In the large majority of patients with breast cancer, lymphoscintigraphy and gamma-probe-guided surgery can be used to locate the sentinel node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel-node biopsy routinely, and may be spared complete axillary dissection when the sentinel node is disease-free.

Background. Axillary lymph‐node dissection is an important staging procedure in the surgical treatment of breast cancer. However, early diagnosis has led to increasing numbers of dissections in which axillary nodes are free of disease. This raises first, questions about the need for the procedure. We carried out a study to assess, first, whether a single axillary lymph node (sentinel node) initially receives malignant cells from a breast carcinoma and, second, whether a clear sentinel node reliably forecasts a disease‐free axilla. Methods. In a consecutive series of 163 women with operable breast carcinoma, we injected microcolloidal particles of human serum albumin labelled with technetium‐99m. This tracer was injected subdermally, close to the tumor site, on the day before surgery, and scintigraphic images of the axilla and breast were taken 10 min, 30 min, and 3 h later. A mark was placed on the skin over the site of the radioactive node (sentinel node). During breast surgery, a hand‐held γ‐ray det$ector probe was used to locate the sentinel node, and make possible its separate removal via a small axillary incision. Complete axillary lymphadenectomy was then done. The sentinel node was tagged separately from other nodes. Permanent sections of all removed nodes were prepared for pathological examination. Findings. From the sentinel node, we could accurately predict axillary lymph‐node status in 156 (97.5%) of the 160 patients in whom a sentinel node was identified, and in all cases (45 patients) with tumours less than 1.5 cm in diameter. In 32 (38%) of the 85 cases with metastatic axillary nodes, the only positive node was the sentinel node. Interpretation. In the large majority of patients with breast cancer, lymphoscintigraphy and γ‐probe‐guided surgery can be used to locate the sentinel node in the axilla, and thereby provide important information about the status of axillary nodes. Patients without clinical involvement of the axilla should undergo sentinel‐node biopsy routinely, and may be spared complete axillary dissection when the sentinel node is disease‐free.

The nipple- and areola-sparing mastectomy, although resulting in a relatively high frequency of necrotic complications, is a valuable surgical option for patients with small, peripheral tumors and for women undergoing prophylactic mastectomy. The procedure seems to be safer for women under 45 years of age.

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O presente estudo abordou o tema colostomia temporária e teve como objetivo analisar suas repercussões na vida das pessoas com base nos corpos: individual, social e político. Estudo descritivo de abordagem qualitativa, com base na História de Vida Focal. Os sujeitos do estudo foram oito pessoas com colostomia temporária que frequentaram o ambulatório de estomias de um hospital universitário público de Cuiabá-MT. Os dados foram coletados por meio de entrevistas semiestruturadas, no período de outubro a novembro de 2008. As entrevistas foram gravadas e, após transcritas, procedeu-se a análise temática. Foram assim, identificadas duas categorias: as repercussões das informações sobre a necessidade da colostomia e seu cuidado; as repercussões de viver com uma colostomia temporária nos corpos individual, social e político. Ressaltamos a importância do papel da enfermagem em focalizar as particularidades das pessoas com colostomias temporárias, considerando o contexto sociocultural e a subjetividade de cada uma delas. Descritores: Colostomia; Cultura; Enfermagem.

