RESUMEN
Myositis ossificans (MO) is an uncommon tumor characterized by a rapidly growing mass following a history of local trauma. Few cases of MO affecting the breast have been reported, and some were misdiagnosed as primary osteosarcoma of the breast or metaplastic breast carcinoma. The following case report presents a patient with a growing breast lump whose core biopsy result was suspicious for breast cancer. MO was diagnosed after analysis of the mastectomy specimen. This case highlights the importance of MO as a differential diagnosis of a growing soft-tissue mass after trauma to avoid unnecessary overtreatment. Keywords: Myositis Ossificans, Osteosarcoma, Breast Cancer, Mastectomy, Heterotopic Ossification © RSNA, 2023.
RESUMEN
RESUMO Objetivo: Descrever o IMPACTO-MR, um estudo brasileiro de plataforma nacional em unidades de terapia intensiva focado no impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Métodos: Descrevemos a plataforma IMPACTO-MR, seu desenvolvimento, critérios para seleção das unidades de terapia intensiva, caracterização da coleta de dados, objetivos e projetos de pesquisa futuros a serem realizados na plataforma. Resultados: Os dados principais foram coletados por meio do Epimed Monitor System® e consistiram em dados demográficos, dados de comorbidades, estado funcional, escores clínicos, diagnóstico de internação e diagnósticos secundários, dados laboratoriais, clínicos e microbiológicos e suporte de órgãos durante a internação na unidade de terapia intensiva, entre outros. De outubro de 2019 a dezembro de 2020, 33.983 pacientes de 51 unidades de terapia intensiva foram incluídos no banco de dados principal. Conclusão: A plataforma IMPACTO-MR é um banco de dados clínico brasileiro de unidades de terapia intensiva focado na pesquisa do impacto das infecções por bactérias multirresistentes relacionadas à assistência à saúde. Essa plataforma fornece dados para o desenvolvimento e pesquisa de unidades de terapia intensiva individuais e ensaios clínicos observacionais e prospectivos multicêntricos.
ABSTRACT Objective: To describe the IMPACTO-MR, a Brazilian nationwide intensive care unit platform study focused on the impact of health care-associated infections due to multidrug-resistant bacteria. Methods: We described the IMPACTO-MR platform, its development, criteria for intensive care unit selection, characterization of core data collection, objectives, and future research projects to be held within the platform. Results: The core data were collected using the Epimed Monitor System® and consisted of demographic data, comorbidity data, functional status, clinical scores, admission diagnosis and secondary diagnoses, laboratory, clinical, and microbiological data, and organ support during intensive care unit stay, among others. From October 2019 to December 2020, 33,983 patients from 51 intensive care units were included in the core database. Conclusion: The IMPACTO-MR platform is a nationwide Brazilian intensive care unit clinical database focused on researching the impact of health care-associated infections due to multidrug-resistant bacteria. This platform provides data for individual intensive care unit development and research and multicenter observational and prospective trials.
RESUMEN
Introduction: Breast cancer screening has enhanced earlystage diagnosis by detection of impalpable tumors which require histopathological evaluation. Main percutaneous biopsy types are core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). CNB is less invasive and related to less bleeding and pain. VAB allows larger tissue samples and permits metal clip placement in biopsy bed for posterior localization in case of surgery. Access to VAB is restricted in Brazil due to its high costs. Objectives: To evaluate the agreement between pathological results of ultrasound (US) guided CNB with metal clip placement and surgery and settle false negative rates (FNR), sensibility, specificity, and accuracy of this method, for breast lesions < 20 mm. Methods: 388 US-guided CNB were retrospectively reviewed. Results: Surgical excision was performed in 317 patients. Overall FNR was 9.8%, (5.2% for lesions 1020 mm), sensibility 90.2% (94.8% for lesions 1020 mm), specificity 94.9% (94.1% for lesions 1020 mm), and accuracy 91.1% (94.7% for lesions 1020 mm). Cost of VAB varies from 2.2 to 12.5 times US-guided CNB. With metal clip placement, VAB costs 1.95 to 5.2 times US-guided CNB. Conclusions: For lesions that can be identified in US, CNB with metal clip placement has high sensitivity, specificity, and accuracy, as well as low FNR.
