The Examination of Thoracic Metastases with Imaging Methods/Surgery of Lung Metastases [antikvár]

CHAPTER 2 The Examination of Thoracic Metastases with Imaging Methods MÁRIA GÖDÉNY 2.1. RADIOLOGICAL DIAGNOSTIC METHODS Pulmonary metastases spread along different courses, the various forms of propagation have characteristic radiological morphologies. The task of the imaging diagnostic methods is to detect or exclude the metastatic alteration in the lung, thus to determine the initial stage of the tumor disease, to take part in the monitoring, in the course of treatment and in the post-therapeutical follow-up, moreover, to employ the invasive methods which allow for histological sampling. Their role is to define the main therapy, including surgery, and to give accurate information on the extent and localization of the alteration prior to a planned surgical intervention. If radiotherapy is the selected treatment, they should support in planning the exact dose. A diagnostic algorithm has to be created which is effective and cost-effective at the same time (Herold et al. 1966). 2.1.1. ANATOMICAL IMAGING MODALITIES 2.1.1.1. PLAIN CHEST RADIOGRAPHY This is the most generally used method of examination in both the detection and follow-up of pulmonary metastases, and is the first diagnostic step when a pulmonary nodulus is suspected (Lehman and Himmighöfer 1994) (Figs 2.1-2.2). The conventional plain chest radiography is cheap, sensitive enough for the detection of pulmonary noduli, making well visible noduli measuring about 1 cm. However, on the plain chest film the anatomical structures are superimposed upon each other what makes the evaluation difficult, especially in the mediastinum and along the diaphragm and the chest wall. It is hardly suitable for the analysis of mediastinal structures, since only masses larger than 3 cm broaden the mediastinum and raise the suspicion of a tumor. CHAPTER 3 Surgery of Lung Metastases ISTVÁN BESZNYÁK and EGON SVASTICS INTRODUCTION Sedillot performed the first pulmonary resection for a metastasis in 1855. In 1882 Weinlechner removed a lung metastasis en bloc with a recurrent chest wall sarcoma. In 1884 Krönlein published a case report describing the resection of a tumor nodule at the lung periphery following resection of a recurrent chest wall sarcoma. Röpke carried out the first planned lobectomy in 1921 for a metastasis of a breast cancer operated on three years previously (cit: Vogt-Moykopf et al. 1988a). Lung metastasectomy as a separate procedure was performed in 1926 in Prague by Divis (1927) removing a solitary metastasis of a soft tissue sarcoma and in 1930 by Torek (1931) resecting a metastatic carcinoma of the lung and the mediastinum. The report of Barney and Churchill (1939) on the resection of a solitary pulmonary metastasis from a hypernephroma and that patient's survival for 23 years after nephrectomy was an impetus for further attempts at curative resection (Putnam and Roth 1995). Alexander and Haight presented a large series of patients for the first time in 1947. Thomford et al. (1965) already reported on 205 patients operated on at Mayo Clinic for lung metastases. In the fifties and sixties reports of series were published in which excisions of solitary metastases and multiple metastases from a variety of carcinomas and sarcomas were described. Then a ten-year hiatus followed (Goldstraw 1983). Patients in the UK who have had a pulmonary resection for lung metastases are registered in the UK Thoracic Surgical Register. The number of patients undergoing thoracotomy for secondary lung malignancies was 166 in 1985, 184 in 1986,183 in 1987,194 in 1988 and 193 in 1989, respectively (Underwood et al. 1992). The UK figures may be underestimated, however, for various reasons. The figures for lung metastasectomies in Hungary (population 10 million) are shown in Table 3.2.