Biomedical subjects

S Catarzi

Publications and source records attributed to S Catarzi.

7 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

[A multicenter study for the evaluation of the diagnostic efficiency of mammography and echography in nonpalpable breast neoplasms].

The Breast Section of the Italian Society of Radiology set up a cooperative study which included 17 Departments of Radiology and Breast Diagnosis in order to evaluate the diagnostic accuracy of US versus mammography in nonpalpable breast lesions. From January 1, 1989 to december 31, 1990, 400 nonpalpable breast lesions (142 benign lesions, 59 in situ and 199 infiltrating carcinomas) were detected by mammography and/or US; they had questionable/suspicious findings which called for further investigation by means of cytology and/or histology. US proved much less sensitive in non-palpable carcinomas than mammography (49.2% vs 93.8%), also in younger women, and failed to detect 50% of the benign/malignant nonpalpable lesions identified by mammography. US sensitivity was directly related to lesion diameter and probe frequency: 38.7% in infiltrating carcinomas < or = 5 mm vs 56.8% in those > 10 mm; 12% in the patients examined with a 5-MHz probe vs 57.7% in those examined with a > or = 7.5-MHz probe. Furthermore, the most significant US patterns of nonpalpable lesion were irregular contours, posterior attenuation and irregular internal echoes, while an irregular skin line and Cooper ligaments had no significant relation with carcinoma. Thus, breast US cannot be used as a screening test on asymptomatic patients not even on young women with radiologically dense breasts. On the contrary, US performed with high-frequency probes is useful in the assessment of nonpalpable lesions identified by mammography, and allows, in many cases, US-guided cytology and preoperative localization.

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

Causes of breast cancer misdiagnosis at physical examination.

2740 consecutive breast cancers undergoing physical examination were reviewed. Ninety-two subclinical cancers detected at mammography were excluded from further evaluation and the study focused on palpable false benign cancers. The sensitivity of physical examination varied according to T category (TIS = 0.48, T1 = 0.70, T2 = 0.90, T3 = 0.89, T4 = 0.93), age (20-29 = 0.77, 30-39 = 0.58, 40-49 = 0.75, 50-59 = 0.84, 60-69 = 0.90, greater than 69 = 0.94) and operator (range 0.69-0.89), a significant difference being recorded in favor of more expert operators. Multivariate analysis (Cox) showed that T category, patient's age and operator experience are independent determinants of sensitivity. This study confirms that physical examination is not very sensitive, particularly for small tumors and in younger women and should always be performed by expert operators.

Adult↗

PubMedDate not supplied

[Stereotaxic cytologic examination of non-palpable lesions of the breast. Experience with 791 consecutive cases].

The authors report on 791 consecutive cases undergoing stereotaxic cytology for nonpalpable lesions detected at mammography. Histologic diagnosis (malignant = 179, benign = 107) or mammographic follow-up after at least one year (benign = 275) was available in 561 cases. The overall inadequacy rate of stereotaxic cytology was 0.21, and dependent on lesion type (benign = 0.25, malignant = 0.13 p less than 0.001) and on sampling operator experience (range 0.17-0.31, p less than 0.001). Sensitivity (dubious + positive, after exclusion of inadequates) was 0.83 and dependent on histologic type (infiltrating = 0.87, intraductal = 0.68). Specificity (negative/benign, after exclusion of inadequates) was 0.96. Stereotaxic cytology helped in reducing the number of unnecessary benign biopsies and the biopsy ratio was 0.6 benign to 1 malignant biopsy. In cases with moderate suspicion at mammography the radiologist felt reassured by negative cytology and advised mammographic control rather than surgical biopsy. Cytology was determinant in advising surgical biopsy in 9 cancer cases whereas the absence of cytologic positivity contributed to diagnostic delay in 2 cancer cases. Overall, stereotaxic cytology allowed a relevant reduction of unnecessary benign biopsies and should be routinely employed in the diagnostic work-up of nonpalpable lesions detected at mammography.

Adult↗