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Biomedical subjects

C B Stelling

Publications and source records attributed to C B Stelling.

At least 37 records · Page 2Linked to original sources
PubMed1989

Sensitivity, specificity, predictive value and accuracy of film/screen mammography. A three-year experience.

Mammographic and pathologic findings of 312 breast lesions biopsied at the University of Kentucky Medical Center over a three-year period (Jan 1, 1984 through Dec 31, 1986) were correlated. Each of the 312 mammographic examinations was classified as a true positive, true negative, false positive, or false negative interpretation based on the final pathologic diagnosis. The data on 88 wire directed biopsies for clinically occult mammographic lesions and data on 224 biopsies of palpable lesions performed without wire localization were evaluated separately and in combination. From this data the sensitivity, specificity, predictive value, and accuracy of mammography for detecting breast cancer were calculated. Results of all breast biopsies 1984-1986 gave a sensitivity of 84%, specificity of 59%, positive predictive value of 40%, negative predictive value of 92%, and an accuracy of 65% for film-screen mammography. Wire directed biopsies increased the false positive diagnosis from 22 to 96 but also accounted for the detection of 14 clinically occult breast cancers, of which 84% had negative lymph nodes.

Biopsy↗
PubMed1988

Carcinoma of the breast: detection with MR imaging versus xeromammography.

Detectability of breast cancer with magnetic resonance (MR) imaging versus xeromammography was quantitatively compared. MR images were obtained of breasts of 120 women who underwent xeromammography. T1 values were determined for masses larger than 2 cm. Cancer was histologically confirmed in 39 breasts and was considered excluded from 81 due to results of biopsy, cyst aspiration, or sonography or absence of change in xeromammographic findings over time. Images were blindly interpreted by three observers, and results were expressed as receiver operating characteristic curves. Detectability of breast cancer was substantially better with xeromammography than with MR imaging for all observers (P less than .03, 10(-6), and .001). On MR images, spiculation of a mass, distorted architecture, skin thickening, and nipple or skin retraction were specific but relatively insensitive indicators of cancer. Masses with smooth, distinct margins and signal intensity greater than that of fat on T2-weighted images were always benign. Other findings and T1 values were not diagnostically useful. The authors conclude that xeromammography is superior to MR imaging in detection of breast cancer.

Breast Diseases↗
PubMed1988

Affordable screening mammography: current status.

Societal pressure from physicians and patients for low-cost screening mammography is increasing. The American Cancer Society's guidelines for use of mammography in asymptomatic women older than 40 years of age are not being fully implemented, largely because of the high cost of mammography--more than $100 in many practices. This issue is discussed with a review of the recommendations to lower cost through high-volume programs and separation of screening examinations from consultation examinations.

Age Factors↗
PubMed1988

Magnetic resonance imaging of the human female breast. Current status and pathologic correlations.

Over the past decade, research in MR of the female breast has focused on in vitro studies of excised breast tissue samples or mastectomy specimens and on in vivo clinical imaging of patients, usually with biopsy correlation. The results of in vitro measurement of T1 and T2 times of excised benign and malignant breast tissue do not conclusively demonstrate a clear separation based on these values alone. In particular, benign tumors (fibroadenomas) cannot be distinguished from carcinomas and there is considerable overlap in values for cancer and fibrocystic disease. MR images produced from mastectomy specimens allow detailed correlation with mammographic and histologic findings but are incompletely applicable to in vivo images because of numerous factors including tissue changes associated with disruption of blood supply. In vivo studies have shown that benign tumors (fibroadenomas), fibrocystic changes, and cancers can be imaged successfully by MR. To date the best images show a resolution of about 2 mm. Small cancers and cysts have been imaged successfully but proliferative patterns of fibrocystic disease cannot be differentiated at this time. Carcinomas occurring in dense fibroglandular breasts which are a problem to image mammographically have not been successfully imaged by MR in vivo and in only one instance in vitro in a mastectomy specimen. Since MR cannot image microcalcifications, it does not appear likely to replace mammography as the imaging modality of choice at the present time. Newer magnets of increased strength, specialized surface coils specifically for breast imaging, and the use of contrast enhancing agents all may increase the usefulness of MR as an imaging modality for the detection of breast disease. In particular, increased resolution and contrast enhancing agents which may aid in tissue differentiation should be studied for their ability to detect carcinomas in dense fibroglandular breast tissue and to identify lesions of carcinoma in situ and proliferative patterns of fibrocystic disease. The need for careful collaborative studies between radiologists and pathologists will be essential for the success of these research efforts.

Adenofibroma↗
PubMed1987

Fibroadenomas: histopathologic and MR imaging features.

Twelve fibroadenomas were studied in vivo using magnetic resonance (MR) imaging with a cylindrical surface coil and at 0.15 T. On T1-weighted images, most fibroadenomas had an intensity similar to that of normal fibroglandular tissue; areas of inhomogeneity were seen in six. On five of the T2-weighted images, the fibroadenomas gave a signal equal to or slightly greater than that of normal fibroglandular tissue; five showed a marked increase in intensity, and two gave a low signal intensity. Four fibroadenomas were inhomogeneous on both T1- and T2-weighted images, and two additional lesions became inhomogeneous on T2-weighted images. No consistent correlations were found between MR appearances and histopathologic findings in the fibroadenomas. It is concluded that the appearance of fibroadenomas on MR images is sufficiently variable that it would be difficult to differentiate benign from malignant circumscribed tumors on the basis of MR imaging alone.

