Comparing accuracy of tomosynthesis plus digital mammography or synthetic 2D mammography in breast cancer screening: baseline results of the MAITA RCT consortium.

AIM: The analyses here reported aim to compare the screening performance of digital tomosynthesis (DBT) versus mammography (DM). METHODS: MAITA is a consortium of four Italian trials, REtomo, Proteus, Impeto, and MAITA trial. The trials adopted a two-arm randomised design comparing DBT plus DM (REtomo and Proteus) or synthetic-2D (Impeto and MAITA trial) versus DM; multiple vendors were included. Women aged 45 to 69 years were individually randomised to one round of DBT or DM. FINDINGS: From March 2014 to February 2022, 50,856 and 63,295 women were randomised to the DBT and DM arm, respectively. In the DBT arm, 6656 women were screened with DBT plus synthetic-2D. Recall was higher in the DBT arm (5·84% versus 4·96%), with differences between centres. With DBT, 0·8/1000 (95% CI 0·3 to 1·3) more women received surgical treatment for a benign lesion. The detection rate was 51% higher with DBT, ie. 2·6/1000 (95% CI 1·7 to 3·6) more cancers detected, with a similar relative increase for invasive cancers and ductal carcinoma in situ. The results were similar below and over the age of 50, at first and subsequent rounds, and with DBT plus DM and DBT plus synthetic-2D. No learning curve was appreciable. Detection of cancers >= 20 mm, with 2 or more positive lymph nodes, grade III, HER2-positive, or triple-negative was similar in the two arms. INTERPRETATION: Results from MAITA confirm that DBT is superior to DM for the detection of cancers, with a possible increase in recall rate. DBT performance in screening should be assessed locally while waiting for long-term follow-up results on the impact of advanced cancer incidence.

Efficiency and effectiveness of an innovative RIS function for patient information reconciliation directly integrated with PACS.

In RIS-PACS systems, potential errors occurring during the execution of a radiologic examination can amplify the clinical risks of the patient during subsequent treatments, e.g., of oncologic patients or of those who must do additional treatments based on the initial diagnosis. In Reggio Emilia Province Diagnostic Imaging Department (REDID) we experienced different strategies to reduce clinical risks due to patient reconciliation errors. In 2010, we developed a procedure directly integrated in our RIS-PACS that uses Health Level 7 (HL7) standard messaging, which generates an overlay with the text "under investigation" on the images of the study to be corrected. All the healthcare staff is informed of the meaning of that overlay, and only the radiologist and the emergency services staff can consult these images on PACS. The elimination of image overlay and of any access limitation to PACS was triggered to confirm of the right correction made by RIS-PACS system administrator (SA). The RIS-PACS integrated tool described in this paper allows technologists and radiologists to efficiently highlight patient exam errors and to inform all the users to minimize the overall clinical risks, with a significant savings in costs. Over the years, we have observed a steady decrease in the percentage of reconciled studies. Error reconciliation requires an effective and efficient mechanism. The RIS-PACS integrated tool described in this paper enables technologists and radiologists to quickly and efficiently highlight patient exam errors and inform all the users. Next generation of RIS-PACS could be equipped with similar reconciliation tools.

[Focal nodular hyperplasia of the liver. A case report]. / Iperplasia nodulare focale multipla del fegato.

Focal nodular hyperplasia (FNH) of the liver is a benign disorder that usually occurs in women during their reproductive years. Multiple FNH is very rare. A case of multiple FNH of the liver occurring in a 34-year-old woman is described. FNH diagnosis was confirmed by means of US, CT, MR, scintigraphy and hepatic biopsy. There was no further change in either size or appearance of liver masses in the ensuing 6 years of follow-up.

[Multiple bilateral chondromatous hamartomas of the lung. A rare entity mimicking carcinoma]. / Amartoma condromatoso multiplo bilaterale del polmone. Una condizione rara che simula metastasi tumorali.

Multiple chondromatous hamartomas of the lung are extremely rare. We report a case of a 78 year-old man admitted to our service for a neurological syndrome associated with cerebral cancer. Chest-X-ray and computed tomography revealed multiple and bilateral pulmonary nodules. A metastatic carcinoma was initially taken into account but, in the light of natural history of the disease, clinical examination and CT-scan characteristics of the lesions, we formulated the final diagnosis of multiple bilateral chondromatous hamartomas of the lung.