We just completed a 7-day cruise on the Norwegian Gem, and we used ItalyTours for 3 tours. We used them for Sicily (Mt Etna and Taormina), Naples (Pompeii and the Amalfi Coast), and Livorno (Florence only--no Pisa). I would highly recommend their services. The drivers were safe, spoke good English, and gave us some good insight on their towns. We only had 6-10 people per tour. We loved having extra guides in Pompeii and Florence. Without them, we would have missed a lot of pertinent info. ItalyTours provided a lot of extra value compared to the cruise line tours, and they guarantee a return to the ship. Some of the cruise members were a bit anxious to get back to the port, and some even tried to pressure our Pompeii tour guide to cut it short to get back earlier. We were back in Naples about 60 minutes prior to all on board time, so we had plenty of time.
Although this was not ItalyTours's fault, I would consider skipping Mt Etna and just going to Taormina and/or Castelmola. We live near volcanoes, we have seen craters/cones, etc.. and while it was cool because it was in Italy, I would have preferred more time in Taormina. However, the honey and olive oil from Mt Etna was delicious, so.. choose your tours carefully depending on what you really want to see. We were trying to see it all, so sometimes we only had 2 hours in 1 place (and if you want to eat in Italy, sometimes the service is very slow).