Trans bronchial echography: A major advance for the assessment of mediastinal involument of lung cancer?

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GADOLINIDM-DTPA ENBANCEMENT OF REGEONAL CANCER IN MAGNETIC LYMPH NODES OF LUNG RESONANCE IMAGING N. Iwai, Y. Yamaguchi, T. Fujisawa, M. Baba, M. Shiba, H. Saito, Y. Kawano, N. Tamiya, Y. Npmoto, K. Shibuya, H. Kohno. Institute of Pulmonary Cancer Dept. of surgery, Research, School of Medicine, Chiba Univ., Chiba, 260 Japan Enhanced MR imagings were performed on thirty-one patients of primary lung cancer with intravenous administration of 0.1 mmol/ kg Gadolinium-DTPA (Gd-DTPA). A spin-eho pulse sequence (SE 400/40) with 0.5-Tesla MR system was The Gd-DTPA enhancement of lymph nodes was used. studied for 61 nodes (29 metastatic lymph nodes and 38 non-metastatic lymph nodes) on the hilar and mediastinal regions. The mean signal intensity of metastatic lymph nodes was enhanced higher than that of non-metastatic lymph nodes On the criterion of the signal (P
ANALYSIS OF WALL SOLITABY pulll)llbpy BODBLBB (SPB) BY D BABBO ON RADIOLOGICTBBBB~IIuIBsIOBhZ. PATEOLOCIC COWKIATION K. Yamadal), T. Yoshiokal), I. Nomural), K. Nodal),

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TRANS BRONCHIAL ECHOGRAPHY : A MAJOR ADVANCE FOR THE ASSESSMENT OF MEDIASTINAL INVOLUMENT OF LUNG CANCER ? P.J.SOUQUET,JC SOUQUET, C.H.BOHAS, B.GUIBERT, R.LAMBERT, J.P.BERNARD. Department of Thoracic Oncology,CH LYON SUD,693 10 PIERRE BENITE - PRANCE Mediastinal involvment of lung cancers (by lymph nodes or by direct extension) is oftendiffrcult to diagnose by non invasive technics. Chest computerised tomography or RMI give only size criteria with quite poor specificity and sensibility. On the other hand mediastinoscopy can evaluate media&ml lymph nodes involvment but only in selected areas. Transoesophageal echography (T.O.E.) is used since 5 years with a gastric endoscope. This echographic sound has a diameter of 5 mm and need a total occlusion of the oesophagus with a ballonet.Results show that T.O.E. is a performant technique to evaluate oesophageal , aortic or subcarina involvment but not for the hilar or other mediastianal area Since mid 1993 we use a 2 mm diameter echographic (with 12 or 20 Mhz energy) through the chanel of the fiberoptic bronchoscope (Olympus). The simple application of this sound (without bronchial occlusion) on the bronchus or tracheal surface allows to see and evahtate the lymph nodes and adjacent tissues of the trachea and bronchus. Preliminary results seem to show that transbronchial echography is a valuable and non invasive technique to evaluate (in pre operative assessment) N2 disease, some case of Nl disease and direct extension to the trachea or bronchus of lung cancers.

THE DfLEMbIA OF THE CONTRAfATERAL PULMDNARY NODULE LJ Kohman and SA Groskff, Departmentsof Surgery and Radfffogy, SUNY Heakh Science Center, Syracuse NY 13210

H. Hosodap), Y. Hayashiz), M. Ishibashiz), Y. Kamedas) Departments of Thoracic Disease l), Surgery 2) and Pathology 3), Kanagawa Cancer Center, Yokohama, Japan

(PBBPOSE) To facilitate the accurate diagnosis of small SPN with less than 25 mm in diameter, we retrospectively evaluated the images of three dimensional computed tomography (3D-CT) on comparison with conventional CT (10 mm slice). (PATIENTSand HETEtODS) There were 34 patients with SPN (2.2lung cancers, 12 benign lesions) who underwent CT examination before thoracotomy. Conventional CT (Toshiba TCT-900S, HELIX) images were examined by an extended scale (window level: -600, window width: 1900) using high resolution images. 3D-CT images were made using TCT-900S, HELIX software (Toshiba, Tokyo). (EESIILTS)Comparison of diagnoses on CT findings and on pathological findings showed that 3D-CT images were mnre accurate for detecting involved vessels and displaying the morphology of SPN than conventional CT images. The specific features on 3D-CT findings of lung cancers, including the appearance of the margin and the relationship between lesions and surrounding vessels, were different from those of benign lesions. (CONCLUSION) Our results may suggest that 3D-CT images could have a significant clinical role in differetiating SPN by demonstrating the relationship between lesions and the surrounding vessels and displaying the morphology of the lesions. To obtain m"re precise differential diagnosis of small SPN, it is necessary to accumulate mm-e knowledge concerning radiologic-pathologic correlation.

CT scan is conskfered a routinecomponent of staging in bronchogeniccarcinoma. We hare seen a number of patients wkh a potentiallyresectabfe lung cancer and an abnormalityon the other side detected by CT onfy. We reviewed our erperience wkh this proMem to detem’rfnethe ffkefye5ofogy of these fesionsand the prediiive value of radffaphff apfMamnce. We rev&wed charts of patients referred for evaluationof pctentfaffyresectab4elung cancer. We identifiedthose patients who had a contrafateralffndingon chest CT which posed a diagnostic probfem. Wedidnotincfudepatimtswfthffndfngseesffydfmisaeda.s scar, granuloma, or some other benign or fong-standfngprocess. The CT scans were rev&wed wfthoul kmwfedge of cfinff outcome. We classffiedthe likelihoodof malignancy(O-25%,25-50%, 51-75%) on the basis of s&e, edge charactenstfcsand density. Nine patfents met the criteria d: (I) resectable bronchogenic carcinoma, (2) contra1ateralnodufe Mble only on CT, and (3) pathok@f oonffrmatfonOt the nature of the contrafatsralprocess. Seven of these patfents had a contrafateralmafignancy,wfth a radffraphfc predictionof mafignancyof O-25% (4) 2550% (1) and 56 75% (2). Two patients had a benffn cont~ral process: 1 granuloma (predictfonof maff@narwy51-75%) and 1 hamartoma (O-Z%). AlesionvisiMeMl)ycnCTscanlessthanlcmindiameterwith indfffnct margfns cannci be refff cfass#fedas benfgn and suggests biopsy or carefuf radiobgic fofknv-up. In tfte future, hfgh resofutfonCT may hefp to better d&ine margin characteristii, aiding in dkferentiating benign from malignant nodules,