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Park TY, Kwon LM, Hyeon J, Cho BJ, Kim BJ. Deep Learning Prediction of Axillary Lymph Node Metastasis in Breast Cancer Patients Using Clinical Implication-Applied Preprocessed CT Images. Curr Oncol 2024; 31:2278-2288. [PMID: 38668072 PMCID: PMC11049657 DOI: 10.3390/curroncol31040169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Accurate detection of axillary lymph node (ALN) metastases in breast cancer is crucial for clinical staging and treatment planning. This study aims to develop a deep learning model using clinical implication-applied preprocessed computed tomography (CT) images to enhance the prediction of ALN metastasis in breast cancer patients. Methods: A total of 1128 axial CT images of ALN (538 malignant and 590 benign lymph nodes) were collected from 523 breast cancer patients who underwent preoperative CT scans between January 2012 and July 2022 at Hallym University Medical Center. To develop an optimal deep learning model for distinguishing metastatic ALN from benign ALN, a CT image preprocessing protocol with clinical implications and two different cropping methods (fixed size crop [FSC] method and adjustable square crop [ASC] method) were employed. The images were analyzed using three different convolutional neural network (CNN) architectures (ResNet, DenseNet, and EfficientNet). Ensemble methods involving and combining the selection of the two best-performing CNN architectures from each cropping method were applied to generate the final result. Results: For the two different cropping methods, DenseNet consistently outperformed ResNet and EfficientNet. The area under the receiver operating characteristic curve (AUROC) for DenseNet, using the FSC and ASC methods, was 0.934 and 0.939, respectively. The ensemble model, which combines the performance of the DenseNet121 architecture for both cropping methods, delivered outstanding results with an AUROC of 0.968, an accuracy of 0.938, a sensitivity of 0.980, and a specificity of 0.903. Furthermore, distinct trends observed in gradient-weighted class activation mapping images with the two cropping methods suggest that our deep learning model not only evaluates the lymph node itself, but also distinguishes subtler changes in lymph node margin and adjacent soft tissue, which often elude human interpretation. Conclusions: This research demonstrates the promising performance of a deep learning model in accurately detecting malignant ALNs in breast cancer patients using CT images. The integration of clinical considerations into image processing and the utilization of ensemble methods further improved diagnostic precision.
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Affiliation(s)
- Tae Yong Park
- Medical Artificial Intelligence Center, Doheon Institute for Digital Innovation in Medicine, Hallym Univesity Medical Center, Anyang-si 14068, Republic of Korea;
| | - Lyo Min Kwon
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Republic of Korea;
| | - Jini Hyeon
- School of Medicine, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea;
| | - Bum-Joo Cho
- Medical Artificial Intelligence Center, Doheon Institute for Digital Innovation in Medicine, Hallym Univesity Medical Center, Anyang-si 14068, Republic of Korea;
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Republic of Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Republic of Korea
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Zhong Y, Cai C, Chen T, Gui H, Deng J, Yang M, Yu B, Song Y, Wang T, Sun X, Shi J, Chen Y, Xie D, Chen C, She Y. PET/CT based cross-modal deep learning signature to predict occult nodal metastasis in lung cancer. Nat Commun 2023; 14:7513. [PMID: 37980411 PMCID: PMC10657428 DOI: 10.1038/s41467-023-42811-4] [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: 03/25/2023] [Accepted: 10/20/2023] [Indexed: 11/20/2023] Open
Abstract
Occult nodal metastasis (ONM) plays a significant role in comprehensive treatments of non-small cell lung cancer (NSCLC). This study aims to develop a deep learning signature based on positron emission tomography/computed tomography to predict ONM of clinical stage N0 NSCLC. An internal cohort (n = 1911) is included to construct the deep learning nodal metastasis signature (DLNMS). Subsequently, an external cohort (n = 355) and a prospective cohort (n = 999) are utilized to fully validate the predictive performances of the DLNMS. Here, we show areas under the receiver operating characteristic curve of the DLNMS for occult N1 prediction are 0.958, 0.879 and 0.914 in the validation set, external cohort and prospective cohort, respectively, and for occult N2 prediction are 0.942, 0.875 and 0.919, respectively, which are significantly better than the single-modal deep learning models, clinical model and physicians. This study demonstrates that the DLNMS harbors the potential to predict ONM of clinical stage N0 NSCLC.
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Affiliation(s)
- Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuang Cai
- School of Computer Science and Communication Engineering, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao Gui
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Minglei Yang
- Department of Thoracic Surgery, Ningbo HwaMei Hospital, Chinese Academy of Sciences, Zhejiang, China
| | - Bentong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Yongxiang Song
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Tingting Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yangchun Chen
- Department of Nuclear Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Behinaein P, Treffalls J, Hutchings H, Okereke IC. The Role of Sublobar Resection for the Surgical Treatment of Non-Small Cell Lung Cancer. Curr Oncol 2023; 30:7019-7030. [PMID: 37504369 PMCID: PMC10378348 DOI: 10.3390/curroncol30070509] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023] Open
Abstract
Lung cancer is the most common cancer killer in the world. The standard of care for surgical treatment of non-small cell lung cancer has been lobectomy. Recent studies have identified that sublobar resection has non-inferior survival rates compared to lobectomy, however. Sublobar resection may increase the number of patients who can tolerate surgery and reduce postoperative pulmonary decline. Sublobar resection appears to have equivalent results to surgery in patients with small, peripheral tumors and no lymph node disease. As the utilization of segmentectomy increases, there may be some centers that perform this operation more than other centers. Care must be taken to ensure that all patients have access to this modality. Future investigations should focus on examining the outcomes from segmentectomy as it is applied more widely. When employed on a broad scale, morbidity and survival rates should be monitored. As segmentectomy is performed more frequently, patients may experience improved postoperative quality of life while maintaining the same oncologic benefit.
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Affiliation(s)
- Parnia Behinaein
- School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - John Treffalls
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Hollis Hutchings
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
| | - Ikenna C Okereke
- Department of Surgery, Henry Ford Health, Detroit, MI 48202, USA
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Zhou J, Cai T, Wu D, Chen X, Wang F. The role of endoscopic ultrasound-guided fine-needle aspiration/biopsy in the diagnosis of mediastinal lesions. Front Surg 2023; 9:1065070. [PMID: 36684177 PMCID: PMC9852620 DOI: 10.3389/fsurg.2022.1065070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/24/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) is an accurate technique for sampling the pancreas and mediastinum. The aim of this study was to determine the value of EUS-FNA/FNB in the diagnosis of mediastinal lesions. Methods Data from 107 patients who underwent EUS-FNA/FNB for mediastinal lesions were evaluated. Results The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNA/FNB for mediastinal lesions were 92.00%, 100%, 100%, and 85%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNA for malignant mediastinal lesions were 92.00%, 100%, 100%, and 86.00%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS-FNB for malignant mediastinal lesions were 92.00%, 100%, 100%, and 82.00%, respectively. Except for the discomfort caused by conventional gastroscopy, none of the patients had any complications, such as damage to surrounding large blood vessels or nerves. Conclusion EUS-FNA/FNB is an effective tool for diagnosing unknown mediastinal lesions, without any obvious complications.
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Affiliation(s)
- Jingjing Zhou
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ting Cai
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dongwen Wu
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiong Chen
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Fen Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China,Correspondence: Fen Wang
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Zhong Y, She Y, Deng J, Chen S, Wang T, Yang M, Ma M, Song Y, Qi H, Wang Y, Shi J, Wu C, Xie D, Chen C. Deep Learning for Prediction of N2 Metastasis and Survival for Clinical Stage I Non-Small Cell Lung Cancer. Radiology 2021; 302:200-211. [PMID: 34698568 DOI: 10.1148/radiol.2021210902] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Preoperative mediastinal staging is crucial for the optimal management of clinical stage I non-small cell lung cancer (NSCLC). Purpose To develop a deep learning signature for N2 metastasis prediction and prognosis stratification in clinical stage I NSCLC. Materials and Methods In this retrospective study conducted from May 2020 to October 2020 in a population with clinical stage I NSCLC, an internal cohort was adopted to establish a deep learning signature. Subsequently, the predictive efficacy and biologic basis of the proposed signature were investigated in an external cohort. A multicenter diagnostic trial (registration number: ChiCTR2000041310) was also performed to evaluate its clinical utility. Finally, on the basis of the N2 risk scores, the instructive significance of the signature in prognostic stratification was explored. The diagnostic efficiency was quantified with the area under the receiver operating characteristic curve (AUC), and the survival outcomes were assessed using the Cox proportional hazards model. Results A total of 3096 patients (mean age ± standard deviation, 60 years ± 9; 1703 men) were included in the study. The proposed signature achieved AUCs of 0.82, 0.81, and 0.81 in an internal test set (n = 266), external test cohort (n = 133), and prospective test cohort (n = 300), respectively. In addition, higher deep learning scores were associated with a lower frequency of EGFR mutation (P = .04), higher rate of ALK fusion (P = .02), and more activation of pathways of tumor proliferation (P < .001). Furthermore, in the internal test set and external cohort, higher deep learning scores were predictive of poorer overall survival (adjusted hazard ratio, 2.9; 95% CI: 1.2, 6.9; P = .02) and recurrence-free survival (adjusted hazard ratio, 3.2; 95% CI: 1.4, 7.4; P = .007). Conclusion The deep learning signature could accurately predict N2 disease and stratify prognosis in clinical stage I non-small cell lung cancer. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Park and Lee in this issue.
