Safety of treatment with ulipristal acetate on the mammary gland: A pilot prospective study / Seguridad del tratamiento con acetato de ulipristal en la glándula mamaria: un estudio piloto prospectivo

IntroductionHeavy menstrual bleeding is the major complaint in women with symptomatic fibroids. Ulipristal acetate (UPA) is a “selective progesterone receptor modulator” in which mixed agonist and antagonist activity appears to offer a novel approach to medical management of symptomatic uterine fibroids. There are currently no studies that have assessed its effect on the mammary gland in humans.MethodsProspective observational study conducted in a tertiary hospital, in which 14 consecutive patients diagnosed with uterine fibroids by transvaginal ultrasound were included. The patients received two cycles of UPA 5mg/day for 3 months each, with a rest period of two months between both cycles. To assess the safety on the mammary gland, 3 mammary ultrasounds were performed at three different points: prior to the first cycle of UPA, between the two cycles and at the end of the second cycle.ResultsOf the 14 recruited patients, 9 completed the study period. Breast ultrasound reports were normal in all patients. In 4 patients (44.4%), the 3 breast ultrasounds were classified as BI-RADS 2. In 2 patients (22.2%) the 3 breast ultrasounds were classified as BI_RADS1; and in 3 patients (33.3%), the first breast ultrasound was classified as BI-RADS 3 and the last two as BI-RADS 2.ConclusionIn conclusion, our study showed that 2 cycles of treatment with UPA in patients with symptomatic uterine fibroids is safe for normal breast tissue with an acceptable adverse effects profile. Nonetheless, further research is required to confirm our findings.

IntroducciónEl sangrado menstrual abundante es el principal síntoma en mujeres con miomas uterinos. Acetato de ulipristal (AUP) es un «modulador selectivo del receptor de progesterona» que parece ofrecer una nueva opción al manejo médico de los miomas debido a su acción mixta agonista y antagonista. Actualmente no hay estudios que evalúen su efecto en la glándula mamaria en humanos.MétodosEs un estudio prospectivo observacional realizado en un hospital terciario, en el cual se incluyeron 14 mujeres con diagnóstico de miomas uterinos mediante ecografía transvaginal. Las pacientes recibieron 2 ciclos de AUP 5mg/día durante 3 meses cada ciclo, con un período de descanso de 2 meses entre ambos ciclos. Para evaluar el impacto en la glándula mamaria se realizaron 3 ecografías mamarias en 3 momentos diferentes: previo al inicio del primer ciclo, entre los 2 ciclos y al terminar el segundo ciclo.ResultadosDe las 14 pacientes reclutadas, 9 completaron el período de estudio. Las ecografías mamarias en todas las pacientes fueron normales. En 4 pacientes (44,4%), las 3 ecografías mamarias fueron catalogadas como BI-RADS® 2. En 2 pacientes (22,2%) las 3 ecografías fueron catalogadas como BI-RADS® 1, y en 3 pacientes (33,3%), la primera ecografía mamaria fue catalogada como BI-RADS® 3 y las 2 últimas BI-RADS® 2.ConclusiónEn conclusión, nuestro estudio muestra que 2 ciclos de tratamiento con AUP en pacientes con miomas uterinos sintomáticos es seguro para el tejido mamario sano con efectos adversos aceptables. Sin embargo, hacen falta más estudios para confirmar nuestros resultados.

Usefulness of the twinkling artifact on Doppler ultrasound for the detection of breast microcalcifications. / Utilidad del artefacto Doppler de centelleo de color (twinkle) en la detección ecográfica de microcalcificaciones mamarias.

OBJECTIVE: To determine whether the twinkling artifact on Doppler ultrasound imaging corresponds to microcalcifications previously seen on mammograms and to evaluate the usefulness of this finding in the ultrasound management of suspicious microcalcifications. MATERIAL AND METHODS: We used ultrasonography to prospectively examine 46 consecutive patients with groups of microcalcifications suspicious for malignancy identified at mammography, searching for the presence of the twinkling artifact to identify the microcalcifications. Once we identified the microcalcifications, we obtained core-needle biopsy specimens with 11G needles and then used X-rays to check the specimens for the presence of microcalcifications. We analyzed the percentage of detection and obtainment of microcalcifications by core-needle biopsy with this technique and the radiopathologic correlation. Microcalcifications that were not detected by ultrasound or discordant lesions were biopsied by stereotaxy at another center. We also used ultrasound guidance for preoperative marking with clips, usually orienting them radially. RESULTS: We identified and biopsied 41 of the 46 lesions under ultrasound guidance, including 24 of 25 carcinomas (17 in situ). B-mode ultrasound was sufficient for biopsying the microcalcifications in 14 patients, although the presence of the twinkling artifact increased the number of microcalcifications detected and thus enabled more accurate preoperative marking. Thanks to the twinkling sign, we were able to identify 27 additional groups of microcalcifications (89% vs. 30%; p < 0.05). All the surgical specimens had margins free of disease. CONCLUSIONS: The twinkling artifact is useful for microcalcifications in ultrasound examinations, enabling a significant increase in the yield of ultrasound-guided biopsies and better preoperative marking of groups of microcalcifications.

