PubMed Health⌕ Search

Biomedical subjects

R Bonardi

Publications and source records attributed to R Bonardi.

At least 19 recordsLinked to original sources
PubMed1992

Quality control for colposcopy in the Florence screening program for cervical cancer.

The authors report on the quality control for colposcopy adopted in the Florence District screening program. The sensitivity of colposcopy was determined on all cases of CIN III recorded in the local cancer registry in a four-year period. However although this showed that a centralized colposcopic clinic employing a limited number of expert operators is superior to the performance of colposcopy in private practice, such a parameter was impractical for further routine quality control since differences among operators were too small and statistically insignificant. Other parameters for quality control were chosen, namely a) the rate of colposcopically directed biopsies performed, b) the detection rate of CIN II or more severe lesions, and c) the positive predictive value of a directed biopsy for CIN II or more severe lesions. Analysis of these indicators after stratification by cytologic report allows the identification of those operators who need additional training and provides useful information for colposcopists to optimize their diagnostic and operative criteria.

Adult↗
PubMed1992

Evaluation of the sensitivity of cervicography in a consecutive colposcopic series.

Cervicography was performed in 606 women referred for colposcopy. Cervigrams were blindly reviewed by two independent readers. The positivity rate at cervicography was high (operator A = 50%, B = 58.8%). The sensitivity for papillomavirus infection (HPV)/cervical intraepithelial neoplasia I (CIN I) (n = 141) was 79.4% for operator A and 80.8% for operator B. The sensitivity for CIN II or more severe lesions (n = 22) was 95.2% and 90.5% for operators A and B, respectively. The positive predictive value for HPV/CIN I or CIN II, or more severe lesions was 36.9% and 6.9% for operator A and 32.1% and 5.3% for operator B, respectively. Interobserver variability was acceptable (kappa = 0.62). Cervicography suspected 27 HPV/CIN I, 1 CIN II and 1 CIN III which showed no cytologic abnormalities. This study confirms that cervicography has a good sensitivity for cervical lesions, but it is based on a selected series, not representative of a screening condition. The combination of cervicography and cytology in screening is presently under evaluation in a prospective study of screened women.

Adult↗
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 dynamic computed tomography of small hepatocarcinomas treated by US-guided percutaneous ethanol injections. The short- and long-term follow-up aspects].

Dynamic CT studies with an automatic injector of iodinated contrast medium were performed in 22 patients affected with 29 hepatocellular carcinomas (HCCs) (phi: 0.8-4.5 cm) before and after treatment with percutaneous ethanol injection (PEI) and during the follow-up period, every 6-9 months. Before PEI, most of the HCCs showed contrast enhancement on CT scans. Treatment was suspended when US-guided fine-needle biopsy demonstrated the absence of malignant cells and when the lesions were unenhanced on dynamic CT scans. Dynamic CT detected 21 HCCs (72.4%) before PEI and 24 HCCs (82.8%) after PEI and during the follow-up period. After PEI, 14 HCCs exhibited a thin and hyperdense peripheral rim on dynamic CT scans. Nine of these lesions, with long-term follow-up (12-31 months), have a smaller diameter than the primary lesion; 6 patients have no HCC recurrence. The authors conclude that dynamic CT is useful for evaluating the effectiveness of PEI in the treatment of HCCs; moreover, their personal experience suggests that the finding of a thin and hyperdense peripheral rim cannot always be related to viable cancerous tissue.

Carcinoma, Hepatocellular↗
PubMed1992

Phyllodes tumor of the breast: a multicenter series of 59 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy.

