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Prospective comparison of radiologic, thoracoscopic and pathologic staging in mediastinoscopy-negative non-small cell lung cancer
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Pulmonary Imaging/BF+Staging
In this study, relationship between positive cancer cells by intraoperative pleural lavage and postoperative prognosis is evaluated in primary lung cancer. Methods: From 1994 to 1999, intraoperative pleural lavage was performed in 190 cases which had no macroscopic dissemination, and 17 cases (9%) had cancer cells at the time of thoracotomy. They were 7 male and 10 female, their ages ranged from 51 to 80 years, and were classified as thirteen cases of adenocarcinoma, 3 cases of small cell carcinoma and one case of squamous cell carcinoma. In the pathological staging, there was one case of I A, 3 of I B, 2 of II B, 4 of Ill A, 5 of III B and 2 of IV. Lavage cytology was done at the chest closure in 13 cases which were divided into two groups; P) cytologically positive group (5 cases out of 6 were over III A), and N) cytologically negative group (3 cases out of 7 were over III A). Results: 1) Cancer cells were found in 17 cases (9%) at thoracotomy and 6 cases among which were under stage-II B. 2) Two year survival rate of the 17 cases was 34%, among which 6 cases of those under stage-II B was 83% and 11 cases of those over stage-Ill A was only 9%. 3) The cytologically positive group at chest closure was found in more advanced cases than in the negative group, but each survival rate had no difference. Conclusion: Intraoperative pleural lavage cytology is expected to be one of the prognostic factors, and more evaluation will be needed.
21.3% histological type are not established. Pathological diagnosis was established by various methods. Sputum cytology was performed only in small number of patients with only 11.82% positive result for malignant calls. Bronchoscopy was performed in all cases; in 56.2% the bronchoscopic appearance were normal. Bronchial stenosis and infiltration were the most frequent appearance (25.7%), while intrabronchial mass were seen in 18.11% of cases. Seventy three cases with abnormal bronchoscopic appearance underwent bronchial biopsy, resulting positively in 47 (64.4%). During bronchoscopy the specimen for cytologic examination were obtained by bronchial washing (195 cases), bronchial brushing (131 cases), bronchial currettage (4 cases) and transbronchial needle aspiration (2 cases). The results were positive for malignant cells in consecutively 70.30%, 55%, 100% and 0%. Beside bronchoscopy, transbronchial lung biopsy were performed in 14 cases, with 92.9% positive result. Other methods of examination include transthoracic (aspiration lung) biopsy with fine needle, especially for peripheral lesions, pleural biopsy and cytology for cases with pleural effusions thoracascopy and exploratory thoracotomi. In 67 patients with lymph nodes metastasis or superficial nodes, fine needle aspiration biopsy were performed, resulting positively for cancer cells in 80.6% of cases.
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Prospective comparison of radiologic, thoracoscopic and pathologic staging in mediastinoscopy-negative non-small cell lung cancer
J.R. Roberts. Vanderbilt-lngram Cancer Center, Nashville, Tennessee, USA
Introduction: Accurate staging of NSCLC will become more important as stage-specific therapies are developed. Specifically, the use of neoadjuvant chemotherapy for some subsets of mediastinoscopynegative patients will require accurate definition of those stages prior to resection. CT scanning is the only modality widely used to stage early NSCLC. We prospectively compared radiologic, thoracoscopic and pathologic staging in patients undergoing resection for NSCLC. Methods: All patients undergoing resection for NSCLC between October 1, 1997 and January 1, 2000 were eligible for analysis. Preoperative CT scans were obtained on all patients. Ninty-eight patients had negative mediastinal nodes and underwent thoraocoscopy prior to resection. The CT and thoracoscopic stage were compared for accuracy, using pathologic staging as the gold standard. Results: CT scanning was as likely to overstage as understage patients with NSCLC such that 28% were understaged, 43% were accurately staged and 29% were overstaged. Thoracoscopy was considerably more accurate, with 16% understaged, 82% accurately staged, and 2% overstaged (p < 0.0001). This difference was greatest with respect to the T factor, as several patients with large benign pleural effusions ultimately underwent resection and several were found to have small malignant effusions not seen on CT. Conclusions: Thoracoscopic staging was considerably more accurate than CT scanning in treatment decisions in early NSCLC. The information gained with thoracascopy led to resection in patients that were considered incurable by CT staging.
