The role of bronchoscopy and needle aspiration in the diagnosis of peripheral lung masses.

Sixty patients underwent flexible fiberoptic bronchoscopy and percutaneous needle aspiration of peripheral lung lesions with fluoroscopic monitoring. A single general anesthetic was used. We found that percutaneous needle aspiration was the more accurate of the two procedures in establishing a diagnosis but that flexible fiberoptic bronchoscopy proved complementary in some instances. The incidence of pneumothorax was 27% but aspiration was needed in only 8%. There were no other complications. In 84% of patients with primary carcinoma of the lung presenting as a peripheral lesion, the diagnosis was established by these procedures. The accuracy was less in metastatic lesions and considerably less in benign lesions.

Low-density supradiaphragmatic band artifact on advanced multiple-beam equalization radiography of the chest.

RATIONALE AND OBJECTIVES: A low-density dark band artifact was found above the diaphragm on advanced multiple-beam equalization radiography (AMBER) of the chest and was evaluated. METHODS: Fifty consecutive chest radiographs were evaluated for the presence of the artifact. AMBER radiographs of a phantom were scanned with a microdensitometer. RESULTS AND CONCLUSION: The presence of the artifact is confirmed on the patient chest radiographs (present in 84% on posteroanterior view; 94% on lateral view) and on the phantom images. The artifact was probably caused by a delayed system response to scanning across a sharp boundary.

Characterization of reactive versus tumor-bearing lymph nodes with interstitial magnetic resonance lymphography in an animal model.

RATIONALE AND OBJECTIVES: To determine if magnetic resonance lymphography performed with subcutaneously administered AMI-227, a nanoparticulate iron oxide contrast agent, can distinguish reactive from tumor-bearing lymph nodes. MATERIALS AND METHODS: Mature male Copenhagen rats were inoculated with cell suspensions of R3327-MAT-LyLu rat prostate carcinoma (n = 21) or Freund's complete adjuvant (n = 15) in the left footpad to generate ipsilateral popliteal lymph node metastases or lymphadenitis. At 12 to 14 days after inoculation, T1-and T2-weighted magnetic resonance images of bilateral popliteal areas were obtained before and 24 hours after subcutaneous administration of AMI-227. Contrast-to-noise ratios were calculated in precontrast and postcontrast images. Bilateral popliteal nodes were excised for pathologic assessment. RESULTS: AMI-227 resulted in decreased contrast-to-noise ratios in reactive (T1-W = -7.01 +/- 1.13, T2- W = -31.64 +/- 5.35) and normal (T1 - W = -13.56 +/- 1.97, T2 - W = -21.62 +/- 2.51) nodes. Contrast-to-noise ratios were unchanged (T1 - W = -0.22 +/- 1.71, T2 - W = -2.20 +/- 4.19) in tumor-containing nodes. These differences in contrast-to-noise ratio changes between tumor-bearing versus nontumor-bearing nodes were statistically significant (P < 0.05). Histologic analysis showed similar distribution of AMI-227 within normal and reactive nodes, but not in tumor-bearing nodes. CONCLUSIONS: Differences in AMI-227-uptake between tumor- and nontumor-bearing nodes detected with magnetic resonance imaging are helpful for distinguishing the two entities.

The promise of computer aided detection in digital mammography.

Computer-aided detection (CAD) is a new technology now being implemented in many clinics to reduce the false negative rate in mammography screening. A large clinical study has been completed which shows that a substantial false negative (miss) rate exists in screening mammography, a significant fraction of the missed cancers are not subtle, and CAD has high sensitivity to these missed cancers. Full field digital mammography is now coming on the scene, but has not yet been proven in clinical practice. The authors believe that full acceptance of the new digital technology depends not merely on demonstrations of 'substantial equivalence' to film-screen technology, but rather on more complete exploitation of the unique advantages of digital technology, and that CAD can play a key role. These advantages derive from CAD's ability to quickly (in near real-time) perform analytical computations on digital information that is not readily available to the radiologist until after the cost of film-processing has occurred.

Assessment of laryngeal function by digital subtraction laryngography.

