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Vanni G, Materazzo M, Lorenzo NDI, Tacconi F, Pellicciaro M, Berretta M, Mauro GDI, Pistolese CA, Noce A, Longo B, Cervelli V, Buonomo OC. Contrast-enhanced Ultrasound Using Intradermal Microbubble Sulfur Hexafluoride in Non-invasive Axillary Staging in Breast Cancer: Are we Missing a Chance? Anticancer Res 2024; 44:2021-2030. [PMID: 38677765 DOI: 10.21873/anticanres.17005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND/AIM In the context of surgical de-escalation in early breast cancer (EBC), this study aimed to evaluate the contrast enhancement ultrasound (CEUS) sentinel lymph node (SLN) procedure as a non-invasive axillary staging procedure in EBC in comparison with standard SLN biopsy (SLNB). PATIENTS AND METHODS A subanalysis of the AX-CES study, a prospective single-arm, monocentric phase 3 study was performed (EudraCT: 2020-000393-20). The study included patients with EBC undergoing upfront surgery and SLN resection, with no prior history of locoregional treatment, and weighing between 40-85 kg. All patients underwent the CEUS SLN procedure as a non-invasive axillary staging procedure, with CEUS SLN accumulation marked using blue dye. After the CEUS SLN procedure, all patients underwent the standard mapping procedure. Data on success rate, systemic reactions, mean procedure time, mean surgical procedure, mean procedure without axillary staging, CEUS SLN appearance (normal/pathological), SLN number, and concordance with standard mapping procedure were collected. RESULTS After the CEUS SLN procedure, 29 LNs among 16 patients were identified and marked. In all cases, CEUS SLN revealed at least one LN enhancement. Six (37.50%) LNs were defined as pathological after the CEUS SLN procedure. Definitive staining of CEUS SLN pathology revealed metastatic involvement in four (66.67%) of the cases. Two SLNs were identified during the CEUS SLN procedure; however, owing to the low disease burden, no change in the surgical plan was reported. CONCLUSION The CEUS SLN procedure shows promise as a technique for non-invasive assessment of the axilla, potentially enabling safe axillary de-escalation in EBC by estimating the axillary disease burden.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata, Rome, Italy;
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Nicola DI Lorenzo
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata, Rome, Italy
- Ph.D. Program in Applied Medical-Surgical Sciences, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Massimiliano Berretta
- Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Giordana DI Mauro
- Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Benedetto Longo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata, Rome, Italy
- Division of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | - Valerio Cervelli
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata, Rome, Italy
- Division of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata, Rome, Italy
- Engineering School, University of Basilicata, Potenza, Italy
- Faculty of Medicine, Catholic University "Our Lady of Good Counsel", Tirana, Albania
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2
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Vanni G, Materazzo M, Pellicciaro M, Caspi J, Portarena I, Tacconi F, Noce A, Marsella VE, Granai AV, Pistolese CA, Buonomo OC. Anxiety and Fear of Breast Cancer Patients During and After the COVID-19 Era. Anticancer Res 2023; 43:3255-3263. [PMID: 37351959 DOI: 10.21873/anticanres.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND/AIM Coronavirus-19 (COVID-19) pandemic had a huge impact on medical resource allocation. While it is clear that the surgery refusal rate of patients with breast cancer (BC) was higher during the pandemic, long-term effect of COVID-19 pandemic on hospital admission in the post-pandemic period has not been fully evaluated. This study aimed to estimate how patients' behavior changed following the pandemic and whether the cross-infection risk is still influencing patients' decision-making process. PATIENTS AND METHODS Between the 16th of January and 18th of March 2020, between 19th of March 2020 and the 20th of March 2020, and between 19th of March 2023 and the 20th of March 2023, 266 patients were enrolled and divided into PRE-COVID-19, COVID-19, and POST-COVID-19 groups, respectively. A total of 137 patients with a suspected breast lesion (SBL) were divided into 3 groups: PRE-COVID-19-SBL, COVID-19-SBL, and POST-COVID-19-SBL groups. In addition, 129 BC patients were divided into PRE-COVID-19-BC, COVID-19-BC and POST-COVID-19-BC groups. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure refusal (PR) and Surgical refusal (SR) were also recorded with their reason. RESULTS BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). While higher rate of PR and SR rates were reported in COVID-19-SBL and COVID-19-BC groups when compared with PRE-COVID-19 (p=0.003, p=0.013, respectively) and POST-COVID-19 (p=0.005, p=0.004, respectively) groups, no statistical difference was found between PRE-COVID-19 and POST-COVID-19 subanalysis. CONCLUSION Thanks to preventive measures, COVID-19 does not currently seem to affect the decision-making process of patients with BC.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Jonathan Caspi
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Annalisa Noce
- UOC of Internal Medicine-Center of Hypertension and Nephrology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
- Faculty of Medicine, Catholic University "Our Lady of Good Counsel", Tirana, Albania
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Meucci R, Buonomo OC, Perretta T, Manenti G, Vanni G, Lombardo E, Serio ML, DI Pietro F, Pellicciaro M, Montesanto F, Palombi C, Rufi F, Materazzo M, Pistolese CA. Vacuum-assisted Evacuation (VAEv) of Symptomatic and/or Voluminous Breast Haematomas Following Surgeries and Percutaneous Procedures. Anticancer Res 2023; 43:2135-2143. [PMID: 37097673 DOI: 10.21873/anticanres.16375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/AIM Among postoperative complications in breast surgery, postoperative hematoma is the most common occurrence. While mostly self-limited, in some cases surgical revision is mandatory. Among percutaneous procedures, preliminary studies demonstrated the efficacy of vacuum-assisted breast biopsy (VAB) in evacuating postprocedural breast hematomas. However, no data are available regarding VAB evacuating postoperative breast hematomas. Therefore, the present study aimed to investigate the efficacy of the VAB system in evacuating postoperative and postprocedural hematoma, symptom resolution, and avoidance of surgery. PATIENTS AND METHODS From January 2016 to January 2020, patients with ≥25 mm symptomatic breast hematomas developed after breast-conserving surgery (BCS) and percutaneous procedures were retrospectively enrolled from a perspective-maintained database. Hematoma maximum diameter, estimated hematoma volume, total procedure time, and visual analog scale (VAS) score before ultrasound (US) vacuum-assisted evacuation (VAEv) were recorded. At one-week VAS score, residual hematoma volume, and complications were recorded. RESULTS Among 932 BCSs and 618 VAB procedures, a total of 15 late postoperative hematomas were recorded (9 after BCS and 6 after VAB). Preoperative median diameter was 43.00 (35.50-52.50) mm and median volume 12.60 (7.35-18.30) mm3 Regarding VAEv, median time recorded was 25.92 (21.89-36.81) min. At one week, the median hematoma reduction was 83.00% (78.00%-87.5%) with a statistically significant VAS reduction (5.00 vs. 2.00; p>0.001). No surgical treatment was needed and only one case of seroma occurred. CONCLUSION VAEv represents a promising safe, time and resource-sparing treatment modality for the evacuation of breast hematomas, potentially decreasing the rate of reoperation after surgery.
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Affiliation(s)
- Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Guglielmo Manenti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Eleonora Lombardo
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Maria Lina Serio
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Francesca DI Pietro
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Montesanto
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Palombi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Flavia Rufi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
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Buonomo OC, Pellicciaro M, Materazzo M, Berardi S, Gigliotti PE, Caspi J, Meucci R, Perretta T, Portarena I, Dauri M, Pistolese CA, Vanni G. Surgical Treatments for Ductal Carcinoma In Situ (DCIS) in Elderly Patients. Anticancer Res 2023; 43:1555-1562. [PMID: 36974780 DOI: 10.21873/anticanres.16305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND/AIM Despite an aging population, there is no consensus regarding ductal carcinoma in situ (DCIS) treatment for elderly women. Breast surgery can be well tolerated even in elderly patients. The aim of this study is to evaluate the surgical management of DCIS in elderly patients. PATIENTS AND METHODS We retrospectively analyzed patients with DCIS from 2016 to 2022 at our Breast Unit and divided our population according to age. RESULTS Out of 231 patients with DCIS, 45 (19.5%) were elderly. The Charlson comorbidity index and American Society of Anesthesiology (ASA) score was significantly higher in the elderly (p<0.001 for both). Among the elderly, 10 (22.2%) patients received upstaging diagnoses, versus 18 (9.7%) in the control (p=0.048). Twelve (26.7%) of the elderly patients underwent sentinel lymph node biopsy, versus 93 (50%) in the control group (p=0.005). No difference was reported between groups in terms of breast conserving surgeries performed. A higher incidence of surgeries performed using local anesthesia was reported in the elderly group (p=0.041). Thirty-day surgical complications, according to Clavien-Dindo, did not show significant differences. CONCLUSION Despite higher comorbidity and ASA score, breast surgery is safe and feasible in elderly patients. Due to the higher risk of upstaging to invasive ductal carcinoma, surgery should be performed but sentinel lymph node biopsy should be omitted, owing to the low risk of lymph node metastasis and lower use of adjuvant treatments.
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Affiliation(s)
- Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy;
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Simone Berardi
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Paola Elda Gigliotti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Mario Dauri
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV Policlinico Tor Vergata University, Rome, Italy
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Buonomo OC, Materazzo M, Pellicciaro M, Iafrate G, Ielpo B, Rizza S, Pistolese CA, Perretta T, Meucci R, Longo B, Cervelli V, Vanni G. Contrast-enhanced Ultrasound Using Intradermal Microbubble Sulfur Hexafluoride for Identification of Sentinel Lymph Nodes During Breast Cancer Surgery: A Clinical Trial. Anticancer Res 2023; 43:557-567. [PMID: 36697065 DOI: 10.21873/anticanres.16192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM Sentinel lymph node (SLN) procedures have gained popularity in early breast cancer thanks to the reduction of surgical side-effects. The standard SLN mapping procedure uses 99mTc-nanocolloid human serum albumin with/without blue dye; limitations include logistical challenges and adverse reactions. Recently, contrast-enhanced ultrasound (CEUS) using sulfur hexafluoride has emerged as a promising technique for SLN mapping. Our study aimed to compare the CEUS technique with the standard isotope method. MATERIALS AND METHODS AX-CES, a prospective, monocentric, single-arm phase-3 study was designed (EudraCT: 2020-000393-20). Inclusion criteria were histologically diagnosed early breast cancer eligible for upfront surgery and SLN resection, bodyweight 40-85 kg, and no prior history of ipsilateral surgery or radiotherapy. All patients underwent CEUS prior to surgery and blue dye injection was performed in areas with contrast accumulation. After the experimental procedure, all patients underwent the standard mapping procedure and SLN frozen section assessment was performed. Data on the success rate, systemic reactions, mean procedure time, CEUS appearance, SLN number, and concordance with standard mapping procedure were collected. RESULTS Among 16 cases, a median of two SLNs were identified during CEUS. In all cases, at least one SLN was identified by CEUS (100%). In six cases, SLNs were classified during CEUS as abnormal, which was confirmed by definitive staining in four cases. After the standard mapping technique, in 15 out of the 16 cases (87.50%), at least one SLN from the standard mapping procedure was marked with blue dye in the CEUS procedure. In our series, sensitivity and specificity of SLN detection by CEUS were 75% and 100%, respectively. CONCLUSION CEUS is a safe and manageable intraoperative procedure. When compared with standard techniques, US appearance during CEUS may provide additional information when associated with histological assessment.
