Background and Objectives Marking positive lymph nodes (LNs) before neoadjuvant chemotherapy (NAC) may improve the accuracy of sentinel lymph node biopsy (SLNB). The aim of this study was to determine the feasibility of marking LNs with 4% carbon microparticle suspension (CMS) before NAC and to evaluate if this technique would improve the SLNB identification rate. Methods A prospective study of patients with cT1‐T4, cN1‐N2 breast cancer who underwent US‐guided fine‐needle aspiration biopsy (FNAB) of suspected LNs and concomitant marking with 4% CMS was performed. After NAC, LNs marked with 4% CMS and those marked with Patent Blue V dye (PBV) were identified and resected. Results Of the 123 patients included, 74 (60.1%) had positive LNs at FNAB. During axillary surgery, 4% CMS was identified in 121 of 123 patients (98.3%) and blue sentinel LNs in 91% (112 of 123 patients) (P = .0103). Comparing isolated results of PBV and 4%CMS + PBV, the association was better in identifying positive LNs (72.2% vs 97.7%) (P = .02). Conclusion The association of 4% CMS and PBV is feasible and significantly increased the identification rate of positive LNs. 4% CMS may play an important role as a complementary technique in patients submitted to NAC.

Objective: Breast cancer is one of the main challenges in Brazilian public health due to the high associated mortality. Mortality has different patterns according to age group, usually increasing with age. The demographic stability in Paraná, with the growth of the elderly population, has a direct impact on the epidemiology of this disease. This study aimed to assess, on a population-based basis, the rates and trends of mortality from breast cancer among the age groups of women in the state of Paraná from 2000 to 2017. Methods: A statistical descriptive retrospective series study was carried out to analyze, on a population-based basis, the trend in breast cancer mortality rates among the age groups of women in the state of Paraná, from 2000 to 2017. The trend analysis of annual mortality rates was carried out through the software and simple linear regression models. Results: The population-based analysis showed that women aged 45–54 and 55–64 years had the highest number of deaths during the study period. However, when calculating the mortality rates by age group, it was observed that the mortality pattern increases proportionally to the longevity of the female population in the state. Trend analyses indicated an upward trend in mortality among women aged 25–34 years throughout the study period. The same trend was observed in women aged 35–44 years, but in a shorter period, from 2005 to 2017. Conclusion: Mortality rates, per 100,000 women, were directly proportional to age, increasing with age, indicative of greater mortality from the disease in elderly women. There was a trend of increasing mortality, with statistical significance, in the age groups from 25 to 34 and 35 to 44. The others were considered stable trends.

Background: Autologous reconstruction techniques can provide a long-lasting natural breast reconstruction for patients. This study aimed to further investigate outcomes in the conversion of breast implant reconstruction into a lipofilled mini dorsi flap, focusing on reviewing its techniques, efficiency, and final results. Methods: Over 3 years, we performed a number of breast implant replacements via the lipofilled mini dorsi flap technique. The artificial implants were replaced to a deepithelized flap. The efficiency and tolerance of the technique were evaluated by the whole surgical team, and the achieved results were also analyzed by the patients in terms of postoperative pain, functional impact, and the softness of the reconstructed breast by comparing their prior condition to the lipofilled mini dorsi flap condition at least 9 months after operation. Results: Forty-seven consecutive operations were prospectively studied. The mean ± standard deviation volume of the removed implants was 348.66 ± 86.54 mL. The mean volume of fat injected was 284.13 ± 62.94 mL. The procedure’s average duration was 108.93 ± 17.65 minutes. The surgical team evaluated the results as very satisfactory in 32 cases (68.1%), satisfactory in 15 cases (31.9%), and moderately satisfactory or unsatisfactory in zero cases (0.0%). Eighteen patients (38.3%) evaluated their reconstruction as very good, while 20 patients (42.6%) considered their reconstruction as good, four (8.5%) as average, and zero (0.0%) as insufficient. Conclusion: According to our experience, the lipofilled mini dorsi flap is a simple, less invasive, and quick procedure to convert breast implants into natural breast reconstruction.

Objective: To select cases of bilateral breast carcinoma (BBC) of patients seen at Hospital de Clínicas of Paraná, besides recognizing clinical and family characteristics, histological and immunohistochemical pattern, and incidences of synchronic/metachronic tumor in these patients. Method: Observational and analytical study of BBC cases of patients treated at Hospital de Clínicas of Paraná, from 2003 to 2019, developed from the analysis of medical records. Result: A total of 42 patients with BBC were selected. The incidence of BBC was 3.64%. All patients were women, mostly of white skin color and postmenopausal, with an average age of 51.82 years. Half patients showed a positive family history for cancer, with breast cancer present in 46%, ovarian cancer in 16%, and other topographies in 68%. In this sample, the synchronous tumor was present in 55% of patients, and the metachronous tumor, in 45%. Regarding patients’ initial clinical staging, 61% had a locally advanced tumor at diagnosis. Both in the group of synchronic and metachronic tumors, the ductal subtype was the most frequent. Regarding the immunohistochemical subtype, patients in both groups had Luminal B tumors more frequently. In the group of metachronic tumors, the average time between the diagnosis of the first tumor and the second tumor was 5.68 years. Conclusion: In this sample, BBC is associated with a relevant family history, with a synchronic presentation pattern, from histology to ductal and immunohistochemistry to Luminal B as the most frequent.

