Application of artificial intelligence in predicting malignancy risk in breast masses on ultrasound / Aplicação de inteligência artificial na predição de risco de malignidade em nódulos mamários na ultrassonografia

Abstract Objective: To evaluate the results obtained with an artificial intelligence-based software for predicting the risk of malignancy in breast masses from ultrasound images. Materials and Methods: This was a retrospective, single-center study evaluating 555 breast masses submitted to percutaneous biopsy at a cancer referral center. Ultrasonographic findings were classified in accordance with the BI-RADS lexicon. The images were analyzed by using Koios DS Breast software and classified as benign, probably benign, low to intermediate suspicion, high suspicion, or probably malignant. The histological classification was considered the reference standard. Results: The mean age of the patients was 51 years, and the mean mass size was 16 mm. The radiologist evaluation had a sensitivity and specificity of 99.1% and 34.0%, respectively, compared with 98.2% and 39.0%, respectively, for the software evaluation. The positive predictive value for malignancy for the BI-RADS categories was similar between the radiologist and software evaluations. Two false-negative results were identified in the radiologist evaluation, the masses in question being classified as suspicious by the software, whereas four false-negative results were identified in the software evaluation, the masses in question being classified as suspicious by the radiologist. Conclusion: In our sample, the performance of artificial intelligence-based software was comparable to that of a radiologist.

Resumo Objetivo: O objetivo deste trabalho foi avaliar os resultados de um software baseado em algoritmo de inteligência artificial para predição do risco de malignidade em nódulos mamários. Materiais e Métodos: Estudo retrospectivo e unicêntrico que avaliou 555 nódulos mamários submetidos a biópsia percutânea em um centro de referência oncológico. Os achados ultrassonográficos foram classificados de acordo com o léxico do BI-RADS. As imagens foram analisadas pelo software Koios DS Breast e divididas em benigna ou provavelmente benigna, suspeita baixa ou intermediária, suspeita alta ou provavelmente maligna. O resultado histopatológico foi considerado como padrão ouro. Resultados: A média de idade das pacientes foi de 51 anos e o tamanho médio dos nódulos foi de 16 mm. A sensibilidade e a especificidade foram de 99,1% e 34,0% para o radiologista e 98,2% e 39,0% para o software, respectivamente. O valor preditivo positivo para malignidade para as categorias BIRADS foi semelhante para o radiologista e para o software. Foram identificados dois resultados falso-negativos na avaliação pelo radiologista que foram classificados como suspeitos pelo software, e quatro resultados falso-negativos na avaliação pelo software que foram classificados como suspeitos pelo radiologista. Conclusão: Na nossa amostra, o software de inteligência artificial demonstrou resultados comparáveis à avaliação pelo radiologista.

Iodinated Contrast Enhancement of Breast Cancer on Prone Multidetector Computed Tomography-Preliminary Findings.

OBJECTIVES: Contrast-enhanced breast imaging has gained increasing importance in the diagnosis and management of breast cancer. The aim of this study was to assess breast cancer enhancement after contrast administration on prone multidetector computed tomography (MDCT). MATERIALS AND METHODS: This retrospective, unicentric, institutional review board-approved study included patients with newly diagnosed breast cancer who were submitted to contrast-enhanced MDCT in prone position, with image acquisition before and after nonionic iodinated contrast administration. RESULTS: Sixty breast cancer patients aged between 31 and 74 years (mean, 49 years) were included. Most patients (n = 50, 83.3%) had no special type invasive breast carcinoma and luminal subtype (n = 45, 75%). All index breast tumors were identified on prone MDCT. Forty-three cases (70.5%) presented as mass, 13 (21.3%) as nonmass enhancement and 4 (6.6%) as both mass and nonmass enhancement. Mean tumor density was 37.8 HU and 87.9 HU on precontrast and postcontrast images, respectively. Mean contrast enhancement was 50.2 HU (range, 20-109 HU). There were no statistically significant differences in tumor enhancement according to histological type, molecular subtype, nuclear grade, tumor size, or imaging presentation. CONCLUSIONS: Our results show that breast cancer usually can be identified and have significant contrast enhancement on prone MDCT images. This method could be used as an alternative when other contrast-enhanced breast imaging methods are not available.

Application of artificial intelligence in predicting malignancy risk in breast masses on ultrasound.

