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.

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.

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.

[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).

[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.