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Biomedical subjects

S Catarzi

Publications and source records attributed to S Catarzi.

At least 37 records · Page 2Linked to original sources
PubMed1995

Independent double reading of screening mammograms.

OBJECTIVE: To evaluate the cost effectiveness of independent double reading of screening mammograms. SETTING: Prospective study of 18,817 women undergoing first or repeat screening in a population based programme in the Florence district. METHODS: Mammograms were independently double read by experienced radiologists. Subjects with mammographic abnormalities reported by at least one reader were recalled for diagnostic assessment. The mean increase in recall rate, cancer detection rate, and screening costs attributable to double reading was calculated. RESULTS: Eleven of 125 cancers were detected by only one reader. The mean increase in cancer detection rate attributable to double reading compared with single reading was 4.6% (95% confidence interval (CI) 1.1 to 8.9). From a total of 748 cases referred for diagnostic assessment, 196 subjects were referred by one reader only. The mean increase in referral rate attributable to double reading compared with single reading was 15.1% (CI 12.3 to 17.8). Double reading caused a marked increase in the cost for each woman screened -8.5% at the first screening and 6.2% at repeat screening and a more limited increase in the cost for each cancer detected -3.5% at the first screening and 2.7% at repeat screening. Cancers detected by only one screener were at an earlier stage than those detected by both screeners (P = 0.6, not significant). CONCLUSIONS: Independent double reading results in only a modest increase in the detection of cancers and therefore may not be cost effective.

Aged↗
PubMed1994

Assessment of lesions detected at mammographic screening: performance at first or repeat screening in the Florence programme.

OBJECTIVE: To evaluate the assessment criteria and the results achieved in the detection of breast lesions at mammographic screening. SETTING: Review of cases assessed in the last screening round of Florence city (FC--first screening round: 29,522 subjects) and Florence district (FD --repeat screening round: 13,268 subjects) programmes. METHODS: Referral and biopsy rates, predictive values, and prevalence of cancers detected by screening were determined, as well as the frequency of the diagnostic procedures used at assessment, and their contribution to the final diagnosis according to the mammographic appearance of the suspected lesion. Assessment costs were estimated. RESULTS: Referral rate (FC 4.2%; FD 1.8%), referral positive predictive value (FC 18.7%; FD 28.3%), surgical biopsy rate (FC 0.96%; FD 0.6%), benign/malignant biopsy ratio (FC 0.20; FD 0.13), and prevalence of cancers detected by screening (FC 0.78%; FD 0.5%) were all within the European Community (EC) recommended standards for screening performance. The benign biopsy rate was considerably lower than that of recommended standards. The cost for each subject assessed was 179,000 Italian lire at the first and 116,000 lire at repeat screening. The cost for each subject screened that was attributable to assessment was 7600 lire at the first or 2100 lire at repeat screening. CONCLUSIONS: Limited referral rates and costs were achieved and the proportion of cancers detected by screening was high. The number of referrals was further reduced at repeat screening, and assessment had a limited impact on total screening costs. Detail or magnification mammography, palpation, sonography, and fine needle aspiration cytology all contributed to the final diagnosis and should be immediately available at the assessment clinic. The observed benign biopsy rate was particularly low and suggests that EC recommended standards should be modified.

Aged↗
PubMed1994

The contribution of ultrasonography to the differential diagnosis of breast cancer.

Overall consecutive breast abnormalities (259 carcinomas, 1820 benign) examined with breast ultrasonography (US) are reported. US sensitivity, specificity and positive predictive value were 67.6, 97.7 and 81.0%, resp. (the corresponding values were 57.9, 97.9 and 77.2% for palpation, 79.9, 93.5 and 73.7% for mammography, and 97.6, 92.6 and 87.6% for cytology). US sensitivity was unaffected by age, whereas it was strongly influenced by tumor size (pT1-76.1%; pT2-87.1%) and histologic type (intraductal-7.4%; invasive ductal/lobular-83.4%; invasive special types-64.1%). The features of the lesions at US were significantly associated with cancer (irregular margins, posterior acoustic shadowing) or benign lesions (anechoic structure, lateral shadowing, posterior acoustic enhancement) but had a limited diagnostic accuracy. Overall, US visualized 174 (benign-24, suspicious-150) of 188 palpable, and 32 (benign-7, suspicious-25) of 71 nonpalpable cancers. US contribution was determinant to final diagnosis in 4 of 7 cancers, missed at palpation and mammography, but was at least partially responsible for 8 unnecessary biopsies of benign lesions. A negative/benign US report contributed to avoid unnecessary biopsy in 71 suspicious cases at palpation/mammography. Routine US examination of clinical/mammographic abnormalities is recommended for the advantages of US-guided aspiration and to reduce the frequency of unnecessary biopsies.

