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Palumbo G, Arrigoni F, Peruzzo D, Parazzini C, D'Errico I, Agazzi GM, Pinelli L, Triulzi F, Righini A. Onset of Chiari type 1 malformation: insights from a small series of intrauterine MR imaging cases. Neuroradiology 2023; 65:1387-1394. [PMID: 37329352 DOI: 10.1007/s00234-023-03183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 06/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Morphometric studies on idiopathic Chiari malformation type 1 (CM1) pathogenesis have been mainly based on post-natal neuroimaging. Prenatal clues related to CM1 development are lacking. We present pre- and post-natal imaging time course in idiopathic CM1 and assess fetal skull and brain biometry to establish if clues about CM1 development are present at fetal age. METHODS Multicenter databases were screened to retrieve intrauterine magnetic resonance (iuMR) of children presenting CM1 features at post-natal scan. Syndromes interfering with skull-brain growth were excluded. Twenty-two morphometric parameters were measured at fetal (average 24.4 weeks; range 21 to 32) and post-natal (average 15.4 months; range 1 to 45) age; matched controls were included. RESULTS Among 7000 iuMR cases, post-natal scans were available for 925, with postnatal CM1 features reported in seven. None of the fetuses presented CM1 features. Tonsillar descent was clear at a later post-natal scan in all seven cases. Six fetal parameters resulted to be statistically different between CM1 and controls: basal angle (p = 0.006), clivo-supraoccipital angle (p = 0.044), clivus' length (p = 0.043), posterior cranial fossa (PCF) width (p = 0.009), PCF height (p = 0.045), and PCFw/BPDb (p = 0.013). Postnatally, only the clivus' length was significant between CM1 cases and controls. CONCLUSION Pre- and post-natal CM1 cases did not share striking common features, making qualitative prenatal assessment not predictive; however, our preliminary results support the view that some of the pathogenetic basis of CM1 may be embedded to some extent already in intrauterine life.
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Affiliation(s)
- Giovanni Palumbo
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy.
| | - Filippo Arrigoni
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | - Denis Peruzzo
- Neuroimaging Unit, Scientific Institute, IRCCS "Eugenio Medea", Bosisio Parini, Lecco, Italy
| | - Cecilia Parazzini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
| | | | | | | | - Fabio Triulzi
- Neuroradiology Department, Fondazione IRRCS Ca' Granda Ospedale Policlinico Di Milano, Milan, Italy
| | - Andrea Righini
- Pediatric Radiology and Neuroradiology Department, Children's Hospital V. Buzzi, Via Castelvetro 32, 20154, Milan, Italy
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Pesapane F, Rotili A, Valconi E, Agazzi GM, Montesano M, Penco S, Nicosia L, Bozzini A, Meneghetti L, Latronico A, Pizzamiglio M, Rossero E, Gaeta A, Raimondi S, Pizzoli SFM, Grasso R, Carrafiello G, Pravettoni G, Cassano E. Women’s perceptions and attitudes to the use of AI in breast cancer screening: a survey in a cancer referral centre. Br J Radiol 2022; 96:20220569. [DOI: 10.1259/bjr.20220569] [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: 11/16/2022] Open
Abstract
Objective: Although breast cancer screening can benefit from Artificial Intelligence (AI), it is still unknown whether, to which extent or under which conditions, the use of AI is going to be accepted by the general population. The aim of our study is to evaluate what the females who are eligible for breast cancer screening know about AI and how they perceive such innovation. Methods: We used a prospective survey consisting of a 11-multiple-choice questionnaire evaluating statistical associations with Chi-Square-test or Fisher-exact-test. Multinomial-logistic-regression was performed on items with more than two response categories. Odds ratio (OR) with 95% CI were computed to estimate the probability of a specific response according to patient’s characteristics. Results: In the 800 analysed questionnaires, 51% of respondents confirmed to have knowledge of AI. Of these, 88% expressed a positive opinion about its use in medicine. Non-Italian respondents were associated with the belief of having a deep awareness about AI more often than Italian respondents (OR = 1.91;95% CI[1.10–3.33]). Higher education level was associated with better opinions on the use of AI in medicine (OR = 4.69;95% CI[1.36–16.12]). According to 94% of respondents, the radiologists should always produce their own report on mammograms, whilst 77% agreed that AI should be used as a second reader. Most respondents (52%) considered that both the software developer and the radiologist should be held accountable for AI errors. Conclusions: Most of the females undergoing screening in our Institute approve the introduction of AI, although only as a support to radiologist, and not in substitution thereof. Yet, accountability in case of AI errors is still unsolved. advances in knowledge: This survey may be considered as a pilot-study for the development of large-scale studies to understand females’s demands and concerns about AI applications in breast cancer screening.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Elena Valconi
- Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Therapeutic Advanced Technology, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milan, Italy
| | - Giorgio Maria Agazzi
- Diagnostic and Interventional Radiology Unit, Department of Diagnostic and Therapeutic Advanced Technology, Azienda Socio Sanitaria Territoriale Santi Paolo and Carlo Hospital, Milan, Italy
| | - Marta Montesano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Bozzini
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Antuono Latronico
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Eleonora Rossero
- Laboratorio dei Diritti Fondamentali, Collegio Carlo Alberto, Torino ER, Turin, Italy
| | - Aurora Gaeta
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | | | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology and Department of Health Sciences, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico and University of Milano, Milan, Italy
| | - Gabriella Pravettoni
- Dipartimento di Oncologia ed Emato Oncologia, Università degli studi di Milano, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
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Pesapane F, Agazzi GM, Rotili A, Ferrari F, Cardillo A, Penco S, Dominelli V, D'Ecclesiis O, Vignati S, Raimondi S, Bozzini A, Pizzamiglio M, Petralia G, Nicosia L, Cassano E. Prediction of the Pathological Response to Neoadjuvant Chemotherapy in Breast Cancer Patients With MRI-Radiomics: A Systematic Review and Meta-analysis. Curr Probl Cancer 2022; 46:100883. [PMID: 35914383 DOI: 10.1016/j.currproblcancer.2022.100883] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 12/30/2022]
Abstract
We performed a systematic review and a meta-analysis of studies using MRI-radiomics for predicting the pathological complete response in breast cancer patients undergoing neoadjuvant therapy , and we evaluated their methodological quality using the radiomics-quality-score (RQS). Random effects meta-analysis was performed pooling area under the receiver operating characteristics curves. Publication-bias was assessed using the Egger's test and visually inspecting the funnel plot. Forty-three studies were included in the qualitative review and 34 in the meta-analysis. Summary area under the receiver operating characteristics curve was 0,78 (95%CI:0,74-0,81). Heterogeneity according to the I2 statistic was substantial (71%) and there was no evidence of publication bias (P-value = 0,2). The average RQS was 12,7 (range:-1-26), with an intra-class correlation coefficient of 0.93 (95%CI:0.61-0.97). Year of publication, field intensity and synthetic RQS score do not appear to be moderators of the effect (P-value = 0.36, P-value = 0.28 and P-value = 0.92, respectively). MRI-radiomics may predict response to neoadjuvant therapy in breast cancer patients but the heterogeneity of the current studies is still substantial.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | | | - Anna Rotili
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Ferrari
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Cardillo
- Radiology Department, Università degli studi di Torino, Turin, Italy
| | - Silvia Penco
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Silvano Vignati
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Bozzini
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Luca Nicosia
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO European Institute of Oncology IRCCS, Milan, Italy
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Ravanelli M, Grammatica A, Squassina G, Bertagna F, Albano D, Lancini D, Bosio P, Zigliani A, Agazzi GM, Maroldi R, Nicolai P, Giubbini R, Piazza C, Farina D. Value of [18F]FDG PET-CT in the follow-up of surgically treated oral tongue squamous cell carcinoma: single centre cohort analysis on 87 patients. Nucl Med Rev Cent East Eur 2021; 24:58-62. [PMID: 34382669 DOI: 10.5603/nmr.2021.0016] [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: 10/13/2020] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the diagnostic performance of [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG-PET/CT) scan in detecting local recurrences in patients with surgically treated oral tongue squamous cell cancer (OTSCC). MATERIAL AND METHODS Eighty-seven patients who had undergone surgery for OTSCC were monitored clinically and [¹⁸F]FDGPET/CT and magnetic resonance (MR). PET uptakes were classified as functional (Type A), suspicious (Type B), or highly suggestive of local recurrence (Type C). A multidisciplinary team (MDT) evaluated case-by-case the surveillance strategy based on PET uptake. RESULTS Fifty-nine patients presented FDG-PET uptake during follow-up: this report was significantly more frequent in patients who received flap reconstruction than in those without (73% vs 50%; p = 0.05). In 13 patients with Type A (n = 1), Type B (n = 9), and Type C (n = 3) uptakes an additional MR was considered preferable and discovered recurrence in 12.PET-CT had 9 true positives, 17 false positives, 71 true negatives, and no false-negative, resulting in sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of 100%, 80.7%, 34.6%, and 100%. CONCLUSIONS The present results demonstrated a change in diagnostic strategy, as decided by the MDT, in about one-fifth of patients. The results should prompt in designing a rational surveillance schedule in surgically treated OTSCC.
