Coopmans de Yoldi G

Diagnostic efficacy of physical examination, mammography, fine needle aspiration cytology (triple-test) in solid breast lumps: An analysis of 1708 consecutive cases

The clinical-radiologic-cytologic triplet was used for diagnostic evaluation in 1708 women over 30 years old with a breast lump. All the lumps were subjected to surgery except for 258 cases in which clinical resolution took place within 1-2 months. Seven-hundred and ninety-three out of 1450 nodules removed were cancers. Sensitivity of the clinical, mammographic and cytologic examinations was 82%, 73% and 68%, respectively. It increased to 95% when they were as sociated. Specificity was 63%, 80% and 97%, respectively. The predictive value of positive results of the triple test was 100%. No patient with malignant cytology was subsequently shown to have benign disease. The systematic use of the triple test in solid breast lumps for the early detection of cancer is recommended as a routine procedure. However, participation of experienced radiologists and pathologists as well as physicians skilled in fine needle puncture is required.

Systematic Use of the Clinical-Mammographic-Cytologic Triplet for the Early Diagnosis of Mammary Carcinoma

Of about 8500 women with a minimum age of 30 years who had a breast examination at our Ouptatient Clinic from April 1982 to March 1983, we found in 286 cases a clinically evident carcinoma, and in 534 cases an apparently benign or suspect solid lump. All 534 of these cases were subjected to the triplet clinical, mammographic and cytologic diagnostic investigation by needle aspiration within 1 to 4 days. The clinical judgment was based on a method of scoring of the characters of 9 physical features (Clinical Diagnostic Index) in use at our Institute. The results of the examinations were grouped into 5 categories: 1) certain benignancy or negativity of the examination; 2) probable benignancy (excluding the cytologic examination); 3) probable malignancy; 4) certain malignancy; 5) nonevaluability of the examination (excluding the clinical examination). Except for 80 cases with collectively negative examinations which were clearly or completely regressed at the control within 2 months, all the others were subjected to surgery. On the basis of the histologic examination (or if regression occurred), 284 of the 534 lumps examined were found to be benign or nontumoral, whereas the other 250 (47%) were carcinomas. Of the latter, 57% were not more than 20 mm in size, whereas in 67.6% there was no microscopic evidence of axillary metastases. Sensitivity of the clinical, mammographic and cytologic examinations was 0.79, 0.76 and 0.72, respectively; specificity 0.71, 0.75 and 0.94, respectively, and the predictive value for malignancy of the positive response of the three examinations 0.71, 0.75 and 0.93, respectively. The use of the diagnostic triplet demonstrated an overall sensitivity of 0.95, specificity of 0.59, and a predictive value for malignancy of 0.98 and 0.93 for benignancy. These results confirm the usefulness of the systematic use of the diagnostic triplet in solid breast lumps of over thirty aged women for the early detection of cancer.

Nipple discharge as a sign of preneoplastic lesions and occult carcinoma of the breast: clinical and galactographic study in 103 consecutive patients.

A clinical and galactographic investigation was carried out on 103 patients with hematic, serous-hematic, and serous nipple discharge. The age of the patients ranged from 18 to 72 years. A single papilloma was found in 20 cases, diffuse papillomatosis in 2 cases, atypical ductal hyperplasia in 8 cases, and ductal carcinoma in 4 cases (3 of these were infiltrating and 1 was noninfiltrating associated with a diffuse papillomatosis). Mammography gave no indications of carcinoma in any of the 4 cases. In the remaining 49 patients, pictures of ductal hyperplasia, periductal mastitis or sclerosis, sclerosing adenosis, or ductal ectasia were observed. The various types of lesions were often associated. Lacunae, stenosis, or occlusion of the ducts, evidenced by galactography, correlated well with the histologic findings of proliferative lesions of the ductal epithelium. Nevertheless, in practice, it should be the type of discharge that indicates surgery rather than galactographic or cytologic data, which appeared to have little diagnostic value. The frequency with which preneoplastic (or limit) lesions, and also nonsuspect carcinomas were found in patients with a significant nipple discharge confirm the importance of this symptom for a secondary prevention or early diagnosis of mammary neoplastic lesions originating from galactophorous ducts. Finally, complete resection of the galactophorous ducts must be considered as the best treatment in all patients with a suspicious nipple discharge that requires surgery.

Xeroradiography of bone and soft tissue tumors.

Xeroradiography was used for the study of 233 cases of bone and soft tissue tumors, both benign and malignant, 177 of which were histologically proven. In 150 cases, comparative x-ray films were also available. In bone tumors, xeroradiography was more effective than film radiography in 33 cases (44%), less effective in 16 cases (22%) and the 2 techniques were substantially equivalent in 25 cases (34%). In soft tissue tumors, xeroradiography was more effective than film radiography in 59 cases (78%), less effective in 2 cases (3%) and equivalent in 15 cases (19%). Xeroradiography is held to be a useful second-line technique in selected bone tumors, in particular for the study of trabecular structure, periosteal calcifications and cortical bone. In the field of soft tissue tumors, xeroradiography can be a promising first-choice examination in the presence of a mass or when a recurrence is suspected. The advantages and drawbacks of this technique in both types of tumors are reviewed and discussed.

Ultrasonographic evaluation of palpable breast masses: analysis of 134 cases.

