Early caloric deprivation in preterm infants affects Bayley-III scales performance at 18-24 months of corrected age.

BACKGROUND: Adequate nutrition is essential for optimal neurodevelopment to preterm infants. Our aim was to evaluate the impact of caloric deprivation on Bayley-III scales performance at 18-24 months of corrected age, in a cohort of preterm infants. METHODS: We prospectively enrolled infants with gestational age <30 weeks and birth weight <1500 g. Apart from a whole cohort analysis, we performed a subgroup analysis between infants received inadequate calories (<85 Kcal/kg/day) during the first two weeks of age, compared to a standard nutrition group. All infants underwent a Bayley-III assessment at 18-24 months of corrected age. RESULTS: From the 63 preterm infants analysed, 25% had caloric deprivation compared to 75% with adequate nutrition. Caloric deprived infants were of lower gestational age and birth weight, and received a lower amount of enteral feeding during the first 14 days of age. There were no differences between the two groups regarding the common neonatal co-morbidities. Caloric deprived infants had significantly lower composite index scores at 18-24 months of corrected age. Caloric deprivation, late onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia were significant risk factors of neurodevelopmental impairment. CONCLUSIONS: Several neonatal factors affect the neurodevelopmental outcome of preterm infants, and nutrition may pose an important role.

Lung cancer induced from chemotherapy a 20 years old case.

Lung cancer is diagnosed at a late stage although we have novel diagnostic tools. The association of smoking and other environmental factors are well known. However; there are cases where a malignancy is associated with previous radiation treatment. There is an association between radiotherapy treatment and cancer incidence. We present a case where lung cancer and laryngeal cancer was induced 20 years after radiation therapy of a hogkin lymphoma.

Beware of hemopneumothorax following core needle breast biopsy.

Minimal diagnostic procedures are conducted regularly by the radiologists for several lesions within the body. The usual methodology is biopsy with a needle, either fine needle aspiration or core biopsy. The guidance is under CT or U/S. Fine needle aspiration has usually small diameter in comparison to the core biopsy. In any case the radiologist will choose the appropriate method based on the site of the lesion and safety of the patient. Pneumothorax and hemothorax are adverse effects that can be managed either on site with the help of a small catheter, however; there are cases where video-assisted thoracic surgery is needed in order to manage a more severe case. In the current study we present such a case where video-assisted surgery was necessary.

Development and validation of a tool to assess knowledge and attitudes towards generic medicines among students in Greece: The ATtitude TOwards GENerics (ATTOGEN) questionnaire.

INTRODUCTION: The use of generic medicines is a cost-effective policy, often dictated by fiscal restraints. To our knowledge, no fully validated tool exploring the students' knowledge and attitudes towards generic medicines exists. The aim of our study was to develop and validate a questionnaire exploring the knowledge and attitudes of M.Sc. in Health Care Management students and recent alumni's towards generic drugs in Greece. MATERIALS AND METHODS: The development of the questionnaire was a result of literature review and pilot-testing of its preliminary versions to researchers and students. The final version of the questionnaire contains 18 items measuring the respondents' knowledge and attitude towards generic medicines on a 5-point Likert scale. Given the ordinal nature of the data, ordinal alpha and polychoric correlations were computed. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales. Confirmatory factor analysis and Generalized Linear Latent and Mixed Model analysis (GLLAMM) with the use of the rating scale model were used in the second sample to assess goodness of fit. An assessment of internal consistency reliability, test-retest reliability, and construct validity was also performed. RESULTS: Among 1402 persons contacted, 986 persons completed our questionnaire (response rate = 70.3%). Overall Cronbach's alpha was 0.871. The conjoint use of exploratory and confirmatory factor analysis resulted in a six-scale model, which seemed to fit the data well. Five of the six scales, namely trust, drug quality, state audit, fiscal impact and drug substitution were found to be valid and reliable, while the knowledge scale suffered only from low inter-scale correlations and a ceiling effect. However, the subsequent confirmatory factor and GLLAMM analyses indicated a good fit of the model to the data. CONCLUSIONS: The ATTOGEN instrument proved to be a reliable and valid tool, suitable for assessing students' knowledge and attitudes towards generic medicines.

Giving Your Last Gift: A Study of the Knowledge, Attitude and Information of Greek Students Regarding Organ Donation.

