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Resumen La mamografía contrastada (CEDM, contrast-enhanced digital mammography) es una herramienta nueva que ha ido implementándose de forma creciente. Aparece como alternativa a la resonancia magnética (RM), y al igual que esta, tiene como principio el uso de contraste endovenoso para explorar la angiogénesis tumoral. Combina la imagen de mamografía convencional (Mx) con la técnica de sustracción con energía dual poscontraste, lo que resulta en un incremento en la detección de cáncer de mama, en un tiempo corto de estudio y a un bajo costo. Es un método prometedor en casos seleccionados y de fácil lectura, siendo útil principalmente en pacientes con diagnóstico de cáncer de mama para detectar lesiones adicionales y determinar el tamaño tumoral, ayudando en la planificación quirúrgica, así como también en la evaluación de la respuesta a la neoadyuvancia. También en el seguimiento de pacientes operadas, para caracterizar lesiones dudosas en Mx y ecografía, o como alternativa ante contraindicación de la RM. El objetivo de este trabajo es valorar la utilidad de la mamografía contrastada en la práctica diaria y determinar sus principales indicaciones. Repasamos con casos propios las utilidades y características del método.
Abstract Contrast-enhanced digital mammography (CEDM) is an emerging tool that has been increasingly implemented. It appears as an alternative to magnetic resonance imaging (MRI), using intravenous contrast to explore tumor angiogenesis. It combines conventional mammography (Mx) with post-contrast dual energy subtraction technique, resulting in increased detection of breast cancer, in a short study time and at a low cost. It is a promising method in selected cases and easy to read, being useful mainly in patients with breast cancer to detect additional lesions and determine the tumor size, that helps surgical planning, as well as in the evaluation of post-neoadjuvant chemotherapy response in the follow-up of patients treated with surgery, to address inconclusive findings in screening mammogram, or as an alternative when MRI is contraindicated. The purpose of this article is to assess the usefulness of contrasted mammography in daily practice and to determine its main indications. We review with our own cases the applications and characteristics of this method.
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Las manifestaciones cutáneas de los tumores malignos comprenden un grupo de dermatosis que pueden ser marcadores de la presencia de neoplasias ocultas y permiten su diagnóstico oportuno. El objetivo de este informe es presentar las características clínicas de una acantosis nigricans asociada a carcinoma de mamario. Para ello, se describe el caso clínico de una paciente de 50 años, color de piel negro, asistida en la consulta de Dermatología del Policlínico Universitario Raúl Sánchez, por tener una placa única eritematosa localizada en la mama izquierda, acompañada de dolor, aumento de la temperatura local y máculas hipercrómicas en las axilas; así como adenopatías axilares múltiples. Los exámenes complementarios mostraron la presencia de acantosis nigricans maligna asociada a un carcinoma inflamatorio de la mama izquierda. Fue intervenida quirúrgicamente, con la consiguiente desaparición de las lesiones cutáneas, pero con un pronóstico reservado. La mayoría de los síndromes paraneoplásicos son inespecíficos; existe una necesidad urgente de sospechar una correlación entre los cambios cutáneos y la posibilidad de una neoplasia interna, por lo que es de suma importancia derivar a estos pacientes para su identificación y el diagnóstico precoz de la enfermedad de base. Esto mejoraría el pronóstico y atenuaría en gran medida las consecuencias.
The skin manifestations of malignant tumors include a group of dermatoses that can be the sign of the occult neoplasms presence and allow their timely diagnosis. The objective of this report is to present the acanthosis nigricans' clinical characteristics associated with breast carcinoma. The clinical case of a 50-years-old black-skinned patient is described, assisted in the Dermatology consultation of the Raúl Sánchez University Polyclinic, for having a single erythematous plaque located in the left breast, accompanied by pain, increased local temperature and hyperchromic macules in the armpits; as well as multiple axillary lymphadenopathy. Complementary examinations showed the presence of malignant acanthosis nigricans associated with an inflammatory carcinoma of the left breast. She underwent surgery, with the consequent disappearance of the skin lesions, but with a reserved prognosis. Most paraneoplastic syndromes are nonspecific; there is an urgent need to suspect a correlation between skin changes and the possibility of an internal neoplasia, so it is of utmost importance to refer these patients for identification and early diagnosis of the underlying disease. This would improve the prognosis and greatly mitigate the consequences.
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Resumen OBJETIVO: Identificar los principales hallazgos histopatológicos benignos y determinar la tasa de falsos positivos que suelen causar conflicto al categorizar las mastografías en el sistema BI-RADS por su aspecto, que puede simular un proceso maligno. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en pacientes atendidas en la Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) con reporte mastográfico alterado o sospecha clínica de malignidad. Para el análisis estadístico se utilizó el programa JASP 2.0 y χ2 para la diferencia de proporciones entre grupos. RESULTADOS: De un grupo de 11,481 pacientes, se reportaron 1643 mastografías alteradas: 444 con reportes falsos positivos, 23 pacientes con sospecha clínica y exclusión de 16 que no cumplieron con los criterios de inclusión establecidos. La muestra poblacional estudiada fue de 451 pacientes. La mayoría permaneció asintomática al momento del estudio (42.1%). El hallazgo histopatológico benigno con mayor prevalencia fue el fibroadenoma y su síntoma más relevante el nódulo palpable. La tasa de falsos positivos fue de 4.3%. CONCLUSIONES: En la actualidad, gracias a la implementación de programas de tamizaje es posible establecer diagnósticos de cáncer de mama en etapas tempranas, aunque con la desventaja que el reporte puede resultar falso positivo y ello dar lugar a incremento de la morbilidad y sobretratamiento. Los estándares internacionales indican que estos no deben sobrepasar el 10%.
