ABSTRACT
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.
Subject(s)
Breast Neoplasms/diagnostic imaging , Ultrasonography, Mammary , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Large-Core Needle , Breast Neoplasms/pathology , Child , Cross-Sectional Studies , Female , Humans , Middle Aged , Predictive Value of Tests , Sensitivity and Specificity , Ultrasonography, Mammary/standards , Ultrasonography, Mammary/statistics & numerical data , Young AdultABSTRACT
A analise retrospectiva de 2.893 prontuarios de pacientes submetidos a laparotomia por trauma, de 1978 a 1987, no Hospital de Pronto Socorro (HPS), evidenciou 706 casos de traumatismos do figado onde foram mais acometidos os adultos jovens do sexo masculino; predominou o trauma aberto (76,21%) com armas brancas e armas de fogo como principais agentes; o trauma fechado foi produzido em sua maioria por acidentes de transito, acompanhado de lesoes mais graves, maior numero de lesoes associadas e maior reposicao volemica. A cirurgia mais empregada foi a hepatorrafia simples e as complicacoes pos-operatorias mais comuns foram hipovolemia, hemoperitonio, peritonite e hemorragia digestiva alta, estando a primeira mais intimamente relacionada com os traumas fechados
Subject(s)
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Abdominal Injuries/complications , Abdominal Injuries/etiology , Liver/injuries , Hepatectomy , Wounds, Gunshot , Wounds, Stab , Accidents, Traffic , Blood Transfusion , Postoperative Complications , Retrospective StudiesABSTRACT
Analisados 2.893 prontuarios de pacientes submetidos a laparotomia por trauma, entre 1978 e 1987, no Hospital de Pronto Socorro (HPS), 407 apresentaram traumatismo esplenico, exclusivo ou acompanhado de outras lesoes. O adulto jovem do sexo masculino foi o mais acometido, e os principais agentes foram os acidentes de transito (52,09%), seguidos das armas de fogo e armas brancas (30,22%). O trauma fechado acompanhou-se de maior numero de lesoes associadas, onde predominaram as fraturas osseas, o traumatismo cranioencefalico e os ferimentos hepaticos e diafragmaticos, nesta ordem. A esplenectomia foi a cirurgia mais empregada, tendo crescido significativamente ao longo dos anos o emprego de tecnicas mais conservadoras; o choque hipovolemico foi a complicacao e a causa de obito mais comum.
Subject(s)
Humans , Male , Female , Spleen/injuries , Splenic Rupture/surgery , Splenectomy , Abdominal Injuries/surgery , Accidents, Traffic , Brain Injuries/surgery , Brazil , Postoperative Complications , Splenic Rupture/complications , Shock/surgery , Wounds, Gunshot/surgery , Wounds, Stab/surgeryABSTRACT
Relata-se uma experiência em 24 casos de pacientes, portadores de Carcinoma de Esôfago, tratados paliativamente, com o uso de prótese. Analisam-se as indicaçöes, a técnica e as complicaçöes mais freqüentes como: sangramento, dor torácica, vômitos, fratura do tumor, migraçäo e obstruçäo da prótese. Nesta experiência, o método apresenta inúmeras vantagens sobre o gastro ou jejunostomia, pois além de restabelecer a via oral, previne a aspiraçäo de saliva para a árvore respiratória