BACKGROUND: Organ donation rates in Greece are the lowest in the European Union. Studying and improving young students' awareness may increase organ donation rates. This study aimed to investigate young students' knowledge, attitude and information regarding organ donation and whether they are modified by putative predictors. MATERIAL AND METHODS: A 62-item electronic questionnaire was sent to 1451 eligible students aged 18-30 years in 16 Greek public technical schools. Two composite scales (knowledge and attitude) were created. The multivariate statistical analysis included ordinal logistic and linear regression, as appropriate. RESULTS: Only 37.9% of the students knew the correct definition of organ donation, 40.3% knew which organs can be donated, 27.4% were informed about the new Greek legislation, and 83.1% acknowledged the need for better information. Although 60.5% would donate an organ after death, only 16.1% would become living donors. Although 83.1% of the students declared knowing what brain death means, 18.6% believe that a brain-dead person could fully recover and 32.3% are unsure about it. Being a health professional or a blood donor, the parent's educational level, the wish to donate all organs after death, the information from announcements or posters, the fear of organ removal after death without prior consent, the consent for autopsy, the wish for better information, and the misbelief that a brain-dead person could fully recover emerged as important predictors of the knowledge and attitude, regarding organ donation. CONCLUSIONS: An important lack of knowledge and misperceptions were noted regarding organ donation. Significant predictors were identified.

Screening in the era of economic crisis: misperceptions and misuse from a longitudinal study on Greek women undergoing benign vacuum-assisted breast biopsy.

BACKGROUND: To evaluate knowledge about screening tests and tests without proven screening value in a Greek Breast Unit population undergoing benign vacuum-assisted breast biopsy (VABB). MATERIALS AND METHODS: This study included 81 patients. Three knowledge-oriented items (recommended or not, screening frequency, age of onset) were assessed. Regarding screening tests two levels of knowledge were evaluated: i). crude knowledge (CK), i.e. knowledge that the test is recommended and ii). advanced knowledge (AK), i.e. correct response to all three knowledge-oriented items. Solely CK was evaluated for tests without proven screening value. Risk factors for lack of knowledge were assessed with multivariate logistic regression. A second questionnaire was administered 18 months after VABB to assess its impact on the performance of tests. RESULTS: Concerning screening tests considerable lack of AK was noted (mammogram, 60.5%; Pap smear, 59.3%; fecal occult blood testing, 93.8%; sigmoidoscopy, 95.1%). Similarly lack of CK was documented regarding tests without proven screening value (breast self-examination, 92.6%; breast MRI, 60.5%; abdominal ultrasound, 71.6%; barium meal, 48.1%; urine analysis, 90.1%; chest X-Ray, 69.1%; electrocardiogram, 74.1%; cardiac ultrasound, 75.3%). Risk factors for lack of AK were: place of residence (mammogram), age (Pap smear), personal income (sigmoidoscopy); risk factors for lack of CK included number of offspring (breast MRI, chest X-Ray), BMI (abdominal ultrasound), marital status (urine analysis), current smoking status (electrocardiogram). VABB's only effect was improvement in mammogram rates. CONCLUSIONS: A considerable lack of knowledge concerning screening tests and misperceptions regarding those without proven value was documented.

Hsp90 in the continuum of breast ductal carcinogenesis: Evaluation in precursors, preinvasive and ductal carcinoma lesions.

