M.Tech. / To determine whether a combination of real-time B-Mode ultrasound, Doppler Color flow and Power Doppler flow mapping would be reliable in differentiating benign from malignant breast nodules in an attempt to avoid unnecessary biopsies, where after ultrasound guidelines would be formulated. A quantitative cross-sectional comparative descriptive design in a study population which consisted of 62 women over the age of 35 years who came to Klerksdorp Radiology services for mammography. Both breast ultrasound imaging and mammography was used as a routine procedure as part of the workup for the classification of breast nodules, before histologic specimens were obtained. All nodules were classified according to the ultrasonographic BI-RADS lexicon and compared with the pathologic results. Of the 63 patients, 63 breast nodules were detected and confirmed by biopsy. Thirty seven (59%) nodules were found to be malignant and 26 (41%) were benign according to biopsy results. Mammography had 87% sensitivity and ultrasound 60% sensitivity in detecting malignancy. It is recommended that B-mode, Color Doppler flow and Power Doppler flow mapping be used in combination with mammography for screening as a gold standard.

Orientador: Jorge Nahás Neto / Coorientador: Eliana Aguiar Petri Nahás / Banca: Paulo Traiman / Banca: Eduardo Carvalho Pessoa / Resumo: Avaliar o efeito da isoflavona da soja sobre o tecido mamário em mulheres na pós-menopausa. Trata-se de estudo clínico, prospectivo, randomizado, duplo-cego, placebo controlado, envolvendo 80 mulheres na pós-menopausa com sintomas vasomotores, idade entre 45 a 70 anos, acompanhadas no Ambulatório de Climatério e Menopausa da Faculdade de Medicina de Botucatu-Unesp, de janeiro de 2005 a dezembro de 2006. Na randomização, 40 pacientes receberam 100 mg isoflavona da soja/dia (duas cápsulas de 125 mg de extrato seco de glicine Max) e 40 pacientes placebo (duas cápsulas de lactose) durante 10 meses. A densidade mamária (DM) foi avaliada pela mamografia e o parênquima mamário pela ultrassonografia de mamas no início e após dez meses de seguimento. Para análise estatística foram utilizados o teste t-Student, ANOVA, teste de Mann-Whitney e teste do Qui-Quadrado. Na comparação das características clínicas iniciais entre os grupos de usuárias de isoflavona e placebo, não houve diferenças significantes, com valores médios de idade de 55,1±6,0 e 56,2±7,7 anos, tempo de menopausa de 6,6±4,8 e 7,1±4,2 anos e IMC de 29,7±5,0 e 28,5±4,9 kg/m2, respectivamente (p>0,05). Concluíram o estudo 32 pacientes sob isoflavona e 34 sob placebo. Na comparação da densidade mamográfica entre os momentos inicial e final, não houve diferença estatisticamente significativa. Na avaliação do parênquima mamário pela ultrassonografia, não houve diferença entre os grupos. Na comparação entre os momentos dentro de cada grupo, não foram constatadas diferenças significativas nos parâmetros da mamografia e ultrassonografia. No período de 10 meses, o uso de isoflavona de soja não modificou o tecido mamário, avaliado pela mamografia e ultrassonografia, em mulheres na pós-menopausa / Abstract: To evaluate the effect of soy isoflavone on breast tissue in postmenopausal women. This study is a prospective, randomized, double-blind, placebo-controlled trial involving 80 postmenopausal women with vasomotor symptoms, aged 45-70 years, followed in Climacteric and Menopause Clinic of the Botucatu Medical School-UNESP, from January 2005 to December 2006. At randomization, 40 patients received 100 mg of soy isoflavone/day (two capsules of 125 mg standardized soy extract, Glicine max) and 40 patients, placebo (two capsules of lactose) for 10 months. The breast density was evaluated by mammography and breast parenchyma by ultrasound, at baseline and after ten months of follow-up. The Student t-test, ANOVA, Mann-Whitney and Chi-Square were used in the statistical analysis. In comparison of baseline clinical characteristics between the isoflavone and placebo groups, there were no significant differences, with mean age of 55.1 ± 6.0 and 56.2 ± 7.7 years, duration of menopause 6.6 ± 4.8 and 7.1 ± 4.2 years and BMI 29.7 ± 5.0 and 28.5 ± 4.9 kg/m2, respectively (p> 0.05). Concluded the study, 32 patients on isoflavone and 34 in the placebo group. In comparison in mammographic density (MD) between moments, baseline and final, there was no difference statistically significant. In the evaluation of breast parenchyma by ultrasound, there was no difference between groups. In comparing the moments within each group, there were no significant differences in the parameters of mammography and ultrasound. In 10 months, the use of soy isoflavone did not affect breast tissue, as assessed by mammography and ultrasound, in postmenopausal women / Doutor

