Screening diagnosis staging prognosis biological features

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                                            39. Screening, diagnosis, staging, prognosis,
                                                        biological features

                                            The feasibility of a lung cancer screening program in rural Ireland
                                            Mark V. Roberts, S. Hall, K. McManus, P. Convery. Department of Emergency
                                            Medicine, Craigavon Area Hospital, Craigavon, County Armagh, United
                                            Kingdom; Department of Radiology, Craigavon Area Hospital, Craigavon,
                                            County Armagh, United Kingdom; Department of Cardiothoracic Surgery, Royal
                                            Victoria Hospital, Belfast, County Antrim, United Kingdom; Department of
                                            Respiratory Medicine, Craigavon Area Hospital, Craigavon, County Armagh,
                                            United Kingdom

                                            Objective: to establish the feasibility of a lung cancer screening program on a
                                            rural Irish population using low-dose CT scanning.
                                            Participants: men and women meeting inclusion criteria (45-65 yr olds, the ability
                                            to climb 2 flights of stairs and a 20 or more pack year history of smoking) and
                                            exclusion criteria (acute illness or clinical suspicion of cancer).
                                            Rationale: lung cancer remains a major cause of cancer mortality. Late disease
                                            presentation challenges us to identify effective means of early detection in asymp-
                                            tomatic cases. To date detection rates have been extremely low and selection bias has
                                            affected the quality of many previous screening studies, as well as a high incidence
                                            of false positives due to incidental fungal lung pathology. No study has investigated
                                            the effects of a screening program on a population with a high prevalence of heavy
                                            smoking together with a relatively low incidence of incidental lung pathology.
                                            These factors are characteristic of the rural Northern Irish population and coupled
                                            with accessible CT scanning facilities and surgical support, we feel this presents
                                            an opportunity to contribute to the debate surrounding lung cancer screening.
                                            Specific issues under consideration: selection methods that minimise selection
                                            bias; sample size sufficient for clinical significance; securing £140,000 ( 203,000)
                                            funding for a 2 year pilot study; ethical approval.
                                            Main outcome measures: number, stage and prevalence of asymptomatic lung
                                            cancers in the study population; numbers and proportion of detected lung cancer
                                            patients referred and undergoing surgery; sensitivity and specificity of the screening
                                            test; the 5 year survival rate for detected cancers.

                                            Autofluorescence bronchoscopy in the diagnosis of preneoplastic changes and
                                            synchronous bronchial carcinoma
                                            Andrej Debeljak, Nadja Triller, Peter Kecelj, Izidor Kern. Department of
                                            Pulmology, University Clinic of Respiratory and Allergic Diseases, Golnik,

                                            We wanted to find out the sensitivity of auto fluorescence, flexible and video
                                            bronchoscopy for preneoplastic changes and synchronous bronchial carcinoma.
                                            One hundred and one patients, 87 male, 20 female, age 64, 5±9, 4 years were
                                            examined: 50 with video and 51 with flexible bronchoscope with Storz D light/auto
                                            979 biopsies were performed at 252 biopsy sites. We histologically confirmed inva-
                                            sive carcinoma in 91 patients. Additionally carcinoma was confirmed at 17 biopsy
                                            sites; synchronous bronchial carcinoma in 5. We found preneoplastic changes at
                                            11 biopsy sites.
                                            Sensitivity of auto fluorescence (0, 92), video (0,91) and flexible bronchoscope
                                            (0,84) for invasive carcinoma was the same. Sensitivity of auto fluorescence bron-
                                            choscope (0,89) was higher for the preneoplastic lesions than of video and flexible
                                            bronchoscope (0,45).
                                            Specificity of auto fluorescence bronchoscope (0,69) was lower (p>0,05) than
                                            specificity of video (0,88) and flexible (0,75) bronchoscope.
                                            Auto fluorescence bronchoscope was more sensitive and less specific for preneo-
                                            plastic lesions. Sensitivity of auto fluorescence, flexible and video bronchoscope
                                            for invasive bronchial carcinoma was the same.
                                            In central bronchial carcinoma auto fluorescence bronchoscope can be used to find
                                            additional premalignant changes of bronchial mucosa.

                                            Urgent referrals to respiratory medicine from radiology: an audit
                                            Nicola J. Deans, Sally Bradley. Respiratory Medicine, Ninewells Hospital,
                                            Dundee, United Kingdom

                                            Introduction: Radiologists reporting outpatient CXR have the facility to refer
                                            patients to Chest Clinic without referring back to the primary care physician. This
                                            facility exists mainly to ensure rapid investigation of suspected lung cancer.
                                            Aims: 1 To determine reason for referral, and compare with final diagnosis
                                            2 To categorise investigation pathways
                                            3 To quantify investigations generated
                                            Method: Radiology referrals to Ninewells from April to September 2005 (n=52)
                                            were selected from the Lung Cancer Management database. Types, dates and
                                            results of investigations were collected from the computerised results system.


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Results: 44/52 (84.6%) were referred due to a lesion “suspicious of bronchogenic                   E561
carcinoma”. 8/52 were due to other abnormalities, such as nodules, effusions and                   Comparison of luiquid-based cytology and conventional cytology: abnormal
pleural changes.                                                                                   lesion on bronchoscopy
                                                                                                   Eugene Choi, Ji Woong Son. Division of Pulmonology, College of Medicine,
Final diagnosis of suspected carcinoma and other abnormalities                                     Konyang University, Daejeon, South Korea
NSCLC                                16       Benign effusion                            2
(Squamous)                          (11)      Infection                                  3         Background: Currently the Luiquid-based cytology is known as an effective
Small cell lung cancer                6       Malunited clavicle fracture                1         method and especially the cervical cytology it has shown to be a highly effective
“Lung cancer”                         7       Benign nodule                              1         one of malignancy detection. In our study, wet compared the cytological detection
Metastatic carcinoma                  3       Round atalectasis                          1         rates of the thinprep (Luiquid-based cytology) with the conventional cytology
Mass, no further investigations       2       No abnormality on further investigation    1         (bronchial washing & brushing) about endobronchial lesion.
Squamous CIS                          1       total                                     44         Method: Data from 30patients with respiration symptom who had shown abnormal
NSCLC                                 3       Composite shadow                           1         lesion on bronchoscopy were collected between July 2005 and september 2005.
(Adenocarcinoma)                     (1)      Scarring                                   1         Results: The bronchoscopic biopsy group was consisted of 30 specimens with
Mesothelioma                          1       Benign nodule                              1         cytodiagnoses and 24 cases were confirmed malignancy. The others were 4 tubercu-
Pleural plaque                        1       total                                      8         losis, 1 bronchitis, 1 bronchopulmonary fistula. Among 24 cases of malignancy, we
                                                                                                   detected cancer or atypical cell in 19cases of thinprep, 17cases of brushing cytol-
Overall, 39/52 (75%)were found to have malignant disease.                                          ogy, 12cases of washing cytology. No one detected cancer cell in non-malignancy
28/52 (53.8%) required CT and bronchoscopy to reach a diagnosis. The remainder                     specimen. The washing cytology has shown 50% of sensitivity, 100% of specificity,
of investigations are summarised below.                                                            100% of positive predictive value, 33.3% of negative predictive vlaue whereas
                                                                                                   the brushing cytology has shown 70.8% of sensitivity, 100% of specificity, 100%
                                                                                                   of positive predictive value, 46.2% of negative predictive vlaue. The thinprep has
CT alone                           13             CT+pleural tap+pleural biopsy         1
                                                                                                   shown 79.2% of sensitivity, 100% of specificity, 100% of positive predictive value,
CT+ CT guided biopsy                3             FNA node+bronchoscopy                 1
CT + pleural tap                    3             Bronchoscopy                          1          54% of negative predictive vlaue.
CT + node biopsy                    1             Pleural tap                           1          Conclusions: The thinprep-liquid based cytology- showed better good effctiveness
                                                                                                   for lung cancer evaluation than conventional cytology.

