CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A gastrectomia com linfadenectomia ampliada ainda à o padrÃo ouro para o tratamento curativo do cÃncer de estÃmago (CaE), embora este procedimento possa levar a alto Ãndice de morbidade ou mortalidade, principalmente nos pacientes que nÃo apresentem disseminaÃÃo linfÃtica da doenÃa. A pesquisa do linfonodo sentinela (LS), jà consagrada nos tumores iniciais de mama e nos melanomas, apresenta-se cada vez mais freqÃente no trato digestÃrio, em especial no CaE com resultados animadores. Estudos iniciados nos meados do ano 2000 retratam busca crescente e bastante prÃspera para esclarecimento desta questÃo. O objetivo deste trabalho à elaborar um modelo experimental que possa demonstrar tecnicamente, em laboratÃrio, a viabilidade da pesquisa do LS no antro gÃstrico da cadela. Foram estudadas 25 cadelas com peso aproximado de 11 Kg e idade de 01 a 02 anos, sem raÃa definida (SRD), clinicamente saudÃveis, proveniente do Centro de Controle de Zoonoses do MunicÃpio de Fortaleza (CCZ) que tinham programaÃÃo para eutanÃsia. Com escolha aleatÃria, estes animais foram estudados individualmente e semanalmente. Utilizou-se, separadamente, TecnÃcio (99mTc) com traÃador/colÃide Fitato e corante vital azul patente V Guerbert 2,5 % (AP) injetados a 01 cm do piloro, na pequena curvatura no antro gÃstrico da cadela e analisados nos tempos zero, 05, 10, 15 e 20 minutos. ApÃs este perÃodo realizou-se pesquisa âin vivoâ do local de injeÃÃo do marcador e linfonodos encontrados e âex-vivoâ destes linfonodos. Para o estudo com o 99mTc utilizou-se o aparelho Gamma Probe modelo Nuclearlab DGC-II - detector para cirurgia radioguiada e sonda captadora de irradiaÃÃo acoplada com unidade de contagem e rastreamento sonoro e para o AP, visÃo direta. Para a anÃlise estatÃstica utilizou-se o teste de McNemar e o Coeficiente de ConcordÃncia de Kappa. Foi estabelecido em 5% o nÃvel de significÃncia (p≤0,05). Com o uso do 99mTc isolado foi identificado a presenÃa do LS em 20 animais (80%). Quando se utilizou o corante AP isolado a presenÃa do LS foi identificada em 24 animais (96 %). NÃo houve significÃncia estatÃstica quanto ao uso destes marcadores para a pesquisa do LS no antro gÃstrico da cadela. Concluiu-se que (1) O estÃmago da cadela à adequado para modelo experimental de pesquisa âin vivoâ do linfonodo sentinela e (2) O tecnÃcio (99mTc) e corante vital â azul patente V Guerbert 2,5 % (AP) sÃo eficientes como marcadores de linfonodo sentinela do antro gÃstrico da cadela. / The gastrectomy with extensive lymphadenectomy still is the gold standard for the dressing treatment of the gastric cancer (GC), even so these procedures can take high index of morbidity or mortality, mainly in the patients who do not present lymphatic dissemination of the illness. The research of sentinel lymph node (SLN), already consecrated in the initial tumors of breast and the melanomas, presents each time more frequent for upper gastrointestinal cancers, specially in GC with encouraging results. Studies initiated in the middles of 2000 portray increasing and sufficiently prosperous search for clarification of this question. The objective of this work is to elaborate an experimental model that can demonstrate technically, in laboratory, the research viability of SLN in gastric antrum of the dog. 25 female dogs had been studied with approach weight of 11 kg and age of 01/02 years, without definite race (WDR), healthful clinically, proceeding from the Control Center of Zoonosis of Fortaleza City with programming for euthanasia. With random choice, these animals had been studied individually and weekly. It was used, separately, radioisotopic 99mtechnetium labeled phytate and patent blue dye (V Guerbert 2.5%) injected at 01 cm above the piloro, on the small bending in the antrum gastric of the dog and