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Al Zreibi C, Gibault L, Fabre E, Le Pimpec-Barthes F. [Surgery for small-cell lung cancer]. Rev Mal Respir 2021; 38:840-847. [PMID: 34099357 DOI: 10.1016/j.rmr.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/06/2021] [Indexed: 11/18/2022]
Abstract
Small-cell lung cancer (SCLC) is a high-grade neuroendocrine carcinoma, metastatic at the time of initial diagnosis in 70% of cases. Within the 30% of localised tumours only 5% of patients are eligible for surgical treatment according to the recommendations of learned societies. These recommendations are mainly based on old phase II and III randomised prospective trials and more recent registry studies. Surgical care is only possible within a multimodal treatment and essentially concerns small-sized tumours without involvement of hilar or mediastinal lymph nodes. As with non-small cell lung cancer (NSCLC), lobectomy with radical lymph node removal is the recommended procedure to achieve complete tumour resection. Patient selection for surgery includes age, performance status and comorbidity factors. Adjuvant chemotherapy combining Platinum salts and Etoposide for resected stage I tumours is recommended by ASCO, ACCP and NCCN. The precise sequence of neo-adjuvant or adjuvant treatments remains controversial because of the large heterogeneity in clinical practice reported in the studies and the context at the time of SCLC discovery. The 5-year survival rate of patients with early stage disease (pT1-2N0M0) treated by lobectomy and adjuvant chemotherapy is between 30% and 58%, which validates the primary place that surgery must have in these early forms. There is certainly little or even no place for such a therapeutic sequence in locally advanced stages (T3-T4 or N2). However, the stage heterogeneity, as in NSCLC, makes final conclusions difficult. In fact, some registry studies with pairing scores reported a median survival of more than 20 months in N2 SCLC. So, all files of SCLC must be evaluated in a multidisciplinary meeting in order to find the optimal solution for patients with rare and heterogeneous tumours.
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Affiliation(s)
- C Al Zreibi
- Hôpital Européen Georges-Pompidou, service de chirurgie thoracique, 20, rue Leblanc, Paris 75908, France
| | - L Gibault
- Hôpital Européen Georges-Pompidou, service d'anatomopathologie, Paris, France
| | - E Fabre
- Hôpital Européen Georges-Pompidou, service d'oncologie thoracique, Paris, France
| | - F Le Pimpec-Barthes
- Hôpital Européen Georges-Pompidou, service de chirurgie thoracique, 20, rue Leblanc, Paris 75908, France.
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Abstract
Small-cell lung cancer (SCLC) represents about 15% of all lung cancers and is marked by an exceptionally high proliferative rate, strong predilection for early metastasis and poor prognosis. SCLC is strongly associated with exposure to tobacco carcinogens. Most patients have metastatic disease at diagnosis, with only one-third having earlier-stage disease that is amenable to potentially curative multimodality therapy. Genomic profiling of SCLC reveals extensive chromosomal rearrangements and a high mutation burden, almost always including functional inactivation of the tumour suppressor genes TP53 and RB1. Analyses of both human SCLC and murine models have defined subtypes of disease based on the relative expression of dominant transcriptional regulators and have also revealed substantial intratumoural heterogeneity. Aspects of this heterogeneity have been implicated in tumour evolution, metastasis and acquired therapeutic resistance. Although clinical progress in SCLC treatment has been notoriously slow, a better understanding of the biology of disease has uncovered novel vulnerabilities that might be amenable to targeted therapeutic approaches. The recent introduction of immune checkpoint blockade into the treatment of patients with SCLC is offering new hope, with a small subset of patients deriving prolonged benefit. Strategies to direct targeted therapies to those patients who are most likely to respond and to extend the durable benefit of effective antitumour immunity to a greater fraction of patients are urgently needed and are now being actively explored.
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Affiliation(s)
- Charles M Rudin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Elisabeth Brambilla
- Institute for Advanced Biosciences, Université Grenoble Alpes, Grenoble, France
| | - Corinne Faivre-Finn
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Julien Sage
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
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Chenesseau J, Bourlard D, Cluzel A, Trousse D, D'Journo XB, Thomas PA. Intent-to-cure surgery for small-cell lung cancer in the era of contemporary screening and staging methods. Interact Cardiovasc Thorac Surg 2020; 30:541-545. [PMID: 31919500 DOI: 10.1093/icvts/ivz299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to report on the contemporaneous single-centre experience of patients with small-cell lung cancer (SCLC) who had lung resection with curative intent. METHODS Between 2005 and 2018, 31 patients were operated on for SCLC with curative intent. There were 11 women and 20 men whose ages averaged 63 ± 10 years. The clinical diagnosis was incidental in 16 patients (51.6%). All patients were screened with high-resolution computed tomography, positron emission tomography and brain imaging. Eight patients (25.8%) had invasive mediastinal lymph node staging. RESULTS Preoperative tissue diagnosis was unknown or erroneous in 26 patients (83.9%). Lung resections comprised mainly lobectomies (n = 23; 74.2%). Lymphadenectomies harvested a mean of 16.3 ± 3 lymph nodes, leading to upstaging in 38.7% of the cases. An R0 resection was achieved in 28 patients (90.3%). Pathological analysis disclosed pure small cell histological specimens in 24 patients (77.4%). There were no 90-day deaths. Perioperative platinum-based chemotherapy was performed in 27 patients (87.1%); adjuvant thoracic irradiation, in 7 (50%) of the 14 N+ patients; and prophylactic cranial irradiation, in 8 (29.6%) of the 27 potential candidates. Overall, disease-free and disease-specific survival rates at 5 years were 32.9 ± 10%, 35.2 ± 10% and 44.1 ± 11.3%, respectively. CONCLUSIONS Despite the use of contemporary screening and staging methods, selection of SCLC candidates for surgery remained haphazard, surgery was typically performed in ignorance of the actual histological and adherence to treatment guidelines was inconsistent. Nevertheless, one-third of patients with SCLC who were operated on were cured, even in cases of regional or oligometastatic disease.
