Performance des explorations cliniques et de l'échographie mammaire dans le diagnostic des tumeurs bénignes du sein en milieu peu équipé d'Afrique subsaharienne / Performance of clinical investigations and breast ultrasound in the diagnosis of benign breast tumors in low-resource settings in sub-Saharan Africa

Contexte et objectif. Malgré leur fréquence élevée, très peu d'études ont été menées sur les tumeurs bénignes du sein (TBS) en Afrique subsaharienne. L'objectif de la présente étude a été d'évaluer la valeur diagnostique des explorations clinique et échographique mammaire des TBS en milieu peu équipé. Méthodes. Il s'agissait d'une étude documentaire, sur les TBS suivies aux Cliniques Universitaires de Kinshasa, entre janvier 2016 et décembre 2021. La valeur diagnostique des explorations clinique et échographique mammaire des TBS (sensibilité, spécificité, valeur prédictive négative VPN, VPP, coefficient Kappa) a été calculée en prenant pour référence la découverte anatomopathologique des pièces biopsiques. Résultats. Au total, 81 dossiers de TBS ont été colligés. Le Fibroadénome 58 (71,6 %), la Maladie fibrokystique (MFK) 15 (18,5 %), l'Adénome tubuleux 6(7,4 %), la Tumeur Phyllode (TP) 1(1,2 %) et le kyste 1(1,2 %) étaient les tumeurs diagnostiquées à l'anatomopathologie, après tumorectomies. A l'examen clinique, la capacité diagnostique des TBS autres que le Fibroadénome était nulle. La spécificité, la VPN et le coefficient kappa étaient respectivement, de 60,0 %, 39,1 % et 32,2 % pour le diagnostic du Fibroadénome. L'échographie mammaire était faite dans 98,6 % tandis que la mammographie seulement dans 11,1 % des cas. La majorité des tumeurs étaient classées Breast Imaging reporting and Data system (BIRADS) 2 (70,0 %). La spécificité, la VPN et le coefficient kappa étaient respectivement, de 80,6 %, 40,9 % et 39,0 % pour le Fibroadénome, et de 84,4 %, 66,7 % et 1,9 % pour la MFK. La TP était classée BIRADS3. Conclusion. L'échographie mammaire très réalisée, est très performante dans la classification BIRADS des TBS; les cliniciens exerçant en milieu peu équipé peuvent donc sans équivoque suivre les recommandations sur la prise en charge des tumeurs classées BIRADS2 et BIRADS3 à l'échographie, bien que sa performance en ce qui concerne le diagnostic différentiel de ces tumeurs soit moindre.

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—2

Breast imaging is a prerequisite for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in patients who present to health professionals for treatment. These patients present to doctors of different subspecialties as well as to general practitioners in our country. It is important, therefore, to provide uniform guidance to doctors in different healthcare setups of our country, urban and rural, government and private, for optimal management of breast diseases. These guidelines framed by the task group set up by the Breast Imaging Society, India, have been formulated focusing primarily on the Indian patients and health care infrastructures. They aim to provide a framework for the referring doctors and practicing radiologists to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 2 of these guidelines focuses on the best practice principles for breast interventions and provides algorithms for the investigation of specific common breast symptoms and signs. Ultrasound is the preferred imaging modality for image-guided breast interventions due to real-time needle visualization, easy availability, patient comfort and absence of radiation. Stereotactic mammography guided procedures are performed if the lesion is visualized on mammography but not visualized on ultrasound. 14-gauge automated core biopsy device is preferred for breast biopsies although vacuum assisted biopsy devices are useful for biopsy of certain abnormalities as well as for imaging guided excision of some pathologies. MRI guided biopsy is reserved for suspicious lesions seen only on MRI. Algorithms for investigation of patients presenting with mastalgia, breast lumps, suspicious nipple discharge, infections and inflammation of the breast have been provided. For early breast cancers routine use of investigations to detect occult distant metastasis is not advised. Metastatic work up for advanced breast cancer is required for selection of appropriate treatment options.

