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The role of mediastinoscopic biopsy in preoperative assessment of lung cancer
Abstracts/Lung
213
Cancer 10 (1993) 266-286
~mmuoobistochemical stodyoftbesePntigensmay~wef”l CDDP sensitivity in lung caocer.
forpredicting
Genotype and phenotype of glutathione S-traasferase class isoenzymes and psi in lung cance patients and controls Brockmoller I, Kerb R, Drakoulis N. Nitz M, Roots I. Inrrifut fir Klinische Pharmakologie,
KlinikumSteglirz,Hinaenburgdamm
30. D-
Res 1993;53:1OL%11. Glutathione S-transferase class (GSTMI) is known to detoxify certain carcinogens or their activated metabolites. In a previous study using Phenotyping methods, individuals genetically devoid of this enzyme activity were significantly overrepresented among lung cancer patients compared to controls, suggesting that this trait is P risk factor forlungcaocer. Here, GSTclass stah~~hasbeendetbothpher~oand genotypically, i.e., (a) by ex viva measurement of tram-stilbeoe oxide conjugation in lymphocytes, (b) by GSTMI quantification in blood using an immunoassay, and (c) by the application of polymeruse chain reaction to genomic DNA with characterization of an inactivating mutation responsible for the null allele and a G/C single base allelic variance corresponding to the polymorphism of GSTMl isoazymes and psi, respectively. One hundred seventeen long cancer patients and 155 control patients were studied. The two groups were of Gemno origin and were similar with respect to age, sex. smoking history, and catchmat area. In about 97% of cases, the three methods of assigning actiwty typeofGSTMI gavecorresponding results. By genotype, 55 of 117l”“gcaocerpat~e”ts(47.0%)and73of l55controlpatients(47.1%) were GSTMl active. The contml group was confmned by analysis of GSTMI genotype in 200 further, independently studied reference patients: 101 ofthemwereGSTMI active(50.5%). Thus, thehypothesis of heritable GSTMl deficiency as a host factor predisposing to lung cancer proved inappropriate. Detailed analysis of subgroups with respect to smoking habits, age, and sex failed to reveal an impact ofGST class genotype on lung cancer risk. Among the total of 272 patients studied. 36 mdwlduals carried at least one psi allele; however, no unexpected frequency distributton was observed. loo0 Berlin 45. Cancer
Clinical assessment Clinical wefubws5 of serum assays of neuron-specific enolase, carcinoembryonic antigen and CA-SO antigen in the diagnosis of lung= Bergman B, Brezich F-T, Engstrom C-P, Lasso” S. Re~~~tromska Hospital, Box 17301, S-402 64 Coreborg. Eur J Cancer Palt A Gen Top 1993;29:198-202. serum concentrations of neuron-specific enolase (NSE), carcinoembryooic antigen (CEA) and CA-50 antigen were determined * 168 consecutive patients wrth lung cancer. All three markers were sigmticaotly elevated compared with levels in 102 patients with ““nmalignant chest diseases. NSE and CEA varied significantly across histological lung cancer types, with most highly elevated serum levels insmallcell lungcamcerandadenocarcinomas, respectively. Theoverall diagnostic accuracy wasO.66 for NSE, 0.74 forCEA, aad0.62for CA50, implying that CEA best discrimioated behveen lung cancer and benign chest diseases, while CA-50 was less efficient as P diagnostic marker. In multivariate analysis of the three markers combined, a positive predictive value of9546 for long cancercouldbeachievedwitb adiagnosticseositivityof57%,withacut~ffleveldefinedasO.O37~NSE + O.OSZ‘CEA + O.Oll-CA-50 > 1. In22% ofthecancerpatients, the tone from admission to histological or cytological lung cancer diagnosis exceeded 1 month. IO52% of these patients, the initial weighted turnour marker index was > I, strongly implying the cancer diagnosis. The study lends support to the potential use of combined analysis of NSE. CEA and CA-50 as a complementary tool in the diagnosis of lung cancer.
tnferiorveaacavn(IVC)sndszygouscontiDuPtionoftheIVCcausedby bronchogenic carcinoma. CT has been touted as the modality of choice for mediastinal evaluation. MRI is presently considered to be the initial mcdalityofchoiceformediastinalvesselevalution.MRIisncainvasive, there is no radiation dose to the patient, multiplaoar imaging can be done, and there is “o need for iodinated contrast material. The satisfactory evaluation of am individual patient may require the use of MRI and CT in a complementary fashion.
