Scalene Node Research Articles

Occult metastasis from occult papillary carcinoma of the thyroid.

A patient underwent a total thyroidectomy after the incidental discovery of normal appearing thyroid tissue in a scalene lymph node. When the thyroid was examined by a subserial technique, which provided a section for examination at every 50μ, a minute primary carcinoma measuring 0.2 × 0.3 × 0.6 mm was found. A postoperative 131I scan of the neck revealed residual radioactivity in the neck, some of which may be neoplastic. A primary thyroid carcinoma should be considered as the source of thyroid follicles in a cervical lymph node unless serial sectioning of the entire thyroid fails to reveal the primary carcinoma. In none of the reported cases of so-called “benign inclusions” of thyroid in cervical lymph nodes has the histologic examination been adequate to rule out a focus of carcinoma as small as the one noted in the present case. The authors know of no other case of thyroid cancer with metastasis in which the primary lesion was smaller than in the present case.

Postirradiation costal osteochondritis simulating metastatic cancer.

Radiation injuries to subcutaneous tissues and underlying bones can create difficulty in differential diagnosis because their appearance may simulate metastasis or local recurrent cancer. Their recognition is important in order to avoid unnecessary surgical procedures, chemotherapy, or even reirradiation. This report will describe three cases of postirradiation osteochondritis involving the costochondral and sternoclavicular joints, simulating chest wall recurrences. Case I: A 65-year-old male, complaining of hemoptysis, was admitted to The University of California San Francisco Medical Center. A diagnosis was made of inoperable bronchogenic carcinoma, on the basis of a large right hilar mass and Class V sputum cytology. Palliative x-ray therapy, utilizing a cobalt-60 unit, was administered. In November 1964, 1,000 R was given on three consecutive days through a 9 × 7 cm right anterior field over the right hilus. After four weeks, another course of 3 times 1,000 R was given in three days to the same area. Thus, a total given dose of 6,000 R was administered in 6 treatments over a period of five weeks. In September 1965, nine months after completion of x-ray therapy, the patient was admitted to the emergency room for acute pain in the right chest and shoulder. A painful mass was felt over the irradiated right parasternal region (Fig. 1). The skin adherent to the mass was woody, wrinkled, and erythematous. X-ray films of the rib cage showed a soft-tissue mass associated with the involved costochondral joint. Although no bony destruction was evident even in the tomograms, the problem was diagnosed clinically as a metastasis. Since further x-ray therapy was contraindicated, the patient was discharged on Darvon compound. After three months, the lesion became asymptomatic; the mass did not disappear, but the skin discoloration faded. The patient was last seen on Nov. 1, 1966, free of disease. Case II: A 40-year-old female, on the basis of chest x-ray films taken in April 1965, was found to have an anterior mediastinal mass. Complete gastrointestinal studies, intravenous pyelography, mammography, and thyroid scan were reported normal. A right scalene node biopsy on May 11, 1965, revealed metastatic adenocarcinoma. At the University of California San Francisco Medical Center, initial chemotherapy was ineffective, and the patient was referred for radiation therapy in July 1965. The patient was seen by a radiotherapist in August and found to have pulmonary osteoarthropathy, as evidenced by clubbing of the fingers and swelling and pain in the left ankle and shoulder. In addition to the mediastinal mass, which had not regressed after chemotherapy, there were several metastatic subcutaneous masses. Through a single 10 × 9 cm anterior field with the cobalt-60 unit, the superior mediastinum and the left hilus were covered; doses of 1,000 R were delivered daily from Sept. 27 to 29, 1965.

A comparison of mediatinoscopy and scalene node biopsy.

A comparison of mediatinoscopy and scalene node biopsy.

Aspiration biopsy of thoracic lesions

We have performed percutaneous needle aspiration biopsy of intrathoracic lesions under fluoroscopic control on 50 patients. Lesions as small as 1 to 1·5 cm. in diameter were aspirated. Thirty of the 36 cases of malignant neoplasm were diagnosed by this method. Of the 14 non-neoplastic cases, granuloma was diagnosed in two, and in eight of the remaining 12 the clinical diagnosis was supported by the nature of the aspirated material. Pneumothoraces are to be expected as a complication of the method. Most will be asymptomatic; a small proportion will require treatment. There will also be the occasional haemoptysis. The procedure can be quickly performed and it is well tolerated by the patient. It causes less discomfort than bronchoscopy or scalene lymph node biopsy. The interpretation of the cytological material presents no undue difficulty to the pathologist experienced in conventional pulmonary exfoliative cytology.

