Evaluation of the accuracy of mammography, ultrasound and magnetic resonance imaging in suspect breast lesions

OBJECTIVES: In breast cancer diagnosis, mammography (MMG), ultrasonography (USG) and magnetic resonance imaging (MRI) are the imaging methods most used. There is a scarcity of comparative studies that evaluate the accuracy of these methods in the diagnosis of breast cancer. METHODS: A cross-sectional study was carried out through the review of electronic medical records of 32 female patients who underwent breast imaging examinations at a imaging diagnostic center in Teresina, State of Piauí, Brazil. Patients who had these three imaging methods at the time of the evaluation of the same nodule were included. The nodule must have been classified as suspect by the BI-RADS® system in at least one of the methods. Data from each method were compared with the histopathological examination. Statistical analysis used the calculation of proportions in Excel 2010. RESULTS: MMG showed 56.2%, 87.5%, 81.8%, 66.7% and 71.8% of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, respectively. USG had 75%, 18.8%, 48%, 42.8% and 46.9% of sensitivity, specificity, PPV, NPV and accuracy, respectively. In turn, MRI had 100%, 50%, 66.7%, 100% and 75% of sensitivity, specificity, PPV, NPV and accuracy, respectively. CONCLUSION: Thus, MRI and MMG were more accurate in evaluating suspicious breast lumps. MRI had a low specificity, mainly to high breast density, while MMG had also sensitivity limited due to high breast density and USG has been proven to be useful in these patients.

Association between matrix metalloproteinase-9 gene polymorphism and breast cancer in Brazilian women

OBJECTIVE: This study aimed to determine the relationship between rs17576 (MMP-9) polymorphism and increased cancer risk in a Brazilian breast cancer cohort. METHODS: This study included 141 women (71 breast cancer patients and 70 controls without breast cancer) who donated 3 mL of their peripheral blood for genomic DNA extraction. This DNA was then genotyped using a real-time polymerase chain reaction. RESULTS: The AG (rs17576) genotype was identified in 26 (18.43%) participants in the case group and in 22 (15.60%) participants in the control group (p=0.274), while the GG genotype was identified in ten (7.09%) participants in the case group and in one (0.70%) participant in the control group (p<0.003 - OR (95% CI) 13.13 (1.73, 593.08). No significant difference in the incidence rates was observed for AG or GG rs17576 genotypes in premenopausal women, p=0.813 and p=0.556, respectively. However, in postmenopausal women, the AG genotype was shown to occur in 14 (22.5%) participants in the case group and in 4 (6.45%) participants in the control (p<0.043), while GG genotype occurred in eight (12.90%) of the individuals in the case group and in none of the individuals in the control group (p<0.006). CONCLUSION: In this study, the MMP-9 rs17576 GG polymorphic variant was shown to be significantly associated with breast cancer risk in premenopausal women, while the AG and GG genotypes were associated with increased cancer risk in postmenopausal women.

Inhibition of Mmp-9 Expression through Nf-Kβ by Natural Compounds as a Possible Therapeutic Adjuvant Strategy in Breast Cancer: A Systematic Review

MMP-9 expression may be induced at the transcriptional level in response to different agents. Due to its fundamental role in cancer progression, the control of MMP expression, especially MMP-9, is the possible target of future adjuvant therapies that seek to reduce metastases and angiogenesis in women with breast cancer. Therefore, the aim of this study was to search in the literature available evidences of extracts/or natural compounds that have potential therapeutic capacity to inhibit MMP-9 expression. Extracts and/or natural compounds identified in this review play a significant role in the inhibition of MMP-9 expression via NF-kβ, and may act on the prevention of metastases from primary breast tumors. The majority of the studies found have shown that natural products are capable of suppressing migration and invasion of breast cancer cells, thus inhibiting the formation of in vitro metastases. Further studies are warranted to understand the potential mechanisms of breast cancer metastasis from signaling cascades intrinsic to the tumor. Moreover, the NF-kβ, followed by Mitogen Activated Protein Kinases / Activator protein 1 (MAPK / AP-1) were the major pathways affected by the extracts and / or compounds studied. These pathways are directly linked to MMP-9 expression.

