Value of an abbreviated protocol of breast magnetic resonance imaging for screening high-risk patients

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Paciente de 42 años BRCA1, con antecedentes familiares de hermana y prima con carcinoma de mama. Antecedente personal de histerectomía y doble anexectomía. En la resonancia magnética de cribado se visualiza en la mama derecha un realce nodular de 10 mm asociado a un realce lineal periférico sugestivo de CDIS." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Marquina Martínez, S. Cruz Ciria, A.I. García Barrado, I. Suñén Amador, C. García Mur" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Marquina Martínez" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Cruz Ciria" ] 2 => array:2 [ "nombre" => "A.I." "apellidos" => "García Barrado" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Suñén Amador" ] 4 => array:2 [ "nombre" => "C." 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B) Selective arteriogram of left internal iliac artery, with 10° cranial and 35° ipsilateral angulation, with the aim of identifying the exit of the inferior vesical artery/prostate artery (arrow). C) Selective catheterisation, with microcatheter in the left prostatic artery (arrow). Prior to the embolisation with 250-micron microparticles. D) Follow-up angiogram post-embolisation, which shows the vessel to be completely sealed; in this case the left prostatic artery." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Monreal, C. Robles, M. Sánchez-Casado, J.J. Ciampi, M. López-Guerrero, R.J. Ruíz-Salmerón, C. Lanciego" "autores" => array:7 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Monreal" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Robles" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Sánchez-Casado" ] 3 => array:2 [ "nombre" => "J.J." "apellidos" => "Ciampi" ] 4 => array:2 [ "nombre" => "M." 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(A) The photograph signals the left parascrotal mass. (B) Doppler imaging shows a multiloculated cystic mass with vessels (arrows) between the locules (Ls). (C) T2-enhanced coronal magnetic resonance imaging (MRI) confirming the presence of an inguinoscrotal cystic mass (MV) in close relation to the left spermatic cord (LCS). (D) T2-enhanced axial MRI showing fluid–fluid levels (arrow). (E) Surgical photograph showing the testis (LT), spermatic cord (LSC) and mass (MV)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Arango-Díaz, M.V. Trujillo-Ariza, M.M. Liñares-Paz, S. Baleato-González, M. García-Palacios" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Arango-Díaz" ] 1 => array:2 [ "nombre" => "M.V." "apellidos" => "Trujillo-Ariza" ] 2 => array:2 [ "nombre" => "M.M." "apellidos" => "Liñares-Paz" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Baleato-González" ] 4 => array:2 [ "nombre" => "M." 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Marquina Martínez, S. Cruz Ciria, A.I. García Barrado, I. Suñén Amador, C. García Mur" "autores" => array:5 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Marquina Martínez" "email" => array:1 [ 0 => "diamarquina@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Cruz Ciria" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.I." "apellidos" => "García Barrado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "I." 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"apellidos" => "García Mur" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Radiología Mamaria, Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital San Jorge, Huesca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor del protocolo abreviado de resonancia magnética mamaria en el cribado de pacientes de alto riesgo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 811 "Ancho" => 2426 "Tamanyo" => 216549 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Example of a case with infiltrating ductal carcinoma (IDC) + DCIS. A 42-year-old patient, BRCA1, with a family history of a sister and cousin with breast cancer. Personal history of hysterectomy and double adnexectomy. Magnetic resonance imaging screening showed 10 mm nodular enhancement in the right breast, associated with a peripheral linear enhancement suggestive of DCIS." ] ] ] "textoCompleto" => "IntroductionBreast cancer (BC) is currently the most common type of tumour and the leading cause of death in the female population worldwide. Early detection is essential to improve prognosis and survival.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>Magnetic resonance imaging (MRI) is the tool which has shown the greatest sensitivity to detect BC<a class="elsevierStyleCrossRefs" href="#bib0005">1,3</a>; however, MRI screening is associated with high direct and indirect costs, and images are time consuming to acquire and read.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>In usual clinical practice, screening with MRI is performed using the same acquisition protocol as MRI staging studies.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The use of an abbreviated protocol that includes the basic sequences for detecting BC would significantly reduce scanning time, simplify reading and save resources without compromising diagnostic effectiveness.MRI screening is recommended in women with more than 20 % risk of developing BC.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> The abbreviated protocol would increase access to MRI screening for these patients, and could be extended to other risk groups.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>In this context, we analysed the effectiveness of abbreviated MRI screening protocols for BC in high-risk patients vs. the complete protocol, and determined the diagnostic accuracy of both protocols in characterising breast lesions.Material and methodsAs this was a retrospective study, we did not require authorisation from the research ethics committee. All patients signed the informed consent form to undergo the MRI study.Patients did not sign an informed consent form to participate in the study.Study populationThe MRIs of patients studied in the breast radiology section of our hospital from January 2011 to January 2017 were reviewed retrospectively.Inclusion criteria were: high-risk patient, including BRCA1, BRCA2 carriers and/or women with a family and/or personal history of BC or ovarian cancer and a personal history of thoracic radiotherapy. All patients had undergone breast MRI using a complete standard protocol.The exclusion criteria were: pregnancy, contraindication for MRI due to the presence of pacemakers or metal implants, obesity (over 135 kg), renal insufficiency (glomerular filtration rate less than 30 ml/min) or allergy to gadolinium. Incomplete or poor technical quality studies were excluded.The following data were collected: age, hormonal status, presence of BRCA1 and BRCA2 mutations, personal or family history of BC or ovarian cancer, history of thoracic radiotherapy, presence of premalignant or high-risk breast lesions, prophylactic or therapeutic mastectomy, and study findings using conventional techniques. We also evaluated the histopathology and biopsy technique used: core needle (CNB) or vacuum-assisted (VAB).The reference standard was biopsy in BI-RADS category 4 and 5 lesions and no changes in BI-RADS category 1 and 2 cases after at least one year of follow-up. Biopsy was also performed in BI-RADS category 3 lesions, except in patients who refused the procedure and were referred to follow-up.MRI findings were correlated with the results of percutaneous biopsy of the lesions. Where biopsy was not performed, we evaluated patient follow-up using conventional techniques (ultrasound and mammography) or MRI.MRI techniqueThe patients were studied in the prone position using a 1.5 T Signa® HD RM device (GE Healthcare, Milwaukee, USA) with Echo Speed Plus 33/120 ACGD gradients and 8 channel HD breast array. The protocol used included the following sequences: Axial T2-weighted (T2W) FSE (TR: 4.64; TE: 90.9; ET: 13; slice thickness: 2 mm; FOV: 32 × 32; matrix: 320 × 224), SE-EPI diffusion-weighted, axial plane, with factors b = 0 and b = 600 (TR: 8000; TE: 61.3; slice thickness: 5 mm; FOV: 34 × 34; matrix: 64 × 128), and dynamic 3 D FSPGR T1-weighted (T1W) study (TR: 5; TE: 2.4; slice thickness: 2 mm; FOV: 34 × 34; matrix: 320 × 224), before and 1, 2, 3, 4 and 5 min after intravenous administration of paramagnetic contrast, 0.15 mmol/kg of Gd-DTPA at 3 ml/s, followed by a saline bolus of 20 ml.In postprocessing, we obtained subtracted images and maximum intensity projection (MIP) images. Multiplanar reconstructions were performed, and time-signal intensity curves were plotted and analysed.Reading of protocolsWe first read images obtained using the MIP protocol, then the abbreviated protocol, and finally the complete protocol.MIP protocolThis includes the post-processed MIP images obtained from subtracting the post-contrast axial T1W VIBRANT (volume imaging for breast assessment) sequence acquired over 1 min from the pre-contrast axial T1W sequence images.The presence or absence of pathological enhancements was assessed.Abbreviated protocolThe pre- and post-contrast axial T1W VIBRANT sequence acquired over 1 min, with and without subtraction, was read and added to the MIP protocol. This allowed us to study and characterise the morphology and the type of enhancement of the lesions.Complete protocolThe reading of the remaining dynamic sequences (post-contrast T1W axial VIBRANT from the 2nd to the 5th minute) was added to the abbreviated protocol.We also analysed the T2W sequence and the time-signal intensity curves were plotted.