Introduction. The rapid spread of COVID-19 across the globe is forcing surgical oncologists to change their daily practice. We sought to evaluate how breast surgeons are adapting their surgical activity to limit viral spread and spare hospital resources. Methods. A panel of 12 breast surgeons from the most affected regions of the world convened a virtual meeting the 7 th of April 2020 to discuss the changes in their local surgical practice during the COVID-19 pandemic. Similarly, a web-based poll based was created to evaluate changes in surgical practice among breast surgeons from several countries. Results. The virtual meeting showed that distinct countries and regions were experiencing different phases of the pandemic. Surgical priority was given to patients with aggressive disease not candidate for primary systemic therapy, those with progressive disease under neoadjuvant systemic therapy, and post-neoadjuvant patients. One hundred breast surgeons filled out the poll. The trend showed reductions in operating room schedules, indications for surgery, and consultations, with an increasingly restrictive approach to elective surgery with worsening of the pandemic. Conclusion. The COVID-19 emergency should not compromise treatment of a potentially lethal disease such as breast cancer. Our results reveal that physicians are instinctively reluctant to abandon conventional standards of care when possible. However, as the situation deteriorates, alternative strategies of de-escalation are being adopted. The Oncologist 2020;9999:• •

We declare that all persons involved in this research project did not have any potential conflict or financial support. How to become a breast cancer specialist in 2018: the point of view of the second cohort of the Certificate of Competence in Breast Cancer (CCB2)

Papillary carcinoma of the breast is a rare type of breast malignancy, making up less than 2% of breast cancers, and only some are encapsulated papillary carcinoma. Usually, EPC are low-grade luminal like tumors. The authors report a case of a 50-year-old female with the diagnosis of an unusual high-grade triple negative encapsulated papillary carcinoma with an area of invasive papillary carcinoma and negative axillary lymph nodes. Considering its rarity, the description of this case and its clinical management are important in order to better understand this entity and choose the best clinical approach.

IntroductionBreast lesions include a heterogeneous group of entities with variable clinical behaviour and morphological presentation, mostly classified as benign or malignant, with predictable behaviour. However, there are lesions with clinical, breast imaging and/or biopsy characteristics that do not clarify their nature. These lesions have an uncertain behaviour regarding their malignant potential at diagnosis.We intend to relate the preoperative diagnosis of neoplasm of uncertain behaviour of the breast (NUnBB) regarding the core needle biopsy and the histological result after excisional biopsy.MethodsThis is a retrospective study of patients submitted to local excision of breast lesions with a perioperative diagnosis of NUnBB, classified as 2383 at ‘International Statistical Classification of Diseases and Related Health Problems’ (ICD 9), between January 2007 and October 2016 in a breast unit.ResultsNinety-two cases with the diagnosis of NUnBB were analysed: 91 females with a mean age of 59 ± 14 years. All were submitted to local excision of breast lesion as ambulatory surgery with the following histology: 64% benign, 3% malignant potential and 33% malignant. Of those who presented malignant results, 69% underwent a surgical re-intervention for local control of the disease.DiscussionRegarding the considerable number of malignant lesions at final histology and the high percentage of which are re-operated, NUnBB should be treated with the same priority as a confirmed malignant neoplasm and whenever possible, using the most appropriate surgical technique.

The Chapadinha microregion, located in the eastern part of the state of Maranhão, Brazil, maintains a large agricultural production, especially soybeans, causing beyond largesse of the economy, which promotes a degradation of large areas of native forests. The analysis of space - temporal with remote sensing images can be a tool for understanding the area and possible decision making of allocated mandates. The objective of this study is to analyze spatial and temporal variation of the micro-Chapadinha, Maranhão, Brazil by remote sensing technique called Normalized Difference Vegetation Index - NDVI for the years 2007, 2010 and 2014. It is used Lands at 5 images - TM and 8 - OLI orbits 220 / 62-63 months of 22/07/2007, 15/08/2010 and 25/07/2014and it being applied processing equations of radiometric radiance, reflectance and NDVI. The NDVI for micro-Chapadinha vegetation indicated a fall of the years 2007 to 2010 and at the same time, an increase in agricultural activity; low NDVI areas that are not exposed in 2007 were observed in 2010, one of the causes of this advent can be the event El Niño in the Northeast. In 2014, vegetation indices showed high in much of the micro-region; the response of this increase may be the reaction of trees was once under water stress the great rainfall that year. The municipalities of Brejo, Milagres of Maranhão and Buriti are the most affected by farming, they still come extending and have propensities to leave the micro limits. Remote sensing responded with great efficiency, but the complexity of the natural environment make it necessary that there interconnections with other indices therefore resulting in a more efficient monitoring and analysis.