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Almurshedi AS, Radwan MA, Al Quadeib B, Aldosari B, Alfagih IM, Almarshidy SS. Pharmacokinetics of Afatinib after Intravenous and Oral Administrations in Rats Using Validated UPLC MS/MS Assay. J Chromatogr Sci 2024; 62:249-256. [PMID: 36617945 DOI: 10.1093/chromsci/bmac110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/24/2022] [Accepted: 12/26/2022] [Indexed: 01/10/2023]
Abstract
Afatinib is designated as the first-line management therapy for patients with advanced non-small cell lung cancer, and metastatic head and neck cancer. LC coupled to MS/MS can be utilised in therapeutic drug monitoring to ensure optimal use of Afatinib with the reduction of its possible adverse reactions. The aim of this investigation was to determine the pharmacokinetics of Afatinib in rats after single IV (2 mg/kg) and oral (8 mg/kg) doses. Therefore, a selective, sensitive and precise UPLC MS/MS assay thru electrospray ionisation basis with positive ionisation approach was established to measure Afatinib concentrations in the rat. The precision and accuracy of the developed assay method in the concentration range of 10-1000 ng/ml show no significant difference among inter- and-intra-day analysis (P > 0.05). Linearity was detected over the studied range with correlation coefficient, r > 0.995 (n = 6/day). The pharmacokinetics of Afatinib in the rat after a single IV dose showed a mean terminal half-life of 4.6 ± 0.97 h, and a mean clearance 480 ± 80 ml/h/kg. After PO administration, a short absorption phase with a mean Tmax of 1.3 ± 0.6 h with the highest concentration of 513.9 ± 281.1 ng/ml, and the lowest concentration detected after 24 h was 18.8 ± 10.7 ng/ml.
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Affiliation(s)
- Alanood S Almurshedi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 12331 Riyadh, Saudi Arabia
| | - Mahasen A Radwan
- Department of Pharmacy Practice/Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Cairo-Suez Road, 11829 Cairo, Egypt
| | - Bushra Al Quadeib
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 12331 Riyadh, Saudi Arabia
| | - Basmah Aldosari
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 12331 Riyadh, Saudi Arabia
| | - Iman M Alfagih
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 12331 Riyadh, Saudi Arabia
| | - Salma S Almarshidy
- Department of Pharmaceutics, College of Pharmacy, King Saud University, 12331 Riyadh, Saudi Arabia
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2
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Sihoe AD. Surgical management of ground glass opacities of the lung. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Alan D.L. Sihoe
- School of Biomedical SciencesThe University of Hong Kong Hong Kong SAR China
- Gleneagles Hong Kong Hospital Hong Kong SAR China
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3
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Zang X, Gibbs JD, Cheirsilp R, Byrnes PD, Toth J, Bascom R, Higgins WE. Optimal route planning for image-guided EBUS bronchoscopy. Comput Biol Med 2019; 112:103361. [PMID: 31362107 PMCID: PMC6820695 DOI: 10.1016/j.compbiomed.2019.103361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 12/25/2022]
Abstract
The staging of the central-chest lymph nodes is a major lung-cancer management procedure. To perform a staging procedure, the physician first uses a patient's 3D X-ray computed-tomography (CT) chest scan to interactively plan airway routes leading to selected target lymph nodes. Next, using an integrated EBUS bronchoscope (EBUS = endobronchial ultrasound), the physician uses videobronchoscopy to navigate through the airways toward a target node's general vicinity and then invokes EBUS to localize the node for biopsy. Unfortunately, during the procedure, the physician has difficulty in translating the preplanned airway routes into safe, effective biopsy sites. We propose an automatic route-planning method for EBUS bronchoscopy that gives optimal localization of safe, effective nodal biopsy sites. To run the method, a 3D chest model is first computed from a patient's chest CT scan. Next, an optimization method derives feasible airway routes that enables maximal tissue sampling of target lymph nodes while safely avoiding major blood vessels. In a lung-cancer patient study entailing 31 nodes (long axis range: [9.0 mm, 44.5 mm]), 25/31 nodes yielded safe airway routes having an optimal tissue sample size = 8.4 mm (range: [1.0 mm, 18.6 mm]) and sample adequacy = 0.42 (range: [0.05, 0.93]). Quantitative results indicate that the method potentially enables successful biopsies in essentially 100% of selected lymph nodes versus the 70-94% success rate of other approaches. The method also potentially facilitates adequate tissue biopsies for nearly 100% of selected nodes, as opposed to the 55-77% tissue adequacy rates of standard methods. The remaining nodes did not yield a safe route within the preset safety-margin constraints, with 3 nodes never yielding a route even under the most lenient safety-margin conditions. Thus, the method not only helps determine effective airway routes and expected sample quality for nodal biopsy, but it also helps point out situations where biopsy may not be advisable. We also demonstrate the methodology in an image-guided EBUS bronchoscopy system, used successfully in live lung-cancer patient studies. During a live procedure, the method provides dynamic real-time sample size visualization in an enhanced virtual bronchoscopy viewer. In this way, the physician vividly sees the most promising biopsy sites along the airway walls as the bronchoscope moves through the airways.
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Affiliation(s)
- Xiaonan Zang
- School of Electrical Engineering and Computer Science, USA; EDDA Technologies, Princeton, NJ, 08540, USA
| | - Jason D Gibbs
- School of Electrical Engineering and Computer Science, USA; X-Nav Technologies, Lansdale, PA, 19446, USA
| | - Ronnarit Cheirsilp
- School of Electrical Engineering and Computer Science, USA; Broncus Medical, San Jose, CA, USA
| | | | - Jennifer Toth
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Penn State University, University Park and Hershey, PA, USA
| | - Rebecca Bascom
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Penn State University, University Park and Hershey, PA, USA
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Einoch Amor R, Nakhleh MK, Barash O, Haick H. Breath analysis of cancer in the present and the future. Eur Respir Rev 2019; 28:28/152/190002. [DOI: 10.1183/16000617.0002-2019] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/19/2019] [Indexed: 12/11/2022] Open
Abstract
Most of the currently used diagnostics for cancerous diseases have yet to meet the standards of screening, as they are insufficiently accurate and/or invasive and risky. In this review, we describe the rationale, the progress made to date, and the potential of analysing the exhaled volatile organic compounds as a pathway for enabling early diagnosis of cancer and, therefore, for achieving better clinical prognosis and survival rates. The review highlights the major advancements made in this field, from fundamentals, up to translational phases and clinical trials, with a special emphasis on sensing platforms based on nanomaterials. The prospects for breath analysis in early cancerous disease are presented and discussed.
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5
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Duarte-Flores JO, González-Fausto AA, Corona-Sevilla LI, Gómez-Herrero H. [Adaptation of diagnostic tests and non-invasive management in the elderly with lung cancer: ultrasound guided fine needle puncture of enlarged supraclavicular lymph node]. Rev Esp Geriatr Gerontol 2018; 53:356-357. [PMID: 29895443 DOI: 10.1016/j.regg.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/17/2018] [Accepted: 05/09/2018] [Indexed: 06/08/2023]
Affiliation(s)
- José Octavio Duarte-Flores
- Servicio de Geriatría, Hospital General Regional 72, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - Aura Anaid González-Fausto
- Servicio de Geriatría, Hospital General Regional 72, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Luis Isaac Corona-Sevilla
- Servicio de Geriatría, Hospital General Regional 72, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Helena Gómez-Herrero
- Servicio de Radiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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6
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Sun S, Chen Z, Cao C, Wu B, Wang B, Yu Y, Chen Z, Hu Z, Deng Z. Diagnostic value of epidermal growth factor, cancer antigen 125, and cancer antigen 15-3 in bronchoalveolar lavage fluid of lung cancer. ACTA ACUST UNITED AC 2017; 24:e180-e184. [PMID: 28680284 DOI: 10.3747/co.24.3348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM In the present study, we assessed the diagnostic value of epidermal growth factor (egf) and cancer antigens 125 (ca125) and 15-3 (ca15-3) in bronchoalveolar lavage fluid (balf) of lung cancer from 79 enrolled patients with suspected lung cancer. METHODS All patients underwent fibrescopic examination, during which balf samples were collected. Levels of egf, ca125, and ca15-3 were determined in balf using commercially available test kits. RESULTS The results showed that levels of egf in balf were significantly higher in patients with lung cancer than in patients with benign diseases (p < 0.01); no significant differences for ca125 (p = 0.67) or ca15-3 (p = 0.43) in balf were observed between the lung cancer patients and the non-cancer control subjects. With a cut-off value of 27.22 pg/mL, egf showed a sensitivity of 63.6% and a specificity of 65.7% in predicting the malignant nature of pulmonary disease. CONCLUSIONS The study findings suggest that levels of egf are significantly increased in balf from patients with lung cancer than in balf from patients with benign disease. Detection of the level of egf in balf is proposed as a noninvasive test to identify patients at high risk for lung cancer.
