El rendimiento de la RM en la estadificación preoperatoria del carcinoma de mama sería independiente de factores clínicos y patológicos: análisis de subgrupos / Is the performance of MRI in preoperative staging of breast cancer independent of clinical and histological factors? A subgroup analysis

Objetivo: Determinar si la densidad mamaria, la edad, el estado menopáusico y el carcinoma in situ en la biopsia constituyen grupos de pacientes en quienes la RM mamaria preoperatoria es más rentable. Material y métodos: Estudiamos retrospectivamente a 264 pacientes intervenidas por cáncer de mama a las que se había realizado mamografía, ecografía y RM. Comparamos el tamaño tumoral medido con las 3 técnicas y su sensibilidad para detectar lesiones adicionales, tanto en todas los pacientes como en las clasificadas por densidad mamaria, edad, estado menopáusico o presencia de carcinoma intraductal en el estudio anatomopatológico. El estándar de referencia fue el diagnóstico anatomopatológico definitivo. Resultados: La RM fue la técnica que coincidió más con el tamaño anatomopatológico y mejor detectó las lesiones adicionales. Con la RM no observamos diferencias entre grupos al establecer el tamaño tanto en el total de la muestra como en el subgrupo de pacientes donde la RM tuvo valor añadido. Tampoco hubo diferencias para detectar lesiones adicionales en el grupo general excepto para lesiones multicéntricas, mayor en pacientes de más edad (p = 0,02). En el grupo de pacientes donde la RM tuvo valor añadido, la sensibilidad para las lesiones bilaterales fue superior en las pacientes con mamas grasas (p = 0,04). Las lesiones multifocales se detectaron significativamente mejor en pacientes premenopáusicas (p = 0,03). Conclusiones: La RM es mejor que la mamografía y la ecografía para establecer el tamaño tumoral y detectar lesiones adicionales. Nuestros resultados no identifican subgrupos donde la técnica sea más rentable (AU)

Objective: To determine whether preoperative breast MRI is more useful in patients according to their breast density, age, menopausal status, and biopsy findings of carcinoma in situ. Material and methods: We retrospectively studied 264 patients treated for breast cancer who had undergone mammography, ultrasonography, and MRI. We compared the size of the tumor on the three techniques and the sensitivity of the techniques for detecting additional lesions both in the overall group and in subgroups of patients classified according to their breast density, age, menopausal status, and histological findings of intraductal carcinoma. The definitive histological diagnosis was used as the gold standard. Results: MRI was the technique that was most concordant with the histological findings for the size of the lesion, and it was also the technique that detected the most additional lesions. With MRI, we observed no differences in lesion size between the overall group and the subgroups in which MRI provided added value. Likewise, we observed no differences in the number of additional lesions detected in the overall group except for multicentric lesions, which was larger in older patients (P=.02). In the subgroup of patients in which MRI provided added value, the sensitivity for bilateral lesions was higher in patients with fatty breasts (P=.04). Multifocal lesions were detected significantly better in premenopausal patients (P=.03). Conclusions: MRI is better than mammography and better than ultrasonography for establishing the size of the tumor and for detecting additional lesions. Our results did not identify any subgroups in which the technique was more useful (AU)

Is the performance of MRI in preoperative staging of breast cancer independent of clinical and histological factors? A subgroup analysis.

OBJECTIVE: To determine whether preoperative breast MRI is more useful in patients according to their breast density, age, menopausal status, and biopsy findings of carcinoma in situ. MATERIAL AND METHODS: We retrospectively studied 264 patients treated for breast cancer who had undergone mammography, ultrasonography, and MRI. We compared the size of the tumor on the three techniques and the sensitivity of the techniques for detecting additional lesions both in the overall group and in subgroups of patients classified according to their breast density, age, menopausal status, and histological findings of intraductal carcinoma. The definitive histological diagnosis was used as the gold standard. RESULTS: MRI was the technique that was most concordant with the histological findings for the size of the lesion, and it was also the technique that detected the most additional lesions. With MRI, we observed no differences in lesion size between the overall group and the subgroups in which MRI provided added value. Likewise, we observed no differences in the number of additional lesions detected in the overall group except for multicentric lesions, which was larger in older patients (P=.02). In the subgroup of patients in which MRI provided added value, the sensitivity for bilateral lesions was higher in patients with fatty breasts (P=.04). Multifocal lesions were detected significantly better in premenopausal patients (P=.03). CONCLUSIONS: MRI is better than mammography and better than ultrasonography for establishing the size of the tumor and for detecting additional lesions. Our results did not identify any subgroups in which the technique was more useful.

El hipotiroidismo primario autoinmune: causa de tos crónica en pediatría / Primary autoimmune hypothyroidism, a cause of chronic cough in pediatrics

La tos crónica (la que persiste más de 4 semanas) es un motivo de consulta frecuente en atención primaria. La evaluación de un niño con tos crónica debe incluir una historia clínica detallada, una radiografía de tórax y una espirometría en el niño colaborador; además se suele recomendar un estudio de alergia en los niños mayores de 3-4 años. Presentamos el caso de una niña de 10 años de edad con tos crónica, y describimos el proceso diagnóstico desarrollado, así como la presencia de bocio hipotiroideo autoinmune, que relacionamos con sus síntomas y la evolución posterior. El bocio puede ser causa de tos crónica. En los pacientes con tos crónica, además de realizar una historia general y dirigida, las exploraciones complementarias según los datos obtenidos y un seguimiento clínico, se recomienda valorar la vía respiratoria superior y el cuello(AU)

Chronic cough (a cough lasting longer than 4 weeks) is a common symptom presented to primary care. The evaluation of a child with chronic cough should include a detailed medical history, physical examination, chest radiograph, spirometry (if the child is able), and allergy evaluation-skin test- is often recommended (elder than 3-4 years old). We describe evaluation, diagnosis, treatment, and evolution in a 10 years old girl with chronic cough and the relationship between goiter, autoimmune hypothyroidism and her symptoms. A goiter can cause chronic cough. In patients with chronic cough, besides detailed medical history, physical examination, further investigation in accordance with the previous results and follow-up, it is recommended not to forget to evaluate the upper airway and neck(AU)