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Salvestrini V, Valzano M, Meattini I, Becherini C, Visani L, Francolini G, Morelli I, Bertini N, Orzalesi L, Bernini M, Bianchi S, Simontacchi G, Livi L, Desideri I. Anatomical assessment of local recurrence site in breast cancer patients after breast reconstruction and post-mastectomy radiotherapy: implications for radiation volumes and techniques. Radiol Med 2024:10.1007/s11547-024-01812-z. [PMID: 38602657 DOI: 10.1007/s11547-024-01812-z] [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] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Post-mastectomy radiotherapy (PMRT) improves local control rates and survival in patients with adverse prognostic features. The dose coverage to target volumes is critical to yield maximum benefit to treated patients, increasing local control and reducing risk of toxicity. This study aims to assess patterns of breast cancer relapse in patients treated with mastectomy, breast reconstruction and PMRT. METHODS Breast cancer patients treated with PMRT between 1992 and 2017 were retrospectively reviewed. Clinical and pathological characteristics of patients were collected. Recurrences were defined as "in field," "marginal" or "out of field." Survival analyses were performed in relation to progression-free survival (PFS) and overall survival (OS). Correlation between baseline features was explored. RESULTS Data of 140 patients are collected. After a median follow-up time of 72 months, median PFS and OS of 63 and 74 months were detected, respectively. Neoadjuvant chemotherapy, lympho-vascular space invasion (LVI) and size of primary tumor were all significantly associated with worst PFS and OS. Ten patients developed local recurrence: 30% "in field," 30% marginal recurrences, 20% "out of field" and 20% both "in field" and "out of field." No recurrence was detected under the expander, 80% above the device and 20% patients relapsed on IMN chain. The mean distant relapse-free survival was 39 months. Overall, 39 of 140 patients developed distant metastases. CONCLUSIONS The onset of local-regional relapses occurred mainly above the expander/prosthesis, underlying the importance of inclusion of the subcutaneous tissues within the target volume. In order to refine new contouring recommendations for PMRT and breast reconstruction, future prospective studies are needed.
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Affiliation(s)
- Viola Salvestrini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy.
| | - Marianna Valzano
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Luca Visani
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Ilaria Morelli
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Niccolò Bertini
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Oncology Department, Careggi University Hospital, Viale Morgagni 85, 50134, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
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Bernini M, Gigliucci G, Cassetti D, Tommasi C, Gaggelli I, Arlia L, Becherini C, Salvestrini V, Visani L, Nori Cucchiari J, De Benedetto D, Di Naro F, Bicchierai G, Bellini C, Bianchi S, Orzalesi L, Livi L, Meattini I. Pre-pectoral breast reconstruction with tissue expander entirely covered by acellular dermal matrix: feasibility, safety and histological features resulting from the first 64 procedures. Gland Surg 2024; 13:297-306. [PMID: 38601291 PMCID: PMC11002490 DOI: 10.21037/gs-23-432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024]
Abstract
Background Reconstructive options that can be used following conservative mastectomy, skin-, nipple-sparing and skin-reducing mastectomies, allow a remarkable variety of safe methods to restore the natural shape and aesthetics of the breast mound. In case of two-stage breast reconstruction, tissue expanders (TEs) are usually placed in a subpectoral position. The purpose of this retrospective cohort study is to evaluate the feasibility and safety of two-step reconstruction with TE in pre-pectoral position covered by acellular dermal matrix (ADM). Methods Between March 2021 and May 2023, at the Azienda Ospedaliero Universitaria Careggi, University of Florence, 55 patients with BRCA 1/2 mutations or early breast cancer underwent conservative mastectomy with immediate pre-pectoral reconstruction using TE covered with ADM, followed by a second surgery with replacement of the expander with definitive prosthesis. Demographic, oncological, and histological data along with surgical complications were recorded. Results A total of 64 conservative mastectomies were performed. In 2 patients (3.1%) complications were found that required reintervention and, in both cases, the TE had to be removed. Two patients developed hematoma and one patient developed seroma. Two patients showed wound dehiscence, both healed after conservative treatment and without implant exposure. No case of necrosis of the skin or nipple-areola complex has been observed, neither of capsular contracture. Capsule formed around TE was populated with cells and blood vessels and showed a thin area of synovial metaplasia. Conclusions In selected cases it may be more cautious to perform a two-stage breast reconstruction after radical breast surgery by means of TEs. The placement of TEs in pre-pectoral position combines the excellent aesthetic and functional results of the pre-pectoral philosophy with a quite safer and more prudent two-step approach. Our experience reports optimistic results: the ADM covering the TE is seen successfully integrating during tissue expansion and becoming a vascularised new self-tissue. Complications rates are low and such ADM-assisted two-stage pre-pectoral reconstructive technique is a safe, practical, and reproducible method.
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Affiliation(s)
- Marco Bernini
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Giacomo Gigliucci
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Dario Cassetti
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Cinzia Tommasi
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Ilaria Gaggelli
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Lorenzo Arlia
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Carlotta Becherini
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Viola Salvestrini
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luca Visani
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jacopo Nori Cucchiari
- Diagnostic Senology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Chiara Bellini
- Diagnostic Senology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Simonetta Bianchi
- Pathology Division, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi - University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Icro Meattini
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Bianchi S, Caini S, Vezzosi V, Orzalesi L, Piovesan L, Mantellini P, Ambrogetti D. Upgrade rate to malignancy of uncertain malignant potential breast lesions (B3 lesions) diagnosed on vacuum-assisted biopsy (VAB) in screen detected microcalcifications: Analysis of 366 cases from a single institution. Eur J Radiol 2024; 170:111258. [PMID: 38091661 DOI: 10.1016/j.ejrad.2023.111258] [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: 10/20/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE We retrospectively investigated clinical, radiological, and pathological features of B3 lesions associated with the risk of subsequent upgrade to malignancy. METHODS We included consecutive vacuum-assisted biopsies (VABs) performed during 2011-2020 on suspicious microcalcifications not associated with other radiological signs diagnosed as B3 lesions and followed by surgical excision (SE) with definitive histological examination. Multiple logistic regression models were fitted to identify independent predictors of malignancy. RESULTS Out of the 366 B3 lesions included, 56 (15.3 %, 95 % CI 11.8-19.4 %) had upgraded to malignancy at SE: of these, 42/366 (11.5 %, 95 % CI 8.4-15.2 %) and 14/366 (3.8 %, 95 % CI 2.1-6.3 %) were in situ and invasive carcinoma, respectively. At univariate analysis, variables positively associated with upgrade to malignancy were age ≥ 60 years (p = 0.008), mixed morphology (p = 0.018), scattered distribution (p = 0,001), extension of microcalcifications > 10 mm (p = 0.001), and mixed B3 lesion (p = 0.017). Among B3 subtypes, the highest rates of upgrade were observed for AIDEP, LCIS/LIN2, FEA + AIDEP, FEA + LCIS/LIN2, and FEA + AIDEP + LCIS/LIN2 (24.6 %, 21.4 %, 25.3 %, 20.0 % and 40.0 % respectively), while FEA and ALH/LIN1 had a lower rates of upgrade (7.5 % and 3.7 %, respectively). Multiple logistic regression analysis confirmed as risk factors older age (p = 0.029), larger extension (p = 0.001) and mixed morphology (p = 0.007) of microcalcifications, AIDEP (p = 0.011) among pure B3 lesions, and FEA + AIDEP (p = 0.001) and FEA + AIDEP + LCIS/LIN2 (p = 0.037) among mixed B3 lesions. CONCLUSIONS Based on our findings, vacuum-assisted excision is reasonable as definitive management for FEA and ALH/LIN1, while SE should remain the mainstay of treatment for AIDEP and LCIS/LIN2, whose upgrade rates are too high to safely recommend VAE.
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Affiliation(s)
- Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Vania Vezzosi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Division of Breast Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luisa Piovesan
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Paola Mantellini
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Daniela Ambrogetti
- Breast Cancer Screening Branch, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
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Rago A, Palumbo G, Tordi A, Bianchi S, Offidani M, di Toritto TC. A synchronous therapy with daratumumab and enzymatic replacement therapy (ERT) in a patient with Gaucher disease and multiple myeloma. Ann Hematol 2023; 102:2977-2978. [PMID: 37432414 DOI: 10.1007/s00277-023-05319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Affiliation(s)
- A Rago
- Haematology Unit, ASL ROMA 1, Rome, Italy.
| | - G Palumbo
- Department of Translational and Precision Medicine, Haematology, A.O.U Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - A Tordi
- Haematology Unit, ASL ROMA 1, Rome, Italy
| | - S Bianchi
- Department of Translational and Precision Medicine, Haematology, A.O.U Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Bellini C, Nori Cucchiari J, Di Naro F, De Benedetto D, Bicchierai G, Franconeri A, Renda I, Bianchi S, Susini T. Breast Lesions of Uncertain Malignant Potential (B3) and the Risk of Breast Cancer Development: A Long-Term Follow-Up Study. Cancers (Basel) 2023; 15:3521. [PMID: 37444630 DOI: 10.3390/cancers15133521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Breast lesions of uncertain malignant potential (B3) are frequently diagnosed in the era of breast cancer (BC) screening and their management is controversial. They are generally removed surgically, but some international organizations and guidelines for breast research suggest follow-up care alone or, more recently, propose vacuum-assisted excision (VAE). The risk of upgrade to BC is known, but very little data exist on its role as risk factor for future BC development. We analyzed 966 B3 lesions diagnosed at our institution, 731 of which had long-term follow-up available. Surgical removal was performed in 91%, VAE in 3.8%, and follow-up in 5.2% of cases. The B3 lesions included flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), lobular intraepithelial neoplasia (LIN), atypical papillary lesions (PLs), radial scars (RSs), and others. Overall, immediate upgrade to BC (invasive or in situ) was 22.7%. After long-term follow-up, 9.2% of the patients were diagnosed with BC in the same or contralateral breast. The highest risk was associated with ADH diagnosis, with 39.8% of patients upgraded and 13.6% with a future BC diagnosis (p < 0.0001). These data support the idea that B3 lesions should be removed and provide evidence to suggest annual screening mammography for women after a B3 diagnosis because their BC risk is considerably increased.
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Affiliation(s)
- Chiara Bellini
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Jacopo Nori Cucchiari
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Andrea Franconeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Irene Renda
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Simonetta Bianchi
- Pathology Unit, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Tommaso Susini
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50121 Florence, Italy
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Niccolai E, Baldi S, Nannini G, Gensini F, Papi L, Vezzosi V, Bianchi S, Orzalesi L, Ramazzotti M, Amedei A. Breast cancer: the first comparative evaluation of oncobiome composition between males and females. Biol Sex Differ 2023; 14:37. [PMID: 37277847 DOI: 10.1186/s13293-023-00523-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Emerging evidence suggests that breast microbiota dysbiosis contributes to cancer initiation, progression, prognosis and treatment efficacy. Anyway, available data are referred only to female patients, and studies on males are completely missing. Male breast cancer (MBC) is 70-100 times less frequent, but the mortality rate adjusted to incidence is higher in men than in females. Currently, MBC diagnostic approaches and treatments have generally been extrapolated from the clinical experience gained in women, while few studies focus on characterizing male cancer biology. Taking into account the rising importance of the oncobiome field and the need of MBC targeted studies, we explored the breast cancer oncobiome of male and female patients. METHODS 16S rRNA gene sequencing was performed in 20 tumor and 20 non-pathological adjacent FFPE breast tissues from male and female patients. RESULTS We documented, for the first time, the presence of a sexually dimorphic breast-associated microbiota, here defined as "breast microgenderome". Moreover, the paired analysis of tumor and non-pathological adjacent tissues suggests the presence of a cancer-associated dysbiosis in male patients, with surrounding tissue conserving a healthier microbiome, whereas in female patients, the entire breast tissue is predisposed to cancer development. Finally, the phylum Tenericutes, especially the genera Mesoplasma and Mycobacterium, could to be involved in breast carcinogenesis, in both sexes, deserving further investigation, not only for its role in cancer development but even as potential prognostic biomarker. CONCLUSIONS Breast microbiota characterization can enhance the understanding of male breast cancer pathogenesis, being useful for detection of new prognostic biomarkers and development of innovative personalized therapies, remarking the relevant gender differences.
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Affiliation(s)
- Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesca Gensini
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Laura Papi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Vania Vezzosi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Orzalesi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
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Susini T, Nesi I, Renda I, Giani M, Nori J, Vanzi E, Bianchi S. Reducing the Use of Frozen Section for Sentinel Node Biopsy in Breast Carcinoma: Feasibility and Outcome. Anticancer Res 2023; 43:2161-2170. [PMID: 37097648 DOI: 10.21873/anticanres.16378] [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: 02/02/2023] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/AIM Sentinel lymph node biopsy (SLNB) is a standard practice for staging the axilla in breast cancer. Initially, intraoperative frozen section (FS) examination was used but was time-consuming and often provided false-negative results. Delayed permanent section (PS) analysis is currently performed; FS-SLNB is maintained for selected high-risk cases. The aim of this study was to evaluate the feasibility of this approach. PATIENTS AND METHODS All patients with breast cancer with clinically negative lymph nodes undergoing SLNB at our institution from 2004 to 2020 were analyzed, comparing operative time, re-operation rate and clinical outcome in terms of regional lymphatic recurrence-free and overall survival by type of SLNB (FS vs. PS). RESULTS FS-SLNB comprised 100% of the procedures in 2004 and 18.2% at the end of the study period. The use of PS-SLNB instead of FS-SLNB was associated with a significantly reduced rate of axillary dissection (AD): 4.4% vs. 27.2, respectively (p<0.001). There was no significant difference in re-operation rate for AD: 3.9% vs. 6.9%, respectively (p=0.20). The use of PS-SLNB significantly reduced the operative time (mean=51 minutes) (p<0.001). After a mean follow-up of 70.9 months (range=16-180 months) there were no differences in regional lymphatic recurrence free or overall survival. CONCLUSION The reduced use of FS-SLNB resulted in a significantly lower rate of AD, and significant operative time and costs savings, without any increase in the reoperation rate and lymphatic recurrences. Therefore, this approach is feasible, safe and beneficial, both for patients and healthcare services.
