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Annarita PECCHI

Professore Associato
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto

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2024 - Role of Body Composition in Patients with Resectable Pancreatic Cancer [Articolo su rivista]
Pecchi, Annarita; Valoriani, Filippo; Cuoghi Costantini, Riccardo; Squecco, Denise; Spallanzani, Andrea; D'Amico, Roberto; Dominici, Massimo; Di Benedetto, Fabrizio; Torricelli, Pietro; Menozzi, Renata

: This study investigates the role of body composition parameters in patients with pancreatic cancer undergoing surgical treatment. The research involved 88 patients diagnosed with pancreatic cancer who underwent surgery at the Modena Cancer Center between June 2015 and October 2023. Body composition parameters were obtained from CT scans performed before and after surgery. The percentage of sarcopenic patients at the time of diagnosis of pancreatic cancer is 56.82%. Of the patients who died between the first and second CT evaluated, 58% were sarcopenic, thus confirming the role of sarcopenia on outcome. The study found that all body composition parameters (TAMA, SMI, VFI, and SFI) demonstrated a trend towards reduction between two examinations, indicating an overall depletion in muscle and adipose tissue. We then evaluated the relationships between fat-related parameters (VFI, SFI and VSR) and survival outcomes: overall survival and progression-free survival. Cox univariate regression model show significant parameter related to outcomes was adipose tissue, specifically VFI. The study found that higher VFI levels were associated with greater survival rates. This research holds promise for advancing our understanding of the link between body composition and the prognosis of pancreatic cancer patients.

2024 - Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics [Articolo su rivista]
Trovato, Piero; Simonetti, Igino; Morrone, Alessio; Fusco, Roberta; Setola, Sergio Venanzio; Giacobbe, Giuliana; Brunese, Maria Chiara; Pecchi, Annarita; Triggiani, Sonia; Pellegrino, Giuseppe; Petralia, Giuseppe; Sica, Giacomo; Petrillo, Antonella; Granata, Vincenza

Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.

2023 - "Functional Outcomes and Quality of Life After Laparoscopic Nerve-Sparing Radical Treatment of Parametrial Deep Infiltrating Endometriosis" [Articolo su rivista]
Alboni, Carlo; Sampogna, Veronica; Airoud, Mirvana; Malmusi, Stefania; Farulla, Antonino; Colucci, Giuseppe; Camacho Mattos, Ludovica; Pecchi5, Annarita; Gaia, Giorgia; LA MARCA, Antonio

2023 - Liver transplantation for iatrogenic injuries secondary to cholecystectomy: a systematic review [Articolo su rivista]
Guidetti, C.; Pang, N. Q.; Catellani, B.; Magistri, P.; Caracciolo, D.; Guerrini, G. P.; Pecchi, A.; Di Sandro, S.; Di Benedetto, F.

INTRODUCTION: Iatrogenic injury to the liver hilum during cholecystectomy is a severe surgical complication, with liver transplantation (LT) as the final drastic solution. The authors report the experience of our center and conduct a review of the literature on the outcomes of LT performed in this setting. METHODS: Data sources included MEDLINE, EMBASE, and CENTRAL from inception to 19 June 2022. Studies reporting on patients treated with LT for liver hilar injuries following cholecystectomy were included. Incidence, clinical outcomes, and survival data were synthesized through a narrative review. RESULTS: Twenty-seven articles were identified, including 213 patients. Eleven (40.7%) articles highlighted deaths within 90-days post-LT. Post-LT mortality was reported in 28 (13.1%) patients. Severe complications (≥Clavien III) occurred in at least 25.8% ( n =55) of patients. Within larger cohorts, 1-year overall survival (OS) was 76.5-84.3%, and 5-year OS was 67.2-83.0%. The authors also highlight our own experience managing 14 patients with liver hilar injury secondary to cholecystectomy, of which two required LT. CONCLUSION: While short-term morbidity and mortality is significant, available long-term data suggests reasonable OS in these patients following LT. Future studies are necessary to better understand the relationship between different types of liver hilar injury, transplant indication, and outcomes of LT in this setting.

2023 - Successful living donor liver transplantation from an HIV and HCV positive donor: report from the first case in the world [Articolo su rivista]
Di Sandro, Stefano; Catellani, Barbara; Guidetti, Cristiano; Magistri, Paolo; Ballarin, Roberto; Pecchi, Annarita; Caracciolo, Daniela; Guaraldi, Giovanni; Guerrini, Gian Piero; Di Benedetto, Fabrizio

: HIV (human-immunodeficiency-virus) and HCV (hepatitis-C-virus) infections cause millions of deaths across the world every year. Since the introduction of effective therapies for HIV, in the middle of 1990 s, and HCV, after 2013, those two untreatable infections became completely controlled. Donor safety is the main goal in living donor liver transplantation (LDLT). An accurate pre-donation screening is mandatory for excluding risk factors related with any increase of donors' short-term and long-term morbidity. We present the first LDLT from a donor with both HIV and HCV previous infections. Donor and recipient did not experience any complication. Individuals with well controlled HIV/HCV infections and without any risk factors may be suitable for donation of a part of their healthy liver. An infographic is available for this article at:

2022 - Impact of sarcopenia in SARS-CoV-2 patients during two different epidemic waves [Articolo su rivista]
Menozzi, R.; Valoriani, F.; Prampolini, F.; Banchelli, F.; Boldrini, E.; Martelli, F.; Galetti, S.; Fari', R.; Gabriele, S.; Palumbo, P.; Forni, D.; Pantaleoni, M.; D'Amico, R.; Pecchi, A.

Background: Sarcopenia was reported to be associated with poor clinical outcome, higher incidence of community-acquired pneumonia, increased risk of infections and reduced survival in different clinical settings. The aim of our work is to evaluate the prognostic role of sarcopenia in patients with the 2019 novel coronavirus disease (COVID-19). Materials and methods: 272 COVID-19 patients admitted to the University Hospital of Modena (Italy) from February 2020 to January 2021 were retrospectively studied. All included patients underwent a chest computed tomography (CT) scan to assess pneumonia during their hospitalization and showed a positive SARS-CoV-2 molecular test. Sarcopenia was defined by skeletal muscle area (SMA) evaluation at the 12th thoracic vertebra (T12). Clinical, laboratory data and adverse clinical outcome (admission to Intensive Care Unit and death) were collected for all patients. Results: Prevalence of sarcopenia was high (41.5%) but significantly different in each pandemic wave (57.9% vs 21.6% p < 0.0000). At the multivariate analysis, sarcopenia during the first wave (Hazard Ratio 2.29, 95% confidence intervals 1.17 to 4.49 p = 0.0162) was the only independent prognostic factor for adverse clinical outcome. There were no significant differences in comorbidities and COVID19 severity in terms of pulmonary involvement at lung CT comparing during the first and second wave. Mixed pattern with peripheral and central involvement was found to be dominant in both groups. Conclusion: We highlight the prognostic impact of sarcopenia in COVID-19 patients hospitalized during the first wave. T12 SMA could represent a potential tool to identify sarcopenic patients in particular settings. Further studies are needed to better understand the association between sarcopenia and COVID-19.

2022 - Statins increase pathological response in locally advanced rectal cancer treated with chemoradiation: a multicenter experience. [Articolo su rivista]
Caputo, F; Santini, C; Casadei-Gardini, A; Cerma, K; Bardasi, C; Garajovà, I; Lattanzi, E; Passardi, A; Rapposelli, Ig; Spallanzani, A; Salati, M; Bonetti, Lr; Gelmini, R; Meduri, B; Piccoli, M; Pecchi, A; Benatti, S; Piacentini, F; Dominici, M; Luppi, G; Gelsomino, F.

Aims: To investigate the influence of various concomitant medications on outcomes in patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Materials & methods: The authors retrospectively identified 246 patients from 2003 to 2018, collecting demographic and clinicopathological data of interest. Odds ratio (OR) was used to assess the association between concomitant drugs and outcomes. Results: The authors found an association between statins and a Dworak regression grade of 3-4 (OR = 8.78; p = 0.01). Furthermore, statins were significantly associated with more frequent chemoradiation-related toxicity (OR = 2.39; p = 0.0098) and chemotherapy dose reduction or discontinuation (OR = 2.26; p = 0.03). Conclusion: Despite higher frequency of radiotherapy and chemotherapy interruption or dose reduction, the concomitant use of statins during neoadjuvant chemoradiation proved to be associated with better tumor regression.

2022 - Strong impact of sarcopenia as a risk factor of survival in resected gastric cancer patients: first Italian report of a Bicentric study [Articolo su rivista]
Ricciardolo, A A; De Ruvo, N; Serra, F; Prampolini, F; Solaini, L; Battisti, S; Missori, G; Fenocchi, S; Rossi, E G; Sorrentino, L; Salati, M; Spallanzani, A; Cautero, N; Pecchi, A; Ercolani, G; Gelmini, R

Gastric cancer (GC) accounts for 4% of all cancers in Europe. Sarcopenia is a complex syndrome characterized by a loss of muscle mass and function associated with age, often present in neoplastic patients. Recently, several studies have shown a significant association between sarcopenia and poor prognosis in various pathological conditions. The current observational retrospective study investigates the association between sarcopenia and overall survival (OS) and recurrence-free survival (RFS) in patients with GC undergoing up-front surgery with curative intent. Resected GC patients' clinical records and CT images were retrospectively assessed. The preoperative CT calculation of the skeletal muscle index (SMI) at L3 level allowed us to categorize patients as sarcopenic or not. Kaplan-Meyer and univariate and multivariate Cox regression analyses were performed to determine the difference in survival and presence of independent prognostic factors. Fifty-five patients, 28 male and 27 female, out of 298 studied for gastric cancer were enrolled in the current study from two cancer referral centers in Italy. The preoperative CT calculation of the SMI at L3 level allowed us to identify 39 patients with and 16 without sarcopenia. A statistically significant difference between the sarcopenic and non-sarcopenic groups was observed in both OS and RFS (p < 0.023; p < 0.006). Moreover, sarcopenia was strongly correlated to a higher risk of recurrence in univariate and multivariate analysis (p < 0.02). Sarcopenia can be considered a critical risk factor for survival in patients with resectable GC treated with up-front surgery. Identifying sarcopenic patients at the time of diagnosis would direct selection of patients who could benefit from early nutritional and/or physical treatments able to increase their muscle mass and possibly improve the prognosis. More extensive multicenter studies are needed to address this issue.

