Purpose: To determine the value of lung perfusion on predicting unresectability of lung carcinoma in patients with exploratory thoracotomy.
Materials and methods: We analyzed retrospectively the value of lung perfusion scintigraphy in 25 cases with primary lung carcinoma who had an exploratory thoracotomy (18 right and 7 left thoracotomy), regarding preoperative suggestion of unresectability. In most of these patients other noninvasive diagnostic methods (X-ray and CT) did not indicate inoperability.
Results: Only the perfusion lung scintigraphy demonstrated defects near the ipsilateral hilum and/or an enlargement of the mediastinum, displacement of mediastinum, displacement (pulling) of the hilum of the affected lung or a part of it to the mediastinum. At thoracotomy we found an involvement of hilar vessels and the mediastinum by the tumor or by `bulky` nodal metastases. Common peripheral concentric decrease of affected lung perfusion image dimensions, lacking or negligible perfusion of the affected lung also suggest inoperability. Perfusion indices at localization of the tumor in the right lung (15 of the patients) were mean=40,8%, SD=11,02%, SE=2,7%, and at localization in the left lung (6 of the patients) mean=36,27%, SD=10,60%, SE=4,01%.
Conclusion: These findings show that in some patients with bronchial carcinoma the perfusion scintigraphy image can suggest a potential unresectability and requires a more extensive staging like mediastinoscopy or thoracoscopy.
Buyuklyan A.N, Gabunia R.I., Romagin V.K. Complex
ventilation-perfusion scan in chronic inflammatory
and tumor diseases of the lungs. Med. Radiol.
, 1, 15-20. (in Russian)
Ellis D.A., Hawkins T., Gibson G.J., Nariman S.
Role of lung scanning in assessing the respectability
of bronchial carcinoma. Thorax. 1983;38:
-266.
Katsarov T., Piperkova E., Hristova N., Marinkova
I., Diagnostic significance of perfusion scintigraphy
in pre-operative preparation of patients with lung
cancer. 7th National Congress of Radiology, nuclear
medicine and radiobiology 1-3 June 1990 Smolyan.
Abstracts (in Bulgarian)
Klisarova A., Dancheva Zh., PET in lung cancer
staging. MORE 2010 Learner`s book 2010. Clinical
behavior in lung carcinoma. Under editorial of
D.Kalev. 2010,15-22. (in Bulgarian)
Levcheva V., Mluchkov M., Angelov V., Dzhambazov
V., Chervenyakov A., Potential of perfusion
scintigraphy to determine the volume of pathologic
processes in the lungs. Symposium - Modern diagnostic
and therapeutic methods in pneumology.
Varna 16-17.10.1987, Abstr.p.16. (in Bulgarian)
Lipscomb D.J, Pride N.B. Ventilation and perfusion
scans in the preoperative assessment of bronchial
carcinoma. Thorax 1977; 32: 720-725.
Lovyagin E.V., Yakovleva L.A., Muss V.F, Moerman
B.A., Scintigraphic and radio bronchologic evaluation
of lung cancer dissemination. Medicinskaia radiologia
, 10, 20-26. (in Russian)
Mluchkov Hr., Palashev Y., Boyadzhieva Z., Nuclear-
medical diagnostics of primary lung carcinoma.
th National Congress of Radiology, Nuclear Medicine
and Radiobiology 1-3 June 1990; Smolyan; Abstracts.
p.140.
Mountain CF. A New International Staging System
for Lung Cancer. Chest 1986;89:225-33S.
Secker-Walker R.H.,Alderson P.O.,Wilhelm J. et al.
Ventilation-Perfusion Scanning in Carcinoma of
the Bronchus. Chest 1974; 65; 660-663.
Secker-Walker R.H., Provan J.L. Scintillation Scanning
of Lungs in Preoperative Assessment of Carcinoma
of Bronchus. Br. Med .J., 1969, 3, 327-330.
Von Beyer-Enke S.A., Clorius J., Becker H. et al.
Synopsis von Computertomographie, Szintigraphye
und Bronhoscopie bei der Diagnostik des Bronchialkarzinoms.
RöFo, 1988; 149: 121-238.