Abstract P4-02-03: FDG PET/CT for early monitoring of response to neoadjuvant chemotherapy in breast cancer patients.

Abstract Introduction: Neoadjuvant chemotherapy (NAC), initially used only for locally advanced breast cancer, is now commonly used in patients with operable but large breast cancer or unfavorable tumor/breast size index because increases the chances of performing breast conservative surgery (BCS) instead of mastectomy in this group of patients. Patients and Methods: This is a prospective unicenter trial. FDG PET/CT were performed in 40 patients at baseline and after the second cycle of NAC. The level and relative changes in standardized uptake value (SUV) of FDG uptake were assessed regarding their ability to predict histopathologic response. Pathologic complete response (pCR) was defined as no malignant cells (no invasive ductal carcinoma and no ductal carcinoma in situ) identifiable in sections from the site of the tumor in the breast and in the axillary lymph node. Results: This prospectively study analyzed forty patients undergoing NAC, all female, age ranged 27–64 years (mean 41.0 years and median 38 years), all tumors were invasive ductal carcinoma, histological tumor grade 1, 2 and 3 were present respectively at 5%, 38.5% and 100% of the sample and nuclear grade 2 and 3 were present respectively at 12.5% and 87.5%. Estrogen receptor was positive in 60% of patients and the progesterone receptor was positive in 47.5% of patients. Her 2 was overexpressed in 12 patients (30%). Phenotype in this sample had the following distribution: 12.5% luminal A (5 patients), 50% Luminal B (20 patients: 14 patients with Ki-67&amp;gt; 14% and 6 cases with HER 2 overexpression), 15 % HER 2 (6 patients) and cases triple negative 9 (22.5%). size of the primary tumor ranged from 4.10 cm to 12.0 cm (mean 7.10 cm). The size of the primary tumor ranged from had a mean of 6.7 cm and a median of 6.0 cm. This group showed great uniformity in relation to primary chemotherapy. NAC with cyclophosphamide and adriamycin were administered to 38 patients. In this study, pCR was obtained in 12 patients (30%). Baseline FDG SUV referring to pCR group was 11.26 and 7.26 in non-pCR group (p = 0.04). FDG SUV after second cycle was 2.73 in pCR group and 4.64 in non-pCR group (p = 0.048). When analyzing ΔSUV (difference between baseline SUV and SUV after second cycle), pCR group had a mean reduction of 81.58% and non-pCR group had a mean reduction of 81.58% (p = 0.001). Receiver operating curve analyses were performed to deter mine optimal differentiation cut-off values of ΔSUV for differentiation of pCR and non-pCR. After two courses of NAC the optimal cutoff value to early differentiation between pCR from non-pCR were 59,1% in decrease of SUV. The sensitivity and specificity were 64,3% and 100,0%, respectively. Conclusion: The optimum role of FDG PET in predicting the response of breast cancers to neoadjuvant chemotherapy is still not clearly defined and the SUV cut-off needs to be validated. FDG-PET allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after two cycles of chemotherapy and FDG-PET may be helpful for individual treatment stratification in breast cancer patients. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-02-03.</jats:p

Abstract P3-02-11: Clinical examination and breast MRI as predictors of pathologic complete response post neoadjuvant therapy in HER2 overexpressed subtypes and triple negative breast cancer

Abstract Background: Preoperative identification of pathologic complete response (pCR) is important to decrease surgical morbity. The objective of this study was to determine diagnostic validity of clinical examination and magnetic resonance imaging (MRI) in determining pathologic response in patients with breast cancer subtypes HER 2 overexpressed and triple negative after neoadjuvant therapy. Methods: This is a cross- sectional study, with a sample comprising 72 patients woman with HER-2 overexpressed or triple negative breast submitted to neoadjuvant treatment at Hospital Sirio Libanês between January 2005 and December 2012. All patients were clinically evaluated by a group of seven breast surgeons. Double reading of breast MRI was performed in three periods: at the beginning of treatment, after the second cycle of chemotherapy and after treatment. Photographic record of the breast was done before and after chemotherapy. HER-2 and hormone receptors were assessed using immunohistochemistry. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (VNP) were estimated using pathology as the gold standard. Area under ROC curve and the corresponding 95% confidence intervals (95% CI) were calculated. Results: Thirty- two patients (44,4%) had triple negative tumors while 40 (55.6%) overexpressed HER-2. Among those with triple negative tumors, clinical examination evidenced a completed response in 31.2% (10/32) of the cases. pCR was observed in 3 patients (9.4%). Diagnostic validity measures for clinical examination were: Se= 100%, Sp=75.9%, PPV=42.9% and NPV=100%. In this group, MRI detected a complete response in 7 cases (21.9%). Therefore, MRI presented a Se=66.8%, Sp=82.8%, PPV 28.6% and NPV= 96%. Area under ROC curve was 0.88 (95% CI 0.80-0.96) and 0.75 (95% ci 0.41-1.00) for clinical examination and MRI, respectively. Among woman with tumors over expressing HER-2, complete response was observed through clinical examination in 45% (18/40) of these cases, showing Se= 100%, Sp=71%, PPV=100% and NPV=70,9%. In this group, complete radiological response was noted in 8 cases (20%). Therefor, MRI had Se=33.3%, Sp=83.9%, PPV 37.5% and NPV=96%. Area under ROC curve was 0.85 (95% CI 0.77-0.94) and 0.59 (95% CI 0.41-0.76) for clinical examination and MRI, respectively. Conclusions: Our findings demonstrate that clinical examination is superior to MRI to predict pCR for woman wth tumor overexpressing HER-2, while for tumor patients with triple negative tumors the two methods were equivalent. Therefore, clinical examination can be used with MRI to monitor tumor response to neoadjuvant chemotherapy and also to determine the best course of surgical action. Monitoring and assessment, however, are better when both methods are associates. Citation Format: Andrade FEM, De Barros ACS, Docema MF, Heinzen RN, De Andrade JZ, Nimir C, Mano MDS, Gianotti D, Ribeiro KDCB. Clinical examination and breast MRI as predictors of pathologic complete response post neoadjuvant therapy in HER2 overexpressed subtypes and triple negative breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-11.</jats:p

