[CT-assisted needle biopsy in pulmonary and mediastinal space-occupying lesions. The effect of spiral CT and various biopsy needles on results]. / CT-gestützte Nadelbiopsie bei pulmonalen und mediastinalen Raumforderungen. Der Einfluss der Spiral-CT und unterschiedlicher Biopsienadeln auf die Ergebnisse.

The efficacy of percutaneous CT-guided needle biopsies was investigated in 68 patients with pulmonary lesions and in 65 patients with mediastinal masses. In comparison with conventional multisectional CT, the time needed for the localization of the needle tip could be reduced by use of spiral CT. Comparing aspiration and cutting biopsy needle we achieved a higher accuracy of 94% in case of mediastinal masses and of 90% by using cutting needles. The rate of complications, such as pneumothoraces, is relatively low.

[Computed tomography of renal cell carcinoma]. / Computertomographie bei Nierenkarzinomen.

The value of computed tomography in the diagnosis and monitoring of renal carcinoma is reviewed on the basis of personal experience with 405 patients and a comparison with the literature. CT is of high sensitivity and specificity in the detection of small renal carcinomas as well in differential diagnosis and may remain the favored imaging method in this field. In local pretherapeutic tumor staging, CT, particularly dynamic studies, has achieved an accuracy of more than 90%. This method has its limits in precise estimation of the cranio-caudal extension of the tumor; complementary information is expected from MRI. In the monitoring of nonsurgically, treated renal tumors, CT is indicated where sonographic findings are doubtful only. In the diagnosis of small recurrent renal tumors, CT is more sensitive and should be a regular element in follow-up studies.

Modern development of imaging procedures in oncology.

From the oncologic point of view, imaging diagnostic techniques have been and will be of steadily increasing significance. This paper gives a survey of the present state of the art and of various aspects of current international trends in X-ray diagnostics, computed tomography, ultrasound and magnetic resonance. High tech developments raise the expenditures, so that the cost-benefit-relations have to be considered in future diagnostic strategies. Some aspects for further research tasks are mentioned. The aim of all improvements in imaging procedures is to increase the influence of diagnostic procedures on treatment planning and to improve the treatment results and, ultimately, the prognosis of cancer patients.

Phase II study of pirarubicin (THP-adriamycin) in metastatic breast cancer patients.

Fourteen patients with metastatic breast cancer previously treated with one chemotherapy regimen received Pirarubicin at a dose of 70 mg/m2 at 3-week intervals. In 7 patients the dose had to be reduced, in 1 patient to 40 mg/m2 and in 6 patients to 50-60 mg/m2. There were 1 complete and 2 partial remissions. These objective responses were observed in soft tissue, lung and pleural areas and lasted 1+; 4+ and 5+ months. Grade 3 and 4 leukopenia was found in 42%, grade 3 thrombocytopenia in 2%, grade 3 nausea/vomiting in 29% of the cycles. Grade 1 and 2 alopecia occurred in 64% of the patients, the remaining 36% of the patients did not suffer from any alopecia. No cardiotoxic side effects were observed in 13 patients. In 1 patient with severe coronary heart disease extrasystoles and reduction in left ventricular ejection fraction occurred. Pirarubicin has antitumor activity in previously treated metastatic breast cancer patients.

[The fundamental problems and evaluation criteria for rational imaging diagnosis in oncology]. / Zu grundlegenden Problemen und Bewertungskriterien für die rationelle bildgebende Diagnostik in der Onkologie.

The increasing number of imaging procedures in the oncological diagnostics requires the rational and economic reasonable use of these methods. To avoid an "overdiagnosis" due to the use of multiple expensive methods for the same diagnostic problem, precise information about the cost-benefit-risk relations are necessary and should be available for radiologists, oncologists and other authorities. The aim is to receive a fast and more reliable diagnosis with lower risk and burden for the patients in reasonable expense. As a result may be the reduction of less effective outmoded methods. This paper formulates basic considerations which can be used for further more detailed and intensive investigations for establishing a rational diagnosis.

[A comparison of systemic radiotherapy, chemotherapy or local radiotherapy in the treatment of extensive small-cell bronchial carcinoma. Results of a randomized series]. / Vergleich zwischen systemischer Strahlentherapie, Chemotherapie oder lokaler Strahlentherapie bei der Behandlung des ausgedehnten kleinzelligen Bronchialkarzinoms. Ergebnisse einer randomisierten Serie.

Between 1982 and 1987 we carried out a prospective randomized study to compare the effectiveness of high-dose half-body irradiation (HBI) (A), intensive combined chemotherapy (B), and local or locoregional radiotherapy (C) in the therapy of extended small cell lung carcinoma (SCLC). 99 patients with a histologically proved SCLC were assigned to the three therapeutic groups of series: A = 31 patients, B = 37 patients, C = 31 patients. The median survival period showed a statistically significant advantage (p less than 0.01) for the chemotherapy group (B = 46 weeks) versus the two radiotherapy groups (A = 19 weeks, C = 23 weeks). The survival after half a year, one year, and two years also gave a clear advantage for the chemotherapy group. No difference was found between the radiotherapy groups A and C. The high-dose HBI gave no improvement of the sad therapeutic situation for the extended SCLC.

Computed tomography and endosonography in the preoperative staging of rectal carcinoma.

In 30 patients with rectal carcinoma the accuracy of computed tomography (CT) and endosonography (ES) was compared with the surgical specimen. Three cases were overstaged by ES and 4 cases were understaged by CT. The accuracy of ES was 84% and of CT only 76%. Both methods had advantages and limitations. An accurate staging of lymph node metastases was possible neither by ES nor by CT. - We advocate endosonography as the first imaging examination after proctoscopy. CT is recommended in endosonographic doubtful findings and in tight stenoses.