Pancoast tumor: Use of MRI for tumor staging Beak R, SkaterR, Hennington M, Keagy B. UNC Department of Surgery, 210 Burnen-Womack, CB 7210, Chapel Hill, NC 27599. South Med J 1992;85:1260-3. Pancoast honors (superior sulcus tumors) are apical long cancers that may cause any or all of the symptoms originally described in 1932 as Pancoast’s syndrome. We have presented a case report and a review of pertinent literature on the treatment of this tumor. Chx patient was treated with preoperative radiation and en bloc tomor raectioo, the current standard of care for cure of Pancoast tumor. We support an aggressive approach in the treatment of this tomor, as radiation followed by radical tumor resection offers good palliation and the best chance for cure. Magnetic resonance imaging has emerged as the procedure of choice to assess the local extent of honor, and in “or patient, MRI accurately predicted that the tumor was resectable. The role of mediastinoscopic biopsy in preoperative assessment of lung cancer Funatsu T, Matsubara Y, Hatakenaka R, Kosaba S, Yasuda Y, Ikeda S. Respiratory
Division,
Kyoro-Katsura
Hospital,
I7
Yamadahirao,
J Tborac Cardiovasc Surg 1992;lO4:1688-95. Between 1970 and 1989, mediastinoscopy and thoracotomy were perfomwdon 619patieots admitted toourclinic with lung cancer. When mediastinoscopy was analyzed by lymph node location, the highest sensitivity (95.7%) was for the left pamtracheal nodes and the lowest (64.0%) was for nodes at the bifurcation (p < 0.01). The 5.year survivals according to the results of mediastinoscopy were 47% for negative results, 14% for false-negative results, and 6 W for posItwe results. The 5-year survival rate however, was significantly higher (28%) inpatients (n = 13) with positive mediastinoscopic fmdings who underwent complete resection of the primary tumor and all involved “odes than in patients (n = 78) who underwent incomplete resection @ < 0.01). These data support “or “potion that patients with posrtive mediastmoscopic results should not always be excluded from treatment by thoracotomy. The role of mediastinoscopy is not to select patients for thoracotomy but to evaluate lung cancer at the pretreatment stage. Nishikyo, Kyoro 615.
Cloning and characterization of a Lamb&-Eaton myasthenic syndrome antigen Rosenfeld MR, Wang E, Dalma” 1, Manley G, Posner JB, Sher E et al. Molecular
Neuro-oncology
Laboratory.
Memorial
Sloan-Kertering
AM Neural 1993;33: 113-20. Lambat-Eaton myasthenic syodmme is a paranwplastic neuromuscular disorder in which an immune response directed against a small-cell lung tumor crossreacts with antigens I” the neuromuscular junction. To isolateand characterize theantigens, we screened a human fetal brainexpression library with a high-titer serum from a patient with Lambert-Eaton myasthenic syndrome. This screening resulted I” the isolation of a complementary DNA clone encoding an antigen we call myasthenic syndrome antigen B (MysB). Approximately 43 W (3 of 7) Cancer
Crr.,
1275
of Lambert-Eaton MysBfosionprotein,
York Ave. New
York, NY lCO21.
myastheoic syndrome sera specifically wherwnoneof34control
recogmled
seradid. Thepredicted
amino acid sequence of this clone shows a high degree of homology to the II subunit of calcium channel complexes. The MysB pre- messenger
Thrombosis of the IVC and azygow continuation of IVC by bronchogenic cancer: CT and MRI sppearanee Cranston PE, Saif M, Hunrick-Turner JE. Dq~nmenr ofRadiology, Univ. of Mississippi Medical Center, 2500 Nonh State Street, Jackson, US 39216-4505. Cornput Med Imaging Graph 1992;16:397-9.
The authors describe the computed tomography (CT) and magnetx resonance Imaging (MRI) findings io P patient with thrombosis of the
RNA is alternatively spliced to yield 3 forms of the protean differing in the domain between two highly conserved a-helical segments.
