Validity of radiological examinations of patients with breast cancer in different age groups in a population based study.

By studying which radiological examinations had been performed before breast cancer operations the aim was to assess, how much benefit ultrasonography (US) and fine or core needle biopsy (FNAB, CNB) gave in addition to mammography, and whether the sensitivity of these examinations varied with the age of the patient. There were 659 consecutive histologically and six cytologically verified breast cancer cases included in the study. Information on mammography, US and FNAB findings were retrieved from the original patient files and classified as malignant or benign. The sensitivity (Se) of these was compared in three age groups (26-49, 50-59 and 60-92). Seventeen (3%) tumours had operations without any radiological examination and 73 (11%) without cytological or histological verification. The sensitivity of mammography (Se=0.92) was statistically significantly higher than the sensitivity of FNAB (Se=0.85, P=0.002) or US (Se=0.86, P=0.003). The sensitivity of mammography increased with age; US sensitivity was slightly higher amongst younger than older patients; the sensitivity of FNAB did not depend on the age of the patient. The sensitivity using a cutoff level of class 5 for mammography was higher (50% typical malignant findings) than for US (45%) or FNAB (30%). Among cases with benign mammographic finding (classes 1-2), the US finding was malignant (classes 3-5) in 4% and FNAB was malignant in 7%. Mammography is a reliable method of breast examination especially for women over 50 years of age. Ultrasonography is beneficial, particularly in younger women, but it is mainly performed as a complementary examination to a mammography and therefore could not be evaluated as an independent examination. FNAB and CNB results were not related to the age of the patient.

Correlation between mobility restrictions and radiologic changes in ankylosing spondylitis.

STUDY DESIGN: In 151 adult patients with ankylosing spondylitis who participated in an inpatient rehabilitation program of 3-4 weeks, 10 different range of motion (ROM) values were measured, and their lumbar spine and sacroiliac joints were radiographed. OBJECTIVES: To determine whether a correlation obtained between restriction of ROM and progression of radiologic findings in ankylosing spondylitis, together with a high enough reliability level in measurements. SUMMARY OF BACKGROUND DATA: A significant correlation was observed between the restriction of eight ROMs: the Schober test, thoracolumbar rotation, thoracolumbar flexion, cervical rotation, occiput-wall distance, chin-chest distance, chest expansion, finger-floor distance, and overall radiologic changes in both lumbar spine and sacroiliac joints; straight leg raise did not correlate, and vital capacity only with sacroiliac joint changes. Spearman's correlation coefficients for ROMs were slightly higher to lumbar spine changes than to sacroiliac joint changes. A corresponding correlation was also observed between spinal mobility restrictions and six detailed changes in lumbar roentgenogram: syndesmophytes, apophyseal arthritis, sclerotic anterior borders of vertebrae, straightened anterior surface of vertebrae, and ossification of interspinous and anterior longitudinal ligaments. Other detailed lumbar spine findings did not correlate. As assessed by erythrocyte sedimentation rate values the disease activity increased in the course of radiologic progression, decreasing again, however, to the end stage. METHODS: Conventional methods with a tape and (Myrin) inclinometer were used to measure thoracolumbar flexion, cervical rotation, occiput-wall distance, chin-chest distance, finger-floor distance, chest expansion, vital capacity, and straight leg raise. In addition, a new method of thoracolumbar rotation and a new modification of the Schober test were introduced. Thirty-nine patients were randomized for a reliability assessment using repeated measurements of ROMs. Radiologic changes were evaluated (in a masked fashion) using the method of Dale and Vinje. RESULTS: The reliability of all ROMs was good (except for interrater intraclass correlation coefficients of chest expansion: 0.53). CONCLUSIONS: The clear correlation between radiologic sacroiliac joint and lumbar spine progression and eight ROMs showed that these are useful noninvasive measurements of disease progression and severity in ankylosing spondylitis that can be used in daily practice.

