Introduction: Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men. Some cases need surgical intervention. Traditional open surgery by semicircular inferior periareolar incision is the most common surgical approach. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE). Objective: To describe the technical surgical approach of ultrasound-guided VAE of GM and its results from a case series. Method: This is an evaluation of seven GM cases submitted to ultrasound-guided VAE with a 10G needle using the ENCOR® BD whole circumference automated breast biopsy system in Redimasto – Redimama, a Brazilian breast center. The result was considered good or satisfactory when it showed minimal remaining gland, good symmetry, no retraction, necrosis, hypertrophic scar, or displacement of the nipple-areola complex. All patients answered a questionnaire to evaluate their satisfaction and perception of the procedure. Results: Seven (7) patients with Simon grade 1 and 2 bilateral GM underwent ultrasound-guided VAE. No case of displacement, necrosis, or retraction of the nipple-areola complex, post-procedure bleeding, infection, skin necrosis, or asymmetry was detected. No patient reported decrease or change in nipple sensation or erection. All patients had bruises and hematomas that spontaneously resolved within 30 days. All results were considered good or excellent by patients and surgeons. Conclusion: Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results, small scar, and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery.

Introduction: Breast cancer is the most common malignancy in women worldwide, with the exception of nonmelanoma skin tumors. The initial stage of breast cancer is one of the main predictors of survival. Mammographic screening is the most effective method for an early detection of breast cancer and premalignant lesions, with an impact on reducing mortality, considering that correct positioning during the examination is a critical factor for its quality. Methods: A casecontrol study of a mammography positioning training program (MMG) in a private center specialized in breast diagnosis. In total, 200 incidences were evaluated in 50 examinations performed by two experienced techniques, 25 examinations each. Performance criteria were evaluated in the mediolateral oblique (MLO) and craniocaudal (CC) views. In the CC, well-demonstrated lateral quadrants (QLAT), visualization of the pectoral muscle (MP), centralized nipples (MC), welldemonstrated medial quadrants (QMED), absence of pleats or folds, centralized nipples, and symmetrical breasts were considered as adequate positioning. Buck’s low positioning was considered an error criterion. In the MLO assessment, the criteria for adequate positioning were the inframammary angles (AI) visualized, nipples profiled and at the height of the MP, symmetrical breasts, absence of pleats and folds, and symmetrical MP. Pending breasts and pectoralis minor (PP) visualization were considered positioning failures. An 11-h theoretical-practical training was applied: 7 h of practice and 4 h of theory; new tests were performed and the quality criteria were reassessed. Results: Positioning errors were significantly decreased after the training. Errors in the CC incidence decreased from 39% to 11% and in the MLO from 36% to 13%. After the training, the following improved criteria were evaluated in CC: QLAT well shown rose from 50% to 94%, MP visualization rose from 21% to 62%, MC rose from 49% to 79%, QMED well shown rose from 45% to 100%, absence of pleats or folds rose from 74% to 88%, profiled nipples rose from 91% to 95%, and symmetrical breasts rose from 86% to 98%. Buck’s low positioning dropped from 19% to 0%. In the MLO incidence, the criteria that improved were: AI visualization rose from 45% to 82%, profiled nipples rose from 93% to 95%, nipples at MP height rose from 24% to 84%, absence of pleats or folds rose from 39% to 70%, symmetrical breasts rose from 90% to 100%, symmetrical MP rose from 56% to 82%, symmetrical nipples rose from 72% to 86%, and PP visualization dropped from 13% to 7%. Conclusion: The MMG positioning training program improved examination quality. It acts on a vulnerable part, which is human error. The result indicates that a simple, low-cost intervention with low technological complexity can significantly impact the quality of MMG and screening programs in our country.

Introduction: Mammography (MMG) reduces breast cancer mortality. Positioning is a critical factor for the quality of the test. Objective: To evaluate a positioning training program (PTP) to improve MMG quality. Methods: This is a case-control study of an MMG PTP. This study was performed in a private service specialized in breast diagnosis. We evaluated 200 projections from 50 MMGs carried out by two experienced technicians (6 years and 17 years of practice) – 25 screenings each. Performance criteria were evaluated in the mediolateral oblique (MLO) and craniocaudal (CC) views. In CC, we considered adequate positioning a good projection of outer quadrants (OQ), visualization of the pectoralis major (PM), centered nipples (CN), good projection of inner quadrants (IQ), no folds or creases, nipples in profile, and symmetrical breasts (SB). The low positioning of the Bucky was considered an error criterion. In the MLO evaluation, the criteria for an adequate positioning were the visualization of inframammary angles (IMA), nipples in profile and at the PM level, SB, no folds or creases, and symmetrical PM. Hanging breasts and visualization of the pectoralis minor (Pm) were considered positioning failures. An 11-hour theoretical and practical training was provided: 7 hours of practice and 4 hours of theory; new tests were performed, and the quality criteria were evaluated. Results: Positioning errors significantly decreased after the PTP. CC errors dropped from 39% to 11%. MLO errors decreased from 36% to 13%. After the PTP, the CC criteria evaluated improved: good projections of OQ – from 50% to 94%; visualization of the PM – from 21% to 62%; CN – from 49% to 79%; good projections of IQ – from 45% to 100%; lack of folds or creases – from 74% to 88%; nipples in profile – from 91% to 95%; SB – from 86% to 98%. The low positioning of the Bucky dropped from 19% to 0%. The MLO criteria evaluated also improved after the PTP: visualization of IMA – from 45% to 82%; nipples in profile – from 93% to 95%; nipples at the PM level – from 24% to 84%; lack of folds or creases – from 39% to 70%; SB – from 90% to 100%; symmetrical PM – from 56% to 82%; symmetrical nipples – from 72% to 86%; visualization of the Pm – from 13% to 7%. Conclusions: The MMG PTP improved the quality of the test, the gold standard in the early detection of breast cancer. PTP acts in a vulnerable part – the human. The results indicate that a simple and low-cost intervention of low technological complexity can significantly affect the quality of MMGs and screening programs in our country.