Efeito de um protocolo de Facilitação Neuromuscular Proprioceptiva (FNP) no equilíbrio postural de idosas / Resultado de un protocolo de Facilitación Neuromuscular Propioceptivo (FNP) en el balance postural de adultos mayores / Effect of a Proprioceptive Neuromuscular Facilitation (PNF) protocol on the postural balance of older women

RESUMO Envelhecimento é um processo no qual existem alterações morfológicas, funcionais e bioquímicas. Os pés são estruturas acometidas nesse processo, afetando o equilíbrio corporal e aumentando o risco de quedas. Para minimizar esses efeitos, a Facilitação Neuromuscular Proprioceptiva (FNP) pode ser utilizada, pois melhora a perfusão, a força e a coordenação dos membros inferiores. Teve objetivo avaliar os efeitos da FNP no equilíbrio de idosos. Trata-se de estudo longitudinal e quantitativo, realizado em um hospital público em Teresina (PI). Participaram 20 idosas com idade entre 65 e 85 anos, submetidas a um protocolo de FNP. Foram coletados dados baropodométricos (áreas total, do antepé e do retropé) de forma estática (sem perturbação) e dinâmica (com perturbação), além do teste Timed Up and Go (TUG) e do teste de alcance funcional. Não houve diferença nas áreas plantares antes e após a intervenção, apesar da diminuição da área após os exercícios na avaliação estática (retropé antes: 150,85cm² e depois: 147,40cm²; p=0,0593) e na avaliação dinâmica (retropé antes: 154,30cm² e depois: 151,40cm²; p=0,0783). Foi observada diminuição do tempo do TUG de 10,75s para 8,23s (p<0,0001) um aumento da área de deslocamento, de 21,07cm para 31,10cm (p<0,0001) no teste de alcance funcional. As idosas apresentaram maior ativação dos músculos plantares, com diminuição da área de apoio após o protocolo de FNP. Houve melhora significativa no tempo de marcha e no alcance funcional nas idosas, o que está associado a um menor risco de quedas após os exercícios.

RESUMEN Envejecer es un proceso en el que ocurre cambios morfológicos, funcionales y bioquímicos. Los pies sufren este proceso, lo que afecta al balance corporal y aumenta el riesgo de caídas en los adultos mayores. Para minimizar estos efectos, la Facilitación Neuromuscular Propioceptiva (FNP) es empleada ya que mejora la perfusión, la fuerza y la coordinación de los miembros inferiores. Este estudio tiene el propósito de evaluar los resultados de la FNP en el balance postural de adultos mayores. Se trata de un estudio de tipo longitudinal y cuantitativo, llevado a cabo en un hospital público de la ciudad de Teresina, Brasil. Participaron veinte adultos mayores entre 65 y 85 años de edad, y los sometieron a un protocolo de FNP. Se recolectaron datos baropodométricos (áreas total, del antepié y del retropié) de forma estática (sin interferencias) y dinámicas (con interferencias), además de aplicar la prueba Timed Up and Go (TUG) y la prueba del alcance funcional. Las áreas plantares antes y después de la intervención no presentaron diferencias, aunque ocurrió una disminución del área después de los ejercicios en la evaluación estática (retropié antes: 150,85cm² y después: 147,40cm²; p=0,0593) y en la evaluación dinámica (retropié antes: 154,30cm² y después: 151,40cm²; p=0,0783). Se observó una disminución del tiempo del TUG de 10,75s para 8,23s (p<0,0001) y un aumento del área de desplazamiento de 21,07cm para 31,10cm (p<0,0001) en la prueba del alcance funcional. Los adultos mayores tuvieron sus músculos plantares más activados, con una disminución del área de apoyo después del protocolo FNP. Además, presentaron una mejora significativa en el tiempo de marcha y en el alcance funcional, lo que puede asociar a un menor riesgo de caídas después de los ejercicios.