Conclusion: The high pick up rate of our Radiologists, and the facility for direct
referral of patients with abnormal CXRs, have improved the efficiency of the                        E562
service delivered to patients with suspected lung cancer.                                          Evaluating the role of muc4 expression in the differential diagnosis of
                                                                                                   mesothelioma and adenocarcinoma of the lung
                                                                                                   Aydanur Kargi 1 , Ahu Hayretdag 2 , Zekiye Aydogdu 3 , Duygu Gurel 1 ,
E559                                                                                               Ahmet Onen 4 , Aydin Sanli 4 , Atila Akkoclu 5 . 1 Pathology, Dokuz Eylul University
The invasive diagnostics of lung cancer with secondary inflammatory changes                         Faculty of Medicine, Izmir; 2 Chest Diseases, Dokuz Eylul University Faculty of
Igor M. Kuznetsov, Olga B. Ilina, Gennady S. Zubov, Sergei A. Shalaev, Leonid                      Medicine, Izmir; 3 Pathology, Izmir Tepecik Education Hospital, Izmir; 4 Thorasic
N. Bisenkov. Chair of Thoracic Surgery, Military Medical Academy,                                  Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
St.-Petersburg, Russia
                                                                                                   Aim: There are difficulties in histopathologic and cytologic studies for the dif-
We have performed the comparative estimation of various biopsies in patients,                      ferential diagnosis of epithelial mesotheliomas (EM) and adenocarcinomas (AK)
operated due to non-complicated lung cancer (1st group - 305 patients) and lung                    infiltrating the pleura. To distinguish these two malignancies many studies have
cancer with secondary inflammatory changes (2 group - 291 patients). A sensitivity                  been performed evaluating immunohistochemically the value of a variety of mark-
of endobronchial biopsy at 1st and 2nd groups has made 95% and 93%, trans-                         ers most of which are positive for AK and some of which are positive for malign
bronchial biopsy - 76% and 71%, transtoracal biopsy - 88% and 84% accordingly.                     mesothelioma (MM). The research in this area continues. In one study evaluating
We have not revealed any reliable differences in the compared groups.                              the value of MUC4 which is a membrane bound mucin and is expressed in normal
The high informativeness of the invasive diagnostics in case of complicated lung                   respiratory epithelium and lung adenocarcinoma, MUC4 was found to be positive
cancer in our research is caused by use of x-ray computed tomography for visu-                     in 91.4% of AK and negative in 100% of EM.
alization of the pathological focus during the biopsy and use of automatic needles                 Materials and Methods: Twelve cases diagnosed as mesothelioma pathologically
(Bard Monopty), which helped us to get a material for histological research.                       and radiologically between 1999 and 2005 were reevaluated for the diagnosis. All
In case of absence of the histological diagnosis before operation in 37 cases (19                  of the cases were CEA (-) and calretinin (-). Cross sections from the parafin blocks
patients of 1st group and 18 patients of 2nd group), the first stage of the operative               of 37 lung AK and 12 EM patients were taken on lysin containing slides. Sec-
intervention was a videothoracoscopy. In case of non-complicated cancer, the diag-                 tions were stained immunohistochemically with 1:100 diluted MUC4 monoclonal
nosis was verified in all cases. The problems related to adhesions and incomplete                   antibody using streptavidin-biotin immunoperoxidase method.
lung collapse at complicated lung cancer have not allowed to verify the diagnosis                  Results: Sections of 29 (85%) of 37 AK cases stained positive for MUC4 in
in 7 of 18 cases. And the mean duration of this manipulation, including a time                     varying degrees. In 9 (24%) cases, over 50% of the cells were stained. None of
for the urgent histological research has made 40 minutes that is comparable to the                 the Mesothelioma cases showed MUC4 immunoreactivity.
duration of the basic stage of the operation.                                                      Conclusion: Although MUC4 is 100% specific and 85% sensitive for AK, since
Conclusions: The paracancerous changes do not have a considerable influence on                      generally focal staining is observed in sections over 1 cm. prepared from lobectomy
informativeness of transtoracal and transbronchial biopsy. Indications for videotho-               material in Ak cases, sensitivity can be lower in small pleural biopsies. However,
racoscopy in case of complicated lung cancer come to necessity of diagnostic of                    with sufficient amount of material MUC4 can be useful in distinguishing AK and
pleural and pericardial carcinomatosis.                                                            EM.

E560                                                                                               E563
Clinical pathology of bronchioloalveolar carcinoma                                                 Small cell lung cancer- possibility and difficulties in cytological diagnosis
Lev M. Grinberg, Roman B. Berdnikov. Pathology Department, Ural State                              Joanna J. Domagala-Kulawik, Rafal Krenke, Ryszarda Chazan. Pneumonology,
Medical Academy, Ekaterinburg, Russia; Pathology Department, Ural Research                         Medical University, Warsaw, Poland
Institute of Phthisiopulmonology, Ekaterinburg, Russia
                                                                                                   Small cell lung cancer (SCLC) is a very aggressive neoplasm and differs signifi-
Bronchioloalveolar Carcinoma (BAC) is a unique lung tumor which does not form                      cantly in the biology, course and treatment from those of non-small cell histological
its own stroma. Within 1967-2005 285 BAC cases were verified from operation                         types. Accurate and quick diagnosis is crucial to initiate a proper treatment.
and autopsy data in the Pathology Department of Yekaterinburg Pulmonary Cen-                       The aim of this study was to establish the value of initial cytological diagnosis
ter. Based on the developed criteria (LG) X-ray-anatomical forms were defined:                      in cases in which there were difficulties in obtaining histological biopsy. In this
nodular – 197 (69,1%), pneumonia-like - 42 (14,7%) and disseminated – 46                           presentation we demonstrate the morphology and typical features of SCLC cells
(16,2%). Three tumor types were histologically diagnosed: mucous – 73 (25,5%),                     and we discuss the differential diagnosis.
non-mucous – 45 (15.8%) and mixed – 167 (58.6%). Electronic microscopy (in                         100 cases were analyzed. There were: fine needle aspiration biopsies (FNAB)
collaboration with Elena Smirnova) revealed that each histological type has its own                of peripheral tumors (n=9), FNAB of supraclavicular lymph nodes (16), trans-
predecessor cells (goblet cells, type 2 pneumocites, Clar’s cells et al.), which do                bronchial fine needle biopsies of lung tumors or mediastinal lymph nodes (16),
not differ from the predecessor cells for bronchogenic adenocarcinoma. Differen-                   bronchial brushings (32), pleural fluids (13) and the metastases to soft tissue and
tial diagnostic groups were formulated based on anatomic forms and histological                    other organs (15). In about 70% cases there were no difficulties with establishing
tumor types.                                                                                       diagnosis, especially in the samples obtained by bronchial brushings and FNAB.
                                                                                                   The morphology of SCLC cells was not uniform and often a mixture of non-small
                                                                                                   atypical cells and bronchial epithelilal cells with signs of metaplasia was observed.
                                                                                                   The main diagnostic problem was to distinguish small cell lung cancer from
                                                                                                   lymphomas, atypical carcinoid and undifferentiated non small cell lung cancer
                                                                                                   consisting of small cells.


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We concluded that diagnosis of SCLC in cytological smears is possible, but the                          cell lung cancer and to identify the correlation between p53 expression in bronchus
clinical data are necessary and differential diagnosis with other tumors of small                       biopsy and lymph node invasion disclosed through mediastinoscopy. Materials
cells have to be taken into account.                                                                    and methods: Forty-two non-small cell lung cancer patients staged as Stage I-IIIB
                                                                                                        were enrolled. All the cases had undergone mediastinoscopy for the purpose of
                                                                                                        staging. On the sections cut from paraffin blocks of bronchus biopsies, p53 dye
E564                                                                                                    was applied. Correlation between the presence of mediastinal lymphadenopathy
The value of HMBE-1, calretinin and cytokeratin5/6 for diagnosis of                                     revealed by mediastinoscopy and p53 expression in bronchus biopsy was computed
epitheloid malignant mesothelioma                                                                       statistically.
Jelena M. Stojsic 1 , Jelena K. Radojicic 1 , Vera N. Todorovic 2 , Neda                                Results: According to preoperative evaluation, 12 cases were staged as Stage I, 6
C. Drndarevic 2 . 1 Department for Pathology, Institute for Lung Diseases and                           as Stage II, 11 as Stage IIIA, and 13 as Stage IIIB. Considering the p53 dye uptake
Tuberculosis, Belgrade, Serbia; 2 Department for Pathology, Institute for Medical                       in bronchus biopsies, 22 cases had no uptake; while 8 cases had less than 25%, 8
Research, Belgrade, Serbia                                                                              cases had uptake between 25% and 50%, and 4 cases had more than 50% uptake of
                                                                                                        dye. Out of 13 cases with lymph node invasion revealed through mediastinoscopy,
Tubulopapillary growth pattern of epitheloid type of malignant mesothelioma                             7 (53.8%) had positive p53 dye uptake (p>0.05). Discussion and conclusion: p53
(EMM) on pleural biopsy (pbp.) is also morphologicaly similar to lung adeno-                            expression rates in bronchus biopsy specimens from our cases were similar to the
carcinoma involving pleura. Panel of monoclonal antibodies was: mesothelial cell                        findings in present literature. No statistical significance was established between
antigen (HBME-1), calretinin and cytokeratin5/6 for pathological diagnosis of                           lymph node invasion and p53 expression.
EMM. Cytoplasmatic sensitivity of monoclonal antibodies was labeled as positiv-
ity. We diagnosed 34 EMMs on pleural biopsies applying immunohistochemistry.
HBME-1 was the most sensibile antibody in 100% biopsies, as a linear apical,                            E567
membrane positivity. Calretinin and cytokeratin5/6 were positive in malignant                           CT scanning is an imperfect means of predicting pathological stage in lung
mesothelial cells cytoplasm in 82.4% and in 70.6% of all pbps. Our results was                          cancer
similar with the other authors’ ones. HBME-1 is sensitive in regular as well as in                      Raja Dhar, Vandana Jeebun, Howell W. Clague. Respiratory Medicine,
malignant mesothelial cells. Calretinin and cytokeratin 5/6 are highly sensitive in                     Sunderland Royal Hospital, Sunderland, United Kingdom
malignant mesothelial cells. No antibody itself is enough for diagnosis of EMM.
It is necessary to apply a broad spectrum of antibodies for precise diagnosis of                        Introduction: We have reflected on our experience of CT scanning as a predictor
EMM and differentiation from lung adenocarcinoma.                                                       of pathological stage in our practice of potentially resectable lung cancer.
                                                                                                        Methods: Retrospectively we studied 35 cases of lung cancer who underwent a
                                                                                                        potentially curative surgical procedure during 2005.
E565                                                                                                    Results: Preoperatively 24 patients had Stage 1, 8 patients Stage 2 and 3 patients
Diagnostic yield of cytology and percutaneous biopsy in pleural malignancy                              Stage 3 disease. 15 of the patients were above 70 years of age. Only 12 patients
Rahul Mukherjee, Wanhaniza Mohamad, Jonathan S. Mann. Respiratory                                       had preoperative staging that accurately matched the postoperative pathological
Medicine, New Cross Hospital, Wolverhampton, West Midlands, United Kingdom                              stage. In 20 patients the disease was up staged during surgery. This resulted in
                                                                                                        2 cases having a Pneumonectomy rather than a planned Lobectomy and 7 cases
Background: The role of percutaneous (blind) pleural biopsy has been questioned                         a salvage wedge resection with further adjuvant therapy. In the former 2 cases
in favour of newer techniques with higher diagnostic yield in selected patient                          improved imaging would have resulted in better surgical planning. In at least 4
populations, which often exclude the elderly in whom the incidence of malignancy                        of the 7 cases having wedge resection, surgery might have been avoided with
is increasing. Also, the newer techniques are not widely available in publicly                          more meticulous preoperative staging. In 3 cases preoperative staging was later
funded health systems. The continuing role of blind biopsy in the diagnosis of                          down-staged by surgery but the change was relatively minor and in our practice
pleural malignancy therefore demands continuing quality assessment and raises                           did not alter the planned surgical procedure.
training issues.                                                                                        Conclusion: In parts of the UK with a high incidence of lung cancer access to
Methods: Retrospective analysis of pleural fluid cytology and histological exam-                         improved staging techniques such as CT – PET scanning is still deficient. This
inations of blind biopsy specimens obtained at our department on patients with                          small series underlines the importance of recent initiatives to provide more uniform
exudative pleural effusions over a 12-month period (1/8/2003 – 31/7/2004) through                       access to improved staging techniques for all patients being considered for radical
computer records and medical notes.                                                                     treatment.
Results: A total of 126 exudative pleural effusions were investigated out of which
57 (45%) had histologically proven malignancies; 45 (79% of proven malignan-
cies) were diagnosed by combined cytology and blind biopsy, the latter increasing                       E568
the diagnostic yield by 15%.                                                                            Computer tomographic-guided transthoracic needle aspiration biopsy – 5
                                                                                                        years in review
Diagnostic yield of pleural fluid cytology and blind biopsy                                              Barbara M. Seabra 1 , Antonia Furtado 2 , Rosete Nogueira 2 , Isabel Bastos 3 ,
Total malignancy:      Positive in cytology      Positive in both biopsy     Positive in biopsy         Barbara Parente 1 . 1 Oncologic Pulmonology, Centro Hospitalar Vila Nova de
n                         alone: n (%)            and cytology: n (%)          alone: n (%)             Gaia, Centro Hospitalar Vila Nova de Gaia, Portugal; 2 Clinical Pathology,
                                                                                                        Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal; 3 Radiology,
57                          29 (51%)                   10 (17%)                  6 (10%)                Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal

