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Berrino F, Villarini A, Gargano G, Krogh V, Grioni S, Bellegotti M, Venturelli E, Raimondi M, Traina A, Zarcone M, Amodio R, Mano MP, Johansson H, Panico S, Santucci de Magistris M, Barbero M, Gavazza C, Mercandino A, Consolaro E, Galasso R, Del Riccio L, Bassi MC, Simeoni M, Premoli P, Pasanisi P, Bonanni B, Bruno E. The Effect of Diet on Breast Cancer Recurrence: The DIANA-5 Randomized Trial. Clin Cancer Res 2024; 30:965-974. [PMID: 37847493 PMCID: PMC10905522 DOI: 10.1158/1078-0432.ccr-23-1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/02/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The DIANA-5 randomized controlled trial assessed the effectiveness of a diet based on Mediterranean and macrobiotic traditions (macro-Mediterranean diet) in reducing breast cancer recurrence. PATIENTS AND METHODS The DIANA-5 study involved 1,542 patients with breast cancer at high risk of recurrence because of estrogen receptor-negative cancer, or metabolic syndrome, or high plasma levels of insulin or testosterone. Women were randomly assigned to an active dietary intervention (IG) or a control group (CG). Both groups received the 2007 American Institute for Cancer Research/World Cancer Research Fund recommendations for cancer prevention. The intervention consisted of meetings with kitchen classes, community meals, and dietary recommendations. Recommended foods included whole grain cereals, legumes, soy products, vegetables, fruit, nuts, olive oil, and fish. Foods to be avoided were refined products, potatoes, sugar and desserts, red and processed meat, dairy products, and alcoholic drinks. A compliance Dietary Index was defined by the difference between recommended and discouraged foods. RESULTS Over the 5 years of follow-up, 95 patients of the IG and 98 of the CG developed breast cancer recurrence [HR = 0.99; 95% confidence interval (CI): 0.69-1.40]. The analysis by compliance to the dietary recommendations (IG and CG together) showed that the women in the upper tertile of Dietary Index change had an HR of recurrence of 0.59 (95% CI: 0.36-0.92) compared with women in the lower tertile. CONCLUSIONS The DIANA-5 dietary intervention trial failed to show a reduction in breast cancer recurrence, although self-reported diet at year 1 in IG and CG combined showed a protective association with the higher Dietary Index change. See related commentary by McTiernan, p. 931.
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Affiliation(s)
- Franco Berrino
- Department of Epidemiology and Data Science, S.C. Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- La Grande Via Foundation, Milan, Italy
| | - Anna Villarini
- Department of Medicine and Surgery, Section of Hygiene and Public Health, University of Perugia, Perugia, Italy
| | - Giuliana Gargano
- Department of Epidemiology and Data Science, S.C. Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Vittorio Krogh
- Department of Epidemiology and Data Science, S.C. Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Sara Grioni
- Department of Epidemiology and Data Science, S.C. Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Manuela Bellegotti
- Department of Epidemiology and Data Science, S.C. Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Elisabetta Venturelli
- Department of Experimental Oncology, S.S.D. Nutrition Research and Metabolomics, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Milena Raimondi
- Department of Epidemiology and Data Science, S.C. Epidemiology and Prevention, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Adele Traina
- Palermo and Province Cancer Registry, Clinical Epidemiology Unit with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, University of Palermo, Palermo, Italy
| | - Maurizio Zarcone
- Palermo and Province Cancer Registry, Clinical Epidemiology Unit with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, University of Palermo, Palermo, Italy
| | - Rosalba Amodio
- Palermo and Province Cancer Registry, Clinical Epidemiology Unit with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico “Paolo Giaccone”, University of Palermo, Palermo, Italy
| | - Maria Piera Mano
- Dipartimento Scienze Chirurgiche, Study University, Turin, Italy
- S.C. Epidemiologia dei Tumori, AOU Città della Salute e della Scienza, CPO Piemonte, Turin, Italy
| | - Harriet Johansson
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | | | | | | | | | | | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS-CROB, Rionero in Vulture, Italy
| | - Luciana Del Riccio
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS-CROB, Rionero in Vulture, Italy
| | | | | | | | - Patrizia Pasanisi
- Department of Experimental Oncology, S.S.D. Nutrition Research and Metabolomics, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Eleonora Bruno
- Department of Experimental Oncology, S.S.D. Nutrition Research and Metabolomics, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Baù MG, Borella F, Mano MP, Giordano L, Carosso M, Surace A, Mondino A, Gallio N, Benedetto C. Adherence to Quality Indicators for Breast Cancer Management in a Multidisciplinary Training Program. J Pers Med 2023; 13:1693. [PMID: 38138920 PMCID: PMC10744846 DOI: 10.3390/jpm13121693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Background: The management of early breast cancer (BC) needs supervision and skill maintenance, and should be performed by specialists working as a team in multidisciplinary breast units. This approach aims to improve the long-term survival and quality of life of patients with BC. Methods: This was a prospective observational study including patients newly diagnosed with operable BC. The study encompassed the pre-surgical phase, throughout the diagnostic and surgical workout, and included post-therapeutic master multidisciplinary team meetings (MTMs) sessions, between 2019 and 2022. Results: We enrolled 280 patients with BC from eight breast units. The Senonetwork indicators regarding diagnosis, waiting time, loco-regional treatment, and adjuvant therapy were collected for each patient discussed. Conclusions: Overall, the majority of quality indicators were respected among breast units. The most critical issue referred to timing indicators: more than 30 days from MTM to surgery, more than 42 days from diagnosis to surgery, and more than 60 days from the first screening mammogram to surgery for many patients. Some aspects of the histopathological diagnosis of intraductal BC also need to be improved. Furthermore, other critical issues in our study regarded some aesthetical indicators, demonstrating low interest in these essential quality indicators.
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Affiliation(s)
- Maria Grazia Baù
- Gynecology and Obstetrics Unit, Maria Vittoria Hospital, 10144 Turin, Italy;
| | - Fulvio Borella
- Gynecology and Obstetrics Unit 1, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy; (M.C.); (C.B.)
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
| | - Maria Piera Mano
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
| | - Livia Giordano
- Unit of Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, San Giovanni Antica Sede, 10123 Turin, Italy
| | - Marco Carosso
- Gynecology and Obstetrics Unit 1, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy; (M.C.); (C.B.)
| | - Alessandra Surace
- Gynecology and Obstetrics Unit, Michele e Pietro Ferrero Hospital, 12060 Verduno, Italy;
| | - Aurelia Mondino
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
| | - Niccolò Gallio
- Gynecology and Obstetrics Unit 2, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy;
| | - Chiara Benedetto
- Gynecology and Obstetrics Unit 1, AOU Città della Salute e della Scienza di Torino, Sant’Anna Hospital, 10126 Turin, Italy; (M.C.); (C.B.)
- Department of Surgical Sciences, University of Turin, Via Ventimiglia 1, 10126 Turin, Italy (A.M.)
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Bruno E, Krogh V, Gargano G, Grioni S, Bellegotti M, Venturelli E, Panico S, Santucci de Magistris M, Bonanni B, Zagallo E, Mercandino A, Bassi MC, Amodio R, Zarcone M, Galasso R, Barbero M, Simeoni M, Mano MP, Berrino F, Villarini A, Pasanisi P. Adherence to Dietary Recommendations after One Year of Intervention in Breast Cancer Women: The DIANA-5 Trial. Nutrients 2021; 13:nu13092990. [PMID: 34578868 PMCID: PMC8468802 DOI: 10.3390/nu13092990] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
The Diet and Androgen-5 (DIANA-5) trial aimed at testing whether a dietary change based on the Mediterranean diet and on macrobiotic principles can reduce the incidence of breast cancer (BC)-related events. We analyzed the adherence to the DIANA-5 dietary recommendations by randomization group after 1 year of intervention. We evaluated the association between dietary adherence and changes in body weight and metabolic syndrome (MS) parameters. BC women aged 35-70 years were eligible. After the baseline examinations, women were randomized into an intervention group (IG) or a control group (CG). A total of 1344 BC women (689 IG and 655 CG) concluded the first year of dietary intervention. IG showed greater anthropometric and metabolic improvements compared to CG. These changes were significantly associated with increased adherence to the dietary recommendations. Women who increased recommended foods consumption or reduced discouraged foods consumption showed an Odds Ratio (OR) of 1.37 (0.70-2.67) and 2.02 (1.03-3.98) to improve three or more MS parameters. Moreover, women in the higher category of dietary change showed a four times higher OR of reducing body weight compared to the lower category (p < 0.001). The DIANA-5 dietary intervention is effective in reducing body weight and MS parameters.
