Analysis of breast cancer screening among rural women in Qinba area / 肿瘤研究与临床

Objective:To analyze the results of the free breast cancer screening project for rural women in Qinba area, and to investigate intervention measures for the improvement of screening rate.Methods:The data of 5 974 rural women aged 35 to 64 years old with breast cancer in Qinba area during two cancer screening in 3201 Hospital Affiliated to Xi'an Jiaotong University College of Medicine and Nanjiang County Women and Children Hospital between August 2021 and March 2022 were retrospectively analyzed. The characteristics of the screened population, the results of breast ultrasonography, mammography and pathological examination were statistically analyzed.The differences in the positive rates of breast ultrasonography and breast ultrasonography supplemented with mammography in the clinical screening of breast cancer among different age groups were compared.Results:The highest participation rate was found in those aged 45 to 49 years old, accounting for 29.56% (1 766/5 974); the lowest participation rate was those aged 60 to 64 years old, accounting for 3.65% (218/5 974). According to breast ultrasonography screening, 976 (16.34%) cases were suspected positive, 282 (4.72%) cases were positive; 84 (1.41%) were screened for mammography, 18 (21.43%) cases were suspected positive and 6 (7.14%) cases were positive; and the detection rate of breast cancer was 66.96/ 100 000 (4/5 974). There were statistically significant differences in the positive rate of clinical breast cancer screening by breast ultrasonography and breast ultrasonography supplemented with mammography among different age groups (all P < 0.05). Conclusions:Breast cancer screening in Qinba area has achieved some good results. The screening mode of physical examination combined with breast ultrasound supplemented with mammography is suitable for this area, but the compliance of the population is poor. The scientific awareness of breast cancer in rural women should be improved.

Application progress of ultrasound examination in the diagnosis and treatment of breast cancer / 中国基层医药

Breast cancer ranks first in incidence in female malignant tumors, which obviously endangers patients' health. There is an increasing number of young female patients with breast cancer. If a breast lump is discovered early, and its benign or maligant nature can be identified, then the patient can be treated in time, and therefore the risk of breast cancer death can be greatly reduced. In recent years, with the continuous development of contrast-enhanced ultrasound and other technologies, breast cancer diagnosis is increasing, which provides an auxiliary role for clinical treatment. This review summarizes ultrasound examination, in particular contrast-enhanced ultrasound, for diagnosis and treatment of breast cancer and helps provide evidence for clinical treatment of this disease

Presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática / Clinical presentation and radiological findings of patients with histopathological diagnosis of idiopathic granulomatous mastitis

INTRODUCCIÓN. La mastitis granulomatosa idiopática es una patología inflamatoria benigna de mama con clínica y hallazgos imagenológicos no específicos; usualmente confundida con cáncer de mama. El síntoma más frecuente es una masa mamaria palpable. El diagnóstico es histopatológico. OBJETIVO. Describir el perfil demográfico, presentación clínica y hallazgos radiográficos de pacientes con diagnóstico histopatológico de mastitis granulomatosa idiopática. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo. Población de 1130 y muestra de 49 datos de historias clínicas electrónicas de pacientes con diagnóstico histológico de mastitis granulomatosa idiopática con el código CIE10 N61x Trastornos Inflamatorios de la mama, atendidas en la Unidad Técnica de Imagenología del Hospital de Especialidades Carlos Andrade Marín en la ciudad de Quito entre enero 2019 hasta diciembre 2021. El criterio de inclusión fue la confirmación histopatológica de mastitis granulomatosa idiopática. Los criterios de exclusión: antecedentes de neoplasia maligna de mama, antecedentes de HIV, patología inflamatoria sistémica como granulomatosis de Wegener, sarcoidosis, infecciones granulomatosas crónicas como tuberculosis, brucelosis, histoplasmosis, sífilis y reacciones a cuerpos extraños como material de implantes mamarios. Se analizaron datos demográficos, presentación clínica, hallazgos mamográficos, ecográficos y la categorización BIRADS. Se efectuó un análisis univarial; para las variables cualitativas se realizó frecuencias y porcentajes; para las variables cuantitativas se realizó medidas de tendencia central. La información recolectada fue analizada en el programa estadístico International Business Machines Statistical Package for the Social Sciences. RESULTADOS La mediana de la edad fue 36 años. El 94,00% de pacientes tenían por lo menos un hijo; 77,50% presentaron con una masa palpable; 55,10% se acompañaron de signos inflamatorios; 16,00% asociaron fístulas y 24,40% presentaron secreción. Solo 1 caso presentó afectación bilateral. CONCLUSIÓN En este estudio, la mastitis granulomatosa idiopática afecta a mujeres en edad reproductiva sin antecedentes de malignidad quienes presentan una masa mamaria palpable que puede estar acompañada de signos inflamatorios, colecciones y fístulas. La realización de una biopsia core eco guiada, para confirmar su diagnóstico.

