Evaluación de la aplicabilidad del léxico BI-RADS(R) de la resonancia magnética para la interpretación de la mamografía digital con contraste / Evaluation of the applicability of BI-RADS(R) MRI for the interpretation of contrast-enhanced digital mammography

OBJETIVO: Se plantea comprobar la utilidad del léxico BI-RADS(R) de la resonancia magnética de la mama (RMM) para la descripción morfológica y la categorización de las imágenes obtenidas mediante mamografía digital con realce de contraste (CESM) en comparación con el diagnóstico final. MATERIAL Y MÉTODOS: Se incluyeron pacientes con lesiones de mama palpables o que necesitaban una aclaración de anormalidades previamente identificadas por otra técnica de diagnóstico por imagen, o una evaluación complementaria de parénquima mamario heterogéneamente denso. Tres radiólogos evaluaron de forma independiente las lesiones de mama estudiadas por CESM utilizando una plantilla que contenía los descriptores morfológicos cualitativos del léxico BI-RADS(R) de la RMM. En una segunda etapa, otros dos radiólogos experimentados proporcionaron una opinión consensuada sobre casos discrepantes. Los lectores también proporcionaron una clasificación en la escala BI-RADS(R) de 1 a 5 para cada una de las lesiones, tanto benignas como malignas. Todos los resultados se compararon con el estado real de la enfermedad (estándar de referencia apropiado para el tipo de lesión) y la significación estadística fue evaluada mediante la prueba de χ2. RESULTADOS: El estudio incluyó 218 lesiones benignas y 426 malignas. Hubo un alto acuerdo interobservador entre los tres radiólogos (valor de kappa de Fleiss-Cohen=0,805; IC al 95% 0,728-0,837). De forma similar a lo que se ha descrito para la RMM, la evaluación de los descriptores morfológicos de las lesiones que dan efecto de masa mostró que las lesiones malignas tienden a presentar una forma irregular, con bordes espiculados o mal definidos y un patrón de realce intenso y heterogéneo (p <0,001). Sin embargo, a diferencia de la RMM, el patrón de realce en anillo no se puede describir como un criterio independiente de malignidad con esta técnica. Con respecto a las lesiones que no dan efecto de masa, el único descriptor significativo fue la intensidad de la captación del medio de contraste (p <0,05). La aplicación global del léxico BI-RADS(R) de la RMM para CESM permitió la clasificación adecuada del 85% de las categorías benignas (BI-RADS 1 y lesiones BI-RADS 2 y 3) y el 93% de las lesiones malignas (BI-RADS 4-5), que son valores similares a los descritos para RMM. CONCLUSIONES: Los descriptores morfológicos del léxico BI-RADS(R) de la RMM se pueden aplicar al análisis morfológico de lesiones de mama estudiadas por CESM. Las discrepancias parciales en la interpretación no influyeron en la puntuación final de BI-RADS(R), lo que permite una buena diferenciación de las lesiones benignas y malignas

OBJECTIVE: To determine the usefulness of BI-RADS(R) MRI for the morphological description and categorization of images obtained with contrast-enhanced digital mammography in comparison with the final diagnosis. MATERIAL AND METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS(R) MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS(R) scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test. RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS(R) MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI. CONCLUSIONS: The morphological descriptors used in BI-RADS(R) MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS(R) score, and the score enabled good differentiation between benign and malignant lesions

Evaluation of the applicability of BI-RADS® MRI for the interpretation of contrast-enhanced digital mammography. / Evaluación de la aplicabilidad del léxico BI-RADS® de la resonancia magnética para la interpretación de la mamografía digital con contraste.

OBJECTIVE: To determine the usefulness of BI-RADS® MRI for the morphological description and categorization of images obtained with contrast-enhanced digital mammography in comparison with the final diagnosis. MATERIAL AND METHODS: We included patients who had palpable breast lesions, those who needed clarification regarding abnormalities identified with another imaging technique, and those which needed a complementary evaluation of heterogeneously dense breast parenchyma. Three radiologists working independently used a template with the BI-RADS® MRI qualitative descriptors to evaluate the breast lesions studied with contrast-enhanced digital mammography. In a second phase, two other experienced radiologists reached a consensus about discrepant interpretations. Readers also classified each lesion (both benign and malignant lesions) on the BI-RADS® scale (1 - 5). All the results were compared with the real state of disease (determined by the appropriate gold standard for each type of lesion), and the statistical significance was assessed with the chi-square test. RESULTS: A total of 218 benign lesions and 426 malignant lesions were included. The interobserver agreement among the three radiologists was high (Fleiss-Cohen kappa=0.805; 95% CI: 0.728-0.837). Similarly to what has been reported about breast MRI, on contrast-enhanced digital mammography, malignant lesions with mass effect tended to have an irregular shape with spiculated or ill-defined margins and a pattern of intense and heterogeneous enhancement (p <0.001). Nevertheless, unlike on breast MRI, ring enhancement was not an independent criterion of malignancy on contrast-enhanced digital mammography. For lesions without a mass effect, the only significant descriptor was the intensity of contrast material uptake (p <0.05). Applying the BI-RADS® MRI material to contrast-enhanced digital mammography images enabled the correct classification of 85% of lesions in the benign categories (BI-RADS 1 and BI-RADS 2 and 3 lesions) and of 93% of the lesions in the malignant categories (BI-RADS 4-5); these values are similar to those reported for breast MRI. CONCLUSIONS: The morphological descriptors used in BI-RADS® MRI can be applied to the morphological analysis of breast lesions studied with contrast-enhanced digital mammography. The partial discrepancies in the interpretation did not influence the final BI-RADS® score, and the score enabled good differentiation between benign and malignant lesions.

