1,721,032 research outputs found
Biopsia del Linfonodo Sentinella. Esame istologico intraoperatorio parziale, vantaggi e risultati
No full text“Utilizzo di una nuova forbice ad ultrasuoni nella linfoadenectomia ascellare. Risultati preliminari”
No full textMinerva Chirurgica Vol. 63 Supll.1, N. 3, pgg 158-6
The Proper Ki-67 Cut-Off in Hormone Responsive Breast Cancer. A Monoinstitutional Analysis with Long-Term Follow-Up
Full text linkIntroduction: Breast cancer is a heterogeneous disease. Our study focuses on a monoinstitutional series of patients affected by Hormone Responsive carcinomas (luminal A and luminal B) and aims to define an optimal Ki-67 cut-off, to correctly stratify these patients into risk classes, using the ImmunoHistoChemical (IHC) surrogates of the Molecular Subtypes, according to the St. Gallen guidelines. Methods: We analyzed 1685 patients. These patients underwent both radical and conservative surgeries with Sentinel Lymph Node Biopsy eventually followed by Axillary Dissection (AD). Furthermore, all the patients underwent adjuvant therapies according to the guidelines. A retrospective univariate analysis was performed and survival curves (Disease-Related Survival, DRS, and Disease-Free Survival, DFS) were carried out according to the following ki-67 risk classes: Low Risk (Ki-67 ≤ 14%); Intermediate Risk (Ki-67 15% ÷ 20%); High Risk (Ki-67 > 20%). Results: 14 yy DRS was 98% in LA and 85% in LB with a ki-67 cut-off of 14% (p=0.037) vs 95% (LA) and 83% (LB) with a ki-67 cut-off of 20% (p=0.003). 14yy DFS was 85% in LA and 72% in LB with a ki-67 cut-off of 14% (p=0.017) vs 83% (LA) and 66% (LB) with a ki-67 cut-off of 20% (p<0.000). Discussion: Our results confirmed that the 20% Ki-67 cut-off is more reliable in differentiating patients at low or high risk of recurrence and death, and stratifying patients eligible for adjuvant chemotherapy. Thus, despite its poor reproducibility, the identification of the most accurate ki-67 index assumes a pivotal relevance in guiding a tailored strategy among patients with this specific profile of breast cancer, as well as the molecular surrogates, in order to avoid harmful overtreatments
Outcome according to immunohistochemical surrogates of the molecular subtypes in early breast cancer
No full textUse of mesh to repair the submuscolar pocket in breast reconstruction: A new possible technique
No full textFrozen section in sentinel lymph node biopsy for breast cancer in the era of ACOSOG Z0011 and IBCSG 23-10 trials
No full textBackground. Frozen Section (FS) intraoperatively performed on Sentinel Lymph Node (SLN) has low sensitivity for detecting micro-metastases (< 2 mm), resulting in patients who later undergo deferred axillary dissection. The results of recent trials as ACOSOG Z0011 and IBCSG 23-10 changed our approach to the management of the axilla in case of positive SLN. Aim of the study is to determine the best clinical approach to deciding which patients would derive real benefit from ALND, minimizing the functional and psychological damage caused by a delayed surgery while also minimizing the risk of undertreating EBC patients.
Methods. We evaluated 1453 patients with early breast cancer (EBC) undergone SLN biopsy, FS and definitive evaluation, focusing on cause of discrepancy and the need for further surgery.
Results. FS were carried out in 1226 cases (86%). False negative FS were 146 (11.9%). The global sensitivity of FS in detecting both macro and micrometastases was 53.7% . According to ACOSOG Z0011 criteria ALND could be spared in 236 patients, but 40 were found having > 3 positive axillary lymph nodes (17%). Applying the IBCSG23-10 trial criteria, (3.1%) we found patients with>3 positive axillary lymph nodes in 3 cases only.
Conclusions. This study confirms the low sensitivity of FS in detecting micrometastases (19%) and a reasonable sensitivity for macrometastases (75%). False negatives were more commonly smaller metastases (mean 2.1mm) and more likely in Infiltrating Lobular Carcinoma. If we retrospectively modelled the IBCSG 23-10 criteria, we would have found a reduction of deferred surgery from 12% to 4%. In case of patients with 4 axillary metastatic lymph nodes, the main guidelines recommend irradiation of lymph node drainage stations. Patients who met Z0011 criteria showed that, if we did not perform an ALND they would have been undertreated. This risk decreases to 3% omitting the axillary clearing only in case of micrometastases
- …