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Affiliation(s)
- Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Giada Iafrate
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Benedetto Ielpo
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Stefano Rizza
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Benedetto Longo
- Division of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | - Valerio Cervelli
- Division of Plastic and Reconstructive Surgery, Department of Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Giuliano FD, Perretta T, Pitocchi F, Pucci N, Serio ML, Caliandro A, Picchi E, Ferrazzoli V, Pistolese CA, Garaci F, Floris R. Coexistence of primary central nervous system lymphoma and primary breast lymphoma: Clinical presentation, imaging features, and treatment management. Radiol Case Rep 2022; 17:2470-2476. [PMID: 35586158 PMCID: PMC9108739 DOI: 10.1016/j.radcr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/02/2022] [Accepted: 04/05/2022] [Indexed: 11/19/2022] Open
Abstract
The presence of synchronous dual hematological diseases is an uncommon finding. We report an unusual case of coexistence of primary central nervous system lymphoma and primary breast lymphoma without systemic involvement in an immunocompetent patient. To our knowledge a similar case has not yet been reported in the literature. We especially focus on presenting the imaging features, the associated clinical findings and treatment management of each entity, with the aim of raising awareness on these two rare types of lymphomas and the possibility of their coexistence.
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Affiliation(s)
- Francesca Di Giuliano
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Tommaso Perretta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Francesca Pitocchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Noemi Pucci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
- Corresponding author.
| | - Maria Lina Serio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Aurelia Caliandro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Eliseo Picchi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Valentina Ferrazzoli
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, Rome, 00133, Italy
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Perretta T, Meucci R, Serio ML, Caliandro A, Censi M, Beninati E, Collura A, Vanni G, Giacobbi E, Anemona L, Pistolese CA. Small vascular lesions of the breast diagnosed by magnetic resonance imaging‐guided vacuum assisted biopsy: Report of 2 cases. Radiol Case Rep 2022; 17:2492-2500. [PMID: 35586166 PMCID: PMC9109119 DOI: 10.1016/j.radcr.2022.03.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022] Open
Abstract
Vascular lesions of the breast comprise a heterogeneous group that includes a variety of benign, atypical, and malignant lesions. These are a diagnostic challenge given variable clinical, radiological and pathological presentation, especially when they are small and asymptomatic. We present 2 cases of these rare lesions of the breast which were occult to mammographics and ultrasound studies. Both the lesions were detected only on magnetic resonance imaging, most helpful in the diagnosis of these rare tumor. Histopathological examinations following the magnetic resonance guided biopsies, were initially interpreted as negative for breast cancer in both cases. These turned out to be respectively a low grade angiosarcoma and a benign vascular lesion after a new histopathological examination following a larger magnetic resonance guided biopsies performed in light of the radiology-pathology discordance. Although rare, it is important to consider vascular tumours of the breast; radiologists need to be aware such tumors may present non-specific imaging features.
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8
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Meucci R, Pistolese CA, Perretta T, Vanni G, Beninati E, DI Tosto F, Serio ML, Caliandro A, Materazzo M, Pellicciaro M, Buonomo OC. Background Parenchymal Enhancement in Contrast-enhanced Spectral Mammography: A Retrospective Analysis and a Pictorial Review of Clinical Cases. In Vivo 2022; 36:853-858. [PMID: 35241542 DOI: 10.21873/invivo.12773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Despite the popularity of contrast enhanced spectral mammography (CESM), univocal classification of the background parenchymal enhancement (BPE), a bilateral enhancement of the normal breast parenchyma after contrast administration, is lacking. The present study aimed to evaluate the application of BPE Breast Imaging Reporting and Data System Magnetic Resonance (BI-RADS-MR) score for the CESM BPE. Moreover, a pictorial review of four different cases with CESM is provided. PATIENTS AND METHODS A single-center, retrospective study from a prospectively maintained database of all women undergoing digital mammography (DM) and CESM in our institution between 2016 and 2019. DM and CESM were classified by two experienced radiologists. RESULTS No statistically significant difference between DM breast density and BPE CESM classification was found. Agreement between readers ranged from substantial to almost perfect. CONCLUSION BIRADS-RM score for the CESM BPE represents a handy option for radiologists with high inter-reader and DM agreement.
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Affiliation(s)
- Rosaria Meucci
- UOC Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy.,Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Tommaso Perretta
- UOC Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Emanuela Beninati
- UOC Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy
| | - Federica DI Tosto
- UOC Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Lina Serio
- UOC Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy
| | - Aurelia Caliandro
- UOC Diagnostic Imaging, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Minosse S, Picchi E, Giuliano FD, di Cio F, Pistolese CA, Sarmati L, Teti E, Andreoni M, Floris R, Guerrisi M, Garaci F, Toschi N. Compartmental models for diffusion weighted MRI reveal widespread brain changes in HIV-infected patients. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:3834-3837. [PMID: 34892070 DOI: 10.1109/embc46164.2021.9629510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Diffusion tensor imaging (DTI) has been used to explore changes in the brain of subjects with human immunodeficiency virus (HIV) infection. However, DTI notoriously suffers from low specificity. Neurite orientation dispersion and density imaging (NODDI) is a compartmental model able to provide specific microstructural information with additional sensitivity/specificity. In this study we use both the NODDI and the DTI models to evaluate microstructural differences between 35 HIV-positive patients and 20 healthy controls. Diffusion-weighted imaging was acquired using three b-values (0, 1000 and 2500 s/mm2). Both DTI and NODDI models were fitted to the data, obtaining estimates for fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD), neurite density index (NDI) and orientation dispersion index (ODI), after which we performed group comparisons using Tract-based spatial statistics (TBSS). While significant group effects were found in in FA, MD, RD, AD and NDI, NDI analysis uncovered a much wider involvement of brain tissue in HIV infection as compared to DTI. In region-of interest (ROI)-based analysis, NDI estimates from the right corticospinal tract produced excellent performance in discriminating the two groups (AUC = 0.974, sensitivity = 90%; specificity =97%).
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Vanni G, Pellicciaro M, Combi F, Papi S, Materazzo M, Segattini S, Rizza S, Chiocchi M, Perretta T, Meucci R, Portarena I, Pistolese CA, Ielpo B, Campanelli M, Lisi G, Chiaravalloti A, Tazzioli G, Buonomo OC. Impact of COVID-19 Pandemic on Surgical Breast Cancer Patients Undergoing Neoadjuvant Therapy: A Multicentric Study. Anticancer Res 2021; 41:4535-4542. [PMID: 34475080 DOI: 10.21873/anticanres.15265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Due to the SARS-CoV-2 pandemic, many scientific committees proposed neoadjuvant therapy (NACT) bridging treatment as a novel strategy and indication. The aim of the study was to evaluate the impact of COVID-19 pandemic on breast cancer patients undergoing NACT. PATIENTS AND METHODS All breast cancer patients referred to two Breast Units during COVID-19-pandemic were enrolled. RESULTS Out of 814 patients, 43(5.3%) were enrolled in the COVID-19-group and compared with 94 (7.9%) similar Pre-COVID-19 patients. We observed a reduction in the number of patients undergoing NACT, p=0.0019. No difference was reported in terms of clinical presentation, indications, and tumor response. In contrast, a higher number of vascular adverse events was reported (6.9% vs. 0% p=0.029). Immediate breast cancer reconstructions following invasive surgery suffered a significant slowdown (5.9% vs. 47.7%, p=0.019). CONCLUSION COVID-19 caused a reduction in the number of patients undergoing NACT, with no changes in terms of indications, clinical presentation, and tumor response. Furthermore, there was an increased incidence of vascular events.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Francesca Combi
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Simona Papi
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Silvia Segattini
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Stefano Rizza
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome, Rome, Italy
| | - Benedetto Ielpo
- Unidad de Chirugia Hepatobiliopancreática, Hospital Universitario del Mar, Barcelona, Spain
| | | | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Giovanni Tazzioli
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilila, Modena, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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11
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Vanni G, Pedini D, Materazzo M, Farinaccio A, Perretta T, Pistolese CA, Buonomo OC. Unusual Presentation of a Post-procedural Breast Hematoma: A Case Report. In Vivo 2021; 35:2957-2961. [PMID: 34410994 DOI: 10.21873/invivo.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Hematoma is the most frequent complication after Vacuum-Assisted Breast Biopsy (VABB) in 13% of cases. A direct communication channel with patients eases the diagnosis of VABB complications and ensures treatment at an early stage, as outpatients, in most cases. In 2020, due to the COVID-19 pandemic, we observed a reduction of self-reported postoperative complication leading to delay in the identification of harmful complications, therefore leading to need for more invasive treatment. CASE REPORT A 50-year-old patient was admitted to the Emergency Department for dry cough, fever, chest discomfort, dyspnea, and slight confusion four days after VABB. Due to the reported symptoms, the patient was sent to our COVID-19 Emergency Department. The COVID-19 swab was negative. Ultrasound revealed a large hematoma at the biopsy site, with active bleeding. Open evacuation with accurate hemostasis was planned with rapid and complete resolution of the clinical symptoms. After surgery, the patient reported that she intentionally avoided admittance in the hospital due to the risk of COVID-19 infection. The patient was discharged in the first postoperative day and maintained in quarantine for 14 days. CONCLUSION In the COVID-19 era due to the risk of hospital cross-infections, reduction of patient-doctor communication could lead to misdiagnosis, delay in recognition of procedural complications thus leading to requirement for invasive treatment, hospitalization, while also further multiplying the risk of COVID-19 infection.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Domiziana Pedini
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Andrea Farinaccio
- Cardiac and Thoracic Anesthesia Unit, Tor Vergata University Hospital, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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12
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Meucci R, Pistolese CA, Perretta T, Luciani ML, Beninati E, Di Tosto F, D'Alfonso V, Buonomo OC. Primary Extranodal Follicular T-Cell Lymphoma and Ductal Breast Carcinoma Diagnosed by a Magnetic Resonance Imaging-Guided Vacuum-Assisted Biopsy: A Case Report. Am J Case Rep 2021; 22:e929309. [PMID: 34226439 PMCID: PMC8272939 DOI: 10.12659/ajcr.929309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extranodal non-Hodgkin lymphomas (NHL) are low-grade B-cell lymphomas and the breast is not a common site for this condition. This case report describes a 62-year-old woman with a primary NHL and ductal carcinoma in situ (DCIS) of the left breast diagnosed by a magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy. The simultaneous diagnosis of breast cancer and NHL is rare, with few cases described in the literature. Primary breast lymphomas account only for 0.04% to 0.5% of breast malignancies. CASE REPORT In November 2016, a 62-year-old woman was treated for a peripheral T-cell lymphoma (follicular helper T-cell phenotype) of the left upper central breast; later she underwent periodic breast imaging follow-ups. In October 2018, MRI revealed a focal 33-mm non-mass contrast enhancement (according to the Breast Imaging Reporting and Data System -MRI lexicon of the American College of Radiology) in the lower external quadrant of the left breast. Neither mammography nor ultrasonography demonstrated any suspicious features. The multidisciplinary medical team performed an MRI-guided vacuum-assisted breast biopsy and the histological analysis confirmed the diagnosis of a DCIS. Subsequently, she underwent surgery resulting in eradication of the disease and has had regular follow-ups, including mammography, ultrasonography, and MRI. CONCLUSIONS This is a rare case of both a primary NHL of the breast and DCIS, which was detected only by MRI. It highlights the role of an MRI-guided vacuum-assisted breast biopsy, which allows an accurate and economic diagnosis in case of suspicious findings on MRI. We recommend the use of MRI in follow-ups for patients with previous breast lymphomas (high-risk patients).
