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Fior D, Di Provvido S, Leni D, Corso R, Moramarco LP, Pileri M, Grasso RF, Santucci D, Faiella E. Spontaneous Soft Tissue Hematomas in Patients with Coagulation Impairment: Safety and Efficacy of Transarterial Embolization. Tomography 2023; 9:1083-1093. [PMID: 37368541 DOI: 10.3390/tomography9030089] [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: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m2. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.
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Affiliation(s)
- Davide Fior
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Stefano Di Provvido
- Department of Radiology, Desio Hospital, ASST Brianza, Via Giuseppe Mazzini 1, Desio, 20832 Monza, Italy
| | - Davide Leni
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Rocco Corso
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900 Monza, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Matteo Pileri
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Rosario Francesco Grasso
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Domiziana Santucci
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
| | - Eliodoro Faiella
- Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy
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Seminati D, Ceola S, Pincelli AI, Leni D, Gatti A, Garancini M, L'Imperio V, Cattoni A, Pagni F. The Complex Cyto-Molecular Landscape of Thyroid Nodules in Pediatrics. Cancers (Basel) 2023; 15:cancers15072039. [PMID: 37046700 PMCID: PMC10093758 DOI: 10.3390/cancers15072039] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
Thyroid fine-needle aspiration (FNA) is a commonly used diagnostic cytological procedure in pediatric patients for the evaluation of thyroid nodules, triaging them for the detection of thyroid cancer. In recent years, greater attention has been paid to thyroid FNA in this setting, including the use of updated ultrasound score algorithms to improve accuracy and yield, especially considering the theoretically higher risk of malignancy of these lesions compared with the adult population, as well as to minimize patient discomfort. Moreover, molecular genetic testing for thyroid disease is an expanding field of research that could aid in distinguishing benign from cancerous nodules and assist in determining their clinical management. Finally, artificial intelligence tools can help in this task by performing a comprehensive analysis of all the obtained data. These advancements have led to greater reliance on FNA as a first-line diagnostic tool for pediatric thyroid disease. This review article provides an overview of these recent developments and their impact on the diagnosis and management of thyroid nodules in children.
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Affiliation(s)
- Davide Seminati
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Stefano Ceola
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Angela Ida Pincelli
- Department of Endocrinology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Davide Leni
- Department of Radiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Andrea Gatti
- Department of Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Mattia Garancini
- Department of Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Alessandro Cattoni
- Department of Pediatrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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Seminati D, Mane E, Ceola S, Casati G, Putignano P, Garancini M, Gatti A, Leni D, Pincelli AI, Fusco N, L’Imperio V, Pagni F. An Indeterminate for Malignancy FNA Report Does Not Increase the Surgical Risk of Incidental Thyroid Carcinoma. Cancers (Basel) 2022; 14:cancers14215427. [PMID: 36358845 PMCID: PMC9657155 DOI: 10.3390/cancers14215427] [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: 09/19/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Incidental thyroid carcinomas (ITCs) are a fairly frequent finding in daily routine practice, with papillary thyroid microcarcinoma being the most frequent entity. In our work, we isolated incidental cases arising in thyroids removed for other cytologically indeterminate and histologically benign nodules. We retrospectively retrieved cases with available thyroid Fine Needle Aspiration (FNA, 3270 cases), selecting those with an indeterminate cytological diagnosis (Bethesda classes III−IV, 652 cases). Subsequently, we restricted the analysis to surgically treated patients (163 cases) finding an incidental thyroid carcinoma in 22 of them. We found a 13.5% ITC rate, with ITCs representing 46.8% of all cancer histologically diagnosed in this indeterminate setting. Patients received a cytological diagnosis of Bethesda class III and IV in 41% and 59% of cases, respectively. All ITC cases turned out to be papillary thyroid microcarcinomas; 36% of cases were multifocal, with foci bilaterally detected in 50% of cases. We found an overall ITC rate concordant with the literature and with our previous findings. The assignment of an indeterminate category to FNA did not increase the risk of ITCs in our cohort. Rather, a strong statistical significance (p < 0.01) was found comparing the larger size of nodules that underwent FNA and the smaller size of their corresponding ITC nodule.
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Affiliation(s)
- Davide Seminati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
- Correspondence:
| | - Eltjona Mane
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Stefano Ceola
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Gabriele Casati
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Pietro Putignano
- Endocrinology, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Andrea Gatti
- Surgery, ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | - Davide Leni
- Radiology ASST Monza, San Gerardo Hospital, 20900 Monza, Italy
| | | | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Vincenzo L’Imperio
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
| | - Fabio Pagni
- Department of Pathology, University of Milano—Bicocca (UNIMIB), 20900 Monza, Italy
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Ippolito D, Capodaglio C, Maino C, Corso R, Leni D, Fior D, Giandola T, Ragusi M, Talei Franzesi C, Gandola D, Rovere A, Sironi S. Compressive ultrasound can predict early pulmonary embolism onset in COVID patients. J Ultrasound 2022; 25:571-577. [PMID: 35000130 PMCID: PMC8742694 DOI: 10.1007/s40477-021-00625-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/12/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the usefulness of compressive ultrasound (CUS) for the diagnosis of deep vein thrombosis (DVT) in patients with SARS-CoV-2-related infection. METHODS 112 hospitalized patients with confirmed SARS-CoV-2 infection were retrospectively enrolled. CUS was performed within 2 days of admission and consisted in the assessment of the proximal and distal deep venous systems. Lack of compressibility, or direct identification of an endoluminal thrombus, were the criteria used for the diagnosis of DVT. Pulmonary embolism (PE) events were investigated at computed tomography pulmonary angiography (CTPA) within 5 days of follow-up. Logistic binary regression was computed to determine which clinical and radiological parameters were independently associated with PE onset. RESULTS Overall, the incidence of DVT in our cohort was about 43%. The most common district involved was the left lower limb (68.7%) in comparison with the right one (58.3%) while the upper limbs were less frequently involved (4.2% the right one and 2.1% the left one, respectively). On both sides, the distal tract of the popliteal vein was the most common involved (50% right side and 45.8% left side). The presence of DVT in the distal tract of the right popliteal vein (OR = 2.444 95%CIs 1.084-16.624, p = 0.038), in the distal tract of the left popliteal vein (OR = 4.201 95%CIs 1.484-11.885, p = 0.007), and D-dimer values (OR = 2.122 95%CIs 1.030-5.495, p = 0.003) were independently associated with the onset on PE within 5 days. CONCLUSIONS CUS should be considered a useful tool to discriminate which category of patients can develop PE within 5 days from admission.
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Affiliation(s)
- Davide Ippolito
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Carlo Capodaglio
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Cesare Maino
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Rocco Corso
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Davide Leni
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Davide Fior
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Teresa Giandola
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Maria Ragusi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Davide Gandola
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Antonio Rovere
- Department of Diagnostic Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- Department of Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, H Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, BG, Italy
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Capitoli G, Piga I, L’Imperio V, Clerici F, Leni D, Garancini M, Casati G, Galimberti S, Magni F, Pagni F. Cytomolecular Classification of Thyroid Nodules Using Fine-Needle Washes Aspiration Biopsies. Int J Mol Sci 2022; 23:ijms23084156. [PMID: 35456973 PMCID: PMC9028391 DOI: 10.3390/ijms23084156] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 12/13/2022] Open
Abstract
Fine-needle aspiration biopsies (FNA) represent the gold standard to exclude the malignant nature of thyroid nodules. After cytomorphology, 20–30% of cases are deemed “indeterminate for malignancy” and undergo surgery. However, after thyroidectomy, 70–80% of these nodules are benign. The identification of tools for improving FNA’s diagnostic performances is explored by matrix-assisted laser-desorption ionization mass spectrometry imaging (MALDI-MSI). A clinical study was conducted in order to build a classification model for the characterization of thyroid nodules on a large cohort of 240 samples, showing that MALDI-MSI can be effective in separating areas with benign/malignant cells. The model had optimal performances in the internal validation set (n = 70), with 100.0% (95% CI = 83.2–100.0%) sensitivity and 96.0% (95% CI = 86.3–99.5%) specificity. The external validation (n = 170) showed a specificity of 82.9% (95% CI = 74.3–89.5%) and a sensitivity of 43.1% (95% CI = 30.9–56.0%). The performance of the model was hampered in the presence of poor and/or noisy spectra. Consequently, restricting the evaluation to the subset of FNAs with adequate cellularity, sensitivity improved up to 76.5% (95% CI = 58.8–89.3). Results also suggest the putative role of MALDI-MSI in routine clinical triage, with a three levels diagnostic classification that accounts for an indeterminate gray zone of nodules requiring a strict follow-up.
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Affiliation(s)
- Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Isabella Piga
- Proteomics and Metabolomics Unit, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (I.P.); (F.C.); (F.M.)