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Affiliation(s)
- Eleonora Bruno
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
| | - Vittorio Krogh
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
| | - Giuliana Gargano
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
- Correspondence: ; Tel.: +39-022-390-3514; Fax: +39-022-390-3516
| | - Sara Grioni
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
| | - Manuela Bellegotti
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
| | - Elisabetta Venturelli
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
| | | | | | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, 20141 Milano, Italy; (B.B.); (E.Z.)
| | - Emanuela Zagallo
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, 20141 Milano, Italy; (B.B.); (E.Z.)
| | | | | | - Rosalba Amodio
- Clinical Epidemiology and Cancer Registry Unit, Palermo Province Cancer Registry, Palermo University Hospital P. Giaccone, 90127 Palermo, Italy; (R.A.); (M.Z.)
| | - Maurizio Zarcone
- Clinical Epidemiology and Cancer Registry Unit, Palermo Province Cancer Registry, Palermo University Hospital P. Giaccone, 90127 Palermo, Italy; (R.A.); (M.Z.)
| | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS-CROB, Basilicata, 85028 Rionero in Vulture, Italy;
| | - Maggiorino Barbero
- Obstetrics and Gynecology Unit, Cardinal Massaia Hospital, 14100 Asti, Italy;
| | | | - Maria Piera Mano
- Dipartimento Scienze Chirurgiche, Study University, 10124 Turin, Italy;
- S.C. Epidemiologia dei Tumori, AOU Città della Salute e della Scienza, CPO Piemonte, 10126 Turin, Italy
| | - Franco Berrino
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
| | - Anna Villarini
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
| | - Patrizia Pasanisi
- Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (E.B.); (V.K.); (S.G.); (M.B.); (E.V.); (F.B.); (A.V.); (P.P.)
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Pasquero G, Surace A, Ponti A, Bortolini M, Tota D, Mano MP, Arisio R, Benedetto C, Baù MG. Role of Magnetic Resonance Imaging in the Evaluation of Breast Cancer Response to Neoadjuvant Chemotherapy. In Vivo 2020; 34:909-915. [PMID: 32111803 DOI: 10.21873/invivo.11857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIM The aim of the study was to evaluate whether residual tumor assessment by magnetic resonance imaging (MRI) after neoadjuvant chemotherapy (NACT) is fundamental for a successive surgical strategy. PATIENTS AND METHODS We collected 55 MRIs performed after NACT. RESULTS Pathological response rate was 20%. MRI's sensitivity, specificity, PPV and NPV were 50%, 88%, 54% and 86%, respectively. We observed a high variability between the different subgroups, with high number of false positives in luminal A/B tumors. Triple negative and HER2+ tumors had almost the same specificity and sensitivity (81% and 50%). Nevertheless, in the HER2+ group, PPV was greater than that in the triple negative group (71% and 33% respectively) and the NPV of the triple negative group was greater than that of the HER2+ one (90% and 64%, respectively). Statistical analysis showed a weak but significant correlation between MRI and pathological assessment of residual tumor dimension. CONCLUSION The present study, confirms literature data about MRI accuracy in diagnosing HER2+ and triple negative tumors, but suggests caution in case of luminal tumors' evaluation.
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Affiliation(s)
- Giorgia Pasquero
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Alessandra Surace
- Gynecology and Obstetrics 2, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Antonio Ponti
- AOU Città della Salute e della Scienza, CPO Piemonte and EUSOMA Data Centre, Turin, Italy
| | | | - Donatella Tota
- Radiology, Department of Diagnostic Imaging and Radiotherapy, City of Health and Science, University of Turin, Turin, Italy
| | - Maria Piera Mano
- AOU Città della Salute e della Scienza, CPO Piemonte and EUSOMA Data Centre, Turin, Italy
| | - Riccardo Arisio
- Pathology, Department of Laboratory Medicine, City of Health and Science, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
| | - Maria Grazia Baù
- Gynecology and Obstetrics 3, Department of Surgical Sciences, City of Health and Science, University of Turin, Turin, Italy
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Baù MG, Surace A, Gregori G, De Sanctis C, Marra V, Marengo C, Tota D, Borella F, Benedetto C, Mano MP. Vacuum intraoperative specimen mammography: A novel technique. Eur J Obstet Gynecol Reprod Biol 2020; 253:1-6. [PMID: 32745814 DOI: 10.1016/j.ejogrb.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Intraoperative specimen mammography (ISM) is a diffuse technique that allows surgeons to check specimens immediately after lumpectomy. Although the specimen is slightly compressed, the radiological image can be distorted by tissue overlap, and this may affect the evaluation of tumour borders, resulting in extension of the lumpectomy. As ISM may be less precise due to inadequate compression, a vacuum effect was applied to the specimen to increase the precision of margin detection. STUDY DESIGN This study was conducted at St. Anna Hospital Breast Unit, Turin, Italy. Women who underwent lumpectomy for cancer were eligible for inclusion. Both standard ISM (sISM) and vacuum ISM (vISM) were performed. Eighteen specimens obtained after lumpectomy from 1 April 2018 to 31 April 2018 were scanned. sISM (two orthogonal projections) was performed. Next, the specimen was placed in a vacuum, and vISM was performed. The examination was completed with a second orthogonal projection after removal of the vacuum, replacement of the specimen and repositioning of the vacuum. Additional tissue was removed if the surgeon considered that excision was inadequate. Finally, the specimen was sent for definitive histopathological analysis, which is the gold standard for the assessment of surgical margins. Intraoperative histological margin assessment was not performed. The sISM and vISM images and final histopathology reports were compared. RESULTS For sISM, specificity was 47 % [95 % confidence interval (CI) 25-70], sensitivity was 67 % (95 % CI 21-94), positive predictive value (PPV) was 20 % (95 % CI 6-51) and negative predictive value (NPV) was 88 % (95 % CI 53-98). For vISM, specificity was 100 % (95 % CI 80-100), sensitivity was 67 % (95 % CI 21-94), PPV was 100 % (95 % CI 34-100) and NPV was 94 % (95 % CI 72-99). CONCLUSION These data suggest that the vacuum technique is feasible, cost-saving and yields results that are similar to those from frozen sections but without the limitations, such as prolonged operating time, high variability in sensitivity due to pathologists' abilities, risk of compromising the histological report, and unreliability for small lumps and ductal carcinoma in situ.
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Affiliation(s)
- Maria Grazia Baù
- AOU Città della Salute e della Scienza, Department of Gynaecology, University of Turin, Turin, Italy
| | - Alessandra Surace
- AOU Città della Salute e della Scienza, Department of Gynaecology, University of Turin, Turin, Italy.
| | - Gianluca Gregori
- AOU Città della Salute e della Scienza, Department of Gynaecology, University of Turin, Turin, Italy
| | - Corrado De Sanctis
- AOU Città della Salute e della Scienza, Department of Gynaecology, University of Turin, Turin, Italy
| | - Vincenzo Marra
- AOU Città della Salute e della Scienza, Department of Radiology, St Anna Hospital, Turin, Italy
| | - Cecilia Marengo
- AOU Città della Salute e della Scienza, Department of Gynaecology, University of Turin, Turin, Italy
| | - Donatella Tota
- AOU Città della Salute e della Scienza, Department of Radiology, St Anna Hospital, Turin, Italy
| | - Fulvio Borella
- AOU Città della Salute e della Scienza, Department of Gynaecology, University of Turin, Turin, Italy
| | - Chiara Benedetto
- AOU Città della Salute e della Scienza, Department of Gynaecology, University of Turin, Turin, Italy
| | - Maria Piera Mano
- AOU Città della Salute e della Scienza, Department of Epidemiology, University of Turin, Turin, Italy
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Serra M, Li AQ, Cataliotti L, Cianchetti E, Corsi F, De Vita R, Fabiocchi L, Fortunato L, Friedman D, Klinger M, Marotti L, Murgo R, Ponti A, Roncella M, Del Turco MR, Rinaldi S, Surace A, Taffurelli M, Tinterri C, Tomatis M, Mano MP. Aesthetic results following breast cancer surgery: A prospective study on 6515 cases from ten Italian Senonetwork breast centers. Eur J Surg Oncol 2020; 46:1861-1866. [PMID: 32723610 DOI: 10.1016/j.ejso.2020.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/20/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022] Open
Abstract
Breast cancer treatment has deeply changed in the last decades, since clinical and oncological cure cannot be achieved without patient's satisfaction in term of aesthetic outcomes. Several methods have been proposed to objectively assess these results. However, Italian breast centers have not yet agreed on measurable, reproducible and validated aesthetic outcome indicators to monitor their performance. METHODS The study was designed and conducted by Senonetwork, a not-for-profit association of Italian breast centers. Ten breast centers were selected based on specific eligibility criteria. This multicentre observational prospective study recruited 6515 patients with diagnosis of in situ or invasive breast cancer who underwent breast surgery in the years 2013-2016. Thirteen indicators of aesthetic results and of related quality of care were analyzed. Data collection and analysis were conducted using a common study database. RESULTS On average, seven out of ten centers were able to collect data on the proposed indicators with a proportion of missing values < 25%. By expert consensus based on study results, some seven indicators have been defined as "mandatory" while the remaining six have been defined as "recommended" because they require further refinement before they can be proposed for monitoring aesthetic outcomes or because there are doubts on the feasibility of data collection. The minimum standard is reached for 5 of 13 indicators. This finding and the wide range between centers reveal that there is ample room for improvement. CONCLUSIONS From the present study useful measurable aesthetic parameters have emerged, leading to the definition of target objectives that breast centers can use for benchmarking and improvement of quality of care.
