Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
1.
Br J Surg ; 107(12): 1615-1624, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32492194

RESUMO

BACKGROUND: The aim of this study was to determine preoperative factors and tumour characteristics related to a high nodal tumour burden in patients with clinically node-positive breast cancer. These findings were used to construct a predictive tool to evaluate the patient-specific risk of having more than two axillary lymph node metastases. METHODS: Altogether, 507 consecutive patients with breast cancer and axillary lymph node metastasis diagnosed by preoperative ultrasound-guided needle biopsy were reviewed. These patients underwent breast surgery and axillary lymph node dissection at Helsinki University Hospital between 2010 and 2014. Patients were grouped into those with one or two, and those with more than two lymph node metastases. RESULTS: There were 153 patients (30·2 per cent) with one or two lymph node metastases and 354 (69·8 per cent) with more than two metastases. Five-year disease-free survival was poorer for the latter group (P = 0·032). Five-year overall survival estimates for patients with one or two and those with more than two lymph node metastases were 87·0 and 81·4 per cent respectively (P = 0·215). In multivariable analysis, factors significantly associated with more than two lymph node metastases were: age, tumour size, lymphovascular invasion in the primary tumour, extracapsular extension of metastasis in lymph nodes, and morphology of lymph nodes. These factors were included in a multivariable predictive model, which had an area under the curve of 0·828 (95 per cent c.i. 0·787 to 0·869). CONCLUSION: The present study provides a patient-specific prediction model for evaluating nodal tumour burden in patients with clinically node-positive breast cancer.


Assuntos
Neoplasias da Mama/patologia , Metástase Linfática/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Biópsia por Agulha , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática/diagnóstico , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
2.
Eur J Surg Oncol ; 43(8): 1385-1392, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28625797

RESUMO

Breast lymphomas comprise a rare group of malignant breast tumors. Among these, a new entity has emerged as a potentially under-diagnosed disease. Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) most often manifests as a late periprosthetic effusion between 1 and 10 years after the implantation of silicone or saline-filled breast prostheses. BI-ALCL is an anaplastic lymphoma kinase-negative T-cell lymphoma that has a distinctively different clinical course than other breast lymphomas or ALCLs. Diagnosis is based on aspiration of the effusion around the implant and CD30 positivity of the sample. Every periprosthetic effusion after breast augmentation or reconstruction using implants should be considered as potential BI-ALCL until proven otherwise. The majority of cases at diagnosis are in the in situ stage, i.e., confined to the lumen around the prosthesis. Most patients have an excellent prognosis when complete removal of the capsule and prosthesis with negative margins is achieved surgically. Some patients, however, develop infiltrative disease with a potentially life-threatening clinical course. Treatment planning regarding the extent of surgery and role of adjuvant therapy, especially in advanced cases, requires further investigation.


Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etiologia , Neoplasias da Mama/terapia , Carcinoma in Situ/diagnóstico , Carcinoma in Situ/etiologia , Carcinoma in Situ/terapia , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/terapia , Neoplasias da Mama/patologia , Carcinoma in Situ/patologia , Terapia Combinada , Remoção de Dispositivo , Progressão da Doença , Feminino , Humanos , Linfoma Anaplásico de Células Grandes/patologia , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida
3.
Scand J Surg ; 103(3): 209-214, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24623806

