Stefania Rizzo

Magnetic resonance mammography in the evaluation of recurrence at the prior lumpectomy site after conservative surgery and radiotherapy

IntroductionThe aim was to assess the value of magnetic resonance mammography (MRM) in the detection of recurrent breast cancer on the prior lumpectomy site in patients with previous conservative surgery and radiotherapy.MethodsBetween April 1999 and July 2003, 93 consecutive patients with breast cancer treated with conservative surgery and radiotherapy underwent MRM, when a malignant lesion on the site of lumpectomy was suspected by ultrasound and/or mammography. MRM scans were evaluated by morphological and dynamic characteristics. MRM diagnosis was compared with histology or with a 36-month imaging follow-up. Enhancing areas independent of the prior lumpectomy site, incidentally detected during the MRM, were also evaluated.ResultsMRM findings were compared with histology in 29 patients and with a 36-month follow-up in 64 patients. MRM showed 90% sensitivity, 91.6% specificity, 56.3% positive predictive value and 98.7% negative predictive value for detection of recurrence on the surgical scar. MRM detected 13 lesions remote from the scar. The overall sensitivity, specificity, positive predictive value and negative predictive value of MRM for detection of breast malignancy were 93.8%, 90%, 62.5% and 98.8%, respectively.ConclusionMRM is a sensitive method to differentiate recurrence from post-treatment changes at the prior lumpectomy site after conservative surgery and radiation therapy. The high negative predictive value of this technique can avoid unnecessary biopsies or surgical treatments.

Diffusion-weighted MR imaging in assessing cervical tumour response to nonsurgical therapy.

PurposeThis study was undertaken to assess whether there is a correlation between the response of cervical tumours to nonsurgical therapy (chemo- and/or radiotherapy) and apparent diffusion coefficient (ADC) values.Patients and methodsSeventeen consecutive patients prospectively underwent pelvic magnetic resonance (MR) imaging including diffusion-weighted imaging (DWI) sequences before and after nonsurgical therapy for cervical cancer. A control group of 17 patients without cervical pathology was matched to the study group. Differences in baseline ADC maps between the two groups and within the study group before and after therapy were assessed by nonparametric tests.ResultsThe diameter and volume of cervical cancers decreased after therapy in 14/17 lesions (responders) and increased in 3/17 lesions (nonresponders). The ADC values of responders increased significantly (p=0.0009). Percent changes in ADC values before and after therapy were higher in responders than nonresponders (p=0.04). There was no significant difference in ADC values between responders and nonresponders at the staging MR examination (p=0.09) and no significant correlation between pretreatment ADC values and percentage of tumour reduction. Tumours with higher percent ADC value increase showed higher tumour reduction volume, but this was not significant (p=0.12).ConclusionsADC values of cervical cancer after therapy showed significant differences compared with pretherapy values, particularly for responders.RiassuntoObiettivoScopo del nostro lavoro è stato valutare se esiste una correlazione tra la risposta dei tumori della cervice uterina alle terapie non chirurgiche (chemio- e/o radioterapia) e i valori di coefficiente di diffusione apparente (ADC).Pazienti e metodiDiciassette pazienti consecutive sono state prospetticamente sottoposte ad esami di risonanza magnetica (RM) della pelvi, comprendenti sequenze pesate in diffusione (DWI), prima e dopo terapie non chirurgiche per tumore della cervice uterina. A questo gruppo di studio è stato associato un gruppo di controllo (stesso numero di soggetti, senza patologia della cervice). Le differenze dei valori delle mappe ADC tra i due gruppi alla baseline, e nel gruppo di studio prima e dopo terapia sono state valutate con test non parametrici.RisultatiDiametro e volume dei tumori cervicali si sono ridotti dopo le terapie in 14/17 lesioni (rispondenti), sono invece aumentati in 3/17 lesioni (non rispondenti). I valori ADC dei rispondenti sono aumentati significativamente (p=0,0009). Le variazioni percentuali dei valori ADC prima e dopo terapia erano superiori nei rispondenti rispetto ai non rispondenti (p=0,04). Non si sono riscontrate differenze significative nei valori di ADC alla RM basale tra rispondenti e non rispondenti (p=0,09), né tra valori ADC basali e percentuale di riduzione del tumore. I tumori con più alto incremento percentuale di valori di ADC hanno mostrato più elevata riduzione del volume tumorale, ma questo non è risultato significativo (p=0,12).ConclusioniI valori di ADC del tumore della cervice uterina hanno mostrato significativo incremento dopo terapia rispetto ai valori pre-terapia, particolarmente per i tumori rispondenti.

