- Email: [email protected]
The usefulness of serum carcinoembryonic antigen (CEA) for patients (PTS) undergoing diagnostic bronchoscopic examination
75 286
ENDOBRONCHIAL ULTRASOUND-GUIDED NEEDLE METHOD FOR IMPROVED ASPIRATION. AN DIAGNOSING INTRATHORACIC LYMPHADENOPATHY. J. Shannon, F. Becker, J. Orens, R. Bode, J. Rubin, R. Whyte,
PROGNOSTIC NODELS FOR NSCLC - PROSPECTIVE AND NULTIVARXATE RESULTS. H. Biilzebruck,P. Drings, B. Danzer, M. Odemer, M. Schrenk, I. Vogt-Moykopf. Thoraxklinik Heidelberg, Heidelberg, Germany. Data of 2,630 patients with NSCLC were prospectively analyzed to identify patient-, tumorand iherapy-related prognostic factors with multivariate methods to answer the questions: 1. What is the prognostic impact of one factor after adjustment of the prognostic influence of all other factors? 2. Which are the factors of most prognostic influence? 3. What is the minimal final set of independent prognostic factors? 4. How can prognostic indices be established to define risk groups and estimate individual prognosis? In the 1,216 resected patients (median survival: 30 months, S-year survival: 37.4%) the final prognostic model included age, histology, stage and completeness of resection. For the 996 patients with chemo- and/or radiotherapy (median survival: 8 months, 5-year survival: 5.6%) performance status, sex, stage and treatment result were members of the final set of prognostic factors. Only the stage and the cause of no treatment (no treatment proposal of the physician, refusal of resection, refusal of chemo- and/or radiotherapy. refusal of any diagnostic or therapy) were relevant for the prognosis of the 418 patients without any tumor-specific treatment (median survival: 4 months, 5-year survival: 2.3%).
A. Turrisi, F. Martinez. University of Michigan Medical Center, Ann Arbor, Ml., U.S.A. Transbronchial needle aspiration (TBNA) of mediastinal adenopathy is an useful adjunct to radiographic evaluation in patients suspected of having intrathoracic malignancy. Ultrasound (US) catheters which can be passed through the suction channel of a standard flexible bronchoscope have allowed better definition of mediastinal structures. We prospectively examined 30 patients referred for evaluation of mediastinal lymphadenopathy. All patients had TBNA, with 12 procedures guided by US (USTBNA); all were performed with on-site cytopathology. Ability to sample adenopathy (defined by presence of lymphocytes or cancer cells) was 83% for routine TBNA and 89% for USTBNA. The yield of diagnostic aspirates was similarly high for TBNA vs. USTBNA. However, when we analyzed those patients with paratracheal masses (n=12).we found USTBNA (n=5) to have higher sensitivity than routine TBNA (n=7), with sensitivity of 80% and 571, respectively. We experienced no complications with USTBNA and noted a trend toward fewer passes for diagnosis with USTBNA. We conclude that 1) TBNA is highly efficacious in sampling mediastinal nodes; 2) USTBNA and routine TBNA are in diagnosing subcarinal masses, efficacious equally provided on-site cytopathology: 3) USTBNA affords a very paratracheal masses. high diagnostic yield, especially in While the exact role of USTBNA remains to be identified with randomized prospective studies, we feel that it may cost-effective means of diagnosing afford an efficient, intrathoracic nodes and sparing patients more invasive diagnostic procedures.
287
288
RADIOGRAPHIC SCREENING FOR LUNG CANCER:PROPOSED PARADIGMFOR RFQUISITRRESEARCH. C. I. Henschke, J. Caro, D. D. Libby, D. McCauley, G. McGuinness, OS. Miettinen, D. Naidich, M. Pasmantier. J.P. Smith, D.F. Yankelevitz, The New York Hospital-Cornell Medical Center and New York University Medical Center, New York, NY. Computed tomographic (CT) allows excellent detection and characterization of small solitary pulmonary nodules (SSPN). It raises three types of question: 1) How often does CT imaging lead to detection of SSPN? 2) How often is such a SSPN malignant? 3) If malignant, how curable is it? The first question pertains to decisions about screening use of CT, the second to decisions about screening for SSPN and diagnosis of malignancy given SSPN, and the third to decisions about screening for SSPN, diagnosis given SSPN and intervention given malignant SSPN. Our three component study design addresses these questions. Some 1CCKl persons at high risk for lung cancer will be screened for SSPN using screening-type CT. The primary aim is to determine the prevalence of CT-detectable SSPN as a joint function of risk-relevant aspects of the person. The second component addresses the prevalence of malignancy among the detected cases of SSPN. To develop the prevalence function, a larger series of CT-detected SSPNs will be obtained by developing a multi-center SSPN “registry”. A subsequent, third component will focus on the registered cases of malignant SSPN incidentally detected and addresses their curability on the basis of longterm follow-up. This designrepresents a new paradigm for applied research on radiologic technologies in cancer screening with advantages of research efficiency about decisions needed diagnostic work-up and therapeutic intervention.
