260

is recommended for safe and rapid assess-

ment of the value of MR in bronchial car- cinoma staging.

Incidence of Pulmona~Nodules Detected by Computed Tomography in Patients with Bron- chial Carcinoma. Mitchell, D.M., Shah, S.H., Edwards, D. et al. University College Hospital, London WCIE 6AU, United Kingdom. Clin. Radiol. 37: 151-152, 1986.

Computed tomography (CT) is more sensi- tive in detecting pulmonary nodules than conventional chest radiography. The inci- dence of pulmonary nodules on thoracic CT scans, not visible on chest radiographs, in patients with small-cell carcinoma of the bronchus (SCCB) was 27%, and in patients with non-small-cell carcinoma (non-SCCB) the incidence was 28%. Some of these nodu- les may be malignant. This has implications for the surgical staging of patients with lung cancer in the United Kingdom, where there is a lower incidence of benign gra- nulomatous nodules than in the USA.

Prospective Evaluation of Mediastinoscopy for Assessment of Carcinoma of the Lung. Luke, W.P., Pearson, F.G., Todd, T.R.J. et al. Division of Thoracic Surgery, Toron- to General Hospital, Toronto, Ont. M5G IL7, Canada. J. Thorac. Cardiovasc. Surg. 91: 53-56, 1986.

Between 1979 and 1984, mediastinoscopy was performed on 1,000 of the 1,500 patients admitted to the Thoracic Surgical Service of the Toronto General Hospital with the diagnosis of carcinoma of the lung. In 144 cases, concomitant anterior mediastinosco- py was also performed. Abnormal mediasti- nal nodes were found in 296 (29.6%). The overall complication rate was 2.3%, with no deaths. Mediastinoscopy revealed diseased nodes in 24% of patients with squamous cell carcinoma, 29% with adenocarcinoma, 54% with small cell undifferentiated carcinoma, 31% with large cell undifferentiated carci- noma, and 12% with bronchoalveolar carcino- ma. Abnormal mediast inal nodes were found with equal frequency in right- and left- sided tumors and occurred in 31% of tumors in the main bronchus, 25% of upper lobe tumors, and 17% of lower lobe tumors. Of the 704 patients having negative results of mediastinoscopy, 590 were subjected to tho- racotomy. Ninety-three percent underwent resection (85% curative, 7% palliative) and 7% had unresectable tumors. Of the resecti- ons, 20% were pneumonectomies. At thoraco- tomy, 52 of the 590 patients with negative mediastinoscopy were selected for thoraco- tomy. Eighty-six percent had resectable lesions (67% curative, 18% palliative) and 14% unresectable. The pneumonectomy rate in

this group WaS 35%. These current data sup-

port our previous opinion that routine medi- astinoscopy can be done with negligible mor- bidity and provides essential information for the classification and management of can- cer of the lung.

Role of Mediastinoscopy in Pretreatment Sta- ging of Patients with Primary Lung Cancer. Coughlin, M., Deslauriers, J., Beaulieu, M. et al. Division of Thoracic Surgery, Le Cen- tre de Penumologie de Laval, Quebec, PQ GIV 4G5, Canada. Ann. Thorac. Surg. 40: 556-560,

1985~ Since the introduction of mediastinosco-

py, there has been a great deal of discus- sion regarding indications for this techni- que and the significance of positive findings. We undertook this study to determine the ro- le of clinical staging and the value of rou- tine mediastinoscopy in the treatment selec- tion of patients with primary lung cancer. From 1975 to 1983, 1,259 consecutive patients with proven and operable lung cancer under- went preresection mediastinoscopy. Nodes were sampled at three levels, and findings were recorded by location, invasiveness, and histology. There were no operative deaths, but 3 patients had a major complication.Me- diastinoscopy was positive in 339 (27%) pa- tients and negative in 920 (73%). In the group with positive findings, 303 patients had no operation because a curative resec- tion was not possible (extranodal metasta- ses, 180; location, 76; histology, 47). No patient survived 5 years, and only 4% sur- vived 2 years. Of the 36 patients considered to have operable disease, 28 underwent resec- tion with a projected 5-year survival of 18%. In the group with negative findings, 89% had a curative resection with a hospital mor- tality of 3.2% and 5-year survival of 53%. When results of mediastinoscopy were corre- lated with findings at thoracotomy, the sen- sitivity of the test was 93% on nodes in the superior mediastinum and the specificity, 100%. This study shows that mediastinoscopy is safe and is an accurate indicator of the presence or absence of tumor in superior mediastinal nodes. If positive nodes are found, a curative resection is generally not possible, thoracotomy is avoided, and the overall survival is low.

Comparative Merits of Conventional, Computed Tomographic, and Magnetic Resonance Imaging in Assessing Mediastinal Involvement in Sur- g~cally Confirmed Lung Carcinoma. Martini, N., Heelan, R., Westcott, J. et al. Memorial Sloan-Kettering Cancer Center, New York, NY 10021, U.S.A.J. Thorac. Cardiovasc. Surg. 90: 639-648, 1985.

Thirty-four patients with operable ma- lignant tumors of the lung had computed to- mography and magnetic resonance imaging of