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... Investigations of Carcinoma Bronchus 52
I-Conventional Radiology 55
II-Ultrasound 76
III-Computed Tomography 82
IV-MRI 91
V-Radionuclide Scanning 94
6. ... Bibliography 152
CERTIFICATE
It is certified that this dissertation titled "RADIOLOGICAL DIAGNOSIS OF BRONCHOGENIC CARCINOMA" has been performed by DR. ...
INTRODUCTION
Radiological diagnosis of carcinoma of bronchus: it is not a new or rare topic, then why I selected this topic? ...
In our country carcinoma of bronchus is becoming commoner and is now holding a position next to tuberculosis as far as pulmonary involvement are concerned. ... People who develop carcinoma of bronchus have a long smoking history and that also many cigarettes a day some times even upto 1-2 packs per day. ... Non availability of competent doctors to cover the population who could help in early diagnosis. ... Paucity of even simpler means of diagnosis particularly X-Rays facilities. ... The high prevalence of lung infections especially tuberculosis which confuses and causes delay in the establishment of the diagnosis of bronchogenic carcinoma.
Early detection of bronchogenic carcinoma is the most important factor affecting the out look for the individual patient. Early suspicion alone can lead to earlier diagnosis of the disease. Any person of cancer age that is 40 years or above who has been a smoker and has chest symptoms needs investigations to exclude bronchogenic carcinoma. ...
HISTORICAL BACKGROUND
The epidemic of carcinoma bronchus as it has occurred in the civilized world during the 20th century will be referred by medical historians for centuries to come.
Recognition of Entity:
From the historical review of the literature, it becomes evident that the history of carcinoma bronchus merges with that of its etiology. ... (Harting, Herse cited by Spencer H, 1969)
Later in the year 1922 it was found that the mysterious consuming pulmonary disease endemic among the miners of the Schneeberg was, and always had been bronchogenic carcinoma. (Boyd, 1977)
Recognition of Etiology:
Arton Ochsner deserves much credit as one of the first to propose the concept that tobacco smoking particularly cigarette smoking is the primary causative factor responsible for the sudden increase in the incidence of carcinoma bronchus, which he noticed in men smoking heavily after first world war. ... In 1985, the incidence of bronchogenic carcinoma was 135,000 cases in USA In Pakistan it constitute 11% of all cancers in males (Fatimi, 1993). ...
The final piece of human evidence that smoking was the primary cause of bronchogenic carcinoma came from the autopsy studies by Auerbach in the 1950s and in the 1970s where they found that the histologic changes consistent with precancerous lesions were directly related to the amount of smoking in a dose response manner. (Auerbach, 1979)
Diagnostic Improvement:
The incidence of carcinoma bronchus kept on rising as did also the need for better means for defining the extent of the disease, exact understanding of its pathologic behavior and above all the pretreatment evaluation of various prognostic factors which would better define the further course of treatment planning. ...
Among the invasive diagnostic techniques the development of fibreoptic bronchoscopy by Ikeda (Macdonald JB, 1975) in 1968 brought almost a revolution in the field of diagnosis of this disease by allowing to visualized lesions upto segmental to subsegmental bronchii and to sample washings, brushings and biopsy of suspected areas. ... (Sears TA, Berger AJ, Phillipson EA)
PATHOLOGY (Kumar, Cortan, Robbins 1992)
95% of primary lung tumors arise from the bronchial epithelium (bronchogenic carcinomas) and the remaining 5% are a miscellaneous group that includes bronchial carcinoids, mesotheliomas, bronchial gland neoplasms, mesenchymal malignancies, lymphomas and a few benign lesions.
Bronchogenic carcinoma is with out doubt the number one cause of cancer related death in industrialized countries, related to the causal relationship of cigarette smoking. ...
Male cigarette smokers are about 10 times more likely to die of bronchogenic carcinoma than are non smokers.
Lung cancer in patients younger than 40 years of age (Jubelirer-SJ 1991)
The record of 52 patients younger than 40 years of age who had bronchogenic carcinoma diagnosed between 1965-1985 were reviewed. ...
