title: Ultrasonic assessment of hemidiaphragmatic movement: an indirect method of evaluating mediastinal invasion in non-small cell lung cancer.
abstract: This preliminary study aimed to assess the potential value of diaphragmatic ultrasound (DUS) in evaluating phrenic nerve involvement indirectly, in the non-invasive pre-operative staging of mediastinal invasion in non-small cell lung cancer (NSCLC). A prospective study of 30 patients with NSCLC comparing the findings of diaphragmatic ultrasound, chest radiograph, computed tomography (CT) thorax and mediastinoscopy was performed. In all cases adequate quantitiative assessment of hemidiaphragmatic excursion was obtained. There was discordance in four of 30 patients between DUS and chest radiograph. Three of nine patients with extensive mediastinal disease on CT had abnormal DUS, and two of eight patients with indeterminate mediastinal disease on CT had abnormal DUS and were later found to be non-resectable. No abnormal cases of DUS were found in those cases with normal mediastinal CT. There was no clear relationship between the site, size and side of the primary tumour on CT, or its pleural or diaphragmatic contiguity, and hemidiaphragmatic excursion. There was concordance between DUS and mediastinoscopy in 17 of 21 patients. Two patients had normal mediastinoscopy and abnormal DUS but were not resectable at thoracotomy. No patient with abnormal DUS was resectable. DUS may be of potential value in the pre-operative staging of NSCLC and is therefore worthy of further evaluation.
authors.affiliation: Department of Radiology, Western Infirmary, Glasgow, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Houston
authors.forename: M
authors.initials: M
authors.lastname: Fleet
authors.forename: N
authors.initials: N
authors.lastname: McMillan
authors.forename: M D
authors.initials: MD
authors.lastname: Cowan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging*; D003964:Diaphragm / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography