Estimación semiautomática de la densidad mamaria con DM-Scan / Semiautomatic estimation of breast density with DM-Scan software

Objetivo. Evaluar la reproducibilidad del cálculo de la densidad mamaria con la aplicación informática DM-Scan, basada en la segmentación semiautomática del tejido fibroglandular, y compararla con la de la inspección visual. Material y métodos. El estudio incluyó 655 mamografías digitales directas en proyección cráneo-caudal. Tres expertos radiólogos analizaron la densidad de las mamografías con DM-Scan, y se calcularon las concordancias inter e intraobservador entre pares de radiólogos para las escalas Boyd y BI-RADS®, utilizando el índice de correlación intraclase. Las concordancias se compararon con las obtenidas previamente para la inspección visual, en el mismo conjunto de imágenes, utilizando el índice Kappa. Resultados. Con el análisis visual, la concordancia media interobservador fue de 0,876 (IC 95%: 0,873-0,879) para la escala de Boyd, y 0,823 (IC 95%: 0,818-0,829) para la clasificación BI-RADS®. La concordancia intraobservador fue de 0,813 (IC 95%: 0,796-0,829) para la escala de Boyd, y 0,770 (IC 95%: 0,742-0,797) para la clasificación BI-RADS®. Con DM-Scan, la concordancia media inter e intraobservador fue de 0,92, notablemente superior a las concordancias de la clasificación visual. Conclusión. El cálculo de la densidad mamaria con la aplicación semiautomática DM-Scan es más fiable y reproducible, y disminuye la subjetividad y variabilidad de la estimación visual (AU)

Objective. To evaluate the reproducibility of the calculation of breast density with DM-Scan software, which is based on the semiautomatic segmentation of fibroglandular tissue, and to compare it with the reproducibility of estimation by visual inspection. Material and methods. The study included 655 direct digital mammograms acquired using craniocaudal projections. Three experienced radiologists analyzed the density of the mammograms using DM-Scan, and the inter- and intra-observer agreement between pairs of radiologists for the Boyd and BI-RADS® scales were calculated using the intraclass correlation coefficient. The Kappa index was used to compare the inter- and intra-observer agreements with those obtained previously for visual inspection in the same set of images. Results. For visual inspection, the mean interobserver agreement was 0,876 (95% CI: 0,873-0,879) on the Boyd scale and 0,823 (95% CI: 0,818-0,829) on the BI-RADS® scale. The mean intraobserver agreement was 0,813 (95% CI: 0,796-0,829) on the Boyd scale and 0,770 (95% CI: 0,742-0,797) on the BI-RADS® scale. For DM-Scan, the mean inter- and intra-observer agreement was 0,92, considerably higher than the agreement for visual inspection. Conclusion. The semiautomatic calculation of breast density using DM-Scan software is more reliable and reproducible than visual estimation and reduces the subjectivity and variability in determining breast density (AU)

Semiautomatic estimation of breast density with DM-Scan software.

OBJECTIVE: To evaluate the reproducibility of the calculation of breast density with DM-Scan software, which is based on the semiautomatic segmentation of fibroglandular tissue, and to compare it with the reproducibility of estimation by visual inspection. MATERIAL AND METHODS: The study included 655 direct digital mammograms acquired using craniocaudal projections. Three experienced radiologists analyzed the density of the mammograms using DM-Scan, and the inter- and intra-observer agreement between pairs of radiologists for the Boyd and BI-RADS® scales were calculated using the intraclass correlation coefficient. The Kappa index was used to compare the inter- and intra-observer agreements with those obtained previously for visual inspection in the same set of images. RESULTS: For visual inspection, the mean interobserver agreement was 0,876 (95% CI: 0,873-0,879) on the Boyd scale and 0,823 (95% CI: 0,818-0,829) on the BI-RADS® scale. The mean intraobserver agreement was 0,813 (95% CI: 0,796-0,829) on the Boyd scale and 0,770 (95% CI: 0,742-0,797) on the BI-RADS® scale. For DM-Scan, the mean inter- and intra-observer agreement was 0,92, considerably higher than the agreement for visual inspection. CONCLUSION: The semiautomatic calculation of breast density using DM-Scan software is more reliable and reproducible than visual estimation and reduces the subjectivity and variability in determining breast density.

Expectativas ante la reconstrucción mamaria en mujeres mastectomizadas / No disponible