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Affiliation(s)
- Tommaso Susini
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy;
| | - Ilaria Nesi
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Irene Renda
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Milo Giani
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Pathology Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Bicchierai G, Pugliese F, Amato F, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cossu E, Miele V, Nori J. Percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions): a preliminary single-centre Italian experience. Radiol Med 2023; 128:528-536. [PMID: 37029852 DOI: 10.1007/s11547-023-01626-5] [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] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/27/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE In recent years vacuum-assisted excision (VAE) has been described as an alternative treatment for some B3 lesions. This study aims to assess the effectiveness of using VAE to manage selected B3 lesions by quantifying the number of B3 lesions undergoing VAE, the malignant upgrade rate, and the complications encountered. MATERIALS AND METHODS Our department evaluated all B3 lesions diagnosed between January 2019 and October 2021 and treated them with VAE. The data were collected during the initial biopsy and final histology based on VAE image guidance, also considering initial lesions and complications. The exclusion criteria were: B3 lesion of size > 20 mm, presence of a concomitant malignant lesion, lesion < 5.0 mm distant from the skin, nipple or pectoral muscle, phyllodes tumours or indeterminate B3 lesions. Lesions that upgraded to malignancy underwent surgical excision, while benign lesions performed radiological follow-ups. RESULTS From 416 B3 lesions diagnosed, 67 (16.1%) underwent VAE. VAE was performed under X-ray (50/67) or ultrasound guidance (17/67). Five cases (7.5%) upgraded to a malignant lesion, 2 ADH, 2 LIN and one papillary lesion that underwent surgery. No malignancy or new lesions has occurred at the site of the VAE, with an average radiological follow-up of 14.9 months. CONCLUSIONS VAE could be a safe and effective pathway for managing selected B3 lesions. Lesions initially subjected to CNB with ADH and LN outcome, before undergoing VAE, should perform a VAB for better tissue characterization and management.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy.
| | - Francesca Pugliese
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Elsa Cossu
- Diagnostic and Interventional Imaging, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, FlorenceFlorence, Italy
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Banini M, Valzano M, Becherini C, Visani L, Scoccimarro E, Salvestrini V, Lorenzetti V, Frosini G, Peruzzi A, Orzalesi L, Nori J, Bianchi S, Livi L, Meattini I. P106 De-escalation of radiation therapy after primary systemic therapy in non-metastatic breast cancer: patterns of recurrence from a real-world single-centre cohort of patients. Breast 2023. [DOI: 10.1016/s0960-9776(23)00223-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Grisanti S, Borghetti P, Bianchi S, Vultaggio C, Mandruzzato M, Facheris G, Fassi E, Ammoni L, Baggi A, Prina MM, Magrini S, Berruti A. 167P Five-years incidence of SCLC and analysis of PM2.5 air pollution in the province of Brescia: Preliminary results. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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11
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Bianchi S, Muñoz-Martin I, Covi E, Bricalli A, Piccolboni G, Regev A, Molas G, Nodin JF, Andrieu F, Ielmini D. A self-adaptive hardware with resistive switching synapses for experience-based neurocomputing. Nat Commun 2023; 14:1565. [PMID: 36944647 PMCID: PMC10030830 DOI: 10.1038/s41467-023-37097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
Neurobiological systems continually interact with the surrounding environment to refine their behaviour toward the best possible reward. Achieving such learning by experience is one of the main challenges of artificial intelligence, but currently it is hindered by the lack of hardware capable of plastic adaptation. Here, we propose a bio-inspired recurrent neural network, mastered by a digital system on chip with resistive-switching synaptic arrays of memory devices, which exploits homeostatic Hebbian learning for improved efficiency. All the results are discussed experimentally and theoretically, proposing a conceptual framework for benchmarking the main outcomes in terms of accuracy and resilience. To test the proposed architecture for reinforcement learning tasks, we study the autonomous exploration of continually evolving environments and verify the results for the Mars rover navigation. We also show that, compared to conventional deep learning techniques, our in-memory hardware has the potential to achieve a significant boost in speed and power-saving.
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Affiliation(s)
- S Bianchi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano and IUNET, Milano, 20133, Italy
- Infineon Technologies, Villach, Austria
| | - I Muñoz-Martin
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano and IUNET, Milano, 20133, Italy
- Infineon Technologies, Villach, Austria
| | - E Covi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano and IUNET, Milano, 20133, Italy
- NaMLab gGmbH, Dresden, Germany
| | | | | | - A Regev
- Weebit Nano, Hod Hasharon, Israel
| | - G Molas
- Weebit Nano, Hod Hasharon, Israel
| | - J F Nodin
- Univ. Grenoble Alpes, CEA, Leti, F-38000, Grenoble, France
| | - F Andrieu
- Univ. Grenoble Alpes, CEA, Leti, F-38000, Grenoble, France
| | - D Ielmini
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano and IUNET, Milano, 20133, Italy.
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Meattini I, Francolini G, Cataldo VD, Visani L, Becherini C, Scoccimarro E, Mangoni M, Salvestrini V, Masi L, Bellini C, Doro R, Naro FD, Bernini M, Nori J, Orzalesi L, Bianchi S, Livi L. Abstract PD3-03: Preoperative robotic radiosurgery for early breast cancer: results of the phase II ROCK trial (NCT03520894). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd3-03] [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: 03/06/2023]
Abstract
Abstract
Introduction. Breast-conserving surgery (BCS) followed by postoperative radiotherapy (RT) still represents the standard of care for early breast cancer (BC) patients. Hypofractionated schedules in maximum 15 fractions are currently accepted as the gold standard for external beam whole and partial breast irradiation (PBI). PBI for selected early BC patients allowed a shorter overall treatment duration and an improved patient compliance as compared to old-fashioned RT schedules. Preoperative PBI, due to the advantage of treating a well-defined volume, has been gaining attention in this multidisciplinary scenario. It avoids local treatment delay and might allow tumour downstaging with increased rates of BCS and improved cosmetic outcomes. Since local recurrence might be driven by biological mechanisms of radioresistance rather than geographical miss, higher dose per fraction may overcome repair mechanisms allowing tumoral cells to escape from conventional RT damage. We report the results of the phase II ROCK trial (NCT03520894), enrolling early BC patients treated with preoperative robotic radiosurgery (prRS), in terms of acute and early late toxicity, disease control, and cosmesis. Material and methods. The study recruited between August 2018 and September 2021 at the Radiation Oncology Unit of the University of Florence (Florence, Italy). Eligible patients were women aged 50+ years, with histologically proven invasive early BC, HR+/HER2- disease, without lymph vascular invasion, tumour size up to 25 mm suitable for BCS. Exclusion criteria were clinical node positive disease, multiple foci tumours, and patients with breast lesion limiting within 5 mm from the skin surface. The study aimed to prospectively assess the safety and feasibility of a single Cyberknife® (Accuray Incorporated, Sunnyvale, CA, USA) 21Gy-fraction prRS in preoperative setting, and to identify predictive factors for outcomes based on biologic and clinical features. The primary endpoint was the acute skin toxicity (from the end of prRS to surgery) according to the RTOG and the EORTC scales. Secondary endpoints were the rate of early late skin and non-skin toxicity as measured 90 days from the end of prRS, the rate of pathological complete response (pCR) according to Chevalier score. Cosmetic outcomes were prospectively scored every 6-month using the BCCT.core software. Results. From August 2018 to September 2021, a total of 70 patients were recruited and enrolled. Of those, 41 were excluded due to tumour biology exclusion criteria and 7 due to multiple foci breast disease evidenced at basal MRI. Therefore, 22 patients were successfully treated with pRS. Median age at diagnosis was 68 years (range 50-86), median tumour size was 14 mm (range 7.5-25). Required target dosimetric parameters were met in all patients, as well as normal tissue constraints. Patients received surgery after a median time of 29 days from biopsy, without any delay or postoperative complication. Overall, three G1 adverse events (13.6%) were recorded within 7 days from prRS (1 erythema, 2 breast pain). Three events (13.6%) were recorded between 7 and 30 days from prRS, one G2 breast oedema and two G1 breast pain. No acute toxicity greater than G2 was recorded. Five patients experienced early late G1 toxicity (1 breast pain, 4 breast induration). One patient reported G2 breast induration. No early late toxicity greater than G2 was observed. At a median follow up of 18 months (range 6-29.8), cosmetic results were scored excellent/good and fair in 14 and 5 patients, respectively, while 3 patients experienced a poor cosmetic outcome. Overall, pCR after surgery was reported in 2 patients (9%). Two patients received postoperative whole breast irradiation, according to histopathological results. Conclusions. ROCK trial showed that a single 21 Gy dose prRS represents a feasible technique for selected patients affected by early BC, showing a good safety profile and a promising effectiveness.
Citation Format: Icro Meattini, Giulio Francolini, Vanessa Di Cataldo, Luca Visani, Carlotta Becherini, Erika Scoccimarro, Monica Mangoni, Viola Salvestrini, Laura Masi, Chiara Bellini, Raffaela Doro, Federica Di Naro, Marco Bernini, Jacopo Nori, Lorenzo Orzalesi, Simonetta Bianchi, Lorenzo Livi. Preoperative robotic radiosurgery for early breast cancer: results of the phase II ROCK trial (NCT03520894) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD3-03.
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Affiliation(s)
- Icro Meattini
- 1Florence University Hospital and Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence
| | | | | | | | | | | | - Monica Mangoni
- 7Florence University Hospital and Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence
| | | | | | - Chiara Bellini
- 10Florence University Hospital and Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence
| | | | | | | | | | | | | | - Lorenzo Livi
- 17Florence University Hospital and Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence
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13
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Cserni B, Kilmartin D, O’Loughlin M, Andreu X, Bagó-Horváth Z, Bianchi S, Chmielik E, Figueiredo P, Floris G, Foschini MP, Kovács A, Heikkilä P, Kulka J, Laenkholm AV, Liepniece-Karele I, Marchiò C, Provenzano E, Regitnig P, Reiner A, Ryška A, Sapino A, Stovgaard ES, Quinn C, Zolota V, Webber M, Glynn SA, Bori R, Csörgő E, Oláh-Németh O, Pancsa T, Sejben A, Sejben I, Vörös A, Zombori T, Nyári T, Callagy G, Cserni G. ONEST (Observers Needed to Evaluate Subjective Tests) Analysis of Stromal Tumour-Infiltrating Lymphocytes (sTILs) in Breast Cancer and Its Limitations. Cancers (Basel) 2023; 15:cancers15041199. [PMID: 36831541 PMCID: PMC9954449 DOI: 10.3390/cancers15041199] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Tumour-infiltrating lymphocytes (TILs) reflect antitumour immunity. Their evaluation of histopathology specimens is influenced by several factors and is subject to issues of reproducibility. ONEST (Observers Needed to Evaluate Subjective Tests) helps in determining the number of observers that would be sufficient for the reliable estimation of inter-observer agreement of TIL categorisation. This has not been explored previously in relation to TILs. ONEST analyses, using an open-source software developed by the first author, were performed on TIL quantification in breast cancers taken from two previous studies. These were one reproducibility study involving 49 breast cancers, 23 in the first circulation and 14 pathologists in the second circulation, and one study involving 100 cases and 9 pathologists. In addition to the estimates of the number of observers required, other factors influencing the results of ONEST were examined. The analyses reveal that between six and nine observers (range 2-11) are most commonly needed to give a robust estimate of reproducibility. In addition, the number and experience of observers, the distribution of values around or away from the extremes, and outliers in the classification also influence the results. Due to the simplicity and the potentially relevant information it may give, we propose ONEST to be a part of new reproducibility analyses.
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Affiliation(s)
- Bálint Cserni
- TNG Technology Consulting GmbH, Király u. 26., 1061 Budapest, Hungary
| | - Darren Kilmartin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Mark O’Loughlin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Xavier Andreu
- Pathology Department, Atryshealth Co., Ltd., 08039 Barcelona, Spain
| | - Zsuzsanna Bagó-Horváth
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Paulo Figueiredo
- Laboratório de Anatomia Patológica, IPO Coimbra, 3000-075 Coimbra, Portugal
| | - Giuseppe Floris
- Laboratory of Translational Cell & Tissue Research and KU Leuven, Department of Imaging and Pathology, Department of Pathology, University Hospitals Leuven, University of Leuven, Oude Market 13, 3000 Leuven, Belgium
| | - Maria Pia Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, 40139 Bologna, Italy
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University Budapest, Üllői út 93, 1091 Budapest, Hungary
| | - Anne-Vibeke Laenkholm
- Department of Surgical Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Inta Liepniece-Karele
- Department of Pathology, Riga Stradins University, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Caterina Marchiò
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Elena Provenzano
- Department of Histopathology, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge CB2 0QQ, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria
| | - Angelika Reiner
- Department of Pathology, Klinikum Donaustadt, 1090 Vienna, Austria
| | - Aleš Ryška
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, 50003 Hradec Kralove, Czech Republic
| | - Anna Sapino
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | | | - Cecily Quinn
- Department of Histopathology, Irish National Breast Screening Programme, BreastCheck, St. Vincent’s University Hospital and School of Medicine, University College Dublin, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Vasiliki Zolota
- Department of Pathology, School of Medicine, University of Patras, 26504 Rion, Greece
| | - Mark Webber
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Sharon A. Glynn
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Rita Bori
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | - Erika Csörgő
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | | | - Tamás Pancsa
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, 6720 Szeged, Hungary
| | - Grace Callagy
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
- Correspondence:
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Salvestrini V, Becherini C, Visani L, Desideri I, Morelli I, Scoccimarro E, Cerbai C, Bonaparte I, Bertini N, Bettazzi B, Scotti V, Bernini M, Orzalesi L, Nori J, Bianchi S, Francolini G, Meattini I, Livi L. Hypofractionated Postmastectomy Radiotherapy (HF-PMRT): What did We Learn from COVID-19 Era? CLIN EXP OBSTET GYN 2023. [DOI: 10.31083/j.ceog5002041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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15
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Visani L, Livi L, Ratosa I, Orazem M, Ribnikar D, Saieva C, Becherini C, Salvestrini V, Scoccimarro E, Valzano M, Cerbai C, Desideri I, Bernini M, Orzalesi L, Nori J, Bianchi S, Morandi A, Meattini I. Safety of CDK4/6 inhibitors and concomitant radiation therapy in patients affected by metastatic breast cancer. Radiother Oncol 2022; 177:40-45. [PMID: 36349599 DOI: 10.1016/j.radonc.2022.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/20/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) currently represent the standard of care for the initial treatment of patients with metastatic hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer. The aim of our study is to evaluate the safety of the use of concomitant radiation therapy (RT) in a consecutive series of HR+/HER2- patients treated in two academic institutions with CDK4/6i in the metastatic setting. METHODS AND MATERIALS From September 2017 to February 2020, we retrospectively collected and analysed data on a sequential series of patients treated with CDK4/6i, receiving RT or not, at two European institutions. Primary outcome of the study was the association between RT and any adverse events (AEs) ≥ G3. Secondary outcomes were the association between RT and any AEs (any grade), CDK4/6i dose reduction rate, and CDK4/6i treatment discontinuation rate. RESULTS We analysed a total of 132 consecutive women; RT was prescribed in 57 (43.2%) patients (70 irradiated lesions). The median age of the series was 52.1 years (range 32.3-78.2). Concomitant RT administration was not significantly related to higher AEs ≥ G3 (p = 0.19) and any grade AEs (p = 1.0); there was no association with RT and CDK4/6i dose reduction (p = 0.49) and discontinuation rates (p = 0.14). At a median follow-up of 18.8 months, the progression-free survival (PFS) rate was 35% and the overall survival (OS) rate was 38.7% in the whole group. The use of concomitant RT did not affect both PFS (p = 0.71) and OS rates (p = 0.55). CONCLUSIONS Our data are encouraging regarding the safety of this combination, showing that concurrent RT did not increase severe toxicity and did not have an impact on systemic treatment conduction.
