Mamografía con contraste: nuestra experiencia / Contrast-enhanced digital mammography: our experience

Resumen La mamografía contrastada (CEDM, contrast-enhanced digital mammography) es una herramienta nueva que ha ido implementándose de forma creciente. Aparece como alternativa a la resonancia magnética (RM), y al igual que esta, tiene como principio el uso de contraste endovenoso para explorar la angiogénesis tumoral. Combina la imagen de mamografía convencional (Mx) con la técnica de sustracción con energía dual poscontraste, lo que resulta en un incremento en la detección de cáncer de mama, en un tiempo corto de estudio y a un bajo costo. Es un método prometedor en casos seleccionados y de fácil lectura, siendo útil principalmente en pacientes con diagnóstico de cáncer de mama para detectar lesiones adicionales y determinar el tamaño tumoral, ayudando en la planificación quirúrgica, así como también en la evaluación de la respuesta a la neoadyuvancia. También en el seguimiento de pacientes operadas, para caracterizar lesiones dudosas en Mx y ecografía, o como alternativa ante contraindicación de la RM. El objetivo de este trabajo es valorar la utilidad de la mamografía contrastada en la práctica diaria y determinar sus principales indicaciones. Repasamos con casos propios las utilidades y características del método.

Abstract Contrast-enhanced digital mammography (CEDM) is an emerging tool that has been increasingly implemented. It appears as an alternative to magnetic resonance imaging (MRI), using intravenous contrast to explore tumor angiogenesis. It combines conventional mammography (Mx) with post-contrast dual energy subtraction technique, resulting in increased detection of breast cancer, in a short study time and at a low cost. It is a promising method in selected cases and easy to read, being useful mainly in patients with breast cancer to detect additional lesions and determine the tumor size, that helps surgical planning, as well as in the evaluation of post-neoadjuvant chemotherapy response in the follow-up of patients treated with surgery, to address inconclusive findings in screening mammogram, or as an alternative when MRI is contraindicated. The purpose of this article is to assess the usefulness of contrasted mammography in daily practice and to determine its main indications. We review with our own cases the applications and characteristics of this method.

Determinants of breast cancer screening mammography uptake: Results from Jordan population and family health survey

Background: Screening for breast cancer utilizing mammography is associated with reduced advanced cancer diagnosis and reduced breast cancer mortality. We aimed to assess the lifetime history of breast cancer screening utilization for Jordanian women aged 40 and 49 years and determinants of this utilization. Methods: This paper reports the analyzed data from the seventh cycle of the Jordan Population and Family Health Survey (JPFHS). For this study, the analysis was confined to 4486 women aged between 40 and 49 years at the time of data collection who reported their nationality as Jordanian. We used multivariate logistic regression analysis to assess whether any socio?demographic variables could predict greater breast cancer screening utilization. Results: Only 14% of all respondents aged 40� years reported ever having a mammogram. Results of multivariate logistic regression showed that area of residence, husband抯 level of education, younger age, and living in a wealthy status were strong predictors of lifetime history of breast cancer screening. Conclusions: This study elucidates that breast cancer screening mammography among Jordanian women has remained opportunistic and underutilized despite the efforts of national entities to promote screening and early detection of breast cancer. There is a geographic and social disparity in the utilization of mammography screening among Jordanian women.

Breast cancer after thoracic radiotherapy in young patients: what does the radiologist need to know? / Câncer de mama após radioterapia torácica em pacientes jovens: o que o radiologista precisa saber?

Abstract Radiation-induced secondary tumors constitute a rare complication of radiation therapy and typically occur in or near the irradiated area. Women who undergo thoracic radiotherapy before 30 years of age have a significantly greater lifetime risk of developing breast cancer than do those in the general population. It is recommended that a patient who has previously received thoracic radiotherapy with a radiation dose ≥ 10 Gy subsequently undergo annual screening with mammography and magnetic resonance imaging, beginning eight years after the initial treatment or when the patient has reached 25 years of age (whichever comes later). The treatment of secondary breast cancer in this population should be individualized and should be discussed with a multidisciplinary team to avoid toxicity related to the treatment of the primary cancer.

Resumo Os cânceres secundários induzidos por radiação são complicações raras da radioterapia e geralmente ocorrem na área tratada ou próximo a ela. Mulheres com menos de 30 anos de idade tratadas com radioterapia torácica têm risco significativamente aumentado de desenvolver câncer de mama ao longo da vida, em comparação com a população em geral. Para as pacientes tratadas com irradiação torácica com dose igual ou superior a 10 Gy é recomendado rastreamento anual com mamografia e ressonância magnética iniciando oito anos após o tratamento, desde que este início seja após 25 anos de idade. O tratamento do câncer de mama secundário nessa população deve ser individualizado e discutido com equipe multidisciplinar, para evitar toxicidade relacionada ao tratamento do câncer primário.

