Mamografía con contraste: nuestra experiencia / Contrast-enhanced digital mammography: our experience

Resumen La mamografía contrastada (CEDM, contrast-enhanced digital mammography) es una herramienta nueva que ha ido implementándose de forma creciente. Aparece como alternativa a la resonancia magnética (RM), y al igual que esta, tiene como principio el uso de contraste endovenoso para explorar la angiogénesis tumoral. Combina la imagen de mamografía convencional (Mx) con la técnica de sustracción con energía dual poscontraste, lo que resulta en un incremento en la detección de cáncer de mama, en un tiempo corto de estudio y a un bajo costo. Es un método prometedor en casos seleccionados y de fácil lectura, siendo útil principalmente en pacientes con diagnóstico de cáncer de mama para detectar lesiones adicionales y determinar el tamaño tumoral, ayudando en la planificación quirúrgica, así como también en la evaluación de la respuesta a la neoadyuvancia. También en el seguimiento de pacientes operadas, para caracterizar lesiones dudosas en Mx y ecografía, o como alternativa ante contraindicación de la RM. El objetivo de este trabajo es valorar la utilidad de la mamografía contrastada en la práctica diaria y determinar sus principales indicaciones. Repasamos con casos propios las utilidades y características del método.

Abstract Contrast-enhanced digital mammography (CEDM) is an emerging tool that has been increasingly implemented. It appears as an alternative to magnetic resonance imaging (MRI), using intravenous contrast to explore tumor angiogenesis. It combines conventional mammography (Mx) with post-contrast dual energy subtraction technique, resulting in increased detection of breast cancer, in a short study time and at a low cost. It is a promising method in selected cases and easy to read, being useful mainly in patients with breast cancer to detect additional lesions and determine the tumor size, that helps surgical planning, as well as in the evaluation of post-neoadjuvant chemotherapy response in the follow-up of patients treated with surgery, to address inconclusive findings in screening mammogram, or as an alternative when MRI is contraindicated. The purpose of this article is to assess the usefulness of contrasted mammography in daily practice and to determine its main indications. We review with our own cases the applications and characteristics of this method.

Acantosis nigricans maligna y carcinoma mamario. Presentación de un caso

Las manifestaciones cutáneas de los tumores malignos comprenden un grupo de dermatosis que pueden ser marcadores de la presencia de neoplasias ocultas y permiten su diagnóstico oportuno. El objetivo de este informe es presentar las características clínicas de una acantosis nigricans asociada a carcinoma de mamario. Para ello, se describe el caso clínico de una paciente de 50 años, color de piel negro, asistida en la consulta de Dermatología del Policlínico Universitario Raúl Sánchez, por tener una placa única eritematosa localizada en la mama izquierda, acompañada de dolor, aumento de la temperatura local y máculas hipercrómicas en las axilas; así como adenopatías axilares múltiples. Los exámenes complementarios mostraron la presencia de acantosis nigricans maligna asociada a un carcinoma inflamatorio de la mama izquierda. Fue intervenida quirúrgicamente, con la consiguiente desaparición de las lesiones cutáneas, pero con un pronóstico reservado. La mayoría de los síndromes paraneoplásicos son inespecíficos; existe una necesidad urgente de sospechar una correlación entre los cambios cutáneos y la posibilidad de una neoplasia interna, por lo que es de suma importancia derivar a estos pacientes para su identificación y el diagnóstico precoz de la enfermedad de base. Esto mejoraría el pronóstico y atenuaría en gran medida las consecuencias.

The skin manifestations of malignant tumors include a group of dermatoses that can be the sign of the occult neoplasms presence and allow their timely diagnosis. The objective of this report is to present the acanthosis nigricans' clinical characteristics associated with breast carcinoma. The clinical case of a 50-years-old black-skinned patient is described, assisted in the Dermatology consultation of the Raúl Sánchez University Polyclinic, for having a single erythematous plaque located in the left breast, accompanied by pain, increased local temperature and hyperchromic macules in the armpits; as well as multiple axillary lymphadenopathy. Complementary examinations showed the presence of malignant acanthosis nigricans associated with an inflammatory carcinoma of the left breast. She underwent surgery, with the consequent disappearance of the skin lesions, but with a reserved prognosis. Most paraneoplastic syndromes are nonspecific; there is an urgent need to suspect a correlation between skin changes and the possibility of an internal neoplasia, so it is of utmost importance to refer these patients for identification and early diagnosis of the underlying disease. This would improve the prognosis and greatly mitigate the consequences.

