{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:16:34Z","timestamp":1791314194217,"version":"4.3.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T00:00:00Z","timestamp":1698105600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T00:00:00Z","timestamp":1698105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005743","name":"Universit\u00e0 Cattolica del Sacro Cuore","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005743","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiol med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Rationale and objectives<\/jats:title>\n                <jats:p>Our multicentric study analysed clinical, radiologic and pathologic features in patients with atypical ductal hyperplasia (ADH) diagnosed with vacuum-assisted biopsy (VAB), to identify factors associated with the risk of upgrade, to develop a scoring system to support decision making.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Patients with ADH on VAB under stereotactic\/tomosynthesis guidance (2012\u20132022) were eligible. Inclusion criteria were availability of surgical histopathological examination of the entire lesion or radiologic follow-up (FUP)\u2009\u2265\u200924\u00a0months. VAB results were compared with surgical pathological results or with imaging FUP evolution to assess upgrade. A backward stepwise linear regression was used to identify predictors of upgrade. The discriminatory power of the model was calculated through the area under the receiver operating curve (ROC\u2013AUC); the Hosmer\u2013Lemeshow test was used to assess model calibration. The points system was developed based on the selected risk factors, and the probability of upgrade associated with each point total was determined.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>112 ADH lesions were included: 91 (91\/112, 81.3%) underwent surgical excision with 20 diagnosis of malignancy, while 21 (21\/112, 18.7%) underwent imaging FUP with one interval change (mean FUP time 48\u00a0months). Overall upgrade rate was 18.7% (21\/112). Age, menopausal status, concurrent breast cancer, BIRADS classification and number of foci of ADH were identified as risk factors for upgrade. Our model showed an AUC\u2009=\u20090.85 (95% CI 0.76\u20130.94). The points system showed that the risk of upgrade is &lt;\u20092% when the total score is \u2264\u20091.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our scoring system seemed a promising easy-to-use decision support tool for management of ADH, decreasing unnecessary surgeries, reducing patients\u2019 overtreatment and healthcare costs.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11547-023-01740-4","type":"journal-article","created":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T14:02:22Z","timestamp":1698156142000},"page":"38-47","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Atypical ductal hyperplasia on vacuum-assisted breast biopsy: a scoring system to predict the risk of upgrade to malignancy"],"prefix":"10.1007","volume":"129","author":[{"given":"Rossella","family":"Rella","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8260-4753","authenticated-orcid":false,"given":"Marco","family":"Conti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Borghetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Belli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Morciano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Rossati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Caneva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Di Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Franceschini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Gori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Fornasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Tommasini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Romanucci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,10,24]]},"reference":[{"key":"1740_CR1","unstructured":"Tavassoli FA (1999) Pathology of the Breast. Stamford, CT: Appleton & Lange"},{"issue":"5","key":"1740_CR2","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1016\/j.rcl.2010.06.004","volume":"48","author":"D Georgian-Smith","year":"2010","unstructured":"Georgian-Smith D, Lawton TJ (2010) Controversies on the management of high risk lesions at core biopsy from a radiology\/pathology perspective. Radiol Clin North Am 48(5):999\u20131012","journal-title":"Radiol Clin North Am"},{"issue":"5","key":"1740_CR3","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1016\/j.amjsurg.2018.12.020","volume":"217","author":"T Sutton","year":"2019","unstructured":"Sutton T, Farinola M, Johnson N, Garreau JR (2019) Atypical ductal hyperplasia: clinicopathologic factors are not predictive of upgrade after excisional biopsy. Am J Surg 217(5):848\u2013850","journal-title":"Am J Surg"},{"issue":"10","key":"1740_CR4","doi-asserted-by":"publisher","first-page":"3264","DOI":"10.1245\/s10434-012-2575-0","volume":"19","author":"LJ McGhan","year":"2012","unstructured":"McGhan LJ, Pockaj BA, Wasif N, Giurescu ME, McCullough AE, Gray RJ (2012) Atypical ductal hyperplasia on core biopsy: an automatic trigger for excisional biopsy? Ann Surg Oncol 19(10):3264\u20133269","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"1740_CR5","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1007\/s10549-018-05071-1","volume":"174","author":"CJ Rageth","year":"2019","unstructured":"Rageth CJ, O\u2019Flynn EAM, Pinker K et al (2019) Second international consensus conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat 174(2):279\u2013296","journal-title":"Breast Cancer Res Treat"},{"key":"1740_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2020.109194","volume":"130","author":"G Mariscotti","year":"2020","unstructured":"Mariscotti G, Durando M, Ruggirello I et al (2020) Lesions of uncertain malignant potential of the breast (B3) on vacuum-assisted biopsy for microcalcifications: Predictors of malignancy. Eur J Radiol 130:109194","journal-title":"Eur J Radiol"},{"issue":"1","key":"1740_CR7","doi-asserted-by":"publisher","first-page":"229","DOI":"10.2214\/AJR.08.1342","volume":"192","author":"PR Eby","year":"2009","unstructured":"Eby PR, Ochsner JE, DeMartini WB, Allison KH, Peacock S, Lehman CD (2009) Frequency and upgrade rates of atypical ductal hyperplasia diagnosed at stereotactic vacuum-assisted breast biopsy: 9-versus 11-gauge. AJR Am J Roentgenol 192(1):229\u2013234","journal-title":"AJR Am J Roentgenol"},{"issue":"4","key":"1740_CR8","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1016\/j.ejso.2018.12.008","volume":"45","author":"ND Forester","year":"2019","unstructured":"Forester ND, Lowes S, Mitchell E, Twiddy M (2019) High risk (B3) breast lesions: what is the incidence of malignancy for individual lesion subtypes? A systematic review and meta-analysis. Eur J Surg Oncol 45(4):519\u2013527","journal-title":"Eur J Surg Oncol"},{"issue":"2","key":"1740_CR9","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1007\/s00330-020-07161-5","volume":"31","author":"M Lucioni","year":"2021","unstructured":"Lucioni M, Rossi C, Lomoro P et al (2021) Positive predictive value for malignancy of uncertainmalignant potential (B3) breast lesions diagnosed on vacuum-assisted biopsy (VAB): is surgical excision still recommended? Eur Radiol 31(2):920\u2013927","journal-title":"Eur Radiol"},{"issue":"3","key":"1740_CR10","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1245\/s10434-010-1127-8","volume":"18","author":"CV Nguyen","year":"2011","unstructured":"Nguyen CV, Albarracin CT, Whitman GJ, Lopez A, Sneige N (2011) Atypical ductal hyperplasia in directional vacuum-assisted biopsy of breast microcalcifications: considerations for surgical excision. Ann Surg Oncol 18(3):752\u2013761","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"1740_CR11","doi-asserted-by":"publisher","first-page":"1120","DOI":"10.3390\/diagnostics11061120","volume":"11","author":"L Nicosia","year":"2021","unstructured":"Nicosia L, Latronico A, Addante F et al (2021) Atypical ductal hyperplasia after vacuum-assisted breast biopsy: can we reduce the