JOSE ROBERTO FILASSI
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
LIM/58 - Laboratório de Ginecologia Estrutural e Molecular, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Cost-effectiveness analysis of locally advanced estrogen receptor-positive, HER-2 negative breast cancer care using a tailored treatment approach in Brazil(2018) GONCALVES, Rodrigo; REINERT, Tomas; ELLIS, Matthew J.; SARIAN, Luis O.; FILASSI, Jose R.- Ethical issues surrounding breast cancer screening in Brazil(2019) GONCALVES, Rodrigo; SOARES- JR., Jose Maria; BARACAT, Edmund Chada; FILASSI, Jose Roberto
- Papillomas of the breast: factors associated with underestimation(2018) BOUFELLI, Gabriela; GIANNOTTI, Marcelo A.; RUIZ, Carlos A.; BARROS, Nestor de; CHALA, Luciano E.; MAESAKA, Jonathan Y.; GONCALVES, Rodrigo; BRESCIANI, Barbara H.; VIANNA, Paula; SOARES JR., Jose. M.; BARACAT, Edmund C.; FILASSI, Jose. R.The distinction between benign and malignant papilloma of the breast through percutaneous needle biopsy can be difficult because of limited samples; the underestimation rate can be up to 25%. The aim of this study is to identify clinical and histological factors associated with underestimation, invasive ductal carcinoma, or ductal in-situ carcinoma (DCIS) of the breast found in surgical specimens from papillary lesions. This may contribute toward selection of patients for a follow-up strategy without the need for surgical excision. From a database of 3563 patients, we identified 85 with intraductal papilloma between 2007 and 2013 who had undergone breast-imaging studies, percutaneous needle biopsy, and surgical resection of the lesion. Central papillomas normally present with a palpable mass, whereas peripheral papillomas generally do not have clinical manifestations (microcalcifications); both central and peripheral papillomas were related to atypical lesions, 13.5 and 15.4%, respectively. Among the 59 cases of central papillomas, there were four cases of underestimation, three DCIS and one invasive ductal carcinoma (6.8%). Among the 26 cases of peripheral papillomas, there was one case of DCIS (3.8%), with a total underestimation rate of 5.8%; all underestimated lesions measured more than 1cm. The median size was 11mm at mammography and 19mm at ultrasound. Our data suggest that lesions less than 1cm in size, without atypia and concordant imaging and clinical findings, may not require surgical resection.
- Effects of preoperative magnetic resonance image on survival rates and surgical planning in breast cancer conservative surgery: randomized controlled trial (BREAST-MRI trial)(2023) MOTA, Bruna Salani; REIS, Yedda Nunes; BARROS, Nestor de; CARDOSO, Natalia Pereira; MOTA, Rosa Maria Salani; SHIMIZU, Carlos; TUCUNDUVA, Tatiana Cardoso de Mello; FERREIRA, Vera Christina Camargo de Siqueira; GONCALVES, Rodrigo; DORIA, Maira Teixeira; RICCI, Marcos Desiderio; TRINCONI, Angela Francisca; CAMARGO, Cristina Pires; RIERA, Rachel; BARACAT, Edmund Chada; JR, Jose Maria Soares; FILASSI, Jose RobertoBackgroundBreast magnetic resonance imaging (MRI) has high sensitivity in detecting invasive neoplasms. Controversy remains about its impact on the preoperative staging of breast cancer surgery. This study evaluated survival and surgical outcomes of preoperative MRI in conservative breast cancer surgery.MethodsA phase III, randomized, open-label, single-center trial including female breast cancer participants, stage 0-III disease, and eligible for breast-conserving surgery. We compared the role of including MRI in preoperative evaluation versus radiologic exam routine with mammography and ultrasound in breast cancer conservative candidates. The primary outcome was local relapse-free survival (LRFS), and secondary outcomes were overall survival (OS), mastectomy rate, and reoperation rate.Results524 were randomized to preoperative MRI group (n = 257) or control group (n = 267). The survival analysis showed a 5.9-years LRFS of 99.2% in MRI group versus 98.9% in control group (HR = 0.72; 95% CI 0.12-4.28; p = 0.7) and an OS of 95.3% in the MRI group versus 96.3% in the control group (HR = 1.37 95% CI 0.59-3.19; p = 0.8). Surgical management changed in 21 ipsilateral breasts in the MRI group; 21 (8.3%) had mastectomies versus one in the control group. No difference was found in reoperation rates, 22 (8.7%) in the MRI group versus 23 (8.7%) in the control group (RR = 1.002; 95% CI 0.57-1.75; p = 0.85).ConclusionPreoperative MRI increased the mastectomy rates by 8%. The use of preoperative MRI did not influence local relapse-free survival, overall survival, or reoperation rates.