Impacto da COVID-19 no rastreamento do câncer de mama no Sistema Único de Saúde (SUS) / Impact of COVID-19 on breast cancer screening in the Brazilian Unified Health System (SUS)

Objetivos: investigar o impacto da pandemia no rastreamento do câncer de mama no Sistema Único de Saúde e comparar os dados obtidos com os de outros países. Métodos: foi realizado um estudo observacional transversal quantitativo, com dados provenientes do Sistema de Informação do Câncer ­ SISCAN sobre o número de mamografias feitas de 2014 a 2022 por mulheres, no Brasil. Resultados: os dados referentes à mamografia na população de risco elevado demonstraram uma queda de 38,39% de 2019 para 2020. Enquanto na mamografia de rastreamento a queda foi ligeiramente maior, de 39,18% nesse mesmo período. Em relação à mamografia diagnóstica, a redução foi de 33,15%, e na mamografia de população-alvo, o ápice foi em 2019 com 2.721.075. Em contrapartida, a realização de mamografia em pacientes já tratadas, teve uma menor queda, de 9,35%. Conclusões: observou-se uma queda significativa no número de mamografias realizadas em 2019 e 2020, o que poderá acarretar em diagnósticos tardios da doença e piores prognósticos (AU).

Objectives: investigating the impact of the pandemic on breast cancer screening in the Unified Health System, in addition to comparing the data obtained from other countries. Methods: a quantitative cross-sectional observational study was carried out, with references from the Cancer Information System - SISCAN on the number of mammograms performed from 2014 to 2022 by women in Brazil. Results: data regarding mammography in the high-risk population showed a drop of 38,39% from 2019 to 2020. While in screening mammography, the decline was slightly more significant, at 39.18% in the same period. Regarding diagnostic mammography, the reduction was 33.15%, and in target population mammography, the peak was in 2019 with 2.721.075. On the other hand, the performance of mammography in patients already treated had a smaller decrease of 9.35%. Conclusions: there was a significant reduction in the number of mammograms performed in 2019 and 2020, which might lead to a late diagnosis of the disease and a worse prognosis (AU),

Ferramenta de apoio à decisão no rastreamento mamográfico para mulheres de 40 a 49 anos / Decision aid for mammographic screening for women aged 40 to 49 / Herramienta de apoyo a la decisión de cribado mamográfico para mujeres de 40 a 49 años

Introdução: O rastreamento do câncer de mama no Brasil é recomendado para as mulheres de 50 a 69 anos, conforme diretrizes nacionais para a detecção precoce do câncer de mama do Instituto Nacional de Câncer/Ministério da Saúde. Embora ele seja tradicionalmente difundido como prática apenas benéfica, as evidências científicas apontam sua complexidade e a necessidade de comunicar o balanço entre os riscos e os benefícios, sobretudo em mulheres mais jovens. Objetivo: Descrever o processo participativo de elaboração de uma ferramenta de apoio à decisão para o rastreamento do câncer de mama quando buscado por mulheres com idade entre 40 e 49 anos no Brasil. Métodos: Estudo qualitativo-participativo que envolveu nove médicos de diferentes estados do Brasil e 104 mulheres na etapa de elaboração e 40 na de avaliação da ferramenta, seguindo as recomendações do International Patient Decision Aid Standards, em quatro etapas: rodas de conversa, síntese de evidências, revisão de ferramentas e avaliação da ferramenta por médicos e mulheres. Resultados: A ferramenta elaborada é inédita no Brasil e todos os médicos que a utilizaram a consideraram útil na conversa sobre os riscos e benefícios do rastreamento; 88,9% avaliaram que as informações facilitaram o entendimento ­ visão compartilhada por 80% das mulheres ­ e 77,8% consideraram que reduziu ou não interferiu no tempo de consulta. A ferramenta foi posteriormente aprimorada conforme as críticas e sugestões. Conclusões: O estudo mostrou o alcance do objetivo da ferramenta em oferecer suporte à decisão compartilhada e boa aceitação entre médicos e mulheres.

Introduction: Breast cancer screening in Brazil is recommended for women aged 50 to 69 years, according to national guidelines for early detection of breast cancer of the National Cancer Institute/Ministry of Health. Although it is traditionally disseminated only as a beneficial practice, scientific evidence points to its complexity and the need to communicate the balance between risks and benefits, especially in younger women. Objective: To describe the participatory process of developing a decision aid for breast cancer screening when sought by women aged between 40 and 49 years in Brazil. Methods: Qualitative-participatory study that involved nine physicians and 104 women in the development process, following the recommendations of the International Patient Decision Aid Standards, which include four stages: conversation circles, evidence synthesis, and decision aid review and evaluation by physicians and women. Results: The decision aid developed is unprecedented in Brazil and all the physicians who used it considered it useful to help the conversation about the risks and benefits of breast cancer screening; 88.9% assessed that the information facilitated understanding ­ a view shared by 80% of the women ­ and 77.8% considered that it reduced or did not interfere with the consultation time. The decision aid was later improved with the suggestions. Conclusions: The study showed that the decision aid achieved its objective

