Navegando por Palavras-chave "Mamografia"

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    Abrangência da política de detecção precoce de câncer de mama no Brasil
    (Universidade Federal de São Paulo, 2024-08-30) Souza, Isabella Ferreira de [UNIFESP]; Fonseca, Fernando Luiz Affonso [UNIFESP]; http://lattes.cnpq.br/6772382797320564
    Este trabalho aborda os desafios encontrados na cobertura do rastreamento de câncer de mama no Brasil. O rastreamento do câncer de mama com mamografia é uma importante estratégia para a detecção precoce da doença. Com dados coletados do Sistema de Informação do Câncer (SISCAN), foram observadas diferenças significativas na realização de mamografias entre as regiões brasileiras e entre os níveis de a escolaridade que podem ser fatores determinantes para a adesão ao exame, assim como o período de coleta analisado. Ademais, a forma de coleta dos dados também pode impactar nos números disponibilizados. A conscientização da população sobre a importância da mamografia e a capacitação dos profissionais de saúde são fundamentais para aumentar a cobertura do exame. Portanto, é necessário investir em estratégias de conscientização e em uma rede de atenção à saúde preparada para acolher as mulheres com sinais e sintomas suspeitos, garantindo a investigação e o tratamento adequados dos casos confirmados.
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    Acurácia diagnóstica da biópsia percutânea com agulha grossa orientada por estereotaxia nas lesões mamárias categoria BI-RADS® 4
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2007-12-01) Moutinho, Maria Silvia Petty [UNIFESP]; Elias, Simone [UNIFESP]; Kemp, Claudio [UNIFESP]; Nazário, Afonso Celso Pinto [UNIFESP]; Baracat, Edmund Chada [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    PURPOSE: to assess the accuracy (rate of correct predictions) of stereotactic core needle biopsy (CNB) of risk category BI-RADS® 4 breast lesions. METHODS: a retrospective analysis of category BI-RADS® 4 breast lesions that had been submitted to a stereotactic core-needle biopsy from June 1998 to June 2003. Patients with histological benign results consistent with the radiographic image were referred to mammographic follow-up. Patients with malign diagnosis and papillary lesions were submitted to standard specific treatment. Excisional biopsies were performed when results were benign, but in disagreement with the mammographic image. It was considered as a gold-standard attendance: (1) the mammographic follow-up of low suspicion lesions with benign results at CNB, which stayed unchanged for, at least, three years, and (2) surgical resection when specimen results were malign or benign, but with a high suspicion on mammography. Sensitivity (S) specificity (E) and overall accuracy of stereotactic CNB were statistically analyzed. RESULTS: among the 118 non-palpable lesions of category BI-RADS® 4 submitted to CNB, the results obtained were: 27 malign cases, 81 benign, and ten lesions with atypical or papillary lesions. The statistical analysis comprised 108 patients (atypical and papillary lesions were excluded). CNB sensitivity was 87.1% and specificity 100%. The positive predictive value was 100% and the negative, 95.1%. False negatives occurred in 3.7% (4/108) of cases. The prevalence of malign diagnostics in the BI-RADS® 4 lesions of this sample was 29.7 (31/118).The accuracy of this method in this casuistic was 96.3%. CONCLUSIONS: these results support stereotactic CNB as an extremely reliable alternative to open biopsy, in the diagnosis and definition of breast lesions. In positive results, it is possible to indicate the appropriate therapy, and, in negative (when mammography shows low suspicion), it allows a follow up.
