2D shear wave elastography in evaluation of prognostic factors in breast cancer.

PURPOSE: To evaluate the reproducibility of the 2D shear wave elastography (2D-SWE) method and to identify the prognostic factors of breast lesions. METHODS: In this prospective study, 44 female patients were consecutively included from January 2020 to September 2021. All patients showing visible masses at B-mode ultrasound underwent to clinical evaluation, followed by qualitative and quantitative 2D-SWE by two different operators with over 15-year and 2-year experience, respectively. Subsequently, patients underwent to surgical treatment after core needle biopsy. Reproducibility of qualitative and quantitative 2D-SWE was evaluated by Cohen's kappa and intraclass correlation coefficient (ICC). Clinical, imaging, and histopathological data and 2D-SWE evaluations were analysed with Spearman's rank correlation test. RESULTS: The mean age of the patients was 55 years ± 12. The mean histological and ultrasound tumour size of were 23.1 mm ± 13.2 and 17.2 mm ± 10.2, respectively. The interobserver agreement showed a good reproducibility limited to the qualitative evaluation colour maps (Cohen's kappa = 0.603) and to the quantitative evaluation E ratio (ICC = 0.771). Correlation analysis between the ultrasound and 2D-SWE values and the clinical-pathological parameters showed a significant relationship between E ratio and Elston-Ellis grading (P < 0.030) and between tumour size and Elston-Ellis grading (P < 0.041). CONCLUSION: The 2D-SWE has shown good reproducibility among operators with different experience. It could be a promising tool in the evaluation of some prognostic factors in ultrasound visible breast cancer.

Invasive ductal carcinoma mammographic findings: Correlation with age, breast composition and tumor size.

BACKGROUND/OBJECTIVE: The aim of this study was to identify the mammographic findings associated with malignancy in different age groups, taking into account breast composition (BC) and lesion size. METHODS: Preoperative mammograms of 1023 invasive ductal carcinomas were retrospectively evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion and asymmetry, and breasts were assessed as non-dense (A or B BC) and dense (C or D BC). Patient cohort was subdivided into three age groups (group 1: <50 years of age; group 2: between 50 and 69; group 3: ≥70 years of age). RESULTS: Significant results of multinomial logistic regression were the association between mass and non-dense breast (p < 0.0001) and the association between mass and tumor size larger than 15 mm (p = 0.0049). CONCLUSIONS: Mass finding of invasive ductal breast carcinoma is associated with breast composition and tumor size.

Invasive lobular carcinoma mammographic findings: correlation with age, breast composition, and tumour size.

PURPOSE: The aim of this study was to evaluate mammographic findings associated with invasive lobular carcinoma in different age groups, taking into account breast composition and tumour size. MATERIAL AND METHODS: A total of 1023 invasive lobular carcinoma preoperative mammograms were evaluated. According to the American College of Radiology Breast Imaging Reporting and Data System, cancer mammographic findings were classified as mass, calcifications, architectural distortion, and asymmetry, and breasts were assessed as dense (C or D breast composition) or non-dense (A or B). The patient cohort was subdivided into 3 age groups (< 50, 50-69, ≥ 70 years of age). In order to make the size and age groups dichotomous variables and to perform multiple regression analysis, a cut-off of 10 mm was chosen for tumour size, and < 50-years-old and 50-69-years-old age groups were grouped together (< 70-years-old age group). RESULTS: Significant results of multivariate analysis were the association between mass finding and non-dense breasts and size ≥ 10 mm (p < 0.0001), between calcifications, and dense breasts, size < 10 mm and < 70-years-old age group (p < 0.0001), between distortion and < 70-years-old age group (p = 0.0366), and between asymmetry and ≥ 70-years-old age group (p = 0.0090). CONCLUSIONS: Various mammographic findings are differently associated with age group, breast composition, and tumour size.

Morphological MR features and quantitative ADC evaluation in invasive breast cancer: Correlation with prognostic factors.

