Biomedical subjects
Emanuele Crocetti
Publications and source records attributed to Emanuele Crocetti.
Clinical significance and optimal management of patients with an "atypia, probably benign" (C3) report at FNAC of the breast.
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What is hidden behind urban and semiurban cancer incidence and mortality differences in central Italy?
AIMS AND BACKGROUND: To analyze differences in cancer incidence and mortality between urban and semiurban municipalities in central Italy. METHODS AND STUDY DESIGN: Population-based survey in the provinces of Florence and Prato in Central Italy involving cancer patients diagnosed between 1985 to 1997 and cancer deaths from 1985 to 1998. RESULTS: Urban-semiurban incidence ratios were significantly high in both genders for all cancer sites combined (males 1.06, females 1.09), lung (1.11 and 1.37), Kaposi's sarcoma (1.96 and 2.39) and urinary bladder (1.23 and 1.44) and significantly low for stomach cancer (0.76 and 0.84). Among females, urban incidence excesses were present for breast, cervix uteri and skin melanoma and among males for prostate, Hodgkin disease, non-Hodgkin lymphomas and mesotheliomas. Most of the cancer mortality rate ratios corresponded to the incidence rate ratios. CONCLUSIONS: We found that cancer risks and deaths were not homogeneously distributed in the analyzed area, but an urban gradient was present. Part of the differences can probably be attributed to environmental exposures and lifestyle.
Incidence and survival cancer trends in children and adolescents in the Provinces of Florence and Prato (Central Italy), 1985-1997.
AIMS AND BACKGROUND: The incidence of childhood and adolescent cancers has been increasing during the last decades in most Western countries. Improvements in cancer survival rates have also been observed according to the availability of more efficient therapies. METHODS AND STUDY DESIGN: A total of 518 cancer cases (age, 0-19 years) incident in the period 1985-1997 in the Tuscany Cancer Registry area, corresponding to the Provinces of Florence and Prato (Central Italy), were analyzed. Incidence rates and estimated annual percentage change were computed according to sex, 5-year age groups and diagnostic groups of the International Classification for Childhood Cancer. All patients were actively followed at 31.12.1998, and 5-year survival rates were computed for cases diagnosed in 1985-1990 and 1991-1997. RESULTS: Overall age-standardized incidence rates were 186.7/10(6) for males and 175.4 for females. In 1991-1997, standardized incident rates were 50.8 for leukemias, 44.6 for lymphomas, and 34.3 for CNS tumors. There was a marked increasing trend for lymphomas that grew at a yearly rate of +12.1% and less evident increasing tendency for leukemias, CNS tumors and carcinomas. The overall survival rate was 88% at one year, 78% at 3 years, and 74% at 5 years. A slight improving tendency in survival was evident over time. CONCLUSIONS: The study pointed out that in the examined area, during 1985-1997, there was a significant increasing incidence trend for lymphomas. Survival rates were as high as in other Western countries - evidence of the high level of diagnostic and treatment services in the area.
Free to total PSA ratio is not a reliable predictor of prostate biopsy outcome.
AIMS AND BACKGROUND: The aim of this study was to assess the validity of predictors of prostate biopsy outcome in order to improve their positive predictive value. MATERIAL AND METHODS: The study material consisted of a consecutive series of 410 prostate biopsies performed during 2003. The variables tested as possible predictors were age, findings at palpation (DRE) and ultrasonography (TRUS), total prostate-specific antigen (PSA), and free-to-total prostate-specific antigen (F/T) ratio. The association with biopsy outcome (cancer vs non-cancer) was investigated by univariate and multivariate analysis. RESULTS: All tested variables showed a statistically significant and independent association with biopsy outcome both in univariate and multivariate analysis. Nevertheless, no variable had good performance as a biopsy indicator: depending on the considered variable, three to nine cancer biopsies would be delayed in order to avoid ten benign biopsies. Using 0.12, 0.15 and 0.20 as the cutoff for F/T would avoid 77.3%, 64.4% and 43.1% of benign biopsies but would delay 54.0%, 35.6% and 21.0% of cancer biopsies, respectively. CONCLUSION: Although it may contribute to diagnostic suspicion, F/T should never exclude a biopsy indicated because of suspicion arising from other diagnostic tests.
Long-term results in patients affected by testicular seminoma treated with radiotherapy: risk of second malignancies.
AIMS: To report clinical results in patients with testicular seminoma treated with postoperative radiotherapy with regard to survival, acute and late toxicity, and risk of second malignancy. MATERIALS AND METHODS: 176 stage I-Il testicular seminoma patients treated with radiotherapy from 1964 to 1994 at the Radiotherapy Division of Pisa University, using 60Co or Linac, were analyzed retrospectively. The follow-up ranged from 0.13 to 32.37 years, with a median of 12.1 years. The observed numbers of second malignancies were compared with those expected, taking into account age, sex, and incidence rates from the Tuscany Tumor Registry. RESULTS: Overall and specific survival at 10-15 years were 89-82% and 93-92%, respectively. Multivariate analysis revealed a significantly better survival in patients younger than 50 years and in those treated with Linac. Severe late sequelae occurred in 8% of the patients. Sixteen second malignancies were observed (14 solid tumors and 2 leukemias); median latency was 13 years (range, 3-27) and the observed/expected ratio 1.4 (P not significant). Solid cancers were localized in the bladder (2), kidney (2), skin (2), stomach (1), prostate (1), lung (1), larynx (1), uvea (1) and contralateral testicle (1); 1 patient presented an intestinal carcinoid and 1 a metastasis from an unknown primary. The risk of a second malignancy was higher in the patient group receiving less than 4000 cGy (observed/expected, 2.8; P = 0.015). CONCLUSIONS: The study confirmed the high cure rate in stage I-II seminomas after postoperative radiotherapy. Incidence of a second malignancy was higher than expected, but the difference was not statistically significant.
