Giovanni Mauri
@grupposandonato.it
IRCCS Ospedaòe Galeazzi - Sant'Ambrogio
2
Scopus Publications
Scopus Publications
- Post-surgical Persistent Hyperparathyroidism Successfully Treated with Parathyroid Radiofrequency Ablation: A Case Report
Francesco Di Marco, Claudio Cusini, Anna Ferrulli, Giovanni Mauri, and Livio Luzi
Bentham Science Publishers Ltd.
Background: Currently, parathyroidectomy is the standard treatment for Primary Hyperparathyroidism (PHPT). Surgical treatment is often effective, although not free of complications and relapses. Minimally invasive techniques, such as Microwave Ablation (MWA) and Radiofrequency Ablation (RFA), are an alternative to surgery in selected patients. We have, herein, reported on the successful use of RFA in a patient with post-surgical persistent hyperparathyroidism. Case Presentation: A 54-year-old woman was referred to our Center for mild hypercalcemia with exams revealing Primary Hyperparathyroidism (PHPT). Neck ultrasound and Technetium- 99 Methoxy-isobutyl-isonitrile (99mTc-MIBI) scintigraphy scanning revealed a suspicious right parathyroid hyperplasia/adenoma. She underwent parathyroidectomy and histological examination showed a parathyroid nodular hyperplasia. During the follow-up, she suffered from persistent hyperparathyroidism due to a left parathyroid hyperplasia. Thus she was treated with RFA. Blood tests after the procedure showed the remission of the disease 7 months post-treatment. Conclusion: A minimally invasive technique for PHPT may represent a valid alternative to surgery, especially in patients with an elevated surgery-related risk. More studies are necessary to investigate the benefit of RFA as a first-line treatment in PHPT. - Microwave vs radiofrequency ablation for small renal masses: perioperative and oncological outcomes
Letizia Maria Ippolita Jannello, Franco Orsi, Stefano Luzzago, Giovanni Mauri, Francesco A. Mistretta, Mattia Luca Piccinelli, Chiara Vaccaro, Marco Tozzi, Daniele Maiettini, Gianluca Varano,et al.
Wiley
ObjectiveTo conduct a comprehensive comparison of microwave ablation (MWA) vs radiofrequency ablation (RFA) outcomes in the treatment of small renal masses (SRMs), specifically: TRIFECTA ([i] complete ablation, [ii] absence of Clavien–Dindo Grade ≥III complications, and [iii] absence of ≥30% decrease in estimated glomerular filtration rate) achievement, operative time (OT), and local recurrence rate (LRR).Patients and MethodsWe retrospectively analysed 531 patients with SRMs (clinical T1a–b) treated with MWA or RFA at a single centre (2008–2022). First, multivariable logistic regression models were used for testing TRIFECTA achievement. Second, multivariable Poisson regression models were used to evaluate variables associated with longer OT. Finally, Kaplan–Meier plots depicted LRR over time. All analyses were repeated after 1:1 propensity score matching (PSM).ResultsOf 531 patients with SRMs, 373/531 (70.2%) underwent MWA and 158/531 (29.8%) RFA. MWA demonstrated superior TRIFECTA achievement (314/373 [84.2%]) compared to RFA (114/158 [72.2%], P = 0.001). These differences were driven by higher rates of complete ablation in MWA‐ vs RFA‐treated patients (348/373 [93.3%] vs 137/158 [86.7%], P < 0.001). In multivariable logistic regression models, MWA was associated with higher TRIFECTA achievement, compared to RFA, before (odds ratio [OR] 1.92, P = 0.008) and after PSM (OR 1.99, P = 0.023). Finally, the median OT was shorter for MWA vs RFA (105 vs 115 min; P = 0.002). At Poisson regression analyses, MWA predicted shorter OT before (incidence rate ratio [IRR] 0.86, P < 0.001) and after PSM (IRR 0.85, P < 0.001). Local recurrence occurred in 17/373 (4.6%) MWA‐treated patients and 21/158 (13.3%) RFA‐treated patients (P = 0.29) after a median (interquartile range) follow‐up of 24 (8–46) months. There were no differences in the LRR in Kaplan–Meier plots before (P = 0.29) and after PSM (P = 0.42).ConclusionMicrowave ablation provides higher TRIFECTA achievement, and shorter OT than RFA. No significant differences were found regarding the LRR. - Role of Locoregional Therapies in the Treatment of Thyroid Pathology: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel
Alexander H. Lam, Elizabeth Holt, Fourat Ridouani, R. Michael Tuttle, Ralph P. Tufano, Auh Whan Park, Giovanni Mauri, Jennifer H. Kuo, Jung Hwan Baek, Nadine Abi-Jaoudeh,et al.
