Acesso e acessibilidade ao rastreamento de câncer em mulheres brasileiras com lesão medular / Acceso y accesibilidad al rastreo de cáncer en mujeres brasileñas con lesión medular / Access and accessibility to cancer screening for Brazilian women with spinal cord injury

Resumo Objetivo identificar e analisar a acessibilidade e o acesso de mulheres brasileiras com lesão medular para a realização de exames preventivos do câncer de mama e colo de útero. Método estudo quantitativo e transversal desenvolvido em plataforma virtual. Realizadas análises estatísticas descritivas e de associação entre as variáveis qualitativas por meio do teste exato de Fisher. Quando identificada a associação (p<0,05), foi realizada a regressão logística. Resultados participaram 120 mulheres brasileiras com lesão medular com idades entre 25 e 67 anos; 85,83% foram ao ginecologista após a lesão medular, 79,17% realizaram a citologia e 52,50%, a mamografia. Observou-se que as mulheres que utilizavam a saúde suplementar apresentaram maior probabilidade de terem ido ao ginecologista do que as usuárias do serviço público. Aquelas com companheiro e as de maior idade apresentaram maior probabilidade de terem realizado o exame de citologia. Para a mamografia, aquelas de maior idade e que utilizavam a saúde suplementar apresentaram maiores chances de terem realizado o exame de mamografia após a lesão medular. Conclusão mulheres com lesão medular buscam a realização de exames de rastreamento. Entretanto, encontram dificuldades relacionadas à estrutura física, aos equipamentos, transporte, profissionais da saúde, assim como dificuldades sociodemográficas e quanto ao serviço de saúde utilizado.

Resumen Objetivo este estudio tuvo como objetivo identificar y analizar la accesibilidad y el acceso de mujeres brasileñas con lesión medular para la realización de exámenes preventivos de cáncer de mama y de cuello uterino. Método se desarrolló un estudio cuantitativo y transversal, realizado en un entorno virtual. Los análisis estadísticos descriptivos y la asociación entre variables cualitativas se realizaron mediante la prueba exacta de Fisher, cuando se identificó una asociación se realizó una regresión logística. Resultados participaron 120 mujeres brasileñas con lesión medular, la edad de las participantes varió de 25 a 67 años. Con relación al rastreo, el 85,83% de las mujeres acudió al ginecólogo tras la LM, el 79,17% se sometió a citología y el 52,50% a mamografía. Se observó que las mujeres que utilizaban un seguro médico privado tenían más probabilidades de haber visto a un ginecólogo que las usuarias del servicio público. Las que tenían pareja y mayores tenían más probabilidades de someterse a citología oncótica. Para la mamografía, las que eran mayores y que usaban un seguro médico privado tenían más probabilidades de someterse al examen después de la LM. Conclusión las mujeres con LM buscan pruebas de detección. Sin embargo, enfrentan dificultades relacionadas con la estructura física, equipamientos, transporte, profesionales de la salud, así como dificultades sociodemográficas relacionadas con el tipo de servicio de salud utilizado.

Abstract Objective to identify and analyze the accessibility and accessibility of Brazilian women with spinal cord injury to preventive examinations for breast and cervical cancer. Method quantitative and cross-sectional study developed in a virtual platform. Descriptive statistical analysis was performed, as well as association analysis between qualitative variables using Fisher's exact test. When identified the association (p<0.05), logistic regression was performed. Results a total of 120 Brazilian women with spinal cord injury, aged between 25 and 67 years participated in the study; 85.83% visited a gynecologist after the spinal cord injury, 79.17% underwent cytology and 52.50% underwent mammography. It was observed that women who used the supplementary health plan were more likely to have visited a gynecologist than those who used the public service. Those who had a partner and were older were more likely to have undergone the cytology exam. For mammography, those who were older and who used supplementary health care were more likely to have had mammography exams after the spinal cord injury. Conclusion women with spinal cord injury seek screening tests. However, they encounter difficulties related to the physical structure, equipment, transportation, health professionals, as well as socio-demographic difficulties and difficulties regarding the health service used.

