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Diagnostic and therapeutic approach for peripheral small lung carcinoma
Pulmonary Imaging
250
18-•
Radiologic-pathologic correlation of synchronous multiple lung adenocarcinomas detected by computed tomography
T. Kondo 1, K. Yamada1, K. Noda1, H. Nakayama2, Y. Kameda3.
~Department of Thoracic Disease; 2Department of Thoracic Surgery; 3Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan Thirteen cases (28 tumors) of patients who had undergone resection and been pathologically diagnosed for synchronous multiple lung adenocarcinomas were reviewed to correlate the appearance of highresolution CT (HRCT) images with the pathological features. All the cases involved double adenocarcinomas. Three cases with double adenocarcinomas contained multiple atypical adenomatous hyperplasia (AAH). A definite pathological diagnosis had been obtained preoperatively for only four tumors. Resection was conducted in all cases based on a preoperative diagnosis of synchronous multiple primary lung cancer which had been strongly suspected based on the HRCT images. Our preoperative diagnosis depended on the differentiation of findings on the HRCT images, which offered good grounds for a diagnosis of multiple lung cancers. The HRCT images have suggested that more or less ground glass opacity (GGO) was contained in the tumor opacity of the early small-sized adenocarcinomas. In our investigation, all the double adenocarcinoma cases involved a combination of more or less GGO. Thus, it is suggested that analysis of HRCT findings of multiple lesions of lung cancer may contribute to preoperative diagnosis of multiple lung adenocarcinomas.
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The correlation among morphological classification based on HRCT findings, pathological findings and prognosis of small adenocarcinomas less than 20 mm in diameter
G. Tanaka, K. Yamada, T. Kondo, K. Noda, H. Nakayama, Y. Kameda.
Kanagawa Cancer Center, Yokohama; Department of Thoracic Disease, Kanagawa Cancer Center, Yokohama, Japan Objectives: It is said that HRCT (high-resolution CT) findings correlate with pathological morphological classifications (Noguchi's histological classifications of small adenocarcinoma) to some degree, but no preoperative analysis leading to a decision on the surgical approach and prognosis has yet been reported based only on morphological classifications based on HRCT findings. Study Design: We studied the correlation among the HRCT findings, pathological findings and prognosis for 148 cases with small adenocarcinomas less than 20 mm in diameter retrospectively. And we evaluated the usefulness of morphological classifications based on HRCT findings for determining the surgical approach. Results: All cases were classified into two types, the "air-containing type" and the "solid-density type", accordings to the attenuation of the tumor opacity on the HRCT images. No lymph node metastasis was observed pathologically in the 73 "air-containing type" adenocarcinomas, and microscopic metastasis of pleural, vascular or lymphatic invasion was observed in only one "air-containing type" adenocarcinoma. Furthermore, no relapse or death was observed on the relapse-free and overall survival curves. On the other hand, the 75 "solid-density type" adenocarcinomas proved to have a poor prognosis. Conclusion: We can predict the prognosis by morphological classification based on HRCT findings, and the "air-containing type" adenocarcinomas less than 20 mm in diameter are likely to be susceptible to treatment by positive limited lung resection.
•8--5•
Simulation of low-dose CT image for Lung Cancer
Screening
Y. Shimizu, H. Takagi, K. Kaneki, Y. Miyazaki, T. Matsumoto, K. Nishizawa, T. Suzuki. Hitachi Medical Corporation, Kashiwa-shi,
Chiba; National Institute of Radio/ogica/ Science, Chiba-shi, Chiba; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka-shi, Osaka, Japan A simulation low-dose CT image reconstruction algorithm has been developed for evaluation image quality of Lung Cancer Screening. The
low-dose (25, 10, 3 mA) simulation images were reconstructed from 140 mA scan raw data of volunteers and screening. Each image was evaluated image quality by seven medical doctors. The 25 mA each image was equal. The 10 mA and 3 mA simulation images were better than scanning images. ~-5--~ Diagnostic and therapeutic approach for peripheral small
lung carcinoma S. Yoneda, T. Shirakusa, K. Kawahara, A. Iwasaki. Second
Department of Surgery, Fukuoka University, Fukuoka, Japan Purpose: Nowadays in Japan, by the application of helical computed tomography (CT) and high-resolution CT, small or tiny lung carcinoma in peripheri has been discovered in great quantities. Generally, TBLB (trans-bronchial lung biopsy) is not perfect in the diagnosis for the peripheral small nodules. The CT-guided lung biopsy is very useful for these small lesions, however, we cannot always use CT for the purpose of lung biopsy because of various situations of the hospital. On the other hand, the thoracoscopic needle aspiration is very convenient for the diagnosis of small lesion in peripheri, in particular, for the nodules at a little deep subpleural area. Methods and Results: Twenty cases of needle aspiration cytology under thoracoscope were reviewed in this series. The diameter of these lesions were less 20 mm in all and its average was 15 mm. Those were 6 cases with less 10 mm diameter, 8 cases between 10 mm and 15 mm and 6 cases between 15 mm and 20 mm. The outcome of rapid cytologic diagnosis intraoperatively were adenocarcinoma in 10 cases, squamous cell carcinoma in 2 cases, small cell carcinoma in 1, malignant cells (cell type unknown) in 3 and benign cells in 4. The accurate diagnostic rate was 94%. Conclusion: The intraoperative rapid cytology under thoracoscope is very convenient because of its simple method, safety and quickness. Moreover, according to its result, if malignant, the VATS Iobectomy, segmentectomy or partial resection would be easily followed. ~-~A
