Abstracts /Lung Cancer 12 (1995) 113-160 129

mediastinaI staging. Seventeen patients were involved in a prospective, blind study, to compare IS with CT-scan imaging of the mediastinum. Sensitivity and specificity of both methods were analyzed with reference to pathological staging by med&inal lymph node sampling. IS hnagmg was not possible in two patients owing to a thyroid uptake and one patient retimed surgery. Among the 14 evahtable patients, sensitivity and speciticity were 0.83 and 0.12 for IS, and 0.66 and 0.50 for CT- scan, respectively. We used different thresholds of positivity for both methods in order to evaluate the sensitivity-specificity relationship. When compared with that of IS. the area under the receiver operating characteristic (R.O.C.) curves of the CT-scan was bigger. Although one patient had pathologically confirmed N2 with negative CT-scan and positive IS, the results of IS were hampered by a very high level of false positivity. Finally, there was no relationship between positivity of IS and a high serum CEA level. Lack of speciticity and the insu&ient sensitivity of the iodine-131 anti-CEA-anti-CA 19-9, lead to the conclusion that IS adds weak information to a CT-scan, in the non- invasive mediastinal staging of lung cancer. Mom efficient radionuclides and markers are needed in the setting of lung cancer staging.

Bilateral Pancoast syndrome in a patient with metachmaous primary lung cancer Rea F, Marzucm C, Breda C, Fiore D, Sartori F. Chirurgia Toracica, Policlinico. Via Giustiniani 2, 35128 Padova. Ann Thorac Surg 1994;58:550-1. A rare case of double Pancoast tumor in a patient with metachronous imary cancer of the lung was treated with irradiation and operation. Both tumors were managed with pulmonary wedge resection and excision of involved chest wall. Six years atIer the first operation the patient is doing well without pain and respiratory failure.

Pucosyl-GM, in small-cell lung cancer. A comparison with the tumour marker neuron-specitic eaolase Drivsholm L, Vangsted A, Pallesen T, Hansen M, Dombemowsky P, Hirsch F et al.Department of Oncology, 5074 Rigshospitalet, 9 Blegdamwej, DK-2100 Copenhagen. AM Oncol 1994;5:6236. Backgmund: Recently, the ganglioside Fucosyl-GM, (FucGM,) has been described as a possible new tumour marker for small-cell lung cancer (SCLC). FucGM, has been detected in 75% to 90% of SCLC tumours by immunohistochemical analysis and in about 50% of sera from SCLC patients. Neuron-specific enolase (NSE) is a glycolytic enzyme which is expressed in the majority of SCLC tumours and patient sera. Patients and methods: Sera from 156 patients with SCLC were analyzed for FucGM, with a scintillation proximity assay (SPA), which is a simple and sensitive analysis. Sera were analyzed before the initiation of chemotherapy, and twenty patients were monitored during and after treatment. The concentration of FucGM, was compared to the tumour marker NSE and related to clinical data and survival. Results: Sixiy- three per cent of the patients were positive for FucGM,. The concentrations did not correlate with NSE or clinical data including stage of disease, organ site of metastases or ABO blood group status. Nor did the expression of FucGM, correlate with survival. As a monitor of clinical response, a correlation was found in 8 out of 20 patients. Eighty-four per cent of the patients were positive for NSE; and 97% were positive for either FucGM, or NSE. Conclusion: We conclude that FucGM, does not have a clinical role as a tumour marker for patients with SCLC at diagnosis or during treatment.

Effect of inhaled indomethacin for broncborrbea in a case of bnmchioloalveolar carcinoma Kawagochi S, Kobayashi H, Kanou S, Kiryo T, Nagata N, Shibata H. Third Dept. of Internal Medicine, National De/ewe Medical College, Tokomzmva, Saitama. Lung Cancer (Japan) 1994;34:53 1-5. We report the effectiveness of inhahxl indomethacin therapy for a case of bronchioloalveolar carcinoma with bronchorrhea. A 61-year-old woman was admitted to our hospital because of dyspnea, cough, and a large amount of transparent sputum. Chest roentgenogram showed bilateral difbtse intiltrative opacities. On admission, she produced about 100 ml of sputum a day (bronchorrhea). Chest CT scan showed the CT augiogram sign which has been reported to be a characteristic finding in bronchioloalveolar carcinoma. Transbronchial lung biopsy revealed well differentiated adenocarcinoma. Since the patient’s condition deteriorated, treatment was directed to reducing sputum volume and supportive care. There was no improvement atter 30 mg of prednisone daily, and she produced about 500 ml of sputum each day. Therefore, inhalation indomethacin therapy was started. Although sputum volume did not decrease, respiratory ditBcuhies were improved by a change in the increased viscosity of sputum which resulted in an easier expectoration. She died due to progressive respiratory failure, and autopsy revealed typical features of bronchioloalveolar carcinoma with marked mutinous production.

lmmunoscintigraphy using l%-Lahelled F(AB’), fragments of anti- carcinoembryonic antigen (CEA) monoclonal antibody for staging of non-small cell lung carcinoma Vuillez J-P, Moro D, Brambilla E, Brichon P-Y, Ferretti G, Saccavini JC, Brambilla C. Dept. Nuclear Med. and Biophysics, L.E.R., (IRA, CNRS 1287, U.ER. de Medicine. Domaine de la Merci, 38700 La Tronche. Eur J Cancer Part A Gen Top 1994;30: 1089-92. 28 patients with primitive lung cancers were imaged by immuno- scintigraphy (IS) with “‘iridium&belled F(ab’), anticarcinoembryonic antigen (CEA), to assess this technique for mediastinaI staging. IS revealed primitive tumours in 21 cases in whom mediastinai extension was assessed. Them was wnwrdance between clinical staging and IS confirmed by surgery in 17 cases, and discordance in 4. After surgery, discordance was in favour of IS in 2 cases (1 true positive and 1 true negative) and in favour of clinical staging in 2 (false positive of immunoscintigraphy). Anti-CEA IS could be useful for improving mediastinal staging of lung cancer.

Assessment of tumour necrosis and detection of mediastinal lymph node metastasis in bronchial carcinoma with technetium-99m sestamibi imaging: Comparison with CT scan Aktohm C, Bayhan H, Pabuccu Y, Bilgic II, Acar H, Koylu R. Nuclear Medicine Unit, Dept Diag Radio, Hammersmith Hop, Royal Postgraduate Medical School, Du Cane Road, London WI2 OHS. Eur J Nucl Med 1994;21:973-9. Thirty+ht patients with four major types ofbronchial carcinoma were studied to evaluate technetium-99m sestamrbi imaging in the assessment of tmnour necrosis and the detection of hilar and mediastinal lymph node metastasis. Quantitative analysis was also performed to ascertain whether tumour uptake values correlate with histological types of bronchial carcinoma. Gfthe patients, 34 showed tumour uptake on planar imaging (n = 38) and 27 on single-photon emission tomography (SPET) (n = 29), the overall sensitivity in the locahsation of primary tumour being 89% with planar imaging and 93% with SPET. Four types of tumour uptake pattern were identified: (1) focal uptake, (2) focal uptake