Randomized Clinical Trial Comparing Two Methods of Measuring Insertion Length of Nasogastric Tubes in Newborns.

INTRODUCTION: The selection of a method for measuring the insertion length of nasogastric tubes in newborns is an important factor in establishing the safe use of this device. OBJECTIVE: The objective was to verify whether there is a difference in the proportion of correctly placed nasogastric tubes when using the nose, earlobe, mid-umbilicus (NEMU) method and the weight-based equation for measuring the insertion length. METHODS: This study is a randomized, controlled, blinded study comparing 2 methods of nasogastric insertion at a neonatal unit, with intensive and intermediate care, on 162 randomized individuals. Radiological assessment and pH test were conducted to verify tube placement. Data were collected on sex, birth weight, gestational age, and days of life. A log-binomial model was used to verify whether there were placement differences between investigated methods. RESULTS: Of the patients, 56.1% were male, who had a mean birth weight of 1886.8 g and gestational age of 32.9 weeks and were 10.8 days old. Radiological images demonstrated that tubes were properly placed in the gastric body in 67.5% of patients using the NEMU method and in 91.5% using the weight-based equation: the weight-based equation was superior to the NEMU method, with a prevalence ratio of 1.36 (95% CI, 1.15-1.44). There was no difference between the 2 methods, according to pH test (P-value: .7179). CONCLUSION: Based on radiographic confirmation, the weight-based equation for measuring the insertion length of the nasogastric tube in newborns resulted in significantly more nasogastric tubes being placed in the correct intragastric location.

Use of pH reagent strips to verify gastric tube placement in newborns.

OBJECTIVE: to confirm the accuracy of the pH test in identifying the placement of the gastric tube in newborns. METHOD: double-blind, diagnostic test study conducted with 162 newborns admitted to a neonatal intensive care unit and an intermediate care unit. The subjects were submitted to enteral intubation, followed by pH test with reagent strip, which was analyzed by a nurse, and radiological examination, analyzed by radiologist. Blinding was kept among professionals regarding test results. Diagnostic accuracy analysis of the pH test in relation to the radiological exam was performed. RESULTS: the sample consisted of 56.17% boys, with average birth weight of 1,886.79g (SD 743,41), 32.92 (SD 2.99) weeks of gestational age and the mean pH was 3.36 (SD 1.27). Considering the cutoff point of pH≤5.5, the sensitivity was 96.25%, specificity 50%, positive predictive value 99.35% and negative predictive value 14.29%. CONCLUSION: The pH test performed with reagent strips is sensitive to identify the correct placement of the gastric tube, so it can be used as an adjuvant technique in the evaluation of the gastric tube placement. In interpreting the results, pH ≤5.5 points to correct placement and values > 5.5 require radiological confirmation.

The Use of Ultrasonography for Verifying Gastric Tube Placement in Newborns.

BACKGROUND: The use of gastric tubes in newborns admitted to a neonatal intensive care unit is fairly high, and there is a risk of serious complications related to this procedure. PURPOSE: Considering the need to find a method that does not involve the patient's exposure to radiation, this study aimed to evaluate the diagnostic accuracy of ultrasonography for verifying gastric tube placement in newborns. METHODS: This was a prospective, double-blind, observational study performed in a neonatal intensive care unit, in which 159 infants had gastric intubation using ultrasound examination and radiological imaging, to verify positioning. Results were analyzed in terms of diagnostic accuracy. RESULTS: The tubes were correctly positioned in 157 cases (98.7%), according to radiological images, and in 156 cases (98.1%), according to ultrasound. The sensitivity analysis was 0.98 and the positive predictive value was 0.99. It was not possible to perform a specificity analysis, as there were not enough negative cases in the sample. IMPLICATIONS FOR PRACTICE: The use of ultrasonography to identify correct positioning of gastric tubes in infants and newborns shows good sensitivity. IMPLICATIONS FOR RESEARCH: It was not possible to evaluate the ultrasonography specificity; further studies with greater samples are probably necessary, so that this objective can be achieved.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=29&autoPlay=true.

Radiological findings associated with the death of newborns with necrotizing enterocolitis.