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Affiliation(s)
- Luca Visani
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ivica Ratosa
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Orazem
- Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Domen Ribnikar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research Prevention and Clinical Network, Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Erika Scoccimarro
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marianna Valzano
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Cecilia Cerbai
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Morandi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
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16
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Meattini I, Francolini G, Di Cataldo V, Visani L, Becherini C, Scoccimarro E, Salvestrini V, Bellini C, Masi L, Doro R, Di Naro F, Loi M, Salvatore G, Simontacchi G, Greto D, Bernini M, Nori J, Orzalesi L, Bianchi S, Mangoni M, Livi L. Preoperative robotic radiosurgery for early breast cancer: Results of the phase II ROCK trial (NCT03520894). Clin Transl Radiat Oncol 2022; 37:94-100. [PMID: 36177053 PMCID: PMC9513617 DOI: 10.1016/j.ctro.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 12/04/2022] Open
Abstract
Preoperative partial breast irradiation treats well-defined target. Stereotactic body radiation therapy have been routinely implemented in clinical practice. No acute toxicity greater than grade 2 was recorded. A single 21 Gy dose preoperative robotic radiosurgery represents a feasible technique.
Background and purpose Preoperative partial breast irradiation (PBI) has got the advantage of treating a well-defined target. We report the results of the phase II ROCK trial (NCT03520894), enrolling early breast cancer (BC) patients treated with preoperative robotic radiosurgery (prRS), in terms of acute and early late toxicity, disease control, and cosmesis. Material and methods The study recruited between 2018 and 2021 at our Radiation Oncology Unit. Eligible patients were 50 + years old BC, hormonal receptors positive/human epidermal growth factor receptor 2 negative (HR+/HER2-), sized up to 25 mm. The study aimed to prospectively assess the toxicity and feasibility of a robotic single 21 Gy-fraction prRS in preoperative setting. Results A total of 70 patients were recruited and 22 patients were successfully treated with pRS. Overall, three G1 adverse events (13.6 %) were recorded within 7 days from prRS. Three events (13.6 %) were recorded between 7 and 30 days, one G2 breast oedema and two G1 breast pain. No acute toxicity greater than G2 was recorded. Five patients experienced early late G1 toxicity. One patient reported G2 breast induration. No early late toxicity greater than G2 was observed. At a median follow up of 18 months (range 6–29.8), cosmetic results were scored excellent/good and fair in 14 and 5 patients, respectively, while 3 patients experienced a poor cosmetic outcome. Conclusions ROCK trial showed that a single 21 Gy dose prRS represents a feasible technique for selected patients affected by early BC, showing an acceptable preliminary toxicity profile.
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Affiliation(s)
- Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luca Visani
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.,CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Carlotta Becherini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Erika Scoccimarro
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Viola Salvestrini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.,CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Chiara Bellini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Laura Masi
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Raffaela Doro
- CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mauro Loi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Giulia Salvatore
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Monica Mangoni
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.,Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Clerici E, Navarria P, Bellu L, Pessina F, Simonelli M, Marini B, Bianchi S, Scorsetti M. JS09.7.A Reirradiation for recurrent high grade glioma (HGG) patients: results of a single arm prospective phase 2 study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.029] [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: 11/14/2022] Open
Abstract
Abstract
Background
Standard of care for recurrent high grade glioma (HGG) is missing. Several treatment options have been investigated including re-irradiation (re-RT). Results are promising but provided by retrospective studies. We designed a single arm prospective phase II study aiming to evaluate efficacy, and toxicity of re-irradiation.
Material and Methods
Adults patients with good performance status, HGG diagnosis reclassified according to the new 2021 fifth edition WHO CNS classification, an interval time (IT) from previous RT ≥ 6 months were included. Outcome was evaluated by MRI imaging at 1 month, and every 3 months thereafter. Toxicities were evaluated in terms of radionecrosis occurrence, and neurocognitive status.
Results
Ninety recurrent HGG patients were treated, 11 oligodendroglioma grade 3, 18 astrocytoma grade 3 and 4, and 61 glioblastoma grade 4. The median age was 54 years, and majority had KPS 90-100. The median IT between first-RT and re-RT was 24 months. Re-surgery has been performed in 56.6%, and chemotherapy in 53.3%. The median follow up time was 64 months; median overall survival (OS) time,1,2,3-year OS rates were 17 months (95%CI 14-19), 66.7%±4.9, 32.6%±5.0, and 22.2 ± 4.7. Prognostic factors impacting on survival were age (p = 0.0154), IT between first RT and re-RT (p = 0.0051), glioma grade (p = 0.0090), and IDH status (p = 0.0001). Radionecrosis grade 2-3 occurred in 9 (10%) patients; neurocognitive functions remained stable until disease progression.
Conclusion
Re-RT proved to be a safe and feasible treatment option with low toxicity. Younger patients with grade 3 IDH mutated gliomas, and a longer IT had the better outcome.
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Affiliation(s)
- E Clerici
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - P Navarria
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - L Bellu
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - F Pessina
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - M Simonelli
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - B Marini
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - S Bianchi
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - M Scorsetti
- IRCCS Humanitas Research Hospital , Rozzano , Italy
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18
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Mandruzzato M, Cortinovis D, Fassi E, Ammoni L, Zamparini M, Colonese F, Bianchi S, Baggi A, Berruti A, Grisanti S, Frigerio M. EP08.02-172 Effect of EGFR Inhibition on Bone Health in NSCLC Patients without Skeletal Metastasis. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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19
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Bianchi S, Brasili F, Saglimbeni F, Cortese B, Di Leonardo R. Optical diffraction tomography of 3D microstructures using a low coherence source. Opt Express 2022; 30:22321-22332. [PMID: 36224932 DOI: 10.1364/oe.454910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/18/2022] [Indexed: 06/16/2023]
Abstract
Optical diffraction tomography (ODT) is a label-free technique for three dimensional imaging of micron-sized objects. Coherence and limited sampling of 3D Fourier space are often responsible for the appearance of artifacts. Here we present an ODT microscope that uses low temporal coherence light and spatial light modulators to retrieve reliable 3D maps of the refractive index. A common-path interferometer, based on a spatial light modulator, measures the complex fields transmitted by a sample. Measured fields, acquired while scanning the illumination direction using a digital micro-mirror device, are fed into a Rytov reconstruction algorithm to obtain refractive index maps whose accuracy is directly evaluated on microfabricated 3D test objects. Even for challenging shapes such as pyramids, bridges, and dumbbells, we obtain volumetric reconstructions that compare very well with electron microscopy images.
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20
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Meynet I, Stabile G, Mantica M, Ferraro A, D’ammando M, Scaglione M, Di Cori A, Schillaci V, Ottaviano L, Mantovan R, Ferrari F, Bianchi S, Solimene F, Malacrida M, De Sanctis V. The impact of RF wattage level on local impedance and procedural parameters in AF ablation cases. Europace 2022. [DOI: 10.1093/europace/euac053.222] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Local impedance (LI) measurement can provide information on catheter tip contact, but also changes in LI during ablation can inform the extent and effectiveness of RF energy delivery. To date the relationship between highly LI measurements and contact force (CF) during atrial fibrillation (AF) ablation at different levels of energy delivery is still lacking.
Purpose
We aimed to evaluate the impact of power setting on LI and key procedural parameters in AF ablation cases.
Methods
A novel CF ablation catheter equipped with dedicated algorithm was used to measure LI at the distal electrode of this catheter. Radiofrequency (RF) catheter applications ≥45 watts were categorized as high power (HP) and applications <45w as standard power (SP). Ablations were also grouped according to different levels of CF (<5g, 5-14g, 15-24g and ≥25g). Data are reported as mean±SD.
Results
Sixty-two consecutive pts undergoing RF catheter ablation of AF from the CHARISMA registry were included A total of 4619 ablation spots performed around PVs were analyzed (58% paroxysmal, 84% de novo, RF deliveries per pt=76±27, RF delivery time=9.1±5s, CF=12.3±8g). The majority of these were HP applications (n=4192, 91%). The mean LI was 158±17Ω prior to ablation and 138±14Ω after ablation (p<0.0001, absolute LI drop of 21.9±8Ω) with a LI drop rate equal to 4.4±3Ω/s. HP ablations had significantly shorter RF delivery times, 8.8±4s vs 12±7s (p<0.0001), larger LI drops (22.2±8Ω vs 19.3±9Ω, p<0.0001) and higher LI drop rates (4.5±3Ω/s vs 3.6±2Ω/s, p<0.0001) than SP, respectively. For both HP and SP settings, the magnitude of LI drop increased and RF delivery time decreased with increasing amounts of CF. The largest differences between HP and SP were found when CF was <15g (RF delivery time: 9±5s at HP vs 12.9±7s at SP, percentage of difference 26.3%, p<0.0001; LI drop: 21.2±8Ω at HP vs 18.6±9Ω, percentage of difference -14.3%, p<0.0001). No major complications occurred during the procedures. All PVs were successfully isolated.
Conclusions
This preliminary experience suggests that, HP ablation is effective and safe and resulting in shorter RF delivery times and larger LI drops than SP ablation.
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Affiliation(s)
| | - G Stabile
- Montevergine Clinic, Mercogliano, Italy
| | - M Mantica
- Clinical Institute Saint Ambrogio, Milan, Italy
| | | | - M D’ammando
- Hospital Santa Maria Della Misericordia, Perugia, Italy
| | | | - A Di Cori
- University Hospital of Pisa, Pisa, Italy
| | | | - L Ottaviano
- Clinical Institute Saint Ambrogio, Milan, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Ferrari
- Hospital Molinette of the University Hospital S. Giovanni Battista, Turin, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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21
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Fassini GM, De Simone A, Iacopino S, Bianchi S, Bencardino G, Pecora D, Iuliano A, Moltrasio M, Rossi P, Perna F, La Greca C, Placentino F, Riva S, Tondo C, Stabile G. Novel cryo-balloon technology for a successful pulmonary vein isolation: acute outcome and follow-up from a large multicenter Italian clinical setting. Europace 2022. [DOI: 10.1093/europace/euac053.217] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Complete electrical pulmonary vein isolation (PVI) by cryo-balloon approach is a well-established ablation strategy of atrial fibrillation (AF). Recently, a new cryoablation system (POLARx) with unique features has been made available for clinical use. To date, limited data exist on acute and follow-up outcome of this system in a multicentric clinical practice.
Purpose
We reported the preliminary experience of this novel technology in a multicenter Italian registry.
Methods
Consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 6 Italian centres were included. Protocol-directed cryoablation was delivered for 180 sec or 240 sec according to operator’s preference for isolation achieved in ≤60 sec, or 240 sec if isolation occurred >60 sec or when time to isolation (TTI) was not available. The ablation endpoint was PV isolation as assessed by entrance and exit block. Rhythm monitoring during the follow-up examinations was performed via the clinical assessment of AF recurrence, ECG and Holter monitoring, according to the clinical practice of each center. All patients were followed-up for at least 6 months after the procedure. Arrhythmia recurrences within the first 3 months (blanking period) were classified as early recurrences and were not considered procedural failures
Results
Six-hundred twenty-four cryoapplications from 112 pts (439 PVs) were analyzed (n=89, 79.5% paroxysmal AF, n=23, 20.5% persistent AF, mean age 61.5±9 years, 76% male, 22% with an history of AT, mean LVEF 49±10%). PVI was achieved in all pts using only cryoablation. The mean number of freeze applications per pt was 5.6±2.1 (1.4±1.2 for LSPV, 1.5±1.1 for LIPV, 1.3±0.8 for RSPV and 1.3±0.8 for RIPV), with 318 (72.4%) PVs treated with a single cryoablation (92, 21% with 2 cryoablation; 29, 6.6% with more than 2 cryoablations). Fourty-four (39.3%) pts were treated with a single application to each of the PVs. Over a median of 296[245 to 382] days of follow-up, five (4.5%) patients experienced an early recurrence of AF/AT during the 90-day blanking period. Overall, 12 patients (10.7%) suffered an AF/AT recurrence after the 90-day blanking period (median time to recurrence 200[124 to 297] days). Specifically, 8 (7.1%) patients had AF recurrence only, 3 (2.7%) had AT recurrence only and 1 (0.9%) experienced both events. One (0.9%) patient underwent a repeated ablation procedure. The proportion of patients exhibiting AF/AT recurrences was similar between AF types (10 out 89, 11.2% for paroxysmal AF vs 2 out 23, 8.7% for persistent AF, p=1.00) with a hazard ratio of 0.9 (95%CI: 0.2 to 3.9, log-rank p=0.8894). One transient phrenic nerve palsy was observed, with full recovery in the 48-h post procedure; no major procedure-related adverse events were reported.
Conclusion
In this first multicentric experience, the novel cryo-balloon system proved to be safe and effective and resulted in a very low rate of AF/AT recurrence during follow-up.
