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Query: UMLS:C0242379 (lung cancer)
 71,905 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Previous reports have shown differences in the ability of CT to detect mediastinal lymph nodes, depending on the precise mediastinal location of the nodes. Poorest correlation between findings on CT and findings at autopsy has been described for left-sided lymph nodes, particularly those in the left peribronchial region (American Thoracic Society node station 10L), suggesting that cancers of the left lung might be less well staged by CT than cancers of the right lung. The relationship between the accuracy of mediastinal lymph node staging and the location of the primary lung cancer was examined in a retrospective study. In 103 patients with non-small-cell bronchogenic carcinoma who had preoperative CT evaluation of the mediastinum, the accuracy of preoperative staging was 81% for tumors of the right lung (70 patients) and 97% for tumors of the left lung (33 patients). The conclusion is that cancers of the left lung are staged at least as accurately as cancers of the right lung, despite the fact that left-sided mediastinal nodes are depicted more poorly on CT. Subcarinal and crossover (contralateral) nodal metastases and a low prevalence of metastasis involving only region 10L were the most important factors minimizing staging differences based on the site of the primary tumor.
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PMID:CT evaluation of mediastinal lymph nodes in lung cancer: influence of the lobar site of the primary neoplasm. 349 14

Computed tomography was evaluated for its accuracy in diagnosing mediastinal node metastases, direct chest wall invasion, and direct mediastinal invasion by lung cancer among 61 patients who subsequently underwent surgery. Using 15-mm diameter or larger mediastinal lymph nodes as the criterion for metastasis, the sensitivity was 36% (8/22); the specificity was 92% (34/37). The accuracy for direct chest wall invasion was relatively high, with a sensitivity of 100% (7/7) and a specificity of 92% (22/24). Direct mediastinal invasion had a sensitivity of 67% (4/6) and a specificity of 91% (10/11). These results suggest that the ability of computed tomography to diagnose mediastinal lymph node metastasis when such nodal size is used as a criterion is limited.
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PMID:Computed tomography for preoperative evaluations of lung cancer. 369 33

Forty-one patients with two subtypes of stage IIIM0 non-small-cell lung cancer treated over a 7-year period were evaluated. The first group of 20 patients had ipsilateral parietal pleural involvement not contiguous with the primary tumor but no distant metastases. Fifteen had positive pleural fluid cytology, seven with positive pleural biopsy in addition; four had extensive pleural studding or a positive biopsy but no effusion; and one had negative pleural fluid cytology. Treatment consisted of radiation therapy followed by combination chemotherapy in all. Due to symptoms, eight patients first had fluid drainage with or without sclerosis and two patients had a pleurectomy. Nine had progressive pleural disease despite the local treatment. To all modalities of therapy, only two patients had a partial response. One patient who had a pleurectomy lived 25 months. Median survival was 6.9 months. Cause of failure involved local progression in 17 patients. There was no difference in median survival by age, sex, histology, side of effusion, location of nodal disease, or use of local therapy. The second group of 21 patients had localized involvement of the parietal pleura by the primary tumor. There was deeper chest wall invasion in nine. All patients were rendered free of known disease by surgical resection, were stage T3N0-2M0, and received radiation and chemotherapy in addition to resection. The median survival was 13.5 months. There was local recurrence in nine patients but only one developed an effusion. Five patients were alive at 29-82 months. No variable unfavorably influenced survival except a central versus peripheral primary. Thus, the median survival of the patients in the first group with multiple sites of pleural involvement was similar to that of patients with distant metastases but with the cause of failure primarily local progression. In the majority of patients in the second group, parietal pleural and chest wall involvement, even with nodal metastases, did not translate into local failure, and long-term survival was possible.
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PMID:Pleural involvement in stage IIIM0 non-small-cell bronchogenic carcinoma. A need to differentiate subtypes. 372 77

The results of preoperative evaluation of tumor expansion and regional lymph node involvement were checked during surgery in 2 groups of lung cancer patients. Group 1 included 247 cases with preexisting and concomitant pulmonary pathology, while group 2-another 247 patients without such diseases. Errors in preoperative evaluation of tumor expansion were significantly more frequent in patients with concomitant pathology. Errors in assessing the nodal status were significantly more frequent in cases of preexisting and concomitant pulmonary diseases. The results may be useful in the choice of a surgical procedure for lung cancer.
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PMID:[Effect of prior and co-existing lung diseases on the determination of the degree of spread of lung cancer]. 378 78

CT was used to investigate the number and size of normal mediastinal lymph nodes at 11 intrathoracic nodal stations defined by the American Thoracic Society lymph-node mapping scheme. Nodal size was measured both as short- and long-axis diameters in the transverse plane. Findings for 56 patients show the largest normal mediastinal nodes to be in the subcarinal and right tracheobronchial regions. Upper paratracheal nodes were smaller than lower paratracheal or tracheobronchial nodes, and right-sided tracheobronchial nodes were larger than left-sided ones. From the distributions of node sizes, thresholds were set above which nodes in any region might be considered enlarged. These thresholds, in agreement with a prior investigation of patients with lung cancer, suggest 1.0 cm as the upper limit of normal for the short axis of a mediastinal node in the transverse plane.
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PMID:Normal mediastinal lymph nodes: number and size according to American Thoracic Society mapping. 387 Dec 68

