Ultrasound-guided core-needle biopsy has high sensitivity in the diagnosis of breast cancer. The present study is aimed at detailing the main steps of such procedure, including indications, advantages, limitations, follow-up and description of the technique, besides presenting a checklist including the critical steps required for an appropriate practice of the technique. In the recent years, an increasing number of patients have required breast biopsy, indicating the necessity of a proportional increase in the number of skilled professionals to carry out the procedures and histological diagnoses. A multidisciplinary approach involving the tripod clinical practice-radiology-pathology is responsible for the highest rate of accuracy of the technique and must always be adopted.

ObjectiveTo propose an algorithm to determine the necessity for ultrasonography-guided fine-needle aspiration (US-FNA) in preoperative axillary lymph node staging of patients with invasive breast cancer.Materials and MethodsProspective study developed at National Cancer Institute. The study sample included 100 female patients with breast cancer referred for axillary staging by US-FNA.ResultsThe overall US-FNA sensitivity was set at 79.4%. The positive predictive value was calculated to be 100%, and the negative predictive value, 69.5%. The US-FNA sensitivity for lymph nodes with normal sonographic features was 0%, while for indeterminate lymph nodes it was 80% and, for suspicious lymph nodes, 90.5%. In the assessment of invasive breast tumors stages T1, T2 and T3, the sensitivity was respectively 69.6%, 83.7% and 100%. US-FNA could avoid sentinel node biopsy in 54% of cases.ConclusionAxillary ultrasonography should be included in the preoperative staging of all patients with invasive breast cancer. The addition of US-FNA in cases of lymph nodes suspicious for malignancy may prevent more than 50% of sentinel lymphadenectomies, significantly shortening the time interval to definitive therapy.

97 Background: To reduce arm morbidity the sentinel lymph node biopsy was implemented in the breast cancer treatment. The aim of this study was to investigate the arm morbidity after sentinel lymph node biopsy or axillary lymph node dissection. Methods: This is a prospective cohort study of women who underwent surgical treatment of breast cancer at a single institution. Arm and shoulder morbidity were measured before, 1 and 6 months after the operation. Analyses were performed to compare morbidity between sentinel lymph node biopsy (SLND) and axillary lymph node dissection (ALND). This study obtained approval from the National Cancer Institute research and ethics committee. Results: Were included 203 patients and, during the study, 6 were excluded and there was 23 losses of follow-up. The average age of women was 58 years (DP=13). SLND was made in 31,6% with an average of 3 lymph nodes removed. Among those submitted to ALND, the average lymph node removed was 18 (p<0.0001). After 45 days of surgery, the incidence of arm morbidity was: 23% of shoulder restriction (ALND 22%, SLND 1%, p<0.001); 28% of axillar web syndrome (ALND 24%, SLND 4%, p<0.001); 38% of seroma (ALND 32%, SLND 6%, p<0.001); 5% of arm edema (ALND 4%, SLND 1%, p<0.001). In the final evaluation occurred 6 months after the surgery, it was observed de following incidence: 4% of shoulder restriction (ALND 3%, SLND 1%, p=0.371); 18% of arm pain (ALND 12%, SLND 6%, p=0.460); 18% of axillar web syndrome (ALND 16%, SLND 2%, p<0.002); 5% of arm edema (ALND 4%, SLND 1%, p=0.417). Conclusions: After 45 days of surgery, patients with SLND has less arm morbidity compared with patients submitted to ALND. After 6 months, it was observed less incidence of arm symptoms and only axillary web syndrome were more incident in patients with axillary dissection.

