Search

Objective: Although breast cancer screening can benefit from Artificial Intelligence (AI), it is still unknown whether, to which extent or under which conditions, the use of AI is going to be accepted by the general popula-tion. The aim of our study is to evaluate what the females who are eligible for breast cancer screening know about AI and how they perceive such innovation. Methods: We used a prospective survey consisting of a 11-multiple-choice questionnaire evaluating statis-tical associations with Chi-Square-test or Fisher-exact-test. Multinomial-logistic-regression was performed on items with more than two response categories. Odds ratio (OR) with 95% CI were computed to estimate the probability of a specific response according to patient’s characteristics. Results: In the 800 analysed questionnaires, 51% of respondents confirmed to have knowledge of AI. Of these, 88% expressed a positive opinion about its use in medicine. Non-Italian respondents were associated with the belief of having a deep awareness about AI more often than Italian respondents (OR = 1.91;95% CI[1.10– 3.33]). Higher education level was associated with better opinions on the use of AI in medicine (OR = 4.69;95% CI[1.36–16.12]). According to 94% of respond-ents, the radiologists should always produce their own report on mammograms, whilst 77% agreed that AI should be used as a second reader. Most respondents (52%) considered that both the software developer and the radiologist should be held accountable for AI errors. Conclusions: Most of the females undergoing screening in our Institute approve the introduction of AI, although only as a support to radiologist, and not in substitution thereof. Yet, accountability in case of AI errors is still unsolved. advances in knowledge: This survey may be considered as a pilot-study for the development of large-scale studies to understand females’s demands and concerns about AI applications in breast cancer screening.

The aim of this study was to evaluate the diagnostic performance of contrast-enhanced spectral mammography (CESM) in predicting breast lesion malignancy due to microcalcifications compared to lesions that present with other radiological findings. Three hundred and twenty-one patients with 377 breast lesions that underwent CESM and histological assessment were included. All the lesions were scored using a 4-point qualitative scale according to the degree of contrast enhancement at the CESM examination. The histological results were considered the gold standard. In the first analysis, enhancement degree scores of 2 and 3 were considered predictive of malignity. The sensitivity (SE) and positive predictive value (PPV) were significative lower for patients with lesions with microcalcifications without other radiological findings (SE = 53.3% vs. 82.2%, p-value < 0.001 and PPV = 84.2% vs. 95.2%, p-value = 0.049, respectively). On the contrary, the specificity (SP) and negative predictive value (NPV) were significative higher among lesions with microcalcifications without other radiological findings (SP = 95.8% vs. 84.2%, p-value = 0.026 and NPV = 82.9% vs. 55.2%, p-value < 0.001, respectively). In a second analysis, degree scores of 1, 2, and 3 were considered predictive of malignity. The SE (80.0% vs. 96.8%, p-value < 0.001) and PPV (70.6% vs. 88.3%, p-value: 0.005) were significantly lower among lesions with microcalcifications without other radiological findings, while the SP (85.9% vs. 50.9%, p-value < 0.001) was higher. The enhancement of microcalcifications has low sensitivity in predicting malignancy. However, in certain controversial cases, the absence of CESM enhancement due to its high negative predictive value can help to reduce the number of biopsies for benign lesions

Rationale and Objectives: The new version of the Contrast Enhanced Mammography (CEM) Breast imaging Reporting and Data System (BIRADs) encourages investigations of a new enhancement descriptor: “Lesion Conspicuity” (LC). The study aims to assess the diagnostic performance and the relationship with the receptor profile of this new enhancement descriptor. Materials and Methods: Three hundred twenty-five patients with 381 breast lesions who underwent CEM before histological assessmentwere selected. Four radiologists, blinded to each other, categorized LC into the following levels: absent, low, moderate, and high. Considering moderate and high evaluations as predictive of malignancy, the diagnostic performance of CEM was calculated using histological results of the biopsy as the gold standard. The association between LC values and the receptor profile of the neoplasms was also evaluated. Results: The median age at the CEM examination was 50 years (IQR: 45-59). Considering the value of LC of the most experienced radiologist with the interpretation of Low Energy images (LE), we obtained a sensitivity (SE) of 91.9% (95% CI: 88.6%-95.2%) and a specificity (SP) of 67.2% (95% CI: 58.9%-75.5%). An association between “high” lesion conspicuity with ER/PgR not expressed (p = 0.025), with Ki-67>20% (p = 0.033), and with Grading G3 (p = 0.020) was observed. Conclusion: The new feature of enhancement, “Lesion Conspicuity”, demonstrated satisfactory performance in predicting the malignancy of lesions and significant correlation with the receptor profile of malignant breast neoplasms.

