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Objective. Ductal carcinoma in situ (DCIS) of the breast is becoming more and more frequent in women after the introduction of breast screening programmes. Once the diagnosis is confirmed on the surgical specimen, its prognosis is excellent, but still some tumours recur as in situ or even invasive neoplasms in the same or contralateral breast. Neoductgenesis (NGD), defined by László Tabár and Tibor Tot as the presence of “casting type” calcifications on mammography, an abnormal number of ducts, periductal desmoplastic reaction and lymphocytic infiltrate, has been proposed as a marker of aggressiveness in “early” breast carcinoma (1 2). We analysed this phenomenon in pure DCIS by correlating its presence with clinical and instrumental findings, morphological and immunohistochemical features, and with patients’ prognosis. Materials and Methods. We selected 199 cases of breast DCIS undergone surgery between 2004 and 2016, available at the Unit of Pathology of the Academic Hospital of Trieste, and performed a re-evaluation of the histological slides in order to define the presence or absence of NDG, based on the morphological features previously described2. Furthermore, a subgroup of 64 cases underwent radiological review by two expert radiologists (AF, MT) in order to re-classify the mammographic findings according to specific types of calcifications1. The correlation between morphological NDG, casting type calcifications and prognostic markers of breast DCIS, such as extension, grade and expression of hormonal receptors and HER2-neu, as well as with disease recurrence, was evaluated through Chi-Square independence test or Fisher test as appropriate. Results. NDG was identified in 33 cases (16.6%) and was found to be positively associated with the larger size of lesions on mammography (p=0.008), histological high grade (p

Breast Fine Needle Aspiration Cytology (FNAC) represents first choice diagnostic tool to determine mammographic lesions and clinically palpable breast nodules. FNAC is affected anyway by a certain degree of subjectiveness, that is more evident with the so- called “grey zone” cases (the ones not clearly benign or not clearly malignant) and when there are some doubts about material adequacy. These situations may create some misunderstandings between clinicians and pathologists with possible over or undertreatment for patients. The need for clear communication is extremely important, but it becomes a priority in senology because of the multidisciplinary aspects of the field. For this reasons a breast cytology reporting system has been proposed since 1993 within a U.K. mammographic breast screening programme. From our experience we think only a cytological exam with well demonstrated and well documented quality which satisfies those criteria suggested by guidelines will be able to play a key role in patients’ clinical management. It will allow reducing as much as possible diagnostic biopsies on benign lesions and frozen sections to confirm malignant lesions.We believe that a good quality cytology can provide an important and relevant contribution to define breast lesions’ nature without using other invasive procedures and to obtain in most cases good material for subsequent molecular investigations. Cytological approach to breast lesions was also validated in Breast Unit of Trieste during EUSOMA certification visit.

Fine needle aspiration (FNA) has traditionally been regarded as the simplest, less invasive and less expensive diagnostic procedure for the definition of breast lesions. In expert hands, it allows obtaining an accurate diagnosis in most breast lesions. The introduction of widespread mammographic screeningprogrammes and the consequent detection of a large number of small, non-palpable lesions have increasingly brought to the routine use of other minimally invasive biopsy methods using heavier gauge cutting needles – the so-called core biopsies (CB) and other automatic, imaging-guideddevices, such as vacuum assisted biopsies (VAB) – partially obscuring the central role of FNA. Recently, new recommendations propose to definitively abandon FNA, restricting all morphological investigations to CB.Has FNA completely lost its role as to let us to remove it from the routine diagnostic practice? In our personal experience from the breast unit of Trieste, where there systematic use of FNA is available, it is proved that this method may bring to a definitive diagnosis 2/3 of the lesions investigated. The unjustified abandonment of the technique by breast healthcare centres must be avoided, since it could only have negative repercussions on the whole preoperative diagnostics.it is necessary for the pathologists to guarantee the maintenance of their professional expertise in this field, and to transmit it to the young.

