Valoración de las categorías BI-RADS ® de la densidad mamaria entre radiólogos y respecto a un método cuantitativo de medición / Evaluation of the BI-RADS® categories between readers and with regard to a quantitative method

Objetivo. Valorar la concordancia al clasificar las densidades mamarias empleando el sistema BI-RADS® y la variabilidad entre este método empleado por un lector experto en comparación con los valores obtenidos mediante un sistema de medición automática (Quantra®). Pacientes y métodos. Estudio descriptivo en 2 fases. Primero se evaluó la clasificación BI-RADS® de 5 lectores de una muestra seleccionada de forma aleatoria y estratificada por grupos (516 pacientes), para medir la variabilidad intraobservador e interobservador (índice kappa). Finalmente se analizó la concordancia entre el radiólogo con más experiencia y el software Quantra® que permite la valoración volumétrica de la densidad. Resultados. La concordancia por parejas varió entre débil a moderada (kappa 0,35-0,67), el grupo presentó un valor moderado de reproducibilidad (0,58), siendo mayor en las densidades extremas y en los grupos de edad límite. La variabilidad intraobservador fue de moderada a buena (0,52-0,79). Respecto a la clasificación de la densidad por categorías entre el lector experto y la aplicación, no se evidenció concordancia (kappa = 0,0737). Conclusiones. Los valores de concordancia obtenidos corroboran la evidencia descrita en la literatura, considerando que la lectura la realizaron radiólogos con experiencia y dedicación exclusiva en mama. No se apreció concordancia en la clasificación lector versus Quantra® (esta pondera las densidades en menor porcentaje respecto al análisis visual), y esto podría deberse al punto de corte por categoría (AU)

Objective. To assess agreement in breast density classification using the BI-RADS® system and the concordance between this measurement method compared with a dedicated software program (Quantra®). Patients and methods. A descriptive study was carried out in 2 phases. First, we analyzed the BI-RADS® breast density classification assessed by 5 readers in a sample of 516 patients randomly selected and stratified into groups. Intraobserver and interobserver reproducibility were calculated (kappa index). Second, we evaluated the agreement between the most experienced reader and a software package that calculates the volumetric fraction of fibroglandular tissue (Quantra®). Results. The agreement between pairs ranged from fair to moderate (kappa 0.35-0.67). The reading group showed moderate reproducibility (0.58) with the highest values in high breast densities and in the youngest and oldest patients. Intraobserver agreement ranged from moderate to substantial (0.52-0.79). In density classification, there was no evidence of agreement between the expert reader and the software application (kappa = 0.0737). Conclusions. The agreement values obtained corroborate the evidence described in the literature on reading performed by experienced radiologists working exclusively with mammograms. No agreement was found in reader classification versus Quantra® (which classifies densities with a lesser percentage than visual analysis), which could be due to the cut off by category (AU)

Primary squamous cell carcinoma of the breast: A rare case report.

BACKGROUND: Squamous cells are normally not found inside the breast. Therefore, a primary squamous cell carcinoma of the breast is an exceptional phenomenon and the management of this type of disease is still debated. AIM: Clinical outcome assessment of a patient with squamous cell carcinoma of the breast. MATERIALS AND METHODS: We report a case of primary squamous cell carcinoma of the breast (T1cN0M0) in a 51-years-old woman who underwent breast conserving surgery plus adjuvant chemotherapy and radiation therapy (RT). RESULTS: With a follow up of 43 months, the patient is alive with no evidence of local or distant recurrence. The patient had Grade 2 acute skin toxicity. No late skin or respiratory toxicity was observed. CONCLUSIONS: Pure primary squamous cell carcinoma of the breast is a rare and aggressive disease, often treatment-refractory. Our case shows that the addition of RT after breast conserving surgery, allows to achieve a high local control without adding severe toxicity. A multidisciplinary approach seems to be the optimal management for early stages in this rare disease.