analyzed in the times zero, 05, 10, 15 and 20 minutes. After this period, the injection place of the markers and gastric lymph nodes were appraised âin vivoâ (in the animal) and the gastric lymph nodes âex vivoâ (out of the animal). For the study with the 99mtechnetium it was used the device Gamma Probe model Nuclearlab DGC-II (radioguiada surgery with sounding lead of irradiation connected to unit of counting and sonorous tracking) and for the patent blue dye, direct vision. For the analysis statistics were used the test of McNemar and the Quantify agreement with Kappa. The level of significance was established in 5% (p≤0,05). When the radioisotopic 99mtechnetium labeled phytate was used single, the LS was identified in 20 animals (80%). With the patent blue dye single, in 24 animals (96%). There is no statistic significance with the use of those markers for the LS research in the gastric antrum of the dog. The conclusions are (1) The stomach of the dog is adjusted for experimental model in alive research of the sentinel lymph node (2) The radioisotopic 99mtechnetium labeled phytate and patent blue dye (V Guerbert 2.5%) are efficients as markers of sentinel lymph node of the dogâs gastric antrum.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / O cÃncer de vulva corresponde a aproximadamente 1% das neoplasias malignas da mulher e de 3% a 5% de tumores genitais femininos. 90% destes sÃo carcinomas espino-celulares, curÃveis quando diagnosticado precocemente. O tratamento radical inclui o esvaziamento inguinal bilateral na maioria dos casos. Aproximadamente 30% das pacientes operÃveis tÃm disseminaÃÃo linfonodal, as 70% restantes tÃm mutilaÃÃo desnecessÃria. A possibilidade de aplicar o conceito de linfonodo sentinela, na conservaÃÃo dos linfonodos regionais da vulva, ainda nÃo à consenso. O modelo experimental na vulva da cadela à um passo importante no reconhecimento das peculiaridades da drenagem linfÃtica deste ÃrgÃo pela similaridade com a drenagem em humanos. Este trabalho experimental, em modelo canino tem como objetivo apresentar o modelo para a pesquisa do linfonodo sentinela na vulva da cadela usando o Azul Patente e Fitato de TecnÃcio; avaliar o Azul Patente como marcador do linfonodo sentinela da vulva da cadela; avaliar o Fitato de TecnÃcio como marcador do linfonodo sentinela na vulva da cadela, comparar os mÃtodos obtidos pelas duas tÃcnicas. Foram utilizados nos procedimentos 25 cadelas, adultas, sadias, com peso variando entre 10 e 12kg. InjeÃÃo de 5ÂCI de TecnÃcio na regiÃo vulvar, com espera de 30â. Rastreamento com probe das regiÃes de drenagem vulvar, injeÃÃo de 0,5mL de azul patente na regiÃo vulvar, com espera de 15â. Definidos os pontos âquentesâ com o probe, por incisÃes inguinais abordou-se o linfonodo, avaliando-se com o probe o linfonodo sentinela in-vivo e ex-vivo, anotando-se os valores; registrados os linfonodos corados e nÃo corados com azul patente; comparados os dois mÃtodos. Em 88% dos linfonodos houve presenÃa da lateralidade, tal diferenÃa foi significante (&#61539; = 28.88 e p<0,0001). NÃo houve diferenÃa significante (p>0,05) entre os lados direito e esquerdo, quanto à intercessÃo dos dois mÃtodos. Os nÃveis de radiaÃÃo detectados foram idÃnticos em ambos os lados (p>0,05), tambÃm nÃo foi verificada diferenÃa significante (p>0,05) em ambos os lados, nas contagens in vivo e ex vivo, e no nÃmero de linfonodo corado com azul patente. O modelo experimental apresentado foi capaz de definir o linfonodo sentinela utilizando o Azul Patente e TecnÃcio(99mTc). A identificaÃÃo do linfonodo sentinela à exequÃvel com Azul Patente no mapeamento da cadeia linfÃtica; o mapeamento linfÃtico com TecnÃcio(99mTc), permite identificar com detalhes o sistema de drenagem linfÃtica; nÃo houve diferenÃa significante entre os dois mÃtodos (p=1,0), Azul Patente e TecnÃcio(99mTc).