upgrade to breast cancer to an acceptable rate? Diagnostics (Basel) 11(6):1120","journal-title":"Diagnostics (Basel)"},{"issue":"1","key":"1740_CR12","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1007\/s12282-020-01186-w","volume":"28","author":"CJ Rageth","year":"2021","unstructured":"Rageth CJ, Rubenov R, Bronz C et al (2021) Correction to: Atypical ductal hyperplasia and the risk of underestimation: tissue sampling method, multifocality, and associated calcification significantly influence the diagnostic upgrade rate based on subsequent surgical specimens. Breast Cancer 28(1):246 (Erratum for: Breast Cancer. 2019 Jul; 26(4):452\u2013458)","journal-title":"Breast Cancer"},{"issue":"7","key":"1740_CR13","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1016\/j.acra.2018.09.010","volume":"26","author":"KE Williams","year":"2019","unstructured":"Williams KE, Amin A, Hill J et al (2019) Radiologic and pathologic features associated with upgrade of atypical ductal hyperplasia at surgical excision. Acad Radiol 26(7):893\u2013899","journal-title":"Acad Radiol"},{"issue":"7","key":"1740_CR14","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1177\/10668969211010954","volume":"29","author":"C Zhang","year":"2021","unstructured":"Zhang C, Wang EY, Liu F, Ruhul Quddus M, James SC (2021) Type of architecture, presence of punctate necrosis, and extent of involvement in atypical ductal hyperplasia can predict the diagnosis of breast carcinoma on excision: a clinicopathologic study of 143 cases. Int J Surg Pathol 29(7):716\u2013721","journal-title":"Int J Surg Pathol"},{"issue":"1","key":"1740_CR15","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1148\/radiol.2019190748","volume":"294","author":"S Schiaffino","year":"2020","unstructured":"Schiaffino S, Calabrese M, Melani EF et al (2020) Upgrade rate of percutaneously diagnosed pure atypical ductal hyperplasia: systematic review and meta-analysis of 6458 lesions. Radiology 294(1):76\u201386","journal-title":"Radiology"},{"key":"1740_CR16","unstructured":"American College of Radiology (2013) ACR BI-RADS atlas: breast imaging reporting and data system (5th ed.), Reston, Virginia"},{"issue":"10","key":"1740_CR17","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1002\/sim.1742","volume":"23","author":"LM Sullivan","year":"2004","unstructured":"Sullivan LM, Massaro JM, D\u2019Agostino RB Sr (2004) Presentation of multivariate data for clinical use: the framingham study risk score functions. Stat Med 23(10):1631\u20131660","journal-title":"Stat Med"},{"issue":"7","key":"1740_CR18","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1001\/jamaoncol.2015.2510","volume":"1","author":"SA Narod","year":"2015","unstructured":"Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P (2015) Breast cancer mortality after a diagnosis of ductal carcinoma in situ. JAMA Oncol 1(7):888\u2013896","journal-title":"JAMA Oncol"},{"issue":"4","key":"1740_CR19","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1038\/s41416-019-0478-6","volume":"121","author":"M van Seijen","year":"2019","unstructured":"van Seijen M, Lips EH, Thompson AM et al (2019) Ductal carcinoma in situ: to treat or not to treat, that is the question. Br J Cancer 121(4):285\u2013292","journal-title":"Br J Cancer"},{"key":"1740_CR20","doi-asserted-by":"publisher","first-page":"4994","DOI":"10.3390\/app13084994","volume":"13","author":"CL Piccolo","year":"2023","unstructured":"Piccolo CL, Mallio CA, Messina L et al (2023) Radiological features of b3 lesions in mutation carrier patients: a single-center retrospective analysis. Appl Sci 13:4994","journal-title":"Appl Sci"},{"issue":"5","key":"1740_CR21","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1007\/s11547-023-01626-5","volume":"128","author":"G Bicchierai","year":"2023","unstructured":"Bicchierai G, Pugliese F, Amato F, De Benedetto D, Boeri C, Vanzi E, Di Naro F, Bianchi S, Cossu E, Miele V, Nori J (2023) Percutaneous vacuum-assisted excision (VAE) of breast lesions of uncertain malignant potential (B3 lesions): a preliminary single-centre Italian experience. Radiol Med 128(5):528\u2013536","journal-title":"Radiol Med"},{"issue":"19","key":"1740_CR22","doi-asserted-by":"publisher","first-page":"2671","DOI":"10.1200\/JCO.2006.09.0217","volume":"25","author":"AC Degnim","year":"2007","unstructured":"Degnim AC, Visscher DW, Berman HK et al (2007) Stratification of breast cancer risk in women with atypia: a Mayo cohort study. J Clin Oncol. 