OBJECTIVE: The present study was aimed at evaluating the BI-RADS® classification accuracy in mammography. Additionally, the frequency of different findings was described and the interobserver agreement was evaluated. MATERIALS AND METHODS: Mammographic images of 115 patients were independently and blindly reviewed by two specialists in compliance with BI-RADS recommendations, and later compared with histological data. The BI-RADS accuracy in mammography was evaluated. The interobserver agreement was analyzed with the Cohen's kappa (κ) test, and the differences between groups were evaluated with the chi-squared test. RESULTS: The present study demonstrated that the mammographic accuracy ranged from 75% to 62% in the differentiation between benign and malignant lesions with the utilization of the BI-RADS classification. Statistically significant interobserver agreement was observed in the description of masses margins (κ= 0.66). A low agreement rate was identified in the description of masses borders (shape) (κ= 0.40) and calcifications, both in relation to their distribution (κ= 0.24) and morphology (κ= 0.36). CONCLUSION: The present study demonstrated the BI-RADS accuracy in the differentiation between benign and malignant lesions. The interobserver agreement was poor in the analysis of calcifications morphology and distribution, but a progressive increase in the positive predictive values was observed in the subcategory 4.

Keywords: Breast cancer, Mammography, Histopathology, Accuracy, BI-RADS, Ultrasonography

OBJECTIVE: The main purpose of the present study is to evaluate the accuracy of ultrasonography (BI-RADS) in the diagnosis of breast cancer whereas the additional specific objectives are to describe the frequency of different sonographic findings and evaluating interobserver agreement. MATERIALS AND METHODS: Images of 110 patients who had been referred for biopsy with previous diagnosis of breast nodules were independently reviewed by two specialists according to the BI-RADS classification. Histological findings were utilized as a gold-standard. The accuracy of findings was determined. The chi-squared test for categorical variables was utilized in the analysis of the differences resulting from the groups comparison, and the interobserver agreement was calculated with kappa () statistics. RESULTS: Among 110 breast masses evaluated by ultrasonography, 76 (69%) were benign and 34 (30.9%) were malignant. According to the radiologists, the sensitivity ranged from 70.5% to 82.3%, negative predictive value, from 81.1% to 87.5%, positive predictive value, from 42.1% to 45.1%, specificity from 56.58% to 55.2%, and accuracy from 60.9% to 63.6%. The global interobserver agreement was considered as moderate ( = 0.50). CONCLUSION: The fourth edition of BI-RADS provides radiologists with an accurate clinical decision support system for the diagnosis and management of breast disease.

Keywords: Breast cancer, Ultrasonography, BI-RADS, Anatomopathological, Accuracy

OBJECTIVE: To identify the characteristics of physicians in the State of Goiás, Brazil, regarding patient management, beliefs, opinions and knowledge about breast cancer. MATERIALS END METHODS: A total of 592 questionnaires were mailed to gynecologists, mastologists and geriatricians. The survey covered the following main aspects: 1 - socio-demographic characteristics (sex, age, year of graduation, private or public practice); 2 - ability to recognize breast cancer risk factors; 3 - implementation of educational activities for the patients; 4 - perception of obstacles to breast cancer screening; 5 - generic questions. RESULTS: The total number of answered questionnaires was 105 (21.2%); 70.5% were male physicians; mean age was 43.9 years (26-70 years); 73.5% had 20 years or less of graduation; 88.6% were gynecologists, 4.8% gynecologists/mastologists, 3.8% mastologists and 2.8% geriatricians; 62.5% were practicing in private and public clinics. Only 13.3% of the physicians recognized the five breast cancer risk factors presented. Approximately 95% of the physicians attended continuing medical education courses in the last two years previous to the survey. CONCLUSION: Breast cancer screening guidelines seemed to be misleading for most physicians. The answers regarding educational activities were sometimes contradictory. The beliefs and opinions regarding breast cancer screening were strongly positive. Insufficient number of equipments and the high cost of the tests were pointed out as obstacles to breast cancer screening.

Keywords: Mammography, Screening, Breast cancer

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.

Keywords: Magnetic resonance imaging, Mammography, Ultrasonography, Scintimammography, Breast cancer

We studied the profile of 2,000 women who were submitted to mammography studies at a public hospital and at a private clinic in the city of Goiânia, GO, Brazil. Data were collected through interviews. The mean age of the women was 49 years. Most women resided in the city, 11.5% had not breastfed whereas two thirds had breastfed for more than 6 months. Hormone-replacement therapy was used by over 20% of the women, of which one fifth had never been submitted to a mammography study. Family history of breast cancer was reported in 13.3% of the women examined at the public hospital and in 7.5% of the women examined at the private clinic. Of these, 28.67% and 33.33%, respectively, had never been submitted to a mammography study before. Screening for cancer was the main cause that motivated the exam. A great number of the interviewed women had not been submitted to a mammography study due to the lack of a medical request, or simply because they considered it unnecessary at the time of request.

