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Article ; Online: Assessing the malignancy of suspicious breast microcalcifications: the role of contrast enhanced mammography.

Depretto, Catherine / D'Ascoli, Elisa / Della Pepa, Gianmarco / Irmici, Giovanni / De Berardinis, Claudia / Ballerini, Daniela / Bonanomi, Alice / Ancona, Eleonora / Ferranti, Claudio / Scaperrotta, Gianfranco Paride

La Radiologia medica

2024

Abstract: Purpose: To assess the role of contrast-enhanced mammography (CEM) in predicting the malignancy of breast calcifications.: Material and methods: We retrospectively evaluated patients with suspicious calcifications (BIRADS 4) who underwent CEM and ... ...

Abstract	Purpose: To assess the role of contrast-enhanced mammography (CEM) in predicting the malignancy of breast calcifications. Material and methods: We retrospectively evaluated patients with suspicious calcifications (BIRADS 4) who underwent CEM and stereotactic vacuum-assisted biopsy (VAB) at our institution. We assessed the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of CEM in predicting malignancy of microcalcifications with a 95% confidence interval; we performed an overall analysis and a subgroup analysis stratified into group A-low risk (BIRADS 4a) and group B-medium/high risk (BIRADS 4b-4c). We then evaluated the correlation between enhancement and tumour proliferation index (Ki-67) for all malignant lesions. Results: Data from 182 patients with 184 lesions were collected. Overall the SE of CEM in predicting the malignancy of microcalcifications was 0.70, SP was 0.85, the PPV was 0.82, the NPV was 0.76 and AUC was 0.78. SE in group A was 0.89, SP was 0.89, PPV was 0.57, NPV was 0.98 and AUC was 0.75. SE in group B was 0.68, SP was 0.80, PPV was 0.87, NPV was 0.57 and AUC was 0.75. Among malignant microcalcifications that showed enhancement (N = 52), 61.5% had Ki-67 ≥ 20% and 38.5% had low Ki-67 values. Among the lesions that did not show enhancement (N = 22), 90.9% had Ki-67 < 20% and 9.1% showed high Ki-67 values 20%. Conclusions: The absence of enhancement can be used as an indicative parameter for the absence of disease in cases of low-suspicious microcalcifications, but not in intermediate-high suspicious ones for which biopsy remains mandatory and can be used to distinguish indolent lesions from more aggressive neoplasms, with consequent reduction of overdiagnosis and overtreatment.
Language	English
Publishing date	2024-04-12
Publishing country	Italy
Document type	Journal Article
ZDB-ID	205751-7
ISSN	1826-6983 ; 0033-8362
ISSN (online)	1826-6983
ISSN	0033-8362
DOI	10.1007/s11547-024-01813-y
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Article: Chest X-ray in Emergency Radiology: What Artificial Intelligence Applications Are Available?

Irmici, Giovanni / Cè, Maurizio / Caloro, Elena / Khenkina, Natallia / Della Pepa, Gianmarco / Ascenti, Velio / Martinenghi, Carlo / Papa, Sergio / Oliva, Giancarlo / Cellina, Michaela

Diagnostics (Basel, Switzerland)

2023 Volume 13, Issue 2

Abstract: Due to its widespread availability, low cost, feasibility at the patient's bedside and accessibility even in low-resource settings, chest X-ray is one of the most requested examinations in radiology departments. Whilst it provides essential information ... ...

Abstract	Due to its widespread availability, low cost, feasibility at the patient's bedside and accessibility even in low-resource settings, chest X-ray is one of the most requested examinations in radiology departments. Whilst it provides essential information on thoracic pathology, it can be difficult to interpret and is prone to diagnostic errors, particularly in the emergency setting. The increasing availability of large chest X-ray datasets has allowed the development of reliable Artificial Intelligence (AI) tools to help radiologists in everyday clinical practice. AI integration into the diagnostic workflow would benefit patients, radiologists, and healthcare systems in terms of improved and standardized reporting accuracy, quicker diagnosis, more efficient management, and appropriateness of the therapy. This review article aims to provide an overview of the applications of AI for chest X-rays in the emergency setting, emphasizing the detection and evaluation of pneumothorax, pneumonia, heart failure, and pleural effusion.
Language	English
Publishing date	2023-01-06
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13020216
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Article ; Online: Diagnosis and Treatment of Post-Prostatectomy Lymphedema: What's New?

