Nuestros investigadores

Arlette María Elizalde Pérez

Publicaciones científicas más recientes (desde 2010)

Autores: Solans, B. ; López, A; Elizalde, Arlette María; et al.
ISSN 1365-2125  2019  págs. 1-14
Autores: Solans, B. P.; López, A; Elizalde, Arlette María; et al.
ISSN 0306-5251  Vol. 85  Nº 8  2019  págs. 1670 - 1683
AimsImmunotherapy is a rising alternative to traditional treatment in breast cancer (BC) patients in order to transform cold into hot immune enriched tumours and improve responses and outcome. A computational modelling approach was applied to quantify modulation effects of immunotherapy and chemotherapy response on tumour shrinkage and progression-free survival (PFS) in naive BC patients. MethodsEighty-three Her2-negative BC patients were recruited for neoadjuvant chemotherapy with or without immunotherapy based on dendritic cell vaccination. Sequential tumour size measurements were modelled using nonlinear mixed effects modelling and linked to PFS. Data from another set of patients (n=111) were used to validate the model. ResultsTumour size profiles over time were linked to biomarker dynamics and PFS. The immunotherapy effect was related to tumour shrinkage (P < .05), with the shrinkage 17% (95% confidence interval: 2-23%) being higher in vaccinated patients, confirmed by the finding that pathological complete response rates in the breast were higher in the vaccinated compared to the control group (25.6% vs 13.6%; P=.04). The whole tumour shrinkage time profile was the major prognostic factor associated to PFS (P < .05), and therefore, immunotherapy influences indirectly on PFS, showing a trend in decreasing the probability of progression with increased vaccine effects. Tumour subtype was also associated with PFS (P < .05), showing that luminal A BC patients have better prognosis. ConclusionsDendritic cell-based immunotherapy is effective in decreasing tumour size. The semi-mechanistic validated model presented allows the quantification of the immunotherapy treatment effects on tumour shrinkage and establishes the relationship between the dynamics of tumour size and PFS.
Autores: González de la Huebra, Ignacio Javier, (Autor de correspondencia); Elizalde, Arlette María; García, Alejandra; et al.
ISSN 0730-725X  Vol. 57  2019  págs. 317 - 322
Background: The use of preoperative breast MRI remains controversial despite being the most sensitive technique for the detection of breast malignancies. Purpose: To evaluate the benefit of preoperative breast MRI after performing the three conventional techniques (DM, US, DBT). To analyze the influence of breast density in the sensitivity of the different imaging techniques. Material and methods: Retrospective review of 280 histologically confirmed breast cancers in 192 women. We reviewed the medical records and evaluated the change of treatment induced by MRI. Also, we assessed the reports of DM and the combination of the different imaging techniques, and categorized them according to ACR density (a-d) and as negative (BI-RADS 1-3) or positive (BIRADS 4 or 5). The gold standard was the pathologic assessment of the surgical specimen. The sensitivity of the different techniques was compared using McNemar test. Results: Among these 192 women the use of MRI did not significantly increase the mastectomy rate (from 16.6% to 17.6%; p = 0.5). The addition of any technique demonstrated a higher sensitivity than DM alone. The sensitivity of DM alone was 52.5% while using all the techniques, including MRI, was 94.3% (p < 0.001). Regardless of breast density pattern, the addition of any technique significantly increased the sensitivity of DM (p < 0.001). Conclusions: The addition of MRI to the three conventional techniques increased the sensitivity but did not significantly modify the rate of mastectomies. Additional techniques increased the sensitivity of DM in both dense and non-dense breasts.