Elsevier BV - Artificial intelligence in interventional radiology: state of the art
Pierluigi Glielmo, Stefano Fusco, Salvatore Gitto, Giulia Zantonelli, Domenico Albano, Carmelo Messina, Luca Maria Sconfienza, and Giovanni Mauri
Springer Science and Business Media LLC
AbstractArtificial intelligence (AI) has demonstrated great potential in a wide variety of applications in interventional radiology (IR). Support for decision-making and outcome prediction, new functions and improvements in fluoroscopy, ultrasound, computed tomography, and magnetic resonance imaging, specifically in the field of IR, have all been investigated. Furthermore, AI represents a significant boost for fusion imaging and simulated reality, robotics, touchless software interactions, and virtual biopsy. The procedural nature, heterogeneity, and lack of standardisation slow down the process of adoption of AI in IR. Research in AI is in its early stages as current literature is based on pilot or proof of concept studies. The full range of possibilities is yet to be explored.Relevance statement Exploring AI’s transformative potential, this article assesses its current applications and challenges in IR, offering insights into decision support and outcome prediction, imaging enhancements, robotics, and touchless interactions, shaping the future of patient care.Key points• AI adoption in IR is more complex compared to diagnostic radiology.• Current literature about AI in IR is in its early stages.• AI has the potential to revolutionise every aspect of IR. Graphical Abstract - Liquid nitrogen-based cryoablation: complication rates for lung, bone, and soft tissue tumors cryoablation
Franco Orsi, Aida Shazlin Hamiddin, Caterina Sattin, Caterina Pizzi, Gianluca Maria Varano, Paolo Della Vigna, Giovanni Mauri, Daniele Maiettini, and Guido Bonomo
Oxford University Press (OUP)
Abstract Objective This study aimed to assess the complication rate during and 24 hours after cryoablation in lung, bone, and soft tissue tumors. Methods We reviewed complications in a total of 85 consecutive patients who underwent cryoablation using a liquid nitrogen-based system in various lesions between April 2017 and October 2022. There were no liver and renal lesions. Complications were categorized using the Society of Interventional Radiology classification. Results Eighty-five patients were treated for 96 lesions in the bone (36.4%; 35 of 96), lung (18.8%; 18 of 96), and soft tissue (44.8%; 43 of 96). The primary technical success rate was 97.7% (83 of 85). The total grade 2 and 1 complication rates were 5.2% (5/96) and 20.8% (20/96), respectively. Two patients had asymptomatic pulmonary embolisms incidentally noted at the 24-hour follow-up computed tomography (grade 2). The most frequent complications were simple and hemorrhagic pleural effusions (18.7%; 18 of 96). Lung procedures had the highest complication rate, where 13 patients (72.2%; 13 of 18) reported complications, including 2 cases of symptomatic hydropneumothorax requiring drainage (grade 2) and an additional 2 days of hospital stay. Eight patients (24.2%; 8 of 33) with bone lesions and 4 (9.3%; 4 of 43) with soft tissue lesions experienced complications. Conclusion Cryoablation using a liquid nitrogen-based system is safe, with only minor complications observed. Advances in knowledge This study provides data on the safety of liquid nitrogen-based percutaneous cryoablation in tumors located in lung, in bones and in soft tissues. Despite using larger diameter cryoprobes than those typically reported with argon-based system, our experience shows that complications are mostly low and comparable in frequency and severity. - Central Neck Dissection in Papillary Thyroid Carcinoma: Benefits and Doubts in the Era of Thyroid Lobectomy
Jacopo Zocchi, Gioacchino Giugliano, Chiara Mossinelli, Cecilia Mariani, Giacomo Pietrobon, Francesco Bandi, Stefano Malpede, Enrica Grosso, Marco Federico Manzoni, Elvio De Fiori,et al.
