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PubMed2003

Synchronous colorectal carcinoma: clinico-pathological features and prognosis.

OBJECTIVE: The present study was undertaken to clarify the clinical and pathological features of synchronous colorectal carcinomas, to compare prognosis between cases with synchronous carcinomas and those with single carcinomas and to explore prognostic factors of synchronous carcinomas. PATIENTS AND METHODS: Among 876 surgically resected primary colorectal carcinomas, 42 cases (4.8%) with synchronous carcinomas were identified. Clinical characteristics, routine pathological findings according to the TNM classification and postoperative survival were compared between synchronous cases and single cases. Prognostic factors of synchronous cases were explored using the proportional hazard model. RESULTS: The index lesions of synchronous cases did not differ from single lesions in age, size, differentiation, location, pT value, pN value, pathological stage, morphology or lymphatic invasion. However, the male:female ratio was higher and distant metastasis was more frequent in synchronous cases than in single cases. Although postoperative survival of synchronous cases was shorter than that of single cases, they were similar in the multivariate proportional hazard model including pathological stage and curability as co-factors. Only pathological stage and curability of the index lesion were significant co-factors of postoperative survival of synchronous cases. CONCLUSION: Synchronous carcinomas and single carcinomas were similar in clinical characteristics and routine pathological findings. The prognosis of synchronous cases and that of single cases did not differ if the pathological stages were identical and the resections were curative.

Adult↗
PubMed2004

T2-weighted turbo spin-echo images, maximum-intensity projections, and three-dimensional volume-rendering for delineation of pathologies and anatomic details of the inner ear.

PURPOSE: The aim of the current study was to compare 3-dimensional T2-weighted turbo spin-echo (TSE) axial slices, maximum-intensity projections (MIPs), and volume-rendered images with respect to the delineation of pathologic findings and anatomic structures of the inner ear. Each of the compared image types was available at 2 different resolutions. MATERIALS AND METHODS: In 64 patients, 3-dimensional T2-TSE images were acquired with a matrix of 128 x 100 and 230 x 230 (field-of-view 90 x 90 mm). Direct axial images, MIPs, and volume-rendered images from the 2 datasets were evaluated in terms of the delineation of pathologic findings and anatomic structures. Analysis was performed by 2 radiologists in consensus. RESULTS: Though axial images acquired with a matrix of 230 x 230 showed more anatomic details than images acquired with a matrix of 128 x 100, pathologic findings (33 in total) were assessable with the same confidence on images of either resolution. Pathologies completely surrounded by fluid were best assessed on axial slices. The delineation of pathologies not embedded in a fluid was almost equally good in axial slices, MIPs, or 3-dimensional volume-rendered images. CONCLUSION: Reading the axial images cannot be replaced by viewing postprocessed reconstructions for initial diagnosis, because only some of the pathologies can be delineated on MIPs and volume reconstructions. However, reconstructions can be valuable for assessing the extent of pathologies and their spatial relation to the anatomic structures.

Adolescent↗
PubMed1981

The effect of fantasies of merging with a good mother on schizophrenic pathology.

The purpose of this study was to investigate the effect of subliminal symbiotic stimulation alone and in conjunction with an enhancement procedure on the pathology of relatively differentiated and relatively undifferentiated schizophrenics. It was hypothesized that enhancing the positive attributes of the schizophrenic's image of his mother prior to stimulating a fantasy of a symbiotic merger might increase his ability to benefit from the subliminal symbiotic stimulus. This hypothesis was not supported. Differentiated schizophrenics who received both enhancement procedure and the subliminal symbiotic stimulus showed no pathology reduction, whereas differentiated schizophrenics who received only the subliminal symbiotic stimulus manifested significant reductions in both pathological thinking and pathological behavior. Undifferentiated schizophrenics showed no reduction in pathology after the symbiotic stimulus regardless of whether or not they also received the enhancement procedure. An important finding which emerged was that the subliminal enhancement stimulus alone--i.e., without the symbiotic stimulus--resulted in reductions in pathological behavior for both differentiated and undifferentiated schizophrenics. It was concluded that although enhancing the positive attributes of the schizophrenic's maternal representation did not increase his ability to benefit from subliminal symbiotic stimulation, it did reduce pathology in its own right.

Adult↗
PubMed1997

The effects of additional pathology on the cognitive deficit in Alzheimer disease.