Risk factors for complications of CT-guided lung biopsies

PurposeThis study assessed the risk factors for pneumothorax and intrapulmonary haemorrhage after computed tomography (CT)-guided lung biopsies.Materials and methodsCT-guided lung biopsies performed between January 2007 and July 2008 were retrospectively evaluated to select the study cohort. Whenever possible, emphysema was quantified by using dedicated software. Features related to the patient, the lesion and the needle and its intrapulmonary path were recorded, along with the pathology findings and operators’ experience. The occurrence of pneumothorax and parenchymal haemorrhage was recorded. Univariate and multivariate statistical analyses were performed to assess the association between risk factors and complications. P values <0.05 were considered significant.ResultsIn 157/222 of the procedures considered, complications were associated with small lesion size and length of the intrapulmonary needle path. Transfissural course and type of needle were associated with pneumothorax using univariate analysis, whereas transfissural course was associated with intrapulmonary haemorrhage using both univariate and multivariate analysis. Emphysema, nodule type, patient position, access site and needle diameter were not significant. Fine-needle aspirates and operator experience were significantly correlated with inadequate biopsy samples.ConclusionsThe size of the lesion and the length of the intrapulmonary trajectory are risk factors for pneumothorax and parenchymal haemorrhage. The transfissural course of the needles is frequently related to pneumothorax and intrapulmonary haemorrhage, and the type of the needle is related to pneumothorax.RiassuntoObiettivoScopo del presente lavoro è stato valutare i fattori di rischio per l’insorgenza di pneumotorace e soffusione polmonare dopo biopsie polmonari guidate tramite tomografia computerizzata (TC).Materiali e metodiSono state valutate retrospettivamente le biopsie polmonari TC-guidate eseguite nel periodo gennaio 2007-luglio 2008. Ove possibile, è stato quantificato l’enfisema mediante software dedicato. Sono state valutate caratteristiche relative al paziente, alla lesione, all’ago e al tragitto intrapolmonare in relazione al risultato patologico e all’esperienza degli operatori, all’eventuale presenza post-bioptica di pneumotorace e di soffusione parenchimale. È stata eseguita un’analisi statistica univariata e multivariata. Valori di p<0,05 sono stati considerati significativi.RisultatiIn 157/222 procedure incluse, le complicanze sono state associate con lesioni piccole e lunghezza del tragitto intrapolmonare dell’ago. Tragitto trans-scissurale e tipo di ago sono associati allo pneumotorace nell’analisi univariata; il tragitto trans-scissurale è correlato alla soffusione polmonare sia nell’analisi univariata che multivariata. Quantificazione dell’enfisema, tipo di nodulo, posizione del paziente, accesso e diametro dell’ago non sono risultati significativi. Gli ago-aspirati e l’esperienza degli operatori sono correlati con l’inadeguatezza del campione bioptico.ConclusioniDimensione della lesione e lunghezza del tragitto intrapolmonare dell’ago sono fattori di rischio sia per pneumotorace che per soffusione parenchimale. Il tragitto trans-scissurale dell’ago è spesso associato con pneumotorace e soffusione, gli aghi citologici con pneumotorace.