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Affiliation(s)
- Yifan Zhong
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Yunlang She
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Jiajun Deng
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Shouyu Chen
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Tingting Wang
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Minglei Yang
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Minjie Ma
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Yongxiang Song
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Haoyu Qi
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Yin Wang
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Jingyun Shi
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Chunyan Wu
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Dong Xie
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
| | - Chang Chen
- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
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- From the Departments of Thoracic Surgery (Y.Z., Y. She, J.D., D.X., C.C.), Radiology (T.W., J.S.), and Pathology (C.W.), Shanghai Pulmonary Hospital, Tongji University School of Medicine, 507 Zhengmin Rd, Shanghai 200433, China; Department of Computer Science and Technology, College of Electronics and Information Engineering, Tongji University, Shanghai, China (S.C., H.Q., Y.W.); Department of Thoracic Surgery, Ningbo No. 2 Hospital, Chinese Academy of Sciences, Zhejiang, China (M.Y.); Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China (M.M., C.C.); The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Gansu Province, China (M.M., C.C.); and Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China (Y. Song)
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Makarenko VV, DeLelys ME, Hasserjian RP, Ly A. Lymph node FNA cytology: Diagnostic performance and clinical implications of proposed diagnostic categories. Cancer Cytopathol 2021; 130:144-153. [PMID: 34661975 DOI: 10.1002/cncy.22523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite widespread clinical use, lymph node fine-needle aspiration cytology (LN-FNAC) lacks universal acceptance for definitively diagnosing lymphomas. This is likely due to reports of lower diagnostic performance, inconsistent terminology use in cytopathology diagnostic reports, and only limited data on the clinical implications of LN-FNAC diagnoses. Recently, a uniform LN-FNAC cytopathological diagnostic reporting system was proposed (the Sydney System). This study evaluated LN-FNAC diagnostic performance and risks of malignancy associated with the proposed diagnostic categories. METHODS LN-FNAC specimens obtained in 2018-2019, with and without concurrent core biopsy, to evaluate for suspected lymphoma were analyzed (n = 349). LN-FNAC diagnoses were compared with final diagnoses obtained via subsequent tissue biopsy and/or clinical assessment. RESULTS The mean patient age was 57.6 years, and 41% were female. LN-FNAC was the initial diagnostic test in 223 (63.9%), and it was used to evaluate for recurrence in 126 (36.1%). LN-FNAC diagnosed 202 hematological malignancies (57.9%), 23 nonhematological malignancies (6.6%), and 124 reactive processes (35.5%). Subsequent tissue biopsy was performed in 42 (12%). The risks of malignancy per diagnostic category were as follows: inadequate, 58.3%; benign, 6.4%; atypical, 69.2%; suspicious, 96.7%; and malignant, 99.3%. LN-FNAC demonstrated up to 96.3% sensitivity, 91.91% specificity, and 87.35% accuracy. Optimal specimen quality and the use of intradepartmental consultation reduced diagnostic error rates in FNA cases without concurrent core biopsy (P = .029 and P = .0002 respectively). CONCLUSIONS LN-FNAC is accurate and reliable for the diagnosis of lymphoma. Inadequate LN-FNAC samples should be resampled due to a significant associated risk of lymphoma. The diagnostic performance of LN-FNAC may be improved with good specimen quality and reviews by multiple pathologists. Understanding the risks of malignancy associated with LN-FNAC diagnostic categories will help to guide optimal patient management.
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Affiliation(s)
- Vladislav V Makarenko
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michelle E DeLelys
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
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Computed Tomography Radiomics for Residual Positron Emission Tomography-Computed Tomography Uptake in Lymph Nodes after Treatment. Cancers (Basel) 2020; 12:cancers12123564. [PMID: 33260608 PMCID: PMC7761511 DOI: 10.3390/cancers12123564] [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: 10/23/2020] [Revised: 11/17/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In this study we explored the predictive ability of radiomics in non-small cell lung cancer patients, and reported the complementary role of radiomics in predicting the treatment response of the lymph nodes. Radiomics analysis is a cutting-edge technology for the noninvasive assessment of tumor biology, which converts medical images into mineable high-dimensional data. Our method is cost-effective with no need for additional studies, and moreover, we used an easily reproducible study method that can be applicable in further studies using radiomics in oncology. Abstract Although a substantial decrease in 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) uptake on positron emission tomography-computed tomography (PET-CT) indicates a promising metabolic response to treatment, predicting the pathologic status of lymph nodes (LN) remains challenging. We investigated the potential of a CT radiomics approach to predict the pathologic complete response of LNs showing residual uptake after neoadjuvant concurrent chemoradiotherapy (NeoCCRT) in patients with non-small cell lung cancer (NSCLC). Two hundred and thirty-seven patients who underwent NeoCCRT for stage IIIa NSCLC were included. Two hundred fifty-two CT radiomics features were extracted from LNs showing remaining positive FDG uptake upon restaging PET-CT. A multivariable logistic regression analysis of radiomics features and clinicopathologic characteristics was used to develop a prediction model. Of the 237 patients, 135 patients (185 nodes) met our inclusion criteria. Eighty-seven LNs were proven to be malignant (47.0%, 87/185). Upon multivariable analysis, metastatic LNs were significantly prevalent in females and patients with adenocarcinoma (odds ratio (OR) = 2.02, 95% confidence interval (CI) = 0.88–4.62 and OR = 0.39, 95% CI = 0.19–0.77 each). Metastatic LNs also had a larger maximal 3D diameter and higher cluster tendency (OR = 9.92, 95% CI = 3.15–31.17 and OR = 2.36, 95% CI = 1.22–4.55 each). The predictive model for metastasis showed a discrimination performance with an area under the receiver operating characteristic curve of 0.728 (95% CI = 0.654–0.801, p value < 0.001). The radiomics approach allows for the noninvasive detection of metastases in LNs with residual FDG uptake after the treatment of NSCLC patients.
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Sun L, Liu WK, Du XW, Liu XL, Li G, Yao Y, Han T, Li WY, Gu J. Large-scale transcriptome analysis identified RNA methylation regulators as novel prognostic signatures for lung adenocarcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:751. [PMID: 32647676 PMCID: PMC7333141 DOI: 10.21037/atm-20-3744] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The abnormal expression of genes is an essential factor affecting the prognosis of cancer. RNA modification is a way of regulating post-transcriptional levels, including m6A, m5C, m1A RNA methylation. Studies have found that RNA methylation regulates tumorigenesis development and stem cell regeneration. However, there are few studies on lung adenocarcinoma. This study aims to explore the clinical value of RNA methylation for lung adenocarcinoma. Methods We summarized thirty-one RNA methylation regulators. The training set was obtained from The Cancer Genome Atlas (TCGA) database, and the test set was obtained from the Gene Expression Omnibus (GEO) database. The Wilcoxon test was used to analyze the expression of RNA methylation regulators. We constructed tumor subgroup models and risk models based on the expression of those regulators. Principal component analysis (PCA) and the receiver operating characteristic (ROC) confirmed the accuracy of the models. Real-time polymerase chain reaction (PCR) validates the results in vitro. Results Most RNA methylation regulators had distinct expressions in tumor tissues and adjacent tissues (P<0.05). All the models showed high predictive performance (AUC: 0.65-0.82), and the five-year survival of patients in each group was statistically different (P<0.05). The patients in the high-risk group were more likely to have a higher stage, more lymph node metastases, and distant metastases, showing a poor clinical outcome. Patients with high expression of NOP2 or HNRNP were more likely to have a poorly differentiated in vitro experiment. Conclusions With our study, we found that the expressions of most RNA methylation regulators were significantly different in cancer and para-cancerous tissues. Different molecular phenotypes constructed by RNA methylation regulators can be independent risk factors for the prognosis of lung adenocarcinoma. Our study demonstrates the critical role of RNA methylation in lung adenocarcinoma, and it is expected to supply a reference for the prognostic stratification and treatment strategy development of lung adenocarcinoma.
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Affiliation(s)
- Lei Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wen-Ke Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiao-Wei Du
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China.,Jinzhou Medical University, Jinzhou, China
| | - Xiang-Li Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Gao Li
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yao Yao
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tao Han
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Wen-Ya Li
- Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jia Gu
- Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Panunzio A, Sartori P. Lung Cancer and Radiological Imaging. Curr Radiopharm 2020; 13:238-242. [PMID: 32445458 PMCID: PMC8206195 DOI: 10.2174/1874471013666200523161849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/16/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer is the neoplasm with the highest prevalence and mortality rates in the world. Most patients with lung cancer that are symptomatic have hemoptysis, coughing, shortness of breath, chest pain and persistent infections. Less than 10% of patients are asymptomatic when the tumor is detected as an incidental finding. OBJECTIVE The present expert review aims to describe the use of radiological imaging modalities for the diagnosis of lung cancer. METHODS Some papers were selected from the international literature, by using mainly Pubmed as a source. RESULTS Chest x-ray (CXR) is the first investigation performed during the workup of suspected lung cancer. In the absence of a rib erosion, CXR cannot distinguish between benign and malignant masses, therefore computed tomography (CT) with contrast enhancement should be performed in order to obtain a correct staging. Magnetic resonance imaging of the chest is considered a secondary approach as the respiratory movement affects the overall results. CONCLUSION Radiological imaging is essential for the management of patients affected by lung cancer.