The diagnosis of Alzheimer disease (AD) according to current criteria is a combined clinical and pathological exercise. The clinical discrimination of AD from other types of dementia may be complicated when the patient suffers from more than one disease. In particular the concomitant presence of other neurological conditions may significantly influence the severity of cognitive deficit. In this study we analyze the extent of the influence of vascular and other neurodegenerative pathology on the cognitive deficit in a consecutive series of 88 prospectively assessed elderly subjects. We find that, for any given level of cognitive deficit, the densities of either all plaques or neuritic plaques alone in the neocortex are significantly lower in cases of AD mixed with other CNS pathology than in cases of AD with no other CNS pathology. In AD combined with cerebrovascular disease, the total plaque density makes a significant contribution to cognitive deficit, while neurofibrillary tangle (NFT) densities do not. In contrast, in pure AD tangle density is the major determinant of cognitive deficit. Our findings draw attention to the influence of coexisting brain pathologies on the clinical manifestation of dementia in subjects with AD. These findings indicate that pathological diagnostic criteria for AD should take into account such additional pathology in demented subjects. They also improve understanding of the circumstances in which the amyloid component of AD can play a decisive role in precipitating clinical dementia.

Aged↗
PubMed1996

A study of the dopamine D2 receptor gene in pathological gambling.

Pathological gambling has been termed both the 'pure' and the 'hidden' addiction. 'Pure' because it is not associated with the intake of any addicting substance, and 'hidden' because it is an extension of a common, socially accepted behaviour. The Taq A1 variant of the human DRD2 gene has been associated with drug addiction, some forms of severe alcoholism, and other impulsive, addictive behaviours. We have sought to determine if there is a similar association with pathological gambling. A total of 222 non-Hispanic Caucasian pathological gamblers from multiple sites across the US participated in the study. Of these 171 donated a sample of blood, 127 filled out several questionnaires, and 102 did both. Of the 171 pathological gamblers 50.9% carried the D2A1 allele versus 25.9% of the 714 known non-Hispanic Caucasian controls screened to exclude drug and alcohol abuse, p < 0.00000001, odds ratio (OR) = 2.96. For the 102 gamblers who filled out the questionnaires, 63.8% of those in the upper half of the Pathological Gambling Score (more severe) carried the D2A1 allele (OR versus controls = 5.03), compared to 40.9% in the lower half (less severe). Of those who had no comorbid substance abuse, 44.1% carried the D2A1 allele, compared to 60.5% of those who had comorbid substance abuse. Forty-eight controls and 102 gamblers completed a shorter version of the Pathological Gambling Score. Of the 45 controls with a score of zero, 17.8% carried the D2A1 allele. Of the 99 gamblers with a score of 5 or more, 52.5% carried the D2A1 allele (chi 2 = 15.36, p = 0.00009). These results suggest that genetic variants at the DRD2 gene play a role in pathological gambling, and support the concept that variants of this gene are a risk factor for impulsive and addictive behaviours.

Adult↗
PubMed2003

Hip joint pathology: clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases.

BACKGROUND: The hip joint is becoming increasingly recognized as a source of groin pain and, in the authors' experience, buttock and low back pain. OBJECTIVES: To determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings in the hip joint. METHODS: We prospectively studied 25 consecutive hip arthroscopies to determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings. RESULTS: All of the hips arthroscoped had pathology. Back pain and hip pain were the 2 most common presentations. The only consistently positive clinical test result was a restricted and painful hip quadrant compared with the contralateral hip. Of the 17 patients whose flexion, abduction, external rotation (FABER) test results were reported at the time of examination, 15 (88%) were positive, and 2 (12%) negative. Plain radiographs were normal in all patients. All but 1 patient underwent magnetic resonance arthrography. Although specificity of 100% was achieved in our study, the sensitivity was significantly lower, with a relatively high number of false negatives. Hip arthroscopy proved the definitive diagnostic procedure for intraarticular pathology. CONCLUSIONS: Hip pathology, particularly labral pathology, may be more common than has been previously recognized. In those patients with chronic groin and low back pain, a high index of suspicion should be maintained. Clinical signs of a painful, restricted hip quadrant and a positive FABER test result should suggest magnetic resonance arthrography in the first instance, but a negative magnetic resonance image should not preclude hip arthroscopy if there is high clinical suspicion of hip joint pathology.