Keywords: Mammography, Breast cancer, Screening

Objetivo: A principal utilidade da tomografia por emissão de pósitrons com 18-fluordeoxiglicose (FDG-PET) está no estadiamento do câncer de pulmão. Porém, ela também pode ser utilizada para diferenciar lesões pulmonares indeterminadas, mas seu impacto na ressecção cirúrgica de lesões benignas é desconhecido. O objetivo deste estudo foi comparar a prevalência de lesões benignas em toracotomias feitas por suspeição de câncer de pulmão, antes e após a introdução do FDG-PET, em um centro de referência de cirurgia torácica. Materiais e Métodos: Os autores analisaram, prospectivamente, uma base de dados cirúrgicos de todos os pacientes consecutivos submetidos a toracotomia por câncer de pulmão suspeito ou comprovado e compararam a prevalência de lesões benignas em dois grupos ao longo de dois anos consecutivos, respectivamente antes (grupo I) e depois (grupo II) da introdução da FDG-PET. Resultados: Ressecção cirúrgica foi feita em 1.233 pacientes durante o período do estudo. A prevalência de lesões benignas na cirurgia nos grupos I e II foi similar (44/626 e 41/607, ambas correspondendo a 7%), e também no grupo II, entre aqueles submetidos a FDG-PET e os restantes (21/301 e 20/306 respectivamente, ambos correspondendo a 7%). No grupo II, dos 21 pacientes com lesões benignas submetidos a FDG-PET, 19 tiveram um estudo falso-positivo (valor médio padrão de captação 5.3 [faixa 2.6–12.7]). Desses, respectivamente 13 e 4 pacientes tiveram broncoscopia não diagnóstica e biópsia transtorácica percutânea de pulmão antes da toracotomia. Não houve diferença na proporção de lesões benignas diferentes ressecadas entre o grupo I e aqueles submetidos a FDG-PET no grupo II. Conclusão: A introdução da FDG-PET não alterou a proporção de pacientes submetidos a toracotomia por lesões benignas, principalmente devido à avidez pelo isótopo de algumas lesões não malignas. Tais resultados falsos-positivos devem ser considerados nos casos em que se contempla a possibilidade de ressecção cirúrgica em pacientes com câncer de pulmão não confirmado.

Keywords: Tomografia por emissão de pósitrons; Tomografia computadorizada; Pulmão – lesões benignas ou congênitas; Câncer de pulmão – diagnóstico e estadiamento; Câncer de pulmão – cirurgia.

Objetivo: Avaliar a percepção de médicos residentes em radiologia de 4º ano sobre as melhores modalidades de imagem na investigação de neoplasias e trauma. Materiais e Métodos: Vinte e sete médicos residentes de 4º ano de quatro programas de residência em radiologia americanos participaram do estudo. Aos participantes foi perguntado sobre a melhor modalidade de imagem para se avaliar o cérebro e a coluna vertebral, pulmões, abdome e o sistema musculoesquelético. As modalidades de imagem disponíveis foram: RM, TC, ultrassonografia, PET e radiografia simples. Todos os achados foram comparados com os Critérios de Adequação de Exames de Imagem e Radioterapia do ACR. Resultados: A RM foi escolhida como melhor modalidade de imagem para se avaliar neoplasias encefálicas, espinhais, abdominais e musculoesqueléticas por 96,3%, 100%, 70,4% e 63% dos residentes, respectivamente. A TC foi escolhida por 88,9% dos residentes para avaliar neoplasias pulmonares. A modalidade de imagem ótima para se avaliar trauma foi a TC para lesões encefálicas (100%), espinhais (92,6%), pulmonares (96,3%), abdominais (92,6%) e grandes lesões traumáticas musculoesqueléticas (74,1%); a RM foi escolhida para lesões esportivas (96,3%). Observou-se concordância com os critérios de adequação do ACR. Conclusão: Houve concordância entre a percepção dos residentes sobre as melhores modalidades de imagem para avaliação de neoplasias e trauma e os critérios de adequação do ACR.

Keywords: Formação de residentes; Educação médica; Modalidades de imagem.

