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Parasternal mediastinoscopy. Assessment of operability in left upper lobe lung cancer: A prospective analysis. Schreinemakers HHJ, Joosten HJM, Mravunac M, LacquetLKDepart- ment of Thoracic. Cardiac, and Vascular Surgery, Radboud University Hospiml, 6525 GHNijmegen. J Thorac Cardiovasc Surg 1988;95:298- 302.

Between 1976 and 1984,242 patients with presumably operable lung cancer were treated surgically. In the Canisius Wilhelmina Hospital, Nijmegen, The Netherlands, in the period 1976 to 1980, 109 of I31 (83.2%) patients underwent cervical mediastinoscopy to assess opera- bility. They were studied retrospectively. During this examination, lymphnodemctastasiswasdemonsuatedin threeof 19(15.8%)patients with left upper lobe lung cancer. At thoracotomy after a normal cervical mediastinoscopic study or no mcdiastinoscopic study, periaortic lymph node metastases were found in eight of 34 (23.5%) patients with left upper lobe lung cancer. In the period 1981 to 1984, the value of left parastemal mediastinoscopy was studied prospectively in patients with left lung cancer in the Canisius Wilhelmina Hospital, Nijmegen; in the Lung Ccnue of the Radboud University Hospital, Nijmegen; and in the Lung Center of tbe Dckkerswald Medical Centre, Groesbeek. Cervical or cervical and parastemal mediastinoscopy were performed in 69 of 111 (62.2%) patients. At parastcmal mcdiastinoscopy performed after anormal cervical mediastinoscopic study, periaortic lymph node metas- tascs were found in seven of 3 1(22.6%) patients with left upper lobe lung cancer. All periaortic lymph node metastases showed intranodal and extranodal growth. The rcsectability rate in left upper lobe cancer was 79.4% in the retrospcctivc group and 96.5% in the prospective group. There were no serious complications after parastemal mediastinoscopy. These data point to the reliability of parastemal mediastinoscopy in the assessment of left upper lobe lung cancer. The study provides essential information for the staging and treatment of non-small cell lung cancer of the left upper lobe.

Clinical evaluation of serum NSE level in cases of small cell lung cancer. Moriya H, Hisa S, Satoh T et al. Jpn J Clin Radio1 1988;33:31-4.

In I3 small cell lung cancer patients, we compared the evaluation of therapeutic effects by the level of serum-NSE with that by the chest X- ray film. The two forms of evaluation nearly agreed. Serum-NSE were raised to levels higher than the previous levels in cases of relapse or progression. Serum-NSE were increased transiently in 16 episodes among 23 with chemotherapy. Serum-NSE may be a useful marker for monitoring of response to therapy, and for recognition of relapse and progression.

Importance of biologic status to the postoperative prognosis of patients with stage III nonsmall cell lung cancer. Nakahara K, Monden Y, Ohno K, Fujii Y, Hashimoto J, Kitagawa Y, Kawashima Y. First Departmen; ofSurgery, Osaka Universiry Medical School, Fukushimu-Ku, Osaka, 533. J Surg Oncol 1987;36:155-60.

The prognosis of patients with stage III nonsmall cell lung cancer was studied, with special attention to their biologic status prior to lung resection. The biologic status was estimated from the neuuophib lymphocyte ratio in the peripheral blood, serum albumin level, and erytbrocyte sedimentation ram. Among 46 patients who underwent potentially curative operations, 3 I cases of biologic status A or B (more than two parameters normal) revealed 37.6% of a 5-year survival rate, whereas there was no 5year survivor in 15 cases of biologic status C or D (more than two parameters abnormal). Of the 5-year survival rate in T,N, disease of biologic status A or B, the 60% surviving (of 10 cases) was in marked contrast to the same stage disease of biologic status C or D whcrc only 1 patient (of IO cases) was still surviving at more than 30 months. In 30 patients with T,N,, T,N,, and T,N, diseases of biologic status A or B, where long-term survivors were derived, the 5-year

smvivalratein30patientsofbiologicstatusAorB was36.6% incontrast to no long-term survivor in the same stage diseases of biologic status C or D (n = 25). We conclude that surgical results in stage III nonsmall cell lung cancer will be beneficial in patients of biologic status A or B, but nonbcncficial in patients with the same stage of biologic status C or D.

Tumor markers in pleural effusion diagnosis. Tamura S. Nishigaki T. Moriwaki Yet al. III Department of fnlernal Medicine, Hyogo College of Medicine, Hyogo 663. Cancer 1988;61:298-302.