Adolescent↗
PubMed2005

Pathology of the insular cortex in Alzheimer disease depends on cortical architecture.

The insular cortex plays important roles in a variety of regulatory mechanisms ranging from visceral control and sensation to covert judgments regarding inner well-being. The dementia of Alzheimer disease (AD) often includes behavioral dyscontrol and visceral dysfunction not observed in other diseases affecting cognition. This could be related to autonomic instability and to loss of the sense of self, and pathologic changes within the insula may play essential roles. The pattern of insular pathology of 17 patients with AD was examined and the severity of pathology was compared with that of the entorhinal cortex (EC), a region involved early in AD with reciprocal connections to the insula. Thioflavin S staining and Alz-50 immunostaining revealed that the insula carries a heavy burden of pathology in AD. Neurofibrillary tangles (NFTs) were largely confined to the deep layers of the cortex, whereas neuritic plaques (NPs) were distributed throughout the cellular layers and subcortical white matter. The density of NFTs, but not NPs, was highly correlated with the degree of EC pathology. However, NFTs were not seen in the insula until EC pathology reached a relatively advanced level. The density of insular NFTs varied according to architectonic type, with agranular cortex most affected, dysgranular cortex less affected, and granular cortex least affected. Thus, the insula is often involved in AD, and some of the behavioral abnormalities in AD may reflect insular pathology.

Aged↗
PubMed2006

Co-occurrence analysis for discovery of novel breast cancer pathology patterns.

To discover novel patterns in pathology co-occurrence, we have developed algorithms to analyze and visualize pathology co-occurrence. With access to a database of pathology reports, collected under a single protocol and reviewed by a single pathologist, we can conduct an analysis greater in its scope than previous studies looking at breast pathology co-occurrence. Because this data set is unique, specialized methods for pathology co-occurrence analysis and visualization are developed. Primary analysis is through a co-occurrence score based on the Jaccard coefficient. Density maps are used to visualize global co-occurrence. When our co-occurrence analysis is applied to a population stratified by menopausal status, we can successfully identify statistically significant differences in pathology co-occurrence patterns between premenopausal and postmenopausal women. Genomic and proteomic experiments are planned to discover biological mechanisms that may underpin differences seen in pathology patterns between populations.

Algorithms↗
PubMed2006

Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress.

BACKGROUND: Gastro-oesophageal reflux (GOR) is common in infants with persistent crying. Empirical treatment with antireflux medications is common practice, although on clinical grounds it may be difficult to determine whether GOR is abnormal. AIMS: To examine the diagnostic accuracy of clinical predictors of pathological GOR in infants with persistent crying. METHODS: One hundred and fifty-one infants (82 male; median age 2.5 months, range 0.5-8.2 months) with persistent crying were prospectively studied. Crying and fussing were charted for 24 h, and parents completed a validated questionnaire on reflux symptoms. All infants underwent oesophageal 24-h pH monitoring. RESULTS: Twenty-seven (17.9%) infants had pathological GOR with a fractional reflux time (FRT) >10%. There was no significant association between total crying duration per 24 and FRT (P = 0.84) or the number of reflux episodes (P = 0.68). Pathological GOR was more common in infants under 3 months, compared to older infants (P = 0.04). Feeding difficulties were significantly associated with pathological GOR (P = 0.02). Backarching was not increased in infants with GOR (P = 0.30). Pathological GOR was significantly associated with the frequency of regurgitation (P = 0.04), but not with vomitus volume (P = 0.62). Regurgitation more than 5 times daily was the most specific reflux symptom (specificity 70.9%), but was a poor predictor of pathological GOR (positive predictive value 22.2%). In the absence of frequent regurgitation or feeding difficulties, pathological GOR was unlikely (negative predictive value 87-90%). CONCLUSIONS: Investigation and treatment of GOR in infants with persistent crying should be primarily directed at infants presenting with frequent regurgitation or feeding difficulties.

Age Factors↗
PubMed2002

Pathological lesions in vascular dementia.