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Diagnostic of lung cancer in Jakarta, Indonesia
A. Jusuf, E. Suratman, A.M. Jayusman, S. Arumdati, N. Arief, I.M. Nasar, I. Bakri. Dharmais National Cancer Center Hospital, Jakarta, Indonesia Five hundred and forty one cases of lung cancer have been admitted to Dharmais National Cancer Center Hospital in Jakarta, Indonesia, from 1993 until December 1997. There were 79.5% male and 20.5% female, the most frequent age were 56-70 yrs (46.6%). Squamous and adenocarcinoma are the most frequent histological type, comprising 25.5% and 38.1%, respectively. Other histological types are large cell carcinoma, 2%, small call carcinoma 6.5% and others 8.5%. In
Endobronchial ultrasound for detection of early cancer
H.D. Becker, F. Herth, K. Mueller. Department of Interdisciplinary Endoscopy, Heidelberg; BG Klinik Bergmannsheil, Bochum, Germany
Introduction: Autofluorescence-bronchoscopy (AF) improves early detection of lung cancer. Endobronchial Ultrasound (EBUS) allows a jugdement of the bronchial wall and the peribronchial tissue. Material and Methods: In a prospective study we examined patients with normal radiological findings (X-ray thorax and CT-scan) and a abnormal or suspicious findings in an AF- or white-light-bron-choscopy (WLB) additionally with EBUS. Results: Between 04/99-12/99 178 patients were randomised in an AF-study. 31 patients (12 female, 19 male, mean age 62 [Range (R) 42-76]) had a suspicious lesions, patients with radiological or bronchoscopic visible tumors were excluded. EBUS was performed on all lesions and the findings were classifed as benign or malignant by the investigator. 8 proved to be of malignant and 13 of benign histology. In patients with malignant lesions WLB gave a positive prediction in 27%, AF in 63% and EBUS in 87%. In benign lesions the positive prediction of WLB was 85%, of AF 77% and of EBUS also 77%. The combination of AF and EBUS improved the positive prediction up to 92%. There were no complications in all investigations. Summary: Endobronchial Ultrasound improves the prediction in autofluorescance- or white-light-bronchoscopy of suspicious lesions because of the additional information on the bronchial wall and the surrounding structures.
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randomized study of fluorescence bronchoscopy versus white-light bronchoscopy for early detection of lung cancer in high risk patients
T.C. Kennedy, F.R. Hirsch, Y.E. Miller, S. Prindiville, J.R. Murphy, E. Dempsey, S. Proudfoot, P.A. Bunn, W.A. Franklin. Lung Cancer Institute of Colorado, Denver, CO; University of Colorado Cancer Center, Denver, CO, USA The present randomized study evaluates the diagnostic specificity and sensitivity of fluorescence (LIFE) bronchoscopy compared to whitelight bronchoscopy (WLB) in the detection of moderate dysplasia or worse in a high-risk population. The trial was designed to eliminate both the bias of order of procedure and intraobserver bias. Subjects with known or suspected lung cancer or with >30 pack-year smoking history, airflow obstruction and cellular atypia on sputum cytology underwent bronchoscopy. Each subject was examined by LIFE and WLB by two different bronchoscopists randomly assigned by order of inspection and bronchoscopy modality. The individual bronchoscopist did only one procedure, and the result from one observer was blinded
Pulmonary Imaging/BF+Staging
In this study, relationship between positive cancer cells by intraoperative pleural lavage and postoperative prognosis is evaluated in primary lung cancer. Methods: From 1994 to 1999, intraoperative pleural lavage was performed in 190 cases which had no macroscopic dissemination, and 17 cases (9%) had cancer cells at the time of thoracotomy. They were 7 male and 10 female, their ages ranged from 51 to 80 years, and were classified as thirteen cases of adenocarcinoma, 3 cases of small cell carcinoma and one case of squamous cell carcinoma. In the pathological staging, there was one case of I A, 3 of I B, 2 of II B, 4 of Ill A, 5 of III B and 2 of IV. Lavage cytology was done at the chest closure in 13 cases which were divided into two groups; P) cytologically positive group (5 cases out of 6 were over III A), and N) cytologically negative group (3 cases out of 7 were over III A). Results: 1) Cancer cells were found in 17 cases (9%) at thoracotomy and 6 cases among which were under stage-II B. 2) Two year survival rate of the 17 cases was 34%, among which 6 cases of those under stage-II B was 83% and 11 cases of those over stage-Ill A was only 9%. 3) The cytologically positive group at chest closure was found in more advanced cases than in the negative group, but each survival rate had no difference. Conclusion: Intraoperative pleural lavage cytology is expected to be one of the prognostic factors, and more evaluation will be needed.
21.3% histological type are not established. Pathological diagnosis was established by various methods. Sputum cytology was performed only in small number of patients with only 11.82% positive result for malignant calls. Bronchoscopy was performed in all cases; in 56.2% the bronchoscopic appearance were normal. Bronchial stenosis and infiltration were the most frequent appearance (25.7%), while intrabronchial mass were seen in 18.11% of cases. Seventy three cases with abnormal bronchoscopic appearance underwent bronchial biopsy, resulting positively in 47 (64.4%). During bronchoscopy the specimen for cytologic examination were obtained by bronchial washing (195 cases), bronchial brushing (131 cases), bronchial currettage (4 cases) and transbronchial needle aspiration (2 cases). The results were positive for malignant cells in consecutively 70.30%, 55%, 100% and 0%. Beside bronchoscopy, transbronchial lung biopsy were performed in 14 cases, with 92.9% positive result. Other methods of examination include transthoracic (aspiration lung) biopsy with fine needle, especially for peripheral lesions, pleural biopsy and cytology for cases with pleural effusions thoracascopy and exploratory thoracotomi. In 67 patients with lymph nodes metastasis or superficial nodes, fine needle aspiration biopsy were performed, resulting positively for cancer cells in 80.6% of cases.
