"Are changes in breast density during the menstrual cycle relevant? To what?"

PURPOSE: Cancers can be hidden by high breast density (BDen)- the masking effect (ME). BDen is also a modifiable and highly prevalent breast cancer risk (BCR) factor. The purposes of this study were to determine how much glandular volume (GVol), breast volume (BVol) and their ratio: BDen change during the menstrual cycle, and if these changes could affect ME or be relevant to results of interventional studies aiming to diminish BCR using these parameters as surrogates. METHODS: We retrieved GVol, BVol and BDen data values obtained from 39,997 right mammograms performed with photon counting technique of 19,904 premenopausal women who reported their first day of last menses (FDLM). Many women had more than one study included over the years (with a different FDLM) but were not studied longitudinally. We segregated women by age (yearly), divided the menstrual cycle in 4 weeks, and assigned results with respect to the FDLM. RESULTS: All parameters vary cyclically, with higher values in week 4 (GVol and BDen) or week 1 (BVol). Mean inter-week differences were very small for the three parameters, and diminished with age. However, especially in the youngest women, inter-week differences could be more than 10% for BDen, 15% for GVol, and 50% for BVol. CONCLUSION: Small inter-week mean differences almost certainly rule out relevant changes to ME directly attributable to BDen. However, the possibility of large differences during the menstrual cycle in younger women, who are the ideal targets of interventional studies to diminish BCR, might distort results and should be accounted for.

Breast density measured volumetrically in a clinical environment: cross-sectional study with photon counting technology.

OBJECTIVE: Mammographic breast density (BDen), the ratio of glandular volume (GVol) to breast volume (BVol), is the second most prevalent risk factor for breast cancer (BC). Newly developed photon counting technology allows precise and systematic measurements in clinical practice. Our objective is to see how these parameters change with age in women with and without cancer. MATERIALS AND METHODS: This retrospective study analyzed results of BDen, GVol, and BVol in 64,182 mammograms performed with photon counting technology on 32,448 consecutive women from April 2014 to December 2015. Only their first study was included. We excluded women with incomplete data or with breast implants. RESULTS: Mean age of women without BC diagnosed during the study period was 52.1 ± 9.9. BC and was found in 263 women (0.81%). Mean age was 53.0 ± 10.4. BDen, GVol, and BVol were 14%, 24%, and 2% greater in women with BC (P < 0.001 for BDen and GVol and P = 0.02 for BVol). BDen and GVol diminished following similar patterns across age in both groups, with soft slopes before and after a steep drop from 50 to 60, probably due to menopause. CONCLUSION: BDen diminishes with age in women with or without BC, but it is generally higher in women with BC. GVol could be a more robust indicator associated with BC risk than BDen. This technology can ease the way to studies of interventions to diminish BDen (or GVol) in the hope of diminishing BC incidence or predict if longitudinal changes are indicative of impending cancer.

Biopsia de microcalcificaciones de mama bajo guía estereotáxica. Factores que influyen en los resultados / Stereotactically-guided biopsy of breast microcalcifications. Factors influencing the results

Objetivo. Valorar la eficacia diagnóstica de la biopsia de microcalcificaciones bajo guía estereotáxica con dispositivo de vacío, relacionándose con la presencia o no de microcalcificaciones en los cilindros, el tamaño de la lesión y el número de cilindros extraídos. Material y métodos. Se revisaron retrospectivamente 173 biopsias en mesa prona guiadas por estereotaxia con aguja de vacío 9 G, de enero de 2008 a julio de 2012, con correlación histológica de las cirugías o seguimiento con mamografía. Se calcularon los falsos negativos, las infravaloraciones y la sensibilidad. Los resultados se relacionaron con el número de cilindros obtenidos, la presencia de microcalcificaciones y el tamaño de la lesión. Resultados. Se realizaron 173 biopsias en 169 pacientes, excluyéndose 7 biopsias por carecer de seguimiento o de diagnóstico histológico definitivo; finalmente se evaluaron 166 biopsias. Se intervinieron 104 casos (40 benignas, una de alto riesgo, 63 malignas) y se hizo seguimiento mamográfico en 62. En 140 casos (84,3%) se obtuvieron microcalcificaciones, en 14 (8,4%) estaban ausentes y en 12 (7,2%) se hallaron en escaso número (< 3). Hubo 7 falsos negativos (8,6%), en 5 de los cuales no se obtuvieron microcalcificaciones, con un diámetro de las lesiones de 5-13 mm, extrayéndose entre 7-24 cilindros, y 13 infravaloraciones (7,8%), con un diámetro de 5-25 mm, obteniéndose 7-20 cilindros. La sensibilidad del método fue de un 91,4%. La presencia o ausencia de microcalcificaciones y el número de cilindros fueron estadísticamente significativos en relación con los falsos negativos. Conclusión. En la biopsia de microcalcificaciones bajo guía estereotáxica con aguja de vacío es esencial obtener microcalcificaciones en los cilindros. Su ausencia aumenta la tasa de falsos negativos de forma significativa (AU)