OBJECTIVE: The aim of this study was to identify radiological and clinical risk factors for death in newborns with necrotizing enterocolitis. MATERIALS AND METHODS: This was a retrospective cohort study, based on radiological examinations and medical charts of 66 infants with necrotizing enterocolitis, as confirmed by a finding of intestinal pneumatosis (stage IIA, according to modified Bell's staging criteria). Radiological and clinical variables were evaluated. RESULTS: Of the 66 infants evaluated, 14 (21.2%) presented pneumatosis in the large and small bowel; 7 (10.6%) presented air in the portal system; and 12 (18.2%) died. Bivariate analysis revealed that the following variables were associated with death: bowel perforation; pneumatosis in the large and small bowel; air in the portal system; earlier gestational age; longer time on mechanical ventilation before the identification of pneumatosis; and longer time on mechanical ventilation before discharge or death. In the multivariate regression, the following variables remained as predictors of death: pneumatosis in the large and small intestines (odds ratio [OR] = 12.4; 95% confidence interval [95% CI] = 1.2-127.4; p = 0.035), perforation (OR = 23.2; 95% CI = 2.2-246.7; p = 0.009), and air in the portal system (OR = 69.7; 95% CI = 4.3-[not calculated]; p = 0.003). CONCLUSION: The set of factors most strongly associated with death in infants with necrotizing enterocolitis comprised extensive pneumatosis, pneumoperitoneum, and air in the portal system. Our findings confirm the importance of radiological imaging in the diagnosis and monitoring of necrotizing enterocolitis.

Radiological findings associated with the death of newborns with necrotizing enterocolitis / Achados radiológicos associados ao óbito de recém-nascidos com enterocolite necrosante

Abstract Objective: The aim of this study was to identify radiological and clinical risk factors for death in newborns with necrotizing enterocolitis. Materials and Methods: This was a retrospective cohort study, based on radiological examinations and medical charts of 66 infants with necrotizing enterocolitis, as confirmed by a finding of intestinal pneumatosis (stage IIA, according to modified Bell's staging criteria). Radiological and clinical variables were evaluated. Results: Of the 66 infants evaluated, 14 (21.2%) presented pneumatosis in the large and small bowel; 7 (10.6%) presented air in the portal system; and 12 (18.2%) died. Bivariate analysis revealed that the following variables were associated with death: bowel perforation; pneumatosis in the large and small bowel; air in the portal system; earlier gestational age; longer time on mechanical ventilation before the identification of pneumatosis; and longer time on mechanical ventilation before discharge or death. In the multivariate regression, the following variables remained as predictors of death: pneumatosis in the large and small intestines (odds ratio [OR] = 12.4; 95% confidence interval [95% CI] = 1.2-127.4; p = 0.035), perforation (OR = 23.2; 95% CI = 2.2-246.7; p = 0.009), and air in the portal system (OR = 69.7; 95% CI = 4.3-[not calculated]; p = 0.003). Conclusion: The set of factors most strongly associated with death in infants with necrotizing enterocolitis comprised extensive pneumatosis, pneumoperitoneum, and air in the portal system. Our findings confirm the importance of radiological imaging in the diagnosis and monitoring of necrotizing enterocolitis.

Resumo Objetivo: Determinar fatores de risco radiológicos e clínicos para o desfecho de óbito em recém-nascidos com enterocolite necrosante. Materiais e Métodos: Estudo de coorte retrospectivo de exames radiológicos e prontuários de 66 recém-nascidos com enterocolite necrosante confirmada pela presença de pneumatose intestinal (estágio IIA, segundo os critérios modificados de Bell). Foram estudados achados radiológicos e variáveis clínicas. Resultados: Catorze casos (21,2%) apresentaram pneumatose nos intestinos grosso e delgado, 7 (10,6%) apresentaram ar no sistema porta e 12 (18,2%) faleceram. As análises bivariadas indicaram que as variáveis significativas para o óbito foram: perfuração intestinal, pneumatose localizada nos intestinos grosso e delgado, ar no sistema porta, menor idade gestacional, longos períodos de ventilação mecânica até a identificação da pneumatose e longos períodos de ventilação mecânica até a data de alta/óbito. Na regressão multivariada, mantiveram-se como preditores do óbito: pneumatose localizada nos intestinos grosso e delgado (odds ratio [OR] = 12,4; intervalo de confiança de 95% [IC 95%] = 1,2-127,4; p = 0,035), perfuração (OR = 23,2; IC 95% = 2,2-246,7; p = 0,009) e ar no sistema porta (OR = 69,7; IC 95% = 4,3-não calculado; p = 0,003). Conclusão: Pneumatose extensa, pneumoperitônio e ar no sistema porta compuseram o melhor conjunto de fatores associados ao óbito. Esses achados corroboram a importância da radiografia simples de abdome no diagnóstico e acompanhamento da enterocolite necrosante.

Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects.

OBJECTIVE: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. MATERIALS AND METHODS: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher's exact test. The level of significance was set at p < 0.05. RESULTS: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. CONCLUSION: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects / Atelectasia pulmonar em recém-nascidos com doenças clinicamente tratáveis submetidos a ventilação mecânica: aspectos clínicos e radiológicos

Abstract Objective: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. Materials and Methods: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher's exact test. The level of significance was set at p < 0.05. Results: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. Conclusion: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

Resumo Objetivo: Analisar os aspectos radiológicos da atelectasia pulmonar em recém-nascidos com doenças clinicamente tratáveis submetidos a ventilação mecânica e atendidos em uma unidade de tratamento intensivo neonatal, associando características da atelectasia com o posicionamento da cabeça e da cânula endotraqueal na radiografia de tórax e com variáveis clínicas. Materiais e Métodos: Estudo de corte transversal e retrospectivo, em que foram incluídos 60 pacientes internados entre 1985 e 2015. A coleta dos dados foi realizada por meio da revisão dos prontuários e dos laudos das radiografias dos recém-nascidos. Para associação das variáveis foi realizado o teste exato de Fisher. O nível de significância adotado foi p < 0,05. Resultados: As características clínicas associadas à localização inadequada da cânula foram prematuridade e o peso ao nascer inferior a 1000 g. A doença clínica mais frequentemente encontrada foi a doença da membrana hialina. O lobo pulmonar superior direito foi o que apresentou maior frequência de atelectasia, e casos de atelectasia completa foram mais frequentes no pulmão esquerdo. O mau posicionamento da cabeça mostrou uma tendência de associação com atelectasia no lobo superior esquerdo. Conclusão: A atelectasia pulmonar representou uma complicação importante em recém-nascidos submetidos a ventilação mecânica, sendo a avaliação radiológica do posicionamento da cânula endotraqueal relevante para a correção precoce dessa condição.

CLINICAL, MAMMOGRAPHIC AND HISTOPATHOLOGICAL CORRELATION OF BREAST CANCER IN WOMEN AGED BETWEEN 50 AND 70 YEARS / Correlação clínica, mamográfica e histopatológica do câncer mamário em mulheres com idade entre 50 e 70 anos

Objective: To correlate the clinical, mammographic and histopathological findings of women aged between 50 and 70 years old who were diagnosed with breast cancer and were assisted between 1998 and 2013 at the Mastology Outpatient Clinic of the Center for Full Attention to Women's Health in Universidade Estadual de Campinas (CAISM-Unicamp). Methods: This was a cross-sectional and retrospective study, in which the medical records and mammograms of 160 women were analyzed, a sufficient sample size for the statistical analysis. The variables used for comparison were the clinical, mammographic and histopathological findings, analyzed through descriptive and associative statistics. Results: Of the 160 cases analyzed, 76.9% were symptomatic, and the main clinical findings included palpable nodule (68.1%) and skin alterations (30%). The prevalent mammographic presentations in asymptomatic women were microcalcifications (48.7%), nodules (43.2%) and architectural distortion (8.1%). Regarding the histological type, 81.3% presented invasive ductal carcinoma (IDC) and 10.7%, ductal carcinoma in situ (DCIS). Conclusion: The present study showed that there was a predominance of symptomatic women with mammographic presentation of spiculated nodules and histological type of IDC. In the other patients with lesions detected in the screening test, pleomorphic microcalcifications were prevalent as the main finding of DCIS. Diagnostic mammography was the main form of detection of breast cancer, which may represent the lack of access of these women to screening or early detection of malignant lesions. This reveals the need to improve control actions and care protocols of these patients.