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—1

Breast imaging is one of the prerequisites for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in women and men who present to health professionals for treatment. Patients with breast disease present to doctors of different subspecialties as well as general practitioners in our country. It is important therefore to provide uniform guidance to doctors in different health care setups of our country, urban and rural, government and private, for breast diseases to be diagnosed and treated optimally. These guidelines framed by the task group set up by the Breast Imaging Society, India have been formulated focusing primarily on the Indian patients and health care infrastructures. These guidelines aim to provide a framework for the referring doctors and practicing radiologists, to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 1 of these guidelines focuses on the best practice principles for mammography, breast ultrasound and breast magnetic resonance imaging. In the absence of a population-based screening program in India, the guidelines to be followed for those women who wish to be screened by mammography have been provided. The key points of these guidelines include the recommendations that mammography is the modality of choice for breast screening and investigation of symptomatic women aged over forty years. Screening is advised annually from the age of forty. Ultrasound is the investigation of choice for pregnant and lactating women and women less than thirty years of age. For women between thirty to thirty-nine years of age, ultrasound can be used initially followed by mammography in presence of clinical or sonographic suspicion of breast cancer. All women diagnosed with breast cancer should have ultrasound and mammography. Breast MRI is useful for assessment of disease extent, problem solving, evaluation of response to neo-adjuvant chemotherapy, identifying occult breast primary and evaluation of augmented breasts.

Comparison of X-ray mammography and ultrasound in the diagnosis of suspected breast lesions / 中国辐射卫生

Objective To evaluate and compare the diagnostic efficiency of X-ray mammography and breast ultrasound for suspected breast lesions. Methods A total of 80 female patients with suspected breast lesions diagnosed by X-ray mammography or breast ultrasound were selected as the study subjects. The histopathological testresults served as the gold standard, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of X-ray mammography and breast ultrasound for the diagnosis of breast lesions were estimated and compared. Results Among the 80 female patients with suspected breast lesions, 57 patients were histopathologically diagnosed with breast cancer and 23 patients with benign breast lesions. The sensitivity, specificity, NPV, PPV, and accuracy of X-ray mammography for the diagnosis of suspected breast lesions in women were 63.16%, 73.91%, 44.74%, 85.71%, and 66.25%, respectively, and those of breast ultrasound were 78.95%, 21.74%, 29.41%, 71.43%, and 62.50%, respectively. There were no significant differences between X-ray mammography and breast ultrasound for the diagnosis of suspected breast lesions in women in terms of sensitivity (χ2 = 3.45, P > 0.05), NPV (χ2 = 1.15, P > 0.05), PPV (χ2 = 2.92, P > 0.05), and accuracy (χ2 = 0.25, P > 0.05). However, specificity showed a significant difference between X-ray mammography and breast ultrasound (χ2 = 12.55, P < 0.01). Conclusion A comparable accuracy of X-ray mammography and breast ultrasound is found for the diagnosis of suspected breast lesions in women. However, X-ray mammography presents a significantly higher specificity than breast ultrasound for the diagnosis of suspected breast lesions in women.

Comparison of automated breast ultrasound and hand-held breast ultrasound in the screening of dense breasts / Comparação entre a ultrassonografia automatizada e a ultrassonografia convencional no rastreio de mamas densas

Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p<0.05 considered of statistical significance. Results Atotal of 440 patientswere evaluated. Regarding lesions,HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p<0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS. Conclusion Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.