The evaluation of vocal cord function can be problematic in the presence of oropharyngeal tumors, hypopharyngeal tumors, and supraglottic lesions and in noncompliant adult and pediatric patients. The use of computer image subtraction techniques coupled with digital fluoroscopy has inherent high-quality resolution that can provide an excellent image of vocal cord symmetry and movement. The use of air as the contrast medium provides the ability to measure the extent of vocal cord excursion as well as the extent of piriform sinus lesions. In addition, it is a noninvasive procedure that requires a minimal imaging exposure time, with the result that the patient undergoes minimal radiation exposure.

The mediastinum in Hodgkin's and non-Hodgkin's lymphomas.

The mediastinum is commonly involved with disease in patients with Hodgkin's and non-Hodgkin's lymphomas. The involvement may be permeative, or individual groups of nodes may be enlarged. The parietal nodes of the mediastinum may also be abnormal with either type. Precise mapping of all disease is important when radiation therapy is to be a major component of treatment planning. Detection of relapse following mantle irradiation is frequently dependent on having a new comparative baseline after the distortions of mediastinal contours consequent to radiation treatment have stabilized.

Radiologic investigation of thoracic metastases from unknown primary sites.

When a patient presents with thoracic metastases from a tumor whose site of origin is not apparent from the initial history, physical examination, and routine laboratory studies, there is a considerable likelihood that the individual will be subjected to an extensive and frequently unrewarding series of radiologic examinations. An analysis of the "behavior" of so-called tumors of unknown origin suggests that these tumors metastasize to distant sites with a frequency that is different from the more common tumors, that is to say, those whose primary site is readily apparent. While compulsive testing should unquestionably be eschewed, certain radiologic tests are still appropriate. These studies should be supplemented, when necessary, by newer pathologic studies, primarily those that involve the rapidly developing field of immunocytochemistry.

[Comparison of radiological findings in children with Hodgkin's disease and non-Hodgkin's lymphomas at disease presentation (author's transl)]. / Raffronto dei rilievi radiografici in bambini con malattia di Hodgkin e linfomi non-hodgkin al primo riscontro della malattia

From January 1968 to March 1975, 115 patients with malignant lymphomas, all aged under 15 years were admitted to the Istituto Nazionale Tumori of Milan : 57 had Hodgkin's disease (mean age 9.7 years) and 58 non-Hodgkin's lymphomas (mean age 7.7 yrs). In this group of consecutive unselected and untreated patients the incidence of lesions radiologically evident at disease presentation was comparatively evaluated in relation to histology, 36 cases underwent a subsequent diagnostic laparotomy with splenectomy.

The role of lymphography in "apparently localized" prostatic carcinoma.

The preliminary results of an ongoing protocol which is attempting to determine the incidence of lymph node metastasis in unselected patients with previously untreated "apparently localized" carcinoma of the prostate are briefly presented. All patients have disease confined to the prostate gland or periprostatic bed, without evidence of metastasis by standard clinical, laboratory, and radiographic (excluding lymphography) tests. Following lymphography, a "staging laparotomy" is performed which permits histologic documentation of lymph node metastais and provides data for the evaluation of lymphographic accuracy.

Lymphography in malignant histiocytosis: case report.

Malignant histiocytosis is an uncommon, progressive disease with a poor prognosis which is characterized by malaise, fever, lymphadenopathy, and splenomegaly. Lymphadenopathy is commonly present at presentation as well as during the course of the disease. The lymphographic findings in this case report were very similar to those encountered in malignant lymphoma, a not unexpected situation since the clinical and pathological resemblances to histiocytic lymphoma are striking.

Lymphography in childhood: six years experience with 242 cases.

From January, 1969 - December, 1974, 242 children less than 15 years of age underwent lymphography at the National Cancer Institute, Milan. Successful lymphatic cannulation was accomplished in 97% (440/463) of the sites where it was attempted. No major or permanent complications were encountered, although minor untoward effects might not have been recorded. In those children undergoing biopsy of opacified lymph nodes, lymphographic-histologic correlation was 98% (45/46). Nonspecific reactive hyperplasia lymphographic patterns were encountered in 36% of all studies, confirming its high incidence in the pediatric age group. This study has shown that lymphography in childhood can be as readily performed as in the adult and that its diagnostic accuracy is acceptable. As in adults, it is useful in treatment planning, evaluating results of therapy, and detecting recurrent tumor. The frequent occurrence of nonspecific reactive hyperplasia in the pediatric lymphogram should not be mistaken for evidence of tumor, particularly lymphoma.