What gender differences in cancer incidence changed during the last 10 years in central Italy?
AIMS AND BACKGROUND: We have investigated whether gender differences in cancer incidence have changed during the mid 1980s to late 1990s, and whether certain changes could be clues for gender-specific modifications in carcinogenic exposures. METHODS: We used the incidence data from the Tuscany Cancer Registry and computed the standardized (on the European standard population) male-to-female incidence rate ratios (IRR) for two periods, 1986-87 and 1996-97, with corresponding 95% confidence intervals. Such statistics were calculated for two age groups, 0-59 years and 60 years and over. RESULTS: Among younger subjects there was a remarkable reduction in the IRR for smoking-related cancer sites such as oral cavity (IRR from 4.3 to 2.2), esophagus (IRR from 6.2 to 4.2), larynx (IRR from 13.3 to 5.7), and lung (IRR from 6.5 to 3.3). Less evident changes were observed among subjects aged 60 and over, eg for lung the IRR fell from 8.1 to 6.2. CONCLUSIONS: Most of the differences examined were probably due to changes in tobacco smoking which were different between genders during the last decade, with a decreasing prevalence of smokers among males and an increasing trend among females.
[Estimates of cancer incidence in Tuscany, year 2000. Between method accuracy and communication appropriateness].
This study applies a method for the estimation and temporal projection of cancer incidence. The estimates are disaggregated to the Local Health Units; they refer to Tuscany for the year 2000 and to the incidence of cancer at three specific sites (lung, breast, prostate). The mortality data derive from the Regional Mortality Registry and the incidence data from the Tuscan Cancer Registry, which includes two provinces: Florence and Prato. The choice of method is discussed and a validation of the estimates obtained, using the incidence data observed in the province of Prato. The estimates and the temporal projections are required for accurate health planning, and they present the means to overcome health planning based on the historical data of medical care only. We suggest that appropriate communication of these estimates should address their limits, due to the uncertainty of the temporal prediction on the one hand and the possibility (only partially verifiable) of the violation of the assumptions on which any method for the estimation of cancer incidence is based.
Association of endometrial thickness assessed at trans-vaginal ultrasonography to endometrial cancer in postmenopausal women asymptomatic or with abnormal uterine bleeding.
PURPOSE: To define the normal cut off of endometrial thickness as measured at transvaginal ultrasonography (TVUS) in order to define postmenopausal women without symptoms or with abnormal uterine bleeding (AUB) at risk of endometrial carcinoma (EC). MATERIALS AND METHODS: 3460 postmenopausal women (2240 asymptomatic, 1220 with AUB) undergoing TVUS. These series was linked with the Tuscany Cancer Registry archives in order to identify subjects who developed EC subsequent (within two years) to TVUS. RESULTS: Thickness (half layer) was significantly reduced in 2234 subjects not developing EC (1.68 mm; range = 0-20, SD 3.14) as compared to 6 subjects developing EC (4.67 mm, range = 0-10, SD 3.67) (p=0.02). A 4 mm cut off was associated with a sensitivity of 66.7%, a specificity of 92.1%, a positive predictive value of 2.2% and a negative predictive value of 99.9%. Similarly, in subjects with AUB, thickness (half layer) was significantly smaller in the 1175 subjects not developing EC (2.46 mm, range 0-20, SD 3.59) as compared to 45 subjects developing EC (8.0 mm, range 0-44, SD 6.76) (p<0.001). The best cut off for clinical purposes was 4 mm, with a sensitivity of 91.1%, a specificity of 79.8%, a positive predictive value of 14.8% and a negative predictive value of 99.6%. CONCLUSIONS: The study confirms the usefulness of measuring endometrial thickness (half layer cut off = 4 mm) with TVUS in asymptomatic postmenopausal women, both in asymptomatic subjects to indicate further special surveillance and in subjects with AUB to indicate immediate invasive assessment.
Changes from mid-1980s to late 1990s among clinical and demographic correlates of melanoma thickness.
