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T S Kline

Publications and source records attributed to T S Kline.

At least 19 recordsLinked to original sources
PubMed1992

Radiologists, communication, and Resolution 5: a medicolegal issue.

Resolution 5, adopted by the American College of Radiology, sets forth principles of direct communication that are important to every radiologist. This article reviews pertinent court decisions that affect radiologists and illustrates the importance of Resolution 5. In recent cases in state courts, liability standards have focused on four areas: negligence based on failure to personally inform clinicians of the diagnosis, ability of the jury to decide whether the radiologist's actions were appropriate, provision of information to the correct person, and necessity for expert testimony to define urgency. An important factor in liability cases appears to be the judgment of the radiologist in selection of the correct individual to receive the radiology report. The authors believe that electronic communication devices (eg, voice mail and fax machines) may potentially breach confidentiality and that such devices should therefore be used sparingly. Verbal communication by the radiologist to the referring physician, in addition to a written report, should avoid liability and improve quality of care for the patient.

Communication↗
PubMed1992

Terminology and specimen adequacy in cervicovaginal cytology. The College of American Pathologists Interlaboratory Comparison Program experience.

The 600 participants in the College of American Pathologists 1991 Interlaboratory Comparison Program in Cervicovaginal Cytology were surveyed by mailed questionnaire in March 1991. The total annual gynecologic specimen volume of the 362 respondents was over 7 million. Nearly all participants (94%) used a descriptive diagnosis for cases not within normal limits. Most (87%) have implemented or plan to implement the Bethesda System. A Papanicolaou class system was not used by 66%. Terminology for reporting squamous lesions with premalignant potential was variable, with many laboratories using two or more sets of terms. Specimen adequacy was routinely reported by 66% of participants. Median rates of unsatisfactory and "less than optimal" specimens reported by participants in 1990 were 0.5% to 0.9% (range, 0% to greater than 20%) and 3.0% to 4.9% (range, 0% to greater than 40%), respectively. Leading reasons for both unsatisfactory and less than optimal smears included scant cellularity, obscuring inflammation, obscuring blood or menses, and poor preservation. Absent endocervical component was also a leading reason for less than optimal specimens. The largest number of respondents required endocervical columnar cells and/or metaplastic cells as the criteria for an endocervical component. In conclusion, nearly all laboratories use descriptive terminology for smears that are abnormal, and most laboratories routinely report specimen adequacy. Frequency and criteria for unsatisfactory and less than optimal smears vary significantly, supporting the need for consensus definitions of specimen adequacy.

Cytodiagnosis↗
PubMed1991

Aspiration biopsy cytology of occult breast lesions by use of the "scouting needle". A prospective study of 261 cases.

The increased use of mammography for the detection of impalpable breast lesions has resulted in a need for new diagnostic techniques. In a prospective study of 261 occult breast lesions, aspiration biopsy was done with a standard fine needle and syringe. This "scouting needle" technique permits the collection of diagnostic cytologic material in the clinician's office without specialized radiologic equipment. Thirty of 53 malignant lesions (57%) were detected cytologically. A benign cytologic diagnosis, which was made in 220 patients, did not preclude additional investigation. Aspiration biopsy using the "scouting needle" is a rapid, low-cost, easily performed, initial procedure which complements "watchful waiting." When diagnostic of carcinoma, it results in immediate surgical intervention and may obviate two-stage surgical treatment.

Biopsy, Needle↗
PubMed1991

Intraoperative pancreatic fine needle aspiration biopsy. Results in 166 patients.

Intraoperative fine needle aspiration biopsy (NAB) of undiagnosed pancreatic masses was studied in 166 patients over a 17-year period. The cytologic diagnoses were correlated with histologic specimens, autopsy results, or clinical follow-up (benign disease was documented if the patient was alive without malignancy at least 2 years after laparotomy). Aspirates were interpreted as benign, suspicious, malignant, or unsatisfactory. Malignant disease was the final diagnosis in 109 patients; the cytology was concordant in 101 and was interpreted as suspicious in four. Four patients with benign cytology later proved to have malignant disease--a false-negative rate of 2.5 per cent. A total of 57 patients had benign disease; 51 of these had benign cytology. The remaining patients had "unsatisfactory" cytology reports. A 93 per cent sensitivity, 100 per cent specificity, and 0 per cent complication rate are reported. There were no false-positive cytology reports. Complications are rare and represent case reports, thus, additional sampling is at minimal risk. Intraoperative pancreatic NAB is a safe, easy, more accurate biopsy technique than historical wedge or core needle biopsies. It is the biopsy method of choice for pancreatic masses found at laparotomy.

Adult↗
PubMed1990

The male breast and malignant neoplasms. Diagnosis by aspiration biopsy cytology.

