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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2021.tde-09082021-124841
Document
Author
Full name
Yedda Nunes Reis
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Filassi, Jose Roberto (President)
Cunha, Angela Francisca Trinconi da
Júnior, José Maria Soares
Santos, Cesar Cabello dos
Title in Portuguese
Análise da associação entre as densidades mamárias macroscópica e mamográfica em pacientes candidatas à cirurgia conservadora para câncer de mama
Keywords in Portuguese
Densidade da mama
Doenças mamárias
Mamografia
Neoplasia da mama
Patologia
Ressonância magnética nuclear
Abstract in Portuguese
Introdução: A classificação de densidade mamográfica modificou-se ao longo das últimas décadas. Dentre os cinco principais padrões de classificação da densidade mamária de acordo com a mamografia, o modelo atualmente mais adotado é aquele do ACR-BI-RADS®. A alta densidade mamária na mamografia está associada ao risco de câncer de mama e redução da sensibilidade para detecção de tumores. Entretanto, o estudo da densidade mamária e sua correlação dos padrões radiológicos com a anatomia patológica é um campo pouco explorado e heterogêneo na literatura. Objetivo: O objetivo desse estudo é avaliar a correspondência da densidade mamográfica (DMG) e a densidade mamária macroscópica (DMM) na anatomia patológica, assim como a associação entre DMM e características clínicas e tumorais. Métodos: Análise post-hoc do estudo BREAST-MRI, realizado de novembro de 2014 a outubro de 2018. Critérios de inclusão: carcinoma invasivo ou carcinoma in situ de mama em mulheres acima de 18 anos, submetidas à tripla avaliação (exame físico, mamografia e ultrassonografia), candidatas à cirurgia conservadora. A DMM foi definida como inversamente proporcional à porcentagem de gordura peritumoral na análise macroscópica do setor mamário, sendo então classificada de maneira análoga ao ACR-BI-RADS® (A, B, C ou D). Resultados: 431 pacientes foram incluídas na análise de DMM. A classificação das mamas por DMM foi distribuída da seguinte forma: 303 (70,3%) A, 85 (19,7%) B, 36 (8,4%) C e 7 (1,6%) D. Houve diferença na distribuição entre os achados de DMG e DMM de acordo com a classificação ACR-BI-RADS®, sendo que as DMM A, B, C e D tiveram a correspondência no ACR-BIRADS mamográfico em 22/24 (91,7%) mamas A, 34/187(18,2%) mamas B, 26/199 (13,1%) mamas C, e 1/21 (4,8%) mama D, respectivamente (p < 0.001). As mamas com maior teor de gordura na análise macroscópica eram de pacientes mais velhas, com maior IMC, multíparas e na menopausa (p 0.001). Não houve diferença entre os grupos em relação ao histórico de terapia hormonal, estádio clínico, imuno-histoquímica e peso da peça cirúrgica. Conclusão: Houve diferença na distribuição entre os achados de densidade mamográfica e densidade mamária macroscópica, de acordo com BIRADS. Pacientes mais velhas, com maior IMC, multíparas e menopausas apresentaram mamas com maior teor de gordura na peça cirúrgica
Title in English
Macroscopic examination breast density versus mammographic breast density in breast cancer conserving surgery
Keywords in English
Breast density, Mammography
Breast diseases
Breast neoplasms
Nuclear magnetic resonance
Pathology
Abstract in English
Introduction: Mammographic breast density (MBD) classification has changed over the past decades. Among the 5 most important categorizations, current ACR-BIRADS® classification is the most widely adopted. High MBD is associated with high risk of breast cancer and reduced sensitivity for breast cancer screening. On the other hand, in the anatomopathological context, the study of breast density has been superficially explored and is heterogeneous in current medical literature. Objective: The aim of this study is to explore the association between MBD and macroscopic examination of breast density (MEBD), as well as the association between MEBD and multiple clinical and tumoral characteristics. Methods: Post-hoc analysis from the BREAST-MRI trial database, from November 2014 to October 2018. Inclusion criteria were biopsyproven invasive breast cancer or ductal carcinoma in situ in female patients aged 18 years or older, who were selected to breast conserving surgery after triple assessment (physical exam, mammography and ultrasound). MEBD was estimated by an experienced pathologist by calculating the ratio between stromal and fatty tissue in each breast histopathological sample, and then patients were classified similarly to the ACR BI-RADS® criteria. Results: A total of 431 MEBD were selected for the final analysis. MEBD classification was distributed as follows: 303 (70,3%) were classified as A, 85 (19,7%) as B, 36 (8,4%) as C and 7 (1,6%) as D. We found no correspondence when comparing distribution of MBD and MEBD in our breast surgical specimens, being that MEBD A, B, C and D had the corresponded to DMG in 22/24 (97,1%) of A breasts, 34/187 (18,2%) of B breasts, 26/199 (13,1%) of C breasts and 1/21 (4,8%) of D breasts, respectively (p < 0,001). Breasts with highest fat content in macroscopic analysis were associated with older patients, higher BMI, multiparity and post-menopausal status (p 0.001). There was no difference among groups regarding history of hormone replacement therapy, clinical stage, immunohistochemical, weight of the surgical specimen, and number of patients who underwent breast MRI examination. Conclusion: we found no correspondence in the distribution of MEBD and MBD according to the ACR-BIRADS® classification. Breasts with highest fat content in macroscopic analysis were associated with older patients, higher BMI, multiparity and post-menopausal status
 
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Publishing Date
2021-08-11
 
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