Autores: Elizalde, Arlette María; Rodríguez-Spiteri, Natalia;
ISSN 0214-1582  Vol. 30  Nº 1  2017  págs. 21 - 27
Debido a las limitaciones de la mamografía de cribado, especialmente en mamas densas, ha surgido una nueva técnica complementaria: la tomosíntesis. Esta técnica, al ser tomográfica, permite aumentar la detección de cánceres ocultos en la mamografía a la vez que puede disminuir los resultados falsos positivos provocados por superposición de imágenes. En este artículo revisamos el papel de la tomosíntesis en el cribado, analizando los 3 principales ensayos clínicos prospectivos que han tenido lugar en Europa: el ensayo OSLO, el ensayo STORM y el ensayo MALMÖ. Aunque la técnica mamográfica empleada es diferente en el estudio MALMÖ, los 3 han demostrado un significativo aumento de la sensibilidad (32, 34 y 43%, respectivamente), existiendo más diferencias en cuanto a las rellamadas (+32%, ¿27%, +43%). A pesar de que el tiempo de lectura se incrementa, parece que la técnica es coste-efectiva y contribuye poco al sobrediagnóstico, por lo que la tomosíntesis está llamada a jugar un papel importante en el cribado del cáncer de mama.
Autores: Elizalde, Arlette María; et al.
ISSN 0284-1851  Vol. 58  Nº 6  2017  págs. 645 - 651
Background: Digital breast tomosynthesis (DBT) and ultrasound (US) can detect additional cancers after negative mammography. However, not all cancers are visible by both techniques. Purpose: To study the role of the amount of peritumoral fat in the detection of additional cancers with DBT or US. Material and Methods: One reader retrospectively reviewed 142 breast cancers in 109 women who underwent mammography, DBT, US, and magnetic resonance imaging (MRI). Two readers in consensus evaluated the additional cancers detected by US, DBT, or MRI, and classified them into four groups according to the amount of peritumoral adipose tissue: group I, > 75% of peritumoral fat; group II, 50-74%; group III, 25-49%, and group IV, 0-24%. The detection of additional cancers by US and DBT with respect to the other imaging techniques was evaluated. Results: Seventy-eight cancers were detected by mammography and the remaining 64 cancers were detected by DBT, US, or MRI. US and DBT detected 46 (71.8%) and 25 (39.06%) additional tumors, respectively. Statistical significance was only found in group IV (P < 0.01). Conclusion: US detected more tumors than DBT in lesions surrounded by a small amount of fat. No significant differences were found between US and DBT in the detection of additional cancers in the other groups.
Autores: Garcia-Velloso, Maria Jose; Rodríguez-Fraile, M; et al.
ISSN 0938-7994  Vol. 27  Nº 8  2017  págs. 3190-3198
Our aim was to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) fused with prone 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in primary tumour staging of patients with breast cancer. METHODS: This retrospective study evaluated 45 women with 49 pathologically proven breast carcinomas. MRI and prone PET-CT scans with time-of-flight and point-spread-function reconstruction were performed with the same dedicated breast coil. The studies were assessed by a radiologist and a nuclear medicine physician, and evaluation of fused images was made by consensus. The final diagnosis was based on pathology (90 lesions) or follow-up¿¿¿24 months (17 lesions). RESULTS: The study assessed 72 malignant and 35 benign lesions with a median size of 1.8 cm (range 0.3-8.4 cm): 31 focal, nine multifocal and nine multicentric cases. In lesion-by-lesion analysis, sensitivity, specificity, positive and negative predictive values were 97%, 80%, 91% and 93% for MRI, 96%, 71%, 87%, and 89% for prone PET, and 97%. 94%, 97% and 94% for MRI fused with PET. Areas under the curve (AUC) were 0.953, 0.850, and 0.983, respectively (p¿<¿0.01). CONCLUSIONS: MRI fused with FDG-PET is more accurate than FDG-PET in primary tumour staging of breast cancer patients and increases the specificity of MRI.
Autores: Cambeiro, Felix Mauricio; Martínez, Fernando; Rodríguez-Spiteri, Natalia; et al.
