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The diagnostic accuracy of a solitary pulmonary nodule, using thin-section high resolution CT: A solitary pulmonary nodule by HRCT
396
Abstracts/Lung
Cancer
14 (19%)
377-408
and ~CCU~C~ of 30 I, 93 96, and 80 46 (diagnosis of progression), and 18%, 92%. and 78% (prediction of progression). Similar diagnostic yields were observed using progressively increasing or progressively decreasing changes of the marker level. In lung cancer, the diagnosis (and even the anticipation) of disease status is often possible using appropriate threshold value of TPA.
they proved to be dependent on the stage of the disease and were not confirmed as independent variables in the Cox-model. Their importance during the followup is diminished by the frequent lack of therapeutic approaches in the case of disease progression. Certainly a more favorable prognosis in case of a posttherapeutic normalization of previously elevated values was found.
The diagnostic accuracy of a solitary pulmonary nodule, using thin-section high resolution CT: A solitary pulmonary nodule by HRCT Takanashi N, Nobe Y, Asoh H, Yano T, I&nose Y. Depariment of
Investigation for mediastinal disease in patients with apparently operable lung cancer
Chest Surgery, NationalKyushu Cancer Center, 3-l-l Notame, Minamiku. Fukuoka 815. Lung Cancer (Ireland) 1995; 13: 105-12. A solitary pulmonary nodule (SPN) less than 2 cm in diameter of 60 patients was evahrated with thin-section, high-resolution computed tomography (HRCT). The presence of an irregular margin, spiculation, convergence of the surrounding structure, an air bronchogram and the involvement of more than 3 vessels was observed more frequently in malignant nodules than in benign nodules. When one point was given for each Ending, the mean total scores of each histologic type were as follows; adenocarcinoma; 2.7, squamous cell carcinoma; 2.5, benign tumor; 0.3, tuberculosis; 1.3, pneumonia; 2.0. When SPNs were classified by the total scores, the SPNs with higher scores ( 3) included 18 of 33 (56 46) malignant lesions and only 2 of 28 (7 I$) benign lesions. Thismeans that sensitivity andspecificity in thediagnosisofmalignancy in the SPNs with high scores were 56% and 93 96, respectively. These observations suggest that SPNs with a score higher than 3 points would be highly suspicious for malignancy but the number of such SPNs is rather limited. Therefore, more sophisticated methods may be necessary to better differentiate between malignant and benign SPNs.
Tumor markers as prognostic factors in non-small-cell lung cancer Nieder C, Nestle U, Ukena D, Niewald M, Sybrecht GW, Schnabel K. Abteilung fir Strahlentherapie, Radiologische Universitatsklinik, D64421 Homburg/Saar. Strahlenther Gnkol 1995;171:587-93. Purpose: Considerations of different therapeutic approaches require a realistic estimation of the prognosis. The usefulness of tumor markers as prognostic indicators was evaluated by’means of a multivariate analysis. Patienfs at&Methods: The data of 300 patients who had been irradiated for their primary tumor were analysed retrospectively. The serum concentrations of CEA, SCCA, NSE, and LDH were available before treatment and 3 months thereafter in a sufficient number of cases. The prognostic factors for survival and progression-free survival resulting from univariate tests were further evaluated by a Coxproportional-haaards model. Resuhs: The serum levels of the particular tumor markers were pathologically elevated in 25 to 36.5 % of the cases. Their values correlated with the stage of the disease and separately the N-stage too. A normaliLation of increased marker levels after irradiation occurred in 37.5 to67 I of thecases. Survival ofpatients wi!h increased pretherapeuticvalues of CEA, SCCA, and LDH was significantly worse. compared to those with normal valuea. In the case. of a posttherapeutic return to normal levels, prognosis was significantly better than for those where the elevation persisted. However, after inclusion of all other parameters in multivariate analysisthe tumor markers were meaningless. Karnofsky-performance status, total dose of radiotherapy, stage of the disease, and weight-loss evolved as independent prognostic factors for survival. For progression-free survival only stage of the disease was important. All subgroup analyses (restriction on patieats with favorable prognosis) showed the same results. Conclusion: A prognostic importance of NSE could not be demonstrated. CEA, SCCA, and LDH were univariate predictors for survival and progression-free survival. But
Guyatt GH, Eddy RJ, Ginsberg RJ, PattersonGA, CookDJ, LefcoeMS et al. Dept. Clin. Epid./Biostatistics, McMaster Univ. Health Scis. Center, 1200 Main St W, Hamilton, Ont. LSN 325. Ann Thorac Surg 1995;60: 1382-9. Barkground. Theoptinml approach to theinvestigationofmediitinal disease in patients with apparently operable non-small cell carcinoma of the lung is controversial. Methods. We conducted a randomized, controlled trial in thoracic surgery services at mainly academic. tertiary and secondary care general hospitals. We recruited 685 patients with apparently operable, suspected or proven, non-small cell carcinoma of the lungwho underwent either mediastinoscopy or computed tomography. Depending on the apparent presence or absence of mediastinal nodes of greater than 1 cm, patients undergoing computed tomography either underwent mediastinoscopy or went directly to thoracotomy. The primary outcome was thoracotomy without cure, defined as resection with recurrence. Secondaryoutcomesincludedthoracotomiesundertaken in patients with benign disease and costs of the two strategies. Results. The relative risk of thoracotomy without cure in patients in the computed tomography group was 0.95 (95% confidence interval, 0.75 to 1.19). The relative risk ofthoracotomy without cure or thoracotomy in patients with benign disease was 0.88 (95 % confidence interval, 0.71 to 1.10). The mediastinoscopy strategy cost $708 more per patient (95 46 confidence interval, $723 to $2,140). Conclusions. The computed tomography strategy is likely to produce the same number of or fewer unnecessary thoracotomies incomparisonwithdoingmediastinoscopyonallpatients, and is also likely to be as or less expensive.
