Role of BI-RADS Ultrasound Subcategories 4A to 4C in Predicting Breast Cancer.

BACKGROUND: The Breast Imaging Reporting and Data System (BI-RADS) ultrasound (US) categorization revised in 2013 by the American College of Radiology resulted in unquestionable standardization of reports and confirmed category 3 and 5 as benign and malignant lesions, respectively. In contrast, suspected images (category 4) have subcategorization criteria, although theses have been detailed difficult to apply. The aim of the present study was to determine the role of the US 4A to 4C BI-RADS subcategories in predicting malignancy. PATIENTS AND METHODS: We performed a cross-sectional study of diagnostic tests to estimate the performance of the US BI-RADS categorization to clearly differentiate benign from malignant lesions. A total of 975 US examinations performed at the Hospital Femina, Grupo Hospitalar Conceição teaching hospitals from January 2012 through March 2015 were included in the present study. The US BI-RADS lexicon was used to classify the examination findings. Suspicious lesions underwent core needle biopsy, and the US and histology reports were compared to determine the performance using receiver operating characteristic curves. RESULTS: Overall, the BI-RADS US categorization showed good discriminating accuracy with a receiver operating characteristic curve of 91% (95% confidence interval [CI], 88%-93%). However, BI-RADS subcategory 4b had a positive predictive value of 25% (95% CI, 20%-31%) and subcategory 4A had a positive predictive value of only 6% (95% CI, 3.5%-9.8%). CONCLUSION: Our results have shown that US BI-RADS subcategories 4A and 4B are clearly unfit for use in screening tests, because they cannot rule out the need for biopsy. Therefore, management will not be improved by subcategorizing category 4, because all suspicious lesions will still require definite biopsy.

Aplicação do índice prognóstico de Nottingham em pacientes com câncer de mama atendidas em um hospital público / Application of the Nottingham prognosis index in breast cancer patients treated at a public hospital

Um estudo de coorte histórico foi desenvolvido incluindo 116 pacientes com câncer de mamaatendidas no Hospital Femina, Grupo Hospitalar Conceição (GHC), Ministério da Saúde (MS),entre setembro de 1997 e dezembro de 2000. Foi aplicado o índice prognóstico de Nottingham(IPN) na população em estudo e avaliada a sua associação com a recidiva da doença. O IPNconseguiu identificar um grupo com bom prognóstico, em que de 26 pacientes somente 2 (7,7%)evoluíram para recidiva, e um grupo de 32 pacientes com pobre prognóstico, em que 24 delas(75%) evoluíram para recidiva em cinco anos. Nesta amostra composta de pacientes provenientesda rede pública, a média e o desvio-padrão do tamanho tumoral foi de 3,1 ± 1,8 cm e somente25% das mulheres apresentaram tumores menores do que 2 cm na primeira consulta no hospitalterciário. Isso sugere que o diagnóstico de câncer de mama ainda está sendo realizado tardiamente,em nosso meio.

A history cohort study that included 116 breast cancer patients treated at the Femina Hospital, GrupoHospitalar Conceição (GHC), Health Ministry (HM), between September 1997 to December 2000 wasconducted. The Nottingham Prognostic Index (NPI) and its association with the disease recidivationwas assessed in the study population. The NPI identified two groups; good prognosis group (n = 26) with7.7% recidivation and a poor prognosis group (n = 32) with 75% recidivation at 5 years. The tumorsize in our study population was 3.1 ± 1.8 cm and it was less than 2 cm in only 25% of the patients atthe first consultation at a tertiary hospital. These observations suggested that the breast cancer diagnosis isperformed late in our environment.

Pulmonary epithelial permeability in patients treated with bleomycin containing chemotherapy detected by technetium-99m diethylene triamine penta-acetic acid aerosol (99mTc-DTPA) scintigraphy.

