Breast diseases Archives - Revista Brasileira de Ginecologia e Obstetrícia

  • Original Article

    Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo34

    Summary

    Original Article

    Bacteriological characteristics of primary breast abscesses in patients from the community in the era of microbial resistance

    Revista Brasileira de Ginecologia e Obstetrícia. 2024;46:e-rbgo34

    DOI 10.61622/rbgo/2024rbgo34

    Views166

    Abstract

    Objective:

    The aim of this study is to evaluate the etiological profile and antimicrobial resistance in breast abscess cultures from patients from the community, treated at a public hospital located in Porto Alegre, Brazil.

    Methods:

    This is an retrospective cross-sectional study that evaluated the medical records of patients with bacterial isolates in breast abscess secretion cultures and their antibiograms, from January 2010 to August 2022.

    Results:

    Based on 129 positive cultures from women from the community diagnosed with breast abscesses and treated at Fêmina Hospital, 99 (76.7%) of the patients had positive cultures for Staphylococcus sp, 91 (92%) of which were cases of Staphylococcus aureus. Regarding the resistance profile of S. aureus, 32% of the strains were resistant to clindamycin, 26% to oxacillin and 5% to trimethoprim-sulfamethoxazole. The antimicrobials vancomycin, linezolid and tigecycline did not show resistance for S. aureus.

    Conclusion:

    Staphylococcus aureus was the most common pathogen found in the breast abscess isolates during the study period. Oxacillin remains a good option for hospitalized patients. The use of sulfamethoxazole plus trimethoprim should be considered as a good option for use at home, due to its low bacterial resistance, effectiveness and low cost.

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  • Review Article

    Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review

    Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(1):67-73

    Summary

    Review Article

    Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review

    Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(1):67-73

    DOI 10.1055/s-0041-1741409

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    Abstract

    Objective

    To evaluate the underestimation rate in breast surgical biopsy after the diagnosis of radial scar/complex sclerosing lesion through percutaneous biopsy.

    Data Sources

    A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The PubMed, SciELO, Cochrane, and Embase databases were consulted, with searches conducted through November 2020, using specific keywords (radial scar OR complex sclerosing lesion, breast cancer, anatomopathological percutaneous biopsy AND/OR surgical biopsy).

    Data collection

    Study selection was conducted by two researchers experienced in preparing systematic reviews. The eight selected articles were fully read, and a comparative analysis was performed.

    Study selection

    A total of 584 studies was extracted, 8 of which were selected. One of them included women who had undergone a percutaneous biopsy with a histological diagnosis of radial scar/complex sclerosing lesion and subsequently underwent surgical excision; the results were used to assess the underestimation rate of atypical and malignant lesions.

    Data synthesis

    The overall underestimation rate in the 8 studies ranged from 1.3 to 40% and the invasive lesion underestimation rate varied from 0 to 10.5%.

    Conclusion

    The histopathological diagnosis of a radial scar/complex sclerosing lesion on the breast is not definitive, and it may underestimate atypical andmalignant lesions, which require a different treatment, making surgical excision an important step in diagnostic evaluation.

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    Underestimation Rate in the Percutaneous Diagnosis of Radial Scar/Complex Sclerosing Lesion of the Breast: Systematic Review
  • Artigos Originais

    Association between breast arterial calcifications and cardiovascular risk factors in menopausal women

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):315-319

    Summary

    Artigos Originais

    Association between breast arterial calcifications and cardiovascular risk factors in menopausal women

    Revista Brasileira de Ginecologia e Obstetrícia. 2014;36(7):315-319

    DOI 10.159/S0100-720320140004977

    Views1

    PURPOSE:

    To analyze associations between mammographic arterial mammary calcifications in menopausal women and risk factors for cardiovascular disease.

    METHODS:

    This was a cross-sectional retrospective study, in which we analyzed the mammograms and medical records of 197 patients treated between 2004 and 2005. Study variables were: breast arterial calcifications, stroke, acute coronary syndrome, age, obesity, diabetes mellitus, smoking, and hypertension. For statistical analysis, we used the Mann-Whitney, χ2 and Cochran-Armitage tests, and also evaluated the prevalence ratios between these variables and mammary artery calcifications. Data were analyzed with the SAS version 9.1 software.

