Evaluation of the applicability of BI-RADS® MRI for the interpretation of contrast-enhanced digital mammography. / Evaluación de la aplicabilidad del léxico BI-RADS® de la resonancia magnética para la interpretación de la mamografía digital con contraste.

OBJECTIVE: To determine the usefulness of BI-RADS® MRI for the morphological description and categorization of images obtained with contrast-enhanced digital mammography in comparison with the final diagnosis. MATERIAL AND METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS® MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS® scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test. RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS® MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI. CONCLUSIONS: The morphological descriptors used in BI-RADS® MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS® score, and the score enabled good differentiation between benign and malignant lesions.

Factors affecting the precision of lesion sizing with contrast-enhanced spectral mammography.

AIM: To evaluate the precision of the pre-surgical measurement of the size of breast cancer by contrast-enhanced spectral mammography (CESM). MATERIAL AND METHODS: This was a retrospective study of 204 breast cancers. Variables related to tumour biology and anthropometric variables were recorded and considered when evaluating the efficacy of CESM in predicting tumour size. Microscopic measurement of the largest diameter of the tumour at pathology was chosen as the reference standard. RESULTS: The mean size of tumours at pathology was 20.7±15.8 mm, while at CESM it was 23.6±16.7 mm (Bland-Altman 2.9 mm overestimation, 2.9 mm; 95% confidence interval [CI]: -10.3-16.2 mm). Spearman's correlation coefficient was 0.83 (p<0.0001). The concordance analysis indicated that 37.8% of the measurements were concordant, 47% were overestimated, and 15.2% were underestimated. Tumour size, nodal involvement, breast density, and breast size significantly modified the sizing accuracy. CONCLUSION: Quality of tumour size prediction with CESM is good, and this appears to be a promising imaging technique in the surgical planning of breast cancer. Biological tumour features, and anthropological characteristics of the patients do, however, affect the diagnostic precision and should be taken into account.

[Neonatal management in the emergency department of a tertiary children's hospital]. / Asistencia a neonatos en el servicio de urgencias de un hospital pediátrico terciario.

OBJECTIVE: To determinate the chief complaints in neonates presenting to a pediatric emergency service and their management. MATERIAL AND METHODS: We performed a retrospective study of patients younger than 28 days old who presented to the pediatric emergency department in 2003. Patients directly admitted to the neonatal unit and those attended by the surgery and orthopedic surgery departments were excluded. Information on sex, age, time and date, waiting time, visit duration, source of referral, presenting complaint, complementary examinations, final diagnosis, and hospital admission were analyzed. RESULTS: There were 1,481 neonatal visits. The mean chronological age was 15.8 days and 57.3 % were boys. Visits were most frequent on Fridays, evening shifts, and in July and December. The most frequent chief complaints were crying/irritability (16.3 %), fever (13.6 %), vomiting (11 %), and influenza (10.8 %). The most frequent final diagnoses were feeding problems (12.6 %), infantile colic (12.4 %), and upper respiratory tract infections (12 %). No abnormalities were detected in 11.7 % of the patients and complementary examinations were not required in 45.9 %. The admission rate was 26 %, most commonly due to fever and bronchiolitis. CONCLUSIONS: Many visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care. Because of the greater vulnerability of this age group, thorough investigation is required to rule out severe disease. This phenomenon was reflected by the large number of complementary examinations and admissions.