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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. 2007;29(7):366-369
DOI 10.1590/S0100-72032007000700007
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):366-369
DOI 10.1590/S0100-72032007000700007
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.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):533-536
DOI 10.1590/S0100-72031998000900007
Purpose: to evaluate the effects of tamoxifen (TAM) on plasma levels of estradiol, progesterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and steroid hormone-binding globulin (SHBG) when given to premenopausal women in the doses of 10 and 20 mg/day for 22 days. Patients and Methods: a randomized double-blind study was performed with 43 premenopausal eumenorrheic women. The patients were divided into three groups: A (N = 15, placebo); B (N = 15, TAM 10 mg/day) and C (N = 13, 20 mg/day). They started taking an oral dose of TAM or placebo on the very first day of the menstrual cycle. Two hormone determinations were performed, both on the 22nd day of the menstrual cycle: the first in the cycle that preceded the use of the drug and the second, in the following cycle, after 22 days of using the medication. We used the Levine and Student tests in order to evaluate the homogeneity of the sample and the variation of the hormone determinations respectively. Results:serum levels of estradiol, progesterone and SHBG increased significantly in groups B and C. In group C, we also observed increase in serum level of FSH (p < 0.0045) and a fall in prolactin level (p < 0.0055). Conclusions: TAM promoted a significant increase in serum concentrations of estradiol, progesterone and SHBG either in the doses of 10 or 20 mg/day. However, significant increase in FSH and decrease in prolactin were obtained only with the dose of 20 mg/day.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):533-536
DOI 10.1590/S0100-72031998000900007
Purpose: to evaluate the effects of tamoxifen (TAM) on plasma levels of estradiol, progesterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and steroid hormone-binding globulin (SHBG) when given to premenopausal women in the doses of 10 and 20 mg/day for 22 days. Patients and Methods: a randomized double-blind study was performed with 43 premenopausal eumenorrheic women. The patients were divided into three groups: A (N = 15, placebo); B (N = 15, TAM 10 mg/day) and C (N = 13, 20 mg/day). They started taking an oral dose of TAM or placebo on the very first day of the menstrual cycle. Two hormone determinations were performed, both on the 22nd day of the menstrual cycle: the first in the cycle that preceded the use of the drug and the second, in the following cycle, after 22 days of using the medication. We used the Levine and Student tests in order to evaluate the homogeneity of the sample and the variation of the hormone determinations respectively. Results:serum levels of estradiol, progesterone and SHBG increased significantly in groups B and C. In group C, we also observed increase in serum level of FSH (p < 0.0045) and a fall in prolactin level (p < 0.0055). Conclusions: TAM promoted a significant increase in serum concentrations of estradiol, progesterone and SHBG either in the doses of 10 or 20 mg/day. However, significant increase in FSH and decrease in prolactin were obtained only with the dose of 20 mg/day.
