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Biomedical subjects

A Herbert

Publications and source records attributed to A Herbert.

At least 109 records · Page 6Linked to original sources
PubMed1988

Use of ultrasound localization to improve results of fine needle aspiration cytology of breast masses.

A prospective randomized controlled trial of 116 patients with breast masses was conducted to compare the accuracy of 'blind' aspiration cytology performed in the clinic with aspiration cytology using ultrasound localization. The unsatisfactory aspiration cytology rate was significantly reduced by ultrasound localization (P = 0.028). This was mainly due to an improvement in the unsatisfactory rate for tumours less than 3 cm in diameter (P = 0.036). The results were influenced by the number of needle manoeuvres performed, less than 10 needle manoeuvres being associated with a 54% unsatisfactory aspiration rate compared with 25% when greater than 10 manoeuvres were performed (P = less than 0.02). One experienced aspirator in the clinic had results comparable to those achieved with ultrasound localization. It is concluded that experience and technique are the most important factors in obtaining a satisfactory aspirate from breast masses. Routine ultrasound localization prior to aspiration confers some benefit. Consideration should be given to the use of the ultrasound-assisted technique following a previous unsatisfactory aspiration, particularly if the tumour is less than 3 cm in diameter.

Biopsy, Needle↗
PubMed1988

Wide excision of primary breast cancer: the incidence of residual carcinoma at the site of excision.

Fifty-one consecutive women with early breast cancer underwent wide excision and axillary clearance. After wide excision five biopsies were taken from the walls of the cavity. On histological examination tumour was present in the cavity biopsies in 13 cases (25%). The presence of ductal carcinoma in situ in the primary tumour was not associated with an increased number of positive cavity biopsies. In nine cases incomplete excision was due to separate foci of invasive or in situ carcinoma, in two cases tumour was contiguous with the primary carcinoma and in two, separate foci and contiguous disease both occurred. The high incidence of residual local tumour after wide excision of breast cancer demands the need for postoperative irradiation to the breast and frequent review.

Adult↗
PubMed1987

Surgery after initial chemotherapy for localized small-cell carcinoma of the lung.

Despite the high response rates induced by chemotherapy, many patients with limited small-cell lung cancer (SCLC) relapse at the site of primary disease. Failure of radiotherapy to overcome this has led to the use of surgery as part of a combined modality approach. Between December 1981 and December 1985, 189 patients with SCLC were assessed for suitability for surgery after an initial three cycles of chemotherapy (doxorubicin, cyclophosphamide, and etoposide). Fifty-seven were found to have limited disease, and of these, 19 were ineligible or unfit for surgery. Of the 38 eligible patients, 84% had an objective response to three cycles of chemotherapy and 25 were deemed suitable for surgery after restaging. At thoracotomy, four were inoperable, nine had a lobectomy, and 12 had a pneumonectomy. There was no evidence of viable SCLC in four resection specimens (one stage 1, two stage 2, one stage 3 at presentation), no viable SCLC but an entirely separate focus of viable poorly differentiated squamous carcinoma (SqLC) in one, and the remaining specimens contained viable SCLC. Survival of patients selected to undergo tumor resection was excellent (median survival, 33 months; plateau phase, 48% alive at 3 to 5 years), but survival of the entire group with limited SCLC was not dissimilar from that reported in previous series of limited-stage tumor treated with chemotherapy alone. Long-term survival appeared to be largely restricted to those with no evidence of viable SCLC at surgery (no viable SCLC, zero of five relapsed; viable SCLC, 13 of 16 relapsed and/or died). This prospective study confirms the feasibility of the combined modality approach, but suggests that any improvement in overall survival is likely to be small. Until the results from multicenter randomized trials are available, surgery, as part of a combined modality program, should be regarded as experimental.

Actuarial Analysis↗
PubMed1987

Fine needle aspiration cytology of breast masses: an evaluation of its accuracy and reasons for diagnostic failure.