La diagnosi e la gestione dei tumori fillodi della mammella è complessa a causa del basso tasso di incidenza e dell’imprevedibilità del comportamento di questo tipo di neoplasie (meno dell’1% tra tutti i tumori della mammella [1]). L’obiettivo di questo studio è analizzare i casi di tumori filloidi diagnosticati a Trieste nel periodo 2006-2014 al fine di contestualizzare il comportamento particolarmente aggressivo di un tumore fillode maligno insorto in una paziente con pregressi fillodi benigni.

Il ruolo dei fattori riproduttivi nel rischio di sviluppare un carcinoma alla mammella è ancora controverso e poco si sa su come questi influiscano sul rischio dei differenti sottotipi molecolari . La maggior parte degli studi pubblicati riguardano coorti di donne in pre e postmenopausa o solo donne in postmenopausa. Scopo del nostro studio è stato analizzare il ruolo dell’allattamento e dei fattori riproduttivi nei tumori Luminali, il 75% di tutti i carcinomi della mammella, in un campione di donne giovani residenti nella provincia di Trieste, situata in Friuli-Venezia Giulia, una tra le regioni con i più alti tassi d’incidenza di carcinoma mammario.

Aims and objectives Methods and materials Results Conclusion Personal information References, Aims and objectives: At the SYRMEP (Synchrotron Radiation for Medical Physics) beamline of Elettra Laboratory, the Italian Synchrotron Radiation (SR) facility in Trieste (Italy), the first clinical study in SR Mammography (SRM) has been carried out since 2006 [1]. The...

Purpose: To prospectively compare clinical breast examination (CBE), mammography, ultrasonography (US), and contrast material-enhanced magnetic resonance (MR) imaging for screening women at genetic-familial high risk for breast cancer and report interim results, with pathologic finding as standard. Materials and Methods: Institutional review board of each center approved the research; informed written consent was obtained. CBE, mammography, US, and MR imaging were performed for yearly screening of BRCA1 or BRCA2 mutation carriers, first-degree relatives of BRCA1 or BRCA2 mutation carriers, or women enrolled because of a strong family history of breast or ovarian cancer (three or more events in first-or second-degree relatives in either maternal or paternal line; these included breast cancer in women younger than 60 years, ovarian cancer at any age, and male breast cancer at any age). Results: Two hundred seventy-eight women (mean age, 46 years ± 12 [standard deviation]) were enrolled. Breast cancer was found in 11 of 278 women at first round and seven of 99 at second round (14 invasive, four intraductal; eight were ≤10 mm in diameter). Detection rate per year was 4.8% (18 of 377) overall; 4.3% (11 of 258) in BHCA1 or BRCA2 mutation carriers and first-degree relatives of BRCA1 or BRCA2 mutation carriers versus 5.9% (seven of 119) in women enrolled because of strong family history; and 5.3% (nine of 169) in women with previous personal breast and/or ovarian cancer versus 4.3% (nine of 208) in those without. In six (33%) of 18 patients, cancer was detected only with MR imaging. Sensitivity was as follows: CBE, 50% (95% confidence interval [CI]: 29%, 71%); mammography, 59% (95% CI: 36%, 78%); US, 65% (95% CI: 41%, 83%); and MR imaging, 94% (95% CI: 82%, 99%). Positive predictive value was as follows: CBE, 82% (95% CI: 52%, 93%); mammography, 77% (95% CI: 50%, 92%); US, 65% (95% CI: 41%, 83%); and MR imaging, 63% (95% CI: 43%, 79%). Conclusion: Addition of MR imaging to the screening regimen for high-risk women may enable detection of otherwise unsuspected breast cancers. © RSNA, 2007.

