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L Bucchi

Publications and source records attributed to L Bucchi.

At least 37 records · Page 2Linked to original sources
PubMed1998

Cervicography and HPV DNA testing as triage criteria for patients with abnormal pap smear.

Cervicography and HPV DNA testing have been proposed as intermediate triage techniques for the management of patients with Pap smear showing minor-grade atypia. The aims of the present study of 221 patients with positive Pap smear (ages 16-65) were (1) to evaluate the association of cervicography and HPV DNA test with the probability of biopsy and final histology diagnosis of CIN2 or worse, (2) to identify the combinations of results on cervicography and HPV DNA test associated with the absence of such lesions, and (3) to estimate the cost of a potential triage protocol for patients with HPV-CIN1 smear. The probability of biopsy showed a univariate association with the severity of the smear result and the cervicography classification but not the HPV DNA test. In the multivariate analysis, only the cervicography result was a significant predictor of biopsy. The final histology diagnosis showed a univariate association with each of the three tests and a multivariate association with the degree of cytology positivity and the cervicography result. Among patients with HPV-CIN1 smears, only a negative cervicography (with any HPV DNA test result) was always associated with the absence of severe histologic lesions. This pattern accounted only for 7% of such patients. The additional costs of a potential triage protocol based on cervicography were estimated to exceed the savings resulting from the reduced colposcopy rate.

Adolescent↗
PubMed1998

Multiple myeloma and work in agriculture: results of a case-control study in Forlì, Italy.

OBJECTIVES: To evaluate the relation between the exposure to specific pesticides in agricultural work and the risk of multiple myeloma (MM). METHODS: A case-control study was conducted in the province of Forlì, Italy. Forty-six cases of MM (20 females, 26 males; mean age 64 years, range 40 to 74) identified through the Romagna Cancer Registry in the years 1987-90, and 230 age- and gender-matched controls from the general population were interviewed in-person using a structured questionnaire focused on exposure to pesticides and other occupational and nonoccupational variables. RESULTS: Among nonoccupational factors, the education level and the altitude of the place of residence were related inversely to MM risk. First-degree familiarity for hematolymphopoietic neoplasias and previous herpes zoster diagnosis were associated positively with the disease. A nonsignificant increase in MM risk was observed among workers in agriculture as a whole (odds ratio [OR] = 1.31, 95 percent confidence interval [CI] = 0.62-2.74). An increased risk was associated specifically with the cultivation of apples and pears (OR = 1.75, CI = 1.05-2.91). As regards pesticide exposure, only the chlorinated insecticides were related to an increase in the risk of MM. CONCLUSIONS: This study suggests that agricultural work and exposure to pesticides have a role in the etiology of MM.

Adult↗
PubMed1998

Epiluminescence microscopy versus clinical evaluation of pigmented skin lesions: effects of Operator's training on reproducibility and accuracy. Dermatology and Venereology Society of the Canton of Ticino.

BACKGROUND: An acceptable level of reliability is a prerequisite for the introduction of epiluminescence microscopy (ELM) into the diagnosis of pigmented skin lesions. OBJECTIVE: To assess the effects of a training program on the reproducibility and accuracy of ELM as compared to clinical evaluation. METHODS: Before and after the program, 48 clinical images and their ELM counterparts were independently evaluated by seven participants. Reproducibility was measured by the kappa index, accuracy by the rate of exact diagnoses (RED) assuming histology as a reference. RESULTS: We observed (i) no effect of training on clinical reproducibility, (II) an improved reproducibility of ELM diagnoses of non-melanocytic lesions (NML) and melanomas but not of melanocytic nevi (MN), (iii) a greater increase in the clinical RED of NML and melanomas compared with MN and (iv) a similar though more pronounced increase in the RED on ELM. CONCLUSIONS: The effects of training were greater for ELM as compared to clinical diagnosis, and for NML and melanomas as compared to MN.

Dermatology↗
PubMed1998

The cancer registry in the monitoring of cervical screening practice: the neglected value of the Pap smear in patients diagnosed with CIN3 on biopsy.

