Bronchogenic carcinoma with extramucosal development. Diagnostic problems

Bronchogenic carcinoma is characterized by three different patterns of spread: endobronchial, the commonest, submucosal, and peribronchial. While the diagnostic yield of bronchoscopy is very high for endobronchial masses, both submucosal and peribronchial tumors are more difficult to detect, and standard forceps biopsy can be negative. In such cases transbronchial needle aspiration biopsy allows higher diagnostic accuracy. CT findings of extramucosal neoplastic spread are not specific. Thickening of the bronchial walls is the commonest sign, but CT is inaccurate in predicting whether bronchial thickening will result in endobronchial/extramucosal neoplasm, fibrosis or bronchial wall edema. Despite this inaccuracy, CT is complementary to bronchoscopy since it allows to: 1) detect a pathology in the bronchial walls, which appear thickened; 2) delineate the extent of extraluminal spread; 3) help plan transbronchial needle aspiration biopsy.     

Bone scanning in pregnant patients with breast carcinoma

Radionuclide scanning is usually contraindicated in pregnancy because of the danger of fetal radiation exposure. Radionuclide bone scanning with Tc-99m MDP is a sensitive indicator of early osseous metastases in breast cancer. Three cases of breast cancer during pregnancy are reported; modified bone scanning was utilized for staging and decision analysis. Modifications of bone scanning techniques to minimize fetal radiation exposure and fetal dosimetry calculations are described.     

Prognostic value of axillary lymphoscintigraphy in breast carcinoma patients

Axillary lymphoscintigraphy (AxLS) with bilateral interdigital injection of [99mTc]antimony sulfide colloid carried out concurrently with internal mammary lymphoscintigraphy in 488 patients with breast carcinoma was evaluated. Patterns of radiocolloid distribution within the ipsilateral axilla and supraclavicular fossa were compared with similar features on the contralateral side to determine whether image characteristics are significantly disrupted by prior surgery, reflect the presence of metastases, and can predict treatment failure. Interpretive criteria for AxLS were refined after correlation of the identified image components with clinical parameters including axillary surgery, lymph node histology and relapse within a follow-up period of 2 years from the study. Results indicate that AxLS is at least as accurate as clinical assessment and provides data predictive of relapse to complement axillary lymph node status although the technique cannot presently replace lymph node sampling for patient staging.     

Bronchogenic cysts in children

Radiographic, surgical and pathological features of 33 paediatric patients with bronchogenic cysts are reviewed. These congenital lesions usually presented as spheroid mediastinal masses, near the carina or right paratracheal area, 2-3 cm in diameter with sharply delineated borders. Occasionally, the masses were lobulated or triangular in shape. Some cysts produced considerable airway distortion. All intrapulmonary cysts had connections, sometimes patent, with the trachea or main-stem bronchi. Thin-walled, completely aerated cysts became thick-walled with infection. A few air-filled and solid cysts grew rapidly. Cystic lung disease distal to central bronchogenic cysts was observed.     

Value of axillary lymphoscintigraphy in patients with operated breast carcinoma

PURPOSE: To evaluate axillary dissection with axillary lymphoscintigraphy (ALS) in postoperative patients with breast carcinoma and its role in adjuvant radiotherapy (RT). Additionally, to define axillary dissection as complete and incomplete with ALS and to correlate it with the number of removed lymph nodes. MATERIAL AND METHODS: In the last two years, 121 women were studied four weeks after operation. Bilateral second interdigital subcutaneous injections were performed for ALS. Complete and incomplete axillary dissection were interpreted according to the number of surgically removed lymph nodes. ALS was interpreted as complete if no accumulation was shown. RESULTS: There was a good correlation between the number of surgically removed lymph nodes and complete and incomplete interpretation on ALS (p < 0.004). The number of removed lymph nodes was equal to or greater than 15 in 72% patients with complete dissection according to ALS. Of 48 patients with surgically incomplete axillary dissection, 18 (38%) showed no accumulation in the axillary region, while 25 of 68 (37%) patients with surgically complete dissection showed accumulation in the axillary region and were interpreted as incomplete according to ALS. Indication of RT was changed after ALS in patients with 1 to 3 involved lymph nodes. While RT was not considered in 12 of these patients before ALS, they were included in RT planning. On the other hand, 17 patients, considered for RT previously, were excluded from RT planning after ALS. CONCLUSION: Evaluation of axillary dissection with ALS especially in suspicious patients with 1 to 3 lymph node metastases might prevent unnecessary morbidity and can be useful in selecting patients who truly need axillary irradiation.     

