Tratamento Cirúrgico Conservador do Câncer de Mama

Nos últimos 15 anos o tratamento cirúrgico do câncer de mama foi revolucionado por alguns novos conceitos na história natural destes tumores. A impossibilidade de controlar a doença com uma cirurgia alargada, a identificação de tumores cada vez menores com o uso da mamografia, a possibilidade da "paciente atual" participar da escolha do tratamento, criaram as condições para um tratamento conservador. Os resultados retrospectivos e, especialmente, prospectivos, dos estudos sobre o tratamento conservador têm demonstrado que a terapia de combinação pode fornecer um adequado controle local do tumor. O Trial 1 de Milão, comparando a mastectomia de Halsted versus a QUART(quadrantectomia, dissecção axilare radioterapia), forneceu uma importante contribuição mostrando não existir diferenças na sobrevida global, período livre de doença e recidivas locais entre os dois tipos de tratamento

Strategies for Breast Cancer Surgery During & After COVID-19 Pandemic

Background: In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), also named "COVID-19", has produced a global pandemic and has seriously affected many health systems around the world. Since the World Health Organization (WHO) declared the novel COVID-19 outbreak as a global pandemic, many international societies and groups of experts have published clinical guidelines and recommendations for surgical management of breast cancer patients in this time of crisis and issued COVID guidelines to prioritize surgery where time is critical and it cannot be deferred.Methods: In this study, we review current recommendations for breast cancer surgery during the COVID-19 pandemic and propose a plan for future waves of the current pandemic while minimizing the risk of the contagious disease and oversaturating the health systems regarding the burden of accumulating untreated disease.Results: We create a critical and constructive vision from learnt lessons for similar future situations and propose a moving forward plan during and after the COVID-19 pandemic. Conclusion: Although in many parts of world, it would appear that now we are past the peak of the COVID-19 pandemic, we still face as uncertainty as to the future course of the pandemic and the challenges of the second wave. It is important to reappraise continuously the guidance and to emphasize the need for new protocols under new norms to continue to deliver breast cancer surgery safely

The management of ductal intraepithelial neoplasia (DIN): open controversies and guidelines of the Istituto Europeo di Oncologia (IEO), Milan, Italy

International audienceThe management of ductal intraepithelial neoplasia (DIN) has substantially changed over the past 30 years, as its incidence has increased (from 2-3% to more than 20%), mainly due to the widespread use of mammography screening. This article describes not only the more widespread theoretical concepts on DIN but also the differences in the practical applications of the theory between different countries, different oncology specialists, and different cancer centers. Papers related to the international multicentric-randomized trials and retrospective studies were analyzed. We include articles and papers published between 1993 and 2010 related to patients with DIN, and abstracts and reports from MEDLINE and other sources were indentified. The standard of care for DIN consists of (a) breast conservative surgery (mastectomy is still indicated in large lesions--masses or microcalcifications--in about 30% of cases); (b) radiotherapy (RT) after conservative surgery, and (c) medical treatment in estrogen receptors-positive patients. However, most studies have shown significant differences between theory and practical application. Moreover, there are differences regarding (a) the indications of sentinel lymph node biopsy, (b) the definition and identification of low-risk DIN subgroups that can avoid RT and tamoxifen, and (c) the research into new alternative drugs in adjuvant medical therapy. A general agreement on the best management of DIN does not exist as yet. New large trials are needed in order to define the best management of DIN patients which is (in most respects) still complex and controversial

Giant malignant phyllodes tumor of the breast: Insights into optimal management and reconstructive options for a rare and challenging entity

Giant malignant phyllodes tumor of the breast: Insights into optimal management and reconstructive options for a rare and challenging entit

A Model to Predict Upstaging to Invasive Carcinoma in Patients Preoperatively Diagnosed with Low-Grade Ductal Carcinoma In Situ of the Breast

Background: We aimed to create a model of radiological and pathological criteria able to predict the upgrade rate of low-grade ductal carcinoma in situ (DCIS) to invasive carcinoma, in patients undergoing vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. Methods: A total of 3100 VABBs were retrospectively reviewed, among which we reported 295 low-grade DCIS who subsequently underwent surgery. The association between patients’ features and the upgrade rate to invasive breast cancer (IBC) was evaluated by univariate and multivariate analysis. Finally, we developed a nomogram for predicting the upstage at surgery, according to the multivariate logistic regression model. Results: The overall upgrade rate to invasive carcinoma was 10.8%. At univariate analysis, the risk of upgrade was significantly lower in patients with greater age (p = 0.018), without post-biopsy residual lesion (p < 0.001), with a smaller post-biopsy residual lesion size (p < 0.001), and in the presence of low-grade DCIS only in specimens with microcalcifications (p = 0.002). According to the final multivariable model, the predicted probability of upstage at surgery was lower than 2% in 58 patients; among these 58 patients, only one (1.7%) upstage was observed, showing a good calibration of the model. Conclusions: An easy-to-use nomogram for predicting the upstage at surgery based on radiological and pathological criteria is able to identify patients with low-grade carcinoma in situ with low risk of upstaging to infiltrating carcinomas