Solange Moraes Sanches

Aims: Phyllodes tumours of the breast (PTs) present complex histological features that challenge classification. The WHO 5th Edition (2019) defines malignancy based on five simultaneous criteria, which may under‐recognize tumours with metastatic potential. Alternative diagnostic systems have been proposed, but comparative data are limited. Methods and results: We reviewed 62 PTs diagnosed as borderline or malignant between 2015 and 2025. Histological features were re‐evaluated, and tumours were classified according to WHO (2019), Tan et al. (2025), and the Refined Criteria (2023). After exclusion of 4 reclassified benign cases, 58 tumours (42 borderline, 16 malignant) were analysed. The mean patient age was 45 years, and the mean tumour size was 6.7 cm. After a median follow‐up of 31.7 months, 6 borderline PTs recurred locally without metastasis. Among malignant PTs, seven developed distant metastases, with two disease‐related deaths. High stromal mitotic activity (≥30/10 HPF, P = 0.005) and malignant heterologous elements ( P < 0.001) were independently associated with metastasis. Tan et al. 's classification showed 97% concordance with WHO 2019, whereas the Refined Criteria reclassified 52% of borderline tumours as malignant; none of the reclassified tumours developed distant metastases during the available follow‐up. Conclusions: In this cohort, high stromal mitotic activity and malignant heterologous elements were the strongest predictors of recurrence in PTs. Tan et al. 's classification system demonstrated close concordance with the WHO (2019) criteria, whereas the Refined Criteria classified a substantially greater proportion of tumours as malignant without improving prognostic discrimination during the available follow‐up period. Comprehensive tumour sampling remains essential for accurate classification and reliable prognostic assessment of PTs of the breast.

O câncer de mama luminal, caracterizado pela expressão de receptores hormonais, tem como pilar terapêutico o bloqueio endócrino. Contudo, as estratégias para intensificar a supressão hormonal trazem desafios clínicos significativos, especialmente na esfera reumatológica. O uso de moduladores seletivos do receptor de estrogênio, como o tamoxifeno, e inibidores de aromatase (IA) estão associados a efeitos adversos musculoesqueléticos que variam conforme o status menopausal. Enquanto o tamoxifeno pode proteger a densidade óssea em mulheres pós-menopáusicas, os IA frequentemente causam a síndrome musculoesquelética associada aos inibidores de aromatase, manifestada por artralgias, rigidez articular e mialgias. Tais sintomas afetam a qualidade de vida e são causas principais de descontinuação precoce do tratamento, elevando o risco de recorrência da doença. Recentemente, a incorporação dos inibidores de ciclina 4 e 6 (iCDK4/6) trouxe avanços apresentando um perfil de toxicidade musculoesquelética mais favorável e potencial efeito protetor contra a desmineralização óssea. O manejo eficaz desses efeitos exige uma abordagem multidisciplinar entre oncologistas e reumatologistas, incluindo a monitorização da saúde óssea, suplementação de vitamina D (com alvos superiores a 40 ng/ml) e a prática de atividade física regular. Além disso, é essencial a vigilância sobre interações medicamentosas via CYP3A4 ao associar terapias-alvo a fármacos reumatológicos. Em suma, o reconhecimento precoce e o tratamento adequado das queixas musculoesqueléticas são fundamentais para garantir a adesão terapêutica e otimizar os desfechos oncológicos a longo prazo, equilibrando a eficácia do tratamento com o bem-estar da paciente e benefício clínico.

To assess the degree of spirituality and religiosity in patients with breast cancer and its relationship with treatment, the Spiritual/Religious Coping (SRCOPE) scale and World Health Organization's Quality of Life Instrument – Spirituality, Religion and Personal Beliefs Module (WHOQOL-SRPB) questionnaires were applied to 49 patients. For 91.9% of the patients, there was a contribution of faith to their well-being and the connection with a spiritual being helped them tolerate the stress. There were correlations between axillary lymph node dissection and religious actions toward spirituality (p = 0.024), adjuvant chemotherapy and hope/optimism (p = 0.02), and immediate reconstructive surgery and a search for meaning (p = 0.005) and support (p = 0.032). In conclusion, identifying the religious and spiritual needs of patients might promote better quality of life during cancer treatment.