BACKGROUND: Hsp90 (heat shock protein90) is a chaperone protein essential for preserving and regulating the function of various cellular proteins. Elevated Hsp90 expression seems to be a trait of breast cancer and may be an integral part of the coping mechanisms that cancer cells exhibit vis-à-vis stress. This manuscript tries to examine the immunohistochemical expression of Hsp90 all along the continuum of breast ductal lesions encompassing ductal hyperplasia without atypia (DHWithoutA), atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC). METHODS: Tissue specimens were taken from 30 patients with DHWithoutA, 31 patients with ADH, 51 with DCIS and 51 with IDC. Immunohistochemical assessment of Hsp90 was performed both in the lesion and the adjacent normal breast ducts and lobules; the latter serving as control. Concerning Hsp90 assessment the percentage of positive cells and the intensity were separately analyzed. Subsequently, the Allred score was calculated. Post hoc analysis on the correlations between Hsp90 Allred score and possible predictors (grade, nodal status, tumor size, ER Allred score, PR Allred score, c-erbB-2 status and triple negative status) was conducted in IDC. RESULTS: Hsp90 exhibited mainly cytoplasmic immunoreactivity. Hsp90 Allred score exhibited an increasing trend along the continuum of breast ductal lesions (Spearman's rho = 0.169, p = 0.031). Compared to the adjacent normal ducts and lobules, no statistically significant differences were noted in DHwithoutA, ADH and DCIS. Hsp90 expression (intensity, positive cells, Allred score) was higher in IDC, compared to the adjacent normal tissue. Higher Hsp90 expression was observed in grade 2/3 IDCs (borderline association) and tumors of larger size. At the univariable analysis, higher Hsp90 expression was associated with higher ER Allred score, PR Allred score and c-erbB-2 positivity in IDC. Triple-negative IDCs exhibited significantly lower Hsp90 expression. The multivariable logistic regression model revealed that between the three markers, solely ER Allred score and c-erbB-2 positivity were independently associated with higher Hsp90 expression in IDC. CONCLUSION: The above point to significant variability in Hsp90 expression with significant implications upon the effectiveness and limitations of anti-Hsp90 drugs.

Volume of blood suctioned during vacuum-assisted breast biopsy predicts later hematoma formation.

BACKGROUND: To evaluate whether the volume of blood suctioned during vacuum-assisted breast biopsy (VABB) is associated with hematoma formation and progression, patient's age and histology of the lesion. FINDINGS: 177 women underwent VABB according to standardized protocol. The volume of blood suctioned and hematoma formation were noted at the end of the procedure, as did the subsequent development and progression of hematoma. First- and second-order logistic regression was performed, where appropriate. Cases with hematoma presented with greater volume of blood suctioned (63.8 +/- 44.7 cc vs. 17.2 +/- 32.9 cc; p < 0.001, Mann-Whitney-Wilcoxon test for independent samples, MWW); the likelihood of hematoma formation was increasing till a volume equal to 82.6 cc, at which the second-order approach predicts a maximum. The volume of blood suctioned was positively associated with the duration of the procedure (Spearman's rho = 0.417, p < 0.001); accordingly, hematoma formation was also positively associated with the latter (p = 0.004, MWW). The volume of blood suctioned was not associated with patients' age, menopausal status and histopathological diagnosis. CONCLUSION: The likelihood of hematoma is increasing along with increasing amount of blood suctioned, reaching a plateau approximately at 80 cc of blood lost.

Health-related quality of life in vacuum-assisted breast biopsy: short-term effects, long-term effects and predictors.

BACKGROUND: The impact of Vacuum-assisted breast biopsy (VABB, 11-Gauge) upon Health-related Quality of Life (HRQoL) remains an open field. This study aims to: i) assess short-term (4 days after VABB) responses in terms of HRQoL after VABB, ii) evaluate long-term (18 months after VABB) responses, if any, and iii) examine whether these responses are modified by a variety of possible predictors (anthropometric, sociodemographic, lifestyle habits, breast-related parameters, reproductive history, VABB-related features and complications, seasonality). METHODS: This study included 102 eligible patients undergoing VABB and having benign lesions. A variable number of cores (24-96 cores) has been excised. HRQoL was assessed by EQ-5D and SF-36(R) questionnaires: i) in the morning of the VABB procedure day (baseline measurement), ii) four days after VABB (early post-biopsy measurement) and iii) 18 months after VABB (late post-biopsy measurement). Statistical analysis comprised two steps: i. evaluation of differences in EQ-5D/SF-36 dimensions and calculated scores (baseline versus early post-biopsy measurement and baseline versus late post-biopsy measurement) and ii. assessment of predictors through multivariate linear, logistic, ordinal logistic regression, as appropriate. RESULTS: At baseline patients presented with considerable anxiety (EQ-5D anxiety/depression dimension, EQ-5D TTO/VAS indices, SF-36 Mental Health dimension). At the early post-biopsy measurement women exhibited deterioration in Usual Activities (EQ-5D) and Role Functioning-Physical dimensions. At the late measurement women exhibited pain (EQ-5D pain/discomfort and SF-36 Bodily Pain), deterioration in Physical Functioning (SF-36 PF) and overall SF-36 Physical Component Scale (PCS). Mastalgia, older age and lower income emerged as significant predictors for baseline anxiety, whereas seasonality modified early activities-related responses. Pain seemed idiosyncratic. CONCLUSIONS: The HRQoL profile of patients suggests that VABB exerts effects prior to its performance at a psychological level, immediately after its performance at a functioning-physical level and entails long-term effects associated with pain.