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Affiliation(s)
- GM Fassini
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - G Bencardino
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - A Iuliano
- San Michele Clinic, Maddaloni, Italy
| | - M Moltrasio
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - F Perna
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - S Riva
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - C Tondo
- Cardiology Center Monzino (IRCCS), Arrhythmology Unit, University of Milan, Milan, Italy
| | - G Stabile
- San Michele Clinic, Maddaloni, Italy
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22
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Visani L, Meattini I, Francolini G, Di Cataldo V, Becherini C, Nori J, Bernini M, Orzalesi L, Sanchez L, Scoccimarro E, Lucidi S, Bellini C, Desideri I, Scotti V, Doro R, Masi L, Loi M, Bianchi S, Mangoni M, Livi L. OC-0932 Preoperative radiation therapy in early breast cancer: phase II ROCK trial (NCT03520894). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Audrito V, Moiso E, Ugolini F, Messana VG, Brandimarte L, Manfredonia I, Bianchi S, De Logu F, Nassini R, Szumera-Ciećkiewicz A, Taverna D, Massi D, Deaglio S. Tumors carrying BRAF-mutations over-express NAMPT that is genetically amplified and possesses oncogenic properties. J Transl Med 2022; 20:118. [PMID: 35272691 PMCID: PMC8908704 DOI: 10.1186/s12967-022-03315-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/19/2022] [Indexed: 01/01/2023] Open
Abstract
Background Nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in nicotinamide adenine dinucleotide (NAD) biosynthesis, is up-regulated in several cancers, including metastatic melanoma (MM). The BRAF oncogene is mutated in different cancer types, among which MM and thyroid carcinoma (THCA) are prominent. Drugs targeting mutant BRAF are effective, especially in MM patients, even though resistance rapidly develops. Previous data have linked NAMPT over-expression to the acquisition of BRAF resistance, paving the way for therapeutic strategies targeting the two pathways. Methods Exploiting the TCGA database and a collection of MM and THCA tissue microarrays we studied the association between BRAF mutations and NAMPT expression. BRAF wild-type (wt) cell lines were genetically engineered to over-express the BRAF V600E construct to demonstrate a direct relationship between over-activation of the BRAF pathway and NAMPT expression. Responses of different cell line models to NAMPT (i)nhibitors were studied using dose–response proliferation assays. Analysis of NAMPT copy number variation was performed in the TCGA dataset. Lastly, growth and colony forming assays were used to study the tumorigenic functions of NAMPT itself. Results The first finding of this work is that tumor samples carrying BRAF-mutations over-express NAMPT, as demonstrated by analyzing the TCGA dataset, and MM and THC tissue microarrays. Importantly, BRAF wt MM and THCA cell lines modified to over-express the BRAF V600E construct up-regulated NAMPT, confirming a transcriptional regulation of NAMPT following BRAF oncogenic signaling activation. Treatment of BRAF-mutated cell lines with two different NAMPTi was followed by significant reduction of tumor growth, indicating NAMPT addiction in these cells. Lastly, we found that several tumors over-expressing the enzyme, display NAMPT gene amplification. Over-expression of NAMPT in BRAF wt MM cell line and in fibroblasts resulted in increased growth capacity, arguing in favor of oncogenic properties of NAMPT. Conclusions Overall, the association between BRAF mutations and NAMPT expression identifies a subset of tumors more sensitive to NAMPT inhibition opening the way for novel combination therapies including NAMPTi with BRAFi/MEKi, to postpone and/or overcome drug resistance. Lastly, the over-expression of NAMPT in several tumors could be a key and broad event in tumorigenesis, substantiated by the finding of NAMPT gene amplification. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03315-9.
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Affiliation(s)
- Valentina Audrito
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Via Nizza, 52, 10126, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Enrico Moiso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.,Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Filippo Ugolini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenzo Gianluca Messana
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Via Nizza, 52, 10126, Torino, Italy
| | - Lorenzo Brandimarte
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Via Nizza, 52, 10126, Torino, Italy
| | - Ilaria Manfredonia
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Via Nizza, 52, 10126, Torino, Italy
| | - Simonetta Bianchi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesco De Logu
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Romina Nassini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.,Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Daniela Taverna
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Daniela Massi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Deaglio
- Laboratory of Functional Genomics, Department of Medical Sciences, University of Turin, Via Nizza, 52, 10126, Torino, Italy.
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24
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Bernini M, Meattini I, Saieva C, Becherini C, Salvestrini V, Visani L, Stocchi G, Bellini C, Lorenzetti V, Sordi S, Nori J, De Benedetto D, Desideri I, Bianchi S, Livi L, Orzalesi L. Pre-pectoral breast reconstruction: early and long-term safety evaluation of 146 unselected cases of the early pre-pectoral era of a single-institution, including cases with previous breast irradiation and post-mastectomy radiation therapy. Breast Cancer 2021; 29:302-313. [PMID: 34775540 DOI: 10.1007/s12282-021-01314-0] [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: 04/03/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
We re-evaluated acute and early-late toxicity-related factors among pre-pectoral immediate tissue expander/implant (TE/I) breast reconstruction (BR) unselected, first-era, cases, including previous breast radiation treatment and post-mastectomy radiation therapy (PMRT). A retrospective analysis of 146 (117 therapeutic and 29 prophylactic) pre-pectoral reconstructions, between 2012 and 2016, considered patient-related (age, body mass index [BMI], smoke-history, comorbidity, BRCA mutation), and treatment-related characteristics (previous irradiation, axillary surgery, PMRT, pre- and postoperative chemotherapy, endocrine therapy, and target-therapy). Safety was evaluated as acute and early-late complications, and TE/I failures. At multivariate analysis of the 146 cases (117 patients submitted to BR) a significant factor related to acute toxicity was: BMI ≥ 25 (31.3% [≥ 25] vs 8.8% [< 25]; OR 4.44, 95% CI 1.56-12.6; p = 0.003), while previous breast surgery on ipsilateral side presented a borderline significance (31.6% [previous surgery] vs 7.4% [no previous surgery]; OR 3.74, 95% CI 0.97-14.40; p = 0.055). Factors significantly related to TE/I failure were: current or previous smoking exposition (13.8% [smokers] vs 2.6% [non-smokers]; OR 7.32, 95% CI 1.37-39.08; p = 0.02) and preoperative chemotherapy (18.8% [yes] vs 3.5% [no]; OR 8.16, 95% CI 1.29-51.63; p = 0.026). At 4-year median follow-up, 3 deaths, 5 locoregional recurrences, and 14 distant metastases occurred. Immediate pre-pectoral BR is safe and effective, with low rates of acute and early-late complications. BMI and previous breast surgery were related to higher complications but not failure; smoking and preoperative chemotherapy were related to TE/I explant. Previous RT and PMRT were related neither to early-late toxicity nor failure.
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Affiliation(s)
- Marco Bernini
- Breast Surgery, Breast Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, L.go Brambilla 3, 50134, Florence, Italy.
| | - Icro Meattini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Calogero Saieva
- Istituto per lo Studio, la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - Carlotta Becherini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Viola Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Luca Visani
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Giulia Stocchi
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Chiara Bellini
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Victoria Lorenzetti
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Silvia Sordi
- Breast Surgery, Breast Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, L.go Brambilla 3, 50134, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Pathology Division, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
- Radiotherapy Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery, Breast Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, University of Florence, L.go Brambilla 3, 50134, Florence, Italy
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25
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Cauti FM, Rossi P, Iaia L, Polselli M, Pecere A, Bianchi S. Accuracy comparison of the new and previous Kodex occlusion tool software versions to assess pulmonary vein occlusion in atrial fibrillation cryoablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0386] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most frequent sustained arrhythmia worldwide and Cryoballoon ablation (CB) has become a consolidated alternative to the radiofrequency pulmonary vein (PV) isolation. However, CB requires fluoroscopy and dye injections to verify the occlusion grade. The accuracy of the earlier version of the Kodex Occlusion Tool software has been studied.
Purpose
The purpose of this study was to verify the accuracy of the second generation Kodex Occlusion Tool Software of a new dielectric system imaging compared to its first generation to detect PV occlusion during CB ablation in patients with AF.
Methods
15 consecutive patients with paroxysmal AF were enrolled in the study and underwent the procedure with the guidance of the first generation version (1.4.6) of the Kodex Occlusion Tool software. The Kodex recorded procedural data were used to replay the case using the Kodex second generation version (1.4.7) of the Occlusion Tool software when clinically available. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octa-polar circular mapping catheter, PV occlusion was assessed with the Occlusion Tool Software and compared with standard dye injection and angiography, the cryoablation was then performed with a cryoballoon catheter.
Results
A total of 74 PVs CB occlusions were tested. The old version showed 90.7% sensitivity and 74.2% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 82.9%, and the negative predictive value was 85.2%. The new version showed 94.8% sensitivity and 93.7% specificity in assessing a complete PV occlusion verified with same contrast medium injection data. The positive predictive value was 98.2%, and the negative predictive value was 93.7%. Acute isolation was achieved in all PVs and no 30-day complication was observed.
Conclusion
This study demonstrates an increased accuracy of new Occlusion Tool software of the Kodex dielectric imaging system to assess the degree of PV occlusion during a CB ablation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F M Cauti
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - P Rossi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - L Iaia
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - M Polselli
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Pecere
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - S Bianchi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Livi L, Barletta G, Martella F, Saieva C, Desideri I, Bacci C, Del Bene MR, Airoldi M, Amoroso D, Coltelli L, Scotti V, Becherini C, Visani L, Salvestrini V, Mariotti M, Pedani F, Bernini M, Sanchez L, Orzalesi L, Nori J, Bianchi S, Olivotto I, Meattini I. Cardioprotective Strategy for Patients With Nonmetastatic Breast Cancer Who Are Receiving an Anthracycline-Based Chemotherapy: A Randomized Clinical Trial. JAMA Oncol 2021; 7:1544-1549. [PMID: 34436523 DOI: 10.1001/jamaoncol.2021.3395] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Several studies have evaluated cardioprotective strategies to prevent myocardial dysfunction in patients who are receiving cardiotoxic therapies. However, the optimal approach still represents a controversial issue. Objective To determine whether pharmacological cardioprevention could reduce subclinical heart damage in patients with breast cancer who are being treated with anthracycline-based chemotherapy. Design, Setting, and Participants The SAFE trial was a 4-arm, randomized, phase 3, double-blind, placebo-controlled, national multicentric study conducted at 8 oncology departments in Italy. It was a prespecified interim analysis on the first 174 patients who had completed cardiac assessment at 12 months. The study recruitment was conducted between July 2015 and June 2020. The interim analysis was performed in 2020. Patients were eligible for trial inclusion if they had indication to receive primary or postoperative systemic therapy using an anthracycline-based regimen. Patients with a prior diagnosis of cardiovascular disease were excluded. Interventions Cardioprotective therapy (bisoprolol, ramipril, or both drugs compared with placebo) was administered for 1 year from the initiation of chemotherapy or until the end of trastuzumab therapy in case of ERBB2-positive patients. Doses for all groups were systematically up-titrated up to the daily target dose of bisoprolol (5 mg, once daily), ramipril (5 mg, once daily), and placebo, if tolerated. Main Outcomes and Measures The primary end point was defined as detection of any subclinical impairment (worsening ≥10%) in myocardial function and deformation measured with standard and 3-dimensional (3D) echocardiography, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS). Results The analysis was performed on 174 women (median age, 48 years; range, 24-75 years) who had completed a cardiological assessment at 12 months and reached the end of treatment. At 12 months, 3D-LVEF worsened by 4.4% in placebo arm and 3.0%, 1.9%, 1.3% in the ramipril, bisoprolol, ramipril plus bisoprolol arms, respectively (P = .01). Global longitudinal strain worsened by 6.0% in placebo arm and 1.5% and 0.6% in the ramipril and bisoprolol arms, respectively, whereas it was unchanged (0.1% improvement) in the ramipril plus bisoprolol arm (P < .001). The number of patients showing a reduction of 10% or greater in 3D-LVEF was 8 (19%) in the placebo arm, 5 (11.5%) in the ramipril arm, 5 (11.4%) in the bisoprolol, arm and 3 (6.8%) in the ramipril plus bisoprolol arm; 15 patients (35.7%) who received placebo showed a 10% or greater worsening of GLS compared with 7 (15.9; ramipril), 6 (13.6%; bisoprolol), and 6 (13.6%; ramipril plus bisoprolol) (P = .03). Conclusions and Relevance The interim analysis of this randomized clinical trials suggested that cardioprotective pharmacological strategies in patients who were affected by breast cancer and were receiving an anthracycline-based chemotherapy are well tolerated and seem to protect against cancer therapy-related LVEF decline and heart remodeling. Trial Registration ClinicalTrials.gov identifier: NCT2236806.
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Affiliation(s)
- Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
| | - Giuseppe Barletta
- Diagnostic Cardiology, Cardiothoracic, and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Francesca Martella
- Breast and Medical Oncology Units, Oncology Department, Azienda USL Toscana Centro, Florence, Italy
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research Prevention and Clinical Network, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
| | - Carlotta Bacci
- Breast and Medical Oncology Units, Oncology Department, Azienda USL Toscana Centro, Florence, Italy
| | - Maria Riccarda Del Bene
- Diagnostic Cardiology, Cardiothoracic, and Vascular Department, Careggi University Hospital, Florence, Italy
| | - Mario Airoldi
- Medical Oncology Unit 2, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Domenico Amoroso
- Medical Oncology Unit, Ospedale Versilia, Lido di Camaiore, Lucca, Italy
| | - Luigi Coltelli
- Medical Oncology Unit, Livorno Hospital, Azienda USL Toscana Nord Ovest, Livorno, Italy
| | - Vieri Scotti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
| | - Carlotta Becherini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
| | - Luca Visani
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
| | - Viola Salvestrini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
| | - Matteo Mariotti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
| | - Fulvia Pedani
- Medical Oncology Unit 2, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Marco Bernini
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Luis Sanchez
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Orzalesi
- Breast Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Careggi University Hospital, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Oncology Department, Careggi University Hospital, Florence, Italy
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27
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Zelli V, Silvestri V, Valentini V, Bucalo A, Rizzolo P, Zanna I, Bianchi S, Coppa A, Giannini G, Cortesi L, Calistri D, Tibiletti MG, Fox SB, Palli D, Ottini L. Transcriptome of Male Breast Cancer Matched with Germline Profiling Reveals Novel Molecular Subtypes with Possible Clinical Relevance. Cancers (Basel) 2021; 13:cancers13184515. [PMID: 34572741 PMCID: PMC8469418 DOI: 10.3390/cancers13184515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Breast cancer in men is a rare disease; however, morbidity and mortality in male breast cancer (MBC) patients is a serious concern. The identification of specific molecular features in MBC is essential for developing more appropriate and targeted therapeutic strategies for MBC patients. In this study, by transcriptome analysis of 63 MBCs characterized for germline mutations in the most relevant BC susceptibility genes, mainly BRCA1/2, we highlighted possible differences in the molecular pathways underlying MBC pathogenesis in relation to germline mutation status. Furthermore, we identified two distinct subgroups of MBCs of clinical relevance, which are characterized by different biological features and prognosis. Overall, our results showed that transcriptome profiling by RNA sequencing is a valuable approach to dissect the molecular heterogeneity of MBC and suggest that the transcriptome matched with germline profiling may lead to the identification of MBC subtypes with possible relevance in the clinical setting, which is a primary step to improve the clinical management of MBC patients. Abstract Male breast cancer (MBC) is a rare and understudied disease compared with female BC. About 15% of MBCs are associated with germline mutation in BC susceptibility genes, mainly BRCA1/2 and PALB2. Hereditary MBCs are likely to represent a subgroup of tumors with a peculiar phenotype. Here, we performed a whole transcriptome analysis of MBCs characterized for germline mutations in the most relevant BC susceptibility genes in order to identify molecular subtypes with clinical relevance. A series of 63 MBCs, including 16 BRCA2, 6 BRCA1, 2 PALB2, 1 RAD50, and 1 RAD51D germline-mutated cases, was analyzed by RNA-sequencing. Differential expression and hierarchical clustering analyses were performed. Module signatures associated with central biological processes involved in breast cancer pathogenesis were also examined. Different transcriptome profiles for genes mainly involved in the cell cycle, DNA damage, and DNA repair pathways emerged between MBCs with and without germline mutations. Unsupervised clustering analysis revealed two distinct subgroups, one of which was characterized by a higher expression of immune response genes, high scores of gene-expression signatures suggestive of aggressive behavior, and worse overall survival. Our results suggest that transcriptome matched with germline profiling may be a valuable approach for the identification and characterization of MBC subtypes with possible relevance in the clinical setting.
