Manejo de la patología mamaria en el servicio de radiodiagnóstico en un hospital de alta incidencia de COVID-19  <span class="so-article-trans-title" dir="auto"> Translated title: Breast pathology handling by breast radiologists in a high incidence hospital for COVID-19 </span>

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Abstract

Resumen En este artículo pretendemos exponer al lector como hemos realizado el manejo de la patología mamaria por parte de la Sección de Radiología durante la pandemia de COVID-19 en un hospital de alta incidencia, como ha sido el “Complejo Hospitalario Universtiario de Albacete”, donde desarrollamos dicha actividad. Para ello, hemos revisado las principales guías de actuación propuestas por diferentes sociedades, haciendo una comparativa con el manejo que hemos realizado por parte de nuestro servicio y viendo si eran todas aplicables y óptimas o si nos hemos visto en la necesidad de modificar algunas de ellas en beneficio de las pacientes, debido tanto a la alta incidencia de patología mamaria no demorable como a la de COVID-19 en nuestra ciudad, siendo nuestro objetivo evitar al máximo el retraso diagnóstico de patología mamaria y sobre todo de cáncer de mama, así como evitar los contagios tanto del personal sanitario como de las pacientes.

Translated abstract

Abstract In this article we would like to show the reader how we have managed breast pathology along all pandemic COVID-19 period in our Radiology Department, as far as our Hospital (“Complejo Hospitalario Universtiario de Albacete”) has been highly affected by COVID-19. To get to a result, we have revised main breast management guides porpused by different societies, and we have afterwards compared their recommendations with our way of handling the situation, taking into account that some of them were available and others were modified in order to benefit our patients. This was necessary in order to satisfy the attention of our patients with non delaying breast pathology and to manage correctly COVID-19 pandemic as well in a high incidence place. Our principal aims have been avoiding breast pathology diagnosis delay (breast cancer above all), as well as avoiding workers and patients COVID-19 infection.

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Outcome Prediction for Estrogen Receptor–Positive Breast Cancer Based on Postneoadjuvant Endocrine Therapy Tumor Characteristics

Matthew Ellis, Zhen-Yu Tao, Jingqin Luo … (2008)

Background Understanding how tumor response is related to relapse risk would help clinicians make decisions about additional treatment options for patients who have received neoadjuvant endocrine treatment for estrogen receptor–positive (ER+) breast cancer. Methods Tumors from 228 postmenopausal women with confirmed ER+ stage 2 and 3 breast cancers in the P024 neoadjuvant endocrine therapy trial, which compared letrozole and tamoxifen for 4 months before surgery, were analyzed for posttreatment ER status, Ki67 proliferation index, histological grade, pathological tumor size, node status, and treatment response. Cox proportional hazards were used to identify factors associated with relapse-free survival (RFS) and breast cancer–specific survival (BCSS) in 158 women. A preoperative endocrine prognostic index (PEPI) for RFS was developed from these data and validated in an independent study of 203 postmenopausal women in the IMPACT trial, which compared treatment with anastrozole, tamoxifen, or the combination 3 months before surgery. Statistical tests were two-sided. Results Median follow-up in P024 was 61.2 months. Patients with confirmed baseline ER+ clinical stage 2 and 3 tumors that were downstaged to stage 1 or 0 at surgery had 100% RFS (compared with higher stages, P < .001). Multivariable testing of posttreatment tumor characteristics revealed that pathological tumor size, node status, Ki67 level, and ER status were independently associated with both RFS and BCSS. The PEPI model based on these factors predicted RFS in the IMPACT trial (P = .002). Conclusions Breast cancer patients with pathological stage 1 or 0 disease after neoadjuvant endocrine therapy and a low-risk biomarker profile in the surgical specimen (PEPI score 0) have an extremely low risk of relapse and are therefore unlikely to benefit from adjuvant chemotherapy.