In order to discriminate between malignant and benign effusions, the values of carcinoembryonic antigen (CEA), ferritin, be%-microglob- ulin (BMG), acid-soluble glycoprotein (ASP), tissue polypeptide anti- gen (TPA), adenosine deaminase (ADA), and immunosuppressive acidic protein (IAP) were measured in the pleural fluid of 54 patients with lung cancer, 20 with malignancies other than lung cancer, 18 with tuberculous pleurisy, and 22 with benign diseases other than tuberculo- sis. CEA levels in malignant effusions were significantly higher than thosein bcnigneffusions.Atacutofflevelof5ng/ml,68%ofthepatients with lung cancer and 44% of the patients with other malignancies showed elevated pleural fluid CEA levels. In 13 lung cancer cases with negative pleural fluid cytology, nine cases had elevated pleural fluid CEA levels. The mean pleural fluid BMG level of patients with benign diseases was significantly higher than that of patients with malignant diseases, but there was a marked overlap between those with malignant and benign diseases. No significant differences were found in the pleural fluid ferritin, ASP, TPA, and IAP levels between malignant and benign conditions. ASP and IAP pleural fluid levels showed significant corre- lations with the pleural fluid C-reactive protein (CRP) concentrations suggesting that they also reflect inflammatory activity. The mean ADA activity in tubcrculous effusion was significantly higher than that resulting from other causes of pleural effusion.

Transthoracic needle aspiration biopsy. Review of 233 cases Simpson RW, Johnson DA, Wold LE. Goellner JR. Section of Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester, MN55905. Acta Cytol 1988;32:101-4

In 233 cases in which transthoracic needle aspiration was done at the Mayo Clinic from 1980 through 1983, the cytology slides, tissue fragments and patient histories were reviewed; the original and review diagnoses were compared and correlated with the subsequent clinical course. In most cases, Ihe procedure was performed with an Is-gauge needle under fluoroscopic guidance, primarily in cases with suspected malignant masses that were considered to be not surgically resectable. In 70% of the cases, there was a history of malignancy, and 82% of the malignant lesions were of extrapulmonary origin. Correlation of the original diagnosis with the clinical course yielded 70% (164 cases) true positives, 6% (I4 cases) true negatives, 16% (37 cases) false negatives, O%falscpositivcsand8% (18cases)indeterminates. lnnoneofthefalse- negative cases was the slide subsequently read as positive in a blind review. Of the true-positive cases, 12% had positive tissue fragments only,37% hadpositivecytologysmcarsonly,and51% hadbothpositive smears and fragments. In 32% of the cases, there were radiologically demonstrable pncumothoraccs, and in 12%. placement of a chest tube was required. Hcmoptysis occurred in less than 5% of the cases. In summary, transthoracic needle biopsy provides an efficient way to accurately obtain diagnostic tissue, with acceptable minor complica- tions.

Drainage and intrapericardial tetracycline instillation in the treat- ment of malignant pericardial effusion. Frank W, Grosser H, Rutsch W, Mai R, Loddenkemper R. Lungenklinik He&shorn und Klinikum Charlolfenburg der Freien Universirat Ber-

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lin, D-10OOEerlin 39. Prax Klin Pneumol 1987;4l(Spec no):754-5. Basing on the favourable results obtained with palliative-sympto-

matic obliteration (pleurodesis) of malignant pleural effusions with tetracycline hydrochloride, we also used this therapy in 18 cases of malignant pericardial effusions - mostly caused by pleuropulmonary tumors. In 16 patients (88%) it was possible to stop the exudation within 2-l 1 days without recurrence during follow-up treatment. Since no complications worth mentioning were seen, we can consider drainage and intrapericardial instillation of tetracycline as the presently best possible method in the palliative treatment of this tumor complication.

Flare responses in small cell carcinoma of the lung. Cosolo W, Morstyn G, Arkles B, Zimet AS, Zalcberg JR. Deparfmenf ofMedical Oncology, Reparriation General Hospital, Wesr Heidelberg, Vie. 3081. Clin Nucl Med 1988;13:13-6.

Two cases of small cell carcinoma of the lung in which flare responses were demonstrated are discussed. Although the primary tumor and extraskeletal metastases responded to fist-line chemotherapy, bone scintigraphs performed 3 months after the start of treatment suggested tumor progression. Howcvcr, following repeat bone imaging and sub- sequent clinical evaluation, the interim scintigraphs appeared to repre- sent an unusual flare response, in which the activity of pre-existing hot spots increased and new lesions developed.

Scintigraphic diagnosis of rib lesions in patients with lung carci- noma. Matsumoto S. Shibuya H, Umchara I, Suzuki S. DepurfmenlofRadiol- ogy, TokyoMedicalandDental Universily. Bunkyo-ku, Tokyo 113. Clin Nucl Med 1987;12:960-2.

One hundred twenty-five patients with carcinoma of the lung re- ceived 17 1 pyrophosphate bone scans. Twenty-three ( 18%) of these 125 patients had abnormal uptake only in the ribs. Of these 23 patients, 14 (61%) were diagnosed as having a benign lesion. Five showed direct invasion from the primary carcinoma and another four were diagnosed as having mctastatic rib lesions, Benign rib lesions were also suspected in scvcral patients with multiple metastases.

Lack of clinical significance of gallium-67 uptake in non-small cell lung cancer. Buccheri G, Vola F, Ferrigno D, Curcio A, Violante B. Departmenr of Amonio Carle Ilospiuzl, 12100 Cuneo. Eur J Respir Dis 1987;71:356- 61.

