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Jiang S, Wu Y, Wei W, Wang Z, Wang Q. Cetuximab and Dabrafenib Plus Trametinib for Untreated Colonic Metastasis of BRAFV600E Mutant Primary Lung Adenocarcinoma with Signet Ring Cell Features: An Interesting and Rare Case Report. Onco Targets Ther 2022; 15:1057-1062. [PMID: 36186153 PMCID: PMC9524378 DOI: 10.2147/ott.s375436] [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: 05/19/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Colonic metastases of lung adenocarcinoma are extremely rare. Signet ring cell adenocarcinoma (SRCA) has not been described in patients with gastrointestinal metastasis of lung adenocarcinoma. SRCA is a unique subtype of adenocarcinoma with strong invasion and a poor prognosis, and most SRCA found in the lung are due to gastrointestinal metastases. This report describes a rare case of colonic metastasis from primary lung SRCA. A 64-year-old female was admitted to Sun Yat-sen University Cancer Center for feeling of nausea and malaise. Following a positron emission tomography CT (PET-CT) scan, widespread metastases of tumor cells were found in the bilateral lung, liver, bone, and multiple lymph nodes, but there was no evidence of metastasis to the colon. Two months later, the patient received a liver biopsy at Tongji Hospital in Wuhan. Pathology revealed a poorly differentiated adenocarcinoma with SRCA conformation, but immunohistochemical staining did not identify the original source of tumor cells. Considering that SRCA mainly derives from the gastrointestinal tract and that serum gastrointestinal tumor markers were elevated, we performed gastrointestinal endoscopy on the patient. The results showed an isolated polyp in the colon, and the pathology results indicated a poorly differentiated adenocarcinoma that was considered to originate from the lung based on immunohistochemical staining. Meanwhile, genetic tests identified a BRAF V600E mutation. The final diagnosis was colonic metastasis of BRAFV 600E mutated lung SRCA. Considering the positive expression of EGFR in this case, cetuximab was innovatively added to the first-line treatment regime (dabrafenib and trametinib). To date, the patient has received thirty-two weeks of treatment. Interestingly, lung and liver tumors shrank and tumor markers in the blood normalized. Our findings offer valuable diagnostic and therapeutic information for colonic metastasis of BRAFV600E mutant primary lung adenocarcinoma with signet ring cell features.
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Affiliation(s)
- Shujun Jiang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yanran Wu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Wenjie Wei
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zi Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qi Wang
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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2
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Eiswerth MJ, Pinter A, Reynolds SB, Guardiola J. Primary lung sarcoma with gastric metastasis and morphological divergence presenting as melena. BMJ Case Rep 2021; 14:e242364. [PMID: 34385220 PMCID: PMC8362720 DOI: 10.1136/bcr-2021-242364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/18/2022] Open
Abstract
A 61-year-old man was admitted to the medical intensive care unit following a 2-week history of weakness, lightheadedness and melena resulting in an acute anaemia. Upper endoscopy revealed multiple large gastric masses without evidence of active bleeding. CT of the chest revealed a large right upper lobe mass with bony destruction of the third rib and invasion into the anterior chest wall and mediastinum, as well as a soft-tissue density in the left kidney. Biopsy and histopathological review of both pulmonary and gastric masses revealed two distinct sarcomatous malignancies that, while both from a primary lung source, differed in their morphology. Natural history and behaviour are not well understood in sarcomas due to their rarity, but abdominal metastasis is considered an uncommon event in the progression of the disease. Gastrointestinal bleeding as the presenting symptom of a primary lung sarcoma is an atypical finding with no previously reported cases.
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Affiliation(s)
- Michael J Eiswerth
- Internal Medicine Residency, University of Louisville, Louisville, Kentucky, USA
| | - Alexander Pinter
- Internal Medicine Residency, University of Louisville, Louisville, Kentucky, USA
| | - Samuel Benjamin Reynolds
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - John Guardiola
- Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana, USA
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3
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Significance of Brain Imaging for Staging in Patients With Clinical Stage T1-2 N0 Non-Small-Cell Lung Cancer on Positron Emission Tomography/Computed Tomography. Clin Lung Cancer 2021; 22:562-569. [PMID: 34253472 DOI: 10.1016/j.cllc.2021.06.004] [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: 04/15/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Routine positron emission tomography/computed tomography (PET/CT) has been recommended even for clinical stage I non-small-cell lung cancer (NSCLC). In spite of the progress in the screening procedure, and revisions to TNM classification, there is no evidence to support brain imaging screening of patients assessed with the current staging protocol including PET/CT. MATERIALS AND METHODS We retrospectively investigated the frequency of extrathoracic metastasis in 466 consecutive patients with clinical stage T1-2 N0 NSCLC with the complete staging assessment comprised of thin-section CT, PET/CT, and brain contrast-enhanced magnetic resonance imaging between 2008 and 2016. All patients were reclassified according to the eighth edition of the tumor, node, and metastasis (TNM) classification. RESULTS Among all patients, 70% of the tumors were pure solid and 30% had part-solid ground-glass opacity on thin-section CT, and 388 (83%) and 78 (17%) were classified into clinical stages T1 and T2, respectively. Eight patients (1.7%) had extrathoracic metastasis, including 3 (0.6%) with brain metastasis, and all showed pure-solid tumors. The frequency of extrathoracic and brain metastasis was 1.0% and 0.5% in 388 T1 patients, and 5.0% and 3.0% in 78 T2 patients. Although brain metastases were detected in 2 of 7 patients (29%) with PET/CT detectable extrathoracic metastases and 1 of 459 patients (0.2%) without PET/CT detectable extrathoracic metastasis, there were no neurologically asymptomatic brain metastases in patients with early-stage NSCLC confirmed by PET/CT. CONCLUSION Routine screening of brain imaging is unnecessary in patients with early-stage NSCLC, assessed with the current staging protocol including PET/CT.
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Kang DK, Kang MK, Heo W, Hwang Y, Nam KH. Multiple small bowel metastasis of primary non-small cell lung cancer. Clin Case Rep 2021; 9:1896-1898. [PMID: 33936610 PMCID: PMC8077344 DOI: 10.1002/ccr3.3821] [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: 10/26/2020] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022] Open
Abstract
Gastrointestinal metastasis could be considered in the differential diagnosis of melena in the patient with NSCLC history.
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Affiliation(s)
- Do Kyun Kang
- Department of Thoracic and Cardiovascular SurgeryHaeundae Paik HospitalInje University College of MedicineBusanKorea
| | - Min Kyun Kang
- Department of Thoracic and Cardiovascular SurgeryHaeundae Paik HospitalInje University College of MedicineBusanKorea
| | - Woon Heo
- Department of Thoracic and Cardiovascular SurgeryHaeundae Paik HospitalInje University College of MedicineBusanKorea
| | - Youn‐Ho Hwang
- Department of Thoracic and Cardiovascular SurgeryHaeundae Paik HospitalInje University College of MedicineBusanKorea
| | - Kyung Han Nam
- Department of PathologyHaeundae Paik HospitalInje University College of MedicineBusanKorea
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5
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Pararas N, Kirkilessis G, Pikoulis A, Syrigos K, Pikoulis E. A Rare Case of a Metastatic Lung Squamous Cell Carcinoma to the Large Bowel and the Liver. Cureus 2021; 13:e13867. [PMID: 33738176 PMCID: PMC7959874 DOI: 10.7759/cureus.13867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Lung carcinoma is the leading cause of death worldwide, with almost 50% of the patients presenting with distant metastases at the moment of diagnosis. The most common metastases sites are the lymph nodes, the liver, the adrenal glands, the bones, and the brain. The gastrointestinal tract was considered an unusual site for lung metastases, and due to the asymptomatic progress of the disease, they are usually diagnosed at a late stage. In the present case study, the clinical presentation, the treatment, and outcome of a rare case of descending colon and liver metastases from a lung squamous cell carcinoma in a 72-year-old female, two years after the presentation of her primary tumor are reported. The present study aims to increase the awareness for early diagnosis and treatment of metastatic lung cancer to the gastrointestinal tract.