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Affiliation(s)
- Joséphine Chenesseau
- Department of Thoracic Surgery, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Donatienne Bourlard
- Department of Pathology, North Hospital, Aix Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Armand Cluzel
- Department of Thoracic Surgery, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Delphine Trousse
- Department of Thoracic Surgery, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Xavier-Benoît D'Journo
- Department of Thoracic Surgery, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Predictive Oncology Laboratory, CRCM, Inserm UMR 1068, CNRS UMR 7258, Aix-Marseille University UM105, Marseille, France
| | - Pascal Alexandre Thomas
- Department of Thoracic Surgery, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,Predictive Oncology Laboratory, CRCM, Inserm UMR 1068, CNRS UMR 7258, Aix-Marseille University UM105, Marseille, France
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Affiliation(s)
- Julia Kastner
- University of Maryland School of Medicine, Baltimore, MD
| | - Rydhwana Hossain
- University of Maryland School of Medicine, Cardiothoracic Imaging, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD
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Pietanza MC, Byers LA, Minna JD, Rudin CM. Small cell lung cancer: will recent progress lead to improved outcomes? Clin Cancer Res 2016; 21:2244-55. [PMID: 25979931 DOI: 10.1158/1078-0432.ccr-14-2958] [Citation(s) in RCA: 158] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small cell lung cancer (SCLC) is an aggressive neuroendocrine malignancy with a unique natural history characterized by a short doubling time, high growth fraction, and early development of widespread metastases. Although a chemotherapy- and radiation-sensitive disease, SCLC typically recurs rapidly after primary treatment, with only 6% of patients surviving 5 years from diagnosis. This disease has been notable for the absence of major improvements in its treatment: Nearly four decades after the introduction of a platinum-etoposide doublet, therapeutic options have remained virtually unchanged, with correspondingly little improvement in survival rates. Here, we summarize specific barriers and challenges inherent to SCLC research and care that have limited progress in novel therapeutic development to date. We discuss recent progress in basic and translational research, especially in the development of mouse models, which will provide insights into the patterns of metastasis and resistance in SCLC. Opportunities in clinical research aimed at exploiting SCLC biology are reviewed, with an emphasis on ongoing trials. SCLC has been described as a recalcitrant cancer, for which there is an urgent need for accelerated progress. The NCI convened a panel of laboratory and clinical investigators interested in SCLC with a goal of defining consensus recommendations to accelerate progress in the treatment of SCLC, which we summarize here.
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Affiliation(s)
- M Catherine Pietanza
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York.
| | - Lauren Averett Byers
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John D Minna
- Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Charles M Rudin
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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Koinis F, Kotsakis A, Georgoulias V. Small cell lung cancer (SCLC): no treatment advances in recent years. Transl Lung Cancer Res 2016; 5:39-50. [PMID: 26958492 PMCID: PMC4758968 DOI: 10.3978/j.issn.2218-6751.2016.01.03] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/28/2015] [Indexed: 12/23/2022]
Abstract
Small cell lung cancer (SCLC) is an aggressive malignancy with a distinct natural history and dismal prognosis. Given its predisposition for early dissemination, patients are commonly diagnosed with metastatic disease and chemotherapy is regarded as the cornerstone of approved treatment strategies. However, over the last 30 years there has been a distinct paucity of significant breakthroughs in SCLC therapy. Thus, SCLC is characterized as a recalcitrant neoplasm with limited therapeutic options. By employing well-established research approaches, proven to be efficacious in non-small cell lung cancer (NSCLC), a growing amount of data has shed light on the molecular biology of SCLC and enhanced our knowledge of the "drivers" of tumor cell survival and proliferation. New therapeutic targets have emerged, but no significant improvement in patients' survival has been demonstrated thus far. In a sense, the more we know, the more we fail. Nowadays this is starting to change and methodical research efforts are underway. It is anticipated that the next decade will see a revolution in the treatment of SCLC patients with the application of effective precision medicine and immunotherapy strategies.
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Mandegaran R, David S, Screaton N. Cardiothoracic manifestations of neuroendocrine tumours. Br J Radiol 2016; 89:20150787. [PMID: 26781701 DOI: 10.1259/bjr.20150787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cardiothoracic neuroendocrine tumour (NET) manifestations encompass a vast disease spectrum. Pulmonary neuroendocrine tumours represent a range of tumour grade and differentiation characteristics from pre-malignant diffuse neuroendocrine cell hyperplasia, well-differentiated, low-grade carcinoid tumours with excellent outcomes, through to high-grade small-cell lung carcinoma and large-cell neuroendocrine carcinoma with poor prognoses. Rarer thymic NETs represent a similarly wide neoplastic spectrum. Cardiac carcinoid is a paraneoplastic manifestation of the carcinoid syndrome and often the cause of mortality in NETs with hepatic metastases. Cardiothoracic NET manifestations are reviewed herein from a radiologists' perspective, discussing the diverse clinical presentations, spectrum of neoplastic and paraneoplastic manifestations, imaging features and treatment options.
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Affiliation(s)
- Ramin Mandegaran
- 1 Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarojini David
- 2 Department of Radiology, University Hospital of Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Nicholas Screaton
- 3 Department of Radiology, Papworth Hospital NHS Foundation Trust, Papworth Everard Hospital, Cambridge, UK
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Abstract
Small-cell lung cancer (SCLC) comprises approximately 14% of all lung cancer cases. Most patients present with locally advanced or metastatic disease and are therefore treated nonoperatively with chemotherapy, radiotherapy, or both. A small subset of patients with SCLC present with early-stage disease and will benefit from surgical resection plus chemotherapy. The rationale for radiotherapy in these patients remains controversial.
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Affiliation(s)
- Alberto de Hoyos
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA
| | - Malcolm M DeCamp
- Division of Thoracic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA.