According to current diagnostic criteria, a definite diagnosis of vascular dementia (VaD) can be reached on pathological grounds by showing the presence of vascular lesions and the absence of degenerative changes exceeding those expected for age. However, while it is commonly accepted that VaD is a group of heterogeneous entities rather than a process with a unique pathological substrate, the spectrum of vessel and parenchyma changes etiologically associated with the clinical syndrome remains basically unidentified. The review of some recent clinical-pathological series shows that different studies have assessed the presence of dissimilar vascular lesions and that, in many cases, no pathological definition was given. This has hindered the clarification of clinical-pathological correlations in the field of VaD. In this scenario, the use of animal models of cerebrovascular diseases may help to elucidate the type of lesions possibly linked with cognitive impairment in humans and might provide insight into some of the pathophysiological mechanisms of vascular cognitive impairment. A consensus is today needed in order to harmonize the pathological examination of vascular lesions in cases of dementia. An ongoing survey aimed at collecting information about the procedures used in different pathological laboratories in the assessment of lesions possibly associated with dementia is finally presented.

Dementia, Vascular↗
PubMed1996

Benefits and limitations of pathology databases to cancer registries.

In order to assess the benefits and limitations of pathology databases to cancer registries, computerised pathology records of malignant neoplasms diagnosed during 1992 were obtained for a defined area of Scotland for which pathology data were not routinely being used for cancer registration. Apparently 'missed' cancer registrations were identified by computerised probability matching with cancer registration records and their eligibility for registration was determined by reference to medical records, or when these were unavailable, by reference to the text of the original pathology report in conjunction with the local Community Health Index (to establish residency at the time of diagnosis). Misclassifications of site or incidence year were not regarded as 'missed' cases. Of 218 apparently 'missed' cancer registrations identified from computerised pathology records, 133 (5.7% of the revised total number of registrations for the study area in 1992) should have been registered. A further 14 cases were already registered but with misclassified site, morphology and/or behaviour codes. Ascertainment of cases by the Scottish Cancer Registration Scheme seems to be high for most sites. Pathology databases represent a useful additional source of cases but the fact that 71 apparently 'missed' cases were found to be ineligible for registration as independent primary malignant neoplasms suggests that unverified computerised pathology data should not be used uncritically nor independently for cancer registration purposes.

Databases, Factual↗
PubMed1999

Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients.

AIMS: To evaluate whether endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic rather than in gynaecologically asymptomatic postmenopausal breast cancer patients with tamoxifen treatment; and to evaluate the possible influence of various clinical factors on the incidence of endometrial pathology. METHODS: Endometrial histological findings, transvaginal ultrasonographic endometrial thickness, demographic characteristics, health habits, and risk factors for endometrial cancer were compared between 14 gynaecologically symptomatic (group I) and 224 gynaecologically asymptomatic (group II) postmenopausal breast cancer patients with tamoxifen treatment. RESULTS: Overall, 28.6% of the study population had endometrial pathology. The incidence of overall positive endometrial histological findings was significantly higher in group I than in group II (92.9% v 24.6%, p < 0.0001). Atrophic endometrium was more common in group II than in group I (75.3% v 7.1%, p < 0.0001). Most other endometrial pathology was significantly more common in group I than in group II (endometrial hyperplasia, 35.7% v 5.6%, p < 0.0001; endometrial polyps, 35.7% v 13.4%, p < 0.0111; endometrial carcinoma, 21.5% v 0.9%, p < 0.0001). Endometrial pathology appeared considerably later in the gynaecologically asymptomatic patients than in gynaecologically symptomatic patients (p = 0.0002). Vaginal bleeding or spotting occurred exclusively in group I. The incidence of endometrial pathology in the entire study population was consistent with that reported elsewhere, and higher than that reported for healthy postmenopausal women. CONCLUSIONS: Endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic postmenopausal breast cancer patients with tamoxifen treatment, and after a shorter duration of time, than in gynaecologically asymptomatic patients.

Antineoplastic Agents, Hormonal↗
PubMed2000

Pathological switching between languages after frontal lesions in a bilingual patient.

Cerebral lesions may alter the capability of bilingual subjects to separate their languages and use each language in appropriate contexts. Patients who show pathological mixing intermingle different languages within a single utterance. By contrast, patients affected by pathological switching alternate their languages across different utterances (a self contained segment of speech that stands on its own and conveys its own independent meaning). Cases of pathological mixing have been reported after lesions to the left temporoparietal lobe. By contrast, information on the neural loci involved in pathological switching is scarce. In this paper a description is given for the first time of a patient with a lesion to the left anterior cingulate and to the frontal lobe-also marginally involving the right anterior cingulate area-who presented with pathological switching between languages in the absence of any other linguistic impairment. Thus, unlike pathological mixing that typically occurs in bilingual aphasia, pathological switching may be independent of language mechanisms.