Objectives: To present the results of adopting CBR/FEBRASGO/SBM recommendations for breast cancer screening and diagnosis during 2020 COVID-19 PANDEMIC on mammograms (MMG), breast ultrasound (BUS), breast biopsy (BB), and cancer diagnosis (CD) rates. Methodology: Comparing by month the total number of MMG, BUS, BB (composed of fine needle, core, and vacuum procedures), and invasive and in situ cancers diagnosis (CD) performed at Redimama, a private breast unit from Belo Horizonte Brazil, that adopted CBR/FEBRASGO/SBM recommendations for breast cancer screening and diagnosis during the 2020 COVID-19 pandemic year to 2019 same period. Results: In April 2019, 391 MMG, 714 BUS, 223 BB, and 22 CD were performed, compared with 115 (29.4%) MMG, 313 (43.8%) BUS, 116 (52%) BB, and 11 (50%) CD in 2020. A continuous and fast recovery occurred along the time. In 2019 first semester, 2241 MMG, 4229 BUS, 1214 BB, and 84 CD were performed, compared with 1,903 (88.7%) MMG, 4,227 (99.2%) BUS, 1,044 (86%) BB, and 92 (109.5%) DC in 2020. In 2019, 4,424 MMG, 10,395 BUS, 3,304 BB, and 231 CD were performed, compared with 4,561 (110.79%) MMG, 11,549 (120.72%) BUS, 3,011 (91.13%) BB, and 226 (97.83%) CD in 2020. In 2019, the median size in image (T) by MMG/BUS for invasive cancers (IC) was 18.18 mm, from CD 184 (79.66%) were IC, and 47 (20.4%) ductal carcinoma in situ (DCIS) compared to a T of 18.2 mm, 191 (86.52%) IC, and 35 DCIS in 2020. Conclusion: Adopting the CBR/FEBRASGO/SBM recommendations for breast cancer screening and diagnosis results to recovery the prior pandemic levels. Recovery of MMG and BUS is faster and shows a “J” curve compared with recovery of BB and CD that shows a “´U”` curve with a delay. This strategy should be adopted in Brazil in order to maintain breast cancer screening and diagnosis.

Objectives: To evaluate ICPR by VAB or VAE and its clinical implications. Methodology: A retrospective analysis of ICPR by VAB/VAE from January 4, 2017, to September 10, 2020, confirmed no tumor on surgical pathology. Age, imaging, pathological features, guidance approach (ultrasound × stereotaxis), and procedure (VAB × VAE) were analyzed using paired t test. This study was approved by Ethical Committee. Results: Twenty-one ICPR were found, patients’ age ranged from 35 to 91 years (mean 61.57); 14 (66.7%) invasive cancer (IC) (12 ductal and 2 lobular), 6 (28.6%) IC associated with ductal carcinoma in situ (DCIS), 1 (4.7%) IC associated with DCIS with comedonecrosis; 5 (23.8%) nuclear grade (NG) 1, 14 (66.7%) NG2, and 2 (9.5%) NG3; 10 (47.6%) histologic grade (HG) 1, 9 (42.9%) HG2, and 2 (9.5%) HG3; 2 (9.5%) pN1sn (one and two nodes metastatic); 1 (4.8%) multicentric; 3 (14.3%) recurrences; 12 (57.1%) Luminal A, 5 (23.8%) Luminal B, 2 (9.5%) Luminal Her, 1 (4.8%) HER2 positive, and 1 (4.8%) triple negative; 19 (90.5%) VAEs and 2 (9.5%) VABs; 21 (100%) guided by ultrasound (US); 18 (85.7%) masses, and 3 (15.3%) masses associated with calcifications; and tumor size on image (TI) ranged from 4 to 11 mm (mean 7.5 mm; SD 1.9 mm) and 3 to 11 mm on pathological VAB/VAE specimen (TV) (mean 5.7 mm; SD 1.9 mm; p<0.001). Conclusion: It is possible to percutaneously complete resect invasive cancers (ductal or lobular), of any IMQ subtype, smaller than 11 mm, although 9.5% harbors metastatic sentinel nodes. Staging (TNM) should be based on TV, although TI can be used in the absence of TV. Despite TI larger than TV, there is no clinical relevance. For prospective trials of ICPR, selecting criteria should be VAE for US masses, less than 11 mm, of less aggressive subtypes.