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    Analise da aplicacao da cintigrafia mamaria com 99mTC-tetrofosmin e da mamografia convencional por raios X no diagnostico diferencial das lesoes mamarias
    (Universidade Federal de São Paulo (UNIFESP), 1997) Lima, Eduardo Nobrega Pereira [UNIFESP]
    O objetivo deste estudo foi avaliar o uso potencial da cintigrafia mamaria com 99m Tc-Tetrofosmin na deteccao das neoplasias mamarias malignas em uma populacao de alta prevalencia, atraves da comparacao com a mamografia bilateral por raios X e do resultado das biopsias das lesoes mamarias. Em 50 pacientes do sexo feminino ( media etaria : 53,7 + 11,9 anos ) realizaram-se a mamografia bilateral por raios X e a cintigrafia mamaria. As cintigrafias foram iniciadas 30 minutos apos a administracao endovenosa de 25 miliCuries ( 925 MegaBequereis ) de 99m Tc-Tetrofosmin. Em uma gama camera SPECT foram coletadas imagens planares das projecoes anterior de torax e obliquas posteriores de cada mama. A histopatologia das lesoes foi feita atraves de 44 amostras colhidas em cirurgia e 6 amostras de aspiracao com agulha .Verificou-se a presenca de 16 pacientes com patologias mamarias benignas (32 %) e 34 pacientes (68%) portadoras de neoplasia mamaria maligna. A mamografia resultou em 7 estudos indeterminados, 30 verdadeiros positivos ( VP ), 2 verdadeiros negativos ( VN ), 10 falsos positivos ( FP ) e 1 falso negativo ( FN ). A cintigrafia mamaria apresentou 3 estudos indeterminados, 30 VP, 14 VN, 1 FP e 2 FN. o calculo da sensibilidade ( S ) e da especificidade ( E ) foi realizado para a mamografia, obtendo-se S de 97 % e E de 17 % . O mesmo calculo foi realizado para a cintigrafia mamaria que apresentou S de 94 % e E de 93 % . Os mesmos parametros foram estudados separadamente nas lesoes palpaveis e nao palpaveis, onde a cintigrafia mamaria registrou valores de especificidade superiores aos da mamografia. Concluuiu-se que a cintigrafia mamaria com 99mTc-Tetrofosmin detecta a neoplasia mamaria maligna com sensibilidade semelhante a mamografia por raios X e apresenta especificidade maior, especialmente nas lesoes nao palpaveis. A indicacao da cintigrafia mamaria com 99m Tc-Tetrofosmin deve ser realizada como complemento as mamografias das lesoes nao palpaveis
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    Associação da concordância intra e interobservadores no estudo das microcalcificações mamárias, pela mamografia, com análise histopatológica: estudo de acurácia
    (Universidade Federal de São Paulo (UNIFESP), 2003) Batista, Claudio Sergio [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]
    Contexto: A mamografia de alta resolucao e atualmente o exame complementar por imagem indicado para o estudo das mamas de mulheres acima de 35 anos. Com a sua difusao, tornou-se cada vez mais frequente o encontro de microcalcificacoes como achado unico em mulheres assintomaticas. Embora a presenca de microcalcificacoes como achado isolado possa permitir o diagnostico precoce do cancer de mama, nao e possivel ate o momento estabelecer com certeza um criterio diagnostico a partir destas. Isto se deve ao fato de que microcalcificacoes tambem sao achadas em lesoes benignas. A adequada realizacao e interpretacao da mamografia aumenta o desempenho do metodo, revelando sinais diretos ou indiretos de carcinoma. No entanto, pode haver uma variacao na interpretacao dos achados, que pode ser devido tanto a dificuldade de deteccao quanto a caracterizacao da microcalcificacao ao raios X. Objetivo: Avaliar o grau de acuracia da mamografia no estudo das microcalcificacoes mamarias, verificando previamente o grau de concordancia intra e interobservadores na leitura das mamografias. Metodo: Estudo transversal no qual sera verificada tanto a acuracia da rnamografia no estudo das microcalcificacoes quanto o grau de concordancia intra e interobservadores na leitura das mamografias. O procedimento de leitura sera feito com mascaramento das mamografias por meio de pessoa nao participante do estudo e nao havendo, por parte de um leitor, o conhecimento da leitura realizada pelo outro. A analise estatistica sera feita a partir da construcao de tabelas de contingencia 2 x 2, o que permitira que se calcule a acuracia, a sensibilidade, a especificidade, o valor preditivo positivo e o valor preditivo negativo da mamografia quando comparada ao estudo histopatologico (padrao-ouro), e da aplicacao do Teste de Kappa para a avaliacao do grau de concordancia intra e interobservadores nas leituras das mamografias