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Affiliation(s)
- Annalori Panunzio
- UO Radiodiagnostica, Presidio Ospedaliero di Ostuni, ASL Brindisi, Brindisi, Italy
| | - Paolo Sartori
- Ospedale San Giovanni e Paolo, ULSS 3 Veneziana, Venezia, Italy
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10
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Harris D, Saha S. Endobronchial ultrasound-guided biopsy for evaluation of suspected lung cancer. Asian Cardiovasc Thorac Ann 2019; 27:471-475. [DOI: 10.1177/0218492319853184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Historically, mediastinoscopy has been the gold standard for lung cancer diagnosis and staging, but mediastinoscopy has many limitations including sensitivity, the limited number of lymph node levels that can be sampled, and safety. Endobronchial ultrasound-guided transbronchial needle aspiration is a relatively new and less-invasive technique being used for lung cancer screening. Many studies have reported that it has similar sensitivity and specificity compared to mediastinoscopy, with a significantly lower complication rate. We performed this review to determine our institution’s experience with endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer diagnosis and staging. Methods We reviewed the last 150 patients with suspected lung cancer who underwent endobronchial ultrasound-guided transbronchial needle aspiration procedures in our institution from May 26, 2016 to August 31, 2017. Results Ninety-seven of the 150 patients had a confirmed diagnosis of malignancy. Forty patients had a diagnosis other than cancer, and 13 had incomplete information or were lost to follow-up. Endobronchial ultrasound-guided transbronchial needle aspiration was correct in diagnosing malignancy or excluding malignant lymph nodes in 92 of the 97 patients with malignancy. Overall, the sensitivity, specificity, positive-predictive value, and negative-predictive value was 94.0%, 100.0%, 100.0%, and 91.5%, respectively. Only 3 complications were reported: 2 patients suffered minor bleeding, and one suffered major bleeding that resulted in cardiac arrest. Conclusions Real-time endobronchial ultrasound-guided transbronchial needle aspiration has a similar sensitivity and specificity to mediastinoscopy in diagnosing malignancy, with fewer complications and more financial benefit.
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Affiliation(s)
- Dwight Harris
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Sibu Saha
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA
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11
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Needle-based Optical Coherence Tomography to Guide Transbronchial Lymph Node Biopsy. J Bronchology Interv Pulmonol 2018; 25:189-197. [PMID: 29659420 DOI: 10.1097/lbr.0000000000000491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transbronchial needle aspiration (TBNA), often used to sample lymph nodes for lung cancer staging, is subject to sampling error even when performed with endobronchial ultrasound. Optical coherence tomography (OCT) is a high-resolution imaging modality that rapidly generates helical cross-sectional images. We aim to determine if needle-based OCT can provide microstructural information in lymph nodes that may be used to guide TBNA, and improve sampling error. METHODS We performed ex vivo needle-based OCT on thoracic lymph nodes from patients with and without known lung cancer. OCT imaging features were compared against matched histology. RESULTS OCT imaging was performed in 26 thoracic lymph nodes, including 6 lymph nodes containing metastatic carcinoma. OCT visualized lymphoid follicles, adipose tissue, pigment-laden histiocytes, and blood vessels. OCT features of metastatic carcinoma were distinct from benign lymph nodes, with microarchitectural features that reflected the morphology of the carcinoma subtype. OCT was also able to distinguish lymph node from adjacent airway wall. CONCLUSIONS Our results demonstrate that OCT provides critical microstructural information that may be useful to guide TBNA lymph node sampling, as a complement to endobronchial ultrasound. In vivo studies are needed to further evaluate the clinical utility of OCT in thoracic lymph node assessment.
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Sawan P, Plodkowski AJ, Li AE, Li BT, Drilon A, Capanu M, Ginsberg MS. CT features of HER2-mutant lung adenocarcinomas. Clin Imaging 2018; 51:279-283. [PMID: 29906786 PMCID: PMC7382989 DOI: 10.1016/j.clinimag.2018.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To describe the radiological phenotype of HER2-mutant lung cancers on CT at presentation. METHODS Eligible patients with lung adenocarcinomas with HER2 mutations were stage-matched with two control groups (EGFR- and KRAS-mutant groups). Evaluated CT features of the primary tumor included size, location, consistency, contour, presence of pleural tags and pleural retractions. Presence of pleural effusions, lung metastases, adenopathy, chest wall invasion, and were also recorded. Wilcoxon rank-sum and Fisher's exact tests were used to compare continuous and categorical features, respectively. RESULTS One hundred and fifty-four patients were identified: 50 (33%) harbored HER2 mutations, 56 (36%) harbored KRAS mutations, and 48 (31%) harbored EGFR mutations. Compared with KRAS, HER2 tumors presented as smaller lesions (2.3 cm versus 2.9 cm, p = 0.005 for length; 1.6 cm versus 2.1 cm, p = 0.002 for width) with the presence of pleural tags (74% vs. 52%, p = 0.03), pleural retractions (58% vs. 39%, p = 0.006), ipsilateral hilar (36% vs. 16%, p = 0.03) and scalene/supraclavicular N3 adenopathy (24% vs. 7%, p = 0.03). Compared with EGFR, pleural retractions were more prevalent among the HER2 tumors (58% vs. 37%, p = 0.05). CONCLUSIONS Lung adenocarcinomas with HER2 gene mutation exhibit an aggressive behavior manifesting by higher incidence of local invasion, compared to KRAS and EGFR mutant controls, and a nodal metastatic spread compared to KRAS-mutant control. This is the first radiogenomics study of HER2 mutations in lung cancer.
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Affiliation(s)
- Peter Sawan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Angela E Li
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Bob T Li
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Alexander Drilon
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA.
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Lee J, Kim YK, Seo YY, Choi EK, Lee DS, Kim YS, Hong SH, Kang JH, Lee KY, Park JK, Sung SW, Kim HB, Park MS, Yim HW, Kim SJ. Clinical Characteristics of False-Positive Lymph Node on Chest CT or PET-CT Confirmed by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Lung Cancer. Tuberc Respir Dis (Seoul) 2018; 81:339-346. [PMID: 29926557 PMCID: PMC6148105 DOI: 10.4046/trd.2017.0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 12/25/2022] Open
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure to evaluate suspicious lymph node involvement of lung cancer because computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography-CT (PET-CT) have limitations in their sensitivity and specificity. There are a number of benign causes of false positive lymph node such as anthracosis or anthracofibrosis, pneumoconiosis, old or active tuberculosis, interstitial lung disease, and other infectious conditions including pneumonia. The purpose of this study was to evaluate possible causes of false positive lymph node detected in chest CT or PET-CT. Methods Two hundred forty-seven patients who were initially diagnosed with lung cancer between May 2009 and December 2012, and underwent EBUS-TBNA to confirm suspicious lymph node involvement by chest CT or PET-CT were analyzed for the study. Results Of 247 cases, EBUS-TBNA confirmed malignancy in at least one lymph node in 189. The remaining 58 patients whose EBUS-TBNA results were negative were analyzed. Age ≥65, squamous cell carcinoma as the histologic type, and pneumoconiosis were related with false-positive lymph node involvement on imaging studies such as chest CT and PET-CT. Conclusion These findings suggest that lung cancer staging should be done more carefully when a patient has clinically benign lymph node characteristics including older age, squamous cell carcinoma, and benign lung conditions.
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Affiliation(s)
- Jongmin Lee
- Division of Pulmonary, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoon Kim
- Division of Pulmonary, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ye Young Seo
- Department of Nuclear Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Eun Kyoung Choi
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Soo Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeon Sil Kim
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Hee Hong
- Division of Medical Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Hyoung Kang
- Division of Medical Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Whan Sung
- Department of Thoracic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Bin Kim
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Sun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Woo Yim
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joon Kim
- Division of Pulmonary, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Carmo J, Bispo M, Marques S, Chagas C. Prevalence and echo features of mediastinal lymph nodes in EUS for non-malignant indications: a prospective study in a Southern European Population. Endosc Int Open 2018; 6:E432-E436. [PMID: 29607396 PMCID: PMC5876034 DOI: 10.1055/s-0044-101602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/27/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Significant heterogeneity in geographic distribution regarding the prevalence of mediastinal lymph nodes (MLN) has been documented in autopsy and computed tomography (CT) studies. Awareness of the local prevalence and characteristics of lymph nodes will be relevant when performing endoscopic ultrasonography (EUS) for staging of malignant neoplasias. The aims of this study were to document the prevalence and echo features of MLN in patients undergoing EUS for non-malignant extrathoracic disease and to identify predictive factors for the presence of MLN. PATIENTS AND METHODS A prospective single-center study was performed over 6 months. Mediastinal stations 9, 8, 7, 6, 5, 4 L and 2 were systematically evaluated using a linear echoendoscope in all patients undergoing EUS due to benign extrathoracic pathology and without history of oncologic disease. Demographic, clinical and EUS features of the lymph nodes were analysed. RESULTS Seventy-five patients were included: male/female 32/43; mean age, 63 years. The majority of patients (72 %) had lymph nodes in at least one mediastinal station and 88 % of these were found in stations 7 or 4 L. Overall, 133 MLN were identified: 19 % were hypoechogenic, 6 % had a short-axis diameter > 10 mm, and 6 % were round. The prevalence of lymph nodes was higher in smokers (83 % vs 64 %, P = 0.024), with a higher average number of lymph nodes per patient in this group (2.1 vs 1.6; P = 0.017). By logistic regression analysis, none of the variables analyzed were independently associated with the presence of MLN. CONCLUSION This prospective Portuguese study documented a higher prevalence of MLN than previously reported in Northern Europe, in patients with no evidence of oncologic disease. This higher prevalence may negatively influence the specificity and positive predictive value for malignancy of MLN (N) staging by EUS.