INTRODUCTION. Idiopathic granulomatous mastitis is a benign inflammatory breast pathology with nonspecific clinical and imaging findings; usually mistaken for breast cancer. The most frequent symptom is a palpable breast mass. The diagnosis is histopathologic. OBJECTIVE. To describe the demographic profile, clinical presentation and radiographic findings of patients with histopathologic diagnosis of idiopathic granulomatous mastitis. MATERIALS AND METHODS. Observational, descriptive, retrospective study. Population of 1130 and sample of 49 data from electronic medical records of patients with histological diagnosis of idiopathic granulomatous mastitis with ICD10 code N61x Inflammatory disorders of the breast, attended at the Technical Imaging Unit of the Carlos Andrade Marín Specialties Hospital in the city of Quito between January 2019 and December 2021. The inclusion criterion was histopathological confirmation of idiopathic granulomatous mastitis. Exclusion criteria: history of malignant breast neoplasia, history of HIV, systemic inflammatory pathology such as Wegener's granulomatosis, sarcoidosis, chronic granulomatous infections such as tuberculosis, brucellosis, histoplasmosis, syphilis and reactions to foreign bodies such as breast implant material. Demographic data, clinical presentation, mammographic and ultrasound findings and BIRADS categorization were analyzed. Univariate analysis was performed; frequencies and percentages were used for qualitative variables; measures of central tendency were used for quantitative variables. RESULTS. The median age was 36 years. 94,00% of patients had at least one child; 77,50% presented with a palpable mass; 55,10% were accompanied by inflammatory signs; 16,00% were associated with fistulas and 24,40% presented with discharge. Only 1 case presented bilateral involvement. CONCLUSION. In this study, idiopathic granulomatous mastitis affects women of reproductive age with no history of malignancy who present with a palpable breast mass that may be accompanied by inflammatory signs, collections and fistulas. The performance of an echo-guided core biopsy to confirm the diagnosis.

Research progress of artificial intelligence in ultrasound diagnosis of breast cancer / 中国医师杂志

Breast cancer is the cancer with the largest number of new cases in the world, and ranks first in the incidence spectrum and cause of death among women in most countries. In recent years, artificial intelligence (AI), especially deep learning and computer-aided diagnosis, has shown remarkable performance in image analysis and processing, computer vision and other aspects, and has great development potential in the field of medical and health lesions identification, disease diagnosis and other aspects. This paper mainly discusses the application and progress of AI in ultrasound diagnosis of breast cancers.

Application value of artificial intelligence model based on deep learning in Breast Ultrasound Imaging Reporting and Data System: breast nodules classification / 肿瘤研究与临床

Objective:To explore the application value of artificial intelligence (AI) model based on deep learning in breast nodules classification of Breast Imaging Reporting and Data System of ultrasound (BI-RADS-US).Methods:The ultrasound images of 2 426 breast nodules from 1 558 female patients with breast diseases at Beijing Tongren Hospital, Capital Medical University between December 2006 and December 2019 were collected . The image data sets were divided into training (63%), verification (7%), and test (30%) subsets for the construction of AI model. The diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were analyzed by using receiver operating characteristic (ROC) curve. The Cohen weighted Kappa statistic was used to compare the consistency of BI-RADS-US classification among 5 ultrasound doctors' diagnosis with or without AI model assistance. And the changes of BI-RADS-US classification were analyzed before and after each doctor adopted AI model assistance.Results:The differences in diagnostic efficiencies of AI model, doctors' arbitration results and doctors' diagnosis with or without AI model assistance were statistically significant (all P > 0.05). The consistency among 5 ultrasound doctors was improved due to AI model assistance and Kappa value was increased from 0.433 (category 3), 0.600 (category 4a), 0.614 (category 4b), 0.570 (category 4c) and 0.495 (category 5) to 0.812, 0.704, 0.823, 0.690 and 0.509 (all P < 0.05), respectively. The upgrade and downgrade of BI-RADS-US classification occurred in 5 doctors after the classification of AI model assistance. Downgrade from category 4 to 3 in benign nodules of 56.6% (47/76) and upgrade from category 4 to 5 in malignant nodules of 69.4% (34/49) were mostly observed. Conclusions:AI-assisted BI-RADS-US classification can effectively improve the consistency of classification among the doctors without reducing the diagnostic efficiency. AI model shows clinical values in reducing unnecessary biopsy of partial benign lesions and increasing diagnostic accuracy of partial malignant lesions through the adjustment of breast nodule classification.