THE
USBFULlPBSS OF SSRVY CARCINOLYBRYONIC APTIQEI PATIBSTS UWDBRSOI~Q DIAQUOSTIC FOR (PTS) BXANIPATION. BROWZAOSCOPIC Mitsunobu Nakao, Masaaki Kawahara, Kiyoyuki Furuse, Nagahisa Kodama, Mitsumasa Ogawara, Shinji Atagi, Yuji Kawaguchi, Tatsuya Okada, Takao Kamimori, Masashi Yamada, Mitsunori Sakatani, Hideki Hara National Kinki Central Hospital for Chest Diseases, Sakai, Osaka 591, Japan. Serum CEA is a tumor marker used all over the world. There were, however, few studies which used likelihood ratio instead of sensitivity and specificity. The former demonstrates broader information than the latter. We investigated the usefullness of CEA for pts undergoing diagnostic bronchoscopic examination. Five hundred and sixty-three consecutive inpatients entered this study from July 1991 to December 1992. These pts had indication of diagnostic bronchoscopy because of pulmonary symptoms or abnormal chest x-rays. There were 321 primary lung cancers (127 adenocarcinomas, 38 squamous cell carcinomas, 41 large cell carcinomas, 46 small cell lung carcinomas, and 9 mixed forms of lung cancers), 218 benign lung diseases and 24 other "on-pulmonary malignant diseases. CEA was measured by enzyme immune-assay. A 95% cut-off level of CEA is 4.7ng/ml (=n). The likelihood ratio of malignant lung diseases to benign lung diseases was 0.67 for pts with CEAS", 2.06 with n3n, respectively. Of the lung cancers, the likelihood ratio of adeno- or large cell carcinoma of the lung to squamous or small cell lung carcinoma was 0.82 for 0.86 with ncCEA$2n, 0.86 with 2ndn, 3". and 1.07 with 3n3n had a" extremelv high probability of maliqnant luns diseases, in whom the contribution of bronchoscopy to the diagnosis of malignancy would be small. However, CEA could not be useful to differentiate histological types of lung cancer. (CBA)
ENDOBRONCHIAL ULTRASOUND-GUIDED NEEDLE METHOD FOR IMPROVED ASPIRATION. AN DIAGNOSING INTRATHORACIC LYMPHADENOPATHY. J. Shannon, F. Becker, J. Orens, R. Bode, J. Rubin, R. Whyte,
PROGNOSTIC NODELS FOR NSCLC - PROSPECTIVE AND NULTIVARXATE RESULTS. H. Biilzebruck,P. Drings, B. Danzer, M. Odemer, M. Schrenk, I. Vogt-Moykopf. Thoraxklinik Heidelberg, Heidelberg, Germany. Data of 2,630 patients with NSCLC were prospectively analyzed to identify patient-, tumorand iherapy-related prognostic factors with multivariate methods to answer the questions: 1. What is the prognostic impact of one factor after adjustment of the prognostic influence of all other factors? 2. Which are the factors of most prognostic influence? 3. What is the minimal final set of independent prognostic factors? 4. How can prognostic indices be established to define risk groups and estimate individual prognosis? In the 1,216 resected patients (median survival: 30 months, S-year survival: 37.4%) the final prognostic model included age, histology, stage and completeness of resection. For the 996 patients with chemo- and/or radiotherapy (median survival: 8 months, 5-year survival: 5.6%) performance status, sex, stage and treatment result were members of the final set of prognostic factors. Only the stage and the cause of no treatment (no treatment proposal of the physician, refusal of resection, refusal of chemo- and/or radiotherapy. refusal of any diagnostic or therapy) were relevant for the prognosis of the 418 patients without any tumor-specific treatment (median survival: 4 months, 5-year survival: 2.3%).
