Rubina Manuela Trimboli

I.R.C.C.S. Policlinico San Donato, Milano, Lombardy, Italy

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Publications (11)28.8 Total impact

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    ABSTRACT: Purpose To systematically review articles that estimated the ineligibility for partial breast irradiation (PBI) after magnetic resonance (MR) imaging. Materials and Methods No ethics committee approval was needed. A systematic search was performed by using MEDLINE and EMBASE. The rate of patients eligible at standard assessment (ie, clinical examination, mammography, and/or ultrasonography) but ineligible after MR imaging was a study outcome. Odds ratios (ORs) were calculated to identify predictors. Quality was appraised by using the Strengthening Reporting of Observational Studies in Epidemiology checklist. Results Of 93 retrieved articles, six were included (total, 3136 patients). For PBI eligibility, all studies applied National Surgical Adjuvant Breast and Bowel Project B-39 criteria. Ineligibility at standard assessment varied from 21% to 80%; MR imaging prompted ineligibility for PBI in 6%-25% of patients who were initially deemed eligible or in 2%-20% if calculated on the overall number of patients initially screened. Meta-regression showed a negative correlation between ineligibility at standard assessment and ineligibility after MR imaging (P < .001). The pooled percentage of patients eligible at standard assessment but ineligible after MR imaging was 11% (95% confidence interval [CI]: 6%, 19%). Predictors for ineligibility after MR imaging were cancers stage pT2 or greater versus less than stage pT2 (OR, 8.8 [95% CI: 4.7, 16.7]; P < .001), invasive lobular histopathologic results versus invasive ductal pathologic results (OR, 3.0 [95% CI: 1.6, 6.6]; P = .007), pre- versus postmenopausal status (OR, 1.9 [95% CI: 1.3, 2.6]; P < .001), invasive cancer versus ductal carcinoma in situ (OR, 1.6 [95% CI: 1.0, 2.4]; P = .031). Study quality ranged from 17 to 20 (maximum quality, 22). The risk of publication bias was moderate. Conclusion One of nine women (11%), who on the sole basis of standard assessment were candidates to undergo PBI, was found to be ineligible after undergoing MR imaging. Breast MR imaging should be used to select patients for PBI. (©) RSNA, 2015.
    Radiology 06/2015; DOI:10.1148/radiol.2015142508 · 6.87 Impact Factor
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    ABSTRACT: To compare breast density (BD) assessment provided by an automated BD evaluator (ABDE) with that provided by a panel of experienced breast radiologists, on a multivendor dataset. Twenty-one radiologists assessed 613 screening/diagnostic digital mammograms from nine centers and six different vendors, using the BI-RADS a, b, c, and d density classification. The same mammograms were also evaluated by an ABDE providing the ratio between fibroglandular and total breast area on a continuous scale and, automatically, the BI-RADS score. A panel majority report (PMR) was used as reference standard. Agreement (κ) and accuracy (proportion of cases correctly classified) were calculated for binary (BI-RADS a-b versus c-d) and 4-class classification. While the agreement of individual radiologists with the PMR ranged from κ = 0.483 to κ = 0.885, the ABDE correctly classified 563/613 mammograms (92 %). A substantial agreement for binary classification was found for individual reader pairs (κ = 0.620, standard deviation [SD] = 0.140), individual versus PMR (κ = 0.736, SD = 0.117), and individual versus ABDE (κ = 0.674, SD = 0.095). Agreement between ABDE and PMR was almost perfect (κ = 0.831). The ABDE showed an almost perfect agreement with a 21-radiologist panel in binary BD classification on a multivendor dataset, earning a chance as a reproducible alternative to visual evaluation. • Individual BD assessment differs from PMR with κ as low as 0.483. • An ABDE correctly classified 92 % of mammograms with almost perfect agreement (κ = 0.831). • An ABDE can be a valid alternative to subjective BD assessment.
