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912 Laser-induced fluorescence endoscopy in the early detection of lung cancer using the photosensitizer
232
Biology
submitted eight patients, in complete remission after chemo-radiotherapy, to enhanced Octraoscan (whole body planar scintigraphy and SPET at 24 hours) at the same time of conventional re-staging. In six cases enhanced Octreoscan was negative, in agreement with restaging. In 5 out of 6 patients follow-up at 6 months was still negative, while in one patient a local relapse appeared after 2 months. In the other two cases enhanced Octreoscan revealed pathological uptake, respectively in the lung and in the liver. In the first patient, progression of disease was clinically evident after 2 months, with a lung lesion in the area predictively identified by Octreoscan. Progression was confirmed by CT scan and fiberoptic bronchoscopy. In the latter case liver lesions were clinically evident after 3 months since restaging, as confirmed by ultrasound and CT scan. However preliminary these results are, they seem to indicate that enhanced Octreoscan -with a promising negative predictive value of 83% and a positive predictive value of lOO%- could be useful to improve the accuracy of SCLC re-staging. [I]
optical information from the diagnostic environment and displays the image on the TV monitor simultaneously. The equipment was applied clinically on the basis of extensive experimental research. The effectiveness of the system for cancer localization was examined in 24 cases, including 9 cases of carcinoma in situ. All cases were squamous cell carcinoma, except for one case each of adenocarcinoma and large cell carcinoma. Fluorescence was recognized in 23 out of the 24 cases, thus the system was effective for localization. However, false positive results were also observed in 10 out of the 23 cases with 2.0 mg/kg of the photosentizer, Photofrin. To solve these problems, development of new photosensitizers and improvement of devices have been attempted. In particular, a bronchoscope with a fluorescence ratio image analyzer, that measures the ratio of red fluorescence (664, nm) emitted from bronchial tumors to the green autofluorescence (536-570 nm) upon stimulation by violet light (405 nm) has been demonstrated to be capable of detecting and localizing small tumors using the photosensitizer, aspartyl chlorin e6 (NPe6). Also, we have been developing a long wavelength (665 nm) excitation system with the diode laser to detect fluorescence from submucosal tumor invasion. This paper describes and confirms the efficacy of tumor detection systems using laser-induced fluorescence endoscopy and the photosensitizer, NPe6 will be discussed.
Soresi E. et. al.: Intensification of “‘In-DTPA-octreotide scintigraphy by means of pretreatment with cold octreotide in small cell lung cancer. Lung Cancer, in press.
I911
An analysis of early main clinical features of primary tracheal tumors in relation to “the roentaen-dvnamic respiratory screening” clinical screening indications
I
Hui-ing Wang, Xi-an Wang. Department of Respiratory Medicine and Radiology, The Second Affiliated Hospital of Dalian Medical Universif): Dalian 116027, PR China
Purpose: Analysis of early main clinical feature of 32 pathologically proven cases of primary treachaal tumors, especially tumors 2 cm zin diameter, and their relations with “roentgen-dynamic respiratory screening”: clinical screening indications. Methods and Results: The early main clinical features of endotracheal 1-2 cm sized tumors include intermittent and recurrent irritable cough, blood-striked sputum and sudden onset of dyspnea, asthma or hemoptysis which were induced, aggrevated, subside or disappeared abruptly in differently stressed respiratory conditions (i.e. overexertion, overfatigue, changing of body posture or complicated infections). Roentgen dynamiorespiratory examination in 23 of 32 cases were performed. By using (A] Normal smooth respiration: (B) Violent and deep inspiration and expiration: (C) Compressive and intensified violent and deep inspiration and expiration: (D) Repeated and continuously, compressive and intensified respirations. All exhibited abnormal dynamic signs. 19 (82.6%) of cases were plain chest film negative dynamic sign positive. Tumours 2 cm lin diameter were found in 14 cases. One of them perforated the tracheal wall belong to the late stage and 13 cases (56.5%) of tracheal tumours met the (WHO) T, N,M, criteria of early endotracheobronchial tumors. Conclusion: (1) The early main clinical features of tracheal tumours were analysed. (2) The positive practical diagnostic value and it’s clinical significance of the “Selective Roentgen-Dynamic Respiratory Screening” in the early detection of endotracheobronchial tumor were definitively confirmed. (3) It should be aware and vigilant of finding early main clinical features of tracheal tumor which were looked upon as an elementary course of selection of screening dynamic sign as the routine “Selective Roentgen-Dynamic Respiratory Screening” clinical screening indications. When the dynamic signs were found, Tomography, Fibrobronchoscopic biopsy to confirm the diagnosis should be routinely performed.