Adenofibroma↗
PubMed1986

Calcific tendinitis of the flexors of the forefoot.

We report a case of calcific tendinitis in the flexor tendons of the forefoot. A 33-year-old woman presented with a two-day history of foot pain but she recalled no direct trauma to the foot. Physical examination revealed redness, warmth, and tenderness on the plantar surface of the foot near the head of the first metatarsal. Radiographs showed a small focus of calcification in the flexor tendons of the great toe, diagnostic of calcific tendinitis. The patient was treated with supportive therapy and recovered.

Adult↗
PubMed1986

Nonpalpable breast lesions: wire localization and excisional biopsy.

From January, 1984, through July, 1984, 53 women with 56 nonpalpable suspicious mammographic breast lesions underwent breast biopsy directed by pre-operative needlewire localization. All of the suspicious lesions were removed at the first operation, and, although in 10 patients, the localization wire was greater than 2 cm from the lesion, this did not increase the number of attempts required to excise the lesion. Once the specimen and wire were removed, a radiograph was taken to assure removal of the suspicious area. Also, once the blocks were cut, they were x-rayed to pinpoint further which histopathologic sections would include the area in question. Six of the 56 suspicious mammographic lesions removed were intraductal breast carcinomas. All were Stage I tumors. The remainder of the lesions were benign including 24 with nonproliferative fibrocystic changes, 31 with proliferative fibrocystic changes and only one demonstrating proliferative changes with atypical hyperplasia. This procedure can be performed effectively on outpatients utilizing local anesthesia. Excellent communication among surgeon, radiologist, and surgical pathologist is imperative.

Adult↗
PubMed1985

Prototype coil for magnetic resonance imaging of the female breast. Work in progress.

Magnetic resonance imaging (MRI) of the breast was performed in 35 women using a prototype breast coil at 0.15 T. The distribution of fibroglandular and fatty tissues was demonstrated sufficiently well to permit correlation with the mammographic patterns of Wolfe, and it was possible to identify 1-cm cysts. The signal intensity of the cysts varied from low to high as repetition time (TR) and echo time (TE) using the spin echo technique (TR/TE) were prolonged from 250/30 to 1,000/120. In two women, fibroadenomas were seen as low-intensity, smoothly marginated lesions surrounded by fat. A range of in vivo observed T1 values is summarized for normal and pathologic tissues. It is concluded that MRI of the female breast, currently in the developmental phase, is feasible and further evaluation is indicated.

Adipose Tissue↗
PubMed1984

Synovial calcifications associated with long-term steroid therapy for chronic arthritis.

Radiologically detected synovial densities may be related to one of several distinct causes. The associated articular appearance may give a clue to the diagnosis. We have described the stippled appearance of innumerable distinct densities in the knees of two patients who had progressive destructive changes associated with long-term steroid therapy. We suggest that prolonged steroid therapy be added to the list of processes associated with diffuse small synovial calcifications.

Aged↗
PubMed1984

Miliary pulmonary blastomycosis.

Five patients with proved blastomycosis had a diffuse miliary nodular pattern seen on chest radiographs. These cases are presented to emphasize that blastomycosis may be the cause of a miliary pattern in an endemic area. Documentation requires recovery of the organism from body fluids or tissue since skin and serologic testing are unreliable indicators of active disease. With prompt diagnosis and appropriate treatment, the patient may recover from this form of endogenous disseminated reinfection that otherwise may be fatal, particularly in the immunocompromised host.

Adult↗
PubMed1983

Salicylate-induced pulmonary edema.

Noncardiogenic pulmonary edema occurs in 35% of salicylate-intoxicated patients who are over 30 years old. Cigarette smoking, chronic salicylate ingestion, a component of metabolic acidosis, and the presence of neurological symptoms on admission are strong risk factors for the subsequent development of pulmonary edema in the appropriate age group. In the absence of these risk factors, salicylate-induced pulmonary edema is rare. The etiology is multifactorial, but it centers around altered vascular permeability in the lungs.

Acidosis↗
PubMed1983

Adenocarcinoma of the lung: a tumor with a changing pleomorphic character.

Adenocarcinoma is widely accepted to occur as a solitary, peripheral, subpleural, pulmonary mass with infrequent hilar and rare mediastinal involvement. The older literature indicates that hilar involvement occurs in 18% of cases and that mediastinal involvement occurs in only 2% of cases. A retrospective study of 100 randomly selected cases of primary adenocarcinoma of the lung diagnosed between 1976 and 1982 indicates that hilar masses are present in 40% of cases and that mediastinal masses are present in 27% of cases. In all, hilar and mediastinal masses occurred alone or in combination so that 51% of the patients in this series had plain radiographic evidence of such involvement. Since the patients in this series were studied by conventional radiographic techniques in a manner similar to patients in previous reports, it appears that adenocarcinoma of the lung may present with a much more pleomorphic radiographic appearance than was previously recognized. The reasons for this change in the radiographic appearance of adenocarcinoma are not completely understood but include a change in the histopathologic criteria for the diagnosis of adenocarcinoma and an increase in the incidence of adenocarcinoma, particularly of the poorly differentiated form.

Adenocarcinoma↗