Elvira Marques - Academia.edu (original) (raw)

Papers by Elvira Marques

European Journal of Cancer, 2014

The British journal of radiology, Jan 16, 2015

To assess the role of Magnetic Resonance Imaging (MRI) in the preoperative staging of patients wi... more To assess the role of Magnetic Resonance Imaging (MRI) in the preoperative staging of patients with different histological types and molecular subtypes of breast cancer, by the assessment of the dimensions of the main tumour and identification of multifocal and/or multicentric disease. The study included 160 women diagnosed with breast cancer who performed breast MRI for preoperative staging. The size of the primary tumour evaluated by MRI was compared with pathology (gold standard) using the Pearson correlation coefficient (r). The presence of multifocal and/or multicentric disease was also evaluated. The mean age of patients was 52.6 years (range 30-81 years). Correlation between the largest dimension of the main tumour measured by MRI and pathology was worse for non special type/invasive ductal carcinoma than for other histological types, and was better for luminal A and triple-negative than for luminal B and Her-2 molecular subtypes. Multifocal and/or multicentric disease was pr...

To illustrate the imaging spectrum of primary and secondary breast lymphoma based on a series of ... more To illustrate the imaging spectrum of primary and secondary breast lymphoma based on a series of seven patients. To review the imaging characteristics of breast lymphoma on a multimodality evaluation and discuss its occurrence. To alert the radiologist for this diagnostic entity in breast imaging.

PURPOSE/AIM To contribute to literature data through reporting the cases selected, including one ... more PURPOSE/AIM To contribute to literature data through reporting the cases selected, including one case of carcinosarcoma. To review the imaging patterns on different evaluation methods and pathology correlation of 11 cases of metaplastic breast carcinomas, including their four subtypes. To discuss pathology and clinical features by literature review. CONTENT ORGANIZATION Due to rarity of metaplastic breast cancer cases, we decided to execute a retrospective review of patients from our institution diagnosed with carcinosarcoma, matrix-producing carcinoma (chondroid and osteoid), squamous cell and spindle cell carcinoma, from 2005 to 2010. This review focused on clinical and epidemiological aspects, imaging evaluation and pathology correlation. SUMMARY Metaplastic carcinoma constitutes less than 5% of all breast cancers. There are four subtypes: matrix-producing carcinoma, carcinosarcoma, squamous cell and spindle cell carcinoma. They usually manifest as a palpable mass, and the radiol...

PURPOSE/AIM To summarize the sonographic features of ductal carcinoma in situ (DCIS) detected by ... more PURPOSE/AIM To summarize the sonographic features of ductal carcinoma in situ (DCIS) detected by ultrasound (US) and correlate them with mammography, magnetic resonance imaging (MRI) and pathologic findings. CONTENT ORGANIZATION DCIS: - Pathologic changes - Types of DCIS Sonographic Appearance of DCIS: - Size - Shape - Margins - Echogenicity - Posterior acoustic characteristics Correlation with Mammography: - DCIS with microcalcifications - DCIS without microcalcifications Correlation with MRI: - Enhancement patterns - Second-look US Correlation with pathology: - Architectural pattern (micropapillary, papillary, solid, cribriform, and comedo) - Nuclear grade - Presence of necrosis SUMMARY US technique is critical for demonstrating DCIS. The main benefit of identifying a US abnormality in women with suspected DCIS on mammography or MRI is to allow the use of US to guide interventional procedures. Besides, US may be helpful in detecting DCIS without calcifications and in evaluating di...