MDPI AG
Introduction: Surgery is still the main line of treatment for papillary thyroid cancer (PTC) with a current trend for de-intensified treatment based on an excellent prognosis. The role of a routine prophylactic central neck dissection (PCND) is still debated as its impact on oncologic outcomes has never been cleared by a randomized clinical trial. In this study, we aimed to report our long-standing experience in PCND and its potential contemporary role in the treatment of PTC. Methods: A retrospective institutional review was performed on all patients who underwent operation for PTC including PCND between 1998 and 2021. The primary outcomes were the rate of central lymph node metastases (CLNMs), cancer recurrence and incidence of complications. Survivals were analyzed using the Kaplan–Meier estimator and Cox proportional hazard models. Results: A total of 657 patients were included in this study with a median follow-up of 78 months (48–114 months). Two hundred and one patients presented occult CLNMs (30.6%). The presence of a pathological node represented the unique reason for a completion thyroidectomy and I131 therapy in 12.5% of the population. Age lower than 55 years, microscopic or macroscopic extra-thyroid extension (ETE) and multifocality were independent factors predicting CLNMs. The rate of recurrence in the whole population was 2.7% (18 patients). Five-year and ten-year disease-free survival (DFS) was 96.5% (94.7–97.7) and 93.3% (90.3–95.5), respectively. Two patients relapsed in the central neck compartment (0.3%). Age (>55 years), pathological staging (pT) and extranodal extension (ENE) were independent factors associated with a worse DFS. The rate of temporary and permanent vocal fold palsy was 12.8% and 1.8%, respectively, and did not depend on the type of surgical procedure performed. Hypoparathyroidism was temporary in 42.2% and permanent in 11.9% of the patients. A sub-analysis upon cT1b-T2 patients treated primarily with thyroid lobectomy and ipsilateral PCND demonstrated a 2.6% rate of permanent hypoparathyroidism. Conclusions: PCND allows for a high disease-free survival and a proper selection of patients needing adjuvant treatment, in particular, those treated with a unilateral procedure. On the other hand, bilateral approach is burdened by a not-neglectable rate of permanent hypoparathyroidism. - Is sharpest scalpel more important than a good surgeon?
Giovanni Mauri
Elsevier BV - Ultrasound Evaluation of Ablated Thyroid Nodules: An Emerging Problem
Teresa Dionísio and Giovanni Mauri
Mary Ann Liebert Inc
no abstract required on rules. - Thermal Ablation for Small Renal Masses: Identifying Anthropometric Factors for Predicting Perioperative and Oncological Outcomes
Gennaro Musi, Chiara Vaccaro, Stefano Luzzago, Giovanni Mauri, Mattia Luca Piccinelli, Daniele Maiettini, Marco Tozzi, Gianluca Varano, Ettore Di Trapani, Paolo Della Vigna,et al.
Elsevier BV - Radiologists’ Communicative Role in Breast Cancer Patient Management: Beyond Diagnosis
Luciano Mariano, Luca Nicosia, Adriana Sorce, Filippo Pesapane, Veronica Coppini, Roberto Grasso, Dario Monzani, Gabriella Pravettoni, Giovanni Mauri, Massimo Venturini,et al.
MDPI AG
In the landscape of cancer treatment, particularly in the realm of breast cancer management, effective communication emerges as a pivotal factor influencing patient outcomes. This article delves into the nuanced intricacies of communication skills, specifically spotlighting the strategies embraced by breast radiologists. By examining the ramifications of communication on patient experience, interdisciplinary collaboration, and legal ramifications, this study underscores the paramount importance of empathetic and comprehensive communication approaches. A special emphasis is placed on the utilization of the SPIKES protocol, a structured method for conveying sensitive health information, and the deployment of strategies for navigating challenging conversations. Furthermore, the work encompasses the significance of communication with caregivers, the integration of artificial intelligence, and the acknowledgement of patients’ psychological needs. By adopting empathetic communication methodologies and fostering multidisciplinary collaboration, healthcare practitioners have the potential to enhance patient satisfaction, promote treatment adherence, and augment the overall outcomes within breast cancer diagnosis. This paper advocates for the implementation of guidelines pertaining to psychological support and the allocation of sufficient resources to ensure the provision of holistic and patient-centered cancer care. The article stresses the need for a holistic approach that addresses patients’ emotional and psychological well-being alongside medical treatment. Through thoughtful and empathetic communication practices, healthcare providers can profoundly impact patient experiences and breast cancer journeys in a positive manner. - Clinical Outcomes of Thermal Ablation Re-Treatment of Benign Thyroid Nodules: A Multicenter Study from the Italian Minimally Invasive Treatments of the Thyroid Group
Stella Bernardi, Valentina Rosolen, Fabio Barbone, Stefano Borgato, Maurilio Deandrea, Pierpaolo De Feo, Laura Fugazzola, Giovanni Gambelunghe, Roberto Negro, Salvatore Oleandri,et al.
Mary Ann Liebert Inc
Thermal ablation (TA) is an established therapeutic option alternative to surgery in patients with solid, benign thyroid nodules causing local symptoms. However, a variable part of thyroid nodules remain viable after these non-surgical treatments, and as many as 15% of nodules treated with TA may require a second treatment over time. This study aimed to evaluate the outcomes of TA retreatment on symptomatic benign thyroid nodules where the volume decreased by < 50% after the first procedure (=technique inefficacy). METHODS We performed a multicenter retrospective cohort study including patients that underwent retreatment with TA for benign thyroid nodules, whose volume decreased by < 50% after initial treatment. The primary aim was to evaluate volume and volume reduction ratio (VRR) over time and compare the 6- and 12-month VRR after first vs second treatment. The secondary aim was to identify protective or risk factors for technique inefficacy, regrowth and further treatments, expressed as adjusted hazard ratios (HRs) and 95% confidence interval (CI), after adjustment for sex, age, nodule volume, structure and function, nodule regrowth or symptom relapse, technique used and if the same technique was used for the first and second TA and time between them. RESULTS We included 135 patients. Retreatment led to VRR of 50% and 52.2% after 6 and 12 months. VRR after retreatment was greater than after first treatment in small and medium size nodules (<30 mL), while there were no differences for large nodules (>30 mL). After retreatment technique inefficacy rate was 51.9%, regrowth rate was 12.6%, and further treatment rate was 15.6%. Radiofrequency ablation (RFA) was protective towards technique inefficacy (HR 0.40; 95% CI: 0.24-0.65) and need of further treatments (HR 0.30; 95% CI: 0.12-0.76). Large nodule volume (>30 mL) was associated with increased risk of retreatment (HR 4.52; 95% CI: 1.38-14.82). CONCLUSION This is the first study evaluating the outcomes of retreatment on symptomatic benign thyroid nodules with a VRR <50% after the initial TA treatment. Best results were seen in small and medium nodules (<30 mL) and after RFA. Prospective confirmatory studies are needed. - Impact of the introduction of minimally invasive treatments of the thyroid (MITT) for benign thyroid nodules in an Italian hospital: a cost-minimization analysis
Giampaolo Papi, Roberto Novizio, Massimo Brunetti, and Giovanni Mauri
Springer Science and Business Media LLC - Predicting Peri-Operative Outcomes in Patients Treated with Percutaneous Thermal Ablation for Small Renal Masses: The SuNS Nephrometry Score
Gennaro Musi, Stefano Luzzago, Giovanni Mauri, Francesco Alessandro Mistretta, Gianluca Maria Varano, Chiara Vaccaro, Sonia Guzzo, Daniele Maiettini, Ettore Di Trapani, Paolo Della Vigna,et al.
