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K Bottles

Publications and source records attributed to K Bottles.

At least 37 records · Page 2Linked to original sources
PubMed1993

The palpable breast nodule. A cost-effectiveness analysis of alternate diagnostic approaches.

BACKGROUND: Traditionally, open biopsy has been considered the optimal procedure for the diagnosis of breast nodules. Fine-needle aspiration biopsy (FNAB) has been proposed as an alternate method for the diagnosis of many palpable breast lesions. METHODS: The authors compared the diagnostic utility of open biopsy and FNAB using decision tree and cost-effectiveness analyses. RESULTS: When compared with two-step excisional biopsy, FNAB achieved a savings of over $700 at the cost of 0.1% decrease in 10-year overall survival. CONCLUSIONS: These data indicate FNAB to be a reasonable alternative to open biopsy for the diagnosis of palpable breast lesions in many patients.

Adult↗
PubMed1993

Possible mechanism for seeding of tumor during radical prostatectomy.

Prostatic adenocarcinoma sometimes recurs locally in the operative bed after radical prostatectomy. Having observed local recurrence in several patients who had a small tumor confined to the prostate on whole mount serial sections, we postulated that some instances of local recurrence could arise from malignant cells shed in prostatic secretions expressed during surgery. To evaluate whether prostatic secretions contain malignant cells and to estimate the frequency of this phenomenon, we collected fresh prostatic secretions from radical prostatectomy specimens immediately after removal. The secretions were analyzed by cytology for the presence of malignant cells. Of 76 samples collected from consecutive patients with clinical stages T1 and T2 prostate cancer at 3 institutions 11 (14%) contained malignant cells. Positive cytology results were most frequent in patients with poorly differentiated tumors. Of 11 cancers with a Gleason sum of 8 to 10 in the prostatectomy specimen 6 (55%) had a positive cytology result. However, of 63 tumors with a Gleason sum of 5 to 7 only 4 (6%) were positive (p < 0.0001). There was no significant correlation with either clinical or pathological stage of the tumor in this small series. Our findings suggest that malignant cells shed during prostatectomy may seed the surgical bed and could be responsible for some instances of local tumor recurrence. The rate of positive cytology results in our study is similar to the local recurrence rates reported in the literature. Surgeons should make prudent attempts to avoid seeding from this source.

Adenocarcinoma↗
PubMed1993

Cytologic diagnosis of metastatic epithelioid sarcoma. A cytologic mimic of squamous cell carcinoma.

A case of epithelioid sarcoma in a 39-year-old woman who had metastatic lesions in her lung from a primary arm tumor is presented. A review of the literature and analysis of this case did not identify any specific light microscopic or immunohistochemical way to separate definitively the lung cytologic smear in this case from squamous cell carcinoma. The authors believe cytologic smears from epithelioid sarcoma can closely mimic smears from squamous cell carcinoma. Pathologists should be alert to these similarities.

Adult↗
PubMed1992

Clinical determinants for the management of thyroid nodules by fine-needle aspiration cytology.

To evaluate the utility of clinical features for the selection of patients with thyroid lesions suitable for diagnosis by fine-needle aspiration cytologic study, we reviewed 149 cases with complete clinical histories, laboratory evaluations, fine-needle aspirates, and histologic study of the index lesion. Review of these data demonstrated that only the presence of lymphadenopathy was of statistical value in the distinction of benign from malignant nodules. Moreover, once an aspiration diagnosis of "follicular neoplasm" had been made, no clinical, radiologic, or laboratory test aided in the distinction of follicular adenoma from follicular carcinoma.

Analysis of Variance↗
PubMed1991

An approach to fine-needle aspiration biopsy diagnosis of hepatic masses.

After reviewing collection techniques and the cytology of normal and reactive hepatocytes, a systematic approach to the evaluation of fine-needle aspiration biopsy smears of hepatic mass lesions is presented. One of the main problems facing the cytopathologist is the differentiation of cirrhosis from well-differentiated hepatocellular carcinoma. Smears from patients with cirrhosis often contain clusters of bile duct epithelial cells and chronic inflammatory cells, while properly sampled hepatocellular carcinoma smears should contain no bile duct epithelial cells and few inflammatory cells. Key criteria which favor the diagnosis of hepatocellular carcinoma over cirrhosis are: increased nuclear to cytoplasmic ratio, trabecular pattern, and atypical naked hepatocytic nuclei. Key criteria which favor the diagnosis of primary hepatocellular carcinoma over metastatic disease include polygonal cells with centrally placed nuclei, cells separated by sinusoidal capillaries, and bile. This systematic approach to the evaluation of hepatic fine-needle aspiration biopsies must be used with the realization that other uncommon mass lesions of the liver do exist (focal nodular hyperplasia, adenoma, hepatoblastoma, bile duct carcinoma, vascular tumors, mesenchymal tumors, and lymphomas).

Biopsy, Needle↗
PubMed1991

Fibroepithelial polyps of the vagina in pregnancy.

