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van Heumen S, Kramer T, Korevaar DA, Gompelmann D, Bal C, Hetzel J, Jahn K, Poletti V, Ravaglia C, Sadoughi A, Stratakos G, Bakiri K, Koukaki E, Anagnostopoulos N, Votruba J, Šestáková Z, Heuvelmans MA, Daniels JMA, de Bruin DM, Bonta PI, Annema JT. Bronchoscopy with and without needle-based confocal laser endomicroscopy for peripheral lung nodule diagnosis: protocol for a multicentre randomised controlled trial (CLEVER trial). BMJ Open 2024; 14:e081148. [PMID: 38964802 PMCID: PMC11227804 DOI: 10.1136/bmjopen-2023-081148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/31/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Despite many technological advances, the diagnostic yield of bronchoscopic peripheral lung nodule analysis remains limited due to frequent mispositioning. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic feedback on needle positioning, potentially improving the sampling location and diagnostic yield. Previous studies have defined and validated nCLE criteria for malignancy, airway and lung parenchyma. Larger studies demonstrating the effect of nCLE on diagnostic yield are lacking. We aim to investigate if nCLE-imaging integrated with conventional bronchoscopy results in a higher diagnostic yield compared with conventional bronchoscopy without nCLE. METHODS AND ANALYSIS This is a parallel-group randomised controlled trial. Recruitment is performed at pulmonology outpatient clinics in universities and general hospitals in six different European countries and one hospital in the USA. Consecutive patients with a for malignancy suspected peripheral lung nodule (10-30 mm) with an indication for diagnostic bronchoscopy will be screened, and 208 patients will be included. Web-based randomisation (1:1) between the two procedures will be performed. The primary outcome is diagnostic yield. Secondary outcomes include diagnostic sensitivity for malignancy, needle repositionings, procedure and fluoroscopy duration, and complications. Pathologists will be blinded to procedure type; patients and endoscopists will not. ETHICS AND DISSEMINATION Primary approval by the Ethics Committee of the Amsterdam University Medical Center. Dissemination involves publication in a peer-reviewed journal. SUPPORT Financial and material support from Mauna Kea Technologies. TRIAL REGISTRATION NUMBER NCT06079970.
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Affiliation(s)
- Saskia van Heumen
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tess Kramer
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniël A Korevaar
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniela Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Bal
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Juergen Hetzel
- Department of Pneumology, University Hospital Basel, Basel, Switzerland
| | - Kathleen Jahn
- Department of Pneumology, University Hospital Basel, Basel, Switzerland
| | - Venerino Poletti
- Pulmonary Unit, Department of Thoracic Diseases, GB Morgagni-Pierantoni Hospital, Forli, Italy
| | - Claudia Ravaglia
- Pulmonary Unit, Department of Thoracic Diseases, GB Morgagni-Pierantoni Hospital, Forli, Italy
| | - Ali Sadoughi
- Department of Pulmonary Medicine, Montefiore Medical Center Einstein Campus, New York, New York, USA
| | - Grigoris Stratakos
- Interventional Pulmonology Unit of the 1st Respiratory Medicine Department, "Sotiria" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Bakiri
- Interventional Pulmonology Unit of the 1st Respiratory Medicine Department, "Sotiria" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Koukaki
- Interventional Pulmonology Unit of the 1st Respiratory Medicine Department, "Sotiria" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nektarios Anagnostopoulos
- Interventional Pulmonology Unit of the 1st Respiratory Medicine Department, "Sotiria" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jiří Votruba
- 1st Department of Tuberculosis and Respiratory Diseases, General University Hospital in Prague, Prague, Czech Republic
| | - Zuzana Šestáková
- 1st Department of Tuberculosis and Respiratory Diseases, General University Hospital in Prague, Prague, Czech Republic
| | - Marjolein A Heuvelmans
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel M de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peter I Bonta
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Steding-Jessen M, Engberg H, Jakobsen E, Rasmussen TR, Møller H. Progress against lung cancer, Denmark, 2008-2022. Acta Oncol 2024; 63:339-342. [PMID: 38745484 DOI: 10.2340/1651-226x.2024.26180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND PURPOSE There has been marked progress against lung cancer in Denmark. To gain further insight into the different aspects of the improvement, we examined the stage-specific incidence rates, stage-specific survival and mortality rates. MATERIALS AND METHODS We used information from the Danish Lung Cancer Registry on date of diagnosis and clinical stage to calculate age-standardised incidence rates and patient survival by sex, period and stage. Information about age-standardised lung cancer-specific mortality rates by sex and period was extracted from The Danish Health Data Authority. RESULTS Firstly, the decrease in incidence rates was due to a reduction in the rates of advanced stages. Secondly, there was a gradual increase in survival across all stages, and thirdly, the mortality rates gradually decreased over time. INTERPRETATION The improvements in survival and mortality from lung cancer were due to decreasing incidence rates of advanced cancer and improvement in survival at all stages of the disease.