Effect of testosterone on proliferation markers and apoptosis in breasts of ovariectomized rats / Efeito da testosterona em marcadores de proliferação e apoptose em mamas de ratas ovariectomizadas

Abstract Objective To investigate the action of testosterone (T), isolated or associated with estradiol benzoate (EB), on the proliferation markers and apoptosis of breasts of ovariectomized rats. Methods A total of 48 castrated female Wistar rats were divided into 6 groups, and each of them were submitted to one of the following treatments for 5 weeks: 1) control; 2) EB 50 mcg/day + T 50 mcg/day; 3) T 50mcg/day; 4) EB 50 mcg +T 300 mcg/day; 5) T 300 mcg/day; and 6) EB 50 mcg/day. After the treatment, the mammary tissue was submitted to a histological analysis and immunoexpression evaluation of proliferation markers (proliferating cell nuclear antigen, PCNA) and apoptosis (caspase-3). Results There was a statistically significant difference among the groups regarding microcalcifications and secretory activity, with higher prevalence in the groups treated with EB. There was no difference among the groups regarding atrophy, but a higher prevalence of atrophy was found in the groups that received T versus those that received EB +T. There was a difference among the groups regarding the PCNA (p = 0.028), with higher expression in the group submitted to EB +T 300 mcg/day. Regarding caspase-3, there was no difference among the groups; however, in the group submitted to EB +T 300 mcg/day, the expression was higher than in the isolated T group. Conclusion Isolated T did not have a proliferative effect on the mammary tissue, contrary to EB. Testosterone in combination with EB may or may not decrease the proliferation, depending on the dose of T.

Resumo Objetivo Investigar a ação da testosterona (T) isolada ou associada ao benzoato de estradiol (EB) na proliferação e apoptose de mamas de ratas ovariectomizadas. Métodos Um total de 48 ratas Wistar castradas foram divididas em 6 grupos, e cada um foi submetido a um dos seguintes tratamentos durante 5 semanas: 1) controle; 2) BE 50 mcg/dia + T 50mcg/dia; 3) T 50 mcg/dia; 4) BE 50 mcg + T 300mcg/dia; e) T 300 mcg/dia; e f) BE 50 mcg/dia. Após o tratamento, o tecido mamário foi submetido a análise histológica e avaliação de imunoexpressão de marcadores de proliferação (antígeno nuclear de células proliferantes, PCNA) e apoptose (caspase-3). Resultados Houve diferença estatisticamente significante entre os grupos com relação às microcalcificações e à atividade secretora, com maior prevalência nos grupos tratados com BE. Não houve diferença entre os grupos quanto à atrofia, mas houve maior prevalência de atrofia nos grupos que receberam T versus os que receberam BE+ T. Houve diferença entre os grupos quanto ao ANCP (p= 0,028), com maior expressão no grupo BE+ T 300 mcg/dia. Com relação à caspase-3, não houve diferença entre os grupos, mas, no grupo BE+ T 300 mcg/dia, a expressão foi maior do que no grupo de T isolada. Conclusão A T isolada não apresentou efeito proliferativo do tecido mamário, contrariamente ao EB. A T em associação ao EB pode diminuir ou não a proliferação, a depender da dose de T.

Correlación ecográfica, citológica y mamográfica en el diagnóstico del cáncer de mama / Mammographic, cytological, and ecographic correlation in the diagnosis of breast cancer

FUNDAMENTO: el cáncer de mama es la segunda causa de muerte por cáncer y su diagnóstico se basa en la obtención de los factores de riesgo, los hallazgos al examen físico, las pruebas de imágenes y el examen microscópico. OBJETIVO: establecer la correlación ecográfica, citológica y mamográfica en el diagnóstico del cáncer de mama. Métodos: se realizó un estudio de serie de casos, descriptivo, correlacional y prospectivo en un universo de 94 pacientes con diagnóstico de algún tipo de cáncer de mamas atendidas en el Hospital Provincial Universitario Celia Sánchez Manduley, Manzanillo, Granma, desde enero de 2013 a junio de 2014. Los datos fueron obtenidos de las historias clínicas determinándose los hallazgos ecográficos, citológicos, mamográficos y la correlación entre ellos con la biopsia posoperatoria por inclusión en parafina en el establecimiento del diagnóstico definitivo. RESULTADOS: Predominaron los hallazgos ecográficos de una masa sólida hipoecoica de contornos mal definidos e irregulares y mamográficos de una imagen radiopaca de contornos mal definidos, irregulares o espiculados. La correlación entre las pruebas diagnósticas fue de 0,83. CONCLUSIONES: los resultados del diagnóstico ecográfico, citológico y mamográfico en el cáncer de mama eleva la posibilidad de detección de esta enfermedad a valores casi absolutos al tener un coeficiente de correlación elevado.