Clinical assessment of spinal mobility measurements in ankylosing spondylitis: a compact set for follow-up and trials?

Different spinal ranges of motion (ROM) were measured and the results of 17 repeated tests correlated with spinal radiological changes in 52 male patients with ankylosing spondylitis (AS). Both Schober tests and measurements of lumbar and cervical rotations (TRi, TR, CR, CRt) and lateral flexions (LFLf, LFLx, CLFLt, CLFLm), together with thoracolumbar flexion (ThFL), cervical flexion-extension measurements (CFL, CExt), and tragus - wall and occiput - wall distances (OWD,TWD), showed significant correlations with detailed radiological spinal changes. Cervical rotation (CRm, CRt) and flexion (CFLm) correlated only with cervical changes, and thoracolumbar rotation as assessed by instrument (TRi) correlated only weakly with lumbar changes, while chin-chest distance (CCD) and chest expansion (CE) showed no correlation. Inter- and intratester reliability was good in all tests (the intraclass correlation coefficients ranged from 0.84 to 0.98). Three new tape methods for measuring thoracolumbar and cervical rotations and cervical lateral flexion also proved to be valid and reliable, as did the Schober-S1 modification. We conclude that the thoracolumbar segment (Schober), whole (ThFL) and lateral (LFL) flexions and rotation (TR), and chest expansion (CE) (after careful standardisation) together with cervical rotation (CR), extension (CExt) and/or lateral flexion (CLFL) comprise the set of mobility tests for the follow-up and assessment of disease progression in AS. On the other hand, cervical (forward) flexion (CFL), chin-chest distance (CCD) and an instrument method for thoracolumbar rotation (TRi) are not approaches to be recommended.

Assessment of thoracolumbar rotation in ankylosing spondylitis: a simple tape method.

Results of a 'new' method for thoracolumbar rotation by tape (TRPav), simple instrumental rotation (TRi), the modified Schober test and thoracolumbar flexion (ThFL) were correlated with radiological changes in patients with ankylosing spondylitis (AS). TRPav showed a significant radiological correlation (Ls-r: 0.38; Th-r: 0.31), while the instrument method (TRi) did not; both the Schober test and ThFL, again, correlated fairly highly (Ls-r: 0.71, 0.62; Th-r: 0.49, 0.42). Both inter- and intratester reliability of the tests was good (Bland and Altman plots). Thoracolumbar rotation is one of the three principal levels of spinal motion and seems to be less affected by age. TRPav proved a valid and reliable method for measuring thoracolumbar rotation and clinically is a non-invasive, quick and easy complement to AS measurement methodologies.

Bronchography in patients with persistent cough.

Bronchography was performed together with a fibre-optic bronchoscopic study in 98 patients with persistent cough, 33 of whom also had haemoptysis. Finally there were chronic bronchitis in 62 patients, bronchiectasis in 21, subacute bronchitis in 9, inflammatory residuals in 3, pulmonary tuberculosis in 2 patients and metastases in one. In chronic bronchitis, the value of plain chest radiography was low. It was normal in 34 of 62 cases (55%), bronchography in 12 cases (19%). Mild cases of bronchitis were more numerous in bronchography than seen by scopist. Bronchiectasis was found in 21 patients, four of these unexpectedly (two in a tbc scar). Additionally, three cases were overdiagnosed by the radiologist on chest films and eight cases by the scopist with bronchoscopy. In patients with persistent cough and haemoptysis, bronchography mainly revealed alterations of bronchitis.

Gonadal dose reduction in lumbar spine radiography.

Different ways to minimize the gonadal dose in lumbar spine radiography have been studied. Two hundred and fifty lumbar spine radiographs were reviewed to assess the clinical need for lateral L5/S1 projection. Modern film/screen combinations and gonadal shielding of externally scattered radiation play a major role in the reduction of the genetic dose. The number of exposures should be minimized. Our results show that two projections, anteroposterior (AP) and lateral, appear to be sufficient in routine radiography of the lumbar spine.

