A. Çetin TANRIKULU, Abdurrahman ŞENYİĞİT

Malign plevral mezotelyomada akciğerlerin değerlendirilmesinde üç yöntemin (yüksek rezolüsyonlu BT, spirometri, kapiller epitelyal permeabilite) karşılaştırılması

Malign plevral mezotelyoma (MPM) nadir görülmekte olup plevral yüzeydeki mezotel hücrelerinden kaynaklanır. Asbest teması nedeniyle bölgemizde yaşayanlarda MPM insidansı yüksektir. Asbest teması olmayan 20 kontrol vakası çalışmaya alındı. Akciğer grafisi, solunum fonksiyon testleri (SFT), Toraks BT ve yüksek rezolüsyonlu BT (YRBT) tetkikleri yapıldı. Hasta ve kontrol grubuna Tc 99m DTPA aerosol sintigrafisi uygulanarak kapiller epitelyal permeabilite (KEP) değerleri hesaplandı. Hasta grupta KEP sol % 0,727 dakika-1, KEP sağ % 1,008 dakika-1 ve ortalama KEP % 0,872 dakika-1, kontrol grubunda KEP sol % 1,272 dakika-1, KEP sağ % 1,227 dakika-1 ve ortalama KEP % 1,250 dakika-1 saptandı. KEP değerleri hasta grupta istatistiki açıdan önemli oranda düşüktü. Toraks BT’ de plevral efüzyon (PE), diffüz plevral kalınlaşma (PK) ve nodüler PKK’lı hastalarla kontrol grubu ortalama KEP değerleri anlamlı şekilde farklıydı. YRBT’ DE akciğer fibrozis’le hastalarla kontrol grubu ortalama KEP değerleri arasında önemli bir fark saptanmadı. Hastaların SFT ve KEP değerleri arasında istatistiki anlam taşımayan ilişki saptandı. MPM’ de diffüz PK ve PE sonucu Kep’in azaldığı ve Tc 99m DTPA aerosol sintigrafisinin lezyonların yaygınlığını göstermede faydalı bir parametre olduğu düşünüldü.

Anahtar Kelimeler:

Karşılaştırmalı çalışma, Akciğer neoplazmları, Tomografi, x-ışınlı bilgisayarlı, Görülme sıklığı, Mezotelyom, Spirometri, Kapiller geçirgenlik, Solunum fonksiyon testleri, X-ışınlı film, Teknesyum Tc 99m pentetat, Radyonüklid görüntüleme

The comparison of three diagnostic methods (high resolution computed tomography, spirometry, capillary epithelial permeability) in the assessment of lungs in malign pleural mesothelioma

Malignant pleural mesothelioma (MPM) is diagnosed rarely. MPM originates from mesothelial cells which are on pleural surface. Incidence of MPM is high in this area due to contacting to asbestos. Twenty patients with asbestosis and 20 patients without contacting asbestos and any chronic disease were enrolled. Chest x-ray, pulmonary function testing (PFT), thorax CT, and high-resolution computed tomograph (HRCT) were done. Tc 99m DTPA aerosol syntigraphy was performed for calculating CEP’s (Capillary epithelial permeability) results. CEP left was % 0,727 minute-1, CEP right was % 1,008 minute-1 and average CEP was % 0,872 minute-1 in patient group, CEP left was % 1,272, minute-1, CEP right % 1,227 minute-1 and average CEP was % 1,250 minute-1 in healthy group. CEP’s signs were very lower in patients group than healthy group. Patients with diffuse PT and nodular PT in CT were differing from healthy patients about average CEP results. Patients with lung fibrosis in HRCT were not differing from healthy patients about average CEP’s results. We compared pulmonary function tests and CEP’s results and saw that there was a low relationship between them. It was thought that result of the diffuse pleural effusion (PE) and pleural thickening (PT) caused importantly reduced pulmonary permeability in MPM. Tc 99m DTPA aerosol syntigraphy is a useful tool to show amount of lesions.

Keywords:

Comparative Study, Lung Neoplasms, Tomography, X-Ray Computed, Incidence, Mesothelioma, Spirometry, Capillary Permeability, Respiratory Function Tests, X-Ray Film, Technetium Tc 99m Pentetate, Radionuclide Imaging,