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Affiliation(s)
- M Serra
- UOC di Chirurgia Generale e Della Mammella Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy.
| | - A Quattrini Li
- Centro Senologico Azienda Ospedaliera Universitaria Pisana Ospedale Santa Chiara, Pisa, Italy
| | | | - E Cianchetti
- Breast Centre Asl 02 Abruzzo, P.O. G. Bernabeo Ortona, Chieti, Italy
| | - F Corsi
- Breast Unit, Surgery Department, ICS Maugeri S.p.A. SB, Pavia, Italy; Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - R De Vita
- Istituto Nazionale Dei Tumori di Roma "Regina Elena", Rome, Italy
| | - L Fabiocchi
- Centro Di Senologia Rimini - Sant'Arcangelo di Romagna, Rimini, Italy
| | - L Fortunato
- UOSD Centro di Senologia, Azienda Ospedaliera San Giovanni Addolorata, Rome, Italy
| | - D Friedman
- Policlinico San Martino di Genova. University of Genova, DISC Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Genova, Italy
| | - M Klinger
- Breast Centre Humanitas - Istituto Clinico Humanitas - Humanitas Mirasole Spa, Rozzano, (Milan), Italy
| | - L Marotti
- European Society of Breast Cancer Specialists, Florence, Italy
| | - R Murgo
- Dipartimento di Oncoematologia/Unità Operativa Complessa di Chirurgia Senologica, IRCCS Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - A Ponti
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M Roncella
- Centro Senologico Azienda Ospedaliera Universitaria Pisana Ospedale Santa Chiara, Pisa, Italy
| | | | - S Rinaldi
- UOSVD di Chirurgia Senologica Ospedale San Paolo, Bari, Italy
| | - A Surace
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M Taffurelli
- UOC di Chirurgia Generale e Della Mammella Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - C Tinterri
- Breast Centre Humanitas - Istituto Clinico Humanitas - Humanitas Mirasole Spa, Rozzano, (Milan), Italy
| | - M Tomatis
- CPO Piemonte - SSD Epidemiologia Screening - AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M P Mano
- CPO Piemonte - AOU Città Della Salute e Della Scienza di Torino and University of Turin, Turin, Italy
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7
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Lazzaretti MG, Ponti A, Mano MP, Barca A, Casella D, Frigerio A, Giordano L, Mantellini P, Paduos A, Pitarella S, Ravaioli A, Taffurelli M, Tomatis M, Segnan N. Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy. Breast 2018; 42:15-22. [PMID: 30138762 DOI: 10.1016/j.breast.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/16/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Available evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care. MATERIAL AND METHODS This is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50-69 between years 2000 and 2015 in twelve Italian Regions. RESULTS In pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45% of low grade, small DCIS over the whole time period had some form of axillary surgery. CONCLUSION This large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.
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Affiliation(s)
| | - Antonio Ponti
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Maria Piera Mano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alessandra Barca
- Area Prevenzione e Promozione della Salute, Ufficio Screening, Regione Lazio, Italy
| | - Denise Casella
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Frigerio
- SSD Screening, AOU Città della Salute e della Scienza, Torino, Italy
| | - Livia Giordano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paola Mantellini
- SC Prevenzione Secondaria Screening, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | - Adriana Paduos
- Department of Surgery, ASL Biella, Italy, and Fondazione Edo Tempia, Italy
| | - Sabina Pitarella
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Mario Taffurelli
- Chief of Breast Surgery, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Mariano Tomatis
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy; Director of WHO Collaborating Centre for Cancer Early Detection and Screening, Torino, Italy
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8
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Rangel N, Rondon-Lagos M, Annaratone L, Osella-Abate S, Metovic J, Mano MP, Bertero L, Cassoni P, Sapino A, Castellano I. The role of the AR/ER ratio in ER-positive breast cancer patients. Endocr Relat Cancer 2018; 25:163-172. [PMID: 29386247 DOI: 10.1530/erc-17-0417] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 01/06/2023]
Abstract
The significance of androgen receptor (AR) in breast cancer (BC) management is not fully defined, and it is still ambiguous how the level of AR expression influences oestrogen receptor-positive (ER+) tumours. The aim of the present study was to analyse the prognostic impact of AR/ER ratio, evaluated by immunohistochemistry (IHC), correlating this value with clinical, pathological and molecular characteristics. We retrospectively selected a cohort of 402 ER+BC patients. On each tumour, IHC analyses for AR, ER, PgR, HER2 and Ki67 were performed and AR+ cases were used to calculate the AR/ER value. A cut-off of ≥2 was selected using receiver-operating characteristic (ROC) curve analyses. RNA from 19 cases with AR/ER≥2 was extracted and used for Prosigna-PAM50 assays. Tumours with AR/ER≥2 (6%) showed more frequent metastatic lymph nodes, larger size, higher histological grade and lower PgR levels than cases with AR/ER<2. Multivariate analysis confirmed that patients with AR/ER≥2 had worse disease-free interval (DFI) and disease-specific survival (DSS) (hazard ratios (HR) = 4.96 for DFI and HR = 8.69 for DSS, both P ≤ 0.004). According to the Prosigna-PAM50 assay, 63% (12/19) of these cases resulted in intermediate or high risk of recurrence categories. Additionally, although all samples were positive for ER assessed by IHC, the molecular test assigned 47.4% (9/19) of BCs to intrinsic non-luminal subtypes. In conclusion, the AR/ER ratio ≥2 identifies a subgroup of patients with aggressive biological features and may represent an additional independent marker of worse BC prognosis. Moreover, the Prosigna-PAM50 results indicate that a significant number of cases with AR/ER≥2 could be non-luminal tumours.
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Affiliation(s)
- Nelson Rangel
- Department of Medical SciencesUniversity of Turin, Turin, Italy
- Natural and Mathematical Sciences FacultyUniversidad del Rosario, Bogotá, Colombia
| | - Milena Rondon-Lagos
- School of Biological SciencesUniversidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | | | | | - Jasna Metovic
- Department of Medical SciencesUniversity of Turin, Turin, Italy
| | - Maria Piera Mano
- Department of Surgical SciencesUniversity of Turin, Turin, Italy
| | - Luca Bertero
- Department of Medical SciencesUniversity of Turin, Turin, Italy
| | - Paola Cassoni
- Department of Medical SciencesUniversity of Turin, Turin, Italy
| | - Anna Sapino
- Department of Medical SciencesUniversity of Turin, Turin, Italy
- Pathology UnitFondazione del Piemonte per l'Oncologia (FPO) Candiolo Cancer Institute (IRCCS), Candiolo, Italy
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9
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Villarini A, Pasanisi P, Traina A, Mano MP, Bonanni B, Panico S, Scipioni C, Galasso R, Paduos A, Simeoni M, Bellotti E, Barbero M, Macellari G, Venturelli E, Raimondi M, Bruno E, Gargano G, Fornaciari G, Morelli D, Seregni E, Krogh V, Berrino F. Lifestyle and Breast Cancer Recurrences: The DIANA-5 Trial. Tumori 2018; 98:1-18. [DOI: 10.1177/030089161209800101] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aims and Background The DIANA (Diet and Androgens)-5 study is a multi-institutional randomized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles, associated with moderate physical activity, in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu. The intervention is expected to reduce serum insulin and sex hormones, which were associated with breast prognosis in previous studies. Methods Between 2008 and 2010, the study randomly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group, to be followed-up through 2015. General lifestyle recommendations for the prevention of cancer are given to both groups, and the intervention group is being offered a comprehensive lifestyle intervention, including cooking classes, conferences, common meals and exercise sessions. Adherence assessments occurred at baseline and at 12 months and are planned at 36 and 60 months. They include food frequency diaries, anthropometric measures, body fat distribution assessed with impedance scale, one week registration of physical activity with a multisensor arm-band monitor, metabolic and endocrine blood parameters. Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are validated through medical record verification. Results The randomized groups were comparable for age (51.8 years), proportion of ER-negative tumors (22%), axillary node metastasis (42%), reproductive variables, tobacco smoking, blood pressure, anthropometric measurements and hormonal and metabolic parameters. Conclusions DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences. We will assess evidence of effectiveness, first by comparing the incidence of additional breast cancer events (local or distant recurrence, second ipsilateral or contralateral cancer) in the intervention and in the control group, by an intention-to-treat analysis, and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score.