Bianchi, Lorenzo Maria Giuseppe / Irmici, Giovanni / Cè, Maurizio / D'Ascoli, Elisa / Della Pepa, Gianmarco / Di Vita, Filippo / Casati, Omar / Soresina, Massimo / Menozzi, Andrea / Khenkina, Natallia / Cellina, Michaela

Current oncology (Toronto, Ont.)

2023 Volume 30, Issue 5, Page(s) 4512–4526

Abstract: Lymphedema is a chronic progressive disorder that significantly compromises patients' quality of life. In Western countries, it often results from cancer treatment, as in the case of post-radical prostatectomy lymphedema, where it can affect up to 20% of ...

Abstract	Lymphedema is a chronic progressive disorder that significantly compromises patients' quality of life. In Western countries, it often results from cancer treatment, as in the case of post-radical prostatectomy lymphedema, where it can affect up to 20% of patients, with a significant disease burden. Traditionally, diagnosis, assessment of severity, and management of disease have relied on clinical assessment. In this landscape, physical and conservative treatments, including bandages and lymphatic drainage have shown limited results. Recent advances in imaging technology are revolutionizing the approach to this disorder: magnetic resonance imaging has shown satisfactory results in differential diagnosis, quantitative classification of severity, and most appropriate treatment planning. Further innovations in microsurgical techniques, based on the use of indocyanine green to map lymphatic vessels during surgery, have improved the efficacy of secondary LE treatment and led to the development of new surgical approaches. Physiologic surgical interventions, including lymphovenous anastomosis (LVA) and vascularized lymph node transplant (VLNT), are going to face widespread diffusion. A combined approach to microsurgical treatment provides the best results: LVA is effective in promoting lymphatic drainage, bridging VLNT delayed lymphangiogenic and immunological effects in the lymphatic impairment site. Simultaneous VLNT and LVA are safe and effective for patients with both early and advanced stages of post-prostatectomy LE. A new perspective is now represented by the combination of microsurgical treatments with the positioning of nano fibrillar collagen scaffolds (BioBridgeTM) to favor restoring the lymphatic function, allowing for improved and sustained volume reduction. In this narrative review, we proposed an overview of new strategies for diagnosing and treating post-prostatectomy lymphedema to get the most appropriate and successful patient treatment with an overview of the main artificial intelligence applications in the prevention, diagnosis, and management of lymphedema.
MeSH term(s)	Male ; Humans ; Quality of Life ; Artificial Intelligence ; Lymphedema/diagnosis ; Lymphedema/etiology ; Lymphedema/therapy ; Lymphatic Vessels/pathology ; Lymphatic Vessels/surgery ; Prostatectomy/adverse effects
Language	English
Publishing date	2023-04-25
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol30050341
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Article ; Online: Efficacy and safety of vacuum-assisted excision (VAE) of fibroadenomas: experience in a tertiary centre.

Carriero, Serena / Depretto, Catherine / Cozzi, Andrea / Della Pepa, Gianmarco / D'Ascoli, Elisa / Irmici, Giovanni / Tamburrano, Chiara / Ballerini, Daniela / Bonanomi, Alice / Scaperrotta, Gianfranco Paride

La Radiologia medica

2023 Volume 128, Issue 10, Page(s) 1199–1205

Abstract: Purpose: To evaluate the technical success and efficacy rates of US-guided percutaneous vacuum-assisted excision (VAE) of breast fibroadenomas, also assessing procedural complications and long-term patient satisfaction rates.: Materials and methods: ... ...