I
912
Laser-induced fluorescence endoscopy in the early detection of lung cancer using the photosensitizer
K. Furukawa, T. Okunaka, T. Tsuchida, N. Ikeda, T. Hiyoshi, Y. Yamamoto, H. Kumasaka, H. Sakai, C. Konaka, H. Kato. Dept. of Surgery 1, Tokyo Medical College, Tokyo, Japan
913
Autofluorescence of the bronchus
T. Tsuchida, C. Konaka,
of cancer and dysplasia
N. Ikeda, T. Katsumi, K. Furukawa, T. Okunaka, H. Kato. Tokyo Medical Co//ege, Tokyo, Japan
K. Kim,
Recently various endoscopic fluorescence detection systems for bronchial cancer have been created. Most of the systems use laser light for the excitation of cancer fluorescence or autofluorescence. We developed a simplified system with conventional Xenon lamp and an image intensifier which do not require any laser equipment or tumor preferential photosensitizer. The results of autofluorescence diagnosis of bronchial cancer and dysplasia compared with those of conventional bronchoscopy in 62 regions were as follows.
Squamous cell carcinoma Squamous dysplasia Normal bronchus (Autofluorescence
Negative
Positive
01 0 01 6 17/19
21/21 17/11 71 5
BronchoscopylConventional
Sronchoscopy)
The results suggest that the autofluorescence endoscopy great sensitivity for detection of bronchial dysplasia compared tional bronchoscopy.
I
914
system has to conven-
Lung cancer and thorax CT scan findings
M. Bogossian, I.L. Santoro, S. Jamnik, R.T. Rodrigues, H. Tadokoro. Federal University of 530 Paula, Pulmonary Division, .%o Paula, Brazil We studied 158 patients with lung cancer, where thorax CT scans performed. The gender was 129 males and 29 females, with mean ages of 62.0 (& 9.38) 59.4 (+ 10.54) respectively. The smokers were 134 patients. The histological distribution is: 74 squamous (sq), 42 adenocarcinoma (ad), 14 SCLC (SC), 2 large cell lung cancer and finally 13 undefined lung cancer carcinoma. The cough was the principal symptoms (97 patients). Of the total patients 90% had advanced The thorax CT scans findings
Localization
The detection and localization of early stage malignancies are crucial to survival in these patients, thus the development of methods to bring this about is essential. In particular, examinations using tumorphilic photosensitizers that emit fluorescence has been especially beneficial for localization of roentgenographically occult lung cancers. We have developed a system consisting of an excimer laser, which emits a pulsed laser beam, coupled to a dye laser and an endoscopic spectral-image analyzer which detects
diagnosis
Nodule (less 3 cm) Mass (greater 3 cm) Pleural effusion
central periferal RUL Int. Lobe RIL LUL LIL
ipsilateral contralateral
disease (%):
(stage
w 50.5 43.4 24.6 9.1 27.2 35.6 16.2 15.6 61.9 20.6 1.3
Illa, lllb and IV).