Objective: To evaluate the results obtained with an artificial intelligence-based software for predicting the risk of malignancy in breast masses from ultrasound images. Materials and Methods: This was a retrospective, single-center study evaluating 555 breast masses submitted to percutaneous biopsy at a cancer referral center. Ultrasonographic findings were classified in accordance with the BI-RADS lexicon. The images were analyzed by using Koios DS Breast software and classified as benign, probably benign, low to intermediate suspicion, high suspicion, or probably malignant. The histological classification was considered the reference standard. Results: The mean age of the patients was 51 years, and the mean mass size was 16 mm. The radiologist evaluation had a sensitivity and specificity of 99.1% and 34.0%, respectively, compared with 98.2% and 39.0%, respectively, for the software evaluation. The positive predictive value for malignancy for the BI-RADS categories was similar between the radiologist and software evaluations. Two false-negative results were identified in the radiologist evaluation, the masses in question being classified as suspicious by the software, whereas four false-negative results were identified in the software evaluation, the masses in question being classified as suspicious by the radiologist. Conclusion: In our sample, the performance of artificial intelligence-based software was comparable to that of a radiologist.

Objetivo: O objetivo deste trabalho foi avaliar os resultados de um software baseado em algoritmo de inteligência artificial para predição do risco de malignidade em nódulos mamários. Materiais e Métodos: Estudo retrospectivo e unicêntrico que avaliou 555 nódulos mamários submetidos a biópsia percutânea em um centro de referência oncológico. Os achados ultrassonográficos foram classificados de acordo com o léxico do BI-RADS. As imagens foram analisadas pelo software Koios DS Breast e divididas em benigna ou provavelmente benigna, suspeita baixa ou intermediária, suspeita alta ou provavelmente maligna. O resultado histopatológico foi considerado como padrão ouro. Resultados: A média de idade das pacientes foi de 51 anos e o tamanho médio dos nódulos foi de 16 mm. A sensibilidade e a especificidade foram de 99,1% e 34,0% para o radiologista e 98,2% e 39,0% para o software, respectivamente. O valor preditivo positivo para malignidade para as categorias BIRADS foi semelhante para o radiologista e para o software. Foram identificados dois resultados falso-negativos na avaliação pelo radiologista que foram classificados como suspeitos pelo software, e quatro resultados falso-negativos na avaliação pelo software que foram classificados como suspeitos pelo radiologista. Conclusão: Na nossa amostra, o software de inteligência artificial demonstrou resultados comparáveis à avaliação pelo radiologista.

Communication in radiology: evaluation of terminology and TNM descriptor use at a cancer center.

Objective: The purpose of our study was to evaluate the transmission of information from radiologists to physicians, focusing on the level of certainty and the use of imaging descriptors from the tumor-node-metastasis (TNM) staging system. Materials and Methods: Radiologists (n = 56) and referring physicians (n = 50) participated in this questionnaire-based, singlecenter study, conducted between March 20, 2020, and January 21, 2021. Participants were presented with terms commonly used by the radiologists at the institution and were asked to order them hierarchically in terms of the level of certainty they communicate regarding a diagnosis, using a scale ranging from 1 (most contrary to) to 10 (most favoring). They then assessed TNM system descriptors and their interpretation. Student's t-tests and the kappa statistic were used in order to compare the rankings of the terms of certainty. Items related to T and N staging were analyzed by Fisher's exact test. The confidence level was set to 97% (p < 0.03). Results: Although overall agreement among the radiologists and referring physicians on term ranking was poor (kappa = 0.10- 0.35), the mean and median values for the two groups were similar. Most of the radiologists and referring physicians (67% and 86%, respectively) approved of the proposal to establish a standard lexicon. Such a lexicon, based on the participant responses, was developed and graphically represented. Regarding the TNM system descriptors, there were significant differences between the two groups in the reporting of lymph node numbers, of features indicating capsular rupture, and of vessel wall irregularities, as well as in the preference for clear descriptions of vascular involvement. Conclusion: Our findings indicate that ineffective communication and differences in report interpretation between radiologists and referring physicians are still prevalent in the fields of radiology and oncology. Efforts to gain a better understanding of those impediments might improve the objectivity of reporting and the quality of care.

