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Early Detection of the Central RClobronchial ao ’ Tl uptake ratio is a useful index for tumour Tunm by a New Imaging Technique doubling time in lung cancer

SHIMYAM?+ Mi MATSJI E, INCUE A, Do1 H, ( Gifu Univ. Schcol of Medicine, Gifu JAPAN 500) Ey using a new chest radiograph ccmbined with a vari- able sensitivity intensifying screen, we have evalu- ated 15 cases of endobronchial lesions which prcduced clinically symptan such as wheezing simulating asthmatic attack. .'Pherefore, it is clinically important to detect an endobronchial lesion obstruct- ing the central bronchial lmina as early as possible with a clearly identifiable imging technique. In generally, a conventional chest radiograph apts to fail to demonstrate the endobronchial tumor project- ing in the central bronchial lumina which are usually overlapped with mediastinal and heart shadow. The 15 cases we evaluated include sguamus cell ca. of 5 cases, carcinoid of 3 cases, en&bronchial ham&an of 2 cases, bronchial papillan of one case, and endo- bronchial metastasis of 3 cases. The new imaging modality clarified the early detection and lcxaliza- tion of the em&bronchial tumor obstructin$the central bronchial lumina, and extent of the bronchial stricture on a single chest radiograph. Conclusion; We considered that a chest radiograph with these imaging technique is superior imaging modality in the early recognition of an endobronchial lesion obstructing the central bronchial lumina. Also, the new imaging technique is useful to define the extent of central bronchial stricture on a single chest radiograph.

IiiK-OIl0I-i Takekawa’ ’ , K&hi Yamazaki” Naomi Watanabe”, Noriaki Sukou' ’ , Him&i &ikanel’, Shig~iOgura",ShosakuAbe",Yoshikazugawakami", andKszuoIto"' "First Department of Medicine and 2'Depsrtment of Nuclear Medidne, School of Medldne, Hokksldo, University, Sapporo, Japan The growth rate of lung cancer significantly influences the survival of the patient. Indicators for tumour doubling time in lung cfucer is needed to evaluate the prognosis of the lung cancer. Recently it is reported that =O’Tl can detect the lesion of lung cancer better than ‘-0a and that 20’ Tl uptake ratio shows tumour CharacteristiCS. MATERIALS AND METHODS Untreated primary lung cancer patients were studied in our institution. 15 minutes after intravenous administration of 3mCl =01 Tl, single photon emission computed tomography(SPECT) imaging ~sst.aken.~~‘Tl uptakeratioofthelesiontothe normaI lung was calculated. Tumour doubling time was messuredueingtheequationby Schwsrt.zontwoormore post&or-ant.erIorchsstX-rayiilms. RRSULTS "O'T1uptakerstiopostIveIycorreIst.edtumour doubIingt.ImesIgnIfIcantIy. CONCLUSION 20'T1 uptake ratio is a uaefuI index for predIct.IngtumourdoubIIngtImeinlungcancer.

240

A PATHOLOGICAL-RADIOLOGICAL STUDY OF THE TUMOR-LUNG MARGIN (TLM) OF PRIMARY LUNG CANCER.

Y. Fukuda, T. Urano.H. Kamihata. A.Pukmnoto,K.Y.Min,R. Yamamoto*. First DepartmentoftheInternal Medicine.FirstDeparrmentofthePathology*. Osaka MedicalCollege,Takauuki,JAPAN

Bothoftumor tissueitself andassociated oarenchvmal chaneea in thehme . . - are constructed into radiographic images of the tumor. Our pathological-radiological analysis of TLM showed importance of irma-alveolar organization to make radiological images of the tumor.

Slices at 2 to 3 mm in thickness from operatively resected 48 lung lobes for peripherally located lung cancer were obtained both for taking projected picturea on soft x-ray films and for histological analysis (29 adenocarcinomas (a&) and 19 squamous cell carcinomas (sqc)). The soft x-ray radiographs showed the TLW that were analyzed histologically.

Tumor cells had two prominent invasive pattems into the lung parenchyma at the TLM; alveolru filling growth (APO) and epithelium replacing growth (ERG). Irma-alveolar organization (IAO) were often seen nearby the TLM. AFU were often seen in adc cases and both ERG and IA0 were often in sqc (Table). The extents of these. ftiings were classified into 4 degeea (+/- to +++).

As conclusion. our pathological-radiological analysis of the TLMa suggest a reactive histological derangement of intra-alveolar organization can mcdify the radiological characteristics of the TLMs seen in radiographic images including high resolution CT.

Extent of AFG Extent of ERG Extent of IA0 +I- + ++ tc+ +I- + i-b +++ +I- + ++ 4-b-t

adc(29) 18 5 3 3 7 3 0 19 adc (29) 27 2 0 0 sqc (18’) 4 2 1 11 142 2 0 sqc (19) 8 6 1 4 * one case is excluded because of marked IAO.

241

Adrenal Masses in Lung Cancer: Sonographic Diagnosis and Follow-up

Christian Goerg, MD; W.B.Schwerk,MD; M.Wolf,MD; K.Havemann,MD. Department of Oncology, Philipps-University, Baldingerstrasse, 3550 Marburg, Germany

Ultrasound has become an important diagnostic modality in the staging of patients with lung cancer. Between 1980 and 1990 four hundred and ten patients with histologically proved lung cancer were evaluated. In 44 patients (11 %) an adrenal mass was discovered on ultrasound, in 13 patients isolated, in 31 with further of abdominal disease. Sonographic follow-up examinations of adrenal masses showed changes of size in all but 2 patients and therefore found to be adrenal metastases. In the two patients with stable adrenal disease sonographic guided fine-medle biopsy revealed adenomas. In conclusion: adrenal masses in patients with lung cancer are more likely metastatic than benign. The existence of neoplastic adrenal disease can be retrospectively confirmed by changes of size during sonographic follow-up examinations in allmost all patients. Histologic verification would only appear necessary in stable disease and in cases in which prompt diagnosis affects treatment decision.