Orientador: Antônio José Maria Cataneo / Resumo: Introdução: No melanoma primário, a aplicabilidade da biópsia de linfonodo sentinela (BLS), seguida ou não de esvazimento linfonodal (EL) é conhecida. Na recidiva locorregional (RL) de melanoma, alguns serviços tendem a indicá-la, buscando estadiamento mais acurado para embasar condutas individualizadas aos pacientes, ainda que as evidências sejam insuficientes. Objetivo: Avaliar o sucesso da BLS no encontro do linfonodo sentinela (LNS) e sua positividade na RL. Comparar a sobrevida entre os pacientes com LNS positivo e negativo. Verificar diferença na sobrevida pós EL. Métodos: Revisão sistemática, através das bases MEDLINE via PUBMED, LILACS, SCOPUS, EMBASE e CENTRAL, buscando estudos experimentais e observacionais sobre BLS na RL de melanoma. Desfechos avaliados: sucesso na BLS pelo encontro do LNS, positividade para melanoma no LNS; sobrevida no subgrupo LNS positivo comparado com o negativo; sobrevida livre de doença no subgrupo LNS positivo comparada com o negativo; sobrevida dos pacientes submetidos ao EL. Para metanálises, utilizaram-se RevMan 5.3 e StatsDirect 3.0.121. Resultados: Foram identificados 1872 estudos, destes, seis estudos observacionais foram incluídos, totalizando 449 pacientes. O LNS foi encontrado em 98% das BLS (IC 95-100%, I2=53,7% - seis estudos). LNS com 32% de positividade para melanoma (IC 19-47%, I2= 84,6% - seis estudos). A chance de sobrevida global em cinco anos foi 2,49 vezes maior no subgrupo com LNS negativo (IC 95% 1,41-4,38, I2=0% - qua... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: In primary melanoma, the applicability of sentinel lymph node biopsy (SLB), followed or not by complete lymph node dissection (CLND) is known. In locoregional recurrence (LR) of melanoma, some groups may indicate it for more accurate staging to support individualized management, even with scarce evidence. Objective: To evaluate success in SLB and its positivity in LR. Compare survival between patients with positive and negative sentinel lymph node (SLN). Check for survival modification after CLND. Methods: Systematic review through databases such as MEDLINE via PUBMED, LILACS, SCOPUS, EMBASE and CENTRAL, searching for experimental and observational studies on SLB in melanoma LR. Outcomes assessed: success in SLB by finding the SLN, positivity for melanoma in the SLN; survival in the positive SLN subgroup compared to the negative one; disease-free survival in the positive versus negative SLN subgroup; survival of patients undergoing CLND. For meta-analyzes, RevMan 5.3 and StatsDirect 3.0.121 were used. Results: The total number of patients in six observational studies was 449, over 1872 studies indentified. The SNL was found in 98% of SLB (95-100% CI, I2 = 53.7%, 6 studies). SLB detected 32% positivity for melanoma on SNL (CI 19-47%, I2 = 84.6%, 6 studies). The chance of five year overall survival was 2,49 higher in the negative SNL subgroup (95% CI 1.41-4.38, I2 = 0%, 4 studies). Meta-analyzes were not performed due to lack of objective data for disease-free survi... (Complete abstract click electronic access below) / Doutor

Introduction: Sentinel lymph node biopsy is an established method used to investigate the riskof lymphatic metastasis especially in breast cancer and melanoma patients. SPECT/ CT isconsidered to be an advantageous method in mapping of sentinel nodes. Aim: The aim of this systematic literature review was to investigate the clinical value ofSPECT/ CT in the detection of sentinel lymph nodes in breast cancer patients. Method: Using specific search terms the database PubMed was used to find studies of potentialrelevance for this systematic review. Criteria for inclusions and exclusion were decided todetermine article relevance. Eligibility of articles was determined according to these criteriawhich lead to the selection of the specific articles included in this study. Results: Eleven studies were included in this systematic review. Seven out of 8 studies foundhigher identification rates of sentinel lymph nodes with SPECT/ CT in comparison to planarlymphoscintigraphy. SPECT/ CT could detect additional lymph nodes in 9 out of 9 studies.SPECT/ CT detected additional extra-axillary lymph nodes in 6 out of 7 studies. SPECT/ CTdetected lymph nodes in 9 out of 9 studies where planar lymphoscintigraphy was negative.Information from additional SPECT/ CT lead to changes in surgical treatment plan in 4 out of4 studies. None of the included studies contained information about change in oncologicaltreatment plan due to findings on SPECT/ CT. Conclusion: SPECT/ CT is an imaging technique with much potential as it seems to allow amore accurate SLN mapping and more precise anatomical localization of SLN in breast cancerpatients, specifically in certain clinical situations. Despite this however, the impact of SLNmapping through SPECT/ CT on patient prognosis remains uncertain.