Papilomatosis. informe de tres casos / Papillomatosis. report of three cases

Se presentaron tres casos de papilomatosis diagnosticados en el Hospital General Docente Dr Agostinho Neto de Guantánamo en el año 2012 Se describen características ecográficas y mamográficas encontradas en los casos y se comparan con resultados de otros autores. Se hace énfasis en el concepto, clasificación y hallazgos imagenológicos. Luego de la valoración por el equipo multidisciplinario de cáncer de mamas el cual determina la conducta a seguir en cada caso desde el punto de vista ecográfico y mamográfico se manejaron diagnósticas probables. Se realizó estudio morfológico para diagnóstico final y se propone dar a conocer características ecográficas mamográficas encontradas, así como señalamientos de aspectos clínicos y exposición breve de hallazgos imagenológicos de esta entidad(AU)

Three cases of Papilomatosis are presented and diagnosed in the Educational General Hospital Dr Agosthino Neto of Guantánamo in the year 2012. Ultrasound and mammographic characteristics are described and found in the cases and are compared with other authors' results. Emphasis is made on the concept, classification and imaginary discoveries after the valuation for the multidisciplinary team taking into account the behavior in each case from the point of view of the ultrasound and mammographic and probable diagnosis managed by doctors. It was carried out morphological study for a final diagnosis and knows sonographic characteristics opposing mammograms, as well as indications of clinical aspects and brief exhibition of imaginary discoveries of this entity(AU)

[Breast hematoma masking a sarcoma]. / Hematoma mamario enmascarando un sarcoma.

Sarcomas account for less than 1% of malignant breast tumors. We present the case of a sarcoma (malignant fibrous histiocytoma) of the breast that debuted as a lump. The patient associated the lump with trauma, and the clinical, sonographic, and cytological findings were suggestive of a hematoma. The lump grew rapidly, and the follow-up sonogram one month later clearly revealed hypervascular solid poles. This atypical presentation is useful for reviewing the management of lesions suggestive of hematomas, which are often associated with nonspecific findings and occasionally with signs that raise suspicion of malignancy. The emergence of what appears to be a hematoma in the breast, even when accompanied by a history of trauma or a tendency toward bleeding, calls for prudence: very short-term follow-up and biopsy, even excisional biopsy, are recommended if the lesion does not evolve like a hematoma.

[Clinical usefulness of ultrasound-guided alcohol sclerosis in patients with breast fistulas]. / Utilidad clínica de la esclerosis con alcohol guiada con ecografía en pacientes con fístulas de mama.

OBJECTIVE: To study the clinical usefulness of ultrasound-guided alcohol sclerosis as a treatment alternative to surgical intervention for breast fistulas. MATERIAL AND METHODS: This was a retrospective study of data collected in a hospital breast unit over a three-year period (January 2011 through December 2013). The procedure consists of introducing a sclerosing solution into the lumen of the breast fistula under ultrasound guidance. All cases were reviewed by a multidisciplinary committee; patients were offered ultrasound-guided alcohol sclerosis as a first treatment option with surgical intervention as a rescue therapy for those with unsatisfactory outcomes. RESULTS: Ten fistulas were treated in 9 women (median age, 33 y; interquartile range 18.5 y). Five patients (50%) attributed the clinical findings to recurrent mastitis, four (40%) to a previous surgical intervention, and one (10%) to lactation. Seven patients (78%) were smokers. The procedure was well tolerated: nine patients (90%) rated the pain as one or 2 (mild pain) on a visual analogue scale. There were no immediate complications. The response to treatment was considered excellent (absence of secretion and complete closure) in eight fistulas (80%). CONCLUSION: Ultrasound-guided alcohol sclerosis achieved excellent outcomes in 80% of cases and is a viable alternative to surgical treatment.

