6!

variation in measurements was I0 to 265%,

while the intraobserver variation was be- tween 3.5 and 9.5%. The correlation between "responses" calculated on the first and second readings often was no better than chance alone. Subjective impressions of degree om improvemnt showed no good corre- lation with response rates measured objec-

tively. Because of the large variation in mea-

surement and, consequently, in response rates, we recommend that all radiographs should be reviewed by a single observer for any particular study, and pre- and post-treatment radiographs should be eva-

luated together.

Comparison Between Digital Radiography and Conventional X-ray Radiography in the Diagnosis of Lung Cancer. Tanimura, S., Tomoyasu, H., Banba, J., Masaki, M. Department of Thoracic Surgery, Toranomon Hospital, Tokyo, Japan.

Although chest x-ray roentgenogram and tomogram are the first and the most impor- tant examinations in the diagnosis of chest disease, they are always accompanied with the drawbacks of conventional screen-film radiography. Fuji computed radiography (FCR), a new system of digital radiogra- phy by Fuji Photo Film Co. Ltd., elimi- nated these disadvantages of conventional radiography (M. Sonoda, Radiology, 148, 833, 1983). Since March 1983, FCR had been used on 30 selected patients to make a comparison between the capability of FCR and that of conventional radiographs revealing a variety of pathologic states.

The results were as follows: (i) more various types of image enhancement were made possible by manipulation of the digital information in FCR; (2) visibi- lity of various structures like bronchi, pulmonary vessels and so forth was consi- stently better on the digital images; (3) a fairly good image was obtained only with the one tenth x-ray exposure of the

conventional radiography. Because of its high imaging capability,

FCR will be useful in chest x-ray diagno- sis especially in mass surveys for lung cancer and in primary care medicine.

Clinical Detection of Bone Marrow Relapse in Patients with Small Cell Bronchogenic Carcinoma (SCC). Paul E.G. Kristjansen, Kell ~sterlind, and Mogens Hansen, Bispebjerg Hospital and Finsen Institute, Copenhagen, Denmark.

Among 874 consecutively treated patients with SCC, patients with a normal pretreat- ment bone marrow examination and a final post mortem examination, including micro- scopical bone marrow evaluation, were re-

viewed in order to evaluate whether bone

marrow relapses are detectable by routine cli-

nical investigations during treatment.

104 patients fulfilled the criteria for in- clusion into the study. Marrow metastases we- re at autopsy demonstrated in 36 of the 104 patients (36%): in i0 of 29 patients (35%) presenting before treatment with advanced disease, and in 26 of 75 (35%) presenting with local disease.

Only 34% of patients with thrombocytopenia persisting for at least 2 weeks during treat- ment developed marrow metastases. Among pa- tients with a 100% increase in both LDH and alkaline phosphatase concentrations during treatment, 73% had marrow metastases at autop- sy.

95% of patients with marrow metastases at autopsy had a terminal LDH concentration > 2 x nadir.

It is concluded that dose modification, oc- currence of leucopenia plus fever, the need of RBC transfusions, the incidence of leuco- penia, and thrombocytopenia are without any predictive value regarding development of bo- ne marrow relapse during cytostatic treatment. Significant increases of the concentrations of LDH and alkaline phosphatase are, however, correlated to bone marrow relapse in SCC.

Radiologically Occult Cancer of Peripheral Lung. Bai, Y.X., Huang, X.M., Song, H.F., Tang, J. F., Huai, P. General Hospital of PLA, Beijing,

China. Radiologically occult lung cancer occurs

mainly in the large bronchi. This form of peri- pheral lung cancer is extremely rare. To our knowledge, only a few cases have been previ- ously reported in the English Literature. We have observed two patients with occult squa- mous cell carcinoma in this region. Cytologic examination of sputum showed conclusive eviden- ce of carcinoma.

Following this finding a chain of investi- gations, including repeated tomographic stu- dies and bronchoscopies, was instituted with- out any abnormalities found in this two cases. On follow-up observations, a tumor shadow was detected by chest x-ray films in each cases after a lapse of 3 years and 6 months.

Under this condition, a location of the tumor within the reach of bronchoscopy is, na- turally, of paramount importance. Unfortunate- ly, this is often difficult. Then the chest film follow-up examinations become the most helpful procedure in localization of the lesion.

Diagnosis of Lung Cancer Through Linear Array Endoscopic Ultrasonography. Kasashima, M., Tsuda, M., Sugiyama, S., Tatsu-

suma, T., Yamamoto, K. First Department of Sur- gery, Toyama Medical and Pharmaceutical Uni-

versity, Toyama, Japan.

From November 1983 to February 1985, ultra-