MDPI AG
Our objective was to develop a new, simple, and ablation-specific nephrometry score to predict peri-operative outcomes and to compare its predictive accuracy to PADUA and RENAL scores. Overall, 418 patients were treated with percutaneous thermal ablation (microwave and radiofrequency) between 2008 and 2021. The outcome of interest was trifecta status (achieved vs. not achieved): incomplete ablation or Clavien–Dindo ≥ 3 complications or postoperative estimated glomerular filtration rate decrease ≥ 30%. First, we validated the discrimination ability of the PADUA and RENAL scoring systems. Second, we created and internally validated a novel scoring (SuNS) system, according to multivariable logistic regression models. The predictive accuracy of the model was tested in terms of discrimination and calibration. Overall, 89 (21%) patients did not achieve trifecta. PADUA and RENAL scores showed poor ability to predict trifecta status (c-indexes 0.60 [0.53–0.67] and 0.62 [0.55–0.69], respectively). We, therefore, developed the SuNS model (c-index: 0.74 [0.67–0.79]) based on: (1) contact surface area; (2) nearness to renal sinus or urinary collecting system; (3) tumour diameter. Three complexity classes were created: low (3–4 points; 11% of no trifecta) vs. moderate (5–6 points; 30% of no trifecta) vs. high (7–8 points; 65% of no trifecta) complexity. Limitations include the retrospective and single-institution nature of the study. In conclusion, we developed an immediate, simple, and reproducible ablation-specific nephrometry score (SuNS) that outperformed PADUA and RENAL nephrometry scores in predicting peri-operative outcomes. External validation is required before daily practice implementation. - Cyberknife Radiosurgery for Prostate Cancer after Abdominoperineal Resection (CYRANO): The Combined Computer Tomography and Electromagnetic Navigation Guided Transperineal Fiducial Markers Implantation Technique
Andrea Vavassori, Giovanni Mauri, Giovanni Carlo Mazzola, Federico Mastroleo, Guido Bonomo, Stefano Durante, Dario Zerini, Giulia Marvaso, Giulia Corrao, Elettra Dorotea Ferrari,et al.
MDPI AG
In this technical development report, we present the strategic placement of fiducial markers within the prostate under the guidance of computed tomography (CT) and electromagnetic navigation (EMN) for the delivery of ultra-hypofractionated cyberknife (CK) therapy in a patient with localized prostate cancer (PCa) who had previously undergone chemo-radiotherapy for rectal cancer and subsequent abdominoperineal resection due to local recurrence. The patient was positioned in a prone position with a pillow under the pelvis to facilitate access, and an electromagnetic fiducial marker was placed on the patient’s skin to establish a stable position. CT scans were performed to plan the procedure, mark virtual points, and simulate the needle trajectory using the navigation system. Local anesthesia was administered, and a 21G needle was used to place the fiducial markers according to the navigation system information. A confirmatory CT scan was obtained to ensure proper positioning. The implantation procedure was safe, without any acute side effects such as pain, hematuria, dysuria, or hematospermia. Our report highlights the ability to use EMN systems to virtually navigate within a pre-acquired imaging dataset in the interventional room, allowing for non-conventional approaches and potentially revolutionizing fiducial marker positioning, offering new perspectives for PCa treatment in selected cases. - Image-Guided Ablations in Patients with Recurrent Renal Cell Carcinoma
Gaetano Aurilio, Giovanni Mauri, Duccio Rossi, Paolo Della Vigna, Guido Bonomo, Gianluca Maria Varano, Daniele Maiettini, Maria Cossu Rocca, Elena Verri, Daniela Cullurà,et al.