The findings in 28 patients with synchronous lung cancers are reviewed. Mediastinoscopy and systemic staging were performed to exclude the possibilities that one pulmonary lesion was metastatic from the other or that both represented systemic metastases from another tumor. Nineteen patients underwent resection of both tumors. Median survival was 25 months for four patients with definite Stage I synchronous cancers (no nodal involvement; different cell types, bronchoscopically separate endobronchial lesions or arising from separate foci of carcinoma in situ) and was 27 months for seven patients with possible synchronous Stage I cancers (no nodal involvement; similar cell types; located in separate lobes). Median survival was 11 months for 16 patients having Stage II or III lung cancer accompanied by a second synchronous lung cancer. In the absence of hilar or mediastinal nodal involvement and systemic metastases, synchronous tumors should be considered separate primaries when located in different lobes, even if they have similar histologic features. Prognosis of synchronous cancers is related to the presence or absence of nodal metastases. Pneumonectomy is the operation of choice for synchronous unilateral tumors. With bilateral tumors, sequential resection starting with the most advanced lesion is appropriate. Preservation of lung tissue without compromising the cancer operation is critical.
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PMID:Diagnosis and management of synchronous lung cancers. 397 73

Seventy-five patients with lung cancer underwent a gallium scan and thoracotomy with total mediastinal nodal dissection. Evaluation of mediastinal lymph nodes by means of the gallium scan showed a sensitivity of 23 percent (3/13), a specificity of 82 percent (31/38), an accuracy of 67 percent (34/51), a positive predictive valve of 30 percent (3/10), and a negative predictive value of 76 percent (31/41) in those patients whose primary tumors demonstrated uptake of radioactive gallium. The low sensitivity was due to an inability to detect microscopic disease in mediastinal lymph nodes. The specificity was decreased by gallium-67 uptake in enlarged inflamed nodes that contained no metastases. These results do not support the use of the gallium scan in the selection of patients with lung cancer for thoracotomy.
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PMID:Critical evaluation of the gallium-67 scan for surgical patients with lung cancer. 397 28

Evaluation of mediastinal nodal metastases is a critical step in the assessment of potential surgical candidates with lung cancer. Mediastinal tomography (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 value of these three tests for mediastinal staging in 102 surgical patients with lung cancer. All patients underwent thoracotomy and mediastinal nodal dissection. 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 counteracted by the fact that enlarged nodes need not contain metastases and normal-appearing small nodes may harbor microscopic disease. Computed tomography and TOMO had little clinical impact on the assessment of mediastinal nodes in potential surgical candidates with lung cancer.
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PMID:Roentgenographic evaluation of mediastinal nodes for preoperative assessment in lung cancer. 401 74

The estimation of the extension of a lung cancer is actually made according to the rules of TNM system. On the basis of the reports of 100 patients who underwent thoracotomy and were staged according to this system after hystological examination of resected specimen (pTNM), the authors consider some not yet clear aspects of this staging. In particular they underline the wide difference between clinical and post-histological staging; the high rate of nodal involvement, if the surgeon always perform a radical excision of the lymph nodes; the further need of accuracy for the data N2 and T3; the role of the anatomo-pathologist for the correct staging pTNM.
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PMID:[Modern surgical staging of lung cancer]. 627 May 93

Lung cancer in patients under 40 years old is rare. Among 718 patients with lung cancer, 5% or 35 patients were younger than 40. All but one were heavy smokers. Twelve young patients who had operations survived 41.7 (SD 46.3) months: they included six who had resections of Stage 3 disease and who survived 19.2 (SD 16.0) months. The other six young patients treated operatively were free of nodal metastasis N0); all survived more than 3 years and three of them are apparently cured. The 23 young patients who were not treated operatively survived for 5.6 (SD 3.1) months. The 5 year survival rate of these young operated patients was not different from that of 201 operated patients over 40 years of age. Young nonoperated patients survived for a significantly shorter time (p less than 0.0001) than did the older patients who also received only chemotherapy and/or radiation as a treatment. In young patients adenocarcinomas predominated (48.6%), and the incidence of small cell undifferentiated cancers was high (28.6%). These significant differences as compared to the control group did not explain the short survival time of the young patients treated nonsurgically. We conclude that lung cancer in young persons is virulent and that diagnosis is frequently delayed. Therapy, in selected patients, should include aggressive resection, sometimes despite advanced local disease. This group of patients justifies innovative, intensive efforts at more prompt diagnosis and experimental multimodal therapy.
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PMID:Lung cancer in young persons. 627 30


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