A case of desmoid-type fibromatosis arising after thoracotomy for lung cancer with a review of the english and Japanese literature.

Chest wall desmoid-type fibromatoses are rare, locally aggressive tumors that occasionally arise from previous thoracotomy sites. Tumors arising from previous sites of thoracotomy to treat malignant disease should be discriminated from the pleural dissemination of the previous malignancy. In this study, we report a case of desmoid-type fibromatosis arising from a site for thoracotomy to treat lung cancer. Additionally we reviewed 15 reported cases of desmoid-type fibromatosis following thoracotomy and summarized their features. A 62-year-old woman was found to have a tumor on computed tomography (CT) at a 1-year routine checkup for lung cancer. The tumor (diameter, 3.4 cm) was located at the previous thoracotomy site. Positron emission tomography (PET) revealed mild (18)F-fluorodeoxyglucose (FDG) accumulation in the tumor, with a maximal standardized uptake value (SUVmax) of 1.9. CT-guided biopsy revealed only fibrous tissue. Eighteen months after the biopsy, CT revealed apparent tumor growth, and a biopsy revealed the same histology observed previously. The tumor was removed and diagnosed as desmoid-type fibromatosis. Currently, the patient is alive without recurrence 4 years after desmoid surgery.

Aberrant methylation of LINE-1, SLIT2, MAL and IGFBP7 in non-small cell lung cancer.

Genome-wide DNA hypomethylation and gene hypermethylation play important roles in instability and carcino-genesis. Methylation in long interspersed nucleotide element 1 (LINE-1) is a good indicator of the global DNA methylation level within a cell. Slit homolog 2 (SLIT2), myelin and lymphocyte protein gene (MAL) and insulin-like growth factor binding protein 7 (IGFBP7) are known to be hypermethylated in various malignancies. The aim of the present study was to assess the precise methylation levels of LINE-1, SLIT2, MAL and IGFBP7 in non-small cell lung cancer (NSCLC) using a pyrosequencing assay. Methylation of all regions was examined in 56 primary NSCLCs using a pyrosequencing assay. Changes in mRNA expression levels of SLIT2, MAL and IGFBP7 were measured before and after treatment with a demethylating agent. Methylation of these genes was also examined in 9 lung cancer cell lines using RT-PCR and a pyrosequencing assay. Frequencies of hypomethylation of LINE-1 and hypermethylation of SLIT2, MAL and IGFBP7, defined by predetermined cut off values, were 55, 64, 46 and 54% in NSCLCs, respectively and exhibited tumor-specific features. The hypermethylation of all genes was well correlated with changes in expression. The methylation level and frequency of MAL were significantly higher in smokers and in patients without EGFR mutations. Through accurate measurement of methylation levels using pyrosequencing, hypomethylation of LINE-1 and hypermethylation of SLIT2, MAL and IGFBP7 were frequently detected in NSCLCs and associated with various clinical features. Analysis of the methylation profiles of these genes may, therefore, provide novel opportunities for the therapy of NSCLCs.

[Esophageal fish bone migrating to the lung; report of a case].

A 55-year-old female felt a transient chest pain soon after a fish meal. Sixteen days later she presented a local clinic with fever of 38°C. After chest computed tomography( CT) and upper gastrointestinal endoscopy showed fish bone embedded in the wall of the middle portion of the esophagus, she referred to our hospital 22 days after the meal. Thirty days after the meal ,endoscopic removal of the fish bone was challenged bygastroentenologists in vain. Chest CT after the attempt showed migration of the fish bone to the lung adjacent to the right inferior pulmonary vein. The fish bone which stuck out from the lung after division of the pulmonary ligament was removed successfully under thoracoscopic surgery. The patient is well 26 months after the surgery.

Comparison of postoperative pulmonary function and air leakage between pleural closure vs. mesh-cover for intersegmental plane in segmentectomy.

