Sara Ricciardi

Azienda Ospedaliera San Camillo-Forlanini

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Franca Melfi

University of Pisa

Carmelina Cristina Zirafa

University of Pisa

Federico Davini

University of Pisa

Giuseppe Cardillo

Azienda Ospedaliera San Camillo-Forlanini

Giuseppe Cardillo

Azienda Ospedaliera San Camillo-Forlanini

Gaetano Romano

University of Pisa

Marco Lucchi

University of Pisa

Gabriella Fontanini

University of Pisa

Greta Alì

University of Pisa

Francesco Carleo

Carlo Forlanini Hospital

Cooperative Institutions

University of Birmingham

750

NIHR Birmingham Biomedical Research Centre

386

Institut de Virologie

350

Yorkshire Cancer Research

299

Urology Foundation

276

Association for Cancer Surgery

251

Istituti di Ricovero e Cura a Carattere Scientifico

248

Laboratoire des Sciences de l'Ingénieur, de l'Informatique et de l'Imagerie

222

National Institute for Health Research

202

AstraZeneca (Brazil)

172

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Application of Artificial Neural Network to Preoperative 18F-FDG PET/CT for Predicting Pathological Nodal Involvement in Non-small-cell Lung Cancer Patients

Frontiers in Medicine (2021)

Silvia Taralli Valentina Scolozzi Luca Boldrini Jacopo Lenkowicz Armando Pelliccioni

Purpose: To evaluate the performance of artificial neural networks (aNN) applied to preoperative 18 F-FDG PET/CT for predicting nodal involvement in non-small-cell lung cancer (NSCLC) patients. Methods: We retrospectively analyzed data from 540 clinically resectable NSCLC patients (333 M; 67.4 ± 9 years) undergone preoperative 18 F-FDG PET/CT and pulmonary resection with hilo-mediastinal lymphadenectomy. A 3-layers NN model was applied (dataset randomly splitted into 2/3 training and 1/3 testing). Using histopathological reference standard, NN performance for nodal involvement (N0/N+ patient) was calculated by ROC analysis in terms of: area under the curve (AUC), accuracy (ACC), sensitivity (SE), specificity (SP), positive and negative predictive values (PPV, NPV). Diagnostic performance of PET visual analysis (N+ patient: at least one node with uptake ≥ mediastinal blood-pool) and of logistic regression (LR) was evaluated. Results: Histology proved 108/540 (20%) nodal-metastatic patients. Among all collected data, relevant features selected as input parameters were: patients' age, tumor parameters (size, PET visual and semiquantitative features, histotype, grading), PET visual nodal result (patient-based, as N0/N+ and N0/N1/N2). Training and testing NN performance (AUC = 0.849, 0.769): ACC = 80 and 77%; SE = 72 and 58%; SP = 81 and 81%; PPV = 50 and 44%; NPV = 92 and 89%, respectively. Visual PET performance: ACC = 82%, SE = 32%, SP = 94%; PPV = 57%, NPV = 85%. Training and testing LR performance (AUC = 0.795, 0.763): ACC = 75 and 77%; SE = 68 and 55%; SP = 77 and 82%; PPV = 43 and 43%; NPV = 90 and 88%, respectively. Conclusions: aNN application to preoperative 18 F-FDG PET/CT provides overall good performance for predicting nodal involvement in NSCLC patients candidate to surgery, especially for ruling out nodal metastases, being NPV the best diagnostic result; a high NPV was also reached by PET qualitative assessment. Moreover, in such population with low a priori nodal involvement probability, aNN better identify the relatively few and unexpected nodal-metastatic patients than PET analysis, so supporting the additional aNN use in case of PET-negative images.

