OBJECTIVE: Breast cancer is one of the most important causes of death in women. The association of different diagnostic methods has been successfully employed as a means to enhance early diagnosis. In this scenario, the interventional and diagnostic breast ultrasound has played a significant role. This study has two main objectives: to identify echographic criteria related to benignancy and malignancy and to analyze echographic characteristics, evaluating their role as malignancy predictors. MATERIALS AND METHODS: Echographic morphological criteria adopted in the images description were: shape, limits, contour, echogenicity, echotexture, echotransmission, lesion orientation, and secondary signs. Validation was sought on 450 echographic images compared with follow-up and histopathological results. RESULTS: Main benignancy criteria were: well defined shape, regular contour, precise limits, lesions isoechoic to fatty tissue, homogeneous echotexture, and horizontal orientation. The criteria more typically related to malignancy were: ill-defined shape, irregular contour, partially precise limits, and hypoechogenicity. Contour irregularity has presented the greatest sensitivity (92.7%) as well as the highest negative predictive value (98.2%), while vertical orientation of the lesion has presented the greatest specificity (99.3%), and ill-defined shape, the highest positive predictive value (91.0%). CONCLUSION: The standardization of the method for characterization and description of breast ultrasound images has resulted in reports uniformization and optimization, allowing more appropriate therapeutic decisions.

Keywords: Ultrasound, Breast lesions, Diagnosis

Objective: To assess the performance of morphometric parameters calculated from breast lesion contours at ultrasonography, in the quantification of morphological features and in the distinction among BI-RADS categories 2, 3, 4 and 5. Materials and Methods: The present casuistry included 40 cases, with orthogonal imaging of patients submitted to surgery. Based on the lesions segmentation, the following five morphometric parameters were calculated: area ratio, overlap ratio, normalized residual value, circularity and depth-to-width ratio. Linear discriminant analysis was applied to select the best parameters, and ROC curve was utilized as figure of merit. Results: Overlap ratio was able to statistically distinguish breast lesions classified as BI-RADS 3 from others classified as BI-RADS 4 (α = 5%; p = 0.015). Additionally, such parameter presented the best performance in the differentiation between malignant and benign breast lesions. Conclusion: These results indicate that morphometric analysis of breast lesions at ultrasonography seems to be helpful in distinguishing patients who should undergo biopsy from those to be followed-up only with imaging methods.

Keywords: Breast ultrasonography; BI-RADS; Computer-assisted image processing; Computer-assisted image interpretation.

Mammography is the best method for early detection of breast cancer. Nevertheless, approximately 10% to 30% of breast lesions are missed at screening due to limitations of human observers. Computer-aided detection (CAD) is a relatively new technology that has been implemented in some mammography services to allow a double reading of mammograms. Clinical studies have demonstrated that CAD increases the sensitivity by up to 21% in the detection of breast cancer by radiologists. A CAD system is useful in situations where there is a high interobserver variability, lack of trained observers, or impossibility to perform the double reading with two or more radiologists. The objective of the present review is based on the need to get the medical community acquainted with this tool as an auxiliary, quantitative and non-operator-dependent method, to improve the diagnosis of breast cancer.

Keywords: Breast cancer; CAD; Double reading.

OBJECTIVE: To demonstrate the frequency of malignancy and histological characteristics of lesions in patients submitted to vacuum-assisted breast biopsy guided by magnetic resonance imaging (MRI). MATERIALS AND METHODS: This was a retrospective study of MRI-guided vacuum-assisted breast biopsies performed between April 2008 and December 2016, in which we analyzed clinical and epidemiological data, as well as the BI-RADS classification and histopathological results. We compared nodules and non-nodular enhancements, in terms of their correlation with malignancy, using chi-square test. RESULTS: Among 215 cases referred for MRI-guided vacuum-assisted breast biopsy, the procedure was contraindicated in 10 cases (5%) and was technically feasible in the remaining 205 (95%). Non-nodular enhancements were observed in 135 cases (66%), and nodules were observed in 70 (34%), with a mean diameter of 2.2 cm (range, 0.5-9.6 cm) and 0.97 cm (range, 0.5-2.2 cm), respectively. Of the 205 lesions analyzed, 43 (21%) were malignant, 129 (63%) were benign, and 33 (16%) were classified as high-risk lesions. The most common histological findings were invasive ductal carcinoma and, in high-risk cases, lobular neoplasia. There was no significant difference between nodules and non-nodular enhancements in terms of the rate of malignancy (p = 0.725). CONCLUSION: In our sample, the overall malignancy rate was 21%. However, to improve the assessment of these results, it is necessary to correlate them with the surgical data and with data from the follow-up of benign cases.

Keywords: Image-guided biopsy/methods; Breast; Magnetic resonance imaging; Breast neoplasms/diagnosis.

OBJECTIVE: To evaluate the main technical limitations of automated breast ultrasound and to determine the proportion of examinations excluded. MATERIALS AND METHODS: We evaluated 440 automated breast ultrasound examinations performed, over a 12-month period, by technicians using an established protocol. RESULTS: In five cases (1.1%), the examination was deemed unacceptable for diagnostic purposes, those examinations therefore being excluded. CONCLUSION: Automated breast ultrasound is expected to overcome some of the major limitations of conventional ultrasound in breast cancer screening. In Brazil, this new method can be accepted for inclusion in routine clinical practice only after its advantages have been validated in the national context.

Keywords: Ultrasonography, mammary/methods; Breast neoplasms/diagnostic imaging; Breast density; Early detection of cancer/methods; Mass screening/methods.