Real-time reading in mammography breast screening.

PURPOSE: This study was undertaken to assess the role of real-time reading in the mammography screening programme carried out at the Hospital of Marzana, Verona, Italy. MATERIALS AND METHODS: During the 5-year period 1999-2004, 54,472 women attended the screening programme (32,291 first calls: unadjusted uptake 41.4%, adjusted uptake 50.3%; 21,551 2- year routine recalls: unadjusted uptake 86.4%, adjusted uptake 89.9%). Further diagnostic investigations [(FDI), imaging and cytohistological] were performed immediately after real-time reading of the screening mammograms (FDI rate among first calls 10.9%; FDI rate among 2-year recalls 5.4%). Overall, cytohistological FDI were requested in 27% of imaging FDI, with a clear prevalence of cytological [fine-needle aspiration cytology (FNAC) 87%] over histological procedures [core needle biopsy (CNB) 11%; vacuum aspiration biopsy (VAB) 2%]. RESULTS: Imaging FDI proved to be conclusive in 73%. Cytohistological FDI led to the use of surgical biopsy (SB) in 39.5% (ratio between benign and malignant SB: 0.19/first calls, 0.14/2-year recalls). There were a total of 427 screen-detected breast cancers (BC), with a very good breast cancer detection rate (BCDR/first calls 9.7 per thousand; BCDR/2-year recalls 5.1 per thousand). In the 427 screen-detected BC, the incidence of pTis, pT1a,b cancers was 59.6% (diagnostic anticipation); the incidence of pN0 cancers was 61.2%; the incidence of conservative surgical procedures was 78.6%. In interval cancers, the false negative rate was 8.3% only, whereas the proportional incidence was very low indeed (14% first year; 38% second year). CONCLUSIONS: The high sensitivity exhibited by the Marzana mammography screening programme suggests that the value of real-time reading should be validated by other programmes adopting a similar approach.

Pre-operative prediction of invasive vs intraductal breast cancer type: multivariate analysis of the accuracy of clinical and imaging findings.

Two consecutive series of 107 invasive carcinomas and 108 carcinomas in situ of the breast were considered retrospectively. The main symptomatic, clinical and cytological features were retrieved from clinical records, whereas the features at mammography and/or ultrasonography were reclassified at a blinded review by an expert radiologist. The power of predicting invasion on the basis of these features was then evaluated. The accuracy of such a prediction was compared to that of a mathematical model using the same diagnostic features by multivariate logistic regression analysis. Neither approach reached a satisfactory accuracy, but the radiologist's judgment (sensitivity 97.1%, specificity 81.9%, positive predictive value 98.4%, negative predictive value 71.6%, overall accuracy 95.8%) was slightly superior to the mathematical model (sensitivity 93.2%, specificity 87.9% positive predictive value 98.8%, negative predictive value 53.7%, overall accuracy 92.8%). Although some presentations are significantly associated with invasive or in situ status, diagnostic features alone are not sufficiently accurate to bypass histological confirmation, although they might give useful clinical indications.

[Determination of the vertical dimension using the Slavicek method in 6 cases of complete denture rehabilitation]. / Ricerca dell'altezza verticale secondo la metodologia di Slavicek in sei casi di riabilitazione protesica totale.

The vertical dimension of occlusion in complete denture cases can be established with different techniques; one of these includes the use of a lateral cephalogram and its analysis. Accurate indications of the amount of the vertical dimension can be obtained through anatomical reference points. The method that we describe can be performed on mounted costs more easily than on patients at the dental chair. We report the data of six clinical cases in which the method has been used: the results, clinically analyzed, seem to be good, functionally and aesthetically.

Fibronectin and laminin expression in breast cancer and lymph node metastases: lack of correlation with fibronectin plasmatic levels

