J Thorac Cardiovasc Surg 1995;109:815
© 1995 Mosby, Inc.
Evaluating the impact of magnetic resonance imaging on patients with operable non-small-cell lung cancer and unilateral adrenal masses: Importance of appropriate technique
Michael Burt, MD, PhDa,
Robert Heelan, MDb
Department of Surgery a
Reply to the Editor:
In response to Dr. Donald G. Mitchell's letter to the Editor, we have the following comments. We thank Dr. Mitchell for his comments and criticisms. Although magnetic resonance imaging (MRI) methods are currently being investigated that possibly could lead to better discrimination of adrenal masses as being benign or metastatic in non-small-cell lung cancer, Dr. Mitchell did not take into account the time it takes for a scientific study to come to full publication. The inception of the study was in February of 1990, and it was approved by our institutional review board in April of 1990. The accrual of the patients reported in our study began in August of 1990 and was completed in October of 1992. An abstract of our study was submitted to The American Association for Thoracic Surgery on November 11, 1993, and the paper was presented at the Seventy-third Annual Meeting in April of 1993. A manuscript was submitted at this meeting. This manuscript was accepted August 20, 1993, and published in the February 1994 issue of THE JOURNALOF THORACIC AND CARDIOVASCULAR SURGERY. Dr. Mitchell published his technique of chemical shift MRI in the November 1992 issue of Radiology, after the completion of our study.
Although newer techniques are being developed in MRI to differentiate benign from malignant adrenal masses, few studies have histologic documentation of all patients reported. Therefore, although our study used the MRI techniques available during the period of the study, the point is still valid that the gold standard for determining the cause of adrenal masses is by cytopathologic or histopathologic study. We too are currently evaluating chemical-shift MRI and other newer MRI techniques, but we remain convinced that histologic examination is the gold standard by which to compare any new MRI technique.