ISSN 1538-4721  Vol. 15  Nº 4  2016  págs. 485 - 494
Purpose: To assess the safety, feasibility, and efficacy of free-hand intraoperative multicatheter breast implant (FHIOMBI) and perioperative high-dose-rate brachytherapy (PHDRBT) in early breast cancer. Methods and Materials: Patients with early breast cancer candidates for breast conservative surgery (BCS) were prospectively enrolled. Patients suitable for accelerated partial breast irradiation (APBI) (low or intermediate risk according GEC-ESTRO criteria) received PHDRBT (3.4 Gy BID × 10 in 5 days). Patients not suitable for APBI (high risk patients according GEC-ESTRO criteria) received PHDRBT boost (3.4 Gy BID × 4 in 2 days) followed by whole breast irradiation. Results: From June 2007 to November 2014, 119 patients were treated and 122 FHIOMBI procedures were performed. Median duration of FHIOMBI was 25 minutes. A median of eight catheters (range, 4-14) were used. No severe intraoperative complications were observed. Severe early postoperative complications (bleeding) were documented in 2 patients (1.6%), wound healing complications in 3 (2.4%), and infection (mastitis or abscess) in 2 (1.6%). PHDRBT was delivered as APBI in 88 cases (72.1%) and as a boost in 34 (27.8%). The median clinical target volume T was 40.8 cc (range, 12.3-160.5); median D90 was 3.32 Gy (range, 3.11-3.85); median dose homogeneity index was 0.72 (range, 0.48-0.82). With a median followup of 38.4 months (range, 8.7-98.7) no local, elsewhere, or regional relapses were observed; there was only one distant failure in PHDRBT boost. No major (acute or late) RTOG grade 3 or higher were documented in any of the 119 patients treated with PHDRBT. Cosmetic outcome in APBI patients was excellent or good in (87.0%) and fair or poor in (11.9%) while in boost patients was excellent or good in (76.4%) and fair in (23.5%). Conclusion: The FHIOMBI-PHDRBT program does not add complications to conservative surgery. It allows precise selection of APBI patients and offers excellent results in disease control and cosmetics. It also offers logistic advantages because it dramatically shortens the time of local treatment and avoids further invasive procedures.
Autores: Elizalde, Arlette María; Rodríguez-Spiteri, Natalia;
ISSN 0214-1582  Vol. 29  Nº 2  2016  págs. 69-74
La mamografía es la técnica habitual para el cribado poblacional del cáncer de mama. Sin embargo, la sensibilidad mamográfica disminuye mucho en las mamas densas, pudiendo ser de tan solo el 50%. En estos casos la ecografía complementaria puede jugar un papel importante al mejorar la sensibilidad, llegando a tasas de detección de cáncer de hasta el 0,3%. Sin embargo, la ecografía disminuye la especificidad y aumenta la tasa de rellamadas y de biopsias. La ecografía manual es operador dependiente, obliga a emplear mucho tiempo de radiólogo y no permite una revisión retrospectiva. La ecografía automatizada permite solventar varias de estas limitaciones, por lo que puede llegar a emplearse en el cribado como técnica adicional a la mamografía, especialmente en el caso de las mamas densas.
Autores: Rodríguez-Spiteri, Natalia; Martínez, Fernando; Olartecoechea, Begoña; et al.
ISSN 0009-739X  Vol. 91  Nº 8  2013  págs. 490 - 495
Introduction: Accelerated partial breast irradiation (APBI) with multicatheters after lumpectomy for breast cancer (BC) may be an alternative to whole breast irradiation in selected patients. The aim is to show our 5 year experience. Method: Between June 2007 and June 2012, 87 BC patients have been evaluated for APBI. Inclusion criteria were: age over 40 years, unifocal tumour, infiltrating ductal or intraductal carcinoma, tumour size smaller than 3 cm and no lymph node involvement. Complications, cosmetic results and local and distant recurrences were evaluated. Results: Treatment was completed in 48 patients and contraindicated in 39. The average age of treated patients was 59 years. Operating time was 123. min with 9 implanted catheters in each patient. No complications were observed during surgery or radiotherapy. Patients were discharged from hospital after 4 days. Tumour size was 11. mm. Of these, 35 were infiltrating ductal and 13 intraductal carcinomas. A total of 44 patients received adjuvant treatment. Mean follow-up was 22 months with no evidence of local or distant recurrence. The cosmetic outcome was good or excellent in 66% of cases. Conclusions: APBI with multicatheter placed after lumpectomy for BC is feasible and safe but requires a strict selection of patients.
Autores:  et al.
ISSN 0033-8338  Vol. 54  Nº 4  2012  págs. 350 - 356
Objective: To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. Material and methods: We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. Results: The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9 mm vs 22.3 mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). Conclusion: When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance