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Resumen: Objetivo: Resumir el impacto que generó la introducción de la clasificación molecular del cáncer de mama en las distintas especialidades implicadas, para ofrecer al radiólogo una visión global del manejo actual de esta enfermedad, desde el diagnóstico hasta el tratamiento. Hallazgos: En las dos últimas décadas la información molecular basada en el análisis genómico ayudó a comprender la diversidad biológica de los cánceres mamarios y ha generado profundos cambios en la práctica clínica oncológica. Con pruebas inmunohistoquímicas más sencillas y disponibles se logra aproximar la clasificación molecular, que hace posible predecir el comportamiento clínico de los diferentes subtipos (Luminales, HER2-positivos y Triple- negativos) y su respuesta a diferentes terapias, permitiendo el diseño de tratamientos individualizados. Aunque no se han descrito hallazgos absolutamente patognomónicos en mamografía, ecografía y resonancia magnética, desde ya existe utilidad concreta de la clasificación molecular, tanto para predecir los cánceres de fenotipo Luminal A o Triple-negativo en imágenes, como para la evaluación de la respuesta a quimioterapia neoadyuvante en la resonancia. Una aplicación futura se presume en el área de radiogenómica. Conclusiones: Los radiólogos dedicados a imágenes mamarias deben estar familiarizados con los conceptos de la clasificación molecular, necesarios para la correlación radio-patológica de los resultados de biopsias mamarias y para proporcionar una atención óptima a las pacientes.

Background: An important side effect of radioactive iodine (RAI) therapy in patients treated for papillary thyroid cancer (PTC) is chronic sialadenitis. Neck ultrasonography (US) easily recognizes radioiodine-induced salivary gland abnormalities. The objectives of this study were to determine the prevalence of US-detected sialadenitis caused by RAI and to identify the risk factors associated with this damage. Methods: This nonconcurrent cohort study includes all PTC-operated patients who were treated with RAI between 2007 and 2017 and were systematically evaluated with preoperative and follow-up neck US that included targeted exploration of the major salivary glands. Patients with pre-existing salivary gland diseases were excluded. The anatomical damage (diminished glandular volume, wavy contours, hypoechogenicity, and heterogeneity) was qualitatively assessed and compared with the preoperative study. RAI activity, sex, age, and preparation method were evaluated as risk factors using univariate and multivariate analyses with logistic regression. Results: Enrolled in this study were 570 patients who received a median RAI activity of 3700 MBq (100 mCi). On US, we found 143 patients (25.1%) with damage in at least one of their salivary glands: all had parotid damage (77 bilaterally) and 14 (9.8%) also had submandibular gland damage (7 of them bilaterally). The multivariate analysis indicated that the risk of sialadenitis was significantly (p < 0.01) correlated with both RAI activity and sex (14.1% of males vs. 28.5% of females). However, the main risk factor was RAI activity; no injury was detected in 156 patients who received 1110 MBq (30 mCi) and 1850 MBq (50 mCi) of RAI. In the groups of patients receiving 3700 MBq (100 mCi), 5550 MBq (150 mCi) and ≥7400 MBq (≥200 mCi), atrophy was found in 21%, 46.9%, and 77.7% of patients, respectively. Age and preparation method were not related to an increased risk of atrophy in this study. Conclusions: Chronic sialadenitis is common and affects approximately one fourth of patients who receive 3700 MBq (100 mCi) or higher RAI activity. The main risk factor for this injury is the total RAI activity administered. By using the lowest effective activity possible, irreversible anatomical damage in salivary glands can be minimized. US is an excellent tool to diagnose post-RAI atrophy.

