Biomedical subjects
Publications and source records attributed to D L Schaffer.
Clinical examinations with the whole body CT scanner require considerable individualization of examination technique in relation to specific organs, anatomic areas, and clinical problems. Careful selection of radiographic factors, patient position, contrast agents, and pharmacologic adjuncts will optimize diagnostic results and patient throughput.
A method for assessing the effect of computed body tomography on diagnostic understanding and therapeutic decision making is described and the results in the first 184 patients are presented. The patients' referring physicians provided the primary data used for the evaluation. CT improved diagnostic understanding in 41% of patients, reassured the physician about previously planned therapy in 43%, contributed to a change in therapy in 17%, and improved precision of previously planned treatment in an additional 10%. CT contributed to a decision not to perform surgery in 21% of patients in whom an operation had been provisionally planned While CT can play an important role in patient management, its measured value depends on the clinical problems investigated and the level of efficacy on which it is judged.
A total of 42 women with proved minimal (14) or occult (28) breast carcinoma were evaluated for up to 48 months (mean = 28 months). Bone scans, radiographs, blood chemistries, enzyme levels, and operative findings demonstrated metastases only in those 6 patients (14%) who presented with symptomatic metastases from an unknown primary source. The other 36 women are free of metastases. Preoperative radionuclide bone scans may not be necessary for women with minimal and asymptomatic occult breast cancers.
Patients (219) with prostatic adenocarcinoma were classified on the basis of whether or not their bone scans were positive for metastasis. Acid and alkaline phosphatase determinations and clinical evaluations for bone metastases were reviewed. Of those with proved metastases, 43% had no bone pain, 39% had normal acid phosphatase levels, 23% normal alkaline phosphatase levels, 19% normal levels of both enzymes, and 15% normal enzyme levels without bone pain. Twenty-four per cent of the patients with normal enzyme levels and clinically unsuspected bone metastases had bone scans which proved positive for metastasis; 62% of these had normal radiographs.
Sixty-four carcinomas were detected in 1,315 women examined by xeromammography in 1973. Seventeen carcinomas were occult and 14 were detected in women referred for clinically benign lesions. The remaining 33 carcinomas were diagnosed on the basis of both clinical and roentgenographic examination. There were three false-negatives. Two of these lesions were obscured by very dense fibrocystic disease. The third lesion was called benign due to an error in interpretation. There were eight false-positives; four of these demonstrated intraductal hyperplasia and asymmetry, which may be a precursor to frank malignant change. Xeromammography is suggested as a highly accurate means of detecting occult mammary carcinomas and clarifying the nature of clinically suspected lesions.