Objective: Background: Rare disease An epithelial inclusion cyst within a lymph node denotes a heterotopic phenomenon. Nodal epithelial inclusion cysts have been reported in a variety of anatomical locations including pelvic, abdominal, mediastinal, and axillary regions. While nodal melanocytic nevus (also known as nevus cell aggregates) is the most common heterotopic phenomena involving the axillary lymph nodes, the presence of benign epithelial inclusion cysts in axillary lymph nodes is a rare but well-reported finding. Such documentation is in part due to assessment of sentinel lymph nodes in breast cancer becoming standard of care. These epithelial inclusion cysts offer a diagnostic pitfall in evaluation of sentinel lymph node in the setting of breast carcinoma. They also complicate assessment of sentinel lymph node during intraoperative frozen sections analysis. Case Report: We report a case of co-existent of benign squamous-type and glandular-type epithelial inclusions cysts in 2 sentinel lymph nodes in a patient with grade III invasive ductal carcinoma involving the left breast. There have been at least 4 cases reported in literature in which benign epithelial inclusion cysts in sentinel lymph nodes were first mistakenly diagnosed as metastatic carcinoma both during intraoperative frozen section analysis and during review of permanent sections. The missed diagnosis could potentially occur intraoperatively during frozen section sentinel lymph node analysis secondarily due to lack of availability of the primary tumor for comparison and inability to use immunohistochemical stains. Conclusions: Pathologists should be aware of this pitfall especially in frozen section analysis of sentinel lymph node to avoid misdiagnosis and its associated potential grave consequences.

1 ABSTRACT Background Breast cancer cell population characteristics are used in common clinical practice for estimation of prognosis of the malignant disease (prognostic factors) and for prediction of reactivity of the tumor to certain therapeutic modality (predictive factors). Also axillary lymph node status is an independent prognostic factor in women with early breast cancer. Therefore, surgical excision and following histopathological examination of the nodes is the obligatory part of primary breast cancer surgery. The extension of axillary surgery varies widely, although sentinel lymph node biopsy is considered to be the standard procedure. However, it must be admitted that this type of procedure need not be optimal for all the breast cancer patients. Aims of the study The aim of this study is the verify the hypothesis whether or not the axillary lymph node metastatic affection can be effectively estimated using non-surgical methods - i.e. by evaluation of the combination of prognostic and predictive factors of the primary breast tumor. Statistical model composed on the basis of data of early breast cancer patients is the basic tool for this prediction. Application of this model In everyday practice can enable to adjust the extent of axillary surgery for each individual patient. Patients and methods A...

1 ABSTRACT Background Breast cancer cell population characteristics are used in common clinical practice for estimation of prognosis of the malignant disease (prognostic factors) and for prediction of reactivity of the tumor to certain therapeutic modality (predictive factors). Also axillary lymph node status is an independent prognostic factor in women with early breast cancer. Therefore, surgical excision and following histopathological examination of the nodes is the obligatory part of primary breast cancer surgery. The extension of axillary surgery varies widely, although sentinel lymph node biopsy is considered to be the standard procedure. However, it must be admitted that this type of procedure need not be optimal for all the breast cancer patients. Aims of the study The aim of this study is the verify the hypothesis whether or not the axillary lymph node metastatic affection can be effectively estimated using non-surgical methods - i.e. by evaluation of the combination of prognostic and predictive factors of the primary breast tumor. Statistical model composed on the basis of data of early breast cancer patients is the basic tool for this prediction. Application of this model In everyday practice can enable to adjust the extent of axillary surgery for each individual patient. Patients and methods A...