A series of 59 phyllodes tumors of the breast was retrospectively reviewed (average follow-up = 3.9 years). Clinical features (age, size of tumor) and diagnostic tests (palpation, mammography, sonography and cytology) were found to be inaccurate in predicting benign (n = 22), borderline (n = 12) or malignant (n = 25) histological type. Limited surgery was associated with a relatively high proportion of local recurrence (enucleation/enucleoresection = 3/5, wide resection = 12/30) compared with mastectomy (2/24). No significant association was observed between the probability of local recurrence and patient's age, histological type or lesion size. Although the study confirms that limited surgery may cure phyllodes tumor, careful follow-up of all patients is needed, since no reliable risk factors for recurrence are available. In malignant cases, axillary node involvement was nil and distant metastases were infrequently observed (3/25). Axillary dissection and search for asymptomatic metastases is not recommended.

Adult↗
PubMed1992

Loop electrosurgical excision procedure of the transformation zone and colposcopically directed punch biopsy in the diagnosis of cervical lesions.

OBJECTIVE: To estimate the disagreement between the histologic reports at colposcopically directed punch biopsy of the cervix and subsequent loop excision of the transformation zone, and to assess the indications for loop excision in current practice. METHODS: The histologic diagnoses from loop electrosurgical excision procedures and concurrent colposcopically directed punch biopsies were compared in 337 consecutive women undergoing loop excision in a 5-year period. RESULTS: Disagreement between punch biopsy and loop excision was recorded in 190 cases (56.4%). The undercall and overcall rates for punch biopsy were 14 and 42.4%, respectively. Undercall at punch biopsy occurred in 24 of 46 cases of cervical intraepithelial neoplasia (CIN) III and in one microinvasive cancer diagnosed at loop excision, and disagreement was within one grade of CIN in 16 cases. CONCLUSIONS: Loop electrosurgical excision allows further and more accurate histologic examination of the transformation zone and should be the standard assessment procedure in all cases of CIN II detected at punch biopsy and whenever cytology or colposcopy suggests the risk of punch biopsy undercall. Immediate treatment by local destruction should not be performed, to avoid underestimation of the severity of the lesion.

Biopsy↗
PubMed1992

Sarcomas of the breast: a multicenter series of 70 cases.

A multicenter retrospective series of 70 breast sarcomas (malignant cystosarcoma phyllodes (25), osteosarcoma (12), liposarcoma (10), stromal sarcoma (8), angiosarcoma (7), mixed types sarcoma (4), malignant histiocytoma (3), leiomyosarcoma (1)) was reviewed. The average follow-up was 5.9 years. Diagnostic tests (palpation, mammography, sonography and cytology) were poorly sensitive, and a large proportion of cases, appearing as regular, sharp bordered, rounded masses were diagnosed as benign fibroadenomas. Surgery (limited (29), mastectomy (41)) was the treatment of choice. Axillary nodes were rarely involved (2 of 31) at pathologic staging. No significant predictors of local recurrences (12 cases) were observed although recurrences were more frequent in larger lesions (0-20 mm = 1.1%, 21-50 mm = 1.7%, > 50 mm = 6.1% women-year) and in cases treated with limited surgery (limited surgery 4.6%, mastectomy 2.0% women-year). Distant metastases (16 cases) were less frequent in malignant cystosarcoma phyllodes or liposarcoma patients, but no other significant predictors of distant metastases were evidenced. Five-year disease-free or overall survival was 50% or 66%, respectively. The study confirms that breast sarcomas are rare, difficult to diagnose, but can be cured by surgical treatment in a considerable proportion of cases.

Adult↗
PubMed1992

[Role of echography in the differential diagnosis of accessory lobulations and small capsular traumatic fissures of the spleen].

