A. Luparia

Breast cancer screening with tomosynthesis (3D mammography) with acquired or synthetic 2D mammography compared with 2D mammography alone (STORM-2): a population-based prospective study

BACKGROUND Breast tomosynthesis (pseudo-3D mammography) improves breast cancer detection when added to 2D mammography. In this study, we examined whether integrating 3D mammography with either standard 2D mammography acquisitions or with synthetic 2D images (reconstructed from 3D mammography) would detect more cases of breast cancer than 2D mammography alone, to potentially reduce the radiation burden from the combination of 2D plus 3D acquisitions. METHODS The Screening with Tomosynthesis Or standard Mammography-2 (STORM-2) study was a prospective population-based screening study comparing integrated 3D mammography (dual-acquisition 2D-3D mammography or 2D synthetic-3D mammography) with 2D mammography alone. Asymptomatic women aged 49 years or older who attended population-based screening in Trento, Italy were recruited for the study. All participants underwent digital mammography with 2D and 3D mammography acquisitions, with the use of software that allowed synthetic 2D mammographic images to be reconstructed from 3D acquisitions. Mammography screen-reading was done in two parallel double-readings conducted sequentially for 2D acquisitions followed by integrated acquisitions. Recall based on a positive mammography result was defined as recall at any screen read. Primary outcome measures were a comparison between integrated (2D-3D or 2D synthetic-3D) mammography and 2D mammography alone of the number of cases of screen-detected breast cancer, the cancer detection rate per 1000 screens, the incremental cancer detection rate, and the number and percentage of false-positive recalls. FINDINGS Between May 31, 2013, and May 29, 2015, 10 255 women were invited to participate, of whom 9672 agreed to participate and were screened. In these 9672 participants (median age 58 years [IQR 53-63]), screening detected 90 cases of breast cancer, including 74 invasive breast cancers, in 85 women (five women had bilateral breast cancer). To account for these bilateral cancers in cancer detection rate estimates, the number of screens used for analysis was 9677. Both 2D-3D mammography (cancer detection rate 8·5 per 1000 screens [82 cancers detected in 9677 screens]; 95% CI 6·7-10·5) and 2D synthetic-3D mammography (8·8 per 1000 [85 in 9677]; 7·0-10·8) had significantly higher rates of breast cancer detection than 2D mammography alone (6·3 per 1000 [61 in 9677], 4·8-8·1; p<0·0001 for both comparisons). The cancer detection rate did not differ significantly between 2D-3D mammography and 2D synthetic-3D mammography (p=0·58). Compared with 2D mammography alone, the incremental cancer detection rate from 2D-3D mammography was 2·2 per 1000 screens (95% CI 1·2-3·3) and that from 2D synthetic-3D mammography was 2·5 per 1000 (1·4-3·8). Compared with the proportion of false-positive recalls from 2D mammography alone (328 of 9587 participants not found to have cancer at assessment) [3·42%; 95% CI 3·07-3·80]), false-positive recall was significantly higher for 2D-3D mammography (381 of 9587 [3·97%; 3·59-4·38], p=0·00063) and for 2D synthetic-3D mammography (427 of 9587 [4·45%; 4·05-4·89], p<0·0001). INTERPRETATION Integration of 3D mammography (2D-3D or 2D synthetic-3D) detected more cases of breast cancer than 2D mammography alone, but increased the percentage of false-positive recalls in sequential screen-reading. These results should be considered in the context of the trade-off between benefits and harms inherent in population breast cancer screening, including that significantly increased breast cancer detection from integrating 3D mammography into screening has the potential to augment screening benefit and also possibly contribute to overdiagnosis. FUNDING None.

