Mammograms from the Canadian National Breast Screening Study (NBSS) were reviewed by three external experts to provide an objective evaluation of their technical quality, to establish a model for auditing mammograms in a screening program, and to assess whether NBSS mammograms improved over time. The sample reviewed included 10 randomly chosen mammograms from each of 15 screening centers for each calendar year of their operation between 1980 and 1987. All 830 mammograms were reviewed on two consecutive days in randomized sequence by each reader, and rated 0-3 for each of four criteria including positioning and image quality, with a total possible score of 0-12. Although the mammograms were not in temporal sequence when reviewed, the scores assigned by each reader were significantly higher for mammograms dating from later years. Subjects' ages at entry (40-49 vs 50-59 years) did not affect the score. The largest increase in scores was associated with a 1985 protocol change in which mediolateral oblique positioning replaced straight mediolateral positioning. This study reinforces the importance of monitoring technical quality in screening programs and establishes that the NBSS benefited from technical improvements during its operation. A retrospective review of NBSS mammography by three external reviewers confirmed that technical quality improved from 1980 to 1987. This improvement was associated with improved technology (film, processing, and units) and with the quality assurance programs operating during the NBSS, which identified problems and offered remedies.

Diagnostic CytopathologyVolume 2, Issue 4 p. 271-276 Editorial Value and limitations of transthoracic and transabdominal fine-needle aspiration cytology in clinical practice L. C. Tao M.D., F.R.C.P.(C), Corresponding Author L. C. Tao M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaDepartment of Pathology, 3-301 Eaton Wing, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4Search for more papers by this authorD. E. Sanders M.D., F.R.C.P.(C), D. E. Sanders M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this authorG. L. Weisbrod M.D., F.R.C.P.(C), G. L. Weisbrod M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this authorC. S. Ho M.B.B.S., F.R.C.P.(C), C. S. Ho M.B.B.S., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this authorS. Wilson M.D., F.R.C.P.(C), S. Wilson M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this author L. C. Tao M.D., F.R.C.P.(C), Corresponding Author L. C. Tao M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaDepartment of Pathology, 3-301 Eaton Wing, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4Search for more papers by this authorD. E. Sanders M.D., F.R.C.P.(C), D. E. Sanders M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this authorG. L. Weisbrod M.D., F.R.C.P.(C), G. L. Weisbrod M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this authorC. S. Ho M.B.B.S., F.R.C.P.(C), C. S. Ho M.B.B.S., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this authorS. Wilson M.D., F.R.C.P.(C), S. Wilson M.D., F.R.C.P.(C) Departments of Pathology and Radiology, University of Toronto, and the Department of Radiology and the Divisions of Cytopathology, Gastrointestinal Radiology, and Ultrasound, Toronto General Hospital, Toronto, Ontario, CanadaSearch for more papers by this author First published: December 1986 https://doi.org/10.1002/dc.2840020402Citations: 8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume2, Issue4December 1986Pages 271-276 RelatedInformation

From 1970 to June 1984, 275 patients with bronchioloalveolar carcinoma were admitted to the Toronto General Hospital. Of these, 181 (190 aspiration biopsies, including nine repeat samples) had this diagnosis made following the use of transthoracic fine-needle aspiration biopsy. Based on the cytomorphologic features observed in the aspiration preparations, the tumor was subclassified into three types: nonsecretory, secretory, and poorly differentiated. The cytologic features of these three types of bronchioloalveolar carcinoma are presented and illustrated. Cytomorphologically, the three types of this tumor are distinctly different and their features are sufficiently distinctive from those of bronchogenic adenocarcinoma and metastatic adenocarcinomas to be of diagnostic value. Transthoracic fine-needle aspiration biopsy appears to be a definitive minimally invasive means of establishing the diagnosis of bronchioloalveolar carcinoma preoperatively and especially to be of value for those small peripheral cancers which are relatively inaccessible to direct method of study and are potentially surgically curable.