Resumo Objetivo Comparar a ultrassonografia convencional das mamas (US) com a ultrassonografia automatizada das mamas (ABUS) no rastreio do câncer. Métodos Realizamos um estudo transversal com pacientes com mamas mamograficamente densas, sendo avaliadas pela US e pela ABUS. A US foi realizada por radiologistas e a ABUS por técnicos de mamografia e analisada por radiologistas especializados em mama. A classificação Breast Imaging Reporting and Data System (BIRADS) do exame e das lesões o tempo de leitura e de aquisição foram avaliados. A análise estatística foi realizada através de medidas de tendência central, dispersão e frequências, teste t de Student e regressão logística univariada, através do odds ratio, com intervalo de confiança de 95%, e com p<0,05 sendo considerado estatisticamente significante. Resultados Foram avaliadas 440 pacientes. Em relação às lesões, a US detectou 15 (7,7%) BI-RADS 2, 175 (89,3%) BI-RADS 3 e 6 (3%) BI-RADS 4, das quais 3 foram confirmadas, por biópsia, como carcinomas ductais invasivos e 3 falso-positivos. A ABUS identificou 12 (12,9%) BI-RADS 2, 75 (80,7%) BI-RADS 3 e 6 (6,4%) BI-RADS 4, incluindo 3 lesões detectadas pela US e confirmadas como carcinomas ductais invasivos, além de 1 carcinoma lobular invasivo e 2 lesões de alto risco não detectadas pela US. O tempo de leitura dos exames da ABUS foi estatisticamente inferior ao tempo do radiologista para realizar a US (p<0,001). A concordância foi de 80,9%. Um total de 219 lesões foram detectadas, das quais 70 por ambos os métodos, 126 observadas apenas pela US (84,9% não eram lesões suspeitas no ABUS) e 23 apenas pela ABUS. Conclusão Comparado à US, a ABUS permitiu adequado estudo complementar no rastreio do câncer de mamas heterogeneamente densas e extremamente densas.

Core needle biopsy in fibroepithelial tumors: predicting factors for phyllodes tumors

OBJECTIVES: This study aimed to evaluate the clinical and imaging predictive factors for the diagnosis of phyllodes tumors in patients with inconclusive results from core needle biopsy (fibroepithelial lesions). METHODS: We retrospectively analyzed data of patients who underwent surgical excision of breast lesions previously diagnosed as fibroepithelial lesions. Numeric variables were analyzed using the Shapiro-Wilk and t-tests, and categorical variables were analyzed using the chi-square and Fisher's exact tests. Multivariate logistic regression was performed to calculate odds ratios and detect predictive factors for the diagnosis of PT. RESULTS: A total of 89 biopsy samples were obtained from 77 patients, of which 43 were confirmed as fibroadenomas, 43 as phyllodes tumors, and 3 as other benign, non-fibroepithelial breast lesions. The mean tumor size was 3.61 cm (range, 0.8-10 cm) for phyllodes tumors and 2.4 cm (range, 0.8-7.9 cm) for fibroadenomas. The predictive factor for phyllodes tumor diagnosis was lesion size >3 cm (p<0.001). CONCLUSION: Our data indicate that fibroepithelial lesions of the breast larger than 3 cm are more likely to be phyllodes tumors.

Automated Breast Ultrasound Screening for Dense Breasts

Automated Breast Ultrasound System for Breast Cancer Evaluation: Diagnostic Performance of the Two-View Scan Technique in Women with Small Breasts

0.05).CONCLUSION: 2-VST of ABUS achieved comparable scan coverage and diagnostic performance to that of conventional 3-VST in women with small breasts.

Reliability of automated versus handheld breast ultrasound examinations of suspicious breast masses

PURPOSE: The purpose of this study was to assess the reliability of automated breast ultrasound (ABUS) examinations of suspicious breast masses in comparison to handheld breast ultrasound (HHUS) with regard to Breast Imaging Reporting and Data System (BI-RADS) category assessment, and to investigate the factors affecting discrepancies in categorization. METHODS: A total of 135 masses that were assessed as BI-RADS categories 4 and 5 on ABUS that underwent ultrasound (US)-guided core needle biopsy from May 2017 to December 2017 were included in this study. The BI-RADS categories were re-assessed using HHUS. Agreement of the BI-RADS categories was evaluated using kappa statistics, and the positive predictive value of each examination was calculated. Logistic regression analysis was performed to identify the mammography and US findings associated with discrepancies in the BI-RADS categorization. RESULTS: The overall agreement between ABUS and HHUS in all cases was good (79.3%, kappa=0.61, P<0.001). Logistic regression analysis revealed that accompanying suspicious microcalcifications on mammography (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.83 to 11.71; P=0.001) and an irregular shape on US (OR, 5.59; 95% CI, 1.43 to 21.83; P=0.013) were associated with discrepancies in the BI-RADS categorization. CONCLUSION: The agreement between ABUS and HHUS examinations in the BI-RADS categorization of suspicious breast masses was good. The presence of suspicious microcalcifications on mammography and an irregular shape on US were factors associated with ABUS yielding a lower level of suspicion than HHUS in terms of the BI-RADS category assessment.