Background: Although most thyroid nodules with indeterminate cytology are benign, in most of the world, surgery remains as the most frequent diagnostic approach. We have previously reported a 10-gene thyroid genetic classifier, which accurately predicts benign thyroid nodules. The assay is a prototype diagnostic kit suitable for reference laboratory testing and could potentially avoid unnecessary diagnostic surgery in patients with indeterminate thyroid cytology. Methods: Classifier performance was tested in two independent, ethnically diverse, prospective multicenter trials (TGCT-1/Chile and TGCT-2/USA). A total of 4061 fine-needle aspirations were collected from 15 institutions, of which 897 (22%) were called indeterminate. The clinical site was blind to the classifier score and the clinical laboratory blind to the pathology report. A matched surgical pathology and valid classifier score was available for 270 samples. Results: Cohorts showed significant differences, including (i) clinical site patient source (academic, 43% and 97% for TGCT-1 and -2, respectively); (ii) ethnic diversity, with a greater proportion of the Hispanic population (40% vs. 3%) for TGCT-1 and a greater proportion of African American (11% vs. 0%) and Asian (10% vs. 1%) populations for TGCT-2; and (iii) tumor size (mean of 1.7 and 2.5 cm for TGCT-1 and -2, respectively). Overall, there were no differences in the histopathological profile between cohorts. Forty-one of 155 and 45 of 115 nodules were malignant (cancer prevalence of 26% and 39% for TGCT-1 and -2, respectively). The classifier predicted 37 of 41 and 41 of 45 malignant nodules, yielding a sensitivity of 90% [95% confidence interval; CI 77–97] and 91% [95% CI 79–98] for TGCT-1 and -2, respectively. One hundred one of 114 and 61 of 70 nodules were correctly predicted as benign, yielding a specificity of 89% [95% CI 82–94] and 87% [95% CI 77–94], respectively. The negative predictive values for TGCT-1 and TGCT-2 were 96% and 94%, respectively, whereas the positive predictive values were 74% and 82%, respectively. The overall accuracy for both cohorts was 89%. Conclusions: Clinical validation of the classifier demonstrates equivalent performance in two independent and ethnically diverse cohorts, accurately predicting benign thyroid nodules that can undergo surveillance as an alternative to diagnostic surgery.

Background: In most of the world, diagnostic surgery remains the most frequent approach for indeterminate thyroid cytology. Although several molecular tests are available for testing in centralized commercial laboratories in the United States, there are no available kits for local laboratory testing. The aim of this study was to develop a prototype in vitro diagnostic (IVD) gene classifier for the further characterization of nodules with an indeterminate thyroid cytology. Methods: In a first stage, the expression of 18 genes was determined by quantitative polymerase chain reaction (qPCR) in a broad histopathological spectrum of 114 fresh-tissue biopsies. Expression data were used to train several classifiers by supervised machine learning approaches. Classifiers were tested in an independent set of 139 samples. In a second stage, the best classifier was chosen as a model to develop a multiplexed-qPCR IVD prototype assay, which was tested in a prospective multicenter cohort of fine-needle aspiration biopsies. Results: In tissue biopsies, the best classifier, using only 10 genes, reached an optimal and consistent performance in the ninefold cross-validated testing set (sensitivity 93% and specificity 81%). In the multicenter cohort of fine-needle aspiration biopsy samples, the 10-gene signature, built into a multiplexed-qPCR IVD prototype, showed an area under the curve of 0.97, a positive predictive value of 78%, and a negative predictive value of 98%. By Bayes' theorem, the IVD prototype is expected to achieve a positive predictive value of 64–82% and a negative predictive value of 97–99% in patients with a cancer prevalence range of 20–40%. Conclusions: A new multiplexed-qPCR IVD prototype is reported that accurately classifies thyroid nodules and may provide a future solution suitable for local reference laboratory testing.

Resumen El hamartoma mioide es una lesion infrecuente; fue descrita por primera vez por Davies y Riddell en el ano 1973; se define histologicamente como la mezcla de tejido glandular adiposo y conjuntivo fibroso, asociado a extensos focos de celulas musculares fusiformes. Se presentan 7 casos de HM diagnosticados en 7 pacientes, haciendo enfasis en las caracteristicas imagenologicas y los hallazgos de las respectivas biopsias core. La importancia de realizar biopsia en estas lesiones radica en la necesidad de diferenciarla de patologias malignas; asi mismo no existe necesidad de biopsia excisional, ya que se trata de una entidad que no se asocia a lesiones de alto riesgo o con cancer.

Resumen: Objetivo. Determinar en qué método de imagen se logra visualizar y caracterizar mejor una distorsión de la arquitectura mamaria (DAM). Material y método. Estudio retrospectivo, aprobado por el Comité de Ética. Se seleccionaron los estudios mamográficos con diagnóstico de DAM en nuestro servicio entre agosto de 2015 y agosto de 2016. Se incluyeron casos estudiados con al menos 3 de las modalidades de imágenes disponibles en PACS: mamografía digital (2D), tomosíntesis (TS), ecografía (US), resonancia (RM) y que fueron biopsiados en nuestra institución. Se excluyeron casos de DAM asociadas con microcalcificaciones y cambios posquirúrgicos. Se evaluaron la tasa de detección, las características imagenológicas y la concordancia histopatológica. Resultados. En 15 meses se detectaron 81 casos de DAM en mamografía; de estos, 52 cumplieron con los criterios de inclusión. Según la histopatología, 23 (44%) resultaron malignas, 17 (33%) benignas y 12 (23%) lesiones de alto riesgo (LAR). Todas fueron detectadas por TS y US, clasificadas como lesiones sospechosas (BI-RADS 4 o 5). En mamografía 2D, 24 casos (46%) quedaron ocultos, y de estos, 8 (33%) resultaron malignos. Las lesiones malignas presentaron centro denso en el 87% de los casos. La lesión más frecuente en ecografía fue el área hipoecogénica (60%), en el 86% de las lesiones con vasos penetrantes. Se contó con 21 RM, identificándose captación tipo masa en las patologías malignas. Conclusión. La DAM es mejor visualizada en TS que en mamografía 2D. Pese a sus características, un estudio histológico es indispensable (incluso al observar un centro radiolúcido). El US dirigido es el paso a seguir, ya que permite visualizar la lesión y dirigir su biopsia percutánea en la mayoría de los casos.

Objectives To determine ultrasound (US) and clinical findings of thyroid microcalcifications in the absence of a nodule and their association with the risk of malignancy. Methods The Institutional Review Board approved a 5-year retrospective study. Twenty-one patients with clustered or scattered thyroid microcalcifications in the absence of nodules on US images who underwent fine-needle aspiration biopsies (FNABs) were included. Demographic and clinical data, US findings, and pathologic results were registered. Patients with a suspicion of malignancy or papillary thyroid carcinoma (PTC) on FNAB underwent thyroidectomy. Patients with benign results on FNAB underwent clinical and US surveillance. Results The mean age of the 21 patients was 33.2 years (29.5 years in patients with PTC patients and 39.4 years in those with benign findings; P = .034). Eleven of 21 patients had clustered microcalcifications (9 had cancer), and 10 of 21 patients had scattered microcalcifications (4 of 10 had cancer; P = 0.063). Sixty-two percent of the patients had FNAB findings that were suspicious for cancer or had a diagnosis of cancer. Eleven of 13 patients had surgical thyroidectomy performed in our institution; in all cases, Hashimoto thyroiditis was confirmed. Univariate and multivariate analysis showed that only age was significant (odds ratio, 0.9; P Conclusions Our study suggests that the presence of thyroid microcalcifications without a nodule is suspicious for PTC. We found that both patterns were suspicious for PTC, particularly in young patients. Special concern arises for those clustered microcalcifications on a background of Hashimoto thyroiditis.

