Objetivo: Avaliar o acesso e a adesão da população feminina, atendida pelo Sistema Único de Saúde (SUS), à Diretriz Brasileira de Detecção Precoce do Câncer de Mama, em duas cidades de médio porte de uma região metropolitana do estado de São Paulo, Brasil. Métodos: Estudo transversal. Os dados foram coletados no Sistema de Informação do Câncer (Siscan) e nas Secretarias Municipais de Saúde no período de 01/01 a 31/12 de 2017. Resultados: Em Santa Bárbara d'Oeste, foram realizadas 3.106 mamografias: 2.931 (94,4%) BI-RADS® 1-2; 21 (0,7%) BI-RADS® 3; 12 (0,4%) BI-RADS® 4-5; 142 (4,5%) BI-RADS® 0. A maioria dos exames (1.855 59,7%) foi realizada em mulheres de 50 a 69 anos. A cobertura mamográfica na população de risco foi de 11,2%. O envelhecimento foi relacionado ao BI-RADS® 4-5 (p = 0,005). A idade jovem esteve relacionada ao maior número de BI-RADS® 0 (p = 0,03). Em Vinhedo, foram realizadas 1.996 mamografias: 1.835 (91,9%) BI-RADS® 1-2; 9 (0,45%) BI-RADS® 3; 7 (0,35%) BI-RADS® 4-5; 145 (7,3%) BI-RADS® 0. A maioria dos exames (975 48,8%) foi realizada em mulheres de 50-69 anos. A população coberta pela mamografia foi de 17%. Reunindo ambas as análises populacionais, evidenciou-se que o envelhecimento esteve relacionado ao maior número de casos suspeitos (p = 0,007). Conclusão: A maioria das mamografias foi realizada em mulheres de 50-69 anos. A cobertura mamográfica ficou aquém da encontrada no Brasil e recomendada pela Organização Mundial da Saúde.
Objective: To evaluate the access and adherence of the female population, assisted by Health Unic System (SUS), to Brazilian Breast Cancer Early Detection Guideline in two medium-sized cities of a metropolitan region in the State of São Paulo, Brazil. Methods: Cross-sectional study. Data were collected from the Cancer Information System (Siscan) and from the Municipal Health Secretariats between 01/01 to 12/31, 2017. Results: In Santa Bárbara d'Oeste 3,106 mammograms were performed: 2,931 (94.4%) BI-RADS® 1-2; 21 (0.7%) BI-RADS® 3; 12 (0.4%) BI-RADS® 4-5; 142 (4.5%) BI-RADS® 0. Most of the exams (1,855 59.7%) among women aged 50-69 years. The mammographic coverage at risk population was 11.2%. Aging was related to BI-RADS® 4-5 (p = 0.005). The young age was related to the highest number of BI-RADS® 0 (p = 0.03). In Vinhedo 1,996 mammograms were performed: 1,835 (91.9%) BI-RADS® 1-2; 9 (0.45%) BI-RADS® 3; 7 (0.35%) BI-RADS® 4-5; 145 (7.3%) BI-RADS® 0. Most of the exams (975 48.8%) among women aged 50-69 years. The population covered by mammography was 17%. Gathering both population analysis, it was shown that aging was related to the highest number of suspected cases (p = 0.007). Conclusion: Most mammograms were performed between 50-69 years. Mammographic coverage fell short of that found in Brazil and recommended by the World Health Organization.