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Affiliation(s)
- Nikolaos Pararas
- General Surgery, Dr Sulaiman Al Habib/Alfaisal University, Riyadh, SAU
| | - Georgios Kirkilessis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Andreas Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Konstantinos Syrigos
- Oncology Unit, Third Department of Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, GRC
| | - Emmanouil Pikoulis
- Third Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
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6
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Parker NA, McBride C, Forge J, Lalich D. Bowel obstruction caused by colonic metastasis of lung adenocarcinoma: a case report and literature review. World J Surg Oncol 2019; 17:63. [PMID: 30961608 PMCID: PMC6454752 DOI: 10.1186/s12957-019-1611-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/29/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction Lung cancer is the most common cause of cancer-related deaths globally. Metastatic disease is often found at the time of initial diagnosis in the majority of lung cancer patients. However, colonic metastases are rare. This report describes an uncommon case of colonic metastasis from lung adenocarcinoma. Case presentation A 64-year-old female presented to her gastroenterologist for progressively worsening abdominal pain and constipation. Exploratory colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. Her specialist recommended she immediately go to her regional hospital for further workup. On admission, she complained of continued abdominal pain and constipation. Notably, she had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed 1 year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. Upon hospital admission, she underwent an urgent colostomy, ileocecectomy and anastomosis, and rectosigmoid mass resection with tissue sampling. Pathology confirmed the diagnosis of colonic metastasis from primary lung adenocarcinoma. Treatment was with systemic chemotherapy followed by localized radiation to the pelvic region was started. She did not respond well to these therapies. Subsequent imaging showed refractory tumor growth in the pelvic region. Treatment could not be completed due to the patient experiencing a debilitating stroke, and she was transitioned to hospice care. Conclusions Clinicians should have a low threshold for intestinal investigation and considerations for colonic metastasis when patients with a history of primary lung cancer have abdominal symptoms.
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Affiliation(s)
- N A Parker
- Department of Internal Medicine, University of Kansas School of Medicine, 2817 N Tallgrass St, Wichita, KS, 67226, USA.
| | - C McBride
- Department of Internal Medicine, University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - J Forge
- Department of Internal Medicine, University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - D Lalich
- Department of Anatomical and Clinical Pathology, Wesley Medical Center, 550 N. Hillside St, Wichita, KS, 67214, USA
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7
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Parker N, McBride C, Forge J, Lalich D. Colonic Metastasis of Lung Adenocarcinoma: A Case Report. Cureus 2019; 11:e4341. [PMID: 31187006 PMCID: PMC6541151 DOI: 10.7759/cureus.4341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Colonic metastases are extremely rare, regardless of primary lung cancer type. A 64-year-old female was referred to the hospital by her gastroenterologist after a same-day colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. On admission, she complained of abdominal pain and constipation. She had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed one year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. She underwent urgent surgical intervention and mass resection with tissue sampling. Pathology confirmed the diagnosis of metastatic lung adenocarcinoma. Systemic chemotherapy with pemetrexed and carboplatin followed by localized radiation to the pelvic region was administered. A refractory pelvic region tumor growth was evident on subsequent imaging. Cessation of chemoradiation therapy occurred after the patient experienced a debilitating stroke and she was transferred to hospice care. Colonic metastasis should be considered when patients with a history of primary lung cancer have abdominal symptoms.
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Affiliation(s)
- Nathaniel Parker
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - Chloe McBride
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
| | - John Forge
- Internal Medicine, University of Kansas School of Medicine, Wichita, USA
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8
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Thota PN, Plesec T. Metastatic lung adenocarcinoma presenting as diminutive colonic polyp. AME Case Rep 2018; 2:14. [PMID: 30264010 DOI: 10.21037/acr.2018.03.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/11/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Prashanthi N Thota
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Thomas Plesec
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
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9
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Isolated colonic metastasis two years after resection of stage IA primary adenocarcinoma of the lung: A case report. Respir Med Case Rep 2018; 25:86-88. [PMID: 30094153 PMCID: PMC6076219 DOI: 10.1016/j.rmcr.2018.07.002] [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: 05/09/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 02/07/2023] Open
Abstract
Colonic metastasis from lung cancer is rare, generally asymptomatic and usually develop at advanced cancer stages. Here, we report a case with a resected stage IA lung adenocarcinoma in a 51yo male patient that presented two years later with mild abdominal pain due to intestinal obstruction caused by a metastatic colon tumor. The patient underwent colonoscopy followed by surgical resection and the pathologic report was adenocarcinoma which was the same as that from a lung nodule that was excised two years earlier. Immunohistochemistry was cytokeratin 7 (CK7) positive, thyroid transcription factor 1 (TTF1) focally positive and cytokeratin 20 (CK20), caudal-related homeobox transcription factor 2 (CDX2) negative on both lung biopsy and colon surgical specimens. Interestingly there was no obvious lung cancer recurrence both at the time of metastasis and one year following chemotherapy.
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10
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Matys T, Drury R, David S, Rassl DM, Qian W, Rintoul RC, Screaton NJ. Routine preoperative brain CT in resectable non-small cell lung cancer – Ten years experience from a tertiary UK thoracic center. Lung Cancer 2018; 122:195-199. [DOI: 10.1016/j.lungcan.2018.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/23/2018] [Accepted: 06/09/2018] [Indexed: 12/25/2022]
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11
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Nguyen TC, Jaffe AM, Gray D, Cain J, Brown T. Colovesical Fistula As An Uncommon Presentation Of Metastatic Lung Cancer. Cureus 2018; 10:e2767. [PMID: 30101046 PMCID: PMC6082581 DOI: 10.7759/cureus.2767] [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] [Indexed: 11/05/2022] Open
Abstract
Colovesical fistula is an atypical communication between the colon and the bladder. The most common causes of colovesical fistula are diverticulitis, inflammatory bowel disease, lymphoma and complication from radiation therapy. Patients with colovesical fistula present with recurrent urinary tract infections (UTI), dysuria, frequency, abdominal pain, pneumaturia, faecaluria, and hematuria. We present a case of a patient with stage IV lung adenocarcinoma presented with abdominal pain, dysuria, and faecaluria who was found to have a colovesical fistula. Although colovesical fistula may be sequelae of advanced colon or bladder cancer, it is a very uncommon presentation of metastatic cancer from distant sites. Our case is the first to show that colovesical fistula may present from metastatic lung adenocarcinoma. Clinical awareness of this very unusual presentation of metastatic cancer can lead to faster diagnosis and treatment, possibly minimizing excessive use of antibiotics.
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Affiliation(s)
- Thu-Cuc Nguyen
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Aaron M Jaffe
- Internal Medicine, University of Central Florida College of Medicine/Ocala Health, Orlando, USA
| | | | - John Cain
- Radiology, University of Central Florida College of Medicine/Ocala Health, Orlando, USA
| | - Thomas Brown
- Internal Medicine, University of Central Florida College of Medicine/Ocala Health, Orlando, USA
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12
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Nitipir C, Ginghina O, Popa L, Andrei F, Tudor N, Radu I, Iaciu C, Orlov C, Vasilescu F, Balalau C, Leon G, Negrei C, Barbu MA. A rare case of advanced lung cancer presenting as a symptomatic gastric tumor. Mol Clin Oncol 2018. [PMID: 29541469 DOI: 10.3892/mco.2018.1565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Although gastric metastases have been estimated to occur in less than 2% of cancer patients, an increased use of upper digestive tract endoscopy allows for a higher detection of secondary gastric tumors. We describe the case of a 66-year-old male patient presenting with mild pain in the sternum and upper abdominal area. Physical examination revealed a right parietal skull tumor, with no other significant clinical changes. Upon exclusion of an acute coronary syndrome, upper digestive tract endoscopy was performed, showing the presence of an ulcerated tumor located in the gastric fundus. Histopathologic examination of the biopsy sample and immunohistochemical tests suggested a pulmonary origin of the gastric tumor. Whole body computer tomography showed the presence of tumors in the gastric fundus, left lung, liver, kidneys, bones and brain. Transbronchial biopsy of the lung tumor certified the diagnosis of non-small cell lung cancer, with the same immunohistochemical profile as the gastric tumor. Hence, it was considered the origin of the metastases. Biopsy of the skull tumor also had the identical tumor histology. Whole brain radiotherapy was performed for the brain metastases and subsequent chemotherapy was administered. Although non-specific, gastrointestinal signs and symptoms occurring in lung cancer patients should alert the clinicians as to the possibility of gastrointestinal metastases and prompt endoscopic evaluation.