The delay of breast cancer diagnosis during the COVID-19 pandemic in São Paulo, Brazil / O atraso no diagnóstico do câncer de mama durante a pandemia da COVID-19 em São Paulo, Brasil

ABSTRACT Objective To evaluate the impact of COVID-19 pandemic on breast cancer diagnosis in a breast imaging center. Methods This was a retrospective cohort study that included women submitted to breast exams and procedures in a private hospital in São Paulo, SP, Brazil, as from the period of most strict social isolation measures, in 2020 (separated in first period of social isolation, March 24 to June 21, 2020, and second period, June 22 to December 31, 2020), as compared to the same period in 2019. The number of exams, cancer detection rates, pathologic findings and risk factors were analyzed. Results A total of 32,144 patients were included in the study. Breast imaging exams and procedures decreased by 78.9% in the first period, and 2.7% in the second period, in 2020. By the end of 2020, the number of breast cancer lesions detected was just six cases less than in 2019, although the number of patients submitted to mammograms was 35% lower. Conclusion There was a drop in number of breast exams and cancer diagnoses in the first 90 days of the pandemic. The decrease in diagnosis of cancer was partially compensated in the second period, but the number of patients submitted to mammograms by the end of 2020 was lower, still considering a large number of patients with delayed exams.

RESUMO Objetivo Avaliar o impacto da pandemia da COVID-19 no diagnóstico de câncer de mama em um centro de imagem de mama. Métodos Estudo de coorte retrospectivo que incluiu mulheres submetidas a exames e procedimentos de mama em um hospital privado em São Paulo, SP, Brasil, no período de medidas mais rigorosas de isolamento social em 2020 (dividido em primeiro período, de 24 de março a 21 de junho de 2020, e em segundo período, de 22 de junho a 31 de dezembro de 2020), comparado com o mesmo período de 2019. Foram analisados o número de exames, as taxas de detecção de câncer, os achados patológicos e os fatores de risco. Resultados Foram incluídas 32.144 pacientes. Os exames e os procedimentos de imagem da mama em 2020 tiveram redução de 78,9% no primeiro período e 2,7% no segundo período. Ao final de 2020, foram diagnosticadas com câncer de mama seis pacientes a menos do que em 2019, embora o número de pacientes submetidas à mamografia tenha sido 35% menor. Conclusão Houve queda no número de exames de mama e de diagnósticos de câncer nos primeiros 90 dias da pandemia. A redução dos diagnósticos de câncer foi parcialmente compensada no segundo período, mas o número de pacientes submetidas a exames de mamografia até o final do ano foi menor, considerando ainda um grande número de pacientes com exames atrasados.

Ultrasound-guided minimally invasive mammotomy versus conventional surgery for benign breast tumors / 中国基层医药

Objective:To investigate the clinical efficacy of ultrasound-guided mammotomy versus conventional surgery in the treatment of benign breast tumors. Methods:Sixty patients with benign breast tumors who received treatment in Jiamusi Central Hospital from September 2018 to September 2019 were included in this study. They were randomly assigned to undergo either conventional surgery (control group, n = 30) or ultrasound-guided mammotomy (treatment group, n = 30). Intraoperative blood loss, operative time, incision length, and the incidence of complications were compared between the two groups. Results:Intraoperative blood loss, operative time, and incision length in the treatment group were (4.25 ± 1.23) mL, (15.36 ± 3.21) minutes, (0.41 ± 0.05) cm, respectively, which were significantly lower or shorter than those in the control group [(10.75 ± 2.12) mL, (29.68 ± 7.23) minutes, (2.9 ± 0.8) cm, t = 14.526, 9.915, 17.015, all P < 0.05]. In the treatment group, the incidence of complications was 3.33% (local hematoma n = 1, skin depression n = 0, flap necrosis n = 0, postoperative bleeding n = 0), which was significantly lower that 23.00% in the control group (local hematoma n = 2, skin depression n = 1, flap necrosis n = 1, postoperative bleeding n = 3, χ2 = 5.192, P < 0.05). Conclusion:Compared with the traditional treatment, ultrasound-guided minimally invasive mastectomy is more effective in the treatment of benign breast tumors.

Preliminary study of the technical limitations of automated breast ultrasound: from procedure to diagnosis / Estudo preliminar das limitações técnicas da ultrassonografia automatizada da mama: do procedimento ao diagnóstico

Abstract Objective: To evaluate the main technical limitations of automated breast ultrasound and to determine the proportion of examinations excluded. Materials and Methods: We evaluated 440 automated breast ultrasound examinations performed, over a 12-month period, by technicians using an established protocol. Results: In five cases (1.1%), the examination was deemed unacceptable for diagnostic purposes, those examinations therefore being excluded. Conclusion: Automated breast ultrasound is expected to overcome some of the major limitations of conventional ultrasound in breast cancer screening. In Brazil, this new method can be accepted for inclusion in routine clinical practice only after its advantages have been validated in the national context.