Surgery Spontaneous remission of a cancer of the right lung, following left side pneumonectomy because of squamous cell lung cancer, four years ago Schmidt W. Abteilung fur Pneumalogie, Hildegardis-Krankenhaus. HiLiegardstrasse2, D-55131 M&u. Atemwegs-Lunge&r 199.5;21:5368. A 62 year old man underwent pneumonectomy of the left lung because of a squamous cell cancer. Four years after a histological identical tumor appeared in the right lung, but disappeared within nine months. The patient is disease free from cancer for nine years and still alive. In the meantimehe had a traumatic pneumothorax, an amputation of the right upper leg from osteomyelitis, a rupture of a tendon of papillary muscle, inguinal hemiotomy, and cataract operation on both sides.
Treatment of multiple primary squamous cell carcinomas of the lung Murakami S, Watanabe Y, Saitoh H, Yamashita R, Shimizu J, Gda M et al. Department of Surgery, Kanazawa University, School of Medin’ne, 13-I Takaramachi, Kanazawa 920. AM Thorac Surg 1995;60:964-9. Background. The prevalence of multiple primary bronchogenic cancers, especially squamous cell carcinoma, has been increasing as a result of improvements in early detection and cancer therapy. Materials.
Abstracts/Lung
Cancer
14 (19%)
377-408
and ~CCU~C~ of 30 I, 93 96, and 80 46 (diagnosis of progression), and 18%, 92%. and 78% (prediction of progression). Similar diagnostic yields were observed using progressively increasing or progressively decreasing changes of the marker level. In lung cancer, the diagnosis (and even the anticipation) of disease status is often possible using appropriate threshold value of TPA.
they proved to be dependent on the stage of the disease and were not confirmed as independent variables in the Cox-model. Their importance during the followup is diminished by the frequent lack of therapeutic approaches in the case of disease progression. Certainly a more favorable prognosis in case of a posttherapeutic normalization of previously elevated values was found.
The diagnostic accuracy of a solitary pulmonary nodule, using thin-section high resolution CT: A solitary pulmonary nodule by HRCT Takanashi N, Nobe Y, Asoh H, Yano T, I&nose Y. Depariment of
Investigation for mediastinal disease in patients with apparently operable lung cancer
Chest Surgery, NationalKyushu Cancer Center, 3-l-l Notame, Minamiku. Fukuoka 815. Lung Cancer (Ireland) 1995; 13: 105-12. A solitary pulmonary nodule (SPN) less than 2 cm in diameter of 60 patients was evahrated with thin-section, high-resolution computed tomography (HRCT). The presence of an irregular margin, spiculation, convergence of the surrounding structure, an air bronchogram and the involvement of more than 3 vessels was observed more frequently in malignant nodules than in benign nodules. When one point was given for each Ending, the mean total scores of each histologic type were as follows; adenocarcinoma; 2.7, squamous cell carcinoma; 2.5, benign tumor; 0.3, tuberculosis; 1.3, pneumonia; 2.0. When SPNs were classified by the total scores, the SPNs with higher scores ( 3) included 18 of 33 (56 46) malignant lesions and only 2 of 28 (7 I$) benign lesions. Thismeans that sensitivity andspecificity in thediagnosisofmalignancy in the SPNs with high scores were 56% and 93 96, respectively. These observations suggest that SPNs with a score higher than 3 points would be highly suspicious for malignancy but the number of such SPNs is rather limited. Therefore, more sophisticated methods may be necessary to better differentiate between malignant and benign SPNs.