Subject(s)Humans , Female , Breast Neoplasms/mortality , Breast Neoplasms/epidemiology , Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Unified Health System , Health Services Coverage , Brazil/epidemiology , Cross-Sectional Studies
OBJECTIVE@#To investigate the value of quantitative synthetic magnetic resonance imaging (SyMRI) in distinguishing between benign and malignant breast lesions.@*METHODS@#We retrospectively collected data of preoperative conventional MRI and multi-dynamic multi-echo sequences from 95 patients with breast lesions showing mass-type enhancement on DCE-MRI, including 27 patients with benign lesions and 68 with malignant lesions. The MRI features of the lesions (shape, margin, internal enhancement pattern, time-signal intensity curve, and T2WI signal) were analyzed, and for each lesion, SyMRI-generated quantitative parameters including T1 and T2 relaxation time and proton density (PD) were measured before and after enhancement and recorded as T1p, T2p, PDp and T1e, T2e, and PDe, respectively. The relative change rate of each parameter was calculated. Logistic regression and all-subset regression analyses were performed for variable selection to construct diagnostic models of the breast lesions, and receiver-operating characteristic (ROC) analysis was used to assess the performance of each model for differentiation of benign and malignant lesions.@*RESULTS@#There were significant differences in the MRI features between benign and malignant lesions (P < 0.05). All the SyMRI-generated quantitative parameters, with the exception of T2e and Pdp, showed significant differences between benign and malignant lesions (P < 0.05). Among the constructed diagnostic models, the model based on all the DCE-MRI features combined with SyMRI parameters T2p and T1e (DCE-MRI+T2p+T1e) showed the best performance in the differential diagnosis malignant breast masses with an AUC of 0.995 (95% CI: 0.983-1.000).@*CONCLUSION@#Quantitative SyMRI can be used for differential diagnosis of benign and malignant breast lesions.
Subject(s)Female , Humans , Breast/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Contrast Media , Diagnosis, Differential , Magnetic Resonance Imaging/methods , ROC Curve , Retrospective Studies
OBJECTIVES@#Accurate breast lesion surface localization can guarantee accurate biopsy and local treatment. But there is no guideline to regular equipment and methods for the localization of breast lesions. The conventional non-invasive localization method is marker-based localization. The advantages of this method are simple and efficient. The disadvantages are that markers disappear easily under coupling agents; the positioning length of markers cannot last long on skin; and healthcare associated infection due to many patients using the same marker pen is potentially unavoidable. Breast lesion sticker (called sticker for short) is a new-type localization medical instrument in 2020. Our study aims to explore the clinical value of a new lesion stickers in breast lesion surface localization via comparison of the sticker and marker pen localization methods.@*METHODS@#This was a prospective cohort study. It was conducted in 67 patients who needed breast lesion surface localization before biopsy. The patients were randomly assigned into 2 groups. One group of patients used marker pen to mark breast lesion surface location by ultrasonography. The other group of patients used stickers. Patients labeled with markers on skin were swabbed agents before marking. Then the markers were checked by ultrasound scan. If the surface positions of breast lesion were not correct, the above procedure was repeated. In the sticker group, the stickers were released synchronously after the lesions were detected by ultrasound scan. Then locations were checked via scanning hole. If the surface positions of breast lesion were not correct, the above procedure was repeated. The accuracy of positioning, the length of positioning time and satisfaction of patients between the 2 groups were compared. The length of positioning time was calculated from the time when ultrasound detected the lesion to the time when the surface position of breast lesion was confirmed. The total score of patients' satisfaction was 5 points according to Service Quality Evaluation of SERVQUAL Scale, including sonographers' service attitude and their technical proficiency, other medical staffs' service attitude and their technical proficiency, hospital service procedures, positioning comfort, and positioning effects.@*RESULTS@#All 67 patients were females, aged 18-66 (39.73±13.10). There were 35 patients in the marker pen group and 32 patients in the sticker group. The time length of group used marker pen to localization was 22-88 (52.20±2.90) s, and the sticker group was 3-15 (9.22±0.58) s in length. The length of positioning time for the stickers was significantly shorter than that of the marker (P<0.01). Both methods were accurate in the surface localization of lesions before operation. The total scores of patients' satisfaction was 4-5 (4.92±0.02) in the stickers group, and 1-5 (3.35±0.10) in the marker pen group. The patients' satisfaction scores with the sticker were significantly higher than those with the marker pen (P<0.01). The length of positioning time and patients' satisfication scores for sonographer with 20 years' working experience were shorter and higher than those of sonographer with 10 years' working experience, respectively (both P<0.05).@*CONCLUSIONS@#The new breast lesion positioning stickers have more advantages than the marker pen in localization efficiency. It could reduce the workload of medical workers and increase patients' satisfaction to some extent. The stickers can be used not only in the breast lesions surface localization, but also in the skin location of pleural effusion and ascites, the skin location of surface masses, the skin location of thyroid nodule, and many other clinical marker areas, to further expand the scope of clinical application and value of the stickers.