Resumo Objetivo: O objetivo deste estudo foi avaliar as principais limitações técnicas e a porcentagem de exames excluídos de ultrassonografia automatizada. Materiais e Métodos: Foram realizados 440 exames de ultrassonografia automatizada das mamas no período 12 meses, por técnicas, com protocolo estabelecido. Resultados: Em cinco casos (1,1%) a interpretação do estudo foi inaceitável, sendo o exame excluído do presente estudo para fins de diagnóstico. Conclusão: A ultrassonografia automatizada das mamas apresenta a expectativa de resolver importantes limitações da ultrassonografia convencional no rastreamento do câncer de mama, sendo necessária uma maior validação de dados brasileiros, para que este novo método seja aceito na prática clínica de rotina.

Diagnosis of breast architectural distortion with digital breast tomosynthesis / 中国医学影像技术

Objective: To compare the value of digital breast tomosynthesis (DBT) and flly-field digital mammography (FFDM) in evaluating breast architectural distortion (AD) lesions, and the value of DBT and ultrasound in differentiating benign and malignant breast AD. Methods: DBT, FFDM and ultrasound data of 58 patients with AD lesions detected with DBT were retrospectively analyzed. Taken pathological outcomes as standards, the sensitivity, specificity and accuracy of DBT and FFDM in evaluating breast AD were compared and analyzed. The consistency of results of DBT and ultrasound in differentiating benign and malignant breast AD with pathological results was analyzed. ROC curve of DBT and ultrasound for differentiating benign and malignant breast AD were drawn, and the diagnostic efficacies were compared. Results: All patients underwent FFDM, and 41 of them also underwent ultrasound examination. Among 58 cases of breast AD detected with DBT, only 23 AD were found with FFDM (χ2=33.03, P0.05). Median consistency of DBT and ultrasound results was observed in differentiating benign and malignant breast AD and pathological results (Kappa=0.65, 0.71, both P0.05). Conclusion: The sensitivity and accuracy of DBT in evaluating breast AD are higher than FFDM. DBT is comparable to ultrasound in differentiating benign and malignant breast AD. AD detected with DBT has relatively high malignancy, so it is recommended to conduct timely biopsy for correct diagnosis.

Image quality and artifacts in automated breast ultrasonography

Three-dimensional automated breast ultrasonography (ABUS) has been approved for screening Epub ahead of print studies as an adjunct to mammography. ABUS provides proper orientation and documentation, resulting in better reproducibility. Optimal image quality is essential for a proper diagnosis, and high-quality images should be ensured when ABUS is used in clinical settings. Image quality in ABUS is highly dependent on the acquisition procedure. Artifacts can interfere with the visibility of abnormalities, reduce the overall image quality, and introduce clinical and technical problems. Nipple shadow and reverberation artifacts are some of the artifacts frequently encountered in ABUS. Radiologists should be familiar with proper image acquisition techniques and possible artifacts in order to acquire high-quality images.

CEUS in evaluation of malignant risk of BI-RADS 4 levels of breast lesions with different sizes / 中国医学影像技术

Objective: To evaluate the value of CEUS in evaluating of malignant risk of breast imaging report and data system (BI-RADS) 4 levels of breast lesions with different sizes. Methods: The CEUS characteristics of BI-RADS 4 levels of the benign and malignant breast lesions with diameter ≤2 cm (n=120) and diameter >2 cm (n=63) were analyzed retrospectively. Binary Logistic regression analysis was used to screen CEUS characteristic parameters that could predict malignant lesions. Results: There were differences of enhanced shape, enhanced intensity, homogeneity, perfusion pattern, nourishing vessels, enhanced area expansion, initial rates and fading rates between the benign and malignant lesions with diameter ≤2 cm (all P2 cm (all P<0.05); regression analysis showed that nourishing vessels, centripetal enhancement pattern and enhanced area expansion were independently correlated with malignant breast lesions of BI-RADS 4 levels (all P<0.05). Conclusion: CEUS can be used to evaluate the malignant risk of BI-RADS 4 levels of breast lesions with different sizes.