Ya que las alteraciones de las membranas basales (BMs) se asocian a procesos de invasión y metástasis nos hemos propuesto estudiar si dos componentes de dichas membranas, la laminina (LA) y la fibronectina (FN) se ebcuentran alterados en carcinomas de mama humano y en sus respectivas metástasis ganglionares. Estos datos se analizaron en función del estadío clínico, grado histológico de malignidad y número de metástasis ganglionares. Se ha estudiado con el método de preoxidasa-antiperoxidasa la presencia y distribución de FN y LA en una serie de 25 tumores primários de mama, 22 nódulos linfáticos metastáscios y 10 biopsias de tejido mamario no tumoral. La tinción de las BMs par FN fue entre moderada y extensa en17/25 carcinomas, aunque éstas mostraron siempre discontinuidades. La tinción para LA de las BMs fue negativa o muy pobre e irregular en la mayoría de los casos. Se observó que 6/9 pacientes agrupados en estadio III (TNM) presentaron tinción pobre o negativa para FN en las BMs de los tumores primarios mientras que solo 1/15 de los pacientes agrupados en estadio I y II fue negativo para la misma glicoproteína. La desaparición de LA de las BMs se correlacionaría con el grado histológico de malignidad. En 19/22 metástasis ganglionares se destacó una marcada tinción intracelular par FN. La expresión de FN y LA en las BMs de metástasis ganglionares y los tumores primários correspondientes fue similar. No se hallo correlación entre los niveles de FN plasmática de las 19 pacientes estudiadas y la expresión de FN tisular. Este estudio demuestra alteraciones cuali y cuantitativas en la expresión de FN y LA en el tumor primario de mama y sugiere que los niveles de FN plasmáticos serían independientes de la expresión de la FN tisular tumoral

Fibronectin and laminin expression in breast cancer and lymph node metastases: lack of correlation with fibronectin plasmatic levels

Ya que las alteraciones de las membranas basales (BMs) se asocian a procesos de invasión y metástasis nos hemos propuesto estudiar si dos componentes de dichas membranas, la laminina (LA) y la fibronectina (FN) se ebcuentran alterados en carcinomas de mama humano y en sus respectivas metástasis ganglionares. Estos datos se analizaron en función del estadío clínico, grado histológico de malignidad y número de metástasis ganglionares. Se ha estudiado con el método de preoxidasa-antiperoxidasa la presencia y distribución de FN y LA en una serie de 25 tumores primários de mama, 22 nódulos linfáticos metastáscios y 10 biopsias de tejido mamario no tumoral. La tinción de las BMs par FN fue entre moderada y extensa en17/25 carcinomas, aunque éstas mostraron siempre discontinuidades. La tinción para LA de las BMs fue negativa o muy pobre e irregular en la mayoría de los casos. Se observó que 6/9 pacientes agrupados en estadio III (TNM) presentaron tinción pobre o negativa para FN en las BMs de los tumores primarios mientras que solo 1/15 de los pacientes agrupados en estadio I y II fue negativo para la misma glicoproteína. La desaparición de LA de las BMs se correlacionaría con el grado histológico de malignidad. En 19/22 metástasis ganglionares se destacó una marcada tinción intracelular par FN. La expresión de FN y LA en las BMs de metástasis ganglionares y los tumores primários correspondientes fue similar. No se hallo correlación entre los niveles de FN plasmática de las 19 pacientes estudiadas y la expresión de FN tisular. Este estudio demuestra alteraciones cuali y cuantitativas en la expresión de FN y LA en el tumor primario de mama y sugiere que los niveles de FN plasmáticos serían independientes de la expresión de la FN tisular tumoral (AU)

Serum and tissue copper content in two mammary adenocarcinomas with different biological behaviour.

We have determined serum copper levels in BALB/c female mice subcutaneously inoculated with two related mammary adenocarcinoma tumors. Serum copper content increased progressively with tumor size in animals bearing either variant, and reached levels up to four times those of control mice. In contrast, copper levels detected by cytochemistry in tumor cells are higher in the slow growing tumor variant. It is suggested that the stronger angiogenic effect previously described for this variant could be related to its higher cellular copper content.

Systemic IFN-alpha treatment of multiple bladder papilloma grade I or II patients: pilot study.

Bladder papillomatosis offers a good target to evaluate IFN-alpha systemic treatment. We carried out a pilot study on eight multiple bladder papilloma patients under the same treatment scheme (1 x 10(6) IU/amp. every 48 h over six months), and they were followed-up for over two years after treatment. Recurrent patients underwent a similar second treatment. IFN-alpha therapy showed the following variations of effects: total disappearance, size decrease or persistence of papillomas, neither size increase nor appearance of new ones, remarkable valuable recurrence frequency rate decrease in all cases, and recurrences with smaller papillomas. This IFN-alpha treatment scheme would be fit to carry out broader controlled studies to show frequencies of the different kinds of responses. The inclusion of a minimum (dose-frequency-period) IFN-alpha treatment period after the first six months' therapy is proposed in order to achieve total disappearance of recurrences.