MDPI AG
Renal cell carcinoma (RCC) is one of the most frequently diagnosed tumors and a leading cause of death. The high risk of local recurrence and distant metastases represent a significant clinical issue. Different image-guided ablation techniques can be applied for their treatment as an alternative to surgery, radiotherapy or systemic treatments. A retrospective analysis was conducted at our institution, including a total number of 34 RCC patients and 44 recurrent RCC tumors in different locations (kidney, lung, adrenal gland, liver, pancreas, pararenal and other) using microwave ablation, radiofrequency ablation, cryoablation and laser ablation. The estimated time to local and distant tumor progression after treatment were 22.53 ± 5.61 months and 24.23 ± 4.47 months, respectively. Systemic treatment was initiated in 10/34 (29%) treated patients with a mean time-to-systemic-therapy of 40.92 ± 23.98 months. Primary technical success was achieved in all cases and patients while the primary efficacy rate was achieved in 43/44 (98%) cases and 33/34 (97%) patients, respectively, with a secondary technical success and efficacy rate of 100%. At a mean follow-up of 57.52 months ± 27.86 months, local tumor progression occurred in 3/44 (7%) cases and distant progression in 25/34 (74%) patients. No significant complications occurred. Image-guided ablations can play a role in helping to better control recurrent disease, avoiding or delaying the administration of systemic therapies and their significant adverse effects. - Image-Guided Ablation of Thyroid Tissue: A Potential Therapeutic Option for Selected Cases of Relapsing Hyperthyroidism?
Giovanni Mauri and Enrico Papini
Springer Science and Business Media LLC - Minimally Invasive Treatments for Malignant Thyroid Lesions: Time for an International Registry
Giovanni Mauri and Luca Maria Sconfienza
Radiological Society of North America (RSNA) - Immunocytochemistry Profile of Benign Thyroid Nodules Not Responding to Thermal Ablation: A Retrospective Study
Stella Bernardi, Silvia Taccogna, Martina D’Angelo, Fabiola Giudici, Giovanni Mauri, Bruno Raggiunti, Doris Tina, Fabrizio Zanconati, Enrico Papini, and Roberto Negro
Hindawi Limited
Purpose. Thermal ablations (TA) are gaining ground as alternative options to conventional therapies for symptomatic benign thyroid nodules. Little is known about the impact of nodule biology on the outcomes of TA. The aim of our study was to evaluate the baseline immunocytochemistry profile of thyroid nodules that were poorly responsive to TA in order to identify potential predictors of the treatment response. Methods. From a cohort of 406 patients with benign thyroid nodules treated with TA and followed for 5 years, we retrospectively selected two groups of patients: NONRESPONDERS (patients who did not respond to TA and were later surgically treated) and RESPONDERS (patients who responded to TA). The fine-needle aspiration cytology (FNAC) slides obtained before TA were stained for Galectin-3, HBME-1, CK-19, and Ki-67. Results. Benign nodules of NONRESPONDERS (n = 19) did not express CK-19 ( p = 0.03 ), as compared to RESPONDERS (n = 26). We combined the absence of CK-19 and the presence of Ki-67 to obtain a composite biomarker of resistance to TA, which discriminated between likelihood of retreatment and no retreatment with an AUC of 0.68 (95%CI: 0.55-0.81) and a sensitivity, specificity, PPV, and NPV of 29%, 91%, 71%, and 64%, respectively. Conclusion. In benign thyroid nodules, the absence of CK-19 was associated with resistance to TA, while the presence of CK-19 was predictive of response to TA. If confirmed, this finding could provide rapid and inexpensive information about the potential outcome of TA on benign thyroid nodules. In addition, as CK-19 can be expressed in adenomatous hyperplasia, it could be speculated that these nodules, rather than follicular adenomas, might be better candidates for TA. - Italian Guidelines for the Management of Non-Functioning Benign and Locally Symptomatic Thyroid Nodules
Enrico Papini, Anna Crescenzi, Annamaria D'Amore, Maurilio Deandrea, Anna De Benedictis, Andrea Frasoldati, Roberto Garberoglio, Rinaldo Guglielmi, Celestino Pio Lombardi, Giovanni Mauri,et al.