Sonography has become a helpful adjunct to mammography mainly for a differential diagnosis between simple cysts and solid masses. The authors examined by ultrasound 134 palpable masses in the breast which had been previously evaluated by clinical examination and mammography and then submitted to biopsy or fine needle aspiration. The exact diagnosis of a simple cyst was made in 94.1% of the cases, whereas the diagnosis of fibroadenoma was made in 80% of the cases. Ultrasound examination proved to be useful in patients with dense breasts: in this group, 82.1% of the patients with a histologic diagnosis of benign status had a correct ultrasound diagnosis. In agreement with other authors, we believe that breast sonography has no part in screening programs.

Contribution to the radiographic study of mammary cysts with gaseous contrast medium

The radiological diagnosis of mammary cysts is not easy in glandular or fibrous breasts intensely radiopaque, whereas such alterations are better visualized in atrophic, fatty, radiotransparent breasts. The authors performed systematically the liquid withdrawing puncture in cystic formations discovered with the clinico-radiographical examination and filled these with air. The described procedure serves the twofold purpose of demonstrating intracystic neoformations developed in the wall and projecting into the cavity and of better recognizing normal or pathological pericystic structures. The procedure is safe, easy to perform, and supplies generally demonstrative radiographical pictures.

[Clinico-statistical analysis of rhinopharyngeal neoplasms treated by radiotherapy from 1928 to 1963 (314 cases)].

Results obtained by radiotherapy in 314 cases of rhinopharyngeal neoplasms treated from 1928 to 1963 at the Institute of Radiology of the Medical School and at the National Cancer Institute are presented. The series of cases includes 61 epithelial neoplasms, 117 rhinopharyngiomas, 112 connective neoplasms and 24 cases non histologically proved. In 41.7 % of the cases regional lymph node invasion was the first sign of the disease. Regional lymph node involvement was present at the beginning of radiotherapy in 72.5 % of the cases. Sixty-eight cases, hospitalized from 1928 to 1945, were prevailingly treated with endocavitary radiumtherapy and by roentgentherapy. One hundred and sixty cases, hospitalized from 1946 to 1958, were treated by various procedures and, in the last years, almost exclusively by multiple small fields roentgentherapy and by convergent roentgentherapy. Most of the 80 cases treated from 1959 to 1963 were submitted to telecobalt therapy. In the connective neoplasms (lympho- and reticulosarcomas) the overall 3-year and 5-year survival rate has been 34.2 % and 28.5 % respectively. In particular, cases without regional lymph node invasion at the beginning of the treatment had a 5-year survival rate of 61.5 %, opposite to 15.4 % in patients with lymph node metastases. In the other histological forms (rhinopharyngiomas, epitheliomas and non ascertained cases) the overall 3-year survival was 28 %, and the 5-year survival 19.6 %. In patients showing no lymph node involvement at the beginning of the treatment the 5-year survival rate was 37.8 %, in those with unilateral invasion 15.8 %, and in those with bilateral lymph node metastases 5.8 %. In epithelial neoplasms, the 5-year survival was 12.5 % in patients who had, at the beginning of the treatment, neurological or radiological signs of metastases to the base of the skull, and 21.9 % in patients, without involvement of the base of the skull. A statistical analysis of the results obtained in the various periods showed a more favourable outcome in patients treated by telecobalt therapy, as demonstrated both by average life and 3-year and 5-year survival rates.

The role of magnetic resonance imaging in the evaluation of neoplastic lesions of the breast.

Thirty-seven patients were evaluated for suspected breast cancer by magnetic resonance imaging (MRI) using 0.5- and 1.5-Tesla. We esamined the patterns in breast images and the use of MRI in evaluating neoplasms. At the moment the cost/benefit ratio is unfavorable, mainly because of the availability of alternative methods of high accuracy and low cost, like mammography and ultrasonography. Furthermore fine needle aspiration biopsy is not possible with MRI. The widespread use of MRI for breast pathology seems not to be justified by the results obtained.

Surgical or Radiosurgical Failures on Cervical Lymph Nodes in Treatment of Head and Neck Cancer

From a series of 850 patients with head and neck carcinoma and subjected to lymph node dissection, 80 cases of recurrences in the neck have been collected. Postoperative radiotherapy was performed only in cases with metastatic extranodal spread. Of these recurrences, 56 occurred in the area of lymph node dissection, 7 were marginal and 17 were contralateral. The recurrences occurred prevalently in node-positive (N +) patients (70 of 80). The incidence of recurrences in the dissection area was 41.6 % (25 of 60) in cases with metastatic extranodal spread, despite postoperative radiotherapy. The incidence of recurrences in cases with clinically evident metastases at the time of dissection but without extranodal spread and not subjected to postoperative radiotherapy was relatively high (24.1 %, or 28 of 116). Since recurrences occurred, despite postoperative radiotherapy, in a relatively high percentage of cases with carcinoma of the oral floor and of the tongue (59.1 % and 50 %, respectively), it seems justifiable to perform preoperative radiation treatment in cases with clinically evident metastatic lymph nodes. As regards marginal recurrences, which all occurred in patients with carcinoma of the oral floor, it is considered sufficient to extend the surgical treatment to the subhyoid region. The high incidence of contralateral recurrences, which occurred mainly in patients with carcinoma of the larynx (13 of 17), shows the usefulness of radiation treatment of the contralateral region of the neck in these tumors, when dissection is limited to only one side of the neck.