Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC).

OBJECTIVE: To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). METHODS: We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. RESULTS: We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). CONCLUSION: We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. KEY POINTS: • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.

Himen imperforado / Imperforate hymen

El himen imperforado es una anomalía obstructiva del tracto genital inferior femenino que se da en menos del 0,1% de los recién nacidos. El hecho de no realizar una exploración ginecológica a adolescentes sintomáticas por pudor conlleva frecuentemente al retraso diagnóstico. Presentamos a una paciente adolescente sin menarquia remitida a urgencias para estudio de dolor abdominal cíclico asociado a una masa abdominal con retención de orina y estreñimiento. La simple inspección de los genitales externos nos permitió realizar el diagnóstico después de 2 años de sintomatología(AU)

Imperforate hymen is an obstructive anomaly of the female reproductive tract which occurs in less than 0.1% of newborns. Not performing an adequate gynecologic physical examination in symptomatic adolescent girls due to embarrassment can often delay its diagnosis. We present the case of an adolescent girl without menarche who was referred to our hospital for cyclic abdominal pain associated with an abdominal mass accompanied by urinary retention and constipation. Examination of her external genitalia allowed rapid diagnosis after a 2-year history of these symptoms(AU)