Double reading in mammographic screening

OBJECTIVE: To evaluate the efficacy of double reading on routine screening mammography for the detection of breast cancer in a non-academic environment. MATERIALS AND METHODS: During one year, 22,024 screening mammograms of asymptomatic women were submitted to independent double reading by two radiologists specialized in breast imaginology. Data analyzed were the number of additional carcinomas found after a second reading and the absolute number of recalls on account of the second reading. RESULTS: Nine additional carcinomas were detected after the second reading: 55.5% were ductal carcinoma in situ and the remainder were ductal invasive carcinomas up to 1.5 cm. Our absolute recall rate generated by the double reading was only 1.8%, with a percentage of false-positive findings of 98%. CONCLUSION: Double reading increased cancer detection rate by 8.5% and all tumors detected were stage 0 or 1.OBJETIVO: Avaliar a eficácia da dupla leitura de mamografias de rotina para rastreamento do câncer de mama, em ambiente privado (não acadêmico). MATERIAIS E MÉTODOS: Durante um ano, 22.024 mamografias de rastreamento, em mulheres assintomáticas, foram submetidas a dupla leitura independente, por dois radiologistas especializados em imaginologia mamária. Foram determinados o número de carcinomas adicionais encontrados com a dupla interpretação e o número absoluto de reconvocações geradas por tal prática. RESULTADOS: Foram detectados nove carcinomas adicionais com a dupla leitura, sendo 55,5% ductal in situ e o restante, ductal invasivo até 1,5 cm. Nosso índice de reconvocação absoluto gerado pela dupla interpretação foi de apenas 1,8%, com achados falso-positivos em 98%. CONCLUSÃO: O uso da dupla leitura no rastreamento mamográfico aumentou o índice de detecção de câncer em 8,5% e todos os tumores encontrados foram estádio 0 ou 1.Laboratório FleuryColégio Brasileiro de Radiologia e Diagnóstico por ImagemUniversidade Federal de São Paulo (UNIFESP)Laboratório Fleury Serviço de Imaginologia MamáriaUNIFESPSciEL

Confocal fluorescence microscopy for rapid evaluation of invasive tumor cellularity of inflammatory breast carcinoma core needle biopsies

Tissue sampling is a problematic issue for inflammatory breast carcinoma, and immediate evaluation following core needle biopsy is needed to evaluate specimen adequacy. We sought to determine if confocal fluorescence microscopy provides sufficient resolution to evaluate specimen adequacy by comparing invasive tumor cellularity estimated from standard histologic images to invasive tumor cellularity estimated from confocal images of breast core needle biopsy specimens. Grayscale confocal fluorescence images of breast core needle biopsy specimens were acquired following proflavine application. A breast-dedicated pathologist evaluated invasive tumor cellularity in histologic images with hematoxylin and eosin staining and in grayscale and false-colored confocal images of cores. Agreement between cellularity estimates was quantified using a kappa coefficient. 23 cores from 23 patients with suspected inflammatory breast carcinoma were imaged. Confocal images were acquired in an average of less than 2 min per core. Invasive tumor cellularity estimated from histologic and grayscale confocal images showed moderate agreement by kappa coefficient: κ = 0.48 ± 0.09 (p < 0.001). Grayscale confocal images require less than 2 min for acquisition and allow for evaluation of invasive tumor cellularity in breast core needle biopsy specimens with moderate agreement to histologic images. We show that confocal fluorescence microscopy can be performed immediately following specimen acquisition and could indicate the need for additional biopsies at the initial visit