Search

EUSOBI and 30 national breast radiology bodies support mammography for population-based screening, demonstrated to reduce breast cancer (BC) mortality and treatment impact. According to the International Agency for Research on Cancer, the reduction in mortality is 40 % for women aged 50-69 years taking up the invitation while the probability of false-positive needle biopsy is <1 % per round and overdiagnosis is only 1-10 % for a 20-year screening. Mortality reduction was also observed for the age groups 40-49 years and 70-74 years, although with "limited evidence". Thus, we firstly recommend biennial screening mammography for average-risk women aged 50-69 years; extension up to 73 or 75 years, biennially, is a second priority, from 40-45 to 49 years, annually, a third priority. Screening with thermography or other optical tools as alternatives to mammography is discouraged. Preference should be given to population screening programmes on a territorial basis, with double reading. Adoption of digital mammography (not film-screen or phosphor-plate computer radiography) is a priority, which also improves sensitivity in dense breasts. Radiologists qualified as screening readers should be involved in programmes. Digital breast tomosynthesis is also set to become "routine mammography" in the screening setting in the next future. Dedicated pathways for high-risk women offering breast MRI according to national or international guidelines and recommendations are encouraged.Key Points: • EUSOBI and 30 national breast radiology bodies support screening mammography. • A first priority is double-reading biennial mammography for women aged 50-69 years. • Extension to 73-75 and from 40-45 to 49 years is also encouraged. • Digital mammography (not film-screen or computer radiography) should be used. • DBT is set to become "routine mammography" in the screening setting in the next future. [ABSTRACT FROM AUTHOR]

Aims: The 2005 International Society of Urological Pathology (ISUP) modification of Gleason grading recommended that the highest grade should always be included in the Gleason score (GS) in prostate biopsies. We analysed the impact of this recommendation on reporting of GS 6 versus 7. Methods and results: Fifteen expert uropathologists reached two-thirds consensus on 15 prostate biopsies with GS 6-7 cancer. Eighty-five microphotographs were graded by 337 of 617 members of the European Network of Uropathology (ENUP), representing 19 countries. There was agreement between expert and majority member GS in 12 of 15 cases, while members upgraded in three cases. Among members and the expert consensus, a GS >6 was assigned by 64.5% and 60%, respectively. Mean member GS was higher than consensus GS in nine of 15 cases. A Gleason pattern (GP) 5 was reported by 0.3-5.6% in 10 cases. Agreement between consensus and member GS was 58.2-89.3% (mean 71.4%) in GS 6 cases and 46.3-63.8% (mean 56.4%) in GS 7 cases ( P = 0.009). Conclusions: While undergrading of prostate cancer used to be prevalent, some now tend to overgrade. Minimum diagnostic criteria for GP 4 and 5 in biopsies need to be better defined. Image libraries reviewed by experts may be useful for standardization. [ABSTRACT FROM AUTHOR]

Abstract: This paper presents an analysis of fatal train accident rates and trends on Europe''s main line railways from 1980 to 2009. The paper uses a new set of data for the European Union together with Norway and Switzerland, assembled partly under the auspices of the European Railway Agency and partly on the author''s own account. The estimated overall trend in the number of fatal train collisions and derailments per train-kilometre is −6.3% per year from 1990 to 2009, with a 95% confidence interval of −8.7% to −3.9%. The estimated accident rate in 2009 is 1.35 fatal collisions or derailments per billion train-kilometres, giving an estimated mean number of fatal accidents in 2009 of 6.0. The overall number of fatalities per fatal accident in 1990–2009 is 4.10, with no apparent long term change over time, giving an estimated mean of 24.6 fatalities per year in train collisions and derailments in 2009. There are statistically significant differences in the fatal train accident rates and trends between the different European countries, although the estimates of the rates and trends for many individual countries have wide confidence limits. The distribution of broad causes of accidents appears to have remained unchanged over the long term, so that safety improvements appear to have been across the board, and not focused on any specific cause. The most frequent cause of fatal train collisions and derailments is signals passed at danger. In contrast to fatal train collisions and derailments, the rate per train-kilometre of serious accidents at level crossings remained unchanged in 1990–2009. The immediate causes of most of the serious level crossing accidents are errors or violations by road users. [Copyright &y& Elsevier]

In this article the author discusses the global growth in policy supporting the planting of bioenergy crops to mitigate greenhouse gas emissions in Europe. The authors argue that the effort is important for bird conservation and agriculture in the continent. The authors view that if using the knowledge regarding causes of loss of biodiversity from agricultural systems to ensure bird conservation is a success, it could be a turning point in 2010.