Role of multidetector CT and FDG-PET/CT in the diagnosis of local and distant recurrence of resected rectal cancer

PurposeThe aim of this study was to compare the diagnostic value of multidetector computed tomography (MDCT) and F18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT) for the detection of local and distant recurrence in patients operated on for rectal cancer.Materials and methodsSixty-seven patients who underwent radical surgery for rectal cancer and were followed up with FDG-PET/CT and MDCT were included in this retrospective study. The FDG-PET/CT and MDCT findings were independently compared with histological sampling or 2 years’ follow-up.ResultsLocal recurrence occurred in 15/67 patients. MDCT diagnosed local recurrence in 15/15 cases and FDG-PET/CT in 14/15. Sensitivity and specificity were 100% and 98% for MDCT and 93% and 98% for FDG-PET/CT, respectively. Hepatic lesions were found in 17/67 patients. All hepatic metastases were detected by both techniques. Pulmonary metastases occurred in 8/67 patients: they were correctly identified in all cases by MDCT and in 6/8 by FDG-PET/CT.ConclusionsMDCT and FDG-PET/CT showed high sensitivity and specificity for the detection of local recurrence of rectal cancer. Both techniques were equally accurate for the detection of hepatic metastases. MDCT showed slightly higher sensitivity and positive predictive value in detecting pulmonary metastases compared with FDG-PET/CT.RiassuntoObiettivoConfrontare il valore diagnostico della TC multistrato (TCMD) e della FDG-PET/TC nella diagnosi di recidiva locale e di metastasi a distanza in pazienti operati di tumore del retto.Materiali e metodiIn questo studio retrospettivo sono stati inclusi 67 pazienti operati per tumore rettale e sottoposti a PET/TC e TCMD durante il follow-up. I risultati di PET/TC e TCMD sono stati confrontati con il risultato istologico o con le indagini di 2 anni di follow-up.RisultatiLa recidiva locale si è verificata in 15/67 pazienti. La TCMD ha posto diagnosi corretta in 15/15 casi; la PET/TC in 14/15. Sensibilità e specificità nella diagnosi di recidiva locale sono risultati rispettivamente 100% e 98% per la TCMD e 93% e 98%, per la PET/TC. Metastasi epatiche sono state diagnosticate in 17/67 pazienti: tutte sono state diagnosticate correttamente da entrambe le metodiche. Metastasi polmonari sono state diagnosticate in 8/67 pazienti: tutte sono state diagnosticate correttamente dalla TCMD, e 6/8 sono state identificate dalla PET/TC.ConclusioniTCMD e PET/TC hanno mostrato alta sensibilità e specificità nella diagnosi di recidiva locale di tumore del retto. Entrambe le metodiche sono state ugualmente accurate nella diagnosi di metastasi epatiche. La TCMD ha mostrato maggiore sensibilità e valore predittivo positivo nella diagnosi di metastasi polmonari.

Discordant hormone receptor and human epidermal growth factor receptor 2 status in bone metastases compared to primary breast cancer

Abstract Background. In patients with metastatic breast cancer, the evaluation of the biological characteristics of metastatic bone deposits may be a valuable adjunct in clinical practice. We assessed the discordance in expression levels for estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) between primary tumor and bone metastases and its clinical impact on patient management. Material and methods. We retrospectively reviewed 363 CT-guided bone biopsies performed from January 1997 to December 2009. The proportions of ER, PgR and HER2 positive tumors at primary diagnosis and bone metastases, determined by IHC and/or FISH, were compared using McNemars test. The impact of the biopsy reassessment on treatment choice was evaluated with Fishers exact test. Results. We selected 109 metastatic breast cancer patients with histologically confirmed bone metastases. Among 107 assessable patients the overall discordance rate was detected in 22 (20.5%) and in 47 (43.9%) patients for ER and PgR, respectively, and in six of 86 assessable patients (6.9%) for HER2 status. The indication to change endocrine therapy occurred in 62% and 30% of patients with ER discordance and ER concordance, respectively (p = 0.01). The indication to change targeted therapy occurred in 67% and 8% of patients with HER2 discordance and HER2 concordance, respectively (p = 0.002). Conclusions. We confirm that biopsy of metastases, including bone metastases, for reassessment of biology should be considered, since it is likely to impact on treatment choice.