Objetivo: O propósito do nosso estudo foi analisar a transmissão das informações de radiologistas para médicos assistentes, com foco no nível de certeza e uso de descritores de imagem do sistema de estadiamento tumor­nódulo­metástase (TNM). Materiais e Métodos: Radiologistas (n = 56) e médicos assistentes (n = 50) participaram neste estudo unicêntrico, baseado em questionários respondidos entre 20 de março de 2020 e 21 de janeiro de 2021. Os participantes ordenaram hierarquicamente termos comumente usados por radiologistas da instituição para descrever o nível de certeza utilizando uma escala que variou de 1 (mais contrário) a 10 (mais favorável). Em seguida, foram avaliados os descritores relacionados ao sistema TNM e sua interpretação. O teste t de Student e o coeficiente de correlação kappa foram empregados para comparar a classificação dos termos. Os itens relacionados aos estadiamentos T e N foram analisados pelo teste exato de Fisher. O nível de confiança foi fixado em 97% (p < 0,03). Resultados: A concordância geral entre radiologistas e médicos assistentes na classificação hierárquica dos termos foi baixa (kappa = 0,10­0,35), porém, os valores médios e medianos dos dois grupos foram semelhantes. A maioria dos médicos (86%) e radiologistas (67%) foi receptiva à introdução de um léxico padronizado. Uma proposta de léxico foi elaborada com base nas respostas dos participantes e representada graficamente. Em relação aos descritores do sistema TNM, diferenças estatisticamente significativas foram observadas nos seguintes itens: forma de relatar o número de linfonodos; menção a características indicativas de ruptura capsular nodal; menção de irregularidades nas paredes vasculares; e preferência por descrições sucintas para comprometimento de estruturas vasculares. Conclusão: Falhas de comunicação e diferenças na interpretação de laudos entre radiologistas e médicos assistentes ainda são prevalentes em radiologia e oncologia. Esforços para melhor compreendê-los podem melhorar a objetividade do laudo radiológico e a qualidade do atendimento médico.

Communication in radiology: evaluation of terminology and TNM descriptor use at a cancer center / Comunicação em radiologia: avaliação da terminologia e uso dos descritores TNM em um centro oncológico

Abstract Objective: The purpose of our study was to evaluate the transmission of information from radiologists to physicians, focusing on the level of certainty and the use of imaging descriptors from the tumor-node-metastasis (TNM) staging system. Materials and Methods Radiologists (n = 56) and referring physicians (n = 50) participated in this questionnaire-based, single-center study, conducted between March 20, 2020, and January 21, 2021. Participants were presented with terms commonly used by the radiologists at the institution and were asked to order them hierarchically in terms of the level of certainty they communicate regarding a diagnosis, using a scale ranging from 1 (most contrary to) to 10 (most favoring). They then assessed TNM system descriptors and their interpretation. Student's t-tests and the kappa statistic were used in order to compare the rankings of the terms of certainty. Items related to T and N staging were analyzed by Fisher's exact test. The confdence level was set to 97% (p < 0.03). Results: Although overall agreement among the radiologists and referring physicians on term ranking was poor (kappa = 0.10-0.35), the mean and median values for the two groups were similar. Most of the radiologists and referring physicians (67% and 86%, respectively) approved of the proposal to establish a standard lexicon. Such a lexicon, based on the participant responses, was developed and graphically represented. Regarding the TNM system descriptors, there were significant differences between the two groups in the reporting of lymph node numbers, of features indicating capsular rupture, and of vessel wall irregularities, as well as in the preference for clear descriptions of vascular involvement. Conclusion: Our findings indicate that ineffective communication and differences in report interpretation between radiologists and referring physicians are still prevalent in the fields of radiology and oncology. Efforts to gain a better understanding of those impediments might improve the objectivity of reporting and the quality of care.

