Juliana Pinho Espinola

Pericardial window used in the diagnosis of cardiac injury

PURPOSE The purpose of the present study is to analyze the results of subxiphoid pericardial window (SPW) and transdiaphragmatic pericardial window (TDP) procedures comparing the two techniques. METHODS During the period of January, 1994 to December, 2004, at UNICAMP, 245 patients underwent a pericardial window (PW) procedure to evaluate the possibility of cardiac injury. We reviewed the medical records of those patients in order to compare both procedures. RESULTS Two hundred and seven patients (84.5%) underwent the SPW procedure, and 38 (15.5%) underwent the TDP procedure. Of the patients who underwent a SPW procedure, 151 (72.9%) had gunshots injuries, and 56 (27.1%) had stab wounds. In the group of patients submitted to TDP procedure, the wound was caused by gunshot in 26 (68.4%). The SPW method has shown a sensitivity of 97.5%, specificity of 95.8%, and an accuracy of 96.1%. The TDP method demonstrated a sensitivity of 100%, specificity of 97% and a 97.4% of accuracy rate. This review showed 8 (3.3%) false positive results. There was a single case (2.6%) of complications directly associated to the TDP, and this patient developed pericarditis. CONCLUSIONS Both techniques presented an equally great result, with high sensitivity and specificity. Both surgical techniques must be carefully done to avoid false positive results.

Janela pericárdica transdiafragmática no diagnóstico de lesão cardíaca

OBJETIVO: Avaliar a eficacia e as complicacoes da utilizacao da janela pericardica (JP) transdiafragmatica no diagnostico de lesao cardiaca por ferimento penetrante. METODO: No periodo de janeiro de 1994 a dezembro de 2004 a JP foi indicada em 245 casos com suspeita de trauma cardiaco por ferimento penetrante. Em 38 deles (15,5%) a JP foi realizada atraves de acesso transdiafragmatico, constituindo a populacao do presente estudo. RESULTADOS: O mecanismo de lesao foi ferimento por projetil de arma de fogo (FPAF) em 26 casos (68,4%) e por arma branca (FAB) em 12 casos (31,6%). Na maioria dos pacientes (27 casos - 71%) os ferimentos eram multiplos. A media de RTS foi de 7,32 e a media de PATI foi de 9,8. A JP foi considerada positiva em seis casos (15,8%) dos quais cinco (83%) por FPAF e um (17%) por FAB. Houve um paciente, vitima de multiplos FPAF, com JP positiva e toracotomia em que nao foi identificada lesao cardiaca. A sensibilidade do metodo foi de 97,4% e a especificidade de 100%. Em 12 (31,6%) pacientes houve associacao de lesao com perfuracao de viscera oca. Houve um unico caso (2,6%) de complicacao diretamente relacionada ao procedimento, em uma vitima de multiplos FPAF com lesao perfurada de figado, estomago e colon, que evoluiu com pericardite, necessitando posteriormente de drenagem pericardica, com boa resolucao. A mortalidade foi de 7,9% (tres casos), um dos quais em pos-operatorio de reparo de lesao cardiaca por coagulopatia/acidose. CONCLUSOES: A JP trandiafragmatica e um procedimento que permite o rapido diagnostico de lesao cardiaca em pacientes nos quais a prioridade e a laparotomia. Trata-se de metodo de facil realizacao e alta sensibilidade.

