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Bejani M, Taghizadieh A, Samad‐Soltani T, Asadzadeh A, Rezaei‐Hachesu P. The effects of virtual reality-based bronchoscopy simulator on learning outcomes of medical trainees: A systematic review. Health Sci Rep 2023; 6:e1398. [PMID: 37415680 PMCID: PMC10320745 DOI: 10.1002/hsr2.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Background and Aims Conventional medical training routes of bronchoscopy may decrease patients' comfort and increase procedure-related morbidity. Virtual reality (VR)-based bronchoscopy is a beneficial and safe solution for teaching trainees. The aim of this systematic review was to study the effectiveness of VR-based bronchoscopy simulators on the learning outcomes of medical trainees. Methods Well-known sources (i.e., Scopus, ISI Web of Science, and Medline via PubMed) were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on December, 2021. Peer-reviewed English papers that used VR-based simulation for bronchoscopy training were included. The articles that were studying other technologies, or those that were unrelated to the topic, were excluded. The risk of bias was assessed using the Joanna Briggs Institute checklists for quasi-experimental studies and randomized controlled trials (RCTs). Results Out of 343 studies, 8 of them met our inclusion criteria. An appropriate control group and statistical analysis were the most common and unavoidable sources of bias in included non-RCTs, and lack of blinding in participants was the most common source of bias in RCTs. The included studies evaluated learning outcomes regarding dexterity (N = 5), speed (N = 3), the accuracy of procedures (N = 1), and the need for verbal assistance (N = 1). Based on the results, 100% (5/5) and 66% (2/3) of studies showed that the use of VR-based simulation on the learning outcomes of medical trainees led to improvement in manual ability (i.e., dexterity) and swiftness of execution (i.e., speed in performance), respectively. Additionally, improving the accuracy of subjects' performance, and reducing the need for verbal guidance and physical assistance was reported in studies that evaluated these variables. Conclusion VR bronchoscopy simulator as a training method for teaching medical trainees, especially for novices has the potential to improve medical trainees' performance and reduce complications. Further studies are needed to evaluate the positive effects of VR-based simulation on the learning outcomes of medical trainees.
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Affiliation(s)
- Mahmud Bejani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Ali Taghizadieh
- Department of Emergency Medicine, Tuberculosis and Lung Research Center, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
| | - Taha Samad‐Soltani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Afsoon Asadzadeh
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Peyman Rezaei‐Hachesu
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
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Marie MM, Jaber SN, Ahmed OF, Kakamad FH, Amin BJH, Tahir SH, Salih AM, Abdalla SH, Ali RK, Rashid RJ, Mohammed SH, Mustafa SM, Ali RA, Rahim HM. Resectability in bronchogenic carcinoma: A single‑center experience. Oncol Lett 2023; 25:219. [PMID: 37153056 PMCID: PMC10157354 DOI: 10.3892/ol.2023.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/09/2023] [Indexed: 05/09/2023] Open
Abstract
Bronchogenic carcinoma comprises >90% of primary lung tumors. The present study aimed to estimate the profile of patients with bronchogenic carcinoma and assess the cancer resectability in newly diagnosed patients. This is a single-center retrospective review conducted over a period of 5 years. A total of 800 patients with bronchogenic carcinoma were included. The diagnoses were mostly proven with either cytological examination or histopathological diagnosis. Sputum analysis, cytological examination of pleural effusion and bronchoscopic examination were performed. Lymph node biopsy, minimally invasive procedures (mediastinoscopy and video-assisted thoracoscopic surgery), tru-cut biopsy or fine-needle aspiration was used to obtain the samples for diagnosis. The masses were removed by lobectomy and pneumonectomy. The age range was between 22 and 87 years, with a mean age of 62.95 years. Males represented the predominant sex. Most of the patients were smokers or ex-smokers. The most common symptom was a cough, followed by dyspnea. Chest radiography revealed abnormal findings in 699 patients. A bronchoscopic evaluation was performed for the majority of patients (n=633). Endobronchial masses and other suggestive malignancy findings were present in 473 patients (83.1%) of the 569 who underwent fiberoptic bronchoscopy. Cytological and/or histopathological samples of 581 patients (91.8%) were positive. Small cell lung cancer (SCLC) occurred in 38 patients (4.75%) and non-SCLC was detected in 762 patients (95.25%). Lobectomy was the main surgical procedure, followed by pneumonectomy. A total of 5 patients developed postoperative complications without any mortality. In conclusion, bronchogenic carcinoma is rapidly increasing without a predilection for sex in the Iraqi population. Advanced preoperative staging and investigation tools are required to determine the rate of resectability.
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Affiliation(s)
| | - Sabah N. Jaber
- Department of Surgery, Medical City, Baghdad 10011, Republic of Iraq
| | - Okba F. Ahmed
- Department of Surgery, Mousl Cardiac Center, Mousl 41001, Republic of Iraq
| | - Fahmi H. Kakamad
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- College of Medicine, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Correspondence to: Dr Fahmi H. Kakamad, College of Medicine, University of Sulaimani, Doctor City, Building 11, Apartment 50, Madam Mitterrand Street, Sulaimani 46000, Republic of Iraq, E-mail:
| | - Bnar J. Hama Amin
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Soran H. Tahir
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- College of Medicine, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Abdulwahid M. Salih
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- College of Medicine, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Shalaw H. Abdalla
- Department of Oncology, Hiwa Cancer Hospital, Sulaimani 46000, Republic of Iraq
| | - Razhan K. Ali
- Department of Cardiothoracic and Vascular Surgery, Shar Hospital, Sulaimani 46000, Republic of Iraq
| | - Rezheen J. Rashid
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Department of Oncology, Hiwa Cancer Hospital, Sulaimani 46000, Republic of Iraq
| | - Shvan H. Mohammed
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Shevan M. Mustafa
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Department of Medical Laboratory Technology, Al Qalam University College, Kirkuk 36001, Republic of Iraq
| | - Rebwar A. Ali
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
| | - Hawbash M. Rahim
- Kscien Organization for Scientific Research, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Smart Health Tower, University of Sulaimani, Sulaimani 46000, Republic of Iraq
- Department of Medical Laboratory Science, Komar University of Science and Technology, Sulaimani 46000, Republic of Iraq
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Wang Q, Zeng A, Zhu M, Song L. Dual inhibition of EGFR‑VEGF: An effective approach to the treatment of advanced non‑small cell lung cancer with EGFR mutation (Review). Int J Oncol 2023; 62:26. [PMID: 36601768 PMCID: PMC9851127 DOI: 10.3892/ijo.2023.5474] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/01/2022] [Indexed: 01/04/2023] Open
Abstract
On a global scale, the incidence and mortality rates of lung cancer are gradually increasing year by year. A number of bad habits and environmental factors are associated with lung cancer, including smoking, second‑hand smoke exposure, occupational exposure, respiratory diseases and genetics. At present, low‑dose spiral computed tomography is routinely the first choice in the diagnosis of lung cancer. However, pathological examination is still the gold standard for the diagnosis of lung cancer. Based on the classification and stage of the cancer, treatment options such as surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy are available. The activation of the EGFR pathway can promote the survival and proliferation of tumor cells, and the VEGF pathway can promote the formation of blood vessels, thereby promoting tumor growth. In non‑small cell lung cancer (NSCLC) with EGFR mutation, EGFR activation can promote tumor growth by promoting VEGF upregulation through a hypoxia‑independent mechanism. The upregulation of VEGF can make tumor cells resistant to EGFR inhibitors. In addition, the expression of the VEGF signal is also affected by other factors. Therefore, the use of a single EGFR inhibitor cannot completely inhibit the expression of the VEGF signal. In order to overcome this problem, the combination of VEGF inhibitors and EGFR inhibitors has become the method of choice. Dual inhibition can not only overcome the resistance of tumor cells to EGFR inhibitors, but also significantly increase the progression‑free survival time of patients with NSCLC. The present review discusses the associations between the EGFR and VEGF pathways, and the characteristics of dual inhibition of the EGFR‑VEGF pathway.
