Neither 'hands-off' nor 'conservative'
are words that can be used to describe Professor Eli Wusch.
So when a computed tomography (CT) lung cancer screen
revealed a mass in the 75-year-old chain smoker's mediastinum,
Eli concurred with his doctor that it was better to take
an aggressive approach. He opted to have the mass surgically
excised and have done with it — despite the risks
inherent in the invasive procedure. However, as reported
at the recent Radiological Society of North America's
90th Scientific Assembly and Annual Meeting held in Chicago,
these lesions may be better handled by a hands-off, conservative
approach. Eli wouldn't approve, why should we?
Well, the evidence provided is
quite compelling. First of all, the findings are based
on a large study group. Data from 9,286 baseline CT
scans and 9,992 screenings done a year later were used.
Of the 9,286 people examined, scans detected 128 mediastinal
masses (about 1.4% of the scans). Over 90% of the masses
were found in folks over 60.
Secondly, despite the fact that
patients in this trial were all at high risk of lung
cancer due to their longterm smoking or advanced age,
only 20% of thymic masses under 3cm in diameter had
increased in size one year later at the followup exam.
Moreover, no change was evident in 72% of the masses
and 8% actually shrank.
PUT
DOWN THE KNIFE
So while some physicians who were consulted about the
findings thought that the surgical option should be
pursued, presenter Dr Claudia Henscke of Weill Medical
College of Cornell University in Ithaca, NY believes
that the "research suggests that mediastinal masses
found in the context of CT screening for lung cancer
in asymptomatic people should be approached in a conservative
manner, as most did not increase in size and some even
decreased in size."
The take-home message from Dr Henscke's
presentation was not to be too hasty in wielding the
knife in response to a mediastinal mass. "I think that
these lesions should be left alone, too," said session
chair Dr Robert Tarver, of Indiana University School
of Medicine in Indianapolis. "They're slow-growing lesions
and are probably not going to do anything bad to the
patient."
Surgery might not really accomplish
much anyway, according to Dr Tarver. He noted that one
lesion that was excised turned out to be esophageal
cancer. Even if this type of cancer is detected and
dealt with early, the patient's outlook is not too rosy.
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