consideration about the development styles of malignant pleural mesothelioma on the basis of cytology, hyaluronic acid value and thoracoscopic findings - Superficial development style and underlaid development style
H. Miura, K. Takabe, H. Akabane, S. Aida, Y. Kimula, M. Okouchi, H. Nodera, M. Tamaoka, Y. Miyamoto, M. Kobayashi, T. Morohoshi, I. Ohara. Yokosuka-Kyosai Hospital, Yokosuka; Tsuchiura-Kyodo
Hospital, Tsuchiura; National Defense Medical College, Tokorozawa, Japan Background: In malignant pleural mesothelioma (MPM), the reason why effusion cytology is not always positive has not been elucidated yet. It is similar about hyaluronic acid (HA) value. However, it is already revealed that there are two types of thoracoscopic findings in epithelial and biphasic MPM, the multiple nodular type with superficial tumor growth and the pleuml thickening type without it. (Takabe et al, Haigan 37: 335, 1997). Method: About 28 definite MPM cases (1991-99), the histological type and the cytology and HA value of the effusion provided with the first thoracenthesis were examined retrospectively. The thoracoscopic findings were compared with them (15 cases). The sandwich-binding protein assay method (Chugai Kit) was used for the measurement of HA. Result: As for all the sarcomatous MPM, the HA value was low and the cytology was negative. The mean of HA value was highest in class V, 588.4 mg/I (range 59.5-1235) with subsequent order of class IV, II1. The lake ball-like cell clusters were found in 6 of 13 cases of which HA values were higher than 100 mg/I. The thorscoscopic pleural thickening type had negative cytology and low HA value. Conclusion: There are two development styles of malignant pleural mesothelioma, the superficial development style, in which tumor cells grow superficially along the mesothelial sheet, and the underlaid one, in which cells grow under the sheet as underlay. If the enough
250
18-•
Radiologic-pathologic correlation of synchronous multiple lung adenocarcinomas detected by computed tomography
T. Kondo 1, K. Yamada1, K. Noda1, H. Nakayama2, Y. Kameda3.
~Department of Thoracic Disease; 2Department of Thoracic Surgery; 3Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan Thirteen cases (28 tumors) of patients who had undergone resection and been pathologically diagnosed for synchronous multiple lung adenocarcinomas were reviewed to correlate the appearance of highresolution CT (HRCT) images with the pathological features. All the cases involved double adenocarcinomas. Three cases with double adenocarcinomas contained multiple atypical adenomatous hyperplasia (AAH). A definite pathological diagnosis had been obtained preoperatively for only four tumors. Resection was conducted in all cases based on a preoperative diagnosis of synchronous multiple primary lung cancer which had been strongly suspected based on the HRCT images. Our preoperative diagnosis depended on the differentiation of findings on the HRCT images, which offered good grounds for a diagnosis of multiple lung cancers. The HRCT images have suggested that more or less ground glass opacity (GGO) was contained in the tumor opacity of the early small-sized adenocarcinomas. In our investigation, all the double adenocarcinoma cases involved a combination of more or less GGO. Thus, it is suggested that analysis of HRCT findings of multiple lesions of lung cancer may contribute to preoperative diagnosis of multiple lung adenocarcinomas.
~-~
The correlation among morphological classification based on HRCT findings, pathological findings and prognosis of small adenocarcinomas less than 20 mm in diameter
G. Tanaka, K. Yamada, T. Kondo, K. Noda, H. Nakayama, Y. Kameda.
Kanagawa Cancer Center, Yokohama; Department of Thoracic Disease, Kanagawa Cancer Center, Yokohama, Japan Objectives: It is said that HRCT (high-resolution CT) findings correlate with pathological morphological classifications (Noguchi's histological classifications of small adenocarcinoma) to some degree, but no preoperative analysis leading to a decision on the surgical approach and prognosis has yet been reported based only on morphological classifications based on HRCT findings. Study Design: We studied the correlation among the HRCT findings, pathological findings and prognosis for 148 cases with small adenocarcinomas less than 20 mm in diameter retrospectively. And we evaluated the usefulness of morphological classifications based on HRCT findings for determining the surgical approach. Results: All cases were classified into two types, the "air-containing type" and the "solid-density type", accordings to the attenuation of the tumor opacity on the HRCT images. No lymph node metastasis was observed pathologically in the 73 "air-containing type" adenocarcinomas, and microscopic metastasis of pleural, vascular or lymphatic invasion was observed in only one "air-containing type" adenocarcinoma. Furthermore, no relapse or death was observed on the relapse-free and overall survival curves. On the other hand, the 75 "solid-density type" adenocarcinomas proved to have a poor prognosis. Conclusion: We can predict the prognosis by morphological classification based on HRCT findings, and the "air-containing type" adenocarcinomas less than 20 mm in diameter are likely to be susceptible to treatment by positive limited lung resection.
•8--5•
Simulation of low-dose CT image for Lung Cancer
Screening
Y. Shimizu, H. Takagi, K. Kaneki, Y. Miyazaki, T. Matsumoto, K. Nishizawa, T. Suzuki. Hitachi Medical Corporation, Kashiwa-shi,
Chiba; National Institute of Radio/ogica/ Science, Chiba-shi, Chiba; Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka-shi, Osaka, Japan A simulation low-dose CT image reconstruction algorithm has been developed for evaluation image quality of Lung Cancer Screening. The
low-dose (25, 10, 3 mA) simulation images were reconstructed from 140 mA scan raw data of volunteers and screening. Each image was evaluated image quality by seven medical doctors. The 25 mA each image was equal. The 10 mA and 3 mA simulation images were better than scanning images. ~-5--~ Diagnostic and therapeutic approach for peripheral small
lung carcinoma S. Yoneda, T. Shirakusa, K. Kawahara, A. Iwasaki. Second
Department of Surgery, Fukuoka University, Fukuoka, Japan Purpose: Nowadays in Japan, by the application of helical computed tomography (CT) and high-resolution CT, small or tiny lung carcinoma in peripheri has been discovered in great quantities. Generally, TBLB (trans-bronchial lung biopsy) is not perfect in the diagnosis for the peripheral small nodules. The CT-guided lung biopsy is very useful for these small lesions, however, we cannot always use CT for the purpose of lung biopsy because of various situations of the hospital. On the other hand, the thoracoscopic needle aspiration is very convenient for the diagnosis of small lesion in peripheri, in particular, for the nodules at a little deep subpleural area. Methods and Results: Twenty cases of needle aspiration cytology under thoracoscope were reviewed in this series. The diameter of these lesions were less 20 mm in all and its average was 15 mm. Those were 6 cases with less 10 mm diameter, 8 cases between 10 mm and 15 mm and 6 cases between 15 mm and 20 mm. The outcome of rapid cytologic diagnosis intraoperatively were adenocarcinoma in 10 cases, squamous cell carcinoma in 2 cases, small cell carcinoma in 1, malignant cells (cell type unknown) in 3 and benign cells in 4. The accurate diagnostic rate was 94%. Conclusion: The intraoperative rapid cytology under thoracoscope is very convenient because of its simple method, safety and quickness. Moreover, according to its result, if malignant, the VATS Iobectomy, segmentectomy or partial resection would be easily followed. ~-~A
consideration about the development styles of malignant pleural mesothelioma on the basis of cytology, hyaluronic acid value and thoracoscopic findings - Superficial development style and underlaid development style
H. Miura, K. Takabe, H. Akabane, S. Aida, Y. Kimula, M. Okouchi, H. Nodera, M. Tamaoka, Y. Miyamoto, M. Kobayashi, T. Morohoshi, I. Ohara. Yokosuka-Kyosai Hospital, Yokosuka; Tsuchiura-Kyodo
Hospital, Tsuchiura; National Defense Medical College, Tokorozawa, Japan Background: In malignant pleural mesothelioma (MPM), the reason why effusion cytology is not always positive has not been elucidated yet. It is similar about hyaluronic acid (HA) value. However, it is already revealed that there are two types of thoracoscopic findings in epithelial and biphasic MPM, the multiple nodular type with superficial tumor growth and the pleuml thickening type without it. (Takabe et al, Haigan 37: 335, 1997). Method: About 28 definite MPM cases (1991-99), the histological type and the cytology and HA value of the effusion provided with the first thoracenthesis were examined retrospectively. The thoracoscopic findings were compared with them (15 cases). The sandwich-binding protein assay method (Chugai Kit) was used for the measurement of HA. Result: As for all the sarcomatous MPM, the HA value was low and the cytology was negative. The mean of HA value was highest in class V, 588.4 mg/I (range 59.5-1235) with subsequent order of class IV, II1. The lake ball-like cell clusters were found in 6 of 13 cases of which HA values were higher than 100 mg/I. The thorscoscopic pleural thickening type had negative cytology and low HA value. Conclusion: There are two development styles of malignant pleural mesothelioma, the superficial development style, in which tumor cells grow superficially along the mesothelial sheet, and the underlaid one, in which cells grow under the sheet as underlay. If the enough