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. 2006;28(11):658-663
DOI 10.1590/S0100-72032006001100005
PURPOSE: to analyze breast tissue of postmenopausal women before and after six months of continuous combined estrogen-progestin replacement therapy (0.625 mg conjugated equine estrogens associated with 2.5 mg medroxyprogesterone acetate). METHODS: all patients were evaluated before treatment and considered eligible to receive the drug. The material was obtained from the upper outer left quadrant, through a percutaneous large-core breast biopsy. Epithelial density and nuclear volume on hematoxylin-eosin-stained plates were evaluated for the morphological study. Morphometry was graphically analyzed by optical microscopy (400X) after acquisition of image by a digital image-capturing system (Vidcap 32) and image analysis system (Imagelab 2000 Software®). RESULTS: after six months of estrogen-progestin replacement therapy, there was a significant increase in nuclear volume in late postmenopausal women (103.6 to 138.1 µm³). There was no difference in epithelial density with the treatment (before 0.08 and later 0.10). CONCLUSIONS: estrogen-progestin combined replacement therapy for six months induced an enhacement in nuclear volume of breast epithelial cells, suggesting an increase in their metabolic activity. However, it is important to emphasize that this finding was observed only in late postmenopausal women. The increased nuclear volume could precede other events that confirm the stimulation of cellular proliferation by these hormones.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(11):658-663
DOI 10.1590/S0100-72032006001100005
PURPOSE: to analyze breast tissue of postmenopausal women before and after six months of continuous combined estrogen-progestin replacement therapy (0.625 mg conjugated equine estrogens associated with 2.5 mg medroxyprogesterone acetate). METHODS: all patients were evaluated before treatment and considered eligible to receive the drug. The material was obtained from the upper outer left quadrant, through a percutaneous large-core breast biopsy. Epithelial density and nuclear volume on hematoxylin-eosin-stained plates were evaluated for the morphological study. Morphometry was graphically analyzed by optical microscopy (400X) after acquisition of image by a digital image-capturing system (Vidcap 32) and image analysis system (Imagelab 2000 Software®). RESULTS: after six months of estrogen-progestin replacement therapy, there was a significant increase in nuclear volume in late postmenopausal women (103.6 to 138.1 µm³). There was no difference in epithelial density with the treatment (before 0.08 and later 0.10). CONCLUSIONS: estrogen-progestin combined replacement therapy for six months induced an enhacement in nuclear volume of breast epithelial cells, suggesting an increase in their metabolic activity. However, it is important to emphasize that this finding was observed only in late postmenopausal women. The increased nuclear volume could precede other events that confirm the stimulation of cellular proliferation by these hormones.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):581-589
DOI 10.1590/S0100-72032006001000003
PURPOSE: To assess the presence of estrogen receptor gene polymorphisms HaeIII and MspI as well as clinical factors, and their possible associations with high mammographic density in post-menopausal women. METHODS: One hundred and fifteen post-menopausal women, not in use of hormonal therapy and without clinical or mammographic lesions were evaluated. Three independent observers have determined the mammographic density pattern based on the ACR-BIRADS® 2003 (two subjective and one objective evaluations - Adobe Photoshop 7.0 software). Oral swabs (Cytobrush) were obtained to extract DNA and the polymerase chain reaction - restriction fragment length polymorphism) was performed to assess the presence of polymorphisms in intron 1 and exon 1 from estrogen receptor gene (HaeIII and MspI). RESULTS: The HaeIII polymorphism was found in 43 (37.4%) of the 115 women, while MspI was found in 96 (83.5%) of them. There was a good agreement among determinations of the three observers with regard to mammographic density. Thirty-four (29.6%) women had dense breasts and eighty-one (70.4%) had non-dense breasts. CONCLUSION: The estrogen receptor gene polymorphism Haelll showed no association with mammographic density (Fisher = 0.712), while the association between estrogen receptor gene polymorphism Mspl and mammographic density was near significance (Fisher = 0.098). The associations among age, parity and body mass index revealed statistical significance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2006;28(10):581-589
DOI 10.1590/S0100-72032006001000003
