The 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

Accelerated hypofractionated whole-breast radiotherapy (WBRT) is considered a standard therapeutic option for early breast cancer (EBC) in the postoperative setting after breast conservation (BCS). A boost to the lumpectomy cavity may further increase local control. We herein report on the 10-year results of a series of EBC patients treated after BCS with hypofractionated WBRT with a concomitant photon boost to the surgical bed over 4 weeks. Between 2005 and 2007, 178 EBC patients were treated with a basic course of radiotherapy consisting of 45 Gy to the whole breast in 20 fractions (2.25 Gy daily) with an additional boost dose of 0.25 Gy delivered concomitantly to the lumpectomy cavity, for an additional dose of 5 Gy. Median follow-up period was 117 months. At 10-year, overall, cancer-specific, disease-free survival and local control were 92.2% (95% CI 88.7-93.4%), 99.2% (95% CI 96.7-99.7%), 95.5% (95% CI 91.2-97.2%) and 97.3% (95% CI 94.5-98.9%), respectively. Only eight patients recurred. Four in-breast recurrences, two axillary node relapses and two metastatic localizations were observed. Fourteen patients died during the observation period due to other causes while breast cancer-related deaths were eight. At last follow-up, ≥G2 fibrosis and telangiectasia were seen in 7% and 5% of patients. No major lung and heart toxicities were observed. Cosmetic results were excellent/good in 87.8% of patients and fair/poor in 12.2%. Hypofractionated WBRT with concomitant boost to the lumpectomy cavity after BCS in EBC led to consistent clinical results at 10 years. Hence, it can be considered a valid treatment option in this setting.

Vacuum-assisted breast biopsy (VABB) plays a fundamental role in the preoperative assessment of breast lesions providing large histology samples that are useful to define diagnoses and biological parameters to guide treatment planning. This technique has been used in our institute since 2000 and two new wireless handheld ultrasound-guided VABB devices have been introduced since May 2012. In this report we analyze our experience with these revolutionary devices which are able to provide the option of single-insertion contiguous tissue samples respectively with a 13/14-gauge aperture. Our initial experience on 75 lesions shows that these devices are safe, fast, procedurally advantageous for operators and well accepted by patients. Finally VABB procedures can markedly reduce the need for surgical biopsy.

The presence of symptoms warrants mammography, which is an accurate method for identifying male breast cancer. The frequency of invasive disease observed in our study was consistent with the literature (80%-90% IDC). The hormonal alterations induced by excess fat in our series appear to be correlated with the development of carcinomas with positive receptor status for both oestrogen and progesterone.

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Objectives: The purpose of this study is to assess the performance of radiologists using a new software called “COVID-19 score” when performing chest radiography on patients potentially infected by coronavirus disease 2019 (COVID-19) pneumonia. Chest radiography (or chest X-ray, CXR) and CT are important for the imaging diagnosis of the coronavirus pneumonia (COVID-19). CXR mobile devices are efficient during epidemies, because allow to reduce the risk of contagion and are easy to sanitize. Material and Methods: From February–April 2020, 14 radiologists retrospectively evaluated a pool of 312 chest X-ray exams to test a new software function for lung imaging analysis based on radiological features and graded on a three-point scale. This tool automatically generates a cumulative score (0–18). The intra- rater agreement (evaluated with Fleiss’s method) and the average time for the compilation of the banner were calculated. Results: Fourteen radiologists evaluated 312 chest radiographs of COVID-19 pneumonia suspected patients (80 males and 38 females) with an average age of 64, 47 years. The inter-rater agreement showed a Fleiss’ kappa value of 0.53 and the intra-group agreement varied from Fleiss’ Kappa value between 0.49 and 0.59, indicating a moderate agreement (considering as “moderate” ranges 0.4–0.6). The years of work experience were irrelevant. The average time for obtaining the result with the automatic software was between 7 s (e.g., zero COVID-19 score) and 21 s (e.g., with COVID-19 score from 6 to 12). Conclusion: The use of automatic software for the generation of a CXR “COVID-19 score” has proven to be simple, fast, and replicable. Implementing this tool with scores weighed on the number of lung pathological areas, a useful parameter for clinical monitoring could be available.

We previously reported on a cohort of breast cancer patients affected with ductal carcinoma in situ (DCIS) that were treated with breast conservative surgery and hypofractionated whole-breast radiotherapy with a concomitant boost to the lumpectomy cavity. We now report on the long-term results of the oncological and toxicity outcomes, at a median follow-up of 11.2 years. We also include an analysis of the predictive factors for local recurrence (LR). Eighty-two patients with long-term observation were considered for this report. All received hypofractionated post-operative radiotherapy with a concomitant boost (45 Gy/20 fractions to the whole breast and 50 Gy/20 fractions to the lumpectomy cavity). We report on LC rates at 5 and 10 years, overall survival (OS), and breast-cancer-specific survival (BCSS), employing the Kaplan–Meier method. Cox proportional regression analysis was used to determine the role of selected clinical parameters on the risk of local recurrence, by the univariate and multivariate models. After a median follow-up of 11.2 years (range 5–15 years), 9 pts (11%) developed LR. The LR rates at 5 years and 10 years were 2.4% and 8.2%, respectively. The 5- and 10-year overall survival rates were 98.8% and 91.6%, respectively. The 5- and 10-year breast-cancer-specific survival rates were 100.0% and 99.0%. Late skin and subcutaneous toxicities were generally mild, and cosmetic results were good–excellent for most patients. For the univariate regression analysis, ER positive status (HR; 95% CI, p = 0.021), PgR positive status (HR; 95% CI, p = 0.012), and the aggregate data of positive hormonal status (HR; 95% CI, p = 0.021) were inversely correlated to LR risk. Conversely, a high tumor grade (G3) was directly correlated with the risk of LR (HR; 95% CI, p = 0.048). For the multivariate regression analysis, a high tumor grade (G3) confirmed its negative impact on LR (HR 0.40; 95% CI 0.19–0.75, p = 0.047). Our long-term data demonstrate hypofractionated whole-breast radiotherapy with a concomitant boost to be feasable, effective, and tolerable. Our experience suggests positive hormonal status to be protective with respect to LR risk. A high tumor grade is a risk factor for LR.

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