Self-inflicted burns in Brazil: systematic review and meta-analysis.

INTRODUCTION: burns represent a pivotal component of trauma in Brazil, accounting for 2 million incidents and 2,500 deaths annually. Self-intentional burns are associated with a worse prognosis, larger burned surface area, higher infection rates, and death. The lack of studies on the issue of self-immolation raises epidemiological questions regarding Brazilian victims. This study aimed to investigate the profile of burn events associated with self-injurious behavior among Brazilian victims. METHODS: this systematic review was performed according to PRISMA 2020 guidelines and evaluated the correlation between self-injurious behavior as a cause of burns in Brazilian victims and its epidemiological implications in the last 20 years (2003-2023). The MeSH terms "Burns", "Self-Injurious Behavior", "Epidemiology" and "Brazil" were queried in the PubMed/MEDLINE, SciELO, and Cochrane Library databases, and, after selection by inclusion/exclusion criteria, the most relevant studies were critically analyzed. RESULTS: From 1,077 pre-selected studies, 92 were potentially eligible, resulting in 7 manuscripts incorporated in this review. From 3,510 burned victims assembled in the pool of selected studies, 311 cases displayed self-injurious behavior. Burned patients who attempted to burn their lives have a higher risk of death (p<0.05; RR=5.1 [3.2-8.1]) and larger burned surface area (p<0.05; MD=19.2 [10-28.2]), compared to accidental cases. Moreover, the female gender was at a higher risk of attempting self-immolation (p<0.05; RR=4.01 [2.9-5.5]). CONCLUSION: our results show that self-inflicted burn cases were associated with a larger burned surface area and a higher risk of death, and the female gender was identified as a relevant risk factor in Brazil.

Self-inflicted burns in Brazil: systematic review and meta-analysis / Queimaduras autoprovocadas no Brasil: revisão sistemática e meta-análise

ABSTRACT Introduction: burns represent a pivotal component of trauma in Brazil, accounting for 2 million incidents and 2,500 deaths annually. Self-intentional burns are associated with a worse prognosis, larger burned surface area, higher infection rates, and death. The lack of studies on the issue of self-immolation raises epidemiological questions regarding Brazilian victims. This study aimed to investigate the profile of burn events associated with self-injurious behavior among Brazilian victims. Methods: this systematic review was performed according to PRISMA 2020 guidelines and evaluated the correlation between self-injurious behavior as a cause of burns in Brazilian victims and its epidemiological implications in the last 20 years (2003-2023). The MeSH terms "Burns", "Self-Injurious Behavior", "Epidemiology" and "Brazil" were queried in the PubMed/MEDLINE, SciELO, and Cochrane Library databases, and, after selection by inclusion/exclusion criteria, the most relevant studies were critically analyzed. Results: From 1,077 pre-selected studies, 92 were potentially eligible, resulting in 7 manuscripts incorporated in this review. From 3,510 burned victims assembled in the pool of selected studies, 311 cases displayed self-injurious behavior. Burned patients who attempted to burn their lives have a higher risk of death (p<0.05; RR=5.1 [3.2-8.1]) and larger burned surface area (p<0.05; MD=19.2 [10-28.2]), compared to accidental cases. Moreover, the female gender was at a higher risk of attempting self-immolation (p<0.05; RR=4.01 [2.9-5.5]). Conclusion: our results show that self-inflicted burn cases were associated with a larger burned surface area and a higher risk of death, and the female gender was identified as a relevant risk factor in Brazil.