Patients diagnosed with CIN3 on biopsy without a Pap smear are an inevitable correlate of the extensive utilization of colposcopy as a basic screening test. In a series of 248 CIN3 cases diagnosed on biopsy and notified to the Romagna Cancer Registry between 1986 and 1993, we evaluated the independent association between the Pap smear result and (1) the final histology diagnosis, (2) the first choice treatment, and (3) the appropriateness of hysterectomy. The patients were grouped into the following categories: (1) no smear, ie colposcopy only (n = 40 or 16%), (2) CIN1, CIN2, LGSIL, and minor changes, (3) CIN3 and HGSIL, and (4) carcinoma. In multiple logistic regression analysis, patients without a Pap smear were used as a reference category. Patients with smears reported as CIN1-2/LGSIL or less as well as CIN3/HGSIL had a significantly lower probability of invasive squamous carcinoma (odds ratio = 0.26 for both categories) compared with those not undergoing cytology. The Pap smear result was not a determinant of the first choice treatment. Hysterectomy had a greater probability of being unnecessary if performed in patients with smears reported as showing CIN3/HGSIL (odds ratio = 5.05) or less. In conclusion, this registry-based study demonstrated that the Pap smear had an independent but neglected value in the assessment of cases reported as CIN3 on colposcopy-guided biopsy.

Colposcopy↗
PubMed1998

[Analysis of the intralaboratory diagnostic variability in the Imola cervical screening program].

The value of the assessment of intralaboratory variability as a method for quality control of cervical screening is an ill-defined one. This model has been advocated and utilized by some Authors and only indirectly addressed by others. In Italy, only occasional studies have been published. The present analysis is part of a series of studies for the evaluation and quality control of the population cervical screening programme in the area of Imola. The agreement between the 5 cytologists was tested over a series of 150 smears selected from the routine material. The data were analyzed with the k statistic and the degree and direction of discrepancies were assessed by the percent distribution of paired diagnoses. The k values for agreement between the 10 possible pairs of cytologists varied between 0.25 and 0.49 (average value, 0.37). The indexes for agreement as based on three classes ('Negative'/ASCUS + LGSIL + HGSIL/'Unsatisfactory') varied from 0.35 to 0.56 (average value, 0.46). The cytologist-specific k values (as based on five classes) ranged from 0.29 to 0.43. For the observer with the lowest specific coefficient (designated as C4), the excess disagreement was restricted to the ASCUS class and the 'Unsatisfactory' notation. In particular, C4 diagnosed more often 'Negative' smears (74% vs. 44-55%) and less frequently ASCUS (11% vs. 22-31%) and 'Unsatisfactory' smears (3% vs. 6-11%). ASCUS was the least reproducible diagnosis (k = 0.22). The evaluation of the degree and direction of the diagnostic discrepancies between the five cytologists showed that the frequency of concordant diagnoses of ASCUS was as low as 39.7%. However, the discrepancies were almost always of one degree and were directed towards the 'Negative' class. Conversely, ASCUS was associated with considerable proportions of the 'Negative' diagnoses (17.3%) and those of LGSIL (31.8%). In the occasions when one observer interpreted a smear as 'Unsatisfactory' the paired diagnoses were almost evenly distributed among 'Unsatisfactory' (49.2%) and 'Negative' (43.0%). In absolute terms, the k coefficients in this study were compatible with moderate agreement. However, they were unfavourably influenced by the modalities for smear selection. The study specimens were selected by all cytologists from the routine material over a short time period and did not include smears interpretable as showing carcinoma. A comprehensive evaluation of the diagnostic performance of C4 showed that the disagreement with other cytologists was restricted to the diagnosis of ASCUS and the 'Unsatisfactory' notation and was accounted for by a lower frequency of such reports coupled with a greater frequency of the 'Negative' diagnoses. A conservative approach to lesions of minor significance is the most likely explanation for that pattern of disagreement. Although characterized by the poorest k value, the ASCUS diagnosis proved to be generally matched with reports of minor cytology changes. This was consistent with the formal definition for ASCUS in the original Bethesda System. The observation that the ASCUS diagnosis is applied to those changes is a prerequisite for a more conservative utilization of such report. In conclusion, the study revealed important correlates of the k coefficients and provided an encouraging picture of the cytologic substrates of the diagnosis of ASCUS.

Carcinoma↗
PubMed1998

[The PAPNET system in the rescreening of negative cervical/vaginal smears. A study from the Imola cytology laboratory].