Resumo Objetivo: O propósito do nosso estudo foi analisar a transmissão das informações de radiologistas para médicos assistentes, com foco no nível de certeza e uso de descritores de imagem do sistema de estadiamento tumor-nódulo-metástase (TNM). Materiais e Métodos: Radiologistas (n = 56) e médicos assistentes (n = 50) participaram neste estudo unicêntrico, baseado em questionários respondidos entre 20 de março de 2020 e 21 de janeiro de 2021. Os participantes ordenaram hierarquicamente termos comumente usados por radiologistas da instituição para descrever o nível de certeza utilizando uma escala que variou de 1 (mais contrário) a 10 (mais favorável). Em seguida, foram avaliados os descritores relacionados ao sistema TNM e sua interpretação. O teste t de Student e o coeficiente de correlação kappa foram empregados para comparar a classificação dos termos. Os itens relacionados aos estadiamentos T e N foram analisados pelo teste exato de Fisher. O nível de confança foi fixado em 97% (p < 0,03). Resultados: A concordância geral entre radiologistas e médicos assistentes na classificação hierárquica dos termos foi baixa (kappa = 0,10-0,35), porém, os valores médios e medianos dos dois grupos foram semelhantes. A maioria dos médicos (86%) e radiologistas (67%) foi receptiva à introdução de um léxico padronizado. Uma proposta de léxico foi elaborada com base nas respostas dos participantes e representada graficamente. Em relação aos descritores do sistema TNM, diferenças estatisticamente significativas foram observadas nos seguintes itens: forma de relatar o número de linfonodos; menção a características indicativas de ruptura capsular nodal; menção de irregularidades nas paredes vasculares; e preferência por descrições sucintas para comprometimento de estruturas vasculares. Conclusão: Falhas de comunicação e diferenças na interpretação de laudos entre radiologistas e médicos assistentes ainda são prevalentes em radiologia e oncologia. Esforços para melhor compreendê-los podem melhorar a objetividade do laudo radiológico e a qualidade do atendimento médico.

Relationship between anxiety and internet searches before percutaneous ultrasound-guided diagnostic procedures: A prospective cohort study.

Invasive procedures guided by ultrasound (US) are part of routine medical diagnostic investigation. The lack of knowledge surrounding the technical aspects of such procedures can lead patients to seek complementary information on the Internet, which may in turn trigger anxiety. However, the intersection between the fields of Radiology and Psychology is poorly studied. Here, we identify the profile of an anxious patient before an US-guided intervention. We prospectively studied 133 patients undergoing image-guided procedures. The State-Trait Anxiety Inventory (STAI) was applied for psychometry. Significantly higher anxiety scores were observed in female patients (p = .001), those who believed they had received inadequate information from their referring physician (p = .006), and in patients who considered online information unreliable or difficult to access (p = .007 and p = .001, respectively). Participants who defined themselves as proactive online reported lower anxiety levels (p = .003).

Análise dos materiais didáticos utilizados por radiologistas e residentes de radiologia brasileiros: mudança de paradigma.

Objetivo: Identificar o perfil de utilização dos recursos didáticos pelos médicos radiologistas e residentes em radiologia e diagnóstico por imagem brasileiros. Materiais e Métodos: Estudo observacional, transversal e descritivo, realizado por meio de questionário eletrônico contendo perguntas referentes ao perfil do médico, formação, local de atuação, perfil de acesso a recursos educacionais e tipos de recursos mais utilizados. Resultados: Responderam ao questionário 265 médicos com idade média de 38,2 anos, sendo a maioria radiologistas formados (170; 64,2%), do sexo masculino (166; 62,6%), trabalhando em instituições privadas (174; 65,7%), sem vínculo acadêmico (167; 63,0%), atuando principalmente nas áreas de ultrassonografia (212; 80,0%) e tomografia computadorizada (206; 77,7%). A carga horária média de estudo semanal foi de 9,6 horas (mediana: 6 horas), sendo maior no grupo dos médicos que estão em formação e nos que atuam em instituições públicas e acadêmicas. Quanto ao recurso para o acesso do material de estudo, observou-se uma tendência pela maior utilização do computador (65,3%). A maioria dos respondentes optou por acessar materiais didáticos sem custo (61,9%), sendo os sites da web, livros e revistas eletrônicas os mais pesquisados. Conclusão: Os radiologistas brasileiros utilizam recursos eletrônicos e digitais como principais materiais didáticos, sendo os sites da web, livros e revistas eletrônicas as fontes mais utilizadas.

Análise dos materiais didáticos utilizados por radiologistas e residentes de radiologia brasileiros: mudança de paradigma / Analysis of the use of educational materials by radiologists and radiology residents in Brazil: paradigm shift