Emergency US in patients with abdominal trauma has become a routine diagnostic exam thanks to both its high reliability and its short acquisition time. US allows the overall evaluation of the patient, relative to both the localization of even very small fluid collections and the evaluation of traumatic changes in parenchymatous abdominal organs, especially the spleen which is often injured. Twelve patients were selected of all the cases submitted to emergency abdominal US between February 1989 and March 1992. All the cases with evident traumatic lesions of the spleen were excluded. In 10 cases US demonstrated interrupted splenic parenchyma, which was highlighted by intraperitoneal fluid collections; the interruption of splenic parenchyma is also evidenced by a thin hyperechoic capsular line with no changes in the echopattern of deep parenchyma. Surgery in 6 patients--4 of them as an emergency for hemoperitoneum and 2 operated subsequently--and US monitoring in the extant cases confirmed the diagnosis of simple accessory splenic lobulations. On the contrary, in 2 patients hospitalized in emergency, US showed no evident traumatic splenic alterations but only interruption of the hyperechoic capsular line with low hypoechogenicity in the splenic parenchyma below and a small fluid collection next to the lower splenic pole. Splenectomy confirmed a limited marginal tear of about 1.5 cm. The misdiagnosis of traumatic tears can be avoided if congenital splenic lobulation--evidenced by hemoperitoneum--is considered. US must also be employed to demonstrate minimal alterations in the hyperechoic capsular line of the spleen, in order to point out possible small tears and, if necessary, to suggest the need for clinical monitoring.

Diagnosis, Differential↗
PubMed1992

Nuclear grading and prognosis in node negative breast cancer.

The authors evaluated retrospectively 287 node negative breast cancer patients treated solely with surgery and followed-up for at least five years. Cases were retrospectively classified according to nuclear grade. The prognostic value of T category and nuclear grade were compared at univariate and multivariate analysis. Five-year overall or relapse-free survival was dependent on T (T1 = 0.96 or 0.86, T2 = 0.88 or 0.76, T3 - 4 = 0.58 or 0.38, T2 - 4 = 0.86 or 0.72) and on nuclear grade (G1 = 0.94 or 0.82, G2 = 0.88 or 0.74, G3 = 0.80 or 0.72, G2 - 3 = 0.88 or 0.74). Nuclear grade was associated to T category, as low grading tumors were more frequent among T1 as compared to T2 - 4 cases (chi-square = .09, df = 2, p less than 0.05), but both nuclear grade (G2 - 3 vs. G1: relative risk = 1.89, p = 0.022) and T category (T2 - 4 vs. T1: relative risk = 2.23, p = 0.013) were independently and significantly associated to overall survival. Although their limited discriminating power does not justify their clinical use in selecting high risk node negative patients to adjuvant therapy, they should be used as prognostic factors as they are as efficient as other new indicators and by far cheaper and simpler to assess.

Adult↗
PubMed1991

Is breast cancer ever cured? Follow-up study of 5623 breast cancer patients.

The authors evaluated 5623 cases of primary breast cancer followed for 1 to 21 years. Overall and breast cancer death rates were determined and compared to expected rates. Breast cancer patients showed overall and breast cancer death rates significantly higher than expected and which persisted at long-term follow-up. The observed/expected overall death ratios for follow-up periods of 0-5, 6-10, 11-15 or 16-20 years were 3.61, 2.55, 1.60 and 2.11, respectively. Death rates from breast cancer at 5, 10, 15 and 20 years were 20%, 32%, 40% and 48% respectively. The evidence of a persistent excess mortality even after long-term follow-up suggests the hypothesis that breast cancer is a systemic disease when clinically diagnosed. This study provided no evidence of a "clinical" cure for breast cancer patients. Even for N- patients the 5, 10, 15 and 20 year death rates from breast cancer were 12%, 20%, 28% and 38%, respectively. N- breast cancer, which is currently considered as a localized disease cured by surgery in most cases, would be better regarded to as a slow-growing metastatic disease, although "personal" cure may be achieved in many subjects dying of causes other than breast cancer.

Breast Neoplasms↗
PubMed1991

Hemoccult sensitivity estimate in a screening program for colorectal cancer in the Province of Florence.