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Affiliation(s)
- Joana Carmo
- Gastroenterology Department, Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal,Corresponding author Joana Carmo Gastroenterology DepartmentHospital Egas Moniz – CHLORua da Junqueira 1261349-019 LisboaPortugal+351 213624139
| | - Miguel Bispo
- Gastroenterology Department, Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Susana Marques
- Gastroenterology Department, Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Cristina Chagas
- Gastroenterology Department, Hospital de Egas Moniz – Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Diagnostic Accuracy of Mediastinal Lymph Node Staging Techniques in the Preoperative Assessment of Nonsmall Cell Lung Cancer Patients. J Bronchology Interv Pulmonol 2018; 25:17-24. [DOI: 10.1097/lbr.0000000000000425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zang RC, Qiu B, Gao SG, He J. A Model Predicting Lymph Node Status for Patients with Clinical Stage T1aN0-2M0 Nonsmall Cell Lung Cancer. Chin Med J (Engl) 2017; 130:398-403. [PMID: 28218211 PMCID: PMC5324374 DOI: 10.4103/0366-6999.199838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Lymph node status of patients with early-stage nonsmall cell lung cancer has an influence on the choice of surgery. To assess the lymph node status more correspondingly and accurately, we evaluated the relationship between the preoperative clinical variables and lymph node status and developed one model for predicting lymph node involvement. Methods: We collected clinical and dissected lymph node information of 474 patients with clinical stage T1aN0-2M0 nonsmall cell lung cancer (NSCLC). Logistic regression analysis of clinical characteristics was used to estimate independent predictors of lymph node metastasis. The prediction model was validated by another group. Results: Eighty-two patients were diagnosed with positive lymph nodes (17.3%), and four independent predictors of lymph node disease were identified: larger consolidation size (odds ratio [OR] = 2.356, 95% confidence interval [CI]: 1.517–3.658, P < 0.001,), central tumor location (OR = 2.810, 95% CI: 1.545–5.109, P = 0.001), abnormal status of tumor marker (OR = 3.190, 95% CI: 1.797–5.661, P < 0.001), and clinical N1–N2 stage (OR = 6.518, 95% CI: 3.242–11.697, P < 0.001). The model showed good calibration (Hosmer–Lemeshow goodness-of-fit, P < 0.766) with an area under the receiver operating characteristics curve (AUC) of 0.842 (95% [CI]: 0.797–0.886). For the validation group, the AUC was 0.810 (95% CI: 0.731–0.889). Conclusions: The model can assess the lymph node status of patients with clinical stage T1aN0-2M0 NSCLC, enable surgeons perform an individualized prediction preoperatively, and assist the clinical decision-making procedure.
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Affiliation(s)
- Ruo-Chuan Zang
- Department of Thoracic Surgery, Peking Union Medical College, Cancer Hospital and Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Bin Qiu
- Department of Thoracic Surgery, Peking Union Medical College, Cancer Hospital and Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Shu-Geng Gao
- Department of Thoracic Surgery, Peking Union Medical College, Cancer Hospital and Chinese Academy of Medical Sciences, Beijing 100021, China
| | - Jie He
- Department of Thoracic Surgery, Peking Union Medical College, Cancer Hospital and Chinese Academy of Medical Sciences, Beijing 100021, China
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Oberkampf H, Zillner S, Overton JA, Bauer B, Cavallaro A, Uder M, Hammon M. Semantic representation of reported measurements in radiology. BMC Med Inform Decis Mak 2016; 16:5. [PMID: 26801764 PMCID: PMC4722630 DOI: 10.1186/s12911-016-0248-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/20/2016] [Indexed: 12/23/2022] Open
Abstract
Background In radiology, a vast amount of diverse data is generated, and unstructured reporting is standard. Hence, much useful information is trapped in free-text form, and often lost in translation and transmission. One relevant source of free-text data consists of reports covering the assessment of changes in tumor burden, which are needed for the evaluation of cancer treatment success. Any change of lesion size is a critical factor in follow-up examinations. It is difficult to retrieve specific information from unstructured reports and to compare them over time. Therefore, a prototype was implemented that demonstrates the structured representation of findings, allowing selective review in consecutive examinations and thus more efficient comparison over time. Methods We developed a semantic Model for Clinical Information (MCI) based on existing ontologies from the Open Biological and Biomedical Ontologies (OBO) library. MCI is used for the integrated representation of measured image findings and medical knowledge about the normal size of anatomical entities. An integrated view of the radiology findings is realized by a prototype implementation of a ReportViewer. Further, RECIST (Response Evaluation Criteria In Solid Tumors) guidelines are implemented by SPARQL queries on MCI. The evaluation is based on two data sets of German radiology reports: An oncologic data set consisting of 2584 reports on 377 lymphoma patients and a mixed data set consisting of 6007 reports on diverse medical and surgical patients. All measurement findings were automatically classified as abnormal/normal using formalized medical background knowledge, i.e., knowledge that has been encoded into an ontology. A radiologist evaluated 813 classifications as correct or incorrect. All unclassified findings were evaluated as incorrect. Results The proposed approach allows the automatic classification of findings with an accuracy of 96.4 % for oncologic reports and 92.9 % for mixed reports. The ReportViewer permits efficient comparison of measured findings from consecutive examinations. The implementation of RECIST guidelines with SPARQL enhances the quality of the selection and comparison of target lesions as well as the corresponding treatment response evaluation. Conclusions The developed MCI enables an accurate integrated representation of reported measurements and medical knowledge. Thus, measurements can be automatically classified and integrated in different decision processes. The structured representation is suitable for improved integration of clinical findings during decision-making. The proposed ReportViewer provides a longitudinal overview of the measurements.
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Affiliation(s)
- Heiner Oberkampf
- Department of Computer Science, Software Methodologies for Distributed Systems, University of Augsburg, Universitätsstraße 6a, 86159, Augsburg, Germany. .,Corporate Technology, Siemens AG, Otto-Hahn-Ring 6, 81739, Münech, Germany.
| | - Sonja Zillner
- Corporate Technology, Siemens AG, Otto-Hahn-Ring 6, 81739, Münech, Germany. .,School of International Business and Entrepreneurship, Steinbeis University, Kalkofenstraße 53, 71083, Herrenberg, Germany.
| | | | - Bernhard Bauer
- Department of Computer Science, Software Methodologies for Distributed Systems, University of Augsburg, Universitätsstraße 6a, 86159, Augsburg, Germany.
| | - Alexander Cavallaro
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
| | - Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
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Gogia P, Insaf TZ, McNulty W, Boutou A, Nicholson AG, Zoumot Z, Shah PL. Endobronchial ultrasound: morphological predictors of benign disease. ERJ Open Res 2016; 2:00053-2015. [PMID: 27730169 PMCID: PMC5005152 DOI: 10.1183/23120541.00053-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/16/2015] [Indexed: 12/25/2022] Open
Abstract
The objective of this study was to assess the utility of endobronchial ultrasound (EBUS) morphology of lymph nodes in predicting benign cytology of transbronchial needle aspirates in a prospective observational study. Five ultrasonic morphological characteristics of mediastinal and hilar lymph nodes were recorded: size, shape, margins, echogenic appearance and the presence of a central blood vessel. These characteristics were correlated with the final diagnosis. A total of 402 consecutive patients (237 males and 165 females) undergoing EBUS were studied. The final diagnosis was malignant disease in 244 (60.6%) and benign disease in 153 (38.05%) subjects. Out of 740 sampled nodes, in 463 (62.6%) malignant cells were identified, whereas in 270 (36.5%) nodes, no malignant cells were identified. On univariate analysis small size, triangular shape and the presence of a central vessel were predictive of a benign aetiology. In the final multivariate model, a predictive probability of 0.811 (95% CI 0.72-0.91) for benign disease was found if lymph node size was <10 mm and a central vessel was present. Sonographic appearances of lymph nodes improve the predictive probability of EBUS for benign aetiologies, and may reduce the number of nodes requiring sampling and the need for further invasive investigations.
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Affiliation(s)
- Pratibha Gogia
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK
| | - Tabassum Z Insaf
- School of Public Health University at Albany, State University of New York, Rensselaer, NY, USA
| | - William McNulty
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Afroditi Boutou
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK
| | - Andrew G Nicholson
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Dept of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Zaid Zoumot
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Respiratory and Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; These authors contributed equally
| | - Pallav L Shah
- The NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield National Health Service (NHS) Foundation Trust and Imperial College, London, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; These authors contributed equally
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Folch E, Costa DB, Wright J, VanderLaan PA. Lung cancer diagnosis and staging in the minimally invasive age with increasing demands for tissue analysis. Transl Lung Cancer Res 2015; 4:392-403. [PMID: 26380180 DOI: 10.3978/j.issn.2218-6751.2015.08.02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 12/25/2022]
Abstract
The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. As an important component to a multidisciplinary team approach in the care of patients with lung cancer, these minimally invasive modalities have proven invaluable for the rapid and safe acquisition of tissue used for the diagnosis, staging, and molecular testing of tumors to identify the best evidence-based treatment plan. The continuous evolution of the field of lung cancer staging and treatment has translated into improvements in survival and quality of life for patients. Although differences in clinical practice between academic and community hospital settings still exist, improvements in physician education and training as well as adoption of technological advancements should help narrow this gap going forward.
