Diagnóstico de precisão das lesões mamárias / Accurate diagnosis of breast lesions

PONTOS-CHAVE As lesões mamárias compreendem uma ampla variedade de diagnósticos que apresentam comportamentos diversos. As lesões mamárias podem ser classificadas como lesões benignas, de potencial de malignidade indeterminado (B3), carcinoma in situ e carcinoma invasor. Na era da medicina personalizada, individualizar e obter um diagnóstico preciso faz grande diferença no desfecho final da paciente, principalmente no caso do câncer de mama. Exames de imagem direcionados e de qualidade, métodos de biópsia adequadamente selecionados e análises de anatomopatologia convencional, imuno-histoquímica e até molecular são determinantes no diagnóstico e no manejo das pacientes.

Axillary lymph node in rheumatoid arthritis: Does it associate disease activity?

Lymph node [LN] in rheumatoid arthritis [RA] has been the focus of recent research work; as it is implicated in disease pathogenesis. Power Doppler ultrasonography [PD-US] is increasingly used for imaging of lymph nodes in conditions other than arthritis. To assess the axillary LN in RA using PD-US, and to correlate the findings to disease activity. Fourteen Consecutive RA patients were subjected to clinical examination and PD-US of axillary LNs, metacarpophalangeal joints [MCPJs] and wrist joints of the ipsilateral sides. LNs were assessed for cortex/hilum [CH] area ratio, longitudinal/transverse [LT] axis ratio and PD signal type. Joints were assessed for grey scale [GS] score and PD score. GS and PD signals were assigned to each joint in accordance with semi-quantitative 0-3 scales for each. DAS28 score was used for disease activity assessment. PD-US detected subclinical LN changes in 24/28 of the examined axillae in RA patients. Changes included hypertrophy mainly of the cortical area and amplification of vascularity of the central type. LN changes did not correlate to DAS28 score; rather correlated to GS and PD scores of ipsilateral wrist and MCPJs as assessed by PD-US. PD-US detects subclinical axillary LN changes in RA patients. These changes do not correlate to DAS28. Axillary LN changes associate signs of synovitis in ipsilateral wrist and MCPJs as assessed by PD-US. Owing to the small number of patients enrolled, results presented in this work should be considered preliminary

Value of preoperative axillary ultrasonography as a useful guide to sentinel LN biopsy in clinically node negative with large sized breast carcinoma

Breast carcinoma is most'y diagnosed beyond stage I in Egyptian patients. Here, we evakiate the use of preoperative ultrasonography to predict axillary lymph nodes involvement. We speculate that preoperative ultrasonographic evaluation may be of paramount importance in the era of sentinel node biopsy. Consecutive 110 clinically node-negative breast carcinomas were ultrasonographically examined for axillary nodes using 10 MHz linear transducer The images were recorded for analysis. Descriptive statistics of morphologic features of the examined lymph node in relation to final pathology were performed. Mean age was 47.5 years. Axillary lymph nodes were pathologically invaded in 80 patients [72.7%] with an average infiltration of 4.2 nodes per axilla. Compared to pathologic find ings, gray sca'e ultrasonography was highly significant in differentiating malignant from benign tumors [p<0.001], Gray sca'e examination had a sensitivity for detecting nodal metastases of 85.0%, specificity of 63.3% and overall accuracy of 79.1%. Surgeon-performed axillary ultrasonography is a helpful adjunct to clinical examination to improve preoperative staging in clinically node negative breast cancer especially in larger-sized tumors. However if sonography is negative sentinel node biopsy should be done due to considerable percentage of false negative results