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Francesca Clerici
- Proteomics and Metabolomics Unit, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (I.P.); (F.C.); (F.M.)
| | - Davide Leni
- Department of Radiology, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy;
| | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy;
| | - Gabriele Casati
- Department of Clinical Pathology, San Gerardo Hospital, ASST Monza, 20900 Monza, Italy;
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Fulvio Magni
- Proteomics and Metabolomics Unit, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (I.P.); (F.C.); (F.M.)
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, 20900 Monza, Italy;
- Correspondence: ; Tel.: +39-03-9233-2090
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Seminati D, Capitoli G, Leni D, Fior D, Vacirca F, Di Bella C, Galimberti S, L’Imperio V, Pagni F. Use of Diagnostic Criteria from ACR and EU-TIRADS Systems to Improve the Performance of Cytology in Thyroid Nodule Triage. Cancers (Basel) 2021; 13:cancers13215439. [PMID: 34771602 PMCID: PMC8582424 DOI: 10.3390/cancers13215439] [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] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary From a prospective series of 480 thyroid nodules, we compared the performances of the American College of Radiology (ACR) and the European Thyroid Association (EU) scoring systems in triaging thyroid nodules for fine-needle aspiration (FNA). FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting ≥TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive value (77.5% vs. 50.7%, p < 0.0001) of the cytology alone, maintaining an excellent sensitivity and negative predictive value. Abstract Objective: The American College of Radiology (ACR) and the European Thyroid Association (EU) have proposed two scoring systems for thyroid nodule classification. Here, we compared the ability of the two systems in triaging thyroid nodules for fine-needle aspiration (FNA) and tested the putative role of an approach that combines ultrasound features and cytology for the detection of malignant nodules. Design and Methods: The scores obtained with the ACR and EU Thyroid Imaging Reporting and Data Systems (TIRADS) from a prospective series of 480 thyroid nodules acquired from 435 subjects were compared to assess their performances in FNA triaging on the final cytological diagnosis. The US features that showed the highest contribution in discriminating benign nodules from malignancies were combined with cytology to improve its diagnostic performance. Results: FNA was recommended on 46.5% and 51.9% of the nodules using the ACR and EU-TIRADS scores, respectively. The ACR system demonstrated a higher specificity as compared to the EU-TIRADS (59.0% vs. 52.4%, p = 0.0012) in predicting ≥ TIR3A/III (SIAPEC/Bethesda) nodules. Moreover, specific radiological features (i.e., echogenic foci and margins), combined with the cytological classes improved the specificity (97.5% vs. 91%, p < 0.0001) and positive predictive values (77.5% vs. 50.7%, p < 0.0001) compared to cytology alone, especially in the setting of indeterminate nodules (TIR3A/III and TIR3B/IV), maintaining an excellent sensitivity and negative predictive value. Conclusions: The ACR-TIRADS system showed a higher specificity compared to the EU-TIRADS in triaging thyroid nodules. The use of specific radiological features improved the diagnostic ability of cytology.
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Affiliation(s)
- Davide Seminati
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Davide Leni
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Davide Fior
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Francesco Vacirca
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Camillo Di Bella
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (G.C.); (S.G.)
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
| | - Fabio Pagni
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, 20900 Monza, Italy; (D.S.); (C.D.B.); (V.L.)
- Correspondence:
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7
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Leni D, Seminati D, Fior D, Vacirca F, Capitoli G, Cazzaniga L, Di Bella C, L’Imperio V, Galimberti S, Pagni F. Diagnostic Performances of the ACR-TIRADS System in Thyroid Nodules Triage: A Prospective Single Center Study. Cancers (Basel) 2021; 13:cancers13092230. [PMID: 34066485 PMCID: PMC8124822 DOI: 10.3390/cancers13092230] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 03/16/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 01/21/2023] Open
Abstract
Simple Summary On a prospective series of 480 thyroid nodules, the ACR-TIRADS demonstrated a sensitivity and specificity in performing FNA of 58.9% and 59%, respectively. The execution of FNA on nodules with ACR class ≥3 independently from the dimensional criteria would increase the sensitivity to 95% and reduce the false negatives rate (7.3%, 7/96), prompting a re-evaluation of the size criteria. The need for reduction in inappropriate hospital admissions prompts a rigorous triage of patients, and future prospective studies to improve current performances might be considered. Abstract Ultrasound scores are used to determine whether thyroid nodules should undergo Fine Needle Aspiration (FNA) or simple clinical follow-up. Different scores have been proposed for this task, with the American College of Radiology (ACR) TIRADS system being one of the most widely used. This study evaluates its ability in triaging thyroid nodules deserving FNA on a large prospective monocentric Italian case series of 493 thyroid nodules from 448 subjects. In ACR 1–2, cytology never prompted a surgical indication. In 59% of cases classified as TIR1c-TIR2, the FNA procedure could be ancillary, according to the ACR-TIRADS score. A subset (37.9%) of cases classified as TIR4-5 would not undergo FNA, according to the dimensional thresholds used by the ACR-TIRADS. Applying the ACR score, a total of 46.5% thyroid nodules should be studied with FNA. The ACR system demonstrated a sensitivity and specificity of 58.9% and 59% in the identification of patients with cytology ≥TIR3A, with a particularly high false negative rate for ACR classes ≥3 (44.8%, 43/96), which would dramatically decrease (7.3%, 7/96) if the dimensional criteria were not taken into account. In ACR 3–4–5, a correspondence with the follow-up occurred in 60.3%, 50.2% and 51.9% of cases. The ACR-TIRADS is a useful risk stratification tool for thyroid nodules, although the current dimensional thresholds could lead to an underestimation of malignant lesions. Their update might be considered in future studies to increase the screening performances of the system.
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Affiliation(s)
- Davide Leni
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Davide Seminati
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Davide Fior
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Francesco Vacirca
- Department of Radiology, ASST Monza, 20900 Monza, Italy; (D.L.); (D.F.); (F.V.)
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (G.C.); (S.G.)
| | - Laura Cazzaniga
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Camillo Di Bella
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Vincenzo L’Imperio
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (G.C.); (S.G.)
| | - Fabio Pagni
- Department of Pathology, University of Milan—Bicocca (UNIMIB), 20900 Monza, Italy; (D.S.); (L.C.); (C.D.B.); (V.L.)
- Correspondence:
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8
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Pozzi M, Giani M, Fumagalli B, Calabria M, Leni D, Segramora V, Bellani G, Foti G. Role of Complete Duplex Ultrasound to Diagnose Deep Vein Thrombosis in COVID-19 Critical Patients. J Vasc Ultrasound 2021; 45:11-14. [PMID: 35330906 PMCID: PMC7803790 DOI: 10.1177/1544316720985812] [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] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
An increased risk of deep vein thrombosis (DVT) has been reported in critical COVID-19 patients, despite adequate thromboprophylaxis, and most of DVT are probably asymptomatic. As a screening approach has been advocated, the best examination protocol is unknown. The objective of this study is to assess the role of a Complete Duplex Ultrasound (CDUS) examination in detecting DVT in a large population of COVID-19 patients admitted to intensive care unit (ICU) for respiratory failure. Single-center retrospective study of 145 COVID-19 patients admitted to ICU. DVT was assessed with a CDUS performed by experienced radiologist after ICU admission. DVT was confirmed in 38 patients (26%). Most DVT were distal to the knee (66%), while only 16% were proximal. At the time of the examination, 55% of the patients received full-dose anticoagulation, while 45% received thromboprophylaxis, and there were no differences in anticoagulation regimen between positive and negative patients. Patients with DVT had higher dimers compared with those with negative CDUS (P < .002). The observed frequency of DVT is high despite adequate anticoagulation. A comprehensive and experienced ultrasound examination protocol can allow to recognize a large number of distal DVT otherwise missed, albeit their clinical significance is unknown.