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Affiliation(s)
- Erik Folch
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Daniel B Costa
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Jeffrey Wright
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Paul A VanderLaan
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Ding N, Mao Y. [Advances of mediastinal lymph node metastasis and the extent of lymph node
dissection in patients with stage T1 non-small cell lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2015; 18:34-41. [PMID: 25603871 PMCID: PMC5999745 DOI: 10.3779/j.issn.1009-3419.2015.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
肺癌是我国发病率和死亡率最高的恶性肿瘤。非小细胞肺癌(non-small cell lung cancer, NSCLC)约占肺癌80%。临床上,早期NSCLC以手术治疗为主要治疗方式,淋巴结分期及手术中清扫程度直接影响着患者的预后。不同肺叶原发NSCLC的淋巴结转移区域存在一定规律。解剖性肺叶切除加系统性淋巴结清扫一直以来被认为是NSCLC的标准手术方式,但近年来T1期NSCLC手术中纵隔淋巴结清扫的程度存在较大争议,选择性淋巴结清扫已逐渐被大多数学者所重视。
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Affiliation(s)
- Ningning Ding
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences,
Beijing 100021, China
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Systematic mediastinal lymphadenectomy or mediastinal lymph node sampling in patients with pathological stage I NSCLC: a meta-analysis. World J Surg 2014; 39:410-6. [PMID: 25277979 DOI: 10.1007/s00268-014-2804-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate the evidence comparing systematic mediastinal lymphadenectomy (SML) and mediastinal lymph node sampling (MLS) in the treatment of pathological stage I NSCLC using meta-analytical techniques. METHODS A literature search was undertaken until January 2014 to identify the comparative studies evaluating 1-, 3-, and 5-year survival rates. The pooled odds ratios (OR) and the 95 % confidence intervals (95 % CI) were calculated with either the fixed or random effect models. RESULTS One RCT study and four retrospective studies were included in our meta-analysis. These studies included a total of 711 patients: 317 treated with SML, and 394 treated with MLS. The SML and the MLS did not demonstrate a significant difference in the 1-year survival rate. There were significant statistical differences between the 3-year (P = 0.03) and 5-year survival rates (P = 0.004), which favored SML. CONCLUSIONS This meta-analysis suggests that in pathological stage I NSCLC, the MLS can get the similar outcome to the SML in terms of 1-year survival rate. However, the SML is superior to MLS in terms of 3- and 5-year survival rates.
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Liu H, Zhou J, Feng QL, Wan G, Xie YJ, Gu HT. Minimally invasive endoscopic staging for mediastinal lymphadenopathy in lung cancer: a systematic review protocol. BMJ Open 2014; 4:e005707. [PMID: 25082423 PMCID: PMC4120311 DOI: 10.1136/bmjopen-2014-005707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Minimally invasive endoscopic biopsy techniques have been widely available as potential alternatives for mediastinal lesions staging in patients with known or suspected lung cancer. Previous efforts have been made to evaluate the diagnostic performance of specific endoscopic modality alone at the level of the mediastinum for staging lung cancer, however, few studies focus on the accuracy of comparisons between different endoscopic modalities, especially at the level of any individual lymph node station. The objective of our study is to determine the diagnostic yields of different endoscopic modalities for staging mediastinal lymphadenopathy in lung cancer, especially concerning the individual lymph node station. METHODS/DESIGN A systematic electronic search of MEDLINE, EMBASE, SinoMed and ISI Web of Science were performed to identify studies evaluating endoscopic modalities accuracy with restriction of English and Chinese languages from inception to an update until May 2014. Data were extracted with the patient as the unit of analysis with regards to the abilities of different endoscopic modalities at the level of mediastinum and particular lymph node station. The methodological quality was assessed independently according to the Quality Assessment of Diagnostic Accuracy Study (QADAS) criteria. An exact binomial rendition of bivariate mixed-effects regression model was used to estimate the pooled sensitivity and specificity. Also, pre-post probability analysis, publication bias analysis and sensitivity analysis were performed for a synthesis of knowledge of this context. DISSEMINATION The findings will advance our better available knowledge of optimal clinical decision-making when dealing with staging of mediastinal metastasis in lung cancer. TRIAL REGISTRATION NUMBER PROSPERO-NIHR Prospective Register of Systematic Reviews (CRD42014009792).
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Affiliation(s)
- Hong Liu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jie Zhou
- Department of Ultrasonography, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiao-ling Feng
- Key Laboratory of Diagnostic Medicine of Education Ministry, Institute of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Gang Wan
- Department of Radiation Oncology, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Yong-jun Xie
- National Center for Medical Simulation of China, Chengdu Medical College, Chengdu, China
- Department of Histo-anatomy, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, China
| | - Hai-tao Gu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Apostolakis E, Papakonstantinou NA, Chlapoutakis S, Prokakis C. Save or sacrifice the internal mammary pedicle during anterior mediastinotomy? Ann Thorac Med 2014; 9:138-43. [PMID: 24987471 PMCID: PMC4073569 DOI: 10.4103/1817-1737.134067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/17/2013] [Indexed: 12/03/2022] Open
Abstract
Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior mediastinotomy may experience long survival that makes the development of ischemic heart disease throughout their life possible. Therefore, the un-judicial sacrifice of the internal mammary pedicle may deprive them from the benefit to have their internal mammary artery used as a graft in order to successfully bypass severe left anterior descending artery stenoses. We recommend the preservation of the internal mammary pedicle during anterior mediastinotomy, which should be a common message among our colleagues from the beginning of their training.
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Affiliation(s)
- Efstratios Apostolakis
- Department of Cardiothoracic Surgery, School of Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Nikolaos A Papakonstantinou
- Department of General Surgery, General Oncology Hospital of Kifissia "Agioi Anargyroi", 41 Kaliftaki Street, P.C. 14564, Kifissia, Athens, Greece
| | - Serafeim Chlapoutakis
- Department of Cardiothoracic Surgery, School of Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
| | - Christos Prokakis
- Department of Cardiothoracic Surgery, School of Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece
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Darling G, Malthaner R, Dickie J, McKnight L, Nhan C, Hunter A, McLeod RS. Quality Indicators for Non-Small Cell Lung Cancer Operations With Use of a Modified Delphi Consensus Process. Ann Thorac Surg 2014; 98:183-90. [DOI: 10.1016/j.athoracsur.2014.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/26/2014] [Accepted: 03/04/2014] [Indexed: 11/25/2022]
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New CT criteria for nodal staging in non-small cell lung cancer. Clin Imaging 2014; 38:448-453. [PMID: 24651060 DOI: 10.1016/j.clinimag.2014.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 01/25/2014] [Accepted: 02/10/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of our study was to develop a simple noninvasive technique for nodal staging using routine preoperative computed tomography (CT). MATERIALS AND METHODS The institutional review board approved this retrospective study, and written informed consent to perform the initial and follow-up CT studies was obtained from all patients. Preoperative CT findings (n=218 patients with resectable non-small cell lung cancer) and pathological diagnoses after surgical resection were evaluated. Using CT images, lymph node section area, circumference, and lesion attenuation values (LAVs) were drawn freehand, and the short axis (SA) and long axis (LA) were measured using caliper software. Receiver operating characteristic (ROC) curves were then used to analyze the section area, circumference, and LAVs. RESULTS Based on ROC curves, two cut-off values, lymph node section area >30 mm(2) and circumference >25 mm, showed greater sensitivity for nodal staging than the conventional criterion of lymph node SA ≥10 mm or the LA, SA/LA ratio or LAVs. Using lymph node section area >30 mm(2) for diagnosis, the sensitivity, specificity, and accuracy of nodal staging were 90.5%, 56.3%, and 58.3%, respectively. Using lymph node circumference >25 mm, the values were 76.2%, 70.4%, and 70.8%, respectively. CONCLUSION Lymph node section area >30 mm(2) and circumference >25 mm can serve as supportive criteria used by radiologists and surgeons to determine nodal staging. If these CT criteria are met, use of a more sensitive procedure such as positron emission tomography or mediastinoscopy is recommended. CONCISE ABSTRACT CT is used routinely during preoperative management of lung cancer. Based on ROC analyses, the cut-off values for surface area, circumference, the SA/LA ratio, and LAVs for diagnosis of lymph node metastasis were 30 mm(2), 25 mm, 0.65, and 50 Hounsfield units, respectively. Our findings indicate that lymph node surface area >30 mm(2) and circumference >25 mm are supportive criteria that can be used by radiologists and thoracic surgeons to determine nodal staging and surgical indications.
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Choi YR, An JY, Kim MK, Han HS, Lee KH, Kim SW, Lee KM, Choe KH. The diagnostic efficacy and safety of endobronchial ultrasound-guided transbronchial needle aspiration as an initial diagnostic tool. Korean J Intern Med 2013; 28:660-7. [PMID: 24307841 PMCID: PMC3846991 DOI: 10.3904/kjim.2013.28.6.660] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/06/2012] [Accepted: 02/07/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND/AIMS Real-time, convex probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is used for the staging of malignant mediastinal lymph nodes. We evaluated the diagnostic efficacy and safety of EBUS-TBNA when used as an initial diagnostic tool. METHODS We retrospectively studied 56 patients who underwent EBUS-TBNA as an initial diagnostic tool between August 2010 and December 2011. Procedure purpose were classified into four categories: 1) intrathoracic masses adjacent to the central airway; 2) enlarged lymph nodes for concurrent diagnosis and staging in suspected malignancy; 3) enlarged lymph nodes in suspected malignancy cases with inability to perform percutaneous core needle biopsy (PCNB); and 4) solely mediastinal masses/lymph nodes in lieu of mediastinoscopy. RESULTS The diagnostic accuracy of EBUS-TBNA regardless of procedure purpose was calculated to be 83.9%. Furthermore, the diagnostic accuracy of malignant disease was significantly higher than benign disease (93.9% vs. 70.6%, p < 0.001). The diagnostic accuracy of EBUS-TBNA for each disease is as follows: tuberculosis, 50%; sarcoidosis, 60%; aspergillosis, 100%; lung abscess, 100%; lung cancer, 93%; and lymphoma, 100%. There were minor complications in seven patients during the EBUS-TBNA procedure. The complications included mild hypoxia and bleeding. CONCLUSIONS In conclusion, EBUS-TBNA is a useful initial diagnostic tool for both benign and malignant diseases. EBUS-TBAN is also a very safe procedure and less invasive compared to mediastinoscopy or PCNB.