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Affiliation(s)
- Marco Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Alberto Grammatica
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Guido Squassina
- Department of Radiology, University of Brescia, Brescia, Italy
| | | | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy.
| | - Davide Lancini
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Paolo Bosio
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Angelo Zigliani
- Department of Radiology, University of Brescia, Brescia, Italy
| | | | - Roberto Maroldi
- Department of Radiology, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Brescia, Italy
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Pesapane F, Rotili A, Penco S, Montesano M, Agazzi GM, Dominelli V, Trentin C, Pizzamiglio M, Cassano E. Inter-Reader Agreement of Diffusion-Weighted Magnetic Resonance Imaging for Breast Cancer Detection: A Multi-Reader Retrospective Study. Cancers (Basel) 2021; 13:cancers13081978. [PMID: 33924033 PMCID: PMC8073591 DOI: 10.3390/cancers13081978] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In order to evaluate the use of un-enhanced magnetic resonance imaging (MRI) for detecting breast cancer, we evaluated the accuracy and the agreement of diffusion-weighted imaging (DWI) through the inter-reader reproducibility between expert and non-expert readers. MATERIAL AND METHODS Consecutive breast MRI performed in a single centre were retrospectively evaluated by four radiologists with different levels of experience. The per-breast standard of reference was the histological diagnosis from needle biopsy or surgical excision, or at least one-year negative follow-up on imaging. The agreement across readers (by inter-reader reproducibility) was examined for each breast examined using Cohen's and Fleiss' kappa (κ) statistics. The Wald test was used to test the difference in inter-reader agreement between expert and non-expert readers. RESULTS Of 1131 examinations, according to our inclusion and exclusion criteria, 382 women were included (49.5 ± 12 years old), 40 of them with unilateral mastectomy, totaling 724 breasts. Overall inter-reader reproducibility was substantial (κ = 0.74) for expert readers and poor (κ = 0.37) for non- expert readers. Pairwise agreement between expert readers and non-expert readers was moderate (κ = 0.60) and showed a statistically superior agreement of the expert readers over the non-expert readers (p = 0.003). CONCLUSIONS DWI showed substantial inter-reader reproducibility among expert-level readers. Pairwise comparison showed superior agreement of the expert readers over the non-expert readers, with the expert readers having higher inter-reader reproducibility than the non-expert readers. These findings open new perspectives for prospective studies investigating the actual role of DWI as a stand-alone method for un-enhanced breast MRI.
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Affiliation(s)
- Filippo Pesapane
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
- Correspondence:
| | - Anna Rotili
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Silvia Penco
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Marta Montesano
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | | | - Valeria Dominelli
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Chiara Trentin
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Maria Pizzamiglio
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
| | - Enrico Cassano
- Radiology Department, Breast Imaging Division, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.R.); (S.P.); (M.M.); (V.D.); (C.T.); (M.P.); (E.C.)