Abstract OBJECTIVE: To identify the main benign histopathological findings that often cause conflict when categorizing mastographies in the BI-RADS system due to their appearance, which may simulate a malignant process and false positive rate. MATERIALS AND METHODS: Retrospective cohort study carried out in patients attended at the Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) with an altered mastographic report or clinical suspicion of malignancy. For statistical analysis we used the JASP 2.0 programme and χ2 for the difference in proportions between groups. RESULTS: From a group of 11,481 patients, 1,643 altered mastograms were reported: 444 with false positive reports, 23 patients with clinical suspicion and exclusion of 16 who did not meet the established inclusion criteria. The population sample studied was 451 patients. The majority remained asymptomatic at the time of the study (42.1%). The most prevalent benign histopathological finding was fibroadenoma and the most relevant symptom was a palpable nodule. The false positive rate was 4.3%. CONCLUSIONS: Currently, thanks to the implementation of screening programmes it is possible to establish breast cancer diagnoses in early stages, although with the disadvantage that the report may be false positive and this may lead to increased morbidity and overtreatment. International standards indicate that these should not exceed 10%.
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Abstract Objective: To evaluate the indications for and results of magnetic resonance imaging (MRI) examinations for breast cancer screening at a cancer center in Brazil. Materials and Methods: This was a retrospective observational study, based on electronic medical records, of patients undergoing MRI for breast cancer screening at a cancer center in Brazil. Results: We included 597 patients between 19 and 82 years of age. The main indications for MRI screening were a personal history of breast cancer, in 354 patients (59.3%), a family history of breast cancer, in 102 (17.1%), and a confirmed genetic mutation, in 67 (11.2%). The MRI result was classified, in accordance with the categories defined in the Breast Imaging Reporting and Data System, as benign (category 1 or 2), in 425 patients (71.2%), probably benign (category 3), in 143 (24.0%), or suspicious (category 4 or 5), in 29 (4.9%). On MRI, 11 malignant tumors were identified, all of which were invasive carcinomas. Among those 11 carcinomas, six (54.5%) were categorized as minimal cancers (< 1 cm), and the axillary lymph nodes were negative in 10 (90.9%). The cancer detection rate was 18.4/1,000 examinations, and the positive predictive value for suspicious lesions submitted to biopsy was 37.9%. Conclusion: In our sample, the main indication for breast MRI screening was a personal history of breast cancer. The results indicate that MRI is a highly accurate method for the early detection of breast neoplasms in this population.
Resumo Objetivo: Avaliar as indicações e resultados de exames de ressonância magnética (RM) para rastreamento de câncer de mama em um centro oncológico no Brasil. Materiais e Métodos: Estudo observacional, realizado mediante análise retrospectiva de pacientes submetidos a RM das mamas para rastreamento de câncer de mama, por meio de revisão do prontuário eletrônico em um centro oncológico. Resultados: Foram incluídas 597 pacientes com idade variando de 19 a 82 anos. As principais indicações para rastreamento foram história pessoal de câncer de mama em 354 (59,3%) pacientes, história familiar em 102 (17,1%) e mutação genética confirmada em 67 (11,2%). O resultado da RM foi benigno (BI-RADS 1 ou 2) em 425 (71,2%) pacientes, provavelmente benigno (BI-RADS 3) em 143 (24,0%) e suspeito (BI-RADS 4 ou 5) em 29 (4,9%). Foram identificados 11 tumores malignos na RM, todos carcinomas invasivos, porcentagem de cânceres "mínimos" (< 1 cm) de 54,5% e porcentagem de axila negativa de 90,9%. A taxa de detecção de câncer na RM foi 18,4/1000 exames e o valor preditivo positivo para as lesões suspeitas submetidas a biópsia foi 37,9%. Conclusão: A principal indicação para RM de rastreamento na nossa população foi história pessoal de câncer de mama. Os resultados mostraram que a RM constitui um método com alta acurácia para detecção precoce de neoplasias da mama nessa população.
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Introducción: En Cuba, el cáncer de mama constituye, actualmente, la primera causa de mortalidad oncológica en la mujer, acorde a lo establecido en la clasificación BI-RADS. A las lesiones mamarias categorizadas 5, por sospecha de malignidad, se les debe realizar una toma de biopsia para su evaluación histopatológica. Objetivo: Correlacionar los hallazgos clínicos e histológicos en pacientes portadores de lesiones mamográficas tipo BI-RADS 5. Materiales y métodos: Se realizó un estudio observacional, descriptivo y transversal sobre la relación existente entre el cáncer de mama tipo 5 de la clasificación BI-RADS y el resultado histológico, en una muestra dada por 30 pacientes. De esta se tomaron edad, raza, antecedentes oncológicos familiares, factores de riesgo, examen clínico, alteraciones de la mamografía e histológicas, datos que fueron manejados según estadísticas descriptivas. Resultados: Predominaron personas de la tercera edad, blancas, con familiares con enfermedades oncológicas, sedentarias y obesas con criterios imagenológicos de BI-RADS 5 e histología, prevaleciendo el carcinoma ductal. Conclusiones: El diagnóstico precoz del cáncer mamario mediante autoexamen o mamografía de escrutinio es fundamental.
