Introdução: o status dos linfonodos axilares permanece um dos mais importantes fatores prognósticos no carcinoma de mama em estágios iniciais, além de definir o uso de terapias complementares. A biópsia de linfonodo sentinela (BLNS) surgiu com a finalidade de estadiar a axila com o mínimo de morbidade, tendo como objetivo a identificação e o estudo patológico do primeiro linfonodo axilar proveniente da drenagem linfática da mama. Pacientes com axila clinicamente negativa têm indicação de biópsia de linfonodo sentinela como método de estadiamento da axila, e quando o resultado era positivo para metástase recomendava-se o esvaziamento axilar. Por recomendação do ACOSOG Z0011, o esvaziamento axilar (EA) após uma biópsia de linfonodo sentinela positivo não é necessário. Esse estudo demonstrou não haver benefício em realizar o EA na presença de LNS positivo na sobrevida global ou na sobrevida livre de doença. Objetivos: Avaliar a taxa de recidiva e morte em pacientes submetidas à cirurgia conservadora de mama e BLNS positiva com posterior esvaziamento axilar no Hospital de Clínicas de Porto Alegre; e, como objetivo secundário, avaliar as características clínicas e patológicas dessa população. Método: foi realizado um estudo de coorte retrospectiva, incluindo pacientes com diagnóstico de carcinoma de mama invasor submetidas à cirurgia conservadora da mama e BLNS, cujo resultado foi positivo para presença de metástases, e foram submetidas ao EA o período de janeiro de 2004 a dezembro de 2008. Resultados: foram incluídas 144 pacientes submetidas à biópsia de linfonodo sentinela e CCM; 33 tiveram o achado de biópsia de linfonodo sentinela positivo para metástase, e dessas 33 pacientes restaram 27 para análise dos dados. A taxa de sucesso na identificação do LNS foi de 0,96. A idade média das pacientes foi de 53,8 anos, o número de LNS ressecados foi de 1,6 por paciente; a média do tamanho tumoral foi de 2,3 cm. Seis pacientes apresentaram doença axilar residual correspondendo a 22,2% da amostra e tiveram um risco relativo de morte de 3 vezes mais para aquelas sem doença axilar residual e 50% a mais de desenvolvimento de metástases. Conclusão: O comprometimento axilar é importante fator no prognóstico das pacientes com câncer de mama, quanto maior o comprometimento da axilar pior será o desfecho de sobrevida livre de doença e de morte. Acreditamos que se pode aplicar a conduta do ACOSOG Z0011 também nas pacientes do HCPA devido à alta sensibilidade do método no nosso meio. / Introduction: The status of axillary lymph nodes remains one of the most important prognostic factors in breast carcinoma in the early stages, in addition it helps to defining the use of complementary therapies. Sentinel lymph node biopsy (SLNB) was developed with the purpose of staging the axilla with minimal morbidity, aiming at the identification and pathological study of the first axillary lymph node from the lymphatic drainage of the breast. Patients with clinically negative lymph node have indication of SLNB as a method of axillary staging, and with a positive finde for metastasis the axilar clereance was performed. Nowadays, due to the ACOSOG Z0011 Study, the axillary dissection (AD) after a positive SLNB for metastasis was put in check. This estudy have as a result no difference in global survive ou disease free survive if ALND was not performed in a positive SLNB. In the present study, we intend to evaluate the clinical and histopathological characteristics of patients submitted to breast conservative surgery and sentinel lymph node biopsy with a positive result for metastasis. Main objective: Evaluate the rate of recurrence and death in patients submitted to conservative breast surgery and BLNS with posterior axillary emptying at Hospital de Clínicas, Porto Alegre. It is a secondary objective to evaluate the clinical and pathological characteristics of this population. Material and Methods: A retrospective cohort study was performed, including 144 patients diagnosed with invasive breast carcinoma submitted to conservative breast surgery and SLNB, whose results were positive for metastases, and were submitted to AD, at the Mastology Unit of the Hospital de Clinicas de Porto Alegre (HCPA), from January 2004 to December 2008. Results: Of 144 patients submitted to SLNB and BCS, 33 had SLNB positive for metastasis, of these 33 patients remained 27 for data analysis. The success rate in LNS identification was 0.96. The mean age of the patients was 53.8 years, the number of resected SLN was 1.6 per patient; The mean tumor size was 2.3 cm. Six patients had residual axillary disease corresponding to 22.2% of the sample and had a relative risk of death of 3 times more for those without residual axillary disease and 50% more for the development of metastases. Conclusion: Axillary involvement is an important factor in the prognosis of patients with breast cancer, and the greater the axillary impairment, the worse the diseasefree survival outcome and death. We believe that the ACOSOG Z0011 trial can also be applied to HCPA patients who meet the inclusion criteria for this purpose, due to the high sensitivity of the method in our environment.

