Subtipos moleculares de câncer de mama não estão associados ao subestadiamento ou ao superestadiamento do câncer de mama

Purpose to evaluate the agreement between the clinical and pathological stagings of breast cancer based on clinical and molecular features. Methods this was a cross-sectional study, in which clinical, epidemiological and pathological data were collected from 226 patients who underwent surgery at the Prof. Dr. José Aristodemo Pinotti Women's Hospital (CAISM/Unicamp) from January 2008 to September 2010. Patients were staged clinically and pathologically, and were classified as: understaged, when the clinical staging was lower than the pathological staging; correctly staged, when the clinical staging was the same as the pathological one; and overstaged, when the clinical staging was greater than the pathological staging. Results understaged patients were younger (52.2 years; p < 0.01) and more symptomatic at diagnosis (p = 0.04) when compared with correctly or overstaged patients. Clinicopathological surrogate subtype, menopausal status, parity, hormone replace therapy and histology were not associated with differences in staging. Women under 57 years of age were clinically understaged mainly due to underestimation of T ( tumor staging) (p < 0.001), as were the premenopausal women (p < 0.01). Patients whose diagnosis was made due to clinical complaints, and not by screening, were clinically understaged due to underestimation of N (lymph nodes staging) (p < 0.001). Conclusion the study shows that the clinicopathological surrogate subtype is not associated with differences in staging, while younger women diagnosed because of clinical complaints tend to have their breast tumors understaged during clinical evaluation.Objetivo avaliar a concordância entre o estadiamento clínico e patológico do câncer de mama em função das características clínicas e moleculares das pacientes. Métodos estudo de corte transversal, sendo coletados dados clínicos, epidemiológicos e anátomo-patológicos de 226 pacientes operadas no Hospital da Mulher Prof. Dr. José Aristodemo Pinotti (Centro de Atenção Integral à Saúde da Mulher - CAISM/ Unicamp), de janeiro de 2008 a setembro de 2010. As pacientes foram estadiadas clínica e patologicamente e classificadas como: subestadiadas, quando o estadiamento clínico foi menor do que o patológico; corretamente estadiadas, quando o estadiamento clínico foi equivalente ao patológico; e superestadiadas, quando o estadiamento clínico foi maior do que o patológico. Resultados as pacientes subestadiadas eram mais jovens (52,2 anos; p < 0,01) e sintomáticas ao diagnóstico (p = 0,04) do que as pacientes corretamente estadiadas ou superestadiadas. O subtipo clinico-patológico, o status menopausal, a paridade, a terapia de reposição hormonal e a histologia não foram associados com a diferença no estadiamento. Detectamos que as mulheres com menos de 57 anos de idade foram clinicamente subestadiadas principalmente devido à subestimação do T (p < 0 ,001), assim como as mulheres na pré-menopausa (p < 0,01). Por outro lado, as pacientes cujo diagnóstico foi realizado por queixa clínica, e não rastreamento, foram clinicamente subestadiadas devido à subestimação do N (p < 0,001). Conclusão o estudo nos mostra que o subtipo clinico-patológico não está associado a diferenças de estadiamento, enquanto mulheres mais jovens, e que tiveram seu diagnóstico por queixa clínica, tendem a ter seus tumores mais frequentemente subestadiados.38523924

Subtipos Moleculares De Câncer De Mama Não Estão Associados Ao Subestadiamento Ou Ao Superestadiamento Do Câncer De Mama

Purpose to evaluate the agreement between the clinical and pathological stagings of breast cancer based on clinical and molecular features. Methods this was a cross-sectional study, in which clinical, epidemiological and pathological data were collected from 226 patients who underwent surgery at the Prof. Dr. José Aristodemo Pinotti Women's Hospital (CAISM/Unicamp) from January 2008 to September 2010. Patients were staged clinically and pathologically, and were classified as: understaged, when the clinical staging was lower than the pathological staging; correctly staged, when the clinical staging was the same as the pathological one; and overstaged, when the clinical staging was greater than the pathological staging. Results understaged patients were younger (52.2 years; p &lt; 0.01) and more symptomatic at diagnosis (p = 0.04) when compared with correctly or overstaged patients. Clinicopathological surrogate subtype, menopausal status, parity, hormone replace therapy and histology were not associated with differences in staging. Women under 57 years of age were clinically understaged mainly due to underestimation of T ( tumor staging) (p &lt; 0.001), as were the premenopausal women (p &lt; 0.01). Patients whose diagnosis was made due to clinical complaints, and not by screening, were clinically understaged due to underestimation of N (lymph nodes staging) (p &lt; 0.001). Conclusion the study shows that the clinicopathological surrogate subtype is not associated with differences in staging, while younger women diagnosed because of clinical complaints tend to have their breast tumors understaged during clinical evaluation.38523924