O câncer de mama (CA de mama), com exceção do câncer de pele do tipo não melanoma, é o tumor de maior incidência dentre as mulheres, sendo que no Brasil são encontrados principalmente nas regiões Sul e Sudeste. Seu principal tratamento é o cirúrgico. A disseminação do tumor pode ocorrer por via linfática, acometendo linfonodos regionais. A biópsia do linfonodo sentinela (BLNS) é um procedimento altamente relevante, é altamente sensível na identificação de metástases. A técnica de linfocintilografia (LINCT) pré-operatória é essencial, pois permite avaliar a cadeia linfática acometida e possibilita a visualização do linfonodo sentinela (LNS) durante a cirurgia. O objetivo é descrever os padrões de drenagem linfática e avaliar a contribuição da LCINT na localização dos LNS em pacientes com CA de mama. No período de março de 2009 a agosto de 2011 foram estudados 70 casos sequenciais da rotina clínica, submetidos ao tratamento cirúrgico do CA de mama com estudo do LNS através da técnica de LCINT. Na LCINT foram aplicadas 4 injeções intradérmicas contendo 37 MBq (1,0 mCi) do FITATO-Tecnécio99m, ao redor da aréola mamária. Após a localização do LNS foi realizado marcações na pele, nas incidências anterior, oblíqua e lateral, para auxiliar o cirurgião na abordagem cirúrgica ulterior, juntamente com a sonda gama intra-operatória e corante azul patente. Dos 70 casos submetidos ao estudo, todos são do sexo feminino (100%) com faixa etária entre 28 e 77 anos, média de 54 anos. O tamanho médio do tumor encontrado nos pacientes foi de 1,4 cm. Os tipos histológicos mais incidentes foram o carcinoma ductal invasivo com 45 (64,4%) pacientes, seguido de carcinoma ductal in situ com 16 (22,8%). No exame de LCINT, todos os pacientes apresentaram drenagem linfática do radiofármaco a partir do local da injeção. Em 43 (61.5%) pacientes, observamos drenagem para 1 LNS, em 21 (30%) para 2 LNS/LNNS (linfonodo não sentinela), em 5 (7%) para 3 LNS/LNNS e em 1 (1.5%) para 4LNS/LNNS. Dos 70 pacientes, 68 (97%) apresentaram drenagem linfática ipsilateral e 2 (3%) apresentaram drenagem linfática bilateral. Em relação aos territórios de drenagem linfática dos LNS/LNNS, em 68 (97%) pacientes apresentaram drenagem para a região axilar, 1 (1,5%) para a região mamária interna e 1 (1,5%) para as regiões axilar e mamária interna. Os LNS/LNNS presentes na cadeia mamária interna não foram retirados. No intra-operatório, os cirurgiões utilizaram o corante azul patente em 35 (50%) pacientes, destes o corante identificou os LNS/LNNS em 79% dos casos. A técnica de LCINT possibilitou a visualização de todos os LNS e em alguns casos não foi possível a visualização do LNNS, o qual foi localizado e retirado com a sonda gama. Com isso, a técnica de LCINT foi eficaz em 88,5% dos casos. Dos 69 pacientes submetidos à BLNS apenas 13 (18,8%) pacientes apresentaram LNS/LNNS metastáticos, sendo estes submetidos à linfadenectomia axilar. Conclui-se que o exame pré-operatório de LCINT foi muito eficiente para o estudo da drenagem linfática, visualizando os canais linfáticos, linfonodos funcionalmente ativos e seus respectivos territórios de drenagem. Por tanto, esta técnica auxiliou o cirurgião na abordagem cirúrgica juntamente com a sonda gama intra-operatória e corante azul patente para a realização da BLNS. / With the exception of non-melanoma skin cancer, the Breast cancer (breast CA) is the most incident cancer in women. In Brazil, the breast CA is more often found in South and Southeast regions. The main treatment of breast CA is the surgery. The main pathway for the tumor spreading is the lymphatic system, which may affect the regional lymph nodes. The sentinel node biopsy (SLNB) is of considerable importance, once it has a high sensitivity in identifying metastases. The technique of preoperative lymphoscintigraphy (LINCT) is essential because it allows evaluating the lymphatic drainage chain and enables the visualization of sentinel lymph node (SLN) during surgery. We aim here to describe the lymphatic drainage patterns and to evaluate the contribution of LCINT to the location of SLN in patients with breast CA. We evaluated 70 patients sequentially selected from the clinical routine, between march 2009 and august 2011, and that underwent the surgical