Introducción: El tamizaje de cáncer de mama en Brasil se recomienda para mujeres de 50 a 69 años, de acuerdo con las directrices nacionales para la detección temprana de cáncer de mama del Instituto Nacional del Cáncer/Ministerio de Salud. Aunque tradicionalmente se difunde como una práctica puramente beneficiosa, la evidencia científica apunta a su complejidad y la necesidad de comunicar el equilibrio entre riesgos y beneficios, especialmente en mujeres más jóvenes. Objetivo: Describir el proceso participativo de desarrollo de una herramienta de apoyo a la decisión para el tamizaje de cáncer de mama cuando lo buscan mujeres de 40 a 49 años en Brasil. Método: Estudio cualitativo-participativo que involucró a médicos y mujeres en el desarrollo de la herramienta, siguiendo recomendaciones el International Patient Decision Aid Standards, que recomienda cuatro etapas: círculos de conversación, síntesis de evidencia, revisión de la herramienta y evaluación de la herramienta por parte de médicos y mujeres. Resultados: la herramienta desarrollada es inédita en Brasil y todos los médicos que la utilizaron la consideraron útil en la conversación sobre los riesgos y beneficios del tamizaje; el 88,9% evaluó que la información facilitaba la comprensión ­ visión compartida por el 80% de las mujeres ­ y el 77,8% consideró que reducía o no interfería en el tiempo de consulta. La herramienta fue posteriormente mejorada con sugerencias. Conclusiones: El estudio mostró el alcance del objetivo de la herramienta al dar apoyo a la decisión compartida y buena aceptación entre médicos y mujeres.

Performance of physical activity as a predictor of women's mammography screening attendance in a population of Northeast Brazil

Introduction: Despite the increasing incidence of breast cancer among women in Northeast Brazil, there have been no studies on the association between physical activity and attendance to mammography screening. Objective: This study of Brazilian women addressed socio-economic variables, physical activity, and knowledge about breast cancer and their impact on attendance to mammography screening. Methods: A cross-sectional quantitative study was conducted as an epidemiological evaluation. Data were obtained by interviewing 307 women in a public health center. Logistic regression analysis was applied to determine the odds ratio (ORs) and confidence intervals (CI) of variables. Results: Mean age of women was 49.79 (SD=8.63) years and 172 (56.0%) were between 40 and 49 years old. Women aged from 40 to 49 and ≥50 years who performed physical activity, had a 2.4-fold (95% CI: 1.13-5.04) and 10.6-fold (95% CI: 2.66-41.95) increased chance to attend MS every year (p=0.040; p<0.001). Women aged between 40 and 49 years with a low and middle income, had a 10.3-fold (OR=0.097; 95% CI: 0.02-0.53) and 13.2-fold (OR=0.076; 95% CI: 0.11 0.53) decreased chance to attend MS every second year (p=0.007). The MS attendance of women aged ≥50 years with basic education level was 13.3 (OR=0.075; 95% CI: 0.09-0.66) times decreased (p=0.010). Conclusion: Physical activity represented an important predictor of MS attendance of all women. The impact of income and education level, in contrast, depended strongly on the age group.

Tendência de desigualdades na realização de mamografia nas capitais brasileiras nos últimos dez anos / Trend of inequalities in the performance of mammography in Brazilian capitals in the last ten years

Resumo O objetivo foi verificar a tendência de desigualdade na realização de mamografia de acordo com a posse de plano de saúde e escolaridade a partir de dados do período de 2011 a 2020 do VIGITEL. Estudo de base populacional com dados provenientes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) entre 2011 e 2020. Desfecho: exame de mamografia nos últimos dois anos em mulheres de 50 a 69 anos. A magnitude das desigualdades do desfecho em relação às exposições (plano de saúde e escolaridade) foi estimada por meio de dois índices: slope index of inequality (SII) e concentration index (CIX). A prevalência de cobertura da realização de mamografia (2011-2020) passou de 74,4% para 78,0%, com tendência estável. As prevalências de quem possuía plano de saúde foram 85,7% e 86,4%, e de quem não possuía, 63,4% e 71,2%, com tendência crescente. De acordo com a escolaridade, em mulheres com 0-8 anos de estudo a prevalência passou de 68,2% para 72,6%; 9-11 anos, de 80,4% para 80,0% (tendência decrescente); 12 anos ou mais, de 88,0% para 86,6% (tendência decrescente). Quanto aos índices de desigualdade absoluta (SII) e relativa (CIX) da escolaridade e plano de saúde, mostram que há uma diminuição na desigualdade nos últimos dez anos.

Abstract The objective was to verify the trend of inequality in the realization of mammography exam according to the possession of health insurance plan and schooling from data from the period 2011 to 2020 of VIGITEL. Population-based study with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL) between 2011 and 2020. Outcome: mammography exam in the last 2 years in women aged 50 to 69 years. The magnitude of inequalities of outcome in relation to exposures (health insurance plan and education) was estimated using two indices: inequality slope index (SII) and concentration index (CIX). The prevalence of mammography exam (2011-2020) increased from 74,4% to 78,0%, with a stable trend. The prevalence of those with health insurance plan were 85,7% and 86,4%, and without 63.4% and 71.2%, with an increasing trend. According to education, women with 0-8 years of schooling the prevalence increased from 68,2% to 72,6%, 9-11 years from 80,4% to 80,0% (decreasing trend), 12 years or more 88,0% to 86,6% (decreasing trend). As for the absolute (SII) and relative (CIX) inequality indices of schooling and health insurance plan show that there is a decrease in inequality over the last 10 years.