OBJECTIVE: Assess the correlation between MRI characteristics of invasive breast cancer and tumor prognostic features. MATERIALS AND METHODS: 95 women with invasive breast cancer underwent pre-treatment MR. Morphological findings and quantitative ADC were retrospectively evaluated. RESULTS: Smaller size, round shape, spiculated margins and homogeneous internal enhancement pattern on dynamic MRI were independently associated with established predictors of good prognosis, while larger size and rim enhancement pattern were related to predictors of poor prognosis. A positive correlation was observed between ADC value and clinical stage. CONCLUSIONS: MRI may be a useful tool for breast cancer aggressiveness prediction and for guiding subsequent clinical-therapeutic management.

Impact of thrombus aspiration on myocardial tissue reperfusion and left ventricular functional recovery and remodeling after primary angioplasty.

BACKGROUND: Failure to achieve myocardial reperfusion often occurs during percutaneous coronary intervention (PCI) in patients with myocardial infarction with ST-segment elevation. We hypothesized that manual thrombus aspiration during primary PCI would favorably influence tissue-level myocardial perfusion and left ventricular (LV) functional recovery and remodeling. METHODS AND RESULTS: We prospectively randomized 111 patients with ST-segment elevation myocardial infarction to either standard or thrombus-aspiration PCI. Primary end point of the study was postprocedural incidence of ST-segment resolution >or=70%. Secondary end points included Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grade >or=2, the combination of TIMI myocardial perfusion grade >or=2 and ST-segment resolution >or=70%, post-PCI TIMI grade 3 flow, corrected TIMI frame count, myocardial contrast echocardiography score index, the absence of persistent ST-segment deviation, and time course of wall-motion score index, LV ejection fraction, and LV volume in the 2 groups. The incidence of ST-segment resolution >or=70% was 71% and 39% in the thrombus-aspiration and standard PCI groups, respectively (odds ratio, 3.7; 95% CI, 1.7 to 8.3; P=0.001). TIMI myocardial perfusion grade >or=2 was attained in 93% in the thrombus-aspiration group compared with 71% in the standard PCI group (P=0.006). The percentage of patients with ST-segment resolution >or=70% and TIMI myocardial perfusion grade >or=2 was significantly greater in the thrombus-aspiration group compared with the standard PCI group (69% versus 36%, P=0.0006). Myocardial contrast echocardiography score index was significantly higher in the thrombus-aspiration group compared with the standard PCI group (0.86+/-0.20 versus 0.65+/-0.31; P<0.0001). A significantly greater improvement in LV ejection fraction and in wall-motion score index from baseline to 6-month follow-up was observed in the thrombus-aspiration group compared with the standard PCI group (LV ejection fraction from 48+/-6% to 55+/-6% versus 48.7+/-7% to 49+/-8%, P<0.0001; wall-motion score index from 1.59+/-0.13 to 1.31+/-0.19 versus 1.64+/-0.20 to 1.51+/-0.26, P=0.008). Twelve patients (11%) developed LV remodeling at 6 months, 2 (4%) in the thrombus-aspiration group and 10 (18%) in the standard PCI group (P=0.02). CONCLUSIONS: Manual thrombus aspiration in the setting of primary PCI improves myocardial tissue-level perfusion as well as LV functional recovery and remodeling.

Comparative study of breast implant rupture using mammography, sonography, and magnetic resonance imaging: correlation with surgical findings.

Purpose of this study was to evaluate the accuracy of mammography, ultrasonography, and magnetic resonance imaging (MRI), in the detection of breast implant rupture and to make a correlation with findings at explantation. The study population consisted of 63 women with 82 implants, undergoing surgical explantation. Implant rupture status was blindly determined obtaining diagnosis of rupture, possible rupture, or intact implant. Strictly predetermined rupture criteria were applied and compared with findings at surgery, which were considered the gold standard. False-positives and false-negatives were retrospectively evaluated to identify pitfalls in the investigation. All associations between imaging signs and surgical findings were evaluated by using chi-square test. The respective sensitivity and specificity of investigations are reported. Our experience suggests that MRI is the more accurate method for identification of breast implant rupture, even if it should be performed following the diagnostic algorithm proposed.

Transfer for primary angioplasty in elderly patients with acute myocardial infarction.

