Beatriz Regina Alvares

Simple rules for ultrasonographic subcategorization of BI-RADS ® -US 4 breast masses

OBJECTIVES To evaluate an objective method for ultrasonographic (US) subcategorization of BI-RADS(®)-US 4 breast masses based on clear and simple rules in order for woman to benefit from a more complete and homogeneous breast mass analysis. METHODS In this cross-sectional study, we selected 330 women, with 339 US breast masses, classified as BI-RADS(®)-US 4. Three physicians experienced in breast imaging independently reviewed all US images, assessing mass shape, margins, orientation, echo texture and vascularity. These experts further subdivided the masses into subcategories 4a, 4b and 4c, according to simple US rules. Inter-observer agreement was calculated for US features categories and for final subcategory assessment. We also estimated the positive predictive value (PPV) for BI-RADS(®)-US subcategories 4a, 4b and 4c assigned by each of the three observers. RESULTS Pathological examination of all masses confirmed 144 (42%) malignant and 195 (58%) benign tumors. Moderate agreement was obtained for mass shape, margins, vascularity and for final BI-RADS(®)-US 4 subcategory. Substantial agreement was obtained for the description of mass orientation and echo texture. The PPV for subcategories 4a, 4b and 4c were, 17%, 45% and 85%, respectively, for the first observer and 20%, 38% and 79% and 17%, 40% and 85% for the other two observers. CONCLUSION Standardization of a US subcategorization of BI-RADS(®)-US 4 breast masses seems to be feasible, with substantial inter-observer agreement and progressive increase in the PPV in the subcategories 4a, 4b and 4c, provided that clear and simple classification rules are defined.

Correlação radiológica e histológica de lesões mamárias não-palpáveis em pacientes submetidas a marcação pré-cirúrgica, utilizando-se o sistema BI-RADS

OBJETIVO: Avaliar as categorias 3, 4 e 5 da classificacao BI-RADS (Breast Imaging Reporting and Data Sys-tem) como fator preditivo para malignidade, correlacionando os achados mamograficos e histologicos emlesoes nao-palpaveis da mama. MATERIAIS E METODOS: Estudo analitico descritivo de 169 mulheres sub-metidas a biopsia cirurgica, apos localizacao estereotaxica de lesoes mamarias nao-palpaveis. As mamogra-fias dessas pacientes foram classificadas de acordo com a quarta edicao do BI-RADS, avaliando-se as cate-gorias 3, 4 (A, B e C) e 5. Correlacionaram-se os achados mamograficos com os exames histologicos daslesoes, avaliando-se o valor preditivo positivo em cada categoria. RESULTADOS: No total de 169 casos,foram diagnosticados 42 casos de câncer (24,8%). Destes, houve apenas um caso na categoria 3, 19 casosna categoria 4 e 22 casos na categoria 5. Os valores preditivos positivos para as categorias 3, 4A, 4B, 4Ce 5 foram, respectivamente, de 3,4%, 10,3%, 11,3%, 36% e 91,7%. As microcalcificacoes foram o achadomais frequente relacionado a doenca maligna, ocorrendo em 61,5% do total. CONCLUSAO: Este estudodemonstrou que a classificacao BI-RADS permite predizer com seguranca que ha alta suspeicao de maligni-dade para achados classificados na categoria 5 e diminuta chance para os achados da categoria 3. Quantoa categoria 4, foi constatada elevacao progressiva dos valores preditivos positivos nas subcategorias A, B eC, mostrando que esta subdivisao contribui de forma mais detalhada e precisa na indicacao de lesoes sus-peitas para malignidade.Unitermos: Câncer de mama; Mamografia; BI-RADS; Diagnostico histologico.Radiological and histological correlation of non-palpable breast lesions in patients submitted to preoperativemarking according to BI-RADS classification.OBJECTIVE: To evaluate the positive predictive value for BI-RADS (Breast Imaging Reporting and Data Sys-tem) categories 3, 4 and 5, correlating mammographic and histological diagnosis in non-palpable breast le-sions. MATERIALS AND METHODS: Analytical-descriptive study of 169 women submitted to stereotacticlocalization for surgical biopsy of non-palpable breast lesions. Mammographic and histological findings werecorrelated, analyzing the predictive positive value for each category. RESULTS: Forty-two (24.8%) caseswere diagnosed with breast cancer — only one in category 3, 19 in category 4, and 22 in category 5. Thepositive predictive value for categories 3, 4A, 4B, 4C and 5 were, respectively, 3.4%, 10.3%, 11.3%, 36%and 91.7%. Microcalcifications were the most frequent finding related to malignancy, present in 61.5% ofthese cases. CONCLUSION: The present study has demonstrated that BI-RADS allows a safe prediction ofhigh suspicion of malignancy in lesions category 5 and low suspicion for category 3. As regards the cat-egory 4, the positive predictive value has shown a progressive increase in subcategories A, B and C, dem-onstrating that this subclassification represents an invaluable contribution for a more detailed and accurateassessment of lesions suspicious for malignancy.Keywords: Breast cancer; Mammography; BI-RADS; Histological diagnosis.

