OBJECTIVE: To evaluate the occurrence and causes of unplanned interruption of radiotherapy. MATERIALS AND METHODS: Retrospective study developed in the Division of Radiotherapy of Hospital Alemão Oswaldo Cruz in São Paulo, SP, Brazil, with data collected from 560 dossiers of patients submitted to radiotherapy in the period between January 1, 2005 and December 31, 2005. Chi-squared and Student t tests were utilized in the data analysis, and p < 0.05 was considered as statistically significant. RESULTS: Interruption of treatment was identified in 350 cases, corresponding to 62.5% of the patients. The reasons for treatment interruption were the following: preventive device maintenance (55%), patient's own private reasons (13%), adverse reactions to the treatment or to combined radiotherapy/chemotherapy (6%), clinical worsening (3%), two or more combined reasons (23%). The interruption time interval ranged between 1 and 24 days (mean 1.4 day). One-day interruption was mostly due to preventive device maintenance (84.4%); two-five-day interruption was due to combined reasons (48.28%). CONCLUSION: The most frequent cause of interruption was preventive device maintenance, with maximum two-day time interval.

Keywords: Radiotherapy, Cancer, Interruptions, Treatment

OBJECTIVE: To evaluate the yielding of chest computed tomography in comparison with mediastinoscopy for detection of mediastinal nodal metastases in patients with bronchial carcinoma, and identifying the most problematic regions. MATERIALS AND METHODS: We have analyzed 195 patients with bronchial carcinoma, comparing the findings of chest computed tomography and mediastinoscopy with biopsy. RESULTS: As regards mediastinal nodal metastasis, 33.9% of patients presented peribronchial and/or ipsilateral hilar nodal metastases, 46.1% ipsilateral and/or subcarinal mediastinal metastases, and 20% contralateral mediastinal and/or hilar, scalenic or supraclavicular metastatic disease. Higher sensitivity values were found in the following regions: right tracheobronchial, right upper paratracheal, and left upper paratracheal. Higher specificity values were found in the following nodal regions: left upper paratracheal, right upper paratracheal and tracheobronchial. CONCLUSION: Chest computed tomography has shown to be an important diagnostic tool for detection of mediastinal lymph nodes abnormalities. However, the neoplastic nature of such mediastinal nodes should be confirmed by means of mediastinoscopy or even thoracotomy, aiming at making the correct decision regarding the treatment of patients with non-small cell lung cancer.

Keywords: Lung cancer, Computed tomography, Mediastinoscopy

Prostate adenocarcinoma is the second tumor in incidence and mortality among malignant neoplasms in men. The differentiation between tumors confined to the organ and those with extraprostatic extension is critical for an appropriate therapeutic planning. Different studies have demonstrated that magnetic resonance imaging of the prostate with endorectal coil is useful in the local staging of these tumors. The present article presents information on the prostate gland anatomy, the tumor aspect at magnetic resonance imaging, specific signs of extracapsular extension and seminal vesicles invasion, protocol suggestions, general principles and relevance of proton spectroscopy, perfusion and diffusion imaging, role of magnetic resonance imaging in the postoperative and post-radiotherapy detection of local tumor recurrence, and also in the detection of lesions in patients with clinical/laboratory suspicion of prostate adenocarcinoma. Additionally, the present article describes differential diagnoses and limitations of the method.

Keywords: Prostate cancer, Adenocarcinoma, Magnetic resonance imaging, Cancer staging

OBJECTIVE: To review the literature about the positive predictive value of Breast Imaging Reporting and Data System (BI-RADS®) categories 3, 4 and 5. MATERIALS AND METHODS: A research was performed in the online Medline database, entering the terms "predictive value" and "BI-RADS". Eleven studies were included in this review. RESULTS: The positive predictive values ranged respectively between 0% and 8%, 4% and 62%, and 54% and 100% for BI-RADS® categories 3, 4 and 5. Three studies have also evaluated morphological criteria with higher positive predictive value in mammography, mass with spiculated margins being the finding with highest positive predictive value for malignancy. CONCLUSION: A high variability was found in the reviewed literature among positive predictive values of BI-RADS® categories 3, 4 and 5, although methodological differences have been identified, limiting the comparative analysis.

