the mesotheliomas gave positive reactions.

The monoclonal anti-CEA antibody was reac-

tive in 36 of the adenocarcinomas (72%), but

in none of the mesotheliomas. Our results

indicate that, in addition to HMFG-2 and

CEA, the expression of Leu M1 antigen by

most primary pulmonary adenocarcinoma (94%)

and its absence in mesothelioma could be

used as a valuable marker for primary

adenocarcinoma of the lung that involves the

pleura and permits its differentiation from

mesothelioma.

5. CLINICAL ASSESSMENT

Bronchial Brushing and Bronchial Biopsy:

Comparison of Diagnostic Accuracy and Cell

Typing Reliability in Lung Cancer.

Matsuda, M., Horai, T., Nakamura, S. et al.

Department of Respiratory Diseases and

Clinical Cytology, Center for Adult Dis-

eases, Higshinari-ku, Osaka, Japan. Thorax

41: 475-478, 1986.

A total of 443 patients with lung can-

cer underwent brush and forceps biopsy

through a fiberoptic bronchoscope. The

biopsy was taken from the area of suspected

malignancy which had been brushed. Of 443

patients, 400 (90.3%) showed positive

results on brushing and 287 (64.8%) on

biopsy. A combination of both techniques

yielded the highest percentage of positive

diagnoses (93.7%). Histologically, there was

a high incidence of positive diagnosis for

squamous and small cell carcinoma. One

hundred and three (83.7%) of 123 specimens

obtained by brushing and 75 (81.5%) of 92

specimens obtained by biopsy agreed with the

cell type found in the surgical or necropsy

specimen. Cell typing accuracy was higher in

squamous and in small cell carcinoma in both

techniques. As the cell typing accuracy of

the two methods is similar, the results ob-

tained by both techniques should be taken

into consideration in the management of in-

dividual cases of lung cancer.

Transbronchial Needle Aspiration Staging of

Bronchogenic Carcinoma.

Schenk, D.A., Bower, J.H., Bryan, C.L. et

al. Pulmonary Disease Service, (SGHMMP),

USAF Medical Center, Lackland, AFB, TX

78236, U.S.A. Am. Rev. Respir. Dis. 134:

146-148, 1986.

Transbronchial needle aspiration (TBNA)

has been advocated as a reliable technique

in the nonsurgical staging of patients with

37

bronchogenic carcinoma. Some have questioned

the reliability of TBNA, however. We used

TBNA directed by computed tomography (CT) in

88 consecutive patients with bronchogenic

carcinoma who had undergone chest CT. Chest

CT was 94% sensitive, 79% specific, and 85%

accurate in evaluating the mediastinum for

malignant lymphadenopathy. There were 19

malignant aspirates in 44 patients with

malignancy and apparent adenopathy evaluated

by chest CT. No malignant carinal aspirates

were obtained in any patient with a normal

mediastinum evaluated by chest CT. There

were 2 false positive needle aspirates. One

patient with apparent right paratracheal

adenopathy and malignant needle aspirate had

no mediastinal neoplasm detected at surgery.

The other false positive aspirate had been

contaminated by tracheal debris. The overall

sensitivity, specificity, and accuracy of

TBNA mediastinal staging were 50, 96, and

78%, respectively. We conclude that CT scan-

ning is a useful adjunct in the staging of

patients with bronchogenic carcinoma, and

that TBNA is a sensitive and highly specific

staging technique that may negate the need

for surgical staging in a large number of

patients with bronchogenic carcinoma.

Primary Lung Cancer Staging: Prospective

Comparative Study of MR Imaging with CT.

Musset, D., Grenier, P., Carette, M.F. et

al. Department of Diagnostic Radiology,

Hopital A. Beclere, 92140 Clamart, France.

Radiology 160: 607-611, 1986.

Forty-four patients with bronchogenic

carcinoma were studied prospectively by both

computed tomography (CT) and magnetic

resonance (MR) ~m~ging of the thorax during

the week preceding thoracotomy. Transaxial

MR imaging sequences included TL- and T2-

weighted sequences. Coronal and sagittal TI-

weighted sequences were added according to

tumor location. CT and MR studies were

reviewed separately, and the results were

compared with surgical and pathologic find-

ings on the basis of TNM classification. No

statistically significant differences were

found between the two imaging methods for

the evaluation of tumor extent or node in-

volvement. T2-weighted sequences did not

yield further information on tumor extent or

node involvement. Additional imaging planes

(coronal or sagittal) appeared useful to

study chest wall invasion. Analysis of con-

cordances and discordances did not indicate

whether one modality could be substituted