RESUMO Introdução: Queimaduras representam um componente fundamental do trauma no Brasil, sendo responsáveis por 2 milhões de incidentes e 2.500 mortes anualmente. Queimaduras autointencionais estão associadas a pior prognóstico, maior superfície corporal queimada, maiores taxas de infecção e morte. A falta de estudos sobre a problemática da autoimolação levanta questões epidemiológicas em relação às vítimas brasileiras. O estudo se objetivou investigar o perfil das queimaduras associados ao comportamento autolesivo entre vítimas brasileiras. Métodos: Esta revisão sistemática foi realizada de acordo com as diretrizes PRISMA 2020 e avaliou a correlação entre comportamento autolesivo como causa de queimaduras em vítimas brasileiras e suas implicações epidemiológicas nos últimos 20 anos (2003-2023). Os termos MeSH "Burns", "Self-Injurious Behavior", "Epidemiology" e "Brazil" foram elencados no PubMed/MEDLINE, SciELO e Cochrane Library e, após seleção por critérios de inclusão/exclusão, os estudos mais relevantes foram analisados criticamente. Resultados: Dos 1.077 estudos pré-selecionados, 92 foram potencialmente elegíveis, resultando em 7 manuscritos incorporados nesta revisão. Das 3.510 vítimas queimadas reunidas no conjunto de estudos selecionados, 311 casos apresentaram comportamento autolesivo. Pacientes que tentaram autoimolação apresentam maior risco de morte (p<0,05; RR=5,1 [3,2-8,1]) e maior superfície corporal queimada (p<0,05; MD=19,2 [10-28,2]), em comparação com casos acidentais. Ademais, o sexo feminino apresentou maior risco para tentativa de autoimolação (p<0,05; RR=4,01 [2,9-5,5]). Conclusão: Nossos resultados mostram que os casos de queimaduras autoprovocadas foram associados a uma maior área de superfície corporal queimada e a um maior risco de morte, e o sexo feminino foi identificado como um fator de risco relevante no Brasil.

Trends in the morbidity and mortality of coronavirus disease 2019 in different ethnic groups and gender in a large Brazilian city.

As the coronavirus disease 2019 (COVID-19) outbreak spread, evidence has emerged that gender and race would bear a disproportionate impact on the morbimortality of COVID-19. Here, we conducted a retrospective observational study using the TabNet/Departamento de informática do sistema único de saúde platform of the city of São Paulo. COVID-19 records from March 2020 through December 2021 were included, and we evaluated the temporal trends of confirmed cases and case fatality rate by gender and ethnicity. Statistical analysis was performed using the R-software and BioEstat-software, considering p < 0.05 significant. From March/2020 to December/2021, 1 315 160 COVID-19 confirmed cases were recorded (57.1% females), and 2973 deaths were due to COVID-19. Males presented higher median mortality (0.44% vs. 0.23%; p < 0.05) and intensive care unit (ICU) admission rates (0.34% vs. 0.20%; p < 0.05). Men were also associated with a higher risk of death (risk ratio [RR] = 1.28; p < 0.05) and a higher chance of requiring ICU care (RR = 1.29; p < 0.05). Black ethnicity was associated with a higher risk of death (RR = 1.19; p < 0.05). White patients were more likely to require ICU admission (RR = 1.13; p < 0.05), whereas Browns were associated with a protective effect (RR = 0.86; p < 0.05). Furthermore, men presented a higher chance of death than women across the three major ethnic groups: Whites (RR = 1.33; p < 0.05), Blacks (RR = 1.24; p < 0.05), and Browns (RR = 1.35; p < 0.05). In this study of COVID-19 in São Paulo, men were associated with worse outcomes, including in the three major ethnicities in the population. Blacks exhibited a higher risk of death, Whites were more likely to require intensive care, and Browns were at protection from ICU hospitalization.

A POPULATION STUDY ON GENDER AND ETHNICITY DIFFERENCES IN GALLBLADDER DISEASE IN BRAZIL.