Introduction: In Cuba, breast cancer is currently the first cause of oncological mortality in women, according to what is to established in the BI-RADS (Breast Imaging-Reporting and Data System). Breast lesions categorized 5, due to suspicion of malignancy, should be biopsied for their histopathological evaluation. Objective: To correlate the clinical and histological findings in patients with type 5 BI-RADS mammographic lesions. Materials and methods: A cross-sectional, descriptive and observational study was carried out on the relationship between type 5 mamma cancers of the BI-RADS classification and histological results in a sample of 30 patients. From them, age, race, family oncological history, risk factors, clinical examination, mammography and histological alterations were taken, data that were managed according to descriptive statistics. Results: White, elderly people predominated, with sedentary and obese relatives with oncological diseases, and BI-RADS 5 imaging criteria and histology, prevailing ductal carcinoma. Conclusions: Early diagnosis of breast cancer through auto examination or screening mammography is essential.
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Objectif: Le cancer du sein chez la femme jeune est rare etprésente des caractéristiques épidémiologiques, diagnostiques et pronostiques propres. L'objectif de notre étude est d'évaluerles caractéristiques radiologiques (mammographiques, échographiqueset par résonnancemagnétique IRM du cancer du sein chez la femme jeune Algérienne, de moins de 35 ans. Matériels etméthodes: Etude prospective, descriptiveau sein du service d'imagerie médicale du Centre Pierre et Marie Curie,d'Algerincluant 204patientes âgées de moins 35ans, étalée sur 3 ans allantentre janvier 2015et janvier 2017,chez lesquelles undiagnostic de cancer du sein a été porté,Elles ont toutes bénéficiésd'une mammographie numérique, d'une échographie et d'une IRM mammaireet d'unprélèvement percutané.Résultats:La fréquence du cancer du sein chez la femme jeune de moins de 35 ans était de 10,6%. L'âge moyen était de 30.9 ans. L'autopalpation d'un nodule était prédominante (87.2%). La densité mammaire était de type c et d dans 67.7%. Contrairement à l'idée établie, la mammographie avait permis souvent le diagnostic de ces tumeurs. A la mammographie, la répartition des cas selon le stade BI-RADS révèle que plus de la moitié (53.9%) était classée BI-RADS 5 ; 35.5 % des cas classés en BIRADS 4, 7.2% classés en BI-RADS 3 et un faible pourcentage (3.6 %) en BI-RADS 0. Pour l'échographie, la répartition des cas selon les stades BI-RADS révèle que plus de la moitié était classée ACR5, ce qui représente 64 %, 32.7 % classée en ACR4 et 3.3% en ACR3.A l'IRM, 71.1 % des cas ont été classés en ACR 5, 28.4% en ACR4 et 0.5 des cas en ACR 3. Le type histologique était de type carcinome canalaire infiltrant de grade III et II selon Scarff-Bloom et Richardson (SBR) dans 96.11% descas.Conclusion: L'expression radiologique est souvent non spécifique et évocatrice d'une lésion suspecte néanmoins nous avons constaté une plus grande fréquence de tumeurs d'allure bénigne en mammographie par rapport à l'échographie mammaire et à l'IRM mammaire. L'IRM mammaire reste donc utile dans la caractérisation lésionnelle et le bilan d'extension
Objective: Breast cancer in young women is rare and has its own epidemiological, diagnostic and prognostic features. The aim of our study was to evaluate the radiological (mammographic, ultrasonographic and MRI) characteristics of breast cancer iMaterials and methods: Prospective, descriptive study in the medical imaging department of the CPMC in Algiers, including 204 patients under 35 years of age, over a 3-year period from January 2017 to January 2020, diagnosed with breast cancer. They all underwent digital mammography, ultrasound and MRI of the breast and percutaneous sampling.Results: The incidence of breast cancer in young women under 35 was 10.6%. The mean age was 30.9 years. Autopalpation of a nodule was predominant (87.2%). Breast density was type c and d in 67.7%. Contrary to popular belief, these tumorswere often diagnosed by mammography. On mammography, the distribution of cases according to BIRADS stage revealed that over half (53.9%) were classified as BIRADS 5; 35.5% of cases classified as BIRADS 4, 7.2% classified as BIRADS 3 and a small percentage (3.6%) as BIRADS 0.On ultrasonography, the distribution of cases according to BIRADS staging revealed that over half were classified as ACR5, representing 64%, 32.7% as ACR4 and 3.3% as ACR3. On MRI, 71.1% of cases were classified as ACR 5, 28.4% as ACR4 and 0.5 of cases as ACR 3. Histological type was infiltrating ductal carcinoma grade III and II according to Scarff-Bloom and Richardson (SBR) in 96.11% of cases.Conclusion: Radiological expression is often non-specific and suggestive of a suspicious lesion. Nevertheless, we found a greater frequency of benign tumorsin mammography than in breast ultrasound and breast MRI. Breast MRI therefore remains useful for lesion characterization and extension assessmenn young Algerian women under 35 years of age.