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Affiliation(s)
- S Sun
- Department of Respiratory Medicine, The Affiliated Hospital of Medical College, Ningbo University, Ningbo
| | - Z Chen
- Department of Emergency Medicine, Ningbo First Hospital, Ningbo
| | - C Cao
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo
| | - B Wu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital, Institute of Respiratory Diseases, Guangdong Medicine College, Guangdong; and
| | - B Wang
- Department of Respiratory Medicine, The Affiliated Hospital of Medical College, Ningbo University, Ningbo
| | - Y Yu
- Department of Respiratory Medicine, The Affiliated Hospital of Medical College, Ningbo University, Ningbo
| | - Z Chen
- Department of Respiratory Medicine, The Affiliated Hospital of Medical College, Ningbo University, Ningbo
| | - Z Hu
- Department of Respiratory Medicine, Cixi People's Hospital, Cixi, P.R.C
| | - Z Deng
- Department of Respiratory Medicine, The Affiliated Hospital of Medical College, Ningbo University, Ningbo
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Kaplan A, Akalin Ciftci G, Kutlu HM. The apoptotic and genomic studies on A549 cell line induced by silver nitrate. Tumour Biol 2017; 39:1010428317695033. [PMID: 28381165 DOI: 10.1177/1010428317695033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lung cancer is the leading cause of male cancer deaths worldwide. Metal-based anticancer drugs have evolved significantly during the past decades. Recently, silver ions have been investigated for their anticancer effects. We aimed to study the time-course cytotoxic effects of silver nitrate on A549 adenocarcinomic human alveolar basal epithelial cells to provide insights into the molecular-level understanding of growth suppression mechanism involved in apoptosis. The influences of silver nitrate were studied via MTT assay, flow cytometry, immunocytochemical, confocal and transmission electron microscopy, and microarray assays. Silver nitrate showed inhibitory effects against A549 cells in a dose- and time-dependent manner for 24, 48, and 72 h and induced apoptosis. The early and late apoptotic cells and depolarized mitochondrial membrane potential were determined by the half-maximal inhibitory concentration (IC50) value of silver nitrate treated for 72 h. But cysteinyl aspartate proteinase-3 was not activated for 72 h. Furthermore, IC50 value of silver nitrate also induced apoptosis according to immunocytochemical assays for 72 h. The downregulated CCNY, HNRNPL, ASF1B, PIAS4, HNRNPH1, EIF2C2, TAF15, FOXC1, LEP, and PCB2 genes administered with silver nitrate IC50 were identified as apoptosis-leading genes. Silver nitrate may be a suitable therapeutic agent against lung cancer.
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Affiliation(s)
- Ayse Kaplan
- 1 Faculty of Science, Department of Biology, Anadolu University, Eskişehir, Turkey
| | - Gulsen Akalin Ciftci
- 2 Faculty of Pharmacy, Department of Biochemistry, Anadolu University, Eskişehir, Turkey
| | - Hatice Mehtap Kutlu
- 1 Faculty of Science, Department of Biology, Anadolu University, Eskişehir, Turkey
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8
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Ustabasioglu FE, Samanci C, Alis D, Samanci NS, Kula O, Olgun DC. Apparent Diffusion Coefficient Measurement in Mediastinal Lymphadenopathies: Differentiation between Benign and Malignant Lesions. J Clin Imaging Sci 2017; 7:12. [PMID: 28400998 PMCID: PMC5360005 DOI: 10.4103/jcis.jcis_84_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/25/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives: We aimed to prospectively assess the diagnostic value of apparent diffusion coefficient (ADC) measurement in the differentiation of benign and malignant mediastinal lymphadenopathies. Materials and Methods: The study included 63 consecutive patients (28 women, 35 men; mean age 59.3 years) with 125 mediastinal lymphadenopathies. Echoplanar diffusion-weighted magnetic resonance imaging of the mediastinum was performed with b-factors of 0 and 600 mm2/s before mediastinoscopy and mediastinotomy, and ADC values were measured. The ADC values were compared with the histological results, and statistical analysis was done. P < 0.05 was considered statistically significant. Results: The mean ADC value of malignant mediastinal lymphadenopathy (1.030 ± 0.245 × 10−3 mm2/s) was significantly lower (P < 0.05) when compared to benign lymphadenopathies (1.571 ± 0.559 × 10−3 mm2/s). For differentiating malignant from benign mediastinal lymphadenopathy, the best result was obtained when an ADC value of 1.334 × 10−3 mm2/s was used as a threshold value; area under the curve 0.848, accuracy 78.4%, sensitivity 66%, specificity of 86%, positive predictive value 76.7%, and negative predictive value of 79.2%. Interobserver agreement was excellent for ADC measurements. Conclusions: ADC measurements could be considered an important supportive method in differentiating benign from malignant mediastinal lymphadenopathies.
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Affiliation(s)
- Fethi Emre Ustabasioglu
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, K.M. Pasa, Istanbul, Turkey
| | - Cesur Samanci
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, K.M. Pasa, Istanbul, Turkey
| | - Deniz Alis
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, K.M. Pasa, Istanbul, Turkey
| | - Nilay Sengul Samanci
- Department of Internal Medicine, Haseki Research and Training Hospital, Haseki, Istanbul, Turkey
| | - Osman Kula
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, K.M. Pasa, Istanbul, Turkey
| | - Deniz Cebi Olgun
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, K.M. Pasa, Istanbul, Turkey
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9
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Lee DH, Yoon TM, Lee JK, Lim SC. Supraclavicular Lymph Node Excision Biopsy in Patients with Suspected Supraclavicular Lymph Node Metastasis of Lung Cancer: Experience in a Tertiary Hospital. Chonnam Med J 2017; 53:69-72. [PMID: 28184341 PMCID: PMC5299132 DOI: 10.4068/cmj.2017.53.1.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/11/2016] [Accepted: 11/13/2016] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to evaluate the usefulness and accuracy of supraclavicular lymph node excision biopsy in the diagnosis of suspected supraclavicular lymph node metastasis of lung cancer. A retrospective review was performed to evaluate patients with suspected supraclavicular lymph node metastasis of lung cancer who underwent supraclavicular lymph node excision biopsy from January 2011 to July 2014. Forty-six patients with suspected supraclavicular lymph node metastasis of lung cancer underwent supraclavicular lymph node excision biopsy, which diagnosed benign diseases in 6 patients and malignant diseases in 40 patients. Supraclavicular lymph node excision biopsy was usually performed on patients during their first clinical visit under local anesthesia. For diagnosing suspected lung cancer, supraclavicular lymph node excision biopsy had a diagnostic sensitivity of 100%, specificity of 97.6%, positive-predictive value of 83.3%, negative-predictive value of 100%, and accuracy of 97.8%. No major complication resulted from surgical intervention. Supraclavicular lymph node excision biopsy is a useful and accurate adjunct for the evaluation of suspected supraclavicular lymph node metastasis of lung cancer in a tertiary hospital.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae Mi Yoon
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Joon Kyoo Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Vernon J, Andruszkiewicz N, Schneider L, Schieman C, Finley CJ, Shargall Y, Fahim C, Farrokhyar F, Hanna WC. Comprehensive Clinical Staging for Resectable Lung Cancer: Clinicopathological Correlations and the Role of Brain MRI. J Thorac Oncol 2016; 11:1970-1975. [DOI: 10.1016/j.jtho.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/10/2016] [Accepted: 06/12/2016] [Indexed: 12/25/2022]
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Rudokas M, Najlah M, Alhnan MA, Elhissi A. Liposome Delivery Systems for Inhalation: A Critical Review Highlighting Formulation Issues and Anticancer Applications. Med Princ Pract 2016; 25 Suppl 2:60-72. [PMID: 26938856 PMCID: PMC5588529 DOI: 10.1159/000445116] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 03/01/2016] [Indexed: 12/18/2022] Open
Abstract
This is a critical review on research conducted in the field of pulmonary delivery of liposomes. Issues relating to the mechanism of nebulisation and liposome composition were appraised and correlated with literature reports of liposome formulations used in clinical trials to understand the role of liposome size and composition on therapeutic outcome. A major highlight was liposome inhalation for the treatment of lung cancers. Many in vivo studies that explored the potential of liposomes as anticancer carrier systems were evaluated, including animal studies and clinical trials. Liposomes can entrap anticancer drugs and localise their action in the lung following pulmonary delivery. The safety of inhaled liposomes incorporating anticancer drugs depends on the anticancer agent used and the amount of drug delivered to the target cancer in the lung. The difficulty of efficient targeting of liposomal anticancer aerosols to the cancerous tissues within the lung may result in low doses reaching the target site. Overall, following the success of liposomes as inhalable carriers in the treatment of lung infections, it is expected that more focus from research and development will be given to designing inhalable liposome carriers for the treatment of other lung diseases, including pulmonary cancers. The successful development of anticancer liposomes for inhalation may depend on the future development of effective aerosolisation devices and better targeted liposomes to maximise the benefit of therapy and reduce the potential for local and systemic adverse effects.