From 1967 to 1981, 37 cases were diagnosed as thymoma by transthoracic fine needle aspiration biopsy. All were verified histologically, with no false-positive results. The various cytomorphologic patterns of thymoma are presented. All aspirates from the thymomas were reviewed and found to be composed of epithelial elements, with an admixture of lymphocytes in various proportions. There were 13 cases of lymphocytic predominance, 11 of epithelial-cell predominance, 4 of spindle-cell predominance, and 9 of mixed cell types. In the cytologic preparations the epithelial elements from different tumors exhibited different cytologic appearances and were tentatively subclassified into five types: small, intermediate, large, large pleomorphic and spindle shaped. The cytologic features of thymoma observed in aspiration biopsies are sufficiently distinctive from those of other anterior mediastinal tumors to be diagnostic. It appears feasible to investigate an anterior mediastinal mass with percutaneous fine needle aspiration for the purpose of establishing the diagnosis of thymoma prior to median sternotomy or thoracotomy.

We reviewed our experience with 2,114 percutaneous aspiration needle biopsies of intrathoracic lesions. Aspiration was performed for cytological diagnosis employing biplane fluoroscopy and a 20 gauge needle, 0.9 mm in outside diameter. A satisfactory specimen was obtained in 88% of biopsies, and the chance of obtaining a correct diagnosis of a malignant lesion was 81.5%. The false positive rate was 2.3%, and the cytologists could always distinguish between primary and secondary neoplasms. A false negative rare of 13.6% (36 patients) resulted in only three delayed thoracotomies and two instances of interval metastases discovered at mediastinoscopy. Cellular specificity in primary tumors was not sufficiently accurate to affect therapy. Pneumothoraces occurred frequently (31.9% of patients) but wee generally small; 10.4% of patients required chest drainage. There were no recorded instances of tumor implantation in needle tracts. We conclude that a rapid and accurate diagnosis of intrathoracic pathology can be obtained by this technique. It is associated with an acceptable morbidity and may greatly expedite both patient care and investigation.

Departments of Anaesthesia and Radiology, University of Toronto and Toronto General Hospital, Toronto, Canada

Developmental abnormalities of the tracheobronchial tree and its vascular components may be seen in both pediatric and adult patients. These abnormalities occur as pure bronchial anomalies (in which the vascular organization is normal), as pure vascular anomalies (in which the bronchial arborization has proceeded normally) or as combined bronchial and vascular anomalies. The clinical syndromes associated with these anomalies may usefully be considered together as different aspects of potential failure of bronchovascular development. In the adult the bronchogenic cyst is the most commonly encountered pure bronchial abnormality, arteriovenous malformation the commonest pure vascular anomaly and sequestration the most frequent mixed defect. Between 1958 and 1978, 32 bronchogenic cysts, 14 sequestrations and 18 parenchymal aneurysms were treated at the Toronto General Hospital. Diagnostic and therapeutic considerations suggest that surgical intervention is warranted in most cases.

Exogenous lipoid pneumonitis: pulmonary patternsJK Lipinski, GL Weisbrod and DE SandersAudio Available | Share

Treatment with intermittent positive pressure breathing (IPPB) and incentive spirometry (I.S.) was compared in 109 patients after heart surgery with cardiopulmonary bypass. Assessment was done by measurement of vital capacity, arterial oxygen tension and identification of the radiological signs of atelectasis. All patients were instructed pre-operatively in the treatment which was to be used.

The clinical and radiologic diagnosis of exogenous lipoid pneumonitis often goes unrecognized. A specific history of lipoid aspiration is rarely obtained unless specifically sought. We analysed the clinical, radiologic and pathologic findings in 11 patients with pathologically-proven exogenous lipoid pneumonitis. Lipid aspiration results in a predictable pathologic and consequently radiologic pattern of disease, often simulating bronchogenic carcinoma. Transthoracic percutaneous fine-needle aspiration biopsy is useful as a complementary procedure to bronchoscopy in making the diagnosis.

Pulmonary alveolar proteinosis is a rare disease with varied radiographic and clinical manifestations. Thirteen patients are presented and the role of pulmonary lavage in management is illustrated. Six patients had associated diseases such as nocardiosis, leukemia, and silicosis. The broad spectrum of relationships found in alveolar proteinosis suggests that it represents one mechanism by which the lung responds to a variety of insults.