ABSTRACT Aging causes morphological, functional and biochemical changes. Feet are affected in this process, which impairs the functional balance and increases the risk of falls. To reduce such effects, Proprioceptive Neuromuscular Facilitation (PNF) can be used, because it improves perfusion, strength and coordination of lower limbs. Objective: To evaluate the effects of PNF on balance in older adults. Method: This is a longitudinal and quantitative study, from a public hospital in Teresina-Piauí. Twenty women aged from 65 to 80 years were submitted to a PNF protocol. Baropodometry (total, forefoot and hindfoot areas) was measured in static (no perturbation) and dynamic (with perturbation) conditions. Timed Up and Go (TUG) and functional reach were also tested. No differences were found in forefoot when the areas before and after intervention were compared. However, the area decreased after the exercises in static (hindfoot before: 150.85cm² and after: 147.40cm²; p=0.0593) and dynamic assessments (hindfoot before: 154.30cm² and after: 151.40cm²; p=0.0783). TUG decreased from 10.75s to 8.23s (p<0.0001) and functional reach increased from 21.07cm to 31.10cm (p<0.0001). Older women showed higher activation of plantar muscles and the plantar area decreased after the PNF protocol. Gait speed and functional reach improved after the exercises and such improvement is associated to a lower risk of falls.

Avaliação da qualidade de sono em pacientes com câncer de mama em quimioterapia / Sleeping quality evaluation in patients with breast cancer in chemotherapy

Introdução: A quimioterapia consiste na forma mais utilizada para a retardação e o controle de tumores na mama. Entretanto, pacientes em quimioterapia muitas vezes têm que lidar com inú- meras complicações durante o tratamento, o que pode interferir na qualidade do sono. Objetivos: Avaliar a qualidade de sono de pacientes com câncer de mama em quimioterapia e comparar os grupos de boa (G1) e de má (G2) qualidade de sono. Métodos: Estudo observacional, quantitativo e transversal com amostra de 36 pacientes. Coletou-se índice de massa corporal (IMC), estadiamento do câncer, bem como aplicou-se os questionários PSQI-Br, EORTC-C30, escala Piper ­ Revisada, ESS-Br, Índice de Gravidade de Insônia, Escala Visual Analógica. Utilizou-se o teste de correlação de Pearson para associar as variáveis entre si, bem como o Teste t e o Teste do χ2 para efeito comparativo entre os grupos G1 e G2. Resultados: O PSQI-Br da amostra analisada foi de 5,36±2,73. Das 36 participantes da pesquisa, 21 (58,4%) apresentaram má qualidade de sono, obtendo uma pontuação entre 5 e 10. Já as outras 15 pacientes (41,8%) obtiveram pontuação entre 0 e 4, evidenciando uma boa qualidade de sono. Conclusão: Os níveis de PSQI-Br expuseram uma má qualidade de sono em pacientes com câncer de mama em quimioterapia. Ocorreu diferença significativa entre os grupos G1 e G2 nas variáveis idade, IMC, dor, fadiga, qualidade de vida e de sono.

Introduction: Chemotherapy is more used for retardation and control of breast neoplasms. However, patients undergoing chemotherapy often have to deal with numerous complications during treatment, which can affect the quality of sleeping. Objectives: To evaluate the sleeping quality of patients with breast cancer undergoing chemotherapy and to compare groups with good (G1) and poor (G2) quality of sleeping. Methods: Observational, quantitative and cross-sectional study with 36-patient sample. It was collected body mass index (BMI), cancer staging and it was applied the PSQI- Br, EORTC-C30, revised Piper Scale, ESS-Br, Insomnia Severity Index, Visual Analog Scale. We used the Pearson correlation test to associate the variables between themselves as well as the t test and χ2 test for comparison purposes between groups G1 and G2. Results: The PSQI- Br of the sample analyzed was 5.36±2.73. Out of 36 participants, 21 (58.4%) had poor sleep getting a score of 5 to 10. As for the other 15 patients (41.8%) had a score of 0 to 4, showing a good sleeping quality. Conclusion: The levels of PSQI-Br exposed a poor quality of sleeping in patients with breast cancer chemotherapy as well as significant difference between the groups G1 and G2 in the variables age, BMI, pain, fatigue, quality of sleeping and life.