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Affiliation(s)
- Qian Wang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, P.R. China
| | - Anqi Zeng
- Institute of Translational Pharmacology and Clinical Application, Sichuan Academy of Chinese Medical Science, Chengdu, Sichuan 610041, P.R. China
| | - Min Zhu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, P.R. China,Correspondence to: Dr Linjiang Song or Dr Min Zhu, School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Chengdu, Sichuan 611137, P.R. China, E-mail: , E-mail:
| | - Linjiang Song
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, P.R. China,Correspondence to: Dr Linjiang Song or Dr Min Zhu, School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Chengdu, Sichuan 611137, P.R. China, E-mail: , E-mail:
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Gene Mutation Analysis in Non-Small Cell Lung Cancer Patients using Bronchoalveolar Lavage Fluid and Tumor Tissue as Diagnostic Markers. Int J Biol Markers 2014; 29:e328-36. [PMID: 24519547 DOI: 10.5301/jbm.5000075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 12/24/2022]
Abstract
Non-small cell lung cancer (NSCLC) is one of the main causes of cancer death in the world. Early detection of NSCLC can improve its outcome. The aim of this study was to identify the mutations of the KRAS and p53 genes in bronchoalveoar lavage (BAL) fluid for the early detection of peripheral NSCLC. We examined the DNA obtained from the tumor, nearby normal lung tissue, and matched BAL fluid for mutations in the KRAS and p53 genes; the material was obtained from 48 patients with peripheral NSCLC, and was analyzed by PCR-single strand conformation polymorphism and DNA sequencing. BAL fluids from 26 patients with benign lung disease were used as controls. Positive rates of KRAS and p53 mutations were distributed as follows: in NSCLC tissue, 52% and 58%; in BAL fluid of NSCLC patients, 38% and 44%; in normal lung tissue, 6% and 4%; and in BAL fluid of patients with benign lung disease, 8% and 4%. The combined detection of both KRAS and p53 mutations yielded a sensitivity of 66% for the diagnosis of peripheral NSCLC, which is markedly higher than that of cytology plus histology by first bronchoscopy (38%, p=0.008). In each patient with the 2 gene mutations in BAL fluid, mutation type and location were the same as those of the primary tumor. Our study indicates that the detection of the KRAS and p53 mutations in BAL fluids could be a helpful addition to cytology and histology examination for the diagnosis of peripheral NSCLC.
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Capalbo E, Peli M, Lovisatti M, Cosentino M, Mariani P, Berti E, Cariati M. Trans-thoracic biopsy of lung lesions: FNAB or CNB? Our experience and review of the literature. Radiol Med 2013; 119:572-94. [DOI: 10.1007/s11547-013-0360-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 05/13/2013] [Indexed: 11/29/2022]
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Zhu T, Zhang X, Xu J, Tian J, Li H, Liu D, Chen R, Li Q, Bai C. Endobronchial ultrasound guided-transbronchial needle aspiration vs. conventional transbronchial needle aspiration in the diagnosis of mediastinal masses: A meta-analysis. Mol Clin Oncol 2013; 2:151-155. [PMID: 24649325 DOI: 10.3892/mco.2013.206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/17/2013] [Indexed: 12/25/2022] Open
Abstract
Whether an endobronchial ultrasound (EBUS) is required for transbronchial needle aspiration (TBNA) in the diagnosis of mediastinal masses is currently a disputed subject. Previous studies have demonstrated that EBUS-TBNA performs better compared to conventional TBNA as it is capable of sampling in real-time compared with conventional TBNA. However, some clinicians consider conventional TBNA to be sufficient for diagnosis. In this meta-analysis, we evaluated these two methods according to diagnostic yield. A search was conducted through PubMed, Embase and the proceedings of major conferences, for studies comparing TBNA with EBUS-TBNA in the diagnosis of mediastinal masses. The identified studies were evaluated for publication bias and heterogeneity. The primary outcome was diagnostic yield. Pooled odds ratio (OR) estimated with 95% confidence intervals (CIs) was calculated using the fixed-effects model. Five studies, including a total of 407 patients, were included in the meta-analysis. The EBUS-TBNA arm was associated with a significantly higher OR compared to that of the TBNA arm in terms of diagnostic yield (OR=2.72, 95% CI: 1.72-4.30, P<0.001). There was no evidence of heterogeneity (I2=0%, P=0.540) or publication bias (Egger's test, P=0.568; Begg-Mazumdar test, P=0.806). In conclusion, EBUS-TBNA and conventional TBNA are safe and provide good diagnostic yield in the diagnosis of hilar and mediastinal masses and lymphadenopathies; however, EBUS-TBNA performs better compared to conventional TBNA, with a shorter aspiration time and higher sensitivity.
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Affiliation(s)
- Tianyi Zhu
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Xinji Zhang
- Departments of Health Statistics, Second Military Medical University, Shanghai
| | - Junnan Xu
- Pathophysiology, Second Military Medical University, Shanghai
| | - Jun Tian
- Department of Immunology, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Hui Li
- Departments of Health Statistics, Second Military Medical University, Shanghai
| | - Dan Liu
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Ruohua Chen
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Qiang Li
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Second Military Medical University, Shanghai
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7
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Abstract
BACKGROUND Guidelines recommend multiple types of cytologic and tissue samplings in the diagnosis of lung cancer by bronchoscopy, but differences of opinion exist as to the relative value of bronchial brushings and endobronchial or transbronchial biopsies. Our objective was to determine concordance of these procedures by a test of symmetry in a historical cohort referred to the pulmonary diagnostic laboratory. METHODS From 1988 to 2001, patients with pathologic confirmation of primary lung cancer were examined by standard bronchoscopic techniques of that period. An electronic medical record system was used, with statistical analysis of symmetry between brushings and biopsies establishing the diagnosis. RESULTS Of 968 patients, 98% had bronchoscopy for 624 central and 322 peripheral suspect lesions. Bronchial brushings from 915 patients confirmed pulmonary malignancy in 811 (89%) patients. Endobronchial or transbronchial biopsies from 739 patients showed lung cancer in 603 (82%) cases. Bronchial washings in 16 patients and transthoracic needle biopsies in 30 patients established diagnosis. Transbronchial needle aspiration of mediastinal nodes identified metastases in 94 patients. Only 14 patients required a surgical procedure for diagnosis, but 188 received surgical excision as primary treatment. Statistical evaluation used only patients with both bronchial brushings and endobronchial or transbronchial biopsies. Analysis by a test of symmetry showed a significant difference (P<0.0001). CONCLUSIONS Positive, suspicious, and negative specimens were consistent, with bronchial brushings being more sensitive with a lower false-negative rate than endobronchial or transbronchial biopsies. Multiple techniques are recommended for bronchoscopic confirmation of lung cancer, but bronchial brushings should be collected initially, as technical or patient limitations might preclude diagnostic tissue biopsies.
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8
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Li J, Chen P, Mao CM, Tang XP, Zhu LR. Evaluation of diagnostic value of four tumor markers in bronchoalveolar lavage fluid of peripheral lung cancer. Asia Pac J Clin Oncol 2013; 10:141-8. [PMID: 23551358 DOI: 10.1111/ajco.12066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 01/23/2023]
Abstract
AIM The diagnostic role of carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) antigen, Cyfra 21-1 and neuron-specific enolase (NSE) in the bronchoalveolar lavage fluid (BALF) for lung cancer is still controversial. The aim of this study was to evaluate the diagnostic value of these four tumor markers in BALF for peripheral lung cancer. METHODS We measured and compared the levels of CEA, SCC, Cyfra21-1 and NSE in BALF in 42 patients with peripheral lung cancer and 22 patients with benign lung disease. In the patients with peripheral lung cancer, the BAL was separately performed in the bronchus of the tumor-bearing lung and in the corresponding bronchus of the opposite healthy lung. RESULTS The levels of CEA, SCC, Cyfra21-1 and NSE were significantly elevated in BALF from the tumor-bearing lung compared with the opposite healthy lung in the lung cancer patients (P < 0.001) or the benign lung disease patients (P < 0.005). The diagnostic sensitivities of Cyfra21-1 (86 and 76%), with a specificity of 91%, were the highest among the four tumor markers for the tumor-bearing lung versus the opposite healthy lung and benign lung disease. The combination of Cyfra21-1 and CEA increased the sensitivity to 93 and 86 percent, respectively. CONCLUSION The assay of these tumor markers in BALF may be used as a diagnostic tool to complement a cytological examination in the diagnosis of peripheral lung cancer.