Hallazgos mastográficos benignos que simulan malignidad: un dilema diagnóstico / Benign mammographic findings that simulate malignancy: a diagnostic dilemma

Resumen OBJETIVO: Identificar los principales hallazgos histopatológicos benignos y determinar la tasa de falsos positivos que suelen causar conflicto al categorizar las mastografías en el sistema BI-RADS por su aspecto, que puede simular un proceso maligno. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en pacientes atendidas en la Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) con reporte mastográfico alterado o sospecha clínica de malignidad. Para el análisis estadístico se utilizó el programa JASP 2.0 y χ2 para la diferencia de proporciones entre grupos. RESULTADOS: De un grupo de 11,481 pacientes, se reportaron 1643 mastografías alteradas: 444 con reportes falsos positivos, 23 pacientes con sospecha clínica y exclusión de 16 que no cumplieron con los criterios de inclusión establecidos. La muestra poblacional estudiada fue de 451 pacientes. La mayoría permaneció asintomática al momento del estudio (42.1%). El hallazgo histopatológico benigno con mayor prevalencia fue el fibroadenoma y su síntoma más relevante el nódulo palpable. La tasa de falsos positivos fue de 4.3%. CONCLUSIONES: En la actualidad, gracias a la implementación de programas de tamizaje es posible establecer diagnósticos de cáncer de mama en etapas tempranas, aunque con la desventaja que el reporte puede resultar falso positivo y ello dar lugar a incremento de la morbilidad y sobretratamiento. Los estándares internacionales indican que estos no deben sobrepasar el 10%.

Abstract OBJECTIVE: To identify the main benign histopathological findings that often cause conflict when categorizing mastographies in the BI-RADS system due to their appearance, which may simulate a malignant process and false positive rate. MATERIALS AND METHODS: Retrospective cohort study carried out in patients attended at the Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) with an altered mastographic report or clinical suspicion of malignancy. For statistical analysis we used the JASP 2.0 programme and χ2 for the difference in proportions between groups. RESULTS: From a group of 11,481 patients, 1,643 altered mastograms were reported: 444 with false positive reports, 23 patients with clinical suspicion and exclusion of 16 who did not meet the established inclusion criteria. The population sample studied was 451 patients. The majority remained asymptomatic at the time of the study (42.1%). The most prevalent benign histopathological finding was fibroadenoma and the most relevant symptom was a palpable nodule. The false positive rate was 4.3%. CONCLUSIONS: Currently, thanks to the implementation of screening programmes it is possible to establish breast cancer diagnoses in early stages, although with the disadvantage that the report may be false positive and this may lead to increased morbidity and overtreatment. International standards indicate that these should not exceed 10%.

Analysis of the indications for and results of breast cancer screening by magnetic resonance imaging at a cancer center in Brazil / Análise das indicações e resultados da ressonância magnética para rastreamento de câncer de mama em um centro oncológico brasileiro

Abstract Objective: To evaluate the indications for and results of magnetic resonance imaging (MRI) examinations for breast cancer screening at a cancer center in Brazil. Materials and Methods: This was a retrospective observational study, based on electronic medical records, of patients undergoing MRI for breast cancer screening at a cancer center in Brazil. Results: We included 597 patients between 19 and 82 years of age. The main indications for MRI screening were a personal history of breast cancer, in 354 patients (59.3%), a family history of breast cancer, in 102 (17.1%), and a confirmed genetic mutation, in 67 (11.2%). The MRI result was classified, in accordance with the categories defined in the Breast Imaging Reporting and Data System, as benign (category 1 or 2), in 425 patients (71.2%), probably benign (category 3), in 143 (24.0%), or suspicious (category 4 or 5), in 29 (4.9%). On MRI, 11 malignant tumors were identified, all of which were invasive carcinomas. Among those 11 carcinomas, six (54.5%) were categorized as minimal cancers (< 1 cm), and the axillary lymph nodes were negative in 10 (90.9%). The cancer detection rate was 18.4/1,000 examinations, and the positive predictive value for suspicious lesions submitted to biopsy was 37.9%. Conclusion: In our sample, the main indication for breast MRI screening was a personal history of breast cancer. The results indicate that MRI is a highly accurate method for the early detection of breast neoplasms in this population.

Resumo Objetivo: Avaliar as indicações e resultados de exames de ressonância magnética (RM) para rastreamento de câncer de mama em um centro oncológico no Brasil. Materiais e Métodos: Estudo observacional, realizado mediante análise retrospectiva de pacientes submetidos a RM das mamas para rastreamento de câncer de mama, por meio de revisão do prontuário eletrônico em um centro oncológico. Resultados: Foram incluídas 597 pacientes com idade variando de 19 a 82 anos. As principais indicações para rastreamento foram história pessoal de câncer de mama em 354 (59,3%) pacientes, história familiar em 102 (17,1%) e mutação genética confirmada em 67 (11,2%). O resultado da RM foi benigno (BI-RADS 1 ou 2) em 425 (71,2%) pacientes, provavelmente benigno (BI-RADS 3) em 143 (24,0%) e suspeito (BI-RADS 4 ou 5) em 29 (4,9%). Foram identificados 11 tumores malignos na RM, todos carcinomas invasivos, porcentagem de cânceres "mínimos" (< 1 cm) de 54,5% e porcentagem de axila negativa de 90,9%. A taxa de detecção de câncer na RM foi 18,4/1000 exames e o valor preditivo positivo para as lesões suspeitas submetidas a biópsia foi 37,9%. Conclusão: A principal indicação para RM de rastreamento na nossa população foi história pessoal de câncer de mama. Os resultados mostraram que a RM constitui um método com alta acurácia para detecção precoce de neoplasias da mama nessa população.