BACKGROUND: breast cancer is the second cause of death due to this condition and its diagnosis is based on the obtaining of risks factors, finds in the physical examination, imaging tests, and the microscopic test. OBJECTIVE: to establish the mammographic, cytological, and ecographic correlation in the diagnosis of breast cancer. Methods: a prospective, correlation, descriptive, case series study was conducted in a universe of 94 patients with the diagnosis of any type of breast cancer treated in the Celia Sánchez Manduley Provincial Teaching Hospital, Manzanillo, Granma, from January, 2013 to June, 2014. The data were obtained from medical histories. Ecographic, cytological, mammographic finds and their correlation with the postoperative biopsy by paraffin inclusion were determined, establishing the definite diagnosis. RESULTS: ecographic finds of a hypoechoic solid mass of irregular and non-defined margins predominated, as well as mammographic finds of a radiopaque image of spicular, irregular, non-defined margins. The correlation among the diagnostic tests was of 0, 83. CONCLUSIONS: the results of the ecographic, cytological and mammographic diagnosis in breast cancer increases the possibility of detecting the disease to almost-absolute values since there is a high correlation coefficient.

Sewing Needle in Breast Parenchyma.

A 38 year old woman presented with pain in her left breast for last 8 days. She had a history of fall in road 8 days back. She was investigated with X-ray, ECG but no abnormality found. She was treated symptomatically, but got no relief. When we examined the patient, a stiff cord like structure was found deep in the lower outer quadrant of the left breast parenchyma. In the same old X-ray, a long thin pointed foreign body was seen in parallel and superimposed on an underline rib. The breast was explored under local anesthesia; a swing needle was found and removed. Foreign body like sewing needle in breast tissue is an extremely uncommon clinical condition; proper clinical examination and correlation with investigation can clinch the diagnosis early.

La relación núcleo-citoplasmática en la diferenciación y transformación celular del epitelio mamario / The nucleo-cytoplasmic relationship in the differentiation and cellular transformation of the mammary epithelium

ANTECEDENTES: Las células pertenecientes a la línea HC11 son estimuladas tanto a proliferar mediante el Factor de Crecimiento Epidérmico, como a diferenciar estimuladas con dexametasona, insulina y prolactina, dando origen a los tipos celulares HC11 GM y HC11 IM, respectivamente. De igual manera cuando ellas son transfectadas con el oncogén ras generan Q6 GM y Q6 IM, células transformadas. Producto de ambos mecanismos estas células asumen distintas propiedades modificando tanto sus componentes como sus funciones, los cuales pueden ser cuantificados mediante técnicas morfométricas. OBJETIVO: Evidenciar en términos cuantitativos y morfológicos las variaciones experimentadas tanto por los núcleos como los citoplasmas y su correspondiente relación núcleo-citoplasmática (N/C) pertenecientes a células mamarias de la línea HC11 con el decorrer de los mecanismos de diferenciación y de transformación celular. MÉTODO: Se estudió a nivel de microscopia electrónica de transmisión los tipos celulares en proceso de diferenciación y transformación, cuantificando variaciones de la relación núcleo-citoplasmática y su respectiva funcionalidad. RESULTADOS: Se evidencian diferencias estadísticamente significativas referentes a las áreas nucleares y citoplasmáticas pertenecientes a estos tipos celulares. CONCLUSIÓN: Las células del epitelio mamario en proceso de diferenciación como de transformación, presentan diferentes valores en su relación N/C hecho que responde a funcionalidades específicas en cada tipo celular.

BACKGROUND: Cells of the HC11 line are stimulated to proliferate using the Epidermic Growth Factor, and to differentiate with dexamethasone, insulin and prolactin, giving rise to cell types HC11 GM and HC11 IM, respectively. Likewise when they are transfected with the ras oncogen they generate Q6 GM and Q6 IM transformed cells. As a result of these two mechanisms, these cells assume different properties, in which both their components and their functions are modified. The modifications can be quantified by morphometric techniques. OBJECTIVE: To show in quantitative and morphological terms the variations effected in both the nuclei and the cytoplasms, and the corresponding nuclear-cytoplasmic ratio of mammary cells of the HC11 line, under the effects of cellular differentiation and transformation mechanisms. METHOD: The cell types undergoing differentiation and transformation processes were studied by transmission electron microscope, permitting quantification of variations in the nuclear-cytoplasmic ratio and its relation with the respective functions. RESULTS: Statistically significant differences were found in the nuclear and cytoplasmic areas of these cell types. CONCLUSION: cells of the mammary epithelium undergoing differentiation and transformation processes present different values for their nuclear-cytoplasmic ratio, and this responds specific functions in each cell-type.