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Affiliation(s)
- Anna Villarini
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Patrizia Pasanisi
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Adele Traina
- Department of Oncology ARNAS Ospedali Civico e Benfratelli G. Di Cristina e M. Ascoli, Palermo
| | - Maria Piera Mano
- Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte (CPO), Turin
| | | | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Università Federico II, Naples
| | - Corrado Scipioni
- Centro di Prevenzione, Diagnosi e Terapia del Tumore alla Mammella “Giunone”, Avezzano, L'Aquila
| | - Rocco Galasso
- Department of Oncology, Centro di Riferimento Oncologico, Rionero in Vulture (Potenza)
| | | | | | - Elena Bellotti
- Unit of Radiology, Azienda Ospedaliera di Busto Arsizio (Varese)
| | | | | | - Elisabetta Venturelli
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Milena Raimondi
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Eleonora Bruno
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Giuliana Gargano
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Giuseppe Fornaciari
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Daniele Morelli
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ettore Seregni
- Department of Diagnostic Imaging and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Vittorio Krogh
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Franco Berrino
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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10
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Giordano L, Segnan N, Mano MP, Gallo F, Bellisario C, Senore C. [Integrating cancer screening and primary prevention: a review]. Epidemiol Prev 2015; 39:360-365. [PMID: 26554687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cancer screening may represent an ideal setting for promoting healthy lifestyle. We conducted a literature review of intervention studies of primary prevention interventions implemented in the context of established screening programmes. We identified 11 trials, 3 of which conducted in Italy. A positive impact of these interventions in favouring the adoption of cancer protective dietary behaviours was observed in all studies. A limited impact was reported for physical activity, while no effect could be observed for interventions aimed to promote smoking cessation. Long term maintenance of the observed behavioural changes and the sustainability overtime of these interventions within population-based programmes should be assessed. To enhance their effectiveness, these health education programmes should include multiple strategies, integrating and combining models of individual, social, and environmental change.
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Affiliation(s)
- Livia Giordano
- AOU Città della salute e della scienza, Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino.
| | - Nereo Segnan
- AOU Città della salute e della scienza, Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
| | - Maria Piera Mano
- AOU Città della salute e della scienza, Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
| | - Federica Gallo
- AOU Città della salute e della scienza, Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
| | - Cristina Bellisario
- AOU Città della salute e della scienza, Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
| | - Carlo Senore
- AOU Città della salute e della scienza, Centro di riferimento per l'epidemiologia e la prevenzione oncologica in Piemonte, Torino
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11
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Bruno E, Gargano G, Villarini A, Traina A, Johansson H, Mano MP, Santucci De Magistris M, Simeoni M, Consolaro E, Mercandino A, Barbero M, Galasso R, Bassi MC, Zarcone M, Zagallo E, Venturelli E, Bellegotti M, Berrino F, Pasanisi P. Adherence to WCRF/AICR cancer prevention recommendations and metabolic syndrome in breast cancer patients. Int J Cancer 2015; 138:237-44. [PMID: 26175188 DOI: 10.1002/ijc.29689] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/18/2015] [Accepted: 07/01/2015] [Indexed: 12/18/2022]
Abstract
Metabolic syndrome (MetS), conventionally defined by the presence of at least three out of five dismetabolic traits (abdominal obesity, hypertension, low plasma HDL-cholesterol and high plasma glucose and triglycerides), has been associated with both breast cancer (BC) incidence and prognosis. We investigated the association between the prevalence of MetS and a score of adherence to the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) recommendations for the prevention of cancer in a cross-sectional study of BC patients. The DIet and ANdrogen-5 study (DIANA-5) for the prevention of BC recurrences recruited 2092 early stage BC survivors aged 35-70. At recruitment, all women completed a 24-hour food frequency and physical activity diary on their consumption and activity of the previous day. Using these diaries we created a score of adherence to five relevant WCRF/AICR recommendations. The prevalence ratios (PRs) and 95% confidence intervals (CIs) of MetS associated with the number of recommendations met were estimated using a binomial regression model. The adjusted PRs of MetS decreased with increasing number of recommendations met (p < 0.001). Meeting all the five recommendations versus meeting none or only one was significantly associated with a 57% lower MetS prevalence (95% CI 0.35-0.73). Our results suggest that adherence to WCRF/AICR recommendations is a major determinant of MetS and may have a clinical impact.
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Affiliation(s)
- Eleonora Bruno
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Giuliana Gargano
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Anna Villarini
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Adele Traina
- Department of Oncology, A.R.N.A.S Ospedali Civico E Benfratelli G. Di Cristina E M. Ascoli, Palermo, Italy
| | - Harriet Johansson
- Division of Chemoprevention and Genetics, European Institute Of Oncology, Milan, Italy
| | - Maria Piera Mano
- Dipartimento Scienze Chirurgiche, Study University, Turin, Italy.,S.C. Epidemiologia Dei Tumori, AOU Città Della Salute E Della Scienza, CPO Piemonte, Turin, Italy
| | | | - Milena Simeoni
- Associazione LUMEN, San Pietro In Cerro (Piacenza), Italy
| | | | | | | | - Rocco Galasso
- Biostatistics and Cancer Registry, Unit Of Clinical Epidemiology, IRCCS Centro Di Riferimento Oncologico Di Basilicata, Rionero In Vulture (Potenza), Italy
| | | | - Maurizio Zarcone
- Department of Oncology, A.R.N.A.S Ospedali Civico E Benfratelli G. Di Cristina E M. Ascoli, Palermo, Italy
| | - Emanuela Zagallo
- Division of Chemoprevention and Genetics, European Institute Of Oncology, Milan, Italy
| | - Elisabetta Venturelli
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Manuela Bellegotti
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Franco Berrino
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Patrizia Pasanisi
- Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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12
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Ponti A, Mano MP, Tomatis M, Baiocchi D, Barca A, Berti R, Casella D, D'Ambrosio E, Delos E, Donati G, Falcini F, Frammartino B, Frigerio A, Giudici F, Mantellini P, Naldoni C, Olla Atzeni C, Orzalesi L, Pagano G, Pietribiasi F, Pitarella S, Ravaioli A, Silvestri A, Taffurelli M, Tidone E, Zanconati F, Segnan N. Audit system on Quality of breast cancer diagnosis and Treatment (QT): results of quality indicators on screen-detected lesions in Italy, 2011-2012. Epidemiol Prev 2015; 39:40-47. [PMID: 26405775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This annual survey, conducted by the Italian group for mammography screening (GISMa), collects individual data on diagnosis and treatment of about 50% of screen-detected, operated lesions in Italy. The 2011-2012 results show good overall quality and an improving trend over time. A number of critical issues have been identified, including waiting times (which have had a worsening trend over the years) and compliance with the recommendation of not performing frozen section examination on small lesions. Pre-operative diagnosis improved constantly over time, but there is still a large variation between Regions and programmes. For almost 90% of screen-detected invasive cancers a sentinel lymph node (SLN) biopsy was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN dissection for ductal carcinoma in situ, although apparently starting to decline, deserves further investigation. The detailed results have been distributed, among other ways by means of a web-based data-warehouse, to regional and local screening programmes, in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. The problem of waiting times should be assigned priority. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times.
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Affiliation(s)
- Antonio Ponti
- CPO Piemonte, AOU Città della salute e della scienza, Torino.
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13
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Ponti A, Lynge E, James T, Májek O, von Euler-Chelpin M, Anttila A, Fitzpatrick P, Mano MP, Kawai M, Scharpantgen A, Fracheboud J, Hofvind S, Vidal C, Ascunce N, Salas D, Bulliard JL, Segnan N, Kerlikowske K, Taplin S. International variation in management of screen-detected ductal carcinoma in situ of the breast. Eur J Cancer 2014; 50:2695-704. [PMID: 25149183 PMCID: PMC4275301 DOI: 10.1016/j.ejca.2014.07.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. METHODS We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. RESULTS Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. CONCLUSIONS Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.
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Affiliation(s)
- Antonio Ponti
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ted James
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | | | - Maria Piera Mano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Masaaki Kawai
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | | | | | - Carmen Vidal
- Cancer Detection and Control Programme, Catalan Institute of Oncology, Barcelona, Spain
| | - Nieves Ascunce
- Breast Cancer Screening Programme, Instituto de Salud Pública, Navarra, Spain
| | - Dolores Salas
- General Directorate Research and Public Health and Centre for Public Health Research, Valencia, Spain
| | | | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Karla Kerlikowske
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Stephen Taplin
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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14
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Berrino F, Villarini A, Traina A, Bonanni B, Panico S, Mano MP, Mercandino A, Galasso R, Barbero M, Simeoni M, Bassi MC, Consolaro E, Johansson H, Zarcone M, Bruno E, Gargano G, Venturelli E, Pasanisi P. Metabolic syndrome and breast cancer prognosis. Breast Cancer Res Treat 2014; 147:159-65. [PMID: 25104441 DOI: 10.1007/s10549-014-3076-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/21/2014] [Indexed: 01/06/2023]
Abstract
Metabolic syndrome (MS), conventionally defined by the presence of at least three out of five dysmetabolic traits (abdominal obesity, hypertension, low plasma HDL-cholesterol, high plasma glucose and high triglycerides), has been associated with an increased risk of several age-related chronic diseases, including breast cancer (BC). This may have prognostic implications for BC survivors. 2,092 early stage BC survivors aged 35-70, recruited in eleven Italian centres 0-5 years after surgical treatment (1.74 years on average), were followed-up over 2.8 years on average for additional BC-related events, including BC-specific mortality, distant metastasis, local recurrences and contralateral BC. At recruitment, 20 % of the patients had MS. Logistic regression models were carried out to generate OR and 95 % confidence intervals (CI) for new BC events associated with MS, adjusting for baseline pathological prognostic factors. New BC events occurred in 164 patients, including 89 distant metastases. The adjusted ORs for women with MS versus women without any MS traits were 2.17 (CI 1.31-3.60) overall, and 2.45 (CI 1.24-4.82) for distant metastasis. The OR of new BC events for women with only one or two MS traits was 1.40 (CI 0.91-2.16). All MS traits were positively associated with new BC events, and significantly so for low HDL and high triglycerides. MS is an important prognostic factor in BC. As MS is reversible through lifestyle changes, interventions to decrease MS traits in BC patients should be implemented in BC clinics.
