RESUMO
INTRODUCTION: The COVID-19 pandemic has changed health systems across the world, both in general hospitals and in oncology institutes or centres.For cancer specialists, particularly breast cancer (BC), the COVID-19 pandemic represents a combination of challenges since the hospital resources and staff have become more limited; this has obliged oncology specialists to seek a consensus and establish which patients with BC require more urgent attention and which patients can wait until there is a better control of this pandemic. The health system in Latin America has some special characteristics; in some of the countries, there are shortages which limit access to several specialities (surgery, clinical oncology and radiotherapy) in some regions. OBJECTIVE: After a systematic review of the most recent literature regarding the management of BC during the COVID-19 pandemic, the main objective is to understand the position of the different Latin American Societies of Mastology in terms of available alternatives for the treatment of BC. METHODS: After carrying out a comprehensive and exhaustive search of the most recent guides on the management of BC during the COVID-19 pandemic, the board members of the Latin American Federation of Mastology invited, via email, different specialists, all experts in BC care, to complete an anonymous survey online.The survey was distributed between 30 and 10 May 2020. The survey included 27 questions on four topics: demographic information, consultations, imaging and treatment of BC.The questionnaire was sent and then distributed to various health specialists including breast surgeons, clinical oncologists, radiation oncologists and radiologists via the Presidents of the different Latin American Societies of Mastology in 18 countries. The results are summarised as tallies based on the number of responses to each question. RESULTS: A total of 499 responses were received. The majority of the respondents were males (275 (55.11%)); 290 participants were over 45 years (58.11%).The questionnaire presented those surveyed with three possible answers (agree, disagree and neither agree nor disagree). The results reflect that there was consensus in the majority of situations presented. Only seven questions revealed disagreement among those responding. The results are presented as recommendations. CONCLUSION: The management of patients with BC presents unique challenges during the current world health situation produced by COVID-19 pandemic. Breast care specialists (surgical oncologists, breast care clinicians, clinical oncologists, radiation oncologists and radiologists) from 18 countries in Central and South America submitted through their responses and recommendations for the treatment of BC during the COVID-19 pandemic.
RESUMO
Introducción: El estudio biópsico del linfonodo centinela axilar ha reemplazado la disección axilar estándar en el manejo del cáncer de mama en etapa temprana en los grandes centros internacionales preocupados del tema. Esto no ha ocurrido a nivel nacional y solo se han presentado algunas series pequeñas con la intención de demostrar las técnicas e intentar así validar el procedimiento. Objetivo: Trabajo prospectivo para medir la tasa de detección del linfonodo centinela con el uso de colorante azul patente (Lymphazurin 1 por ciento) y determinar la sensibilidad y especificidad del procedimiento al compararlo con la disección axilar de los niveles I y II de Berg, como forma de validar el método. Material y Método: Desde febrero del 2000 y agosto 2003 en todas las pacientes con cáncer de mama en etapa in situ con microinvasión (5), T1 (75) T2 (40) con axila clínicamente negativa se intentó la biopsia del linfonodo centinela usando la técnica del colorante azul patente inyectado en el sitio de la tumorectomía previa (93), en el plexo periareolar de Sappey (19) o en ambos (8). Se consideró linfonodo centinela aquél claramente teñido o cuando los linfáticos aferentes se encontraban teñídos con el colorante. Este ganglio se procesó completo con cortes seriados para tinción de H&E estándar. En 115 pacientes se realizó disección axilar y estudio normal H&E de los ganglios encontrados. Resultados: En 14 de los 120 pacientes no se identificó lifonodo centinela (88,3 por ciento de éxito). De los 115 pacientes en que se disecó la axila solo se pesquisó compromiso tumoral en 35 (30,4 por ciento). El linfonodo centinela fue positivo para metástasis en 26 de los 106 pacientes en que se logró biopsiar, en 12 el compromiso era exclusivo a ese ganglio. En solo 3 de los 80 pacientes en que el linfonodo fue considerado histológicamente negativo, otro ganglio en la axila tenía tumor. Son los considerados falsos negativos. Conclusiones: En esta serie el porcentaje de detección del linfonodo centinela con azul patente es semejante al de series extensas internacionales, así como la tasa de falso negativos, la sensibilidad y especificidad del procedimiento: por lo que concluimos que puede reemplazar la disección axilar estándar para cáncer de mama en nuestro medio.