Breast self-examination and adherence to mammographic follow-up: an intriguing diptych after benign breast biopsy.

This study evaluates the effect of palpability upon breast self-examination (BSE) and adherence to annual mammogram after benign breast biopsy (BBB). Seven hundred and fifty-two women with palpable (WP, n = 359) or nonpalpable (WNP, n = 393) lesions were evaluated 2 years before and after BBB. BSE was considered adequate when it was performed at least once per month, and inadequate when it was performed with a frequency of less than once per month. Prebiopsy/postbiopsy adherence was characterized as inadequate when at least one session of mammographic examination was lost within the 2-prebiopsy/postbiopsy (including the last visit) years, respectively. The prebiopsy frequency of adequate BSE was higher in WP [49 (176 of 359) vs. 38.9% (153 of 393) for WNP; Pearson's chi2 (1) = 7.77, P = 0.005]. However, the opposite happened regarding the prebiopsy adherence to mammogram, as the frequency of adequate adherence was 64.1% (252 of 393) in WNP, but only 46.0% (165 of 359) in WP. After BBB, adherence to mammogram significantly increased in both groups, reaching 76.1% (299 of 393) for WNP and 65.2% (234 of 359) for WP. However, BSE increased significantly only in WNP. Regarding the WP group, the postBBB BSE did not exhibit any significant change. Noticeably, the aforementioned increase in BSE among WNP resulted in the disappearance of the initial WP-WNP discrepancy regarding BSE; the postBBB BSE did not differ between WP and WNP. However, concerning adherence to mammogram, the superiority of WNP versus WP persisted (76.1 vs. 65.2%, respectively). In conclusion WP and WNP may perceive BBB differently, as reflected upon the differentially modified patterns.

Biopsy method: a major predictor of adherence after benign breast biopsy?

OBJECTIVE: Adopting a longitudinal approach to assess women after breast biopsy with a benign result, this study aimed to comparatively evaluate the effect of the biopsy method on compliance with clinical recommendations for follow-up. MATERIALS AND METHODS: For this study, 410 patients who underwent biopsy of a breast lesion were included: fine-needle aspiration biopsy, n = 95 patients; core biopsy, n = 84; local excision under local anesthesia, n = 72; vacuum-assisted breast biopsy, n = 100; and hookwire localization, n = 59. Information about patient age, place of residence, whether complications occurred, and type of lesion was collected. RESULTS: Compliance was higher among women who had undergone vacuum-assisted breast biopsy than those who had undergone one of the other biopsy methods. The superiority (carryover effect) of vacuum-assisted breast biopsy persisted for 18 months after the biopsy procedure. Patient compliance for all of the other biopsy methods followed an M pattern, with the peaks corresponding to the follow-up mammography sessions. In patients who had undergone vacuum-assisted breast biopsy, a gradual decrease in compliance over time was observed. Older women were more compliant than younger women with follow-up recommendations regardless of biopsy method. A subanalysis of the vacuum-assisted breast biopsy group indicated that complications are associated with better compliance. CONCLUSION: Women more often adhere to clinical recommendations for follow-up sessions comprising mammography. Patient age and whether biopsy complications occurred also seem to modify compliance. Further studies should assess whether superior compliance after vacuum-assisted breast biopsy persists in other settings, such as with stereotactic or ultrasound guidance, different numbers of cores, and procedures of various durations.

Pain during vacuum-assisted breast biopsy: are there any predictors?

INTRODUCTION: To assess the putative predictors that may be implicated in the pain experienced during stereotactic vacuum-assisted breast biopsy (VABB). MATERIALS AND METHODS: One hundred and thirty-five consecutive women with microcalcifications underwent VABB on the Fischer's table. The visual analogue scale was used to measure the degree of the "average pain" (AP). RESULTS: At the univariable analysis, the AP was positively associated with the duration of the procedure, the diagnosis of malignant/preinvasive lesions and the volume of blood lost. Although menopausal status was not associated with the AP, within the premenopausal subpopulation, luteal phase was associated with higher VAS score. These findings also persisted at the multivariable ordinal logistic regression model. However, the mean experienced pain was associated neither with the volume of tissue excised nor with the hematoma formation, nor with patients' age. CONCLUSION: The aforementioned factors were independent positive predictors of the mean experienced pain during VABB.

