Publications by authors named "Antonella Petrillo"

153 Publications

Comparative environmental evaluation of recycled aggregates from construction and demolition wastes in Italy.

Sci Total Environ 2021 Jul 23;798:149250. Epub 2021 Jul 23.

Department of Engineering, University of Naples "Parthenope", Centro Direzionale, Isola C4, 80143 Napoli, Italy. Electronic address:

Ensure sustainable consumption and production patterns requires urgent actions to combat climate change and its impacts as established by Sustainable Development Goals (SDGs). In this context, this study demonstrates the feasibility to produce structural concrete using recycled aggregates from construction and demolition waste in Italy. More specifically, the present research aims to analyze the environmental impacts caused by five mixtures of concrete, with similar mechanical properties and workability, but with a different amount of recycled coarse aggregate and natural coarse aggregate (0% - 30% - 50% - 70% - 100%). Fixed plant and a mobile plant treatments are investigated as two different modes of production of recycled aggregates. Life Cycle Assessment (LCA) methodology is applied to achieve this goal. The main results demonstrate that mixtures formed by recycled coarse aggregates have a better environmental impacts than the only one formed exclusively by natural coarse aggregates and results improve when the amount of recycled coarse aggregate is higher.
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http://dx.doi.org/10.1016/j.scitotenv.2021.149250DOI Listing
July 2021

Effect of Bevacizumab in Combination With Standard Oxaliplatin-Based Regimens in Patients With Metastatic Colorectal Cancer: A Randomized Clinical Trial.

JAMA Netw Open 2021 Jul 1;4(7):e2118475. Epub 2021 Jul 1.

Experimental Pharmacology Unit, Istituto Nazionale Tumori-IRCCS, Fondazione G. Pascale, Napoli, Italy.

Importance: Although bevacizumab is a standard of care in combination treatments for metastatic colorectal cancer (mCRC), its clinical benefit has been limited.

Objective: To determine whether sequential scheduling of bevacizumab administration in combination with chemotherapy improves treatment efficacy in patients with mCRC, in keeping with the tumor vascular normalization hypothesis.

Design, Setting, And Participants: This open-label, randomized clinical phase 3 trial was conducted from May 8, 2012, to December 9, 2015, at 3 Italian centers. Patients aged 18 to 75 years with unresectable, previously untreated, or single line-treated mCRC were recruited. Follow-up was completed December 31, 2019, and data were analyzed from February 26 to July 24, 2020.

Interventions: Patients received 12 biweekly cycles of standard oxaliplatin-based regimens (modified FOLFOX-6 [levo-folinic acid, fluorouracil, and oxaliplatin]/modified CAPOX [capecitabine and oxaliplatin]) plus bevacizumab administered either on the same day as chemotherapy (standard arm) or 4 days before chemotherapy (experimental arm).

Main Outcomes And Measures: The primary end point was the objective response rate (ORR) measured with Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary end points included progression-free survival, overall survival, safety, and quality of life (QOL).

Results: Overall, 230 patients (136 men [59.1%]; median age, 62.3 [interquartile range, 53.3-67.6] years) were randomly assigned to the standard arm (n = 115) or the experimental arm (n = 115). The median duration of follow-up was 68.3 (95% CI, 61.0-70.0) months. No difference in ORR (57.4% [95% CI, 47.8%-66.6%] in the standard arm and 56.5% [95% CI, 47.0-65.7] in the experimental arm; P = .89) or progression-free survival (10.5 [95% CI, 9.1-12.3] months in the standard arm and 11.7 [95% CI, 9.9-12.9] months in the experimental arm; P = .15) was observed. However, the median overall survival was 29.8 (95% CI, 22.5-41.1) months in the experimental arm compared with 24.1 (95% CI, 18.6-29.8) months in the standard arm (adjusted hazard ratio, 0.73; 95% CI, 0.54-0.99; P = .04). Moreover, the experimental arm was associated with a significant reduction in the rate of severe diarrhea (6 [5.3%] vs 19 [16.5%]; P = .006) and nausea (2 [1.8%] vs 8 [7.0%]; P = .05) and improved physical functioning (mean [SD] change from baseline, 0.65 [1.96] vs -7.41 [2.95] at 24 weeks; P = .02), and constipation scores (mean [SD] change from baseline, -17.2 [3.73] vs -0.62 [4.44]; P = .003).

Conclusions And Relevance: In this randomized clinical trial, sequential administration of bevacizumab plus chemotherapy did not improve ORR, the primary end point. However, the overall survival advantage, fewer adverse effects, and better health-related QOL associated with sequential bevacizumab administration might provide the basis for exploring antiangiogenic combination treatments with innovative perspectives.

Trial Registration: EudraCT Identifier: 2011-004997-27; ClinicalTrials.gov Identifier: NCT01718873.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.18475DOI Listing
July 2021

Diagnostic evaluation and ablation treatments assessment in hepatocellular carcinoma.

Infect Agent Cancer 2021 Jul 19;16(1):53. Epub 2021 Jul 19.

Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.

This article provides an overview of diagnostic evaluation and ablation treatment assessment in Hepatocellular Carcinoma (HCC). Only studies, in the English language from January 2010 to January 202, evaluating the diagnostic tools and assessment of ablative therapies in HCC patients were included. We found 173 clinical studies that satisfied the inclusion criteria.HCC may be noninvasively diagnosed by imaging findings. Multiphase contrast-enhanced imaging is necessary to assess HCC. Intravenous extracellular contrast agents are used for CT, while the agents used for MRI may be extracellular or hepatobiliary. Both gadoxetate disodium and gadobenate dimeglumine may be used in hepatobiliary phase imaging. For treatment-naive patients undergoing CT, unenhanced imaging is optional; however, it is required in the post treatment setting for CT and all MRI studies. Late arterial phase is strongly preferred over early arterial phase. The choice of modality (CT, US/CEUS or MRI) and MRI contrast agent (extracelllar or hepatobiliary) depends on patient, institutional, and regional factors. MRI allows to link morfological and functional data in the HCC evaluation. Also, Radiomics is an emerging field in the assessment of HCC patients.Postablation imaging is necessary to assess the treatment results, to monitor evolution of the ablated tissue over time, and to evaluate for complications. Post- thermal treatments, imaging should be performed at regularly scheduled intervals to assess treatment response and to evaluate for new lesions and potential complications.
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http://dx.doi.org/10.1186/s13027-021-00393-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287696PMC
July 2021

Organ Sparing for Locally Advanced Rectal Cancer after Neoadjuvant Treatment Followed by Electrochemotherapy.

Cancers (Basel) 2021 Jun 26;13(13). Epub 2021 Jun 26.

Division of Colorectal Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, I-80131 Naples, Italy.