Present Diagnostic Approach to Sarcoidosis in Japan

Sarcoidosis is a rare disease in Japan. Bilateral hilar adenopathy is suggestive of malignant tumor rather than sarcoidosis. Hematology and plasma chemistry offer no clues to the diagnosis of sarcoidosis. The Kveim test is still poor in reliability even in biopsy-confirmed patients in this country. One-third of patients with bilateral hilar node swelling or pulmonic mottled silhouette alone are left undiagnosed even after Daniels' scalene lymph node biopsy. Sarcoidosis was discovered in 18 patients among those who underwent thoracotomy biopsy to exclude definitely the possibility of malignancy.

Scalene Node Biopsy in Pulmonary Diseases: Report of 110 Cases

An analysis of 110 cases of scalene node biopsy in pulmonary disease is presented. A positive diagnosis was obtained in 85 per cent of 20 cases with clinically palpable nodes, and in 28.9 per cent of 90 cases with clinically non-palpable nodes. Sarcoidosis and malignancy gave the highest percentage of positive histologic diagnosis. The procedure was found to be of no value in the diagnosis of pulmonary fibrosis. Occasionally, carcinoma and tuberculosis may coexist, but scalene node biopsy may be positive for tuberculosis alone. There has been evidence of spread of malignancy to the contralateral side. Positive diagnosis can, in some cases, be made from histologic examination of the scalene fat pad, though the lymph nodes may not show any involvement. The bacteriologic studies were not of much help in making a diagnosis. We feel that scalene node biopsy should be a part of the various investigations for establishing the diagnosis of pulmonary disease. Through its frequent use and proper interpretation, thoracotomy may be avoided in a number of cases with primary or metastatic pulmonary malignancy.

Mediastinoscopy in a Community Hospital

Mediastinoscopy is being used as a diagnostic tool with increasing frequency in this country. In the absence of peripheral nodes, it is a more rewarding procedure than scalene node biopsy in the diagnosis of sarcoidosis. Mediastinoscopy is a better method of detecting lymphatic extension of bronchogenic carcinoma than scalene node biopsy. This technique is useful in the determination of the operability of lung carcinoma. The procedure is usually accomplished with minimal complications.

Air Embolism following Mediastinoscopy and Scalene Node Biopsy: Report of a Case

Air Embolism following Mediastinoscopy and Scalene Node Biopsy: Report of a Case

Combined superior vena cavography and azygography in patients with suspected lung carcinoma.

Intraosseous costal or spinous process azygography has occasionally been used for visualization of the thoracic venous system in the preoperative assessment of carcinoma of the lung (2, 7). Obstruction of the superior vena cava or extrinsic compression or invasion of its lumen is a relatively frequent finding in the natural history of pulmonary carcinoma, especially when the lesion originates in the right lung (3). In 85 per cent of 33 cases coming to autopsy in one series, cancer was the etio-logic agent producing superior vena caval obstruction (1). To our knowledge, the combined use of superior vena cavography and azygography as part of the preoperative assessment of pulmonary carcinoma has not been previously reported. Our experience with 63 consecutive patients who have been evaluated for suspected primary lung carcinoma by the use of superior vena cavography and azygography forms the basis of this report. The roentgenographic patterns of abnormality are evaluated and presented. The importance of proper technic is discussed. Assessment of each study separately and in combination is made to determine its value in defining resectability. Materials and Technic Sixty-three patients with suspected primary pulmonary cancer were evaluated by a diagnostic work-up which included pos-tero-anterior and lateral chest roentgenograms, transtracheal bronchography (6), azygography and superior vena cavography, scalene node biopsy, bronchoscopy, sputum cytology, and pulmonary function studies. The clinical records of each patient were reviewed, and the significance of the findings from azygography and superior vena cavography was correlated with the operative and pathological findings. Azygography and superior vena cavography were performed at the same time in all cases. Each patient was premedicated with 50 mg meperidine (Demerol), 100 mg secobarbital (Seconal), and 25 mg Phener-gan thirty minutes before the start of the procedure. A rapid-sequence film-changer should be used for both azygography and superior vena cavography if really meaningful results are to be obtained. False-negative examinations are greatly minimized (Fig.1). False-positive examinations due to spurious physiologic obstruction from the Valsalva maneuver or tightening of neck and shoulder musculature are eliminated by using serial exposures and by cautioning the patient to remain relaxed and to continue breathing normally throughout the injection and exposure times (Fig. 2, A and B). The equipment for superior vena cavography includes two 30 cc syringes, each containing 25 cc of 50 per cent Hypaque and No. 16 gauge needles with plastic connecting tubing. The basilic veins in both antecubital fossae are injected simultaneously by hand to give complete visualization of the innominate veins as well as of the superior vena cava. The total injection time is between two and three seconds.

