Practical Challenges of DBT-Guided VABB: Harms and Benefits, from Literature to Clinical Experience

Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson's correlation and χ2 test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41-84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76-1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.

Correction to: In search of potential predictors of erythropoiesis-stimulating agents (ESAs) hyporesponsiveness: a population-based study

An amendment to this paper has been published and can be accessed via the original article.

In Search of Predictors of Switching Between Erythropoiesis-Stimulating Agents in Clinical Practice: A Multi-Regional Cohort Study

BACKGROUND AND OBJECTIVES

Switching between different erythropoiesis-stimulating agents (ESAs) during the first year of therapy is frequent (15-20%), much more so toward reference products than biosimilars. The objectives of this study were to investigate the frequency and identify the potential predictors of switching between biosimilar and originator ESAs during the first year of treatment in patients with chronic kidney disease (CKD), or chemotherapy-related anemia from six large Italian geographic areas in the years 2009-2015.

METHODS

A retrospective cohort study was conducted using six Italian regional claims databases (≥ 13 million inhabitants) during 2009-2015. Among incident epoetin users, the frequency of single, multiple, and backward switch during the first year of treatment was evaluated. Using frailty Cox models, potential predictors of first switch were identified. All analyses were stratified by the main indications for use.

RESULTS

Among 102,240 incident epoetin users, 15,853 (15.5%) switched to another epoetin during the first year of therapy; only 18% of these switched to biosimilars. Single switch was more common (62.2% of the switchers) than multiple (23.5%) or backward switch (14.3%). In cancer, the cumulative number of transfusions and iron preparations dispensed, as well as hyperparathyroidism, were predictors of switching. In CKD, the cumulative number of transfusions, number of vitamin A/D preparations dispensed, and CKD severity increased the probability of switching.

CONCLUSIONS

Switching between ESAs was frequent in both CKD and cancer patients. The number of cumulative transfusions and severity of disease seemed to affect the switch.

The P.I.N.K. Study Approach for Supporting Personalized Risk Assessment and Early Diagnosis of Breast Cancer

Breast cancer is a clear example of excellent survival when it is detected and properly treated in the early stage. Currently, screening of this cancer relies on mammography, which may be integrated by new imaging techniques for more exhaustive evaluation. The Personalized, Integrated, Network, Knowledge (P.I.N.K.) study is a longitudinal multicentric study involving several diagnostic centres across Italy, co-ordinated by the Italian National Research Council and co-funded by the Umberto Veronesi Foundation. Aim of the study is to evaluate the increased diagnostic accuracy in detecting cancers obtained with different combinations of imaging technologies, and find the most effective diagnostic pathway matching the characteristics of an individual patient. The study foresees the enrolment of 50,000 women over the age of 40 years presenting for breast examination and providing informed consent to data handling. So far, the 15 participating centres across Italy have recruited a total of 22,848 patients. Based on the analyses of the first 175 histopathological-proven breast cancers, mammographic sensitivity was estimated to be 61.7% (n = 108 cancers), whereas diagnostic accuracy increased by 35.5% (n = 44 cancers) when mammography was integrated with other imaging modalities (ultrasound and/or digital breast tomosynthesis). Increase was mainly determined by ultrasound alone. Given the ongoing data collection and recruitment, the number of cancers detected is too low to allow any further in-depth analysis to explore links to patient characteristics. Past studies show that the uniform approach of population screening guidelines should be revised in favour of more personalised regimens, where known standards are integrated by imaging techniques most suitable for the individual's characteristics. With the ultimate goal of identifying early breast cancer detection strategies, our preliminary results suggest that integrated diagnostic approach could lead to a paradigm shift from an age-based regimen toward more specific and effective risk-based personalised screening regimens, in order to reduce mortality from breast cancer.

Special Issue "New Advances in Breast Imaging"

Breast cancer (BC) is the most common cancer in women of all ages, with more than 2 million diagnoses every year and a high economic and psychological impact on both the health care system and the population [...].

Breast Cancer: A Multi-Disciplinary Approach from Imaging to Therapy

Breast cancer (BC) is the most prevalent form of cancer among women worldwide, accounting for over 2 million diagnoses annually [...].

Contrast-enhanced mammography in high-dense breasts: a narrative review

Background and Objective

Contrast-enhanced mammography (CEM) combines iodine-based contrast agents with dual-energy imaging to enhance the detection of breast cancer, especially in women with dense breast tissue. Dense breasts, which obscure conventional mammography results, present unique diagnostic challenges and an elevated risk of cancer. This review explores the role of CEM in improving diagnostic accuracy in high-density breasts, its comparative performance with other imaging modalities, and its potential implications for clinical practice.

