Ronald A. Castellino

Radiographic Distribution of Intrathoracic Disease in Previously Untreated Patients with Hodgkin's Disease and Non-Hodgkin's Lymphoma

An analysis was made of the incidence of various intrathoracic abnormalities noted on plain chest radiographs and tomograms in a consecutive series of 300 patients with untreated Hodgkins disease and nonHodgkins lymphoma. Those with Hodgkins disease have a higher incidence of intrathoracic disease at presentation than those with non-Hodgkins lymphoma (67% vs. 43%). Bulky superior mediastinal lymphadenopathy is the hallmark of Hodgkins disease. Lung involvement was more common in Hodgkins disease (11.6% vs. 3.7%) and was always accompanied by mediastinal and/or hilar lymphadenopathy.

Latent Radiation Injury of Lungs or Heart Activated by Steroid Withdrawal

Abstract Seven patients with Hodgkins disease had radiation pneumonitis or radiation-induced heart disease that developed during MOPP (nitrogen mustard, vincristine sulfate (Oncovin®), procarbazin...

External beam radiation therapy of primary carcinoma of the prostate

During the past 10 years, some 15 publications have appeared in the English literature on the definitive radiotherapy of prostatic cancer. The long‐term followup required for rational assessment of the treatment of prostatic cancer is not yet available for most of these studies. However, in the Stanford series, the direct disease‐free survival at 5 years for patients with disease localized to the prostate is 70%; at 10 years, 42%. The direct disease‐free survival at 5 years for patients with extracapsular extension is 36%, and at 10 years, 29%. Recently, mapping of potential lymph node metastases has been studied by several authors. Early results of extended‐field irradiation required for regional treatment are presented.

Staging laparotomies in unselected previously untreated patients with non‐Hodgkin's lymphomas

Sixty‐nine unselected, previously untreated patients with non‐Hodgkins lymphomas underwent staging laparotomies at the Stanford University Medical Center during the years 1971 and 1972, as part of their pre‐therapy evaluation. This disclosed involvement of para‐aortic lymph nodes in 42% of these patients, splenic lymphoma in 32%, and hepatic involvement in 16%. Significantly, mesenteric lymph nodes were affected by lymphoma in 61% of the 31 patients who underwent mesenteric node biopsies. Approximately 30% of the patients changed stage as a result of the laparotomy findings. Lymphangiography demonstrated an overall accuracy of 92%. However, gastrointestinal series and barium enemas were found to be of little value in detecting subdiaphragmatic lymphoma preoperatively in asymptomatic patients, and bone marrow aspirates also correlated poorly with the presence of marrow involvement as demonstrated by biopsy. It appears therefore, that laparotomy with open iliac crest bone marrow biopsy is valuable in staging patients with non‐Hodgkins lymphomas, but whether it will lead to better management or imporved survival must be determined by further clinical trials.

Pneumocystis carinii pneumonia: CT and HRCT observations.

We examined the chest radiography, CT, and high resolution CT (HRCT) of 14 patients with proven Pneumocystis carinii pneumonia. We compared the radiographic and HRCT patterns of abnormal lung parenchyma with histologic sections obtained in those 11 patients who had had transbronchial lung biopsies. Diffuse bilateral perihilar airspace disease was the most common radiographic pattern. Both CT and HRCT showed “ground glass” opacity in the lungs, through which the vessels remained visible in all patients. No enlarged lymph nodes or pleural effusions were seen in patients without associated lymphoproliferative disorders.

Computed Tomography as an Adjunct in the Staging of Hodgkin's Disease and Non-Hodgkin's Lymphomas

Computed tomography (CT) of the abdomen has been evaluated as an adjunct in the staging of 25 patients with Hodgkins disease and non-Hodgkins lymphomas. Enlarged para-aortic nodes were consistently identified as were splenomegaly and larger splenic nodules. While lymphography and other staging procedures remain necessary in the evaluation of such patients, CT provides additional information useful to the surgeon. The cross-sectional display aids in the planning of appropriate therapy ports since the adenopathy is often found to be more extensive than was demonstrated at lymphography.

