Abstmc1s/L4oIg cancer I4 (19%) 149-179 157

Detecth of polypeptides assodated with the bistopatbo- logical diffenWiatloa of primary lung carchoma Hirano T, Franzen B, Uryu K, Ohuaawa K, Alaiya AA, Vanky F. Lkportment of Surgery. Tokyo Medical College, 6- 7-1 Nishishinjuku, Shinjuku-h, Tokyo 160. Br J Cancer 1995;72:840-8.

Two-dimensional polyacrylamide gel electrophtgesis combined withaMmcaymatic~plepnparationtecbniqueisusefulforaoalysin8 clinical tmour material. Using these techniques, we analysed the relationship between the hi~logical findiqs in primary llmg malignancies and the expression of a number of unidentified poly- peptides that were detected in the molecular weight region 20-35 l&a, Inthisshdy45casesofprimarylungcancer(PLC)(21casesof adwxarcinoma, ten cases of squamous cell carcinoma, five cases of large-cell carcinoma, one case of adenosquamous cell carcinoma, five casesofsmall-cellcarcioomaandthnecasesofearciooid~our)were examined. Forreference,ahumandiploidAbroblastcell line (wI38)and normal peripheral lymphocytes were used. Sixteen polypeptides were judged to be associated with hismpathological features. These poly- peptidesseemtobevaluableasdi&rmtiation~ers.Thesimultaneous evaluation of these polypeptides and some other proliferation markers (e.g. PCNA, PCNA ‘satellite’, Numatinprotein B23 and lamin B) seems to clarify the chamct.sristlcs of each case of PLC. Futthermore, it is possible to classify PLC based on the two-dimensional electrophoresis findings, and this classification of PLC is suggested to reflect the biological features ofthe tumour more precisely than that based only on morphology.

Diagnosing the indetermiaate pulmoaary nodule: Percuta- neous biopsy versus tboraeascopy MitnrkaS,LandreneauRI,MackUI,FenermanLS,Gammie J,Bartley S. General Thomcic Surgery. Liliane Kaufinonn Building, University of Pittsburgh. 3459FphAve.. Pittsburgh PA 15213. Sllrgery 1995;l l8:67C 84.

Background. The malignant potential of indeterminate solitary, pulmonary nodules (SPN) mandates accurate diagnostic management. tierhods. 6 I3 patients undergoing either computed tomographic lung biopsy (CT-Bx) (n = 3 12) or thoracosco pit excisional biopsy (Thor-Bx) (n 2 30 i) for the diagnosis of SPN wereevaluated for relative accuracy, complications,andeffectonclinicsJtreatment.Re.ruI&CT-Bxidentified a malignant diagnosis (Dx) in 20 I (64%) of 3 12 patients; 85 (42%) underwent operations. A total of I 16 patients (58%) with synchronous cancer (n = 16). impaired physiologic condition, or unresectable lesions (n = 100) were not operated. Surgical treatment was deferred for 20 patients (6%) with a ‘specific benign’ Dx and 44 physiologically impairedpatientswith’nonspecificbenign’CT-Bx.Forty-sevenpatients with ‘nonspecific benign’ Dx underwent operation. Thirty-two (68%) lesions were malignant (4 metastatic, 28 primary cancer). CT-Bx accuracy was 86% for malignant and 79 (71%) of I1 1) for benign lesions. Surgery was still required for 132 (82%) of 163 patients with resectable lesions. Complications occurred in 24% of patients. A specific benign or malignant Dx was obtained in 292 (96%) of 301 patientsundergoing’fbor-Bx. Conversiontothoracotomy for lobectomy occurred in 38 (21%) of 179 patients with lung cancer. One hundred forty-one patients with lung cancer and impaired physiologic condition and all patients with metastatic (n = 44) and benign lesions (n = 78) had thoracoscopic resection alone. Complications occurred in 22% of patients. Conclusions. Limited accuracy, for benign Dx with CT-Bx requires surgical biopsy for patients with SPN with adequate physiologic reserve. Thor-Bx is a safe and accurate minimally, invasive surgical approach to resectable peripheral SPN.

