Diagnostic value of halo sign in young women (aged 45 to 49 years) in a breast screening programme with synthesized 2D mammography.

OBJECTIVE:: To assess the clinical performance of the halo sign in tomosynthesis and synthesized 2D mammography, and to identify age groups where its diagnostic value may be greater. METHODS:: 183 patients with nodules were recalled from the breast screening programme (with tomosynthesis and 2D synthesized mammograms). The patients were separated into two groups, 45-49 years and 50-69 years, and depending on the presence or not of halo sign. We calculated the predictive values for the different age groups. RESULTS:: In 45-49 years group, 86 nodular lesions were recalled, 66 (76.7%) with positive halo sign and 20 (23.3%) with negative halo sign. In positive halo sign group, biopsy was considered in 23 (34.8%), with histological features of benignity. In 50-69 years group, 98 nodular lesions from 97 patients were recalled, 51 (52%) with positive halo sign and 47 (48%) with negative halo sign. In positive halo sign group, biopsy was considered in 13 (25.5%); four (30.8%) were malignant and nine (69.2%) were benign. CONCLUSION:: Halo sign could be considered as a marker of benign lesion in females < 50 years. In females ≥ 50 years, other breast imaging techniques should be considered, with or without histological studies, to rule out malignancy. ADVANCES IN KNOWLEDGE:: The trend of a positive halo sign to act as a marker of benign lesion could be improve the recall rate and positive predictive values in the breast screening programme with tomosynthesis and synthesized 2D mammography, especially in young females.

Valoración de las categorías BI-RADS ® de la densidad mamaria entre radiólogos y respecto a un método cuantitativo de medición / Evaluation of the BI-RADS® categories between readers and with regard to a quantitative method

Objetivo. Valorar la concordancia al clasificar las densidades mamarias empleando el sistema BI-RADS® y la variabilidad entre este método empleado por un lector experto en comparación con los valores obtenidos mediante un sistema de medición automática (Quantra®). Pacientes y métodos. Estudio descriptivo en 2 fases. Primero se evaluó la clasificación BI-RADS® de 5 lectores de una muestra seleccionada de forma aleatoria y estratificada por grupos (516 pacientes), para medir la variabilidad intraobservador e interobservador (índice kappa). Finalmente se analizó la concordancia entre el radiólogo con más experiencia y el software Quantra® que permite la valoración volumétrica de la densidad. Resultados. La concordancia por parejas varió entre débil a moderada (kappa 0,35-0,67), el grupo presentó un valor moderado de reproducibilidad (0,58), siendo mayor en las densidades extremas y en los grupos de edad límite. La variabilidad intraobservador fue de moderada a buena (0,52-0,79). Respecto a la clasificación de la densidad por categorías entre el lector experto y la aplicación, no se evidenció concordancia (kappa = 0,0737). Conclusiones. Los valores de concordancia obtenidos corroboran la evidencia descrita en la literatura, considerando que la lectura la realizaron radiólogos con experiencia y dedicación exclusiva en mama. No se apreció concordancia en la clasificación lector versus Quantra® (esta pondera las densidades en menor porcentaje respecto al análisis visual), y esto podría deberse al punto de corte por categoría (AU)

Objective. To assess agreement in breast density classification using the BI-RADS® system and the concordance between this measurement method compared with a dedicated software program (Quantra®). Patients and methods. A descriptive study was carried out in 2 phases. First, we analyzed the BI-RADS® breast density classification assessed by 5 readers in a sample of 516 patients randomly selected and stratified into groups. Intraobserver and interobserver reproducibility were calculated (kappa index). Second, we evaluated the agreement between the most experienced reader and a software package that calculates the volumetric fraction of fibroglandular tissue (Quantra®). Results. The agreement between pairs ranged from fair to moderate (kappa 0.35-0.67). The reading group showed moderate reproducibility (0.58) with the highest values in high breast densities and in the youngest and oldest patients. Intraobserver agreement ranged from moderate to substantial (0.52-0.79). In density classification, there was no evidence of agreement between the expert reader and the software application (kappa = 0.0737). Conclusions. The agreement values obtained corroborate the evidence described in the literature on reading performed by experienced radiologists working exclusively with mammograms. No agreement was found in reader classification versus Quantra® (which classifies densities with a lesser percentage than visual analysis), which could be due to the cut off by category (AU)

Rendimiento de la ecografía con contraste (CEUS) en la valoración de las complicaciones del injerto renal / Contrast Enhanced Ultrasound (CEUS) efficiency in renal graft complications evaluation

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