Hirokazu Aikawa

Correlation between glucose transporter-1 expression and 18F-fluoro-2-deoxyglucose uptake on positron emission tomography in lung cancer

PurposeThe aim of this study was to determine if glucose transporter-1 (Glut1) expression correlates with 18F-FDG (18F-fluoro-2-deoxyglucose) uptake on positron emission tomography (PET) in lung cancer and to examine the similarities and differences between them.MethodsA total of 34 patients with resected primary lung cancers were investigated in this study. There were 17 adenocarcinomas, 12 squamous cell carcinomas, and 5 cancers of other cell types. Immunohistochemical Glut1 intensity was categorized into three groups: negative, positive, and strongly positive. Glut1 frequency was defined by the proportion of positive cells among all cancer cells, and it was graded on a semiquantitative scale as 0–100% in 10% increments. The data are expressed as the mean ± SD.ResultsMaximum standardized uptake values (SUVmax) were 4.8 ± 6.3 in “negative” Glut1 intensity cases, 4.7 ± 3.1 in “positive” Glut1 intensity cases, and 11.2 ± 5.2 in “strongly positive” Glut1 intensity cases. Although SUVmax correlated significantly with tumor size (correlation coefficient 0.58, P = 0.00033), Glut1 frequency did not correlate significantly with tumor size (correlation coefficient 0.18, P = 0.301). Cell type and cell differentiation correlated significantly with Glut1 expression and 18F-FDG uptake.ConclusionGlut1 expression correlates significantly with 18F-FDG uptake. There are similarities in cell differentiation and cell type between Glut1 expression and 18F-FDG uptake. 18F-FDG uptake correlates significantly with tumor size, but Glut1 expression does not.

Results of Long-term Follow-up of Photodynamic Therapy for Roentgenographically Occult Bronchogenic Squamous Cell Carcinoma

BACKGROUNDnPhotodynamic therapy (PDT) is considered a useful and minimally invasive modality for treating centrally located early lung cancer. To date, there has been limited information on the long-term outcome of patients treated with PDT, especially those who are medically operable.nnnMETHODSnBeginning in 1994, patients with roentgenographically occult bronchogenic squamous cell carcinoma (ROSCC) who met our criteria underwent PDT at Tohoku University Hospital and were followed up through 2006. Our criteria were as follows: (1) ROSCC without distant metastasis; (2) medically operable by means of lobectomy or further resection; (3) longitudinal tumor length of <or= 10 mm; and (4) superficial bronchoscopic tumor findings.nnnRESULTSnA total of 48 patients with ROSCC underwent PDT. The complete response (CR) rate was 94% (45 of 48 of patients). Nine patients (20%) had local recurrence after CR. A total of 11 deaths was observed, with 6 resulting from multiple primary lung cancer and only 1 from the original ROSCC. The 5-year and 10-year overall survival rates for all 48 patients were 81% and 71%, respectively. The Cox proportional hazard model showed that only metachronous multiple primary lung cancer was an independent poor prognostic factor.nnnCONCLUSIONSnPDT is thought to be a first-line modality for patients who have ROSCC with a tumor length of <or= 10 mm, even if the tumor is medically operable. Most local recurrence can be cured by active therapy such as surgery, radiotherapy, or PDT. Multiple primary lung cancer subsequent to PDT is an important issue from the viewpoint of survival.

Intrapulmonary Solitary Fibrous Tumor Diagnosed by Immunohistochemical and Genetic Approaches: Report of a Case

Although solitary fibrous tumors (SFTs) of the pleura are not uncommon, intrapulmonary SFTs are extremely rare. A 72-year-old woman was admitted to our hospital for an investigation of an enlarging intrapulmonary tumor. Because a definitive diagnosis could not be readily established, a pulmonary wedge resection under video-assisted thoracic surgery was performed. Grossly, the tumor was white, well circumscribed, and separate from the pleural surface. Histologically, it consisted of spindle cells proliferating in a vague fascicular pattern, with many dilated capillaries, and intermingled glandular components. These findings suggested a differential diagnosis that included SFT and nonchondromatous pulmonary hamartoma. On immunohistochemical analysis, the spindle cells showed a strong positive reaction to the CD34 antigen. Interphase fluorescent in situ hybridization revealed an absence of HMGA-1 and -2 translocations. These results supported a diagnosis of SFT. A genetic approach may therefore be useful in the differentiation of SFT from nonchondromatous hamartoma.

Do Japanese thoracic surgeons think that dissection of the pulmonary ligament is necessary after an upper lobectomy

It is uncertain whether the dissection of the pulmonary ligament is necessary in patients who undergo an upper lobectomy. A questionnaire was sent to the directors of Thoracic Surgery in 102 hospitals, asking whether dissection of the pulmonary ligament is performed in such patients, and the complications associated with dissecting or preserving the ligament. Seventy-eight directors (76%) returned the questionnaire. The preservation of the ligament is the current practice in 54 hospitals (69%), while 13 hospitals (17%) occasionally dissect, 9 hospitals (11%) regularly dissect, and 2 hospitals (3%) half dissect the ligament. Thirty directors experienced complications which were thought to be associated with dissecting the ligament: bronchial stenosis (21 directors), atelectasis (8), and bronchial obstruction (4). Twenty-six directors described complications thought to be associated with preserving the ligament: the pooling of pleural effusion (19 directors), insufficient expansion of lung (18), atelectasis (8), and empyema (7). Preservation of the ligament may therefore be useful in preventing bronchial stenosis and obstruction, while its dissection may be useful to prevent the pooling of pleural effusion.