- the high incidence of advanced stage at diagnosis (77% stage III & IV) of these patients. ...
HISTOLOGIC CLASSIFICATION OF BRONCHOGENIC CARCINOMA AND
APPROXIMATE INCIDENCE
I. NON SMALL CELL LUNG CARCINOMA (NSCLC) ( 70-75%)
1. Squamous cell (epidermoid) Carcinoma (25-30%)
2. Adenocarcinoma, including bronchioloalveolar carcinoma (30-35%)
3. Large cell carcinoma (10-15%)
II. SMALL CELL LUNG CARCINOMA (SCLC) (20-25%)
III. ... The relevant issues with bronchogenic carcinoma as with all cancer relate to the nature of genetic changes that result in malignant transformation of bronchial epithelium and the factors that induce these changes. ... (Morison-D 1994)
Twin cases of bronchoalveolar, squamous and anaplastic bronchogenic carcinoma have been previously reported. ...
There is a linear correlation between the intensity of exposure to cigarette smoke and epithelial changes beginning with atypical squamous metaplasia, the dysplasia and ultimately abnormalities approaching carcinoma in situ followed in most instances by the bad news. ...
There is increased incidence of Carcinoma bronchus in miners of radioactive ores, asbestos workers (particularly where coupled with smoking) and workers exposed to dusts containing arsenic, chromium, uranium, nickel, vinyl chloride and mustard gas. ...
These patients are characterized by a relatively young age at diagnosis (median, 43 years) and prevalence of adenocarcinoma subtype (13 of 25 patients). ... (Aaron-SD, 1994)
MORPHOLOGY
Bronchogenic carcinomas in the various histologic categories share several features
1. ...
SQUAMOUS CELL CARCINOMA
More common in men than in women, they tend to arise centrally in major bronchi and eventually spread to local hilar nodes but they disseminate outside the thorax later than do other histologic types.
Squamous cell carcinomas are often preceded for years by atypical metaplasia or dysplasia in the bronchial epithelium, which then transform to carcinoma in situ, a phase that may last several years. ...
Squamous cell carcinoma have a slightly better prognosis than other histologic types because they tend to develop into large, bulky, centrally obstructing symptomatic masses before they metastasize and are therefore more often surgically resectable. (Robbins 1992)
ADENOCARCINOMA
Almost equally common in men and women, association with cigarette smoking is weaker than for squamous cell carcinoma. ...
BRONCHIOLOALVEOLAR CARCINOMA
A special category of adenocarcinoma, occurs as two variant. ...
BAC has a better prognosis than other bronchogenic carcinomas, the multifocal variant has 20 to 25% five year survival rate, and the localized single mass has 50-70% five year rate.
LARGE CELL CARCINOMA
These neoplasms are generally bulky and are more often peripheral than central, they have a poor prognosis because of their tendency to spread to distant sites easily in their course. ...
SMALL CELL LUNG CARCINOMA
They are more common in men than in women, and are strongly associated with cigarette smoking. ... The clinical staging of cancer: Stage grouping in carcinoma of the lung. ... Kumar 1987)
OCCULT CARCINOMA
TX N0 M0 An occult carcinoma with positive cytology but without other evidence of the primary tumor or without evidence of metastasis to the regional lymph nodes or distant metastasis.
STAGE I
T1S N0 M0 Carcinoma in situ
T1 N0 M0 A carcinoma can be classified T1 without any metastasis or with metastasis to the lymph nodes in the peribronchial and
T1 N1 M0 or a tumor than be classified T2 without any metastasis to
T2 N0 M0 nodes or distant metastasis
STAGE II
T2 N1 M0 A tumor classified as T2 with metastasis to lymph nodes in the peribronchial and / or ipsilateral hilar region only. ... Enlarged supraclavicular lymph nodes are frequently found with small cell carcinoma. ... Carcinoma in the apex of the lung can erode the ribs and involve the lower part of the brachial plexus (C8, T1 & T2) causing severe pain in the shoulder and down the inner surface of the arm (Pancoasts tumor)
- The sympathetic ganglion may also be involved producing Horners syndrome. ...