Accuracy of tumour size assessment in the preoperative staging of breast cancer: comparison of digital mammography, tomosynthesis, ultrasound and MRI

PurposeAccurate measurement of breast tumour size is fundamental for treatment planning. We compared the accuracy of digital mammography (DM), digital breast tomosynthesis (DBT), ultrasound (US) and magnetic resonance imaging (MRI) for the preoperative evaluation of breast cancer size.Materials and methodsWe retrospectively reviewed 149 breast cancers in 110 patients who underwent DM, DBT, US and MRI between January 2010 and December 2011, before definitive surgery. The lesions were measured by two radiologists, without knowledge of the final histological examination, considered the gold standard. For each imaging modality, the maximum tumour size was measured to the nearest millimetre; the measurements were considered concordant if they were within ±5 mm. Pearson’s correlation coefficient was calculated for each imaging modality.ResultsThe median pathological tumour size was 22.3 mm. MRI and DBT had a level of concordance with pathology of 70% and 66%, respectively, which was higher than that of DM (54%). DBT and MRI measurements had a better correlation with pathological tumour size (R:0.89 and R:0.92, respectively) compared to DM (R:0.83) and US (R:0.77).ConclusionsDBT and MRI are superior to DM and US in the preoperative assessment of breast tumour size. DBT seems to improve the accuracy of DM, although MRI remains the most accurate imaging modality for breast cancer extension.RiassuntoObiettivoLa corretta valutazione pre-operatoria dell’estensione del carcinoma mammario è fondamentale nella pianificazione chirurgica-terapeutica. Scopo dello studio è stato confrontare l’accuratezza di mammografia digitale (DM), tomosintesi (DBT), ecografia (US) e risonanza magnetica (RM) nella valutazione preoperatoria delle dimensioni del tumore mammario rispetto all’istologia definitiva.Materiali e metodiSono stati valutati retrospettivamente 149 carcinomi in 110 pazienti, sottoposte a DM, DBT, US e RM prima dell’intervento chirurgico tra gennaio 2010 e dicembre 2011. Le lesioni sono state rivalutate e misurate da due radiologi non a conoscenza dell’estensione istologica. Le dimensioni valutate all’esame istologico sono state utilizzate come gold standard. Per ogni metodica, è stata valutata l’estensione massima tumorale; le misurazioni sono state considerate concordanti con l’istologia se comprese nei ±5 mm. è stato calcolato il coefficiente di correlazione di Pearson rispetto all’estensione istologica per ciascuna metodica.RisultatiIl diametro medio delle lesioni è stato 22,3 mm. RM e DBT hanno avuto rispettivamente una concordanza del 70% e 66% con l’istologia, superiore alla DM (54%). La DBT e l’RM hanno avuto un coefficiente di correlazione di Pearson con l’istologico definitivo(R: 0,89 e R: 0,92 rispettivamente) più elevato rispetto a DM (R: 0,83) e US (R: 0,77).ConclusioniDBT e RM sono risultate superiori a DM e US nella valutazione pre-operatoria dell’estensione tumorale. L’impiego della DBT sembra implementare i risultati della DM, sebbene l’RM rimanga la metodica di riferimento.

Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions

PurposeThis study was performed to evaluate the diagnostic accuracy of sonoelastography in differentiating and characterising nodular breast lesions.Materials and methodsA total of 120 nodular lesions diagnosed on mammography and/or ultrasonography in 110 women (mean age 51.27 years) were evaluated with sonoelastography and classified according to elasticity score (S1–S5). Needle biopsy was performed in 104/120 cases, whereas 16/120 were sent for follow-up. Sensitivity and specificity of sonoelastography were determined by taking biopsy findings as the gold standard.ResultsBiopsy yielded the following results: 66 benign, three equivocal and 35 malignant lesions. Sensitivity and specificity of sonoelastography were, respectively, 88.5% and 92.7%. All nodules with an elasticity score of 5 were malignant, and those with a score ≤3 were benign, with the exception of four cases of invasive carcinoma with atypical elasticity (two lobular and two ductal with liquefaction necrosis). Twenty-two lesions were scored 4: 17 were malignant, two equivocal (columnar cell hyperplasia and complex sclerosing lesion) and three benign (sclerotic fibroadenomas).ConclusionsThe use of sonoelastography to complement mammography and ultrasonography could help in the differential diagnosis of nodular breast lesions, especially in Breast Imaging Reporting Data System (BI-RADS) 3 lesions with marked elasticity (S≤3). In these cases, the high concordance between elastography and cytology or histology in diagnosing benign lesions could reduce the number of needle biopsies and guide women at low radiological risk towards follow-up.RiassuntoObiettivoValutare l’accuratezza dell’elastosonografia nella differenziazione e caratterizzazione dei noduli mammari.Materiali e metodiValutazione con elastosonografia di 120 lesioni nodulari (classificate con score elastico (S1–S5) diagnosticate mammograficamente e/o ecograficamente in 110 donne (età media 51,27 anni). Sono state sottoposte ad agobiopsia 104/120 lesioni, mentre in 16/120 casi e stato scelto il follow-up. La sensibilità e la specificità dell’elastosonografia sono state calcolate assumendo i risultati anatomopatologici come gold standard.RisultatiL’esito dei 104 prelievi è stato: 66 benigni, 3 dubbi, 35 maligni. La sensibilità e specificità dell’elastosonografia sono risultate rispettivamente del 88,5% e del 92,7%. Tutti i noduli S5 sono risultati maligni mentre quelli con S≤3 sono tutti risultati benigni, eccetto quattro casi di carcinomi infiltranti con elasticità atipica (2 lobulari e 2 duttali con necrosi colliquativa). Le 22 lesioni S4 sono risultate: 17 maligne, 2 dubbie (iperplasia a cellule colonnari e lesione sclerosante complessa), 3 benigne (fibroadenomi sclerotici).ConclusioniL’elastosonografia utilizzata come metodica complementare alla mammografia ed all’ecografia consente un’accurata diagnosi differenziale dei noduli mammari, specialmente nelle lesioni Breast Imaging Reporting Data System (BI-RADS) 3 dotate di elevata elasticità (S≤3). L’alta concordanza tra le caratteristiche elastiche ed il riscontro anatomopatologico di benignità potrebbe evitare il prelievo agobioptico indirizzando verso il follow-up nei casi con basso rischio radiologico.

Role of axillary ultrasound in the preoperative diagnosis of lymph node metastases in patients affected by breast carcinoma

PurposeThis study was conducted to evaluate the diagnostic accuracy of axillary ultrasound (US) alone or in combination with fine-needle-aspiration cytology (FNAC) in patients with breast carcinoma, in comparison with the final histological examination (sentinel node biopsy and/or axillary dissection).Materials and methodsBetween January 2005 and June 2008, we evaluated 427 breast cancer patients with axillary US. The findings were classified according to the following criteria: hilum and cortex morphology, ratio between longitudinal and transverse diameter and ratio between hilar and longitudinal diameter of the lymph node. Patients with breast lesions ≤3 cm (n=147) underwent FNAC of the most suspicious lymph node.ResultsOverall concordance between axillary US and final histological examination was 85%, sensitivity was 72.3% and specificity was 93.4%. Concordance between FNAC and final histological examination was 93%, sensitivity was 88.1% and specificity was 100%.ConclusionsIn 48.3% of patients, the combination of axillary US and FNAC guided treatment decisions towards immediate axillary dissection, thus sparing the patients sentinel node biopsy, with a significant reduction of costs and hospitalization time.RiassuntoObiettivoScopo del nostro lavoro è stato valutare, in pazienti affette da carcinoma mammario, l’accuratezza diagnostica dell’ecografia (US) del cavo ascellare da sola oppure associata ad agoaspirato con ago sottile (FNAC) assumendo come parametro di confronto l’esame istologico definitivo (biopsia del linfonodo sentinella e/o dissezione ascellare).Materiali e metodiTra gennaio 2005 e giugno 2008 in 427 pazienti affette da neoplasia mammaria è stato eseguito lo studio ecografico del cavo ascellare. Per la classificazione dei reperti ecografici sono stati valutati: la morfologia dell’ilo e della corticale, il rapporto tra diametro longitudinale e trasversale e il rapporto tra diametro della regione ilare e longitudinale del linfonodo. In 147 pazienti, con neoplasia mammaria≤3 cm, è stata eseguita l’US-FNAC del linfonodo più sospetto.RisultatiSi è evidenziata una concordanza complessiva tra US del cavo ascellare e istologico definitivo dell’85%, una sensibilità del 72,3% ed una specificità del 93,4%. La concordanza dell’US-FNAC con l’istologico definitivo è risultata del 93%, la sensibilità dell’88,1% e la specificità del 100%.ConclusioniL’ecografia del cavo ascellare associata alla FNAC nel 48,3% dei casi ha permesso di evitare la biopsia del linfonodo sentinella, orientando il trattamento chirurgico verso una dissezione ascellare immediata, con sensibile riduzione dei costi e del tempo di ospedalizzazione.

