Navegando por Palavras-chave "Carcinoma Ductal In Situ"

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    Ressonância Magnética Com Contraste Dinâmico Como Ferramenta Complementar Para A Avaliação De Calcificações Bi-Rads 4
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Zacarias, Marina Silva [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Breast cancer is the second most common neoplasm in the world among women, with an average estimate of 22% of new cases each year. According to the National Institute of Cancer José Alencar Gomes da Silva (INCA), the estimate for 2014 is 57120 new cases with 13345 deaths, 13225 women and 120 men (1). Due to the limitations in the primary prevention of breast cancer applicable to the population in general, the technological advances have been directed to its early diagnosis, once that in the early stages or in the noninvasive form, this disease has a good chance of cure, with a 5-year survival rate of 98% (2). As a result, tracking programs have emerged, the main role of which is to reduction of breast cancer mortality through the detection of early-stage cancer in asymptomatic women, ie without clinical signs that can be detected in self-examination or clinical examination. As a secondary result, there is an increase in survival due to the disease and reduction of surgical treatment extension, allowing less mutilating surgeries, as well as as reducing the need for chemotherapy (3). Despite the significant increase in the number of new cases both in developed countries, mortality rates are in decline in populations under regular programs of screening (4,5). These programs chose to adopt mammography as the method of which is considered the most sensitive method to detect breast cancer in the pre-clinical phase (6). The most important mammographic finding for screening is calcification. She may represent the only sign of malignancy, the first finding being in about 70% of ductal carcinomas in situ (DCIS) detected in screening tests (7). Histologically, these represent intraductal calcifications in areas of necrotic tumor or calcifications mucin secreting tumors, such as the cribriform or micropapillary subtype of intraductal cancer (8-10). The radiological appearance of suspected calcifications includes amorphous, coarse and heterogenous and fine pleomorphic with or without a linear branching pattern (2,7,8). Branched linear calcifications have a higher predictive value for malignancy than nonlinear calcifications, especially for high grade DCIS. Unfortunately, cancer of the breast, including CDIS, most often presents as granular, overlapping 6 with benign findings, which reduces the specificity of mammography (10% to 60%) and results in in the detection of a large number of calcifications that require a complementary examination (7,10). The mammographic aspect just can not differentiate between breast cancers invasive ductal carcinomas, because there is no invasion of the basement membrane. In addition, the method may be limited in the assessment of the extension of the disease, due to areas of the tumor without calcification in the interior (11,12). Due to the fact that some areas of these tumors are not calcified, several studies report changes in therapeutic planning in 11% to 15% of cases when mammography to another imaging method, evidencing additional foci of malignancy not detectable mammographically in about 27% to 34% of the cases (4,11,13). In this scenario, magnetic resonance imaging (MRI) complement the mammographic evaluation (11,13,14). Recent studies have shown that the magnetic resonance imaging of the breast with intravenous contrast injection has sensitivity exceptional for the diagnosis of invasive carcinoma (88% - 100%) (13,15,16). For another To date, there has been no agreement on the sensitivity and specificity of magnetic resonance imaging for the detection of CDIS; although cases of DCIS detected only in MRI have been reported, the role of magnetic resonance imaging in the characterization of suspect calcifications remains a controversial subject (13,17).