[The value of computed tomography in monitoring the preoperative chemotherapy of osteosarcoma]. / Zum Wert der Computertomographie für das Monitoring der präoperativen Chemotherapie des Osteosarkoms.

Computed tomography was performed in 45 patients with osteosarcomas before and after preoperative chemotherapy. Changes of bone alterations, intramedullary tumour spread and the size of soft tissue masses are computer tomographic criteria for tumour response after chemotherapy. The computed tomography decision of responder or non-responder was correct in 37/45 patients. In comparison with conventional x-rays CT was superior. CT is a reliable method for preoperative extension diagnosis and for the decision-marking for limb-saving operations.

[Computed tomography of recurrent rectal cancer with reference to guided fine-needle biopsy]. / Computertomographie des Rektumkarzinom-Rezidivs unter Berücksichtigung der gezielten Feinnadelbiopsie.

Computed tomography as a non-invasive imaging method is of high sensitivity and specificity for the detection and the extent diagnosis of recurrent rectal carcinomas. CT-guided fine-needle-biopsy can be necessary to prove presacral masses, before appropriate therapeutic decisions can be done. In our material CT-guided FNB showed an accuracy of 78% in 27 of 35 patients. Possibilities and limitations of the method are described.

[The value of computed tomography for the pretherapeutic staging of esophageal cancer]. / Zum Wert der Computertomographie für das prätherapeutische Staging des Osophaguskarzinoms.

CT examination was performed in 50 patients with histologically proved carcinoma of the esophagus. In 21 patients the CT findings were compared with the surgical or autopsy specimens. CT is revealed as a valuable diagnostic method for the estimation of infiltrating tumors. Limitations were seen in the precise judgement of the infiltration into the different layers of the adjacent organs and in the recognition of regional lymph node metastases. Nevertheless CT is recommended as a valuable staging procedure in carcinoma of the esophagus.

[Computed tomography in the diagnosis of isolated bone metastases and its influence in therapy planning]. / Computertomographie in der Diagnostik isolierter Knochenmetastasen und ihr Einfluss auf die Therapie-Planung.

In a collective of 70 patients with bone metastases the importance of CT for detection and extension diagnosis is shown. In 53% CT proved the scintigraphic and/or roentgenologic suspicion. In 30% CT gave more information than scintigraphy and plain radiography, but without any influence in the treatment. In 17% only CT gave such important information, that the planned treatment must be changed. The results led to the conclusion, that CT can be important for the optimization of radiological treatment.

[Malignant fibrous histiocytoma of soft tissue. Possibilities and limitations of computed tomography]. / Das maligne fibröse Histiozytom (MFH) der Weichteile. Möglichkeiten und Grenzen der Computertomographie.

Computed tomography was performed in 27 patients with confirmed malignant fibrous histiocytoma of the soft tissue. Compared with the CT results obtained in other tumours of the soft tissues. CT accuracy in malignant fibrous histiocytoma was only 74%. Non-typical attenuation values, diffuse tumour growth and non-typical contrast enhancement are discussed as reasons for the diagnostic understaging or overstaging of these soft tissue tumours. A higher accuracy was found on ultrasound examination with regard to tumour extension. Bone destruction was better visualised by CT. A base-line CT is recommended postoperatively for the earlier detection of recurrent tumours in further investigations.

The value of computed tomography in the diagnostics of recurrent rectal tumors.

Computed tomography as a noninvasive X-ray method offers new facilities for detecting and diagnosing recurrences after surgical treatment of rectal carcinomas. In a comparative study the CT findings of 14 patients with recurrent rectal tumors of the Kuwait Cancer Control Center and of 77 patients of the Central Institute for Cancer Research in Berlin-Buch/GDR were reviewed. CT is of high sensitivity and specificity for the detection and the extent diagnosis of recurrent rectal tumors and is helpful in taking the appropriate therapeutic decision (surgery, radiotherapy). CT examination becomes mandatory for the postoperative follow-up and further assessment.

[Confirmation power of computer tomography for suspected mediastinal tumors]. / Aussagekraft der Computertomographie bei Verdacht auf Mediastinaltumoren.

CT investigations of the mediastinum were compared in their diagnostic power with conventional X-ray pictures. With striking mediastinal broadening, CT always allowed to identify the origin of the tumour, its exact location and relationship with neighbouring organs and vessels. Determining its expansion proved valuable for the further therapeutic procedure. Density measurements gave indications as to the type of tumour. Fine-needle puncture permitted to narrow differential diagnostic findings. Finally, CT was used especially with systemic diseases for the search of lymph nodes in case of known tumours such as bronchial and mammary cancer. Also, pathological vascular processes, such as aneurysms, could be well visualized. This allowed to restrict the more stressing investigations, e.g. mediastinoscopy and angiography.

[Evaluation of computerized tomograms using a black and white and a color monitor: an ROC (receiver operation characteristic) comparison]. / Die Auswertung von Computertomogrammen am Schwarzweiss- und am Farbmonitor: Ein ROC-Vergleich.

Different views about the value of a colour monitor for the evaluation of computer tomograms have prompted us to carry out this ROC (Receiver Operation Characteristic) examination. The latter was based on patient computer tomograms in which lesions of the liver were simulated by image manipulation. 5 radiologists analysed the image material (a) on a black-and-white monitor, (b) on a colour monitor, and (c) simultaneously on a black-and-white and a colour monitor. The study shows that the use of a colour monitor gives no essentially different result than evaluation with a black-and-white monitor. The slightly better result of 2% more true positive findings with simultaneous representation of black-and-white and colour image relative to the sole use of black-and-white display is within error limits. The colour representation gives no advantage for the evaluation of usual computer tomograms because the window technique enables a contrast representation in black-and-white too.