Abstracts/Lung Cancer 12 (1995) 265-329

Diagnosis of mediastioal lymph node metastasis from primary lung caneeronMRim~ngnitbtheSTIRtechnique-Reevl)urtion ofuse- tidnewComparLwnwitbCT,conventionalMRIandMRIwiththeSTlR technique Fujimoto K, Meno S, Abe T, Edamitsu 0, Nishimura H, Hayabuchi N et al. Deporbnent ofRadio/ogv. Kwume University School ofMedicine. Kurume 830. Lung Cancer (Japan) 1994;34:91 l-22.

Sixty-one patients with primary lung cancer who had previously undergone CT and MR imaging (MRI) within two weeks before surgery were studied retrospectively. The accuracy of diagnosis of mediastinal lymph node metastasis W&P 80% on CT, 79% on conventional h@U (C-w, and 87% on conventional MRI with the STIR technique (STIR-MRI) according to our criteria. Nincty- one new patients with primary lung cancer were studied prospectively according to the same methods. The accuracy of diagnosis of mediastinal lymph node metastasis was 81% on CT, 81% on C-MRI, and 87% on STIR-MRI. AS the results of reevaluation using a prospective study corresponded to those of the retrospective study, it is suggested that STIR-MU is useful to diagnose mediastinal lymph node metastasis from lung cancer. Pathological findings of false positive cases were reactive lymphadcnopathy and those of false negative cases were micromctastases fmm adenocarcinomas. It seems to be diffwdt to distinguish reactive lymph adenopsthy from met&& lymphadmopnthy and to distinguish normal node from micrometastatic node, even though STIR-MIU is used. However, the accuracy of STIR-MRI was higher than CT and C-MRI, and the possibility of enhancement of diagnostic accuracy of lymph node metastasis fmm lung cancer is suggested by combining MR imaging with the STIR technique with CT.

Cliiopathological characteristics oftumor doubling time in primary llmgeancer Usuda K, Saito Y, Aikawa K, Sakurads A, Chen Y, Endo C et al. Department of Thoracic Surgery, Inst. ofDeveopmenUA~‘n~Canc~ Tohokx Universily, Sendai 980. Lung Cancer (Japan) 1994;34:875-81.

A total of 174 casts with primary lung cancer which were detected in local municipalities during a limited period were examined with regard to their distribution and the clinicopathological characteristics of tumor doubling time (DT). 1) A&r logarithmic conversion ofDT in lung cancer, a small skew (0.7204) and a small kurtosis (-0.0643) showed a normal distribution. DT was found to have a log-normal distribution. 2) The minimum DT was 30 days,and the maximum 1077 days in the present study. Arithmetic mean i standard deviation of DT was 163.7 f 177.5 days, and geometric mean was 113.3 days. 3) Mean DT in males

was significantly shorter than that in females, and that in cases with a smoking history was significantly shorter than that in cases without a smoking history. In cases with symptoms, DT was also significantly shorter than that in cases without symptoms. The mean DT in cases with adenocarcinoma was significantly longer than that in cases with squamous cell carcinoma, small cell carcinoma and large cell carcinoma. The mean DT in cases with Tl lung cancerwas significantly longer than that in cases with T2, T3, and T4 lung cancer, and that in cases with stage I lung cancer was significantly longer than that in cases with stage III lung center

The prognostic value of argyrophil oucleolar organizer regions (AgNORs) and fibmnectin antibody in stage I lung cancer Gomibuchi M, Kanno S, Masaki Y, Haraguchi S, Tanaka S, Shoji T et al. Department of Thoracic Surgery. Nippon Medical School, Tokyo. Lung Cancer (Japan) 1994;34:861-6.

We studied the usefulness of AgNORs and tibronmtin antibody (FN) to predict the survival in stage I lung cancer patients. A total of 72 lung cancer specimens were used: 36 cases (A group) which had no recurrence for more than tivc years aftcropcration and 36 cases(l3 gmup) which died from cancer recurrence within five years. Both groups consisted of 18 adenocarcinomas, 16 squamous cell carcinomas and two large cell carcinomas. Cases were divided into 3 groups and awarded point according to the number of AgNORs: cases with less than 3.0 (hvo points), those behveen 3.0 and 5.0 (one point) and those 5.0 or mire (zero points). The amount of FN was also classified into three groups: + + (2 points), + (1 point) and - (zero point). The survival time for each score for AgNORs, FN, and both together was studied. A group and B group were statistically compared using AgNORs scores, FN scores and total scores. The results were as follows: (1) Cases with a total score of zero had a shorter survival time than cases with I-

2 points (p = 0.025,0.0076). (2) AgNORs scores of the A group were higher than those of the B 8rO”p (p = 0.029). The same result was found for FN score (p = 0.022) end total score (p = 0.0057). (3) In adcnocarcinomas a total score of 2 had longer survival time than that of zero and A 8roup had higher total score than the B group. No statistical difference was found in squamous cell carcinomas. (4) All eight cases with a zero score were in the B group. Five cases out of 6 with II score of 3 were in the A group. From these results AgNORs and FN have some value for the prediction of the prognosis in stage I lung cancer patients.