PURPOSE: To evaluate pulmonary epithelial permeability using 99mTc-DTPA scintigraphy in patients treated with bleomycin-containing regimens. MATERIAL AND METHODS: Twelve non-smoking chemotherapy-naïve patients with no clinical or radiological evidence of pulmonary disease and treated with bleomycin-containing chemotherapy were tested with 99mTc-DTPA scintigraphy before the first cycle and every 3 weeks until the third month after the end of chemotherapy (total cumulative dose of bleomycin 347.9 mg). RESULTS: Pretreatment values (T1/2 74.93 minutes) of 99mTc-DTPA scintigraphy were significantly higher than those obtained after the total dose of bleomycin (T1/2 51.00 minutes) (p < 0.001). This difference was more important in the later evaluations especially, on the third week and third month measures after discontinuing treatment (p < 0.001). All the tests of Within-Subjects Effects were significant (p < 0.001). Comparing pretreatment and post-treatment scintigraphies the mean T1/2 99mTc-DTPA values decreased as the bleomycin dose increased. CONCLUSION: We conclude that cumulative bleomycin doses are related to increased pulmonary epithelial permeability at a dose of 256.5 mg. However, whether this is related to clinical toxicity is uncertain and large, multi-center prospective studies are needed.

Protective effect of alpha-tocopherol in head and neck cancer radiation-induced mucositis: a double-blind randomized trial.

BACKGROUND: the study was designed to test whether vitamin E (VE) provides oral mucosal protection in patients with irradiated cancers of the head and neck. METHODS: Fifty-four patients with cancer of the oral cavity and oropharynx were randomly assigned to rinse the oral cavity in an oil solution containing either VE or placebo before every conventional fraction of 2 Gy and again 8 to 12 hours later during the 5 to 7 weeks of radiotherapy (RT). RESULTS: Thirty-six events/167 patient-weeks (21.6%) and 54 events/161 patient-weeks (33.5%) of symptomatic mucositis were observed in VE and placebo groups, respectively (p =.038). VE reduced the risk by 36%. Subjective data at the end of the treatment revealed that VE decreased pain grades 2 to 3 during RT (3 of 28 patients vs 14 of 26 patients, p =.0001). No significant influence was detected in survival. CONCLUSION: VE decreased the incidence of symptomatic oral radio-induced mucositis in patients with cancer of the oropharynx and oral cavity.

Respiratory disease in neutropenic patients: diagnosis and treatment

The associations between malignancy, immunossupression and infectious morbidity and mortality have been established, and the use of more intensive chemotherapic regimens have produced a higher number of immunosuppressed oncologic patients. Thus, the benefits of the antineoplastic therapy can be limited by the mortality associated with the complications of life-threatening infection. This have raised the necessity of empiric therapy, which main goal is to prevent the death in the carly stage, until a more specific choice can be determined based on the results of the bacteriological examination and the patient's response. Pulmonary infiltrates, which are generally the first manifestation of respiratory infection in immunocompromised patients, can be classified as localized (early, refractory or late) or diffuse. this classification helps to establish more directed empiric approaches. The choices of the initial empiric antibiotic therapy include (a) aminoglycoside + extended-spectrum beta-lactam, (b) complication of 2 beta-lactams, or (c) extended-spectrum monotherapy. It is also possible to coadministrate speciffically oriented. The optimal duration of empiric therapy and empiric antifungal therapy are also discussed in this review. The prevention of pulmonary infections is justified by the reduction in the morbidity, mortality, and hospital costs. Selective decontamination with the use of agents that preserve the anaerobic flora have had variable results, being SMZ/TMP the agent more commonly used for this purpose. Hemotopoietic growth factors have shown to be effective in reducing the duration and the severity, but not the incidence of the chemotherapy-associated neutropenia, the number of infection episodes, or the mortally associated to infection.

Marcadores tumorais / Tumor markers

Os autores apresentam os marcadores tumorais mais utilizados na pratica da clinica, associando-os ao diagnostico e seguimento de doencas malignas