CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O cÃncer de mama (CM) à um problema de saÃde pÃblica mundial. Uma em cada oito mulheres terà cÃncer de mama, tornando-se assim a neoplasia mais freqÃente entre as mulheres. O cÃncer de mama està ligado à identidade feminina no tocante a sua potÃncia orgÃstica e a sua sensualidade. Elaborar estratÃgicas cirÃrgicas confiÃveis pouco agressivas e menos multilantes tem sido busca de respostas a muitas pesquisas. Objetivo: O presente estudo visou avaliar a concordÃncia do volume tumoral entre a avaliaÃÃo anatomopatolÃgica e os mÃtodos de diagnÃstico por imagem dedicados a mama: Mamografia (MX), Ultra-som (US) e RessonÃncia magnÃtica (RMM), em mulheres com cÃncer de mama localmente avanÃado, submetidas à quimioterapia neoadjuvante. Pacientes e MÃtodos: Foram analisadas 95 mulheres portadoras de neoplasia mamÃria oriundas dos ambulatÃrios da Maternidade Escola Assis Chateaubriant (MEAC), Centro Regional e Integrado de Oncologia (CRIO) e Instituto do CÃncer do Cearà (ICC), no perÃodo de marÃo de 2003 a marÃo de 2005. Estas pacientes foram divididas em dois grupos. Grupo Tratamento (GT) com n=46 e Grupo Controle (GC) com n=49. Realizou-se anÃlise nÃo paramÃtrica correlacionando as variÃveis estudadas com o padrÃo ouro, ou seja, a anatomia patolÃgica. Os resultados mostraram concordÃncia na anÃlise volumÃtrica dos mÃtodos imaginolÃgicos e o padrÃo-ouro no GT nos seguintes percentuais: RMM: 0,70; US: 0,63 e MX: 0,42. Quando comparado ao grupo controle os valores encontrados foram RMM: 0,72; US: 0,70 e MX: 0,41. ConclusÃo: A RMM deteve os maiores valores de concordÃncia volumÃtrica em percentuais semelhantes nos dois grupos (GT e GC) e a MX, mÃtodo de imagem mais difundido, ofereceu os menores Ãndices de concordÃncia imaginolÃgica quando comparado com a avaliaÃÃo anatomopatolÃgica. A US apresentou valores de concordÃncia volumÃtrica satisfatÃria quando, comparada a RMM, devendo ressaltar que se trata de mÃtodo operador dependente. / The cancer of breast (CB) it is a problem of world public health. One in each eight women will have cancer of breast, becoming like this the most frequent neoplasia among the women. CB it is tied up the feminine identity concerning its potency of orgasm and her sensuality. To elaborate surgical strategic reliable not very aggressive and less mutilate has been search of answers to many researches. Objective: The present study was to evaluate the agreement of the volume of tumor to the evaluation anatomopathological and the diagnosis methods for image dedicated to he/she suckles her: Mammography (MX), Ultra-sound (US) and magnetic Resonance (RMM), in women with cancer of breast locally advanced, submitted to the neoadjuvante chemotherapy. Patient and Methods: 95 women carriers of mammary neoplasia originating from of the national health clinics of the Maternity Escola Assis Chateaubriant (MEAC), Center Regional and Integrated of Oncology (CRIO) and Institute of Cancer of Cearà (ICC) were analyzed at the period of 2003 March to 2005 March. These patient ones were divided in two groups. Treatment Group (TG) with n=46 and Control Group (CG) with n=49. Non parametric analysis correlating the variables was compared with the standard gold, the anatomopathological analysis. Results: The data showed agreement in it analyzes at volumÃtrica of the imaginolÃgicos methods and the pattern-gold in TG in the following percentages: RMM: 0.70; US: 0.63 and MX: 0.42, when compared to the control group, where were found values of RMM: 0.72; US: 0.70 and MX: 0.41. Conclusion: RMM stopped the largest values of agreement volumÃtrica in percentile similar in the two groups (GT and GC) and MX, spread image method, offered the smallest indexes of agreement imaginolÃgica when compared with the evaluation anatomopathological. US presented values of agreement satisfactory volumÃtrica when, compared RMM, should stand out that is method dependent operator.