Cardiac tampomtde caused by primary lung cancer and the management of pericardial effusion Okamoto H, Shiokai T. Yam&do M. Saijo N. DepanmentofInrernal
213
Cancer 10 (1993) 266-286
~mmuoobistochemical stodyoftbesePntigensmay~wef”l CDDP sensitivity in lung caocer.
forpredicting
Genotype and phenotype of glutathione S-traasferase class isoenzymes and psi in lung cance patients and controls Brockmoller I, Kerb R, Drakoulis N. Nitz M, Roots I. Inrrifut fir Klinische Pharmakologie,
KlinikumSteglirz,Hinaenburgdamm
30. D-
Res 1993;53:1OL%11. Glutathione S-transferase class (GSTMI) is known to detoxify certain carcinogens or their activated metabolites. In a previous study using Phenotyping methods, individuals genetically devoid of this enzyme activity were significantly overrepresented among lung cancer patients compared to controls, suggesting that this trait is P risk factor forlungcaocer. Here, GSTclass stah~~hasbeendetbothpher~oand genotypically, i.e., (a) by ex viva measurement of tram-stilbeoe oxide conjugation in lymphocytes, (b) by GSTMI quantification in blood using an immunoassay, and (c) by the application of polymeruse chain reaction to genomic DNA with characterization of an inactivating mutation responsible for the null allele and a G/C single base allelic variance corresponding to the polymorphism of GSTMl isoazymes and psi, respectively. One hundred seventeen long cancer patients and 155 control patients were studied. The two groups were of Gemno origin and were similar with respect to age, sex. smoking history, and catchmat area. In about 97% of cases, the three methods of assigning actiwty typeofGSTMI gavecorresponding results. By genotype, 55 of 117l”“gcaocerpat~e”ts(47.0%)and73of l55controlpatients(47.1%) were GSTMl active. The contml group was confmned by analysis of GSTMI genotype in 200 further, independently studied reference patients: 101 ofthemwereGSTMI active(50.5%). Thus, thehypothesis of heritable GSTMl deficiency as a host factor predisposing to lung cancer proved inappropriate. Detailed analysis of subgroups with respect to smoking habits, age, and sex failed to reveal an impact ofGST class genotype on lung cancer risk. Among the total of 272 patients studied. 36 mdwlduals carried at least one psi allele; however, no unexpected frequency distributton was observed. loo0 Berlin 45. Cancer
Clinical assessment Clinical wefubws5 of serum assays of neuron-specific enolase, carcinoembryonic antigen and CA-SO antigen in the diagnosis of lung= Bergman B, Brezich F-T, Engstrom C-P, Lasso” S. Re~~~tromska Hospital, Box 17301, S-402 64 Coreborg. Eur J Cancer Palt A Gen Top 1993;29:198-202. serum concentrations of neuron-specific enolase (NSE), carcinoembryooic antigen (CEA) and CA-50 antigen were determined * 168 consecutive patients wrth lung cancer. All three markers were sigmticaotly elevated compared with levels in 102 patients with ““nmalignant chest diseases. NSE and CEA varied significantly across histological lung cancer types, with most highly elevated serum levels insmallcell lungcamcerandadenocarcinomas, respectively. Theoverall diagnostic accuracy wasO.66 for NSE, 0.74 forCEA, aad0.62for CA50, implying that CEA best discrimioated behveen lung cancer and benign chest diseases, while CA-50 was less efficient as P diagnostic marker. In multivariate analysis of the three markers combined, a positive predictive value of9546 for long cancercouldbeachievedwitb adiagnosticseositivityof57%,withacut~ffleveldefinedasO.O37~NSE + O.OSZ‘CEA + O.Oll-CA-50 > 1. In22% ofthecancerpatients, the tone from admission to histological or cytological lung cancer diagnosis exceeded 1 month. IO52% of these patients, the initial weighted turnour marker index was > I, strongly implying the cancer diagnosis. The study lends support to the potential use of combined analysis of NSE. CEA and CA-50 as a complementary tool in the diagnosis of lung cancer.
tnferiorveaacavn(IVC)sndszygouscontiDuPtionoftheIVCcausedby bronchogenic carcinoma. CT has been touted as the modality of choice for mediastinal evaluation. MRI is presently considered to be the initial mcdalityofchoiceformediastinalvesselevalution.MRIisncainvasive, there is no radiation dose to the patient, multiplaoar imaging can be done, and there is “o need for iodinated contrast material. The satisfactory evaluation of am individual patient may require the use of MRI and CT in a complementary fashion.