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Affiliation(s)
- Jian Li
- Department of Pulmonary Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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9
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Lankarani A, Wallace MB. Endoscopic ultrasonography/fine-needle aspiration and endobronchial ultrasonography/fine-needle aspiration for lung cancer staging. Gastrointest Endosc Clin N Am 2012; 22:207-19, viii. [PMID: 22632944 DOI: 10.1016/j.giec.2012.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This article reviews different techniques available for diagnosis and staging of patients with non-small cell lung cancer (NSCLC). The advantages and disadvantages of each staging method are highlighted. The role of the gastroenterologist in NSCLC staging is explored. A new algorithm is proposed for the staging of NSCLC that incorporates endoscopic and endobronchial ultrasonography for mediastinal staging in patients with intrathoracic disease.
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Affiliation(s)
- Ali Lankarani
- Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA
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10
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The results of computed tomography guided tru-cut transthoracic biopsy: complications and related risk factors. Wien Klin Wochenschr 2011; 123:79-82. [DOI: 10.1007/s00508-011-1538-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
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11
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Fan YB, Wang QS, Ye L, Wang TY, Wu GP. Clinical application of the SurePath liquid-based Pap test in cytological screening of bronchial brushing for the diagnosis of lung cancer. Cytotechnology 2010; 62:53-9. [PMID: 20401634 DOI: 10.1007/s10616-010-9261-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 03/08/2010] [Indexed: 11/29/2022] Open
Abstract
The SurePath liquid-based Pap test (LPT) is successfully and widely used to assess sputum cytology. This study aimed to compare the cytological findings and diagnostic sensitivity of LPT with those of the conventional Pap smear (CPS) method for diagnosing lung cancer. Bronchial brushing specimens from 204 patients diagnosed with lung cancer were studied. LPT slides showed decreased areas of cell monolayers, a clearer background and distinct, stereoscopic cytological features. The LPT had a significantly higher diagnostic sensitivity for lung cancer (71.6%) than the CPS method (57.8%, p < 0.05), particularly for small cell lung carcinoma and >2 cm lesions (p < 0.05). Combination of the LPT with the CPS method showed obviously higher diagnostic sensitivity for the detection of adenocarcinoma (63.6%), central lesions (85.0%) and >2 cm lesions (81.4%) compared with the CPS method alone (p < 0.05, p < 0.01). Thus, LPT is a useful and easily performed technique that can be widely applied, and is suitable for the early diagnosis of lung cancer.
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Affiliation(s)
- Yi-Bo Fan
- Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, 110001, Shenyang, China,
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12
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Estadificación del cáncer de pulmón mediante punción aspirativa con aguja fina guiada por ultrasonografía endoscópica y endobronquial. Arch Bronconeumol 2009; 45:603-10. [DOI: 10.1016/j.arbres.2008.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 08/27/2008] [Accepted: 09/02/2008] [Indexed: 11/15/2022]
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Usefulness of diffusion-weighted MR imaging in the evaluation of pulmonary lesions. Eur Radiol 2009; 20:807-15. [PMID: 19862533 DOI: 10.1007/s00330-009-1629-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 08/16/2009] [Accepted: 08/20/2009] [Indexed: 12/20/2022]
Abstract
PURPOSE The role of diffusion-weighted MR imaging (DWI) in the differential diagnosis of pulmonary malignant tumours and solid benign lesions was investigated. METHODS Sixty-two patients with 66 lesions underwent conventional MRI and DWI (diffusion factor of 0 and 500 s/mm(2)) examinations with 1.5-T MRI. The signal intensity of DWI images was observed and the apparent diffusion coefficient (ADC) values of the lesions were measured. Statistical analyses were performed with the independent samples t test, Pearson's chi-square test and receiver operating characteristic (ROC) analysis. RESULTS The signal intensities of pulmonary malignant tumours and solid benign lesions were not significantly different, but the ADC value of benign lesions was statistically higher than that of malignant tumours (p = 0.001). By ROC analysis, the optimal threshold of ADC was 1.400 x 10(-3) mm(2)/s and the sensitivity and specificity were 83.3% and 74.1%, respectively. There were statistical differences between small cell carcinoma (SCLC) and non-small cell carcinoma (NSCLC) as well; the former was lower than the latter (p = 0.007). CONCLUSION Our data indicate that quantitative analysis of ADC values may help diagnose or distinguish pulmonary lesions, and it also provides a promising method for characterising the pulmonary masses.
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Suda Y, Tanaka A, Hayashi K, Shindoh Y, Iijima H. A novel needle-type sampling device for flexible ultrathin bronchoscopy. TOHOKU J EXP MED 2008; 216:81-93. [PMID: 18719342 DOI: 10.1620/tjem.216.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diagnosis of suspected cancer in the periphery of the lung is difficult. A flexible ultrathin bronchoscope has been developed for the diagnosis of peripherally located pulmonary lesions that cannot be reached with the sampling devices for standard flexible bronchoscopes. The diagnostic yield with forceps and a brush for ultrathin bronchoscopes, however, is not adequate, especially when a lesion is not exposed to the bronchial lumen. We have thus developed a novel needle-type sampling device and tested its yield in transbronchial cytology. The device consists of an elongated dental H-file (0.4 mm in diameter and 110 cm in length), a housing sheath (1.0 mm in outer diameter), and a novel handle, which enables rapid out-and-in motion of the needle. Ten consecutive patients with a peripheral pulmonary lesion who had an indication for diagnostic procedure with a flexible ultrathin bronchoscope were enrolled. The optimal bronchial route to the lesion was analyzed with virtual bronchoscopy in a data set obtained with high-resolution computed tomography, and a novel bronchial route labeling system (prior-ridge-based relative orientation nomenclature) was employed to guide insertion of the bronchoscope. Sampling with the novel needle was performed prior to use of the forceps and brush under conventional fluoroscopy. In all the cases, sampling with the needle was successful and the amount of the specimen was sufficient for cytology. Our novel sampling system with flexible ultrathin bronchoscopes may contribute to accurate and minimally invasive diagnosis of peripheral pulmonary lesions.
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Affiliation(s)
- Yuji Suda
- Department of Respiratory Medicine, Sendai City Medical Center, Sendai, Japan.
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15
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Demiral AN, Alicikus ZA, Işil Ugur V, Karadogan I, Yöney A, Andrieu MN, Yalman D, Pak Y, Aksu G, Ozyigit G, Ozkan L, Kilçiksiz S, Koca S, Caloğlu M, Yavuz AA, Başak Cağlar H, Beyzadeoğlu M, Iğdem S, Serin M, Kaplan B, Koç M, Korkmaz E, Karakoyun-Celik O, Dinçer S, Kinay M. Patterns of care for lung cancer in radiation oncology departments of Turkey. Int J Radiat Oncol Biol Phys 2008; 72:1530-7. [PMID: 18707825 DOI: 10.1016/j.ijrobp.2008.03.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Revised: 11/19/2007] [Accepted: 03/11/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the patterns of care for lung cancer in Turkish radiation oncology centers. METHODS AND MATERIALS Questionnaire forms from 21 of 24 (87.5%) centers that responded were evaluated. RESULTS The most frequent histology was non-small cell lung cancer (NSCLC) (81%). The most common postoperative radiotherapy (RT) indications were close/(+) surgical margins (95%) and presence of pN2 disease (91%). The most common indications for postoperative chemotherapy (CHT) were ">/= IB" disease (19%) and the presence of pN2 disease (19%). In Stage IIIA potentially resectable NSCLC, the most frequent treatment approach was neoadjuvant concomitant chemoradiotherapy (CHRT) (57%). In Stage IIIA unresectable and Stage IIIB disease, the most frequent approach was definitive concomitant CHRT (91%). In limited SCLC, the most common treatment approach was concomitant CHRT with cisplatin+etoposide for cycles 1-3, completion of CHT to cycles 4-6, and finally prophylactic cranial irradiation in patients with complete response (71%). Six cycles of cisplatin + etoposide CHT and palliative thoracic RT, when required, was the most commonly used treatment (81%) in extensive SCLC. Sixty-two percent of centers did not have endobronchial brachytherapy (EBB) facilities. CONCLUSION There is great variation in diagnostic testing, treatment strategies, indications for postoperative RT and CHT, RT features, and EBB availability for LC cases. To establish standards, national guidelines should be prepared using a multidisciplinary approach.