- Bronchial carcinoma can also directly invade the phrenic nerve causing paralysis of the diaphragm. ...
NON-METASTATIC EXTRA-PULMONARY MANIFESTATIONS OF BRONCHIAL CARCINOMA (Parveen J Kumar: Michael L Clark 1987)
METABOLIC (Universal at some stage)
- loss of weight
- lassitude
- anorexia
ENDOCRINE (10%)
- ectopic adrenocorticotrophin syndrome. ...
- hypercalcemia (usually squamous cell carcinoma). ...
NEUROLOGICAL (2-16%)
- encephalopathies
- myelopathies
- neuropathies
- muscular disorders polymyopathy myasthenic syndrome
VASCULAR AND HEMATOLOGICAL (rare)
- thrombophlebitis migraines
- non-bacterial thrombotic endocarditis
- microcytic and normocytic anemia
- disseminated intravascular coagulopathy
- hemolytic anemia
SKELETAL
- clubbing (30%)
- hypertrophic osteoarthropathy (3%)
CUTANEOUS
- dermatomyositis
- acanthosis nigricans
- herpes zoster
TUMOR MARKERS
A wide variety of tumor markers has been described in bronchial carcinoma. ... (Gropp-C-1991)
THE METHOD OF INVESTIGATIONS OF NORMAL CHEST
THE PLAIN CHEST FILM
This is the most frequently requested radiological examination. ...
MRI
It appears to be helpful in the diagnosis of hilar masses lymph adenopathy. ...
INVESTIGATIONS OF CARCINOMA BRONCHUS
Investigations are directed to the establishment of a diagnosis, the extent of disease and the mode of treatment
Once a suspicion of carcinoma has been raised the prime investigation are sputum cytology and bronchoscopy with biopsy.
1-Taking account of the natural history of the disease it is probably necessary to abandon the concept of an early diagnosis of a tumor which is already too late, it is towards a search for precancerous lesions which are still reversible that the research effort should be turned. ...
Needle aspiration of extra thoracic metastasis from bronchogenic carcinoma: five patients with suspected metastatic bronchogenic carcinoma underwent needle aspiration of peripheral metastatic lesions instead of diagnostic bronchoscopy. ... Two patients had non small cell carcinoma, two had small cell carcinoma and one patient had a non diagnostic aspirate. The procedure had insignificant morbadity, was easy to perform, quickly established a diagnosis of metastatic disease and obviated the need for more invasive diagnostic procedure in 4 of 5 patients. ... 1977)
BRONCHOGENIC CARCINOMA
In any case of carcinoma bronchus, the topography of the growth, its manner of spread through the lungs and complication resulting from bronchial obstruction are the prime importance in determining the x-ray picture. ... (Liebow A 1955)
RELATION OF TOPOGRAPHY TO CELL TYPE
Most of the bronchogenic carcinoma can be classified into four groups:
1. Squamous cell or epidermoid carcinoma. ... Small or oat cell carcinoma. ... Anaplastic carcinoma. ... The manner of growth and spread of a carcinoma of the lung depends largely on whether it originates in the hilar or peripheral portion of the lung. ...
On the other hand in the case of carcinoma of the larger bronchi the tendency to rapid spread is influenced by the cell type. ( Heitzman ER, 1977)
ROOT BRONCHUS CARCINOMA
The roentgen appearance of carcinomas arising in the main or lobar bronchi depends largely on the presence or absence of bronchial obstruction. ... (Anderson, 1954)
If the cavity is visualized in the vicinity of lung root on all views, an excavated carcinoma should be suspected. ...
A pleural effusion associated with obstructive atelectasis of one or more lobes is most frequently due to bronchogenic carcinoma. ... G 1942)
NON STENOSING TYPE
A non obstructing carcinoma at the root of the lung may be completely hidden by the mediastinal structures and the film show no abnormality. ...