Introduction: For the 2020-2022 trieniumm more than 2 million cases of breast cancer were estimated worldwide. De novo metastatic breast cancer is so called when metastasis is diagnosed at the same time as the primary tumor. It affects approximately 3.5 to 10% of breast cancer patients and only 25% of these will be alive after 5 years. Methods: We conducted a retrospective cohort study of women with de novo metastatic breast cancer treated at a single center from January 1, 2000 to December 31, 2012. Cases were identified in the Hospital Cancer Registry. Overall survival (OS) was estimated at 5 years with the Kaplan-Meier product limit, and the log-rank test was used to test differences between curves; Cox multiple regression and all tests were considered significant with p<0.05. Results: Of the 265 patients in the study, the estimated 5-year OS was 31.3%. There was a difference in survival according to the following: age group (p<0.046); having had breast surgery (p<0.001); having undergone chemotherapy simultaneously with radiotherapy, hormone therapy, targeted therapy or surgery (p<0.088); use of exclusive or multimodal hormone therapy (p<0.001); education (p<0.001); luminal tumors (p<0.003); and being treated between 2006 and 2012 (p=0.043). In the multiple model adjusted by age group and education, the following factors remained as predictors of a better prognosis: having undergone surgery (hazard ratio — HR=0.46, 95% confidence interval — 95%CI 0.32–0.66); luminal tumors (HR=0.34, 95%CI 0.23–0.50); and targeted therapy (HR=0.27, 95%CI 0.15–0.46). Conclusion: The risk of death in patients with de novo metastatic breast cancer was lower than in those undergoing local surgical treatment as part of multimodal treatment, as well as the luminal molecular subtype and the introduction of better systemic treatment strategies, such as target.

Background: Triple‐negative breast cancer (TNBC) is the neoplasia most associated with BRCA1 germline pathogenic variants (PV) and is more likely to develop metastases than the other breast cancer (BC) subtypes, mainly in the lungs and the central nervous system (CNS). Recently, BRCA2 carriers were shown to have a higher risk for developing CNS metastases. However, the patterns of recurrence and metastases of BRCA2 carriers with TNBC are unknown.Methods: TNBC patient data attending the A.C. Camargo Cancer Center, from 1998 through 2020, were verified either by medical records or by BRCA1/2 genetic testing carried out. Multivariable logistic regression models were fit to the data to assess the independent factors for bone and CNS metastases. Adjustment was done using all independent variables with p < 0.2 in the univariable Cox model to describe the relationship between the independent variables until time of death.Results: A total of 388 TNBC patients were evaluated. We identified PV in BRCA1/2 genes in 21% (82/388), being 17.7% (69/388) in BRCA1 and only 3.3% (13/388) in BRCA2. A total of 120 patients (31%) developed distant metastases. Bone or CNS metastases were observed in 40% and 60% of BRCA2 PV carriers (p = 0.155), respectively. The BRCA2 carriers tended to have a higher likelihood of developing bone metastases (OR, 4.06; 95% CI, 0.82–20.01; p = 0.085), when compared to BRCA1 carriers (OR, 0.6; 95% CI, 0.12–2.87; p = 0.528). BRCA2 carriers had an OR of 1.75 (95% CI, 0.33–9.14; p = 0.503) for CNS metastasis development, while BRCA1 carriers had an OR of 0.72 (95% CI, 0.23–2.23; p = 0.574).Conclusions: Patients with TNBC and PV in the BRCA2 gene had higher frequencies of secondary bone involvement and CNS in the course of the disease. However, the BRCA2 PV did not represent an independent outcome predictor of metastases and overall survival. Efforts to increase the number of BRCA2 carriers among TNBC patients are crucial for determining their risk of developing bone and CNS metastases compared to BRCA2 noncarriers.

