Régis Resende Paulinelli

Risk of Malignancy in Solid Breast Nodules According to Their Sonographic Features

The purpose of this study was to assess the risk of malignancy for each type of sonographic feature in solid breast nodules.

A situação do câncer de mama em Goiás, no Brasil e no mundo: tendências atuais para a incidência e a mortalidade

O câncer de mama apresenta elevada incidencia e mortalidade em todo o mundo, representando um grave problema de saude publica. A incidencia dessa neoplasia vem aumentando nas ultimas decadas, mesmo em areas de tradicional baixa incidencia, em grande parte devido as mudancas nos habitos de vida e no perfil epidemiologico da populacao. Varios paises desenvolvidos tem conseguido, apesar desse aumento na incidencia, reduzir a sua mortalidade, atraves de um diagnostico mais precoce e de um tratamento mais eficaz. Nesse artigo comentamos as tendencias atuais para o câncer de mama em varios locais do mundo, de forma comparativa, bem como os possiveis fatores envolvidos nessas mudancas. Dispensamos particular atencao a situacao do Brasil, e da cidade de Goiânia.

Association between maternal and fetal weight gain: cohort study

CONTEXT AND OBJECTIVE Excessive gestational weight gain is related to many complications (both maternal and fetal), such as macrosomia. The most common complications in macrosomic fetuses include: increased risk of intrauterine death, need for intensive care, fractures, neonatal hyperbilirubinemia, paralysis of the brachial plexus and obesity in childhood and adulthood. The aim of this study was to evaluate the association between gestational and fetal weight gain and the incidence of macrosomia in two maternity hospitals. DESIGN AND SETTING Cohort study in two public maternity hospitals in Goiânia, Brazil. METHODS This was a cohort study on 200 healthy pregnant women with normal body mass index, divided into two groups: one with normal weight gain and the other with excessive weight gain during pregnancy. RESULTS The cohorts were similar regarding maternal age, per capita income, schooling level and reproductive behavior. The fetal weight was greater in the cohort with excessive maternal weight gain (3,388.83 g ± 514.44 g) than in the cohort with normal weight (3,175.86 g ± 413.70 g) (P < 0.01). The general incidence of macrosomia was 6.5%: 13.0% (13 cases) in the cohort with excessive maternal weight gain and 0.0% (0 cases) in the cohort with adequate weight gain. CONCLUSION Excessive maternal weight gain was associated with increased fetal birth weight and incidence of macrosomia.

Estudo Prospectivo das Características Sonográficas no Diagnóstico de Nódulos Sólidos da Mama

Purpose: to evaluate, in a prospective way, the importance of ultrasound features of solid breast lesions in the differentiation between benign and malignant lumps. Methods: one hundred and forty-two patients with solid breast lesions, from the Department of Gynecology and Obstetrics of the Federal University of Goias (Brazil), were included in the trial. All ultrasound examinations were performed by a training doctor, always supervised by an experienced professional. The characteristics of the lesions studied were: shape, retrotumoral echoes, internal echoes, oriented diameter, halo of bright echoes and Cooper ligaments. Each of the ultrasound features was compared to the results of the histological examination. Results: among the 142 patients included in the trial, 90 (63%) had their lesions excised, and 77 (86%) had pathologic diagnoses of benign tumors and 13 (14%) of malignant tumors. The following characteristics were statistically significant in the diagnosis of the breast cancer (c2): masses with retrotumoral shadowing (p=0.0001), irregular shape (p=0.0007), heterogeneous internal echoes (p=0.0015) and vertically oriented - taller than wide (p<0.0001). The presence of halo of bright echoes anterior to the lump and the presence of wider Cooper ligaments were not related to the correct diagnosis of malignancy in this trial. Conclusion: ultrasound is a diagnostic method that can help physicians between the differentiation of benign and malignant breast lumps. The presence of retrotumoral shadowing, irregular shape, heterogeneous internal echoes and vertical orientation - lesions taller than wide - were related to the pathologic diagnosis of breast malignancies.

Comparação de métodos de avaliação da gordura corporal total e sua distribuição

OBJECTIVE To compare two methods for evaluating total body fat and its distribution. METHODS Cross-sectional, cohort-nested study. Sixty-two women received a nutritional status evaluation which included total body fat (BF) obtained through the sum of skinfolds (ΣSF) and bioimpedance (BIA). Visceral fat distribution was measured using ultrasonography (USG) (intra-abdominal fat thickness) (IAT) and waist circumference (WC). The concordance correlation coefficient (CCC) and the determination coefficient (r²) were calculated. RESULTS Mean patient age was 48.19 (8.99) years. Thirty-six women (58.06%) had a very large WC and 42 (67.74%) had high body fat. There was moderate concordance (r² = 0.42; CCC = 0.59; p < 0.01) between the methods for determining body fat (%) and optimal concordance (r² = 0.90; CCC = 0.91; p < 0.01) for body fat (kg) determined by BIA and ΣSF. The comparison between WC and IAT (USG) showed moderate concordance (r² = 0.49; p < 0.01) between the methods. CONCLUSIONS Moderate concordance in determining total body fat (%) and optimal concordance in determining body fat (kg) were found between the methods. Moderate concordance was found between the methods for determining body fat distribution.