Acne fulminans with bone lesions.

We present 5 young men who developed acne fulminans. During the acute, febrile illness, all had musculoskeletal symptoms, and X-ray and bone scan examinations revealed that 4 of the patients had osteolytic bone lesions. The disease was resistant to various antibiotics and one patient needed surgical trepanation of the sternum. No evidence of sepsis or bacterial osteomyelitis was found, as all bacteriological cultures proved negative and the tissue reaction was unspecific. The dermatopathogenetic origin of bone lesions in the present patients seems evident, but speculation that the etiology depends on immune mechanisms remains open.

The relative value of spinal and thoracic mobility measurements in ankylosing spondylitis.

The relative value of nine spinal and thoracic mobility measurements was investigated in 73 male patients with ankylosing spondylitis (AS). The value of a test was obtained by the relative ranks of validity, reliability and sensitivity to change. Validity was determined as age-adjusted correlation of the test result with AS-specific radiological changes in the lumbar spine. Reliability was determined as inter-observer error. Sensitivity to change was determined as change in test result during an intensive rehabilitation course. The five most valuable tests were rotation of the thoracolumbar spine (TR), finger-to-floor distance (FFD), the Schober test, thoracolumbar flexion and occiput-to-wall distance. Of these, FFD had high reliability and sensitivity ranks, but poor correlation with AS-specific spinal changes. TR had high validity and sensitivity ranks, and improvement of the measurement technology would probably result in a superior test for the follow-up of AS. Chest expansion and vital capacity had low ranks in all comparisons.

Age and spinal mobility in ankylosing spondylitis.

Mobility measurements of spine, chest, hips, and shoulder in 73 adult males with ankylosing spondylitis (AS) were correlated with the duration of disease. Several mobility tests showed a significant correlation with the duration of AS, but after adjustment for age, only rotation of the thoracolumbar spine maintained a highly significant correlation. It is concluded that age has a strong effect on the mobility tests. Rotation of the thoracolumbar spine seems to be a valid measure for AS-specific changes.

Bronchography in patients with suspected lung malignancy.

Bronchography and flexible fiberoptic bronchoscopy (FFB) were performed on 95 patients with suspected lung malignancy. Finally, 66 of 95 lesions turned out to be malignant and 29 benign. Bronchographic diagnosis was correct in 46 of 66 cases of cancer (70%) but gave a false negative result in 20 malignant lesions and a false positive result in four benign lesions of which three had pulmonary tuberculosis and one hamartoma of the lung. It is concluded that bronchography is rarely indicated in central malignant lesions. In peripheral lesions bronchographic findings for malignancy are unreliable or negative.

Neck mobility assessment in ankylosing spondylitis: a clinical study of nine measurements including new tape methods for cervical rotation and lateral flexion.

The objective was to carry out a clinical assessment of different cervical mobility measurements in ankylosing spondylitis (AS), including two new tape methods for measuring cervical rotation and lateral bending. A range of cervical movements was measured in 52 consecutive male AS patients and the results correlated with detailed radiological changes in the whole spine and sacroiliac joints. Occiput- and tragus-to-wall distance (OWD/TWD), cervical rotation (CR) and lateral flexion (CLF) using a Myrin inclinometer (My) and a tape method (t), cervical flexion-extension (CFl-CExt/My) motion and chin chest distance (CCD) measurements were taken and repeated (test-retest). The results showed a highly significant correlation of all measurements with cervical radiological changes, except for CCD, and also those of OWD/TWD with lumbar changes. CLF and CExt also correlated significantly with lumbar changes, other measurements did not, and only TWD and CExt correlated with thoracic changes. All measurements showed good reliability, intra-class correlation coefficients (ICC) ranging from 0.89 to 0.98. Occiput- or tragus-to-wall distance, cervical extension and lateral flexion proved to be valid and reliable measurements in AS, but cervical rotation also appeared to be a clinically relevant method. Cervical lateral flexion is a recommendable measurement for clinical trials in AS. The two new tape methods for measuring cervical rotation and lateral bending were as valid and reliable as the inclinometer method (Myrin), but also quick and easy. Chin-to-chest distance was not among the most valid tests in AS.