Frecuencia de cáncer en pacientes con ecografía mamaria BI-RADS 4A / Rate of breast cancer diagnosis in patients categorized as bi-rads 4A on screening ultrasound

Las imágenes son fundamentales en la evaluación de la patología mamaria. El Colegio Americano de Radiología estandarizó los reportes con el Breast Imaging Reporting and Data System (BI-RADS), que permite predecir según las características morfológicas la probabilidad de malignidad y la conducta a seguir. En la cuarta edición de 2003 se amplió para incluir el primer lexicón de ecografía. Los BI-RADS 4 y 5 corresponden a lesiones sospechosas de malignidad y en la 4 fue necesario crear tres subgrupos, de los cuales el 4A son lesiones con posibilidad baja de cáncer (entre 2% y 10%). Como en la primera publicación presentamos los resultados del valor predictivo positivo del reporte BI-RADS 4A mamográfico, el objetivo del presente estudio es determinar la tasa de malignidad en BI-RADS 4A ecográfico en los hospitales de San José e Infantil Universitario de San José de Bogotá DC, Colombia, incluyendo casos de BI-RADS 4A mamográfico para contrastar con el estudio inicial. Cuatro de 72 pacientes con ecografía mamaria BI-RADS 4A fueron diagnosticadas con cáncer de mama (VPP del 5.5%), todos en nódulos sólidos. Algunos pudieron catalogarse como BI-RADS 3 por los radiólogos...

Imaging is essential for breast pathology evaluation. The American College of Radiology provides a standardized classification system the Breast Imaging-Reporting and Data System (BI-RADS), allowing prediction of malignancy probability based on appearance and providing guidelines to be followed. The 2003 fourth edition was extended to include the first ultrasound lexicon. BI-RADS 4 and 5 categories are lesions with suspicious changes of malignancy, and category 4 was divided into three sub groups, 4A lesions have low possibility of cancer (between 2% and 10%). As our first publication presented the results of the positive predictive value of BI-RADS 4A mammographic reports, the objective of the present study is to determine the malignancy rate in BI-RADS 4A ultrasound reports at San José and Infantil Universitario de San José hospitals in Bogotá DC, Colombia, including BI-RADS 4A mammographic exam cases to compare with the initial study. Of the 72 BI-RADS 4a lesions on ultrasound screening, four were malignant (VPP 5.5%) all detected as solid nodules. Some could have been categorized as BI-RADS 3 by radiologists...

Análise dos achados ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário diagnosticados por core biópsia / Analyzing the ecographic features of pseudoangiomatous stromal hyperplasia masses diagnosed by core biopsy

Objetivos: Descrever os aspectos ecográficos em nódulos de hiperplasia pseudoangiomatosa do estroma mamário, classificando-os segundo o BI-RADS®. Métodos: Foi realizado um estudo retrospectivo, de 2009 a 2010, da base de dados do nosso serviço (UD diagnóstico por imagem) para identificar nódulos evidenciados na ecografia mamária, com diagnóstico histopatológico confirmado de hiperplasia pseudoangiomatosa do estroma mamário, por meio de core biópsia orientada por ultrassonografia, com agulha de 16 gauge. Foram identificadas 16 pacientes com lesões ecográficas que tinham hiperplasia pseudoangiomatosa do estroma mamário como diagnóstico. Resultados: O fator determinante para a classificação em categorias 4a e 4b, segundo o léxico BI-RADS® para ultrassonografia, foi as margens não-circunscritas, que estavam presentes em 93,3% das lesões, as demais características ecográficas das lesões foram compatíveis com lesões benignas. Conclusão: Nódulos ecográficos de hiperplasia pseudoangiomatosa do estroma mamário podem apresentar características ecográficas que sejam determinantes para a realização de biópsias, mesmo sabendo-se que esta patologia tem curso tipicamente benigno.

Objectives: To describe the ecographic features of pseudoangiomatous stromal hyperplasia masses, classifying them according to the BI-RADS® lexicon. Methods: A retrospective review was performed during the period from 2009 to 2010, using the database of our service (UD diagnóstico por imagem), in order to find ecographic masses with pseudoangiomatous stromal hyperplasia diagnosis, which were performed with 16-gauge core biopsy ultrasound guided. We identified 16 patients with ecographic masses diagnosed with pseudoangiomatous stromal hyperplasia. Results: The most important finding that changes the classification of the BI-RADS® was noncircumscribed margins, which were foundin 93.3% of the lesions, other ultrasound characteristics found were benign features. Conclusion: Pseudoangiomatous stromal hyperplasiamasses may present ecographic findings that support biopsy indication; although it is known that it is a benign pathology.