mammography Archives - Page 2 of 3 - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):492-495
DOI 10.1590/S0100-72032009001000004
PURPOSE: to report a series of three cases of a normal variation known as sternal muscle, simulating a breast lesion. METHODS: the diagnostic suspicion was based on the clinical picture, findings in the physical examination and imaging, being confirmed by sectional imaging methods such as computerized tomography (CT) and magnetic resonance imaging (MRI). A review of the literature has been made in the data Medline and in breast radiology textbooks about the anatomic, clinical and imaging aspects of the sternal muscle. RESULTS: three female patients, without complaints, who presented nodular breast lesions in the medial quadrants projection (two in a routine mammographic exam and one in a computerized tomography). The diagnosis of sternal muscle was confirmed through breast MRI or through thoracic CT, showing an elongated image in the left parasternal region, adjacent to the breast muscle. CONCLUSIONS: the sternal muscle is an unusual variation of the muscles of the thoracic wall, present in about 2 to 8% of the population. The knowledge of this entity is crucial, as it can simulate a breast node.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):492-495
DOI 10.1590/S0100-72032009001000004
PURPOSE: to report a series of three cases of a normal variation known as sternal muscle, simulating a breast lesion. METHODS: the diagnostic suspicion was based on the clinical picture, findings in the physical examination and imaging, being confirmed by sectional imaging methods such as computerized tomography (CT) and magnetic resonance imaging (MRI). A review of the literature has been made in the data Medline and in breast radiology textbooks about the anatomic, clinical and imaging aspects of the sternal muscle. RESULTS: three female patients, without complaints, who presented nodular breast lesions in the medial quadrants projection (two in a routine mammographic exam and one in a computerized tomography). The diagnosis of sternal muscle was confirmed through breast MRI or through thoracic CT, showing an elongated image in the left parasternal region, adjacent to the breast muscle. CONCLUSIONS: the sternal muscle is an unusual variation of the muscles of the thoracic wall, present in about 2 to 8% of the population. The knowledge of this entity is crucial, as it can simulate a breast node.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):508-512
DOI 10.1590/S0100-72032009001000007
PURPOSE: to check epidemiological data from a breast diagnostic clinic. METHODS: mammographies from 35,041 patients were studied, within a period of 2 years and 7 months, from 2004 to 2006, 32,049 (91.5%) of them from screening, and 2,992 from symptomatic patients (8.5%). The calculated parameters were: detection rate of the screening patients, percentage of cancer among the symptomatic patients, rate of biopsy indication, percentage of minimal, in situ, and stage 0-1 carcinomas, recall rate, and predictive value of mammographies considered as abnormal and of biopsies' indications in screening patients. RESULTS: 228 diagnoses of breast cancer were made, 111 in screening patients (0.34% detection rate) and 117 in symptomatic patients (3.91% detection rate). The number of biopsies' recommendations among screening patients was 544 (1.7% of those patients). There were 28% of minimal carcinomas, 10% of in situ carcinomas and 93% of stage 0-1 carcinomas among the screening patients. Recall rate was 19%. Positivity of mammographies considered as abnormal (VPP1) was 1.65%. The rate of biopsies' positivity (VPP2) was 21.9%. CONCLUSIONS: this study brings important epidemiological data for the audit of mammographic screening, rare among us. Data have been analyzed as compared to what is recommended by the literature, the detection rate and the percentage of minimal and in situ carcinomas found being comparable to the established values, but with the VPP value lower than the ideal.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2009;31(10):508-512
DOI 10.1590/S0100-72032009001000007