OBJETIVO: Este estudo teve por finalidade avaliar a perfusão miocárdica de pacientes com diabetes mellitus tipo 1 (DM1) e tipo 2 (DM2) assintomáticos, sem diagnóstico prévio de doença arterial coronariana (DAC) ou acidente vascular cerebral. MATERIAIS E MÉTODOS: Cinquenta e nove pacientes consecutivos (16 DM1, 43 DM2) foram submetidos a cintilografia de perfusão miocárdica com sestamibi-^99mTc (CPM). Foram avaliados quanto ao índice de massa corpórea, controle metabólico do diabetes, dislipidemia, terapia para o diabetes, hipertensão arterial sistêmica, nefropatia, retinopatia, neuropatia periférica, tabagismo e história familiar de DAC. RESULTADOS: CPM foi anormal em 25,4%: 12 (20,3%) com alterações de perfusão e 3 com disfunção ventricular esquerda isolada. Os mais fortes preditores de perfusão miocárdica anormal foram: idade igual ou maior a 60 anos (p = 0,017, odds ratio [OR] = 6,0), neuropatia periférica (p = 0,028, OR = 6,1), nefropatia (p = 0,031, OR = 5,6) e ECG de esforço positivo para isquemia (p = 0,049, OR = 4,08). CONCLUSÃO: A isquemia miocárdica silenciosa ocorre em mais de um em cada cinco diabéticos assintomáticos. Os mais fortes preditores de isquemia foram: idade avançada, neuropatia periférica, nefropatia, retinopatia e ECG de esforço positivo para isquemia.

Keywords: Diabetes mellitus; Cintilografia de perfusão miocárdica; Isquemia miocárdica silenciosa; Doença arterial coronariana.

OBJETIVO: Avaliar a completude das fissuras, resposta radiológica ao tratamento e análise quantitativa por TC (AQTC) em população de pacientes com enfisema grave submetidos ao implante de valvas endobrônquicas (VEB). MATERIAIS E MÉTODOS: Foram estudados exames de TC multidetectores de 29 pacientes, realizados com protocolo de baixo dose, cortes finos, sem contraste. Dois radiologistas revisaram, retrospectivamente, os exames em consenso. A completude das fissuras foi estimada em escala de 5% e a resposta radiológica (atelectasia/perda volumétrica do lobo alvo) foi avaliada. AQTC foi realizada nos exames pré e pós-tratamento utilizando programa completamente automático. RESULTADOS: Resposta radiológica positiva foi vista em 16/29 pacientes. Os 13 pacientes sem resposta à TC apresentavam fissuras incompletas e completude média das fissuras obliquas de 72,8%, contra 88,3% no outro grupo. Os resultados mais significativos da AQTC mostraram redução do volume pulmonar (VP) total (média de 542 ml), VP tratado (700 ml) e volume de enfisema (331,4 ml) no grupo com resposta positiva, que também apresentou melhora nos testes funcionais. CONCLUSÃO: O benefício das VEB é maior em pacientes com fissuras completas e que desenvolvem atelectasia lobar. Nos pacientes sem resposta radiológica encontramos maior prevalência de fissuras incompletas e grau de incompletude das fissuras. Nossa AQTC automática detectou as alterações pós-tratamento, principalmente considerado a análise do pulmão tratado.

Keywords: Enfisema; Terapia de colapso pulmonar; Tomografia computadorizada.

Axillary staging of patients with early-stage breast cancer is essential in the treatment planning. Currently such staging is intraoperatively performed, but there is a tendency to seek a preoperative and less invasive technique to detect lymph node metastasis. Ultrasonography is widely utilized for this purpose, many times in association with fine-needle aspiration biopsy or core needle biopsy. However, the sonographic criteria for determining malignancy in axillary lymph nodes do not present significant predictive values, producing discrepant results in studies evaluating the sensitivity and specificity of this method. The present study was aimed at reviewing the literature approaching the utilization of ultrasonography in the axillary staging as well as the main morphological features of metastatic lymph nodes.

Keywords: Breast cancer; Axillary lymph nodes; Axillary ultrasonography; Morphological features.

Sarcomas of the breast belong to a heterogeneous group of breast tumors of mesenchymal origin, without epithelial components. These tumors can be primary or secondary (after previous treatment for breast cancer), are rare, present aggressive behavior, and have a poor prognosis. They occur mainly in women between 45 and 50 years of age, with the exception of angiosarcomas, which can occur in younger patients. Clinically, breast sarcomas manifest as palpable, mobile, rapidly growing masses, without skin thickening, axillary lymphadenopathy, or nipple discharge. Although the imaging findings are non specific, they can be suggestive of sarcoma. For instance, a solitary mass showing rapid growth, with circumscribed or indistinct margins and, a complex (solid-cystic) or heterogeneous echotexture, without axillary lymph node involvement, can raise the suspicion of sarcoma. The treatment is not well established, because of the rarity and heterogeneity of this type of neoplasm. The principles of treatment for sarcoma of the breast have been addressed only in small cohort studies. In most cases, the treatment of choice is surgery without axillary lymphadenectomy.

