861 Brain metastasis in resectable lung cancer: Preoperative evaluation with MRI — Comparison with CT

Biology the diagnostic yield, site, histological sub-type and procedural morbidity. These patients did not have adequate peripheral lesions for FNAC/Biopsy nor were their failure. Out of 58 smears analysed 50 (86.2%) could have positive histological diagnosis. Eight smears were insufficient for interpretation. 48/50 (96%) had adequate histological sub type. 44/50 (88%) were of neoplastic histology, 4 were inflammatory and 2 had mixed lymphoid cells. Among the neoplasms. 39/44 (88.6%) were malignant, 5/44 (11.4%) were benign. The malignant neoplasms were from lung 28/39 (71.8%), germ cells 4/39 (10.3%). lymphomas 4/39 (10.3%) and neuroblastomas 3/39 (7.7%). Out of 28 lung cancers, 9/28 (32.1%) were squamous cell carcinomas, 12/28 (42.9%) were adenocarcinomas, l/28 (3.6%) were small cell carcinomas and 6/28 (21.4%) were poorly differentiated carcinomas. In 11/28 (39.3%) lung cancers even nuclear grading was even possible. The benign lesions were Thymomas in a vast majority. The yield was better in bulky central lesions. 39/58 (67.2%) had X-ray/CT correlation with reference to the site. 20/28 (71.4%) were stage Ill, 8/28 (28.6%) were stage IV. Complete staging/treatment decisions could not however be made on ultrasound findings alone. There were no major morbidities ascribable to the procedure. From our study it appears that ultrasound guided FNAC could be a useful, safe and cost effective diagnostic tool with reasonable histological precision in intrathoracic malignant neoplasms and therefore we recommend this procedure for countries with limited resources.

860 L--

No. of pts.

Brain m&stases Preope. Postope. (51 Y)

Total

CT

153 177

1 (0.7%) 6 (3.4%)

11 (7.2%) 12 (6.8%)

MRI

10 (6.5%) 6 (3.4%)

BMs occurred at the same incidence in the both groups. The preoperative detectability of BMs by MRI was superior than that of CT (6/12, 50% vs l/11, 9%). Furthermore, survival time after treatment of BMs in 12 pts of the MRI group was slightly longer than that in 11 pts of the CT group. Group

No. of pts. with BMs

MST(M)

1 YS (%)

2 YS (%)

CT MRI

11 12

10 18

27 65

27 26

In conclusion, we consider that preoperative cilitate early detection and effective treatment lung cancer.

PUBLISHED

evaluation with MRI mayfaof BMs in pts with resectable

ABSTRACTS

CA-19-9 at of the lung

We have analyzed the value of the tumor markers (TM) CEA, MCA and CA-19-9 in pleural effusion (PE), at 34 patients with lung carcionoma and PE. At 21 patients, the malignant PE was confirmed by citology or blind pleural biopsy (I gr.). At 13 patients (II gr.) we didn’t obtain any proof of malignant PE. The mostfrequent pathohistological tipe of tumor in the I gr. was adenocarcinoma (11) and in the II gr. was carcinoma planocellulare (6). The control group (Ill gr.) was consisted of 30 patients with PE of benign origin. The TM were determined with two levels of enzymatic immunoassay principle using the sandwich method. Between the patients of I gr. and II gr. there was statistically significant difference concerning the main value of CEA, MCA and CA-19-9 in the PE (p < 0.001). in this study, we have also determined the sensitivity and specificity of 3 TM for the PE. TM

cut-off

SE%

SP%

PVP

PVN

CEA (ngiml) MCA (U/ml) CA-19-9 (U/ml)

3.721 25.384 22.009

65.29 47.06 55.88

93.33 93 33 93 33

93 55 88 89 90 48

84 85 60 87 65 12

Of all 3 TM, the one with the highest sensitivity in the PE was CEA TM, and therefor it can be recommended as a routine diagnostic test at patients with PE and primary lung carcinoma.

