Cytological features of nipple adenoma in scraping smears.

INTRODUCTION: Nipple adenoma (NA) is a benign epithelial lesion of the breast that can clinically simulate Paget's disease or invasive ductal carcinoma. Therefore, correct pre-operative diagnosis is important for appropriate management. METHODS: Cytological samples may be obtained by different methods such as fine needle aspiration, nipple discharge or nipple scraping. Herein, the cytological features of three cases of NA are described in which samples were derived from nipple scraping. RESULTS: In all three cases, patients were adult females presenting with a sub-areolar nodule, showing skin ulceration in 2 of 3 cases. The nipple scraping cytological smears were characterised by a bloody background with epithelial cells arranged in clusters or singularly, showing an irregular nuclei profile. These features could simulate a malignant process. However, at higher magnification, fine nuclear chromatin with inconspicuous nucleoli and presence of myoepithelial cells were helpful to exclude malignancy. DISCUSSION: NA may present "worrisome" cytological features on smears derived from nipple scraping. Therefore, knowledge of the cytological spectrum of this lesion is important to avoid misdiagnosis.

Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy.

Percutaneous core biopsy (CB) has been introduced to increase the ability of accurately diagnosing breast malignancies without the need of resorting to surgery. Compared to conventional automated 14 gauge needle core biopsy (NCB), vacuum-assisted needle core biopsy (VANCB) allows obtaining larger specimens and has recognized advantages particularly when the radiological pattern is represented by microcalcifications. Regardless of technical improvements, a small percentage of percutaneous CBs performed to detect breast lesions are still classified, according to European and UK guidelines, in the borderline B3 category, including a group of heterogeneous lesions with uncertain malignant potential. We aimed to assess the prevalence and positive predictive values (PPV) on surgical excision (SE) of B3 category (overall and by sub-categories) in a large series of non-palpable breast lesions assessed through VANCB, also comparison with published data on CB. Overall, 26,165 consecutive stereotactic VANCB were identified in 22 Italian centres: 3107 (11.9%) were classified as B3, of which 1644 (54.2%) proceeded to SE to establish a definitive histological diagnosis of breast pathology. Due to a high proportion of microcalcifications as main radiological pattern, the overall PPV was 21.2% (range 10.6%-27.3% for different B3 subtypes), somewhat lower than the average value (24.5%) from published studies (range 9.9%-35.1%). Our study, to date the largest series of B3 with definitive histological assessment on SE, suggests that B3 lesions should be referred for SE even if VANCB is more accurate than NCB in the diagnostic process of non-palpable, sonographically invisible breast lesions.

"CADEAT": considerations on the use of CAD (computer-aided diagnosis) in mammography.

Computer-aided diagnosis (CAD) has been extensively reported to increase sensitivity by about 10% when added to a single reading while increasing recall rate by 12%, and its current use can be safely recommended in clinical practice. CAD has been suggested as a possible alternative to conventional double reading in screening. Uncontrolled comparison is consistent and suggests that CAD is comparable to double reading in incremental cancer detection rate (CAD +10.6%, double reading +9.1%) and possibly better in recall rate (CAD +12.5%, double reading +28.8%). However, controlled studies comparing single reading + CAD to conventional double reading are not consistent and on average suggest a lower cancer detection rate (-5.1%) and a lower recall rate (-9.8%) for CAD. Scientific evidence is not sufficient for a safe recommendation of single reading + CAD as a current alternative to conventional double reading.

Dynamic contrast enhanced magnetic resonance imaging subtraction in evaluating osteosarcoma response to chemotherapy.

PURPOSE: To evaluate the results of a new technique of dynamic contrast enhanced Magnetic Resonance (MR) imaging subtraction in the assessment of osteosarcoma response to chemotherapy. METHODS: 24 patients with high grade osteosarcoma, treated with preoperative neo-adjuvant chemotherapy, underwent MR at high field strength (1.5 T). Both unenhanced conventional SE T1- and T2-weighted sequences in the coronal and axial plane and dynamic Gd-DTPA-enhanced SE T1-weighted sequences in the coronal plane were performed. Image postprocessing included subtraction of unenhanced image from enhanced images (arbitrary called "angiographic subtraction") and subtraction of each enhanced image from the last-enhanced image (arbitrary called "pathologic area" subtraction). The early enhancing areas detected in the angiographic subtraction and the pathologic areas detected in the pathologic area subtraction were correlated with histopathological findings on histological macrosections obtained from the resected specimen. The sensitivity, specificity, accuracy, positive and negative predictive value of both the subtraction techniques were calculated. RESULTS: The early enhancing areas of angiographic subtraction were related not only to viable tumor but also to the host reactions such as flogosis and granulation tissue. The pathologic areas detected at the pathologic area subtraction correlated in most cases with viable tumor, while in 3 cases they did not correspond to viable tumor tissue and in 1 case a small area of residual viable tumor was missed. In assessing response to chemotherapy, pathologic areas subtraction had an accuracy of 95% (specificity: 100%, sensitivity: 93%, PPV: 100%, NPV: 88%), whereas angiographic subtraction had an accuracy of 79% (specificity: 37%, sensitivity: 100%, PPV: 76%, NPV: 100%). CONCLUSIONS: Pathologic area subtraction may be a useful technique for assessing the response of osteosarcoma to chemotherapy and for detecting residual viable tumor tissue.