Adult↗
PubMed1994

[The diagnostic role of breast echography].

The authors reviewed a consecutive series of 4,160 breast lesions (511 carcinomas and 3,649 benign lesions) studied with 10-MHz US in 1990-1991. US sensitivity was 72.6%, specificity was 97.3% and positive predictive value was 78.9%. Sensitivity was independent of age whereas it strongly depended on tumor size (pT1a = 54.2%, pT1b = 70.6%, pT1c = 80.6%, pT2-4 = 90.2%) (81.1% palpable masses and 41.3% nonpalpable masses) and histologic type (11.4% intraductal carcinomas and 69.4% special types). The association was confirmed of the classic US signs with carcinoma (irregular margins and posterior shadowing) and benign lesions (lateral shadowing, no echogenicity and posterior acoustic enhancement) patterns, even though the former are not accurate enough for diagnostic purposes. US demonstrated 376 of 402 palpable carcinomas (50 diagnosed as benign and 326 as suspicious) and 58 of 109 nonpalpable carcinomas (13 diagnosed as benign and 45 as suspicious). US was the only imaging method to yield findings suggestive of cancer in 13 of 511 total cases and contributed to final diagnosis in 6 more clinically and radiologically negative cases in which US findings suggested a benign lesion but indicated the need for aspiration cytology. If on the one hand US was the only method responsible for unnecessary biopsy in 21 of 141 surgical benign lesions, on the other hand negative or benign US findings helped avoid unnecessary biopsy in 277 cases diagnosed as suspicious at palpation or mammography. US should be used as the routine examination in the assessment of clinical and mammographic abnormalities. Its contribution to cancer detection is limited but it allows the number of unnecessary biopsies to be markedly reduced as well as a more accurate guide for fine needle aspiration in most palpable cancers and in approximately half of nonpalpable ones.

Adult↗
PubMed1994

[The mammographic aspect and the prognosis of breast carcinoma].

The authors report on 354 consecutive cases of invasive breast carcinoma followed up 3 to 13 years. The prognostic value of the mammographic appearance of cancer, determined according to Broberg, was studied, as well as that of other indicators, such as pT, pN and estrogen receptor content. An association was found between the mammographic appearance and the other prognostic indicators, but such an association was at the limits of statistical significance (pT p = 0.033, pN p = 0.039, ER p = 0.033) and the mammographic patterns associated with more favorable indicators were not consistent across the three variables. Ten-year actuarial overall survival was significantly associated with pT (p < 0.0001), pN (p < 0.0001) or estrogen receptor content (p < 0.001), but not with mammographic appearance. Multivariate analysis confirmed such results. We found no evidence, as suggested in some literature reports, of any association of the mammographic appearance of breast cancer with survival, and we believe that this indicator has no practical use in predicting prognosis in breast cancer patients.

Actuarial Analysis↗
PubMed1993

Radial scars of the breast: review of 38 consecutive mammographic diagnoses.

The authors report 38 consecutive cases of histologically proved breast radial scars (RSs) detected at mammography. In a retrospective review of mammograms in 30 matched cases of nonpalpable RS and nonpalpable scirrhous cancer, the characteristic mammographic features of RS were confirmed: (a) the absence of a central opacity, often substituted by a radiolucent area; (b) the presence of multiple elongated thin spicules radiating from the center of the lesion; (c) the infrequency of any palpable finding, even for superficial lesions of relatively large size. Microcalcifications with aspecific structure were found in the lesions on mammograms of 14 of the 38 cases and in 24 of the histologic specimens. The typical mammographic features of RS were not specific to RS, being present in a minority of cancer cases. For two blinded readers, sensitivity was 86.7% and 76.7% and specificity was 78% and 80%, respectively. Although some specific mammographic features may suggest the presence of RS, the final differential diagnosis from scirrhous cancer should be based on histologic evidence, and surgical biopsy should be advised for any stellate lesion detected at mammography.

Adenocarcinoma, Scirrhous↗
PubMed1993

Fine-needle aspiration cytology of nonpalpable breast lesions: US versus stereotaxic guidance.