Lymphadenectomy

Grading (engineering)

10.3389/fmed.2021.664529

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Citations (7)

Managing of screening-detected sub-solid nodules—a European perspective

Translational Lung Cancer Research (2021)

Sara Ricciardi Richard Booton René Horsleben Petersen Maurizio Infante Marco Scarci

Abstract: Since the National Lung Screening Trial in 2011 showed a 20% reduction in lung cancer mortality using annual low-dose computed tomography (LDCT), several randomised controlled trials and studies have been started in Europe. These include the Italian lung study (ITALUNG), the Dutch-Belgian lung cancer screening trial (NELSON), the UK lung cancer screening trial (UKLS), the Detection and screening of early lung cancer with novel imaging technology (DANTE), the Danish lung cancer screening trial (DLCST), the German lung cancer screening intervention trial (LUSI), the Multicentric Italian lung detection trial (MILD) and the CT screening for lung cancer study (COSMOS). As a result of the increasing number of screening trials and the growing utilization of LDCT, the high detection of subsolid nodules is an increasingly important clinical problem. In the last few years, several guidelines have been published and providing guidance on the optimal management of subsolid nodules, but many controversies still exist. Follow-up imaging plays an important role in clinical assessment and subsequent management of this particular type of lung nodules, since they can be transient inflammatory lesions, and if persistent they can be both benign lesions or lung cancers of variable clinical behaviour. However, the vast majority of subsolid nodules retain an indolent course over many years. The aim of this review is to present a European perspective in management of screening detected subsolid nodules.

Nodule (geology)

10.21037/tlcr.2020.03.37

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Citations (18)

[Influenza risk perception and vaccination attitude in medical and nursing students during the vaccination campaigns of 2007/2008 (seasonal influenza) and 2009/2010 (H1N1 influenza)].

PubMed (2011)

R. Falato Sara Ricciardi Giovanni Franco

The Italian law on health and safety at work requires that (i) employers provide workers with safe and efficient vaccines, (ii) occupational physicians inform workers about the benefits and inconveniences deriving from immunization.To assess risk perception of influenza and attitudes to vaccination among medical and nursing students of the School of Medicine of Modena during two vaccination campaigns.The study, including 598 medical and nursing students (212 vaccinated and 386 non-vaccinated) exposed to influenza virus, was performed in October 2007-April 2008 (during the seasonal influenza campaign), in October-November 2009 and in March-May 2010 (during and after the H1N1 influenza campaign, respectively). Information on influenza risk perception and attitude towards vaccination, as well as perception of different risk factors (smoking, traffic pollution, driving, mobile phones, nuclear power, alcoholic beverages) was collected by a self-administered 4-point Likert scales (1 = low risk, 4 high risk) questionnaire.The students perceived the risk of both influenza and of influenza immunization at a lower level compared with other risks. Whereas overall risk perception (excluding influenza and vaccination) was similar within the groups, influenza risk perception was significantly lower in the 2007/2008 group whereas the risk of immunization increased in the 2010 group. Age, gender and being a medical or nursing student did not influence risk perception and vaccination attitude.Although influenza vaccination is recommended, its coverage in medical and nursing students is generally low due to different factors, including underestimation of a preventable disease, lack of knowledge about the benefits of immunization and, according to this study, to the perception of risk associated both with the disease and immunization practice.

Risk Perception

Seasonal influenza

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Robotic-assisted thoracic surgery versus uniportal video-assisted thoracic surgery: is it a draw?

Journal of Thoracic Disease (2018)

Sara Ricciardi Carmelina Cristina Zirafa Federico Davini Franca Melfi

In the last two decades the role of minimally invasive surgery (MIS) for non-small cell lung cancer (NSCLC) treatment has grown considerably and numerous studies comparing the surgical results of MIS with open surgery, have confirmed that the MIS constitutes an excellent approach for the treatment of lung cancer, especially in early stages.

Cardiothoracic surgery

10.21037/jtd.2018.03.94

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Citations (2)

EGFR mutations in patients with non-small cell lung cancer (NSCLC) and correlation with sensitivity to erlotinib

European Journal of Cancer Supplements (2008)

Sara Ricciardi Beatrice Tedesco M.R. Migliorino Paolo Graziano Alvaro Leone

10.1016/j.ejcsup.2008.06.065

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Citations (1)

P36.02 A Case of Recurrent Giant Malignant Solitary Fibrous Tumour of the Pleura: An Elephant in the Room?