PURPOSE: To assess the presence of estrogen receptor gene polymorphisms HaeIII and MspI as well as clinical factors, and their possible associations with high mammographic density in post-menopausal women. METHODS: One hundred and fifteen post-menopausal women, not in use of hormonal therapy and without clinical or mammographic lesions were evaluated. Three independent observers have determined the mammographic density pattern based on the ACR-BIRADS® 2003 (two subjective and one objective evaluations - Adobe Photoshop 7.0 software). Oral swabs (Cytobrush) were obtained to extract DNA and the polymerase chain reaction - restriction fragment length polymorphism) was performed to assess the presence of polymorphisms in intron 1 and exon 1 from estrogen receptor gene (HaeIII and MspI). RESULTS: The HaeIII polymorphism was found in 43 (37.4%) of the 115 women, while MspI was found in 96 (83.5%) of them. There was a good agreement among determinations of the three observers with regard to mammographic density. Thirty-four (29.6%) women had dense breasts and eighty-one (70.4%) had non-dense breasts. CONCLUSION: The estrogen receptor gene polymorphism Haelll showed no association with mammographic density (Fisher = 0.712), while the association between estrogen receptor gene polymorphism Mspl and mammographic density was near significance (Fisher = 0.098). The associations among age, parity and body mass index revealed statistical significance.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(7):415-420
DOI 10.1590/S0100-72032005000700008
PURPOSE: to evaluate the cost of preventive mammographic screening in climacteric women, as compared to the cost of breast cancer treatment in more advanced stages. METHODS: one thousand and fourteen patients attended at the Climacteric outpatient service of the Gynecology Department, Federal University of São Paulo Paulista School of Medicine, were included in the study and submitted to mammographic test. All mammographic test's were analyzed by the same two physicians and classified according to the BI-RADS (Breast Imaging Reporting and Data System American College of Radiology) categories. The detected lesions were submitted to cytological and histological examination. RESULTS: the final diagnostic impression of the 1014 examinations, according to the classification of BI-RADS categories was: 1=261, 2=671, 3=59, 4=22 and 5=1. The invasive procedures were performed through a needle guided by ultrasound or stereotactic examinations: 33 fine-needle aspiration biopsies, 6 core biopsies guided by ultrasound and 20 core biopsies guided by stereotactic examination. Five cancer diagnoses were established. The total cost of this screening based on Brazilian procedure values was R$ 76,593.79 (25,534 dollars). Therefore, the cost of the diagnosis of the five cases of cancer in this screening was R$ 15,318.75 (5,106 dollars) each. However, the average cost per patient screened was R$ 75.53 (25 dollars). CONCLUSIONS: considering that the total treatment cost of only one case of breast cancer in advanced stage including hospital costs, surgery, chemotherapy, radiotherapy and hormonal treatment is similar to the cost of 1,000 mammographic screenings in climacteric women, it may be concluded that the cost of the early cancer diagnosis program is worth it and should be included in the public health program, as a way of lowering the public health expense.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(7):415-420
DOI 10.1590/S0100-72032005000700008
PURPOSE: to evaluate the cost of preventive mammographic screening in climacteric women, as compared to the cost of breast cancer treatment in more advanced stages. METHODS: one thousand and fourteen patients attended at the Climacteric outpatient service of the Gynecology Department, Federal University of São Paulo Paulista School of Medicine, were included in the study and submitted to mammographic test. All mammographic test's were analyzed by the same two physicians and classified according to the BI-RADS (Breast Imaging Reporting and Data System American College of Radiology) categories. The detected lesions were submitted to cytological and histological examination. RESULTS: the final diagnostic impression of the 1014 examinations, according to the classification of BI-RADS categories was: 1=261, 2=671, 3=59, 4=22 and 5=1. The invasive procedures were performed through a needle guided by ultrasound or stereotactic examinations: 33 fine-needle aspiration biopsies, 6 core biopsies guided by ultrasound and 20 core biopsies guided by stereotactic examination. Five cancer diagnoses were established. The total cost of this screening based on Brazilian procedure values was R$ 76,593.79 (25,534 dollars). Therefore, the cost of the diagnosis of the five cases of cancer in this screening was R$ 15,318.75 (5,106 dollars) each. However, the average cost per patient screened was R$ 75.53 (25 dollars). CONCLUSIONS: considering that the total treatment cost of only one case of breast cancer in advanced stage including hospital costs, surgery, chemotherapy, radiotherapy and hormonal treatment is similar to the cost of 1,000 mammographic screenings in climacteric women, it may be concluded that the cost of the early cancer diagnosis program is worth it and should be included in the public health program, as a way of lowering the public health expense.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):37-42
DOI 10.1590/S0100-72032004000100006