El estudio preoperatorio en búsqueda de multifocalidad, multicentricidad y bilateralidad es fundamental para el adecuado manejo terapéutico del cáncer (CA) mamario. El estándar de referencia para realizarlo es la resonancia magnética (RM) mamaria. Basados en la literatura, adaptamos el protocolo de TC de tórax para el estudio de la mama. El objetivo de este trabajo es demostrar la factibilidad de la TC con énfasis en mama como método alternativo a la RM pre-operatoria, en lugares donde ésta no está disponible. Se realizaron TC pre-operatorias en todas las pacientes con diagnóstico reciente de CA mamario entre agosto de 2013 y septiembre de 2014. Los estudios fueron revisados en forma retrospectiva y según su resultado se los dividió en cuatro categorías. Grupo1: La TC no aportó información nueva. 1A: concordante con exámenes convencionales (Mx y US previos), 1B: cáncer visible en Mx y/o US, pero sin representación en la TC. Grupo 2: Al detectar lesiones adicionales, mejoró la etapificación radiológica, sin cambiar el tipo de la cirugía planificada. Grupo 3: Demostró nuevas lesiones no malignas y causó cirugía innecesaria. Grupo 4: Cambió correctamente el tipo de cirugía planeada en base a los estudios convencionales. En los 13 meses se realizaron 47 TC mamarias preoperatorias en 46 pacientes (edades: de 34 a 81 años, promedio: 56,7 años) La distribución por grupos fue: Grupo 1A (79%), Grupo 1B (8,3%), Grupo 2 (8,3%), Grupo 3 (0%) y Grupo 4 (4,1%). En el 87,5% de los estudios se visualizó la lesión primaria y se pudo evaluar su extensión. Seis cánceres no fueron identificados: correspondieron a un caso en que no se administró contraste intravenoso por falla renal, un verdadero negativo, en donde sólo existían adenopatías axilares de origen pulmonar y cuatro CDIS (8,3%). En nuestra práctica, la TC preoperatoria influyó favorablemente en la toma de decisiones terapéuticas, mejoró la etapificación radiológica en el 8,3% y cambió correctamente el enfoque quirúrgico en el 4,1% de las pacientes.

To assess performance of TIRADS classification on a prospective surgical cohort, demonstrating its clinical usefulness. Between June 2009 and October 2012, patients assessed with pre-operative ultrasound (US) were included in this IRB-approved study. Nodules were categorised according to our previously described TIRADS classification. Final pathological diagnosis was obtained from the thyroidectomy specimen. Sensitivity, specificity, positive/negative predictive values and likelihood ratios were calculated. The study included 210 patients with 502 nodules (average: 2.39 (±1.64) nodules/patient). Median size was 7 mm (3–60 mm). Malignancy was 0 % (0/116) in TIRADS 2, 1.79 % (1/56) in TIRADS 3, 76.13 % (185/243) in TIRADS 4 [subgroups: TIRADS 4A 5.88 % (1/17), TIRADS 4B 62.82 % (49/78), TIRADS 4C 91.22 % (135/148)], and 98.85 % (86/87) in TIRADS 5. With a cut-off point at TIRADS 4–5 to perform FNAB, we obtained: sensitivity 99.6 % (95 % CI: 98.9–100.0), specificity 74.35 % (95 % CI: 68.7–80.0), PPV 82.1 % (95 % CI: 78.0–86.3), NPV 99.4 % (95 % CI: 98.3–100.0), PLR 3.9 (95 % CI: 3.6–4.2) and an NLR 0.005 (95 % CI: 0.003–0.04) for malignancy. US-based TIRADS classification allows selection of nodules requiring FNAB and recognition of those with a low malignancy risk. • TIRADS classification allows accurate selection of thyroid nodules requiring biopsy (TIRADS 4–5). • The recognition of benign/possibly benign patterns can avoid unnecessary procedures. • This classification and its sonographic patterns are validated using surgical specimens.