ad
SC
sothers
23.7 26.2 35.5 11.1 15.5 31 .l 20.0 20.0 75.5 35.5 6.1
13.4 0 54.0 20.0 14.0 14.0 4.0 20.0 60.0 33.3 0.7
12.4 26.4 26.6 19.5 0 38.1 0.5 33.3 61.9 19.1 0
Biology
submitted eight patients, in complete remission after chemo-radiotherapy, to enhanced Octraoscan (whole body planar scintigraphy and SPET at 24 hours) at the same time of conventional re-staging. In six cases enhanced Octreoscan was negative, in agreement with restaging. In 5 out of 6 patients follow-up at 6 months was still negative, while in one patient a local relapse appeared after 2 months. In the other two cases enhanced Octreoscan revealed pathological uptake, respectively in the lung and in the liver. In the first patient, progression of disease was clinically evident after 2 months, with a lung lesion in the area predictively identified by Octreoscan. Progression was confirmed by CT scan and fiberoptic bronchoscopy. In the latter case liver lesions were clinically evident after 3 months since restaging, as confirmed by ultrasound and CT scan. However preliminary these results are, they seem to indicate that enhanced Octreoscan -with a promising negative predictive value of 83% and a positive predictive value of lOO%- could be useful to improve the accuracy of SCLC re-staging. [I]
optical information from the diagnostic environment and displays the image on the TV monitor simultaneously. The equipment was applied clinically on the basis of extensive experimental research. The effectiveness of the system for cancer localization was examined in 24 cases, including 9 cases of carcinoma in situ. All cases were squamous cell carcinoma, except for one case each of adenocarcinoma and large cell carcinoma. Fluorescence was recognized in 23 out of the 24 cases, thus the system was effective for localization. However, false positive results were also observed in 10 out of the 23 cases with 2.0 mg/kg of the photosentizer, Photofrin. To solve these problems, development of new photosensitizers and improvement of devices have been attempted. In particular, a bronchoscope with a fluorescence ratio image analyzer, that measures the ratio of red fluorescence (664, nm) emitted from bronchial tumors to the green autofluorescence (536-570 nm) upon stimulation by violet light (405 nm) has been demonstrated to be capable of detecting and localizing small tumors using the photosensitizer, aspartyl chlorin e6 (NPe6). Also, we have been developing a long wavelength (665 nm) excitation system with the diode laser to detect fluorescence from submucosal tumor invasion. This paper describes and confirms the efficacy of tumor detection systems using laser-induced fluorescence endoscopy and the photosensitizer, NPe6 will be discussed.
Soresi E. et. al.: Intensification of “‘In-DTPA-octreotide scintigraphy by means of pretreatment with cold octreotide in small cell lung cancer. Lung Cancer, in press.
I911
An analysis of early main clinical features of primary tracheal tumors in relation to “the roentaen-dvnamic respiratory screening” clinical screening indications
I
Hui-ing Wang, Xi-an Wang. Department of Respiratory Medicine and Radiology, The Second Affiliated Hospital of Dalian Medical Universif): Dalian 116027, PR China
Purpose: Analysis of early main clinical feature of 32 pathologically proven cases of primary treachaal tumors, especially tumors 2 cm zin diameter, and their relations with “roentgen-dynamic respiratory screening”: clinical screening indications. Methods and Results: The early main clinical features of endotracheal 1-2 cm sized tumors include intermittent and recurrent irritable cough, blood-striked sputum and sudden onset of dyspnea, asthma or hemoptysis which were induced, aggrevated, subside or disappeared abruptly in differently stressed respiratory conditions (i.e. overexertion, overfatigue, changing of body posture or complicated infections). Roentgen dynamiorespiratory examination in 23 of 32 cases were performed. By using (A] Normal smooth respiration: (B) Violent and deep inspiration and expiration: (C) Compressive and intensified violent and deep inspiration and expiration: (D) Repeated and continuously, compressive and intensified respirations. All exhibited abnormal dynamic signs. 19 (82.6%) of cases were plain chest film negative dynamic sign positive. Tumours 2 cm lin diameter were found in 14 cases. One of them perforated the tracheal wall belong to the late stage and 13 cases (56.5%) of tracheal tumours met the (WHO) T, N,M, criteria of early endotracheobronchial tumors. Conclusion: (1) The early main clinical features of tracheal tumours were analysed. (2) The positive practical diagnostic value and it’s clinical significance of the “Selective Roentgen-Dynamic Respiratory Screening” in the early detection of endotracheobronchial tumor were definitively confirmed. (3) It should be aware and vigilant of finding early main clinical features of tracheal tumor which were looked upon as an elementary course of selection of screening dynamic sign as the routine “Selective Roentgen-Dynamic Respiratory Screening” clinical screening indications. When the dynamic signs were found, Tomography, Fibrobronchoscopic biopsy to confirm the diagnosis should be routinely performed.
