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 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.

[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.

Imaging for the diagnosis of an unusual case of left ventricular aneurysm.

An isolated ventricular diverticulum in an adult patient investigated for chest pain is reported. An exhaustive diagnosis was obtained by different means and complementary imaging techniques such as echocardiography, cardiovascular magnetic resonance imaging and cineangiography.

[Meniscal injuries of the knee: arthrographic and echographic study]. / Le lesioni meniscali del ginocchio: studio artrografico ed ecografico.

In order to evaluate the diagnostic capabilities of sonography (US) in meniscal lesions of the knee, 65 unquestionable cases of meniscopathy at arthrography were studied with high-resolution US. In 92% of the cases, inhomogeneous echo structure was demonstrated in correspondence with pathological meniscus, with irregular hyperechoic areas and, in some cases, with hyperechoic lines corresponding to the tear. 40% of patients presented with tumefaction and external bulging of the parameniscal region, while in 87% of the cases the articular capsule was thickened. These results confirm that, as reported by some authors, US is a promising method for the study of meniscopathies. We therefore believe that US could nowadays be at least employed as a complement to clinical examination, while its diagnostic capabilities are further assessed through other studies.

[Intracortical tunnels: an early sign of hyperparathyroidism in chronic uremia under periodic hemodialysis]. / I tunnel intra-corticali: precoce segno di iperparatiroidismo nell'uremico cronico in emodialisi periodica.

The authors studied the hand bones in 83 uremic patients undergoing periodic hemodialytic treatment, with microfocus and magnification, valuing particularly the debated findings of cortical striation (tunnelling). In 33 cases the radiological signs have been compared with the values of plasma parathyroid hormone and a significant relationship was found between the hyperparathyroidism and the development of cortical striation. The intracortical tunnels are proposed as an important sign for the early diagnosis of renal osteodystrophy.

[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.

[Echography in the diagnosis of spontaneous hematoma of the rectus muscle]. / L'ecografia nella diagnosi dell'ematoma spontaneo del muscolo retto.

After a brief explanation of the pathogenesis and of the clinical picture of spontaneous rectus muscle hematoma, the Authors describe 9 diagnosed cases by ultrasonography. The various echographic appearances of this disease are described and the importance of ultrasonography for a correct diagnosis and to avoid unnecessary laparotomy is emphasized.

[Ioexol in arthrography]. / Ioexolo in artrografia.

Single contrast knee arthrography was performed in a group of 50 patients, using either Urografin or Ioexol as contrast agents. Both contrast media were well tolerated clinically and no significant difference was found to exist as far as image quality is concerned. However, while Urografin produced a significant increase of the white cells in the synovial fluid, no inflammatory change was observed in the synovial fluid after Ioexol. So we believe that Ioexol is a significantly preferable contrast medium in arthrography, especially in patients with inflammatory joint diseases.

[A simple method of studying cruciate ligaments in arthrography]. / Un semplice metodo per lo studio dei legamenti crociati in artrografia.

After a review of the methods employed for arthrographic visualization of cruciate ligaments (CL), the authors present a new technique to separately study the anterior and posterior CL during traction. This technique enables to obtain a good visualization of CL and a good diagnostic accuracy; it can radiographically demonstrate a pathologic sagittal instability of the knee; it is easy to perform and is easily repeatable in different patients.

CT diagnosis of spontaneous dissection of the superior mesenteric artery.

We report two cases of spontaneous superior mesenteric artery dissection diagnosed by CT. In both cases lamination of the arterial wall and enhancement of both true and false lumina were the key to the diagnosis.

[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.

[Pericardial liquid layer as an occasional finding in internal echography. Normal patterns and pathologic limits]. / Falda liquida pericardica come riscontro occasionale nell'ecografia internistica. Quadri normali e limiti con il patologico.

A small amount of fluid in the pericardial sac is often observed incidentally during upper abdomen US studies. In order to assess the normality range for this finding, 500 patients undergoing liver US were evaluated for the presence of pericardial fluid, the thickness of which was subsequently measured in positive cases. In a group of 20 patients with pericardial fluid thickness ranging 5-9 mm and in 6 cases with pericardial effusion greater than 10 mm, cardiologic evaluation was performed (clinical examination, ECG, echocardiography). Pericardial fluid was quite a common finding (20.8%) which had no clinical relevance when less than 10 mm. On the contrary, its clinical relevance was high when greater than 10 mm, and extending around the heart.

[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.

[Echography with portable equipment. Its possibilities and limits in the hepatobiliary area]. / Ecografia con apparecchi portatili. Possibilità e limiti nella regione epato-biliare.

Ultrasound examination of the liver by simple low-cost equipment (LCUS) is currently performed. In order to evaluate the accuracy of this imaging technique in the detection of liver diseases, 150 outpatients were examined with a LCUS unit. The same patients were then re-examined with more sophisticated equipment (SEUS) in a department of radiology. The images thus obtained were compared to the previous ones: LCUS appears to be a valuable screening method, even though several US features--i.e. hyperechogenicity of the liver, focal hypoechoic lesions, and microlithiasis--are better demonstrated by more sophisticated units.

[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.