Valoración de un método automático de diagnóstico asistido por ordenador en la RM de pacientes con cáncer de mama / No disponible

Objetivo: Valorar y comparar entre el programa manualestándar y un nuevo programa de diagnóstico asistido por ordenador(CAD) en el estudio del cáncer de mama por RM.Material y métodos: Durante 24 meses se han estudiadode forma prospectiva 51 pacientes con 66 lesiones mamarias,57 malignas y 9 benignas, remitidas para la estadificación localprequirúrgica por RM de mama.Tras realizar el estudio dinámico tridimensional con contrasteendovenoso, se analiza el postprocesado de cada lesiónmediante el programa de análisis manual y el automático dediagnóstico asistido por ordenador (CADstream®), comparandolos resultados obtenidos y su correlación definitiva con anatomíapatológica.Resultados: El método automático de diagnóstico asistidopor ordenador en la valoración del cáncer de mama muestrauna sensibilidad (95%) ligeramente superior al método manual(89%) y con una especificidad igual con ambos métodos(66%). La fiabilidad es del 91 y 86% respectivamente, siendoestos resultados superiores debido a que el programa automáticovalora con más precisión la curva de captación en toda lalesión, pero sin variación en los hallazgos morfológicos.Ambos métodos modificaron la actitud terapéutica en un18% de los casos.El método automático consigue un elevado índice de correlaciónhistológica respecto al tamaño real del tumor (ligeramentesuperior al manual), reduce de forma significativa artefactosmejorando la calidad de imágenes y disminuyenotablemente el tiempo de análisis del radiólogo.Conclusiones: El método de diagnóstico asistido por ordenadoraplicado en RM mama es un método fiable y una herramientade trabajo muy útil en el análisis del postprocesado(AU)

Objective: To assess a new program for computer-aided diagnosisin breast MRI and to compare it with standard manualsoftware.Material and methods: We studied 66 breast lesions (57malignant and 9 benign) in 51 women referred for breast MRIfor preoperative local staging.After dynamic breast MRI with intravenous contrast andthree-dimensional reconstruction, we processed each lesionwith both standard manual software and the computer-aideddiagnosis program (CADstream®). We compared the twomethods on diagnostic accuracy and their correlations with thehistological findings.Results: The sensitivity of the computer-aided diagnosisprogram for staging breast was slightly higher than that of themanual method (95 vs. 89%); the specificity of the two techniqueswas similar (66%). The overall diagnostic accuracy was91% for the computer-aided method and 86% for the manualmethod. The automatic method is more accurate because itassesses the curve for the entire lesion better, without changesin the assessment of the morphological features.MRI examination modified the therapeutic approach in18 cases, regardless of the method used.The correlation of the automatic method with the histologicalfindings for tumor size was slightly higher than that of themanual method. The automatic method also yielded better imagequality with fewer artifacts and significantly reduced thetime radiologists needed to analyze the images.Conclusions: The computer-aided diagnosis program is reliableand useful for analyzing postprocessing breast MRI(AU)

[Comparison between intratumoral and peritumoral injection of radiotracer for locating and biopsying the sentinel lymph node in nonpalpable breast cancer]. / Comparación entre la inyección intratumoral y peritumoral del radiotrazador para la localización y biopsia del ganglio centinela en cáncer de mama no palpable.

OBJECTIVE: To determine whether there are differences in the technical efficacy in detecting and biopsying the sentinel node after intratumoral or peritumoral administration of the radiotracer in patients with nonpalpable early-stage breast cancer. MATERIAL AND METHODS: This prospective, randomized study included 80 patients with nonpalpable breast cancer without axillary adenopathies who were scheduled for primary surgical treatment. Patients were randomized to one of two groups: the INTRA group (intratumoral radiotracer administration, n=35) or the PERI group (peritumoral radiotracer administration, n=45). Patients with suspicious axillary lymph nodes at clinical or ultrasonographic examination that had positive results after fine-needle aspiration cytology were excluded. RESULTS: The rates of sentinel node detection were 97.1% (34/35) for intratumoral injection and 84.4% (38/45) for peritumoral injection. Radiotracer migration failure occurred in 8 cases (one in the INTRA group and 7 in the PERI group). The sentinel node was detected in an extra-axillary location in 21.9% of cases (11/59 in the INTRA group and 16/64 in the PERI group). CONCLUSIONS: Our study found no statistically significant differences in the detection rates of axillary or extra-axillary sentinel lymph nodes between the two groups; however, we observed greater technical efficacy with intratumoral radiotracer administration.