Imagenología en la patología mamaria durante el embarazo y la lactancia / Imaging of breast pathology during pregnancy and lactation

La patología mamaria durante el embarazo y la lactancia representa un desafío debido a que los cambios fisiológicos del tejido mamario durante este periodo pueden afectar la interpretación de los hallazgos clínicos e imagenológicos. El objetivo de esta revisión es conocer el diagnóstico diferencial de las enfermedades mamarias durante el embarazo y la lactancia. La mayoría de las patologías mamarias durante el embarazo y la lactancia son benignas y pueden ser clasificadas en tres categorías: 1) aquellas relacionadas con cambios fisiológicos, 2) enfermedades inflamatorias y 3) tumores benignos. Solo el 3% de los cánceres mamarios se desarrollan durante el embarazo. Los factores de mal pronóstico, como receptores hormonales negativos o HER2/neu positivo, en las mujeres embarazadas tienen una prevalencia similar a la observada en no embarazadas de la misma edad. El diagnóstico precoz es de crucial importancia pronóstica, por lo que es necesario mantener los esquemas de tamizaje recomendados. Es importante estar familiarizado con los cambios fisiológicos durante el embarazo y la lactancia, y conocer las patologías más prevalentes que afectan a las mujeres durante este periodo.

Breast pathology throughout pregnancy and lactation represents a challenge because the physiological changes of mammary tissue during this period may affect the interpretation of clinical and imaging findings. The objective of this presentation is to review the differential diagnosis of breast diseases during pregnancy and lactation. Most of breast pathology during pregnancy and lactation is benign and can be further classified into three categories: 1) those related to physiological changes, 2) inflammatory diseases, and 3) benign tumors. Only 3% of breast cancers will develop during pregnancy. Risk factors for worst prognosis, such as negative hormonal receptors or HER2/neu positive, in pregnant women have similar prevalence than in non-pregnant women of the same age. Early diagnose is of the outmost prognostic importance, therefore it`s important to maintain screening schedule as recommended. It is important to be familiarized with the physiological changes of the breast during pregnancy and lactation, and to know the most prevalent diseases affecting women during this period.

Evaluation of breast stiffness pathology based on breast compression during mammography: Proposal for novel breast stiffness scale classification

Abstract Breast cancer is diagnosed through a patient's Breast Self-Examination (BSE), Clinical Breast Examination (CBE), or para-clinical methods. False negativity of PCM in breast cancer diagnostics leads to a persisting problem associated with breast tumors diagnosed only in advanced stages. As the tumor volume/size at which it becomes invasive is not clear, BSE and CBE play an exceedingly important role in the early diagnosis of breast cancer. The quality and effectiveness of BSE and CBE depend on several factors, among which breast stiffness is the most important one. In this study, the authors present four methods for evaluating breast stiffness pathology during mammography examination based on the outputs obtained during the breast compression process, id est, without exposing the patient to X-Ray radiation. Based on the subjective assessment of breast stiffness by experienced medical examiners, a novel breast stiffness classification was designed, and the best method of its objective measurement was calibrated to fit the scale. Hence, this study provides an objective tool for the identification of patients who, being unable to perform valid BSE, could benefit from an increased frequency of mammography screening. Dum vivimus servimus.

Interobserver reproducibility of tumor-infiltrating lymphocyte evaluations in breast cancer

Aim: Tumor-infiltrating lymphocytes (TILs) have a prognostic value in breast cancer (BC); however, because of the lack of standard evaluation methods, we aimed to assess the interobserver agreement of stromal TILs (sTILs) and intratumoral TILs (iTILs) as well as the effect of hot spot areas and molecular subtyping on the overall agreement. Methods: The study consisted of 121 haematoxylin and eosin (H and E)-stained slides of invasive BC samples obtained from the pathology archives. The TIL assessment was based on the International TIL Working Group recommendations for the percentage of sTILs and was conducted by four pathologists. The percentage of iTILs, the number of lymphocytes in hot spot areas (iTILs-HS), and the overall interobserver agreement for the molecular subtypes were evaluated. The interclass correlation coefficient (ICC) was used to assess interobserver agreement among the four pathologists. Results: The ICC score among the observers for the sTIL percentages was 0.74, and the individual ICC values for each molecular subtype were 0.55, 0.88, and 0.79 for luminal, HER2-positive, and triple-negative tumors, respectively. The compliance value for the iTILs was 0.29 (95% confidence interval (CI) = 0.06–0.48], whereas the compliance value for the iTILs-HS was 0.63 (95% CI = 0.49–0.71). The compliance values for the iTILs-HS subtypes were 0.72, 0.43, and 0.55 for luminal, HER2-positive, and triple-negative tumors, respectively. Conclusion: The IWTILG recommendations are reproducible and reliable. The interobserver agreement of the sTIL percentages was considerably higher for the triple-negative and HER2-positive cases than the luminal cases, whereas the interobserver agreement for the assessment of iTILs-HS in tumors was higher for the luminal subtype.