2021 - Body composition and inflammation impact in non-small cell lung cancer patients treated by first-line immunotherapy [Articolo su rivista]
Baldessari, Cinzia; Pecchi, Annarita; Marcheselli, Raffaella; Guaitoli, Giorgia; Bonacini, Riccardo; Valoriani, Filippo; Torricelli, Pietro; Reverberi, Linda; Menozzi, Renata; Pugliese, Giuseppe; Vitale, Maria Giuseppa; Sabbatini, Roberto; Bertolini, Federica; Barbieri, Fausto; Dominici, Massimo

Lay abstract Inflammation and malnutrition in cancer patients may affect the immune system and response to therapy. We noticed an increase in inflammation and visceral fat and a decrease in muscle and subcutaneous fat during therapy. No variation showed a significant correlation with survival. Muscle mass, adipose tissue and body mass index do not confirm any prognostic impact or relationship with response to therapy. More interesting results were observed with parameters related to inflammation. Probably, for the best treatment choice, a combination of clinical and biological factors will be necessary. Further studies with a multidimensional approach are needed to propose the best treatment and the best support to everyone.Tweetable abstract Body composition, nutritional and inflammatory status changed during first-line immunotherapy on NSCLC patients. Inflammation has interesting prognostic implications. Combined with other factors, these clinical characteristics may be important to optimize the care of patients.Background: Immunotherapy changed the landscape of non-small cell lung cancer (NSCLC). Efforts were made to implement its action. This study aims to describe body composition, nutritional and inflammatory status in NSCLC patients treated by first-line immunotherapy, their correlation, variation and impact. Patients and methods: We retrospectively analyzed 44 consecutive patients who received pembrolizumab treatment. Results: During the therapy, inflammation and visceral fat increased, whereas muscle and subcutaneous fat decreased. Parameters related to inflammation had an interesting prognostic impact. High numbers of white blood cells remained significantly correlated with a high risk of death in multivariate model. Conclusion: For the best treatment choice, a combination of clinical and biological factors will be most likely be necessary. Prospective and larger studies with a multidimensional approach are needed.

2021 - Impact of body composition, nutritional and inflammatory status on outcome of non-small cell lung cancer patients treated with immunotherapy [Articolo su rivista]
Baldessari, C.; Guaitoli, G.; Valoriani, F.; Bonacini, R.; Marcheselli, R.; Reverberi, L.; Pecchi, A.; Menozzi, R.; Torricelli, P.; Bertolini, F.; Barbieri, F.; Dominici, M.

Background and aims: Body composition and balance of nutritional and inflammatory status are important for the immune system. Alterations of these aspects may impact on response, outcome and toxicities of immunotherapy. In this review we try to clarify some definitions and tools used for the assessment of the different aspects of nutritional disorders, body composition and inflammatory status with a focus on lung cancer. Methods: We primary investigate the definitions of malnutrition, cachexia, sarcopenia and overweight. Secondary, tools used to measure body composition, nutritional and inflammatory status, mainly in lung cancer are reviewed. Results: All these features, in the time of precision medicine may improve assessment and selection of patients, incorporating also early palliative care in standard therapy. Conclusions: A multimodal approach based on nutrition assessment and physical exercise should be evaluated to improve aspects of the immune response against cancer and to propose the best treatment to every patient.

2021 - Sarco-Model: A score to predict the dropout risk in the perspective of organ allocation in patients awaiting liver transplantation [Articolo su rivista]
Lai, Quirino; Magistri, Paolo; Lionetti, Raffaella; Avolio, Alfonso W; Lenci, Ilaria; Giannelli, Valerio; Pecchi, Annarita; Ferri, Flaminia; Marrone, Giuseppe; Angelico, Mario; Milana, Martina; Schinniná, Vincenzo; Menozzi, Renata; Di Martino, Michele; Grieco, Antonio; Manzia, Tommaso M; Tisone, Giuseppe; Agnes, Salvatore; Rossi, Massimo; Di Benedetto, Fabrizio; Ettorre, Giuseppe M

BACKGROUND & AIMS: Sarcopenia in liver transplantation (LT) cirrhotic candidates has been connected with higher dropouts and graft losses after transplant. The study aims to create an "urgency" model combining sarcopenia and MELDNa to predict the risk of dropout and identify an appropriate threshold of post-LT futility.METHODS: A total of 1,087 adult cirrhotic patients were listed for a first LT during Jan2012-Dec2018. The study population was split into a Training (n=855) and a Validation Set (n=232).RESULTS: Using a competing-risk analysis of cause-specific hazards, we created the Sarco-Model2 . According to the model, one extra-point of MELDNa was added for each 0.5-cm2 /m2 reduction of Total Psoas Area (TPA)<6.0 cm2 /m2 . At external validation, the Sarco-Model2 showed the best diagnostic ability for predicting the risk of 3-month dropout in patients with MELDNa<20 (AUC=0.93; p=0.003). Using the net reclassification improvement, 14.3% of dropped-out patients were correctly reclassified using the Sarco-Model2 . As for the futility threshold, transplanted patients with TPA<6.0 cm2 /m2 and MELDNa 35-40 (n=16/833, 1.9%) had the worse results (6-month graft loss=25.5%).CONCLUSIONS: In sarcopenic patients with MELDNa<20, the "urgency" Sarco-Model2 , should be used to prioritize the list, while MELDNa value should be preferred in patients with MELDNa ≥20. The Sarco-Model2 played a role in more than 30% of the cases in the investigated allocation scenario. In sarcopenic patients with a MELDNa value of 35-40, "futile" transplantation should be considered.

2021 - Surgical treatment of deep endometriosis with adenomyosis externa: a challenging case in an infertile woman [Articolo su rivista]
Alboni, C.; Mattos, L. C.; Botticelli, L.; Malmusi, S.; Facchinetti, F.; Pecchi, A.

Objective: To describe the management and the fertility-enhancing potential of surgery in an infertile patient with deep-infiltrating endometriosis and adenomyosis externa. Design: Video case report. Setting: Minimally invasive and robotic gynecologic surgery unit of a university hospital. Patient(s): A 31-year-old nulliparous patient with dysmenorrhea, dysuria, dyspareunia, and primary infertility. Intervention(s): Bimanual examination, transvaginal ultrasound, and magnetic resonance imaging (MRI) were performed as a comprehensive preoperative workup. The findings were consistent with bladder endometriosis and a 4-cm right pararectal cystic mass suggestive of adenomyosis externa. Laparoscopic excision of all visible endometriosis was performed. A pararectal lesion was found, completely developing in the retroperitoneal spaces, from the right medial pararectal space to the rectovaginal space, reaching the pelvic floor fascia without infiltration of the levator ani muscle. According to Koninckx classification, this kind of lesion corresponds to type III endometriosis or adenomyosis externa. Nerve-sparing eradication of the nodule was performed. The decision to use these techniques was taken with the intention to treat the patient, and not with the aim of testing the procedures performed. Therefore, as a common clinical practice in our institution and for the above reasons, there was no need for consultation of the institutional review board for approval. Main Outcome Measure(s): Improvement of symptoms and spontaneous conception after surgical removal of all endometriotic implants. Result(s): There were no intraoperative or postoperative complications, and the patient was discharged after 3 days. She discontinued postoperative hormone therapy with gonadotropin-releasing hormone analogue after 3 months because she desired fertility. She conceived spontaneously after 2 months of attempting. She delivered vaginally and had no complications during pregnancy and labor. Neither recurrence of pain symptoms nor voiding or rectal dysfunctions were reported by the patient. Conclusion(s): In the management of a case of deep endometriosis, the preoperative assessment should be carefully carried out to give the surgeon the most accurate information about the extent of the disease and the patient's main objectives. Imaging techniques such as ultrasound and MRI play a fundamental role along with the clinical evaluation in also detecting lesions that are not visible at first laparoscopic inspection. In this case of a young woman without any detectable fertility issues except for endometriosis, the laparoscopic excision of endometriosis was feasible, safe, and effective in improving the patient's fertility and pain symptoms. The fertility-enhancing potential of complete eradication of pelvic endometriosis, including removal of deep posterior localizations such those presented in this case, has been hypothesized by various investigators. It has been suggested that skilled surgical management for symptomatic deep endometriosis may be followed by a high pregnancy rate, with most pregnancies resulting from postoperative natural conception even in patients with primary infertility.

2021 - The Prognostic Role of Early Skeletal Muscle Mass Depletion in Multimodality Management of Patients with Advanced Gastric Cancer Treated with First Line Chemotherapy: A Pilot Experience from Modena Cancer Center [Articolo su rivista]
Rimini, M; Pecchi, A; Prampolini, F; Bussei, C; Salati, M; Forni, D; Martelli, F; Valoriani, F; Canino, F; Bocconi, A; Gelsomino, F; Reverberi, L; Benatti, S; Piacentini, F; Menozzi, R; Dominici, M; Luppi, G; Spallanzani, A

Background: Few data about the link between nutritional status and survival are available in the metastatic gastric cancer (GC) setting. The aim of this work was to evaluate the prognostic role of tissue modifications during treatment and the benefit of a scheduled nutritional assessment in this setting. Methods: Clinical and laboratory variables of 40 metastatic GC patients treated at Modena Cancer Center were retrieved: 20 received a nutritional assessment on the oncology’s discretion, the other 20 received a scheduled nutritional assessment at baseline and every 2–4 weeks. Anthropometric parameters were calculated on Computed Tomography (CT) images at the baseline and after 3 months of chemotherapy. Results: A correlation between baseline Eastern Cooperative Oncology Group Performance Status (ECOG PS), Lymphocyte to Monocyte Ratio (LMR), C-reactive protein (PCR), Prognostic Nutritional Index (PNI) and Overall survival (OS) was highlighted. Among the anthropometric parameters, early skeletal muscle mass depletion (ESMMD) >10% in the first months of treatment significantly impacted on mOS (p = 0.0023). A link between ESMMD and baseline LDH > 460 U/L, baseline CRP > 2.2 mg/dL and weight decrease during treatment emerged. Patients evaluated with a nutritional scheduled support experienced a mean gain in subcutaneous and visceral fat of 11.4% and 10.21%, respectively. Conclusion: We confirm the prognostic impact of ESMMD > 10% during chemotherapy in metastatic GC. The prognostic role of a scheduled nutritional assessment deserves further confirmation in large prospective trials.

2020 - MRI of placenta accreta: diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women [Articolo su rivista]
Fiocchi, Federica; Monelli, Filippo; Besutti, Giulia; Casari, Federico; Petrella, Elisabetta; Pecchi, Annarita; Caporali, Cristian; Bertucci, Emma; Busani, Stefano; Botticelli, Laura; Facchinetti, Fabio; Torricelli, Pietro

To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI.

2020 - Magnetic resonance imaging performed before and after preoperative chemoradiotherapy in rectal cancer: predictive factors of recurrence and prognostic significance of MR-detected extramural venous invasion [Articolo su rivista]
Prampolini, Francesco; Taschini, Stefania; Pecchi, Annarita; Sani, Francesco; Spallanzani, Andrea; Gelsomino, Fabio; Kaleci, Shaniko; Torricelli, Pietro

Purpose: To evaluate the role of magnetic resonance imaging (MRI) performed before and after neoadjuvant chemoradiotherapy (nCRT) in predicting risk of recurrence in rectal cancer and to investigate the prognostic significance of MR-detected extramural venous invasion (mr-EMVI) and of its regression after nCRT. Methods: During 2005–2016, 87 patients with rectal cancer underwent pre- and post-nCRT MRI before surgery. Two radiologists independently reviewed MR examinations retrospectively, assessing T stage, nodal involvement, circumferential resection margin (CRM) status, and mr-EMVI. All four parameters assessed in pre- and post-nCRT MRI were correlated with the risk of recurrence. Correlation with disease-free survival (DFS) was investigated for significant predictive factors in pre-nCRT MRI and for mr-EMVI and its possible regression in post-nCRT MRI. Results: 15 of 87 patients developed recurrence, with a relapse-rate of 17.2%. Statistical analysis showed a significant correlation between CRM involvement and mr-EMVI assessed in pre-nCRT MRI and the risk of recurrence; 3 years-DFS in patients positive for these two parameters was significantly shorter compared with negatives. In post-nCRT MRI, all four parameters correlated significantly with recurrence: mr-EMVI affected significantly 3 years-DFS and its regression after nCRT correlated with a trend toward improvement of survival outcomes, although not statistically significant. Conclusions: CRM involvement and mr-EMVI assessed in pre-nCRT MRI should be considered early predictive factors of recurrence in rectal cancer. MRI performed after nCRT has a significant value in predicting risk of recurrence: mr-EMVI confirmed to be a poor prognosis predictor and its regression or persistence after nCRT could have influences on treatment and follow-up strategies.