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Affiliation(s)
- Ayşe Nur Demiral
- Dokuz Eylul University Medical School, Department of Radiation Oncology, Izmir, Turkey
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Lee HS, Kwon SY, Kim DK, Yoon HI, Lee SM, Lee JH, Lee CT, Chung HS, Han SK, Shim YS, Yim JJ. Bronchial washing yield before and after forceps biopsy in patients with endoscopically visible lung cancers. Respirology 2007; 12:277-82. [PMID: 17298463 DOI: 10.1111/j.1440-1843.2006.01001.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The need for routine use of bronchial washing in addition to forceps biopsy has been debated in the diagnosis of endoscopically visible lung tumours. Moreover, the optimal sequence for obtaining bronchial washing and forceps biopsy specimens from endoscopically visible tumours through a flexible bronchoscope has not been well established. METHODS A multicentre 13-month prospective randomized study was performed. Two hundred and thirty consecutive patients with endoscopically visible tumours were randomly assigned into a bronchial washing before forceps biopsy (pre-biopsy) group and a bronchial washing after forceps biopsy (post-biopsy) group. Bronchial washing and forceps biopsy were performed according to the assigned sequence. RESULTS Two hundred and seven patients with a definite cytological or histological diagnosis of lung cancer were included in the analyses. One hundred and three were in the pre-biopsy group and 104 were in the post-biopsy group. The diagnostic yield of bronchial washing was 57.3% (59/103) in the pre-biopsy group and 55.8% (58/104) in the post-biopsy group (P = 0.88). In addition, bronchial washing provided the diagnosis in six patients without definite diagnosis from forceps biopsy, and its addition to forceps biopsy significantly increased the overall diagnostic yield of bronchoscopy from 93.7% to 96.6% (P = 0.03). CONCLUSION The sequence for performing bronchial washing before or after forceps biopsy did not affect the diagnostic yield of bronchial washing in patients with endoscopically visible lung cancers. However, bronchial washing led to a significant increase in the overall diagnostic yield of bronchoscopy in patients with lung cancers.
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Affiliation(s)
- Hee Seok Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University Hospital, Seoul, Republic of Korea
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Ang TL, Tee AKH, Fock KM, Teo EK, Chua TS. Endoscopic ultrasound-guided fine needle aspiration in the evaluation of suspected lung cancer. Respir Med 2006; 101:1299-304. [PMID: 17116391 DOI: 10.1016/j.rmed.2006.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2006] [Revised: 10/08/2006] [Accepted: 10/11/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM The role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis and staging of lung cancer is still not fully explored. This prospective study aimed to define the effectiveness of EUS-FNA as an adjunct to computer tomography (CT) and bronchoscopy in the evaluation of suspected lung cancer in routine clinical practice. METHODS Over a period of 20 weeks, the data of 16 consecutive patients suspected of lung cancer on account of respiratory symptoms, and/or the findings of either a mass or mediastinal lymph nodes on helical CT, who were referred for evaluation by EUS, were prospectively collected. Fourteen of these patients underwent sequential bronchoscopy followed by EUS-FNA in the same setting. RESULTS Bronchoscopy was performed in 15 patients, while EUS was performed in all 16 patients. Bronchoscopy diagnosed 9 cases of non-small-cell lung cancer (NSCLC) but was falsely negative in 3 cases of malignancies, which were all established by EUS-FNA of mediastinal lymph nodes (2 cases of NSCLC and 1 case of esophageal squamous cell cancer). EUS-FNA also diagnosed advanced NSCLC in another patient who did not undergo bronchoscopy, such that eventually 13 patients were diagnosed to have malignancies. Distant metastases were diagnosed by EUS-FNA in 4 cases of NSCLC (2 cases of left adrenal gland and 2 cases of pancreatic metastases). Two patients were diagnosed to have sarcoidosis and 1 patient was diagnosed to have pneumoconiosis eventually. CONCLUSIONS EUS-FNA is useful as an adjunct to CT and bronchoscopy in the evaluation of suspected lung cancer.
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Affiliation(s)
- T L Ang
- Division of Gastroenterology, Changi General Hospital, 2 Simei St. 3, Singapore 529889, Singapore.
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18
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Singh P, Camazine B, Jadhav Y, Gupta R, Mukhopadhyay P, Khan A, Reddy R, Zheng Q, Smith DD, Khode R, Bhatt B, Bhat S, Yaqub Y, Shah RS, Sharma A, Sikka P, Erickson RA. Endoscopic ultrasound as a first test for diagnosis and staging of lung cancer: a prospective study. Am J Respir Crit Care Med 2006; 175:345-54. [PMID: 17068326 DOI: 10.1164/rccm.200606-851oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Multiple tests are required for the management of lung cancer. OBJECTIVES Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was evaluated as a single test for the diagnosis and staging (thoracic and extrathoracic) of lung cancer. METHODS Consecutive subjects with computed tomography (CT) findings of a lung mass were enrolled for EUS and results were compared with those from CT and positron emission tomography scans. RESULTS Of 113 subjects with lung cancer, EUS was performed as a first test (after CT scan) for diagnosis in 93 (82%) of them. EUS-FNA established tissue diagnosis in 70% of cases. EUS-FNA, CT, and positron emission tomography detected metastases to the mediastinal lymph nodes with accuracies of 93, 81, and 83%, respectively. EUS-FNA was significantly better than CT at detecting distant metastases (accuracies of 97 and 89%, respectively; p = 0.02). Metastases to lymph nodes at the celiac axis (CLNs) were observed in 11% of cases. The diagnostic yields of EUS-FNA and CT for detection of metastases to the CLNs were 100 and 50%, respectively (p < 0.05). EUS was able to detect small metastases (less than 1 cm) often missed by CT. Metastasis to the CLNs was a predictor of poor survival of subjects with non-small cell lung cancer, irrespective of the size of the CLNs. Of 44 cases with resectable tumor on CT scan, EUS-FNA avoided thoracotomy in 14% of cases. CONCLUSIONS EUS-FNA as a first test (after CT) has high diagnostic yield and accuracy for detecting lung cancer metastases to the mediastinum and distant sites. Metastasis to the CLNs is associated with poor prognosis. EUS-FNA is able to detect occult metastasis to the CLNs and thus avoids thoracotomy.
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Affiliation(s)
- Pankaj Singh
- Division of Gastroenterology, Central Texas Veterans Health Care System, Temple, TX 76504, USA.
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Heyer CM, Kagel T, Lemburg SP, Walter JW, de Zeeuw J, Junker K, Mueller KM, Nicolas V, Bauer TT. Transbronchial biopsy guided by low-dose MDCT: a new approach for assessment of solitary pulmonary nodules. AJR Am J Roentgenol 2006; 187:933-9. [PMID: 16985137 DOI: 10.2214/ajr.05.0763] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of our study was to determine whether transbronchial bronchoscopic biopsy of solitary pulmonary nodules under CT guidance using a low-dose protocol can increase diagnostic yield in patients who had undergone unsuccessful conventional bronchoscopic biopsy. SUBJECTS AND METHODS We included 33 consecutive patients (25 men; mean age +/- SD, 64 +/- 9.6 years) with solitary pulmonary nodules at different sites and with a lesion-to-pleura distance of at least 2 cm who previously underwent conventional bronchoscopy that did not result in histologic diagnosis. All patients were prospectively investigated with transbronchial bronchoscopic biopsy under MDCT guidance. Examinations were performed with the patient in conscious sedation using a low-dose protocol (80 kV, 20 mAs, 5-mm collimation, 10-mm slices). The position of the tip of the biopsy device was confirmed and documented before biopsies were performed. All specimens were examined by standard histopathologic techniques. The effective radiation dose was calculated for every patient. RESULTS The diagnostic yield was 24 in 33 selected patients (overall accuracy, 72.7%): 13 (54%) had primary lung cancer and 11 (46%) had benign diagnoses. The formal operative characteristics were sensitivity, 59%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 55%. The final diagnoses of the remaining nine patients in whom transbronchial bronchoscopic biopsy was not diagnostic were non-small cell lung cancer (n = 3); small cell lung cancer (n = 3); and alveolar carcinoma, carcinoid tumor, and hemorrhaged bulla (n = 1 each). All nonmalignant diagnoses were confirmed by 6 months radiographic and clinical follow-up. The mean duration of the procedure was 39 +/- 15 minutes, and the average effective dose was 0.7 mSv (range, 0.5-1.1 mSv). One case of pulmonary hemorrhage (3%) occurred after the procedure. CONCLUSION MDCT-guided transbronchial bronchoscopic biopsy is a promising and safe tool for the diagnostic pathway of solitary pulmonary nodules in previously undiagnosed patients. Image quality was sufficient with low-dose protocols, which resulted in low radiation exposure for patients and personnel.