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Agazzi GM, Ravanelli M, Roca E, Medicina D, Balzarini P, Pessina C, Vermi W, Berruti A, Maroldi R, Farina D. CT texture analysis for prediction of EGFR mutational status and ALK rearrangement in patients with non-small cell lung cancer. Radiol Med 2021; 126:786-794. [PMID: 33512651 DOI: 10.1007/s11547-020-01323-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 12/03/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To develop a CT texture-based model able to predict epidermal growth factor receptor (EGFR)-mutated, anaplastic lymphoma kinase (ALK)-rearranged lung adenocarcinomas and distinguish them from wild-type tumors on pre-treatment CT scans. MATERIALS AND METHODS Texture analysis was performed using proprietary software TexRAD (TexRAD Ltd, Cambridge, UK) on pre-treatment contrast-enhanced CT scans of 84 patients with metastatic primary lung adenocarcinoma. Textural features were quantified using the filtration-histogram approach with different spatial scale filters on a single 5-mm-thick central slice considered representative of the whole tumor. In order to deal with class imbalance regarding mutational status percentages in our population, the dataset was optimized using the synthetic minority over-sampling technique (SMOTE) and correlations with textural features were investigated using a generalized boosted regression model (GBM) with a nested cross-validation approach (performance averaged over 1000 resampling episodes). RESULTS ALK rearrangements, EGFR mutations and wild-type tumors were observed in 19, 28 and 37 patients, respectively, in the original dataset. The balanced dataset was composed of 171 observations. Among the 29 original texture variables, 17 were employed for model building. Skewness on unfiltered images and on fine texture was the most important features. EGFR-mutated tumors showed the highest skewness while ALK-rearranged tumors had the lowest values with wild-type tumors showing intermediate values. The average accuracy of the model calculated on the independent nested validation set was 81.76% (95% CI 81.45-82.06). CONCLUSION Texture analysis, in particular skewness values, could be promising for noninvasive characterization of lung adenocarcinoma with respect to EGFR and ALK mutations.
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Affiliation(s)
- Giorgio Maria Agazzi
- Department of Radiology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Marco Ravanelli
- Department of Radiology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Elisa Roca
- Department of Oncology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Daniela Medicina
- Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Piera Balzarini
- Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Carlotta Pessina
- Department of Radiology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - William Vermi
- Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Alfredo Berruti
- Department of Oncology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Maroldi R, Rondi P, Agazzi GM, Ravanelli M, Borghesi A, Farina D. Which role for chest x-ray score in predicting the outcome in COVID-19 pneumonia? Eur Radiol 2020; 31:4016-4022. [PMID: 33263159 PMCID: PMC7707903 DOI: 10.1007/s00330-020-07504-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/09/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022]
Abstract
Objective We aim to demonstrate that a chest X-ray (CXR) scoring system for COVID-19 patients correlates with patient outcome and has a prognostic value. Methods This retrospective study included CXRs of COVID-19 patients that reported the Brixia score, a semi-quantitative scoring system rating lung involvement from 0 to 18. The highest (H) and lowest (L) values were registered along with scores on admission (A) and end of hospitalization (E). The Brixia score was correlated with the outcome (death or discharge). Results A total of 953 patients met inclusion criteria. In total, 677/953 were discharged and 276/953 died during hospitalization. A total of 524/953 had one CXR and 429/953 had more than one CXR. H-score was significantly higher in deceased (median, 12; IQR 9–14) compared to that in discharged patients (median, 8; IQR 5–11) (p < 0.0001). In 429/953 patients with multiple CXR, A-score, L-score, and E-score were higher in deceased than in discharged patients (A-score 9 vs 8; p = 0.039; L-score 7 vs 5; p < 0.0003; E-score 12 vs 7; p < 0.0001). In the entire cohort, logistic regression showed a significant predictive value for age (p < 0.0001, OR 1.13), H-score (p < 0.0001, OR 1.25), and gender (p = 0.01, male OR 1.67). AUC was 0.863. In patients with ≥ 2 CXR, A-, L-, and E-scores correlated significantly with the outcome. Cox proportional hazards regression indicated age (p < 0.0001, HR 4.17), H-score (< 9, HR 0.36, p = 0.0012), and worsening of H-score vs A score > 3 (HR 1.57, p = 0.0227) as associated with worse outcome. Conclusions The Brixia score correlates strongly with disease severity and outcome; it may support the clinical decision-making, particularly in patients with moderate-to-severe signs and symptoms. The Brixia score should be incorporated in a prognostic model, which would be desirable, particularly in resource-constraint scenarios. Key Points • To demonstrate the importance of the Brixia score in assessing and monitoring COVID-19 lung involvement. • The Brixia score strongly correlates with patient outcome and can be easily implemented in the routine reporting of CXR.
