Visualization of the abdominal organs was satisfactory even in patients who had only fasted and received water. The use of laxative and antiflatulent preparations is not required before routine abdominal ultrasound examinations.
Objective To evaluate the diagnostic accuracy of elastography for breast cancer identification in patients with indeterminate lesions on ultrasound. Methods This prospective, descriptive study included patients with indeterminate breast lesions in the ultrasound and with indication for percutaneous or surgical biopsy. The elastography was evaluated by qualitative analysis and by two methods for the semi quantitative analysis. Results We evaluated 125 female patients with 159 lesions, with a mean age of 47 years, and a range of 20-85 years. Ultrasound has shown to be a method with good sensitivity (98.1%), but with a lower specificity (40.6%). On the elastography qualitative analysis, the specificity and accuracy were of 80.2% and 81.8% respectively. The mean size of the lesions showed no difference in classification by elastography. For the semiquantitative elastography, the mean values of the malignant lesions were statistically higher when compared with the subcutaneous tissue or the adjacent fibroglandular tissue. The analysis of the receiver operating characteristic (ROC) curves for these two semiquantitative methods showed that both are considered satisfactory, with an area under the curve above 0.75 and statistical significance (p < 0.0001). The best results were obtained when using the findings of combined conventional ultrasound and qualitative elastography, with 100% sensitivity and 63.2% specificity. Conclusions Elastography can be a useful complementary method, increasing the specificity and diagnostic accuracy of conventional ultrasound for the diagnosis of breast cancer in patients with indeterminate breast lesions. ResumoObjetivo Avaliar a acurácia diagnóstica da elastografia para identificação do câncer de mama em pacientes com lesões indeterminadas por ultrassom. Métodos Estudo prospectivo, descritivo, com pacientes com lesões mamárias indeterminadas no ultrassom e indicação de biópsia percutânea ou cirúrgica. A elastografia foi avaliada por análise qualitativa e dois métodos de análise semiquantitativa.
Historically, radiology has developed in a way that has increasingly distanced the radiologist from the patient. Currently, diagnostic imaging results are predominantly communicated through written reports. Written communication is not considered sufficient, verbal communication being essential for the performance of the modern radiologist to be considered satisfactory. However, a lack of preparation on the part of the radiologist when communicating the diagnosis, especially when it is not favorable (as is often the case in a cancer hospital), makes that conversation quite challenging. Studies conducted in other countries have demonstrated that there are a variety of opinions on the part of requesting physicians and patients regarding radiologist-patient communication, which can be explained by cultural differences. Although there is no rule regarding the best way to accomplish such communication, there are definitely incorrect ways. To bridge the gap between radiologists and patients and improve radiologist-patient communication, preparation of radiologists during their medical residency is fundamental. Therefore, it is important to address this question in Brazil. The objective of this study was to identify deeper discussions about the topic in the scientific literature. This analysis could help us map those involved and plan strategies to improve the ethical behavior of radiologists toward their patients.
BackgroundBecause of its safety, relative low cost and widespread availability, conventional ultrasound (US) is the modality of choice for initial evaluation of the liver. Following US, in patients eligible for surgery, further computed tomography and/or magnetic resonance imaging is usually recommended for surgical planning. There are no recent published series focusing on conventional abdominal US exclusively employed for the evaluation of liver nodules before surgery. The objective of this study is to evaluate the efficacy of focused conventional preoperative US in detecting liver lesions, and the impact of US findings on surgical management.MethodsSixty-seven noncirrhotic patients underwent surgical resection, after being previously submitted to focused liver US evaluation. US results were compared with intraoperative US (IOUS) and histology (gold standard). The IOUS was performed by the same radiologist who performed the preoperative US. Patient-by-patient and lesion-by-lesion analyses were performed.ResultsA total of 241 lesions were depicted in 67 patients. The mean number of lesions detected per patient by US and IOUS was 2.37 and 3.37, respectively (P = 0.001). In 52.2% of patients, US and IOUS depicted the same number of liver lesions. Surgery with curative intent was conducted in 61 (91.0%) patients. Histological evaluation was obtained in 196 lesions; 155 were considered malignant. The overall lesions detection rate by US was 65.6%. For lesions <15 mm and lesions ≥15 mm, US showed a sensitivity rate of 55.3% and 75.5%, respectively.ConclusionsThe relatively high sensitivity rates achieved by US focused on liver evaluation, with the aim of lowering costs but not efficiency, places the method in focus again for use in the routine preoperative staging of candidates for liver resection. We suggest for preoperative evaluation that US could be associated with one section imaging method (computed tomography or magnetic resonance imaging) as routine.