Objective. To assess the diagnostic accuracy of vacuum-assisted stereotactically-guided biopsy of breast microcalcifications related to the presence and number of microcalcifications in the specimens, lesion size, and the number of specimens obtained. Material and methods. We retrospectively reviewed the results of 173 biopsies of microcalcifications obtained from January 2008 to July 2012 under stereotactic guidance with a vacuum-assisted biopsy system with a 9-gauge probe. We correlated the results with surgery or long-term mammographic follow-up. The false negative rate, underestimation rate and sensitivity were calculated. We correlated these findings with the number of specimens obtained, the presence of microcalcifications and lesion size. Results. There were 173 biopsies of microcalcifications in 169 patients. Seven biopsies were excluded due to the lack of long-term follow-up or final histologic diagnosis. A total of 104 patients underwent surgery (the results showed benign lesions in 40 patients, a high-risk lesion in one patient and malignancy in 63 patients). Microcalcifications were obtained in 140 specimens (84.3%), were absent in 14 (8.4%) and were scarce (< 3) in 12 specimens (7.2%). There were 7 false negative results (8.6%), of which 5 biopsy specimens showed no microcalcifications. The average lesion diameter was 5-13 mm and 7-24 specimens were obtained. In 13 there was underestimation (7.8%), lesion diameter was 5-25 mm and 7-20 specimens were retrieved. Sensitivity was 91.4%. The presence of microcalcifications in the specimens and their number were statistically significant factors influencing the results. Conclusion. An adequate number of microcalcifications in the specimens from stereotactic vacumm-assisted biopsy is paramount. The absence of microcalcifications will significantly increase the rate of false negatives (AU)

Role of elastography in the assessment of breast lesions: preliminary results.

OBJECTIVES: The purposes of this study were to evaluate the diagnostic utility of elastography in differentiating benign from malignant breast lesions and compare it with conventional sonography. METHODS: A total of 124 breast lesions (59 malignant and 65 benign) were examined with B-mode sonography and subsequently with elastography. Conventional sonographic findings were classified according to the American College of Radiology Breast Imaging Reporting and Data System for sonography, and elastographic images were assigned an elasticity score of 1 to 5 (1-3, benign; 4 and 5, malignant) according to the Ueno classification. Cytologic diagnoses obtained from fine-needle aspiration and histopathologic results from a core-needle biopsy or surgical biopsy were used as reference standards. Statistical analysis included sensitivity, specificity, and positive and negative predictive values for both elastography and conventional sonography. RESULTS: B-mode sonography had sensitivity of 96.6% (95% confidence interval, 93.3%-99.9%), specificity of 76.9% (69.2%-84.6%), a positive predictive value of 79.2% (72.1%-86.2%), and a negative predictive value of 96.2% (92.4%-99.9%), compared with sensitivity of 69.5% (60.5%-78.5%), specificity of 83.1% (76.3%-89.8%), a positive predictive value of 78.9% (70.6%-87.1%), and a negative predictive value of 75.0% (67.4%-82.6%) for elastography. Elastography showed less sensitivity but higher specificity than conventional sonography. CONCLUSIONS: Our results show that elastography may be useful as a complementary technique in addition to conventional sonography in the characterization of breast lesions because it increases the diagnostic specificity, thus reducing the false-positive rate.