Value of contrast-enhanced ultrasonography in evaluating the efficacy of neoadjuvant chemotherapy for triple negative breast cancer in the elderly / 中华老年医学杂志

Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)in neoadjuvant chemotherapy(NAC) for triple negative breast cancer(TNBC)in the elderly.Methods A total of 16 elderly patients with TNBC admitted to hospital from October 2017 to June 2018 were selected,and they underwent ultrasound examination before treatment.Changes in lesion size and time intensity curve (TIC)parameters were compared against postoperative microscopic diagnoses,which were used as the gold standard,to evaluate the effect of NAC in elderly TNBC patients.Results Compared with pre-treatment imaging data,the sum of the diameters of target lesions was reduced by 38.0％ after NAC treatment[(7.29±1.62)cm vs.(4.52± 1.21)cm,t =2.313,P＜0.05],and TIC parameters showed that the peak intensity(PI)and the time to peak(TTP)and the slope of the ascending part of the curve,or Grad,were statistically different between pre and post-NAC treatment measurements[(-65.14± 3.75)dB vs.(57.67± 1.93)dB,(11.57±7.34)s vs.(5.35±0.83)s,(1.21±0.27) vs.(2.29± 0.45),t =3.512,2.271 and 2.727,P =0.003,0.049 and 0.026,respectively].When compared with microscopic examination results,CEUS TIC analysis for evaluating the efficacy of NAC showed an accuracy of 87.5％ (14/16),a sensitivity of 92.9％ (13/14),a specificity of 50.0％ (1/2),a positive predictive value of 81.3％ (13/16) and an inter-method kappa value of 0.429(x2=0.500,P=0.230).Using CEUS to evaluate the efficacy of NAC achieved an accuracy rate of 81.3％(13/16).Conclusions CEUS can effectively evaluate the efficacy of NAC in elderly patients with TNBC,and guide the clinician to develop an accurate,individualized treatment program benefiting the patients.

Breast ultrasound in the interior of the state of Santa Catarina, Brazil / Ultrassom de mama no interior do estado de Santa Catarina

Breast ultrasound is an essential tool in Mastology. This technology can help in the diagnosis of lesions affecting the mammary gland, identifying both benign and malignant tumors. However, ultrasound examination has precise indications in medical practice; and should be indicated cautiously, as one should not think it can tackle all diagnoses of the breast. In this paper, the author assesses 197 breast ultrasounds in the city of Chapecó, Santa Catarina, Brazil. The author reports lack of clinical criteria in many indications of ultrasound examination by health professionals at Basic Health Units of the city

O exame de ultrassom de mama é imprescindível em mastologia. Essa tecnologia pode ajudar no diagnóstico de lesões que acometem a glândula mamária, identificando tumores tanto benignos como, possivelmente, malignos. Entretanto, o uso desse exame tem indicações precisas na prática médica. Ele deve ser pedido com critério e não se deve acreditar que solucionará todos os diagnósticos das lesões mamárias. Neste trabalho, o autor analisa 197 pedidos de exame de ultrassom de mama, realizados na cidade de Chapecó (SC). O autor atribui a falta de critério clínico em muitas indicações para o exame de ultrassom pelos profissionais de saúde que atendem nas Unidades Básicas de Saúde da cidade

Ultrasound-guided biopsy of breast calcifications using a new image processing technique: initial experience / Biópsia de microcalcificações mamárias guiada por ultrassonografia: experiência inicial

Abstract The aim of this paper is to describe the use of a new ultrasound imaging processing technique to guide biopsies of suspicious breast calcifications. We used this technique in 13 patients with suspicious breast calcifications that could not be submitted to stereotactic biopsy. Suspicious calcifications were identified by ultrasound, and the biopsy was successfully performed in all cases. Although mammography continues to be the method of choice for the detection and characterization of microcalcifications, this new technique can be an alternative means of guiding biopsy procedures in selected patients who are not candidates for stereotactic biopsy.

Resumo O objetivo deste trabalho é descrever o uso de uma nova técnica de processamento de imagens na ultrassonografia para guiar biópsia de microcalcificações mamárias suspeitas. Utilizamos esta técnica em 13 pacientes que não puderam ser submetidos a biópsia por estereotaxia. As calcificações suspeitas foram identificadas na ultrassonografia e a biópsia foi realizada com sucesso em todos os casos. Apesar de a mamografia ser o método de escolha para detecção e caracterização de microcalcificações, esta técnica pode ser uma alternativa para guiar biópsia em pacientes selecionados em que não foi possível realizar biópsia estereotáxica.