ÍNDICE DE CANDIDATOS A DOAÇÃO DE SANGUE EM UM HEMOCENTRO DO NORDESTE DO BRASIL

Introdução: A doação de sangue é, ainda hoje, um problema de interesse mundial, pois não há uma substância que possa, em sua totalidade, substituir o tecido sanguíneo. Os hemocentros têm dificuldades em manter o estoque de sangue para atender às necessidades específicas e emergenciais, colocando em risco a saúde e a vida da população. As estatísticas mundiais mostram que as doações de sangue não acompanham o aumento de transfusões. Muitos países enfrentam dificuldades em suprir a demanda de sangue e hemocomponentes, principalmente, aqueles em que há uma política proibitiva em relação à comercialização do sangue. Objetivos: A presente pesquisa tencionou apresentar os índices de candidatos à doação de reposição, doação voluntária, a doação em campanha em um Hemocentro do Nordeste Brasileiro. Metodologia: Foi efetuado um exame transversal com dados retrospectivos, com observação dos dados a partir dos registros da Gerência de Cadastro doação de sangue no período de janeiro, fevereiro e março de 2024. Para fins de análise, os dados obtidos foram tabulados e apresentados em frequência absoluta. Resultados: Relativamente ao número de candidatos que comparecem vinculando sua doação ao paciente/N°total de candidatos X 100 em janeiro foram de 49,3%, fevereiro 33,17% e março foram de 39,24%. Quanto ao número de candidatos que compareceram sem vinculação ao paciente/N°candidatos X 100 foram em janeiro de 46.49%, fevereiro 51,09% e março 40,00%. No que tange aos candidatos a doação que compareceram através de grupos agendados/ N°de candidatos X 100 foram em janeiro de 2,99%, fevereiro 14,8% e março foi de 17,54%. No que concerne aos candidatos que compareceram através de convocação/ N°doadores convocados X 100 foram em janeiro de 1,31%, fevereiro 0,92% e março foi de 3,2%. Em referência aos candidatos a doação de sangue do sexo masculino/ N°de candidatos X 100 foram em janeiro de 55,65%, fevereiro 55,73% e março foi de 51,41% e candidatos femininos foram concomitantemente 44,4%, 44,26% e 44,58%. Discussão: O índice de candidatos à doação de reposição nos meses de janeiro, fevereiro e março de 2024 alcançou a meta. Atribuímos o resultado ao trabalho educativo que vem sendo desenvolvido pela equipe no sentido de esclarecer o processo e a importância da doação voluntária, não comprometendo o atendimento da solicitação sangue. Em relação ao índice de candidatos a doação voluntária nos meses de janeiro e fevereiro de 2024 foi alcançada, não obstante Quanto ao mês de março a meta não foi alcançada devido à solicitação por parte dos hospitais, da apresentação de comprovante de doação, bem como a abordagem por parte de familiares de pacientes para direcionar sua doação voluntária em reposição. Quanto à doação em campanha no mês de janeiro não foi alcançado. Atribuímos o ocorrido em virtude do período de férias, pós-festividades e grande incidência de viroses. Nota-se que o índice de doadores do sexo masculino, bem como do sexo feminino atingiu a meta proposta nos meses de janeiro, fevereiro e março de 2024. Conclusão: Sendo assim, ressaltamos a importância das autoridades para o incentivo ao desenvolvimento de projetos que visem à educação da população para a doação de sangue, especialmente, os que desenvolvem seus trabalhos junto aos jovens, pois estes serão os nossos futuros doadores

Rating Scales for Pain in Parkinson's Disease: Critique and Recommendations

Background: We aimed at critically appraising the clinimetric properties of existing pain scales or questionnaires and to give recommendations for their use in Parkinson's disease (PD). Methods: Clinimetric properties of pain scales used in PD were systematically evaluated. A scale was classified as ‘recommended’ if was used in PD, showed adequate clinimetric properties, and had been used by investigators other than the original developers; as ‘suggested’ if it was used in PD and fulfilled only one other criterion; and as ‘listed’ if it was used in PD but did not meet the other criteria. Only scales rating pain intensity or for syndromic classification were assessed. Results: Eleven of the 34 scales initially considered fulfilled inclusion criteria. Among the scales rating pain intensity, the “Brief Pain Inventory short form,” “McGill Pain Questionnaire short and long forms,” “Neuropathic Pain Symptoms Inventory,” “11-point Numeric Rating Scale,” “10-cm Visual Analog Scale,” and “Pain-O-Meter” were “recommended with caution” because of lack of clinimetric data in PD, whereas the “King's PD Pain Scale” was “recommended.” Among scales for pain syndromic classification, the “DN4” was “recommended with caution” because of lack of clinimetric data in PD; the “Leeds Assessment of Neuropathic Symptoms and Signs,” “Pain-DETECT,” and the “King's PD Pain Scale” were “suggested.”. Conclusions: King's PD pain scale can be recommended for the assessment of pain intensity in PD. Syndromic classification of pain in PD may be achieved by the DN4, but clinimetric data in PD are needed for this scale