Background: To create a predictive score of malignancy of a breast lesion based on the main contrast enhancement features ascertained by contrast-enhanced spectral mammography (CESM). Methods: In this single-centre prospective study, patients with suspicious breast lesions (BIRADS > 3) were enrolled between January 2013 and February 2022. All participants underwent CESM prior to breast biopsy, and eventually surgery. A radiologist with 20 years’ experience in breast imaging evaluated the presence or absence of enhancement and the following enhancement descriptors: intensity, pattern, margin, and ground glass. A score of 0 or 1 was given for each descriptor, depending on whether the enhancement characteristic was predictive of benignity or malignancy (both in situ and invasive). Then, an overall enhancement score ranging from 0 to 4 was obtained. The histological results were considered the gold standard in the evaluation of the relationship between enhancement patterns and malignancy. Results: A total of 321 women (median age: 51 years; range: 22–83) with 377 suspicious breast lesions were evaluated. Two hundred forty-nine lesions (66%) have malignant histological results (217 invasive and 32 in situ). Considering an overall enhancement score ≥ 2 as predictive of malignancy, we obtain an overall sensitivity of 92.4%; specificity of 89.8%; positive predictive value of 94.7%; and negative predictive value of 85.8%. Conclusions: Our proposed predictive score on the enhancement descriptors of CESM to predict the malignancy of a breast lesion shows excellent results and can help in early breast cancer diagnosis and in avoiding unnecessary biopsies.

In the last few years, ultrasound-guided vacuum-assisted breast biopsy (US-VABB) has replaced surgical biopsy due to higher diagnostic accuracy and lower patient discomfort, and, at present, an even greater possibility is represented by the new wireless ultrasound-guided VAB device (Wi-UVAB). The purpose of our study is to determine the diagnostic accuracy of this new device in a sizeable representative number of patients. From January 2014 to June 2018, 168 biopsies were performed in our institution using the new Wi-UVAB device. We analyzed sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of biopsies obtained with the new device using surgical results as reference point, following patients for at least one year. In our cohort, we obtained a complete sensitivity of 97.5%, an absolute sensitivity of 94.3%, a complete specificity of 98%, and an absolute specificity of 98%. The positive predictive value of the procedure was 97.5% while the negative predictive value was 98%. The diagnostic accuracy was 98%. The Wi-UVAB is a safe procedure with high diagnostic accuracy, comparable to that of the traditional vacuum-assisted breast biopsy and even higher than that of core needle biopsy (CNB). Moreover, the Wi-UVAB is easy to use and shows low costs as core needle biopsy (CNB).

Purpose: To evaluate if a computer-aided diagnosis (CAD) system on ultrasound (US) can improve the diagnostic performance of inexperienced radiologists. Methods: We collected ultrasound images of 256 breast lesions taken between March and May 2020. We asked two experienced and two inexperienced radiologists to retrospectively review the US features of each breast lesion according to the Breast Imaging Reporting and Data System (BI-RADS) categories. A CAD examination with S-DetectTM software (Samsung Healthcare, Seoul, South Korea) was conducted retrospectively by another uninvolved radiologist blinded to the BIRADS values previously attributed to the lesions. Diagnostic performances of experienced and inexperienced radiologists and CAD were compared and the inter-observer agreement among radiologists was calculated. Results: The diagnostic performance of the experienced group in terms of sensitivity was significantly higher than CAD (p < 0.001). Conversely, the diagnostic performance of inexperienced group in terms of both sensitivity and specificity was significantly lower than CAD (p < 0.001). We obtained an excellent agreement in the evaluation of the lesions among the two expert radiologists (Kappa coefficient: 88.7%), and among the two non-expert radiologists (Kappa coefficient: 84.9%). Conclusion: The US CAD system is a useful additional tool to improve the diagnostic performance of the inexperienced radiologists, eventually reducing the number of unnecessary biopsies. Moreover, it is a valid second opinion in case of experienced radiologists.

Most studies on gender and psychosis have focused on gender differences at illness onset or on the long-term outcome, whereas little is known about the impact of gender on the first years after psychosis onset. A total of 185 first episode psychosis (FEP) patients were followed for 5 years after psychosis onset, and gender differences were explored in psychopathology (PANSS), needs for care (CAN), and insight (SAI-E). Male patients showed more negative symptoms than females over time, whereas female patients showed higher levels of depressive symptoms than males throughout the study period. In addition, female patients presented more functioning unmet needs for care, but higher levels of insight into illness than males. Therapy and rehabilitative programs for FEP patients should be gender-targeted, as gender has proved to impact on psychopathology, needs for care, and insight in the very first years following psychosis onset.