Objetivo: Correlacionar os achados clínicos, mamográficos e histopatológicos de mulheres na faixa etária entre 50 e 70 anos que tiveram diagnóstico de câncer mamário e foram atendidas, entre 1998 e 2013, no Ambulatório de Mastologia do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-Unicamp). Métodos: Trata-se de um estudo de corte transversal e retrospectivo, no qual foram analisados os prontuários e as mamografias de 160 mulheres, tamanho amostral suficiente para a análise estatística. As variáveis usadas para comparação foram os achados clínicos, mamográficos e histopatológicos, analisados por meio da estatística descritiva e associativa. Resultados: Entre os 160 casos analisados, 76,9% eram sintomáticos e os principais achados clínicos incluíram nódulo palpável (68,1%) e alterações de pele (30%). As apresentações mamográficas prevalentes nas mulheres assintomáticas foram microcalcificações (48,7%), nódulos (43,2%) e distorção arquitetural (8,1%). Com relação ao tipo histológico, 81,3% apresentaram carcinoma ductal invasivo (CDI) e 10,7%, carcinoma ductal in situ (CDIS). Conclusão: O presente trabalho evidenciou que houve uma predominância de mulheres sintomáticas, com apresentação mamográfica de nódulos espiculados e tipo histológico de CDI. Já nas demais pacientes com lesões detectadas no exame de rastreamento predominaram as microcalcificações pleomórficas como o principal achado do CDIS. A mamografia diagnóstica foi a principal forma de detecção do câncer mamário, podendo representar a falta de acesso dessas mulheres aos exames de rastreamento ou à não detecção precoce das lesões malignas, o que revela a necessidade de melhorar as ações de controle e os protocolos de atendimento dessas pacientes.

Cateteres umbilicais em recém-nascidos: indicações, complicações e diagnóstico por imagem / Umbilical catheters in newborns: indications, complications and imaging diagnosis

Objetivos: Revisar os últimos dados de literatura acerca do cateterismo umbilical quanto a indicações, complicações e diagnóstico de sua localização através de exames de imagem.Métodos: Foram pesquisados artigos nas bases de dados PubMed, SciELO e LILACS, através dos seguintes descritores, assim como dos termos correspondentes em inglês: cateteres umbilicais; exame radiológico; ultrassonografia; recém-nascido; e cuidados intensivos neonatais. Foram incluídos também livros texto clássicos em literatura neonatal.Resultados: Foram selecionados 51 artigos, quatro livros texto e um manual versando sobre cateteres umbilicais venosos e arteriais em recém-nascidos. Revisamos indicações, novas técnicas de inserção, complicações associadas, fatores de risco e diagnóstico por imagem, com ênfase nas referências anatômicas utilizadas para o diagnóstico da posição da extremidade do cateter.Conclusões: O cateterismo umbilical representa um importante acesso à corrente sanguínea do recém-nascido e o diagnóstico por imagem desempenha um papel fundamental na avaliação correta do seu posicionamento, possibilitando, em caso de mau posicionamento, a conduta imediata para prevenção de complicações.

Aims: To review the latest literature on umbilical catheterization including its indications, complications, and diagnostic imaging for verification of catheter position.Methods: The PubMed, SciELO, and LILACS databases were searched using the following keywords and the corresponding terms in Portuguese: umbilical catheters; radiological examination; ultrasonography; newborn; and neonatal intensive care. Classic textbooks on neonatology were also reviewed.Results: A total of 51 articles, four classic textbooks, and one manual dealing with venous and arterial umbilical catheterization in neonates were selected. We reviewed the indications, new insertion techniques, complications, risk factors and, diagnostic imaging, with emphasis on the anatomic landmarks used for determination of catheter tip position.Conclusions: Umbilical catheterization is an important access to the bloodstream of the newborn, and diagnostic imaging plays a key role in the assessment of catheter tip position, thus enabling immediate management and preventing complications in cases of misplacement.

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

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.

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. .

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition / Presença de ar no sistema porta hepático associada a cateter umbilical venoso mal posicionado

The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

Apresentamos um caso relacionado a cateter umbilical venoso mal posicionado, associado à presença de ar no sistema portal, em um recém-nascido prematuro. A hipótese de enterocolite necrosante foi considerada inicialmente, porém o recém-nascido evoluiu sem achados da doença, tendo o ar desaparecido em radiografia de controle. O diagnóstico diferencial deste achado evita condutas clínicas desnecessárias.

Simple rules for ultrasonographic subcategorization of BI-RADS®-US 4 breast masses.