[Technical considerations of a system of phosphor digital radiography and its cost-effectiveness in a radiology center]. / Considerazioni tecniche su un sistema di radiologia digitale con fosfori e ricaduta sulla gestione per budget di un centro di responsabilità di radiologia.

The authors report the technical-applicative characteristics of a storage phosphor system (ADC 70, Ag-fa), experimentally used at the Department of Radiology of the University of Modena (Azienda Ospedaliera Policlinico) and analyze its effects on the center budget. The system was applied to urologic, osteoarticular and thoracic diagnoses, with bedside exams in the latter case. An automatic system (chest changer, Dupont) was used for hospitalized walking patients and for nonhospitalized patients. The data relative to the consumption of films and chemical products and the relative cost were analyzed and It. L. 84,284,782 appeared to have been saved on the annual budget. The data extrapolated from the practical experience of the Modena Radiology Department showed an average 900 exams a month, with 2,019 films being used for conventional radiography versus 918 with the ADC system. Reusing the same evaluation system, the implementation of the same system was simulated in another hospital with different characteristics (Azienda USL Imola, Bologna). The final result was an estimated annual saving of about It L. 83,000,000. The total workload of X-ray rooms afferent to the developing ADC system was considered for both departments and the cost of the conventional system compared with that of the digital system with laser print: about 197 square meters of film were used monthly with the conventional system, versus 55 after the implementation of the ADC system. The estimated figures were about 424 versus 235 for the implementation of the same ADC system in the second hospital. 9-10% was the estimated saving of the ADC system versus the conventional one thanks to fewer of the so-called refuses-i.e., exams that must be repeated; 63-81% chemical products were also saved because fewer films were developed. The cost-effectiveness of the ADC system in the budget of the two centers is stressed, with about 40% total saving. In particular, using the transfer price system for intermediate departments by Regione Emilia Romagna, the annual full cost per exam (weight = 1) decreased from It. L. 4,343 to It. L. 4,120 before and after the ADC system implementation, respectively.

[Use of a digital radiology system with phosphors in the assessment of thoracic diseases in bedside radiography]. / Impiego di un sistema di radiologia digitale con fosfori nella valutazione delle malattie del torace degli esami eseguiti a letto del paziente.

We report our experience with a storage phosphor radiography system; to assess both the image resolution and the dynamic range of the system, a phantom simulating chest average density was used. Finally, we investigated the system impact on portable chest radiographs. The radiographs were taken on 35 x 43 cm phosphor plates, with 80 kV, 3 mAs and focus-film distance of 130 cm. The phosphor plates were scanned with a 75 microns laser beam, postprocessed with the system software and, finally, printed on a 20 x 25 cm film. As reported by other Authors, the storage phosphor system showed similar spatial resolution to conventional radiography (2.5 lp/mm for 35 x 43 cm films and 4.5 lp/mm for 20 x 25 cm films), a wide dynamic range always allowing correcting exposure, but increased noise; these features allow film density optimization even in such "critical" situations and bedside radiographs. Pneumonia, pneumothorax, emphysema, pleural effusions and catheters or tubes positioning were always easily depicted. In our experience, the phosphor plate storage system exhibits many advantages over conventional radiography, namely image postprocessing, the opportunity to choose between several sizes of laser films and finally, the possibility of linking the system to a network and possibly to a digital archive. The main drawbacks of the system are its increased noise and, at present, with the available hardware, slow plate reading.

[Real-time high-resolution echotomography and oral cholecystography in the study of hyperplastic cholecystosis]. / Ecotomografia real-time ad alta definizione e colecistografia per via orale nello studio delle colecistosi iperplastiche.

A series of 305 patients underwent both cholecystosonography and oral cholecystography. Ultrasounds showed a higher diagnostic accuracy in the diffuse and localized cholesteroloses. Oral cholecystography is still reliable in the diagnosis of adenomyomatosis, especially of the fundus. As present diagnostic and therapeutical indications are nonhomogeneous, early sonographic visualization and follow-up of small cholesterol polyps are valuable for understanding the development of the disease and its clinical and prognostic significance.