Abstracts/Lung Cancer 10 (1994) 395-430 415

The role of tnutsthotacic needle biopsy for the diagnosis and staging of lung cancer Sahzar AM, Westcott JL. Department ofRodiology. Thornap Jefferson Univeniry Hospital. 111 South 11th Street, PhiLadelphia. PA 19107. Clia Chest Med 1993; 14:99- 110

Percutaneous transtboracic needle biopsy (TNB) is a simple and safe procedure with high diagnostic accuracy for the diagnosis and staging of cancer in the lung, hilum, and mediastinum. The complication rate is low and consists ptimarily of pneumothorax, with only a small percentageofthese requiring chest tube reexpansion. Major complications are rare. Computed tomographically guided biopsy is a powerfitl adjunct to fluoroscopic biopsy and expands the application of TNB to include most thoracic lesions. TNB is the initial diagnostic procedure of choice in peripheral lung lesions, suspected focal metastases. and most hilar and mediastinal masses. Its proper role in the diagnosis and staging of lung cancer requires the close collaboration of the radiologist, cytopathologist. and the patient’s primary physician.

The role of broocboscopy in lung cancer Arroliga AC. Mattbay RA. Pulmonary and Critical Cure Secrion. Yale Uniwrsiry School of Medicine, 333 Cedar Screer, New Haven, CT 06510. Clin Chest Med 1993;14:87-98.

Flexible tiberoptic bronchoscopy isthe most us&l invasive technique for diagnosing lung cancer. This article details the use and efficacy of bronchoscopy with such established techniques as forceps biopsy, brush biopsy, and bronchial washing in the diagnosis and staging of bronchoscopically visible central lung cancrr and peripheral lung cancer. The efficacy of such newer techniques as trambronchial needle aspiration, transbronchial curettage, ultradtin tibroptic bronchoscopy, and quantitation of tumor markers in bronchoalveolar lavage tluid is also discussed. along with the complications of bronchoscopy and new techniques for detecting early lung cancer.

Value of serum neuron-specific enolase in nonsmall ceil lung cuocer Diez M. Torres A. Ortega L, Maestro M, Harnsndo F. Gomez A et al. Cirurgia General, !I. Hospiral Univers. San Carlos. Madrid. Oncology (Switzerland) 1993;50: 127-31.

To assess the prognostic value of pretreatment serum neuron- specific enolase (NSE) in nonsmall cell lung cancer (NSCLC), levels were measured in 84 NSCLC patients, 40 healthy controls, and 20 patients with benign pulmonary diseases. NSE concentration was higher inNSCLC(11.7 k 10.8ng/ntl)(mean k SD: median = 9.7nglrnl)than in the two control groups (p < 0.001). Serum NSE was neither related with the tumor-node-metastasis (TNM) stage, nor with histologic subtype At a cutoff value of I5 nglml. NSE had a sensitivity of 27.3 % and a specificity of 96%. Patients with a preoperative NSE level < 15 n&J showed siqniticantly longer 24.month survival than those whose initial levels were > 15 ng/mJ (70 vs. 47%; p C 0.05), and this was continued after stratitying by TNM stage. Likelihood of tumor relapse in I, II, and IIIa TNM stages showed similar behavior. These Endings suggest that NSE could be used as an adjunctive prognostic test in NSCLC patients.

Surgery

Surgical treatment of &coast tumor Rerntnen HJ. Racquet LK. Van Son JAM, Morshuis WJ. Cox AL. Dept. of i%oracic/CanlacSurgery. University HospiroiSt. Radboud. Postbox 9101, 65lXl HB Nijmegen. J Cardiovasc Surg 1993;34: 1.5761.

The treatment of superior pulmonary sulcus (Pancoast) tumor is not uniform and is still discussed. Literature data and our retrospective

study are ptesertted. Fourteen pattents were opemted for a Pancoast tumor. Ninepatientsundetwentmediastinoscopyfollowedbypreopetative radiotherapy. Five patients received adjuvant radiotherapy after incomplete resection. Five patients who did not bave preoperative radiotherapy, received postoperative irradiation. All three patients who survived five years or more, had preoperatrve radiotherapy and two of them underwent a complete resection. LitefaNfe data are discussed and emphasis is laid on the importance of preoperative staging, including muliaatinoscopy, preoperative radiotherapy and complete ‘en bloc’ resoztion.