Conclusions: It was shown between 1973 and 1991 that the sensitivity of pleural                         Transthoracic Needle Aspiration Biopsy (TNB) was first successfully performed
fluid cytology varies from 40% to 87% (Maskell NA et al. Thorax 2003; 58:                                over 120 years ago. Gradual improvement of this technique has slowly allowed
ii8–ii17) with about 12% increase in diagnostic yield by a blind biopsy. Our results                    it to become a safe and efficient diagnostic tool, particularly after the Computer
are therefore reassuring in terms of procedural quality, are broadly similar to more                    Tomographic-guided biopsy (CTTNB) evolved.
recent series from other parts of the United Kingdom and support the continuing                         Besides the experience of the technique’s performer, several factors interfere with
acquisition of blind pleural biopsy skills by pulmonary medicine trainees.                              the obtained results. In this review of 231 CTTNBs executed between the years
                                                                                                        2000 and 2004, with close on site cytopathologist cooperation, numerous variables
                                                                                                        were observed; among these, the location (lung, pleura or mediastinum) and size of
E566                                                                                                    the lesion itself were particularly held into account. Further analysis of the number
Correlation between p53 expression in bronchus biopsies from non-small cell                             of samples excised, technique sensitivity, specificity and associated complication
lung cancer cases and mediastinal lymph node invasion demonstrated                                      rate ensued.
through mediastinoscopy                                                                                 The population sample included 217 patients, 71.9% male, aged 11 to 90 (medium
Ebru Artan, Murat Kiyik, Huseyin C. Tigin, Tunc Karadeli, Kursat Epozturk,                              61.6 years of age). Among 231 exams performed, the number of biopsy attempts
Nur Urer, Hayati Ozyurt, Sadettin Cikrikcioglu. Pulmonary Diseases, Yedikule                            ranged from 1 to 5 (medium – 1.8 attempts).19 were performed in the absence of
Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul,                          a cytopathologist. Of the remaining samples submitted to immediate pathological
Turkey; Pulmonary Diseases, Yedikule Chest Diseases and Thoracic Surgery                                examination (212): 7 were not representative, 22 non conclusive and the remainder
Education and Research Hospital, Istanbul, Turkey; Pulmonary Diseases,                                  were diagnostic.
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital,                           Specificity and sensitivity for particular subgroups, namely for benign and ma-
Istanbul, Turkey; Pulmonary Diseases, Yedikule Chest Diseases and Thoracic                              lignant lesions and according to lesion size and location are currently under
Surgery Education and Research Hospital, Istanbul, Turkey; Pulmonary Diseases,                          analysis.
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital,                           The complication rate was of 10%. None of the complications led to hospital
Istanbul, Turkey; Pathology, Yedikule Chest Diseases and Thoracic Surgery                               admission or fatalities.
Education and Research Hospital, Istanbul, Turkey; Pulmonary Diseases,                                  This review work aims to determine the accuracy and limitations of CTTNB with
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital,                           on site cytopathological observation and to evaluate and eventually improve the
Istanbul, Turkey; Pulmonary Diseases, Yedikule Chest Diseases and Thoracic                              patient (and thoracic lesion characteristics) selection criteria for this diagnostic
Surgery Education and Research Hospital, Istanbul, Turkey                                               technique.

Introduction and objective: We aimed to demonstrate p53 (a tumor suppressor
gene) mutation in bronchus biopsy specimens from patients diagnosed as non-small


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E569                                                                                         with negative N2 lymph nodes were evaluated. Micrometastases were examined
Impact of PET scanning on lung cancer management in a U.K. centre                            with cytokeratin 8/18 in bone morrow and lymph node specimen.
David A. Stock, Andrea McIver, Kamlesh Mohan, Martin J. Ledson, Martin                       Results: Using immunohistochemical dyes, micrometastases in bone morrow spec-
J. Walshaw. Liverpool Lung Cancer Unit, Cardiothoracic Centre, Liverpool,                    imens were detected in none of the forty patients. Onto the specimens from 26 cases
United Kingdom                                                                               with negative N2 lymph nodes, cytokeratin 8/18 dye was applied; micrometastasis
                                                                                             was disclosed in 4 (15.4%) of these. Of these 26 patients, 22 (84.6%) were sur-
Current lung cancer guidelines recommend the utilisation of 18 F-deoxyglucose                viving at the end of two-year follow-up. Out of 4 patients with micrometastases,
positron emission tomography (FDG-PET) scanning in patients considered suit-                 2 were disease-free and the other two were deceased.
able for curative surgery or radical radiotherapy. This modality can also be used to         Discussion and conclusion: Positive CK results seem to be a poor prognostic
evaluate solitary pulmonary nodules where percutaneous CT-guided biopsy cannot               factor; however, this was statistically insignificant due to the limited number of
be performed or has failed. We report our first years experience with FDG-PET.                the cases. Consequently, immunohistochemical detection of the transmission of
We reviewed the records of 71 patients who underwent FDG-PET scanning from                   the cancerous cells into bone morrow and lymph nodes may be a better prognostic
Mar 2005 to Jan 2006.                                                                        procedure than conventional methods and can support consideration of the presence
26 scans were performed for solitary pulmonary nodules. 16 showed intensely                  of micrometastases in the staging algorithm.
increased uptake suggestive of malignancy (1 with mediastinal disease); 9 were
normal or consistent with benign pathology. 1 was indeterminate, but the scan
suggested malignant disease in the neck (false positive). Mediastinal disease was            E572
missed in one case. In one patient a second (4mm) nodule seen on CT was negative             Influence of verbal and written patient information on tolerance of fiberoptic
on FDG-PET but wedge excision confirmed malignancy.                                           bronchoscopy in a Tunisian pneumology unit
43 scans were requested for cancer staging prior to treatment. In 24 cases the               Hichem Aouina, Sonia Fnina, Saousen Bacha, Leila Gharbi, Mohamed Ali
initial staging was confirmed. 12 patients were downstaged by FDG-PET (5 normal               Baccar, Saloua Azzabi, Hend Bouacha. Pneumology Unit, Charles Nicolle
scans) and 6 were upstaged. One scan detected an incidental oesophageal primary;             Hospital, Tunis, Tunisia
in the same patient the pulmonary lesion was positive but histology showed an or-
ganising pneumonia. Involvement of mediastinal nodes was missed on 3 occasions               Fibreoptic bronchoscopy is currently undertaken by the majority of respiratory
(2 confirmed by surgery, one by CT-PET).                                                      physicians, but under varying conditions. The tolerance of this examination is usu-
The remaining 2 scans were requested by the oncologist for radiotherapy planning.            ally poor.The need to provide understandable patient information before bronchial
FDG-PET provided additional useful information in 42% of cases in our series,                endoscopy is being increasingly recognised. Unfortunately this information still
thus underlining the value of this imaging tool to lung cancer services. In a small          very poor in the Tunisian physician’s practice.
proportion (9%) the scan report proved misleading - hopefully a shift to CT-PET              Methods: A prospective study of the tolerance of the endoscopic examination was
will improve accuracy in the future.                                                         made in the pneumology unit of Charles Nicolle’s hospital, on 100 consecutive
                                                                                             patients by questionnaire, comparing 2 groups: GI: receiving verbal and written
                                                                                             patient information before endoscopy, including description of the procedure, and
E570                                                                                         possible side effects, and GII: receiving minimal verbal information. Evalua-
Is bone marrow biopsy needed in staging small cell carcinoma?                                tion criteria were: patient’s anxiety, pain, dyspnoea, or nausea, and whether the
Elif Torun, Benan Caglayan, Ali Fidan, Banu Salepci. Chest Diseases, Dr. Lutfi                information and declaration were adequate.
Kirdar Kartal Education and Research Hospital, Istanbul, Turkey                              Results: At first, 86% of the patients had no precise idea about the procedure.
                                                                                             Before receiving information, 83% of the patients of GI were anxious, but only
SCLC patients diagnosed in our clinic between July 2002 and July 2003 (n=45)                 56% of them remained so after information (p< 0.01). 52% of the patients of GI
were prospectively analysed. Thoracal CT, abdominal USG or CT, bone scintigra-               reported some pain during endoscopy vs 95% of GII (p < 0.01). 62% of patients
phy and cranial CT or MRI were used for metastases detection. Nineteen patients              of GI reported dyspnoea vs 87% (p: 0.017), and 33% nausea vs 71% of GII (p <
who had no radiologically detected distant metastases were considered as limited             0.01). 83% of the patients said that they had received information appropriate to
stage and underwent bone marrow biopsy. Iliac crest was site of bone marrow                  the examination undergone. 71% of GI would agree to a repeat examination under
biopsy performed with Galini (8G 10cm) needle. All the cases underwent detailed              the same conditions, vs 42% of GII (p < 0.001).
biochemical analyses and were found to have normal LDH levels and blood                      Conclusion: Verbal and written patient information improves tolerance of the
counts. None of these 19 cases demonstrated bone marrow invasion, therefore                  procedure and should be provided.
we conclude that bone marrow biopsy is not needed in staging of SCLC cases
having no laboratory finding in favor of metastases, unless an academic survey
recommends. Bone marrow metastases is found in 20-25% of the cases at time                   E573
of diagnosis and it is strongly correlated with LDH levels. Less than 2% of cases            Association of smoking status and bronchoscopic findings in primary lung
with bone marrow invasion have normal LDH levels. As a result, bone marrow                   cancer
biopsy is not necessary in staging of SCLC cases with no symptoms and normal                 Sibel Arinc, Muyesser Ertugrul, Cuneyt Salturk, Leyla Yagci Tuncer, Ebru Sulu,
LDH levels.                                                                                  Huriye Berk Takir, Adnan Yilmaz. Pulmonology, Sureyyapasa Thoracic and
                                                                                             Cardiovascular Diseases Training and Investigation Hospital, Istanbul, Turkey