Introduction. Triple-negative cancers (TNC) refers to any breast cancer that does not express the genes for estrogen receptor (ER), progesterone receptor (PR) or human epidermal grow factor, receptor type 2. Herceptin (HER2). They tend to be more aggressive; often being diagnosed in young patients, sometimes as interval cancers, they can grow to be large in size and patients frequently present initially with axillary metastases. They show a worse prognosis compared to other breast cancer tumors, with an increased risk of distant recurrence and death, especially in the first 5 years after diagnosis. Patients and methods. We conducted a descriptive, retrospective observational study of TNC cases diagnosed at our institution between March 2005 and June 2012 in order to identify their imaging features. Results. TNC may not be seen on mammography (Mx) if the parenchyma is dense (ACR types 3 and 4), mainly because they appear as masses or focal asymmetries without microcalcifications. Both on mammography and ultrasound (US) they can evoke a benign lesion. On US studies they frequently manifest as a solid single nodule, markedly hypoechoic with posterior acoustic enhancement and well-defined contours. They appear hypo/ avascular on color Doppler examinations (or vascularized in the periphery without central vessels) and various afferent pedicles may be present. Magnetic resonance imaging (MRI) clearly identifies suspicious lesions with some characteristic features: mass preferably with posterior and prepectoral location, markedly hyperintense on T2- weighted images with a ring-like pattern of contrast agent uptake, presenting washout curve, sometimes with septa increased uptake in the lesion center. Conclusion. Triple receptor-negative cancers often exhibit imaging features that distinguish them from other types of tumors. Keywords: Breast carcinoma, Breast neoplasma, Doppler sonography, Mammography, Sonography, Triple receptor-negative breast cancer, Ultrasound, Vascularity. Resumen: Introduccion. Los canceres triple negativo (CTN) son aquellos que no presentan receptores de estrogeno, progesterona ni human epidermal grow factor, receptor type 2. Herceptin (HER2). Tienden a ser mas agresivos; a menudo se diagnostican en pacientes jovenes, a veces como canceres de intervalo, llegan a ser de gran tamano y mas frecuentemente presentan metastasis axilares al momento del diagnostico. Su pronostico es peor que otros canceres mamarios, existiendo una mayor probabilidad de recurrencia a distancia y de muerte, especialmente en los primeros 5 anos. Pacientes y metodos. Se efectuo una revision retrospectiva descriptiva de los casos de CTN diagnosticados en nuestra institucion (periodo entre marzo de 2005 y junio de 2012) con el fin de identificar sus caracteristicas imaginologicas. Resultados. Los CTN pueden quedar ocultos en mamografia (Mx) si el parenquima es denso (tipo ACR 3 y 4), puesto que aparecen principalmente como masas o asimetrias focales, sin microcalcificaciones. Tanto en Mx como en ultrasonido (US) pueden evocar una lesion de morfologia benigna. En US se manifiestan frecuentemente como un nodulo solido unico, marcadamente hipoecogenico con refuerzo posterior, de contornos bastante circunscritos y que aparece hipo/avascular al Doppler color (o vascularizado en la periferia sin vasos centrales) y varios pediculos aferentes. La resonancia magnetica (RM) identifica hallazgos claramente sospechosos con algunos elementos caracteristicos: masa cuya localizacion es preferentemente posterior, pre-pectoral, marcadamente hiperintensa en T2 que capta el contraste en anillo y presenta curva de lavado, a veces con septos hipercaptantes en el centro de la lesion. Conclusion. Los CTN presentan a menudo caracteristicas en imagenes que los diferencian de otros tipos de tumores. Palabras clave: Cancer de mama triple negativo, Carcinoma mamario, Ecografia, Mamografia, Neoplasia de mama, Sonografia Doppler, Ultrasonido, Vascularidad.

Context: There is a high prevalence of thyroid nodules on ultrasonographic (US) examination. However, most of them are benign. US criteria may help to decide cost-effective management. Objective: Our objective was to develop a standardized US characterization and reporting data system of thyroid lesions for clinical management: the Thyroid Imaging Reporting and Data System (TIRADS). Design: This was a prospective study using the TIRADS, which is based on the concepts of the Breast Imaging Reporting Data System of the American College of Radiology. Materials: A correlation of the US findings and fine needle aspiration biopsy (FNAB) results in 1959 lesions biopsied under US guidance and studied histologically during an 8-yr period was divided into three stages. In the first stage, 10 US patterns were defined. In the second stage, four TIRADS groups were defined according to risk. The percentages of malignancy defined in the Breast Imaging Reporting and Data System were followed: TIRADS 2 (0% malignancy), TIRADS 3 (80% malignancy). Results: The TIRADS classification was evaluated at the third stage of the study in a sample of 1097 nodules (benign: 703; follicular lesions: 238; and carcinoma: 156). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88, 49, 49, 88, and 94%, respectively. The ratio of benign to malignant or follicular FNAB results currently is 1.8. Conclusions: The TIRADS has allowed us to improve patient management and cost-effectiveness, avoiding unnecessary FNAB. In addition, we have established standard codes to be used both for radiologists and endocrinologists.