Sujets)
Humains , FemelleRésumé
Objectif.Depuis 2008, la Haute Autorité Sanitaire recommande la réalisation du scanner cardiaque dans le diagnostic des cardiopathies congénitales. Celui-ci aide à confirmer et préciser les anomalies mal définies à l'échocardiographie. Dans les pays développés, le scanner cardiaque est un examende routine pour le diagnostic des cardiopathies congénitales. En Côte-d'Ivoire, sa pratique est récente.L'objectif de cette étude était de décrire les techniques et résultats des scanners cardiaques pédiatriques réalisés dans une structure privée à Abidjan.Matériels et méthodes.Il s'agissait d'une étude descriptive rétrospective sur une période de 2 mois qui a inclus tous les enfants reçus à la clinique la rosette pour la réalisation d'un scanner cardiaque indiqué pour l'évaluation d'une cardiopathie congénitale. Les examens ont été réalisés sous sédation légère pour les enfants de moins de 7 ans.Résultats.Vingt scanners cardiaques pédiatriques ont été réalisés. Les indications des scanners cardiaques pédiatriques étaient la tétralogie de Fallot (15 cas), l'atrésie pulmonaire à septum ouvert (APSO) (2 cas), la communication inter auriculaire (CIA) (1 cas), la CIA associée à une communication interventriculaire (CIV) (1 cas) et la sténose pulmonaire supra valvulaire (1 cas). Dans les cas de Tétralogie deFallot et d'APSO, les branches pulmonaires et les collatérales aorto-pulmonaires ont été visualisées et mesurées. Pour le bilan de , un retour veineux pulmonaire non visualisé à l'échocardiographie a été retrouvé au scanner cardiaque. Dans tous les cas, un bilan tomodensitométrique malformatif était réalisé : recherche d'anomalies coronaires et d'arcs aortiques.Après réalisation du scanner cardiaque, 5 enfants ont bénéficié d'une cure chirurgicale. On notait une concordance entre les diagnostics peropératoires et tomodensitométriques
Objective. Since 2008, the French National Authority for Health recommends the use of a cardiac scanner for the diagnosis of congenital heart disease. It helps to confirm and clarify abnormalities that are poorly defined on echocardiography. In developed countries,cardiac CT is a routine examination for the diagnosis of congenital heart disease. In Côte d'Ivoire, its practice is recent. Materials and Methods. This was a retrospective descriptive study over a period of 2 months which included all children received at the Rosette clinic for a cardiac scan indicated for the evaluation of congenital heart disease. The examinations were performed under light sedation for children under 7 years of age. Results. Twenty paediatric cardiac scans were performed. The indications for the paediatric cardiac scans were tetralogy of Fallot (15 cases), pulmonary atresia with ventricular septal defect (PAVSD) (2 cases), atrial septal defect (ASD) (1 case), ASD associated with ventricular septal defect (VSD) (1 case) and supravalvular pulmonary stenosis (1 case). In cases of Tetralogy of Fallot and APSO, pulmonary arteries and aorto-pulmonary collaterals were visualised and measured. For the assessment of ASD, an anomalous pulmonary venous return not visualised on echocardiography was found on cardiac computed tomography (CT). In all cases, a malformative CT scan was performed: search for coronary, aortic arch. After the cardiac, 5 children underwent surgical treatment. There was concordance between the intraoperative and CT diagnoses. Conclusion. In our experience, cardiac CT now represents, minimally invasive, complementary diagnostic tool for the evaluation of congenital heart disease.
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Humains , Cardiopathies congénitalesRésumé
Background: Screening for breast cancer utilizing mammography is associated with reduced advanced cancer diagnosis and reduced breast cancer mortality. We aimed to assess the lifetime history of breast cancer screening utilization for Jordanian women aged 40 and 49 years and determinants of this utilization. Methods: This paper reports the analyzed data from the seventh cycle of the Jordan Population and Family Health Survey (JPFHS). For this study, the analysis was confined to 4486 women aged between 40 and 49 years at the time of data collection who reported their nationality as Jordanian. We used multivariate logistic regression analysis to assess whether any socio?demographic variables could predict greater breast cancer screening utilization. Results: Only 14% of all respondents aged 40� years reported ever having a mammogram. Results of multivariate logistic regression showed that area of residence, husband抯 level of education, younger age, and living in a wealthy status were strong predictors of lifetime history of breast cancer screening. Conclusions: This study elucidates that breast cancer screening mammography among Jordanian women has remained opportunistic and underutilized despite the efforts of national entities to promote screening and early detection of breast cancer. There is a geographic and social disparity in the utilization of mammography screening among Jordanian women.
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Abstract Radiation-induced secondary tumors constitute a rare complication of radiation therapy and typically occur in or near the irradiated area. Women who undergo thoracic radiotherapy before 30 years of age have a significantly greater lifetime risk of developing breast cancer than do those in the general population. It is recommended that a patient who has previously received thoracic radiotherapy with a radiation dose ≥ 10 Gy subsequently undergo annual screening with mammography and magnetic resonance imaging, beginning eight years after the initial treatment or when the patient has reached 25 years of age (whichever comes later). The treatment of secondary breast cancer in this population should be individualized and should be discussed with a multidisciplinary team to avoid toxicity related to the treatment of the primary cancer.
Resumo Os cânceres secundários induzidos por radiação são complicações raras da radioterapia e geralmente ocorrem na área tratada ou próximo a ela. Mulheres com menos de 30 anos de idade tratadas com radioterapia torácica têm risco significativamente aumentado de desenvolver câncer de mama ao longo da vida, em comparação com a população em geral. Para as pacientes tratadas com irradiação torácica com dose igual ou superior a 10 Gy é recomendado rastreamento anual com mamografia e ressonância magnética iniciando oito anos após o tratamento, desde que este início seja após 25 anos de idade. O tratamento do câncer de mama secundário nessa população deve ser individualizado e discutido com equipe multidisciplinar, para evitar toxicidade relacionada ao tratamento do câncer primário.