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Mizugaki H, Fujiwara Y, Yamamoto N, Yagishita S, Kitazono S, Tanaka A, Horinouchi H, Kanda S, Nokihara H, Tsuta K, Asamura H, Tamura T. Adjuvant chemotherapy in patients with completely resected small cell lung cancer: a retrospective analysis of 26 consecutive cases. Jpn J Clin Oncol 2014; 44:835-40. [PMID: 25097183 DOI: 10.1093/jjco/hyu092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Several clinical studies have demonstrated the efficacy and safety of adjuvant chemotherapy in patients with completely resected small cell lung cancer for a selected limited stage. However, it is unclear whether adjuvant chemotherapy is feasible in clinical practice. The objective of this study was to analyze the efficacy and safety of adjuvant chemotherapy for small cell lung cancer patients retrospectively in clinical practice. METHODS From January 2002 to March 2012, 56 small cell lung cancer patients underwent surgery as initial therapy in our institute. Of these, 26 patients received adjuvant chemotherapy. The clinical data of patients who received adjuvant chemotherapy were retrospectively analyzed. RESULTS The chemotherapy regimens were cisplatin and irinotecan in 16 patients, cisplatin and etoposide in 1 and carboplatin and etoposide in 9. Median follow-up time was 44.8 months. Nineteen (73%) patients received the full course of chemotherapy. Median recurrence-free survival was 21.4 months. Median survival time was not reached. There was no treatment-related death. CONCLUSION Adjuvant chemotherapy may be generally safe and efficacious in selected small cell lung cancer patients.
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Affiliation(s)
- Hidenori Mizugaki
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | | | - Satoru Kitazono
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | - Ayako Tanaka
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | | | - Shintaro Kanda
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | - Hiroshi Nokihara
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
| | - Koji Tsuta
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo
| | - Hisao Asamura
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Tomohide Tamura
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo
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Koyama H, Ohno Y, Nishio M, Takenaka D, Yoshikawa T, Matsumoto S, Seki S, Maniwa Y, Ito T, Nishimura Y, Sugimura K. Diffusion-weighted imaging vs STIR turbo SE imaging: capability for quantitative differentiation of small-cell lung cancer from non-small-cell lung cancer. Br J Radiol 2014; 87:20130307. [PMID: 24786147 DOI: 10.1259/bjr.20130307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To compare the capability of differentiation of small-cell lung cancer (SCLC) from non-SCLC (NSCLC) between diffusion-weighted imaging (DWI) and short tau inversion recovery (STIR) turbo spin-echo imaging. METHODS The institutional review board of Kobe University Hospital, Kobe, Japan, approved this study, and written informed consent was obtained from each patient. 49 patients with NSCLC (30 males and 19 females; mean age, 66.8 years) and 7 patients with SCLC (5 males and 2 females; mean age, 68.6 years) enrolled and underwent DWI and STIR. To quantitatively differentiate SCLC from NSCLC, apparent diffusion coefficient (ADC) values on DWI and contrast ratios (CRs) between cancer and muscle on STIR were evaluated. ADC values and CRs were then compared between the two cell types by Mann-Whitney's U-tests, and the diagnostic performances were compared by McNemar's test. RESULTS There were significant differences of mean ADC values (p < 0.001) and mean CRs (p = 0.003). With adopted threshold values, the specificity (85.7%) and accuracy (85.7%) of DWI were higher than those of STIR (specificity, 63.3%; p = 0.001 and accuracy, 66.1%; p = 0.001). In addition, the accuracy of combination of both indexes (94.6%; p = 0.04) could significantly improve as compared with DWI alone. CONCLUSION DWI is more useful for the differentiation of SCLC from NSCLC than STIR, and their combination can significantly improve the accuracy in this setting. ADVANCES IN KNOWLEDGE Pulmonary MRI, including DWI and STIR, had a potential of the suggestion of the possibility as SCLC.
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Affiliation(s)
- H Koyama
- 1 Division of Radiology, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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Takeda A, Kunieda E, Sanuki N, Aoki Y, Oku Y, Handa H. Stereotactic body radiotherapy (SBRT) for solitary pulmonary nodules clinically diagnosed as lung cancer with no pathological confirmation: comparison with non-small-cell lung cancer. Lung Cancer 2012; 77:77-82. [PMID: 22300750 DOI: 10.1016/j.lungcan.2012.01.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/07/2012] [Accepted: 01/09/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In non-surgical candidates with solitary pulmonary nodules (SPNs) and no histological confirmation, optimal management remains uncertain. METHODS Between February 2005 and February 2011 we treated 298 lung cancers with stereotactic body radiotherapy (SBRT), including SPNs clinically diagnosed as lung cancer (CDLC). Among them, we extracted patients treated with a total dose of 40-50 Gy per 5 fractions and followed up more than 6 months. Patients who had a history of previously treated lung cancer, or were diagnosed pathologically, or suspected as having small-cell lung cancer or large cell neuroendcrine cancer were excluded from this study. The remaining patients were divided into two groups; CDLC and non-small-cell lung cancer (NSCLC) patients and their outcomes were assessed and compared. RESULTS Fifty-eight CDLC and 115 NSCLC patients were included in this study. The proportions of female and inoperable cases were significantly higher in the CDLC group. Other characteristics, including T stage and standard uptake value, were well balanced. Median follow-up durations were 20.2 (range, 6.0-58.8) and 21.2 (range, 6-63.7) months, respectively. The 3-year local control, regional-free, metastasis-free, progression-free, cause-specific survival, and overall survival rates were 80% and 87% (p = 0.73), 88% and 91% (p = 0.72), 70% and 74% (p = 0.57), 64% and 67% (p = 0.45), 74% and 71% (p = 0.17), 54% and 57% (p = 0.48), respectively. CONCLUSION These results indicate that the treatment outcome of CDLC group was almost identical to that of NSCLC and that few benign lesions seemed to be included. We advocate that SBRT can be legitimately applied to CDLC, provided that they are carefully diagnosed by integrating various clinical findings.