A 38-year old pregnant woman presented with a polypoid tumor of the vagina. A biopsy revealed benign fibroepithelial polyps. Her pregnancy progressed normally, and she underwent an uncomplicated vaginal delivery. Once the benign nature of the lesion has been established, a spontaneous vaginal delivery is not contraindicated. However, operative vaginal delivery should be avoided to reduce the risk of trauma and hemorrhage. Local excision is curative and may be performed as an interval procedure when the vaginal vascularity has returned to normal.

Adult↗
PubMed1991

Cytologic criteria to distinguish hepatocellular carcinoma from nonneoplastic liver.

The authors reviewed a series of fine-needle aspiration biopsy (FNAB) specimens of the liver to identify useful cytologic criteria to distinguish hepatocellular carcinoma (HCC) from nonneoplastic liver. Ten cytologic features were examined in this study: high cellularity, acinar pattern, trabecular pattern, hyperchromasia, pleomorphism, irregularly granular chromatin, uniformly prominent nucleoli, multiple nucleoli, increased nuclear/cytoplasmic ratio, and atypical naked hepatocytic nuclei. These features were examined in a series of 82 FNAB specimens from 52 patients with HCC and 30 patients with nonneoplastic lesions. With the use of a step-wise logistic regression analysis, three features were identified as predictive of HCC: increased nuclear/cytoplasmic ratio (P = 0.001), trabecular pattern (P = 0.002), and atypical naked hepatocytic nuclei (P = 0.03). When these three criteria were used, the sensitivity of diagnosing HCC by FNAB was 100%, and the specificity was 87%.

Biopsy, Needle↗
PubMed1991

Cytologic criteria used to diagnose adenocarcinoma in pleural effusions.

A stepwise logistic regression analysis was employed to evaluate the usefulness of the following criteria to distinguish adenocarcinoma in pleural effusion from benign pleural effusion: increased size of nucleus, increased nuclear to cytoplasmic ratio, irregular nuclear borders, sharply defined cytoplasmic boundaries, large nucleoli, aggregates with variable size nuclei, aggregates with nuclear overlap, irregular noncentral vacuoles, aggregates with nuclear molding, multinucleation, three-dimensional aggregates, aggregates with large cytoplasmic vacuoles, atypical mitoses, nuclear vacuoles, homogeneous cytoplasm, aggregates with associated lymphocytes and neutrophils, and uniform size aggregates. A total of 223 patients with benign pleural effusion cases and 221 patients with adenocarcinoma in their pleural effusion were scored as to the presence or absence of the above criteria. The resulting data were subjected to a stepwise logistic regression analysis that chose increased nuclear/cytoplasmic ratio, irregular nuclear borders, large nucleoli, sharply defined cytoplasmic boundaries, and three-dimensional aggregates as the best criteria to differentiate adenocarcinoma in pleural effusion from benign pleural effusion. When used together, these five features had a sensitivity of 94% and a specificity of 93% for predicting adenocarcinoma.

Adenocarcinoma↗
PubMed1991

Problems encountered with the Bethesda System: the University of Iowa experience.

This paper provides a descriptive summary of 1 year's experience with the Bethesda Cytologic Classification System at the University of Iowa Hospitals and Clinics. Cytotechnologists and pathologists criticized the failure of the new classification system to provide microscopic criteria for the following categories: adequacy of the smear (satisfactory, less than optimal, unsatisfactory), atypical squamous cells of undetermined significance, atypical glandular cells of undetermined significance, and inflammation-associated changes. Clinicians criticized the "less than optimal" category and the reporting of koilocytosis, moderate dysplasia, and endometrial cells. Suggestions for modifying the Bethesda System include: eliminating the less than optimal response, defining what constitutes an unsatisfactory smear, eliminating the terms low-grade and high-grade squamous intraepithelial lesion, and changing the reporting of endometrial cells.

Attitude of Health Personnel↗
PubMed1989

Abdominal lymphoma in AIDS: evaluation with US.

The sonographic findings in 38 patients with abdominal lymphomas related to acquired immunodeficiency syndrome (AIDS) were reviewed. Thirty-three patients had non-Hodgkin lymphoma, and five had Hodgkin disease. Abnormal masses were detected with sonography in 33 patients (87%). Focal hypoechoic liver lesions up to 10 cm in diameter were visible in 17 patients. Several lesions were anechoic and septated, mimicking fluid. Adenopathy (at the retroperitoneum, mesentery, or porta hepatis) was seen in 15 patients. Other involved areas included bowel, omentum, spleen, kidney, and adrenal gland. AIDS-related abdominal lymphomas frequently cause extranodal masses that can be readily imaged with ultrasound. Ultrasound-guided fine needle aspiration biopsy allows a specific diagnosis to be made in many cases.

Abdominal Neoplasms↗
PubMed1989

The use of fine-needle aspiration biopsy in children.