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Affiliation(s)
- Cornelia Nitipir
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Octav Ginghina
- Department of Surgery, 'Sf. Ioan' Clinical Emergency Hospital, Carol Davila University, Faculty of Dental Medicine, 042122 Bucharest, Romania
| | - Liliana Popa
- Department of Dermatology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Florin Andrei
- Department of Histopathology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Nicolaie Tudor
- Department of Gastroenterology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Irina Radu
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Cristian Iaciu
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Cristina Orlov
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
| | - Florina Vasilescu
- Department of Pathology, Emergency University Military Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 020021 Bucharest, Romania
| | - Cristian Balalau
- Department of Surgery, 'Sf. Pantelimon' Clinical Emergency Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 021659 Bucharest, Romania
| | - Grigoris Leon
- Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, Medical School, 10679 Athens, Greece
| | - Carolina Negrei
- Department of Toxicology, Faculty of Pharmacy, 'Carol Davila' University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Maria Alexandra Barbu
- Department of Oncology, Elias University Clinical Hospital, Carol Davila University, Medicine and Pharmacy Faculty, 011461 Bucharest, Romania
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Taira N, Kawabata T, Gabe A, Furugen T, Ichi T, Kushi K, Yohena T, Kawasaki H, Higuchi D, Chibana K, Fujita K, Nakamoto A, Owan I, Kuba M, Ishikawa K. Analysis of gastrointestinal metastasis of primary lung cancer: Clinical characteristics and prognosis. Oncol Lett 2017; 14:2399-2404. [PMID: 28781676 DOI: 10.3892/ol.2017.6382] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/03/2017] [Indexed: 01/19/2023] Open
Abstract
The prevalence of gastrointestinal metastasis of lung cancer is low. The aim of the present study was to analyze the frequency and clinical characteristics of metastases to the gastrointestinal tract by retrospectively assessing the clinical records of 2,066 patients with lung cancer. A total of 7 patients (0.33%) were diagnosed with gastrointestinal metastasis, including 4 patients with adenocarcinoma, 1 patient with large cell carcinoma and 2 patients with pleomorphic carcinoma. Furthermore, 3 of the patients presented with small bowel metastases, 2 with gastric metastases, 1 with large bowel metastasis and 1 with metastasis of the appendix. The mean time between the diagnosis of the lung tumors and the identification of gastrointestinal metastasis was 13.5 months (range, 3-49 months). The mean time between the identification of the gastrointestinal metastasis and mortality was 100.6 days (range, 21-145 days). In conclusion, the prognosis of patients with recurrence in distant organs, including the gastrointestinal tract, may be worse than patients with recurrence in distant organs, excluding the gastrointestinal tract, particularly those with symptomatic gastrointestinal metastasis. Therefore, the presence of clinical gastrointestinal metastasis may be life threatening; comprehensive evaluations are required to detect and monitor gastrointestinal metastasis during follow-up.
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Affiliation(s)
- Naohiro Taira
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Tsutomu Kawabata
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Atsushi Gabe
- Department of General Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Haebaru, Okinawa 9011193, Japan
| | - Tomonori Furugen
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Takaharu Ichi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kazuaki Kushi
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Tomofumi Yohena
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Hidenori Kawasaki
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Daisuke Higuchi
- Department of Gastroenterology, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kenji Chibana
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kaori Fujita
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Atsushi Nakamoto
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Isoko Owan
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Mutsuo Kuba
- Department of Respiratory Medicine, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
| | - Kiyoshi Ishikawa
- Department of General Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa 9012214, Japan
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14
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Ding LY, Liu KJ, Jiang ZL, Wu HY, Wu SX. Targeted therapy of multiple liver metastases after resected solitary gastric metastasis and primary pulmonary adenocarcinoma. Oncotarget 2016; 7:87479-87484. [PMID: 27829227 PMCID: PMC5350003 DOI: 10.18632/oncotarget.13114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/31/2016] [Indexed: 01/16/2023] Open
Abstract
Gastric metastases from lung adenocarcinoma are rare and usually asymptomatic. A 61-year-old woman was referred to our department because of a right lower pulmonary mass found on a chest X-ray film in August 2012. Right lower lobectomy was performed for pulmonary adenocarcinoma. Four months later, she developed epigastric discomfort. A fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG-PET/CT) scan showed a malignancy at the cardias of the stomach. A biopsy diagnosed poorly differentiated carcinoma and a gastric carcinoma was suspected. She underwent a subtotal gastrectomy and part of esophagectomy. The histologic diagnosis was metastasis from the pulmonary adenocarcinoma. She visited us again for her increasing level of carcinoembryonic antigen (CEA) after two months. FDG-PET/CT showed multiple malignant lesions in her liver, considering metastases from pulmonary origin. As she harbored activating epidermal growth factor receptor (EGFR) mutation, she received erlotinib from April, 2013. She survives 4 years after the lung resection and is still on erotinib treatment with complete response. Although gastric metastasis from lung cancer is considered a late stage of the disease, a radical resection might provide survival in solitary metastasis. Moreover, systemic therapy was emphasized after local treatment in some late stage cases.
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Affiliation(s)
- Ling-Yu Ding
- Department of Medical Oncology, Hangzhou Cancer Hospital, Hangzhou, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Ke-Jun Liu
- Department of Medical Oncology, Dongguan People's Hospital, Dongguan, China
| | - Zhe-Long Jiang
- Department of Emergency, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Hai-Ying Wu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Shi-Xiu Wu
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, China
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15
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Tattersfield A, Seaton A. Thorax at 70. Thorax 2016; 71:203-5. [PMID: 26880710 DOI: 10.1136/thoraxjnl-2016-208290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Colonic Metastasis with Anemia Leading to a Diagnosis of Primary Lung Adenocarcinoma. Case Rep Oncol Med 2016; 2016:5275043. [PMID: 26925278 PMCID: PMC4748099 DOI: 10.1155/2016/5275043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/11/2016] [Indexed: 02/08/2023] Open
Abstract
Metastasis occurs with 50% of lung carcinomas, most commonly to lymph nodes, adrenal glands, liver, bone, and brain. It is extremely rare for lung cancer to present with symptoms of a gastrointestinal metastasis and even more so pertaining to the colon. To the best of our knowledge, only 12 such cases have been reported in the literature. We describe a case of a 71-year-old female presenting with refractory iron deficiency anemia that was found to have a lesion in the transverse colon. Pathology revealed adenocarcinoma of the lung and a subsequent lung lesion was discovered in a retrograde fashion.
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Cuellar SLB, Marom EM, Erasmus JJ. Imaging Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Iwamuro M, Miyabe Y, Hanae K, Yoshinari K, Katsuyoshi T, Murakami T, Hirofumi M, Yamamoto K. Regression of metastatic colon tumour from primary adenocarcinoma of the lung due to fistulisation to the bowel lumen. Ecancermedicalscience 2014; 8:412. [PMID: 24834113 PMCID: PMC3971873 DOI: 10.3332/ecancer.2014.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Indexed: 12/28/2022] Open
Abstract
An 80-year-old Japanese male was diagnosed with pulmonary adenocarcinoma. The patient exhibited extensive extra pulmonary involvement in the bone, adrenal gland, abdominal lymph nodes, and sigmoid colon. A single course of chemotherapy with carboplatin and pemetrexed was administered as the first-line treatment. Subsequently, the patient received pemetrexed monotherapy. Two months after the diagnosis, rapid regression of the metastatic tumour in the sigmoid colon was observed. Based on the findings of CT scanning and colonoscopic examination, tumour-bowel fistulisation was considered to be a cause of the rapid regression. This case report illustrates a tumour-bowel fistula of a colonic metastatic tumour in a patient with lung cancer. Radiographic and endoscopic features of the rare manifestation are presented.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology, Onomichi Municipal Hospital, Onomichi 722-8503, Japan
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yoshio Miyabe
- Department of Gastroenterology, Onomichi Municipal Hospital, Onomichi 722-8503, Japan
| | - Kai Hanae
- Department of Gastroenterology, Onomichi Municipal Hospital, Onomichi 722-8503, Japan
| | - Kawai Yoshinari
- Department of Gastroenterology, Onomichi Municipal Hospital, Onomichi 722-8503, Japan
| | - Takata Katsuyoshi
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Toshi Murakami
- Department of Respiratory Medicine, Onomichi Municipal Hospital, Onomichi 722-8503, Japan
| | - Mifune Hirofumi
- Department of Radiology, Onomichi Municipal Hospital, Onomichi 722-8503, Japan
| | - Kazuhide Yamamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Silvestri GA, Gonzalez AV, Jantz MA, Margolis ML, Gould MK, Tanoue LT, Harris LJ, Detterbeck FC. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e211S-e250S. [PMID: 23649440 DOI: 10.1378/chest.12-2355] [Citation(s) in RCA: 945] [Impact Index Per Article: 85.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Correctly staging lung cancer is important because the treatment options and prognosis differ significantly by stage. Several noninvasive imaging studies and invasive tests are available. Understanding the accuracy, advantages, and disadvantages of the available methods for staging non-small cell lung cancer is critical to decision-making. METHODS Test accuracies for the available staging studies were updated from the second iteration of the American College of Chest Physicians Lung Cancer Guidelines. Systematic searches of the MEDLINE database were performed up to June 2012 with the inclusion of selected meta-analyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. RESULTS The sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were approximately 55% and 81%, respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, estimates of sensitivity and specificity for identifying mediastinal metastasis were approximately 77% and 86%, respectively. These findings demonstrate that PET scanning is more accurate than CT scanning, but tissue biopsy is still required to confirm PET scan findings. The needle techniques endobronchial ultrasound-needle aspiration, endoscopic ultrasound-needle aspiration, and combined endobronchial ultrasound/endoscopic ultrasound-needle aspiration have sensitivities of approximately 89%, 89%, and 91%, respectively. In direct comparison with surgical staging, needle techniques have emerged as the best first diagnostic tools to obtain tissue. Based on randomized controlled trials, PET or PET-CT scanning is recommended for staging and to detect unsuspected metastatic disease and avoid noncurative resections. CONCLUSIONS Since the last iteration of the staging guidelines, PET scanning has assumed a more prominent role both in its use prior to surgery and when evaluating for metastatic disease. Minimally invasive needle techniques to stage the mediastinum have become increasingly accepted and are the tests of first choice to confirm mediastinal disease in accessible lymph node stations. If negative, these needle techniques should be followed by surgical biopsy. All abnormal scans should be confirmed by tissue biopsy (by whatever method is available) to ensure accurate staging. Evidence suggests that more complete staging improves patient outcomes.
