Ultrasonography combined with fine-needle aspiration is more accurate than clinical examination in assessing preoperative axillary status in women with breast cancer. Those who are US-FNA positive can be directed towards axillary lymph node dissection straight away, and only those who are US-FNA negative should be considered for sentinel lymph node biopsy.

Introduction: Since the 90s, breast ultrasound (US) features that predict malignancy or benignity are well established, but recently Stravos and Taboul et al. brought new concepts that set out to understand lobar anatomy and its relationship with breast lesions. Nowadays we seek to understand the relationship between breast anatomy and imaging to differentiate malignant from benign lesions and to predict their biological behavior. Objectives: To correlate breast lesions morphology and tumor biology with BIRADS® ultrasound predictors. Methods: This study was performed from 2012 to 2017. A total of 1,070 breast lesions underwent US examination and anatomopathological study. Collected data included patients’ age, tumor size, presence or absence of echogenic halo and ultrasound predictors of BIRADS® 5th edition (shape, margin, surrounding tissue, presence of calcifications, echogenicity, posterior acoustic effect, lesion borders, orientation and doppler). Patients ≥18 years old with benign lesions and breast carcinomas were included. Results: When a lesion grows affronting lobar anatomy in a non-parallel manner, a malignant process is suspected. The risk of malignancy for this predictor was 7.92-times higher. Benign lesions do not infiltrate adjacent tissue, resulting in a circumscribed margin. Breast carcinomas grow infiltratively creating tissue reactions. Thus, when margins are infiltrative, there is a greater risk of malignancy – spiculated (61.4 times), angulated (24.4 times), microlobulated (9.4 times), indistinct (6.8 times). The presence of halo increased the risk by 25.3 times and thickening of the surrounding tissue by 6.7 times. In carcinomas, irregular shape is the most prevalent. But in fast growing lesions, round shape can also be found. We found a 6.27-fold increased risk in irregular tumors and 1.86-fold in round ones. Carcinomas with a large fibrous component generate posterior acoustic shadowing, a finding linked to cancer. We found a 2.56-fold increased risk. Acoustic enhancement was also observed in high cellularity tumors, such as triple negative. In our series, the risk of malignancy was 8.1 times higher. Ultrasound also contribute to the study of calcifications. Its presence within the nodule increased the risk by 3.55 times for malignancy. Heterogeneous lesions in this study showed a 5.1-fold risk. Angiogenesis is important in differentiating benign and malignant lesions, using doppler to assess this. Lesions with inner flow increased the risk by 5.39 times. Conclusions: Breast imaging, mainly with radiogenomics and radiomics development, is used to assess predictors of malignancy and benignity from a new perspective. It is important to understand the reason of a particular phenotype and its biological implications. In this context, the present study shows new data and brings a reflection on the reason for each finding, adapting the interpretation of US predictors to a new era of breast imaging.

No abstract

Com intuito de detectar a predição da resposta ao tratamento quimioterápico em carcinoma de mama triplo negativo (CMTN), assim como, um padrão específico, propusemos a cintilografia de mamas com sestamibi-99mTc como método de diagnóstico para avaliação. Foram estudadas 49 pacientes, no período de 2011 a 2016, com diagnóstico de CMTN submetidas à cintilografia de mamas pré-quimioterapia neoadjuvante e avaliação do espécime cirúrgico. Na cintilografia de mamas foram avaliadas características qualitativas como intensidade de concentração do sestamibi-99mTc na lesão da mama e presença de acúmulo do mesmo em linfonodo axilar e quantitativa pela relação da área de interesse na lesão tumoral pela mesma área em espelho em tecido mamário sem alterações na mesma mama. A análise descritiva mostrou a idade 54,24 + 11,39 anos, com variação de 26 a 79 anos e mediana de 55 anos. A mama acometida pelo tumor foi 25 (51,0%) na mama direita e 24 (49,0%) esquerda. O esquema quimioterápico empregado nas pacientes foi de 36 (73,5%) com cloridrato de doxorrubicina, ciclofosfamida e placlitaxel e 13 (26,5%) com cloridrato de doxorrubicina e ciclofosfamida. Vinte e sete pacientes (55,1%) foram submetidas a mastectomia e 22 (44,9%) a quadrantectomia. A resposta patológica completa (RPC) foi presente em 18(36,7%) e ausente 31(63,3%). Na cintilografia, a análise quantitativa mostrou índice com média e desvio padrão de 2,58 + 1,01, com mínimo de 1,17 e máximo de 5,60 e mediana de 2,29. A análise qualitativa revelou intensidade de concentração em lesões na mama: discreta em 3(6,1%), moderada em 26(53,1) e acentuada em 20(40,8%). A concentração axilar foi visualizada na cintilografia de mamas em 41 pacientes (83,7%) e ausente em 8(16,3%). As associações dos dados cintilográficos quantitativo e qualitativo não mostraram significância estatística em predizer a resposta patológica completa. Em nosso estudo observamos uma predominância de lesões com maior intensidade de concentração do sestamibi-99mTc, o que ocorre em carcinomas de mama mais agressivos. No entanto, as análises quantitativa e qualitativa da cintilografia de mamas não puderam predizer a resposta patológica completa.

Resumo de tese Palavras-chave Esfregaço cérvico-vaginal Amostra adequada Lesão intraepitelial escamosa Rastreio diagnóstico