From the experiences in dealing with 2591 cases of transthoracic and transabdominal fine-needle aspiration biopsies (1967-1978), we present our views on the value of this relatively new diagnostic method to clinical practice. Virtually any accessible localized lesion in any organ of the body can be investigated by fine-needle aspiration biopsy, which is considered most useful in patients with suspected malignant disease. Transthoracic and transabdominal fine-needle aspiration biopsy may provide information otherwise obtainable only by thoracotomy or laparotomy. It is an inexpensive and safe method with high accuracy for obtaining a pathologic diagnosis, and can impart some practical significance to clinical practice, especially in clinical management. The pitfalls in cytomorphologic interpretation, which often cause unsuccessful attempts, can be readily avoided with increased practical experience, as indicated by the increase in detection rate of lung cancer by fine-needle aspiration method from 82.8% in 1967-1968 to 93.4% in 1976 at the Toronto General Hospital. The accuracy of cytologic diagnosis plays a major role in spreading this still relatively unfamiliar but excellent diagnostic method. We believe that the method deserves widespread clinical application and when this happens, it will bring about great savings in health care resources.

Radiological evidence of pulmonary complications and possible aetiological factors were investigated in 50 consecutive patients after heart operations with cardiopulmonary bypass. Atelectasis was the most frequent pulmonary complication except for small pleural effusions, with an incidence of 64 per cent. Several types of atelectasis frequently co-existed, with a predominance of the less extensive plate and subsegmental forms. The incidence of atelectasis was the same on each side and the site of atelectasis was basal in three quarters of the patients. Preoperative clinical and catheter data were unrelated to the incidence of atelectasis. There was a significant positive correlation between a short cardiopulmonary bypass time and plate atelectasis, between a large fluid load after bypass and segmental atelectasis, between re-operation for bleeding and subsegmental atelectasis and between post-operative gastric dilation and atelectasis. The type of operation, the use of the intra-aortic balloon and the length of postoperative respiratory ventilation were unrelated to the incidence of atelectasis. The mechanism of development of atelectasis is discussed.

From 1970 to 1977, 101 patients with bronchiolo-alveolar carcinoma were admitted to the Toronto General Hospital. Cytology preparations from 97 patients were reviewed and analyzed in correlation with biologic behavior of the tumours. The value of cytologic diagnosis was reassessed. It appears that routine cytology methods were of limited value in the investigation of patients with a peripheral solitary tumor and therefore, percutaneous fine needle aspiration with positive results in 92% of cases examined, was the only useful cytologic examination for this type of lesion. For multicentric tumors, routine cytology methods achieved positive results in 87.9% of cases and fine needle aspiration 100%. Based on cytomorphologic features, bronchioloalveolar carcinoma can be subclassified into three types: secretory, nonsecretory and poorly differentiated. In this series, 84% of solitary tumors were secretory or nonsecretory type with favorable prognosis, and 16% of solitary tumors were poorly differentiated type with poor prognosis. 55.2% of multicentric tumors were poorly differentiated type and 77.3% of multicentric tumors showed positive lymph nodes at surgery. Our results demonstrate that patients with multicentric or poorly differentiated tumors had poor prognosis.

Pulmonary aspergillosis is being diagnosed with increasing frequency, particularly in larger referral centers. The spectrum of lung pathology can be classified into 3 major groups: A) non-invasive mycetoma; B) allergic bronchopulmonary aspergillosis and C) invasive aspergillosis. Five patients with pulmonary aspergillosis are presented, illustrating unusual features of each major group. Transthoracic needle aspiration biopsy was diagnostic in 3 patients. It is important to differentiate a mycetoma developing in a pre-existing cavity from a cavitating Aspergillus abscess. The radiologic appearances may be similar, but evolution of the 2 lesions is entirely different.

A preliminary assessment of the effectiveness of the Bartlett-Edwards incentive spirometer was made using it as part of the post-operative treatment of 34 patients after open-heart surgery. Its effects on atelectasis were assessed by measuring vital capacity, arterial oxygen tensions, clinical signs and radiological changes. It was found that vital capacity fell after surgery to 41.5 per cent of the pre-operative level, but this rose after the use of the incentive spirometer by an average of 15.5 per cent. Arterial oxygen tensions were unaltered by the use of the incentive spirometer. Temperature, pulse and respirations were of little help in the early diagnosis of atelectasis, but all patients who were still pyrexic four days after operation showed radiological evidence of atelectasis. The incidence of atelectasis demonstrated radiologically was total 84 per cent and plate 69 per cent, sub-segmental 34 per cent and segmental 9 per cent. The implications of these findings are discussed.