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Affiliation(s)
- Rosaria Meucci
- UOC of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy.,UOSD Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | | | - Tommaso Perretta
- UOC of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | | | - Emanuela Beninati
- UOC of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Federica Di Tosto
- UOC of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | | | - Oreste Claudio Buonomo
- UOSD Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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13
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Vanni G, Santori F, Pellicciaro M, Materazzo M, Caspi J, Granai AV, DE Majo A, Servadei F, Giacobbi E, Perretta T, Meucci R, Pistolese CA, Buonomo OC. Extremely Advanced Breast Cancer Presentation: Possible Effect of Coronavirus Pandemic Anxiety. In Vivo 2021; 35:2331-2335. [PMID: 34182514 DOI: 10.21873/invivo.12508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM Corona virus infection dramatically spread worldwide during 2020 and extraordinary restrictions have been implemented in order to reduce viral transmission. These measures compelled a complete restructuring of the health system, including temporary cancer screening suspension and a significant slow-down in cancer diagnoses and treatments. CASE REPORT We report five cases of extremely advanced breast cancer referred to our Department amid the COVID-19 pandemic. These patients exhibited a poor prognosis or worse quality of life due to their oncological disease. CONCLUSION In our opinion, both the slow-down of diagnosis and treatment of oncological disease and anxiety over COVID-19 influenced this presentation. Moreover, other patients were unable to receive palliative care. Hopefully, these cases will not develop into extremely advanced-stage disease, and we will be able to provide at least the necessary palliative care.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Tor Vergata School of Medicine and Surgery, Policlinico Tor Vergata University, Rome, Italy
| | | | - Adriano DE Majo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine,Policlinico Tor Vergata University, Rome, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine,Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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14
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Pistolese CA, Perretta T, Claroni G, Anemona L, Servadei F, Collura A, Censi M, Materazzo M, Pellicciaro M, Lamacchia F, Vanni G. A Prospective Evaluation of Tru-Cut Biopsy and Fine-needle Aspiration Cytology in Male Breast Cancer Detection. In Vivo 2021; 34:3431-3439. [PMID: 33144451 DOI: 10.21873/invivo.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Male breast-cancer (MBC) is often diagnosed late. Our purpose was to evaluate fine-needle aspiration cytology (FNAC) versus Tru-Cut biopsy (TCNB) in MBC diagnosis. PATIENTS AND METHODS Men with suspicious breast lesions were prospectively enrolled; 54 met the inclusion criteria and underwent FNAC and TCNB. FNAC, TCNB and gold-standard results were compared. RESULTS Unsatisfactory results were 11.1% after FNAC and none after TCNB (p=0.027). After gold-standard evaluation, the diagnosis of FNAC and TCNB was confirmed, respectively, in 63.0% and 98.1% and changed in 37.0% and 1.9% (p<0.001). The malignancy rate after FNAC, TCNB and surgery were, respectively, 25.9%, 33.3% and 35.1% (FNAC vs. TCNB p=0.5276, FNAC vs. surgery p=0.404; TCNB vs. surgery p=1). Among invasive carcinomas, 93.8% were identified by FNAC vs. 87.5% by TCNB (p=1); all ductal carcinoma in situ (DCIS) were detected after TCNB and none after FNAC (p=0.1). CONCLUSION FNAC leads to a significantly higher number of inadequate samplings and seems to be subject to increased DCIS misdiagnoses. TCNB correlated better to the final histological report.
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Affiliation(s)
- Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Tommaso Perretta
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Giulia Claroni
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Alberto Collura
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Michela Censi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Materazzo
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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Di Giuliano F, Minosse S, Picchi E, Ferrazzoli V, Da Ros V, Muto M, Pistolese CA, Garaci F, Floris R. Qualitative and quantitative analysis of 3D T1 Silent imaging. Radiol Med 2021; 126:1207-1215. [PMID: 34131844 DOI: 10.1007/s11547-021-01380-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/20/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare brain magnetic resonance imaging (MRI) using T1 3D Silent and fast T1 3D Gradient-Echo (GRE) BRAin VOlume (known as BRAVO) sequences. The primary aim is to assess the quantitative and qualitative analysis of Silent and BRAVO images by the measurement of the contrast (C), the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR). The second aim is to estimate the subjective sound levels and the specific absorption rate (SAR). METHODS Twenty-two subjects had T1 3D Silent and T1 3D BRAVO sequences added to the standard MR examination. The qualitative analysis of the two sequences was performed by two radiologists independently. The quantitative analysis was performed by placing regions of interest on the cerebrospinal fluid, on the white and grey matter. The C, the CNR and the SNR were calculated for each sequence. After each T1-3D sequence, subjects gave a score rating to evaluate the acoustic noise. Finally, the SAR was evaluated by the digital imaging and communications in medicine (DICOM) tags. RESULTS The image quality scores obtained by the two radiologists were higher for BRAVO compared to the Silent. However, qualitatively, the Silent images were similar to BRAVO for diagnostic use. Quantitatively, CNR for GM-CSF was comparable in the two sequences and SNR in CSF was higher in Silent than BRAVO. The acoustic noise of Silent sequence was statistically lower compared with BRAVO. The maximum SAR measured was 1.4 W/kg. CONCLUSIONS 3D T1 Silent can be a valid alternative technique to conventional BRAVO to reduce the acoustic noise preserving the diagnostic accuracy. However, radiologists preferred the conventional sequence to Silent.
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Affiliation(s)
- Francesca Di Giuliano
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy
| | - Silvia Minosse
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy.
| | - Eliseo Picchi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Valentina Ferrazzoli
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy
| | - Massimo Muto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100, Naples, Italy
| | - Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy
- San Raffaele Cassino, Cassino, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Viale Oxford 81, 00133, Rome, Italy
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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16
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Vanni G, Pellicciaro M, Materazzo M, Pedini D, Portarena I, Buonomo C, Perretta T, Rizza S, Pistolese CA, Buonomo OC. Advanced Stages and Increased Need for Adjuvant Treatments in Breast Cancer Patients: The Effect of the One-year COVID-19 Pandemic. Anticancer Res 2021; 41:2689-2696. [PMID: 33952500 DOI: 10.21873/anticanres.15050] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The COVID-19 lockdown includes restrictive measures and temporary health system reorganization. Resources were shifted to COVID-19 patients, screening programs were temporary suspended, and oncological care suffered slow-down. The aim of the study was to evaluate the impact of these measures on breast cancer patients. PATIENTS AND METHODS All breast cancer patients referred to our unit from February 21, 2019 to February 21, 2021 were enrolled. Type of treatments and surgery, TNM, tumor diameter, and predictive and prognostic factors were analyzed. RESULTS Out of 445 patients with a breast cancer diagnosis, 182 (40.9%) were enrolled in the COVID-19 group (from February 21, 2010 to February 21, 2021). These patients were compared with 263 (59.1%) patients pre-COVID-19. Tumor diameters were bigger in the COVID-19 group. Type of surgery and N staging were statistically significantly different. Extreme advanced disease incidence was significantly different between the groups (2.7% COVID-19 group vs. 0 pre-COVID-19 group, p=0.011). Incidence of post-surgical radiation-therapy was higher in the COVID-19 group. Other variables analyzed were comparable without a statistically significant difference. CONCLUSION COVID-19 led to increased tumor dimensions, advanced N-staging, and increased need for adjuvant treatments in breast cancer.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy;
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Domiziana Pedini
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Stefano Rizza
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Minosse S, Picchi E, Di Giuliano F, Sarmati L, Teti E, Pistolese CA, Lanzafame S, Di Ciò F, Guerrisi M, Andreoni M, Floris R, Toschi N, Garaci F. Functional brain network reorganization in HIV infection. J Neuroimaging 2021; 31:796-808. [PMID: 33900655 DOI: 10.1111/jon.12861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE To investigate the reorganization of the central nervous system provided by resting state-functional MRI (rs-fMRI), graph-theoretical analysis, and a newly developed functional brain network disruption index in patients with human immunodeficiency virus (HIV) infection. METHODS Forty HIV-positive patients without neurological impairment and 20 age- and sex-matched healthy controls underwent rs-fMRI at 3T; blood sampling was obtained the same day to evaluate biochemical variables (absolute, relative, and nadir CD4 T-lymphocytes value and plasmatic HIV-RNA). From fMRI data, disruption indices, as well as global and local graph theoretical measures, were estimated and examined for group differences (HIV vs. controls) as well as for associations with biochemical variables (HIV only). Finally, all data (global and local graph-theoretical measures, disruption indices, and biochemical variables) were tested for putative differences across three patient groups based on the duration of combined antiretroviral therapy (cART). RESULTS Brain function of HIV patients appeared to be deeply reorganized as compared to normal controls. The disruption index showed significant negative association with relative CD4 values, and a positive significant association between plasmatic HIV-RNA and local graph-theoretical metrics in the left lingual gyrus and the right lobule IV and V of right cerebellar hemisphere was also observed. Finally, a differential distribution of HIV clinical biomarkers and several brain metrics was observed across cART duration groups. CONCLUSION Our study demonstrates that rs-fMRI combined with advanced graph theoretical analysis and disruption indices is able to detect early and subtle functional changes of brain networks in HIV patients.