The comparative analysis of paracentesis and segment resection therapy in patients with early plasma cell mastiffs / 实用医学杂志

Objective To investigate the recurrence and satisfaction of paracentesis and segment resection on patients with early plasma cell mastitis,and to choose a more effective and cost-effective treatment.Methods Eighty-nine patients with early plasma cell mastitis received paracentesis in the treatment group and 101 cases received segment resection therapy in the comparison group.The recurrence and satisfaction of patients with early plasma cell mastitis in the two groups were compared.Results (1) The recurrence rates of patients with early plasma cell mastitis received paracentesis or segment resection were 29.21％ and 21.78％,without significant difference (x2 =5.437;P =0.285).(2) No significant differences in pain degree and time of therapy Were observed (P =0.323;P =0.102),but obvious difference in aesthetic measure was found between two groups (P =0.01).Conclusion Ultrasound guided puncture is used to treat patients with early plasma cell mastitis resulted in the therapeutic effect of segmental excision and better patient satisfaction,which has important significance and clinical promotion value for early plasma cell mastitis treatment.

Clinics in diagnostic imaging (180). Ductal carcinoma in situ (DCIS)

A 26-year-old woman presented with a slow-growing right breast lump. Excision biopsy of the lump showed invasive ductal carcinoma with adjacent ductal carcinoma in situ (DCIS). Preoperative imaging was performed to assess the extent of disease. Magnetic resonance (MR) imaging of the breasts showed an area of clustered ring enhancement deep to the biopsy site, which was representative of residual DCIS. DCIS is a common noninvasive malignancy that manifests as a primary breast tumour or in association with other lesions. The radiological features of DCIS are discussed herein, with special attention to the clustered ring enhancement pattern on MR imaging.

Comparison of mammography with automated breast ultrasound system for detecting breast lesions / 中国肿瘤临床

Objective:To compare the clinical utility of mammography with automated breast ultrasound system (ABUS) for detecting breast lesions. Methods:Data of 142 patients with 149 breast lesions who underwent both mammography and ABUS in Tianjin Medi-cal University Cancer Institute and Hospital were collected from Jnly 2016 to September 2016. The detection rates of the two methods were then determined. Results:The overall detection rate using ABUS was significantly higher than that of mammography (mammog-raphy: 87.2% vs. ABUS: 98.0%, P<0.05). However, no significant difference was observed in breast cancer detection rates between mammography and ABUS (mammography:91.1%vs. ABUS:97.0%, P<0.05). Moreover, the benign lesion detection rate was significant-ly higher in ABUS than in mammography (mammography:79.2%, vs. ABUS:100%, P<0.05). In dense breasts, the detection rates of overall lesions, breast cancers, and benign lesions for ABUS were 97.7%, 96.5%, and 100.0%, respectively;whereas those for mammog-raphy were 86.0%, 90.6%, and 77.3%, respectively (P<0.05). Owing to overlapping dense breast tissue and deep anatomic location, sev-eral lesions were missed on mammography. Conversely, most lesions missed on ABUS presented as calcifications. Conclusion:Com-pared with mammography, ABUS can detect more lesions especially in dense breasts. However, ABUS failed to detect calcifications, whereas mammography had distinct advantages in this regard. Overall, the two methods had potential supplementary value for breast cancer screening.