The effect of age and density of the breast on the sensitivity of breast cancer diagnostic by mammography and ultasonography.

PURPOSE: We studied which, age of the patient or density of the breast accounts for the sensitivity of mammography and ultrasonography (US). Furthermore we studied whether the overall impression on the density of the breast or the density in tumour area accounts for the sensitivity of mammography and ultrasonography. MATERIALS AND METHODS: The material consisted of 572 consecutive histologically and 5 cytologically verified breast cancer cases. Mammography and US examinations were performed immediately before breast cancer operations and information on the findings were received from the original patient files and classified as malignant or benign. The density of breast parenchyma to fatty, mixed or dense in total breast and separately in tumour area was defined by a radiologist group from the original mammograms by comparing to model mammograms. The sensitivity (Se) of mammography and US was compared in 3 age groups (26-49, 50-59 and 60-92) and in the different density classes. RESULTS: Sensitivity of mammography increased by age (density-adjusted OR = 0.2, 95%, CI 0.1-0.5) in age group 26-49 compared to age group 60-92) and with fattiness of the breast (age-adjusted OR= 0.4, 95%, CI 0.1-1.0 for dense breast parenchyma in tumour area compared to fatty breast). Sensitivity of US was inversely related to age (density-adjusted OR = 2.3, 95%, CI 1.0-5.2 in age group 26-49 compared to age group 60-92) and directly related with fattiness of breast (age-adjusted OR = 0.5, 95%, CI 0.2-0.9 by dense breast parenchyma in tumour area compared to fatty breast). Density in the tumour area compared to total breast density was related only mariginally better sensitivity both of mammography (0.4 vs. 0.6) and of US (0.5 vs. 0.6). CONCLUSION: Sensitivity of both mammography and sensitivity of US are independently related both to the age of the patient and to the density of the breast. The effect of age is inverse and that of density parallel between mammography and US on sensitivity. The effect of overall breast density was close to the effect of density at the site of the tumour on the sensitivity of both mammography and US.

The visibility of cancer on previous mammograms in retrospective review.

AIM: To study how many tumours were visible in restrospect on mammograms originally reported as normal or benign in patients coming to surgery with proven breast cancer. The effect of making the pre--operative mammogram available was also assessed. MATERIALS AND METHODS: Three hundred and twenty initial mammograms of consecutive new breast cancer cases were analysed by a group of radiologists in the knowledge that all patients were later diagnosed with breast cancer. The films were read twice, first without and then with the later (pre-operative) mammograms available. The parenchymal density in the location of the tumour was classified as fatty, mixed or dense, and the tumours were classified as visible or not visible. The reasons for the invisibility of the tumour in the earlier examination were analysed. RESULTS: Fourteen per cent (45) of cancers were retrospectively visible in earlier mammograms without the pre-operative mammograms having been shown, and 29% (95) when pre-operative mammograms were shown. Breast parenchymal density decreased with age and the visibility of tumours increased with age. When considered simultaneously, the effect of age (over 55 vs under 55) was greater (OR = 2.9) than the effect of density (fatty vs others) (OR = 1.5). The most common reasons for non-detection were that the lesion was overlooked (55%), diagnosed as benign (33%) or was visible only in one projection (26%). Growing density was the most common (37%) feature of those lesions originally overlooked or regarded as benign. CONCLUSIONS: Tumours are commonly visible in retrospect, but few of them exhibit specific signs of cancer, and are recognized only if they grow or otherwise change. It is not possible to differentiate most of them from normal parenchymal densities. Saarenmaa, I. (2001). Clinical Radiology56, 40-43.