Introduction: A potential prognostic biomarker for predicting the response to immunotherapy in breast cancer (BC) is tumor-infiltrating lymphocytes (TILs). The purpose of this research is to examine if preoperative characteristics of breast magnetic resonance imaging (MRI) may be used to predict TIL levels in a group of BC patients. In addition, we aimed to assess any potential relationship between the various tumor biology subgroups and MR imaging characteristics. Materials and Methods: This retrospective analysis comprised 145 participants with histologically confirmed BC who had preoperative DCE MRI. We collected and examined patient information as well as tumor MRI features, such as size and shape, edema, necrosis, multifocality/multicentricity, background parenchymal enhancement (BPE), and apparent diffusion coefficient (ADC) values. We divided patients into two groups based on their TIL levels: low-TIL (<10%) and high-TIL groups (≥10%). Following core needle biopsy, tumors were categorized as Luminal A, Luminal B, HER2+, and Triple Negative using immunohistochemical analysis. TIL levels were correlated with tumor biological profiles and MRI features using both parametric and non-parametric tests. Results: Patients were categorized as having a high TIL level (≥10%; 54/145 patients) and a low TIL level (<10%; 91/145 patients) based on the median TIL level of 10%. Of the lesions, 13 were HER2-positive, 16 were Triple Negative, 49 were Luminal A, and 67 were Luminal B. Higher TIL levels were statistically correlated with TNBC (11/16 individuals, p: 0.007). ADC values (p = 0.01), BPE levels (p = 0.008), and TIL levels were all significantly negatively correlated. Significantly more homogenous enhancement was seen in tumors with elevated TIL levels (p = 0.001). The ADC values and the enhancing characteristics were the most important factors in predicting TIL levels, according to logistic regression analysis, and when combined, they demonstrated the strongest ability to distinguish between the two groups (AUC = 0.744). Conclusions: MRI features, particularly ADC values and enhancement characteristics, may play a pivotal role in the assessment of TIL levels in BC before surgery. This could help patients to better customize treatments to the features of their tumors.

Background/Objectives: This study aims to assess the relation between the ADA score with the severity of pneumonia, as evaluated by chest tomography using a severity score. Methods: In this observational study we enrolled 350 consecutive adult patients (≥18 years) with COVID-19-related severe acute pneumonia requiring hospitalization, consecutively admitted to non-intensive care unit (ICU) medical wards from April 2020 to March 2022. A standard high-resolution chest computed tomography (HRCT) was performed in all cases with a multidetector CT scanner without intravenous contrast injection, except in case of suspicion of pulmonary embolism. The ADA score and semi-quantitative 25-point CT Severity Score (CTSS) were calculated for all patients. Results: A total of 350 COVID-19 patients (154 males (44%) and 196 females (56%)) were recruited. A logistic regression analysis showed that CTSS is statistically associated with the ADA score (Exp(B): 1.116; 95% CI: 1.027–1.212; p = 0.009) and the need for ICU (Exp(B): 8.719; 95% CI: 2.994–25.390; p < 0.001), while the linear regression analysis showed a relation between the CTSS and ADA score, GFR and CRP (p = 0.003) (predictors: ADA score [β coeff 0.276; 95% CI: 0.041–−0.402; p = 0.017], GFR [β coeff −0.219; 95% CI: −0.095–−0.001; p = 0.045], CRP [β coeff −0.226; IC 95% −0.077–−0.001; p = 0.044]). Furthermore, a ROC curve analysis determined the optimal ADA score cut-off values for predicting severe CT findings at 44.5 (sensibility: 0.971; 1-specificity: 0.670; AUC: 0.750; SE 0.039; p < 0.001; 95% CI: 0.674–0.826; Youden’s J index= 0.301). Conclusions: This study highlights the potential clinical utility of integrating laboratory- and imaging-based scores for a comprehensive assessment of patients hospitalized with SARS-CoV-2 infection. The combined use of these scores may enable a more accurate identification of patients with extensive pulmonary involvement and an increased prothrombotic burden at hospital admission, facilitating the early recognition of high-risk patients.

