The role of contrast-enhanced mammography in the preoperative evaluation of invasive lobular carcinoma of the breast.

AIM: To assess the performance of contrast-enhanced mammography (CEM) in the preoperative staging of invasive lobular carcinoma (ILC) of the breast. MATERIALS AND METHODS: The present study was a multicentre, multivendor, multinational retrospective study of women with a histological diagnosis of ILC who had undergone CEM from December 2013 to December 2021. Index lesion size and multifocality were recorded for two-dimensional (2D) mammography, CEM, and when available magnetic resonance imaging (MRI). Comparison with histological data was undertaken for women treated by primary surgical excision. Pearson correlation coefficients and Bland-Altman's analysis of agreement were used to assess differences with a significance level of 0.05. RESULTS: One hundred and fifteen ILC lesions were included, 46 (40%) presented symptomatically and 69 were screening detected. CEM demonstrated superior sensitivity when compared to standard mammography. The correlation between the histological size measured on the surgical excision specimen size was greater than with standard mammography (r=0.626 and 0.295 respectively, p=0.001), with 19% of lobular carcinomas not visible without a contrast agent. The sensitivity of CEM for multifocal disease was greater than standard mammography (70% and 20% respectively, p<0.0001). CEM overestimated tumour size by an average of 1.5 times, with the size difference increasing for larger tumour. When MRI was performed (n=22), tumour size was also overestimated by an average of 1.3 times. The degree of size overestimation was similar for both techniques, with the tumour size on CEM being on average 0.5 cm larger than MRI. CONCLUSION: CEM is a useful tool for the local staging of lobular carcinomas and could be an alternative to breast MRI.

Evaluation of a computer-aided detection (CAD)-enhanced 2D synthetic mammogram: comparison with standard synthetic 2D mammograms and conventional 2D digital mammography.

AIM: To evaluate the diagnostic performance of computer-aided detection (CAD)-enhanced synthetic mammograms in comparison with standard synthetic mammograms and full-field digital mammography (FFDM). MATERIALS AND METHODS: A CAD-enhanced synthetic mammogram, a standard synthetic mammogram, and FFDM were available in 68 breast-screening cases recalled for soft-tissue abnormalities (masses, parenchymal deformities, and asymmetric densities). Two radiologists, blinded to image type and final assessment outcome, retrospectively read oblique and craniocaudal projections for each type of mammogram. The resulting 204 pairs of 2D images were presented in random order and scored on a five-point scale (1, normal to 5, malignant) without access to the Digital breast tomosynthesis (DBT) slices. Receiver operating characteristic (ROC) curve analysis was performed. RESULTS: There were 34 biopsy-proven malignancies and 34 normal/benign cases. Diagnostic accuracy was significantly improved for the CAD-enhanced synthetic mammogram compared to the standard synthetic mammogram (area under the ROC curve [AUC]=0.846 and AUC=0.683 respectively, p=0.004) and compared to the conventional 2D FFDM (AUC=0.724, p=0.027). The CAD-enhanced synthetic mammogram had the highest diagnostic accuracy for all soft-tissue abnormalities, and for malignant lesions sensitivity was not affected by tumour size. For all 68 cases, there was an average of 3.2 areas enhanced per image. For the 34 cancer cases, 97.4% of lesions were correctly enhanced, with 2.1 false areas enhanced per image. CONCLUSIONS: CAD enhancement significantly improves performance of synthetic 2D mammograms and also exhibits improved diagnostic accuracy compared to conventional 2D FFDM.

Morphological and Chemical Characterization of the Invasive Ants in Hives of Apis mellifera scutellata Lepeletier (Hymenoptera: Apidae).

