Late recurrence (more than 10 years) in early (tumors equal to or smaller than 2 cm) breast cancer patients

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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.

Diabetic macular edema: an OCT-based classification.

PURPOSE: More than ten years after ETDRS, Optical Coherence Tomography (OCT) greatly enhanced our ability to detect macular thickening and has brought new insights on the morphology of edema and on the presence of vitreal traction. In this study we propose a new classification of macular edema based on OCT findings to better catalogue and follow this complex clinical entity. METHODS: Since January 2000 we analysed with OCT 2 (Zeiss Inc.) more than one thousand and two hundred eyes with DME. RESULTS: The classification takes into account five parameters: retinal thickness, diffusion, volume, morphology and presence of vitreous traction. Standard figures and numerical values for every parameter are given. CONCLUSION: Although ETDRS guidelines for laser treatment of DME still remain the only proven therapy for this condition, many other strategies are now on trial, and the vast majority of authors use OCT as the best indicator of therapeutic benefit. The amount of information given by OCT demonstrates that macular edema is a complex clinical entity with various morphology and gravity, and disclaimed the limitations of a simple "clinical" definition. As in many other examples such as macular holes and choroidal neovascularization, a uniform and precise definition of macular edema would increase the possibility to compare and judge the result of different therapeutic strategies. Aim of this classification is to implement the ETDRS clinical definition of DME with the precise and useful data given by OCT to better diagnose, catalogue and follow macular edema.

Epidemiology of endogenous uveitis in north-eastern Italy. Analysis of 655 new cases.

PURPOSE: To report the results of a retrospective analysis among endogenous uveitis patients in the north-eastern area of Italy. METHODS: The authors reviewed a series of 655 new cases treated between October 1986 and December 1993. The incidence of endogenous uveitis was calculated based on a 100,000 patient population. RESULTS: The average incidence was 11.40/100,000. The majority of patients were between the ages of 20 and 70 years (74.43%). A probable diagnosis was determined in 55.57% of cases; anterior uveitis was diagnosed in 58.01% of cases, posterior uveitis in 26.11%, panuveitis in 12.98%, and intermediate uveitis in 2.9% of cases. The authors observed recurrences in 25.49% of cases. While the first cases are almost equally distributed in the various months, the recurrences seem to be significantly more frequent in the cold (from November to February; mean air temperature <8 degrees) and transitional months (October and from March to May; mean air temperature from 8 degrees C to 18 degrees C) than in the warm months (from June to September; mean air temperature >18 degrees C). Respectively p=0.003 and p=0.029. CONCLUSION: The incidence in this series is lower than in other European and American studies. Despite the high rate of idiopathic cases in this study, the authors support that the presentation of single case experiences may allow improved multi-centric analysis and a greater understanding of the epidemiology of uveitis.