1
|
Wang G, Jin Y, Xiong K, Jin X, Wang L, Li C. Utility of auto fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions. Photodiagnosis Photodyn Ther 2024; 46:104057. [PMID: 38508439 DOI: 10.1016/j.pdpdt.2024.104057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Bronchoscopy is currently the most common technique for lung cancer diagnosis. Patients suspected of malignancy often undergo bronchoscopic examination, and biopsy is routinely used in patients with visible bronchial lesions. However, it is difficult to differentially diagnose lung cancer in patients with bronchial mucosal lesions. Thus, this study was conducted to investigate the utility of fluorescence-guided biopsy in suspected lung cancer patients with bronchial mucosal lesions. METHODS We conducted a retrospective study in a single screening center to assess the sensitivity and specificity of fluorescence-guided biopsy compared with white light bronchoscopy (WLB) in patients with bronchial mucosal lesions. RESULTS A total of 301 patients with bronchial mucosal lesions were enrolled in this study. The sensitivity for patients with fluorescence-guided biopsy was 60.3 % (95 % confidence interval [CI]: 53.1 %-67.1 %), which was higher than that of patients with WLB alone (45.2 %, 95 % CI: 38.2-52.4 %) (P = 0.0026). Additionally, compared with the WLB group, the fluorescence -guided biopsy group was found to have a significantly higher specificity (100 %, 95 % CI: 95.5-100 % versus 69.6 %, 95 % CI: 59.6-78.1 %), positive predictive value (100 %, 95 % CI: 96.1-100 % versus 74.3 %, 95 % CI: 65.5-81.7 %) and negative predictive value (56.3 %, 95 % CI: 48.8-63.6 % versus 39.4 %, 95 % CI: 32.3-47.0 %). CONCLUSION Fluorescence-guided biopsy can serve as an important adjunct to WLB for the differential diagnosis of lung cancer in patients with bronchial mucosal lesions.
Collapse
Affiliation(s)
- Gaozhe Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China; School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yan Jin
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Kunlong Xiong
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Xiaoyan Jin
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Linfeng Wang
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, China.
| | - Chenwei Li
- Department of Cerebral Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, China.
| |
Collapse
|
2
|
Teng F, Xu J, Wang J, Yang B, Wu YZ, Jiang YQ, Wang ZQ. Correlation between gene mutation status and clinicopathologic features in early multiple primary lung cancer. Front Oncol 2023; 13:1110259. [PMID: 37124493 PMCID: PMC10130385 DOI: 10.3389/fonc.2023.1110259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Objective To understand the characteristics of genetic mutation in multiple primary lung cancer so as to guide clinical decisions in targeted therapy. Methods We analyzed a total of 265 tumors from 111 patients who underwent surgery for multiple lung cancers. Individual tumors were subjected to histological evaluation and gene mutation analysis using ABI 7500 Fluorescence quantitative PCR. Results In this study, we analyzed demographic and clinical parameters such as age, gender, smoking, alcohol consumption, pathological type, number of nodules, and other details of 111 patients with early multiple primary lung cancer. We also compared the clinicopathologic characteristics of different populations based on the gene mutation status of pulmonary nodules. Subsequently, we performed a clinicopathological analysis of all 265 pulmonary nodules from these patients. Results showed significant differences in clinicopathological features of pulmonary nodules in different genetic mutations. Conclusion This study revealed the gene mutation characteristics and clinicopathological features in early multiple primary lung cancer. We found that the gene mutation status between different nodules in patients with early multiple primary lung cancer was inconsistent in most cases. Therefore, the use of targeted therapy based on the genetic sequencing of only one nodule, is unreliable. We hope this study can be helpful in guiding clinical treatment decisions.
Collapse
Affiliation(s)
- Fei Teng
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
| | - Jian Xu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
| | - Jian Wang
- Department of Neurovascular Surgery, The First Hospital of Jilin University, Changchun, China
| | - Bo Yang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yong-Zhong Wu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
| | - Yue-Quan Jiang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
- *Correspondence: Yue-Quan Jiang, ; Zhi-Qiang Wang,
| | - Zhi-Qiang Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing, China
- *Correspondence: Yue-Quan Jiang, ; Zhi-Qiang Wang,
| |
Collapse
|
3
|
Zhu Q, Yu H, Liang Z, Zhao W, Zhu M, Xu Y, Guo M, Jia Y, Zou C, Yang Z, Chen L. Novel image features of optical coherence tomography for pathological classification of lung cancer: Results from a prospective clinical trial. Front Oncol 2022; 12:870556. [PMID: 36338729 PMCID: PMC9634220 DOI: 10.3389/fonc.2022.870556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to explore the characteristics of optical coherence tomography (OCT) imaging for differentiating between benign and malignant lesions and different pathological types of lung cancer in bronchial lesions and to preliminarily evaluate the clinical value of OCT. Methods Patients who underwent bronchoscopy biopsy and OCT between February 2019 and December 2019 at the Chinese PLA General Hospital were enrolled in this study. White-light bronchoscopy (WLB), auto-fluorescence bronchoscopy (AFB), and OCT were performed at the lesion location. The main characteristics of OCT imaging for the differentiation between benign and malignant lesions and the prediction of the pathological classification of lung cancer in bronchial lesions were identified, and their clinical value was evaluated. Results A total of 135 patients were included in this study. The accuracy of OCT imaging for differentiating between benign and malignant bronchial lesions was 94.1%, which was significantly higher than that of AFB (67.4%). For the OCT imaging of SCC, adenocarcinoma, and small-cell lung cancer, the accuracies were 95.6, 94.3, and 92%, respectively. The accuracy, sensitivity, and specificity of OCT were higher than those of WLB. In addition, these main OCT image characteristics are independent influencing factors for predicting the corresponding diseases through logistic regression analysis between the main OCT image characteristics in the study and the general clinical features of patients (p<0.05). Conclusion As a non-biopsy technique, OCT can be used to improve the diagnosis rate of lung cancer and promote the development of non-invasive histological biopsy.
Collapse
Affiliation(s)
- Qiang Zhu
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Hang Yu
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhixin Liang
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Wei Zhao
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Minghui Zhu
- Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yi Xu
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Mingxue Guo
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Yanhong Jia
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Chenxi Zou
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhen Yang
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Zhen Yang, ; Liangan Chen,
| | - Liangan Chen
- Department of Respiratory Medicine, The First Medical Center of Chinese People Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Zhen Yang, ; Liangan Chen,
| |
Collapse
|
4
|
Ma J, Huang W, Zhu C, Sun X, Zhang Q, Zhang L, Qi Q, Bai X, Feng Y, Wang C. miR-423-3p activates FAK signaling pathway to drive EMT process and tumor growth in lung adenocarcinoma through targeting CYBRD1. J Clin Lab Anal 2021; 35:e24044. [PMID: 34714955 PMCID: PMC8649330 DOI: 10.1002/jcla.24044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lung adenocarcinoma (LUAD) is a malignant tumor with a high fatality rate and poor overall survival, while molecular targets diagnosing and alleviating lung cancer remain inadequate. METHODS In this article, we highlighted the upregulation of microRNA-423-3p (miR-423-3p) in LUAD, especially in smokers aged over 40, and revealed that the high expression of miR-423-3p was significantly associated with smoker, age, and pathologic stage of LUAD patients. RESULTS Moreover, overexpressing miR-423-3p could facilitate LUAD cell proliferation, invasion, adhesion, and epithelial-mesenchymal transition (EMT) process, while depleted miR-423-3p caused repressive influence upon it. Mechanically, we identified that miR-423-3p could activate FAK signaling pathway through binding to the 3'-UTR of cytochrome B reductase 1 (CYBRD1). Furthermore, we demonstrated that CYBRD1 was lowly expressed in LUAD, and miR-423-3p overexpression could rescue the impairment of LUAD cell proliferation, invasion, adhesion, and EMT caused by CYBRD1 depletion. Noticeably, miR-423-3p depletion efficiently hindered LUAD tumor growth in vivo. CONCLUSION Collectively, our findings demonstrated that miR-423-3p/CYBRD1 axis could be regarded as a promising biomarker to alleviate the poor LUAD prognosis.
