Are All Views with and without Displacement Maneuver Necessary in Augmentation Mammography? Putting Numbers Into Perspective.

OBJECTIVE: Augmentation implants pose a challenge for radiologists. Displacing the implant allows slightly more breast tissue to be visualized than the standard compression views. The objective of this study was to verify the agreement between craniocaudal (CC) views and CC with implant displacement (CC-ID), mediolateral oblique (MLO) and MLO-ID and the inter- and intraobserver agreement of mammographic images for finding abnormal images. METHODS: The main outcomes [BI-RADS® normal=1,2; abnormal=3,4,5)] were analysed by 3 readers (reader1; reader 2, 1st round, reader 2, 2nd round) in 360 women with breast implants. Comparison between CC/CC-ID and MLO/MLO-ID, and degree of agreement for mammographic images between researchers were made using Kappa index. Proportions were calculated using a 95% confidence interval (95%CI). RESULTS: A total of 87 abnormal findings were identified by reader 2, 2nd round. Abnormal findings were observed in CC-ID=18.8% (68 out of 360; 95%CI=15.1%-23.2%) compared to CC=10.8% (39 out of 360; 95%CI=8%-14.4%, k=0.49); in MLO=10.5% (38 out of 360; 95%CI=7.7%-14.1%) compared to MLO-ID=15.8% (57 out of 360; 95%CI=12.4%-19.9%, k=0.55). The CC-ID was the view that singly identified more abnormal findings (20 out of 87; 23%; 95%CI=15.4% to 32.8%) and the CC was the view that least detected abnormal findings (1 out 87; 95%CI=0.2% to 6.2%). The inter- and intraobserver agreement between readers views was 0.67 and 0.74 respectively. CONCLUSIONS: In women with breast augmentation implants, all views are necessary to identify breast tissue abnormalities. In our sample, the inter- and intraobserver agreement were "substantial".

Clinical quality assurance in breast cancer screening and diagnosis: a warning regarding mammographic positioning

This study aimed to evaluate the clinical image quality of mammograms performed in users of the Brazilian Unified Health System (SUS) referred to a tertiary hospital. Methods: A prospective study assessed mammograms from women referred to a specialist breast center in Goiânia, Goiás, Brazil, between May and October 2017. Scans performed in the preceding 6 months, either screening or diagnostic, were included in the study. Clinical quality was determined from 40 variables related to patient identification, technical performance, the equipment, radiological findings, reporting of results, and breast positioning. Scans performed in the public and private healthcare networks were compared regarding mammographic positioning. Results: Overall, 4,560 variables associated with the clinical quality of the images were evaluated in scans from 114 women with a mean age of 50.6 years. A total of 660 (14.47%) inadequacies were found, 443 (67.12%) of which were related to breast positioning. The most common errors were as follows: pectoral muscle could not be seen in 86.8% of scans in the craniocaudal view and inframammary angle could not be seen in 79.8% of scans in the mediolateral oblique view. Considering the breast-positioning criteria evaluated in the mediolateral oblique view, there was a greater risk of the breast not being centrally positioned with the nipple in profile (RR 4.66; 95%CI 1.05−20.62; p=0.02) and of nonvisualization of the retro-areolar area (RR 4.14; 95%CI 0.92−18.66; p=0.04) in the exams performed in the private compared to the public network.

Knowledge of basic attention professionals about prevention and early detection of breast cancer in the state of Goiás

