Italian adaptation of the European guidelines for breast cancer diagnosis, staging, and preoperative planning: a GRADE-ADOLOPMENT approach

An Italian guideline panel issued the national recommendations for breast cancer diagnosis, staging, and preoperative planning. The panel employed the ADOLOPMENT process to adopt or adapt the guidelines developed by the European Commission Initiative on Breast Cancer (ECIBC). This process utilises the Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework. Hereby, we present 15 prioritised recommendations from the second chapter of the Italian guidelines. All of the recommendations as originally developed by the ECIBC were adopted. For the assessment of women with positive screening result, the diagnostic recommendations suggest using digital breast tomosynthesis instead of additional mammographic projections. Recommendations include using needle core biopsy (NCB) instead of fine-needle aspiration for suspicious lesions, and stereotactic-guided –rather than ultrasound-guided– NCB for suspicious calcifications. For preoperative planning, they recommend clip marking after biopsy and not using additional magnetic resonance imaging (MRI) for confirmed ductal carcinoma in situ. Contrast-enhanced mammography is preferred over MRI for presurgical planning, when needed. Other imaging tests are not recommended for stage I, IIa, and IIb BC without signs of metastasis, while positron emission tomography-computed tomography alone is suggested for stage III BC. Adjuvant hormone therapy is recommended when 1% or more tumour cells show oestrogen or progesterone receptor positivity, which replaces the 10% threshold. Adopting shared and trustworthy guidelines for BC screening across Europe will help standardise the process across settings and advance healthcare quality and equity.