treatment for breast CA, including the usage of the technique of LCINT for the SLN location. The LCINT were performed by the injection of four periareolar intradermal injections containing 37 MBq (1.0 mCi) of the radiopharmaceutical PHYTATE-99m-Technetium. Based on the LCINT images, we performed skin marks in the dermal projections of the SLN in all anterior/posterior, oblique and lateral views. Additionally, the gamma probe and blue dye were used to help surgeons in the surgical location of the SLN. All of the 70 patients of our study were female, ranging from 28 to 77 years, mean 54 years. The average tumor size was 1.4 cm. The most commonly found histological types were invasive ductal carcinoma (45 patients, 64.4%), followed by the in situ ductal carcinoma (16 patients, 22.8%). All LCINT procedures were well succeeded in demonstrating at least one SLN in our sample of patients. We observed lymphatic drainage for only one SLN in 43 patients (61.5%), for 2 SLN/SLNN in 21 (30%) (non sentinel lymph node), for 3 SLN/SLNN in 5 (7%) and for 4 SLN/SLNN in one patient (1.5%). From the 70 patients, 68 (97%) exhibited ipsilateral and 2 (3%) exhibited bilateral lymphatic drainage. Concerning the lymphatic territories, 68 patients (97%) exhibited drainage to SLN/SLNN in the axillary region, 1 patient (1.5%) in the internal mammary region and another patient (1.5%) in both axillary and internal mammary regions. The two SLN/SLNN found in the internal mammary chain were not removed. Complimentary to the LCINT, the surgeons used blue dye in 35 patients (50%), which enabled them to identify the SLN/SLNN in 79% of cases. On the other hand, LCINT allowed the visualization of all SLN (100%). In some cases, in which was not possible to visualize the SLNN, these ones were found by the use of the gamma probe. Thus, the LCINT technique was effective to localize the SLN in 88.5% of cases. From the 69 patients who underwent SLN biopsy, only 13 patients (18.8%) exhibited metastatic infiltration of the SLN/ SLNN. All these patients were submitted to the axillary dissection. We conclude that the preoperative LCINT was very effective for the study of lymphatic drainage, enabling the visualization of the lymphatic channels, functionally active nodes and their drainage areas. Therefore, this technique helped surgeons in the surgical approach with intraoperative gamma probe and patent blue dye for SLNB.

Made available in DSpace on 2016-03-22T17:26:57Z (GMT). No. of bitstreams: 1 Neivo.pdf: 343535 bytes, checksum: e65c41380c8ceabe9bc780ffcc1c99f1 (MD5) Previous issue date: 2005-02-14 / Objective: The objective of this study is to describe the reproducibility of the sentinel lymph node technique in patients with prostate cancer and verify if there is improved accuracy over modified lymphadenectomy. Material and methods: Twenty-three patients with biopsy proven prostate cancer were enrolled in this study. Lymphoscintigraphy was performed after the transrectal administration of 99mTc-Sulphur Colloid guided by ultrasound, with one injection in each prostate lobe. Images were obtained 15 and 180 minutes after injection. Sentinel lymph node was harvested during surgery using a gamma probe, followed by extended lymphadenectomy. Results: The mean age of the patients in this study was 66 years old. An average of 3.36 sentinel lymph nodes was found for each patient. Radioactive lymph nodes were identified by the gamma probe in 21 out of 23 patients. In one of the patients there was no radiopharmaceutical migration from the injection site and in another the sentinel lymph node was visualized by lymphoscintigraphy but was not found during surgery. Three patients had lymph node metastasis; in one of these patients the sentinel lymph node was the only positive node and was found outside the modified lymphadenectomy region (dissection of the lymph nodes from the obturator fossa and the external iliac). Conclusion: Sentinel lymph node biopsy in prostate cancer adds important information to the staging of patients, not always attained through the lymphadenectomy restricted to the obturator fossa and external iliac. Such information is essencial for the choice of the best treatment to be applied. / n

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.