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Biomedical subjects

S Ciatto

Publications and source records attributed to S Ciatto.

At least 199 records · Page 11Linked to original sources
PubMed1981

Postoperative radiotherapy in N- breast cancer. A retrospective case-control study.

The role of postoperative radiotherapy in N- breast cancer with centrally or medially located tumors is still controversial. The authors report the results of a retrospective non-randomized case-control study of T1-2 N- breast cancer patients with centrally or medically located tumors, treated or not with postoperative radiotherapy after radical mastectomy. Sixty-four patients were treated with postoperative radiotherapy (Co-60) to the internal mammary chain and supraclavicular nodes. Sixty-four control cases, matched by T size and site, N status, age and menstrual status and simply followed-up after radical mastectomy were selected. No significant differences in actuarial recurrence and NED survival rates were observed at 5 years in the 2 compared groups, thus indicating that postoperative radiotherapy for patients with N- centrally or medially located breast cancers is not worthwhile treatment policy.

Adult↗
PubMed1981

Criteria of clinical and radiological diagnosis in nonpuerperal acute phlogistic-like processes of the breast: considerations on 97 consecutive cases.

The authors report a series of 97 cases of phlogistic-like process of the breast. Clinical and radiological signs and criteria of differential diagnosis between benign phlogosis and cancer are investigated. The location in the areolar/periareolar region, the presence of fever, and the radiological evidence of limited skin thickening were the features more significantly correlated with benign phlogosis, while cancer should be suspected in the case of lesions located in the upper-outer quadrant and in presence of a diffuse skin thickening at radiological examination. These diagnostic criteria seem particularly useful since the typical clinical or radiological signs of cancer are present only in 50% of cancer cases. The cytological examination of nipple discharge or needle aspiration fluid is of particular help: no false positive or negative cases were observed in a series of 42 examined patients.

Adult↗
PubMed1980

Salvage with radiotherapy of postsurgical relapses of endometrial cancer.

From January 1960 to June 1974, 71 patients with a postsurgical relapse of endometrial adenocarcinoma have been referred to the Radiology Institute of the University of Florence. Eleven patients showed hematogenous metastases; the remaining 60 cases showed locoregional relapses and were treated with radiotherapy. Forty-eight patients, whose relapse was localized to the pelvis, vagina, inguinal nodes or perineal scar, were treated with a radical aim (4,500-6,000 rad in 5-6 weeks); the treatment was palliative in 12 cases with abdominal extrapelvic relapse. The therapeutic response was not evaluated in 8 patients lost to follow-up shortly after the treatment. In the cases treated with a radical scope, a complete regression was attained in 22 of 43 (51%); a survival rate of 16 of 43 (37%) was attained at 5 years. In 9 cases treated with a palliative aim, only subjective remission was attained, and no patient was alive one year after the therapy. The most favorable therapeutic response was attained in the vaginal relapses (50% survivors at 5 years) and the cases with a late recurrence (more than 3 years) after the initial surgery. No definite correlation was found between the prognosis of the relapse and the histological grading of the primary tumor.

Adenocarcinoma↗
PubMed1980

Radiotherapy for postoperative failures of carcinoma of the cervix uteri.

A series of 115 patients with a local postsurgical recurrence of carcinoma of the cervix uteri, treated with radiotherapy, were analyzed. Recurrences were subdivided into three categories based upon the site and extent of the disease, namely central, peripheral limited and peripheral massive recurrences. The objective and symptomatic response to the treatment and long term survival were examined separately for each category of lesion. Several correlations were attempted between the extension of the recurrence and the survival of treated patients and some clinical features, such as the length on the interval from primary operation, type of operation, age of the patient and the objective response to treatment. Only the objective response to treatment seems to be related to survival which was evidently better in complete responders. Local radiation achieved good results in the treatment of reported recurrence, depending mainly on the extent of the disease; those in the central recurrences group had the best results, with a high five year cure rate; in peripheral limited recurrence group, the curve rate was significantly lower, while, in peripheral massive recurrence group, palliation was the result.

Female↗
PubMed1979

Clinically occult breast lesions: criteria of radiological diagnosis as a guide to the choice of biopsy technique.