Clasificación BI-RADS y resultado de biopsia en pacientes con patología mamaria / BI-RADS Classification and Biopsy Results in Patients with Breast Pathology

El objetivo de la investigación fue establecer la asociación entre los hallazgos de la clasificación BI-RADS y los resultados de la biopsia definitiva en pacientes con patología mamaria. Se seleccionaron 368 pacientes con algún tipo de patología mamaria que ameritara la realización de la mamografía y biopsia estereotáctica de la lesión que asistieron al Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. Se evaluaron características de las pacientes, clasificación BI-RADS y los resultados de la biopsia definitiva. La edad promedio de las pacientes fue de 62,4 +/- 8,9 años. Basado en el diagnóstico patológico final, 216 lesiones (58,6 %) fueron catalogadas como benignas, 142 lesiones (38,6 %) como malignas y 10 lesiones (2,7 %) como premalignas. La clasificación BI-RADS final para las pacientes estudiadas fue: 34 pacientes (9,2 %) incluidas en la categoría 3, 219 pacientes (59,5 %) incluidas en la categoría 4 y 105 pacientes (28,8 %) incluidas en la categoría 5. Se observó que existe una asociación significativa entre las categorías de la clasificación BI-RADS con las lesiones mamarias malignas (p < 0,05). Se concluye que existe una asociación significativa entre los hallazgos de la clasificación BI-RADS y los resultados de la biopsia definitiva en pacientes con patología mamaria.

The objective of research was to establish de association between findings of BI-RADS classification and biopsy results in patients with breast pathology. Three hundred and sixty eighth patients with any kind of breast pathology who submitted to mammography and estereotactic biopsy of lesion who assisted to Hospital Central Dr. Urquinaona, Maracaibo, Venezuela were selected. Patient characteristics, Bi-RADS classification and result of definitive biopsy were evaluated.Mean age of patients was 62.4 +/- 8.9 years-old. Based on final pathological diagnosis, 216 lesions (58,6 %) were considered as benign, 142 lesions (38,6 %) as malignant and 10 lesions (2,7 %) as pre-malignant. Final BI-RADS classification for studied patients was: 34 patients (9,2 %) were included in category 3, 219 patients (59.5%) were included in category 4 and 105 patients (28,8 %) were included in category 5. There was observed a significant association between BI-RADS category classification with malignant breast lesions (p < 0.05). It is concluded that there is a significant association between findings in BI-RADS classification and the results of definitive biopsies in patients with breast pathology.

Imaging and Pathologic Characterization of the Skin Thickening or Enhancement under the Breast MRI

The purpose of this paper is to show the radiologic features of various lesions appearing as skin thickening or enhancement under the breast MRI. And histopathologic results of the skin lesions were correlated. Radiologist must be familiar with normal appearance of the breast skin under the MRI and a wide variety of conditions may affect the skin of the breast.

