Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

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SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

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Objective: To compare the rates of pathological complete response (pCR) after treatment with neoadjuvant chemotherapy, in the different subtypes of breast cancer in patients followed at the Mastology Service of Hospital do Servidor Público Estadual. Methods: Descriptive and retrospective study, in which medical records of 213 patients diagnosed with breast cancer and submitted to neoadjuvant chemotherapy were reviewed, from February 2011 through January 2018. Histological data collected were: hormone receptors, hyperexpression of HER-2, grade, histological type and clinical data: age of the patient at diagnosis, tumor size and clinical stage at diagnosis and after chemotherapy, and rate of pCR. Results: The mean age of patients at diagnosis was 53.97 years. Forty-six patients (21,6%) had pCR, 77 (36.1%) were grade 2 and 136 (63.9%) were grade 3. Regarding cancer subtype, 29 patients (13.6%) were reported to have pure HER2 subtype, 48 patients (22.5%) corresponded to Luminal A subtype, 51 (23.9%) to Luminal B, and 66 patients (31.0%) were characterized as Triple Negative, while only 17 patients (7.9%) had Luminal B HER. Conclusion: The subtypes Pure HER 2 and Luminal B had the highest pCR rates.

Introduction: Breast cancer is currently considered a public health problem, being the most frequent in women in Brazil. In the past, and in places where screening programs are not very successful, the diagnosis was made during the clinical examination, being carried out late, which compromised the prognosis and survival of the patient. To avoid late diagnosis, an attempt is made to have the strategy of appropriate screening programs that make an early detection by applying the test to the asymptomatic population and identifying lesions in the pre-clinical stage. Objectives: To analyze the incidence of reports highly suggestive of malignancy in patients undergoing mammography in Brazil between 2013 and 2021. Methodology: A retrospective and analytical cross-sectional study of the notifications available in the cancer information system (SISCAN) was carried out. The incidence of report notifications by the Breast Imaging Reporting Data System (BI-RADS) classification system was compared between high-risk and normal-risk women for breast cancer. In addition to the information regarding the BI-RADS report, they were analyzed comparing epidemiological data between high-risk and normal-risk women. Other variables analyzed were the age group of the screened population and the size of the nodule according to the BI-RADS. Results: In the period analyzed from 2013 to 2021, 16,065,383 screening mammograms were performed and reported in Brazil. Of these, 13,167,259 mammograms were performed on women at normal risk, while 2,898,124 mammograms were performed on women reported as high risk. To analyze the difference between the reports in women at usual risk and those at high risk, the relative risk between them and the number necessary to cause harm was calculated, having found a relative risk of 0.5412 (CI 95 % 0.5341 - 0.5483) in B4 and a relative risk of 0.433 (95% CI 0.4203 - 0.4462). As for the number needed to deal damage, it was observed 203 (95% CI 198 - 209) for B4 and 788 (95% CI 754 - 825) for B5. Discussion: Although the need for breast cancer screening programs to reduce mortality is already well established, some aspects of screening do not have much consensus. In our study, as proposed in the literature, the incidence of reports suggestive of malignant breast lesions was higher in high-risk women. This finding may be consistent with the fact that women with risk factors are more likely to develop breast cancer than those with usual risk. Some studies show that exams from high-risk patients tend to be examined in greater detail, in order to have a higher false positive rate than low-risk patients, just as low-risk patients have a higher false negative rate. Conclusions: Our study showed an increased prevalence of reports suggestive of malignancy in high-risk patients when compared to usual-risk patients. Such findings may mean that high-risk patients have a higher prevalence of malignancy, but also that clinicians review the examinations of high-risk patients more carefully, increasing the rate of reports suggestive of malignancy in these patients. Reports of mammograms performed in the target population and in high-risk women in Brazil between 2013 and 2021 Risco relativo a depender do tamanho do nódulo e o laudo BI-RADS entre mulheres de alto risco e risco habitual Citation Format: MARCELO ANTONINI, GABRIEL D. PANNAIN, ODAIR FERRARO, REGINALDO G. COELHO LOPES, ANDRE MATTAR, JULIANA M. REAL. Comparative analysis between screening mammography performed in patients at usual risk and patients at high risk for breast cancer in the early detection program for breast cancer in Brazil [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 P5-04-02.

Objetivo: Avaliar as características clínicas e patológicas do tumor filoides e identificar fatores relacionados com risco de recidivas em pacientes acompanhadas no ambulatório de Mastologia do Hospital do Servidor Público Estadual de São Paulo (HSPE-SP). Método: Estudo retrospectivo descritivo de dados de 52 pacientes, entre 1976 e 2013, dentre os quais: idade, tamanho do tumor, tipo histológico, margens cirúrgicas, tipo de cirurgia, recidivas e tempo para recidiva. Resultados: A idade média das pacientes foi 45,7 anos. O tamanho médio do tumor foi de 7,8 cm. O tratamento em 12 pacientes foi a mastectomia, e as demais 40 a excisão ampla. O tipo histológico encontrado em 30 pacientes foi tumores benignos, 11 malignos e 11 de variedade borderline. Após o seguimento médio de 53,93 meses, observaram-se 17 recidivas. Não houve relevância estatística entre a recorrência local e as variáveis avaliadas. Conclusões: A amostra avaliada tem características clínicas e patológicas condizentes com a literatura, com média de idade de 45 anos, tamanho do tumor de 7,8 cm, sendo encontrados na maioria tumor filoides benigno e 33% de recidivas. Não houve significância estatística entre características avaliadas e o risco de recidiva.PALAVRAS-CHAVE: Doenças da mama; cirurgia; tumores de mama; tumor filoide; mama. RESUMO ABSTRACTObjective: To evaluate the clinical and pathological characteristics of phyllodes tumors, and to identify possible associated risk factors for relapses among patients from the Breast Surgery Department of the Hospital do Servidor Público Estadual of São Paulo (HSPE-SP). Methods: Retrospective, descriptive study of data from 52 patients, between 1976 and 2013. The following data were collected: age, tumor size, histological type, surgical margins, type of surgery performed, relapses and amount of time before relapse. Results: The mean age of the patients was 45.7 years old, the mean size of the tumor was 7.8 cm. A mastectomy was performed on 12 patients, and the others underwent a wide excision. Benign phyllodes tumors were found in 30 patients, and the others were found as follows: 11 with borderline tumors and 11 with malign phyllodes tumors. There was no statistical relevance with regard to the relapses and the characteristics evaluated. Conclusion: The sample studied has similar clinical and pathological characteristics as described in the scientific literature, with the mean age at diagnosis being 45 years old, the mean tumor size, 7.8 cm. The majority found were benign phyllodes tumors and 33% were from relapses. There was no statistical significance between the evaluated variables and the risk for relapse.