The Journal of Thoracic and Cardiovascular Surgery, Vol 77, 76-82, Copyright © 1979 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Evaluation of the mediastinum by gallium-67 scintigraphy in lung cancer
RG Fosburg, GB Hopkins and MK Kan
Delineation of the metastatic spread of lung cancer has been attempted by a
variety of means. Controversy as to the indications for organ surveys,
mediastinoscopy, scintillation scanning, and biopsy techniques still
exists. Since definition of the micrometastatic state is yet unachieved,
the staging of disease for therapy continues to be predicted on documented
spread beyond the site of the origin. The records of 75 patients in whom
the presence or absence of mediastinal metastases was known were
retrospectively reviewed to establish the sensitivity, specificity,
predictive values, and accuracy of 67Ga scintigrams. Comparisons were made
with chest roentgenograms, mediastinal tomograms, and endoscopic findings.
Five patients had 67Ga- negative studies. In the 70 patients having
67Ga-positive lung lesions, mediastinal 67Ga uptake had a sensitivity of
88%, a specificity of 86%, predictive values of 93% for a positive test and
76% for a negative test, and a test accuracy of 87%. These studies, plus
those of others, permit selectivity of choosing candidates for
mediastinoscopy. If the primary is 67Ga positive, a negative mediastinal
scan obviates mediastinoscopy. If the mediastinum is 67Ga positive,
mediastinal exploration is indicated. The level of involvement dictates
whether resection is undertaken in suitable surgical candidates. This
approach, employed since 1976, has lowered the costs of staging, and 67Ga
has become our scintigram of choice.