Quality assurance and patient safety protocols for breast and gynecologic pathology in an Academic Women's Hospital

Background: Quality assurance and peer-review practices in surgical pathology have been well described in the literature, but the majority of these reports apply to the realm of general surgical pathology. We focused on the peer-review reporting system of a specialty women's health pathology practice consisting exclusively of breast and gynecologic pathology, with the specific aims of identifying diagnostic discrepancies that affected patient care. Methods: The quality measures in this specialty practice are monitored, and the Medical Director reviews all amended/corrected reports. Error types are qualitative, and are categorized according to impact on patient care. QA data of all amended reports from 2012 to 2014 in breast and gynecologic pathology, as a measure of error type and frequency, were reviewed. Results: Of all specimens during this time period, 343 (0.54% of all reports) required amendment due to a QA metric-discovered discrepancy. Breast specimens demonstrated a higher amendment rate than GYN specimens (1.14% of breast specimens versus 0.27% of GYN specimens). The most common error type requiring an amendment for both breast and GYN specimens was a type A, or Minor Disagreement (reports amended for type A discrepancy: 78.7% of total; 81.9% of breast; 72.6% of GYN). Type B, or Moderate Disagreement discrepancies, accounted for 21.3% of all amended cases (reports amended for type B discrepancy: 18.1% of breast; 27.3% of GYN). Of all breast and GYN reports reviewed during the QA evaluation, there were no cases categorized as type C, or Major Disagreements, which would significantly alter patient reatment. Conclusion: When surgical pathology is practiced in a laboratory utilizing comprehensive quality assurance protocols, major diagnostic interpretation errors are infrequent. The practice minimizes error, maximizes patient safety, and maximizes educational opportunities of practicing pathologists in real-time (AU)

Breast necrosis induced by the use of coumadin: case report and review of literature / Necrose mamária induzida pelo uso de cumarínico: relato de caso e revisão da literatura

The coumadin-induced skin necrosis is rare and occurs more frequently in the breasts, thighs and buttocks. We describe the first case of coumadin necrosis of the breast in Brazil in a 62-year-old patient.

A necrose cutânea induzida por cumarínicos é um evento raro e ocorre com maior frequência nas mamas, coxas e nádegas. Descrevemos o primeiro caso de necrose cumarínica das mamas no Brasil em paciente de 62 anos.

Riesgo de cáncer de mama en mujeres con patología mamaria benigna / Risk of breast cancer in women with benign breast disease

La enfermedad benigna de la mama incluye nódulos o anomalías del estado de la glándula mamaria. Constituyen un grupo heterogéneo de lesiones que incluyen anormalidades del desarrollo, lesiones inflamatorias, proliferaciones epiteliales y estromales, y neoplasias. El objetivo de esta investigación documental es realizar una descripción clínico-patológica de las lesiones benignas de mama más frecuentes, para dar a conocer el riesgo implícito que tienen cada una de ellas en el desarrollo del cáncer de mama. Cabe destacar, que algunas de estas lesiones están asociadas a un riesgo para desarrollar la enfermedad, sin embargo, sólo la hiperplasia ductal y lobulillar atípica y el papiloma, han mostrado una clara tendencia a elevar el mismo, no así otras lesiones que necesitan de la concurrencia de enfermedad proliferativa con o sin atipia, para ocasionar un incremento del riesgo.

Benign breast disease including lumps or abnormalities state of the mammary gland. They are a heterogeneous group of lesions that include developmental abnormalities, inflammatory lesions, epithelial and stromal proliferation, and neoplasia. The objective of the research is to perform a clinical and pathological description of benign breast lesions frequently, to publicize the risk involved with each; in the development of breast cancer. Remarkably, some of these lesions are associated with a risk for developing the disease, however, only the ductal hyperplasia and lobular atypical papilloma, have sh own a clear tendency to increase it, but not other injuries that require the concurrent with or proliferative disease without atypia, to cause an increased risk.

Patología mamaria en niñas y adolescentes: a propósito de un caso / Breast pathology in adolescents: case report

La patología mamaria en el grupo de niñas y adolescentes es poco frecuente, correspondiendo generalmente a lesiones benignas, sin embargo, crea gran ansiedad en la paciente y su grupo familiar .El propósito del presente artículo es en base a un caso clínico larevisión de la patología mamaria benigna más frecuente en este grupo etario, las imágenes y su tratamiento...

Pediatric and adolescents breast masses are relatively rare, and most are benign, nevertheless, is very disconcerting in the patient and her family. The purpose of this article is based on a case review the benign breast conditions, the imaging findings and treatmentstrategies in this population...

