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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(4): 562-566, 2020 Apr 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895136

RESUMO

OBJECTIVE: To evaluate the diagnostic efficacy of Kaiser score for breast lesions presenting as non-mass enhancement. METHODS: We collected data from patients with breast lesions presenting as non-mass enhancement on preoperative DCE-MRI between January, 2014 and June, 2019. All the cases were confirmed by surgical pathology or puncture biopsy. With pathology results as the gold standard, we evaluated the diagnostic efficacy of Kaiser score and MRI BI-RADS classification and the consistency between the diagnostic results by the two methods and the pathological results. RESULTS: A total of 90 lesions were detected in 88 patients, including 28 benign lesions (31.1%) and 62 malignant lesions (68.9%). For diagnosis of the lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Kaiser Score were 100%, 75%, 89.9%, 100% and 92%, as compared with 93.5%, 46.4%, 79.5%, 76.5% and 78.9% of MRI BI-RADS, respectively. The diagnostic specificity of Kaiser score was significantly higher than that of BI-RADS classification (P=0.021). CONCLUSIONS: The Kaiser score system provides a diagnostic strategy for BI-RADS classification of breast lesions with non-mass enhancement and has a better diagnostic efficacy than BI-RADS classification alone. The use of Kaiser score can significantly improve the diagnostic specificity of such breast lesions for inexperienced radiologists.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mama , Humanos , Imagem por Ressonância Magnética
2.
Adv Exp Med Biol ; 1252: 9-16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816257

RESUMO

Physical exam of the breast is a very important part of breast assessment both for breast cancer screening, and when approaching breast lesions. Examination during pregnancy and breastfeeding follows exactly the same method as non-pregnancy periods. However, physical changes that occur in the breast during these times due to hormonal effects cause alterations that can on one hand conceal some pathologic disorders, and may on the other hand appear as pathologic findings while being purely physiologic. This chapter focuses first on some key points for an accurate breast examination, and then reviews some challenging controversial findings that may be noticed during breast exam in a pregnant or lactating woman.


Assuntos
Doenças Mamárias/diagnóstico , Mama/anatomia & histologia , Mama/patologia , Lactação/fisiologia , Exame Físico , Mama/fisiologia , Doenças Mamárias/patologia , Aleitamento Materno , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Gravidez
3.
Adv Exp Med Biol ; 1252: 17-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816258

RESUMO

All breast disorders found during pregnancy and lactation should be carefully evaluated. Most of them are benign, but it is essential to exclude pregnancy-associated breast cancer (PABC), which is too often diagnosed late. The first-line imaging technique is ultrasound (US), which must be completed by mammography if there is any clinical or US suspicious sign . In lactating patients with PABC , breast magnetic resonance imaging (MRI) can be useful for local assessment.Management depends on the precise analysis and BI-RADS classification of the lesion. During pregnancy and lactation, there is an overlap in imaging: many benign lesions can grow, infarct, become heterogeneous and thus suspicious, and on the other hand, PABC does not always present with typical malignant features. That is why biopsy must be performed if after the clinical and radiological evaluation the doubt persists, i.e. for all BI-RADS 4 and 5 lesions, and for some BI-RADS 3 lesions.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mama/diagnóstico por imagem , Lactação , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Gravidez
4.
Adv Exp Med Biol ; 1252: 27-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816259

RESUMO

Breast tissue reveals some physiologic changes during pregnancy and lactation due to hormonal alterations. Whole range of breast diseases including inflammatory, benign and malignant neoplasms can be seen in pregnancy but due to concurrent physiologic changes, may lead to diagnostic challenges. This chapter reviews sampling methods and histologic features of common benign breast lesions in pregnancy and lactation periods.


Assuntos
Doenças Mamárias/patologia , Mama/citologia , Mama/patologia , Lactação/fisiologia , Complicações na Gravidez , Gravidez/fisiologia , Neoplasias da Mama/patologia , Feminino , Humanos
5.
Adv Exp Med Biol ; 1252: 33-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816260

RESUMO

The breast tissue undergoes significant physiological change during pregnancy and lactation. These changes can give rise to some unique disorders during pregnancy , puerperium and lactation or exaggerate pre-existing conditions. Clinical examination becomes less reliable due to textural change and density of breast tissue as a result of hormonal changes. The main symptoms during pregnancy and lactation are breast pain, mastitis, lactational abscess, breast lump, and blood- stained nipple discharge.Lactational mastitis/ abscess must be treated without delay. Open incision and drainage of lactational abscess is rarely required, any lactational abscess should be treated with appropriate antibiotics and ultrasound guided aspiration of the pus.Any breast lump during pregnancy and lactation should be investigated with triple assessment. Pregnancy associated breast cancer (PABC ) must be ruled out. The choice of investigations and treatment needs careful consideration. While ultrasound is the investigation of choice, mammography can be performed with abdominal shielding if malignancy is suspected. Core biopsy is necessary for evaluation of any breast pathology but it comes with risk of infection, bleeding, hematoma and even milk fistula.The treating clinical specialist must be aware of certain unusual unique clinical conditions in pregnancy and lactation including accessory axillary breast tissue, gigantomastia and Raynaud's phenomenon.