PURPOSE: to check epidemiological data from a breast diagnostic clinic. METHODS: mammographies from 35,041 patients were studied, within a period of 2 years and 7 months, from 2004 to 2006, 32,049 (91.5%) of them from screening, and 2,992 from symptomatic patients (8.5%). The calculated parameters were: detection rate of the screening patients, percentage of cancer among the symptomatic patients, rate of biopsy indication, percentage of minimal, in situ, and stage 0-1 carcinomas, recall rate, and predictive value of mammographies considered as abnormal and of biopsies' indications in screening patients. RESULTS: 228 diagnoses of breast cancer were made, 111 in screening patients (0.34% detection rate) and 117 in symptomatic patients (3.91% detection rate). The number of biopsies' recommendations among screening patients was 544 (1.7% of those patients). There were 28% of minimal carcinomas, 10% of in situ carcinomas and 93% of stage 0-1 carcinomas among the screening patients. Recall rate was 19%. Positivity of mammographies considered as abnormal (VPP1) was 1.65%. The rate of biopsies' positivity (VPP2) was 21.9%. CONCLUSIONS: this study brings important epidemiological data for the audit of mammographic screening, rare among us. Data have been analyzed as compared to what is recommended by the literature, the detection rate and the percentage of minimal and in situ carcinomas found being comparable to the established values, but with the VPP value lower than the ideal.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(2):75-79
DOI 10.1590/S0100-72032008000200005
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2008;30(2):75-79
DOI 10.1590/S0100-72032008000200005
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(12):608-613
DOI 10.1590/S0100-72032007001200002
PURPOSE: to assess the accuracy (rate of correct predictions) of stereotactic core needle biopsy (CNB) of risk category BI-RADS® 4 breast lesions. METHODS: a retrospective analysis of category BI-RADS® 4 breast lesions that had been submitted to a stereotactic core-needle biopsy from June 1998 to June 2003. Patients with histological benign results consistent with the radiographic image were referred to mammographic follow-up. Patients with malign diagnosis and papillary lesions were submitted to standard specific treatment. Excisional biopsies were performed when results were benign, but in disagreement with the mammographic image. It was considered as a gold-standard attendance: (1) the mammographic follow-up of low suspicion lesions with benign results at CNB, which stayed unchanged for, at least, three years, and (2) surgical resection when specimen results were malign or benign, but with a high suspicion on mammography. Sensitivity (S) specificity (E) and overall accuracy of stereotactic CNB were statistically analyzed. RESULTS: among the 118 non-palpable lesions of category BI-RADS® 4 submitted to CNB, the results obtained were: 27 malign cases, 81 benign, and ten lesions with atypical or papillary lesions. The statistical analysis comprised 108 patients (atypical and papillary lesions were excluded). CNB sensitivity was 87.1% and specificity 100%. The positive predictive value was 100% and the negative, 95.1%. False negatives occurred in 3.7% (4/108) of cases. The prevalence of malign diagnostics in the BI-RADS® 4 lesions of this sample was 29.7 (31/118).The accuracy of this method in this casuistic was 96.3%. CONCLUSIONS: these results support stereotactic CNB as an extremely reliable alternative to open biopsy, in the diagnosis and definition of breast lesions. In positive results, it is possible to indicate the appropriate therapy, and, in negative (when mammography shows low suspicion), it allows a follow up.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(12):608-613
DOI 10.1590/S0100-72032007001200002
PURPOSE: to assess the accuracy (rate of correct predictions) of stereotactic core needle biopsy (CNB) of risk category BI-RADS® 4 breast lesions. METHODS: a retrospective analysis of category BI-RADS® 4 breast lesions that had been submitted to a stereotactic core-needle biopsy from June 1998 to June 2003. Patients with histological benign results consistent with the radiographic image were referred to mammographic follow-up. Patients with malign diagnosis and papillary lesions were submitted to standard specific treatment. Excisional biopsies were performed when results were benign, but in disagreement with the mammographic image. It was considered as a gold-standard attendance: (1) the mammographic follow-up of low suspicion lesions with benign results at CNB, which stayed unchanged for, at least, three years, and (2) surgical resection when specimen results were malign or benign, but with a high suspicion on mammography. Sensitivity (S) specificity (E) and overall accuracy of stereotactic CNB were statistically analyzed. RESULTS: among the 118 non-palpable lesions of category BI-RADS® 4 submitted to CNB, the results obtained were: 27 