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Affiliation(s)
- Mindaugas Rudokas
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston
| | - Mohammad Najlah
- Faculty of Medical Science, Anglia Ruskin University, Chelmsford, UK
| | - Mohamed Albed Alhnan
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston
| | - Abdelbary Elhissi
- Pharmaceutical Sciences Section, College of Pharmacy, Qatar University, Doha, Qatar
- *Dr. Abdelbary Elhissi, Pharmaceutical Sciences Section, College of Pharmacy, Qatar University, PO Box 2713, Doha (Qatar), E-Mail
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12
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Li W, Zhang T, Chen Y, Liu C, Peng W. Diagnostic Value of Convex Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Mediastinal Tuberculous Lymphadenitis: A Systematic Review and Meta-Analysis. Med Sci Monit 2015; 21:2064-72. [PMID: 26177653 PMCID: PMC4510950 DOI: 10.12659/msm.894526] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been widely used in the diagnosis of mediastinal lymphadenopathies. Here, we performed a systematic review and meta-analysis to explore the diagnostic value of EBUS-TBNA in mediastinal tuberculous lymphadenopathy (TBLA). Material/Methods PubMed, EMBASE, and Sinoced were systematically searched for articles published in English or Chinese that reported the diagnostic yield of EBUS-TBNA in mediastinal TBLA. The quality of studies was assessed using the QualSyst tool. Using 95% confidence intervals (CI), the diagnostic yields of EBUS-TBNA were calculated for the individual studies, and the results were then pooled using a random-effects model. Heterogeneity and publication bias were also assessed. Results A total of 14 studies, consisting of 684 patients with mediastinal TBLA, were finally included. The pooled diagnostic yield of EBUS-TBNA for mediastinal TBLA was 80% (95% CI: 74–86%). Significant heterogeneity (I2=77.9%) and significant publication bias were detected (Begg’s test p=0.05 and Egger’s test p=0.02). From subgroup analyses, significant differences in the diagnostic yield of EBUS-TBNA were associated with Asian vs. European (UK) studies, retrospective vs. prospective studies, those employing rapid on-site cytological evaluation vs. not, those employing different anesthetic types, and those employing smear vs. culture. However, microbiological examination and the number of lymph node passes did not have a significant effect on the diagnostic yield of EBUS-TBNA. Fifteen minor complications for EBUS-TBNA were reported. Conclusions EBUS-TBNA appears to be an efficacious and safe procedure and should be used as an initial diagnostic tool for mediastinal TBLA.
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Affiliation(s)
- Wei Li
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Ting Zhang
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Yuqing Chen
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Chao Liu
- Department of Respiratory Disease, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China (mainland)
| | - Wenjia Peng
- Department of Epidemiology and Health Statistics, Bengbu Medical College, Bengbu, Anhui, China (mainland)
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13
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Cheirsilp R, Bascom R, Allen TW, Higgins WE. Thoracic cavity definition for 3D PET/CT analysis and visualization. Comput Biol Med 2015; 62:222-38. [PMID: 25957746 PMCID: PMC4429311 DOI: 10.1016/j.compbiomed.2015.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/10/2015] [Accepted: 04/11/2015] [Indexed: 12/25/2022]
Abstract
X-ray computed tomography (CT) and positron emission tomography (PET) serve as the standard imaging modalities for lung-cancer management. CT gives anatomical details on diagnostic regions of interest (ROIs), while PET gives highly specific functional information. During the lung-cancer management process, a patient receives a co-registered whole-body PET/CT scan pair and a dedicated high-resolution chest CT scan. With these data, multimodal PET/CT ROI information can be gleaned to facilitate disease management. Effective image segmentation of the thoracic cavity, however, is needed to focus attention on the central chest. We present an automatic method for thoracic cavity segmentation from 3D CT scans. We then demonstrate how the method facilitates 3D ROI localization and visualization in patient multimodal imaging studies. Our segmentation method draws upon digital topological and morphological operations, active-contour analysis, and key organ landmarks. Using a large patient database, the method showed high agreement to ground-truth regions, with a mean coverage=99.2% and leakage=0.52%. Furthermore, it enabled extremely fast computation. For PET/CT lesion analysis, the segmentation method reduced ROI search space by 97.7% for a whole-body scan, or nearly 3 times greater than that achieved by a lung mask. Despite this reduction, we achieved 100% true-positive ROI detection, while also reducing the false-positive (FP) detection rate by >5 times over that achieved with a lung mask. Finally, the method greatly improved PET/CT visualization by eliminating false PET-avid obscurations arising from the heart, bones, and liver. In particular, PET MIP views and fused PET/CT renderings depicted unprecedented clarity of the lesions and neighboring anatomical structures truly relevant to lung-cancer assessment.
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Affiliation(s)
- Ronnarit Cheirsilp
- School of Electrical Engineering and Computer Science, Penn State University, University Park, PA, United States
| | - Rebecca Bascom
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Thomas W Allen
- Department of Radiology, Penn State University, Milton S. Hershey Medical Center, Hershey, PA, United States
| | - William E Higgins
- School of Electrical Engineering and Computer Science, Penn State University, University Park, PA, United States.
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14
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Heerboth S, Housman G, Leary M, Longacre M, Byler S, Lapinska K, Willbanks A, Sarkar S. EMT and tumor metastasis. Clin Transl Med 2015; 4:6. [PMID: 25852822 PMCID: PMC4385028 DOI: 10.1186/s40169-015-0048-3] [Citation(s) in RCA: 532] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 01/26/2015] [Indexed: 02/07/2023] Open
Abstract
EMT and MET comprise the processes by which cells transit between epithelial and mesenchymal states, and they play integral roles in both normal development and cancer metastasis. This article reviews these processes and the molecular pathways that contribute to them. First, we compare embryogenesis and development with cancer metastasis. We then discuss the signaling pathways and the differential expression and down-regulation of receptors in both tumor cells and stromal cells, which play a role in EMT and metastasis. We further delve into the clinical implications of EMT and MET in several types of tumors, and lastly, we discuss the role of epigenetic events that regulate EMT/MET processes. We hypothesize that reversible epigenetic events regulate both EMT and MET, and thus, also regulate the development of different types of metastatic cancers.
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Affiliation(s)
- Sarah Heerboth
- />Cancer Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Genevieve Housman
- />School of Human Evolution and Social Change, Arizona State University, Tempe, AZ USA
| | - Meghan Leary
- />Cancer Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | | | - Shannon Byler
- />Cancer Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Karolina Lapinska
- />Cancer Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Amber Willbanks
- />Cancer Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
| | - Sibaji Sarkar
- />Cancer Center, Department of Medicine, Boston University School of Medicine, Boston, MA USA
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15
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Abstract
Bronchoscopy is a commonly used minimally invasive procedure for lung-cancer staging. In standard practice, however, physicians differ greatly in their levels of performance. To address this concern, image-guided intervention (IGI) systems have been devised to improve procedure success. Current IGI bronchoscopy systems based on virtual bronchoscopic navigation (VBN), however, require involvement from the attending technician. This lessens physician control and hinders the overall acceptance of such systems. We propose a hands-free VBN system for planning and guiding bronchoscopy. The system introduces two major contributions. First, it incorporates a new procedure-planning method that automatically computes airway navigation plans conforming to the physician's bronchoscopy training and manual dexterity. Second, it incorporates a guidance strategy for bronchoscope navigation that enables user-friendly system control via a foot switch, coupled with a novel position-verification mechanism. Phantom studies verified that the system enables smooth operation under physician control, while also enabling faster navigation than an existing technician-assisted VBN system. In a clinical human study, we noted a 97% bronchoscopy navigation success rate, in line with existing VBN systems, and a mean guidance time per diagnostic site = 52 s. This represents a guidance time often nearly 3 min faster per diagnostic site than guidance times reported for other technician-assisted VBN systems. Finally, an ergonomic study further asserts the system's acceptability to the physician and long-term potential.
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Çetinkaya E, Özgül MA, Tutar N, Özgül G, Çam E, Bilaçeroglu S. The Diagnostic Utility of Real-Time EBUS-TBNA for Hilar and Mediastinal Lymph Nodes in Conventional TBNA Negative Patients. Ann Thorac Cardiovasc Surg 2014; 20:106-12. [DOI: 10.5761/atcs.oa.12.02072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gibbs JD, Graham MW, Bascom R, Cornish DC, Khare R, Higgins WE. Optimal procedure planning and guidance system for peripheral bronchoscopy. IEEE Trans Biomed Eng 2013; 61:638-57. [PMID: 24235246 DOI: 10.1109/tbme.2013.2285627] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With the development of multidetector computed-tomography (MDCT) scanners and ultrathin bronchoscopes, the use of bronchoscopy for diagnosing peripheral lung-cancer nodules is becoming a viable option. The work flow for assessing lung cancer consists of two phases: 1) 3-D MDCT analysis and 2) live bronchoscopy. Unfortunately, the yield rates for peripheral bronchoscopy have been reported to be as low as 14%, and bronchoscopy performance varies considerably between physicians. Recently, proposed image-guided systems have shown promise for assisting with peripheral bronchoscopy. Yet, MDCT-based route planning to target sites has relied on tedious error-prone techniques. In addition, route planning tends not to incorporate known anatomical, device, and procedural constraints that impact a feasible route. Finally, existing systems do not effectively integrate MDCT-derived route information into the live guidance process. We propose a system that incorporates an automatic optimal route-planning method, which integrates known route constraints. Furthermore, our system offers a natural translation of the MDCT-based route plan into the live guidance strategy via MDCT/video data fusion. An image-based study demonstrates the route-planning method's functionality. Next, we present a prospective lung-cancer patient study in which our system achieved a successful navigation rate of 91% to target sites. Furthermore, when compared to a competing commercial system, our system enabled bronchoscopy over two airways deeper into the airway-tree periphery with a sample time that was nearly 2 min shorter on average. Finally, our system's ability to almost perfectly predict the depth of a bronchoscope's navigable route in advance represents a substantial benefit of optimal route planning.
