Breast Imaging

Director

Enrico Cassano

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Clinical Trials

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The well-established investigations routinely carried out are:
• breast examination
• mammography
• breast ultrasound
• magnetic resonance
• cytological sampling
• microhistological sampling

A recent addition to the Division is tomosynthesis. This is a three-dimensional high-definition mammography technique that enables the breast to be examined in “layers”: this has the great advantage of facilitating the understanding of radiology reports which may be non-immediate or incompletely visualised with classical 2D mammography.

Our Activities

The significant reduction in breast cancer mortality in the population is attributable to improvements in treatment, but even more so to the increasingly accurate and timely diagnosis of the disease. Every action undertaken, above all, every investment dedicated to this end, is therefore of pivotal importance. To implement early diagnosis, it is important that breast centres avail themselves of appropriate equipment and dedicated staff.
It is on this first step – that of accurate and early diagnosis – that the subsequent treatment pathway is based. In the field of breast diagnosis today, the important objective is not however just the “timeliness” of the diagnosis, but also its “completeness”.

It is necessary to diagnose a neoplasm when it is still small, and yet one must also provide contextual data regarding its biological characteristics. It is these characteristics in particular that will determine the treatment plan. These are the principal objectives of the clinical, scientific and educational activities undertaken by the Breast Imaging Division of the European Institute of Oncology.

AI and RADIOMICS

Recently, the IEO Breast Imaging Unit has reinforced its commitment to innovation in breast cancer diagnosis by incorporating artificial intelligence (AI) into its diagnostic protocols, particularly in mammography. This move solidifies its status as a leader in technological advancement within the field, distinguishing it as one of the few centers developing in-house neural network-based software. The AI tools, crafted by a multidisciplinary team including radiologists, data scientists, and engineers, are developed to automatically detect suspicious findings in mammographic images. This integration supports radiologists' workflow, improving diagnostic accuracy and efficiency, with the aim of shortening waiting lists and enhancing the accessibility of breast cancer screening.

In addition to AI, the unit is also advancing in the field of radiomics, which involves extracting quantifiable data from medical images that can be used to predict disease characteristics and outcomes. This emerging area complements the AI efforts by providing deeper insights into tumor biology and patient prognosis, further enriching the diagnostic process.

Furthermore, the Breast Imaging Unit actively engages with psychologists and sociologists to evaluate the impact and patient perceptions of AI and radiomics in clinical settings, ensuring that technological advancements align with patient needs. This comprehensive approach not only bolsters diagnostic capabilities but also promotes patient-centered care in breast cancer screening.

Our staff
Breast Imaging
Director
Enrico Cassano
- Integrated Breast Diagnostic Unit
  Director Maria Pizzamiglio
Staff Breast Imaging
- - High specialized physician Anna Carla Bozzini
  - High specialized physician Lorenza Meneghetti
  - Physician Francesca Abbate
  - Physician Valeria Dominelli
  - Physician Mariagiorgia Farina
  - Physician Federica Ferrari
- - Physician Antuono Latronico
  - Physician Irene Marinucci
  - Physician Stefano Meroni
  - Physician Luca Nicosia
  - Physician Silvia Penco
  - Physician Filippo Pesapane
- - Physician Francesca Priolo
  - Physician Anna Rotili
  - Physician Giulia Signorelli
  - Physician Chiara Trentin
  - Medical Consultant Miriam Bosco
  - Medical Consultant Franco Cernigliaro
CLINICAL TRIALS IN EVIDENCE

CEM

Our division was among the first in Italy to engage in contrast-enhanced mammography (CEM).

We conducted the first examinations in 2013 as part of a study protocol (protocol number: IEO S626/311); subsequent study protocols were carried out in 2020 and 2023 (protocol number: IEO 960).

Our division has published numerous scientific papers in national and international journals on this relatively recent and innovative technique, contributing to establishing the main indications of CEM in clinical practice and also exploring the role of radiomics in managing patients undergoing CEM (doi: 10.3390/healthcare11040511; doi: 10.3390/ijms232315322; doi: 10.1007/s11547-022-01561; doi: 10.3390/cancers14174337; doi: 10.1186/s13244-024-01612-z; doi: 10.3390/healthcare11111596; doi: 10.1007/s10549-023-07096-7; doi: 10.1007/s10549-023-07093-w; doi: 10.3390/cancers15092413; DOI: 10.1016/j.acra.2023.02.008).

Currently, our division is evaluating the promising role that CEM may play in the management of patients with ductal carcinoma in situ.

CEM (clinical)

In recent years, Contrast-Enhanced Mammography (CEM) has shown its worth as a valuable tool in managing patients with breast lesions, showcasing outstanding diagnostic capabilities. Various international approved indications for implementing CEM in clinical settings exist, with key ones comprising: local and regional assessment of newly diagnosed breast cancer, problem solving, monitoring treatment response to neoadjuvant therapy, screening dense-breasted high-risk patients, and follow-up surveillance in individuals with a previous breast cancer history.
After gaining extensive experience in the scientific field, our division is ready to offer Contrast-Enhanced Mammography (CEM) in clinical practice.

VACUUM ASSISTED BREAST BIOPSY

Our division was at the forefront of conducting vacuum-assisted diagnostic procedures, utilizing ultrasound, stereotactic guidance, and MRI guidance. Consequently, numerous scientific publications have emerged in both national and international journals (doi: 10.1111/tbj.14216. Epub 2021 Mar 6; doi: 10.3390/cancers13040868; doi: 10.1007/s10549-022-06689-y. doi: 10.3390/cancers14020370; doi: 10.3390/diagnostics11061120; doi: 10.1007/s00330-014-3132-y; doi: 10.1007/s10549-006-9305-x. 10.1016/j.breast.2009.01.001; doi: 10.2214/AJR.10.4208.).

Currently, our division is investigating the role of vacuum-assisted biopsy (VAE) as a potential alternative to surgery for specific patients with certain pathologies (B3 and breast carcinoma in situ) in a study protocol (protocol number: UID3840). Additionally, we are among the first centers in Europe to explore the role of vacuum-assisted biopsies guided by contrast-enhanced mammography.

MALE BREAST CARCINOMA

Our division is a national reference point in the diagnostic management of patients with male breast carcinoma, a rare and challenging condition to manage. Recent research activities have demonstrated our division's significant expertise in handling this very rare pathology. Our latest works propose management guidelines for patients with a history of male breast tumor pathology or at higher risk of developing male breast neoplasms (doi: 10.1007/s10549-022-06689-y; doi: 10.3390/diagnostics14010104).
OUTPATIENT CLINIC FOR PREGNANT CLINIC

Outpatient clinic for pregnant women

The clinical and instrumental approach to pregnant or lactating symptomatic patients has been defined and duly applied.

The difficulties in arriving at a timely and accurate breast diagnosis are linked essentially to the known hormonal, and therefore morphological, changes in the breast during pregnancy, the limited experience of specialists and an inexact knowledge in the area of radioprotection when examining pregnant patients.

Where research becomes treatment in real time

Breast Imaging

Enrico Cassano

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Our Activities

Breast Imaging

Enrico Cassano

Integrated Breast Diagnostic Unit

Staff Breast Imaging