Pancoast tumor: Use of MRI for tumor staging Beak R, SkaterR, Hennington M, Keagy B. UNC Department of Surgery, 210 Burnen-Womack, CB 7210, Chapel Hill, NC 27599. South Med J 1992;85:1260-3. Pancoast honors (superior sulcus tumors) are apical long cancers that may cause any or all of the symptoms originally described in 1932 as Pancoast’s syndrome. We have presented a case report and a review of pertinent literature on the treatment of this tumor. Chx patient was treated with preoperative radiation and en bloc tomor raectioo, the current standard of care for cure of Pancoast tumor. We support an aggressive approach in the treatment of this tomor, as radiation followed by radical tumor resection offers good palliation and the best chance for cure. Magnetic resonance imaging has emerged as the procedure of choice to assess the local extent of honor, and in “or patient, MRI accurately predicted that the tumor was resectable. The role of mediastinoscopic biopsy in preoperative assessment of lung cancer Funatsu T, Matsubara Y, Hatakenaka R, Kosaba S, Yasuda Y, Ikeda S. Respiratory
Division,
Kyoro-Katsura
Hospital,
I7
Yamadahirao,
J Tborac Cardiovasc Surg 1992;lO4:1688-95. Between 1970 and 1989, mediastinoscopy and thoracotomy were perfomwdon 619patieots admitted toourclinic with lung cancer. When mediastinoscopy was analyzed by lymph node location, the highest sensitivity (95.7%) was for the left pamtracheal nodes and the lowest (64.0%) was for nodes at the bifurcation (p < 0.01). The 5.year survivals according to the results of mediastinoscopy were 47% for negative results, 14% for false-negative results, and 6 W for posItwe results. The 5-year survival rate however, was significantly higher (28%) inpatients (n = 13) with positive mediastinoscopic fmdings who underwent complete resection of the primary tumor and all involved “odes than in patients (n = 78) who underwent incomplete resection @ < 0.01). These data support “or “potion that patients with posrtive mediastmoscopic results should not always be excluded from treatment by thoracotomy. The role of mediastinoscopy is not to select patients for thoracotomy but to evaluate lung cancer at the pretreatment stage. Nishikyo, Kyoro 615.
Cloning and characterization of a Lamb&-Eaton myasthenic syndrome antigen Rosenfeld MR, Wang E, Dalma” 1, Manley G, Posner JB, Sher E et al. Molecular
Neuro-oncology
Laboratory.
Memorial
Sloan-Kertering
AM Neural 1993;33: 113-20. Lambat-Eaton myasthenic syodmme is a paranwplastic neuromuscular disorder in which an immune response directed against a small-cell lung tumor crossreacts with antigens I” the neuromuscular junction. To isolateand characterize theantigens, we screened a human fetal brainexpression library with a high-titer serum from a patient with Lambert-Eaton myasthenic syndrome. This screening resulted I” the isolation of a complementary DNA clone encoding an antigen we call myasthenic syndrome antigen B (MysB). Approximately 43 W (3 of 7) Cancer
Crr.,
1275
of Lambert-Eaton MysBfosionprotein,
York Ave. New
York, NY lCO21.
myastheoic syndrome sera specifically wherwnoneof34control
recogmled
seradid. Thepredicted
amino acid sequence of this clone shows a high degree of homology to the II subunit of calcium channel complexes. The MysB pre- messenger
Thrombosis of the IVC and azygow continuation of IVC by bronchogenic cancer: CT and MRI sppearanee Cranston PE, Saif M, Hunrick-Turner JE. Dq~nmenr ofRadiology, Univ. of Mississippi Medical Center, 2500 Nonh State Street, Jackson, US 39216-4505. Cornput Med Imaging Graph 1992;16:397-9.
The authors describe the computed tomography (CT) and magnetx resonance Imaging (MRI) findings io P patient with thrombosis of the
RNA is alternatively spliced to yield 3 forms of the protean differing in the domain between two highly conserved a-helical segments.
Cardiac tampomtde caused by primary lung cancer and the management of pericardial effusion Okamoto H, Shiokai T. Yam&do M. Saijo N. DepanmentofInrernal