The rescreening of negative cervical/vaginal smears is one of the potential areas of utilization of the systems for computer-assisted cytology diagnosis. In the Imola cytology laboratory, a random sample of 1309 conventionally prepared smears that had been originally reported as negative was rescreened with the PAPNET System (Neuromedical Systems, Inc., Suffern, NY). Smears with a PAPNET diagnosis other than negative were further and independently evaluated by the staff of the laboratory and classified according to the majority report. The PAPNET rescreening confirmed the original negative diagnosis for 1188 smears (907.6/1000) and led to the detection of 46 ASCUS/LGSIL cases (35.1/1000) and 2 AGUS/HGSIL cases (1.5/1000). Seventy-three smears (55.8/1000) were interpreted as unsatisfactory. The majority report confirmed the original negative diagnosis for 42 (91%) of the 46 PAPNET diagnoses of ASCUS/LGSIL and 50 (68%) of the 73 smears interpreted as unsatisfactory. The 2 cases of AGUS/HGSIL diagnosed by PAPNET were confirmed. The detection rate of ASCUS/LGSIL decreased from 35.1/1000 to 3.1/1000 (rate ratio 0.09, 95% confidence interval [95% CI] 0.02-0.22). The rate of unsatisfactory smears decreased from 55.8/1000 to 17.6/1000 (rate ratio 0.31, 95% CI 0.20-0.47). The rate of negative smears increased from 907.6/1000 to 977.9/1000 (rate ratio 1.08, 95% CI 1.02-1.14). In conclusion, the PAPNET rescreening of negative smears brought about a low detection rate of severe cellular changes. Though greater, the detection rate of low grade changes was substantially and significantly reduced by the majority reports. At our laboratory, the PAPNET rescreening does not appear to improve the performance of conventional cytodiagnosis.

Carcinoma, Squamous Cell↗
PubMed1997

Protonophoric activity of NADH coenzyme Q reductase and ATP synthase in coupled submitochondrial particles from horse platelets.

A method to prepare coupled submitochondrial particles from horse platelets is described. The method allowed us to study the protonophoric activities of both complex I and complex V following the fluorescence quenching of the monoamine 9-amino-6-chloro-2 methoxyacridine (ACMA), a probe highly sensitive to the generation of a transmembrane delta pH. We carried out a kinetic analysis of each enzyme complex studying the proton translocation and the electron transfer activities of complex I as well as the proton translocation and the ATP hydrolytic activities of complex V. A micromethod to prepare coupled submitochondrial particles from platelets might be useful to investigate cell bioenergetic damage occurring in mitochondrial diseases and ageing.

Adenosine Triphosphatases↗
PubMed1997

Cohort study of association of risk of breast cancer with cyst type in women with gross cystic disease of the breast.

OBJECTIVE: To assess correlation between type of breast cyst and risk of breast cancer in women with gross cystic disease of the breast. DESIGN: Cohort study of women with breast cysts aspirated between 1983 and 1993 who were followed up until December 1994 for occurrence of breast cancer. SETTING: Major cancer prevention centre. SUBJECTS: 802 women with aspirated breast cysts. MAIN OUTCOME MEASURES: Type of breast cyst based on cationic content of cyst fluid: type I (potassium:sodium ratio > 1.5), type II (potassium:sodium ratio < 1.5), or mixed (both types). Subsequent occurrence and type of breast cancer. RESULTS: After median follow up of six years (range 2-12 years) 15 cases of invasive breast cancer and two ductal carcinomas in situ were diagnosed in the cohort: 12 invasive cancers (and two carcinomas in situ) among the 417 women with type I cysts, two cancers among the 325 women with type II cysts, and one among the 60 women with mixed cysts. The incidence of breast cancer in women with type I cysts was significantly higher than that in women with type II cysts (relative risk 4.62 (95% confidence interval 1.26 to 29.7)). These results were confirmed after adjustment for several risk factors for breast cancer (relative risk 4.24 (1.12 to 27.5)). CONCLUSIONS: The increased risk of breast cancer of women with breast cysts seems to be concentrated among women with type I breast cysts.

Adult↗
PubMed1997

Distal hyperplastic polyps do not predict proximal adenomas: results from a multicentric study of colorectal adenomas.

BACKGROUND: The association between distal hyperplastic polyps and proximal adenomas is still a matter of debate. We investigated this association while taking into account patient characteristics. METHODS: After exclusion of patients with inflammatory bowel diseases, familial adenomatous polyposis, or any cancer, 3088 eligible consecutive subjects aged 18 to 69 years underwent total colonoscopy in four gastroenterology units. The odds ratios (OR) of having proximal adenomas according to patient characteristics (age, sex, medical center, year of endoscopy, reasons for referral, and distal findings) were estimated in univariate and multivariate analyses. RESULTS: Patients with distal polyps of any type showed an adjusted OR of 2.5 (95% CI [1.9, 3.1] p < .001) of having proximal adenomas as compared with those without distal polyps. When distal adenomas and distal hyperplastic polyps were included in the multivariate model as independent factors, the presence of adenomas significantly increased the risk of proximal adenomas (OR = 2.8: 95% CI [2.2, 3.6] p < .001), whereas the presence of hyperplastic polyps did not (OR = 1.1: 95% CI [0.8, 1.5] p = .64). No association with number, size, or location of distal hyperplastic polyps was seen. CONCLUSIONS: Our data show that the presence of hyperplastic polyps should not be the sole indication for total colonoscopy because they are not associated with proximal adenomas when adjusting for patient characteristics and presence of distal adenomas.