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Merritt SA, Khare R, Bascom R, Higgins WE. Interactive CT-video registration for the continuous guidance of bronchoscopy. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:1376-96. [PMID: 23508260 PMCID: PMC3911781 DOI: 10.1109/tmi.2013.2252361] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bronchoscopy is a major step in lung cancer staging. To perform bronchoscopy, the physician uses a procedure plan, derived from a patient's 3D computed-tomography (CT) chest scan, to navigate the bronchoscope through the lung airways. Unfortunately, physicians vary greatly in their ability to perform bronchoscopy. As a result, image-guided bronchoscopy systems, drawing upon the concept of CT-based virtual bronchoscopy (VB), have been proposed. These systems attempt to register the bronchoscope's live position within the chest to a CT-based virtual chest space. Recent methods, which register the bronchoscopic video to CT-based endoluminal airway renderings, show promise but do not enable continuous real-time guidance. We present a CT-video registration method inspired by computer-vision innovations in the fields of image alignment and image-based rendering. In particular, motivated by the Lucas-Kanade algorithm, we propose an inverse-compositional framework built around a gradient-based optimization procedure. We next propose an implementation of the framework suitable for image-guided bronchoscopy. Laboratory tests, involving both single frames and continuous video sequences, demonstrate the robustness and accuracy of the method. Benchmark timing tests indicate that the method can run continuously at 300 frames/s, well beyond the real-time bronchoscopic video rate of 30 frames/s. This compares extremely favorably to the ≥ 1 s/frame speeds of other methods and indicates the method's potential for real-time continuous registration. A human phantom study confirms the method's efficacy for real-time guidance in a controlled setting, and, hence, points the way toward the first interactive CT-video registration approach for image-guided bronchoscopy. Along this line, we demonstrate the method's efficacy in a complete guidance system by presenting a clinical study involving lung cancer patients.
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Affiliation(s)
| | - Rahul Khare
- Sheikh Zayed Institute at the Childrens National Medical Center, Washington, DC 20010 USA
| | - Rebecca Bascom
- Department of Medicine, Pennsylvania State Hershey Medical Center, Hershey, PA 17033 USA
| | - William E. Higgins
- Departments of Electrical Engineering, Computer Science and Engineering, and Bioengineering, Pennsylvania State University, University Park, PA 16802 USA
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Koukis I, Gkiozos I, Ntanos I, Kainis E, Syrigos KN. Clinical and surgical-pathological staging in early non-small cell lung cancer. Oncol Rev 2013; 7:e7. [PMID: 25992228 PMCID: PMC4419614 DOI: 10.4081/oncol.2013.e7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 07/14/2013] [Accepted: 08/26/2013] [Indexed: 12/25/2022] Open
Abstract
Staging is of the utmost importance in the evaluation of a patient with non-small cell lung cancer (NSCLC) because it defines the actual extent of the disease. Accurate staging allows multidisciplinary oncology teams to plan the best surgical or medical treatment and to predict patient prognosis. Based on the recommendation of the International Association for the Study of Lung Cancer (IASLC), a tumor, node, and metastases (TNM) staging system is currently used for NSCLC. Clinical staging (c-TNM) is achieved via non-invasive modalities such as examination of case history, clinical assessment and radiological tests. Pathological staging (p-TNM) is based on histological examination of tissue specimens obtained with the aid of invasive techniques, either non-surgical or during the intervention. This review is a critical evaluation of the roles of current pre-operative staging modalities, both invasive and non-invasive. In particular, it focuses on new techniques and their role in providing accurate confirmation of patient TNM status. It also evaluates the surgical-pathological staging modalities used to obtain the true-pathological staging for NSCLC.
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Affiliation(s)
- Ioannis Koukis
- Department Cardiothoracic Surgery, 401 Army General Hospital, Athens
| | - Ioannis Gkiozos
- Oncology Unit, GPP, Medical School of Athens, Sotiria General Hospital, Athens, Greece
| | - Ioannis Ntanos
- Oncology Unit, GPP, Medical School of Athens, Sotiria General Hospital, Athens, Greece
| | - Elias Kainis
- Oncology Unit, GPP, Medical School of Athens, Sotiria General Hospital, Athens, Greece
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Hu L, Liang G, Yuliang W, Bingjing Z, Xiangdong Z, Rufu X. Assessing the effectiveness and safety of liposomal paclitaxel in combination with cisplatin as first-line chemotherapy for patients with advanced NSCLC with regional lymph-node metastasis: study protocol for a randomized controlled trial (PLC-GC trial). Trials 2013; 14:45. [PMID: 23413951 PMCID: PMC3599280 DOI: 10.1186/1745-6215-14-45] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 01/28/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer is still the leading cause of cancer-related mortality worldwide. Around 80 to 85% of lung cancers are non-small cell lung cancer (NSCLC). Regional lymphatic metastasis is a frequent occurrence in NSCLC, and the extent of lymphatic dissemination significantly determines the prognosis of patients with NSCLC. Hence, identification of alternative treatments for these patients should be considered a priority. Liposomal paclitaxel is a new formulation composed of paclitaxel and liposomes, with favorable pharmacokinetic properties. In particular, it produces dramatically higher drug concentrations in the lymph nodes than occurs with the current formulations of paclitaxel, thus we believe that patients with NSCLC with regional lymphatic metastasis may benefit from this new drug. Cisplatin-based doublet chemotherapy is recommended as the first-line treatment for patients with advanced NSCLC. We have designed a trial to assess whether first-line chemotherapy using liposomal paclitaxel combined with cisplatin (LP regimen) is superior to gemcitabine combined with cisplatin (GP regimen) in efficacy (both short-term and long-term efficacy) and safety (adverse events; AEs). METHOD/DESIGN This is a prospective, open-label, controlled randomized clinical trial (RCT) to assess the therapeutic effects and safety of liposomal paclitaxel. The study aims to enroll 126 patients, who will be randomly allocated to one of the two treatment groups (LP and GP), with 63 patients in each group. Patients will receive four to six cycles of the assigned chemotherapy, and primary outcome will be assessed every two cycles. Patients will be recommended for surgery if the tumor becomes resectable. All participants will be followed up for at least 12 months. The objective response rate (ORR), changes in regional lymphatic metastasis (including number and size) and TNM (tumor, node, metastasis) staging will be the primary outcome measures. Progression-free survival, objective survival, median survival time, 1-year survival rate, toxicity, and time to disease progression will be the secondary outcome measures. CONCLUSIONS A systematic search has indicated that this proposed study will be the first RCT to evaluate whether liposomal paclitaxel plus cisplatin will have beneficial effects, compared with gemcitabine plus cisplatin, on enhancing ORR, changing TNM staging, improving long-term survival, and reducing the frequency of AEs for patients with NSCLC with regional lymphatic metastasis. TRIAL REGISTRATION http://www.chictr.org Identifier: ChiCTR-TRC-12602105.
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Affiliation(s)
- Luo Hu
- Department of Respiratory Diseases, The First Affiliated Hospital of Third Military Medical University, Chongqing 400038, People's Republic of China.
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21
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Mediastinal atlas creation from 3-D chest computed tomography images: application to automated detection and station mapping of lymph nodes. Med Image Anal 2011; 16:63-74. [PMID: 21641269 DOI: 10.1016/j.media.2011.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 11/23/2022]
Abstract
One important aspect of lung cancer staging is the assessment of mediastinal lymph nodes in 3-D chest computed tomography (CT) images. In the current clinical routine this is done manually by analyzing the 3-D CT image slice by slice to find nodes, evaluate them quantitatively, and assign labels to them for describing the clinical and pathologic extent of metastases. In this paper we present a method to automate the process of lymph node detection and labeling by creation of a mediastinal average image and a novel lymph node atlas containing probability maps for mediastinal, aortic, and N1 nodes. Utilizing a fast deformable registration approach to match the atlas with CT images of new patients, our method can maintain an acceptable runtime. In comparison to previously published methods for mediastinal lymph node detection and labeling it also shows a good sensitivity and positive predictive value.
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22
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Schuhmann M, Eberhardt R, Herth FJF. Direct nodal sampling by echoendoscopy in lung cancer: the clinician's expectations: Direct nodal sampling by echoendoscopy in lung cancer. Insights Imaging 2011; 2:133-140. [PMID: 22347942 PMCID: PMC3259317 DOI: 10.1007/s13244-010-0058-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Revised: 11/01/2010] [Accepted: 12/09/2010] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Mediastinal lymph node staging for lung cancer remains one of the most important factors to determine patient outcome. METHODS: Noninvasive imaging techniques such as CT, MRI, PET and PET-CT provide some answers but no tissue diagnosis. RESULTS: The development of endo-oesophageal (EUS) and endobronchial ultrasound (EBUS) with fine-needle aspiration has provided the clinician with a tool to investigate the mediastinum and the adrenal gland with a safe, minimally invasive procedure that can be performed on an outpatient basis. CONCLUSION: The aim of this article was to give radiologists an overview of the techniques of EUS and EBUS and their role in the staging of lung cancer patients.
