Hallazgos mastográficos benignos que simulan malignidad: un dilema diagnóstico / Benign mammographic findings that simulate malignancy: a diagnostic dilemma

Resumen OBJETIVO: Identificar los principales hallazgos histopatológicos benignos y determinar la tasa de falsos positivos que suelen causar conflicto al categorizar las mastografías en el sistema BI-RADS por su aspecto, que puede simular un proceso maligno. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en pacientes atendidas en la Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) con reporte mastográfico alterado o sospecha clínica de malignidad. Para el análisis estadístico se utilizó el programa JASP 2.0 y χ2 para la diferencia de proporciones entre grupos. RESULTADOS: De un grupo de 11,481 pacientes, se reportaron 1643 mastografías alteradas: 444 con reportes falsos positivos, 23 pacientes con sospecha clínica y exclusión de 16 que no cumplieron con los criterios de inclusión establecidos. La muestra poblacional estudiada fue de 451 pacientes. La mayoría permaneció asintomática al momento del estudio (42.1%). El hallazgo histopatológico benigno con mayor prevalencia fue el fibroadenoma y su síntoma más relevante el nódulo palpable. La tasa de falsos positivos fue de 4.3%. CONCLUSIONES: En la actualidad, gracias a la implementación de programas de tamizaje es posible establecer diagnósticos de cáncer de mama en etapas tempranas, aunque con la desventaja que el reporte puede resultar falso positivo y ello dar lugar a incremento de la morbilidad y sobretratamiento. Los estándares internacionales indican que estos no deben sobrepasar el 10%.

Abstract OBJECTIVE: To identify the main benign histopathological findings that often cause conflict when categorizing mastographies in the BI-RADS system due to their appearance, which may simulate a malignant process and false positive rate. MATERIALS AND METHODS: Retrospective cohort study carried out in patients attended at the Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) with an altered mastographic report or clinical suspicion of malignancy. For statistical analysis we used the JASP 2.0 programme and χ2 for the difference in proportions between groups. RESULTS: From a group of 11,481 patients, 1,643 altered mastograms were reported: 444 with false positive reports, 23 patients with clinical suspicion and exclusion of 16 who did not meet the established inclusion criteria. The population sample studied was 451 patients. The majority remained asymptomatic at the time of the study (42.1%). The most prevalent benign histopathological finding was fibroadenoma and the most relevant symptom was a palpable nodule. The false positive rate was 4.3%. CONCLUSIONS: Currently, thanks to the implementation of screening programmes it is possible to establish breast cancer diagnoses in early stages, although with the disadvantage that the report may be false positive and this may lead to increased morbidity and overtreatment. International standards indicate that these should not exceed 10%.

Fibroadenoma gigante juvenil de mama: presentación de un caso clínico / Juvenile giant fibroadenoma of the breast: presentation of a clinical case

RESUMEN El fibroadenoma gigante juvenil es un tumor de mama benigno y una variante rara de los fibroadenomas. La presentación clínica suele ser una masa tumoral unilateral, de crecimiento rápido e indolora. En este artículo presentamos el caso de un fibroadenoma gigante juvenil de 12 cm de diámetro en la mama de una niña de 13 años. Se realiza estudio radiológico e histológico de la lesión siendo categorizada como un fibroadenoma gigante juvenil por lo que se realiza tumorectomía completa con remodelación mamaria posterior. A los dos meses de seguimiento, la paciente se encuentra sin signos de recidiva, con buena situación general y a la espera de cirugía de remodelación mamaria.

ABSTRACT Juvenile giant fibroadenoma is a benign breast tumor and a rare variant of fibroadenomas. The clinical presentation is usually a painless, fast growing, unilateral tumor mass. In this article we present the case of a giant juvenile fibroadenoma of 12 cm in diameter in the breast of a 13-year-old girl. A radiological and histological study of the lesion was carried out and it was categorized as a juvenile giant fibroadenoma, so a complete lumpectomy with posterior breast remodeling was performed. After two months of follow-up, the patient is without signs of recurrence, in good general condition and waiting for the breast remodeling surgery.

Descarga papilar: relação com o câncer de mama e estratégias para a sua abordagem / Nipple discharge: relation with breast cancer and its approach

A descarga papilar está presente em 5% das mulheres e ocorre em razão de causas fisiológicas, doenças benignas da mama e câncer de mama. Algumas das lesões benignas da mama estão relacionadas a um maior risco de desenvolvimento de patologia maligna mamária. A papilar para a avaliação desse sintoma mamário e sua relação com as lesões benignas importância da descarga papilar está na possibilidade de essa condição associar-se a câncer de mama. Uma avaliação clínica detalhada é fundamental para a determinação da abordagem terapêutica da paciente com descarga papilar. Foram avaliadas 23 pacientes do Serviço de Mastologia do Instituto Fernandes Figueira/Fiocruz submetidas à exérese de árvore ductal em virtude de descarga e com o câncer de mama. Das 23 pacientes analisadas, o resultado histopatológico foi de lesão benigna não proliferativa em 26,1%, lesão proliferativa sem atipias em 60,8%, hiperplasia ductal com atipias em 8,7% e câncer em 4,4%. Os resultados demonstraram que em 69,5% dos casos a histopatologia foi de lesão proliferativa de mama, que, apesar de benigna, apresenta maior risco de desenvolvimento do câncer de mama. Apesar de a descarga papilar estar na maioria dos casos relacionada à doença mamária benigna, em alguns casos esta se associa a um risco aumentado de câncer de mama. É fundamental ressaltar que pode haver uma relação entre a descarga papilar e o câncer de mama, embora este não seja a correspondência histopatológica mais freqüente da descarga papilar.

Nipple discharge is present in 5% of women and occurs due to physiological causes, benign breast disease and breast cancer. Some of benign breast lesions are associated with a higher risk of malignant breast diseases development. The importance of nipple discharge is the possibility of this condition to be associate with breast cancer. A detailed clinical evaluation is fundamental to determinate the therapeutic approach of a patient with nipple discharge. Twenthy-three patients from the Mastology Department of Fernandes Figueira Institute/Fiocruz were submitted to removal of central mammary ducts due to nipple discharge for evaluation of this symptom and its relationship with benign breast lesions and breast cancer. The histopathological results from 23 patients that have been analysed were not proliferative benign breast lesions in 26.1%, proliferative lesions without atypias in 60.8%, atypical ductal hyperplasia in 8.7% and 4 cancer in 4,4%. The results proved 69.5% of proliferative breast lesions thats presents a higher risk of breast cancer development. Although nipple discharge is associated in most of the cases with benign breast diseases sometime it is related to a higher risk of breast cancer. It is important to emphasize that it could be a relation between nipple discharge and breast cancer even if it is not the most frequent, histopathological correspondence of nipple discharge.