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Objetivos: investigar o impacto da pandemia no rastreamento do câncer de mama no Sistema Único de Saúde e comparar os dados obtidos com os de outros países. Métodos: foi realizado um estudo observacional transversal quantitativo, com dados provenientes do Sistema de Informação do Câncer SISCAN sobre o número de mamografias feitas de 2014 a 2022 por mulheres, no Brasil. Resultados: os dados referentes à mamografia na população de risco elevado demonstraram uma queda de 38,39% de 2019 para 2020. Enquanto na mamografia de rastreamento a queda foi ligeiramente maior, de 39,18% nesse mesmo período. Em relação à mamografia diagnóstica, a redução foi de 33,15%, e na mamografia de população-alvo, o ápice foi em 2019 com 2.721.075. Em contrapartida, a realização de mamografia em pacientes já tratadas, teve uma menor queda, de 9,35%. Conclusões: observou-se uma queda significativa no número de mamografias realizadas em 2019 e 2020, o que poderá acarretar em diagnósticos tardios da doença e piores prognósticos (AU).
Objectives: investigating the impact of the pandemic on breast cancer screening in the Unified Health System, in addition to comparing the data obtained from other countries. Methods: a quantitative cross-sectional observational study was carried out, with references from the Cancer Information System - SISCAN on the number of mammograms performed from 2014 to 2022 by women in Brazil. Results: data regarding mammography in the high-risk population showed a drop of 38,39% from 2019 to 2020. While in screening mammography, the decline was slightly more significant, at 39.18% in the same period. Regarding diagnostic mammography, the reduction was 33.15%, and in target population mammography, the peak was in 2019 with 2.721.075. On the other hand, the performance of mammography in patients already treated had a smaller decrease of 9.35%. Conclusions: there was a significant reduction in the number of mammograms performed in 2019 and 2020, which might lead to a late diagnosis of the disease and a worse prognosis (AU),
Sujets)
Humains , Femelle , Tumeurs du sein/diagnosticRésumé
Resumo O objetivo foi verificar a tendência de desigualdade na realização de mamografia de acordo com a posse de plano de saúde e escolaridade a partir de dados do período de 2011 a 2020 do VIGITEL. Estudo de base populacional com dados provenientes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) entre 2011 e 2020. Desfecho: exame de mamografia nos últimos dois anos em mulheres de 50 a 69 anos. A magnitude das desigualdades do desfecho em relação às exposições (plano de saúde e escolaridade) foi estimada por meio de dois índices: slope index of inequality (SII) e concentration index (CIX). A prevalência de cobertura da realização de mamografia (2011-2020) passou de 74,4% para 78,0%, com tendência estável. As prevalências de quem possuía plano de saúde foram 85,7% e 86,4%, e de quem não possuía, 63,4% e 71,2%, com tendência crescente. De acordo com a escolaridade, em mulheres com 0-8 anos de estudo a prevalência passou de 68,2% para 72,6%; 9-11 anos, de 80,4% para 80,0% (tendência decrescente); 12 anos ou mais, de 88,0% para 86,6% (tendência decrescente). Quanto aos índices de desigualdade absoluta (SII) e relativa (CIX) da escolaridade e plano de saúde, mostram que há uma diminuição na desigualdade nos últimos dez anos.
Abstract The objective was to verify the trend of inequality in the realization of mammography exam according to the possession of health insurance plan and schooling from data from the period 2011 to 2020 of VIGITEL. Population-based study with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL) between 2011 and 2020. Outcome: mammography exam in the last 2 years in women aged 50 to 69 years. The magnitude of inequalities of outcome in relation to exposures (health insurance plan and education) was estimated using two indices: inequality slope index (SII) and concentration index (CIX). The prevalence of mammography exam (2011-2020) increased from 74,4% to 78,0%, with a stable trend. The prevalence of those with health insurance plan were 85,7% and 86,4%, and without 63.4% and 71.2%, with an increasing trend. According to education, women with 0-8 years of schooling the prevalence increased from 68,2% to 72,6%, 9-11 years from 80,4% to 80,0% (decreasing trend), 12 years or more 88,0% to 86,6% (decreasing trend). As for the absolute (SII) and relative (CIX) inequality indices of schooling and health insurance plan show that there is a decrease in inequality over the last 10 years.
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Introduction: Despite the increasing incidence of breast cancer among women in Northeast Brazil, there have been no studies on the association between physical activity and attendance to mammography screening. Objective: This study of Brazilian women addressed socio-economic variables, physical activity, and knowledge about breast cancer and their impact on attendance to mammography screening. Methods: A cross-sectional quantitative study was conducted as an epidemiological evaluation. Data were obtained by interviewing 307 women in a public health center. Logistic regression analysis was applied to determine the odds ratio (ORs) and confidence intervals (CI) of variables. Results: Mean age of women was 49.79 (SD=8.63) years and 172 (56.0%) were between 40 and 49 years old. Women aged from 40 to 49 and ≥50 years who performed physical activity, had a 2.4-fold (95% CI: 1.13-5.04) and 10.6-fold (95% CI: 2.66-41.95) increased chance to attend MS every year (p=0.040; p<0.001). Women aged between 40 and 49 years with a low and middle income, had a 10.3-fold (OR=0.097; 95% CI: 0.02-0.53) and 13.2-fold (OR=0.076; 95% CI: 0.11 0.53) decreased chance to attend MS every second year (p=0.007). The MS attendance of women aged ≥50 years with basic education level was 13.3 (OR=0.075; 95% CI: 0.09-0.66) times decreased (p=0.010). Conclusion: Physical activity represented an important predictor of MS attendance of all women. The impact of income and education level, in contrast, depended strongly on the age group.
