The differential diagnosis of primary lung cancer: inter-observer agreement and contribution of specific diagnostic procedures.

In order to investigate inter-observer variability in the differential diagnosis of primary lung cancer among women and the contribution of specific diagnostic procedures to this diagnosis, a group of 449 suspect cases of this disease was studied. Based on a standard dossier (including clinical data and the reports, if present, of radiology, bronchoscopy and histology) six different physicians independently judged, for each woman, at each diagnostic step, the presence of a primary lung cancer. A final consensus was organized in order to define the true cases. Radiology and especially histology seem to give the most important contribution to the diagnosis. On the other hand bronchoscopy seems to be useful mainly as a guide for biopsy. A predictive value of 90% was found when both radiology and bronchoscopy were positive; in the other cases histology seems to be needed to reach an adequate discrimination. Inter-rater agreement increases with an increasing amount of information but is not very high even when histology is available.

[Role of ultrasonic diagnosis as a complementary method in contrast radiography of the intestines]. / Ruolo dell'ectomografia come metodica complementare alle indagini contrastografiche intestinali.

This study was aimed at evaluating US reliability and sensitivity in identifying inflammatory or neoplastic bowel diseases in symptomatic patients. Two hundred and fifty patients who had been referred to our Unit for double-contrast barium enema of small bowel and colon, underwent panoramic and targeted abdominal US. According to well-known pathological criteria--i.e., intestinal wall thicker than 5 mm, and pseudo-kidney pattern--US had 61.7% sensitivity for inflammatory and neoplastic bowel diseases. The results indicate that US findings negative for intestinal disease are not reliable unless confirmed by contrastographic and endoscopic examinations. However, panoramic US occasionally demonstrated intestinal abnormalities and allowed collateral diseases to be observed in other organs or apparatuses. These abnormalities had been missed at contrastography, and were sometimes responsible for the symptoms the patients complained of. Targeted US emerged as a useful tool for detailing the lesions demonstrated by double-contrast barium enema, especially in case of expansive pathologies (size of the mass and relationship to adjacent organs).

[Radiologic deontology in daily practice]. / La deontologia radiologica nella pratica quotidiana.

The rapid and far-reaching technological evolution that has taken place in diagnostic imaging has deeply changed the radiologist's role, increasing his professional liability. He is in fact responsible for the materials and the equipment employed, for the choice of the examination necessary to solve the clinical problems, for the proper execution of the test, for the validity of the iconographic documentation, for the correct diagnostic interpretation and final report. Whenever the instrumental research involves actual risks of damage (not only potential) it is up to the radiologist to inform the patient to obtain the consent for the execution of the test.

Inter-observer variability in the interpretation of mammograms.

Inter-observer agreement was tested in the interpretation by 8 radiologists of mammograms from 45 women (for a total of 180 films per radiologist). The radiologists were representative of the whole range of those involved in mammography in the town of Torino, with a number of films read per year ranging from 100 to 4000. Out of the 45, 9 women were affected by breast cancer (histologically proved), 25 had benign disease (diagnosed with fine-needle aspiration) and 11 had normal breasts. Weighted kappa values were in the range 0.27-0.82 (median 0.60) for parenchymal patterns; 0.33-0.67 (0.48) for diagnosis in five categories; and 0.22-0.57 (0.38) for indications for further diagnostic tests. These values are comparable with those reported from other investigations.

[Mammography using stationary grids. Qualitative and dosimetric considerations]. / La mammografia con griglie fisse. Considerazioni qualitative e dosimetriche.

The authors report their experience with ultra-high-strip-density (UHSD) stationary grids in mammography, based upon dosimetric measurements carried out in a phantom and mammographic examination of 62 patients. Utilization of UHSD grids made it necessary an increase in radiation exposure by a factor 3.5 in a breast 5 cm thick 50% water and 50% fat by weight. Improvement in image-quality is apparent with voltages not exceeding 30 kV, particularly in cases of questionable masses within areas of locally increased breast density. The authors believe that UHSD grids may be useful in selected cases, such as in the performance of adjunctive whole-breast or locally aimed radiograms and in the radiological examination of surgical specimens.