Caracterización de los tumores mamarios BI-RADS 5 según mamografía e histología

Introducción: En Cuba, el cáncer de mama constituye, actualmente, la primera causa de mortalidad oncológica en la mujer, acorde a lo establecido en la clasificación BI-RADS. A las lesiones mamarias categorizadas 5, por sospecha de malignidad, se les debe realizar una toma de biopsia para su evaluación histopatológica. Objetivo: Correlacionar los hallazgos clínicos e histológicos en pacientes portadores de lesiones mamográficas tipo BI-RADS 5. Materiales y métodos: Se realizó un estudio observacional, descriptivo y transversal sobre la relación existente entre el cáncer de mama tipo 5 de la clasificación BI-RADS y el resultado histológico, en una muestra dada por 30 pacientes. De esta se tomaron edad, raza, antecedentes oncológicos familiares, factores de riesgo, examen clínico, alteraciones de la mamografía e histológicas, datos que fueron manejados según estadísticas descriptivas. Resultados: Predominaron personas de la tercera edad, blancas, con familiares con enfermedades oncológicas, sedentarias y obesas con criterios imagenológicos de BI-RADS 5 e histología, prevaleciendo el carcinoma ductal. Conclusiones: El diagnóstico precoz del cáncer mamario mediante autoexamen o mamografía de escrutinio es fundamental.

Introduction: In Cuba, breast cancer is currently the first cause of oncological mortality in women, according to what is to established in the BI-RADS (Breast Imaging-Reporting and Data System). Breast lesions categorized 5, due to suspicion of malignancy, should be biopsied for their histopathological evaluation. Objective: To correlate the clinical and histological findings in patients with type 5 BI-RADS mammographic lesions. Materials and methods: A cross-sectional, descriptive and observational study was carried out on the relationship between type 5 mamma cancers of the BI-RADS classification and histological results in a sample of 30 patients. From them, age, race, family oncological history, risk factors, clinical examination, mammography and histological alterations were taken, data that were managed according to descriptive statistics. Results: White, elderly people predominated, with sedentary and obese relatives with oncological diseases, and BI-RADS 5 imaging criteria and histology, prevailing ductal carcinoma. Conclusions: Early diagnosis of breast cancer through auto examination or screening mammography is essential.

Particularités en imagerie du cancer du sein de la femme jeune de moins de 35 ans / Particularities of breast cancer imaging in young women under 35 years of age

Objectif: Le cancer du sein chez la femme jeune est rare etprésente des caractéristiques épidémiologiques, diagnostiques et pronostiques propres. L'objectif de notre étude est d'évaluerles caractéristiques radiologiques (mammographiques, échographiqueset par résonnancemagnétique IRM du cancer du sein chez la femme jeune Algérienne, de moins de 35 ans. Matériels etméthodes: Etude prospective, descriptiveau sein du service d'imagerie médicale du Centre Pierre et Marie Curie,d'Algerincluant 204patientes âgées de moins 35ans, étalée sur 3 ans allantentre janvier 2015et janvier 2017,chez lesquelles undiagnostic de cancer du sein a été porté,Elles ont toutes bénéficiésd'une mammographie numérique, d'une échographie et d'une IRM mammaireet d'unprélèvement percutané.Résultats:La fréquence du cancer du sein chez la femme jeune de moins de 35 ans était de 10,6%. L'âge moyen était de 30.9 ans. L'autopalpation d'un nodule était prédominante (87.2%). La densité mammaire était de type c et d dans 67.7%. Contrairement à l'idée établie, la mammographie avait permis souvent le diagnostic de ces tumeurs. A la mammographie, la répartition des cas selon le stade BI-RADS révèle que plus de la moitié (53.9%) était classée BI-RADS 5 ; 35.5 % des cas classés en BIRADS 4, 7.2% classés en BI-RADS 3 et un faible pourcentage (3.6 %) en BI-RADS 0. Pour l'échographie, la répartition des cas selon les stades BI-RADS révèle que plus de la moitié était classée ACR5, ce qui représente 64 %, 32.7 % classée en ACR4 et 3.3% en ACR3.A l'IRM, 71.1 % des cas ont été classés en ACR 5, 28.4% en ACR4 et 0.5 des cas en ACR 3. Le type histologique était de type carcinome canalaire infiltrant de grade III et II selon Scarff-Bloom et Richardson (SBR) dans 96.11% descas.Conclusion: L'expression radiologique est souvent non spécifique et évocatrice d'une lésion suspecte néanmoins nous avons constaté une plus grande fréquence de tumeurs d'allure bénigne en mammographie par rapport à l'échographie mammaire et à l'IRM mammaire. L'IRM mammaire reste donc utile dans la caractérisation lésionnelle et le bilan d'extension