Abstract	Purpose: To evaluate the technical success and efficacy rates of US-guided percutaneous vacuum-assisted excision (VAE) of breast fibroadenomas, also assessing procedural complications and long-term patient satisfaction rates. Materials and methods: The institutional database of a tertiary breast cancer referral centre was retrospectively reviewed to retrieve all women with fibroadenomas who underwent US-guided VAE between May 2011 and September 2019. We subsequently included in this study all fibroadenomas with a maximum diameter of 3 cm at US and an available histological confirmation obtained by core-needle biopsy before VAE. Immediately after VAE, technical success (defined as the correct VAE execution) and the occurrence of procedural complications were evaluated. Imaging follow-up (US ± mammography) after 6, 12, 24 and 36 months was performed to evaluate technical efficacy (defined as the absence of fibroadenoma recurrence at 6-month follow-up). Long-term patient satisfaction was evaluated with telephonic interviews in October 2022. Results: We retrospectively included 108 women (median age 46 years) with 110 fibroadenomas diagnosed at core-needle biopsy with a median lesion size at US of 12 mm. Technical success was obtained in 110/110 VAEs (100%). Minor procedural complications (haematomas) occurred in 7/110 VAEs (6%), whereas 8/110 patients had a fibroadenoma recurrence at 6-month follow-up, resulting in a 93% technical efficacy (102/110 VAEs). All patients available for telephonic follow-up (104/104, 100%) reported high satisfaction with VAE results. Conclusion: US-guided VAE is a safe and effective procedure for the excision of fibroadenomas, representing a viable alternative to surgery, with a low complication rate and high patient satisfaction.
MeSH term(s)	Female ; Humans ; Middle Aged ; Fibroadenoma/diagnostic imaging ; Fibroadenoma/surgery ; Fibroadenoma/pathology ; Retrospective Studies ; Ultrasonography, Interventional/methods ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Breast Neoplasms/pathology ; Mammography
Language	English
Publishing date	2023-08-02
Publishing country	Italy
Document type	Journal Article
ZDB-ID	205751-7
ISSN	1826-6983 ; 0033-8362
ISSN (online)	1826-6983
ISSN	0033-8362
DOI	10.1007/s11547-023-01684-9
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Article ; Online: Utility of detection of breast calcifications with integrated real-time radiography system (IRRS) during digital breast tomosynthesis (DBT)-guided vacuum assisted biopsy (VAB): initial single-center experience.

Giambersio, Emilia / Depretto, Catherine / Trimboli, Rubina Manuela / Di Leo, Giovanni / D'Ascoli, Elisa / Della Pepa, Gianmarco / Irmici, Giovanni / Rabiolo, Lidia / Scaperrotta, Gianfranco Paride

La Radiologia medica

2023 Volume 128, Issue 6, Page(s) 699–703

Abstract: Purpose: To determine whether the presence of calcifications in specimens collected during stereotactic-guided vacuum-assisted breast biopsies (VABB) is sufficient to ascertain their adequacy for final diagnosis at pathology.: Materials and methods: ... ...

Abstract	Purpose: To determine whether the presence of calcifications in specimens collected during stereotactic-guided vacuum-assisted breast biopsies (VABB) is sufficient to ascertain their adequacy for final diagnosis at pathology. Materials and methods: Digital breast tomosynthesis (DBT)-guided VABBs were performed on 74 patients with calcifications as target. Each biopsy consisted of the collection of 12 samplings with a 9-gauge needle. This technique was integrated with a real-time radiography system (IRRS) which allowed the operator to determine whether calcifications were included in the specimens at the end of each of the 12 tissue collections through the acquisition of a radiograph of every sampling. Calcified and non-calcified specimens were separately sent to pathology and evaluated. Results: A total of 888 specimens were retrieved, 471 containing calcifications and 417 without. In 105 (22.2%) samples out of 471 with calcifications cancer was detected, while the remaining 366 (77.7%) were non-cancerous. Out of 417 specimens without calcifications 56 (13.4%) were cancerous, whereas 361 (86.5%) were non-cancerous. Seven hundred and twenty-seven specimens out of all 888 were cancer-free (81.8%, 95%CI 79-84%). Conclusion: Although there is a statistical significative difference between calcified and non-calcified samples and the detection of cancer (p < 0.001), our study shows that the sole presence of calcifications in the specimens is not sufficient to determine their adequacy for final diagnosis at pathology because non-calcified samples can be cancerous and vice-versa. Ending biopsies when calcifications are first detected through IRRS could lead to false negative results.
MeSH term(s)	Humans ; Female ; Retrospective Studies ; Mammography/methods ; Breast/diagnostic imaging ; Breast Diseases/diagnostic imaging ; Biopsy, Needle ; Calcinosis/diagnostic imaging ; Image-Guided Biopsy/methods ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/pathology ; Biopsy
Language	English
Publishing date	2023-04-28
Publishing country	Italy
Document type	Journal Article
ZDB-ID	205751-7
ISSN	1826-6983 ; 0033-8362
ISSN (online)	1826-6983
ISSN	0033-8362
DOI	10.1007/s11547-023-01636-3
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Article ; Online: Magnetic Localization of Breast Lesions: A Large-Scale European Evaluation in a National Cancer Institute.

Depretto, Catherine / Della Pepa, Gianmarco / De Berardinis, Claudia / Suman, Laura / Ferranti, Claudio / Marchesini, Monica / Maugeri, Ilaria / Martelli, Gabriele / Gennaro, Massimiliano / Folli, Secondo / Pruneri, Giancarlo / Scaperrotta, Gianfranco Paride

Clinical breast cancer

2023 Volume 23, Issue 8, Page(s) e491–e498

Abstract: Introduction: For decades the standard for preoperative breast lesions' localization has been wire localization. In recent years the options for nonwired localization have significantly expanded and include radioactive seeds, radar reflectors, ... ...