<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the abbreviated and complete protocols.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Images from the three breast MRI protocols were read by a radiologist with more than 10 years of experience in breast radiology.All the lesions identified were classified according to the criteria of the fifth edition of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS).<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Statistical analysisThe mean and standard deviation (SD) were used to describe continuous clinical variables. Categorical variables were analysed as percentages.We calculated sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and validity (V), together with their 95 % confidence intervals. For this, images showing BI-RADS category 3, 4 or 5 (positive diagnosis) and another showing BI-RADS category 1 or 2 (negative diagnosis) were compared with the result of the corresponding histopathology study.A receiver operating characteristic curve (ROC) was constructed for each MRI protocol, and the areas under the curve (AUC) were compared.Statistical significance was set at p < 0.05.Statistical analysis was performed on SPSS (IBM Corporation, Somers, NY, USA) and Epidat version 3.1 (Galician Health Service, Spain).ResultsWe reviewed 157 MRI scans of 82 patients with high risk of BC. Six scans were excluded because they did not meet the technical requirements. The final sample was 151 MRI scans distributed as follows: 88 (58.28 %) screening, 9 (5.96 %) staging, and 54 (35.76 %) follow-up.The staging group included high-risk screening patients whose diagnosis of BC was made with conventional techniques, and MRI was performed subsequently for staging.The follow-up group included high-risk patients with a personal history of BC or a known premalignant lesion.The mean age of the patients was 46.84 ± 11.23 years.<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the study sample.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>A total of 12 lesions were categorised as BI-RADS 4 and 5 and were biopsied; of these, 11 (91.67 %) were malignant and one (8.33 %) was benign. The malignant lesions were distributed as follows: four ductal carcinoma in situ (DCIS) (33.33 %) and seven infiltrating ductal carcinomas (IDC) (58.33 %).<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a> show the images corresponding to two cases from our study.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>The mean size of the DCIS in the MRI studies was 20.5 ± 11.73 mm. The histological grade of these tumours was intermediate (G2) in two cases and high (G3) in the other two cases.The mean size of the IDCs in the MRI studies was 16.14 ± 7.11 mm. After immunohistochemistry tests, five (71.43 %) cases were classified as luminal A tumours and two (28.57 %) as triple negative tumours. The histological grade distribution was one case of low grade (G1) (14.29 %) and six cases of G2 (85.71 %).Twelve lesions were categorised as BI-RADS 3: in 10 (83.33 %) cases follow-up was performed because the patients refused histological study; they remained stable in subsequent radiological follow-up studies, and in two (16.66 %) biopsy was performed and the lesion was diagnosed as benign.The remaining studies (84.11 %) were categorised as BI-RADS 1 and 2. Biopsy was performed in seven (5.83 %) of these, due to patient anxiety, and benignity was confirmed.<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the BI-RADS categories and their management.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>In total, 21 biopsies were performed, 19 ultrasound-guided CNB and two ultrasound-guided VAB.The AUC obtained from each ROC curve was 0.9977 for the complete protocol, 0.9932 for the abbreviated protocol and 0.9831 for the MIP protocol. All lesions were identified using all three protocols, and no significant differences were found between their respective AUCs (p = 0.0650). <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> shows the ROC curves corresponding to each protocol. Taking a BI-RADS ≥3 as the optimal classification criteria, the sensitivity, specificity, NPV and PPV of each protocol were determined with their corresponding 95 % confidence intervals, without observing statistically significant differences.<elsevierMultimedia ident="fig0020"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the validity of each diagnostic protocol for characterising MRI lesions.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionOur study shows that there are no significant differences between the different protocols (MIP, abbreviated and complete) analysed in terms of sensitivity, specificity, PPV and NPV.Kuhl et al. published a study in 2014 arguing that current breast MRI protocols were designed to characterise lesions and that a contrast-enhanced sequencing time of one minute is sufficient to detect BC. In their study, the authors showed that the abbreviated protocol was equivalent to the complete protocol, using the same sequences used in our study.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> However, like Mango et al. (2015), they found that the MIP image alone was not sufficient to detect BC or to correctly categorise the finding according to BI-RADS.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> In our series, all BCs were detected using images acquired with all three protocols (MIP, abbreviated and complete), this could be due to mean size of the lesions (17 ± 8.74 mm) and to a possible memory bias, since the radiologist who retrospectively reviewed the cases was the same clinician who performed the first reading.Given the advantages offered by abbreviated protocols, many studies analysing their benefits have been published recently. The majority involve acquisition of a T1W sequence for one minute both pre- and post-intravenous contrast administration, although some authors include additional sequences. Moschetta et al. found no significant differences between the complete and abbreviated protocol, including STIR and T2W sequences.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> Strahle et al. concluded that pre-contrast T2W and T1W sequences, the first post-contrast T1W sequence, and the late sequences were needed to correctly screen their series.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>The vast majority of studies with abbreviated protocols (using different sequences) maintained their diagnostic accuracy with respect to the complete protocol. All the studies concluded that invasive cancers were detected in early stages (85.71 % of infiltrating lesions were stage T1, that is, less than 2 cm) and DCIS were predominantly intermediate or high grade (100 % of the DCIS were Nottingham histological grade II or III). For this reason, many authors recommend using mammography and MRI to detect in situ and infiltrating BC, respectively.