Breast tumor classification in ultrasound images using support vector machines and neural networks

Abstract Introduction The use of tools for computer-aided diagnosis (CAD) has been proposed for detection and classification of breast cancer. Concerning breast cancer image diagnosing with ultrasound, some results found in literature show that morphological features perform better than texture features for lesions differentiation, and indicate that a reduced set of features performs better than a larger one. Methods This study evaluated the performance of support vector machines (SVM) with different kernels combinations, and neural networks with different stop criteria, for classifying breast cancer nodules. Twenty-two morphological features from the contour of 100 BUS images were used as input for classifiers and then a scalar feature selection technique with correlation was used to reduce the features dataset. Results The best results obtained for accuracy and area under ROC curve were 96.98% and 0.980, respectively, both with neural networks using the whole set of features. Conclusion The performance obtained with neural networks with the selected stop criterion was better than the ones obtained with SVM. Whilst using neural networks the results were better with all 22 features, SVM classifiers performed better with a reduced set of 6 features.

Lobular Carcinoma in Situ with Atypical Mass Presentation: a Case Report / Carcinoma lobular in situ com apresentação nodular atípica: relato de caso

Lobular carcinoma in situ (LCIS) is associated with an increased risk of breast cancer and accounts for 1 to 2% of all breast cancers. LCIS diagnosis currently remains one of the major identifiable risk factors for subsequent breast cancer development. Imaging methods are becoming increasingly sensitive, and the consequent detection of small lesions and subtle abnormalities increases the chance of detection of in situ and invasive carcinomas, leading to a reduction in mortality. This report describes a case of a palpable complaint with abnormal imaging findings, including a solid LCIS mass.

O Carcinoma Lobular in situ (CLIS) está associado a um aumento do risco de câncer de mama e representa 1-2% de todas as neoplasias mama. Atualmente, o diagnóstico de CLIS continua a ser um dos maiores fatores de risco identificáveis para o posterior desenvolvimento de câncer de mama. Os métodos de imagem estão cada vez mais sensíveis, fazendo com que a detecção de pequenas lesões e anormalidade sutis aumentemo risco de detecções de carcinomas in situ e invasivos, levando a diminuição da mortalidade. Neste relato será descrito um caso de queixa clínica palpável com alteração de achados de imagem como massa sólida de CLIS.

Retrieval Rate and Accuracy of Ultrasound-Guided 14-G Semi-Automated Core Needle Biopsy of Breast Microcalcifications

OBJECTIVE: To evaluate the retrieval rate and accuracy of ultrasound (US)-guided 14-G semi-automated core needle biopsy (CNB) for microcalcifications in the breast. MATERIALS AND METHODS: US-guided 14-G semi-automated CNB procedures and specimen radiography were performed for 33 cases of suspicious microcalcifications apparent on sonography. The accuracy of 14-G semi-automated CNB and radiology-pathology concordance were analyzed and the microcalcification characteristics between groups with successful and failed retrieval were compared. RESULTS: Thirty lesions were successfully retrieved and the microcalcification retrieval rate was 90.9% (30/33). Thirty lesions were successfully retrieved. Twenty five were finally diagnosed as malignant (10 invasive ductal carcinoma, 15 ductal carcinoma in situ [DCIS]) and five as benign. After surgery and mammographic follow-up, the 25 malignant lesions comprised 12 invasive ductal carcinoma and 13 DCIS. Three lesions in the failed retrieval group (one DCIS and two benign) were finally diagnosed as two DCIS and one benign after surgery. The accuracy of 14-G semi-automated CNB was 90.9% (30/33) because of two DCIS underestimates and one false-negative diagnosis. The discordance rate was significantly higher in the failed retrieval group than in the successful retrieval group (66.7% vs. 6.7%; p < 0.05). Punctate calcifications were significantly more common in the failed retrieval group than in the successful retrieval group (66.7% vs. 3.7%; p < 0.05). CONCLUSION: US-guided 14-G semi-automated CNB could be a useful procedure for suspicious microcalcifications in the breast those are apparent on sonography.