Resumo Objetivo: Identificar o perfil de utilização dos recursos didáticos pelos médicos radiologistas e residentes em radiologia e diagnóstico por imagem brasileiros. Materiais e Métodos: Estudo observacional, transversal e descritivo, realizado por meio de questionário eletrônico contendo perguntas referentes ao perfil do médico, formação, local de atuação, perfil de acesso a recursos educacionais e tipos de recursos mais utilizados. Resultados: Responderam ao questionário 265 médicos com idade média de 38,2 anos, sendo a maioria radiologistas formados (170; 64,2%), do sexo masculino (166; 62,6%), trabalhando em instituições privadas (174; 65,7%), sem vínculo acadêmico (167; 63,0%), atuando principalmente nas áreas de ultrassonografia (212; 80,0%) e tomografia computadorizada (206; 77,7%). A carga horária média de estudo semanal foi de 9,6 horas (mediana: 6 horas), sendo maior no grupo dos médicos que estão em formação e nos que atuam em instituições públicas e acadêmicas. Quanto ao recurso para o acesso do material de estudo, observou-se uma tendência pela maior utilização do computador (65,3%). A maioria dos respondentes optou por acessar materiais didáticos sem custo (61,9%), sendo os sites da web, livros e revistas eletrônicas os mais pesquisados. Conclusão: Os radiologistas brasileiros utilizam recursos eletrônicos e digitais como principais materiais didáticos, sendo os sites da web, livros e revistas eletrônicas as fontes mais utilizadas.

Abstract Objective: To profile the use of educational materials by radiologists and radiology residents in Brazil. Materials and Methods: This was a cross-sectional, descriptive, observational study in which an electronic questionnaire was sent via email to physicians working in the field of radiology. The questionnaire contained questions regarding the profile, education, and place of work of the physicians, as well as their access to educational resources and the types of educational materials they used most. Results: The questionnaire was completed by 265 physicians. The mean age of the respondents was 38.2 years. Of the 265 respondents, 212 (80.0%) worked with ultrasound, 206 (77.7%) worked with computed tomography, 170 (64.2%) were board-certified, 166 (62.6%) were male, 174 (65.7%) worked at private facilities, and 167 (63.0%) had no academic affiliation. The mean weekly total study time was 9.6 h (median, 6 h), being higher among physicians in training, among those who worked at public facilities, and among those who worked at teaching hospitals. Regarding the device employed in order to access educational materials, there was a trend toward greater use of computers, which were employed by 65.3%. The majority of the respondents (61.9%) chose to access educational materials that were free of charge, the most common sources being websites, eBooks, and online journals. Conclusion: Electronic and digital resources are the main means of access to educational materials used by radiologists in Brazil, the most commonly used resources being web sites, eBooks, and online journals.

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications.

OBJECTIVE: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. MATERIALS AND METHODS: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. RESULTS: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. CONCLUSION: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

OBJETIVO: Avaliar a técnica, eficácia e segurança das biópsias percutâneas guiadas por tomografia computadorizada (TC) de lesões de cabeça e pescoço. MATERIAIS E MÉTODOS: Este estudo retrospectivo e unicêntrico incluiu pacientes submetidos a biópsia percutânea guiada por TC de lesões de cabeça e pescoço. Para avaliação da acurácia diagnóstica, os resultados da biópsia foram comparados com o diagnóstico final determinado por avaliação histológica ou acompanhamento clínico. RESULTADOS: Foram avaliadas 74 biópsias realizadas em 68 pacientes. A média de idade dos pacientes foi de 55,6 anos. A maioria das lesões (79,7%) estava localizada na região supra-hioide e o maior diâmetro variou de 11 a 128 mm. Os acessos mais comuns utilizados foram paramaxilar (32,4%), retromandibular (21,6%) e periorbital (14,9%). Cinco pacientes (6,8%) desenvolveram complicações menores e não houve associação estatisticamente significante entre a presença de complicações e fatores clínicos, radiológicos ou relacionados ao procedimento. Foi obtido material suficiente para análise histológica em todos os casos. Trinta e oito biópsias (51,4%) tiveram diagnóstico histológico de malignidade. Houve três (8,3%) resultados falso-negativos e nenhum falso-positivo, demonstrando sensibilidade de 92,7%, especificidade de 100% e acurácia de 96,0%. CONCLUSÃO: Nossos resultados demonstram que a biópsia percutânea guiada por TC de lesões de cabeça e pescoço é um procedimento seguro e efetivo para obter material para análise histológica.