Objective: Breast cancer in young women is rare and has its own epidemiological, diagnostic and prognostic features. The aim of our study was to evaluate the radiological (mammographic, ultrasonographic and MRI) characteristics of breast cancer iMaterials and methods: Prospective, descriptive study in the medical imaging department of the CPMC in Algiers, including 204 patients under 35 years of age, over a 3-year period from January 2017 to January 2020, diagnosed with breast cancer. They all underwent digital mammography, ultrasound and MRI of the breast and percutaneous sampling.Results: The incidence of breast cancer in young women under 35 was 10.6%. The mean age was 30.9 years. Autopalpation of a nodule was predominant (87.2%). Breast density was type c and d in 67.7%. Contrary to popular belief, these tumorswere often diagnosed by mammography. On mammography, the distribution of cases according to BIRADS stage revealed that over half (53.9%) were classified as BIRADS 5; 35.5% of cases classified as BIRADS 4, 7.2% classified as BIRADS 3 and a small percentage (3.6%) as BIRADS 0.On ultrasonography, the distribution of cases according to BIRADS staging revealed that over half were classified as ACR5, representing 64%, 32.7% as ACR4 and 3.3% as ACR3. On MRI, 71.1% of cases were classified as ACR 5, 28.4% as ACR4 and 0.5 of cases as ACR 3. Histological type was infiltrating ductal carcinoma grade III and II according to Scarff-Bloom and Richardson (SBR) in 96.11% of cases.Conclusion: Radiological expression is often non-specific and suggestive of a suspicious lesion. Nevertheless, we found a greater frequency of benign tumorsin mammography than in breast ultrasound and breast MRI. Breast MRI therefore remains useful for lesion characterization and extension assessmenn young Algerian women under 35 years of age.

Scanner cardiaque pédiatrique dans le diagnostic des cardiopathies congénitales: expérience abidjanaise / Pediatric cardiac computed tomography in the diagnosis of congenital heart disease: Abidjan experience

Objectif.Depuis 2008, la Haute Autorité Sanitaire recommande la réalisation du scanner cardiaque dans le diagnostic des cardiopathies congénitales. Celui-ci aide à confirmer et préciser les anomalies mal définies à l'échocardiographie. Dans les pays développés, le scanner cardiaque est un examende routine pour le diagnostic des cardiopathies congénitales. En Côte-d'Ivoire, sa pratique est récente.L'objectif de cette étude était de décrire les techniques et résultats des scanners cardiaques pédiatriques réalisés dans une structure privée à Abidjan.Matériels et méthodes.Il s'agissait d'une étude descriptive rétrospective sur une période de 2 mois qui a inclus tous les enfants reçus à la clinique la rosette pour la réalisation d'un scanner cardiaque indiqué pour l'évaluation d'une cardiopathie congénitale. Les examens ont été réalisés sous sédation légère pour les enfants de moins de 7 ans.Résultats.Vingt scanners cardiaques pédiatriques ont été réalisés. Les indications des scanners cardiaques pédiatriques étaient la tétralogie de Fallot (15 cas), l'atrésie pulmonaire à septum ouvert (APSO) (2 cas), la communication inter auriculaire (CIA) (1 cas), la CIA associée à une communication interventriculaire (CIV) (1 cas) et la sténose pulmonaire supra valvulaire (1 cas). Dans les cas de Tétralogie deFallot et d'APSO, les branches pulmonaires et les collatérales aorto-pulmonaires ont été visualisées et mesurées. Pour le bilan de , un retour veineux pulmonaire non visualisé à l'échocardiographie a été retrouvé au scanner cardiaque. Dans tous les cas, un bilan tomodensitométrique malformatif était réalisé : recherche d'anomalies coronaires et d'arcs aortiques.Après réalisation du scanner cardiaque, 5 enfants ont bénéficié d'une cure chirurgicale. On notait une concordance entre les diagnostics peropératoires et tomodensitométriques

Objective. Since 2008, the French National Authority for Health recommends the use of a cardiac scanner for the diagnosis of congenital heart disease. It helps to confirm and clarify abnormalities that are poorly defined on echocardiography. In developed countries,cardiac CT is a routine examination for the diagnosis of congenital heart disease. In Côte d'Ivoire, its practice is recent. Materials and Methods. This was a retrospective descriptive study over a period of 2 months which included all children received at the Rosette clinic for a cardiac scan indicated for the evaluation of congenital heart disease. The examinations were performed under light sedation for children under 7 years of age. Results. Twenty paediatric cardiac scans were performed. The indications for the paediatric cardiac scans were tetralogy of Fallot (15 cases), pulmonary atresia with ventricular septal defect (PAVSD) (2 cases), atrial septal defect (ASD) (1 case), ASD associated with ventricular septal defect (VSD) (1 case) and supravalvular pulmonary stenosis (1 case). In cases of Tetralogy of Fallot and APSO, pulmonary arteries and aorto-pulmonary collaterals were visualised and measured. For the assessment of ASD, an anomalous pulmonary venous return not visualised on echocardiography was found on cardiac computed tomography (CT). In all cases, a malformative CT scan was performed: search for coronary, aortic arch. After the cardiac, 5 children underwent surgical treatment. There was concordance between the intraoperative and CT diagnoses. Conclusion. In our experience, cardiac CT now represents, minimally invasive, complementary diagnostic tool for the evaluation of congenital heart disease.

Breast cancer after thoracic radiotherapy in young patients: what does the radiologist need to know? / Câncer de mama após radioterapia torácica em pacientes jovens: o que o radiologista precisa saber?