It is more frequently noted on the right side and is then almost always associated with marked thickening of the short fissure by the spreading carcinoma. ...
The carcinoma often extends by way of lymphatics to involve the pleura producing one or more scalloped shadows or an effusion. When the pleural involvement is secondary to a carcinoma arising from a large bronchus it is almost always associated with recognizable infiltrations in the lung.
PERIPHERAL CARCINOMA
A carcinoma originating in a segmental or subsegmental bronchus tends to form a localized tumor and may present radiologically as a circumscribed . ... The presence of a mass at the mesial extremity of a segmental area of pneumonia is diagnostic of a bronchogenic carcinoma. ... The Fleischner line peripheral to a circumscribed density is a definitive diagnostic sign of primary bronchogenic carcinoma. ... On the other hand cavitation associated with a tumor of a large bronchus occurs in the lung distal to the obstructing carcinoma and is secondary of infection. ... 1960)
The peripheral carcinoma which has undergone cavitation may appear identical to an abscess of the lung however certain characteristics are often present which point of the diagnosis of neoplasm. ... Tomograms may be required to demonstrate this protuberance which is diagnostic of a carcinoma. ... 1955)
Even in the absence of these distinguishing features persistence of a cavity with little change in a patient whose sputum is negative for tubercle bacilli should suggest the likelihood of an under lying carcinoma. ... One or more ribs over the tumor can be destroyed in this fashion however the area of rib destruction does not extend beyond the confines of the shadow of the tumor In this respect a peripherally invasive lung carcinoma differs from many cases of primary or metastatic tumor of a rib. ...
APICAL CARCINOMA AND PANCOAST SYNDROME
Peripheral neoplasms at the apex of the lung frequently present special characteristics
1- These have a great tendency to invade the extra pleural tissues. ...
A definitive diagnosis of Pancoast tumor may be made when there are destructive changes in the adjacent ribs or spine. ...
The differential diagnosis of a tumor at the apex of the lung is from mass of large cervical lymph nodes which depress the parietal pleura at the dome of the thorax and indent the apex of the lung without invading it.
CALCIFICATION IN PERIPHERAL CARCINOMA
Calcification within a nodular shadow in the lung makes the possibility of bronchogenic carcinoma unlikely. ...
SPECIAL DIAGNOSTIC METHODS
Other views in addition to the conventional frontal projection are often helpful in the diagnosis of carcinoma of the lung. ...
4- Panetrating Film
5- Bronchography was occasionally used in the diagnosis of bronchogenic carcinoma but with the advent of C. ... Characteristically a carcinoma produces a long irregular funnel shaped narrowing of the involved bronchus giving a rat tail appearance to the column of contrast material within its lumen. ...
In case of peripheral tumors the small bronchi are frequently splayed around the mass which grows largely by expansion, this sign is not pathognomonic of carcinoma since it does occur occasionally in inflammatory lesions. ... 1963)
DIAGNOSTIC CLUES
Frequently the diagnosis of bronchogenic carcinoma is quiet evident on casual examination of the roentgen film however often the diagnosis is not as clear. ... (Felson B 1977)
1- Not infrequently a carcinoma of the lung presents as a pneumonic shadow since at least part of the shadow is cast by the tumor it never resolve completely. ...
2- Recurrences of pneumonia in the same portion of the lung even though complete clearing has occurred between episodes should suggest the possibility of partial obstruction of a bronchus which may be due to a carcinoma.
3- The earliest roentgen manifestation of a peripheral carcinoma is a small non descript smudge like shadow, usually measuring less than 2 cm in diameter. ...
4- The presence of a large lymph node at the root of the lung or one jutting out from the mediastinum in combination with a smudge like density or a larger pneumonic shadow in a person of cancer age favors the diagnosis of Ca bronchus.
5- Detection of an area of erosion or destruction in a rib overlying a nodular lesion in the lung is extremely important in the recognition of a peripheral carcinoma. ...
6- The presence of a Fleischner line peripheral to a nodular shadow is practically diagnostic of primary bronchogenic carcinoma.