Clinicopathological and ultrasound characteristics of extranodal extension in metastatic papillary thyroid carcinoma patients / 中华肿瘤杂志

Objective@#To explore clinicopathological and ultrasound characteristics of extranodal extension in metastatic papillary thyroid carcinoma patients.@*Methods@#176 patients with papillary thyroid carcinoma who were diagnosed in Tianjin Medical University Cancer Institute and Hospital between March 2011 and March 2016 were identified and recruited in the study. Among the 176 patients, 59 patients were diagnosed with regional lymph nodes metastasis accompanied with extranodal extension (extranodal extension positive group), 117 patients were regional lymph nodes metastasis without extranodal extension (extranodal extension negative group). The clinicopathological and ultrasound characteristics between extranodal extension positive group and extranodal extension negative group were also discussed in this article.@*Results@#59 patients were diagnosed with regional lymph nodes metastasis accompanied with extranodal extension (extranodal extension positive group). Single lymph node region of extranodal extension was identified in 40 patients, while 19 patients were confirmed with more than 2 regions of extranodal extension. The most frequent extranodal extension were detected in region Ⅵ lymph nodes(32 cases), following by Ⅲ(25 cases), Ⅳ(16 cases), Ⅱ(11 cases). In the aspect of ultrasound characteristics, metastatic papillary thyroid carcinoma with extranodal extension showed a higher incidence of node matting[13.6%(8/59) vs 3.4%(4/117), P=0.022], micro-calcification[66.1%(39/59) vs 46.2%(54/117), P=0.016], cystic[28.8%(17/59) vs 12.8%(15/117), P=0.013], aspect ratio(L/S)<2[88.1%(52/59) vs 75.2%(88/117), P=0.032] and larger diameter(1.95±1.01 cm vs 1.63±0.94 cm, P=0.028). Logistic multivariate analysis demonstrated that node matting (P=0.025) and cystic (P=0.026) were independent risk factors for extranodal extension.@*Conclusion@#Node matting, micro-calcification, cystic, aspect(L/T)>2 and larger diameter were associated with extranodal extension in metastatic papillary thyroid carcinoma patients, especially node matting and cystic, which might help topre-operative ultrasound diagnosis of extranodal extension.

Can diffusion-weighted imaging add information in the evaluation of breast lesions considered suspicious on magnetic resonance imaging? / A difusão pode acrescentar informações na avaliação de lesões mamárias suspeitas na ressonância magnética?

Abstract Objective: To assess the role of diffusion-weighted imaging (DWI) in the evaluation of breast lesions classified as suspicious on magnetic resonance imaging (MRI), correlating the findings with the results of the histological analysis. Materials and Methods: This was a retrospective, descriptive study based on a review of the medical records of 215 patients who were submitted to MRI with DWI before undergoing biopsy at a cancer center. Apparent diffusion coefficient (ADC) values were calculated for each lesion, and the result of the histological analysis was considered the gold standard. Results: The mean age was 49 years. We identified 252 lesions, 161 (63.9%) of which were found to be malignant in the histological analysis. The mean ADC value was higher for the benign lesions than for the malignant lesions (1.50 × 10-3 mm2/s vs. 0.97 × 10−3 mm2/s), the difference being statistically significant (p < 0.001). The ADC cut-off point with the greatest sensitivity and specificity on the receiver operating characteristic curve was 1.03 × 10−3 mm2/s. When the DWI and conventional MRI findings were combined, the accuracy reached 95.9%, with a sensitivity of 95.7% and a specificity of 96.4%. Conclusion: The use of DWI could facilitate the characterization of breast lesions, especially those classified as BI-RADS 4, increasing the specificity and diagnostic accuracy of MRI.

Resumo Objetivo: Avaliar o papel da sequência em difusão na avaliação de lesões mamárias suspeitas na ressonância magnética (RM), correlacionando seus achados com os resultados histológicos. Materiais e Métodos: Foi realizado estudo retrospectivo, descritivo, baseado na análise de prontuários médicos de 215 pacientes que realizaram RM com sequência em difusão e que foram submetidas a biópsia em um centro de referência oncológico. Foi calculado o valor do coeficiente de difusão aparente (ADC - apparent diffusion coefficient) para cada lesão e o resultado histológico foi considerado como padrão ouro. Resultados: A idade média das pacientes foi 49 anos. Foram identificadas 252 lesões, e destas, 161 (63,9%) eram lesões malignas na avaliação histológica. A média obtida do valor do ADC nas lesões benignas (1,50 × 10-3 mm2/s) foi superior à média das lesões malignas (0,97 × 10-3 mm2/s), com significância estatística (p < 0,001). O ponto de corte com maior sensibilidade e especificidade pela curva receiver operating characteristic foi 1,03 × 10-3 mm2/s. Com a combinação da difusão com os achados da RM, a acurácia chegou a 95,9%, com sensibilidade de 95,7% e especificidade de 96,4%. Conclusão: O uso da sequência em difusão pode auxiliar na caracterização das lesões mamárias, principalmente daquelas classificadas como BI-RADS 4, aumentando a especificidade e a acurácia diagnóstica da RM.