Abstract	Introduction: For decades the standard for preoperative breast lesions' localization has been wire localization. In recent years the options for nonwired localization have significantly expanded and include radioactive seeds, radar reflectors, radiofrequency identification tags and magnetic seeds. The aim of our study is to evaluate on a large scale the performance of preoperative magnetic seed localization of nonpalpable breast lesions. Material and methods: We prospectively collected data on all patients undergoing image-guided magnetic seed localization from September 2019 to December 2022. We analyzed imaging findings, histological results, and type of surgery. The primary outcome was the successful localization rate. Secondary outcomes were the successful placement rate, the ease of percutaneous positioning, the procedural complications, and the reintervention rate. Results: A total of 1123 magnetic seeds were placed in 1084 patients by 4 radiologists under ultrasound (1053) or stereotactic (70) guidance. All seeds were detectable transcutaneously in all breasts sizes and at all depths by 7 surgeons with a success rate of 100%. A total of 97.5% seeds were correctly placed into the target lesions (only 2.5% were dislocated). All radiologists have shown good compliance during the procedure, and there were no complications or safety issues. The reoperation rate was 5.1%. Conclusions: Image-guided localization with magnetic seeds is an easy, safe, reliable, and effective method for localizing nonpalpable breast lesions. Both radiologists and surgeons agreed that the technology was intuitive to use and that it can be widely applied in preoperative localization in breast units.
MeSH term(s)	United States ; Humans ; Female ; National Cancer Institute (U.S.) ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Breast/diagnostic imaging ; Breast/surgery ; Ultrasonography ; Magnetic Phenomena
Language	English
Publishing date	2023-08-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2106734-X
ISSN	1938-0666 ; 1526-8209
ISSN (online)	1938-0666
ISSN	1526-8209
DOI	10.1016/j.clbc.2023.08.004
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Article: MRI-Derived Tumour-to-Breast Volume Is Associated with the Extent of Breast Surgery.

Cozzi, Andrea / Schiaffino, Simone / Della Pepa, Gianmarco / Carriero, Serena / Magni, Veronica / Spinelli, Diana / Carbonaro, Luca A / Sardanelli, Francesco

Diagnostics (Basel, Switzerland)

2021 Volume 11, Issue 2

Abstract: The tumour-to-breast volume ratio (TBVR) is a metric that may help surgical decision making. In this retrospective Ethics-Committee-approved study, we assessed the correlation between magnetic resonance imaging (MRI)-derived TBVR and the performed ... ...

Abstract	The tumour-to-breast volume ratio (TBVR) is a metric that may help surgical decision making. In this retrospective Ethics-Committee-approved study, we assessed the correlation between magnetic resonance imaging (MRI)-derived TBVR and the performed surgery. The TBVR was obtained using a fully manual method for the segmentation of the tumour volume (TV) and a growing region semiautomatic method for the segmentation of the whole breast volume (WBV). Two specifically-trained residents (R1 and R2) independently segmented T1-weighted datasets of 51 cancer cases in 51 patients (median age 57 years). The intraobserver and interobserver TBVR reproducibility were calculated. Mann-Whitney
Language	English
Publishing date	2021-01-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics11020204
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Article: Role of Fusion Imaging in Image-Guided Thermal Ablations.

Carriero, Serena / Della Pepa, Gianmarco / Monfardini, Lorenzo / Vitale, Renato / Rossi, Duccio / Masperi, Andrea / Mauri, Giovanni

Diagnostics (Basel, Switzerland)

2021 Volume 11, Issue 3

Abstract: Thermal ablation (TA) procedures are effective treatments for several kinds of cancers. In the recent years, several medical imaging advancements have improved the use of image-guided TA. Imaging technique plays a pivotal role in improving the ablation ... ...

Abstract	Thermal ablation (TA) procedures are effective treatments for several kinds of cancers. In the recent years, several medical imaging advancements have improved the use of image-guided TA. Imaging technique plays a pivotal role in improving the ablation success, maximizing pre-procedure planning efficacy, intraprocedural targeting, post-procedure monitoring and assessing the achieved result. Fusion imaging (FI) techniques allow for information integration of different imaging modalities, improving all the ablation procedure steps. FI concedes exploitation of all imaging modalities' strengths concurrently, eliminating or minimizing every single modality's weaknesses. Our work aims to give an overview of FI, explain and analyze FI technical aspects and its clinical applications in ablation therapy and interventional oncology.
Language	English
Publishing date	2021-03-19
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics11030549
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Article: Visceral adipose tissue area predicts intensive care unit admission in COVID-19 patients.