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Affiliation(s)
- Maren Schuhmann
- Department of Pneumonology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany
- Southampton University Hospital Trust, Southampton, UK
| | - Ralf Eberhardt
- Department of Pneumonology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany
| | - Felix J. F. Herth
- Department of Pneumonology and Critical Care Medicine, Thoraxklinik at University Hospital Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany
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Min KH, Park SJ, Lee KS, Hwang SH, Kim SR, Moon H, Han HJ, Chung MJ, Lee YC. Clinical usefulness of D2-40 in non-small cell lung cancer. Lung 2010; 189:57-63. [PMID: 21107593 DOI: 10.1007/s00408-010-9268-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 11/01/2010] [Indexed: 11/28/2022]
Abstract
D2-40 is a recently developed monoclonal antibody that reacts with a 40 kDa O-linked sialoglycoprotein and has been used for the assessment of lymphatic invasion in tumor specimens. We have evaluated the diagnostic usefulness of D2-40 and association of its immunopositivity with clinicopathological parameters in adenocarcinoma and squamous cell carcinoma of the lung. We investigated 97 cases of surgically resected adenocarcinoma or squamous cell carcinoma of the lung for the determination of D2-40 positivity in tumor cells and peritumoral lymphatic vessel density (LVD) using an immunostaining method. D2-40 immunoreactivity in tumor cells was invariably negative in adenocarcinoma but 47% of squamous cell carcinomas were positive. D2-40 positivity in the tumor was significantly associated with high LVD in squamous cell carcinoma (P < 0.006). There was no significant association between peritumoral LVD and clinicopathologic parameters, including lymphatic vessel invasion, lymph node metastasis, and survival in adenocarcinoma and squamous cell carcinoma. These results suggest that D2-40 immunoreactivity in tumor cells can be used for distinguishing between adenocarcinoma and squamous cell carcinoma and that the reactivity of tumor cells with D2-40 is positively correlated with LVD in squamous cell carcinoma but not with lymph node metastasis in adenocarcinoma and squamous cell carcinoma.
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Affiliation(s)
- Kyung Hoon Min
- Department of Internal Medicine, Chonbuk National University Medical School, San 2-20 Geumam-dong Deokjin-gu Jeonbuk, Jeonju 561-180, South Korea
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24
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Al-Shibli K, Al-Saad S, Andersen S, Donnem T, Bremnes RM, Busund LT. The prognostic value of intraepithelial and stromal CD3-, CD117- and CD138-positive cells in non-small cell lung carcinoma. APMIS 2010; 118:371-82. [PMID: 20477813 DOI: 10.1111/j.1600-0463.2010.02609.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The major value of prognostic markers in potentially curable non-small cell lung carcinoma (NSCLC) should be to guide therapy after surgical treatment. Although tumor-infiltrating T lymphocytes and plasma cells have been documented in NSCLC, a clear association with clinical outcome, especially for the stromal component, has not been well established. The aim of this study was to elucidate the prognostic significance of these cells/markers in the epithelial and stromal compartments of NSCLC. Tissue microarrays from 335 resected, stage I-IIIA, NSCLC were constructed by duplicate cores from viable neoplastic epithelial and stromal areas. Immunohistochemistry was used to evaluate the infiltration of CD3(+), CD117(+) as well as CD138(+) cells in epithelial and stromal areas. In univariate analyses, increasing numbers of stromal CD3(+) (p = 0.001) and epithelial CD3(+) cells (p = 0.004) correlated significantly with an improved disease-specific survival. No such relation was noted with CD3(+) or CD117(+) cells. In the multivariate analysis, stromal CD3(+) cells was an independent prognostic factor for disease-specific survival (HR 1.925, CI 1.21-3.04, p = 0.005). Increased presence of the pan T-cell marker, CD3, which is an independent factor, correlates with improved clinical outcome in NSCLC. This prognostic impact of T cells is clearer in the tumor stroma. Neither plasma cells nor mast cells were prognostic indicators in our cohort.
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Affiliation(s)
- Khalid Al-Shibli
- Department of Pathology, Nordland Central Hospital, Bodø, Norway.
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25
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Abstract
Lung cancer represents one of the most frequent causes of death due to neoplastic disease in Poland and around the world. The high mortality which accompany neoplastic diseases used to be ascribed mainly to dissemination of cancerous cells. Studies on animal models suggest that tumour lymphangiogenesis represents the principal factor in the process of metastases formation. Lymphangiogenesis involves a process of formation of new lymphatic vessels from already existing lymphatic capillaries. Lymphangiogenesis is stimulated by vascular endothelial growth factors (VEGF) and other, recently reported factors, such as, e.g., cyclooxygenase 2, fibroblast growth factor 2, angiopoetin-1 and the insulin-resembling growth factor. In lymphangiogenesis a key role is played by neutropilin 2 or podoplanin and this promoted development of studies on lymphangiogenesis. Activation of VEGF-C/VEGF-D/VEGFR-3 axis increases motility and invasiveness of neoplastic cells, promotes development of metastases in several types of tumours such as, e.g., lung cancer, mammary carcinoma, cancers of the neck, prostate and large intestine. In recent years lymphangiogenesis provided topic of many studies. A positive correlation was detected between expressions of VEGF-C/D and VEGFR-3 in non-small cell lung cancer. In patients with lung cancer with high expression of VEGF-C a markedly abbreviated survival was noted. Positive correlation was detected between expression of VEGF-C and VEGF-D on one hand and expression of LYVE-1 on the other in sentinel lymph nodes with metastases of neoplastic cells in patients with non-small cell lung cancer. Also, high density of lymphatic vessels and high density of intraneoplastic microvessels proved to be independent poor prognostic indices in patients with non-small cell lung cancer. Extensive hope is linked to studies on inhibitors of lymphangiogenesis, which may improve results of treatment also in tumour patients.
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26
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Sit AKY, Sihoe ADL, Suen WS, Cheng LC. Positron-Emission Tomography for Lung Cancer in a Tuberculosis-Endemic Region. Asian Cardiovasc Thorac Ann 2010; 18:33-8. [PMID: 20124294 DOI: 10.1177/0218492309352119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A potential limitation of integrated positron-emission tomography and computed tomography in non-small-cell lung cancer may be false-positive results due to granulomatous disease. This retrospective study examined the accuracy of this imaging modality for mediastinal nodal staging of non-small-cell lung cancer in Hong Kong where tuberculosis remains endemic. There were 249 lymph node stations evaluated in 107 patients, of whom 38 (36%) had active tuberculosis or evidence of previous tuberculosis. Imaging results were compared with histological findings. The sensitivity, specificity, and accuracy of integrated imaging for mediastinal nodal staging were 52%, 86%, and 80%, respectively; the overall positive-predictive value for mediastinal nodal metastasis was 46%, and the overall negative-predictive value was 89%. The positive-predictive value for mediastinal nodal metastasis was 39% in patients with tuberculosis and 50% in controls; the negative-predictive value was high in both groups (92% and 87%). The likelihood ratio for true positives was 6.47 in patients with tuberculosis vs. 10.97 in controls. This suggests that the reliability of positron-emission/computed tomography may be substantially poorer in patients with tuberculosis. Histological confirmation should be considered mandatory in patients with suspected metastasis on integrated imaging.
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Affiliation(s)
- Alva KY Sit
- Division of Cardiothoracic Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Alan DL Sihoe
- Division of Cardiothoracic Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Wai Sing Suen
- Division of Cardiothoracic Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Lik Cheung Cheng
- Division of Cardiothoracic Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong SAR, China
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Al-Shibli K, Al-Saad S, Donnem T, Persson M, Bremnes RM, Busund LT. The prognostic value of intraepithelial and stromal innate immune system cells in non-small cell lung carcinoma. Histopathology 2009; 55:301-12. [PMID: 19723145 DOI: 10.1111/j.1365-2559.2009.03379.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS The major value of prognostic markers in potentially curable non-small cell lung carcinoma (NSCLC) should be to guide therapy after surgical resection. The prognostic significance of tumour-infiltrating macrophages, their growth factor, macrophage colony-stimulating factor (M-CSF), and its receptor, colony-stimulating factor-1 receptor (CSF-1R), as well as natural killer cells and dendritic cells, is controversial. The aim of this study was to elucidate the prognostic significance of these markers in the epithelial and stromal compartments of NSCLC. METHODS AND RESULTS Tissue microarrays from 335 resected NSCLC, stage I-IIIA were constructed from duplicate cores of epithelial and stromal areas. Immunohistochemistry was used to evaluate epithelial and stromal areas for CD68, M-CSF, CSF-1R, CD56 and CD1a. On univariate analysis, increasing numbers of stromal CD1a+ (P = 0.011) and CD56+ cells (P = 0.014) correlated significantly with improved disease-specific survival (DSS). On multivariate analysis, stromal CD56+ cells were an independent prognostic factor for DSS (hazard ratio = 2.3, confidence interval = 1.1, 5.0, P = 0.031). CONCLUSIONS High density of stromal CD56+ cells is an independent factor associated with improved prognosis in resected NSCLC, suggesting that these cells mediate an antitumour immune response in the tumour stroma.
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Affiliation(s)
- Khalid Al-Shibli
- Department of Pathology, Nordland Central Hospital, Bodo 8092, Norway.