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Affiliation(s)
- Silvia Minosse
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Eliseo Picchi
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Francesca Di Giuliano
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Elisabetta Teti
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Simona Lanzafame
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Di Ciò
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Guerrisi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts, USA
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,San Raffaele Cassino, Frosinone, Italy
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18
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Materazzo M, Vanni G, Pellicciaro M, Anemona L, Servadei F, Giacobbi E, Farinaccio A, Pistolese CA, Perretta T, Chiocchi M, Bruno V, Tacconi F, Sadri A, De Majo A, Di Pasquali C, Meucci R, Santori F, Cotesta M, Buonomo OC. Case Report: Early Breast Cancer Recurrence Mimicking BIA-ALCL in a Patient With Multiple Breast Procedures. Front Surg 2021; 8:606864. [PMID: 33768110 PMCID: PMC7985528 DOI: 10.3389/fsurg.2021.606864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/18/2021] [Indexed: 12/02/2022] Open
Abstract
Breast reconstruction plays a fundamental role in the therapeutic process of breast cancer treatment and breast implants represents the leading breast reconstruction strategy. Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), locoregional recurrence in the skin flap, and skin flap necrosis are well-known complications following mastectomy and immediate breast reconstruction (IBR). We report a case of locoregional cancer recurrence in the mastectomy flap mimicking BIA-ALCL, in a patient who underwent 6 breast procedures in four facilities across 15 years including immediate breast reconstruction with macrotextured breast implants. Despite the rate and onset of the disease, clinicians should be aware of BIA-ALCL. Due to the risk of false negative results of fine needle aspiration, clinical suspicion of BIA-ALCL should drive clinicians' choices, aside from cytological results. In the present case, surgical capsulectomy of the abnormal periprosthesic tissue revealed locoregional recurrence.
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Affiliation(s)
- Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Erika Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Andrea Farinaccio
- Department of Cardiothoracic Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology and Obstetrics, Academic Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Federico Tacconi
- Division of Thoracic Surgery, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Amir Sadri
- Plastic Surgery, Great Hormond Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Adriano De Majo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Camilla Di Pasquali
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Cotesta
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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19
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Perretta T, Meucci R, Pistolese CA, Manenti G, Stefano CD, Vanni G, Anemona L, Ferrari D, Lamacchia F, De Stasio V, Buonomo OC. Ultrasound-Guided Laser Ablation After Excisional Vacuum-Assisted Breast Biopsy for Small Malignant Breast Lesions: Preliminary Results. Technol Cancer Res Treat 2021; 20:1533033820980089. [PMID: 33618620 PMCID: PMC7905484 DOI: 10.1177/1533033820980089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The purpose of this preliminary study is to evaluate the
feasibility of the excisional ultrasound (US) guided
vacuum-assisted breast biopsy (VAE), followed by US-guided Laser
Interstitial Thermal Therapy (LITT) in the treatment of unifocal
ductal breast carcinomas ≤ 1 cm and estimate the ablation rate
analyzing the final histopathological results after subsequent
surgical excision. Methods: In a single session 11 female patients with unifocal less than a
centimeter breast cancer underwent 2 different minimally
invasive percutaneous US-guided techniques: a VAE breast biopsy
with an 8 G needle to remove the lesion and, immediately after,
a LITT ablation in the biopsy site. Four weeks later, all
patients underwent radiological follow-up. Afterward, a
systematic surgery was performed, the ablation rate was
calculated, and iconographic and histological features were
correlated. Results: Average maximum diameter of the lesions was 7.6 mm (5-10 mm). No
patient reported pain or discomfort during procedure. 1/11
patient (9.1%) reported an early minor complication (a small
superficial skin burn). After surgical excision, the
histopathological evaluation reported in 10/11 cases (90.9%)
complete ablation of the target lesion. In only one case (9.1%)
residual cancer was detected. The necrotic-hemorrhagic cavities
showed a mean maximum diameter of 27.3 mm (20-35 mm). Conclusions: Laser ablation performed after excisional biopsy could be
considered a valid alternative to surgical excision for the
treatment of lesions ≤ 1 cm, if carried out by expert
radiologists. The association of these minimally invasive
percutaneous methods has proven to be reliable, fast, and safe
with an ablation rate of 90.9% and excellent aesthetic results.
RM and CESM are potentially able to quantifying treatment
results and to follow-up the ablation effects.
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Affiliation(s)
- Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy.,Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Guglielmo Manenti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Donatella Ferrari
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Vincenzo De Stasio
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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20
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Vanni G, Materazzo M, Pellicciaro M, Morando L, Portarena I, Anemona L, D'Angelillo MR, Barbarino R, Chiaravalloti A, Meucci R, Perretta T, Deiana C, Orsaria P, Caspi J, Pistolese CA, Buonomo OC. Does Age Matter? Estimating Risks of Locoregional Recurrence After Breast-conservative Surgery. In Vivo 2021; 34:1125-1132. [PMID: 32354901 DOI: 10.21873/invivo.11884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM In 2016, in the United States, more than 50% of breast cancer (BC) cases were diagnosed in patients older than 60 years of age. Our study aimed to estimate the risk of locoregional recurrence (LR) in patients who underwent breast-conservative treatment (BCT), according to age. PATIENTS AND METHODS This retrospective monocentric study analyzed 613 cases of patients who underwent BCT between 2003 and 2014. Patients were divided into groups according to age: Under70 (under 70 years old) and Over70 (above 70 years old). Margins width, histology results, prognostic and predictive factors were compared. Subgroup analysis was performed for patients who experienced LR. RESULTS LR Incidence among Under70 and Over70 was 5.4% and 1.7%, respectively (p<0.01). Group Over70 is characterized by larger tumors and a lower Ki67 index (p<0.01). CONCLUSION Operation time reduction, better aesthetic results and reduced LR risk support BCT. The Over70 group exhibited better outcomes in terms of LR despite larger tumor dimensions.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ljuba Morando
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Rolando D'Angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Barbarino
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Rosaria Meucci
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.,Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Camilla Deiana
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Jonathan Caspi
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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21
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Cotesta M, Buonomo OC, De Majo A, Vanni G, Materazzo M, Santori F, Granai AV, Pistolese CA, Servadei F, Finocchiaro S, Giacobbi E, Anemona L, Pellicciaro M. Breast Trauma and Triple-Negative Hemorrhagic Cystic Carcinoma: Management and Treatment. Am J Case Rep 2020; 21:e925014. [PMID: 33311426 PMCID: PMC7744597 DOI: 10.12659/ajcr.925014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patient: Female, 59-year-old Final Diagnosis: Invasive breast carcinomas of no special type (NST) Symptoms: Recurrent hemorrhagic cystic lesion Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Maria Cotesta
- Breast Unit, Department of Surgical Science, Tor Vergata Hospital Polyclinic, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Tor Vergata Hospital Polyclinic, Rome, Italy
| | - Adriano De Majo
- Breast Unit, Department of Surgical Science, Tor Vergata Hospital Polyclinic, Rome, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, Tor Vergata Hospital Polyclinic, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Tor Vergata Hospital Polyclinic, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Tor Vergata Hospital Polyclinic, Rome, Italy
| | | | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata Hospital Polyclinic, Rome, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Susanna Finocchiaro
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Roma, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Lucia Anemona
- Department of Experimental Medicine and Surgery, Tor Vergata Hospital Polyclinic, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Tor Vergata Hospital Polyclinic, Rome, Italy
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22
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Vanni G, Tazzioli G, Pellicciaro M, Materazzo M, Paolo O, Cattadori F, Combi F, Papi S, Pistolese CA, Cotesta M, Santori F, Caspi J, Chiaravalloti A, Muscoli S, Lombardo V, Grasso A, Caggiati L, Raselli R, Palli D, Altomare V, D'Angelillo RM, Palombi L, Buonomo OC. Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients. Anticancer Res 2020; 40:7119-7125. [PMID: 33288611 DOI: 10.21873/anticanres.14741] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Extraordinary restrictions aimed to limit Sars-CoV-2 spreading; they imposed a total reorganization of the health-system. Oncological treatments experienced a significant slowdown. The aim of our multicentric retrospective study was to evaluate screening suspension and surgical treatment delay during COVID-19 and the impact on breast cancer presentation. PATIENTS AND METHODS All patients who underwent breast surgery from March 11, 2020 to May 30, 2020 were evaluated and considered as the Lockdown group. These patients were compared with similar patients of the previous year, the Pre-Lockdown group. RESULTS A total of 432 patients were evaluated; n=223 and n=209 in the Lockdown and Pre-lockdown-groups, respectively. At univariate analysis, waiting times, lymph-nodes involvement and cancer grading, showed a statistically significant difference (p<0.05). Multivariate analysis identified waiting-time on list (OR=1.07) as a statistically significant predictive factor of lymph node involvement. CONCLUSION Although we did not observe a clinically evident difference in breast cancer presentation, we reported an increase in lymph node involvement.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Rome, Italy
| | - Giovanni Tazzioli
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Rome, Italy;
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Rome, Italy
| | - Orsaria Paolo
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Francesca Cattadori
- Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Francesca Combi
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilia, Modena, Italy.,Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy.,Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy.,PhD Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona Papi
- Division of Breast Surgical Oncology Department of Medical and Surgery, Maternal-infantile and Adult Sciences, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Cotesta
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Tor Vergata School of Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Saverio Muscoli
- Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Vittorio Lombardo
- Department of General Surgery, I.R.C.C.S. Centro Neurolesi Bonino Pulejo P.O. Piemnote, Messina, Italy
| | - Antonella Grasso
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Lorenza Caggiati
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Roberta Raselli
- Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Dante Palli
- Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Rolando Maria D'Angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Rome, Italy
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23
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Pellicciaro M, Granai AV, Marchese G, Materazzo M, Cotesta M, Santori F, Giacobbi E, Servadei F, Grelli S, Perretta T, Meucci R, Pistolese CA, Vanni G. Breast cancer patients with hormone neoadjuvant bridging therapy due to asymptomatic Corona virus infection. Case report, clinical and histopathologic findings. Int J Surg Case Rep 2020; 76:377-380. [PMID: 33052300 PMCID: PMC7543888 DOI: 10.1016/j.ijscr.2020.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
Oncological treatments experienced a significant slowdown due to COVID-19 pandemic. Breast cancer management has changed according to scientific recommendations. Breast cancer patients with simultaneous COVID-19 could receive delayed treatments. Treatments delay could impact breast cancer staging.