The role of Basic Health Care (BHC) professionals is essential in the primary and secondary prevention of breast cancer. The aim of this study was to characterize BHC professionals in the Health Regions of a federative unit and to assess their knowledge about breast cancer. This was a prospective study carried out with BHC professionals from the state of Goiás. Phase 1 ­ Preparation of material and training of the team. Phase 2 ­ Agreement of actions between executing team and coordination of health regions. Phase 3 ­ Presentation of project at the collegiate meeting. Phase 4 ­ Qualification of BHC professionals with different learning methods and application of questionnaires, evaluating the contribution of the action. A total of 1,133 professionals were included; mean age was 36.3 years, and they were predominantly women (87.6%), working as community health agents (59.2%) and at public service (76.3%). Only 53.8% of professionals identified the female sex as a risk factor for breast cancer, while 90% identified family history as an important factor for the development of the disease. Important changes in physical examination that can occur in patients with the disease, such as skin retraction, skin bulging and nipple injury, were mentioned as a risk factor only by 35.3%, 31.3% and 39.7%, respectively. BHC professionals who participated in the project had less than ten years of professional experience and significant restrictions of knowledge about primary and secondary prevention of breast cancer. They still experience difficulties in accessing mammography and specialized care.

Opportunistic mammography screening by the Brazilian Unified Health System in 2019

Introduction: Mammography screening has been the best method for detecting early tumors and reducing breast cancer mortality according to different studies. In Brazil, the number of women who undergo mammography tests by the Brazilian Unified Health System (SUS) has been far below international recommendations. Objective: To describe the number of mammographies, mammography coverage, and the amount spent on this exam during 2019 by SUS, in Brazil. Method: Ecological study with data from the Department of Informatics of the Brazilian Unified Health System and the Brazilian Institute for Geography and Statistics in order to verify the number of mammographies performed by the SUS concerning the Brazilian female population in Brazil, in the age group of 50 to 69 years, in the states and in macro-regions during 2019. Results: In 2019, 2,660,469 mammographies were performed in the country out of the expected total of 12,154,979, accounting for a 21.9% mammography coverage by SUS at the cost of BRL 117,841,231.97. The lowest coverage rates were verified in the states of Amapá (0.6%) and the Federal District (4.9%), whereas the best rates were found in the states of Paraná (29.7%) and Alagoas (29.6%). Conclusions: The number of mammographies performed in Brazil in 2019 by SUS corresponded to almost » of the country's need, with mammography coverage far below the target and being widely different among the many Brazilian states.

Mean glandular dose in digital mamography in women with breast implants.

PURPOSE: Mean Glandular Dose (MGD) is the quantity related to the risk of radiation-induced breast cancer. This study aimed to evaluate the MGD in screening mammography for women with breast implants. METHODS: This retrospective study used data of 2680 mammographies of 335 asymptomatic women with mammary implants examined in a digital direct x-ray unit. Each woman had a total of eight images: four in standard views and four with posterior displacement of the implant (ID). Data on kV, mAs, target/filter combination, compressed breast thickness and MGD were obtained from the DICOM header of the stored images. Quantitative variables were presented through descriptive statistics for median (5th-95th percentiles); and the qualitative variables were presented by numbers and percentages. Mean glandular doses of standard views and ID views were compared and statistical analysis was used to assess the influence of implant position, breast glandularity and thickness on mean glandular doses. RESULTS: Median MGD for standard views were 3.30 (2.60-4.00) mGy for CC and 3.31 (2.70-4.20) mGy for MLO. For ID views, median were 1.20 (0.90-2.20) mGy and 1.40 (0.97-3.74) mGy for CC and MLO views, respectively. Median MGD for the whole examination of women with breast implants was 9.60 (7.92-12.07) mGy, ranging from 6.25 to 21.50 mGy. When comparing MGD median for standard and ID views it was found a statistically significant difference (p < 0.05), with higher doses for the standard views due to the greater compressed breast thickness in these views. It was observed that, in the standard views, MGD decreases with increasing breast thickness due to the manual radiographic techniques used to expose the women. It was also observed that implant position does not affect MGD in breast augmentation mammography. CONCLUSION: Mammography of women with mammary implants gives higher radiation doses when compared with those without implants. For more accurate dose assessment in augmented breast mammography, it is necessary that specific conversion factors for the calculation of MGD based on air kerma at entrance of breasts with implants are made available.