional, nested cohort study assessed Female Sexual Function Index (FSFI) scores in postmenopausal women with breast cancer receiving primary chemotherapy.MethodsThe FSFI questionnaire was administered to 24 postmenopausal women one month after diagnosis of breast cancer (post-diagnosis group) and one month after completion of the first cycle of primary anthracyclin-based chemotherapy (post-chemotherapy group). Scores were compared to those of 24 healthy postmenopausal women seeking routine gynecological care (control group). All patients were sexually active at the time of enrollment. Mean age was 57.29 ± 11.82 years in the breast cancer group and 52.58 ± 7.19 years in the control group.ResultsScores in all domains of the FSFI instrument were significantly lower in the post-diagnosis group than in controls (−41.3%, p < 0.001). A further major reduction in FSFI scores was evident on completion of one cycle of primary chemotherapy (down 46.7% from post-diagnosis scores, p < 0.003), again in all domains. Six patients (25%) ceased all sexual relations, in a significant change from baseline (p < 0.001). After one chemotherapy cycle, a further five patients ceased sexual activity, for a total of 11 (45.8%) participants – a borderline significant difference (p = 0.063).ConclusionThe present study shows that female sexual function as assessed by the FSFI declines significantly at two distinct points in time: upon diagnosis of breast cancer and after administration of systemic chemotherapy.

Reproducibility of three classification systems of ductal carcinoma in situ of the breast using a web-based survey

This study assessed the degree of diagnostic agreement among pathologists between three classification systems of ductal carcinoma in situ of the breast (DCIS). Thirteen pathologists received the same set of digitized images of microscopy of 43 DCIS cases and answered a questionnaire containing the criteria to compose the three classification systems studied: Holland, modified Lagios, and Van Nuys. A computer program was created, which organizes the information collected from each pathologist, supplying the histological grading of the cases within the three classification systems. The results were analyzed using percental agreement and the Kappa test. Diagnostic agreement for the three DCIS of the breast classification systems presented K values that varied from 0.27 to 0.37. Among the three classifications used, most agreement was for Van Nuys, showing a Kappa index of 0.37. These results matched the interobserver agreements, with Kappa indices varying from 0.13 to 0.64 for the Holland classification; 0.23 to 0.61 for the modified Lagios classification; and 0.23 to 0.74 for the Van Nuys classification. Pathologists specialized in breast pathology showed greater reproducibility for all the criteria evaluated. Comparing the three classification systems, diagnostic agreement and accuracy were rated higher for the classification of Van Nuys compared to modified Lagios and Holland.

Inframammary Fold Reconstruction

Creating a well-defined inframammary fold is very important for the success of breast reconstruction, regardless of the surgical technique used. Inframammary fold reconstruction is mainly performed in the case of late postmastectomy breast reconstruction. Several surgical techniques have been described for both creation and correction or better definition of the inframammary fold. These techniques may be used during primary breast reconstruction or later, when the tissue expander is replaced with flaps, implants, or both. We describe four techniques for reconstructing the inframammary fold—external approach, internal approach, anchor approach, and allograft approach—as secondary procedures after breast reconstruction.

Lipofiling Adds Diagnostic Difficulties in Imaging Evaluation After Radiotherapy? Case-Control Study

INTRODUCTION: Immediate autologous fat grafting has yet to be assessed as an alternative for breast reconstruction following conserving surgery. The present study sought to compare mammographically, patients undergoing conserving surgery with patients undergoing autologous adipose tissue immediately to conserving surgery, after completion of radiation. MATERIALS AND METHODS: This is a case-control study. The convenience sampling occurred between June 2010 and Dec 2011, where 28 patients coming from the outpatient Breast Care Unit with the indication of breast conserving surgery underwent breast reconstruction with fat grafting. Controls were consecutive cases, 60 patients, of conservative surgery that occurred in the same period. After the surgical procedure, all were subjected to radiotherapy. All patients underwent clinical and radiological evaluation at 6 months. RESULTS: The results of early evaluation in six months, showed no difference between the mammographic findings in patients undergoing conservative surgery and conventional surgical repair with fat grafting. CONCLUSION: Immediate autologous fat grafting is a promising technique for reconstruction after breast-conserving surgery. The evaluation performed by an observer who did not contain the information of the fat grafting technique has been shown that increased degree of harder it not for the diagnosis of changes in mammographic post surgery patients submitted to this technique. KEYWORDS: Autologous fat grafting; breast-conserving surgery; breast reconstruction; lipofilling; breast cancer.