    European Radiology 05/2015; DOI:10.1007/s00330-015-3784-2 · 4.01 Impact Factor
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    ABSTRACT: Objective: The purpose of this study was to investigate the diagnostic performance of unenhanced MRI in detecting breast cancer and to assess the impact of double reading. Materials and methods: A total of 116 breasts of 67 women who were 36-89 years old were studied at 1.5 T using an unenhanced protocol including axial T1-weighted gradient-echo, T2-weighted STIR, and echo-planar diffusion-weighted imaging (DWI). Two blinded readers (R1 and R2) independently evaluated unenhanced images using the BIRADS scale. A combination of pathology and negative follow-up served as the reference standard. McNemar and kappa statistics were used. Results: Per-breast cancer prevalence was 37 of 116 (32%): 30 of 37 (81%) invasive ductal carcinoma, five of 37 (13%) ductal carcinoma in situ, and two of 37 (6%) invasive lobular carcinoma. Per-breast sensitivity of unenhanced MRI was 29 of 37 (78%) for R1, 28 of 37 (76%) for R2, and 29 of 37 (78%) for double reading. Specificity was 71 of 79 (90%) for both R1 and R2 and 69 of 79 (87%) for double reading. Double reading did not provide a significant increase in sensitivity. Interobserver agreement was almost perfect (Cohen κ = 0.873). Conclusion: An unenhanced breast MRI protocol composed of T1-weighted gradient echo, T2-weighted STIR, and echo-planar DWI enabled breast cancer detection with sensitivity of 76-78% and specificity of 90% without a gain in sensitivity from double reading.
    American Journal of Roentgenology 09/2014; 203(3):674-81. DOI:10.2214/AJR.13.11816 · 2.73 Impact Factor
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    ABSTRACT: Our aim was to evaluate the surgical impact of preoperative MRI in young patients. We reviewed a single-institution database of 283 consecutive patients below 40 years of age and who were treated for breast cancer. Thirty-seven (13 %) patients who received neoadjuvant chemotherapy were excluded. The remaining 246 patients included 124 (50 %) who preoperatively underwent conventional imaging (CI), i.e., mammography/ultrasonography (CI-group), and 122 (50 %) who underwent CI and dynamic MRI (CI + MRI-group). Pathology of surgical specimens served as a reference standard. Mann-Whitney, χ (2), and McNemar statistics were used. There were no significant differences between groups in terms of age, tumor pathologic subtype, stage, receptor, or nodal status. The mastectomy rate was 111/246 (45 %) overall but was significantly different between groups (46/124, 37 %, for the CI group and 65/122, 53 %, for the CI + MRI group; p = 0.011). Of 122 CI + MRI patients, 46 (38 %) would have undergone mastectomy due to CI alone, while MRI determined 19 additional mastectomies, increasing the mastectomy rate from 38 % to 53 % (p < 0.001). The number of patients with multifocal, multicentric, synchronous, or bilateral cancers was significantly different between groups (10/124, 8 %, for the CI group and 33/122, 27 %, for the CI + MRI group; p < 0.001). In the CI + MRI group, multifocal, multicentric, or synchronous bilateral cancers were detected with mammography in 5/33 (15 %) patients, with ultrasonography in 15/33 (45 %) patients, and with MRI in 32/33 (97 %) patients (p < 0.005). Two mastectomies were due to false positives at both conventional tests in the CI group (2/124, 1.6 %) and two mastectomies were due to MRI false positives in the CI + MRI group (2/122, 1.6 %). In conclusion, breast cancer in young patients was treated with mastectomy in 37-38 % of cases on the basis of CI only and in these patients MRI was more sensitive than CI for multifocal, multicentric, or synchronous bilateral cancers, resulting in an additional mastectomy rate of 15 %. A low probability of inappropriate imaging-based decision-making for mastectomy exists for both CI alone and for CI + MRI, making presurgical needle biopsy mandatory for findings that suggest a need for mastectomy.
