The Role of Bone Scans in Routine Preoperative Evaluations of Non-Small Cell Lung Cancer Patients / 대한흉부외과학회지

BACKGROUND: The objective of this study was to assess the usefulness of bone scans in routine preoperative examinations of patients with newly diagnosed non-small cell lung carcinoma. MATERIAL AND METHOD: We reviewed the medical records of 258 patients who were newly diagnosed with non-small cell lung cancer in our hospital between January 2000 and December 2000. More than half of the patients (132) were deemed to be inoperable due to their advanced stage based on the CT scans. The remaining 126 patients were considered potentially operable. For these patients, clinical evaluation including the presence of bone pain, serum alkaline phosphatase, and calcium levels was used as clinical predictors of bone metastasis. All patients received bone scans. Bone X-rays, MRI or bone biopsy were performed to confirm the presence of bone metastasis. The usefulness of the bone scan was evaluated by comparing its power of predicting bone metastasis to that of the clinical information. RESULT: In all patients, the positive and negative predictive values of bone scans for the bone metastasis were 44%, and 99%, respectively. Those of the clinical information were 38% , and 94%. However, in potentially operable patients, the negative predictive value of the clinical information was as high as 99%. CONCLUSION: If newly diagnosed non-small cell lung cancer patients are presented as potentially operable on the basis of CT scan with no clinical evidence of distant metastases, curative resection could be considered without performing routine bone scans because of the low probability of bone metastasis. However, if there are positive clinical findings, further evaluations, including bone scan should be followed as metastasis will be documented in more than 30% of patients.

Metastatic Angiosarcoma of the Lung: HRCT Findings

We describe a case of cavitary metastasis to the lungs from a small angiosarcoma of the scalp, in which themetastatic lesions were complicated by pneumothorax and pulmonary hemorrhage. On high-resolution CT, the lesionssimulated the findings of Langerhans cell histiocytosis. Thin-walled cavitary metastatic lesions were similar tothose of thin walled air cysts in Langerhans cell histiocytosis. Ground-glass opacity simulated the findings ofsmoke r's respiratory bronchiolitis in Langerhans cell histio-cytosis but histologically represented hemorrhageduring metastasis of the angiosarcoma.