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Affiliation(s)
- Franco Berrino
- Epidemiology & Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
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15
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Sacerdote C, Bordon R, Pitarella S, Mano MP, Baldi I, Casella D, Di Cuonzo D, Frigerio A, Milanesio L, Merletti F, Pagano E, Ricceri F, Rosso S, Segnan N, Tomatis M, Ciccone G, Vineis P, Ponti A. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy. BMC Health Serv Res 2013; 13:28. [PMID: 23351327 PMCID: PMC3566978 DOI: 10.1186/1472-6963-13-28] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/15/2013] [Indexed: 12/03/2022] Open
Abstract
Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL) for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL) and 621 in 2004 (post-PGL). Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368) and 77.5% (N = 383) in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS) as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268) and 63.6% (N = 252) received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%). The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10) among the 92 estrogen receptor-negative patients in 2004 (p < 0.01). Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14 reached statistical significance. We did not find any change in the risk of mortality in the post-PGL versus the pre-PGL group (adjusted hazard ratio 0.94, 95%CI 0.56–1.56). Conclusions These results highlight the need to continue to improve breast cancer care and to measure adherence to PGL.
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Affiliation(s)
- Carlotta Sacerdote
- Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Turin, Italy.
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16
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Ponti A, Mano MP, Tomatis M, Baiocchi D, Barca A, Berti R, Bisanti L, Casella D, Deandrea S, Delrio D, Donati G, Falcini F, Frammartino B, Frigerio A, Mantellini P, Naldoni C, Orzalesi L, Pagano G, Pietribiasi F, Ravaioli A, Sedda ML, Taffurelli M, Cataliotti L, Segnan N. [Audit system on quality of breast cancer diagnosis and treatment: results of quality indicators on screen-detected lesions in Italy, 2010]. Epidemiol Prev 2012; 36:87-95. [PMID: 23293273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This survey, conducted by the Italian breast screening network (GISMa), collects yearly individual data on diagnosis and treatment on about 50% of all screen-detected, operated lesions in Italy. The 2010 results show good overall quality and an improving trend over time. Critical issues were identified, including waiting times and compliance with the recommendations on not performing frozen section examination on small lesions. Preoperative diagnosis improved constantly over the years, but there is still a large variation between regions and programmes. For almost 90% of screen-detected invasive cancers the sentinel lymph node technique (SLN) was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN for ductal carcinoma in situ deserves further investigation. The detailed results have been distributed, also by means of a web data warehouse, to regional and local screening programmes in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. It should be assigned priority to the problem of waiting times. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times.
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MESH Headings
- Aged
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/therapy
- Early Detection of Cancer/standards
- Female
- Humans
- Italy/epidemiology
- Mammography
- Mass Screening/standards
- Medical Audit
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Quality Indicators, Health Care
- Sentinel Lymph Node Biopsy
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17
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Villarini A, Pasanisi P, Traina A, Mano MP, Bonanni B, Panico S, Scipioni C, Galasso R, Paduos A, Simeoni M, Bellotti E, Barbero M, Macellari G, Venturelli E, Raimondi M, Bruno E, Gargano G, Fornaciari G, Morelli D, Seregni E, Krogh V, Berrino F. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Tumori 2012. [PMID: 22495696 DOI: 10.1700/1053.11494] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS AND BACKGROUND The DIANA (Diet and Androgens)-5 study is a multi-institutional randomized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles, associated with moderate physical activity, in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu. The intervention is expected to reduce serum insulin and sex hormones, which were associated with breast prognosis in previous studies. METHODS Between 2008 and 2010, the study randomly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group, to be followed-up through 2015. General lifestyle recommendations for the prevention of cancer are given to both groups, and the intervention group is being offered a comprehensive lifestyle intervention, including cooking classes, conferences, common meals and exercise sessions. Adherence assessments occurred at baseline and at 12 months and are planned at 36 and 60 months. They include food frequency diaries, anthropometric measures, body fat distribution assessed with impedance scale, one week registration of physical activity with a multisensor arm-band monitor, metabolic and endocrine blood parameters. Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are validated through medical record verification. RESULTS The randomized groups were comparable for age (51.8 years), proportion of ER-negative tumors (22%), axillary node metastasis (42%), reproductive variables, tobacco smoking, blood pressure, anthropometric measurements and hormonal and metabolic parameters. CONCLUSIONS DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences. We will assess evidence of effectiveness, first by comparing the incidence of additional breast cancer events (local or distant recurrence, second ipsilateral or contralateral cancer) in the intervention and in the control group, by an intention-to-treat analysis, and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score.
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Affiliation(s)
- Anna Villarini
- Department of Predictive and Preventive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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18
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Ponti A, Tomatis M, Baiocchi D, Barca A, Berti R, Bisanti L, Bordon R, Casella D, Cogo C, Deandrea S, Delrio D, Donati G, Falcini F, Frigerio A, Leonardo N, Mancini S, Mantellini P, Naldoni C, Pagano G, Ravaioli A, Pietribiasi F, Sedda ML, Taffurelli M, Zorzi M, Cataliotti L, Segnan N, Mano MP. Audit on quality of breast cancer diagnosis and treatment in Italy, 2008-2009. Epidemiol Prev 2011; 35:87-95. [PMID: 22166352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This survey, conducted by the Italian breast screening network (GISMa), collects individual data yearly on about 50% of all screen-detected, operated lesions in Italy. The 2008-2009 results show good overall quality of diagnosis and treatment and an improving trend over time. Critical issues were identified, including waiting times and compliance with the recommendations on not performing frozen section examination on small lesions. Pre-operative diagnosis reached the acceptable target, but there is a large variation between regions and programmes. For almost 90% of screen-detected invasive cancers the sentinel lymph node technique (SLN) was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN deserves further investigation. The detailed results have been distributed, also by means of a web-based data warehouse, to regional and local screening programmes in order to allow multidisciplinary discussion and identification of the appropriate solutions to any problem documented by the data. Specialist breast units with adequate case volume and enough resources would provide the best setting for making audits effective in producing quality improvements with shorter waiting times.
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19
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Canavese G, Candelaresi G, Castellano I, Mano MP. Expression of proteoglycan versican in in situ breast lesions: relations between stromal changes, histotype, and invasion. Pathol Res Pract 2010; 207:97-103. [PMID: 21185131 DOI: 10.1016/j.prp.2010.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/28/2010] [Accepted: 10/28/2010] [Indexed: 01/08/2023]
Abstract
The role of the stromal constituents in the natural history of breast cancers is still poorly defined. The aim of the present study was to evaluate the expression of proteoglycan versican, a constituent of desmoplastic stroma of invasive carcinomas, in preinvasive breast lesions. We selected 41 cases of breast carcinoma: 28 pure in situ lesions and 13 invasive lesions with in situ-associated lesions. The study provided evidence that versican is strongly expressed in the perilesional stroma of a subclass of ductal in situ carcinomas, and that the extension of versican immunostaining is statistically related to the high grade (G3) category (54% of diffuse expressors; p=0.01), and with a comedo pattern (67% of diffuse expressors, p=0.003). On the other hand, the expression of versican in the cases of classic lobular in situ carcinomas that we selected for the study was confined to the anatomical structures that usually contain the proteoglycan in adult breast tissues. In our cohort, versican synthesis was found to be associated with spindle-shaped elements with myofibroblastic phenotype, as in the stroma of invasive carcinoma. These data, taken together with evidence from previous studies on proteins strongly related to versican, suggest that various histotypes of breast in situ carcinomas could follow different pathways of epithelial stromal interactions. In particular a category of in situ lesions shows constituents of desmoplastic stroma before the manifestation of the morphological signs of invasion. Study of the connective tissue modifications that trigger the pivotal phase of invasion could provide new prospects in oncology.
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Affiliation(s)
- G Canavese
- Pathology Department, Breast Unit A.O. U. Giovanni Battista Molinette, Turin, Italy.