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    Associação entre os polimorfismos HaeIII e MspI do gene para o receptor alfa de estrogênio e densidade mamográfica em mulheres após a menopausa
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2006-10-01) Ramos, Eduardo Henrique de Moura [UNIFESP]; Kemp, Claudio [UNIFESP]; Silva, Ismael Dale Cotrim Guerreiro da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To assess the presence of estrogen receptor gene polymorphisms HaeIII and MspI as well as clinical factors, and their possible associations with high mammographic density in post-menopausal women. METHODS: One hundred and fifteen post-menopausal women, not in use of hormonal therapy and without clinical or mammographic lesions were evaluated. Three independent observers have determined the mammographic density pattern based on the ACR-BIRADS® 2003 (two subjective and one objective evaluations - Adobe Photoshop 7.0 software). Oral swabs (Cytobrush) were obtained to extract DNA and the polymerase chain reaction - restriction fragment length polymorphism) was performed to assess the presence of polymorphisms in intron 1 and exon 1 from estrogen receptor gene (HaeIII and MspI). RESULTS: The HaeIII polymorphism was found in 43 (37.4%) of the 115 women, while MspI was found in 96 (83.5%) of them. There was a good agreement among determinations of the three observers with regard to mammographic density. Thirty-four (29.6%) women had dense breasts and eighty-one (70.4%) had non-dense breasts. CONCLUSION: The estrogen receptor gene polymorphism Haelll showed no association with mammographic density (Fisher = 0.712), while the association between estrogen receptor gene polymorphism Mspl and mammographic density was near significance (Fisher = 0.098). The associations among age, parity and body mass index revealed statistical significance.
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    Associação entre polimorfismos do gene do receptor alfa de estrogênio com a densidade mamográfica em mulheres após a menopausa
    (Universidade Federal de São Paulo (UNIFESP), 2009-04-29) Ramos, Eduardo Henrique de Moura [UNIFESP]; Nazário, Afonso Celso Pinto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Genes that encode proteins involved at biosynthesis, action and metabolism of sexual steroids are polymorphics. This condition could explain individual variations in mammographic density. The objectives of this study were to evaluate a possible association of clinical characteristics and polymorphisms HaeIII, MspI and XbaI of the estrogen receptor gene alpha with postmenopausal mammographic density. Methods: Prospective evaluation was made of 120 women who were not hormone therapy users and had no identified breast lesions. Bilateral mammography was obtained from the group, and the radiological density was determined by three independent observers, with two subjective evaluations based on the ACR-BIRADS® (2003) classification of mammographic patterns and one computerized evaluation – the grey-scale histogram tool of the Adobe Photoshop® 7.0 software. Peripheral blood samples were obtained for DNA extraction, performed according to the GFX® Kit protocol from Amersham-Pharmacia. PCR-RFLP (Polymerase Chain Reaction - Restriction Fragment Length Polymorphism) was carried out for an analysis of the polymorphisms present in intron 1 (HaeIII and XbaI) and in exon 1 (MspI) of the estrogen receptor gene. Results: There was a high degree of concordance among the observers in the determination of mammographic density (Kappa, Pearson and Spearman index - p<0.001). The associations of clinical characteristics with mammographic density were: age (p=0,04), body mass index (p<0.0001), age at menarche (p=0.02), age at menopause (p=0.120), age at first delivery (p=0.120) and parity (p=0.09). The relation between the allele distribution of the polymorphisms and the density was: XbaI (p=0.02), HaeIII (p=0.65) and MspI (p=0.65). Conclusion: Polymorphism XbaI and the clinical factors age, menarche and body mass index showed to be associated with postmenopausal mammographic density.