Journal of Thoracic Oncology (2021)

Sara Ricciardi Niccolò Daddi Giovanni Tallini Giampiero Dolci Filippo Antonacci

10.1016/j.jtho.2021.08.426

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Citations (0)

Absorbable Powder Haemostat Use in Minimally Invasive Thoracic Surgery

Sara Ricciardi Akshay J. Patel Danilo Alunni Fegatelli Sara Volpi Federico Femia

Background: Significant intraoperative and postoperative blood loss are rare but possibly life-threatening complications after lung resection surgery either during open or minimally invasive procedure. Microporous Polysaccharide Hemospheres (ARISTA™AH) have demonstrated time-efficient haemostasis, lower post-operative blood volumes and a lower blood transfusion requirement, without any identified adverse events across other specialities.The primary aim of our study was to evaluate the impact of haemostatic agents on short-term postoperative outcomes in thoracic surgery. Methods: We retrospectively reviewed a prospectively collected database of consecutive early-stage lung cancer patients surgically treated in two European centres(October 2020-December 2022).Exclusion criteria:open surgery,patients with coagulopathy/anticoagulant medication,major intraoperative bleeding,non-anatomical lung resection and age <18 years.The cohort was divided into 5 groups according to the haemostatic agent used.Propensity score matching was used to estimate the effect of ARISTA™AH on various intra- and post-operative parameters(continuous and binary outcome modelling). Results:482 patients(M/F:223/259; VATS 97/RATS 385)with a mean age of 68.9(±10.6)years were analysed.In 253 cases ARISTA™AH was intraoperatively used to control bleeding.This cohort of patients had a significant reduction in total drain volume by 135 mls(standard error 53.9; p=0.012).The use of ARISTA™AH did reduce the average length of hospital stay(-1.47 days)and duration of chest drainage(-0.596 days)albeit not significant.In the ARISTA™AH group,we observed no postoperative bleeding,no blood transfusion required,no 30-day mortality and no requirement for redo-surgery.The use of ARISTA™AH significantly reduced the odds of post-operative complications,need for transfusion and redo surgery. Conclusion: Our data showed that Microporous Polysaccharide Hemospheres are a safe and effective haemostatic device.Its use has a positive effect in short term postoperative outcomes of patients surgically treated for early-stage lung cancer.

10.20944/preprints202411.0534.v1

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Citations (0)

Which Surgery for Stage II–III Empyema Patients? Observational Single-Center Cohort Study of 719 Consecutive Patients

Journal of Clinical Medicine (2022)

Sara Ricciardi Delia Giovanniello Francesco Carleo Marco Martino Massimo Osvaldo Jaus

Objective: Recent guidelines support the use of thoracoscopic surgery in stage II-III empyema; however, there is still debate regarding the best surgical approach. The aim of our study is to compare postoperative outcomes of VATS and open surgical approaches for the treatment of post-pneumonic empyema. Methods: Observational cohort study on prospectively collected cases of post-pneumonic empyema surgically treated in a single center (2000–2020). Patients were divided into an open group (OT, posterolateral muscle sparing thoracotomy) and VATS group (VT, 2 or 3 port ± utility incision). The primary outcome of the study was empyema resolution, assessed by the recurrence rate. Secondary outcomes were mortality, complications, pain and return to daily life. All patients were followed up at 1, 3 and 6 months after surgery in the outpatient clinic with a chest radiograph/CT scan. Results: In total, 719 consecutive patients were surgically treated for stage II–III empyema, with 644 belonging to the VT group and 75 to the OT group. All patients had a clinical history of pneumonia lasting no more than 6 months before surgery, and 553 (76.9%) had stage II empyema. Operative time was 92.7 ± 6.8 min for the OT group and 112.2 ± 7.4 for the VT group. The conversion rate was 8.4% (46/545) for stage II and 19.2% (19/99) for stage III. Twelve patients (1.86%) in the VT group and four patients (5.3%) in the OT group underwent additional surgery for bleeding. Postoperative mortality was 1.25% (9/719): 5.3% (4/75) in OT and 0.77% (5/644) in VT. Postoperative stay was 10 ± 6.5 days in OT and 8 ± 2.4 in VT. Overall morbidity was 14.7% (106/719): 21.3% (16/75) in OT and 13.9% (90/644) in VT. In VT, six patients (0.93%) showed recurrent empyema: five were treated with chest drainage and one with additional open surgery. Conclusions: Our findings suggest that the VATS approach, showing a 99% success rate, shorter length of stay and lower postoperative morbidity, should be considered the treatment of choice for thoracic empyema.

