ULTRASONIC ASSESSMENT OF HEMIDIAPHRAGMATIC MOVEMENT - AN INDIRECT METHOD OF EVALUATING MEDIASTINAL INVASION IN NONSMALL CELL LUNG-CANCER

This preliminary study aimed to assess the potential value of diaphrag matic ultrasound (DUS) in evaluating phrenic nerve involvement indirec tly, in the non-invasive pre-operative staging of mediastinal invasion in non-small cell lung cancer (NSCLC). A prospective study of 30 pati ents with NSCLC comparing the findings of diaphragmatic ultrasound, ch est radiograph, computed tomography (CT) thorax and mediastinoscopy wa s performed. In all cases adequate quantitiative assessment of hemidia phragmatic excursion was obtained. There was discordance in four of 30 patients between DUS and chest radiograph. Three of nine patients wit h extensive mediastinal disease on CT had abnormal DUS, and two of eig ht patients with indeterminate mediastinal disease on CT had abnormal DUS and were later found to be non-resectable. No abnormal cases of DU S were found in those cases with normal mediastinal CT. There was no c lear relationship between the site, size and side of the primary tumou r on CT, or its pleural or diaphragmatic contiguity, and hemidiaphragm atic excursion. There was concordance between DUS and mediastinoscopy in 17 of 21 patients. Two patients had normal mediastinoscopy and abno rmal DUS but were not resectable at thoracotomy. No patient with abnor mal DUS was resectable. DUS may be of potential value in the pre-opera tive staging of NSCLC and is therefore worthy of further evaluation.