BI-RADS 3 lesions in North Indian population: Their outcome and how to proceed for follow-up

Background: Breast Imaging Reporting and Data System (BI?RADS) classification for breast lesions was proposed for uniformity in categorizing breast lesions. While BI?RADS 1, 2 and 4–6 categories are straightforward, BI?RADS 3 is an intermediate category lesion with significantly different meanings and findings for mammography, ultrasound, and magnetic resonance imaging and is diagnostically challenging. Our study aims to determine the frequency and the malignancy rate of BI?RADS category 3 lesions detected on ultrasound breast and digital X?ray mammography by doing follow?ups at 6, 12, and 24 months of imaging. Materials and Methods: This ambispective study was conducted in the Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, from October 2020 to October 2022, which included 55 patients referred for digital X?ray and breast ultrasound. All BI?RADS category 3 in the initial sonomammography and digital X?ray mammography were included in the study and were followed up for final diagnosis and outcome either by pathological analysis or follow?up using sonomammography and digital X?ray mammography for a maximum of 24 months. Results: Fifty?five patients were categorized into the benign or malignant category from the results of tissue diagnosis or via follow?up. Fifty?four patients (98.18%) showed benign lesions, and one (1.82%) got malignant lesions. In the majority, 31 (56.36%) patients, the mean follow?up time was 6 months, followed by 12 months 10 (18.18%). Follow?up was 24 months in only 1 out of 55 patients (1.82%). The mean value of time to follow?up (months) of study subjects was 6 ± 4.6 with a median (25th–75th percentile) of 6. Conclusion: Short?term interval follow?up in BI?RADS category: three patients are enough to detect early breast malignancy, and this will avoid unnecessary tissue diagnosis (invasive procedure) in benign lesions. In our study, the malignancy yield in the follow?up of BI?RADS 3 was 1.82% (<2%).

Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations / Recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil

Abstract Objective: To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities. Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.

Resumo Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline (PubMed), Excerpta Medica (Embase), Cochrane Library, Ebsco, Cinahl e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos, ou ainda portadoras de mutação genética ou com forte história familiar, se beneficiam do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível.

Association of polycystic ovary syndrome with mammographic density in Turkish women: a population-based case-control study

SUMMARY OBJECTIVE: The objective of this study was to investigate the breast densities and Breast Imaging-Reporting and Data System scores of patients with polycystic ovary syndrome and normoovulatory women and to determine whether these patients constitute a high-risk population for breast cancer. METHODS: This retrospective case-control study was conducted at our institution between January 2022 and December 2022, involving patients diagnosed with polycystic ovary syndrome. Menstrual periods, hyperandrogenemic findings, and ultrasound reports of the patients were retrieved from our hospital's database. Patients who met at least two of the Rotterdam criteria were included in the polycystic ovary syndrome group. A total of 70 premenopausal patients over the age of 40 years, diagnosed with polycystic ovary syndrome, and 70 normoovulatory women, matched for age and body mass index, were included in the study. The two groups were compared regarding age at menarche, menstrual pattern, gravida, parity, levels of follicle-stimulating hormone, luteinizing hormone, and estradiol, endometrial thickness, breast density category, and Breast Imaging-Reporting and Data System classifications. RESULTS: Patients in the polycystic ovary syndrome group had a higher age at menarche (12.7 vs. 12.3, p=0.006). There was no difference between the gonadotropin levels in both groups. However, the estradiol level was higher in the polycystic ovary syndrome group (p<0.001). There was no statistically significant difference between the two groups in terms of breast density and Breast Imaging-Reporting and Data System scores (p=0.319 and p=0.650, respectively). CONCLUSION: Although we can conclude that the risk of breast malignancy is not increased in patients with polycystic ovary syndrome, the impact of the complex hormonal status of polycystic ovary syndrome on breast cancer remains unclear in the literature.

Tendência de realização da mamografia e fatores associados em mulheres de 50 a 69 anos / Mammography trend and associated factors in women from 50 to 69 years

Resumo Introdução A mamografia é o principal método de detecção precoce de neoplasias mamárias. Objetivou-se conhecer a tendência temporal de realização da mamografia e identificar os fatores associados à realização desse exame em algum momento da vida e nos últimos dois anos. Objetivo Descrever a tendência temporal de realização da mamografia e identificar fatores associados à realização desse exame em algum momento da vida e nos últimos dois anos. Método Estudo transversal utilizando dados autorreferidos por mulheres, de 50 a 69 anos, oriundos do Vigitel. Para análise da tendência de realização da mamografia, tanto em algum momento da vida quanto nos últimos dois anos, foram analisados dados de 2007 a 2015 da cidade de João Pessoa, Paraíba, por meio de regressão linear simples, e, para identificação dos fatores associados, foram estimadas razões de prevalências utilizando-se da regressão de Poisson com dados de 2015. Resultados A prevalência de realização da mamografia, de 2007 a 2015, aumentou nos dois desfechos. Entre as variáveis analisadas, apenas a posse de plano de saúde manteve-se associada à realização da mamografia em algum momento da vida. Para a realização do exame nos últimos dois anos, mantiveram-se associados o estado civil casada/união estável e a posse de plano de saúde. Conclusão É necessário haver ações prioritárias nos serviços públicos de saúde, com a ampliação do acesso à solicitação e à realização da mamografia, garantindo acesso igualitário entre todas as mulheres.