Aphasia↗
PubMed1990

Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical-shift, and STIR MR imaging.

Differentiation of benign from pathologic compression fractures of vertebral bodies was evaluated with magnetic resonance imaging in a prospective study of 53 patients. Twenty-six patients had 34 benign posttraumatic compression fractures. Twenty-seven patients had metastatic disease to the vertebral column and seven pathologic fractures. T1- and T2-weighted spin-echo (SE) sequences (1.5 T) were performed in all patients. A presaturation technique was used to obtain "fat" and "water" images to better assess the degree of normal fatty marrow replacement in fractured vertebrae. Short inversion-time inversion-recovery (STIR) images were also obtained. Discrimination between benign and pathologic compression fractures was generally possible with the SE sequences. Chronic benign fractures demonstrated isointense marrow signal intensity (SI), compared with that of normal vertebrae with all sequences. Pathologic fractures showed low SI on T1-weighted images and high SI on T2-weighted images. Fat images revealed complete replacement of normal fatty marrow, shown as absent SI in the involved vertebral body. Water and STIR images showed diffuse high SI in pathologic fractures, with STIR images having the highest contrast between abnormal and normal marrow. Acute benign compression fractures also demonstrated high SI on T2-weighted, water, and STIR images, but the SI was less pronounced and the pattern was generally more inhomogeneous than that of pathologic compressions. In general, fat images showed only partial replacement of normal fatty marrow by low SI, in contrast to the complete absence of marrow SI typical of pathologic fractures.

Adolescent↗
PubMed2005

[Macroscopic liver pathology in patients with dissociated cholestasis].

OBJECTIVE: To establish the prevalence of liver focal pathology in patients with increase of alkaline phosphatase and gamma-glutamil transpeptidase and normal bilirubin (dissociated cholestasis), and to analyze the related risk factors for such pathology. METHODS: All laboratory studies of patients admitted to an Internal Medicine Department were reviewed prospectively throughout a period of 9 months. For the purpose of detecting focal liver pathology imaging liver studies (echography and/or CT) were carried out in those in which biochemical analyses showed dissociated cholestasis. RESULTS: A dissociated cholestasis pattern was found in 81 patients. In 13 of them (16%) focal liver pathology was demonstrated. The majority of the lesions (10 of 13) were local or metastatic malignant neoplasms. Sex, alcohol consumption, presence of diabetes mellitus, tumor or hepatobiliar disease previously known, or abnormalities in liver physical examination were not risk factors. No liver pathology was found in patients with an alkaline phosphatase level higher than double of gamma-glutamil transpeptidase level (sensitivity: 100%; negative predictive value: 100%). Diagnosis of a non-hepatic malignant neoplasm at discharge was associated to a risk 12 times bigger for the presence of liver lesions (p < 0.01). CONCLUSIONS: It is uncommon to find focal liver pathology in patients with dissociated cholestasis. It is more common to discover focal liver pathology in patients with non-hepatic tumors and less probable when phosphatase alcaline: gamma-glutamil transpeptidase ratio is higher than two.

Adult↗
PubMed2004

Ability to predict metastasis based on pathology findings and alterations in nuclear structure of normal-appearing and cancer peripheral zone epithelium in the prostate.