Characterization of the ontogenic program is essential to infer about palnts adaptation strategies. Frequently, morphogenesis of tropical forage grasses is reported to be analogous to that of temperate forage grasses. However, tropical grasses show stem development still during the vegetative phase of growth and under high light availability conditions. Stem elongation potentially impacts plants growth, with implications for grazing management. In tropical conditions, elephantgrass cv. Napier is considered one of the most productive grass species under grazing. The objective of this study was to characterize the ontogenic development of elephantgrass, coordination between phytomers, stem elongation and leaf and internode coordination in main and primary axes, using an isolated plant protocol. The experiment was conducted in Piracicaba, SP, during the Spring (2015), Summer (2016) and Autumn (2016), using a complete randomized block design, with 4 replicates. Eighty fiber cement tanks (0.343 m3) were used. Each block was composed of 20 tanks, 10 used to evaluate the morphogenic and developmental characteristics and 10 for the destructive evaluations. Measurements of leaf and stem elongation were performed every two days to determine the following variables: leaf appearance rate (LAR), leaf elongation rate (LER), leaf elongation duration (LED) and final leaf length (FLL). From day 10 of the evaluation period in Summer and Autumn and day 25 in Spring, 10 cuts were performed for destructive assessments every 5 days. At the time of the destructive evaluations, the following variables were measured: apical meristem heigth (AMH); sheath tube length (STL); number of expanding leaves (NEL); number of expanded leaves (NEXL). Measurements of sheath length (SL) and internode length (IL) were performed only on the main axis. On the main axis LAR (0.02 leaves degree-days-1) and LER (0.26 cm degree-days-1) were constant, whereas LED and FLL increased with leaf rank on the axis. LED ranged from 150 to 280 degree-days from phytomer 10 to 20. In Autumn, due to flowering, LED decreased with leaf rank. SL increased until reaching a maximum value of approximately 10-12 cm from the phytomer 12-13 onwards. When evaluated in phyllochronic units, similar pattern was observed across seasons of the year for a common leaf rank group. However, in all seasons, higher leaf ranks presented greater LED. Higher LAR were reported for topmost primary axes and LER increased with leaf rank until reaching a maximum, remaining constant afterwards. The LED increased with leaf rank in main and primary axes. The stem elongation began from phytomer 8 on the main axis in all seasons of the year, and in earlier phytomers for the other primary axes. In the main axis, internode length ranged from 0.5-2.0 cm for phytomer 8 until reaching a maximum value of 8-10 cm for phytomers 12-13 onwards, in Spring and Summer. During Autumn, maximum values of internode length were approximately 20 cm. Internode elongation begins concomitantly with the cessation of leaf elongation, and after 5 phyllochronic units from leaf appearance. In all axes, STL increased until reaching a maximum value of approximately 12-13 cm in Summer and 11-12 cm in Spring, coinciding with the beginning of stem elongation. The ontogenic development described for elephantgrass differs from that reported for temperate forage grasses. There was a seasonality effect. Axes development presents a hierarchical and synchronized organization. However, for the upper axes and topmost phytomers behavior is different and needs to be investigated. The stem elongation process can be described by the number of produced leaves. This study provides a key element for understanding phenotypic plasticity and corresponds to an useful information to identify the onset of stem elongation in field conditons. This result can potentially be used for functional-structural plant modelling. / A caracterização do desenvolvimento ontogênico é de fundamental importância para inferir sobre estratégias de adaptação das plantas. Frequentemente, a morfogênese de gramíneas tropicais é reportada como análoga à de gramíneas de clima