Objectively, PD was more favorable regarding quality of life, for the large number of items with significant results when compared to HD. However, the two variables of greatest significance found in HD (physical functioning and emotional functioning) ended up having a much greater impact on well-being and daily-life of the patient in the environment external to the clinic than those who were higher in DP, making HD the most favorable for patient quality of life.
Background Axillary lymph node involvement is one important prognostic factor in breast cancer, but the way to access this information has been modified over the years. This study evaluated if axillary ultrasound (US) coupled with fine-needle aspiration cytology (FNAC) can accurately predict clinically relevant node metastasis in patients with breast cancer, and thus assist clinical decisions Methods This is a cross-sectional study with retrospective data collection of 241 individuals (239 women and 2 men) with unilateral operable breast cancer who were submitted to preoperative axillary assessment by physical exam, US and FNAC if suspicious nodes by imaging. We calculated sensitivity, specificity, and accuracy of the methods. We compared the patient's characteristics using chi-square test, parametrics and non-parametrics statistics according to the variable. Results The most sensible method was US (0.59; 95% CI, 0.50–0.69), and the most specific was US coupled with FNAC (0.97; 95% CI, 0.92–0.99). Only 2.7% of the patients with normal axillary US had more than 2 metastatic nodes in the axillary lymph node dissection, against 50% of the patients with suspicious lymph nodes in the US and positive FNAC. Conclusions Axillary US coupled with FNAC can sort patients who have a few metastatic nodes at most from those with heavy axillary burden and could be one more tool to initially evaluate patients and define treatment strategies.
Introduction: The ACR BI-RADS® ATLAS for ultrasound (US) is an excellent tool used to categorize breast masses and classify the masses into seven categories according to the risk of malignancy. However, it is well accepted that some clinical characteristics of the patients and functional characteristics of the masses can modify the risk of malignancy. Objective: This study aims to evaluate possible relevant predictors of malignancy in addition to the ACR BI-RADS® for US categorization. Methods: This is a cross-sectional study that included patients with breast masses who were submitted to US-guided core biopsy in our division, from January 2015 to December 2021. Patients included had masses measuring up to 3 cm in the greatest diameter. We evaluated all masses with Doppler sonography and obtained the resistance index (RI) of the vessel through spectral analysis, when penetrating vessels were identified. We retrospectively collected the clinical data from medical records. The study was approved by the Institutional Ethics Committee. Results: We included 924 patients with suspicious breast masses measuring up to 3 cm that underwent US-guided core biopsy. The mean age was 53.4 years and the median size of the mass was 1.7 cm. We had 621 palpable masses and 295 nonpalpable lesions. The Doppler analysis revealed penetrating vessels in 560 lesions and no penetrating vessels in 364. The median RI in the spectral analysis was 0.79. All masses were classified according to the ACR BI-RADS® ATLAS for the US, and the risk of malignancy observed in each category agrees with data from the literature. We compared the characteristics of the benign and malignant masses and their clinical and functional characteristics. Moreover, the presence of penetrating vessels in the mass in the Doppler analysis conferred a higher risk of malignancy for the lesions initially classified in subcategories 4a, 4b, and 4c based on the ACR BI-RADS® descriptors. To define the best RI cutoff point, we used the receiver operating characteristic curve. Using the cutoff point of 0.71, we achieved a sensitivity of 0.84 and specificity of 0.61; the area under the curve was 0.75. The risk of malignancy of lesions 4a that had internal vascularization and high RI (>0.71) was 25%, which is much higher than expected for the category. This was also observed in lesions 4b (70% risk of malignancy in the presence of vessels with high resistance). Conclusion: Clinical characteristics influence the risk of malignancy of the breast masses and functional characteristics of the masses, such as the presence of blood vessels in the Doppler analysis, especially vessels with high resistance can better define the risk of malignancy than the ultrasonographic characteristics alone.
Introduction: Ultrasound is considered the main complementary diagnostic method to mammography in screening malignant breast nodules. The fifth edition of the BI-RADS® classification suggests analyzing nodule vascularity and the resistance index (RI) during the ultrasound. However, they are still not considered a decisive factor for the final classification. Objectives: To evaluate if the vascularity of breast nodules is a predictive factor for malignancy, and identify the RI value of the vessel most associated with malignant results. Methodology: This retrospective cross-sectional study assessed 750 ultrasound-guided breast biopsies performed at the Mastology Outpatient Clinic of the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP) from August 2015 to May 2017. The variables analyzed included examination date, ultrasound BI-RADS® category, internal nodule vascularity, RI value, and biopsy result. Exams from patients with no breast nodule were excluded. The statistical analysis was performed using Pearson's X² test. Results: The presence of vessels inside the nodule was highly associated with malignancy (OR=7.2, p<0.0001) and also with BI-RADS® categories of greater risk (p<0.0001). The median RI was 0.7 (interquartile range – IQR=0.23) in benign nodules with vessel and 0.86 (IQR=0.23) in malignant ones, with statistical significance (p<0.0001). The RI cut-off point to predict malignancy was 0.71 with 83.8% accuracy, 91.9% sensitivity, and 57% specificity (according to the Receiver Operating Characteristic – ROC – curve). Nodules initially classified as 4A but with internal vascularity and high resistance (RI>0.71) proved to be malignant in the biopsy in 35.7% of cases, that is, much higher than expected for the category (2% to 10%). Similarly, 72% of nodules initially classified as 4B but with internal vascularity and high resistance were malignant. On the other hand, 18.4% of nodules classified as 4C but without internal vascularity had malignancy confirmed by biopsy, far below the expected for the category (50% to 95%). Conclusion: The presence of internal vascularity and the RI were important factors for differentiating benign nodules from malignant ones on ultrasound, and in images classified as BI-RADS® 4, this information can be essential when dividing these nodules into subcategories (4A, 4B, and 4C).
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