80

The eeho-delays(TE) are 30 ms and 60 ms. The inversion time (TI) 400 ms. Compared with the surgical and pathological fin-

dings, the MR examination accurately pre- dicts the presence or absence of metasta- tic mediastinal lymph node disease in 86% of the patients. Receiver operator charac- teristic (ROC) analysis is used to com- pare the performance of MR and CT.

Cancer Localization by Detection of Fluo- rescence Using a New Diagnostic System with Hematop0rphyrin Derivative, Laser Photoradiation and A Spectroscope. Konaka, C., Kato, H., Aizawa , K., Ni- shimiya, K., Kinoshita, K., Sakai, H., Noguchi, M., Hayata, Y. Department of Surgezy, and I. Physiology, Tokyo Med&cal College, Tokyo, Japan.

Roentgenologically occult lung cancer can be detected by sputum cytology exami- nation. In such cases, fiberoptic bron- choscopy facilitates the localization of the focus; but there are still cases, par- ticularly occult cases, that endoscopically show no gross abnormal findings and pre- sent problems in localization. Recently, fluorescence bronchoscopy has been intro- duced for the detection and localization of early s~age lung cancer using hematopo- rphyrin derivative (HpD) which is speci- fically retained by malignant tissue. HpD emits fluorescence with peaks of 630 and 690 nm wavelength. It is therefore theore- tically possible to make a diagnosis of malignant tumors by detecting HpD-specific fluorescence in cases of very early stage cancers using a fluorescence detection system with a 630 um barrier filter becau- se the normal epithelium also has auto- fluorescence showing a single peak at around G00 nm. Therefore, we developed a spectroscope system compatible with the fiberoptic bronchoscope to analyze the shape of the fluorescence light wavelength emission pattern. This permits the detec- tion of HpD-specific fluorescence and can assist in the diagnosis and localization of early lung cancer.

Utility of SerL~n Carcinoembryonic Antigen (CEA) and Calcitonin (CAL) Levels as Pre- dictors of Extent of Disease in Small Cell Lung Cancer. Hirte, H.W., Osoba, D., Malkin, A., Malkin, D.G. Toronto-Bayview Regional Cancer Cen- tre and Sunnybrook Medical Center, Toron- to, ON, Canada M4N 3M5.

During the initial staging investigation of patients with small cell lung cancer 92 had CEA levels and 71 had CAL levels measured. In 60% the CEA levels were > 3 ug/l; in 69% the CAL levels were > 60ng/L. Determination of the sensitivi-

ty (sens) and specificity (spec) of CEA

and CAL levels as predictors of the extent of disease was based upon the results of standard

staging procedures (physical exam, chest x-ray, liver/spleen scan, bone scan, bone marrow aspi- rate and biopsy and computerized tomography scan of the brain). After staging, 52/92 (57%) patients with CEA determinations and 42/71 (59%) of patients with CAL determinations had extensive disease (ext. dis.). Receiver opera- ting characteristic (ROC) curves were constr~c- ted to determine the most appropriate cut-off levels of CEA and CAL as predictors of ext. dis. and liver metastases (liver mets).

CEA CAL Variable ug/L sens spec ng/L sens spec

ext. dis. >7 .61 .56 >200 .71 .67 liver mets. >7 .69 .59 >200 .83 .58

Thus, CEA levels >7 ug/L and CAL levels >200ng/L appear to be correlated with extent of disease and particularly with the presence of liver metastases. Initial analyses of argi- nine vasopressin and ACTH levels do not suggest a correlation with extent of disease.

CEA: A Useful Prognostic Marker for Small Cell Lung Cancer (SCLC). Sagman, U., Sculier, J.P., Feld, R., Evans, W. K., Shepherd, F.A., DeBoer, G., Malkin, D.G., Malkin, A. University of Toronto, Canada.

Pretreatment CEA levels were determined in 276 patients presenting with SCLC staged by physical examination, chest x-ray, bone, brain and liver scans and bone marrow aspiration and biopsy. Initial treatment consisted of cyclo- phosphamide, doxorubicin and vincristine follo- wed by chest irradiation. 102 patients (37%) had an initial abnormal level (CEA > 6 ng/ml) with 32 (12%) > 50 ng/ml. Patients with exten- sive disease (~9/126) presented with a higher incidence of CEA elevation than those (43/150) with limited disease (p=0.0026). Patients with an elevated CEA level had a shorter survival (p=0.002). The median survival time and 1-year and 2-year survival rates for patients with elevated CEA levels were 8.9 months, 39% and 5% respectively but for those with a normal CEA level were 12.3 months, 54% and 18% respec- tively. There was also a trend to poorer survival with increasing initial CEA levels. When adjust- ment was made for extent of disease, ECOG per- formance status and treatment, a significant decrease in survival persisted for patients with elevated CEA (p=0.014, log-rank analysis). It is interesting to note at this time that all 12 patients who have survived longer than 2.5 years had a normal initial CEA. From these da- ta it appears CEA has some independent prog- nostic significance. It might be useful to assess the value of CEA monitoring in the follow- up of these patients.

Prognostic Significance of Galli~n (Ga) Scan- ning in Small Cell Lung Cancer (SCLC).

Sridhar, K.S., Chandarlapaty, S.K.C., Fernandez,