Subject(s)Female , Humans , Male , Breast/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Prospective Studies , Skin
OBJECTIVE@#To evaluate the value of ultrasound S-Detect in the diagnosis of breast masses.@*METHODS@#A total of 85 breast masses in 62 female patients were diagnosed by S-Detect technique and conventional ultrasound. The diagnostic efficacy of conventional ultrasound and S-Detect technique was analyzed and compared with postoperative pathological results as the gold standard.@*RESULTS@#When operated by junior physicians, the diagnostic efficacy of conventional ultrasound was significantly lower than that of S-Detect technique (P < 0.05), but this difference was not observed in moderately experienced and senior physicians (P>0.05). S-Detect technique was positively correlated with the diagnostic results of senior physicians (r=0.97). Using S-Detect technique, the diagnostic efficacy did not differ significantly between the long axis section and its vertical section (P>0.05). Routine ultrasound showed a better diagnostic efficacy than S-Detect for breast masses with a diameter below 20 mm (P < 0.05), but for larger breast masses, its diagnostic efficacy was significantly lower than that of SDetect (P < 0.05).@*CONCLUSION@#S-Detect can be used in differential diagnosis of benign and malignant breast masses, and its diagnostic efficiency can be comparable with that of BI-RADS classification for moderately experienced and senior physicians, but its diagnostic efficacy can be low for breast masses less than 20 mm in diameter.
Subject(s)Female , Humans , Breast/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Diagnosis, Differential , Sensitivity and Specificity , Ultrasonics , Ultrasonography , Ultrasonography, Mammary/methods
Resumen: Introducción: se han producido múltiples avances tecnológicos en la historia de la mamografía. En los años más recientes surge la mamografía digital directa con tomosíntesis con mayores capacidades para detectar el cáncer. Objetivo: evaluar el efecto de la nueva tecnología en el desempeño de la mamografía, en la Unidad de Diagnóstico Mamario del Hospital Británico. Material y métodos: se compara el desempeño de la mamografía durante los años 2019-2020 en relación con los años 2010-2018. En el año 2019 se sustituyó la tecnología anterior por un mamógrafo digital directo con tomosíntesis, Hologic modelo Selenia Dimensions. Resultados: en los años 2019 a 2020 se realizaron 10.725 mamografías. Se detectaron 84 cánceres y la tasa de detección de cáncer fue de 8/1.000. El VPP fue de 35%. En los años 2010 a 2018 se realizaron 45.438 mamografías. Se detectaron 229 cánceres y la tasa de detección de cáncer fue de 5/1.000. EL VPP fue de 40%. En relación a las manifestaciones imagenológicas, se destaca el aumento de las microcalcificaciones en el período 2019-2020, que pasaron de ser 7% de los casos, a ser 19% de los casos. Las distorsiones aumentaron de 11% a 13%. En relación a los tipos histológicos de cáncer, se destaca el porcentaje del carcinoma ductal in situ (CDIS) que fue 4 veces superior en el período 2019-2020 en relación al anterior (17% de todos los casos detectados). Conclusiones: con la incorporación de la tomosíntesis aumentó 60% la tasa de detección de cáncer y el porcentaje de CDIS aumentó 4 veces.
Abstract: Introduction: significant technological progress has been made in the history of mammography. Recently, direct digital mammography plus tomosynthesis arrived and improved breast cancer screening. Objective: to evaluate the effects of new technology in the performance of mammography, at the Breast Diagnostic Service of the British Hospital. Method: mammography performance during 2019- 2020 was compared to that between 2010 and 2018. In 2019 the previous tehcnology was substituted by a direct digital mammogram with tomosynthesis, Hologic, Selenia Dimensions model. Results: 10.725 mammographies were done in 2019-2020. Cancer was detected in 84 cases and the cancer detection rate was 8 per 1000 persons. PPV was 35%. 45.438 mammographies were done in 2010-2018. Cancer was detected in 229 cases and the cancer detection rate was 5 per 1.000 persons. PPV was 40%. As to images, it is worth pointing out an increase in microcalcifications between 2019 and 2020, when they grew from 7% of cases to 19% of cases and distortions increased from 11% to 13%. DCIS was 4 times greater in 2019-2020 when compare to the previous period of time (17% of all detected cases). Conclusions: the integration of tomosynthesis increased 60% the cancer detection rate and the DCIS was 4 times greater.