A series of 90 clinically occult operated breast lesions, diagnosed in the course of mammographic mass screening for early detection of breast cancer, is reported. Five radiological patterns of suspect lesions are identified and compared with histological diagnosis of the biopsy. Diagnostic quadrantectomy is suggested for clinically unapparent lesions showing a radiologic pattern which has a high probability of finding a cancer or preneoplastic lesion (severe epitheliosis). Alternative biopsy methods to diagnostic quadrantectomy are recommended for lesions showing other radiological patterns, allowing for a more limited breast tissue excision.

Adult↗
PubMed1979

Malignant lymphoma of the testis.

The clinical features and the results of treatment in 12 cases of malignant lymphoma of a series of 280 consecutive cases of testicular tumor are reported. The tendency of these neoplasms for bilateral involvement and the association with skin and upper respiratory tract lesions, reported in the literature, were confirmed. Long survival of a few cases after orchidectomy or regional treatment only (2 in the present series) suggests the existence of malignant lymphoma of the testis as a primary condition, although in most cases a lymphomatous involvement of the testis must be considered as a local manifestation of disseminated lymphoma.

Adult↗
PubMed1978

Mass screening for early breast cancer detection.

In 1969 the Center for Social Diseases of Florence started a screening program for early breast cancer detection. The female population over 40 years of age of a group of outlying towns of the District was invited. From January 1969 till March 1977, 21,725 women have been examined in the program. Mammography was the diagnostic procedure of choice, followed by physical examination if necessary. Negative cases were controlled with biennial mammography. This paper summarizes and evaluates the results of this screening program. At first mammography, 67 cancers were detected, 37% of which were clinically unapparent, 62.3% staged T1A, and 52% N--. The average stage at diagnosis is certainly better than the average stage of cancers diagnosed in unscreened women, thus a better prognosis is expected. Actuarial survival rate of detected cancers was 94 +/- 3.7% at 5 years. False negative and false positive cases are reported. The possibility of hazards in the use of repeated mammography in mass screening is discussed. According to reported data the value of this screening program in terms of secondary prevention (early diagnosis) is confirmed.

Adult↗
PubMed1978

Radiotherapy of seminoma of the testis. Report on 129 patients.

From 1958 to 1974, 129 patients with pure seminoma of the testis were admitted to the Institute of Radiology, University of Florence. Sixty-two were in Stage I, 36 in Stage II A, 23 in Stage II B, 3 in Stage III, and 5 in Stage IV, Para-aortic and ipsilateral iliac nodes were treated in all cases with doses ranging from 3000 to 4200 rads. In the treatment of the supradiaphragmatic area, uniform criteria were not adopted. Out of 124 cases in Stage I, II A and B, and III, 17 suffered a replase; aall relapsed cases died except for one. Site and cause of the failures were analyzed. Prophylactic irradiation of the mediastinum and supraclavicular area appears to lower the probability of recurrence in Stage II. Doses over 3500 rads may be necessary to destroy large metastases. The presence of nonseminomatous areas in the seminoma showing inadequate regression after radiotherapy must be suspected; an exploratory laparotomy should be indicated in such a case.

Adolescent↗
PubMedDate not supplied

Detection of false-negative Pap smears using the PAPNET system.

AIMS AND BACKGROUND: False-negative cytological diagnoses represent the critical point of a screening program for early detection of cervical cancer. Computer-assisted reading using neural network technology has been suggested as a possible approach to manage the problem. The study assessed the performance and the cost-outcome ratio of computer-assisted versus conventional manual Pap smear reading. METHODS: One thousand routine smears, seeded with 81 false-negative smears, were independently interpreted by two readers by conventional and PAPNET-assisted reading. Results of both readings were compared in terms of: a)sensitivity for false-negative smears, b)specificity, and c) cost-outcome (cost per CIN2+ lesion detected). RESULTS: PAPNET-assisted reading showed a small increase in sensitivity only for one reader. Including the cost of PAPNET, the cost per detected lesion would be $7,543 and the cost per additional detected lesion would be $25,748. CONCLUSIONS: The present study provides further evidence that PAPNET-assisted screening may allow the detection of a few extra cases of CIN2+ lesions with respect to conventional reading, though at a very high cost.