Prevalence of vulvovaginitis and bacterial vaginosis in patients with koilocytosis

CONTEXT AND OBJECTIVE Empirical discussion regarding an association between koilocytosis and vulvovaginitis often occurs. Thus, the objective of this study was to assess the prevalence of microorganisms associated with bacterial vaginosis and vulvovaginitis in women with and without koilocytosis. DESIGN AND SETTING Analytical cross-sectional study including two cohorts of women (with and without koilocytosis) who attended a cancer hospital in the city of Goiânia, state of Goiás. METHODS A total of 102 patients entered the study. The whiff test, Gram and Papanicolaou staining and bacterial and fungal culturing were performed. The results were observed using univariate analysis. The odds ratio and confidence interval (CI) of the variables were calculated; P-values < 0.05 were considered significant. RESULTS The prevalence of bacterial colonization was similar in patients with and without koilocytosis. The odds ratio for candidiasis was 1.43 (CI 1.05-1.95) and the odds ratio for trichomoniasis was 1.78 (CI 1.49-2.12), in patients with koilocytosis. CONCLUSIONS The prevalence of candidiasis and trichomoniasis seems to be higher in patients with koilocytosis.

Modified radical mastectomy sparing one or both pectoral muscles in the treatment of breast cancer: intra and postoperative complications

CONTEXT AND OBJECTIVE Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS The patients demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (+/- 29.9) and 102 minutes (+/- 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (+/- 7.6) for Patey and 19.8 (+/- 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeons discretion.

Prevalence of bacteria in the nipple discharge of patients with duct ectasia

The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI‐PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non‐infectious inflammatory process.

Sonobreast: Predicting Individualized Probabilities of Malignancy in Solid Breast Masses with Echographic Expression

Abstract:  To create an individualized predictive tool for the risk of malignancy in solid breast masses, based on echographic and clinical characteristics. Research Ethics Committee approval and informed consent were obtained. This multi‐center study included 1,403 solid breast masses prospectively. Each ultrasound feature was analyzed and compared with the definitive diagnosis. The ultrasound results, women’s ages and family histories of breast cancer were included in a multivariate logistic regression model. Among the 1,403 lesions included in the study, 1,390 (99.1%) had a conclusive diagnosis: 343 malignant tumors (24.7%), and 1,047 benign masses (75.3%). The odds ratio (and confidence interval) for breast malignancy for each variable included in the model, as calculated by multivariate analysis, were as follows: irregular shape/noncircumscribed margins, 16.02 (7.75–33.09); heterogeneous echo texture, 4.50 (2.42–8.23); vertical orientation (not parallel to the skin), 2.23 (1.04–4.75); anterior echogenic rim, 2.62 (1.09–6.31); posterior shadowing, 2.38 (1.23–4.62); age more than 40 years, 2.19 (1.26–3.81); positive first‐degree family history (mother, sister or daughter), 7.50 (2.65–21.18). There was no advantage in including the presence of internal vascularity, presence of thickened Cooper’s ligaments or size of the mass, in the model. The predictive tool was named SONOBREAST and it is freely available for medical purposes on the internet site: http://www.sonobreast.com. The probability of malignancy in breast masses can be specified based on their ultrasound features, the woman’s age and the family history of breast cancer.

Fine-needle aspiration biopsy for breast lesions: a comparison between two devices for obtaining cytological samples

CONTEXT AND OBJECTIVE Fine-needle aspiration biopsy has been accepted worldwide for breast lesions. However, some questions remain, including the appropriateness of the puncture method. The objective of this work was to compare aspirates obtained by the auto-vacuum device and by the syringe pistol holder. DESIGN AND SETTING Randomized trial for validation of diagnostic method, at Hospital das Clínicas da Universidade Federal de Goiás and Hospital Araújo Jorge, Goiânia. METHODS 351 patients presenting breast lumps underwent fine-needle aspiration biopsy, either with the auto-vacuum device or the syringe pistol holder. A single cytopathologist analyzed all of the cytology slides. The rates of insufficient material, cellularity, cell distortion and background hemorrhage were evaluated. RESULTS The percentages of insufficient material were 16% and 22% (p = 0.18), for the auto-vacuum and pistol aspirates, respectively. Good cellularity was seen in 34% of auto-vacuum and 29% of pistol samples (p = 0.4). Cell distortion was seen in 31 and 26 cases, respectively (p = 0.7). Background hemorrhage occurred in 63 (35%) and 54 cases (31%) (p = 0.2), for auto-vacuum and pistol. The sensitivity was 88% and 86%; specificity 99% and 100%, positive predictive value 96% and 100%, negative predictive value 96% and 95% and total accuracy 76% and 75% for the auto-vacuum and pistol, respectively. CONCLUSION The results obtained from the two fine-needle aspiration biopsy methods were equivalent. Therefore, the auto-vacuum device is a good option for obtaining aspirates for cytology.