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28
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Loscertales J, Jimenez-Merchan R, Congregado M, Ayarra FJ, Gallardo G, Triviño A. Video-assisted surgery for lung cancer. State of the art and personal experience. Asian Cardiovasc Thorac Ann 2009; 17:313-26. [PMID: 19643863 DOI: 10.1177/0218492309104747] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper reviews the role of videothoracoscopy in lung cancer, highlighting its utility in definitive staging, diagnosis, and treatment. We show exploratory videothoracoscopy to be the perfect technique for last-minute staging, looking for tumor invasion, especially parietal T3 and vascular T4 (due to videopericardioscopy), management of solitary pulmonary nodules, and the possibility of radical treatment with video-assisted thoracoscopic lobectomy. We perform an overview of the literature and analyze our experience of 1,381 patients with lung cancer. In 1,277 of them, the final decision on resectability was made by exploratory videothoracoscopy, including 91 by videopericardioscopy (only 30 were considered non-resectable on videopericardioscopy). Solitary pulmonary nodules were diagnosed in 382 cases (190 were cancer), and we performed 260 major lung resections by video-assisted thoracoscopic surgery (22 pneumonectomies, 238 lobectomies/bilobectomies).
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Affiliation(s)
- Jesus Loscertales
- General and Thoracic Surgery Department, Virgen Macarena University Hospital, 41007 Seville, Spain.
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29
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Gallardo-Valera G, Triviño-Ramírez A, Congregado M, Jiménez-Merchán R, Ayarra Jarné FJ, Loscertales J. Utilidad de la videotoracoscopia para una correcta estadificación de tumores T3 por invasión de pared. Arch Bronconeumol 2009; 45:325-9. [DOI: 10.1016/j.arbres.2009.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 02/25/2009] [Accepted: 03/18/2009] [Indexed: 12/25/2022]
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Establishment of a multi-analyte serum biomarker panel to identify lymph node metastases in non-small cell lung cancer. J Thorac Oncol 2009; 4:338-47. [PMID: 19190517 DOI: 10.1097/jto.0b013e3181982abf] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In non-small cell lung cancer (NSCLC), the presence of locoregional lymph node metastases remains the most important prognostic factor and significantly guides treatment regimens. Unfortunately, currently-available noninvasive staging modalities have limited accuracy. The objective of this study was to create a multianalyte blood test capable of discriminating a patient's true (pathologic) nodal status preoperatively. METHODS Pretreatment serum specimens collected from 107 NSCLC patients with localized disease were screened with 47 biomarkers implicated in disease presence or progression. Multivariate statistical algorithms were then used to identify the optimal combination of biomarkers for accurately discerning each patient's nodal status. RESULTS We identified 15 candidate biomarkers that met our criteria for statistical relevance in discerning a patient's preoperative nodal status. A 'random forest' classification algorithm was used with these parameters to define a 6-analyte panel, consisting of macrophage inflammatory protein-1alpha, carcinoembryonic antigen, stem cell factor, tumor necrosis factor-receptor I, interferon-gamma, and tumor necrosis factor-alpha, that was the optimum combination of biomarkers for identifying a patient's pathologic nodal status. A Classification and Regression Tree analysis was then created with this panel that was capable of correctly classifying 88% of the patients tested, relative to the pathologic assessments. This value is in contrast to our observed 85% classification rate using conventional clinical methods. CONCLUSIONS This study establishes a serum biomarker panel with efficacy in discerning preoperative nodal status. With further validation, this blood test may be useful for assessing nodal status (including occult disease) in NSCLC patients facing tumor resection therapy.
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Gibbs JD, Graham MW, Higgins WE. 3D MDCT-based system for planning peripheral bronchoscopic procedures. Comput Biol Med 2009; 39:266-79. [PMID: 19217089 DOI: 10.1016/j.compbiomed.2008.12.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 12/13/2008] [Accepted: 12/23/2008] [Indexed: 11/17/2022]
Abstract
The diagnosis and staging of lung cancer often begins with the assessment of a suspect peripheral chest site. Such suspicious peripheral sites may be solitary pulmonary nodules or other abnormally appearing regions of interest (ROIs). The state-of-the-art process for assessing such peripheral ROIs involves off-line procedure planning using a three-dimensional (3D) multidetector computed tomography (MDCT) chest scan followed by bronchoscopy with an ultrathin bronchoscope. We present an integrated computer-based system for planning peripheral bronchoscopic procedures. The system takes a 3D MDCT chest image as input and performs nearly all operations automatically. The only interaction required by the physician is the selection of ROI locations. The system is computationally efficient and fits smoothly within the clinical work flow. Integrated into the system and described in detail in the paper is a new surface-definition method, which is vital for effective analysis and planning to peripheral sites. Results demonstrate the efficacy of the system and its usage for the live guidance of ultrathin bronchoscopy to the periphery.
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Affiliation(s)
- Jason D Gibbs
- Department of Electrical Engineering, Penn State University, University Park, PA 16802, USA
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32
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Yu KC, Gibbs JD, Graham MW, Higgins WE. Image-based reporting for bronchoscopy. J Digit Imaging 2008; 23:39-50. [PMID: 19050956 DOI: 10.1007/s10278-008-9170-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 10/12/2008] [Accepted: 10/26/2008] [Indexed: 11/30/2022] Open
Abstract
Bronchoscopy is often performed for staging lung cancer. The recent development of multidetector computed tomography (MDCT) scanners and ultrathin bronchoscopes now enable the bronchoscopic biopsy and treatment of peripheral diagnostic regions of interest (ROIs). Because these ROIs are often located several generations within the airway tree, careful planning and interpretation of the bronchoscopic route is required prior to a procedure. The current practice for planning bronchoscopic procedures, however, is difficult, error prone, and time consuming. To alleviate these issues, we propose a method for producing and previewing reports for bronchoscopic procedures using patient-specific MDCT chest scans. The reports provide quantitative data about the bronchoscopic routes and both static and dynamic previews of the proper airway route. The previews consist of virtual bronchoscopic endoluminal renderings along the route and three-dimensional cues for a final biopsy site. The reports require little storage space and computational resources, enabling physicians to view the reports on a portable tablet PC. To evaluate the efficacy of the reporting system, we have generated reports for 22 patients in a human lung cancer patient pilot study. For 17 of these patients, we used the reports in conjunction with live image-based bronchoscopic guidance to direct physicians to central chest and peripheral ROIs for subsequent diagnostic evaluation. Our experience shows that the tool enabled useful procedure preview and an effective means for planning strategy prior to a live bronchoscopy.
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Affiliation(s)
- Kun-Chang Yu
- Endographics Imaging Systems, State College, PA 16801, USA
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Al-Shibli KI, Donnem T, Al-Saad S, Persson M, Bremnes RM, Busund LT. Prognostic effect of epithelial and stromal lymphocyte infiltration in non-small cell lung cancer. Clin Cancer Res 2008; 14:5220-7. [PMID: 18698040 DOI: 10.1158/1078-0432.ccr-08-0133] [Citation(s) in RCA: 461] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The major value of prognostic markers in potentially curable non-small cell lung cancer (NSCLC) should be to guide therapy after surgical resection. In this regard, the patients' immune status at the time of resection may be important and also measurable. The immune system has paradoxical roles during cancer development. However, the prognostic significance of tumor-infiltrating lymphocytes is controversial. The aim of this study is to elucidate the prognostic significance of epithelial and stromal lymphocyte infiltration in NSCLC. EXPERIMENTAL DESIGN Tissue microarrays from 335 resected NSCLC, stage I to IIIA were constructed from duplicate cores of viable and representative neoplastic epithelial and stromal areas. Immunohistochemistry was used to evaluate the epithelial and stromal CD4+, CD8+, and CD20+ lymphocytes. RESULTS In univariate analyses, increasing numbers of epithelial CD8+ (P = 0.023), stromal CD8+ (P = 0.002), epithelial CD20+ (P = 0.023), stromal CD20+ (P < 0.001), and stromal CD4+ (P < 0.001) lymphocytes correlated significantly with an improved disease-specific survival. No such relation was noted for epithelial CD4+ cells. Furthermore, a low level of stromal CD8+ lymphocyte infiltration was associated with an increased incidence of angiolymphatic invasion (P = 0.032). In multivariate analyses, a high number of stromal CD8+ (P = 0.043) and CD4+ (P = 0.002) cells were independent positive prognostic factors for disease-specific survival. CONCLUSIONS High densities of CD4+ and CD8+ lymphocytes in the stroma are independent positive prognostic indicators for resected NSCLC patients. This may suggest that these cells are mediating a strong antitumor immune response in NSCLC.