Is T factor of the TNM staging system a predominant prognostic factorinpathol~ics~eInon~l-eelll~eancer?r\multiv;uiate prognostic factor analysis of 151 patients Ichinose Y, Hare N. Ohta M, Yano T, Maeda K, Asoh H et al. Depamnenr of Chest Surgery. National Kyllshu Cancer Cemer. 3-I-1, Norame, Minwni-ku. Fukuoka 835. J Thorac Cardiovasc Surg 1993; 106:w-t.

We attempted to clarify whether the T factor of the TNM staging system should be viewed as a predominant prognostic factor in patients with pathologic stage I non-small-cell lung cancer when analyzed

ploidypattemoftumors. Westudied I51 patientswho werein thisstage. Histopathologic factors used in the analysis were as follows: histologic cell type (squamous or nonsquamous cell carcinoma), grade of differentiation, and Nmor invasion of visceral pleura and vessels. Deoxyribonucleic acid ploidy pattern of NmOIs was analyzed by flow cytometry, and the tumors were classified as diploid or aneuploid tumors. Signiticantpmgnosticfactors(p < 0.05) thatweredemonstrated by univariate analysis of survival curves were as follows: (1) Tl versus T’2; (2) well versus moderately or poorly differentiated tumor; (3) the absence versus presence of tumor exposed on pleura. (4) artery invasion, (5) lymphatic vessel invasion; and (6) diploid versus aneuploid tumor. Multivariatepmgnotiicfacroraoalysisshowedthegmdeofdifferentiation and dwxyribonucleic acid ploidy pattern to be predominant prognostic factors. The T2 NmOr group had significantly more cases with tumor invasion of lymphatic vessels than did the Tl tumor group and included I8 cases witb Nmor exposed on pleura. When these two factors were excluded from multivariate analysis, the T factor was marginally si@icant (p = 0.08). These observations suggest that the T factor is not necessarily a predominant pro8mostic factor in pathologic stage I non-small-cell lung cancer.

Bloodvessel invasion by tumor cellspredictsrerurrence in completely resected Tl NO MO non-small-cell lung cilllcer Macchiarini P. Footanini G, Hardin MJ. Chuanchieh H, Bigini D. Vignati S et al. Dept. of l7zoracicNaxular Surgery. Hopiral Marie- Lannelongue. Pa&&d Universi~. 133 Avenue de la Resismnce, 92350 Plessis Robinron. Paris. J Thorac Cardiovasc Surg 1993; 106: SO- 9.

The prognostic significance of traditional and newer Nmor cell- related biologic parameters, like dwxyrihonucleic acid ploidy (flow cytometry),protiferativeactivity(expressionof~liferatingcellnuclear antigen by immunohistochemistry), mitotic count. and intratumotal or periNmoral (or both) blood or lymphatic vessel invasion by tumor cells was investigated in 95 consecutive patients who had Tl NO MO non- small-cell lung cancer and who had operation alone between 1975 and 1985. The median follow-up for the entire gmup is now 8.3 years, and overall 5-, IO-. and 15-year-survivals were 75 96, 69%, and 61%, respectively. Twenty-two patients died of either local (n = 3) or systemic (n = 19) recurrent non-small-cell lung cancer, 5 of non-cancer- related causes, 2 of new primary lung cancer, and I of an cxtrathoracic

Jaxm~ alsnbape oe apwcud ol ads sKarmre Jokm pee Sunl a~ ,o

‘1 ‘Z s&n dnoJS lo~luos rq] ql!,n p?JedmoJ JaqlaSol sdnoJS Stnldmes J!FWSKS PW (3Nw ?¶ VJ! “as!p ZN JOJ O!lSJ ,bSAOjs!p apl ‘aNW

Kq pasne3 KlqaqoJd ,,e ‘pcxuursqo Adam woq~olr(q~ ,o mpos!d:, arm pue awau p&iaK~~(lel luwn~ aql JO suo!say aaJq~, .sdncuS aq] uwnlaq luaJ*$J!p K~lliTJDy!ll+ lo” aJaM K[arr!~SJ?dO$Md ~Stll?J, poO,q qflIn

JO Jaqmnn pue oo~larado aqi Sump ]so, poo1q~o amn,o* 3pwuo3 2q] ql!m panrdmos ‘aNW pm Suqdmes wnua]sKs q~!rn sdnoJSaqa u! su!e~p aqa e!n oo!lmqwJd pg JawuS Kpmx~yp~S~se sern 3~2~ ‘s3ys~al3gitzq3 pz3Pg3 ]wlJodm! 01 Su!p~o5x? alqeiadmos aJar+. sdnoJS aq1