Significance of mediastinoscopy in carcinoma of the lung.

EXPLORATION of the mediastinum for the purpose of obtaining the diagnosis of intrathoracic pathology was stimulated by Daniels¹in 1949 when he reported the first series of supraclavicular node biopsies. The quest for diagnoses was pursued further by Harkins and associates²when they proposed exploring behind the clavicle with a laryngoscope at the time of scalene node biopsy. In 1959 Carlens³was able to report 100 cases in which he had biopsied hilar and subcarinal lymph nodes from a supraclavicular incision during a procedure he called mediastinoscopy. These steps in the development of mediastinoscopy have a definite anatomic basis in the work done by Rouviere⁴and confirmed by Palva,⁵when they demonstrated that the lung lymphatics drained to subcarinal and paratracheal areas and then up along the sides of the trachea of the supraclavicular areas. Each advance in the evolution of mediastinoscopy has brought the

Simulation of Lung Cancer By Metastatic Tumors

To the Editor:— The criteria for the diagnosis of bronchogenic carcinoma highlighted in Current Concepts in Cancer—No. 9 ( 195 :653, 1966) are illusory and help to perpetuate the erroneous diagnosis of bronchogenic carcinoma on the basis of biopsy and radiographic confirmation. Bronchial and scalene node biopsies positive for cancer are not pathognomonic of bronchogenic carcinoma. These findings are indicative only of a malignant tumor in the lung and do not specify whether the tumor is of primary or secondary origin. Metastatic involvement of the bronchi may simulate both the gross and histological appearance of bronchogenic tumors. Secondary tumors involving the subepithelial lymphatics may ulcerate through the bronchial mucosa and present an accessible mass visible on bronchoscopy ( Cancer 16 :1521, 1963). On occasion, histological examination of malignant biopsied material may reveal findings characteristic of certain extrathoracic carcinomas (thyroid, kidney, etc), but most often the tissue is reported as undifferentiated carcinoma apparently

Pre-scalene lymph node biopsy in the evaluation of gastric carcinoma.

Routine pre-scalene lymph node biopsies were done on 127 patients with gastric carcinoma. No lymphatic tissue was present in 27 of the specimens. Metastatic carcinoma was found in 12 out of the 100 biopsies where lymph nodes were present. Of these 12,4 were obtained from patients with other signs of metastatic disease.Eighty-three of the 88 patients with negative nodes were subjected to laparotomy. Forty-three of these cases had an operable gastric carcinoma.In one patient with metastasis a gastroenterostomy was performed as a palliative procedure.Routine scalene node biopsy therefore saved 8 patients from an unnecessary laparotomy. A negative node biopsy was of no value in determining operability.

Bronchogenic Carcinoma Stage I

The successful treatment of lung cancer by any modality alone remains highly disappointing. It is for this reason that combined approaches using surgery, irradiation, and chemotherapy are being widely explored. The natural history of lung cancer and host resistance determines which lesions remain localized, which ones spread regionally, and which will disseminate widely. Since the most elaborate preoperative diagnostic methods cannot predict the development of metastatic spread microscopically, adjuvant therapy has been instituted with the hope of increasing salvage in favorable cases. The main advocates of preoperative irradiation were interested in determining if irradiation could arrest the local growth and sterilize reginal hilar, mediastinal, and scalene nodes, extending the number of patients who could be managed surgically. The possibility of rendering inoperable cases operable has been studied in the process. The gains in survival, the lowering of regional recurrences, and the prevention of metastases have also been analyzed in reference

Bronchographic Signs Useful in the Diagnosis of Lung Cancer

SUMMARY Bronchography is a useful tool in the diagnosis of lung cancer. A complete bronchographic study which should include chest fluoroscopy will uncover more than 89 per cent of all cases of pulmonary malignancy. It provides a greater diagnostic yield than any other standard screening method including bronchoscopy, scalene node biopsy and cytologic examination of sputa, aspirates and pleural fluid. It enables identification and localization of upper lobe bronchus tumors which are inaccessible to the bronchoscope. Shifts of the mediastinum, diaphragmatic abnormalities and pleural effusions which are noted at fluoroscopy help to identify and localize lung cancers. Fluoroscopic monitoring of the instillation of contrast medium is necessary to ensure complete filling and enables spot film recording of findings. Bronchial alterations which are found in pulmonary malignancy include abrupt bronchial obstruction, localized bronchial displacement, concentric bronchial narrowing, thumb-print impression and abrupt bronchial narrowing without termination.

Lymphatic extension of carcinoma of the lung to the anterior chest wall

1. 1. A case of lymphatic metastases from carcinoma of the lung to the skin of the anterior chest wall after anterior scalene node removal is discussed. 2. 2. It is believed that this is the first time this complication of scalene fat pad excision has been reported.

