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A guideline panel formulated a set of recommendations for breast cancer screening and diagnosis to implement clinical activities in Italy in alignment with the European Breast Cancer Guidelines on Screening and Diagnosis (European Commission Initiative on Breast Cancer-ECIBC). The panel issued national recommendations through adopting, adapting, and/or developing recommendations from the European guidelines (ADOLOPMENT approach). This process utilizes the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence to decision (EtD) framework. An additional PubMed search was conducted using search terms specific to Italy to tailor the EU guidelines to the national context. Nine articles were included as contextual evidence in the EtD. A total of 13 recommendations were finalized, either adapted or adopted to suit the national context. Organized breast cancer screening is strongly recommended for women aged 50-69 every 2 years, and it is conditionally recommended every 3 years for women aged 70-74, as well as every 1 or 2 years for women aged 45-49. Annual mammography received a strong recommendation against for women aged 50 and older. Developing shared national guidelines for the management of mammography screening will improve the standardization of processes across all settings, thereby promoting health equity., Competing Interests: Declarations. Conflict of interest: Silvia Deandrea is the President of the Italian Mammography Screening Group; Marco Rosselli Del Turco was a medical consultant for senology at FORA s.p.a. Paolo Giorgi Rossi is a member of the panel that developed the European guidelines on breast cancer screening and diagnosis, referred document for the ADOLOPMENT process; Livia Giordano is a member of the panel that developed the European guidelines on breast cancer screening and diagnosis, referred document for the ADOLOPMENT process; Elena Parmelli was a contract staff member at the Joint Research Centre (JRC) of the European Commission, Ispra, VA (Italy); Cannatà Vittorio has been Vice-President of the Italian Association of Medical Physics (AIFM); Isabella Castellano has been professional consultant for symposium “Choosing the best therapy in ER + /HER2- breast cancer” (Token of attendance at the National Congress of Anatomic Pathology, October 2019), Myriad Genetics, s.r.l.; Stefano Pacifici is the President of the Italian Association of Senology Radiographers (AITeRS); Trianni Annalisa is a member of the Italian Association of Medical Physics (AIFM); Paola Golinelli was reimbursed for participation in the European Federation of Organization for Medical Physics (EFOMP) Working Group on mammographic tomosynthesis equipment. Pierpaolo Pattacini received a software by I-CAD. The other authors have no relevant financial or non-financial interest to disclose. Competing interests: All panellists were required to disclose all financial, non-financial, personal, and institutional interests relevant to the scope of the guidelines by completing a standardized form, following SNLG guidance. The Scientific Committee (SC) assessed each individual interest, and ultimately, no panellist was excluded from the voting procedures. This policy was upheld throughout the entire process, including the selection of panel members, the generation and prioritization of research questions, and participation in the formulation of recommendations. The SC consistently monitored the declaration of conflicts of interest (COI). Ethical approval: Ethical approval was not necessary for this kind of scientific work. Informed consent: Not applicable., (© 2024. Italian Society of Medical Radiology.)

Introduction: In 2016, the Italian Group for Mammography Screening and the Italian College of Breast Radiologists by the Italian Society of Medical and Interventional Radiology recommended that screening programmes and specialist breast centres actively invite women with a history of breast cancer to follow-up imaging., Objective: A survey of breast centres associated with Senonetwork, the Italian network of breast cancer services, has offered the opportunity to assess the implementation of this recommendation., Methods: A national, cross-sectional, voluntary, online survey was developed, pre-tested, and administered during the months July-October 2020. Five of the 73 questionnaire items concerned breast cancer follow-up., Results: The response rate was 82/128 (65%). Of the 82 respondent centres, 69 (84%) were involved in a screening programme. Fifty-six (68%) reported the presence of a programme of active invitation to breast cancer follow-up targeted at patients living in their catchment area, with a significant north-to-south gradient. Four centres (5%) reported that the screening programme was responsible for actively initiating follow-up during the 10-year period since diagnosis. Only after 10 years did the proportion increase moderately., Conclusion: Screening programmes have still a marginal role in active breast cancer follow-up., (© 2022. Italian Society of Medical Radiology.)

Background: Radiology is an essential tool in the management of a patient. The aim of this manuscript was to build structured report (SR) Mammography based in Breast Cancer., Methods: A working team of 16 experts (group A) was composed to create a SR for Mammography Breast Cancer. A further working group of 4 experts (group B), blinded to the activities of the group A, was composed to assess the quality and clinical usefulness of the SR final draft. Modified Delphi process was used to assess level of agreement for all report sections. Cronbach's alpha (Cα) correlation coefficient was used to assess internal consistency and to measure quality analysis according to the average inter-item correlation., Results: The final SR version was built by including n = 2 items in Personal Data, n = 4 items in Setting, n = 2 items in Comparison with previous breast examination, n = 19 items in Anamnesis and clinical context; n = 10 items in Technique; n = 1 item in Radiation dose; n = 5 items Parenchymal pattern; n = 28 items in Description of the finding; n = 12 items in Diagnostic categories and Report and n = 1 item in Conclusions. The overall mean score of the experts and the sum of score for structured report were 4.9 and 807 in the second round. The Cronbach's alpha (Cα) correlation coefficient was 0.82 in the second round. About the quality evaluation, the overall mean score of the experts was 3.3. The Cronbach's alpha (Cα) correlation coefficient was 0.90., Conclusions: Structured reporting improves the quality, clarity and reproducibility of reports across departments, cities, countries and internationally and will assist patient management and improve breast health care and facilitate research., (© 2022. The Author(s).)

