Laia Bernet

Elaboration of a nomogram to predict nonsentinel node status in breast cancer patients with positive sentinel node, intraoperatively assessed with one step nucleic amplification: Retrospective and validation phase

BackgroundTumor-positive sentinel lymph node (SLN) biopsy results in a risk of non sentinel node metastases in micro- and macro-metastases ranging from 20 to 50%, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. We have previously developed a mathematical model for predicting patient-specific risk of non sentinel node (NSN) metastases based on 2460 patients. The study reports the results of the validation phase where a total of 1945 patients were enrolled, aimed at identifying a tool that gives the possibility to the surgeon to choose intraoperatively whether to perform or not axillary lymph node dissection (ALND).MethodsThe following parameters were recorded: Clinical: hospital, age, medical record number; Bio pathological: Tumor (T) size stratified in quartiles, grading (G), histologic type, lymphatic/vascular invasion (LVI), ER-PR status, Ki 67, molecular classification (Luminal A, Luminal B, HER-2 Like, Triple negative); Sentinel and non-sentinel node related: Number of NSNs removed, number of positive NSNs, cytokeratin 19 (CK19) mRNA copy number of positive sentinel nodes stratified in quartiles. A total of 1945 patients were included in the database. All patient data were provided by the authors of this paper.ResultsThe discrimination of the model quantified with the area under the receiver operating characteristics (ROC) curve (AUC), was 0.65 and 0.71 in the validation and retrospective phase, respectively. The calibration determines the distance between predicted outcome and actual outcome. The mean difference between predicted/observed was 2.3 and 6.3% in the retrospective and in the validation phase, respectively. The two values are quite similar and as a result we can conclude that the nomogram effectiveness was validated. Moreover, the ROC curve identified in the risk category of 31% of positive NSNs, the best compromise between false negative and positive rates i.e. when ALND is unnecessary (<31%) or recommended (>31%).ConclusionsThe results of the study confirm that OSNA nomogram may help surgeons make an intraoperative decision on whether to perform ALND or not in case of positive sentinel nodes, and the patient to accept this decision based on a reliable estimation on the true percentage of NSN involvement. The use of this nomogram achieves two main gools: 1) the choice of the right treatment during the operation, 2) to avoid for the patient a second surgery procedure.

Ultrastructural Pathology of Anaplastic and Grade II Ependymomas reveals Distinctive Ciliary Structures – Electron Microscopy Redux

ABSTRACT Ependymoma tumors likely derive from the ependymal cells lining the CNS ventricular system. In grade II ependymomas, tumor cells resemble typical ependymocytes, while anaplastic ependymomas are poorly differentiated. We studied three grade II and one anaplastic ependymoma, focusing on the ciliary structures. To unambiguously characterize the ultrastructure and number of cilia, we performed electron microscopy serial section analysis of individual cells. Differentiated ependymomas contained large basal bodies and up to three cilia, and lacked centrioles. Anaplastic ependymoma cells showed instead two perpendicularly oriented centrioles and lacked cilia or basal bodies. These findings could contribute to understand the mechanisms of ependymoma aggressiveness.

Encuesta nacional sobre la actitud ante el hallazgo de metástasis en el ganglio centinela por cáncer de mama en distintas unidades hospitalarias

Resumen Objetivo En los ultimos anos, ha cambiado la indicacion de la linfadenectomia axilar como gesto integrante del manejo del cancer de mama, sobre todo desde la introduccion de la biopsia del ganglio centinela. El objetivo es conocer la actitud actual en funcion de los hallazgos de enfermedad en este. Pacientes y metodos Se realizo un estudio descriptivo a partir de datos obtenidos de una encuesta, dirigida especificamente a unidades de mama espanolas, sobre las consideraciones que, en el tratamiento quirurgico y adyuvante, supone el hallazgo de metastasis en el ganglio centinela dependiendo de su carga tumoral. Resultados Se recibieron un total de 66 encuestas cumplimentadas de 110 solicitadas (60%). El estudio del ganglio centinela se hace mayoritariamente de forma intraoperatoria (84,8%) y mediante la tecnica de OSNA (69,7%). El hallazgo de celulas tumorales aisladas no conlleva linfadenectomia, aunque hay mas variabilidad ante el hallazgo de macrometastasis y, sobre todo, de micrometastasis (en las que se realiza en un 86,3 y un 33,3%, respectivamente). En este sentido resulta llamativa la falta de uniformidad en los criterios para indicar o no la linfadenectomia y la asociacion de tratamientos adyuvantes. Conclusiones En la actualidad existe una gran variabilidad en la actitud ante el hallazgo de enfermedad ganglionar en el ganglio centinela en el cancer de mama, especialmente en el caso de enfermedad considerada de baja carga tumoral (micrometastasis). Esta variabilidad se refiere tanto a la indicacion de completar la linfadenectomia, como a la indicacion de tratamientos adyuvantes en esos casos concretos.