Background: Currently, 45-55% of rectal cancer patients receive preoperative chemo- radio-therapy for Locally Advanced Rectal Cancer (LARC). The idea of our study is to use Electrochemotherapy (ECT) before surgery, in patients with major clinical response after neoadjuvant therapy, to allow for a more conservative surgical approach.

Objective: To evaluate the increase of the complete response rate after neoadjuvant treatment in LARC and to spare organ function due to total mesorectal excision (TME).

Patients And Methods: This is a Phase II randomized controlled trial enrolling 70 patients that will be developed in two stages. In the first step, 28 patients will be enrolled: 14 of these will receive ECT for four weeks after neo-adjuvant treatment and then local excision (treatment group) and 14 patients will receive neo-adjuvant treatment and then local excision (control group). If an increase of response rate is observed in the first stage, and/or feasibility/safety is demonstrated, the second stage of the trial will be performed, enrolling an additional 42 patients. The treatment response. in both the control arm and the treatment arm, will be assessed using the histopathological tumor regression grade on tissue specimens after local excision.
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http://dx.doi.org/10.3390/cancers13133199DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267997PMC
June 2021

Local ablation of pancreatic tumors: State of the art and future perspectives.

World J Gastroenterol 2021 Jun;27(23):3413-3428

Department of Surgery, Istituto Nazionale Tumori -IRCCS- Fondazione G. Pascale, Naples 80131, Italy.

Background: Currently, the technologies most commonly used to treat locally advanced pancreatic cancer are radiofrequency ablation (RFA), microwave ablation, and irreversible (IRE) or reversible electroporation combined with low doses of chemotherapeutic drugs.

Aim: To report an overview and updates on ablative techniques in pancreatic cancer.

Methods: Several electronic databases were searched. The search covered the years from January 2000 to January 2021. Moreover, the reference lists of the found papers were analysed for papers not indexed in the electronic databases. All titles and abstracts were analysed.

Results: We found 30 studies (14 studies for RFA, 3 for microwave therapy, 10 for IRE, and 3 for electrochemotherapy), comprising 1047 patients, which were analysed further. Two randomized trials were found for IRE. Percutaneous and laparotomy approaches were performed. In the assessed patients, the median maximal diameter of the lesions was in the range of 2.8 to 4.5 cm. All series included patients unfit for surgical treatment, but Martin assessed a subgroup of patients with borderline resectable tumours who underwent resection with margin attenuation with IRE. Most studies administered chemotherapy prior to ablative therapies. However, several studies suggest that the key determinant of improved survival is attributable to ablative treatment alone. Nevertheless, the authors suggested chemotherapy before local therapies for several reasons. This strategy may not only downstage a subgroup of patients to curative-intent surgery but also support to recognize patients with biologically unfavourable tumours who would likely not benefit from ablation treatments. Ablation therapies seem safe based on the 1047 patients assessed in this review. The mortality rate ranged from 1.8% to 2%. However, despite the low mortality, the reported rates of severe post procedural complications ranged from 0%-42%. Most reported complications have been self-limiting and manageable. Median overall survival varied between 6.0 and 33 mo. Regarding the technical success rate, assessed papers reported an estimated rate in the range of 85% to 100%. However, the authors reported early recurrence after treatment. A distinct consideration should be made on whether local treatments induce an immune response in the ablated area. Preclinical and clinical studies have shown that RFA is a promising mechanism for inducing antigen-presenting cell infiltration and enhancing the systemic antitumour T-cell immune response and tumour regression.

Conclusion: In the management of patients with pancreatic cancer, the possibility of a multimodal approach should be considered, and conceptually, the combination of RFA with immunotherapy represents a novel angle of attack against this tumour.
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http://dx.doi.org/10.3748/wjg.v27.i23.3413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8218359PMC
June 2021

Radiomics in hepatic metastasis by colorectal cancer.

Infect Agent Cancer 2021 Jun 2;16(1):39. Epub 2021 Jun 2.

Radiology Division, "ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, Napoli, Italy", Via Mariano Semmola, Naples, Italy.

Background: Radiomics is an emerging field and has a keen interest, especially in the oncology field. The process of a radiomics study consists of lesion segmentation, feature extraction, consistency analysis of features, feature selection, and model building. Manual segmentation is one of the most critical parts of radiomics. It can be time-consuming and suffers from variability in tumor delineation, which leads to the reproducibility problem of calculating parameters and assessing spatial tumor heterogeneity, particularly in large or multiple tumors. Radiomic features provides data on tumor phenotype as well as cancer microenvironment. Radiomics derived parameters, when associated with other pertinent data and correlated with outcomes data, can produce accurate robust evidence based clinical decision support systems. The principal challenge is the optimal collection and integration of diverse multimodal data sources in a quantitative manner that delivers unambiguous clinical predictions that accurately and robustly enable outcome prediction as a function of the impending decisions.

Methods: The search covered the years from January 2010 to January 2021. The inclusion criterion was: clinical study evaluating radiomics of liver colorectal metastases. Exclusion criteria were studies with no sufficient reported data, case report, review or editorial letter.

Results: We recognized 38 studies that assessed radiomics in mCRC from January 2010 to January 2021. Twenty were on different tpics, 5 corresponded to most criteria; 3 are review, or letter to editors; so 10 articles were included.

Conclusions: In colorectal liver metastases radiomics should be a valid tool for the characterization of lesions, in the stratification of patients based on the risk of relapse after surgical treatment and in the prediction of response to chemotherapy treatment.
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http://dx.doi.org/10.1186/s13027-021-00379-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173908PMC
June 2021

A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response.

Int J Environ Res Public Health 2021 05 24;18(11). Epub 2021 May 24.

Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, I-80131 Naples, Italy.

Background: Imaging methods and the most appropriate criteria to be used for detecting and evaluating response to oncological treatments depend on the pathology and anatomical site to be treated and on the treatment to be performed. This document provides a general overview of the main imaging and histopathological findings of electroporation-based treatments (Electrochemotherapy-ECT and Irreversible electroporation-IRE) compared to thermal approach, such as radiofrequency ablation (RFA), in deep-seated cancers with a particular attention to pancreatic and liver cancer.

Methods: Numerous electronic datasets were examined: PubMed, Scopus, Web of Science and Google Scholar. The research covered the years from January 1990 to April 2021. All titles and abstracts were analyzed. The inclusion criteria were the following: studies that report imaging or histopathological findings after ablative thermal and not thermal loco-regional treatments (ECT, IRE, RFA) in deep-seated cancers including pancreatic and liver cancer and articles published in the English language. Exclusion criteria were unavailability of full text and congress abstracts or posters and different topic respect to inclusion criteria.

Results: 558 potentially relevant references through electronic searches were identified. A total of 38 articles met the inclusion criteria: 20 studies report imaging findings after RFA or ECT or IRE in pancreatic and liver cancer; 17 studies report histopathological findings after RFA or ECT or IRE; 1 study reports both imaging and histopathological findings after RFA or ECT or IRE.