2020 - Robotic liver resection versus percutaneous ablation for early hcc: Short-and long-term results [Articolo su rivista]
Magistri, P.; Catellani, B.; Frassoni, S.; Guidetti, C.; Olivieri, T.; Assirati, G.; Caporali, C.; Pecchi, A.; Serra, V.; Ballarin, R.; Guerrini, G. P.; Bagnardi, V.; Di Sandro, S.; Di Benedetto, F.

Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR); therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short-and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.

2019 - Breast ultrasonography (BU) in the screening protocol for women at hereditary-familial risk of breast cancer: has the time come to rethink the role of BU according to different risk categories? [Articolo su rivista]
Cortesi, Laura; Canossi, Barbara; Battista, Rachele; Pecchi, Annarita; Drago, Antonella; Dal Molin, Chiara; Toss, Angela; De Matteis, Elisabetta; Marchi, Isabella; Torricelli, Pietro; Cascinu, Stefano

This article evaluates the breast cancer (BC) screening efficacy of biannual ultrasound (US) in three different risk categories. In a single-center, prospective, nonrandomized comparison study, BRCA mutation carriers and women with high risk (HR) or intermediate risk (IR) received mammography (MMG), ultrasound, (US) and Magnetic Resonance Imaging (MRI), scheduled according to the risk categories. Single and combined sensitivity were evaluated in specific groups of risk and the US performance at six-monthly interval was notably considered. Among 2,313 asymptomatic women at different risk (136 mutation carriers, 1,749 at HR and 428 at IR) 211 developed a BC, of which 193 (91.5%) were screen detected BC (SDBC) and 18 (8.5%) were interval BC (IBC). The SDBC detection rate (DR) was 11.2 per 1.000 person-years (37.9, 8.5 and 16.1 for BRCA, HR and IR, respectively); 116 BC were detected by MMG (DR = 6.6 × 1,000 persons-years), 62 by US (DR = 3.6 × 1,000 persons-years) and 15 by MRI, that was applied only in 60 BRCA women (DR = 37 × 1,000 persons-years). At the six-monthly US, 52 BC were detected (DR = 3.0 × 1,000 persons/years), of which 8 were BRCA-related. The most sensitive technique was MRI (93.7%) followed by MMG (55%) and US (29.4%). Combined sensitivity for MMG plus US was 100% in HR and 80.4% for IR women (p < 0.01). In BRCA mutated patients, MRI alone with annual US performed after six months, could be offered. In HR patients, MMG plus biannual US provide the most sensitive diagnosis and for IR group an annual MMG could be sufficient.

2019 - Deeper Insights Into the Fontan Circulation [Articolo su rivista]
Roncati, Luca; Manenti, Antonio; Pecchi, Anna Rita; Gallo, Graziana

2019 - Impact of body composition parameters on tumor response to neoadjuvant chemotherapy in operable breast cancer patients. [Poster]
Palumbo, Patrizia; Draisci, Stefano; Barbolini, Monica; Nasso, Cecilia; Isca, Chrystel; Bocconi, Alessandro; Balduzzi, Sara; Pecchi, Annarita; Galetti, Silvia; Torricelli, Pietro; Piacentini, Federico; Moscetti, Luca; Cascinu, Stefano; Omarini, Claudia

Fat tissue promotes cancer progression by increasing cell proliferation, cell survival and metastatic processes. Adipose tissue determines a dysregulation of several metabolic pathways by a continuous crosstalk between fat tissue and cancer cells. Moreover, influence of adipose tissue on cancer development depend on the type of fat too BMI cannot account for differences in fat distribution and cannot distinguish between adipose tissue and muscles Computed tomography (CT) imaging can be a useful tool for a directly measure of body fat distribution distinguishing among visceral, subcutaneous, internal fat tissue (mostly in the liver) and skeletal muscles mass. Patients treated with neoadjuvant chemotherapy for early BC at the Modena Cancer Center from 2005 to 2017 we collected. According to BMI score, patients were categorized in two main classes: normal weight (BMI < 25) and overweight (BMI ≥ 25) (Table 1) Using Advance workstation (General Electric), software ADW server 3.2 or 4.7. we calculated body composition parameters (BCPs) from pre-treated CT scan images. BCPs considered are: subcutaneous fat area (SFA, cm2), visceral fat area (VFA, cm2), lumbar muscle cross-sectional area (LMCA, m2) and liver steatosis (L/S ratio) BMI score and BCPs value were correlated with pathological complete response (pCR) and survival outcomes. All analyses were performed using STATA 14 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP). pre-treatment CT scan imagine available for BCPs analysis 55% of the women had BMI < 25 versus 45% with BMI >25 Overweight was significantly associated with postmenopausal status, older age and hormonal receptor positive BC (Table 1) Menopausal status was associated with higher VFA, presence of fatty liver disease and obesity disease compared to pre-menopausal one (Table 2). No association between BMI classes and pCR was detected. High VFA and liver steatosis were negative predictive factors for pCR (pCR rate: 35% normal VFA vs 20% high VFA, no steatosis 32% vs steatosis 13%; p<0.05) ( Figure 1) Neither BMI classes nor BCPs significantly influenced overall survival and relapse free survival. The evaluation of BCPs is the best way to assess the real body composition Menopausal status is associated with higher VFA, presence of fatty liver disease and obesity disease Visceral adiposity as well as liver steatosis were negative predictive factors for pCR in BC patients treated with neoadijuvant chemotherapy .

2019 - Not just minor resections: robotic approach for cystic echinococcosis of the liver [Articolo su rivista]
Magistri, P.; Pecchi, A.; Franceschini, E.; Pesi, B.; Guadagni, S.; Catellani, B.; Assirati, G.; Guidetti, C.; Guerrini, G. P.; Tarantino, G.; Ballarin, R.; Codeluppi, M.; Morelli, L.; Coratti, A.; Di Benedetto, F.

Introduction: Human echinococcosis is among the 17 neglected tropical diseases recognized by the World Health Organization. It is responsible for over $3 billion of health costs every year being endemic in large areas worldwide, and liver is affected in 70% of the cases. Surgery associated to medical treatment is the gold standard and robotic approach may be a valuable tool to achieve safe, parenchyma sparing resections. Methods: We retrospectively analyzed the outcomes of patients that underwent robotic radical surgical treatment for hydatid liver disease, from prospectively maintained databases of three Italian centers. Results: 15 patients were included in this study, median age 51 years (24–76). 1 right hepatectomy, 2 left lateral sectionectomies, 5 segmentectomies (including 1 caudatectomy), 3 wedge resections and 5 cyst-pericystectomies were performed. Median estimated blood loss was of 100 ml (50–550 ml), and median operative time including docking was 210 min (95–590 min), with no need for conversion to open. Median hospital stay was 4 days, with only one readmission for fever. Only one patient experienced recurrence in a different liver segment. Conclusions: In our experience, robotic approach for cystic echinococcosis of the liver proved to be a safe and effective strategy also in the so-called “difficult segments”, with short post-operative stay and quick return to daily activities, along with the absence of surgical site recurrences. To the best of our knowledge, this is the largest report of robotic approach to hydatid liver disease.

2019 - Predictive Role Of Body Composition Parameters In Operable Breast Cancer Patients Treated With Neoadjuvant Chemotherapy. [Articolo su rivista]
Omarini, C; Palumbo, P; Pecchi, A; Draisci, S; Balduzzi, S; Nasso, C; Barbolini, M; Isca, C; Bocconi, A; Moscetti, L; Galetti, S; Tazzioli, G; Torricelli, P; Cascinu, S; Piacentini, F.

BACKGROUND: Fat tissue is strongly involved in BC tumorigenesis inducing insulin resistance, chronic inflammation and hormonal changes. Computed tomography (CT) imaging instead of body mass index (BMI) gives a reliable measure of skeletal muscle mass and body fat distribution. The impact of body composition parameters (BCPs) on chemosensitivity is still debated. We examined the associations between BCPs and tumor response to neoadjuvant chemotherapy (NC) in patients treated for operable breast cancer (BC). METHODS: A retrospective review of BC patients treated with NC in Modena Cancer Center between 2005 and 2017 was performed. BCPs, such as subcutaneous fat area (SFA), visceral fat area (VFA), lumbar skeletal muscle index (LSMI) and liver-to-spleen (L/S) ratio were calculated by Advance workstation (General Electric), software ADW server 3.2 or 4.7. BMI and BCPs were correlated with pathological complete response (pCR) and survival outcomes. RESULTS: 407 patients were included in the study: 55% with BMI < 25 and 45% with BMI ≥ 25. 137 of them had pre-treatment CT scan imagines. Overweight was significantly associated with postmenopausal status and older age. Hormonal receptor positive BC was more frequent in overweight patients (p<0.05). Postmenopausal women had higher VFA, fatty liver disease and obesity compared to premenopausal patients. No association between BMI classes and tumor response was detected. High VFA and liver steatosis were negative predictive factors for pCR (pCR rate: 36% normal VFA vs 20% high VFA, p= 0.048; no steatosis 32% vs steatosis 13%, p=0.056). Neither BMI classes nor BCPs significantly influenced overall survival and relapse-free survival. CONCLUSION: Visceral adiposity as well as steatosis were closely involved in chemosensitivity in BC patients treated with NC. Their measures from clinically acquired CT scans provide significant predictive information that outperform BMI value. More research is required to evaluate the relationship among adiposity site and survival outcomes.

2019 - University of Modena Experience With Liver Grafts From Donation After Circulatory Death: What Really Matters in Organ Selection? [Articolo su rivista]
Olivieri, T.; Magistri, P.; Guidetti, C.; Baroni, S.; Rinaldi, S.; Assirati, G.; Catellani, B.; Chierego, G.; Cantaroni, C.; Bondi, F.; Campagna, A.; Sangiorgi, G.; Pecchi, A.; Serra, V.; Tarantino, G.; Ballarin, R.; Guerrini, G. P.; Girardis, M.; Bertellini, E.; Di Benedetto, F.

Introduction: The use of grafts from donation after circulatory death (DCD) is an important additional source to implement within the donor pool. We herein report the outcomes of our early experience with DCD grafts for liver transplantation (LT). Methods: Ten patients successfully underwent LT with grafts from DCD donors between August 2017 and January 2019 at the Hepato-Pancreato-Biliary Surgery and Liver Transplant Unit of University of Modena and Reggio Emilia. All donors underwent normothermic regional perfusion after death declaration and, after the procurement, all the suitable grafts underwent ex situ hypothermic perfusion prior to transplantation. Results: Mean postoperative hospital stay after transplant was 12.7 days (range, 5-26), and in 5 cases we placed a biliary drainage (Kehr tube) during surgery. Primary graft nonfunction did not occur after LT in this cohort, although, we registered one case of biliary anastomosis stricture that was managed endoscopically by endoscopic retrograde cholangiopancreatography. All patients are alive and none required retransplantation. Conclusions: In our experience with controlled DCD donors, the demonstration of: (1) a negative trend of lactate during normothermic regional perfusion; (2) an aspartate aminotransferase and alanine aminotransferase level lower than 2000 mU/dL; and (3) less than 1 hour of functional warm ischemia time along with no signs of microscopic or macroscopic ischemia of the grafts, are related to positive outcomes in the first year after transplant. A DCD risk score based on Italian population characteristics and regulations on death observation may improve donor-recipient match and avoid futile transplants.