Tumor markers as prognostic factors in non-small-cell lung cancer Nieder C, Nestle U, Ukena D, Niewald M, Sybrecht GW, Schnabel K. Abteilung fir Strahlentherapie, Radiologische Universitatsklinik, D64421 Homburg/Saar. Strahlenther Gnkol 1995;171:587-93. Purpose: Considerations of different therapeutic approaches require a realistic estimation of the prognosis. The usefulness of tumor markers as prognostic indicators was evaluated by’means of a multivariate analysis. Patienfs at&Methods: The data of 300 patients who had been irradiated for their primary tumor were analysed retrospectively. The serum concentrations of CEA, SCCA, NSE, and LDH were available before treatment and 3 months thereafter in a sufficient number of cases. The prognostic factors for survival and progression-free survival resulting from univariate tests were further evaluated by a Coxproportional-haaards model. Resuhs: The serum levels of the particular tumor markers were pathologically elevated in 25 to 36.5 % of the cases. Their values correlated with the stage of the disease and separately the N-stage too. A normaliLation of increased marker levels after irradiation occurred in 37.5 to67 I of thecases. Survival ofpatients wi!h increased pretherapeuticvalues of CEA, SCCA, and LDH was significantly worse. compared to those with normal valuea. In the case. of a posttherapeutic return to normal levels, prognosis was significantly better than for those where the elevation persisted. However, after inclusion of all other parameters in multivariate analysisthe tumor markers were meaningless. Karnofsky-performance status, total dose of radiotherapy, stage of the disease, and weight-loss evolved as independent prognostic factors for survival. For progression-free survival only stage of the disease was important. All subgroup analyses (restriction on patieats with favorable prognosis) showed the same results. Conclusion: A prognostic importance of NSE could not be demonstrated. CEA, SCCA, and LDH were univariate predictors for survival and progression-free survival. But
Guyatt GH, Eddy RJ, Ginsberg RJ, PattersonGA, CookDJ, LefcoeMS et al. Dept. Clin. Epid./Biostatistics, McMaster Univ. Health Scis. Center, 1200 Main St W, Hamilton, Ont. LSN 325. Ann Thorac Surg 1995;60: 1382-9. Barkground. Theoptinml approach to theinvestigationofmediitinal disease in patients with apparently operable non-small cell carcinoma of the lung is controversial. Methods. We conducted a randomized, controlled trial in thoracic surgery services at mainly academic. tertiary and secondary care general hospitals. We recruited 685 patients with apparently operable, suspected or proven, non-small cell carcinoma of the lungwho underwent either mediastinoscopy or computed tomography. Depending on the apparent presence or absence of mediastinal nodes of greater than 1 cm, patients undergoing computed tomography either underwent mediastinoscopy or went directly to thoracotomy. The primary outcome was thoracotomy without cure, defined as resection with recurrence. Secondaryoutcomesincludedthoracotomiesundertaken in patients with benign disease and costs of the two strategies. Results. The relative risk of thoracotomy without cure in patients in the computed tomography group was 0.95 (95% confidence interval, 0.75 to 1.19). The relative risk ofthoracotomy without cure or thoracotomy in patients with benign disease was 0.88 (95 % confidence interval, 0.71 to 1.10). The mediastinoscopy strategy cost $708 more per patient (95 46 confidence interval, $723 to $2,140). Conclusions. The computed tomography strategy is likely to produce the same number of or fewer unnecessary thoracotomies incomparisonwithdoingmediastinoscopyonallpatients, and is also likely to be as or less expensive.
Surgery Spontaneous remission of a cancer of the right lung, following left side pneumonectomy because of squamous cell lung cancer, four years ago Schmidt W. Abteilung fur Pneumalogie, Hildegardis-Krankenhaus. HiLiegardstrasse2, D-55131 M&u. Atemwegs-Lunge&r 199.5;21:5368. A 62 year old man underwent pneumonectomy of the left lung because of a squamous cell cancer. Four years after a histological identical tumor appeared in the right lung, but disappeared within nine months. The patient is disease free from cancer for nine years and still alive. In the meantimehe had a traumatic pneumothorax, an amputation of the right upper leg from osteomyelitis, a rupture of a tendon of papillary muscle, inguinal hemiotomy, and cataract operation on both sides.
Treatment of multiple primary squamous cell carcinomas of the lung Murakami S, Watanabe Y, Saitoh H, Yamashita R, Shimizu J, Gda M et al. Department of Surgery, Kanazawa University, School of Medin’ne, 13-I Takaramachi, Kanazawa 920. AM Thorac Surg 1995;60:964-9. Background. The prevalence of multiple primary bronchogenic cancers, especially squamous cell carcinoma, has been increasing as a result of improvements in early detection and cancer therapy. Materials.