Digital breast tomosynthesis as an adjunct to digital mammography for detecting and characterising invasive lobular cancers: a multi-reader study

AIM To examine the interpretive performance of digital breast tomosynthesis (DBT) as an adjunct to digital mammography (DM) compared to DM alone in a series of invasive lobular carcinomas (ILCs) and to assess whether DBT can be used to characterise ILC. MATERIALS AND METHODS A retrospective, multi-reader study was conducted of 83 mammographic examinations of women with 107 newly diagnosed ILCs ascertained at histology. Consenting women underwent both DM and DBT acquisitions. Twelve radiologists, with varying mammography experience, interpreted DM images alone, reporting lesion location, mammographic features, and malignancy probability using the Breast Imaging-Reporting and Data System (BI-RADS) categories 1-5; they then reviewed DBT images in addition to DM, and reported the same parameters. Statistical analyses compared sensitivity, false-positive rates (FPR), and interpretive performance using the receiver operating characteristics (ROC) curve and the area under the curve (AUC), for reading with DM versus DM plus DBT. RESULTS Multi-reader pooled ROC analysis for DM plus DBT yielded AUC=0.89 (95% confidence interval [CI]: 0.88-0.91), which was significantly higher (p<0.0001) than DM alone with AUC=0.84 (95% CI: 0.82-0.86). DBT plus DM significantly increased pooled sensitivity (85%) compared to DM alone (70%; p<0.0001). FPR did not vary significantly with the addition of DBT to DM. Interpreting with DBT (compared to DM alone) increased the correct identification of ILCs depicted as architectural distortions (84% versus 65%, respectively) or as masses (89% versus 70%), increasing interpretive performance for both experienced and less-experienced readers; larger gains in AUC were shown for less-experienced radiologists. Multifocal and/or multicentric and bilateral disease was more frequently identified on DM with DBT. CONCLUSION Adding DBT to DM significantly improved the accuracy of mammographic interpretation for ILCs and contributed to characterising disease extent.

Breast cancer detection using single-reading of breast tomosynthesis (3D-mammography) compared to double-reading of 2D-mammography: Evidence from a population-based trial