Clinicopathologic features of small cell lung cancer presenting as a sdiwpulmoorry- Yamaji Y, Yamadori I, Fujita T, Fujita J, T&ham J, Ma& M et al. First Dept. of IntemolMedicine, KagawaMedicalSchwl. Kagawa 761-07. LungCancer(Jspan) 1994;34:853-9.

Although we, small cell lung cancer(SCLC) presenting as a solitary pulmonary nodule (SPN-SCLC) without lymph node involvement, has interesting clinical and biological features. In this study our objectives are to elucidate whether SPN- SCLC is an independent entity and differs clinically or pathologically from usual forms of SCLC. We reviewed the clinical and pathological feahmzs of 80 patients treated at Kagswa Medical School Hospital behveen 1983 and 1992 on a diagnosis of SCLC. The features of SPN-SCLC were wmpered with those of non-SPN- SCLC or of the peripherally originated, but locally advanced, subgroup in non- SPN-SCLC. Ten SPN-SCLC patients (9 male and 1 female) were identified among the 80 SCLC patients. In terms of histological subclassification, oat cell type was diagnosed in 3 and intermediate cell type in 7. Good chemotherapeutic response was observed among SIX SPN-SCLC patients who received induction chemotherapy (one CR and 5 PR). However, 4 out of the 6 SPN-SCLC patients relapsed at the primaty sites. Surgical operation was performed in 6 (3 surgery alone, 1 neoadjuvant surgery and 2 acjuvant surgery) and additional radiation therapy after induction chemotherapy in one among 10 SPN-SCLC patients. Although, the SPN-SCLC patients had a longer survival time than non-SPN- SCLC patients, we could not find any differences in pathological and biological characteristics behveen SPN-SCLC and non-SPN-SCLC. Since it was difficult to curatively treat SPN-SCLC patients by chemotherapy alone, additional surgery combined with chemotherapy for the SPN-SCLC patients may be feasible for cure in such cases.

Features and significance of nonbacterial thmmbotic endocarditis in patients with lung cancer Tamura A, Matsubara 0, Komatsu H, Mohri M, Katayama T. Deporbnent o/ Pathology Faculry of Medicine, Tohyo Medic&Dental Uniwrsiry. Bunhyu-h, Tokyo. Lung Cancer (Japan) 1994,34:843-52.

To examine feahu-es and signiticancc of nonbacterial thrombotic endocarditis (NBTE) in patients with lung cancer, WC clinicopthologically reviewed 142 autopsicd patients with lung cancer. Eleven (7.7%) of the patients had NBTE. Incidence of NBTE was 13% (E/62 cases) in adcnocarcinoma and 8.6% (3135 cases) in squamous cell carcinoma. None of the patients with small cell carcinoma (34 cases) had NBTE. Eleven of the 142 patients had pathologically proved disseminated intravascular coagulation (DIG), and 4 of the 1 I patients (36%) also had NBTE. There was significant correlation behvccn DIC and NBTE (p < 0.01). Seven of the 11 patients with NBTE had systemic thromboembolism mostly accompanied by infarction. Organs with thrombocmbolism were as follows: spleen (7 cases), brain (5 cases), kidneya (4 cases), heart (3 cases), and mcsentcry (2 cases). Multiple, hemorrhagic cerebral infarction (4 cases) was fatal. Myocardial infarction and peritonitis caused by mesenteric arterial embolization also contributed to death. The present study revealed that NBTE occasionally occured in patients with lung cancer and that systemic thromboembolism due to NBTE affected prognosis of the patients. The authors stress that clinicians should keep in mind the features and significance of NBTE in tr&b,g patients with lung cancer.

Anatomic basi8 of lymphatic spread of lung carcinoma to the media- stinum: Anatomo-clinical correlations Riquet M, h4anac’h D, Dupont P, Dujon A, Hidden G, Debesse B. Service de Chirwgie Thocacique, HopitalLaennec. 42, NC de Sewes, F-75007Paris. Surg Radio1 Anat 1994,16:229-38.

Correlation of the anatomic and surgical features in 360 cadavers and in 260 patients opcratcd for bronchial carcinoma reveals that the lymphatics of the lung