The authors evaluated ultrasound (US)-guided fine-needle aspiration cytology (FNAC) in 270 patients with suspicious findings at mammography. FNAC with a 10-MHz transducer and real-time scanner was performed when a lesion seen mammographically was unequivocally depicted at US. The needle was inserted with variable obliquity to the scanning plane. Stereotaxically guided FNAC was performed when lesions were not visible at US. High suspicion at mammography and positive cytologic reports led to surgical biopsy. Of the 270 lesions, 120 (44.4%) were visible at US. Opacities were the most frequently visualized lesions. Inadequate samplings were most frequently reported for opacities with smooth margins. Differences in accuracy and inadequacy rate between the two modalities were not significant. Cancer was surgically confirmed in 86 of 110 cases. The other 160 lesions were considered benign, and mammographic follow-up in 120 has shown no change. Because FNAC with US guidance was faster and less expensive, it is recommended as the technique of choice in lesions detectable with US.

Adult↗
PubMed1992

Breast cancer: reliability of mammographic appearance as a predictor of hormone receptor status.

The association of mammographic appearance with hormone receptor status was investigated in 397 patients with primary breast cancers. The mammographic appearance was classified as type 1, spiculated (n = 159); type 2, structural changes (density) (n = 102); type 3, calcifications (n = 30); type 4, circumscribed opacity (n = 65); and type 5, not visible on mammogram (n = 41). Univariate analysis showed a significant association with estrogen receptor (ER) status for age (less than 50 vs greater than or equal to 50 years), tumor TNM category (those in category 1 vs those in higher categories), and mammographic appearance; with progesterone receptor status, the association was significant only for age. Multivariate analysis adjusted for potential confounders confirmed a significant association between ER status and mammographic appearance (ER status was more likely with type 1 than with the other mammographic types), but the strength of the association was limited. The mammographic appearance of breast cancer is not a reliable method to predict hormone receptor status for clinical purposes.

Breast↗
PubMed1992

[The differential diagnostic criteria of breast microcalcifications].

The authors evaluated 127 cases (31 infiltrating carcinomas, 22 intraductal carcinomas, 74 benign lesions) of breast microcalcifications with no palpable lesions. The patients had undergone mammography, stereotaxic cytology and direct magnification (87 cases). Blind interpretation of standard films and of direct magnification was performed by two independent readers (A, B), who classified the cases according to radiologic pattern (annular, punctate, granular, linear, branching), degree of suspicion and need for surgical biopsy. The study confirmed the association of different types of microcalcifications with breast cancer (predictivity: annular, punctate, granular, linear, branching; A = 25%, 15%, 40%, 92%, 86%; B = 14%, 26%, 39%, 90%, 100%). However, diagnosis was not very accurate (sensitivity: A = 83%, B = 71.1%; specificity: A = 83%, B = 78.4%); it was also observed that most cancers can be diagnosed only at a relatively high cost in terms of unnecessary biopsies. Interobservers' agreement was high relative to diagnosis (negative/dubious vs. suspicious/positive = -88.9%; K = 58.5) and low for pattern attribution (52%). Direct magnification allowed better detail definition but if sensitivity improved (A = 87% vs. 80.6%; B = 64.5% vs. 51.6%), specificity was negatively affected (A = 73.2% vs. 80.4%; B = 69.6% vs. 80.3%), due to an excess of false positives. Stereotaxic cytology [inadequacy rate = 26%, sensitivity and specificity (ex inadequates) = 80% and 100%, respectively] was more accurate than mammography as far as the decision for surgical biopsy was concerned, and was correct in identifying most (A = 6/7, B = 7/11) of the cancers which had been misdiagnosed as benign at conventional and magnification mammography. Stereotaxic cytology should be routinely performed in cases of microcalcifications with no associated palpable lesions.

Adult↗
PubMed1992

[A multicenter study for the evaluation of the diagnostic efficiency of mammography and echography in nonpalpable breast neoplasms].

The Breast Section of the Italian Society of Radiology set up a cooperative study which included 17 Departments of Radiology and Breast Diagnosis in order to evaluate the diagnostic accuracy of US versus mammography in nonpalpable breast lesions. From January 1, 1989 to december 31, 1990, 400 nonpalpable breast lesions (142 benign lesions, 59 in situ and 199 infiltrating carcinomas) were detected by mammography and/or US; they had questionable/suspicious findings which called for further investigation by means of cytology and/or histology. US proved much less sensitive in non-palpable carcinomas than mammography (49.2% vs 93.8%), also in younger women, and failed to detect 50% of the benign/malignant nonpalpable lesions identified by mammography. US sensitivity was directly related to lesion diameter and probe frequency: 38.7% in infiltrating carcinomas < or = 5 mm vs 56.8% in those > 10 mm; 12% in the patients examined with a 5-MHz probe vs 57.7% in those examined with a > or = 7.5-MHz probe. Furthermore, the most significant US patterns of nonpalpable lesion were irregular contours, posterior attenuation and irregular internal echoes, while an irregular skin line and Cooper ligaments had no significant relation with carcinoma. Thus, breast US cannot be used as a screening test on asymptomatic patients not even on young women with radiologically dense breasts. On the contrary, US performed with high-frequency probes is useful in the assessment of nonpalpable lesions identified by mammography, and allows, in many cases, US-guided cytology and preoperative localization.