The clinical value of needle localization biopsy technique in clinical nonpalpable breast disease / 中国基层医药

Objective To study the clinical value of mammography and ultrasound needle localization biopsy technique in clinical nonpalpable breast disease.Methods 148 patients with negative clinical palpation were operated only because of the mammography or ultrasound findings of lesions.They were undergone localized excision biopsy and derived definite pathological diagnosis.By histopathology diagnosis,benign and malignant lesions,lesion size,complete resection rate were statistically analyzed.Results 21 cases in 148 cases were malignant lesions(14.2％),which were all early breast cancer.The other 127 cases were benign breast disease(85.8％).147 cases were successfully resected at the first time and 1 case was successfully resected at the second time.Conclusion Mammography and Ultrasound fine needle localized biopsy in nonpalpable breast disease diagnosis and treatment has great significance,which can raise early diagnosis rate of breast cancer without mass,and this method is simple and easy for promotion.

Caracterización imaginológica y citológica en la neoplasia de mama / Imaging and cytology characterization in breast neoplasia

El cáncer de mama se considera un problema de salud en Cuba, de gran incidencia anual. Para caracterizar a las mujeres presuntas portadoras de neoplasia de mama que acudieron a la consulta central de mama durante el 2005, se describieron las alteraciones ecográficas y mamográficas que presentaban y se identificó la relación entre los estudios imaginológico y citológico. Se realizó esta investigación descriptiva de corte transversal en el Hospital Clinicoquirúrgico Dr. Salvador Allende, se les indicó ultrasonido, mamografía y biopsia aspirativa con aguja fina a 60 mujeres. Se caracterizaron diferentes variables. Se observó predominio en los grupos etarios de 40 a 79 años. 15 refirieron antecedentes patol¾gicos familiares maternos de cßncer mamario; 6, antecedentes patológicos personales de enfermedad mamaria y 6, menarquia precoz, entre otros. Factores como la nuliparidad y el primer parto después de los 30 años resultaron poco significativos. En ambos estudios imaginológicos se encontró que la lesión es más frecuente en el CSE de la mama izquierda, con márgenes irregulares y tamaño mayor de 10 mm. Algo más de un tercio presentó, en la mamografía, microcalcificaciones de aspecto maligno. Estos y otros elementos permitieron clasificar a más de la mitad de las pacientes en la categoría altamente sugestiva de malignidad. La relación entre ambos estudios imaginólogicos y entre ellos y el estudio citológico, arrojó resultados significativos; lo cual se refleja en las conclusiones que resumen, además, la caracterización de las variables propuestas y los resultados de los estudios diagnósticos realizados

Breast cancer is a health problem in Cuba with a high yearly incidence. To characterize those women supposed carriers of breast neoplasia seen in the central breast consultation over 2005; we describe the present echography and mammography alterations identifying the relation among imaging and cytology studies. A cross-sectional and descriptive research was conducted in the Dr. Salvador Allende Clinical Surgical Hospital prescribing them ultrasound (US), mammography and fine needle aspiration biopsy in 60 women. Different variables were characterized. There was predominance in age-groups of 40-79 years. Fifteen had pathologic maternal backgrounds of breast cancer; six had personal pathologic backgrounds of breast disease and six had an early menarche among other entities. Factors like nulliparity and the first labor at 30 years old were not much significant. In both imaging studies the lesion is more frequent in the left breast CSE with irregular edges larger than 10 mm. Almost more than the third part showed, according mammography, potential malignant microcalcifications. These and others elements allowed us to classify more than a half of patients within the category of highly suggestive of malignancy. The relation between both imaging studies including the cytology study, yielded significant results showed in conclusions also summarizing the characterization of the proposed variables and the results of diagnostic studies conducted

Doppler color en el estudio de la mama: ¿Cómo lo hacemos nosotros? / Color doppler in the study of the braest: how do we perform it?