Abstract Radiation-induced secondary tumors constitute a rare complication of radiation therapy and typically occur in or near the irradiated area. Women who undergo thoracic radiotherapy before 30 years of age have a significantly greater lifetime risk of developing breast cancer than do those in the general population. It is recommended that a patient who has previously received thoracic radiotherapy with a radiation dose ≥ 10 Gy subsequently undergo annual screening with mammography and magnetic resonance imaging, beginning eight years after the initial treatment or when the patient has reached 25 years of age (whichever comes later). The treatment of secondary breast cancer in this population should be individualized and should be discussed with a multidisciplinary team to avoid toxicity related to the treatment of the primary cancer.

Resumo Os cânceres secundários induzidos por radiação são complicações raras da radioterapia e geralmente ocorrem na área tratada ou próximo a ela. Mulheres com menos de 30 anos de idade tratadas com radioterapia torácica têm risco significativamente aumentado de desenvolver câncer de mama ao longo da vida, em comparação com a população em geral. Para as pacientes tratadas com irradiação torácica com dose igual ou superior a 10 Gy é recomendado rastreamento anual com mamografia e ressonância magnética iniciando oito anos após o tratamento, desde que este início seja após 25 anos de idade. O tratamento do câncer de mama secundário nessa população deve ser individualizado e discutido com equipe multidisciplinar, para evitar toxicidade relacionada ao tratamento do câncer primário.

Determinants of breast cancer screening mammography uptake: Results from Jordan population and family health survey

Background: Screening for breast cancer utilizing mammography is associated with reduced advanced cancer diagnosis and reduced breast cancer mortality. We aimed to assess the lifetime history of breast cancer screening utilization for Jordanian women aged 40 and 49 years and determinants of this utilization. Methods: This paper reports the analyzed data from the seventh cycle of the Jordan Population and Family Health Survey (JPFHS). For this study, the analysis was confined to 4486 women aged between 40 and 49 years at the time of data collection who reported their nationality as Jordanian. We used multivariate logistic regression analysis to assess whether any socio?demographic variables could predict greater breast cancer screening utilization. Results: Only 14% of all respondents aged 40� years reported ever having a mammogram. Results of multivariate logistic regression showed that area of residence, husband抯 level of education, younger age, and living in a wealthy status were strong predictors of lifetime history of breast cancer screening. Conclusions: This study elucidates that breast cancer screening mammography among Jordanian women has remained opportunistic and underutilized despite the efforts of national entities to promote screening and early detection of breast cancer. There is a geographic and social disparity in the utilization of mammography screening among Jordanian women.

Impacto da COVID-19 no rastreamento do câncer de mama no Sistema Único de Saúde (SUS) / Impact of COVID-19 on breast cancer screening in the Brazilian Unified Health System (SUS)

Objetivos: investigar o impacto da pandemia no rastreamento do câncer de mama no Sistema Único de Saúde e comparar os dados obtidos com os de outros países. Métodos: foi realizado um estudo observacional transversal quantitativo, com dados provenientes do Sistema de Informação do Câncer ­ SISCAN sobre o número de mamografias feitas de 2014 a 2022 por mulheres, no Brasil. Resultados: os dados referentes à mamografia na população de risco elevado demonstraram uma queda de 38,39% de 2019 para 2020. Enquanto na mamografia de rastreamento a queda foi ligeiramente maior, de 39,18% nesse mesmo período. Em relação à mamografia diagnóstica, a redução foi de 33,15%, e na mamografia de população-alvo, o ápice foi em 2019 com 2.721.075. Em contrapartida, a realização de mamografia em pacientes já tratadas, teve uma menor queda, de 9,35%. Conclusões: observou-se uma queda significativa no número de mamografias realizadas em 2019 e 2020, o que poderá acarretar em diagnósticos tardios da doença e piores prognósticos (AU).

Objectives: investigating the impact of the pandemic on breast cancer screening in the Unified Health System, in addition to comparing the data obtained from other countries. Methods: a quantitative cross-sectional observational study was carried out, with references from the Cancer Information System - SISCAN on the number of mammograms performed from 2014 to 2022 by women in Brazil. Results: data regarding mammography in the high-risk population showed a drop of 38,39% from 2019 to 2020. While in screening mammography, the decline was slightly more significant, at 39.18% in the same period. Regarding diagnostic mammography, the reduction was 33.15%, and in target population mammography, the peak was in 2019 with 2.721.075. On the other hand, the performance of mammography in patients already treated had a smaller decrease of 9.35%. Conclusions: there was a significant reduction in the number of mammograms performed in 2019 and 2020, which might lead to a late diagnosis of the disease and a worse prognosis (AU),

Performance of physical activity as a predictor of women's mammography screening attendance in a population of Northeast Brazil