The sensitivity of Hemoccult testing (HO) in a population-based screening for colorectal cancer was evaluated. HO sensitivity estimates were calculated as the ratio of screen-detected HO-positives to total screen or interval-detected cancers. Sensitivity was estimated according to 1, 2, and 3-year rescreening intervals. Corresponding estimates are 69.4%, 61.8% and 57.7%, respectively. No significant correlation was observed between HO sensitivity and other variables, such as calendar period, tumor stage or site, or patient age or sex. HO sensitivity as estimated in the present experience is consistent with other reports of population-based screenings. Screening every year would achieve too limited an increase in sensitivity, compared to biennal screening, to be worth the difficulties of doubling organizational efforts and costs.

Adult↗
PubMed1991

Attendance to a screening program for cervical cancer in the city of Florence.

The study was aimed to assess: a) the proportion of true refusers among non-attenders resulting from residents and screening database matching, b) the typology of refusers compared to attenders, and c) the reasons for non-attendance as stated by refusers. Three hundred and forty-one non-attenders according to computer-produced lists were interviewed: 29 were not evaluable, 148 had had a Pap test, 18 had not attended for valid reasons, and 146 were true refusers; 94 refusers accepted the interview as far a points b) and c) were concerned. Ninety-four attenders, matched by age and residence, were interviewed for comparison. Attendance at private laboratories or incorrect identification of subjects on the screening record accounted for 45% or 55% of misclassified cases, respectively. The adjusted true refusal rate in the last 10 years was 18.1% compared to a computer-assessed non-attendance rate of 40.7%. Refusal was significantly associated to socioeconomic status (geographic origin, working activity and educational level of both women and husbands), whereas no significant association was observed for sexual history (deliveries, age at first sexual relation, number of partners) or health-related behavior. Attendance and counseling at the gynecologist's office were strongly associated to attendance, and gynecologists should be stimulated to promote opportunistic screening. The belief that screening is useless in the absence of symptoms, the fear of cancer being detected, postponement or laziness were the reasons for non-attendance stated by 80% of refusers. Improving knowledge about the purpose of the Pap test should be the main goal of any action aimed to improve screening attendance.

Adult↗
PubMed1991

The risk of breast cancer subsequent to histologic diagnosis of benign intraductal papilloma follow-up study of 339 cases.

The risk of developing breast cancer was investigated in 339 patients in whom histologically confirmed intraductal papilloma had been surgically removed. Follow-up ranged from 2 to 14 years, (average, 6.62 years). Ten breast cancers were observed, whereas 3 were expected on the basis of age-specific incidence rates drawn from local cancer registries (relative risk = 3.33, 95% confidence interval = 1.60-6.13). No significant difference in the relative risk was observed as far as papilloma type (single or multiple) was concerned. All breast cancers observed occurred in the same breast as the papilloma. Women in whom a benign intraductal papilloma has been excised should be carefully followed since they at are higher risk for ipsilateral breast cancer.

Adult↗
PubMed1991

Fine-needle cytology of the breast: a controlled study of aspiration versus nonaspiration.

We report on 534 breast masses examined by fine-needle aspiration cytology. Two samples were obtained from each mass, one with aspiration and the other without. Aspiration, equivalent to that obtained by a 20-ml syringe on full aspiration, was obtained by an automatic aspirator. The two sampling modalities did not differ apart from aspiration and were compared in terms of inadequate sampling rates. The inadequacy rate was the same in 166 cancers (6.6%), whereas a significant difference was recorded in favor of aspiration (13.6 versus 24.4%) in 368 benign masses. When inadequate results were excluded, the accuracy of the two modalities was almost the same. Sensitivity was 97.4% and 96.7% and specificity was 99.4% and 99.3% for sampling with and without aspiration, respectively. Reducing the rate of inadequate sampling from benign masses seems to be the major advantage of aspiration. Double sampling, independent of the specific techniques, reduced inadequacy rates to very low levels (1.2% for cancers; 5.9% for benign masses) and may be useful as a routine policy.

Biopsy, Needle↗
PubMed1991

[Treatment of small hepatocarcinomas by percutaneous ultrasound-guided alcohol injections. Personal experience in 14 lesions].