RESUMEN
Introduction: Breast cancer screening has enhanced earlystage diagnosis by detection of impalpable tumors which require histopathological evaluation. Main percutaneous biopsy types are core-needle biopsy (CNB) and vacuum-assisted biopsy (VAB). CNB is less invasive and related to less bleeding and pain. VAB allows larger tissue samples and permits metal clip placement in biopsy bed for posterior localization in case of surgery. Access to VAB is restricted in Brazil due to its high costs. Objectives: To evaluate the agreement between pathological results of ultrasound (US) guided CNB with metal clip placement and surgery and settle false negative rates (FNR), sensibility, specificity, and accuracy of this method, for breast lesions < 20 mm. Methods: 388 US-guided CNB were retrospectively reviewed. Results: Surgical excision was performed in 317 patients. Overall FNR was 9.8%, (5.2% for lesions 1020 mm), sensibility 90.2% (94.8% for lesions 1020 mm), specificity 94.9% (94.1% for lesions 1020 mm), and accuracy 91.1% (94.7% for lesions 1020 mm). Cost of VAB varies from 2.2 to 12.5 times US-guided CNB. With metal clip placement, VAB costs 1.95 to 5.2 times US-guided CNB. Conclusions: For lesions that can be identified in US, CNB with metal clip placement has high sensitivity, specificity, and accuracy, as well as low FNR.
RESUMEN
Introdução. O diagnóstico e o tratamento do câncer trazem consigo a realidade das hospitalizações freqüentes e prolongadas, os procedimentos invasivos, os efeitos indesejados da terapêutica, o ambiente físico incomum, a mudança de rotina e o afastamento dos entes queridos. Esta experiência caracteriza-se como um período de estresse físico e emocional, tanto para a criança/adolescente quanto para os seus familiares, e que ainda soma-se às limitações na compreensão do diagnóstico, os mitos acerca do câncer, o desajuste financeiro, a angústia, a dor e o medo frente a possibilidade constante da morte. Objetivos e Método. Este estudo propõe a validação de um instrumento Psychosocial Assessment Tool (PAT 2.0) para avaliação psicossocial da família da criança recém-diagnosticada com câncer para a cultura e idioma brasileiros, com caracterização da população de estudo segundo variáveis sócio-demográficas e clínicas e avaliação psicossocial da família. Trata-se de um estudo com corte transversal realizado com uma amostra de conveniência. A população do estudo incluiu as famílias de pacientes pediátricos recém-diagnosticados (com até 30 dias do momento da entrega do resultado) com câncer até 18 anos, sem antecedente de doença crônica ou de ameaça à vida, matriculados em quatro instituições brasileiras. Os procedimentos para tradução do questionário seguiram as recomendações de GUILLEMIN et al. (2000) e as dos autores do instrumento original. Para validação, foram realizadas as seguintes análises: análise fatorial confirmatória, consistência interna (KR 20), reprodutibilidade (teste de diferenças de médias t-pareado), validade discriminante (teste de associação pelo qui-quadrado) e validade concorrente (comparação com PIP - Pediatric Inventory for Parents, através de coeficiente de correlação Spearman). Resultados e Conclusão. Das 4 instituições parceiras, cerca de 61% das coletas ocorreram no estado de São Paulo; 92,8% são mães; 90,0% dos participantes tem entre 21 e 40 anos; 82,5% são casados; cerca de 48,0% vivem com menos de R$1000,00; 52,6% são classificados como classe C no Critério Brasil; 8,2% são classe D; das crianças, 60,8% são meninas e pelo menos 2/3 tem até 12 anos de idade em ambos os sexos; 34,0% tem o diagnóstico de Leucemias Linfocíticas Agudas (LLA). Da análise fatorial confirmatória do instrumento PAT 2.0, foram definidos 3 fatores, com variância acumulada de 43%. O Instrumento como um todo e as subescalas apresentaram KR20 satisfatório (PAT 2.0 0,77; "Problemas com irmãos" 0,87; "Problemas com a criança" 0,73), com exceção das subescalas "Suporte Social" 0,59; "Crenças familiares" 0,48; "Reação ao estresse" 0,45; "Problemas Familiares' 0,26 e "Estrutura Familiar e Fontes" 0,23. Foram observadas várias correlações significativas entre as Subescalas do Score-PAT 2.0 e os domínios do instrumento PIP (p<0,001). Na avaliação da reprodutibilidade do Instrumento, não foi encontrada diferença estatisticamente significativa entre a primeira e a segunda aplicação em todas as subescalas. Foram encontradas associações estatisticamente significativas entre as categorias de risco psicossocial (Universal, Alvo ou Clínico) e Critério Brasil, sexo do paciente, número de filhos e idade do paciente. A partir desta validação, acreditamos que o instrumento possa ser bastante útil na avaliação das famílias recém-diagnosticas e, desta maneira, oferecer suporte adequado durante o processo de tratamento.
