Which is a real valuable screening tool for lung cancer and measure thoracic diseases, chest radiography or low-dose computed tomography?: A review on the current status of Japan and other countries.

Chest radiography (CR) has been used as a screening tool for lung cancer and the use of low-dose computed tomography (LDCT) is not recommended in Japan. We need to reconsider whether CR really contributes to the early detection of lung cancer. In addition, we have not well discussed about other major thoracic disease detection by CR and LDCT compared with lung cancer despite of its high frequency. We review the usefulness of CR and LDCT as veridical screening tools for lung cancer and other thoracic diseases. In the case of lung cancer, many studies showed that LDCT has capability of early detection and improving outcomes compared with CR. Recent large randomized trial also supports former results. In the case of chronic obstructive pulmonary disease (COPD), LDCT contributes to early detection and leads to the implementation of smoking cessation treatments. In the case of pulmonary infections, LDCT can reveal tiny inflammatory changes that are not observed on CR, though many of these cases improve spontaneously. Therefore, LDCT screening for pulmonary infections may be less useful. CR screening is more suitable for the detection of pulmonary infections. In the case of cardiovascular disease (CVD), CR may be a better screening tool for detecting cardiomegaly, whereas LDCT may be a more useful tool for detecting vascular changes. Therefore, the current status of thoracic disease screening is that LDCT may be a better screening tool for detecting lung cancer, COPD, and vascular changes. CR may be a suitable screening tool for pulmonary infections and cardiomegaly.

Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto's thyroiditis.

OBJECTIVE: Papillary thyroid carcinoma (PTC) sometimes occurs with Hashimoto's thyroiditis (HT). It is often difficult to differentiate between benign and malignant nodules in HT because HT varies greatly on ultrasonography. We aimed to characterize the ultrasonographic features of PTC with HT. PATIENTS AND METHODS: In this retrospective study, 2167 patient records (1897 women and 270 men) were examined for ultrasonographic features and thyroid autoantibodies between 1998 and 2002 at our university. Patients with Graves' disease, positive TSH receptor autoantibody (TRAb) or thyroid-stimulating antibody (TSAb) were excluded. PTC was diagnosed by pathological examination. RESULTS: Of the 1644 patients who were autoantibody negative (MCHA, TGHA, TgAb, TPOAb), 54 (3.3%) had PTC, while 29 (5.5%) of the 523 patients who were autoantibody positive had PTC. On ultrasonography, the frequency of dense calcification in patients with HT was significantly higher (P=0.0064) and frequency of psammoma bodies was less than PTC patients without HT (P<0.0001). On the other hand, PTC with HT had more irregular shapes and ill-defined edges of the borders with less hypoechogenecity and calcification than PTC without HT, but the difference was not significant. CONCLUSION: The frequency of psammoma bodies in PTC with HT was less, while dense calcifications were greater than in those of PTC without HT. Any type of ultrasonographic calcification features may represent a risk for PTC.

Preclinical Cushing's disease characterized by massive adrenal hyperplasia and hormonal changes after three years of metyrapone therapy.

A 66-year-old woman had massive bilateral adrenal macronodular hyperplasia, found incidentally on an abdominal ultrasonogram. Her plasma ACTH and serum cortisol levels were normal, but they were not suppressed by low-dose dexamethasone. The patient did not exhibit any typical signs or symptoms of Cushing's disease. MRI showed no evidence of a tumor in the pituitary gland. A diagnosis of preclinical Cushing's disease was made, and she was treated with 11-hydroxylase inhibitor metyrapone. As the dose of metyrapone was increased, plasma ACTH levels gradually increased. After three years of treatment, she developed moon-face. Her plasma ACTH and serum cortisol concentrations were at their highest levels. A pituitary microadenoma was detected by MRI, whose source of ACTH was demonstrated by the definite step-up of central/peripheral ratio of ACTH obtained by cavernous sinus sampling. Overt Cushing's disease was diagnosed, and a pituitary tumor was removed by transsphenoidal surgery. In conclusion, the clinically and endocrinologically overt Cushing's disease characterized by macronodular adrenal hyperplasia was converted from a preclinical form. This case offers some insight into the clinical and biological features of preclinical Cushing's disease.