Resumo: Introdução: a história da mamografia registra vários avanços tecnológicos. Nos anos mais recentes, a mamografia digital direta com tomossíntese surgiu com uma maior capacidade de detectar a presença de câncer. Em 2019 a Unidade de Diagnóstico de Mama (UDM) do Hospital Britânico no Uruguai, incorporou um mamógrafo digital direto com tomossíntese, Hologic modelo Selenia Dimensions. Objetivo: avaliar desempenho do mamógrafo digital direto com tomossíntese na UDM. Material e métodos: faz-se uma comparação dos resultados das mamografias durante dois períodos 2019-2020 e 2010-2018. Resultados: no período 2019 a 2020 foram realizadas 10.725 mamografias; 84 cânceres foram detectados com una taxa de detecção de 8/1000. O valor preditivo positivo (VPP) foi de 35%. No período 2010-2018, foram realizadas 45.438 mamografias, 229 cânceres foram detectados com una taxa de detecção de 5/1000. O VPP foi de 40%. Em relação às manifestações de imagem, destaca-se o aumento das microcalcificações no período 2019-2020, que passou de 7% para 19% dos casos. As distorções aumentaram de 11% para 13%. Em relação aos tipos histológicos de câncer, destaca-se a porcentagem de carcinoma ductal in situ (CDIS), que foi quatro vezes maior no período 2019-2020 do que no anterior (17% do total de casos detectados). Conclusões: com a incorporação da tomossíntese, a taxa de detecção de câncer aumentou 60% e a porcentagem de CDIS aumentou quatro vezes.
Subject(s)Breast Neoplasms/diagnostic imaging , Mammography , Breast Neoplasms/prevention & control
SUMMARY OBJECTIVE To explore the values of automated breast volume scanning (ABVS) combined with shear wave elastography (SWE) in the differential diagnosis of triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2-positive breast cancers (HER2+BC). METHODS In this study, 28 patients with TNBC and 32 patients with HER2+BC were enrolled. The characteristics of ABVS and virtual touch quantification (VTQ) in SWE of all patients were reviewed. The multivariate logistic regression analysis was carried out and the receiver operating characteristic curves of ABVS and ABVS+VTQ were drawn. RESULTS In ABVS imaging, the microcalcification, posterior echo, internal echo, shape, and edge had significant difference between TNBC and HER2+BC groups (p<0.05). The regular shape was the independent factor for TNBC (p=0.04, odds ratio [OR]=4.479), and the microcalcification in mass was the independent factor for HER2+BC (p=0.01, OR=2.997). In VTQ imaging, the shear wave velocity (SWV)max, SWVmin, and SWVmean in TNBC group were significantly lower than those in HER2+BC group (p<0.001). The sensitivity, specificity, and accuracy of ABVS+VTQ in diagnosing TNBC were higher than those of ABVS alone. CONCLUSIONS ABVS combined with SWE has certain advantages in differentiating TNBC from HER2+BC, which is helpful for the treatment planning and prognosis judgment.
Subject(s)Humans , Female , Breast Neoplasms/diagnostic imaging , Elasticity Imaging Techniques , Triple Negative Breast Neoplasms/diagnostic imaging , Breast , ROC Curve , Receptor, ErbB-2
Resumen Introducción: Promover la detección de cáncer de mama (CaMa) en mujeres mediante mastografía es una estrategia viable para disminuir los diagnósticos en fases clínicamente avanzadas y la mortalidad. Objetivos: Describir los resultados reportados por estudios de mastografía en mujeres realizados a nivel nacional durante 2013-2017 y analizar la tendencia espaciotemporal de categorías BIRADS (Breast Imaging Reporting and Data System) sugestivas de malignidad por Estado. Método: Diseño analítico longitudinal que incluyó información sobre estudios de mastografía de mujeres según grupo de edad (< 40 e ≥ 40), valoradas en unidades de la Secretaría de Salud, México, durante 2013-2017. Se estimó la frecuencia de categorías según BIRADS, tasa estandarizada sugestiva de malignidad (categorías 4 y 5) en mujeres ≥ 40 años y se utilizó estadística espacial para analizar la tendencia por Estado. Resultados: Se analizaron 3,659,151 mastografías, el 98.5 % en mujeres ≥ 40 años. La tasa sugestiva de malignidad disminuyó de 38.3 (2013) a 31 (2017) por 100 mil mujeres ≥ 40 años; sin embargo, el riesgo de detección aumentó hasta 13 veces en diez Estados. Conclusiones: Aunque el riesgo de detección en categorías sugestivas de malignidad disminuyó a nivel nacional, algunos Estados requieren reforzar la aplicación de programas de detección del CaMa mediante mastografía e incrementar la participación de la población blanco.