BACKGROUND Most population breast cancer (BC) screening programs use double-reading of 2D-mammography. We recently reported the screening with tomosynthesis or standard mammography-2 (STORM-2) trial, showing that double-read tomosynthesis (pseudo-3D-mammography) detected more BC than double-read 2D-mammography. In this study, we compare screen-detection measures for single-reading of 3D-mammography with those for double-reading of 2D-mammography, to inform screening practice. METHODS This is a secondary analysis based on STORM-2 which prospectively compared 3D-mammography and 2D-mammography in sequential screen-readings. Asymptomatic women ≥49 years who attended population-based screening (Trento, 2013-2015) were recruited. Participants recalled at any screen-read from parallel double-reading arms underwent further testing and/or biopsy. Single-reading of 3D-mammography, integrated with acquired or synthetized 2D-mammograms, was compared to double-reading of 2D-mammograhy alone for screen-detection measures: number of detected BCs, cancer detection rate (CDR), number and percentage of false-positive recall (FPR). Paired binary data were compared using McNemars test. RESULTS Screening detected 90, including 74 invasive, BCs in 85 of 9672 participants. CDRs for single-reading using integrated 2D/3D-mammography (8.2 per 1000 screens; 95% CI 6.5-10.2) or 2D synthetic/3D-mammography (8.4 per 1000 screens; 95% CI: 6.7-10.4) were significantly higher than CDR for double-reading of 2D-mammography (6.3 per 1000 screens; 95% CI: 4.8-8.1), P<0.001 both comparisons. FPR% for single-read 2D/3D-mammography (2.60%; 95% CI: 2.29-2.94), or single-read 2D synthetic/3D-mammography (2.76%; 95% CI: 2.45-3.11), were significantly lower than FPR% for double-read 2D-mammography (3.42%; 95% CI: 3.07-3.80), P<0.001 and P=0.002 respectively. CONCLUSIONS Single-reading of 3D-mammography (integrated 2D/3D or 2Dsynthetic/3D) detected more BC, and had lower FPR, compared to current practice of double-reading 2D-mammography alone - these findings have implications for population BC screening programs.

Efficacy and cost-effectiveness of stereotactic vacuum-assisted core biopsy of nonpalpable breast lesions: analysis of 602 biopsies performed over 5 years

PurposeThe authors sought to evaluate the diagnostic accuracy and cost-effectiveness of vacuum-assisted core biopsy (VACB) in comparison with diagnostic surgical excision for characterisation of nonpalpable breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) categories R3 and R4.Materials and methodsFrom January 2004 to December 2008, we conducted 602 stereotactic, 11-gauge, VACB procedures on 243 nonpalpable breast lesions categorised as BI-RADS R3, 346 categorised as BI-RADS R4 and 13 categorised as BI-RADS R5. We calculated the diagnostic accuracy and cost savings of VACB by subtracting the cost of the stereotactic biopsy from that of the diagnostic surgical procedure.ResultsA total of 56% of the lesions were benign and required no further assessment. Lesions of uncertain malignant potential (B3) (23.6%) were debated at multidisciplinary meetings, and diagnostic surgical biopsy was recommended for 83.1% of them. All malignant lesions (B4 and B5) underwent surgical excision. VACB had a sensitivity of 94.9%, specificity of 98.3% and diagnostic accuracy of 97.7%. The cost savings per VACB procedure were 464.00 euro; by obviating 335 surgical biopsies, the overall cost savings was 155,440.00 euro over 5 years.ConclusionsVACB proved to have high diagnostic accuracy for characterising abnormalities at low to intermediate risk of malignancy and obviated surgical excision in about half of the cases, allowing for considerable cost savings.RiassuntoObiettivoValutare l’accuratezza diagnostica ed il vantaggio economico della biopsia percutanea vacuum assistita (VACB) rispetto alla biopsia diagnostica chirurgica nella caratterizzazione di lesioni non palpabili classificate in base al Breast Imaging Reporting and Data System (BI-RADS) come R3 e R4.Materiali e metodiTra gennaio 2004 e dicembre 2008, sono state eseguite 602 VACB con ago da 11 G, sotto guida stereotassica, su 243 lesioni classificate come BI-RADS R3, 346 come BI-RADS R4 e 13 come BI-RADS R5. Sono stati calcolati l’accuratezza diagnostica ed il risparmio effettivo derivante dalla procedura, sottraendo al costo del rimborso della biopsia chirurgica quello per la VACB.RisultatiIl 56% delle lesioni sono risultate benigne e non hanno richiesto ulteriori interventi. Le lesioni B3 (23,6%) sono state discusse in sessioni multidisciplinari; di queste l’83,1% è stato sottoposto a verifica chirurgica, come tutte le lesioni risultate B4 e B5. La sensibilità della VACB è stata del 94,9%, la specificità 98,3% e l’accuratezza diagnostica 97,7%. La VACB ha consentito un risparmio di 464,00 euro a procedura; essendo state evitate 335 biopsie chirurgiche, il risparmio complessivo in cinque anni è risultato di 155440,00 euro.ConclusioniLa VACB è risultata metodica accurata nella caratterizzazione di lesioni a basso e medio rischio, evitando l’intervento chirurgico in oltre la metà dei casi con un effettivo risparmio economico.