Assuntos
Doenças Mamárias/diagnóstico , Doenças Mamárias/fisiopatologia , Lactação , Complicações na Gravidez , Abscesso , Mama , Doenças Mamárias/patologia , Aleitamento Materno , Feminino , Humanos , Mastite , Gravidez
6.
Adv Exp Med Biol ; 1252: 43-51, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816261

RESUMO

Benign cystic or solid lumps frequently occur in the breasts of young women, and consequently can also be seen during pregnancy and lactation. Simple cysts do not increase the risk of malignancy. The current management is routine follow-up. Complex cysts are thick walled or contain a mass, and should be followed by a US-guided biopsy and then treated similar to any non-gravid, non-lactating patient.Galactoceles can be detected during the last trimester of pregnancy and during or after stopping lactation. Aspiration can be done to confirm the content. Co-existence of galactocele and malignancy is extremely rare, and the key is to follow up until it resolves.Fibroadenoma is the most frequent lesion found during pregnancy and lactation. Management is usually conservative after triple assessment. Surgery is usually not recommended in pregnant and lactating women unless rapid increase in size occurs or there is discordance in the triple assessment.Lactating adenomas are sometimes interpreted as a variant of fibroadenoma . They can naturally disappear at the end of pregnancy or lactation. Management is usually conservative, and an excisional biopsy is only mandated if it is rapidly enlarging or if there is discordance in the triple assessment.Gestational gigantomastia is a rare condition consisting of diffuse severe hypertrophy of both breasts during pregnancy . Mastectomy and reconstruction may rarely be required in such cases.


Assuntos
Doenças Mamárias , Lactação , Complicações na Gravidez , Mama , Cisto Mamário , Feminino , Fibroadenoma , Humanos , Mastectomia , Gravidez
7.
Medicine (Baltimore) ; 99(30): e20797, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791669

RESUMO

To evaluate the value of a breast computed tomography (CT) (B-CT) in assessing breast density, pathologies and implant integrity in women with breast implants.This retrospective study was approved by the local ethics committee. B-CT images of 21 women with implants (silicone/saline; 20 bilateral, 1 unilateral) who underwent opportunistic screening or diagnostic bilateral B-CT were included. Breast density, implant integrity, extensive capsular fibrosis, soft tissue lesions and micro-/macrocalcifications were rated. In 18 of the 21 women, an additional ultrasound and in two patients breast magnetic resonance imaging was available for comparison. The average dose was calculated for each breast using verified Monte Carlo simulations on 3D image data sets.Breast density was nearly completely fatty (ACR a) in two patients, scattered fibroglandular (ACR b) in five, heterogeneously dense (ACR c) in ten and very dense (ACR d) in four women. In three women showed a unilateral positive Linguine sign indicative of an inner capsule rupture. Extensive capsular fibrosis was found in three women. In three women, soft tissue lesions were depicted, which revealed to be cysts (n = 2) and lymph nodes (n = 1) on subsequent sonography. Diffuse, non-clustered microcalcifications were found in nine women. Eleven women showed cutaneous or intramammary macrocalcifications. Average dose was 6.45 mGy (range 5.81-7.28 mGy).In women with implants, B-CT presents a promising modality for evaluating breast density, implant integrity, extensive capsular fibrosis, soft tissue lesions and micro-/macrocalcifications without the need of breast compression utilizing a lower dose compared to doses reported for conventional four-view mammography.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Implantes de Mama , Mama/diagnóstico por imagem , Tomografia Computadorizada Espiral , Adulto , Idoso , Mama/patologia , Feminino , Fibrose , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 99(27): e21063, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629735