Collapse
Affiliation(s)
- Jun Ma
- Department of Lung CancerTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerTianjinChina
- Department of Thoracic SurgeryShanxi Provincial People’s HospitalTaiyuanChina
| | - Wuhao Huang
- Department of Lung CancerTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerTianjinChina
| | - Chaonan Zhu
- Department of Thoracic SurgeryNorth China University of Science and Technology Affiliated HospitalTangshanChina
| | - Xiaoyan Sun
- Department of Lung CancerTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerTianjinChina
| | - Qiang Zhang
- Department of Lung CancerTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerTianjinChina
| | - Lianmin Zhang
- Department of Lung CancerTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerTianjinChina
| | - Qi Qi
- Department of Lung CancerTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerTianjinChina
| | - Xiaoming Bai
- Department of Thoracic SurgeryShanxi Provincial People’s HospitalTaiyuanChina
| | - Yun Feng
- Department of Thoracic SurgeryShanxi Provincial People’s HospitalTaiyuanChina
| | - Changli Wang
- Department of Lung CancerTianjin Medical University Cancer Institute and HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjin’s Clinical Research Center for CancerTianjinChina
| |
Collapse
|
5
|
Abstract
BACKGROUND Screening for lung cancer has used chest radiography (CR), low dose computed tomography (LDCT) and sputum cytology (SC). Estimates of the lead time (LT), i.e., the time interval from detection of lung cancer by screening to the development of symptoms, have been derived from longitudinal studies of populations at risk, tumor doubling time (DT), the ratio between its prevalence at the first round of screening and its annual incidence during follow-up, and by probability modeling derived from the results of screening trials. OBJECTIVE To review and update the estimates of LT of lung cancer. METHODS A non-systematic search of the literature for estimates of LT and screening trials. Search of the reference sections of the retrieved papers for additional relevant studies. Calculation of LTs derived from these studies. RESULTS LT since detection by CR was 0.8-1.1 years if derived from longitudinal studies; 0.6-2.1 years if derived from prevalence / incidence ratios; 0.2 years if derived from the average tumor DT; and 0.2-1.0 if derived from probability modeling. LT since detection by LDCT was 1.1-3.5 if derived from prevalence / incidence ratios; 3.9 if derived from DT; and 0.9 if derived from probability modeling. LT since detection of squamous cell cancer by SC in persons with normal CR was 1.3-1.5 if derived from prevalence/incidence ratios; and 2.1 years if derived from the DT of squamous cell cancer. CONCLUSIONS Most estimates of the LT yield values of 0.2-1.5 years for detection by CR; of 0.9-3.5 years for detection by LDCT; and about 2 years or less for detection of squamous cell cancer by SC in persons with normal CR. The heterogeneity of the screening trials and methods of derivation may account for the variability of LT estimates.
Collapse
Affiliation(s)
- Jochanan Benbassat
- Department of Medicine (retired), Hadassah Medical Center, PO Box 3894, 91037, Jerusalem, Israel.
| |
Collapse
|
6
|
Ikeda N, Usuda J, Maehara S. Photodynamic therapy for central-type early-stage lung cancer. Gen Thorac Cardiovasc Surg 2019; 68:679-683. [DOI: 10.1007/s11748-019-01240-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022]
|
7
|
Jiang L, Zheng X, Wu S, Zhang J, Ru G, Li Y. A Rare Case Of Synchronous Multiple Primary Lung Cancer: Squamous Cell Cancer And Small Cell Lung Cancer. Onco Targets Ther 2019; 12:8801-8806. [PMID: 31749623 PMCID: PMC6817713 DOI: 10.2147/ott.s213259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022] Open
Abstract
The incidence of synchronous multiple primary malignancies has been reported to be low. We report a rare case of synchronous lung squamous cell cancer and small cell lung cancer in an 82-year-old male patient. There is a lack of standard diagnostic criteria for multiple primary lung cancer. Two tumors with similar morphology are difficult to draw conclusions about the same lineage or different lineages. If the patient's physical condition permits, multiple tumors should be sampled and tested. Besides, imaging features are helpful for identification. It is advisable to diagnose synchronous multiple primary malignancies in an early stage, which contributes to a favorable outcome.
Collapse
Affiliation(s)
- Luxi Jiang
- Department of Respiratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang310014, People’s Republic of China
| | - Xiangxin Zheng
- Department of General Intensive Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang310052, People’s Republic of China
| | - Shengchang Wu
- Department of Respiratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang310014, People’s Republic of China
| | - Jie Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang310014, People’s Republic of China
| | - Guoqing Ru
- Department of Pathology Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang310014, People’s Republic of China
| | - Yaqing Li
- Department of Respiratory Medicine, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang310014, People’s Republic of China
- Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, Zhejiang310014, People’s Republic of China
| |
Collapse
|
8
|
|
9
|
Zhu J, Li W, Zhou J, Chen Y, Zhao C, Zhang T, Peng W, Wang X. The diagnostic value of narrow-band imaging for early and invasive lung cancer: a meta-analysis. Clinics (Sao Paulo) 2017; 72:438-448. [PMID: 28793005 PMCID: PMC5525163 DOI: 10.6061/clinics/2017(07)09] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/14/2017] [Indexed: 01/15/2023] Open
Abstract
This study aimed to compare the ability of narrow-band imaging to detect early and invasive lung cancer with that of conventional pathological analysis and white-light bronchoscopy. We searched the PubMed, EMBASE, Sinomed, and China National Knowledge Infrastructure databases for relevant studies. Meta-disc software was used to perform data analysis, meta-regression analysis, sensitivity analysis, and heterogeneity testing, and STATA software was used to determine if publication bias was present, as well as to calculate the relative risks for the sensitivity and specificity of narrow-band imaging vs those of white-light bronchoscopy for the detection of early and invasive lung cancer. A random-effects model was used to assess the diagnostic efficacy of the above modalities in cases in which a high degree of between-study heterogeneity was noted with respect to their diagnostic efficacies. The database search identified six studies including 578 patients. The pooled sensitivity and specificity of narrow-band imaging were 86% (95% confidence interval: 83-88%) and 81% (95% confidence interval: 77-84%), respectively, and the pooled sensitivity and specificity of white-light bronchoscopy were 70% (95% confidence interval: 66-74%) and 66% (95% confidence interval: 62-70%), respectively. The pooled relative risks for the sensitivity and specificity of narrow-band imaging vs the sensitivity and specificity of white-light bronchoscopy for the detection of early and invasive lung cancer were 1.33 (95% confidence interval: 1.07-1.67) and 1.09 (95% confidence interval: 0.84-1.42), respectively, and sensitivity analysis showed that narrow-band imaging exhibited good diagnostic efficacy with respect to detecting early and invasive lung cancer and that the results of the study were stable. Narrow-band imaging was superior to white light bronchoscopy with respect to detecting early and invasive lung cancer; however, the specificities of the two modalities did not differ significantly.
Collapse
Affiliation(s)
- Juanjuan Zhu
- Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- Provincial Key Laboratory of Respiratory Disease in Anhui, Bengbu 233004, China
- *Corresponding author. E-mail:
| | - Wei Li
- Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- Provincial Key Laboratory of Respiratory Disease in Anhui, Bengbu 233004, China
- *Corresponding author. E-mail:
| | - Jihong Zhou
- Department of Biochemistry and Molecular Biology, Bengbu Medical College, Bengbu 233004, China
| | - Yuqing Chen
- Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- Provincial Key Laboratory of Respiratory Disease in Anhui, Bengbu 233004, China
| | - Chenling Zhao
- Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- Provincial Key Laboratory of Respiratory Disease in Anhui, Bengbu 233004, China
| | - Ting Zhang
- Department of Respiratory Disease, No.2 People’s Hospital of Fuyang City, Fuyang 236015, China
| | - Wenjia Peng
- Department of Epidemiology and Health Statistics, Bengbu Medical College, Bengbu 233030, China
| | - Xiaojing Wang
- Department of Respiratory Disease, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China
- Provincial Key Laboratory of Respiratory Disease in Anhui, Bengbu 233004, China
| |
Collapse
|
10
|
Andolfi M, Potenza R, Capozzi R, Liparulo V, Puma F, Yasufuku K. The role of bronchoscopy in the diagnosis of early lung cancer: a review. J Thorac Dis 2016; 8:3329-3337. [PMID: 28066614 PMCID: PMC5179455 DOI: 10.21037/jtd.2016.11.81] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/20/2016] [Indexed: 12/25/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide with an overall 5-year survival rate of 17% after diagnoses. Indeed many patients tend to have a very poor prognosis, due to being diagnosed at an advanced stage. Conversely patients who are diagnosed at an early stage have a 5-year survival >70%, indicating that early detection of lung cancer is crucial to improve survival. Although flexible bronchoscopy is a relatively non-invasive procedure for patients suspected of having lung cancer, only 29% of carcinoma in situ (CIS) and 69% of microinvasive tumors were detectable using white light bronchoscopy (WLB) alone. As a result, in the past two decades, new bronchoscopic techniques have been developed to increase the yield and diagnostic accuracy, such as autofluorescence bronchoscopy (AFB), narrow band imaging (NBI) and high magnification bronchovideoscopy (HMB). However, due to the low specificity and the limitation to detect only proximal bronchial tree, new probe-based technologies have been introduced: radial endobronchial ultrasound (R-EBUS), optical coherence tomography (OCT), confocal laser endomicroscopy (CLE) and laser Raman spectroscopy (LRS). To date, although tissue biopsy remains the gold standard for diagnosing malignant/premalignant airway disease and some techniques are still investigational, bronchoscopic technologies can be considered the safest and most accurate tools to evaluate both central and distal airway mucosa.
