Waiting time for outpatient specialist care in Lombardy Region: evaluating accessibility and quality of information on websites of public health agencies and healthcare structures.

BACKGROUND: Waiting time for outpatient specialist care is an ever-present problem for all Countries with a universal healthcare system. In Italy, information about waiting times must be available on all websites belonging to public health agencies and healthcare structures. The aim of the present descriptive study is to evaluate the accessibility and quality of such information on websites of all public health agencies and healthcare structures in Lombardy Region. METHODS: All websites belonging to 8 health agencies (ATS), 27 public hospitals (ASST), 4 research and teaching hospitals (IRCCS) were analyzed using a newly designed 30-item checklist. The items were scored 0/1 and grouped in five categories: Accessibility, Architecture, Content, Interactivity, Utility. RESULTS: In all, 76.3% of websites reported their waiting times directly, but three did not update data at least monthly as required by current legislation. Less than half of websites provided information aimed at raising awareness and tackling no-shows, and only 10.5% explained the role of private practice in public structures when maximum waiting times are exceeded. CONCLUSIONS: The lack of exposition of waiting times on some websites belonging to ATS, ASST and IRCCS appears to be a relevant issue. There is also little empowering information that may help tackle waiting times themselves. These results warrant further efforts to improve accessibility, quality and transparency of information for all citizens.

[18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results.

BACKGROUND: significance of incidental thyroid 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake on positron emission tomography/computed tomography (PET/CT) scans remains controversial. We aimed to evaluate the ability of [18F]FDG-PET/CT texture analysis to predict final diagnosis in thyroid incidentaloma. METHODS: We retrospectively evaluated medical records of all patients who performed a [18F]FDG-PET/CT from January 2012 to October 2016. Those patients who presented a thyroid incidentaloma described in the medical records and performed a fine needle aspiration in our institution were considered for the analysis. Cytological and/or histological results were used as reference standard to define the final diagnosis. In case of negative cytology, the nodule was considered benign. In case of non-diagnostic or inconclusive results ultrasound, follow-up and further cytology/histology were used as final diagnosis. For suspected or positive cytological result, histology was used as reference standard. PET images were segmented using a General Electric AW workstation running PET VCAR software (GE Healthcare, Waukesha, WI, USA) settled with a threshold of 40% SUVmax. LifeX software (http://www.lifexsoft.org) was used to perform texture analysis. Statistical analysis was performed with R package (https://www.r-project.org). RESULTS: We identified 55 patients with incidental thyroid [18F]FDG uptake. Five patients were excluded from the analysis because a final diagnosis was not available. Thirty-two out of 50 patients had benign nodules while in 18/50 cases a malignancy (primary thyroid cancer = 15, metastases = 3) was diagnosed. Conventional PET parameters and histogram-based features were calculated for all 50 patients, while other matrices-based features were available for 28/50 patients. SUVmax and skewness resulted significantly different in benign and malignant nodules (p = 0.01 and = 0.02, respectively). Using ROC analysis, seven features were identified as potential predictors. Among all the textural features tested, skewness showed the best area under the curve (= 0.66). SUV-based parameters resulted in the highest specificity while MTV, TLG, skewness and kurtosis, as well as correlationGLCM resulted better in sensitivity. CONCLUSIONS: [18F]FDG-PET/CT texture analysis seems to be a promising approach to stratify the patients with thyroid incidentaloma identified on PET scans, with respect to the risk of the diagnosis of a malignant thyroid nodule and thus, could refine the selection of the patients to be referred for cytology.

[Giant fibroadenoma of the breast. Its clinical picture and differential diagnosis. A report of a clinical case]. / Fibroadenoma gigante della mammella. Inquadramento clinico e diagnosi differenziale. Descrizione di un caso clinico.

An 18-year-old girl came to our Institute with a large tumefaction at the right breast, that during the last year had risen slowly but continuously. She underwent some clinical and instrumental exams that allow us to diagnose a giant adenofibroma or cystosarcoma phyllodes without excluding either of them. Then she undergoes a subcutaneous mastectomy with an application of a prosthesis. From the histologic point of view it is a giant adenofibroma. Giant adenofibroma is a rare breast pathology, always benign. Nowadays we have some difficulties distinguishing it from cystosarcoma phyllodes, which has both a benign and malignant form. It is important to distinguish the two pathologies before operation as they have a different therapeutic approach and a different follow-up. Cystosarcoma phyllodes can in fact relapse and when malignant can cause metastasis.