The objective of this study was to compare two different scanning protocols in patients suspected to have multiple trauma using multidetector 16-row computed tomography (CT) to better define scanning time, imaging quality and radiation exposure. Forty-six patients, between March 2004 and March 2005, with suspected multiple trauma (cerebral, spine, chest, abdominal and pelvis) were evaluated with two different protocols: Protocol "A" 26 patients; Protocol "B" 20 patients. Protocol A consists of a single-pass continuous whole-body acquisition (from vertex to pubic symphysis), whereas Protocol B of conventional segmented acquisition with scanning of body segments individually. Both protocols were performed using a multidetector 16-rows CT (Light-Speed 16, General Electric Medical System, Milwaukee, WI, USA) with the same technical factors. Radiation dose was evaluated in two ways: computer tomography dose index (CTDI) = dose measured in central and peripheral region of the subjects as a direct result of a CT section acquisition of T millimeters thick (independent from the two protocols) and dose length product (DLP) = total dose deposited over the length of the acquisition (dependent from the two protocols). Image quality was rated according to the following scores: 1, excellent; 2, good; 3, satisfactory; 4, moderate and 5, poor. The results were compared using Wilcoxon's test to identify significant difference in terms of image quality, scanning time, radiation exposure and presence of artifacts, assuming significance at a p value of <0.05. In the single-pass scanning, DLP was 2.671 mGy x cm and a total scan time of 35 s. In whole-body protocols, we have seen artifacts due to arm adduction in thorax and less image quality in brain. In the conventional segmented study, DLP was 3.217 mGy x cm and a total scan time of 65 s; this protocol offered less extraction capabilities of off-axial on focused images of the entire spine, aorta, facial bones or hip without rescanning. Protocol A revealed a significant decrease in scan time (35 vs 65 min, p < 0.05), time in the CT examination room (21.7 vs 31.6 min.; p < 0.05), and final image analysis (83.7 vs 102.9 min; p < 0.05) and radiation dose compared to protocol B (p < 0.05). No significant difference was found for patient transport time, image reconstruction time and imaging quality. Reconstruction and isotropic reformation of axial image acquired by whole-body, single-pass protocols due to entire spine evaluation, aortic and splanchnic CT angiography eliminate additional studies. The whole-body, single-pass protocols, compared with segmented acquisitions protocols, resulted in a reduced total radiation dose without relevant loss of diagnostic image information.

Radiomics is an emerging translational field of medicine based on the extraction of high-dimensional data from radiological images, with the purpose to reach reliable models to be applied into clinical practice for the purposes of diagnosis, prognosis and evaluation of disease response to treatment. We aim to provide the basic information on radiomics to radiologists and clinicians who are focused on breast cancer care, encouraging cooperation with scientists to mine data for a better application in clinical practice. We investigate the workflow and clinical application of radiomics in breast cancer care, as well as the outlook and challenges based on recent studies. Currently, radiomics has the potential ability to distinguish between benign and malignant breast lesions, to predict breast cancer’s molecular subtypes, the response to neoadjuvant chemotherapy and the lymph node metastases. Even though radiomics has been used in tumor diagnosis and prognosis, it is still in the research phase and some challenges need to be faced to obtain a clinical translation. In this review, we discuss the current limitations and promises of radiomics for improvement in further research.

No abstract

Numerous imaging modalities may be used for the staging of women with advanced breast cancer. Although bone scintigraphy and multiplanar-CT are the most frequently used tests, others including PET, MRI and hybrid scans are also utilised, with no specific recommendations of which test should be preferentially used. We review the evidence behind the imaging modalities that characterise metastases in breast cancer and to update the evidence on comparative imaging accuracy.

