[Neurogenic tumors of the mediastinum in childhood].
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Biomedical subjects
Publications and source records attributed to F Virno.
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The introduction of cytologic examination in to the diagnostic procedure has made it possible to define breast lesions better as early as the preoperative stage. However, there are interpretative problems depending on the nature of the lesions that make a histologic examination necessary. The cytology of nipple discharge or FNA of breast lesions would permit the best possible selection of the cases, indicating not only whether surgery is necessary, but also the basis on which it should be performed (outpatient under local anesthesia or inpatient under general anesthesia). The definitive histologic diagnosis of 447 cases submitted to surgery under general anesthesia and of 379 who were operated under local anesthesia has been correlated with the relative cytologic examination. The sensitivity and specificity of the cytologic examination are respectively 97.7% and 98.8%.
The aim of the earliest possible diagnosis of breast carcinoma achieved through the integration of clinical, mammographic, sonographic and cytologic data has determined an increased detection of breast lesions and a greater accuracy in their description. Nevertheless, the nature of some of these lesions cannot be well-defined because of their biological characteristics and their physical, radiological or cytological aspects. The need to obtain a definitive diagnosis in any case has given rise to a paradoxical increase in histologic examinations: in specific conditions and for certain kinds of lesions, outpatient surgery under local anesthesia could very well represent a supplementary tool in the diagnostic and therapeutic strategy for the management of breast lesions. The data here reported concern 397 breast lesions for which it was thought appropriate to complete the diagnostic procedure with the surgical excision on an outpatient basis under local anesthesia. Excluding the 3 breast lymphomas and the 19 loco-regional recurrences, for which the purpose of outpatient surgery was therapeutic, at the histologic examination 35% benign lesions, of which 91 associated with an increased risk of breast cancer, were found, as well as 11 in situ and 10 invasive carcinomas (false negatives), with a therapeutic option error of 2.5%. Now that one of the principal aims of public management is to put a check on health expenditures, outpatient surgery would contribute to obtaining the correct balance between proper management of breast lesions and low cost/effective ratio.
The clinical features of a patient with a primary lymphoma of the breast are herein reported. The diagnosis was reached by histological examination after outpatient surgery. Surgical resection was followed by cytostatic treatment and locoregional radiotherapy. This case report is an example where the integration of physical and mammographic examination together with ultrasonography (and cytology), in the context of diagnostic procedures, induced us to perform a surgical excision on an outpatient basis. This line of action allowed us, in one step, to arrive at both the definitive diagnosis and the appropriate choice of therapy. Thus we believe that this diagnostic procedure should be carried out whenever a breast lesion, thought to be "probably benign", is found by physical or mammographic exam in a peri-postmenopausal woman.
The purpose of this work was to evaluate the effectiveness of US scanning in detecting breast cancer associated with isolated clustered microcalcifications (MC) mammographically identified. 52 isolated clusters of MC mammographically detected underwent histological examination. In all cases, ultrasonographic of (US) and cytologic examinations were performed for the improved definition of the nature of the MC. Fine needle aspiration was performed under radiographical (Rx)-guidance, only in cases of US-negativity. Ultrasound detected a breast lesion in 31 cases, out of which 24 (77.4%) were found to be carcinomas (invasive in 87.5% of the cases). Out of the remaining 21 US-negative cases, 7 (33.3%) were malignant lesions (15% invasive). Statistical analysis demonstrated that US-positivity significantly correlated with the presence of malignant lesions (p < 0.001). US-examination should also be performed in cases of isolated clustered microcalcifications for a more accurate selection of cases requiring histological verification.