7- Apparent pleural thickening over the apex of one lung in the absence of tuberculous scarring beneath it is strongly suggestive of a carcinoma. ... (Decker DA 1978)
9- Evidence of periosteal new bone formation in the extremities in conjunction with a lesion in the lung is an indication of primary bronchogenic carcinoma. ... 1960)
10- Lobar atelectasis in older patients is strongly suggestive of an obstructing bronchial carcinoma.
11- A mediastinal mass in a person of cancer age is usually secondary to bronchogenic carcinoma even though no lesion can be visualized in the lungs.
If the cases with obvious aortic aneurysm and those in which the mass is situated in the anterior mediastinum and abuts on the sternum are excluded over 90% will prove to be primary bronchogenic neoplasms.
12- Carcinoma of the lung is a frequent complication of asbestosis. ... A nodular lesion with calcification or other evidence of asbestosis practically always represents a primary bronchogenic carcinoma.
13- Patient with hemoptysis, persistent cough or a constant rhoncus with an apparently negative chest film require further roentgen study from the stand point of bronchogenic carcinoma. ...
15- Complete endobronchial obstruction due to bronchogenic carcinoma, undetectable radiographically can occur frequently in patients at risk for lung cancer and has significant incidence. (Shure-D 1991)
There are certain point that eliminates bronchogenic carcinoma from consideration e. ... 5 cm in diameter even if not exquisitely demarcated rarely represents a primary bronchogenic carcinoma. ... 1950)
OTHER PRIMARY MALIGNANT NEOPLASMS
BRONCHIOLAR CARCINOMA (ALVEOLAR CELL CARCINOMA)
Bronchiolar carcinoma manifests itself in three different forms:
1. ... 1962)
NUMEROUS NODULES
The least common presentation of bronchiolar carcinoma is characterized by numerous nodules diffusely studding both lungs. ... In general the multinodular forms of bronchiolar carcinoma cannot be differentiated from metastatic neoplasms from other organs. ...
ULTRASOUND
Ultrasound examination is indispensable in the complete diagnosis and treatment of Ca. ... Ultrasound abdomen is basically carried out in cases of Carcinoma Bronchus to rule out any liver, adrenal or abdominal lymph nodes metastasis and it also helps in confirmation of pleural effusion. ... The diagnosis of metastasis is based on two kinds of pathological features:
either contour abnormalities or
textural tissue echo abnormalities. ... Abnormal mediastinal or hilar contours, complex pleural disease and staging of carcinoma are a few examples. ... patients with normal chest x-ray films but abnormal sputum cytology and hence a possible bronchogenic cancer. ... 1981)
DISTANT METASTASIS (M)
Routine CT of the brain, liver and upper abdomen in the staging of small cell carcinoma is of little value because in this non surgical disease CT is limited to radiotherapy planning and treatment response evaluation. (Poom PY, 1982)
The management of non oat cell carcinoma is on the other hand affected by the discovery of distant metastasis. ... BRONCHOGENIC CARCINOMA
The appearance on CT of bronchogenic carcinoma may be indistinguishable from that of a bronchial adenoma.
Certain features of bronchogenic carcinoma however are distinctive.
Centrally bronchogenic carcinoma may arise in a central air way and infiltrate circumferentially for a considerable length.
Peripherally bronchogenic carcinoma frequently have lobulated or speculated margins, although perfectly smooth lesions may still be malignant. More important, bronchogenic carcinoma frequently arise at point of bronchial bifurcation. ... (Onitsuka-H 1991)
MRI IN LUNG TUMORS
CT is an established technique in the staging of lung carcinoma with MRI currently used in a problem solving role. ... 1987)
In a small series of patients with proximal lung carcinoma and distal lobar collapse, evaluated by dynamic contrast enhanced CT and MRI, CT was more successful than MRI in differentiating tumor mass from collapsed lung. ...
The diagnosis of nodal disease depends on the same size criteria as for CT generally nodes greater than 10 mm are considered to be enlarged and involved by tumor.