Transdiaphragmatic pericardical window in the diagnosis of cardiac injury

BACKGROUND: This retrospective study was undertaken to evaluate the efficacy and the complications of the transdiaphragmatic pericardial window (TPW) on the diagnosis of heart injury caused by penetrating wounds. METHODS: During the period of january, 1994 to december, 2004, the pericardial window (PW) was indicated in 245 suspicious cases of cardiac trauma caused by penetrating wounds. In 38 of them (15.5%), PW was accomplished through trandiaphragmatic approach, composing the population of this study RESULTS: The trauma mechanism was gunshot in 26 patients (68.4%) and stab wounds in 12 (31.6%). Most of the patients presented multiple wounds (27 cases - 71%). The RTS average was 7.32 and the PATI average was 9.8. The PW was considered positive in 6 cases (15.8%) of those: 5 (83%) by gunshot e 1 (17%) by stab wounds. There was one patient, with multiple gunshot wounds, that present a positive PW but thoracotomy showed no cardiac injury. The sensibility of TPW was 97.4% and the specificity was 100%. In 12 (31.6%) patients there was association between injury and a perforated hollow gut. There was a single case (2.6%) of complication directly associated to the procedure, being this patient a victim of multiple gunshot wounds with perfurated liver, stomach and colon, who developed pericarditis and needed pericardial drainage, later with good outcome. The mortality rate was 7.9% (3 cases), and one of this patients died in because of postoperative acidosis and coagulopathy. CONCLUSION: The TPW procedure allows rapid diagnostic of cardiac injury in patients who have the lapatotomy as a priority. It is an easy method with high sensibility.OBJETIVO: Avaliar a eficácia e as complicações da utilização da janela pericárdica (JP) transdiafragmática no diagnóstico de lesão cardíaca por ferimento penetrante. MÉTODO: No período de janeiro de 1994 a dezembro de 2004 a JP foi indicada em 245 casos com suspeita de trauma cardíaco por ferimento penetrante. Em 38 deles (15,5%) a JP foi realizada através de acesso transdiafragmático, constituindo a população do presente estudo. RESULTADOS: O mecanismo de lesão foi ferimento por projétil de arma de fogo (FPAF) em 26 casos (68,4%) e por arma branca (FAB) em 12 casos (31,6%). Na maioria dos pacientes (27 casos - 71%) os ferimentos eram múltiplos. A média de RTS foi de 7,32 e a média de PATI foi de 9,8. A JP foi considerada positiva em seis casos (15,8%) dos quais cinco (83%) por FPAF e um (17%) por FAB. Houve um paciente, vítima de múltiplos FPAF, com JP positiva e toracotomia em que não foi identificada lesão cardíaca. A sensibilidade do método foi de 97,4% e a especificidade de 100%. Em 12 (31,6%) pacientes houve associação de lesão com perfuração de víscera oca. Houve um único caso (2,6%) de complicação diretamente relacionada ao procedimento, em uma vítima de múltiplos FPAF com lesão perfurada de fígado, estômago e cólon, que evoluiu com pericardite, necessitando posteriormente de drenagem pericárdica, com boa resolução. A mortalidade foi de 7,9% (três casos), um dos quais em pós-operatório de reparo de lesão cardíaca por coagulopatia/acidose. CONCLUSÕES: A JP trandiafragmática é um procedimento que permite o rápido diagnóstico de lesão cardíaca em pacientes nos quais a prioridade é a laparotomia. Trata-se de método de fácil realização e alta sensibilidade.293

Concordance between clinical and pathological staging according to intrinsic clinics-pathologic surrogate subtype of breast cancer