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Affiliation(s)
- Christoph M Heyer
- Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG Clinics Bergmannsheil, Buerkle-de-la Camp Platz 1, Ruhr-University of Bochum, Bochum D-44791, Germany.
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Sawhney MS, Kratzke RA, Lederle FA, Holmstrom AM, Nelson DB, Kelly RF. EUS-guided FNA for the diagnosis of advanced lung cancer. Gastrointest Endosc 2006; 63:959-65. [PMID: 16733110 DOI: 10.1016/j.gie.2005.11.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2005] [Accepted: 11/08/2005] [Indexed: 02/08/2023]
Abstract
BACKGROUND A majority of patients with lung cancer are incurable but are symptomatic and may benefit from palliative therapy. Currently available diagnostic methods are either too risky or unsuccessful in obtaining a tissue diagnosis in up to 30% of patients. OBJECTIVE To evaluate the role of EUS-guided FNA in obtaining a tissue diagnosis in patients with advanced lung cancer. DESIGN Prospective, uncontrolled. SETTING Veterans Administration Medical Center. SUBJECTS AND METHODS Patients with suspected lung cancer who were not candidates for curative therapy were prospectively identified. CT scans were reviewed, and patients with lesions considered suitable for sampling by EUS were enrolled. Outcomes were analyzed by a final tissue diagnosis or by serial imaging. RESULTS Sixty-nine patients met inclusion criteria, of which 3 refused participation. The remaining 66 patients constituted the study population. EUS was technically successful in 95% of patients. A final diagnosis was based on tissue in 63 of 66 patients, serial imaging in 1 of 66 patients, and was unavailable in 2 of 66 patients. A lung mass was sampled in 21 patients, and a metastatic lesion was sampled in 45 patients. EUS made a correct diagnosis in 55 of 64 patients (86%, 95% confidence interval [CI] 77%-93%), including 24% that had undergone a failed prior attempt at diagnosis. The sensitivity of EUS was 86%, and the specificity was 100%. Sampling a metastasis was more likely to yield a correct diagnosis than sampling a lung mass (P = .02). Two self-limited complications were noted during the study. CONCLUSIONS EUS was an accurate and a safe method for obtaining a tissue diagnosis in patients with advanced incurable lung cancer.
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Affiliation(s)
- Mandeep S Sawhney
- Section of Gastroenterology, Center for Epidemiological and Clinical Research, Minneapolis VA Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA
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Lee JH, Yang JK, Jung IB, Lee JH, Sul HJ, Kim YM, Kim BK, Choi YJ, Na MJ, Son JW. Comparison of Thinprep (Liquid-Based Cytology) and Conventional Cytology : Abnormal Lesion on Bronchoscopy. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.61.6.547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jung Ho Lee
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - Jung Kyung Yang
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - In Bum Jung
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - Jung Hea Lee
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Korea
| | - Hae Jung Sul
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Korea
| | - Yoon Mi Kim
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Korea
| | - Bum Kyeng Kim
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Korea
| | - Yue Jin Choi
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - Moon Joon Na
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
| | - Ji Woong Son
- Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
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Shimizu K, Ikeda N, Tsuboi M, Hirano T, Kato H. Percutaneous CT-guided fine needle aspiration for lung cancer smaller than 2 cm and revealed by ground-glass opacity at CT. Lung Cancer 2005; 51:173-9. [PMID: 16378659 DOI: 10.1016/j.lungcan.2005.10.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2005] [Revised: 09/22/2005] [Accepted: 10/03/2005] [Indexed: 11/21/2022]
Abstract
The purpose of this retrospective study was to evaluate the value of preoperative percutaneous CT-guided fine needle aspiration biopsy (CTNB) for peripheral lung cancers less than 2 cm in size, especially in cases showing of ground-glass opacities (GGO). From 1999 to 2002, 151 small lung cancers were resected in Tokyo Medical University Hospital. Among them, 96 patients (63.6%) in whom the lesions were located in the outer half of the lung field underwent CTNB in order to obtain a preoperative diagnosis. The factors influencing the diagnostic yield were analyzed. The overall diagnostic yield of CTNB was 64.6%: 48.5% for lesions smaller than 10 mm, 62.5% for those 11-15 mm, and 83.9% for those 16-20 mm, respectively. The diagnostic yield in GGO-dominant lesions (GGO ratio < 50%) and solid-dominant lesions (GGO ratio < 50%) were 51.2% and 75.6% (p = 0.018). In the GGO-dominant group, the diagnostic yields were 35.2% for lesions smaller than 10 mm, 50.0% for those 11-15 mm, and 80.0% for those 16-20 mm. In the solid-dominant group, diagnostic yield was 62.5% for cases smaller than 10 mm, 75% for 11-15 mm and 85.7% for 16-20 mm, respectively. Satisfactory diagnostic yield (>80%) was obtained by CTNB in cases larger than 15 mm. CTNB is a useful diagnostic modality for peripheral small lung cancers; however, for GGO-dominant lesions, the preoperative diagnostic yield is not significantly better than for solid-dominant lesions.
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Affiliation(s)
- Katsuhiko Shimizu
- First Department of Surgery, Tokyo Medical University, Nishishinjyuku, Shinjyuku-ku, Japan.
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Nakajima J, Sato H, Takamoto S. Does Preoperative Transbronchial Biopsy Worsen the Postsurgical Prognosis of Lung Cancer? Chest 2005; 128:3512-8. [PMID: 16304307 DOI: 10.1378/chest.128.5.3512] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Our aim was to clarify the hypothesis that the postsurgical prognosis of patients with non-small cell lung cancer (NSCLC) proven by preoperative diagnostic transbronchial biopsy (TBLB) was worse than that of the patients with NSCLC determined at the time of surgery. DESIGN We entered the propensity score as a continuous variable in the Cox proportional hazards model, along with the success/failure of TBLB and other covariates that were adjusted for the bias inherent to the success/failure of the TBLB examination. PATIENTS Five hundred ninety-nine consecutive patients with NSCLC undergoing complete resection were divided into two groups. Pathologic diagnosis by TBLB was preoperatively determined in patients belonging to group 1 (n = 367). TBLB was unsuccessful and exploratory thoracotomy or thoracoscopy was followed by surgical resection in patients belonging to group 2 (n = 232). The overall recurrence-free survival rate was examined as the surgical outcomes. RESULTS The postsurgical recurrence-free rate was significantly higher in group 2 than in group 1. Group 2 patients showed better prognosis than group 1 patients, even when the data between the two groups were adjusted by propensity score. When the groups were subdivided by the pathologic stage of disease, the subgroup consisting of group 2 patients with stage IA and IB lung cancer still showed a higher recurrence-free rate than those in group 1 by propensity score analysis. CONCLUSIONS The postsurgical prognosis of the patients with NSCLC was significantly better if the preoperative TBLB was unsuccessful. This result suggested that advanced NSCLC had a tendency to be diagnosed with TBLB and, possibly, that the TBLB procedure might worsen the prognosis of patients with resectable NSCLC. We suggest that intraoperative diagnosis followed by the consecutive resection of NSCLC may be beneficial for improving the surgical outcomes of NSCLC patients.
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Affiliation(s)
- Jun Nakajima
- Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Japan.
