OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

CONTEXTO E OBJETIVO: A mastectomia radical modificada continua a ser amplamente usada para o tratamento de câncer de mama. Porém, até agora, a preservação do músculo peitoral secundário (técnica de Madden) não foi prospectivamente comparada à técnica de Patey. O objetivo deste trabalho foi comparar as duas técnicas de mastectomias radicais modificadas, analisando o grau de dificuldade e as complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado, realizado na Unidade de Mama do Hospital Araújo Jorge, Faculdade de Medicina da Universidade Federal de Goiás, Goiás, Brazil. MÉTODOS: 430 pacientes portadoras de câncer de mama com indicação de mastectomia radical modificada foram incluídas no programa. Foram disponíveis para análise 426 pacientes, das quais 225 alocadas no grupo Patey e 201 no grupo Madden. A análise foi feita por intenção de tratamento, usando-se o Qui-quadrado ou o teste t de Student, quando aplicáveis. RESULTADOS: A distribuição das características demográficas pacientes foi semelhante entre os grupos. A duração média da cirurgia foi de 105 minutos (DP ± 29.9) e 102 (DP ± 33) para o grupo Patey e Madden, respectivamente (p = 0,6). O tempo de internação foi de 2,3 dias para ambos os grupos. A média de linfonodos ressecados foi de 20,3 (DP ± 7,6) para Patey e 19,8 (DP ± 8,1) para Madden (p = 0,5). Não houve diferenças entre as complicações vasculares, nervosas, hematomas, infecções, bem quanto à dificuldade relatada pelo cirurgião. CONCLUSÃO: A retirada do músculo pequeno peitoral não influenciou nenhuma das variáveis estudadas. As técnicas de mastectomias radicais modificadas, Patey e Madden, foram semelhantes em todos os critérios observados, podendo ser executadas de acordo com a preferência do cirurgião.

CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS: The patients’ demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (± 29.9) and 102 minutes (± 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (± 7.6) for Patey and 19.8 (± 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon’s discretion.

OBJETIVOS: Avaliar o nível de conhecimento sobre o rastreamento e diagnóstico do câncer de mama entre os ginecologistas do Estado de Goiás, Brasil. MÉTODOS: Foi enviado um questionário contendo perguntas sobre a formação profissional e sobre o diagnóstico do câncer de mama, para os 427 sócios da Sociedade Goiana de Ginecologia e Obstetrícia, entre maio e julho de 1999. RESULTADOS: Dos 427 questionários enviados, 26 (6%) foram devolvidos por endereçamento incorreto. Dos 401 médicos que receberam o questionário, 85 (21%) responderam e retornaram. Destes, 28% eram do sexo feminino, a média do tempo de profissão foi de 17 anos e 70% possuía a residência médica como maior titularidade. A média de idade foi de 44 anos. As taxas de respostas corretas foram: 94% sabiam o sinal mais freqüente do câncer de mama, 75% o melhor método para rastreamento, 88% o período de quando iniciar a mamografia, 93% a periodicidade da mamografia após os 50 anos e 83% sobre a indicação da ultra-sonografia complementar. O fato de o profissional ter cursado um programa de Residência Médica foi o único fator que influenciou na taxa de respostas corretas, se comparado àqueles que não cursaram. O sexo do profissional, portadores de Título de Especialista em ginecologia e obstetrícia (TEGO) e a cidade de atuação não influenciaram nas taxas de respostas corretas. CONCLUSÕES: Os ginecologistas do Estado de Goiás que responderam ao questionário têm um bom conhecimento sobre o rastreamento e diagnóstico do câncer de mama, sendo que apenas a Residência Médica influenciou na taxa de respostas corretas.

OBJECTIVES: To evaluate the knowledge level on the screening and diagnosis of breast cancer among the gynecologists of the State of Goiás, Brazil. METHODS: Questionnaires containing professional information and questions on breast cancer screening were posted for all the 427 gynecologists associated to the Goiás Society of Gynecology and Obstetrics, between May and July of 1999. RESULTS: Of the 427 questionnaires, 26 (6%) were returned because incorrect mailing address. Of the 401 doctors who received the questionnaire, 85 (21%) answered and returned them back. Of these, 28% were female; the average of the profession time was of 17 years. The medical residence was the highest title level for 70%. The average age of the doctors was 44 years. The rates of correct answers were: 94% for the knowledge of the most frequent sign of breast cancer, 75% for the best method for screening, 88% for the period of when the mammography begins, 93% for the periodicity of the mammography after the 50 years and 83% about the indication of the complementary ultrasound. The doctors who have studied in a program of medical residence was the only factor that influenced the rate of correct answers, if compared to those that did not cursed it. The professional's gender, the Title in Gynecology and Obstetrics Specialty (TEGO) holders and the city of work did not influence the rates of correct answers. CONCLUSION: The gynecologists of the State of Goiás who answered the questionnaire have a good knowledge on the screening and diagnosis of breast cancer. Medical residence was the single factor that influenced the rate of correct answers.

O carcinoma espinocelular do parênquima mamário é um tipo raro de neoplasia, representando menos de 1% de todos os carcinomas mamários. Esse trabalho relata a condução de um caso diagnosticado e tratado no Serviço de Ginecologia e Mama do Hospital Araújo Jorge/ACCG. São discutidos a apresentação clínica, o diagnóstico e o prognóstico destes tumores.

Squamous cell carcinoma of the mammary tissue is a very rare neoplasm, representing less than 1% of all breast carcinomas. The present study reports a case of squamous cell carcinoma of the breast, treated at the Hospital Araújo Jorge/ACCG. The tumor diagnosis, treatment and prognosis are also discussed.