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Serum concentrations of carboxyterminal telopeptide of type I collagen (ICTP) and aminoterminal propeptide of type I collagen (PICP) as biochemical markers for bone metastasis of primary lung cancer
Pulmonary Imaging
256
tumor (the product of the area and the maximum diameter of a tumor perpendicular to this area). Tumor responses by unidimensional measurement were compared with those by bidimensional measurement. Correlation of the changes in length and area to the changes in volume were evaluated. Results: Of 114 pts with NSCLC who received cisplatin (CDDP)based chemotherapy in clinical trials between January 1996 and September 1999, 106 pts were eligible and enrolled onto this study. Patient characteristics were male/female = 72134, median age = 61 (range 38-75), and stage &VB/&W = 39•67. Chemotherapy regimens were CDDP and paclitaxel in 30 pts, CDDP and vindesine in 25 pts, CDDP, docetaxel and ifosfamide in 21 pts, CDDP and irrinotecan in 12 pts, CDDP and docetaxel in 11 pts, CDDP, navelbine and mitomycin in 4 pts, and CDDP, vindesine and mitomycin in 3 pts. Response evaluation was CR 0/0, PR 24/24, SD 61/64, and PD 21/18 by the bidimensional/unidimensional measurements, respectively. Response evaluation was not identical in 3 pts, but the response rate was the same. Percentage changes in the area of tumor correlated better than the percentage length changes with the percentage volume changes (r = 0.976 vs r = 0.920ACp < 0.01). Conclusion: Although bidimensional measurement reflected tumor volume changes better than unidimensional measurement, the response rate was identical by both methods in our series. Unidimensional measurement may be sufficient for evaluating the tumor response to chemotherapy for NSCLC.
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Probability of malignancy in solitary pulmonary nodule
H. Kim, S. Kang, K. Lee, J. Kim. Samsung Medica/Center,
Sungkyunkwan Univ. Schoo/ of Medicine, Seoul, Korea Up to 40% of solitary pulmonary nodules (SPN) are known to be malignancy and early diagnosis of malignant SPN is essential for good prognosis. To identify clinical and radiological characteristics of malignant SPN and determine predictors favoring malignancy, we performed retrospective analysis of 201 patients who showed equal or less than 3 cm SPN in chest X-ray and underwent pathologic diagnosis. We evaluated clinical factors (age, sex, smoking history, past history of diabetes and tuberculosis) and radiological factors (size, location, edge, pleural tag, satellite lesion, lymph node enlargement, calcification, cavitation, etc). Among 201 patients, 93 showed benign nodules (55 tuberculoma, 17 hamartoma, etc) and 108 was confirmed malignant (69 adenocarcinoma, 20 squamous carcinoma, etc). Multivariate analysis showed that malignancy was more probable if the patient has smoking history more than 40 pack-year or chest CT shows pleural tag or lymph node enlargement. In addition, if chest CT shows cavitation or satellite lesion, probability of malignanct was remarkably low (OD ratio 0.24 and 0.079, p = 0.015 and 0.002 respectively). We concluded that cavitation or satellite lesion could be negative predictive factors for malignancy in SPN. Serum concentrations of carboxyterminal telopeptide of [88• type I collagen (ICTP) and aminoterminal propeptide of
type I collagen (PICP) as biochemical markers for bone metastasis of primary lung cancer H. Oda, T. Kashii, T. Miwa, K. Sassa, N. Arai, S. Matsui, N. Yamashita, M. Maruyama, M. Kobayashi. Toyama Medica/and Pharmaceutica/
University, Toyama, Japan We usually examine the plain bone roentgenogram and the bone scintigram for diagnosis of bone metastasis of lung cancer. The plain bone roentgenogram has just lower sensitivity on detection and the bone scintigram is inconvenient to outpatients. More sensitive and easier examinations may be required to detect bone metastasis. In this purpose, we evaluate the relationship between the values of serum concentrations of the cross-linked carboxyterminal telopeptide of Type I collagen (ICTP), the aminoterminal propeptide of Type I collagen (PICP) and bone metastasis. The serum concentrations of ICTP were analyzed in 23 patients with lung cancer. Six patients (mean age 69.2
years, range 51--81) have bone metastasis with either roentgenogram or scintigram and 17 (71.1 years, 52-82) have not. Four age-matched patients (60.3 years, 30-86) with benign lung disease were used for control. The serum concentrations of ICTP in the patients with bone metastasis (10.6 +/- 5.0 ng/ml) were significantly higher than those of the patients without bone metastasis (6.16 +/- 1.6 ng/ml). The serum concentrations of PICP between the patients with and without bone metastasis were almost equivalent values (109 +/- 71.4 ng/ml and 102 +/- 32.5 ng/ml). The serum concentrations of ICTP have the tendency to be correlated with clinical stage, number of metastatic lesions, and level of other tumor markers. Preradiotherapy values of ICTP tend to be increased in patients who did not respond to radiotherapy compared with those who responded. Cut-off value in detecting bone metastasis of malignancy is said to be 4.5 ng/ml. In this study, using this value, the specificity and sensitivity of ICTP was 16.7% and 83.3% respectively. When the cut-off value is raised to 9.5 ng/ml, specificity and sensitivity is 94% and 66.7%, respectively. Higher cut-off value is favorable for the detection of bone metastasis.