Introduction: The axillary lymph node status is one of the most important prognostic factors in breast cancer. For locally advanced tumors, neoadjuvant chemotherapy favors higher rates of breast lumpectomy and downstaging tumor burden of axilla. The aim of this study was to evaluate the use of a standardized image-guided protocol after neoadjuvant chemotherapy to enable sentinel node dissection in patients with axillary downstaging, avoiding axillary dissection. Methods: Retrospective cohort study of data collected from medical records of patients who underwent neoadjuvant chemotherapy in a single center, from January 2014 to December 2018. The protocol comprises the placement of a metal clip in positive axillary lymph node, in patients with up to two clinically abnormal lymph nodes presented on imaging. After neoadjuvant chemotherapy, and once a radiologic complete response was achieved, sentinel node dissection was performed using blue dye and radiotracer. Axillary dissection were avoided in patients whose clipped sentinel node were negative for metastasis and in patients with three identified and negative sentinel node dissection. Results: A total of 471 patients were analyzed for this study: 303 before and 165 after the implementation of the protocol; 3 cases were excluded. The rate of sentinel node dissection in clinical nodes positive patients was statistically higher in this group when compared to patients treated before the protocol implementation (22.8% vs. 40.8%; p=0.001). Patients with triple negative and HER2-positive tumors underwent sentinel node dissection more frequently when compared to luminal tumors (p=0.03). After multivariate analysis, the variables that were associated with a greater chance of performing sentinel node dissection were clinical staging, type of surgery performed and implementation of the axillary assessment protocol. Conclusions: The results showed that the use of an easily and accessible image-guided protocol can improve sentinel node dissection in selected patients, even if the lymph node was positive previously to neoadjuvant treatment.

Purpose Knowledge on whether low expressions of HER2 have prognostic impact in early-stage breast cancer (BC) and on its response to current chemotherapy protocols can contribute to medical practice and development of new drugs for this subset of patients, changing treatment paradigms. This study aims to evaluate the impact of HER2-low status on response to neoadjuvant chemotherapy (NACT) and survival outcomes in early-stage HER2-negative BC. Methods Records from all BC patients treated with NACT from January 2007 to December 2018 in a single cancer center were retrospectively reviewed. HER2-negative (immunohistochemistry [IHC] 0, + 1, or + 2 non-amplified by in situ hybridization [ISH]) patients were included. HER2-low was defined by IHC + 1 or + 2 ISH non-amplified and HER2-0 by IHC 0. The coprimary objectives were to compare pathological complete response (pCR) and relapse-free survival (RFS) between luminal/HER2-low versus luminal/HER2-0 populations and between triple negative (TNBC)/HER2-low versus TNBC/HER2-0. Results In total, 855 HER2-negative patients were identified. The median follow-up was 59 months. 542 patients had luminal subtype (63.4%) and 313 had TNBC (36.6%). 285 (33.3%) were HER2-low. Among luminal patients, 145 had HER2 IHC + 1 (26.8%) and 91 had IHC + 2/ISH non-amplified (16.8%). In TNBC, 36 had HER2 IHC + 1 (11.5%) and 13 had IHC + 2/ISH non-amplified (4.2%). Most patients had locally advanced tumors, regardless of subtype or HER2-low status. For luminal disease, pCR was achieved in 13% of HER2-low tumors versus 9.5% of HER2-0 (p = 0.27). Similarly, there was no difference in pCR rates among TNBC: 51% versus 47% in HER2-low versus HER2-0, respectively (p = 0.64). HER2-low was also not prognostic for RFS, with 5-year RFS rates of 72.1% versus 71.7% (p = 0.47) for luminal HER2-low/HER2-0, respectively, and 75.6% versus 70.8% (p = 0.23) for TNBC HER2-low/HER2-0. Conclusion Our data does not support HER2-low as a biologically distinct BC subtype, with no prognostic value on survival outcomes and no predictive effect for pCR after conventional NACT.

Breast cancer (BC) is the most common neoplasm in women. Biopsy of metastatic lesions is recommended to confirm estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status as there are discrepancies in ...