Adult↗
PubMed1992

[Errors in mammography. II. False positives].

The authors evaluate 261 consecutive mammographic false positives observed from 1985 to 1987. Histological evidence of benign lesion followed in all cases. The comparison with the actual number of cancers and of the whole of mammographic examinations performed in the study period allowed specificity and positive predictive value of mammography to be assessed as 99.5% and 83%, respectively. Specificity and predictivity are lower in younger women, but this is more likely to depend on a different age-related incidence of cancer and benign lesions than on an intrinsic limitation of the method. The reader's diagnostic aggressivity, more than his experience, seems to affect both specificity and predictivity. At review, false positives were mostly due to asymmetric densities (49) or to circumscribed opacities with clear-cut (44) or blurred (62) outlines, whereas irregular star-like opacities or distortions (19) were infrequent. Microcalcifications were, in most cases, apparently benign (39) or dubious (76); strong suspicion was rare (4). Overall, one-fourth to one-third (27.9%) of the cases were reported as strongly suspicious at review. Palpation and cytology were also falsely suspicious--that is, co-responsible for unnecessary biopsies in over 50% of cases. Our results suggest that further improvement in the specificity or positive predictive value of mammography seems unlikely. Moreover, the benign/malignant biopsy ratio (0.2:1) presently achieved in suspicious mammographic cases appears quite satisfactory.

Adult↗
PubMed1991

[Diagnostic errors in mammography. I. False negative results].

The authors evaluate 1455 consecutive breast cancers detected 1985-1987, undergoing mammography 6 months before diagnosis at the most. One hundred and seventy-eight cases reported as negative/benign were assumed as false negatives. Overall sensitivity was 88%, and was influenced by tumor stage (TIS = 80%, T1 = 83%, T2 = 91%, T3-4 = 95%) and patients' age (less than 40 = 76%, 40-49 = 78%, 50-59 = 91%, greater than 59 = 94%). Sensitivity varied also with readers' experience full- or part-time involved in reading mammograms (total cases = 92% vs 88%, T1 cases = 86% vs 74%). No correlations were evidenced between mammographic sensitivity and histologic type of cancer. Palpation and cytology allowed the correct identification of 98% of mammographic false negatives. One hundred and seventy-eight false negatives and 142 more cases showing evidence of a mammographic error more than 6 months before diagnosis were reviewed to assess the most common types of radiologic fault. A benign-like lesion was the most frequent finding (49.4%), whereas suspicious signs were infrequent at review (16.6%). Failure to encompass the lesion in the mammographic field or poor technique accounted for 3.8 or 1.3% of cases, respectively. 29% of false-negative subjects (mostly young or with a dense breast) showed no lesion even at review. This study confirms the good sensitivity of mammography but suggests a less confident diagnostic approach in younger women, stresses the need for other tests whenever a minimal doubt is present, and encourages the radiologist's full-time involvement in mammography and breast diagnosis to achieve greater experience and improve his diagnostic sensitivity.

Adult↗
PubMed1991

Causes of breast cancer misdiagnosis at physical examination.

2740 consecutive breast cancers undergoing physical examination were reviewed. Ninety-two subclinical cancers detected at mammography were excluded from further evaluation and the study focused on palpable false benign cancers. The sensitivity of physical examination varied according to T category (TIS = 0.48, T1 = 0.70, T2 = 0.90, T3 = 0.89, T4 = 0.93), age (20-29 = 0.77, 30-39 = 0.58, 40-49 = 0.75, 50-59 = 0.84, 60-69 = 0.90, greater than 69 = 0.94) and operator (range 0.69-0.89), a significant difference being recorded in favor of more expert operators. Multivariate analysis (Cox) showed that T category, patient's age and operator experience are independent determinants of sensitivity. This study confirms that physical examination is not very sensitive, particularly for small tumors and in younger women and should always be performed by expert operators.

Adult↗
PubMed1988

The role of galactography in the detection of breast cancer.