From May 1988 to March 1990, 57 patients with focal solid lesions of the liver underwent percutaneous US-guided fine-needle biopsy which demonstrated the primitive neoplastic nature of these tumors--mainly trabecular hepatocellular carcinoma (HCC). Eight of these patients affected with chronic liver disease presented with 14 lesions (less than 3 cm phi); they were considered inoperable and therefore treated with percutaneous ethanol injection (PEI) under US guidance. Three to eleven sessions of PEI (total: 78) were administered to each nodule, according to nodular size and to modality of ethanol distribution within the tumor. All these lesions showed post-treatment US and CT structural changes of fibronecrotic degeneration: the final fine-needle biopsy demonstrated the absence of malignant cells in all cases. Today all patients are alive and 7 present no recurrences of HCC on US and CT scans; the follow-up period was 18 months for 3 patients and 12, 9, 6, and 3 months for the extant 4 patients, respectively. The nodules have a smaller diameter than the primitive tumors. In conclusion PEI, besides being a simple and cheap method, is also readily available and effective for the treatment of small inoperable hepatocellular carcinomas.

Aged↗
PubMed1990

Intraductal breast carcinoma. Review of a multicenter series of 350 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy.

A multicenter series of 350 intraductal breast cancers (DCIS) is reported. Mammography was the most sensitive test but suspicion arose only at palpation in 13% of cases whereas in 10% of cases biopsy was recommended for a benign lesion and DCIS was an unexpected finding. Mammography, physical examination and cytology must be combined to achieve optimal sensitivity. Systematic biopsy of apparently benign masses would increase DCIS detection rates but the cost-effectiveness of such a policy is questionable. A trend of conservative surgery was evident over time (from 1968-79, 28%; 1985-1989, 50%) but breast irradiation followed only in one fourth of the cases. The local recurrence rate was significantly higher in cases of limited surgery (with or without irradiation) with respect to mastectomy (1.2 vs 0.2 x 100 patient-years at risk). Most recurrences (7 of 8) in the conserved breast were infiltrating, but no recurrence was seen in subclinical DCIS cases. Three patients died of breast cancer after local recurrence in the conserved breast (2 cases) or mastectomy scar (1 case). Eligibility for conservative surgery of DCIS needs to be carefully discussed to avoid under-treatment. Contralateral breast cancer was recorded in 44 cases and the incidence of further metachronous cancer to the other breast was ten times higher than expected in normal breasts. Four patients died of contralateral breast cancer, free of ipsilateral recurrence. A careful follow-up of the contralateral breast in DCIS cases looks as important as surveillance of the conserved breast.

Adult↗
PubMed1990

Male breast carcinoma: review of a multicenter series of 150 cases. Coordinating Center and Writing Committee of FONCAM (National Task Force for Breast Cancer), Italy.

The authors report on a consecutive retrospective series of 150 male breast cancers. Clinical, diagnostic and therapeutic features are compared over time and with respect to a large consecutive series of female breast cancers. Both age at diagnosis and tumor stage were more advanced in males than in females. Poor alertness of both men and doctors for this infrequent disease may account for such a delay in diagnosis. The use of mammography increased over time and sonography or cytology were frequently and successfully employed in the last decade. Unfortunately no improvement of tumor stage at diagnosis was observed over time in the present series. A time trend was also evident for the type of surgical and postoperative treatment. Modified radical mastectomy and adjuvant chemo- or hormone therapy were increasingly adopted, although Halsted operation and postoperative radiotherapy were still common in the last decade due to the relatively high proportion of locally advanced T3-4 cancers. Both disease-free and overall survival were worse in men than in women, even after adjustment by stage at diagnosis. This study suggests that male breast cancer has a worse prognosis with respect to female breast cancer and provides no complete explanation of this finding, except for an intrinsic higher aggressivity. No evidence was found which may justify a different diagnostic or therapeutic approach with respect to female breast cancer.

Adult↗