OBJECTIVES: To evaluate an objective method for ultrasonographic (US) subcategorization of BI-RADS(®)-US 4 breast masses based on clear and simple rules in order for woman to benefit from a more complete and homogeneous breast mass analysis. METHODS: In this cross-sectional study, we selected 330 women, with 339 US breast masses, classified as BI-RADS(®)-US 4. Three physicians experienced in breast imaging independently reviewed all US images, assessing mass shape, margins, orientation, echo texture and vascularity. These experts further subdivided the masses into subcategories 4a, 4b and 4c, according to simple US rules. Inter-observer agreement was calculated for US features categories and for final subcategory assessment. We also estimated the positive predictive value (PPV) for BI-RADS(®)-US subcategories 4a, 4b and 4c assigned by each of the three observers. RESULTS: Pathological examination of all masses confirmed 144 (42%) malignant and 195 (58%) benign tumors. Moderate agreement was obtained for mass shape, margins, vascularity and for final BI-RADS(®)-US 4 subcategory. Substantial agreement was obtained for the description of mass orientation and echo texture. The PPV for subcategories 4a, 4b and 4c were, 17%, 45% and 85%, respectively, for the first observer and 20%, 38% and 79% and 17%, 40% and 85% for the other two observers. CONCLUSION: Standardization of a US subcategorization of BI-RADS(®)-US 4 breast masses seems to be feasible, with substantial inter-observer agreement and progressive increase in the PPV in the subcategories 4a, 4b and 4c, provided that clear and simple classification rules are defined.

Densidade mamográfica em mulheres menopausadas assintomáticas: correlação com dados clínicos e exames ultrassonográficos / Mammographic density in asymptomatic menopausal women: correlation with clinical and sonographic findings

OBJETIVO: Avaliar a densidade mamográfica de mulheres menopausadas, assintomáticas, correlacionando com dados clínicos e ultrassonográficos. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, as mamografias e os dados clínicos e ultrassonográficos de 238 pacientes assintomáticas, no período entre fevereiro de 2002 e junho de 2006. As variáveis analisadas foram: padrões de densidade mamográfica, achados ultrassonográficos, idade, paridade, índice de massa corporal e uso de terapia de reposição hormonal. RESULTADOS: Idade, paridade e índice de massa corporal apresentaram relação inversa com os padrões de densidade mamográfica, enquanto o uso de terapia de reposição hormonal apresentou relação direta. Foram realizados exames ultrassonográficos complementares em 103 (43,2%) pacientes, sendo constatadas alterações em 34 (33%) delas. Os nódulos ultrassonográficos foram mais frequentes nas mulheres com padrões mamários 3 e 4 e sem expressão mamográfica. CONCLUSÃO: Concluímos que os padrões mamográficos de densidade foram influenciados pela idade, índice de massa corporal, paridade e tempo de uso de terapia de reposição hormonal. Apesar de não termos encontrado alterações malignas nos casos estudados, evidenciamos alterações ultrassonográficas benignas nas mulheres com padrões mamários de alta densidade e que apresentaram mamografias sem alterações, demonstrando a importância da ultrassonografia complementar para a detecção de lesões mamárias nessas pacientes.

OBJECTIVE: To evaluate mammographic breast density in asymptomatic menopausal women in correlation with clinical and sonographic findings. MATERIALS AND METHODS: Mammograms and clinical and sonographic findings of 238 asymptomatic patients were retrospectively reviewed in the period from February/2022 to June/2006. The following variables were analyzed: mammographic density patterns, sonographic findings, patients' age, parity, body mass index and use of hormone replacement therapy. RESULTS: Age, parity and body mass index showed a negative correlation with breast density pattern, while use of hormone replacement therapy showed a positive correlation. Supplementary breast ultrasonography was performed in 103 (43.2%) patients. Alterations which could not be visualized at mammography were found in 34 (33%) of them, most frequently in women with breast density patterns 3 and 4. CONCLUSION: The authors concluded that breast density patterns were influenced by age, parity, body mass index and time of hormone replacement therapy. Despite not having found any malignant abnormality in the studied cases, the authors have observed a predominance of benign sonographic abnormalities in women with high breast density patterns and without mammographic abnormalities, proving the relevance of supplementary ultrasonography to identify breast lesions in such patients.