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    Aumento da discriminação entre microcalcificações e seus arredores em imagens mamográficas: Uma abordagem morfológica
    (Universidade Federal de São Paulo, 2020-07-10) Marconatto, Lucas Pinazza [UNIFESP]; Moraes, Matheus Cardoso [UNIFESP]; http://lattes.cnpq.br/1854451408004051
    Atualmente, a mamografia é o único exame que apresenta eficácia comprovada na redução da mortalidade ocasionada pelo câncer de mama quando aplicado em programas de rastreamento da doença. Microcalcificações detectadas por exames de mamografia podem ser um indicativo para um possível surgimento do câncer de mama. Para melhor visualização dessas anomalias, métodos de processamento de imagens podem ser implementados. Tais métodos promovem o aumento da qualidade da imagem, permitindo a melhor visualização e facilitando a detecção de anomalias. Entretanto, os métodos encontrados na literatura possuem limitações ao se tratar do realce de microcalcificações além de proporem métodos avaliativos que podem omitir informações relevantes sobre a metodologia. Portanto apresentamos um novo método que promove o realce das microcalcificações presentes em mamografias e uma proposta de avaliação voltada apenas para as regiões de interesse. O método proposto consiste na combinação de técnicas de filtragem usando máscaras Laplacianas, operações morfológicas e aplicação de um filtro morfológico denominado white tophat filter. A metodologia é dividida em cinco etapas: Segmentação da Mama - operações morfológicas são aplicadas para segmentar a mama, eliminando artefatos irrelevantes da imagem; Pré-processamento - uma técnica de filtragem Laplaciana é aplicada para aumentar a nitidez das bordas detalhando melhor as informações da imagem; Extração de Características - o filtro morfológico white tophat é aplicado para extrair características sobre as microcalcificações; Realce - a imagem resultante da etapa de Pré-processamento e imagem resultante da etapa de Extração de Características são combinadas resultando no realce das microcalcificações através do aumento da discriminação de intensidade entre as microcalcificações e seus arredores; Avaliação - o realce é analisado com base no cálculo do módulo da diferença da intensidade média entre as microcalcificações e seus arredores. A avaliação foi realizada pela aplicação do método em 5 imagens mamográficas retiradas de um banco de dados aberto ao público. Os resultados mostram que a metodologia proposta resultou em um aumento da discriminação entre as regiões de microcalcificações e seus arredores em até 856,85%. A média do aumento da discriminação entre as regiões foi de 391,61% para as imagens utilizadas. A eficácia do método desenvolvido é sustentada pelos resultados obtidos através da proposta de avaliação que considera apenas as regiões de interesse e seus arredores, permitindo uma avaliação mais precisa quando comparado com métodos de avaliação de outros trabalhos que consideram a qualidade da imagem como um todo. Por fim, os resultados obtidos pelo método colaboram para a redução de diagnósticos incorretos, consequentemente direcionando à correta abordagem para o tratamento da doença, aumentando drasticamente as chances de cura do paciente.
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    Avaliação do desempenho dos equipamentos mamográficos e da qualidade das imagens em Serviços de Saúde do Município de São Paulo
    (Universidade Federal de São Paulo (UNIFESP), 2011-07-27) Ruberti Filha, Eny Moreira [UNIFESP]; Medeiros, Regina Bitelli [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: Verify equipment performance and image quality according to National and European test protocols. Identify the essential quality control test set that can be performed in the mammography services in order to guarantee quality in the imaging acquisition and reading process. Methods: Firstly, were evaluated the performance tests of five mammographic equipment of the public facilities. The signal detection was verified by Alvim statistic phantom and kappa value was measured in consonance with the specialist. Secondly, five weeks of consecutive tests were performed relating the film processing, the reference optical density (OD) constancy and the AEC performance. The CIRS phantom quality images were analyzed and the entrance surface air kerma (ESAK) was performed with TLD dosimeters. Thirdly, tests were replicated in thirteen mammography units. At this step, CIRS phantom images were digitalized and contrast and noise parameters were evaluated. The average glandular dose (MGD) was also calculated. Fourthly, the quality check tests were performed in two digital mammography equipment (DR) of private facilities and two conventional mammography equipment units