Claudin-4 Expression Is Associated With Disease-Free Survival in Breast Carcinoma-in-Situ: Mean Follow-up of 8.2 Years

Introduction Claudins are tight junctions associated with breast cancer prognosis. The claudin‐low intrinsic subtype of invasive carcinoma is associated with high‐grade carcinoma, low junction molecule expression, and worse response to chemotherapy. However, it is not known whether the expression of claudins may provide clues as to carcinoma‐in‐situ (CIS) prognosis. The aim of this study was evaluate claudin‐4 expression in CIS and its association with disease‐free survival and histologic type of local recurrence (in situ or invasive). Methods A tissue microarray block, constructed from 137 pure CIS paraffin blocks, was submitted to immunohistochemical staining for claudin‐4, &bgr;‐catenin, E‐cadherin, estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and Ki‐67. A claudin‐4 score categorized samples as claudin‐4‐low or ‐high. Clinical and treatment data were obtained from medical records. Results Claudin‐4 expression was evaluated in 86 samples; 88.4% were high and 11.6% low. Mean follow‐up was 98.4 months, and the local recurrence rate was 10.4%. There was a significant difference in disease‐free survival between claudin‐4‐high and ‐low (4.9 and 1.9 years, respectively, P = .02); however, there was no difference between them in histologic type of recurrence (invasive or in situ) (P = .44). Conclusion In our samples, high claudin‐4 expression in CIS was more frequent than low expression. Claudin‐4‐low expression had a worse prognosis in CIS (inferior disease‐free survival), but it was similar to high claudin‐4 in histologic type of local recurrence. Micro‐Abstract Claudin‐4 expression in carcinoma‐in‐situ (CIS) is unknown. In 86 patients with pure CIS and mean follow‐up of 8.2 years, claudin‐4‐high expression was more frequent than claudin‐4‐low. However, claudin‐4‐low was associated with worse disease‐free survival than claudin‐4‐high.

Abstract P3-17-05: Claudin-4 expression is associated with disease free survival in breast carcinoma in situ: Mean follow up of 8.2 years

Introduction: Claudins are tight junction molecules that have been associated with breast cancer prognosis. The claudin-low intrinsic subtype of invasive carcinoma was recently described and associated with high grade carcinoma, low junction molecules expression and worse response to chemotherapy. However, it is not known whether the expression of claudins may provide clues as to carcinoma in situ prognosis. The aim of study was evaluate the association between claudin–4 expression and disease-free survival and histologic type of local recurrence in carcinoma in situ after longer follow up. Methods: A tissue microarray (TMA) block was constructed from 137 pure carcinoma in situ paraffin blocks sampled from patients treated from 1999 to 2009. The TMA was submitted to immunohistochemical staining for claudin-4. A claudin-4 score calculated based on percentage and intensity of expression, categorized samples as: claudin-4-low or claudin–4-high. Clinical data, treatment data, local recurrence data and survival of each patient were reanalyzed from medical records. Kaplan-Meier curves, log-rank and Wilcoxon tests were used to analyze disease-free survival; qui-square and Fisher test were employed to compare others variables; a significance level of 5 % was used. Results: Claudin-4 expression was evaluated in 86 samples, 88.4% were claudin-4-high and 11.6% claudin-4-low. Mean follow up was 8.2 years ( and local recurrence rate was 10.5 %. There was significant difference in the disease-free survival between claudin-4-high and claudin-4-low (4.9 x 1.9 respectively, p= 0.02); however there was no difference between both in histologic type of recurrence, invasive or in situ (p=0.44). Conclusion: In our samples, claudin-4-high expression in carcinoma in situ was more frequent than low expression. Our data showed that claudin-4-low expression had a worse prognosis in carcinomas in situ (inferior disease-free survival) but it was similar to claudin-4-high in histologic type of local recurrence. Citation Format: Duarte GM, Almeida NR, Tocchet F, Espinola J, Pinto T, Barreto CT, Pinto GA, Soares FA, Marshall P, Paiva GR. Claudin-4 expression is associated with disease free survival in breast carcinoma in situ: Mean follow up of 8.2 years [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-17-05.