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Affiliation(s)
- Roberto Maroldi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Paolo Rondi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Giorgio Maria Agazzi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
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Ravanelli M, Grammatica A, Maddalo M, Ramanzin M, Agazzi GM, Tononcelli E, Battocchio S, Bossi P, Vezzoli M, Maroldi R, Farina D. Pretreatment DWI with Histogram Analysis of the ADC in Predicting the Outcome of Advanced Oropharyngeal Cancer with Known Human Papillomavirus Status Treated with Chemoradiation. AJNR Am J Neuroradiol 2020; 41:1473-1479. [PMID: 32732272 DOI: 10.3174/ajnr.a6695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has increased in the period from the 1970s to 2004, due to increase of infection with human papilloma virus (HPV). This study aimed to examine the role of histogram analysis of the ADC in treatment response and survival prediction of patients with oropharyngeal squamous cell carcinoma and known human papillomavirus status. MATERIALS AND METHODS This was a retrospective single-center study. Following inclusion and exclusion criteria, data for 59 patients affected by T2-T4 (according to the 8th edition of the AJCC Cancer Staging Manual) oropharyngeal squamous cell carcinoma were retrieved. Twenty-eight had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 had human papillomavirus-negative oropharyngeal squamous cell carcinoma. All patients underwent a pretreatment MR imaging. Histogram analysis of ADC maps obtained by DWI (b = 0-1000 mm/s2) was performed on the central section of all of tumors. The minimum follow-up period was 2 years. Histogram ADC parameters were associated with progression-free survival and overall survival. Univariable and multivariable Cox models were applied to the data; P values were corrected using the Benjamini-Hochberg method. RESULTS At univariable analysis, both human papillomavirus status and mean ADC were associated with progression-free survival (hazard ratio = 0.267, P < .05, and hazard ratio = 1.0028, P ≤ .05, respectively), while only human papillomavirus status was associated with overall survival (hazard ratio = 0.213, P ≤ .05) before correction. At multivariable analysis, no parameter was included (in fact, human papillomavirus status lost significance after correction). If we separated the patients into 2 subgroups according to human papillomavirus status, ADC entropy was associated with overall survival in the human papillomavirus-negative group (hazard ratio = 4.846, P = .01). CONCLUSIONS ADC and human papillomavirus status are related to progression-free survival in patients treated with chemoradiation for advanced oropharyngeal squamous cell carcinoma; however, this association seems to result from the strong association between ADC and human papillomavirus status.
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Affiliation(s)
- M Ravanelli
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | | | | | - M Ramanzin
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - G M Agazzi
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - E Tononcelli
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | | | | | - M Vezzoli
- Molecular and Translational Medicine (M.V.), University of Brescia, Brescia, Italy
| | - R Maroldi
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
| | - D Farina
- From the Departments of Radiology (M. Ravanelli, M. Ramanzin, G.M.A., E.T., R.M., D.F.)
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9
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Suter MB, Pesapane F, Agazzi GM, Gagliardi T, Nigro O, Bozzini A, Priolo F, Penco S, Cassano E, Chini C, Squizzato A. Diagnostic accuracy of contrast-enhanced spectral mammography for breast lesions: A systematic review and meta-analysis. Breast 2020; 53:8-17. [PMID: 32540554 PMCID: PMC7375655 DOI: 10.1016/j.breast.2020.06.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022] Open
Abstract
Breast cancer diagnosis and staging is based on mammography, ultrasound, and magnetic resonance imaging (MRI). Contrast enhanced spectral mammography (CESM) has gained momentum as an innovative and clinically useful method for breast assessment. CESM is based on abnormal enhancement of neoplastic tissue compared to surrounding breast tissue. We performed a systematic review of prospective trial to evaluate its diagnostic performance, following standard PRISMA-DTA. We used a bivariate random-effects regression approach to obtain summary estimates of both sensitivity and specificity of CESM. 8 studies published between 2003 and 2019 were included in the meta-analysis for a total of 945 lesions. The summary area under the curve obtained from all the study was 89% [95% CI 86%-91%], with a sensitivity of 85% [95% CI 73%-93%], and a specificity of 77% [95% CI 60%-88%]. With a pre-test probability of malignancy of 57% a positive finding at CESM gives a post-test probability of 83% while a negative finding a post-test probability of 20%. CESM shows a suboptimal sensitivity and specificity in the diagnosis of breast cancer in a selected population, and at present time, it could be considered only as a possible alternative test for breast lesions assessment when mammography and ultrasound are not conclusive or MRI is contraindicated or not available.
