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Wang J, Wu N, Lv C, Yang Y. External validation of the eighth edition of the TNM classification for lung cancer in 3,611 surgically treated patients at a single institution. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:122. [PMID: 32175415 PMCID: PMC7049062 DOI: 10.21037/atm.2020.01.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/14/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND A new revision of the tumor, node, metastasis (TNM) classification for lung cancer has been proposed by the International Association for the Study of Lung Cancer (IASLC), but external validation for it is required. This study aimed to evaluate stage groupings in the 8th edition of the TNM classification in an independent Chinese cohort. METHODS We retrospectively analyzed 3,611 patients who were diagnosed as stage I to IV non-small cell lung cancer (NSCLC) and who received surgical treatment at our institute in China between October 2009 and August 2017. Long-rank tests were used to compare survival between two adjacent stage groups. RESULTS Based on the 8th edition of the TNM classification, differences between every 2 adjacent stage groups were found to be significant except between Ia1 and Ia2 (P=0.062), and between IIIc and IVa (P=0.063). Significant differences were found between every 2 adjacent categories stratified by the T and N descriptors. Additionally, significant differences were found between M0 and M1a (P<0.001), while no significant difference was observed between M1a and M1b (P=0.092). CONCLUSIONS Our study provides an external validation of the stage groupings in the 8th edition of the TNM staging system in surgically treated Chinese patients with NSCLC.
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Affiliation(s)
- Jia Wang
- Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Nan Wu
- Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Chao Lv
- Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yue Yang
- Department of Thoracic Surgery II, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Hassani C, Saremi F. Comprehensive Cross-sectional Imaging of the Pulmonary Veins. Radiographics 2018; 37:1928-1954. [PMID: 29131765 DOI: 10.1148/rg.2017170050] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The pulmonary veins carry oxygenated blood from the lungs to the heart, but their importance to the radiologist extends far beyond this seemingly straightforward function. The anatomy of the pulmonary veins is variable among patients, with several noteworthy variant and anomalous patterns, including supernumerary pulmonary veins, a common ostium, anomalous pulmonary venous return, and levoatriocardinal veins. Differences in pulmonary vein anatomy and the presence of variant or anomalous anatomy can be of critical importance, especially for preoperative planning of pulmonary and cardiac surgery. The enhancement or lack of enhancement of the pulmonary veins can be a clue to clinically important disease, and the relationship of masses to the pulmonary veins can herald cardiac invasion. The pulmonary veins are also an integral part of thoracic interventions, including lung transplantation, pneumonectomy, and radiofrequency ablation for atrial fibrillation. This fact creates a requirement for radiologists to have knowledge of the pre- and postoperative imaging appearances of the pulmonary veins. Many of these procedures are associated with important potential complications involving the pulmonary veins, for which diagnostic imaging plays a critical role. A thorough knowledge of the pulmonary veins and a proper radiologic approach to their evaluation is critical for the busy radiologist who must incorporate the pulmonary veins into a routine "search pattern" at computed tomography (CT) and magnetic resonance imaging. This article is a comprehensive CT-based imaging review of the pulmonary veins, including their embryology, anatomy (typical and anomalous), surgical implications, pulmonary vein thrombosis, pulmonary vein stenosis, pulmonary vein pseudostenosis, and the relationship of tumors to the pulmonary veins. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Cameron Hassani
- From the Department of Radiology, Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Farhood Saremi
- From the Department of Radiology, Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
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Mandegaran R, David S, Screaton N. Cardiothoracic manifestations of neuroendocrine tumours. Br J Radiol 2016; 89:20150787. [PMID: 26781701 DOI: 10.1259/bjr.20150787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cardiothoracic neuroendocrine tumour (NET) manifestations encompass a vast disease spectrum. Pulmonary neuroendocrine tumours represent a range of tumour grade and differentiation characteristics from pre-malignant diffuse neuroendocrine cell hyperplasia, well-differentiated, low-grade carcinoid tumours with excellent outcomes, through to high-grade small-cell lung carcinoma and large-cell neuroendocrine carcinoma with poor prognoses. Rarer thymic NETs represent a similarly wide neoplastic spectrum. Cardiac carcinoid is a paraneoplastic manifestation of the carcinoid syndrome and often the cause of mortality in NETs with hepatic metastases. Cardiothoracic NET manifestations are reviewed herein from a radiologists' perspective, discussing the diverse clinical presentations, spectrum of neoplastic and paraneoplastic manifestations, imaging features and treatment options.