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Isaka M, Nakagawa K, Ohde Y, Okumura T, Watanabe R, Ito I, Nakajima T, Kondo H. A clinicopathological study of peripheral, small-sized high-grade neuroendocrine tumours of the lung: differences between small-cell lung carcinoma and large-cell neuroendocrine carcinoma. Eur J Cardiothorac Surg 2011; 41:841-6. [PMID: 22219429 DOI: 10.1093/ejcts/ezr132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Small-cell lung carcinoma (SCLC) and large-cell neuroendocrine carcinoma (LCNEC) are categorized as high-grade neuroendocrine tumours because of their poor prognosis compared with those of other neuroendocrine tumours of the lung. There have been no clinicopathological studies focusing on small-sized high-grade neuroendocrine tumours. We analysed clinicopathological features of peripheral, small-sized high-grade neuroendocrine tumours of the lung retrospectively. METHODS A total of 28 patients with peripheral, small-sized tumours (maximum diameter of 3.0 cm) of SCLC and LCNEC underwent surgical resection in our hospital and were enrolled in this study. RESULTS Of 28 tumours, 18 were SCLC and 10 were LCNEC. In terms of serum tumour marker levels, carcinoembryonic antigen was elevated in 50% of both types of tumour, and progastrin-releasing peptide was elevated in 28% of SCLC and 10% of LCNEC. With regard to preoperative diagnosis, only seven SCLC cases were correctly diagnosed as SCLC, but no LCNEC case was correctly diagnosed before surgery. Lymphatic involvement was significantly more frequent in SCLC than in LCNEC (P = 0.013). Although adjuvant chemotherapy was carried out more frequently in the patients with SCLC than LCNEC, the recurrence rate after the standard surgery was significantly higher in the patients with SCLC than LCNEC (P = 0.0037). There was a significant difference between SCLC and LCNEC in terms of overall survival in clinical-stage IA small-sized tumours (P = 0.029). CONCLUSIONS In peripheral, small-sized high-grade neuroendocrine tumours, there are several clinicopathological differences between SCLC and LCNEC. This study suggested that the prognosis of patients with LCNEC tended to be better than for those with SCLC in small-sized tumours.
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Affiliation(s)
- Mitsuhiro Isaka
- Division of Thoracic Surgery, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan.
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Haddadin S, Perry MC. History of Small-Cell Lung Cancer. Clin Lung Cancer 2011; 12:87-93. [DOI: 10.1016/j.cllc.2011.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/12/2010] [Accepted: 07/16/2010] [Indexed: 01/22/2023]
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Kim MJ, Ha SY, Kim NR, Cho HY, Chung DH, Kim GY. Aspiration cytology features of pulmonary basaloid carcinoma. Cytopathology 2009; 20:336-9. [DOI: 10.1111/j.1365-2303.2007.00542.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hashimoto M, Miyauchi T, Heianna J, Sugawara M, Ishiyama K, Watarai J, Nanjo H. Accurate Diagnosis of Peripheral Small Cell Lung Cancer with Computed Tomography. TOHOKU J EXP MED 2009; 217:217-21. [DOI: 10.1620/tjem.217.217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | - Makoto Sugawara
- Department of Radiology, Akita University School of Medicine
| | - Koichi Ishiyama
- Department of Radiology, Akita University School of Medicine
| | - Jiro Watarai
- Department of Radiology, Akita University School of Medicine
| | - Hiroshi Nanjo
- Department of Pathology, Akita University School of Medicine
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Gustafsson BI, Kidd M, Chan A, Malfertheiner MV, Modlin IM. Bronchopulmonary neuroendocrine tumors. Cancer 2008; 113:5-21. [PMID: 18473355 DOI: 10.1002/cncr.23542] [Citation(s) in RCA: 319] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bronchopulmonary neuroendocrine tumors (BP-NETs) comprise approximately 20% of all lung cancers and represent a spectrum of tumors arising from neuroendocrine cells of the BP-epithelium. Although they share structural, morphological, immunohistochemical, and ultrastructural features, they are separated into 4 subgroups: typical carcinoid tumor (TC), atypical carcinoid tumor (AC), large-cell neuroendocrine carcinoma (LCNEC), and small-cell lung carcinoma (SCLC), which exhibit considerably different biological characteristics. The clinical presentation includes cough, hemoptysis, and obstructive pneumonia but varies depending on site, size, and growth pattern. Less than 5% of BP-NETs exhibit hormonally related symptoms such as carcinoid syndrome, Cushing, acromegaly, and SIADH. SCLC is the most common BP-NET, while LCNEC is rare, approximately 10% and < or =1%, respectively, of all lung cancers. Both SCLC and LCNEC progress rapidly, are aggressively metastatic, and exhibit a poor prognosis. The incidence of BP-carcinoids (TC and AC) in the US was 1.57 of 100,000 in 2003 (an unexplained and substantial increase over the last 30 years, approximately 6% per year). No curative treatment except for radical surgery (almost never feasible) exists. The slow-growing TC exhibit a fairly good prognosis ( approximately 88%, 5-year survival), whereas AC demonstrate a 5-year survival of approximately 50%, and the highly malignant LCNEC and SCLC5-year survival of 15% to 57% and <5%, respectively. This review provides a broad overview on BP-NETs and focuses on the evolution of the disease, general features, and current diagnostic and therapeutic options.
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Affiliation(s)
- Bjorn I Gustafsson
- Department of Surgery, Yale University School of Medicine, New Haven, CT 06520-8062, USA
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Chong S, Lee KS, Kim BT, Choi JY, Yi CA, Chung MJ, Oh DK, Lee JY. Integrated PET/CT of pulmonary neuroendocrine tumors: diagnostic and prognostic implications. AJR Am J Roentgenol 2007; 188:1223-31. [PMID: 17449764 DOI: 10.2214/ajr.06.0503] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to describe retrospectively integrated PET/CT findings on pulmonary neuroendocrine tumors and to correlate the findings with prognosis. MATERIALS AND METHODS Between May 2003 and February 2005, 37 consecutively enrolled patients (33 men and four women; mean age, 60 years) with histopathologically proven pulmonary neuroendocrine tumors underwent 18F-FDG PET/CT after enhanced standalone CT. CT was used to analyze the morphologic features of the tumors and PET to measure maximum standardized uptake value (SUV). Maximum SUVs of carcinoid tumors, large-cell neuroendocrine carcinomas (LCNECs), and small-cell lung carcinomas (SCLCs) were compared, and maximum SUV and tumor stage and prognosis were correlated. RESULTS Four (two typical and two atypical) of the seven carcinoid tumors had no FDG uptake or less than mediastinal uptake. The maximum SUVs of primary tumors, in increasing order, were significantly different for carcinoids (mean, 4.0; median, 3.4), LCNECs (mean, 12.0; median, 10.7), and SCLCs (mean, 11.6; median, 11.7) (p = 0.006, Kruskal-Wallis test). There was no significant correlation between maximum SUV of the primary tumor and the tumor stages of carcinoids, LCNECs, or SCLCs (p = 0.08, Jonckheere-Terpstra test; p = 0.768, Mann-Whitney test). Results of receiver operating characteristics analysis showed a maximum SUV greater than 13.7 suggested a poor survival period in cases of LCNEC and SCLC. CONCLUSION The maximum SUVs of neuroendocrine tumors are significantly different for carcinoid tumors, LCNECs, and SCLCs, and a high maximum SUV suggests short survival of patients with LCNEC or SCLC.
