Eduardo de Faria Castro Fleury

IBCC Insituto Brasileiro de Controle do Câncer · Radiology

Many complications related to silicone implants have been reported recently, from clinical symptoms manifestations to association with some specific types of cancer. During the early 2010s, it was believed that implants were biocompatible and inert to the human body and that gel bleeding/leakage events were rare and without repercussions for the hu...

The evaluation of silicone implants by imaging methods is increasingly present in the radiologist's clinical practice. Currently, radiologists do not have dedicated available tools to classify all changes observed in silicone implants by MRI, Ultrasound, CT, and PET-CT. Often, patients have clinical complaints related to implants that are not diag...

Current therapies for HER2-positive breast cancer have limited efficacy in patients with triple-positive breast cancer (TPBC). We conduct a multi-center single-arm phase 2 trial to test the efficacy and safety of an oral neoadjuvant therapy with pyrotinib, letrozole and dalpiciclib (a CDK4/6 inhibitor) in patients with treatment-naïve, stage II–III...

The past six decades of silicone breast implant history encompass manufacturing secrecy, regulatory laxity, inadequate informed consent, clever advertising, overly simplistic research methodology, diverse and controversial opinions, changing social patterns, safety issues, information ambiguity, speculation, and deception. This review addresses the...

Objective To propose a new classification system for evaluating fibrous capsules around silicone implants using magnetic resonance. Methods We retrospectively evaluated 90 consecutive patients who underwent breast MRI scans at a single center from February to March 2022. All patients with silicone implants and contrast dynamic sequences were inclu...

Rationale and Objectives According to the Breast Imaging and Reporting Data System (BI-RADS), one of the main limitations of MRI is diagnosing the non-mass enhancement (NME). The NME lesion is challenging since it is unique to the MRI lexicon. This study aims to report our experience with NME lesions diagnosed by MRI referred for MRI-guided biopsie...

Recently, there has been an increase in surgeries to treat silicones implant complications. These procedures are generally related to diseased fibrous capsules, with capsular contracture the most common clinical manifestation. However, patients often do not undergo a magnetic resonance imaging (MRI) scan for the explant surgical programming to acce...

Background Silicone implants have been used since the 1960s for aesthetic purposes and breast reconstructions. During this period, many women have reported up to 40 similar symptoms, including fatigue, the emergence of autoimmune diseases, Raynaud Phenomenon, arthritis, arthralgias, and hair loss, among others. However, most of the time, these symp...

We described a breast papillary lesion related to silicone breast implant exposure. The case report is in accordance with our initial publication, where we proposed that silicone particles may trigger a process of reverse morphogenesis in pericapsular tissue resulting in metaplasia of the epithelial cells. The relationship between breast metaplasia...

Recently, there has been an increase in surgeries to treat silicone implants complications. These procedures are generally related to diseased fibrous capsules, whose most common clinical manifestation is capsular contracture. Other frequently found presentations are intracapsular collection and local inflammatory signs. The causes of these complic...

A solitary dilated duct visualized by mammography is a rare event. According to the latest edition of BI-RADS® it is classified as category 4. This series of cases shows complementary ultrasound of a solitary dilated duct can reduce false-positive results on mammography.

Breast reconstructive surgery with silicone implants is routinely one of the techniques performed immediately after a mastectomy and before adjuvant radiotherapy. Implant shell degradation may result in gel bleeding that can trigger capsular disease. The silicone corpuscle in contact with the implant fibrous capsule can promote an inflammatory reac...

Complications related to breast implants have received much attention recently. Breast implant-associated anaplastic large cell lymphoma, silicone-induced granuloma of breast implant capsule, and breast implant illness are the main complications reported in the medical literature. However, the literature contains limited evidence regarding the poss...

We recently described silicone induced granuloma of breast implant capsule (SIGBIC) as an implant capsule illness related to intact silicone breast implants. The precursor to SIGBIC development is gel bleeding/shedding from the implant shell/interior content. Currently, although the literature widely discussed the pathogenesis of breast implant-ass...

The book: "The voice of silence: when science is the enemy. The Breast Implant Illness story." is available for sale on amazon.com. In the book, I talk about my participation in the saga of this disease. I address all the victories and difficulties we had during our study regarding silicone implants, from the initial denial of our findings by the A...

Aim: To correlate solitary dilated ducts (SDDs) detected by mammography with ultrasound and histopathological findings of intraductal lesions and evaluate the association with invasive or in situ breast carcinoma. The secondary goal was to evaluate the prevalence of SDDs in screening and diagnostic mammography. Materials and methods: This prospe...