Conclusions: Imaging features are related to the type of therapy administrated, to the timing of re-assessment post therapy and to the imaging technique being used to observe the effects. Histological findings after both ECT and IRE show that the treated area becomes necrotic and encapsulated in fibrous tissue, suggesting that the size of the treated lesion cannot be measured as an endpoint to detect response. Moreover, histology frequently reported signs of apoptosis and reduced vital tissue, implying that imaging criteria, which take into account the viability and not the size of the lesion, are more appropriate to evaluate response to treatment.
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http://dx.doi.org/10.3390/ijerph18115592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197272PMC
May 2021

Blood Oxygenation Level Dependent Magnetic Resonance Imaging (MRI), Dynamic Contrast Enhanced MRI, and Diffusion Weighted MRI for Benign and Malignant Breast Cancer Discrimination: A Preliminary Experience.

Cancers (Basel) 2021 May 17;13(10). Epub 2021 May 17.

Senology Surgical Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy.

Purpose: To combine blood oxygenation level dependent magnetic resonance imaging (BOLD-MRI), dynamic contrast enhanced MRI (DCE-MRI), and diffusion weighted MRI (DW-MRI) in differentiation of benign and malignant breast lesions.

Methods: Thirty-seven breast lesions (11 benign and 21 malignant lesions) pathologically proven were included in this retrospective preliminary study. Pharmaco-kinetic parameters including , , , and were extracted by DCE-MRI; BOLD parameters were estimated by basal signal S0 and the relaxation rate R*; and diffusion and perfusion parameters were derived by DW-MRI (pseudo-diffusion coefficient (), perfusion fraction (), and tissue diffusivity ()). The correlation coefficient, Wilcoxon-Mann-Whitney U-test, and receiver operating characteristic (ROC) analysis were calculated and area under the ROC curve (AUC) was obtained. Moreover, pattern recognition approaches (linear discrimination analysis and decision tree) with balancing technique and leave one out cross validation approach were considered.

Results: R* and D had a significant negative correlation (-0.57). The mean value, standard deviation, Skewness and Kurtosis values of R* did not show a statistical significance between benign and malignant lesions ( > 0.05) confirmed by the 'poor' diagnostic value of ROC analysis. For DW-MRI derived parameters, the univariate analysis, standard deviation of , Skewness and Kurtosis values of D* had a significant result to discriminate benign and malignant lesions and the best result at the univariate analysis in the discrimination of benign and malignant lesions was obtained by the Skewness of D* with an AUC of 82.9% (-value = 0.02). Significant results for the mean value of , mean value, standard deviation value and Skewness of , mean value, Skewness and Kurtosis of were obtained and the best AUC among DCE-MRI extracted parameters was reached by the mean value of and was equal to 80.0%. The best diagnostic performance in the discrimination of benign and malignant lesions was obtained at the multivariate analysis considering the DCE-MRI parameters alone with an AUC = 0.91 when the balancing technique was considered.

Conclusions: Our results suggest that the combined use of DCE-MRI, DW-MRI and/or BOLD-MRI does not provide a dramatic improvement compared to the use of DCE-MRI features alone, in the classification of breast lesions. However, an interesting result was the negative correlation between R* and .
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http://dx.doi.org/10.3390/cancers13102421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155852PMC
May 2021

Breast Cancer Screening during COVID-19 Emergency: Patients and Department Management in a Local Experience.

J Pers Med 2021 May 6;11(5). Epub 2021 May 6.

Department of Radiology, Marcianise Hospital, Caserta Local Health Authority, Viale Sossietta Scialla, 81025 Marcianise, Italy.

Background: During the COVID-19 public health emergency, our breast cancer screening activities have been interrupted. In June 2020, they resumed, calling for mandatory safe procedures to properly manage patients and staff.

Methods: A protocol supporting medical activities in breast cancer screening was created, based on six relevant articles published in the literature and in the following National and International guidelines for COVID-19 prevention. The patient population, consisting of both screening and breast ambulatory patients, was classified into one of four categories: 1. Non-COVID-19 patient; 2. Confirmed COVID-19 in an asymptomatic screening patient; 3. suspected COVID-19 in symptomatic or confirmed breast cancer; 4. Confirmed COVID-19 in symptomatic or confirmed breast cancer. The day before the radiological exam, patients are screened for COVID-19 infection through a telephone questionnaire. At a subsequent in person appointment, the body temperature is checked and depending on the clinical scenario at stake, the scenario-specific procedures for medical and paramedical staff are adopted.

Results: In total, 203 mammograms, 76 breast ultrasound exams, 4 core needle biopsies, and 6 vacuum-assisted breast biopsies were performed in one month. Neither medical nor paramedical staff were infected on any of these occasions.

Conclusion: Our department organization model can represent a case of implementation of National and International guidelines applied in a breast cancer screening program, assisting hospital personnel into COVID-19 infection prevention.
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http://dx.doi.org/10.3390/jpm11050380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148132PMC
May 2021

Validation of the standardized index of shape tool to analyze DCE-MRI data in the assessment of neo-adjuvant therapy in locally advanced rectal cancer.

Radiol Med 2021 Aug 26;126(8):1044-1054. Epub 2021 May 26.

Radiology Unit, Department of Diagnostic Imaging, Radiant and Metabolic Therapy, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80131, Naples, Italy.

Purpose: Standardized index of shape (SIS) tool validation to examine dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) in preoperative chemo-radiation therapy (pCRT) assessment of locally advanced rectal cancer (LARC) in order to guide the surgeon versus more or less conservative treatment.

Materials And Methods: A total of 194 patients (January 2008-November 2020), with III-IV locally advanced rectal cancer and subjected to pCRT were included. Three expert radiologists performed DCE-MRI analysis using SIS tool. Degree of absolute agreement among measurements, degree of consistency among measurements, degree of reliability and level of variability were calculated. Patients with a pathological tumour regression grade (TRG) 1 or 2 were classified as major responders (complete responders have TRG 1).

Results: Good significant correlation was obtained between SIS measurements (range 0.97-0.99). The degree of absolute agreement ranges from 0.93 to 0.99, the degree of consistency from 0.81 to 0.9 and the reliability from 0.98 to 1.00 (p value <  < 0.001). The variability coefficient ranges from 3.5% to 26%. SIS value obtained to discriminate responders by non-responders a sensitivity of 95.9%, a specificity of 84.7% and an accuracy of 91.8% while to detect complete responders, a sensitivity of 99.2%, a specificity of 63.9% and an accuracy of 86.1%.