False Negative Reactions↗
PubMedDate not supplied

The role of whole body scan and skeletal radiography in the preoperative staging of breast cancer.

442 patients with breast cancer were studied by means of radiologic and scintigraphic examination of the skeleton to detect the presence of bone metastases. All the patients have been clinically followed-up for a mean period of 22 months. The overall prevalence of bone metastases at staging was 4.5%. Bone scan showed a higher sensitivity in detecting bone metastases (90% vs 45%) and a lower positive predictive value (60% vs 75%) with respect to X-ray examination. In the presence series no asymptomatic case with bone metastases was found in limited stages (T1-T2 N0-N1). The authors suggest that the bone scan be routinely included in the staging of advanced breast cancer cases and that the use of this procedure be restricted to the symptomatic patients in the more limited stages.

Adult↗
PubMedDate not supplied

Performance of fine-needle aspiration cytology of the breast-multicenter study of 23,063 aspirates in ten Italian laboratories.

AIMS AND BACKGROUND: The aim of this study was to assess the performance of routine breast cytology in a group of Italian laboratories, as a basis for interlaboratory quality control. METHODS: A multicenter retrospective consecutive series of 23,063 aspirates from breast lesions (5,130 invasive carcinoma, 247 intraductal carcinoma, 2,386 benign lesions [histological], 13,144 benign lesions [follow-up], 2,156 other [no follow-up]) was reviewed. Standard accuracy measurements (inadequacy rate, sensitivity, specificity, predictive value) were determined, as well as the contribution of diagnostic tests such as physical examination and instrumental diagnostic procedures (mammography, sonography). RESULTS: Overall, inadequacy rate was 6.5% for malignant and 23.2% for benign lesions. Sensitivity was 92.2%, specificity was 95.3%, and the positive predictive value of an equivocal or malignant report was 53.4% or 96.9%, respectively. Sensitivity was associated with histological type (intraductal vs invasive: 77.0% vs 92.9%, p < 0.000001; lobular vs other invasive: 85.5% vs 94%, p = 0.0025) as well as with tumor size (pT1 = 91.6%, pT2 = 94.3%, pT3-4 = 96.0%, p < 0.000001). Observed differences in performance indicators between centers may be explained by variability in sampling or reading accuracy, and warrant the need for some adjustment in single centers, especially, as far as the criteria to report an equivocal smear are concerned. Cytology contributed to detect otherwise unsuspected carcinomas, although in some centers this benefit was poor and not cost-effective because a large number of unnecessary biopsies were caused by false equivocal/positive reports. CONCLUSIONS: Although centers scored, on average, well within standards recommended by national authorities, this study suggests the opportunity of interlaboratory quality control to achieve more homogeneous criteria.

Biopsy, Needle↗
PubMedDate not supplied

Comparing two modalities of screening for prostate cancer: digital rectal examination + transrectal ultrasonography vs. prostate-specific antigen.

AIMS AND BACKGROUND: To evaluate the performance and feasibility of screening for prostate cancer by comparing screening modalities. METHODS: Prospective study of two comparable cohorts of healthy resident males aged 60 to 75 years. Screening attenders in the two invited cohorts were screened either by digital rectal examination (DRE) and transrectal ultrasonography (TRUS), or by serum prostate-specific antigen determination (PSA: cutoff 4 ng/ml). Attendance and biopsy rates, predictive values, prevalence of screen-detected cancers, as well as screening costs were determined, and the efficiency of the two screening modalities was compared. RESULTS: 1425 subjects were screened by DRE+TRUS. Attendance rate was 33.7%, the biopsy rate was 2.7%, and the prevalence of detected cancers was 1.82%. A total of 1315 subjects was screened by PSA. Attendance rate was 66.9%, the biopsy rate was 2.8%, and the prevalence of detected cancers was 1.67%. Screen-detected cancer stage was more favorable than observed in clinical practice, and early detection was evident, with the prevalence/incidence ratio higher than 10:1 in both programs. The cost per subject screened was about 34,000 Lire for DRE+TRSU and about 30,000 Lire for PSA program. CONCLUSIONS: The study confirms that early detection of prostate cancer is possible and that screening is practically feasible. Both screening modalities achieved comparable results as regards early detection, but screening by PSA had a higher compliance and lower costs. PSA seems the ideal test to be used in prospective controlled studies aimed at demonstrating screening efficacy.

