Tomosíntesis de mama: una nueva herramienta en el diagnóstico del cáncer de mama / Breast tomosynthesis: a new tool for diagnosing breast cancer

El cáncer de mama sigue siendo el tumor maligno más frecuente entre las mujeres occidentales. La mamografía es, hoy por hoy, la técnica de elección para el cribado poblacional. Aunque es una técnica ampliamente validada, tiene limitaciones, especialmente en las mamas densas. La tomosíntesis de mama ha supuesto una revolución en el diagnóstico de cáncer de mama. Permite definir lesiones ocultas en el interior del tejido glandular y, por tanto, detectar tumores de mama no visibles mediante estudios mamográficos convencionales. Para considerar el uso combinado de ambas técnicas, hay que tener en cuenta muchos factores aparte de la detección de cáncer, como la radiación adicional, la tasa de rellamadas, y el tiempo de realización y lectura de ambas pruebas. En este artículo revisamos los principios técnicos de la tomosíntesis, sus principales utilidades y las perspectivas de futuro de esta técnica de imagen (AU)

Breast cancer continues to be the most common malignant tumor in women in occidental countries. Mammography is currently the technique of choice for screening programs; however, although it has been widely validated, mammography has its limitations, especially in dense breasts. Breast tomosynthesis is a revolutionary advance in the diagnosis of breast cancer. It makes it possible to define lesions that are occult in the glandular tissue and therefore to detect breast tumors that are impossible to see on conventional mammograms. In considering the combined use of mammography and tomosynthesis, many factors must be taken into account apart from cancer detection; these include additional radiation, the recall rate, and the time necessary to carry out and interpret the two tests. In this article, we review the technical principles of tomosynthesis, it main uses, and the future perspective for this imaging technique (AU)

[Breast tomosynthesis: a new tool for diagnosing breast cancer]. / Tomosíntesis de mama: una nueva herramienta en el diagnóstico del cáncer de mama.

Breast cancer continues to be the most common malignant tumor in women in occidental countries. Mammography is currently the technique of choice for screening programs; however, although it has been widely validated, mammography has its limitations, especially in dense breasts. Breast tomosynthesis is a revolutionary advance in the diagnosis of breast cancer. It makes it possible to define lesions that are occult in the glandular tissue and therefore to detect breast tumors that are impossible to see on conventional mammograms. In considering the combined use of mammography and tomosynthesis, many factors must be taken into account apart from cancer detection; these include additional radiation, the recall rate, and the time necessary to carry out and interpret the two tests. In this article, we review the technical principles of tomosynthesis, it main uses, and the future perspective for this imaging technique.

Impact of a CAD system in a screen-film mammography screening program: a prospective study.

OBJECTIVE: The purpose of our study was to perform a prospective assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years. MATERIALS AND METHODS: Our study was carried out on a population of 21,855 asymptomatic women (45-65 years). Mammograms were processed in a CAD system and independently interpreted by one of six radiologists. We analyzed the following parameters: sensitivity of radiologist's interpretation (without and with CAD), detection increase, recall rate and positive predictive value of biopsy, CAD's marks, radiologist's false negatives and comparative analysis of carcinomas detected and non-detected by CAD. RESULTS: Detection rate was 4.3‰. CAD supposed an increase of 0.1‰ in detection rate and 1% in the total number of cases (p<0.005). The impact on recall rate was not significant (0.4%) and PPV of percutaneous biopsy was unchanged by CAD (20.23%). CAD's marks were 2.7 per case and 0.7 per view. Radiologist's false negatives were 13 lesions which were initially considered as CAD's false positives. CONCLUSIONS: CAD supposed a significant increase in detection, without modifications in recall rates and PPV of biopsy. However, better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted.

Adenocarcinoma del saco endolinfático en la enfermedad de von Hippel-Lindau. A propósito de un caso / Adenocarcinoma of the endolymphatic sac in von Hippel-Lindau disease. A case report

Los tumores originarios del sistema endolinfático son extraordinariamente raros, siendo muy escaso el número de artículos publicados que hacen referencia a este tipo de tumores. Hasta en un 15% de los casos se asocian a la enfermedad de von Hippel-Lindau (vHL).Este artículo describe el caso de un paciente diagnosticado previamente de enfermedad de vHL que presenta, de forma brusca, pérdida de audición en el oído izquierdo. Estudios radiológicos específicos (tomografía computarizada [TC] y resonancia magnética [RM]) demostraron la presencia de una neoformación originada en el saco endolinfático izquierdo. El análisis histológico de la pieza quirúrgica correspondió a un adenocarcinoma del saco endolinfático (AU)

Tumors originating in the endolymphatic system are extremely rare, and very few articles have been published about this type of tumors. Up to 15% of cases are associated to von Hippel-Lindau disease. This article describes the case of a patient previously diagnosed with von Hippel-Landau disease that presented a sudden loss of hearing in the left ear. Specific imaging tests (computed tomography [CT] and magnetic resonance imaging [MRI]) showed the presence of a neoplasm originating in the left endolymphatic sac. Histological analysis of the surgical specimen determined it corresponded to an adenocarcinoma of the endolymphatic sac (AU)

[Adenocarcinoma of the endolymphatic sac in von Hippel-Lindau disease. A case report]. / Adenocarcinoma del saco endolinfático en la enfermedad de von Hippel-Lindau. A propósito de un caso.