2019 - Vacuum-assisted management of surgical site infections after liver transplantation: 15-year experience in a tertiary hepatobiliary center [Articolo su rivista]
Magistri, P.; Olivieri, T.; Serra, V.; Tarantino, G.; Assirati, G.; Pecchi, A.; Ballarin, R.; Di Benedetto, F.

Immune compromised as well as critically ill patients are at higher risk of surgical wound infection and dehiscence. Wound infections critically influence the outcomes after liver transplantation. In particular, it was shown that they significantly reduce the overall survival rate when compared to patients with uneventful wound healing, and their occurrence is associated with death or graft loss within 1-year post-transplantation. From January 2001 through December 2017, 763 patients underwent liver transplantation in our Institution, the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, "Policlinico" University Hospital, University of Modena and Reggio Emilia, Modena, Italy. We retrospectively analyzed data from our prospectively maintained database of patients treated with a negative pressure therapy device due to wound or abdominal infections. 13 patients underwent negative pressure treatments for surgical site infection after liver transplantation in our institution. Ten superficial "supra-fascial" applications (SF group) and three deeper abdominal (Ab group) were reported. Mean in-hospital stay for the SF group was 42.6 days, ranging from 8 to 80, while for the Ab group was 62 days (range 23-133), with an overall survival of 34 and 4.6 months, respectively. A multifactorial multidisciplinary approach is needed in the prevention of surgical site infections instead of mere antimicrobial prophylaxis The application of negative pressure wound therapy may help in controlling the diffusion of the infection and preventing sepsis.

2018 - Extra-Anatomic Jump Graft from the Right Colic Vein: A Novel Technique to Manage Portal Vein Thrombosis in Liver Transplantation [Articolo su rivista]
Magistri, Paolo; Tarantino, Giuseppe; Olivieri, Tiziana; Pecchi, Annarita; Ballarin, Roberto; Di Benedetto, Fabrizio

In the context of cirrhosis, portal vein thrombosis (PVT) is present in 2.1% to 26% of patients. PVT is no longer considered an absolute contraindication for liver transplantation, and nowadays, surgical strategies depend on the extent of PVT. Complete PVT is associated with higher morbidity rates and poor prognosis, while comparable long-term outcomes can be achieved as long as physiological portal inflow is restored.

2018 - Laparoscopic pancreaticoduodenectomy for tumors of the head of the pancreas; 10 cases for a single center experience [Articolo su rivista]
Ballarin, R; Magistri, P; Tarantino, G; Assirati, G; Pecchi, A; Guerrini, Gp; Di Benedetto, F

We read with great interest the article by Caruso et al1 regarding their experience in a series of 10 patients undergoing laparoscopic pancreaticoduodenectomy (LPD) for a tumor in the head of the pancreas. The authors reported their single-center experience in this field so far, focusing on outcomes compared with open pancreaticoduodenectomy (PD).

2017 - Multimodal oncological approach in patients affected by recurrent hepatocellular carcinoma after liver transplantation [Articolo su rivista]
Guerrini, Gp; Berretta, M; Tarantino, G; Magistri, P; Pecchi, A; Ballarin, R; Di Benedetto, F

Hepatocellular Carcinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. Liver transplantation (LT) is an excellent treatment for patients with small HCC associated with cirrhosis. The purpose of this review is to investigate the possible strategies for the treatment of HCC recurrence after LT based on current clinical evidence.

2017 - The Evolving Role of Local Treatments for HCC in the Third Millennium [Articolo su rivista]
Magistri, Paolo; Tarantino, Giuseppe; Ballarin, Roberto; Berretta, Massimiliano; Pecchi, Annarita; Ramacciato, Giovanni; DI Benedetto, Fabrizio

Hepatocellular carcinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. The aim of this review was to clarify the role of local treatments for HCC, analyzing the indications and defining future perspectives.

2016 - Adenomyosis of the Extrapelvic Portion of the Round Ligament [Articolo su rivista]
Cagnacci, Angelo; Xholli, Anjeza; Grandi, Giovanni; Ficarra, Guido; Pecchi, Annarita

Background: Adenomyosis is a disease of the uterus characterized by invasion of endometrial cells within the myometrium. Adenomyosis is typically confined to the uterus, with no distant localizations. This article reports on a case of adenomyosis of the distal extrapelvic portion of the round ligament. Case: The patient, a 49-year-old woman, had previously undergone surgery for pelvic endometriosis. This prior surgery included removal of uterus, fallopian tubes, and a portion of the sigmorectal intestine. She then presented with a nodule on the right side of her pubis. The nodule was close to the upper part of her right labia majora. She was experiencing cyclic pain, nodule enlargement, and edema on the right side of her pubis. The entire round ligament, from the internal inguinal canal to its distal end above the pubis, was removed. Histology testing revealed that the distal nodule was a myomalike neoformation containing endometrial tissue; this was definable as adenomyosis. Results: After the surgical procedure, the patient recovered quickly and after 6 months she was still free of symptoms. Conclusions: To the current authors' knowledge, this is the first case describing such a distant migration of endometrial cells up to the final extraperitoneal end of the round ligament to form a nodule of adenomyosis. A physical examination and imaging should be performed to rule out hernia, a cyst of the Nuck's duct, or lymph-node enlargement. Complete excision is curative. (J GYNECOL SURG 32:204)

2016 - Giant elephantiasis neuromatosa in the setting of neurofibromatosis type 1: A case report [Articolo su rivista]
Ponti, Giovanni; Pellacani, Giovanni; Martorana, Davide; Mandel, Victor Desmond; Loschi, Pietro; Pollio, Annamaria; Pecchi, Annarita; Dealis, Cristina; Seidenari, Stefania; Tomasi, Aldo

Elephantiasis neuromatosa (EN) can arise from a plexiform neurofibroma of the superficial and deep nerves developing from a hyperproliferation of the perineural connective tissue infiltrating adjacent fat and muscles. To date, the clinical association between EN and neurofibromatosis type 1 (NF1) has been poorly defined, particularly with regard to the role of lymphatic alterations and the consequent lymphedema. The present study reports the clinical and biomolecular features of EN in a NF1 patient with the clear clinical diagnostic criteria of multiple cafè-au-lait macules, neurofibromas, EN, a positive family history and a novel NF1 germline c.1541_1542del mutation. Lymphoscintigraphy (LS) highlighted marked dermal backflow in the affected limb, hypertrophy of the ipsilateral inguinal and external iliac lymph nodes, and a bilateral lower limb lymph flow delay. These data support the hypothesis that an extensive hyperproliferative process involving perineural connective, limb soft tissues, bones and the lymphatic system can be responsible for EN in NF1 patients, on the basis of adipocyte metaplasia triggered by lymphostasis and lymphedema, and bone overgrowth and gigantism caused by chronic hyperemia. LS and magnetic resonance imaging can be efficacious tools in the diagnosis and clinical characterization of the early onset of the disease.

2016 - Redefine staging of hepatocellular carcinoma on a "bench-to-bedside" approach [Articolo su rivista]
Magistri, P; Tarantino, G; Pecchi, A; Ballarin, R; Di Benedetto, F

2015 - Everolimus effectively blocks pulmonary metastases from meningioma [Articolo su rivista]
Bertolini, Federica; Pecchi, Annarita; Stefani, Alessandro; Fontana, Annalisa; Rossi, Giulio

L'utilizzo di everolimus a lungo termine ha permesso in una paziente affetta da metastasi multiple polmonari bilaterali da meningioma di bloccare l'evoluzione della malattia.

D'Amico, G; Tarantino, G; Ballarin, R; Serra, V; Pecchi, A R; Guaraldi, G; Di Benedetto, F

HIV-infected patients now live longer and often have complications of liver disease, especially with hepatitis B or C virus co-infection. Hepatocellular carcinoma (HCC) is an increasing cause of mortality in HIV positive and negative individuals. There is a lack of consensus regarding the clinical presentation, treatment options, and outcome in HIV-infected patients with HCC. Unfortunately, HCC is frequently diagnosed at an advanced stage, and mortality continues to be very high. Earlier diagnosis, which may allow potentially curative therapy, is necessary. Liver resection is considered the most potentially curative treatment for HCC patients when liver transplantation is not an option or is not immediately accessible. The aim of this article was to describe our liver resection strategy, describing our experience, for HCC in HIV infected patients.

2015 - Post-transplantation hepatocellular carcinoma recurrence: Patterns and relation between vascularity and differentiation degree [Articolo su rivista]
Pecchi, Annarita; Besutti, Giulia; de Santis, Mario; DEL GIOVANE, Cinzia; Nosseir, Sofia; Tarantino, Giuseppe; DI BENEDETTO, Fabrizio; Torricelli, Pietro

Aim: To evaluate the relationship between hepatocellular carcinoma (HCC) vascularity and grade; to describe patterns and vascular/histopathological variations of post-transplantation recurrence. Methods: This retrospective study included 165 patients (143 men, 22 women; median age 56.8 years, range 28-70.4 years) transplanted for HCC who had a follow-up period longer than 2 mo. Pre-transplantation dynamic computed tomography or magnetic resonance examinations were retrospectively reviewed, classifying HCC imaging enhancement pattern into hypervascular and hypovascular based on presence of wash-in during arterial phase. All pathologic reports of the explanted livers were reviewed, collecting data about HCC differentiation degree. The association between imaging vascular pattern and pathological grade was estimated using the Fisher exact test. All follow-up clinical and imaging data were reviewed for evidence of recurrence. Recurrence rate was calculated and imaging features of recurrent tumor were collected, classifying early and late recurrences based on timing (< or ≥ 2 years after transplantation) and intrahepatic, extrahepatic and both intrahepatic and extrahepatic recurrences based on location. All intrahepatic recurrences were classified as hypervascular or hypovascular and the differentiation degree was collected where available. The presence of variations in imaging enhancement pattern and pathological grade between the primary tumor and the intrahepatic recurrence was evaluated and the association between imaging and histopatholgical variations was estimated by using the χ2 test. Results: Of the 163 patients with imaging evidence of viable tumor, 156 (95.7%) had hypervascular and 7 (4.3%) hypovascular HCC. Among the 125 patients with evidence of viable tumor in the explanted liver, 19 (15.2%) had grade 1, 56 (44.8%) grade 2, 40 (32%) grade 3 and 4 (3.2%) grade 4 HCC, while the differentiation degree was not assessable for 6 patients (4.8%). A significant association was found between imaging vascularity and pathological grade (P = 0.035). Post-transplantation recurrence rate was 14.55% (24/165). All recurrences occurred in patients who had a hypervascular primary tumor. Three patients (12.5%) experienced late recurrence; the location of the first recurrence was extrahepatic in 14 patients (58.3%), intrahepatic in 7 patients (29.2%) and both intrahepatic and extrahepatic in 3 patients (12.5%). Two patients had a variation in imaging characteristics between the primary HCC (hypervascular) and the intrahepatic recurrent HCC (hypovascular), while 1 patient had a variation of histopathological characteristics (from moderate to poor differentiation), however no association was found between imaging and histopathological variations. Conclusion: A correlation was found between HCC grade and vascularity; some degree of variability may exist between the primary and the recurrence imaging/histopathological characteristics, apparently not correlated.