Objetivo: El objetivo de este estudio es valorar las expectativasque las pacientes mastectomizadas tienen sobre elprocedimiento de la reconstrucción mamaria, entendiendopor expectativa la idea o creencia que la paciente tiene sobrelos cambios que la reconstrucción puede facilitar en diversasáreas de la persona. Se trata asimismo de relacionardichas expectativas con las respuestas emocionales y conlos cambios en la imagen corporal.Pacientes y métodos: La muestra consta de 61 mujeresmastectomizadas con una media de edad de 47,1 ± 6,6(rango entre 26 y 66 años), con evolución favorable de laenfermedad y que no reciben tratamientos complementarios.Acudieron a consulta de Cirugía Plástica del HospitalUniversitario La Fe de Valencia para iniciar el proceso dereconstrucción mamaria y fueron entrevistadas habiendotranscurrido un tiempo medio de 3,3 años (DT = 2,2), (rangoentre 9 meses y 10 años) desde la mastectomía. Para laevaluación de las expectativas se creó un cuestionario con31 ítems y 5 áreas: funcional-práctica, personal, sexual, derelación con los demás y una área técnica; además valoramosla satisfacción global esperada. Otros instrumentos utilizados:Escala Hospitalaria de Ansiedad y Depresión(HADS) de Zigmond y Snaith y cuestionario específico sobrecambios en relación con su cuerpo de López Pérez. Serealizaron análisis estadísticos descriptivos, correlación dePearson y ANOVA.Resultados: En conjunto las mujeres presentan mayoresexpectativas en la satisfacción global, el área funcionalprácticay los aspectos técnicos de la reconstrucción. Laspuntuaciones en la subescala de depresión y ansiedad correlacionaronpositivamente con las expectativas del área personal(autoestima y estado de ánimo), la sexualidad y la relacióncon los demás. También se aprecia una relaciónsignificativa entre una menor aceptación del cambio de imageny mayor presencia de síntomas depresivos y de ansiedad...(AU)

Objective: The aim of this study was to assess expectationson breast reconstruction procedure in mastectomisedpatients. The expectation construct means the idea or beliefthe woman has regarding changes that reconstruction canprovide in different personal areas. We also assess the relationbetween these expectations, anxiety and depressionand body image change.Patients and methods: The sample consisted of 61 mastectomisedwomen with a mean age of 47.1 ± 6.6 (age rangebetween 24 and 66 years), favourable disease progressand no additional treatments. Patients referred to PlasticSurgery consultation at the University Hospital La Fe in Valenciato initiate breast reconstruction procedure. The intervalbetween mastectomy and interview varied from 9 monthsto 10 years (mean of 3.3 years and SD = 2.2). A specificquestionnaire was performed to evaluate expectations. Itconsisted of 31 items and 5 areas: functional-practical, personal,sexual and social functioning and technical area.Furthermore, we assessed the expected global satisfaction.Other used instruments were: the Hospital Anxiety and DepressionScale (HADS) from Zigmond and Snaith, and aspecific questionnaire on body image change from LópezPérez. Descriptive, Pearson correlation and ANOVA statisticalanalyses were done.Results: Overall, women showed greater expectations onglobal satisfaction, functional-practical area and technicalaspects of breast reconstruction. Anxiety and depressionsub-scale scores were positively correlated with expectations on the personal area (self-esteem and emotional well-being),sexuality and social functioning. The results also showed astatistical significant correlation between a lower acceptanceof body image changes and a higher level of anxiety anddepression. On the other hand we found a negative correlationbetween body image changes and general satisfactionwith breast reconstruction procedure...(AU)

Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography.

PURPOSE: To evaluate short-term follow-up of nonpalpable probably benign lesions in a 2-year mammographic screening. MATERIALS AND METHODS: Of 13,790 women aged 45-65 years who underwent first-round screening, 795 (5.8%) underwent short-term mammographic follow-up (every 6 months for 2 years) of nonpalpable probably benign lesions (eg, masses, focal asymmetric densities, and calcifications) previously assessed at an additional imaging evaluation, including ultrasonography. When no changes were found at short-term mammographic follow-up, women were assigned to the 2-year screening interval. Needle localization and surgical biopsy were performed when the lesion progressed (was enlarged or had an increased number or size of calcifications or modification of their initial characteristics). The effectiveness of this approach was evaluated with statistical analysis. RESULTS: Of 795 lesions, 788 (99%) remained stable, and seven (1%) had changes prompting surgical biopsy. Two cancers (0.3%), one microinvasive intraductal carcinoma and one 7-mm invasive ductal carcinoma without positive nodes, were found. Four of the five benign histologic results were probably benign calcifications with progression at short-term follow-up. The sensitivity, specificity, accuracy, and positive and negative predictive values were 100%, 99%, 99%, 29%, and 100%, respectively. CONCLUSION: The benign nature of most nonpalpable probably benign lesions can be typified with short-term mammographic follow-up. This approach permitted identification of a few low-stage carcinomas, but progression in the probably benign calcifications was usually unrelated to malignancy.