Determinação radiológica do índice e do tamanho craniano por mensuração dos diâmetros cranianos em uma população infantil brasileira

OBJETIVO: Realizar as medidas dos diâmetros cranianos obtidos por metodo radiologico e elaborar, por meio delas, o indice e o tamanho craniano, para comparar com as medidas dos diâmetros e os indices propostos por alguns trabalhos da literatura, principalmente os do estudo de Haas. MATERIAIS E METODOS: Foram avaliados 732 pacientes sem doencas cranianas, medidos seus diâmetros cranianos e, posteriormente, formulados o indice e o tamanho craniano, que mostram as diferentes fases do crescimento do crânio, pelas medidas de tabua interna a tabua interna. RESULTADOS: O estudo comparativo das medias dos diâmetros, por medidas de tabuas internas, mostrou aumento do crescimento francamente progressivo no primeiro ano de vida para ambos os sexos e aumento menor a partir do segundo ano de vida. As medias globais dos diâmetros nao apresentaram diferenca significativa entre os sexos feminino e masculino. CONCLUSAO: O indice e o tamanho craniano sao bons indicadores do crescimento craniano, principalmente nos quatro primeiros anos de vida, quando o crescimento aumenta vertiginosamente no primeiro ano e, posteriormente, ocorre aumento moderado ate os quatro anos de idade. Apos esta idade, ocorre um leve e estavel aumento e seu valor estatistico diminui. Nao houve diferenca estatisticamente significante, no crescimento, para ambos os sexos. Recomenda-se o uso dos valores medios dos diâmetros para ambos os sexos e sugere-se o uso do indice craniano, ate os quatro anos de idade, e o tamanho craniano, apos os quatro anos, sendo ideal para o acompanhamento do crescimento do crânio.

Mammographic artifact leading to false-positive result.

Dear Editor,A female, 75-year-old was referred by another service withprevious screening mammogram demonstrating clustered pleo-morphic microcalcifications in the superolateral quadrant of herleft breast, classified as highly suspicious mammographic find-ings (BI-RADS category 5), to be submitted to mammography-guided needle localization followed by excisional biopsy of thesuspicious lesion.A new mammography demonstrated an apparently benignnodule already present and stable in relation to the findings of theprevious mammogram, besides the presence of clustered pleo-morphic microcalcifications, both findings located in the supero-lateral quadrant of the left breast. The finding of suspicious micro-calcifications drew attention for being a round-shaped cluster(Figures 1A and 1B).A new assessment detected a skin nevus with irregular sur-face presenting with talc residues in the lesion fissures. Once thelesion was marked with a metal clip, a new mammographic im-age revealed that the microcalcifications corresponded to artifactsrelated to the talc residues present on the dermal nevus surface(Figures 1C and 1D). The mammogram was reclassified as be-nign mammographic findings (BI-RADS category 2) and the pa-tient was referred for follow-up at the public basic health network.Except for non-melanoma skin tumors, breast cancer is themost frequent neoplasm with high mortality in women in Bra-zil