Introduction Breast cancer management during COVID-19 pandemic has changed and in case of COVID-19 patients with simultaneous neoplasia, it has been strongly recommended to treat Sars-CoV-2 infection firstly. Presentation of case We reported a case of a 53-years-old women with early breast cancer and simultaneous asymptomatic SARS-CoV-2 infection. According to COVID-19 breast cancer recommendations she underwent hormone neoadjuvant treatment as a bridging therapy for surgery. Six months from the diagnosis, after virus eradication, patient underwent breast surgery. No SARS-CoV-2 RNA was found both in the surgical specimen and sentinel lymph node but micrometastasis were reported. During the last follow-up, the patient was in good clinical condition and started the adjuvant chemotherapy. Discussion COVID-19 outbreak determined the publication of temporary recommendation leading to an extensive use of neoadjuvant chemotherapy in breast cancer patients. Although endocrine therapy is a mainstay in the adjuvant treatment, its role in the neoadjuvant schedule is unclear. Conclusion Upfront awake surgery should be preferred especially in asymptomatic COVID-19 patient with early breast cancer when monitoring of tumor response is not feasible.
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Affiliation(s)
- Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Alessandra Vittoria Granai
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | | | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.
| | - Maria Cotesta
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Sandro Grelli
- Department of Experimental Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
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24
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Vanni G, Pellicciaro M, Materazzo M, Bruno V, Oldani C, Pistolese CA, Buonomo C, Caspi J, Gualtieri P, Chiaravalloti A, Palombi L, Piccione E, Buonomo OC. Lockdown of Breast Cancer Screening for COVID-19: Possible Scenario. In Vivo 2020; 34:3047-3053. [PMID: 32871851 DOI: 10.21873/invivo.12139] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Coronavirus disease is spreading worldwide. Due to fast transmission and high fatality rate drastic emergency restrictions were issued. During the lockdown, only urgent medical services are guaranteed. All non-urgent services, as breast cancer (BC) screening, are temporarily suspended. The potential of breast cancer screening programs in increasing the survival rate and decreasing the mortality rate has been widely confirmed. Suspension could lead to worse outcomes for breast cancer patients. Our study aimed to analyse the data and provide estimates regarding the temporary BC screening suspension. PATIENTS AND METHODS Data regarding breast cancer and respective screening programs were achieved through literature research and analysis. RESULTS Considering three different scenarios with respect to the lockdown's impact on breast cancer screening, we estimate that approximately 10,000 patients could have a missed diagnosis during these 3 months. Considering a 6-month period, as suggested by the Imperial college model, the number of patients who will not receive a diagnosis will rise to 16,000. CONCLUSION Breast cancer screening should be resumed as soon as possible in order to avoid further breast cancer missed diagnosis and reduce the impact of delayed diagnosis.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Oldani
- Department of Economics and Engineering, University of Viterbo 'La Tuscia', Viterbo, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Paola Gualtieri
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy
| | - Emilio Piccione
- Section of Gynecology, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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25
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Minosse S, Picchi E, Giuliano FD, Lanzafame S, Manenti G, Pistolese CA, Sarmati L, Teti E, Andreoni M, Floris R, Guerrisi M, Garaci F, Toschi N. Disruption of brain network organization in patients with human immunodeficiency virus (HIV) infection. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:1726-1729. [PMID: 33018330 DOI: 10.1109/embc44109.2020.9176449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In 2019, approximately 38 million people were living with human immunodeficiency virus (HIV). Combined antiretroviral therapy (cART) has determined a change in the course of HIV infection, transforming it into a chronic condition which results in cumulative exposure to antiretroviral drugs, inflammatory effects and aging. Relatedly, at least one quarter of HIV-infected patients suffer from cognitive, motor and behavioral disorder, globally known as HIV-associated neurocognitive disorders (HAND). In this context, objective, neuroimaging-based biomarkers are therefore highly desirable in order to detect, quantify and monitor HAND in all disease stages. In this study, we employed functional MRI in conjunction with graph-theoretical analysis as well as a newly developed functional brain network disruption index to assess a putative functional reorganization in HIV positive patients. We found that brain function of HIV patients is deeply reorganized as compared to normal controls. Interestingly, the regions in which we found reorganized hubs are integrated into neuronal networks involved in working memory, motor and executive functions often altered in patients with HAND. Overall, our study demonstrates that rs-fMRI combined with advanced graph theoretical analysis and disruption indices is able to detect early, subtle functional changes of brain networks in HIV patients before structural changes become evident.
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26
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Vanni G, Materazzo M, Santori F, Pellicciaro M, Costesta M, Orsaria P, Cattadori F, Pistolese CA, Perretta T, Chiocchi M, Meucci R, Lamacchia F, Assogna M, Caspi J, Granai AV, DE Majo A, Chiaravalloti A, D'Angelillo MR, Barbarino R, Ingallinella S, Morando L, Dalli S, Portarena I, Altomare V, Tazzioli G, Buonomo OC. The Effect of Coronavirus (COVID-19) on Breast Cancer Teamwork: A Multicentric Survey. In Vivo 2020; 34:1685-1694. [PMID: 32503830 DOI: 10.21873/invivo.11962] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). PATIENTS AND METHODS In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. RESULTS A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. CONCLUSION Working in a COVID-19-hospital represents a factor that negatively affects psychosocial well-being. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Costesta
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Paolo Orsaria
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Francesca Cattadori
- UO Breast Surgery, Breast Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Marcello Chiocchi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Meucci
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy.,Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Massimo Assogna
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | | | - Adriano DE Majo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Maria Rolando D'Angelillo
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Rosaria Barbarino
- Radiotherapy Unit, Department of Oncology and Hematology, Policlinico Tor Vergata University, Rome, Italy
| | - Sara Ingallinella
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ljuba Morando
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Stefania Dalli
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, University Campus Bio-Medico, Rome, Italy
| | - Giovanni Tazzioli
- Oncologic Breast Surgery Unit, Azienda Ospedaliero-Universitaria Policlinico Hospital of Modena, Modena, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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27
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Vanni G, Materazzo M, Pellicciaro M, Ingallinella S, Rho M, Santori F, Cotesta M, Caspi J, Makarova A, Pistolese CA, Buonomo OC. Breast Cancer and COVID-19: The Effect of Fear on Patients' Decision-making Process. In Vivo 2020; 34:1651-1659. [PMID: 32503825 DOI: 10.21873/invivo.11957] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19. PATIENTS AND METHODS Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason. RESULTS BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients. CONCLUSION COVID-19-related anxiety could affect patients' decision-making process.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Sara Ingallinella
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maurizio Rho
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Francesca Santori
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Maria Cotesta
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Anna Makarova
- School of Economics, Università degli Studi di Roma, Tor Vergata, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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28
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Perretta T, Lamacchia F, Ferrari D, Beninati E, DI Tosto F, DE Stasio V, Meucci R, DI Stefano C, Buonomo OC, Vanni G, Pistolese CA. Evaluation of Ultrasound-guided 8-Gauge Vacuum-assisted Excision System for the Removal of US-detectable Breast Lesions. Anticancer Res 2020; 40:1719-1729. [PMID: 32132080 DOI: 10.21873/anticanres.14125] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 11/10/2022]
Abstract
AIM To assess the ability of ultrasound (US)-guided vacuum-assisted breast excision (VAE) to remove Breast Imaging Reporting and Data System (BI-RADS) ≥3 breast lesions in order to analyze US features most frequently associated with complete excision. MATERIALS AND METHODS A total of 266 BI-RADS ≥3 lesions without microcalcifications underwent US-VAE. US-VAE and gold standard pathological results were compared. US features of lesions were analyzed. RESULTS The complete excision rate was 93.61%; the VAE agreement rate was 99.62%. Circumscribed margins, regular shape, parallel orientation, and the absence of posterior features were favorable US features associated with complete excision. Lesions completely excised were: BI-RADS 3 ≤21.10 mm and BI-RADS 4 ≤18.70 mm with one unfavorable US characteristic, and BI-RADS 4 lesions ≤13.5 mm with two unfavorable US features hindered complete removal. Two atypical ductal hyperplasias (<10 mm, one unfavorable feature) and eight ductal carcinomas in situ (≤8.7 mm, one/two unfavorable features) were completely removed. CONCLUSION US-VAE is highly accurate for diagnostic purpose and, in some cases, highly successful for complete lesion excision. This success also depends on the US characteristics and size of the lesion.
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Affiliation(s)
- Tommaso Perretta
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Feliciana Lamacchia
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Donatella Ferrari
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Emanuela Beninati
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Federica DI Tosto
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Vincenzo DE Stasio
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Rosaria Meucci
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.,Applied Medical-Surgical Sciences, Tor Vergata University of Rome, Rome, Italy
| | - Carla DI Stefano
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Chiara Adriana Pistolese
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
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29
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Pistolese CA, Lamacchia F, Tosti D, Anemona L, Ricci F, Censi M, Materazzo M, Vanni G, Collura A, DI Giuliano F, Perretta T, Buonomo OC. Reducing the Number of Unnecessary Percutaneous Biopsies: The Role of Second Opinion by Expert Breast Center Radiologists. Anticancer Res 2020; 40:939-950. [PMID: 32014938 DOI: 10.21873/anticanres.14027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The research objectives of this study were the estimation of the number of misdiagnosed breast lesions by non-expert-center-breast-radiologists (NEBR) and the investigation of the discordant rate (DR) calculated between initial and second opinion. Moreover, this study evaluated the impact of second opinion and the factors associated with DR. MATERIALS AND METHODS A total of 399 patients were sent to our Tertiary Breast Cancer (BC) Center to perform fine needle aspiration/core needle biopsy (FNAC/CNB) after external examination. Lesions were reclassified according to Breast Imaging-Reporting and Data System (BI-RADS). External examinations were classified as breast-expert, not-breast-expert and physicians as expert-center-breast-radiologists (EBR), NEBR, and non-radiologists (NR). Personal/family history of breast cancer (BC), breast-density and presence of prior imaging were collected. RESULTS DR was 74.3%. After second opinion, FNAC/CNB was proposed in 25.7% of cases and 2 additional cancers were detected. About 59.5% of unnecessary FNAC/CNB were avoided. Dense breast, no prior imaging examination and BC family-history were associated with higher DR (p-value<0.001); personal BC-history was associated in NEBR evaluations (p-value=0.0383). CONCLUSION Second opinion review of outside examinations at expert BC Center may decrease unneeded biopsy, reducing health-care costs.
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Affiliation(s)
- Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Daniela Tosti
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca Ricci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Michela Censi
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Materazzo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Alberto Collura
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Francesca DI Giuliano
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit - Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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30
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Buonomo OC, Grasso A, Pistolese CA, Anemona L, Portarena I, Meucci R, Morando L, Deiana C, Materazzo M, Vanni G. Evaluation of Concordance Between Histopathological, Radiological and Biomolecular Variables in Breast Cancer Neoadjuvant Treatment. Anticancer Res 2020; 40:281-286. [PMID: 31892577 DOI: 10.21873/anticanres.13950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Neoadjuvant chemotherapy (NAC) for breast cancer (BC) is the gold standard treatment for locally advanced tumors (LABC) that aims at achieving a complete pathological response (pCR). Studies have been conducted to evaluate and identify te concordance between radiological, histopathological and biological variables of BC and final response to therapy, verified by definitive histological examination after surgery. PATIENTS AND METHODS Ninety-five BC patients were examined and subjected to NAC. Immunohistochemical markers including oestrogen-receptor (ER), progesterone-receptor (PR), Ki67 index, and human epidermal growth factor receptor 2 (HER2) score were examined before and after neoadjuvant treatment. RESULTS Younger age and a significant decrease in ER expression were associated with better prognosis. Triple Negative (TN) and Her2-type breast cancers benefited most from neoadjuvant chemotherapy with higher frequency of pCR. CONCLUSION HER2-type and TN BC are correlated with best response to NAC. A statistically significant correlation between radiological images and definitive histological examination was not observed.