malign cases, 81 benign, and ten lesions with atypical or papillary lesions. The statistical analysis comprised 108 patients (atypical and papillary lesions were excluded). CNB sensitivity was 87.1% and specificity 100%. The positive predictive value was 100% and the negative, 95.1%. False negatives occurred in 3.7% (4/108) of cases. The prevalence of malign diagnostics in the BI-RADS® 4 lesions of this sample was 29.7 (31/118).The accuracy of this method in this casuistic was 96.3%. CONCLUSIONS: these results support stereotactic CNB as an extremely reliable alternative to open biopsy, in the diagnosis and definition of breast lesions. In positive results, it is possible to indicate the appropriate therapy, and, in negative (when mammography shows low suspicion), it allows a follow up.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):303-308
DOI 10.1590/S0100-72031998000600002
Objective: to compare mammographic density changes, case by case, according to image digitization in three consecutive evaluations of users or nonusers of hormonal replacement therapy (HRT). Methods: 59 postmenopausal women were evaluated, 43 being users of cyclic or continuous estro-progestin hormonal replacement therapy, and 16 nonusers. The criteria of inclusion were: amenorrhea for at least 12 months, a normal mammographic examination at the beginning of the HRT (users) or the clinical follow-up without HRT (nonusers), at two incidences (mediolateral and craniocaudal). The following variables were used for the evaluation of mammary density: initial change - the difference between the first mammography after HRT performed in 12 ± 3 months and the mammography performed before HRT-and final change - the difference between the second mammography after HRT performed in 24 ± 3 months and the mammography performed before HRT. Wilcoxon and c² tests were used in order to evaluate the differences in mammographic density changes. Results: more than half (56.3%) of the women, HRT users with initial increase in mammographic density remained with the increase after the final evaluation. This finding was not significant (p=0.617). In the same group, the initial nonincrease was significantly associated with the final nonincrease (p=0.017). Among the nonusers, all breasts that were not totally fat at the initial evaluation presented a mammographic density decrease at the final evaluation. Conclusions: the majority of HRT users presenting mammographic density increase at the first evaluation, after approximately one year of use, remained with the increase at a second evaluation. After some time, the nonusers tended to present a significant mammographic density decrease (p=0.003).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(6):303-308
DOI 10.1590/S0100-72031998000600002
Objective: to compare mammographic density changes, case by case, according to image digitization in three consecutive evaluations of users or nonusers of hormonal replacement therapy (HRT). Methods: 59 postmenopausal women were evaluated, 43 being users of cyclic or continuous estro-progestin hormonal replacement therapy, and 16 nonusers. The criteria of inclusion were: amenorrhea for at least 12 months, a normal mammographic examination at the beginning of the HRT (users) or the clinical follow-up without HRT (nonusers), at two incidences (mediolateral and craniocaudal). The following variables were used for the evaluation of mammary density: initial change - the difference between the first mammography after HRT performed in 12 ± 3 months and the mammography performed before HRT-and final change - the difference between the second mammography after HRT performed in 24 ± 3 months and the mammography performed before HRT. Wilcoxon and c² tests were used in order to evaluate the differences in mammographic density changes. Results: more than half (56.3%) of the women, HRT users with initial increase in mammographic density remained with the increase after the final evaluation. This finding was not significant (p=0.617). In the same group, the initial nonincrease was significantly associated with the final nonincrease (p=0.017). Among the nonusers, all breasts that were not totally fat at the initial evaluation presented a mammographic density decrease at the final evaluation. Conclusions: the majority of HRT users presenting mammographic density increase at the first evaluation, after approximately one year of use, remained with the increase at a second evaluation. After some time, the nonusers tended to present a significant mammographic density decrease (p=0.003).