Chest radiograph

Thoracotomy

Cardiothoracic surgery

10.3390/jcm12010136

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Citations (6)

Is Adjuvant Chemotherapy Worthwhile After Radical Resection for Single Lung Metastasis From Colorectal Cancer? A Multicentric Analysis Evaluating the Risk of Recurrence

Frontiers in Oncology (2019)

Cristian Rapicetta Filippo Lococo Federico Davini Francesco Carleo Juha Kauppi

Background. Adjuvant chemotherapy after resection of colorectal cancer (CRC) lung metastases may reduce recurrences and improve survival. The choice of best candidates for adjuvant chemotherapy in this setting is controversial, especially when a single lung metastases is resected. The aim of this study is to evaluate the risk of recurrence after radical resection for single lung metastasis from colorectal cancer (CRC). Patients and methods. Demographic, clinical and pathological data were retrospectively collected for patients radically operated for single pulmonary metastasis from CRC in 4 centers. Survival was computed by Kaplan-Meyer methods. Chi-square, log-rank test and, for multivariate analysis, Cox-regression and binary logistic regression were used when indicated. Results. The sample consisted of 344 patients, mean age 65-yrs. Overall 5-yrs survival was 61.9% respectively. Recurrence occurred in 113 pts (32,8%). At univariate analysis, age>70 (p=0.046) and tumour size>2 cm (p=0.038) were predictive of worst survival, while synchronous lung metastasis (p=0.039), previous resection of extrathoracic metastasis (p=0.017), uptake at FDG-PET scan (p=0.006) and short (4 ng/mL) was associated to worst survival (HR: 4.3, p=0.014), while prior abdominal surgery (HR: 3, p=0.033), PET positivity (HR: 2.7, p=0.041) and DFI > 12 months (HR: 0.14, p<0.001) confirmed to predict recurrence of disease. Conclusions. Surgical resection of solitary lung metastases from CRC is associated with prolonged survival. High value of CEA, PET positivity, previous extrathoracic resected metastasis and short (<12 months) DFI were found to be predictive of death or disease recurrence and might identify in this scenario patients at higher risk which could potential benefit of chemotherapy.

Univariate analysis

10.3389/fonc.2019.00763

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Citations (14)

Robotic approach for early stage thymic tumors—surgical and oncologic outcomes

Shanghai Chest (2019)

Gaetano Romano Carmelina Cristina Zirafa Ilenia Cavaliere Sara Ricciardi Federico Davini

Abstract: Thymoma is a rare tumor with epithelial origin, which represents about 50% of the malignant lesions of the anterior mediastinum. This neoplasm is often associated with myasthenia gravis (MG), in fact, about 30% of the patients with thymoma develops symptoms of myasthenia. The gold standard in the treatment of thymoma is surgical resection and according to ITMIG guidelines is recommended extended thymectomy, particularly in myasthenic patients. For a long time, sternotomy has represented the approach of choice for the exeresis of anterior mediastinal lesions. Nevertheless, nowadays, the advancement of new technologies has allowed the use of minimally invasive methods such as robotic surgery.

10.21037/shc.2019.01.06

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