Il est maintenant bien établi que le système immunitaire joue un rôle majeur dans le contrôle des tumeurs, y compris dans les carcinomes pulmonaires. Cependant, les interactions entre les cellules tumorales et les cellules immunitaires du microenvironnement tumoral sont mal connues. Dans ce travail, nous avons étudié les caractéristiques morphologiques et moléculaires des cellules tumorales provenant d’adénocarcinomes pulmonaires et leur association avec la composition du microenvironnement immunitaire. Nous avons rapporté la valeur pronostique des paramètres morphologiques de ces tumeurs, comme le grade histologique des adénocarcinomes, et leur association avec le statut moléculaire EGFR et KRAS. Nous avons émis l’hypothèse que la diversité morphologique et moléculaire de ces tumeurs pouvait être associée à une signature immunitaire intra-tumorale spécifique et que cela pourrait avoir un impact pronostique. Nous avons mis en évidence que la densité des cellules dendritiques matures, situées au sein de structures lymphoïdes tertiaires, variait en fonction du statut moléculaire EGFR et KRAS des tumeurs. De même, l’impact pronostique des cellules dendritiques matures et des lymphocytes CD8+ variait en fonction du statut moléculaire des tumeurs. Nous avons également retrouvé la valeur pronostique de l’environnement immunitaire, représenté par la densité en cellules dendritiques matures et en lymphocytes CD8+, sur la survie à long terme des carcinomes pulmonaires de stade III-N2 opérés après chimiothérapie néoadjuvante. Enfin, nous avons démontré que la chimiothérapie n'est pas associée à de profondes modifications de l’infiltrat immunitaire, alors qu’elle entraîne des modifications des cellules tumorales. L’ensemble de ces résultats suggère que l’infiltrat immunitaire est intimement lié à la cellule tumorale et que la composition du microenvironnement immunitaire varie avec les caractéristiques de la tumeur. Cette interaction entre les cellules tumorales et les cellules immunitaires contribue au pronostic de ces tumeurs. Ces données démontrent l’intérêt d’utiliser des traitements combinant des drogues cytotoxiques, telle la chimiothérapie conventionnelle, à des traitements immunomodulateurs permettant de favoriser une réponse immunitaire anti-tumorale efficace. / The major role of the immune system against tumor development is now clearly established, including lung carcinoma. Nevertheless, interaction between tumoral cells and immune environment is less well-defined. In that study, we have studied morphological and molecular tumoral cells characteristics from lung adenocarcinoma and their role in the composition of immune environment. We reported the prognostic value of morphological parameters, as histological grade of adenocarcinoma, and their association with molecular EGFR and KRAS status. We hypothesized that morphological and molecular diversity of these tumors could be associated with a specific intratumoral immune signature, and could have an impact in prognosis. We showed that mature dendritic cells density, located in tertiary lymphoid structures, differed according to EGFR and KRAS status. Morever, molecular status of tumors modified the pronostic value of mature dendritics cells and CD8+ T cells. We found a prognostic value of immune environment, represented by dendritic cells and T CD8+ cells, in operated stage III-N2 lung carcinomas treated by neoadjuvant chemotherapy. At last, we demonstrated that chemotherapy is not associated with wide modifications in immune infiltrate, whereas it induced modifications in tumoral cells. All together, these data strongly argue for a close link between tumoral cells and immune environment, which seems to depend on tumoral cell characteristics. This interaction between tumoral cells and immune cells contribute to the prognosis of these tumors. These results show the evidence that combine cytotoxic treatment, like conventional chemotherapy, with immunomodulators, favour a protective anti-tumor immune response.