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and NSCLC were statistically significant (p < 0.05). in contrast to the CEA values. Using an arbttrary NSE cut-off level of 2.5 @I all patients with NSCLC were found to have values below 25 *g/I, whereas 5 1% of SCLC patients still showed increased NSE levels. The percentage of elevated NSE and CEA concentrations increased with the extent of the disease. However, CEA was within the normal range and NSE was elevated only in 33% of SCLC patients with tumor stage TNM II, this limits the use of these markers in early tumor stages. Liver and bone metastases were always indicated by elevated NSE levels. CEA was increased in 3/4 patients with brain metastases, and NSE only in l/4 patients.Theserum levelsof NSEandCEAdependedonthe histological subtypesofSCLC. IncreasedCEAIevelsweremorefrequent inpatients having the intermediate type of SCLC than in patients with the oat-cell type. CEA was more frequently positive than NSE in patients with limited disease and intermediate cell type, whereas NSE was positive more often than CEA in the oat cell type. The pretherapeutic NSE concentrations were found to be of prognostic significance, in contrast to theCEAvalues.Patients with NSEleveIs< 11.8 *g/l had significantly longer survival rates than patients with NSE > 1 I .8 agil. The usefulness of serial NSE and CEA determinations during the treatment and follow- up of 90 patients with small cell lung cancer (SCLC) was investigated.

Treatment of SCLC by chemotherapy resulted in a decrease of the pretherapeutically elevated NSE levels to normal values (< 12.5 *fl) when there was clinical evidence of complete or partial remission in 27l 31 (90%) patients after the first and in 31/31 (100%) after the second cycle of therapy. By contrast, CEA reached normal values (< 5 -gfi) in 6/31 (19.4%) patients after the first and in 15/31 (48.4%) after the sixth cycleoftreatment. In 1 l/l 1 (lOO%)patients with StabIediseasetheNSE levels did not normalize, and the CEA values remained above normal in 7/S (87.5%). Progressive disease (PD) was accompanied by rising NSE levels in 40/42 (95.2%) patients and by rising CEA levels in 28/42 (66.7%). The rise of NSE preceded the clinical evidence of PD by 34.7 - 7.8 days whereas increasing CEA values were observed 36.6 ?? 15.4 days prior to or 54.2 - 6.9 days after the radiological signs. The survival time of patients from the start of rising NSE values at PD correlated significantly withthedoubling-timeoftheNSEconcentrations,whereas the CEA doubling-time did not correlate with survival.

Clinical evaluation of Tl-201 single photon emission computed tomography in patients with suspected bronchogenic carcinoma Tonami N, Shuke N, Seki H et al. Departmem of Nuclear Medicine, Kanazawa University School of Medicine, Kanamva City 920. Jpn 1 Nucl Med 1988;25:1381-94.

Single photon emission computed tomography (Early scan and Delayed scan) was performed using 8-10 mCi of n-201 chloride in 30 patients with suspected bronchogenic carcinoma. An abnormal uptake was observed in a11 of 23 malignant lung lesions including 21 broncho- genie carcinomas. A small primary lesion of 1.5 x 1.0 x 1.5 cm was clearly visualized. Two of 7 benign conditions showed positive TI-201 studies. In theTl-201 uptakeratio pervoxel of the lesion to theopposite normal lung in the Delayed scan, there was a significant difference between bronchogeniccarcinomaandbenigncondition(p<O.Ol). In the Tl-201 Retention Index which was obtained from both Early and Delayed scans, there was a significant difference between bronchogenic carcinomaandbenigncondition (p<O.O5). In thedetection of mediastl- nal metastases from bronchogenic carcinoma on TI-201 Delayed scan Vuc positive was 71% (5/7). The smallest lesion was 5.1 cm in diameter. Two patients with false negative had small metastases less than 1 .O cm in diameter. Two of 10 patients without mediastinal melastasis showed false positive. Our results show that Tl-201 SPECT provides excellent scnsltivity in the detection of malignant pulmonary lesions and can effectively differentiate malignant lesions from benign conditions and can be also used in the diagnosis of mediastinal m&stases from hronchogenic carcinoma.

Liver-spleen visualization following aerosol lung ventilation with Technetium-99m DTPA. Goyer P, Silverman E, Karvelis K. Division ofNuclearMedicin.e, Naval Hospital, Bethesda, MD 20814. Clin Nucl Med 1989;14:141-2.