Recently, many breast surgeons report silicone breast implants transformation prior to their introduction and after explantation in clinical practice. Often the complications are associated with reports of increased implant volumes and others of reduction. However, what is intriguing in these cases is that there are no obvious macroscopic signs of...

Objective The study aims to assess the impact of radiomics in the clinical practice of breast ultrasound, to determine which lesions are undetermined by the software, and to discuss the future of the radiologist’s role. Methods Consecutive analyses of 207 ultrasound masses from January 2018 to April 2019 referred for percutaneous breast biopsy. Br...

Objective To evaluate the sensitivity (S) of BMRI to detect silicone gel bleeding in a prospective observational study, including consecutive patients referred for BMRI scan. Methods From January 2017 to March 2018, we evaluated patients with breast implants referred for BMRI in a prospective observational study. For SIGBIC diagnosis, we adopted t...

Background The intima-media thickness of the carotid artery (cIMT) and endothelial dysfunction are associated with cardiovascular (CV) disease. Objectives To evaluate the correlation between cIMT, brachial intraluminal diameter and flow-mediated vasodilation on the reactive hyperemia phase in adolescents with obesity with predictors of CV risk. M...

Objective: To evaluate the ability of BMRI to detect silicone gel bleeding in a prospective observational study including consecutive patients referred for BMRI scan. Methods: From January 2017 to March 2018, patients referred for BMRI were evaluated in a prospective observational study. Patients who had breast implants were included. BMRI recorded...

Since 2017, there have been an increasing number of reported cases regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in the literature. Although significant attention was dispensed for this relevant issue, there is no consensus on what the trigger points for disease development are. BIA-ALCL trigger point speculation inc...

Objective: To determine the best cutoff value for classifying breast masses by ultrasound elastography, using dedicated software for strain elastography, and to determine the level of interobserver agreement. Materials and Methods: We enrolled 83 patients with 83 breast masses identified on ultrasound and referred for biopsy. After B-mode ultrasou...

Background: The purpose of this work was to evaluate computable Breast Imaging Reporting and Data System (BI-RADS) radiomic features to classify breast masses on ultrasound B-mode images. Methods: The database consisted of 206 consecutive lesions (144 benign and 62 malignant) proved by percutaneous biopsy in a prospective study approved by the l...

Objective: To evaluate the usefulness of elastography (using manual compression) as an additional diagnostic tool for children and adolescents with thyroid nodules. Materials and Methods: This was a prospective study conducted between September 2012 and August 2013 at a hospital in Brazil. We performed elastography, ultrasound, and fine-needle asp...

Solitary dilated duct (SDD) visualized by mammography is a rare event.-The correlation with ultrasound (US) second look may present: ductal ectasia with homogeneous or heterogeneous content, being papilloma the main finding in heterogeneous images.-When related to carcinoma usually comes from associated finding, not being the main finding of mammog...

Learning objectives - Compare BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) findings described in literature with SIGBIC (Silicone-Induced Granuloma of Breast Implant Capsule) findings described by our group. - Determine diagnostic criteria for diagnosis. - Discuss similarities between the two pathologies.

Currently, attention has been given to complications related to breast implants, especially due to the presence of anaplastic large cell lymphoma (ALCL) related to silicone implants. Many manuscripts attempt to associate silicone presence with clinical complaints reported by patients, while others try to demonstrate the mechanisms of silicone bleed...

Purpose: Evaluation of the performance of a computer-aided diagnosis (CAD) system based on the quantified color distribution in strain elastography imaging to evaluate the malignancy of breast tumors. Methods: The database consisted of 31 malignant and 52 benign lesions. A radiologist who was blinded to the diagnosis performed the visual analysis o...

Currently, attention has been given to complications related to breast implants, especially due to the presence of anaplastic large cell lymphoma (ALCL) related to silicone implants. Many manuscripts attempt to associate silicone presence with clinical complaints reported by patients, while others try to demonstrate the mechanisms of silicone bleed...

To the Editor I read with great interest the systematic review by Leberfinger et al¹ on breast implant–associated anaplastic large cell lymphoma (BIA-ALCL). The authors analyze 95 patients with BIA-ALCL and suppose it is caused by a complex process involving many factors, including bacterial biofilm growth, textured implant surface, immune response...

Objectives: To determine the applicability of a computer-aided diagnostic system strain elastography system for the classification of breast masses diagnosed by ultrasound and scored using the criteria proposed by the breast imaging and reporting data system ultrasound lexicon and to determine the diagnostic accuracy and interobserver variability....

