Prognostička vrijednost CT morfoloških karakteristika nemikrocelularnih karcinoma pluća u IA i IB stadiju bolesti

PURPOSE: The aim of this work is to estimate the prognostic value of preoperative chest computed tomography (CT) morphological characteristics in patients resected for non-small cell lung cancer (NSCLC) and classified as stage IA and IB. MATERIALS AND METHODS: 194 patients operated between 1996 and 2001, and classified as stage IA and IB of NSCLC, all patients underwent lobectomy or pulmectomy with hilar and mediastinal lymph node dissection. The chest CT imaging and clinicopathologic records were examined. We retrospectively analyzed sex, age, date of operation, type of resection, location, histology type, stage, and date of death. The chest CT morphological data examined and analyzed were tumor size, tumor margins, tumor structure, periphery of tumor and relation of tumor and visceral pleura. The Kaplan-Meier bivariable method was used to estimate survival. Multivariable method used for predicting survival was Cox proportional hazards regression model. RESULTS: The tumor size, T stage, tumor margins, tumor structure, periphery of tumor and relation tumor to visceral pleura showed significant influence on survival in the bivariable analysis. In the multivariable analysis according Cox model only tumor margins, tumor perphery and tumor relation with visceral pleura entered into regression. CONCLUSION: The CT morphological characteristics of tumor margins, tumor periphery and tumor relation with visceral pleura in IA and IB stage of NSCLC are important preoperative predictive factors for patients outcome after surgery

Perkutana biopsija medijastina tankom iglom pod kontrolom ultrazvuka

The clinicoradiological diagnostic possibilities in mediastinal processes have improved with the introduction of percutaneous and endoscopic biopsies. The aim of this paper is to evaluate the diagnostic reliability of percutaenous mediastinal biopsies (PMB) with a fine needle under ultrasound guidance in patients with a mediastinal mass. 73 PMB with ultrasound guidance have been performed in 66 patients. In this investigation, only patients with primary or secondary solid or cystic formations of the anterior and posterior mediastinum have been included. Patients with achalasia of the oesophagus, diverticles, herniation, mediastinitis and vascular changes have been excluded by conventional radiologic means (summary chest radiographs in two projections), and when required by additional methods (tomography, ultrasound, CT, angiography). The material obtained was examined cytologically. The cytologic results of fine-needle PMB were verified histologically after surgery, surgical biopsies, cytochemical and microbiologic examinations in addition to clinical and radiologic follow-up. The specificity, sensitivity and accuracy of radiological and PMB results was calculated. A microscopic diagnosis was established in all examined cases: primary malignant processes 31 (46.97%), metastases 14 (21.21%), benign tumors 6 (9.09%), inflammation 9 (13.64%), thyroid goiter and sarcoidosis 6 (9.09%). A high degree of accuracy (90%), specificity (100%) and sensitivity (100%) was obtained. There were no complications. The diagnostic safety of a technically simple, rapid and low cost method has been established, as a frequent alternative to open surgical biopsy and other biopsies under ionizing radiation devices.Kliničkoradiološke dijagnostičke mogućnosti u dijagnosticiranju procesa u medijastinu su napredovale uvođenjem perkutanih i endoskopskih biopsija. Cilj ovog rada je vrednovati dijagnostičku pouzdanost perkutane biopsije medijastina (PMB) tankom iglom pod kontrolom ultrazvuka u pacijenata s ekspanzivnim procesom u medijastinu. U 66 pacijenata su učinjene 73 PMB pod kontrolom ultrazvuka. U ovo su istraživanje uključeni samo pacijenti s primarnim ili sekundarnim solidnim ili cističkim tvorbama u prednjem ili stražnjem medijastinu. Pacijenti s ahalazijom, divertiklima, hernijama, medijastinitisom i vaskularnim promjenama su isključeni konvencionalnom radiološkom obradom (sumacijski telerendgenogrami u dva smjera) i, eventualno, dodatnim metodama (tomografija, ultrazvuk, CT, angiografija). Dobiveni materijal je analiziran citološki. Citološki rezultati PMB učinjene tankom iglom verificirani su histološki nakon operativnog zahvata, otvorene biopsije, citokemijskke i mikrobiološke pretrage uz kliničko i radiološko praćenje. Izračunana je specifičnost, senzitivnost i točnost radioloških i PMB rezultata. Mikroskopska dijagnoza je postavljena u svim obra|enim slučajevima: primarni maligni process 31 (46,97%), metastaze 14 (21,21%), benigni tumori 6 (9,09%), upale 9 (13,64%), struma i sarkoidoza 6 (9,09%). Dobiven je visok stupanj točnosti (90%), specifičnosti (100%) i senzitivnosti (100%). Nije bilo komplikacija. Ustanovljena je dijagnostička sigurnost jednostavne, brze i jeftine metode kao česte alternative otvorenoj biopsiji i drugim biopsijama izvedenim pod kontrolom ure|aja s ionizantnim zračenjem

Synchronous Bilateral Breast Carcinoma with Two Different Morphology Subtypes: A Case Report

We report a case of synchronous bilateral breast cancer with ductal and medullary carcinoma. A 60-year-old woman presented with lesion in both breasts which were mammographicaly found two years ago. Ultrasonography proved two suspected masses in breasts. Fine needle cytology was performed and confirmed bilateral carcinoma but with different cytological findings. The cytological feature of the left breast suggested ductal carcinoma and of the right breast raised possibility of a medullary carcinoma. Patient underwent bilateral quadrectomy with evacuation of axillary lymph nodes. Histological examination showed bilateral carcinoma with two different histological features: ductal in the left and medullary carcinoma in the right breast

Synchronous bilateral breast carcinoma with two different morphology subtypes: a case report [Istovremeni obostrani karcinom dojke različitog morfološkog subtipa: prikaz slučaja]

We report a case of synchronous bilateral breast cancer with ductal and medullary carcinoma. A 60-year-old woman presented with lesion in both breasts which were mammographically found two years ago. Ultrasonography proved two suspected masses in breasts. Fine needle cytology was performed and confirmed bilateral carcinoma but with different cytological findings. The cytological feature of the left breast suggested ductal carcinoma and of the right breast raised possibility of a medullary carcinoma. Patient underwent bilateral quadrectomy with evacuation of axillary lymph nodes. Histological examination showed bilateral carcinoma with two different histological features: ductal in the left and medullary carcinoma in the right breast

Description of Diffuse Interstitial Lung Diseases and Assessment of Their Activity

Conventional roentgenograms constitute the groundwork for the evaluation of diffuse interstitial lung disease (DILD). ILO classification with its symbols (additionally extended to granulomatoses) does not comprise pathoanatomic assumptions and does not enter lesion genesis for it could lead to diagnostic misconception. »High resolution« computer tomography (HRCT) provides the evaluation of lesion morphology and disease activity. After having treated our 129 patients with diffuse interstitial lung disease we have come to the conclusion that, beside pneumoconiosis, the application of extended standard ILO symbols are suitable to other interstitial pathology for the homogeneity of morphologic characteristics. As for diagnoses making, in distinction to other methods, it can be said that analyzing roentgenograms of the extended ILO provides high level of lesion evaluation standardization for diffuse interstitial disease as well as substantial congruity with CT finding. It is clear that such analysis cannot be applied in our daily work, however we have both concluded and proved that on conventional roentgenograms the condition of interstitial lesion can roughly be assessed. This is of high importance considering minimal dose of radiation exposure by standard tests in comparison with other radiological techniques. Nevertheless, CT scanning should be performed if there should be the need for the assessment of the morphology and the activity of lesion, to the benefit of our patients