connected with computerized radiography system(CR) installed in the public health facilities. Results: The equipment performance presented satisfactory results, except for the HVL, AEC and film processing. The Alvim phantom images were analyzed in a teleradiology facility by specialists and the results of the fiber and microcalcification detection were unacceptable, except for a single one. On the first reading, the kappa values varied from 0.02 to 0.68, being kappa for the microcalcifications from 0.26 to 0.6 and kappa for fibers from 0.06 to 0.76. On the second one, the kappa values were statistically superior. The mean glandular dose was 1.95mGy (0.65-3.5) and the OD measurements varied from 1.54 to 1.85. The five weeks tests results related to the film processing, OD constancy and AEC performance were unacceptable. The mean ESAK result was 9.33mGy (6.54-17.26), OD was 1.84(1.05-2.46), developer and fixer temperatures varied from 30.8 to 470C and 21 to 640C, respectively. On the third step, the MGD calculated for 4.5cm breast thickness varied from 1.0 to1.8mGy and 2.43 to 4.95mGy for 6.5cm breast thickness. The kappa values varied from 0.34 to 0.63, being kappa for microcalcification from 0.32 to 0.71 and kappa for fibers from 0.40 to 0.68. In this period, the OD analysis presented values below 1.4 that suggested a subprocessing image. The SNR varied from 5.9 to 24, 6% and 6.0 to 24, 6% for 4.5 and 6.5cm breast thicknesses, respectively. Conclusion: The methodology allowed verifying the importance of controlling process since the generation until the image analysis by the specialist. This control must be performed more often than required by the Brazilian law. It has become necessary to introduce the MGD calculation in the quality assurance program nationwide. The image analysis performed at the teleradiology facilities showed the need of diagnosis language standardization, as well as the viewing conditions. Clearly, the tests frequency showed that inadequate film processing is a recurring item and also contributes effectively for the quality image reduction.
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    Avaliação dos mutirões de mamografia realizados na região da direção regional de saúde de Marília nos anos de 2005 e 2006
    (Universidade Federal de São Paulo (UNIFESP), 2010-10-27) Marconato, Roseli Regina Freire [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: to describe the mammography findings, and to evaluate the performance indicators of the mammographies and describe the direct cost of the mammography campaigns in 2005 and 2006 realized by the Regional Health Section of Marilia. Methods: It is a cross sectional observational study of the radiographic findings during the mammography campaigns of 2005 and 2006, in the Regional Health Section of Marilia. A total of 11.952 mammographies, in 8 health institutions, comprising women from 37 nearby municipalities and the classification of the mammographies outcomes was done according to BI-RADS; the performance indicators analyzed were the ones employed in outcomes auditory and the cost analysis was based on the amount paid by the Unique Health System (SUS), based on the Tables SIA/SUS of 2005. The data were stored in Excel and furthermore analyzed, employing the statistical method SPSS, version 15. Results: From the 11.592 mammographies, 9.35% (1.117) were classified into BI-RADS 0 and for BI-RADS 1 and 2 87.86% (10.501), for the classification BI-RADS 3, 2.53% (302) and for classification 4 and 5, was 0.26%. The highest participation on the campaign comprised women from 40 to 49 years old. Women whose ages ranged from 50 to 59 and 60 to 69 represented 45.59%. The predictive positive value of BI-RADS 4 and 5 were 29.63 and 50% respectively. A total of 10 cases of breast cancer were diagnosed (0.84 per 1000 mammographies), 70% of the ages ranged from 50 to 69 years. The cost of these campaigns and the follow-up cost totaled R{dollar} 450.019.91, considering that R{dollar} 431.467.20 was destined for he payment of 11.952 mammographies and R{dollar}18.552.71 for the diagnoses of 29 suspicious cases, for the treatment of 3 cases of benign tumors and 6 cases of cancer. The cost of each diagnosed case was R{dollar} 43.268.10. Conclusion: The medical prescription for mammographic exams out of the age range recommended by the Ministry of Health, the low proportion of breast cancer cases detected by the exams and the high cost of each diagnosed case, indicate the necessity of implementation of effective screening programs in this region of the state, investing in specific medical programs comprising all levels of health care and fast access to secondary and third party health units for integrated and effective attendance to this specific population.
