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Background. Axillary surgical management in patients with node-positive breast cancer at the time of diagnosis converted to negative nodes through neoadjuvant chemotherapy (NAC) remains unclear. Removal of more than two sentinel nodes (SLNs) in these patients may decrease the false negative rate (FNR) of sentinel lymph node biopsies (SLNBs). We aim to analyse the detection rate (DR) and the FNR of SLNB assessment according to the number of SLNs removed. Methods. A retrospective study was performed from October 2012 to December 2018. Patients with invasive breast cancer who had a clinically node-positive disease at diagnosis and with a complete axillary response after neoadjuvant chemotherapy were selected. Patients included underwent SLNB and axillary lymph node dissection (ALND) after NAC. The SLN was considered positive if any residual disease was detected. Descriptive statistics were used to describe the clinicopathologic features and the results of SLNB and ALND. The DR of SLNB was defined as the number of patients with successful identification of SLN. Presence of residual disease in ALND and negative SLN was considered false negative. Results. A total of 368 patients with invasive breast cancer who underwent surgery after complete NAC were studied. Of them, 85 patients met the eligibility criteria and were enrolled in the study. The mean age at diagnosis was 50.8 years. Systematic lymphadenectomy was performed in all patients, with an average of 10 lymph nodes removed. The DR of SLNB was 92.9%, and the FNR was 19.1. The median number of SLNs removed was 3, and at least, three SLNs were obtained in 42 patients (53.2%). When at least three sentinel nodes were removed, the FNR decreased to 8.7%. Conclusions. In this cohort, the SLN assessment was associated with an adequate DR and a high FNR. Removing three or more SLNs decreased the FNR from 19.1% to 8.7%. Complementary approaches may be considered for axillary lymph node staging after neoadjuvant chemotherapy. The study was approved by our institution’s ethics committee (Instituto de Investigacion Sanitaria Hospital 12 de Octubre (imas12), Universidad Complutense de Madrid, Madrid, Spain) (https://clinicaltrials.gov/ct2/show/NCEI:20/0048).

testing with 16/18 genotyping and triage with p16/Ki-67 immunocytochemistry. Methodology Women between 30 and 60 years who had in 12 collaborating centres regular annual Pap smear were cotested in 3 years interval for HPV DNA with selective 16/18 genotyping (Cobas 4800, Roche). All HPV 16/18 positive cases and/or those with severe abnormality in cytology were directly refered to colposcopy; HPV non-16/18 positive cases and LSILs were triaged using p16/Ki-67 dual-stained cytology (CINtec Plus, Roche) and positive cases were refered to colposcopy. Result(s)* Altogether 2407 patiens were eligible for analysis. Mean age of subjects was 43 years. The first round showed 8 cases with severe and 105 cases with mild Pap smear abnormalities. There were 7.4% (180/2418) patients with HPV positivity, out of them 50 had HPV 16 and/or 18. Triage using p16/Ki-67 was positive in 22.5% cases (29/129). After 2 years of follow-up biopsy confirmed 38 HSILs and 2 glandular lesions, all of them were HPV positive. Conclusion* Screening based on HPV testing with selective 16/18 genotyping and p16/Ki-67 triage proved during three years four times more high-grade lesions including glandular lesions than standard screening based on Pap smears.

Background: The inflammatory reaction after a surgical intervention could exacerbate the course of the COVID-19. We aim to determine the rate of COVID-19 and its complications among gynecological surgeries in the context of different measures taken during the pandemic period in our department. Methods: A retrospective longitudinal observational study was conducted. Clinical records of patients who underwent gynecological surgery from March 1 st to April 10 th , 2020 were reviewed. During this period, three different approachs were made: first phase, without any screening or surgical restrictions; second phase, with presurgical epidemiological screening using a specific questionnaire; and third phase, also with presurgical SARS-COV-19 RT-PCR. During the second and third phases the surgical activity and complexity were restricted, and different workflows were established for patient with suspected/confirmed infection. After hospital discharge, telephone follow-up was performed and screening for COVID-19 was carried out. Complications from the disease were analyzed. Results : Of the 118 patients that underwent gynecological surgeries, 10 (8.5%) were perioperatively diagnosed with COVID-19. Of these patients, 8 (80%) were not pre-surgical screened for SARS-CoV-2 infection, neither clinical nor with RT-PCR. The other 2 (20%) were preoperative screened with RT-PCR, one of them with a positive test result. Screening false negative rate was 0.8%. No postoperative complications derived from COVID-19 were observed. Conclusions: The establishment of different surgical workflows, the reduction of surgical complexity, and the use of a pre-surgical screening to detect patient at SARS-CoV-2 infection risk, could reduce the postoperative complications derived from that infection and improve surgical outcomes.