temperado. No entanto, gramíneas tropicais apresentam colmo ainda na fase vegetativa e com elevada disponibilidade de luz. O alongamento de colmo potencialmente altera a dinâmica do desenvolvimento, com implicações sobre o manejo do pastejo. Em condições tropicais, o capim-elefante cv. Napier é considerado uma das gramíneas mais produtivas sob condições de pastejo. Objetivou-se com esse estudo caracterizar o desenvolvimento ontogênico do capim-elefante, a coordenação entre fitômeros, o alongamento de colmo e a coordenação entre folha e entrenó em perfilhos principais e axilares, em condições de plantas isoladas. O experimento foi conduzido em Piracicaba-SP, durante a Primavera (2015), Verão (2016) e Outono (2016), utilizando um delineamento em blocos completos casualizados, com 4 repetições. Foram instalados 80 tanques de fibrocimento (0,343 m3). Cada bloco era composto por 20 tanques, sendo que 10 foram utilizados para avaliar as características morfogênicas e de desenvolvimento e os outros 10 para as avaliações destrutivas. Medições do alongamento da lâmina foliar e do colmo foram realizadas a cada dois dias, para determinação das variáveis: taxa de aparecimento de folhas (TAF), taxa de alongamento de folhas (TAlF), duração do alongamento de folhas (DAF) e comprimento final da folha (CFF). A partir do dia 10 do período de avaliação no Verão e no Outono e do dia 25 na Primavera, foram feitos 10 cortes para avaliações destrutivas, a cada 5 dias. Por ocasião das avaliações destrutivas, as seguintes variáveis foram medidas: altura do meristema apical (AMA); comprimento do tubo de bainha (CTB); número de folhas em expansão (NFE); número de folhas expandidas (NFEX). Medições da bainha foliar (BF) e do comprimento do entreno (CE) foram realizadas apenas para o eixo principal (perfilho basal). No eixo principal, a TAF (0,02 folhas graus-dias-1) e a TAlF (0,26 cm graus-dias-1) foram constantes, enquanto que a DAF e o CFF aumentou com nível de inserção da folha no perfilho. A DAF variou de 150 a 280 graus-dias do fitômero 10 ao 20. No Outono, em função do florescimento, a DAF diminuiu com o nível de inserção da folha. O comprimento da BF foi crescente até atingir um valor máximo de aproximadamente 10-12 cm do fitômero 12-13 em diante. Quando avaliado em unidades filocrônicas, padrão semelhante foi observado entre épocas do ano para um grupo comum de níveis de inserção de folhas. No entanto, em todas as estações, níveis de inserção de folhas superiores apresentaram maiores DAF. Maiores TAF foram reportadas para eixos primários (perfilhos axilares) localizados acima do nível do solo e a TAlF foi crescente com o nível de inserção da folha até atingir um nível máximo, apartir do qual foi constante. A DAF foi crescente com o nível de inserção da folha em todos os eixos. O alongamento do colmo ocorreu a partir do fitômero 8 no eixo principal em todas as estações do ano, e em fitômeros anteriores para os demais eixos primários. No eixo principal, o CE variou de 0,5-2,0 cm no fitômero 8 até atingir valores máximos de 8-10 cm do fitômero 12-13 em diante, na Primavera e Verão. No Outono, valores máximos de entrenó foram de aproximadamente 20 cm. O alongamento do entrenó inicia-se concomitantemente ao término do alogamento da folha, e a um tempo de 5 filocronos do aparecimento da folha. Em todos os eixos, o CTB aumentou até atingir um valor máximo de aproximadamente 12-13 cm no verão e 11-12 cm na primavera, momento que coincidiu com o início do alongamento do colmo. O desenvolvimento ontogênico descrito para capim-elefante diverge daquele descrito para gramíneas de clima temperado. Houve efeito de sazonalidade. O desenvolvimento dos eixos apresenta organização hierárquica e sincronizada. No entanto, para os eixos superiores e fitômeros acima do nível do solo, o comportamento é diferente. O alongamento do colmo pode ser descrito pelo número de folhas produzidas. Este estudo fornece um elemento-chave para a compreensão da plasticidade fenotítipa e informações úteis para identificar o início do alongamento do colmo no campo. Este resultado pode ser utilizado potencialmente para modelagem de processos estrutura-função da planta.

