Biomedical subjects
Publications and source records attributed to S Ous.
Lymphography was performed in 69 patients with a non-seminomatous testicular tumor and a normal CT scan. Retroperitoneal lymph node dissection and microscopy were carried out in all patients and revealed metastases in 28, only 4 of whom had a positive lymphogram.
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CT was performed before and after lymphadenectomy in 105 patients with early stage non-seminomatous testicular tumor. Retroperitoneal blurring and retracted bowel were the most common findings and might cause interpretation problems. A reference CT making future comparison possible should be routinely performed two months after the operation.
The reliability of computed tomography (CT) using different criteria for abnormal size of retroperitoneal lymph nodes (5, 10, 15 mm in largest diameter) was evaluated prospectively in 90 consecutive patients with a non-seminomatous testicular tumor and lymph nodes less than 20 mm at CT. Correlation was made with histologic findings following retroperitoneal lymphadenectomy. Histologic examination revealed metastases in 38 patients (42%). Using a strict criterion of 15 mm for abnormal node size, sensitivity was 37%, specificity 98%, positive predictive value 93% and negative predictive value 68%. A relaxed criterion of 5 mm led to a sensitivity of 71%, specificity 67%, positive predictive value 61% and negative predictive value 76%. Overall accuracy was approximately 70% with the 5, 10 and 15 mm criteria for abnormal size. The inability of a normal scan to exclude metastases was the main limitation of CT.
From the SWENOTECA Project, the CT findings in 156 patients treated by bilateral retroperitoneal lymphadenectomy were reviewed. Of these, 112 were in stage I (no metastases) and 44 in stage II A (metastases in normal-sized lymph nodes and in nodes with a maximum diameter in the transverse plane of less than or equal to 20 mm). The normal size of lymph nodes in young Scandinavian men was found to be less than 10 mm X 8 mm above the bifurcation, except in the area below the left renal vein to the left of the aortic midline where the normal size was found to be maximally 14 mm X 10 mm. The addition of a lymphangiographic contrast medium did not change the size of the lymph nodes significantly above the bifurcation, while changes of importance were noticed in the pelvic area. Normal size without contrast medium was found to be at the most 15 mm X 10 mm and after addition of contrast medium to the nodes 28 mm X 12 mm. The results of the CT findings in the stage II A group were not impressive but changed somewhat for the better using the new limits concerning size of retroperitoneal lymph nodes. The impact of using different limits is discussed and it is concluded that metastases in normal-sized or almost normal-sized lymph nodes will continue to be a diagnostic problem, at least when using CT.
The relative 5-year survival was 32 per cent in 97 patients with T2 or T3 bladder carcinoma (1972-1978) treated with high dose radiation therapy (CRE greater than or equal to 1700 reu). A slight but significant difference was noted between the two T categories. Fifty-three patients who were tumour-free 3 to 4 months after irradiation had a 55 per cent survival. No other prognostic parameters were identified on the basis of histologic or radiologic findings. In 14 patients severe radiation complications were observed (bladder 9, small bowel 3, combined 2). In patients with radiation sensitive bladder carcinoma, radical radiation therapy seems to be a comparable alternative to total cystectomy.
Tumour cells from 74 biopsies from human urinary bladder carcinomas were cultivated in a semisolid system (Courtenay and Mills method). In 51 cases DNA flow cytometry (FCM) was performed. Significant growth was obtained in 53 of 74 cases (71.6%), and good quality DNA histograms from FCM were obtained in all 51 attempts. No correlations between clinical or histopathological data and plating efficiency (PE) were found, nor between ploidy and PE. However, a very high S-phase (greater than 15%) correlated with a low PE. This work shows that bladder carcinoma cells can be studied in a semisolid agar system. It also suggests that there exists no correlation between PE and DNA FCM data or clinical or histopathological data.
Variety Range (difference between the maximum and minimum transverse diameters in percentage of the minimum diameter) was calculated for 86 lumbar lymph nodes with maximum diameter ranging between 5 mm and 19 mm at CT. The nodes were located within a group (pre- and paracaval, interaortico-caval, pre- and paraaortic) which was removed during primary lymphadenectomy for non-seminomatous testicular tumor. Most nodes were fairly rounded with a Variety Range less than 20%. There was no difference between the largest node in a metastasis group (Variety Range less than 20% in 29 out of 36) and tumor free nodes (Variety Range less than 20% in 39 out of 50). A rounded shape of lymph nodes measuring less than 20 mm on transverse CT sections was not a reliable sign of metastasis in patients with non-seminomatous testicular tumor.
Comparison of reliability of CT with contiguous and non-contiguous scan reading was performed in 100 consecutive patients with a non-seminomatous testicular tumor and lymph nodes less than 20 mm at CT. The patients underwent primary lymphadenectomy and histologic examination of removed nodes. Ten mm thick slices at adjacent 10 mm intervals were used and non-contiguous reading was based on sections with uneven numbers. Reading of non-contiguous scans led to drop in sensitivity from 71% to 66% compared with contiguous scans when 5 mm was used as criterion for abnormal node size. Corresponding decrease was from 47% to 39% with the 10 mm criterion and from 37% to 26% with the 15 mm criterion. Other parameters were only slightly influenced by the scan reading technique. The benefit of contiguous as opposed to non-contiguous scanning was small in the present series.
Fifty-two patients (53 lesions) with muscle invasive carcinoma (T2/T3) of the urinary bladder were examined with computed tomography (CT) before planned total cystectomy. The object of CT was to demonstrate perivesical growth. All patients were examined before and after intravenous injection of contrast medium. The stages obtained from the precontrast and postcontrast scans were compared with the histopathologic stage from the cystectomy specimen. CT staged correctly 35 of the 53 lesions in the precontrast series and 46 of the 53 lesions in the postcontrast series. The improved accuracy from contrast enhancement resulted primarily from fewer cases being overstaged. The use of intravenous contrast medium improved accuracy of CT in evaluation of perivesical tumor growth.
Fourteen patients with known muscle invasive bladder carcinoma were examined with computed tomography (CT) before and five to seven days after diagnostic transurethral resection (TUR). The CT examinations included pre- and postcontrast series. In order to standardize the technique, we examined on a distended bladder. No significant changes occurred for the whole group after TUR. Individual changes were seen. In six patients the largest measured area of the bladder tumor increased after resection and in four the largest measured thickness increased, and this should be borne in mind when CT is used to evaluate tumor response to treatment. Perivesical changes occurred only after extensive diathermy or perforation. They did not show contrast enhancement and could therefore not be mistaken for tumor growth.