Utilidad del índice pronóstico de Van Nuys en el manejo del carcinoma intraductal de mama

Abstract

Synthesis of Thesis - Utility of the Modified Van Nuys Prognostic Index in the Management of Intraductal Breast Carcinoma The increase in the diagnosis of ductal carcinoma in situ (DCIS) since the second half of the 90s, also due to the introduction of screening through serial mammography, a program implemented by the Government in the Region of Murcia in 1994, developed by the Spanish Association Against Cancer (AECC) to all women over 50 years old up to 70, this period, already known as the highest incidence of breast cancer. This program made the CDIS was more deeply studied. Simultaneous to this study, the Modified Van Nuys Prognostic Index (USC/VNPI) was idealized in the United States with the intention of having a tool in which, through an algorithm, it was possible to establish the severity and choose the appropriate treatment in relation to the severity of the case. The VNPI is based on 4 variables: the age of the patient, the tumor size, distance between the edge of the tumor and healthy tissue (margins) and histological grade in which each of these variables receives a score, forming 3 groups of patients The group of less serious, moderate and more serious. Specific treatments are recommended for each of the groups. In group 1, of lesser severity, tumorectomy is exclusively indicated. In group 2, moderate severity, conservative surgery (tumorectomy or quadrantectomy) with adjuvant radiotherapy is also indicated and finally in group 3, more serious, mastectomy is proposed as treatment. During the follow-up, hormone therapy is accepted for at least 5 years, that is, treatment with the use of anti-estrogen drugs. For the possible implantation of the USC / VNPI in a protocolized manner in the Region of Murcia, a retrospective period of 10 years was studied, from 2002 to 2012, 101 patients who suffered from DCIS and were treated and followed at the Hospital Universitario Virgen de la Arrixaca - Murcia. Knowing the evolution of these patients, it was possible to make a comparison of how the hypothetical evolution would be using this index. All 101 patients were classified and assigned to one of the 3 groups of the USC / IPVN. With this work, it was possible to better understand the characteristics of the patients who developed the DCIS, such as the mean age, 54.2 years, mean of children, 2.1 per patient; as well as knowing about personal, family history, use of hormones, smoking, breastfeeding among other variables (38 in total) to be able to associate or not with the development of DCIS or its relapses. With the help of the statistical studies, it was possible to have an idea about the disease-free period (SLE), that is, period without relapses, that each patient would have. First, it was clear that the relapse rate in this Region was higher than the global average during the years of the study. It was also demonstrated where the possible failures could be, such as the non-complete resection of the tumor, thus requiring more than one intervention exceptionally. It was concluded that, if the Index had been used, it could increase the disease-free period even though this increase has not been statistically significant, but with a tendency to be significant.