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20
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Mano MP, Ponti A, Tomatis M, Baiocchi D, Barca A, Berti R, Bordon R, Casella D, Delrio D, Donati G, Falcini F, Frigerio A, Furini A, Mantellini P, Naldoni C, Pagano G, Piccini P, Ravaioli A, Rodella D, Sapino A, Sedda ML, Taffurelli M, Vettorazzi M, Zorzi M, Cataliotti L, Segnan N. Audit system on Quality of breast cancer diagnosis and Treatment (QT): results of quality indicators on screen-detected lesions in Italy, 2007. Epidemiol Prev 2010; 34:81-88. [PMID: 21220839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This survey, conducted by the Italian Breast Screening Network (GISMa), collects individual data yearly on about 50% of all screen-detected, operated lesions in Italy. The 2007 results show good overall quality of diagnosis and treatment and an improving trend over time. Critical issues were identified concerning waiting times, compliance with the recommendations on not performing frozen section examination on small lesions and on performing specimen X-rays. Preoperative diagnosis reached the acceptable target, but there is a large variation between Regions and programmes. For more than 80%of screen-detected invasive cancers the sentinel lymph node technique (SLN) was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN deserves further investigation. The detailed results have been distributed, also by means of a web data-warehouse, to regional and local screening programmes in order to allow multidisciplinary discussion and identification of the appropriate solutions to any problem documented by the data. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making audits effective in producing quality improvements with a shorter waiting times.
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21
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Castellano I, Marchiò C, Tomatis M, Ponti A, Casella D, Bianchi S, Vezzosi V, Arisio R, Pietribiasi F, Frigerio A, Mano MP, Ricardi U, Allia E, Accortanzo V, Durando A, Bussolati G, Tot T, Sapino A. Micropapillary ductal carcinoma in situ of the breast: an inter-institutional study. Mod Pathol 2010; 23:260-9. [PMID: 19915523 DOI: 10.1038/modpathol.2009.169] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The clinical significance of micropapillary growth pattern in ductal carcinoma in situ is controversial and the impact of nuclear grading in terms of recurrence of this lesion is yet to be clarified. Our aim was to evaluate, on a series of micropapillary in situ carcinomas, the histological features correlated with recurrence and whether the micropapillary subtype had a different behavior from other non-micropapillary ductal carcinoma in situ. We collected 55 cases of micropapillary in situ carcinomas from four institutions. All cases were reviewed for nuclear grade, extent, necrosis, microinvasion and tested for estrogen and progesterone receptors, Ki67, HER2, EGFR and p53 expression. Clinical data, type of surgery and follow up were obtained for all patients. Our results showed that the nuclear grade is crucial in determining the biology of micropapillary carcinoma in situ, so that the high nuclear grade micropapillary ductal carcinoma in situ more frequently overexpressed HER2, showed higher proliferation index, displayed necrosis and microinvasion and was more extensive than low/intermediate nuclear grade. Logistic regression analysis confirmed the high nuclear grade (Odds ratio: 6.86; CI: 1.40-33.57) as the only parameter associated with elevated risk of local recurrence after breast-conserving surgery. However, the recurrence rate of 19 micropapillary carcinoma in situ, which were part of a cohort of 338 consecutive ductal carcinoma in situ, was significantly higher (log-rank test, P-value=0.019) than that of non-micropapillary, independently of the nuclear grade. In conclusion, although nuclear grade may significantly influence the biological behavior of micropapillary ductal carcinoma in situ, micropapillary growth pattern per se represents a risk factor for local recurrence after breast-conserving surgery.
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Affiliation(s)
- Isabella Castellano
- Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy
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22
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Tomatis M, Mano MP, Baiocchi D, Barca A, Bordon R, Casella D, Donati G, Berti R, Filippini L, Frigerio A, Furini A, Mantellini P, Naldoni C, Pagano G, Ramera D, Ravaioli A, Sapino A, Taffurelli M, Vettorazzi M, Zorzi M, Cataliotti L, Rosselli Del Turco M, Segnan N, Ponti A. Audit system on Quality of breast cancer diagnosis and Treatment (QT): results of quality indicators on screen-detected lesions in Italy for 2006 and preliminary results for 2007. Epidemiol Prev 2009; 33:83-90. [PMID: 19776489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Within this survey, conducted by the Italian Breast Screening Network (Gruppo Italiano per lo Screening Mammografico, GISMa), individual data are collected yearly on more than 50% of all screen-detected operated lesions in Italy. In 2006, results showed overall good diagnosis and treatment quality and an improving trend over time. Critical issues were identified in waiting times, compliance with recommendations on not performing frozen section examination on small lesions and on performing specimen X-ray. Pre-operative diagnosis reached the acceptable target, but there is a large variation between Regions and programmes. The sentinel lymph node technique (SLN) was performed on the axilla in more than 70% of screen-detected invasive cancers, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN in ductal carcinoma in situ deserves further investigation. The detailed results have been distributed to regional and local screening programmes, also by means of an online database, in order to allow multidisciplinary discussion and the identification of appropriate solutions to any problems documented by the data. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making audit effective in producing quality improvement with a shortening of waiting times.
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23
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Mano MP, Distante V, Tomatis M, Baiocchi D, Barca A, Bordon R, Donati G, Filippini L, Frigerio A, Mantellini P, Naldoni C, Pagano G, Ramera D, Ravaioli A, Sapino A, Taffurelli M, Vettorazzi M, Zangirolami F, Zorzi M, Cataliotti L, Rosselli del Turco M, Segnan N, Ponti A. Audit system on quality of breast cancer diagnosis and treatment (QT): results of quality indicators on screen-detected lesions in Italy in 2005 and preliminary results for 2006. Epidemiol Prev 2008; 32:77-84. [PMID: 18770996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Within this survey, conducted by the Italian Group of Mammography Screening (GISMa), individual data are collected yearly on more than 50% of all screen-detected operated lesions in Italy. In 2005, results showed overall good diagnosis and treatment quality, and an improving trend over time. Critical issues were identified in waiting times, compliance with the recommendations on not performing frozen section examination on small lesions and on performing specimen X-ray. Pre-operative diagnosis has reached the acceptable target, but room for improvement still exists. The sentinel lymph node technique (SLN) was performed on the axilla in more than 70% of screen-detected invasive cancers, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN deserves further investigation. The detailed results have been distributed to local and regional screening programmes in order to allow multidisciplinary discussion and the identification of appropriate solutions to any problems documented by the data. Specialist Breast Units with adequate case volume would provide the best setting for making audit effective in producing quality improvement.
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24
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Cardoso MJ, Cardoso J, Amaral N, Azevedo I, Barreau L, Bernardo M, Christie D, Costa S, Fitzal F, Fougo JL, Johansen J, Macmillan D, Mano MP, Regolo L, Rosa J, Teixeira L, Vrieling C. Turning subjective into objective: The BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast 2007; 16:456-61. [PMID: 17606373 DOI: 10.1016/j.breast.2007.05.002] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2007] [Revised: 03/22/2007] [Accepted: 05/03/2007] [Indexed: 10/23/2022] Open
Abstract
Twelve expert observers from nine different countries convened in a workshop to evaluate the validity of the Breast Cancer Conservative Treatment. Cosmetic results (BCCT.core) software, an objective method for the aesthetic evaluation of breast cancer conservative treatment. Experts were initially asked to subjectively classify the aesthetic results of 30 photographed cases submitted to breast cancer conservative treatment according to the four-point Harris scale. It was pre-established that if at least two-thirds [Cardoso MJ, Cardoso J, Santos AC, Barros H, Oliveira MC. Interobserver agreement and consensus over the esthetic evaluation of conservative treatment for breast cancer. Breast 2005] of participants provided the same classification this would be considered a consensual evaluation for that case. For cases where such agreement was not reached, consensus was obtained using a nominal group technique. Experts then individually performed objective evaluation of the same set of photographs using the BCCT.core software. This provides an automatic rating of aesthetic results, once scale and reference points in the photograph have been chosen. Agreement between observers, between each observer and the consensus, for computer evaluation obtained by the different participants and between software and consensus was calculated using multiple kappa (k) and weighted kappa (wk) statistics. In the subjective assessment, first-round consensus was achieved in 17 (57%) cases. Overall interobserver agreement was fair to moderate (k=0.40, wk=0.57). In the objective assessment there was a higher level of concordance between participants (k=0.86, wk=0.90). Agreement between software and consensus classification was fair (k=0.34, wk=0.53), but was higher in the 17 cases that reached first-round consensus (k=0.60, wk=0.73). Merging the two middle classes of the Harris scale, to form a three-point scale, led to an improvement of all non-weighted measures of agreement. These results show that the BCCT.core software provides consistent evaluation of cosmesis. It has the potential to become a gold standard method for assessment of breast cosmesis in clinical trials, as it can be used simultaneously by a panel of observers from different parts of the world to provide more reliable assessments than has been possible previously.
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Affiliation(s)
- Maria João Cardoso
- Department of Surgery, Faculdade de Medicina do Porto, Hospital S. João, Alameda do Prof. Hernãni Monteiro 4200-319, Porto, Portugal.