It was concluded that in cancer patients DUS has a high sensitivity for diagnosis of DVT and that DVT diagnosis in these patients correlates with a shorter overall survival. Since there are no reliable clinical predictors to identify cancer patients with DVT, DUS should be performed whenever DVT is suspected.
INTRODUÇÃODentre os tumores malignos do fígado, as lesões metastáticas são as mais comuns e sua presença está associada a mau prognóstico, que pode ser melhorado através do emprego de terapias agressivas, como a ressecção hepática.Os pacientes com câncer e lesões secundárias no fígado que podem se beneficiar da ressecção das metástases, são aqueles com carcinoma colorretal (CCR), tumores neuroendócrinos e carcinoma renal (7) . Entre esses, os mais estudados são os com metástase de CCR, pela sua maior freqüência, com índices de sobrevida que seriam de 8 a 9 meses sem tratamento cirúrgico, podendo atingir 40% a 50% em 5 anos após a ressecção (9,10) . Para metástases hepáticas de tumores neuroendócrinos são descritos índices de sobrevida de 5 anos acima de 60% após a ressecção e, mesmo quando esta não é curativa, a cirurgia oferece excelente controle da doença (29) . Em pacientes com metástases de tumores renais, a cirurgia é considerada a única chance de cura, com índices de sobrevida de 5 anos de cerca de 20% (1) . Dentre os outros tumores metastáticos para o fígado, estão ainda em estudo dentro de protocolos, os benefícios da ressecção para metástases de tumores de mama, testículo, sarcomas, papila, melanoma e tumores ginecológicos, com índices de sobrevida que podem alcançar 20% (7,8,31) . O diagnóstico das metástases hepáticas baseia-se no rastreamento com exames radiológicos, uma vez que sinais e sintomas clínicos e a elevação das enzimas hepáticas ocorrem tardiamente, quando o paciente já não tem mais chance de cura através do tratamento cirúrgico. Entre os métodos de imagem mais difundidos destacam-se a ultra-sonografia percutânea do abdome (US), a tomografia computadorizada (TC) e a ressonância nuclear magnética do abdome (RNM).RESUMO -Racional -Vinte e cinco a 50% dos pacientes com metástases hepáticas são potenciais candidatos à cirurgia curativa.A ultra-sonografia intra-operatória tem sido usada com grande acurácia para orientar a ressecção das lesões hepáticas. Objetivo -Avaliar em nosso meio a importância desse método nas cirurgias hepáticas e comparar seus achados com os dos métodos de imagem pré-operatórios. Pacientes e Métodos -Estudou-se prospectivamente 35 pacientes com metástases hepáticas e indicação cirúrgica, com os seguintes tumores primários: cólon (24), tumor neuroendócrino (3), carcinoma de células renais e melanoma (2) e outros (4). A idade mediana foi de 56 anos, sendo 20 pacientes do sexo feminino. Os pacientes foram submetidos a pelo menos um exame entre tomografia computadorizada (30), ultra-sonografia (14) e ressonância magnética (8). Resultados -A ultra-sonografia intra-operatória foi útil em 23 (65,6%) das 35 cirurgias, e mudou o plano cirúrgico em 9 (25,7%) pacientes. Houve correlação estatisticamente significativa entre o número de nódulos identificados por ultrasonografia percutânea do abdome, tomografia computadorizada e ressonância magnética, e a ultra-sonografia intra-operatória, sendo que a média de nódulos por paciente encontrados pela ressonância magnética (2,6) e pela ul...
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