Fine-needle aspiration biopsy is now an established procedure for the evaluation of breast masses in women. On the other hand, there are only occasional reports of aspirates from male breast masses. During the past 19 years from more than 14,000 mammary aspirates, the authors examined the aspiration biopsy cytology (ABC) from 14 cases of malignant mammary tumors in men. There were ten infiltrating ductal carcinomas, one mucinous carcinoma, two metastatic carcinomas, and one leiomyosarcoma. The cytologic and clinicopathologic feature of these cases are presented. Because these specimens can be readily differentiated from gynecomastia, aspiration biopsy is recommended as the initial procedure for all breast masses in men.

Adenocarcinoma, Mucinous↗
PubMed1990

Medullary carcinoma of the breast. An unusual cytologic finding in cyst fluid aspirates.

Cystic medullary carcinoma of the breast is unusual. This report describes five patients with medullary carcinoma who presented clinically with a breast cyst. Fine-needle aspiration biopsy (NAB) was performed as part of the initial physical examination and the retrieved cyst fluid was examined cytologically. Four of the five patients were premenopausal, more typical of benign cystic disease and significantly younger than the average (60+ years) for other forms of cystic breast carcinoma. Only three of the five patients demonstrated suspicious findings of hemorrhagic cyst fluid, a residual mass after NAB, or refilling of the cyst. Due to the relatively young age of most patients, the innocuous clinical presentation, and the abundant inflammatory component noted in the aspiration biopsy cytologic study (ABC), misinterpretation as an inflamed cyst is possible. The ABC of cystic medullary carcinoma is presented with histologic correlation.

Adult↗
PubMed1990

Transbronchial needle aspiration biopsy in the diagnosis of pulmonary neoplasms.

To evaluate the usefulness of transbronchial needle aspiration biopsy (TBNAB) in the primary diagnosis of lung cancer, we undertook a prospective study of this technique, assessing specimens from 124 patients over a 3-yr period. Cytologic and/or histologic material obtained by an alternate technique was available for 105 (84.7%) of the patients. The diagnostic sensitivity of TBNAB was comparable with that of other bronchoscopic techniques; with the addition of TBNAB, the overall sensitivity of bronchoscopy was increased from 54% to 72% (P less than 0.001). Because of its usefulness for diagnosis of submucosal tumors and its safety, we conclude that TBNAB is a useful addition to current methods for the diagnosis of suspicious pulmonary lesions.

Biopsy, Needle↗
PubMed1990

Metaplastic carcinoma of the breast--diagnosis by aspiration biopsy cytology: report of two cases and literature review.

The unusual metaplastic carcinomas have a variety of names, each emphasizing the dominant histologic pattern. Components may include features of ductal, spindle, or squamous carcinoma with pseudosarcomatous, cartilaginous, or boney areas. A few reports from individual tumors examined by fine-needle aspiration biopsy have emphasized an array of findings. This study includes two of our cases with a review of 12 others from the literature. The breast neoplasm has a characteristic pattern on aspiration biopsy cytology (ABC). The cell-rich aspirate reveals benign multinucleated giant cells intermingled with malignant spindled or squamous cells on a background of necrotic debris, inflammatory cells, and blood. Additionally, cells from infiltrating ductal carcinoma and mesenchymal fragments are often seen.

Aged↗
PubMed1989

Monoclonal antibody B72.3. An adjunct for evaluation of suspicious aspiration biopsy cytology from the breast.

Monoclonal antibody B72.3 (MoAb B72.3) is a potentially valuable diagnostic adjunct when applied to aspiration biopsy cytology (ABC). In this prospective study, its reactivity was tested on the ABC from 25 breast lesions interpreted as suspicious. The stain was applied directly to the Papanicolaou-stained specimen by the avidin-biotin peroxidase methodology at a concentration of 40 micrograms/ml. In 11 aspirates from invasive carcinomas, the reactivity to MoAb B72.3 was strongly positive in nine cases and weakly positive in two. Ten of these tumors were homogeneous or heterogeneous infiltrating lobular neoplasms, tumors causing special diagnostic pitfalls by ABC. The cells from seven of the nine benign lesions were nonreactive, and in two cases from fibrocystic change, weakly reactive. The ABC from five patients with noninvasive carcinomas or atypical lobular hyperplasia showed a variety of responses. The findings indicate that in select circumstances, MoAb B72.3 used in conjunction with clinical and cytologic findings may be a useful diagnostic adjunct.

Antibodies, Monoclonal↗
PubMed1989

Male breast lesions: gynecomastia and its distinction from carcinoma by aspiration biopsy cytology.

Gynecomastia is a benign proliferative lesion of the male breast. It may present as a diffuse bilateral process or a unilateral, discrete mass, clinically suggestive of carcinoma. We examined the aspiration biopsy cytology of 50 cases of gynecomastia to define the cytologic criteria and to distinguish it from carcinoma. The parameters of cellularity, architecture, single columnar cells, naked nuclei, nuclear and cell size, nuclear and cytoplasmic characteristics, and extraneous cells were accessed. Diagnostic confusion with carcinoma may occur because of cellularity with loose groups and single cells; however, the mixed cell population, composed of cohesive sheets or groups of bland cells, bipolar naked nuclei, and single tall columnar cells, delineates gynecomastia from carcinoma of the male breast.

Adolescent↗