Transthoracic Needle Biopsy for Lung Cancer

In the diagnosis of lung cancer, some lesions defy our routinemethods of sputum cytology and transbronchial lung biopsy, orcytology by using the bronchofiberscope; or under some circumstances,neither cytology nor histology by means of the bronchofiberscopecan possibly be applied. To obtain a definite diagnosis of suchcases the biopsy needle, 0.4 mm in diameter and 125 mm in length,has been developed. Since September 1969, transthoracic needlebiopsy has been performed on 276 thoracic lesions, consistingof 86 of lung cancer, 71 of metastatic lung tumors, 10 of malignantmediastinal tumors, and 109 of benign lesions, resulting ina positive diagnosis for all of the 86 lesions of lung cancer,of which 74 (86.0%) were of the peripheral type, and nine wereless than 2 cm. The complications following biopsy were 29 instancesof bloody sputum (10.5%) and 25 of pneumothorax (9.1%). Thoracicdrainage was used for eight patients but no tumor implantationwas observed, nor did any of the complications prove serious.From these results it is considered that transthoracic needlebiopsy, with its high degree of diagnostic accuracy, painlessnessand safety to the patient, simplicity and low cost may be ofgreat value in the diagnosis of lung cancer, especially of theperipheral type.     

Prognostic Significance of Extranodal Cancer Invasion of Mediastinal Lymph Nodes in Lung Cancer

The presence of perinodal cancer invasion in specimens obtainedfrom the mediastinum during curative surgery on 49 patientswith metastasis-bearing mediastinal nodes was determined andevaluated with special reference to its prognostic significance. When an en-bloc dissection technique for the mediastinal lymphnodes and fatty tissue surrounding the nodes during surgerywas used, lymphatic vessel invasion in fatty tissue other thana breach in the capsule of a lymph node by cancer could be seen.A breach in the node capsule and lymphatic vessel invasion aredesignated as "extranodal invasion" in this paper. A breach in the capsule was seen in 16 cases, lymphatic vesselinvasion in 12 and both a breach in the capsule and lymphaticvessel invasion in 4. In 17 cases there was only intranodalcancer metastasis. The 5-yr survival rate was 37.5% and 17.7%for patients with and without extranodal invasion, respectively.However, extranodal invasion did not seem to be a distinctiveprognostic factor.     

Surgical Treatment of Lung Cancer in Patients over the Age of 70 Years

The number of elderly patients receiving surgical treatmentfor lung cancer is rapidly increasing. There were 199 patients over the age of 70 yr among 1,210 patientswho underwent lung resection for lung cancer. Among the 199,156 were between the ages of 70 and 74, 36 between 75 and 79and seven over the age of 80. One hundred and sixty-nine received lobectomy, 25 pneumonectomyand five a smaller lung resection. Mediastinal lymph node dissectionwas carried out in 145 cases. The crude 5-yr survival rate of84 patients who were operated upon during the period from 1962to 1976 was 30% and was similar to that of patients less than70 yr old. Because of the higher postoperative mortality rateof patients with pneumonectomy and with combined resection oflung and neighboring organ(s), 16% and 15% respectively, itwas considered reasonable that the use of these two operativemodalities for elderly patients should be limited. From these results patients over the age of 70 yr can be saidto be a proper target of lung surgery for lung cancer when alobectomy shows that such surgery is indicated.     

BCG Immunotherapy as an Adjuvant to Surgery in Lung Cancer: A Randomized Prospective Clinical Trial

A protocol was drawn up and a prospective randomized study wascarried out to test the effectiveness of BCG on lung cancer.BCG obtained from the Japan BCG Institute was used. A dose of5.4 mg or 2–4 x 10⁸ viable organisms was administeredinto the arm by the tine technique. Administration of BCG wascarried out once before surgery and four times after surgery.Surgery consisted basically of radical lobectomy or pneumonectomywith complete mediastinal lymphadenectomy. The survival rate in the BCG administered group was significantly(P < 0.05) more than in the control group. Further, whenonly the cases that were treated strictly in accordance withthe protocol were taken into consideration, the effectivenessof BCG was even more significant (P < 0.02). The period ofobservation of these cases was from a minimum of 10 months toa maximum of 28 months. On the basis of these results, it can be said that BCG is beneficialin the treatment of lung cancer.     

A Clinico-Pathological Study of Surgical Treatment for Small Cell Carcinoma of the Lung

Thirty-seven patients with histologically confirmed small cellcarcinoma (SCLC), who underwent surgical resection at the NationalCancer Center Hospital between 1963 and 1983, were reviewed.They were divided into two groups, 25 patients who were operatedon between 1963 to 1979 and 12 who were operated on between1980 and 1983. When these two groups were compared, a significantdifference in 5-year survival was found (8% vs 50%). An accumulationof various factors including adjuvant chemotherapy was consideredto contribute to the improvement in survival. After carefullyanalyzing these factors, we have come to the conclusion thatadjuvant chemotherapy was the most important factor among them.An additional six patients with SCLC, who were operated on in1984 and 1985, were also studied. They were either those whowere given an adequate dose of combination chemotherapy beforesurgical resection or those whose local carcinoma which recurredafter complete response was achieved by chemotherapy and/orchest radiation was surgically removed. In two cases, a tumor-likemass which was clearly visible on X-ray film- and in the surgeon'shand at the time of thoracotomy revealed a histo pathological"cure." In another two cases, tissue diagnosis of SCLC whichwas obtained without thoracotomy before chemotherapy and/orradiation was started was reported as NSCLC after the resectedspecimen was histo-pathologically examined. In both of them,the cancer tissue was made up of NSCLC of small cell type. Adiscrepancy between clinical TNM after treatment and pathologicalTNM was noted in two cases. Microinvasion and micrometastases,which were the reasons for the discrepancy, are considered tobe a core of eventual recur rence following induction of completeresponse.