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Affiliation(s)
| | - Marco Giani
- ASST Monza, Italy
- Università degli Studi di Milano-Bicocca, Monza, Italy
| | | | | | | | | | - Giacomo Bellani
- ASST Monza, Italy
- Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Giuseppe Foti
- ASST Monza, Italy
- Università degli Studi di Milano-Bicocca, Monza, Italy
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9
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Piga I, Capitoli G, Clerici F, Mahajneh A, Brambilla V, Smith A, Leni D, L'Imperio V, Galimberti S, Pagni F, Magni F. Ex vivo thyroid fine needle aspirations as an alternative for MALDI-MSI proteomic investigation: intra-patient comparison. Anal Bioanal Chem 2020; 413:1259-1266. [PMID: 33277997 PMCID: PMC7892726 DOI: 10.1007/s00216-020-03088-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/05/2020] [Accepted: 11/21/2020] [Indexed: 12/22/2022]
Abstract
Fine needle aspiration (FNA) is the reference standard for the diagnosis of thyroid nodules. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) has been successfully used to discriminate the proteomic profiles of benign and malignant thyroid FNAs within the scope of providing support to pathologists for the classification of morphologically borderline cases. However, real FNAs provide a limited amount of material due to sample collection restrictions. Ex vivo FNAs could represent a valuable alternative, increasing sample size and the power of statistical conclusions. In this study, we compared the real and ex vivo MALDI-MSI proteomic profiles, extracted from thyrocyte containing regions of interest, of 13 patients in order to verify their similarity. Statistical analysis demonstrated the mass spectra similarity of the proteomic profiles by performing intra-patient comparison, using statistical similarity systems. In conclusion, these results show that post-surgical FNAs represent a possible alternative source of material for MALDI-MSI proteomic investigations in instances where pre-surgical samples are unavailable or the number of cells is scarce.
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Affiliation(s)
- Isabella Piga
- Proteomics and Metabolomics Unit, School of Medicine and Surgery, University of Milano - Bicocca, 20854, Vedano al Lambro, Italy.
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, 20900, Monza, Italy
| | - Francesca Clerici
- Proteomics and Metabolomics Unit, School of Medicine and Surgery, University of Milano - Bicocca, 20854, Vedano al Lambro, Italy
| | - Allia Mahajneh
- Proteomics and Metabolomics Unit, School of Medicine and Surgery, University of Milano - Bicocca, 20854, Vedano al Lambro, Italy
| | - Virginia Brambilla
- Pathology, School of Medicine and Surgery, San Gerardo Hospital, ASST, University of Milano - Bicocca, 20900, Monza, Italy
| | - Andrew Smith
- Proteomics and Metabolomics Unit, School of Medicine and Surgery, University of Milano - Bicocca, 20854, Vedano al Lambro, Italy
| | - Davide Leni
- Radiology, San Gerardo Hospital, ASST, 20900, Monza, Italy
| | - Vincenzo L'Imperio
- Pathology, School of Medicine and Surgery, San Gerardo Hospital, ASST, University of Milano - Bicocca, 20900, Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, 20900, Monza, Italy
| | - Fabio Pagni
- Pathology, School of Medicine and Surgery, San Gerardo Hospital, ASST, University of Milano - Bicocca, 20900, Monza, Italy
| | - Fulvio Magni
- Proteomics and Metabolomics Unit, School of Medicine and Surgery, University of Milano - Bicocca, 20854, Vedano al Lambro, Italy
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10
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Piga I, Capitoli G, Clerici F, Brambilla V, Leni D, Scardilli M, Canini V, Cipriani N, Bono F, Valsecchi MG, Galimberti S, Magni F, Pagni F. Molecular trait of follicular-patterned thyroid neoplasms defined by MALDI-imaging. Biochim Biophys Acta Proteins Proteom 2020; 1868:140511. [PMID: 32750549 DOI: 10.1016/j.bbapap.2020.140511] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/24/2022]
Abstract
In the field of thyroid neoplasms, the most interesting recent change regards the introduction of a new terminology for follicular-patterned thyroid tumors, named Noninvasive Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP). This pre-malignant tumor is considered to be the putative precursor of invasive carcinoma. However, given that several issues are still unresolved, the application of ancillary tools, based on omics-techniques, may improve the clinical management of these challenging cases. The present paper highlights the proteomic profiles of a series of NIFTPs submitted to Fine Needle Aspirations (FNAs) and analysed by MALDI-imaging in order to confirm the heterogeneous phenotype of nodules included in the present NIFTP terminology and to underline the necessity of more accurate biomarkers that can be used for their characterization. Ethical and economic implications in terms of healthcare costs, operative risks, morbidity, as well as the potential need for lifelong hormone replacement therapy, seem to be significant reasons to approach the characterization of NIFTPs using alternative tools such as MALDI-MSI.
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Affiliation(s)
- Isabella Piga
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Francesca Clerici
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | | | - Davide Leni
- Radiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | | | - Valentina Canini
- Department of Medicine and surgery, UNIMIB, Pathology, Monza, Italy
| | - Nicole Cipriani
- Gross Pathology and Anatomic Pathology Informatics, University of Chicago, Chicago, USA
| | - Francesca Bono
- Department of Medicine and surgery, UNIMIB, Pathology, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fulvio Magni
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Fabio Pagni
- Department of Medicine and surgery, UNIMIB, Pathology, Monza, Italy.
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Capitoli G, Piga I, Clerici F, Brambilla V, Mahajneh A, Leni D, Garancini M, Pincelli AI, L'Imperio V, Galimberti S, Magni F, Pagni F. Analysis of Hashimoto's thyroiditis on fine needle aspiration samples by MALDI-Imaging. Biochim Biophys Acta Proteins Proteom 2020; 1868:140481. [PMID: 32645440 DOI: 10.1016/j.bbapap.2020.140481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/04/2020] [Accepted: 06/27/2020] [Indexed: 12/11/2022]
Abstract
Matrix-Assisted Laser Desorption/Ionization (MALDI)-Mass Spectrometry imaging (MSI) has been applied in various diseases aimed to biomarkers discovery. In this study diagnosis and prognosis of Hashimoto Thyroiditis (HT) in cytopathology by MALDI-MSI has been investigated. Specimens from a routine series of subjects who underwent UltraSound-guided thyroid Fine Needle Aspirations (FNAs) were used. The molecular classifier trained in a previous study was modified to include HT as a separate entity in the group of benign lesions, in the diagnostic proteomic triage of thyroid nodules. The statistical analysis confirmed the existence of signals that HT shares with hyperplastic lesions and others that are specific and characterize this subgroup. Statistically relevant HT-related peaks were included in the model. Then, the discriminatory capability of the classifier was tested in a second validation phase, showing a good agreement with cytological diagnoses. The possibility to overlap the molecular signatures of both the lymphocytes and epithelial cells components (ROIs or pixel-by-pixel analysis) confirmed the composite proteomic background of HT. These results open the way to their possible translation as alternative serum biomarkers of this autoimmune condition.
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Affiliation(s)
- Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Isabella Piga
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Francesca Clerici
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Virginia Brambilla
- Pathology, Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, ASST, Monza, Italy
| | - Allia Mahajneh
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Davide Leni
- Department of radiology, San Gerardo Hospital, ASST, Monza, Italy
| | | | | | - Vincenzo L'Imperio
- Pathology, Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, ASST, Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Fulvio Magni
- Proteomics and Metabolomics, School of Medicine and Surgery, University of Milano-Bicocca, Vedano al Lambro, Italy.
| | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, ASST, Monza, Italy.
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12
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Verga L, Leni D, Cazzaniga G, Crosta S, Seminati D, Rossi M, L'Imperio V, Pagni F. The spectrum of the cytopathological features of primary effusion lymphoma and human herpes virus 8-related lymphoproliferative disorders. Cytopathology 2020; 31:541-546. [PMID: 32171033 DOI: 10.1111/cyt.12820] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/04/2020] [Accepted: 03/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Human herpes virus 8-related lymphoproliferative disorders are a complex and heterogeneous group of entities and some of them are eminently diagnosed by cytopathology. In a routine laboratory, these lesions account for less than 1% of the effusion fluids samples. However, they represent up to 30% of all the lymphoma diagnosis from effusion cytological samples and their consideration in the diagnostic flow chart is mandatory, especially in human immunodeficiency virus-positive patients. METHODS A retrospective series of cytological specimens from cavity effusions (n = 605) were analysed. Five human herpes virus 8-related lymphoproliferative processes were recruited. A combination of morphological criteria (enhanced with May-Grünwald Giemsa staining), cell block-based immunocytochemistry and flow cytometry were undertaken for final characterisation. RESULTS The identification of malignant cells may be difficult. Some specimens are particularly rich, easily leading to suspect a lymphoproliferative process, whereas in other cases, the presence of abundant reactive mesothelial cells, histiocytes, neutrophils, small reactive T and B lymphocytes may obscure the neoplastic process. The biological behaviour may be very heterogeneous and a standardised therapy for these cases is still lacking, although some patients may benefit from antiretroviral therapy in a human immunodeficiency virus setting. CONCLUSIONS The present case series highlights some characteristic findings of these entities to reaffirm useful cytopathological diagnostic criteria, stressing the crucial role of the appropriate technical processing of effusion fluids to obtain the best performances.