Collapse
Affiliation(s)
- Marco Andolfi
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Rossella Potenza
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Rosanna Capozzi
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Valeria Liparulo
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Francesco Puma
- Division of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| |
Collapse
|
11
|
Shen C, Wang X, Tian L, Zhou Y, Chen D, Du H, Wang W, Liu L, Che G. "Different trend" in multiple primary lung cancer and intrapulmonary metastasis. Eur J Med Res 2015; 20:17. [PMID: 25889108 PMCID: PMC4339418 DOI: 10.1186/s40001-015-0109-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/27/2015] [Indexed: 02/05/2023] Open
Abstract
Background The distinguishing of intrapulmonary metastatic tumors from multiple primary lung cancers is difficult but of great importance for the therapeutic management and prognosis of these patients. Methods We used genomic DNA analyzed by six microsatellites (D7S1824, D15S822, D2S1363, D10S1239, D6S1056, and D22S689) with PCR to identify discordant allelic variation from 12 patients. There are five patients with multiple primary lung cancers and seven patients who were diagnosed with intrapulmonary metastases from 850 patients with primary lung cancer in our hospital. The experiments were approved by the West China Hospital Ethics committee (No. 2013 (33)) and all patients agreed to participate in the study and signed an informed consent form. Results In the group of metachronous lung tumor, three of five patients have different histological types and one of five patients have the same histological type which showed “contradictory trend”. The other one showed “unique trend”. In the second group (intrapulmonary metastasis lung tumor), one patient showed “contradictory trend” and the others showed “unique trend”. Conclusions “Different trends” are useful in discrimination of intrapulmonary metastasis lung cancer and multiple primary lung cancer even diagnosed with the histopathological evaluation.
Collapse
Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Xin Wang
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Long Tian
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yubin Zhou
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Dali Chen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Heng Du
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Weiya Wang
- Department of Pathology, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Lunxu Liu
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
12
|
Lung Cancer Screening Beyond Low-Dose Computed Tomography: The Role of Novel Biomarkers. Lung 2014; 192:639-48. [DOI: 10.1007/s00408-014-9636-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/28/2014] [Indexed: 02/07/2023]
|
13
|
Advanced imaging (positron emission tomography and magnetic resonance imaging) and image-guided biopsy in initial staging and monitoring of therapy of lung cancer. Cancer J 2013; 19:208-16. [PMID: 23708067 DOI: 10.1097/ppo.0b013e318295185f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The results of the National Lung Screening Trial strongly support early detection and definitive treatment to reduce lung cancer mortality. Once lung cancer is discovered, accurate staging at baseline is imperative to maximize patient benefit and cost-effective use of health care resources. Although computed tomography (CT) remains a powerful tool for staging of lung cancer, advances in other imaging modalities, specifically positron emission tomography/CT and magnetic resonance imaging, can improve baseline staging over CT alone and can allow a more rapid and accurate assessment of response to treatment. Although noninvasive imaging is extremely useful, tissue diagnosis remains the criterion standard for staging lung cancer and monitoring treatment response. Accordingly, tissue sampling using advanced bronchoscopic imaging guidance, such as ultrasound or electromagnetic navigation, allows precise tissue location and sampling of mediastinal nodes or lung nodules in the least invasive manner. In the future, bronchoscopy may allow real-time microscopic analysis.
Collapse
|
14
|
Lung Cancer Screening: Adjuncts and Alternatives to Low-Dose CT Scans. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
15
|
Shen C, Xu H, Liu L, Zhou Y, Chen D, Du H, Han Z, Che G. "Unique trend" and "contradictory trend" in discrimination of primary synchronous lung cancer and metastatic lung cancer. BMC Cancer 2013; 13:467. [PMID: 24106770 PMCID: PMC3852048 DOI: 10.1186/1471-2407-13-467] [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: 03/13/2013] [Accepted: 10/01/2013] [Indexed: 02/05/2023] Open
Abstract
Background Distinguishing between multiple primary lung cancers and metastatic tumors is often difficult when the tumor histology is same. Since genomic instability is a common feature of cancer, we hypothesized that independently arising neoplasms in an individual patient would exhibit measurable genomic variation, enabling discrimination of tumor lineage and relatedness. The feasibility of analyzing genomic instability expression profiles to distinguish multiple primary lung cancers from metastatic tumors was evaluated. Methods This study enrolled 13 patients, with multiple primary lung cancers demonstrating with the histology, who underwent surgery between April 2003 and December 2012 at the Department of the Thoracic Surgery at West China Hospital in Sichuan province of China and 10 patients who were diagnosed as metastasis disease during the same period for comparison purposes. Genomic DNA from lung cancers from individual patients was analyzed by six microsatellites (D2S1363, D6S1056, D7S1824, D10S1239, D15S822, and D22S689) with PCR to identify discordant allelic variation. The experiments were approved by the West China Hospital Ethics committee (No.2013 (33)) and all patients agreed to participate in the study and signed an informed consent form. Results All of the 10 patients with distant metastasis showed a consistent consequence that we called “unique trend” between primary tumor and distant metastasis. The “trend” is representive in this study, which means that all alleles corresponding to six microsatellite markers were detected in DNA from primary tumors but were reduced or not observed in DNA from metastatic tumors. In the group of synchronous lung tumor with different histological types, the result showed a “contradictory trend”. Some alleles were detected in DNA from primary tumors but were reduced or not observed in DNA from metastatic tumors and other alleles corresponding to six microsatellite markers were detected in DNA from metastatic tumors but were reduced or not observed in DNA from primary tumors. In the third group (synchronous lung tumor with same histological types), 2 of 8 patients showed “unique trend” and the others showed “contradictory trend”. Conclusions With polymorphic microsatellite markers, the “unique trend” that represents metastasis cancers and the “contradictory trend” that represents primary multiple tumors are useful in the diagnosis between tumors found at the same time in the pulmonary even diagnosed with the histopathological evaluation from a single patient.
Collapse
Affiliation(s)
- Cheng Shen
- Department of Cardiovascular and Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu 610041, China.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Wisnivesky JP, Yung RCW, Mathur PN, Zulueta JJ. Diagnosis and treatment of bronchial intraepithelial neoplasia and early lung cancer of the central airways: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e263S-e277S. [PMID: 23649442 DOI: 10.1378/chest.12-2358] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bronchial intraepithelial lesions may be precursors of central airway lung carcinomas. Identification and early treatment of these preinvasive lesions might prevent progression to invasive carcinoma. METHODS We systematically reviewed the literature to develop evidence-based recommendations regarding the diagnosis and treatment of intraepithelial lesions. RESULTS The risk and timeline for progression of bronchial intraepithelial lesions to carcinoma in situ (CIS) or invasive carcinoma are not well understood. Multiple studies show that autofluorescence bronchoscopy (AFB) is more sensitive that white light bronchoscopy (WLB) to identify these lesions. In patients with severe dysplasia or CIS in sputum cytology who have chest imaging studies showing no localizing abnormality, we suggest use of WLB; AFB may be used as an adjunct when available. Patients with known severe dysplasia or CIS of central airways should be followed with WLB or AFB, when available. WLB or AFB is also suggested for patients with early lung cancer who will undergo resection for delineation of tumor margins and assessment of synchronous lesions. However, AFB is not recommended prior to endobronchial therapy for CIS or early central lung cancer. Several endobronchial techniques are recommended for the treatment of patients with superficial limited mucosal lung cancer who are not candidates for resection. CONCLUSION Additional information is needed about the natural history and rate of progression of preinvasive central airway lesions. Patients with severe dysplasia or CIS may be treated endobronchially; however, it remains unclear if these therapies are associated with improved patient outcomes.