Orientador: Luis Otavio Zanatta SarianDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Introdução: O estadiamento do câncer de mama envolve a avaliação adequada da extensão local e distante da doença, e deve ser feito de maneira precisa, a fim de levar a um correto diagnóstico, e indicação de terapia adequada. Os tumores são classificados de acordo com o American Joint Comitee on Cancer (AJCC), tanto clínica, quanto patologicamente, não sendo levadas em consideração as características moleculares. Ainda não se sabe como a avaliação das características dos pacientes e seus tumores pode limitar a avaliação correta do estadiamento clínico do câncer de mama. Neste estudo, foram examinados fatores que podem, em teoria, ser associadas a uma discrepância entre o estadiamento clínico e patológico dos tumores de mama em mulheres virgens de tratamento. Objetivo: Avaliar a concordância entre o estadiamento clínico e patológico do câncer de mama em função das características clinicas e moleculares das pacientes. Sujeitos e métodos: Estudo de corte transversal, sendo coletados dados clínicos, epidemiológicos e anátomo-patológico de 226 pacientes operadas no Hospital da Mulher Prof. Dr. José Aristodemo Pinotti Hospital ¿ CAISM- UNICAMP, de janeiro de 2008 a setembro de 2010. Foram incluídas mulheres submetidas a tratamento cirúrgico primário de câncer de mama, com carcinoma ductal invasivo ou carcinoma lobular invasivo. Foram excluídas da análise pacientes submetidas a quimioterapia neoadjuvante, metastáticas ou já tratados para câncer de mama anteriormente. Resultados: As pacientes que foram subestadiadas eram mais jovens (idade ao diagnóstico = 52,2 anos; p < 0,01) e sintomáticas ao diagnóstico (p = 0,04) em relação às pacientes corretamente estadiadas ou superestadiadas. O subtipo clinico-patológico, status menopausal, paridade, história prévia de câncer de mama, a terapia hormonal e histologia (se ductal ou não-ductal) não foram associados com a diferença no estadiamento clinico e patológico. Detectamos que as mulheres com menos de 57 anos de idade foram clinicamente subestadiadas principalmente devido à subestimação do T (p < 0,001) assim como as mulheres na pré-menopausa (p < 0,01). Por outro lado, as pacientes cujo diagnóstico foi realizado por queixa clínica, e não rastreamento, foram clinicamente subestadiadas devido à subestimação do N (p < 0,001). Conclusão: O estudo nos mostra que o subtipo clinico-patológico não está associado a diferenças de estadiamento, enquanto mulheres mais jovens, e que tiveram seu diagnóstico por queixa clínica e não por rastreamento, tendem a ter seus tumores mais frequentemente subestadiadosAbstract: Background: The staging of breast cancer involves the proper assessment of local and distant extent of disease, and should be done accurately in order to lead to a correct diagnosis and indication of appropriate therapy. Tumors are classified according to the American Joint Committee on Cancer (AJCC), both clinically and pathologically, not taking into account molecular characteristics. It is unclear how the evaluation of patient characteristics and their tumors may limit the correct evaluation of the clinical stage of breast cancer. In this study, we examined factors that can, in theory, be associated with a discrepancy between clinical and pathological staging of breast tumors in women undergoing surgery. Objective: To evaluate the concordance between clinical and pathological staging of breast cancer on the basis of clinical and molecular features. Subjects and Methods: This was a cross-sectional study developed at Women's Hospital Prof. Dr. Jose Aristodemo Pinotti ¿ UNICAMP, from January 2008 to September 2010. We included 226 women undergoing primary surgical treatment for breast cancer, whose histological samples could provide material for the accurate diagnosis of cancer and its staging. Patients undergoing neoadjuvant chemotherapy, with metastasis or treated previously for breast cancer were excluded from the analysis. Results: The understaged patients were younger (age at diagnosis = 52.2 years; p <0.01) and symptomatic at diagnosis (p = 0.04) compared with correctly staged or overstaged patients. The clinical-pathological surrogates subtype, menopausal status, parity, previous history of breast cancer, hormone therapy and histology (if ductal or non-ductal) were not associated with a difference in clinical and pathological staging. We found that women under 57 years of age were clinically understaged mainly due to underestimation of T (p <0.001) as well as women in pre-menopause (p < 0.01). On the other hand, patients whose diagnosis was made by clinical complaints, and not by screening, were clinically understaged due to underestimation of N (p < 0.001). Conclusion: The study shows that clinical-pathological surrogates subtypes were not associated with understaging, whereas younger women, and who had their diagnosis by clinical complaints and not by screening, tend to have their tumors more often understagedMestradoOncologia Ginecológica e MamáriaMestra em Ciências da Saúd

