岩神 真一郎, 高橋 伸宜, 小幡 賢一, 植木 純, 玉城 繁, 檀原 高, 福地 義之助

Shin-ichiro IWAKAMI, Shingi TAKAHASHI, Ken-ichi OBATA, Jun UEKI, Shigeru TAMAKI, Takashi DAMBARA, Yoshinosuke FUKUCHI

順天堂大学医学部呼吸器内科

Department of Respiratory Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan

キーワード : Pleural invasion, Primary lung cancer, Ultrasonographic diagnosis

Staging of the lesion is an important factor in selecting, a proper treatment for patients with primary lung cancer. We evaluated the diagnostic yield of the ultrasonographic grading of pleural invasion of lung cancer, according to criteria decided at The 69th Meeting of the Japan Society of Ultrasonics in Medicine in 1997. The causes of discrepancies between ultrasonographic assessment and histologic findings were assessed in 112 cases of primary lung cancer in which surgery had been performed. Sensitivity was 93% (25⁄27) in grade p0 (lack of histologic invasion of the primary lesion to the visceral pleura), 81% (26⁄32) in grade p1 (histologic invasion to the affected visceral pleura with intact pleural surface), 52% (14⁄27) in grade p2 (extension of the lesion to the surface of the visceral pleura), and 69% (18/26) in grade p3 (invasion of the lesion to the parietal pleura). The predictive values were 83% (25⁄30) in uP0, 60% (26⁄43) in uP1, 67% (14⁄21) in uP2, and 100% (18⁄18) in uP3, and agreement between both measures was 74% (83/112). The causes of discrepancies between the ultrasonographic grade and histologic findings were as follows: (1) impairment of the ultrasonic visibility of the lesion by bone and air, (2) changes in the pleural lining resulting from such noncancerous processes as previous inflammation and pulmonary interstitial fibrosis; and (3) movement between the lesion and the chest wall not visible on respiration because of pleural adhesion resulting from a noncancerous process or because the lesion was located in the apical portion, an area of relatively low ventilation. This is the first published study on the diagnostic yield of the ultrasonographic grading of pleural invasion of lung cancer based on the criteria of the Japan Society of Ultrasonics in Medicine. We suggest that the discrepancies cited here should be considered when evaluating grade of pleural invasion of lung cancer from ultrasound images.