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Jewell J. Diagnostic value and cost-effectiveness of bronchial brushings in the diagnosis of bronchial malignancy - Author's reply. Cytopathology 2005. [DOI: 10.1111/j.1365-2303.2005.00274.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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van der Drift MA, van der Wilt GJ, Thunnissen FBJM, Janssen JP. A Prospective Study of the Timing and Cost-Effectiveness of Bronchial Washing During Bronchoscopy for Pulmonary Malignant Tumors. Chest 2005; 128:394-400. [PMID: 16002962 DOI: 10.1378/chest.128.1.394] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The value of obtaining washings during fiberoptic bronchoscopy in the workup of lung cancer is controversial. Moreover, the optimal timing of washing relative to biopsy and brushing is not known. In this study, the diagnostic yields of washings before and after biopsy and brushings were compared. The different diagnostic strategies were assessed in terms of yield and costs. DESIGN A prospective study performed from 2001 to 2003 in a secondary care medical center. MEASUREMENTS AND RESULTS Two hundred twenty-one patients underwent flexible bronchoscopy, and the diagnostic yield of washings before biopsy and brushing (strategy I) and after biopsy and brushing (strategy II) specimens were assessed. Using the known probabilities and costs for various bronchoscopic procedures, the expected utility of a number of diagnostic strategies was estimated. Patients (147 men and 74 women) were included in the study in whom a definite cytologic or histologic diagnosis of pulmonary malignancy had been made. The diagnostic yield of strategy I was 72% for visible tumors and 36% for nonvisible tumors. For strategy II, the diagnostic yield was 74% for visible tumors and in 42% for nonvisible tumors. The comparison of strategies I and II for both visible and nonvisible tumors revealed that 176 cases were concordant (80%); in 19 cases (9%) the cytologic analysis of washings in strategy I was positive for malignancy and negative in strategy II. In 26 cases (12%) washings in strategy II were positive and negative in strategy I (p = 0.37). An analysis of the diagnostic yield of both washings in visible tumors and nonvisible tumors showed no significant difference. In 13 patients, a diagnosis of malignancy was established only by washings (6%). Confining the laboratory investigations of washings or brush samples to those cases in which the initial findings of the biopsies are negative (the two-stage procedure) is more cost-effective than examining all biopsy, brushing, and washing specimens. In patients with visible tumors, brushing or washing in addition to biopsy is equally cost-effective; in patients with nonvisible tumors, biopsy combined with washing is the preferred option. CONCLUSIONS No difference in the diagnostic yield could be demonstrated for washings before or after biopsies and brushings. Although the additional diagnostic yield of washing and brushing during bronchoscopy is relatively low, it is cost-effective to use these procedures in the diagnostic workup of patients who are clinically suspected of having a pulmonary malignancy.
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Affiliation(s)
- Miep A van der Drift
- Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6525 SZ Nijmegen, the Netherlands.
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Annema JT, Veseliç M, Rabe KF. EUS-guided FNA of centrally located lung tumours following a non-diagnostic bronchoscopy. Lung Cancer 2005; 48:357-61; discussion 363-4. [PMID: 15893004 DOI: 10.1016/j.lungcan.2004.11.017] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Revised: 11/08/2004] [Accepted: 11/17/2004] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the feasibility and yield of endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) in diagnosing centrally located lung tumours after a previously non-diagnostic bronchoscopy. BACKGROUND AND HYPOTHESIS Bronchoscopy fails to establish a diagnosis in up to 30% of patients with suspected lung cancer. Intrapulmonary tumours located near or adjacent to the esophagus might be visualized and biopsied under real-time ultrasound guidance by EUS-FNA. DESIGN Patients with suspected lung cancer and an intrapulmonary tumour located near or adjacent to the esophagus who had undergone a non-diagnostic bronchoscopy, underwent EUS-FNA for diagnostic purposes. Surgical-pathological verification occurred when EUS-FNA was non-diagnostic and in those patients diagnosed with non-small-cell lung cancer by EUS-FNA who were surgical candidates. RESULTS EUS-FNA diagnosed lung cancer in 31 of 32 patients (97%). No complications occurred. The diagnosis obtained by EUS-FNA was confirmed in all 11 patients who were operated. In one case, in which EUS-FNA was non-diagnostic, a lymphoma was diagnosed after pneumonectomy. CONCLUSIONS AND SIGNIFICANCE EUS-FNA qualifies as the next diagnostic step in patients with suspected lung cancer and a non-diagnostic bronchoscopy if the intrapulmonary mass is located adjacent or near the esophagus. In these cases, EUS-FNA may replace computed tomography of the chest (CT)-guided biopsies and reduce the number of exploratory thoracotomies.
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Affiliation(s)
- Jouke T Annema
- Division of Pulmonary Medicine, Leiden University Medical Center, Leiden, The Netherlands.
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Grote HJ, Schmiemann V, Kiel S, Böcking A, Kappes R, Gabbert HE, Sarbia M. Aberrant methylation of the adenomatous polyposis coli promoter 1A in bronchial aspirates from patients with suspected lung cancer. Int J Cancer 2004; 110:751-5. [PMID: 15146565 DOI: 10.1002/ijc.20196] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Promoter hypermethylation is a major mechanism for gene silencing and offers a promising starting point for developing molecular biomarkers. The purpose of our study was to determine aberrant methylation of the adenomatous polyposis coli (APC) gene promoter 1A with respect to its prevalence and quantitative level in bronchial aspirates from patients with suspected lung cancer. Applying quantitative methylation-specific PCR, 155 bronchial aspirates from patients with non-small cell cancer (NSCLC) and small cell cancer (SCLC) of the lung as well as 67 bronchial aspirates from patients diagnosed for nonneoplastic lung disease were examined in a retrospective case-control study. Aberrant APC promoter 1A methylation was seen in 71% of NSCLCs, 38% of SCLCs and 42% of patients with nonneoplastic lung disease, being therefore not specific for the presence of primary lung cancer. In contrast, quantitative analysis showed a significantly higher methylation level of bronchial aspirates from NSCLC as compared to patients without neoplastic lung disease. Introducing a cutoff point that defined high level of APC hypermethylation NSCLC could be discriminated from cases without neoplastic disease with a specificity of 98.5% and a sensitivity of 39%. The data suggest that quantitative analysis of APC hypermethylation may serve as a biomarker of primary lung cancer.
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Affiliation(s)
- Hans J Grote
- Institute of Cytopathology, Heinrich-Heine-University, Düsseldorf, Germany.
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Lacasse Y, Martel S, Hébert A, Carrier G, Raby B. Accuracy of virtual bronchoscopy to detect endobronchial lesions. Ann Thorac Surg 2004; 77:1774-80. [PMID: 15111185 DOI: 10.1016/j.athoracsur.2003.10.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Virtual bronchoscopy (VB) could obviate flexible bronchoscopy (FB) if no endobronchial lesion is detected in patients presenting with a suspicion of malignancy. Our objectives were to evaluate the accuracy (in terms of sensitivity and specificity) of VB in detecting endobronchial lesions, and to determine the anatomical limit of detection of endobronchial lesions by VB. METHODS This study involved, in a blind comparison of VB and FB, consecutive patients presenting with symptoms or plain chest radiography abnormalities raising the suspicion of pulmonary neoplasm. After the standard chest computed tomography (CT), additional helical CT data were acquired from the aortic arch to the origin of the segmental bronchi of the inferior lobes in one 20-second breath hold using an helicoidal CT scan (3.0-mm collimation with a pitch of 1.5 and 1.5-mm reconstruction intervals). RESULTS One hundred ninety patients were enrolled; 136 patients (including 63 with an endobronchial lesion at FB) contributed to the primary analysis. The sensitivity and specificity of VB to detect endobronchial lesions were 68% (95% confidence interval [CI]: 55% to 79%) and 90% (95% CI: 81% to 96%), respectively. Overall, the agreement between VB and FB regarding the location on endobronchial lesions was substantial (weighted kappa: 0.66). However, VB detected only 26 of the 34 lobar lesions (sensitivity: 76%; CI: 59% to 89%) and 11 of the 23 segmental lesions (sensitivity: 48%; CI: 27% to 69%). CONCLUSIONS Beyond the mainstem bronchi, VB is not accurate enough to detect endobronchial lesions and to obviate FB in patients presenting with a suspicion of malignancy.
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Affiliation(s)
- Yves Lacasse
- Centre de Recherche and Department of Radiology, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, Sainte-Foy, Quebec, Canada.
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Haro Estarriol M, Rubio Goday M, Vizcaya Sánchez M, Baldó Padró X, Casamitjá Sot M, Sebastián Quetglás F. Biopsia pulmonar broncoscópica con fluoroscopia en lesiones pulmonares localizadas. Estudio de 164 casos. Arch Bronconeumol 2004. [DOI: 10.1016/s0300-2896(04)75578-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Herth F, Becker HD, Ernst A. Conventional vs Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Chest 2004; 125:322-5. [PMID: 14718460 DOI: 10.1378/chest.125.1.322] [Citation(s) in RCA: 249] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY OBJECTIVE Our group performed a randomized trial to assess whether the addition of endobronchial ultrasound (EBUS) guidance will lead to better results than standard transbronchial needle aspiration (TBNS). EBUS guidance seems to be beneficial in increasing the yield of TBNA but has not been proven to be superior to conventional procedures in a randomized trial. METHODS Consecutive patients who were referred for TBNA were randomized to an EBUS-guided and a conventional TBNA arm. Patients with subcarinal lymph nodes were randomized and analyzed separately (group A) from all other stations (group B). A positive result was defined as either lymphocytes or a specific abnormality on cytology. RESULTS Two hundred patients were examined (100 patients each in groups A and B). Half of the patients underwent EBUS-guided TBNA rather than conventional TBNA. In group A, the yield of conventional TBNA was 74% compared to 86% in the EBUS group (difference not significant). In group B, the overall yields were 58% and 84%, respectively. This difference was statistically highly significant (p < 0.001). The average number of passes was four. CONCLUSION EBUS guidance significantly increases the yield of TBNA in all stations except in the subcarinal region. It should be considered to be a routine adjunct to TBNA. On-site cytology may be unnecessary, and the number of necessary needle passes required is low.
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Affiliation(s)
- Felix Herth
- Department of Interdisciplinary Endoscopy (Drs. Herth and Becker), Thoraxklinik, Heidelberg, Germany
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Ehya H, Young NA. Cytologic approach to tumors of the tracheobronchial tree. CHEST SURGERY CLINICS OF NORTH AMERICA 2003; 13:41-62. [PMID: 12698637 DOI: 10.1016/s1052-3359(02)00044-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cytologic testing is an integral part of the workup of patients suspected of having lung cancer. These tests are less invasive than other tissue procurement methods, with minimal risk of complications. In experienced hands, the tests are highly accurate and reliable. To achieve good results and avoid diagnostic errors, clinicians must be educated in proper collection and fixation methods and the pathologist should be cognizant of clinical and radiologic data. Close communication between the clinician and pathologist should be encouraged.
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Affiliation(s)
- Hormoz Ehya
- Department of Pathology, Fox Chase Cancer Center, 7701 Burholme Avenue, Philadelphia, PA 19111, USA.
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A Stiff Bristled, Spiral-Shaped Ectocervical Brush. Obstet Gynecol 2002. [DOI: 10.1097/00006250-200212000-00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mazzone P, Jain P, Arroliga AC, Matthay RA. Bronchoscopy and needle biopsy techniques for diagnosis and staging of lung cancer. Clin Chest Med 2002; 23:137-58, ix. [PMID: 11901908 DOI: 10.1016/s0272-5231(03)00065-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lung cancer is the leading cause of cancer deaths in the United States. The individual therapeutic approach and prognosis depends on accurate diagnosis and staging. Flexible bronchoscopy (FB) and transthoracic needle biopsy (TNB) are the most widely used techniques for this purpose. This article provides a critical overview of indications, diagnostic yield, and limitations of bronchoscopy and TNB in the diagnosis of lung cancer.
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Affiliation(s)
- Peter Mazzone
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Affiliation(s)
- J Martin
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Vansteenkiste JF, Stroobants SG. The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology. Eur Respir J 2001; 17:802-20. [PMID: 11401078 DOI: 10.1183/09031936.01.17408020] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the past 5 yrs, positron emission tomography (PET) with 18F-fluoro-2-deoxy-D-glucose (FDG) has become an important imaging modality in lung cancer patients. At this time, the indication of FDG-PET as a complimentary tool to computed tomography in the diagnosis and staging of nonsmall cell lung cancer has gradually gained more widespread acceptance and also reimbursement in many European countries. This review focuses on the data of FDG-PET in the diagnosis of lung nodules and masses, and in locoregional and extrathoracic staging of nonsmall cell lung cancer. Emphasis is put on the potential clinical implementation of the currently available FDG-PET data. The use of FDG-PET in these indications now needs further validation in large-scale multicentre randomized studies, focusing mainly on treatment outcome parameters, survival and cost-efficacy. Interesting findings with 18F-fluoro-2-deoxy-D-glucose-positron emission tomography have also been reported for the evaluation of response to radio- or chemotherapy, in radiotherapy planning, recurrence detection and assessment of prognosis. Finally, a whole new field of application of positron emission tomography in molecular biology, using new radiopharmaceuticals, is under extensive investigation.
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Affiliation(s)
- J F Vansteenkiste
- Respiratory Oncology Unit, Dept of Pulmonology, University Hospital Gasthuisberg, Catholic University Leuven, Belgium
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38
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Abstract
The unfavourable epidemiological data of lung cancer has not been changed during the past ten years. The only possibility to cure this malignancy is surgical resection. The five year survival rate after surgery is highly dependent on early discovery of the tumor. Today, bronchoscopy plays a central role in the diagnosis staging and therapy of lung cancer. The main indications of diagnostic bronchoscopy are the identification of the tumor and the determination of its extent. The aim of therapeutic bronchoscopy - laser photocoagulation, high dose rate afterloading irradiation and stent implantation - is to provide an acceptable quality of life and to manage symptoms such as bleeding, cough and dyspnea.
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Affiliation(s)
- János Strausz
- Korányi National Institute of Pulmonology, 6th Department of Pulmonology, Budapest, Hungary
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39
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Lung Neoplasms. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Goldberg SN, Raptopoulos V, Boiselle PM, Edinburgh KJ, Ernst A. Mediastinal lymphadenopathy: diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance-initial experience. Radiology 2000; 216:764-7. [PMID: 10966708 DOI: 10.1148/radiology.216.3.r00se32764] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether the use of computed tomographic (CT) fluoroscopy to guide transbronchial needle aspiration (TBNA) of mediastinal lymph nodes can improve the diagnostic yield. MATERIALS AND METHODS CT fluoroscopy was used to guide TBNA in 12 consecutive patients with mediastinal lymphadenopathy who had previously undergone nondiagnostic conventional TBNA. CT fluoroscopy was used to confirm the location of the biopsy needle by using a "quick-check" technique (ie, fluoroscopy was performed sparingly after needle insertion). The location of each needle, the total procedural and fluoroscopic times, and any complications were recorded. RESULTS All CT fluoroscopic procedures were performed in less than 1 hour, and a tissue diagnosis was established in all patients. Eighteen lymph nodes with a diameter of 0.8-2.4 cm were sampled with 116 needle passes. CT fluoroscopy documented inadequate positioning in 48 of the 116 (41.3%) needle passes. Eighteen (15.5%) needles did not fully penetrate the tracheobronchial tree. Six needles (5.2%) were placed into the great vessels. Malignant disease was diagnosed in nine patients, and benign disease was diagnosed in three. The mean fluoroscopic exposure time was 20.5 seconds +/- 12.7. No pneumothoraces or substantial hemorrhage were observed. CONCLUSION CT fluoroscopic guidance for TBNA procedures is a safe and efficient means of providing diagnostic material and should be considered for patients who have previously undergone nondiagnostic blinded TBNA.
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Affiliation(s)
- S N Goldberg
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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43
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Abstract
TNB of the mediastinum is an accurate, safe, and cost-effective diagnostic tool for the evaluation of mediastinal masses and lymphadenopathy. The technique is most useful in the staging of carcinoma, where it serves as a less expensive and minimally invasive alternative to mediastinoscopy for establishing unresectability. With recent advances in immunohistochemical and core biopsy techniques, TNB has become more accurate for establishing the initial diagnosis of lymphoma and for confirming recurrent disease. Core-needle biopsy has improved the accuracy of TNB and is particularly useful when fine-needle aspiration fails to yield a specific diagnosis, or when lymphoma or a noncarcinomatous lesion is suspected.
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Affiliation(s)
- Z Protopapas
- Department of Radiology, Hospital of Saint Raphael, New Haven, Connecticut 06511, USA.
