Breast Cancer Subtypes Can Be Determinant in The Decision Making Process to Avoid Surgical Axillary Staging: A retrospective cohort study

Purpose: The need for performing axillary lymph-node dissection in early breast cancer when the sentinel lymph node (SLN) is positive has been questioned in recent years. The purpose of this study was to identify a lowrisk subgroup of early breast cancer patients in whom surgical axillary staging could be avoided, and to assess the probability of having a positive lymph-node (LN). Methods: We retrospectively evaluated 612 consecutive women affected by early breast cancer. We considered age, tumour size, histological grade, vascular invasion, lymphatic invasion and cancer subtype (Luminal A, Luminal B HER-2+, Luminal B HER-2-, HER-2+, and Triple Negative) as variables for univariate and multivariate analyses to assess probability of there being a positive SLN o non-sentinel lymph node (NSLN). Chi-square, Fisher’s Exact test and Student’s t tests were used to investigate the relationship between variables; whereas logit models were used to estimate and quantify the strength of the relationship among some covariates and SLN or the number of metastases. Results: A significant positive effect of vascular invasion and lymphatic invasion, and a negative effect of TN were noted. With respect to positive NSLN, size alone has a significant (positive) effect on tumour presence, but focusing on the number of metastases, also age has a (negative) significant effect. Conclusion: This work shows correlation between subtypes and the probability of having positive SLN. Patients not expressing vascular invasion, lymphatic invasion and, moreover, a triple-negative tumor subtype may be good candidates for breast conservative surgery without axillary su

Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer

The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents ≤ 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB

Localization of sentinel lymph node in breast cancer. A prospective study

Introduction: Sentinel Lymph Node Biopsy (SLNB) is the standard of care for staging axillary lymph nodes in women with breast cancer and clinically negative nodes. It is associated with reduced arm morbidity, moderated or severe lymphoedema, and a better quality of life in comparison with standard axillary treatment. Unfortunately, skip metastases makes all minimally invasive approaches, such as axillary sampling, unreliable. The aim of the present clinical prospective study is to evaluate the position of SLN in an important number of cases and establish the real incidence of skip metastases in clinically nodenegative patients. Patients and methods: A cohort of 898 female patients with breast carcinoma was considered, from 2001 to 2008. Once SLN was localized, by means of radio-colloid or blue dye staining, and isolated, a biopsy was performed. Only those positive for metastases were submitted to axillary dissection. Results: Only in nine cases a SLN was not isolated. We had 819 cases of first level SLN (group A) and 69 cases of second level SLN (group B). Considering all of 889 cases, SLN was localized in the second level in 69 patients (7.8%); but if we consider metastatic SLN alone (340 cases), it was in the second level in 23 subjects (6.8%). In total, we had a positive second level SLN in 2.3% of cases (23/889). Conclusion: Second level SLN could be considered only an anomalous lymphatic axillary drainage and it does not linked to particular histological variants of the primitive tumour. In our study, skip metastases were recognized in only 2.6% of cases, therefore, whenever a SLN is not isolated for any reason, the first level sampling represent a viable operative choice

Impiego degli Inibitori della Pompa protonica (IPP) in Piemonte: indagine sulle abitudini prescrittive dei Medici di Medicina Generale

Proton Pump Inhibitors (PPIs) (Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole and Esomeprazole), one of the most commonly prescribed classes of medications in the primary care setting, are considered a major advance in the treatment of acid-peptic diseases. In Italy PPIs are reimbursed by National Health Service on the basis of CUF (Commissione Unica del Farmaco) 1 and 48 Notes. In 2002 and 2003 a significant increase in PPIs consumption and expenditure have been documented, showing differences between regions. The aim of this study is to investigate and monitor, at regional level, type and entity of PPIs use through a drug utilization study, evaluating prescribing behaviour and compliance of PPIs treatments with CUF Notes indications. The study has been carried out on a sample of 436 General Practitioners belonging to 22 Piemonte's ASL (Aziende Sanitarie Locali). The data analysis shows that acid-related pathologies are significantly more common in patients with at least 50 years of age and the most frequent condition is represented by gastroesophageal reflux disease. Despite the general conditions of PPIs use by General Practitioners in terms of duration and dosage of therapy result in most cases (from 49% to 80% for duration and from 54% to 97% for dosage) compliant with what proposed by CUF Notes, in some cases the same CUF Notes indications seem to be not observed. Consequently the Piemonte Region has decided to plan a guideline on PPIs rational use. Such guideline, expected to be introduced in the regional area, may also be considered as an instrument able to lead to a more appropriate expenditure for this drug class. Moreover, in order to control PPIs expenditure, pharmacoeconomic methodologies can be applied allowing to identify the most cost - effective active substance and therapeutic scheme, overcoming CUF Notes which consider all PPIs use under the same reimbursement conditions