Collapse
Affiliation(s)
- Juan P Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Rex Chin-Wei Yung
- Division of Pulmonary Medicine and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Praveen N Mathur
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Department of Medicine, Indiana University Medical Center, Indianapolis, IN
| | | |
Collapse
|
17
|
Daniels JMA, Sutedja TG. Detection and minimally invasive treatment of early squamous lung cancer. Ther Adv Med Oncol 2013; 5:235-48. [PMID: 23858332 DOI: 10.1177/1758834013482345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) is the most common cause of cancer deaths worldwide. The majority of patents presenting with NSCLC have advanced disease, which precludes curative treatment. Early detection and treatment might result in the identification of more patients with early central lung cancer and improve survival. In addition, the study of early lung cancer improves understanding of lung carcinogenesis and might also reveal new treatment targets for advanced lung cancer. Bronchoscopic investigation of the central airways can reveal both early central lung cancer in situ (stage 0) and other preinvasive lesions such as dysplasia. In the current review we discuss the detection of early squamous lung cancer, the natural history of preinvasive lesions and whether biomarkers can be used to predict progression to cancer. Finally we will review the staging and management of preinvasive lung cancer lesions and the different therapeutic modalities that are available.
Collapse
Affiliation(s)
- Johannes M A Daniels
- Department of Pulmonary Diseases, Z 4A48, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | | |
Collapse
|
18
|
Abstract
BACKGROUND This is an updated version of the original review published in The Cochrane Library in 1999 and updated in 2004 and 2010. Population-based screening for lung cancer has not been adopted in the majority of countries. However it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography (CT) are effective in reducing mortality from lung cancer. OBJECTIVES To determine whether screening for lung cancer, using regular sputum examinations, chest radiography or CT scanning of the chest, reduces lung cancer mortality. SEARCH METHODS We searched electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), MEDLINE (1966 to 2012), PREMEDLINE and EMBASE (to 2012) and bibliographies. We handsearched the journal Lung Cancer (to 2000) and contacted experts in the field to identify published and unpublished trials. SELECTION CRITERIA Controlled trials of screening for lung cancer using sputum examinations, chest radiography or chest CT. DATA COLLECTION AND ANALYSIS We performed an intention-to-screen analysis. Where there was significant statistical heterogeneity, we reported risk ratios (RRs) using the random-effects model. For other outcomes we used the fixed-effect model. MAIN RESULTS We included nine trials in the review (eight randomised controlled studies and one controlled trial) with a total of 453,965 subjects. In one large study that included both smokers and non-smokers comparing annual chest x-ray screening with usual care there was no reduction in lung cancer mortality (RR 0.99, 95% CI 0.91 to 1.07). In a meta-analysis of studies comparing different frequencies of chest x-ray screening, frequent screening with chest x-rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23); however several of the trials included in this meta-analysis had potential methodological weaknesses. We observed a non-statistically significant trend to reduced mortality from lung cancer when screening with chest x-ray and sputum cytology was compared with chest x-ray alone (RR 0.88, 95% CI 0.74 to 1.03). There was one large methodologically rigorous trial in high-risk smokers and ex-smokers (those aged 55 to 74 years with ≥ 30 pack-years of smoking and who quit ≤ 15 years prior to entry if ex-smokers) comparing annual low-dose CT screening with annual chest x-ray screening; in this study the relative risk of death from lung cancer was significantly reduced in the low-dose CT group (RR 0.80, 95% CI 0.70 to 0.92). AUTHORS' CONCLUSIONS The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Annual low-dose CT screening is associated with a reduction in lung cancer mortality in high-risk smokers but further data are required on the cost effectiveness of screening and the relative harms and benefits of screening across a range of different risk groups and settings.
Collapse
Affiliation(s)
- Renée Manser
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, St Andrew's Place, East Melbourne 3002, Victoria, and Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.
| | | | | | | | | | | | | |
Collapse
|
19
|
Wang Y, Wang Q, Feng J, Wu Q. Comparison of autofluorescence imaging bronchoscopy and white light bronchoscopy for detection of lung cancers and precancerous lesions. Patient Prefer Adherence 2013; 7:621-31. [PMID: 23874085 PMCID: PMC3711948 DOI: 10.2147/ppa.s46749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The purpose of this paper was to compare the sensitivity, specificity, and overall diagnostic performance of autofluorescence imaging bronchoscopy (AFI) versus white light bronchoscopy (WLB) in the detection of lung cancers and precancerous lesions by meta-analysis. METHODS We performed a literature search using the PubMed and EMBASE databases to identify studies published between March 1991 and March 2012. Article selection, quality assessment, and data extraction were then performed. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the curve of the summary receiver operating characteristic for AFI versus WLB were calculated using Stata version 12.0 software. RESULTS Six studies were included in the meta-analysis. The pooled sensitivity of AFI and WLB was 0.89 (95% confidence interval [CI] 0.81-0.94) and 0.67 (95% CI 0.46-0.83) and the pooled specificity of AFI and WLB was 0.64 (95% CI 0.37-0.84) and 0.84 (95% CI 0.74-0.91), respectively. The diagnostic odds ratio for AFI and WLB was 14.5 (95% CI 3.76-55.63) and 10.9 (95% CI 3.12-38.21), and the area under the curve for AFI and WLB was 0.89 (95% CI 0.86-0.92) and 0.85 (95% CI 0.81-0.88), respectively. The pooled positive and negative likelihood ratios were 2.5 (95% CI 1.21-4.97) and 0.17 (95% CI 0.08-0.36) for AFI, and the corresponding values for WLB were 4.3 (95% CI 2.13-8.52) and 0.39 (95% CI 0.21-0.73). The pooled positive likelihood ratio for AFI and WLB was not higher than 10, and the pooled negative likelihood ratio for AFI and WLB was not lower than 0.1. CONCLUSION The sensitivity of AFI is higher than that of WLB, while the specificity of AFI is lower than that of WLB. The overall diagnostic performance of AFI is slightly better than that of WLB in detecting lung cancers and precancerous lesions. AFI should find its place in routine bronchoscopic examination and may improve the diagnostic outcome on endoscopy.
Collapse
Affiliation(s)
- Yan Wang
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Qing Wang
- Respiratory Department of the First People’s Hospital of Kunming, Yunnan, People’s Republic of China
| | - Jing Feng
- Respiratory Department of Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
- Correspondence: Jing Feng, Respiratory Department of Tianjin Medical University General Hospital, Tianjin 300052, People’s Republic of China, Tel +139 2050 0251, Fax +86 22 6036 1632, Email
| | - Qi Wu
- Respiratory Department of Tianjin Haihe Hospital, Tianjin, People’s Republic of China
- Qi Wu, Respiratory Department of Tianjin Haihe Hospital, Tianjin 300350, People’s Republic of China, Tel +86 139 2042 0866, Fax +86 22 6036 1632, Email
| |
Collapse
|
20
|
FIELDING DAVID, PHILLIPS MARTIN, ROBINSON PETER, IRVING LOUIS, GARSKE LUKE, HOPKINS PETER. Advanced interventional pulmonology procedures: Training guidelines from the Thoracic Society of Australia and New Zealand. Respirology 2012; 17:1176-89. [DOI: 10.1111/j.1440-1843.2012.02253.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
21
|
Endo C, Sakurada A, Kondo T. Early central airways lung cancer. Gen Thorac Cardiovasc Surg 2012; 60:557-60. [PMID: 22810461 DOI: 10.1007/s11748-012-0102-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Indexed: 01/13/2023]
Abstract
Early central airways lung cancer accounts for very small percentage of all lung cancers. Given this fact, it is much difficult to carry out a prospective randomized comparative clinical trial. Even retrospective studies can offer important information. Early central airways lung cancer is usually detected by sputum cytology. If sputum cytology shows atypical epithelial cells implying malignancy, the next thing we have to do is bronchoscopy. Both autofluorescence bronchoscopy and white light bronchoscopy were superior to white light bronchoscopy alone in detecting this type of lung cancer. Natural history of this cancer showed about the two-thirds of the patients die from original disease within 10 years. If the tumor length is 10 mm or less, photodynamic therapy is a first-line modality. After photodynamic therapy, a 5-year overall survival of about 80 % and a 10-year overall survival of 70 % can be expected. If a cancer does not meet the criteria for photodynamic therapy, surgical resection is recommended, and 5-year overall survival of about 80 % can be expected. Segmentectomy should be considered because of pulmonary function preservation if a tumor is located at segmental bronchi or beyond it. The frequency of multicentricity is high. Treatment strategy for subsequent primary lung cancer is an important key for the prognosis of patients with treated early central airways lung cancer. Surgical resection is still the most reliable treatment of subsequent primary lung cancer, except for in situ or microinvasive carcinoma located centrally, which could be cured by photodynamic therapy.