Abstract Background Mammography is the main method for the early detection of breast cancer. The objective of this study was to learn about the temporal trend for mammography and identify factors associated with the examination at some point in life and in the last two years. Objective Describe the temporal trend of mammograms and identify factors associated with this exam at some point in life and in the last two years. Method A cross-sectional study was carried out using self-reported data from women aged 50 to 69 years from Vigitel. To analyze the tendency to perform mammography, both at some point in life and in the last two years, data from 2007 to 2015 in the city of João Pessoa, Paraíba, were analyzed using simple linear regression, and to identify the associated factors, prevalence ratios were estimated using Poisson regression with data from 2015. Results The prevalence of mammography, from 2007 to 2015, increased in both outcomes. Among the variables analyzed, only possession of a health plan remained associated with mammography at some point in life. For the examination in the last two years, marital status/stable union, and possession of a health plan remained associated. Conclusion Priority actions are needed in public health services, with increased access to requests and the performance of mammography, guaranteeing equal access among all women.

Recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil

Objective: To present the updated recommendations of the Brazilian College of Radiology and Imaging Diagnosis, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Methods: Between January 2012 and July 2022, searches for scientific evidence published in MEDLINE, Embase, Cochrane Library, EBSCO, CINAHL and LILACS were carried out. The recommendations were based on this evidence, with the consensus of a committee of experts from the three institutions. Recommendations: The annual mammography screening is recommended for normal-risk patients aged between 40 and 74 years. For women aged more than 75 years, it is reserved for those whose life expectancy is longer than seven years. Women whose risk is higher than normal, such as those with dense breasts, personal history of atypical lobular hyperplasia, classic in situ lobular carcinoma, atypical ductal hyperplasia, women undergoing breast cancer treatment or thoracic irradiation before the age of 30, or those with genetic mutation or strong family history, benefit from complementary screening, being considered in an individual manner. Tomosynthesis is an evolution of mammography and should be considered in screening whenever accessible and available

Acompanhamento de mulheres rastreadas para o câncer de mama com lesões provavelmente benignas no estado do Rio de Janeiro / Follow-up of women screened for breast cancer with probably benign lesions in Rio de Janeiro state

Resumo Introdução O câncer de mama é a primeira causa de óbito por câncer entre as mulheres no mundo. O rastreamento com mamografia pode detectar lesões iniciais, que se tratadas a evolução será favorável para a maioria dos casos. Objetivo Analisar o seguimento de dois anos das mulheres rastreadas para câncer de mama no estado do Rio de Janeiro, que apresentavam lesões provavelmente benignas (BI-RADS® 3) em 2011. Método Estudo de coorte retrospectiva com dados dos Sistemas de Informação (SIS) do Câncer de Mama (SISMAMA) e de Mortalidade (SIM), utilizando relacionamento probabilístico entre as bases de dados para recuperação do seguimento. A investigação dos fatores associados à repetição do exame de controle baseou-se no modelo de riscos proporcionais de Cox. Resultados Foram identificadas 1.261 mulheres com resultado BI-RADS® 3, dentre as quais foram encontrados o seguimento de 498 mulheres nos SIS. A maioria apresentou resultado normal ou benigno no controle (51,1%). O tempo mediano da repetição do exame foi de 12 meses; com menor tempo para mulheres ≤ 70 anos, residiam fora da capital e apresentavam risco para câncer de mama. Conclusão O tempo de repetição da mamografia encontrado foi superior ao recomendado, indicando necessidade de aprimoramento do rastreamento do câncer de mama.

Abstract Background Breast cancer is the leading cause of cancer deaths among women worldwide. Mammography screening can detect initial lesions, which, if treated, will have a favorable outcome in most cases. Objective To analyze the two-year follow-up of women screened for breast cancer in the state of Rio de Janeiro, who had probable benign lesions (BI-RADS® 3) in 2011. Method A retrospective cohort study with data from the Breast Cancer Information Systems (SISMAMA) and Mortality System (SIM), using a probabilistic linkage between the recovery of follow-up databases. The investigation of factors associated with repeat screening was based on Cox's proportional hazards model. Results 1261 women were identified with BI-RADS® 3 results, of which 498 women received follow-up screening in the SIS. Most presented normal or benign results in the control (51.1%). The median time for repeat screening was 12 months; with shorter time for women ≤ 70 years old, those who lived outside the capital and those who were at risk of breast cancer. Conclusion The mammography repetition time observed was longer than recommended, indicating the need to improve breast cancer screening rates.