INTRODUCTION: The aim of this study was the evaluation of an immediate transfer for primary angioplasty (PPCI) in elderly (age > or = 75 years) patients with ST elevation acute myocardial infarction (STEMI). METHODS AND MATERIALS: All elderly patients with STEMI admitted for PPCI from June 2002 to October 2005, were enrolled. Major Adverse Cardiac Events (MACE) were collected at 6 months. RESULTS: 133 patients (group 1) were admitted directly and 154 patients (group 2) were transferred from peripheral hospitals. Ischemia time was 248 +/- 146 min in group 1 and 276 +/- 169 min in group two (P<0.001); door-to-balloon time was 60+/-30 min in group 1 and 90+/-45 min in group two (P<0.0001). At 6 months cardiac death occurred in 15 (11%) and 16 (10%) patients in group 1 and 2 respectively (P=NS), MI in 3(2%) and 2(1%) respectively (P=NS), clinically driven target lesion revascularization in 6(4%) and 5(3%) respectively, for an overall event-free survival rate of 82% in group 1 and 83% in group 2 (P=NS). Logistic regression analysis showed age (OR: 1.04.1; 95% CI: 1.0-1.2; P=0.049) Killip class > or = 2 (OR: 4.6; 95% CI: 1.3-16.4; P=0.01) to be the only independent predictors of 6-month cardiac mortality. CONCLUSION: Systematic transfer of elderly STEMI patients for PPCI, with a door-to-balloon time <1 h, leads to clinical results similar to those achievable in patients who present directly in hospital with cath.-lab. facilities.

Shifting from pharmacological to systematic mechanical reperfusion therapy for acute myocardial infarction via a cooperating network: impact on reperfusion rate and in-hospital mortality.

BACKGROUND: Primary percutaneous transluminal coronary angioplasty is the preferred reperfusion strategy for acute ST-elevation myocardial infarction in selected settings. Limited data are available about the clinical impact of the implementation of a systematic primary angioplasty infarct reperfusion program in the real world. METHODS AND RESULTS: We organized a comprehensive district network allowing the coordinated and timely transfer of patients with acute ST-elevation myocardial infarction to the hub hospital with catheterization facilities in order to expand the use of mechanical reperfusion. Implementation of the network resulted in increased numbers of patients receiving reperfusion therapies (from 57.5% to 74.1%; P < 0.001). In addition, the proportion of elderly individuals (those aged > or = 75 years) who received a reperfusion therapy significantly increased (from 25.7% to 66.3%; P < 0.001). Accordingly, the proportion of patients not receiving reperfusion therapy dropped from 42.5% to 25.9%. Primary percutaneous transluminal coronary angioplasty usage increased from 24.5% to 73.1% (P < 0.001). As a consequence, in-hospital mortality decreased from 13.5% before establishment of the network to 6.0% (P = 0.016), and major adverse cardiac events decreased from 17.5% to 7.8% (P = 0.005). CONCLUSIONS: Implementation of a systematic primary angioplasty infarct reperfusion program improves reperfusion rate and reduces in-hospital mortality and total major adverse cardiovascular events.

Randomized comparison of upstream tirofiban versus downstream high bolus dose tirofiban or abciximab on tissue-level perfusion and troponin release in high-risk acute coronary syndromes treated with percutaneous coronary interventions: the EVEREST trial.

