Positive predictive value of nonpalpable breast lesions according to bi-rads® classification / Valor preditivo positivo das lesões mamárias não palpáveis utilizando a classificação BI-RADS®

Introduction: Breast cancer is the neoplasm that most affects women in Brazil and the world, and its incidence has increased steadily over the last decade. Due to screening mammography programs, according to age group, the mortality rate of breast cancer has decreased by 31%. With the increase in the number of screening examinations, there has also been increase in the number of suspicious lesions diagnosed and, consequently, increase in the indication and performance of breast biopsies. With the help of the categorizations that the American College of Radiology published, according to the Breast Imaging Reporting and Data System (BI-RADS®), it was possible to standardize the reports and descriptions of breast lesions, both in mammography and ultrasound, facilitating decision-making in regard to suspicious lesions. Objective: To evaluate the positive predictive value (PPV) of nonpalpable breast lesions biopsied in the Radiodiagnostic Service of Hospital Naval Marcílio Dias. Method: A retrospective and analytical study of 88 patients submitted to stereotaxic guided mammary biopsies from December 2015 to December 2016 with suspected diagnosis of malignant lesions, classified by mammographic BI-RADS in categories 4 and 5 and later correlation with the histopathological reports. Results: PPV was high for category 5 lesions, and for category 4 lesions PPV was low and progressively increased with the subcategories. Conclusion: BI­RADS categorization is an effective predictor for the risk of malignancy in suspicious mammographic lesions.

Introdução: O câncer de mama é a neoplasia que mais acomete mulheres no Brasil e no mundo e sua incidência vem aumentando progressivamente ao longo dessa última década. Devido aos programas de rastreamento mamográfico, de acordo com a faixa etária, a taxa de mortalidade por câncer de mama diminuiu em 31%. Com o aumento do número de exames de rastreamento houve aumento, também, da quantidade de lesões suspeitas diagnosticadas e, consequentemente, um aumento na indicação e realização de biópsias mamárias. Com o auxílio das categorizações que o American College of Radiology publicou, segundo o Breast Imaging Reporting and Data System (BI-RADS®), foi possível padronizar os laudos e as descrições das lesões mamárias, tanto na mamografia quanto na ultrassonografia, facilitando a tomada de decisão perante a lesões de aspecto suspeito. Objetivo: Avaliar o valor preditivo positivo (VPP) das lesões mamárias não palpáveis nas quais foi realizada biópsia no Serviço de Radiodiagnóstico do Hospital Naval Marcílio Dias. Método: Estudo retrospectivo e analítico de 88 pacientes submetidas a biópsias mamárias guiadas por estereotaxia no período de dezembro de 2015 a dezembro de 2016 com diagnóstico suspeito de lesões malignas, classificadas no BI-RADS® mamográfico em categorias 4 e 5, com posterior correlação com os laudos histopatológicos. Resultados: Foi encontrado alto valor preditivo positivo na categoria cinco e, nas lesões classificadas como categoria quatro, o VPP foi menor, aumentando progressivamente com as subcategorias. Conclusão: A categorização BI-RADS® é um preditor eficaz para o risco de malignidade nas lesões suspeitas na mamografia.

Gliomatosis cerebri reporte de un caso y revisión de la literatura / Gliomatosis Cerebri case report and literatura review

La Gliomatosis Cerebri (GC) se define como un compromiso infiltrativo difuso de un tumor glial generalmente astrocítico que compromete al menos 3 lóbulos cerebrales de manera bilateral y usualmente la afección se extiende al tallo cerebral. Su incidencia representa aproximadamente el 1% de la totalidad de los tumores encefálicos y se presenta con mayor frecuencia en adultos jóvenes. El diagnóstico se establece por medio de la clínica, la imagenología y confrimación histológica. Las posibilidades terapéuticas son limitadas y la sobrevida cercana a los 2 años mostrando una alta mortalidad. Reportamos el caso de un paciente masculino de 11 años de edad quien fue atendido en el Hospital Militar Central de Bogotá Colombia donde se realizó el diagnóstico y se instauró el tratamiento

Gliomatosis Cerebri (GC) is defined as a diffuse infiltration of a glial tumor generally astrocytic that involves at least 3 cerebral lobes bilaterally and usually the condition extends to the brainstem. Its incidence represents approximately 1% of all brain tumors and occurs more frequently in young adults. The diagnosis is established for the clinic environment, imaging and histological confirmation. The therapeutic possibilities are limited and the survival close to 2 years showing a high mortality. We report the case of an 11-year-old male patient who was treated at the Central Military Hospital of Bogotá Colombia where the diagnosis was made and treatment was instituted

Neuro-Behcet diseases showing pseudotumoral presentation

BACKGROUND AND SIGNIFICANCE: Because of the diverse clinical and radiologic manifestations of Neuro-Behcet disease, it is sometimes difficult to differentiate with multiple sclerosis or tumorous condition. We report two cases of Neuro-Behcet disease underwent by stereotaxic biopsy showing vasculitis without any evidence of malignancy, initially misdiagnosed as solitary tumor and metastatic tumor, respectively. CASE: A 35-year-old male admitted due to right hemiparesis. Brain CT showed low density mass shadow in left thalamus. Under the impression of low grade astrocytoma, stereotaxic biopsy was performed. Dense perivascular lymphocytic infiltration with petechial microhemorrhage mixed with hemosiderin pigment was noted in thalamic region. The other patient (male, 44yrs old) admitted due to seizure. On MRI, there are multiple inhomogenous signals on right occipital and left frontal lobe and left thalamus. Under the impression of metastatic tumor, work-up about the primary tumor was done without any positive findings. To determine the primary focus, stereotaxic biopsy was performed. Only reactive gliosis and mild perivascular lymphocytic infiltration was noted in pathologic specimen. With the retrospective careful history taking and follow-up image study, two patients were confirmed as having a Behcet's disease.