BACKGROUND: To prevent postoperative air leakage after lung segmentectomy, we used two methods for the intersegmental plane: closing it by suturing the pleural edge (pleural closure), or opening it with coverage using polyglycolic acid mesh and fibrin glue (mesh-cover). The preserved forced expiratory volume in one second (FEV1) of each lobe and the postoperative air leakage were compared between the two groups. METHODS: For 61 patients who underwent pleural closure and 36 patients who underwent mesh-cover, FEV1 of the lobe before and after segmentectomy was measured using lung-perfusion single-photon-emission computed tomography and CT (SPECT/CT). The groups' results were compared, revealing differences of the preserved FEV1 of the lobe for several segmentectomy procedures and postoperative duration of chest tube drainage. RESULTS: Although left upper division segmentectomy showed higher preserved FEV1 of the lobe in the mesh-cover group than in the pleural closure one (p = 0.06), the other segmentectomy procedures showed no differences between the groups. The durations of postoperative chest drainage in the two groups (2.0 ± 2.5 vs. 2.3 ± 2.2 days) were not different. CONCLUSIONS: Mesh-cover preserved the pulmonary function of remaining segments better than the pleural closure method in left upper division segmentectomy, although no superiority was found in the other segmentectomy procedures. However, the data include no results obtained using a stapler, which cuts the segment without recognizing even the intersegmental plane and the intersegmental vein. Mesh-cover prevented postoperative air leakage as well as the pleural closure method did.

Diffusion-weighted magnetic resonance for pulmonary nodules: 1.5 vs. 3 Tesla.

The usefulness of diffusion-weighted magnetic resonance for assessing malignant pulmonary nodules was examined in 58 patients with 76 (58 malignant, 18 benign) pulmonary nodules (1.0-5.6 cm) who underwent 1.5-T and 3-Tesla imaging and (18)F-fluorodeoxyglucose positron-emission tomography prior to surgery. The sensitivities and specificities of these techniques for discriminating benign and malignant nodules were compared. The apparent diffusion coefficients of the pulmonary nodules on 1.5-T and 3-T imaging correlated significantly. The sensitivities and specificities for discriminating benign and malignant lesions were similar among the 3 imaging techniques: 1.5-T imaging, 0.91 and 0.90; 3-T imaging, 0.88 and 0.94; positron-emission tomography, 0.94 and 0.94. The apparent diffusion coefficient on 1.5-T imaging showed a significant reverse correlation with positron-emission tomography, and the correlation between 3-T imaging and positron-emission tomography was marginally significant. Both 1.5-T and 3-T diffusion-weighted magnetic resonance imaging modalities are equally useful for assessing malignant pulmonary nodules.

Combined subsegmentectomy: postoperative pulmonary function compared to multiple segmental resection.

BACKGROUND: For small peripheral c-T1N0M0 non-small cell lung cancers involving multiple segments, we have conducted a resection of subsegments belonging to different segments, i.e. combined subsegmentectomy (CSS), to avoid resection of multiple segments or lobectomy. Tumor size, location of tumor, and forced expiratory volume in 1 second (FEV1) of each preserved lobe were compared among the CSS, resection of single segment, and that of multiple segments. METHODS: FEV1 of each preserved lobe were examined in 17 patients who underwent CSS, 56 who underwent resection of single segment, and 41 who underwent resection of multiple segments, by measuring pulmonary function and lung-perfusion single-photon-emission computed tomography and computed tomography before and after surgery. RESULTS: Tumor size in the CSS was significantly smaller than that in the resection of multiple segments (1.4±0.5 vs. 2.0±0.8 cm, p=0.002). Tumors in the CSS were located in the right upper lobe more frequently than those in the resection of multiple segments (53% vs. 5%, p<0.001). Postoperative of FEV1 of each lobe after the CSS was higher than that after the resection of multiple segments (0.3±0.2 vs. 0.2±0.2 l, p=0.07). Mean FEV1 of each preserved lobe per subsegment after CSS was significantly higher than that after resection of multiple segments (0.05±0.03 vs. 0.03±0.02 l, p=0.02). There was no significant difference of these factors between the CSS and resection of single segment. CONCLUSIONS: The CSS is effective for preserving pulmonary function of each lobe, especially for small sized lung cancer involving multiple segments in the right upper lobe, which has fewer segments than other lobes.

