Mammographic and Ultrasonographic Imaging Analysis for Neoadjuvant Chemotherapy Evaluation: Volume Reduction Indexes That Correlate With Pathological Complete Response.

INTRODUCTION: We aimed to evaluate volume reduction in digital mammography (DM) and ultrasound (US) for neoadjuvant chemotherapy (NAC) evaluation, with breast cancer-specific survival and pathological complete response (pCR) associations. METHODS: This is a retrospective observational cohort study analyzing recorded images in 122 selected subjects out of which 569 patients presented with advanced breast cancers. Spearman's correlation and generalized estimating equations (GEE) compared volume reduction on DM and US between pCR and non-pCR after NAC with post-surgical anatomopathology. Cox regression and Kaplan-Meier curves analyzed associations between cancer-specific survival, pCR, and volume reductions. RESULTS: A total of 34.4% (N=42) obtained pCR and 65.6% (N=80) did not. Minimum percentage indexes needed to correlate with pCR over time were, at least, 28.9% for DM (p=0.006) and 10.36% for US (p=0.046), with high specificity (US=98%, DM=93%) but low sensitivity (US=7%, DM=18%). Positive predictive values were 82% (DM) and 86% (US) and negative predictive values were 37% (DM) and 36% (US). Cox regression and Kaplan-Meier curves demonstrated associations of breast cancer-specific survival with pCR (Cox regression coefficient {B}=0.209, CI 95%=0.048-0.914, p=0.038). CONCLUSIONS: At least 28.9% of volume reduction on DM and 10.36% of volume reduction on US are correlated with pCR. Furthermore, pCR was associated with breast cancer-specific survival after NAC in volumetric morphological imaging analysis.

Breast cancer mammographic diagnosis performance in a public health institution: a retrospective cohort study.

OBJECTIVES: To evaluate the quality assurance of mammography results at a reference institution for the diagnosis and treatment of breast cancer in southern Brazil, based on the BIRADS (Breast Imaging Reporting and Data System) 5th edition recommendations for auditing purposes. MATERIALS AND METHODS: Retrospective cohort and cross-sectional study with 4502 patients (9668 mammographies)) who underwent at least one or both breast mammographies throughout 2013 at a regional public hospital, linked to a federal public university. The results were followed until 31 December 2014, including true positives (TPs), true negatives (TNs), false positives (FPs), false negatives (FNs), positive predictive values (PPVs), negative predictive value (NPV), sensitivity and specificity, with a confidence interval of 95%. RESULTS: The study showed high quality assurance, particularly regarding sensitivity (90.22%) and specificity (92.31%). The overall positive predictive value (PPV) was 65.35%, and the negative predictive value (NPV) was 98.32%. The abnormal interpretation rate (recall rate) was 12.26%. CONCLUSIONS: The results are appropriate when compared to the values proposed by the BIRADS 5th edition. Additionally, the study provided self-reflection considering our radiological practice, which is essential for improvements and collaboration regarding breast cancer detection. It may stimulate better radiological practice performance and continuing education, despite possible infrastructure and facility limitations. MAIN MESSAGES: • Accurate quality performance rates are possible despite financial and governmental limitations. • Low-income institutions should develop standardised teamwork to improve radiological practice. • Regular mammography audits may help to increase the quality of public health systems.

Biópsia excisional por agulhamento de lesões mamárias não palpáveis: indicações, técnica e resultados / Excisonal biopsy with wirw localization of non palpable breast lesions: indicators, technique and results

Com o aumento do rastreamento mamográfico, identificam-se cada vez mais lesões menores e não palpáveis, surgindo a necessidade de localiza-las tanto para diagnóstico como para tratamento. Neste trabalho, descreveram-se a técnica e suas indicações e apresentaram-se os resultados dos casos de agulhamento do Serviço de Mastologia e Radiologia do Hospital de Clínicas de Porto Alegre (HCPA). Métodos: Avaliaram-se, retrospectivamente, 586 casos de agulhamento operados no período de 1995 a 2004. As indicações para o procedimento foram as alterações mamográficas de lesões não palpáveis, classificadas de acordo o sistema BIRADS. Resultados: A principal indicação cirúrgica foram as microcalcificações, num total de 373 casos (63,7%), seguidas de nódulos em 37,2%. A idade média das pacientes foi de 53 anos (23 a 82). O valor preditivo positivo (VPP) geral para malignidade foi de 0,30 (177/586 casos). As alterações funcionais benignas da mama (AFBMs) corresponderam ao diagnóstico mais comum (34,1%). Noventa e quatro por cento dos casos de carcinoma ductal in situ (CDIS) foram diagnosticados mamograficamente como microcalcificações. Conclusões: Considerando os dados apresentados e a experiência do serviço, a biópsia por agulhamento continua sendo o principal procedimento para diagnóstico e tratamento de lesões não palpáveis. Trata-se de um método seguro, porém não isento de riscos.