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Affiliation(s)
- Luisa Verga
- Hematology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Davide Leni
- Radiology, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Giorgio Cazzaniga
- Pathology, ASST Monza, San Gerardo Hospital, University Milan Bicocca, Monza, Italy
| | - Simona Crosta
- Pathology, ASST Monza, San Gerardo Hospital, University Milan Bicocca, Monza, Italy
| | - Davide Seminati
- Pathology, ASST Monza, San Gerardo Hospital, University Milan Bicocca, Monza, Italy
| | - Marianna Rossi
- Infectious Disease, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Vincenzo L'Imperio
- Pathology, ASST Monza, San Gerardo Hospital, University Milan Bicocca, Monza, Italy
| | - Fabio Pagni
- Pathology, ASST Monza, San Gerardo Hospital, University Milan Bicocca, Monza, Italy
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13
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Capitoli G, Piga I, Galimberti S, Leni D, Pincelli AI, Garancini M, Clerici F, Mahajneh A, Brambilla V, Smith A, Magni F, Pagni F. MALDI-MSI as a Complementary Diagnostic Tool in Cytopathology: A Pilot Study for the Characterization of Thyroid Nodules. Cancers (Basel) 2019; 11:cancers11091377. [PMID: 31527543 PMCID: PMC6769566 DOI: 10.3390/cancers11091377] [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: 09/06/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 12/12/2022] Open
Abstract
The present study applies for the first time as Matrix-Assisted Laser Desorption/Ionization (MALDI) Mass Spectrometry Imaging (MSI) on real thyroid Fine Needle Aspirations (FNAs) to test its possible complementary role in routine cytology in the diagnosis of thyroid nodules. The primary aim is to evaluate the potential employment of MALDI-MSI in cytopathology, using challenging samples such as needle washes. Firstly, we designed a statistical model based on the analysis of Regions of Interest (ROIs), according to the morphological triage performed by the pathologist. Successively, the capability of the model to predict the classification of the FNAs was validated in a different group of patients on ROI and pixel-by-pixel approach. Results are very promising and highlight the possibility to introduce MALDI-MSI as a complementary tool for the diagnostic characterization of thyroid nodules.
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Affiliation(s)
- Giulia Capitoli
- Center of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano - Bicocca, 20900 Vedano al Lambro, Italy.
| | - Isabella Piga
- Proteomics and Metabolomics platform, Department of Medicine and Surgery, University of Milano - Bicocca, 20900 Vedano al Lambro, Italy.
| | - Stefania Galimberti
- Center of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano - Bicocca, 20900 Vedano al Lambro, Italy.
| | - Davide Leni
- Department of radiology, San Gerardo Hospital, 20900 ASST Monza, Italy.
| | | | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, 20900 ASST Monza, Italy.
| | - Francesca Clerici
- Proteomics and Metabolomics platform, Department of Medicine and Surgery, University of Milano - Bicocca, 20900 Vedano al Lambro, Italy.
| | - Allia Mahajneh
- Proteomics and Metabolomics platform, Department of Medicine and Surgery, University of Milano - Bicocca, 20900 Vedano al Lambro, Italy.
| | - Virginia Brambilla
- Pathology, Department of Medicine and Surgery, University of Milano - Bicocca, San Gerardo Hospital, 20900 ASST Monza, Italy.
| | - Andrew Smith
- Proteomics and Metabolomics platform, Department of Medicine and Surgery, University of Milano - Bicocca, 20900 Vedano al Lambro, Italy.
| | - Fulvio Magni
- Proteomics and Metabolomics platform, Department of Medicine and Surgery, University of Milano - Bicocca, 20900 Vedano al Lambro, Italy.
| | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, University of Milano - Bicocca, San Gerardo Hospital, 20900 ASST Monza, Italy.
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14
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Ippolito D, Galimberti S, Leni D, Vacirca F, Nasr A, Bragazzi NL, Spiga S, Schiavone V, Pincelli AI, Garancini M, Leone BE, Pagni F. Use of Shear Wave Elastography in the Sonographic Triage of Thyroid Nodules: Feasibility Study in a Series of Lesions Already Selected for Fine Needle Aspiration. J Ultrasound Med 2019; 38:1713-1720. [PMID: 30480833 DOI: 10.1002/jum.14857] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/15/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the application of shear wave elastography (SWE) in the routine management of thyroid nodules, as a possible additional tool to the standard sonographic triage. METHODS A total of 248 consecutive patients scheduled for ultrasound-guided thyroid fine-needle aspiration were included in the study. The presence of a pure colloid lesion was an exclusion criterion. Absolute and relative SWE stiffness measurements on color-coded elastograms, expressed in kilopascals and meters per second, were correlated with radiologic and pathologic features. RESULTS SWE values in thyroid nodules were significantly higher than normal thyroid tissue (P = .0001), proving the different elastic properties of the pathologic tissues. Regarding the radiologic characteristics of the nodules, SWE highest values were associated with the largest lesions (P = .0105) but independent from sonographic and Doppler findings. The SWE elasticity was not influenced by the characteristics of the biopsy smears. The final correlation between the SWE results and the pathologic diagnoses showed a trend in stiffness from tender tumors (follicular adenoma) to papillary thyroid carcinoma (P = .016). CONCLUSIONS SWE allows the identification of nodules within normal parenchyma; however, the present study does not confirm the potential role in differentiating between benign and malignant thyroid nodules.
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Affiliation(s)
| | - Stefania Galimberti
- Center of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, Monza, Italy
| | - Davide Leni
- Radiology, Department of Medicine and Surgery, Monza, Italy
| | | | - Ahmed Nasr
- Pathology, Department of Medicine and Surgery, Monza, Italy
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Sara Spiga
- Radiology, Department of Medicine and Surgery, Monza, Italy
| | | | | | - Mattia Garancini
- Department of Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | | | - Fabio Pagni
- Pathology, Department of Medicine and Surgery, Monza, Italy
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15
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Fior D, Vacirca F, Leni D, Pagni F, Ippolito D, Riva L, Sironi S, Corso R. Virtual Guidance of Percutaneous Transthoracic Needle Biopsy with C-Arm Cone-Beam CT: Diagnostic Accuracy, Risk Factors and Effective Radiation Dose. Cardiovasc Intervent Radiol 2019; 42:712-719. [PMID: 30652222 DOI: 10.1007/s00270-019-02163-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/04/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE C-arm cone-beam computed tomography-guided transthoracic lung core needle biopsy (CBCT-CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. The purpose of our study was to evaluate the diagnostic performance, complication rates and effective radiation dose of CBCT-CNB with virtual guidance. MATERIALS AND METHODS We retrospectively collected data regarding 375 CBCT-CNBs performed with virtual guidance (XperGuide-Philips Healthcare, Best, The Netherlands) from January 2010 to June 2015 on 355 patients (mean age, 68.1 years ± 11.8; age range, 31-88 years). Patients were divided into groups and compared based on the diagnostic failure and lesion size (15 mm cutoff). Diagnostic performance, complication rate and effective radiation dose were investigated. Variables influencing diagnostic performance and complications were assessed using Student's T test and Pearson's χ2 test. RESULTS The sensitivity, specificity, positive and negative predictive value and accuracy for patients subjected to CNBs were 96.8%, 100%, 100%, 100% and 97.2%, respectively. Considering risk factors for pneumothorax, no significant differences were found regarding patient and lesion characteristics. Perilesional hemorrhage occurred more frequently in older patients (p = 0.046) and in smaller lesions (p = 0.001). Hemoptysis was significantly more frequent in patients with perilesional hemorrhage (p = 0.01). Mean effective radiation dose in CBCT-CNB was 7.12 ± 8.78 mSv. CONCLUSIONS CBCT-CNB combined with virtual guidance is a reliable and accurate technique that allows exact localization of pulmonary lesions, effective preprocedural planning and real-time fluoroscopy altogether.
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Affiliation(s)
- Davide Fior
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy.
| | - Francesco Vacirca
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Davide Leni
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Fabio Pagni
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Pathology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Davide Ippolito
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
| | - Luca Riva
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
- Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, BG, Italy
| | - Rocco Corso
- Department of Diagnostic and Interventional Radiology, "San Gerardo" Hospital, Via Pergolesi 33, 20900, Monza, MB, Italy
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16
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Piga I, Capitoli G, Tettamanti S, Denti V, Smith A, Chinello C, Stella M, Leni D, Garancini M, Galimberti S, Magni F, Pagni F. Feasibility Study for the MALDI-MSI Analysis of Thyroid Fine Needle Aspiration Biopsies: Evaluating the Morphological and Proteomic Stability Over Time. Proteomics Clin Appl 2018; 13:e1700170. [PMID: 30411853 DOI: 10.1002/prca.201700170] [Citation(s) in RCA: 12] [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: 03/01/2018] [Revised: 10/18/2018] [Indexed: 11/05/2022]
Abstract
PURPOSE MALDI-MS imaging (MALDI-MSI) is an emerging technology that enables the spatial distribution of biomolecules within tissue to be combined with the traditional morphological information familiar to clinicians. Thus, for diagnostic or prognostic purposes, along with predicting response to therapeutic treatment, it is important to properly collect and handle biological specimens in order to avoid degradation or the formation of artifacts in the morphological structure and proteomic profile. EXPERIMENTAL DESIGN In this work, the morphological and proteomic stability of thyroid fine needle aspiration biopsies in PreservCyt (up to 14 days) and CytoLyt (up to 7 days) solutions at 4 °C has been verified, by MALDI-MSI analysis. Moreover, a new measure has been introduced in order to assess the similarity of the obtained MALDI-MSI spectra, by equally taking into account the number of signals (fit and retrofit), and their intensities (Spearman's correlation and spectra overlap). RESULTS Results show no degradation of the cellular morphology and a good stability of the samples up to 14 days in PreservCyt solution. CONCLUSIONS AND CLINICAL RELEVANCE Moreover, this protocol can be easily implemented in pathological units, allowing simple sample collection and shipment to be used not only for the proteomic MALDI-MSI analysis of thyroid FNABs but also for other biological liquid based specimens.
