Orlando José de Almeida

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.

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

Protein expression of c-erbB-2 and p53 in normal ducts, ductal carcinoma in situ and invasive carcinoma of the same breast

CONTEXT AND OBJECTIVE Breast cancer is thought to derive from progressively aberrant, non-invasive breast lesions, but it is not known exactly how invasive breast cancer develops from these lesions. The aim of this study was to verify the changes in c-erbB-2 and p53 protein expression between non-neoplastic ducts, ductal carcinoma in situ and invasive ductal carcinoma found in the same breast. DESIGN AND SETTING This was a cross-sectional study at Centro de Atenção Integral à Saúde da Mulher, Campinas, Brazil. METHODS Fifty-six women with invasive ductal carcinoma and ductal carcinoma in situ in the same breast were included. The expression of c-erbB-2 and p53 proteins was assessed in non-neoplastic and neoplastic cells using immunohistochemical techniques. RESULTS The c-erbB-2 protein was absent in non-neoplastic ducts but was present in 46% and 36% of in situ and invasive carcinoma components, respectively. Only 2% of non-neoplastic ducts, and 18% and 16% of ductal carcinoma in situ and invasive carcinoma components, respectively, were positive for p53 protein. No significant difference in c-erbB-2 and p53 protein expression was observed between in situ and invasive components. The nuclear grade agreement between in situ and invasive carcinoma was very good. CONCLUSIONS The invasiveness of ductal carcinoma in situ seems to be independent of the Her-2/neu and TP53 genes. The general features of an occurrence of breast carcinoma are formulated at the outset of carcinogenesis, and the Her-2/neu and TP53 genes are involved.

Fat necrosis associated with the use of oral anticoagulant therapy: atypical mammographic findings.

Radiol Bras. 2016 Jul/Ago;49(4):267–276 269 http://dx.doi.org/10.1590/0100-3984.2015.0130 left posterior temporal lobe that was distant from the aneurysm and from any subarachnoid cisterns. The case presented here is important because it establishes a mechanism for remote bleeding. In previous reports, a variety of explanations for distant hemorrhage have been proposed, including hypertensive crisis, the formation of jets through subarachnoid cisterns, venous infarction, intraluminal thrombosis, hemorrhagic infarction secondary to vasospasm, and occult vascular anomaly. However, none of those reports provided direct evidence to support any of the proposed mechanisms. In contrast, in our case, we observed definite angiographic evidence of vasospasm in the vessels between the aneurysm and the site of hemorrhage. That constitutes a strong indication that vasospasm-associated hemorrhagic infarction is a mechanism of remote hematoma formation following cerebral aneurysm rupture. In conclusion, we have described a case of ACA aneurysm rupture presenting as remote intraparenchymal hemorrhage in the splenium of the corpus callosum and have demonstrated that vasospasm-induced hemorrhagic infarction is a plausible mechanism for distant bleeding. Neuroradiologists and neurosurgeons should be aware of this rare phenomenon in order to reduce the likelihood of inappropriate treatment.

Clinical, mammographic and histopathological correlation of breast cancer in women aged between 50 and 70 years

Objetivo: Correlacionar os achados clínicos, mamográficos e histopatológicos de mulheres na faixa etária entre 50 e 70 anos que tiveram diagnóstico de câncer mamário e foram atendidas, entre 1998 e 2013, no Ambulatório de Mastologia do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-Unicamp). Métodos: Trata-se de um estudo de corte transversal e retrospectivo, no qual foram analisados os prontuários e as mamografias de 160 mulheres, tamanho amostral suficiente para a análise estatística. As variáveis usadas para comparação foram os achados clínicos, mamográficos e histopatológicos, analisados por meio da estatística descritiva e associativa. Resultados: Entre os 160 casos analisados, 76,9% eram sintomáticos e os principais achados clínicos incluíram nódulo palpável (68,1%) e alterações de pele (30%). As apresentações mamográficas prevalentes nas mulheres assintomáticas foram microcalcificações (48,7%), nódulos (43,2%) e distorção arquitetural (8,1%). Com relação ao tipo histológico, 81,3% apresentaram carcinoma ductal invasivo (CDI) e 10,7%, carcinoma ductal in situ (CDIS). Conclusão: O presente trabalho evidenciou que houve uma predominância de mulheres sintomáticas, com apresentação mamográfica de nódulos espiculados e tipo histológico de CDI. Já nas demais pacientes com lesões detectadas no exame de rastreamento predominaram as microcalcificações pleomórficas como o principal achado do CDIS. A mamografia diagnóstica foi a principal forma de detecção do câncer mamário, podendo representar a falta de acesso dessas mulheres aos exames de rastreamento ou à não detecção precoce das lesões malignas, o que revela a necessidade de melhorar as ações de controle e os protocolos de atendimento dessas pacientes.

Punção aspirativa por agulha fina: desempenho no diagnóstico diferencial de nódulos mamários palpáveis

Objetivo: avaliar, de forma prospectiva, o desempenho da puncao aspirativa por agulha fina (PAAF) no diagnostico diferencial de nodulos mamarios palpaveis. Metodo: avaliaram-se a sensibilidade, a especificidade, os valores preditivos e a acuracia deste teste em 102 mulheres com idade superior a 30 anos, com nodulos mamarios palpaveis, atendidas na Universidade Estadual de Campinas. As puncoes foram realizadas por um unico examinador. Resultados: o procedimento teve sensibilidade de 97%, especificidade de 87%, valor preditivo positivo de 94% e negativo de 93%. A taxa de material insuficiente ou insatisfatorio foi de 16% na primeira puncao, diminuindo para 2% com uma nova PAAF. Conclusoes: Este teste mostrou-se altamente sensivel e especifico no diagnostico diferencial de nodulos mamarios palpaveis, reafirmando-se a sua grande importância na abordagem clinica de nodulos palpaveis.