With the increasing use of mammography, more and smaller non- palpable lesions are found, bringing the need of localize them for diagnostic and even therapeutic purposes. We describe the surgical technique, indications and results with the well-known standard procedure of excision after wire localization. Method: We retrospectively evaluated the result of 586 wire localizations between 1995 and 2004. The indications for the procedure were non-palpable mammographic abnormalities classified according to BIRADS system. Results: The main indication for this procedure were microcalcifications in 63.7% of the cases (n=373), followed by lumps 37.2%. The mean age of these patients was 53 years (range 23- 82 years). We observed an overall positive predictive value (PPV) for malignancy of 0.30 (177/586 cases). Benign fybrocistic changes was found as the most common pathological diagnosis (34.1%). Ninety-four per cent of the ductal carcinoma in situ were detected mammographically as microcalcifications. Conclusions: The authors call attention for the use of a very careful and delicate surgical technique in order to achieve the best results. Our experience confirm that the wire-guided excision of non-palpable breast lesions is a safe and reliable diagnostic/therapeutic procedure.

Complicaçöes precoses e localizaçäo do cateter na cateterizaçäo venosa diagnóstico radiológico / Immediate complications and catheter positions in the central venous catheterization: radiographic diagnosis

A cateterizaçäo venosa central tem sido utilizada amplamente com objetivos terapêuticos e diagnósticos. Apesar da relativa simplicidade na sua execuçäo, näo é uma técnica desprovida de riscos. O presente estudo analisou, prospectivametne, 287 cateterizaçöes em 224 pacientes, onde a incidência de complicaçöes e posiçöes incorretas do cateter foram de 4,6% e 36,4% respectivametne. As complicaçöes encontradas näo tiveram relaçäo com a posiçäo do cateter nem com as vias de acessos utilizas, bem com a faixa etária dos pacientes

Peritonite meconial cistica: relato de um caso / Cystic meconium peritonitis: a case report

Peritonite meconial e um importante diagnostico diferencial do abdomen agudo no periodo neonatal devido a sua elevada taxa de mortalidade. Uma evolucao favoravel depende de um diagnostico precoce e tratamento cirurgico imediato. Um caso de peritonite meconial, forma cistica, e apresentado. Esta forma de apresentacao e a menos frequente das tres principais variantes patologicas. O presente caso teve uma ma evolucao e o recem nascido foi ao obito 24 horas apos o nascimento. Sao apresentados os principais aspectos do diagnostico radiologico desta patologia tanto na sua forma cistica quanto nos tipos generalizada e fibroadesiva

Colocaçäo do filtro de veia cava inferior na profilaxia da embolia pulmonar: relato de três casos / Use of vena cava filter in the prophylaxis of pulmonary embolism: three cases reports

A utilizaçäo de filtros de veia cava inferior para prevenir o deslocamento de êmbolos para a circulaçäo pulmonar é a principal alternativa terapêutica nos pacientes com contra-indicaçäo para a anticoagulaçäo plena ou na ineficácia desta. Relatam-se os três primeiros casos de colocaçäo de filtro (Kimray-Greenfield) em veia cava inferior no Hospital de Clínicas de Porto Alegre, devido a recidiva de embolia pulmonar sob anticoagulaçäo. Tanto a colocaçäo por dissecçäo de veia jugular (um caso) quanto por via femoral com técnica transcutânea (dois casos) foram bem sucedidas. Os pacientes tiveram boa evoluçäo do quadro clínico e mantiveram-se assintomáticos após a alta