Carolina Marini

Ultrasonographic appearance of breast implant complications.

In the last 20 years, we have observed a large diffusion of breast implants used for cosmetic reasons (augmentation mammoplasty) or for reconstructing breast after mastectomy. At the same time, there has been also an increased request for the instrumental evaluation of implants. Clinical examination remains the first approach to symptomatic patients. Mammography is not considered the ideal tool for studying breast implant because of low sensitivity in the detection of implant rupture. According to literature data, the diagnostic accuracy of ultrasonography is debated; in fact, it has a very high sensitivity if it is performed by a skilled radiologist. Currently, magnetic resonance (MR) is considered the gold standard, with a sensitivity higher than 90%. However, in our experience in early complications (acute or subacute bleeding and local infection), ultrasonography represents an useful diagnostic tool both for diagnosis and for interventional procedures such as positioning drain. Interventionist ultrasonography reduces the number of reoperations, allowing a fast problem solution and a reduction of costs. In our experience, ultrasonography may be helpful also for the evaluation of late complications (capsular contractures, intracapsular and extracapsular rupture) that are related to the time elapsed since implant inclusion (more frequent after 8–13 years). The purpose of this study is to evaluate the diagnostic accuracy of ultrasounds and to evaluate if MR is always necessary in the study of breast implants.

Magnetic resonance (MR) features in triple negative breast cancer (TNBC) vs receptor positive cancer (nTNBC)

Few reports in literature describe triple negative breast cancer (TNBC) imaging findings. Aim of the study is to determine MR-features of TNBC compared to receptor positive cancer (nTNBC). From May 2014 to May 2015, we retrospectively enrolled 31 consecutive patients with histological diagnosis of TNBC and a control group of 31 consecutive nTNBC observed in the same period, out of 602 cancer, diagnosed in our department in the same year. Histopathological analysis and MR-features of TNBC (31 patients) were compared to nTNBC (31 patients). MR-features included dimension, fibroglandular tissue (FGT), background parenchimal enhancement (BPE), mass shape, margins, presence of rim, intratumoral signal intensity in T2w, uni-multifocality, kinetic curves. All patients were examined with MR 1,5T (Magnetom Simphony Tim, Siemens Healthcare) performing T2w fat-sat and contrast enhanced high temporal and spatial resolution T1w before and after injection of Gadolinium. 62 staging MR were reviewed. Median age was 50 (30-78ys) with a standard deviation of 10,9. TNBC showed 3 MR features in concordance with current literature: rim enhancement, hyperintensity in T2 sequence and unifocality. Rim enhancement was shown in 67.7% of TNBC (21/31) and 29% of nTNBC (9/31). Higher T2w values were shown in 83.9% of TNBC (26/31) and 58.1% of nTNBC (18/31). Cancer was multifocal in 7/31 (22.6%) of TNBC and 19/31 (61.3%) nTNBC. No correlation was found for dimension (p=0.12), FGT (p=0.959), BPE (p=0.596), homogeneity of enhancement (p=0.43), margins (p=0.671) and kinetic (p=0.37). Multivariate analysis demonstrated that rim enhancement and unifocality correlated independently with TNBC group. Area under ROC curve of our model is 0.835. Furthermore, we evaluated the clinical outcome of all 31 TNBC patients in a follow-up time ranging from 24months to 36months separating them in a free-survival group (23 women) and a recurrence group (8 women with local recurrence or distant metastasis): only kinetic curves resulted to be significantly higher in recurrence group (p=0.042).

Evaluation of Dosimetric Properties in Full Field Digital Mammography (FFDM) - Development of a New Dose Index

According to the World Health Organization (WHO), breast cancer is the most common cancer in women, constituting 29% of all cancers related to the female population. In this context, Full Field Digital Mammography (FFDM) is the reference imaging technique for breast cancer early detection and diagnosis and it is widely employed in screening programs. Therefore, the absorbed radiation dose for each examination shall be evaluated in order to ensure proper radiation exposures for the patient. In addition, the new European Directive 59/2013/EURATOM requires that dosimetric data referred to the radiation exposure should be inserted in the radiological report. For these reasons, we designed a multidisciplinary research project with the intention of realizing and validating a new method for calculating the Average Absorbed Breast Dose (2ABD) by the patient during a mammography procedure. The innovative aspect regards the availability of a quantitative and personalized dosimetric parameter, providing an index that is patient-specific rather than related to the X-ray machine output, directly related to the risk of radiation. Specifically, in this work we present our scientific approach as well as the initial results.