Background To determine whether there is correlation between magnetic resonance imaging (MRI) findings and breast elastography to differentiate seroma/hematoma from silicone-induced granuloma of breast implant capsule (SIGBIC). Methods Prospective study of 99 patients with breast implants submitted to breast MRI during the period from February 1 t...

Complications resulting from the placement of silicone breast implants are becoming more frequent in our clinical practice. This is due to the increase in breast aesthetic surgeries at the beginning of the century, where breast augmentation using silicone implants was the main intervention performed. Generally, studies that discuss the complication...

Eduardo de Faria Castro Fleury,1 Milena Morais Rêgo,1 Luciana Costa Ramalho,1 Veronica Jorge Ayres,1 Rodrigo Oliveira Seleti,2 Carlos Alberto Pecci Ferreira,2 Decio Roveda Jr 2 1Radiology Department, IBCC – Instituto Brasileiro de Controle do Câncer, 2Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil Abstract: Primary breast lymp...

Objective: The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS. Method: A prospective observational st...

Purpose: The purpose of this study was to evaluate BI-RADS indicators in the detection of DCIS by MRI. Materials and methods: Prospective observational study that started in 2014 and lasted 24 months. A total of 110 consecutive patients were evaluated, who presented with suspicious or highly suspicious microcalcifications on screening mammograph...

The aim of this study was to develop a tool to classify breast lesions using ultrasound elastography. Our dataset included a total of 78 patients enrolled for percutaneous biopsy of 85 breast lesions. These lesions were classified into three sonoelastographic scores, where scores of 1 and 2 were considered negative – soft and intermediate respectiv...

Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary...

Objective: the aim of this study was to investigate the addition of elastography to the BI-RADS® lexicon for the classification of breast lesions. Methods: a total of 955 consecutive patients who were subjected to breast percutaneous biopsy from January 2010 to December 2012 were retrospectively assessed. Overall, 26 patients who did not present w...

Background This study assessed factors influencing the sonoelastographic presentation of breast carcinoma. Methods A prospective collaborative study was conducted by the Santa Casa de São Paulo and CTC-Center, on 540 breast lesions in women referred for percutaneous breast biopsy. Eighty-four carcinomas showing lesions on ultrasonography were incl...

Objective To evaluate the BI-RADS as a predictive factor of suspicion for malignancy in breast lesions by correlating radiological with histological results and calculating the positive predictive value for categories 3, 4 and 5 in a breast cancer reference center in the city of São Paulo. Materials and Methods Retrospective, analytical and cross-...

Proposal for the classification of breast masses through ultrasound elastography in order to differentiate benign and malignant lesions with histological correlation. 188 patients enrolled for percutaneous biopsy of 228 breast lesions. Elastography was performed and interpreted according to criteria created by the authors, with scores varying from...

The aim of this study was to show and correlate the imaging features of breast masses, especially fibroadenomas, using sonoelastography. Two hundred thirty-five patients with 302 breast lesions referred for core needle biopsy participated in the study. All lesions appearing as solid masses on conventional US were included. Out of the included lesio...

OBJETIVO: Propor uma sistematização do estudo elastográfico para emprego na rotina ultrassonográfica. MÉTODOS: Avaliação de 308 pacientes encaminhadas ao serviço de intervenção mamária do CTC-Gênese no período de 1 de maio de 2007 a 1 de março de 2008 para a realização de biópsia mamária percutânea. Antes da realização da biópsia percutânea foi rea...

Proposal of systematization for the elastographic study in the ultrasound routine. Evaluation was made of 308 patients forwarded to the breast intervention service in the CTC-Genesis from May 1, 2007 to March 1, 2008 to perform percutaneous breast biopsy. Prior to the percutaneous biopsy, an ultrasound study and an elastography were performed. Lesi...

OBJETIVO: Demonstrar a apresentação mais freqüente das lesões mamárias císticas utilizando a elastografia e discutir a sua aplicabilidade. MATERIAIS E MÉTODOS: A casuística compôs-se de 150 pacientes encaminhadas para realização de biópsia mamária percutânea com 175 lesões. Foram excluídas as lesões com diagnóstico histológico de lesões sólidas (15...

OBJETIVO: Avaliar os valores preditivos positivo e negativo das categorias 3, 4 e 5 do sistema BI-RADS™ em lesões mamárias nodulares não-palpáveis avaliadas por mamografia, ultra-sonografia e ressonância magnética. MATERIAIS E MÉTODOS: Vinte e nove pacientes com achados mamográficos de lesões mamárias nodulares não-palpáveis, das classes 3, 4 e 5 d...