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Affiliation(s)
| | - Anne V Gonzalez
- Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Michael A Jantz
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL
| | | | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Lynn T Tanoue
- Section of Pulmonary and Critical Care Medicine, New Haven, CT
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Gonzalez-Tallon AI, Vasquez-Guerrero J, Garcia-Mayor MA. Colonic Metastases From Lung Carcinoma: A Case Report and Review of the Literature. Gastroenterology Res 2013; 6:29-33. [PMID: 27785223 PMCID: PMC5051117 DOI: 10.4021/gr518e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is the most frequent cause of cancer death in the world. Although about 50% of lung cancers have distant metastases at the time of diagnosis, gastrointestinal metastasis has rarely been described. The most common metastatic site is the small bowel, whereas, colonic metastases are very rare. This report presents a clinical case of a 68-year-old male with a previous diagnosis of non-microcytic lung carcinoma (T4, N2, M1), stage IV, who presented rectorrhagia at the emergency. Colonoscopy showed many ulcerated tumors along the colon and histology proved that these lesions were metastases of primitive lung carcinoma. Gut metastasis from the lung is uncommon but we have to be aware of it in patients who present gastrointestinal symptoms.
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Sakai H, Egi H, Hinoi T, Tokunaga M, Kawaguchi Y, Shinomura M, Adachi T, Arihiro K, Ohdan H. Primary lung cancer presenting with metastasis to the colon: a case report. World J Surg Oncol 2012; 10:127. [PMID: 22741562 PMCID: PMC3433337 DOI: 10.1186/1477-7819-10-127] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 06/28/2012] [Indexed: 01/06/2023] Open
Abstract
Although about 50% of lung cancers have distant metastasis at the time of initial diagnosis, colonic metastases are extremely rare. This report presents a rare clinical case of colonic metastasis from primary squamous cell carcinoma of the lung. A 60-year-old female with anorexia and fatigue was referred to the department of pulmonary surgery in our hospital. The patient was diagnosed with primary squamous cell carcinoma of the lung, T2b N3 M1b Stage IV, and chemoradiotherapy was initiated. This treatment led to a good partial response in the primary lung lesion without any new metastatic lesions. The patient developed left abdominal pain due to a bulky sigmoid colon tumor 6 months later, and was preoperatively diagnosed with primary colon cancer. She underwent colonic resection, and the pathology specimen demonstrated poorly differentiated squamous cell carcinoma that was suspected to be colonic metastasis from the primary lung cancer. The postoperative course was uneventful, and she was discharged. Chemotherapy for the lung cancer was scheduled in the department of pulmonary surgery. This report presented a rare case of colonic metastasis from lung cancer. When patients with advanced primary lung cancer complain of abdominal symptoms, we should consider gastrointestinal tract metastasis from lung cancer.
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Affiliation(s)
- Hiroshi Sakai
- Department of Gastroenterological Surgery, Hiroshima University Hospital, Hiroshima, Japan
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22
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Akgün KM, Crothers K, Pisani M. Epidemiology and management of common pulmonary diseases in older persons. J Gerontol A Biol Sci Med Sci 2012; 67:276-91. [PMID: 22337938 DOI: 10.1093/gerona/glr251] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pulmonary disease prevalence increases with age and contributes to morbidity and mortality in older patients. Dyspnea in older patients is often ascribed to multiple etiologies such as medical comorbidities and deconditioning. Common pulmonary disorders are frequently overlooked as contributors to dyspnea in older patients. In addition to negative impacts on morbidity and mortality, quality of life is reduced in older patients with uncontrolled, undertreated pulmonary symptoms. The purpose of this review is to discuss the epidemiology of common pulmonary diseases, namely pneumonia, chronic obstructive pulmonary disease, asthma, lung cancer, and idiopathic pulmonary fibrosis in older patients. We will review common clinical presentations for these diseases and highlight differences between younger and older patients. We will also briefly discuss risk factors, treatment, and mortality associated with these diseases. Finally, we will address the relationship between comorbidities, pulmonary symptoms, and quality of life in older patients with pulmonary diseases.
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Affiliation(s)
- Kathleen M Akgün
- Pulmonary and Critical Care Section, Department of Internal Medicine, VA Connecticut Healthcare System, West Haven, USA.
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23
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Lee HY, Lee KS, Kim BT, Cho YS, Lee EJ, Yi CA, Chung MJ, Kim TS, Kwon OJ, Kim H. Diagnostic efficacy of PET/CT plus brain MR imaging for detection of extrathoracic metastases in patients with lung adenocarcinoma. J Korean Med Sci 2009; 24:1132-8. [PMID: 19949671 PMCID: PMC2775863 DOI: 10.3346/jkms.2009.24.6.1132] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 01/16/2009] [Indexed: 12/25/2022] Open
Abstract
We aimed to evaluate prospectively the efficacy of positron emission tomography (PET)/computed tomography (CT) plus brain magnetic resonance imaging (MRI) for detecting extrathoracic metastases in lung adenocarcinoma. Metastatic evaluations were feasible for 442 consecutive patients (M:F=238:204; mean age, 54 yr) with a lung adenocarcinoma who underwent PET/CT (CT, without IV contrast medium injection) plus contrast-enhanced brain MRI. The presence of metastases in the brain was evaluated by assessing brain MRI or PET/CT, and in other organs by PET/CT. Diagnostic efficacies for metastasis detection with PET/CT plus brain MRI and with PET/CT only were calculated on a per-patient basis and compared from each other. Of 442 patients, 88 (20%, including 50 [11.3%] with brain metastasis) had metastasis. Regarding sensitivity of overall extrathoracic metastasis detection, a significant difference was found between PET/CT and PET/CT plus brain MRI (68% vs. 84%; P=0.03). As for brain metastasis detection sensitivity, brain MRI was significantly higher than PET/CT (88% vs. 24%; P<0.001). By adding MRI to PET/CT, brain metastases were detected in additional 32 (7% of 442 patients) patients. In lung adenocarcinoma patients, significant increase in sensitivity can be achieved for detecting extrathoracic metastases by adding dedicated brain MRI to PET/CT and thus enhancing brain metastasis detection.
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Affiliation(s)
- Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Tae Kim
- Department of Nuclear Medicine, and Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Department of Nuclear Medicine, and Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jeong Lee
- Department of Nuclear Medicine, and Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin A Yi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Jin Chung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Gastrointestinal Metastasis From Primary Lung Cancer: CT Findings and Clinicopathologic Features. AJR Am J Roentgenol 2009; 193:W197-201. [PMID: 19696259 DOI: 10.2214/ajr.08.1907] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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25
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26
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Saad AG, Yeap BY, Thunnissen FBJM, Pinkus GS, Pinkus JL, Loda M, Sugarbaker DJ, Johnson BE, Chirieac LR. Immunohistochemical markers associated with brain metastases in patients with nonsmall cell lung carcinoma. Cancer 2008; 113:2129-38. [PMID: 18720359 DOI: 10.1002/cncr.23826] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To the authors' knowledge, there are no reliable markers able to identify patients with nonsmall cell lung cancer (NSCLC) that will develop metastases to the brain. The authors investigated associations between immunohistochemical markers and the development of brain metastases in patients with NSCLC. METHODS This was a hospital-based, case-control study of patients who were newly diagnosed with NSCLC between 1989 and 2003, developed brain metastases, and had pathology material available from both the primary NSCLC and the brain metastases. These patients were compared with a control group of patients who had NSCLC and no evidence of brain metastases. NSCLC was examined for expression levels of Ki-67, caspase-3, vascular endothelial growth factor A (VEGF-A), VEGF-C, E-cadherin, and epidermal growth factor receptor (EGFR) in 54 surgical pathology specimens using immunohistochemistry, and associations were evaluated between those markers and the development of brain metastases. RESULTS Brain metastases developed after a median of 12.5 months (range, 1.7-89.4 months) after the diagnosis of NSCLC. A significantly increased risk of developing brain metastases was associated with patients with NSCLC who had primary tumors with high Ki-67 levels (adjusted odds ratio [OR] of 12.2; 95% confidence interval [95% CI], 2.4-70.4 [P < .001]), low caspase-3 expression (adjusted OR of 43; 95% CI, 5.3 to >100 [P < .001]), high VEGF-C expression (adjusted OR of 14.6; 95% CI, 2.0 to >100 [P < .001]), and low E-cadherin (adjusted OR of 3.6; 95% CI, 0.9-16.4 [P = .05]). No significant risk was associated with VEGF-A or EGFR expression. High Ki-67 expression also was associated with a shorter overall survival (P = .04). CONCLUSIONS The results of the current study indicated that patients with NSCLC who had high Ki-67 expression, low caspase-3 expression, high VEGF-C expression, and low E-cadherin expression in their tumors may benefit from close surveillance because they may have an increased risk of developing brain metastases.