861

Modality

Pulmonary imaging The tumor markers CEA, MCA AND pleural effusions and primary tumor

B. Kaeva, T. Stefanovski, B. Polenakovid, M. Demireva, E. Naumovski, S. Stojkovski. Clinic of Pulmology and Allergology Medical faculty Skopje, Macedonia

I

221

Brain metastasis in resectable Preooerative evaluation with CT ’

K. Yokoi, M. Sawafuji, T. Arai, T. Hirose, Cancer Center, Utsunomiya, Japan

lung cancer: MRI - Comoarison

K. Mori, K. Tominaga.

with

862 El

Usefulness variations

of longitudinal evaluation in advanced lung cancer

of CYFRA monitoring

21-1

A. Hamzaoui ‘, P. Thomas ‘, 0. Castelnau I, N. Roux2, F. Roux 2, J.P. Kleisbauer ’ ’ Service d’oncologie respiratoire, Hopita/ Sfe-Marguerite, 13009 Marseille; ‘Laboratoire de radioanalyse, Hopita/ de la Conception, 13005 Marseille, France To investigate the usefulness of Cyfra 21-1 as indicator of therapy effectiveness and prognosis in advanced primary lung cancer, sixty-three patients were selected on the basis of a high Cyfra 21-l serum level (>3.3 rig/ml) at the time of diagnosis. Serial assays of Cyfra 21-l were performed during the first three courses of chemotherapy among 63 patients. The serial values were analysed according to response to treatment and overall survival. After three courses of chemotherapy, a 70% reduction under the initial marker’s value or a return to normal was observed for 36 patients. Twenty-two (61%) of these patients presented an objective response to therapy, making Cyfra 21-1 a moderate indicator in terms of positive predictive value (PPV). However, a significant decrease of Cyfra 21-1 was observed in 88% (sensitivity) of the 25 objective responders. Cyfra 21-1 changes after one course of chemotherapy (61 patients) were not sufficient to predict the future response after three courses (sensitivity 52%, specificity 56%, PPV 45%). Among 30 clinical or radiological relapses, a 10% increase or a return upper reference limit in Cyfra 21-1 level was observed in 18 cases (sensitivity 60%, specificity 1OO%, PPV 100%). Survival data were available for 61 patients. No significant statistical difference (p > 0.05) was found between survival curves depending on a significant decrease of Cyfra 21-1 after the first course of chemotherapy. We can conclude that the only interest of serial Cyfra 21-l assays may be the detection of relapse, where one observes a significant decrease of the marker correlated with an objective response to first treatment.

Tochfgi

Lung cancer is the commonest primary source of brain metastases (BMs), which are usually associated with an ominous outcome. To compare the usefulness of preoperative evaluation with magnetic resonance imaging (MRI) in detection of BMs to that with computed tomography (CT), we prospectively studied 330 patients (pts) without neorological symptoms who had resectable non-small cell lung cancer. 153 pts (CT Group: ‘89. I.-‘92. 9.) were examined with CT and 177 pts (MRI Group: ‘92.10.-‘95.12.) with MRI. Of 296 pts with complete resection of the primary tumor, intensive follow-up with CT/MRI were performed for 6-24 postoperative months (Ann Thorac Surg 1996; 61: 546-551). The preoperative detectabilities of BMs and postoperative intracranial recurrence rates were compared between the two groups. These results were as follows:

I 863

Lactatdehidrgenaza malignant etiology

and

pH in the

pleural

effusion

of

B. Kaeva, T. Stefanovski, Lj. Gligorovski, G. Bresskovska, S. Stojkovski. Clinic of Pulmology and Allergology, Medical f-acultx Skopje, Macedonia During the period of the last 3 years we have analyzed 60 patients with malignant pleural effusion concerning the value of lactatdehidrogenaza (LDH) and pH in the pleural fluid. 7 patients (I group) had malignantmezothelioma and the other 53 patients (II group) had methastatic pleural effusion. LDH was determined by using the enzymatic method of Wroblevski, while pH was determined by gasanalyzer AVC GAS CHECK 938. In the I group the main value of LDH was 902.286 rt 653.764 U/L. In this group the main value of pH was 7.237 f 0.082.