    Breast Cancer Research and Treatment 07/2013; 140(3). DOI:10.1007/s10549-013-2651-6 · 3.94 Impact Factor
  • Francesco Sardanelli · Rubina M Trimboli
    European journal of radiology 10/2012; 81 Suppl 1:S135-6. DOI:10.1016/S0720-048X(12)70056-6 · 2.37 Impact Factor
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    ABSTRACT: This study aimed to estimate the frequency and timing of washout in a series of pathologically proven benign mass-like breast lesions at dynamic magnetic resonance imaging. Institutional review board approval was obtained for this retrospective study. We evaluated enhancement kinetics of 33 pathologically confirmed benign breast lesions: fibroadenomas (n = 22), adenosis (n = 6), typical ductal hyperplasia (n = 2), fibroadenoma with ductal hyperplasia (n = 1), fibrosclerosis (n = 1), and inflammatory lesion (n = 1). Coronal 3-dimensional T1-weighted gradient-echo sequences were acquired before/after intravenous injection of 0.1 mmol/ kg gadoterate meglumine (time resolution, 111 seconds), 1 before and 5 after contrast injection. The time point at which the kinetic curve demonstrated a washout was recorded. Cumulative distribution of lesions showing washout was built. Paired comparisons of specificity for washout kinetics were performed using the McNemar test. Of 33 lesions, washout was never observed in 20 (61%), whereas 13 (39%) showed washout during the study. Of these 13 lesions, only 1 (inflammatory mass) exhibited washout within the first 3 minutes (specificity, 97%), 9 within 6 minutes (specificity, 73%), and 13 within 8 minutes (specificity, 61%). Specificity of washout kinetics within 3 minutes (97%) was significantly larger than that from the sixth minute (73%) and thereafter (P < 0.016). A prolonged observation for dynamic breast magnetic resonance imaging may result in false-positive washout, especially after 6 minutes. Late washout should not be considered a reliable marker of malignancy.
    Journal of computer assisted tomography 05/2012; 36(3):301-5. DOI:10.1097/RCT.0b013e3182506c48 · 1.41 Impact Factor
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    ABSTRACT: Objective: To estimate the spatial displacement of breast lesions and nipples in MR images when the patient is moved from the standard prone to a supine position close to ultrasound (US) or surgical setting. Materials and methods: Eleven patients underwent breast MRI in prone position with dynamic 3D T1-weighted sequences using 0.1 mmol/kg gadobenate dimeglumine. Subsequently, the patient was repositioned in supine position and a 3D volumetric interpolated breathhold examination sequence was acquired using a thoracic surface coil. For both positions we measured the following minimal distances: (A) from lesion margin to the coronal plane passing through the anterior surface of the sternum, antero-posterior, on native axial images; (B) from lesion margin to the medial sagittal plane, on native axial images, latero-medial;
    European journal of radiology 04/2012; 81(6):e771-4. DOI:10.1016/j.ejrad.2012.02.013 · 2.37 Impact Factor
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    ABSTRACT: PURPOSE Our aim was to estimate the prevalence of extramammary incidental findings (EMIFs) in patients undergoing breast MRI. METHOD AND MATERIALS We retrospectively reviewed 74 breast MRI studies of 73 patients, aged from 24 to 87 years (mean 55 ± 14 years) performed from June 1st, 2010 to March 15th, 2011. Studies were evaluated by a radiologist with 4-year experience mainly dedicate to breast imaging. Reported EMIFs were extracted from reports. An independent observer with 5-year experience in body CT and MRI reviewed all images in order to detect EMIFs (focused assessment). Major and minor EMIFs were distinguished. The prevalence of initially reported EMIFs was compared with that obtained with focused assessment, considered as reference standard. McNemar test was used. RESULTS Out of 74 exams, 8 EMIFs were initially reported in 6 patients. The focused assessment resulted in 34 EMIFs in 29 patients: 2 major EMIFs (1 vertebral metastasis and 1 ascending aorta ectasia) and 32 minor EMIFs (10 liver cysts, 6 disventilatory bands, 3 hiatal hernias, 2 small pleural effusions, 2 accessory spleens, 2 pulmonary atelectasias, 1 simple renal cysts, 1 liver hemangioma, 1 focal liver enhancement, 1 rib abnormality, 1 vertebral abnormality, 1 azygous ectasia, 1 abnormal lung density). All of initially reported EMIFs were found at focused assessment. Of 74 exams, 29 presented at least one EMIF with an overall prevalence of 39% (95%CI 28%-51%). The mean frequency of EMIFs per examination was 1:9.2 at initial reporting, while it was 1:2.2 at focused assessment (P<.001). Of the total 34 EMIFs, 26 (76%) were lost at initial reporting. CONCLUSION There is a highly significant difference between the rate of EMIFs initially reported in routine breast imaging practice and those found at a focused assessment by a body radiologist. CLINICAL RELEVANCE/APPLICATION Breast radiologists should pay more attention to EMIFs during routine clinical practice.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: To describe MRI features of fat necrosis of the breast. Twenty-five lesions in 16 patients were retrospectively analyzed. MRI was performed due to equivocal findings at conventional imaging after surgical treatment of cancer (n=14) or during anticoagulant therapy (n=1), after focal mastitis treated with ductal resection (n=1). In the 15 patients with previous surgery MRI was performed after a median interval of 24 months, using short tau inversion recovery (STIR) and contrast-enhanced dynamic T1-weighted sequences. Signal-to-noise ratio (SNR) inside the lesion and surrounding healthy fat was calculated on both STIR and unenhanced T1-weighted images. Maximal lesion diameter was measured on STIR images. All lesions had final clinical and imaging assessment in favor of fat necrosis and negative clinical and imaging follow-up (21-40 months; median 24 months). At STIR sequence, fat necrosis appeared as a "black hole", being markedly hypointense (median SNR=29) compared with surrounding fat (median SNR=95) (P<0.001), while no significant difference was found at unenhanced T1-weighted sequence. No significant correlation with time from treatment was found. Of 25 lesions, 15 showed ring enhancement, with continuous increase (n=10), plateau (n=2), or wash-out curve (n=3). The 11 enhancing lesions in the 8 patients with previous radiation therapy showed an initial enhancement higher than that of the 4 enhancing lesions in the 2 patients who did not, although the difference was not significant (P=0.104). Fat necrosis of the breast exhibits a "black hole" sign on STIR images, allowing for an easier diagnosis in clinical practice.