Item does not contain fulltext Breast computed tomography (BCT) is an emerging application of X-ray tomography in radiological practice. A few clinical prototypes are under evaluation in hospitals and new systems are under development aiming at improving spatial and contrast resolution and reducing delivered dose. At the same time, synchrotron-radiation phase-contrast mammography has been demonstrated to offer substantial advantages when compared with conventional mammography. At Elettra, the Italian synchrotron radiation facility, a clinical program of phase-contrast BCT based on the free-space propagation approach is under development. In this paper, full-volume breast samples imaged with a beam energy of 32 keV delivering a mean glandular dose of 5 mGy are presented. The whole acquisition setup mimics a clinical study in order to evaluate its feasibility in terms of acquisition time and image quality. Acquisitions are performed using a high-resolution CdTe photon-counting detector and the projection data are processed via a phase-retrieval algorithm. Tomographic reconstructions are compared with conventional mammographic images acquired prior to surgery and with histologic examinations. Results indicate that BCT with monochromatic beam and free-space propagation phase-contrast imaging provide relevant three-dimensional insights of breast morphology at clinically acceptable doses and scan times.

In the medical literature, the role of breastfeeding and reproductive factors in the risk of breast carcinoma is still an open debate in premenopausal women. We highlight the role of breastfeeding and reproductive factors in luminal A and luminal B, the most frequent breast cancers. This case-control study analyzes a White premenopausal population of 286 breast cancer patients, divided into molecular subtypes, and 578 controls matched by age. Multivariate logistic regression models were used to assess the relationships of breastfeeding and other reproductive factors (age at menarche, parity, age at first pregnancy, number of children) with the risk of breast cancers. Among the variables examined, reproductive factors did not alter the risk of cancer, whereas breastfeeding up to 12 months was a significant protective factor against luminal B breast cancer (multivariate odds ratio: 0.22, 95% confidence interval: 0.09-0.59, P=0.002). In contrast, luminal A cases did not significantly correlate with breastfeeding or other reproductive factors. Breastfeeding up to 12 months is strongly protective against the more aggressive luminal B, but not against the less aggressive luminal A breast cancer in premenopausal White women.

A quantitative characterization of the soft tissues composing the human breast is achieved by means of a monochromatic CT phase-contrast imaging system, through accurate measurements of their attenuation coefficients within the energy range of interest for breast CT clinical examinations. Quantitative measurements of linear attenuation coefficients are performed on tomographic reconstructions of surgical samples, using monochromatic x-ray beams from a synchrotron source and a free space propagation setup. An online calibration is performed on the obtained reconstructions, in order to reassess the validity of the standard calibration procedure of the CT scanner. Three types of healthy tissues (adipose, glandular, and skin) and malignant tumors, when present, are considered from each sample. The measured attenuation coefficients are in very good agreement with the outcomes of similar studies available in the literature, although they span an energy range that was mostly neglected in the previous studies. No globally significant differences are observed between healthy and malignant dense tissues, although the number of considered samples does not appear sufficient to address the issue of a quantitative differentiation of tumors. The study assesses the viability of the proposed methodology for the measurement of linear attenuation coefficients, and provides a denser sampling of attenuation data in the energy range useful to breast CT.

Item does not contain fulltext Two dosimetric quantities [mean glandular dose (MGD) and entrance surface air kerma (ESAK)] and the diagnostic performance of phase-contrast mammography with synchrotron radiation (MSR) are compared to conventional digital mammography (DM). Seventy-one patients (age range, 41 to 82 years) underwent MSR after a DM examination if questionable or suspicious breast abnormalities were not clarified by ultrasonography. The MGD and the ESAK delivered in both examinations were evaluated and compared. Two on-site radiologists rated the images in consensus according to the Breast Imaging Reporting and Data System assessment categories, which were then correlated with the final diagnoses by means of statistical generalized linear models (GLMs). Receiver operating characteristic curves were also used to assess the diagnostic performance by comparing the area under the curve (AUC). An important MGD and ESAK reduction was observed in MSR due to the monoenergetic beam. In particular, an average 43% reduction was observed for the MGD and a reduction of more than 50% for the ESAK. GLM showed higher diagnostic accuracy, especially in terms of specificity, for MSR, confirmed by AUC analysis ([Formula: see text]). The study design implied that the population was characterized by a high prevalence of disease and that the radiologists, who read the DM images before referring the patient to MSR, could have been influenced in their assessments. Within these limitations, the use of synchrotron radiation with the phase-contrast technique applied to mammography showed an important dose reduction and a higher diagnostic accuracy compared with DM. These results could further encourage research on the translation of x-ray phase-contrast imaging into the clinics.