PURPOSE/AIM To illustrate and discuss the variety of Magnetic Resonance Imaging (MRI) features of... more PURPOSE/AIM To illustrate and discuss the variety of Magnetic Resonance Imaging (MRI) features of mucinous breast cancer and correlate with pathologic findings. CONTENT ORGANIZATION Mucinous Breast Cancer - Definition / Pathology - Epidemiology - Conventional imaging findings - Histological subtypes (pure vs. mixed form) MRI Features - Shape - Margins - T2 signal - Enhancement Pattern - Diffusion-Weighted Imaging - PET/MRI fusion - Correlation with Pathology SUMMARY The major teaching points of this exhibit are: - Clinical and imaging features os mucinous breast cancer may suggest benign lesions and delay the correct diagnosis and treatment. - On MRI, these tumors have varied presentations, with typical findings of benign lesions, such as high signal on T2-weighted sequence and high ADC values in the diffusion-weighted sequence (DWI). - The pattern of post-contrast enhancement can range from no enhancement to heterogeneous or peripheral enhancement, usually with type 1 kinetic curve...

Objective: To evaluate the feasibility of placement of surgical clip for tumor bed localization i... more Objective: To evaluate the feasibility of placement of surgical clip for tumor bed localization in patients undergoing neoadjuvant chemotherapy through thick needle (core biopsy). Methods: Prospective, nonrandomized patients treated at the Breast Unit of A. C. Camargo Cancer Hospital with locally advanced breast cancer (≥ T3 and / or ≥ N2) or T2 lesion with unfavourable tumour/breast size index in which mastectomy would be performed up front. These patients that are candidates to neoadjuvant chemotherapy with the intention to preserve the breast (breast-conserving surgery) would submitted for marking the tumor with a titanium clip LT 200 (Ethicon Endo-Surgery) introduced by core needle biopsy guided by ultrasound. Results / conclusion: This work demonstrate that the introduction of the surgical clip through core needle biopsy is feasible, economical, has quick learning curve and is highly reproducible allowing marking the tumor bed safely in patients undergoing neoadjuvant chemother...

PURPOSE/AIM To illustrate and discuss the use of functional imaging methods to improve the assess... more PURPOSE/AIM To illustrate and discuss the use of functional imaging methods to improve the assessment of breast lesions. CONTENT ORGANIZATION Functional Imaging Methods - Definition - Comparison with Conventional Imaging Methods Magnetic Resonance Imaging (MRI) - Dynamic Contrast-Enhancement (DCE) - Diffusion-Weighted Imaging (DWI) - MR spectroscopy - Indications - Limitations 18F-fluorodeoxyglucose (FDG) PET/CT - Dedicated protocol for breast evaluation - Indications - Limitations - PET/MRI fusion Positron Emission Mammography (PEM) - Technique - Advantages - Indications - Limitations - Guided Biopsy - New radiopharmaceuticals SUMMARY The major teaching points of this exhibit are: - Functional imaging methods show metabolic / biologic alterations in normal breast tissue that may precede anatomic / morphologic alterations that is shown on conventional imaging methods. - MRI can provide functional information through DCE, DWI and MR spectroscopy. - 18F-FDG PET/CT dedicated to breast ...

Radiologia Brasileira

AGV et al. / Resultado do PET/CT em carcinomas mamários Radiol Bras. 2014 Mar/Abr;47(2):67–73 67 ... more AGV et al. / Resultado do PET/CT em carcinomas mamários Radiol Bras. 2014 Mar/Abr;47(2):67–73 67 0100-3984 © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Artigo Original / Original Article Correlação entre resultado do PET/CT e achados histológicos e imuno-histoquímicos em carcinomas mamários * Correlation between PET/CT results and histological and immunohistochemical findings in breast carcinomas CABT. Correlação entre resultado do PET/CT e achados histológicos e imuno-histoquímicos em carcinomas mamários. Radiol Bras. 2014 Mar/Abr;47(2):67–73. Resumo Abstract Objetivo: Correlacionar o resultado da tomografia por emissão de pósitrons/tomografia computadorizada (PET/CT) com 18 F-flúor-2-deoxi-D-glicose (18 F-FDG) realizado com protocolo específico para avaliação das mamas com achados histológicos/imuno-histoquímicos em pacientes com carcinomas mamários. Materiais e Métodos: Estudo transversal, com coleta prospectiva dos dados, em que foram estudadas pacientes com carci...