I
912
Laser-induced fluorescence endoscopy in the early detection of lung cancer using the photosensitizer
K. Furukawa, T. Okunaka, T. Tsuchida, N. Ikeda, T. Hiyoshi, Y. Yamamoto, H. Kumasaka, H. Sakai, C. Konaka, H. Kato. Dept. of Surgery 1, Tokyo Medical College, Tokyo, Japan
913
Autofluorescence of the bronchus
T. Tsuchida, C. Konaka,
of cancer and dysplasia
N. Ikeda, T. Katsumi, K. Furukawa, T. Okunaka, H. Kato. Tokyo Medical Co//ege, Tokyo, Japan
K. Kim,
Recently various endoscopic fluorescence detection systems for bronchial cancer have been created. Most of the systems use laser light for the excitation of cancer fluorescence or autofluorescence. We developed a simplified system with conventional Xenon lamp and an image intensifier which do not require any laser equipment or tumor preferential photosensitizer. The results of autofluorescence diagnosis of bronchial cancer and dysplasia compared with those of conventional bronchoscopy in 62 regions were as follows.
Squamous cell carcinoma Squamous dysplasia Normal bronchus (Autofluorescence
Negative
Positive
01 0 01 6 17/19
21/21 17/11 71 5
BronchoscopylConventional
Sronchoscopy)
The results suggest that the autofluorescence endoscopy great sensitivity for detection of bronchial dysplasia compared tional bronchoscopy.
I
914
system has to conven-
Lung cancer and thorax CT scan findings
M. Bogossian, I.L. Santoro, S. Jamnik, R.T. Rodrigues, H. Tadokoro. Federal University of 530 Paula, Pulmonary Division, .%o Paula, Brazil We studied 158 patients with lung cancer, where thorax CT scans performed. The gender was 129 males and 29 females, with mean ages of 62.0 (& 9.38) 59.4 (+ 10.54) respectively. The smokers were 134 patients. The histological distribution is: 74 squamous (sq), 42 adenocarcinoma (ad), 14 SCLC (SC), 2 large cell lung cancer and finally 13 undefined lung cancer carcinoma. The cough was the principal symptoms (97 patients). Of the total patients 90% had advanced The thorax CT scans findings
Localization
The detection and localization of early stage malignancies are crucial to survival in these patients, thus the development of methods to bring this about is essential. In particular, examinations using tumorphilic photosensitizers that emit fluorescence has been especially beneficial for localization of roentgenographically occult lung cancers. We have developed a system consisting of an excimer laser, which emits a pulsed laser beam, coupled to a dye laser and an endoscopic spectral-image analyzer which detects
diagnosis
Nodule (less 3 cm) Mass (greater 3 cm) Pleural effusion
central periferal RUL Int. Lobe RIL LUL LIL
ipsilateral contralateral
disease (%):
(stage
w 50.5 43.4 24.6 9.1 27.2 35.6 16.2 15.6 61.9 20.6 1.3
Illa, lllb and IV).
ad
SC
sothers
23.7 26.2 35.5 11.1 15.5 31 .l 20.0 20.0 75.5 35.5 6.1
13.4 0 54.0 20.0 14.0 14.0 4.0 20.0 60.0 33.3 0.7
12.4 26.4 26.6 19.5 0 38.1 0.5 33.3 61.9 19.1 0