A study of 1458 patients who had undergone breast aspiration cytology was conducted to determine the diagnostic accuracy of the technique. The effect of tumour histology and size on the unsatisfactory aspirate and false negative rate was examined. Seven hundred and thirty one patients (50%) had histological diagnoses. The sensitivity of aspiration cytology for malignancy was 64% for the first aspiration, but was 91% in patients who had had 3 aspirates. The specificity was 56%, this low figure was almost entirely due to inadequate or unsatisfactory cytological preparations. The positive and negative predictive values of aspiration cytology were 99.4% and 85% respectively demonstrating high diagnostic accuracy given a satisfactory aspirate. Invasive lobular carcinoma yielded a significantly higher unsatisfactory rate than invasive ductal carcinoma (P less than 0.001) and fibroadenoma yielded a significantly lower unsatisfactory rate than fibroadenosis (P less than 0.001). Mass size influenced the unsatisfactory rate for invasive ductal carcinoma (P less than 0.05) and fibroadenoma, but not for invasive lobular carcinoma or fibroadenosis. Only 2 of the 32 false negatives were due to misinterpretation, the remainder resulted from the aspiration needle missing the mass. We conclude that aspiration cytology is an accurate preoperative diagnostic procedure for the evaluation of breast masses. Unsatisfactory or negative aspirates should be regarded as 'non-results' if there is clinical or radiological suspicion of malignancy.

Adolescent↗
PubMed1986

Evaluation of PAS-diastase and carcinoembryonic antigen staining in the differential diagnosis of malignant mesothelioma and papillary serous carcinoma of the ovary.

A series of malignant mesotheliomas and papillary serous carcinomas of the ovary were stained using the periodic acid Schiff reaction with diastase digestion (PAS-D) and an immunoperoxidase technique for carcinoembryonic antigen (CEA). The methods were evaluated in terms of repeatability and validity. Staining reactions were classed as positive or negative by three 'blinded' observers. Within-observer repeatability was greater for PAS-D than for CEA but there was no statistically significant difference for between-observer repeatability. The validity of the methods clearly differed, however, since the sensitivity and specificity of CEA were consistently less than that of PAS-D. Our most consistent estimates of sensitivity and specificity were compared with those of other studies and the reasons for this difference were analysed. Positive PAS-D and CEA staining were uncorrelated but a combination of the two did not appear significantly superior to PAS-D alone. We believe that PAS-D remains the method of choice for differentiating peritoneal mesotheliomas and disseminated papillary serous carcinoma of the ovary in the absence of reliable evidence of an ovarian primary because the significance of CEA positivity in occasional mesothelial tumours remains to be determined.

Amylases↗
PubMed1986

Urinary monoclonal free light chains in primary Sjögren's syndrome: an aid to the diagnosis of malignant lymphoma.

Three patients, two with typical primary Sjögren's syndrome (SS) and the third with several features of SS, including abnormal sialography and reduced tear secretion, developed B cell non-Hodgkin's lymphoma (NHL) of parotid or lung, or both. Isoelectric focusing of concentrated urine specimens in agarose, followed by immunofixation, demonstrated the presence in each patient's urine of monoclonal free light chains of the same class as that shown on the tumour cells. In one patient the level of urinary free light chains was monitored and found to correlate with disease activity. Similar techniques showed no monoclonal light chains in the urine from a further 26 cases of SS with no clinical evidence of lymphoma. The detection of monoclonal urinary free light chains may provide an early diagnostic clue to the development of lymphoma in patients with SS and be a means of tumour monitoring.

Aged↗
PubMed1986

Lymphoma in Sjögren's syndrome: urinary monoclonal free light chains as a diagnostic aid and a means of tumour monitoring.