Apiculture in Brazil is quite profitable and has great potential for expansion because of the favorable climate and abundancy of plant diversity. However, the occurrence of pests, diseases, and parasites hinders the growth and profitability of beekeeping. In the interior of the state of São Paulo, apiaries are attacked by ants, especially the species Camponotus atriceps (Smith) (Hymenoptera: Formicidae), which use the substances produced by Apis mellifera scutellata (Lepeletier) (Hymenoptera: Apidae), like honey, wax, pollen, and offspring as a source of nourishment for the adult and immature ants, and kill or expel the adult bees during the invasion. This study aimed to understand the invasion of C. atriceps in hives of A. m. scutellata. The individuals were classified into castes and subcastes according to morphometric analyses, and their cuticular chemical compounds were identified using Photoacoustic Fourier transform infrared spectroscopy (FTIR-PAS). The morphometric analyses were able to classify the individuals into reproductive castes (queen and gynes), workers (minor and small ants), and the soldier subcaste (medium and major ants). Identification of cuticular hydrocarbons of these individuals revealed that the eight beehives were invaded by only three colonies of C. atriceps; one of the colonies invaded only one beehive, and the other two colonies underwent a process called sociotomy and were responsible for the invasion of the other seven beehives. The lack of preventive measures and the nocturnal behavior of the ants favored the invasion and attack on the bees.

Influence of region of interest size and ultrasound lesion size on the performance of 2D shear wave elastography (SWE) in solid breast masses.

AIM: To evaluate the influence of the region of interest (ROI) size and lesion diameter on the diagnostic performance of 2D shear wave elastography (SWE) of solid breast lesions. MATERIALS AND METHODS: A study group of 206 consecutive patients (age range 21-92 years) with 210 solid breast lesions (70 benign, 140 malignant) who underwent core biopsy or surgical excision was evaluated. Lesions were divided into small (diameter <15 mm, n=112) and large lesions (diameter ≥15 mm, n=98). An ROI with a diameter of 1, 2, and 3 mm was positioned over the stiffest part of the lesion. The maximum elasticity (Emax), mean elasticity (Emean) and standard deviation (SD) for each ROI size were compared to the pathological outcome. Statistical analysis was undertaken using the chi-square test and receiver operating characteristic (ROC) analysis. RESULTS: The ROI size used has a significant impact on the performance of Emean and SD but not on Emax. Youden's indices show a correlation with the ROI size and lesion size: generally, the benign/malignant threshold is lower with increasing ROI size but higher with increasing lesion size. CONCLUSIONS: No single SWE parameter has superior performance. Lesion size and ROI size influence diagnostic performance.

Assessment and quantification of sources of variability in breast apparent diffusion coefficient (ADC) measurements at diffusion weighted imaging.

PURPOSE: Apparent Diffusion Coefficient (ADC) measurements are increasingly used for assessing breast cancer response to neoadjuvant chemotherapy although little data exists on ADC measurement reproducibility. The purpose of this work was to investigate and characterise the magnitude of errors in ADC measures that may be encountered in such follow-up studies- namely scanner stability, scan-scan reproducibility, inter- and intra- observer measures and the most reproducible measurement of ADC. METHODS: Institutional Review Board approval was obtained for the prospective study of healthy volunteers and written consent acquired for the retrospective study of patient images. All scanning was performed on a 3.0-T MRI scanner. Scanner stability was assessed using an ice-water phantom weekly for 12 weeks. Inter-scan repeatability was assessed across two scans of 10 healthy volunteers (26-61 years; mean: 44.7 years). Inter- and intra-reader analysis repeatability was measured in 52 carcinomas from clinical patients (29-70 years; mean: 50.0 years) by measuring the whole tumor ADC value on a single slice with maximum tumor diameter (ADCS) and the ADC value of a small region of interest (ROI) on the same slice (ADCmin). Repeatability was assessed using intraclass correlation coefficients (ICC) and coefficients of repeatability (CoR). RESULTS: Scanner stability contributed 6% error to phantom ADC measurements (0.071×10(-3)mm(2)/s; mean ADC=1.089×10(-3)mm(2)/s). The measured scan-scan CoR in the volunteers was 0.122×10(-3)mm(2)/s, contributing an error of 8% to the mean measured values (ADCscan1=1.529×10(-3)mm(2)/s; ADCscan2=1.507×10(-3)mm(2)/s). Technical and clinical observers demonstrated excellent intra-observer repeatability (ICC>0.9). Clinical observer CoR values were marginally better than technical observer measures (ADCS=0.035×10(-3)mm(2)/s vs. 0.097×10(-3)mm(2)/s; ADCmin=0.09×10(-3)mm(2)/s vs. 0.114×10(-3)mm(2)/s). Inter-reader ICC values were good 0.864 (ADCS) and fair 0.677 (ADCmin). Corresponding CoR values were 0.202×10(-3)mm(2)/s and 0.264×10(-3)mm(2)/s, respectively. CONCLUSIONS: Both scanner stability and scan-scan variation have minimal influence on breast ADC measurements, contributing less than 10% error of average measured ADC values. Measurement of ADC values from a small ROI contributes a greater variability in measurements compared with measurement of ADC across the whole visible tumor on one slice. The greatest source of error in follow-up studies is likely to be associated with measures made by multiple observers, and this should be considered where multiple measures are required to assess response to treatment.

