To investigate whether the assessment of resectability of lung cancer can be reliably made on the basis of computed tomography (CT), the thoracic CT scans of 96 lung cancer patients who were operated on, and in whom the tumour was classified to be of stage III at preoperative CT or at thoracotomy, were analysed. Of the patients, 58 underwent complete resection of the tumour, whereas thoracotomy resulted in non-complete resection or exploration only in 38 cases. Overlapping of the CT findings in the groups of complete and non-successful resection was observed. The majority of tumours with apparent growth to the carina, trachea, oesophagus or great vessels at CT were completely resected. Tumours that only bordered on the pleura could not be distinguished from those with pleural invasion. Mediastinal lymph node enlargement did not always mean metastatic spread. We conclude that there is no definite sign that identifies non-resectability of lung tumours, and a certain proportion of non-curative thoracotomies must be accepted.
Cancer incidence was studied among 6,144 male foundry workers who were invited to participate in either of two Danish national silicosis surveys conducted during 1967-1969 and 1972-1974. Cancer incidence was followed through to the end of 1985 by computerized linkage to the Danish Cancer Registry, and Standardized Morbidity Ratios (SMRs) were calculated based on incidence rates for the Danish population. For the entire cohort, significantly elevated SMRs were seen for all cancers (SMR, 1.09; 95% CI, 1.01-1.18) and lung cancer (SMR, 1.30; 95% CI, 1.12-1.51), and SMRs were at the borderline of statistical significance for bladder cancer (SMR, 1.24; 95% CI, 0.97-1.59). Excess lung and bladder cancer risk were confined to workers who had worked in foundries for at least 20 y. There was a positive correlation between silicosis prevalence in employees at the foundries at the time of the x-ray examinations and lung cancer incidence during the follow-up period. Squamous cell carcinomas, anaplastic carcinomas, and other lung cancers accounted for the excess lung cancer risk, whereas there was not excess risk among the foundry workers for adenocarcinomas of the lung.
The Department of Medical Imaging at the University Health Network in Toronto is performing a lung cancer screening study, utilizing low-dose computed tomography (LDCT) as the modality. Baseline and annual repeat results are reported on the first 3352 participants, enrolled between June 2003 and May 2007.
Enrollment was limited to those aged 50 years or older, with a smoking history of at least 10 pack-years, no previous cancer and general good health. A helical low-dose CT (LDCT) of the chest was performed using 120kVp, 40-60mA, images were reconstructed with 1-1.25mm overlapping slices. The primary objectives were the detection of parenchymal nodules and diagnosis of early stage lung cancer. Baseline LDCTs were termed positive if at least one indeterminate non-calcified nodule 5mm or larger in size, or non-solid nodule 8mm or larger in size was identified. Follow up periods for individuals with a positive baseline LDCT were determined by nodule characteristics.
The median age at baseline was 60 years (range 50-83), with a median of 30 pack-years of cigarette smoking (range 10-189). Baseline CT evaluations were positive in 600 (18%) participants. To date, 2686 (80%) of the participants have returned for at least one annual repeat screening LDCT. Biopsies have been recommended for 82 participants since the study began, and 64 have been diagnosed with screen-detected cancer (62 lung, two plasmacytoma of the rib). A total of 65 lung cancers have been diagnosed (62 screen-detected, 3 interim), 57 are NSCLC (82% with known stage are stage I or II) and the rate of surgical resection was 80%. Sensitivity and specificity of the protocol in successfully diagnosing early stage lung cancers were 87.7% and 99.3%, respectively.
Data indicate that LDCT can identify small lung cancers in an at-risk population. The diagnostic algorithm results in few false-positive invasive procedures. Most cancers are detected at an early stage, where the cancer is resectable with a greater potential for cure. Long-term follow up of lung cancer cases will be carried out to determine survival.
The paper is concerned with the description of clinical, x-ray and morphological investigation of 123 bronchoalveolar cancer patients. Three types of this disease were defined: nodular (homogeneous and nonhomogeneous), pneumonia-like (infiltrative and infiltrative-nodular) and mixed (focal-disseminated, focal-nodular and focal-infiltrative). These types of bronchoalveolar cancer are most probably stages of the same tumor process. Clinical and x-ray signs of each type showed correlation with a morphological picture of a tumor. Shadow nonhomogeneity as one of the main x-ray signs of bronchoalveolar cancer was shown to be determined by the "alveolar" structure of a tumor, a tendency to the formation of small cavities, filled with viscous mucosa and air. Correct clinical and x-ray diagnosis in all types of bronchoalveolar cancer (before the use of the morphological methods) was established in 45.5% of the patients.