Factors associated with the proportion of abnormal results in screening mammograms: ecological study / Factores asociados a la proporción de resultados alterados en mamografías de tamizaje: estudio ecológico / Fatores associados a proporção de resultados alterados nas mamografias de rastreamento: estudo ecológico

ABSTRACT Objective: To analyze the factors associated with the proportion of abnormal results in screening mammograms. Methods: Ecological study, with data from DATASUS/SISCAN, Atlas Brasil do Desenvolvimento Humano, Fundação SEADE, and Sistema e-Gestor, from 2016 to 2019, of women aged 50 to 69 years in the 645 municipalities of São Paulo (Brazil). Independent variables were associated with the outcome: proportion of unsatisfactory coverage of abnormal test results (Breast Imaging Reporting and Data System - BI-RADS® 0, 4 and 5 proportion >10% of tests performed). Multiple Poisson regression was used. Results: Higher proportion of screening mammography (PR=1.20; 95%CI: 1.00;1.45), higher percentage of poor (PR=1.20; 95%CI: 1.07;1.36), low (PR=1.57; 95%CI: 1.38;1.78) and medium coverage of the Family Health Strategy (ESF) (PR=1.30; 95%CI: 1.09;1.52) were associated to the outcome. Conclusion: Socioeconomic and FHS coverage factors mediate the proportion of mammograms with abnormal results in public health services. Therefore, they are important aspects in the fight against breast cancer.

RESUMEN Objetivo: Analizar los factores asociados a la proporción de resultados alterados en las mamografías de tamizaje. Métodos: Estudio ecológico, con datos de DATASUS/SISCAN, Atlas Brasil do Desenvolvimento Humano, Fundação SEADE y Sistema e-Gestor, de 2016 a 2019, de mujeres de 50 a 69 años en los 645 municipios de São Paulo (Brasil). Las variables independientes se asociaron con el resultado: proporción de cobertura insatisfactoria de resultados de pruebas alteradas (BreastImagingReporting and Data System - BI-RADS® 0, 4 y 5 proporción >10% de pruebas realizadas). Se utilizó la regresión de Poisson múltiple. Resultados: Mayor proporción de mamografía de tamizaje (RP=1,20; IC95%: 1,00;1,45), mayor porcentaje de mala (RP=1,20; IC95%: 1,07;1,36), baja (RP=1,57; IC95%: 1,38) ;1,78) y cobertura media de la Estrategia Salud de la Familia (ESF) (RP=1,30; IC95%: 1,09;1,52) se asociaron al desenlace. Conclusión: Factores socioeconómicos y de cobertura de la ESF median la proporción de mamografías alteradas en el servicio público. Por lo tanto, son aspectos importantes en la lucha contra CM.

RESUMO Objetivo: Analisar os fatores associados aproporção de resultados alterados nas mamografias de rastreamento. Métodos: Estudo ecológico, com dados do DATASUS/SISCAN, Atlas Brasil do Desenvolvimento Humano, Fundação SEADE, e Sistema e-Gestor, de 2016 a 2019, de mulheres de 50 a 69 anos dos 645 municípios de São Paulo (Brasil).Variáveis independentes foram associadas ao desfecho: proporção de cobertura insatisfatória de resultados de exames alterados (proporção Breast Imaging Reporting and Data System - BI-RADS® 0, 4 e 5 >10% dos exames realizados). Utilizou-se regressão múltipla de Poisson. Resultados: Maior proporção de mamografia de rastreamento (RP=1,20; IC95%: 1,00;1,45), maior porcentagem de pobres (RP=1,20; IC95%: 1,07;1,36), baixa (RP= 1,57; IC95%: 1,38;1,78) e média cobertura de Estratégia Saúde da Família (ESF) (RP=1,30; IC95%: 1,09;1,52) foram associados ao desfecho. Conclusão: Fatores socioeconômicos e de cobertura da ESF medeiam a proporção de mamografias alteradas no serviço público. Portanto, são aspectos importantes no combate ao câncer de mama.

Recommendations for the Screening of Breast Cancer of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Society of Mastology and Brazilian Federation of Gynecology and Obstetrics Association / Recomendações para o rastreio do câncer de mama do colégio brasileiro de radiologia e diagnóstico por imagem, sociedade brasileira de mastologia e associação da federação brasileira de ginecologia e obstetrícia

Abstract Objective To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. Methods Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. Recommendations Annual mammography screening is recommended for women at usual risk aged 40-74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.

Resumo Objetivo Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Métodos Foram pesquisadas evidências científicas publicadas nas bases de dados Medline EMBASE Biblioteca Cochrane EBSCO CINAHL e Lilacs entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências por consenso do comitê de especialistas das três entidades. Recomendações A mamografia anual é recomendada para mulheres com risco habitual entre 40 e 74 anos. Acima de 75 anos deve ser reservado para aqueles com expectativa de vida superior a sete anos. Mulheres com risco maior do que o normal incluindo aquelas com mamas densas com história pessoal de hiperplasia lobular atípica carcinoma lobular in situ clássico hiperplasia ductal atípica tratamento para câncer de mama ou irradiação de tórax antes dos 30 anos ou ainda portadoras de doença genética mutação ou com forte histórico familiar beneficiam-se de triagem complementar e devem ser considerados individualmente. A tomossíntese é uma forma de mamografia e deve ser considerada na triagem sempre que acessível e disponível.