2015 - Preoperative Carboplatin–Paclitaxel–Bevacizumab in Triple-Negative Breast Cancer: Final Results of the Phase II Ca.Pa.Be Study [Articolo su rivista]
Guarneri, Valentina; Dieci, Maria Vittoria; Bisagni, Giancarlo; Boni, Corrado; Cagossi, Katia; Puglisi, Fabio; Pecchi, Annarita; Piacentini, Federico; Conte, Pier Franco

Purpose: The phase II Ca.Pa.Be trial evaluated preoperative carboplatin–paclitaxel in combination with bevacizumab in triple-negative breast cancer patients with previously untreated stage II–III disease. The primary aim was the assessment of the rate of pathologic complete response (pCR). Secondary aims included safety, breast-conserving surgery rate, and early response assessment with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods: Patients with hormone receptor-negative, HER-2-negative stage II–III breast cancer were eligible. Treatment included paclitaxel 80 mg/mq + carboplatin area under the curve (AUC) 2 on days 1, 8, and 15, combined with bevacizumab 10 mg/kg on days 1 and 15 each 28 days, for 5 courses. At baseline, patients underwent breast DCE-MRI, followed by a single dose of bevacizumab 5 mg/kg (day −6). DCE-MRI was repeated before the initiation of chemotherapy. Results: Forty-four patients were enrolled. Forty-three patients underwent surgery, and 22 (50 %) received breast-conserving surgery (conversion rate from mastectomy indication at baseline, 34.4 %). A pCR in breast and axillary lymph nodes occurred in 22 patients (50 %). Bevacizumab-associated adverse events (AEs) were mild: G1–2 hypertension and bleeding occurred in 6 (13.6 %) and 12 (27 %) patients, respectively. No G4 nonhematologic AEs were recorded. More frequent G3 AEs were liver function test abnormalities (6.8 %), and diarrhea and fatigue (4.5 % each). The only G3–4 hematologic toxicity was neutropenia (G3, 25 %; G4, 9 %). Early assessed DCE-MRI response parameters failed to predict pCR. Conclusions: The neoadjuvant anthracycline-free combination of weekly paclitaxel and carboplatin plus bevacizumab is active and safe in triple-negative breast cancer, and the rate of pCR is comparable to that observed with more intensive carboplatin- and bevacizumab-containing regimens. Further investigation is warranted.

2014 - Skeletal and cranio-facial signs in Gorlin syndrome from ancient Egypt to the modern age: Sphenoid asymmetry in a patient with a novel PTCH1 mutation [Articolo su rivista]
Ponti, Giovanni; Ruini, Cristel; Pastorino, Lorenza; Loschi, Pietro; Pecchi, Annarita; Malagoli, Marcella; Mandel, Victor Desmond; Boano, Rosa; Conti, Andrea; Pellacani, Giovanni; Tomasi, Aldo

Gorlin syndrome is an autosomal dominant disorder linked to PTCH1 mutation, identified by a collection of clinical and radiologic signs. We describe the case of a family in which father and son fulfilled clear cut diagnostic criteria for Gorlin syndrome including multiple basal cell carcinomas, keratocystic odontogenic tumors, atypical skeletal anomalies and a novel PTCH1 germline mutation (c.1041delAA). Craniofacial and other skeletal anomalies displayed at 3D and helical CT scan were: macrocephaly, positional plagiocephaly, skull base and sphenoid asymmetry, bifidity of multiple ribs and giant multilocular odontogenic jaw cysts. Extensive multilamellar calcifications were found in falx cerebri, tentorium, falx cerebelli and in the atlanto-occipital ligament. The inclusion of bifid ribs as a novel major criteri may be useful for the recognition and characterization of misdiagnosed cases.

2014 - Un caso inusuale di interstiziopatia polmonare cistica [Abstract in Atti di Convegno]
Aramini, Beatrice; Stefani, Alessandro; Rossi, Giulio; Pecchi, Annarita; Bertolini, Federica; Falasca, Angelo; Morandi, Uliano

Nel marzo 2011, una donna di 27 anni è stata ricoverata per cefalea persistente. La RMN dell’encefalo mostrava una neoformazione parasagittale destra, eterogenea, con aree emorragiche e compressione del tessuto circostante, compatibile con meningioma. Il radiogramma del torace mostrava una interstiziopatia diffusa reticolonodulare e pneumotorace sinistro. La HRCT evidenziava la presenza di lesioni cistiche bilaterali, diffuse prevalentemente ai lobi inferiori e sottopleuriche, micronoduli peribronchiali e centrolobulari e confermava il pneumotorace, completo a sinistra, soltanto apicale a destra. Le cisti, da pochi millimetri a un centimetro, presentavano pareti sottili e tendenza a confluire. La paziente non riferiva sintomatologia respiratoria. La diagnosi radiologica è stata di interstiziopatia polmonare a componente cistica. Gli esami di laboratorio (compresi test-HIV, ANAtest, immunoelettroforesi) e una TC addome-pelvi sono risultati negativi. La paziente è stata sottoposta ad intervento neurochirurgico di rimozione completa della neoplasia cerebrale in craniotomia. La diagnosi istologica è stata di meningioma benigno (grado I). Dopo tre settimane sono state eseguite biopsie polmonari multiple in videotoracoscopia. L'esame istologico ha mostrato una proliferazione di tipo nodulare e cistico di cellule fusate, con rare mitosi, senza necrosi. All’immunoistochimica queste cellule si presentavano diffusamente positive per vimentina, EMA, CD56 e recettori per estrogeni/progesterone, focalmente positive per S100. In considerazione dell’analogo quadro morfologico e immunoistochimico con la neoplasia cerebrale, è stata posta diagnosi di metastasi polmonari da meningioma. Questa diagnosi è stata ulteriormente avvalorata dai test molecolari. La paziente ha iniziato chemioterapia con idrossiurea, interrotta dopo 12 mesi a causa di progressione della malattia polmonare. Da Giugno 29012 è in terapia con everolimus e da allora la malattia rimane stabile. Le metastasi da meningioma sono rare (0,1 % dei meningiomi) e il polmone è l’organo più colpito. Metastatizzano principalmente i meningiomi maligni (grado II-III), eccezionalmente le forme benigne (circa 20 casi riportati in letteratura). Le metastasi polmonari sono descritte in genere come masse o noduli, più spesso isolate, raramente come lesioni multiple o bilaterali. Questo è il primo caso riportato di presentazione con aspetto microcistico. L’aspetto radiologico poneva la diagnosi differenziale con altre forme di interstiziopatia cistica (linfoangioleiomiomatosi, istiocitosi a cellule di Langherans, neurofibromatosi-1, LIP, collagenopatie), per cui è stata obbligatoria la biopsia polmonare. All’esame istologico l’aspetto morfologico non poteva escludere altre proliferazioni a cellule fusate riscontrabili a livello polmonare, (linfoangioleiomiomatosi, meningoteliomatosi) ma le caratteristiche immunoistochimiche nel contesto clinico di un meningioma cerebrale hanno supportato la diagnosi di metastasi. E’ stata decisiva l’analisi molecolare per la diagnosi di certezza.

2013 - An unusual case of cystic interstitial lung disease [Articolo su rivista]
Stefani, A.; Rossi, G.; Pecchi, A.; Bertolini, F.; Falasca, A.; Aramini, B.; Morandi, U.


2012 - Banked Depopulated Vena Cava Homograft: A New Strategy to Restore Caval Continuity [Articolo su rivista]
DI BENEDETTO, Fabrizio; Giuseppe, D'Amico; Roberto, Montalti; Roberto, Ballarin; Giuseppe, Tarantino; Pecchi, Annarita; Gerunda, Giorgio Enrico

Non disponibile

2012 - MRI before initial surgery outside of clinical trials: the real world! [Articolo su rivista]
Cortesi, Laura; DE MATTEIS, Elisabetta; Cirilli, C.; Filieri, E.; Pecchi, Annarita; Battista, R.; Canossi, B.; Torricelli, Pietro; Federico, Massimo

Abstract not available

2012 - MRI in high risk women: benefits and problems [Articolo su rivista]
Cortesi, Laura; Pecchi, Annarita; DE MATTEIS, Elisabetta; Filieri, E.; Battista, R.; Canossi, B.; Torricelli, Pietro; Federico, Massimo

Abstract not available

2012 - Meso-Pancreatectomy: New Surgical Technique for Wirsung Reconstruction [Articolo su rivista]
Di Benedetto, Fabrizio; D'Amico, Giuseppe; Ballarin, Roberto; Tarantino, Giuseppe; Cautero, Nicola; Pecchi, Anna; Gerunda, Giorgio Enrico


2012 - Microsurgical Testis-sparing Surgery in Small Testicular Masses Seven Years Retrospective Management and Results [Articolo su rivista]
De Stefani, Stefano; Isgrò, G; Varca, V; Pecchi, A; Bianchi, Giampaolo; Carmignani, G; Derchi, Le; Micali, Salvatore; Maccio, L; Simonato, A.

OBJECTIVE: To retrospectively evaluate the clinical outcomes of 20 patients diagnosed with a nonpalpable or small testicular mass (2 cm) at 2 academic urological department. Testis-sparing surgery (TSS) is currently performed routinely for the management of nonpalpable testicular masses. High reliability of frozen section examination (FSE) and high-frequency ultrasound (US) and the adoption of microsurgical techniques improved safety and feasibility of this technique.METHODS: From January 2004 to March 2011, 23 patients underwent microsurgical TSS. An inguinal approach was performed in 22 cases and a suprapubic incision in one bilateral case. All procedures were performed with an operating microscope, with warm ischemia in 21 cases and cold ischemia in 2 cases. Intraoperative US was performed before opening the albuginea. Mean operative time was 89 minutes.RESULTS: After mass excision, FSE was performed; only 2 seminomatous tumors were identified, and the remaining masses were benign lesions. After a mean follow-up >12 months, all patients are free of disease; no hypogonadism developed.CONCLUSIONS: TSS performed using an operating microscope allowed the preservation of testes for 21 patients diagnosed with small testicular and/or nonpalpable mass (<2 cm), without evidence of disease recurrence or de novo onset. This approach could be mandatory in the treatment of bilateral tumors or in solitary testis. Maintaining fertility is not the main goal of TSS because a great number of patients affected by testicular tumors are already infertile. Esthetic outcomes and sparing hormonal function are the main reasons for TSS.

2012 - Radiological screening programs for women at high risk of developing breast cancer [Articolo su rivista]
Cortesi, L.; de Matteis, E.; Sebastiani, F.; Toss, A.; Marchi, I.; Battista, R.; Canossi, B.; Pecchi, A.; Federico, M.

The aim of this review is to identify the evidence for the surveillance of women at high risk of breast cancer with the different modalities. The definition of high risk refers to the subpopulation of women with a family history of breast cancer, including both those with and without identified genetic mutations. The following topic has been evaluated: clinical breast examination (CBE), mammography, ultrasound and MRI accuracy of detecting breast cancer among women at high risk. The search was limited to full reports published in English and published between 1996 and March, 2010. We found consistent evidence that adding MRI provides a highly sensitive screening strategy (sensitivity range: 93-100%) compared to mammography alone (32-86%) or mammography plus ultrasound +/- CBE (26-93%). Three studies that compared MRI plus mammography versus mammography alone showed the sensitivity of MRI plus mammography as 93% (95% CI 86-100%) and the incremental sensitivity of MRI as 60%. Incremental sensitivity of MRI was lower when added to mammography plus ultrasound (43%) or to the combination of mammography, ultrasound plus CBE. Estimates of screening specificity with MRI were less consistent but suggested a 3-5-fold higher risk of patient recall for investigation of false positive results. No studies assessed whether adding MRI reduces patient mortality, interval or advanced breast cancer rates, even if we found strong evidence that MRI leads to the detection of earlier stage disease. This review suggests that a surveillance strategy would be accurate and effective in improving health outcomes for women at high risk of breast cancer, but randomized studies should be considered for a better evaluation of these topics. © 2012 Bentham Science Publishers.