Phyllodes tumours of the breast diagnosed as B3 category on image-guided 14-gauge core biopsy: analysis of 51 cases from a single institution and review of the literature.

AIMS: Image-guided 14-gauge (G) core biopsy (CB) has been shown to be an accurate method providing histological diagnosis of breast lesions. The purpose of this study was to evaluate the reliability of image-guided 14-G CB in the diagnosis of phyllodes tumours (PT) reported as B3 category and its accuracy in distinguishing this lesion from fibroadenomas (FA). MATERIALS AND METHODS: The records of 10 000 image-guided 14-G CB of the breast performed from January 2001 to August 2011 at the Diagnostic Senology Unit of Careggi University Hospital were reviewed; 2554 (25.5%) were fibroepithelial lesions: 56 of them (2%) were diagnosed as PT and reported as B3 category. The database of the Pathological Anatomy Unit of Careggi University Hospital was then searched to verify the histological diagnosis after surgical excision. Fifty-one cases of PT diagnosed as B3 category in 51 women were included in the present study. RESULTS: Of the 51 cases of PT diagnosed as B3 category on 14-G CB, 39 (76.5%) lesions were confirmed as PT on SE (30, 4 and 5 as benign, borderline and malignant PT respectively) with a PPV of 76.5%. Twelve lesions (23.5%) were diagnosed as FA after surgical excision. CONCLUSIONS: Our study shows that 14-G CB is a valuable tool, in a preoperative setting, in diagnosing PT.

The impact of method of biopsy on the incidence of breast cancer sentinel lymph node metastases.

BACKGROUND: The dislocation of the malignant cells along the needle tract during breast cancer (BC) diagnosis has been demonstrated by several studies. However, the published experiences that relate the diagnostic technique with sentinel node (SN) involvement are few and controversial. The aim of our analysis was to evaluate the impact of different techniques for preoperative BC biopsy among prognostic factors of metastases occurrence in SN. MATERIALS AND METHODS: We reviewed the institutional clinical database of our Center. A total of 674 patients were diagnosed between February 1999 and December 2006 with invasive BC. SN metastases classification followed the 2002 American Joint Committee on Cancer (AJCC) TNM pathological staging: macrometastases, micrometastases, isolated tumor cells or negative. Only macrometastases and micrometastases were considered positive. Concerning fine-needle aspiration cytology, we used disposable needles of the size of 21-27 G. For percutaneous biopsy we used cutting needle type "tru-cut"; the Gauge needle ranged between 14 and 20. RESULTS: At univariate analysis of specific parameters using positive SN as outcome, percutaneous diagnostic technique did not affect significantly the SN positivity (p = 0.60). At multivariate models only central quadrant lesion (p = 0.005) and lymph vascular invasion (LVI) presence (p < 0.0001) maintained the statistical significance as risk factor for positive SN status. Polytomic logistics models showed that only LVI maintained the statistical significance both for prediction of micrometastases and macrometastases. CONCLUSIONS: Our analysis showed that different techniques used for BC diagnosis did not influence SN status.

Upper limb evaluation with robotic exoskeleton. Normative values for indices of accuracy, speed and smoothness.

BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient's ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. METHODS: Twenty-five healthy individuals performed the Armeo®Spring device "Vertical Capture" task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.

Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature.

The purpose of this study was to evaluate the reliability of image-guided 14-gauge needle core biopsy in the diagnosis of radial scar without associated atypical epithelial proliferation, by comparison with definitive histological diagnosis on surgical excision. The records of 8792 consecutive image-guided 14-gauge needle core biopsy of the breast performed from January 1996 to December 2009 were reviewed. Forty-nine cases of radial scar without associated atypical epithelial proliferation were identified and compared with definitive histological diagnosis on surgical excision. The definitive histological diagnosis on surgical excision confirmed the results of image-guided 14-gauge needle core biopsy in 36 of 49 cases (73.5%), in 9 cases (18.3%) radial scar was associated with atypical epithelial proliferation, while 4 cases out of 49 cases were upgraded to carcinoma (3 cases of ductal carcinoma in situ and one case of invasive lobular carcinoma), with an underestimation rate of 8.2%. A diagnosis of radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy does not exclude a malignancy on surgical excision; consequently during the multidisciplinary discussion further assessment by surgical excision or vacuum-assisted excision, as recently reported, needs to be considered to obtain a definitive histological diagnosis.

