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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-