Adenoma↗
PubMed1997

Effect of routine mammography practice on tumour size of a registry-based series of breast cancer cases compared with those observed in a screening cohort.

Routine mammography (MX) practice based on self-referral is considered not to be susceptible to monitoring at the population level. Invasive breast cancer cases notified to the Romagna Cancer Registry between 1989 and 1991 (total 654) were stratified by MX experience and were compared for the proportion of lesions greater than 2 cm in size (T2+) with cases observed in the study group of the Swedish Two Counties Screening Trial (TCST). Any MX more than 6 months prior to diagnosis was considered a previous routine examination. The proportion of cases registered in Romagna within 6-11 months of the most recent MX was quite similar to that shown by the interval cases of the TCST (50% vs 53%). T2+ cases registered in Romagna 12-23 months (27%) and 24-35 months (19%) after previous MX were similar in frequency to those detected at second and later screens in the TCST (22%). For longer intervals, the percentage of large tumours in the Romagna series increased, up to 45% among the cases registered more than 48 months since last MX (p < 0.0001). The whole group of cases with previous MX in Romagna and its counterpart in the TCST (i.e. interval cases + cases detected at second and later screens) had the same size distribution (35% vs 34%). The frequency of large tumours in the total series from Romagna was greater than in the total study group of the TCST (45% vs 36%, p < 0.0001). The difference was entirely accounted for by the cases with no previous MX.

Adult↗
PubMed1997

Critical effects of intense sun exposure on the expression of epiluminescence microscopy features of acquired melanocytic nevi.

BACKGROUND: Current knowledge of the histologic counterparts of epiluminescence microscopy (ELM) features in pigmented skin lesions is limited. As a particular aspect of this problem, the transient effects of intense sun exposure on the morphological characteristics of melanocytic nevi may influence the expression of ELM features as well as the demonstration of stable and consistent histologic correlates. OBSERVATIONS: Forty melanocytic nevi from 11 subjects living in Northern Italy were examined by digital ELM before and after 5 to 13 days of sun exposure at latitudes of 5 degrees north to 3 degrees south. A number of multifaceted changes were observed. In particular, 3 lesions showed the expression of some structures compatible with radial streaming, pseudopods, and gray-blue areas. These features are considered to have often severe histologic correlates. In a third image, obtained 5 to 6 weeks later, they showed partial or total regression. Another case showed a massive regression of the pigment network as a result of a progressive inflammatory reaction with marked asymmetry in the distribution of pigmentation. CONCLUSIONS: Digital ELM has the potential to detect subtle changes in the structure of nevi after intense sun exposure. The transient observation of certain ELM features often associated with severe histologic substrates casts doubts on the ability of ELM to characterize sun-exposed nevi by a single examination.

Adult↗
PubMed1996

Intralaboratory reproducibility of cervical cytology diagnoses in the external quality assurance scheme of the Emilia-Romagna region of Italy.

In an external quality assurance (EQA) scheme, 110 selected cervical smears were independently reported by seven cytology laboratories using the 1988 Bethesda System. In one of these, a random sample of 60 study smears was independently classified by five cytologists before undergoing joint examination according to EQA protocol. Internal agreement (i.e., among these cytologists) was compared with external agreement (between these cytologists and the other six laboratories) and with interlaboratory agreement (among these laboratories). The kappa value for internal agreement on sample adequacy (0.57) was considerably greater than those for external (0.16) and interlaboratory agreement (0.10). For interpretation of epithelial abnormalities, internal kappa was excellent (0.80) but not substantially greater compared with external kappa (0.66) and interlaboratory kappa (0.70). Calculation of class-specific kappa values revealed (a) that superiority of internal agreement on sample adequacy was restricted to the notations of "less than optimal" and of "satisfactory," and (b) that internal increase in agreement on cytologic abnormalities was substantial for the diagnosis of "atypical cells of undetermined significance."

Cervix Uteri↗
PubMed1996

Seasonal prevalence of digital epiluminescence microscopy patterns in acquired melanocytic nevi.