• Fatal train accidents per train-kilometre in Europe fell at the rate of 6% per year from 1990 until 2019. • There were 0.85 fatal accidents per billion train-kilometres in 2019. • There was a mean of 4.2 fatalities per fatal accident in 1990–2019. • the proportion of accidents caused by signals passed at danger fell from 40 % in the 1990s to 21 % in the 2010s. This may be due to the increasing deployment of train protection systems. This paper presents an analysis of fatal train accident rates and trends on Europe's main line railways from 1990–2019. It is a sequel to the paper Fatal train accidents on Europe's railways: 1980–2009 (Evans (2011), which covers the three decades 1980–2009. The present paper discards the data for the 1980s, but adds the data for 2010−2019. The data cover the 28 countries of the European Union as in 2019, together with Norway and Switzerland. The source of the recent data is largely the European Union Agency for Railways. The estimated overall trend in the number of fatal train collisions and derailments per train-kilometre was –5.6 % per year from 1990–2019, with a 95 % confidence interval of –7.1 % to -4.2 %. The estimated accident rate in 2019 was 0.85 fatal collisions or derailments per billion train-kilometres, which represents a fall of 78 % since 1990. This gives an estimated mean number of fatal accidents in Europe in 2019 of 3.89. The data and results for 2010−2019 closely match the extrapolation of the results for 1990−2009, so that in 2009 extrapolation would have given a good forward projection for 2019. By the same argument this paper gives a forward projection of the mean number of accidents in 2029 of 2.12, assuming no change in train-kilometres, or pro-rata changes with changes in train-kilometres. The paper investigates the causes of accidents. A notable finding is that the proportion of accidents caused by signals passed at danger (SPADs) fell from 40 % in 1990−1999 to 21 % in 2010−2019. This is probably due to the increasing deployment of train protection systems. The number of fatalities in individual accidents has a skew distribution: most accidents have a small number of fatalities, but a few have a large number. The overall observed number of fatalities per accident is 4.23, and there is no indication that this mean changes with time. This implies that the mean number of fatalities per year has the same downward trend of 5.6 % per year as the mean number of accidents per year. [ABSTRACT FROM AUTHOR]

Accurate Gleason score, pathologic stage, and surgical margin (SM) information is critical for the planning of post-radical prostatectomy management in patients with prostate cancer. Although interobserver variability for Gleason score among urologic pathologists has been well documented, such data for pathologic stage and SM assessment are limited. We report the first study to address interobserver variability in a group of expert pathologists concerning extraprostatic soft tissue (EPE) and SM interpretation for radical prostatectomy specimens. A panel of 3 urologic pathologists selected 6 groups of 10 slides designated as being positive, negative, or equivocal for either EPE or SM based on unanimous agreement. Twelve expert urologic pathologists, who were blinded to the panel diagnoses, reviewed 40x whole-slide scans and provided diagnoses for EPE and SM on each slide. On the basis of panel diagnoses, as the gold standard, specificity, sensitivity, and accuracy values were high for both EPE (87.5%, 95.0%, and 91.2%) and SM (97.5%, 83.3%, and 90.4%). Overall kappa values for all 60 slides were 0.74 for SM and 0.63 for EPE. The kappa values were higher for slides with definitive gold standard EPE (kappa=0.81) and SM (kappa=0.73) diagnoses when compared with the EPE (kappa=0.29) and SM (kappa=0.62) equivocal slides. This difference was markedly pronounced for EPE. Urologic pathologists show good to excellent agreement when evaluating EPE and SM. Interobserver variability for EPE and SM interpretation was principally related to the lack of a clearly definable prostatic capsule and crush/thermal artifact along the edge of the gland, respectively.