Asociación de polimorfismos de la región promotora del gen de la interleucina 10 con la urticaria papular por picadura de pulga / Association of Interleukin 10 (IL-10) gene promoter region polymorphisms with flea bite papular urticaria

Objetivos. Establecer si los polimorfismos en la región promotora del gen de la IL-10 localizados en las posiciones -819 y -592 están asociados con la urticaria papular causada por la picadura de pulga, en pacientes pediátricos que asistieron a consulta de alergia o de dermatología a la Fundación Santa Fe de Bogotá, Colombia. Métodos. La frecuencia de estos dos polimorfismos en el ADN fue analizada en 25 niños con urticaria papular y 22 controles por medio de PCR (Polymerase Chain Reaction) y RFLP (Restriction Fragment Length Polymorphisms). Resultados. No hubo diferencias significativas entre las frecuencias alélicas y genotípicas de cada polimorfismo individual o SNP (-819 o -592) entre pacientes y controles (p=0,21, OR=1,87, IC95% 0,79-4,40) cuando fueron calculados por la prueba exacta de Fisher. Conclusiones. Aunque en este trabajo preliminar no se encontró asociación de los polimorfismos reportados en otras poblaciones con la enfermedad alérgica, hay una tendencia en nuestros experimentos a encontrar un mayor número de haplotipos AT en pacientes que en controles Los resultados publicados por nuestro grupo de investigación, en cuanto a que la secreción de IL-10 in vitro se encuentra disminuida en pacientes con urticaria papular y no en controles sanos, indicar ían que la expresión genética de esta citocina estaría alterada en pacientes y, por consiguiente, esta condición estaría exacerbando la enfermedad. Los niveles disminuidos de esta citocina reguladora permitirían el desarrollo de condiciones hiperinmunes, como la alergia y la autoinmunidad...

Objectives: In this study we aimed to establish whether IL-10 promoter region genetic polymorphisms in positions -819 and -592 were associated with papular urticaria caused by flea bite in pediatric patients from the Fundación Santa Fe de Bogotá, Colombia.Methods: The frequency of these DNA polymorphisms was analyzed in 25 infants suffering papular urticaria and 22 healthy controls, after amplification of their corresponding DNA through polymerase chain reaction (PCR) and further analysis of resulting restriction fragment length polymorphisms (RFLP). Results: We found no significant differences in allelic and genotypic frequencies of either -819 or -592 SNPs between patients and healthy controls (p=0.21, OR=1.87, 95% IC=0.79-4.40). Conclusions: Although we did not find in this preliminary study a genetic association between papular urticaria and previously reported allergyassociated SNPs such as -819 and -592, we found higher numbers of allergy-associated AT haplotypes in patients than in controls. Previously published results from our group showed in vitro a diminished IL-10 secretion in patients and not in healthy controls. This finding, together with our present results, would indicate that the genetic expression of this cytokine could be altered in patients and that this condition could determine the exacerbation of papular urticaria. Low levels of this cytokine would allow for the development of hyperimmune conditions such as allergy and autoimmunity...

Ultrasonido en patología tiroidea: revisión de una serie / Ultrasound in thyroid pathology: review of an serie

Se estudiaron 30 pacientes en la Unidad de Tomografía y Ultrasonido del Centro Médico de Caracas, desde el 1§ de Marzo hasta el 1§ de Diciembre de 1988, los cuales fueron referidos con la clínica del nódulo tiroideo palpable por especialistas en Medicina Interna, Endocrinología, Cirugía General y Oncología. Se analizan los datos relativos a la edad, sexo, Gammagrama tiroideo y hallazgos sonográficos e los ultrasonidos tiroideos de acuerdo a protocolo pre-establecido. En nuestra serie de 30 pacientes, 20 casos correspondieron a Bocio Tiroideo (66,6%), 5 casos (16,6%) a Tiroiditis, 1 caso de Adenoma Folicular (3,3%), 1 caso a Quiste Simple Tiroideo (3,3%). A través del presente trabajo realizado en forma prospectiva se destaca el valor diagnóstico del ultrasonido en la evaluación imagenológica de la glándula tiroides, se estudia su frecuencia en ambos sexos, se compara su efectividad con respecto al Gammagrama tiroideo, se hacen conclusiones y se constatan las indicaciones de este método diagnóstico en la actualidad en los casos de patología tiroidea