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PubMedDate not supplied

Thoracic fine needle aspiration biopsy versus fine needle cutting biopsy. A comparative study of 40 patients.

The fine needle aspiration (FNA) biopsy findings were compared with the results of fine needle cutting (FNC) biopsy in 40 patients. The lesions (38 pulmonary nodules, 1 mediastinal mass and one lytic rib lesion) were biopsied with 22-gauge Greene and 21-gauge E-Z-EM needles through a 19-gauge needle guide. The FNA biopsy findings were based on smears and cell blocks of material obtained with the Greene needles while the FNC biopsy findings were based on tissue cores obtained by the E-Z-EM needles. In 83% of the cases, both techniques yielded specimens with similar cellularity; in seven cases, the FNA samples were more cellular. Malignancy was diagnosed in 80% of the patients: by both techniques in 26 patients, by FNA biopsy only in 5 patients and by FNC biopsy only in 1 patient. The sensitivity of FNA biopsy was higher than that of FNC biopsy (96.8% vs. 84.3%). The specificity and predictive value of positive results were 100% for both techniques. The predictive value of negative results was higher for FNA biopsy (88.8% vs. 54.5%). The majority of FNC biopsy tissue cores consisted mostly of clotted blood, lung tissue and/or fibrous tissue and did not facilitate or improve the diagnosis. Those data suggest that the contribution of FNC biopsy to the diagnosis of thoracic neoplasms is very limited and that the performance of FNC biopsy with an E-Z-EM needle in addition to or instead of FNA biopsy is not justified.

Adenocarcinoma↗
PubMed2001

Perioperative complications with costotransversectomy and anterior approaches to thoracic and thoracolumbar tumors.

OBJECT: Anterior decompression and stabilization for thoracic spinal tumors often involves a thoracotomy and can be associated with surgical approach-related complications. An alternative to thoracotomy is surgery via a costotransversectomy exposure. To delineate the risks of surgery, the authors reviewed their prospective database for patients who had undergone surgery via either of these approaches for thoracic or thoracolumbar tumors. The complications were recorded and graded based on severity and risk of impact on patient outcome. METHODS: Between September 1995 and April 2001, the authors performed 29 costotransversectomies (Group 1) and 18 thoracolumbar or combined (Group 2) approaches as initial operations for thoracic neoplasms. The age, sex, preoperative motor score, and preoperative Frankel grade did not significantly differ between the groups. In the costotransversectomy group there were greater numbers of metastases, upper thoracic procedures, and affected vertebral levels; additionally, the comorbidity rate based on Charlson score, was higher. The mean Frankel grades at discharge were not significantly different whereas the discharge motor and last follow-up motor scores were better in Group 2. There were 11 Group 1 and seven Group 2 patients who suffered at least one complication. The number or patients with complications, the mean number of complications, and severity of complications did not differ between the groups. CONCLUSIONS: Compared with anterior or combined approaches, the incidence and severity of perioperative complications in the surgical treatment of thoracic and thoracolumbar spinal tumors is similar in patients who undergo costotransversectomy. Costotransversectomy may be the preferred operation in patients with significant medical comorbidity or tumors involving more than one thoracic vertebra.

Adolescent↗
PubMedDate not supplied

Somatosensory evoked potentials and magnetic resonance imaging in intraspinal neoplasms.

Median and posterior tibial somatosensory evoked potentials (SEPs) were studied on 25 patients with pathologically proven intraspinal neoplasms, and the results were compared and correlated with the details of clinical examination and the information derived from magnetic resonance imaging (MR). MR was abnormal in all cases and in 23 of 25 (92%) demonstrated an intraspinal expansile lesion. SEP was abnormal in 19 of 25 patients (76%). Abnormal SEPs were found in 18 of 19 patients (94%) with cervical or thoracic neoplasms but only in 1 of 6 patients (16%) with the tumor in the thoracolumbar or lumbar region. SEP-MR correlation was significant (P less than 0.05) for thoracic intraspinal neoplasms where all 9 had an abnormal SEP showing a similar pattern of normal median and abnormal posterior tibial study. Clinically, all 7 patients with posterior column sensory deficits had abnormal SEP (100%). Abnormal SEPs were seen in 7 of 11 (63%) patients with spinothalamic deficits and in 4 of 8 (50%) of those with normal sensory examinations. Four of 9 patients (44%) with a normal neurological examination or an examination disclosing ambiguous results indistinguishable from a peripheral pathology had an abnormal SEP strongly suggesting a central sensory disorder. Comparison of preoperative and postoperative SEPs did not disclose useful prognostic information pertaining to the functional recovery.