RESUMO

BACKGROUND: Overflow breast disease (OBD), also known as breast nipple discharge, refers fluid or liquid that comes out of nipple. Many patients with breast cancer experience such condition. However, it is not easy to detect it at early stage, especially for pathological OBD. Previous study found low-dose CT combined mammography (LDCTMG) could help in diagnosis of OBD. However, there is no systematic review investigating this issue. Therefore, this study will examine the accuracy of LDCTMG in diagnosis of OBD. METHODS: This study protocol will search literature sources in electronic databases and other sources. The electronic databases will be retrieved in The Cochrane Library, the Cochrane Register of Diagnostic Test Accuracy Studies, PUBMED, EMBASE, Web of Science, CINAHL, CNKI, and WANGFANG from inception to the present. We will also search other sources. All literature sources will be sought without restrictions to the language and publication status. Two researchers will independently carry out study selection, data extraction, and study quality assessment. Statistical analysis will be performed using RevMan 5.3. RESULTS: This study will exert a high-quality synthesis of eligible studies on the analysis of LDCTMG in diagnosis of OBD. CONCLUSIONS: The results of this study may provide evidence to help judge whether LDCTMG is accurate in diagnosis of OBD. STUDY REGISTRATION: INPLASY202050116.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mamografia/métodos , Derrame Papilar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Doenças Mamárias/epidemiologia , Doenças Mamárias/patologia , Estudos de Avaliação como Assunto , Feminino , Humanos , Imagem Multimodal/métodos
10.
Medicine (Baltimore) ; 99(21): e20300, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481314

RESUMO

To study the effects of Tui Na therapy on patients with mammary gland hyperplasia.A total of 68 female patients with mammary gland hyperplasia were included in this retrospective study from May 2016 to May 2017 and assigned into control group (N = 34) treated with Rupixiao only (a proprietary Chinese medicine) or Tui Na group (N = 34) treated with Tui Na (Chinese massage) combined with Rupixiao. The pain intensity (visual analogous scale, VAS) and serum levels of luteinizing hormone (LH), estradiol (E2), prolactin (PRL), and progesterone (P) were examined before and after the treatment.The efficacies were 94.1% (32/34) in the Tui Na group and 76.5% (26/34) in the control group (P = .04). After treatment, VAS in Tui Na groups was significantly lower than that in control group (2.1 ±â€Š1.1 vs 3.1 ±â€Š1.1, P < .05). After follow-up for five months, the recurrence rates were 12.5% (4/32) in the Tui Na group and 23.1% (6/26) in the control group (P = .01). The levels of all 4 hormones in the Tui Na group increased significantly after treatment. In control group, only LH and E2 levels were significantly increased after treatment.In patients with mammary gland hyperplasia, Tui Na combined with Rupixiao could improve clinical symptoms, regulate sex hormone levels, and decrease the recurrence rate than Rupixiao alone. Our finding suggests that Tui Na can be potentially used for the treatment of mammary gland hyperplasia.


Assuntos
Acupressão/métodos , Doenças Mamárias/terapia , Massagem/métodos , Plantas Medicinais , Doenças Mamárias/sangue , Feminino , Seguimentos , Hormônios Esteroides Gonadais/sangue , Humanos , Hiperplasia/sangue , Hiperplasia/terapia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Biomed Khim ; 66(2): 167-173, 2020 Feb.
Artigo em Russo | MEDLINE | ID: mdl-32420899

RESUMO

In this work, we have compared malignant and non-malignant diseases of the mammary gland using 8 proteins: HRG, MUC1, PAI-1, HSP90αA1, CDH1, ERα, PGR and IL-12. Their concentrations in the supernatants of blood cells and breast biopsies were compared in terms of spontaneous production, induced by a polyclonal activator and after exposure to biopsy samples of the HLDF differentiation factor, as well as the indices of the effect of the polyclonal activator and HLDF on the protein production. In addition, the correlation relationships of the above indicators with the expression of markers of the epithelial-mesenchymal transition: collagen type II (CII), ß-1 integrin (CD29) and cadherin-E (CDH1) were studied. The study revealed statistically significant differences in the concentration of HRG in the supernatant of blood cells, IL-12 during spontaneous production by biopsy specimens, PGR production of biopsy specimens induced by the polyclonal activator, CDH1 and IL-12 production biopsy specimens exposed to HLDF. According to the influence index of the polyclonal activator and HLDF, statistically significant differences were found for CDH1production. Comparison of non-specific invasive carcinoma biopsy specimens and non-malignant breast diseases by means of the markers of the epithelial-mesenchymal transition revealed statistically significant differences in CD29 expression and the lack of differences in the expression of CDH1 and CII. This indicates the presence of cell atypia in samples of non-malignant breast diseases; it is confirmed by the recognized correlation between the production of certain proteins and the expression of the epithelial-mesenchymal transition markers.