Fine-needle aspiration biopsy has become increasingly popular for evaluating both palpable and nonpalpable masses. Judging from the current body of literature, this procedure is underused by American pediatricians. We report a series of 84 pediatric patients--younger than 16 years--who underwent 92 fine-needle aspiration biopsies to evaluate a large variety of masses. The results of 51 (55%) were benign, and 33 (36%) biopsies revealed malignancy. In two cases (2%) the findings were suggestive of malignancy, and in six cases (7%), insufficient material was rendered for diagnosis. Either histologic or clinical follow-up or both were available for 85 procedures. Based on these cases, the sensitivity of 97% and the specificity was 95%, indicating that fine-needle aspiration biopsy is a good method for screening and observing patients for various malignant tumors in a variety of organs.

Adolescent↗
PubMed1988

A step-wise logistic regression analysis of hepatocellular carcinoma. An aspiration biopsy study.

Fine needle aspiration biopsy (FNAB) has become a popular method to diagnose mass lesions of the liver. Although several reports have listed FNAB criteria to be used to diagnose both primary and metastatic tumors of the liver, none have separated key cytologic criteria from secondary criteria. We reviewed the FNAB smears from 35 patients with proven hepatocellular carcinoma and 74 patients with proven metastatic tumors in the liver. All specimens were coded as to the presence or absence of the following variables: polygonal cells with centrally placed nuclei; well-defined, granular cytoplasm; large nucleoli; small cytoplasmic vacuoles; large cytoplasmic vacuoles; bile; polymorphonuclear leukocytes; malignant cells separated by sinusoidal vessels; endothelial cells surrounding tumor cell clusters; multinucleated tumor giant cells; basophilic intracytoplasmic inclusions; eosinophilic intracytoplasmic inclusions; and intranuclear cytoplasmic inclusions. A step-wise logistic regression analysis was performed on the data to determine the variables predictive of hepatocellular carcinoma. The statistical analysis selected polygonal cells with centrally placed nuclei, malignant cells separated by sinusoidal capillaries, and bile as the key cytologic criteria for hepatocellular carcinoma. Endothelial cells surrounding tumor cell clusters and intranuclear cytoplasmic inclusions were selected as secondary criteria by this analysis.

Biopsy, Needle↗
PubMed1988

Testicular histology in fetuses with the prune belly syndrome and posterior urethral valves.

Intra-abdominal cryptorchidism and infertility are universal features of the prune belly syndrome but they usually are not seen with posterior urethral valves. To understand further the differences between these patients we reviewed testicular histology in 5 fetuses from each of 3 groups: prune belly syndrome, posterior urethral valves and normals. Spermatogonia were noted in all but the numbers were significantly reduced in those with the prune belly syndrome and posterior urethral valves compared to normals: 8.6 and 13.4 versus 31.2 per 10 high power fields, respectively. The fetuses with the prune belly syndrome also had marked Leydig cell hyperplasia in contrast to the other groups. These findings suggest that the testicular pathological condition in patients with the prune belly syndrome is caused by more than mechanical cryptorchidism.

Fetus↗
PubMed1988

Cytologic criteria for fibroadenoma. A step-wise logistic regression analysis.

The authors reviewed the fine-needle aspiration biopsy smears from 62 subjects with proven fibroadenoma, 60 subjects with proven ductal carcinoma, and 42 subjects with proven fibrocystic disease. All smears were coded as to the presence or absence of the following variables: epithelial cells, stroma, honeycomb sheets, antler horn clusters, naked nuclei, nucleoli, marked cellularity, foam cells, apocrine cells, anisokaryosis, atypical nuclear hyperchromasia, single cells with cytoplasm, mitotic figures, and nuclei greater than two red blood cell diameters. Step-wise logistic regression analyses were performed to determine the variables predictive of fibroadenoma. The statistical analyses selected stroma, antler horn clusters, and marked cellularity as the key cytologic criteria to differentiate fibroadenomas from fibrocystic disease. The statistical analyses selected stroma, antler horn clusters, and honeycomb sheets as the key cytologic criteria to differentiate fibroadenoma from ductal carcinoma.

Adenofibroma↗
PubMed1988

Fine-needle aspiration biopsy of patients with acquired immunodeficiency syndrome (AIDS): experience in an outpatient clinic.

One hundred twenty-one fine-needle aspiration biopsies of lymph nodes were done on 113 men followed in the AIDS (acquired immunodeficiency syndrome) Outpatient Clinic of the San Francisco General Hospital. The cytologic diagnoses on these 121 biopsies included 60 (50%) hyperplasias, 24 (20%) non-Hodgkin lymphomas, 21 (17%) mycobacterial infections, 12 (10%) cases of Kaposi sarcoma, and 1 each of Hodgkin disease, giant cell carcinoma, nasopharyngeal carcinoma, and squamous cell carcinoma. No false-positive results occurred in this series, but five false-negative results were seen in the 10 patients with hyperplasia on fine-needle aspiration biopsy specimens who subsequently had open surgical biopsy. From our experience, we believe fine-needle aspiration biopsy is a useful, cost-effective initial method to evaluate lymphadenopathy in patients seen at an AIDS outpatient clinic.

Acquired Immunodeficiency Syndrome↗