Peri-lymph nodal pathological fibrosis and axillary surgical impairment after percutaneous fragment biopsy of sentinel lymph node detected with contrast-enhanced ultrasonography (CEUS) in early breast cancer patients

Orientadores: Rodrigo Menezes Jales, Sophie Françoise Mauricette DerchainDissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: avaliar a fibrose axilar peri-linfonodal em espécimes cirúrgicos de pacientes previamente submetidas a biópsia percutânea de fragmento 14G (BPF) do linfonodo sentinela identificado com ultrassonografia contrastada (USC). Métodos: esse estudo foi originalmente desenhado para avaliar o desempenho da USC+BPF no estadiamento axilar do câncer de mama em estágio inicial. A seleção dos participantes foi interrompida e o desenho foi reformulado para um estudo descritivo transversal após o achado inesperado de fibrose peri-linfonodal reportada em espécimes cirúrgicos axilares. A frequência ou a média das principais variáveis clínicas, ultrassonográficas, cirúrgicas e patológicas foram calculadas. O teste T ou o qui-quadrado de Pearson compararam os grupos de pacientes com e sem diagnóstico de fibrose peri-linfonodal. Resultados: Dados de quarenta e oito pacientes submetidos à USC+BPF e à cirurgia axilar foram elegíveis para o estudo. Os espécimes cirúrgicos axilares mostraram fibrose peri-linfonodal em 9/48 (18,7%) pacientes. A maioria das fibroses peri-linfonodais foi classificada como moderada (4/9 (44,4%)) ou extensa (4/9 (44,4%)) pelo patologista. A idade das pacientes (p = 0,99), o tamanho do tumor (p = 0,60), o número de metástase linfonodais (p = 0,83), o uso de inibidor de aromatase (p = 0,43), o número de injeções do contraste intradérmico (p = 0,68), a identificação do linfonodo sentinela pela USC (p = 0,10), e o diâmetro máximo médio do linfonodo sentinela identificado pela USC (p = 0,24) não diferiram em pacientes com e sem diagnóstico de fibrose axilar peri-linfonodal. Por outro lado, a dificuldade operatória axilar 4/9 (44,4%) e o hematoma axilar 2/9 (22,2%) foram apenas relatados em pacientes com fibrose axilar peri-linfonodal (p <0,001 e p=0,003, respectivamente). Além disso, o tempo médio entre a USC+BPF e a cirurgia axilar em pacientes com fibrose peri-linfonodal (20,1 dias, DP = 13,1, intervalo de 6 a 37 dias) foi menor que em pacientes sem fibrose axilar (37,9 dias, DP = 25,5, intervalo 2-118 dias) (p = 0,04). Conclusão: A fibrose patológica peri-linfonodal pode prejudicar o procedimento cirúrgico axilar de pacientes com câncer de mama precoce estadiadas com USC+BPFAbstract: Purpose: To evaluate peri-lymph nodal pathological fibrosis in axillar surgical specimens of breast cancer patients submitted to 14G percutaneous fragment biopsy (PFB) of axillary sentinel lymph node identified with contrast-enhanced ultrasonography (CEUS) Methods: This study was originally designed to assess the performance of CEUS+PFB on the axillary staging of early-stage breast cancer. The selection of participants was interrupted, and the design was reformulated to this descriptive cross-sectional study after unexpected peri-lymph nodal pathological fibrosis reported in axillary surgery specimens. The frequency or means of the main clinical, ultrasonographic, surgical and pathological characteristics were calculated. T-test or Pearson Chi-Square test compared the groups of patients with and without peri-lymph nodal pathological fibrosis. Results: Data from forty-eight patients submitted to CEUS+PFB and axillary surgery were eligible for this study. Axillary surgical specimens showed peri-lymph nodal fibrosis in 9/48 (18.7%) patients. The majority of peri-lymph nodal fibrosis were described as moderate (4/9(44.4%)) or severe (4/9(44.4%)). There was no significant difference between groups regarding patient age (p=0.99), breast tumor size (p=0.60), rate of lymph-node metastasis (p=0.83), use of aromatase inhibitor (p=0.43), number of intradermal contrast injection (p=0.68), CEUS sentinel lymph identification (p=0.10), and CEUS sentinel lymph node mean maximum diameter (p=0.24). Axillary surgical impairment 4/9(44.4%) and axillary hematoma 2/9(22.2%) were only reported in patients with axillary peri-lymph nodal fibrosis (p<0.001 and p=0.003, respectively). Besides that, mean time between CEUS+PFB and axillary surgery in patients with peri-lymph nodal fibrosis (20.1 days, SD=13.1, range 6 to 37 days) was shorter than in patients without axillary fibrosis (37.9 days, SD=25.5, range 2-118 days) (p=0.04). Conclusion Peri-lymph nodal pathological fibrosis may impair the axillary surgical procedure of early breast cancer patients staged with CEUS+PFBMestradoPesquisa ClínicaMestra em Ciências Médicas2015/22438-3FAPES