The aim of this study was to highlight the advantages that propagation-based phase-contrast computed tomography (PB-CT) with synchrotron radiation can provide in breast cancer diagnostics. For the first time, a fresh and intact mastectomy sample from a 60 year old patient was scanned on the IMBL beamline at the Australian Synchrotron in PB-CT mode and reconstructed. The clinical picture was described and characterized by an experienced breast radiologist, who underlined the advantages of providing diagnosis on a PB-CT volume rather than conventional two-dimensional modalities. Subsequently, the image quality was assessed by 11 breast radiologists and medical imaging experts using a radiological scoring system. The results indicate that, with the radiation dose delivered to the sample being equal, the accuracy of a diagnosis made on PB-CT images is significantly higher than one using conventional techniques.

Interval breast cancers (IBC) have been of great concern since breast mammogram screening programs were introduced. We compared IBC to screen-detected cancers (SDC). IBC accounted for one-fifth of all breast cancers diagnosed in women who followed the regional screening program. IBC appeared to be more aggressive than SDC in terms of tumor invasiveness, size, and St Gallen molecular subtype, leading to worse overall and disease-free survival. Background: The introduction of breast screening programs has raised the problem of interval breast cancers (IBC). The aims of this study were to analyze the impact of IBC on the screening program, to compare IBC and screendetected cancers (SDC), and to identify possible predictors of mortality. Patients and Methods: Patients with breast cancer diagnosed during the regional breast screening program between January 2008 and December 2013 at a single center in Italy were included. Demographic, preoperative, and postoperative data were prospectively collected and retrospectively analyzed. Results: Five hundred thirty-four patients were enrolled; 106 women (19.9%) had IBC and 428 women (80.1%) SDC. IBC presented more aggressive features compared to SDC, such as tumor invasiveness (95% vs. 85%; P ¼ .005), tumor size ( pT2 37% vs. 21%; P ¼ .001), grade (G3 39% vs. 17%; P < .001), and St Gallen molecular subtype (triple negative 22% vs. 7%; P < .001), resulting in higher distant recurrence rate (8% vs. 2%; P ¼ .009) and worse overall and disease-free survival (P ¼ .03 and P ¼ .001, respectively). Cox multivariate regression analysis identified St Gallen molecular subtype as the only predictor of mortality in patients with breast cancer (P ¼ .03). Conclusion: IBC accounted for one-fifth of all breast cancers diagnosed in women who followed the regional screening program. Furthermore, IBC appeared to have more aggressive features compared to SDC, leading to worse survival. These worse survivals depended on St Gallen molecular subtype.

We present the outcomes of combined feasibility studies carried out at Elettra and Australian Synchrotron to evaluate novel protocols for threedimensional (3D) mammographic phase contrast imaging. A custom designed plastic phantom and some tissue samples have been studied at diverse resolution scales and experimental conditions. Several computed tomography (CT) reconstruction algorithms with different pre-processing and post-processing steps have been considered. Special attention was paid to the effect of phase retrieval on the diagnostic value of the reconstructed images. The images were quantitatively evaluated using objective quality indices in comparison with subjective assessments performed by three experienced radiologists and one pathologist. We show that the propagation-based phase-contrast imaging (PBI) leads to substantial improvement to the contrast-to-noise and to the intrinsic quality of the reconstructed CT images compared with conventional techniques as well as to an important reduction of the delivered doses, thus opening the way to clinical implementations.