Subscalene Biopsy in Intrathoracic Diseases

Biopsy of lymph nodes overlying the anterior scalene muscle has been used many years as an aid to diagnosis of intrathoracic disease. This paper describes an extention of this procedure to include transection of the anterior scalene muscle and biopsy of subscalene tissues as an aid to diagnosis of intrathoracic disease. This procedure is particularly useful in those patients with superior sulcus tumors and in whom scalene node biopsy is negative.

Biopsy of scalene and supraclavicular lymph nodes: value in diagnosis.

Biopsy of scalene and supraclavicular lymph nodes: value in diagnosis.

MEDIASTINAL BIOPSY FOR INDETERMINATE PULMONARY AND MEDIASTINAL LESIONS

SUMMARY A simple operative technique is described which permits direct exploration of the mediastinal contents to determine diagnosis and operability of pulmonary or mediastinal lesions. This technique is indicated where conventional methods of diagnosis, including bronchoscopy, cytology, and scalene node biopsy, have failed to produce a diagnosis. It can also be used to assess the resectability of pulmonary or mediastinal lesions without the necessity of formal thoracotomy. It is of particular value in poor risk patients in whom an unnecessary thoracotomy may be avoided.

The Solitary Pulmonary Nodule

This study is a clinical pathological correlation based on 887 resected pulmonary masses. Because of the nature of the study and the source of the material there is a certain amount of selection. The patients were all males, and they had all been healthy enough to have been inducted into the armed services. Only 16 of 887 had significant other pulmonary disease. While the author draws few conclusions, the monograph itself asserts some very forceful points: second primary malignancies can and do occur and may present as pulmonary nodules; pulmonary granulomas can occur in patients with history of malignancy elsewhere; benign tumors of the lung can occur in patients who have had a previous malignancy; preoperative examination with bronchoscopy, cytologic study of the sputum, and scalene node biopsy offer a very low yield of positive diagnoses in pulmonary nodules; size cannot be used as a criterion for determining malignancy; tuberculosis

SCALENE NODE BIOPSY IN LOCALLY ADVANCED PRIMARY BREAST CANCER OF QUESTIONABLE OPERABILITY.

CancerVolume 17, Issue 8 p. 1006-1011 ArticleFree Access Scalene node biopsy in locally advanced primary breast cancer of questionable operability A. N. Papaioannou M.D., A. N. Papaioannou M.D. Breast Service, Memorial Hospital for Cancer and Allied Diseases, 444 E. 68th St., New York 21, N.Y.Search for more papers by this authorJ. A. Urban M.D., J. A. Urban M.D. Breast Service, Memorial Hospital for Cancer and Allied Diseases, 444 E. 68th St., New York 21, N.Y.Search for more papers by this author A. N. Papaioannou M.D., A. N. Papaioannou M.D. Breast Service, Memorial Hospital for Cancer and Allied Diseases, 444 E. 68th St., New York 21, N.Y.Search for more papers by this authorJ. A. Urban M.D., J. A. Urban M.D. Breast Service, Memorial Hospital for Cancer and Allied Diseases, 444 E. 68th St., New York 21, N.Y.Search for more papers by this author First published: August 1964 https://doi.org/10.1002/1097-0142(196408)17:8<1006::AID-CNCR2820170807>3.0.CO;2-CCitations: 15AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Abrao, A., and Gentil, F.: Mastectomia radical ampliada com esvaziamento ganglionar supraclavicular, axilar e da cadeia mamaria interna em monobloco. Rev. paulista med. 46: 217– 226, 1955. 2 Haagensen, C. D.: Diseases of the Breast. Philadelphia, Pa. W. B. Saunders Co. 1956; pp. 584– 585. 3 Handley, W. S.: Cancer of the Breast and Its Operative Treatment. London, England. John Murray. 1906; p. 189. 4 Memorial Hospital, Clinical Statistics: Unpublished data. 5 Palumbo, L. T., and Sharpe, W. S.: Evaluation of scalene node biopsy. Surgery 53: 639– 643, 1963. 6 Robbins, G. F.: Long-term survivals among primary operable breast cancer patients with metastatic axillary lymph nodes at level III. Acta Untio internat. contra cancrum 18: 864– 867, 1962. 7 Urban, J. A., and Farrow, J. H.: Long term results of internal mammary lymph node excision for breast cancer. Acta Unio internal. contra cancrum 19: 1551– 1554, 1963. Citing Literature Volume17, Issue8August 1964Pages 1006-1011 ReferencesRelatedInformation