This position paper, issued by ICBR/SIRM and GISMa, summarizes the evidence on DBT and provides recommendations for its use. In the screening setting, DBT in adjunct to digital mammography (DM) increased detection rate by 0.5-2.7‰ and decreased false positives by 0.8-3.6% compared to DM alone in observational and double-testing experimental studies. The reduction in recall rate could be less prominent in those screening programs which already have low recall rates with DM. The increase in radiation exposure associated with DM/DBT protocols has been solved by the introduction of synthetic mammograms (sDM) reconstructed from DBT datasets. Thus, whenever possible, sDM/DBT should be preferred to DM/DBT. However, before introducing DBT as a routine screening tool for average-risk women, we should wait for the results of randomized controlled trials and for a statistically significant and clinically relevant reduction in the interval cancer rate, hopefully associated with a reduction in the advanced cancer rate. Otherwise, a potential for overdiagnosis and overtreatment cannot be excluded. Studies exploring this issue are ongoing. Screening of women at intermediate risk should follow the same recommendations, with particular protocols for women with previous BC history. In high-risk women, if mammography is performed as an adjunct to MRI or in the case of MRI contraindications, sDM/DBT protocols are suggested. Evidence exists in favor of DBT usage in women with clinical symptoms/signs and asymptomatic women with screen-detected findings recalled for work-up. The possibility to perform needle biopsy or localization under DBT guidance should be offered when DBT-only findings need characterization or surgery.

Women who were previously treated for breast cancer (BC) are an important particular subgroup of women at intermediate BC risk. Their breast follow-up should be planned taking in consideration a 1.0-1.5 % annual rate of loco-regional recurrences and new ipsilateral or contralateral BCs during 15-20 years, and be based on a regional/district invitation system. This activity should be carried out by a Department of Radiology integrating screening and diagnostics in the context of a Breast Unit. We recommend the adoption of protocols dedicated to women previously treated for BC, with a clear definition of responsibilities, methods for invitation, site(s) of visits, methods for clinical and radiological evaluation, follow-up duration, role and function of family doctors and specialists. These women will be invited to get a mammogram in dedicated sessions starting from the year after the end of treatment. The planned follow-up duration will be at least 10 years and will be defined on the basis of patient's age and preferences, taking into consideration organizational matters. Special agreements can be defined in the case of women who have their follow-up planned at other qualified centers. Dedicated screening sessions should include: evaluation of familial/personal history (if previously not done) for identifying high-risk conditions which could indicate a different screening strategy; immediate evaluation of mammograms by one or, when possible, two breast radiologists with possible addition of supplemental mammographic views, digital breast tomosynthesis, clinical breast examination, breast ultrasound; and prompt planning of possible further workup. Results of these screening sessions should be set apart from those of general female population screening and presented in dedicated reports. The following research issues are suggested: further risk stratification and effectiveness of follow-up protocols differentiated also for BC pathologic subtype and molecular classification, and evaluation of different models of survivorship care, also in terms of cost-effectiveness., Competing Interests: The authors declare no funding and no conflict of interest for this article. Ethical standards This article does not contain any studies with human participants or animals performed by any of the authors.

Purpose: Screening mammogram reading volume (SMRV) and total (screening and clinical) mammogram reading volume (TMRV) per year are strongly associated with the radiologist's diagnostic performance in breast cancer screening. The current article reports the prevalence and correlates of a SMRV and a TMRV ≥5000 among Italian breast screening radiologists., Materials and Methods: A questionnaire survey was carried out in 2013-2014 by the Italian Group for Mammography Screening (GISMa). The questionnaire included items of information for radiologist's experience-related characteristics and for facility-level factors supposedly associated with SMRV and TMRV. Multivariate analysis was performed using backward stepwise multiple logistic regression models., Results: Data for 235 radiologists from 51 local screening programmes were received. Of the 222 radiologists who were eligible, 133 (59.9 %) reported a SMRV ≥5000 and 163 (73.4 %) a TMRV ≥5000. Multivariate factors positively associated with both characteristics included: the number of years of experience reading mammograms; the percentage of total working time dedicated to breast imaging and breast care; the participation in diagnostic assessment; and the availability of digital tomosynthesis at facility. Full-time dedication to breast imaging and breast care was associated with the highest odds ratio for a SMRV and a TMRV ≥5000, i.e. 11.80 and 46.74, respectively, versus a percentage of time ≤50 %. An early (<2000) year of implementation of the screening programme and the availability of vacuum-assisted biopsy at facility were associated with a SMRV and, respectively, a TMRV ≥5000., Conclusions: Increasing the proportion of radiologists with full-time dedication to breast imaging and breast care qualified as the most effective approach to improve SMRV and TMRV.