Anti-proliferation effect of Hevea brasiliensis latex B-serum on human breast epithelial cells

The rubber tree [Hevea brasiliensis] extracts are becoming increasingly visible in pharmaceutical and therapeutical research. The present study is aimed at examining the specific anti-proliferation property of H. brasiliensis latex B-serum sub-fractions against human breast cancer epithelial cell lines MCF-7 and MDA-MB231. The results showed that the latex whole B-serum and DBP sub-fraction exerted a specific anti-proliferation activity against cancer origin cells MDA-MB231 but had little effect on non-cancer-origin cells. On the other hand, the anti-proliferative activity was diminished in the pre-heated B-serum fractions. With the low toxicity that the B-serum demonstrated previously in Brine Shrimp Lethality Test [BSLT], the present results suggest the potential use of the B-serum subfractions in cancer treatment

Relevancia de la apoptosis en la reproducción femenina / Relevance of apoptosis in the female reproductive system

La apoptosis es un proceso genéticamente controlado mediante el cual las células inducen su propia muerte. Mensualmente y en forma cíclica, el ovario, el endometrio y la glándula mamaria atraviesan por ciclos de proliferación celular y apoptosis respondiendo a los cambios en la secreción hormonal. Durante el desarrollo embrionario, la apoptosis está implicada en procesos relacionados con la escultura de los diferentes órganos, a través de la eliminación de estructuras innecesarias y con el control de las células defectuosas. Asimismo, la apoptosis juega un papel fundamental en la función ovárica. La reserva folicular se establece durante la vida fetal y luego se va eliminando gradualmente. La apoptosis está involucrada tanto en la muerte celular durante el proceso de reclutamiento del folículo dominante, como en la luteólisis. Durante la pubertad la apoptosis contribuye a la formación del espacio luminal de los ductos terminales de la mama. A su vez, el proceso de involución mamaria luego de la lactancia se caracteriza por una apoptosis masiva de las células epiteliales secretoras. Así como la apoptosis está involucrada en los cambios fisiológicos que ocurren a nivel endometrial, también se ha asociado a la muerte celular programada con procesos patológicos, especialmente en aquellos caracterizados por el incremento en el crecimiento celular como es el caso de la endometriosis. El delicado balance entre la apoptosis y la proliferación celular es fundamental ya que permite que los tejidos puedan responder en forma cíclica a los cambios hormonales fisiológicos y prevenir procesos de transformación neoplásica.

Apoptosis is a genetically controlled form of cell suicide. Due to the cyclic nature of the female reproductive system, the ovary, the endometrium and the mammary gland sustain continuous cycles of cell growth and apoptosis in response to hormonal changes. Apoptotic cell death plays multiple roles during embryonic and organ development. It is involved in sculpturing tissues and serves to delete structures that are no longer required. It is clear that apoptosis plays an active and important role in ovarian physiological functions. Apoptosis plays a major role during folliculogenesis and dominant follicle selection and also plays part in corpus luteum regression. In addition, it has been shown that programmed cell death plays important roles in the mammary gland development and ductal morphogenesis. During puberty, lumen formation is associated with the selective apoptosis of centrally located cells. In turn, postlactational involution of the mammary gland is characterized by the secretory epithelial cells undergoing programmed cell death. Apoptosis has also been associated with physiological, as well as pathological, endometrial processes such as cancer and endometriosis. The delicate balance between apoptosis and cell proliferation is essential in controlling the cyclical growth of the reproductive tissues and plays an important role in the prevention of neoplastic transformation.

Rapidly Growing Bilateral Pseudoangiomatous Stromal Hyperplasia of the Breast

A tumoral pseudoangiomatous stromal hyperplasia (PASH) that causes huge breast enlargement is very rare. Only two cases of huge tumoral PASHs have been reported in the English medical literature. We report here on a surgically confirmed case of bilateral huge tumoral PASH in a 47-year-old woman, and we present the imaging and histopathology findings. We also review the relevant medical literature.