E571                                                                                         The objective of this study was to evaluate the association between smoking status
Immunohistochemical investigation and prognostic evaluation of                               and bronchoscopic findings in primary lung cancer. We retrospectively evaluated
micrometastases within the bone morrow and the lymph nodes                                   the clinical files of 1038 primary lung cancer patients diagnosed in our center
Naciye Mutlu, Murat Kiyik, Huseyin C. Tigin, Lutfiye Kilic, Ebru Artan,                       in 2004. Patients with unknown smoking history or without bronchoscopy were
Tunc Karadeli, Kursat Epozturk, Nur Urer, Hayati Ozyurt, Sadettin Cikrikcioglu.              excluded from the study. The study included 716 cases. All patients were divided
Pulmonary Diseases, Yedikule Chest Diseases and Thoracic Surgery Education                   into four groups according to smoking history. Group 1 included 548 smoker
and Research Hospital, Istanbul, Turkey; Pulmonary Diseases, Yedikule Chest                  patients. 79 patients were exsmoker for 1-9 years in Group 2. In Group 3, 42
Diseases and Thoracic Surgery Education and ResearchHospital, Istanbul,                      patients were exsmoker at least 10 years or more. Group 4 consisted of 47 non-
Turkey; Pulmonary Diseases, Yedikule Chest Diseases and Thoracic Surgery                     smoker patients. The ratio of upper lobe localization in Group 1, 2, 3, and 4 were
Education and Research Hospital, Istanbul, Turkey; Pulmonary Diseases,                       53.8%, 45.7%, 52.4%, and 61.7%, respectively. The tumor was localized in main
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital,                bronchus or lobar bronchus with a ratio of 61.5% in Group 1, 55.7% in Group 2,
Istanbul, Turkey; Pulmonary Diseases, Yedikule Chest Diseases and Thoracic                   64.3% in Group 3, and 34% in Group 4 (p=0.0024). Morphologically, the detection
Surgery Education and Research Hospital, Istanbul, Turkey; Pulmonary Diseases,               of mass and normal appearance ratios were 58% and 13% in Group 1, 59.5%
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital,                and 17.7% in Group 2, 59.5% and 9.5% in Group 3, and 38.3% and 40.4% in
Istanbul, Turkey; Pulmonary Diseases, Yedikule Chest Diseases and Thoracic                   Group 4 (p=0.0014). The most frequent tumor type was adenocarcinoma in Group
Surgery Education and Research Hospital, Istanbul, Turkey; Pathology, Yedikule               4, epidermoid carcinoma in others (p<0.001). The results of our study showed
Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul,               that there was a significant association between smoking habit and bronchoscopic
Turkey; Pulmonary Diseases, Yedikule Chest Diseases and Thoracic Surgery                     findings. Central localization, mass morphology and epidermoid carcinoma are
Education and Research Hospital, Istanbul, Turkey; Pulmonary Diseases,                       more frequent features of smoker patients.
Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital,
Istanbul, Turkey
Objective: In patients suffering non-small cell lung carcinoma, we investigated              Evaluation of lung cancer cases diagnosed by fiberoptic bronchoscopy(Fob)
–using immunohistochemiacal dye- micrometastases within bone morrow and the                  Ozlem Yazicioglu Mocin 1 , Meltem Coban Agca 1 , Pinar Pazarli 2 , Ozge Unal
lymph nodes negative in mediastinoscopy, and its impact on prognosis.                        Bayraktar 1 , Dildar Duman 1 , Oguz Aktas 1 , Turan Karagoz 1 . 1 Chest Diseases,
Material and methods: We enrolled 40 patients who were diagnosed as non-                     Sureyyapasa Chest Cardiovascular Diseases Training Hospital, Istanbul, Turkey;
small cell lung carcinoma.All the patients underwent mediastinoscopy for staging               Chest Diseases, Cankiri State Hospital, Cankiri, Turkey
purposes; positive N2 lymph nodes were detected in 6 patients, positive N3
lymph nodes were revealed in 1 patient. 33 patients were evaluated as N0, medi-              Between January 2003-December 2005 497 lung cancer cases, diagnosed by fob,
astinoscopic specimen of 7 patients noted as N0 could not be obtained. 26 patients           were investigated retrospectively for age, sex, histopathologic type and distribu-