Keywords: Mammography, BI-RADS®, Breast cancer

Breast reconstruction using myocutaneous flaps has been widely used in patients undergoing modified radical mastectomy for the treatment of breast cancer with significant improvement in esthetical results, which also helps to improve self-esteem of the patients as it minimizes the feeling of mutilation, without changing disease prognosis. Previously, it was believed that there was no risk of recurrence in the reconstructed breast due to the complete removal of breast tissue. However, histological studies have shown that a small amount of glandular tissue may remain after mastectomy, with a high potential for malignancy. Clinical follow-up of mastectomy patients is recommended as most recurring lesions occur at the flap margins and can be detected by palpation. In addition, the inclusion of mammographic and ultrasound monitoring has been proposed for the follow-up of patients as these methods may contribute to the diagnosis of recurrent lesions before they become palpable.

Keywords: Breast cancer, Mastectomy, Mammography, Ultrasound

OBJECTIVE: This study focuses on the biochemical response of the following variables: prostate volume, prostate-specific antigen (PSA) value, Gleason scores, staging, the risk of the disease, and hormonotherapy. MATERIALS AND METHODS: In the period between February of 1998 and July of 2001, 46 patients with prostate cancer were treated with radiotherapy, in a combination of teletherapy and high-dose rate brachytherapy (HDR). The age ranged from 51 to 79 years (averaging 66.4 years). T1c stage was the most frequent one: 30 (65%). The Gleason score was below 7 in 78% of the patients. PSA ranged from 3.4 to 33.3, being below 10 in 39% of the cases. The average prostatic volume was 32.3cc. Twenty-eight percent of the patients received hormonotherapy. Teletherapy dose ranged from 45 to 50.4 Gy, associated to four fractions of 4 Gy of HDR. RESULTS: The follow-up period varied from 6 to 43 months. Four patients missed the follow-up and four died (one due to the disease). Out of the 39 patients that were analyzed, 76% presented a less than 1.5 PSA. None of the analyzed variables were found to be of statistical significance (p>0.05) regarding biochemical control. CONCLUSION: The use of HDR brachytherapy was found to be effective in the treatment of prostate cancer and, in this study, the variables considered as prognostic factors did not interfere in the biochemical control.

Keywords: Prostate cancer, Brachytherapy, Interstitial radiotherapy

OBJECTIVE: To present the experience of Santa Cecília Hospital (São Paulo, SP, Brazil) radiology service in the handling of computed tomography-guided fine-needle aspiration biopsy and percutaneous core biopsy of pulmonary lesions, analyzing their importance and associated complications. MATERIALS AND METHODS: One hundred and sixty-eight computed tomography-guided biopsies were performed in 84 men and 84 women. Sixty-four patients underwent fine-needle aspiration biopsy, 68 underwent percutaneous core biopsy and 36 patients underwent both techniques. RESULTS: Pneumothorax occurred in 38 patients, and pulmonary hemorrhage in then cases. The biopsied lesions ranged in size from 0.5 to 15 cm. The diagnosis was achieved at the first attempt in 132 cases and at the second attempt in ten cases. CONCLUSION: The accuracy of fine-needle aspiration and percutaneous core biopsies depends both on the size of the lesion and the patient's cooperation. These techniques are relatively safe and present a high diagnostic accuracy when performed by an experienced professional.

Keywords: Biopsy, Cancer, Computed tomography

We report a case of a patient with actinomycosis of the larynx mimicking a neoplasm. A literature review, clinical features, pathology and imaging findings is also presented. This paper reports a rare disease occurring in an atypical location, simulating larynx neoplasm. To our knowledge, there is no report of this disease and locations evaluated with computed tomography.