Estudios percutáneos de mama: punción aspirativa con aguja fina / Percutaneous studies of the breast: fine needle aspiration

Procedimiento de diagnóstico de patologías benignas y malignas, del que se describe su uso en diagnósticos citológicos, aspiración diagnóstica y/o sintomatológica de quistes y/o formaciones líquidas, instilación de antibióticos en cavidades abscedadas, e instilación de contrastes en ductos.

Análisis morfométrico de lisosomas: marcadores de transformación celular del epitelio mamario / Morphometric analysis of lysosomes: markers of cellular transformation of the mammary epithelium

ANTECEDENTES: Transformación celular es el mecanismo resultante de la potente acción generada por onco-genes transformantes sobre una célula normal, los cuales con la consiguiente expresión de oncoproteínas determinan drásticos cambios tanto en la morfología como en los volúmenes de los componentes celulares, generando una célula con diferente funcionalidad. OBJETIVO: Precisar las modificaciones que caracterizan al mecanismo transformante en células de epitelio mamario transfectado con el oncogén ras (HC1 Iras) en comparación con su tipo celular normal (HC11GM). MÉTODO: Se estudió con microscopía electrónica de transmisión aplicando técnicas morfométricas a estos tipos celulares con énfasis en los lisosomas, cuantificando variaciones del organelo responsable de la digestión celular. RESULTADOS: Todos los parámetros lisosomales evaluados en el tipo celular transformado presentan diferencias significativas con respecto a la célula normal. CONCLUSIÓN: Las drásticas modificaciones experimentadas por los lisosomas se reflejan en la adquisición de nuevas funcionalidades en la célula transformada.

BACKGROUND: Cellular transformation is the result mechanism of powerful action generated by transforming oncogene over a normal cell, which with the subsequent oncoprotein expression leads to drastic changes in morphology as well as in cell components volumes, generating a cell with a different function. OBJECTIVE: To specify the modifications that characterizes the transforming mechanism in mammary epithelial cells transfected with the ras oncogene comparing them with its normal cell type. METHOD: Transmission electronic microscopy using morphometric techniques was applied to this cell types, emphasizing lysosomes variations, trying to clarify its role in each cell type metabolism. RESULTS: Everyone lysosomal parameters examined in transformed cell type present significant differences regarding to the normal cells. CONCLUSION: The drastic changes in lysosomes reflected in the acquisition of new energy requirements and metabolism in the transformed cell.

Correlação entre exame clínico das mamas, exame mamográfico e exame histopatológico de mulheres atendidas em uma clínica de mastologia no Sul do Brasil / Correlation between clinical breast examination, mammography and histopathology examination of women attending in a mastology clinic at the South of Brazil

Objetivos: O objetivo do presente estudo foi correlacionar o exame clínico das mamas, a mamografia e a histopatologia, e verificar a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo. Métodos: Foram analisados 193 prontuários de pacientes atendidas em uma clínica privada no município de Santo Ângelo, RS. As variáveis identificadas foram a idade das pacientes, os resultados dos exames clínicos, mamográficos e histopatológicos. Resultados: As mulheres apresentaram idade média de 48,5 anos, variando de 18 a 92 anos. Tiveram exame clínico negativo ou com alterações benignas 55,4% no histopatológico com o exame clínico. Quando foi correlacionado o diagnóstico histopatológico com o exame clínico das mamas, foi observada associação significante (p < 0,001), com sensibilidade de 94,2%, especifidade de 33,6%, valor preditivo positivo de 53,3% e valor preditivo negativo de 87,8%. O histopatológico com mamográfico teve maior associação, quando analisada a categoria BI-RADS V com sensibilidade de 54,7%, especificidade de 99,1%, valor preditivo positivo de 97,9% e valor preditivo negativo de 73,1%. Conclusão: A palpação mamária isolada pode ser um simples, rápido e eficiente exame clínico de rastreamento para o câncer de mama. O histopatológico benigno apresenta maior correlação dentro do BI-RADS I, II e III. As pacientes com classificação BI-RADS IV e V devem ser submetidas a exame histopatológico pelo alto risco de doença maligna associada.

