Preoperative nodal staging of non-small cell lung cancer using 99mTc-sestamibi spect/ct imaging

OBJECTIVES: The proper nodal staging of non-small cell lung cancer is important for choosing the best treatment modality. Although computed tomography remains the first-line imaging test for the primary staging of lung cancer, its limitations for mediastinum nodal staging are well known. The aim of this study is to evaluate the accuracy of hybrid single-photon emission computed tomography and computed tomography using 99mTc-sestamibi in the nodal staging of patients with non-small cell lung cancer and to identify potential candidates for surgical treatment. METHODS: Prospective data were collected for 41 patients from December 2006 to February 2009. The patients underwent chest computed tomography and single-photon emission computed tomography/computed tomography examinations with 99mTc-sestamibi within a 30-day time period before surgery. Single-photon emission computed tomography/computed tomography was considered positive when there was focal uptake of sestamibi in the mediastinum, and computed tomography scan when there was lymph nodes larger than 10 mm in short axis. The results of single-photon emission computed tomography and computed tomography were correlated with pathology findings after surgery. RESULTS: Single-photon emission computed tomography/computed tomography correctly identified six out of 19 cases involving hilar lymph nodes and one out of seven cases involving nodal metastases in the mediastinum. The sensitivity, specificity, positive predictive value, and negative predictive value for 99mTc-sestamibi single-photon emission computed tomography/computed tomography in the hilum assessment were 31.6 percent, 95.5 percent, 85.7 percent, and 61.8 percent, respectively. The same values for the mediastinum were 14.3 percent, 97.1 percent, 50 percent, and 84.6 percent, respectively. For the hilar and mediastinal lymph nodes, chest tomography showed sensitivity values of 47.4 percent and 57.1 percent, specificity values of 95.5 percent and 91.2 percent, positive predictive values of 90 percent and 57.1 percent and negative predictive values of 67.7 percent and 91.2 percent, respectively. CONCLUSION: Single-photon emission computed tomography/computed tomography with 99mTc-sestamibi showed very low sensitivity and accuracy for the nodal staging of patients with non-small cell lung cancer, despite its high level of specificity. In addition, the performance of single-photon emission computed tomography/computed tomography added no relevant information compared to computed tomography that would justify its use in the routine preoperative staging of non-small cell lung carcinoma.

Tumor de células gigantes do esterno / Giant cell tumor of the sternum

Relatamos o caso de uma paciente de 74 anos portadora de tumor de células gigantes em osso esterno. A apresentação clínica e radiológica indicava neoplasia primária de osso esterno. A paciente realizou exames complementares e cirurgia. O exame patológico confirmou o diagnóstico. Comumente observado em ossos longos no esqueleto apendicular, esse tipo de tumor caracteriza-se por sua agressividade local e pelo potencial metastático. Também fazemos uma revisão sobre o tema.

We report the case of a 74-year-old female patient diagnosed with a giant cell tumor of the sternum. The clinical and radiological presentation was indicative of a primary tumor of the sternum. The patient underwent complementary tests and surgery. The pathological examination confirmed the diagnosis. Commonly observed in the long bones of the appendicular skeleton, this type of tumor is characterized by its local aggressiveness and metastatic potential. We also review the literature on the topic.

Ensaio terapêutico controlado no carcinoma primitivo avançado de pulmäo / Controlled clinical trial in the advanced primary lung cancer

Os AA. apresentam os resultados de ensaio terapêutico controlado no carcinoma primitivo de pulmäo avançado, em que foram incluidos 39 pacientes atendidos no Departamento de Cirurgia torácica do Hospital A. C. Camargo da Fundaçäo Antonio Prudente, Säo Paulo. Brasil. Os grupos foram: 1) Telecobaltoterapia + Quimioterapia e 2) Quimioterapia. A técncia usada no tratamento pelas irradiaçöes foi "split dose" (6.000 rads, em 3 séries de 2.000 rads cada uma). A terapêutica pelas drgas antitumorais constou de 16 séries (5 Fluoro-uracil, Metilhidrazina, Matotrexate, Actinomicina D, Vincristina, Ciclofosfamida), visando um bloqueio sucessivo, sincrônico e funcional da populaçäo celular neoplásica (base citodinâmica). Näo houve diferenças significativas, do ponto de vista estatístico, na comparaçäo das sobrevidas dos pacientes submetidos aos tratamentos propostos: TECO + Qt = 19,3 semanas e Qt = 14,6 semanas