Serena Scomersi

Role of magnetic resonance imaging in managing selected women with newly diagnosed breast cancer

The purpose of this study is evaluation of therapeutic impact of magnetic resonance imaging (MRI) in breast cancer patients that cannot be imaged adequately with traditional radiology: dense breasts, microcalcifications suspicious for carcinoma in situ or discordance between mammography and ultrasound. A review was performed of 493 patients records: determination of breast MRI effect on clinical management was made for the selected 70 cases by analysing pre-MRI and post-MRI therapeutic plans. Analysis of final pathology was useful to determine if the change in surgical plan prompted by MRI was appropriate. Breast MRI added clinical information in 52.9% of patients that resulted in 44.3% of management changes that were judged as appropriate in 83.9% of cases. Breast MRI provides additional useful information, but causes more extensive surgery (40%) with no proven prognostic benefit. MRI should be considered optional in the clinical staging of breast cancer and performed in selected cases.

Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience

PurposeSurgical site infection (SSI) is the most common complication of colorectal surgery, resulting in significant burden in terms of morbidity and length of hospital stay. The aims of this study were to establish the incidence of SSI in patients undergoing colorectal surgeries and to identify potentially modifiable risk factors to reduce overall SSI rates.MethodsThis retrospective study analyzed patients who underwent colorectal resection at our Department. Patients were identified using a prospective SSI database. Univariate and multivariate analyses were used to identify risk factors.ResultsA total of 687 patients were enrolled in the study and the overall SSI rate was 19.9% (137 patients). Superficial incisional surgical site infections (SSSIs) developed in 52 (7.6%) patients, deep incisional surgical site infections (DSSIs) developed in 15 (2.2%), and organ/space infections (OSIs) developed in 70 (10.1%). Univariate and multivariate analyses confirmed that age, diabetes, emergency surgery, and a high infection risk index are risk factors for SSI.ConclusionsThere are some modifiable and non-modifiable risk factors for SSI. IRI and age are non-modifiable, whereas the timing of surgery and diabetes can be modulated by trying to defer some emergency procedures to elective ones and normalizing the glycemia of diabetic patients.

Breastfeeding: a reproductive factor able to reduce the risk of luminal B breast cancer in premenopausal White women

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

ECOG or Karnofsky Performance Status to Assess Functionality in Glioblastoma Patients Among Different Observers

Purpose: Glioblastoma (GB) patients usually have symptoms that affect their functional status, and medical staff, as well as the patients and their caregivers, might have different perceptions about it. The performance status is important to establish a patient’s survival prediction and treatment decisions. This study was aimed to explore whether health care providers, patients, and caregivers have a common perception of patients’ functional statuses and to investigate in further studies whether the functional scales used in oncology clinical practice are objective tools to evaluate brain tumour patients. nMethods: GB patients treated at our Neuro-Oncology Unit were evaluated once using Eastern Cooperative Oncology Group Performance Status (ECOG) and Karnofsky Performance Status (KPS) by a medical oncologist (MO), an independent investigator (II), the patient and the patient’s main caregiver. nResults: Fifty patients were enrolled. Concordance in KPS evaluation among the four observers was low (Fleiss’ Kappa=0.354; p<0.001) and moderate in ECOG one (Fleiss’ K=0.424; p<0.001). Pairing the observers, the concordance between the MO and II was strong (KPS Cohen’s Kappa=0.731; p<0.001, ECOG Cohen’s Kappa=0.741; p=0.001), whereas it was poor between the patient and MO (KPS Cohen’s Kappa=0.250; p=0.007. ECOG Cohen’s Kappa=0.241; p=0.009) and between the caregiver and MO (KPS Cohen’s Kappa=0.350; p<0.001. ECOG Cohen’s Kappa=0.346; p=0.000). nConclusion: Concordance among the observers was poor or moderate according to the functional scale used. Particularly, caregivers’ perception of the patients’ functional status was frequently worse than that of the professionals.

Evaluation of Sentinel Lymph Node Intraoperative Touch Imprint Cytology in Breast Cancer Surgery

Background: One of the strongest prognostic factor for breast cancer is the regional lymph node status, which can be evaluated intraoperatively by sentinel lymph node biopsy. Many methods (e.g. frozen section, touch imprint cytology (TIC) and one-step nucleic-acid amplification) are available to detect metastatic cells in axillary lymph nodes. The aim of this study is to evaluate the feasibility of using TIC to detect metastatic cells in sentinel lymph nodes. nMethods: This is a retrospective single center cohort analysis conducted on prospectively recorded data. The study included all patients admitted to the Department of General Surgery of Trieste University Hospital for invasive clinically node-negative breast cancer who underwent sentinel lymph node assessment by means of TIC. nResults: Between January 2015 and December 2016, 343 patients (338 females and 5 males) underwent breast surgery and sentinel lymph node TIC. Patient’s median age was 66 (33-92) years. nThe sensitivity of TIC was 54% (95% C.I. 39% to 69%), whereas its specificity and accuracy were 99% (95% C.I. 98% to 100%) and 90%, respectively. The median time required to obtain the result was 20 (15-45) min. The overall cost per each TIC analysis was about 20.50€. nConclusion: Touch imprint cytology appears to be a fast, cost-effective and reliable technique to intraoperatively detect breast cancer lymph node metastasis.