Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations.

Objective: To present an update of the recommendations of the Brazilian College of Radiology and Diagnostic Imaging, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published between January 2012 and July 2022 was gathered from the following databases: Medline (PubMed); Excerpta Medica (Embase); Cochrane Library; Ebsco; Cumulative Index to Nursing and Allied Health Literature (Cinahl); and Latin-American and Caribbean Health Sciences Literature (Lilacs). Recommendations were based on that evidence and were arrived at by consensus of a joint committee of experts from the three entities.Recommendations: Annual mammographic screening is recommended for women between 40 and 74 years of age. For women at or above the age of 75, screening should be reserved for those with a life expectancy greater than seven years. Women at higher than average risk are considered by category: those with dense breasts; those with a personal history of atypical lobular hyperplasia, classical lobular carcinoma in situ, or atypical ductal hyperplasia; those previously treated for breast cancer; those having undergone thoracic radiotherapy before age 30; and those with a relevant genetic mutation or a strong family history. The benefits of complementary screening are also addressed according to the subcategories above. The use of tomosynthesis, which is an evolved form of mammography, should be considered in screening, whenever accessible and available.

Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline (PubMed), Excerpta Medica (Embase), Cochrane Library, Ebsco, Cinahl e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades.Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos, ou ainda portadoras de mutação genética ou com forte história familiar, se beneficiam do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível.

Amorphous breast calcifications: is BI-RADS 4a appropriate?

Objective: To evaluate the positive predictive value (PPV) of amorphous calcifications and to analyze the imaging variables that could alter the risk of malignancy associated with this finding. Materials and Methods: This was a retrospective study of 138 stereotactically guided percutaneous vacuum-assisted biopsies of amorphous calcifications, performed between January 2012 and December 2017. All of the patients included were referred for radiological follow-up for a minimum of one year (if the histopathology showed a benign lesion) or for surgical treatment (if the histopathology showed malignancy or a lesion of uncertain malignant potential). Results: We found that the PPV of amorphous calcifications was 9.42%. However, most of the malignant amorphous calcifications were in cases of invasive carcinoma or high-grade ductal carcinoma in situ, indicating clinically relevant disease. The relative risk of malignancy associated with amorphous calcifications was 6.15 times higher in patients with a family or personal history of breast or ovarian cancer. Neither being postmenopausal nor having dense breasts was found to be predictive of malignancy in patients with amorphous calcifications. Conclusion: Amorphous calcifications in the breast had a PPV for malignancy of 9.42%, indicating the possibility of placing the finding in subcategory 4a, which requires histopathological analysis. Our finding that the risk of malignancy associated with this subtype of calcifications is up to 6.15 times higher in patients with a family or personal history of breast cancer warrants greater concern regarding the clinical, radiologic, and histopathologic correlations after biopsy.

Objetivo: Avaliar o valor preditivo positivo (VPP) das calcificações amorfas e possíveis variáveis clínicas e de imagem que possam influenciar no risco de malignidade deste achado de imagem. Materiais e Métodos: Foram revisados, retrospectivamente, 138 resultados de biópsias percutâneas estereotáxicas a vácuo de calcificações amorfas, entre janeiro de 2012 e dezembro de 2017. Todas as pacientes incluídas apresentavam seguimento radiológico mínimo de um ano (histopatológico benigno) ou tratamento cirúrgico (histopatológico maligno). Resultados: O VPP das calcificações amorfas foi de 9,42%. As lesões malignas corresponderam predominantemente a carcinomas invasivos, indicando doença clinicamente relevante. O risco relativo de malignidade das calcificações amorfas foi 6,15 vezes maior em pacientes com história familiar ou pessoal de neoplasia de mama ou ovário. Status pós-menopausa e mamas densas não foram preditores de malignidade nessas pacientes. Conclusão: As calcificações amorfas na mama apresentaram VPP de malignidade de 9,42%, sugerindo possibilidade de classificação do achado na subcategoria 4a, com necessidade de investigação histopatológica. Em pacientes com história familiar ou pessoal de câncer de mama, o risco de malignidade deste subtipo de calcificações pode ser até 6,15 vezes maior, justificando maior preocupação na correlação clínica, radiológica e histopatológica após biópsia.

Apparent diffusion coefficient of normal adrenal glands.