Collapse
Affiliation(s)
- Chiaki Endo
- Department of Thoracic Surgery, Tohoku University Hospital, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | | | | |
Collapse
|
22
|
Abstract
It has been proposed that invasive carcinoma of the bronchus develops through a transition from preinvasive lesions to overt malignancy. Newer diagnostic technologies have provided a more sensitive way to diagnose preinvasive lesions and a better understanding of the prevalence of such lesions. The natural history of preinvasive lesions has not been well defined; however, there is evidence that high-grade lesions are at a higher risk of progression to carcinoma. Molecular alterations have been described in preinvasive lesions and may help better predict which lesions will progress. Several noninvasive techniques are available for the treatment of high-grade lesions.
Collapse
Affiliation(s)
- M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina at Chapel Hill, 4133 Bioinformatics Building, Mason Farm Road, CB # 7020, Chapel Hill, NC 27516, USA.
| |
Collapse
|
23
|
Xue X, Xue Q, Wang N, Zhang L, Guo L, Li X, Sun J, Wang J. Early clinical diagnosis of synchronous multiple primary lung cancer. Oncol Lett 2011; 3:234-237. [PMID: 22740887 DOI: 10.3892/ol.2011.452] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 10/11/2011] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of synchronous multiple primary lung cancer (SMPLC) remains a formidable challenge. The aim of the present study was to identify useful clues for the clinical diagnosis of SMPLC, in particular for the early stages. The medical records of 10 patients diagnosed with SMPLC with different histological types were analyzed retrospectively. Chest computed tomography (CT) findings showed two pulmonary lesions in all patients. The two lesions displayed malignant characteristics of primary lung cancer. The levels of a number of tumor markers, including carcinoembryonic antigen, neuron-specific enolase, cytokeratin fragment 21-1, squamous cell carcinoma and CA125 increased in 2 patients. Auxiliary examinations of other physical sites in these patients did not show signs of neoplasm metastasis. Two tumors were separately staged and appropriate treatment was carried out based on the revised stage, which provided more benefits for SMPLC patients. The diagnosis of SMPLC might be delayed or mistaken owing to its similarity to neoplasm metastasis. A high index of awareness is required for the early diagnosis of this disease. The malignant characteristics of primary lung cancer in various lesions may be valuable clues for the diagnosis of SMPLC. Alterations in the levels of tumor markers may be a poor diagnostic tool for the detection of SMPLC. Separate biopsies for different pulmonary masses should be performed for clinical staging as soon as possible and reasonable treatment based on the stage should also be selected.
Collapse
Affiliation(s)
- Xinying Xue
- The Respiratory Diseases Department of the Chinese PLA General Hospital, Beijing 100853, P.R. China
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Coxson HO, Eastwood PR, Williamson JP, Sin DD. Phenotyping airway disease with optical coherence tomography. Respirology 2011; 16:34-43. [PMID: 21044229 DOI: 10.1111/j.1440-1843.2010.01888.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Airway diseases are a major concern around the world. However, the pace of new drug and biomarker discovery has lagged behind those of other common disorders such as cardiovascular diseases and diabetes. One major barrier in airway research has been the inability to accurately visualize large or small airway remodelling or dysplastic/neoplastic (either pre or early cancerous) changes using non- or minimally invasive instruments. The advent of optical coherence tomography (OCT) has the potential to revolutionize airway research and management by allowing investigators and clinicians to visualize the airway with resolution approaching histology and without exposing patients to harmful effects of ionizing radiation. Thus, with the aid of OCT, we may be able to accurately determine and quantify the extent of airway remodelling in asthma and chronic obstructive pulmonary disease, detect early pre-cancerous lesions in smokers for chemoprevention, study the upper airway anatomy of patients with obstructive sleep apnea in real time while they are asleep and facilitate optimal selection of stents for those with tracheal obstruction. In this paper, we review the current state of knowledge of OCT and its possible application in airway diseases.
Collapse
Affiliation(s)
- Harvey O Coxson
- Providence Heart and Lung Institute and The UBC James Hogg Research Center, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | | |
Collapse
|
25
|
Chen W, Gao X, Tian Q, Chen L. A comparison of autofluorescence bronchoscopy and white light bronchoscopy in detection of lung cancer and preneoplastic lesions: A meta-analysis. Lung Cancer 2011; 73:183-8. [DOI: 10.1016/j.lungcan.2010.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 11/25/2010] [Accepted: 12/03/2010] [Indexed: 11/15/2022]
|
26
|
The Value of Autofluorescence Bronchoscopy Combined with White Light Bronchoscopy Compared with White Light Alone in the Diagnosis of Intraepithelial Neoplasia and Invasive Lung Cancer: A Meta-Analysis. J Thorac Oncol 2011; 6:1336-44. [DOI: 10.1097/jto.0b013e318220c984] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Abstract
Bronchoscopy in the new millennium spells an exciting time for the pulmonologist, which likens to Alice peering through the looking glass into a wonderland of miniaturized probes, optics, and technology that are advancing at a maddening pace. Although scientists continue to push the envelope using nanotechnology that may facilitate further miniaturization of probes to allow imaging at the cellular or molecular level, it is opportune to evaluate the strengths and weaknesses of available technologies and bronchoscopic techniques for the diagnosis and staging of lung cancer, in its early detection and palliation. We appraise current technologies and what they hold for the future.
Collapse
|
28
|
Colt HG, Murgu SD. Interventional bronchoscopy from bench to bedside: new techniques for early lung cancer detection. Clin Chest Med 2010; 31:29-37, Table of Contents. [PMID: 20172430 DOI: 10.1016/j.ccm.2009.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lung cancer is a leading cause of cancer-related death in the world, and it accounts for more deaths than breast, colon, and prostate cancer combined in the United States. From a historical perspective, the premise behind early lung cancer detection strategy is that early detection of lung cancer is justified if early treatment improves the outcome. New optical technologies such as those presented in this article allow dynamic study of these processes at the cellular level, and it is hoped that opportunities for targeted therapy will be provided in the future. Investigators are on the verge of discovering a multidimensional bronchoscopic platform that can be used to narrow in on airway structures, explore vascular flow and angiogenesis, and discover new features of bronchogenic carcinogenesis.
Collapse
Affiliation(s)
- Henri G Colt
- Department of Medicine, Pulmonary and Critical Care Medicine, University of California School of Medicine, 101 The City Drive, Irvine, Orange, CA 92868, USA.
| | | |
Collapse
|
29
|
Combining Autofluorescence and Narrow Band Imaging With Image Analysis in the Evaluation of Preneoplastic Lesions in the Bronchus and Larynx. J Bronchology Interv Pulmonol 2010; 17:109-16. [DOI: 10.1097/lbr.0b013e3181da2ca8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
30
|
Abstract
Lung cancer is the leading cause of cancer-related death worldwide. At the time of initial presentation, most patients are at an advance stage of disease and have a poor associated prognosis. Those diagnosed and treated at earlier stages have a significantly better outcome with 5-year survival for stage I disease approaching 75%. Ideally a screening strategy for lung cancer would detect disease at an earlier stage and allow for potential surgical cure. The purpose of this review is to examine past and current evidence as it relates to lung cancer screening.
Collapse
Affiliation(s)
- Nichole T Tanner
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
31
|
Ono K, Sugio K, Uramoto H, Baba T, Ichiki Y, Takenoyama M, Hanagiri T, Oyama T, Yasumoto K. Discrimination of multiple primary lung cancers from intrapulmonary metastasis based on the expression of four cancer-related proteins. Cancer 2009; 115:3489-500. [DOI: 10.1002/cncr.24382] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
32
|
Lee P, van den Berg RM, Lam S, Gazdar AF, Grunberg K, McWilliams A, Leriche J, Postmus PE, Sutedja TG. Color fluorescence ratio for detection of bronchial dysplasia and carcinoma in situ. Clin Cancer Res 2009; 15:4700-5. [PMID: 19584169 DOI: 10.1158/1078-0432.ccr-08-1644] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Autofluorescence bronchoscopy is more sensitive than conventional bronchoscopy for detecting early airway mucosal lesions. Decreased specificity can lead to excessive biopsy and increased procedural time. Onco-LIFE, a device that combines fluorescence and reflectance imaging, allows numeric representation by expressing red-to-green ratio (R/G ratio) within the region of interest. The aim of the study was to determine if color fluorescence ratio (R/G ratio) added to autofluorescence bronchoscopy could provide an objective means to guide biopsy. METHODS Subjects at risk for lung cancer were recruited at two centers: VU University Medical Centre (Amsterdam) and BC Cancer Agency (Canada). R/G ratio for each site appearing normal or abnormal was measured before biopsy. R/G ratios were correlated with pathology, and a receiver operating characteristic curve of R/G ratio for high-grade and moderate dysplasia was done. Following analysis of the training data set obtained from two centers, a prospective validation study was done. RESULTS Three thousand three hundred sixty-two adequate biopsies from 738 subjects with their corresponding R/G ratios were analyzed. R/G ratio 0.54 conferred 85% sensitivity and 80% specificity for the detection of high-grade and moderate dysplasia, area under the curve was 0.90, and 95% confidence interval was 0.88 to 0.92. In another 70 different sites that were assessed, kappa measurements of agreement of R/G ratios with visual scores and pathology were 0.66 (P < 0.0001) and 0.61 (P < 0.0001), respectively. R/G ratio combined with visual score improved specificity to 88% (95% confidence interval, 0.73-0.96) for high-grade and moderate dysplasia. CONCLUSION Color fluorescence ratio can objectively guide the bronchoscopist in selecting sites for biopsy with good pathologic correlation.