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Affiliation(s)
- Semin Chong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Kangnam-gu, Seoul, South Korea, 135-710
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21
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Su CC, Shieh JM, Li CF. Endobronchial metastatic breast carcinoma clinically, histologically and cytologically mimicking pulmonary small cell carcinoma. Pathology 2007; 39:269-71. [PMID: 17454761 DOI: 10.1080/00313020701230724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Neuroendocrine tumors of the lung: clinical, pathologic, and imaging findings. Radiographics 2006; 26:41-57; discussion 57-8. [PMID: 16418242 DOI: 10.1148/rg.261055057] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neuroendocrine tumors of the lung arise from Kulchitzky cells of the bronchial mucosa and comprise typical carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC). At histopathologic analysis, these tumors demonstrate a progressive increase in the number of mitotic figures per 10 high-power fields of viable tumor and in the extent of necrosis, with typical carcinoid having the lowest values and SCLC having the highest. Typical carcinoid is less aggressive than atypical carcinoid, although these tumors have similar gross pathologic and radiologic features; LCNEC has a prognosis between that of atypical carcinoid and that of SCLC. SCLC is the most aggressive pulmonary neuroendocrine tumor and has the most specific imaging feature: mediastinal or hilar lymphadenopathy. At CT, carcinoid tumors appear as a spherical or ovoid nodule or mass with a well-defined and slightly lobulated border. When nonspherical, the tumor is elongated with its long axis parallel to adjacent bronchi. Calcification or ossification is seen in up to 30% of cases. The CT findings of LCNEC are nonspecific and are similar to those of other non-small cell lung cancers. Although there are some overlapping features between these tumors, integration of the clinical and imaging features may be helpful in differentiation of pulmonary neuroendocrine tumors.
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Affiliation(s)
- Semin Chong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea
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23
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Pelosi G, Rodriguez J, Viale G, Rosai J. Typical and Atypical Pulmonary Carcinoid Tumor Overdiagnosed as Small-Cell Carcinoma on Biopsy Specimens. Am J Surg Pathol 2005; 29:179-87. [PMID: 15644774 DOI: 10.1097/01.pas.0000149690.75462.29] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Seven patients with typical or atypical pulmonary carcinoid tumors overdiagnosed as small-cell carcinoma on bronchoscopic biopsies are described. Bronchial biopsies from 9 consecutive small-cell lung carcinoma patients were used as control group for histologic and immunohistochemical studies (cytokeratins, chromogranin A, synaptophysin, Ki-67 [MIB-1], and TTF-1). The carcinoid tumors presented as either central or peripheral lesions composed of tumor cells with granular, sometimes coarse chromatin pattern, high levels of chromogranin A/synaptophysin immunoreactivity, and low (<20%) Ki-67 (MIB-1) labeling index. The tumor stroma contained thin-walled blood vessels. Small-cell carcinomas always showed central tumor location, finely dispersed nuclear chromatin, lower levels of chromogranin A/synaptophysin, and high (>50%) Ki-67 (MIB-1) labeling index. The stroma contained thick-walled blood vessels with glomeruloid configuration. Judging from this study, overdiagnosis of carcinoid tumor as small-cell carcinoma in small crushed bronchial biopsies remains a significant potential problem in a worldwide sample of hospital settings. Careful evaluation of hematoxylin and eosin sections remains the most important tool for the differential diagnosis, with evaluation of tumor cell proliferation by Ki-67 (MIB-1) labeling index emerging from our review as the most useful ancillary technique for the distinction.
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Affiliation(s)
- Giuseppe Pelosi
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy.
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24
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Oshiro Y, Kusumoto M, Matsuno Y, Asamura H, Tsuchiya R, Terasaki H, Takei H, Maeshima A, Murayama S, Moriyama N. CT Findings of Surgically Resected Large Cell Neuroendocrine Carcinoma of the Lung in 38 Patients. AJR Am J Roentgenol 2004; 182:87-91. [PMID: 14684518 DOI: 10.2214/ajr.182.1.1820087] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to assess the CT features of surgically resected large cell neuroendocrine carcinoma of the lung. MATERIALS AND METHODS The cases of all patients who underwent surgical resection for primary lung cancer in a single institution from 1993 to 2000 and who received an initial diagnosis of poorly differentiated non-small cell lung carcinoma, small cell carcinoma, carcinoid tumor, and large cell neuroendocrine carcinoma were histologically reviewed. The findings for 43 patients were histologically reclassified and confirmed as large cell neuroendocrine carcinoma. The CT scans available for 38 patients were evaluated by two observers. RESULTS In the 38 patients, six central tumors and 32 peripheral tumors, with diameters ranging from 12 to 92 mm (mean +/- SD, 32 +/- 19 mm), were identified. None of the tumors had air bronchograms or calcification in the mass or nodule. Of the 19 patients with thin-section CT scans, 14 (74%) showed the tumor-lung interface as well defined and five (26%) showed the interface to be ill defined. Lobulation was identified on 15 scans (79%) and spiculation was evident on six scans (32%). On contrast-enhanced CT scans, inhomogeneously enhanced tumors appeared to be larger (51 +/- 18 mm) than homogeneously enhanced tumors (25 +/- 10 mm; p < 0.001). At histopathologic examination, gross necrosis was noted in 20 of 28 patients who had undergone contrast-enhanced CT, and the cause of inhomogeneous enhancement on CT scans was determined to be intratumoral necrosis. Multiple microscopic necroses were present in all 28 patients. CONCLUSION Large cell neuroendocrine carcinoma usually appears as a well-defined and lobulated tumor with no air bronchograms or calcification. The inhomogeneous enhancement (caused by necrosis) seen in large cell neuroendocrine carcinomas with large diameters is not necessarily apparent in small-diameter (< 33 mm) large cell neuroendocrine carcinomas, even if the tumor contains necrosis.