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Using MRI in high-risk patients will allow us to optimise screening and reduce over-diagnosis of non-aggressive BC, since low grade, in situ tumours, which have less vascularisation, may be overlooked, and would avoid under-diagnosis of potentially invasive tumours identified at an early stage, before they are visualised on mammography.The randomised, prospective, multicentre ECOG-ACRIN 1141 trial that compares abbreviated protocols against tomosynthesis in the screening of women with dense and heterogeneously dense breasts is currently under way. The results of this trial will be very useful to compare both techniques, the type of cancer identified, and patient perception during the study.We believe the highly sensitive imaging techniques, such as subtracted MIP imaging and the abbreviated protocol, which detect all malignant lesions, should be prioritised in screening programmes. Although we observed no significant differences in BC identification among our three study protocols, the complete protocol, which provides kinetic characterisation of the lesions, is more specific.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Abbreviated protocols do not provide kinetic information. To overcome this limitation, image acceleration techniques have been developed that also significantly decrease acquisition time and increase the specificity of studies.<a class="elsevierStyleCrossRefs" href="#bib0045">9–13</a>Breast MRI studies for both screening and staging of BC require administration of gadolinium contrast. Recently evidence has shown that gadolinium-based contrast agents can cause deposits in the brain, although the clinical implication of this is still unknown. For this reason, efforts are being made to develop sequences without contrast that have the same sensitivity.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Diffusion-weighted imaging could be an option; however, it presents important limitations in small tumours and in non mass-like enhancement, which limits the generalisation of its use as an alternative sequence.Combined diffusion weighting together with abbreviated protocols can provide additional information and improve diagnostic yield.<a class="elsevierStyleCrossRefs" href="#bib0005">1,14–18</a>According to the scientific literature, reading times are shorter in the abbreviated protocols, although this was not measured in our study.The main limitation of our study is the large average tumour size (16 mm IDC and 20 mm DCIS). If most tumours are relatively large, it is only to be expected that all three protocols would have detected all 11 cases of cancer. However, we might have observed differences between the protocols if some of the tumours had been small (<10 mm IDC and <5 mm DCIS), although we cannot be sure of this. Another limitation is the small number of tumours,<a class="elsevierStyleCrossRef" href="#bib0055">11</a> which prevents us from reaching more convincing conclusions. In our study, we reviewed a large number of MRI studies performed in a single centre, with a high percentage of screening patients, which explains the low prevalence of BC.The radiologists from our centre have more than 10 years of experience in the management of breast pathology using both conventional techniques and MRI, following the recommendations of the Sociedad Española de Radiología Médica [Spanish Society of Medical Radiology] (SERAM) for diagnosis of BC.Abbreviated protocols need to be improved, standardised and validated. However, in view of the promising and concordant results of the studies cited, we believe that they will play an important role in the future of breast radiology.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>ConclusionIn this study, we found no significant differences in the effectiveness of the study protocols (complete, abbreviated and MIP) to diagnose BC. The use of abbreviated protocols in high-risk BC screening would have the advantage of shortening turnaround times and thus allowing more studies to be performed.As a result, breast MRI screening need not be limited to high-risk cases, and could be extended to include women with a personal history of BC, and, therefore, a higher risk of tumour recurrence, to benefit from the prognostic and predictive power of this technique.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1335834" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1230265" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1335833" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1230266" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "MRI technique" ] 2 => array:3 [ "identificador" => "sec0025" "titulo" => "Reading of protocols" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "MIP protocol" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Abbreviated protocol" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Complete protocol" ] ] ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-13" "fechaAceptado" => "2019-08-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1230265" "palabras" => array:5 [ 0 => "Breast cancer" 1 => "Cancer screening" 2 => "High-risk" 3 => "Breast magnetic resonance" 4 => "Abbreviated protocol" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1230266" "palabras" => array:5 [ 0 => "Cáncer de mama" 1 => "Cribado" 2 => "Alto riesgo" 3 => "RM mamaria" 4 => "Protocolo abreviado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveValue the utility of breast MRI abbreviated protocols for the screening of breast cancer in high-risk patients compared to the full protocol. MethodsWe performed a retrospective review of 157 breast MRI of 82 high-risk patients practiced in our hospital between January 2011 and January 2017. Clinical, radiological and anatomopathological parameters were analyzed. Reading of the different protocols (MIP, abbreviated and full) was made by an expert radiologist. Subsequent statistical analysis was done. ResultsA total amount of 12 findings classified as BI-RADS 4 and 5 were identified and performed a biopsy, resulting 11 of them to be malignant (91.67 %) and 1 benign (8.33 %). The malignant wounds included 4 intraductal carcinoma (33.33 %) and 7 infiltrating ductal carcinoma (58.33 %). All injuries were detected with the three protocols and no significant differences were found between their respective area under the ROC curve (p = 0.0650). ConclusionsIn our study there are no significant differences between the different protocols (MIP, abbreviated and full), which places the abbreviated protocol as a promising tool for breast cancer screening in high-risk patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoValorar la utilidad de los protocolos abreviados de resonancia magnética (RM) mamaria en el cribado de cáncer de mama en pacientes de alto riesgo, en comparación con el protocolo completo, y determinar la precisión diagnóstica en la caracterización de las lesiones mamarias de ambos protocolos. Material y métodosSe revisaron retrospectivamente 157 estudios de RM mamaria de 82 pacientes de alto riesgo realizadas en nuestro centro, desde enero de 2011 hasta enero de 2017. Se analizaron parámetros clínicos, radiológicos y anatomopatológicos. Se realizó la lectura de los diferentes protocolos: MIP, abreviado y completo por un radiólogo experto. Posteriormente se hizo un análisis estadístico. ResultadosSe identificaron un total de 12 lesiones clasificadas en categoría BI-RADS 4 y 5 que fueron biopsiadas, de las cuales 11 resultaron ser malignas (91,67 %) y 1 benigna (8,33 %). Las lesiones malignas fueron: 4 carcinomas intraductales (33,33 %) y 7 carcinomas ductales infiltrantes (58,33 %). Todas las lesiones fueron detectadas con los tres protocolos y no se encontraron diferencias significativas entre sus respectivas áreas bajo la curva (p = 0,0650). ConclusionesEn nuestro estudio no existen diferencias significativas entre los distintos protocolos (MIP, abreviado y completo). El protocolo abreviado se perfila como una herramienta prometedora en el cribado de cáncer de mama en pacientes de alto riesgo." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Marquina Martínez D, Cruz Ciria S, García Barrado AI, Suñén Amador I, García Mur C. Valor del protocolo abreviado de resonancia magnética mamaria en el cribado de pacientes de alto riesgo. Radiología. 2020;62:198–204." ] ] "multimedia" => array:7 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 874 "Ancho" => 2505 "Tamanyo" => 153692 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Schematic diagram of the abbreviated and complete protocol. The complete protocol consists of T2-weighted sequences, diffusion-weighted sequences, and pre- and post-contrast T1-weighted VIBRANT sequences at 1, 2, 3, 4 and 5 min. The abbreviated protocol includes pre- and post-contrast T1-weighted VIBRANT sequences at one minute." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1261 "Ancho" => 2454 "Tamanyo" => 211732 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Example of a case with infiltrating ductal carcinoma (IDC). A 56-year-old patient, BRCA1, with a family history of a mother and three aunts with breast cancer. Personal history of IDC in right breast. Follow-up magnetic resonance imaging showed a nodular enhancement located in the middle plane of the left upper quadrant of the left breast, measuring 8 × 8 × 11 mm, with rounded morphology, heterogeneous internal enhancement, and type II functional curve." ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 811 "Ancho" => 2426 "Tamanyo" => 216549 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Example of a case with infiltrating ductal carcinoma (IDC) + DCIS. A 42-year-old patient, BRCA1, with a family history of a sister and cousin with breast cancer. Personal history of hysterectomy and double adnexectomy. Magnetic resonance imaging screening showed 10 mm nodular enhancement in the right breast, associated with a peripheral linear enhancement suggestive of DCIS." ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1702 "Ancho" => 1471 "Tamanyo" => 98554 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Graph of the ROC curves of the different diagnostic protocols in 151 magnetic resonance studies. The AUC value was 0.9977 for the complete protocol, 0.9932 for the abbreviated protocol and 0.9831 for the MIP protocol; no significant differences were observed (p = 0.0650)." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "BC: breast cancer." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">High-risk patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BRCA1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (40.24 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BRCA2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (42.24 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BRCA 1 and 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.22 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Personal (PH) or family (FH) history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FH BC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2.22 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FH ovarian cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (8.54 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PH BC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2.44 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PH radiotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2.44 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hormonal state \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Premenopausal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (42.68 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perimenopausal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">103 (3.66 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Postmenopausal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (7.32 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Menopausal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (46.34 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mastectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prophylactic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.22 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Therapeutic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (10.98 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mammogram pattern \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (13.41 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (32.93 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (15.85 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (10.98 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Breast implants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (12.20 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-assessable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (14.63 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total no. of patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2290327.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the study patients." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "DCIS: ductal carcinoma in situ; IDC: infiltrating ductal carcinoma." "tablatextoimagen" => array:3 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BI-RADS 4 and 5 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (100 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Malignant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DCIS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (33.33 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IDC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (58.33 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fibroadenoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (8.33 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2290326.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BI-RADS 3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (93.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (16.67 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Malignant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benign \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fibrocystic changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2290323.png" ] ] 2 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BI-RADS 1 and 2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Screening/follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 (94.49 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Negative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Biopsy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (5.83 %) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fibrocystic changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fibrotic scarring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory infiltrate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radio dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">127 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">151 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2290324.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Tumours identified by the complete MRI protocol classified according to BI-RADS and their management." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S (%) 95 % CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sp (%) 95 % CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PPV (%) 95 % CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NPV (%) 95 % CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">V (%) 95 % CI \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (95.45–100.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.71 (85.55–95.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.83 (23.82–67.85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (99.61–100.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.39 (86.59–96.20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Abbreviated protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (95.45–100.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.43 (86.43–96.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.83 (25.24–70.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (99.61–100.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.05 (87.41–96.70) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MIP protocol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (95.45–100.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91.43 (86.43–96.42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.83 (25.24–70.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.00 (99.61–100.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.05 (87.41–96.70) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2290325.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and validity (V) together with their respective 95 % confidence intervals." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abbreviated MRI of the breast: Does it provide value?" 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Valor del protocolo abreviado de resonancia magnética mamaria en el cribado de pacientes de alto riesgo

D. Marquina Martíneza,b,

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diamarquina@gmail.com

Corresponding author.