Assuntos
Biomarcadores , Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Proteínas/análise , Transição Epitelial-Mesenquimal , Feminino , Humanos
14.
PLoS One ; 15(5): e0232856, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374781

RESUMO

BACKGROUND: Several methods for tumor delineation are used in literature on breast diffusion weighted imaging (DWI) to measure the apparent diffusion coefficient (ADC). However, in the process of reaching consensus on breast DWI scanning protocol, image analysis and interpretation, still no standardized optimal breast tumor tissue selection (BTTS) method exists. Therefore, the purpose of this study is to assess the impact of BTTS methods on ADC in the discrimination of benign from malignant breast lesions in DWI in terms of sensitivity, specificity and area under the curve (AUC). METHODS AND FINDINGS: In this systematic review and meta-analysis, adhering to the PRISMA statement, 61 studies, with 65 study subsets, in females with benign or malignant primary breast lesions (6291 lesions) were assessed. Studies on DWI, quantified by ADC, scanned on 1.5 and 3.0 Tesla and using b-values 0/50 and ≥ 800 s/mm2 were included. PubMed and EMBASE were searched for studies up to 23-10-2019 (n = 2897). Data were pooled based on four BTTS methods (by definition of measured region of interest, ROI): BTTS1: whole breast tumor tissue selection, BTTS2: subtracted whole breast tumor tissue selection, BTTS3: circular breast tumor tissue selection and BTTS4: lowest diffusion breast tumor tissue selection. BTTS methods 2 and 3 excluded necrotic, cystic and hemorrhagic areas. Pooled sensitivity, specificity and AUC of the BTTS methods were calculated. Heterogeneity was explored using the inconsistency index (I2) and considering covariables: field strength, lowest b-value, image of BTTS selection, pre-or post-contrast DWI, slice thickness and ADC threshold. Pooled sensitivity, specificity and AUC were: 0.82 (0.72-0.89), 0.79 (0.65-0.89), 0.88 (0.85-0.90) for BTTS1; 0.91 (0.89-0.93), 0.84 (0.80-0.87), 0.94 (0.91-0.96) for BTTS2; 0.89 (0.86-0.92), 0.90 (0.85-0.93), 0.95 (0.93-0.96) for BTTS3 and 0.90 (0.86-0.93), 0.84 (0.81-0.87), 0.86 (0.82-0.88) for BTTS4, respectively. Significant heterogeneity was found between studies (I2 = 95). CONCLUSIONS: None of the breast tissue selection (BTTS) methodologies outperformed in differentiating benign from malignant breast lesions. The high heterogeneity of ADC data acquisition demands further standardization, such as DWI acquisition parameters and tumor tissue selection to substantially increase the reliability of DWI of the breast.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Adulto , Idoso , Área Sob a Curva , Doenças Mamárias/diagnóstico por imagem , Neoplasias da Mama/patologia , Diagnóstico Diferencial , Feminino , Doença da Mama Fibrocística/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Pessoa de Meia-Idade , Necrose , Valor Preditivo dos Testes , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
16.
Anticancer Res ; 40(4): 2185-2190, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234913

RESUMO

BACKGROUND/AIM: The study aimed at investigating the correlation between ductoscopic and histopathological findings and clarify whether the former allow for accurate prediction of malignancy. PATIENTS AND METHODS: The prospective national multi-center study covered a sample of 224 patients with pathologic nipple discharge. A total of 214 patients underwent ductoscopy with subsequent extirpation of the mammary duct. The ductoscopic findings were categorized according to shape, number, color and surface structure of lesions and vascularity and compared to the histological results and analyses. RESULTS: Ductoscopy revealed lesions in 134 of 214 patients (62.2%). The criteria "multiple versus solitary lesion" differed significantly between malignant and benign lesions. All other criteria were not statistically significant. Malignant tumors were more frequently presented as multiple lesions, benign lesions or masses as solitary lesions (80% vs. 24.8%; p=0.018). CONCLUSION: The ductoscopic criterion "solitary vs. multiple lesion" appears to have a low diagnostic prediction of malignancy or benignity.


Assuntos
Doenças Mamárias/diagnóstico , Neoplasias da Mama/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Endoscopia/métodos , Derrame Papilar , Mamilos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Mamárias/metabolismo , Doenças Mamárias/patologia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/metabolismo , Carcinoma Intraductal não Infiltrante/patologia , Diagnóstico Diferencial , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Mamilos/metabolismo , Estudos Prospectivos , Adulto Jovem
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