Pediconi, Federica / Rizzo, Veronica / Schiaffino, Simone / Cozzi, Andrea / Della Pepa, Gianmarco / Galati, Francesca / Catalano, Carlo / Sardanelli, Francesco

Obesity research & clinical practice

2020 Volume 15, Issue 1, Page(s) 89–92

Abstract: We retrospectively investigated, in 62 consecutive hospitalised COVID-19 patients (aged 70 ± 14 years, 40 males), the prognostic value of CT-derived subcutaneous adipose tissue and visceral adipose tissue (VAT) metrics, testing them in four predictive ... ...

Abstract	We retrospectively investigated, in 62 consecutive hospitalised COVID-19 patients (aged 70 ± 14 years, 40 males), the prognostic value of CT-derived subcutaneous adipose tissue and visceral adipose tissue (VAT) metrics, testing them in four predictive models for admission to intensive care unit (ICU), with and without pre-existing comorbidities. Multivariate logistic regression identified VAT score as the best ICU admission predictor (odds ratios 4.307-12.842). A non-relevant contribution of comorbidities at receiver operating characteristic analysis (area under the curve 0.821 for the CT-based model, 0.834 for the one including comorbidities) highlights the potential one-stop-shop prognostic role of CT-derived lung and adipose tissue metrics.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Body Mass Index ; COVID-19/complications ; COVID-19/metabolism ; Critical Care ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Intra-Abdominal Fat/metabolism ; Logistic Models ; Male ; Middle Aged ; Obesity/complications ; Obesity/epidemiology ; Obesity/metabolism ; Pandemics ; Prognosis ; ROC Curve ; Retrospective Studies ; SARS-CoV-2 ; Severity of Illness Index ; Subcutaneous Fat/metabolism ; Tomography, X-Ray Computed
Language	English
Publishing date	2020-12-11
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2274031-4
ISSN	1878-0318 ; 1871-403X
ISSN (online)	1878-0318
ISSN	1871-403X
DOI	10.1016/j.orcp.2020.12.002
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Article ; Online: Development and Validation of an AI-driven Mammographic Breast Density Classification Tool Based on Radiologist Consensus.

Magni, Veronica / Interlenghi, Matteo / Cozzi, Andrea / Alì, Marco / Salvatore, Christian / Azzena, Alcide A / Capra, Davide / Carriero, Serena / Della Pepa, Gianmarco / Fazzini, Deborah / Granata, Giuseppe / Monti, Caterina B / Muscogiuri, Giulia / Pellegrino, Giuseppe / Schiaffino, Simone / Castiglioni, Isabella / Papa, Sergio / Sardanelli, Francesco

Radiology. Artificial intelligence

2022 Volume 4, Issue 2, Page(s) e210199

Abstract: Mammographic breast density (BD) is commonly visually assessed using the Breast Imaging Reporting and Data System (BI-RADS) four-category scale. To overcome inter- and intraobserver variability of visual assessment, the authors retrospectively developed ... ...

Abstract	Mammographic breast density (BD) is commonly visually assessed using the Breast Imaging Reporting and Data System (BI-RADS) four-category scale. To overcome inter- and intraobserver variability of visual assessment, the authors retrospectively developed and externally validated a software for BD classification based on convolutional neural networks from mammograms obtained between 2017 and 2020. The tool was trained using the majority BD category determined by seven board-certified radiologists who independently visually assessed 760 mediolateral oblique (MLO) images in 380 women (mean age, 57 years ± 6 [SD]) from center 1; this process mimicked training from a consensus of several human readers. External validation of the model was performed by the three radiologists whose BD assessment was closest to the majority (consensus) of the initial seven on a dataset of 384 MLO images in 197 women (mean age, 56 years ± 13) obtained from center 2. The model achieved an accuracy of 89.3% in distinguishing BI-RADS a or b (nondense breasts) versus c or d (dense breasts) categories, with an agreement of 90.4% (178 of 197 mammograms) and a reliability of 0.807 (Cohen κ) compared with the mode of the three readers. This study demonstrates accuracy and reliability of a fully automated software for BD classification.
Language	English
Publishing date	2022-03-16
Publishing country	United States
Document type	Journal Article
ISSN	2638-6100
ISSN (online)	2638-6100
DOI	10.1148/ryai.210199
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