Computed tomography-guided percutaneous biopsy of head and neck masses: techniques, outcomes, and complications / Biópsia percutânea guiada por tomografia computadorizada de lesões de cabeça e pescoço: técnicas, resultados e complicações

Abstract Objective: To assess the technique, efficacy, and safety of computed tomography (CT)-guided percutaneous biopsies of head and neck masses. Materials and Methods: This was a retrospective, single-center study of CT-guided percutaneous core-needle biopsies of head and neck masses. For the analysis of diagnostic accuracy, biopsy results were compared with the final diagnosis, which was determined by histological examination and clinical follow-up. Results: We evaluated 74 biopsies performed in 68 patients. The mean age of the patients was 55.6 years. Most of the lesions (79.7%) were located in the suprahyoid region, and the maximum diameter ranged from 11 mm to 128 mm. The most common approaches were paramaxillary (in 32.4%), retromandibular (in 21.6%), and periorbital (in 14.9%). Five patients (6.8%) developed minor complications. The presence of a complication did not show a statistically significant association with any clinical, radiological, or procedure-related factor. Sufficient material for histological analysis was obtained in all procedures. Thirty-eight biopsies (51.4%) yielded a histological diagnosis of malignancy. There was a false-negative result in three cases (8.3%), and there were no false-positive results. The procedure had a sensitivity of 92.7%, a specificity of 100%, and an accuracy of 96.0%. Conclusion: Our results demonstrate that CT-guided percutaneous core-needle biopsy of head and neck lesions is a safe, effective procedure for obtaining biological material for histological analysis.

Resumo Objetivo: Avaliar a técnica, eficácia e segurança das biópsias percutâneas guiadas por tomografia computadorizada (TC) de lesões de cabeça e pescoço. Materiais e Métodos: Este estudo retrospectivo e unicêntrico incluiu pacientes submetidos a biópsia percutânea guiada por TC de lesões de cabeça e pescoço. Para avaliação da acurácia diagnóstica, os resultados da biópsia foram comparados com o diagnóstico final determinado por avaliação histológica ou acompanhamento clínico. Resultados: Foram avaliadas 74 biópsias realizadas em 68 pacientes. A média de idade dos pacientes foi de 55,6 anos. A maioria das lesões (79,7%) estava localizada na região supra-hioide e o maior diâmetro variou de 11 a 128 mm. Os acessos mais comuns utilizados foram paramaxilar (32,4%), retromandibular (21,6%) e periorbital (14,9%). Cinco pacientes (6,8%) desenvolveram complicações menores e não houve associação estatisticamente significante entre a presença de complicações e fatores clínicos, radiológicos ou relacionados ao procedimento. Foi obtido material suficiente para análise histológica em todos os casos. Trinta e oito biópsias (51,4%) tiveram diagnóstico histológico de malignidade. Houve três (8,3%) resultados falso-negativos e nenhum falso-positivo, demonstrando sensibilidade de 92,7%, especificidade de 100% e acurácia de 96,0%. Conclusão: Nossos resultados demonstram que a biópsia percutânea guiada por TC de lesões de cabeça e pescoço é um procedimento seguro e efetivo para obter material para análise histológica.

Prognostic value of response evaluation based on breast MRI after neoadjuvant treatment: a retrospective cohort study.

OBJECTIVE: To investigate the impact of response evaluation after neoadjuvant chemotherapy (NAC) in breast cancer patients, assessed by both magnetic resonance imaging (MRI) and pathology, on disease-free survival (DFS). METHODS: This single-center, retrospective cohort study included consecutive breast cancer patients who underwent NAC and preoperative breast MRI. Resolution of invasive carcinoma in the breast and axilla was defined as complete pathological response (pCR). Radiological complete response (rCR) was defined as the absence of abnormal enhancement in the tumor site. Kaplan-Meier estimator was used to estimate the disease-free survival on 60 months. Cox regression analysis was used to estimate hazard ratio (HR) values. RESULTS: In total, 317 patients were included with a mean age of 47.3 years and a mean tumor size of 39.8 mm. The most common immunophenotype was luminal (44.9%), followed by triple-negative (26.8%). Overall, 126 patients (39.7%) had an rCR, while 119 (37.5%) had pCR; the radiological and pathological responses agreed in 252 cases (79.5%). During follow-up, patients who had rCR and pCR had a better DFS curve compared to patients with non-rCR and non-pCR, while those who had rCR or pCR presented an intermediate curve (Log-rank p = 0.003). Multivariate analysis showed a higher risk of recurrence in patients with non-rCR and non-pCR (HR: 5,626; p = 0.020) and those who had a complete response on MRI or pathology only (HR: 4,369; p = 0.067), when compared to patients with rCR and pCR. CONCLUSIONS: The association of MRI and pathological responses after NAC might better stratify the risk of recurrence and prognosis in breast cancer patients. KEY POINTS: • Association of response evaluation after neoadjuvant chemotherapy by pathology and MRI allows better stratification of prognosis. • Complete response to neoadjuvant chemotherapy on pathology and MRI was related to better disease-free survival. • Complete response on MRI or pathology only had a greater risk of recurrence.