<p>Breast cancer is the most common malignancy among females in Sweden. Axillary lymph-node dissection is a standard procedure in the management of breast cancer, aiming at obtaining prognostic information for adjuvant therapy decisions. Axillary dissection entails considerable morbidity. The aims of this study were to establish more selective surgical approaches and to investigate angiogenesis, a potential predictor for lymph-node metastases and prognosis.</p><p>Clinical nodal status, tumour size and S-phase were associated with nodal metastases in cohort of 1145 women. The proportion of nodal metastases was 13% in the subgroup with the lowest risk.</p><p>In a study from two registries, 675 and 1035 breast cancers ≤10 mm diagnosed by screening mammography had nodal metastases in 6,5% and 7%, respectively. Clinically detected cancers had a risk of 16% and 14%, respectively.</p><p>In a study on 415 women, a 5-node biopsy of the axilla had a sensitivity of 97,3% and a false negative rate of 2,7% in comparison with axillary dissection.</p><p>Six sections from 21 breast cancers were analysed for microvessel density (MVD). The inter-section variation contributed more to the total variance than inter-tumour variation, 45,0% and 37,3%, respectively.</p><p>In a cohort of 315 women, breast cancers with high MVD more frequently had p53 mutations (27,1%) compared with cases with low MVD (18,4%). This difference was not statistically significant (p=0,075). p53 mutations were associated with a worse outcome, whereas MVD was not.</p><p>In conclusion, women with screening detected ≤10 mm breast cancers have a low risk of lymph node metastases and some may not need axillary dissection in the future. The 5-node biopsy could be an alternative to axillary dissection. MVD is associated with methodological weaknesses and routine use is not recommended.</p>

Breast cancer is the most common malignancy among females in Sweden. Axillary lymph-node dissection is a standard procedure in the management of breast cancer, aiming at obtaining prognostic information for adjuvant therapy decisions. Axillary dissection entails considerable morbidity. The aims of this study were to establish more selective surgical approaches and to investigate angiogenesis, a potential predictor for lymph-node metastases and prognosis. Clinical nodal status, tumour size and S-phase were associated with nodal metastases in cohort of 1145 women. The proportion of nodal metastases was 13% in the subgroup with the lowest risk. In a study from two registries, 675 and 1035 breast cancers ≤10 mm diagnosed by screening mammography had nodal metastases in 6,5% and 7%, respectively. Clinically detected cancers had a risk of 16% and 14%, respectively. In a study on 415 women, a 5-node biopsy of the axilla had a sensitivity of 97,3% and a false negative rate of 2,7% in comparison with axillary dissection. Six sections from 21 breast cancers were analysed for microvessel density (MVD). The inter-section variation contributed more to the total variance than inter-tumour variation, 45,0% and 37,3%, respectively. In a cohort of 315 women, breast cancers with high MVD more frequently had p53 mutations (27,1%) compared with cases with low MVD (18,4%). This difference was not statistically significant (p=0,075). p53 mutations were associated with a worse outcome, whereas MVD was not. In conclusion, women with screening detected ≤10 mm breast cancers have a low risk of lymph node metastases and some may not need axillary dissection in the future. The 5-node biopsy could be an alternative to axillary dissection. MVD is associated with methodological weaknesses and routine use is not recommended.

Several mechanisms have been proposed to explain the process of vein pattern formation in plant tissues. The most widely accepted amongst biologists is the canalization hypothesis, derived from pea root and stem experiments. According to this hypothesis, a signal, thought to be the phytohormone auxin, is transported polarly from cell to cell from the shoot to the root and is canalized progressively into narrow channels of high auxin fluxes that later differentiate to become vascular tissue. In this project, we set out to test whether auxin canalization drives vein pattern formation, using Arabidopsis thaliana mutants with increased auxin transport (max4-1, max3-9, max2-1 and max1-1). We predicted that the mutants would have distinct vein patterns and especially different angles between the primary and secondary veins, compared to the wild type. First rosette leaves of 15 plants per genotype were harvested for analysis each day from 7 to 17 days after sowing, giving a total of eight hundred twenty-five leaf samples to analyze. Venation patterns were extracted and analyzed using custom-made software written with Matlab. Overall, compared with the wild type, mutants with the highest auxin transport (max4-1 and max3-9) had different vein patterns at early developmental stages, confirming a role for auxin transport in vein patterning. However, veins of mutants and wild type connected at similar angles, which is not consistent with the auxin canalization hypothesis, as originally formulated.