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Affiliation(s)
- Young Rak Choi
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jin Young An
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Medical Devices Clinical Trial Center, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mi Kyeong Kim
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hye-Suk Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Hyeong Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Si-Wook Kim
- Department of Thoracic Surgery, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ki Man Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kang Hyeon Choe
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Osarogiagbon RU, Darling GE. Towards optimal pathologic staging of resectable non-small cell lung cancer. Transl Lung Cancer Res 2013; 2:364-71. [PMID: 25806255 PMCID: PMC4367727 DOI: 10.3978/j.issn.2218-6751.2013.10.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/10/2013] [Indexed: 12/21/2022]
Abstract
Pathologic nodal staging is the most accurate means of determining prognosis of patients with resectable non-small cell lung cancer (NSCLC), but confusion prevails about the optimal pre-operative and surgical lymph node examination procedures for candidates of curative-intent resection. The landmark American College of Surgeons Oncology Group Z0030 trial revealed no difference in the survival of patients with clinical T1 or T2, N0 or N1 (hilar node-negative), M0 NSCLC who either had a fastidious, pre-defined systematic hilar and mediastinal lymph node sampling procedure, or who received a complete mediastinal lymph node dissection. We place the results of this major trial into a contemporary clinical practice context, and discuss problems associated with apparent misunderstanding of the lessons from this trial, especially in light of evidence of prevailing sub-optimal nodal examination practices. We also discuss evolving knowledge about the origin of the quality gap in pathologic nodal staging and the emerging literature on corrective interventions.
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Affiliation(s)
- Raymond U. Osarogiagbon
- Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN, USA
| | - Gail E. Darling
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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Imai K, Minamiya Y, Saito H, Motoyama S, Sato Y, Ito A, Yoshino K, Kudo S, Takashima S, Kawaharada Y, Kurihara N, Orino K, Ogawa JI. Diagnostic imaging in the preoperative management of lung cancer. Surg Today 2013; 44:1197-206. [PMID: 23838838 DOI: 10.1007/s00595-013-0660-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/13/2013] [Indexed: 12/25/2022]
Abstract
Surgical resection is the accepted standard of care for patients with non-small cell lung cancer (NSCLC). Several imaging modalities play central roles in the detection and staging of the disease. The aim of this review is to evaluate the utility of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and PET/CT for NSCLC staging. Radiographic staging refers to the use of CT as a non-invasive diagnostic technique. However, while the vast majority of patients undergo only CT, CT is a notoriously inaccurate means of tumor and nodal staging in many situations. PET/CT clearly improves the staging, particularly nodal staging, compared to CT or PET alone. In addition, as a result of the increased soft-tissue contrast, MRI is superior to CT for distinguishing between tissue characteristics. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which is a minimally invasive technique, also has pathological diagnostic potential. Extensive research and the resultant improvements in the understanding of genetics, histology, molecular biology and oncology are transforming our understanding of lung cancer, and it is clear that imaging modalities such as CT, MRI, PET and PET/CT will have an important role in its preoperative management. However, thoracic surgeons should also be aware of the limitations of these techniques.
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Affiliation(s)
- Kazuhiro Imai
- Department of Chest (& Endocrinological) Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan,
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Diagnostic yield and safety of endoscopic ultrasound guided fine needle aspiration of central mediastinal lung masses. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:150492. [PMID: 23818747 PMCID: PMC3683425 DOI: 10.1155/2013/150492] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/11/2013] [Indexed: 11/18/2022]
Abstract
UNLABELLED Background and Aims. EUS-FNA is an accurate and safe technique to biopsy mediastinal lymph nodes. However, there are few data pertaining to the role of EUS-FNA to biopsy central lung masses. The aim of the study was to assess the diagnostic yield and safety of EUS-FNA of indeterminate central mediastinal lung masses. Methods. DESIGN Retrospective review of a prospectively maintained database; noncomparative. SETTING Tertiary referral center. From 10/2004 to 12/2010, all patients with a lung mass located within proximity to the esophagus were referred for EUS-FNA. MAIN OUTCOME MEASUREMENT EUS-FNA diagnostic accuracy and safety. Results. 73 consecutive patients were included. EUS allowed detection in 62 (85%) patients with lack of visualization prohibiting FNA in 11 patients. Among sampled lesions, one patient (1/62 = 1.6%) had a benign lung mass (hamartoma), while the remaining 61 patients (61/62 = 98.4%) had a malignant mass (primary lung cancer: 55/61 = 90%; lung metastasis: 6/61 = 10%). The sensitivity, specificity, and accuracy of EUS-FNA were 96.7%, 100%, and 96.7%, respectively. The sensitivity was 80.8% when considering nonvisualized masses. One patient developed a pneumothorax (1/62 = 1.6%). Conclusions. EUS-FNA appears to be an accurate and safe technique for tissue diagnosis of central mediastinal lung masses.
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Asano F, Aoe M, Ohsaki Y, Okada Y, Sasada S, Sato S, Suzuki E, Semba H, Fukuoka K, Fujino S, Ohmori K. Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res 2013; 14:50. [PMID: 23663438 PMCID: PMC3655828 DOI: 10.1186/1465-9921-14-50] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/07/2013] [Indexed: 12/12/2022] Open
Abstract
Background With the recent widespread use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), there have been occasional reports on complications associated with its use. Previous reviews on EBUS-TBNA have been limited to studies by skilled operators, thus the results may not always be applicable to recent clinical practice. To assess the safety of EBUS-TBNA for the staging and diagnosis of lung cancer in Japan, a nationwide survey on its current usage status and complications associated with its use was conducted by the Japan Society for Respiratory Endoscopy (JSRE). Methods A questionnaire about EBUS-TBNA performed between January 2011 and June 2012 was mailed to 520 JSRE-accredited facilities. Results Responses were obtained from 455 facilities (87.5%). During the study period, EBUS-TBNA was performed in 7,345 cases in 210 facilities (46.2%) using a convex probe ultrasound bronchoscope, for 6,836 mediastinal and hilar lesions and 275 lung parenchymal lesions. Ninety complications occurred in 32 facilities. The complication rate was 1.23% (95% confidence interval, 0.97%-1.48%), with hemorrhage being the most frequent complication (50 cases, 0.68%). Infectious complications developed in 14 cases (0.19%) (Mediastinitis, 7; pneumonia, 4; pericarditis, 1; cyst infection, 1; and sepsis, 1). Pneumothorax developed in 2 cases (0.03%), one of which required tube drainage. Regarding the outcome of the cases with complications, prolonged hospitalization was observed in 14 cases, life-threatening conditions in 4, and death in 1 (severe cerebral infarction) (mortality rate, 0.01%). Breakage of the ultrasound bronchoscope occurred in 98 cases (1.33%) in 67 facilities (31.9%), and that of the puncture needle in 15 cases (0.20%) in 8 facilities (3.8%). Conclusions Although the complication rate associated with EBUS-TBNA was found to be low, severe complications, including infectious complications, were observed, and the incidence of device breakage was high. Since the use of EBUS-TBNA is rapidly expanding in Japan, an educational program for its safe performance should be immediately established.
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Affiliation(s)
- Fumihiro Asano
- Safety Management Committee, Japan Society for Respiratory Endoscopy, Tokyo, Japan.
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Relevance of endoscopic ultrasonography and endobronchial ultrasonography to thoracic surgeons. Thorac Surg Clin 2013; 23:199-210. [PMID: 23566972 DOI: 10.1016/j.thorsurg.2013.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although cervical mediastinoscopy has been considered the gold standard for mediastinal staging in non-small cell lung cancer, new minimally invasive endoscopic ultrasound technology, such as endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound fine-needle aspiration, have changed the practice of invasive staging. Based on the current evidence, minimally invasive endoscopic staging is the recommended choice in patients with high pretest probability of lymph node metastasis; however, all negative results should be verified by mediastinoscopy, especially in centers with low expertise. In patients with low pretest probability, mediastinoscopy may be omitted when adequate sampling is achieved with endoscopic modalities.