PDF

___

1. Metintas M, Gibbs AR, Harmancı E, et al. Malignant localized fibrous tumor of the pleura occurring in a person environmentally exposed to tremolite asbestos. Respiration 1997;64:236-239.
2. Rusch V, Saltz L, Venkatraman E, et al. A phase II trial of pleurectomy/decortication followed by intrapleural and systemic 80
chemotherapy for malignant pleural mesothelioma. J Clin Oncol 1994;12:1156- 1163.
3. Metintas M, Özdemir N, Hillerdal G, et al. Environmental asbestos exposure and malignant pleural mesothelioma. Respir Med 1999; 93: 349-355.
4. Wagner JC, Berry G, Pooley FD. Mesotheliomas and asbestos type in asbestos textile workers: a study of lung contents. Br Med J 1982;285:603-606.
5. Aisner J. Current approach to malignant mesothelioma of the pleura. Chest 1995;107:332S-344S.
6. Rusch VW. International Mesothelioma Interest Group. A proposed new international TNM staging system for malignant pleural mesothelioma. Chest 1995;108:1122-1128.
7. American Thoracic Society: Lung function testing: Selection of reference values and interpretive strategies. Am Rev Respir Dis 1991;144: 1202-1218
8. Yazıcıoğlu S, İlcayto R, Balcı K, Saylı BS, Yorulmaz B. Pleural calcification, pleural mesotheliomas, and bronchial cancers caused by tremolite dust. Thorax, 1980 35:564-569.
9. Yazıcıoğlu S. Pleural calcification associated with exposure to Chrysotile asbestos in Southeast Turkey. Chest 1976;70:43-47.
10. Senyigit A, Babayigit C, Gokirmak M, et al. Incidence of malignant pleural mesothelioma due to environmental asbestos fiber exposure in the southeast of Turkey. Respiration 2000;67:610-614.
11. Şenyiğit A, Özateş M, Işık R, ve ark.. Malign Plevral Mezotelyomada Toraks Bilgisayarlı Tomografisi Bulguları. Tüberküloz ve Toraks Dergisi 1998;46:331-337.
12. Pisani RJ, Colby TV, Williams DE. Malignant mesothelioma of the pleura. Mayo Clin Proc 1988; 63: 1234-1244.
13. Light RW. Tumors of the pleura. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine, vol 2. Philadelphia: Saunders, 1994: 2222-2230.
14. Selcuk ZT, Coplu L, Emri S, et al. Malignant pleural mesothelioma due to environmental mineral fiber exposure in Turkey: Analysis of 135 cases. Chest 1992; 102: 790-796.
15. Işık R, Şimşek M, Coşkunsel M, Bükte Y. CT findings in diagnosis of malignant mesothelioma. Tüberküloz ve Toraks 1993:41:45-50.
16. Bilici A, Uyar A, Özateş M, ve ark. Malign plevral mezotelyomanın bilgisayarlı tomografi bulguları. Dicle Üniv Tıp Fak Derg 1994 21:35-44.
17. Metintas M, Ucgun I, Elbek , et al. Computed tomoghraphy features in malignant pleural mesothelioma and other commonly seen pleural diseases. European Journal of Radiology 2002:41:1-9.
18. Kawashima A, and Libshitz H.I.. Malignant pleural mesothelioma: CT manifestations in 50 cases. Am. J. Radiol. 155 (1990), pp. 965–969.
19. Leung AN, Muller N, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR 1990;154:487-492.
20. Adams VI, Unni KK, Muhm JR, et al. Diffuse malignant pleural mesothelioma. diagnosis and survival in 92 cases. Cancer 1986; 58: 1540-1551.
21. Labrune S, Chinet T, Collignon MA, et al. Mechanisms of increased epithelial lung clearance of DTPA in diffuse fibrosing alveolitis. Eur Respir J 1994;7:651-656.
22. Hill C, Romas E, Kirkham B. Use of sequential DTPA clearance and high resolution computerized tomography in monitoring interstitial lung disease in dermatomyositis. Br J Rheumayol 1996;35:164-166.
23. Yeh SH, Liu RS, Wu LC, et al. 99 Tcm-HMPAO and 99 Tcm-DTPA radioaerosol clearance measurements in idiopathic pulmonary fibrosis. Nucl Med Commun 1995;16:140-144.
24. Susskind H. Technetium-99m-DTPA aerosol to measure alveolar-capillary membrane permeability. J Nucl Med 1994; 35: 207-209.
25. Line RB, Scintigraphic studies of inflammation in diffuse lung disease. Clin Nort Am 1991;29:1095-1114.
26. Kaya H, Şenyğiğt A, Özaydın M. Malign plevral mezotelyomada pulmoner epitelyal permeabiltenin Tc 99m DTPA aerosol sintigrafisi ile incelenmesi. Dicle Tıp Dergisi 1998;25:69-77.
27. Caner B, Ugur O, Bayraktar M et al. Impaired lung epithelial permeability in diabetics detected by Tc 99m DTPA aerosol scintigraphy. J Nucl Med.1994;35:204-206.
28. Osma E. Yüksek Rezolüsyonlu Bilgisayarlı Tomografi terminoloji ve patolojik bulgular. In:Osma E (ed). Solunum Sistemi Radyolojisi Normal ve Patolojik. Çağdaş Ofset. 2000:91-102.
29. Hacıhanefioğlu U. Akciğer Patolojisi. Çelikel Matbaası. İstanbul. 1979;224-6,360- 361.
30. Henderson DW, Attwood HD, ConstanceTJ, et al. Lymphohistiocytoid mesothelioma: A rale lymphomatoid variant of predominantly sarcomatoid mesothelioma. Ultrastructl Pathol 1988;12:367-384.