Achados normais no exame radiológico de tórax do recém-nascido

O objetivo deste trabalho e descrever os achados normais na radiografia de torax do recem-nascido, os criterios usados para avaliar a qualidade tecnica do exame, assim como o posicionamento correto de sondas, cânulas e cateteres, enfatizando as especificidades dos achados radiologicos relacionados a faixa etaria do paciente. No periodo neonatal, a imagem cardiaca e mais proeminente em virtude da conversao da circulacao fetal, as dobras de pele e as variacoes da imagem timica podem simular doencas, a avaliacao do posicionamento adequado de sondas e cateteres evita iatrogenias, o padrao gasoso intestinal apresenta mudancas relacionadas ao numero de horas de vida do paciente e a presenca dos nucleos de ossificacao secundarios na extremidade proximal dos umeros e processo coracoide esta associada com a idade gestacional a termo do recem-nascido, representando, portanto, um sinal radiologico de desenvolvimento osseo normal. O conhecimento das particularidades e dos aspectos radiologicos normais no torax do recem-nascido evita diagnosticos equivocados, reduz as iatrogenias e representa um valioso suporte no diagnostico e no acompanhamento clinico destes pacientes.Achados normais no exame radiologico de torax do recem-nascido. O objetivo deste trabalho e descrever os achados normais na radiografia de torax do recem-nascido, os criterios usados para avaliar a qualidade tecnica do exame, assim como o posicionamento correto de sondas, cânulas e cateteres, enfatizando as especificidades dos achados radiologicos relacionados a faixa etaria do paciente. No periodo neonatal, a imagem cardiaca e mais proeminente em virtude da conversao da circulacao fetal, as dobras de pele e as variacoes da imagem timica podem simular doencas, a avaliacao do posicionamento adequado de sondas e cateteres evita iatrogenias, o padrao gasoso intestinal apresenta mudancas relacionadas ao numero de horas de vida do paciente e a presenca dos nucleos de ossificacao secundarios na extremidade proximal dos umeros e processo coracoide esta associada com a idade gestacional a termo do recem-nascido, representando, portanto, um sinal radiologico de desenvolvimento osseo normal. O conhecimento das particularidades e dos aspectos radiologicos normais no torax do recem-nascido evita diagnosticos equivocados, reduz as iatrogenias e representa um valioso suporte no diagnostico e no acompanhamento clinico destes pacientes. Unitermos: Recem-nascido; Achados normais; Radiografia de torax.

O uso da ressonância magnética na investigação do câncer mamário

Mammography, ultrasonography and scintimammography are essential examinations for the diagnosis and post-surgical follow-up of patients with breast cancer, although all these modalities may present specific limitations. In recent years magnetic resonance imaging has demonstrated good performance in detecting breast tumors in the mammary gland. In this study the authors describe the magnetic resonance imaging main indications and findings in patients with breast cancer, and compare the performance of mammography, ultrasonography and scintimammography, including the advantages and limitations of each modality.

Uncommon presentation of perforated Meckel's diverticulum in preterm newborn.

Dear Editor,A male neonate with gestational age of 30 weeks, weighting940 g at birth, with respiratory failure right after birth, and radio-logical signs compatible with hyaline membrane disease. At histenth day of life, the patient presented vomiting and abdominaldistention, presenting with radiological signs of pneumoperito-neum (Figure 1).Initially, the neonate was submitted to peritoneal drainage,due to the lack of surgical conditions, and at the 19th day, aftergaining weight and present with hemodynamically stable condi-tions, was submitted to exploratory laparotomy. During the sur-gery, a Meckel’s diverticulum (MD) was found, with jejunal per-foration, hepatic blockage and obstruction distal to the blockagedue to the development of adherence. Resection of about 6 cm ofthe jejunal loop including the perforated area was performed, withlater termino-terminal anastomosis. The anatomopathologicalresult was subacute diverticulitis with ulcer and severe peridiverti-culitis. The neonate presented a favorable evolution and was dis-charged at his 82nd day of life.Meckel’s diverticulum represents the most common con-genital malformation of the digestive tube, and is asymptomaticin most cases

Presence of air in the hepatic portal system in association with umbilical venous catheter malposition

The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

Complex Breast Masses Assessment of Malignant Potential Based on Cyst Diameter

The purpose of this study was to assess whether cyst diameter might contribute to the prediction of malignancy in complex breast masses.

Aspectos radiológicos relevantes no diagnóstico da enterocolite necrosante e suas complicações

Necrotizing enterocolitis is one of the most frequent and severe gastrointestinal emergencies occurring in the neonatal period. Once necrotizing enterocolitis is suspected a simple abdominal x-ray is a routine examination and this film will play an essential role in the diagnosis of the disease and the follow-up care of the patient, as well as in the detection of complications. In the present study we reviewed the pertinent literature and described the radiological findings, illustrated with cases from our institution. We concluded that the radiological diagnosis of necrotizing enterocolitis done at all stages contributes for an immediate therapeutic management, reducing the complications and improving the patients survival.