Several mechanisms have been proposed to explain the process of vein pattern formation in plant tissues. The most widely accepted amongst biologists is the canalization hypothesis, derived from pea root and stem experiments. According to this hypothesis, a signal, thought to be the phytohormone auxin, is transported polarly from cell to cell from the shoot to the root and is canalized progressively into narrow channels of high auxin fluxes that later differentiate to become vascular tissue. In this project, we set out to test whether auxin canalization drives vein pattern formation, using Arabidopsis thaliana mutants with increased auxin transport (max4-1, max3-9, max2-1 and max1-1). We predicted that the mutants would have distinct vein patterns and especially different angles between the primary and secondary veins, compared to the wild type. First rosette leaves of 15 plants per genotype were harvested for analysis each day from 7 to 17 days after sowing, giving a total of eight hundred twenty-five leaf samples to analyze. Venation patterns were extracted and analyzed using custom-made software written with Matlab. Overall, compared with the wild type, mutants with the highest auxin transport (max4-1 and max3-9) had different vein patterns at early developmental stages, confirming a role for auxin transport in vein patterning. However, veins of mutants and wild type connected at similar angles, which is not consistent with the auxin canalization hypothesis, as originally formulated.

Several mechanisms have been proposed to explain the process of vein pattern formation in plant tissues. The most widely accepted amongst biologists is the canalization hypothesis, derived from pea root and stem experiments. According to this hypothesis, a signal, thought to be the phytohormone auxin, is transported polarly from cell to cell from the shoot to the root and is canalized progressively into narrow channels of high auxin fluxes that later differentiate to become vascular tissue. In this project, we set out to test whether auxin canalization drives vein pattern formation, using Arabidopsis thaliana mutants with increased auxin transport (max4-1, max3-9, max2-1 and max1-1). We predicted that the mutants would have distinct vein patterns and especially different angles between the primary and secondary veins, compared to the wild type. First rosette leaves of 15 plants per genotype were harvested for analysis each day from 7 to 17 days after sowing, giving a total of eight hundred twenty-five leaf samples to analyze. Venation patterns were extracted and analyzed using custom-made software written with Matlab. Overall, compared with the wild type, mutants with the highest auxin transport (max4-1 and max3-9) had different vein patterns at early developmental stages, confirming a role for auxin transport in vein patterning. However, veins of mutants and wild type connected at similar angles, which is not consistent with the auxin canalization hypothesis, as originally formulated.

Objective: To complete a cost-minimization analysis (CMA) of the cost of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) in the management of early-stage breast cancer (ESBC) in a hypothetical Ontario hospital setting. Methods: Decision-analysis modeling, with a decision-tree and Markov states, was used to estimate hospital costs for the two treatment options. The model was populated with data from the literature and costs from the Ontario Case Costing Initiative, a publicly accessible, government-sponsored, costing database. Model variability and parameter uncertainty were quantified by probabilistic sensitivity analysis (PSA). Results: The SLNB treatment algorithm was cost-minimizing compared to the ALND-only treatment option. The costs of treating postoperative complications did not contribute to the incremental average cost. Conclusion: A treatment algorithm that involves SLNB as the initial axillary-staging procedure in the setting of ESBC offers a cost-savings over the ALND-only option. This result is generalizable to all Ontario hospitals.

Objective: To complete a cost-minimization analysis (CMA) of the cost of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) in the management of early-stage breast cancer (ESBC) in a hypothetical Ontario hospital setting. Methods: Decision-analysis modeling, with a decision-tree and Markov states, was used to estimate hospital costs for the two treatment options. The model was populated with data from the literature and costs from the Ontario Case Costing Initiative, a publicly accessible, government-sponsored, costing database. Model variability and parameter uncertainty were quantified by probabilistic sensitivity analysis (PSA). Results: The SLNB treatment algorithm was cost-minimizing compared to the ALND-only treatment option. The costs of treating postoperative complications did not contribute to the incremental average cost. Conclusion: A treatment algorithm that involves SLNB as the initial axillary-staging procedure in the setting of ESBC offers a cost-savings over the ALND-only option. This result is generalizable to all Ontario hospitals.