25(19):2671\u20137","journal-title":"J Clin Oncol."},{"issue":"7","key":"1740_CR23","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1001\/jama.1992.03480070057030","volume":"267","author":"SJ London","year":"1992","unstructured":"London SJ, Connolly JL, Schnitt SJ, Colditz GA (1992) A prospective study of benign breast disease and the risk of breast cancer. JAMA 267(7):941\u2013439","journal-title":"JAMA"},{"issue":"8","key":"1740_CR24","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/0046-8177(89)90063-4","volume":"20","author":"WD Dupont","year":"1989","unstructured":"Dupont WD, Page DL (1989) Relative risk of breast cancer varies with time since diagnosis of atypical hyperplasia. Hum Pathol 20(8):723\u2013725","journal-title":"Hum Pathol"},{"issue":"2","key":"1740_CR25","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s10549-017-4253-1","volume":"164","author":"A Pe\u00f1a","year":"2017","unstructured":"Pe\u00f1a A, Shah SS, Fazzio RT et al (2017) Multivariate model to identify women at low risk of cancer upgrade after a core needle biopsy diagnosis of atypical ductal hyperplasia. Breast Cancer Res Treat 164(2):295\u2013304","journal-title":"Breast Cancer Res Treat"},{"issue":"1","key":"1740_CR26","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1309\/AJCPGHEJ2R8UYFGP","volume":"131","author":"MJ Wagoner","year":"2009","unstructured":"Wagoner MJ, Laronga C, Acs G (2009) Extent and histologic pattern of atypical ductal hyperplasia present on core needle biopsy specimens of the breast can predict ductal carcinoma in situ in subsequent excision. Am J Clin Pathol 131(1):112\u2013121","journal-title":"Am J Clin Pathol"},{"issue":"1","key":"1740_CR27","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.humpath.2010.06.011","volume":"42","author":"KH Allison","year":"2011","unstructured":"Allison KH, Eby PR, Kohr J, DeMartini WB, Lehman CD (2011) Atypical ductal hyperplasia on vacuum-assisted breast biopsy: suspicion for ductal carcinoma in situ can stratify patients at high risk for upgrade. Hum Pathol 42(1):41\u201350","journal-title":"Hum Pathol"},{"issue":"2","key":"1740_CR28","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1309\/0GYV4F2LLJAV4GFN","volume":"119","author":"N Sneige","year":"2003","unstructured":"Sneige N, Lim SC, Whitman GJ et al (2003) Atypical ductal hyperplasia diagnosis by directional vacuum-assisted stereotactic biopsy of breast microcalcifications Considerations. for surgical excision. Am J Clin Pathol 119(2):248\u2013253","journal-title":"Am J Clin Pathol"},{"key":"1740_CR29","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1097\/00000478-200108000-00005","volume":"25","author":"KA Ely","year":"2001","unstructured":"Ely KA, Carter BA, Jensen RA, Simpson JF, Page DL (2001) Corebiopsy of the breast with atypical ductal hyperplasia: a probabi-listic approach to reporting. Am J Surg Pathol 25:1017\u20131021","journal-title":"Am J Surg Pathol"},{"issue":"3","key":"1740_CR30","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.breast.2010.12.003","volume":"20","author":"S Bianchi","year":"2011","unstructured":"Bianchi S, Caini S, Renne G et al (2011) Positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential (B3) diagnosed by stereotactic vacuum-assisted needle core biopsy (VANCB): a large multi-institutional study in Italy. Breast 20(3):264\u2013270","journal-title":"Breast"},{"key":"1740_CR31","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.ijsu.2017.11.005","volume":"49","author":"M Co","year":"2018","unstructured":"Co M, Kwong A, Shek T (2018) Factors affecting the under-diagnosis of atypical ductal hyperplasia diagnosed by core needle biopsies\u2014a 