Abstract Introduction: Promoting breast cancer (BC) detection in women by means of mammography is a viable strategy to reduce the number of diagnoses at clinically advanced stages and mortality. Objectives: To describe the results reported by mammography studies in women, carried out nationally during 2013-2017, and to analyze the spatiotemporal trend of Breast Imaging Reporting and Data System (BIRADS) categories suggestive of malignancy by State. Method: Longitudinal, analytical design that included information on mammography studies of women according to age group (< 40 and ≥ 40), evaluated in units of the Ministry of Health of Mexico during 2013-2017. The frequency of BIRADS categories and a standardized rate suggestive of malignancy (categories 4 and 5) were estimated in women aged ≥ 40 years, and spatial statistics were used to analyze the trend by State. Results: A total of 3,659,151 mammograms were analyzed, 98.5 % in women aged ≥ 40 years. The malignancy-suggestive rate decreased from 38.3 (2013) to 31 (2017) per 100,000 women aged ≥ 40 years; however, the risk of detection increased up to 13 times in ten States. Conclusions: Although the risk of detection in categories suggestive of malignancy decreased at the national level, some States need to reinforce the application of BC detection programs through mammography and increase the participation of the target population.
Subject(s)Humans , Female , Adult , Middle Aged , Aged , Breast Neoplasms/diagnostic imaging , Mammography/statistics & numerical data , Spatio-Temporal Analysis , Patient Participation/statistics & numerical data , Breast Neoplasms/classification , Breast Neoplasms/epidemiology , Mammography/classification , Linear Models , Space-Time Clustering , Age Factors , Mexico/epidemiology
Abstract Objective To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer. Methods A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p<0.05 considered of statistical significance. Results Atotal of 440 patientswere evaluated. Regarding lesions,HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p<0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS. Conclusion Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.
Resumo Objetivo Comparar a ultrassonografia convencional das mamas (US) com a ultrassonografia automatizada das mamas (ABUS) no rastreio do câncer. Métodos Realizamos um estudo transversal com pacientes com mamas mamograficamente densas, sendo avaliadas pela US e pela ABUS. A US foi realizada por radiologistas e a ABUS por técnicos de mamografia e analisada por radiologistas especializados em mama. A classificação Breast Imaging Reporting and Data System (BIRADS) do exame e das lesões o tempo de leitura e de aquisição foram avaliados. A análise estatística foi realizada através de medidas de tendência central, dispersão e frequências, teste t de Student e regressão logística univariada, através do odds ratio, com intervalo de confiança de 95%, e com p<0,05 sendo considerado estatisticamente significante. Resultados Foram avaliadas 440 pacientes. Em relação às lesões, a US detectou 15 (7,7%) BI-RADS 2, 175 (89,3%) BI-RADS 3 e 6 (3%) BI-RADS 4, das quais 3 foram confirmadas, por biópsia, como carcinomas ductais invasivos e 3 falso-positivos. A ABUS identificou 12 (12,9%) BI-RADS 2, 75 (80,7%) BI-RADS 3 e 6 (6,4%) BI-RADS 4, incluindo 3 lesões detectadas pela US e confirmadas como carcinomas ductais invasivos, além de 1 carcinoma lobular invasivo e 2 lesões de alto risco não detectadas pela US. O tempo de leitura dos exames da ABUS foi estatisticamente inferior ao tempo do radiologista para realizar a US (p<0,001). A concordância foi de 80,9%. Um total de 219 lesões foram detectadas, das quais 70 por ambos os métodos, 126 observadas apenas pela US (84,9% não eram lesões suspeitas no ABUS) e 23 apenas pela ABUS. Conclusão Comparado à US, a ABUS permitiu adequado estudo complementar no rastreio do câncer de mamas heterogeneamente densas e extremamente densas.