Introdução: o status dos linfonodos axilares permanece um dos mais importantes fatores prognósticos no carcinoma de mama em estágios iniciais, além de definir o uso de terapias complementares. A biópsia de linfonodo sentinela (BLNS) surgiu com a finalidade de estadiar a axila com o mínimo de morbidade, tendo como objetivo a identificação e o estudo patológico do primeiro linfonodo axilar proveniente da drenagem linfática da mama. Pacientes com axila clinicamente negativa têm indicação de biópsia de linfonodo sentinela como método de estadiamento da axila, e quando o resultado era positivo para metástase recomendava-se o esvaziamento axilar. Por recomendação do ACOSOG Z0011, o esvaziamento axilar (EA) após uma biópsia de linfonodo sentinela positivo não é necessário. Esse estudo demonstrou não haver benefício em realizar o EA na presença de LNS positivo na sobrevida global ou na sobrevida livre de doença. Objetivos: Avaliar a taxa de recidiva e morte em pacientes submetidas à cirurgia conservadora de mama e BLNS positiva com posterior esvaziamento axilar no Hospital de Clínicas de Porto Alegre; e, como objetivo secundário, avaliar as características clínicas e patológicas dessa população. Método: foi realizado um estudo de coorte retrospectiva, incluindo pacientes com diagnóstico de carcinoma de mama invasor submetidas à cirurgia conservadora da mama e BLNS, cujo resultado foi positivo para presença de metástases, e foram submetidas ao EA o período de janeiro de 2004 a dezembro de 2008. Resultados: foram incluídas 144 pacientes submetidas à biópsia de linfonodo sentinela e CCM; 33 tiveram o achado de biópsia de linfonodo sentinela positivo para metástase, e dessas 33 pacientes restaram 27 para análise dos dados. A taxa de sucesso na identificação do LNS foi de 0,96. A idade média das pacientes foi de 53,8 anos, o número de LNS ressecados foi de 1,6 por paciente; a média do tamanho tumoral foi de 2,3 cm. Seis pacientes apresentaram doença axilar residual correspondendo a 22,2% da amostra e tiveram um risco relativo de morte de 3 vezes mais para aquelas sem doença axilar residual e 50% a mais de desenvolvimento de metástases. Conclusão: O comprometimento axilar é importante fator no prognóstico das pacientes com câncer de mama, quanto maior o comprometimento da axilar pior será o desfecho de sobrevida livre de doença e de morte. Acreditamos que se pode aplicar a conduta do ACOSOG Z0011 também nas pacientes do HCPA devido à alta sensibilidade do método no nosso meio. / Introduction: The status of axillary lymph nodes remains one of the most important prognostic factors in breast carcinoma in the early stages, in addition it helps to defining the use of complementary therapies. Sentinel lymph node biopsy (SLNB) was developed with the purpose of staging the axilla with minimal morbidity, aiming at the identification and pathological study of the first axillary lymph node from the lymphatic drainage of the breast. Patients with clinically negative lymph node have indication of SLNB as a method of axillary staging, and with a positive finde for metastasis the axilar clereance was performed. Nowadays, due to the ACOSOG Z0011 Study, the axillary dissection (AD) after a positive SLNB for metastasis was put in check. This estudy have as a result no difference in global survive ou disease free survive if ALND was not performed in a positive SLNB. In the present study, we intend to evaluate the clinical and histopathological characteristics of patients submitted to breast conservative surgery and sentinel lymph node biopsy with a positive result for metastasis. Main objective: Evaluate the rate of recurrence and death in patients submitted to conservative breast surgery and BLNS with posterior axillary emptying at Hospital de Clínicas, Porto Alegre. It is a secondary objective to evaluate the clinical and pathological characteristics of this population. Material and Methods: A retrospective cohort study was performed, including 144 patients diagnosed with invasive breast carcinoma submitted to conservative breast surgery and SLNB, whose results were positive for metastases, and were submitted to AD, at the Mastology Unit of the Hospital de Clinicas de Porto Alegre (HCPA), from January 2004 to December 2008. Results: Of 144 patients submitted to SLNB and BCS, 33 had SLNB positive for metastasis, of these 33 patients remained 27 for data analysis. The success rate in LNS identification was 0.96. The mean age of the patients was 53.8 years, the number of resected SLN was 1.6 per patient; The mean tumor size was 2.3 cm. Six patients had residual axillary disease corresponding to 22.2% of the sample and had a relative risk of death of 3 times more for those without residual axillary disease and 50% more for the development of metastases. Conclusion: Axillary involvement is an important factor in the prognosis of patients with breast cancer, and the greater the axillary impairment, the worse the diseasefree survival outcome and death. We believe that the ACOSOG Z0011 trial can also be applied to HCPA patients who meet the inclusion criteria for this purpose, due to the high sensitivity of the method in our environment.