Breast calciphylaxis following coronary artery bypass grafting completely resolved with total parathyroidectomy

A 58-year-old woman arrived at our institution complaining of progressive increase of local inflammatory symptoms at her left breast, unresponsive to a 10-day antibiotic treatment. Her clinical history included: subtotal thyroidectomy for goiter, diabetes mellitus, obesity, cardiovascular diseases and a 10-year haemodialitic treatment for chronic kidney disease. Recently, she had undergone coronary artery bypass grafting using left internal mammary artery, complicated with mediastinitis. On physical examination, the left breast presented an erythematous skin aspect, with slight ‘‘peau d’orange’’ in the internal regions, bordering the areola. A lump (about 2 cm of diameter), with intermediatehard consistence, was palpable at the inferior-internal quadrant of the breast. No nipple discharge was detected and the right breast was normal. The patient denied any other symptom. Mammography showed no specific changes, except for multiple and diffuse bilateral calcifications with dystrophic or vascular morphology (Fig. 1a–d). Ultrasound examination evidenced only echostructural changes indicative of tissue edema (Fig. 1e) rather than an inflammatory carcinoma in the area of the palpable mass and no pathologic lymph node in the axilla. At color-power Doppler, the vascular pattern of the region showed no significant alteration. After a week, the patient developed an ulceration and necrosis of the contours of the breast mass (Fig. 2) and other multiple cutaneous plaques of necrosis on her left leg, associated with intolerable pain (unresponsive to standard analgesics), normal white blood cell count, an upper limit serum levels of C-reactive protein and increased levels of calcium (5.54 mEq ⁄ L), phosphorus (5 mg ⁄ dL) and parathyroid hormone (774 pg ⁄ mL). Ultrasound-guided core-needle biopsy (14 G) was performed to differentiate the breast mass from a malignant lesion and to take a small skin fragment. The histological examination, revealing extensive foci of recent fat necrosis and fibrosis, resulted in calciphylaxis. Numerous calcium deposits in the vessel walls and calcifications of non-vascular tissues were associated. A subsequent total parathyroidectomy normalized rapidly the secondary hyperparathyroidism and led to a significant reduction of the pain. A complete healing of the cutaneous breast lesion occurred in a 2-month period (Fig. 3). Two years later the follow-up confirmed the good outcome of the treatment: the residual scar in the breast is smooth and the surrounding skin has normal aspect (Fig. 4). Mammography demonstrated vascular and dystrophic calcifications not significantly modified from the previous control; the left breast only presents a structural retraction in correspondence of the cutaneous scar (Fig. 5). Address correspondence and reprint requests to: Dott. Pier Paolo Campanino, Istituto di Radiologia Diagnostica ed Interventistica, Università di Torino, ASOU San Giovanni Battista di Torino, Sede Molinette, Via Genova 3 – 10126 Torino, Italy, or e-mail: piercamp66@alice.it.