Airway Fistula Closure after Stem-Cell Infusion

Investigators observed the healing of a broncholpeural fistula soon after the injection of mesenchymal stem cells into the area surrounding the fistula.

Stem Cell Transplantation Effectively Occludes Bronchopleural Fistula in an Animal Model

BACKGROUND Bronchopleural fistula after lung resection still represents a challenging life-threatening complication for thoracic surgeons. Considering its extremely high mortality rate, an effective treatment is urgently required. Our project investigated the hypothesis of experimental bronchopleural fistula closure by bronchoscopic injection of autologous bone marrow-derived mesenchymal stem cells into the cavity of the fistula, evaluating its feasibility and safety in a large animal model. METHODS An experimental bronchopleural fistula was created in 9 goats after right upper tracheal lobectomy. The animals were randomly assigned to two groups: one received autologous bone marrow-derived mesenchymal stem cell bronchoscopic transplantation; the other received standard bronchoscopic fibrin glue injection. RESULTS All animals receiving bronchoscopic stem cell transplantation presented fistula closure by extraluminal fibroblast proliferation and collagenous matrix development; none (0%) died during the study period. All animals receiving standard treatment still presented bronchopleural fistula; 2 of them (40%) died. Findings were confirmed by pathology examination, computed tomography, and magnetic resonance imaging. CONCLUSIONS Bronchoscopic transplantation of bone marrow-derived mesenchymal stem cells effectively closes experimental bronchopleural fistula by extraluminal fibroblast proliferation and collagenous matrix development. Stem cells may play a crucial role in the treatment of postresectional bronchopleural fistula after standard lung resection. Although these results provide a basis for the development of clinical therapeutic strategies, the exact mechanism by which they are obtained is not yet completely clear; further studies are required to understand exactly how stem cells work in this field.

Magnetic resonance imaging of primary breast lymphoma

PurposePrimary lymphomas of the breast (PBNHL) are uncommon. Magnetic resonance imaging (MRI) features of these malignancies can be relevant in establishing the extent of disease and planning the appropriate therapeutic strategy, usually represented by chemo- and radiotherapy, rather than surgery. The purpose of this study was to assess MRI features of PBNHL.Materials and methodsMRI examinations performed on seven patients with known PBNHL were retrospectively evaluated. Lesions were analysed for both morphology and kinetics and classified according to the Breast Imaging Reporting and Data System (BI-RADS) categories.ResultsThe mean MRI maximum diameter was 44 mm (range 12–69). Six lesions showed a mass-like enhancement; one lesion showed a non-mass-like enhancement. For mass-like lesions, kinetic curve assessment of initial rise showed slow enhancement in one lesion, rapid enhancement in four lesions and medium enhancement in one lesion. Assessment of delayed enhancement showed plateau in five lesions and washout in one lesion. MRI BI-RADS categories were distributed as follows: one BI-RADS II, one BI-RADS III, three BI-RADS IV and two BI-RADS V.ConclusionsMRI features of primary breast lymphomas in this study cohort suggest that the occurrence of a PBNHL should be considered in the presence of large enhancing lesions of the breast, especially if associated with skin thickening. MRI may also have an important role in the assessment of response to therapy and diagnosis of recurrence.RiassuntoObiettivoI linfomi primitivi della mammella sono una patologia rara. Le caratteristiche alla risonanza magnetica (RM) di queste neoplasie possono essere importanti nello stabilire l’estensione della malattia e nel pianificare la più efficace strategia terapeutica, che di solito è rappresentata da chemio-radioterapia, piuttosto che dall’escissione chirurgica. L’obiettivo di questo studio è una valutazione delle caratteristiche RM dei linfomi primitivi della mammella.Materiali e metodiSono stati valutati retrospettivamente esami RM della mammella di 7 pazienti con linfoma primitivo mammario. Le lesioni sono state analizzate sia per la morfologia che per la cinetica e sono state classificate secondo le categorie Breast Imaging Reporting and Data System (BI-RADS) RM.RisultatiIl diametro principale medio delle lesioni alla RM è risultato di 44 mm (range 12–69); 6 lesioni hanno mostrato un enhancement di tipo nodulare; 1 lesione ha mostrato un enhancement di tipo non-nodulare. Per le lesioni nodulari, la fase iniziale della curva contrastografica dell’intensità del segnale nel tempo ha mostrato un enhancement lento in 1 lesione, intermedio in 1 lesione, rapido in 4 lesioni. La valutazione dell’enhancement tardivo ha mostrato plateau in 5 lesioni, wash out in 1 lesione. Le categorie RM BI-RADS sono state distribuite come segue: 1 BI-RADS II, 1 BI-RADS III, 3 BI-RADS IV, 2 BI-RADS V.ConclusioniLe caratteristiche RM dei linfomi primitivi mammari riscontrate nella nostra casistica non si sono dimostrate patognomoniche della patologia, tuttavia la presenza di un linfoma primitivo mammario dovrebbe essere presa in considerazione in caso di lesioni mammarie di grandi dimensioni, dotate di contrast-enhancement, specie se associate ad ispessimento cutaneo. La RM ha inoltre un ruolo importante nella valutazione della risposta alla terapia e nella diagnosi di recidiva.