PURPOSE: to evaluate the accuracy of directional vacuum-assisted biopsy (mammotomy), guided by ultrasonography, in the diagnosis of nonpalpable breast lesion, as compared with excision biopsy, and to evaluate the therapeutic value of mammotomy in nonpalpable benign lesions. METHODS: 114 patients, who presented nonpalpable breast lesion, visible on ultrasonography, were included. The patients were referred to complementary ultrasonographic evaluation due to mastalgia or earlier found mammographic alteration. All were submitted to mammotomy guided by ultrasonography using Mammotome® (Biopsys, Irvine, Califórnia), with a 11 gauge needle. The excision biopsy was performed with previous puncture of those patients who presented residual lesion after the mammotomy, that is, 88 patients. To evaluate comparatively the mammotomy results with those of excision biopsy, the sensitivity and specificity rates, positive and negative predictive values, and the agreement proportion were calculated. Not only the sensibilities, but also the specificities and the agreement proportions of both examinations were compared through Wald statistics, using a model for classified data. RESULTS: of 114 patients, 88 were submitted to excision biopsy. The remaining 26 did not show post-mammotomy lesions visible on ultrasonography, and for one year they were without alterations on the bi-annual mammographic and ultrasonographic examinations. The diameter of those lesions was less than 1.5 cm. Among the 88 patients that underwent excision biopsy, 69 (78,4%) showed benign and 19 (21,6%), malignant lesions. Mammotomy diagnosed 16 of the malignant lesions, with three false-negative and no false-positive results. The false results occurred in the first cases, showing the existence of a learning curve of the method, or due to technical difficulty such as the blurring of ultrasonographic image by bleeding. The sensitivity and specificity were 84,2% and 100%, respectively, with 100% positive predictive and 95,8% predictive negative values. The mammotomy accuracy was 96,6%. Complications were rare: two cases of hematomas, none of them needing surgical drainage; a case of vasovagal reflex not allowing the conclusion of the examination. The cosmetic results were very favorable due to small incisions (3 mm) and to the smaller amount of excised tissue. CONCLUSION: mammotomy guided by ultrasonography showed to be a diagnostic method with high accuracy, and it may be used as therapy for benign, smaller than 1.5 cm lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):37-42
DOI 10.1590/S0100-72032004000100006
PURPOSE: to evaluate the accuracy of directional vacuum-assisted biopsy (mammotomy), guided by ultrasonography, in the diagnosis of nonpalpable breast lesion, as compared with excision biopsy, and to evaluate the therapeutic value of mammotomy in nonpalpable benign lesions. METHODS: 114 patients, who presented nonpalpable breast lesion, visible on ultrasonography, were included. The patients were referred to complementary ultrasonographic evaluation due to mastalgia or earlier found mammographic alteration. All were submitted to mammotomy guided by ultrasonography using Mammotome® (Biopsys, Irvine, Califórnia), with a 11 gauge needle. The excision biopsy was performed with previous puncture of those patients who presented residual lesion after the mammotomy, that is, 88 patients. To evaluate comparatively the mammotomy results with those of excision biopsy, the sensitivity and specificity rates, positive and negative predictive values, and the agreement proportion were calculated. Not only the sensibilities, but also the specificities and the agreement proportions of both examinations were compared through Wald statistics, using a model for classified data. RESULTS: of 114 patients, 88 were submitted to excision biopsy. The remaining 26 did not show post-mammotomy lesions visible on ultrasonography, and for one year they were without alterations on the bi-annual mammographic and ultrasonographic examinations. The diameter of those lesions was less than 1.5 cm. Among the 88 patients that underwent excision biopsy, 69 (78,4%) showed benign and 19 (21,6%), malignant lesions. Mammotomy diagnosed 16 of the malignant lesions, with three false-negative and no false-positive results. The false results occurred in the first cases, showing the existence of a learning curve of the method, or due to technical difficulty such as the blurring of ultrasonographic image by bleeding. The sensitivity and specificity were 84,2% and 100%, respectively, with 100% positive predictive and 95,8% predictive negative values. The mammotomy accuracy was 96,6%. Complications were rare: two cases of hematomas, none of them needing surgical drainage; a case of vasovagal reflex not allowing the conclusion of the examination. The cosmetic results were very favorable due to small incisions (3 mm) and to the smaller amount of excised tissue. CONCLUSION: mammotomy guided by ultrasonography showed to be a diagnostic method with high accuracy, and it may be used as therapy for benign, smaller than 1.5 cm lesions.