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Il carcinoma della tiroide dalla diagnosi alla terapia

From 1999 to 2007 we performed 104 surgical operations for thyroid malignancies. Over the same period, 312 patients underwent surgery for benign lesions of the thyroid gland. The patients were subdivided on the basis of age bracket and gender and the distribution of cancer and benign nodules was evaluated. Feasibility and diagnostic accuracy of ultrasonography, scintigraphy and fine needle aspiration cytology were also evaluated. The incidence of thyroid cancer was 25% in all patients. Patients aged 71 had the highest rate of malignancies: 52% of patients under 30 years of age and 46% over 70 years. Males showed a higher incidence than females. The scintigraphic findings were an area of low uptake in 19 cases (47.5%), an irregular pattern in 12 patients (30%) and a high uptake in 9 cases (22.5%); in 3 of them (7.5%), cancer was in the contralateral lobe and in 2 cases (5%) the dimensions were 8 and 4 mm. Forty-three patients had a single hypoechoic nodule at ultrasonography (41.3%), 3 (3%) were found with hypoechoic nodules containing calcifications and 1 (0.9%) a single anechoic nodule. Fifty-six patients (53.9%) had multiple nodules and 1 (0.9%) was admitted for a latero-cervical lymph node. FNAC revealed 11 cases of fibronectin expression (14.4%): in particular, 3 patients (4%) had cancer in the contralateral lobe and 3 patients (4%) had tumours measuring less than 5 mm. Thyroid surgery is safe and the morbidity rate is about 2%. We observed only one lesion of recurrent nerve (0.5% of patients), temporary recurrent palsy in 2.8% of patients and transient hypocalcaemia in 6.7% of cases

The sentinel node biopsy is not contraindicated in multifocal breast carcinoma

Aim. Following the availability of the results ofvalidation studies, the sentinel lymph node biopsy(SLNB) has replaced routine axillary dissection(AD) as the new standard of care in early unifocal breast cancers.Multifocal (MF) and multicentric (MC) tumours have been considered as a contraindication for this technique due to the possible incidence of a higher false-negative rate. In this retrospective study we try to demonstrate the usefulness of SLNB in MF/MC breast carcinoma. Patients and Methods. Eight hundreds and fiftyeightpatients with breast carcinoma underwent a conservative surgery and sentinel node excision. Ninety-four out of 858 patients had histological diagnosis of multifocal breast carcinoma; out of these patients, 22 had SLN localization by both radio-colloid and blue dye, and 72 had localization by radio-colloid only. Results. Using radioisotope technique SLN was identified in 90/94 cases (95.7%). Using radioisotope technique and blue dye the SLN was identified in all 94 cases. SLNs were positive for metastases in 53 of the 94 cases (56.4%), in 39 cases (41%) were negative. The axillary dissection was performed in all 53 patients with positive SLNs: in 22 patients (41.5%) the SLN was the only site of axillary metastasis. None of the patients within this group experienced axillary recurrence at follow-up (median 54 months, ranging from 19 to 110 months). Conclusions. The high accuracy of SLNB in MF and MC breast cancer demonstrates,according to the results of other series published in the literature, that bothMF andMC tumours do not represent a contraindication for SLNB anymore. Eur. J. Oncol., 16 (2), 105-110,201

Cervical Specimen Order and Performance Measures of Chlamydia trachomatis Diagnostic Testing

The orders of three endocervical specimens of 3,561 women for Chlamydia trachomatis testing were randomized to determine whether test performance measures of two nucleic acid amplification tests and a DNA probe were affected by swab order. Specimen collection order did not appear to affect the diagnostic accuracy of these tests

Trattamento chirurgico di un caso di fibroistiocitoma maligno del mesocolon trasverso

