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Oses G, Mension E, Pumarola C, Castillo H, Francesc L, Torras I, Cebrecos I, Caparrós X, Ganau S, Ubeda B, Bargallo X, González B, Sanfeliu E, Vidal-Sicart S, Moreno R, Muñoz M, Santamaría G, Mollà M. Analysis of Local Recurrence Risk in Ductal Carcinoma In Situ and External Validation of the Memorial Sloan Kettering Cancer Center Nomogram. Cancers (Basel) 2023; 15:cancers15082392. [PMID: 37190320 DOI: 10.3390/cancers15082392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Adjuvant radiotherapy and hormonotherapy after breast-conserving surgery (BCS) in ductal carcinoma in situ (DCIS) have been shown to reduce the risk of local recurrence. To predict the risk of ipsilateral breast tumor relapse (IBTR) after BCS, the Memorial Sloan Kettering Cancer Center (MSKCC) developed a nomogram to analyze local recurrence (LR) risk in our cohort and to assess its external validation. METHODS A historical cohort study using data from 296 patients treated for DCIS at the Hospital Clínic of Barcelona was carried out. Patients who had had a mastectomy were excluded from the analysis. RESULTS The mean age was 58 years (42-75), and the median follow-up time was 10.64 years. The overall local relapse rate was 13.04% (27 patients) during the study period. Actuarial 5- and 10-year IBTR rates were 5.8 and 12.9%, respectively. The external validation of the MSKCC nomogram was performed using a multivariate logistic regression analysis on a total of 207 patients, which did not reach statistical significance in the studied population for predicting LR (p = 0.10). The expression of estrogen receptors was significantly associated with a decreased risk of LR (OR: 0.25; p = 0.004). CONCLUSIONS In our series, the LR rate was 13.4%, which was in accordance with the published series. The MSKCC nomogram did not accurately predict the IBTR in this Spanish cohort of patients treated for DCIS (p = 0.10).
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Affiliation(s)
- Gabriela Oses
- Department of Radiation Oncology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Eduard Mension
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Claudia Pumarola
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Helena Castillo
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - León Francesc
- Department of Radiation Oncology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Inés Torras
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Isaac Cebrecos
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Xavier Caparrós
- Department of Obstetrics and Gynecology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Sergi Ganau
- Department of Radiology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Belén Ubeda
- Department of Radiology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Xavier Bargallo
- Department of Radiology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Blanca González
- Departament of Pathology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Esther Sanfeliu
- Departament of Pathology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Sergi Vidal-Sicart
- Departament of Nuclear Medicine, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Reinaldo Moreno
- Department of Medical Oncology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Montserrat Muñoz
- Department of Medical Oncology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
| | - Gorane Santamaría
- Department of Radiology, Princess Alexandra Hospital, Brisbane 4102, Australia
| | - Meritxell Mollà
- Department of Radiation Oncology, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
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Bargallo X, Ubeda B, Ganau S, Gonzalez B, Macedo M, Alonso I, Oses G, Vidal M, Santamaria G. Magnetic Resonance Imaging Assessment of Radial scars/complex Sclerosing Lesions of the Breast. Curr Med Imaging 2020; 18:242-248. [PMID: 33390120 DOI: 10.2174/1573405616666201231095918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/02/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the magnetic resonance characteristics of radial scars/complex sclerosing lesions (RS/CSL) of the breast using the current BI-RADS lexicon. To investigate the value of diffusion weighted imaging to predict malignancy. PATIENTS AND METHODS From 2010 to 2017 we have found 25 women with architectural distortion at mammography who underwent surgical resection with a final hystopathologic report of RS/CSL. For description of MRI findings we adhered to BI-RADS classification (5th edition). RESULTS The final pathological diagnosis was: "pure" RS/CSL in 7 cases (28%), RS/CSL with associated high risk lesions in 12 (48%) and 6 cases (24%) were associated with malignancy. Magnetic resonance findings: four of 25 negative or focus. Five of 25 mass enhancement: irregular, non circumscribed spiculated mass with heterogeneous or rim enhancement and most with type II curves. Sixteen of 25 non mass enhancement: focal or linear distribution and heterogeneous internal enhancement most with type I curves. Six of 25 had cancer associated with the complex sclerosing lesion. All six showed non-mass, focal and clustering-ring enhancement. Two cases with invasive breast carcinoma had ADC values under 1.15 x10-3 mm/s while most of the rest had values above. CONCLUSION Most RS/CSL showed enhancement at MR. The predominant pattern was a non-mass, focal, heterogeneous internal enhancement with type 1 curves. All cases with associated cancer showed non mass enhancement. Invasive breast cancers had ADC values < 1.15 10-3 s/mm2.