Expression and significance of Wnt1 and β-catenin proteins in breast invasive ductal carcinoma / 中国医师杂志

Objective To investigate the expressions of Wnt1 and β-catenin proteins in mammary cancer and its relationship with clinical pathological characteristics,and explore its role in the pathogenesis of breast cancer.Methods Immunoshistochemisty (SP method) was used to detect the expressions of Wnt1 and β-catenin proteins in adjacent tissue of breast cancer (n =15),breast hyperplasia tissues (n =25),and breast in vasive ductal carcinoma (n =80).SPSS 17.0 statistical software was used for analysis,such as count data with x2 test and correlation analysis with Spearman test,with significance level of α =0.05.Results The positive rate of Wnt1 and β-catenin in breast cancer group [62.5％ (50/80) and 68.8 (55/80)] was significantly higher than that in hyperplasia group [28％ (7/25) and 20％ (5/25)]and in borderline group [13.33 (2/15) and 13.33 (2/15)] with a significant difference (P ＜ 0.01).Positive expression of Wnt1 and abnormal expression of β-catenin in breast invasive ductal carcinoma were related to lymphatic metastasis (x2 =5.10,4.87,P ＜ 0.05).Abnormal expression of β-catenin was also related to the histological grading of breast invasive ductal carcinoma (x2 =5.61,P ＜ 0.05).The expressions of Wnt1 and β-catenin proteins in invasive ductal carcinoma showed a positive correlation (r =0.313,P ＜ 0.01).Conclusions The high level expression of Wnt1 protein and the abnormal expression of β-catenin protein might play an important role in breast carcinogenesis,and was related to lymph node metastasis.

Actividad quirúrgica en el servicio de mastología del Centro Nacional de Oncología de Luanda (2007) / Surgical activity in the mastology service of the National Center of Oncology, Luanda, Angola (2007)

INTRODUCCIÓN. Las enfermedades mamarias son un problema de salud también en los países subdesarrollados. Ello motivó la creación del Servicio de Mastología en el Centro Nacional de Oncología de Luanda (Angola), en el año 2007. La presente investigación tuvo como objetivo describir la actividad quirúrgica de este centro durante el año 2007. MÉTODOS. Se realizó un estudio transversal descriptivo que incluyó a los 183 pacientes sometidos a algún tipo de cirugía mamaria en el Servicio de Mastología en el Centro Nacional de Oncología de Luanda durante ese período. Los datos fueron recogidos en un formulario confeccionado por los autores y se procesaron mediante el programa estadístico SPSS (versión 13.0). La información fue resumida en frecuencias absolutas y porcentajes. RESULTADOS. En los pacientes intervenidos quirúrgicamente predominaron las enfermedades benignas sobre las malignas, con alta incidencia de fibroadenomas gigantes. La tumorectomía fue el tipo de cirugía más empleada en las enfermedades benignas, acompañadas de técnicas de cirugía plástica en pacientes con fibroadenoma gigante. Todos los pacientes con tumores malignos requirieron cirugías radicales en correspondencia con la estadificación tardía que predominó en esta serie de casos. El índice de complicaciones quirúrgicas fue bajo. Las enfermedades de la mama constituyen un problema de salud en la población estudiada. El diagnóstico tardío de tumores en etapas avanzadas determina el tratamiento quirúrgico radical sobre el conservador(AU)

INTRODUCTION. Breast diseases are also a health problem in developing countries. Hence, the creation of the Mastology Service in the National Center of Oncology of Luanda, Angola in 2007. The aim of present paper was to describe the surgical activity of this institution during 2007. METHODS. A descriptive and cross-sectional study was conducted including 183 patients undergoing some type of breast surgery in above mentioned Service during that period. Data were registered in a form designed by authors and processed using the SPSS statistical program (version 13.0). Information was summarized in absolute frequencies and percentages. RESULTS. In patients operated on there was predominance of benign diseases and plastic surgery techniques in those patients presenting with giant fibroadenoma. All patients with malignant tumors underwent radical surgeries according the late staging present in this series of cases. The rate of surgical complications was low. NS. Breast diseases are a health problem in study population. Late diagnosis of tumors in advanced stages determines the radical surgical treatment above the conservative one(AU)

Effect of Acupuncture on Estrogen,Estrogen Receptor and Estrogen Signal Transduction in Rat Model of Hyperplasia of Mammary Glands / 广州中医药大学学报

0.05).After treatment,the nipple height was increased in the model group(P