RESUMO

BACKGROUND AND AIMS: Reduction mammaplasty is a popular procedure in plastic surgery. Occasionally, occult invasive breast carcinoma or findings demonstrating increased risk of breast cancer occur in reduction mammaplasty specimens. The incidences have been studied elsewhere, but in Finland, the data on this subject are lacking. Our aim was to analyze the incidence of occult invasive and in situ carcinoma and benign breast disease causing increased risk of breast cancer in reduction mammaplasty specimens. We also analyzed preoperative mammograms and ultrasound images and compared findings with reduction mammaplasty specimens. MATERIAL AND METHODS: We performed a retrospective study of 100 women who underwent reduction mammaplasty during 1 January 2007 to 30 April 2009 in Jorvi Hospital day-surgery unit. Demographic data, findings in preoperative imaging, pathology reports, postoperative follow-up, and retrospective reanalysis of preoperative imaging were recorded. RESULTS: Histological abnormality occurred in 14.6% of the patients. In situ carcinoma was diagnosed in 4.5% of the patients, and findings demonstrating increased risk of breast cancer were diagnosed in 13.5% of the patients. More than one lesion demonstrating increased risk of breast cancer was diagnosed in 4.5% of the patients. No invasive carcinoma occurred. Preoperative mammogram was performed for the majority (94.0%) of the patients. CONCLUSIONS: We detected a considerable amount of findings in reduction mammaplasty specimens with prognostic value with regard to future breast cancer risk. We recommend histological analysis for reduction mammaplasty specimens and focus attention on systematically performed preoperative imaging.

4.
Acta Radiol ; 47(7): 655-9, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16950700

RESUMO

PURPOSE: To evaluate the impact of the number of readers on sensitivity and specificity, and compare it with conference consensus reading. MATERIAL AND METHODS: Eight readers read mammography films of 200 women (including 35 false-negative and 16 screen-detected cancers). The sensitivities and specificities of the two methods were calculated: either at least a single cancer-positive opinion within the group (summarized independent reading) or the cancer-positive opinion of the reader majority (conference consensus reading) was considered decisive. RESULTS: The mean sensitivity for summarized independent readings of different groups was 64.7% as compared to the 43.1% mean sensitivity of conference consensus readings. The mean specificities were 92.4% and 97.7%, respectively. The greatest sensitivity of 74.5% was achieved when the readings of the four best-performing readers were combined. CONCLUSION: The sensitivity of reading is maximal when any positive opinion within a pair or a group of readers is taken into consideration. Discordant double reading may best be judged as screening positive, and the value of a third opinion should be questioned.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mamografia/métodos , Programas de Rastreamento/normas , Competência Clínica , Feminino , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
5.
Acta Radiol ; 47(3): 257-63, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16613306

RESUMO

PURPOSE: To evaluate the effect of computer-aided detection (CAD) on the reader's performance. MATERIAL AND METHODS: Four screening radiologists, two novice radiologists, and two residents with no prior experience in CAD read films of 200 women without and with CAD. The films, including 16 screen-detected cancers and 35 cancers "missed" on prior screening, were divided into two rollers: A (free time schedule) and B (prompted time schedule). Reading times were noted. Individual readings without and with CAD were compared, sensitivities and specificities were calculated. RESULTS: The sensitivity of CAD was 70.6% and specificity 15.8%. In 408 cancer readings, the screeners found 10 and other readers 7 new cancers with the aid of CAD. The screeners changed their opinion four times and others six times from true positive to false negative when CAD was negative. CAD output produced 12 versus 13 new false-positive findings respectively after 2352 readings. CAD did not significantly affect the reader's sensitivities/specificities regardless of the time limit (P = not significant). The use of CAD increased mean time for roller reading from 56 to 63 min (P = 0.053). CONCLUSION: Screening radiologists benefited slightly more from CAD than other readers did, but no statistical significant difference was found in personal readings without and with CAD.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma in Situ/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Competência Clínica , Mamografia/métodos , Interpretação de Imagem Radiográfica Assistida por Computador , Feminino , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Sensibilidade e Especificidade
6.
Acta Radiol ; 46(2): 135-9, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15902887