Aged↗
PubMedDate not supplied

Trends in the prevalence of cervical intraepithelial neoplasia grade 3 in the district of Florence, Italy.

AIMS AND BACKGROUND: The objective of this study was to investigate the detection rate of cervical intraepithelial neoplasia grade III (CIN 3) in previously unscreened women, in order to reveal trends over time in the prevalence of CIN 3 in the District of Florence, where a population-based screening for cervical cancer has been going on since 1973. STUDY DESIGN: We considered the women, recorded in the computerized archives of CSPO, who had had no pap test for at least 10 years. Trends of CIN 3 (histologically proven) were analyzed within age groups; the effect of age, cohort and period were considered by means of a Poisson regression model. RESULTS: A total of 648 cases of histologically proven CIN 3 were detected in the study period. The detection rates of CIN 3 increased steadly within age groups over birth cohort and calendar period simultaneously. The Poisson regression analysis showed that only the model with age + time trend was statistically significant. CONCLUSIONS: Although several biases should be taken into account, the analysis seemed to indicate a real increase in CIN 3 prevalence. An increase in frequency of precancerous lesions for cervical cancer in more recent birth cohorts supports the need to keep screening coverage and efficiency as high as possible.

Adult↗
PubMedDate not supplied

A feasibility study of screening for endometrial carcinoma in postmenopausal women by ultrasonography.

BACKGROUND: Abnormal endometrial thickness assessed by ultrasonography has been reported as a reliable indicator for early asymptomatic endometrial carcinoma. STUDY DESIGN: We evaluated the feasibility and the performance of screening by ultrasonography in a consecutive series of postmenopausal volunteers. RESULTS: A total of 2,025 women were screened, and 117 (5.8%) showed abnormal endometrial thickness. Ninety-eight subjects consented to be assessed by outpatient endometrial biopsy, which was not possible in 32 for cervical stenosis. Three cancers were detected among 66 assessed subjects, 34 not-assessed subjects were controlled by repeat sonography (no change), and 17 were lost to follow-up. No other cancer was recorded by the local Cancer Registry among screened subjects. The prevalence/incidence ratio was 2.65:1, and the cost per screen-detected cancer was 18,571,000 Italian lire. CONCLUSIONS: Screening by endometrial sonography is feasible on a practical basis, but its efficacy needs to be proven by prospective controlled studies which would enroll large populations to ensure sufficient statistical power, considering the low incidence and the low lethality of the disease. Studies of screening for other carcinomas may be considered of higher priority.

Adult↗
PubMedDate not supplied

Endometrial ultrasonography - An alternative to invasive assessment in women with postmenopausal vaginal bleeding.

AIMS AND BACKGROUND: To test the reliability of endometrial sonography in selecting women with abnormal postmenopausal vaginal bleeding for further diagnostic assessment. METHODS: Endometrial thickness was measured in 368 consecutive women by abdominal or vaginal sonography prior to invasive assessment (hysteroscopy, curettage). The association of abnormal and endometrial thickness (4 mm or greater) with endometrial cancer was determined. RESULTS: Abnormal endometrial thickness was observed in 116 of 368 women. Subsequent assessment diagnosed endometrial carcinoma in 16 subjects, 15 of whom had abnormal endometrial thickness. One case with normal endometrial thickness was suspected at sonography because of the irregular appearance of the endometrium. CONCLUSIONS: Had it been used to select subjects for further assessment, sonography would have missed no cancer, and unnecessary invasive assessment (under general anesthesia in 20% of cases) would have been spared in 68% (251/368) of the subjects. Endometrial sonography should be routinely used to select women with postmenopausal vaginal bleeding for further investigations.

Endometrial Neoplasms↗