Hypersensitivity to procarbazine (Matulane) manifested by fever and pleuropulmonary reaction.

Three cases of hypersensitivity to oral procarbazine (Matulane®) are described. All occurred during 4‐drug combination chemotherapy of Hodgkins disease. Two reactions primarily involved the skin. The third patient manifested recurrent fever, pulmonary infiltration, pleural effusion, and eosinophilia ultimately demonstrated to be secondary to procarbazine on controlled challenge. The pertinent literature is reviewed.

An Evaluation of Lymphography in Localized Carcinoma of the Prostate

Lymph node biopsies were positive in 20% (7/35) of stage T1 and T2 (stage B) tumors and 64% (21/33) of stage T3 (stage C) tumors in 69 previously untreated and unselected patients with apparently localized carcinoma of the prostate. One patient with a To (stage A) tumor had no evidence of lymph node metastasis. Prospective analysis demonstrated an overall lymphographic accuracy of 78%, sensitivity of 57% and specificity of 92%. The detection of lymph node metastases in the lymphogram is limited by the frequency of microscopic metastasis and the frequency of benign changes within pelvic lymph nodes in this older patient population. Diagnostic criteria for metastatic disease which gives a low incidence of false-positive interpretations should be maintained, since relaxing the criteria will not necessarily improve the detection rate of metastases and would decrease specificity.

CT-Pathologic Correlations in Hodgkin's Disease and Non-Hodgkin's Lymphoma

In order to assess its potential uses in the staging and treatment planning of lymphoma, CT was performed in 27 newly diagnosed, previously untreated patients with Hodgkins disease or non-Hodgkins lymphoma; 18 staging laparotomies provided pathologic correlations. CT detected and defined disease in areas not well evaluated by conventional techniques (high para-aortic, mesenteric, splenic hilar nodes). CT interpretation of splenic size and weight correlated well with splenic weight confirmed at pathology. Nodules were identified in several spleens containing foci of lymphoma.

Effect of Computer-Aided Detection on Independent Double Reading of Paired Screen-Film and Full-Field Digital Screening Mammograms

OBJECTIVE The purpose of this study was to evaluate the performance and potential contribution of computer-aided detection (CAD) to independent double reading of paired screen-film and full-field digital screening mammograms. MATERIALS AND METHODS The cases of 3,683 women who underwent both screen-film mammography and full-field digital mammography (FFDM) with independent double reading for each technique were followed for 2 years to include cancers detected in the interval between screening rounds and cancers detected at the next screening round. Fifty-five biopsy-proven cancers were diagnosed. The baseline screening mammograms of the 55 cancers were defined as having positive findings if at least one of two independent readers scored it 2 or higher on a 5-point rating scale. The baseline mammograms of interval (n = 10) or secondround (n = 16) cancers were retrospectively classified as overlooked (n = 2), minimal sign actionable (n = 8), minimal sign nonactionable (n = 5), and normal (n = 11). The baseline mammograms of these cases of cancer were evaluated with a CAD system, and the CAD results were compared (McNemars test for paired proportions) with the findings at prospective independent double reading of mammograms obtained with each technique. RESULTS For FFDM, CAD sensitivity was 95% (37/39) compared with 64% (25/39) for double reading (p = 0.006), and for screen-film mammography, CAD sensitivity was 85% (33/39) compared with 77% (30/39) for prospective double reading (p = 0.57) of radiographically visible lesions in baseline mammograms. CAD correctly marked five (13%) of 39 cancers on screen-film mammography and 14 (36%) of 39 cancers on FFDM not detected at prospective independent double reading. CONCLUSION CAD showed the potential to increase the cancer detection rate for FFDM and for screen-film mammography in breast cancer screening performed with independent double reading.