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tion according to years, endobronchial location and morphology and diagnostic                 E577
procedures.                                                                                   Prognostic parameters in patients with lung cancer
Endobronchial location was defined as central if tumor was localized in lobe                   Chrisoula S. Tsobanidou 1 , Efimia A. Boutsikou 2 , Doxakis Anestakis 1 ,
bronchus and proximal and as pheripheric if it was located in segment bronchus                Ioannis Boukovinas 3 , Dimitrios S. Rizos 4 , Theano Toliou 1 . 1 Pathology,
and distal. Endobronchial morphology was defined as direct and indirect tumor.                 Theagenio Anticancer Institution, Thessaloniki, Greece; 2 Pulmonology,
The mean age was 60.37±9.73(35-83). 92.2%(458) patients were male There was                   Theagenio Anticancer Institution, Thessaloniki, Greece; 3 Clinical Oncology,
no significant relation between histopathology and sex(p=0.7). 406(81.7%) patients             Theagenio Anticancer Institution, Thessaloniki, Greece; 4 Surgery, General
were nonsmall cell lung cancer(NSCLC) and 91 small cell lung cancer(SCLC).                    Hospital of Thessaloniki “G. Papanikolaou”, Thessaloniki, Greece
Frequency of NSCLC in years 2003,2004,2005 were detected as 81.4%, 81.4%
and 82.5% respectively. According to endobronchial location, 68.6% were central               Lung cancer is the leading cause of death from all malignancies in the world.
and 31.4% pheripheric. 65.3% of NSCLC and 83.5% of SCLC were centrally                        The cure rate remains <15% despite some recent advances in chemotherapeutic
located and the difference was significant(p=0.001). Endobronchial direct tumor                agents.
finding was the most common in both NSCLC and SCLC with 56.9% and                              In this study we aimed to show the effects of some clinical and histopathological
52.7% respectively. Indirect tumor finding was more common in SCLC than                        parameters on response to treatment and long-term survival in patients with lung
NSCLC(47.3%, 38.9%). There was no significant relation between histopathology                  cancer.
and endobronchial morphology(p=0.2). Forceps biopsy was the most common                       Findings of 175 patients diagnosed as lung cancer between 1995-2005 were evalu-
bronchoscopic diagnostic procedure for all cases with 94.4%(n=469). The patho-                ated. The following variables were included: age, performance status, histological
logic result of forceps biopsy, applied in 94.4% of central and 86.5% of peripheric           type, stage, treatment response and survival of the patients.
tumors, was diagnostic.Transbronchial needle aspiration biopsy in SCLC and                    The men age was 62 (between 21 and 79) years. Histopathological diagnosis were
catheter aspiration in NSCLC were diagnostic following probe excision and                     squamous cell carcinoma in 46 (26%), adenocarcinoma in 84 (48%), small cell
lavage.                                                                                       carcinoma in 8 (5%) and undifferentiated large cell carcinoma in 37 (21%) patients.
So SCLC was more centrally located than NSCLC but there was no difference                     115 patients were at the stages IIIb and IV with a median survival 8 months. 42
between morphology and histotype.                                                             of the patients with good performance status had a good treatment modality with
                                                                                              a maximun survival about 25 months.
                                                                                              We conlude that poor performance status, advanced stage and low treatment re-
E575                                                                                          sponse of disease would predict poor prognosis for lung cancer in patients who
Evaluation of the role of bronchoscopy in the diagnosis of lung cancer                        received frequently oncologist’s treatment.
M. Rancic 1 , S. Rancic 1 , M. Cekic 1 , L. Ristic 1 , I. Stankovic 1 , T. Pejcic 1 ,
N. Krstic 2 . 1 Department for Lung Cancer, Clinic for Lung Diseases, Nis, Serbia;
  Cabinet for Invasive Diagnostics, Clinic for Cardiovascular Medicine, Nis,                  E578
Serbia                                                                                        Prognostic factors in small cell carcinoma
                                                                                              Elif Torun 1 , Ali Fidan 1 , Benan Caglayan 1 , Taflan Salepci 2 , Banu Salepci 1 .
The aim of this work is to evaluate the efficacy of flexible bronchoscopy in                      Chest Diseases, Dr. Lutfi Kirdar Kartal Education and Research Hospital,
diagnosis of lung cancer.                                                                     Istanbul, Turkey; 2 Medical Oncology, Dr. Lutfi Kirdar Kartal Education and
We analysed endobronchial findings 2450 patients whose were underwent bron-                    Research Hospital, Istanbul, Turkey
choscopy in Clinic for lung diseases of Clinical center Nis from 2000 to 2005
year.                                                                                         In order to find out prognostic factors and treatment results in SCLC, 40 patients
Lung cancer was verified in 681 (27,8%) pts. (84% male and 16% female). Their                  diagnosed in 1 year period were prospectively analysed. Following history and
ages ranged from 28-83 years.                                                                 physical examination, patients were grouped according to ECOG performance
Bronchoscopically visible toumor were found in 568 (83,4%) cases. Bronchial                   scale(PS) and underwent CXR and thoracic CT. Complete blood count, biochemi-
biopsy of endobronchial lesions gave a positive diagnosis of lung cancer in 374               cal analyses (glucose, urea, creatinine, sodium, potasium, chloride, calcium, LDH,
(65,8%) pts, bronchial biopsy and citology of bronchial secretion were positive               SGOT, SGPT, GGT, ALP, CK, uric acid, protein, albumin), tumor markers (NSE,
in 31 (5,5%) pts. Citology of bronchial secretion alone made diagnosis of lung                CA15-3, CA19-9, CA125, CEA, ferritin) were taken. Abdominal USG or CT,
cancer in 24 (4,2%) pts with endobronchial tumours.                                           bone scintigraphy, cranial CT or MRI and bone marrow biopsy were made for
Transbronchial lung biopsy was performed in 113 pts with peripheral lung lesions.             detection of metastases. Limited stage patients received chemotherapy and tho-
Positive histology only by transbronchial biopsy were found in 52 (46%), tran-                racic RT, whereas cases with extensive disease received chemotherapy. Mean age
scbronchial biopsy and citology were positive in 6 (5,3%) pts. Citology alone was             was 58,57 ± 10,38 (36-77), with a mean follow up period of 6 months(1-19).
conclusive for diagnosis lung cancer only in 8 (7,1%).                                        Nineteen cases had limited and 21 had extensive disease. Six cases had SVCS.
Our investigation shows that efficacy rate of flexible bronchoscopy                             When laboratory findings between 2 stages were compared, LDH, SGOT and
bronchial/transbronchial biopsies for diagnosis lung cancer is 62,6%, and alone               GGT were significantly higher in extensive stage. Overall median survival was
citology efficacy is only 4,7%. To enhance diagnosis we take both method com-                  6±1 months, cumulative survival in 6 and 12 months were 39% and 20.72%,
plementary.                                                                                   respectively. Median survival was 10±2 months in limited stage and 3±1 months
                                                                                              in extensive stage, with a statististically significant difference. Univariate analyses
                                                                                              showed that incresed LDH, CA 15-3, GGT and SGOT levels, hipoproteinemia and
E576                                                                                          poor PS were poor prognostic signs, however multivariate analyses revealed no
Women lung cancer: factors related to survival                                                significant difference. Other blood tests, pleural effusion, age, mediastinal lymph
Elif Sen, Serhat Erol, Akin Kaya, Ismail Savas, Ugur Gonullu. Pulmonary                       node metastases and weight loss had no prognostic effect. Stage was found to be
Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey                              prognostic factor with both univariate and multivariate analyses.

Women lung cancer is increasing in worldwide. This process beginning with the
difference on the susceptibility of tobacco smoking and lung cancer in women                  E579
may be different from men in the prognosis. This study was aimed to evaluate the              Do cavitating non-small cell lung cancer patients have a more aggressive
clinical features, prognostic factors of the female lung cancer patients diagnosed            disease?
between January 2000- December 2005. Mean age was 59,40 ± 11,56 (34-88),                      Marina B. Cekic, Milan H. Rancic. Department for Lung Cancer, Clinic for Lung
no. of smokers: 17 (%15,5). In 20 patients(18,3%), familial cancer history was                Diseases, Nis, Serbia & Montenegro; Department for Lung Cancer, Clinic for
present, 11 of these patients (55%) had a relative with lung cancer. Most common              Lung Diseases, Nis, Serbia & Montenegro
presenting symptoms were cough (81,7%), dyspnea (78,9%), chest pain (40,3%).
Central mass lesion in 37,6%, a peripheral lesion in 23,8%, and pleural effusion in           Cavitating non-small cell lung carcinoma (cNSCLC) is thought to be a distinct
45,8% of the patients were identified. Most common sites of tumor in bronchoscopy              entity represented with a rapid progresion, chemotherapy resistent disease and
were right upper lobe (16,5%), left main bronchus (14,7%). Histopathologically,               generally worse prognosis.
NSCLC 78,9% (adenocarcinoma(n):49, squamous(n): 11, NSCLC (undefined sub-                      We retrospectively analised the clinicopathology, radiology, tumour site, disease
type): 24 patients), SCLC 18,3%, carsinoid tumors were diagnosed in 2,8% of the               TNM stage, treatment modality and therapeutic response rate of 615 hospitalised
patients. 63,9% of NSCLC patients had a stage 4 disease, 55% of SCLC patients                 NSCLC patients (pts) from 2000-2005. Fourty seven pts had cNSCLC at initial
had an extensive disease. Most common sites of metastasis were bone (28,4%),                  presentation (7,6%). 76,6% were male with a median age of 71 years. Squamous
liver(22,9%), and brain(11,9%), there were more than one site of metastasis in 10             histology was found in 92% and adenocarcinoma in 8%. Predominantly TNM
patients. Kaplan –Meier method was used in survival analysis. Median survival                 stages were IIIb (52,14%) and IV (31,15%). Tumour necrosis as cavities were
time was 288 days (5-1855 days) Presence of comorbidity, bone metastasis, ad-                 represented on chest x ray in 36%. Localisation of cavitations were dominant in
vanced disease stage were poor prognostic factors. In conclusion, the most common             upper lobes (68%), in middle lobe and lingula 11% and lower lobes 21%. Only
histopathological subtype was adenocarcinoma.The majority of the patients was                 2/34 pts underwent surgical resection, 48,57% received combined chemotherapy
presented with advanced disease. Advanced stage, poor performance status and                  and paliattive radiotherapy. 33,88% received chemotherapy alone and 17% were
presence of a comorbidity were predictors of short survival in female patients with           offered only simptomatic treatment. Response rate on chemotherapy was 45,5%.
lung cancer.                                                                                  Conclusions: 7,6% pts had cNSCLC at initial presentation, TNM stage III-IV,
                                                                                              with predominantly squamous histology and radiological site in upper lobes. This
                                                                                              is similar to NSCLC without tumour necrosis so cNSCLC do not represent a more
                                                                                              aggresive disease.


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E580                                                                                          median in the malignant group was 11,18±3,35 ng/mL. Only 3 EBC samples from
Serum carcinoembryonic antigen (CEA) level as a predictive marker for                         patients with NSCLC showed a measurable concentration, and this concentration
distant metastasis in non-small cell lung cancer                                              was below 1,5 ng/mL. In patients with out tumor observed only one individual
Ahmet Ursavas 1 , Mehmet Karadag 1 , Ilker Ercan 2 , Ozlem Ozkubat 1 ,                        with a measurable increased level of CYFRA 21-1. In conclusion, our findings
Selma Yesilkaya 1 , R. Oktay Gozu 1 . 1 Department of Pulmonary Medicine,                     confirmed earlier investigations of CYFRA 21-1 in serum, but was unsuccessful
University of Uludag School of Medicine, Bursa, Turkey; 2 Department of                       in the analysis of this tumor marker in EBC.
Biostatistics, University of Uludag School of Medicine, Bursa, Turkey