Collapse
Affiliation(s)
- Pyng Lee
- Pulmonary Diseases and Pathology, VU University Medical Centre, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
Preinvasive lesions are considered the precursors of squamous cell carcinoma of the bronchus. Treatment at the preinvasive stage, before the potential for metastasis, may improve survival from squamous cell carcinoma. An understanding of the natural history and outcome of preinvasive lesions is essential for the accurate interpretation studies of their treatment, and decisions regarding the management of individual lesions. The natural history of preinvasive lesions has only been reported in a small number of highly selected patients and uses different inclusion criteria, treatment criteria. and time-periods of follow-up, making it difficult to draw definitive conclusions. High-grade preinvasive lesions carry a risk of progression to carcinoma but most patients have multiple lesions and a significant probability of developing new lesions over time. Distinguishing lesions with malignant potential, the targets for therapy, from those that will regress or remain indolent is difficult. The American College of Chest Physicians guidelines recommend bronchoscopic follow-up of severe dysplasia and carcinoma-in situ. This review of the evidence regarding the natural history and outcome of preinvasive lesions supports this view, but also shows that further studies in individuals at risk for lung cancer are necessary before guidelines for the management of preinvasive lesions can be developed.
Collapse
|
34
|
Detection and localization of intraepithelial neoplasia and invasive carcinoma using fluorescence-reflectance bronchoscopy: an international, multicenter clinical trial. J Thorac Oncol 2009; 4:49-54. [PMID: 19096306 DOI: 10.1097/jto.0b013e3181914506] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The primary objective of this study was to evaluate the benefit of using a new fluorescence-reflectance imaging system, Onco-LIFE, for the detection and localization of intraepitheal neoplasia and early invasive squamous cell carcinoma. A secondary objective was to evaluate the potential use of quantitative image analysis with this device for objective classification of abnormal sites. DESIGN This study was a prospective, multicenter, comparative, single arm trial. Subjects for this study were aged 45 to 75 years and either current or past smokers of more than 20 pack-years with airflow obstruction, forced expiratory volume in 1 second/forced vital capacity less than 75%, suspected to have lung cancer based on either sputum atypia, abnormal chest roentgenogram/chest computed tomography, or patients with previous curatively treated lung or head and neck cancer within 2 years. MATERIALS AND METHODS The primary endpoint of the study was to determine the relative sensitivity of white light bronchoscopy (WLB) plus autofluorescence-reflectance bronchoscopy compared with WLB alone. Bronchoscopy with Onco-LIFE was carried out in two stages. The first stage was performed under white light and mucosal lesions were visually classified. Mucosal lesions were classified using the same scheme in the second stage when viewed with Onco-LIFE in the fluorescence-reflectance mode. All regions classified as suspicious for moderate dysplasia or worse were biopsied, plus at least one nonsuspicious region for control. Specimens were evaluated by the site pathologist and then sent to a reference pathologist, each blinded to the endoscopic findings. Positive lesions were defined as those with moderate/severe dysplasia, carcinoma in situ (CIS), or invasive carcinoma. A positive patient was defined as having at least one lesion of moderate/severe dysplasia, CIS, or invasive carcinoma. Onco-LIFE was also used to quantify the fluorescence-reflectance response (based on the proportion of reflected red light to green fluorescence) for each suspected lesion before biopsy. RESULTS There were 115 men and 55 women with median age of 62 years. Seven hundred seventy-six biopsy specimens were included. Seventy-six were classified as positive (moderate dysplasia or worse) by pathology. The relative sensitivity on a per-lesion basis of WLB + FLB versus WLB was 1.50 (95% confidence interval [CI], 1.26-1.89). The relative sensitivity on a per-patient basis was 1.33 (95% CI, 1.13-1.70). The relative sensitivity to detect intraepithelial neoplasia (moderate/severe dysplasia or CIS) was 4.29 (95% CI, 2.00-16.00) and 3.50 (95% CI, 1.63-12.00) on a per-lesion and per-patient basis, respectively. For a quantified fluorescence reflectance response value of more than or equal to 0.40, a sensitivity and specificity of 51% and 80%, respectively, could be achieved for detection of moderate/severe dsyplasia, CIS, and microinvasive cancer. CONCLUSIONS Using autofluorescence-reflectance bronchoscopy as an adjunct to WLB with the Onco-LIFE system improves the detection and localization of intraepitheal neoplasia and invasive carcinoma compared with WLB alone. The use of quantitative image analysis to minimize interobserver variation in grading of abnormal sites should be explored further in future prospective clinical trial.
Collapse
|
35
|
Fuwa N, Kodaira T, Tachibana H, Nakamura T, Tomita N, Daimon T. Long-term observation of 64 patients with roentgenographically occult lung cancer treated with external irradiation and intraluminal irradiation using low-dose-rate iridium. Jpn J Clin Oncol 2008; 38:581-8. [PMID: 18723609 DOI: 10.1093/jjco/hyn077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Therapeutic results of intraluminal irradiation were analyzed in 64 patients with roentgenographically occult lung cancer (ROLC). METHODS The subjects were 64 patients who underwent intraluminal irradiation between 1987 and 2003. Radiotherapy was performed by combining external irradiation with intraluminal irradiation using low-dose-rate iridium (four 370-MBq wires) through a catheter with a spacer. The doses of radiation were 0-70 Gy (median value 46 Gy) by external irradiation and 10-60 Gy (median value 29.3 Gy) by intraluminal irradiation. RESULTS The therapeutic effect was CR in 63 patients and PR in 1 patient, and local recurrence was observed in a PR case and in seven of the 63 patients who showed CR. The 5-year overall and relapse-free survival rates were 56 (95% CI, 43-69%) and 55% (95% CI, 43-68%), respectively. Fatal pulmonary hemorrhage was observed in one case. CONCLUSIONS Considering the facts that ROLC often occurs as multiple cancers and that many patients with ROLC have reduced lung function, radiation therapy by a combination of intraluminal and external irradiation may replace surgery as the first choice for the treatment of this disease.
Collapse
Affiliation(s)
- Nobukazu Fuwa
- Department of Radiation Oncology, Southern Tohoku Proton Center, Fukushima, Japan.
| | | | | | | | | | | |
Collapse
|
36
|
Kennedy TC, McWilliams A, Edell E, Sutedja T, Downie G, Yung R, Gazdar A, Mathur PN. Bronchial Intraepithelial Neoplasia/Early Central Airways Lung Cancer. Chest 2007; 132:221S-233S. [PMID: 17873170 DOI: 10.1378/chest.07-1377] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND An evidence-based approach is necessary for the localization and management of intraepithelial and microinvasive non-small cell lung cancer in the central airways. METHODS Material appropriate to this topic was obtained by literature search of a computerized database. Recommendations were developed by the writing committee and then reviewed by the entire guidelines panel. The final recommendations were made by the Chair and were voted on by the entire committee. RESULTS White light bronchoscopy has diagnostic limitations in the detection of microinvasive lesions. Autofluorescence bronchoscopy (AFB) is a technique that has been shown to be a sensitive method for detecting these lesions. In patients with moderate dysplasia or worse on sputum cytology and normal chest radiographic findings, bronchoscopy should be performed. If moderate/severe dysplasia or carcinoma in situ (CIS) is detected in the central airways, then bronchoscopic surveillance is recommended. The use of AFB is preferred if available. In a patient being considered for curative endobronchial therapy to treat microinvasive lesions, AFB is useful. A number of endobronchial techniques as therapeutic options are available for the management of CIS and can be recommended to patients with inoperable disease. In patients with operable disease, surgery remains the mainstay of treatment, although patients may be counseled about these techniques. CONCLUSIONS AFB is a useful tool for the localization of microinvasive neoplasia. A number of endobronchial techniques available for the curative treatment can be considered first-line therapy in inoperable cases. For operable cases, the techniques may be considered and discussed with the patients.