A case of sclerosing hemangioma evaluated with diffusion-weighted magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography.

A 33-year-old female patient was referred to our hospital for further examination of an abnormal shadow evident on a chest X-ray film. Chest computed tomography (CT) revealed a solid nodule 1.9 cm in diameter in the hilum of the upper lobe of the left lung. Positron emission tomography showed high 18F-fluorodeoxyglucose accumulation in the nodule with a maximal standardized uptake value of 4.5, which favored a malignant lesion. Diffusion-weighted magnetic resonance imaging (DWI), which shows differences in the diffusion of water molecules and can discriminate between malignant and benign lesions, indicated that the nodule had a minimum apparent diffusion coefficient of 1.7 × 10-3 mm2/sec, which was higher than the cutoff value of 1.1 × 10-3 mm2/sec for discriminating between malignant and benign diseases; i.e., values equal to or lower than 1.1 × 10-3 mm2/sec favor malignant disease. The results of a CT-guided needle biopsy of the nodule favored sclerosing hemangioma. During surgery, the tumor did not appear to be invasive, and lymph node metastasis and dissemination were not apparent. On the basis of gross appearance, location, preoperative histological diagnosis, and DWI findings, the tumor was enucleated from the pulmonary parenchyma. Seven months after surgery, the patient was alive and had no evidence of recurrent disease.

Three young osteosarcoma patients with small adenocarcinoma or atypical adenomatous hyperplasia of the lung.

Three young osteosarcoma patients with adenocarcinoma (AD) or atypical adenomatous hyperplasia (AAH) of the lung are reported. A 14-year-old male patient with femoral osteosarcoma had solitary AD (case 1); a 23-year-old female patient with femoral osteosarcoma had AAH and lung metastasis (case 2); and a 17-year-old male patient with humeral osteosarcoma had AD and lung metastasis of osteosarcoma (case 3). They have been the youngest patients with lung cancer or AAH in our hospital. The maximum diameter of each lung tumor on computed tomography (CT) was 0.5, 0.6, and 0.5 cm, respectively. On immunohistochemical analyses, the p53 was positive in both AD and osteosarcoma and negative in both AAH and osteosarcoma. On genomic analyses, p53 mutation was detected in only one osteosarcoma (case 3). Epidermal growth factor receptor (EGFR) mutations, short in-frame deletion in exon 19, and insertion in exon 20 were found in AD, but not in AAH or osteosarcoma. There was no apparent genomic relationship between AD/AAH and osteosarcoma in the young patients in this study. Advances in CT and its applications to osteosarcoma patients as a method of assessing lung metastasis might contribute in large part to the detection of AD/AAH in patients younger than 30.

A segmentectomy of the right upper lobe has an advantage over a right upper lobectomy regarding the preservation of the functional volume of the right middle lobe: analysis by perfusion single-photon emission computed tomography/computed tomography.

PURPOSE: To evaluate the advantages of a segmentectomy of the right upper lobe (RUL) over a right upper (RU) lobectomy regarding the preservation of the functional volume of the right middle lobe (RML), the postoperative forced expiratory volume in one second (FEV(1)) of the RML was compared between an RU lobectomy and an RUL segmentectomy, by using a coregistered perfusion single-photon emission computed tomography and computed tomography (SPECT/CT). METHODS: The pulmonary function tests and perfusion SPECT/CT were conducted before and after surgery (RU lobectomy: 7; RUL segmentectomy: 13). The FEV(1) of the RML before and after surgery was calculated from the data of the pulmonary function test and SPECT/CT. RESULTS: In the RU lobectomy group, the percentage change of FEV(1) was 71% +/- 12%, which was significantly lower in comparison to 92% +/- 9% in the RUL segmentectomy group (P = 0.001). In the lobectomy group, the preoperative FEV(1) of the RML was 0.17 +/- 0.10 l, which decreased significantly to 0.06 +/- 0.06l after surgery (P = 0.009). In the segmentectomy group, FEV(1) of the RML before and after the surgery were 0.23 +/- 0.10 l and 0.20 +/- 0.111, of which the difference was not significant. CONCLUSION: An RUL segmentectomy has an advantage over an RU lobectomy regarding the preservation of pulmonary function, due to a greater preservation of not only the lung tissue, but also the FEV(1) of the RML.