, S. Cruz Ciriaa,b, A.I. García Barradoa, I. Suñén Amadora, C. García Mura

a Departamento de Radiología Mamaria, Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, Spain

b Servicio de Radiodiagnóstico, Hospital San Jorge, Huesca, Spain

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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Example of a case with infiltrating ductal carcinoma &#40;IDC&#41; &#43; DCIS&#46; A 42-year-old patient&#44; BRCA1&#44; with a family history of a sister and cousin with breast cancer&#46; Personal history of hysterectomy and double adnexectomy&#46; Magnetic resonance imaging screening showed 10&#8239;mm nodular enhancement in the right breast&#44; associated with a peripheral linear enhancement suggestive of DCIS&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Breast cancer &#40;BC&#41; is currently the most common type of tumour and the leading cause of death in the female population worldwide&#46; Early detection is essential to improve prognosis and survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging &#40;MRI&#41; is the tool which has shown the greatest sensitivity to detect BC<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a>&#59; however&#44; MRI screening is associated with high direct and indirect costs&#44; and images are time consuming to acquire and read&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In usual clinical practice&#44; screening with MRI is performed using the same acquisition protocol as MRI staging studies&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The use of an abbreviated protocol that includes the basic sequences for detecting BC would significantly reduce scanning time&#44; simplify reading and save resources without compromising diagnostic effectiveness&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">MRI screening is recommended in women with more than 20 &#37; risk of developing BC&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The abbreviated protocol would increase access to MRI screening for these patients&#44; and could be extended to other risk groups&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this context&#44; we analysed the effectiveness of abbreviated MRI screening protocols for BC in high-risk patients vs&#46; the complete protocol&#44; and determined the diagnostic accuracy of both protocols in characterising breast lesions&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">As this was a retrospective study&#44; we did not require authorisation from the research ethics committee&#46; All patients signed the informed consent form to undergo the MRI study&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients did not sign an informed consent form to participate in the study&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0040" class="elsevierStylePara elsevierViewall">The MRIs of patients studied in the breast radiology section of our hospital from January 2011 to January 2017 were reviewed retrospectively&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Inclusion criteria were&#58; high-risk patient&#44; including BRCA1&#44; BRCA2 carriers and&#47;or women with a family and&#47;or personal history of BC or ovarian cancer and a personal history of thoracic radiotherapy&#46; All patients had undergone breast MRI using a complete standard protocol&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The exclusion criteria were&#58; pregnancy&#44; contraindication for MRI due to the presence of pacemakers or metal implants&#44; obesity &#40;over 135&#8239;kg&#41;&#44; renal insufficiency &#40;glomerular filtration rate less than 30&#8239;ml&#47;min&#41; or allergy to gadolinium&#46; Incomplete or poor technical quality studies were excluded&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The following data were collected&#58; age&#44; hormonal status&#44; presence of BRCA1 and BRCA2 mutations&#44; personal or family history of BC or ovarian cancer&#44; history of thoracic radiotherapy&#44; presence of premalignant or high-risk breast lesions&#44; prophylactic or therapeutic mastectomy&#44; and study findings using conventional techniques&#46; We also evaluated the histopathology and biopsy technique used&#58; core needle &#40;CNB&#41; or vacuum-assisted &#40;VAB&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The reference standard was biopsy in BI-RADS category 4 and 5 lesions and no changes in BI-RADS category 1 and 2 cases after at least one year of follow-up&#46; Biopsy was also performed in BI-RADS category 3 lesions&#44; except in patients who refused the procedure and were referred to follow-up&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">MRI findings were correlated with the results of percutaneous biopsy of the lesions&#46; Where biopsy was not performed&#44; we evaluated patient follow-up using conventional techniques &#40;ultrasound and mammography&#41; or MRI&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">MRI technique</span><p id="par0070" class="elsevierStylePara elsevierViewall">The patients were studied in the prone position using a 1&#46;5&#8239;T Signa&#174; HD RM device &#40;GE Healthcare&#44; Milwaukee&#44; USA&#41; with Echo Speed Plus 33&#47;120 ACGD gradients and 8 channel HD breast array&#46; The protocol used included the following sequences&#58; Axial T2-weighted &#40;T2W&#41; FSE &#40;TR&#58; 4&#46;64&#59; TE&#58; 90&#46;9&#59; ET&#58; 13&#59; slice thickness&#58; 2&#8239;mm&#59; FOV&#58; 32&#8239;&#215;&#8239;32&#59; matrix&#58; 320&#8239;&#215;&#8239;224&#41;&#44; SE-EPI diffusion-weighted&#44; axial plane&#44; with factors b&#8239;&#61;&#8239;0 and b&#8239;&#61;&#8239;600 &#40;TR&#58; 8000&#59; TE&#58; 61&#46;3&#59; slice thickness&#58; 5&#8239;mm&#59; FOV&#58; 34&#8239;&#215;&#8239;34&#59; matrix&#58; 64&#8239;&#215;&#8239;128&#41;&#44; and dynamic 3 D FSPGR T1-weighted &#40;T1W&#41; study &#40;TR&#58; 5&#59; TE&#58; 2&#46;4&#59; slice thickness&#58; 2&#8239;mm&#59; FOV&#58; 34&#8239;&#215;&#8239;34&#59; matrix&#58; 320&#8239;&#215;&#8239;224&#41;&#44; before and 1&#44; 2&#44; 3&#44; 4 and 5&#8239;min after intravenous administration of paramagnetic contrast&#44; 0&#46;15&#8239;mmol&#47;kg of Gd-DTPA at 3&#8239;ml&#47;s&#44; followed by a saline bolus of 20&#8239;ml&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In postprocessing&#44; we obtained subtracted images and maximum intensity projection &#40;MIP&#41; images&#46; Multiplanar reconstructions were performed&#44; and time-signal intensity curves were plotted and analysed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Reading of protocols</span><p id="par0080" class="elsevierStylePara elsevierViewall">We first read images obtained using the MIP protocol&#44; then the abbreviated protocol&#44; and finally the complete protocol&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">MIP protocol</span><p id="par0085" class="elsevierStylePara elsevierViewall">This includes the post-processed MIP images obtained from subtracting the post-contrast axial T1W VIBRANT &#40;volume imaging for breast assessment&#41; sequence acquired over 1&#8239;min from the pre-contrast axial T1W sequence images&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The presence or absence of pathological enhancements was assessed&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Abbreviated protocol</span><p id="par0095" class="elsevierStylePara elsevierViewall">The pre- and post-contrast axial T1W VIBRANT sequence acquired over 1&#8239;min&#44; with and without subtraction&#44; was read and added to the MIP protocol&#46; This allowed us to study and characterise the morphology and the type of enhancement of the lesions&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Complete protocol</span><p id="par0100" class="elsevierStylePara elsevierViewall">The reading of the remaining dynamic sequences &#40;post-contrast T1W axial VIBRANT from the 2nd to the 5th minute&#41; was added to the abbreviated protocol&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We also analysed the T2W sequence and the time-signal intensity curves were plotted&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the abbreviated and complete protocols&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Images from the three breast MRI protocols were read by a radiologist with more than 10 years of experience in breast radiology&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">All the lesions identified were classified according to the criteria of the fifth edition of the American College of Radiology Breast Imaging Reporting and Data System &#40;BI-RADS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0125" class="elsevierStylePara elsevierViewall">The mean and standard deviation &#40;SD&#41; were used to describe continuous clinical variables&#46; Categorical variables were analysed as percentages&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">We calculated sensitivity &#40;S&#41;&#44; specificity &#40;Sp&#41;&#44; positive predictive value &#40;PPV&#41;&#44; negative predictive value &#40;NPV&#41; and validity &#40;V&#41;&#44; together with their 95 &#37; confidence intervals&#46; For this&#44; images showing BI-RADS category 3&#44; 4 or 5 &#40;positive diagnosis&#41; and another showing BI-RADS category 1 or 2 &#40;negative diagnosis&#41; were compared with the result of the corresponding histopathology study&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">A receiver operating characteristic curve &#40;ROC&#41; was constructed for each MRI protocol&#44; and the areas under the curve &#40;AUC&#41; were compared&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Statistical significance was set at <span class="elsevierStyleItalic">p</span>&#8239;&#60;&#8239;0&#46;05&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Statistical analysis was performed on SPSS &#40;IBM Corporation&#44; Somers&#44; NY&#44; USA&#41; and Epidat version 3&#46;1 &#40;Galician Health Service&#44; Spain&#41;&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0150" class="elsevierStylePara elsevierViewall">We reviewed 157 MRI scans of 82 patients with high risk of BC&#46; Six scans were excluded because they did not meet the technical requirements&#46; The final sample was 151 MRI scans distributed as follows&#58; 88 &#40;58&#46;28 &#37;&#41; screening&#44; 9 &#40;5&#46;96 &#37;&#41; staging&#44; and 54 &#40;35&#46;76 &#37;&#41; follow-up&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The staging group included high-risk screening patients whose diagnosis of BC was made with conventional techniques&#44; and MRI was performed subsequently for staging&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The follow-up group included high-risk patients with a personal history of BC or a known premalignant lesion&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The mean age of the patients was 46&#46;84&#8239;&#177;&#8239;11&#46;23 years&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the characteristics of the study sample&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0175" class="elsevierStylePara elsevierViewall">A total of 12 lesions were categorised as BI-RADS 4 and 5 and were biopsied&#59; of these&#44; 11 &#40;91&#46;67 &#37;&#41; were malignant and one &#40;8&#46;33 &#37;&#41; was benign&#46; The malignant lesions were distributed as follows&#58; four ductal carcinoma in situ &#40;DCIS&#41; &#40;33&#46;33 &#37;&#41; and seven infiltrating ductal carcinomas &#40;IDC&#41; &#40;58&#46;33 &#37;&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#fig0010">Figs&#46; 2 and 3</a> show the images corresponding to two cases from our study&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">The mean size of the DCIS in the MRI studies was 20&#46;5&#8239;&#177;&#8239;11&#46;73&#8239;mm&#46; The histological grade of these tumours was intermediate &#40;G2&#41; in two cases and high &#40;G3&#41; in the other two cases&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The mean size of the IDCs in the MRI studies was 16&#46;14&#8239;&#177;&#8239;7&#46;11&#8239;mm&#46; After immunohistochemistry tests&#44; five &#40;71&#46;43 &#37;&#41; cases were classified as luminal A tumours and two &#40;28&#46;57 &#37;&#41; as triple negative tumours&#46; The histological grade distribution was one case of low grade &#40;G1&#41; &#40;14&#46;29 &#37;&#41; and six cases of G2 &#40;85&#46;71 &#37;&#41;&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Twelve lesions were categorised as BI-RADS 3&#58; in 10 &#40;83&#46;33 &#37;&#41; cases follow-up was performed because the patients refused histological study&#59; they remained stable in subsequent radiological follow-up studies&#44; and in two &#40;16&#46;66 &#37;&#41; biopsy was performed and the lesion was diagnosed as benign&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The remaining studies &#40;84&#46;11 &#37;&#41; were categorised as BI-RADS 1 and 2&#46; Biopsy was performed in seven &#40;5&#46;83 &#37;&#41; of these&#44; due to patient anxiety&#44; and benignity was confirmed&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the BI-RADS categories and their management&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0210" class="elsevierStylePara elsevierViewall">In total&#44; 21 biopsies were performed&#44; 19 ultrasound-guided CNB and two ultrasound-guided VAB&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">The AUC obtained from each ROC curve was 0&#46;9977 for the complete protocol&#44; 0&#46;9932 for the abbreviated protocol and 0&#46;9831 for the MIP protocol&#46; All lesions were identified using all three protocols&#44; and no significant differences were found between their respective AUCs &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;0650&#41;&#46; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows the ROC curves corresponding to each protocol&#46; Taking a BI-RADS &#8805;3 as the optimal classification criteria&#44; the sensitivity&#44; specificity&#44; NPV and PPV of each protocol were determined with their corresponding 95 &#37; confidence intervals&#44; without observing statistically significant differences&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the validity of each diagnostic protocol for characterising MRI lesions&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0225" class="elsevierStylePara elsevierViewall">Our study shows that there are no significant differences between the different protocols &#40;MIP&#44; abbreviated and complete&#41; analysed in terms of sensitivity&#44; specificity&#44; PPV and NPV&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Kuhl et al&#46; published a study in 2014 arguing that current breast MRI protocols were designed to characterise lesions and that a contrast-enhanced sequencing time of one minute is sufficient to detect BC&#46; In their study&#44; the authors showed that the abbreviated protocol was equivalent to the complete protocol&#44; using the same sequences used in our study&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; like Mango et al&#46; &#40;2015&#41;&#44; they found that the MIP image alone was not sufficient to detect BC or to correctly categorise the finding according to BI-RADS&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In our series&#44; all BCs were detected using images acquired with all three protocols &#40;MIP&#44; abbreviated and complete&#41;&#44; this could be due to mean size of the lesions &#40;17&#8239;&#177;&#8239;8&#46;74&#8239;mm&#41; and to a possible memory bias&#44; since the radiologist who retrospectively reviewed the cases was the same clinician who performed the first reading&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Given the advantages offered by abbreviated protocols&#44; many studies analysing their benefits have been published recently&#46; The majority involve acquisition of a T1W sequence for one minute both pre- and post-intravenous contrast administration&#44; although some authors include additional sequences&#46; Moschetta et al&#46; found no significant differences between the complete and abbreviated protocol&#44; including STIR and T2W sequences&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Strahle et al&#46; concluded that pre-contrast T2W and T1W sequences&#44; the first post-contrast T1W sequence&#44; and the late sequences were needed to correctly screen their series&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The vast majority of studies with abbreviated protocols &#40;using different sequences&#41; maintained their diagnostic accuracy with respect to the complete protocol&#46; All the studies concluded that invasive cancers were detected in early stages &#40;85&#46;71 &#37; of infiltrating lesions were stage T1&#44; that is&#44; less than 2&#8239;cm&#41; and DCIS were predominantly intermediate or high grade &#40;100 &#37; of the DCIS were Nottingham histological grade II or III&#41;&#46; For this reason&#44; many authors recommend using mammography and MRI to detect in situ and infiltrating BC&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">Using MRI in high-risk patients will allow us to optimise screening and reduce over-diagnosis of non-aggressive BC&#44; since low grade&#44; <span class="elsevierStyleItalic">in situ</span> tumours&#44; which have less vascularisation&#44; may be overlooked&#44; and would avoid under-diagnosis of potentially invasive tumours identified at an early stage&#44; before they are visualised on mammography&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The randomised&#44; prospective&#44; multicentre ECOG-ACRIN 1141 trial that compares abbreviated protocols against tomosynthesis in the screening of women with dense and heterogeneously dense breasts is currently under way&#46; The results of this trial will be very useful to compare both techniques&#44; the type of cancer identified&#44; and patient perception during the study&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">We believe the highly sensitive imaging techniques&#44; such as subtracted MIP imaging and the abbreviated protocol&#44; which detect all malignant