Preliminary study of the technical limitations of automated breast ultrasound: from procedure to diagnosis.

OBJECTIVE: To evaluate the main technical limitations of automated breast ultrasound and to determine the proportion of examinations excluded. MATERIALS AND METHODS: We evaluated 440 automated breast ultrasound examinations performed, over a 12-month period, by technicians using an established protocol. RESULTS: In five cases (1.1%), the examination was deemed unacceptable for diagnostic purposes, those examinations therefore being excluded. CONCLUSION: Automated breast ultrasound is expected to overcome some of the major limitations of conventional ultrasound in breast cancer screening. In Brazil, this new method can be accepted for inclusion in routine clinical practice only after its advantages have been validated in the national context.

OBJETIVO: O objetivo deste estudo foi avaliar as principais limitações técnicas e a porcentagem de exames excluídos de ultrassonografia automatizada. MATERIAIS E MÉTODOS: Foram realizados 440 exames de ultrassonografia automatizada das mamas no período 12 meses, por técnicas, com protocolo estabelecido. RESULTADOS: Em cinco casos (1,1%) a interpretação do estudo foi inaceitável, sendo o exame excluído do presente estudo para fins de diagnóstico. CONCLUSÃO: A ultrassonografia automatizada das mamas apresenta a expectativa de resolver importantes limitações da ultrassonografia convencional no rastreamento do câncer de mama, sendo necessária uma maior validação de dados brasileiros, para que este novo método seja aceito na prática clínica de rotina.

Preliminary study of the technical limitations of automated breast ultrasound: from procedure to diagnosis / Estudo preliminar das limitações técnicas da ultrassonografia automatizada da mama: do procedimento ao diagnóstico

Abstract Objective: To evaluate the main technical limitations of automated breast ultrasound and to determine the proportion of examinations excluded. Materials and Methods: We evaluated 440 automated breast ultrasound examinations performed, over a 12-month period, by technicians using an established protocol. Results: In five cases (1.1%), the examination was deemed unacceptable for diagnostic purposes, those examinations therefore being excluded. Conclusion: Automated breast ultrasound is expected to overcome some of the major limitations of conventional ultrasound in breast cancer screening. In Brazil, this new method can be accepted for inclusion in routine clinical practice only after its advantages have been validated in the national context.

Resumo Objetivo: O objetivo deste estudo foi avaliar as principais limitações técnicas e a porcentagem de exames excluídos de ultrassonografia automatizada. Materiais e Métodos: Foram realizados 440 exames de ultrassonografia automatizada das mamas no período 12 meses, por técnicas, com protocolo estabelecido. Resultados: Em cinco casos (1,1%) a interpretação do estudo foi inaceitável, sendo o exame excluído do presente estudo para fins de diagnóstico. Conclusão: A ultrassonografia automatizada das mamas apresenta a expectativa de resolver importantes limitações da ultrassonografia convencional no rastreamento do câncer de mama, sendo necessária uma maior validação de dados brasileiros, para que este novo método seja aceito na prática clínica de rotina.

Predictive values of breast imaging reporting and data system category 3 breast masses submitted to percutaneous biopsy by ultrasonography / Valores preditivos dos nódulos mamários categoria 3 pelo sistema de laudos e registro de dados de imagem da mama submetidos à biópsia percutânea por ultrassonografia

Introduction: Breast Imaging Reporting and Data System (BI-RADS) classification allows standardization of breast masses findings, with a recommendation for individualized management. Because of their high frequency, masses classified as 3, probably benign, arouse interest in improving their characterization and in establishing the most appropriate behavior. Objective: Firstly, to demonstrate the positive and negative predictive values of the BI-RADS 3 classification of solid masses submitted to percutaneous biopsy by ultrasonography. Secondly, to suggest a different ultrasound follow-up conduct in these findings. Methods: We retrospectively studied 480 BI-RADS 3 masses, submitted to a biopsy under vacuum or core biopsy, with a conclusive histopathological result considered the gold standard. Results: From 480 masses in 396 patients, 473 were benign and 7 malignant. The positive predictive value for malignancy of category 3 masses was 1.5% (7/480), and the negative predictive value was 98.5%. Conclusion: In view of the low probability of cancer, it is recommended the performance of directed ultrasonography (second look) of masses classified as BI-RADS 3 performed by a specialist in breast radiology before the indication of an invasive procedure, what would substantially reduce the number of unnecessary biopsies, patient's anxiety, as well as costs and possible related complications. This will increase the possibility for the specialist to spend more time on really necessary and targeted examinations, better defining cases of follow-up (annual or biannual) of the indication of investigation in specific cases.