PURPOSE: Malignant transformation in the prostate produces significant alterations in glandular architecture (Gleason grade) and nuclear structure that provide valuable prognostic information. Normal-appearing nuclei (NN) adjacent to cancer may also have altered functions in response to malignancy. We studied NN adjacent to peripheral zone (PZ) prostate cancer (PCa), as well as the PZ cancer nuclei (CaN) using quantitative image cytometry. The nuclear structure information was combined with routine pathological findings to predict metastatic PCa progression and/or death. EXPERIMENTAL DESIGN: Tissue microarrays of normal-appearing and cancer areas were prepared from 182 pathologist-selected paraffin blocks. Feulgen-stained CaN and NN were captured from the tissue microarrays using the AutoCyte Pathology Workstation. Multivariate logistic regression was used to calculate quantitative nuclear grade (QNG) solutions based on nuclear morphometric descriptors determined from NN and CaN. Multivariate logistic regression and Kaplan-Meier plots were also used to predict risk for distant metastasis and/or PCa-specific death using QNG solutions and routine pathology. RESULTS: The pathology model yielded an area under the receiver operator characteristic curve of 72.5%. The QNG-NN and QNG-CaN solutions yielded an area under the receiver operator characteristic curve of 81.6 and 79.9%, respectively, but used different sets of nuclear morphometric descriptors. Kaplan-Meier plots for the pathology variables, the QNG-NN and QNG-CaN solutions, were combined with pathology to defined three statistically significantly distinct risk groups for distant metastasis and/or death (P < 0.0001). CONCLUSIONS: Alterations in cancer or normal-appearing nuclei adjacent to peripheral zone cancer areas can predict PCa progression and/or death. The QNG-NN and QNG-CA solutions could be combined with pathology variables to improve the prediction of distant metastasis.

Adult↗
PubMed2005

A clinico-pathological study of heart and brain lesions in vascular dementia.

All vascular dementia (VaD) cases, neuropathologically verified in a longitudinal prospective dementia project, were classified according to the vascular brain lesion type and related to the dementia type and cardiovascular pathology. From 1976 to 1995, there were 175 VaD cases, 49 of which were pure, without Alzheimer pathology and only one type of cerebrovascular lesion. Furthermore, it was found that 6 cases suffered hypoxic hypoperfusive disease, while 7 were found to have large vessel disease and 36 small vessel disease. In addition to Alzheimer pathology, more than one type of vascular brain pathology was found in the remaining 126 cases. In these cases, diagnosed in accordance with the predominant type of VaD, hypoxic-hypoperfusive lesions were found in 55, large vessel lesions in 50 and small vessel lesions in 110 cases. It should be stressed that 87% of all cases with hypoxic hypoperfusive lesions also had Alzheimer pathology. Cardiovascular and aortic pathologies were more prevalent in small vessel dementia than in the other VaD groups. Clinically diagnosed arterial hypertension was significantly associated with small vessel dementia, but not with hypoxic-hypoperfusive dementia. Cardiovascular symptoms varied considerably in frequency between different dementia groups. VaD is a heterogeneous group regarding lesions caused by different pathophysiological mechanisms and with different combinations of brain pathologies. It is therefore necessary to identify the various types of vascular brain lesions for a correlation with clinical symptoms and for diagnostic purposes in the search for risk factors and therapeutic strategies.

Aged↗
PubMed1996

Radiographic and pathologic correlation of coal workers' pneumoconiosis.

The relationships between chest radiographs (CXR) and corresponding pathology were investigated in 430 autopsied coal miners from West Virginia. Whole-lung sections were reviewed and graded on four-point severity scales for the following lesions of coal workers' pneumoconiosis (CWP): macules, micro- and macronodules (small and large fibrotic nodules), and progressive massive fibrosis (PMF). Antemortem CXR were classified by three B readers using the 1971 International Labor Office (ILO) U/C classification (6). On pathologic examination, 96% of miners had macules, 70% micronodules, 45% macronodules, 15% silicosis, and 28% PMF. By CXR, 69% of the miners had small, rounded opacity profusions of category > or = 0/1. Data analysis revealed increasing odds that small opacities of category > or = 0/1 would be detected with increasing grade of nodules. Profusion category 0/0 was often reported for cases with macules of mild to moderate grade and mild levels of micronodules. Overall, q-type opacities were associated with macules and micronodules, whereas the large r-type opacities were associated with macronodules. By CXR, large opacities showed good correlation with pathologic PMF. However, about one-third of cases identified as having large opacities by CXR were not substantiated as PMF by pathology. One-fourth of these cases could be explained by lung lesions such as Caplan's nodules, tuberculosis scars, and tumors. Similarly, 22% of cases classified as PMF on pathology had no large opacities by CXR. In half of these cases, the radiologists had noted other abnormalities (cancer, tuberculosis) by CXR as large opacities. Overall, the study showed good agreement (Somer's d = 0.64) between the predicted probabilities and observed responses of a profusion category > or = 0/1 for pathologic CWP lesions. However, the study also showed that CXR were insensitive for detecting minimal CWP lesions, and were unreliable indicators in the presence of concomitant pulmonary pathology.

Adult↗