Oral clearance of NaF from chewing gum and tablets in children and adults.

AIM: Aim of the present study was to evaluate the salivary clearance of Fluoride following administration of tablets and chewing gums containing 0.50 mg of Fluoride in the form of NaF. MATERIALS AND METHODS: Ten children (age 10-13 years) and a control group of 10 adults (age 22-27 years) were recruited and selected for the study. The experiment consisted of saliva samples collection from each participant at fixed time intervals. Whole saliva was sampled from ten 10-13 years-old children to assess the baseline fluoride concentration, then participants received one piece of chewing-gum and were asked to chew for 15 minutes. Whole saliva samples were collected 5, 10, 20, 30, 45 and 60 minutes after the chewing period. The day after once again we administered a chewing-gum to each child, instructing them to continuously chew it for 15 minutes; subsequently we collected saliva samples at the same intervals previously fixed. The following day the experiment was repeated, this time requesting the patient to chew as slow as possible for 15 minutes and then news samples were collected. Saliva samples were collected at the same intervals previously fixed from control group of 10 adults. After a week, children's group received one tablet and new saliva samples were collected at the same intervals. The collected samples were analysed by a potentiometric method, assessing the Fluoride concentration by means of a Fluoride ion-selective electrode. RESULTS: The clearance of Fluoride is similar for both the administration methods used. CONCLUSION: Both chewing gum and tablets are valid methods of Fluoride administration and they can be considered useful aids in dental caries prevention (when used in addition to adequate oral hygiene).

A comparison of the in vitro Comet assay with the in vitro chromosome aberration assay using whole human blood or Chinese hamster lung cells: validation study using a range of novel pharmaceuticals.

The in vitro Comet assay, a sensitive, quick and relatively cheap test, could become a valid alternative to the commonly used in vitro chromosomal aberration test, in the preliminary evaluation of new chemical entities early in the development of new pharmaceuticals. A validation of the Comet assay procedure using whole human blood or CHL cells was carried out in comparison with a cytogenetic test utilizing the same target cells with the following compounds which demonstrated positive results in standard chromosomal aberration tests: two well-documented clastogens, methyl methanesulphonate and cyclophosphamide, and eight novel drugs in early development. A 3 h exposure time, in both the absence and presence of metabolic activation, was used for the in vitro Comet assay. Agreement between the results of the Comet assay and the chromosomal aberration tests was found to be satisfactory on a qualitative basis, although positive results in the Comet assay were always at higher doses than in the cytogenetic test. This indicates a reduction in sensitivity using the former genotoxicity end-point. In order to try to explain this observation, a range of exposure times (0.25, 0.5, 1, 2 and 3 h) were investigated in two further experiments to determine the optimal time for detecting Comet induction in this assay procedure. Maximum levels of DNA damage (in terms of Comet induction) were recorded at earlier sampling times (0.25-1 h) in whole human blood using the same positive doses observed in HPLT. Further studies need to be performed to confirm these findings. It is possible that strand breaks are too short lived to allow detection after a 3 h treatment period (due to preferential repair), indicating the need for shorter exposure times in some cases to optimize their detection.

The use of mini- and micro-computers in eye clinical practice.

In an ophthalmological department there are many sectors in which the use of computers can give useful support. We have singled out three major areas of interest: 1. the rationalization of the flow of patients; 2. the management of clinical records; 3. the automatization of ophthalmological devices. Instead of using different dedicated computational systems we preferred to focus our attention on a unique system based on a minicomputer driving several parallel micro-processors. Preliminary results are given.

The visual field examination and its automation.

An automated system for examination of the visual fields is described. The entire campimetric examination was simulated in order to enable an in-depth analysis of actual examinations. The program runs on a HP2100 computer with a 16K core. The main advantages of the system are: greater speed, less patient fatigue, greater reliability, repeatability and accuracy.