Chronic cholecystitis in elderly patients. Correlation of the severity of inflammation with the number and size of the stones.

BACKGROUND: [corrected] The present study focused on cholecystectomized elderly patients and aimed to investigate whether inflammation in the gallbladder wall was associated with the number and size of gallstones, as well as the patients' age. PATIENTS AND METHODS: The present study included 306 cholecystectomized patients aged over 65 years. From the specimens derived from cholecystectomy, the gallstone number, the largest gallstone diameter and gallbladder wall thickness were determined. According to the histopathological examination, chronic inflammation was subdivided into mild-moderate and severe. Univariable analysis and multivariable logistic regression followed. RESULTS: Mild-moderate inflammation characterized 63.4% of the cases and severe inflammation 366%. Solitary gallstones were found in 13.1% of the cases, while multiple gallstones were found in 86.9% of the cases. The largest gallstone diameter was less than 1 cm in the majority of cases (73.2%). The gallbladder wall thickness was associated with the degree of inflammation (p < 0.001, Chi-square). In the univariable analysis, inflammation was positively associated with the diameter of the largest gallstone (p = 0.032, Chi-square), but negatively associated with the number of gallstones (p < 0.001, Chi-square) and patients' age (p = 0.008, logistic regression). The number of gallstones was negatively associated with the diameter of gallstones and positively associated with the patients' age. The diameter of the largest gallstone was negatively associated with the patients' age. In the multivariable logistic regression, the effect of age (OR = 0.95, 95% CI: 0.91-0.99) and solitary gallstones (OR = 2.66, 95% CI: 1.02-6.93) on inflammation persisted, but that of the largest gallstone diameter vanished. CONCLUSION: The elderly population presented mainly with multiple and small gallstones. Solitary gallstones and younger age were the most important predictors for severe inflammation.

Pain in different methods of breast biopsy: emphasis on vacuum-assisted breast biopsy.

This study examines pain (visual analog scale 0-10) in women undergoing breast biopsy. Two hundred and twenty-seven patients with a palpable lesion underwent FNA (21G, n=85), core biopsy (14G, n=86) or open biopsy under local anesthesia (n=56). One hundred and twenty-six women presented with a non-palpable lesion, and underwent vacuum-assisted breast biopsy (VABB, 11G) under mammographic guidance, prone position (n=72) or hook-wire localization followed by open surgery (n=54). The techniques sampling non-palpable lesions were the most painful: hook-wire (9.15+/-0.74) and VABB (4.35+/-1.70). Larger needle diameter was associated with more intense pain. Concerning VABB, an S-shape curve of pain (third-order pattern) was documented. A second dose of lidocaine just before the rapid increase phase was then adopted (n=61), and reduced the total/maximum pain. In conclusion, although VABB is less painful than hook-wire, the pain experienced in VABB is significant; however, it can be attenuated by a second dose of lidocaine.

Secondary breast lymphoma diagnosed by vacuum-assisted breast biopsy: a case report.

INTRODUCTION: Breast lymphoma, either as a manifestation of primary extranodal disease or as secondary involvement, is a rare malignancy, and its diagnosis, prognosis, and treatment have not been clearly defined. On the other hand, Vacuum-assisted breast biopsy (VABB) is a minimally invasive technique with ever-growing use for the diagnosis of mammographically detected, non-palpable breast lesions. CASE PRESENTATION: A symptom-free, 56-year-old woman presented with a non-palpable BI-RADS 4B lesion without microcalcifications. She had a positive family history for breast cancer and a history of atypical ductal hyperplasia in the ipsilateral breast four years ago. She reported having been treated for non-Hodgkin lymphoma 12 years ago. With the suspicion of breast cancer, mammographically guided VABB with 11-gauge probe (on the stereotactic Fisher's table) was performed. VABB made the diagnosis of a non-Hodgkin, grade II, B-cell germinal-center lymphoma. VABB yielded enough tissue for immunohistochemistry/WHO classification. CONCLUSION: This is the first case in the literature demonstrating the successful diagnosis of breast lymphoma by VABB, irrespectively of the level of clinical suspicion. It should be stressed that VABB was able to yield enough tissue for WHO classification. In general, lymphoma should never be omitted in the differential diagnosis, since no pathognomonic radiologic findings exist for its diagnosis.

