The value of lung scintigraphy in the staging of bronchial carcinoma. Prospective study for the determination of TN stages
Ramos, M.; Buri, P.; Rösler, H.
Schweizerische Medizinische Wochenschrift 106(5): 134-141
1976
ISSN/ISBN: 0036-7672 PMID: 1251166 Document Number: 106598
A prospective study has been conducted to determine the clinical importance of lung scintigraphy in the work-up of patients thought to have bronchial carcinoma (i.e., accuracy of the scintigraphic diagnosis, data concerning spread of the primary tumor [=T] as well as the possibility of metastases to the lung hilus and mediastinum [=N]). Ninety-four patients, all of whom were hospitalized for suspected bronchial carcinoma, were examined by 133Xenon i.v., 133Xenon gas inhalation,, and 99mTc-MAA i.v. (macroaggregated albumin or microspheres of human albumin). The suspicion was confirmed in 77 patients. Central and peripheral bronchial carcinomas were kept separate in the evaluation. A normal lung scintigram practically rules out a central bronchial carcinoma. Where the scintigraphic finding prompts suspicion of central bronchial carcinoma, this suspicion must be confirmed by other examinations and preferably those which cytologically and histologically directly demonstrate the tumor. The diagnostic reliability of lung scintigraphy is drastically reduced in patients with bilateral ventilation disturbances. Because of its 27% rate of false negative findings, bronchoscopy is a less suitable means of ruling out bronchial carcinoma than scintigraphy. The peripheral bronchial carcinoma displays no characteristic scintigraphic signs; thus, a normal scintigram does not rule out peripheral bronchial carcinoma. Bronchoscopy was negative in all these patients. Spread of the primary tumor was exactly predicted with bronchoscopy in 11% and with scintigraphy in 42% of cases. When the scintigraphic criteria for hilar or mediastinal involvement are ful filled, it is practically certain that the patient is no longer radically operable. This assertion is valid when mediastinoscopy is normal. Lung scintigraphy possesses the same accuracy in the diagnosis of mediastinal involvement both with peripheral lung tumors and with centrally located tumors.