216

Right Heart Catheterization in the Pre-

operative Evaluation of Patients with Lung Cancer. Brundler, H., Chen, S., Peruchoud, A.P. Division of Respiratory Diseases, Depart- ment of Medicine, Kantonsspital, Universi- ty of Basel, CH-4031 Basel, Switzerland. Respiration 48: 261-268, 1985.

The right heart catherization and lung function data of 637 consecutive patients with lung cancer evaluated preoperatively were analysed retrospectively, in order to review our past experience, and to examine, whether a subgroup of patients could be identified, in whom invasive haemodynamic measurements were dispensable due to a predictable normal result. 95 patients (14.9%) had precapillary pulmonary hyper- tension, 44 (6.9%) already at rest, 51 (8.0%) on exercise only. In contrast, 276 patients (43.3%) had pulmonary hypertension secondary to abnormal left ventricular function, 67 (10.6%) at rest, 20q (32.8%) on exercise only. In order to characterize a subgroup of patients, in whom precapil- lary pulmonary hypertension is very unli- kely to be present, and in whom, therefore, right heart catheterization could be regard- ed as dispensable, a discriminant analysis was performed. By these means a discriminant function using FEVrl, Pa-2, DL (CO) - both on exercise - and RV/TLC as discrl- minant variables was obtained which can provide a qualitative prediction of pulmo- nary hypertension with a high sensitivity (at least 95%) and an acceptable specificity (approximately 50%). The usefulness of such a prediction was verified in a subsequent group of 71 patients. Precapillary pulmona- ry hypertension was correctly predicted in all cases; the specificity was 55%. It is concluded, that right heart catheterization has its value in the preoperative evaluation of candidates for pulmonary resection due to a high prevalence of compromised haemo- dynamics, and that patients with a negli- gible risk of having precapillary pulmona- ry hypertension can be identified by means of non-invasive functional measurements.

Transcarinal Mediastinal Needle Biopsy Com- pared with Mediastinoscopy. Brynitz, S., Struve-Christensen, E., Bor- geskov, S., Bertelsen, S. Department of Thoracic Surgery L, Bispebjerg Hospital, Copenhagen, Denmark. J. Thorac. Cardiovasc. Surg. 90: 21-24, 1985.

A total of 183 patients with abnormali- ties on the chest roentgenogram were ex- amined by bronchoscopy in conjunction with transcarinal mediastinal needle biopsy and mediastinoscopy to investigate the agreement between these methods regarding possible metastases. In 37 of the 159 pa- tients with malignant pulmonary lesions,

needle biopsy demonstrated metastases in the sub-

carinal lymph nodes. Mediastinoscopy had the same percentage of positive findings in the subcarinal nodes, but there was only agreement between the two methods in 20 cases. Transcarinal mediastinal needle biopsy as a supplement to conventional bronchoscopy is applicable in the outpatient evaluation of pa- tients with malignant bronchial lesions as a screen- ing for further examination. The method does not carry complications of any kind. Positive biopsy results, combined with other clinical findings, can at times spare the patient a mediastinoscopy. On the other hand, an adequately indicated needle biopsy which yields negative findings should always b@ followed by mediastinoseopy. In the planning of treatment for patients with malignant lesions of the lungs, it is of decisive importance to evaluate the dissemination of the tumor to the mediastinal. structures, primarily to the subcarinal and the contralateral lymph nodes.

Roentgenographic Evaluation of Mediastinal Nodes for Preoperative Assessment in Lung Cancer. McKenna, R.J. Jr., Libschitz, H.I., Mountain, C.E., McMurtrey, M.J. University of Texas System Cancer Center, MD Anderson Hospital and Tumor Institute, Houston, Tx, U.S.A. Chest 88:206-210, 1985.

Evaluation of mediastinal nodal metastases is a critical step in the assessment of potential surgi- cal candidates with lung cancer. Mediastinal tomo- graphy (TOMO) and chest computerized tomography (CT) visualize the mediastinal nodes more clearly than a chest roentgenogram (CXR). A prospective study was undertaken to determine the clinical vaiue of these three tests for mediastinal staging in 102 surgical patients with lung cancer. All patients underwent thoracotomy and mediastinal nodal dissec- tion. The roentgenographic findings were compared with the histologic evaluation of paratracheal, tracheobronchial angle, aortic window, subcarinal, and inferior pulmonary ligament nodes. TOMO, and especially CT, correctly predicted the size and location of mediastinal nodes; however, the overall accuracies were CXR (74 percent), TOMO (74 percent), CT (61 percent). These results demonstrated that the improvement in mediastinal imaging is counter- acted by the fact that enlarged nodes need not con- tain metastases and normal-appearing small nodes may harbor microscopic disease. Computed tomography and TOMO had little clinical impact on the assess- ment of mediastinal nodes in potential surgical candidates with lung cancer.

Bronchogenic Carcinoma: Staging with ~ Compared ~th Staging with CT and Surgery. Webb, W.R., Jensen, B.G., Sollitto, R. et al. Department of Radiology, University of California, San Francisco, CA, U.S.A. Radiology 156: 117-124, 1985.

Thirty-three patients suspected of having bron- chogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 under- went examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy

procedures performed, and eight underwent bron-