Introduction: Despite the increasing incidence of breast cancer among women in Northeast Brazil, there have been no studies on the association between physical activity and attendance to mammography screening. Objective: This study of Brazilian women addressed socio-economic variables, physical activity, and knowledge about breast cancer and their impact on attendance to mammography screening. Methods: A cross-sectional quantitative study was conducted as an epidemiological evaluation. Data were obtained by interviewing 307 women in a public health center. Logistic regression analysis was applied to determine the odds ratio (ORs) and confidence intervals (CI) of variables. Results: Mean age of women was 49.79 (SD=8.63) years and 172 (56.0%) were between 40 and 49 years old. Women aged from 40 to 49 and ≥50 years who performed physical activity, had a 2.4-fold (95% CI: 1.13-5.04) and 10.6-fold (95% CI: 2.66-41.95) increased chance to attend MS every year (p=0.040; p<0.001). Women aged between 40 and 49 years with a low and middle income, had a 10.3-fold (OR=0.097; 95% CI: 0.02-0.53) and 13.2-fold (OR=0.076; 95% CI: 0.11 0.53) decreased chance to attend MS every second year (p=0.007). The MS attendance of women aged ≥50 years with basic education level was 13.3 (OR=0.075; 95% CI: 0.09-0.66) times decreased (p=0.010). Conclusion: Physical activity represented an important predictor of MS attendance of all women. The impact of income and education level, in contrast, depended strongly on the age group.

Tendência de desigualdades na realização de mamografia nas capitais brasileiras nos últimos dez anos / Trend of inequalities in the performance of mammography in Brazilian capitals in the last ten years

Resumo O objetivo foi verificar a tendência de desigualdade na realização de mamografia de acordo com a posse de plano de saúde e escolaridade a partir de dados do período de 2011 a 2020 do VIGITEL. Estudo de base populacional com dados provenientes do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL) entre 2011 e 2020. Desfecho: exame de mamografia nos últimos dois anos em mulheres de 50 a 69 anos. A magnitude das desigualdades do desfecho em relação às exposições (plano de saúde e escolaridade) foi estimada por meio de dois índices: slope index of inequality (SII) e concentration index (CIX). A prevalência de cobertura da realização de mamografia (2011-2020) passou de 74,4% para 78,0%, com tendência estável. As prevalências de quem possuía plano de saúde foram 85,7% e 86,4%, e de quem não possuía, 63,4% e 71,2%, com tendência crescente. De acordo com a escolaridade, em mulheres com 0-8 anos de estudo a prevalência passou de 68,2% para 72,6%; 9-11 anos, de 80,4% para 80,0% (tendência decrescente); 12 anos ou mais, de 88,0% para 86,6% (tendência decrescente). Quanto aos índices de desigualdade absoluta (SII) e relativa (CIX) da escolaridade e plano de saúde, mostram que há uma diminuição na desigualdade nos últimos dez anos.

Abstract The objective was to verify the trend of inequality in the realization of mammography exam according to the possession of health insurance plan and schooling from data from the period 2011 to 2020 of VIGITEL. Population-based study with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL) between 2011 and 2020. Outcome: mammography exam in the last 2 years in women aged 50 to 69 years. The magnitude of inequalities of outcome in relation to exposures (health insurance plan and education) was estimated using two indices: inequality slope index (SII) and concentration index (CIX). The prevalence of mammography exam (2011-2020) increased from 74,4% to 78,0%, with a stable trend. The prevalence of those with health insurance plan were 85,7% and 86,4%, and without 63.4% and 71.2%, with an increasing trend. According to education, women with 0-8 years of schooling the prevalence increased from 68,2% to 72,6%, 9-11 years from 80,4% to 80,0% (decreasing trend), 12 years or more 88,0% to 86,6% (decreasing trend). As for the absolute (SII) and relative (CIX) inequality indices of schooling and health insurance plan show that there is a decrease in inequality over the last 10 years.

BI-RADS 3 lesions in North Indian population: Their outcome and how to proceed for follow-up

Background: Breast Imaging Reporting and Data System (BI?RADS) classification for breast lesions was proposed for uniformity in categorizing breast lesions. While BI?RADS 1, 2 and 4–6 categories are straightforward, BI?RADS 3 is an intermediate category lesion with significantly different meanings and findings for mammography, ultrasound, and magnetic resonance imaging and is diagnostically challenging. Our study aims to determine the frequency and the malignancy rate of BI?RADS category 3 lesions detected on ultrasound breast and digital X?ray mammography by doing follow?ups at 6, 12, and 24 months of imaging. Materials and Methods: This ambispective study was conducted in the Department of Radiodiagnosis, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, from October 2020 to October 2022, which included 55 patients referred for digital X?ray and breast ultrasound. All BI?RADS category 3 in the initial sonomammography and digital X?ray mammography were included in the study and were followed up for final diagnosis and outcome either by pathological analysis or follow?up using sonomammography and digital X?ray mammography for a maximum of 24 months. Results: Fifty?five patients were categorized into the benign or malignant category from the results of tissue diagnosis or via follow?up. Fifty?four patients (98.18%) showed benign lesions, and one (1.82%) got malignant lesions. In the majority, 31 (56.36%) patients, the mean follow?up time was 6 months, followed by 12 months 10 (18.18%). Follow?up was 24 months in only 1 out of 55 patients (1.82%). The mean value of time to follow?up (months) of study subjects was 6 ± 4.6 with a median (25th–75th percentile) of 6. Conclusion: Short?term interval follow?up in BI?RADS category: three patients are enough to detect early breast malignancy, and this will avoid unnecessary tissue diagnosis (invasive procedure) in benign lesions. In our study, the malignancy yield in the follow?up of BI?RADS 3 was 1.82% (<2%).

Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations / Recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil

Abstract Objective: To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities. Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.

Resumo Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline (PubMed), Excerpta Medica (Embase), Cochrane Library, Ebsco, Cinahl e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos, ou ainda portadoras de mutação genética ou com forte história familiar, se beneficiam do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível.

Association of polycystic ovary syndrome with mammographic density in Turkish women: a population-based case-control study

SUMMARY OBJECTIVE: The objective of this study was to investigate the breast densities and Breast Imaging-Reporting and Data System scores of patients with polycystic ovary syndrome and normoovulatory women and to determine whether these patients constitute a high-risk population for breast cancer. METHODS: This retrospective case-control study was conducted at our institution between January 2022 and December 2022, involving patients diagnosed with polycystic ovary syndrome. Menstrual periods, hyperandrogenemic findings, and ultrasound reports of the patients were retrieved from our hospital's database. Patients who met at least two of the Rotterdam criteria were included in the polycystic ovary syndrome group. A total of 70 premenopausal patients over the age of 40 years, diagnosed with polycystic ovary syndrome, and 70 normoovulatory women, matched for age and body mass index, were included in the study. The two groups were compared regarding age at menarche, menstrual pattern, gravida, parity, levels of follicle-stimulating hormone, luteinizing hormone, and estradiol, endometrial thickness, breast density category, and Breast Imaging-Reporting and Data System classifications. RESULTS: Patients in the polycystic ovary syndrome group had a higher age at menarche (12.7 vs. 12.3, p=0.006). There was no difference between the gonadotropin levels in both groups. However, the estradiol level was higher in the polycystic ovary syndrome group (p<0.001). There was no statistically significant difference between the two groups in terms of breast density and Breast Imaging-Reporting and Data System scores (p=0.319 and p=0.650, respectively). CONCLUSION: Although we can conclude that the risk of breast malignancy is not increased in patients with polycystic ovary syndrome, the impact of the complex hormonal status of polycystic ovary syndrome on breast cancer remains unclear in the literature.

Recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil

Objective: To present the updated recommendations of the Brazilian College of Radiology and Imaging Diagnosis, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Methods: Between January 2012 and July 2022, searches for scientific evidence published in MEDLINE, Embase, Cochrane Library, EBSCO, CINAHL and LILACS were carried out. The recommendations were based on this evidence, with the consensus of a committee of experts from the three institutions. Recommendations: The annual mammography screening is recommended for normal-risk patients aged between 40 and 74 years. For women aged more than 75 years, it is reserved for those whose life expectancy is longer than seven years. Women whose risk is higher than normal, such as those with dense breasts, personal history of atypical lobular hyperplasia, classic in situ lobular carcinoma, atypical ductal hyperplasia, women undergoing breast cancer treatment or thoracic irradiation before the age of 30, or those with genetic mutation or strong family history, benefit from complementary screening, being considered in an individual manner. Tomosynthesis is an evolution of mammography and should be considered in screening whenever accessible and available

Tendência de realização da mamografia e fatores associados em mulheres de 50 a 69 anos / Mammography trend and associated factors in women from 50 to 69 years

Resumo Introdução A mamografia é o principal método de detecção precoce de neoplasias mamárias. Objetivou-se conhecer a tendência temporal de realização da mamografia e identificar os fatores associados à realização desse exame em algum momento da vida e nos últimos dois anos. Objetivo Descrever a tendência temporal de realização da mamografia e identificar fatores associados à realização desse exame em algum momento da vida e nos últimos dois anos. Método Estudo transversal utilizando dados autorreferidos por mulheres, de 50 a 69 anos, oriundos do Vigitel. Para análise da tendência de realização da mamografia, tanto em algum momento da vida quanto nos últimos dois anos, foram analisados dados de 2007 a 2015 da cidade de João Pessoa, Paraíba, por meio de regressão linear simples, e, para identificação dos fatores associados, foram estimadas razões de prevalências utilizando-se da regressão de Poisson com dados de 2015. Resultados A prevalência de realização da mamografia, de 2007 a 2015, aumentou nos dois desfechos. Entre as variáveis analisadas, apenas a posse de plano de saúde manteve-se associada à realização da mamografia em algum momento da vida. Para a realização do exame nos últimos dois anos, mantiveram-se associados o estado civil casada/união estável e a posse de plano de saúde. Conclusão É necessário haver ações prioritárias nos serviços públicos de saúde, com a ampliação do acesso à solicitação e à realização da mamografia, garantindo acesso igualitário entre todas as mulheres.

Abstract Background Mammography is the main method for the early detection of breast cancer. The objective of this study was to learn about the temporal trend for mammography and identify factors associated with the examination at some point in life and in the last two years. Objective Describe the temporal trend of mammograms and identify factors associated with this exam at some point in life and in the last two years. Method A cross-sectional study was carried out using self-reported data from women aged 50 to 69 years from Vigitel. To analyze the tendency to perform mammography, both at some point in life and in the last two years, data from 2007 to 2015 in the city of João Pessoa, Paraíba, were analyzed using simple linear regression, and to identify the associated factors, prevalence ratios were estimated using Poisson regression with data from 2015. Results The prevalence of mammography, from 2007 to 2015, increased in both outcomes. Among the variables analyzed, only possession of a health plan remained associated with mammography at some point in life. For the examination in the last two years, marital status/stable union, and possession of a health plan remained associated. Conclusion Priority actions are needed in public health services, with increased access to requests and the performance of mammography, guaranteeing equal access among all women.