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):69-76
DOI 10.1590/S0100-72031999000200003
Purpose: to evaluate core biopsy (CB) for the diagnosis of subclinical breast lesions, comparing with surgical biopsy previously identified by stereotaxic mammography. Methods: this is a cross-sectional study of 41 subclinical lesion cases over 35 years of age, between January 1995 and February 1997 at the Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. The cases were classified mammographically as benign, probably benign, suspicious and malignant. Benign and probably benign lesions were studied together for statistical purposes. The histopathologic diagnosis of CB was classified as inadequate for diagnosis, absence of malignancy, suspicious and malignant. The histopathologic diagnosis of the surgical biopsy was classified as absence of malignancy, pre-malignant and malignant. The sensitivity, especificity and predictive values of CB were evaluated. Mammography likelihood ratio and core biopsy likelihood ratio were evaluated to predict breast cancer. Results: CB coincided with surgical biopsy in 86.2% of the 29 cases of absence of malignancy. All cases suspected by CB were malignant by surgical biopsy. All cases malignant by CB were also malignant by surgical biopsy. CB sensitivity and specificity were 36.4% and 100%, respectively. Positive predictive value was 100% and negative predictive value was 78.1%. In the group classified mammographically as malignant the likelihood ratio was 9.7; for suspicious lesions it was 1.3 and for probably benign lesions it was 0.1. Core biopsy likelihood ratio was infinite (¥) for suspicious and malignant lesions, 0.4 for cases classified as absence of malignancy and 1.4 for inadequate for diagnosis cases. Conclusions: after analysis of the results, with the use of the likelihood ratio, we conclude that CB report of absence of malignancy did not allow to rule out the diagnosis of malignancy. In these cases, we should correlate the result with mammography. If CB shows absence of malignancy and there is no correlation with mammography, the research must be continued. When the report of CB was suspicious, the probability of a breast carcinoma was very high. In these cases, we should perform a surgical biopsy to establish a definitive diagnosis, because an infiltrating carcinoma needs a different therapy when compared with carcinoma in situ and atypical hyperplasia. In the cases of histopathologic report of malignancy, the probability of breast cancer was high, since we did not observe any false positive CB. In these cases, CB allowed a quick diagnosis without the need of surgical biopsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):69-76
DOI 10.1590/S0100-72031999000200003
Purpose: to evaluate core biopsy (CB) for the diagnosis of subclinical breast lesions, comparing with surgical biopsy previously identified by stereotaxic mammography. Methods: this is a cross-sectional study of 41 subclinical lesion cases over 35 years of age, between January 1995 and February 1997 at the Instituto de Ginecologia da Universidade Federal do Rio de Janeiro. The cases were classified mammographically as benign, probably benign, suspicious and malignant. Benign and probably benign lesions were studied together for statistical purposes. The histopathologic diagnosis of CB was classified as inadequate for diagnosis, absence of malignancy, suspicious and malignant. The histopathologic diagnosis of the surgical biopsy was classified as absence of malignancy, pre-malignant and malignant. The sensitivity, especificity and predictive values of CB were evaluated. Mammography likelihood ratio and core biopsy likelihood ratio were evaluated to predict breast cancer. Results: CB coincided with surgical biopsy in 86.2% of the 29 cases of absence of malignancy. All cases suspected by CB were malignant by surgical biopsy. All cases malignant by CB were also malignant by surgical biopsy. CB sensitivity and specificity were 36.4% and 100%, respectively. Positive predictive value was 100% and negative predictive value was 78.1%. In the group classified mammographically as malignant the likelihood ratio was 9.7; for suspicious lesions it was 1.3 and for probably benign lesions it was 0.1. Core biopsy likelihood ratio was infinite (¥) for suspicious and malignant lesions, 0.4 for cases classified as absence of malignancy and 1.4 for inadequate for diagnosis cases. Conclusions: after analysis of the results, with the use of the likelihood ratio, we conclude that CB report of absence of malignancy did not allow to rule out the diagnosis of malignancy. In these cases, we should correlate the result with mammography. If CB shows absence of malignancy and there is no correlation with mammography, the research must be continued. When the report of CB was suspicious, the probability of a breast carcinoma was very high. In these cases, we should perform a surgical biopsy to establish a definitive diagnosis, because an infiltrating carcinoma needs a different therapy when compared with carcinoma in situ and atypical hyperplasia. In the cases of histopathologic report of malignancy, the probability of breast cancer was high, since we did not observe any false positive CB. In these cases, CB allowed a quick diagnosis without the need of surgical biopsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):113-115
