296 Abstracts/Lung Cancer I2 (1995) 265-329

patients’ usual disease staging in the light of these abnormalities. Methods: After extensive staging investigations, patients’ diseases were classified as limited or extensive. Dorsal and lumbar spine MRI was performed for second staging. Readfs: Thirty-two patients were eligible for this study. In ten patients (31.2 percent), MRI showed abnormalities, in four of them, the BM sample from the posterior iliac crest was free from malignancy. Three of these four patients had extensive disease. The last patient, because he had limited disease, had biopsy at the site of MRI abnormalities; the biopsy specimen revealed a malignant involvement and therefore this patient, initially classiiied as having limited disease, was classified in the extensive disease group. In only 1 of 32 patients, BM-MRI data modified initial staging. Conclusions: The metastases disclosure yield of the MRI in the detection of medullar involvement is higher than BM biopsy but especially in patients with extensive disease. Therefore, MRI should not be considered in routine practice, in particular in patients with extensive disease.

Cranial computed tomography as a part of the initial staging pmce- dures for patients with non-small-cell lung cancer Ferrigno D, Bucchcri G. Ha Romita U. IS, l2OIl Borg0 S. Dalmam, Cuneo. Chest 1994;106:1025-9.

With the possible exception of chemotherapy for the small-cell type, a complete surgical excision is still the only effsctive treatment of lung cancer. Routine brain computed tomography (CT) for staging purposes has been both advocated and opposed. In this retrospective study, we aimed to assess the clinical yield of the technique. We saw I84 consecutive patients with a new histologically proven non-small-cell lung cancer. Using as reference criteria clinical judgment supported by a strict follow-up evaluation, WC counted 1 false- and 23 true-positive brain CT results, plus 2 false- and 158 true-negative findings. These figures allow for sensitivity, specificity, and accuracy of 92 percent, 99 percent, and 98 percent. The frequency of brain metastases did not correlate with the various histologic types, even though adenocarcinoma was the most common cause of cerebral metastases. The absence of neurologic symptoms did not exclude cerebral involvement: in our experience, 16 of 25 patients with positive brain CT scans were asymptomatic (64 percent). Three of 31 subjects (10 percent) with an otherwise operable carcinoma were found to have mctastascs st?er brain CT. We conclude that routine cranial CT is useful in the staging evaluation of the patient with non-small-cell lung cancer (NSCLC) and that it should be performed in any candidate prior to surgical resection.

Role of determination of serum zinc, copper, and copper/zinc ratio in evaluating diagnosis, therapeutic effect and prognosis of lung cancer Zhang Z-T. 4fh PeopleS Hospital. Suzhow Chin J Clin Oncol 1994;21:521-3.

The serum zinc, copper and Cu/Zn ratio were determined in 60 lung cancer patients and 100 healthy people from Nov. 1989 to Jan. 1992. The value of serum Zn in lung cancer group was much lower than that in the control group while the Cu and Cu/Zn ratio was much higher than that in control group 0’ < 0.001) and increased with escalation of disease from Stage I to IV Taking values of Cu 1.191 ppm and Cu/Zn ratio 1.38 as level of demarcation, the respective specificities were 87% and 88%. As compares with CEA value and DNA-P(CA) me.nsurcments ofCu, C&n ratio might contribute to the diagnosis, follow-up observation, therapeutic effect and assessment of the prognosis 8s well.

Serum q euroo-specici endase (S-NSE) in progressive small-cell lung cancer (SCLC) Jorgensen LGM, Osterlind K, Hansen HH, Cooper EH. Deparmtenr o/Clinical Chemisby 339, Hvidowe Hospital, 30 Keftegards AlIe. DK-2650 Hvidowe. Br J Cancer 1994;70:75961.

Clinical decision making is baxd on results from qualitative and quantitative information. To pmwdc quantitative data, various laboratory variables are widely used in the clinical evaluation of patients with small-cell lung cancer (SCLC). The tumour marker serum neuron-specific en&se (S-NSE) and the routine laboratory parameter serum lactate dehydrogenasc (S-LDH) have been investigated, mostly separately. Few shrdies have compared their importance in SCLC, cspcc~slly in progressive disease (PD). The present invesligation was undertaken to evaluate S-NSE for diagnostic efficacy in PD and compare it