Keywords: Breast cancer; Sarcoma; Mammography; Ultrasonography; Magnetic resonance imaging.

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.

Os nervos cranianos representam extensões das estruturas funcionais do cérebro que cruzam a cabeça e o pescoço. Eles estão ligados a diferentes estruturas cranianas e se relacionam com diversas doenças. Uma compreensão profunda de sua complexa anatomia e aparência normal de imagem permite ao examinador identificar e caracterizar com mais precisão as anormalidades. A ressonância magnética com contraste é uma importante ferramenta para avaliar essas estruturas, especialmente as sequências tridimensionais de precessão livre de estado estacionário, que proporcionam alta resolução espacial e de partes moles, apesar da fina espessura dos nervos cranianos. Na maioria dos casos, os achados de imagem são inespecíficos, e uma anamnese completa, exame físico dirigido e testes laboratoriais são necessários para estreitar o diagnóstico diferencial. Este ensaio iconográfico ilustra e discute doenças congênitas, traumáticas e vasculares dos nervos cranianos, mostrando imagens em uma abordagem fisiopatológica.

Keywords: Neuroimagem/métodos; Radiologia/métodos; Ressonância magnética/métodos; Nervos cranianos/diagnóstico por imagem.

OBJETIVO: Avaliar os padrões tomográficos relacionados aos agentes etiológicos da pneumonia em pacientes durante o primeiro ano após transplante renal. MATERIAIS E MÉTODOS: Foram analisados dados de prontuários de 956 pacientes submetidos a transplante renal, no período de 2013 a 2018, em um centro transplantador renal do nordeste do Brasil. Nos pacientes que desenvolveram pneumonia, os agentes etiológicos foram classificados em bactérias piogênicas, micobactérias, fungos, vírus e pneumonia polimicrobiana, enquanto os padrões tomográficos foram classificados em consolidação, broncopneumonia, pneumonia intersticial e nódulos e massas. Para verificar associação estatística entre micro-organismos e padrões tomográficos, foi utilizado o teste exato de Fisher, com p < 0,001. RESULTADOS: Foram encontrados 101 casos de pneumonia, dos quais 60 (59,4%) tiveram agente etiológico identificado, sendo as bactérias piogênicas as mais frequentes, detectadas em 22 (36,7%) dos casos. Entre os pacientes com agente causal identificado, o padrão tomográfico predominante foi o de nódulos e massas, identificado em 25 (41,7%) casos. Foi observada associação entre bactérias piogênicas e o padrão de consolidação, fungos com nódulos e massas, bem como entre agentes virais e padrão intersticial. CONCLUSÃO: Foi demonstrada associação estatística entre micro-organismos causadores de pneumonia e padrões tomográficos, informação que pode contribuir para o planejamento da terapia de pacientes transplantados renais.

Keywords: Pneumonia; Transplante de rim; Tomografia computadorizada.

Accurate preoperative assessment of axillary lymph node status is essential for guiding treatment in early-stage breast cancer. Because clinical examination alone is often inadequate, imaging modalities such as axillary ultrasonography (AUS), mammography, and magnetic resonance imaging (MRI) are integral to axillary staging. Obese women with breast cancer have poorer oncologic outcomes than do their non-obese counterparts, which raises concerns about potential limitations in diagnostic performance due to a high body mass index (BMI). The objective of this study was to evaluate the diagnostic performance of clinical examination, AUS, mammography, and MRI in detecting axillary metastases in overweight and obese women with early-stage breast cancer. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy guidelines. We included studies assessing the diagnostic accuracy of clinical and imaging modalities for detecting axillary metastasis in overweight and obese women. Methodological quality was assessed by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity and specificity data were extracted when available, and summary receiver operating characteristic curves were constructed. Nine studies met the inclusion criteria. The most frequently evaluated modality was AUS, which consistently demonstrated preserved diagnostic performance across weight groups; however, one retrospective cohort study reported that its negative predictive value decreases in parallel with increases in BMI. One study involving over 5,000 patients showed that the clinical examination is not significantly affected by the patient BMI. Mammography and MRI showed more variable results, with one study showing MRI performance potentially being impaired in overweight patients, although that study was rated as having a high risk of bias. Across studies, no substantial evidence supported the need for modifying diagnostic protocols based on BMI. Clinical examination and AUS continue to be reliable methods for axillary staging in overweight and obese women with early-stage breast cancer. Given one contradictory cohort study, negative AUS findings in obese patients should be interpreted with caution until standardized AUS criteria and prospective BMI-stratified studies are available. Further high-quality, prospective studies are needed in order to confirm these findings and to inform evidence-based refinements in staging protocols.

Keywords: Ultrasonography; Mammography; Magnetic resonance imaging; Breast cancer; Obesity.