lesions&#44; should be prioritised in screening programmes&#46; Although we observed no significant differences in BC identification among our three study protocols&#44; the complete protocol&#44; which provides kinetic characterisation of the lesions&#44; is more specific&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Abbreviated protocols do not provide kinetic information&#46; To overcome this limitation&#44; image acceleration techniques have been developed that also significantly decrease acquisition time and increase the specificity of studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;13</span></a></p><p id="par0265" class="elsevierStylePara elsevierViewall">Breast MRI studies for both screening and staging of BC require administration of gadolinium contrast&#46; Recently evidence has shown that gadolinium-based contrast agents can cause deposits in the brain&#44; although the clinical implication of this is still unknown&#46; For this reason&#44; efforts are being made to develop sequences without contrast that have the same sensitivity&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Diffusion-weighted imaging could be an option&#59; however&#44; it presents important limitations in small tumours and in non mass-like enhancement&#44; which limits the generalisation of its use as an alternative sequence&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Combined diffusion weighting together with abbreviated protocols can provide additional information and improve diagnostic yield&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;14&#8211;18</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">According to the scientific literature&#44; reading times are shorter in the abbreviated protocols&#44; although this was not measured in our study&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">The main limitation of our study is the large average tumour size &#40;16&#8239;mm IDC and 20&#8239;mm DCIS&#41;&#46; If most tumours are relatively large&#44; it is only to be expected that all three protocols would have detected all 11 cases of cancer&#46; However&#44; we might have observed differences between the protocols if some of the tumours had been small &#40;&#60;10&#8239;mm IDC and &#60;5&#8239;mm DCIS&#41;&#44; although we cannot be sure of this&#46; Another limitation is the small number of tumours&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which prevents us from reaching more convincing conclusions&#46; In our study&#44; we reviewed a large number of MRI studies performed in a single centre&#44; with a high percentage of screening patients&#44; which explains the low prevalence of BC&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">The radiologists from our centre have more than 10 years of experience in the management of breast pathology using both conventional techniques and MRI&#44; following the recommendations of the <span class="elsevierStyleItalic">Sociedad Espa&#241;ola de Radiolog&#237;a M&#233;dica</span> &#91;Spanish Society of Medical Radiology&#93; &#40;SERAM&#41; for diagnosis of BC&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Abbreviated protocols need to be improved&#44; standardised and validated&#46; However&#44; in view of the promising and concordant results of the studies cited&#44; we believe that they will play an important role in the future of breast radiology&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusion</span><p id="par0295" class="elsevierStylePara elsevierViewall">In this study&#44; we found no significant differences in the effectiveness of the study protocols &#40;complete&#44; abbreviated and MIP&#41; to diagnose BC&#46; The use of abbreviated protocols in high-risk BC screening would have the advantage of shortening turnaround times and thus allowing more studies to be performed&#46;</p><p id="par0300" class="elsevierStylePara elsevierViewall">As a result&#44; breast MRI screening need not be limited to high-risk cases&#44; and could be extended to include women with a personal history of BC&#44; and&#44; therefore&#44; a higher risk of tumour recurrence&#44; to benefit from the prognostic and predictive power of this technique&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0305" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "MRI technique"
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              "titulo" => "Reading of protocols"
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                0 => array:2 [
                  "identificador" => "sec0030"
                  "titulo" => "MIP protocol"
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                  "identificador" => "sec0035"
                  "titulo" => "Abbreviated protocol"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2019-04-13"
    "fechaAceptado" => "2019-08-14"
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        0 => array:4 [
          "clase" => "keyword"
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            0 => "Breast cancer"
            1 => "Cancer screening"
            2 => "High-risk"
            3 => "Breast magnetic resonance"
            4 => "Abbreviated protocol"
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            0 => "C&#225;ncer de mama"
            1 => "Cribado"
            2 => "Alto riesgo"
            3 => "RM mamaria"
            4 => "Protocolo abreviado"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Value the utility of breast MRI abbreviated protocols for the screening of breast cancer in high-risk patients compared to the full protocol&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective review of 157 breast MRI of 82 high-risk patients practiced in our hospital between January 2011 and January 2017&#46; Clinical&#44; radiological and anatomopathological parameters were analyzed&#46; Reading of the different protocols &#40;MIP&#44; abbreviated and full&#41; was made by an expert radiologist&#46; Subsequent statistical analysis was done&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A total amount of 12 findings classified as BI-RADS 4 and 5 were identified and performed a biopsy&#44; resulting 11 of them to be malignant &#40;91&#46;67 &#37;&#41; and 1 benign &#40;8&#46;33 &#37;&#41;&#46; The malignant wounds included 4 intraductal carcinoma &#40;33&#46;33 &#37;&#41; and 7 infiltrating ductal carcinoma &#40;58&#46;33 &#37;&#41;&#46; All injuries were detected with the three protocols and no significant differences were found between their respective area under the ROC curve &#40;p&#8239;&#61;&#8239;0&#46;0650&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">In our study there are no significant differences between the different protocols &#40;MIP&#44; abbreviated and full&#41;&#44; which places the abbreviated protocol as a promising tool for breast cancer screening in high-risk patients&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Valorar la utilidad de los protocolos abreviados de resonancia magn&#233;tica &#40;RM&#41; mamaria en el cribado de c&#225;ncer de mama en pacientes de alto riesgo&#44; en comparaci&#243;n con el protocolo completo&#44; y determinar la precisi&#243;n diagn&#243;stica en la caracterizaci&#243;n de las lesiones mamarias de ambos protocolos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se revisaron retrospectivamente 157 estudios de RM mamaria de 82 pacientes de alto riesgo realizadas en nuestro centro&#44; desde enero de 2011 hasta enero de 2017&#46; Se analizaron par&#225;metros cl&#237;nicos&#44; radiol&#243;gicos y anatomopatol&#243;gicos&#46; Se realiz&#243; la lectura de los diferentes protocolos&#58; MIP&#44; abreviado y completo por un radi&#243;logo experto&#46; Posteriormente se hizo un an&#225;lisis estad&#237;stico&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se identificaron un total de 12 lesiones clasificadas en categor&#237;a BI-RADS 4 y 5 que fueron biopsiadas&#44; de las cuales 11 resultaron ser malignas &#40;91&#44;67 &#37;&#41; y 1 benigna &#40;8&#44;33 &#37;&#41;&#46; Las lesiones malignas fueron&#58; 4 carcinomas intraductales &#40;33&#44;33 &#37;&#41; y 7 carcinomas ductales infiltrantes &#40;58&#44;33 &#37;&#41;&#46; Todas las lesiones fueron detectadas con los tres protocolos y no se encontraron diferencias significativas entre sus respectivas &#225;reas bajo la curva &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#44;0650&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">En nuestro estudio no existen diferencias significativas entre los distintos protocolos &#40;MIP&#44; abreviado y completo&#41;&#46; El protocolo abreviado se perfila como una herramienta prometedora en el cribado de c&#225;ncer de mama en pacientes de alto riesgo&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Marquina Mart&#237;nez D&#44; Cruz Ciria S&#44; Garc&#237;a Barrado AI&#44; Su&#241;&#233;n Amador I&#44; Garc&#237;a Mur C&#46; Valor del protocolo abreviado de resonancia magn&#233;tica mamaria en el cribado de pacientes de alto riesgo&#46; Radiolog&#237;a&#46; 2020&#59;62&#58;198&#8211;204&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic diagram of the abbreviated and complete protocol&#46; The complete protocol consists of T2-weighted sequences&#44; diffusion-weighted sequences&#44; and pre- and post-contrast T1-weighted VIBRANT sequences at 1&#44; 2&#44; 3&#44; 4 and 5&#8239;min&#46; The abbreviated protocol includes pre- and post-contrast T1-weighted VIBRANT sequences at one minute&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Example of a case with infiltrating ductal carcinoma &#40;IDC&#41; &#43; DCIS&#46; A 42-year-old patient&#44; BRCA1&#44; with a family history of a sister and cousin with breast cancer&#46; Personal history of hysterectomy and double adnexectomy&#46; Magnetic resonance imaging screening showed 10&#8239;mm nodular enhancement in the right breast&#44; associated with a peripheral linear enhancement suggestive of DCIS&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">BC&#58; breast cancer&#46;</p>"