Subject(s)Humans , Female , Adult , Aged , Young Adult , Breast Neoplasms/diagnostic imaging , Ultrasonography, Mammary/instrumentation , Cross-Sectional Studies , Sensitivity and Specificity , Equipment Design , Middle Aged
Background: Breast cancer (BC) has a high mortality rate in developing countries due to a scarcity of early detection. Risk communication is critical to support women who face the decision to undertake BC screening. Thus, they can balance their perceived and real risk, and make informed choices. Aim: To describe experts' views on how the provision of information related to BC screening should be made. Material and Methods: A qualitative study with focus groups with national experts was conducted. Open coding was performed. Results: Four categories on the way information about BC screening should be provided emerged: to communicate about the need of the exam; the pros and cons of the test; fear as a barrier for understanding; and involving women in the decision-making process. Conclusions: These findings emphasize the need to include risk communication strategies in the patient-provider relationship and encourage and respect women's autonomy when facing the BC screening decision.
Subject(s)Humans , Female , Breast Neoplasms/diagnostic imaging , Mammography , Mass Screening , Communication , Risk Assessment , Decision Making , Early Detection of Cancer
Os métodos de imagem são de fundamental importância para o manejo de pacientes com câncer de mama, especialmente no diagnóstico precoce de lesões mamárias não-palpáveis. Os principais exames de imagem utilizados neste contexto são a mamografia (MMG), ultrassonografia (US) e ressonância magnética (RM). Para as lesões classificadas como baixo, médio ou intermediário potencial de malignidade, métodos mais avançados como a RM têm permitido melhores resultados na especificidade para lesões malignas. O objetivo principal deste trabalho foi avaliar a taxa de malignidade e características de imagem das lesões mamárias classificadas na categoria BI-RADS® 4 pela RM, a fim de criar um modelo para subcategorizar estas lesões nas categorias 4A, 4B e 4C, de acordo com o risco de malignidade pelos critérios do Léxico BI-RADS®. Foi realizado um estudo observacional, com a avaliação das lesões mamárias com indicação de biópsia percutânea ou cirúrgica em exames de RM realizados no período de 2016 e 2017 no Departamento de Imagem do A.C.Camargo Cancer Center. Para avaliação da validade diagnóstica o resultado histológico foi considerado comopadrão-ouro e, nos casos negativos para malignidade, foi realizado acompanhamento por pelo menos 2 anos. Foram incluídas 166 pacientes com 199 lesões classificadas com BI-RADS®4. 14 (7,5%) não foram biopsiadas, porém apresentaram estabilidade por pelo menos 2 anos ou não se confirmaram em exames subsequentes, inferindo benignidade. Foram avaliadas por biópsia 185 lesões resultando em 140 (75,6%) lesões benignas e 45 (24,3%) lesões malignas. Apresentaram associação estatisticamente significativa com maior risco de malignidade na análise univariada: composição da mama, realce de fundo do parênquima, morfologia, margens e curva cinética (fases inicial e tardia) das lesões nodulares e na análise multivariada, para os realces nodulares apenas o realce de fundo do parênquima, as margens e a curva cinética (fase inicial) confirmaram significância estatística. Os VPP das classificações subjetiva e objetiva foram, respectivamente, para BI-RADS 4 A 0,0% e 4,3%, 4B 11,8% e 21,4% e 4C 62,2% e 78,9%. Nossos resultados afirmam que a subclassificação pode ajudar a diferenciar as lesões quanto a suspeição de malignidade e demonstrou ser viável, tanto através da avaliação subjetiva dos avaliadores, como através da avaliação objetiva utilizando o modelo desenvolvido a partir do valor preditivo positivo dos diferentes descritores utilizados.
