Biomedical subjects

D Morrone

Publications and source records attributed to D Morrone.

5 recordsLinked to original sources

PubMed1992

Breast cancer: reliability of mammographic appearance as a predictor of hormone receptor status.

The association of mammographic appearance with hormone receptor status was investigated in 397 patients with primary breast cancers. The mammographic appearance was classified as type 1, spiculated (n = 159); type 2, structural changes (density) (n = 102); type 3, calcifications (n = 30); type 4, circumscribed opacity (n = 65); and type 5, not visible on mammogram (n = 41). Univariate analysis showed a significant association with estrogen receptor (ER) status for age (less than 50 vs greater than or equal to 50 years), tumor TNM category (those in category 1 vs those in higher categories), and mammographic appearance; with progesterone receptor status, the association was significant only for age. Multivariate analysis adjusted for potential confounders confirmed a significant association between ER status and mammographic appearance (ER status was more likely with type 1 than with the other mammographic types), but the strength of the association was limited. The mammographic appearance of breast cancer is not a reliable method to predict hormone receptor status for clinical purposes.

Breast↗

PubMed1992

[The differential diagnostic criteria of breast microcalcifications].

The authors evaluated 127 cases (31 infiltrating carcinomas, 22 intraductal carcinomas, 74 benign lesions) of breast microcalcifications with no palpable lesions. The patients had undergone mammography, stereotaxic cytology and direct magnification (87 cases). Blind interpretation of standard films and of direct magnification was performed by two independent readers (A, B), who classified the cases according to radiologic pattern (annular, punctate, granular, linear, branching), degree of suspicion and need for surgical biopsy. The study confirmed the association of different types of microcalcifications with breast cancer (predictivity: annular, punctate, granular, linear, branching; A = 25%, 15%, 40%, 92%, 86%; B = 14%, 26%, 39%, 90%, 100%). However, diagnosis was not very accurate (sensitivity: A = 83%, B = 71.1%; specificity: A = 83%, B = 78.4%); it was also observed that most cancers can be diagnosed only at a relatively high cost in terms of unnecessary biopsies. Interobservers' agreement was high relative to diagnosis (negative/dubious vs. suspicious/positive = -88.9%; K = 58.5) and low for pattern attribution (52%). Direct magnification allowed better detail definition but if sensitivity improved (A = 87% vs. 80.6%; B = 64.5% vs. 51.6%), specificity was negatively affected (A = 73.2% vs. 80.4%; B = 69.6% vs. 80.3%), due to an excess of false positives. Stereotaxic cytology [inadequacy rate = 26%, sensitivity and specificity (ex inadequates) = 80% and 100%, respectively] was more accurate than mammography as far as the decision for surgical biopsy was concerned, and was correct in identifying most (A = 6/7, B = 7/11) of the cancers which had been misdiagnosed as benign at conventional and magnification mammography. Stereotaxic cytology should be routinely performed in cases of microcalcifications with no associated palpable lesions.

Adult↗

PubMed1992

[Errors in mammography. II. False positives].

The authors evaluate 261 consecutive mammographic false positives observed from 1985 to 1987. Histological evidence of benign lesion followed in all cases. The comparison with the actual number of cancers and of the whole of mammographic examinations performed in the study period allowed specificity and positive predictive value of mammography to be assessed as 99.5% and 83%, respectively. Specificity and predictivity are lower in younger women, but this is more likely to depend on a different age-related incidence of cancer and benign lesions than on an intrinsic limitation of the method. The reader's diagnostic aggressivity, more than his experience, seems to affect both specificity and predictivity. At review, false positives were mostly due to asymmetric densities (49) or to circumscribed opacities with clear-cut (44) or blurred (62) outlines, whereas irregular star-like opacities or distortions (19) were infrequent. Microcalcifications were, in most cases, apparently benign (39) or dubious (76); strong suspicion was rare (4). Overall, one-fourth to one-third (27.9%) of the cases were reported as strongly suspicious at review. Palpation and cytology were also falsely suspicious--that is, co-responsible for unnecessary biopsies in over 50% of cases. Our results suggest that further improvement in the specificity or positive predictive value of mammography seems unlikely. Moreover, the benign/malignant biopsy ratio (0.2:1) presently achieved in suspicious mammographic cases appears quite satisfactory.

Adult↗

PubMed1991

[Diagnostic errors in mammography. I. False negative results].

The authors evaluate 1455 consecutive breast cancers detected 1985-1987, undergoing mammography 6 months before diagnosis at the most. One hundred and seventy-eight cases reported as negative/benign were assumed as false negatives. Overall sensitivity was 88%, and was influenced by tumor stage (TIS = 80%, T1 = 83%, T2 = 91%, T3-4 = 95%) and patients' age (less than 40 = 76%, 40-49 = 78%, 50-59 = 91%, greater than 59 = 94%). Sensitivity varied also with readers' experience full- or part-time involved in reading mammograms (total cases = 92% vs 88%, T1 cases = 86% vs 74%). No correlations were evidenced between mammographic sensitivity and histologic type of cancer. Palpation and cytology allowed the correct identification of 98% of mammographic false negatives. One hundred and seventy-eight false negatives and 142 more cases showing evidence of a mammographic error more than 6 months before diagnosis were reviewed to assess the most common types of radiologic fault. A benign-like lesion was the most frequent finding (49.4%), whereas suspicious signs were infrequent at review (16.6%). Failure to encompass the lesion in the mammographic field or poor technique accounted for 3.8 or 1.3% of cases, respectively. 29% of false-negative subjects (mostly young or with a dense breast) showed no lesion even at review. This study confirms the good sensitivity of mammography but suggests a less confident diagnostic approach in younger women, stresses the need for other tests whenever a minimal doubt is present, and encourages the radiologist's full-time involvement in mammography and breast diagnosis to achieve greater experience and improve his diagnostic sensitivity.

Adult↗

PubMed1991

[Differential diagnosis of intracystic breast lesions in hemorrhagic cysts].

The authors report on 117 consecutive hemorrhagic breast cysts cases. All patients underwent cytologic examination of cystic fluid content and US or pneumocystography. Ten cancers (9 infiltrating, and 1 lobular in situ) and 22 papillomas had histologic confirmation--out of 45 cases undergoing surgical biopsy. Seventy-two cases exhibiting no intracystic growth have been followed for 5.4 years on the average and no cancer has developed so far. Pneumocystography or US had 100% predictive value for intracystic lesions; we observed that surgical biopsy could be safely avoided when both examinations were negative, that is in about 3/4 cases. No differential diagnosis of cancer and papilloma was possible on pneumocystography or US. Even though positive cytology was highly predictive for cancer, cytology exhibited poor sensitivity and surgical biopsy was necessary in all cases presenting with intracystic growth.

Adult↗