Research progress in the average glandular dose during mammography / 中华放射医学与防护杂志

Mammography has played an essential role in the screening and treatment of breast cancer. However, the application of X-rays will also increase the risks of breast cancer while improving its detection rate. Moreover, the risks will increase with an increase in the radiation dose. Since the glandular tissue in breasts is sensitive to radiation, the evaluation of the average glandular dose (AGD) in mammography has attracted considerable international attention. Compared to relatively mature dosimetric studies on traditional two-dimension mammography and digital breast tomosynthesis, the method for the dose evaluation of the new cone beam CT for breasts are still subjected to research. This paper reviews and explores the current status of studies on the assessment method and relevant influencing factors of AGD under different types of mammography equipment.

Dose comparison of mammography with two photographic modes / 中华放射医学与防护杂志

Objective:To compare radiation dose between digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM), and explore the correlation of average glandular dose(AGD) with breast density and compression thickness.Methods:The mammographic data of patients with breast diseases who underwent digital breast tomosynthesis (DBT) and the population who underwent full-field digital mammography (FFDM) screening in the First Affiliated Hospital of Kunming Medical University from October 2020 to May 2022 were retrospectively collected. The compression thickness, compression force and AGD were recorded. According to the 2013 ACR BI-RADS MAMMOGRAPHY, the breast gland density was classified into 4 types: a(glandular tissue<25%), b(glandular tissue 25%~50%), c(glandular tissue 50%~75%) and d(glandular tissue >75%), by two senior doctors engaged in breast imaging diagnosis. The relationships between different gland densities, different compression thicknesses and AGD under FFDM and DBT mode were analyzed.Results:In both FFDM and DBT modes, the AGD increased significantly with the increase of breast density( F=861.63, 617.83, 330.33, 451.45, 290.47, P<0.001), and AGD a<AGD b<AGD c<AGD d. For type c and d breasts undergoing FFDM, AGD was lowest when the compression thickness was 31~40 mm. Under the same compression thickness, The AGD DBT was significantly higher than the AGD FFDMin all types (Type a: t=-17.88, -42.19, -29.90, -28.14, -24.95, P<0.001; Type b: t=-49.18, -35.94, -27.25, -28.37, -24.10, P<0.001; Type c: t=-11.78, -32.90, -23.13, -20.51, -18.24, P<0.001; Type d: t=-7.94, -26.24, -17.24, -15.44, -13.81, P<0.001). The difference between two AGDs of Type d with compression thickness of 61~70 mm was the largest, which was 1.07 mGy (95% CI: 0.92~1.22). The AGD was positively correlated with breast density and compression thickness, and the relationship of FFDM was stronger than that of DBT. Conclusions:The AGD is positively correlated with breast density and compression thickness in mammography. Compared with FFDM, DBT can increase AGD, The AGD would increase in DBT than FFDM but be safe. DBT would be beneficial to patients with breast diseases in clinical practice.

Diagnostic value of CEM and MRI in differentiating benign and malignant breast lesions based on the 2013 BI-RADS lexicon and the supplement on CEM / 中华放射学杂志

Objective:To explore the diagnostic value of contrast-enhanced mammography (CEM) and MRI in differentiating benign and malignant breast lesions based on the 2013 breast imaging reporting and data system (BI-RADS) lexicon and the supplement on CEM.Methods:The clinical and imaging data of 83 patients with breast lesions from March 2019 to April 2022 in the Third Affiliated Hospital of Soochow University were retrospectively analyzed. Totally 100 breast lesions from 83 female patients aged 28 to 78 (49±14) years, were divided into benign lesions (50 lesions) and malignant lesions (50 lesions) according to the pathological results. The t-test, χ 2 test and Fisher′s exact test were used to compare the differences of clinical and imaging features between benign and malignant lesions, and these imaging features which had statistical differences were established CEM and MRI models by multivariate logistic regression analysis respectively. The receiver operating characteristic curves and the area under the curve (AUC) were used to assess the diagnostic efficacy of two models in differentiating benign and malignant breast lesions. Using the DeLong test compared the AUC. Results:Multivariate logistic regression analysis showed that associated features (OR=9.075,95%CI 1.430-57.570, P=0.019), lesion conspicuity (OR=6.180,95%CI 2.608-14.646, P<0.001), mass margin (OR=2.193,95%CI 1.405-3.422, P=0.001) and calcification distribution (OR=2.147,95%CI 1.157-3.986, P=0.015) were independent predictors of differentiating benign and malignant breast lesions in CEM, and then the predictive model of CEM was constructed. Time-signal intensity curve (OR=9.230, 95%CI 3.178-26.805, P<0.001), associated features (OR=5.289,95%CI 1.343-20.831, P=0.017) and mass margin (OR=2.192,95%CI 1.336-3.597, P=0.002) were independent predictors of differentiating benign and malignant breast lesions in MRI, and the predictive model of MRI was constructed. The AUC of CEM and MRI models for differentiating benign and malignant breast lesions were 0.947 and 0.930 respectively, and two models were no significant difference ( Z=0.68, P=0.494). Conclusion:The diagnostic efficacy of CEM and MRI in differentiating benign and malignant breast lesions is comparable based on the 2013 BI-RADS lexicon and the supplement on CEM.

