200 Abstracts/Lung Cancer 13 (199s) 185-232

Bronchioloalveolar carcinoma Clinical assessment Jones DF, Chin R Jr, Haponik EF. Woke Forerr Universily, Bowman Gray School of Medicine, Department of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-lOS4. Chn Pulm Med 1995;2: 129-37.

Bronchioloaiveolar carcinoma is an increasingly common type of lung cancer. Its nonspecific clinical manifestations, diverse roentgenographic presentations, and associations with some chronic lung intlammatoty conditions make it an important, potentially treatable consideration in many patients, Because of the amenability of localized disease to surgical cure and the devastating course. of dilfuse involvement, recognition of bronchioloalveolar carcinoma in its early stages is essential. More information about cellular origins and predispositions to this tumor is needed if effective prevention is to be achieved.

The role of human chorionic gonadotropin g subunit elevation in small-cell lung cancer patients Sztmmowicz M, Wiatr E, Sakowicz A, Slodkowska J, Rosskowski K, Filipecki Set al. Department ofIntemalMedicine, Institute Tuberculous/ Lung Diseases, Plocka 26, 01-138 Warsaw. J Cancer Res Clin Gncol 1995;121:309-12.

Observer variability in histopathological reporting of malignant bronchial biopsy specimens Burnett RA, Beck JS, Howatson SR, Lee FD, Lessells AM, McLaren Kh4 et al. University of Glasgow, Department of Pathology Western Injrmary, Glasgow GII 6NI: Scotland. J Clin Pathol 1994;47:711-3.

Aims - To evaluate the ability of histopathologists to classify lung carcinomas on bronchial biopsy material using the current World Health Organisation (WHO) chrssiflcation. Methods -Eleven histopathologists each reviewed 100 randomly selected bronchial biopsy specimens which had originally been reported as showing lung carcinoma. A single haematoxylin and eosin stained section from each case was circulated and a standard proforma completed. These were anaJysed using kappa statistics. Results -The histopathologists were. excellent at distinguishing between small cell and non-small-cell carcinoma kappa = 0.86), but not so good at subclassiijing the non-small cell carcinoma group kappa = 0.25). Conclusions - The clinically important distinction between small cell and nonsmall cell carcinoma of the lung is reliably made by competent histopathologists even on limited material.

Human chorionic gonadotropin (HCG)-like immunoreactivity has been found in many non-trophoblastic turnours, but the biological behaviour of HCG-producing cells has not been clarified yet. The aim of the study was to estimate the frequency of Serum HCG 6 subunit (s6HCG) elevation in patients with small-cell lung cancer (SCLC) and to assess its possible prognostic role in this type of tumour. An attempt was also made to reclassify the histology in selected cases to see whether the elevated (st3HCG) level is connected with any special subtype of small-cell lung cancer. A total of 156 SCLC patients entered the study: 93 men, 63 women, medianage 58 years. sgHCG activity was measured by immunoenzyme assay (Abbott EIA DHCG 15-15) before treatment. sgHCG elevation (above 5 mIU/ml) was found in 21 of 156 patients (14%). Response to treatment after chemotherapy (complete and partial response) was obtained in only 48% of those patients in whom elevated sDHCG was found, in comparison to the 73% response rate observed in the remaining patients. Only 5% of patients with elevated sbHCG survived 2 years, in comparison to 2 1% surviving for 2 years among the remaining patients. The prognostic significance of elevated sDHCG and extent of disease were independent ofeach other (Cox’s proportional- hazard model). Thus sbHCG elevation in SCLC seems to be a marker of more resistant tumours and of poor prognosis. We have not found any connection between the subtype of small-cell lung cancer and elevated s6HCG. Elevated sRHCG was found in 2 out of 11 patients with oat-cell carcinoma, in 3 out of 10 patients with an intermediate cell type and in 5 out of 13 patients with small-cell lung cancer in which the assessment of the subtype was not possible.

Intranodal and extranodal tumour growth in early metastasised non-small cell lung cancer: Problems in histological diagnosis Theunissen PHMH, Bollen ECM, KoudstaaJ J, Thunnissen FBJM. Department ofPathologv, De Wever Hospital, PO Box 4446, NL-6401 CX Heerlen. J Clin Pathol 1994;47:920-3.

Serum levels of interleuhin 6 in patients with lung cancer Yanagawa H, Sone S, Takahashi Y, Haku T, Yano S, Shinohara T et al Third Departmentlnternal Medicine, University of Tokushima, School of Medicine, Kuramoto-cho 3. Tokushima 770. Br J Cancer 1995;71:1095-8.