Molecular Subtypes of Breast Cancer Are Not Associated with the Clinical Under- or Overstaging of Breast Cancer

Purpose to evaluate the agreement between the clinical and pathological stagings of breast cancer based on clinical and molecular features. Methods this was a cross-sectional study, in which clinical, epidemiological and pathological data were collected from 226 patients who underwent surgery at the Prof. Dr. José Aristodemo Pinotti Womens Hospital (CAISM/Unicamp) from January 2008 to September 2010. Patients were staged clinically and pathologically, and were classified as: understaged, when the clinical staging was lower than the pathological staging; correctly staged, when the clinical staging was the same as the pathological one; and overstaged, when the clinical staging was greater than the pathological staging. Results understaged patients were younger (52.2 years; p < 0.01) and more symptomatic at diagnosis (p = 0.04) when compared with correctly or overstaged patients. Clinicopathological surrogate subtype, menopausal status, parity, hormone replace therapy and histology were not associated with differences in staging. Women under 57 years of age were clinically understaged mainly due to underestimation of T (tumor staging) (p < 0.001), as were the premenopausal women (p < 0.01). Patients whose diagnosis was made due to clinical complaints, and not by screening, were clinically understaged due to underestimation of N (lymph nodes staging) (p < 0.001). Conclusion the study shows that the clinicopathological surrogate subtype is not associated with differences in staging, while younger women diagnosed because of clinical complaints tend to have their breast tumors understaged during clinical evaluation.

Abstract P5-17-10: Claudin -4 expression in carcinoma in situ and its association with local recurrence, clinical and immunohistochemistry characteristics

Introduction: Claudins are tight junction molecules and have been associated to breast cancer prognosis. Claudin-low intrinsic subtype of invasive carcinoma was described recently and has been related to high grade carcinoma, low junction molecules expression and worse chemotherapy response. However, it is unknown whether Claudins expression could be associated to carcinoma in situ prognostic. The aim of this study was evaluated the Claudin – 4 expression in carcinoma in situ and its association with local recurrence, clinical and immunohistochemistry characteristics. Methods: A tissue microarray (TMA) block was constructed, using region of interesting, with 137 pure carcinoma in situ paraffin blocks of patients treated in the Women 9s Hospital Prof. Dr. Jose Aristodemo Pinotti – UNICAMP from 1999 to 2009. The TMA was submitted to immunohistochemistry analyze to: Claudin-4, beta-catenin, e-caderin, estrogen receptor (ER), progesterone receptor (PR), HER-2 and Ki-67. It was calculated Claudin-4 score based in percentage and intensity of expression and categorized in: Claudin-4 low and Claudin – 4 high. The clinical data, treatment data (surgery, radiotherapy and tamoxifen use), local recurrence data (date and type) and death of each patient were reviewed in the medical records. The statistical analyze used Kaplan-Meier curve and log-rank test to disease free survival; qui-square and Fisher test to compare others variables; significance level of 5 % was used. Results: It was possible to evaluate Claudin-4 expression in 86 cases, 88.4% were Claudin-4 high and 11.6% Claudin-4 low. The follow up mean was 69 months and local recurrence rate was 10.5 %. There was no significant difference in local recurrence rate between Claudin-4 high and Claudin-4 low (10.0% x 10.5% , p=1.0).The disease free survival was similar between Claudin-4 low and Claudin-4 high (p=0.559). The Claudin- 4 high was significantly more frequent in beta-catenin positive patients (p=0.048). There was no association significantly between Claudin-4 expression and: age (p=0.66), histology type (p=0.75), surgery (p=0.102), radiotherapy (p=0.29), tamoxifen use (p=0.432), ER (p=0.33), PR (p=1.0), HER-2 (p=0.23) and e-caderin (p=0.21). Conclusion: Despite the Claudins are related to invasive carcinoma prognosis, our outcome did not show difference in local recurrence and disease free survival between Claudin-4 low and high in carcinoma in situ. The beta-catenin and claudin-4 expressions were significantly associated. Citation Format: Duarte GM, Toucchet F, Espinola JP, Barreto CR, Paiva Silva GR, Almeida NR, Soares F, Pinto G, Marshall P. Claudin -4 expression in carcinoma in situ and its association with local recurrence, clinical and immunohistochemistry characteristics. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-17-10.