    European journal of radiology 07/2011; 81(4):e573-9. DOI:10.1016/j.ejrad.2011.06.048 · 2.37 Impact Factor
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    ABSTRACT: OBJECTIVE: The purpose of this article is to review the use of gadobenate dimeglumine, a high-relaxivity gadolinium-based contrast material, for breast MRI. CONCLUSION: Thanks to its high relaxivity, gadobenate dimeglumine offers valuable advantages in terms of lesion conspicuity, detection rate, and sensitivity for malignant breast lesions. However, a higher enhancement of benign lesions should be taken into account to avoid reduced specificity.
    American Journal of Roentgenology 04/2011; 196(4):942-55. DOI:10.2214/AJR.10.4974 · 2.73 Impact Factor
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    ABSTRACT: PURPOSE To estimate the diagnostic value of vessels feeding breast lesions as a marker of malignancy. METHOD AND MATERIALS We reviewed a series of 94 1.5-T breast MR examinations (patients’ mean age 53±13 years) in which at least a mass-like lesion was detected and pathological examination was available from core-needle or excisional biopsy. The imaging protocol included a dynamic study with 0.1 mmol/kg of gadobenate dimeglumine using a 3D FLASH (TR/TE=11/4.76 ms, matrix 384×384 or 512×512) sequence. Using maximum intensity projection reconstructions, we counted the number of vessels feeding the lesion and the diameter of the largest of them. Spearman correlation coefficient , χ2 test and 95% confidence intervals (95% CIs) were used. RESULTS Out of 94 breast index lesions, 82 (87%) were malignant 64 invasive cancers, 18 DCIS), while the remaining 12 (13%) were fibroadenomas (n=6), papillomas (n=5), and phyllodes (n=1). At least one feeding vessel was detected in 41/82 (50% sensitivity, 95% CI 39%-61%) malignant lesions, while no feeding vessels were associated (P<.001) with the 12 benign lesions (100% specificity, 95% CI 73%-100%). Positive and negative predictive values were 41/41 (100%, 95% CI 91%-100%) and 12/53 (23%, 95% CI 12%-36%), respectively. The pathological grade of malignant lesions correlated with both the number of feeding vessels (r=0.392, P<.001) and the maximal diameter (r=0.364, P<.001). Malignant lesions without feeding vessels had a median diameter lower than those with at least a feeding vessel (15 mm versus 25 mm, P<.001). The maximal diameter of feeding vessels correlated with the lesion diameter (r=0.419, P<.001). There was no significant difference between invasive and in situ cancers in terms of both the presence of feeding vessels (P=.283) and the maximal feeding vessel diameter (P=.342). CONCLUSION While only 50% of cancers were associated with feeding vessels, breast lesions with at least one feeding vessel showed a high probability of being malignant. Moreover, the higher the histological lesion grade, the larger the number and diameter of feeding vessels. CLINICAL RELEVANCE/APPLICATION When assessing breast mass-like lesions with contrast-enhanced MRI, the presence of feeding vessels should be considered as a marker of malignancy to be added to the established BI-RADS descriptors.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 11/2010