PURPOSE/AIM Review the imaging patterns on different evaluation and pathology correlation of 5 ca... more PURPOSE/AIM Review the imaging patterns on different evaluation and pathology correlation of 5 cases of breast lymphoma diagnosed with Hodgkin lymphoma, primary breast low grade NHL, primary breast diffuse large B-cell NHL MALT, secondary breast NHL, and the literature review. CONTENT ORGANIZATION Primary breast lymphoma is rare and predominately non-Hodgkin lymphoma (NHL). Using a multimodality evaluation, such as mammography, ultrasound, CT, MRI, Gallium scintigraphy and positron emission tomography (PET)-CT can provide the radiologist with valuable information for therapeutic decision making.Using a case based pictorial essay, we will review the imaging characteristics of primary and secondary breast lymphomas on multimodality evaluation and discuss their ocurrence. SUMMARY Lobular or irregular unifocal mass, with margins indistinct, intense enhancement on MRI and hipermetabolism on PET-CT evaluation can be found. Sometimes lymphomas do not exhibit characteristics that distinguis...

Radiologia Brasileira, 2012

Carcinoma primário de ovário raramente origina metástase para mama, com poucos casos descritos na... more Carcinoma primário de ovário raramente origina metástase para mama, com poucos casos descritos na literatura. Os autores relatam um caso de uma paciente com carcinoma ovariano que evoluiu com metástase para mama após cerca de oito anos do diagnóstico inicial da neoplasia e realizam revisão bibliográfica do assunto, dando ênfase aos aspectos de imagem. Unitermos: Carcinoma ovariano; Metástase mamária; Aspectos de imagem.

Revista Brasileira de Ginecologia e Obstetrícia, 2009

OBJETIVO: relatar uma série de três casos de uma normal variation conhecida como músculo esternal... more OBJETIVO: relatar uma série de três casos de uma normal variation conhecida como músculo esternal simulando lesão mamária. MÉTODOS: a suspeita diagnóstica foi feita a partir do quadro clínico, achados no exame físico e aspectos de imagem, sendo confirmada por meio de métodos de imagem seccionais, como tomografia computadorizada (TC) e ressonância magnética (RM). Foi realizada uma revisão da literatura no banco de dados Medline e em livros-texto de radiologia mamária sobre os aspectos anatômicos, clínicos e de imagem do músculo esternal. RESULTADOS: três pacientes do sexo feminino, sem queixas, que apresentaram lesões mamárias de aspecto nodular na projeção dos quadrantes mediais (duas em exame mamográfico de rotina e uma em TC). O diagnóstico de músculo esternal foi confirmado por meio de RM de mamas ou TC de tórax, demonstrando imagem alongada, localizada na região paraesternal esquerda, adjacente ao músculo peitoral. CONCLUSÕES: o músculo esternal é uma variante não usual da musculatura da parede torácica, presente em cerca de 2 a 8% da população. O conhecimento dessa entidade é fundamental, pois pode simular nódulo mamário.

European Journal of Radiology, 2014

Objective: To evaluate the impact of adding 18F-fluorine-2-deoxy-d-glucose (FDG) positron emissio... more Objective: To evaluate the impact of adding 18F-fluorine-2-deoxy-d-glucose (FDG) positron emission tomography (PET) in the evaluation of suspicious breast lesions on magnetic resonance imaging (MRI). Methods: Sixty patients with suspicious breast lesions on MRI were selected to perform a PET-CT in prone position, dedicated to the evaluation of the breasts. The areas with increased 18F-FDG concentration relative to normal parenchyma were considered positive on PET-CT. Fusion of PET and MRI images (PET-MRI) was performed on a dedicated workstation to better locate corresponding lesions, and its findings were compared with histological results. Results: 76 lesions were evaluated, including 64 mass lesions (84.2%) and 12 non-mass lesions (15.8%). Lesions' mean diameter on MRI was 29.6 ± 19.2 mm (range 6-94 mm). PET-CT showed increased metabolically activity on 57 lesions (75.0%), with mean maximum SUV of 5.7 ± 5.0 (range 0.8-23.1). On histopathology, there were 17 (22.4%) benign and 59 (79.7%) malignant lesions. Considering all lesions, PET-MRI fusion provided 89.8% sensitivity, 76.5% specificity and 86.8% accuracy. Considering only mass lesions higher than 10 mm, PET-MRI fusion provided 95.8% sensitivity, 83.3% specificity and 93.3% accuracy. Conclusion: The inclusion of 18F-FDG PET on the evaluation of suspicious breast lesions on MRI helped to differentiate benign from malignant breast lesions, especially for mass lesions with a diameter higher than 10 mm.

