Desempenho da mamotomia em alterações pre-neoplasicas e neoplasicas nas lesões não palpaveis da mama

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

Objective: To evaluate the diagnostic performance of the mammotomy in malignant or pre-malignant, not concrete injuries of the breast. Methods: During the period from 2000 April to 2004 May, about 1100 mammotomies had been done in the private clinic, among that 130 presented malignant diagnostic or pre-malignant alteration, indicative of complementary excisional open biopsy. One selected then the patients with not visualized to the ultrasound, not concrete mammary injuries, with diameter until 20mm. Thus, 120 patients had been eligible to the study and the respective blades of therapeutical excisional surgical biopsy. All the biopsies of mammotomy had been carried through by the same surgeon, in system of vertical stereotaxy, with the seated patient (Lorad® - Danbury, CT), with direct fit of the Mammotome® system (Ethicon Endo-Surgery Biopsys - Cincinnatti) under local anesthesia (2% Xylocaine) and used 11 cannula of gauge. All the blades had been revised by the same patologist, in the Laboratory of Pathological Anatomy of FCM/UNICAMP. The standard gold was considered the histological result of bigger gravity between the mammotomy and the therapeutical excisional surgical biopsy, assigned as resulted histological end. A study of the type validation of diagnostic test was realized. The analysis statistics was carried through the calculation of sensitivity, specification, positive (VPP) and negative preditivo value (VPN) of the mammotomy. The same type of analysis was carried through with relation the mamography characteristics: mammary standard, BI-RADS classification, type of injury and size of the same one. The analysis of agreement between the mammotomy and the therapeutical excisional surgical biópsia was made through the Kappa coefficient. Results: The sensitivity of the mammotomy in identifying to alterations daily pay-neoplásicas and neoplásicas in the diagnosis of not concrete the mammary injuries was of 92,9% (IC 88,2 - 97,5), with specification of 100% (IC 100-100), VPP of 100% and VPN of 90,9%. When the standard gold was injury daily pay-neoplásica, in all the studied cases of the mammographic characteristics, met test 100% specific (IC 100-100), as well as the VPP. The sensitivity of the mammotomy in dense breasts was 81% (IC 64,2-97,7), VPN of 81% and effectiveness of 89,5%. For the breasts of intermediate standard, sensitivity was 96.2% (IC 88,8-100), the VPN was 94.1% and the effectiveness was 97,6%. In breasts hipodensas sensitivity was 100% (IC 100-100), the 100% effectiveness and VPN of 100%. With regard to category of BI-RADS: in BI-RADS III or IVA sensitivity was 90% (IC 76,9-100), the VPN was 94.1% and the effectiveness was of 96,2%. In BI-RADS IVB: sensitivity was 93.5% (IC 84,9-100), the VPN was 83.3% and the effectiveness was 95,1%. In BI-RADS IVC: sensitivity was 94.4% (IC 83,9-100), VPN was 88.9% and the effectiveness was 96,2%. In BI-RADS V for only having a case one did not become fullfilled calculations to the respect. In relation to the type of injury: in nodule sensitivity was 100% (IC100-100), the VPN was 100% and the effectiveness was of 100%. In relation the microcalcificacion: sensitivity was 85.7% (IC 72,8-98,7), the VPN was 92% and the effectiveness was 94,6%. In the focal asymmetry/architectural focal distortion: sensitivity was 96.8% (IC 90,6-100), the VPN was 50% and the effectiveness was 96,9%. In relation to the size of the injury: until 10mm sensitivity was 100% (IC100-100), the VPN was 100% and the effectiveness was 100%. Of 10,1mm until 15mm: sensitivity was 95.5% (IC 86,8-100), the VPN was 96.2% and the effectiveness was 97,9%. Of 15,1mm until 20mm: sensitivity was 85.7% (IC 72,8-98,7), the VPN was 60% and the effectiveness was 88,2%.A accuracy of 95,8% and the agreement evaluation enters the histological result of the mammotomy and the final histological diagnosis result presented Kappa coefficient of 0,91 (IC 0,84-0,98). Conclusion: The mammotomy of not concrete injuries of breast guided with vertical system of stereotaxy, presented high accuracy, with sensitivity of 92,9% and specification of 100% in the studied population. The agreement with the final histological diagnosis occurred in 0,91 with low percentage of diagnostic sub-estimation (4,2%), corroborating its application as safe method for breast injuries without clinical translation and ecographycal correlation

ASSUNTO(S)

neoplasias mamarias - cancer - diagnostico mamas - cirurgia mamas - cancer - cirurgia

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