Repeat FDG-PET for predicting pathological tumor response and prognosis after neoadjuvant treatment in nonsmall cell lung cancer: comparison with computed tomography.

BACKGROUND: The efficacy of fluorodeoxyglucose-positron emission tomography (FDG-PET) for predicting pathological tumor response and prognosis after neoadjuvant chemoradiotherapy followed by surgery in locally advanced nonsmall cell lung cancer (NSCLC) was compared to the predictive value of tumor size as determined by computed tomography (CT). METHODS: Thirty-seven consecutive NSCLC patients who received FDG-PET and CT scans both before and after neoadjuvant chemoradiotherapy were enrolled in this study. The percentage point changes in maximum standard uptake value (SUV) on PET and tumor size on CT after neoadjuvant treatment were defined as the SUV ratio and the size ratio, respectively, and were compared with pathological tumor response and prognosis after surgery. A major pathological response was defined as residual viable tumor cells corresponding to less than one-third the size of the original tumor. RESULTS: Nineteen and 18 patients showed major and minor pathological responses, respectively, after neoadjuvant treatment. The optimal cutoff values for predicting a major pathological response were 0.6 for the SUV ratio and 0.79 for the size ratio. The SUV ratio predicted the pathological tumor response with higher accuracy than the size ratio did (P = 0.04). Neither the SUV ratio nor the size ratio predicted prognosis after surgery. CONCLUSION: For predicting the pathological tumor response after neoadjuvant chemoradiotherapy, the SUV ratio on FDG-PET is superior to the size ratio on CT in patients with NSCLC. However, neither the SUV ratio nor the size ratio could predict prognosis.

Diaphragm perforation after radio-frequency ablation for metastatic lung cancer.

A case of diaphragm perforation after radio-frequency ablation (RFA) for lung metastasis from uterine cervical cancer is reported. The patient developed pelvic recurrence and solitary lung metastasis after a radical hysterectomy for uterine cervical cancer. Pelvic radiation and RFA for lung metastasis were performed. Metastasis was located in the laterobasal segment of the lower lobe of the right lung. RFA was repeatedly performed in September 2005 and August 2006. In May 2008, ¹8F-fluoro-deoxy-glucose (FDG) positron emission tomography-computed tomography showed evidence of local recurrence of the lung metastasis. A solid lesion with FDG accumulation accompanying a cystic lesion was observed in the lung base. The patient underwent a wedge resection of the lung in June 2008, during which a perforated area of the diaphragm (3 cm in diameter) was identified under the cystic lesion, which was not herniated. The perforation in the diaphragm was closed with a simple continuous suture.

Postoperative change in pulmonary function of the ipsilateral preserved lung after segmentectomy versus lobectomy.