Collapse
Affiliation(s)
- Timothy C Kennedy
- MBBS, 550 W University Blvd, Suite 4903, Indianapolis IN 46202, USA.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
MTP13-01: Indications and limitations of bronchoscopy. J Thorac Oncol 2007. [DOI: 10.1097/01.jto.0000283054.95956.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Loewen G, Natarajan N, Tan D, Nava E, Klippenstein D, Mahoney M, Cummings M, Reid M. Autofluorescence bronchoscopy for lung cancer surveillance based on risk assessment. Thorax 2007; 62:335-40. [PMID: 17101735 PMCID: PMC2092474 DOI: 10.1136/thx.2006.068999] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 10/10/2006] [Indexed: 11/03/2022]
Abstract
BACKGROUND This is a preliminary report of an ongoing prospective bimodality lung cancer surveillance trial for high-risk patients. Bimodality surveillance incorporates autofluorescence bronchoscopy (AFB) and spiral CT (SCT) scanning in high-risk patients as a primary lung cancer surveillance strategy, based entirely on risk factors. AFB was used for surveillance and findings were compared with conventional sputum cytology for the detection of malignancy and pre-malignant central airway lesions. METHODS 402 patients registering at Roswell Park Cancer Institute were evaluated with spirometric testing, chest radiography, history and physical examination, of which 207 were deemed eligible for the study. For eligibility, patients were required to have at least two of the following risk factors: (1) > or =20 pack year history of tobacco use, (2) asbestos-related lung disease on the chest radiograph, (3) chronic obstructive pulmonary disease with a forced expiratory volume in 1 s (FEV(1)) <70% of predicted, and (4) prior aerodigestive cancer treated with curative intent, with no evidence of disease for >2 years. All eligible patients underwent AFB, a low-dose SCT scan of the chest without contrast, and a sputum sample was collected for cytological examination. Bronchoscopic biopsy findings were correlated with sputum cytology results, SCT-detected pulmonary nodules and surveillance-detected cancers. To date, 186 have been enrolled with 169 completing the surveillance procedures. RESULTS Thirteen lung cancers (7%) were detected in the 169 subjects who have completed all three surveillance studies to date. Pre-malignant changes were common and 66% of patients had squamous metaplasia or worse. Conventional sputum cytology missed 100% of the dysplasias and 68% of the metaplasias detected by AFB, and failed to detect any cases of carcinoma or carcinoma-in-situ in this patient cohort. Sputum cytology exhibited 33% sensitivity and 64% specificity for the presence of metaplasia. Seven of 13 lung cancers (58%) were stage Ia or less, including three patients with squamous cell carcinoma. Patients with peripheral pulmonary nodules identified by SCT scanning of the chest were 3.16 times more likely to exhibit pre-malignant changes on AFB (p<0.001). CONCLUSION Bimodality surveillance will detect central lung cancer and pre-malignancy in patients with multiple lung cancer risk factors, even when conventional sputum cytology is negative. AFB should be considered in high-risk patients, regardless of sputum cytology findings.
Collapse
Affiliation(s)
- Gregory Loewen
- Pulmonary Division, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Jang TW. Autofluorescence Bronchoscopy. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.62.4.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tae Won Jang
- Department of Internal Medicine College of Medicine, Kosin University, Busan, Korea
| |
Collapse
|
40
|
Marcus PM, Bergstralh EJ, Zweig MH, Harris A, Offord KP, Fontana RS. Extended lung cancer incidence follow-up in the Mayo Lung Project and overdiagnosis. J Natl Cancer Inst 2006; 98:748-56. [PMID: 16757699 DOI: 10.1093/jnci/djj207] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A troubling aspect of cancer screening is the potential for overdiagnosis, i.e., detection of disease that, in the absence of screening, would never have been diagnosed. Overdiagnosis is of particular concern in lung cancer screening because newer screening modalities can identify small nodules of unknown clinical significance. Previously published analyses of data from the Mayo Lung Project, a large randomized controlled trial conducted among 9211 male cigarette smokers in the 1970s and early 1980s indicated that overdiagnosis might exist in lung cancer screening. At the end of follow-up (July 1, 1983), no difference in lung cancer mortality was observed, but an excess of 46 cases in the intervention arm suggested overdiagnosis. Because that excess could instead have resulted from short follow-up time, we investigated this possibility by conducting long-term lung cancer incidence follow-up. METHODS We investigated the lung cancer status through 1999 of the 7118 participants in the Mayo Lung Project who were alive and without diagnosed lung cancer in 1983 by use of medical records, surveys mailed to participants or next-of-kin, and state death certificates. RESULTS Information was available for 6101 participants, including 811 with inconclusive lung cancer status. From November 1971 through December 31, 1999, 585 participants in the intervention arm and 500 in the usual-care arm were diagnosed with lung cancer. CONCLUSIONS The persistence of excess cases in the intervention arm after 16 additional years of follow-up provides continued support for overdiagnosis in lung cancer screening.
Collapse
Affiliation(s)
- Pamela M Marcus
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20895-7354, USA.
| | | | | | | | | | | |
Collapse
|
41
|
Ohira T, Suga Y, Nagatsuka Y, Usuda J, Tsuboi M, Hirano T, Ikeda N, Kato H. Early-stage lung cancer: diagnosis and treatment. Int J Clin Oncol 2006; 11:9-12. [PMID: 16508723 DOI: 10.1007/s10147-005-0553-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Indexed: 12/25/2022]
Affiliation(s)
- Tatsuo Ohira
- Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Tokyo, 160-0023, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Autofluorescence bronchoscopy (AFB) is one of the newly developed diagnostic tools to detect the pre-cancerous lesions in the bronchial tissue. The utility of DLight/AFB in the detection of pre-cancerous lesions was compared to the standard white light bronchoscopy (WLB). In 113 patients (male 106, female 7), who visited hospital for evaluation of lung cancer, WLB and AFB were done and 364 biopsy specimens were obtained from November 2001 to August 2002. The bronchoscopic findings on WLB and AFB were compared to the pathological findings. The pathologic diagnoses of the specimens were as follows: normal in 96; hyperplasia in 69; metaplasia in 32; mild dysplasia in 13, moderate dysplasia in 6, severe dysplasia in 4; carcinoma in situ in 6; invasive carcinoma in 57. The relative sensitivity of adjunctive AFB to WLB vs. WLB alone was 1.5 in moderate dysplasia or worse lesions, and 3.2 in intraepithelial neoplasia. The specificity of adjunctive AFB and WLB alone were 0.91 and 0.5, respectively. The adjunctive AFB to the standard WLB increased the detection rate of the localized pre-invasive lesions. However, there was high rate of false positive in AFB.
Collapse
Affiliation(s)
- Tae Won Jang
- Department of Internal Medicine, Kosin University College of Medicine, Suh-gu, Busan, Korea.
| | | | | | | |
Collapse
|
43
|
Kwon SJ, Lee YS, Joung MK, Lee YJ, Jang PS, Lee JE, Chung CU, Park HS, Jung SS, Kim SY, Kim JO. Primary Synchronous Lung Cancer Detected using Autofluorescence Bronchoscopy. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.60.6.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sun Jung Kwon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yun Seun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Mi Kyong Joung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yu Jin Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Pil Soon Jang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Jeung Eyun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Chae Uk Chung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hee Sun Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sung Soo Jung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sun Young Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Ock Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| |
Collapse
|
44
|
Kawaguchi T, Matsumura A, Iuchi K, Ishikawa S, Maeda H, Fukai S, Komatsu H, Kawahara M. Second primary cancers in patients with stage III non-small cell lung cancer successfully treated with chemo-radiotherapy. Jpn J Clin Oncol 2005; 36:7-11. [PMID: 16368713 DOI: 10.1093/jjco/hyi208] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients successfully treated for non-small cell lung cancer (NSCLC) remain at risk for developing second primary cancer (SPC). The purpose of the current study is to assess the incidence of SPC and the impact of smoking status on the SPC in long-term survivors with stage III NSCLC after chemo-radiotherapy. METHODS Using the database from the Japan National Hospital Lung Cancer Study Group between 1985 and 1995, information was obtained on 62 patients who were more than 3 years disease-free survivors. Details of clinical information and most smoking history were available from the questionnaire. RESULTS Nine of the 62 patients developed SPC 3.9-12.2 years (median, 6.2 years) after the initiation of the treatment. The site of SPC was 2 lung, 1 esophagus, 2 stomach, 1 colon, 1 breast, 1 skin and 1 leukemia. Among these nine, three cancers occurred inside the radiation field. The relative risk of any SPC was 2.8 [95% confidence interval (CI) 1.3-5.3]. The risk changed with the passage of time and it increased significantly (5.2 times at or beyond 7 years) after the treatment. In univariate analysis, the patients who were male, had more cumulative smoking and continued smoking, had an increased risk of SPC [relative risk (RR) 2.7, CI 1.1-5.3; RR 3.0, CI 1.2-6.2; RR 5.2, CI 1.6-11.7, respectively]. In multivariate analysis, factors including smoking status and histological type had no effect on the development of a SPC. CONCLUSION The patients with stage III NSCLC successfully treated with chemo-radiotherapy were at risk for developing SPC and this risk increased with time.