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Anisowicz A, Huang H, Braunschweiger KI, Liu Z, Giese H, Wang H, Mamaev S, Olejnik J, Massion PP, Del Mastro RG. A high-throughput and sensitive method to measure global DNA methylation: application in lung cancer. BMC Cancer 2008; 8:222. [PMID: 18673580 PMCID: PMC2546425 DOI: 10.1186/1471-2407-8-222] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Accepted: 08/03/2008] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Genome-wide changes in DNA methylation are an epigenetic phenomenon that can lead to the development of disease. The study of global DNA methylation utilizes technology that requires both expensive equipment and highly specialized skill sets. METHODS We have designed and developed an assay, CpGlobal, which is easy-to-use, does not utilize PCR, radioactivity and expensive equipment. CpGlobal utilizes methyl-sensitive restriction enzymes, HRP Neutravidin to detect the biotinylated nucleotides incorporated in an end-fill reaction and a luminometer to measure the chemiluminescence. The assay shows high accuracy and reproducibility in measuring global DNA methylation. Furthermore, CpGlobal correlates significantly with High Performance Capillary Electrophoresis (HPCE), a gold standard technology. We have applied the technology to understand the role of global DNA methylation in the natural history of lung cancer. World-wide, it is the leading cause of death attributed to any cancer. The survival rate is 15% over 5 years due to the lack of any clinical symptoms until the disease has progressed to a stage where cure is limited. RESULTS Through the use of cell lines and paired normal/tumor samples from patients with non-small cell lung cancer (NSCLC) we show that global DNA hypomethylation is highly associated with the progression of the tumor. In addition, the results provide the first indication that the normal part of the lung from a cancer patient has already experienced a loss of methylation compared to a normal individual. CONCLUSION By detecting these changes in global DNA methylation, CpGlobal may have a role as a barometer for the onset and development of lung cancer.
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Affiliation(s)
- Anthony Anisowicz
- Molecular Therapeutics Division, AmberGen Incorporated, Waltham, Massachusetts, USA
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Rai L, Helferty JP, Higgins WE. Combined video tracking and image-video registration for continuous bronchoscopic guidance. Int J Comput Assist Radiol Surg 2008. [DOI: 10.1007/s11548-008-0241-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Lymph Nodes in the Radiologically and Positron Emission Tomography-Normal Mediastinum in Patients With Lung Cancer. Chest 2008; 133:887-91. [DOI: 10.1378/chest.07-2535] [Citation(s) in RCA: 276] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Higgins WE, Helferty JP, Lu K, Merritt SA, Rai L, Yu KC. 3D CT-video fusion for image-guided bronchoscopy. Comput Med Imaging Graph 2007; 32:159-73. [PMID: 18096365 DOI: 10.1016/j.compmedimag.2007.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 10/01/2007] [Accepted: 11/01/2007] [Indexed: 12/18/2022]
Abstract
Bronchoscopic biopsy of the central-chest lymph nodes is an important step for lung-cancer staging. Before bronchoscopy, the physician first visually assesses a patient's three-dimensional (3D) computed tomography (CT) chest scan to identify suspect lymph-node sites. Next, during bronchoscopy, the physician guides the bronchoscope to each desired lymph-node site. Unfortunately, the physician has no link between the 3D CT image data and the live video stream provided during bronchoscopy. Thus, the physician must essentially perform biopsy blindly, and the skill levels between different physicians differ greatly. We describe an approach that enables synergistic fusion between the 3D CT data and the bronchoscopic video. Both the integrated planning and guidance system and the internal CT-video registration and fusion methods are described. Phantom, animal, and human studies illustrate the efficacy of the methods.
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Affiliation(s)
- William E Higgins
- Department of Electrical Engineering, Penn State University, University Park, PA 16802, United States.
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Interactive segmentation based on the live wire for 3D CT chest image analysis. Int J Comput Assist Radiol Surg 2007. [DOI: 10.1007/s11548-007-0129-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Helferty J, Sherbondy A, Kiraly A, Higgins W. Computer-based System for the Virtual-Endoscopic Guidance of Bronchoscopy. COMPUTER VISION AND IMAGE UNDERSTANDING : CVIU 2007; 108:171-187. [PMID: 18978928 PMCID: PMC2131713 DOI: 10.1016/j.cviu.2006.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The standard procedure for diagnosing lung cancer involves two stages: three-dimensional (3D) computed-tomography (CT) image assessment, followed by interventional bronchoscopy. In general, the physician has no link between the 3D CT image assessment results and the follow-on bronchoscopy. Thus, the physician essentially performs bronchoscopic biopsy of suspect cancer sites blindly. We have devised a computer-based system that greatly augments the physician's vision during bronchoscopy. The system uses techniques from computer graphics and computer vision to enable detailed 3D CT procedure planning and follow-on image-guided bronchoscopy. The procedure plan is directly linked to the bronchoscope procedure, through a live registration and fusion of the 3D CT data and bronchoscopic video. During a procedure, the system provides many visual tools, fused CT-video data, and quantitative distance measures; this gives the physician considerable visual feedback on how to maneuver the bronchoscope and where to insert the biopsy needle. Central to the system is a CT-video registration technique, based on normalized mutual information. Several sets of results verify the efficacy of the registration technique. In addition, we present a series of test results for the complete system for phantoms, animals, and human lung-cancer patients. The results indicate that not only is the variation in skill level between different physicians greatly reduced by the system over the standard procedure, but that biopsy effectiveness increases.
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Affiliation(s)
| | | | - A.P. Kiraly
- Siemens Corporate Research Center, Princeton, NJ
| | - W.E. Higgins
- Dept. of Electrical Engineering, Penn State University, University Park, PA 16802 USA
- *Corresponding author. Fax: 1-814-863-5341., email address: (W.E. Higgins)
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Indications and Developments of Video‐Assisted Thoracic Surgery in the Treatment of Lung Cancer. Oncologist 2007; 12:1205-14. [DOI: 10.1634/theoncologist.12-10-1205] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
PURPOSE OF REVIEW The aim of this review is to analyze recent evidence for optimal treatment of elderly patients with non-small cell lung cancer, focusing on surgery, and possibly to foresee the future strategies to apply in these patients. RECENT FINDINGS Surgery in elderly patients affected by non-small cell lung cancer is safe and feasible when careful preoperative respiratory and cardiac studies have been carried out and the disease has been properly staged. The surgical treatment is not to be denied in elderly patients due to age per se, but when a major contraindication to surgery has been recognized. Long term survival for elderly patients with early stage lung cancer treated by anatomical pulmonary resection is comparable to the survival rate of younger patients. Pneumonectomy, extended surgical procedure or preoperative induction chemotherapy are major risk factors for an increased postoperative morbidity and mortality rate. When co-morbidities are present or a patient is 80 years or older, there is evidence that a non-anatomical resection can be performed without affecting long-term results. SUMMARY Due to the aging of the general population, elderly patients will become a large percentage of the cases of non-small cell lung cancer to be treated. Implementing preoperative cardiologic studies and redefining selective respiratory criteria specifically could dramatically improve results.
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Affiliation(s)
- Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
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Herth FJF, Eberhardt R. Actual role of endobronchial ultrasound (EBUS). Eur Radiol 2007; 17:1806-12. [PMID: 17206430 DOI: 10.1007/s00330-006-0497-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Revised: 08/31/2006] [Accepted: 10/02/2006] [Indexed: 12/25/2022]
Abstract
Many pathologies of the airway involve the bronchial wall and the parabronchial structures. The view of the endoscopist, however, is limited to the lumen and the internal surface of the airway. Processes within the airway wall and outside the airway can only be assessed by indirect signs. Especially in malignancies, this can be of decisive importance for the fate of the patient. Therefore, expanding the endoscopist's view beyond the airway is essential. Endobronchial ultrasound (EBUS) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) are new diagnostic tools that are available on the market. They have great potential for diagnosis of mediastinal processes and staging of lung cancer. After discovering a lung cancer without extrathoracic metastases, the preoperative mediastinal check-up is of great importance in determining operability. The investigation of a suspected malignant adenopathy justifies a complete examination by mediastinoscopy or mediastinotomy, which are considered gold standards. EBUS-TBNA constitutes the recent evolution of TBNA, a method known for 20 years now but underused. The aim of this review is to highlight to the different techniques and to discuss the results of published trials.
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Affiliation(s)
- Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany.
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Herth FJF, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax 2006; 61:795-8. [PMID: 16738038 PMCID: PMC2117082 DOI: 10.1136/thx.2005.047829] [Citation(s) in RCA: 370] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transbronchial needle aspiration (TBNA) is an established method for sampling mediastinal lymph nodes to aid in diagnosing lymphadenopathy and in staging lung cancers. Real-time endobronchial ultrasound (EBUS) guidance is a new method of TBNA that may increase the ability to sample these nodes and hence to determine a diagnosis. A descriptive study was conducted to test this new method. METHODS Consecutive patients referred for TBNA of mediastinal lymph nodes were included in the trial. When a node was detected, a puncture was performed under real-time ultrasound control. The primary end point was the number of successful biopsy specimens. Diagnostic results from the biopsies were compared with operative findings. Lymph node stations were classified according to the recently adopted American Thoracic Society scheme. RESULTS From 502 patients (316 men) of mean age 59 years (range 24-82), 572 lymph nodes were punctured and 535 (94%) resulted in a diagnosis. Biopsy specimens were taken from lymph nodes in region 2L (40 nodes), 2R (53 nodes), 3 (35 nodes), 4R (86 nodes), 4L (77 nodes), 7 (127 nodes), 10R (38 nodes), 10L (43 nodes), 11R (40 nodes) and 11L (33 nodes). The mean (SD) diameter of the nodes was 1.6 (0.36) cm and the range was 0.8-3.2 cm (SD range 0.8-4.3). Sensitivity was 94%, specificity 100%, and the positive predictive value was 100% calculated per patient. No complications occurred. CONCLUSION EBUS-TBNA is a promising new method for sampling mediastinal lymph nodes. It appears to permit more and smaller nodes to be sampled than conventional TBNA, and it is safe.