Factors affecting the precision of lesion sizing with contrast-enhanced spectral mammography.

AIM: To evaluate the precision of the pre-surgical measurement of the size of breast cancer by contrast-enhanced spectral mammography (CESM). MATERIAL AND METHODS: This was a retrospective study of 204 breast cancers. Variables related to tumour biology and anthropometric variables were recorded and considered when evaluating the efficacy of CESM in predicting tumour size. Microscopic measurement of the largest diameter of the tumour at pathology was chosen as the reference standard. RESULTS: The mean size of tumours at pathology was 20.7±15.8 mm, while at CESM it was 23.6±16.7 mm (Bland-Altman 2.9 mm overestimation, 2.9 mm; 95% confidence interval [CI]: -10.3-16.2 mm). Spearman's correlation coefficient was 0.83 (p<0.0001). The concordance analysis indicated that 37.8% of the measurements were concordant, 47% were overestimated, and 15.2% were underestimated. Tumour size, nodal involvement, breast density, and breast size significantly modified the sizing accuracy. CONCLUSION: Quality of tumour size prediction with CESM is good, and this appears to be a promising imaging technique in the surgical planning of breast cancer. Biological tumour features, and anthropological characteristics of the patients do, however, affect the diagnostic precision and should be taken into account.

[Neonatal management in the emergency department of a tertiary children's hospital]. / Asistencia a neonatos en el servicio de urgencias de un hospital pediátrico terciario.

OBJECTIVE: To determinate the chief complaints in neonates presenting to a pediatric emergency service and their management. MATERIAL AND METHODS: We performed a retrospective study of patients younger than 28 days old who presented to the pediatric emergency department in 2003. Patients directly admitted to the neonatal unit and those attended by the surgery and orthopedic surgery departments were excluded. Information on sex, age, time and date, waiting time, visit duration, source of referral, presenting complaint, complementary examinations, final diagnosis, and hospital admission were analyzed. RESULTS: There were 1,481 neonatal visits. The mean chronological age was 15.8 days and 57.3 % were boys. Visits were most frequent on Fridays, evening shifts, and in July and December. The most frequent chief complaints were crying/irritability (16.3 %), fever (13.6 %), vomiting (11 %), and influenza (10.8 %). The most frequent final diagnoses were feeding problems (12.6 %), infantile colic (12.4 %), and upper respiratory tract infections (12 %). No abnormalities were detected in 11.7 % of the patients and complementary examinations were not required in 45.9 %. The admission rate was 26 %, most commonly due to fever and bronchiolitis. CONCLUSIONS: Many visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care. Because of the greater vulnerability of this age group, thorough investigation is required to rule out severe disease. This phenomenon was reflected by the large number of complementary examinations and admissions.

Asistencia a neonatos en el servicio de urgencias de un hospital pediátrico terciario / Neonatal management in the emergency department of a tertiary children’s hospital

Objetivo Conocer qué problemas motivan las consultas de neonatos a un servicio de urgencias y determinar las características de la atención que se les ofrece. Material y métodos Revisión retrospectiva de los informes de urgencias de los neonatos atendidos durante el año 2003. Se excluyen los pacientes que ingresaron directamente en el Servicio de Neonatología y los atendidos por las secciones de Cirugía y Traumatología. Se analizan edad, sexo, hora y fecha de llegada, tiempo de espera y asistencia, derivación por otro médico/centro, motivo de consulta, exploraciones complementarias, diagnóstico final y destino del paciente. Resultados Se realizaron 1.481 visitas, con edad media de 15,8 días. El 53,7 % eran varones. La mayor presión asistencial se registró en viernes, en el turno de tarde y en los meses de julio y diciembre. El principal motivo de consulta fue llanto/irritabilidad (16,3 %), seguido de fiebre (13,6 %), vómitos (11 %) y cuadro catarral (10,8 %). Los diagnósticos más frecuentes fueron: dudas de puericultura (12,6 %), cólico del lactante (12,4 %) e infección de vías respiratorias altas (12 %). En el 11,7 % de los casos no se objetivó ninguna patología y el 45,9 % no precisó exploraciones complementarias. La proporción de ingresos fue del 26 %, principalmente por fiebre sin foco y bronquiolitis. Conclusiones Muchas consultas corresponden a patología menor que no precisan exploraciones complementarias y podrían ser resueltas en centros de atención primaria. La alta vulnerabilidad de la etapa neonatal requiere de una valoración minuciosa por la posibilidad de procesos graves, dato reflejado en la elevada proporción de pruebas diagnósticas e ingresos

Objective To determinate the chief complaints in neonates presenting to a pediatric emergency service and their management. Material and methods We performed a retrospective study of patients younger than 28 days old who presented to the pediatric emergency department in 2003. Patients directly admitted to the neonatal unit and those attended by the surgery and orthopedic surgery departments were excluded. Information on sex, age, time and date, waiting time, visit duration, source of referral, presenting complaint, complementary examinations, final diagnosis, and hospital admission were analyzed. Results There were 1,481 neonatal visits. The mean chronological age was 15.8 days and 57.3 % were boys. Visits were most frequent on Fridays, evening shifts, and in July and December. The most frequent chief complaints were crying/irritability (16.3 %), fever (13.6 %), vomiting (11 %), and influenza (10.8 %). The most frequent final diagnoses were feeding problems (12.6 %), infantile colic (12.4 %), and upper respiratory tract infections (12 %). No abnormalities were detected in 11.7 % of the patients and complementary examinations were not required in 45.9 %. The admission rate was 26 %, most commonly due to fever and bronchiolitis. Conclusions Many visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care. Because of the greater vulnerability of this age group, thorough investigation is required to rule out severe disease. This phenomenon was reflected by the large number of complementary examinations and admissions