Fine-needle Aspiration Biopsy For Breast Lesions: A Comparison Between Two Devices For Obtaining Cytological Samples

Context and Objective: Fine-needle aspiration biopsy has been accepted worldwide for breast lesions. However, some questions remain, including the appropriateness of the puncture method. The objective of this work was to compare aspirates obtained by the auto-vacuum device and by the syringe pistol holder. Design and Setting: Randomized trial for validation of diagnostic method, at Hospital das Clinicas do Universidade Federal de Goiás and Hospital Araújo Jorge, Goiânio. Methods: 351 patients presenting breast lumps underwent fine-needle aspiration biopsy, either with the auto-vacuum device or the syringe pistol holder. A single cytopathologist analyzed all of the cytology slides. The rates of insufficient material, cellularity, cell distortion and background hemorrhage were evaluated. Results: The percentages of insufficient material were 16% and 22% (p = 0.18), for the auto-vacuum and pistol aspirates, respectively. Good cellularity was seen in 34% of autovacuum and 29% of pistol samples (p = 0.4). Cell distortion was seen in 31 and 26 cases, respectively (p = 07). Background hemorrhage occurred in 63 (35%) and 54 cases (31%) (p = 0.2), for auto-vacuum and pistol. The sensitivity was 88% and 86%; specificity 99% and 100%, positive predictive value 96% and and 100%, negative predictive value 96% and 95% and total occuracy 76% and 75% for the auto-vacuum and pistol, respectively. Conclusion: The results obtained from the two fine-needle aspiration biopsy methods were equivalent. Therefore, the auto-vacuum device is a good option for obtaining aspirates for cytology.1236271276Catania, S., Ciatto, S., Breast cytology: Instruments and technique (1992) Breast Cytology in Clinical Practice, pp. 11-60. , In: Ciatto S, editor. 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The World OrganizationGelabert, H.A., Hsiu, J.G., Mullen, J.T., Jaffe, A.H., D'Amato, N.A., Prospective evaluation of the rate of fine-needle aspiration biopsy in the diagnosis and management of patiencs with palpable solid breast lesions (1990) Am Surg, 56 (4), pp. 263-267Rouquayrol, M.Z., Epidemiologia e saúde (1988), Rio de Janeiro: Medsi - Editora CientíficaRoberts, J.C., Rainsbury, R.M., 'Tactile sensation: A new clinical sign during fine needle aspiration of breast lumps Ann (1994) R Coll Surg Eng, 76 (2), pp. 136-138Henderson, M.A., McCready, D.R., A simple technique for fine needle aspiration cytology (1994) J Am Coll Surg, 179 (4), pp. 471-473Sasaki, J., Izu, K., Automatic fine needle aspiration pistol specially designed for small tumors (1998) Acta Cytol, 42 (3), pp. 829-830Tao, L.C., Smith, J.W., Fine-needle aspiration biopsy using a newly-developed pencil-grip syringe holder (1999) Diagn Cytopathol, 20 (2), pp. 99-104Parel, J.J., Garrell, P.C., Smallwood, J.A., Fine needle aspiration cytology of breast masses: An evaluation of its accuracy and reasons for diagnostic failure (1987) Ann R Coll Surg Engl, 69 (4), pp. 156-159Abele, J., Stanley, M.W., Rollnis, S.D., Miller, T.R., What constitutes an adequate smear in fine-needle aspiration cytology of the breast? 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Should breast reconstruction and breast oncoplastic procedures be performed during the coronavirus pandemic?

The onset of the COVID-19 pandemic has changed the face of the treatment of breast cancer and breast reconstruction globally. Mastectomy with immediate implant-based breast reconstruction was on the rise due to advances in meshes and implants. However, due to the prioritisation of the critically ill and diversion of the work force, breast cancer treatment has drastically changed. This is an opinion paper written by the authors with experience and importance in the scenario of breast reconstructive surgery. The authors are from different countries with the COVID-19 pandemic in different stages

Diagnóstico dos problemas e potencialidades da cadeia produtiva do milho no Brasil.

Atualmente, o milho é a maior cultura agrícola do mundo e o futuro reserva um papel ainda mais importante para o cereal. O crescimento da renda de países emergentes tem levando ao aumento de consumo mundial de proteína animal, mercado no qual o milho se destaca como principal insumo das rações. Assim, mesmo sem considerar as potencialidades do etanol de milho, o fato é que o mundo demandará ainda mais o cereal nas próximas décadas. Segundo as estimativas realizadas no estudo, o mundo deve demandar 385 milhões de toneladas adicionais de milho em 2020, quando comparados a 2010. O presente documento teve por objetivo de investigar essa demanda potencial de milho no mundo e discutir as possibilidades do Brasil suprir parte desse montante adicional. Nesse sentido entende-se que há quatro pontos chaves fundamentais para o aumento da produção de milho no Brasil, que são: a) áreas novas potenciais; b) áreas potenciais para plantio de segunda safra; c) incorporação de pastagens degradas e Integração Lavoura Pecuária Floresta (iLPF); d) acréscimo de produtividade em áreas que estão abaixo da média nacional e regional. A partir de indicativos recebidos em reuniões realizadas com diversos stakeholders em regiões produtoras e consumidoras de milho no Brasil, estabeleceu-se 9 (nove) áreas que devem ser agraciadas com ações publicas: i) Irrigação; ii) Logística de Armazenagem e Estoques; iii) Logística de transporte; iv) Pesquisa, Desenvolvimento &Inovação; v) Assistência Técnica; vi) Seguro Agrícola; vii) Crédito Rural Orientado; viii) Patrulhas mecanizadas; ix) Outras políticas.bitstream/item/118533/1/doc-168.pd

Uncertainties and controversies in axillary management of patients with breast cancer

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register

Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy

Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

Aim: Demand for nipple-and skin-sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results: The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recom-mendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions: The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BRPeer reviewe

Retrospective, multicenter analysis comparing conventional with oncoplastic breast conserving surgery: oncological and surgical outcomes in women with high-risk breast cancer from the OPBC-01/iTOP2 study

Introduction: Recent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4). Methods: Data from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed. Results: A total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups. Conclusions: Large resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI