Role of Combining Grayscale Findings With Superb Microvascular Imaging and Shear Wave Elastography in Standardization and Management of NON-MASS Breast Lesions.

ABSTRACT: The non-mass breast lesions on ultrasound (US) are a group of challenging pathology. We aimed to standardize these grayscale findings and investigate the effectiveness of superb microvascular imaging (SMI) and shear wave elastography (SWE). A total of 195 lesions were evaluated by B-mode US, SWE, and SMI in the same session. A "NON-MASS model" was built on grayscale US to group the lesions only as areas and those with associated features: microcalcifications, architectural distortion, ductal changes, and microcysts. The mean stiffness parameters Emean, Eratio, and mean vascular index (VI) were recorded following consecutive measurements. Besides, the microvascularity was graded based on Adler's classification (grades 0 to 3). Lesions were divided into 3 groups: benign, category B3, and malignant. One hundred twelve (57.4%) lesions were benign, 23 (11.8%) were B3, and 60 were (30.8%) in the malignant category. Thirty-eight (19.5%) lesions were observed only as an area, whereas associated features were present in 157 lesions (80.5%). Distortion was the only associated feature predicting malignancy among the grayscale findings (P < 0.001). There was a significant difference between malignant and nonmalignant (benign and B3) groups in terms of Adler's grade, Emean, Eratio, and VI values (P < 0.001). Sensitivity, specificity, and accuracy increased when advanced imaging parameters were added to grayscale findings (P < 0.001). In the presence of microcalcifications, architectural distortion, high elasticity, and hypervascularity in the "NON-MASS" imaging model, the suspicion of malignancy increases. The non-mass findings and advanced imaging techniques have the potential to find greater coverage in the following versions of BI-RADS atlas.

Open-Y technique for the internal mammary vein in the free abdominal flap of unilateral breast reconstruction.

BACKGROUND: In microvascular breast reconstruction, the internal mammary vein (IMV) has emerged as the most common recipient vein. The open-Y technique can increase the vessel diameter via the bifurcation site. This study aimed to investigate the open-Y technique for IMV. METHODS: The characteristics and details of the operative procedure in patients who had undergone unilateral breast reconstruction with and without the open-Y approach for the free abdominal flap were compared. Differences in IMV anastomosis site (the bifurcation of the main duct or that of the perforator branch) were also compared in patients with the open-Y technique. The open-Y technique was performed on the IMV side. RESULTS: The open-Y and conventional groups included 127 and 62 patients, respectively. The main duct diameter of IMV was significantly smaller (median 2.5 vs. 3.0 mm, P < 0.001), and the rate of right-sided anastomosis (47.2 vs. 82.3%, P < 0.001) was significantly lower in the open-Y group. When comparing the main duct and perforator groups, the branch diameter (1.8 vs. 1.0 mm, P < 0.001) and the diameter after the open-Y technique (5.0 vs. 3.9 mm, P < 0.001) were significantly higher, and the angle of bifurcation (45° vs. 60°, P = 0.007) was significantly lower in the main duct group. CONCLUSIONS: Given a small venous diameter, the open-Y technique is superior, especially for left-sided breast reconstruction. Owing to the lower angle of bifurcation and large diameter, the open-Y technique at the main duct bifurcation of IMV causes less turbulence in the blood flow. TAKE HOME MESSAGE: The open-Y technique is especially effective for left-sided breast reconstruction. Considering the lower angle of bifurcation and large diameter, the open-Y technique at the main duct bifurcation of the internal mammary vein causes less turbulence in the blood flow.

Breast arterial calcification is associated with sarcopenia in peri- and post-menopausal women.

PURPOSE: Breast arterial calcification (BAC) refers to medial calcium deposition in breast arteries and is detectable via mammography. Sarcopenia, which is characterised by low skeletal muscle mass and quality, is associated with several serious clinical conditions, increased morbidity, and mortality. Both BAC and sarcopenia share common pathologic pathways, including ageing, diabetes, and chronic kidney disease. Therefore, this study evaluated the relationship between BAC and sarcopenia as a potential indicator of sarcopenia. METHODS: This study involved women aged >40. BAC was evaluated using digital mammography and was defined as vascular calcification. Sarcopenia was assessed using abdominal computed tomography. The cross-sectional skeletal mass area was measured at the third lumbar vertebra level. The skeletal mass index was obtained by dividing the skeletal mass area by height in square meters(m2). Sarcopenia was defined as a skeletal mass index of ≤38.5 cm2/m2. A multivariable model was used to evaluate the relationship between BAC and sarcopenia. RESULTS: The study involved 240 participants. Of these, 36 (15 %) were patients with BAC and 204 (85 %) were without BAC. Sarcopenia was significantly higher among the patients with BAC than in those without BAC (72.2 % vs 17.2 %, P < 0.001). The multivariable model revealed that BAC and age were independently associated with sarcopenia (odds ratio[OR]: 7.719, 95 % confidence interval[CI]: 3.201-18.614, and P < 0.001 for BAC and OR: 1.039, 95 % CI: 1.007-1.073, P = 0.01 for age). CONCLUSION: BAC is independently associated with sarcopenia. BAC might be used as an indicator of sarcopenia on screening mammography.

Associação entre calcificações arteriais mamárias e fatores de risco para doença cardiovascular em mulheres menopausadas / Association between breast arterial calcifications and cardiovascular risk factors in menopausal women

OBJETIVO: Avaliar a presença de calcificações arteriais em mamografias de mulheres menopausadas e a sua associação com fatores de risco para doenças cardiovasculares. MÉTODOS: Trata-se de um estudo de corte transversal e retrospectivo, em que foram analisados as mamografias e os prontuários médicos de 197 pacientes atendidas no período entre 2004 e 2005. As variáveis do estudo foram: calcificação arterial mamária, acidente vascular cerebral, síndrome coronariana aguda, idade, obesidade, diabetes mellitus, tabagismo e hipertensão arterial sistêmica. Para a análise estatística dos dados, utilizaram-se os testes de Mann-Whitney, χ2 e Cochran-Armitage, sendo também avaliadas as razões de prevalência entre as variáveis descritas e calcificação arterial mamária. Os dados foram analisados com o software SAS, versão 9.1. RESULTADOS: Dos 197 exames e prontuários analisados, observou-se a prevalência de 36,6% para calcificações arteriais nas mamografias. Entre os fatores de risco para doença cardiovascular avaliados, os mais frequentes foram: hipertensão (56,4%), obesidade (31,9%), tabagismo (15,2%) e diabetes (14,7%). A síndrome coronariana aguda e o acidente vascular cerebral tiveram prevalências de 5,6 e 2,0% respectivamente. Entre as mamografias de mulheres diabéticas, a maior ocorrência foi de calcificação arterial mamária com razão de prevalência de 2,1 (IC95%1,0-4,1) e valor p de 0,02. Por outro lado, nas mamografias de pacientes fumantes, foi menor a ocorrência de calcificação arterial mamária com razão de prevalência de 0,3 (IC95% 0,1-0,8). Hipertensão arterial sistêmica, obesidade, diabetes mellitus, acidente vascular cerebral e síndrome coronariana aguda não apresentaram ...

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. .