AIM: Gallbladder diseases (GBD) are one of the most common medical conditions requiring surgical intervention, both electively and urgently. It is widely accepted that sex and ethnic characteristics mighty influence both prevalence and outcomes. This study aimed to evaluate the differences on distributions of gender and ethnicity related to the epidemiology of GBD in the Brazilian public health system. METHODS: DATASUS was used to retrieve patients' data recorded under the International Code of Diseases (ICD-10) - code K80 from January 2008 to December 2019. The number of admissions, modality of care, number of deaths, and in-hospital mortality rate were analyzed by gender and ethnic groups. RESULTS: Between 2008 and 2019, a total of 2,899,712 patients with cholelithiasis/cholecystitis (K80) were admitted to the hospitals of the Brazilian Unified Health System, of whom only 22.7% were males. Yet, the in-hospital mortality rate was significantly higher in males (15.9 per 1,000 male patients) than females (6.3 per 1,000 female patients) (p<0.05). Moreover, men presented a significantly higher risk of death (RR=2.5; p<0.05) and longer hospital stay (4.4 days vs. 3.3 days; p<0.05) than females. Compared to females, men presented a higher risk of death across all self-declared ethnic groups: whites (RR=2.4; p<0.05), blacks (RR=2.7; p<0.05), browns (RR=2.6; p<0.05), and Brazilian Indians (RR=2.13; p<0.05). CONCLUSION: In the years 2008-2019, women presented the highest prevalence of hospital admissions for GBD in Brazil, and men were associated with worse outcomes, including all ethnic groups.

A population study on gender and ethnicity differences in gallbladder disease in brazil / Estudo populacional sobre as diferenças de gênero e etnia na doença da vesícula biliar no brasil

ABSTRACT - BACKGROUND: Gallbladder diseases (GBD) are one of the most common medical conditions requiring surgical intervention, both electively and urgently. It is widely accepted that sex and ethnic characteristics mighty influence both prevalence and outcomes. AIM: This study aimed to evaluate the differences on distributions of gender and ethnicity related to the epidemiology of GBD in the Brazilian public health system. METHODS: DATASUS was used to retrieve patients' data recorded under the International Code of Diseases (ICD-10) - code K80 from January 2008 to December 2019. The number of admissions, modality of care, number of deaths, and in-hospital mortality rate were analyzed by gender and ethnic groups. RESULTS: Between 2008 and 2019, a total of 2,899,712 patients with cholelithiasis/cholecystitis (K80) were admitted to the hospitals of the Brazilian Unified Health System, of whom only 22.7% were males. Yet, the in-hospital mortality rate was significantly higher in males (15.9 per 1,000 male patients) than females (6.3 per 1,000 female patients) (p<0.05). Moreover, men presented a significantly higher risk of death (RR=2.5; p<0.05) and longer hospital stay (4.4 days vs. 3.3 days; p<0.05) than females. Compared to females, men presented a higher risk of death across all self-declared ethnic groups: whites (RR=2.4; p<0.05), blacks (RR=2.7; p<0.05), browns (RR=2.6; p<0.05), and Brazilian Indians (RR=2.13; p<0.05). CONCLUSION: In the years 2008-2019, women presented the highest prevalence of hospital admissions for GBD in Brazil, and men were associated with worse outcomes, including all ethnic groups.

RESUMO - RACIONAL: Doenças da vesícula biliar (DVB) são uma das condições médicas mais comuns que requerem intervenção cirúrgica, tanto eletiva como urgente. É amplamente aceito que o sexo e as características étnicas podem influenciar a prevalência e os desfechos. OBJETIVO: Avaliar as diferenças nas distribuições de gênero e etnia relacionados à epidemiologia da DVB no sistema público de saúde brasileiro. MÉTODOS: O DATASUS foi usado para elencar os dados de pacientes registrados no Código Internacional de Doenças (CID-10) sob o código K80, de janeiro de 2008 a dezembro de 2019. O número de admissões, caráter de atendimento, número de óbitos e taxa de mortalidade hospitalar foram analisados por gênero e por etnia. RESULTADO: Entre 2008 e 2019, 2.899.712 pacientes com colelitíase/colecistite (K80) foram admitidos em hospitais do Sistema Único de Saúde (SUS), dos quais apenas 22,7% eram do sexo masculino. Ainda assim, a taxa de mortalidade intra-hospitalar masculina (15,9:1.000 pacientes homens) foi significativamente maior do que a feminina (6,3:1.000 pacientes mulheres) (p<0,05). Ademais, homens apresentaram risco de morte significativamente maior em comparação às mulheres (RR=2,5; p<0,05) e maior tempo de internação hospitalar (4,4 dias versus 3,3 dias; p<0,05). Em comparação ao sexo feminino, homens apresentaram maior risco de morte em todos os grupos étnicos autodeclarados: brancos (RR=2,4; p<0,05), negros (RR=2,7; p<0,05), pardos (RR=2,6; p<0,05) e indígena (RR=2,13; p<0,05). CONCLUSÃO: Nos anos de 2008-2019, as mulheres apresentaram as maiores prevalências de internações hospitalares por DVB no Brasil, porém, os homens foram associados a piores desfechos, inclusive entre todos os grupos étnicos.

Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services.

Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.

In-hospital mortality in patients with acute limb ischemia over a 12-year period in the Brazilian public health-care system / Mortalidade hospitalar na saúde pública brasileira em pacientes com isquemia aguda dos membros em um período de 12 anos

Abstract Background Arterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI). Objectives To analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019. Methods An ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant. Results From 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories. Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased. Conclusions There was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged.

Resumo Contexto Doenças arteriais representam um grave problema de saúde pública no século XXI. Apesar de homens apresentarem maior prevalência geral, estudos sugerem que mulheres podem cursar com quadros assintomáticos, clínica atípica e particularidades hormonais, que resultam em desfechos desfavoráveis e urgências graves, como oclusões arteriais aguda (OAA). Objetivos Analisar o perfil de morbimortalidade das urgências em OAA no Brasil entre 2008 e 2019. Métodos Realizou-se estudo ecológico com dados secundários do Sistema de Informações Hospitalares/Sistema Único de Saúde, utilizando-se o código I.74 do Código Internacional de Doenças-10. Dos números absolutos, obteve-se proporções de internamentos de urgência e taxa de mortalidade intra-hospitalar (TMH) por gênero, etnia e idade. Considerou-se p < 0,05 significativo. Resultados Entre 2008 e 2019, houve 195.567 internamentos de urgência por OAA no Brasil, dos quais 111.145 (56,8%) eram homens. Mulheres tiveram maior TMH (112:1.000 hospitalizações) em comparação a homens (85:1.000 hospitalizações) (p < 0,05), assim como maior chance de morte (odds ratio [OR] = 1,36; p < 0,05). Ademais, a média de sobrevida anual foi maior entre homens do que entre mulheres (8.483/ano vs. 6.254/ano, respectivamente; p < 0,05). Estratificando por etnia, mulheres apresentaram maior chance de óbitos entre brancas (OR = 1,44; p < 0,05), pretas (OR = 1,33; p < 0,05) e pardas (razão de risco [RR] = 1,25; p < 0,05), comparadas a homens das mesmas etnias. Nas análises etárias, mulheres com mais de 50 anos apresentaram maior chance de óbito, com aumento progressivo do risco com o envelhecimento. Conclusões Nossas análises comparativas evidenciaram tendência de pior prognóstico nas urgências em OAA associadas a mulheres, sobretudo em grupos de idade avançada. A literatura evidencia que as razões para essas diferenças ainda são pouco estudadas, estimulando investigações mais robustas sobre essa importante casuística da cirurgia vascular.

Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services / Comparação de desfechos e custo-efetividade de apendicectomias laparoscópicas e abertas em serviços públicos de saúde

ABSTRACT Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.