Bilateral synchronous breast carcinomas followed by a metastasis to the gallbladder: a case report.

BACKGROUND: Breast cancer is usually associated with metastases to lungs, bones and liver. Breast carcinoma metastasizing to the gallbladder is very rare. CASE PRESENTATION: A 59-year-old woman presented with bilateral synchronous breast lesions. A palpable, retroareolar solid lesion of diameter equal to 5 cm was present in the right breast, and a newly developed, non-palpable lesion with microcalcifications (diameter equal to 0.7 cm) was present in the upper outer quadrant of the left breast. Modified radical mastectomy was performed on the right breast and lumpectomy after hook-wire localization was performed on the left breast, combined with lymph node dissection in both sides. The pathological examination revealed invasive lobular carcinoma grade II in the right breast and invasive ductal carcinoma grade I in the left breast. Chemotherapy, radiation therapy, trastuzumab and letrozole were appropriately administered. At her 18-month follow-up, the patient was free of symptoms; the imaging tests (chest CT, abdominal U/S, bone scan), biochemical tests, blood cell count and tumor markers were also normal. At the 20th month after surgery however, the patient developed symptoms of cholecystitis and underwent cholecystectomy. The histopathological examination revealed metastasis of the lobular carcinoma to the gallbladder. CONCLUSION: This extremely rare case confirms on a single patient the results of large series having demonstrated the preferential metastasis of lobular breast cancer to the gallbladder. Symptoms of cholecystitis should not be neglected in such patients, as they might indicate metastasis to the gallbladder.

Is zero underestimation feasible? Extended Vacuum-Assisted Breast Biopsy in solid lesions - a blind study.

BACKGROUND: Vacuum-Assisted Breast Biopsy (VABB) is effective for the preoperative diagnosis of non-palpable mammographic solid lesions. The main disadvantage is underestimation, which might render the management of atypical ductal hyperplasia (ADH), and ductal carcinoma in situ (DCIS) difficult. This study aims to develop and assess a modified way of performing VABB. PATIENTS AND METHODS: A total of 107 women with non-palpable mammographic breast solid tumors BI-RADS 3 and 4 underwent VABB with 11G, on the stereotactic Fischer's table. 54 women were allocated to the recommended protocol and 24 cores were obtained according to the consensus meeting in Nordesterdt (1 offset-main target in the middle of the lesion and one offset inside). 53 women were randomly allocated to the extended protocol and 96 cores were excised (one offset-main target in the middle of the lesion and 7 peripheral offsets). A preoperative diagnosis was established. Women with a preoperative diagnosis of precursor/preinvasive/invasive lesion underwent open surgery. A second pathologist, blind to the preoperative results and to the protocol made the postoperative diagnosis. The percentage of the surface excised via VABB was retrospectively calculated on the mammogram. The discrepancy between preoperative and postoperative diagnoses along with the protocol adopted and the volume removed were evaluated by Fisher's exact test and Mann-Whitney-Wilcoxon test, respectively. RESULTS: Irrespectively of the protocol adopted, 82.2% of the lesions were benign. 14.0% of the lesions were malignancies (5.1% of BI-RADS 3, 5.3% of BI-RADS 4A, 25% of BI-RADS 4B, and 83.3% of BI-RADS 4C lesions). 3.7% of the biopsies were precursor lesions. There was no evidence of underestimation in either protocols. In the standard protocol, the preoperative/postoperative diagnoses were identical. In the extended protocol, the postoperative diagnosis was less severe than the preoperative in 55.5% of cases (55.5% vs. 0%, p = 0.029), and preoperative ADH was totally removed. The phenomenon of discrepancy between diagnoses was associated with larger volume removed (8.20 +/- 1.10 vs. 3.32 +/- 3.50 cm3, p = 0.037) and higher removed percentage of the lesion (97.83 +/- 4.86% vs. 74.34 +/- 23.43%, p = 0.024) CONCLUSION: The extended protocol seems to totally excise precursor lesions, with minimal underestimation. This might possibly point to a modified management of ADH lesions.