To evaluate the clinical significance of tumor Ga-67 uptake, we studied 89 consecutive patients with a potentially resectable non-small cell lung cancer (NSCLC) by performing a whole body Ga-67 scan. For each scintigraphy, an overall Ga-67 accumulation index (T-N) and a volume independent index (T/Nr) were calculated. Both parameters wercrclated todiseaseextent, response to subsequenttreatmentand host survival. With the exception of the significant correlations of T-N to both stage of disease and survival - the higher the T-N, the more advanced the disease and the worse the prognosis no other relationship wasfound.Basedonthcsefindings, weconcludethat,inNSCLCatleast, gallium uptake is mainly dependent on tumor size and, therefore, of limited practical value.

Serum pseudouridine as a biochemical marker in small cell lung cancer. Tamura S, Fujioka H, Nakano T, Hada T, Higashino K. Third Deparf- menI of Internul Medicine, Hyogo College of Medicine, Hyogo 663. Cancer Res 1987;47:6138-41.

The serum lcvcl of pscudouridinc, primarily a degradation product of tRNA, was detcrmincd by high-performance liquid chromatography in

24 patients with small cell lung cancer (SCLC), 13 patients with non- SCLC with advanced stages, 15 patients with pulmonary infectious diseases, and 18 healthy controls. The mean serum pseudouridine concentration was significantly higher in the patients with SCLC I4.75 ??1.76 (SD) nmol/ml] than that in the patients with pulmonary infectious diseases (3.39 ??1.38 nmol/ml) or in healthy controls (2.21 ??0.78 nmol/ ml). The mean serum pseudouridine concentration in the patients with non-SCLC (4.07 ~0.95 nmol/ml) was significantly higher than that in healthy controls but not statistically different from that in the patients with pulmonary infectiousdiseases. Theserum pseudouridine level was elevated above the mean value plus 2 SD for the healthy subjects (3.77 nmol/ml) in 66.7% of all patients with SCLC including 3 of 8 (37.5%) with limited disease and 13 of 16 (81.3%) with extensive disease, and 53.8% oithcpaticnts with non-SCLC. Serumcarcinoembryonicantigen was elevated (>5 ng/ml) in 29.2% and serum neuron-specific enolase (>lOng/ml) in58,3%ofthecases withSCLC. In thepatients withSCLC followed up during chemotherapy, serum pseudouridinc levels changed considerably parallel with the changes in the clinical response. These findings indicate that serum pseudouridine may be a useful biochemical marker in the patients with SCLC.

Clinical experience with tetracycline pleurodesis of malignant pleu- ral effusions. Sherman S, Grady KJ, Seidman JC. Pulmonary Division, Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI 48072. South Med J 1987;80:716-9.

Because many patients with malignant pleural effusions could sur- vive for months to years beyond its onset, definitive management must be safeandeffective. Chemical pleurodesis with tetracyclinehas gained general acceptance as the therapy of choice, even though no large series confirming this viewpoint has appeared in the literature. We reviewed 108 procedures involving tube thoracostomy and tetracycline pleurode- sis, and report a succes rate of 94.4% without serious complications. Considering all patients, 49% were symptom-free at three months, and 13% wcrc alive one year later. Several potentially important changes in technique have emerged since the initial description of this procedure. With adherence to meticulous technique, tetracycline pleurodesis pro- vidcs rapid, effective, and safe palliation of malignant pleural effusions.

Gallium-67 scintigraphy and non-small-cell bronchogenic carci- noma: A quantitative in-vivo predictive assay? Lentle BC, Catz Z, Dierich HC, Scott JR, Hooper HR. Division of Nuclear Medicine, Vanvouver General Hospital, Vancouver, BC VSZ IM9. Can Med Assoc J 1987;137:815-7.

Gallium-67 scintigraphy has been of limited use in detecting lung cancers and micrometastases. To study its potential for determining the aggressiveness of a cancer, we reviewed the charts of 44 patients with non-small-cell bronchogcnic carcinoma who had not been receiving treatment when 67Ga scintigraphy was performed. The mean length of survival for the 18 patients with low or little uptake of the tracer, corrected for tumour size, was 19.7 months, and for the 26 with high uptake 9.4 months (p < 0.01). Such in-vivo predictive assays may be a rational goal for tumour scintigraphy.

Should patients with haemoptysis and a normal chest X-ray be bronchoscoped? Heaton RW. Department ofMedicine, Charing Cross Hospital. Fulham Palace Road, London W6 8RF. Postgrad Med J 1987:63:947-9.

A review of bronchoscopic records over a 5 year period identified 4 1 patients who had undergone fibreoptic bronchoscopy after presenting with haemoptysis and a normal chest X-ray. Carcinoma of the bronchus was found in 4 patients (9.7%) and the procedure yielded a diagnosis in 8 of the 20 patients in whom a specific cause of their bleeding could be