Frecuencia de cáncer en pacientes con ecografía mamaria BI-RADS 4A / Rate of breast cancer diagnosis in patients categorized as bi-rads 4A on screening ultrasound

Las imágenes son fundamentales en la evaluación de la patología mamaria. El Colegio Americano de Radiología estandarizó los reportes con el Breast Imaging Reporting and Data System (BI-RADS), que permite predecir según las características morfológicas la probabilidad de malignidad y la conducta a seguir. En la cuarta edición de 2003 se amplió para incluir el primer lexicón de ecografía. Los BI-RADS 4 y 5 corresponden a lesiones sospechosas de malignidad y en la 4 fue necesario crear tres subgrupos, de los cuales el 4A son lesiones con posibilidad baja de cáncer (entre 2% y 10%). Como en la primera publicación presentamos los resultados del valor predictivo positivo del reporte BI-RADS 4A mamográfico, el objetivo del presente estudio es determinar la tasa de malignidad en BI-RADS 4A ecográfico en los hospitales de San José e Infantil Universitario de San José de Bogotá DC, Colombia, incluyendo casos de BI-RADS 4A mamográfico para contrastar con el estudio inicial. Cuatro de 72 pacientes con ecografía mamaria BI-RADS 4A fueron diagnosticadas con cáncer de mama (VPP del 5.5%), todos en nódulos sólidos. Algunos pudieron catalogarse como BI-RADS 3 por los radiólogos...

Imaging is essential for breast pathology evaluation. The American College of Radiology provides a standardized classification system the Breast Imaging-Reporting and Data System (BI-RADS), allowing prediction of malignancy probability based on appearance and providing guidelines to be followed. The 2003 fourth edition was extended to include the first ultrasound lexicon. BI-RADS 4 and 5 categories are lesions with suspicious changes of malignancy, and category 4 was divided into three sub groups, 4A lesions have low possibility of cancer (between 2% and 10%). As our first publication presented the results of the positive predictive value of BI-RADS 4A mammographic reports, the objective of the present study is to determine the malignancy rate in BI-RADS 4A ultrasound reports at San José and Infantil Universitario de San José hospitals in Bogotá DC, Colombia, including BI-RADS 4A mammographic exam cases to compare with the initial study. Of the 72 BI-RADS 4a lesions on ultrasound screening, four were malignant (VPP 5.5%) all detected as solid nodules. Some could have been categorized as BI-RADS 3 by radiologists...

Análise dos achados ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário diagnosticados por core biópsia / Analyzing the ecographic features of pseudoangiomatous stromal hyperplasia masses diagnosed by core biopsy

Objetivos: Descrever os aspectos ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário, classificando-os segundo o BI-RADS®. Métodos: Foi realizado um estudo retrospectivo, de 2009 a 2010, da base de dados do nosso serviço (UD diagnóstico por imagem) para identificar nódulos evidenciados na ecografia mamária, com diagnóstico histopatológico confirmado de hiperplasia pseudoangiomatosa do estroma mamário, por meio de core biópsia orientada por ultrassonografia, com agulha de 16 gauge. Foram identificadas 16 pacientes com lesões ecográficas que tinham hiperplasia pseudoangiomatosa do estroma mamário como diagnóstico. Resultados: O fator determinante para a classificação em categorias 4a e 4b, segundo o léxico BI-RADS® para ultrassonografia, foi as margens não-circunscritas, que estavam presentes em 93,3% das lesões, as demais características ecográficas das lesões foram compatíveis com lesões benignas. Conclusão: Nódulos ecográficos de hiperplasia pseudoangiomatosa do estroma mamário podem apresentar características ecográficas que sejam determinantes para a realização de biópsias, mesmo sabendo-se que esta patologia tem curso tipicamente benigno.

Objectives: To describe the ecographic features of pseudoangiomatous stromal hyperplasia masses, classifying them according to the BI-RADS® lexicon. Methods: A retrospective review was performed during the period from 2009 to 2010, using the database of our service (UD diagnóstico por imagem), in order to find ecographic masses with pseudoangiomatous stromal hyperplasia diagnosis, which were performed with 16-gauge core biopsy ultrasound guided. We identified 16 patients with ecographic masses diagnosed with pseudoangiomatous stromal hyperplasia. Results: The most important finding that changes the classification of the BI-RADS® was noncircumscribed margins, which were foundin 93.3% of the lesions, other ultrasound characteristics found were benign features. Conclusion: Pseudoangiomatous stromal hyperplasiamasses may present ecographic findings that support biopsy indication; although it is known that it is a benign pathology.