[Truncated abstract] In women, as in other mammals, the ability to successfully lactate depends on both complete functional development of the mammary gland and the stimulation of the milk ejection reflex to enable the suckling young to remove stored milk. Prior to my studies, Sir Astley Cooper’s carried out the most comprehensive investigation of the gross anatomy of the lactating human breast in 1840. I have used ultrasound to image the anatomy of the breasts of fully breastfeeding women (1-6 months, n=22) with particular emphasis on the distribution of the main milk ducts, glandular and adipose tissue. Scanning of the milk duct system demonstrated that the anatomy in the region of the areola and nipple is different to that depicted in standard anatomical textbooks. The main milk ducts were small (diameter, left: 1.9 ± 0.6 mm; right: 2.1 ± 0.7 mm), superficial (depth, left: 4.50 ± 1.98 mm; right: 4.74 ± 1.59 mm) and branched close to the nipple (within 8.20 ± 6.27 mm, left; 7.00 ± 3.98 mm, right) (mean ± SD). The lactiferous sinuses (described in current textbooks) were not observed and the number of main ducts detected at the base of the nipple was less than the quoted 15-20 (9.4, range 4-18). Quantitative descriptions of the morphology of either the lactating or, indeed, the non-lactating breasts have not been attempted using ultrasound. I developed a systematic approach to ultrasound imaging of the breast that provided a semi-quantitative description of the distribution of glandular and adipose tissues within the lactating breast. Approximately two thirds of the breast was comprised of glandular tissue. Intraglandular fat was identified as hypoechoic transects within the hyperechoic glandular tissue. Over 65% of the glandular tissue together with 50% of the intraglandular fat and 25% of the subcutaneous fat was located within a 30 mm radius of the base of the nipple. The absence of lactiferous sinuses and the arrangement of tissue within a 30 mm radius of the nipple suggested that the current conceptualisation of sucking dynamics of the infant requires revision. Successful milk removal depends on the stimulation of the milk ejection reflex and currently subjective assessments of milk ejection such as the mother’s sensations and an alteration in the infants sucking and swallowing are used clinically to confirm milk ejection whereas in research two stressful invasive procedures; changes blood oxytocin and intra-ductal pressure have been used. I have developed a non-invasive ultrasound technique to detect milk ejection in women

Made available in DSpace on 2014-06-11T19:35:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-07-30Bitstream added on 2014-06-13T18:47:00Z : No. of bitstreams: 1 delmanto_a_dr_botfm.pdf: 571026 bytes, checksum: 2efa82a630b3a102bd0c2beed1370eec (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Avaliar o efeito da isoflavona da soja sobre o tecido mamário em mulheres na pós-menopausa. Trata-se de estudo clínico, prospectivo, randomizado, duplo-cego, placebo controlado, envolvendo 80 mulheres na pós-menopausa com sintomas vasomotores, idade entre 45 a 70 anos, acompanhadas no Ambulatório de Climatério e Menopausa da Faculdade de Medicina de Botucatu-Unesp, de janeiro de 2005 a dezembro de 2006. Na randomização, 40 pacientes receberam 100 mg isoflavona da soja/dia (duas cápsulas de 125 mg de extrato seco de glicine Max) e 40 pacientes placebo (duas cápsulas de lactose) durante 10 meses. A densidade mamária (DM) foi avaliada pela mamografia e o parênquima mamário