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Affiliation(s)
| | - Filippo Pesapane
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Giorgio Maria Agazzi
- University of Brescia, Department of Radiology, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Tania Gagliardi
- Department of Radiology, Royal Marsden Hospital, London, UK.
| | - Olga Nigro
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
| | - Anna Bozzini
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Francesca Priolo
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Silvia Penco
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Enrico Cassano
- IEO - European Institute of Oncology IRCCS, Breast Imaging Division, Via Giuseppe Ripamonti 435, Milan, Italy.
| | - Claudio Chini
- Medical Oncology, ASST Sette Laghi, Viale Borri 57, Varese, Italy.
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10
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Ferrara R, Imbimbo M, Paget-Bailly S, Malouf R, Calais F, Agazzi GM, Marchal C, Westeel V. Single or combined immune checkpoint inhibitors compared to first-line chemotherapy with or without bevacizumab for people with advanced non-small cell lung cancer. Hippokratia 2019. [DOI: 10.1002/14651858.cd013257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Roberto Ferrara
- Fondazione IRCSS Istituto Nazionale dei Tumori; Thoracic Oncology Unit; Milano Milano Italy 20133
| | - Martina Imbimbo
- Fondazione IRCSS Istituto Nazionale dei Tumori; Thoracic Oncology Unit; Milano Milano Italy 20133
| | - Sophie Paget-Bailly
- University Hospital of Besançon; Methodological and Quality of Life in Oncology Unit; 2 Place Saint Jacques Besançon France 25030
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France 25000
| | - Reem Malouf
- University of Oxford; National Perinatal Epidemiology Unit (NPEU); Old Road Campus Oxford UK OX3 7LF
| | - François Calais
- University of Franche-Comté; University Library; Besançon France
| | - Giorgio Maria Agazzi
- University of Brescia; Department of Radiology; P.le Spedali Civili 1 Brescia Italy
| | - Corynne Marchal
- University Hospital of Besançon; Department of Thoracic Oncology; 2, Boulevard Alexandre Fleming Besançon France 25030
| | - Virginie Westeel
- University Hospital of Besançon; Methodological and Quality of Life in Oncology Unit; 2 Place Saint Jacques Besançon France 25030
- Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique; Besançon France 25000
- University Hospital of Besançon; Department of Thoracic Oncology; 2, Boulevard Alexandre Fleming Besançon France 25030
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Ravanelli M, Grammatica A, Tononcelli E, Morello R, Leali M, Battocchio S, Agazzi GM, Buglione di Monale E Bastia M, Maroldi R, Nicolai P, Farina D. Correlation between Human Papillomavirus Status and Quantitative MR Imaging Parameters including Diffusion-Weighted Imaging and Texture Features in Oropharyngeal Carcinoma. AJNR Am J Neuroradiol 2018; 39:1878-1883. [PMID: 30213805 DOI: 10.3174/ajnr.a5792] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of Oropharyngeal Squampus Cell Carcinoma (OPSCC) cases is increasing especially in the Western countries due to the spreading of human papilloma virus (HPV) infection. Radiological investigations, MRI in particular, are used in the daily clinical practice to stage OPSCC. The aim of this study was to investigate the association of quantitative MR imaging features including diffusion-weighted imaging and human papillomavirus status in oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS We retrospectively analyzed 59 patients with untreated histologically proved T2-T4 oropharyngeal squamous cell carcinoma. Human papillomavirus status was determined by viral DNA detection on tissue samples. MR imaging protocol included T2-weighted, contrast-enhanced T1-weighted (volumetric interpolated brain examination), and DWI sequences. Parametric maps of apparent diffusion coefficient were obtained from DWI sequences. Texture analysis was performed on T2 and volumetric-interpolated brain examination sequences and on ADC maps. Differences in quantitative MR imaging features between tumors positive and negative for human papillomavirus and among subgroups of patients stratified by smoking status were tested using the nonparametric Mann-Whitney U test; the false discovery rate was controlled using the Benjamini-Hochberg correction; and a predictive model for human papillomavirus status was built using multivariable logistic regression. RESULTS Twenty-eight patients had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 patients had human papillomavirus-negative oropharyngeal squamous cell carcinoma. Tumors positive for human papillomavirus had a significantly lower mean ADC compared with those negative for it (median, 850.87 versus median, 1033.68; P < .001). Texture features had a lower discriminatory power for human papillomavirus status. Skewness on volumetric interpolated brain examination sequences was significantly higher in the subgroup of patients positive for human papillomavirus and smokers (P = .003). A predictive model based on smoking status and mean ADC yielded a sensitivity of 83.3% and specificity 92.6% in classifying human papillomavirus status. CONCLUSIONS ADC is significantly lower in oropharyngeal squamous cell carcinoma positive for human papillomavirus compared with oropharyngeal squamous cell carcinoma negative for it. ADC and smoking status allowed noninvasive prediction of human papillomavirus status with a good accuracy. These results should be validated and further investigated on larger prospective studies.