Breast cancer surveillance in patients treated by radiotherapy for Hodgkin’s lymphoma

PurposeThe authors evaluated the relative risk of developing radiation-induced breast cancer (BC) in women treated with radiotherapy for Hodgkin’s disease (HD) and analysed the imaging features of these breast neoplasms.Materials and methodsWe retrospectively studied 54 women who had all undergone radiotherapy between 1980 and 2010 (median age, 36.6 years). Women aged ≤30 years were screened with clinical breast examination, ultrasound (US) and, if necessary, mammography; women >30 years had clinical breast examination, US and mammography. Three women underwent magnetic resonance (MR) imaging as well.ResultsMammography detected seven invasive breast cancers in 6/54 women (11.1%). Median age at diagnosis was 26.1 years for HD and 42.4 for breast cancer. Breast cancer was diagnosed following a median latent period from radiotherapy of 15.1 years. Mean radiation dose was 37.6 Gy in women who developed breast cancer and 31.3 Gy in the other women.ConclusionsIn our study, women who were exposed to radiation for HD had a 6.2-fold higher risk of developing breast cancer than the general population. In consideration of the young age and high breast density, women aged ≤30 years should be monitored by US and MR imaging; women aged >30 years should be monitored by US, mammography and, when necessary, MR imaging.RiassuntoObiettivoScopo del presente lavoro è stato valutare il rischio relativo di sviluppare neoplasie mammarie in donne radiotrattate per linfoma di Hodgkin (LH) e la presentazione all’imaging convenzionale dei tumori mammari radioindotti.Materiali e metodiIl presente è uno studio retrospettivo condotto su 54 donne che tra il 1980 e il 2010 sono state sottoposte a radioterapia per LH (età media 36,6 anni). Le pazienti con meno di 30 anni hanno effettuato visita clinica, ecografia e mammografia quando indicata, quelle con più di 30 anni visita clinica, ecografia e mammografia. Sono state sottoposte a risonanza magnetica (RM) 3 pazienti.RisultatiSono stati rilevati 7 carcinomi infiltranti della mammella mediante mammografia in 6/54 donne (11,1%). L’età media alla diagnosi è stata di 26,1 anni per LH e di 42,4 per tumore mammario. L’intervallo medio intercorso tra trattamento radioterapico e sviluppo di neoplasia mammaria è stato 15,1 anni. La dose media di radiazioni somministrata nelle donne che hanno sviluppato neoplasia mammaria è stata di 37,6 Gy, nelle altre 31,3 Gy.ConclusioniNel nostro studio, una donna radiotrattata per LH presenta un rischio 6,2 volte superiore rispetto alla popolazione generale di sviluppare un carcinoma mammario. Considerando giovane età e densità mammaria, le pazienti con meno di 30 anni dovrebbero essere sottoposte ad ecografia e RM, mentre quelle con più di 30 anni a mammografia ed ecografia, con eventuale RM, quando necessaria.

B3 core biopsies should be assumed as positive findings for accuracy purposes

The paper by Luparia et al. [1] recently published in “La Radiologia Medica” and dealing with vacuum-assisted breast core biopsy (VAB) suggested me some comments. Apart from uncommon pathological fi gures, such as B3 high prevalence (23.6% as compared to 9-10% average literature fi gures) and a subsequent low positive predictive value (PPV, 4.2% as compared to 25-30% average literature fi gures), or a null PPV for a few B4 cases, I would like to comment on the criteria adopted to assess VAB accuracy. In particular, assuming B3 fi ndings as “negative” is uncommon, as they are currently assumed as “positive” in the literature [2, 3] and usually referred for surgical confi rmation [3]. I admit that a debate is still ongoing on which, if any, subset of B3 cases might be simply followed-up, such as special histological subtypes (e.g. papillary lesions and radial scars) and/ or B3 without atypias, and I understand that the authors, due to the low PPV of their B3 cases, chose for collegial discussion to decide upon surgical confi rmation. However, since they still referred to surgery 83% of B3 cases, it seems confi rmed that B3 were dealt with as “suspicious” cases, that means “positive” for accuracy assessment purposes. Thus it would be more comparable with the current literature (as the authors do in a specifi c Table) if actual results would report 100% sensitivity and 70.2% specifi city. Of course the authors may also comment on a hipotetical scenario where B3 are not sent for surgery, consistent with 94.9% sensitivity and 98.3 specifi city. B3 core biopsies should be assumed as positive fi ndings for accuracy purposes