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

The Possibilities and Limitations of Direct Digital Radiography, Ultrasound and Computed Tomography in Diagnosing Pleural Mesotelioma

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

The possibilities and limitations of direct digital radiography, ultrasound and computed tomography in diagnosing pleural mesotelioma [Mogućnsoti i ograničenja direktne digitalne radiografije, ultrazvuka i kompljutorizirane tomografije u dijagnostici mezotelioma pleure]

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found

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

Mogućnsoti i ograničenja direktne digitalne radiografije, ultrazvuka i kompljutorizirane tomografije u dijagnostici mezotelioma pleure

The goal of this study was to compare the possibilities and limitations of direct digital radiography of the chest (DDR), the use of ultrasound of the chest (US) and single slice computed tomography of the chest (CT) in diagnosing pleural mesothelioma. The study was conducted during the course of one year, on 80 patients who were successively referred to a specialized institution, under clinical suspicion of mesothelioma. The method of investigation was the comparison of findings, obtained by the reviewed methods of examination, with the pathohistologic results of a biopsy performed on each patient. The findings that were obtained by the enumerated methods were classified according to the radiologic signs that were found in each individual patient. We evaluated following radiological findings (signs), on each of the investigated methods: plaques, localized and generalized pleural thickenings, calcifications of the pleura, pleural effusions, parapneumonic effusions, pleural empyema, (round) atelectasis, pneumothorax, tumor mass or node, inflammatory infiltrate, elevation of the hemidiaphragm and osteolysis. The results of these were compared with pathohistologic findings and analyzed by means of standard statistical methods. The highest sensitivity was found for CT (94.4 %), followed by US (92.6%), and by DDR (90.7%). The highest specificity was obtained with DDR (46.2 %), followed by CT (35.5%) and US (23.8%). The comparison of these methods showed 90% diagnostic accuracy for DDR in relation to CT. CT as an individual method best satisfied most of the criteria for diagnosing mesothelioma. No pathognomonic radiologic sign for mesothelioma was found.Cilj istraživanja je bio usporediti mogućnosti i ograničenja direktne digitalne radiografije prsišta (DDR), ultrazvuka prsišta (UZV) i kompjutorizirane tomografije prsišta (CT) u otkrivanju mezotelioma pleure. Istraživanje je provedeno tijekom godine dana, na 80 bolesnika, uzastopno upućenih u specijaliziranu ustanovu, s kliničkom sumnjom na mezoteliom. Metoda istraživanja bila je usporedba nalaza dobivenih ispitivanim metodama sa patohistološkim nalazom biopsije za svakog bolesnika. Nalazi dobiveni navedenim metodama klasificirani su prema pronađenim radiološkim znacima, za svakog pacijenta posebno. Svakom od korištenih metoda analizirani su sljedeći radiološki znakovi: pleuralni izljev, zadebljanja pleure, plakovi, kalcifikati, tumorske mase ili nodusi, pneumotoraks, atelektaza, upalni infiltrate, ožiljne lezije, elevacija ošita i osteoliza. Dobiveni rezultati uspoređeni su s patohistološkim nalazom i obrađeni standardnim statističkim metodama. Najveću osjetljivost pokazao je CT (94,4%). Slijedi UZV (92,6%), te DDR (90,7%). Najveća je specifičnost DDR (46,2%), slijedi CT (35, 5%) i UZV (23, 8%). Usporedba metoda pokazala je 90% dijagnostičku točnost DDR-e u odnosu na CT. UZV je pokazao točnost od 80% u odnosu na CT. CT, kao pojedinačna metoda, najbolje zadovoljava većinu kriterija za dijagnostiku mezotelioma. Nije nađen patognomoničan radiološki znak za dijagnozu mezotelioma