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Background: Breast Imaging Reporting and Data System (BI?RADS) classification for breast lesions was proposed for uniformity in categorizing breast lesions. While BI?RADS 1, 2 and 4–6 categories are straightforward, BI?RADS 3 is an intermediate category lesion with significantly different meanings and findings for mammography, ultrasound, and magnetic resonance imaging and is diagnostically challenging. Our study aims to determine the frequency and the malignancy rate of BI?RADS category 3 lesions detected on ultrasound breast and digital X?ray mammography by doing follow?ups at 6, 12, and 24 months of imaging. Materials and Methods: This ambispective study was conducted in the Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, from October 2020 to October 2022, which included 55 patients referred for digital X?ray and breast ultrasound. All BI?RADS category 3 in the initial sonomammography and digital X?ray mammography were included in the study and were followed up for final diagnosis and outcome either by pathological analysis or follow?up using sonomammography and digital X?ray mammography for a maximum of 24 months. Results: Fifty?five patients were categorized into the benign or malignant category from the results of tissue diagnosis or via follow?up. Fifty?four patients (98.18%) showed benign lesions, and one (1.82%) got malignant lesions. In the majority, 31 (56.36%) patients, the mean follow?up time was 6 months, followed by 12 months 10 (18.18%). Follow?up was 24 months in only 1 out of 55 patients (1.82%). The mean value of time to follow?up (months) of study subjects was 6 ± 4.6 with a median (25th–75th percentile) of 6. Conclusion: Short?term interval follow?up in BI?RADS category: three patients are enough to detect early breast malignancy, and this will avoid unnecessary tissue diagnosis (invasive procedure) in benign lesions. In our study, the malignancy yield in the follow?up of BI?RADS 3 was 1.82% (<2%).
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Mammography has played an essential role in the screening and treatment of breast cancer. However, the application of X-rays will also increase the risks of breast cancer while improving its detection rate. Moreover, the risks will increase with an increase in the radiation dose. Since the glandular tissue in breasts is sensitive to radiation, the evaluation of the average glandular dose (AGD) in mammography has attracted considerable international attention. Compared to relatively mature dosimetric studies on traditional two-dimension mammography and digital breast tomosynthesis, the method for the dose evaluation of the new cone beam CT for breasts are still subjected to research. This paper reviews and explores the current status of studies on the assessment method and relevant influencing factors of AGD under different types of mammography equipment.
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Objective:To compare radiation dose between digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM), and explore the correlation of average glandular dose(AGD) with breast density and compression thickness.Methods:The mammographic data of patients with breast diseases who underwent digital breast tomosynthesis (DBT) and the population who underwent full-field digital mammography (FFDM) screening in the First Affiliated Hospital of Kunming Medical University from October 2020 to May 2022 were retrospectively collected. The compression thickness, compression force and AGD were recorded. According to the 2013 ACR BI-RADS MAMMOGRAPHY, the breast gland density was classified into 4 types: a(glandular tissue<25%), b(glandular tissue 25%~50%), c(glandular tissue 50%~75%) and d(glandular tissue >75%), by two senior doctors engaged in breast imaging diagnosis. The relationships between different gland densities, different compression thicknesses and AGD under FFDM and DBT mode were analyzed.Results:In both FFDM and DBT modes, the AGD increased significantly with the increase of breast density( F=861.63, 617.83, 330.33, 451.45, 290.47, P<0.001), and AGD a<AGD b<AGD c<AGD d. For type c and d breasts undergoing FFDM, AGD was lowest when the compression thickness was 31~40 mm. Under the same compression thickness, The AGD DBT was significantly higher than the AGD FFDMin all types (Type a: t=-17.88, -42.19, -29.90, -28.14, -24.95, P<0.001; Type b: t=-49.18, -35.94, -27.25, -28.37, -24.10, P<0.001; Type c: t=-11.78, -32.90, -23.13, -20.51, -18.24, P<0.001; Type d: t=-7.94, -26.24, -17.24, -15.44, -13.81, P<0.001). The difference between two AGDs of Type d with compression thickness of 61~70 mm was the largest, which was 1.07 mGy (95% CI: 0.92~1.22). The AGD was positively correlated with breast density and compression thickness, and the relationship of FFDM was stronger than that of DBT. Conclusions:The AGD is positively correlated with breast density and compression thickness in mammography. Compared with FFDM, DBT can increase AGD, The AGD would increase in DBT than FFDM but be safe. DBT would be beneficial to patients with breast diseases in clinical practice.