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Affiliation(s)
- Veronica Zelli
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.Z.); (V.S.); (V.V.); (A.B.); (P.R.); (G.G.)
| | - Valentina Silvestri
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.Z.); (V.S.); (V.V.); (A.B.); (P.R.); (G.G.)
| | - Virginia Valentini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.Z.); (V.S.); (V.V.); (A.B.); (P.R.); (G.G.)
| | - Agostino Bucalo
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.Z.); (V.S.); (V.V.); (A.B.); (P.R.); (G.G.)
| | - Piera Rizzolo
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.Z.); (V.S.); (V.V.); (A.B.); (P.R.); (G.G.)
| | - Ines Zanna
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 08518 Florence, Italy; (I.Z.); (D.P.)
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, 08518 Florence, Italy;
| | - Anna Coppa
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Giuseppe Giannini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.Z.); (V.S.); (V.V.); (A.B.); (P.R.); (G.G.)
| | - Laura Cortesi
- Department of Oncology and Haematology, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Daniele Calistri
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Maria Grazia Tibiletti
- Department of Pathology, ASST Settelaghi and Centro di Ricerca per lo Studio dei Tumori Eredo-Familiari, Università dell’Insubria, 21100 Varese, Italy;
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, VIC 3000, Australia;
| | - kConFab
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC 3000, Australia;
- Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab), Research Department, PeterMacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 08518 Florence, Italy; (I.Z.); (D.P.)
| | - Laura Ottini
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.Z.); (V.S.); (V.V.); (A.B.); (P.R.); (G.G.)
- Correspondence: ; Tel.: +39-06-49918268
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28
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Kilmartin D, O’Loughlin M, Andreu X, Bagó-Horváth Z, Bianchi S, Chmielik E, Cserni G, Figueiredo P, Floris G, Foschini MP, Kovács A, Heikkilä P, Kulka J, Laenkholm AV, Liepniece-Karele I, Marchiò C, Provenzano E, Regitnig P, Reiner A, Ryška A, Sapino A, Specht Stovgaard E, Quinn C, Zolota V, Webber M, Roshan D, Glynn SA, Callagy G. Intra-Tumour Heterogeneity Is One of the Main Sources of Inter-Observer Variation in Scoring Stromal Tumour Infiltrating Lymphocytes in Triple Negative Breast Cancer. Cancers (Basel) 2021; 13:cancers13174410. [PMID: 34503219 PMCID: PMC8431498 DOI: 10.3390/cancers13174410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
Stromal tumour infiltrating lymphocytes (sTILs) are a strong prognostic marker in triple negative breast cancer (TNBC). Consistency scoring sTILs is good and was excellent when an internet-based scoring aid developed by the TIL-WG was used to score cases in a reproducibility study. This study aimed to evaluate the reproducibility of sTILs assessment using this scoring aid in cases from routine practice and to explore the potential of the tool to overcome variability in scoring. Twenty-three breast pathologists scored sTILs in digitized slides of 49 TNBC biopsies using the scoring aid. Subsequently, fields of view (FOV) from each case were selected by one pathologist and scored by the group using the tool. Inter-observer agreement was good for absolute sTILs (ICC 0.634, 95% CI 0.539-0.735, p < 0.001) but was poor to fair using binary cutpoints. sTILs heterogeneity was the main contributor to disagreement. When pathologists scored the same FOV from each case, inter-observer agreement was excellent for absolute sTILs (ICC 0.798, 95% CI 0.727-0.864, p < 0.001) and good for the 20% (ICC 0.657, 95% CI 0.561-0.756, p < 0.001) and 40% (ICC 0.644, 95% CI 0.546-0.745, p < 0.001) cutpoints. However, there was a wide range of scores for many cases. Reproducibility scoring sTILs is good when the scoring aid is used. Heterogeneity is the main contributor to variance and will need to be overcome for analytic validity to be achieved.
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Affiliation(s)
- Darren Kilmartin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, H91 TK33 Galway, Ireland; (D.K.); (M.O.); (M.W.); (S.A.G.)
| | - Mark O’Loughlin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, H91 TK33 Galway, Ireland; (D.K.); (M.O.); (M.W.); (S.A.G.)
| | - Xavier Andreu
- UDIAT-Centre Diagnòstic, Pathology Department, Institut Universitari Parc Taulí-UAB, Parc Taulí, 1, 08205 Sabadell, Spain;
| | - Zsuzsanna Bagó-Horváth
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, 50134 Florence, Italy;
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland;
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary;
| | - Paulo Figueiredo
- Laboratório de Anatomia Patológica, Instituto Politécnico de Coimbra, 3000-075 Coimbra, Portugal;
| | - Giuseppe Floris
- Laboratory of Translational Cell and Tissue Research, Department of Imaging and Pathology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Maria Pia Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, 40139 Bologna, Italy;
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden;
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Central Hospital, 00029 Helsinki, Finland;
| | - Janina Kulka
- 2nd Department of Pathology, Semmelweis University Budapest, Üllői út 93, 1091 Budapest, Hungary;
| | - Anne-Vibeke Laenkholm
- Department of Surgical Pathology, Zealand University Hospital, 4000 Roskilde, Denmark;
| | | | - Caterina Marchiò
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy; (C.M.); (A.S.)
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Elena Provenzano
- Department of Histopathology, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge CB2 0QQ, UK;
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria;
| | - Angelika Reiner
- Department of Pathology, Klinikum Donaustadt, 1090 Vienna, Austria;
| | - Aleš Ryška
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, 50003 Hradec Kralove, Czech Republic;
| | - Anna Sapino
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy; (C.M.); (A.S.)
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | | | - Cecily Quinn
- Irish National Breast Screening Programme, BreastCheck, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland;
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Vasiliki Zolota
- Department of Pathology, School of Medicine, University of Patras, 26504 Rion, Greece;
| | - Mark Webber
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, H91 TK33 Galway, Ireland; (D.K.); (M.O.); (M.W.); (S.A.G.)
| | - Davood Roshan
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, H91 TK33 Galway, Ireland;
| | - Sharon A. Glynn
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, H91 TK33 Galway, Ireland; (D.K.); (M.O.); (M.W.); (S.A.G.)
| | - Grace Callagy
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, H91 TK33 Galway, Ireland; (D.K.); (M.O.); (M.W.); (S.A.G.)
- Correspondence:
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29
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Visani L, Ratosa I, Scoccimarro E, Becherini C, Saieva C, Desideri I, Scotti V, Ozarem M, Ribnikar D, Aquilano M, Cerbai C, Orzalesi L, Bernini M, Sanchez L, Nori J, Bianchi S, Meattini I, Livi L. OC-0071 Safety and efficacy of concomitant radiation and CDK4/6 inhibitors in breast cancer patients. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Di Cataldo V, Francolini G, Visani L, Becherini C, Scoccimarro E, Masi L, Doro R, Salvatore G, Bianchi S, Vezzosi V, Lemmi E, Nori J, Sanchez L, Orzalesi L, Bernini M, Loi M, Desideri I, Mangoni M, Meattini I, Livi L. PO-1138 Preoperative radiation therapy in breast cancer: preliminary results from ROCK trial (NCT03520894). Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07589-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Susini T, Saccardin G, Renda I, Giani M, Tartarotti E, Nori J, Vanzi E, Pasqualini E, Bianchi S. Immunohistochemical Evaluation of FGD3 Expression: A New Strong Prognostic Factor in Invasive Breast Cancer. Cancers (Basel) 2021; 13:cancers13153824. [PMID: 34359725 PMCID: PMC8345064 DOI: 10.3390/cancers13153824] [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: 06/12/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022] Open
Abstract
Among new prognostic factors for breast cancer, the most promising one seems to be FGD3 (Facio-Genital Dysplasia 3) gene, whose expression improves outcome by inhibiting cell migration. The aim of the study was to evaluate the prognostic role of FGD3 in invasive breast cancer in a series of 401 women, treated at our unit, by evaluating the expression of this gene by immunohistochemistry. Patients with high FGD3 expression showed a significantly better disease-free survival (DFS) (p < 0.001) and overall survival (OS) (p < 0.001). The prognostic value of FGD3 expression was stronger than that of classical pathologic parameters such as histological grade of differentiation, Ki-67 index and molecular subtype. By multivariate Cox analysis, FGD3 expression was confirmed as significant and independent prognostic factor, ranking second after age at diagnosis (≤40 years) for DFS (p = 0.003) and the second strongest predictor of OS, after AJCC Stage (p < 0.001). Our data suggest that inclusion of FGD3 evaluation in the routine workup of breast cancer patients may result in a more accurate stratification of the individual risk. The possibility to assess FGD3 expression by a simple and cheap technique such as immunohistochemistry may enhance the spread of its use in the clinical practice.
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Affiliation(s)
- Tommaso Susini
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50134 Florence, Italy; (G.S.); (I.R.); (M.G.); (E.T.)
- Correspondence: ; Tel.: +39-055-275-1752
| | - Giulia Saccardin
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50134 Florence, Italy; (G.S.); (I.R.); (M.G.); (E.T.)
| | - Irene Renda
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50134 Florence, Italy; (G.S.); (I.R.); (M.G.); (E.T.)
| | - Milo Giani
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50134 Florence, Italy; (G.S.); (I.R.); (M.G.); (E.T.)
| | - Enrico Tartarotti
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, 50134 Florence, Italy; (G.S.); (I.R.); (M.G.); (E.T.)
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (J.N.); (E.V.)
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (J.N.); (E.V.)
| | - Elisa Pasqualini
- Pathology Unit, Department of Health Sciences, University of Florence, 50134 Florence, Italy; (E.P.); (S.B.)
| | - Simonetta Bianchi
- Pathology Unit, Department of Health Sciences, University of Florence, 50134 Florence, Italy; (E.P.); (S.B.)
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32
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Cauti FM, Rossi P, Vannucci J, Polselli M, Rossi C, Iaia L, Mantovani S, Bruno K, Pugliese F, Quaglione R, Venuta F, Bianchi S, Anile M. Outcome of a modified sympathicotomy for cardiac neuromodulation of untreatable ventricular tachycardia. Europace 2021. [DOI: 10.1093/europace/euab116.346] [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: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OBJECTIVES This study aimed to describe the results of a modified sympathicotomy (uniportal VATs with stellate ganglion sparing) for cardiac sympathetic denervation (CSD) in the setting of untreatable ventricular tachycardia.
BACKGROUND. CSD, in patients with refractory ventricular tachycardia (VT), is comprehensively recognized as an important treatment option for patients with structural heart disease as well as congenital inherited arrhythmia syndrome. A recent case series demostrated the feasibility of the modified technique.
METHODS We consecutively enrolled 8 patients with refractory VT. Baseline demographic, medical, and surgical data as well as arrhythmia outcomes and procedural complications were evaluated.
RESULTS A total of 8 patients ( 7 pts NIDCM, 1 pt IDCM with mean age:68+-8 years) were enrolled for the treatment of refractory VT with a modified CSD technique. Mean sympathicotomy length were 7.3 (SD 3) min per side. 3/8 patients underwent monolateral (LCSD) sympathicotomy due to strong adesion in the right pleural cavity. Mean follow up was 13 months (SD 6). No complication occurred during the sympathicotomy. An overall reduction in VT burden and VT number was observed after the CSD despite an in-hospital early recurrence in 3 patients.
CONCLUSIONS A modified CSD (sympathicotomy T2–T5) with stellate ganglion sparing and the use of unipolar radiofrequency is feasible, effective, and safe in the setting of untreatable VT. Abstract Figure. VT trend
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Affiliation(s)
- FM Cauti
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - P Rossi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - J Vannucci
- Sapienza University of Rome, umberto, Rome, Italy
| | - M Polselli
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | | | - L Iaia
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - S Mantovani
- Sapienza University of Rome, umberto, Rome, Italy
| | - K Bruno
- Sapienza University of Rome, umberto, Rome, Italy
| | - F Pugliese
- Sapienza University of Rome, umberto, Rome, Italy
| | - R Quaglione
- Sapienza University of Rome, umberto, Rome, Italy
| | - F Venuta
- Sapienza University of Rome, umberto, Rome, Italy
| | - S Bianchi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - M Anile
- Sapienza University of Rome, umberto, Rome, Italy
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33
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Tondo C, Stabile G, Filannino P, Moltrasio M, De Simone A, Artale P, Fassini G, La Rocca V, Bianchi S, Perna F, Tundo F, Colella J, Iuliano A, Malacrida M, Iacopino S. Novel cryo-balloon ablation technology for pulmonary vein isolation in patients with atrial fibrillation: preliminary experience from a multicenter clinical practice. Europace 2021. [DOI: 10.1093/europace/euab116.201] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Complete electrical pulmonary vein isolation (PVI) by cryo-balloon approach is a well-established ablation strategy of atrial fibrillation (AF). Recently, a new cryoablation system (POLARx) with unique features has been made available for clinical use. To date, no data exist on procedural characteristics of this system in a multicentric clinical practice.
Purpose
We aimed to characterize the initial experience of this technology in the Italian clinical practice.
Methods
Consecutive patients (pts) undergoing AF ablation from the CHARISMA registry at 5 Italian centres were included. Protocol-directed cryoablation was delivered for 180 sec or 240 sec according to operator’s preference for isolation achieved in ≤60 sec, or 240 sec if isolation occurred >60 sec or when time to isolation (TTI) was not available. The ablation endpoint was PV isolation as assessed by entrance and exit block.