A modal study of the effect of adjusting density exposure steps on image quality and radiation dose in digital mammography / 中华放射学杂志

Objective:To investigate the effect of adjusting density exposure steps on image quality and radiation dose in digital mammography.Methods:Using the automatic exposure control (AEC) mode of the digital mammography machine, five different gland thicknesses of 4.3, 5.3, 6.3, 7.3, and 8.3 cm were simulated by attaching 0, 1, 2, 3, and 4 PMMA plexiglass plates under the RMI-156 modal body, and the density exposure steps were adjusted to -3, -2, -1, 0, 1, 2, 3, and 4 for each thickness. The target/filter combination, tube voltage, tube current, incident body surface dose (ESD), incident surface air kerma (ESAK), half-value layer (HVL) and the average glandular dose displayed by the device (displayed AGD) were recorded at each step and thickness, and the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), figure of merit (FOM) and the calculated average glandular dose (calculated AGD) were calculated. Then, the display effects of simulated fibers, simulated calcifications and simulated masses within the modal body were scored subjectively, and the changes in image quality and radiation dose at different steps were analyzed, and the relationships between ESD and ESAK, displayed AGD and calculated AGD, and displayed AGD/ESD and calculated AGD/ESAK were analyzed. A linear fit was used for the steps with SNR, CNR, and FOM, and an exponential function curve fit was used for the steps with mAs, ESAK, and calculated AGD. The differences between ESD and ESAK, displayed AGD and calculated AGD, and displayed AGD/ESD and calculated AGD/ESAK were analyzed by paired-samples t test. Results:The CNR and SNR of mammographic images rose and fell by about 8% with each increase or decrease of one step. The scores of image simulated fibers, simulated calcifications, and simulated masses showed an overall upward trend with increasing steps, but there were still cases where the scores decreased with increasing grades. FOM varied from 97% to 104% at each grade with little variability. ESD, ESAK, displayed AGD, and calculated AGD, which could measure radiation dose, showed an exponential trend of increasing function with increasing steps, with a variation of about 63% to 165%. There were statistically significant differences ( t=-9.61, P=0.001) between ESD (15.14±10.08) and ESAK (16.66±11.07). However, there were no statistically significant differences ( t=1.20, P=0.240) between displayed AGD and calculated AGD, which were 3.66±2.18 and 3.61±1.99, respectively. Conclusions:The adjustment of density exposure steps can make the image quality change linearly and the radiation dose change exponentially with increasing speed, and the mode and magnitude of the adjustment are appropriately stable with high application value.

The value of deep learning technology based on mammography in differentiating breast imaging reporting and data system category 3 and 4 lesions / 中华放射学杂志

Objective:To explore the value of deep learning technology based on mammography in differentiating for breast imaging reporting and data system (BI-RADS) category 3 and 4 lesions.Methods:The clinical and imaging data of 305 patients with 314 lesions assessed as BI-RADS category 3 and 4 by mammography were analyzed retrospectively in Shenzhen People′s Hospital and Shenzhen Luohu People′s Hospital from January to December 2020. All 305 patients were female, aged 21 to 83 (47±12) years. Two general radiologists (general radiologist A and general radiologist B) with 5 and 6 years of work experience and two professional breast imaging diagnostic radiologists (professional radiologist A and professional radiologist B) with 21 years of work experience and specialized breast imaging training were randomly assigned to read the imaging independently at a 1∶1 ratio, and then to read the imaging again in combination with the deep learning system. Finally, breast lesions were reclassified into BI-RADS category 3 or 4. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the diagnostic performance, and the differences of AUCs were compared by DeLong method.Results:The AUC of general radiologist A combined with deep learning system to reclassify BI-RADS category 3 and 4 breast lesions was significantly higher than that of general radiologist A alone (AUC=0.79, 0.63, Z=2.82, P=0.005, respectively). The AUC of general radiologist B combined with deep learning system to reclassify BI-RADS category 3 and 4 breast lesions was significantly higher than that of general radiologist B (AUC=0.83, 0.64, Z=3.32, P=0.001, respectively). There was no significant difference in the AUCs between professional radiologist A combined with deep learning system and professional radiologist A, and professional radiologist B combined with deep learning system and professional radiologist B in reclassifying BI-RADS category 3 and 4 breast lesions ( P>0.05). Conclusion:The deep learning system based on mammography is more effective in assisting general radiologists to differentiate between BI-RADS category 3 and 4 lesions.