- MRI to Predict Nipple Involvement in Breast Cancer Patients(2016) PIATO, Jose Roberto Morales; ANDRADE, Roberta Dantas Jales Alves de; CHALA, Luciano Fernandes; BARROS, Nestor de; MANO, Max Senna; MELITTO, Alexandre Santos; GONCALVES, Rodrigo; SOARES JUNIOR, Jose Maria; BARACAT, Edmund Chada; FILASSI, Jose RobertoOBJECTIVE. The selection of breast cancer patients as candidates for nipple-sparing mastectomy (NSM) is dependent on the preoperative detection of neoplastic involvement of the nipple-areola complex (NAC). This cross-sectional study was designed to evaluate the accuracy of preoperative breast MRI as a noninvasive method to predict neoplastic involvement of the nipple. MATERIALS AND METHODS. We included 165 female breast cancer patients with a surgical plan that included total mastectomy or breast conservation surgery with the removal of the NAC. All patients underwent MRI before surgery on a 1.5-T unit with a 4-channel in vivo dedicated surface breast coil. One radiologist who was blinded to the results of the histologic evaluations of the specimens evaluated the MRI studies. RESULTS. Of the 170 mastectomy specimens evaluated, 37 (21.8%) had neoplastic involvement of the NAC. The MRI findings of enhancement between the index lesion and the NAC and of nipple retraction were considered statistically significant predictors of nipple involvement in breast cancer patients (p < 0.01 and p = 0.01, respectively). The negative predictive value of the combination of these MRI findings was 83.3%. CONCLUSION. Breast MRI is a safe noninvasive method to preoperatively evaluate breast cancer patients eligible for NSM with a high specificity and a high negative predictive value when enhancement between the index lesion and the nipple and nipple retraction are analyzed.
- The oncological safety of autologous fat grafting: a systematic review and meta-analysis(2022) GONCALVES, Rodrigo; MOTA, Bruna Salani; SOBREIRA-LIMA, Bruno; RICCI, Marcos Desiderio; JR, Jose Maria Soares; MUNHOZ, Alexandre Mendonca; BARACAT, Edmund Chada; FILASSI, Jose RobertoObjective To present a systematic review of the literature and a meta-analysis evaluating the oncological safety of autologous fat grafting (AFG). Summary background data: AFG for breast reconstruction presents difficulties during follow-up radiological exams, and the oncological potential of grafted fat is uncertain. Previous studies confirmed that the fatty tissue could be transferred under a good condition suitable would not interfere with mammographic follow-up, although the issue of oncological safety remains. Methods We reviewed the literature published until 01/18/2021. The outcomes were overall survival (OS), disease-free survival (DFS), and local recurrence (LR). We included studies that evaluated women with breast cancer who undergone surgery followed by reconstruction with AFG. We synthesized data using the inverse variance method on the log-HR (log of the hazard ratio) scale for time-to-event outcomes using RevMan. We assessed heterogeneity using the Chi(2) and I-2 statistics. Results Fifteen studies evaluating 8541 participants were included. The hazard ratios (HR) could be extracted from four studies, and there was no difference in OS between the AFG group and control (HR 0.9, 95% CI 0.53 to 1.54, p = 0.71, I-2 = 58%, moderate certainty evidence), and publication bias was not detected. The HR for DFS could be extracted from six studies, and there was no difference between the AFG group and control (HR 1.01, 95% CI 0.73 to 1.38, p = 0.96, I-2 = 0%, moderate certainty evidence). The HR for LR could be extracted from ten studies, and there was no difference between the AFG group and control (HR 0.86, 95% CI 0.66 to 1.12, p = 0.43, I-2 = 1%, moderate certainty evidence). Conclusion According to the current evidence, AFG is a safe technique of breast reconstruction for patients that have undergone BC surgery and did not affect OS, DFS, or LR.