INTRODUZIONE: I fibroistiocitomi (MFH) sono dei sarcomi che originano dai tessuti molli, solitamente si localizzano nelle estremità dell’organismo nel tronco e nel retroperitoneo; la localizzazione dei MFH primitivi a livello addominale e/o intestinale è molto rara, infatti non più di 40 casi sono stati descritti a tutt’oggi in letteratura. CASO CLINICO: Paziente donna di anni 80 nella quale è stata osservata una tumefazione localizzata a livello della regione epigastrica e dell’ipocondrio di destra, di consistenza teso elastica, ricoperta da cute integra e associata a sintomatologia dispeptica. Gli esami di laboratorio erano nella norma eccetto l’Emoglobina di 8,2 gr/dl, i Globuli Rossi di 3,06x 199/L, la Sideremia 22 μg/ml e la Ferritina di 579 ng/ml. L’ ecografia dell’addome, la TC e la RMN ponevano un orientamento diagnostico per una neoformazione pluriconcamerata a parziale contenuto fluido-sovrafluido nella regione epi-mesogastrica di verosimile pertinenza pancreatica (eteroplasia a contenuto mucinoso). La laparotomia esplorativa evidenziava una voluminosa massa che dislocava anteriormente lo stomaco e lateralmente a sinistra il lobo sinistro del fegato. La neoformazione, di circa 15 cm di diametro massimo, interessava il mesocolon trasverso, era adesa alla parete posteriore dell’antro gastrico e non presentava piani di clivaggio con il corpo e la coda del pancreas. Si è proceduto pertanto allo scollamento della massa con lo stomaco, alla pancreasectomia sinistra e alla conservazione della milza. Il quadro istologico deponeva per fibro istiocitoma maligno, variante a cellule giganti; riguardo il pancreas era sede di pancreatite cronica. CONCLUSIONI: I MFH intraaddominali sono neoplasie molto rare ad alta malignità. La diagnosi differenziale deve includere le neoplasie cistiche del pancreas (cistoadenomi e cistoadenocarcinomi, mucinosi e sierosi) i linfangiomi cistici, i mesoteliomi cistici e i grossi ematomi; si devono prendere in considerazione, inoltre, le grosse neoplasie epatiche, le neoformazioni benigne del fegato e la echinococcosi epatica. La diagnosi preoperatoria è difficile da ottenere, ma può essere sospettata nei casi in cui dalla diagnostica per immaggini evidenzia voluminosa massa addominale soprattutto nei pazienti anziani

Diagnosis and Clinical Management of Neuroendocrine Tumor of the Breast: Report of Six Cases and Systematic Review of Existing Literature

ntroduction: Neuroendocrine neoplasm of the breast (bNENs) are considered a rare disease, even if in WHO data they represent about 2-5 % of all breast cancer. The last WHO classification includes: well-differentiated neuroendocrine tumor (bNET), neuroendocrine carcinoma (NEC) and invasive carcinoma with neuroendocrine differentiation. The current knowledge on clinical management of bNENs is poor and patients are usually treated according to non-endocrine tumor components guidelines. Materials and Methods: We presented our experience of six cases of bNENs. Moreover, we conducted a systematic review of published data on diagnosis, treatment and outcome of this kind of tumors. Results: bNENS usually presented as palpable breast masses, classically appearing as irregular hypoechoic lesions at US examination and as hyperdense masses at mammography. Usually pre-operative tumor biopsy is not able to recognize the neuroendocrine components and the final diagnosis is performed only on definitive histopathological assessment. The most frequent subtype seems to be neuroendocrine carcinoma and synaptophysin is positive in most specimens. Treatment strategies, including surgical treatment, radiotherapy and medical treatment are nowadays based on current non-endocrine breast cancer guidelines, independently from neuroendocrine components, even if some studies have proposed the use of somatostatin analogues for bNET and cisplatin-etoposide for NEC. Prognosis of all bNENs, especially of poorly differentiated neoplasia, seems worse compared to non-neuroendocrine breast cancer and stage and morphology seem the best predictor of tumor outcome. Conclusions: We provide an algorithm for clinical management of bNETs, basing on available data. More studies are necessary for confirming the best treatment strategy for these patients, in order to improve clinical outcome