RESUMO

PURPOSE: To evaluate whether breast cancers detected at screening are visible in previous mammograms, and to assess the performance of a computer-aided detection (CAD) system in detecting lesions in preoperative and previous mammograms. MATERIAL AND METHODS: Initial screening detected 67 women with 69 surgically verified breast cancers (Group A). An experienced screening radiologist retrospectively analyzed previous mammograms for visible lesions (Group B), noting in particular their size and morphology. Preoperative and previous mammograms were analyzed with CAD; a relatively inexperienced resident also analyzed previous mammograms. The performances of CAD and resident were then compared. RESULTS: Of the 69 lesions identified, 36 were visible in previous mammograms. Of these 36 "missed" lesions, 14 were under 10 mm in diameter and 29 were mass lesions. The sensitivity of CAD was 81% in Group A and 64% in Group B. Small mass lesions were harder for CAD to detect. The specificity of CAD was 3% in Group A and 9% in Group B. Together, CAD and the resident found more "missed" lesions than separately. CONCLUSION: Of the 69 breast cancers, 36 were visible in previous mammograms. CAD's sensitivity in detecting cancer lesions ranged from 64% to 81%, while specificity ranged from 9% to as low as 3%. CAD may be helpful if the radiologist is less subspecialized in mammography.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Competência Clínica , Diagnóstico Precoce , Reações Falso-Negativas , Feminino , Humanos , Mamografia , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Am J Obstet Gynecol ; 128(5): 526-30, 1977 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-879212

RESUMO

A computer method for quantification of fetal heart rate (FHR) variability from fetal magnetocardiography during pregnancy and from direct fetal electrocardiography during labor is presented. It is based on statistical analysis of the QRS interval sequences. Beat-to-beat variation is characterized by a differential index (DI) and long-term variation by an interval index (II). The effect of the sample time on the DI is minimal, and hence the DI can be calculated from rather short samples. The II is more sensitive to FHR trends and should be calculated from longer samples, but between the periodic changes, accelerations, and decelerations. Variable amounts of detection pulses are lost in both methods. The DI is sensitive to the missing intervals; no analysis result should be accepted if the number of lost intervals exceeds 10 per cent. The II is less sensitive to the number of missing intervals. The means and standard deviations of the variability indices for eight fetuses during pregnancy and for five fetuses during labor are presented.


Assuntos
Eletrocardiografia , Coração Fetal/fisiologia , Frequência Cardíaca , Magnetismo , Computadores , Feminino , Humanos , Gravidez
9.
Am J Obstet Gynecol ; 125(8): 1115-20, 1976 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-952308

RESUMO

Fetal magnetocardiography (FMCG) is a new complementary external method for accurate antepartal FHR recording. Because of the low magnetic noise level required it is not yet suitable for routine hospital use. Fifty-six simultaneous FMCG and external FECG measurements were made in order to compare these methods for instantaneous FHR recording. The error of the FHR value obtained with the instrumentation described is less than 1 per cent. Our results show that FMCG can be used for FHR processing from week 30 of gestation until term. Thirty-five of the measurements were done during this period. From these, a readable FHR curve was obtained in 21 cases with FMCG and in 12 cases with external FECG. The maternal complexes were always present in the FECG, but in only 15 of the recorded FMCG's.


Assuntos
Fenômenos Eletromagnéticos , Coração Fetal/fisiologia , Frequência Cardíaca , Monitorização Fisiológica , Eletrocardiografia/instrumentação , Fenômenos Eletromagnéticos/instrumentação , Feminino , Humanos , Monitorização Fisiológica/instrumentação , Gravidez
10.
Ann Chir Gynaecol Fenn ; 64(3): 152-4, 1975.
Artigo em Inglês | MEDLINE | ID: mdl-1217840

RESUMO

A new method is presented for detection of the QRS complexes and the fetal heart rate from the fetal magnetocardiogram and from the fetal electrocardiogram. In the method, the amplitude, the polarity and the shape of the QRS complex are tested. By using the described equipment it is possible to detect all consecutive heart beat intervals from a fetal electrocardiogram with less than 1% error in timing. When an external fetal electrocardiogram was used for testing, generally slightly over 10% of the QRS complexes were lost since they were simultaneous with the maternal complexes. In addition, complexes were also lost due to noise.


Assuntos
Eletrocardiografia/métodos , Coração Fetal/fisiologia , Fenômenos Eletromagnéticos , Frequência Cardíaca , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...