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Affiliation(s)
- Yasuji Oshiro
- Department of Radiology, University of Ryukyus School of Medicine, 207 Uehara, Nishihara-cho, Okinawa Prefecture 903-0215, Japan
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25
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Abstract
Lung tumors with neuroendocrine differentiation are made up of several neoplasms with particular epidemiologic, clinical, morphologic, and molecular characteristics. Typical and atypical carcinoid tumors represent low-grade and intermediate-grade carcinomas, respectively, whereas small-cell carcinoma and large-cell neuroendocrine carcinoma are considered high-grade carcinomas. Recent studies support the use of this four-tumor, three-tier classification scheme, but in practice, definitive diagnoses on small tissue samples remain a challenge for even the most experienced lung pathologists.
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Affiliation(s)
- Douglas B Flieder
- Department of Pathology and Laboratory Medicine, Joan and Sanford I. Weill Medical College and Graduate School of Medical Sciences, New York Presbyterian Hospital, New York, New York 10021, USA.
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26
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Yang YJ, Steele CT, Ou XL, Snyder KP, Kohman LJ. Diagnosis of high-grade pulmonary neuroendocrine carcinoma by fine-needle aspiration biopsy: nonsmall-cell or small-cell type? Diagn Cytopathol 2001; 25:292-300. [PMID: 11747218 DOI: 10.1002/dc.2057] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A consensus optimal therapy for large-cell neuroendocrine carcinoma of the lung has not been achieved since this entity was proposed in 1991. Accumulation of clinical data and investigation, however, can be greatly impeded by erroneous cytological diagnosis, based on which treatment may be initiated. To avoid erroneous diagnoses, cytological criteria need to be defined. Twenty cases of fine-needle aspiration specimens with a diagnosis of neuroendocrine tumor by either cytology or follow-up histology were retrospectively reviewed for cytomorphologic features. Patients' clinical data were also reviewed. Three cytomorphologic patterns were identified for large-cell neuroendocrine carcinoma, i.e., nonsmall-cell-like, small-cell-like and, mixed nonsmall-cell-small-cell-like. Small-cell-like large-cell neuroendocrine carcinoma can be mistaken for small-cell carcinoma. The most important differential features between these two entities are nuclear size and perceptibility of nucleoli of tumor cells.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biopsy, Needle
- Carcinoma, Large Cell/chemistry
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/therapy
- Carcinoma, Neuroendocrine/chemistry
- Carcinoma, Neuroendocrine/classification
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Small Cell/chemistry
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/therapy
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Lung Neoplasms/chemistry
- Lung Neoplasms/classification
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Proteins/analysis
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Y J Yang
- Department of Pathology, Upstate Medical University, State University of New York, Syracuse, New York 13210, USA.
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27
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Komaki R, Chasen MH, Travis WD, Putnam JB, Fossella FV, Byhardt RW, Ro JY. Oncodiagnosis panel: 1999. Cancer of the lung: oncodiagnosis. Radiographics 2001; 21:1573-96. [PMID: 11706227 DOI: 10.1148/radiographics.21.6.g01nv311573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R Komaki
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 97, Houston, TX 77030, USA.
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28
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Abstract
Current therapy for small cell lung cancer (SCLC) consists of chemotherapy with or without radiotherapy. Radiotherapy is generally accepted as an essential treatment component of limited stage disease. However, the local failure rate after chemo- and radiotherapy is still high and ranges from 30 to 70%. Furthermore, despite having obtained a complete radiographic response, up to 75% of these patients will have residual disease in the tumor specimen, if resection is performed. Therefore, more effective means are needed to eradicate the primary tumor and to obtain an improved local disease control. Recent phase two trials of multimodal regimens for stage I-IIIA SCLC demonstrate that in selected patients with early stage SCLC the combination of surgery and chemotherapy with or without radiotherapy is feasible with low morbidity and mortality rates. The combination therapy results in satisfying long term outcome depending on the pathological tumor stage and a local disease control is achieved in almost all patients. It is remarkable that the pneumonectomy rate has decreased over the past decades from almost 100 to 27-39%. In order to confirm these promising results, a German multicenter prospective randomized phase III trial has been designed for patients with stage I-IIIA SCLC consisting of induction chemotherapy, followed by surgery, adjuvant thoracic radiotherapy and prophylactic cranial radiation compared to thoracic radiotherapy and prophylactic cranial radiation.
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Affiliation(s)
- B Passlick
- Department of Thoracic Surgery, Asklepios-Fachkliniken München-Gauting, Klinik für Thoraxchirurgie, Robert-Koch-Allee 2, D-82131, Gauting, Germany.
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29
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Wang JC, Sone S, Feng L, Yang ZG, Takashima S, Maruyama Y, Hasegawa M, Kawakami S, Honda T, Yamanda T. Rapidly growing small peripheral lung cancers detected by screening CT: correlation between radiological appearance and pathological features. Br J Radiol 2000; 73:930-7. [PMID: 11064644 DOI: 10.1259/bjr.73.873.11064644] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
12 peripheral small lung cancers (< 20 mm) of rapid growth (volume doubling time < 150 days), detected by repeated low dose CT screening, were evaluated to examine their CT features and to correlate such features with histopathological findings. Each patient's CT images, including follow-up and thin section CT images, were studied retrospectively to determine tumour growth rate and CT morphological features. Nine of the tumours exhibited a solid tumour growth pattern: seven of these showed a well defined, homogeneous, soft tissue density with spicular or lobulated margin. These seven tumours included small cell lung cancer (n = 3), moderately differentiated adenocarcinoma (n = 2), poorly differentiated adenocarcinoma (n = 1) and squamous cell carcinoma (n = 1). The other two tumours, a moderately differentiated adenocarcinoma and a well differentiated adenocarcinoma, appeared as irregular, soft tissue density nodules with poorly defined margins. The latter exhibited an air bronchogram pattern and a small cavity. The remaining three tumours exhibited a lepidic tumour growth pattern. They showed ground glass opacity or ground glass opacity with a higher density central zone on CT images and were well differentiated adenocarcinomas. In conclusion, most peripheral small lung cancers of rapid growth were adenocarcinomas. They also included small cell lung cancer and squamous cell carcinoma. The majority showed solid tumour growth pattern and lacked an air bronchogram and/or small air spaces in the nodule. Some well differentiated adenocarcinomas with lepidic tumour growth pattern also showed rapid growth.