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Affiliation(s)
- Xavier Bargallo
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Belen Ubeda
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Sergi Ganau
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Blanca Gonzalez
- Hospital Clinic de Barcelona, Department of Pathology (CDIC), Barcelona. Spain
| | - Miguel Macedo
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Inma Alonso
- Hospital Clinic de Barcelona, Department of Gynecology (CDIC), Barcelona. Spain
| | - Gabriela Oses
- Hospital Clinic de Barcelona, Department of Radiation Oncology (CDIC), Barcelona. Spain
| | - Maria Vidal
- Hospital Clinic de Barcelona, Department of Oncology (CDIC), Barcelona. Spain
| | - Gorane Santamaria
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
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Macedo M, Bassaganyas C, Ganau S, Sanfeliu E, Ubeda B, Bargallo X. Ultrasound Findings of Breast Adenomas. J Ultrasound Med 2020; 39:2173-2180. [PMID: 32385901 DOI: 10.1002/jum.15328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Breast adenomas are rare benign tumors. The aim of this study was to describe the ultrasound findings of breast adenomas, including less common worrisome features that can mimic malignancy. METHODS From November 2014 to November 2019, we performed 1605 core needle biopsies guided by ultrasound in our department. In all, 229 corresponded to fibroadenomas and 12 to breast adenomas. RESULTS Breast adenomas represented 0.75% of all core needle biopsies; 50% (6 of 12) were tubular adenomas; 17% (2 of 12) were ductal adenomas; and 33% (4 of 12) were lactating adenomas. Tubular and lactating adenomas occurred in young women and ductal adenomas in postmenopausal women. Lactating adenomas occurred in pregnant or breastfeeding women and were larger than the other adenomas. Ultrasound showed a mass with an oval shape, a parallel orientation, circumscribed margins, and hypoechoic and homogeneous patterns in most cases. However, up to one-third of them presented with suspicious findings. CONCLUSIONS Breast adenomas are rare benign entities with no specific clinical and radiologic features. Sometimes, they appear as suspicious tumors on radiologic modalities, requiring a histopathologic assessment to rule out malignancy. Radiologists need to be familiar with this entity to determine concordance between imaging and the final pathologic analysis.
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Affiliation(s)
- Miguel Macedo
- Departments of Radiology, Hospital Clínic, Barcelona, Spain
| | | | - Sergi Ganau
- Departments of Radiology, Hospital Clínic, Barcelona, Spain
| | | | - Belen Ubeda
- Departments of Radiology, Hospital Clínic, Barcelona, Spain
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Lerena I, Boada D, Caparros X, Ganau S, Bargallo X, Ubeda B, Descarrega J, Raigosa M, Yoon T, Santfeliu E, Gonzalez B, Muñoz M, Prat A, Torne A, Carmona F, Fontdevila J, Alonso I. Imaging and clinical predictors for nipple-areola complex (NAC) involvement in breast cancer patients undergoing Nipple-Sparing Mastectomy (NSM). Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fernández J, Monteagudo J, Bargallo X, Jiménez W, Bosch J, Arroyo V, Navasa M. A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis. Hepatology 2005; 42:627-34. [PMID: 16108036 DOI: 10.1002/hep.20829] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The administration of albumin improves circulatory function, prevents hepatorenal syndrome, and reduces hospital mortality in patients with cirrhosis and spontaneous bacterial peritonitis. This randomized unblinded pilot study compared the effect of albumin (10 patients) and the synthetic plasma expander hydroxyethyl starch 200/0.5 (10 patients) on the systemic hemodynamics of patients with spontaneous bacterial peritonitis. Baseline measurements were performed within 12 hours after diagnosis of infection. Patients then received 2 doses of the volume expander (1.5 g/kg body weight after baseline measurements and 1 g/kg body weight on day 3). Measurements were repeated after infection resolution. Treatment with albumin was associated with a significant increase in arterial pressure and a suppression of plasma renin activity, indicating an improvement in circulatory function. This occurred in the setting of a significant expansion of central blood volume (increase in cardiopulmonary pressures and atrial natriuretic factor) and an increase in systolic volume and systemic vascular resistance. In contrast, no significant changes were observed in these parameters in patients treated with hydroxyethyl starch. Von Willebrand-related antigen plasma levels significantly decreased in patients treated with albumin but not in those treated with hydroxyethyl starch. Serum nitrates and nitrites increased in patients treated with hydroxyethyl starch but not in those treated with albumin. These data suggest an effect of albumin on endothelial function. In conclusion, albumin but not hydroxyethyl starch improves systemic hemodynamics in patients with spontaneous bacterial peritonitis. This effect is due not only to volume expansion but also to an action on the peripheral arterial circulation.