Introduction. The pediatric cancer diagnosis and treatment may bring a tough reality to the child/family lives such as frequent hospitalizations, invasive procedures, adverse effects of therapy, unusual environment, and important changes in the family routine as well as distance from loved ones. This experience is characterized as a period of physical and emotional stress that is worsened by the limited understanding of the diagnosis, myths about cancer, the financial imbalance, distress, pain and fear in the face of the possibility of death. Objectives and Method. This study proposes the validation of the Psychosocial Assessment Tool (PAT 2.0) (a tool that is addressed to psychosocial assessment of newly diagnosed families of children with cancer) into the Brazilian culture and language and thus characterize the study population on regards of socio-demographic, clinical aspects and psychosocial risk. It is a cross-sectional study conducted with a convenience sample. The study population included the families of newly diagnosed cancer pediatric patients (up to 30 days of the final diagnosis), with no association of previous chronic or life-threatening disease, enrolled in four Brazilian pediatric oncology institutions. The procedures for translation of the questionnaire followed the international recommendations as well as the supervision of the CHOP (Children´s Hospital of Philadelphia) group (responsible for the development of the tool). For validation, we performed the following analysis: confirmatory factor analysis, reliability (internal consistency KR 20), reproducibility (mean differences throught paired t-test), discriminant validity (Chi-square test) and concurrent validity through comparison of PAT 2.0 and PIP - Pediatric Inventory for Parents (Spearman correlation coefficient). Results and Conclusion. About 61% of the subjects came from São Paulo state, 92.8% were mothers, 90.0% were between 21 and 40 years old, 82.5% were married, about 48.0 % received an income of less than R$1,000.00, 52.6% were classified as C in Brazil Economic Criteria, 8.2% were class D. On regards of the children, 60.8% were girls and at least 2/3 is up to 12 years old, 34.0% had a diagnosis of acute lymphoblastic leukemia (ALL). The PAT 2.0 confirmatory factor analysis showed three factors, with cumulative variance of 43%. The total instrument and its subscales showed satisfactory KR20 (PAT 2.0 0.77, "Problems with brothers" 0.87, "Problems with the child" 0.73), exception to the following subscales "Social Support" 0.59; "Beliefs family" 0.48; "Reaction to distress" 0.45, "Family Problems" and 0.26 "Family Structure and Sources" 0.23. We observed significant correlations between the the -PAT 2.0 subscales and the PIP domains (p <0.001). The analysis od the reproducibility showed no statistically significant difference between the first and second application in all subscales. Statistically significant associations were identified between psychosocial risk categories (Universal, Target or Clinical) and Brazil Economic Criteria, patient gender, number of children and age of the patient. We believe that the instrument may be useful in the evaluation of newly diagnosed families in Brazil, offering valuable information to provide adequate support during the treatment process.