Introdução: A classificação do Breast Imaging Reporting and Data System (BI-RADS) permite a padronização dos achados das massas mamárias, com recomendação para o manejo individualizado. Por causa de sua alta frequência, massas classificadas como 3, provavelmente benignas, despertam interesse em melhorar sua caracterização e em estabelecer o comportamento mais adequado. Objetivo: P rimeiramente, d emonstrar o s v alores p reditivos p ositivos e n egativos d a c lassificação d e m assas s ólidas B I-RADS 3 submetidos a biópsia percutânea por ultrassonografia. Em segundo lugar, sugerir conduta de acompanhamento por ultrassonografia diferente nesses achados. Metodologia: Estudamos, retrospectivamente, 480 massas BI-RADS 3, submetidas a biópsia a vácuo ou corebiopsia, com resultado histopatológico conclusivo considerado padrão-ouro. Resultados: De 480 massas em 396 pacientes, 473 eram benignas e 7 malignas. O valor preditivo positivo para malignidade de categoria 3 foi de 1,5% (7/480) e o valor preditivo negativo foi de 98,5%. Conclusão: Em vista da baixa probabilidade de câncer, recomenda-se a realização de ultrassonografia direcionada (second look) de massas classificadas como BI-RADS 3 por especialista em radiologia da mama antes da indicação de um procedimento invasivo, o que reduziria substancialmente o número de biópsias desnecessárias, ansiedade do paciente, bem como possíveis complicações. Isso aumentará a possibilidade de o especialista passar mais tempo em exames realmente necessários e direcionados, definindo melhor os casos de acompanhamento (anual ou semestral) da indicação da investigação em casos específicos.

Comparative study of clinical, pathological and HRCT findings of primary alveolar proteinosis and silicoproteinosis.

OBJECTIVE: To compare the clinical, high-resolution computed tomography (HRCT) and pathological findings of primary alveolar proteinosis (PAP) and silicoproteinosis. MATERIAL AND METHODS: The study included 15 patients with PAP (6 women, 9 men, mean age 31 years) and 13 with silicoproteinosis (13 men, mean age 29.5 years). PAP was diagnosed by lung biopsy in 13 and bronchoalveolar lavage in two patients and silicoproteinosis by bronchoalveolar lavage in 10 and autopsy in three cases. HRCT images were reviewed by two chest radiologists with consensus for the presence, extent and distribution of ground-glass opacities, septal thickening, consolidation and nodules. Radiological-pathological correlation was performed by one radiologist and one chest pathologist. RESULTS: Seven (46%) patients with PAP were asymptomatic; the remainder presented slowly progressive dyspnea and dry cough. All silicoproteinosis patients had dry cough and rapidly progressive dyspnea. The most common HRCT finding on PAP was the crazy-paving pattern (93%). All cases had areas of geographic sparing in the affected lung. The most common finding in silicoproteinosis (92%) was dependent consolidation with calcification in 83%. Centrilobular nodules were common (85%). On pathology, both diseases demonstrated intra-alveolar accumulation of PAS material, thickening of interlobular septae and alveolar walls and no evidence of fibrosis. A few silica particles were seen in silicoproteinosis. CONCLUSION: Despite the pathological similarities, PAP and silicoproteinosis have distinct clinical and imaging features and prognosis. Bilateral crazy-paving pattern with areas of geographic sparing is characteristic for PAP. Silicoproteinosis presents with bilateral dependent consolidation often with areas of calcification. The crazy-paving pattern is not seen in silicoproteinosis.

Primary mediastinal liposarcoma - computed tomography and pathological findings: a case report.

Liposarcomas are the most common soft tissue sarcoma of adults, and primary mediastinal liposarcomas are rare. We present a case of a 50-year-old man with primary mediastinal liposarcoma without any invasion into the surrounding structures, such as the esophagus, trachea, or left atrium of the heart. Following surgical removal of the liposarcoma, the patient has had no recurrence after one year. Surgical removal is the treatment of choice for a mediastinal liposarcoma; however, careful long-term follow-up is necessary because the recurrence rate is very high.

Consolidation with diffuse or focal high attenuation: computed tomography findings.

This pictorial essay aims to present various lesions that could present as consolidations with diffuse of focal high attenuation on computed tomography, helping to make the diagnosis more confident and specific. The radiologic literature has limited information about such findings and the role of computed tomography in the differential diagnosis. The following diseases are presented: metastatic pulmonary calcification, pulmonary alveolar microlithiasis, amiodarone lung, talcosis, iodinated oil embolism, tuberculosis, silicoproteinosis, and amyloidosis. In conclusion, air-space consolidations can be seen in a wide variety of diseases affecting the lungs. The identification of the different patterns of consolidation with focal high attenuation narrows the differential diagnosis. We present a diagnostic approach based on appearance and distribution of these lesions.