Keywords: Actinomycosis, Computed tomography, Cancer

OBJECTIVE: To evaluate the clinical benefit of pre-ablation scanning in patients with differentiated thyroid carcinoma. MATERIALS AND METHODS: We assessed scannings and serum thyroglobulin (Tg) measurements before the first ablative therapy in 100 patients with hypothyroidism submitted to total thyroidectomy. Scanning was considered clinically significant when it showed resectable metastases or which were treated with higher doses than the initially proposed one (100 mCi of 131I), in addition to cases with no uptake and Tg levels < 5 ng/ml not requiring radioiodine therapy. RESULTS: Scanning showed uptake corresponding to lymph node metastases in 10 patients (10%), distant metastases in 5 (5%), uptake only in the thyroid bed in 76 (76%), and was negative in 9 (9%). The procedure was considered clinically relevant in 18% of the patients (indicating the need of surgery, dose increase or discontinuation of radioiodine therapy). In patients with Tg > 10 ng/ml, scanning influenced therapeutic management in 41% of the cases due to detection of metastases, while in patients with Tg < 10 ng/ml scanning influenced therapeutic management in only 10% of the patients, most of which did not receive radioiodine therapy. CONCLUSION: Scanning provides clinically significant data (presence of metastases) in many patients with Tg levels > 10 ng/ml and, therefore, should be used in these cases.

Keywords: Thyroid cancer, Scanning, Ablative therapy

Currently, mammography is the most effective method for an early diagnosis of breast cancer. In 85% to 90% of the cases, a high quality mammography allows the visualization of a tumor more than two years before the occurrence of lymph nodes involvement in women over 50 years of age. The radiological appearance of a normal and a sick tissue is very similar, therefore, a high quality of the scan is essential to obtain high contrast resolution to allow distinguishing them. Strict and preestablished protocols must be followed during mammography in order to reach high quality standards. Artifacts are defects occurred during film processing that interfere in the quality of the final image and can result in loss or masked information. Several types of artifacts from different sources can occur during image acquisition. These can be caused by the processor, the radiology technician, the mammography unit or the patient, and all result in degradation of the image acquired. The aim of this study is to review the effective methods that can be used in the quality control of mammography and to analyze the most important artifacts occurring in the daily practice, showing illustrations and suggestions on how to avoid them.

Keywords: Breast cancer, Breast radiology, Artifact

The author presents a critical analysis of the recently published BI-RADS TM system. The first recommendation is to always determine if BI-RADS TM is being used for mammography, ultrasound or magnetic resonance by using the term BI-RADS TM-US or a similar term. The advantages of using the BI-RADS TM-US including reproducibility, standardization, auditing, basis of echogenicity are also considered. In addition, some drawbacks of the system are identified: the omission of statistically significant proven descriptors such as marked hypoechogenicity and number of lobulations, the use of non-recognized descriptors such as the Cooper ligament, and the lack of data on the positive predictive value of some very common breast lesions such as hypoechoic nodules. Finally, a suggestion is presented: to classify the descriptors according to its importance as predictors in order to determine the positive predictive value of the lesions.

Keywords: BI-RADS™, Mammography, Breast cancer

The aim of this study is to look over the indications for bone scintigraphy in the staging and follow-up of patients with prostate cancer. The authors reviewed the literature on the subject and analyzed the criteria used for indication of this test, and compared it with other methods for the evaluation of patients with this condition. Clinical applications of bone scintigraphy in prostate cancer are established according to new parameters described in the literature, also taking into consideration its cost-effectiveness.

Keywords: Bone scintigraphy, Prostate cancer

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

The aim of this study was to identify the sentinel node by periareolar injection of the radiopharmaceutical in four points, regardless of tumor topography. The sentinel node biopsy reduces morbidity in axillary staging. Fifty-seven sentinel node biopsies were prospectively performed in two groups: group A (25 patients) and group B (32 patients). The peritumoral injection technique was used in group A and the new injection technique in four points was used in group B. The sentinel node biopsies were studied by imprint cytology and hematoxilin and eosin staining followed by axillary lymph node dissection in all patients of group A and only in the positive cases of group B. In group A, 88% (22/25) of the sentinel nodes were identified. There was no false negative case; the sensibility and specificity were of 100%. In group B, 96% (31/32) of sentinel nodes were identified and the status of the axillary lymph nodes showed a predictive positive value of 100%. The number of sentinel nodes varied from 1 to 7, mode of 1 and median of 2.7. The hotspot area was 10 to 100 times the background radiation. The periareolar injection in four points seems to be a good lymphatic mapping method for identification of the sentinel node. We suggest the standardization of this site for injections to identify the sentinel node, although further studies to confirm these findings are necessary.

Keywords: Breast cancer, Sentinel node, Lymphoscintigraphy

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