Results
Two-hundred sixty-two cryoapplications from 49 pts (194 PVs) were analyzed. PVI was achieved with cryoablation only in all pts. The mean number of freeze applications per pt was 5.3 ± 1.5 (1.3 ± 0.6 for LIPV, LSPV and RSPV, 1.6 ± 1.3 for RIPV), with 143 (73.7%) PVs treated in a single-shot fashion (38, 19.6% with 2 shots; 13, 6.7% with more than 2 shots). Sixteen (33%) pts were treated with a single freeze to each of the PVs. The mean nadir temperature was -55.5 ± 6.9 °C and was colder than -50°C in 83% of the PVs. TTI information was evaluable in 120 (46%) cryoapplications with a median TTI of 47 [32-75] sec (median temperature at TTI = -49 [-53 to -42] °C). The mean time to target -40 °C (TTT) was 30.1 ± 6.9 sec with a TTT < 60 sec achieved in 99.2% of the cryoapplications; the mean thaw time to 0 °C was 18.6 ± 5.8 sec (thaw time >15 sec in 70.3% of the cryoapplications). The mean PV occlusion grade (rank 1-4) was 3.6 ± 0.6 (grade 2 in 5.2% of the cases, grade 3 in 25.6% and grade 4 in 69.2%). No complications were observed at 30 days post-procedure.
Conclusion
In this first multicentric experience in a clinical practice setting, the novel cryo-balloon system proved to be safe and effective and resulted in a high proportion of successful single-freeze isolation. Cooling parameters seem to be slightly different from reference cryo-balloon technology.
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Affiliation(s)
- C Tondo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - G Stabile
- Casa di cura San Michele, Maddaloni, Italy
| | | | - M Moltrasio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - P Artale
- Maria Cecilia Hospital, Cotignola, Italy
| | - G Fassini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - V La Rocca
- Casa di cura San Michele, Maddaloni, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - F Perna
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - F Tundo
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - J Colella
- Maria Cecilia Hospital, Cotignola, Italy
| | - A Iuliano
- Casa di cura San Michele, Maddaloni, Italy
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
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Cauti FM, Rossi P, Iaia L, Polselli M, Pecere A, Andreoli C, Bianchi S. Accuracy comparison of the new and previous kodex occlusion tool software versions to assess pulmonary vein occlusion in atrial fibrillation cryoablation. Europace 2021. [DOI: 10.1093/europace/euab116.249] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background. Atrial fibrillation (AF) is the most frequent sustained arrhythmia worldwide and Cryoballoon ablation (CB) has become a consolidated alternative to the radiofrequency pulmonary vein (PV) isolation. However, CB requires fluoroscopy and dye injections to verify the occlusion grade. The accuracy of the earlier version of the Kodex Occlusion Tool software has been studied.
Purpose. The purpose of this study was to verify the accuracy of the second generation Kodex Occlusion Tool Software of a new dielectric system imaging compared to its first generation to detect PV occlusion during CB ablation in patients with AF.
Methods. 15 consecutive patients with paroxysmal AF were enrolled in the study and underwent the procedure with the guidance of the first generation version (1.4.6) of the Kodex Occlusion Tool software. The Kodex recorded procedural data were used to replay the case using the Kodex second generation version (1.4.7) of the Occlusion Tool software when clinically available. After transseptal access, a detailed image reconstruction of left atrium and PVs was achieved with an octa-polar circular mapping catheter, PV occlusion was assessed with the Occlusion Tool Software and compared with standard dye injection and angiography, the cryoablation was then performed with a cryoballoon catheter.
Results. A total of 72 PVs CB occlusions were tested. The old version showed 90.7% sensitivity and 76.5% specificity in assessing a complete PV occlusion verified with contrast medium injection. The positive predictive value was 80.3%, and the negative predictive value was 88.6%. The new version showed 94.8% sensitivity and 93.7% specificity in assessing a complete PV occlusion verified with same contrast medium injection data. The positive predictive value was 98.2%, and the negative predictive value was 93.7%. Acute isolation was achieved in all PVs and no 30-day complication was observed.
Conclusion. This study demonstrates an increased accuracy of new Occlusion Tool software of the Kodex dielectric imaging system to assess the degree of PV occlusion during a CB ablation. Abstract Figure. Occlusion tool software 1.4.6 vs 1.4.7
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Affiliation(s)
- FM Cauti
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - P Rossi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - L Iaia
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - M Polselli
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Pecere
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - C Andreoli
- FOLIGNO General Hospital, Foligno, Italy
| | - S Bianchi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Rossi P, Cauti FM, Polselli M, Iaia L, Fanti V, Niscola M, Andreoli C, Calore F, Bianchi S. A novel ventricular map of electrograms duration as a method to identify areas of slow conduction during ablation of ventricular tachycardia. Europace 2021. [DOI: 10.1093/europace/euab116.358] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background – Wave front inhomogeneous propagation is crucial for reentry circuit generation. Bipolar EGM duration is indicative of local conduction delay and may identify areas of low conduction as a functional substrate. This study aimed to create a map of EGM duration during the VT (VEDUM Map) to identify the area of the slowest conduction and to verify if RF delivery at this area allows to rapidly interrupt the VT.
Methods – 24 high-density VTs maps (21 patients) were analyzed. Activation maps and voltage maps during SR were performed. An offline remap confirmed with MathLab software was customized to visualize the longest duration electrogram during VT.
Results – All of the VTs were interrupted during the first RF delivery (mean time 7,3 ± 5,4 sec (range 3-25 sec)) at the area with the longest EGM duration (212 ± 47 ms (range 113-330 ms)). . In 9 pts (37,5%) the longest EGM was located at the entrance or exit area of the activation maps while in 5 pts (21%) the EGM covered the full diastolic phase. Finally, in 10 pts the longest EGM occurred in the mid-exit-diastolic phase.
Conclusions - A novel Ventricular map of Electrograms DUration (VEDUM Map) is highly accurate in defining a conductive vulnerable zone of the VT circuit. The longest EGM duration within the isthmus is highly predictive of rapid VT termination. Quantitative variablesQualitative variablesMeanMedianStandard DeviationAge71738.40BMI26.624.54.02LV EDV16315442.7LV EDD61.2629.9LV EF38.7369.74VT cycle lenght (TCL)35537556.4EGM max. duration in VT21220847EGM max dur / TCL58.260.512Maximum EGM duration localization in CLProto = 12.5%Meso = 33.3%Tele = 25%Full = 20.8%Myocardium voltage characteristics in VEDUM EGMHealthy = 25%Transition = 20.8%Scar = 41.7%Critical Isthmus area12.3107.3VT Interruption during RFYes = 79.2%No = 20.8%Time (seconds) to interruption765Access typeEndo = 58.3%Epi = 29.2%Clinical and procedural dataAbstract Figure.
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Affiliation(s)
- P Rossi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - FM Cauti
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - M Polselli
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - L Iaia
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | | | | | - C Andreoli
- FOLIGNO General Hospital, Foligno, Italy
| | | | - S Bianchi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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La Greca C, Cauti FM, Piro A, Di Belardino N, Anselmino M, Scaglione M, Pecora D, Rossi L, Di Cori A, Tola G, Pedretti S, Mantovan R, Solimene F, Rossi P, Bianchi S. Minimal fluoroscopic approaches and factors associated with radiation dose when high-definition mapping is used for supraventricular tachycardia ablation: insight from the CHARISMA registry. Europace 2021. [DOI: 10.1093/europace/euab116.057] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Limited data exist on factors associated with radiation exposure during ablation procedures when a high definition mapping technology is used.
Purpose
To report factors associated with radiation exposure and data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) ablation procedures.
Methods
Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. We included in this analysis consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary. The effective dose (ED) was calculated using accepted formula. For our purpose high dose exposure was defined as an ED greater than the median value of ED of the population exposed to radiation.
Results
This analysis included 325 patients (mean age = 56 ± 17 years, 57% male) undergoing SVT procedures (152 AVNRT, 116 AFL, 41 AP and 16 AT). During the study, 27481 seconds of fluoroscopy was used (84.6 ± 224 seconds per procedure), resulting in a mean equivalent ED of 1.1 ± 3.7 mSv per patient. The mean reconstructed RA volume was 99 ± 54 ml in a mean mapping time of 12.2 ± 7 min. The mean number of radiofrequency ablations (RFC) to terminate each arrhythmia was 9.4 ± 9 (mean RFC delivery time equal to 6.7 ± 6 min). 192 procedures (59.1%) were completed without any use of fluoroscopy; during the remaining 133 procedures (39.9%), 206.6 ± 313.4 seconds of fluoroscopy was used (median ED = 1.2 mSv). In a minority of the cases (n = 25, 7.7%) the fluoroscopy time was higher than 5 minutes (median ED = 6.5 mSv), whereas radiologic exposure time greater than 1 minute occurred in ninety cases (27.7%, median ED = 2.1 mSv). On multivariate logistic analysis adjusted for baseline confounders the RFC application time (OR = 1.0014, 95%CI: 1.0007 to 1.0022; p = 0.0001) was independently associated to an ED greater than 1.2 mSv, whereas female gender had an inverse association (0.54, 0.29 to 0.98; p = 0.0435). Acute success was reached in 97.8% of the cases. During a mean of 290.7 ± 169.6 days follow-up, no major adverse events related to the procedure were reported. Overall, the recurrence rate of the primary arrhythmia during follow-up was 2.5%.
Conclusions
In our experience, arrhythmias ablation through minimal fluoroscopy approach with the use of a novel ablation technology is safe, feasible, and effective in common right atrial arrhythmias. High-dose exposure occurred in a very limited number of cases, without any reduction of the safety and acute and long-term effectiveness profile.
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Affiliation(s)
- C La Greca
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - FM Cauti
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | | | | | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Cardiology, Brescia, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - P Rossi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - S Bianchi
- Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Nori J, Bicchierai G, Amato F, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Miele V. A new technique for the histological diagnosis of Paget's disease of the breast using a semiautomated core needle biopsy with a 14-gauge needle. Radiol Med 2021; 126:936-945. [PMID: 33900526 DOI: 10.1007/s11547-021-01358-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/30/2020] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of our work is to illustrate a new technique for the histological diagnosis of Paget's disease (PD) using a core needle biopsy with a semiautomated 14-gauge needle called nipple-core needle biopsy (N-CNB). We report 3 years' experience in our senology unit. MATERIALS AND METHODS Twenty-six women with 26 clinical of nipple-areola complex (NAC) changes with suspected PD and subjected to core needle biopsy using our new 14G semiautomated needle technique were included in our study group. Institutional review board approval was obtained for this retrospective analysis. A semiautomated biopsy gun with a 14-gauge, 15-cm-long needle was used for this new procedure. After a subcutaneous injection of anesthetic and spray-ice application to the NAC, the 14G needle was opened with the cradle exposed and positioned on the NAC with considerable pressure exerted on the same. The cradle was then closed by triggering the needle spring, and 2-4 core samples were withdrawn by moving the needle position each time. Clinical, instrumental and histological differences between the lesions that gave benign results after N-CNB and those that resulted PD were analyzed by applying the Fisher's exact test. RESULTS After N-CNB, 13/26 lesions were found to be PD (50%) while 13/26 alterations were benign (50%). No malignant lesions were detected during the follow-up in patients with benign N-CNB results. The diagnosis of PD obtained with N-CNB was confirmed in all 13 cases by means of a histological analysis of the surgical specimens. No significant post-biopsy complications were recorded. Patients with PD more frequently presented nipple retraction (ρ = 0.0407) and associated suspicious (i.e., BI-RADS 4 and 5) mammographic (ρ = 0.0006) findings compared to patients whose N-CNB had given benign results and the difference was statistically significant. CONCLUSIONS In conclusion, with this novel technique, we were able to obtain an easy, painless, major complication-free and accurate diagnosis of PD of the NAC using a semiautomated core needle biopsy with a 14-gauge needle.
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Affiliation(s)
- Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni Di Dio, Agrigento, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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De Felice M, D'Abramo M, Mormile P, Scatigna M, Bianchi S, Fabiani L. Risk assessment of biological hazards in University laboratories: checklist and critical control points. Ann Ig 2021; 33:589-601. [PMID: 33779673 DOI: 10.7416/ai.2021.2443] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Results The results highlighted that 40 laboratories fall into the "low risk" and the remaining 2 into the "moderate risk" category. Conclusions Labs with risk factors are a minority. These were properly identified using the proposed methodology. Background and aim Biomedical research in academic settings is an important issue for Public Health and Environment protection. As workplaces, the facilities for research expose their personnel to different hazards and health risks. The University of L'Aquila (Italy) carried out a field study aimed at creating and applying a checklist intended for laboratory staff. Methods The proposed checklist was derived from the procedure illustrated in the Appendix (procedure followed for the identification of a numerical index of biological risk for university facilities) and consists of 9 items. The study was conducted in 42 laboratories.
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Affiliation(s)
- M De Felice
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M D'Abramo
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Mormile
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - M Scatigna
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Bianchi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - L Fabiani
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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Meattini I, Marrazzo L, Saieva C, Desideri I, Scotti V, Simontacchi G, Bonomo P, Greto D, Mangoni M, Scoccianti S, Lucidi S, Paoletti L, Fambrini M, Bernini M, Sanchez L, Orzalesi L, Nori J, Bianchi S, Pallotta S, Livi L. Accelerated Partial-Breast Irradiation Compared With Whole-Breast Irradiation for Early Breast Cancer: Long-Term Results of the Randomized Phase III APBI-IMRT-Florence Trial. J Clin Oncol 2020; 38:4175-4183. [DOI: 10.1200/jco.20.00650] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To report the long-term results of external-beam accelerated partial-breast irradiation (APBI) intensity-modulated radiation therapy (IMRT) Florence phase III trial comparing whole-breast irradiation (WBI) to APBI in early-stage breast cancer. PATIENTS AND METHODS The primary end point was to determine the 5-year difference in ipsilateral breast tumor recurrence (IBTR) between 30 Gy in 5 once-daily fractions (APBI arm) and 50 Gy in 25 fractions with a tumor bed boost (WBI arm) after breast-conserving surgery. RESULTS Five hundred twenty patients, more than 90% of whom had characteristics associated with low recurrence risk, were randomly assigned (WBI, n = 260; APBI, n = 260) between 2005 and 2013. Median follow-up was 10.7 years. The 10-year cumulative incidence of IBTR was 2.5% (n = 6) in the WBI and 3.7% (n = 9) in the APBI arm (hazard ratio [HR], 1.56; 95% CI, 0.55 to 4.37; P = .40). Overall survival at 10 years was 91.9% in both arms (HR, 0.95; 95% CI, 0.50 to 1.79; P = .86). Breast cancer–specific survival at 10 years was 96.7% in the WBI and 97.8% in the APBI arm (HR, 0.65; 95% CI, 0.21 to 1.99; P = .45). The APBI arm showed significantly less acute toxicity ( P = .0001) and late toxicity ( P = .0001) and improved cosmetic outcome as evaluated by both physician ( P = .0001) and patient ( P = .0001). CONCLUSION The 10-year cumulative IBTR incidence in early breast cancer treated with external APBI using IMRT technique in 5 once-daily fractions is low and not different from that after WBI. Acute and late treatment-related toxicity and cosmesis outcomes were significantly in favor of APBI.
