Role and accuracy of rapid on-site evaluation of CT-guided fine needle aspiration cytology of lung nodules.

OBJECTIVE: To prospectively investigate the role of trans-thoracic fine needle aspiration cytology (FNA) and the value of rapid on-site evaluation (ROSE) in the clinical management of patients with pulmonary nodules/masses. Computed tomography (CT)-guided FNA is commonly employed for the diagnosis of lung lesions although its position in the diagnostic work-up is still a matter of debate. METHODS: We reviewed 311 patients (211 males and 100 females, mean age 69.5 years) admitted to the University of Padova from 2004 to 2008, correlating the results of cytology with the available histological findings obtained from biopsies, surgery or autopsy. RESULTS: Smears were adequate in 305 cases (98%) and inadequate in six (2%); a diagnosis of malignancy was achieved in 263 cases (86.2%); 39 cases (12.8%) were classified as non-malignant; and three cases (1%) were classified as suspect for malignancy. When correlated with histology, FNA with ROSE discriminated malignant versus non-malignant lesions (Cohen's kappa 0.78), with three false negatives (sensitivity 96.3%, specificity 100%). Moreover, a satisfactory overall agreement of 71.4% was achieved in differentiating the cancer histological types. Pneumothorax occurred in 13 cases, haemoptysis in four, and chest pain in three. A single aspiration was sufficient in 79.6% of patients; two aspirations were needed in 17.4% and three in 3%. The low complication rate was related to the limited number of aspirations needed due to ROSE. CONCLUSIONS: FNA with ROSE is a safe and useful tool in the diagnostic work-up of lung cancer patients, with no contraindications to its use as the first diagnostic procedure for all patients with peripheral lung lesions. FNA with ROSE should be reconsidered in the guidelines for diagnosing and managing lung cancer.

[The prevalence of diffuse and focal lesions of the hepatic parenchyma in a nonselected, resident population. A prospective echographic study]. / Prevalenza delle lesioni diffuse e focali del parenchima epatico in uná popolazione residente, non selezionata. Studio prospettico ecografico.

A group of 2978 randomly chosen residents from a rural area of Veneto (Italian region), aged 18-69 years, was assumed as a study population. They underwent US examination of the liver, routine liver function tests, and--when necessary--other imaging techniques and liver biopsy. Liver US exam detected diffuse lesions in 26% of cases (mostly bright liver pattern), and focal lesions in 3%; US findings were normal in 66% of patients and questionable or inconclusive in 5%. As far as focal lesions were concerned, the final diagnosis was angioma (24 cases), cyst (31), neoplasm (5). When bright liver pattern was observed, liver function tests were altered in 78% of the patients; when US findings were normal, liver function tests were normal in 59% of cases. In conclusion our data: 1) show that focal and diffuse liver abnormalities are relatively frequent in unselected and asymptomatic people, 2) confirm US diagnostic utility, and 3) suggest that US be employed as a screening exam in study populations.

[Renal parenchymal neoplasm as a chance finding during hepatobiliary echography]. / La neoplasia renale parenchimale come reperto occasionale durante ecografia epato-biliare.

Renal cell carcinomas are often diagnosed as incidental findings during abdominal US or CT carried out for extra-urological reasons. In order to ascertain the incidence of renal carcinoma two groups of patients were considered: a) 2400 outpatients who had undergone hepato-biliary US for routine screening; b) 1330 inpatients who had undergone US, for non-urological purposes, which had been systematically extended to the kidneys. Two cases of renal cell carcinoma (PT1) were found in group A. Four cases were found in group B--2 of them were stage PT1, and 2 were PT3. These results show how a certain number of unsuspected and early-stage renal cell carcinomas can be diagnosed by US, even when the examination is not intended as a renal study. On the basis of the above observations, we suggest that US be performed in all upper abdomen examinations. At any rate, right kidney US seems to us mandatory when hepatobiliary US is performed.

[High-resolution echography of the neck. Preoperative evaluation of lymph node metastases in patients with thyroid carcinoma]. / Ecografia ad alta risoluzione del collo. Valutazione preoperatoria delle metastasi linfonodali nei pazienti con carcinoma tiroideo.

Twenty-six patients with papillary and 4 with medullary thyroid carcinoma were examined by HRUS before surgery in order to evaluate its accuracy in detecting lymph node metastasis (N) of the neck from thyroid carcinoma. All patients underwent total thyroidectomy and nodal dissection. HRUS was accurate in 73% of cases in N staging, while clinical staging was accurate in 60% of cases only. In 50% of patients HRUS provided with interesting additional information, such as disclosing lymphadenopathy in 8 patients with no clinical evidence, proving nodal involvement in 5 cases, and showing extranodal extension in 5 cases. HRUS allowed the observation of anechoic necrotic areas and microcalcified nodes. On the other hand, according to our results, HRUS cannot either discriminate metastatic from benign nodal involvement, or identify mediastinal adenopathy. False negatives are possible due to micrometastatic areas in normal size nodes. Nevertheless, HRUS proved to be a valuable aid to complete clinical examination of the neck, and a good guide for the surgeon during nodal neck dissection.

[High-resolution echography and angiography in the study of vascular accesses for hemodialysis]. / Ecografia ad alta risoluzione e angiografia nello studio degli accessi vascolari per emodialisi.

In 23 hemodialytic patients with clinically presumed complications of the vascular access the arteriovenous shunt was studied by high resolution ultrasonography (US) and by angiography. In 21/23 cases US identified the shape of the shunt correctly; in these patients US always showed the alterations of vascular size (stenosis, aneurysm) and complete occlusion, also detecting the intravascular extension of thrombosis. In 3 patients US identified partial venous thrombosis missed on angiography; furthermore, unlike angiography, US gave precise information on the vascular wall and perivascular tissue changes. These findings suggest that US may represent the first imaging procedure in the study of the vascular access in hemodialytic patients; angiography might be performed when US findings are uncertain or when a vascular map is needed for surgery.

[Pathology of the residual urachus: a congenital anomality of possibly late clinical onset]. / Patologia dei residui uracali: anomalia congenita a possible espressione clinica tardiva.

The authors report on two rare case urachal residue disease of late onset. They define the pathogenic factors contributing to the disease and describe the semeiological and radiological methods used in diagnosing the condition.

The role of computerized axial tomography in the follow-up of patients with carcinoma of the ovary.

In order to assess the accuracy of CAT in the follow-up of the patients affected by ovarian carcinoma, we compared the results of this method to those of second-look laparotomy in 19 patients. In 16 out of 19 patients the CAT showed the presence or absence of disease correctly. There were 3 false negatives, caused by small diffuse peritoneal metastases, and no false positives. The results of this study show that CAT, though useful in studying the evolution of abdominal and pelvic carcinomas, cannot replace the surgical second-look in cases of ovarian cancers, due to the high incidence of false negatives.

[Usefulness of arthrography of the knee in assessing the unfavorable outcome from a meniscectomy intervention]. / Utilità dell'artrografia del ginocchio nella valutazione degli esiti sfavorevoli dell'intervento di meniscectomia.

Knee arthrography was performed in 22 patients suffering from persistent articular symptoms after meniscectomy. In 3 cases a surgically proved tear of the opposite meniscus was assessed. In 4 cases no meniscal tear was found, but 3 out of these patients had a significant anatomic lesion. In 15 cases meniscectomy was found to be incomplete, and a residual posterior horn of the medial meniscus was observed, normal in shape in 7 cases, torn or detached in 8. It is suggested that the persistence of the posterior horn of the medial meniscus after meniscectomy may cause the persistent symptoms; the value of knee arthrography before surgery is emphasized.