Imaging methods are of fundamental importance for the management of patients with breast cancer, especially in the early diagnosis of non-palpable breast lesions. The main imaging tests used in this context are mammography (MMG), ultrasonography (US) and magnetic resonance imaging (MRI). For lesions classified as low, mild or intermediate malignancy potential, more advanced methods such as MRI have allowed better results in specificity for malignancy. The main objective of this study was to evaluate the malignancy rate and imaging characteristics of breast lesions classified in category BI-RADS® 4 by MRI, in order to create a model to subcategorize these lesions into categories 4A, 4B and 4C, according to the risk of malignancy by the criteria of the BI-RADS® Lexicon. An observational study was carried out, with the evaluation of breast lesions with indication for percutaneous or surgical biopsy in the MRI examination carried out in the period of 2016 and 2017 at the Imaging Department of the ACCamargo Cancer Center. To assess the diagnostic validity, the histological result was considered as the gold standard and in cases negative for malignancy, it was followed for at least 2 years. A total of 166 patients with 199 lesions classified as BI-RADS® 4 were included.14 (7.5%) were not biopsied but were stable for at least 2 years or were not confirmed in subsequent examinations, inferring benignity. 185 lesions were evaluated by biopsy resulting in 140 (75.6%) benign lesions and 45 (24.3%) malignant lesions. They presented a statistically significant association with higher risk of malignancy in the univariate analysis: breast composition, background parenchymal enhancement, morphology, margins and kinetic curve (early and late stages) of nodular lesions and in the multivariate analysis, for nodular enhancements only the enhancement of the parenchyma background, the margins and the kinetic curve (initial phase) confirmed statistical significance. The PPV of the subjective and objective classifications were, respectively, for BI-RADS 4A 0.0% and 4.3%, 4B 11.8% and 21.4% and 4C 62.2% and 78.9%. Our results affirm that the subclassification can help to differentiate the lesions as the suspicion of malignancy and it proved to be feasible, both through the subjective evaluation of the evaluators, as through the objective evaluation using the model developed from the positive predictive value of the different descriptors used.
Subject(s)Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Breast Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Survival Analysis
ABSTRACT OBJECTIVE: To report the decrease in breast imaging after covid-19 pandemic, obtaining the number of mammograms performed in 2019 and 2020. Additionally, to investigate if there was an increase in the proportion of women undergoing mammography for diagnostic purposes, with palpable lesions. METHOD: This is a cross-sectional study, based on the number of mammograms performed by the Brazilian public health services, provided by DATASUS, an open access database. Mammograms from private institutions were not included. This study compares the number of mammograms performed in 2019 and 2020, in women aged 50-69 years, stratified by month, in each federal state, and the presence of palpable lumps (physician-reported). RESULTS: In total, 1,948,471 mammograms were performed in 2019 and 1,126,688 in 2020, for the population studied. These values represent a 42% decline. Monthly, a significant decreased is observed after April 2020. The results varied slightly according to federal state; yet the entire country was affected. Rondônia was the most affected state, with 67% decline. The proportion of women presenting palpable lumps increased from 7.06% on average in 2019 to 7.94% in 2020 (OR = 1.135, 95%CI 1.125-1.145, p = 0,001). DISCUSSION: The number of mammograms performed in 2020 declined considerably. Out of the women who presented for mammogram, the proportion of palpable lumps was significantly higher in 2020. Considering the detection rate of digital mammography, the loss of 800,000 exams means 4,000 undiagnosed breast cancer cases, by the end of 2020.
Subject(s)Humans , Female , Aged , Breast Neoplasms/epidemiology , Breast Neoplasms/diagnostic imaging , COVID-19 , Brazil/epidemiology , Mammography , Cross-Sectional Studies , Pandemics , SARS-CoV-2 , Middle Aged
Resumen: El screening mamográfico ha ayudado a identificar el cáncer de mama en sus estadíos más tempranos, cuando los tratamientos son más efectivos. El empleo de la inteligencia artificial (IA) en el análisis de los mamogramas ha demostrado ser capaz de superar la habilidad del ojo humano para detectar lesiones en la mama sospechosas de cáncer. El objetivo del presente trabajo es realizar un aporte reflexivo sobre el avance de la tecnología digital y en particular de la IA en los screening mamográficos, desde el punto de vista técnico y bioético. Se analizan ventajas y limitaciones de la IA, explicando cómo se produce el aprendizaje de los sistemas computacionales. Se propone un debate bioético sobre cuestiones tales como la privacidad, la credibilidad, la responsabilidad y la educación permanente. Se resalta la importancia de establecer canales de diálogo entre todas las partes involucradas en la incorporación de las nuevas tecnologías en medicina.