In the evaluation of distant metastasis from carcinoma of the lung MRI has the potential for characterizing some adrenal masses. ...
RADIONUCLIDE TECHNIQUES IN CARCINOMA OF THE LUNG
a) GALLIUM 67 IMAGING
67 Gallium has been evaluated in the primary diagnosis of bronchogenic carcinoma and has been shown by many workers to be taken up by malignant tissue. ... (Waxman et al, 1984)
b- OTHER AGENTS
99m Tc Methylene diphosphonate (MDP) bone scanning is frequently used as a staging procedure in patients with proven carcinoma of the bronchus, as is 99mm Tc liver colloid imaging and 99mTc brain imaging. ...
POSITRON IMAGING TOMOGRAPHY IN LUNG CARCINOMA
Positron emission tomography (PET) imaging using radiolabelled aminoacids has been used by Kubota et all (1985) in patients with lung cancers and benign tumors. ...
Patients with carcinoma of lung have generally a poor prognosis, with multi organ involvement at the time of presentation. ...
The significance of a positive bone scan in carcinoma of the lung is dire with an 87% mortality with an six months. ... an awareness of the subtle radiological signs for either a malignant change in a preexisting benign condition like tuberculosis or identifying one on the baseline x-rays, therefore may change the clinical fate.
Carcinoma bronchus has been extensively studied radiologically world wide. ... CT, HRCT or MRI a new surge in enthusiasm comes up regarding the potential for better and earlier diagnosis of the disease which still has a 5 years survival of 25% at best.
During the review of literature it was also noted that all the literature regarding the radiological signs is based upon what is stated by the west. ... This resulted in less number of patients undergoing CT despite the fact that CT is the gold standard not only for diagnosis but also for determining the local criteria of resectability. ... with respiratory symptoms and having positive chest x-ray findings were selected and followed from admission to confirmation or exclusion of diagnosis by bronchoscopy / biopsy. Once the diagnosis was confirmed they were followed for all the findings that could be detected on imaging.
Another group of patients included those in patients referred to radiology services from medical / surgical units who were admitted with suspected either primary or secondary disease and were later proven to be suffering from bronchogenic carcinoma. These also included the patients who were suspected to have pulmonary tuberculosis but later turned out to be having coexistent malignancy which escaped early diagnosis under cover of benign infection. ... Histopathological Diagnosis
Type Number of Patients Percentage
I-NON SMALL CELL LUNG
CARCINOMA (NSCLC)
1. Squamous cell 11 37%
carcinoma
2. Adeno carcinoma 08 26%
3. Large cell 05 16%
carcinoma
II- SMALL CELL LUNG 06 20%
CARCINOMA (SLCS)
TABLE 15. ...
Fig3 Name: Mohammed Begum Sex: Female Age: 69 years Non Smoker
Typical sun-ray appearance emerging from the mass in left hilar region
Bronchogenic carcinoma. ... CT guided biopsy revealed poorly differentiated large cell carcinoma, most probably squamous cell carcinoma. ...
Fig 10 Name: Muhammad Yakoob Sex: Male Age: 63 years Smoker: 15 years
Massive collapse of left lung due to left bronchogenic growth, mediastinum shifted to left side, hyperinflation right lung. ...
Association of cigarette smoking to bronchogenic carcinoma was proved and majority of the patients in the study were heavy cigarette smokers of more than 20 cigarettes per day. ...
Histopathologically, squamous cell carcinoma had the highest incidence (11 patients) followed by adenocarcinoma (8 patients) & small cell carcinoma (6 patients). and large cell carcinoma (5 patients) 5 non-smoker patients had adenocarcinoma. ...
Hilar lyphadenopathy was detected in 8 cases; one case simulated lymphoma was later proved to be bronchogenic carcinoma after bronchoscopic biopsy. ... Once a suspicion of bronchogenic carcinoma was raised after x-ray chest, the patient underwent bronchoscopy and biopsy, bronchoscopic biopsy was successful in almost all the cases of centrally located masses, peripherally located masses were biopsied under CT guidance. ...
