O carcinoma de mama triplo-negativo como tumor não rastreável em comparação aos demais subtipos imunoistoquímicos: um estudo transversal
Data
2023-04-18
Autores
Silva, Morgana Domingues da 
Orientadores
Nazário, Afonso Celso Pinto
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Comparar a forma de apresentação ao diagnóstico (por exame clínico
ou exame imaginológico) dos tumores de mama triplo-negativo com os demais
subtipos imunoistoquímicos. Métodos: Trata-se de estudo transversal que avaliou
dados referentes à forma de apresentação dos carcinomas de mama ao
diagnóstico (exame clínico ou achados de exames de imagem de rastreamento),
subtipo imunoistoquímico, grau histológico e tamanho do tumor, em pacientes
diagnosticadas e referenciadas para o serviço de Mastologia do Hospital São
Paulo – Unifesp, em São Paulo – Brasil, no período entre 2012 e 2021, por análise
de dados de prontuário destas pacientes. Resultados: Entre os 699 carcinomas
invasivos diagnosticados, 246 pacientes foram diagnosticadas com perfil luminal
A (35,2%), 257 luminal B (36,8%), 58 luminal B HER-2+ (8,3%), 26 HER-2
enriquecido (3,7%) e 112 triplo-negativo (16%). Os carcinomas triplo-negativos
apresentaram maior taxa de diagnóstico por exame clínico (86,6%), 6,65 vezes
mais chances de serem diagnosticados por exame clínico que os luminais A, além
de apresentarem maior tamanho de lesão. Os subtipos triplo-negativo e HER-2
enriquecido apresentaram os piores cenários de estádio clínico ao diagnóstico.
Entre os tumores diagnosticados por exame de rastreamento, os pertencentes ao
grupo luminal A associaram-se a nódulos vistos em imagem (em 45,1%) e os
subtipos luminal B e luminal B HER-2+ ao aparecimento de microcalcificações.
Não houve casos de triplo-negativos envolvendo microcalcificações em nossa
amostra. As assimetrias foram mais comuns nas imagens de tumores luminais B
HER-2+. Na análise multivariada, observou-se que apenas o grau histológico e o
valor do Ki-67 estão relacionados com a forma de diagnóstico. Tumores com grau
histológico 2 ou 3 apresentam maior chance de serem diagnosticados por exame
clínico e não serem rastreáveis em relação ao grau histológico 1. Quanto ao Ki-67,
o seu aumento de 1 ponto percentual acarreta um aumento de 1,3% na chance de
achado no exame físico. Não houve correlação dos receptores hormonais e HER-
2 com a chance do tumor não ser rastreável. Conclusões: os carcinomas de
mama subtipo triplo-negativo apresentam maior risco de diagnóstico por exame
clínico em comparação aos demais subtipos imunoistoquímicos e, portanto,
tendem a não serem rastreáveis. Parâmetros como Ki-67 e grau histológico
elevados apresentam correlação com essa tendência.
Objective: To compare the form of presentation at diagnosis of triple negative breast tumors with other immunohistochemical subtypes, in relation to clinical examination or imaging examination. Methods: This is a cross sectional study that evaluated data related to the presentation of breast carcinomas at diagnosis (clinical examination or screening imaging examination findings), immunohistochemical subtype, histological grade and tumor size, in diagnosed and referred patients. for the Mastology service at Hospital São Paulo – Unifesp, in São Paulo – Brazil, in the period between 2012 and 2021, by analyzing data from the medical records of these patients. Results: Among the 699 invasive carcinomas diagnosed, 246 patients were diagnosed with luminal profile A (35.2%), 257 luminal B (36.8%), 58 luminal B HER-2+ (8.3%), 26 HER-2 enriched (3.7%) and 112 triple negative (16%). Triple negative carcinomas had a higher rate of diagnosis by clinical examination (86.6%), 6.65 times more likely to be diagnosed by clinical examination than luminal A, in addition to having a larger lesion. The triple negative and HER-2 enriched subtypes presented the worst scenarios of clinical stage at diagnosis. Among the tumors diagnosed by screening examination, those belonging to the luminal A were associated with nodules seen on imaging (in 45.1%) and the subtypes luminal B and luminal B HER-2+ with the appearance of microcalcifications. There were no cases of triple negatives involving microcalcifications in our sample. Asymmetries were more common in images of luminal B HER-2+ tumors. In the multivariate analysis, it was observed that only the histological grade and the Ki-67 value are related to the form of diagnosis. Tumors with histological grade 2 or 3 are more likely to be diagnosed by clinical examination and not be traceable in relation to histological grade 1. As for Ki-67, its increase of 1 percentage point leads to an increase of 1.3% in the chance finding on physical examination. There was no correlation of hormone receptors and HER- 2 with the chance of the tumor not being screenable. Conclusions: triple negative subtype breast carcinomas present a higher risk of diagnosis by clinical examination compared to other immunohistochemical subtypes and, therefore, tend not to be traceable. Parameters such as high Ki-67 and histological grade correlate with this trend.
Objective: To compare the form of presentation at diagnosis of triple negative breast tumors with other immunohistochemical subtypes, in relation to clinical examination or imaging examination. Methods: This is a cross sectional study that evaluated data related to the presentation of breast carcinomas at diagnosis (clinical examination or screening imaging examination findings), immunohistochemical subtype, histological grade and tumor size, in diagnosed and referred patients. for the Mastology service at Hospital São Paulo – Unifesp, in São Paulo – Brazil, in the period between 2012 and 2021, by analyzing data from the medical records of these patients. Results: Among the 699 invasive carcinomas diagnosed, 246 patients were diagnosed with luminal profile A (35.2%), 257 luminal B (36.8%), 58 luminal B HER-2+ (8.3%), 26 HER-2 enriched (3.7%) and 112 triple negative (16%). Triple negative carcinomas had a higher rate of diagnosis by clinical examination (86.6%), 6.65 times more likely to be diagnosed by clinical examination than luminal A, in addition to having a larger lesion. The triple negative and HER-2 enriched subtypes presented the worst scenarios of clinical stage at diagnosis. Among the tumors diagnosed by screening examination, those belonging to the luminal A were associated with nodules seen on imaging (in 45.1%) and the subtypes luminal B and luminal B HER-2+ with the appearance of microcalcifications. There were no cases of triple negatives involving microcalcifications in our sample. Asymmetries were more common in images of luminal B HER-2+ tumors. In the multivariate analysis, it was observed that only the histological grade and the Ki-67 value are related to the form of diagnosis. Tumors with histological grade 2 or 3 are more likely to be diagnosed by clinical examination and not be traceable in relation to histological grade 1. As for Ki-67, its increase of 1 percentage point leads to an increase of 1.3% in the chance finding on physical examination. There was no correlation of hormone receptors and HER- 2 with the chance of the tumor not being screenable. Conclusions: triple negative subtype breast carcinomas present a higher risk of diagnosis by clinical examination compared to other immunohistochemical subtypes and, therefore, tend not to be traceable. Parameters such as high Ki-67 and histological grade correlate with this trend.
Descrição
Citação
SILVA, Morgana Domingues da. O carcinoma de mama triplo-negativo como tumor não rastreável em comparação aos demais subtipos imunoistoquímicos: um estudo transversal. 2023. 71 f. Dissertação (Mestrado em Ginecologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.