Friday, 15 S e p t e m b e r 2000 POSTER SESSION
Pulmonary Imaging
••
Primary and recurrent lung cancer is an important cause of mediastinal mass A. Conlan, P.M. Willette, S. Levin, A. Freire, S. Kopec, J. Balikian. Dept. of Surgery, Univ. of Massachusetts, Worcester, MA; DepL of Surgery Berkshire Medical Center, Pittsfield, MA, Dept. of Surgery, Univ. of Mass., Worcester, MA; Dept. of Pathology, Univ. of Mass., Worcetser, MA; Pulmonary Medicine, Univ. of Massachusetts; Dept. of Radiology, Univ. of Massachusetts Medical School, USA
A recent study of 350 patients with a diagnosis of mediastinal mass was done was done at the University of Massachusetts Medical Center from October 1998 to April 1999. The x-rays, thorax CTs and other studies were reviewed. The definitive and invasive biopsy procedures which allowed diagnosis and staging were defined. The etiology of mediastinal masses included: Lung Cancer 126 patients (adenocarcinoma 47, squamous cell ca 50, small cell lung ca 14, bronchoalveolar ca 6, large cell carcinoma 3, and other carcinoma 6), Mediastinal Adenopathy (noncancerous causes) 76, Lymphoma Masses 72, Mediastinal Lymph Node Metastases other than lung cancer 20, Mediastinal Cysts 15, Thymoma 10, Thyroid 9, Teratoma 3, Castlmans Disease 2, and 1 each, Leiomyoma, Ganglionueroma and Neuroblastoma. 14 patients had nonspecific or normal histopathology. Thoracic CT scan with contrast gave critical information on mass location, it distinguished cystic from solid, vascular from non vascular, and it further defined lypmh node masses from visceral masses. Patient age and symptoms contributed significally to diagnosis. Definitive diagnostic surgical procedures included mediastioscopy 165, thoractomy or sternotomy 145, parasternal mediastinotomy (chamberlain procedure) 27, thorascopy 5, and core needle biposy 5. Definitive diagnosis required adequate tissue with appropriate immunohistological markers. The contributing lung cancers are further defined by type and stage. Both primary and recurrent lung cancer is an important contemporary cause of mediastinal mass. The most valuable investigation was thoracic ct scan. The role of invasive procedures is manadated by mass location and accessability. Understanding of mediastinal location and likely histopathology is fundamental to an accurate choice of biopsy intervention.
256
tumor (the product of the area and the maximum diameter of a tumor perpendicular to this area). Tumor responses by unidimensional measurement were compared with those by bidimensional measurement. Correlation of the changes in length and area to the changes in volume were evaluated. Results: Of 114 pts with NSCLC who received cisplatin (CDDP)based chemotherapy in clinical trials between January 1996 and September 1999, 106 pts were eligible and enrolled onto this study. Patient characteristics were male/female = 72134, median age = 61 (range 38-75), and stage &VB/&W = 39•67. Chemotherapy regimens were CDDP and paclitaxel in 30 pts, CDDP and vindesine in 25 pts, CDDP, docetaxel and ifosfamide in 21 pts, CDDP and irrinotecan in 12 pts, CDDP and docetaxel in 11 pts, CDDP, navelbine and mitomycin in 4 pts, and CDDP, vindesine and mitomycin in 3 pts. Response evaluation was CR 0/0, PR 24/24, SD 61/64, and PD 21/18 by the bidimensional/unidimensional measurements, respectively. Response evaluation was not identical in 3 pts, but the response rate was the same. Percentage changes in the area of tumor correlated better than the percentage length changes with the percentage volume changes (r = 0.976 vs r = 0.920ACp < 0.01). Conclusion: Although bidimensional measurement reflected tumor volume changes better than unidimensional measurement, the response rate was identical by both methods in our series. Unidimensional measurement may be sufficient for evaluating the tumor response to chemotherapy for NSCLC.