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Objective:To explore the diagnostic value of contrast-enhanced mammography (CEM) and MRI in differentiating benign and malignant breast lesions based on the 2013 breast imaging reporting and data system (BI-RADS) lexicon and the supplement on CEM.Methods:The clinical and imaging data of 83 patients with breast lesions from March 2019 to April 2022 in the Third Affiliated Hospital of Soochow University were retrospectively analyzed. Totally 100 breast lesions from 83 female patients aged 28 to 78 (49±14) years, were divided into benign lesions (50 lesions) and malignant lesions (50 lesions) according to the pathological results. The t-test, χ 2 test and Fisher′s exact test were used to compare the differences of clinical and imaging features between benign and malignant lesions, and these imaging features which had statistical differences were established CEM and MRI models by multivariate logistic regression analysis respectively. The receiver operating characteristic curves and the area under the curve (AUC) were used to assess the diagnostic efficacy of two models in differentiating benign and malignant breast lesions. Using the DeLong test compared the AUC. Results:Multivariate logistic regression analysis showed that associated features (OR=9.075,95%CI 1.430-57.570, P=0.019), lesion conspicuity (OR=6.180,95%CI 2.608-14.646, P<0.001), mass margin (OR=2.193,95%CI 1.405-3.422, P=0.001) and calcification distribution (OR=2.147,95%CI 1.157-3.986, P=0.015) were independent predictors of differentiating benign and malignant breast lesions in CEM, and then the predictive model of CEM was constructed. Time-signal intensity curve (OR=9.230, 95%CI 3.178-26.805, P<0.001), associated features (OR=5.289,95%CI 1.343-20.831, P=0.017) and mass margin (OR=2.192,95%CI 1.336-3.597, P=0.002) were independent predictors of differentiating benign and malignant breast lesions in MRI, and the predictive model of MRI was constructed. The AUC of CEM and MRI models for differentiating benign and malignant breast lesions were 0.947 and 0.930 respectively, and two models were no significant difference ( Z=0.68, P=0.494). Conclusion:The diagnostic efficacy of CEM and MRI in differentiating benign and malignant breast lesions is comparable based on the 2013 BI-RADS lexicon and the supplement on CEM.
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Objective:To investigate the effect of adjusting density exposure steps on image quality and radiation dose in digital mammography.Methods:Using the automatic exposure control (AEC) mode of the digital mammography machine, five different gland thicknesses of 4.3, 5.3, 6.3, 7.3, and 8.3 cm were simulated by attaching 0, 1, 2, 3, and 4 PMMA plexiglass plates under the RMI-156 modal body, and the density exposure steps were adjusted to -3, -2, -1, 0, 1, 2, 3, and 4 for each thickness. The target/filter combination, tube voltage, tube current, incident body surface dose (ESD), incident surface air kerma (ESAK), half-value layer (HVL) and the average glandular dose displayed by the device (displayed AGD) were recorded at each step and thickness, and the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), figure of merit (FOM) and the calculated average glandular dose (calculated AGD) were calculated. Then, the display effects of simulated fibers, simulated calcifications and simulated masses within the modal body were scored subjectively, and the changes in image quality and radiation dose at different steps were analyzed, and the relationships between ESD and ESAK, displayed AGD and calculated AGD, and displayed AGD/ESD and calculated AGD/ESAK were analyzed. A linear fit was used for the steps with SNR, CNR, and FOM, and an exponential function curve fit was used for the steps with mAs, ESAK, and calculated AGD. The differences between ESD and ESAK, displayed AGD and calculated AGD, and displayed AGD/ESD and calculated AGD/ESAK were analyzed by paired-samples t test. Results:The CNR and SNR of mammographic images rose and fell by about 8% with each increase or decrease of one step. The scores of image simulated fibers, simulated calcifications, and simulated masses showed an overall upward trend with increasing steps, but there were still cases where the scores decreased with increasing grades. FOM varied from 97% to 104% at each grade with little variability. ESD, ESAK, displayed AGD, and calculated AGD, which could measure radiation dose, showed an exponential trend of increasing function with increasing steps, with a variation of about 63% to 165%. There were statistically significant differences ( t=-9.61, P=0.001) between ESD (15.14±10.08) and ESAK (16.66±11.07). However, there were no statistically significant differences ( t=1.20, P=0.240) between displayed AGD and calculated AGD, which were 3.66±2.18 and 3.61±1.99, respectively. Conclusions:The adjustment of density exposure steps can make the image quality change linearly and the radiation dose change exponentially with increasing speed, and the mode and magnitude of the adjustment are appropriately stable with high application value.
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Objective:To explore the value of deep learning technology based on mammography in differentiating for breast imaging reporting and data system (BI-RADS) category 3 and 4 lesions.Methods:The clinical and imaging data of 305 patients with 314 lesions assessed as BI-RADS category 3 and 4 by mammography were analyzed retrospectively in Shenzhen People′s Hospital and Shenzhen Luohu People′s Hospital from January to December 2020. All 305 patients were female, aged 21 to 83 (47±12) years. Two general radiologists (general radiologist A and general radiologist B) with 5 and 6 years of work experience and two professional breast imaging diagnostic radiologists (professional radiologist A and professional radiologist B) with 21 years of work experience and specialized breast imaging training were randomly assigned to read the imaging independently at a 1∶1 ratio, and then to read the imaging again in combination with the deep learning system. Finally, breast lesions were reclassified into BI-RADS category 3 or 4. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the diagnostic performance, and the differences of AUCs were compared by DeLong method.Results:The AUC of general radiologist A combined with deep learning system to reclassify BI-RADS category 3 and 4 breast lesions was significantly higher than that of general radiologist A alone (AUC=0.79, 0.63, Z=2.82, P=0.005, respectively). The AUC of general radiologist B combined with deep learning system to reclassify BI-RADS category 3 and 4 breast lesions was significantly higher than that of general radiologist B (AUC=0.83, 0.64, Z=3.32, P=0.001, respectively). There was no significant difference in the AUCs between professional radiologist A combined with deep learning system and professional radiologist A, and professional radiologist B combined with deep learning system and professional radiologist B in reclassifying BI-RADS category 3 and 4 breast lesions ( P>0.05). Conclusion:The deep learning system based on mammography is more effective in assisting general radiologists to differentiate between BI-RADS category 3 and 4 lesions.