The association of breast arterial calcification and metabolic syndrome

OBJECTIVES: We investigated the relationship between metabolic syndrome and breast arterial calcification detected via mammography in a cohort of postmenopausal subjects. METHODS: Among 837 patients referred to our radiology department for mammographic screening, 310 postmenopausal females (105 patients with and 205 patients without breast arterial calcification) aged 40 to 73 (mean 55.9±8.4) years were included in this study. The groups were compared with respect to clinical characteristics and metabolic syndrome criteria. Univariate and multivariate analyses identified the factors related to breast arterial calcification. RESULTS: Age, postmenopausal duration and the frequencies of diabetes mellitus, hypertension and metabolic syndrome were significantly higher in the subjects with breast arterial calcification than in those without (p<0.05). Multivariate analysis indicated that age (OR = 1.3, 95% CI = 1.1-1.6, p = 0.001) and metabolic syndrome (OR = 4.0, 95% CI = 1.5−10.4, p = 0.005) were independent predictors of breast arterial calcification detected via mammography. The independent predictors among the features of metabolic syndrome were low levels of high-density lipoproteins (OR = 8.1, 95% ...

Adipocyte morphometric evaluation and angiogenesis in the omentum transposed to the breast: a preliminary study

OBJECTIVE: The purpose of this study was to describe the probable mechanism of the volume increase of laparoscopically harvested omentum flaps used to treat breast deformities. METHODS: A histological analysis of omentum samples was performed to study the volume increase of laparoscopically harvested omentum flaps. Samples were harvested immediately after the transposition of the omentum from the abdominal cavity to the breast region and during the second surgical procedure for breast symmetrization of eight patients submitted to the transposition of the omentum flap. Changes in the morphometric measurements of the adipocytes (perimeter, diameter, and area), microvascular density (as measured by the CD31 endothelial marker), and immunohistochemical expression of VEGF were documented. RESULTS: The increases in adipocyte size and microvascular density were statistically significant (P < 0.012). The expression levels of VEGF were lower in the second set of samples when compared to the first set, but the differences were not statistically significant (P < 0.093). CONCLUSION: These results demonstrate an increase in cellular volume as measured by adipocyte perimeter, diameter, and area. Moreover, the increase in the number of vessels in the second set of samples suggests that neoangiogenesis was stimulated by the initial increase in VEGF expression levels observed in the first set of samples. The increase in VEGF expression in the flap may have been caused by adipocyte hypertrophy resulting from neoangiogenesis.

Doppler color en el estudio de la mama: ¿Cómo lo hacemos nosotros? / Color doppler in the study of the braest: how do we perform it?

The contribution of color Doppler sonography in the study of breast cancer remains a topic of discussion. However, in the daily clinical practice it has become an indispensable instrument, and an integral part of the breast ultrasound (US). The aim of this paper is to demonstrate its utility based on the available evidence as well as on our experience. We describe the technical considerations necessary to conduct a good study, the Doppler signs of benignity/malignancy in focal lesions of the breast and the benefits of its routine use in day-to-day practice. In our experience, it is a useful tool for this purpose. Neverthless, its diagnostic impact as described in the literature is variable. To evaluate its real usefulness, prospective studies along with standardization of the evaluation technique would be required.

La contribución del Doppler color en el estudio de la mama sigue siendo un tema en discusión. No obstante, en la práctica clínica diaria se ha convertido en un instrumento indispensable, formando parte integral del Ultrasonido (US) mamario. El objetivo de este artículo es demostrar su utilidad según la evidencia disponible y a través de nuestra experiencia. Se describen las consideraciones técnicas indispensables para realizar un buen estudio, los signos Doppler de benignidad / malignidad en lesiones focales de la mama y las ventajas de su uso rutinario en la práctica diaria. En nuestra experiencia es una herramienta útil para este propósito, sin embargo su impacto diagnóstico descrito en la literatura es variable. Para evaluar su real utilidad, se requiere de la realización de estudios prospectivos y de la estandarización la técnica.

Doença de Mondor: achados mamográficos e ultra-sonográficos / Mondor's disease: mammography and ultrasound findings

A doença de Mondor da mama é uma tromboflebite superficial da mama que se apresenta como um cordão fibroso e espessado na região subcutânea da mama. É uma enfermidade rara, benigna e autolimitada que apresenta dor e retração da pele no nível do vaso afetado. Neste trabalho relatamos dois casos mostrando os achados mamográficos (caso 1) e ultra-sonográficos (caso 2) típicos desta anomalia.

