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Small-bore (22- or 23-gauge) needles were used to aspirate 458 lung masses. Sensitivity for the detection of malignancy by this method was 96.6% (312 of 323 patients); accuracy was 98.7%. Surgical confirmation was available for comparison in over half of patients with malignancy. Histologic reclassification of malignancy occurred in only 6.1% of patients, with significant misclassification (misdiagnosis of small cell carcinoma) occurring in only two instances. One hundred thirteen of 117 nonmalignant conditions were properly categorized, with an overall specificity of 96.6%. No major complication occurred. While several recent studies have stressed the advantage of using larger needles, to overcome the limitation of smaller aspiration needles that provide only cytologic material, small-needle aspiration appears to be a safe, reliable, and accurate means for diagnosing lung lesions.

A follow-up period averaging 21.6 years was obtained for patients with low-grade papillary intraductal carcinoma initially treated only by biopsy between 1940 and 1950. Subsequent carcinoma was diagnosed in the same breast in seven of the ten patients after an average interval of 9.7 years. Six of the seven subsequent carcinomas were invasive. Two of the patients died of metastatic carcinoma and two were known to be alive with metastases when last contacted. Three patients were without carcinoma following mastectomy. When these results were combined with the few reports available in the literature, it appeared that at least 39% of patients with intraductal carcinoma treated by biopsy alone subsequently had clinically evident carcinoma, invariably in the same breat, with an average latent period of about ten years. This was undoubtedly a result of the multicentric nature of the disease in many patients.

We retrospectively studied nine patients with solitary renal neoplasms that were first visible when smaller than 3 cm in diameter to determine their imaging and pathologic characteristics and clinical course. These neoplasms represented 14% of the total renal neoplasms discovered over a 6-year period, and only one-third were initially identified by screening urography. While seven of the patients had hematuria, most had associated urologic conditions (calculi, prostatism). Two patients had widespread metastases 2 and 4 years after the carcinomas first appeared. The remaining seven patients are alive and well 8 months to 6 years after undergoing nephrectomy, despite the significant delayed diagnosis in three patients. Only one lesion was pathologically benign (an oncocytoma). Two of the renal cell carcinomas were found within the walls of partially calcified renal cysts. Two (22%) of nine neoplasms exhibited aggressive biologic behavior, which suggests that these lesions may have greater metastatic potential than previously thought. We suggest that computed tomography be performed after screening urography and cystoscopy when unexplained hematuria is present.

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