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Affiliation(s)
- Ali G Saad
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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Brauner M, Brillet PY. [Non-small cell lung cancer: evaluation of node and metastatic staging]. REVUE DE PNEUMOLOGIE CLINIQUE 2008; 64:245-249. [PMID: 18995154 DOI: 10.1016/j.pneumo.2008.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 07/14/2008] [Indexed: 05/27/2023]
Affiliation(s)
- M Brauner
- Service de radiologie, UFR santé-médecine-biologie humaine, hôpital Avicenne, université Paris-13, AP-HP, 125, route de Stalingrad, 93009 Bobigny cedex, France.
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28
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Na II, Lee TH, Choe DH, Cheon GJ, Kim CH, Koh JS, Baek H, Ryoo BY, Yang SH, Lee JC. A diagnostic model to detect silent brain metastases in patients with non-small cell lung cancer. Eur J Cancer 2008; 44:2411-7. [PMID: 18707868 DOI: 10.1016/j.ejca.2008.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 06/27/2008] [Accepted: 07/01/2008] [Indexed: 11/19/2022]
Abstract
We aimed to discriminate subgroups according to the risk of brain metastases in patients with non-small cell lung cancer (NSCLC) lacking neurological symptoms. We performed a retrospective review of 433 patients with NSCLC who underwent chest computed tomography (CT), brain magnetic resonance imaging (MRI) and bone scans at an initial staging work-up between April 2003 and April 2007. Brain metastases were determined by MRI. Patients were stratified into groups according to the number of risk factors (0-3) identified by multivariate analysis. In multivariate analysis, histopathology with non-squamous cell carcinoma, nodal stage 2 on CT and presence of bone metastases were three risk factors for brain metastases. Patients were divided into four groups according to the number (0-3) of these predictive factors. The proportions of patients with brain metastases in the four groups were 2%, 3%, 17% and 35%, respectively, and these differences were significant (P<0.001). When analysis was performed in patients with localised disease, the number of risk factors was correlated with the prevalence of brain metastases (P=0.013) but stage was not (P=0.153). Although this diagnostic model should be validated through further studies, our data suggest that the number of risk factors might be a useful tool to identify silent brain metastases in patients with NSCLC.
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Affiliation(s)
- Im Il Na
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Nowon-Gu, Seoul, Republic of Korea.
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Silvestri GA, Gould MK, Margolis ML, Tanoue LT, McCrory D, Toloza E, Detterbeck F. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 2007; 132:178S-201S. [PMID: 17873168 DOI: 10.1378/chest.07-1360] [Citation(s) in RCA: 399] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Correctly staging lung cancer is important because the treatment options and the prognosis differ significantly by stage. Several noninvasive imaging studies including chest CT scanning and positron emission tomography (PET) scanning are available. Understanding the test characteristics of these noninvasive staging studies is critical to decision making. METHODS Test characteristics for the noninvasive staging studies were updated from the first iteration of the lung cancer guidelines using systematic searches of the MEDLINE, HealthStar, and Cochrane Library databases up to May 2006, including selected metaanalyses, practice guidelines, and reviews. Study designs and results are summarized in evidence tables. RESULTS The pooled sensitivity and specificity of CT scanning for identifying mediastinal lymph node metastasis were 51% (95% confidence interval [CI], 47 to 54%) and 85% (95% CI, 84 to 88%), respectively, confirming that CT scanning has limited ability either to rule in or exclude mediastinal metastasis. For PET scanning, the pooled estimates of sensitivity and specificity for identifying mediastinal metastasis were 74% (95% CI, 69 to 79%) and 85% (95% CI, 82 to 88%), respectively. These findings demonstrate that PET scanning is more accurate than CT scanning. If the clinical evaluation in search of metastatic disease is negative, the likelihood of finding metastasis is low. CONCLUSIONS CT scanning of the chest is useful in providing anatomic detail, but the accuracy of chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is poor. PET scanning has much better sensitivity and specificity than chest CT scanning for staging lung cancer in the mediastinum, and distant metastatic disease can be detected by PET scanning. With either test, abnormal findings must be confirmed by tissue biopsy to ensure accurate staging.
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Affiliation(s)
- Gerard A Silvestri
- Medical University of South Carolina, Department of Pulmonary and Critical Care Medicine, 171 Ashley Ave, Room 812-CSB, Charleston, SC 29425-2220, USA.
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30
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Metintas M, Ak G, Akcayir IA, Metintas S, Erginel S, Alatas F, Yildirim H, Kurt E, Ozkan R. Detecting extrathoracic metastases in patients with non-small cell lung cancer: Is routine scanning necessary? Lung Cancer 2007; 58:59-67. [PMID: 17566597 DOI: 10.1016/j.lungcan.2007.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 05/02/2007] [Indexed: 01/03/2023]
Abstract
There is controversy over whether to scan extrathoracic sites for metastases in patients with non-small cell lung cancer (NSCLC). We tested the efficiency of clinical factors to determine whether metastasis has occurred, and whether routine scanning for NSCLC is required. Nine hundred and forty five patients scanned for extrathoracic metasates were included. Clinical factors indicating metastasis were determined using multivariate analysis. Of the 945 cases, 377 (39.9%) had metastasis. Bone metastases were determined by focal skeleton pains, elevated serum alkaline phosphatase levels, adenocarcinoma, KPS</=70, sensitivity of 90.6, specificity of 12.7, PPV of 16.3, NPV of 87.8, and silent metastases rate (SMR) of 9.4%. Brain metastases were determined by neurological symptoms, adenocarcinoma, hematocrite <40 for men and <35 for women, KPS</=70, sensitivity of 89.9, specificity of 7.9, PPV of 9.2, NPV of 88.3, and SMR of 10.1%. Abdominal metastases were determined by abdominal pain/tension, hepatomegaly, elevated GGT levels, serum LDH levels >500 IU, a N2 or N3 case, KPS</=70, sensitivity of 95.9, specificity of 7.1, PPV of 13.3, NPV of 92.1 and SMR of 4.1%. Of the 224 patients with stage I and II disease, 73 had metastasis with a rate of 10.9% silent metastasis. We concluded that routine scanning of NSCLC for staging is necessary.
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Affiliation(s)
- Muzaffer Metintas
- Department of Chest Diseases, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey.
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Cortés Romera M, Talavera Rubio M, García Vicente A, Ruiz Solís S, Poblete García V, Rodríguez Alfonso B, Palomar Muñoz A, Soriano Castrejón A. ¿Se solicitan las gammagrafías óseas en pacientes oncológicos según criterios clínicos reconocidos? ACTA ACUST UNITED AC 2007. [DOI: 10.1157/13109143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Shi AA, Digumarthy SR, Temel JS, Halpern EF, Kuester LB, Aquino SL. Does initial staging or tumor histology better identify asymptomatic brain metastases in patients with non-small cell lung cancer? J Thorac Oncol 2007; 1:205-10. [PMID: 17409858 DOI: 10.1016/s1556-0864(15)31569-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To determine whether the distribution, staging features, or tumor histology of non-small cell lung cancer (NSCLC) distinguishes neurologically symptomatic from asymptomatic patients initially diagnosed with lung cancer, and to determine whether these factors may predict the presence of brain metastasis. METHODS We performed a retrospective review of 809 patients with NSCLC and brain metastases who were treated in our institution between January 1996 and March 2003. Patients who had brain metastasis on initial staging were included. Thoracic computed tomographic scans were reviewed for lung tumor features and staging. Neurological computed tomographic or magnetic resonance image scans were assessed for distribution of brain metastases. Medical records were reviewed for comprehensive staging, tumor histology, and neurological symptoms. Fisher's exact test was used to determine any differences among tumor histology, staging, and imaging features among patients with or without neurological symptoms. RESULTS Of the 809 patients, 181 had brain metastasis at initial staging. Among these 181 patients, 120 (66%) presented with neurological symptoms (group 1); 61 (34%) patients were asymptomatic (group 2). Patients with adenocarcinoma and large-cell carcinoma had greater odds of brain metastases than patients with squamous cell carcinoma (p = 0.001). There were 106 (58.6%) patients with adenocarcinoma, 32 (17.7%) with large cell carcinoma, and 18 (9.9%) with squamous cell carcinoma. In both groups, most lung cancers were in the right lung with upper lobe dominance. No significant difference in tumor histology or T stage was found between groups, although group 2 was more likely to have a higher N stage. Of the 181 patients with brain metastasis, 60 (33.1%) had N0 disease, 51 (28.2%) had T1 disease, and 23 (19.2%) had no other metastasis. There was no correlation between number/distribution of brain metastases and tumor histology, although patients with disease in the cerebellum or temporal lobes had a greater likelihood of neurological symptoms (odds ratio 3.7). CONCLUSION There was no significant difference in tumor histology, staging, or distribution between symptomatic or asymptomatic patients with NSCLC with brain metastases. The odds of brain metastases were greater in those with adenocarcinoma or large-cell carcinoma.