Molecular Imaging of Stem Cell Transplantation for Liver Diseases: Monitoring, Clinical Translation, and Theranostics

Stem cell transplantation has been investigated to rescue experimental liver failure and is promising to offer an alternative therapy to liver transplantation for liver diseases treatment. Several clinical studies in this field have been carried out, but the therapeutic benefit of this treatment is still controversial. A major obstacle to developing stem cell therapies in clinic is being able to visualize the cells in vivo. Imaging modalities allow optimization of delivery, detecting cell survival and functionality by in vivo monitoring these transplanted graft cells. Moreover, theranostic imaging is a brand new field that utilizes nanometer-scale materials to glean diagnostic insight for simultaneous treatment, which is very promising to improve stem cell-based therapy for treatment of liver diseases. The aim of this review was to summarize the various imaging tools that have been explored with advanced molecular imaging probes. We also outline some recent progress of preclinical and clinical studies of liver stem cells transplantation. Finally, we discuss theranostic imaging for stem cells transplantation for liver dysfunction and future opportunities afforded by theranostic imaging.

Efficacy of 90Yttrium‐ibritumomab tiuxetan in relapsed/refractory extranodal marginal‐zone lymphoma

We evaluated clinical activity of 90Yttrium‐ibritumomab (90Y‐ibritumomab) tiuxetan in extranodal marginal‐zone lymphoma. From May 2004 to April 2011, 30 patients affected by relapsed/refractory marginal‐zone lymphoma—arisen at any extranodal site—received 90Y‐ibritumomab tiuxetan at the activity of 0.4 mCi/kg. Median age was 57 years. At time of treatment, 13 out of 30 patients had disseminated disease (stage III/IV). All patients had received a previous treatment with a maximum of 7. Overall response rate was 90%: 23 patients achieved a complete response (77%); partial response occurred in 4 patients (13%), stable disease in 2 patients (7%) and 1 progression (3%). With a median follow‐up of 5.3 years, median time to relapse was not reached; 2 patients relapsed after complete response; 18 out of 23 complete responses are still responders after >3 years, 12 of them after >5 years. 90Y‐ibritumomab tiuxetan seems to be active in patients with extranodal marginal‐zone lymphoma relapsed/refractory to conventional treatment including radiotherapy. These results suggest that radioimmunotherapy could represent a possible option for the treatment in this subset of patients. Copyright