Background: Retroareolar cysts present in female adolescents with palpable subareolar masses that can have concomitant inflammatory changes. The purpose of this study was to report our cases of retroareolar cysts and thus to contribute to a better knowledge and understanding of this entity. Methods: Forty-six girls were diagnosed with retroareolar cysts between December 2000 and July 2002. A retrospective chart review is presented with the clinical and ultrasonographic findings. Results: Age at presentation was 10 to 20 years. The reason for consultation was acute mastalgia and inflammation in 31 cases and palpable nodule in 15 cases. Two patients had areolar discharge. Ultrasonographic imaging in the 46 girls showed retroareolar simple cysts, either multiple or bilateral. The cysts had thin walls and were round, oval, or elongated with a variable diameter always less than 20 mm. They had liquid content with an echogenic or calcific sediment. When retroareolar cysts presented with inflammatory changes, antibiotics and nonsteroidal anti-inflammatory drugs were used. Inflammatory changes disappeared in approximately seven days. All patients experienced favorable outcomes. Conclusions: Retroareolar cysts are a benign form of breast disease in the adolescent. Further investigation is needed to completely understand the pathophysiology, epidemiology, and natural history of this diagnosis.

PURPOSE Challenge current axiom regarding hyperechogenic lesions in breast US categorized as mainly benign lesions. 2) Present frequency of malignant hyperechoic lesions, describe their sonographic and histological characteristics. METHOD AND MATERIALS IRB approved retrospective review of 2369 consecutive US-guided Core biopsies between 2006 and 2014. Lesions were considered hyperechogenic when more than 90% of its volume had higher echogenicity than surrounding subcutaneous tissue. Variables assessed were: age, size, histology, mass or non-mass, margins, echogenicity, acoustic effect, orientation, location, presence of a hypoechoic center, vascularization and BI-RADS category. Qualitative variables were described by percentage distribution, mean and SD. RESULTS Thirty one (1,3%) lesions biopsied were hyperechoic: only 17 (54.8%) were benign. We found 14 patients (range, 39-81 years, mean 57,5 years) with hyperechoic cancers, accounting for 1,77% of all cancers. 12 (85,7%) were ductal and 2 (14,3%) lobular histology (mean 17,5 mm range 8-40mm). All of them exhibited a small central hypoechoic area and were partially or completely surrounded by fatty tissue. Shape, margins, orientation and vascular architecture were highly suggestive of malignancy at US, mammography and in MRI (BI-RADS 4B and 5). On histology, all lesions were surrounded by fatty tissue, with a low–cell count collagenous center with a higher peripheral cellularity, mixing and interweaving with adipose tissue. CONCLUSION Hyperechogenic breast cancers are rare (1.77%), and we challenge the current concept of high rate of benignity with a 45,2% of chances for malignancy. We propose that hyperechogenicity is given by interweaving bundles with adipose tissue, which provide higher amount of acoustic reflective surfaces, thus explaining its sonographic pattern. CLINICAL RELEVANCE/APPLICATION Hyperechogenic breast lesions should not be considered as always benign. Malignancy thresholds should not be influenced by this sonographic characteristic. We propose histopathological explanation of this sonographic pattern. Citation Format: Camacho J, Horvath E, Pizzolon MF, Pinochet MA, Gallegos M, Galleguillos C, Uchida M, Cadiz F, Silva C. Malignant hyperechoic lesions in breast ultrasound - Frequency and characteristics. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-09.