Conclusion: SIS tool is suitable to assess pCRT response both to identify major responders and complete responders in order to guide the surgeon versus more or less conservative treatment.
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http://dx.doi.org/10.1007/s11547-021-01369-1DOI Listing
August 2021

Additional Considerations on Use of Abbreviated Liver MRI in Patients With Colorectal Liver Metastases.

AJR Am J Roentgenol 2021 Jul 19;217(1):W1. Epub 2021 May 19.

Istituto Nazionale Tumori IRCCS Fondazione Pascale, IRCCS di Napoli Naples, Italy.

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http://dx.doi.org/10.2214/AJR.21.25652DOI Listing
July 2021

Unexpected tumor reduction in metastatic colorectal cancer patients during SARS-Cov-2 infection.

Ther Adv Med Oncol 2021 29;13:17588359211011455. Epub 2021 Apr 29.

SSD-Innovative Therapies for Abdominal Metastases, Department of Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS 'G. Pascale,' Naples, Italy.

Herein, we describe three patients affected by metastatic colorectal cancer (mCRC) experiencing infection by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and reduction of disease burden during coronavirus disease 2019 (COVID-19) course. Insights into tumor-associated angiotensin-converting enzyme (ACE)-2 expression and lymphocyte function suggest a correlation between host/SARS-Cov-2 infection and tumor burden reduction. This may shed new light into (a) the infection mechanism of SARS-CoV-2 virus and (b) the multiple aspects of a composite antiviral immune response with potential paradoxical and unexpected applications.
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http://dx.doi.org/10.1177/17588359211011455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107669PMC
April 2021

Radiomics and Artificial Intelligence Analysis with Textural Metrics Extracted by Contrast-Enhanced Mammography in the Breast Lesions Classification.

Diagnostics (Basel) 2021 Apr 30;11(5). Epub 2021 Apr 30.

Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy.

The aim of the study was to estimate the diagnostic accuracy of textural features extracted by dual-energy contrast-enhanced mammography (CEM) images, by carrying out univariate and multivariate statistical analyses including artificial intelligence approaches. In total, 80 patients with known breast lesion were enrolled in this prospective study according to regulations issued by the local Institutional Review Board. All patients underwent dual-energy CEM examination in both craniocaudally (CC) and double acquisition of mediolateral oblique (MLO) projections (early and late). The reference standard was pathology from a surgical specimen for malignant lesions and pathology from a surgical specimen or fine needle aspiration cytology, core or Tru-Cut needle biopsy, and vacuum assisted breast biopsy for benign lesions. In total, 104 samples of 80 patients were analyzed. Furthermore, 48 textural parameters were extracted by manually segmenting regions of interest. Univariate and multivariate approaches were performed: non-parametric Wilcoxon-Mann-Whitney test; receiver operating characteristic (ROC), linear classifier (LDA), decision tree (DT), k-nearest neighbors (KNN), artificial neural network (NNET), and support vector machine (SVM) were utilized. A balancing approach and feature selection methods were used. The univariate analysis showed low accuracy and area under the curve (AUC) for all considered features. Instead, in the multivariate textural analysis, the best performance considering the CC view (accuracy (ACC) = 0.75; AUC = 0.82) was reached with a DT trained with leave-one-out cross-variation (LOOCV) and balanced data (with adaptive synthetic (ADASYN) function) and a subset of three robust textural features (MAD, VARIANCE, and LRLGE). The best performance (ACC = 0.77; AUC = 0.83) considering the early-MLO view was reached with a NNET trained with LOOCV and balanced data (with ADASYN function) and a subset of ten robust features (MEAN, MAD, RANGE, IQR, VARIANCE, CORRELATION, RLV, COARSNESS, BUSYNESS, and STRENGTH). The best performance (ACC = 0.73; AUC = 0.82) considering the late-MLO view was reached with a NNET trained with LOOCV and balanced data (with ADASYN function) and a subset of eleven robust features (MODE, MEDIAN, RANGE, RLN, LRLGE, RLV, LZLGE, GLV_GLSZM, ZSV, COARSNESS, and BUSYNESS). Multivariate analyses using pattern recognition approaches, considering 144 textural features extracted from all three mammographic projections (CC, early MLO, and late MLO), optimized by adaptive synthetic sampling and feature selection operations obtained the best results (ACC = 0.87; AUC = 0.90) and showed the best performance in the discrimination of benign and malignant lesions.
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http://dx.doi.org/10.3390/diagnostics11050815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146084PMC
April 2021

Innovative Materials in Italy for Eco-Friendly and Sustainable Buildings.

Materials (Basel) 2021 Apr 19;14(8). Epub 2021 Apr 19.

Department of Engineering, University of Naples Parthenope, Centro Direzionale, Is. C4, 80143 Naples, Italy.

In the last 20 years, there have been a series of seismic events in Italy that have caused serious damage to civil and building structures. This has led to a significant increase in the use of concrete for the reconstruction of new structures and the repair of existing structures damaged by earthquakes. At the same time, the concrete industry is responsible for the most significant environmental damage during the life cycle of the built environment. The environmental disadvantages characterizing the concrete industry are related to the constant growth of the exploitation of natural aggregates. Therefore, it is necessary to use alternative and innovative aggregates that provide good concrete performance and lower environmental impacts. In this study, a very promising route from an environmental point of view is given by the use of artificial aggregates from industrial waste as substitutes for natural aggregates. An innovative low cost and energy saving granulation process has been employed to produce lightweight aggregates using fly ash from the incineration of municipal solid waste and ground granulated blast furnace slag. The final aim of this research is to demonstrate the environmental sustainability of artificial aggregates, through a comparison of three different mixtures.
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http://dx.doi.org/10.3390/ma14082048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074120PMC
April 2021

Aflibercept or bevacizumab in combination with FOLFIRI as second-line treatment of mRAS metastatic colorectal cancer patients: the ARBITRATION study protocol.

Ther Adv Med Oncol 2021 24;13:1758835921989223. Epub 2021 Mar 24.

Colorectal Cancer Surgery Unit, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Naples, Italy.

Background: The intensive study of predictive factors has strongly ameliorated the therapeutic flow-chart of metastatic colorectal cancer (mCRC) by allowing the selection of patients who benefit from specific therapies. For instance, in mRAS (mutated RAS) mCRC patients, anti-EGFR drugs (cetuximab and panitumumab) are not recommended; in this group of patients, the use of anti-angiogenic drugs (bevacizumab and aflibercept) is predominant. However, at progression to standard bevacizumab-based first-line chemotherapy, still to date, there are no studies to guide oncologists in the choice of the best second-line anti-angiogenic drug (bevacizumab beyond progression aflibercept).