RESUMO Apendicite aguda é a principal causa de cirurgia abdominal de emergência no mundo e a apendicectomia continua sendo o tratamento definitivo de escolha. A presente investigação avalia desfechos e custos das apendicectomias laparoscópicas versus abertas realizadas em serviços públicos de saúde no estado da Bahia (Brasil). Realizou-se estudo observacional retrospectivo, utilizando a base de dados do DATASUS. Incluiu-se dados disponíveis sobre apendicectomias na Bahia entre 2008 e 2019, avaliando-se a tendência temporal de internações, taxas de mortalidade por procedimentos, tempo de permanência e custos. A análise estatística foi realizada no R-software (Fundação R, v.4.0.3) e no software BioEstat (IMDS, v.5.3), considerando p<0,05 significativo. Entre 2008 e 2019, realizou-se 53.024 apendicectomias no serviço público de saúde na Bahia, das quais 94,9% foram cirurgias abertas. A laparotomia foi associada à maior taxa de mortalidade (4,9/1.000 procedimentos; p<0,05) e maior risco de morte (RR=4,5; p<0,05) do que laparoscopia (1,1/1.000 procedimentos). Apendicectomia laparoscópica (mediana de 2,7 dias) obteve menor tempo de internamento do que cirurgia laparotômica (mediana de 4,15 dias) (p<0,05). Não houve diferença entre as medianas dos custos e nem dos serviços hospitalares por procedimento (p=0,08 e p=0,08, respectivamente). A mediana do custo de profissionais na laparoscopia foi significativamente mais elevada, em US$ 1,39 (p<0,05). A cirurgia minimamente invasiva para apendicite é um procedimento seguro e eficaz, proporcionando vantagens sobre a laparotomia (incluindo menor taxa de mortalidade e alta precoce), não implicando, por sua vez, em maiores despesas para cofres públicos no estado da Bahia.

Avaliação da prevalência de câncer de mama diagnosticado após excisão cirúrgica de lesões epiteliais atípicas e sua associação com fatores de risco / Prevalence of breast cancer diagnosed after surgical excision of atypical epithelial lesions and association with prognostic factors

Introdução: A presença de lesões atípicas da mama aumentam em média 4 a 5 vezes o risco de desenvolver câncer de mama. As lesões atípicas estão sendo cada vez mais diagnosticadas através de biópsias realizadas por agulha grossa ou mamotomia devido às campanhas de rastreamento. Após o diagnóstico da lesão atípica, a maioria das pacientes são submetidas à excisão cirúrgica devido à associação de câncer subestimado na biópsia por agulha grossa/mamotomia. A prevalência de câncer nas excisões cirúrgicas variam muito entre os estudos, e a depender do tipo de lesão atípica, essas cirurgias até poderiam ser evitadas caso fosse possível selecionar quais pacientes realmente se beneficiariam deste procedimento cirúrgico. Objetivos: Calcular a prevalência do câncer de mama diagnosticado após ressecção cirúrgica das lesões epiteliais atípicas da mama identificadas por biópsia de agulha grossa (core biopsy ou mamotomia) e associar as variáveis demográficas, de imagem e biópsia com o diagnóstico de câncer na ressecção cirúrgica. Métodos: Foi realizado um estudo retrospectivo baseado na revisão de prontuários do A.C. Camargo Cancer Center no período de agosto de 2007 a dezembro de 2013. Foram incluídas as pacientes submetidas à biópsia por agulha grossa, cujo diagnóstico anatomopatológico foi de lesão epitelial atípica (atipia epitelial plana - AEP; hiperplasia lobular com atipias ­ HLA; hiperplasia ductal com atipias - HDA; carcinoma lobular in situ - CLIS) e que posteriormente foram submetidas à ressecção cirúrgica. Foram excluídas as pacientes com diagnóstico prévio ou simultâneo de câncer de mama e biópsias que não foram revisadas na instituição. Foi considerado câncer de mama a presença de carcinoma ductal in situ (CDIS), carcinoma ductal invasivo (CDI) ou carcinoma lobular invasivo (CLI) após excisão cirúrgica. Resultados: Foram analisadas 200 biópsias em 195 pacientes, com idade variando de 27 a 87 anos, com mediana de 50,8 anos. A mamografia foi o exame que indicou a biópsia em 155 casos (78,3%), ultrassom das mamas em 37 casos (18,5%) e ressonância em 6 casos (3,0%). A principal alteração que demandou uma biópsia foi a presença de microcalcificações em 146 (73,7%), seguido de nódulo em 42 (21,2%) e área de assimetria em 10 (5,1%). De todas as biópsias com microcalcificações 118 (80,8%) não foram ressecadas totalmente na biópsia e 28 (19,2%) haviam sido totalmente ressecadas. Mamotomia foi realizada para avaliar 132 lesões (68,8%) e core biopsy foi utilizada para avaliar 60 lesões (31,3%). Reunindo todas as lesões atípicas, a taxa de subestimação, ou seja, achado de CDIS, CDI ou CLI na cirurgia, foi de 17,5%. Estratificando por tipo de lesão, observamos que nas 55 biópsias com AEP, a taxa de subestimação foi de 14,5%; nas 27 biópsias com HLA, foi de 3,7%; nas 78 biópsias com HDA, foi de 24,4%; e nas 40 biópsias com CLIS, foi de 17,5%. Devido às altas taxas de subestimação das biópsias com AEP, HDA e CLIS, a biópsia cirúrgica parece mandatória. Por outro lado, para HLA, a baixa taxa de subestimação pode sugerir a possibilidade de abordagem mais conservadora. Não houve correlação entre os dados de imagem e da biópsia em relação ao achado ou não de câncer na excisão cirúrgica. Em relação aos dados clínicos, menarca precoce se correlacionou com a presença de carcinoma na peça cirúrgica, porém não se manteve como variável de risco para carcinoma na análise multivariada. Conclusões: A prevalência global de neoplasia maligna diagnosticada após excisão cirúrgica das lesões epiteliais atípicas da mama foi de 17,5%, sendo 14,6% na AEP; 3,7% na HLA; 24,4% na HDA e 17,5% no CLIS. Nenhuma variável mostrou associação estatisticamente significativa com um maior risco de carcinoma na peça da excisão cirúrgica após a análise multivariada.

