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Biomedical subjects

N F Khouri

Publications and source records attributed to N F Khouri.

At least 19 recordsLinked to original sources
PubMed1989

Bronchioalveolar carcinoma: emphasis on localized lesions.

Although well defined pathologically, alveolar cell carcinoma can be difficult to diagnose because of its many clinical presentations. In a retrospective study of 45 cases, we reviewed the radiologic, pathologic, and clinical features of this neoplasm. Forty-one patients had a single peripheral mass that measured between 8 mm and 7 cm. Three patients had multiple nodules, and one had diffuse involvement of the right lung. Other prominent radiologic features included air bronchograms in eight cases, a "tail sign" in ten cases, and universal absence of calcifications. Pathologic examination showed an associated scar in 12 patients. There was a relatively high frequency (16%) of metachronous malignancies, including two osteosarcomas, three basal cell carcinomas, and one case each of chronic lymphocytic leukemia and thymoma. All but one of the associated tumors were diagnosed six months to two years before the diagnosis of alveolar cell carcinoma.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1988

Solitary bronchioloalveolar carcinoma: CT criteria.

The computed tomographic (CT) scans of 30 patients with solitary bronchioloalveolar carcinoma were reviewed. Common features at CT included the peripheral or subpleural location of a pulmonary mass (25 cases), pseudocavitation (18 cases), heterogeneous attenuation (17 cases), irregular margins forming a star pattern (22 cases), and pleural tags (21 cases). Using these CT criteria, four independent observers attempted to identify cases of bronchioloalveolar carcinoma from a larger sample of lung cancers and benign lesions by categorizing a series of test cases into four probability categories. Although the bronchioloalveolar carcinomas were correctly ranked in the two highest probability categories 75% of the time (in 45 of 60 cases), there was considerable overlap with other lung lesions, particularly with adenocarcinoma and large cell undifferentiated carcinoma. However, even though the typical features of bronchioloalveolar carcinoma are not invariable or highly specific, they are characteristic enough to suggest the diagnosis.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1987

Bleomycin-induced pulmonary nodules: a variant of bleomycin pulmonary toxicity.

Bleomycin has been associated with pulmonary toxicity which is typically manifested as an interstitial pneumonitis resulting in fine, diffuse reticular or reticulomicronodular infiltrates. Attention is drawn to an additional radiologic appearance where discrete pulmonary nodules are seen and representative of bleomycin-induced change. The pitfalls of interpreting such changes as toxic effects versus metastatic disease and proposed mechanisms of bleomycin pulmonary toxicity are discussed.

Adolescent↗
PubMed1987

Transthoracic needle aspiration biopsy--optimizing the yield.

Transthoracic needle aspiration biopsy (TNAB) is the procedure of choice for the diagnosis of focal pulmonary processes. TNAB can identify the entire spectrum of focal benign or malignant disease. Technique-dependent factors and the underlying pathologic processes that affect the diagnostic yield of TNAB are reviewed.

Biopsy, Needle↗
PubMed1987

High resolution computed tomography of inflation-fixed lungs. Pathologic-radiologic correlation of centrilobular emphysema.

Centrilobular emphysema (CLE) is a disease defined pathologically. Assessment of the accuracy of high resolution computed tomography (CT) in the diagnosis of centrilobular emphysema has been hampered by a lack of pathologic correlation. We applied high resolution computed tomography to 20 postmortem lung specimens fixed by a method that allows for direct one-to-one pathologic-radiologic correlation. The degree of centrilobular emphysema was assessed radiologically on a visual grading system based on nonperipheral low-attenuation areas. The lungs were then sectioned along the plane of the CT image, and the degree of centrilobular emphysema was graded pathologically by scoring against a panel of standards. A significant correlation (r = 0.91, p less than 0.005) was found between the pathologic grade and the in vitro CT score.

Histological Techniques↗
PubMed1987

The solitary pulmonary nodule. Assessment, diagnosis, and management.

We have presented a brief overview of an approach that has been very successful in our hands in the patient with an SPN. Even though the patient who has undergone a thoracotomy is full of gratitude to his physician when told that the resected lesion was benign and does not question the need for the thoracotomy, we have met equally happy and gratified patients when they were told that their lesion is benign be it after CT densitometry or needle biopsy. When properly performed, these techniques demand care and attention to detail much like the surgeon performing a delicate procedure. Without proper care, these procedures can in fact reflect negatively on the physician performing them and fall in disrepute. CT densitometry and transthoracic needle aspiration biopsy allow effective management of the patient with an SPN with prompt documentation of both malignant or benign lesions. With the proper application of these techniques, the majority of patients with benign disease will not need a thoracotomy for diagnosis with resultant benefits to the patient as well as to third-party payers.