‘8867 Jaw sJ=K aye m PwaJ] u=q psq Kav J! aNw Peq arreq plnom oqm ‘~861 pm 9861 u! 00 paierado swa!wd 0~40 dnoJS ~OJ]IIOS e moJJ asog, W!M paJudmoa alar aoaysd a.wp may euta wuayed ~9 p ]no

p?!JJ~~aNwv’-aw~doz III auop swnpou qdmdl pJogswpm JO @ydmss 3ywaisKs I 1661 JO aIpp!m a¶ puv 8861 uaarmaa ‘J13ue3 SunI 1113 I[EmS-ROR ~~EIJ, k1,t’$JnS T BUMPS JO hJn33E aw Oa uo!lnqgJo~ Q! qsqqns? ol pw (aNW) oo~l~~p apou qdmll Iw!lswpam JO Kup!q~om oql a&i!lsa~~ o] pamro~ad su,n Kprus r

.KlqBuom pm Kl!p!qJomalqadas~ermql~pale~~sses! Kmoxuuomnaodlnq *oo!]a!pe~ asop-qSfq pw Xderaqlomaqs e~!sssJSSe~o oo!smqmos sq] Jaye KlapS

Wo.Pd aq Km Kmoljaqol leq] apnl3005 a* ‘(]so] rq3 Kq ~0.0 > d) Kl!llltlom pm Kl!p!qJOm -3~ qum prlelauo5 Kmo]~uomnaod K[uO Xlsn r!q~ Kq $0’0 < d) uo!:cw.y oaSKxo paJ!dsu! en!~c~adoe~lu! JO ‘m]ElS ~oo~~~lno ‘Sqns-JJ lsal no!]x~y Xlauouqnd a~!lwxioaJd q+~ paas!- aon aJam K~pv~om pw K]!p!q~oW ~Kmol~uomnaod Jage sKep OE podolarrap wql wsy lamaldoqDunorq t ma?( pallnsar qlsap p~!qa v

auoSJapun paq oqm sloa!lad OML wae!]ed Kmol3aqol 9 JO 1 u! pne s)uayd KmolJanomnaod L JO s u! no~le~?do ~aqe Skip 9 01 E padolanapsaru]ly~ Duuouqndlsny!p ‘aa!laSao-amaIn ‘(96 ~p)sqwp wJq~ ql~~ ~S!~OSSC iuam s?~qJaoomnaod L -aqm ‘Dqwom oo q]!m Kmol3aqol anmurpun sma!lsd u!s -SUO~JUJ Kptp K~3-002 m pa~aw~p (KDD 000‘9) •O!]S~JEU! a!jaJoql ~a!pm ~uirrlruo~uos pue :(s pue ‘E ‘I sK=p) +u/Sm 0s *ap!sodo]a !(s qSnw I s.W pvsm oz ‘WIWJ Xs @narq) I SKBP) pPm 008 4 ow ‘r!JsJnoJ=w -5 ptuoy~~~ JO so1aK3 Klgroom om) Jagya JaDm Sun1 [las ~~t%us-uou ~JXIWA~E K~~WO~JO ??oy3asy warmaptm oqm sma!md ~1 JO spew ?q,

palrrdgue s! cun3 J! pay!]sn[ s! uofutaruam! p+SJns a+3&3e rre q3ns lsql a,taqaq 0~ ‘aSualleq3 e aq ]q@u lp~m 3g~oe av Su~perru! Jaxre3 Smq pajmrlrpa oe ~94 uoguahlaiu! fc+SJns sfq8 qSnoq3w x2swelam ps!p Jo Jomna aq]Jo a3uwn3ill pxxq JO asoap!r\;l Kne ~no@n uo!uuado aq~ J~S squmm 91 wql worn JOJ dn pa~o,fo~ uaaq aq (1 am) m?p!d a00 %%dKq huomptdoquw ~?pun uo~le~do pxnpsl pqss?33ns luarmapun oqm ‘w108 aql Smps~u! Ja3w3 SUnl ~~?S~~sOrS-uOu p3tIeApe qI!M Slu?!]ad Ow ??0 SEp UOdaJ aM