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25
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Ponti A, Mano MP, Distante V, Baiocchi D, Bordon R, Federici A, Frigerio A, Mantellini P, Naldoni C, Pagano G, Sapino A, Taffurelli M, Tomatis M, Vettorazzi M, Zangirolami F, Zorzi M, Cataliotti L, Rosselli Del Turco M, Segnan N. Audit system on quality of breast cancer diagnosis and treatment (QT): results from the survey on screen-detected lesions in Italy, 2004. Epidemiol Prev 2007; 31:69-75. [PMID: 17824364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Within this survey, conducted by the Italian Group for Mammography Screening (GISMa), individual data are collected yearly on more than 50% of all screen-detected operated lesions in Italy. In 2004, overall results show a good diagnosis and treatment quality and an improving trend over time. Critical issues have been identified in waiting times, compliance to the recommendations on not performing frozen section examination on small lesions and on performing specimen X-ray. Pre-operative diagnosis has reached an acceptable level, but room for improvement still exists. The sentinel lymph node technique (SLN) was performed on the axilla in almost 70% of screen-detected invasive cancers, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN deserves further investigation. The detailed results have been distributed to local and regional screening programmes in order to enable multidisciplinary discussion and the identification of appropriate solutions to any problems documented by the data. Specialist Breast Units with adequate case volumes would provide the best setting for effective audits leading to quality improvement.
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26
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Zorzi M, Puliti D, Vettorazzi M, De Lisi V, Falcini F, Federico M, Ferretti S, Moffa IF, Mangone L, Mano MP, Naldoni C, Ponti A, Traina A, Tumino R, Paci E. Mastectomy rates are decreasing in the era of service screening: a population-based study in Italy (1997-2001). Br J Cancer 2006; 95:1265-8. [PMID: 17043685 PMCID: PMC2360582 DOI: 10.1038/sj.bjc.6603405] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We enrolled all 2162 in situ and 21 148 invasive cases of breast cancer in 17 areas of Italy, diagnosed in 1997–2001. Rates of early cancer increased by 13.7% in the screening age group (50–69 years), and breast conserving surgery by 24.6%. Advanced cancer rates decreased by 19.4%, and mastectomy rates by 24.2%. Service screening did not increase mastectomy rates in the study population.
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Affiliation(s)
- M Zorzi
- Istituto Oncologico Veneto, Padova, Italy
| | - D Puliti
- Clinical and Descriptive Epidemiology Unit-CSPO-Research Institute of the Tuscany Region, Firenze, Italy
| | | | | | - F Falcini
- Romagna Cancer Registry, Forlì, Italy
| | | | | | - I F Moffa
- Epidemiology Unit-ASL 2, Perugia, Italy
| | - L Mangone
- Reggio-Emilia Cancer Registry, Reggio-Emilia, Italy
| | - M P Mano
- University of Turin-Department of Biological Sciences and Human Oncology, Turin, Italy
| | - C Naldoni
- Screening program-Emilia-Romagna Region Health Department, Bologna, Italy
| | - A Ponti
- Epidemiology Unit-CPO Piemonte, Turin, Italy
| | - A Traina
- Department of Oncology-ARNAS Ascoli, Palermo, Italy
| | - R Tumino
- Cancer Registry and Human Pathology Department-Arezzo Hospital, Ragusa, Italy
| | - E Paci
- Clinical and Descriptive Epidemiology Unit-CSPO-Research Institute of the Tuscany Region, Firenze, Italy
- E-mail:
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27
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Ponti A, Mano MP, Distante V, Taffurelli M, Naldoni C, Zangirolami F, Vettorazzi M, Zorzi M, Pagano G, Federici A, Baiocchi D, Bordon R, Tomatis M, Mantellini P, Cataliotti L, Rosselli del Turco M, Segnan N. Audit system on Quality of breast cancer diagnosis and Treatment (QT): results from the survey on screen-detected lesions in Italy, 2003-2004. Epidemiol Prev 2006; 30:59-63. [PMID: 16937847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Within the Italian Breast Screening Network, individual data are collected yearly on about 50% of all screen-detected operated lesions. In 2003 results showed a good overall quality of diagnosis and treatment, and an improving trend over time. Critical issues were identified in the number of cancers diagnosed pre-operatively, which is still below standards, and in the waiting times for surgery. Compliance with recommendations as to not performing frozen section on small lesions and unnecessary axillary dissection for ductal carcinoma in situ still have not reached the target. The sentinel lymph node technique was performed on the axilla in more than 60% of screen-detected invasive cancers, avoiding a large number of potentially harmful dissections. Preliminary data for 2004 show further progress towards better quality, particularly in pre-operative diagnosis and in the avoidance of frozen section. The detailed results of this survey have been distributed to local and regional screening programmes in order to allow multidisciplinary discussion and the identification of appropriate solutions to any problems documented by the data. Specialist Breast Units with adequate case volume would provide the best setting for making audit effective in producing quality improvement.
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Cserni G, Gregori D, Merletti F, Sapino A, Mano MP, Ponti A, Sandrucci S, Baltás B, Bussolati G. Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer. Br J Surg 2004; 91:1245-52. [PMID: 15376203 DOI: 10.1002/bjs.4725] [Citation(s) in RCA: 229] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The need for further axillary treatment in patients with breast cancer with low-volume sentinel node (SN) involvement (micrometastases or smaller) is controversial. METHODS Twenty-five studies reporting on non-SN involvement associated with low-volume SN involvement were identified using Medline and a meta-analysis was performed. RESULTS The weighted mean estimate for the incidence of non-SN metastases after low-volume SN involvement is around 20 per cent, whereas this incidence is around 9 per cent if the SN involvement is detected by immunohistochemistry (IHC) alone. Subset analyses suggest that studies with axillary dissection after any type of SN involvement result in somewhat higher estimates than studies allowing omission of axillary clearance, as do studies with more detailed histological evaluation of the SN compared with those with a less intensive histological protocol. Higher-quality papers yield lower pooled estimates than lower-quality papers. CONCLUSION The risk of non-SN metastasis with a low-volume metastasis in the SN is around 10-15 per cent, depending on the method of detection of SN involvement. This should be taken into account when assessing the risk of omission of axillary dissection after a positive SN biopsy yielding micrometastatic or immunohistochemically positive SNs.
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Affiliation(s)
- G Cserni
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary.
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Distante V, Mano MP, Ponti A, Cataliotti L, Filippini L, Giorgi D, Lazzaretti MG, Marchesi C, Perfetti E, Segnan N. Monitoring surgical treatment of screen-detected breast lesions in Italy. Eur J Cancer 2004; 40:1006-12. [PMID: 15093575 DOI: 10.1016/j.ejca.2004.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2003] [Revised: 11/05/2003] [Accepted: 01/15/2004] [Indexed: 11/16/2022]
Abstract
The object of this study was to assess quality of care and adherence to treatment guidelines of screen-detected lesions in Italy using a new audit system. Data on screen-detected cases surgically treated in 1997 were collected using a system (QT 2.3) developed within the Italian Group for Planning and Evaluating Mammographic Screening Programmes (GISMa) and the European Breast Cancer Screening Network. Results of 18 performance parameters were considered compared with the reference standards. In 1997, 515 lesions (335 invasive, 60 in situ and 120 benign) in 496 patients were collected from 14 departments in the Central and Northern area of Italy. The 18 indicators were analysed and grouped according to six quality objectives. Some results were good and others were excellent, such as intraoperative identification, breast conservation surgery, adequate axillary procedures and completeness of pathology reports, but most of them failed: waiting times, preoperative diagnosis, employment of frozen section on small lesions and avoiding axillary procedures in ductal carcinoma-in-situ. This work is a first attempt in Italy to evaluate and uniform the criteria adopted for quality control of breast cancer treatment, using a standardised system. Some results are good or excellent, the overall level of compliance with quality indicators is not satisfactory and corrective actions should be undertaken for a number of issues. A continuous monitoring should be performed and appropriate action taken in order to verify the effectiveness of the corrective actions and to provide screen-detected patients with the best quality of care.
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Affiliation(s)
- V Distante
- Università di Firenze, Dipartimento Area Critica Medico Chirurgica, Sezione Clinica Chirurgica, Italy.
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Abstract
A breast unit is a cancer centre specialised in the diagnosis and treatment of patients with breast cancer. The high level of specialised skills involved in running a breast unit makes it an expensive pattern of care. The European Society of Mastology (EUSOMA) recommends a minimum caseload of 150 cases sufficient to maintain expertise for each team member and to ensure cost-effective working of the breast unit. Specific economic analysis evaluating main diagnostic services (radiology and pathology) and treatment are needed. The present study assesses the activity level at which the breast unit represents good value for money in surgically-treated patients. Cost assessment is realised by defining a cost function according to the following assumptions: cost function input is personnel costs and technical equipment and output is the number of newly diagnosed cases of primary breast cancer admitted to the breast care unit each year. The increase from 50 new cancer cases per year to 100 will reduce average costs by almost 50%. Cost reduction is important up to a volume of 200 new cases per year. For economic investment to be justified, it is desirable that intake rises to at least 200 new cases per year. Our result is in-line with the EUSOMA recommendation.