Bentham Science Publishers Ltd.
Aim: This guideline (GL) is aimed at providing a reference for the management of non-functioning, benign thyroid nodules causing local symptoms in adults outside of pregnancy. Methods: This GL has been developed following the methods described in the Manual of the National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinology(AME) identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as “critical” and “important” were considered in the systematic review of evidence and only those classified as “critical” were considered in the formulation of recommendations. Results: The present GL contains recommendations about the respective roles of surgery and minimally invasive treatments for the management of benign symptomatic thyroid nodules. We suggest hemithyroidectomy plus isthmectomy as the first-choice surgical treatment, provided that clinically significant disease is not present in the contralateral thyroid lobe. Total thyroidectomy should be considered for patients with clinically significant disease in the contralateral thyroid lobe. We suggest considering thermo-ablation as an alternative option to surgery for patients with a symptomatic, solid, benign, single, or dominant thyroid nodule. These recommendations apply to outpatients, either in primary care or when referred to specialists. Conclusion: The present GL is directed to endocrinologists, surgeons, and interventional radiologists working in hospitals, in territorial services, or private practice, general practitioners, and patients. The available data suggest that the implementation of this GL recommendations will result in the progressive reduction of surgical procedures for benign thyroid nodular disease, with a decreased number of admissions to surgical departments for non-malignant conditions and more rapid access to patients with thyroid cancer. Importantly, a reduction of indirect costs due to long-term replacement therapy and the management of surgical complications may also be speculated. - Thermal ablation for small renal masses: Identifying the most appropriate tumor size cut-off for predicting perioperative and oncological outcomes
Stefano Luzzago, Francesco A. Mistretta, Giovanni Mauri, Chiara Vaccaro, Gaia Ghilardi, Daniele Maiettini, Andrea Marmiroli, Gianluca Varano, Ettore Di Trapani, Nicola Camisassi,et al.
Elsevier BV - Present Status of Thyroid Ablation in Europe: An International Survey among the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Members
Giovanni Mauri, Lorenzo Monfardini, Elena Lucertini, Roberto Luigi Cazzato, Philippe Pereira, Franco Orsi, and Luca Maria Sconfienza
Springer Science and Business Media LLC - Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies
Giovanni Mauri, Salvatore Gitto, Lorenzo Carlo Pescatori, Domenico Albano, Carmelo Messina, and Luca Maria Sconfienza
Georg Thieme Verlag KG
Abstract Purpose To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions. Materials and Methods This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded. Results Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ± 5 vs. 26 ± 3 minutes, p = 0.002 and 7; 5.25–8.75 vs. 3; 3–3.25, p = 0.001). In controls, the mean procedure duration was 47 ± 4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5–8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal. Conclusion Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes. - The European Institute of Oncology Thyroid Imaging Reporting and Data System for Classification of Thyroid Nodules: A Prospective Study
Elvio De Fiori, Carolina Lanza, Serena Carriero, Francesca Tettamanzi, Samuele Frassoni, Vincenzo Bagnardi, and Giovanni Mauri
MDPI AG
Background: To evaluate the performance, quality and effectiveness of “IEO-TIRADS” in assigning a TI-RADS score to thyroid nodules (TN) when compared with “EU-TIRADS” and the US risk score calculated with the S-Detect software (“S-Detect”). The primary objective is the evaluation of diagnostic accuracy (DA) by “IEO-TIRADS”, “S-Detect” and “EU-TIRADS”, and the secondary objective is to evaluate the diagnostic performances of the scores, using the histological report as the gold standard. Methods: A radiologist collected all three scores of the TNs detected and determined the risk of malignancy. The results of all the scores were compared with the histological specimens. The sensitivity (SE), specificity (SP), and diagnostic accuracy (DA), with their 95% confidence interval (95% CI), were calculated for each method. Results: 140 TNs were observed in 93 patients and classified according to all three scores. “IEO-TIRADS” has an SE of 73.6%, an SP of 59.2% and a DA of 68.6%. “EU-TIRADS” has an SE of 90.1%, an SP of 32.7% and a DA of 70.0%. “S-Detect” has an SE of 67.0%, an SP of 69.4% and a DA of 67.9%. Conclusion: “IEO-TIRADS” has a similar diagnostic performance to “S-Detect” and “EU-TIRADS”. Providing a comparable DA with other reporting systems, IEO-TIRADS holds the potential of being applied in clinical practice. - Multi-institutional analysis of outcomes for thermosphere microwave ablation treatment of colorectal liver metastases: the SMAC study
Francesco De Cobelli, Marco Calandri, Angelo Della Corte, Roberta Sirovich, Carlo Gazzera, Paolo Della Vigna, Guido Bonomo, Gianluca Maria Varano, Daniele Maiettini, Giovanni Mauri,et al.