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Affiliation(s)
- J C Wang
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
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30
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Flieder DB, Vazquez MF. Lung tumors with neuroendocrine morphology. A perspective for the new millennium. Radiol Clin North Am 2000; 38:563-77, ix. [PMID: 10855262 DOI: 10.1016/s0033-8389(05)70185-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary neuroendocrine cell proliferations represent a spectrum of lesions ranging from reactive processes to highly malignant carcinomas. The histogenesis and classification of these lesions is controversial and confusing. Radiologists are performing many diagnostic fine needle aspirations and biopsies, and must be familiar with these tumors. This article describes the various lesions and provides guidelines for their differential diagnosis.
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Affiliation(s)
- D B Flieder
- Department of Pathology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College, Cornell University, New York, USA
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31
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Wilson RW, Frazier AA. Pathological-radiological correlations: pathological and radiological correlation of endobronchial neoplasms: part II, malignant tumors. Ann Diagn Pathol 1998; 2:31-4. [PMID: 9845721 DOI: 10.1016/s1092-9134(98)80033-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The majority of lung neoplasms are malignant. Many of these are central and have an associated endobronchial component. Most such neoplasms are of surface epithelial origin; however, neoplasms of submucosal gland, mesenchymal, and lymphoreticular origin may also demonstrate an endobronchial component. Because of their endobronchial location and associated symptoms, these patients often present at an earlier stage than purely parenchymal lung malignancies. The radiographic features in such cases may be similar to those associated with benign endobronchial tumors; however, there are certain radiological signs that are more suggestive of a malignant process. Despite these circumstances, conservative management such as endoscopic excision are inappropriate in most instances. The clinicopathologic and radiological features of these lesions are detailed.
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Affiliation(s)
- R W Wilson
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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32
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Urschel JD, Antkowiak JG, Takita H. Is there a role for surgery in small-cell lung cancer? J R Soc Med 1997; 90:387-90. [PMID: 9290420 PMCID: PMC1296383 DOI: 10.1177/014107689709000707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- J D Urschel
- Department of Thoracic Surgical Oncology, Roswall Park Cancer Institute, Buffalo, NY 14263-0001, USA
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33
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García Arangüena L, Sampedro Álvarez J, Golpe Gómez R, García Pérez M, Jiménez Gómez A, Mazorra Macho F. Carcinoma pulmonar de células pequeñas en forma de nódulos pulmonares múltiples. Arch Bronconeumol 1997. [DOI: 10.1016/s0300-2896(15)30678-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Colder CD, Postmus PE. The role of surgery in small-cell lung cancer: a case history. Ann Oncol 1996; 7:303-9. [PMID: 8740796 DOI: 10.1093/oxfordjournals.annonc.a010576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- C D Colder
- Department of Pulmonology, Free University Hospital, Amsterdam, The Netherlands
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35
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Abstract
PURPOSE This study analyzed the clinical characteristics, diagnostic evaluation, prevalence of malignancy, and outcome of patients with a solitary pulmonary nodule (SPN) encountered in the outpatient practice of a pulmonologist in an urban university hospital from 1990 to 1993. PATIENTS AND METHODS SPN was defined as a round or ovoid density < or = 3 cm in diameter within the lung parenchyma. Patients with and without lung cancer in SPNs were compared. RESULTS Forty patients had a mean age of 65 years, an almost equal sex distribution, high prevalences of cardiovascular disease (53%) and chronic obstructive pulmonary disease (COPD) (33%), but a low incidence of tuberculosis. The mean size of SPNs was 1.8 cm. The prevalence of malignancy was 53%. In SPNs < or = 2 cm in diameter, the prevalence of malignancy was 43%. Nonsurgical biopsy techniques made a diagnosis in 78% of patients. In 94% of patients with lung cancer in SPNs, the tumor was resectable (stage 1, 2, or 3A), emphasizing the need for early detection. Despite the small size of the SPNs, the prevalence of malignancy was high. CONCLUSION Despite the advanced age and high prevalence of cardiovascular disease and COPD in patients with SPNs, lung cancer that occurs in these lesions appears to have a favorable prognosis if detected promptly.
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Affiliation(s)
- D M Libby
- Department of Medicine, New York Hospital-Cornell Medical Center, New York, USA
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36
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Smit EF, Groen HJ, Timens W, de Boer WJ, Postmus PE. Surgical resection for small cell carcinoma of the lung: a retrospective study. Thorax 1994; 49:20-2. [PMID: 8153935 PMCID: PMC474078 DOI: 10.1136/thx.49.1.20] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND A retrospective review was undertaken of the survival of 21 patients with histologically proven small cell carcinoma of the lung resected between 1977 and 1991. METHODS Twenty one patients (20 men) of median age 60 (range 44-73) years underwent surgical resection. Patients were subjected to standard clinical staging procedures. Preoperative diagnosis was small cell carcinoma of the lung in 13, non-small cell lung cancer in one, and uncertain in seven patients. Clinical staging was stage I disease in 11 and stage II in 10 patients. RESULTS Resection included pneumonectomy in 12 cases, lobectomy in eight, and one wedge resection. Resection was complete in 16 patients. Postoperative histopathological examination confirmed small cell carcinoma of the lung in 19 specimens and mixed small cell and non-small cell carcinoma of the lung in two. Pathological staging was stage I in 11, stage II in three, and stage III in seven patients. The final pathological diagnosis of the resected specimens (n = 18) was atypical carcinoid in one, pure small cell carcinoma of the lung in 15, and mixed small cell and non-small cell carcinoma of the lung in two patients. Fourteen patients also received chemotherapy and 10 received prophylactic cranial irradiation postoperatively. Excluding the patient with a final diagnosis of atypical carcinoid, the median survival (n = 20) was 29 months (range two to 133+). Median survival for patients with pathological stage I and II disease (n = 13) was 40 months (range nine to 133+) and for patients with pathological stage III disease (n = 7) 20 months (range two to 116+). The median disease free survival was 23 months. Eleven patients relapsed between two and 101 months. There was no advantage for those patients who received postoperative chemotherapy. CONCLUSION Curative resection offers the best chance for long term survival in patients with small cell carcinoma of the lung with very limited stage disease.