Janela pericárdica transdiafragmática no diagnóstico de lesão cardíaca

OBJETIVO: Avaliar a eficácia e as complicações da utilização da janela pericárdica (JP) transdiafragmática no diagnóstico de lesão cardíaca por ferimento penetrante. MÉTODO: No período de janeiro de 1994 a dezembro de 2004 a JP foi indicada em 245 casos com suspeita de trauma cardíaco por ferimento penetrante. Em 38 deles (15,5%) a JP foi realizada através de acesso transdiafragmático, constituindo a população do presente estudo. RESULTADOS: O mecanismo de lesão foi ferimento por projétil de arma de fogo (FPAF) em 26 casos (68,4%) e por arma branca (FAB) em 12 casos (31,6%). Na maioria dos pacientes (27 casos - 71%) os ferimentos eram múltiplos. A média de RTS foi de 7,32 e a média de PATI foi de 9,8. A JP foi considerada positiva em seis casos (15,8%) dos quais cinco (83%) por FPAF e um (17%) por FAB. Houve um paciente, vítima de múltiplos FPAF, com JP positiva e toracotomia em que não foi identificada lesão cardíaca. A sensibilidade do método foi de 97,4% e a especificidade de 100%. Em 12 (31,6%) pacientes houve associação de lesão com perfuração de víscera oca. Houve um único caso (2,6%) de complicação diretamente relacionada ao procedimento, em uma vítima de múltiplos FPAF com lesão perfurada de fígado, estômago e cólon, que evoluiu com pericardite, necessitando posteriormente de drenagem pericárdica, com boa resolução. A mortalidade foi de 7,9% (três casos), um dos quais em pós-operatório de reparo de lesão cardíaca por coagulopatia/acidose. CONCLUSÕES: A JP trandiafragmática é um procedimento que permite o rápido diagnóstico de lesão cardíaca em pacientes nos quais a prioridade é a laparotomia. Trata-se de método de fácil realização e alta sensibilidade

Cyclooxygenase-2 (COX2) and p53 protein expression are interdependent in breast cancer but not associated with clinico-pathological surrogate subtypes, tumor aggressiveness and patient survival

In the last decade, different molecular subtypes of breast cancer have been proposed. Although displaying appreciable association with disease prognosis and the prognostic value of cytotoxic and endocrine therapeutic modalities, the subtypes seem to fail at completely explaining disease behavior and response to treatment. Molecules such as those of the cyclocooxigenase (COX) family, currently composed of three entities (COX 1, 2 and 3) have been shown to be associated with breast carcinogenesis, and the analysis of p53 expression in breast tumors may also offer some additional prognostic clues. Our study is aimed at assessing COX2 and p53 expression in these clinico-pathological surrogate subtypes, and to evaluate whether the expression of these molecules can help further explain the variability in prognosis still found within the clinico-pathological subtypes groups of breast cancer. Methods: A total of 183 breast cancer samples were obtained from women treated at the Womenis Hospital of Campinas State University, Campinas, Brazil, between June 2008 and January 2011. Immunohistochemistry was performed to detect the expression of ER, PR, ki67, COX2, and p53 and the HER2 status of the 183 specimens was assessed using FISH. Two COX2 staining thresholds were used to define COX2 positivity: low threshold (LT): moderate and intense staining were considered positive; high-threshold (HT): only intense staining was considered positive. Results: There was no trend in COX2 overexpression from Luminal A-like to Triple-negative subtypes. By contrast, p53 was expressed in roughly 67% of the Luminal A-like tumors, 50% of the Luminal B-like HER2 positive tumors, 60.9% of the Luminal B-like HER2 negative, approximately 82% of the HER2 positive (non-luminal) and 87% of the Triple-negative tumors (p for trends = 0.06). There was a significantly higher proportion of COX2 positive (LT) tumors (66.9%) when p53 was also positive compared to when the tumor was negative for p53 (in which case only 18.0% of the tumors were positive for COX2; p<0.001). Neither marker was found to be associated with patients' survival. Conclusions: There seems to be a positive association between the expressions of COX2 and p53. Otherwise, neither the expression of COX nor that of p53 was associated with clinico-pathological subtypes, tumor features and prognosis. It seems to be too early to elect the detection of COX2 using IHC as prognostic or predictive tool, but incipient evidence points toward a possible role for the marker1182176182FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP2009/17097-