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Li M, Wu N, Zheng R, Liang Y, Liu Y, Zhang W, Li N, Zhao P. Primary tumor PET/CT [¹⁸F]FDG uptake is an independent predictive factor for regional lymph node metastasis in patients with non-small cell lung cancer. Cancer Imaging 2013; 12:566-72. [PMID: 23399986 PMCID: PMC3569669 DOI: 10.1102/1470-7330.2012.0040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Aim: To investigate the correlation between [18F]fluorodeoxyglucose (FDG) uptake in a primary tumor and pathologic N stages, and to further analyze the possible risk factors contributing to the regional lymph node metastasis. Patients and methods: Eighty patients with non-small cell lung cancer (NSCLC) who underwent positron emission tomography/computed tomography were enrolled in the study. The FDG uptake in the primary tumor was compared for the different N staging groups and further correlation was performed. The degree of FDG uptake in the primary tumor and other possible variables related to the incidence of lymph node metastasis were examined by univariate and logistic multivariate analysis. FDG uptake was quantitated using the maximum standardized uptake value (SUVmax). Results: Statistically significant differences were found in the SUVmax of the primary tumors among different N staging groups (F = 4.124, P = 0.023), and the correlation between them was also statistically significant (r = 0.438, P = 0.000). Univariate analysis showed that blood tumor markers, primary tumor size, histologic grade, and SUVmax of the primary tumor were significantly associated with lymph node involvement. Logistic multivariate analysis showed that blood tumor makers and SUVmax of primary tumor might be considered as significant predictive factors for lymph node metastasis in patients with NSCLC. Conclusion: Our results show that there is a significant relationship between the SUVmax of the primary tumor and the pathologic N stage of NSCLC. FDG uptake by the primary tumor may be an independent predictor of regional lymph node metastasis in patients with NSCLC.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, Peoples Republic of China
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Fung SFF, Warren GW, Singh AK. Hope for progress after 40 years of futility? Novel approaches in the treatment of advanced stage III and IV non-small-cell-lung cancer: Stereotactic body radiation therapy, mediastinal lymphadenectomy, and novel systemic therapy. J Carcinog 2012; 11:20. [PMID: 23346013 PMCID: PMC3548357 DOI: 10.4103/1477-3163.105340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 12/13/2012] [Indexed: 12/28/2022] Open
Abstract
Non-small-cell lung cancer (NSCLC) remains a leading cause of cancer mortality. The majority of patients present with advanced (stage III-IV) disease. Such patients are treated with a variety of therapies including surgery, radiation, and chemotherapy. Despite decades of work, however, overall survival in this group has been resistant to any substantial improvement. This review briefly details the evolution to the current standard of care for advanced NSCLC, advances in systemic therapy, and novel techniques (stereotactic body radiation therapy [SBRT], and transcervical extended mediastinal lymphadenectomy [TEMLA] or video-assisted mediastinal lymphadenectomy [VAMLA]) that have been used in localized NSCLC. The utility of these techniques in advanced stage therapy and potential methods of combining these novel techniques with systemic therapy to improve survival are discussed.
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Affiliation(s)
- Simon Fung Fee Fung
- Department of Radiation Medicine, Roswell Park Cancer Institute, University at Buffalo School of Medicine, Elm and Carlton Streets, Buffalo, New York, 14263, USA
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A prediction model for N2 disease in T1 non–small cell lung cancer. J Thorac Cardiovasc Surg 2012; 144:1360-4. [DOI: 10.1016/j.jtcvs.2012.06.050] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/14/2012] [Accepted: 06/18/2012] [Indexed: 11/18/2022]
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Li M, Wu N, Liu Y, Zheng R, Liang Y, Zhang W, Zhao P. Regional nodal staging with 18F-FDG PET–CT in non-small cell lung cancer: Additional diagnostic value of CT attenuation and dual-time-point imaging. Eur J Radiol 2012; 81:1886-90. [DOI: 10.1016/j.ejrad.2011.03.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/20/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
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Chung FT, Kuo CH, Chen HC, Feng PH, Lin SM, Yu CT, Liu CY, Wang CW, Kuo HP. Roles of EBUS-TBNA in non-small cell lung cancer. Thorac Cancer 2012; 3:182-187. [DOI: 10.1111/j.1759-7714.2011.00093.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Objective Review of Mediastinal Lymph Node Examination in a Lung Cancer Resection Cohort. J Thorac Oncol 2012; 7:390-6. [DOI: 10.1097/jto.0b013e31823e5e2d] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Lung cancer is the most frequent cause of mortality worldwide. According to recent estimates, 222,520 new cases of lung cancer (non-small cell and small cell combined) were diagnosed and 157,300 lung cancer-related deaths occurred in 2010 in the United States alone. The two major histologic types of lung cancer are small cell lung cancer and non-small cell lung cancer. The diagnosis and management of lung cancer requires a multidisciplinary approach.
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Affiliation(s)
- David J Sugarbaker
- Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115-6195, USA.
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Xu J, Greenspan H, Napel S, Rubin DL. Automated temporal tracking and segmentation of lymphoma on serial CT examinations. Med Phys 2012; 38:5879-86. [PMID: 22047352 DOI: 10.1118/1.3643027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE It is challenging to reproducibly measure and compare cancer lesions on numerous follow-up studies; the process is time-consuming and error-prone. In this paper, we show a method to automatically and reproducibly identify and segment abnormal lymph nodes in serial computed tomography (CT) exams. METHODS Our method leverages initial identification of enlarged (abnormal) lymph nodes in the baseline scan. We then identify an approximate region for the node in the follow-up scans using nonrigid image registration. The baseline scan is also used to locate regions of normal, non-nodal tissue surrounding the lymph node and to map them onto the follow-up scans, in order to reduce the search space to locate the lymph node on the follow-up scans. Adaptive region-growing and clustering algorithms are then used to obtain the final contours for segmentation. We applied our method to 24 distinct enlarged lymph nodes at multiple time points from 14 patients. The scan at the earlier time point was used as the baseline scan to be used in evaluating the follow-up scan, resulting in 70 total test cases (e.g., a series of scans obtained at 4 time points results in 3 test cases). For each of the 70 cases, a "reference standard" was obtained by manual segmentation by a radiologist. Assessment according to response evaluation criteria in solid tumors (RECIST) using our method agreed with RECIST assessments made using the reference standard segmentations in all test cases, and by calculating node overlap ratio and Hausdorff distance between the computer and radiologist-generated contours. RESULTS Compared to the reference standard, our method made the correct RECIST assessment for all 70 cases. The average overlap ratio was 80.7 ± 9.7% s.d., and the average Hausdorff distance was 3.2 ± 1.8 mm s.d. The concordance correlation between automated and manual segmentations was 0.978 (95% confidence interval 0.962, 0.984). The 100% agreement in our sample between our method and the standard with regard to RECIST classification suggests that the true disagreement rate is no more than 6%. CONCLUSIONS Our automated lymph node segmentation method achieves excellent overall segmentation performance and provides equivalent RECIST assessment. It potentially will be useful to streamline and improve cancer lesion measurement and tracking and to improve assessment of cancer treatment response.
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Affiliation(s)
- Jiajing Xu
- Department of Electrical Engineering, Stanford University, Stanford, CA 94305, USA.
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Alamoudi OS. Lung cancer at a University Hospital in Saudi Arabia: A four-year prospective study of clinical, pathological, radiological, bronchoscopic, and biochemical parameters. Ann Thorac Med 2011; 5:30-6. [PMID: 20351958 PMCID: PMC2841806 DOI: 10.4103/1817-1737.58957] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 11/16/2009] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES AND BACKGROUND Lung cancer accounts for 4% of all newly diagnosed cancers in Saudi Arabia. The pattern of presentation is unknown. The objectives of this study were to assess the clinical, radiological, pathological, biochemical and bronchoscopic abnormalities in lung cancer patients and to compare our findings with those reported in the literature. METHODS A total of 114 patients with proven lung cancer were selected for the study. A questionnaire concerning patients' demographic data was obtained; the abnormalities and the cell types of lung cancer were recorded prospectively in each subject. RESULTS A total of 114 patients with lung cancer were studied. Mean age ± SD was (59.8 ± 10.8) years, and (71.1%) were smokers and 95.1% of them were male, (90.1%) smoked >20 pack/yr (96.2%) for 20 years or more. Cough (76.3%) and clubbing (40.4%) were the most common symptom and physical abnormality respectively. The right lung (64.9%) was more commonly affected than the left (37.7%). Metastases were present in (49.1%) at presentation. The right and left upper bronchi (24% vs. 16%) were the mostly affected. Hypercalcemia was more common in squamous cell, while hyponatremia was more common in adenocarcinoma, and small cell. Squamous cell carcinoma was the most common cell type (51.8%) and significantly associated with smoking (P ≤ 0.001) CONCLUSION Squamous cell carcinoma was the most common cell type, and significantly associated with smoking. The incidence of metastasis was high at presentation. The right lung and right upper bronchus were often affected. Hypercalcemia and hyponatremia were the most common biochemical abnormalities.
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Affiliation(s)
- Omer S Alamoudi
- Department of Medicine, King Abdulaziz University Hospital, (KAUH), Jeddah, Saudi Arabia.
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Abstract
This overview is intended to give a general outline about the basics of Cytopathology. This is a field that is gaining tremendous momentum all over the world due to its speed, accuracy and cost effectiveness. This review will include a brief description about the history of cytology from its inception followed by recent developments. Discussion about the different types of specimens, whether exfoliative or aspiration will be presented with explanation of its rule as a screening and diagnostic test. A brief description of the indications, utilization, sensitivity, specificity, cost effectiveness, speed and accuracy will be carried out. The role that cytopathology plays in early detection of cancer will be emphasized. The ability to provide all types of ancillary studies necessary to make specific diagnosis that will dictate treatment protocols will be demonstrated. A brief description of the general rules of cytomorphology differentiating benign from malignant will be presented. Emphasis on communication between clinicians and pathologist will be underscored. The limitations and potential problems in the form of false positive and false negative will be briefly discussed. Few representative examples will be shown. A brief description of the different techniques in performing fine needle aspirations will be presented. General recommendation for the safest methods and hints to enhance the sensitivity of different sample procurement will be given. It is hoped that this review will benefit all practicing clinicians that may face certain diagnostic challenges requiring the use of cytological material.