It is regretted that no other Pakistani radiological study was available for comparison. ... Chest X-ray is a simple affordable means of diagnosing a bronchogenic lung tumors. ...
“Prevention is better than cure” Carcinoma bronchus is a proof of this time honored principle. ...
APPENDIX
RADIOLOGICAL DIAGNOSIS OF CARCINOMA BRONCHUS
S.NO DATE
NAME AGE SEX
OCCUPATION:
ADDRESS
CLINICAL DATA:
COUGH SINCE
HEMOPTYSIS SINCE
DYSPNOEA SINCE
CHEST PAIN SINCE
WHEEZE OR STRIDOR SINCE
WEIGHT LOSS SINCE
ADDICTION YES/NO
IF YES THEN TYPE OF ADDICTION
IF SMOKES THEN DURATION
NO/DAY FILTERED/NON FILTERED
INVESTIGATIONS
RADIOLOGICAL IMAGING:
X-RAYS
ULTRASOUND
NUCLEAR MEDICINE
CT
MRI
LABORATORY INVESTIGATION
HISTOPATHOLOGICAL DIAGNOSIS
TREATMENT:
RADIOTHERAPY
CHEMOTHERAPY
SURGERY
LIST OF FIGURES
Fig. ... Histological Classification of Bronchogenic Carcinoma 34
3. Clinical Staging of Bronchogenic Carcinoma 44
4. Frequency of Common Symptoms of Bronchogenic Carcinoma on Presentation 45
5. Non Metastatic Extra Pulmonary Manifestation of Bronchogenic Carcinoma 48
6. ... Histopathological Diagnosis 105
14. ... Skeletal Scintigraphy 111
BIBLIOGRAPHY
1 Aaron-SD; Warner-E; (1994)
Bronchogenic carcinoma in patients seropositive for human immunodeficiency virus. ... Alveolar cell carcinoma. ...
Carcinoma of bronchus presenting as thin walled cyst. ...
The solitary circumscribed bronchogenic carcinoma: a radiological study of 100 cases. ...
The many facts of alveolar cell carcinoma on the lung. ...
Differentiation of bronchogenic carcinoma from postobstructive pneumonitis by MR. ...
The significance of pleural effusion complicating otherwise operable bronchogenic carcinoma. ...
The significance of a cytologically negative pleural effusion in bronchogenic carcinoma. ...
CT in preoperative staging of bronchogenic carcinoma. ...
The esophagus and mediastinal lymphadenopathy in bronchial carcinoma. ...
31 Freeman and Tonkin (1976)
Manifestation of HPO in patients with carcinoma of the lung; demonstration by 99m Tc pyrophosphate bone scans. ...
Cavitary carcinoma of the lung roentgenologic features in 19 cases. ... How ominous is an abnormal scan in bronchogenic carcinoma? ...
Tumor markers, significance for clinical diagnosis. ...
Spontaneous pneumothorax as a presenting features of primary carcinoma of the lung. ...
Bronchogenic carcinoma: radiologic-pathologic correlation. ...
Radioisotope scanning in the initial staging of bronchogenic carcinoma. ...
Roentgen findings in terminal bronchiolar carcinoma. ...
The value of radiography and computed tomography in the staging of lung carcinoma. ...
Chronic non malignant pulmonary lesions simulating bronchogenic carcinoma. ...
Pathology of carcinoma of the lung as related to the roentgen shadow. ...
Needle aspiration of extrathoracic metastasis from bronchogenic carcinoma. ...
54 Lopez-Majano and Sabti (1984)
Early diagnosis of pulmonary osteoarthropathy in neoplastic disease. ...
Bronchiolar carcinoma another great imitator, review of 41 cases. ...
Value of CT and MRI in diagnosis of tumorous process of the bronchial system. ...
Bronchography an aid in the diagnosis of peripheral pulmonary carcinoma.
Approximate Word count = 20979
Approximate Pages = 83.9
(250 words per page double spaced)
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