Is breast MRI concordant with pathologic tumor size in breast cancer patients treated with neo-adjuvant chemotherapy?Abstract. Neoadjuvant chemotherapy (NACT) is a treatment used in those breast cancers initially inoperable due to their size, and also in operable breast cancers where NACT could increase the rate of conservative breast surgery. To assess tumor response to treatment, clinical examination, mammography, ultrasound, and breast MRI are used, the latter being the modality that yields the best correlation with histologic tumor volume. We evaluated the correlation of tumor sizes as measured by MRI versus surgical pathological specimen in breast cancers treated with NACT. Eighteen patients underwent MRI to monitor NACT; in 15 (83%) of them the final biopsy was obtained. In this group a very good correlation was observed, with a mean difference between MRI and histology of 4 mm regarding tumor volumen, which has allowed an adequate management of patients in our daily practice.Keywords: Breast MRI, Conservative breast surgery, Neoadjuvant chemotherapy.Resumen. La quimioterapia neoadyuvante (QTNA) es un tratamiento usado en aquellos canceres mama-rios cuyo tamano los hace inoperables al momento del diagnostico y en canceres mamarios operables, pero cuyo uso podria permitir una cirugia conservadora. Para evaluar la respuesta al tratamiento, se ha utilizado el examen clinico, la mamografia, el ultrasonido y la resonancia magnetica mamaria, siendo esta ultima la que mejor correlacion tiene con el tamano tumoral histologico. Quisimos evaluar la concordancia del tamano tumoral medido en resonancia magnetica con el de la biopsia quirurgica, en canceres ma-marios tratados con QTNA. Dieciocho pacientes se realizaron resonancia magnetica para monitorizacion de QTNA, en 15(83%) de ellas se obtuvo la biopsia definitiva. En este grupo observamos una muy buena correlacion, con una diferencia promedio de 4 mm, entre el tamano de la resonancia y el de la histologia, lo que permitio en nuestro medio un adecuado manejo de las pacientes.Palabras clave: Cirugia conservadora de la mama, Quimioterapia neoadyuvante, Resonancia magnetica mamaria.

The purpose of this study was to assess the parallel artery and vein sign at color Doppler breast ultrasound as a predictor of the benign nature of breast masses.A prospective study was performed to identify evidence of a parallel artery and vein in breast lesions consecutively biopsied with a 14-gauge needle under ultrasound guidance. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and 95% CIs for the parallel artery and vein sign were calculated.The parallel artery and vein sign was identified in 142 of the 1074 masses (13.2%). The specificity for benignity was 99.3% (CI 95%, 98.3-100.0%); sensitivity, 17.6% (CI 95%, 15.0-20.3%); positive predictive value, 99.0% (CI 95%, 96.7-100); negative predictive value, 30.0% (CI 95%, 27.0-32.9); positive likelihood ratio, 24.7 (CI 95%, 21.2-28.7); and negative likelihood ratio, 0.83 (CI 95%, 0.80-0.86). Among masses found to have the parallel artery and vein sign, all BI-RADS ultrasound category 3 and 95.1% of BI-RADS 4 lesions were determined to be benign.Although the parallel artery and vein sign is an uncommon finding, it has a significant association with benign pathologic results (96.5%) with a positive likelihood ratio of 24.7. The presence of this color Doppler ultrasound finding in breast masses in BI-RADS ultrasound categories 3 and 4 reinforces the benign nature and may allow follow-up rather than biopsy in the care of some patients.

