SUMMARY OBJECTIVE: This study aimed to evaluate the expression of C-X-C motif chemokine ligand 12 and its C-X-C chemokine receptor type 4, and the tumor-stroma ratio using collagen stromal content of breast cancer samples, correlating it with clinicopathological data. METHODS: Through a retrospective cohort study, samples were obtained from female patients, over 18 years of age, with the disease in stages 1–4, who underwent mastectomy or lumpectomy. The biopsies were provided by the Oncology sector of the Hospital das Clínicas of Universidade Federal de Pernambuco, Recife city, in 2011–2014, including samples of invasive ductal carcinoma, ductal carcinoma in situ, or benign changes (fibroadenoma and hypertrophy), which were analyzed between 2020 and 2022 by immunohistochemistry for the expression of stromal cell characteristics. Collagen content was tested by Gomori staining and digital analysis of images. RESULTS: Absence of stromal expression of C-X-C motif chemokine ligand 12 was associated with longer disease-free survival (disease-free survival=0.481), and expression of C-X-C chemokine receptor type 4 was associated with lower disease-free survival. An association was observed between clinicopathological variables and stromal expression of chemokines, that is, an association of stromal C-X-C motif chemokine ligand 12 with histological grade, angiolymphatic invasion, and an association between C-X-C chemokine receptor type 4 expression and histological grade. Analyses of digital pixels images of collagen and tumor cells showed a lower percentage of collagen in the invasive ductal carcinoma samples (39%), unlike samples without neoplasms (78%). CONCLUSION: Low expression of C-X-C motif chemokine ligand 12 may be associated with a worse prognosis for breast cancer. Collagen staining analyzed using digital images represents an opportunity for clinical application and is indicative of the prognosis of the tumor microenvironment in breast carcinoma.

INTRODUÇÃO: Por sua apresentação clínica inespecífica, a leptospirose é frequentemente confundida com outras doenças febris agudas. Métodos bacteriológicos, sorológicos e moleculares apresentam limitações para o diagnóstico precoce: complexidade técnica, baixa disponibilidade, insensibilidade na doença precoce, ou alto custo. Este estudo objetivou validar uma definição de caso, baseada em dados clínicos e laboratoriais simples, destinada ao diagnóstico da leptospirose em pacientes hospitalizados. MÉTODOS: Foram incluídos pacientes adultos, admitidos em 2 hospitais de referência no Recife, com doença febril de até 21 dias e suspeita clínica de leptospirose, para testar uma definição de caso contendo 10 critérios clínico-laboratoriais. Leptospirose foi confirmada ou afastada por uma combinação de teste de aglutinação microscópica, ELISA e hemoculturas. Foram determinadas as propriedades do teste, para cada número de critérios da definição de caso preenchidos. RESULTADOS: Incluíram-se 97 pacientes, 75 com leptospirose e 22 negativos para a doença. O número médio de critérios da definição de caso preenchidos foi 7,8±1,2 e 5,9±1,5, respectivamente (p < 0,0001). A melhor combinação de sensibilidade (85,3%) e especificifidade (68,2%) foi obtida com a presença de 7 ou mais critérios, atingindo valores preditivos positivo de 90,1% e negativo de 57,7%, e acurácia 81,4%. CONCLUSÕES: A definição de caso proposta, com um ponto de corte de pelo menos 7 critérios presentes, alcançou sensibilidade e especificidade moderadas, mas um elevado valor preditivo positivo. Sua simplicidade e o baixo custo tornam-na útil para o diagnóstico rápido da leptospirose à beira do leito, em pacientes brasileiros hospitalizados com doença aguda febril grave.

INTRODUCTION: Leptospirosis is often mistaken for other acute febrile illnesses because of its nonspecific presentation. Bacteriologic, serologic, and molecular methods have several limitations for early diagnosis: technical complexity, low availability, low sensitivity in early disease, or high cost. This study aimed to validate a case definition, based on simple clinical and laboratory tests, that is intended for bedside diagnosis of leptospirosis among hospitalized patients. METHODS: Adult patients, admitted to two reference hospitals in Recife, Brazil, with a febrile illness of less than 21 days and with a clinical suspicion of leptospirosis, were included to test a case definition comprising ten clinical and laboratory criteria. Leptospirosis was confirmed or excluded by a composite reference standard (microscopic agglutination test, ELISA, and blood culture). Test properties were determined for each cutoff number of the criteria from the case definition. RESULTS: Ninety seven patients were included; 75 had confirmed leptospirosis and 22 did not. Mean number of criteria from the case definition that were fulfilled was 7.8±1.2 for confirmed leptospirosis and 5.9±1.5 for non-leptospirosis patients (p<0.0001). Best sensitivity (85.3%) and specificity (68.2%) combination was found with a cutoff of 7 or more criteria, reaching positive and negative predictive values of 90.1% and 57.7%, respectively; accuracy was 81.4%. CONCLUSIONS: The case definition, for a cutoff of at least 7 criteria, reached average sensitivity and specificity, but with a high positive predictive value. Its simplicity and low cost make it useful for rapid bedside leptospirosis diagnosis in Brazilian hospitalized patients with acute severe febrile disease.