Biopsy, Needle↗
PubMed1986

Solitary pulmonary nodules: CT assessment.

Computed tomography (CT) was used to examine 634 solitary pulmonary nodules (SPNs). Each lesion was assessed as benign or indeterminate on the basis of CT criteria. Benign nodules made up 44% of all SPNs and 58% of the 431 that were 2 cm or less in diameter. All malignant SPNs were assessed as indeterminate, and adenocarcinoma (42%) was the most common primary malignancy. A total of 176 (63% of benign SPNs) were correctly assessed as benign by CT. Ninety SPNs assessed as diffusely calcified were not so identified by conventional tomography at outside institutions. An SPN can be reliably assessed by CT as benign if it exhibits high attenuation values, exceeding a critical level and distributed diffusely throughout a CT section through the center of the lesion and a well-defined edge. Although 38 of 283 (13.4%) primary lung cancers contained localized calcification, there was no significant overlap with the diffuse calcification of benign lesions. Central carcinoid tumors may contain focal ossification, but such lesions may be recognized by noting the proximity of larger bronchi. Assessment of SPNs by CT is most effective for lesions 2.0 cm or less in diameter. For larger lesions, the frequency of benign disease was decreased (14.3% of 203), as was the percentage of benign SPNs correctly assessed as benign by CT (37.9%).

Calcinosis↗
PubMed1986

Pulmonary hamartoma: CT findings.

Forty-seven patients with a proved (n = 31) or presumed (n = 16) diagnosis of pulmonary hamartoma were studied prospectively by thin-section computed tomography (CT). CT criteria for hamartoma included a diameter of 2.5 cm or less, a smooth edge, and focal collections of fat or fat alternating with areas of calcification. No case of cancer (n = 283) or metastatic disease (n = 72) fulfilled these criteria. Seventeen hamartomas with no detectable calcium or fat were not diagnosed by means of CT. Two other lesions contained diffuse calcium deposits. In 28 lesions, a CT diagnosis of hamartoma was based on the detection of fat (n = 18) or calcium plus fat (n = 10). Twelve such cases were proved histologically by means of thoracotomy or needle biopsy; the remainder, including eight in asymptomatic patients aged 65 years or older, were managed with conservative follow-up.

Adult↗
PubMed1985

Computed tomography of the pulmonary parenchyma. Part 2: Interstitial disease.

A series of patients with documented predominantly interstitial pulmonary disease was examined by routine and high-resolution computed tomography (CT) and compared to a series of twenty-one normals. Inspiratory-expiratory lung density measurements were also obtained at predetermined levels. Several basic CT signs of interstitial disease were identified: finely irregular and thickened pleural surfaces; irregular vascular shadows; thickened and irregular bronchial walls making bronchi visible over a longer portion of their course in the lungs; reticular network of lines with three patterns easily distinguishable by the size of their reticular element; hazy patches of increased density of various sizes distinguishable from alveolar filling processes by the fact that vessels can still be visualized through them; and nodules of various sizes. Micronodules are often associated with a small or medium-size reticular network and in most cases seem to represent points of confluence rather than isolated nodules. The hematogenous origin of some nodules can be specifically suggested when feeding vessels are demonstrated on thin-section scans. Nodules associated with a large network of thickened septa are suggestive of lymphangitic carcinomatosis. Inspiratory-expiratory density gradients can be more useful in confirming the diagnosis of interstitial disease than absolute measurements.

Absorptiometry, Photon↗
PubMed1985

Pulmonary hamartoma: diagnosis by transthoracic needle-aspiration biopsy.

Hamartomas of the lung often present as asymptomatic, noncharacteristic masses that can seldom be differentiated from other lung masses such as primary cancer or metastases by conventional radiography. Transthoracic needle-aspiration biopsy (TNAB) has become a popular and reliable method for the diagnosis of a lung lesion, and it offers a valuable alternative to diagnostic thoracotomy. In our study, TNAB established the diagnosis of pulmonary hamartoma in 12 of 14 (86%) patients. In eight patients, one procedure (using one to three punctures) was sufficient to establish the diagnosis, and, in four patients, two procedures (using one to two punctures) were necessary. In two patients, the lesion was missed on second and/or third biopsy procedures, and the correct diagnosis was obtained at surgery. Cytologic examination of the material was diagnostic in five of the 14 patients. Tissue specimens were sent in 13/14 patients, and findings of histologic examination established the correct diagnosis in 11 of these patients. One of the 12 patients in whom hamartoma was correctly diagnosed by TNAB underwent resection of his lesion, and histologic examination confirmed the diagnosis. In the remaining 11 patients, the lesions have been stable on follow-up chest examinations.