‘Z-Of3 :lt:f661

aJJe Jy snq] sqnSaJ qSnoq]le ‘uo!]mle~? ~oqwy spa?” sno!]eJado ~!l~do@hoqwoJq p?mqmo3 aqIJo anpx au vmo+rc2 3!uaSoqxIoJq ql!m noa!rwd pinaaias Kllqa~ue:, tr! suoy.~do rqerns se s-anbqw pgw, aJe SaJnpajoJd ~!]seldo@e pue x]nldoqxmJq ]eql epn13uo” ?fi ‘~hl?sa~ KJaoompIdpas!w_udmo3oou pue p?s!moJdmo3 ql!mswo!]adjo S~]E.I le+Jns home puno~ aram sxuaJa#!p lrre~y!~~S!s K[~ZJ~JS!WF ON ~(~oe~y!uS!s ]ou I d :~t’_cssnuar\ st.1 E) a]m p+uns J~K-E ~pa~o

q ‘may ]ulua#!p Kprraay@~s IOU qlnoqqe ‘wq] Jamor aq o] punql sew K]svldo@m Frye pir!.uns ~e;rK-aan~~ ‘(~‘0 > d) un~!yp~S!s IOU SW aauaJa#!p aw mq ‘(%vEz) dnarS ZIG aq m rreqi (u I ‘EP pue 06 z9) dnoJS IN-ON p?mqmo:, aql II! a[qmoaty atom s&n ph+un~ 3qluom

OZ Pu’J ‘SI ‘I 1 JaW Ilaw P”= a,‘!l8 aJe E Pm =P’JOm EZ Jay’J p?!P I ‘?JnpajoJd ct!lsaldo$iueoqxmJq pamqmo:, e marmapun oqm swa!led t aw JO . B t-1 f pee 06 9.8~ aJarn Kastqdo!Soe Jaye saw p+uns ~e;nK-c pueJwK-ano ‘Kla?gedsu ‘sg’oppue ~~‘~~~amdnolSu!luarq]Jo~ sinw @+uns JB?K-g put ~e2K-aaJq.~ .Krseldo!Sue Jaye a3ualmxlJ pzo] JOJ 1 pm! ‘Kwtqdo!Sue Jaye s!soqmoJql Jepmset.,o rsne~rq 1 *aJnpJv

3!]omolseue ‘04 t ‘(%t.s) swa!wd t u! paJ!nlku SBM Kmo]xwomn?ud ao!laldmoa v .(a]rl 01 nuv ‘KIJB~ 01) (%E’Lz) swayed OZ u! paun33o suoyaJqdmo3 aguado;sod rofsyy ‘(g s9.c) Klarryuadowd pa!p auaysd aarpL ‘~111 dns ~1 put ‘11 rSms Zf ‘asws!p 1 aSas peq swapad Jnoj-Kluam~ .mssldoas aq, JO UO!]EXI~ ~!~JO]~XIE alqm!ns e 10 asntxuq smapsd LS Sugtmu aql II! parrno@ IBM ?mnpajcud pxnqmo3 apr JO 'Kwldo@e ‘Kwqdoqjnarq :uo!]xny hmom~nd pas~oldmo~~o~snajaqo~tswdo~oarmaprm~prdn~nq~~wo~m a~~oqWOJq JOJ pauuopad aJam sa!laldo@n+oqxmJq p+qmo3 P pun ‘vlaldo!Sos 81 ‘sav~doqjoolq IS ‘1661 m 6.~61 moJd

‘Jaxre3 Sonl 11axIpnus-uoo ]uaLlnxu JO loemdolarrap,o 3s~ ,s]oa!lad pT~p!Npu! aql o] paJopa JPxnz3 SRnl ~ja~~p!ms-uou OW ON 11 pa]3asll Kjalrldmo3u! lo~le?~~lrnnnrpeslru?lsKsa*!~~~~~ JO, ~pmo!]t!~ e ap!AoJd SqnsaJ asa= .(lo@).o > d) we&a]uno~ zfsp-mol J!?ql JO avql wq]JaqS!qsam!] (I’LL 4*-g ‘spwa]u! axzapyuos s 56) 99.n sem swagad zfsu-q%g JO] symmrauJ tuwp SE ascawp iuaunxu Sugszy!mm~ JO 7s~ an!l’vJ *q.~ XIOCKYO > d) (91 = u) nua@ qs!-qSm $0 ]eq] wv Jafiol mm!] Q-gZ 4 I ‘9 ‘pJhla]m a3napyuoo3 % 56) E’EI SCM (6~ = II) swa!lt!d qs(su-fiol JOJ Jams Surq ~~rs~p!ms-uou ]rrwnjvJo qleapjo 2s~ er\psla~ au -(mx) = d) OO!SSAII! fassa~ poolq Kq Kpo pacwn~~u! SBM ys+uns aag-asws!p aql ‘rnulno~ Kq :p.t+tJns JO slowpard ]uapuadap~ aram (910.0 = d) ]uno~ a!]o]gu pa (1m.o = d) s[laJ JOWU Kq oop'm~ psarr pocqq %!sK~vu~ ar+ma!qnm Ka ‘Jaxm3

91P