BACKGROUND: Available information of the effect of sun exposure on the biologic activity and morphologic characteristics of nevi is based on a few cross-sectional studies. According to these, nevi excised in summer show a higher mitotic count, a greater extent of the junctional component, and more frequent regression and inflammation. OBJECTIVE: Our goals were to obtain data on the seasonal prevalence of digital epiluminescence microscopy (D-ELM) patterns in acquired melanocytic nevi (AMN) and to test the reliability of D-ELM as a substitute for histology in prospective studies of the morphologic response of AMN to sun exposure. METHODS: Two independent series of AMN located on intermittently sun-exposed body sites and undergoing D-ELM in winter (n=121) and in summer (n=116) were compared for the prevalence of major ELM patterns. RESULTS: Cases in the summer series showed a greater frequency of a broad and prominent pigment network; black dots with varied size, irregular distribution, and peripheral location; and peripheral depigmentation. CONCLUSION: On the basis of known histologic correlates of D-ELM features, our findings were consistent with studies of seasonal histologic changes in AMN. D-ELM may be a useful tool in the prospective evaluation of effects of sun exposure on AMN morphology.

Adolescent↗
PubMed1996

Correlation between the histopathology and the epiluminescence microscopy features of malignant blue nevus.

BACKGROUND: The validation of epiluminescence microscopy (ELM) for the diagnosis of pigmented skin lesions is conditional on the demonstration of consistent histologic correlates of the ELM patterns. The ELM characteristics of malignant blue nevus (MBN) have never been reported previously. OBJECTIVE: To evaluate the histologic counterparts of the ELM features of a case of MBN. METHODS: Comparison between the histologic characteristics observed in step-sections of the lesion and the structures observed in a digital ELM image. RESULTS: On ELM, the lesion showed a diffuse whitish-blue veil, round black blotches, a collection of dark colored punctate spots, and fragmented bluish reticular-like formations in the periphery. At histologic examination, the black blotches and the spots appeared to correlate with areas of intense focal necrosis in the papillary and reticular dermis, and the reticular-like structures were demonstrated to correspond to the presence of free melanin and melanophages in the papillary dermis. CONCLUSION: In this case of MBN, blotches and spots seen on ELM correlated with intense necrosis in the papillary and reticular dermis, and reticular-like formations were the counterparts of free melanin and melanophages in the papillary dermis.

Aged↗
PubMed1995

Intraobserver agreement in interpretation of digital epiluminescence microscopy.

BACKGROUND: Although a major problem with the classification of epiluminescence microscopy (ELM) findings is the lack of standard definitions, reproducibility of the criteria proposed has never been investigated. OBJECTIVES: Our purposes were (1) to perform a review of four major published classifications to obtain a set of apparently well-defined ELM variables and descriptors and (2) to evaluate the ability of one of us to report consistently ELM findings in melanocytic lesions according to these criteria. METHODS: Intraobserver agreement (with a set of 44 selected descriptors) between two readings of 150 digital ELM images was evaluated with the kappa (kappa) statistic. Subgroups of descriptors were compared for kappa value distribution. RESULTS: The median kappa value for the whole series of descriptors was 0.66. Median kappa did not vary significantly among the four classification systems (kappa = 0.61 to 0.67). Agreement was significantly better as to the presence or absence of ELM findings (kappa range, 0.39 to 1.00; median kappa, 0.77) compared with agreement as to their distribution (kappa range, 0.10 to 0.79; median kappa, 0.47; p = 0.0007) and their width, thickness, and size (kappa range, 0.06 to 0.83; median kappa, 0.39; p = 0.0075). CONCLUSION: Although nothing can be inferred from a single study, descriptors associated with low intraobserver agreement are likely to be inadequately defined.

Humans↗
PubMed1995

Wolfe's mammographic patterns in women with gross cystic disease of the breast.

The epidemiologic determinants of the mammographic pattern were studied in 710 patients with aspirated gross (> 1 ml) cysts of the breast. The prevalence of the mammograms classified as P2-DY, that are considered to be associated with an increased breast cancer risk, was 636/710 or 89.6%. No relationship between mammographic patterns and characteristics of breast cyst fluid such as K+/Na+ ratio, apocrine changes and dehydroepiandrosterone sulfate concentration was observed. A significant decrease in the proportion of these patterns with increasing age (p = 0.006), Quetelet Index (p < 0.001), parity (p = 0.001), and in postmenopausal women (p = 0.026) was found. Conversely, P2-DY patterns were significantly associated with a later age at menarche (p = 0.023) and alcohol consumption (p = 0.001). In multivariate analysis, an independent association with age was not observed whereas the associations with age at menarche, parity, and relative weight were confirmed. In conclusion, the epidemiologic determinants of mammographic patterns are the same in Gross Cystic Disease patients as in unaffected women, and the lack of correlation between mammographic pattern and cyst type suggests that the latter may represent an independent predictor of breast cancer risk.

Adult↗