Contrast-Enhanced Mammography (CEM) for Detecting Residual Disease after Neoadjuvant Chemotherapy: A Comparison with Breast Magnetic Resonance Imaging (MRI).

OBJECTIVE: To evaluate the performance of contrast-enhanced mammography (CEM) compared to magnetic resonance imaging (MRI) for estimating residual tumor size after neoadjuvant chemotherapy (NAC) in women with newly diagnosed breast cancer. METHODS: The institutional review board approved this study. This prospective study included women with newly diagnosed breast cancer who underwent breast CEM and MRI at the end of the last cycle of NAC and before definitive surgery. Size of residual malignancy on post-NAC CEM and MRI was compared with surgical pathology. Agreements and correlations of CEM and MRI measurements with histological size were assessed. RESULTS: Thirty-three patients were included with a mean age of 45 years (range 22-76). The sensitivity, specificity, and positive and negative predictive value for detection of residual disease of CEM were 76%, 87.5%, 95%, and 86.4%, and those of MRI were 92%, 75%, 92%, and 75%. Comparing CEM to MRI, the mean difference was -0.8 cm, concordance coefficient was 0.7, and Pearson correlation was 0.7 (p = 0.0003). The concordance coefficient between measurements of each imaging modality and pathologic tumor size was 0.7 for CEM and 0.4 for MRI. Pearson correlation was 0.8 for CEM and 0.5 for MRI. Mean differences between CEM, MRI, and residual histopathological tumor size were 0.8 cm and 1.8 cm, respectively. CONCLUSIONS: CEM has good correlation and agreement with histopathology for measuring residual disease after NAC. CEM was comparable to MRI, showing high positive predictive value and specificity for detecting residual disease.

Novos métodos funcionais na avaliação de lesões mamárias / Novel functional methods in the evaluation of breast lesions

O câncer de mama é um dos mais prevalentes nas mulheres. A mamografia é um excelente método com impacto comprovado na redução da mortalidade pelo câncer de mama. Porém, não é um método perfeito, apresentando alguns pontos fracos, principalmente no rastreamento de mulheres com mamas densas, estadiamento e avaliação de tratamento. A ressonância magnética mamária mostrou a necessidade e importância da avaliação funcional mamária. Descrevemos dois métodos de avaliação funcional mamária e demonstramos nossa experiência com a mamografia digital com contraste e com a imagem molecular mamária realizada em gama-câmara específica. Estes dois métodos já estão disponíveis em nosso meio e apresentam resultados promissores na detecção de lesões mamográficas ocultas, confirmação de lesões suspeitas e redução de biópsias desnecessárias, podendo assim melhorar o estudo mamário, principalmente nos pontos falhos da mamografia.

Breast cancer is one of the most prevalent cancers in women. Mammography is an excellent method with proven impact on breast cancer mortality reduction. Nevertheless, mammography is not a perfect method, with some weaknesses, especially in screening women with dense breasts, preoperative staging and treatment evaluation. Breast magnetic resonance imaging has shown the necessity and relevance of functional evaluation of breast lesions. The authors describe two methods of functional evaluation of breasts and describe their own experience with contrast-enhanced digital mammography and with breast-specific gamma imaging. Both methods are already available in our country and have shown promising results in the detection of mammographically occult lesions, confirmation of suspicious lesions and in the reduction of unnecessary biopsies and may supplement the weaknesses of mammography, particularly in the investigation of dense breasts.

Visualizadores de imagens médicas gratuitos: é possível trabalhar apenas com eles? / Freeware medical image viewers: can we rely only on them?

OBJETIVO: Pesquisar visualizadores de imagens médicas gratuitos disponíveis na internet capazes de funcionar como cliente PACS (picture archiving and communication system) e avaliar suas principais funções e a viabilidade do uso em computadores pessoais. MATERIAIS E MÉTODOS: Foi feita pesquisa, no Google e em sites especializados, por programas gratuitos disponíveis para o Windows. Foram encontrados cerca de 70, sendo 11 capazes de funcionar como cliente PACS, e selecionados seis destes para análise: ClearCanvas Workstation, KPACS, Onis, Synedra View Personal, Mito e Tudor DicomViewer. Com base nas necessidades dos autores, 16 funções foram avaliadas. RESULTADOS: Dos seis programas avaliados, dois possuem 10 das 16 funções avaliadas e um possui apenas duas. Três realizam MPR (reconstrução multiplanar), um realiza MIP (reconstrução por projeção de intensidade máxima), dois realizam VR (renderizações volumétricas), dois funcionam como servidor PACS, dois geram CDs, um realiza fusão de imagens, três permitem utilizar múltiplos monitores e apenas um não é compatível com Windows 7. CONCLUSÃO: Diversos programas gratuitos estão disponíveis e não existe nenhum completo. Cabe ao usuário analisar e selecionar o programa que melhor se enquadra nas suas necessidades, porém, os programas Onis, Synedra e ClearCanvas se destacam, cada um com suas peculiaridades. É totalmente viável o uso de programas gratuitos para o dia-a-dia do radiologista.

OBJECTIVE: To search in the internet for freeware medical image viewers capable of running as a PACS (picture archiving and communication system) client, and to evaluate their main functions as well as the feasibility of their use in personal computers. MATERIALS AND METHODS: The Google search engine and specialized sites were utilized in the search for freeware softwares for Windows. The authors have found about 70 and among them 11 were able to run as PACS clients. Six were selected for analysis: ClearCanvas Workstation, KPACS, Onis, Synedra View Personal, Mito and Tudor DicomViewer. Sixteen functions selected according to the authors' needs were evaluated. RESULTS: Among the six applications, two presented 10 of the 16 functions, and one of them presented only two. Three perform MPR (multiplanar reconstruction), one performs MIP (maximum intensity projection), two perform VR (volume rendering), two can run as a PACS server, two can create CDs, one performs images fusion, three allow the use of multiple monitors and only one is not compatible with Windows 7. CONCLUSION: Although several freeware applications are available, no one of them is complete. It is up to the users to analyze and select the software that best suits their needs. However, Onis, Synedra and ClearCanvas stand out because of their own peculiarities. The use of freeware image viewers is entirely feasible in the radiologists' daily routine.