AIM:Completion axillary lymph node dissection (CALND) performed as a standard procedure after a positive sentinel node biopsy (SLNB) in breast cancer patients results, in almost 40-70% of cases, in no additional positive nodes. A nomogram has been developed at Memorial Sloan Kettering Cancer Center (MSKCC) to predict the likelihood of nonsentinel node metastases (NSLNM) after a positive SLNB. Aim of study was to assess the accuracy of MSKCC nomogram in our community breast cancer population. MATERIAL OF STUDY: From a retrospective database of 276 breast cancer patients we evaluated 62 consecutive cases who underwent CALND after a positive SLNB. Patient and tumor characteristics were collected and the nomogram was used to calculate the probability of NSLNM. The accuracy of MSKCC nomogram was tested by the Receiver Operating Characteristic (ROC) curve. The Area Under the Curve (AUC), sensitivity and specificity were calculated for a 10% cut-off value. RESULTS: Presence of macrometastases (p=0.03) and its extranodal extension (p=0.013) in sentinel node were associated with NSLNM, while other tumor and patient characteristics were not. The accuracy of MSKCC nomogram as measured by AUC was 0.67. The nomogram showed 95% sensitivity and 14% specificity. We revised the nomogram by incorporating the presence of extranodal extension and we obtained a new test with improved specificity (84%). DISCUSSION: The modified predictive model is a useful tool in predicting the likelihood of NSLNM in our cohort of patients and may help decision regarding the need of completion axillary lymph node dissection

AIM: The aim of this study was to determine factors that predict non-sentinel axillary lymph nodes (NSLNs) metastases in breast cancer patients with positive sentinel node biopsy (SLNB). MATERIAL OF STUDY: We reviewed the records of a consecutive series of 176 breast cancer patients who underwent SLNB at our institution. From the database we analysed those cases with one or more positive sentinel lymph nodes (SLNs) in order to determine factors predicting NSLN metastases. RESULTS: From a series of 176 consecutive patients, we evaluated 41 cases (23.3%) with positive SLNB. Subsequent completion axillary lymph node dissection (CALND) revealed NSLN metastases in 15 cases (36.6%). The significant variables predictive of NSLN involvement were the presence of macrometastases with extranodal extension (p = 0.048), the presence of more than one positive SLN (p = 0.08) and a ratio between positive SLN and SLNs globally dissected higher than 0.5 (p = 0.05). DISCUSSION: CALND is the gold standard for patients with positive SLNB, but results, in almost 40-70% of cases, in no additional positive nodes and its therapeutic benefit remains controversial. Clinicopathologic factors predictive of NSLN metastases may be useful in identifying a subset of patients with lower risk of further axillary involvement. CONCLUSIONS: In patients with early breast carcinoma and a positive SLNB, the size of SLN metastases, the presence of extranodal extension, more than one positive SLN and a nodal ratio higher than 0.5 are the factors that significantly increase the frequency of additional axillary positive lymph nodes.

Results are presented of a feasibility study of three-dimensional X-ray tomographic mammography utilising in-line phase contrast. Experiments were performed at SYRMEP beamline of Elettra synchrotron. A specially designed plastic phantom and a mastectomy sample containing a malignant lesion were used to study the reconstructed image quality as a function of different image processing operations. Detailed evaluation and optimization of image reconstruction workflows have been carried out using combinations of several advanced computed tomography algorithms with different pre-processing and post-processing steps. Special attention was paid to the effect of phase retrieval on the diagnostic value of the reconstructed images. A number of objective image quality indices have been applied for quantitative evaluation of the results, and these were compared with subjective assessments of the same images by three experienced radiologists and one pathologist. The outcomes of this study provide practical guidelines for the optimization of image processing workflows in synchrotron-based phase-contrast mammo-tomography.