The authors report on a series of 529 consecutive patients examined on physical examination, mammography, nipple discharge cytology and galactography. The criterion for galactography was essentially bloody nipple discharge (73% of cases). Serous nipple discharge was not considered worthy of routine galactography since it is associated with an extremely low incidence of breast cancer. Surgical excision and histologic examination of the discharging duct was performed in 200 cases. Eighteen cases of breast cancer were detected (10 infiltrating, 8 intraductal) of which 9, 6, 7 or 7 were suspected on physical examination, mammography, cytology or galactography, respectively. All combined tests suspected 13 of 18 breast cancers; 3 intraductal breast cancers were biopsied because of evidence of multiple papillomas on galactography, and 2 infiltrating breast cancers were operated because of persistent bloody nipple discharge in the absence of any other sign. No breast cancer was suspected on galactography alone. Galactography is indicated in the presence of bloody nipple discharge, and a biopsy should be performed when breast cancer or multiple papillomas are suspected. The diagnosis and excision of a single papilloma (breast cancer was never misdiagnosed as a single papilloma on galactography) is not worthwhile since a single papilloma is a benign lesion, and the benefit of its excision is still unclear.

Adolescent↗
PubMed1987

Diagnostic and prognostic role of infrared thermography.

A series of 469 breast cancer studied by physical examination (PE), mammography (M) and infrared thermography (TH) is discussed. Follow-up was performed up to 5 years later. The poor diagnostic role of TH is proven for the low sensitivity in the total series (0.47) and, particularly, in T1 cancers (0.26). TH does not increase significantly the cumulative sensitivity (0.98 vs. 0.97 in the total series). Its limited advantage is offset by the great number of useless biopsies due to TH false positive. A correlation between TH pattern and prognosis is evident only when TH is considered independently from other reliable prognostic indicators such as the T or N categories. If survival curves are stratified by T or N or if a multivariate analysis based on TH, T and N variables is performed, all correlations between TH pattern and prognosis disappear; for this reason the use of TH as a prognostic indicator in the clinical practice is disregarded.

Age Factors↗
PubMedDate not supplied

[Assessment of diagnostic accuracy of mammography carried out for secondary prevention. Results of a test with a sample caseload conducted by 75 Italian radiologists].

PURPOSE: To report the results of a test performed by 75 volunteer radiologists involved in screening program in Italy. MATERIAL AND METHODS: The test includes 12 screening detected cancers and 6 cancers (4 screening detected and 2 interval lesions) with minimal signs at review of a previous negative mammogram. Data on previous experience in mammography (years of activity, years of screening activity, total number of mammograms read and number of mammograms read per year) were also collected. RESULTS: Standards for passing the test were at least 83.3% for sensitivity for screening detected cancers and at most 30% for recall rate among negative cases. Mean sensitivity was 83.9% (median 83.3%, range 50-100%) and mean recall rate was 16.3 (median 14.4%, range 3.8-42.4%). In all, 44 radiologists (58.7%) passed the test. On average 1.4 of 6 cancers with minimal signs were correctly identified. According to readers' experience (at least 5 years in mammographic activity, at least 3 years in screening mammography, at least 10,000 total mammograms read, at least 5,000 per year) radiologists were classified as expert (13) or not (62): no difference in test performance was observed between the two groups. The only significant association occurred for years of mammographic activity and sensitivity. DISCUSSION AND CONCLUSIONS: Test results suggest the need for proper training of radiologists prior to involvement in a screening program. Seeding proficiency tests with cancers with minimal signs was of no benefit as far as evaluation is concerned.

Aged↗
PubMedDate not supplied

Expression of nm23 gene in gastric cancer is associated with a poor 5-year survival.

The nm23 gene is thought to play a role as an inhibitor of metastatic progression in several human cancers and its down-regulation has been associated with increased metastasis and reduced survival in some studies, though not in others. To better investigate the role of nm23 in gastric cancer (GC), the expression and prognostic impact of this gene was examined in 107 radically operated GC patients in a high risk area. The expression of nm23 was determined immunohistochemically by using the rabbit antibody anti-human nm23 protein. The expression of nm23 was detected in 40.2% (n = 43) of 107 gastric tumours and correlated with a poorer clinical outcome. In a survival analysis at 5 years, patients with nm23-positive tumours had significantly worse prognosis than patients (n = 64) with nm23-negative tumours (p < 0.05). The prognostic significance of nm23 expression was confirmed by multivariate analysis including terms for tumour stage and lymph node involvement. Our results suggest that the expression of the nm23 gene in gastric carcinoma is significantly related to tumour progression and poor prognosis at 5 years.

Adult↗