Adolescent↗
PubMed1995

Imaging thoracic malignancy.

The radiological detection of a thoracic neoplasm is often a straightforward exercise. The differentiation of a benign from a malignant lesion is much more challenging and has met with limited success. Computed tomography (CT) may help to differentiate a benign nodule from a malignant lesion but magnetic resonance imaging (MRI) plays no part in the evaluation of a coin lesion. Recent studies indicate MRI to be superior in the staging of bronchogenic carcinoma with reference to chest wall infiltration, mediastinal invasion and vascular involvement. It is now known that in the staging of nodal metastasis, both CT and MRI are less sensitive and specific than previously believed. CT remains the method of choice in the detection of pulmonary metastatic disease. Biopsy under imaging control has contributed significantly in the management of patients with thoracic malignancy. Both CT and MRI are used in the monitoring of patients under treatment. The postlobectomy or pneumonectomy space is best evaluated by MRI. This paper reviews the current status of imaging in the detection, staging and follow-up of patients with thoracic malignancy.

Humans↗
PubMed1999

Fine needle aspiration of thoracic lesions: experience in a Brazilian cancer center.

STUDY OBJECTIVES: This study is a retrospective analysis of cytological specimens of fine needle aspiration (FNA) of thoracic lesions under computed tomography guidance, over a 2-year period to assess the diagnostic performance of cytology method. DESIGN: A total of 134 aspirations were performed using a 22 and 20 gauge needle (spinal long). The cytological diagnosis was achieved in 126 cases (94%). The histopathological findings were correlationed in order observe the cytologic diagnosis performance. PATIENTS: The cases were obtained from patients examined at A. C. Camargo Hospital ambulatory. RESULTS: There were 89 cases of malignant lesions (66.4%), 27 benign lesions (20%) and 10 cases (7.5%) of suspected for malignancy. The correlation with histopathology was possible in cases with previous histopathological exams and with tissue diagnosis after puncture. The correlation between FNA and histology showed an overall sensitivity of 77%, specificity of 100%, false-negative rate of 20% and no false-positive results. CONCLUSIONS: We conclude that FNA is a sensitive and highly specific technique for the diagnosis of thoracic neoplasms.

Adenocarcinoma↗
PubMed2004

Radiation esophagitis: Predictive factors and preventive strategies.

Radiation esophagitis remains the primary dose-limiting acute toxicity in the radiotherapeutic management of thoracic neoplasms. Improved understanding of this toxicity will facilitate dose escalation and enhancement of the therapeutic ratio. This article reviews the predictive factors and preventive strategies for radiation esophagitis. In particular, clinical and dosimetric studies predicting the risk of radiation esophagitis are analyzed. The critical impact of chemotherapy on radiation esophagitis is characterized. Preventive strategies to minimize this toxicity also are explored. Overall, this article reviews the current understanding of radiation toxicity for the esophagus.

Esophagitis↗
PubMed1999

Endovascular treatment of superior vena cava obstruction in patients with malignancies.

The aim of this study was to report our experience on the management of superior vena cava obstruction (SVCO) secondary to malignant disease, using endovascular procedures. Twenty-six patients with SVCO due to primary or secondary tumors of the lung or the mediastinum, or catheter inserted for treatment of an extra-thoracic neoplasm, had an endovascular therapy which consisted of stenting, angioplasty, thrombo-aspiration or local fibrinolysis. Immediately after the procedure, rapid relief of symptoms occurred in 24 (90 %) of the patients. The mean Kishi's score decreased from 5.5 to 0.96. Immediate complications included one death related to pericarditis bleeding following fibrinolysis. Three patients relapsed after 20 days, 4 months and 6 months, and needed a second stenting. At 6 months the primary patency rate was 83 % and the secondary patency rate was 89 %. Endovascular treatment of SVCOs is a simple and safe procedure to restore the patency of the superior vena cava in malignant SVCO. It should be indicated in most cases as first-line treatment and performed as early as possible.

Adult↗