2012 - Radiological screening programs for women at high risk of developing breast cancer [Articolo su rivista]
Cortesi, L.; de Matteis, E.; Sebastiani, F.; Toss, A.; Marchi, I.; Battista, R.; Canossi, B.; Pecchi, A; Federico, M.

The aim of this review is to identify the evidence for the surveillance of women at high risk of breast cancer with the different modalities. The definition of high risk refers to the subpopulation of women with a family history of breast cancer, including both those with and without identified genetic mutations. The following topic has been evaluated: clinical breast examination (CBE), mammography, ultrasound and MRI accuracy of detecting breast cancer among women at high risk. The search was limited to full reports published in English and published between 1996 and March, 2010. We found consistent evidence that adding MRI provides a highly sensitive screening strategy (sensitivity range: 93-100%) compared to mammography alone (32-86%) or mammography plus ultrasound +/- CBE (26-93%). Three studies that compared MRI plus mammography versus mammography alone showed the sensitivity of MRI plus mammography as 93% (95% CI 86-100%) and the incremental sensitivity of MRI as 60%. Incremental sensitivity of MRI was lower when added to mammography plus ultrasound (43%) or to the combination of mammography, ultrasound plus CBE. Estimates of screening specificity with MRI were less consistent but suggested a 3-5-fold higher risk of patient recall for investigation of false positive results. No studies assessed whether adding MRI reduces patient mortality, interval or advanced breast cancer rates, even if we found strong evidence that MRI leads to the detection of earlier stage disease. This review suggests that a surveillance strategy would be accurate and effective in improving health outcomes for women at high risk of breast cancer, but randomized studies should be considered for a better evaluation of these topics. © 2012 Bentham Science Publishers.

2012 - Role of intraoperative ultrasonography for pancreatic schwannoma. [Articolo su rivista]
DI BENEDETTO, Fabrizio; Ballarin, Roberto; Spaggiari, Mario; Pecchi, Annarita; Gerunda, Giorgio Enrico

Non available

2011 - Liver resection for colorectal metastases in older adults: A paired matched analysis [Articolo su rivista]
Di Benedetto, F.; Berretta, M.; D'Amico, G.; Montalti, R.; Ruvo, N. D.; Cautero, N.; Guerrini, G. P.; Ballarin, R.; Spaggiari, M.; Tarantino, G.; Di Sandro, Stefano; Pecchi, A.; Luppi, G.; Gerunda, G.

To assess the safety and long-term results of hepatic resection of colorectal liver metastases (CLM) in older adults.Case-control.Single liver and multivisceral transplant center.Individuals with CLM: 32 aged 70 and older (older group) and 32 younger than 70 (younger group) matched in a 1:1 ratio according to sex, primary tumor site, liver metastases at diagnosis, number of metastases, maximum tumor size, infiltration of cut margin, type of hepatic resection, and hepatic resection timing.Postoperative complications and survival rates.There was no significant difference in preoperative clinical findings between the two study groups. The incidence of cumulative postoperative complications was similar in the older (28.1%) and younger (34.4%) groups (P&nbsp;=&nbsp;.10). One-, 3-, and 5-year disease-free survival rates were 57.6%, 32.9%, and 16.4%, respectively, in the younger group and 67.9%, 29.2%, and 19.5%, respectively, in the older group (P&nbsp;=&nbsp;.72). One-, 3-, and 5-year participant survival rates were 84.1%, 51.9%, and 33.3%, respectively, in the older group and 93.6%, 63%, and 28%, respectively, in the younger group (P&nbsp;=&nbsp;.50).Resection of colorectal liver metastases in older adults can be performed with low mortality and morbidity and offers a long-time survival advantage to many of these individuals. Based on the results of this case-control study, older adults should be considered for surgical treatment whenever possible.

2011 - Magnetic Resonance Imaging and Ultrasonography in Predicting Infiltrating Residual Disease after Preoperative Chemotherapy in Stage II-III Breast Cancer [Articolo su rivista]
Guarneri, Valentina; Pecchi, A; Piacentini, Federico; Barbieri, Elena; Dieci, Mv; Ficarra, G; Tazzioli, Giovanni; Frassoldati, A; Battista, R; Canossi, Barbara; Mauri, C; D'Amico, Roberto; Conte, Pierfranco; Torricelli, Pietro

BACKGROUND: This study was designed to evaluate the accuracy of breast magnetic resonance imaging (MRI) and ultrasonography (US) in predicting the extent of breast residual disease after preoperative chemotherapy. METHODS: Patients withstage II-III invasive breast tumors who received preoperative chemotherapy and were imaged with post-treatment MRI were included. Histopathological verification was available for all patients. The longest diameter of residual tumor measuredwith MRI and US has been compared with the infiltrating residual tumor size at pathologic evaluation. RESULTS: A total of 108 patients were enrolled: 59 were imaged with both MRI and US (MRI group), and 49 were imaged with US only (non-MRI group). The non-MRI group was enrolled as an external control to avoid possible bias in the selection of patients. In the MRI group, the means of the deltas between MRI residual tumor size and pathologic size and between US and pathologic size were 0.16 cm and -0.06 cm respectively (P = not significant). Overall, a discrepancy limited in the interval from -0.5 cm to +0.5 cm compared with the pathologic size was observed in 54% and 51% of the patients with MRI and US, respectively (P = not significant). The linear correlation between the radiological measurement and pathologic tumor size was r = 0.53 for MRI and r = 0.66 for breast US. In the non-MRI group, the mean of the deltas between US residual tumor size and pathologic size was 0.06 cm, and the linear correlation was r = 0.79. CONCLUSIONS: In this series of patients, MRI and US do not show significant differences in predicting the breast residual infiltrating tumor after preoperative chemotherapy.

2011 - Pancreatic metastases from renal cell carcinoma: the state of the art. [Articolo su rivista]
Ballarin, Roberto; Spaggiari, Mario; Cautero, N.; Ruvo, N. D.; Montalti, R.; Longo, C.; Pecchi, Annarita; Giacobazzi, Patrizia; Marco, G. D.; D'Amico, Giuseppe; Gerunda, Giorgio Enrico; DI BENEDETTO, Fabrizio

Pancreatic metastases are rare, with a reported incidence varying from 1.6\% to 11\% in autopsy studies of patients with advanced malignancy. In clinical series, the frequency of pancreatic metastases ranges from 2\% to 5\% of all pancreatic malignant tumors. However, the pancreas is an elective site for metastases from carcinoma of the kidney and this peculiarity has been reported by several studies. The epidemiology, clinical presentation, and treatment of pancreatic metastases from renal cell carcinoma are known from single-institution case reports and literature reviews. There is currently very limited experience with the surgical resection of isolated pancreatic metastasis, and the role of surgery in the management of these patients has not been clearly defined. In fact, for many years pancreatic resections were associated with high rates of morbidity and mortality, and metastatic disease to the pancreas was considered to be a terminal-stage condition. More recently, a significant reduction in the operative risk following major pancreatic surgery has been demonstrated, thus extending the indication for these operations to patients with metastatic disease.

2011 - Role of magnetic resonance imaging in the detection of anastomotic biliary strictures after liver transplantation. [Articolo su rivista]
Pecchi, A.; Santis, M. D.; Gibertini, M. C.; Tarantino, G.; Gerunda, Giorgio Enrico; Torricelli, Pietro; DI BENEDETTO, Fabrizio

Biliary complications after orthotopic liver transplantation (OLT) are the principal cause of morbidity and graft dysfunction, ranging in incidence from 5.8\% to 30\% of cases. Biliary strictures are the most frequent type of late complication. The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) to detect biliary anastomotic strictures among patients undergone OLT with abnormal liver function tests.One hundred twenty-one of 300 patients who underwent OLT were evaluated by MRC for clinically suspected anastomotic biliary strictures. In all patients, we performed various precholangiographic sequences including T1- and T2-weighted and MRC (radial SE 2D and SS-TSE 3D). Magnetic resonance imaging findings were subdivided as absence or presence of an anastomotic stricture. Diagnostic confirmation was obtained by endoscopic retrograde cholangiography (n=32), percutaneous transhepatic cholangiography (n=21) or surgical treatment (n=18).MRC detected 56 anastomotic biliary strictures, 53 of which were confirmed by other imaging modalities. MRC showed two false-negative cases and three false-positive cases. The sensitivity, specificity, positive and negative predictive values, and accuracy of MRC to detect biliary strictures were 96\%, 96\%, 95\%, 97\%, and 96\%, respectively.MRC proved to be a reliable noninvasive technique to visualize the biliary anastomosis and depict biliary strictures after OLT. MRC should be used when a biliary anastomotic stricture is suspected in an OLT patient.

2010 - Contrast-enhanced MRI and PET-CT in the evaluation of patients with suspected local recurrence of rectal carcinoma. [Articolo su rivista]
Fiocchi, F; Iotti, V; Ligabue, Guido; Pecchi, A; Luppi, G; Bagni, B; Rivasi, Francesco; Torricelli, Pietro

This study aimed to evaluate the role of contrast-enhanced magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) in the assessment of local recurrence of rectal cancer.Among 200 patients scheduled for CT follow-up, 60 (48 low risk; 12 high risk) were selected due to CT findings suspicious for or suggestive of local recurrence. Patients underwent contrast-enhanced MRI and PET-CT within 2 weeks. Biopsy was considered the gold standard in 39 cases and follow-up at 6 and 12 months in the remaining 21.Local recurrence was confirmed by histology in 15 cases (7 low risk; 8 high risk) and was excluded in 21 cases by long-term follow-up and in 24 by histology. Sensitivity, specificity, positive and negative predictive value and accuracy were 86.7%, 68.9%, 48.1%, 93.9% and 73.3% for contrast-enhanced MRI and 93.3%, 68.9%, 50%, 96.9% and 75% for PET-CT.Contrast-enhanced MRI and PET-CT can help in the detection of local recurrence of rectal cancer, even though their roles in early detection remains debatable, as the value of these techniques in current surveillance protocols is still to be defined.