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Affiliation(s)
- Mousa A. Al-Abbadi
- Department of Pathology and Cytopathology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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Kirchner J, Kirchner EM, Goltz JP, Lorenz VW, Kickuth R. Prevalence of enlarged mediastinal lymph nodes in heavy smokers--a comparative study. Eur Radiol 2011; 21:1594-9. [PMID: 21479857 DOI: 10.1007/s00330-011-2111-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/08/2011] [Accepted: 02/10/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the frequency of enlarged hilar or mediastinal lymph nodes in heavy smokers (more than 10 pack years) compared with non- smokers. MATERIAL AND METHODS In a prospective study the CT findings of 88 consecutive patients (44 heavy smokers, 44 non- smokers) were analysed. Exclusion criteria were history of thoracic malignancy, sarcoidosis, occupational dust exposure or clinical evidence of pneumonia. Prevalence, size and site of enlarged lymph nodes were assessed by multidetector computed tomography (MDCT) and correlated with the cigarette consumption and the CT- findings of bronchitis and emphysema. RESULTS Twenty-three of the 44 heavy smokers (52%) showed enlarged mediastinal lymph nodes. Non- smokers showed enlarged lymph nodes in 9% (4/44). The most common site of enlarged lymph nodes was the regional station 7 according to the ATS mapping (subcarinal). The difference between the frequency of enlarged lymph nodes in heavy smokers and non- smokers was significant (chi- square 19.3, p < 0.0001). Airway wall thickening and emphysema were often associated with an increased number of enlarged nodes. CONCLUSION The present study demonstrates that enlarged mediastinal lymph nodes may occur in a rather high percentage of heavy smokers, especially in those with a MDCT finding of severe bronchitis.
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Affiliation(s)
- Johannes Kirchner
- Department of Diagnostic and Interventional Radiology, Allgemeines Krankenhaus Hagen, Grünstraße 35, 58095 Hagen, Germany.
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Kuo CH, Chen HC, Chung FT, Lo YL, Lee KY, Wang CW, Kuo WH, Yen TC, Kuo HP. Diagnostic value of EBUS-TBNA for lung cancer with non-enlarged lymph nodes: a study in a tuberculosis-endemic country. PLoS One 2011; 6:e16877. [PMID: 21364919 PMCID: PMC3045379 DOI: 10.1371/journal.pone.0016877] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 01/13/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In tuberculosis (TB)-endemic areas, contrast-enhanced computed tomography (CT) and positron emission tomography (PET) findings of lung cancer patients with non-enlarged lymph nodes are frequently discrepant. Endobronchial ultrasound-guided transbronchial aspiration (EBUS-TBNA) enables real-time nodal sampling, and thereby improves nodal diagnosis accuracy. This study aimed to compare the accuracy of nodal diagnosis by using EBUS-TBNA, and PET. METHODS We studied 43 lung cancer patients with CT-defined non-enlarged mediastinal and hilar lymph nodes and examined 78 lymph nodes using EBUS-TBNA. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 80.6%, 100%, 100%, and 85.7%, respectively. PET had low specificity (18.9%) and a low positive predictive value (44.4%). The diagnostic accuracy of EBUS-TBNA was higher than that of PET (91% vs. 47.4%; p<0.001). Compared to CT-based nodal assessment, PET yielded a positive diagnostic impact in 36.9% nodes, a negative diagnostic impact in 46.2% nodes, and no diagnostic impact in 16.9% nodes. Patients with lymph nodes showing negative PET diagnostic impact had a high incidence of previous pulmonary TB. Multivariate analysis indicated that detection of hilar nodes on PET was an independent predictor of negative diagnostic impact of PET. CONCLUSION In a TB-endemic area with a condition of CT-defined non-enlarged lymph node, the negative diagnostic impact of PET limits its clinical usefulness for nodal staging; therefore, EBUS-TBNA, which facilitates direct diagnosis, is preferred.
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Affiliation(s)
- Chih-Hsi Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan
| | - Hao-Cheng Chen
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan
| | - Yu-Lun Lo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan
| | - Kang-Yun Lee
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan
| | - Chih-Wei Wang
- Department of Pathology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Wen-Han Kuo
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Han-Pin Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taipei, Taiwan
- * E-mail:
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Abstract
Accurate diagnosis and staging are essential for the optimal management of cancer patients. Positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) has emerged as a powerful imaging tool for the detection of various cancers. The combined acquisition of PET and CT has synergistic advantages over PET or CT alone and minimizes their individual limitations. It is a valuable tool for staging and restaging of some tumors and has an important role in the detection of recurrence in asymptomatic patients with rising tumor marker levels and patients with negative or equivocal findings on conventional imaging techniques. It also allows for monitoring response to therapy and permitting timely modification of therapeutic regimens. In about 27% of the patients, the course of management is changed. This review provides guidance for oncologists/radiotherapists and clinical and surgical specialists on the use of 18F-FDG PET/CT in oncology.
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Affiliation(s)
- Ahmad Almuhaideb
- Institute of Nuclear Medicine, University College London Hospitals National Health Service Trust, London, United Kingdom
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Kirchner J, Kirchner EM, Goltz JP, Obermann A, Kickuth R. Enlarged hilar and mediastinal lymph nodes in chronic obstructive pulmonary disease. J Med Imaging Radiat Oncol 2010; 54:333-8. [PMID: 20718913 DOI: 10.1111/j.1754-9485.2010.02179.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To evaluate the frequency of enlarged hilar or mediastinal lymph nodes in patients suffering from chronic obstructive pulmonary disease (COPD). METHODS In a retrospective study, 89 patients with proven COPD were analysed. Exclusion criteria were history of malignant disease or clinical evidence of pneumonia. Prevalence, size, and localisation of enlarged lymph nodes were assessed by multi-slice computed tomography (MSCT) and correlated with the clinical stages following the GOLD classification as well as the MSCT findings of bronchitis and emphysema. RESULTS 44/89 (49%) of our patients showed enlarged lymph nodes. Lymph node enlargement was more often seen in the mediastinum (48%) than the hilar region (20%). The most common localisation of enlarged mediastinal lymph nodes was the regional station 7 following the ATS mapping (infracarinal). Patients with a stage I following the GOLD classification showed enlarged lymph nodes in 49% (18/37), stage II in 46% (12/26), stage III in 58% (7/12) and stage IV in 50% (7/14). These findings did not differ significantly (P > 0.05). Severe airway wall thickening (42/89) was significantly more often associated with an increase of nodal enlargement (64%) (P < 0.05). CONCLUSION The present study demonstrates that enlarged hilar and mediastinal lymph nodes may occur in a rather high percentage of patients suffering from COPD, especially in those with the MSCT finding of severe bronchitis.
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Affiliation(s)
- J Kirchner
- Department of Diagnostic and Interventional Radiology, Allgemeines Krankenhaus Hagen, Germany.
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Yang F, Chen H, Xiang J, Zhang Y, Zhou J, Hu H, Zhang J, Luo X. Relationship between tumor size and disease stage in non-small cell lung cancer. BMC Cancer 2010; 10:474. [PMID: 20813054 PMCID: PMC2941504 DOI: 10.1186/1471-2407-10-474] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 09/02/2010] [Indexed: 12/04/2022] Open
Abstract
Background Whether tumor size and stage distribution are correlated remains controversial. The objective is to assess the relationship between tumor size and disease stage distribution in non-small cell lung cancer (NSCLC). Methods We conducted a retrospective analysis of 917 cases of NSCLC that were resected in the Cancer Hospital of Fudan University and Shanghai Sixth Hospital between January 2000 and February 2009. Tumor sizes were grouped into five categories: ≤20 mm, 21 to 30 mm, 31 to 50 mm, 51 to 70 mm and ≥71 mm. Results Age and tumor size affected stage distribution: patients 60 years or older had a higher percentage of N0M0 disease than patients younger than 60 years (61.67% vs. 44.85%, p < 0.01). The smaller the tumor, the more likely the disease was N0M0 status (p < 0.05). For tumors ≤20 mm in diameter, the proportion of cases with N0M0 status was 70.79%, compared to 58.88% for 21 to 30 mm, 48.03% for 31 to 50 mm, 47.55% for 51 to 70 mm, 33.33% for ≥71 mm. The mean (± SD) tumor size of cases with N0M0 status was 37.17 ± 21.34 mm, compared to 45.75 ± 23.19 mm for cases with other status. Conclusions There is a statistically significant relationship between tumor size and distribution of disease stage of primary NSCLC tumors: the smaller the tumor, the more likely the disease is N0M0 status.
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Affiliation(s)
- Fu Yang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai 200032, China
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García-Yuste M, Matilla JM, González-Aragoneses F, Heras F. [Detection of lymph node involvement and surgical treatment of pulmonary neoplastic processes. Current state of diagnostic and therapeutic procedures]. Arch Bronconeumol 2010; 46 Suppl 1:43-9. [PMID: 20353850 DOI: 10.1016/s0300-2896(10)70011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An analysis is made of different publications associated with the surgical staging and treatment of primary and metastasic pulmonary neoplastic processes. A suitable treatment program is essential to determine lymph node involvement in patients with bronchogenic carcinoma. The indication and sequence of the procedure to use (CT-PET, transbronchial puncture, videomediastinoscopic ultrasound guided transbronchial needle aspiration) is evaluated in accordance to the sensitivity, specificity and positive and negative predictive value of the different methods. Another interesting challenge is to define the criteria for indicating a sublobar resection in certain tumours and patients. Different factors, age, lung function, tumour location and type of sublobar resection, are analysed. Levels of evidence and recommendations of the procedure are also considered. Surgical resection is an accepted therapeutic option in the treatment of colorectal cancer lung metastases. Its indication is based on acceptable survival rates and knowledge of the impact of various factors (interval free of disease, number of metastases, presence of liver metastasis, presence of lymph node involvement, or increased pre-operative levels of carcinoembryonic antigen), is analysed in detail.
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Affiliation(s)
- Mariano García-Yuste
- Servicio de Cirugía Torácica, Hospital Clínico Universitario, Valladolid, España.
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