Stereotaxic Transcerebellar Approach for the Posterior Fossa Lesions with C.R.W. System

6 patients underwnet CT-guided stereotactic biopsy or hematoma aspiration procedure for posterior fossa lesions. Trajectory for biopsy or aspiration was transcerebellar approach. The patients were placed under general endotracheal anesthesia and positioned prone or sitting. No complications were encountered in the postoperative period when this technique was used. Stereotaxic transcerebellar multiple biopsy can safely provide tissue conformation of the neoplastic nature of a posterior fossa lesion thought to be a tumor. In addition, hematoma aspiration has been demonstrated to be safe, reliable, and efficient.

CT-guided Stereotaxic Brain Tumor Biopsy

The authors have performed simple CT-guided free-hand tumor biopsy. CT images and C-arm fluroscopy were taken to determine the coordinates of the target point, which was the center of the tumorous CT findings. This CT-guide stereotaxic approach for biopsy of intracranial tumors have the following advantages: 1) The procedure is simple and safe. 2) The operation can be performed under local anesthesia. 3) The operation can be performed without stereotaxic frame. 4) Tissue biopsy was taken on various sites of tumors. The authors have performed 4 cases as follow: 3 cases of anaplastic astrocytoma, 1 case of metastatic tumor. Neither mortality nor morbidity was noted.

Roles of BRW CT Stereotaxic in Less Accessible Brain Lesions

With improvement of computerized tomography(CT), stereotaxic surgery has been applied for neurosurgery ; aspiration of deep-seated brain lesions, radiotherapy using a small radiogenic sources, and evacuation of hematoma. And so, a prototype Brown-Roberts-Wells(BRW) CT stereotaxic system has been avaible to us. We report its utilization in evaluation and management of less accessible brain lesions. Surgical exploration was undertaken in 25 patients with various less accessible brain lesions using BRW system : 9 superficial lesions including the motor cortex and multiple lesions, 5 deep-seated lesions, 3 parasellar lesions, 8 brain stem lesions. Histologically, there are 5 gliomas, 4 metastatic cancers, 8 hematomas, 3 brain abscesses, 1 medulloblastoma, 1 malignant melanoma, 1 cryptic AVM, and 2 undiagnosed cases. There are two complications : 1 intratumoral bleeing, 1 rebleeding. The diagnostic rate is 92%. There is no mortality in this series. This BRW CT-guidance stereotaxic approach for less accessible lesions have following advantages ; 1) accurate, simple and safe ; 2) performed under local anesthesia ; 3) less traumatic and low cost ; 4) easily diagnosed ; 5) relatively no limitation in lesion sites.

A BRW Stereotaxic Biopsy of Brain Stem Glioma / 영남의대학술지

Histopathological diagnosis of brain stem glioma should be performed for the purpose of the determination of its management and clinical course, but its surgical biopsy has been followed by high mortality and morbidity. We performed the tissue sampling for histological examination with BRW stereotaxic system under local anesthesia successfully.

A Clinical Analysis on the Pineal Region Tumors

The authors analyzed 24 cases of the pineal region tumors which were treated at the Department of Neurosurgery, Yonsei University during the last eight years. Tumors of the pineal region constitutes 2.5% of all brain tumors in authors' series. Most(79.1%) of the patients were younger than 20. Of these 24 cases, 19 were male and 5 were female. Presenting symptoms were headache, vomitting and clouding of sonsciousness due to obstructive hydrocephalus, followed by eye signs, such as Parinaud's syndrome, abducens palsy, and papilledema. Other signs are ataxia and hemiplegia. Plain skull films showed abnormal calcifications and findings of increased intracranial pressure. Location and size of the tumors were most accurately visualized by the brain CT scan. Pathological types of the pineal tumors could be differentiated by the brain CT scan from the patterns of contrast enhancement and tumor density. Among the 24 patients received VP shunt surgery for hydrocephalus. Eighteen patients had the radiation therapy either after the surgery or radiation alone. Germinoma was the most frequent type of pineal region tumors in this series, accounting for half of the patients who had the surgery. There was no immediate postoperative mortality, but one patient with pineoblastoma died from multiple spinal seeding nine months after the surgery. In conclusion, it is most important to identify the pathological type of the tumors in pineal region, because the prognosis of the patient as well as the mode of treatment varies according to the pathological diagnosis. Stereotaxic biopsy of the pineal region tumors is the most accurate diagnostic methods in authors' series among such other methods as brain CT scan, CSF cytology and/or tumor marker study.