EPIDEMIOLOGICAL PROFILE OF THE MASTOLOGY CLINIC IN A UNIVERSITY HOSPITAL IN THE NORTHWEST OF PARANÁ / Perfil epidemiológico do ambulatório de mastologia em um hospital universitário no noroeste do Paraná

Introduction: W ith i ncreased a wareness a bout b reast c ancer, d iscovering a b reast l ump c an c ause e motional s tress i n p atients. Thus, diagnostic methods are used to distinguish and confirm benign and malignant breast pathologies. Objective: To characterize the epidemiological profile of the Mastology Clinic of the University Hospital of Maringá, in a period of one year, defining the incidence of benign and malignant breast diseases in patients undergoing breast cancer screenings in the local public health network. Methods: A cross-sectional, retrospective and descriptive study, with data collection from patients seen at the Mastology Clinic from March 2015 to February 2016. Results: Of the 103 patients, 99% were female, 82.3% were between 40 and 69 years old, and 80.5% were white. Regarding the patient's main complaint, 55% had only one altered imaging exam, 7% had only clinical complaints, and 32% had a palpable nodule in addition to an altered imaging exam. The main findings in the imaging exams were nodules, present in 67.1% of mammograms and 80% of mammographic ultrasonography, with inconclusive or suspected classification in 77.9% of mammograms and 65.7% of ultrasonography. Biopsies were performed in 71.8% of the patients. Benign pathologies corresponded to 76.1% of the diagnoses and 25 cases of breast cancer were identified. Conclusion: The epidemiological profile of the Clinic presented similar characteristics to the literature during the period studied. Referrals to specialists were justified because the changes in the imaging exams warranted further investigation. Diagnostic procedures fulfilled their role, differentiating and confirming benign and malignant breast diseases.

Introdução: Com o aumento da conscientização sobre o câncer de mama, descobrir um nódulo mamário pode causar estresse emocional nos pacientes. Dessa forma, métodos diagnósticos são empregados para distinguir e confirmar patologias mamárias benignas e malignas. Objetivo: Caracterizar o perfil epidemiológico do Ambulatório de Mastologia do Hospital Universitário de Maringá, no período de um ano, definindo a incidência de patologias mamárias benignas e malignas em pacientes submetidos a rastreamento de câncer de mama na rede pública regional. Método: Estudo transversal, retrospectivo e descritivo, com a coleta de dados de pacientes atendidos no ambulatório de mastologia de março de 2015 a fevereiro de 2016. Resultados: Dos 103 pacientes, 99% eram mulheres, 82,3% entre 40 e 69 anos e 80,5% da cor branca. Em relação à queixa principal, 55% apresentaram exclusivamente um exame de imagem alterado, 7% apenas queixa clínica e 32% possuíam nódulo palpável além do exame de imagem com alterações. O principal achado nesses exames foram nódulos, presentes em 67,1% das mamografias e 80% das ultrassonografias mamárias, com classificação inconclusiva ou suspeita em 77,9% nas primeiras avaliações e 65,7% nas últimas. Biópsias foram realizadas em 71,8% dos pacientes. Patologias benignas corresponderam a 76,1% dos diagnósticos e 25 casos de câncer de mama foram identificados. Conclusão: O perfil epidemiológico encontrado no ambulatório analisado apresentou características semelhantes à literatura, no período estudado. Encaminhamentos para a especialidade apresentaram justificativa para tal pelas alterações nos exames de imagem que mereciam maior investigação. Procedimentos diagnósticos cumpriram seu papel, diferenciando e confirmando doenças mamárias benignas e malignas.

CORRELATION BETWEEN ULTRASONOGRAPHIC FEATURES AND HISTOPATHOLOGICAL FINDINGS OF BREAST LESIONS IN BIOPSIES / Correlação entre características ultrassonográficas e achados histopatológicos de lesões mamárias em biópsias

Imaging exams are fundamental tools to characterize palpable lesions and to early detect those not identified on the physical examination. However, the correct interpretation of these findings should be done by correlating them with the probable histological diagnosis of the lesion, and performing the appropriate treatment in a timely manner. The Breast Imaging-Reporting and Data System (BIRADS®) is the system used for this association, which characterizes the findings in mammography, ultrasonography and mammary magnetic resonance images, classifying them according to the probability of malignancy. Objective: To correlate imaging features of breast nodules, evidenced by ultrasonography and classified according to BIRADS®, with the histopathological examination results of material obtained through thick needle biopsy of patients from the mastology ambulatory of the Maternity School Assis Chateaubriand that confirm this predictive value of the imaging examination and the impact on surgical indications. Results: We analyzed 110 patient's medical records that fit the inclusion criteria and found that more than 97% of lesions with low suspicion of malignancy, BIRADS® 4A, presented a benign histopathological result. However, all patients with images of nodules with high suspicion of malignancy had histopathological diagnosis of invasive carcinoma. In conclusion, the ultrasonographic features of breast lesions have high predictive value in the final diagnosis of the lesion, supporting the decision of conduct in adequate time in each situation.