OBJECTIVE: Anatomical repositioning and expansion of the ipsilateral preserved lung after lung resection may influence postoperative pulmonary function. To study the postoperative changes in pulmonary function of the preserved lung after lobectomy compared with that after segmentectomy, the preoperative and postoperative forced expiratory volume in 1s (FEV(1)) of the ipsilateral non-operated lobe was measured using perfusion single-photon-emission computed tomography and computed tomography (SPECT/CT). METHODS: Eighty-nine patients (n=24; lobectomy, n=65; segmentectomy) who were examined with pulmonary function test and perfusion SPECT/CT both before and after surgery were enrolled in this study. The FEV(1) values of the ipsilateral non-operated lobes before and after surgery were measured using perfusion SPECT/CT. RESULTS: The FEV(1) of the ipsilateral non-operated lobe increased after segmentectomy of the right upper lobe (p=0.07) and after both lobectomy and segmentectomy of the left upper lobe (p=0.04 and 0.001, respectively), but decreased after lobectomy of the right upper lobe (p=0.06). In the right upper lobe, the percentage change in FEV(1) of the ipsilateral non-operated lobe after lobectomy was significantly lower than that after segmentectomy (p<0.001). The FEV(1) of the ipsilateral non-operated lobe had not significantly changed after surgery on the lower lobes. CONCLUSIONS: The FEV(1) of the ipsilateral non-operated lobes increased after surgery on left upper lobe, whereas it decreased after right upper lobectomy. The surgery on lower lobe did not affect the FEV(1) of the ipsilateral non-operated lobes. Our data may facilitate determining the indications for lung cancer surgery, especially in patients with tumours involving the upper lobes.

Required area of lymph node sampling during segmentectomy for clinical stage IA non-small cell lung cancer.

OBJECTIVE: To investigate the required area of lymph node sampling during segmentectomy, especially for segmental nodes at the nonresected segments, we examined the distribution of sentinel nodes in patients with non-small cell lung cancer who underwent segmentectomy. METHODS: Ninety-four patients with clinical T1 N0 M0 non-small cell lung cancer were treated by using segmentectomy and dissection of lymph nodes with sentinel node identification using (99m)Tc-phytate. Anatomic locations of the segments were classified as either anterior or posterior, and correlations of anatomic location with the distribution of sentinel nodes at the segmental nodes were then examined. RESULTS: Of the 94 patients, segmental nodes at both the resected and nonresected segments could be dissected in 42 patients. Segmental sentinel nodes were found at the resected segments in 27 (64%) of these 42 patients, a frequency that was significantly higher than that (12/42 [29%]) seen at the nonresected segments (P = .001). Seven (47%) of the 15 patients with tumors in the anteriorly located segments had segmental sentinel nodes at the nonresected segments, a frequency that was significantly higher than that (4/24 [17%]) seen in patients with tumors in the posteriorly located segments (P = .04). CONCLUSION: The lymphatic flow from the anteriorly located segment can frequently go directly to the segmental lymph nodes of the posteriorly located segment, probably because the lobar bronchi locate at the posterior side in the thorax. Therefore segmental lymph nodes should be dissected at both the resected and nonresected segments during segmentectomy, especially for tumors in the anteriorly located segment.

A case of primary mediastinal ependymoma.

A 50-year-old female complained of back pain. Computed tomography showed a well-defined spindle-shaped mass 3.4 x 1.0 cm in size in the left paravertebral posterior mediastinum at the Th 3-4 level. The tumor was completely resected via thoracoscopic surgery, which showed no invasion into the surrounding tissue. It consisted of a cyst with a tiny mural solid element. By means of histological and immunohistochemical examinations, we diagnosed the tumor as ependymoma, and the patient remains alive 59 months after resection. As far as we know, 8 reported cases with primary mediastinal ependymoma have been reported. They had the following specific characteristics: (1) All patients were adult females; (2) The tumors were usually located at the paravertebral upper mediastinum; (3) Most of the tumors consisted of cystic and solid elements; (4) The tumors usually made no invasion into the surrounding tissues, though 2 cases had lymph-node metastases.

Is diffusion-weighted magnetic resonance imaging superior to positron emission tomography with fludeoxyglucose F 18 in imaging non-small cell lung cancer?