Cimetropium bromide as a relaxant for the radiological examination of the stomach and duodenum.

A study was carried out to evaluate the efficacy of two different doses of a new hypotonizing agent, cimetropium bromide, as a premedication for X-ray of the stomach and duodenum. Forty consecutive patients were allocated at random to two groups and treated intravenously in double-blind fashion with 5 mg or 10 mg cimetropium bromide. The drug was administered immediately after the first phase of an upper gastro-intestinal series had been completed. Duration of the drug-induced hypokinesia was recorded fluoroscopically. The hypotonizing effect was evaluated by measuring the diameters of the gastric antrum, duodenal bulb and loop on the pre-injection and post-injection radiographs. In both groups, the relaxant effect started promptly (within 1 minute of injection) and lasted for an average of 10 minutes, which was considered adequate for the study. There were no statistically significant differences between the two groups in relaxant activity. The treatments were scored arbitrarily as 'excellent' in 75% of the examinations after the 10 mg dose and in 60% after the 5 mg dose. The difference between the two groups was not significant. Side-effects were few, of mild entity and not dose-related.

[Multiphase instrumental diagnosis of minimal breast cancer]. / Diagnostica strumentale plurifasica dei carcinomi minimi della mammella.

The value of a breast surgery procedure based on clinical examination, mammography, telethermography, echotomography and cytological examination for the diagnosis of symptomatic or high risk patients was tested through a retrospective survey of 28 patients with minimal breast cancer. The data confirm that mammography is a much better clinical and instrumental test than other systems. When associated with radiography it gives definite, early diagnosis of more breast neoplasias than other methods, facilitating prognosis and reducing the number of biopsies necessary.

[Pulmonary disease after radiotherapeutic treatment of carcinoma of the breast with fast electrons from an 18 MeV betatron]. / Malattia polmonare post-radioterapica nel trattamento del carcinoma della mammella mediante l'impiego di elettroni veloci di un betatrone da 18 MeV.

Instances of lung complications observed at the radiotherapy division of the department of oncology, Greater Hospital of St. John the Baptist and the City of Turin in the treatment of 110 breast cancer patients with fast electrons produced by an 18 MeV betatron are described and compared with those noted 2 yr after TCT treatment of 192 subjects. Lung fibrosis was observed in 5.5% of cases 15 months after fast electron treatment, as opposed to 14.1% after TCT. The mean age of patients with such complications after fast-electron treatment was much higher than after TCT (70.16 yr as opposed to 55.55 yr).

[Dynamic telethermography in primary bone and soft tissue tumours (author's transl)]. / La teletermografia dinamica dei tumori primitivi delle ossa e delle parti molli.

Twelve cases of primative bone neoplasm and of soft tissues sarcomas have been thermographycally observed. All cases were positive and cutaneous hyper-thermic areas corresponding to the neoplasies under consideration were noticed. This hyper-thermic area was in all cases larger than the area of bone's disease radiographycally detectable. Five cases were controlled before during and after a conservative radio-chemotherapic treatment. Thermographic and clinic finding's variation were always according; precocious than radiography. The results are to emphasize the utility of thermography in the prognosis, in the diagnosis of neoplastic extension, in conservative treatment control and in the follow-up of treated patients.

[Personal experience with thermographic studies of skeletal metastasis of breast cancer]. / La nostra esperienza nello studio termografico delle metastasi scheletriche da carcinoma mammario.

Dynamic telethermography may be usefully employed, alone or in association with X-ray or scintigraphy investigations, for the evaluation of skeletal metastases both diagnostically (differential diagnosis, screening of pains in patients with tumours, study of the extent of metastatic bone localizations) and prognostico-therapeutically (assessment of the effectiveness of chemo-hormonal or radiant treatment).