OBJECTIVE: To assess the feasibility and reliability of apparent diffusion coefficient (ADC) measurements of normal adrenal glands. MATERIALS AND METHODS: This was a retrospective study involving 32 healthy subjects, divided into two groups: prepubertal (PreP, n = 12), aged from 2 months to 12.5 years (4 males; 8 females); and postpubertal (PostP, n = 20), aged from 11.9 to 61 years (5 males; 15 females). Diffusion-weighted magnetic resonance imaging (DW-MRI) sequences were acquired at a 1.5 T scanner using b values of 0, 20, 500, and 1000 s/mm2. Two radiologists evaluated the images. ADC values were measured pixel-by-pixel on DW-MRI scans, and automatic co-registration with the ADC map was obtained. RESULTS: Mean ADC values for the right adrenal glands were 1.44 × 10-3 mm2/s for the PreP group and 1.23 × 10-3 mm2/s for the PostP group, whereas they were 1.58 × 10-3 mm2/s and 1.32 × 10-3 mm2/s, respectively, for the left glands. ADC values were higher in the PreP group than in the PostP group (p < 0.05). Agreement between readers was almost perfect (intraclass correlation coefficient, 0.84-0.94; p < 0.05). CONCLUSION: Our results demonstrate the feasibility and reliability of performing DW-MRI measurements of normal adrenal glands. They could also support the feasibility of ADC measurements of small structures.

OBJETIVO: Avaliar se a medida do coeficiente de difusão aparente (CDA) das glândulas suprarrenais é factível e reprodutível. MATERIAIS E MÉTODOS: Neste estudo foram incluídos, retrospectivamente, 32 indivíduos saudáveis divididos em dois grupos: pré-púbere (PreP) (n = 12; 2 meses a 12,5 anos; 4 masculinos e 8 femininos) e pós-púbere (PostP) (n = 20; 11,9-61 anos; 5 masculinos e 15 femininos). Imagens de difusão por ressonância magnética (DWI) das glândulas suprarrenais foram realizadas em aparelho de 1,5 T utilizando-se b valores de 0, 20, 500 e 1000 s/mm2. As medidas do CDA das glândulas suprarrenais foram obtidas pixel-a-pixel por dois radiologistas após co-registro automático do mapa de CDA com DWI. RESULTADOS: A média dos valores do CDA da glândula suprarrenal direita foi 1,44 × 10-3 mm2/s no grupo PreP e 1,23 × 10-3 mm2/s no grupo PostP, e da glândula esquerda foi 1,58 × 10-3 mm2/s e 1,32 × 10-3 mm2/s, respectivamente. Os valores de CDA foram mais altos no grupo PreP comparados aos do PostP (p < 0,05). A concordância interobservador foi quase perfeita (coeficiente de correlação intraclasse: 0,84-0,94; p < 0,05). CONCLUSÃO: Estes resultados mostram que medir o CDA das glândulas suprarrenais é factível e reprodutível. Esta técnica poderia ser utilizada para medir o CDA de estruturas pequenas.

ABCG2 is a potential marker of tumor-initiating cells in breast cancer.

The existence of tumor-initiating cells (TICs) within solid tumors has been hypothesized to explain tumor heterogeneity and resistance to cancer therapy. In breast cancer, the expression of CD44 and CD24 and the activity of aldehyde dehydrogenase 1 (ALDH1) can be used to selectively isolate a cell population enriched in TICs. However, the ideal marker to identify TICs has not been established. The aim of this study was to evaluate the expression of novel potential markers for TIC in breast carcinoma. We prospectively analyzed the expression of CD44, CD24, ABCG2, and CXCR4, and the activity of ALDH1 by using flow cytometry in 48 invasive ductal carcinomas from locally advanced and metastatic breast cancer patients who were administered primary chemotherapy. A mammosphere assay was employed in 30 samples. The relationship among flow cytometric analyses, ABCG2 gene expression, and clinical and pathological responses to therapy was analyzed. The GSE32646 database was analyzed in silico to identify genes associated with tumors with low and high ABCG2 expression. We observed that the presence of ABCG2(+) cells within the primary tumor was the only marker to predict the formation of mammospheres in vitro (R (2) = 0.15, p = 0.029). Quantitative polymerase chain reaction (qPCR) revealed a positive correlation between ABCG2 expression and the presence of ABCG2(+) cells within the primary tumor. The expression of ABCG2 was predictive of the response to neoadjuvant chemotherapy in our experiments and in the GSE32646 dataset (p = 0.04 and p = 0.002, respectively). The in silico analysis demonstrated that ABCG2(Up) breast cancer samples have a slower cell cycle and a higher expression of membrane proteins but a greater potential for chromosomal instability, metastasis, immune evasion, and resistance to hypoxia. Such genetic characteristics are compatible with highly aggressive and resistant tumors. Our results support the hypothesis that the presence of ABCG2(+) cells in breast carcinomas is a marker of resistance to chemotherapy, and based on in vitro assays and the genetic profile, we show, for the first time, that ABCG2 protein can be used as an independent marker for TIC identification in breast cancer.