Recommendations for the Screening of Breast Cancer of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Society of Mastology and Brazilian Federation of Gynecology and Obstetrics Association / Recomendações para o rastreio do câncer de mama do colégio brasileiro de radiologia e diagnóstico por imagem, sociedade brasileira de mastologia e associação da federação brasileira de ginecologia e obstetrícia

Abstract Objective To present the update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology and the Brazilian Federation of Associations of Gynecology and Obstetrics for breast cancer screening in Brazil. Methods Scientific evidence published in Medline, EMBASE, Cochrane Library, EBSCO, CINAHL and Lilacs databases between January 2012 and July 2022 was searched. Recommendations were based on this evidence by consensus of the expert committee of the three entities. Recommendations Annual mammography screening is recommended for women at usual risk aged 40-74 years. Above 75 years, it should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, with a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast cancer or chest irradiation before age 30, or even, carriers of a genetic mutation or with a strong family history, benefit from complementary screening, and should be considered individually. Tomosynthesis is a form of mammography and should be considered in screening whenever accessible and available.

Resumo Objetivo Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Métodos Foram pesquisadas evidências científicas publicadas nas bases de dados Medline EMBASE Biblioteca Cochrane EBSCO CINAHL e Lilacs entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências por consenso do comitê de especialistas das três entidades. Recomendações A mamografia anual é recomendada para mulheres com risco habitual entre 40 e 74 anos. Acima de 75 anos deve ser reservado para aqueles com expectativa de vida superior a sete anos. Mulheres com risco maior do que o normal incluindo aquelas com mamas densas com história pessoal de hiperplasia lobular atípica carcinoma lobular in situ clássico hiperplasia ductal atípica tratamento para câncer de mama ou irradiação de tórax antes dos 30 anos ou ainda portadoras de doença genética mutação ou com forte histórico familiar beneficiam-se de triagem complementar e devem ser considerados individualmente. A tomossíntese é uma forma de mamografia e deve ser considerada na triagem sempre que acessível e disponível.

Analysis of breast cancer screening among rural women in Qinba area / 肿瘤研究与临床

Objective:To analyze the results of the free breast cancer screening project for rural women in Qinba area, and to investigate intervention measures for the improvement of screening rate.Methods:The data of 5 974 rural women aged 35 to 64 years old with breast cancer in Qinba area during two cancer screening in 3201 Hospital Affiliated to Xi'an Jiaotong University College of Medicine and Nanjiang County Women and Children Hospital between August 2021 and March 2022 were retrospectively analyzed. The characteristics of the screened population, the results of breast ultrasonography, mammography and pathological examination were statistically analyzed.The differences in the positive rates of breast ultrasonography and breast ultrasonography supplemented with mammography in the clinical screening of breast cancer among different age groups were compared.Results:The highest participation rate was found in those aged 45 to 49 years old, accounting for 29.56% (1 766/5 974); the lowest participation rate was those aged 60 to 64 years old, accounting for 3.65% (218/5 974). According to breast ultrasonography screening, 976 (16.34%) cases were suspected positive, 282 (4.72%) cases were positive; 84 (1.41%) were screened for mammography, 18 (21.43%) cases were suspected positive and 6 (7.14%) cases were positive; and the detection rate of breast cancer was 66.96/ 100 000 (4/5 974). There were statistically significant differences in the positive rate of clinical breast cancer screening by breast ultrasonography and breast ultrasonography supplemented with mammography among different age groups (all P < 0.05). Conclusions:Breast cancer screening in Qinba area has achieved some good results. The screening mode of physical examination combined with breast ultrasound supplemented with mammography is suitable for this area, but the compliance of the population is poor. The scientific awareness of breast cancer in rural women should be improved.

Values of mammography, ultrasound and magnetic resonance imaging in diagnosing breast cancer with silicone implants / 中华医学美学美容杂志

Objective:To investigate the diagnostic value of X-ray mammography, ultrasound and MRI in breast cancer with silicone implants.Methods:The clinical and imaging data of 20 patients with breast cancer in women with silicone implants in the First Affiliated Hospital of Zhengzhou University from March 2014 to October 2021 were analyzed retrospectively. The mammography, ultrasound and MRI findings were analyzed, and the differences in detection rate, diagnostic accuracy and omission diagnostic rate of breast cancer in women with implants were compared among the three imaging methods.Results:Compared with mammography, both ultrasound and MRI were able to display the prosthesis and breast lesions completely. There were significant differences in detection rate, diagnostic accuracy and omission diagnostic rate among mammography, ultrasound and MRI. And the detection rate and diagnostic accuracy of MRI in breast cancer in women with implants were higher than those of mammography, and the omission diagnostic rate was lower.Conclusions:Ultrasound and MRI are superior to mammography in evaluating breast cancer after silicone prosthesis implantation, and MRI has more advantages in guiding clinical diagnosis and treatment.