Aim - To question the observer reliability or agreement of reports on the intranodal and extranodal ttmtour growth patterns in early meta- stasiscd non-small cell lung cancer (NSCLC). Methods-In a pilot study original histological sections of mediastinal lymph node metastazs from NSCLC obtained by lymph node dissection (n = 82) or by media- stinoscopy (n = 62) were examined and classified independently by three pathologists as extranodal, intranodal, or indefinite. After clear criteria for these growth patterns had been defined sections were re- examined and recategorised one year later, Interobserver agreement was examined for both investigations. Results -In the dissected lymph nodes the kappa value improved significantly Tom 0.52 (moderate agreement) at the first investigation to 0.78 (good agreement) at the second. In the mediastinoscopic lymph node biopsy specimens an increase in kappa value from 0.50 at the first to 0.67 at the second examination was found, although this improvement was not signiticant. In mediastinoscopic biopsy specimens a very high proportion of tissue samples showed indefinite tumour extension Conclusion -Good reproducibility of intra- nodal and extranodal growth patterns in the histological examination of mediastinaJ lymph node memstases can be achieved, provided that pathologists use strictly defined criteria. In mediastinoscopic biopsy specimens it is often impossible to differentiate between intmnodal and extranodal tumour growth.

Senmi interleukin 6 (ILd) levels were measured in 75 patients with lung cancer and in 20 patients with benign lung diseases. IL-6 was detectable in 29 patients with lung cancer (390/o), but was not detect- able in any of the patients with benign lung diseases. Serum C-reactive protein levels and plasma fibrinogen levels were signiticantly higher and serum albumin concentration was signiticantly lower in lung can- cer patients with detectable serum IL-6 levels than in those without detectable serum IL-6 levels and in patients with benign lung diseases. On the other hand, no significant diietence was observed in blood plate- let counts in these three groups. Moreover, serum IL-6 levels were not signiticantly different in lung cancer patients with or without clinically demonstrated distant metastasis. These results suggest that IL-6 may bc a mediator of various reactions including an inflammatory response in lung cancer patients.

CT scanning of bronchioloalveolar carcinoma: Specific appearances Akata S, Fukushima A, Kakizaki D, Abe K, Amino S. Department of Radiology TO~J.V Medical College, 6-7-l Nishi-Shinjuku, Shinjuku-ku. Tokyo 160. Lung Cancer (Ireland) 1995;12:221-30.

We reviewed CT scans in 38 cases with pathologically proved bronchioloalveolar carcinoma. CT revealed three CT patterns: solitary,

Abstracts/Lang Cancer 13 (1995) 185-232 201

pneumonic and diffuse forms. The solitary pattern (22 patients) had a high percentage of air bronchograms (95%). pleural indentation (77%) and spiculation (68%). The pneumonia-like pattern (16 lesions in 10 patients) had air bronchograms in all cases (lOO%), low attenuation (88%) and protrusion of interlobar fissures (63%). The diffuse form (six patients) had 2 or 3 mm ditfuse small nodules scattered throughout the entire lung. CT of bronchioloalveolar carcinoma revealed many findings and was useful in recognizing the tumor distribution and extent. We conclude that CT is helpful for the diagnosis and evaluation of bronchioloalveolar carcinoma.

Molecular markers in early caneer detection: New screening took3 Mulshine JL, Scott F. KWC-800, BPRB, 9610 Medical Center Dr: RockviNe, MD 20850-3300. Chest 1995;107:6 Suppl28OSdS.

Better early detection strategies for lung cancer are clearly needed. About 20 years ago, cytomorphologic criteria were developed for use in staging bronchial epithelimn carcinoma. Yet, when sputum cytology was added to chest radiograph in the largest early-screening-of-lung- cancer study carried out to date, the three-arm trial sponsored by the National Cancer Institute, no major outcome benefit was shown. Sputum samples of participants in one of these trials, the Johns Hopkins Lung Project, have been archived. CurrentIy. sputum immtmostaining using two monoclonal antibodies directed at a dicosylated Lewis X epitope and a 3 I-kilodalton protein show correlation between positive staining of these samples and eventual development of lung cancer in the sampled population. Strategies to neutralize the stimulation of growth factors like gastrin-releasing peptide, which are seen in small-cell disease, are also being explored. Development of an epithelialdirected diagnostic test is the most important goal in obtaining early detection tools for lung cancer. Several new tests await prospective trials to evaluate their utility. In developing an early detection test for lung cancer, due to the chronic nature of the risk and the vast at-risk population, cost and patient compliance are two major concerns.