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Affiliation(s)
- Oreste Claudio Buonomo
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Andrea Grasso
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Lucia Anemona
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Ilaria Portarena
- Department of Oncology, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Ljuba Morando
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Camilla Deiana
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Marco Materazzo
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
| | - Gianluca Vanni
- Breast Unit-Department of Surgical Science, Policlinico Tor Vergata (PTV) University, Rome, Italy
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31
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Di Giuliano F, Minosse S, Picchi E, Marfia GA, Da Ros V, Muto M, Muto M, Pistolese CA, Laghi A, Garaci F, Floris R. Comparison between synthetic and conventional magnetic resonance imaging in patients with multiple sclerosis and controls. MAGMA 2019; 33:549-557. [PMID: 31782035 DOI: 10.1007/s10334-019-00804-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 10/30/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Synthetic magnetic resonance imaging (SyMRI) allows to obtain different weighted-images using the multiple-dynamic multiple-echo sequence lasting 6 min. The aim is to compare quantitatively and qualitatively synthetic- and conventional MRI in patients with multiple sclerosis (MS) and controls assessing the contrast (C), the signal to noise ratio (SNR), and the contrast to noise ratio (CNR). We evaluated the lesion count and lesion-to-white matter contrast ([Formula: see text] in the MS patients. METHODS AND METHODS 51 patients underwent synthetic- and conventional MRI. Qualitative analysis was evaluated by assigning scores to all synthetic- and conventional MRI sequences by two neuroradiologists. Lesions were counted in MS patients both in the conventional- and synthetic T2-FLAIR. Regions of interest were placed in the cerebrospinal fluid, in the white- and grey matter. For the sequences were evaluated: C, CNR, and SNR. RESULTS Synthetic T2-FLAIR images are qualitatively inferior. C and CNR were significantly higher in synthetic T1W and T2W images compared to conventional images, but not for T2-FLAIR. The SNR value was always lower in synthetic images than in conventional ones. CONCLUSIONS SyMRI can be used in clinical practice because it has a similar diagnostic accuracy which reduces the scanning time compared to the conventional one. However, synthetic T2-FLAIR images need to be improved.
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Affiliation(s)
- Francesca Di Giuliano
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.,U.O.C Diagnostic Imaging and Neuroradiology, Department of Integrated Care Processes, Fondazione PTV Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Silvia Minosse
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - Eliseo Picchi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.,U.O.C Diagnostic Imaging and Neuroradiology, Department of Integrated Care Processes, Fondazione PTV Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Girolama Alessandra Marfia
- Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.,Neurology Unit, Department of Neurosciences, Fondazione PTV Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Valerio Da Ros
- Department of Diagnostic Imaging and Interventional Radiology, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Massimo Muto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80100, Naples, Italy
| | - Mario Muto
- Department of Neuroradiology, A.O.R.N. Cardarelli, 80100, Naples, Italy
| | - Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.,U.O.C Diagnostic Imaging and Neuroradiology, Department of Integrated Care Processes, Fondazione PTV Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Radiology Unit, "Sapienza" University of Rome, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Francesco Garaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.,U.O.C Diagnostic Imaging and Neuroradiology, Department of Integrated Care Processes, Fondazione PTV Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.,U.O.C Diagnostic Imaging and Neuroradiology, Department of Integrated Care Processes, Fondazione PTV Policlinico "Tor Vergata", University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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32
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Minosse S, Garaci F, Martucci A, Lanzafame S, Di Giuliano F, Picchi E, Cesareo M, Mancino R, Guerrisi M, Pistolese CA, Floris R, Nucci C, Toschi N. Primary Open Angle Glaucoma Is Associated With Functional Brain Network Reorganization. Front Neurol 2019; 10:1134. [PMID: 31708862 PMCID: PMC6823877 DOI: 10.3389/fneur.2019.01134] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/10/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Resting-state functional magnetic resonance imaging (rs-fMRI) is commonly employed to study changes in functional brain connectivity. The recent hypothesis of a brain involvement in primary open angle Glaucoma has sprung interest for neuroimaging studies in this classically ophthalmological pathology. Object: We explored a putative reorganization of functional brain networks in Glaucomatous patients, and evaluated the potential of functional network disruption indices as biomarkers of disease severity in terms of their relationship to clinical variables as well as select retinal layer thicknesses. Methods: Nineteen Glaucoma patients and 16 healthy control subjects (age: 50–76, mean 61.0 ± 8.2 years) underwent rs-fMRI examination at 3T. After preprocessing, rs-fMRI time series were parcellated into 116 regions using the Automated Anatomical Labeling atlas and adjacency matrices were computed based on partial correlations. Graph-theoretical measures of integration, segregation and centrality as well as group-wise and subject-wise disruption index estimates (which use regression of graph-theoretical metrics across subjects to quantify overall network changes) were then generated for all subjects. All subjects also underwent Optical Coherence Tomography (OCT) and visual field index (VFI) quantification. We then examined associations between brain network measures and VFI, as well as thickness of retinal nerve fiber layer (RNFL) and macular ganglion cell layer (MaculaGCL). Results: In Glaucoma, group-wise disruption indices were negative for all graph theoretical metrics. Also, we found statistically significant group-wise differences in subject-wise disruption indexes in all local metrics. Two brain regions serving as hubs in healthy controls were not present in the Glaucoma group. Instead, three hub regions were present in Glaucoma patients but not in controls. We found significant associations between all disruption indices and VFI, RNFL as well as MaculaGCL. The disruption index based on the clustering coefficient yielded the best discriminative power for differentiating Glaucoma patients from healthy controls [Area Under the ROC curve (AUC) 0.91, sensitivity, 100%; specificity, 78.95%]. Conclusions: Our findings support a possible relationship between functional brain changes and disease severity in Glaucoma, as well as alternative explanations for motor and cognitive symptoms in Glaucoma, possibly pointing toward an inclusion of this pathology in the heterogeneous group of disconnection syndromes.
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Affiliation(s)
- Silvia Minosse
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Garaci
- Neuroradiology Unit, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,San Raffaele Cassino, Cassino, Italy
| | - Alessio Martucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Simona Lanzafame
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Francesca Di Giuliano
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eliseo Picchi
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Cesareo
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Raffaele Mancino
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Guerrisi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Chiara Adriana Pistolese
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Nucci
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, United States
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Garaci F, Picchi E, Di Giuliano F, Lanzafame S, Minosse S, Manenti G, Pistolese CA, Sarmati L, Teti E, Andreoni M, Floris R, Toschi N. Cerebral Multishell Diffusion Imaging Parameters are Associated with Blood Biomarkers of Disease Severity in HIV Infection. J Neuroimaging 2019; 29:771-778. [PMID: 31304996 DOI: 10.1111/jon.12655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND PURPOSE HIV-positive subjects suffer from neurocognitive deficits and disorder. We employ multishell diffusion imaging to investigate possible white matter microstructural correlates of infection severity, quantified through plasmatic percentage value of CD4 T-lymphocytes, Nadir-CD4 count, and plasma concentration of human immunodeficiency virus (HIV)-ribonucleic acid (RNA). METHODS A total of 41 HIV patients underwent magnetic resonance imaging (MRI) and blood sampling to evaluate biochemical markers. Diffusion-weighted imaging was performed at 3 Tesla (b-values: 1000 s/mm² and 2500 s/mm², 64 gradient directions/b-value, 8 b0 images). The Diffusion Tensor Imaging and Diffusional Kurtosis Imaging models were fitted separately after which mean, radial, and axial diffusivity (MD, RD, AD, respectively), fractional anistrotropy (FA), mean and radial kurtosis (MK and RK, respectively), and kurtosis anisotropy (KA) maps were extracted. Associations of each metric with biochemical markers were explored through tract-based spatial statistics followed by threshold-free cluster enhancement. RESULTS We found significant positive associations between Nadir-CD4 values and both KA and FA, and significant negative associations between Nadir-CD4 values and MD. Also, we found significant positive associations among %CD4 and MK, KA, and FA, and significant negative associations among %CD4 values and MD. These associations were bilateral and involved predominantly the long association fibers. Anatomically, these associations were more widespread when using KA as compared to FA. No statistically significant associations with HIV-RNA concentrations were found. CONCLUSIONS In HIV-positive subjects, associations between biochemical and diffusion-MRI variables are found along the association fibers, which connect brain areas involved in memory formation, providing a possible interpretation for the neurobiological substrate underlying cognitive disturbances in HIV.
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Affiliation(s)
- Francesco Garaci
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,San Raffaele Cassino, FR, Italy
| | - Eliseo Picchi
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Di Giuliano
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Simona Lanzafame
- Medical Physics Section, Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Silvia Minosse
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guglielmo Manenti
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Adriana Pistolese
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Elisabetta Teti
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Toschi
- Medical Physics Section, Department of Biomedicine and Prevention, Faculty of Medicine, University of Rome "Tor Vergata", Rome, Italy.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Di Giuliano F, Picchi E, Scaggiante J, Ferrante P, Misciasci T, Da Ros V, Pistolese CA, Floris R, Garaci F. Posterior reversible encephalopathy syndrome and Wernicke encephalopathy in patient with acute graft-versus-host disease. Radiol Case Rep 2019; 14:971-976. [PMID: 31193981 PMCID: PMC6545363 DOI: 10.1016/j.radcr.2019.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022] Open
Abstract
Graft-versus-host disease (GVHD) is an immune triggered process leading to severe immune dysregulation and organ dysfunction until death and it is one of the worst medical complications after a transplant. Patients with GVHD may have several neurological alterations: during this acute severe phase there is coexistence of various and nonspecific neurological symptoms. We are reporting a case of a 53 year old woman with severe GVHD after bone marrow transplant with acute neurological signs and symptoms. MRI study showed findings consistent with Posterior reversible encephalopathy syndrome and Wernicke encephalopathy.