with S-LDH. In 27 patients in a treatment trial of SCLC, regular follow-up laboratory values were prospectively obtained. Chemotherapy was given according to trial protocols, and all clinical evaluation followed the WHO recommendations. At re-evaluation all but three values had nomnlised (hvo S- NSE, one S-LDH). S-NSE at progression was increased in 93% of the patients and S-LDH in 59%. The eff~wy of S-NSE to discriminate behveen response and PD ~89 superior to S-LDH (0.92 vs 0.70). There was no additive effect of the hvo parameters in prediction of PD, and the discriminating power was higher for S-NSE than for S-LDH (P < 0.0008). The disease stahwrelated marker increments in relation to upper reference limits, i.e. the signal-noise relation, were higher for S-NSE than for S-LD. Both of the markers carry information on PD. S-NSE is, however, clearly sup&or to S-LDH in reflecting disease status during therapy. This prompts us to conclude that S-NSE should replace S-LDH as prognostic factor and disease activity monitor in SCLC.

The value of octreotide scintigraphy in patients with lung cancer Kwekkeboom DJ, Kho GS, Lambetts SWJ, Reubi J-C, I&sue JA, Krenning EP. Universily Hospital Dijkzigl, 40 Dr Molewalerp/cin. NL-3015 GD Rotterdom. Eur J Nucl Med 1994;21:1106-13.

We evaluated cctreotidc scintigraphy in 81 untnatld patients who were suspected of having bronchial carcinoma. Octreotidc scintigraphy visualized the primary tumour in all of 40 patients with non-small-cell lung carcinoma (non-SCLC), and all of 26 patients with SCLC. In the remaining patients, other bronchial disease and metastases fmm extrapulmonary carcinomas were also visualized. Modiastinal lymph node involvement and distant mctastases were recognized in 5 of I5 and I of 7 patients with non-SCLC, respxtively. In vitro, none of the non-SCLCs were shown to bear somatostatin receptors. We postulate that the visualization of non-SCLC during octreotidc scintigraphy is caused by binding of labcllcd octreotidc to activated leucocytcs or to proliferating neurocndocrine cells around the hlmours. In patients with SCLC, radiologically suspected lymph node involvement was visualized for 21 of 25 sites. Distant metastaxs. especially to the liver and abdomen, were missed for 14 of 20 sites, most probably because no laxatives were administered and single photon emission tomography of the abdomen was not performed. The failure to recognize liver mctastases is most probably due to a comparable upUlkc of radioactivity by the surrounding normal liver tissue. In 15 of 26 patients, previously unrecognizcal tumour sites were suggested during octreotide scintigraphy, leading to a downstaging of 5 of I4 patients with limited discasc. Unexpected cerebral metastases were suggested in five patients with either limited or extensive disease. In all four of these for whom follow-up was available, cerebral metastases became manifest 5-8 months at?er octrcotidc scintigraphy. We conclude (I) that octreotidc scintigraphy is of no use to differentiate SCLC from other lung disease, and (2) that octmotide scintigraphy should be included in the staging procedure of SCLC because it may allow early detection of metastases, especially to the brain.

Lung adeoocarcinoma and metastasis in cavernous bodies of the penis Casquero Ocio F, Fuertes Velez FJ, Gonzalez Gorospc F, Marws Santos F, Gimcno Alfos L. Ibarrecolmda. 21. 48015 Bilboo. Vizcaya. Neoplaia 1994;11:185-7.

The finding of penis metastases in patients with bronchogenic hunors is rare, both when the primary hunor is diagnosed and during treatment and follow- up. We describe a case of a man with an adenocarcinoma of the lung who presented a metsstases in the corpus cavemosum. We review the literature and we comment the most frequent symptoms, the diflbrent patems of spread and the different treatment modalities

Fiberscopic diagnosis in lung cancer. A report of 45 cases Hu I-Z.Tianjin Cancer Hospihd, Timjim Chin J Clin Oncol 1994;21:673-5.

Forty five cases of occult lung cancer (OLC) diagnosed by bronchotilxrscopy and pathologic examination were reported out of 7150 examinations. Forty one cases weren’t detected by X-ray, by bronchotiberscopy and 4 cases weren’t discovered by the above two methods until cytological diagnosis was made. In this &es, 25% were early stage lung cancer. In patients as seen here ordinaly X-ray examination and tomography atlen gave negative results. CT and NMR were nwrc effective and bronchotiberscopy was most efficacious in the detection of OLC. Repeated tiberscopic examinations and biopsies at different suspicious sites would increase the detective rate.