OBJECTIVES: We aimed to compare the effects of upstream tirofiban versus downstream high-dose bolus (HDB) tirofiban and abciximab on tissue level perfusion and troponin I release in high-risk non-ST-segment elevation acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI). BACKGROUND: Optimal timing and dosage of glycoprotein IIb/IIIa inhibitors for ACS remain to be explored. METHODS: We randomized 93 high-risk ACS patients undergoing PCI to receive upstream (in the coronary care unit) tirofiban, downstream (just prior to PCI) HDB tirofiban, and downstream abciximab. We evaluated the effects of the three drug regimens on tissue-level perfusion using the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count, the TIMI myocardial perfusion grade (TMPG), and intracoronary myocardial contrast echocardiography (MCE) before and immediately after PCI and after cardiac troponin I (cTnI). RESULTS: The TMPG 0/1 perfusion was significantly less frequent with upstream tirofiban compared with HDB tirofiban and abciximab both before (28.1% vs. 66.7% vs. 71%, respectively; p = 0.0009) and after PCI (6.2% vs. 20% vs. 35.5%, respectively; p = 0.015). Upstream tirofiban was also associated with a significantly higher MCE score index (0.88 +/- 0.18 vs. 0.77 +/- 0.32 vs. 0.71 +/- 0.30, respectively; p < 0.05). Post-procedural cTnI elevation was significantly less frequent among patients in the upstream tirofiban group compared with the HDB tirofiban and abciximab groups (9.4% vs. 30% vs. 38.7%, respectively; p = 0.018). The cTnI levels after PCI were significantly lower with upstream tirofiban compared with HDB tirofiban (3.8 +/- 4.1 vs. 7.2 +/- 12; p = 0.015) and abciximab (3.8 +/- 4.1 vs. 9 +/- 13.8; p = 0.0002) CONCLUSIONS: Among high-risk non-ST-segment-elevation ACS patients treated with an early invasive strategy, upstream tirofiban is associated with improved tissue-level perfusion and attenuated myocardial damage.

Elastosonography in the diagnosis of the nodular breast lesions: preliminary report.

PURPOSE: To assess the diagnostic accuracy of elastography in characterising nodular breast lesions. MATERIALS AND METHODS: A total of 82 patients who received mammographic, ultrasonographic and elastographic evaluation in a single session at two Italian centres (Dept of Radiology, Az. Ospedali Riuniti, Ancona, and Ospedale Valduce, Como, Italy) between January and August 2004 according to identical protocols exhibited 91 nodules that were subjected to cytological/histological examination. Lesions were classified and scored and the sensitivity and specificity of elastography calculated. RESULTS: Overall sensitivity and specificity were 79% and 89%, respectively. However, sensitivity was 86% and 65% and specificity 100% and 62% for lesions < 2 cm and > 2 cm in diameter, respectively. Despite the small sample and the fact that it does not include the full range of cell types, tumour cell composition seemed to affect accuracy. CONCLUSIONS: Elastography is easy and rapid to perform. Larger studies are needed to establish semiological patterns; despite the small patient sample, these data provide an interesting contribution.

Elevations in troponin I after percutaneous coronary interventions are associated with abnormal tissue-level perfusion in high-risk patients with non-ST-segment-elevation acute coronary syndromes.

BACKGROUND: In the setting of non-ST-segment-elevation (NSTE) acute coronary syndromes (ACS), the pathophysiological mechanisms underlying post-percutaneous coronary intervention (PCI) cardiac troponin I (cTnI) elevation remain unclear. METHODS AND RESULTS: We evaluated the relationship between troponin elevation and tissue-level perfusion using the TIMI flow grade, corrected TIMI frame count, TIMI myocardial perfusion grade (TMPG), and myocardial contrast enhancement by intracoronary myocardial contrast echocardiography (MCE) before and immediately after PCI performed within 24 to 48 hours of hospital admission in 42 high-risk (angina at rest, unequivocal ST-segment depression, and cTnI elevation) patients with NSTE-ACS. All patients were treated with glycoprotein IIb/IIIa inhibitors (27 with tirofiban and 15 with abciximab) and had successful PCI. Fourteen patients had a postprocedural cTnI elevation, whereas 28 did not. TMPG 0/1 after PCI was observed more frequently in patients with postprocedural cTnI elevation (43% versus 7%; P<0.02). cTnI levels were higher among patients with TMPG 0/1 versus patients with TMPG 2/3 (5.3+/-2.7 versus 1.5+/-1.3 ng/mL; P<0.0001). Patients with postprocedural cTnI elevation also presented a significantly lower number of perfused segments at MCE (59% versus 81%; P=0.02) as well as a lower MCE score index (0.65+/-0.38 versus 0.89+/-0.21; P<0.02). CONCLUSIONS: Postprocedural cTnI elevation in high-risk patients with NSTE-ACS is associated with an abnormal tissue-level perfusion.