Objective: The aim of the present study was to correlate the clinical breast examination, mammography and histopathology, to verify the sensitivity, specificity, negative and positive predictive values. Materials and Methods: Were analized 193 of pacients seen at a private clinic in the city of Santo Ângelo, RS. The variables identified were the pacient's age, the clinical exam results, mammography and histopathological. Results: The average of the women was 48.5 years , varying from 18 to 92. 55.4% had negative exam or benignant alteration on the histopathological. When the histopathological was correlated with the clinical breast examination, a significant association was seen (p < 0.001), with sensitivity 94.2%, specificity 33.6%, negative and positive values 87.8% and 53.3% . The histopathological shows bigger corralation inside BI-RADS V, with sensitivity 54.7%, specificity 99.1%, negative and positive values 73.1% and 97.9%. Conclusion: Mammary touching alone can be a simple, fast and efficient screening clinical examination for breast cancer. The histopathological shows bigger correlation inside BI-RADS 0, I, II, III. Pacients with BI-RADS IV, V must be submitted to histopathological exam for the high risk of associated malignant disease.

Imaging Findings of Implanted Absorbable Mesh in Patients with Breast Partial Resection

PURPOSE: The author presents imaging findings of patients that underwent partial resection of the breast followed by absorbable mesh implantation. MATERIALS AND METHODS: Ultrasonographic (n=18) and mammographic (n=11) images of patients that had undergone absorbable mesh implantation after breast partial resection were reviewed retrospectively. Sequential changes of the lesions were analyzed in follow-up ultrasonographic examinations, focusing on the change of the size and pattern of the lesion. The presence of a mass, asymmetry, focal asymmetry, architectural distortion, and calcification were evaluated by mammography. Pathologic findings of the implanted mesh in available cases were analyzed. RESULTS: Ultrasonograms revealed a well-encapsulated anechoic lesion with (pattern 1, n=11) or without (pattern 2, n=5) internal isoechoic nodular portion, and a hyperechoic mass-like lesion without anechoic portion (pattern 3, n=2). The mean length of the longest diameter decreased gradually as determined in follow-up examinations (3 months, 6.12 +/- 2.599cm; 6 months, 5.08 +/- 2.105cm; 12 months, 3.26 +/- 2.206cm). In mammograms, a mass (n=4) was noted at the surgical site and focal asymmetry, overlapping with the postoperative change, was seen in the remaining seven cases. Pathologic findings of two cases revealed foreign body reaction. CONCLUSION: Ultrasonography of the patients that underwent breast partial resection followed by absorbable mesh implantation showed a well-encapsulated cyst at the surgical site that gradually decreased in follow-up examinations. Adjunctive ultrasonography combined with mammography would be recommended in postoperative follow-up examinations.

Fine-needle aspiration biopsy for breast lesions: a comparison between two devices for obtaining cytological samples

CONTEXTO E OBJETIVO: A punção aspirativa por agulha fina (PAAF) tem sido aceita em todo o mundo como parte da investigação diagnóstica das lesões mamárias. Não obstante, permanece por ser definida qual a melhor técnica na obtenção dos aspirados. O objetivo deste trabalho é comparar os aspirados obtidos pelo dispositivo de autovácuo com aqueles obtidos com a pistola de apreensão de seringa. TIPO DE ESTUDO E LOCAL: Estudo randomizado para validação de teste diagnóstico realizado no Departamento de Ginecologia e Obstetrícia da Universidade Federal de Goiás e Hospital Araújo Jorge da Associação de Combate ao Câncer em Goiás. MÉTODOS: Estudo aleatório, incluindo 351 pacientes, que apresentaram nódulos mamários e foram submetidas à PAAF, por um dos dois métodos de punção. Uma única citologista analisou todas as lâminas. As taxas de material insuficiente, celularidade, distorção celular e hemorragia de fundo foram analisados. RESULTADOS: A taxa percentual de material insuficiente foi de 16% e 2% (p = 0,18), para o dispositivo de autovácuo e para a pistola, respectivamente. Boa celularidade foi observada em 34% das amostras obtidas com o auto-vácuo e em 29% daquelas obtidas com a pistola (p = 0,4). Distorção celular foi vista em 31 casos e 26 casos, respectivamente (p = 0,7). Hemorragia de fundo ocorreu em 63 casos (35%) e em 54 (31%) (p = 0,2), para o autovácuo e para pistola. A sensibilidade foi de 88% e 86%; a especificidade de 99% e 100%, o valor preditivo positivo de 96% e 100%, o valor preditivo negativo de 96% e 95% e a acurácia total de 76% e 75% para o autovácuo e para a pistola, respectivamente. CONCLUSÃO: Os aspirados obtidos por ambas as técnicas foram equivalentes. Assim, o autovácuo se firma como uma boa opção na obtenção de aspirados para estudo citológico de lesões mamárias.