Purpose To estimate the performance of diffusion-weighted imaging (DWI) for breast cancer detection. Methods Consecutive breast magnetic resonance imaging examinations performed from January to September 2016 were retrospectively evaluated. Examinations performed before/after neoadjuvant therapy, lacking DWI sequences or reference standard were excluded; breasts after mastectomy were also excluded. Two experienced breast radiologists (R1, R2) independently evaluated only DWI. Final pathology or > 1-year follow-up served as reference standard. Mc Nemar, χ 2 , and κ statistics were applied. Results Of 1,131 examinations, 672 (59.4%) lacked DWI sequence, 41 (3.6%) had no reference standard, 30 (2.7%) were performed before/after neoadjuvant therapy, and 10 (0.9%) had undergone bilateral mastectomy. Thus, 378 women aged 49 ± 11 years (mean ± standard deviation) were included, 51 (13%) with unilateral mastectomy, totaling 705 breasts. Perbreast cancer prevalence was 96/705 (13.6%). Per-breast sensitivity was 83/96 (87%, 95% confidence interval 78-93%) for both R1 and R2, 89/96 (93%, 86-97%) for double reading (DR) (p = 0.031); per-lesion DR sensitivity for cancers ≤ 10 mm was 22/31 (71%, 52-86%). Per-breast specificity was 562/609 (93%, 90-94%) for R1, 538/609 (88%, 86-91%) for R2, and 526/609 (86%¸ 83-89%) for DR (p < 0.001). Inter-observer agreement was substantial (κ = 0.736). Acquisition time varied from 3:00 to 6:22 min:s. Per-patient median interpretation time was 46 s (R1) and 51 s (R2). Conclusions DR DWI showed a 93% sensitivity and 88% specificity, with 71% sensitivity for cancers ≤ 10 mm, pointing out a potential for DWI as stand-alone screening method.

E-cadherin (CDH1 gene) germline mutations are associated with the development of diffuse gastric cancer in the context of the so-called hereditary diffuse gastric syndrome, and with an inherited predisposition of lobular breast carcinoma. In 2019, the international gastric cancer linkage consortium revised the clinical criteria and established guidelines for the genetic screening of CDH1 germline syndromes. Nevertheless, the introduction of multigene panel testing in clinical practice has led to an increased identification of E-cadherin mutations in individuals without a positive family history of gastric or breast cancers. This observation motivated us to review and present a novel multidisciplinary clinical approach (nutritional, surgical, and image screening) for single subjects who present germline CDH1 mutations but do not fulfil the classic clinical criteria, namely those identified as—(1) incidental finding and (2) individuals with lobular breast cancer without family history of gastric cancer (GC).

Objectives: We aimed to determine whether radiomic features extracted from a highly homogeneous database of breast MRI could non-invasively predict pathological complete responses (pCR) to neoadjuvant chemotherapy (NACT) in patients with breast cancer. Methods: One hundred patients with breast cancer receiving NACT in a single center (01/2017–06/2019) and undergoing breast MRI were retrospectively evaluated. For each patient, radiomic features were extracted within the biopsy-proven tumor on T1-weighted (T1-w) contrast-enhanced MRI performed before NACT. The pCR to NACT was determined based on the final surgical specimen. The association of clinical/biological and radiomic features with response to NACT was evaluated by univariate and multivariable analysis by using random forest and logistic regression. The performances of all models were assessed using the areas under the receiver operating characteristic curves (AUC) with 95% confidence intervals (CI). Results: Eighty-three patients (mean (SD) age, 47.26 (8.6) years) were included. Patients with HER2+, basal-like molecular subtypes and Ki67 ≥ 20% presented a pCR to NACT more frequently; the clinical/biological model’s AUC (95% CI) was 0.81 (0.71–0.90). Using 136 representative radiomics features selected through cluster analysis from the 1037 extracted features, a radiomic score was calculated to predict the response to NACT, with AUC (95% CI): 0.64 (0.51–0.75). After combining the clinical/biological and radiomics models, the AUC (95% CI) was 0.83 (0.73–0.92). Conclusions: MRI-based radiomic features slightly improved the pre-treatment prediction of pCR to NACT, in addiction to biological characteristics. If confirmed on larger cohorts, it could be helpful to identify such patients, to avoid unnecessary treatment.

Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women’s psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.