Purpose: To evaluate the results of a new technique of dynamic contrast enhanced Magnetic Resonance (MR) imaging subtraction in the assessment of osteosarcoma response to chemotherapy., Methods: 24 patients with high grade osteosarcoma, treated with preoperative neo-adjuvant chemotherapy, underwent MR at high field strength (1.5 T). Both unenhanced conventional SE T1- and T2-weighted sequences in the coronal and axial plane and dynamic Gd-DTPA-enhanced SE T1-weighted sequences in the coronal plane were performed. Image postprocessing included subtraction of unenhanced image from enhanced images (arbitrary called "angiographic subtraction") and subtraction of each enhanced image from the last-enhanced image (arbitrary called "pathologic area" subtraction). The early enhancing areas detected in the angiographic subtraction and the pathologic areas detected in the pathologic area subtraction were correlated with histopathological findings on histological macrosections obtained from the resected specimen. The sensitivity, specificity, accuracy, positive and negative predictive value of both the subtraction techniques were calculated., Results: The early enhancing areas of angiographic subtraction were related not only to viable tumor but also to the host reactions such as flogosis and granulation tissue. The pathologic areas detected at the pathologic area subtraction correlated in most cases with viable tumor, while in 3 cases they did not correspond to viable tumor tissue and in 1 case a small area of residual viable tumor was missed. In assessing response to chemotherapy, pathologic areas subtraction had an accuracy of 95% (specificity: 100%, sensitivity: 93%, PPV: 100%, NPV: 88%), whereas angiographic subtraction had an accuracy of 79% (specificity: 37%, sensitivity: 100%, PPV: 76%, NPV: 100%)., Conclusions: Pathologic area subtraction may be a useful technique for assessing the response of osteosarcoma to chemotherapy and for detecting residual viable tumor tissue.

The authors report the technical-applicative characteristics of a storage phosphor system (ADC 70, Ag-fa), experimentally used at the Department of Radiology of the University of Modena (Azienda Ospedaliera Policlinico) and analyze its effects on the center budget. The system was applied to urologic, osteoarticular and thoracic diagnoses, with bedside exams in the latter case. An automatic system (chest changer, Dupont) was used for hospitalized walking patients and for nonhospitalized patients. The data relative to the consumption of films and chemical products and the relative cost were analyzed and It. L. 84,284,782 appeared to have been saved on the annual budget. The data extrapolated from the practical experience of the Modena Radiology Department showed an average 900 exams a month, with 2,019 films being used for conventional radiography versus 918 with the ADC system. Reusing the same evaluation system, the implementation of the same system was simulated in another hospital with different characteristics (Azienda USL Imola, Bologna). The final result was an estimated annual saving of about It L. 83,000,000. The total workload of X-ray rooms afferent to the developing ADC system was considered for both departments and the cost of the conventional system compared with that of the digital system with laser print: about 197 square meters of film were used monthly with the conventional system, versus 55 after the implementation of the ADC system. The estimated figures were about 424 versus 235 for the implementation of the same ADC system in the second hospital. 9-10% was the estimated saving of the ADC system versus the conventional one thanks to fewer of the so-called refuses-i.e., exams that must be repeated; 63-81% chemical products were also saved because fewer films were developed. The cost-effectiveness of the ADC system in the budget of the two centers is stressed, with about 40% total saving. In particular, using the transfer price system for intermediate departments by Regione Emilia Romagna, the annual full cost per exam (weight = 1) decreased from It. L. 4,343 to It. L. 4,120 before and after the ADC system implementation, respectively.

We report our experience with a storage phosphor radiography system; to assess both the image resolution and the dynamic range of the system, a phantom simulating chest average density was used. Finally, we investigated the system impact on portable chest radiographs. The radiographs were taken on 35 x 43 cm phosphor plates, with 80 kV, 3 mAs and focus-film distance of 130 cm. The phosphor plates were scanned with a 75 microns laser beam, postprocessed with the system software and, finally, printed on a 20 x 25 cm film. As reported by other Authors, the storage phosphor system showed similar spatial resolution to conventional radiography (2.5 lp/mm for 35 x 43 cm films and 4.5 lp/mm for 20 x 25 cm films), a wide dynamic range always allowing correcting exposure, but increased noise; these features allow film density optimization even in such "critical" situations and bedside radiographs. Pneumonia, pneumothorax, emphysema, pleural effusions and catheters or tubes positioning were always easily depicted. In our experience, the phosphor plate storage system exhibits many advantages over conventional radiography, namely image postprocessing, the opportunity to choose between several sizes of laser films and finally, the possibility of linking the system to a network and possibly to a digital archive. The main drawbacks of the system are its increased noise and, at present, with the available hardware, slow plate reading.

A series of 305 patients underwent both cholecystosonography and oral cholecystography. Ultrasounds showed a higher diagnostic accuracy in the diffuse and localized cholesteroloses. Oral cholecystography is still reliable in the diagnosis of adenomyomatosis, especially of the fundus. As present diagnostic and therapeutical indications are nonhomogeneous, early sonographic visualization and follow-up of small cholesterol polyps are valuable for understanding the development of the disease and its clinical and prognostic significance.