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    Banco de imagens mamográficas para treinamento na interpretação de imagens digitais
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2004-08-01) Pires, Silvio Ricardo [UNIFESP]; Medeiros, Regina Bitelli [UNIFESP]; Schiabel, Homero [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To make a software available for training professionals in the interpretation of mammography images on digital systems. MATERIALS AND METHODS: The software was developed in Delphi and linked to a Interbase database to store mammographic images in association with the BI-RADS® category results. Images were previously qualified and digitized using a Lumiscan 75 laser scanner. Training is done on 18 × 24 cm images displayed on a 17² commercial monitor. The software allows displaying of each breast view individually, medial-lateral oblique and cranial-caudal views, or four images simultaneously. The user selects an exam from the database and makes a diagnosis classifying the image into BI-RADS® categories. At the end of the process, the software compares the user's interpretation with the data stored in the database and than yields scores. RESULTS: The user becomes familiar with digital systems, images interpretation using BI-RADS® categories and with the quality of the image generating process regarding the detection of fibers and microcalcifications. CONCLUSION: The software is available at Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil, intranet and is a valuable tool for training professionals interested in digital systems.
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    Comparative evaluation of digital mammography and film mammography: systematic review and meta-analysis
    (Associação Paulista de Medicina - APM, 2011-01-01) Iared, Wagner [UNIFESP]; Shigueoka, David Carlos [UNIFESP]; Torloni, Maria Regina [UNIFESP]; Velloni, Fernanda Garozzo [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Atallah, Álvaro Nagib [UNIFESP]; Valente, Orsine [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVE: Mammography is the best method for breast-cancer screening and is capable of reducing mortality rates. Studies that have assessed the clinical impact of mammography have been carried out using film mammography. Digital mammography has been proposed as a substitute for film mammography given the benefits inherent to digital technology. The aim of this study was to compare the performance of digital and film mammography. DESIGN: Systematic review and meta-analysis. METHOD: The Medline, Scopus, Embase and Lilacs databases were searched looking for paired studies, cohorts and randomized controlled trials published up to 2009 that compared the performance of digital and film mammography, with regard to cancer detection, recall rates and tumor characteristics. The reference lists of included studies were checked for any relevant citations. RESULTS: A total of 11 studies involving 190,322 digital and 638,348 film mammography images were included. The cancer detection rates were significantly higher for digital mammography than for film mammography (risk relative, RR = 1.17; 95% confidence interval, CI = 1.06-1.29; I² = 19%). The advantage of digital mammography seemed greatest among patients between 50 and 60 years of age. There were no significant differences between the two methods regarding patient recall rates or the characteristics of the tumors detected. CONCLUSION: The cancer detection rates using digital mammography are slightly higher than the rates using film mammography. There are no significant differences in recall rates between film and digital mammography. The characteristics of the tumors are similar in patients undergoing the two methods.
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    Contribuição da mamografia e da ultra-sonografia na avaliação da mama reconstruída com retalho miocutâneo
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2006-02-01) Louveira, Maria Helena; Kemp, Claudio [UNIFESP]; Vilar, Vanessa Sales [UNIFESP]; Elias, Simone [UNIFESP]; Spadoni, Cristiane Grein Basso; Gracino, Alencar; Szejnfeld, Jacob [UNIFESP]; Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Universidade Federal de São Paulo (UNIFESP); CBR
    Breast reconstruction using myocutaneous flaps has been widely used in patients undergoing modified radical mastectomy for the treatment of breast cancer with significant improvement in esthetical results, which also helps to improve self-esteem of the patients as it minimizes the feeling of mutilation, without changing disease prognosis. Previously, it was believed that there was no risk of recurrence in the reconstructed breast due to the complete removal of breast tissue. However, histological studies have shown that a small amount of glandular tissue may remain after mastectomy, with a high potential for malignancy. Clinical follow-up of mastectomy patients is recommended as most recurring lesions occur at the flap margins and can be detected by palpation. In addition, the inclusion of mammographic and ultrasound monitoring has been proposed for the follow-up of patients as these methods may contribute to the diagnosis of recurrent lesions before they become palpable.