Bronchogenic carcinoma staging: comparison of magnetic resonance/computerized tomography]

The staging of bronchogenic carcinoma is an important factor to select the appropriate treatment. Indeed, the definition of locoregional spread and of hilar and mediastinal node involvement is essential for both correct preoperative assessment and prognostic evaluation of bronchogenic carcinoma. CT and MR imaging are the methods of choice in the evaluation of T and N, even though other techniques--e.g., US and nuclear medicine--can also provide valuable diagnostic information. The authors examined 50 patients with primary bronchogenic carcinoma by means of plain radiographs, CT and MR of the chest. MR and CT findings were compared with surgical results on the basis of TNM classification. In the evaluation of T, sensitivity and specificity were 66% and 88.6%, respectively, for CT and 76% and 92% for MR imaging. No statistically significant differences were found between the two imaging methods (p = 0.19). In the evaluation of N, sensitivity and specificity were 56% and 78%, respectively, for CT and 76% and 88% for MR imaging. A statistically significant difference was found between MR and CT accuracy rates (p = 0.934). CT and MR results were in disagreement especially in the evaluation of hilar lymph nodes. To date, MR imaging cannot be considered a substitute for or a routine adjunct to CT in the staging of bronchogenic carcinoma due to its poor spatial resolution, to the presence of artifacts (especially with high-intensity fields), its cost and limited availability. However, in the evaluation of specific anatomical regions--e.g., the pulmonary apex and the peridiaphragmatic region--MR can provide more diagnostic information than CT thanks to its multiplanarity and better contrast resolution.     

MR imaging of the breast in patients with invasive lobular carcinoma

OBJECTIVE: Our objective was to assess the usefulness of MR imaging in patients diagnosed with invasive lobular carcinoma of the breast. MATERIALS AND METHODS: Between July 1993 and September 1999, 32 women (33 cases) diagnosed with pure invasive lobular carcinoma of the breast underwent contrast-enhanced MR imaging examination. One woman was excluded because of lack of follow-up. Correlation was made between the mammographic and sonographic findings, the MR imaging findings, and the final pathology results for the remaining 32 cases. RESULTS: In 18 women who did not undergo excisional biopsy before the MR imaging, MR imaging showed more extensive tumor burden or the detection of the primary lesion that was occult on conventional imaging in seven (38.9%) of 18 women. In nine (50%) of 18 women, MR imaging performed equally as well as mammography and sonography. In one case (5.6%), MR imaging and mammography underestimated disease extent. In another patient (5.6%), MR imaging overestimated tumor burden, although mammography failed to show the cancer. In 14 patients who had excisional biopsy before the MR imaging, residual tumor was shown in eight women (57.1%) with extensive tumor or additional separate foci in five of the eight patients. In two cases (14.3%) that were interpreted as equivocal, residual tumor was shown in both cases on reexcision. In three cases (21.4%), the MR imaging was interpreted as negative, but microscopic tumor was shown around seroma on reexcision. False-positive enhancement was seen in one case (7.1%). CONCLUSION: MR imaging showed more extensive tumor than conventional imaging and affected the clinical management in 16 (50%) of 32 patients with invasive lobular carcinoma.     

Solitary rib lesions in bone scans of patients with breast carcinoma

The aetiology of solitary rib lesions detected on bone scans was evaluated retrospectively. Seventy-five patients with breast carcinoma, and each with a solitary hot spot on a bone scan, were included in the study. The aetiology of the solitary rib lesions was determined by using all available clinical, laboratory and radiological data, and was clarified in 65 of the 75 patients, and not clarified in the remaining 10. In 17 of those 65 (26.1%), the aetiology of increased uptake was malignant; while in 48 of the 65 (73.8%) it was benign in origin. Linear lesions were mainly metastatic in origin (seven of nine, 77.7%) whereas focal lesions were mostly benign in origin (46 of 56, 82.19%). In the group of 16 hot spots located at the anterior rib end, 14 (87.5%) were benign, and two (12.5%) were malignant in origin. The relation between mastectomy side and the distribution of anterior and anterior rib end localization of hot spots was also investigated. Twenty-three of 32 rib lesions (71.8%) were on the same side as the surgery. In conclusion, solitary rib lesions on bone scans in patients with breast carcinoma are frequently benign in origin, especially if they are focal and located at the anterior rib end.