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Affiliation(s)
- Isabella Piga
- Department of Medicine and Surgery, Clinical Proteomics and Metabolomics Unit, University of Milano-Bicocca, Vedano al Lambro, Italy.,Department of Medicine and Surgery, Section of Pathology, University of Milano-Bicocca, Monza, Italy
| | - Giulia Capitoli
- Department of Medicine and Surgery, Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza, Italy
| | - Silvia Tettamanti
- Department of Medicine and Surgery, Clinical Proteomics and Metabolomics Unit, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Vanna Denti
- Department of Medicine and Surgery, Clinical Proteomics and Metabolomics Unit, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Andrew Smith
- Department of Medicine and Surgery, Clinical Proteomics and Metabolomics Unit, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Clizia Chinello
- Department of Medicine and Surgery, Clinical Proteomics and Metabolomics Unit, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Martina Stella
- Department of Medicine and Surgery, Clinical Proteomics and Metabolomics Unit, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Davide Leni
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | | | - Stefania Galimberti
- Department of Medicine and Surgery, Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza, Italy
| | - Fulvio Magni
- Department of Medicine and Surgery, Clinical Proteomics and Metabolomics Unit, University of Milano-Bicocca, Vedano al Lambro, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Section of Pathology, University of Milano-Bicocca, Monza, Italy
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Piga I, Casano S, Smith A, Tettamanti S, Leni D, Capitoli G, Pincelli AI, Scardilli M, Galimberti S, Magni F, Pagni F. Update on: proteome analysis in thyroid pathology - part II: overview of technical and clinical enhancement of proteomic investigation of the thyroid lesions. Expert Rev Proteomics 2018; 15:937-948. [PMID: 30290700 DOI: 10.1080/14789450.2018.1532793] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION An accurate diagnostic classification of thyroid lesions remains an important clinical aspect that needs to be addressed in order to avoid 'diagnostic' thyroidectomies. Among the several 'omics' techniques, proteomics is playing a pivotal role in the search for diagnostic markers. In recent years, different approaches have been used, taking advantage of the technical improvements related to mass spectrometry that have occurred. Areas covered: The review provides an update of the recent findings in diagnostic classification, in genetic definition and in the investigation of thyroid lesions based on different proteomics approaches and on different type of specimens: cytological, surgical and biofluid samples. A brief section will discuss how these findings can be integrated with those obtained by metabolomics investigations. Expert commentary: Among the several proteomics approaches able to deepen our knowledge of the molecular alterations of the different thyroid lesions, MALDI-MSI is strongly emerging above all. In fact, MS-imaging has also been demonstrated to be capable of distinguishing thyroid lesions, based on their different molecular signatures, using cytological specimens. The possibility to use the material obtained by the fine needle aspiration makes MALDI-MSI a highly promising technology that could be implemented into the clinical and pathological units.
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Affiliation(s)
- Isabella Piga
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy.,b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
| | - Stefano Casano
- b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
| | - Andrew Smith
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Silvia Tettamanti
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Davide Leni
- c Department of Radiology , San Gerardo Hospital , Monza , Italy
| | - Giulia Capitoli
- d Department of Medicine and Surgery , University of Milano-Bicocca, Centre of Biostatistics for Clinical Epidemiology , Monza , Italy
| | | | | | - Stefania Galimberti
- d Department of Medicine and Surgery , University of Milano-Bicocca, Centre of Biostatistics for Clinical Epidemiology , Monza , Italy
| | - Fulvio Magni
- a Department of Medicine and Surgery , University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit , Vedano al Lambro , Italy
| | - Fabio Pagni
- b Department of Medicine and Surgery , University of Milano-Bicocca, Section of Pathology , Monza , Italy
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Smith A, Galli M, Piga I, Denti V, Stella M, Chinello C, Fusco N, Leni D, Manzoni M, Roversi G, Garancini M, Pincelli AI, Cimino V, Capitoli G, Magni F, Pagni F. Molecular signatures of medullary thyroid carcinoma by matrix-assisted laser desorption/ionisation mass spectrometry imaging. J Proteomics 2018; 191:114-123. [PMID: 29581064 DOI: 10.1016/j.jprot.2018.03.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 11/01/2017] [Revised: 03/06/2018] [Accepted: 03/19/2018] [Indexed: 12/17/2022]
Abstract
The main aim of the study was to assess the feasibility of matrix-assisted laser desorption/ionisation mass spectrometry imaging (MALDI-MSI) in the pathological investigation of Medullary Thyroid Carcinoma (MTC). Formalin-fixed paraffin-embedded (FFPE) samples from seven MTC patients were analysed by MALDI-MSI in order to detect proteomic alterations within tumour lesions and to define the molecular profiles of specific findings, such as amyloid deposition and C cell hyperplasia (CCH). nLC-ESI MS/MS was employed for the identification of amyloid components and to select alternative proteomic markers of MTC pathogenesis. Results highlighted the potential of MALDI-MSI to confirm the classic immunohistochemical methods employed for the diagnosis of MTC, with good sensitivity and specificity. Intratumoural amyloid components were also detected and identified, and were characterised by calcitonin, apolipoprotein E, apolipoprotein IV, and vitronectin. The tryptic peptide profiles representative of MTC and CCH were distinctly different, with four alternative markers for MTC being detected; K1C18, and three histones (H2A, H3C, and H4). Finally, a further 115 proteins were identified through the nLC-ESI-MS/MS analysis alone, with moesin, veriscan, and lumican being selected due to their potential involvement in MTC pathogenesis. This approach represents a complimentary strategy that could be employed to detect new proteomic markers of MTC. STATEMENT OF SIGNIFICANCE: Medullary thyroid carcinoma (MTC) is a rare endocrine malignancy that originates from the parafollicular C-cells of the thyroid. The diagnosis is typically established using a combination of fine-needle aspiration biopsy (FNAB) of a suspicious nodule along with the demonstrable elevation of serum biomarkers, such as calcitonin and carcinoembryonic antigen (CEA). Unfortunately, this combination is often associated with a high degree of false-positive results and this can lead to misdiagnosis and avoidable total thyroidectomy. The current study presents the potential role of MALDI-MSI in the search for new proteomic markers of MTC with diagnostic and prognostic significance. MALDI-MSI was capable of detecting the classic immunohistochemical markers employed for the diagnosis of MTC, with good sensitivity and specificity. Furthermore, the complementary combination of MALDI-MSI and nLC-ESI-MS/MS analysis, using a single tissue section, enabled further potential markers to be identified and their spatial localisation visualised within tumoural regions. Such findings could be a valuable starting point for further studies focused on confirming the data presented here using thyroid FNABs, with the final objective being to provide complimentary assistance for the detection of MTC during the pre-operative phase.
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Affiliation(s)
- Andrew Smith
- Department of Medicine and Surgery, University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit, Vedano al Lambro, Italy.
| | - Manuel Galli
- Department of Medicine and Surgery, University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit, Vedano al Lambro, Italy.
| | - Isabella Piga
- Department of Medicine and Surgery, University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit, Vedano al Lambro, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Section of Pathology, Monza, Italy.
| | - Vanna Denti
- Department of Medicine and Surgery, University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit, Vedano al Lambro, Italy.
| | - Martina Stella
- Department of Medicine and Surgery, University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit, Vedano al Lambro, Italy.
| | - Clizia Chinello
- Department of Medicine and Surgery, University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit, Vedano al Lambro, Italy.
| | - Nicola Fusco
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Davide Leni
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Marco Manzoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Section of Pathology, Monza, Italy
| | - Gaia Roversi
- Department of Medicine and Surgery, University of Milano-Bicocca, Section of Genomics, Monza, Italy.
| | | | | | - Vincenzo Cimino
- Department of Endocrinology, San Gerardo Hospital, Monza, Italy
| | - Giulia Capitoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Section of Biostatistics, Monza, Italy.
| | - Fulvio Magni
- Department of Medicine and Surgery, University of Milano-Bicocca, Clinical Proteomics and Metabolomics Unit, Vedano al Lambro, Italy.
| | - Fabio Pagni
- Department of Medicine and Surgery, University of Milano-Bicocca, Section of Pathology, Monza, Italy.