Non Hodgkins lymphoma (NHL) is reported to be at least 40 times more common in Sjögren's syndrome (SS). Diagnosis may be difficult as blood and bone marrow haematology can remain normal, with no evidence of a serum paraprotein band or Bence-Jones proteinuria by routine electrophoresis. Using the technique of isoelectric focusing in agarose, followed by immunofixation, monoclonal free light chains can be found in the urine of 44% and 74% respectively of patients with NHL and B cell chronic lymphocytic leukaemia, but not in normal individuals. Three patients, two with typical severe primary SS and the third with several features of SS including abnormal sialography and reduced tear secretion, developed B cell NHL of parotid and/or lung. Using the above method on concentrated urine specimens, monoclonal free light chains of the same class as that demonstrated on the tumour cells were found to be present in each patient's urine. In one patient the level of urinary free light chains was monitored and found to correlate with disease activity. Using similar techniques no monoclonal light chains could be found in the urine from a further 10 cases of primary SS and 18 cases of SS secondary to rheumatoid arthritis, all of whom had no clinical evidence of lymphoma. Screening of SS patients' urine by the method described for monoclonal urinary free light chains may provide an early diagnostic clue to the development of lymphoma and be a means of tumour monitoring.

Adult↗
PubMed1986

The accuracy of ultrasound in the diagnosis of breast disease.

The accuracy of breast ultrasound using all purpose static beta-scanning equipment has been compared with mammography. Ultrasound was found to be both more sensitive (93%:82%) and specific (95%:89%) in a large retrospective series of 1000 patients undergoing investigation for symptomatic breast disease. In a smaller prospective and consecutive series of 142 patients undergoing surgery where histological proof was obtained ultrasound was also found to be more sensitive (91%:81%) and specific (81%:69%). In both studies, the greater accuracy of ultrasound was attributed to its ability to diagnose lesions hidden in X-ray dense breasts and where mammography had revealed featureless asymmetical densities of uncertain nature. In these instances ultrasound may have a significant role to play as an adjunct to mammography in the preoperative assessment of breast lesions.

Breast Diseases↗
PubMed1985

Accuracy of aspiration cytology in the diagnosis of breast disease.

The accuracy of fine needle aspiration cytology has been assessed in 480 consecutive breast lesions where definitive histology was later available. The results in terms of specificity and sensitivity have also been compared to mammography and clinical examination. With adequate smears aspiration cytology was 100 per cent specific with no false positive diagnosis. This compares with 15 false positive mammograms and 12 false positive diagnoses on clinical examination. Cytology was unsatisfactory in 36 per cent of benign lesions owing to poor cellularity of the sample but when considered with mammography and examination led to a reduction in biopsies for benign disease. A definitive cytological diagnosis of malignant tumours resulted in a reduction in frozen sections with a substantial saving of resources and improvement in patient counselling. No mastectomy was performed for benign disease.

Biopsy, Needle↗
PubMed1985

Lymphocytic interstitial pneumonia identified as lymphoma of mucosa associated lymphoid tissue.

The widespread interstitial pulmonary infiltration in two patients, showing the clinical, radiological and histological features of lymphocytic interstitial pneumonia (LIP), has been characterized by histological and immunological criteria as malignant lymphoma of follicle centre cell (FCC) origin with plasmacytic differentiation. One patient also had malignant lymphoma of the parotid glands which had been present for many years and was previously considered benign (benign lymphoepithelial lesion). The other patient had a long history of Sjögrens syndrome. The lymphomas in these patients are presented as typical examples of malignant lymphoma of mucosa-associated lymphoid tissue.

Aged↗
PubMed1985

The ability of bifunctional and monofunctional pyrrole compounds to induce sister-chromatid exchange (SCE) in human lymphocytes and mutations in Salmonella typhimurium.