    RESULTS:

    In the group of 197 women, there was a prevalence of 36.6% of arterial calcifications on mammograms. Among the risk factors analyzed, the most frequent were hypertension (56.4%), obesity (31.9%), smoking (15.2%), and diabetes (14.7%). Acute coronary syndrome and stroke presented 5.6 and 2.0% of prevalence, respectively. Among the mammograms of women with diabetes, the odds ratio of mammary artery calcifications was 2.1 (95%CI 1.0-4.1), with p-value of 0.02. On the other hand, the mammograms of smokers showed the low occurrence of breast arterial calcification, with an odds ratio of 0.3 (95%CI 0.1-0.8). Hypertension, obesity, diabetes mellitus, stroke and acute coronary syndrome were not significantly associated with breast arterial calcification.

    CONCLUSION:

    The occurrence of breast arterial calcification was associated with diabetes mellitus and was negatively associated with smoking. The presence of calcification was independent of the other risk factors for cardiovascular disease analyzed.

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  • Artigos Originais

    Training and standardized criteria improve the diagnosis of premalignant breast lesions

    Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):550-555

    Summary

    Artigos Originais

    Training and standardized criteria improve the diagnosis of premalignant breast lesions

    Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(11):550-555

    DOI 10.1590/S0100-72032008001100004

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    PURPOSE: to analyze interobserver variability in the histopathological diagnosis of premalignant breast lesions before and after training with diagnostic standardized criteria. METHODS: Slides containing histological sections representative of three kinds of breast lesions (atypical ductal hyperplasia, ductal carcinoma in situ and ductal carcinoma in situ with microinvasion), revised by an international specialist in breast pathology whose diagnoses were considered as golden standard, have been used. The same slides have been evaluated at two different times by five pathologists from the community according to a specific protocol for classifying the lesions. In the first evaluation, the cases were analyzed and classified according to the specific criteria adopted in each service. At the second time, the pathologists were given a tutorial containing diagnostic criteria and representative images, and the lesions were classified again, employing the standardized criteria. Interobserver analysis using percent agreement and weighted Kappa index has been performed. RESULTS: There has been a large diagnostic variation among the pathologists in the initial analysis without the use of standardized diagnostic criteria concerning the diagnostic, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis varied from 0.15 to 0.40). In the second evaluation using standardized criteria, there has been a significant improvement in the diagnostic concordance among the five pathologists concerning the diagnosis, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis have varied from 0.42 to 0.80). CONCLUSIONS: interobserver concordance related to diagnosis and classification of breast premalignant lesions may be improved with specific training and the use of standardized histopathological criteria.

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    Training and standardized criteria improve the diagnosis of premalignant breast lesions
  • Artigos Originais

    Evaluation of breast microcalcifications according to Breast Imaging Reporting and Data System (BI-RADS TM) and Le Gal’s classifications

    Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(2):75-79

    Summary

    Artigos Originais

    Evaluation of breast microcalcifications according to Breast Imaging Reporting and Data System (BI-RADS TM) and Le Gal’s classifications

    Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(2):75-79

    DOI 10.1590/S0100-72032008000200005

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    PURPOSE: the aim of this study is to evaluate the accuracy of mammography in the diagnosis of suspicious breast microcalcifications, using BI-RADS TM and Le Gal's classifications. METHODS: one hundred and thirty cases were selected with mammograms contain only microcalcifications of file and initially classified as suspicious (categories 4 and 5) without lesions clinical detectable and reclassified by two examiners, getting a consensus diagnosis. The biopsies were reviewed by two pathologists getting also a consensus diagnosis. Both, mammogram and histopathologic analysis were double blinded reviewed. Qui-square test, Fleiss-square statistic and EPI-INFO 6.0 were used in this study. RESULTS: the correlation between histopathological and mammographic analysis using BI-RADS TM and Le Gal classification showed the same sensitivity of 96.4%, specificity of 55.9 and 30.3%, positive predictive value (PPV) of 37.5 and 27.5%, and accuracy of 64.6 and 44.6% respectively. The PPV by BI-RADS TM categories was: category 2, 0%; category 3, 1.8%; category 4, 30.8%; and category 5, 60%. The PPV by Le Gal classification was: category 2, 3.1%; category 3, 18.1%; category 4, 26.4%;category 5, 66.7%, and non classified 5.2%. CONCLUSIONS: the results were better for the classification of BI-RADS™, but it did not get to reduce the ambiguity in assessment of breast microcalcifications.

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  • Artigos Originais

    What characteristics proposed by BIRADS ultrasound better distinguish between benign and malignant nodes?

    Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(12):625-632

    Summary

    Artigos Originais

    What characteristics proposed by BIRADS ultrasound better distinguish between benign and malignant nodes?

    Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(12):625-632

    DOI 10.1590/S0100-72032007001200005

    Views1

    PURPOSE: to analyze which characteristics proposed by the BIRADS lexicon for ultrasound have the greatest impact on distinguishing between benign and malignant lesions. METHODS: ultrasonography features from the third edition of the BIRADS were studied in 384 nodes submitted to percutaneous biopsy from February 2003 to December 2006, at the Medical School of Botucatu. For the ultrasonography, the equipment Logic 5 with a 7.5-12 MHz multifrequential linear transducer was used. The ultrasonography analysis of the node considered the features proposed by the BIRADS lexicon for ultrasound. The data were submitted to statistical analysis by the logistic regression model. RESULTS: the benign lesions represented 42.4% and the malignant, 57.6%. The logistic regression analysis found an odds ratio (OR) for cancer of 7.69 times when the surrounding tissue was altered, of 6.25 times when there were microcalcifications in the lesions interior, of 1.95 when the acoustic effect is shadowing, of 25.0 times when there was the echogenic halo, and of 7.14 times when the orientation was non-parallel. CONCLUSIONS: among the features studied, the lesion limit, represented by the presence or not of the halogenic halo, is the most important differentiator of the benign from the malignant masses.

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    What characteristics proposed by BIRADS ultrasound better distinguish between benign and malignant nodes?
  • Artigo de Revisão

    Breast-conserving surgery for breast cancer

    Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(8):428-434

    Summary

    Artigo de Revisão

    Breast-conserving surgery for breast cancer

    Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(8):428-434

    DOI 10.1590/S0100-72032007000800008

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    The surgical strategy for breast cancer treatment has changed considerably over the last decade. The breast conserving surgery (BCS) is the standard treatment for early stage breast cancer nowadays. With the current population breast cancer screening programs and the emerging use of systemic neoadjuvant therapy, an increasing number of patients have been eligible to BCS. However, several specific factors must be considered for the therapeutic planning for these patients. This review provides a surgical methodology overview for the BCS in breast carcinoma.

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    Breast-conserving surgery for breast cancer
  • Artigos Originais

    Multiple bilateral fibroadenomas after kidney transplantation and immunossuppression with cyclosporine A

    Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):366-369

    Summary

    Artigos Originais

    Multiple bilateral fibroadenomas after kidney transplantation and immunossuppression with cyclosporine A

    Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):366-369

    DOI 10.1590/S0100-72032007000700007

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    Fibroadenoma is the most frequent benign neoplasia in the female breast and it is considered a mixed tumor, constituted by variable amounts of connective and epithelial tissue. Cyclosporine A seems to be related with the development of mamary fibroadenomas in patients who underwent kidney transplantation in reproductive age. We reported the case in which the patient, in therapeutic use of cyclosporine A, after kidney transplantation, presented several bilateral lumps. The imaging and palpable findings suggested fibroadenoma, confirmed after biopsy.

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    Multiple bilateral fibroadenomas after kidney transplantation and immunossuppression with cyclosporine A

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