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.

Na mamografia digital, os processos de aquisição da imagem, demonstração e armazenamento são separados, o que leva à otimização de cada uma dessas etapas. A radiação transmitida através da mama é absorvida por um detector eletrônico, em resposta fiel a uma ampla variedade de intensidades. Uma vez que esta informação é armazenada, ela pode ser demonstrada usando técnicas computadorizadas de imagem, permitindo variações de brilho e contraste e ampliação, sem a necessidade de exposições radiológicas adicionais para a paciente. Neste artigo, o estado atual da tecnologia em mamografia digital e dados sobre testes clínicos que dão suporte ao uso dessa tecnologia são revistos. Além disso, algumas aplicações potencialmente utilizáveis que estão sendo desenvolvidas com a mamografia digital são descritas.

Objetivo: apresentar os transtornos somatoformes mais comumente observados na clínica médica diária, relacionando-os com a atual situação de pandemia da COVID-19. Métodos: foi realizada uma revisão bibliográfica descritiva e exploratória, de abordagem qualitativa, utilizando os bancos de dados PubMed, LILACS, SciELO e ScienceDirect; com os seguintes descritores: Somatização, Transtornos Somatoformes, Psicossomática, Hipocondria, Transtorno neurovegetativo, Dor crônica, Pandemia, Epidemia, COVID-19, Coronavírus e o boleano AND. Foram incluídas 18 referências no total. Resultados: A situação de pandemia e as medidas mais efetivas de contenção da doença, que são o isolamento e o distanciamento social, geram novos fatores estressantes aos indivíduos e estimulam o aparecimento ou o agravamento de transtornos somatoformes. Tais transtornos são divididos pela CID-10 em sete subtipos, que têm em comum sinais e sintomas somáticos sem explicação médica e provocam prejuízo no funcionamento cotidiano do indivíduo. É esperado que a incidência e prevalência dos transtornos somatoformes aumentem com a pandemia, e perdurem mesmo após a resolução da crise. Conclusões: É de grande importância que, diante do quadro pandêmico da COVID-19, os pacientes com transtornos somatoformes recebam uma atenção integral e apropriada, que considere os fatores biopsicossociais e espirituais próprios de cada indivíduo. Para tanto, é fundamental que os profissionais da saúde saibam reconhecer tanto as características específicas da doença quanto sua associação ao atual cenário, para que seja feito o diagnóstico e o tratamento adequados.

BackgroundImage-guided charcoal injection in suspicious breast lesions for preoperative localization is a procedure that has been increasing over the years because it is safer, faster, and more affordable when compared to needle-wire preoperative localization. To date, no complications have been associated with the method. However, in recent years there have been some reports about charcoal granulomas mimicking malignant lesions in some postoperative patients or in a conservative follow-up.PurposeTo report a series of 11 cases which had suspicious imaging findings for malignancy and resulted in charcoal granulomas on histopathological analysis.Material and MethodsA database of 1650 patients that attended our center from January 2007 to June 2018 was reviewed and detected 495 patients who had been previously submitted to ultrasound-guided charcoal marking in a breast lesion. Then, patients whose imaging studies were compatible with new suspicious lesions on mammography, breast ultrasound, and/or magnetic resonance imaging and biopsy of this new lesion indicating charcoal granuloma were selected.ResultsFrom 495 patients who had undergone charcoal localization injections in previous biopsies, we selected 11 who had new lesions with malignant characteristics on imaging studies but histopathological analysis resulted in charcoal granuloma.ConclusionCharcoal granuloma should be considered in patients with previous preoperative injection localization, since the residual charcoal in the breast tissue may form granulomas and mimic malignant lesions on follow-up imaging studies.

A reconstrução mamária com retalho miocutâneo tem sido amplamente utilizada em pacientes submetidas a mastectomia radical modificada por câncer de mama, com melhora significativa na auto-estima dessas pacientes, minimizando o sentimento de mutilação e melhorando a estética, sem promover alteração no prognóstico da doença. Inicialmente acreditava-se não haver risco de recorrência do câncer na mama reconstruída devido à remoção completa do tecido mamário. Porém, exames histológicos têm demonstrado que pode restar pequena quantidade de tecido mamário local após a mastectomia, tendo este tecido remanescente alto potencial de malignidade. Tem-se preconizado o acompanhamento clínico dessas pacientes, uma vez que a maioria das lesões recidivantes se situa nos pontos de inserção do retalho e elas são passí-veis de serem detectadas pela palpação. No entanto, tem-se discutido a inclusão da mamografia e da ultrasonografia no controle dessas pacientes, uma vez que estes métodos podem contribuir para o diagnóstico de lesão recorrente antes de esta tornar-se palpável. Unitermos: Câncer de mama; Mastectomia; Mamografia; Ultra-sonografia.Usefulness of mammography and ultrasound for the evaluation of myocutaneous flap-reconstructed breasts. Breast reconstruction using myocutaneous flaps has been widely used in patients undergoing modified radical mastectomy for the treatment of breast cancer with significant improvement in esthetical results, which also helps to improve self-esteem of the patients as it minimizes the feeling of mutilation, without changing disease prognosis. Previously, it was believed that there was no risk of recurrence in the reconstructed breast due to the complete removal of breast tissue. However, histological studies have shown that a small amount of glandular tissue may remain after mastectomy, with a high potential for malignancy. Clinical follow-up of mastectomy patients is recommended as most recurring lesions occur at the flap margins and can be detected by palpation. In addition, the inclusion of mammographic and ultrasound monitoring has been proposed for the follow-up of patients as these methods may contribute to the diagnosis of recurrent lesions before they become palpable. Keywords: Breast cancer; Mastectomy; Mammography; Ultrasound. quando a cirurgia conservadora não é indicada. O método tem demonstrado promover melhora na auto-estima da paciente, por restaurar sua feminilidade, e como resultado final, tem-se obtido melhor aceitação do tratamento, sem alterar o prognóstico da doença (1,2) . As primeiras técnicas de reconstrução mamária com retalho miocutâneo (RMC) surgiram tão logo foi descrita a mastectomia radical por Halsted em 1889. Nessa época, era utilizado o enxerto livre de pele, que objetivava apenas o fechamento das extensas feridas provocadas pela cirurgia, e só posteriormente passou a ter intuito de restauração da mama (3) (Figura 1). A partir de 1960, com o advento das próteses de silicone utilizadas na mamoplastia de aumento, estas também passaram a ser uma opção para a reconstr...

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A distribuição de tecido fibroglandular nas mamas ocorre em sua maioria de forma simétrica, e qualquer alteração nesta simetria pode ser indício de lesão oculta no parênquima. A avaliação da densidade assimétrica constitui, portanto, um dos principais desafios no dia-a-dia do radiologista, no sentido de diferenciar áreas de superposição de estruturas normais de lesões parenquimatosas verdadeiras. O conhecimento das diferentes técnicas e dos recursos que podem ser utilizados na investigação das densidades assimétricas é de grande importância, assim como o estabelecimento de protocolo de sua avaliação, para que a origem dessas densidades seja plenamente estabelecida, uma vez que elas podem representar a única manifestação de um câncer de mama oculto, clínica e radiograficamente.

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.