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                  \t\t\t\t" scope="col"><span class="elsevierStyleItalic">High-risk patients</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;40&#46;24 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BRCA2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">35 &#40;42&#46;24 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>BRCA 1 and 2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;1&#46;22 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FH BC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;22 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>FH ovarian cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;8&#46;54 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PH BC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;44 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PH radiotherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;44 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hormonal state</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Premenopausal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;42&#46;68 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Perimenopausal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103 &#40;3&#46;66 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Postmenopausal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;7&#46;32 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Menopausal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;46&#46;34 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mastectomy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prophylactic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;22 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Therapeutic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;10&#46;98 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mammogram pattern</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;13&#46;41 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;32&#46;93 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;15&#46;85 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;10&#46;98 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Breast implants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;12&#46;20 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non-assessable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;14&#46;63 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total no&#46; of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">DCIS&#58; ductal carcinoma in situ&#59; IDC&#58; infiltrating ductal carcinoma&#46;</p>"
          "tablatextoimagen" => array:3 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BI-RADS 4 and 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;100 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Malignant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DCIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#46;33 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IDC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;58&#46;33 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Benign&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibroadenoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;8&#46;33 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BI-RADS 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;93&#46;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;16&#46;67 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Malignant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Benign&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrocystic changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2290323.png"
              ]
            ]
            2 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">BI-RADS 1 and 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Screening&#47;follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;94&#46;49 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#46;83 &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrocystic changes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fibrotic scarring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflammatory infiltrate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radio dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2290324.png"
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tumours identified by the complete MRI protocol classified according to BI-RADS and their management&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0035"
            "detalle" => "Table "
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          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">S &#40;&#37;&#41; 95 &#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sp &#40;&#37;&#41; 95 &#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PPV &#40;&#37;&#41; 95 &#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">NPV &#40;&#37;&#41; 95 &#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">V &#40;&#37;&#41; 95 &#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complete protocol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;95&#46;45&#8211;100&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;71 &#40;85&#46;55&#8211;95&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;83 &#40;23&#46;82&#8211;67&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;99&#46;61&#8211;100&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;39 &#40;86&#46;59&#8211;96&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Abbreviated protocol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;95&#46;45&#8211;100&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;43 &#40;86&#46;43&#8211;96&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;83 &#40;25&#46;24&#8211;70&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;99&#46;61&#8211;100&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;05 &#40;87&#46;41&#8211;96&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MIP protocol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;95&#46;45&#8211;100&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;43 &#40;86&#46;43&#8211;96&#46;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;83 &#40;25&#46;24&#8211;70&#46;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;00 &#40;99&#46;61&#8211;100&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;05 &#40;87&#46;41&#8211;96&#46;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2290325.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sensitivity &#40;S&#41;&#44; specificity &#40;Sp&#41;&#44; positive predictive value &#40;PPV&#41;&#44; negative predictive value &#40;NPV&#41; and validity &#40;V&#41; together with their respective 95 &#37; confidence intervals&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:18 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Abbreviated MRI of the breast&#58; Does it provide value&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Leithner"
                            1 => "L&#46; Moy"
                            2 => "E&#46;A&#46; Morris"
                            3 => "M&#46;A&#46; Marino"
                            4 => "T&#46;H&#46; Helbich"
                            5 => "K&#46; Pinker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/jmri.26291"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Magn Reson Imaging"
                        "fecha" => "2019"
                        "volumen" => "49"
                        "paginaInicial" => "e85"
                        "paginaFinal" => "e100"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30194749"
                            "web" => "Medline"
                          ]
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Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2019.11.006

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2023 May	3	0	3
2023 April	1	0	1
2023 March	5	2	7
2023 February	3	0	3
2023 January	1	0	1
2021 January	1	0	1
2020 October	1	0	1

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