Chest CT accuracy in the diagnosis of SARS-CoV-2 infection: initial experience in a cancer center.

OBJECTIVE: To evaluate the accuracy of chest computed tomography (CT) in patients with suspected severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection at a cancer center. MATERIALS AND METHODS: This retrospective single-center study selected 91 patients who had chest CT and real-time polymerase chain reaction (RT-PCR) test collected at the same day. CT results were classified in negative, typical, indeterminate or atypical findings. Diagnostic accuracy, sensitivity and specificity were calculated for two different scenarios: in the first, only typical findings on CT were considered positive; in the second, both typical and indeterminate findings were considered positive. RESULTS: Mean patients' age was 58.2 years, most were male (60.4%) and had prior diagnosis of cancer (85.7%). CT showed typical findings in 28.6%, indeterminate findings in 24.2% and atypical findings in 26.4%. RT-PCR results were positive for SARS-CoV-2 in 27.5%. The sensitivity, specificity and accuracy in the first and second scenarios were respectively 64.0%, 84.8% and 79.1%, and 92.0%, 62.1% and 70.3%. CONCLUSION: CT has a high accuracy for the diagnosis of SARS-CoV-2 infection. Different interpretation criteria can provide either high sensitivity or high specificity. CT should be integrated as a triage test in resource-constrained environments during the pandemic to assist in the optimization of PCR-tests, isolation beds and intensive care units.

OBJETIVO: Avaliar a acurácia da tomografia computadorizada (TC) de tórax em pacientes com suspeita de infecção por SARS-CoV-2 em um centro oncológico. MATERIAIS E MÉTODOS: Estudo retrospectivo e unicêntrico que selecionou 91 pacientes que realizaram TC de tórax e teste RT-PCR no mesmo dia. Os resultados da TC foram classificados em negativos, achados típicos, indeterminados ou atípicos. Acurácia diagnóstica, sensibilidade e especificidade foram calculadas para dois cenários: no primeiro, apenas TC com achados típicos foi considerada positiva; no segundo, achados típicos ou indeterminados foram considerados positivos. RESULTADOS: A média de idade dos pacientes foi de 58,2 anos, sendo a maioria homens (60,4%) e com história de câncer prévio (85,7%). TC demonstrou achados típicos em 28,6%, indeterminados em 24,2% e atípicos em 26,4%. Resultados da RT-PCR foram positivos para SARS-CoV-2 em 27,5%. Sensibilidade, especificidade e acurácia no primeiro e segundo cenários foram, respectivamente, de 64,0%, 84,8% e 79,1%, e 92,0%, 62,1% e 70,3%. CONCLUSÃO: A TC tem alta acurácia para o diagnóstico de infecção por SARS-CoV-2. Diferentes critérios de interpretação fornecem maior sensibilidade ou especificidade. A TC deve ser integrada como um teste de triagem em ambientes com recursos limitados durante a pandemia, para ajudar na otimização da utilização de testes de PCR, leitos de isolamento e unidades de terapia intensiva.

Evaluation of whole-body MRI with diffusion-weighted sequences in the staging of pediatric cancer patients.

BACKGROUND: The purpose of this study was to determine whether whole-body MRI (WBMRI) with diffusion-weighted sequences, which is free of ionizing radiation, can perform as well as traditional methods when used alone for staging or follow-up of pediatric cancer patients. METHODS: After obtaining approval from our institutional research ethics committee and appropriate informed consent, we performed 34 examinations in 32 pediatric patients. The examinations were anonymized and analyzed by two radiologists with at least 10 years' experience. RESULTS: The sensitivity and specificity findings, respectively, were as follows: 100% and 100% for primary tumor; 100% and 86% for bone metastasis; 33% and 100% for lung metastasis; 85% and 100% for lymph node metastasis; and 100% and 62% for global investigation of primary or secondary neoplasias. We observed excellent interobserver agreement for WBMRI and excellent agreement with standard staging examination results. CONCLUSIONS: Our results suggest that pediatric patients can be safely imaged with WBMRI, although not as the only tool but in association with low-dose chest CT (for subcentimeter pulmonary nodules). However, additional exams with ionizing radiation may be necessary for patients who tested positive to correctly quantify and locate the lesions.