Elevated serum CEA (S-CEA) levels are sometimes attributable to the production                E583
of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic         Importance of CYFRA-21 in estimation of survival of patients with NSCLC
potential of malignant cell. We investigated the predictive role of S-CEA level               Vukoica Karlicic, Aleksandra Jovelic, Ilija Tomic. Clinic for Lung Disease,
for distant metastasis in non-small cell lung cancer (NSCLC). Consecutive 118                 Military Medical Academy, Belgrade, Serbia; Clinic for Lung Disease, Military
patients NSCLC referred to our department were investigated retrospectively. S-               Medical Academy, Belgrade, Serbia; Clinic for Lung Disease, Clinic for Lung
CEA levels was compared according to age, gender, smoking habits, histologically              Disease, Belgrade, Serbia
type, distant metastases and clinical disease stage in all patients. There were no
significantly relationship between S-CEA level and age, gender, smoking habits.                Cytokeratin 19(Cyfra-21) is tumor marker for non-small cell lung cancer (NSCLC).
There were significant differences in S-CEA level between M0 and M1 patients                   Aim: To foresee survival of patients with NSCLC, depending on concentracion of
(p<0.001). S-CEA levels were not significantly different between symptomatic                   tumor marker Cyfra-21 in patients serum.
and silent metastases (p=0.103). We could not find significant differences in S-CEA             Method: With 100 patients with NSCLC was determined CYFRA 21 serum
levels between T1-2 and T3-4 (p=0,141), N0-1 and N2-3 (p=0,672). In NSCLC,                    concentration, by imunoessay method, with Elecsys commercial kits 1010, 2010
the area under the ROC curve was 0.738 (p<0.001) for the S-CEA threshold                      System, Elecsys Cyfra 21-Roche. Patients are divided by the disease stadium
of 6.4 ng/mL predictive sensitivity, specificity, positive predictive value, negative          (IA,IB,IIA,IIB,IIIA,IIIB i IV), by the histology to plano, adeno and other NSCLC,
predictive value and accuracy for distant metastases were respectively 70.9%,                 and by Karnofski stadium <70% and >70% with survival tracking.
73.0%, %69.6, %74.1 and %72. In multivariate analysis including age, gender,                  Results: Average patients age was 61,58 years. I+II stadium 18%, IIIA-20%, IIIB-
smoking status, histologic type and S-CEA level that only S-CEA levels qualified               30% i IV-32%. Plano-cellular 70%, adeno 28% and others 2%, Karnofski>70-
as an independent predictive factor for distant metastases (p=0.001). We concluded            74%,<70-26%. Cyfra 21 serum concentration according to TNM: I+II -9,25ng/ml,
that S-CEA levels were significant predicting distant metastases. High levels of               IIIA-5,81ng/ml, IIIB-11,28ng/ml and IV- 32,93ng/ml with p<0,05 between IV
S-CEA may be indication to perform routine investigation of distant metastases                and other clinical disease stadiums. Survival in weeks according to stadium: I+II-
even in the absence of symptoms and signs.                                                    127,7; IIIA-57,8; IIIB-32,3 and IV-23,1 more exactly 51,7 for all patients. There
                                                                                              is statistical significance on the level p<0,05 in surviving by the disease stadium.
                                                                                              Survival median according to Kaplan Maier curve, for patients with Cyfra
E581                                                                                          21<6ng/ml is 37 weeks, and for Cyfra 21>6ng/ml 30 weeks with p<0,05.
The usefulness of Cyfra 21-1 as a disease marker in malignant pleural
mesothelioma (MPM)
Katsuhiko Naoki 1,2 , Hiroshi Kunikane 1 , Hiroaki Okamoto 1 , Naoya Hida 1 ,
Yusuke Narita 1 , Ichiro Nakachi 2 , Ichiro Kawada 2 , Hideo Watanabe 2 ,
Hiroyuki Yasuda 2 , Kenzo Soejima 2 , Akitoshi Ishizaka 2 , Koshiro Watanabe 1 .
  Respiratory Medicine, Yokohama Municipal Citizen’s Hospital, Yokohama,
Japan; 2 Respiratory Medicine, Keio University, Tokyo, Japan

Backgrounds: As in Europe and US, patients with malignant pleural mesothelioma
(MPM) is increasing and becoming socio-economical burden in Japan. Although
several chemotherapeutic agents are at hand, it is sometimes difficult to assess the
disease activity from imaging study.
Objective: To assess the usefulness of Cyfra 21-1 (CYFRA; cytokeratin 19 frag-
ments) as a disease activity marker, we retrospectively analyzed MPM patients in
a Japanese community hospital.
Patients: From Jan. 2000 to Dec. 2005, we experienced 16 patients with MPM in
Yokohama Municipal Citizen’s Hospital.
Results: The age of the patients are 46 to 76 (median 66) years old. Nine had
definite history of asbestos exposure. Pathologically, five had epithelial type and
three had sarcomatous type. Nine patients were treated with chemotherapy (six                 Conclusion: Patients with serum concentration of cyfra 21>6ng/ml have shorter
with CDDP+GEM, two with GEM+VNR, and one with CDDP+GEM followed                               median of survival then patients with concentration of Cyfra 21<6ng/ml.
by CDDP+VNR), and resulted in two with PR and six with SD. Five patients are
surviving after 120 to 336 (median 135) days, and eight were dead after 10 to
254 (median 131) days from the first clinic visit. Tumor markers were measured                 E584
at the time of diagnosis. CEA was normal in 12 of 15 patients, on the other hand,             Isoenzyme regan – marker enzymatic – in lung cancer
CYFRA was high in 5 of 11 patients (4.1 to 55, median 7.7; normal range less than             D. Garbulet, A. Tomosoiu. Pneumology, Clinic of Pulmonary Diseases, Iasi,
2.0 ng/ml). We followed CYFRA in recent three cases. CYFRA was decreased                      Romania; Biochemistry, University “Al.I.Cuza”, Iasi, Romania
during the course of chemotherapy in all the three cases. After the chemotherapy,
CYFRA was definitely increased with worsening of the disease in one case, and                  Introduction: Isoenzyme Regan is a enzymatic marker, a fraction of alkaline
in other case it is slowly increasing with minimal imaging change. (One patient is            phosphatase.
under treatment.)                                                                             Materials and methods:The study included 62 patients: 25 patiets with lung
Conclusions: It is suggested that CYFRA will be a useful disease activity marker              cancer, 23 with pulmonary metastasis, 8 with neoplazic pleuresis and 6 with
in MPM.                                                                                       Hodgkin’s disease. Isoenzyma Regan have been identified and quantified through
                                                                                              the means of electrophoresis on gel of agar.
                                                                                              Results: see table 1
Attempt of detection of CYFRA 21-1 in exhaled breath condensate by                            Table 1
patients with NSCLC                                                                                                                Lung     Pulmonary     Neoplazic    Hodgkin’s
Siarhei Tahanovich, Christian Gessner, Hartmut Kuhn, Hubert Wirtz. Department                                                     cancer    metastasis    pleuresis     diseases
of Respiratory Medicine, University of Leipzig, Leipzig, Germany                              Number of patients                    25          23            8            6
                                                                                              Number of patients with isoenzyme
Lung cancer is the most common cause of cancer death. The majority of patients                  Regan present in serum            15(60%)   12 (52,17%)   1 (12,5%)    2 (33,33%)
present with non-small cell lung cancer (NSCLC) in advanced inoperable stages.
Elaboration of new techniques to diagnose lung cancer may help to decrease the
mortality of lung cancer. Exhaled breath condensate (EBC) collection is a non-                Conclusion: 1) Isoenzyme Regan is a efficient enzymatic marker of lung cancer.
invasive technique that involves quiet breathing. The tumor marker CYFRA 21-1                 2) Isoenzyme Regan isn’t presente in patients serum with another pulmonary
has been detected in the serum of patients with lung cancer with high sensitivity. We         affections.
attempted to detect local CYFRA 21-1 secretion by measuring this tumor marker
in EBC of 12 patients with NSCLC. As a control were used EBC of 7 patients with
nonmalignant lung diseases. We also measured CYFRA 21-1 in serum samples
of all patients in order to compare EBC and serum levels. Samples were dried
and protein concentration was measured. Protein ranged from 35 μg/mL to 200
μg/mL. The levels of CYFRA21-1 were by ELISA measured. Serum CYFRA 21-1


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E585                                                                                            Conclusions:Our results indicate that these molecular markers are abnormally
A serum level of IGF-I, IGF-II and IGFBP-3 in patients with small cell lung                     expressed in some lung carcinomas and their expression may have prognostic
cancer (SCLC) during chemotherapy                                                               importance. We will continue with follow-up studies to evaluate the prognostic
Tomasz Izycki, Wojciech Naumnik, Maria Ossolinska, Elzbieta Chyczewska.                         and predictive role of these markers in the monitoring of the patients with lung
Department of Lung Diseases and Tuberculosis, Medical University, Bialystok,                    carcinoma.