Os exames de imagem são ferramentas fundamentais na caracterização de lesões palpáveis e na detecção precoce daquelas não identificadas ao exame físico. Porém, é necessária a interpretação correta desses achados, correlacionando com o provável diagnóstico histológico da lesão, realizando tratamento adequado e em tempo certo. O Breast Imaging-Reporting and Data System (BIRADS®) é o sistema utilizado para essa relação, caracterizando os achados em imagens de mamografia, ultrassonografia e ressonância magnética mamária e classificando-os de acordo com a probabilidade de malignidade. Objetivo: Correlacionar características imagenológicas de nodulações mamárias, evidenciadas por ultrassonografia e classificadas de acordo com o BIRADS®, com os resultados dos exames histopatológicos de material obtido através de biópsia de agulha grossa de pacientes do ambulatório de mastologia da Maternidade Escola Assis Chateaubriand, confirmando esse valor preditivo do exame de imagem e o impacto nas indicações cirúrgicas. Resultados: Foram analisados 110 prontuários de pacientes que se encaixavam nos critérios de inclusão e constatou-se que mais de 97% das lesões com baixa suspeição de malignidade, BIRADS® 4A, apresentaram resultado benigno no exame histopatológico. Entretanto, todas as pacientes com imagens de nódulos com alta suspeição de malignidade tiveram diagnóstico histopatológico de carcinoma invasor. Pode-se concluir que as características ultrassonográficas das lesões mamárias têm alto valor preditivo no diagnóstico final da lesão, fundamentando a decisão de conduta em tempo adequado em cada situação.

BREAST CANCER SCREENING: UPDATED RECOMMENDATIONS OF THE BRAZILIAN COLLEGE OF RADIOLOGY AND DIAGNOSTIC IMAGING, BRAZILIAN BREAST DISEASE SOCIETY, AND BRAZILIAN FEDERATION OF GYNECOLOGICAL AND OBSTETRICAL 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

Objective: To present the current breast cancer screening guidelines in Brazil, as devised by the Brazilian College of Radiology and Diagnostic Imaging (CBR), the Brazilian Society for Breast Disease (SBM) and the Brazilian Federation of Gynecological and Obstetrical Associations (FEBRASGO). Methods: We analyzed scientific studies available in Medline and Lilacs databases. In the absence of evidence, the guidelines reflected the consensus opinion of an expert panel. Guidelines: Annual mammography screening is recommended for women aged 40­74 years. Among women aged 75 years or older, annual mammography screening should be reserved for those with an expected survival of 7 years or more. Complementary ultrasound should be considered for women with dense breasts. Complementary magnetic resonance imaging is recommended for women at high risk. When available, an advanced form of mammography known as tomosynthesis can be considered as a means of screening for breast cancer.

Objetivo: Apresentar as recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), da Sociedade Brasileira de Mastologia (SBM) e da Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO) para o rastreamento por imagem do câncer de mama no Brasil. Métodos: Foram analisados os estudos disponíveis nas bases científicas Medline e Lilacs. Na ausência de dados probatórios, as recomendações refletiram o consenso da comissão de especialistas. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres entre 40 e 74 anos. Acima de 75 anos deve ser reservado para as mulheres que tenham expectativa de vida maior que 7 anos. O rastreamento complementar com ultrassonografia deve ser considerado para as mulheres com mamas densas. O rastreamento complementar com ressonância magnética é recomendado para as mulheres com alto risco. A tomossíntese é uma forma de mamografia que pode ser considerada para o rastreamento do câncer de mama, quando disponível.

UNILATERAL BREAST EDEMA DUE TO SUBCLAVIAN VEIN COMPRESSION / Edema mamário unilateral resultante de compressão da veia subclávia

Unilateral breast edema may have different causes that vary from malignant to benign diseases. The  knowledge of the main etiologies, associated to a detailed clinical examination and to radiological findings, is important in order to establish the correct diagnosis and determine the appropriate management of the patient. This article will report the case of a patient with lung cancer who developed unilateral breast edema; the main differential diagnoses will also be discussed.

O edema mamário unilateral pode ter diferentes causas, que variam desde doenças malignas até benignas. O conhecimento das principais etiologias, associado ao exame clínico detalhado e aos achados radiológicos, é importante para que se estabeleça o diagnóstico correto, e para que se determine o manejo adequado do paciente. Neste artigo, será relatado o caso de uma paciente com câncer de pulmão que desenvolveu edema mamário unilateral; também serão discutidos os principais diagnósticos diferenciais.