Methods: ARBITRATION is a prospective, observational study assessing efficacy differences between second-line fluorouracil/irinotecan (FOLFIRI)/bevacizumab FOLFIRI/aflibercept at progression to fluoropyrimidines, oxaliplatin and bevacizumab in mRAS mCRC patients. A test power of 80%, a median survival of 9 months from second-line treatment start and a hazard ratio of 0.67 between the two schedules were the basis for statistical design. The final sample will be 220 patients (110 per treatment). The significance will be verified with a two-tailed log-rank test with an alpha value of the I-type error of 5%. Time-to-outcome will be described by Kaplan-Meier curves and prognostic factors studied through multivariable analyses based on the Cox model. Secondary objectives include safety, responses' duration and progression-free survival. A translational research will be conducted to measure several angiogenic proteins in patients' serum before starting the therapy in order to evidence any angiogenic factor patterns related to outcome.

Discussion: We present a large, prospective, observational study aiming to answer two scientific questions: (1) outcome differences between second-line treatments with FOLFIRI/bevacizumab beyond progression FOLFIRI/aflibercept in mRAS mCRC patients, (2) angiogenic factors' patterns that could associate with efficacy and help oncologists to apply best the therapeutic anti-angiogenic strategies.

Trial Registration: The ARBITRATION trial (version 0.0, 13 April 2020) has been registered into the clinicaltrials.gov registry on 20 May 2020 with identifier NCT04397601.
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http://dx.doi.org/10.1177/1758835921989223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010802PMC
March 2021

Clinical Phase I/II Study: Local Disease Control and Survival in Locally Advanced Pancreatic Cancer Treated with Electrochemotherapy.

J Clin Med 2021 Mar 22;10(6). Epub 2021 Mar 22.

Hepatobiliary Surgical Oncology Unit, "Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli", 80131 Naples, Italy.

Objective: To assess local disease control rates (LDCR) and overall survival (OS) in locally advanced pancreatic cancer (LAPC) treated with electrochemotherapy (ECT).

Methods: Electrochemotherapy with bleomycin was performed in 25 LAPC patients who underwent baseline Magnetic Resonance Imaging (MRI) and/or Computed Tomography (CT) and Position Emission Tomography (PET) scans before ECT and 1 and 6 months post ECT. LDCR were assessed using Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and Choi criteria. Needle electrodes with fixed linear (N-30-4B) or fixed hexagonal configurations (N-30-HG or I-40-HG or H-30-ST) or variable geometry (VGD1230 or VGD1240) (IGEA S.p.A., Carpi, Italy) were used to apply electric pulses. Pain evaluation was performed pre-ECT, after 1 month and after 6 months with ECT. Overall survival estimates were calculated by means of a Kaplan-Meier analysis.

Results: At 1 month after ECT, 76% of patients were in partial response (PR) and 20% in stable disease (SD). Six months after ECT, 44.0% patients were still in PR and 12.0% in SD. A LDCR of 56.0% was reached six months after ECT: 13 patients treated with fixed geometry had a LDCR of 46.1%, while for the 12 patients treated with variable geometry, the LDCR was 66.7%. The overall survival median value was 11.5 months: for patients treated with fixed geometry the OS was 6 months, while for patients treated with variable geometry it was 12 months. Electrochemotherapy was well-tolerated and abdominal pain was rapidly resolved.

Conclusions: Electrochemotherapy obtained good results in terms of LDCR and OS in LAPC. Multiple needle insertion in a variable geometry configuration optimized by pre-treatment planning determined an increase in LDCR and OS compared to a fixed geometry configuration.
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http://dx.doi.org/10.3390/jcm10061305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005134PMC
March 2021

Abbreviated MRI Protocol for the Assessment of Ablated Area in HCC Patients.

Int J Environ Res Public Health 2021 03 30;18(7). Epub 2021 Mar 30.

Hepatobiliary Surgical Oncology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli", 80131 Naples, Italy.

Background: Liver Imaging Reporting and Data Systems (LI-RADS) Treatment Response Algorithm (TRA) was created to provide a standardized assessment of hepatocellular carcinoma (HCC) following loco regional therapy. The aim of this study was to compare sensitivity of standard MRI protocol versus abbreviated protocol (only T1-Weigthed fat suppressed (FS) sequences pre- and post-contrast phase) in the detection of ablated area according to LI-RADS Treatment Response (LR-TR) categories.

Methods: From January 2015 to June 2020, we selected 64 patients with HCC, who underwent Radiofrequency ablation (RFA) or Microwave ablation (MWA) treatment. According to inclusion criteria, 136 pathologically proven treated HCC (median 2, range 1-3 per patient; mean size 20.0 mm; range 15-30 mm) in 58 patients (26 women, 32 men; median age, 74 years; range, 62-83 years) comprised our study population. For each ablated area, abbreviated protocol, and standard Magnetic Resonance Imaging (MRI) studies were independently and blindly assessed in random order within and between three expert radiologists. Each radiologist assessed the ablated area by using the following categories: "LR-TR Non-viable" = 1; "LR-TR Equivocal" = 2 and "LR-TR Viable" = 0.

Results: According to the concordance between MRI and Contrast enhancement ultrasound (CEUS) among 136 treated HCCs, 115 lesions were assessed as non-viable or totally ablate and 21 as viable or partially ablate. The accuracy for standard MRI protocol and abbreviated MRI protocol for predicting pathologic tumor viability of a consensus reading was 98.6% (sensitivity = 100%; specificity = 98.3%; positive predictive value = 91.3% and negative predictive value = 100%). No differences were found in sensitivity or specificity between standard MRI LR-TR viable and abbreviated MRI LR-TR viable categories ( value > 0.05 at McNemar test).

Conclusion: The abbreviated dynamic protocol showed similar diagnostic accuracy to conventional MRI study in the assessment of treated HCCs, with a reduction of the acquisition study time of 30% respect to conventional MRI.
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http://dx.doi.org/10.3390/ijerph18073598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037601PMC
March 2021

Lymphadenopathy after Covid-19 Vaccine: Preliminary Ultrasound Findings.

Biology (Basel) 2021 Mar 11;10(3). Epub 2021 Mar 11.

Radiology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli", 80131 Naples, Italy.

During a spontaneous and autonomous study, we assessed the ultrasound finding of lymphadenopathy after Pfizer vaccine. We enrolled 18 patients with 58 lymphadenopathies: in 10 patients, they were in the laterocervical side, while in 8 patients in the axillar site. The largest diameter was 16 mm with a range from 7 to 16 mm (median value = 10 mm). In the same patient, we found different ultrasound nodal findings. A total of 25 nodes showed eccentric cortical thickening with wide echogenic hilum and oval shape. In total, 19 nodes showed asymmetric eccentric cortical thickening with wide echogenic hilum and oval shape. Overall, 10 nodes showed concentric cortical thickening with reduction in the width of the echogenic hilum and oval shape. A total of four nodes showed huge reduction and displacement of the echogenic hilum and round or oval shape. No anomaly was found at the Doppler echocolor study. In conclusion, eccentric cortical thickening with wide echogenic hilum and oval shape, asymmetric eccentric cortical thickening with wide echogenic hilum and oval shape, concentric cortical thickening with reduction in the width of the echogenic hilum and oval shape, and a huge reduction and displacement of the echogenic hilum and round shape are the features that we found in post Covid-19 Vaccine lymphadenopathies.
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http://dx.doi.org/10.3390/biology10030214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001230PMC
March 2021

Covid-19 infection in cancer patients: the management in a diagnostic unit.