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Abstract
Lung cancer is the biggest cancer killer among men and women in the United States. Lung cancer can present in a myriad of ways and the goal of prompt diagnosis and staging requires that the clinician be able to knowledgeably choose from a variety of tools available for such purpose. Review of some of these tools and general strategies with regard to staging is provided. Many new technologies are becoming available and much evaluation needs to be done before their proper roles become well defined. Little has changed with regard to staging of small cell lung cancer in recent years. The International System for Staging Non-Small-Cell Lung Cancer was revised for a second time in 1997. Although the revisions have largely corrected the shortcomings of the 1985 version, some controversies persist. Whenever possible, a multidisciplinary approach to diagnosis, staging, and therapy should be utilized. This should include incorporating the services of the pulmonologist, the thoracic surgeon, the medical oncologist, the radiologist, the radiation therapist, the pathologist, the respiratory therapist, and the social worker.
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Affiliation(s)
- J D Hyer
- Division of Pulmonary and Critical Care Medicine, Allergy, and Clinical Immunology, Medical University of South Carolina, Charleston, USA
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Abstract
Clinical staging of lung cancer helps to determine the extent of disease and stratify patients into similar therapeutic and prognostic categories. A primary goal of clinical staging is to separate patients with potentially resectable disease from those that are unresectable. Initial assessment of the patient by history and physical examination combined with laboratory values can suggest metastatic spread of the disease. When abnormal, these clinical factors may have value in terms of predicting prognosis, but their use in early stage lung cancer is limited because of the low prevalence of symptoms, physical exam findings, and laboratory abnormalities in this group. For clinical staging, patients almost always undergo a postero-anterior and lateral chest radiograph and a computed tomography (CT) scan of the chest and upper abdomen to include the liver and adrenal glands. Although CT scanning provides exquisite anatomic information, it is less than optimal for determining lymph node status. Over the last several years, CT scanning combined with positron-emission tomography (PET) using fluorodeoxyglucose (FDG) has significantly improved the accuracy of clinical staging. The use of FDG-PET continues to be defined in the non-invasive evaluation of the primary tumor, nodal involvement, and metastatic disease. Despite the recent advancements in radiologic assessment of lung cancer, invasive sampling is still often performed for pathologic confirmation.
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Affiliation(s)
- C L Lau
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Greses JV, Soler JJ, Perpiñá M, Sanchís J, Vera F. [Factors related to diagnostic reliability of bronchial biopsy in primary bronchogenic carcinoma]. Arch Bronconeumol 1997; 33:556-60. [PMID: 9580039 DOI: 10.1016/s0300-2896(15)30512-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To analyze the diagnostic reliability of bronchial biopsy (BB) in bronchogenic carcinoma and the impact of several factors, among them patient symptoms and condition, tumor characteristics and the endoscopist's and pathologist's experience. One hundred eighty-four BB from 151 patients diagnosed of bronchogenic carcinoma in our hospital in the years 1993 and 1994 were reviewed. We first performed single variable analysis, and later logistical regression analysis taking BB positivity or negativity as the dependent variable. The independent variables were age, tumor stage, histological type, lesion necrosis, number of biopsy fragments collected, size of the largest fragment, the endoscopist who performed the BB and the pathologist who studied the specimen. The diagnosis sensitivity of BB was 69.6%. The variables that significantly influenced diagnostic accuracy, in both the single variable and multiple factorial analyses, were clinical status (p < 0.0004) and necrosis (p < 0.0057) with odds ratios of 4.6088 and 0.3766, respectively. The patient's clinical status and the presence or absence of necrosis are the factors that most influence diagnostic accuracy in BB for bronchogenic carcinoma. The likelihood of obtaining a diagnosis is 4.6 greater when clinical status is severe, and 2.7 times greater in the absence of necrosis. The experience of the bronchoscopist, after a learning period, and of the examining pathologist, do not appear to have a decisive effect on diagnostic reliability in this technique.
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Affiliation(s)
- J V Greses
- Servicio de Neumología, Hospital Universitario La Fe, Valencia
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Pretreatment evaluation of non-small-cell lung cancer. The American Thoracic Society and The European Respiratory Society. Am J Respir Crit Care Med 1997; 156:320-32. [PMID: 9230769 DOI: 10.1164/ajrccm.156.1.ats156.1] [Citation(s) in RCA: 234] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Cataluña JJ, Perpiñá M, Greses JV, Calvo V, Padilla JD, París F. Cell type accuracy of bronchial biopsy specimens in primary lung cancer. Chest 1996; 109:1199-203. [PMID: 8625667 DOI: 10.1378/chest.109.5.1199] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVES To evaluate the diagnostic accuracy of bronchial biopsy (BB) specimens in establishing the specific cell type in primary lung cancer (LC), and to study the influence of several factors on this accuracy. SETTING Tertiary health-care center. PATIENTS One hundred forty-six patients with LC diagnosed by BB specimens who underwent thoracotomy (T). MEASUREMENTS We have studied the specific LC cell type observed in the BB specimen and compared it with the T specimen (reference diagnosis). Age, location and type of bronchial lesion, number and size of the biopsy fragments, tumoral size, sample necrosis, degree of cell differentiation, tumoral stage, pathologist's experience, and the presence of other diagnostic tests with the same cell type were analyzed to assess their influence on the concordance between the two diagnoses. RESULTS The overall concordance between BB and T histologic diagnosis was 0.70 (kappa coefficient [K]). Of the different histologic types, the worst result was obtained in large cell carcinoma (LLC) (K, 0.49). Squamous carcinoma and adenocarcinoma gave similar results (0.74 and 0.77, respectively), while small cell lung cancer (SCLC) only reached a value of 0.60. The degree of cell differentiation, the absence of necrosis, and presence of other preoperative diagnoses were the variables that most influenced the histologic accuracy of BB specimens. Therefore, the probability of BB accuracy was 2.7, 7.7, and 25 times higher in well-differentiated, than in poorly differentiated, moderately differentiated, or undifferentiated carcinomas; 5.2 times higher when there was no necrosis in the sample; and 7.43 higher when there was another preoperative diagnosis. CONCLUSIONS The histologic results of BB must be examined carefully, especially in cellular subtypes like LLC. The absence of differentiation and presence of necrosis in BB samples were the factors that require the greatest caution in ascertaining the cell type. When they are involved and also in all cases in which identifying the specific cell type has important implications, we prefer to classify the patients as having SCLC or non-small cell lung cancer, and then reclassify them later after using a second diagnostic technique.
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Affiliation(s)
- J J Cataluña
- Hospital Universitario La Fe, Servicio de Neumología y Cirugía Torácica, Valencia, Spain
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49
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Affiliation(s)
- S P Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, ROC
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50
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Govert JA, Kopita JM, Matchar D, Kussin PS, Samuelson WM. Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor. Chest 1996; 109:451-6. [PMID: 8620721 DOI: 10.1378/chest.109.2.451] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVE Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. Collection of brushing and washing specimens for cytology is common during bronchoscopy for endobronchial abnormality, but it is unknown if collection of these specimens is cost-effective. DESIGN Retrospective review of a computerized database with cost-effectiveness analysis. SETTING Tertiary care medical center. PATIENTS Two hundred one patients undergoing bronchoscopy for endobronchial lung tumor. INTERVENTION All patients in the study underwent fiberoptic bronchoscopy that included forceps biopsies, washings, and brushings. In addition to analyzing the sensitivity of forceps-biopsy, washings, and brushings at diagnosing malignancy, we analyzed the cost-effectiveness of three potential specimen collection strategies. These strategies were (1) collection of both washings and brushings in addition to forceps biopsy specimen, (2) collection of either washings or brushings in addition to forceps biopsy specimen, and (3) collection of forceps biopsy specimen only. MEASUREMENTS AND RESULTS The sensitivity of bronchoscopy, including biopsy, washing, and brushing is 85.3% (95% confidence interval [CI], 80.1 to 90.5%). The sensitivity of forceps biopsy is 80.8% (95% CI, 75.0 to 86.6%). The addition of washings and brushings increases the sensitivity of bronchoscopy from 80.8 to 85.3% (McNemar's p = 0.01). Cost-effectiveness analysis reveals that forceps biopsy plus washing or brushing has a marginal cost-effectiveness ratio of $308 per reduced-quality day avoided compared with forceps alone. Adding an additional cytology specimen has a marginal cost-effectiveness ratio of $5,500 per reduced-quality day avoided. CONCLUSIONS There is a modest but definite increase in the sensitivity of bronchoscopy in diagnosing endobronchial cancer with the addition of washings and brushings for cytology. Cost-effectiveness analysis reveals that collection of either washings or brushings is probably the best strategy.
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Affiliation(s)
- J A Govert
- Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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