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Affiliation(s)
- Ann A Shi
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Ursavas A, Karadag M, Uzaslan E, Rodoplu E, Demirdögen E, Burgazlioglu B, Gozu RO. Can clinical factors be determinants of bone metastases in non-small cell lung cancer? Ann Thorac Med 2007; 2:9-13. [PMID: 19724668 PMCID: PMC2732073 DOI: 10.4103/1817-1737.30355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 11/01/2006] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the correlations among symptoms, laboratory findings of bone metastasis and whole body bone scanning (WBBS) and the frequency of occurrence of bone metastases MATERIALS AND METHODS Hundred and six patients who were diagnosed with non-small cell lung cancer (NSCLC) between June 2001 and September 2005 were investigated retrospectively. Bone pain, detection of bone tenderness on physical examination, hypercalcemia and increased serum alkaline phosphatase were accepted clinical factors of bone metastases. Presence of multiple asymmetric lesions in WBBS was also accepted as bone metastases. Subjects whose clinical factors and WBBS indicated doubtful bone metastases were evaluated with magnetic resonance and/or biopsy. RESULTS Occurrence of bone metastases was 31.1% among all patients. Bone metastases were determined in 21 (52.5%) of 40 patients who had at least one clinical factor. Asymptomatic bone metastases without any clinical factors were established in 11.3% of all NSCLC patients and 15.3% of 26 operable patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the clinical factors of bone metastases were 63.6, 73.9, 52.5, 81.8 and 70.7% respectively. There was no significant relationship between histologic type and bone metastases. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of WBBS in detection of bone metastases were 96.9, 86.3, 76.2, 98.4, 89.6% respectively. CONCLUSION Sensitivity and specificity of the clinical factors of bone metastases are quite low. Routine WBBS prevented futile thoracotomies. Therefore, routine WBBS should be performed in all NSCLC patients, even in the absence of bone-specific clinical factors.
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Affiliation(s)
- Ahmet Ursavas
- Department of Pulmonary Medicine, School of Medicine, University of Uludag, Bursa, Turkey.
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Erasmus JJ, Macapinlac HA, Swisher SG. Positron emission tomography imaging in nonsmall-cell lung cancer. Cancer 2007; 110:2155-68. [PMID: 17896784 DOI: 10.1002/cncr.23051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Positron emission tomography (PET) using 18F-2-deoxy-D-glucose, a D-glucose analog labeled with fluorine-18, complements conventional radiologic assessment in the evaluation of patients with nonsmall-cell lung cancer (NSCLC). PET is being routinely used to improve the detection of nodal and extrathoracic metastases. PET is also currently being evaluated in the assessment of prognosis and therapeutic response and by potentially allowing an earlier assessment of response may prove invaluable in the oncologic management of patients. The article discusses the diagnosis, staging, and assessment of treatment response and prognosis with an emphasis on the appropriate clinical use of PET in management.
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Affiliation(s)
- Jeremy J Erasmus
- Division of Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Staging of Lung Cancer. Lung Cancer 2006. [DOI: 10.1017/cbo9780511545351.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
INTRODUCTION The overall prognosis of non-small cell carcinoma of the bronchus (NSCLC) remains poor on account of frequently late diagnosis and associated co-morbidity preventing the optimal treatment of the tumour. Surgical resection remains the best curative treatment for limited stage disease. STATE OF THE ART The pre-operative assessment should determine whether the extent of the tumour permits complete resection and whether the physiological state of the patient would tolerate the curative resection required. The ultimate goal is to improve 5-year survival. In the case of initial inoperability the assessment should determine whether pre-operative oncological treatment might make an advanced tumour operable (e.g. stage IIIA), or whether targeted medical treatment might improve the patient sufficiently to tolerate an intervention initially judged too risky. The rapid development of the technical modalities available for the assessment requires a continuous review of the current practice guidelines. Positron emission tomography has considerably augmented the accuracy of classical radiological assessment. Nevertheless staging by imaging alone remains imprecise to the extent that invasive examinations are still necessary to provide histological proof of the clinical stage of NSCLC. The techniques for assessing mediastinal invasion are developing rapidly and becoming more accurate and less invasive. Mediastinoscopy enhanced by modern video technology, ultrasound guided endoscopic biopsies and thoracoscopy are complimentary rather than competing techniques. The functional assessment should estimate the operative risk of the proposed pulmonary resection, identify the targeted actions aimed at reducing this risk or, in the absence of such actions, suggest less invasive but less well validated surgical techniques or even palliative treatments. When the operative risk cannot be reduced its precise estimation at least allows the patient to decide whether the risk seems acceptable in relation to the chances of a cure. VIEWPOINT AND CONCLUSIONS In the future the pre-operative assessment of NSCLC should improve the detection of micro-metastases in order to optimise the choice of induction and adjuvant therapies. The increasing use of induction chemotherapy before surgical resection can only increase the importance of a detailed assessment for the selection of patients and the evaluation of results.
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Affiliation(s)
- G Decker
- Département de Chirurgie Thoracique, Groupe Thorax, Centre Hospitalier Luxembourg.
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Gontier E, Vaylet F, Bonardel G, Mantzarides M, Salles Y, Guigay J, Foehrenbach H, L'Her P. [18-FDG positon emission tomography and distal metastasis from lung cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2005; 61:248-57. [PMID: 16208188 DOI: 10.1016/s0761-8417(05)84820-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
"Whole body" FDG-PET usually covers the body from the base of the skull to the upper third of the thighs, arms in abduction. Thus, the upper part of the head and the lower limbs are not included in the acquisition field. We report the cases of three patients with non-small-cell lung cancer who developed secondary distal localizations beyond the acquisition field of "whole body" FDG-PET. Lung cancer is known to favor hematogenic dissemination, raising the possibility of early distal metastasis. A pretherapeutic PET scan which includes the extremities can be useful to search for distal extension. These true whole body scans are time consuming and can thus limit machine availability. Furthermore, the diagnostic yield of this type of examination may be low since it can be estimated that about 1% of patients will develop isolated distal metastases (3 out of 293 patients in our series initially treated for non-metastatic non-small-cell lung cancer). In the current context of technical availability, systematic inclusion of the lower limbs in the PET scan acquisition field would not appear warranted for the initial work-up of patients with non-small-cell lung cancer. However, clinicians must be aware that distal metastases (brain, lower limbs) may not be detected.
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Affiliation(s)
- E Gontier
- Service de Médecine Nucléaire, Hôpital d'Instruction des Armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris Cedex 5.
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Erasmus JJ, Truong MT, Munden RF. CT, MR, and PET imaging in staging of non-small-cell lung cancer. Semin Roentgenol 2005; 40:126-42. [PMID: 15898410 DOI: 10.1053/j.ro.2005.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Jeremy J Erasmus
- Department of Diagnostic Radiology, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
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Erturan S, Yaman M, Aydin G, Uzel I, Müsellim B, Kaynak K. The Role of Whole-Body Bone Scanning and Clinical Factors in Detecting Bone Metastases in Patients With Non-small Cell Lung Cancer. Chest 2005; 127:449-54. [PMID: 15705981 DOI: 10.1378/chest.127.2.449] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Correct detection of bone metastases in patients with non-small cell lung cancer (NSCLC) is crucial for prognosis and selection of an appropriate treatment regimen. The aim of this study was to investigate the role of whole-body bone scanning (WBBS) and clinical factors in detecting bone metastases in NSCLC. DESIGN AND PATIENTS One hundred twenty-five patients with a diagnosis made between 1998 and 2002 were recruited (squamous cell carcinoma, 54.4%; adenocarcinoma, 32.8%; non-small cell carcinoma, 8.8%; large cell carcinoma, 4%). Clinical factors suggesting bone metastasis (skeletal pain, elevated alkaline phosphatase, hypercalcemia) were evaluated. WBBS was performed in all patients, and additional MRI was ordered in 10 patients because of discordance between clinical factors and WBBS findings. MEASUREMENTS AND RESULTS Bone metastases were detected in 53% (n = 21) of 39 clinical factor-positive patients, 5.8% (n = 5) of 86 clinical factor-negative patients, and 20.8% of total patients. The existence of bone-specific clinical factors as indicators of metastasis presented 53.8% positive predictive value (PPV), 94.2% negative predictive value (NPV), and 81.6% accuracy. However, the findings of WBBS showed 73.5% PPV, 97.8% NPV, and 91.2% accuracy. Adenocarcinoma was the most common cell type found in patients with bone metastasis (39%). The routine bone scanning prevented two futile thoracotomies (8%) in 25 patients with apparently operable lung cancer. CONCLUSIONS In spite of the high NPV of the bone-specific clinical factors and the high value obtained in the false-positive findings in the bone scan, the present study indicates that in patients for whom surgical therapy is an option, preoperative staging using WBBS can be helpful to avoid misstaging due to asymptomatic bone metastases.