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Grasso M, Blanco S, Segramora V, Grasso EC, Leni D, Conti GM. Optional caval filter in kidney cancer patients with tumor thrombus level I and II. Minerva Urol Nephrol 2017; 70:74-78. [PMID: 28752725 DOI: 10.23736/s0393-2249.17.02867-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Kidney diseases requiring a radical surgical approach can come up complicated by the presence of a thrombus of the renal vein or the inferior vena cava (IVC). The overwhelming majority of these cases concern the presence of a kidney tumor, especially renal cell carcinoma (RCC). Kidney tumor presenting with thrombus extension into the IVC represents a difficult operative challenge, especially for the risk of thrombus dislocation due to the manipulation of the IVC during tumor isolation, which may result in pulmonary embolism (PE). METHODS We propose a retrospective cohort study regarding 10 patients (thrombus level I or II) operated in our center from 2010 to 2015. All of them had a renal tumor. In 8 patients TC proved tumor thrombus extended into the IVC<2 cm above the renal vein (level I), in the remaining patients the thrombus entered the IVC>2 cm above the renal vein but below the hepatic veins (level 2). All the patients underwent an IVC temporary/optional filter placement as a preoperative maneuver before radical nephrectomy. RESULTS The efficacy of the procedure is confirmed by the absence of any inter- or postsurgical thromboembolic event in all patients; filter was removed in 3 patients, moreover, concerning the long-term information we obtained about the patients, none of them has showed complete occlusion of IVC. CONCLUSIONS The results of the study support effectiveness of preoperative temporary IVC placement to prevent thrombosis embolism shedding and to improve surgical safety.
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Affiliation(s)
- Marco Grasso
- Department of Urology, San Gerardo Hospital, Monza, Italy -
| | | | | | | | - Davide Leni
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Grazia M Conti
- Department of Urology, San Gerardo Hospital, Monza, Italy
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Macchini D, Degrate L, Oldani M, Leni D, Padalino P, Romano F, Gianotti L. Timing of percutaneous cholecystostomy tube removal: systematic review. MINERVA CHIR 2016; 71:415-426. [PMID: 27280869] [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: 06/06/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy (PC) is an effective procedure to treat moderate or severe acute cholecystitis (AC) in high-risk patients. The ideal timing of the drainage removal is argued. The aim of this study is to analyze our experience and perform a systematic review about the ideal timing of a percutaneous cholecystostomy (PC) tube removal. EVIDENCE ACQUISITION A web-based literature search was performed and studies reporting the length of the catheter maintenance were analyzed. A regression analysis between the timing of tube removal and morbidity, mortality and disease recurrence was performed. Patients who underwent PC as definitive treatment of moderate or severe acute cholecystitis at our institution between 2011 to 2015 were analyzed. Clinical and technical success, morbidity, mortality and recurrence rates were retrospectively retrieved from a perspective database. EVIDENCE SYNTHESIS The systematic review yield to analyze 50 studies. None of them focused exclusively on outcome measures in relation to PC tube duration. The timing of the drain removal varied from 2 to 193 days. Regression analyses showed no correlation between length of tube maintenance and the considered outcomes. We studied 35 patients. The median age was 78 (range 52-94) and 88.5% had an ASA score ≥3. P-POSSUM estimated morbidity was 68.7% (range 34.3-99.0) and mortality was 15.8% (range 1.9-80.2). Clinical success was 97.1%. Procedure-related morbidity was 34.3%: 2 abscess, 1 bleeding, 1 biloma and 8 tube dislodgment. Biliary leakage was not observed. The observed 30-day overall mortality was 11.4%. The median follow-up was 16 months. Recurrence rate was 12.1%. CONCLUSIONS PC is an effective procedure in high-risk patients with moderate or severe AC. At the moment there is no evidence whether the duration of PC tube may affect outcome.
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Affiliation(s)
- Daniele Macchini
- School of Medicine and Surgery, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy -
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21
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Pagni F, De Sio G, Garancini M, Scardilli M, Chinello C, Smith AJ, Bono F, Leni D, Magni F. Proteomics in thyroid cytopathology: Relevance of MALDI-imaging in distinguishing malignant from benign lesions. Proteomics 2016; 16:1775-84. [PMID: 27029406 DOI: 10.1002/pmic.201500448] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 11/13/2015] [Revised: 03/11/2016] [Accepted: 03/24/2016] [Indexed: 12/23/2022]
Abstract
Several proteomic strategies are used extensively for the purpose of biomarker discovery and in order to obtain insights into the molecular aspects of cancers, using either body fluids or tissue as samples. Among them, MALDI-imaging can be applied to cytological thyroid specimens to investigate the molecular signatures of different pathological conditions and highlight differences in the proteome that are of relevance for diagnostic and pathogenetic research. In this study, 26 ex-vivo fine needle aspirations from benign thyroid nodules (n = 13) and papillary thyroid carcinomas (n = 13) were analyzed by MALDI-imaging. Based on the specific protein signatures capable of distinguishing the aforementioned patients, MALDI-imaging was able to correctly assign, in blind, the specimens from ten additional FNABs to a malignant or benign class, as later confirmed by the morphological classification. Moreover, some proteins presented a progressive overexpression in malignant phenotypes when compared with Hashimoto's thyroiditis and hyperplastic/follicular adenoma. This data not only suggests that a MALDI-imaging based approach can be a valuable tool in the diagnosis of thyroid lesions but also in the detection of proteins that have a possible role in the promotion of tumorigenic activity.
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Affiliation(s)
- Fabio Pagni
- Department of Medicine and Surgery, Proteomics, University Milan Bicocca, Monza, Italy
| | - Gabriele De Sio
- Department of Medicine and Surgery, Proteomics, University Milan Bicocca, Monza, Italy
| | | | | | - Clizia Chinello
- Department of Medicine and Surgery, Proteomics, University Milan Bicocca, Monza, Italy
| | - Andrew James Smith
- Department of Medicine and Surgery, Proteomics, University Milan Bicocca, Monza, Italy
| | - Francesca Bono
- Department of Medicine and Surgery, Proteomics, University Milan Bicocca, Monza, Italy
| | - Davide Leni
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Fulvio Magni
- Department of Medicine and Surgery, Proteomics, University Milan Bicocca, Monza, Italy
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Castagna L, Maggioni E, Coppo A, Cortinovis B, Meroni V, Sosio S, Vacirca F, Leni D, Avalli L. Safe ECMO femoral decannulation by placement of inferior vena cava filter via internal jugular vein. J Artif Organs 2016; 19:297-300. [PMID: 27003432 DOI: 10.1007/s10047-016-0892-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/14/2016] [Accepted: 03/04/2016] [Indexed: 11/25/2022]
Abstract
Veno-arterial extracorporeal membrane oxygenation (ECMO) is a lifesaving treatment in patients with cardiogenic shock or cardiac arrest caused by massive pulmonary embolism. In these patients, positioning an inferior vena cava filter is often advisable, especially if deep venous thrombosis is not resolved at the time of the ECMO suspension. Moreover, in ECMO patients, a high incidence of deep venous thrombosis at the site of venous cannulation has been reported, and massive pulmonary embolism following ECMO decannulation has been described. Nonetheless, an inferior vena cava filter cannot be positioned as long as an ECMO cannula is inside the inferior vena cava. Thus, we developed a strategy to allow placement of an inferior vena cava filter through the internal jugular concurrently with the removal of the femoral venous ECMO cannula. In two women supported by veno-arterial ECMO for cardiac arrest secondary to pulmonary embolism, this novel approach allowed for safe ECMO decannulation.