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Affiliation(s)
- Javier Fernández
- Liver Unit, IMDM and IDIBAPS, Hospital Clínic, University of Barcelona, Spain.
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Laguno M, Murillas J, Blanco JL, Martínez E, Miquel R, Sánchez-Tapias JM, Bargallo X, García-Criado A, de Lazzari E, Larrousse M, León A, Loncá M, Milinkovic A, Gatell JM, Mallolas J. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for treatment of HIV/HCV co-infected patients. AIDS 2004; 18:F27-36. [PMID: 15316335 DOI: 10.1097/00002030-200409030-00003] [Citation(s) in RCA: 313] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current therapies for chronic hepatitis C virus (HCV) in HIV co-infected patients have a low success rate and are poorly tolerated. We have evaluated the efficacy and safety of interferon alfa-2b (IFN) + ribavirin (RBV) versus pegylated interferon alfa-2b (PEG-INF) + RBV. METHODS Randomized, single-centre, open-label clinical trial including patients with: detectable HCV-RNA, alanine aminotransferase > 1.5-fold upper limit of normal, abnormal liver histology, CD4 cell count > 250 x 10/l and HIV RNA < 10 000 copies/ml. Patients were assigned to INF (3 x 10 units three times/week) or PEG-IFN (100-150 microg/week) plus RBV (800-1200 mg/day). Duration of treatment was 48 weeks (only 24 weeks for HCV genotypes 2 or 3 and baseline HCV RNA < 800 000 IU/ml). The primary endpoint was a sustained virological response (SVR). RESULTS Ninety-five patients were randomized (43 INF + RBV, 52 PEG-INF + RBV), 68% males, 82% injecting drug users; 63% genotypes 1 or 4 and 36% genotypes 2 or 3; 62% fibrosis index grade >/=2 and 30% bridging fibrosis/cirrhosis. SVR was significantly higher in the PEG-INF + RBV arm, 44% versus 21% (intent to treat; P = 0.017). Among patients with genotypes 1 or 4, SVR were 38% versus 7% (P = 0.007) and 53% versus 47% (P = 0.730) for genotypes 2 or 3. CD4 cell count but not its percentage dropped in both arms and HIV RNA viral load did not change from baseline. Side effects were very frequent in both arms leading to treatment discontinuation in 14 patients without statistical differences between arms (P = 0.565). CONCLUSION PEG-INF + RBV was significantly more effective than INF + RBV for the treatment of chronic hepatitis C in HIV co-infected patients, mainly of genotype 1 or 4.
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Affiliation(s)
- Montserrat Laguno
- Infectious Diseases Unit, the Pathology Service, Hospital Clínic Universitari de Barcelona-IDIBAPS, University of Barcelona, Spain
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Gilabert R, Bargallo X, Forns X, Bru C, Rimola A, Salmeron JM, Garcia-Valdecasas JC, Grande L, Visa J, Rodes J. Value of duplex-doppler ultrasound findings in liver transplant recipients with poor graft function. Transplantation 1996; 61:832-5. [PMID: 8607192 DOI: 10.1097/00007890-199603150-00027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R Gilabert
- Department of Radiology, Hospital Clinic i Provincial, University of Barcelona, Spain
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