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    Correlacao entre a classificacao BI-RADS® 4, e os achados anatomopatologicos e imunoistoquimicos, nas lesoes nao nodulares representadas por microcalcificacoes agrupadas
    (Universidade Federal de São Paulo (UNIFESP), 2011) Kandelman, Jose David [UNIFESP]
    Objetivos: Correlacionar imagens obtidas em mamografias, classificadas pelo sistema BI-RADS® (Breast Imaging Reporting and Data System Atlas) como categoria 4 e suas subdivisoes A, B e C, com o diagnostico histopatologico; verificar a correlacao entre as categorias BI-RADS® 4A, 4B e 4C e os achados imunoistoquimicos da expressao de proteinas que interferem nos mecanismos de adesao celular e invasao tumoral: Claudina, Paxilina, HER-2 e FRA-1; propor uma revisao critica da ultima versao da classificacao de BI-RADS®, no que diz respeito a subdivisao da categoria 4. Metodos: Este e um estudo longitudinal, realizado entre agosto de 2006 e julho de 2007, e idealizado em duas frentes: uma para comparacao entre os diagnosticos radiologico e histopatologico em mulheres com microcalcificacoes mamarias, e outra verificando, nesta mesma casuistica, a presenca de marcadores imunoistoquimicos de malignidade, e sua associacao com o resultado histopatologico. Foram incluidos todos os casos de mulheres consecutivamente encaminhadas a um servico particular de radiologia, portadoras de mamografias de rotina/rastreamento realizados em outros servicos, com achados de microcalcificacoes, encaminhadas para realizacao de biopsia estereotaxica, e classificadas, no laudo final, entre: portadoras de lesoes benignas, hiperplasias ou malignas. Associacoes entre as variaveis clinicas, patologicas e radiologicas foram avaliadas. Resultados: No periodo do estudo, 127 pacientes com microcalcificacoes mamarias, classificadas como BI-RADS® 4, foram admitidas. A analise histologica revelou 16 casos malignos. As amostras eram benignas na maioria dos casos reportados como BI-RADS® 4A, e malignas na maioria dos BI-RADS® 4B ou 4C (p = 0,0387). Considerando a avaliacao de BI-RADS® inicial, antes do agrupamento das categorias 4B e 4C, a porcentagem de biopsias malignas foi significativamente maior nas amostras caracterizadas como 4B. As categorias 4C e 4A apresentaram a maior porcentagem de resultados de atipia; e nao havia amostras com atipia na classificacao 4B. Entre os resultados benignos (106 casos), a categoria 4A compreendeu a maior parte dos casos. Conclusoes: Houve correlacao entre os resultados do exame histopatologico e a categoria 4 de BI-RADS®. Houve correlacao significativa entre o diagnostico radiologico, morfologico e expressao de HER-2 e de FRA-1. Nao houve correlacao entre o diagnostico radiologico, morfologico e a expressao de Claudina e Paxilina. A reuniao das subcategorias B e C da classificacao BI-RADS® 4 mantem significativa correlacao entre os achados imagenologicos e morfologicos, promovendo uma clara mensagem para a formulacao da conduta medica
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    Correlacoes entre calcificacoes arteriais intramamarias e doenca coronariana em mulheres
    (Universidade Federal de São Paulo (UNIFESP), 2005) Ferreira, Eliane Maria Pinto Fiuza [UNIFESP]
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    Custos dos mutirões de mamografia de 2005 e 2006 na Direção Regional de Saúde de Marília, São Paulo, Brasil
    (Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, 2011-08-01) Marconato, Roseli Regina Freire [UNIFESP]; Soárez, Patrícia Coelho De [UNIFESP]; Ciconelli, Rozana Mesquita [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Departamento Regional de Saúde de Marília
    The aim of this study was to measure the direct costs of mammogram campaigns conducted by the Regional Health Division of Marília, São Paulo State, Brazil, in 2005 and 2006. A total of 11,952 mammograms were performed. Mammographic outcomes were classified according to BI-RADS. Cost analysis was based on the amount paid by the Brazilian Unified National Health System (SUS). Ten cases of breast cancer were diagnosed (0.84 per 1,000 mammograms), 70% of which between 50 and 69 years of age. The campaigns and follow-up cost a total of R$450,019 (U$280,000), with R$431,467 paid for 11,952 mammograms and R$18,552 for diagnosing 29 suspected cases and treating 3 cases of benign tumors and 6 cancer cases. Mean cost per diagnosed case was R$43,268. The high cost per diagnosed case highlights the need to implement effective screening programs and improve the quality of mammography services in this region of São Paulo State.