DOI 10.1590/S0100-72031999000200010
The authors report a rare case of dermatomyositis diagnosed at the Mastology Sector of the Division of Gynecology of the Federal University of São Paulo - Escola Paulista de Medicina, which caused breast deformity due to formation of bilateral dystrophic calcifications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):113-115
DOI 10.1590/S0100-72031999000200010
The authors report a rare case of dermatomyositis diagnosed at the Mastology Sector of the Division of Gynecology of the Federal University of São Paulo - Escola Paulista de Medicina, which caused breast deformity due to formation of bilateral dystrophic calcifications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):133-137
DOI 10.1590/S0100-72031999000300003
Purpose: to evaluate how knowledgeable medical students at the Universidade Federal de Goiás were concerning the basic diagnostic principles breast cancer. The study also aimed at promoting a debate among the students and at assessing the understanding of the students in the fifth year of medical school, who had already attended the Gynecology course. Methods: Through questionnaires given to 348 individuals, from the first to the fifth year, out of a total population of 550 students, the authors searched for information with regard to basic knowledge on the diagnosis of breast cancer. Of the 348 questionnaires, 55 (16%) were given to fifth-year students, who had already attended the Gynecology course. Furthermore, 43% of the students were women, 62% had medical doctors in their immediate family, and 17% had a family history of breast cancer. Results: in regard to the knowledge of diagnostic methods, 84% of the students were aware of the most frequent sign of breast cancer, 34% knew which was the best screening method, 49% knew when to refer asymptomatic women to mammography, 37% knew the recommended interval between mammography for women above the age of 50, and 24% knew when to associate ultrasound to mammography for the detection of breast cancer. The fifth-year students provided correct answers at a significantly higher rate, when compared to the others. Concerning gender, the only difference regarded the fact that women showed a better knowledge as to the best time for self-examination and when to recommend ultrasound associated with mammography. The presence of medical doctors in the family and a history of family members with breast cancer did not have any influence on the answers. Conclusion: The lack of information in regard to the diagnosis of breast cancer is very high, even among medical students. Nevertheless, the rate of information increases significantly after students are taught Gynecology, which is only offered during the fifth year of the medical school.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(3):133-137
DOI 10.1590/S0100-72031999000300003
Purpose: to evaluate how knowledgeable medical students at the Universidade Federal de Goiás were concerning the basic diagnostic principles breast cancer. The study also aimed at promoting a debate among the students and at assessing the understanding of the students in the fifth year of medical school, who had already attended the Gynecology course. Methods: Through questionnaires given to 348 individuals, from the first to the fifth year, out of a total population of 550 students, the authors searched for information with regard to basic knowledge on the diagnosis of breast cancer. Of the 348 questionnaires, 55 (16%) were given to fifth-year students, who had already attended the Gynecology course. Furthermore, 43% of the students were women, 62% had medical doctors in their immediate family, and 17% had a family history of breast cancer. Results: in regard to the knowledge of diagnostic methods, 84% of the students were aware of the most frequent sign of breast cancer, 34% knew which was the best screening method, 49% knew when to refer asymptomatic women to mammography, 37% knew the recommended interval between mammography for women above the age of 50, and 24% knew when to associate ultrasound to mammography for the detection of breast cancer. The fifth-year students provided correct answers at a significantly higher rate, when compared to the others. Concerning gender, the only difference regarded the fact that women showed a better knowledge as to the best time for self-examination and when to recommend ultrasound associated with mammography. The presence of medical doctors in the family and a history of family members with breast cancer did not have any influence on the answers. Conclusion: The lack of information in regard to the diagnosis of breast cancer is very high, even among medical students. Nevertheless, the rate of information increases significantly after students are taught Gynecology, which is only offered during the fifth year of the medical school.