To investigate whether 201Tl uptake is associated with cell proliferation and angiogenesis in non-small-cell lung carcinoma (NSCLC).Eighty-four patients with scheduled NSCLC underwent 201Tl single photon emission computed tomography (SPECT) imaging: 15 min (early scan) and 240 min (delayed scan) after intravenous injection of 111 MBq of 201Tl chloride. 201Tl indices were calculated on early images (early ratio: ER) and delayed images (delayed ratio: DR). The retention index (RI) was also calculated from these two parameters. Using surgically resected cancer specimens (54 adenocarcinoma, 24 squamous cell carcinoma (SCC), six large-cell carcinoma), immunohistochemical stains for both Ki-67 (MIB-1 index) and CD34 were performed to examine the proliferative activity and the micro-vessel density (MVD), respectively.The mean value of 201Tl index was 1.69+/-0.77 (ER) and 2.31+/-1.08 (DR). The average RI was 42.6+/-42.9%, respectively. Both DR and RI positively correlated with MIB-1 index (r = 0.68, P < 0.05 and r = 0.52, P < 0.05). When we analyse adenocarcinoma and SCC separately, there was a significant positive correlation (r = 0.62, P < 0.05) between RI and MIB-1 index in adenocarcinoma but not in SCC (r = 0.20, P = NS). The value of ER positively correlated with MVD (r = 0.75, P < 0.05). It demonstrated strong positive correlation with both histological types (adenocarcinoma: r = 0.80, P < 0.05, SCC: r = 0.66, P < 0.05).201Tl SPECT imaging is effective non-invasive method for assessing both the proliferation and the angiogenesis in NSCLC. Both DR and RI are useful indicators for assessing cancer cell proliferation in lung adenocarcinoma. ER is a useful marker for assessing the tumour angiogenesis in NSCLC.
Predictivity of mediastinal lymph nodes metastasis of 201Tl SPECT were examined before operation in 113 patients with non-small cell lung cancer (69 adenocarcinoma, 31 squamous cell carcinoma, 10 large cell carcinoma, 2 bronchiolo-alveolar carcinoma, 1 neuroendocrine cell carcinoma). Patients were classified into two groups, with or without lymph nodes metastasis according to the pathological diagnosis. We calculated parameters of 201Tl SPECT early ratio, delayed ratio, retention index (RI) and maximal diameters. In addition, we calculated optimal cut-off value of RI to estimate the mediastinal lymph nodes metastasis. Mediastinal lymph nodes metastasis was confirmed pathologically in 62 patients. ER and DR did not show any statistical significance between two groups. Maximal diameters of primary tumor were also comparable between two groups. RI was significantly higher in mediastinal lymph node metastasis positive group compared to that in mediastinal lymph node metastasis negative group. The sensitivity (Sen), specificity (Spe), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Acc) of 201Tl SPECT were 82.2%, 82.3%, 85.0%, 79.2% and 82.3%. These parameters were similar of higher than 72.6%, 82.4%, 83.3%, 71.2% and 77.0% of chest CT. The RI of 201Tl SPECT was useful tool for predicting lymph nodes metastasis in non-small cell lung cancer. The optimum cut-off value of RI in the prediction of mediastinal lymph nodes metastasis was 35%. We should take into account of upstaging in cases with higher RI (>35%).
We compared the differential diagnostic capabilities of 201Tl-SPECT and biopsy methods and serum tumor marker in 125 patients with solitary pulmonary lesions composed of 87 lung cancer and 38 benign lesions. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 201Tl-SPECT were 76%, 95%, 97%, 63%, and 82%, respectively. These parameters are similar in biopsy methods. Although sensitivity improved to be 85% by the combination with tumor marker methods, both specificity and accuracy deteriorated to be 55% and 76%. Using combination method with 201Tl-SPECT and biopsy, sensitivity, NPV and accuracy improved to be 84%, 70% and 85%. Based on its high PPV value, 201Tl-SPECT could be useful when biopsy method could not prove lung cancer or in case whose biopsy is considered to be invasive. Because of the lower NPV value owing to false negative cases in some adenocarcinoma, negative 201Tl-SPECT case should be followed up carefully.
Based on a good long-patency of the internal thoracic arteries (ITA) in coronary arterial bypass graft (CABG), the postoperative early patency of the inferior epigastric artery (IEA) was evaluated by means of the proximal anastomosed types as a composite graft. Among patients performed with CABG during October in 1998 to June, 2000, 39 cases with the IEA composite graft were studied for this clinical outcome (31 males and 8 females, the averaged age was 66.4 +/- 8.0 year old). The preoperative diagnosis were done as acute myocardial infarction (4), old myocardial infarction with angina pectoris (8), effort angina (12), and unstable angina (15). The coronary disease was left main trunk disease (8), 3 vessels (22), and 2 vessels (9). The operation was performed with cold blood-cardioplegia (20 degrees C, blood-GIK liquor used) on cardiopulmonary bypass with a single atrial and aortic cannulation. The averaged extracorporeal circulation time and the aortic clamping one were done for 169 and 131 min, respectively. The bypass number was double (n = 5), triple (n = 10), quadruple (n = 16), and quintuple (n = 8). Total bypass number was 150 (the averaged bypass number was 3.7 +/- 0.9), and total anastomosal number was 145. The postoperative early-patency of IEA was 94.9% (37/39). The proximal sites of IEA were anastomozed to ITA with I-shaped end-to-end (n = 15), to ITA with Y-shaped end-to-side (n = 5), and to SVG with Y-shaped end-to-side (n = 19). Compared with the postoperative early-patency of I-shaped anastomosis to ITA and that of Y-shaped one to ITA or SVG, there was no significance among these cases (100%, 15/15 versus 91.7%, 22/24, p = 0.6738), however, that of Y-shaped one to ITA was significantly better than that of Y-shaped one to SVG (60%, 3/5 versus 100%, 19/19, p = 0.0488). It should be available for spreading of the anastomotic objective vessels that the IEA as a composite graft was used with the proximal site anastomozed to ITA by I-shaped end-to-end and with to SVG by Y-shaped end-to-side, which clinical outcome would sufficiently benefit to the patients.
We present a rare case of Peutz-Jeghers (P-J) syndrome in a 29-year-old woman who developed adenocarcinoma of the thyroid and polyps in the gastrointestinal tract. Polyps removed from the stomach, colon and ileum showed features typical of hamartomas. Histological examination indicated that the tumor resected from the right lobe of the thyroid was a papillary adenocarcinoma. This appears to be the first precise report of a P-J syndrome associated with thyroid carcinoma. This case adds an example of predisposition of P-J syndrome to extraintestinal malignancy and indicates the importance of long-term observation of malignancy.(Internal Medicine 31 : 1117-1119, 1992)