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    Densidade mamográfica assimétrica: como investigar? (Revisão de literatura e apresentação de rotina de investigação)
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2004-06-01) Louveira, Maria Helena [UNIFESP]; Kemp, Claudio [UNIFESP]; Ramos, Mônica Moron [UNIFESP]; Freitas, Andréa [UNIFESP]; Castro, Íris Moura [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The distribution of fibroglandular tissue in the breast is often symmetrical. Changes in that symmetry may indicate a hidden lesion in the parenchyma. The evaluation of asymmetric densities in the breast is one of the main day-to-day challenges for radiologists, i.e., differentiating normal superimposed structures from true parenchymal lesions. The knowledge of different techniques and resources used to investigate asymmetric densities as well as evaluation protocols are essential to establish the nature of the lesions. Asymmetric densities may be the only sign of breast cancer otherwise clinically and radiologically concealed.
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    Dermatomiosite e Calcinose Mamária
    (Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 1999-03-01) Facina, Gil [UNIFESP]; Bernardes Jr., Júlio Roberto De M. [UNIFESP]; Nazário, Afonso Celso Pinto [UNIFESP]; Kemp, Claudio [UNIFESP]; Gebrim, Luiz Henrique [UNIFESP]; Lima, Geraldo Rodrigues De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The authors report a rare case of dermatomyositis diagnosed at the Mastology Sector of the Division of Gynecology of the Federal University of São Paulo - Escola Paulista de Medicina, which caused breast deformity due to formation of bilateral dystrophic calcifications.
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    Dosimetria de raios X, energia na faixa do radiodiagnóstico, por radiofotoluminescência (RPL)
    (Universidade Federal de São Paulo (UNIFESP), 2019-08-21) Ogussuko, Meire [UNIFESP]; Tatumi, Sonia Hatsue [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    In recent decades, the use of X rays for diagnostic exams, such as X-ray imaging, tomography, mammography, and others, has increased considerably, because the general population has more access to execute them in the diagnostic centers. Consequently, the absorbed dose by the population (patients and area workers) has been increasing as well. Thus, the measurement of the dose to be applied in these exams with high precision has become an important activity to be evaluated. In addition, to the dose value itself, knowledge of the dose distribution in the total area to be examined is also an essential factor. The present work developed a methodology of dosimetry applied to X rays with radiophotoluminescent dosimeters (RPLGD) FD-7 glass, GD-351 model, by Dose Ace (Chiyoda Technol Corporation). Conventional X-ray source, conventional mammography and microdose mammography were used to irradiate the PMMA simulators. From the experiments performed with the RPL dosimeters using to measure the irradiation field with the conventional X-ray source, for 2D and 3D imaging, we obtained satisfactory measurements and we observed details such as the anodic and the edge effect (lead collimation). The study of the dose distribution versus 'patient thickness' showed that the increase was 0,54 for the normalized dose in the air to 1 for the 25 cm thickness. In the case of decay of average doses as a function of phantom depth, the normalized dose at the surface entrance was 1, it decreased and reached a minimum value 0,13 to a depth of 9 cm. In tests performed with the conventional mammograph, a non-homogeneous dose distribution as a function of area was noted. There was greater uniformity in the dose distribution in the PHILIPS MicroDose SI mammograph compared to the conventional mammography. The results of dosimeter calibration show that they have linear growth with the dose and have some energy dependence in the energy range of 16.4 to 18.2 keV. The RPL dosimetry showed great efficiency, practicality and high sensitivity in all tests performed.