pela ultrassonografia de mamas no início e após dez meses de seguimento. Para análise estatística foram utilizados o teste t-Student, ANOVA, teste de Mann-Whitney e teste do Qui-Quadrado. Na comparação das características clínicas iniciais entre os grupos de usuárias de isoflavona e placebo, não houve diferenças significantes, com valores médios de idade de 55,1±6,0 e 56,2±7,7 anos, tempo de menopausa de 6,6±4,8 e 7,1±4,2 anos e IMC de 29,7±5,0 e 28,5±4,9 kg/m2, respectivamente (p>0,05). Concluíram o estudo 32 pacientes sob isoflavona e 34 sob placebo. Na comparação da densidade mamográfica entre os momentos inicial e final, não houve diferença estatisticamente significativa. Na avaliação do parênquima mamário pela ultrassonografia, não houve diferença entre os grupos. Na comparação entre os momentos dentro de cada grupo, não foram constatadas diferenças significativas nos parâmetros da mamografia e ultrassonografia. No período de 10 meses, o uso de isoflavona de soja não modificou o tecido mamário, avaliado pela mamografia e ultrassonografia, em mulheres na pós-menopausa / To evaluate the effect of soy isoflavone on breast tissue in postmenopausal women. This study is a prospective, randomized, double-blind, placebo-controlled trial involving 80 postmenopausal women with vasomotor symptoms, aged 45-70 years, followed in Climacteric and Menopause Clinic of the Botucatu Medical School-UNESP, from January 2005 to December 2006. At randomization, 40 patients received 100 mg of soy isoflavone/day (two capsules of 125 mg standardized soy extract, Glicine max) and 40 patients, placebo (two capsules of lactose) for 10 months. The breast density was evaluated by mammography and breast parenchyma by ultrasound, at baseline and after ten months of follow-up. The Student t-test, ANOVA, Mann-Whitney and Chi-Square were used in the statistical analysis. In comparison of baseline clinical characteristics between the isoflavone and placebo groups, there were no significant differences, with mean age of 55.1 ± 6.0 and 56.2 ± 7.7 years, duration of menopause 6.6 ± 4.8 and 7.1 ± 4.2 years and BMI 29.7 ± 5.0 and 28.5 ± 4.9 kg/m2, respectively (p> 0.05). Concluded the study, 32 patients on isoflavone and 34 in the placebo group. In comparison in mammographic density (MD) between moments, baseline and final, there was no difference statistically significant. In the evaluation of breast parenchyma by ultrasound, there was no difference between groups. In comparing the moments within each group, there were no significant differences in the parameters of mammography and ultrasound. In 10 months, the use of soy isoflavone did not affect breast tissue, as assessed by mammography and ultrasound, in postmenopausal women

Indiana University-Purdue University Indianapolis (IUPUI) / Mammographic density is an important risk factor for breast cancer, detecting and screening at an early stage could help save lives. To analyze breast density distribution, a good segmentation algorithm is needed. In this thesis, we compared two popularly used segmentation algorithms, EM-MPM and K-means Clustering. We applied them on twenty cases of synthetic phantom ultrasound tomography (UST), and nine cases of clinical mammogram and UST images. From the synthetic phantom segmentation comparison we found that EM-MPM performs better than K-means Clustering on segmentation accuracy, because the segmentation result fits the ground truth data very well (with superior Tanimoto Coefficient and Parenchyma Percentage). The EM-MPM is able to use a Bayesian prior assumption, which takes advantage of the 3D structure and finds a better localized segmentation. EM-MPM performs significantly better for the highly dense tissue scattered within low density tissue and for volumes with low contrast between high and low density tissues. For the clinical mammogram, image segmentation comparison shows again that EM-MPM outperforms K-means Clustering since it identifies the dense tissue more clearly and accurately than K-means. The superior EM-MPM results shown in this study presents a promising future application to the density proportion and potential cancer risk evaluation.