- Improved frozen section examination of the retroareolar margin for prediction of nipple involvement in breast cancer(2016) PIATO, J. R.; AGUIAR, F. N.; MOTA, B. S.; DORIA, M. T.; ALVES-JALES, R. D.; MESSIAS, A. P.; GONCALVES, R.; MANO, M. S.; SOARES, J. M.; RICCI, M. D.; FILASSI, J. R.; BARACAT, E. C.
conferenceObject Does conservative surgery treatment for locally advanced breast cancer safe after neoadjuvant treatment?(2018) BOUFELLI, Gabriela; MOTA, Bruna Salani; FRANCA, Flavia Cardoso; DORIA, Maira Teixeira; MAESAKA, Jonathan Yugo; RICCI, Marcos Desiderio; PIATO, Jose Roberto Morales; ROCHA, Fernanda Barbosa Coelho; GIRIBELA, Aricia Helena Galvao; GONCALVES, Rodrigo; MASILI-OKU, Sergio; MANO, Max Senna; CHALA, Luciano Fernandes; THOMPSON, Bruna Maria; BARACAT, Edmund Chada; FILASSI, Jose Roberto- Validation of the Residual Cancer Burden Index as a prognostic tool in women with locally advanced breast cancer treated with neoadjuvant chemotherapy(2023) CUNHA, Juliana Pierobon Gomes da; GONCALVES, Rodrigo; SILVA, Fernando; AGUIAR, Fernando Nalesso; MOTA, Bruna Salani; CHEQUIM, Bruna Bello; SOARES, Jose Maria; BARACAT, Edmund C.; FILASSI, Jose RobertoAims To correlate the 'Residual Cancer Burden' (RCB) index with overall survival (OS) and disease-free survival (DFS) in women undergoing neoadjuvant chemotherapy at the Cancer Institute of the State of Sao Paulo. Methods We analysed the medical records of patients with breast cancer who underwent neoadjuvant chemotherapy and breast surgery, from 2011 to December 2017. Variables analysed were age, clinical and pathological staging, molecular subtype, number of recurrences or metastases, number of deaths, value and class of the RCB index. We used the Kaplan-Meier and the log-rank statistics to evaluate the possible association between RCB and OS and DFS. A regression model was used to determine the independent association of the RCB with the outcomes controlling for confounding factors. Results 347 patients were included in the analysis with a mean age of 49.39 years. Initial clinical staging was T3 in 57.9% of patients and 43.8% of patients had N1 axillary status. Survival analysis showed a statistically significant better prognosis for the RCB 0 (pCR) subgroup compared with RCB 1, 2 and 3 (log rank p=0.01). In a multivariate analysis, only the RCB classification showed a statistically significant correlation with DFS (RCB 1, HR 6.9, CI 1.9 to 25.4, p=0.004; RCB 2, HR 4.2, CI 1.6 to 10.8, p=0.03; and RCB 3, HR 7.6, CI 2.76 to 20.8, p=0.00). Conclusion We demonstrated a positive and significant relationship between the RCB index and the risk of relapse and death.
- Magnetic resonance imaging to predict nipple involvement in breast cancer patients(2016) PIATO, J. R.; CHALA, L. F.; ALVES-JALES, R. D.; DORIA, M. T.; MOTA, B. S.; MESSIAS, A. P.; GONCALVES, R.; MANO, M. S.; SOARES, J. M.; BARROS, N. de; FILASSI, J. R.; BARACAT, E. C.