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Affiliation(s)
- Serdar Erturan
- Nevşehirli Ibrahim Paşa Cad. 26/4 Fatih, 34230 Istanbul, Turkey.
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Finke NM, Aubry MC, Tazelaar HD, Aughenbaugh GL, Lohse CM, Pankratz VS, Deschamps C. Autopsy results after surgery for non-small cell lung cancer. Mayo Clin Proc 2004; 79:1409-14. [PMID: 15544020 DOI: 10.4065/79.11.1409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the percentage of metastatic and unexpected residual lung cancer at autopsy in patients considered for curative resection of non-small cell lung cancer during a time when computed tomography was available as a preoperative staging tool. MATERIAL AND METHODS Clinical data and surgical and autopsy slides of all patients who underwent curative resection of nonsmall cell lung cancer at the Mayo Clinic in Rochester, Minn, between 1985 and 1999 and who underwent autopsy within 30 days of surgery were reviewed retrospectively for the presence of residual or metastatic disease. RESULTS The study group consisted of 25 men and 7 women, with a mean age of 70 years. A pulmonary metastasis was identified at surgery in 1 patient (3%). Metastases were found in an additional 5 patients (16%) at autopsy, 1 of whom had 2 sites involved. These sites included the liver in 2 and lung, epicardium, adrenal gland, and kidney in 1 each. The average diameter of metastases was 1.6 cm. No factor studied was found to be significantly associated with the presence of unrecognized metastatic disease at autopsy. CONCLUSION The advent of computed tomography as a staging tool has decreased the percentage of patients with undiagnosed metastatic disease at surgery; however, preoperative understaging in lung cancer remains a problem.
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Affiliation(s)
- Nicole M Finke
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Hochstenbag MMH, Twijnstra A, Hofman P, Wouters EFM, ten Velde GPM. MR-imaging of the brain of neurologic asymptomatic patients with large cell or adenocarcinoma of the lung. Does it influence prognosis and treatment? Lung Cancer 2003; 42:189-93. [PMID: 14568686 DOI: 10.1016/s0169-5002(03)00291-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Magnetic resonance imaging (MRI) of the brain and extensive neurological examination by a neurologist was performed as part of initial staging evaluation of 91 neurologic asymptomatic patients with large cell carcinoma or adenocarcinoma of the lung. Patients were followed up for at least 6 months. Evidence of metastatic brain disease was documented in 13 (14%) patients. Two of these patients were found suspective of brain metastases (BM) by the neurologist. The detection of BM resulted in upstaging of 1 (3%) patient in stage I/II, 4 (21%) patients in stage IIIA and 2 (11%) patients in IIIB. Especially for patients in stage III this upstaging is of importance as aggressive locoregional treatment can be abandoned. Evaluation of the brain with MRI is a sensitive method of detecting BM in neurologic asymptomatic patients and is recommended as part of the initial staging of patients with large cell carcinoma or adenocarcinoma of the lung in stage III. Additional examination by the neurologist is of little value to provide information of the neurologic status.
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Affiliation(s)
- M M H Hochstenbag
- Department of Respiratory Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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Montero C, Rosales M, Otero I, Blanco M, Rodríguez G, Peterga S, Pita S, Verea H. [Lung cancer in the health care area of A Coruña (Spain): incidence, clinical approach and survival]. Arch Bronconeumol 2003; 39:209-16. [PMID: 12749803 DOI: 10.1016/s0300-2896(03)75363-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine the incidence, clinical approach, diagnostic delay and survival for bronchogenic carcinoma (BC) in the public health area of A Coruña (Spain). PATIENTS AND METHOD This was a retrospective study of patients with a diagnosis of BC made in 1995 and 1996 in a health care area with 509,000 inhabitants. For analysis we gathered demographic, clinical and cyto-histologic data and analyzed diagnostic delay, extension of disease and time of death. Crude, age-specific and age-standardized incidences were calculated. RESULTS BC was diagnosed in 378 patients (95% men and 5% women). The crude incidence was 37 per 100,000 inhabitants (73.7 per 100,000 men and 3 per 100,000 women) and the age-standardized incidence was 21.7 per 100,000. Diagnosis was by cyto-histology in 87% of the cases, and the most frequent biopsy finding was epidermoid carcinoma. Diagnosis was by clinical or radiologic findings for 13.7%, and patients in that group were older and had greater comorbidity. No symptoms were present in 13% and in those patients diagnosis was earlier, with non-small BC predominating and 60% treated surgically. The diagnostic delay (time from the first symptom to histologic confirmation) was 2.5 months (median, 2.1), and length of delay did not affect survival. Surgery was performed in 23% of the patients with non-small BC. The median survival was 7.1 months (5.2 months for patients who were not treated surgically, and 37.6 for those who were). CONCLUSIONS The incidence of BC in men in our study is consistent with that reported for other Spanish regions, although the incidence we observed for women is much lower. Diagnostic delay did not affect survival. The percentage of patients with surgical-stage disease is very low and survival is very short. These findings support the need for early diagnosis.
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Affiliation(s)
- C Montero
- Servicio de Neumología. Hospital Universitario Juan Canalejo. A Coruña. España
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Smythe WR. Treatment of Early-Stage Non-Small Cell Carcinoma of the Lung. Lung Cancer 2003. [DOI: 10.1007/0-387-22652-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003; 123:137S-146S. [PMID: 12527573 DOI: 10.1378/chest.123.1_suppl.137s] [Citation(s) in RCA: 513] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
STUDY OBJECTIVES To determine the test performance characteristics of CT scanning, positron emission tomography (PET) scanning, MRI, and endoscopic ultrasound (EUS) for staging the mediastinum, and to evaluate the accuracy of the clinical evaluation (ie, symptoms, physical findings, or routine blood test results) for predicting metastatic disease in patients in whom non-small cell lung cancer or small cell lung cancer is diagnosed. DESIGN, SETTING, AND PARTICIPANTS Systematic searches of MEDLINE, HealthStar, and Cochrane Library databases to July 2001, and of print bibliographies. Studies evaluating the staging results of CT scanning, PET scanning, MRI, or EUS, with either tissue histologic confirmation or long-term clinical follow-up, were included. The performance of the clinical evaluation was compared against the results of brain and abdominal CT scans and radionuclide bone scans. MEASUREMENT AND RESULTS Pooled sensitivities and specificities for staging the mediastinum were as follows: for CT scanning: sensitivity, 0.57 (95% confidence interval [CI], 0.49 to 0.66); specificity, 0.82 (95% CI, 0.77 to 0.86); for PET scanning: sensitivity, 0.84 (95% CI, 0.78 to 0.89); specificity, 0.89 (95% CI, 0.83 to 0.93); and for EUS: sensitivity, 0.78 (95% CI, 0.61 to 0.89); specificity, 0.71 (95% CI, 0.56 to 0.82). For the evaluation of brain metastases, the summary estimate of the negative predictive value (NPV) of the clinical neurologic evaluation was 0.94 (95% CI, 0.91 to 0.96). For detecting adrenal and/or liver metastases, the summary NPV of the clinical evaluation was 0.95 (95% CI, 0.93 to 0.96), and for detecting bone metastases, it was 0.90 (95% CI, 0.86 to 0.93). CONCLUSIONS PET scanning is more accurate than CT scanning or EUS for detecting mediastinal metastases. The NPVs of the clinical evaluations for brain, abdominal, and bone metastases are > or = 90%, suggesting that routinely imaging asymptomatic lung cancer patients may not be necessary. However, more definitive prospective studies that better define the patient population and improved reference standards are necessary to more accurately assess the true NPV of the clinical evaluation.
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Affiliation(s)
- Eric M Toloza
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
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Silvestri GA, Tanoue LT, Margolis ML, Barker J, Detterbeck F. The noninvasive staging of non-small cell lung cancer: the guidelines. Chest 2003; 123:147S-156S. [PMID: 12527574 DOI: 10.1378/chest.123.1_suppl.147s] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Correctly staging lung cancer is extremely important because the treatment options and the prognosis differ significantly by stage. Several noninvasive imaging studies are available to aid in identifying disease both within and outside of the chest. Chest CT scanning is useful in providing anatomic detail that better identifies the location of the tumor, its proximity to local structures, and whether or not lymph nodes in the mediastinum are enlarged. Unfortunately, the accuracy of chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is unacceptably low. Whole-body positron emission tomography (PET) scanning provides functional information on tissue activity and has much better sensitivity and specificity than chest CT scanning for staging lung cancer in the mediastinum. In addition, metastatic disease can be detected by PET scan. Still, positive findings of PET scans can occur from nonmalignant etiologies (eg, infections), so that tissue sampling to confirm the suspected malignancy must be performed. The clinical evaluation tool, which is composed of a thorough history and physical examination, remains the best predictor of metastatic disease. If the findings from the clinical evaluation are negative, then imaging studies such as a CT scan of the head, a bone scan, or an abdominal CT scan are unnecessary, and the search for metastatic disease is complete. If signs, symptoms, or findings from the physical examination suggest the presence of malignancy, then sequential imaging, starting with the most appropriate study based on the clues obtained by the clinical evaluation, should be performed. Abnormalities detected by all of the aforementioned imaging studies are not always cancer. Unless overwhelming evidence of metastatic disease is present on an imaging study, in situations in which it will make a difference in treatment, all abnormal scan findings require tissue confirmation of malignancy so that patients are not precluded from having potentially curative surgery.