~-~ ~-]
Prospective comparison of radiologic, thoracoscopic and pathologic staging in mediastinoscopy-negative non-small cell lung cancer
J.R. Roberts. Vanderbilt-lngram Cancer Center, Nashville, Tennessee, USA
Introduction: Accurate staging of NSCLC will become more important as stage-specific therapies are developed. Specifically, the use of neoadjuvant chemotherapy for some subsets of mediastinoscopynegative patients will require accurate definition of those stages prior to resection. CT scanning is the only modality widely used to stage early NSCLC. We prospectively compared radiologic, thoracoscopic and pathologic staging in patients undergoing resection for NSCLC. Methods: All patients undergoing resection for NSCLC between October 1, 1997 and January 1, 2000 were eligible for analysis. Preoperative CT scans were obtained on all patients. Ninty-eight patients had negative mediastinal nodes and underwent thoraocoscopy prior to resection. The CT and thoracoscopic stage were compared for accuracy, using pathologic staging as the gold standard. Results: CT scanning was as likely to overstage as understage patients with NSCLC such that 28% were understaged, 43% were accurately staged and 29% were overstaged. Thoracoscopy was considerably more accurate, with 16% understaged, 82% accurately staged, and 2% overstaged (p < 0.0001). This difference was greatest with respect to the T factor, as several patients with large benign pleural effusions ultimately underwent resection and several were found to have small malignant effusions not seen on CT. Conclusions: Thoracoscopic staging was considerably more accurate than CT scanning in treatment decisions in early NSCLC. The information gained with thoracascopy led to resection in patients that were considered incurable by CT staging.
•
Diagnostic of lung cancer in Jakarta, Indonesia
A. Jusuf, E. Suratman, A.M. Jayusman, S. Arumdati, N. Arief, I.M. Nasar, I. Bakri. Dharmais National Cancer Center Hospital, Jakarta, Indonesia Five hundred and forty one cases of lung cancer have been admitted to Dharmais National Cancer Center Hospital in Jakarta, Indonesia, from 1993 until December 1997. There were 79.5% male and 20.5% female, the most frequent age were 56-70 yrs (46.6%). Squamous and adenocarcinoma are the most frequent histological type, comprising 25.5% and 38.1%, respectively. Other histological types are large cell carcinoma, 2%, small call carcinoma 6.5% and others 8.5%. In
Endobronchial ultrasound for detection of early cancer
H.D. Becker, F. Herth, K. Mueller. Department of Interdisciplinary Endoscopy, Heidelberg; BG Klinik Bergmannsheil, Bochum, Germany
Introduction: Autofluorescence-bronchoscopy (AF) improves early detection of lung cancer. Endobronchial Ultrasound (EBUS) allows a jugdement of the bronchial wall and the peribronchial tissue. Material and Methods: In a prospective study we examined patients with normal radiological findings (X-ray thorax and CT-scan) and a abnormal or suspicious findings in an AF- or white-light-bron-choscopy (WLB) additionally with EBUS. Results: Between 04/99-12/99 178 patients were randomised in an AF-study. 31 patients (12 female, 19 male, mean age 62 [Range (R) 42-76]) had a suspicious lesions, patients with radiological or bronchoscopic visible tumors were excluded. EBUS was performed on all lesions and the findings were classifed as benign or malignant by the investigator. 8 proved to be of malignant and 13 of benign histology. In patients with malignant lesions WLB gave a positive prediction in 27%, AF in 63% and EBUS in 87%. In benign lesions the positive prediction of WLB was 85%, of AF 77% and of EBUS also 77%. The combination of AF and EBUS improved the positive prediction up to 92%. There were no complications in all investigations. Summary: Endobronchial Ultrasound improves the prediction in autofluorescance- or white-light-bronchoscopy of suspicious lesions because of the additional information on the bronchial wall and the surrounding structures.
•
8
-
-
3
•
A
randomized study of fluorescence bronchoscopy versus white-light bronchoscopy for early detection of lung cancer in high risk patients
T.C. Kennedy, F.R. Hirsch, Y.E. Miller, S. Prindiville, J.R. Murphy, E. Dempsey, S. Proudfoot, P.A. Bunn, W.A. Franklin. Lung Cancer Institute of Colorado, Denver, CO; University of Colorado Cancer Center, Denver, CO, USA The present randomized study evaluates the diagnostic specificity and sensitivity of fluorescence (LIFE) bronchoscopy compared to whitelight bronchoscopy (WLB) in the detection of moderate dysplasia or worse in a high-risk population. The trial was designed to eliminate both the bias of order of procedure and intraobserver bias. Subjects with known or suspected lung cancer or with >30 pack-year smoking history, airflow obstruction and cellular atypia on sputum cytology underwent bronchoscopy. Each subject was examined by LIFE and WLB by two different bronchoscopists randomly assigned by order of inspection and bronchoscopy modality. The individual bronchoscopist did only one procedure, and the result from one observer was blinded