Biologic and molecular prognostic factors - Impact on treatment of patients with non-small cell lung cancer Johnson BE. Lung Cancer Biology Section, National Naval Medical Centec National Cancer Institute, Bethesda, MD. Chest 1995;107:6 Suppl:287S-90s.

A wide range of genetic and phenotypic abnormalities have been identified in lung cancer. However, only a few are known to have an impact on patient outcome and thus may influence choice of therapy. Biologic and molecular factors known in this regard include the epidermal growth factor family and its receptors, markers of neuroendocrine differentiation in non-small cell lung cancer, and mutations of the ras gene family. None of these factors, however, can be considered a standard for selection of patients for therapy until additional information is gleaned from ongoing prospective studies.

Radiologic evaluation in chest malignancies: A review of imaging modalities Pugatch RD. Department of Radiology, Harvard Medical School. Boston, u4. Chest 1995;107:6 Suppl:294S7S.

Radiologic evaluation of the patient with non-small ceil lung cancer (NSCLC) includes chest radiographs for detecting nodules, computed tomography (CT) for further characterizing them, CT and magnetic resonance imaging (MU) to evaluate the mediastlnum, and extmthoracic imaging of bones, the adrenal gland, the central nervous system, and liver. The current practice standards for each are reviewed. Asympto-

matic solitary pulmonary nodules, which are usually detected on chest radiographs obtained for other indications, inevitably require a precise diagnosis. The radiologic characteristics that differentiate benign from malignant pulmonary lesions are given. Mediastinal CT is the preferred modality for examining the mediastinum in patients with NSCLC. Magnetic resonance imaging is used selectively, eg, in patients with superior sulcus tumors who are candidates for surgery. When evaluation for N2M3 disease is requested, mcdiastinoscopy should replace CT using the latter as a ‘roadmap.’ The role ofextrathoracic imaging in evaluating asymptomatic patients with NSCLC at initial presentation is equivocal. Computed tomographic scanning of the head is reasonable in most patients with lung cancer, given the significant incidence of occult brain metastases in this population and that solitary brain lesions may bc resected in some protocol settings. Routine liver and adrenal gland scanning is similarly controversial Bone scans do not appear to be useful in patientswithNSCLC unless they have clinical signs, symptoms, or laboratory findings to indicate possible metastases. Although heavily affected by local practice, radiologic evaluation of the patient with NSCLC should attempt to provide accurate determination of local disease and a search for distant metastases.

Prognostic issues in non-small cell lung cancer Harpole DH Jr. Division of Thoracic Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. Chest 1995;107:6 Suppl:267S-9s.

A rational for the creation of a reproducible pathologic and molecular

cancer is presented along with an example patient.

18FDG in the primary staging of lung tumors. Results with a gamma camera and a 511 keV collimator Trampert L, Holle LH, Bertuzich R Alexander C, Ukena D, Ruth T et al. Radiologische Klinik. Abteilung Nuklearmedizin, Universitatsklinik, D-66424 Homburg/Saa,: Nuklearmedizin 1995;34:79-86.

The diagnosis of primary lung tumors requires a precise staging according to the TNM classitication. In contrast to established imaging methods ‘8Rxi describes the fnnctional metabolic processes in the tumor tissue due to increased glycolysis. This paper describes the use of ‘BFDG in the primary staging of lung tumors and metastasea 44 patients were studied with a gamma camera and a 5 11 keV collimator. In comparison to pulmonary ttmtors and me&stases detected by other imaging methods (107) the accumulation of ‘BFDG has a sensitivity of SS%, in lesions verified by histology (50) of 89%, in primary tumors (35) of 100% and in metastases (63) of 76% As an alternative to FDG PET studies, primary staging of lung tumors is possible with a gamma camera, suitable for FCT and fitted with a 5 11 keV collimator.

An overview of prognostic factor in lung’cancer Kudo S, Hino M. IVth Dept. of Internal Medicine, Nippon Medical School, I-1-5 Sendagi, Bunkyo-ku, Tokyo 113. Jpn JCancer Chemother 1995;22:827-35.

The current treatment results for lung cancer clearly call for improved therapy and also for careful selection of patients for the treatment options from which they are most likely to benefit. A detail knowledge of prognostic factor is important for achieving these goals. By the stratification of the important prognostic factors, the clinical studies can be ameased properly. In this report, prognostic thctors that established hitherto, clinicopathological factors, molecular biological factors are reviewed.