Background: Pain is among the most frequent reasons for seeking medical care and presenting to the Emergency Department (ED). In Italy, Law No. 38/2010 establishes the right to pain therapy and requires pain intensity and its evolution during treatment to be assessed and documented. This process may be challenging in patients with language barriers because conventional verbal or numerical instruments require a degree of linguistic or numerical comprehension. Emoji-based visual tools may provide an additional means of communicating pain intensity in linguistically diverse clinical settings. Methods: We conducted a single-center, prospective, observational pilot study involving adult patients presenting to the ED with acute pain and a clinically relevant language barrier. Pain was assessed before and after analgesic treatment using a six-category Emoji-Based Pain Scale, scored 0, 2, 4, 6, 8, and 10, and the 11-point Numeric Rating Scale (NRS). Feasibility, independent completion, monotonic association, and agreement between the instruments were evaluated. Spearman’s rank correlation, exploratory Bland–Altman analysis, and quadratic-weighted Cohen’s kappa were calculated separately before and after treatment. A post hoc ancillary rank-ordering exercise was subsequently conducted in 50 adult volunteers using the same unlabelled and randomly shuffled emoji cards. Results: Eighty-seven ED patients were enrolled. The Emoji-Based Pain Scale was completed independently by 78 patients (89.7%), compared with 61 patients (70.1%) for the NRS. Mean pre-treatment scores were 4.90 ± 1.77 for the Emoji-Based Pain Scale and 5.15 ± 1.65 for the NRS; post-treatment scores were 2.16 ± 1.62 and 2.46 ± 1.73, respectively. Strong positive associations were observed before treatment (Spearman’s ρ = 0.860, p < 0.001) and after treatment (ρ = 0.805, p < 0.001). Mean paired differences were −0.25 points before treatment and −0.30 points after treatment. Quadratic-weighted kappa was 0.747 before treatment (95% bootstrap confidence interval [CI], 0.661–0.818) and 0.720 after treatment (95% bootstrap CI, 0.609–0.806). Exact categorical agreement was observed in 62.1% and 58.6% of assessments, respectively. In the ancillary exercise, all 50 volunteers reproduced the prespecified emoji sequence, with no inversion of the two upper anchors. Conclusions: The Emoji-Based Pain Scale was feasible and more frequently completed without assistance than the NRS in this selected population of adult ED patients with language barriers. Strong monotonic association, good ordinal agreement, and limited mean differences were observed between the instruments. These findings support further evaluation of the scale but do not establish formal validity, reliability, or interchangeability. Direct psychometric comparison with established visual pain scales remains necessary before routine clinical integration.

Breast-conserving therapy, consisting of lumpectomy followed by adjuvant radiotherapy, is the standard of care for early-stage breast cancer, providing oncologic outcomes equivalent to mastectomy while preserving breast anatomy and quality of life. Radiotherapy remains a cornerstone of treatment across disease stages, significantly reducing local recurrence rates and improving long-term survival. Advances in radiotherapy techniques—including conventional fractionation, hypofractionation, tumor-bed boost delivery, and regional nodal irradiation—have optimized oncologic efficacy while inducing a broad spectrum of time-dependent morphological changes in breast tissue. Accurate imaging surveillance is therefore essential to distinguish expected post-radiotherapy changes from tumor recurrence and to avoid unnecessary diagnostic or therapeutic interventions. This review provides a comprehensive overview of contemporary breast radiotherapy protocols, their impact on post-treatment imaging appearances, and current recommendations for imaging surveillance. Characteristic findings across mammography, ultrasound, magnetic resonance imaging, and nuclear medicine modalities are discussed, with emphasis on their temporal evolution from acute inflammatory changes to chronic fibrosis, fat necrosis, and architectural distortion. Recognition of these imaging patterns, together with integration of radiotherapy-related parameters into image interpretation, is crucial for accurate diagnosis, early detection of recurrence, and informed clinical management of breast cancer survivors.

Background/Objectives: Acute pelvic pain in pediatric female patients is a common presentation in the emergency setting and poses significant diagnostic challenges. Ultrasonography is the first-line imaging modality, but a substantial proportion of examinations remain inconclusive. Magnetic resonance imaging (MRI) is increasingly used as a second-line modality in this context; however, evidence comparing the diagnostic performance of non-contrast-enhanced and contrast-enhanced MRI protocols in pediatric patients remains limited. The aim of this study was to assess the diagnostic accuracy of MRI in pediatric females with acute pelvic pain after inconclusive ultrasonography and to compare non-contrast-enhanced and contrast-enhanced MRI protocols. Methods: This single-center observational study included pediatric female patients presenting with acute pelvic pain who underwent MRI after inconclusive ultrasonography. MRI examinations were performed using a standardized protocol including non-contrast-enhanced sequences and diffusion-weighted imaging. Administration of contrast material was determined by the attending radiologist according to clinical indications. Three radiologists with different levels of experience independently reviewed all examinations in two separate reading sessions (without and with contrast). Diagnostic performance, interobserver and intraobserver agreement, diagnostic confidence, and examination duration were assessed using a composite clinical reference standard. Results: Eighty-eight patients (mean age, 13.5 years; range, 7–17 years) were included. MRI identified a specific cause of acute pelvic pain in 60 patients (68.2%), with gynecological conditions accounting for 75.0% of positive findings. Hemorrhagic ovarian cysts and adnexal torsion were the most frequent diagnoses. Both non-contrast-enhanced and contrast-enhanced MRI demonstrated high diagnostic accuracy across all readers, with no statistically significant differences in sensitivity or specificity between protocols (p > 0.05). Contrast-enhanced MRI was associated with higher diagnostic confidence for all readers (p < 0.001) but longer examination times. Conclusions: MRI is a reliable second-line imaging modality for evaluating acute pelvic pain in pediatric female patients after inconclusive ultrasonography. Non-contrast-enhanced MRI combined with diffusion-weighted imaging provides robust diagnostic performance in most cases, while contrast-enhanced MRI may be reserved for selected equivocal cases.