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Affiliation(s)
- Francesca Di Giuliano
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Eliseo Picchi
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Jacopo Scaggiante
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Ferrante
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Teresa Misciasci
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Valerio Da Ros
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Adriana Pistolese
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Garaci
- Neuroradiology Unit, Policlinico Tor Vergata, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Picchi E, Di Giuliano F, Marziali S, Minosse S, Ferrazzoli V, Da Ros V, Gaziev J, Pistolese CA, Floris R, Garaci F. Radiological findings of Posterior Reversible Encephalopathy Syndrome in transplanted children previous affected by hemoglobinopathy: A neuroimaging retrospective analysis. Eur J Radiol Open 2019; 6:144-151. [PMID: 31016209 PMCID: PMC6468159 DOI: 10.1016/j.ejro.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/17/2019] [Indexed: 11/15/2022] Open
Abstract
To evaluate, by Magnetic Resonance Imaging, if there is a typical pattern or severity of PRES in transplanted children for hemoglobinopathy. Secondary point was to investigate the pattern and severity of PRES in children with thalassemia-THAL and sickle-cell disease-SCD after autologous hematopoietic stem cell transplantation (aHSCT). Finally, we evaluate the presence of atypical PRES presentation and the involved area of central nervous system. Two neuroradiologists analyzed retrospectively MRI of 21 transplanted children for THAL or SCD treated with CI, with neurological symptoms and signs of PRES. The Bartynski and Boardman classification has been used for PRES pattern while McKinney scale for PRES severity. Fisher Exact Probability test or Chi-square test were used to compare the categorical data. In the 21 transplanted children the PRES severity was typically mild (85.7%) without preferring radiological pattern at MRI. The analysis didn't show significant association between PRES pattern or PRES severity and previous hemoglobinopathy (THAL or SCD). No atypical PRES presentation has been found. PRES severity in transplanted children for hemoglobinopathy is typically mild. Notwithstanding children affected by SCD have a damage on the capillary endothelium, after aHSCT our data didn't show a different PRES severity and pattern than THAL children.
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Affiliation(s)
- Eliseo Picchi
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Francesca Di Giuliano
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Simone Marziali
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Silvia Minosse
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valentina Ferrazzoli
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Valerio Da Ros
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Javid Gaziev
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia. Mediterranean Institute ofHematology, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Chiara Adriana Pistolese
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Francesco Garaci
- Diagnostic Imaging and Neuroradiology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
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Pistolese CA, Tosti D, Citraro D, Ricci F, Di Stefano C, Lamacchia F, Ferrari D, Floris R. Probably Benign Breast Nodular Lesions (BI-RADS 3): Correlation between Ultrasound Features and Histologic Findings. Ultrasound Med Biol 2019; 45:78-84. [PMID: 30340921 DOI: 10.1016/j.ultrasmedbio.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/30/2018] [Accepted: 09/05/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this retrospective study was to determine the validity of the BI-RADS system in ultrasound findings assigned to BI-RADS 3 category, using cytologic and histologic results as a benchmark. Our study population consisted of 122 ultrasound nodular lesions in 122 women who underwent fine-needle aspiration cytology and biopsy for probably benign lesions (Breast Imaging Reporting and Data System [BI-RADS] category 3). Contrary to what was previously reported in the literature (risk of malignancy of BI-RADS 3 <2%), malignancy was the outcome in seven of 122 cases (5.7%). Our study also found that the presence of a cellular component with a mobile fluid-fluid level in a cystic lesion and small (<3 mm) anechoic components in solid lesions is not always an indication of benignity. Our experience seems to indicate the need to consider the presence of non-homogeneous echoes in the corpuscular cyst and solid nodular lesions with cystic components as suspicious, especially in lesions with large dimensions. Therefore it would be necessary to conduct further studies to establish a dimensional criterion in the assessment of the malignant nature of the mentioned lesions. The management of probably benign nodular lesions should not only be guided by BI-RADS classification; it is also necessary to include clinical and anamnestic data and apply a multidisciplinary approach to select cases that require histologic verification instead of the usual follow-up.
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Affiliation(s)
| | - Daniela Tosti
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Daniele Citraro
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Francesca Ricci
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Carla Di Stefano
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy.
| | | | - Donatella Ferrari
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
| | - Roberto Floris
- Department of Diagnostic Imaging, Tor Vergata University Rome, Rome, Italy
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Picchi E, Di Giuliano F, Ferrari D, Pistolese CA, Garaci F, Floris R. Pleural thymoma: Radiological and histological findings. Eur J Radiol Open 2018; 5:147-152. [PMID: 30191163 PMCID: PMC6125801 DOI: 10.1016/j.ejro.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Eliseo Picchi
- Diagnostic Imaging and Neuroradiology, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Francesca Di Giuliano
- Diagnostic Imaging and Neuroradiology, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Donatella Ferrari
- Diagnostic Imaging and Neuroradiology, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Chiara Adriana Pistolese
- Diagnostic Imaging and Neuroradiology, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Francesco Garaci
- Diagnostic Imaging and Neuroradiology, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Floris
- Diagnostic Imaging and Neuroradiology, Policlinico Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Bonfiglio R, Scimeca M, Toschi N, Pistolese CA, Giannini E, Antonacci C, Ciuffa S, Tancredi V, Tarantino U, Albonici L, Bonanno E. Radiological, Histological and Chemical Analysis of Breast Microcalcifications: Diagnostic Value and Biological Significance. J Mammary Gland Biol Neoplasia 2018; 23:89-99. [PMID: 29744755 DOI: 10.1007/s10911-018-9396-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/03/2018] [Indexed: 12/28/2022] Open
Abstract
Classification of mammary microcalcifications is based on radiological and histological characteristics that are routinely evaluated during the diagnostic path for the identification of breast cancer, or in patients at risk of developing breast cancer. The main aim of this study was to explore the relationship between the imaging parameters most commonly used for the study of mammary microcalcifications and the corresponding histological and chemical properties. To this end, we matched the radiographic characteristics of microcalcifications to breast lesion type, histology of microcalcifications and elemental composition of microcalcifications as obtained by energy dispersive x ray (EDX)-microanalysis. In addition, we investigated the properties of breast cancer microenvironment, under the hypothesis that microcalcification formation could result from a mineralization process similar to that occurring during bone osteogenesis. In this context, breast lesions with and without microcalcifications were compared in terms of the expression of the main molecules detected during bone mineralization (BMP-2, BMP-4, PTX3, RANKL OPN and RUNX2). Our data indicate that microcalcifications classified by mammography as "casting type" are prevalently made of hydroxyapatite magnesium substituted and are associated with breast cancer types with the poorest prognosis. Moreover, breast cancer cells close to microcalcifications expressed higher levels of bone mineralization markers as compared to cells found in breast lesions without microcalcifications. Notably, breast lesions with microcalcifications were characterized by the presence of breast-osteoblast-like cells. In depth studies of microcalcifications characteristics could support a new interpretation about the genesis of ectopic calcification in mammary tissue. Candidating this phenomenon as an integral part of the tumorigenic process therefore has the potential to improve the clinical management of patients early during their diagnostic path.
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Affiliation(s)
- Rita Bonfiglio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Manuel Scimeca
- OrchideaLab S.r.l., via del Grecale 6, Morlupo, Rome, RM, Italy
- IRCCS San Raffaele Pisana, 00166, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
- Martinos Center for Biomedical Imaging, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chiara Adriana Pistolese
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - Elena Giannini
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Chiara Antonacci
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Sara Ciuffa
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Virginia Tancredi
- IRCCS San Raffaele Pisana, 00166, Rome, Italy
- Department of Systems Medicine, School of Sport and Exercise Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Umberto Tarantino
- Department of Orthopedics and Traumatology, "Tor Vergata" University of Rome, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - Loredana Albonici
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Elena Bonanno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
- IRCCS Neuromed Lab. 'Diagnostica Medica' & 'Villa dei Platani', 83100, Avellino, Italy.
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Scimeca M, Antonacci C, Toschi N, Giannini E, Bonfiglio R, Buonomo CO, Pistolese CA, Tarantino U, Bonanno E. Breast Osteoblast-like Cells: A Reliable Early Marker for Bone Metastases From Breast Cancer. Clin Breast Cancer 2017; 18:e659-e669. [PMID: 29306659 DOI: 10.1016/j.clbc.2017.11.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/29/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The development of bone metastasis from breast cancer results from a functional interaction between tumor cells and osteoclasts or osteoblasts. The main aim of this study was therefore to test the hypothesis that the appearance of breast osteoblast-like cells (BOLCs) in primary mammary lesions is a precursor (and hence an early predictor) of the formation of breast cancer metastases to bone. PATIENTS AND METHODS In this study, we collected 64 breast infiltrating carcinomas, 50 breast benignant lesions, and 10 biopsies of bone metastasis selected from patients with infiltrated carcinoma. Immunohistochemical, western blot, and ultrastructural analysis allowed us to investigate the presence of BOLCs in breast cancer lesions and metastatic sites. RESULTS We established the presence of a high amount of breast cancer cells that underwent mesenchymal transformation in infiltrating carcinomas. In addition, our results demonstrated that the microenvironment of breast cancer is very similar to the microenvironment of bone. We noted a significantly higher expression of BMP-2/4 and PTX3 in breast-infiltrating carcinomas compared with benign lesions. Moreover, we also identified numerous BOLCs positive to RANKL and Vitamin D receptor. Thanks to ultrastructural analysis, we also revealed the presence of BOLCs at the metastatic site. CONCLUSIONS The identification of breast cancer cells with high affinity for a bone environment opens new perspectives on prevention and therapy of bone metastases from breast.
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Affiliation(s)
- Manuel Scimeca
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy; OrchideaLab S.r.l., Morlupo, Rome, Italy; IRCCS San Raffaele Pisana, Rome, Italy
| | - Chiara Antonacci
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Martinos Center for Biomedical Imaging, Boston, MA; Harvard Medical School, Boston, MA
| | - Elena Giannini
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Rita Bonfiglio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Umberto Tarantino
- Department of Orthopedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Elena Bonanno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy; TMALab s.r.l., Spin-off of University of Rome Tor Vergata, Rome, Italy.