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Affiliation(s)
- M Ravanelli
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - A Grammatica
- Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - E Tononcelli
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - R Morello
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.).,Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - M Leali
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | | | - G M Agazzi
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | | | - R Maroldi
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - P Nicolai
- Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - D Farina
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
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12
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Amoroso V, Fazio N, Mosca A, Roca E, Spada F, Foroni C, Agazzi GM, Berruti A. When Should Everolimus Be Administered in the Natural History of Pancreatic Neuroendocrine Tumors? J Clin Oncol 2017; 35:1487-1488. [DOI: 10.1200/jco.2016.71.0103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vito Amoroso
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Nicola Fazio
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Alessandra Mosca
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Elisa Roca
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Francesca Spada
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Chiara Foroni
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Giorgio Maria Agazzi
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Vito Amoroso, University of Brescia at ASST Spedali Civili, Brescia, Italy; Nicola Fazio, European Institute of Oncology, Milan, Italy; Alessandra Mosca, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy; Elisa Roca, University of Brescia at ASST Spedali Civili, Brescia, Italy; Francesca Spada, European Institute of Oncology, Milan, Italy; and Chiara Foroni, Giorgio Maria Agazzi, and Alfredo Berruti, University of Brescia at ASST Spedali Civili, Brescia, Italy
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13
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Amoroso V, Agazzi GM, Roca E, Fazio N, Mosca A, Ravanelli M, Spada F, Maroldi R, Berruti A. Regression of advanced neuroendocrine tumors among patients receiving placebo. Endocr Relat Cancer 2017; 24:L13-L16. [PMID: 27965278 DOI: 10.1530/erc-16-0475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/13/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Vito Amoroso
- Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy )
| | - Giorgio Maria Agazzi
- Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, Radiology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Elisa Roca
- Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Nicola Fazio
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine TumorsEuropean Institute of Oncology, Milan, Italy
| | - Alessandra Mosca
- Medical Oncology UnitMaggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, Radiology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Francesca Spada
- Unit of Gastrointestinal Medical Oncology and Neuroendocrine TumorsEuropean Institute of Oncology, Milan, Italy
| | - Roberto Maroldi
- Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, Radiology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, Medical Oncology Unit, University of Brescia at ASST Spedali Civili, Brescia, Italy
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Paget-Bailly S, Paulus V, Pana-Katatali H, Agazzi GM, Trinquart L, Calais F, Westeel V. Maintenance therapy for advanced non-small cell lung cancer (NSCLC). Hippokratia 2015. [DOI: 10.1002/14651858.cd011631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sophie Paget-Bailly
- University Hospital of Besançon; Methodological and Quality of Life in Oncology Unit; 2 Place Saint Jacques Besançon France 25030
| | - Valérie Paulus
- University Hospital of Besançon; Thoracic Oncology; 3, Boulevard Alexandre Fleming Besançon France 25030
| | - Héloïse Pana-Katatali
- University Hospital of Besançon; Thoracic Oncology; 3, Boulevard Alexandre Fleming Besançon France 25030
| | | | | | - François Calais
- University of Franche-Comté; University Library; Besançon France
| | - Virginie Westeel
- University Hospital of Besançon; Thoracic Oncology; 3, Boulevard Alexandre Fleming Besançon France 25030
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