Analysis of false positive and false negative cytological diagnosis of breast lesions

To study the reasons for interpretive errors in false negative and false positive diagnosis of breast carcinoma on fine needle aspiration cytology material. We reviewed only those cases in which cytohistological discrepancies were found, where the cytologic material was abnormal and to some extent misinterpreted or both. There was only one false negative case [false negative fraction 0.32%] proved histologically as ductal carcinoma and four false positive cases [false positive fraction 1.2%]; 2 fibroadenoma; 1 fibrocystic disease; and 1 stromal fibrosis. Smears of the two false positive fibroadenoma cases showed very high cellularity, overcrowded clusters and frequent stripped nuclei. The fibrocystic case showed tight clusters of apocrine cells and sheets of loosely aggregated macrophages that were over interpreted. Smears of the false negative ductal carcinoma was hypocellular overall, and the cells showed minimal nuclear pleomorphism. Overcrowded clusters and hypercellular smears should be carefully assessed for uniformity of cells and detailed nuclear and cytomorphological features. If the full-blown malignant cytomorphological changes are not visible, a diagnosis of suspicious or inconclusive should be made and frozen section recommended before surgery. Hypocellularity and relatively nuclear monomorphism are the reasons for failure to diagnose malignant breast lesions. Careful attention should be paid to extreme nuclear monomorphism and absence of naked bipolar cells. A cytologically atypical or suspicious diagnosis together with positive radiological and clinical findings should suggest a diagnosis of malignancy

Pattern of breast diseases in a teaching hospital in Jeddah, Saudi Arabia

The aim of this case series study is to evaluate the outline and pattern of male and female breast diseases in Saudi Arabia. Also to compare 8 studies of literature discussing the profile of malignant and benign female breast diseases in the Kingdom. We hope that this study will assist us to appreciate the prototype breast diseases in our region. Our study consisted of 1084 consecutive male and female breast lesions. Data on these specimens, received in the time frame of 15 years between January 1984 and March 2000, was retrieved from the records of the laboratory. The outline of breast lesions were tabulated and classified into inflammatory, benign and malignant lesions. In female breasts, benign lesions comprised 57% of all lesions [mean age 28.5], most commonly reported being fibroadenoma 47%, fibrocystic disease 22% and fibroadenosis 14%. Malignant lesions comprised 32.5% of all lesions [mean age 48.49], most commonly reported being ductal carcinoma 88% and lobular carcinoma 4.5%. Inflammatory lesions comprised 11% of all lesions [mean age 35.0], most commonly reported lesion being chronic mastitis 31% and ductectasia 19%. Male benign lesions comprised 55 cases [87%]. Eight cases [13%] of malignant lesions, 6 ductal carcinomas and 2 metastatic adenocarcinomas, were also identified. The rates for female breast lesions varied in different studies but benign fibroadenoma constituted the most common breast lesion and secondly ductal carcinoma. The mean age for malignant lesion in 7 different studies came to be 44.05. In the male breast, carcinomas constituted 3% of all breast carcinomas. Gynecomastia being the most common male breast lesion constituting 54%

Correlación entre hallazgos de anatomía patológica y mamografía: Hospital Militar "Dr. Carlos Arvelo", enero-diciembre 1994 / Correlation between find of anatomy patology and mammographic: Hospital Militar \"Dr. Carlos Arvelo\" january-december 1994

La mamografía es el estudio más aceptado en pesquisa de cáncer en la actualidad. La mortalidad por cáncer de mama ha disminuido significativamente gracias al diagnóstico combinado por mamografía y citología de secreción o por punción con aguja fina. Con el objeto de describir las lesiones mamarias y hallar una correlación radiocitológica, se revisaron 194 informes de citología realizados durante 1994 junto con las historias clínicas, historias de patología mamaria y las mamografías en el archivo del HMCA. La mayoría de las muestras (77,84 por ciento) provino del HMCA, y del Servicio de Patología Mamaria con mayor frecuencia (38,4 por ciento). Se obtuvo información radiológica de 62 pacientes (31,96 por ciento). La Mediana de edad para toda la muestra y para pacientes con citología positiva, fue respectivamente 45 (12-84) y 50 (27-67) años, con predominio del grupo de 40-49 años (36,08 por ciento) sobre los otros grupos. Se obtuvo diagnóstico en 92 citologías (47 por ciento), y las restantes fueron "no concluyentes", con mayor compromiso del cuadrante súpero-externo, sin diferencia entre ambas mamas. Se encontró correlación mamográfico-citológica de la patología benigna, y en los casos de cáncer la radiología concluyó malignidad. Aún cuando la punción con aguja fina es un método valioso en el diagnóstico precoz de cáncer de mama, en el HMCA el procedimiento no reportó resultados satisfactorios por una toma de muestras aparentemente poco efectiva y ausencia de base radiológica que la justifique. La patología benigna puede ser diagnósticada sin estudios invasivos y la mamografia es de elección para el tamizado de cáncer de mama en mujeres mayores de 40 años

