Avaliação de concordância entre protocolos abreviado e completo por ressonância magnética, no rastreamento do câncer de mama em mulheres de moderado e alto risco.
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Data
2022-08-26
Autores
Guedes, Mariana Mitraud Ottoni
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Pacientes com mamas densas possuem um risco maior de desenvolver câncer de mama e uma redução na sensibilidade da mamografia, por isso podem se beneficiar de uma estratégia de rastreio personalizada. A sensibilidade da ressonância magnética das mamas (RM) mostrou ser substancialmente maior do que a mamografia, mas apesar da superioridade, esta apresenta algumas limitações, como uso de contraste, o longo tempo de realização do exame e um alto custo. Buscando minimizar essas limitações, o protocolo abreviado por ressonância magnética, se apresenta como uma alternativa. Objetivo: Avaliar a concordância intraobservador entre os protocolos abreviado e completo na interpretação das imagens por ressonância magnética. Como objetivo específico, foi avaliado o tempo de aquisição e leitura das imagens, e laudo do protocolo abreviado. Métodos: Estudo transversal, em mulheres assintomáticas, com mamas de composição densa, de risco moderado e alto, submetidas a ressonância magnética das mamas em instituições privadas de Belo Horizonte/ MG - Brasil. Cada paciente foi submetida a um único exame de rastreio com sequências de imagens adquiridas, de acordo com o protocolo completo das instituições participantes. O protocolo abreviado foi realizado pelo computador, através da seleção de algumas sequências de imagem do estudo completo. A leitura dos exames foi realizada de forma independente, obtendo-se uma categoria do Breast Imaging - Reporting and Data System (BI-RADS), e os resultados laudados dos protocolos abreviado e completo comparados intra-observadores. Resultados: O estudo incluiu 170 mulheres e observou-se taxa de concordância excelente do BI-RADS laudado, entre os protocolos completo e abreviado, para a população do estudo. O valor de Kappa simples é de 0,955 ( IC 95% 0,916-0,993 ) e o valor de Kappa ponderado de 0,969 (IC 95% 0,943-0,995). Além disso, houve redução de 21 minutos para realização do exame abreviado. Conclusão: A concordância entre os protocolos indica que, apesar da redução do tempo de captação, do número de imagens adquiridas e da complexidade do método, a RM abreviada é capaz de atender à maioria das demandas de rastreamento, com impacto nos custos e na tolerabilidade das pacientes, o que torna o exame mais acessível.
Introduction: Patients with dense breasts have a higher risk of developing breast cancer and a reduced sensitivity of mammography, so they can benefit from a personalized screening strategy. The sensitivity of breast magnetic resonance imaging (MRI) has been shown to be substantially higher than that of mammography, but despite its superiority, it has some limitations, such as the use of contrast, the long examination time and high cost. Seeking to minimize these limitations, the abbreviated magnetic resonance protocol presents itself as an alternative. Objective: To evaluate the intraobserver agreement between the abbreviated and complete protocols in the interpretation of magnetic resonance images. As a specific objective, the acquisition and reading time of the images and the abbreviated protocol report were evaluated. Methods: A cross-sectional study in asymptomatic women with dense breasts, at moderate and high risk, submitted to breast MRI in private institutions in Belo Horizonte/MG - Brazil. Each patient underwent a single screening exam with acquired image sequences, according to the complete protocol of the participating institutions. The abbreviated protocol was performed by computer, by selecting some image sequences from the complete study. The examinations were read independently, obtaining a category from the Breast Imaging - Reporting and Data System (BI-RADS), and the results reported from the abbreviated and complete protocol were compared intraobserver. Results: 170 women were included and an excellent BI-RADS agreement rate report between the full and abbreviated protocols for the study population. The single Kappa value is 0.955 (95% CI 0.916-0.993) and the weighted Kappa value is 0.969 (95% CI 0.943-0.995). In addition, there was a reduction of 21 minutes for performing the abbreviated exam. Conclusion: The agreement between the protocols indicates that, despite the reduction in the capture time, the number of images acquired and the complexity of the method, the abbreviated MRI is able to meet most of the screening demands with an impact on the costs and tolerability of the patients, which makes the exam more accessible.
Introduction: Patients with dense breasts have a higher risk of developing breast cancer and a reduced sensitivity of mammography, so they can benefit from a personalized screening strategy. The sensitivity of breast magnetic resonance imaging (MRI) has been shown to be substantially higher than that of mammography, but despite its superiority, it has some limitations, such as the use of contrast, the long examination time and high cost. Seeking to minimize these limitations, the abbreviated magnetic resonance protocol presents itself as an alternative. Objective: To evaluate the intraobserver agreement between the abbreviated and complete protocols in the interpretation of magnetic resonance images. As a specific objective, the acquisition and reading time of the images and the abbreviated protocol report were evaluated. Methods: A cross-sectional study in asymptomatic women with dense breasts, at moderate and high risk, submitted to breast MRI in private institutions in Belo Horizonte/MG - Brazil. Each patient underwent a single screening exam with acquired image sequences, according to the complete protocol of the participating institutions. The abbreviated protocol was performed by computer, by selecting some image sequences from the complete study. The examinations were read independently, obtaining a category from the Breast Imaging - Reporting and Data System (BI-RADS), and the results reported from the abbreviated and complete protocol were compared intraobserver. Results: 170 women were included and an excellent BI-RADS agreement rate report between the full and abbreviated protocols for the study population. The single Kappa value is 0.955 (95% CI 0.916-0.993) and the weighted Kappa value is 0.969 (95% CI 0.943-0.995). In addition, there was a reduction of 21 minutes for performing the abbreviated exam. Conclusion: The agreement between the protocols indicates that, despite the reduction in the capture time, the number of images acquired and the complexity of the method, the abbreviated MRI is able to meet most of the screening demands with an impact on the costs and tolerability of the patients, which makes the exam more accessible.
Descrição
Palavras-chave
Ressonância magnética abreviada das mamas, Mamas densas, Rastreio pacientes alto risco câncer de mama, Rastreio paciente de risco moderado para câncer de mama