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Affiliation(s)
- Ramin Mandegaran
- 1 Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarojini David
- 2 Department of Radiology, University Hospital of Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Nicholas Screaton
- 3 Department of Radiology, Papworth Hospital NHS Foundation Trust, Papworth Everard Hospital, Cambridge, UK
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Aerogenous metastases: a potential game changer in the diagnosis and management of primary lung adenocarcinoma. AJR Am J Roentgenol 2015; 203:W570-82. [PMID: 25415722 DOI: 10.2214/ajr.13.12088] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purposes of this article are to summarize the relevant literature on aerogenous metastasis, explain the putative pathogenetic mechanism of aerogenous spread, present the characteristic imaging and pathologic features, and review the importance of aerogenous spread to staging and clinical management. CONCLUSION Cumulative evidence suggests that aerogenous spread may exist and is underrecognized. Imaging features are helpful in differentiating possible aerogenous spread of tumor from hematogenous and lymphatic metastases and from synchronous primary tumors. The putative occurrence of intrapulmonary aerogenous metastasis of lung cancer has staging, management, and prognostic implications.
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Kinsey CM, Estepar RSJ, Zhao Y, Yu X, Diao N, Heist RS, Wain JC, Mark EJ, Washko G, Christiani DC. Invasive adenocarcinoma of the lung is associated with the upper lung regions. Lung Cancer 2014; 84:145-50. [PMID: 24598367 PMCID: PMC4004700 DOI: 10.1016/j.lungcan.2014.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/03/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVES We postulated that ventilation-perfusion (V/Q) relationships within the lung might influence where lung cancer occurs. To address this hypothesis we evaluated the location of lung adenocarcinoma, by both tumor lobe and superior-inferior regional distribution, and associated variables such as emphysema. MATERIALS AND METHODS One hundred fifty-nine cases of invasive adenocarcinoma and adenocarcinoma with lepidic features were visually evaluated to identify lobar or regional tumor location. Regions were determined by automated division of the lungs into three equal volumes: (upper region, middle region, or lower region). Automated densitometry was used to measure radiographic emphysema. RESULTS The majority of invasive adenocarcinomas occurred in the upper lobes (69%), with 94% of upper lobe adenocarcinomas occurring in the upper region of the lung. The distribution of adenocarcinoma, when classified as upper or lower lobe, was not different between invasive adenocarcinoma and adenocarcinoma with lepidic features (formerly bronchioloalveolar cell carcinoma, P = 0.08). Regional distribution of tumor was significantly different between invasive adenocarcinoma and adenocarcinoma with lepidic features (P = 0.001). Logistic regression analysis with the outcome of invasive adenocarcinoma histology was used to adjust for confounders. Tumor region continued to be a significant predictor (OR 8.5, P = 0.008, compared to lower region), whereas lobar location of tumor was not (P = 0.09). In stratified analysis, smoking was not associated with region of invasive adenocarcinoma occurrence (P = 0.089). There was no difference in total emphysema scores between invasive adenocarcinoma cases occurring in each of the three regions (P = 0.155). There was also no difference in the distribution of region of adenocarcinoma occurrence between quartiles of emphysema (P = 0.217). CONCLUSION Invasive adenocarcinoma of the lung is highly associated with the upper lung regions. This association is not related to smoking, history of COPD, or total emphysema. The regional distribution of invasive adenocarcinoma may be due to V/Q relationships or other local factors.
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Affiliation(s)
- C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington VT 05405, United States
| | - Raul San Jose Estepar
- Department of Environmental Health and Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, United States; Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Nancy Diao
- Department of Environmental Health and Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, United States
| | - Rebecca Suk Heist
- Division of Hematology and Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - John C Wain
- Division of Thoracic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Eugene J Mark
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - George Washko
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States
| | - David C Christiani
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Departments of Environmental Health and Epidemiology, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115, United States.
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