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Affiliation(s)
- F J F Herth
- Department of Internal Medicine, Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Germany.
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Abstract
CONTEXT Tumor stage is the most important prognostic and predictive factor for patients with lung cancer, the most lethal neoplasm in the United States. It is used by thoracic surgeons, radiation therapists, and oncologists to determine whether patients with these neoplasms will be treated surgically with curative intent or with palliative radiation therapy and/or chemotherapy. OBJECTIVE To review the variety of practical problems that can arise during the assessment of the pathologic stage and other prognostic/predictive factors included in the College of American Pathologist checklist for evaluation of resected lung neoplasms. DATA SOURCES Potential practical difficulties that can arise during the pathologic staging of lung cancer patients include the distinction between pT1, pT2, and pT3 lesions based on their location and the presence of visceral pleura and/or parietal pleura invasion; the differential diagnosis between multiple synchronous or metachronous primary lung neoplasms (pT1m) and intrapulmonary metastasis of non-small cell carcinoma of the lung (pT4 or pM1 according to their location); and the role of the recent American Joint Committee on Cancer terminology for the classification of lymph nodes (isolated tumor cells, micrometastases, and metastases). CONCLUSIONS The variety of practical problems that can arise during the assessment of important prognostic and predictive features such as resection margin status and evaluation of lymphovascular invasion are reviewed. A brief discussion of the assessment of the effects of neoadjuvant therapy on resected lung neoplasms is also included.
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Affiliation(s)
- Alberto M Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
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Renyi-Vamos F, Tovari J, Fillinger J, Timar J, Paku S, Kenessey I, Ostoros G, Agocs L, Soltesz I, Dome B. Lymphangiogenesis correlates with lymph node metastasis, prognosis, and angiogenic phenotype in human non-small cell lung cancer. Clin Cancer Res 2006; 11:7344-53. [PMID: 16243806 DOI: 10.1158/1078-0432.ccr-05-1077] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Recent experimental studies have revealed that lymphangiogenesis plays an important role in cancer progression, but its clinical significance in the case of non-small cell lung cancer (NSCLC) remains unclear. Our aim was to assess the lymphangiogenesis of human NSCLC, and to correlate this with angiogenic phenotype (angiogenic versus nonangiogenic growth pattern) and clinical behavior. EXPERIMENTAL DESIGN One hundred and three patients with NSCLC and complete follow-up information were included. Tumor samples were immunostained for vascular endothelial growth factor-C (VEGF-C), the lymphatic endothelial markers, LYVE-1 and D2-40/Podoplanin, and the panvascular marker, CD31. Lymphatic vessel density (LVD) and perimeters were evaluated within the tumor and peritumorally. RESULTS LVDs at the tumor periphery were significantly higher in lymph node metastatic tumors (P < 0.005) and high LVDs correlated with poor overall survival (P < 0.001). However, this tendency proved to be significant only in the angiogenic tumor group (P < 0.001). Although 68% of the patients with nonangiogenic tumors had lymph node metastasis (P = 0.0048 versus angiogenic tumors), in the patient group with nonangiogenic NSCLCs, there was no information from the LVDs in any investigated tumor area (P > 0.05). In contrast to angiogenic tumors, which had actively sprouting lymphatics in all of the investigated tumor areas, nonangiogenic tumors showed no Ki67 staining intratumorally. CONCLUSIONS Our results reveal tumor lymphangiogenesis as a novel prognostic indicator for the risk of lymph node metastasis in NSCLC. Moreover, it also provides the first evidence that nonangiogenic NSCLCs mainly co-opt host tissue lymphatics during their growth, in contrast to most of the angiogenic tumors, which expand with concomitant lymphangiogenesis.
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Affiliation(s)
- Ferenc Renyi-Vamos
- Department of Tumor Biology, National Koranyi Institute of Pulmonology, Budapest, Hungary
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Luh SP, Liu HP. Video-assisted thoracic surgery--the past, present status and the future. J Zhejiang Univ Sci B 2006; 7:118-28. [PMID: 16421967 PMCID: PMC1363755 DOI: 10.1631/jzus.2006.b0118] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Accepted: 12/07/2005] [Indexed: 12/20/2022]
Abstract
Video-assisted thoracic surgery (VATS) has developed very rapidly in these two decades, and has replaced conventional open thoracotomy as a standard procedure for some simple thoracic operations as well as an option or a complementary procedure for some other more complex operations. In this paper we will review its development history, the present status and the future perspectives.
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Affiliation(s)
- Shi-ping Luh
- Department of Cardiothoracic Surgery, Taipei Tzu-Chi Medical University Hospital, Taiwan 231, China.
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Ross P, Grecula J, Bekaii-Saab T, Villalona-Calero M, Otterson G, Magro C. Incorporation of photodynamic therapy as an induction modality in non-small cell lung cancer. Lasers Surg Med 2006; 38:881-9. [PMID: 17115382 DOI: 10.1002/lsm.20444] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Incorporation of photodynamic therapy (PDT) into the induction therapy regimen utilized for treatment of locally advanced primary non-small cell bronchogenic carcinoma (NSCLC) is explored. STUDY DESIGN/MATERIALS AND METHODS We present a retrospective review of 41 patients diagnosed with non-metastatic NSCLC who underwent induction PDT with chemotherapy and/or radiation. RESULTS Fifty percent of patients initially deemed unresectable, were able to undergo definitive surgical resection after trimodality induction therapy. Twenty-seven percent of patients considered to require pneumonectomy were able to have a lobectomy. The pathological stage was less than the preinduction clinical stage in 14 of 22 cases; of which four patients had no residual tumor. There was no 30/90-day postoperative mortality. Mean survival was 35.9 months (lobectomy), 25.5 months (pneumonectomy) and 14.7 months (no surgery). Median survival was 78% (12 months) and 46% (36 months). The main postoperative complication following pneumonectomy was bronchopleural fistula formation. All patients who developed this complication had undergone trimodality induction therapy. Incorporation of PDT into the induction arsenal for patients with loco-regionally advanced NSCLC may be safely performed. CONCLUSIONS PDT may define an alternative induction strategy for patients requiring pneumonectomy; further studies exploring the true efficacy of PDT as an induction modality are encouraged.
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Affiliation(s)
- Patrick Ross
- The Ohio State University Medical Center, Division of Cardiothoracic Surgery, Columbus, Ohio, USA
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Lathan CS, Neville BA, Earle CC. The effect of race on invasive staging and surgery in non-small-cell lung cancer. J Clin Oncol 2005; 24:413-8. [PMID: 16365180 DOI: 10.1200/jco.2005.02.1758] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Black patients with early-stage non-small-cell lung cancer (NSCLC) have worse overall survival than white patients. Decreased likelihood of resection has been implicated. To isolate the effect of decision making from access to care, we used receipt of surgical staging as a proxy for access and willingness to undergo invasive procedures, and examined treatments and outcomes by race. PATIENTS AND METHODS We examined registry and claims data of Medicare-eligible patients with nonmetastatic NSCLC in areas monitored by the Surveillance, Epidemiology, and End Results program from 1991 to 2001. Patients who obtained invasive staging, defined as bronchoscopy, mediastinoscopy, or thoracoscopy, were included. Logistic regression and Cox modeling calculated the odds of having staging and surgery, and survival outcomes. RESULTS A total of 14,224 patients underwent staging, and 6,972 had surgery for lung cancer. Black patients were less likely to undergo staging (odds ratio [OR] = 0.75; 95% CI, 0.67 to 0.83), and once staged, were still less likely to have surgery than whites (OR = 0.55; 95% CI, 0.47 to 0.64). Survival for blacks and whites was equivalent after resection (hazard ratio = 1.02; P = .06). Staged black patients were less likely to receive a recommendation for surgery when it was not clearly contraindicated (67.0% v 71.4%; P < .05), and were more likely to decline surgery (3.4% v 2.0%; P < .05). CONCLUSION Black patients obtain surgery for lung cancer less often than whites, even after access to care has been demonstrated. They are more likely not to have surgery recommended, and more likely to refuse surgery. Additional research should focus on the physician-patient encounter as a potential source of racial disparities.
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Affiliation(s)
- Christopher S Lathan
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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Kim HW, Sim SB, Kim CK, Kim J, Choi C, You H, Soh KS. Spontaneous photon emission and delayed luminescence of two types of human lung cancer tissues: adenocarcinoma and squamous cell carcinoma. Cancer Lett 2005; 229:283-9. [PMID: 16111805 DOI: 10.1016/j.canlet.2005.04.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Accepted: 04/29/2005] [Indexed: 11/17/2022]
Abstract
We measured spontaneous photon emission and delayed luminescence from human cancerous lung tissue and compared with those from adjacent normal lung tissue. For the detection of extremely weak photon emission from tissue we used a sensitive photomultiplier tube attached to a dark chamber. The samples were illuminated with a metal halide lamp for measurement of delayed luminescence. Extracted samples from surgery were measured within an hour. We found that the delayed luminescence showed salient aspects in making discrimination between tumor and adjacent normal tissue. Squamous cell carcinoma had more prominent character in delayed luminescence than adenocarcinoma.
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Affiliation(s)
- Hwan-Wook Kim
- Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea, Seoul 137-701, South Korea
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