OBJECTIVE: This retrospective analysis examined whether diffusion-weighted magnetic resonance imaging might be as useful as positron emission tomography with fludeoxyglucose F 18 for (1) discriminating between non-small cell lung cancer and benign pulmonary nodules and (2) predicting aggressiveness of non-small cell lung cancer. METHODS: Diffusion-weighted magnetic resonance imaging and positron emission tomography were performed before surgery in 110 patients with 124 pulmonary nodules smaller than 3 cm, including 96 non-small cell lung cancers and 28 benign nodules. Diffusion of water molecules in magnetic resonance imaging was measured by minimum value of apparent diffusion coefficient. The criterion standard was the result of histologic diagnosis or follow-up examination. Sensitivity and specificity for differentiating between cancers and benign nodules were compared between diffusion-weighted imaging and positron emission tomography. Apparent diffusion coefficient in diffusion-weighted imaging and fludeoxyglucose F 18 uptake in positron emission tomography were examined with respect to pathologic tumor stage; lymphatic, vascular and pleural involvements; and histologic differentiation. RESULTS: There were no significant differences between diffusion-weighted magnetic resonance imaging and positron emission tomography in sensitivity or specificity for non-small cell lung cancer. Whereas positron emission tomography showed significant differences in fludeoxyglucose F 18 uptake between pathologic stages IA versus IB or more advanced stages; between tumors with and without lymphatic, vascular, or pleural involvement; and between well-differentiated and moderately or poorly differentiated adenocarcinomas (P <.01-0.001), no significant differences in apparent diffusion coefficient values in were observed. CONCLUSION: Diffusion-weighted magnetic resonance imaging is equivalent to positron emission tomography in distinguishing non-small cell lung cancer from benign pulmonary nodules but is not as useful for predicting aggressiveness of non-small cell lung cancer.

Positron emission tomography in lung cancer.

Recent advances in positron emission tomography (PET) with 2-deoxy-2-fluoro [F-18]-D: -glucose (FDG) has enabled not only the diagnosis and staging of lung cancer but also the prediction of its malignancy grade. However, FDG-PET has been known to have several pitfalls for imaging of lung cancer. For the effective clinical use of FDG-PET in lung cancer, we reviewed the pitfalls of using FDG-PET in the diagnosis of pulmonary nodules, semiquantitative analysis of FDG-uptake, N-staging, prediction of tumor aggressiveness, prognostic significance, and prediction of pathological response after chemoradiotherapy.

Extrapleural pneumonectomy with reconstruction of diaphragm and pericardium using autologous materials.

The procedures and results for extrapleural pneumonectomy through a lower door open thoracotomy with reconstruction of the diaphragm and the pericardium using a reversed latissimus dorsi muscle flap and a fascia lata graft, respectively, for the treatment of malignant pleural mesothelioma are reported. A posterolateral thoracotomy was extended along the anterior costal arch with cutting of the sixth to ninth costal cartilages. Defects of the diaphragm and the pericardium were reconstructed using reversed latissimus dorsi muscle flaps and fascia lata grafts, respectively. We conducted this procedure for seven patients with malignant pleural mesothelioma, with successful outcome.

Quantification of the impact of segmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomography.

OBJECTIVE: The impact of segmentectomy for preservation of pulmonary function was quantified by using a co-registered perfusion single-photon-emission computed tomography and multidetector computed tomography (SPECT/CT). METHODS: Pulmonary function tests and perfusion SPECT/CT were conducted before and after segmentectomy in 56 patients. Actual values of forced expiratory volume in 1 second (FEV(1)) after segmentectomy were compared with the FEV(1) after virtual lobectomy, which was calculated by SPECT/CT. The preoperative and postoperative FEV(1) of each lobe that had undergone segmentectomy was measured by SPECT/CT. RESULTS: The mean percent of FEV(1) preserved after segmentectomy was significantly higher than the value after virtual lobectomy (88% +/- 9% vs 77% +/- 7%; P < .001). Whereas the mean value of the preoperative FEV(1) of each lobe that was undergoing segmentectomy was 0.51+/-0.21 L, segmentectomy could preserve 41% +/- 24% of it. The FEV(1) of each lobe after the resection of more than three segments (n = 4) was preserved in 17% +/- 12% of the preoperative values, which was significantly less than 49% +/- 23% and 35% +/- 22% after the resection of one (n = 29) and two (n = 23) segments (P = .02 and .08, respectively). The FEV(1) of the left upper lobe after the upper division segmentectomy (n = 8) was preserved in 21% +/- 11% of the preoperative values, which was significantly less than 35% +/- 12% after the lingular segmentectomy (n = 7) (P = .03). CONCLUSION: Segmentectomy can preserve the pulmonary function more significantly than lobectomy, except for the resection of more than three segments or the left upper division segmentectomy.