expression profiling and prediction of response to hormonal neoadjuvant treatment with anastrozole in surgically resectable breast cancer. Breast Cancer Research and Treatment, Springer Verlag, 2010, 121 (2), pp.399-411. <10.1007/s10549-010-0887-y>. CLINICAL TRIALGene expression profiling and prediction of response to hormonal neoadjuvant treatment with anastrozole in surgically resectable breast cancer Abstract Aromatase inhibition (AI) is the most effective endocrine treatment for breast cancer in post-menopausal patients, but a percentage of hormone receptor-positive cancers do not benefit from such therapy: for example, about 20% of patients treated with anastrozole do not respond and it is still impossible to accurately predict sensitivity. Our main goal was to identify a robust expression signature predictive of response to neoadjuvant treatment with anastrozole in patients with ER? breast cancer. At the same time, we addressed the question of delineating treatment effects and possible mechanisms of intrinsic resistance occurring in non-responder patients. We analyzed the transcriptome of 17 tru-cut biopsies before treatment and 13 matched surgical samples after 3 months treatment with anastrozole taken from ER? breast tumors. Molecular profiles were related to clinical response data. Treatment with anastrozole was associated with a decreased expression of genes relating to cell proliferation and an increased expression of genes relating to inflammatory processes. There was also an enrichment of induction of T-cell anergy, positive regulation of androgen signalling, synaptic transmission and vesicle trafficking in non-responders, and of cell cycle inhibition and induction of immune response in responders. We identified an expression signature of 77 probes (54 genes) that predicted response in 100% of our cases. Five of them were able to accurately predict response on an independent dataset (P = 0.0056) of 52 ER? breast cancers treated with letrozole. Ten fixed independent samples from the anastrozole study were also used for RT-qPCR validations. This study suggests that a relative small number of genes analysed in a pre-treatment biopsy may identify patients likely to respond to AI neoadjuvant treatment. This may have practical utility translatable to the clinics. Furthermore, it Maurizia Mello-Grand and Vijay Singh contributed equally to the work.Electronic supplementary material The online version of this article (doi:10.1007/s10549-010-0887-y) contains supplementary material, which is available to authorized users. delineates novel mechanisms of intrinsic resistance to AI therapy that could be further investigated in order to explore circumventing treatments.

Abstract:The problem of nipple-areola complex (NAC) preservation during mastectomy is a very intriguing and stimulating issue. In fact, in order to perform an oncologically safe operation, no mammary tissue (enclosed in the main galactophoric ducts) should remain; on the other hand, without the blood supply coming from the breast gland, NAC viability is greatly impaired because the surrounding vascular dermal network is not developed enough to support its metabolic requirements. We suggest therefore a two-step surgical procedure. The first step, on an outpatient basis with local tumescent anesthesia, is a mini-invasive cutting and coagulating procedure. It addresses the autonomization of the vascular supply to the NAC by detaching the galactophore stalk from the nipple and coagulating the deep vascular plexus. The second step, under general anesthesia and again with tumescent technique, removes the breast within its capsule, with careful checks of any remnant and adequate approach to the axilla. A subpectoralis prosthesis completes the procedure. In our view, this technique is electively suitable for prophylactic mastectomy, but also for stage I breast cancer, 2.5 cm from the NAC and 1.5 cm from the skin and pectoralis fascia, and it is very safe, simple, and effective. Key Words: delayed nipple-sparing modified subcutaneous mastectomy, mastectomy, nipple-areola complex preservation T he inheritable breast cancer recently detectable by evidence of the BRCA-1 / BRCA-2 gene mutation, lobular hyperplasia, atypical ductal hyperplasia, and lobular carcinoma in situ are currently faced on a preventive basis with selective screening and follow-up, chemoprevention, and /or prophylactic mastectomy (1-4). The surgical options of simple mastectomy and subcutaneous mastectomythe former excising the nipple-areola complex (NAC) together with the gland, the latter leaving intact the NACprovides 95 -99% and 90 -95% breast tissue removal, respectively, and thus being inadequate as to oncologic radicality (5). Therefore when risk of breast cancer is high, total mastectomy is the golden standard.A 13% increase (from 81% to 94%) of total mastectomies in cohorts of women with a family history of breast malignancy has been observed since 1995, followed by an high rate of reconstruction. Metcalfe et al. (6) report breast restoration in 60% of these patients, compared with 6 -13% of nonprophylactic mastectomies.Our study addresses the hypothesis of a new radical approach to subcutaneous mastectomy while retaining the integrity of the NAC, without leaving any gland stalk or parenchyma underneath, and thus obtaining complete clearance of the breast tissue. Primary reconstruction with subpectoralis prosthesis or two-stage replacement with an expander are the surgical options to complete the procedure in order to achieve satisfactory cosmetic results. This procedure addresses both cancer prophylaxis and stage I cancer treatment.

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