Drug therapies for obstructive sleep apnoea: a systematic review and meta-analysis protocol

Introduction Obstructive sleep apnoea (OSA) is a common disorder that can affect the quality of life and increase the risk for psychiatric, neurological and cardiometabolic diseases. Despite the significant burden, it poses on health and well-being, there is a lack of evidence regarding the use of drug therapies in these patients. This work aims to evaluate the efficacy and safety of pharmacological treatment alternatives for patients with OSA.Methods and analysis Databases, including PubMed, Embase, Web of Science, SciELO, LILACS, Scopus, Cochrane Register of Controlled Trials and ClinicalTrials.gov, will be used for the search. A search strategy was developed to retrieve clinical trials that have evaluated polysomnographic primary outcome (Apnoea-Hypopnoea index) and secondary outcomes (eg, daytime sleepiness, adverse events) of any drug therapy used for OSA. No date or language restrictions will be applied. Two authors will independently select the studies meeting the inclusion criteria by screening the title, abstract and full text. Data will be extracted, and the risk of bias will be evaluated using the Cochrane Risk of Bias Tool. Review Manager V.5.4.1 will be used for data synthesis. The Grading of Recommendation Assessment, Development and Evaluation will be used to assess the strength of the evidence.Ethics and dissemination As a review of published data, it is not necessary to obtain ethical approval. The findings of this systematic review will be published in a peer-reviewed journal.PROSPERO registration number CRD42022362639

Perinodal fibrosis developed after ultrasonography-guided core-needle biopsy of a contrast-enhanced ultrasound-detected sentinel axillary node interferes with subsequent surgical sentinel node dissection

To evaluate perinodal fibrosis after 14-gauge staging core-needle biopsy (CNB) of the axillary sentinel lymph node (SLN) identified using contrast-enhanced ultrasonography (CEUS) and its interference with subsequent surgical SLN dissection in breast cancer patients. Methods Frequencies or means of main clinical, sonographic, pathological, and surgical characteristics were calculated. We also compared patient groups with and without perinodal pathological fibrosis. Results Forty-eight patients who underwent CEUS + CNB and axillary surgery were eligible for this cross-sectional study. Axillary surgical specimens showed perinodal fibrosis in 9/48 (18.7%) patients. Interference with SLN dissection was reported in 4/48 (8.3%) patients (two hematomas, three abnormal palpation findings, and four difficult dissections). The overall surgical detection rate of SLN was 43/48 (89.6%). In the majority of cases, perinodal fibrosis was described as moderate (4/9 [44.4%]) or severe (4/9 [44.4%]). The mean time elapsed between CEUS + CNB and axillary dissection was shorter in patients with perinodal fibrosis (P = .04). Interference with SLN dissection was only reported in patients with perinodal fibrosis (P < .001). Surgical SLN detection was successful in all nine cases in which perinodal pathological fibrosis or interference with SLN dissection was reported. Conclusion Perinodal fibrosis may impair the surgical SLN dissection in early stage breast cancer patients who were staged using CEUS + CNB using a14-gauge needle.478445452CNPQ - Conselho Nacional de Desenvolvimento Científico e TecnológicoFAPESP – Fundação de Amparo à Pesquisa Do Estado De São Paulo303742/2018‐62015/22438‐