Radiol Oncol 2021 03 5;55(2):121-129. Epub 2021 Mar 5.

Radiology Division, Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli, Naples, Italy.

Background: COVID-19 infection is particularly aggressive in frail patients, as cancer patients. Therefore, the more suitable management of the oncological patient requires a multidisciplinary assessment, to identify which patients should be treated, as inpatients or outpatients, and which treatments can be procrastinated.

Conclusions: The role of radiologist is crucial, and, all cancer patients who need an imaging evaluation will need to be studied, using the most appropriate imaging tools related to the clinical question and paying a special attention to preserve public health. Guidelines are necessary in the correct organization of a radiology unit to manage patients with suspected or confirmed COVID-19 infection, and whenever possible, a satellite radiography center with dedicated equipment should be used to decrease the transmission risk.
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http://dx.doi.org/10.2478/raon-2021-0010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042821PMC
March 2021

Quantitative imaging decision support (QIDS) tool consistency evaluation and radiomic analysis by means of 594 metrics in lung carcinoma on chest CT scan.

Cancer Control 2021 Jan-Dec;28:1073274820985786

Division of Radiodiagnostic, 18561"Azienda Ospedaliero-Universitaria Careggi," Firenze, Italy.

Objective: To evaluate the consistency of the quantitative imaging decision support (QIDS) tool and radiomic analysis using 594 metrics in lung carcinoma on chest CT scan.

Materials And Methods: We included, retrospectively, 150 patients with histologically confirmed lung cancer who underwent chemotherapy and baseline and follow-ups CT scans. Using the QIDS platform, 3 radiologists segmented each lesion and automatically collected the longest diameter and the density mean value. Inter-observer variability, Bland Altman analysis and Spearman's correlation coefficient were performed. QIDS tool consistency was assessed in terms of agreement rate in the treatment response classification. Kruskal Wallis test and the least absolute shrinkage and selection operator (LASSO) method with 10-fold cross validation were used to identify radiomic metrics correlated with lesion size change.

Results: Good and significant correlation was obtained between the measurements of largest diameter and of density among the QIDS tool and the radiologists measurements. Inter-observer variability values were over 0.85. HealthMyne QIDS tool quantitative volumetric delineation was consistent and matched with each radiologist measurement considering the RECIST classification (80-84%) while a lower concordance among QIDS and the radiologists CHOI classification was observed (58-63%). Among 594 extracted metrics, significant and robust predictors of RECIST response were energy, histogram entropy and uniformity, Kurtosis, coronal long axis, longest planar diameter, surface, Neighborhood Grey-Level Different Matrix (NGLDM) dependence nonuniformity and low dependence emphasis as Volume, entropy of Log(2.5 mm), wavelet energy, deviation and root man squared.

Conclusion: In conclusion, we demonstrated that HealthMyne quantitative volumetric delineation was consistent and that several radiomic metrics extracted by QIDS were significant and robust predictors of RECIST response.
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http://dx.doi.org/10.1177/1073274820985786DOI Listing
February 2021

Radiomics-Derived Data by Contrast Enhanced Magnetic Resonance in RAS Mutations Detection in Colorectal Liver Metastases.

Cancers (Basel) 2021 Jan 25;13(3). Epub 2021 Jan 25.

Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Via Mariano Semmola, 80121 Naples, Italy.

: To assess the association of RAS mutation status and radiomics-derived data by Contrast Enhanced-Magnetic Resonance Imaging (CE-MRI) in liver metastases. : 76 patients (36 women and 40 men; 59 years of mean age and 36-80 years as range) were included in this retrospective study. Texture metrics and parameters based on lesion morphology were calculated. Per-patient univariate and multivariate analysis were made. Wilcoxon-Mann-Whitney U test, receiver operating characteristic (ROC) analysis, pattern recognition approaches with features selection approaches were considered. : Significant results were obtained for texture features while morphological parameters had not significant results to classify RAS mutation. The results showed that using a univariate analysis was not possible to discriminate accurately the RAS mutation status. Instead, considering a multivariate analysis and classification approaches, a KNN exclusively with texture parameters as predictors reached the best results (AUC of 0.84 and an accuracy of 76.9% with 90.0% of sensitivity and 67.8% of specificity on training set and an accuracy of 87.5% with 91.7% of sensitivity and 83.3% of specificity on external validation cohort). : Texture parameters derived by CE-MRI and combined using multivariate analysis and patter recognition approaches could allow stratifying the patients according to RAS mutation status.
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http://dx.doi.org/10.3390/cancers13030453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865653PMC
January 2021

Coronavirus Disease 2019 (COVID-19) in Italy: Double Reading of Chest CT Examination.

Biology (Basel) 2021 Jan 25;10(2). Epub 2021 Jan 25.

Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80121 Naples, Italy.

To assess the performance of the second reading of chest compute tomography (CT) examinations by expert radiologists in patients with discordance between the reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test for COVID-19 viral pneumonia and the CT report. Three hundred and seventy-eight patients were included in this retrospective study (121 women and 257 men; 71 years median age, with a range of 29-93 years) and subjected to RT-PCR tests for suspicious COVID-19 infection. All patients were subjected to CT examination in order to evaluate the pulmonary disease involvement by COVID-19. CT images were reviewed first by two radiologists who identified COVID-19 typical CT patterns and then reanalyzed by another two radiologists using a CT structured report for COVID-19 diagnosis. Weighted к values were used to evaluate the inter-reader agreement. The median temporal window between RT-PCRs execution and CT scan was zero days with a range of (-9,11) days. The RT-PCR test was positive in 328/378 (86.8%). Discordance between RT-PCR and CT findings for viral pneumonia was revealed in 60 cases. The second reading changed the CT diagnosis in 16/60 (26.7%) cases contributing to an increase the concordance with the RT-PCR. Among these 60 cases, eight were false negative with positive RT-PCR, and 36 were false positive with negative RT-PCR. Sensitivity, specificity, positive predictive value and negative predictive value of CT were respectively of 97.3%, 53.8%, 89.0%, and 88.4%. Double reading of CT scans and expert second readers could increase the diagnostic confidence of radiological interpretation in COVID-19 patients.
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http://dx.doi.org/10.3390/biology10020089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911408PMC
January 2021

Sustainable production of diapers and their potential outputs for the Pakistani market in the circular economy perspective.