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Affiliation(s)
- Luigi Castagna
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy.
| | - Elena Maggioni
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - Anna Coppo
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - Barbara Cortinovis
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - Veronica Meroni
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - Simone Sosio
- School of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza (MB), 20900, Italy
| | - Francesco Vacirca
- Department of Radiology, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - Davide Leni
- Department of Radiology, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy
| | - Leonello Avalli
- Department of Anesthesia and Intensive Care, San Gerardo Hospital, Via Pergolesi 33, Monza (MB), 20900, Italy
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Pagni F, Jaconi M, Smith AJ, Brenna A, Valente MG, Leoni S, Leni D, Vacirca F, Sozzi D. The Role of Fine Needle Aspiration of Orbital Lesions: A Case Series. Acta Cytol 2016; 60:31-8. [PMID: 26986454 DOI: 10.1159/000444385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This paper analyzes a series of ultrasound (US)-guided orbital fine needle aspirations (FNAs) which provide diagnostic information that cytopathologists approaching orbital lesions for the first time can find useful and underlines the importance of teamwork. STUDY DESIGN The investigators retrospectively obtained data from 24 consecutive orbital FNAs. For all patients, a complete clinicoradiological database was created. FNAs were performed under US guidance with 25-gauge needles and an aspiration biopsy syringe gun, and sent to the Department of Pathology for examination and data management. RESULTS The mean age of the patients was 54 years. Imaging studies included US, magnetic resonance imaging and computed tomography scans; 9 lesions involved the right orbit and 15 the left orbit. The mean lesion size was 23.6 ± 7.2 mm. After microscopic examination, 7 smears were labeled as 'nondiagnostic', while in 17 cases a definitive diagnosis was proposed, which always proved to be correct (70.8%, specificity = 100%). CONCLUSIONS The investigators believe that FNA biopsy of orbital masses is a necessary step; its weaknesses lie in the particularly delicate site of sampling and the extreme heterogeneity of lesions. Nevertheless, when orbital FNA is performed within a well-coordinated multidisciplinary team, it is a powerful tool that can be used to define the most appropriate management of these patients.
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Affiliation(s)
- Fabio Pagni
- Division of Pathology, University Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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24
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Jaconi M, Pagni F, Vacirca F, Leni D, Corso R, Cortinovis D, Bidoli P, Bono F, Cuttin MS, Valente MG, Pesci A, Bedini VA, Leone BE. C-arm cone-beam CT-guided transthoracic lung core needle biopsy as a standard diagnostic tool: an observational study. Medicine (Baltimore) 2015; 94:e698. [PMID: 25816042 PMCID: PMC4554007 DOI: 10.1097/md.0000000000000698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
C-arm cone-beam computed tomography (CT)-guided transthoracic lung core needle biopsy (CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. This article will focus on the clinical features related to CNB in terms of diagnostic performance and complication rate. Moreover, the concept of categorizing pathological diagnosis into 4 categories, which could be used for clinical management, follow-up, and quality assurance is also introduced. We retrospectively collected data regarding 375 C-arm cone-beam CT-guided CNBs from January 2010 and June 2014. Clinical and radiological variables were evaluated in terms of success or failure rate. Pathological reports were inserted in 4 homogenous groups (nondiagnostic--L1, benign--L2, malignant not otherwise specified--L3, and malignant with specific histotype--L4), defining for each category a hierarchy of suggested actions. The sensitivity, specificity, and positive and negative predictive value and accuracy for patients subjected to CNBs were of 96.8%, 100%, 100%, 100%, and 97.2%, respectively. Roughly 75% of our samples were diagnosed as malignant, with 60% lung adenocarcinoma diagnoses. Molecular analyses were performed on 85 malignant samples to verify applicability of targeted therapy. The rate of "nondiagnostic" samples was 12%. C-arm cone-beam CT-guided transthoracic lung CNB can represent the gold standard for the diagnostic evaluation of pulmonary nodules. A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data. This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate). The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.
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Affiliation(s)
- Marta Jaconi
- From the Department of Pathology (MJ, FP, FB, MSC, MGV), University Milan Bicocca; Department of Radiology (FV, DL, RC); Department of Oncology (DC, PB); Department of Health Sciences (AP), Pneumology Unit, University Milan Bicocca; Department of Thoracic Surgery (VB), San Gerardo Hospital, Monza; and Department of Pathology (BEL), Desio Hospital, University Milan Bicocca, Desio, Italy
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Moltrasio F, Brenna A, Bovo G, Sala E, Jaconi M, Blanco S, Grasso M, Leni D, Pagni F. Pathological features of Xp11 translocation renal cell carcinoma using urine liquid-based cytology with FISH. Cytopathology 2014; 26:325-8. [DOI: 10.1111/cyt.12208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F. Moltrasio
- Department of Pathology; San Gerardo Hospital; University Milan Bicocca; Monza Italy
| | - A. Brenna
- Department of Pathology; San Gerardo Hospital; University Milan Bicocca; Monza Italy
| | - G. Bovo
- Department of Pathology; San Gerardo Hospital; University Milan Bicocca; Monza Italy
| | - E. Sala
- Department of Pathology; San Gerardo Hospital; University Milan Bicocca; Monza Italy
| | - M. Jaconi
- Department of Pathology; San Gerardo Hospital; University Milan Bicocca; Monza Italy
| | - S. Blanco
- Department of Urology; San Gerardo Hospital; Monza Italy
| | - M. Grasso
- Department of Urology; San Gerardo Hospital; Monza Italy
| | - D. Leni
- Department of Radiology; San Gerardo Hospital; Monza Italy
| | - F. Pagni
- Department of Pathology; San Gerardo Hospital; University Milan Bicocca; Monza Italy
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26
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Ippolito D, Fior D, Franzesi CT, Capraro C, Casiraghi A, Leni D, Vacirca F, Corso R, Sironi S. Tumour-related neoangiogenesis: functional dynamic perfusion computed tomography for diagnosis and treatment efficacy assessment in hepatocellular carcinoma. Dig Liver Dis 2014; 46:916-22. [PMID: 25023006 DOI: 10.1016/j.dld.2014.06.002] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/24/2014] [Accepted: 06/02/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Aim of the study was to determine the value of perfusion computed tomography in the quantitative assessment of tumour-related neoangiogenesis for the diagnosis and treatment of hepatocellular carcinoma lesions. METHODS Overall, 47 consecutive patients with cirrhotic liver disease, with a high risk of hepatocellular carcinoma, and undergoing standard surveillance (six-month intervals) were eligible for inclusion in this prospective study; based on Barcelona Clinic Liver Cancer guidelines, 27 patients were enrolled. Perfusion computed tomography was performed in 29 biopsy-proven hepatocellular carcinoma lesions before and after treatment with transarterial chemoembolization or radiofrequency ablation. The dynamic study was performed with a 256-slice multidetector-computed tomography scanner; the following parameters were measured: hepatic perfusion, arterial perfusion, blood volume, hepatic perfusion index, and time-to-peak in all patients. RESULTS Hepatocellular carcinoma lesions had the following median perfusion values: perfusion 46.3mL/min/100g; blood volume 20.4mL/100mg; arterial perfusion 42.9mL/min; hepatic perfusion index 92.5%; time to peak 18.7s. Significantly lower perfusion values were obtained in correctly treated lesions or surrounding parenchyma than in viable hepatocellular carcinoma tissue. CONCLUSIONS In hepatocellular carcinoma, perfusion computed tomography could contribute to a non-invasive quantification of tumour blood supply related to the formation of new arterial structures, and enable the assessment of therapeutic response.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy.
| | - Davide Fior
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Cammillo Talei Franzesi
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Cristina Capraro
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Alessandra Casiraghi
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Davide Leni
- Department of Interventional Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Francesco Vacirca
- Department of Interventional Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Rocco Corso
- Department of Interventional Radiology, H. S. Gerardo, Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo, Monza, MB, Italy
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Ippolito D, Fior D, Bonaffini PA, Capraro C, Leni D, Corso R, Sironi S. Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients. Eur J Radiol 2014; 83:1665-71. [PMID: 24962900 DOI: 10.1016/j.ejrad.2014.05.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 12/28/2013] [Revised: 05/11/2014] [Accepted: 05/23/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess if radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may influence the evaluation of perfusion parameters obtained with CT-perfusion (CT-p) in HCC treated patients. MATERIALS AND METHODS Thirty-three consecutive cirrhotic patients with biopsy-proven diagnosis of HCC lesions and candidates to TACE or RFA were included. The CT-p study of hepatic parenchyma and of treated lesions was performed about 1 month after treatment on 16 multidetector CT after injection of 50mL of non ionic contrast agent (350mg I/mL) at a flow rate of 6mL/s acquiring 40 dynamic scans. A dedicated perfusion software which generated a quantitative map of arterial and portal perfusion by means of colour scale was employed.The following perfusion parameters were assessed before and after RFA or TACE treatment: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), time to peak (TTP), hepatic perfusion index (HPI). RESULTS A complete treatment was obtained in 16 cases and incomplete treatment in the 17 remaining cases. The perfusion data of completely treated lesions were: HP 10.2±6.3; AP 10.4±7; BV 4.05±4.8; TTP 38.9±4.2; HPI 9.9±9.2, whereas in partially treated lesions were: HP 43.2±15.1mL/s/100g; AP 38.7±8.8mL/min; BV 20.7±9.5mL/100mg; TTP 24±3.7s; HPI 61.7±7.5%. In adjacent cirrhotic parenchyma, the parameters of all evaluated patients were: HP 13.2±4; AP 12.3±3.4; BV 11.8±2.8; TTP 43.9±2.9; and HPI 17.1±9.8. A significant difference (P<0.001) was found for all parameters between residual viable tumor tissue (P<0.001) compared to successfully treated lesion due to the presence of residual arterial vascular structure in viable portion of treated HCC. CONCLUSION According to our results, CT-p evaluation is not influenced by TACE or RFA treatments, thus representing a feasible technique that allows a reproducible quantitative evaluation of treatment response in HCC patients.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy.