Tumour thickness is the most relevant prognostic factor for cutaneous melanoma. Although the increasing incidence of melanoma is currently attributable to "thin" lesions, the incidence rates of "thick" melanomas have not declined. We want to identify the clinical and demographic characteristics of patients that are associated with diagnosis of thick (> 3 mm) cutaneous melanoma and whether they had changed from mid-1980s to late-1990s. Cutaneous malignant melanomas incidence in 1985-87 and in 1995-97 were retrieved from the Tuscany Cancer Registry, central Italy. Only cases with Breslow-thickness information (182/260 in 1985-87 and 387/490 in 1995-97) were included. Thickness was categorised in < = 1 mm, 1-3 mm and > 3 mm. Thickness was evaluated for each period of time according to gender, age, histological type, site and residence. For cases diagnosed in 1995-97 the effect of such variables in predicting the risk of a thick tumour (vs. a thin one) was analysed in a logistic model. In 1985-87 patients with thick melanoma were more likely to be - with a statistically significant difference - males (38.1 % of thick tumours) than females (19.4 %), over 70 (57.7 % of thick tumour), with nodular melanoma (62.1 %) and residents far from the city of Florence (30.3 %); no differences were evidenced according to site. From 1985-87 to 1995-97 there was a global shift towards thinner melanomas. In 1995-97 nodular type and old age were the only variables significantly associated with thick melanomas when other factors were taken into account in a multivariate analysis. According to most recent data, early detection activities should be focused on older patients and on nodular histotype. Male sex and residence was no longer found to be associated with late melanoma diagnosis.
Cancer trends in Italy: figures from the cancer registries (1986-1997).
The Italian Network of Cancer Registries analyzed incidence and mortality cancer trends during the period 1986-1997 Overall, 525,645 incident cancers and 269,902 cancer deaths (in subjects 15 years and older) were included. Age-adjusted rates, joinpoints (points in time where trend significantly changes from linearity) and estimated annual percent changes in rates (EAPC) were computed. Overall cancer incidence was significantly increasing in both sexes and cancer mortality was significantly decreasing (since 1991 among males). Incidence and mortality trends are summarised for single cancer sites. Crude rates are also showed to evaluate the effect of population ageing in terms of diagnostic and therapeutic burden for the National Health System.
The use of models for estimating overall incidence trend.
Several approaches to evaluate an overall trend including Registries with different length of activity with a defined period of time have been evaluated in the cancer trend study of the Italian Network of Cancer Registries (AIRT). The study used the nine Registries of the pool AIRT in the period 1986-1997. Data for 1986-1993 from the Registry of Ragusa have been excluded to simulate the inclusion of a Registry with partial observation. Four different approaches have been used: Golden standard (GS) as a weighted mean of the observed standardised (European population) rates in the whole pool AIRT; 2) Raw trend (TG) computed with partial data of Ragusa; 3) Model trend (TM) estimated by means of a log-linear model including age, registry and period as independent variables and applied on the partial data set; Adjusted trend (TC) computed on complete data for eight Registries, observed 1994-1997 data of Ragusa and estimated data for Ragusa for 1986-1993 computed by (3) model. The trend estimates, as estimated annual percent change of the standardised rates (EAPC) have been compared with GS. The results of this preliminary analysis do not recommend the use of raw trend and indicate adjusted trend as the most reliable method for trend estimate.
[Temporal trends in AIDS incidence and mortality in Tuscany (1987-2000)].
OBJECTIVE: To describe temporal trends in AIDS incidence and mortality in an Italian region. DESIGN: Descriptive study based on incidence and mortality registries. SETTING: Tuscany. MAIN OUTCOME MEASURES: AIDS incidence and mortality annual truncated rates, age-standardized; joinpoint analysis highlighted significant changes in the temporal trends. RESULTS: AIDS incidence rose until 1995 and then decreased by 30% every year; AIDS mortality rose in men until 1995 and in women until 1996, then decreased by 35.9% and 49.7% every year respectively. Differences in AIDS mortality have been found between the residents of the coastline municipalities and those of other municipalities. CONCLUSION: Differences in the temporal trends may mirror differences in risk group composition and in health-care access.
[Automatic coding of pathologic cancer variables by the search of strings of text in the pathology reports. The experience of the Tuscany Cancer Registry].
The present study evaluates the application of an automatic system for variables coding by means of strings reading in the text of the pathology reports, in the database of the Tuscany Cancer Registry. Incidence data for the years 2000 (n. 6297) and 2001 (n. 6291) for subjects for whom computerised pathology reports were available were included. The system is based on Queries (SQL language) linked to Functions (Visual Basic for Applications) that work on Windows Access. The agreement between original data inputted by the registrars and variables coded by means of automatic reading has been evaluated by means of Cohen's kappa. The following variables were analysed: cancer site (kappa = 0.87 between "manual" and automatic coding, for cases incident in the year 2001), morphology (kappa=0.75), Berg's morphology groups (kappa=0.87), behaviour (kappa=0.70), grading (kappa=0.90), Gleason (kappa=0.90), focality (kappa=0.86), lateralily (kappa=0.36), pT (kappa=0.92), pN (kappa=0.76), pM (kappa=0.28), number of lymph nodes (kappa=0.69), number of positive lymph nodes (kappa=0.70), Breslow thickness (kappa=0.94), Clark level (kappa=0.91), Dukes (kappa=0.74). The system of automatic reading of strings allows to collect a very huge amount of reliable information and its use should be implemented by the Registries.