Diffusion-weighted imaging (DWI) signal intensity and distribution represent the amount of cancer cells and their distribution in primary lung cancer

The aim of this study was to interpret diffusion-weighted imaging (DWI) signals in lung cancers. They were converted into several three-dimensional DWI signals patterns, which represent the degree of DWI signal intensity by height and the degree of distribution by area: flat, low elevation, irregular elevation, single-peak elevation, multiple-peak elevation, and nodular elevation. There were 39 adenocarcinomas and 21 squamous cell carcinomas. Three-dimensional DWI signals decreased significantly in order of cell differentiation. Tumor cellular densities were increased according to the increase in three-dimensional DWI signals. DWI signal intensity and distribution can represent the amount of cancer cells and their distribution in the carcinoma.

Four years experience of the survey on quality control of lung cancer screening system in Japan

Although quality control is essential in mass screening system for early detection of cancer, no global method for quality control has not been established, because the mass screening system in each country is quite different from each other. At present, we have to find appropriate method for each cancer and for each country. In 2000, The Lung Cancer Screening Division (LCSD) of the Miyagi Prefectural Committee for Management of the Cancer Screening System (Miyagi PCMCSS) decided to evaluate annually whether the local governments had appropriate information to evaluate the quality of lung cancer screening systems, announcing that the results would be informed to residents. On the basis of the manual developed by the Ministry of Health, Labor and Welfare, 45 items were selected as indicators for the survey, which could be obtained easily when the screening had been conducted according to the standard method. LCSD of Miyagi PCMCSS sent a questionnaire including the 45 items to the municipalities. According to the reply to the questionnaire, LCSD rated each municipality using a 5-rank classification depend on the number of insufficient items: A: 0; B: 1-4; C: 5-8; D: 9 or more; E: no reply. As the results, 58, 3, 6, 3, and 0 municipalities were categorized in 2002 as A, B, C, D, and E, respectively. In 2003, the number of municipalities changed to 60, 7, 2, 1, and 0. In 2005, the distribution improved more, such as 68, 2, 0, 0, and 0. The detection rate of lung cancer also improved. It is possible for PCMCSS to annually conduct surveys to determine whether the local government has appropriate information to evaluate the quality of lung cancer screening systems. Such surveys improve the distribution of response to better direction.

Lung cancer screening and its efficacy

The efficacy of lung cancer screening should not be evaluated by the survival rate of lung cancer patients but by lung cancer mortality in a certain population because the survival rate can be greatly affected by several types of bias. Randomized controlled trials that were conducted during the 1970s and 1980s in Europe and the United States failed to prove the efficacy of lung cancer screening in decreasing the mortality rate; but recently the results of case-control studies in Japan have revealed that undergoing currently available screening decreases the risk of lung cancer deaths by 30%–60%. A system is now being created in Japan whereby the guidelines regarding cancer screening will continue to be updated. The preliminary reports concerning lung cancer screening using thoracic computed tomography revealed that not only the detection rate of lung cancer but also the survival rate of detected lung cancer patients were surprisingly high. However, the presence of some potential bias in these studies cannot be ignored; therefore, it is still unknown whether there is actual efficacy. Several randomized controlled trials are presently in progress overseas, but the interim results were not favorable. A randomized controlled trial should therefore immediately be started in Japan as well.

Multicentricity in resected occult bronchogenic squamous cell carcinoma

The frequency and the treatment of multicentricity in 127 patients with resected roentgenographically occult bronchogenic squamous cell carcinoma were studied. The cumulative rate and the incidence of postoperative metachronous multiple primary lung cancer were 0.11 at 5 years after initial operation and 0.022 per patient-year, respectively. The cumulative rate and the incidence of second primary lung cancer, which includes synchronous and subsequent metachronous cancer in patients with initial lung cancer, were 0.17 at 5 years after the initial operation and 0.041 per patient-year, respectively. The cumulative rate and the incidence of third primary lung cancer in patients with second primary lung cancer were 0.47 at 5 years, which was significantly higher (p = 0.05) than that of second primary lung cancer, and 0.11 per patient-year, respectively. In all 12 patients with synchronous multiple primary lung cancer, no recurrence was observed after treatment, but 3 had subsequent multiple primary lung cancer. Among the 13 patients with postoperative metachronous multiple primary lung cancer, recurrence was observed in 1 of the 6 patients who underwent resection and in 2 of the 4 patients treated with laser or radiation therapy or both. The overall survival rate at 5 years after initial operation in patients with solitary and those with multicentric occult bronchogenic squamous cell carcinomas was 0.90 and 0.59, respectively.