2010 - Contrast-enhanced ultrasound in the characterisation of breast masses: utility of quantitative analysis in comparison with MRI. [Articolo su rivista]
Caproni, N; Marchisio, F; Pecchi, A; Canossi, B; Battista, R; D'Alimonte, P; Torricelli, Pietro

OBJECTIVE: To evaluate the reliability of contrast-enhanced ultrasound quantitative analysis (CE-US) in characterizing breast lesions, in comparison with MRI. MATERIALS: Thirty-nine patients with breast lesions BI-RADS 3-5 at US or mammography underwent CE-US and MRI. All lesions underwent histological and quantitative enhancement evaluation with both imaging methods. B-mode US, colour/power Doppler US and CE-US were used; an amplitude and phase modulation technique (CPS) read the signals produced by microbubbles and dedicated software produced the following parameters on time/intensity (T/I) curves: peak %, time to peak (TTP), mean transit time (MTT), regional blood volume (RBV) and regional blood flow (RBF). Student's t test was used to calculate the diagnostic accuracy of CE-US parameters compared with histological results. MRI (1.5 T) was performed before and after bolus gadolinium enhancement. Time/intensity curves were generated for all nodules and Fischer's multimodal score was used to classify them. RESULTS: Pathology showed 43 nodules (11 benign; 32 malignant). Peak and RBF were the most significant parameters in differential diagnosis, with p values of 0.02 and 0.004, respectively. Positive predictive value (PPV) of CE-US evaluation was 91%, negative predictive value (NPV) was 73% with a high concordance index (k = 0.59) with MRI. CONCLUSIONS: CE-US quantitative analysis offers an objective and reproducible assessment of lesion vascularisation, with good correlation with the results of MRI.

2010 - Liver transplantation due to iatrogenic injuries: two case reports. [Articolo su rivista]
DI BENEDETTO, Fabrizio; A., Mimmo; G., D'Amico; N. D., Ruvo; Cautero, Nicola; R., Montalti; G. P., Guerrini; Ballarin, Roberto; Spaggiari, Mario; G., Tarantino; V., Serra; Pecchi, Annarita; M. D., Santis; Gerunda, Giorgio Enrico

The transjugular intrahepatic portosystemic shunt (TIPS) is an acceptable procedure that has proven benefits in the treatment of patients who have complications from portal hypertension due to liver cirrhosis. In the literature few reports have described complications after TIPS placement. Initial surgery and local hemostasis have been needed to manage abdominal bleeding: if this treatment is insufficient, it may be necessary to perform a liver transplantation. This report describes the role of liver transplantation to manage dangerous complications in 2 patients after TIPS placement, when surgical procedures and hemostasis were unable to stop the bleeding.

2010 - Role of magnetic resonance cholangiography in biliary complications of orthotopic liver transplantation. [Articolo su rivista]
Pecchi, Annarita; M. D., Santis; DI BENEDETTO, Fabrizio; Gibertini, Maria Chiara; Gerunda, Giorgio Enrico; Torricelli, Pietro

PURPOSE: The aim of this study was to evaluate the role of magnetic resonance cholangiography (MRC) in the detection of biliary complications following orthotopic liver transplantation (OLT). MATERIALS AND METHODS: Seventy-eight transplant patients with clinically suspected biliary complications were evaluated with 1.5-T magnetic resonance imaging (MRI) using a surface coil. All patients were imaged with the following sequences: axial T1-weighted and axial and coronal T2-weighted, 2D spin echo (SE) breath-hold radial cholangiography, and coronal 3D single-shot turbo spin echo (SS-TSE) with respiratory triggering. Patients with negative MRI underwent clinical and sonographic followup. When biliary complications were present, diagnostic confirmation was obtained by endoscopic retrograde cholangiopancreatography (ERCP) (n=13), percutaneous transhepatic cholangiography (PTC) (n=20), ultrasonography (n=10) or computed tomography (CT) (n=2). In 11 cases, surgical confirmation was also obtained. RESULTS: MRC detected biliary complications in 44/78 patients, in particular, 42 biliary strictures (37 anastomotic and five intrahepatic), 40 of which were confirmed by other imaging modalities. In 25/37 cases of anastomotic stricture, preanastomotic dilatation of the biliary tract was also demonstrated. Other MRC-detected biliary complications were biliary sludge (n=4), biloma (n=5), and biliary stones (n=3). In four cases, PTC revealed biliary complications that had not been detected with MRC (false negative results). In two cases, MRC showed unconfirmed strictures of the intrahepatic ducts and biliodigestive anastomosis (false positive results). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy of MRC were 93.5\%, 94.4\%, 96.7\%, 89.5\% and 93.9\%, respectively. CONCLUSIONS: Our results confirm that MRC is a reliable technique for depicting biliary anastomoses and detecting biliary complications after OLT. The high diagnostic accuracy of MRC indicates that this examination should be routinely employed in all OLT patients with clinically suspected biliary complications.

2009 - Magnetic resonance imaging and ultrasonography in predicting pathologic extent after preoperative chemotherapy in stage II-III breast cancer [Abstract in Rivista]
Guarneri, Valentina; Pecchi, Annarita; Torricelli, Pietro; Piacentini, Federico; A., Frassoldati; C., Mauri; R., Battista; B., Canossi; D'Amico, Roberto; Conte, Pierfranco

Introduction and aims: the main advantage of preoperative chemotherapy (PCT) is tumor down-staging, that can allow either mastectomy in large, inoperable primaries, or breast conserving surgery (BCS) for patients initially candidate to mastectomy. Therefore, an accurate measurement of residual disease after PCT is critical in the optimal surgical planning. Aim of this study is to evaluate the accuracy of breast magnetic resonance imaging (MRI) and ultrasonography (USG) in predicting the extent of breast residual disease. Patients and Methods: patients with stage II-III invasive breast tumor receiving PST and imaged with post-treatment MRI, USG or both were included; deltas were calculated as differences between the longest tumor diameter as measured by MRI and USG and the pathologic size of residual breast tumor. Differences between deltas were tested by using T test for paired data. Results: 45 patients treated with PCT in our Institution were eligible. Patients characteristics were as follows: mean age 50 yrs (range 30-70 yrs); stage IIA 31%, IIB 49%, IIIA-B: 20%. Eighty-nine % of the cases had ductal histology, 69% had ER positivity, and 24% had HER2 over-expression. The mean T size at diagnosis was 3.8 cm (range 1.5-8 cm). PCT type was anthracycline-based (24%) or anthracycline-taxane combination (76%). Forty-four patients have been evaluated after PCT by MRI, 41 by USG, 40 patients by both MRI and USG. The mean T size (range) after PCT was 2 cm (0-6.5 cm) and 1.7cm (0-5cm) as measured by MRI and USG respectively. The mean interval between breast imaging and surgery was 20 days (range 1-63). Type of surgery was mastectomy in 45% and BCS in 55% of the cases; 6 patients (13%) achieved a pathologic complete response (pCR). The mean pathologic T size was 1.98 cm (range 0-6 cm). The mean of the deltas were 0.04 (SD 1.91) and -0.19 (SD 1.53) for MRI and USG respectively (p=0.22). A complete response by MRI was observed in 9 cases: 3 cases were confirmed as pCRs; 2 cases presented with scattered microscopic residual disease. An USG complete response was observed in 8 cases (4 confirmed pCRs). Conclusion: in this series of patients, MRI and USG do not show significant differences in predicting the breast residual tumor after PCT. The major challenge for breast imaging after PCT is represented by scattered residual disease.

2006 - Breast cancer screening in women at increased risk according to different family histories: an update of the Modena Study Group experience [Articolo su rivista]
Cortesi, L; Turchetti, D; Marchi, I; Fracca, A; Canossi, B; Battista, R; Ruscelli, Silvia; Pecchi, Ar; Torricelli, Pietro; Federico, Massimo

Background: Breast cancer ( BC) detection in women with a genetic susceptibility or strong family history is considered mandatory compared with BC screening in the general population. However, screening modalities depend on the level of risk. Here we present an update of our screening programs based on risk classification. Methods: We defined different risk categories and surveillance strategies to identify early BC in 1325 healthy women recruited by the Modena Study Group for familial breast and ovarian cancer. Four BC risk categories included BRCA1/2 carriers, increased, intermediate, and slightly increased risk. Women who developed BC from January 1, 1994, through December 31, 2005 (N = 44) were compared with the number of expected cases matched for age and period. BRCA1/2 carriers were identified by mutational analysis. Other risk groups were defined by different levels of family history for breast or ovarian cancer (OC). The standardized incidence ratio ( SIR) was used to evaluate the observed and expected ratio among groups. All statistical tests were two-sided. Results: After a median follow-up of 55 months, there was a statistically significant difference between observed and expected incidence [SIR = 4.9; 95% confidence interval (CI) = 1.6 to 7.6; p < 0.001]. The incidence observed among BRCA carriers (SIR = 20.3; 95% CI = 3.1 to 83.9; P < 0.001), women at increased ( SIR = 4.5; 95% CI = 1.5 to 8.3; P < 0.001) or intermediate risk ( SIR = 7.0, 95% CI = 2.0 to 17.1; P = 0.0018) was higher than expected, while the difference between observed and expected among women at slightly increased risk was not statistically significant (SIR = 2.4, 95% CI = 0.9 to 8.3; P =.74). Conclusion: The rate of cancers detected in women at high risk according to BRCA status or strong family history, as defined according to our operational criteria, was significantly higher than expected in an age-matched general population. However, we failed to identify a greater incidence of BC in the slightly increased risk group. These results support the effectiveness of the proposed program to identify and monitor individuals at high risk, whereas prospective trials are needed for women belonging to families with sporadic BC or OC.

2005 - Focal nodular hyperplasia of the liver. A case report [Articolo su rivista]
Mengoli, M.; Bernini, M. V.; Tolomelli, S.; Saetti, C.; Pecchi, A.; Tondelli, G.

Focal nodular hyperplasia (FNH) of the liver is a benign disorder that usually occurs in women during their reproductive years. Multiple FNH is very rare. A case of multiple FNH of the liver occurring in a 34-year-old woman is described. FNH diagnosis was confirmed by means of US, CT, MR, scintigraphy and hepatic biopsy. There was no further change in either size or appearance of liver masses in the ensuing 6 years of follow-up.

2005 - MRI evaluation of myometrial invasion by endometrial carcinoma. Comparison between fast-spin-echo T2W and coronal FMPSPGR Gadolinium-dota-enhanced sequences [Articolo su rivista]
Nasi, F; Fiocchi, F; Pecchi, A; Rivasi, Francesco; Torricelli, Pietro

Purpose. The depth of myometrial invasion by endometrial carcinoma strongly affects the incidence of metastasis to regional nodes and influences the surgical strategies. The aim of this paper is to compare the results of FSE T2-w and Gadolinium-enhanced FMPSGR MR sequences in assessing the depth of myometrial invasion by endometrial cancer. Materials and methods. Forty-five women with histopathologically-proven endometrial carcinoma underwent preoperative MRI. Axial SE T1w, axial, sagittal and para-coronal FSE T2w and para-coronal Gadolinium-enhanced FMPSGR sequences were performed using a high field strength magnet (1.5T). Within one month of MR all patients underwent hysterectomy, and anatomical evaluation of the surgical specimen was done sectioning the uterus along the short axis. Based upon the results of the histological evaluation the results of the FSE T2w and Gadolinium-enhanced sequences were compared and the statistical difference between the results obtained was statistically evaluated. Results. The histological evaluation showed intramucosal neoplasm in 1 patients, myometrial infiltration less than 50% in 31 patients, myometrial infiltration more than 50% in 12 patients and transmural cancer in 1 patient. Statistical evaluation showed that the FSE T2w sequence had a global sensitivity and specificity of 80.6% and 87.6%, respectively, with a mean Negative Predictive Value of 92.6% and a mean Positive Predictive Value of 86%. Gadolinium-enhanced FMPSPGR sequence had a global sensitivity and specificity of 90.6% and 93.3%, respectively, with a mean Negative Predictive Value of 96,3% and a mean Positive Predictive Value of 88%. The staging accuracy (chi(2) test) on FMPSPGR images (95%) was higher than that on FSE T2w images (78%). Conclusions. In our experience Gadolinium-enhanced dynamic sequences increase the accuracy of MR imaging in diagnosing the depth of myometrial invasion. In particular they improve the visualisation of the inner myometrium, the so called subendometrial enhancing zone, whose disruption or changes are essential for diagnosing myometrial invasion. The major diagnostic advantages of the enhanced sequences were found in postmenopausal women, where visualisation of the junctional zone may be difficult in the T2w sequences. We believe that Gadolinium-enhanced dynamic sequences should be used whenever the diagnosis is unclear at FSE T2w sequences.