A. Turrisi, F. Martinez. University of Michigan Medical Center, Ann Arbor, Ml., U.S.A. Transbronchial needle aspiration (TBNA) of mediastinal adenopathy is an useful adjunct to radiographic evaluation in patients suspected of having intrathoracic malignancy. Ultrasound (US) catheters which can be passed through the suction channel of a standard flexible bronchoscope have allowed better definition of mediastinal structures. We prospectively examined 30 patients referred for evaluation of mediastinal lymphadenopathy. All patients had TBNA, with 12 procedures guided by US (USTBNA); all were performed with on-site cytopathology. Ability to sample adenopathy (defined by presence of lymphocytes or cancer cells) was 83% for routine TBNA and 89% for USTBNA. The yield of diagnostic aspirates was similarly high for TBNA vs. USTBNA. However, when we analyzed those patients with paratracheal masses (n=12).we found USTBNA (n=5) to have higher sensitivity than routine TBNA (n=7), with sensitivity of 80% and 571, respectively. We experienced no complications with USTBNA and noted a trend toward fewer passes for diagnosis with USTBNA. We conclude that 1) TBNA is highly efficacious in sampling mediastinal nodes; 2) USTBNA and routine TBNA are in diagnosing subcarinal masses, efficacious equally provided on-site cytopathology: 3) USTBNA affords a very paratracheal masses. high diagnostic yield, especially in While the exact role of USTBNA remains to be identified with randomized prospective studies, we feel that it may cost-effective means of diagnosing afford an efficient, intrathoracic nodes and sparing patients more invasive diagnostic procedures.
287
288
RADIOGRAPHIC SCREENING FOR LUNG CANCER:PROPOSED PARADIGMFOR RFQUISITRRESEARCH. C. I. Henschke, J. Caro, D. D. Libby, D. McCauley, G. McGuinness, OS. Miettinen, D. Naidich, M. Pasmantier. J.P. Smith, D.F. Yankelevitz, The New York Hospital-Cornell Medical Center and New York University Medical Center, New York, NY. Computed tomographic (CT) allows excellent detection and characterization of small solitary pulmonary nodules (SSPN). It raises three types of question: 1) How often does CT imaging lead to detection of SSPN? 2) How often is such a SSPN malignant? 3) If malignant, how curable is it? The first question pertains to decisions about screening use of CT, the second to decisions about screening for SSPN and diagnosis of malignancy given SSPN, and the third to decisions about screening for SSPN, diagnosis given SSPN and intervention given malignant SSPN. Our three component study design addresses these questions. Some 1CCKl persons at high risk for lung cancer will be screened for SSPN using screening-type CT. The primary aim is to determine the prevalence of CT-detectable SSPN as a joint function of risk-relevant aspects of the person. The second component addresses the prevalence of malignancy among the detected cases of SSPN. To develop the prevalence function, a larger series of CT-detected SSPNs will be obtained by developing a multi-center SSPN “registry”. A subsequent, third component will focus on the registered cases of malignant SSPN incidentally detected and addresses their curability on the basis of longterm follow-up. This designrepresents a new paradigm for applied research on radiologic technologies in cancer screening with advantages of research efficiency about decisions needed diagnostic work-up and therapeutic intervention.
THE
USBFULlPBSS OF SSRVY CARCINOLYBRYONIC APTIQEI PATIBSTS UWDBRSOI~Q DIAQUOSTIC FOR (PTS) BXANIPATION. BROWZAOSCOPIC Mitsunobu Nakao, Masaaki Kawahara, Kiyoyuki Furuse, Nagahisa Kodama, Mitsumasa Ogawara, Shinji Atagi, Yuji Kawaguchi, Tatsuya Okada, Takao Kamimori, Masashi Yamada, Mitsunori Sakatani, Hideki Hara National Kinki Central Hospital for Chest Diseases, Sakai, Osaka 591, Japan. Serum CEA is a tumor marker used all over the world. There were, however, few studies which used likelihood ratio instead of sensitivity and specificity. The former demonstrates broader information than the latter. We investigated the usefullness of CEA for pts undergoing diagnostic bronchoscopic examination. Five hundred and sixty-three consecutive inpatients entered this study from July 1991 to December 1992. These pts had indication of diagnostic bronchoscopy because of pulmonary symptoms or abnormal chest x-rays. There were 321 primary lung cancers (127 adenocarcinomas, 38 squamous cell carcinomas, 41 large cell carcinomas, 46 small cell lung carcinomas, and 9 mixed forms of lung cancers), 218 benign lung diseases and 24 other "on-pulmonary malignant diseases. CEA was measured by enzyme immune-assay. A 95% cut-off level of CEA is 4.7ng/ml (=n). The likelihood ratio of malignant lung diseases to benign lung diseases was 0.67 for pts with CEAS", 2.06 with n