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Objective:To investigate the value of gray value (GV) measurement of subtraction images in contrast-enhanced spectral mammography (CESM) in the differential diagnosis of breast benign and malignant calcification.Methods:This was a retrospective study. A total of 95 patients received CESM only with mammographic calcifications without any associated mass or distortions from March 2017 to July 2021 in Peking University Cancer Hospital were enrolled. The patients were all female with an average age of 34-76(48±7) years. The craniocaudal (CC) projection of bilateral breasts was obtained prior to the mediolateral-oblique (MLO) projection. Two radiologists were asked to independently review the images to diagnose the calcification as either benign or malignant based on the presence of enhancement on subtracted imaging. GV of the calcification and background parenchyma including breast parenchyma tissue, the pectoralis major muscle and subcutaneous fatty tissue were measured by another two radiologists. The difference of lesion to background parenchyma GV (D GV) and lesion to background parenchyma gray value ratio (DR GV) were calculated. The consistency of observers was compared using the Kappa statistic. The stability of GV was evaluated with coefficient of variation. Differences of GV, D GV and DR GV between benign and malignant calcification were compared using t test or Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of GV in differentiating benign from malignant calcification. Comparisons between diagnostic efficacies were performed using χ 2 tests. Results:Totally 97 calcification (35 malignant and 62 benign) from 95 patients were enrolled. The consistency and stability of GV values on MLO and CC projections measured by two physicians were high. The GV, D GV and DR GV of malignant calcification were significantly higher than those of the benign lesions ( P<0.05). The area under the ROC curve for the differential diagnosis of benign and malignant calcification by GV in the MLO and CC positions was 0.799 and 0.843, respectively. Threshold of calcified area GV=2015.5 in CC position, its diagnostic accuracy was 76.8%, which was similar to the subjective diagnosis of radiologists (82.1%, 78/95, P>0.05). Conclusion:Quantitative GV on subtracted imaging of CESM can differentiate benign from malignant breast calcification, especially on craniocaudal projection.
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Objective:To investigate whether ultrasound features, mammographic features and immunohistochemical indicators show any association with rates of axillary pathologic complete response(pCR) in cN 1 breast cancer patients receiving neoadjuvant chemotherapy(NAC), and to construct prediction models of axillary pCR to predict axillary lymph nodes (ALN) status, so as to select suitable patients for less invasive axillary surgery after NAC. Methods:This retrospective study evaluated 134 consecutive cN 1 breast cancer patients with ALN metastasis who underwent NAC in the Second Affiliated Hospital and Tumor Hospital of Harbin Medical University from July 2020 to July 2022. According to the pathological results of ALN surgery after NAC, the cases were divided into pCR and non pathologic complete respose(npCR) groups. The ultrasound images, mammographic images and immunohistochemical indicators of the two groups were compared. In terms of logistic regression algorithm, the model A(the ultrasound model), the model B(the ultrasound combined with mammography model), the model C(the ultrasound combined with immunohistochemistry model) and the model D(the ultrasound combined with mammography and immunohistochemistry model) were respectively established for predicting the pathological state of axillary lymph nodes in breast cancer patients, ROC curves were plotted to evaluate the performance of the models, and the diagnostic efficiency of different models was compared by Delong′s test. The model with the best predictive performance was shown in a nomogram. Results:①The P values between two groups of the short diameter of ALN, the ratio of long/short diameter of ALN, fatty hilum and central hilar vascularity, mammographic spiculation, estrogen receptor(ER), progesterone receptor(PR), human epidermal growth factor receptor 2(HER2) were <0.05 by the t test and χ 2 test analysis. ②The ratio of long/short diameter and fatty hilum in the model A were independent factors for predicting the pathological status of ALN after NAC. The independent predictors of model B and Model C were respectively added with mammographic spiculation and immunohistochemical indicators (ER, PR) on the basis of model A. In the model D, the ratio of long/short diameter, short diameter, fatty hilum, mammographic spiculation, and immunohistochemical indicators (ER, PR) remained significant independent predictors associated with axillary pCR. ③The area under ROC curve (AUC) of the model A, B, C, D was 0.78, 0.84, 0.84 and 0.89, respectively. The sensitivity was 0.71, 0.80, 0.78 and 0.86, the specificity was 0.76, 0.74, 0.76 and 0.80, and the accuracy was 0.73, 0.76, 0.77 and 0.83, respectively. ④Delong′s test showed the model D had an improved AUC of 0.89(0.89 vs 0.78, 0.84, 0.84, all P<0.05). Conclusions:The prediction models combining bi-modal imaging and immunohistochemical indicators show good prediction ability and can provide reference for selecting suitable patients for less invasive axillary surgery after NAC.