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Affiliation(s)
- Icro Meattini
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Livia Marrazzo
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Calogero Saieva
- Istituto per lo Studio la Prevenzione e la Rete Oncologica (ISPRO), Florence, Italy
| | - Isacco Desideri
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Vieri Scotti
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | | | | | - Daniela Greto
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Monica Mangoni
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | | | | | - Lisa Paoletti
- Ospedale Santa Maria Annunziata–Azienda Usl Toscana Centro, Florence, Italy
| | - Massimiliano Fambrini
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Marco Bernini
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Luis Sanchez
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Lorenzo Orzalesi
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Jacopo Nori
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Stefania Pallotta
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- University of Florence, Florence, Italy
- Azienda Ospedaliero–Universitaria Careggi, Florence, Italy
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Visani L, Saieva C, Desideri I, Scotti V, Dominici L, Scoccimarro E, Aquilano M, Cerbai C, Palmieri V, Maragna V, Becherini C, Bernini M, Sanchez L, Orzalesi L, Nori J, Antonuzzo L, Bianchi S, Meattini I, Livi L. PO-0928: Safety and efficacy of concomitant RT and CDK4/6 inhibitors in metastatic breast cancer patients. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00945-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Solimene F, Cauti F, Stabile G, Rossi P, Schillaci V, Polselli M, Arestia A, Iaia L, Shopova G, Bianchi S. Novel occlusion tool software for pulmonary vein occlusion verification in atrial fibrillation cryoballoon ablation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Optimal pulmonary vein (PV) occlusion, checked with selective contrast injection, is mandatory to obtain an effective PV isolation with a cryoballoon.
Purpose
The purpose of this study was to verify the feasibility of a new dielectric sensing system in assessing PV occlusion during cryoballoon ablation in patients with atrial fibrillation (AF).
Methods
We enrolled 25 consecutive patients with paroxysmal or persistent AF. After transseptal access a detailed image reconstruction of left atrium and PVs was achieved with a decapolar circular mapping catheter and a novel dielectric imaging system. The degree of PV occlusion with the inflated cryoballoon catheter was verified by a new occlusion tool software of the dielectric imaging system and compared to the angiography with dye injection in each PV.
Results
A total of 114 PV cryoballoon occlusion were tested. The new occlusion tool software showed a 91.7% sensitivity and 81.5% specificity in assessing a complete PV occlusion verified with dye injection. The positive predictive value was 84.6% and the negative predictive value was 89.8%. Acute isolation was achieved in all PVs. No 30 days complications were observed.
Conclusion
This is the first study that demonstrates the feasibility of a new occlusion tool software, using the novel dielectric imaging system, in verifying the degree of PV occlusion during cryoballoon ablation.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - F.M Cauti
- Fatebenefratelli Hospital, Roma, Italy
| | - G Stabile
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - P Rossi
- Fatebenefratelli Hospital, Roma, Italy
| | - V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | | | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - L Iaia
- Fatebenefratelli Hospital, Roma, Italy
| | - G Shopova
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - S Bianchi
- Fatebenefratelli Hospital, Roma, Italy
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Anselmino M, Cauti F, Piro A, Di Belardino N, Scaglione M, Pecora D, Rossi L, Di Cori A, Tola G, Pedretti S, Mantovan R, Solimene F, Rossi P, Iaia L, Bianchi S. Minimal fluoroscopy approach in current clinical practice with a novel ablation technology for supraventricular tachycardia: a large multicenter experience from an Italian registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0691] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Electrophysiological studies and ablation procedures expose both physicians and patients to a large amount of radiation. Most of 3-D mapping systems provide improved tracking of catheters, possibly allowing relevant reductions in radiation exposure. No data exists on the ability of the Rhythmia mapping system to minimize fluoroscopy time and dose.
Purpose
To report preliminary data on feasibility and safety of a minimal fluoroscopic approach using the Rhythmia mapping system in supraventricular tachycardia (SVT) procedures.
Methods
Consecutive patients indicated for arrhythmia ablation were enrolled in the CHARISMA study at 12 centers. For our purpose consecutive right-side procedures performed through a minimal fluoroscopy approach with the Rhythmia mapping system were analyzed. A 3D geometry of chambers of interest was reconstructed on the basis of the electroanatomic information taken from the mapping system. Fluoroscopy was used only if deemed necessary.
Results
This analysis included 266 patients (mean age = 57±17 years, 57% male) undergoing SVT procedures (120 AVNRT, 91 AFL, 32 AP, 11 AT and 12 other right atrial procedures). In all cases, diagnostic EP and ablation catheters were positioned using a low fluoroscopic electroanatomic guided approach. The mean fluoroscopy time needed for each procedure was 55±128 s. The median reconstructed RA volume was 92 [63–131] ml in a median mapping time of 11 [7–17] min. The median number of radiofrequency ablations to terminate each arrhythmia was 6 [3–12] (total RF delivery time of 291 [180–505] s). Sixty-five percent of the procedures (n=174) were completed with less than 10 s of fluoroscopy. Low fluoroscopy approach with less than 10 s (minimal fluoroscopy approach) was most frequently obtained in case of AVNRT (91, 76%) compared to other arrhythmias' ablation (83, 57%, p=0.001) Achievement of a minimal fluoroscopic approach was not affected by operator's experience (65% vs 66%, p=1.00, respectively within physician with more or less of 10 years of active practice), whereas it was affected by presence of a fellow in training during the procedure (72% without fellow vs 26% with fellow, p<0.0001). A 100% rate of acute success was observed, and no procedure-related complications occurred. At multivariate logistic regression analysis adjusted for baseline confounders, both the total number of RF ablations (OR: 0.93 (95% CI:0.88 to 0.96; p=0.0053) and the presence of a fellow in training during the procedure (OR: 0.29; 95% CI: 0.1 to 0.87; p=0.0278) had an inverse association to the achievement of a minimal fluoroscopic approach.
Conclusions
In our preliminary experience, arrhythmias' ablation through minimal fluoroscopy approach with the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be dramatically reduced in most cases, without any reduction of the safety and acute effectiveness profile.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Anselmino
- A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy
| | - F.M Cauti
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | | | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | | | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - P Rossi
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
| | - L Iaia
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
| | - S Bianchi
- Ospedale S. Giovanni Calibita, Fatebenefratelli Isola Tiberina, Rome, Italy
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Bernini M, Meattini I, Sordi S, Orzalesi L, Cucchiari J, Scotti V, Desideri I, Bianchi S, Livi L. Quality of life improvement and pain reduction in implant-based breast reconstruction by means of selective pectoralis major muscle denervation. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30587-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bicchierai G, Amato F, Vanzi B, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cirone D, Cozzi D, Miele V, Nori J. Which clinical, radiological, histological, and molecular parameters are associated with the absence of enhancement of known breast cancers with Contrast Enhanced Digital Mammography (CEDM)? Breast 2020; 54:15-24. [PMID: 32889303 PMCID: PMC7479440 DOI: 10.1016/j.breast.2020.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/03/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background CEDM has demonstrated a diagnostic performance similar to MRI and could have similar limitations in breast cancer (BC) detection. Purpose The aim of our study was to systematically analyze the characteristics of the lesions with the absence of enhancement with CEDMs, called false-negatives (FNs), in order to identify which clinical, radiological, histological and molecular parameters are associated with the absence of enhancement of known BCs with CEDMs, and which types of BC are most likely to cause FNs in CEDMs. We also tried to evaluate which parameters instead increased the probability of showing enhancement in the same context. Materials and methods Included in our study group were 348 women with 348 diagnosed BCs performing CEDM as preoperative staging. Two breast-imaging radiologists reviewed the CEDM exams. The absence of perceptible contrast enhancement at the index cancer site was indicative of an FN CEDM, whereas cases with appreciable enhancement were considered true positives (TPs). Dichotomic variables were analyzed with Fisher’s exact probability test or, when applicable, the chi-square test. Binary logistic regression was performed on variables shown to be significant by the univariate analysis in order to assess the relationship between predictors (independent variables) and TFNs (outcome). Results Enhancement was observed in 317 (91.1%) of the 348 BCs. From the 31 (8.9%) lesions which were FNs, we excluded 12 (38.7%) which showed an artifact generated by the post biopsy hematoma and 6 (19.4%) which were outside the CEDM field of vision. We thus obtained 13 (41.9%) BCs considered “True False Negatives” (TFNs), i.e. BCs which showed no enhancement despite being within the CEDM field of vision and failed to show post biopsy hematoma artifacts. We found that the TFNs frequently have a unifocal disease extension, diameter <10 mm, a lower number of luminal B HER2-subtypes, a higher number of DCIS, and an index lesion with microcalcifications. Conclusions The parameters we found to be associated with no enhancement of known BCs with CEDMs were: unifocal disease extension, DCIS histotype, lesion dimensions <10 mm, and index lesion with microcalcifications. The characteristics that instead increase the probability of showing enhancement were US mass, Luminal B HER2 negative molecular subtype, the presence of an invasive ductal component, and lesion dimensions ≥10 mm. The variables associated with an increased risk of no enhancement were unifocal disease extension, non-classifiable molecular subtype, DCIS histotype, lesion dimensions <10 mm, index lesion represented by microcalcifications. A greater probability of showing enhancement entailed the presence of an invasive ductal component, index lesion represented by ultrasound mass, Luminal B HER2 negative molecular subtype, lesion dimensions ≥10 mm, multifocal disease extension.
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Affiliation(s)
- Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Amato
- Radiology Department, Ospedale San Giovanni di Dio, Agrigento, Italy
| | - Bianca Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Diego De Benedetto
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cecilia Boeri
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Federica Di Naro
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Division of Pathological Anatomy, University of Florence, Florence, Italy
| | - Donatello Cirone
- General Management Staff, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Diletta Cozzi
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Vittorio Miele
- Emergency Radiology Department, Azienda Ospedaliero-Universitaria Careggi Florence, Italy
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Mariscotti G, Durando M, Ruggirello I, Belli P, Caumo F, Nori J, Zuiani C, Tagliafico A, Bicchierai G, Romanucci G, Londero V, Campanino PP, Bussone R, Castellano I, Mule' A, Caneva A, Bianchi S, Di Loreto C, Bergamasco L, Calabrese M, Fonio P, Houssami N. Lesions of uncertain malignant potential of the breast (B3) on vacuum-assisted biopsy for microcalcifications: Predictors of malignancy. Eur J Radiol 2020; 130:109194. [PMID: 32795765 DOI: 10.1016/j.ejrad.2020.109194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/04/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate clinical, radiologic and pathologic features of B3 lesions diagnosed on VABB targeting microcalcifications, for identifying predictors of malignancy. METHOD This retrospective multi-centre study included consecutive VABBs performed over a 10-year period on suspicious microcalcifications not associated with other radiological signs diagnosed as B3 on histology from VABB, with outcomes ascertained by surgical excision. Clinical, demographic, radiological and histological (B3 subcategory) data were collected. For statistical analysis (univariate and binary logistic regression), the primary outcome variable was the upgrade rate to malignancy after surgery. Predictors of upgrade to malignancy were identified from clinical, demographic, radiological and pathological variables (including B3 subcategory). RESULTS Amongst 447 VABBs, there were 57(12.7 %) upgrades to malignancy at surgical histology (36 DCIS and 21 invasive cancer). At univariate analysis, variables significantly associated with increased risk of upgrade to malignancy were age>55 years (p = 0.01), lesion size>10 mm (p < 0.0001), BI-RADS 4b-c and 5 (p = 0.0001), and fine pleomorphic morphology (p = 0.002) of microcalcifications. Binary logistic regression confirmed as significant independent risk factors age, lesion size and BI-RADS category (p = 0.02, 0.02 and 0.0006 respectively). Amongst subcategories of B3 lesions, lobular neoplasia was significantly(p = 0.04) associated with upgrade, confirmed as an independent risk factor [p = 0.03, OR = 2.3(1.1-4.7)]. Flat epithelial atypia was significantly(p = 0.004) associated with reduced odds of upgrade, but binary logistic regression showed only borderline association [p = 0.052, OR = 0.4(0.2-1.01)]. CONCLUSIONS Across B3 lesions diagnosed on histology from VABB of suspicious microcalcifications, older age, size>10 mm, BI-RADS category≥ 4b on imaging, and lobular neoplasia were risk factors for upgrade to malignancy. This information can be used to discuss patients' tailored management options.
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Affiliation(s)
- Giovanna Mariscotti
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Manuela Durando
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Irene Ruggirello
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Paolo Belli
- Department of Radiological, Radiotherapic and Hematological Sciences, Fondazione Policlinico A. Gemelli IRCCS - Universita' Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | - Francesca Caumo
- Radiology Department, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
| | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, P.le S. Maria della Misericordia, 15, 33100, Udine, Italy.
| | - Alberto Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy; Department of Radiology, IRCCS San Martino Hospital, 16132, Genova, Italy.
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Giovanna Romanucci
- UOSD Breast Unit ULSS9, Ospedale di Marzana, Piazzale Lambranzi, 1, 37034 Verona, Italy.
| | - Viviana Londero
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, P.le S. Maria della Misericordia, 15, 33100, Udine, Italy.
| | - Pier Paolo Campanino
- Breast Imaging Service, Ospedale Koelliker, C.so Galileo Ferraris 256, 10100, Torino, Italy.
| | - Riccardo Bussone
- Breast Surgery, Presidio Sanitario Ospedale Cottolengo, Via S. Giuseppe Benedetto Cottolengo, 9, 10152, Torino, Italy.
| | | | - Antonino Mule'
- Department of Histopathology and Cytodiagnosis, Fondazione Policlinico A. Gemelli IRCCS -Universita' Cattolica Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
| | | | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of medical and surgical critical care, University of Florence, Florence, Italy.
| | - Carla Di Loreto
- Anatomic Pathology Institute, Department of Medicine (DAME), University of Udine, Udine, Italy.
| | - Laura Bergamasco
- Department of Surgical Sciences, University of Torino, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, C.so Bramante 88, 10126, Torino, Italy.
| | - Massimo Calabrese
- Diagnostic Senology, IRCCS - Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Paolo Fonio
- Radiology Institute, University of Turin, Department of Diagnostic Imaging and Radiotherapy, A. O. U. Citta della Salute e della Scienza di Torino - Presidio Ospedaliero Molinette, Via Genova 3, 10126, Torino, Italy.
| | - Nehmat Houssami
- Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney 2006, NSW, Australia.
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Solimene F, Cauti FM, Zucchelli G, Schillaci V, Rossi P, De Lucia R, Arestia A, Iaia L, Bongiorni MG, Bianchi S, Piccolo F, Maddaluno F, Malacrida M, Segreti L. P441Targeted ablation of residual luminal pulmonary vein potentials through high density mapping: preliminary results from the CHARISMA registry. Europace 2020. [DOI: 10.1093/europace/euaa162.221] [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: 11/13/2022] Open
Abstract
Abstract
Background
A high incidence of pulmonary vein (PV) reconnection has been reported in patients (pts) with clinical recurrences of AF. Low-voltage activity beyond PVs (e.g. antral activity) may contribute to ablation failures in the long term. Detailed characterization of PV antra through high density mapping (HDM) and automated algorithm is still lacking.