Materials and methods: In this study took part 18 patients (15 males and 3 fe-                  E588
male) with mean age 59,8 with histological small cell lung cancer (SCLC) defined.                Impaired oxidant/antioxidant balance and relationships between
In this group, there were 10 patients with extensive disease (ED) and 8 patients                inflammatory markers and antioxidants in patients with primary lung cancer
with limited disease (LD). The control group was made with 10 healthy persons.                  Hikmet Firat, Sevgi Yardim Akaydin, Emel Caliskan, Recai Ergun, Sadik Ardic,
The peripheral blood were taken before and after 4 cycles of chemotherapy. The                  Bolkan Simsek. Department of Pulmonary Medicine and Tuberculosis, SB. D. YB
assessment of IGF-I, IGF-II and IGFBP-3 was made by ELISA method.                               Traianing and Research Hospital, Ankara, Diskapi, Turkey; Department of
Results: Patients with SCLC demonstrated markedly higher concentrations of                      Biochemistry, Gazi University, Faculty of Pharmacy, Ankara, Etiler, Turkey;
IGF–I and IGF-II both before and after chemotherapy in comparison with controls.                Department of Biochemistry, Gazi University, Faculty of Pharmacy, Ankara,
Significantly lower concentrations of IGFBP–3 were reported in these patients                    Etiler, Turkey; Department of Pulmonary Medicine and Tuberculosis, SB. D. YB
before chemotherapy in comparison with controls. After cytoreduction treatment,                 Traianing and Research Hospital, Ankara, Diskapi, Turkey; Department of
patients presented lower IGFBP–3 levels when compared to controls, however with-                Pulmonary Medicine and Tuberculosis, SB. D. YB Traianing and Research
out statistical significance. Patients before cytoreduction treatment had markedly               Hospital, Ankara, Diskapi, Turkey; Department of Biochemistry, Gazi University,
lower levels of IGFBP–3 in comparison with patients after treatment. No signifi-                 Faculty of Pharmacy, Ankara, Diskapi, Turkey
cant differences in levels of IGF-I, IGF-II and IGFBP-3 were observed between
patients with a limited disease (LD) and an extensive disease (ED) of SCLC.                     Objective and design: Recent studies have shown that systemic inflammatory
Conclusions: The serum level of IGF-I and IGF-II was significant higher and a                    response plays an important role in reducing circulating antioxidant levels in acute
serum level of IGFBP-3 was significant lower in patients with lung cancer before                 or chronic diseases, such as critical illness, cardiovascular diseases and cancer.
chemotherapy than in control group. There were no influence of chemotherapy on                   Our aim in this study was to investigate the relationship between the markers of
serum level of IGF-I and IGF-II. Chemotherapy was reported to have an effect on                 oxidative stress and systemic inflammation in lung cancer.
IGFBP – 3 levels in patients with small cell lung cancer (SCLC). Extension of                   Material and subjects: Serum C-reactive protein (CRP), erythrocyte sedimenta-
SCLC did not influence serum level of IGF-I, IGF-II and IGFBP-3.                                 tion rate (ESR), malondialdehyde (MDA), vitamin A and C, uric acid and total
                                                                                                antioxidant response (TAR) were measured in fasting blood samples of patients
                                                                                                with lung cancer (n=38) and healthy controls (n=24).
E586                                                                                            Results: The levels of MDA and CRP, and ESR were significantly higher (p<0.001,
The evaluation of bromodeoxyuridine labelling index in lung cancer                              p<0.0001 and p<0.0001, respectively) and retinol, vitamin C and uric acid and
Bektas Akpolat 1 , Ayhan Bilir 2 , Serhan Tanju 1 , Sedat Ziyade 1 , Alper Toker 1 ,            TAC (p<0.0001, p<0.0001, p<0.0001, and p<0.05, respectively) were signifi-
Sukru Dilege 1 , Goksel Kalayci 1 . 1 Thoracic Surgery, Istanbul Universty Istanbul             cantly lower in patients than the ones in the controls. There were significantly
Medical School, Istanbul, Turkey; 2 Histology, Istanbul Universty Istanbul                      negative correlations between the levels of retinol, vitamin C and CRP (r=-
Medical School, Istanbul, Turkey                                                                0.446, p=0.005, and r=-0.3335, p=0.04, respectively), and between TAR and ESR
                                                                                                (r=-0.416, p=0.009) in patients.
Objective: Bromodeoxyuridine labelling index (BRDU-LI) was reported to be one                   Conclusions: In the current study, there is an impairment in the oxidant/antioxidant
of the prognostic factors in breast, colon and ovarian malignancies. We aimed to                balance in favor of lipid peroxidation in lung cancer patients. Our results suggest
analyze the effects of in vitro BRDU-LI on survival of non small cell lung cancer               that chronic inflammation is an important factor in lowering the levels of certain
patients (NSCLC) after a curative lung resection.                                               antioxidants in lung cancer.
Methods: BRDU-LI of 39 patients were recorded and analyzed with predocu-
mented prognostic factors and development of metastatic disease during follow-up
period and survival. Prognostic factors were recorded as age, tumor histology,                  E589
diameter, and lymph node involvement. Mann-Whitney U Test and Kaplan-Meier                      Polymorphism of GSTT1 and GSTM1 genes in lung cancer
Test were used in statistical analyzes.                                                         Alla I. Dmitrieva, Vjacheslav V. Novitski, Natalija V. Sevostyanova. Siberian
Results: The mean BRDU-LI was calculated to be 8.7±9.8. The mean duration of                    State Medical University, Diagnostic Center, Tomsk, Russia
follow-up period was 30 months ± (48 months-16 months). All prognostic factors,
development of metastatic disease during follow-up period and survival were not                 The frequency of GSTT1 0/0 and GSTM1 0/0 genes was significantly higher
found to be statisticly significant when analyzed with BRDU-LI.                                  in lung cancer patients than in healthy persons (51%; 59,4% and 15%, 43%
Conclusions: In this group of patients the value of BRDU-LI was not a prognostic                respectively; p<0,005).
factor. Its level was not related with prognostic factors. It did not give any clue for         A significant increase in the frequency of 0/0 genotype of GSTT1 gene was
early metastatic disease. We concluded that further studies with BRDU-LI were                   observed in patients with small cell lung cancer as compared with that observed in
necessary.                                                                                      patients with squamous cell lung cancer (67,7% and 48%, respectively; p=0,045).
                                                                                                The frequency of homozygous alleles of GSTT1 0/0 was significantly higher in
                                                                                                lung cancer patients having metastases than in lung cancer patients having no
E587                                                                                            metastases (59% and 52%, respectively; p=0,022). It should be noted that sim-
Molecular markers in non-small cell lung carcinoma                                              ilar observations were registered for GSTM1 0/0 (67% and 51%, respectively;
Biljana T. Ilievska Poposka 1 , Gordana K. Petrusevska 2 , Biljana Dimova 2 , Sonja             p=0,022).
A. Atanasova 1 , Stefan Z. Talevski 1 , Snezana Smickova 3 , Tome Stefanovski 4 .               The presence of nuclear proteins of Epstein-Barr virus (EBV) in tumor cells was
  Bronchology, Institute for Lung Diseases and Tuberculosis, Skopje, Macedonia;                 determined by immunohistochemical methods. GSTT1 0/0 was observed in 40
  Immunology, Institute for Pathology, Skopje, Macedonia; 3 Immunology, Institute               patients of 66 virus-positive cases and in 53 patients of 115 virus-negative cases
for Radiotherapy and oncology, Skopje, Macedonia; 4 Bronchology, Clinic for                     (p=0,05).
Pulmonology, Skopje, Macedonia                                                                  The frequency of GSTM1 0/0 was significantly higher in EBV-positive patients
                                                                                                than in EBV-negative patients (89,4% and 53,0%, respectively; p=0,0001).
Background: Bcl-2 and p53 are the most relevant proteins in apoptosis and tumor                 Depending on the disease outcome, the frequency of GSTT1 0/0 for patients
development. Her-2/neu proto-oncogene which encodes tyrosine kinase receptor                    with unfavorable outcome significantly increased that observed in patients with
p185 is overexpressed in a lot of human tumors, and is thought to play a role in                favorable outcome (63,6% and 44,3%, respectively; p=0,012), similar dependence
the aberrant proliferation of cancer cells. The aim of this study was to examine the            was observed for GSTM1 0/0 (80,3% and 48,6%, respectively; p=0,0001).
expression of p53, bcl-2, Her-2/neu and Ki67 in patients with non small cell lung               In addition, the correlated associations of GSTT1 0/0 with histological type of the
cancer (NSCLC).                                                                                 tumor, the disease stage, the presence of metastases, GSTM1 0/0 and the outcome
Methods: In the study 35 NSCLC patients were involved: 16 patients with squa-                   of the disease were found (p<0,05).
mous cell carcinoma, 9 with adenocarcinoma, 3 with large cell carcinoma and 7
patients with non-differentiated lung carcinoma. Paraffin-embedded tumor sam-
ples were immunostained using anti- p53, anti-bcl-2, ati Her-2/neu and anti- Ki67               E590
monoclonal antibodies with LCAB+ immunoperoksidase technics (DAKO tests).                       Lung resistance-related protein in lung cancer and lung lesions in Hodgkin
Staining was graded as negative or positive.                                                    disease
Results: The prevalence of p53, bcl-2 and Her-2/neu expression in NSCLC is                      Dimitry A. Bazyka 1 , Liudmila I. Shvayko 1 . Dept. of Clinical Immunology,
54,2%, 20% and 31,4% respectively. Her-2/neu expression is seen more frequently                 Research Centre for Radiation Medicine, Kiev, Ukraine; Dept. of Pulmonology,
in adenocarcinomas (55,5%); p53 is seen more frequently in squamous (62,5%)                     Research Centre for Radiation Medicine, Kiev, Ukraine
and non differentiated carcinomas (57,1%). There was no bcl-2 expression in
the patients with adenocarcinoma; only patients with squamous and large cell                    Objective: To study the role of lung resistance-related protein (LRP) and multidrug
carcinomas showed positive bcl-2 expression. Her-2/neu and p53 expression were                  resistance (MDR) in pulmonary lesions in leukemia and lung cancer in radiation
more relevant with advanced stage of tumor: 72,7% and 68,4%. Bcl-2 expression                   exposed.
is associated with low grade tumors.                                                            Methods: 15 patients were studied with newly diagnosed lung cancer and Hodgkin