•
Probability of malignancy in solitary pulmonary nodule
H. Kim, S. Kang, K. Lee, J. Kim. Samsung Medica/Center,
Sungkyunkwan Univ. Schoo/ of Medicine, Seoul, Korea Up to 40% of solitary pulmonary nodules (SPN) are known to be malignancy and early diagnosis of malignant SPN is essential for good prognosis. To identify clinical and radiological characteristics of malignant SPN and determine predictors favoring malignancy, we performed retrospective analysis of 201 patients who showed equal or less than 3 cm SPN in chest X-ray and underwent pathologic diagnosis. We evaluated clinical factors (age, sex, smoking history, past history of diabetes and tuberculosis) and radiological factors (size, location, edge, pleural tag, satellite lesion, lymph node enlargement, calcification, cavitation, etc). Among 201 patients, 93 showed benign nodules (55 tuberculoma, 17 hamartoma, etc) and 108 was confirmed malignant (69 adenocarcinoma, 20 squamous carcinoma, etc). Multivariate analysis showed that malignancy was more probable if the patient has smoking history more than 40 pack-year or chest CT shows pleural tag or lymph node enlargement. In addition, if chest CT shows cavitation or satellite lesion, probability of malignanct was remarkably low (OD ratio 0.24 and 0.079, p = 0.015 and 0.002 respectively). We concluded that cavitation or satellite lesion could be negative predictive factors for malignancy in SPN. Serum concentrations of carboxyterminal telopeptide of [88• type I collagen (ICTP) and aminoterminal propeptide of
type I collagen (PICP) as biochemical markers for bone metastasis of primary lung cancer H. Oda, T. Kashii, T. Miwa, K. Sassa, N. Arai, S. Matsui, N. Yamashita, M. Maruyama, M. Kobayashi. Toyama Medica/and Pharmaceutica/
University, Toyama, Japan We usually examine the plain bone roentgenogram and the bone scintigram for diagnosis of bone metastasis of lung cancer. The plain bone roentgenogram has just lower sensitivity on detection and the bone scintigram is inconvenient to outpatients. More sensitive and easier examinations may be required to detect bone metastasis. In this purpose, we evaluate the relationship between the values of serum concentrations of the cross-linked carboxyterminal telopeptide of Type I collagen (ICTP), the aminoterminal propeptide of Type I collagen (PICP) and bone metastasis. The serum concentrations of ICTP were analyzed in 23 patients with lung cancer. Six patients (mean age 69.2
years, range 51--81) have bone metastasis with either roentgenogram or scintigram and 17 (71.1 years, 52-82) have not. Four age-matched patients (60.3 years, 30-86) with benign lung disease were used for control. The serum concentrations of ICTP in the patients with bone metastasis (10.6 +/- 5.0 ng/ml) were significantly higher than those of the patients without bone metastasis (6.16 +/- 1.6 ng/ml). The serum concentrations of PICP between the patients with and without bone metastasis were almost equivalent values (109 +/- 71.4 ng/ml and 102 +/- 32.5 ng/ml). The serum concentrations of ICTP have the tendency to be correlated with clinical stage, number of metastatic lesions, and level of other tumor markers. Preradiotherapy values of ICTP tend to be increased in patients who did not respond to radiotherapy compared with those who responded. Cut-off value in detecting bone metastasis of malignancy is said to be 4.5 ng/ml. In this study, using this value, the specificity and sensitivity of ICTP was 16.7% and 83.3% respectively. When the cut-off value is raised to 9.5 ng/ml, specificity and sensitivity is 94% and 66.7%, respectively. Higher cut-off value is favorable for the detection of bone metastasis.
Friday, 15 S e p t e m b e r 2000 POSTER SESSION
Pulmonary Imaging
••
Primary and recurrent lung cancer is an important cause of mediastinal mass A. Conlan, P.M. Willette, S. Levin, A. Freire, S. Kopec, J. Balikian. Dept. of Surgery, Univ. of Massachusetts, Worcester, MA; DepL of Surgery Berkshire Medical Center, Pittsfield, MA, Dept. of Surgery, Univ. of Mass., Worcester, MA; Dept. of Pathology, Univ. of Mass., Worcetser, MA; Pulmonary Medicine, Univ. of Massachusetts; Dept. of Radiology, Univ. of Massachusetts Medical School, USA
A recent study of 350 patients with a diagnosis of mediastinal mass was done was done at the University of Massachusetts Medical Center from October 1998 to April 1999. The x-rays, thorax CTs and other studies were reviewed. The definitive and invasive biopsy procedures which allowed diagnosis and staging were defined. The etiology of mediastinal masses included: Lung Cancer 126 patients (adenocarcinoma 47, squamous cell ca 50, small cell lung ca 14, bronchoalveolar ca 6, large cell carcinoma 3, and other carcinoma 6), Mediastinal Adenopathy (noncancerous causes) 76, Lymphoma Masses 72, Mediastinal Lymph Node Metastases other than lung cancer 20, Mediastinal Cysts 15, Thymoma 10, Thyroid 9, Teratoma 3, Castlmans Disease 2, and 1 each, Leiomyoma, Ganglionueroma and Neuroblastoma. 14 patients had nonspecific or normal histopathology. Thoracic CT scan with contrast gave critical information on mass location, it distinguished cystic from solid, vascular from non vascular, and it further defined lypmh node masses from visceral masses. Patient age and symptoms contributed significally to diagnosis. Definitive diagnostic surgical procedures included mediastioscopy 165, thoractomy or sternotomy 145, parasternal mediastinotomy (chamberlain procedure) 27, thorascopy 5, and core needle biposy 5. Definitive diagnosis required adequate tissue with appropriate immunohistological markers. The contributing lung cancers are further defined by type and stage. Both primary and recurrent lung cancer is an important contemporary cause of mediastinal mass. The most valuable investigation was thoracic ct scan. The role of invasive procedures is manadated by mass location and accessability. Understanding of mediastinal location and likely histopathology is fundamental to an accurate choice of biopsy intervention.