Sci Total Environ 2021 May 14;769:145084. Epub 2021 Jan 14.

Università degli Studi di Cassino e del Lazio Meridionale, via G. Di Biasio, 43, 03043 Cassino, FR, Italy. Electronic address:

One of the challenging issues of any country's agenda today is the management of solid waste in the circular economy and eco-efficiency perspective. In this context, there has been much debate about the disposal of diapers, but the current research lacks data for developing countries. Furthermore, the research lacks quantification of data, in terms of output products generated through sustainable waste management practices particularly for diapers. Thus, this research aims to develop a quantitative study based on Life Cycle Assessment (LCA) and Life Cycle Costing Analysis (LCCA) which help to evaluate the overall eco-efficiency of various disposal methods by taking into account their net input and resultant monetary value, in the context of Pakistan. To cover limitations of LCA approach, results have been compared along with the expert's opinion using the well-known multi-criteria method Fuzzy logic and Technique for Order of preference by similarity to ideal solution (TOPSIS) technique. Human health and environment have been used as end-point indicators. The main research result points out that incorporating small scale incineration plants along with recycling using Thermal Pyrolysis Hydrolysis (TPH) plants can help to sustainably dispose-off diapers. The results also indicate the importance for policy makers and industrial sector to find solutions to facilitate implementation of circular economy principles for diapers. In fact, the recycling of diapers using waste-to-energy technologies is a significantly eco-efficient alternative for the Pakistani market, which can be pivotal for Sustainable development and initiation of a circular economy model.
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http://dx.doi.org/10.1016/j.scitotenv.2021.145084DOI Listing
May 2021

Assessment of Ablation Therapy in Pancreatic Cancer: The Radiologist's Challenge.

Front Oncol 2020 27;10:560952. Epub 2020 Nov 27.

Hepatobiliary Surgical Oncology Division, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Naples, Italy.

This article provides an overview of imaging assessment of ablated pancreatic cancer. Only studies reporting radiological assessment on pancreatic ablated cancer were retained. We found 16 clinical studies that satisfied the inclusion criteria. Radiofrequency ablation and irreversible electroporation have become established treatment modalities because of their efficacy, low complication rates, and availability. Microwave Ablation (MWA) has several advantages over radiofrequency ablation (RFA), which may make it more attractive to treat pancreatic cancer. Electrochemotherapy (ECT) is a very interesting emerging technique, characterized by low complication rate and safety profile. According to the literature, the assessment of the effectiveness of ablative therapies is difficult by means of the Response Evaluation Criteria in Solid Tumors (RECIST) criteria that are not suitable to evaluate the treatment response considering that are related to technique used, the timing of reassessment, and the imaging procedure being used to evaluate the efficacy. RFA causes various appearances on imaging in the ablated zone, correlating to the different effects, such as interstitial edema, hemorrhage, carbonization, necrosis, and fibrosis. Irreversible electroporation (IRE) causes the creation of pores within the cell membrane causing cell death. Experimental studies showed that Diffusion Weigthed Imaging (DWI) extracted parameters could be used to detect therapy effects. No data about functional assessment post MWA is available in literature. Morphologic data extracted by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) do not allow to differentiate partial, complete, or incomplete response after ECT conversely to functional parameters, obtained with Position Emission Tomography (PET), MRI, and CT.
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http://dx.doi.org/10.3389/fonc.2020.560952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731725PMC
November 2020

The clinical and translational research activities at the INT - IRCCS "Fondazione Pascale" cancer center (Naples, Italy) during the COVID-19 pandemic.

Infect Agent Cancer 2020 Nov 23;15(1):69. Epub 2020 Nov 23.

Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy.

COVID-19 pandemic following the outbreak in China and Western Europe, where it finally lost the momentum, is now devastating North and South America. It has not been identified the reason and the molecular mechanisms of the two different patterns of the pulmonary host responses to the virus from a minimal disease in young subjects to a severe distress syndrome (ARDS) in older subjects, particularly those with previous chronic diseases (including diabetes) and cancer. The Management of the Istituto Nazionale Tumori - IRCCS "Fondazione Pascale" in Naples (INT-Pascale), along with all Health professionals decided not to interrupt the treatment of those hospitalized and to continue, even if after a careful triage in order not to allow SARS-CoV-2 positive subjects to access, to take care of cancer patients with serious conditions. Although very few (n = 3) patients developed a symptomatic COVID-19 and required the transfer to a COVID-19 area of the Institute, no patients died during the hospitalization and completed their oncology treatment. Besides monitoring of the patients, all employees of the Institute (physicians, nurses, researchers, lawyers, accountants, gatekeepers, guardians, janitors) have been tested for a possible exposure. Personnel identified as positive, has been promptly subjected to home quarantine and subdued to health surveillance. One severe case of respiratory distress has been reported in a positive employees and one death of a family member. Further steps to home monitoring of COVID-19 clinical course have been taken with the development of remote Wi-Fi connected digital devices for the detection of early signs of respiratory distress, including heart rate and oxygen saturation.In conclusion cancer care has been performed and continued safely also during COVID-19 pandemic and further remote home strategies are in progress to ensure the appropriate monitoring of cancer patients.
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http://dx.doi.org/10.1186/s13027-020-00330-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681193PMC
November 2020

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting.

PLoS One 2020 19;15(11):e0241431. Epub 2020 Nov 19.

Radiology Division, "Istituto Nazionale Tumori IRCCS Fondazione Pascale - IRCCS di Napoli", Naples, Italy.

Background: MRI is the most reliable imaging modality that allows to assess liver metastases. Our purpose is to compare the per-lesion and per-patient detection rate of gadoxetic acid-(Gd-EOB) enhanced liver MRI and fast MR protocol including Diffusion Weighted Imaging (DWI) and T2-W Fat Suppression sequence in the detection of liver metastasis in pre surgical setting.

Methods: One hundred and eight patients with pathologically proven liver metastases (756 liver metastases) underwent Gd-EOBMRI were enrolled in this study. Three radiologist independently graded the presence of liver lesions on a five-point confidence scale assessed only abbreviated protocol (DWI and sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) fat suppressed sequence) and after an interval of more than 2 weeks the conventional study (all acquired sequences). Per-lesion and per-patient detection rate of metastases were calculated. Weighted к values were used to evaluate inter-reader agreement of the confidence scale regarding the presence of the lesion.

Results: MRI detected 732 liver metastases. All lesions were identified both by conventional study as by abbreviated protocol. In terms of per-lesion detection rate of liver metastasis, all three readers had higher detection rate both with abbreviated protocol and with standard protocol with Gd-EOB (96.8% [732 of 756] vs. 96.5% [730 of 756] for reader 1; 95.8% [725 of 756] vs. 95.2% [720 of 756] for reader 2; 96.5% [730 of 756] vs. 96.5% [730 of 756] for reader 3). Inter-reader agreement of lesions detection rate between the three radiologists was excellent (k range, 0.86-0.98) both for Gd-EOB MRI and for Fast protocol (k range, 0.89-0.99).