2005 - Radiologic imaging of the transplanted small bowel [Articolo su rivista]
Pecchi, A; DE SANTIS, M; Torricelli, Pietro; Romagnoli, R; Francesco, Fd; Cautero, Nicola; Pinna, A.

Background: The radiologic evaluation of the transplanted bowel is largely unknown and rather complex because it involves several techniques that depend on indications and times that have not been fully defined. Methods: From December 2000 to November 2002 in the Section of Radiology I of the University of Modena and Reggio Emilia (Modena, Italy), 11 patients with transplanted bowel were studied with different methods: traditional radiologic evaluation with contrast agent (all patients), evaluation of transit time with radiopaque markers (five patients), ultrasonographic (US) evaluation of the intestinal wall and Doppler US of the vascular axes (five patients), computed tomographic (CT) evaluation (all patients), and magnetic resonance (MR) evaluation of the bowel and the vascular axes (five patients). Traditional contrast examination enabled evaluation of the gastroesophageal transit and cardia functionality; anatomy and integrity of the anastomoses (proximal and distal); time of gastric emptying; morphology, tone, and kinesis of the transplanted small bowel loops and time of global transit. The study of transit with radiopaque markers was carried out in five patients to define the time of transit through the entire transplanted bowel, confirm recovery of intestinal motility, and identify possible abnormalities. The US examination was carried out in five patients to evaluate the morphology, thickness, and echo structural features of the intestinal loops. Color Doppler was performed to visualize the superior mesenteric artery and a wall arteriole of the sampled loop. CT examination was performed 2 to 4 weeks after surgery to evaluate the anatomy of the transplanted organs, arterial and venous anastomoses in case of complications identified with other methods or suspected, and periodically in the follow-up of patients who underwent transplantation due to Gardner syndrome. The protocol for MR evaluation of the bowel included coronal single-shot fast spin-echo T2-weighted sequences, axial and/or sagittal single-shot fast spin-echo T2-weighted sequences, coronal fast multiplanar spoiled gradient-echo (FMP- SPGR) sequences, coronal FMPSPGR sequences with and without administration of intravenous paramagnetic contrast agent, and axial or sagittal FMPSPGR fat-saturated sequences performed after dynamic gadolinium administration. Results and conclusion: The study of transit with radiopaque markers was useful in patients with chronic intestinal pseudo-obstruction because it identified recovery and normalization of motility. Traditional contrast examination of the gastrointestinal tract continues to play an important role in transplanted patients because it is a simple examination that allows evaluation of the graft anatomy and recovery of motility of the residual native bowel and the transplanted loops. Moreover, it plays a crucial role in early detection of major postoperative complications such as intestinal obstruction, perforation, fistulas, and anastomotic complications (stenosis and dehiscence). CT examination is crucial for the detection of fluid collections, abscesses, and fistulas because it can serve as a guide of drainage and during follow-up of patients with Gardner syndrome can be used to investigate all possible sites in which desmoids might arise in addition to their relation to the graft. Because patients with transplanted bowel are generally rather a young population of reproductive age and because of technologic advances, MR may represent an effective method that does not use ionizing radiation and can therefore substitute for traditional radiologic evaluation. US represents a quick examination technique that is easily available and well tolerated by patients, and it has a role to play in the follow-up of transplanted patients and in the identification of major postoperative complications. However, its role in monitoring possible rejection remains to be defined with studies on wider and more representative samples.

2003 - Associazione di calcificazioni arteriose mammarie, valutate con mammografia e calcificazioni arteriose coronariche quantificate con Tomografia Computerizzata multistrato in una popolazione di donne in postmenopausa [Articolo su rivista]
Pecchi, Annarita; Rossi, Rosario; Coppi, Francesca; Ligabue, Guido; Modena, Maria Grazia; Romagnoli, Renato

Purpose. To assess the correlation between the presence and extent of breast arterial calcifications (BAC) detected at mammography and the extent of coronary atherosclerosis, as evaluated by multislice computed tomography (MSCT) coronary calcium quantification in a population of post-menopausal women. Materials and methods. Seventy-four post-menopausal women aged under 65 years who had undergone mammography at our Department were studied by MSCT for coronary calcium quantification. The mammograms were screened for vascular calcifications which were graded according to severity and extension. The presence of coronary artery calcifications was assessed by MSCT using the «Smart Score» cardiac reconstruction software. The data obtained were analyzed using the statistical package SPSS (version 10.1) for Windows. Results. The presence and severity of breast arterial calcifications showed a strong correlation with coronary calcifications in both models. Discussion and conclusions. The study demonstrated that the presence of BAC is strongly correlated with the amount of coronary calcium detected by MSCT and therefore with the extent of coronary atherosclerosis. Moreover, there is a linear correlation between BAC severity and coronary calcium content, each incremental increase in BAC severity being associated with an average increase in coronary calcium content. Therefore, the presence and severity of BAC may provide indirect qualitative and quantitative information on the calcium present in the coronaries. As mammography is increasingly used as a screening test for breast carcinoma, breast arterial calcifications may represent an important sign with epidemiological and clinical significance for primary prevention.

2003 - Gadolinium-enhanced MRI with dynamic evaluation in diagnosing the local recurrence of rectal cancer [Articolo su rivista]
Torricelli, Pietro; Pecchi, A; Luppi, G; Romagnoli, R.

Background: At early stages, the diagnosis of local recurrence of rectal cancer is often difficult and magnetic resonance imaging (MRI) is currently considered the most accurate method for diagnosing recurrence. We evaluated the role of unhenhanced and gadolinium-enhanced MRI for the diagnosis of local recurrence of rectal cancer. Methods: Thirty-six patients, suspected of having a pelvic recurrence of rectal cancer, were evaluated by a high field strength MRI unit. Unenhanced spin-echo T1- and T2-weighted sequences and gadolinium-enhanced dynamic fast multiplanar spoiled gradient recalled sequences were performed in all patients. The dynamic images were re-elaborated with semiquantitative postprocessing by plotting intensity-time curves and calculating the percentage of signal increase at the end of the first postcontrast dynamic sequence. The pelvic lesions were classified as recurrent or not recurrent by applying the following diagnostic criteria: (a) morphology and signal intensity of the lesion in unenhanced sequences and (b) percentage of enhancement in dynamic enhanced sequences. Diagnosis was confirmed by computed tomography-guided needle biopsy (12 patients), surgery (four patients), clinical and imaging follow-up (20 patients). Results: The diagnosis was local recurrence in 15 patients and noncancerous lesions in 21 patients. Unenhanced MRI had 80% sensitivity and 86% specificity. Analysis of the percentage of enhancement showed 87% sensitivity and 100% specificity. Conclusion: In agreement with the literature, our results showed a high sensitivity and specificity for dynamic MRI. This technique thus can be considered an important adjunct to unenhanced MRI, especially in selected cases in which unenhanced MRI cannot rule out local recurrences. However, these results must be validated by further investigations.

2003 - Metastasi pancreatica solitaria da carcinoma renale: Descrizione di 1 caso simulante tumore neuroendocrino [Solitary pancreatic metastasis from renal cell carcinoma. A case report] [Articolo su rivista]
Pecchi, A.; Cesinaro, A. M.; Torricelli, Pietro


2003 - Tracheobronchopathia osteochondroplastica: Report of a case diagnosed using multidetector CT [La tracheobroncopatia osteocondroplastica: Descrizione di un caso diagnosticato con TC multistrato] [Articolo su rivista]
Pecchi, A.; Torricelli, Pietro; Marchioni, A.; Pellegrino, M.; Romagnoli, R.


2003 - Tumori non odontogeni. [Capitolo/Saggio]
Torricelli, Pietro; Pecchi, A.; Chiarini, Luigi; Figurelli, S.; Romagnoli, R.

Nell'ambito della diagnostica per immagini nella patologia odontostomatologica e maxillo-facciale, questo capitolo di libro si occupa dei tumori non odontogeni.

2002 - La RM con bobina endorettale nella stadiazione locale del carcinoma rettale [Endorectal coil MRI in local staging of rectal cancer] [Articolo su rivista]
Torricelli, Pietro; Lo Russo, S.; Pecchi, A.; Luppi, G.; Cesinaro, A. M.; Romagnoli, Renato


2002 - La Risonanza nella valutazione dei disordini funzionali del pavimento pelvico femminile [Magnetic resonance imaging in evaluating functional disorders of female pelvic floor] [Articolo su rivista]
Torricelli, Pietro; Pecchi, A.; Caruso Lombardi, A.; Vetruccio, E.; Vetruccio, S.; Romagnoli, R.

urpose. To evaluate the diagnostic capabilities of MRI in the study of functional diseases of the female pelvic floor. Materials and methods. Ten healthy volunteers and 30 patients with clinically suspected pelvic floor deficiency, with or without pelvic organ prolapse, were evaluated by a high field strength magnet operating at 1.5 T. In each case SSFSE sequences (TR/TE:25720/67) in axial, coronal and sagittal planes, both at rest and during Valsalva's manoeuvre, were performed. Based on the MRI findings using fixed and mobile anatomical landmarks, the functional disease of the pelvic floor was diagnosed and quantified based on the identification and grading of visceral prolapse. The MRI findings were compared with the clinical findings in all cases and with the surgical data in the 7 patients who had undergone surgery. Results. The MR image quality was adequate in all cases. In the group of symptomatic women MRI diagnosed: urethral hypermobility syndrome: 22 cases; isolated abnormalities of the anterior compartment: 8 cases of cystocele (low grade: 2, middle grade: 2, severe: 4); isolated abnormalities of the middle compartment: 6 cases of hysterocele (low grade: 2, middle grade: 4); isolated abnormalities of the posterior compartment: 5 cases of low-grade rectocele; 2 cases of enterocele (1 low grade, 1 middle grade ); multi-compartment abnormalities: 11 cases; joint prolapse of anterior and middle compartment: 5 cases; joint prolapse of posterior and middle compartment: 3 cases; joint prolapse of anterior, middle and posterior compartment: 3 cases. The values of both fixed and mobile landmarks were significantly higher in the symptomatic group compared with the healthy volunteers. MRI confirmed the pelvic examination findings in all cases; in particular MRI findings were in total agreement with the clinical severity of prolapse, as defined by the Baden-Walker classification. In 7 cases MRI detected additional alterations (4 cases of hysterocele and 3 of enterocele) that had been missed at clinical evaluation. Discussion and conclusions. In our experience MRI made an important contribution to the diagnosis and grading of functional disorders of the female pelvic floor and pelvic organ prolapse. The ability to simultaneously demonstrate both muscular and ligamentous structures and pelvic viscera, without using X-rays or contrast agents, is the main reason for the good results achieved by MRI and for its widespread use in this disorder. Furthermore the use of fast, breath-hold sequences can provide high-quality images both at rest and during Valsalva's manoeuvre.