Integrating self-referral for mammography into organised screening: results from an Italian experience.

OBJECTIVE: To compare self-referred screenees with respondents to invitation for main performance indicators of mammography screening. SETTING: First round of an organised, population-based screening programme in six districts of northern Italy. METHODS: The screening test was a two-view mammography. Eligible women aged 50-69 years were invited. Self-referred attendees were accepted if they were eligible for screening and had not yet been invited or had been invited >6 months before presentation. Age-specific performance indicators were compared with the calculation of their ratio and 95% confidence intervals (CIs). Total ratios were age standardised. In situ carcinomas were excluded. RESULTS: The eligible population was 183 542 women. There were 112 188 respondents to invitation and 20 280 self-referred attendees. Self-referral rate was inversely related to age. Performance indicators were as follows: recall rate, 5.6% for self-referred attendees vs 5.5% for respondents (ratio 1.02, 95% CI 0.96 to 1.08); total aspiration cytology rate, 37.3% vs 28.3% (1.37, 1.24 to 1.51); biopsy rate, 17.0 vs 12.6 x 1000 (1.51, 1.35 to 1.67); total detection rate, 10.7 vs 7.5 x 1000 (1.70, 1.48 to 1.94); detection rate of pT1 carcinoma, 7.0 vs 6.1 x 1000 (1.35, 1.14 to 1.59); detection rate of pT2-4 carcinoma, 3.5 vs 1.2 x 1000 (3.51, 2.75 to 4.43); false-positive rate, 4.5% vs 4.7% (0.93, 0.87 to 0.99); positive predictive value (PPV) of mammography, 19.1% vs 13.5% (1.59, 1.39 to 1.82); PPV of biopsy, 63.7% vs 60.6% (1.13, 0.98 to 1.29); detected:expected ratio, 5.02 vs 3.37 (1.49, 1.28 to 1.74). All differences were more pronounced among or restricted to women aged 50-54 years. CONCLUSIONS: Self-referred screenees were similar to respondents to invitation in main indicators of screening feasibility such as recall rate and PPV of biopsy, while showing important increases in detection rates and detected:expected ratios, especially among women aged 50-54 years.

[Osteo-articular amyloidosis caused by dialysis. Clinical and radiologic aspects]. / Amiloidosi osteoarticolare da dialisi. Aspetti clinici e radiologici.

Twenty-nine patients who had received chronic hemodialysis for more than 5 years provided the material for the present study. In 12 of them (41%) there were radiological findings of dialysis related amyloidosis, mainly destructive spondyloarthropathy of the cervical spine (n = 11) and geodes of the shoulder (n = 5). When compared with negative patients, these patients were significantly older (p less than 0.001 and had been dialyzed for longer periods of time (p less than 0.01). Moreover, in such patients there was an higher incidence of carpal tunnel syndrome (p less than 0.025) and shoulder pain (p less than 0.001). Our results confirm that osteoarticular amyloidosis is a frequent long-term complication of chronic hemodialysis and underline the correlation between clinical and radiological findings.

[Radiologic and clinical aspects of osteoarticular amyloidosis caused by dialysis]. / Aspetti radiologici e clinici dell'amiloidosi osteoarticolare da dialisi.

Many long-term (greater than 60 months) hemodialysis patients develop a severe osteoarticular disease, called "dialysis arthropathy", which is characterized by the deposition in bone and synovia of a new type of amyloid made mainly of beta 2-microglobulin. In the present study, 31 patients (17 males, 14 females; age 54.1 +/- 13 years), undergoing chronic hemodialysis for 60-125 months, were examined for dialysis arthropathy by means of clinics and of radiological investigations (conventional radiography and computed tomography). Sixteen patients (51.6%) had radiographic evidence of dialysis arthropathy: geodes (shoulders, 12 cases; wrists, 11; hips, 2; knees, 2) and/or destructive arthropathies (cervical spine, 13 cases, dorsolumbar spine, 2; hands, 2; hips, 1). Within 24 months, these lesions were found to progress slowly in the majority of cases. In the diagnostic process, CT should be employed in the study of spine, shoulders and hips when the lesions have not been sufficiently demonstrated by conventional radiography in the presence of evident clinical signs. Patients with dialysis arthropathy had undergone dialysis for longer periods than those without it (p less than 0.005) and showed a significantly higher incidence of both carpal tunnel syndrome (p less than 0.0005) and shoulder pain (p less than 0.005). Our findings confirm the high incidence and clinical importance of dialysis arthropathy in long-term hemodialysis patients and the value of diagnostic imaging in screening such patients for those lesions.

[Acquired cystic kidney disease among hemodialysis patients: echographic and clinical study]. / Malattia renale cistica acquisita nei pazienti in emodialisi: studio ecografico e clinico.

Thirty-six of 56 (64%) patients on chronic hemodialysis for 1 to 194 months were found to have ACKD (at least 3 cysts per kidney) by means of ultrasonographic evaluation. The number, size and extent of cysts were positively and significantly correlated with the months on hemodialysis. There was also a significant positive correlation between grade of ACKD and Hb. Moreover there was a significant positive association of abdominal pain; none had suffered from hemorrhage or neoplasm.

[Diagnostic imaging for the study of popliteal masses in dialyzed patients]. / La diagnostica per immagini nella valutazione delle masse poplitee dei pazienti in dialisi.

A new type of amyloidosis, secondary to the massive deposition of beta 2-microglobulin, has been identified which is peculiar to long-term (greater than or equal to 5 years) hemodialysis. Popliteal masses have recently been described as a possible manifestation of this type of amyloidosis. We report the results of a clinical-radiologic study of the popliteal region in 28 patients (14 males, 14 females; age 52.9 +/- 12.6 years) undergoing chronic hemodialysis for 60-212 months (mean 127 +/- 40). We aimed at determining the role of diagnostic imaging (conventional radiography, ultrasonography, Computed Tomography) in this pathologic condition. Clinics detected popliteal masses in 4 patients (bilateral in 1). US allowed 2 more cases to be detected and demonstrated the cystic nature of the lesion. Ultimately, popliteal masses could be demonstrated in 6 (bilateral in 5) of 28 patients (incidence 21.4%). In the 3 patients who were investigated by CT, cysts were seen to communicate with the joint cavity (Baker's cysts). In 1 case, immunocytochemical analysis showed diffuse beta 2-microglobulin positive amyloid deposition within the synovial wall of the surgically removed cyst. All the 6 patients experienced some of the major features of dialysis-related amyloidosis: carpal tunnel syndrome (6 cases), destructive arthropathy (5 cases), carpal and shoulder bone radiolucencies (5 and 4 cases, respectively). These findings, while documenting the high prevalence of popliteal cysts among long-term hemodialysis patients and the strong correlation with dialysis-related amyloidosis, stress the importance of diagnostic imaging in the detection and follow-up of such lesions.