Background: The assessment of breast density is one of the main goals of radiologists because the masking effect of dense fibroglandular tissue may affect the mammographic identification of lesions. The BI-RADS 5th Edition has revised the mammographic breast density categories, focusing on a qualitative evaluation rather than a quantitative one. Our purpose is to compare the concordance of the automatic classification of breast density with the visual assessment according to the latest available classification. Methods: A sample of 1075 digital breast tomosynthesis images from women aged between 40 and 86 years (58 ± 7.1) was retrospectively analyzed by three independent readers according to the BI-RADS 5th Edition. Automated breast density assessment was performed on digital breast tomosynthesis images with the Quantra software version 2.2.3. Interobserver agreement was assessed with kappa statistics. The distributions of breast density categories were compared and correlated with age. Results: The agreement on breast density categories was substantial to almost perfect between radiologists (κ = 0.63–0.83), moderate to substantial between radiologists and the Quantra software (κ = 0.44–0.78), and the consensus of radiologists and the Quantra software (κ = 0.60–0.77). Comparing the assessment for dense and non-dense breasts, the agreement was almost perfect in the screening age range without a statistically significant difference between concordant and discordant cases when compared by age. Conclusions: The categorization proposed by the Quantra software has shown a good agreement with the radiological evaluations, even though it did not completely reflect the visual assessment. Thus, clinical decisions regarding supplemental screening should be based on the radiologist’s perceived masking effect rather than the data produced exclusively by the Quantra software.

This study examines the impact of audit committee characteristics, specifically independence and expertise, on sustainability performance. It also explores the mediating role of sustainability reporting quality in the relationship between audit committee characteristics and sustainability performance. The study analyzes a sample of 8336 firm‐year observations across 18 European countries and 10 economic sectors from 2012 to 2022. The results reveal that audit committee independence and expertise are positively associated with sustainability performance. Furthermore, the quality of sustainability reporting mediates this relationship, explaining how audit committee characteristics enhance sustainability performance. Empirical evidence regarding the relationship between audit committees and sustainability performance within European countries is limited. Prior research mainly focuses on the direct effects of audit committees on sustainability performance. To the best of the authors' knowledge, this is the first study that provides useful evidence regarding the mediating impact of sustainability reporting quality on the relationship between audit committee characteristics and sustainability performance, offering novel insights into this underexplored area. The findings offer important implications for managers focused on identifying the drivers and enablers for improving sustainability performance. They also contribute to the ongoing regulatory debate by highlighting that a deeper understanding of audit committees' composition and expertise would make European companies more sustainable and more focused on enhancing the quality of sustainability reporting.

Aim: To evaluate the local impact of the coronavirus disease 2019 (COVID-19) pandemic on breast cancer (BC) care, with particular attention to the economical and psychological consequences of the possible delay of new diagnoses and treatments. Methods: Three years’ activity (from 2019 to 2021) has been compared. The number of BCs diagnosed from the total amount of mammographic and ultrasound (US) examinations performed in women aged more than 40 years old has been considered. A Pearson’s chi-squared test was performed to verify differences between results. Statistical significance was set at P ≤ 0.01. Results: A statistically significant difference was found in the number of BC diagnosed between screening and ambulatory care patients in both the 2019–2020 (χ2 = 24.93, P < 0.01) and 2019–2021 (χ2 = 29.93, P < 0.01) comparisons. No statistically significant difference was found in the data recorded between 2020 and 2021 (χ2 = 2.35, P > 0.01). By evaluating the specific age groups for each year, a statistically significant difference (P < 0.01) was found in the number of BC diagnosed in screening patients aged 50–69 years old in both 2019–2020 and 2019–2021 comparisons. The percentages of early BC diagnosed in 2019, 2020, and 2021 were 80.9%, 91.7%, and 89.8%, respectively. The adherence rates to screening in 2019, 2020, and 2021 were 67.5%, 45.2%, and 56.9%, respectively. Conclusions: Results showed a reduction of new diagnoses in the screening range during the pandemic in comparison with the previous period. The high percentage of early BC would seem to have prevented worsening outcomes. Nevertheless, women who have not undergone screening could present a more advanced stage disease in the following years. Consequently, the evaluation of possible solutions to guarantee an essential level of care with the purpose to avoid worsening patients’ outcomes and the increase in healthcare costs is mandatory.

We investigate the effects of hedge accounting usage on firms’ level of capital investment. Analyzing a set of 286 public firms in the European Union during the period 2016–2019, our findings are threefold. Firstly, we provide evidence that firms which apply hedge accounting under IFRS requirements increase their level of capital investment more than firms that do not exploit these accounting principles. Second, we also suggest that this link is mediated by the earnings volatility mitigation. Lastly, we find that such a relationship is exacerbated after the IFRS 9 implementation period, consistently with the view that the newest hedge accounting rules provided by the IASB are recognized to be more effective and more beneficial for firms, comparatively to IAS 39. These results are robust to different measures of capital investment, alternative models’ specifications, and after correcting for potential endogeneity concerns. We contribute with the first empirical study that explores the role of hedge accounting on investment behavior under different IFRS requirements. This research is valuable for standard setters and regulators to understand how their accounting requirements may affect firms’ economic decisions. From a managerial point of view, our study offers particular insights into hedge accounting mechanisms and practical implications about the role of accounting choices in real investments’ decision-making.

Vacuum-assisted breast biopsy (VABB) guided by digital breast tomosynthesis (DBT) represents one of the best instruments to obtain a histological diagnosis of suspicious lesions with no ultrasound correlation or those which are visible only on DBT. After a review of the literature, we retrospectively analyzed the DBT-guided VABBs performed from 2019 to 2022 at our department. Descriptive statistics, Pearson’s correlation and χ² test were used to compare distributions of age, breast density (BD) and early performance measures including histopathology. We used kappa statistics to evaluate the agreement between histological assessment and diagnosis. Finally, we compared our experience to the literature to provide indications for clinical practice. We included 85 women aged 41–84 years old. We identified 37 breast cancers (BC), 26 stage 0 and 11 stage IA. 67.5% of BC was diagnosed in women with high BD. The agreement between VABB and surgery was 0.92 (k value, 95% CI: 0.76–1.08). We found a statistically significant inverse correlation between age and BD. The post-procedural clip was correctly positioned in 88.2%. The post-procedural hematoma rate was 14.1%. No infection or hemorrhage were recorded. When executed correctly, DBT-guided VABB represents a safe and minimally invasive technique with high histopathological concordance, for detecting nonpalpable lesions without ultrasound correlation.