Abstract              Background: Lung cancer has for many years been a disease with poor prognosis. Lung cancer may be detected in a variety of different ways. Sometimes, there may not be any signs or symptoms of the disease, but it may be discovered during other medical procedures. Accurately determining the diagnosis and stage of lung cancer is important to enable patients to be offered the best possible treatment. Aim and objective: To study the radiological manifestations in patients of lung cancer. Material and methods: A cross-sectional study carried out on 58 primary lung cancer patients in a tertiary level hospital and teaching center. chest x-ray USG done on all patients. Ultra sonography of Chest was done to see for fluid/mass/plural nodules. USG guidance was used for pleural tapping and biopsies in case of minimal or loculated effusions and for FNAC of pulmonary masses. Results and discussion: Incidence of lung carcinoma was found to be most common in the 6th decade. Male incidence was more than female 2.86:1. Conclusion: Right lung (62.06%) was more often affected than the left (37.93%) with the preponderance of upper lobes. Radiologically centrally situated lesions were mostly of squamous cell carcinoma (57.14%) followed by small cell carcinoma (28.57%).53.44% patients were showing mass lesion on X-ray chest; and 27(46.55%) presented with pleural effusion on USG.

Key Words: lung malignancy.

 

INTRODUCTION

Lung cancer is among the five main types of cancer leading to overall cancer mortality contributing about 1.3 million deaths/year globally1, a number of imaging modalities like chest x-ray, CT, MRI play an important role in diagnosis of lung cancer. Chest radiography still remains the basic imaging modality in diagnosis of patients of lung cancer. In this study we studied the relationship radiological manifestations in patients of lung cancer.

MATERIAL AND METHODS

This was a cross-sectional study carried out on 58 lung cancer patients in a tertiary level hospital and teaching center. Patients who were having high index of clinical, radiological suspicion of carcinoma of lung during the period January 2000 to March 2002 were studied. Patients with positive end diagnosis of lung carcinoma proved by Histopathological examination were included. Patients with secondaries in lung, those patients not willing for diagnostic procedure were excluded. Data collection was done with predesigned questionnaire. It includes name, age, sex, residence, occupation, smoking history including object, duration, family history, associated co morbid conditions. Routine investigations like BSL, BUL, CBC, LFT, KFT done. Special investigations like sputum chest x-ray USG done. X-ray Chest done in PA and relevant lateral views, Bucky and apicogram in selected cases. Ultra sonography of Chest was done to see for fluid/mass/plural nodules. USG guidance was used for pleural tapping and biopsies in case of minimal or loculated effusions and for FNAC of pulmonary masses. C. T. Scan study was done when the patient could afford to spent for it, as it was to be done from elsewhere due to nonavailability of the facility at this Hospital.

 

RESULTS                   

Table 1: Distribution of patients according to radiological features and USG features

Table 2: Distribution of patients according to radiological features and side involvement

 

Table 3: Distribution of patients according to radiological location of various lesions

Incidence of lung carcinoma was found to be most common in the 6^th decade. Male incidence was more than female 2.86:1. There were 31 (72.09%) males and 13 (86.66%) females from rural area out of 43 (74.13%) and 15 (25.86%) respectively. Male urban to rural ratio was 1:2.8 while female urban to rural ratio was 1:6.5. It was observed that out of 58 patients, 31 (53.44%) were showing mass lesion on X-ray chest; and 27 (46.55%) presented with pleural effusion which on USG showed underlying lung lesion. Metasis to liver was confirmed by USG in 10 (17.24%) cases. Mediastinal widening was seen in 10 (17.24%) cases. Cavity and diaphragmatic paralysis was present in 4 cases, 2 in each respectively (Table 1). The extent of lesions based on X-ray chest prior to the other diagnostic procedure was studied. It was observed that right side involvement was seen in 36 (62.06%) patients while 22 (37.93%) patients showed involvement of left side (Table 2). Radiologically central lesions were seen in 7 cases (12.06%) peripheral lesions were found in 24 (41.37%) and 46.55% patients presented with pleural effusion with underlying lung lesion. Mass lesions were predominant in upper zone. (25.86%), while effusion with underlying lung lesion was seen in lower zone (Table 3). It was observed that central lesions (12.06%) were seen in 7 cases,. amongst them squamous cell carcinoma was present in 27.14% cases, small cell carcinoma in 28.57% cases and adenocarcinoma in 14.28 cases. Peripheral lesions (41.37%) were seen predominantly in Squamous cell carcinoma (50%) and adenocarcinoma (41.66%). Only two cases had small cell carcinoma and unclassified carcinoma is contributing one case (4.16%)   Pleural effusion with underlying lung lesions (46.55%) were seen predominantly in Squamous cell carcinoma and unclassified carcinoma comprising 29.62% each. Small cell carcinoma and adenocarcinoma was observed in 22.22% and 14.81% respectively. Non Hodgkin's lymphoma was observed in a single case (3.70%) (Table 4).

 

DISCUSSION

In this study, the right lung was commonly involved (62.06%) than left (37.93%). The ratio of right lung to left was 1.63:1. Shield's T. W. et al (1972)² gives the ratio of right to left lung involvement as 6:4 and states that upper lobe is more involved than lower lobe. P N Chhajed et al (1999)³ also found right sided involvement (57%) more than left side (40%). Remaining were involving both sides (3%). Lam et al (1983)⁴ also found common location of tumour in right lung irrespective of cell type. Ultrasonography proved to be useful in diagnosis of minimal effusions and for ultrasonographically guided pleural aspiration and FNAC of pulmonary masses. In our study, pleural effusion was seen in 27 (46.55%) cases and mass lesion in 31 (53.44%) cases. Cavity presentation was seen in 3.44% cases. Solitary pulmonary nodule was found in only one case (1.72%). Mediastinal widening was seen in 10 (17.24%) cases while diaphragmatic paralysis was observed in 2 (3.44%) cases. Secondaries in liver was confirmed by ultrasonography and found in 10 (17.24%) cases. In our study radio logically upper zone involvement was common in (25.86%) in mass lesion than mid zone (12.06%) and lower zone (15.51%). Effusion with underlying lung lesion was present in 27 (46.55%) cases. Rosen Blatt and Lisa et al (1956)⁵ found 60% of bronchial neoplasm belonging to central and hilar group. The right and left major bronchi were usually involved. Sen Gupta et al (1971)⁶ reported 25% central tumour and 15% of these patients had peripheral lesion. W. E. Miller et al (1967)⁷ found unilateral hilar enlargement in all his patients before onset of symptoms. According to T.W.Shields Shield T. (1972)² upper lobe involvement is more than lower lobe involvement and middle lobe is involved the least.

 

CONCLUSION

Radio graphically right lung (62.06%) was more often affected than the left (37.93%) with the preponderance of upper lobes.Radio logically centrally situated lesions were mostly of squamous cell carcinoma (57.14%) followed by small cell carcinoma (28.57%) and peripheral lesions were mostly of squamous cell carcinoma (50%) and adenocarcinoma (41.66%). Pleural effusion with underlying lung lesion was commonest feature of squamous cell carcinoma (29.62%).

 

REFERENCES

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