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Affiliation(s)
- E Pagano
- Unit of Cancer Epidemiology, University of Turin and CPO-Piemonte, Italy.
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31
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Arisio R, Sapino A, Cassoni P, Accinelli G, Cuccorese MC, Mano MP, Bussolati G. What modifies the relation between tumour size and lymph node metastases in T1 breast carcinomas? J Clin Pathol 2000; 53:846-50. [PMID: 11127267 PMCID: PMC1731116 DOI: 10.1136/jcp.53.11.846] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate which pathological and clinical parameters modify the relation between tumour size and lymph node metastases in invasive breast carcinomas < 20 mm. METHODS In a retrospective study, 1075 patients with pT1 invasive breast carcinoma and with known nodal status were analysed. The size of the infiltrating tumour was microscopically evaluated, and the in situ component was not considered. The additional pathological parameters considered were: tumour grade, peritumoral vascular invasion, multicentricity, and angiogenesis. The immunophenotype of the tumour was determined as: the expression of oestrogen (ER) and progesterone (PR) receptors, p53, and c-erbB2. The patients were grouped by age as follows: < 50, 51-70, and > 70 years old. RESULTS Three hundred and seventy four patients (34.8%) were node positive. Univariate analysis showed that nodal positivity was significantly correlated with large tumour size (> 10 mm), vascular invasion, grade 2-3, multicentricity, and high angiogenesis (> 100 microvessels/x20 high power frame). No significant correlation was found between nodal positivity and ER, PR, p53, or c-erbB2 status. Interestingly, the association with in situ carcinoma was correlated with lower nodal positivity in tumours presenting equally sized infiltrating components. Age was an independent variable and significantly modified the risk of nodal positivity in tumours < 1 cm. In fact, in patients under 51 years of age, the proportion of nodal positivity in pT1a tumours was sevenfold higher than in older patients. In patients from 51 to 70 years old, nodal positivity correlated with tumour size, and multicentricity was an additional risk factor. CONCLUSIONS These data suggest that, together with tumour size, the presence of in situ carcinoma, and vascular invasion, age is one of the most important predictors of metastatic diffusion in breast carcinomas.
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Affiliation(s)
- R Arisio
- Department of Pathology, S. Anna Hospital, C. Spezia 60, 10126 Turin, Italy
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Abstract
To investigate the behavioral consequences of benzodiazepines in subjects whose septo-hippocampal cholinergic (ACh) activity was impaired, C57BL/6 mice received an injection of 2.5 microg/0.2 microl of scopolamine into the medial septal area with an i.p. injection of 0.5 mg/kg of diazepam. The consequences of these treatments administered in combination or alone were evaluated on anxiety measured in an elevated plus-maze and on spontaneous alternation carried out in a T-maze, using two different intertrial intervals (ITI: 5s or 30s). In these conditions, only the combined treatment provoked a decrease of the anxiety level, which was associated with an impairment of spontaneous alternation restricted to the 5s ITI. Because mice were not impaired during the sequential 30s ITI, this seems to rule out the possibility that this alternation deficit resulted from a working memory loss. These results suggest an involvement of a septal ACh-GABA-A/BDZ interaction in the exaggeration of cognitive deficits produced by benzodiazepines in patients characterized by a cholinergic hypofunction.
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Affiliation(s)
- M Belotti
- Laboratoire de Neurosciences Comportementales et Cognitives, CNRS URA 339, Université de Bordeaux I, Talence, France
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Abstract
From January of 1990 to December of 1992, 6,954 consecutive cytologic breast fine-needle aspiration biopsies (FNAB) were performed at the Laboratory of Pathology of Sant'Anna Hospital in Turin. Of these cases 62% were solid nodes, 35% were cystic nodes, and 2.7% were nonpalpable breast lesions (stereotaxic or ultrasound guided FNAB). We verified 4,110 cases: 913 cases underwent surgery and 3,197 were evaluated clinically, and/or cytologically, and/or with mammography at least 1 yr after the first diagnosis, or checked with the database of the Tumor Registry of Turin. In our series the FNAB sensitivity was 94.6%, specificity was 99.9%, accuracy was 98.8%, inadequate samples were 6.4%, false-negative rate was 1.4%, and false-positive rate was 0.3%. Our results indicate that the use of cell block improves sensitivity (from 85.2 to 94.6%) and strongly reduces false-negative results (from 3.9 to 1.4%). We conclude that FNAB is a discriminant procedure to the surgical biopsy in cases with clinical, ultrasound, or mammographic low or intermediate suspect, contributing to allow a high malignant/benign surgical biopsy rate and to reduce the need for frozen section diagnosis and medical costs.
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Affiliation(s)
- R Arisio
- Servizio di Anatomia e Istologia Patologica e Citodiagnostica, Ospedale Sant'Anna, Torino, Italy.
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Russo Frattasi CA, Bolgiani MP, Bozzolini IR, Colombo ML, di Sario PN, Fonsati M, Gamba G, Lanza M, Mano MP, Marcer IF. [The safe transportation of children in automobiles]. Pediatr Med Chir 1989; 11:329-32. [PMID: 2594562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The Author emphasizes the significant number of children who sustain fatal accidents during their transport on motor vehicles and relates the Act recently promulgated by the Italian Parliament on the mandatory use of particular restraining devices as well as safety harness for children.
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Mano MP, Barengo R, Sinistrero G, Giurgola L, Sismondi P. [Bone marrow toxicity of chemotherapy combinations in operable carcinoma of the breast]. Minerva Ginecol 1985; 37:335-8. [PMID: 4034081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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36
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Mano MP, Giurgola N, Tetti M, Barengo R, Sismondi P. [Rehabilitation: treatment of lymphedema of the arm after mastectomy]. Minerva Ginecol 1985; 37:121-5. [PMID: 3875061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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37
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Sismondi P, Aimone V, Genta F, Voglino G, Deltetto F, Giardina G, Botta G, Ghiringhello B, Mano MP, Zola P, Bocci A. Prognostic value of estrogen receptors determined by radiochemical vs. histochemical methods in breast cancer. Breast Cancer Res Treat 1985; 6:67-73. [PMID: 2413929 DOI: 10.1007/bf01806012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Estrogen receptors (ER) were evaluated in 634 breast cancer patients by the dextran-coated charcoal method (DCC). In 206, ER and progesterone receptors (PR) were also tested by cytochemistry (Lee method), and in 124 ER were tested by immunofluorescence (Pertschuk method). The median follow-up is 3.7 years. Comparisons have been made between receptor content and: anatomical and clinical features, disease-free survival (DFS), and survival. The following conclusions can be drawn: there is no correlation between ER determinations by DCC and by immunofluorescence or cytochemical methods; there is no evidence of association between ER and PR determined by Lee's method and anatomical and clinical features; a highly significant positive association was found between ER rich specimens and age, post-menopausal status, lobular and tubular histologic types; there is no association between ER values and TNM stage, WHO grading, pathologic prognostic factors of primary tumor and of lymph nodes; and the DFS was not affected by ER status, except for tumors with more than 50 fmol/mg protein.
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38
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Sismondi P, Giai M, Mano MP, Catolla Cavalcanti T, Lamberto A. [Bone marrow toxicity of the chemotherapy of gynecological tumors]. Minerva Ginecol 1985; 37:27-30. [PMID: 4011025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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39
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Sismondi P, Mano MP, Sussio M, De Fabiani E, Corradine MP, Bocci A. [Breast carcinoma and pregnancy]. Minerva Ginecol 1984; 36:689-704. [PMID: 6527824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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40
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Bocci A, Sismondi P, Giardina G, Mano MP, Saluzzo F. [Staging and identification of therapeutic categories]. Minerva Ginecol 1982; 34:909-12. [PMID: 7155417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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41
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Bocci A, Sismondi P, Sinistrero G, Fessia L, Zola P, Giardina G, Saluzzo F, Mano MP, Dalmassso A. Radiosurgical treatment of uterine cervix carcinoma at the 1st Clinic of Obstetrics and Gynecology of the University of Turin, (in the period 1972-1978). EUR J GYNAECOL ONCOL 1981; 2:9-16. [PMID: 7333314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The Authors report the results of a planned prospective study on Radiosurgical treatment of carcinoma of the cervix at stage Ia, Ib, and IIa. The protocol adopted is based on preoperative Curietherapy performed by Ir192 on a after loading technique device, hysterectomy according the Wertheim-Meigs' technique with systematic lymphadenectomy for the internal and external iliacs and obturator stations, Telecobalt therapy in cases with hystological evidence of lymphatic spread. The Authors discuss the results after three and five years in term of survival according to stage and type of treatment, the anatomosurgical examination and the histologic findings of the lymph nodes. At the end, they analysed the complications according to the stage and the kind of treatment, studying only recovered patients and performing the analysis after three years, in order to allow all complications to appear.
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