El estudio preoperatorio en busqueda de multifocalidad, multicentricidad y bilateralidad -antes considerada la indicacion mas solida de la resonancia magnetica (RM) mamaria- hoy se encuentra fuertemente cuestionada en la literatura. En este trabajo nos propusimos evaluar la capacidad de la RM mamaria en nuestro centro para mejorar la etapificacion radiologica preoperatoria realizada por metodos convencionales y determinar la proporcion de las pacientes en que genera cambio en el enfoque quirurgico. Hemos revisado retrospectivamente las RM preoperatorias entre enero de 2009 y junio de 2010. Clasificacion: Grupo1: la RM no aporto informacion nueva. Grupo 2: al detectar lesiones adicionales, mejoro la etapificacion radiologica, sin cambiar el tipo de la cirugia planificada. Grupo3: demostro nuevas lesiones no malignas y causo cirugia inutil. Grupo 4: cambio correctamente el tipo de cirugia planeada en base a los estudios convencionales. En los 18 meses se realizaron 419 RM mamarias, el 39% de ellas en preoperatorio. Para el analisis se han reclutado 128 pacientes con la siguiente distribucion en los grupos predeterminados: Grupo 1(66%), Grupo 2(20%), Grupo 3(2%) y Grupo 4(12%). En el 95,3% de las pacientes se logro realizar una sola cirugia con margenes libres. Este trabajo demostro la utilidad de la RM preoperatoria en nuestra practica: permite una mejor etapificacion radiologica en el tercio de las pacientes e incluso cambia correctamente el enfoque quirurgico en el 12% de los casos.

Depending on age, sex, and geographic area, 19 to 67% of the general population is found to have thyroid nodules when submitted to ultrasonica- lly-guided diagnostic puncture. Being benign in more than a 80%, most of them corresponds to colloid nodules. Indiscriminate fine-needle aspiration not only increases health costs but also generates anxiety in patients. The echographic-histological correlation of thyroid nodules made it possible to define five typical patterns (colloid patterns 1, 2, 3; neoplastic type, and malignant pattern). Thirty three percent of colloid nodules may appear as follicular neoplasms or malign nodules, being puncture the only means for recognizing and establishing the difference between them. Nevertheless, 67% of nodules presents a typical appearance that corresponds to colloid patterns 1, 2, and 3, which show a weak association to cancer risk (0%, 0% and 1,5%, respectively). On this basis, ultrasound follow-up is advised to recognize them in order to significantly diminish unnecessary diagnostic histological punctures.

Los quistes retroareolares son frecuentes en niñas pre y postmenárquicas. Raramente se diagnostican en el varón. Corresponden a dilataciones quísticas de glándulas mamarias accesorias que se abren junto con una glándula sebácea en la areola, pueden ser únicos o múltiples, uni o bilaterales, palpables o hallazgos incidentales en ecografía. Los no complicados tienen morfología variable, paredes delgadas y contenido anecogénico, pudiendo observarse sedimento calcico en su lumen. Los complicados presentan paredes engrosadas, hipervascularizadas, con contenido ecogénico, avascular, tejidos adyacentes hiperecogénicos y aumento de la vascularización al Doppler color. Sin tratamiento, pueden transformarse en abscesos retroareolares. La complicación inflamatoria se trata con antiinflamatorios y/o antibióticos. No requieren biopsia diagnóstica ni punción evacuadora, puesto que se drenan espontáneamente a la areola. El conocimiento del cuadro clínico y su aspecto ul-trasonográfico permitirá orientar adecuadamente a los pacientes y sus familias Retroareolar cysts are common in pre and postmenarchic girls. Boys are rarely diagnosed with this condition. They correspond to cystic dilatations of the accessory mammary glands that open along with a sebaceous gland at the areola and can be single or multiple, uni or bilateral, palpable or incidental findings on ultrasound. They have variable morphology, thin walls, anechogenic content, sometimes calcic sediment can be observed in their lumen. Infected cysts present enlarged, hypervascularized walls; their content is echogenic, avascular and the adjacent tissue is hyperechogenic, with increased vascularization at color Doppler. If not treated, may become retroareolar abscesses. Inflamatory complications are treated with anti-inflamatory drugs and/or antibiotics. No diagnostic biopsy or puncture aspiration is required, since they are spontaneously drained at the areola. In order to appropriately advise patients and families, it is necessary to have knowledge of both the medical and the ultrasonographic aspects of them and their complications