Evaluation of semiquantitative assessments of fluorodeoxyglucose uptake on positron emission tomography scans for the diagnosis of pulmonary malignancies 1 to 3 cm in size.

BACKGROUND: To determine the optimal method of evaluating fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) for the diagnosis of pulmonary malignancies, the sensitivity and specificity of visual assessment and the several semiquantitative analyses were compared. METHODS: Positron emission tomography data were analyzed for 130 pulmonary nodules from 1 to 3 cm in size (101 malignant and 29 benign nodules). The FDG uptake was measured by maximum standard uptake value (SUVmax), the contrast ratio (CR) of the SUV to the cerebellum (CR brain), and the CR of the SUV to the contralateral lung (CR lung). The CR lung was calculated from the SUV of the tumor (T) and that of the contralateral normal lung (N) and then was measured by two formulas, namely, T-N/T+N and T/N. RESULTS: The sensitivities of both CR lung T-N/T+N and CR lung T/N were significantly higher than those of visual assessment, SUVmax, and CR brain (p = 0.01 to p < 0.001). No significant difference in sensitivity was observed between the CR lung T-N/T+N and CR lung T/N. Both CR lung T-N/T+N and CR lung T+N successfully imaged well-differentiated lung adenocarcinoma more frequently than the visual assessment, SUVmax, and CR brain (p = 0.002 to p < 0.001), whereas there were no significant differences of sensitivity among those five methods for the diagnosis of other histologic types of pulmonary malignancies. CONCLUSIONS: The FDG uptake evaluated by the CR lung is superior to that evaluated using the visual assessment, SUVmax, and CR brain for the diagnosis of pulmonary malignancies, especially for well-differentiated lung adenocarcinoma. The simplified formula of CR lung with T/N can be used in place of that with T-N/T+N.

Difference of sentinel lymph node identification between tin colloid and phytate in patients with non-small cell lung cancer.

BACKGROUND: The advantages and disadvantages of technetium Tc 99m tin colloid and technetium Tc 99m phytate as tracers for sentinel node (SN) identification in patients with clinical stage I non-small cell lung cancer were examined retrospectively. METHODS: Sentinel node identification was conducted using tin colloid and phytate, respectively, in 73 and 74 patients with clinical stage I non-small cell lung cancer. We compared these two tracers in terms of identification rates, numbers of SNs, characteristics of patients whose SNs could not be identified, and the pathologic results of SNs. RESULTS: The tin colloid tracer identified SNs in 54 of the 73 patients (74%), which was significantly lower than the 89% (66 of 74 patients) in the phytate group (p = 0.02). The number of SNs per patient was 1.7 +/- 0.8 in the tin colloid group, which was significantly less than the 2.4 +/- 1.5 in the phytate group (p = 0.002). Although patients in the tin colloid group whose SNs could not be identified had a significantly lower forced expiratory volume in 1 second to forced vital capacity ratio than those whose SNs could be identified (p = 0.04), the phytate group did not show such a difference. Eleven of 120 patients whose SNs could be identified had pathologic N1 or N2 disease, but neither group showed any false-negative results for SN identification. CONCLUSIONS: Both tin colloid and phytate are reliable tracers for identifying SNs in non-small cell lung cancer. The advantage of phytate is that SNs can be detected more frequently than with tin colloid, even in patients with a low forced expiratory volume in 1 second to forced vital capacity ratio. However, tin colloid requires fewer nodes than phytate to identify SNs.