A automatização da ultrassonografia mamária e o tempo médico dedicado ao método

Alves, Katyane Larissa; Freitas Junior, Ruffo; Paulinelli, Régis Resende; Borges, Marcus Nascimento

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev Bras Ginecol Obstet 45 (7) • 2023 • https://doi.org/10.1055/s-0043-1772176 copiar

A automatização da ultrassonografia mamária e o tempo médico dedicado ao método

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Na presente revisão integrativa, objetivamos descrever os registros de tempo dedicado pelos médicos à ultrassonografia mamária em revisão de artigos da literatura, visando observar se a automação do método possibilitou redução destes valores. Selecionamos artigos nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e MEDLINE, através da Biblioteca Virtual em Saúde (BVS), Scientific Electronic Library Online (SciELO), PubMed e Scopus. Obtivemos 561 artigos e, após a exclusão de artigos duplicados e procedimentos de triagem, foram selecionados 9 artigos, cujas informações principais relativas à pergunta norteadora da pesquisa foram sintetizadas e analisadas. Foi concluído que a automação da ultrassonografia mamária representa uma possível estratégia de otimização do tempo médico dedicado ao método; porém, essa conclusão necessita ser melhor avaliada em estudos comparativos entre ambos os métodos (tradicional e automatizado), com metodologia direcionada à investigação específica desta potencialidade.

Palavras-chave
ultrassonografia mamária; diagnóstico por imagem; neoplasias da mama; imageamento tridimensional

Authors Characterization	Philadelpho et al.	Tutar et al.
Article title	Comparison of Automated Breast Ultrasound and Hand-Held Breast Ultrasound in the Screening of Dense Breasts	Comparison of automated versus hand–held breast US in supplemental screening in asymptomatic women with dense breasts: is there a difference regarding woman preference, lesion detection and lesion characterization?
Country/year of publication	Brazil/2021	Turkey/2020
Type of study/level of evidence	Cross-sectional study/level 4	Cross-sectional study/level 4
Sample/inclusion criteria	440/asymptomatic women with dense breasts on mammography	340/women with dense breasts and normal mammograms
Exclusion criteria	Women with breast surgery for cancer or benign causes (including implants) and/or breast radiotherapy in the last 12 months	Women at high risk and/or with suspicious clinical findings and/or with a history of breast cancer
Objectives	Comparing conventional ultrasonography with ultrasonography automated breasts in breast cancer screening	Compare ABUS and HHUS in terms of workflow, patient preference, effectiveness in detecting and characterizing lesions
Metodology	HHUS first and ABUS next (independent evaluation) HHUS: breast radiologists (n = 13) and non-specialized (n = 17) ABUS: breast radiologists only (n = 6)	ABUS first and HHUS in the sequence HHUS: breast radiologists only (n = 2) bilateral breast and underarm examination ABUS: assessment by both breast radiologists in consensus
Conclusions	Compared to HHUS, ABUS allowed adequate complementary study in the breast cancer screening	No significant differences in lesion detection, lower PPV with ABUS, more than 50% of patients prefer HHUS
Time HHUS Breast Radiologists	7 min e 45 s	12.5 min
Time HHUS non-specialist radiologists	4 min e 15 s	------------
Time ABUS breast radiologists	4 min e 25 s	14.5 min
p-value	p < 0.001 ^* * Student t-test (difference between mean time of breast radiologists for HHUS and ABUS).	-----------

AUTHOR/YEAR	TYPE OF STUDY/LEVEL OF EVIDENCE	SAMPLE/INCLUSION CRITERIA	EXCLUSION CRITERIA	METHODOLOGY	AVERAGE TIME ABUS
Skaane et al., 2015	Retrospective study/level 4	90 included symptomatic patients or those with clinical or mammographic alterations	Did not restrict patient participation	ABUS evaluated by 5 breast radiologists	9 min
Wilczek et al., 2016 (Easy Study)	Randomized clinical trial/Level 2	1,668 included patients aged ≥ 40 years, asymptomatic, with dense breasts	Pregnant or lactating women with a history of breast surgery and/or diagnosis and/or treatment of breast cancer in the last 12 months were excluded.	The ABUS images were analyzed by 5 breast radiologists, after evaluating the corresponding mammography	5–7 min
Vourtsis e Kachulis 2017	Non-randomized clinical trial/level 3	1,886 patients symptomatic or not, with dense breasts	Did not restrict patient participation	ABUS images evaluated after respective mammograms, when available according to the case, by 2 breast radiologists	3 min
Jiang et al., 2018	Retrospective study/level 4	185 patients with dense breasts	Patients submitted to previous breast interventions	18 breast radiologists interpreted the ABUS images twice (with and without the aid of computer-CAD systems)	3.5 min (without CAD) 2 min and 24 s (with CAD)

AUTHOR/YEAR CHARACTERIZATION	Berg et al., 2008 (ACRIN 6666)	Chang et al., 2015	Phalak et al., 2018
Type of study/level of evidence	Randomized clinical trial/2	Retrospective study/4	Cross-sectional study/4
Sample/inclusion criteria	2,725 women at high risk for breast cancer with at least heterogeneously dense breasts in at least 1 quadrant. Patients undergoing breast cancer follow-up could be included	1,526 asymptomatic women	100 patients with a history of lobular neoplasia
Exclusion criteria	excluded women with signs or symptoms of breast cancer, with surgery, or breast intervention procedures or breast exams less than 11 months ago, pregnant women, breastfeeding women, with breast implants, with metastatic cancer	Women with a personal or family history of breast cancer and/or suspicious MMG findings	Patients with > 20% risk for breast cancer by risk models and/or with breast cancer
Methodology	USG performed by radiologists. Axillary assessment could be included and added to the total exam time	USG performed by breast radiologists. Axillary assessment routinely included in the exam and added to the total exam time	USG performed by technologists and images reviewed by radiologists. If necessary, a breast radiologist would redo the exam
HHUS average time	19 min	15–20 min	20 min

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[1] Address for correspondence Katyane Larissa Alves Mastology Program, Clinical Hospital of UFG, 1aAvenida, s/n°, Setor Universitário Goiânia Goiás, Brazil, ZIP: 74.605-050 (e-mail: katyane_alves@yahoo.com.br)