The ability to induce sister-chromatid exchange (SCE) in human lymphocytes and mutations in Salmonella typhimurium has been assessed for 4 pyrrole compounds. Three of the compounds, 2,3-bishydroxymethyl-1-methylpyrrole (BHMP), 2-hydroxymethyl-1-methylpyrrole (2HMP) and 3-hydroxymethyl-1-methylpyrrole (3HMP) are synthetic pyrrolic alcohols; the fourth compound, dehydroretronecine (DHR) is a metabolite of several naturally occurring pyrrolizidine alkaloids. The activity of these compounds was compared with that of mitomycin C (MMC) and decarbamoyl mitomycin C (DCMMC), chemicals related structurally to the pyrrole compounds. All 6 compounds caused an increase in the numbers of SCEs. Whereas the bifunctional pyrroles, DHR and BHMP, and the mitomycins, MMC and DCMMC, increased levels of SCEs by 8-12 times control levels, the monofunctional pyrroles gave increases of only 2 times. Three of the 4 pyrrole compounds (DHR, BHMP and 3HMP) induced mutations in the Salmonella typhimurium base substitution strain TA92, the fourth (2HMP) was not found to be mutagenic in any of the 8 strains used. The mitomycins induced mutations in the frameshift strain TA94 in addition to the base substitution strain TA92, with DCMMC always more mutagenic and less cytotoxic than MMC. All bifunctional compounds induced more mutations and were less cytotoxic in strains containing an efficient excision-repair system. With the pyrrole compounds numbers of SCEs and mutations were only increased when using chemical concentrations significantly higher than those required for the mitomycins: more than twice as high to produce significant numbers of SCEs and more than 100 times as high to produce equal numbers of mutations.

Humans↗
PubMed1984

Primary malignant lymphoma of the lung: histopathologic and immunologic evaluation of nine cases.

Nine primary malignant lymphomas of the lung are described. Seven were localized lesions, and two were diffuse bilateral infiltrations. Histopathologic examination of these lesions suggests that they represent examples of the same entity and that it is a malignant lymphoma rather than a reactive infiltration or "pseudolymphoma." Histologic evidence of lymph node involvement is unusual, even in the presence of mediastinal or pleural infiltration. Immunohistochemical studies demonstrated a monotypic B-cell population in cases in which suitable tumor tissue was available for study (four of nine). Of the other five cases, two had a population of monotypic B lymphocytes in the peripheral blood, and in one of these and in one additional case gastric lymphomas subsequently developed. It is suggested that these lymphomas arise from bronchus-associated lymphoid tissue, which would explain both their histologic features and their tendency to remain localized to the lung for long periods.

Adult↗
PubMed1984

Use of antibodies to carcinoembryonic antigen and human milk fat globule to distinguish carcinoma, mesothelioma, and reactive mesothelium.

Antibodies raised against human milk fat globule (HMFG 1 and 2) and carcinoembryonic antigen were used in an immunoperoxidase technique to differentiate mesothelioma, carcinoma, and benign, reactive mesothelium. Sixteen mesotheliomas, 27 lung carcinomas, and 13 specimens of reactive mesothelium were examined. Staining for carcinoembryonic antigen was not seen in reactive mesothelium or mesothelioma but was present in 22 of 27 carcinomas. Mesothelioma and carcinoma usually stained with HMFG 1 and 2; reactive mesothelium did not. These three antibodies may help to distinguish carcinoma, mesothelioma, and reactive mesothelium.

Adenocarcinoma↗
PubMed1984

Assessment of a scoring scheme for the preoperative diagnosis of breast lumps.

The value and accuracy of a scoring system applied to clinical examination, aspiration cytology and mammography has been assessed in the diagnosis of 224 consecutive 'new' patients attending a breast clinic with a breast lump. In 72 of 99 patients with breast cancer (80%) the scores were high enough to allow definitive surgery without formal histology; all were subsequently confirmed as breast carcinomas. Cytology proved the most accurate investigation with no false positives and a correct diagnosis in 146 of 148 adequate specimens (98.6%). This system reduced the frozen section rate by 74% and allowed for a more appropriate counselling of patients prior to mastectomy.

Adult↗
PubMed1983

Association between hepatoblastoma and polyposis coli.

We have identified five children with hepatoblastoma who have a family history of polyposis coli affecting the mother and maternal relatives. We believe that the familial association of these two conditions is unlikely to have occurred by chance. Cytogenetic studies on three of the families have shown no evidence of a chromosomal abnormality.

Adolescent↗