BACKGROUND: The infiltrating lobular carcinoma (ILC) comprises approximately 10% of breast cancers and appears to have a distinct biology. Because it is less common than infiltrating ductal carcinoma (IDC), there are less data published regarding about their clinical outcomes. This study estimates survival rates in women with infiltrating lobular carcinoma of the breast, diagnosed between 2000 to 2009 that had undergone treatment in the National Cancer Institute of Brazil. OBJECTIVES: Analyze overall survival and the main prognostic factors among women with infiltrating lobular carcinoma of the breast, diagnosed from 2000 to 2009 that had undergone treatment in the National Cancer Institute of Brazil. MATERIALS AND METHODS: The survival curves were obtained in a hospital cohort of 843 patients with infiltrating lobular carcinoma of the breast diagnosed and treated between 2000 to 2009. The study variables were: age, race, tobacco, alcohol consumption, tumor-related variables, and treatment-related variables. Survival functions were calculated by the Kaplan-Meier method. RESULTS: The mean follow up time was 64,27 months (sd 33,76), with 30,2% of deaths occurred in the period where the mean patients age was 58,58 years (sd 13,22). The overall survival (OS) was 105,61 months (95% CI, 101,68 to 109,54). The OS for patients with 4 or more positives axillary lymph nodes was 91,66 months (95% CI, 83,19 to 100,13; p &lt; 0,0001) worse than patients with no positive axillary lymph node, where the overall survival was 124,26 months (95% CI, 119,41 to 129,12; p &lt; 0.0001). The OS in patients with estrogen receptor positive was 109,05 months (95% IC, 104,83 to 113,28; p &lt; 0.001) whereas in patients with hormone estrogen receptor negative, the OS was 81,75 months (95% CI, 69,93 to 93,58; p &lt; 0,0001). Among smokers patients, the OS was 97,46 months (95% CI, 90,80 to 104,12; p = 0,012) and for no smoking patients, the OS was109,01 months (95% CI, 104,24 to113,79; p = 0,012). Patients in stage 1 and 2 show an mean overall survival of 126,76 months (95% CI, 122,77 to130,75; p &lt; 0.0001) and patients in stage 3 and 4 show a worse overall survival with mean 74,61 months (95% CI, 68,59 to 80,62; p &lt; 0.0001). The patients younger than 40 years old had worse overall survival, with mean 88,88 months (95% C, 72,98 to 104,72; p = 0.032) than those with more than 40 years old, where the mean was 106,77 months (95% CI, 102,74 to 110,79; p = 0,032). The consumption of alcoholic beverages and pleomorphic histological variant showed no statistically significant difference in overall survival. CONCLUSION: The mean follow up time was 64,27 months with 30,2% of deaths occurred in the period. The overall survival (OS) was 105,61 months. The OS was asssociated with axillary involvement, estrogen and progesterone receptor hormone, age and tobacco. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-44.

Background: Germline mutation screening of BRCA1 and BRCA2 genes is performed in suspected familial breast cancer cases, but a causative mutation is found in only 30% of patients. The development of additional methods to identify good candidates for BRCA1 and BRCA2 analysis would therefore increase the efficacy of diagnostic mutation screening. With this in mind, we developed a study to determine molecular signatures of BRCA1—or BRCA2—mutated breast cancers. Materials and Methods: Array-cgh (comparative genomic hybridization) and transcriptomic analysis were performed on a series of 103 familial breast cancers. The series included 7 breast cancers with a BRCA1 mutation and 5 breast cancers with a BRCA2 mutation. The remaining 91 cases were obtained from 73 families selected on the basis of at least 3 affected first-degree relatives or at least 2 affected first-degree relatives with breast cancer at an average age of 45 years. Array-cgh analyses were performed on a 4407 BAC-array (CIT-V8) manufactured by IntegraGen. Transcriptomic analyses were performed using an Affymetrix Human Genome U133 Plus 2.0 chip. Results: Using supervised clustering analyses we identified two transcriptomic signatures: one for BRCA1-mutated breast cancers consisting of 600 probe sets and another for BRCA2-mutated breast cancers also consisting of 600 probes sets. We also defined cgh-array signatures, based on the presence of specific genomic rearrangements, one for BRCA1-mutated breast cancers and one for BRCA2-mutated breast cancers. Conclusions: This study identified molecular signatures of breast cancers with BRCA1 or BRCA2 germline mutations. Genes present in these signatures could be exploited to find new markers for such breast cancers. We also identified specific genomic rearrangements in these breast cancers, which could be screened for in a diagnostic setting using fluorescence in situ hybridization, thus improving patient selection for BRCA1 and BRCA2 molecular genetic analysis.