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disease and 8 patients after radiotherapy. Lung pathology (inflammatory processes              The aim of our retrospective study is to describe clinicopathological and surgical
– bronchitis, alveolitis) was found in 12, pulmonary fibrosis in 4, none of                    characteristics of LC in Tunisian women.
cases exhibited symptoms of cytostatic disease, Expression of transport proteins              We included 103 women operated on for LC in our department of thoracic and
(P-glycoprotein, LRP, MRP1) responsible for cytostatic agents ATP-dependent                   cardiovascular surgery in Ariana hospital between 1985 and 2002. The age ranged
transfer against the concentration gradient pro- (Fas, p53, Bax) and anti-apoptotic           between 13 and 83 years with a mean age of 51 years. Sixty percent of patients
(Bcl-2, Bcl-XL) regulators was examined by flow cytometry.                                     were smokers with a mean cigarette consumption of 33 pack-year. Presenting
Results: We found no relationship between LRP expression and irradiation dose.                symptoms were cough (58,3%), chest pain (55,3%), hemoptysis (40, 8%), dysp-
Expression of the LRP was the highest in comparison with MRP1 and glycoprotein                nea (21,4%) and weight loss (2%). Thirty women were asymptomatic. Surgical
P in primary cancer cases without radiotherapy or chemotherapy. After treatment               treatment consisted of lobectomy in 48,3%, bilobectomy in 15%, pneumonectomy
a positive concentration was shown between LRP expression, neutropenia and                    in 26,8% and conservative resection in 9,6%. Surgical stage was Ia in 11,7%,
secondary lung infections. No correlations were shown with with p53 or Bcl-2.                 Ib in 46,6%, IIb in 14,6%, IIIa in 8,7%, IIIb 10,7 in % and IV in 8%. Com-
                                                                                              pared to other stages, women were younger in stage Ia. Histopathological types
                                                                                              were carcinoid tumor (40,7%), adenocarcinoma (31%), squamous cell carcinoma
E591                                                                                          (15,6%), large cell carcinoma (3%), adenosquamous carcinoma (1,9%), pleiomoph
Nucleolar organizer regions in lung cancer in plutonium plant workers                         carcinoma (1%) and were undetermined in 6,9%. The percentage of carcinoid
Maxim V. Belosokhov. FMBA, Southern-Urals Biophysics Institute, Ozyorsk,                      tumors was significantly higher in young women (< 45 years). Follow-up showed
Chelyabinskaya Obl, Russia                                                                    local recurrence and metastasis in respectively 9 and 16 women and 17 patients
Registration of ribosomal DNA activity is one of the objective methods for re-                Our study shows that carcinoid tumors and adenocarcinoma are the predominant
flection of cell proliferative potential. The aim of our investigation is the study of         LC in women and underlines the high percentage of women having early stage at
proliferative activity in lung cancer cells in plutonium plant workers.                       presentation.
21 cases of lung cancer (LC) in plutonium plant workers (main group) and 16
cases of LC in nuclear reactor workers (for comparison) were analyzed. For
argyrophilic nuclear organizer regions (AgNORs) visualization the silver staining             E594
method was used (Crocker J., Nar P., 1987). The cells were divided in accordance              Lung cancer morbidity in women
with character of AgNORs nuclear distribution: I type (AgNOR-I) is cells contain-             Hristo G. Ganchev, Dimitar N. Kalev, Yancho M. Yanchev, Eleonora
ing the intranucleolar granules only; III type (AgNOR-III) is cells containing the            G. Dimitrova, Edmond V. Derderyan. Department of Pulmonary Diseases and
extranucleolar granules only; II type (AgNOR-II) is cells containing both intra-              Oncology, St. Marina University Hospital, Varna, Bulgaria
and extranucleolar granules.
LC in main group is characterized by statistical significance of increasing activity           The aim of the current study is to analyse the structure of the lung cancer morbidity
of AgNORs on the whole, as well as intra- and extranucleolar AgNORs separately.               in women. There were followed prospectively 619 patients diagnosed with lung
There were no differences in mean number of AgNOR-I between groups with the                   cancer at St. Marina University Hospital, Varna, Bulgaria, for a three year period
exception of squamous cell cancer. The significance growth of all extranucleolar               (2003-2005).
granules number for both AgNOR-II and AgNOR-III in adenocarcinomas and                        Lung cancer is diagnosed in 63 women aged between 28 and 84 years. The ratio
squamous cell lung cancer in the main group was obtained (p<0.05). The equal                  women/men is 1/9.8, while in our previous studies it was 1/6.8. The percentage
containing of AgNOR-II-cells in adenocarcinomas of two groups was revealed.                   of women smokers (with 20-year-history of smoking, at least 1 pack a day) is
Peak number of AgNOR-III-cells was registered in adenocarcinomas and small-cell               80.95%, which is similar to the percentage in men (82.31%). The patients with
in comparison group (p<0.05).                                                                 squamous cell carcinoma dominate (34.9%), followed by adenocarcinoma patients
Results of our study let us talk about the higher intensity of plastic processes              (25.4%). Seven women (11.1%) have small cell lung cancer, and all of them are
occur in plutonium plant workers LC. Tumors in reactor workers had less level of              smokers, while only 2 of the women with adenocarcinoma are smokers.
proliferation and cell renewal comparing with personal of plutonium plant.                    Conclusion: The percentage of diseased women with lung cancer is decreased.
                                                                                              The commonly observed in women adenocarcinoma is left behind by squamous
                                                                                              cell type.
The prevalence of human papillomavirus infection in Korean non-small cell
lung cancer patients                                                                          E595
Moo Suk Park 1 , Woo Young Chung 1 , Shin Myung Kang 1 , Min Kwang Byun 1 ,                   CA-125 index and non small cell lung cancer: case report
Jae Hee Jung 1 , Sang Bong Choi 1 , Chang Hoon Hahn 2 , Young Sam Kim 1 ,                     Alfonso Tafur, Ivan Cherrez-Ojeda, Ronnie Mantilla, Thomas Guerrero,
Joon Chang 1 , Sung Kyu Kim 1 , Se Kyu Kim 1 . 1 Internal Medicine, Yonsei                    Ivan Mendoza, Olmedo Arroba, Gabriel Jordan. Pulmonology, Kennedy
University College of Medicine, Seoul, South Korea; 2 Internal Medicine, National             Hospital-INERA, Guayaquil, Guayas, Ecuador
Health Insurance Corporation Ilsan Hospital, Goyang, South Korea
                                                                                              We found CA 125 in pleural effusion as a guiding marker for a lung cancer
Background: Human papillomavirus (HPV) infection contributes to the patho-                    diagnosis. We present 64-year-old male presented a right pleural effusion. Tumor
genesis of and is a co-carcinogen of lung cancer.                                             marker CA-125 in pleural fluid was 70327.00 (normal range < 35.00 U/ml) and
Materials & method: To evaluate the prevalence of HPV infection, polymerase                   597.7 in serum (normal range< 35.00 U/ml). The index fluid/serum was 117.7.
chain reaction (PCR) was employed to detect HPV 16, 18, and 33 DNA in tumor                   This index was obtained dividing the tumor marker in pleural fluid to the value
tissues of 112 patients with non-small cell lung cancer (NSCLC) who underwent                 found in serum. Later on, a bronchoscopy with needle biopsy showed a lung
curative surgery from Jan. 1995 to Dec. 1998 at Severance Hospital, Seoul, Korea.             adenocarcinoma.
Results: The patients consisted of 90 men and 22 women. Nineteen patients were                CA 125 is a glycoprotein, released by the mesothelium. Is used commonly in the
less than 50 years old (17%), and 92 patients (82%) were smokers. Fifty-three                 detection and therapy evaluation of ovarian carcinoma. However, little is written
patients had adenocarcinomas, while 59 patients had non-adenocarcinomas. Early                about the association with lung adenocarcinoma we should not ignore this marker
stage (I and II) was 64 patients (57.1%) and advanced stage (III and IV) was 48               as it guided us through further studies.
(42.9%). The prevalence of HPV types 16, 18, and 33 were 12 (10.7%), 11 (9.8%),
and 37 (33.0%), respectively. Smoking status, sex, and histologic type were not
statistically different in the presence of HPV DNA. The presence of HPV 16 was
more common in younger patients and HPV 18 was more common in advanced
stage patients.
Conclusion: This study showed that the prevalence rate of HPV infection in
NSCLC tissue was low, suggesting HPV infection played a limited role in lung
carcinogenesis of Korean.

Operated lung cancer in women: Tunisian experience
Adel Marghli, Belhassen Smati, Hedia Ghrairi, Samira Aouadi, Mohamed Abid,
Faouzi Mezni, Habiba Djilani, Tarek Kilani. Department of Thoracic and
Cardiovascular Surgery, A Mami Hospital Ariana, Ariana, Tunisia; Department
of Thoracic and Cardiovascular Surgery, A Mami Hospital Ariana, Ariana,
Tunisia; Department of Respiratory Diseases, A Mami Hospital Ariana, Ariana,
Tunisia; Department of Respiratory Diseases, A Mami Hospital Ariana, Ariana,
Tunisia; Department of Thoracic and Cardiovascular Surgery, A Mami Hospital                   Abnormal values of CA 125 and non small cell lung cancers (NSCLC) are clearly
Ariana, Ariana, Tunisia; Department of Anatomopathology, A Mami Hospital                      related. In our case, the abnormally high values found in pleural fluid and serum
Ariana, Ariana, Tunisia                                                                       lead us to measure a fluid/serum index. This index guided us to suspect the presence
                                                                                              of a NSCLC. Although Trape et al evaluated, among other things, sensitivity and
The number of lung cancer (LC) in women has increased over the last years.                    specificity of several tumor markers Fluid/serum index and suggested that CA 125


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index was not appropriate. This study was done using only 22 malignant pleural
effusions. Furthermore, many neoplasms were considered; making a conclusion
difficult. We encourage a study to evaluate the possible diagnosis value of this
index in NSCLC.


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