Medicine, 2014

The purpose of this study was to evaluate the diagnostic accuracy of multiparametric evaluation o... more The purpose of this study was to evaluate the diagnostic accuracy of multiparametric evaluation of breast lesions combining information of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), and 18 Ffluoro-deoxi-glucose ( 18 F-FDG) positron emission tomography/computed tomography (PET-CT). After approval of the institutional research ethics committee, 31 patients with suspicious breast lesions on MRI performed 18 F-FDG PET-CT with a specific protocol for breast evaluation. Patients' mean age was 47.8 years (range, 29-77 years). Positron emission tomography and magnetic resonance imaging (PET-MRI) images were fused. A lesion was considered positive on multiparametric evaluation if at least 1 of the following was present: washout/type 3 kinetic curve on DCE-MRI, restricted diffusion on DWI with minimum apparent diffusion coefficient value <1.00 Â 10 À3 mm 2 /s, and abnormal metabolism on 18 F-FDG PET-CT (higher than the physiologic uptake of the normal breast parenchyma). Thirty-eight lesions with histologic correlation were evaluated on the 31 included patients, being 32 mass lesions (84.2%), and 6 nonmass lesions (15.8%). Lesions' mean diameter was 31.1 mm (range, 8-94 mm). Multiparametric evaluation provided 100% sensitivity, 55.5% specificity, 87.9% positive predictive value, 100% negative predictive value, and 89.5% accuracy, with 29 true-positives results, 5 true-negatives, 4 false-positives, and no false-negative results. Multiparametric evaluation with PET-MRI functional data showed good diagnostic accuracy to differentiate benign from malignant breast lesions, reducing the number of unnecessary biopsies, without missing any diagnosis of cancer in our case series. (Medicine 93(22):e115) Abbreviations: 18 F-FDG = 18 F-fluoro-deoxi-glucose, ADC = apparent diffusion coefficient, BI-RADS = Breat Imaging Report and Data System, DCE = dynamic contrast enhanced, DCIS = ductal carcinoma in situ, DWI = diffusion-weighted imaging, Gd-DTPA = gadopentetate dimeglumine, GRE = gradient echo, IDC = invasive ductal carcinoma, MRI = magnetic resonance imaging, NPV = negative predictive value, PET-CT = positron emission tomography/computed tomography, PPV = positive predictive value, ROI = region of interest, SUV = standard uptake value.

Revista da Associação Médica Brasileira, 2011

-Protruding and hardened palpable mass occupying the upper quadrants of the right breast, with ac... more -Protruding and hardened palpable mass occupying the upper quadrants of the right breast, with accentuated vascularization and periareolar scar.

Radiologia Brasileira, 2014

Bitencourt AGV et al. / PET/CT results in breast carcinomas Radiol Bras. 2014 Mar/Abr;47(2):67-73... more Bitencourt AGV et al. / PET/CT results in breast carcinomas Radiol Bras. 2014 Mar/Abr;47(2):67-73 67 0100-3984 © Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Original Article Correlation between PET/CT results and histological and immunohistochemical findings in breast carcinomas * Correlação entre resultado do PET/CT e achados histológicos e imuno-histoquímicos em carcinomas mamários Bitencourt AGV, Lima ENP, Chojniak R, Marques EF, Souza JA, Graziano L, Andrade WP, Osório CABT. Correlation between PET/CT results and histological and immunohistochemical findings in breast carcinomas. Radiol Bras. 2014 Mar/Abr;47(2):67-73.