Punción aspiración con aguja fina en lesiones mamarias probablemente benignas o malignas por radiografía / Fine-needle aspiration in breast lesions radiologically classified as probably bening or probably malignant

Objetivo: El propósito de nuestro trabajo es evaluar la validez de la punción aspiración con aguja fina (PAAF) en nuestro medio en dos grupos definidos por la clasificación radiográfica como lesiones probablemente benignas (PB) o probablemente malignas (PM). Material y Métodos: Se estudian retrospectivamente 96 lesiones mamarias, 55 clasificadas como PB y 41 como PM. En todas se realizó PAAF y se obtuvo comprobación histológica. Resultados: En las citologías de los 55 pacientes con lesión mamaria PB, encontramos en seis casos material insuficiente, 37 benignas, nueve sospechosas de malignidad y tres positivas. Se realizó estudio comparativo entre el informe citológico y el histológico. Hubo tres falsos negativos (FN) y dos falsos positivos (FP). Se obtuvo una especificidad del 99 por ciento y un valor predictivo negativo (VPN) del 92 por ciento. En las citologías de los 41 pacientes con lesión mamamria PM, encontramos cinco casos de material insuficiente, 21 positivas, nueve sospechosas de malignidad y seis negativas. Se realizó estudio comparativo entre el informe citológico y el histológico. Hubo dos FP y dos FN. Se obtuvo una sensibilidad y un valor predictivo positivo (VPP) del 93 por ciento. Conclusiones: Ante una lesión clasificada por radiografía como PB, la PAAF puede considerarse una buena alternativa frente a los controles radiológicos periódicos. Las lesiones clasificadas por radiografía como PM precisan biopsia para evitar los FN que existen con la PAAF (AU)

Breast cancer screening: first round in the population-based program in Valencia, Spain. Collaborative Group of Readers of the Breast Cancer Screening Program of the Valencia Community.

PURPOSE: To analyze the results of round 1 of the population-based Valencia Breast Cancer Screening Program. MATERIALS AND METHODS: In this program, 78,224 (72.98%) of the 107,178 women invited (aged 45-65 years) underwent screening. Complementary views were obtained in 5,771 women (7.38%). Among the total population studied, 3,502 (4.48%) underwent short-term mammographic follow-up studies; 3,898 (4.98%) underwent additional studies and treatment at hospitals. Five hundred eighty-seven women (0.75%) underwent biopsy. RESULTS: Cancer was detected in 334 patients (4.27 cancers per 1,000 women [3.24 per 1,000 women aged 45-49 years, 6.30 per 1,000 women aged 60-65 years]; six patients with lobular carcinoma in situ excluded). The estimated sensitivity was 89%; specificity, 99%. The positive predictive value of mammography was 8.56%; of mammography with additional examinations, 26.82%; and of biopsy, 56.89%. Forty-one patients (12.28%) had ductal carcinoma in situ; 284 (85.03%) had infiltrating carcinoma. In 73 (25.70%) of the 284 patients, infiltrating carcinomas were smaller than 1 cm. Two hundred twenty-five patients (76.27%) had no lymph node involvement. One hundred seventy-nine (61.09%) had stage 0 or 1 cancer. CONCLUSION: Results are consistent with other published results; differences are due to methods and patient population characteristics.

[Analysis of interval cancers in the Program of Early Diagnosis of Cancer of the Breast of the Community of Valencia. Group of Readers of the Prevention Units of Cancer of the Breast]. / Análisis de los cánceres de intervalo en el Programa de Diagnóstico Precoz de Cáncer de Mama de la Comunidad Valenciana. Grupo de Lectores de las Unidades de Prevención de Cáncer de Mama.

A retrospective search was performed of interval cancers in the Programa de Prevención de Cáncer de Mama de la Comunidad Valenciana. The cancer rate observed was 0.5 per 1,000 women studied. The mean diagnostic time from the first mammography was 11 months, and the most frequent detection means was a positive palpation. The frequency was higher in women aged less than 55 years. More "non-common" histologic types were found and a lower percentage of conservative therapies regarding cancers detected at the first round of the Program, although the stage was similar to the latter.

Computed tomography differentiation between cystic bronchiectasis and bullae.

Bronchiectatic lung cysts are larger on inspiration than on expiration. Bullae do not change in size during the different phases of respiration. By adding expiratory CT scans when cystic lung lesions are found, it is possible to distinguish bronchiectatic cysts from bullae.

CT findings in Swyer-James syndrome.

Swyer-James syndrome (SJS) is usually diagnosed with plain chest radiographs obtained during inspiration/expiration. The authors studied patients with CT to assess its value in the evaluation of this syndrome. In patients with SJS, CT was useful in the determination of bronchial patency (all nine patients), lung parenchymal changes (subpleural infiltrates in six patients, atelectasis in two, and cavities in two), and the extent and degree of bronchiectasis (all nine patients). If CT is used for the evaluation of bronchiectasis, knowledge of the main findings associated with SJS (hyperlucent lung without anteroposterior gradient attenuation [n = 8], small lung [n = 6], and diminished central and peripheral pulmonary arteries [n = 9]) should facilitate the diagnosis of associated SJS. Expiration CT would support the diagnosis with demonstration of air trapping.

[Extraperitoneal appendicular calculi (author's transl)]. / Calcul appendiculaire de situation extrapéritonéale

Two retrocecal and extraperitoneal appendix cases are showed. Atypical clinical signs, slow evolution, perforation and abscess were found. Radiological diagnosis is based by seeing the calculus and the appendix by means of barium enema. When appendix calculus is demonstrated and clinical signs are present, a surgical operation must be order urgently. Profilactic appendicectomy is recommended when no symptoms.