Conclusion: Abbreviated protocol showed the same detection rate than conventional study in detection of liver metastases.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241431PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676687PMC
December 2020

COVID-19 pneumonia: computer-aided quantification of healthy lung parenchyma, emphysema, ground glass and consolidation on chest computed tomography (CT).

Radiol Med 2021 Apr 18;126(4):553-560. Epub 2020 Nov 18.

Division of Radiodiagnostic, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy.

Objective: To calculate by means of a computer-aided tool the volumes of healthy residual lung parenchyma, of emphysema, of ground glass opacity (GGO) and of consolidation on chest computed tomography (CT) in patients with suspected viral pneumonia by COVID-19.

Materials And Methods: This study included 116 patients that for suspected COVID-19 infection were subjected to the reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test. A computer-aided tool was used to calculate on chest CT images healthy residual lung parenchyma, emphysema, GGO and consolidation volumes for both right and left lung. Expert radiologists, in consensus, assessed the CT images using a structured report and attributed a radiological severity score at the disease pulmonary involvement using a scale of five levels. Nonparametric test was performed to assess differences statistically significant among groups.

Results: GGO was the most represented feature in suspected CT by COVID-19 infection; it is present in 102/109 (93.6%) patients with a volume percentage value of 19.50% and a median value of 0.64 L, while the emphysema and consolidation volumes were low (0.01 L and 0.03 L, respectively). Among quantified volume, only GGO volume had a difference statistically significant between the group of patients with suspected versus non-suspected CT for COVID-19 (p < < 0.01). There were differences statistically significant among the groups based on radiological severity score in terms of healthy residual parenchyma volume, of GGO volume and of consolidations volume (p < < 0.001).

Conclusion: We demonstrated that, using a computer-aided tool, the COVID-19 pneumonia was mirrored with a percentage median value of GGO of 19.50% and that only GGO volume had a difference significant between the patients with suspected or non-suspected CT for COVID-19 infection.
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http://dx.doi.org/10.1007/s11547-020-01305-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673247PMC
April 2021

Blood oxygenation level dependent magnetic resonance imaging and diffusion weighted MRI imaging for benign and malignant breast cancer discrimination.

Magn Reson Imaging 2021 01 17;75:51-59. Epub 2020 Oct 17.

Radiology Division, ISTITUTO NAZIONALE TUMORI - IRCCS - FONDAZIONE G. PASCALE, Naples, Italy.

Purpose: The purpose of this study is to assess Blood oxygenation level dependent Magnetic Resonance Imaging (BOLD-MRI) and Diffusion Weighted Magnetic Resonance Imaging (DW-MRI) in the differentiation of benign and malignant breast lesions.

Methods: Fifty-nine breast lesions (26 benign and 33 malignant lesions) pathologically proven in 59 patients were included in this retrospective study. As BOLD parameters were estimated basal signal S and the relaxation rate R2*, diffusion and perfusion parameters were derived by DWI (pseudo-diffusion coefficient (Dp), perfusion fraction (fp) and tissue diffusivity (Dt)). Wilcoxon-Mann-Whitney U test and Receiver operating characteristic (ROC) analyses were calculated and area under ROC curve (AUC) was obtained. Moreover, pattern recognition approaches (linear discrimination analysis (LDA), support vector machine, k-nearest neighbours, decision tree) with least absolute shrinkage and selection operator (LASSO) method and leave one out cross validation approach were considered.

Results: A significant discrimination was obtained by the standard deviation value of S0, as BOLD parameter, that reached an AUC of 0.76 with a sensitivity of 65%, a specificity of 85% and an accuracy of 76%. No significant discrimination was obtained considering diffusion and perfusion parameters. Considering LASSO results, the features to use as predictors were all extracted parameters except that the mean value of R2* and the best result was obtained by a LDA that obtained an AUC = 0.83, with a sensitivity of 88%, a specificity of 77% and an accuracy of 83%.

Conclusions: Good performance to discriminate benign and malignant lesions could be obtained using BOLD and DWI derived parameters with a LDA classification approach. However, these findings should be proven on larger and several dataset with different MR scanners.
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http://dx.doi.org/10.1016/j.mri.2020.10.008DOI Listing
January 2021

Coronavirus disease 2019 (COVID-19) in Italy: features on chest computed tomography using a structured report system.

Sci Rep 2020 10 14;10(1):17236. Epub 2020 Oct 14.

Division of Radiodiagnostic, "Università Degli Studi Della Campania Luigi Vanvitelli", Naples, Italy.

To assess the use of a structured report in the Chest Computed Tomography (CT) reporting of patients with suspicious viral pneumonia by COVID-19 and the evaluation of the main CT patterns. This study included 134 patients (43 women and 91 men; 68.8 years of mean age, range 29-93 years) with suspicious COVID-19 viral infection evaluated by reverse transcription real-time fluorescence polymerase chain reaction (RT-PCR) test. All patients underwent CT examinations at the time of admission. CT images were reviewed by two radiologists who identified COVID-19 CT patterns using a structured reports. Temporal difference mean value between RT-PCRs and CT scan was 0.18 days ± 2.0 days. CT findings were positive for viral pneumonia in 94.0% patients while COVID-19 was diagnosed at RT-PCR in 77.6% patients. Time mean value to complete the structured report by radiologist was 8.5 min ± 2.4 min. The disease on chest CT predominantly affected multiple lobes and the main CT feature was ground glass opacity (GGO) with or without consolidation (96.8%). GGO was predominantly bilateral (89.3%), peripheral (80.3%), multifocal/patching (70.5%). Consolidation disease was predominantly bilateral (83.9%) with prevalent peripheral (87.1%) and segmental (47.3%) distribution. Additional CT signs were the crazy-paving pattern in 75.4% of patients, the septal thickening in 37.3% of patients, the air bronchogram sign in 39.7% and the "reversed halo" sign in 23.8%. Less frequent characteristics at CT regard discrete pulmonary nodules, increased trunk diameter of the pulmonary artery, pleural effusion and pericardium effusion (7.9%, 6.3%, 14.3% and 16.7%, respectively). Barotrauma sign was absent in all the patients. High percentage (54.8%) of the patients had mediastinal lymphadenopathy. Using a Chest CT structured report, with a standardized language, we identified that the cardinal hallmarks of COVID-19 infection were bilateral, peripheral and multifocal/patching GGO and bilateral consolidation with peripheral and segmental distribution.
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http://dx.doi.org/10.1038/s41598-020-73788-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566610PMC
October 2020
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