The contribution of color Doppler sonography in the study of breast cancer remains a topic of discussion. However, in the daily clinical practice it has become an indispensable instrument, and an integral part of the breast ultrasound (US). The aim of this paper is to demonstrate its utility based on the available evidence as well as on our experience. We describe the technical considerations necessary to conduct a good study, the Doppler signs of benignity/malignancy in focal lesions of the breast and the benefits of its routine use in day-to-day practice. In our experience, it is a useful tool for this purpose. Neverthless, its diagnostic impact as described in the literature is variable. To evaluate its real usefulness, prospective studies along with standardization of the evaluation technique would be required.

La contribución del Doppler color en el estudio de la mama sigue siendo un tema en discusión. No obstante, en la práctica clínica diaria se ha convertido en un instrumento indispensable, formando parte integral del Ultrasonido (US) mamario. El objetivo de este artículo es demostrar su utilidad según la evidencia disponible y a través de nuestra experiencia. Se describen las consideraciones técnicas indispensables para realizar un buen estudio, los signos Doppler de benignidad / malignidad en lesiones focales de la mama y las ventajas de su uso rutinario en la práctica diaria. En nuestra experiencia es una herramienta útil para este propósito, sin embargo su impacto diagnóstico descrito en la literatura es variable. Para evaluar su real utilidad, se requiere de la realización de estudios prospectivos y de la estandarización la técnica.

Automated Breast Ultrasound

Breast US is currently considered to be a first-line examination with a role for both the detection and characterization of breast lesions, and breast US has helped significantly improve breast cancer detection compared with mammography alone. However, the issue of the operator dependence of hand-held ultrasound (HHUS) is a major concern when considering the wide-spread use of whole-breast US. Automated breast ultrasound (ABUS) has several advantages over HHUS: it is more reproducible, it has 3D capability through multiplanar reconstruction, it allows delayed interpretation and it offers the potential for complete documentation. In addition, several studies have shown similar results for the detection and characterization of lesions as compared with that of HHUS. Thus, ABUS will serve as a supplemental tool to mammographic screening and especially for women with dense breast tissue. This review provides a summary of the current state of ABUS and it describes the method of ABUS and the potential clinical applications for breast imaging.

The Interobserver Variability and Diagnostic Performance of 3-Dimensional Breast Ultrasound

PURPOSE: We wanted to evaluate the interobserver variability and diagnostic performance of 3-dimensional (3D) breast ultrasound (US) as compared with that of 2-dimensional (2D) US. MATERIALS AND METHODS: We included 150 patients who received US-guided core biopsy and 3D US between June 2009 and April 2010. Three breast imaging radiologists analyzed the 2D and 3D US images using the Breast Imaging Reporting and Data System (BI-RADS) lexicon. The intra-observer agreement and inter-observer agreement were calculated. The sensitivity and specificity of 2D and 3D US were evaluated. RESULTS: The intra-observer agreement between 2D and 3D US was mostly slight or fair agreement. However, in terms of the final category, there was substantial agreement for all three radiologists. The inter-observer agreement of 3D US was similar to that of 2D US (moderate agreement for shape, orientation, circumscribed margin and boundary; fair agreement for indistinct margin, angular margin, microlobulated margin, echo pattern and final category). The sensitivity of 3D US for breast cancer was higher than that of 2D US for two radiologists (2D vs. 3D for reader 2: 55.8% vs. 61.5%, 2D vs. 3D for reader 3: 59.6% vs. 63.5%), and the specificity of 3D US was lower than that of 2D US for all the readers (2D vs. 3D for reader 1: 90.8% vs. 86.7%, 2D vs. 3D for reader 2: 90.8% vs. 87.8%, 2D vs. 3D for reader 3: 94.9% vs. 90.8%), but the difference was not significant (p > or = 0.05). CONCLUSION: The interobserver variability and diagnostic performance of 3D breast US were similar to those of 2D US.