10-year retrospective study and review of the literature. Int J Surg 49:27\u201331","journal-title":"Int J Surg"},{"issue":"9","key":"1740_CR32","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1038\/modpathol.2011.73","volume":"24","author":"I de Mascarel","year":"2011","unstructured":"de Mascarel I, Brouste V, Asad-Syed M, Hurtevent G, Macgrogan G (2011) All atypia diagnosed at stereotactic vacuum-assisted breast biopsy do not need surgical excision. Mod Pathol 24(9):1198\u2013206","journal-title":"Mod Pathol"},{"issue":"1","key":"1740_CR33","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/s10549-007-9824-0","volume":"112","author":"E Ko","year":"2008","unstructured":"Ko E, Han W, Lee JW et al (2008) Scoring system for predicting malignancy in patients diagnosed with atypical ductal hyperplasia at ultrasound-guided core needle biopsy. Breast Cancer Res Treat 112(1):189\u2013195","journal-title":"Breast Cancer Res Treat"},{"key":"1740_CR34","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.ejca.2011.08.011","volume":"48","author":"S Bendifallah","year":"2012","unstructured":"Bendifallah S, Defert S, Chabbert-Buffet N et al (2012) Scoring to predict the possibility of upgrades to malignancy in atypical ductal hyperplasia diagnosed by an 11-gauge vacuum-assisted biopsy device: an external validation study. Eur J Cancer 48:30\u201336","journal-title":"Eur J Cancer"},{"issue":"3","key":"1740_CR35","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1148\/radiol.2017170549","volume":"286","author":"M Bahl","year":"2018","unstructured":"Bahl M, Barzilay R, Yedidia AB, Locascio NJ, Yu L, Lehman CD (2018) High-risk breast lesions: a machine learning model to predict pathologic upgrade and reduce unnecessary surgical excision. Radiology 286(3):810\u2013818","journal-title":"Radiology"},{"issue":"2","key":"1740_CR36","first-page":"260","volume":"29","author":"\u00d6 Aslan","year":"2023","unstructured":"Aslan \u00d6, Oktay A, Katuk B et al (2023) Prediction of malignancy upgrade rate in high-risk breast lesions using an artificial intelligence model: a retrospective study. Diagn Interv Radiol 29(2):260\u2013267","journal-title":"Diagn Interv Radiol"},{"issue":"2","key":"1740_CR37","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1111\/j.1365-2559.2010.03568.x","volume":"57","author":"MA Lopez-Garcia","year":"2010","unstructured":"Lopez-Garcia MA, Geyer FC, Lacroix-Triki M, Marchi\u00f3 C, Reis-Filho JS (2010) Breast cancer precursors revisited: molecular features and progression pathways. Histopathology 57(2):171\u2013192","journal-title":"Histopathology"},{"issue":"3","key":"1740_CR38","doi-asserted-by":"publisher","first-page":"293","DOI":"10.3233\/CBM-160641","volume":"17","author":"AK Polat","year":"2016","unstructured":"Polat AK, Soran A, Kanbour-Shakir A, Menekse E, Levent Balci F, Johnson R (2016) The role of molecular biomarkers for predicting adjacent breast cancer of atypical ductal hyperplasia diagnosed on core biopsy. Cancer Biomark 17(3):293\u2013300","journal-title":"Cancer Biomark"}],"container-title":["La radiologia medica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-023-01740-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11547-023-01740-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-023-01740-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T14:57:50Z","timestamp":1706108270000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11547-023-01740-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,24]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["1740"],"URL":"https:\/\/doi.org\/10.1007\/s11547-023-01740-4","relation":{},"ISSN":["1826-6983"],"issn-type":[{"value":"1826-6983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,24]]},"assertion":[{"value":"27 June 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 October 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was performed in accordance with the Declaration of Helsinki statement for medical research involving human subjects.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}