Introduction: Atypical breast lesions increase in average 4-5 fold the risk of breast cancer. The atypical lesions have been diagnosed as a result of increasing number of biopsies due to screening programs. After atypical lesion diagnosis, most patients are submitted to surgical excisions, as these lesions are associated to cancer underestimated by the biopsies. The cancer prevalence after surgical excision varies widely between studies and is different between the types of atypical lesion. Some of these surgeries could be potentially avoided after selecting a group of patients with low likelihood of having an underlying breast cancer. Objectives: Calculate the prevalence of breast cancer diagnosed after surgical excision of atypical epithelial breast lesions identified by needle biopsy (core biopsy or mammotomy) and associate demographic, image and biopsy variables with the diagnosis of cancer after the surgical resection. Methods: A retrospective study was performed based on review of A.C. Camargo Cancer Center records from August 2007 to December 2013. Patients that had needle biopsy with pathological finding of atypical epithelial lesions (flat epithelial atypia ­ FEA; atypical lobular hyperplasia ­ ALH; atypical ductal hyperplasia ­ ADH; lobular carcinoma in situ ­ LCIS) and further submitted to surgical resection were included. Patients with previous or simultaneous breast cancer diagnosis and biopsies that were not performed or reviewed in our institution were excluded. Breast cancer was considered as the presence of ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC). Results: Two hundred biopsies from 195 patients were analyzed. Median age was 50.8 years (range 27-87). Mammography indicated the biopsy in 155 cases (78.3%), ultrasound in 37 (18.5%), and magnetic resonance in 6 (3.0%). The main finding that indicated the biopsy was micro-calcifications in 146 cases (73.7%), presence of nodule in 42 (21.2%) and asymmetry in 10 (5.1%). From all biopsies with micro-calcifications 118 (80.8%) were not totally resected and 28 (19.2%) were totally resected. Mammotomy was used to evaluate 132 lesions (68.8%) and core biopsy in 60 lesions (31.3%). For all atypical lesions, the underestimation rate, with final pathology of DCIS, IDC or ILC after surgical resection was 17.5%. Furthermore, we observed an underestimation rate of 14.5% for FEA (n=55), 3,7% for ALH (n=27) 24.4% for ADH (n=78), and 17.5% for LCIS (n=40). Because of the high rates of underestimation of biopsies with FEA, ADH and LCIS, the surgical biopsy seems mandatory. However, the low rate of underestimation found for ALH may turn possible a more conservative approach. There was no correlation between both imaging or biopsy data and the finding of cancer after surgical excision. Moreover, early menarche correlated with the presence of cancer in the surgical specimen, however it was not an independent variable in multivariate analysis. Conclusions: The overall prevalence of breast cancer diagnosed after surgical excision of atypical epithelial breast lesions was 17.5%. For each atypical lesion, the prevalence of breast cancer was: 14.6% for FEA, 3.7% for ALH 24.4% for ADH, and 17.5% for LCIS. No variable retained the risk of carcinoma after surgical resection in multivariable analysis.