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Affiliation(s)
- E F Smit
- Department of Pulmonary Diseases, University Hospital, Groningen, The Netherlands
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37
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Abstract
BACKGROUND The incidence and mortality rates of lung cancer have been increasing in many countries. However, the true effectiveness of screening for lung cancer is still controversial. This study aimed to examine the growth pattern of lung cancer and to evaluate the efficacy of screening. METHODS The authors linked the records of annual radiologic screening to cancer registry data and conducted a retrospective follow-up study of radiographs in all patients with lung cancer arising in a population undergoing screening. RESULTS Among a total of 305,934 participants, screening detected 206 lung cancers, 103 of which were Stage I disease. Seventy-one of the 131 adenocarcinomas were Stage I, and 58% of them showed evidence of cancer for 2 years on a retrospective review of radiographs. Presentation as small faint lesions overlapping the normal chest structures delayed the early detection of adenocarcinoma. The overall sensitivity of screening was 70%, 52% for squamous cell carcinoma and 50% for small cell carcinoma. Rapidly growing Stage II-IV tumors without retrospective evidence of cancer on previous radiographs accounted for most of the cancers detected during the intervals between screening. CONCLUSIONS Both the low detectability of Stage I adenocarcinoma and the late recognition of rapidly growing small cell and squamous cell carcinomas reduced the effectiveness of screening. More effective imaging methods and an antismoking campaign are required to reduce lung cancer mortality.
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Affiliation(s)
- H Soda
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan
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38
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Abstract
The treatment of choice for most cases of non-small-cell lung cancer is surgical resection; however, which patients with stage IIIA disease are surgical candidates is debatable. For many patients with stage IIIA or IIIB disease, the preferred modality is thoracic radiotherapy. In several randomized prospective trials, the addition of chemotherapy to thoracic radiotherapy produced a significant but clinically small survival advantage over radiotherapy alone. For patients with stage IV lung cancer, no curative treatment or "standard therapy" is available. Accordingly, many patients are offered investigational agents in phase I or II clinical trials. Small-cell lung cancer has a 60 to 90% rate of initial response to available chemotherapeutic agents. Patients with limited disease are generally given combination chemotherapy and thoracic radiotherapy, approximately 50% of whom have a complete clinical remission. Patients with extensive disease (spread beyond one radiation port) also have a high rate of initial response to chemotherapy, but only 20 to 40% have a complete remission and few survive for 5 years. New agents are being tested in previously untreated patients with extensive small-cell lung cancer. Promising new chemotherapeutic agents for lung cancer are being studied in clinical trials. Currently, only 1% of patients with lung cancer in the United States are enrolled in prospective clinical trials. Primary-care physicians are urged to encourage their patients to consider participation in approved prospective clinical trials at reputable medical centers, in an effort to discover new, effective agents with novel mechanisms of action. Information about such studies is available through Physician Desk Query (PDQ) or the cancer hotline (1-800-4-CANCER).
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Affiliation(s)
- J R Jett
- Division of Thoracic Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
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39
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Kreisman H, Wolkove N, Quoix E. Small cell lung cancer presenting as a solitary pulmonary nodule. Chest 1992; 101:225-31. [PMID: 1309497 DOI: 10.1378/chest.101.1.225] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- H Kreisman
- Department of Internal Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec
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40
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Abstract
The solitary pulmonary nodule (SPN), a single intrapulmonary spherical lesion that is fairly well circumscribed, is a common clinical problem. About half of SPNs seen in clinical practice are malignant, usually bronchogenic carcinomas. Some nodules are primary tumors of other kinds or metastatic. Virtually all benign SPNs are tuberculous or fungal granulomas. The standard management of the SPN of unknown cause is prompt surgical removal unless benignity is established by prior chest roentgenograms showing that the nodule has been stable (i.e., showing no growth) for 2 years or by the presence of a "benign" pattern of calcification. Less universally accepted criteria for benignity include (1) transthoracic needle aspiration biopsy (TNAB) showing a specific benign process, and (2) patient's age under 30 to 35 years. Bronchoscopy has a low diagnostic yield, particularly for benign nodules. SPNs usually grow at constant rates, expressed as the "doubling time" (DT). A nodule with a DT between 20 and 400 days is usually malignant. Benign nodules usually have a DT greater than 400 days. The prospective determination of DT by serial chest roentgenograms (the "wait and watch" strategy) is widely criticized but has clinical utility in special circumstances, particularly if the likelihood of malignancy is low and/or the anticipated surgical mortality is high. The presence and pattern of calcification are best shown by high-resolution thin-section computed tomography (CT). Diffuse, laminated, central or "popcorn" patterns of calcification indicate benignity. An eccentric calcium deposit or a stippled pattern does not rule out malignancy. CT densitometry will often show "occult" calcification in nodules that show no direct visual evidence of calcium deposition. The characteristics of the edge of the nodule correlate with the likelihood of malignancy. Nodules with irregular or spiculated margins are almost always malignant. The probability that the nodule is malignant (pCA) is related to the age of the patient, the diameter of the nodule, the amount of tobacco smoke inhalation, the overall prevalence of malignancy in SPNs, the nature of the edge of the lesion, and the presence or absence of occult calcification. It is possible by Bayesian techniques to combine these factors to calculate a more precise and comprehensive prediction of pCA in any given nodule. The 5-year survival after nodule resection depends on the size of the nodule at the time of surgery; it may be as high as 80% with nodules that are 1 cm in diameter. Lymph node involvement is uncommon with small tumors, and many authorities question the need for CT staging in such cases.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- G A Lillington
- Department of Internal Medicine, University of California, Davis, Medical Center, Sacramento
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