In addition to lung distribution, a Tc-99m DTPA aerosol study also

revealed prominent hepatic and splenic uptake. These images sW3est the presence of colloidal forms of Tc-99m and thus ilIas@ate the necessity of rigorous radiopharmaceutical quality control. ParticoIarIY if clearance times are calculated.

Technetium-99m HMPAO and SPECT in the assessment of blood llow in human long turnours. RoweII NP, McCready VR, Tait DetaLMRCRadiobiology I/nil, Oxon. OX11 ORD. Br J Cancer 1989;59:135-41.

In order to assess the blood flow patterns through human lung turnours. 20 patients received 400-750 MBq 99Tc”HMPA0 intrave- nously 10 min before single photon emission computed tomography (SPECT). Ratios of uptake in the whole tumour relative to normal lung ranged from 0.35 to I.53 (mean 1.01) with eight turnours showing less uptake than normal lung and ten showing greater uptake. In one patient thetumoorwasnotdistinguishablefrom surroundinglungandinanother a large Pleural effusion prevented evaluation. Tumour: lung ratios for central tumour regions ranged from 0 to 1.83 (mean 0.80) with 13 showingloweruptakedmnnormallungand fiveshowinggreateruptake. Duplicate scans were performed in eight patients demonstrating satis- factory reproducibility. This technique provides a simple and reproduc- ible method for the assessment of turnour blood flow.

Submaximal invasive exercise testing and quantitative long scan- ning in the evaluation for tolerance of lung resection. Olsen GN, Weiman DS, Bolton JWR et al. Deparmenr of Medicine, University of South Carolina School of Medicine, Columbia. SC 29208. Chest 1989:95:267-73.

Lung resection in patients with cardiopulmonary dysfunction is associated wilh increased risk. We studied52 elderly male patients with airfIow obstruction and a lung mass. Studies were performed at rest with routine ventilatory tests and lung scan quantitation of right-left lung function. Cycle ergometry exercise was then performed at 2 submaxl- mal workIoads(25and40watts).Dalawereobtainedus~ngsystcmicand pulmonary artery catheterization for blood pressures, thermal dilution cardiac output, and blood gases. Twenty-nine patients underwent lung rescctionandseven failed to tolerate theprocedure(death within6Odays or prolonged ventilator dependence). Those parameters most clearly scparatingthcgrouptoleratingsurgery(n=22)from themtolerantgroup (n = 7) were obtained durmg exercise and included: cardiac index (tolerant5.5. 1.3vsinto1erant3.9~0.3L/min/m2,p<.01).0,delivery (p < .Ol) and calculated V*mdO, ml/kg/min (tolerant 11.3 - 2. I vs intolerant 7.8 * 1.5 mI/kg/min, p < ,001). Pulmonary vascular pressures and calculated resistance did not predict intolerance. Calculated V*mdO, at40 watts did not separate those patients who had survivable complications from those who did not (p >> .05). Multivariate analysis suggests that exercise V*mdO, is an important predictor of tolerance of lung resection because it reflects the effects of cardiac function and 0, transport. In our patients with COPD, submaximal exercise testing predicted intolerance of lung resection better than calculation usmg quantitative lung scanning. Exercise testing may accomplish this goal by uncovering deficits in 0, transport.

Diagnostic etXcacy of multiple tumor markers in lung cancer Pohl AL, Worofka B, Dudczak R, Schemper M. lnsrimfefor Clinical Chemistry, Laboratory Medicine, University of Vienna, A-1090 Vienna. J Tumor Marker Oncol 1988:3:387-97.

The tumor markers NSE, CA 19.9, CA 125, CA 15-3, CA 50, CEA and TPA were measured in strum from 106 patients with different bronchogenic carcinomas (n = 63) and non-neoplastlc lung diseases (n = 43). Multiple permutations of these markers were studied in search of the optimal combination of tests for differential diagnosis. Statistical processmg of all data by multivariate stepwise discriminant analysis (BMDP) yielded the marker panels with the greatest discriminative power. Classification functions (general form, e.g.: aIn[NSE] + bln[CA19-9]+ cIn[CA125] d) were used to assign the patients to the differentpathologicalgroups. NSE+CEA+CA 19.9discrimmatedbtxt between benign lung diseases (88% accuracy) and lung cancer (67%) as well as between small cell lung cancer (SCLC, 77%) and non-small cell lung cancer (non-SCLC, 55%); NSE + CA 19-9 = CA 125 classified correctly 74% of SCLC, 86%) of non-SCLC, 82% of lung adenocarcino-