Methods

We conducted a narrative analysis on the use of CEM in dense breast tissue by searching PubMed, Web of Science (WoS), and Google Scholar between September and November 2024. Keywords, rather than MeSH terms, were utilized to refine the search, focusing on terms appearing in article titles. Sixty-six articles were identified, and duplicates or non-eligible studies were excluded, resulting in a final selection of 21 articles published between 2013 and 2024. Additional references were identified through snowballing to contextualize findings.

Key Content and Findings

CEM demonstrates high sensitivity (89-97.7%) and specificity (50-89%) in detecting malignancies within dense breasts, offering comparable diagnostic accuracy to magnetic resonance imaging (MRI) but with better accessibility and lower cost. Unlike traditional mammography, CEM enhances visibility through functional imaging of contrast uptake, improving detection of small or occult lesions. It also aids in pre-surgical planning by assessing tumor size and multiplicity with greater precision. However, CEM is not without limitations, including radiation exposure and variability in equipment standards. Comparative analyses suggest CEM bridges the gap between conventional mammography and advanced techniques like MRI, particularly in resource-constrained settings.

Conclusions

CEM represents a significant advancement in breast cancer detection, addressing limitations posed by dense breast tissue. Its diagnostic accuracy, cost-effectiveness, and patient accessibility position it as a valuable tool in personalized screening strategies. Further standardization and integration into clinical workflows could expand its role in routine breast cancer management.

Mammography in Breast Disease Screening and Diagnosis

Female breasts can suffer from a wide spectrum of pathologies, ranging from inflammatory diseases to benign and malignant tumors [...].

[Evaluation of therapeutical appropriateness in psychiatric treatment of schizophrenia, by integrating computer data records with clinical audit results]

AIM

The aim is to evaluate prescriptive patterns of atypical antipsychotic drugs for the treatment of schizophrenia in the LHU Caserta in 2011-2013, and to indicate potentially inappropriate therapy; to plan or schedule corrective/preventive activities to support the continuous improvement of health services.

METHODS

Retrospective cohort study, based on integration of health records and clinical audit. The study was performed in the following steps: data retrieval and analysis; comparison of data with international literature; editing of the Diagnostic-Therapeutic Path. The analysis was performed by using the administrative database of drug prescriptions and treatment plans in the SANIARP portal, a web platform available to specialist facilities and private and public pharmacies of LHU Caserta. The subject of our analysis was to gain information about the diagnosis and treatment of users of atypical antipsychotics in the LHU of Caserta in the years 2011-2013.

RESULTS

We identified 2,768 patients with at least one prescription of atypical antipsychotics and diagnosis coded in the study period. Schizophrenia is the most frequent diagnosis (31.1%) and the most common drug in use is olanzapine (29.1%). About 70% of schizophrenics were on monotherapy with no change in drug, 23.6% were under polytherapy and 7.9% made a switch.

DISCUSSION AND CONCLUSION

Our findings were a starting point for editing Diagnostic and Therapeutic Paths aimed at raising the awareness of the scientific community about the appropriateness of diagnosis and treatment in schizophrenia. Pharmacological treatment of schizophrenia should be focused on improving the overall quality of life aimed at remission and possible recovery, although difficult.

A Comparative Analysis of Mobile versus Stationary Mammography Units: Performance and Outcomes in a Breast Cancer Screening Program

Purpose

Breast cancer screening programs often encounter challenges related to high costs and limited accessibility, particularly in rural areas. Mobile mammography units (MMUs) have emerged as a potential solution to address these barriers. This study aimed to compare the outcomes of mammography screenings conducted in fixed units and MMUs, focusing on recall rates, follow-up adherence, and screen-detected breast cancer (BC) rates.

Patients and Methods

This retrospective study analyzed data from 790 women aged 50-69 years who underwent mammography screening between January and February 2023. Participants were divided into two groups: group A (525 women, screened at fixed units) and group B (265 women, screened at MMUs). Key metrics included recall rates, biopsy rates, screen-detected BC rates, and refusal rates for follow-up evaluations. Statistical comparisons were made between the two groups to assess differences in outcomes.

Results

In group A (mean age 58.8 ± 5.7 years), the recall rate was 6.1%, with 32 recalls, 8 biopsies, and 7 confirmed BC cases, yielding a screen-detected BC rate of 1.33%. In group B (mean age 59.6 ± 5.8 years), the recall rate was higher at 10.6%, with 28 recalls, 5 biopsies, and 3 BC cases, resulting in a screen-detected BC rate of 1.13%. Notably, refusal rates for follow-up evaluations were significantly higher in group B (42.9%) compared to group A (9%).

Conclusion

While MMUs improve accessibility to underserved areas, they face challenges such as higher refusal rates for follow-up evaluations. The comparable screen-detected BC rates between MMUs and fixed units underscore the potential of combining both approaches in breast cancer screening programs. These findings highlight the importance of awareness campaigns to improve follow-up adherence and suggest that future research should focus on cost-effectiveness and sociocultural factors to optimize breast cancer prevention strategies.