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Abstract
Since publication of the Radiologic Diagnostic Oncology Group Report in 1991, the clinical application of pulmonary magnetic resonance (MR) imaging to patients with lung cancer has been limited. Computed tomography has been much more widely available for staging of lung cancer in clinical situations. Currently, ventilation and perfusion scintigraphy is the only modality that demonstrates pulmonary function while 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography is the only modality that reveals biological glucose metabolism of lung cancer. However, recent advancements in MR imaging have made it possible to evaluate morphological and functional information in lung cancer patients more accurately and quantitatively. Pulmonary MR imaging may hold significant potential to substitute for nuclear medicine examinations. In this review, we describe recent advances in MR imaging of lung cancer, focusing on (1) characterization of solitary pulmonary nodules; (2) differentiation from secondary change; evaluation of (3) medastinal invasion, (4) chest wall invasion, (5) lymph node metastasis, and (6) distant metastasis; and (7) pulmonary functional imaging. We believe that further basic studies, as well as clinical applications of newer MR techniques, will play an important role in the management of patients with lung cancer.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Spiro SG, Porter JC. Lung cancer--where are we today? Current advances in staging and nonsurgical treatment. Am J Respir Crit Care Med 2002; 166:1166-96. [PMID: 12403687 DOI: 10.1164/rccm.200202-070so] [Citation(s) in RCA: 169] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lung cancer remains the commonest cause of cancer death in both men and women in the developed world, although mortality rates for men are dropping. Spiral computed tomography (CT) of the chest in middle-aged, smoking subjects may identify two to four times more lung cancers than a chest X-ray, with more than 70% of tumors being Stage I. The incidence of benign nodules is high, making interpretation difficult. Randomized controlled trials are required to determine whether spiral CT detects lung cancer early enough to improve mortality. Preoperative staging has relied on CT scans, but positron emission tomography scanning has greater sensitivity, specificity, and accuracy than CT and is recommended as the final confirmatory investigation when the CT shows resectable disease. In locally advanced non-small cell lung cancer, there is a small advantage for the addition of chemotherapy to radiotherapy, but no advantage for postoperative radiotherapy. Chemotherapy gives no benefit when given as neoadjuvant or adjuvant treatment around surgery. In advanced disease, newer cytotoxic agents confer a small survival advantage over older combinations, but the advantage in median survival over best supportive care remains a few months with modest improvements in quality of life. Survival with small cell lung cancer has shown little increase over the last 15 years despite multiple attempts to manipulate the timing, dose intensity of chemotherapy, and the potential of radiotherapy. Novel therapies are urgently needed for all cell types of lung cancer.
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Affiliation(s)
- Stephen G Spiro
- Department of Respiratory Medicine, University College, London Hospitals National Health Service Trust, United Kingdom.
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Abstract
Carcinoma of the lung is one of the most frequent malignancies and a major cause of mortality. The use of positron emission tomography (PET) has been extensively investigated in patients with carcinoma of the lung and has established clinical utility and cost-effectiveness in characterization of solitary pulmonary nodules and preoperative staging of carcinoma of the lung. Evolving applications in carcinoma of the lung include detection of recurrence, assessment of treatment response, radiotherapy planning, and prognosis. In addition, there is developing interest in combined anatomic/metabolic imaging and new tracer techniques, in particular gene expression imaging. This review aims to present existing data supporting the use of PET in carcinoma of the lung and to explore the evolving indications and future prospects of PET and lung cancer.
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Affiliation(s)
- I Ho Shon
- Clinical PET Centre, Lambeth Wing, St Thomas' Hospital, London, UK
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Bilgin S, Yilmaz A, Ozdemir F, Akkaya E, Karakurt Z, Poluman A. Extrathoracic staging of non-small cell bronchogenic carcinoma: relationship of the clinical evaluation to organ scans. Respirology 2002; 7:57-61. [PMID: 11896902 DOI: 10.1046/j.1440-1843.2002.00358.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of systemic evaluation of extrathoracic extension of non-small cell lung cancer and to assess the value of the clinical evaluation in detecting extrathoracic metastases. METHODOLOGY The study included 90 patients [87 men, three women; mean age 57.5 years (range 28-76)] with potentially resectable non-small cell carcinoma. Fifty-two were squamous cell carcinomas and 38 were adenocarcinomas. Organ-specific and non-organ-specific clinical findings suggesting metastases were analysed and computed tomographic scans of the brain and abdomen and whole-body bone scanning were performed in all patients. RESULTS Extrathoracic metastases were detected in 23 (25.5%) of 90 patients. The metastases were located in the following areas: brain (n = 12, 13.3%); bone (n = 9, 10%); liver (n = 5, 5.6%); and adrenal gland (n = 5, 5.5%). Histological analysis revealed metastases in 21.1% (11/52) of the squamous cell carcinomas and 31.6% (12/38) of the adenocarcinomas (P > 0.05). Eleven (47.8%) of the 23 patients with extrathoracic metastases had no organ-specific clinical findings suggesting metastases. Eight patients with squamous cell carcinomas were intrathoracic T1N0 stage and in two (25%) of these patients extrathoracic metastases were detected. These patients had no organ-specific or non-organ-specific clinical factors suggesting metastases. CONCLUSIONS Evaluation of extrathoracic extension should be routinely performed in all patients with newly diagnosed lung cancer. This approach will prevent many unnecessary thoracotomies.
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Affiliation(s)
- Sevinç Bilgin
- SSK Süreyyapasa Center for Chest Disease and Thoracic Surgery, Istanbul, Turkey
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Maya Martínez M, Carrión Valero F, Díaz López J, Mollá Landete MA, Marín Pardo J. [Influence of computed tomography of the abdomen for staging lung cancer]. Arch Bronconeumol 2002; 38:123-9. [PMID: 11900689 DOI: 10.1016/s0300-2896(02)75169-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To analyze the influence of routine imaging of the upper abdomen by conventional computed tomography (CT) to stage bronchopulmonary carcinoma and to detect liver or adrenal metastasis. A second objective was to describe the characteristics of a large group of patients in our practice. MATERIAL AND METHODS Retrospective study of 387 patients (367 men and 20 women; mean age [+/-SD] 62.3 +/- 10.4 years, range 34-90 years) who had received a diagnosis of lung cancer (203 epidermoid carcinoma, 75 adenocarcinoma, 15 non-small cell carcinoma, 68 small cell carcinoma and 25 mixed tumors). CT images were obtained of the chest and upper abdomen with intravenous contrast except in patients with a history of allergy or renal insufficiency. The characteristics associated with abdominal CT images aiding or confusing diagnosis were analyzed by Spearman coefficient. Differences related to sex or histology were studied using a Mann-Whitney U-test and Kruskal-Wallis test. RESULTS The upper abdominal CT changed the staging of 27 patients (7%): non-small cell carcinoma 5% (16/319) and small-cell carcinoma 16.2% (11/68). Twelve patients (3.1%) showed evidence of unconfirmed adrenal or hepatic metastasis. Change of staging after CT was associated with a high creatinine concentration in blood (p = 0.032), whereas confusion of diagnosis after CT was more common for women (p = 0.002) and patients for whom the diagnosis was established by cytology of sputum or bronchial aspirate (p = 0.019). Differences between men and women were found for from pathology (p = 0.027), confusion after CT (p = 0.002), hemoglobin (p = 0.011), hematocrit (p = 0.019) and smoking (p = 0.000). CONCLUSION Given the considerable limitations of CT imaging of the upper abdomen, new technologies should be developed to facilitate a more rational approach to the problem.
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MESH Headings
- Adenocarcinoma/diagnosis
- Adenocarcinoma/diagnostic imaging
- Adrenal Gland Neoplasms/diagnosis
- Adrenal Gland Neoplasms/diagnostic imaging
- Adrenal Gland Neoplasms/secondary
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/diagnostic imaging
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/diagnostic imaging
- Clinical Enzyme Tests
- Data Interpretation, Statistical
- Female
- Humans
- Liver Neoplasms/diagnosis
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/secondary
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Male
- Middle Aged
- Radiography, Abdominal
- Radiography, Thoracic
- Retrospective Studies
- Sex Factors
- Tomography, X-Ray Computed
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Affiliation(s)
- M Maya Martínez
- Servicios de Neumología. Hospital Clínico Universitario de Valencia. Universitat de València
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