RESUMEN
OBJECTIVE: We performed a retrospective review to determine the need for reexcision after excisional biopsy in patients with breast cancer who were treated with breast-conserving therapy. MATERIALS AND METHODS: Eighty-seven patients with infiltrating ductal carcinoma of the breast underwent excisional biopsy followed by reexcision of the tumor site. Reexcision specimens were evaluated for residual disease and correlated with initial mammographic and pathologic findings. RESULTS: Tumors with an extensive intraductal component (EIC) were more likely to have residual disease at reexcision than those without an EIC (65% versus 6%, p < .01). Initially positive margins did not predict residual disease at reexcision significantly better than did initially negative margins (29% versus 13%, p = .08). Suspicious mammographic calcifications, absence of a discernible mass detected mammographically, or both were associated with a significantly increased risk of residual disease at reexcision. By combining all features (EIC, margin status, and mammography), we found that subsets of patients had significantly different risks of residual disease, which ranged from 6% to 83% (p < .01). CONCLUSION: Mammographic and pathologic findings are useful in predicting the adequacy of breast resection before radiation therapy in patients treated with breast-conserving therapy. An EIC is the most useful predictor of residual disease at reexcision. When combined, EIC, margin status, and mammographic findings form a powerful tool to judge the need for reexcision before radiation therapy.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/diagnóstico por imagen , Mamografía , Adulto , Anciano , Biopsia , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/patología , Carcinoma Ductal de Mama/cirugía , Femenino , Humanos , Recién Nacido , Persona de Mediana Edad , Reoperación , Estudios RetrospectivosRESUMEN
Transbronchial fine needle aspiration (TBFNA) was used to confirm the diagnosis of bronchogenic cyst in two asymptomatic patients with mediastinal masses who declined surgical exploration. Both masses were located subcarinally but differed in computed tomographic density (7 and 59 Hounsfield units). Aspirate cytology demonstrated predominately bronchial columnar epithelial cells in mucus, without the lymphocytes and polymorphonuclear leukocytes normally seen in intrabronchial secretions. The denser cyst additionally contained some alveolar macrophages with ingested surfactant. While benignity cannot be absolutely assured, it is corroborated by serial evaluation of these patients, which has revealed no interval change in symptoms or roentgenographic size for two and three years, respectively. Under selected circumstances, it appears that TBFNA can be used to extend bronchoscopic diagnosis to benign mediastinal masses if the cytologic features of such aspirates are unique.
Asunto(s)
Quiste Mediastínico/patología , Biopsia con Aguja , Citodiagnóstico , Humanos , Masculino , Quiste Mediastínico/diagnóstico , Persona de Mediana EdadRESUMEN
Thirty-three patients with peripheral pulmonary malignancies contiguous with a pleural surface were evaluated for chest wall invasion by computed tomography (CT). CT criteria included pleural thickening adjacent to the tumor, encroachment on or increased density of the extrapleural fat, asymmetry of the extrapleural soft tissues adjacent to the tumor, apparent mass invading the chest wall, and rib destruction. The CT scans were classified as positive, negative, or equivocal for invasion, and a decision matrix was constructed comparing CT results with pathologic data. The sensitivity of CT was 38%, specificity was 40%, and accuracy was 39% for evaluation of invasion if equivocal CT results were counted as radiologic errors. CT scanning has low accuracy in assessing chest wall invasion in patients with peripheral lung cancers.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Retrospectivos , Neoplasias Torácicas/patologíaAsunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Diagnóstico Diferencial , Empiema/diagnóstico por imagen , Granuloma/diagnóstico por imagen , Humanos , Absceso Pulmonar/diagnóstico por imagen , Enfermedades Pulmonares Fúngicas/complicaciones , Enfermedades Pulmonares Fúngicas/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Linfoma/diagnóstico por imagen , Traumatismos por Radiación/diagnóstico por imagen , Radiografía Torácica , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico por imagenRESUMEN
Clinical and roentgen features of hirsute esophagus in 3 patients are described. Exuberant hair growth and masses of hair in the endopharyngoesophagus produced the classic clinical triad of progressive dysphagia, hair-spitting, and choking spells. This unique and rare complication of reconstructive surgery of the pharynx and esophagus is related to the skin flaps which are mobilized and rotated to reconstruct a skin tube endopharyngoesphagus and to restore anatomical continuity of the gastrointestinal tract.
Asunto(s)
Enfermedades del Esófago/etiología , Cabello , Complicaciones Posoperatorias , Enfermedades del Esófago/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Trasplante de Piel , Colgajos QuirúrgicosRESUMEN
The sonographic and CT appearance of squamous cell carcinoma of the renal pelvis is described. Clinical presentation, pathology, and radiologic diagnosis of this rare urothelial tumor are discussed. The sonographic or CT appearance may suggest this diagnosis preoperatively.