Avaliação da prevalência de câncer de mama diagnosticado após excisãocirúrgica de lesões epiteliais atípicas e sua associação com fatores de risco

Introdução: A presença de lesões atípicas da mama aumentam em média 4 a 5 vezeso risco de desenvolver câncer de mama. As lesões atípicas estão sendo cada vez mais diagnosticadas através de biópsias realizadas por agulha grossa ou mamotomia devido às campanhas de rastreamento. Após o diagnóstico da lesão atípica, a maioria das pacientes são submetidas à excisão cirúrgica devido à associação de câncer subestimado na biópsia por agulha grossa/mamotomia. A prevalência de câncer nas excisões cirúrgicas variam muito entre os estudos, e a depender do tipo de lesão atípica, essas cirurgias até poderiam ser evitadas caso fosse possível selecionar quaispacientes realmente se beneficiariam deste procedimento cirúrgico. Objetivos:Calcular a prevalência do câncer de mama diagnosticado após ressecção cirúrgicadas lesões epiteliais atípicas da mama identificadas por biópsia de agulha grossa(core biopsy ou mamotomia) e associar as variáveis demográficas, de imagem ebiópsia com o diagnóstico de câncer na ressecção cirúrgica. Métodos: Foi realizado um estudo retrospectivo baseado na revisão de prontuários do A.C. Camargo Cancer Center no período de agosto de 2007 a dezembro de 2013. Foram incluídas as pacientes submetidas à biópsia por agulha grossa, cujo diagnóstico anatomopatológico foi de lesão epitelial atípica (atipia epitelial plana - AEP; hiperplasia lobular com atipias – HLA; hiperplasia ductal com atipias - HDA; carcinoma lobular in situ - CLIS) e que posteriormente foram submetidas à ressecção cirúrgica. Foram excluídas as pacientes com diagnóstico prévio ou simultâneo de câncer de mama e biópsias que não foram revisadas na instituição. Foi considerado câncer de mama a presença de carcinoma ductal in situ (CDIS), carcinoma ductal invasivo (CDI) ou carcinoma lobular invasivo (CLI) após excisão cirúrgica...

Introduction: Atypical breast lesions increase in average 4-5 fold the risk of breast cancer. The atypical lesions have been diagnosed as a result of increasing number of biopsies due to screening programs. After atypical lesion diagnosis, most patients are submitted to surgical excisions, as these lesions are associated to cancer underestimated by the biopsies. The cancer prevalence after surgical excision varies widely between studies and is different between the types of atypical lesion. Some of these surgeries could be potentially avoided after selecting a group of patients withlow likelihood of having an underlying breast cancer. Objectives: Calculate theprevalence of breast cancer diagnosed after surgical excision of atypical epithelialbreast lesions identified by needle biopsy (core biopsy or mammotomy) andassociate demographic, image and biopsy variables with the diagnosis of cancer after the surgical resection. Methods: A retrospective study was performed based on review of A.C. Camargo Cancer Center records from August 2007 to December2013. Patients that had needle biopsy with pathological finding of atypical epithelial lesions (flat epithelial atypia – FEA; atypical lobular hyperplasia – ALH; atypical ductal hyperplasia – ADH; lobular carcinoma in situ – LCIS) and further submitted to surgical resection were included. Patients with previous or simultaneous breast cancer diagnosis and biopsies that were not performed or reviewed in our institution were excluded. Breast cancer was considered as the presence of ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC).Results: Two hundred biopsies from 195 patients were analyzed. Median age was50.8 years (range 27-87). Mammography indicated the biopsy in 155 cases (78.3%), ultrasound in 37 (18.5%), and magnetic resonance in 6 (3.0%). The main finding that indicated the biopsy was micro-calcifications in 146 cases (73.7%), presence of (73.7%)...