Springer Science and Business Media LLC
Abstract Objectives Oligometastatic colorectal cancer benefits of locoregional treatments but data concerning microwave ablation (MWA) are limited and interactions with systemic therapy are still debated. The aim of this study is to evaluate safety and effectiveness of Thermosphere™ MWA (T-MWA) of colorectal liver metastases (CLM) and factors affecting local tumor progression-free survival (LTPFS). Methods In this multi-institutional retrospective study (January 2015–September 2019), patients who underwent T-MWA for CLM were enrolled. Complications according to SIR classification were collected, primary efficacy and LTP were calculated. Analyzed variables included CLM size at diagnosis and at ablation, CLM number, ablation margins, intra-segment progression, chemotherapy before ablation (CBA), variations in size (ΔSDIA-ABL), and velocity of size variation (VDIA-ABL) between CLM diagnosis and ablation. Uni/multivariate analyses were performed using mixed effects Cox model to account for the hierarchical structure of data, patient/lesions. Results One hundred thirty-two patients with 213 CLM were evaluated. Complications were reported in 6/150 procedures (4%); no biliary complications occurred. Primary efficacy was achieved in 204/213 CLM (95.7%). LTP occurred in 58/204 CLM (28.4%). Six-, twelve-, and eighteen-month LTPFS were 88.2%, 75.8%, and 69.9%, respectively. At multivariate analysis, CLM size at ablation (p = 0.00045), CLM number (p = 0.046), ablation margin < 5 mm (p = 0.0035), and intra-segment progression (p < 0.0001) were statistically significant for LTPFS. ΔSDIA-ABL (p = 0.63) and VDIA-ABL (p = 0.38) did not affect LTPFS. Ablation margins in the chemo-naïve group were larger than those in the CBA group (p < 0.0001). Conclusion T-MWA is a safe and effective technology with adequate LTPFS rates. Intra-segment progression is significantly linked to LTPFS. CBA does not affect LTPFS. Anticipating ablation before chemotherapy may take the advantages of adequate tumor size with correct ablation margin planning. Key Points • Thermosphere™-Microwave ablation is a safe and effective treatment for colorectal liver metastases with no registered biliary complications in more than 200 ablations. • Metastases size at time of ablation, intra-segment progression, and minimal ablation margin < 5 mm were found statistically significant for local tumor progression-free survival. • Chemotherapy before ablation modifies kinetics growth of the lesions but deteriorates ablation margins and does not significantly impact local tumor progression-free survival. - Small-size (40 µm) Beads Loaded with Irinotecan in the Treatment of Patients with Colorectal Liver Metastases
Giovanni Mauri, Duccio Rossi, Samuele Frassoni, Guido Bonomo, Nicola Camisassi, Paolo Della Vigna, Vincenzo Bagnardi, Daniele Maiettini, Gianluca Maria Varano, Maria Giulia Zampino,et al.
Springer Science and Business Media LLC