Adult↗
PubMed1985

Transthoracic needle aspiration biopsy of benign and malignant lung lesions.

Transthoracic needle aspiration biopsy (TNAB) of lung lesions is a well established procedure for diagnosing lung lesions. The emphasis in the literature has been on diagnosing malignant lesions with an accuracy rate greater than 90% frequently reported. Experience with 650 patients showed that TNAB can diagnose malignant lesions in 95% of patients with cancer, and more importantly that TNAB can identify benign lesions in 88% of patients with such lesions. In this patient population, 22% of undiagnosed, noncalcified lung lesions were benign. Therefore, TNAB of lung lesions has a potential of limiting diagnostic thoracotomies to fewer than 8% of patients with lung lesions, significantly reducing the number of unnecessary thoracotomies for benign disease. The success of TNAB is affected by equipment, technique, skill, and experience and is enhanced by close cooperation among the various physicians involved.

Aged↗
PubMed1984

Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study.

The Johns Hopkins Lung Project was designed to determine whether the addition of cytologic screening to the radiographic screening of high-risk volunteers could enhance the early detection of asymptomatic lung cancer and whether early therapeutic intervention in detected cases could significantly reduce the mortality from this disease. Male volunteers, 45 yr of age and older, who smoked at least 1 pack of cigarettes per day were recruited from the Baltimore metropolitan area. All of the 10,387 acceptable high-risk volunteers received annual chest radiographic screening. By random assignment, one half received cytologic examination of induced sputum in addition to the roentgenogram. This report describes the results of the initial screening. Compared with usual methods of clinical diagnosis, screening by both roentgenography and cytology identified a greater proportion of the lung cancer cases at an earlier stage. Screening by sputum cytology was found to improve the detection only of squamous cell carcinoma. In the dual-screen group, sputum cytology accounted for 28% of the detected cases, and resulted in 39% additional detection of lung cancer over that achieved by roentgenography. There was no corresponding decrease in prevalence. Lung cancers detected by cytology alone were found at very early stages. Although there has been an increase in average survival, much of this increase, if not all, may have resulted from lead-time and sampling bias.

Adenocarcinoma↗
PubMed1983

Computed tomography of lobar collapse: 1. Endobronchial obstruction.

The computed tomographic (CT) appearance of lobar collapse has yet to be defined. In an attempt to determine the characteristic appearance of collapse 95 cases were reviewed retrospectively in a wide variety of clinical settings over a 3 year period ending January 1983. In this report 38 cases of lobar collapse secondary to endobronchial occlusion are analyzed; the appearance of collapse without endobronchial obstruction forms the basis of a subsequent report. Computed tomography was accurate in determining the site of bronchial occlusion in all cases. In 36 of 38 cases collapse was caused by endobronchial tumors, including bronchogenic carcinoma, bronchial carcinoids, endobronchial metastases, and lymphoma. Differentiation between these tumors was not feasible with CT. Most cases of collapse were caused by central tumor. In those cases in which a bolus of contrast material was used differentiation between tumor mass and collapsed pulmonary parenchyma was possible. Two of 38 cases were found to have benign bronchial occlusion. In one case a mucous plug obstructing the left lower lobe bronchus was accurately defined. In another case a bronchial stricture occluded the right lower lobe bronchus. This represented the only false positive case in this series. It is concluded that CT is an accurate means for establishing the diagnosis of endobronchial obstruction. In most cases the diagnosis of neoplasia was possible, provided a bolus of contrast material was used to define tumor mass. The potential role of CT in evaluating patients with lobar collapse is discussed.

Adenocarcinoma↗
PubMed1979

Pulmonary interstitial changes following bone marrow transplantation.

Observations of 20 consecutive bone marrow transplantation recipients disclosed two distinctive categories of pulmonary interstitial changes. Interstitial infiltrates occurring less than 14 days after transplantation were observed in 13 of 20 patients and are believed to represent pulmonary edema. A late pulmonary interstitial process, which appears more than 30 days following transplantation (median 57 days), was encountered in 10 of 14 patients with successful grafts; the late changes represent interstitial pneumonia, a common cause of morbidity and mortality following bone marrow transplantation. It is probably attributable to a combination of factors including the preparatory chemotherapy and radiotherapy, and delayed immunologic reconstitution following transplantation.

Adult↗