Purpose
to characterize PV gaps and the low-voltage activity in tissue such as the PV antra during and after ablation of PVs in AF pts.
Methods
Consecutive pts undergoing AF ablation from the CHARISMA registry with complete characterization of residual PV antral activity were included. A complete map of the left atrium and PVs was performed prior and after ablation through the Rhythmia HDM system. A novel map analysis tool (Lumipoint - LM -) that automatically identifies split potentials and continuous activation was used sequentially on each PV component, in order to assess the presence of gaps (PVG) and residual potential within the antral scar (RAP, defined as any low voltage high frequency fractionated signal propagating within the antral scar without conduction into the vein) and characterize electrical propagation. After ablation we reassessed with repeat voltage and propagation maps that electrical quiescence was achieved. Ablation endpoint was PV isolation.
Results
Thirty-six cases of AF ablation were analyzed (11 de novo, 25 redo). A total of 36 PVG in 13 (36%) patients were detected after remap (1 case of de novo) or initial map of redo patients (12 cases). A total of 34 RAP in 20 cases (56%) were found: 4 (36%) cases of de novo (all after ablation and remap) and 16 (64%) cases of redo (all after initial map). In 7 (19%) cases we found at least one RAP in pts with complete absence of PV conduction. 100% of PVG (n = 36) and 89% of RAP (n = 29) were fully detected though a first pass automated annotation. In 5 RAPs (11%) an additional temporal consistency of low-voltage signal relative to neighboring activation was needed due to the very low voltage EGM (≤0.1 mV). PVGs were more common at right PV sites (n = 26, 72%) and anterior PV sites (n = 20, 55.6%) whereas RAPs were detected more frequently at left PV sites (n = 20, 59%) and anterior PV sites (n = 21, 62%). RAP showed a lower median voltage compared with PVG (0.22[0.2-0.3]mV for RAP vs 0.97[0.6-1.3]mV for PVG, p < 0.0001) whereas the median number of EGM peaks were higher (6.5[5-8] for RAP vs 3[2-4] for PVG, p < 0.0001). No complications during the procedures were reported. The acute procedural success was 100%, with all PVs successfully isolated and RAPs completely abolished in all study pts.
Conclusion
In our preliminary experience, local vulnerabilities in antral lesion sets were commonly discernible using HDM system both in de novo or redo patients when no PV conduction was present. The applied workflow seemed to be useful to quickly pinpoint and accelerate the search of local PV activity or concealed low-voltage activity.
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Affiliation(s)
- F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - F M Cauti
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - G Zucchelli
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - V Schillaci
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - P Rossi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - R De Lucia
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - A Arestia
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - L Iaia
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - M G Bongiorni
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - S Bianchi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - F Piccolo
- Boston Scientific Italy, Milan, Italy
| | | | | | - L Segreti
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Cauti FM, Piro A, Di Belardino N, Tola G, Anselmino M, Pecora D, Scaglione M, Rossi L, Pedretti S, Solimene F, Mantovan R, Di Cori A, Rossi P, Iaia L, Bianchi S. P1452Low fluoroscopy approach with a novel ablation technology in right side procedures: a large multicenter experience from the CHARISMA registry. Europace 2020. [DOI: 10.1093/europace/euaa162.247] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
NO FUNDING
Background
Electrophysiological studies and ablation procedures expose both physicians and patients to a significant amount of radiation. Nowadays, most of 3-D mapping systems allow for improved tracking of catheters with possible reduction in radiation exposure. No data exists on the ability to minimize fluoroscopy time and dose while using the Rhythmia mapping system.
Purpose
To report preliminary data on feasibility and safety of a low fluoroscopic approach using the Rhythmia mapping system in SVT procedures.
Methods
The CHARISMA study is a non-randomized, multicenter, prospective study in which consecutive patients indicated for arrhythmia were enrolled. For our purpose consecutive right-side procedures performed through a low fluoroscopy approach with the Rhythmia mapping system were analyzed. The mapping system was used to create the 3D geometry of chambers of interest and anatomic reference points and to visualize the catheters from the beginning to the end of the procedure. Fluoroscopy was used only if deemed necessary.
Results
204 unselected consecutive cases of SVT from 11 centers were included in the study (mean age = 55 ± 18 years, 53% male, 85 AVNRT, 75 AFL, 28 AP, 9 AT and 7 other right atrial procedures). In all the cases, diagnostic EP and ablation catheters were positioned using only the low fluoroscopic guided mapping approach. During the study, a total of 7157 s of fluoroscopy was needed in 204 patients (51 ± 137 s per procedure). One hundred fourty-one procedures (69%) were completed with less than 10 seconds of fluoroscopy, whereas in 169 (83%) of the cases the fluoroscopy time was lower than 60 seconds. Low fluoroscopy approach with less than 10 seconds was less frequently obtained in case of AFL (46, 61.3%) compared to AVNRT ablation (65, 76.5%, p = 0.041) whereas no differences were found comparing with AP (21, 75%, p = 0.248). The median reconstructed RA volume was 94[65-133] ml in a median mapping time of 11 [6-16] min. The median number of radiofrequency ablations to terminate each arrhythmia was 5 [3-12] (total RF delivery time of 293 [180-505] sec). A 100% rate of acute success was observed in our case series. No complications occurred.
Conclusions
In our preliminary experience, arrhythmias ablation through low fluoroscopy approach and the use of a novel ablation technology seems to be safe, feasible, and effective in common right atrial arrhythmias. Use of fluoroscopy can be nearly avoided in most cases, without any reduction of the safety and effectiveness profile.
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Affiliation(s)
- F M Cauti
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - A Piro
- Umberto I Polyclinic of Rome, Rome, Italy
| | | | - G Tola
- AO Brotzu Hospital, Cagliari, Italy
| | - M Anselmino
- Hospital Molinette of the University Hospital S. Giovanni Battista/City University Hosp of Health an, Turin, Italy
| | - D Pecora
- Poliambulanza Foundation Hospital Institute of Brescia, Brescia, Italy
| | | | - L Rossi
- Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - F Solimene
- Montevergine Cardiology Clinic, Mercogliano, Italy
| | - R Mantovan
- Conegliano General Hospital, Conegliano, Italy
| | - A Di Cori
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - P Rossi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - L Iaia
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - S Bianchi
- S.Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, Bianchi S, Ciriello E, Facchinetti F, Gervasi MT, Iurlaro E, Kustermann A, Mangili G, Mosca F, Patanè L, Spazzini D, Spinillo A, Trojano G, Vignali M, Villa A, Zuccotti GV, Parazzini F, Cetin I. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG 2020; 127:1116-1121. [PMID: 32339382 PMCID: PMC7267664 DOI: 10.1111/1471-0528.16278] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To report mode of delivery and immediate neonatal outcome in women infected with COVID-19. DESIGN Retrospective study. SETTING Twelve hospitals in northern Italy. PARTICIPANTS Pregnant women with COVID-19-confirmed infection who delivered. EXPOSURE COVID 19 infection in pregnancy. METHODS SARS-CoV-2-infected women who were admitted and delivered from 1 to 20 March 2020 were eligible. Data were collected from the clinical records using a standardised questionnaire on maternal general characteristics, any medical or obstetric co-morbidity, course of pregnancy, clinical signs and symptoms, treatment of COVID 19 infection, mode of delivery, neonatal data and breastfeeding. MAIN OUTCOME AND MEASURES Data on mode of delivery and neonatal outcome. RESULTS In all, 42 women with COVID-19 delivered at the participating centres; 24 (57.1%, 95% CI 41.0-72.3) delivered vaginally. An elective caesarean section was performed in 18/42 (42.9%, 95% CI 27.7-59.0) cases: in eight cases the indication was unrelated to COVID-19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI 29.8-61.3) cases: of these, 7/19 (36.8%, 95% CI 16.3-61.6) required oxygen support and 4/19 (21.1%, 95% CI 6.1-45.6) were admitted to a critical care unit. Two women with COVID-19 breastfed without a mask because infection was diagnosed in the postpartum period: their newborns tested positive for SARS-Cov-2 infection. In one case, a newborn had a positive test after a vaginal operative delivery. CONCLUSIONS Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn. TWEETABLE ABSTRACT This study suggests that vaginal delivery may be associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn.
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Affiliation(s)
- E Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Frigerio
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - V Savasi
- Department of Woman, Mother and Neonate, Sacco Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy.,Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - P Vergani
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, Monza, Italy.,University of Milano Bicocca, Monza, Italy
| | - F Prefumo
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy.,University of Brescia, Brescia, Italy
| | - S Barresi
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - S Bianchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Ciriello
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - F Facchinetti
- Obstetrics Unit, Mother Infant Department, AOU of Modena, Modena, Italy
| | - M T Gervasi
- Obstetrics and Gynecology Unit, Department of Woman's and Child's, Health University Hospital of Padua, Padua, Italy
| | - E Iurlaro
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Kustermann
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Mangili
- Department of Neonatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - F Mosca
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Milano, Italy
| | - L Patanè
- Dept of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - D Spazzini
- Obstetrics and Gynecology Unit, Azienda Ospedaliera Bolognini, Seriate, Italy
| | - A Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy.,IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - G Trojano
- Obstetrics and Gynecology Department "Madonna delle Grazie" Hospital, Matera, Italy
| | - M Vignali
- Obstetrics and Gynecology Unit, P.O. Macedonio Melloni-ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Villa
- Obstetrics and Gynecology Unit, Hospital of Treviglio-Caravaggio, Bergamo, Italy
| | - G V Zuccotti
- Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Department of Pediatrics, Ospedale dei Bambini V. Buzzi, Milan, Italy
| | - F Parazzini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - I Cetin
- Dept of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.,Department of Woman, Mother and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco Milan, Italy
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49
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Meattini I, Scoccimarro E, Saieva C, Desideri I, Visani L, Dominici L, Cerbai C, Aquilano M, Ciccone LP, Palmieri VE, Scotti V, Nori J, Bernini M, Orzalesi L, Sanchez L, Dieci MV, Bianchi S, Livi L. Impact of metastases directed radiation therapy on CDK4/6 inhibitors dose reduction and treatment discontinuation for metastatic HR+/HER2- breast cancer (MBC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
562 Background: Cyclin-Dependent Kinase 4/6 inhibitors (CDK4/6i) represent the standard I-II line for hormonal receptors positive/human epidermal growth factor receptor 2 negative metastatic breast cancer (MBC) patients. Metastases directed radiotherapy (RT) for these patients is commonly used with palliative or radical schedules during systemic treatment. Although encouraging preliminary results were published, there is still a lack of robust data on the safety concerning RT during CDK4/6i treatment. Methods: we analyzed at Our Institution 85 consecutive patients treated in I (n=47) and II line (n=38) for MBC with CDK4/6i between April 2017 and September 2019 (22 ribociclib, 63 palbociclib). Overall, 25 (29.4%) patients received metastases directed RT during CDK4/6i treatment, including 14 concomitant (16.5%) and 11 sequential (12.9%). Estimated CDK4/6i half-life is 26 and 30 hours for palbociclib and ribociclib, respectively. Five half-lives are required to reduce drug concentration by 95-97%; thus, we also analyzed CDK4/6i treatment as non-concomitant or sequential to RT. Main endpoints of our analysis were impact of RT on CDK4/6i dose reduction and discontinuation, overall adverse events rate (any grade and grade ≥2), and neutropenia grade ≥2 as per CTCAE scale version 5.0. Results: at a median follow up of 12 months (range 3-29), we observed a CDK4/6i dose reduction in 35 patients (41.2%) and 5 patients (5.9%) discontinued treatment due to adverse events; 82 patients (96.5%) experienced any grade of toxicity, 72 (84.7%) a grade ≥2 and 70 patients (82.4%) neutropenia grade ≥2. We did not observe significant difference in terms of CDK4/6i dose reduction or discontinuation, any grade or grade ≥2 toxicity, neutropenia grade ≥2 in the comparison between patients receiving RT versus no RT and between patients receiving concomitant RT versus sequential RT versus no-RT (Table). Conclusions: our results showed that the prescription of a metastases directed RT during treatment with a CDK4/6i as I-II line for MBC did not significantly impact on dose reduction or discontinuation caused by an exceeding in adverse event rate. Although these promising results, caution should be used and cooperative initiatives strongly encouraged. [Table: see text]
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Affiliation(s)
- Icro Meattini
- Radiation Oncology Unit-Oncology Department, University of Florence, Florence, Italy
| | | | - Calogero Saieva
- Istituto per Lo Studio, La Prevenzione e La Rete Oncologica (ISPRO), Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | | | - Lorenzo Livi
- Radiation Oncology Unit-Oncology Department, University of Florence, Florence, Italy
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50
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Giani M, Renda I, Vallario A, Tavella K, Villanucci A, Nori J, Vanzi E, Bianchi S, Susini T. Long-term Results After Neoadjuvant Chemotherapy for Breast Cancer: A Single-center Experience. Anticancer Res 2020; 40:1079-1085. [PMID: 32014957 DOI: 10.21873/anticanres.14046] [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: 12/19/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We evaluated the efficacy of neoadjuvant chemotherapy (NACT) in reducing locally-advanced breast cancer (LABC) size, thus improving breast-conserving surgery (BCS) rates, as well as its long-term outcome. PATIENTS AND METHODS We analyzed 59 patients treated between 1999-2017 with NACT and subsequent surgery for LABC. RESULTS We observed a tumor size reduction in 95% of cases, resulting in downstaging in 62.7%. The average tumor shrinkage was 49%. Women with a reduction in tumor size >50% after NACT had better 10-year OS rates than women with a reduction ≤50% (p=0.025). NACT allowed to perform BCS in 44% cases, whereas the remaining 56% cases underwent mastectomy. Overall, we observed recurrences in 37.2% patients. Recurrence rates after BCS and mastectomy were 30.7% (6 loco-regional and 2 distant cases) and 42.4% (5 loco-regional and 9 distant cases), respectively (p=0.07). CONCLUSION NACT confirmed its effectiveness in reducing mastectomy rates by approximately 50%, without increasing the risk of local or distant recurrences.
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Affiliation(s)
- Milo Giani
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Irene Renda
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Arianna Vallario
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy
| | - Ketty Tavella
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Jacopo Nori
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ermanno Vanzi
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simonetta Bianchi
- Pathology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Tommaso Susini
- Breast Unit, Gynecology Section, Department of Health Sciences, University of Florence, Florence, Italy
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