Abstract: Mammographic screening has helped to identify breast cancer in its earliest stages, when treatment is most effective. The use of Artificial Intelligence in the analysis of mammograms has proved to be able to excel the human eye in detecting lesions in the breast that may be suspicious for cancer. The objective of this study is to make a reflective contribution on the advancement of digital technology and in particular, Artificial Intelligence in mammographic screening, from the technical and bioethical points of view. Advantages and limitations of Artificial Intelligence are analyzed explaining how machine learning occurs. A bioethical debate is proposed on issues such as privacy, credibility, accountability and continuous education. The importance of establishing channels of dialogue between all stakeholders in the incorporation of new technologies in medicine is highlighted.
Resumo: O rastreamento mamográfico ajuda a identificar o câncer de mama em seus estágios iniciais, quando os tratamentos são mais eficazes. O uso da Inteligência Artificial (AI) na análise de mamografias tem se mostrado capaz de superar a capacidade do olho humano em detectar lesões na mama suspeitas de câncer. O objetivo deste trabalho é fazer uma contribuição reflexiva sobre o avanço da tecnologia digital e, em particular, a AI em mamografia, do ponto de vista técnico e bioético. As vantagens e limitações da AI são analisadas explicando como o aprendizado de sistemas computacionais é feito. Propõe-se um debate bioético sobre questões como privacidade, credibilidade, responsabilidade e educação ao longo da vida. Destaca-se a importância do estabelecimento de canais de diálogo entre todas as partes envolvidas na incorporação de novas tecnologias na medicina.
Subject(s)Bioethics , Breast Neoplasms/diagnostic imaging , Artificial Intelligence/ethics , Mammography , Mass Screening
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.
Subject(s)Breast Neoplasms/epidemiology , Breast Neoplasms/diagnostic imaging , COVID-19 , Brazil/epidemiology , Retrospective Studies , Pandemics , SARS-CoV-2
In order to overcome the shortcomings of high false positive rate and poor generalization in the detection of microcalcification clusters regions, this paper proposes a method combining discriminative deep belief networks (DDBNs) to automatically and quickly locate the regions of microcalcification clusters in mammograms. Firstly, the breast region was extracted and enhanced, and the enhanced breast region was segmented to overlapped sub-blocks. Then the sub-block was subjected to wavelet filtering. After that, DDBNs model for breast sub-block feature extraction and classification was constructed, and the pre-trained DDBNs was converted to deep neural networks (DNN) using a softmax classifier, and the network is fine-tuned by back propagation. Finally, the undetected mammogram was inputted to complete the location of suspicious lesions. By experimentally verifying 105 mammograms with microcalcifications from the Digital Database for Screening Mammography (DDSM), the method obtained a true positive rate of 99.45% and a false positive rate of 1.89%, and it only took about 16 s to detect a 2 888 × 4 680 image. The experimental results showed that the algorithm of this paper effectively reduced the false positive rate while ensuring a high positive rate. The detection of calcification clusters was highly consistent with expert marks, which provides a new research idea for the automatic detection of microcalcification clusters area in mammograms.
Subject(s)Humans , Algorithms , Breast Neoplasms/diagnostic imaging , Calcinosis/diagnostic imaging , Early Detection of Cancer , Mammography , Neural Networks, Computer
Both feature representation and classifier performance are important factors that determine the performance of computer-aided diagnosis (CAD) systems. In order to improve the performance of ultrasound-based CAD for breast cancers, a novel multiple empirical kernel mapping (MEKM) exclusivity regularized machine (ERM) ensemble classifier algorithm based on self-paced learning (SPL) is proposed, which simultaneously promotes the performance of both feature representation and the classifier. The proposed algorithm first generates multiple groups of features by MEKM to enhance the ability of feature representation, which also work as the kernel transform in multiple support vector machines embedded in ERM. The SPL strategy is then adopted to adaptively select samples from easy to hard so as to gradually train the ERM classifier model with improved performance. This algorithm is verified on a B-mode ultrasound dataset and an elastography ultrasound dataset, respectively. The results show that the classification accuracy, sensitivity and specificity on B-mode ultrasound are (86.36±6.45)%, (88.15±7.12)%, and (84.52±9.38)%, respectively, and the classification accuracy, sensitivity and specificity on elastography ultrasound are (85.97±3.75)%, (85.93±6.09)%, and (86.03±5.88)%, respectively. It indicates that the proposed algorithm can effectively improve the performance of ultrasound-based CAD for breast cancers with the potential for application.