Doxycycline, an Inhibitor of Mitochondrial Biogenesis, Effectively Reduces Cancer Stem Cells (CSCs) in Early Breast Cancer Patients: A Clinical Pilot Study

Background and objectives: Cancer stem cells (CSCs) have been implicated in tumor initiation, recurrence, metastatic spread and poor survival in multiple tumor types, breast cancers included. CSCs selectively overexpress key mitochondrial-related proteins and inhibition of mitochondrial function may represent a new potential approach for the eradication of CSCs. Because mitochondria evolved from bacteria, many classes of FDA-approved antibiotics, including doxycycline, actually target mitochondria. Our clinical pilot study aimed to determine whether short-term pre-operative treatment with oral doxycycline results in reduction of CSCs in early breast cancer patients. Methods: Doxycycline was administered orally for 14 days before surgery for a daily dose of 200 mg. Immuno-histochemical analysis of formalin-fixed paraffin-embedded (FFPE) samples from 15 patients, of which 9 were treated with doxycycline and 6 were controls (no treatment), was performed with known biomarkers of “stemness” (CD44, ALDH1), mitochondria (TOMM20), cell proliferation (Ki67, p27), apoptosis (cleaved caspase-3), and neo-angiogenesis (CD31). For each patient, the analysis was performed both on pre-operative specimens (core-biopsies) and surgical specimens. Changes from baseline to post-treatment were assessed with MedCalc 12 (unpaired t-test) and ANOVA. Results: Post-doxycycline tumor samples demonstrated a statistically significant decrease in the stemness marker CD44 (p-value < 0.005), when compared to pre-doxycycline tumor samples. More specifically, CD44 levels were reduced between 17.65 and 66.67%, in 8 out of 9 patients treated with doxycycline. In contrast, only one patient showed a rise in CD44, by 15%. Overall, this represents a positive response rate of nearly 90%. Similar results were also obtained with ALDH1, another marker of stemness. In contrast, markers of mitochondria, proliferation, apoptosis, and neo-angiogenesis, were all similar between the two groups. Conclusions: Quantitative decreases in CD44 and ALDH1 expression are consistent with pre-clinical experiments and suggest that doxycycline can selectively eradicate CSCs in breast cancer patients in vivo. Future studies (with larger numbers of patients) will be conducted to validate these promising pilot studies.

Average absorbed breast dose in mammography: a new possible dose index matching the requirements of the European Directive 2013/59/EURATOM

BackgroundThe new European Directive 2013/59/EURATOM requires that patients are informed about the risk associated with ionising radiation and that detailed information on patient exposure is included in the radiological report. This implies a revision of the routinely used dose indexes to obtain quantities related to individual exposure evaluable from acquisition parameters. Here we propose a new mammography dose index consistent with the average glandular dose (AGD).MethodsAn equation has been developed for calculating the average absorbed breast dose (2ABD). It depends on incident air kerma ka,i and on energy absorption coefficient μen; ka,i can be calculated for each anode-filter combination, based on kVp, mAs, the yield of the tube used Ytb, and the breast thickness d; μen depends on kVp and has been evaluated for each anode-filter combination. 2ABD has been compared to AGD evaluated by Dance or Wu methods, which represent the reference standards, for 20 patients of our university hospital.ResultsThe incident air kerma ka,i, calculated as a function of kVp, mAs, Ytb and d, was in good agreement with the same quantity directly measured: the relative uncertainty is < 0.10. The results of the comparison between 2ABD and AGD evaluated by both Dance and Wu methods appear to be consistent within the uncertainties.Conclusions2ABD is easily evaluable for each mammogram from the acquisition parameters. It can be proposed as a new suitable dose index, consistent with AGD, matching the requirements of the 2013 European Directive.