Collapse
|
45
|
Feller-Kopman D, Lunn W, Ernst A. Autofluorescence Bronchoscopy and Endobronchial Ultrasound: A Practical Review. Ann Thorac Surg 2005; 80:2395-401. [PMID: 16305928 DOI: 10.1016/j.athoracsur.2005.04.084] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 04/20/2005] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
Endobronchial ultrasound (EBUS) and autofluorescence bronchoscopy (AFB) are the two technologies to have the largest impact on diagnostic bronchoscopy in the last forty years. The AFB utilizes inherent tissue properties to identify preinvasive lesions of the central airways. The EBUS can accurately define airway invasion versus compression from tumors, guide transbronchial needle aspiration of hilar and mediastinal lymph nodes, and predict, based on ultrasound morphology, whether peripheral nodules are benign or malignant. It is also extremely useful for determining the proximal and distal extent of tumors in and around the airway, and aid in surgical planning. This article will review the principles and clinical applications of these two technologies.
Collapse
Affiliation(s)
- David Feller-Kopman
- Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
| | | | | |
Collapse
|
46
|
Miyazu YM, Miyazawa T, Hiyama K, Kurimoto N, Iwamoto Y, Matsuura H, Kanoh K, Kohno N, Nishiyama M, Hiyama E. Telomerase Expression in Noncancerous Bronchial Epithelia Is a Possible Marker of Early Development of Lung Cancer. Cancer Res 2005; 65:9623-7. [PMID: 16266979 DOI: 10.1158/0008-5472.can-05-0976] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Centrally located lung cancers in smokers frequently associated with subsequent primary tumors. We evaluated the telomerase expression chronologically in noncancerous epithelia as a risk factor of susceptibility to lung cancer development. Telomerase protein expression was examined in situ by immunohistochemistry in 26 noncancerous bronchial epithelia adjacent to centrally located early-stage lung cancers in sequential 23 patients treated by photodynamic therapy or surgery among 206 patients who underwent autofluorescence bronchoscopy from 1997 to 2003. Among the 15 lesions in 12 patients treated by photodynamic therapy alone, 11 lesions achieved complete remission after photodynamic therapy, and none of their noncancerous bronchial epithelia was telomerase positive. On the contrary, in the remaining four lesions, either recurrence or secondary lung cancer developed adjacent to the successfully treated primary cancer within 26 months, and the telomerase protein expression in noncancerous epithelia was detected before the secondary cancer development (P < 0.001). The overall relationship of human telomerase reverse transcriptase positivity in noncancerous epithelia and subsequent lung cancer development, including patients treated by radiation or surgery, showed higher significance (P < 0.0001). Histologically “normal” bronchial epithelia in smokers may unphysiologically express telomerase as a field, and such epithelia are likely susceptible to develop lung cancer. We propose that ectopic expression of telomerase in bronchial epithelia may precede transformation in human lung cancer development and that detection of telomerase protein in noncancerous bronchial epithelia will become a useful marker detecting high-risk patients for lung cancer development.
Collapse
|
47
|
Breuer RH, Pasic A, Smit EF, van Vliet E, Vonk Noordegraaf A, Risse EJ, Postmus PE, Sutedja TG. The Natural Course of Preneoplastic Lesions in Bronchial Epithelium. Clin Cancer Res 2005. [DOI: 10.1158/1078-0432.537.11.2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To study the natural history of preneoplastic lesions in the bronchial mucosa of the individuals at risk.
Patients and Methods: White light and autofluorescence bronchoscopy examinations have been done in 52 individuals harboring 134 preneoplastic lesions (WHO criteria). End points were the development of carcinoma in situ (CIS) or squamous cell cancer (SCC) or the highest category of dysplasia up until March 1, 2003 for the remaining preneoplastic lesions.
Results: Distribution and outcome of preneoplastic lesions have been found to be unrelated to various risk factors such as smoking history, past history of cancer, or chronic obstructive pulmonary disease. Nonstepwise changes of preneoplastic lesions are seen. Regression rate has been 54%. Progression to CIS/SCC has been 13.4% (18 of 134) and was for severe dysplasia, significantly higher (P < 0.003) than preneoplastic lesions showing lower-grade dysplasia (squamous metaplasia, mild and moderate dysplasia). Time to progression was not significantly different. However, when analyzed per individual, no significant difference of progression rate between individuals with or without severe dysplasia was seen (39% versus 26%; P = 0.36).
Conclusions: The 54% regression rate of all preneoplastic lesions, 26% to 39% progression rate to CIS/SCC of individuals with lower-grade dysplasia or severe dysplasia with no significant difference in progression rate and time to progression combined with nonstepwise histologic changes unrelated to the initial histologic grading indicate that one cannot differentiate the potentially more malignant preneoplastic lesions among the many preneoplastic lesions present in the bronchial mucosa. The initial WHO classification of any preneoplastic lesion cannot be reliably used for accurate risk assessment of field carcinogenesis.
Collapse
Affiliation(s)
| | | | | | | | | | - Elle J. Risse
- 2Pathology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | | | | |
Collapse
|
48
|
Pasic A, Postmus PE, Sutedja TG. What is early lung cancer? A review of the literature. Lung Cancer 2004; 45:267-77. [PMID: 15301867 DOI: 10.1016/j.lungcan.2004.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2003] [Revised: 01/26/2004] [Accepted: 01/29/2004] [Indexed: 01/02/2023]
Abstract
The dismal cure rate of patients with lung cancer and the stage shift hypothesis have propelled the interest to perform screening at large, despite that previous randomized clinical trials failed to show any mortality benefit and the controversial issue of overdiagnosis. Due to early detection programs, a larger number of individuals at risk will be found to harbor small and potentially malignant early stage lesions. The application of non- and minimal invasive techniques for early detection, staging and treatment will become increasingly important. This review deals with the available clinical, surgical and pathological data focusing on early lung cancer lesions < or =1 cm. Literature data from both centrally located and parenchymal lesions < or =3 cm. have been analyzed. For all sub-centimeter lesions, minimal invasive staging and treatment approaches must still be considered inappropriate. Less invasive and less extensive treatment methods may be considered in high risk individuals with < or =1 cm. peripheral lesion showing > or =50 ground glass opacity on high resolution CT scan and those with superficial lesion in their central airways without deeper tumor invasion in the bronchial wall. Caution is necessary, however, as clinical staging remains inferior to pathological staging which is based on tissue samples collected after complete tumor removal and mediastinal lymph nodes dissection have been performed.
Collapse
Affiliation(s)
- Arifa Pasic
- Department of Pulmonary Medicine, Vrije Universiteit Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | | |
Collapse
|
49
|
Abstract
Detection of clinically occult lung neoplasms may represent an opportunity for early curative intervention. Fluorescent bronchoscopy is a sensitive technique for detecting early endobronchial tumors that may be combined with CT scanning as part of a comprehensive lung cancer screening program. Identification and longitudinal follow-up of dysplastic endobronchial changes with fluorescent bronchoscopy should facilitate studies of chemoprevention and further knowledge regarding the natural history of these lesions. Analysis of bronchial epithelium with novel techniques such as genomic hybridization and gene expression arrays might provide even better predictors of progression of dysplastic endobronchial lesions.
Collapse
Affiliation(s)
- Sebastien Gilbert
- Division of Thoracic and Foregut Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite C800, Pittsburgh, PA 15213, USA
| | | | | |
Collapse
|
50
|
Zeng H, McWilliams A, Lam S. Optical spectroscopy and imaging for early lung cancer detection: a review. Photodiagnosis Photodyn Ther 2004; 1:111-22. [DOI: 10.1016/s1572-1000(04)00042-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|