A thin horizontal linear area of hyperattenuation that extends laterally from the mediastinal surface of the lung within the area between the inferior pulmonary vein and the diaphragm is a common observation on computed tomographic (CT) scans of the chest. To determine the anatomic basis for this structure, the authors examined four normal human lungs (two right and two left lungs) fixed in an inflated state at pathologic and histologic examination and at CT. The structure in question was identified in one right and two left lungs. The linear area of hyperattenuation seen at CT is a septum of thin, loose intraparenchymal connective tissue that is bounded medially by the base of the pulmonary ligament, where the two sleeves of the visceral pleura appose one another, and laterally by a vertically oriented vein. The septum was identified in 39 of 50 (78%) normal chest CT scans. The pulmonary ligament often appeared to look like a beak at the mediastinal side of the lung. The septum, when visible (n = 39), was bounded medially by the beak in 28 CT scans (72%) and laterally by a vein in 24 scans (62%).
The role of gallium-67 in the differentiation between active disease and fibrotic changes in patients with childhood lymphoma involving the mediastinum and neck was evaluated prospectively. Ga-67 imaging and computed tomography (CT) were correlated with clinical findings at the time of initial presentation and follow-up in 19 patients. Both modalities enabled detection of active disease on all occasions, but CT results were false-positive for residual disease in 10 patients (53%), whereas Ga-67 imaging results were false-positive in only one patient (5%). Neither modality, however, proved accurate in patients with rebound thymic hyperplasia. Ga-67 imaging is a useful tool for assessing response to therapy in children with lymphoma of the mediastinum and neck.
A palpable 3.2 cm infiltrating ductal carcinoma was removed from a 27-year-old woman. Radiologic evaluation of the breasts with mammography and sonography identified an intramammary node between the carcinoma and the axilla. This was localized and removed at the time of axillary dissection. Isosulfan blue, which had been injected into the walls of the lumpectomy cavity to facilitate identification of the sentinel node in the axilla, stained the intramammary node. It contained several foci of carcinoma. Excision of the intramammary nodes may be indicated in breast cancer patients treated with breast conservation.
Background. Accurate assessment of response to treatment is necessary to treat appropriately primary breast cancers that are not surgically removed. This retrospective study was undertaken to compare the effectiveness of physical examination (PE) and mammography to assess response of primary breast cancer to medical therapy in women who were ineligible for initial surgical treatment. Methods. Thirteen women with 14 breast carcinomas were evaluated for interval changes. Except for 1 patient who had two follow‐up studies, the other 12 each had a single follow‐up study including PE and mammography; changes therefore were assessed in 15 instances. Response to treatment also was judged by mastectomy results in two instances, changes in metastatic disease by other imaging procedures in five, and changes in primary tumor by computed tomography in two breasts. Results. In 11 of 15 assessments of posttherapy changes, PE and mammography results were similar concerning treatment response. Of four discordant follow‐ups, the tumors were found to be stable by PE, whereas they were found to be increasing by mammography in two. In both of these cases, progression of disease outside the breast was identified by other imaging studies, consistent with the mammographic findings. In another case, disease appeared to regress by PE but was unchanged by mammography; disease extent in mastectomy specimens was consistent with that found mammographically and more extensive than that suggested by physical examination. In the fourth case, superficial healing of a fungating tumor was obvious by clinical examination but could not be appreciated by mammography. The detectability of changes was not related to type of treatment. Conclusions. Physical examination and mammography are both useful in the serial evaluation of breast cancers. Although usually complimentary, disease progression, when it occurs, may be detected by only one of these methods. Cancer 1995; 75:2093‐8.
A small percentage of breast cancers are not visible on mammography. Since mammographically occult malignancies may be more difficult to diagnose, we hypothesized that the lack of visualization would cause a delay in detection, more aggressive surgical and adjuvant therapy, and poorer outcome. Patients with mammographically occult malignancies were compared to patients with cancers visible on mammogram. The significance of mammographic visibility for treatment and local and distant recurrence rates were evaluated. Ninety-one of the 813 (11%) cancers were mammographically occult. Patients with mammographically occult malignancies were significantly younger, of lower body weight, and had fewer pregnancies than patients with cancers visible on mammography: age, body weight, and parity were statistically significant (p < 0.001) in stepwise logistic regression. Ductal carcinoma in situ was significantly more frequently diagnosed in patients with mammographically visible malignancies (14% versus 4%, p = 0.0163) and nodal involvement was significantly more frequent in patients with mammographically occult malignancies (35% versus 24%, p = 0.0391). Diagnostic delays exceeding 3 months were experienced by 24% of patients with mammographically occult malignancies compared to 13% of patients with tumor visible on mammography (p < 0.0001). Adjuvant chemotherapy was given to 63% of patients with occult malignancies compared to 41% of patients with mammographically visible cancers (p = 0.0027). The use of breast-conserving therapy and adjuvant radiation and tamoxifen were comparable. Survival free of local recurrence and distant metastases for the 403 patients followed for 5 years or more was not related to mammographic visibility.
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