Afecções mamárias lactacionais: ocorrência e conseqüências sobre a celularidade e composição nutricional do leite materno / Lactational breast disorders: ocorrency and consequences on the cellular and nutritional composition of breast milk

A manifestação de afecções mamárias lactacionais (AML) é um determinante negativo para o estabelecimento e manutenção do aleitamento materno em condições ideais para o binômio mãe-filho. Estas afecções comportam problemas com a mama puerperal que podem ter início com uma evolução inadequada da lactação promovendo estase láctea e evoluindo para ingurgitamento, traumatismos mamilo-areolares, mastite ou abscesso mamário. Similarmente ao que ocorre com animais leiteiros, a manifestação das AML em humanos sugere uma modificação nas condições de produção e secreção do leite materno, com repercussões em sua leucometria e composição em macronutrientes. Para verificar a ocorrência das AML, foram analisados 3201 registros realizados em 1916 Fichas de atendimento individual utilizadas em seis Bancos de Leite Humano (BLH) da rede pública de saúde do Distrito Federal, preenchidas entre os anos de 1992 e 1995. Durante o ano de 1994, o mais representativo por conter informações de todos os BLH, 34 por cento dos registros referiram-se a AML sendo 45 por cento de casos de ingurgitamento mamário, 26 por cento de fissuras, 20 por cento de mastites e 9 por cento de abscessos. O impacto sobre o curso de lactação e composição do leite foi avaliado transversalmente em 206 nutrizes recrutadas nos BLH, estando 52 por cento em fase colostral (C), 9 por cento secretando leite de transição (LT) e 39 por cento leite maduro (LM). As nutrizes distribuíram-se em 88 portadoras de algum tipo de AML e 118 com mamas hígidas. A natureza das AML foi classificada em 70 por cento de casos de ingurgitamentos associados ou não a traumatismos mamilo-areolares, 6 por cento de fissuras e 24 por cento de mastites e abscessos. Entre as 88 mães portadoras de AML, 12 já haviam interrompido provisoriamente o aleitamento exclusivo e 3 manifestaram a intenção de fazê-lo definitivamente. A vigência de AML não determinou diferença significativa na leucometria do C, LT e LM...

Doença de Mondor da mama: relato de um caso / Mondor's disease in breast: case report

A doença de Mondor da mama é um evento pouco frequënte na prática clínica, com cerca de 281 casos na literatura mundial de 1966 a 2002, caracterizando-se por uma tromboflebite de veia superficial da região toracoabdominal de natureza benigna. Pode manifestar-se secundariamente a doenças sistêmicas, a intervenções cirúrgicas ou idiopáticas. Geralmente tem regressão espontânea em poucas semanas. Os autores relatam o caso de uma paciente do sexo feminino, 35 anos, que apresentou-se com dor e cordão fibroso na região toracoabdominal ântero-lateral esquerda havia um mês, sem outros sintomas associados. Ao exame físico apresentava bom estado geral, mamas normais e presença de endurecimento em todo o trajeto da veia torácica lateral esquerda. Com diagnóstico clínico de doença de Mondor, submeteu-se à realização de exames complementares que foram normais. Recebeu antiinflamatórios não-hormonais, com melhora sintomática em duas semanas. A resolução completa do cordão fibroso ocorreu após 18 meses de seguimento.

Mondor's disease of breast is an uncommon benign condition with approximately 281 cases related in world literature from 1966 to 2002, characterized by thoracoabdominal superficial vein thrombophlebitis. It can be secondary to sistemic diseases, surgical procedures, or idiopathic. It is generally a self-limited condition. The authors present a case of a 35-year-old female who complained of pain and a fibrous "string" on the left anterolateral thoracoabdominal region for one month, without correlated symptoms. At a physical examination she presented good health, normal breast and skin induration along left lateral thoracic vein. With clinical diagnosis of Mondor's disease she was submitted to complementary exams which were normal. She received nonsteroidal anti-inflammatory drug with symptomatic relief in two weeks. After 18 months, complete resolution of the fibrous "string" ocurred.

Doença de Mondor / Mondor's disease

Os autores relatam um caso da doença de Mondor em mulher jovem. A síndrome foi identificada como uma tromboflebite da veia toracoepigástrica direito, com o aparecimento do sinal característico: cordão duro e doloroso, visível e palpável no hemitórax direito, indo da região axilar até o epigástrio, mais visível quando o braço é elevado. Todos os exames complementares realizados mostraram-se dentro da faixa de normalidade, evidenciando, mais uma vez, a soberania da clínica.

O estudo dos tumores da mama pela dopplerfluxometria / The study of breast tumors by dopplerflowmetry

Os autores estudaram 30 pacientes, portadoras de nódulos mam rios, através da ultra-sonografia associada ao Doppler puls til näo colorido, para detectar fluxo sangüíneo anormal. O fluxo, quando presente, foi classificado em três tipos: leve, moderado e acentuado, procurando-se associá-los ao tipo de tumor. Os resultados mostraram para o método uma sensibilidade de 0,84; especificidade de 0,82; valor preditivo positivo de 0,89 e valor preditivo negativo de 0,75.

A irrigaçäo da mama e as técnicas de mamoplastia / Breast blood supply and mammaplasty techniques

Em funçäo das complicaçöes existentes e descritas em diferentes técnicas de mamoplastia redutora e sendo a maior parte de ordem circulatória, foi realizado um estudo de irrigaçäo mamária. Foram dissecadas dez mamas de cadáveres frecos, fornecidos pelo Serviço de Verificaçäo de Obitos da Escola Paulista de Medicina, com retirada em bloco único da glândula e estruturas retromamárias e realizada injeçäo de látex, para melhor identificaçäo das artérias. Diante dos achados anatômicos, nos quais observou-se ser a irrigaçäo mamária realizada pelas artérias torácica interna, torácica lateral e intercostais posteriores, assim como uma grande participaçäo da torácica superior, procurou-se correlacionar esses resultados com as diversas técnicas de mamoplastia redutora, criando-se uma classificaçäo em seis grupos, de acordo com os pedículos preservados: superior, inferior, central, lateral, medial e duplo

Personal experience with the central pedicle reduction mammaplasty

In the period from 1986 to 1990 the authors have performed 41 reduction mammaplasties with the central breast pedicle technique presented by Hester et al. in 1985. tha advantages of this technique are the rich blood supply, which allows for a very natural superior movement of the nipple also in the difficult cases, and the sculpturing of a conical gland with a nipple completely freed from dermal connections, which yyelds nicely shaped breasts and excellent nipple areola projection. Complication rate was low and in particular hypertrophic scarring was experienced in 6 cases only. We think that this method is a valid alternative to more popular brast reduction techniques utilized today in which the common scars pattern is represented by an inverted "T"

Determinaçäo da elevaçäo térmica pré-ovulatória da mama como indicador da ovulaçäo nos ciclos estimulados com clomifeno e gonadotrofinas / Determination of pre-ovulatory thermic rise of the mammary skin as indicator of ovulation in the cycles stimulated by clomiphene and gonadotropin

A determinaçäo do dia da ovulaçäo é fato importante, tanto para as questöes de esterilidade, como para aquelas de anticoncepçäo. Neste trabalho, estudaram-se 36 pacientes em programa de fertilizaçäo in vitro, objetivando avaliar se a temperatura da superfície da mama, medida através da termografia de placa, serviria como indicador da ovulaçäo. Os resultados demonstram aumento da temperatura mamária a partir de dois ou três dias antes da ovulaçäo. Porém näo houve confiabilidade suficiente para sua utilizaçäo em programas de fertilizaçäo in vitro