Citopunción ecoguiada de lesiones mamarias no palpables. Ventajes y limitaciones / Cytopuncture guided of nonpalpable breast lessions. Advantes and limitations

La nueva imagenología mamaria ha descubierto un grupo de lesiones no palpables que puede alcanzar hasta el treinta por ciento de los casos examinados

Estudio comparativo entre biopsia por aspiración vrs. biopsia excisión en el manejo de nódulos mamarios / Comparative study between aspiration biopsy vrs. excisional biopsy in the management of breast lesion

Se estudiaron 50 pacientes que consultaron por nódulo mamario en el lapso de mayo de 1993 a septiembre de 1995 para determinar la sensibilidad de la Biopsia por aspiración con aguja fina. El 62/100 de las pacientes fueron de 30 años (31), el 80/100 premenopáusicas; a todas se les realizó en el preoperatorio la biopsia por aspiración con aguja fina y sin importar el resultado, todas las masas sólidas fueron escindidas. Fueron reportados 9 casos de carcinoma mamario, 7 de los cuales fueron falsos negativos y ningún caso falso positivo, lo que reportó una sensibilidad del 33/100. Concluímos que los nódulos mamarios no pueden ser manejados únicamente con los resultados de la biopsia por aspiración con aguja fina. Debe tenerse la confirmación histológica, para determinar el tratamiento adecuado

Punción de tumoraciones mamarias con aguja fina / Punction of breast tumors with a fine needle

El cáncer mamario ocupa el segundo lugar de las tumoraciones malignas que afectan a la mujer en nuestro medio y la biopsia con aguja fina ha mostrado ser una técnica con alta sensibilidad y especificidad. El motivo del presente estudio es dar a conocer nuestra experiencia con esta técnica, así como su especificidad y sensibilidad en nuestra institución. Se estudiaron 22 pacientes, en las cuales el diagnóstico clínico fue de tumoraciones mamarias. A todas se les efectuó una biopsia con aguja fina y posteriormente se sometieron a una intervención quirúrgica. En todos los casos la citología inicial correlacionó con el hallazgo histopatológico. No se presentaron complicaciones. En este estudio se puede concluir que con una técnica correcta de la biopsia con aguja fina, es posible esperar buenos resultados ya que tanto la sensibilidad como la especificidad son altas y la correlación entre el estudio citopatológico e histopatológico es buena. Por ser un procedimiento simple y de bajo costo, debe ser considerado en el estudio de las pacientes con tumoraciones mamarias

Intra-operative cytology and frozen sections of breast lesions: a comparison from a Saudi teaching hospital

Evaluate the usefulness of intraoperative cytology in providing rapid and accurate diagnosis for various breast lesions and to compare its diagnostic yield with that of frozen and paraffin sections. Setting: All surgically excised breast lesions submitted to the Histopathology and Cytology Department at King Khalid University Hospital [KKUH], Saudi Arabia during a period of 18 months [May 1993 till October 1994]. Subjects: Fifty Saudi female patients admitted to the surgical wards at KKUH because of breast-related clinical complaints and who have had subsequent surgical excision of their breast lesions. Design: Touch imprints and scalpel blade scrapes were made from the cut surfaces of 50 different breast lesions. The cytological preparations were stained using the "Diff-Quick" method. Frozen sections were also performed on all cases. There were 28 benign and 22 malignant lesions. There were three cases of significant discrepancies between the intra-operative cytology and frozen section diagnosis. Our findings indicate that intra-operative cytology alone gave the correct diagnoses in 94% of the cases examined. Intraoperative cytology is a reliable and cost-effective technique which can be used as an adjunct to frozen section of breast lesions. The histopathologist should, however, be aware of the patient's clinical details, mammographic findings and the macroscopic appearances of the lesions examined