Tumors originating in the endolymphatic system are extremely rare, and very few articles have been published about this type of tumors. Up to 15% of cases are associated to von Hippel-Lindau disease. This article describes the case of a patient previously diagnosed with von Hippel-Landau disease that presented a sudden loss of hearing in the left ear. Specific imaging tests (computed tomography [CT] and magnetic resonance imaging [MRI]) showed the presence of a neoplasm originating in the left endolymphatic sac. Histological analysis of the surgical specimen determined it corresponded to an adenocarcinoma of the endolymphatic sac.

Metastases to the breast: a review of 33 cases.

The aim of the study was to show the clinical and radiological manifestations of metastases to the breast (MB). From 1987 to 2006, 33 patients with MB were diagnosed at our institution. Their clinical and radiological features were retrospectively evaluated. Of the 33 cases, 31 presented as a palpable breast lump. On mammography, their findings were classified as follows: well-circumscribed masses (11 cases), ill-circumscribed masses (five), focal asymmetric densities (one) and inflammatory skin changes (six). Mammograms were normal in six cases (all of them showed dense breast tissue). Four CT scans showed two well-circumscribed masses and two ill-circumscribed masses. Ultrasonography was available in 18 cases: hypoechoic lesions (15 cases) were more frequent than hyperechoic (one) or isoechoic lesions (two). The appearance on magnetic resonance was similar to primary breast cancer (one case). The most common primary tumours causing MB were haematological malignancies (nine cases) and melanomas (seven). Metastases to the breast showed a wide range of mammographic and ultrasonographic appearances, resembling both benign and malignant lesions. Any patient who presents with a breast lump with a history of cancer should undergo a core-needle biopsy in order to determine the histology of the lump.

Análisis de los resultados clínicos y la carga asistencial del screening oportunista en una Unidad de Diagnóstico por la Imagen de la Mama / Analysis of the clinical results and the nursing workloads and costs of opportunist screening in a Breast Diagnostic Imaging Unit

El objetivo de este trabajo es analizar el impacto diagnóstico y la carga asistencial del screening oportunista (SO). Se analizó la actividad desarrollada entre 2003 y 2006. Se estudiaron 24.317 pacientes (9.487 remitidas como SO) y se realizaron44.269 mamografías en el Programa Poblacional. El SO supuso el 42% de la demanda, 39% de pacientes, 33,69% de estudios y 22,32% de costes. El coste/carcinoma fue 964 URVs, frente a 461,16 URVs en Programa y 195,64 URVs en sintomáticas. El SO supone un alto volumen de actividad y consumo de recursos. Es necesario reducir la carga asistencial promoviendo la participación en Programas e introduciendo estrategias de gestión para reducir costes (AU)

The objective of this work is to analyse the diagnostic impact and nursing workloads and costs of opportunist screening (OS). After analyzing the diagnostic impact and nursing workloads and costs of opportunist screening (OS). After analyzing the activity carried out between 2003 and 2006, a high volume of activity and consumption of resources is observed. It thus concludes that it is necessary to reduce the nursing workloads and costs encouraging the participation in Programmes and introducing management strategies to reduce costs (AU)

Atypical evolution of a calcified lipid cyst presenting spontaneously as a suspicious cluster of microcalcifications.

We report an infrequent mammographic case in which a gross-calcified lipid cyst evolved spontaneously to form a cluster of pleomorphic microcalcifications which were indistinguishable from those seen in breast cancer. The biopsy performed was consistent with fat necrosis. Ultrasonography of the specimen showed a nodule with mixed echogenicity surrounded by a hypoechoic rim. To our knowledge, this behavior is extremely rare, with only one similar case reported in the literature.

Clip placement facilitating the approach to breast lesions.

We describe a novel technique for marking non-palpable breast lesions with the aim of selecting the best approach prior to performing a biopsy. The technique employs a new coil, specifically designed for breast localization, guided by stereotaxy. This technique is reserved for selected cases in which the lesion is seen peripherally in only one mammographic view with negative or non-conclusive ultrasonographic results, and deeply seated after a stereotactic study. Once the coil is released beside the lesion, the shortest approach from the skin may be employed to perform the biopsy. To our knowledge, this is the first report of this technique.

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