Introduction: Breast cancer is a cancer that most affects women around the world. The neoadjuvant chemotherapy, nowadays, has been extended to the initial cases in order to de-escalate treatments, reducing the surgical aggressiveness of the breast and axilla. Pathologic complete response (pCR) is the major desired outcome, aiming to improve the overall and disease-free survival in a subgroup. Which factors would be correlated with pCR in our population and could help reduce the surgical extension in a SUS service in northeastern Brazil? Objective: The aim of this study is to find predictive factors of pCR after neoadjuvant chemotherapy, a subject that is still very controversial in the literature. Methods: This is an observational, analytical, longitudinal study carried out at the Brazilian Public Health System oncology service in the state of Sergipe with the participation of patients diagnosed with breast cancer who would undergo neoadjuvant chemotherapy between June 2019 and June 2020. Patients with a histological diagnosis of breast cancer who were admitted to the service with indication for neoadjuvant therapy were included. Patients with a histological diagnosis of carcinomatype breast cancer, of any age group, from stages I to III were included. Molecular subtypes were determined by immunohistochemical evaluation of core-needle biopsy material. After the treatment, the patients underwent mastectomy or breast-conserving surgery, depending on the indication of the attending physician at the service, without intervention by the researcher. For the treatment of the axilla, sentinel lymph node dissection or axillary dissection was performed. RECIST (response evaluation criteria for solid tumors) criteria were used to categorize the response. The hypothesis of independence between categorical variables was tested using Pearson’s χ2 or Fisher’s exact test. The hypothesis of the adherence of continuous variables to the normal distribution was tested using the Shapiro-Wilks test. Once this hypothesis was rejected, the hypothesis of equality of medians was tested using the Mann-Whitney U test. The significance level adopted was 5% and the software used was the R Core Team 2021 (version 4.1.0). Results: Data from 69 patients were collected during the study period. Of the patients analyzed prospectively, 17 achieved a pathological complete response (25.37%). The median age of these patients was 49 years. Despite a complete pathological response, 64.7% of these patients underwent mastectomy and 58.8% underwent axillary dissection. The median number of lymph nodes dissected in patients with rPC was 5 and in patients without rPC, it was 14.5. The median number of lymph nodes involved was 0.5 in patients who did not achieve rPC (p=0.006). Stages I and II were present in 76.5% of cases who achieved a complete pathological response. Among patients with a complete pathological response, 52.9% of cases were triple-negative tumors, 29.4% overexpressed HER2, and 17.6% Luminal (p=0.033). There were 11.8% of patients with metastases and complete pathological responses. Of the patients with rPC, 76.5% had a clinically negative axilla before chemotherapy and only 28.6% of the patients who did not achieve rPC (p=0.001) had a clinically negative axilla. Tumor staging before chemotherapy was initial (I and II) in patients with RPC in 76.5% and in those without rPC in 46% (p=0.04). In all, 76.5% of patients with rPC were from the capital and patients without rPC 60% were from the interior of the state (p=0.01). The median Ki67 of 50 was compared to the median Ki67 of 30 in patients without rPC (p=0.05). In a multivariate analysis, we observed the origin of the state capital and the initial clinically uncompromised axilla as independent predictors for pCR. Conclusion: The absence of prechemotherapy lymph node involvement and the origin of the capital proved to be independent predictors of complete pathological response to neoadjuvant chemotherapy in our study.
Histoplasma is a thermally dimorphic fungus with endemic and opportunistic behavior, which causes a systemic disease known as histoplasmosis. The habitat for this fungus is soil laden with bird and bat droppings, in caves and henhouses, and it persists in the environment long after the contamination. This fungus is widely disseminated in the American continent. In South American countries, the disease is mainly present in Venezuela, Colombia, Peru, Brazil, Argentina, and Uruguay. Man is contaminated by inhaling conidia present in nature, and most infections are mild and subclinical. After being inhaled, conidia undergo phagocytosis by macrophages and mononuclear cells, which are unable to destroy them. They multiply inside these cells, traveling through mediastinal and hilar lymph nodes and into the bloodstream, spleen, bone marrow, liver, skin, and subcutaneous tissue. The diagnosis is based on the detection of the fungus in secretions or tissues and in serology tests. Among these tests, enzyme-linked immunosorbent assays are more sensitive and specific than complement fixation. Tissue biopsies show epithelioid granulomas, with or without necrosis, and fungi within phagocytic cells. Gomori-Groccot staining is required for the visualization of the fungus. A 22-year-old female patient, an undergraduate psychology student, from the urban area of the inner state of Sergipe, no comorbidities, vegetarian, visited a mastologist due to the recent appearance of a nodule in the right breast associated with signs of inflammation and no fever. The clinical examination showed a 2 cm palpable, retroareolar thickening, and thickening of the areolar skin with discrete hyperemia, and no palpable axillary lymph nodes. The patient was initially treated with amoxicillin and clavulanic acid for 7 days. After treatment, there was regression of the inflammation signs upon physical examination; however, the thickening remained and the areolar skin was still thickened and hard. An ultrasound of the right breast showed a well-defined heterogeneous, superficial, and elongated retroareolar nodular image, measuring 3.4×1.2 cm. A breast ultrasound-guided fine-needle aspiration (FNA) was performed, and the cytology test suggested an inflammatory process. After 1 month, the patient returned with two areolar fistulas with yellowish discharge. A new cycle of antimicrobial therapy was started with clindamycin for 14 days. The secretion was decreased over the antibiotic period; however, 14 days after the treatment, the two areolar fistulas were still present with yellowish discharge. A third cycle of antibiotic therapy with metronidazole was administered with no improvement. An excisional biopsy was performed of the area around the fistula and the underlying breast tissue. Two specimens were examined — one skin specimen with the fistulizing areas measuring 1.9×0.8×0.8 cm, and the other specimen measuring 1.7 cm, corresponding to the breast tissue beyond the fistulas, measuring 1.7×1×0.2 cm. Histopathological evaluation of the specimen showed a chronic, granulomatous inflammatory process, with exudative foci and formation of a fistulous tract, chronic inflammatory lymphoplasmacytic reaction, fibrosis, and giant cell reaction. Screening for fungi (Groccot) showed small, clustered yeast-like structures in the cytoplasm of macrophages, suggestive of histoplasmosis. The patient’s clinical tests included hemoglobin of 9 and a white blood cell count of 3,500, with a normal differential count. Screenings for HIV, hepatitis B, and hepatitis C were negative, fasting blood glucose was normal, and liver function was normal. The anemia investigation revealed only a ferroprivic component because of the vegetarian diet. The patient was subjected to general chest and abdominal examinations with no abnormalities. The patient was started on itraconazole 200 mg a day for 1 year, with no relapse until the end of the treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.