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Scimeca M, Giannini E, Antonacci C, Pistolese CA, Spagnoli LG, Bonanno E. Microcalcifications in breast cancer: an active phenomenon mediated by epithelial cells with mesenchymal characteristics. BMC Cancer 2014; 14:286. [PMID: 24758513 PMCID: PMC4021315 DOI: 10.1186/1471-2407-14-286] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 04/16/2014] [Indexed: 11/21/2022] Open
Abstract
Background Mammary microcalcifications have a crucial role in breast cancer detection, but the processes that induce their formation are unknown. Moreover, recent studies have described the occurrence of the epithelial–mesenchymal transition (EMT) in breast cancer, but its role is not defined. In this study, we hypothesized that epithelial cells acquire mesenchymal characteristics and become capable of producing breast microcalcifications. Methods Breast sample biopsies with microcalcifications underwent energy dispersive X-ray microanalysis to better define the elemental composition of the microcalcifications. Breast sample biopsies without microcalcifications were used as controls. The ultrastructural phenotype of breast cells near to calcium deposits was also investigated to verify EMT in relation to breast microcalcifications. The mesenchymal phenotype and tissue mineralization were studied by immunostaining for vimentin, BMP-2, β2-microglobulin, β-catenin and osteopontin (OPN). Results The complex formation of calcium hydroxyapatite was strictly associated with malignant lesions whereas calcium-oxalate is mainly reported in benign lesions. Notably, for the first time, we observed the presence of magnesium-substituted hydroxyapatite, which was frequently noted in breast cancer but never found in benign lesions. Morphological studies demonstrated that epithelial cells with mesenchymal characteristics were significantly increased in infiltrating carcinomas with microcalcifications and in cells with ultrastructural features typical of osteoblasts close to microcalcifications. These data were strengthened by the rate of cells expressing molecules typically involved during physiological mineralization (i.e. BMP-2, OPN) that discriminated infiltrating carcinomas with microcalcifications from those without microcalcifications. Conclusions We found significant differences in the elemental composition of calcifications between benign and malignant lesions. Observations of cell phenotype led us to hypothesize that under specific stimuli, mammary cells, which despite retaining a minimal epithelial phenotype (confirmed by cytokeratin expression), may acquire some mesenchymal characteristics transforming themselves into cells with an osteoblast-like phenotype, and are able to contribute to the production of breast microcalcifications.
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Affiliation(s)
| | | | | | | | | | - Elena Bonanno
- Anatomic Pathology Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy.
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Pistolese CA, Ciarrapico AM, della Gatta F, Simonetti G. Inappropriateness of breast imaging: cost analysis. Radiol Med 2013; 118:984-94. [DOI: 10.1007/s11547-013-0948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 09/14/2012] [Indexed: 10/26/2022]
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Pistolese CA, Ciarrapico A, Perretta T, Cossu E, della Gatta F, Giura S, Caramanica C, Simonetti G. Cost-effectiveness of two breast biopsy procedures: surgical biopsy versus vacuum-assisted biopsy. Radiol Med 2011; 117:539-57. [PMID: 22020428 DOI: 10.1007/s11547-011-0735-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 02/21/2010] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to compare the cost-effectiveness of two breast biopsy procedures: surgical biopsy and vacuum-assisted biopsy (VAB). MATERIALS AND METHODS Between November 2008 and September 2009, 200 patients with suspicious breast lesions underwent biopsy procedures at our radiology department: 100 underwent VAB and 100 underwent surgical biopsy. 66 lesions were sampled under sonographic guidance, 109 under mammographic guidance and 25 under magnetic resonance guidance. RESULTS All procedures were successfully completed. No significant differences in diagnostic efficacy were found between the biopsy procedures. Surgical biopsy has a higher unit cost compared with VAB. CONCLUSIONS Our analysis emphasises the benefits of VAB compared with surgical biopsy in terms of both cost-effectiveness, and less invasiveness from a psychological and aesthetic point of view.
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Affiliation(s)
- C A Pistolese
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Terapia Radiante, Università degli Studi di Roma Tor Vergata (PTV), Viale Oxford 81, 00133, Rome, Italy.
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Fiaschetti V, Pistolese CA, Perretta T, Cossu E, Arganini C, Salimbeni C, Scarano AL, Arduini S, Simonetti G. 3-5 BI-RADs Microcalcifications: Correlation between MRI and Histological Findings. ISRN Oncol 2011; 2011:643890. [PMID: 22084735 PMCID: PMC3200091 DOI: 10.5402/2011/643890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 05/12/2011] [Indexed: 12/03/2022]
Abstract
Purpose. To evaluate the correlation between MRI and histopathological findings in patients with mammographically detected 3–5 BI-RAD (Breast Imaging Reporting And Data Systems) microcalcifications and to allow a better surgical planning.
Materials and Method. 62 female Patients (age 50 ± 12) with screening detected 3–5 BI-RAD microcalcifications underwent dynamic 3 T contrast-enhanced breast MRI. After 30-day (range 24–36 days) period, 55 Patients underwent biopsy using stereotactic vacuum-assisted biopsy (VAB), 5 Patients underwent stereotactic mammographically guided biopsy, and 2 Patients underwent MRI-guided VAB. Results. Microhistology examination demonstrated 36 malignant lesions and 26 benign lesions. The analysis of MRI findings identified 8 cases of MRI BI-RADS 5, 23 cases of MRI BI-RADS 4, 11 cases of MRI BI-RADS 3, 4 cases type A and 7 cases type B, and 20 cases of MRI BI-RADS 1-2. MRI sensitivity, specificity, positive predictive value, and negative predictive value were 88.8%, 76.9%, 84.2%, and 83.3%, respectively.
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Affiliation(s)
- Valeria Fiaschetti
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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Pistolese CA, Perretta T, Cossu E, Della Gatta F, Giura S, Simonetti G. Value of the correct diagnostic pathway through conventional imaging (mammography and ultrasound) in evaluating breast disease. Radiol Med 2011; 116:584-94. [PMID: 21431300 DOI: 10.1007/s11547-011-0657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the role of the correct diagnostic pathway through conventional imaging in evaluating breast disease. MATERIALS AND METHODS Six hundred patients aged between 35 and 75 years were enrolled in the study. All patients underwent detailed history and clinical examination, ultrasound (US) and mammography. US scans were repeated after mammography. All suspicious lesions were studied by cytological and histological characterisation and magnetic resonance (MR) imaging. RESULTS The first US scan showed 147 solid lesions, 67 lesions characterised by posterior acoustic shadowing and 193 areas of heterogeneous echostructure. The second US scan, performed after mammography, confirmed 123/147 solid nodular lesions, 53/67 lesions characterised by posterior acoustic shadowing and 183/193 areas of heterogeneous echostructure; it also showed 13 nodular lesions not seen on the first scan and two cases of nodular lesions with irregular calcifications. CONCLUSIONS Our experience suggests that US not performed in conjunction with mammography gives rise to incorrect diagnostic interpretations (either false positive or false negative results). The detection rate of the US scan performed after mammography increases from 4.16% to 5.5%.
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Affiliation(s)
- C A Pistolese
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Terapia Radiante, Università degli studi di Roma Tor Vergata (PTV), Viale Oxford 81, 00133, Roma, Italy.
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Pistolese CA, Tanga I, Cossu E, Perretta T, Yamgoue M, Bonanno E, Simonetti G. A phyllodes tumor in a child. J Pediatr Adolesc Gynecol 2009; 22:e21-4. [PMID: 19539191 DOI: 10.1016/j.jpag.2007.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 11/19/2007] [Accepted: 11/20/2007] [Indexed: 10/20/2022]
Abstract
Phyllodes tumor of the breast is a rare neoplasm, particularly in adolescent girls and young women. It is usually presented as a unilateral palpable mass. We are reporting the case of an 11-year-old adolescent girl who came to our Diagnostical Imaging Department with non-hematic nipple discharge. Ultrasound, mammography, and magnetic resonance imaging were performed. The histological examination showed a phyllodes tumor. The management and the biological behavior of this uncommon tumor are discussed with particular regard to the very unusual clinical presentation in this patient.
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Affiliation(s)
- Chiara Adriana Pistolese
- Department of Diagnostical Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome 00133, Italy
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Pistolese CA, Ciarrapico AM, Della Gatta F, Perretta T, Cossu E, Bolacchi F, Bonanno E, Simonetti G. Cost-effectiveness analysis of two vacuum-assisted breast biopsy systems: Mammotome and Vacora. Radiol Med 2009; 114:743-56. [PMID: 19484585 DOI: 10.1007/s11547-009-0404-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 08/07/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was undertaken to compare the cost effectiveness of two vacuum-assisted breast biopsy devices, the Mammotome and Vacora systems. MATERIALS AND METHODS Between January and June 2006, 238 vacuum-assisted breast biopsies were performed at our radiology department. Five out of 238 lesions were excluded because of inadequate sampling. The Mammotome system was used in 108/233 lesions and the Vacora system in 125/233. Fifty-eight lesions underwent ultrasound-guided breast biopsy, and 50 lesions underwent mammography-guided biopsy with both Mammotome and Vacora devices. Magnetic-resonance-guided biopsy was possible with the Vacora system only (17/125 lesions). RESULTS All procedures were successfully completed. No significant differences were found between the results of the Mammotome and Vacora biopsies in terms of effectiveness: sensitivity was 84.4% and 86.2%, respectively, and specificity 100%. In terms of cost, the Mammotome system has higher costs per procedure compared with the Vacora. CONCLUSIONS Our clinical results confirm the diagnostic accuracy of both the Mammotome and Vacora systems, whereas our cost analysis shows that there is a considerable difference, mostly related to the initial investment.
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Affiliation(s)
- C A Pistolese
- Imaging Diagnostics, Molecular Imaging, Interventional Radiology, and Radiation Therapy Department, University "Tor Vergata" (PTV), Rome, Italy.
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Quaranta V, Manenti G, Bolacchi F, Cossu E, Pistolese CA, Buonomo OC, Carotenuto L, Piconi C, Simonetti G. FEM analysis of RF breast ablation: multiprobe versus cool-tip electrode. Anticancer Res 2007; 27:775-84. [PMID: 17465202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Radio-frequency ablation (RFA) has recently received much attention as an effective minimally invasive strategy for the local treatment of tumors. The purpose of this study was to evaluate the efficacy of single-needle cool-tip RF breast ablation in terms of temperature distribution and duration of the procedure as compared to multiprobe RF breast ablation. MATERIALS AND METHODS Two different commercially available radiofrequency ablation needle electrodes were compared. Finite-element method (FEM) models were developed to simulate the thermoablation procedures. A series of ex vivo radiofrequency thermal lesions were induced to check the response of the FEM calculations. RESULTS Data obtained from FEM models and from ex vivo procedures showed that cool-tip RF breast ablation assures better performances than multiprobe RF breast ablation in terms of temperature distribution and duration of the procedure. Histopathological analysis of the cool-tip RF thermoablated specimens showed successful induction of coagulation necrosis in the thermoablated specimens. CONCLUSION Data obtained from FEM models and from ex vivo procedures suggest that the proposed cool-tip RF breast ablation may kill more tumor cells in vivo with a single application than the multiprobe RF breast ablation.
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Affiliation(s)
- V Quaranta
- 1Tecnobiomedica S.p.A. Via Vaccareccia 41, 00040 Pomezia, Rome, Italy.
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Gandini R, Masala S, Maspes F, Assegnati G, Pistolese CA, Simonetti G. [Use of a new type of cholangioscopy-guided lithotriptor (Monolith) in the treatment of a large calculus of the bilio-digestive junction]. Radiol Med 1997; 93:150-2. [PMID: 9380858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R Gandini
- Istituto di Radiologia, Ospedale S. Eugenio, Università Tor Vergata, Roma
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