Pttlmo~8ty sar ardmoma: Repast of the cam ud review of the literature Lee BY, Guerra J, Cagir B, Madden BE, Greene JO. Lkpurrmenr of Surgeq VA Medical Center, G&e Point, New York. NY. Mil Med 1995;160:537-41.

Puhnonary scar carcinoma wa9 deserlbcd aa a distinct cliniwpat- hological entity over 50 years ago. There arr many theories on the fommtion of this entity. We present three cases of pulmonary scat cerciuoma with a high ratio of aderwcarciuoma 0ae petient had a favorable postoperative course despite a l4-month delay in treatment. Necropsy specimen of another patient showed two primary scar carch~omas unrelated to each other. Literature review and discussion of *iology,diagnosis,aod~e~modalitiesofpulmonarysaucarcinoma weredone. Pathogenesisandprognosisoftheneoplasmsasso&atedwith apical sears are not clearly understood.

Mediastinal staging of aon-small-cell lung caacer: Computed tomography and cervical mediastlaoscopy Aaby C, Kristensen S, Nielsen SM. Lkparrmenr of Orolaryngology, Cenrral Hospital LX-6700 Esbjerg. ORL 1995;57:279-85.

The exact indications for computed tomography (CT) of the thorax and mediastinoscopy (MS) in lung cancer still remain incompletely detined.Thepresentstudywasdesignedtoestablishastandardapproach to cervical MS for otolaryngologists, who in Denmark are traditionally involved in the staging of non-small-cell lung cancer (NSCLC). Sixty- four potentially operable patients with NSCLC underwent thoracic CT prior to bronchoscopy and cervical MS. Cervical MS alone established the histological diagnosis in 20% of the patients. In diagnosing lymph node metastases in the superior mediastinum, a criterion of IO mm for abnormal enlargement resulted in an overall sensitivity and specificity of mediastinal CT of 81 and 84%, respectively, and the overall false- negativeandfake-positiveratesappeatedtobe 1Oand29%,respectively. It could be demonstrated that media&al lymph nodes in patients with media&al metastaseswere significantlylargerthanmediastinaJ lymph nodes in patients without metastases. No clinicopathological character- istics could be identified to influence the accuracy ofCT, except for the finding that the rate of false-negative mediastinal CT was significantly higher in patients with right-sided than in patients with left-sided lesions. It is concluded that because of the relatively low sensitivity and specificity of mediastinal CT, cervical MS remains essential in the evaluation of patients with presumed or verified NSCLC and that cervical MS, in experienced hands, is a safe and accurate procedure. For Danishotolaryngologists, the strategy ofroutine cervical MS, performed under general anaesthesia in the same. stage as bronchoscopy, is advocated as a standard approach to mediastinal assessment for the StagingofNSCLC. However,thoraco-abdominalCTisadvocatedforal1 patients with NSCLC, in whom operation is contemplated, as a supplementary investigation after other routine diagnostic and staging procedures, including cervical MS, have been carried out.

The prognostic significance of accumulatloa of p53 protein in stage III non-small cell luag caacer treated by radiotberapy Langendijk JA, Thunnissen FBJM, Lamers RJS, De Jong JMA, Ten Velde GPM, Wouters EN. Radiotherapeutic Institute Limburg, P. 0. Box 4446, 6401 CXHeerlen. Badiother Oncol 1995;36:218-24.

In the present study the prognostic significance of accumulation of nuclear ~53 protein on survival and freedom from local progression was investigated. Formahn-fixed, paraBin-embedded sections obtained by bronchoscopy or mediastinoscopy were used to examine the expression ofnuclearp53 protein using immunohistochemistry. In 37 cases (57%) overexpression of the ~53 protem was detected. No relation was found