| | - Davide Fior
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Pietro Andrea Bonaffini
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Cristina Capraro
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Davide Leni
- Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Rocco Corso
- Department of Interventional Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
| | - Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, MB, Italy; Department of Diagnostic Radiology, H. S. Gerardo Monza, Via Pergolesi 33, 20900 Monza, MB, Italy
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Corso R, Vacirca F, Patelli C, Leni D. Use of "Time-Out" checklist in interventional radiology procedures as a tool to enhance patient safety. Radiol Med 2014; 119:828-34. [PMID: 24651938 DOI: 10.1007/s11547-014-0397-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/22/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was done to evaluate the feasibility and effectiveness of adopting a safety checklist (SC) in the angiography suite during interventional radiology (IR) procedures to enhance patient safety. MATERIALS AND METHODS Surgical SC was successfully introduced in 2009 with the aim of drastically reducing the morbidity and mortality caused by human error on patients during their stay in the operating room. Even CIRSE, the Cardiovascular and Interventional Radiological Society of Europe, recently published its own SC recommending its use in IR suites. Since January 2012, in our routine practice in the angiographic unit, we have used a 20-item checklist named "Time-Out" derived from the CIRSE SC. The main items are: in the Time-Out phase, active verbal communication within the team; correct identification of the patient and of the procedure site and side. Additionally, during the preprocedure (Sign-In) and postprocedure (Sign-Out) stages a series of clinical data are collected such as administration of prophylaxis against contrast allergy or contrast-induced nephropathy (CIN), when needed informed consent, discontinuation of anticoagulation therapy, fasting, correct labelling of biological samples, etc. RESULTS Preliminary educational sessions were held to sensitise all the staff involved in the Time-Out project (physicians, nurses, radiographers) and ensure satisfactory compliance from the outset in consideration of the increased time and paperwork that checklist implementation would involve. CONCLUSIONS The use of a checklist in IR, named "Time-Out" in our experience was feasible and effective allowing elimination of adverse events in the first year of use and promoting significant involvement and awareness of patient safety among the health-care team. The level of implementation, completeness and acceptability of the SC within the team increased after adequate training had been provided.
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Affiliation(s)
- Rocco Corso
- Radiologia Interventistica, Ospedale San Gerardo, Via Pergolesi, 33, 20900, Monza, Italy,
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Ippolito D, Bonaffini PA, Capraro C, Leni D, Corso R, Sironi S. Viable residual tumor tissue after radiofrequency ablation treatment in hepatocellular carcinoma: evaluation with CT perfusion. Abdom Imaging 2013; 38:502-10. [PMID: 22743839 DOI: 10.1007/s00261-012-9924-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the role of CT perfusion technique in detection of blood flow changes related to the therapeutic effects in HCC lesion treated with RFA. METHODS 14 cirrhotic patients with known HCC underwent a perfusion study about 4 months (range 1-13 months) after RFA on a 16-slice MDCT scanner (Brilliance, Philips). Dynamic CT was performed acquiring 8 dynamic slice/scan, after injection of 50 mL of contrast media. In treated lesion, surrounding parenchyma and hypervascular tissue suspicious for residual disease/recurrence, the following perfusion parameters were analyzed: perfusion (P, mL/100 g min); arterial perfusion (AP, mL/min); blood volume (BV, mL/100 mg); hepatic perfusion index (HPI, %), and time to peak (TTP, s). Univariate Wilcoxon signed rank test was used for statistical analysis. RESULTS In patients with residual disease (8/14) values of perfusion parameters measured within tumor were: P, median = 45.2; AP, median = 48.2; BV, median = 18.9; HPI, median = 35.8; and TTP, median = 19.4. The values calculated in ablated area were: P, median = 10.9; AP, median = 9.6; BV, median = 5.5; HPI, median = 14.6; TTP, median = 39.6. The parameters calculated in the surrounding parenchyma were: P, median = 15.8; AP, median = 14.2; BV, median = 12.0; HPI, median = 17.9; TTP, median = 43.2. A significant difference (P < 0.05) was observed in mean values of P, AP, and HPI, calculated between treated lesions with residual tumor and those successfully treated. CONCLUSION Perfusion CT enables assessment of HCC vascularity after RFA treatment, by adding quantitative information about the presence of residual arterial vessels within the viable residual neoplastic tissue.
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Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Via Pergolesi 33, Monza, MB, Italy.
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Corso R, Rampoldi A, Vercelli R, Leni D, Vanzulli A. Percutaneous repair of radial artery pseudoaneurysm in a hemodialysis patient using sonographically guided thrombin injection. Cardiovasc Intervent Radiol 2006; 29:130-2. [PMID: 15999239 DOI: 10.1007/s00270-004-0055-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of a radial artery pseudoaneurysm complicating an incorrect puncture of a Brescia-Cimino hemodialysis fistula that was treated with percutaneous ultrasound-guided thrombin injection. The pseudoaneurysm recurred after the initial successful thrombin injection. With a second injection we obtained permanent pseudoaneurysm occlusion. Our case illustrates that this procedure is an effective treatment in this type of arteriovenous fistula complication. We compare this case with the only similar one we could find in the literature.
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Affiliation(s)
- Rocco Corso
- Department of Diagnostic and Interventional Radiology, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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Corso R, Carrafiello G, Rampoldi A, Leni D, Ticca C, Vercelli R, Vanzulli A. Pseudoaneurysm after spontaneous rupture of renal angiomyolipoma in tuberous sclerosis: successful treatment with percutaneous thrombin injection. Cardiovasc Intervent Radiol 2005; 28:262-4. [PMID: 15719182 DOI: 10.1007/s00270-004-0154-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of a large perinephric pseudoaneurysm due to spontaneous rupture of renal angiomyolipoma, occluded by percutaneous thrombin injection under ultrasound guidance in a young woman affected by tuberous sclerosis.
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Affiliation(s)
- Rocco Corso
- Department of Diagnostic and Interventional Radiology, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy.
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Catalano OA, Napolitano M, Leni D, Ticca C, Vanzulli A. Contrast enhanced computer tomography of two cases of bilateral acute cortical necrosis, one of which related to amphetamine abuse. Emerg Radiol 2005; 11:306-8. [PMID: 16133628 DOI: 10.1007/s10140-005-0418-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Accepted: 03/11/2005] [Indexed: 11/26/2022]
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Leni D, Trevisan R, Vanzulli A. [Imaging of living donor liver transplantation]. Radiol Med 2004; 107:58-68. [PMID: 15031697] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE This paper presents our experience in the evaluation of 23 potential living liver donors examined from January 2001 to December 2002. MATERIALS AND METHODS Between January 2001 and December 2002, a total of 23 potential living liver donors were evaluated (20 men, 3 women; mean age 30 years) with MSCT and MR. Vascular reconstructions (MIP and Thin MIP) and volumetric evaluation of liver "in toto" and of the right hepatic lobe to be harvested were obtained with CT. MR was performed with in- and out-of-phase GE acquisitions in order to detect liver steatosis and with SSFSE T2 weighted thick-slab (50 mm) coronal acquisitions to obtain MR cholangiography. MR cholangiography was also obtained with post-contrast (Gd-BOPTA 90 min) 3D GE thin (1.5 mm) coronal sequences. Ten potential living liver donors also underwent angiography. RESULTS The radiological examinations demonstrated abnormalities of the portal vein bifurcation in 7/23 potential living liver donors, variants of the arterial anatomy in 5/23 and abnormalities of the biliary anatomy in 20/23. One case showed gallbladder dysmorphism. The MR examinations led to the exclusion from the transplantation of one potential living liver donor owing to the detection of liver steatosis that was subsequently confirmed by biopsy. 7/23 potential living liver donors were considered eligible for the surgical procedure and underwent preoperative colour Doppler sonography and intraoperative cholangiography. CONCLUSIONS The diagnostic protocols used at our centre provide the clinician with important information and an exhaustive picture of the hepatic anatomy to evaluate the inclusion of potential living liver donors in the transplantation program.
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Affiliation(s)
- Davide Leni
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano.
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