Background: The use of axillary marking before neoadjuvant systemic therapy (NST) is the standard of care in patients with positive lymph nodes (LN). Several methods have been tested leading to reduced false negative rate compared to sentinel lymph node biopsy (SLNB). With the increase in therapies in patients with residual disease, it is necessary to improve the accuracy of the axillary assessment. The aim of this study was to evaluate oncological outcomes in patients undergoing targeted axillary dissection with positive LN pre-NST marked with 4% carbon marker, the secondary objective was to evaluate the association between SLNB and pre-NST marked lymph node. Methods: A prospective study was performed in patients with cT1-T4, cN1-N2 breast cancer who underwent NST. An ultrasound-guided 4% carbon marking was performed before proposed treatment. After NST, the carbon marked lymph node (CMLN) was identified and resected associated with SLNB. When at least one lymph node was positive, axillary dissection was performed. The oncological outcomes registered were overall survival (OS), specific survival (SS), disease-free survival (DFS), axillary recurrence (AR) and local recurrence (LR). Results: 176 patients operated between July 2014 and January 2019 were included in the analysis. The CMLN were identified in 168/176 (95.4%) and the SLNB 145/176 (82.3%) operations. SLNB and CMLN were coincident in 93/176 (52.8%) cases. The LNs were not coincident in 44/176 (25%) cases and at least one of the methods were not identified in 39/176 (22.1%). When condensing the lymph nodes not found as positive lymph node, the sample agreement was 148/176 (81.4%) [Kappa = 0.67 (95%CI: 0.56 – 0.78)], when separating the positive lymph nodes from the lymph nodes not found, the agreement was 133/176 (75.6%) [Kappa = 0.56 (95%CI: 0.46 – 0.66)] (Table 1). With a mean follow-up of 49 months, 168 patients were included in the analysis of oncologic outcomes. Among the patients analyzed, 7/168 (4,1%) had LR, 5/168 (2,9%) had AR, 28/168 (16.6%) had distant recurrences [DFS = 83.3%]. There were 10/168 (5,9%) deaths [OS = 94%], with 5 confirmed by breast cancer and 4 of undetermined cause. There was a significant association between axillary dissection and axillary recurrence (0 versus 6% p = 0.012). OS for clinical stages 2B, 3A and 3B were 97, 88 and 87.5% respectively. Conclusions: The use of 4% carbon marker is a feasible and cheap method for targeted axillary dissection. The oncological outcomes are compatible with the survival curves of the American Joint Committee on Cancer 8th edition, therefore, a safe tool to spare women cN+ from axillary dissection when there is a complete axillary response to NST. The concordance rate between the CMLN and the SLNB was moderate when we took into account the failure of some method, noting the need for a supplementary method to the SLNB after NST. Frequency and percentages of anatomopathological results and methods of lymph node identification. SLNB = sentinel lymph node biopsy; CMLN = carbon marked lymph node Occurrence of oncological outcomes Citation Format: Lucas R. Budel, Cleverton C. Spautz, Maria Helena Louveira, Teresa Cristina S. Cavalcanti, Alessandra C. Fornazari, Plinio Gasperin, Leonardo P. Nissen, Vinicius M. Budel. Oncological outcomes in patients undergoing targeted axillary dissection with carbon marker [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-11.

Introduction: Bilateral breast cancer (BBC) is a rare clinical entity. This pattern of neoplasia can be considered synchronous (simultaneous) or metachronous (1 month to 1 year later). Objective: To select cases of BBC patients seen at HC-UFPR and to recognize in these patients clinical and family characteristics, histological and immunohistochemical patterns, and incidences of synchronous/metachronous occurrences. Method: An observational and analytical study of BBC cases of patients treated at HC-UFPR, from January 2003 to October 2019, based on the analysis of medical records, was developed. Result: 42 patients with BBC were selected and 4 patients were excluded from the study due to incomplete information in the medical record. The incidence of BBC in the surveyed period was 3.64%. All patients are women with a mean age of 51.82 years. White ethnicity is the most prevalent one (82%). With regard to menopausal status, 42% of the subjects are pre-menopausal and 58%, post-menopausal. Regarding parity, only 16% were nulliparous. Half of the patients have a positive family history for neoplasms, with breast cancer present in 46%, ovarian cancer in 16%, and other topography in 68%. In this sample, the synchronous tumor was present in 55% of the patients and the metachronous tumor in 45%. Regarding the patients’ initial clinical staging, 61% presented with locally advanced tumor at the first consultation. In the group of synchronous tumors, the ductal type was the most frequent one (93%), followed by the lobular type (7%). Regarding immunohistochemical subtypes, patients had Luminal B tumors (43%), followed by HER (29%), Triple negative (24%), and Luminal A (5%). Comparing the immunohistochemical profile in both tumors, 62% were in agreement and 48%, in disagreement. In the group of metachronous tumors, the mean time between the diagnosis of the first tumor and that of the second tumor was 5.68 years. The most common histological type was ductal carcinoma (73%), followed by lobular carcinoma (11%), medullary carcinoma (9%), and metaplastics (7%). Regarding the immunohistochemical profile, the most present was Luminal B in 32%, Luminal A in 29%, Triple negative in 24%, and HER 2 in 15%. The immunohistochemical profile was consistent in only 29% of the patients. Conclusion: In this sample, BBC is associated with relevant family history, with a pattern of presentation, synchronous; frequently, ductal is histological and Luminal B is immunohistochemistry.