Imaging exams are fundamental tools to characterize palpable lesions and to early detect those not identified on the physical examination. However, the correct interpretation of these findings should be done by correlating them with the probable histological diagnosis of the lesion, and performing the appropriate treatment in a timely manner. The Breast Imaging-Reporting and Data System (BIRADS ® ) is the system used for this association, which characterizes the findings in mammography, ultrasonography and mammary magnetic resonance images, classifying them according to the probability of malignancy. Objective: To correlate imaging features of breast nodules, evidenced by ultrasonography and classified according to BIRADS ® , with the histopathological examination results of material obtained through thick needle biopsy of patients from the mastology ambulatory of the Maternity School Assis Chateaubriand that confirm this predictive value of the imaging examination and the impact on surgical indications. Results: We analyzed 110 patient's medical records that fit the inclusion criteria and found that more than 97% of lesions with low suspicion of malignancy, BIRADS ® 4A, presented a benign histopathological result. However, all patients with images of nodules with high suspicion of malignancy had histopathological diagnosis of invasive carcinoma. In conclusion, the ultrasonographic features of breast lesions have high predictive value in the final diagnosis of the lesion, supporting the decision of conduct in adequate time in each situation.KEYWORDS: Ultrasonography, mammary; breast; biopsy, needle. ABSTRACT RESUMOOs exames de imagem são ferramentas fundamentais na caracterização de lesões palpáveis e na detecção precoce daquelas não identificadas ao exame físico. Porém, é necessária a interpretação correta desses achados, correlacionando com o provável diagnóstico histológico da lesão, realizando tratamento adequado e em tempo certo. O Breast Imaging-Reporting and Data System (BIRADS ® ) é o sistema utilizado para essa relação, caracterizando os achados em imagens de mamografia, ultrassonografia e ressonância magnética mamária e classificando-os de acordo com a probabilidade de malignidade. Objetivo: Correlacionar características imagenológicas de nodulações mamárias, evidenciadas por ultrassonografia e classificadas de acordo com o BIRADS ® , com os resultados dos exames histopatológicos de material obtido através de biópsia de agulha grossa de pacientes do ambulatório de mastologia da Maternidade Escola Assis Chateaubriand, confirmando esse valor preditivo do exame de imagem e o impacto nas indicações cirúrgicas. Resultados: Foram analisados 110 prontuários de pacientes que se encaixavam nos critérios de inclusão e constatou-se que mais de 97% das lesões com baixa suspeição de malignidade, BIRADS ® 4A, apresentaram resultado benigno no exame histopatológico. Entretanto, todas as pacientes com imagens de nódulos com alta suspeição de malignidade tiveram diagnóstico histopatológico de carcinoma invasor. Pode-se...
Mastite granulomatosa (MG) é uma condição inflamatória crônica de difícil diagnóstico e tratamento. OBJETIVOS: Identificar etiologia e desfechos terapêuticos da tuberculose mamária (TM) e MG idiopática (MGI). METODOLOGIA: Estudo retrospectivo com 76 mulheres (55 TM e 21 MGI), entre 2007 e 2017, baseado em achados clínicos, histológicos, laboratoriais (Ziehl Neelsen [ZN], cultura e PCR) e terapêuticos. As variáveis foram analisadas pelo teste qui-quadrado, exato de Fisher, t de Student e o Kappa a concordância entre diagnóstico presuntivo e definitivo de TM e MGI. RESULTADOS: Não significância estatística entre variáveis clínicas no diagnóstico de TM/MGI; associação positiva encontrada na evidência de células gigantes multinucleadas de Langhans à histologia. Sensibilidade da cultura para identificar o bacilo da tuberculose foi 10%, ZN em aspirado mamário 7,1% e 3,3% no ZN à histologia. O diagnóstico baseado na presunção (sem evidência do bacilo) apresentou concordância de 98,1% e coeficiente de Kappa 0,95; falha terapêutica em 10 (18,1%) casos de TM e 9 (42,8%) de MGI. CONCLUSÃO: O diagnóstico de TM e MGI baseado na presunção foi considerado ótimo e confiável pelo teste de concordância. A sensibilidade dos métodos microbiológicos foi baixa, mas necessários na definição etiológica e redução da falha terapêutica.
Introduction: The triple-negative breast cancer (TNBC) is one of the most aggressive types of breast cancer, corresponding to about 15% to 20% of invasive breast tumors. They are those tumors that in immunohistochemistry do not express homone receptors and epidermal growth factor type 2 (cerbB2). This tumor phenotype does not yield many treatment options, beyond standard chemotherapy, and within this context, the evidence of some markers of this type of tumor may contribute to the discovery of more effective types of treatment. Case report and Objectives: The aim of this study was to define predictive and prognostic factors in TNBC that could be related with a pathologic complete response after neoadjuvant chemotherapy treatment. Methods: A descriptive and retrospective study, a case series type, in women with TNBC who had underwent neoadjuvant chemotherapy and surgery at the Mastology Service of Maternidade Escola Assis Chateaubriand – Brazil - from May 2015 to June 2020. A statistical analysis was performed considering the 5% significance level. Results: From 108 women, only 47 were included in the study, with median age of 49 years (+14 years); about 30 (42.6%) had a family history of breast cancer in first or seconddegree relatives. About 44 (93.6%) cases were classified as invasive ductal tumor and grade II or III; the value of Ki67 greater than 14% was evidenced in 46 (97.9%) women and 26 (55.3%) had clinical stage III. Pathologic complete response to chemotherapy was evidenced in 16 (34%) cases, partial response in 13 (27.7%) and no response in 18 (38.3%) cases. The latter cases correspondeded to those who had stable or progression of disease. There was recurrence in 13 (27.7%) women, about 8 distant metastases, with the lungs as the most frequent site of metastasis followed by the brain. Eleven patients, about 23.4%, died. In the survival analysis of the studied population, the overall survival was 5.6 months and disease-free survival was 19.4 months. No association was observed in the study between the outcome of pathologic complete response to neoadjuvant chemotherapy and anatomopathological characteristics of the tumor. Conclusion: The results of this study did not show statistical significance to determine the possible predictive and prognostic factors for obtaining a complete clinical response to TNBC in a public reference service for the treatment of breast cancer, where there is no genetic signature, PDL1 status or access to differentiated treatment for such a heterogeneous tumor profil. This shows a need for further studies in order to understand this disease and for greater accessibility to high-cost exams and more effective treatments.
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