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Affiliation(s)
| | - Henriette Engberg
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aarhus, Denmark
| | - Erik Jakobsen
- Department of Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; The Danish Lung Cancer Registry (DLCR), Odense University Hospital, Odense, Denmark
| | | | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aarhus, Denmark; Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
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Henriksen MB, Hansen TF, Jensen LH, Brasen CL, Peimankar A, Ebrahimi A, Wiil UK, Hilberg O. A collection of multiregistry data on patients at high risk of lung cancer-a Danish retrospective cohort study of nearly 40,000 patients. Transl Lung Cancer Res 2023; 12:2392-2411. [PMID: 38205206 PMCID: PMC10774999 DOI: 10.21037/tlcr-23-495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
Background Lung cancer (LC) is the leading cause of cancer related deaths, and several countries are implementing screening programs. Risk models have been introduced to refine the LC screening criteria, but the use of real-world data for this task demands a robust data infrastructure and quality. In this retrospective cohort study, we aim to address the different relevant risk factors in terms of data sources, descriptive statistics, completeness and quality. Methods Data on comorbidity, prescription medication, smoking history, consultations, symptoms, familial predispositions, exposures, laboratory data among others were collected for all patients examined on a risk of LC over a 10-year period in the Region of Southern Denmark. Data were delivered from the regional data warehouse as well as the Danish Lung Cancer Registry. Associations between LC and non-LC groups were examined through Chi-squared test (categorical variables) and Wilcoxon signed-rank test (continuous variables that were non-parametric). These associations were investigated on both the original datasets and the subset of patients with complete data. Results The number of examined individuals increased over the study period and more patients were diagnosed with LC in stage I-II, from 18% in 2009 to 31% in 2018. LC patients were more likely to be older, smoker, with a registered prescription of the included medication. They also exhibited differences in laboratory analysis indicating inflammation and hyponatremia. Weight loss, fatigue and pain were more prevalent in the LC group, while hemoptysis and fever were more common among the non-LC patients. Advanced-stage LC patients experienced a higher rate of symptoms compared to those in the low stages. Within the sub-cohort with complete dataset results, most observed trends persisted, although data on comorbidities were susceptibility to change. Conclusions This study provides key insights into LC risk assessment using a robust dataset of patients examined for suspected LC. A consistent positive trend in early-stage LC diagnosis was observed throughout the study period. LC patients exhibited distinct smoking behaviors, medication patterns, variations in lab results, and specific symptoms. These discoveries have the potential to enhance discrimination in machine learning-based prediction models, particularly those capable of handling complex distributions. Serving as a detailed account of real-world data collection and processing, the study establishes a foundation for future development of prediction models aimed at facilitating the early referral of LC patients.
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Affiliation(s)
| | | | | | - Claus Lohman Brasen
- Department of Biochemistry and Immunology, Vejle University Hospital, Vejle, Denmark
| | - Abdolrahman Peimankar
- SDU Health Informatics and Technology, Mærsk Mc-Kinney Møller Instituttet, University of Southern Denmark, Odense, Denmark
| | - Ali Ebrahimi
- SDU Health Informatics and Technology, Mærsk Mc-Kinney Møller Instituttet, University of Southern Denmark, Odense, Denmark
| | - Uffe Kock Wiil
- SDU Health Informatics and Technology, Mærsk Mc-Kinney Møller Instituttet, University of Southern Denmark, Odense, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Vejle University Hospital, Vejle, Denmark
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Scorziello C, Borcea MC, Biffoni M, Pernazza A, Arienzo F, Melcarne R, Ventrone L, Laca A, Grani G, Durante C, Consorti F, Giacomelli L. Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report. Clin Case Rep 2023; 11:e7417. [PMID: 37484755 PMCID: PMC10362120 DOI: 10.1002/ccr3.7417] [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: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/25/2023] Open
Abstract
Incidental sonographic discovery of thyroid nodules is an increasingly common event in clinical practice. Less frequently, patients with cytological benign thyroid nodules have suspicious cervical lymph nodes detected by ultrasound examination or by cytological exam. Here, we discuss an intriguing case of cervical lymph node metastasis with a probable thyroid origin in a 65-year-old asymptomatic male smoker. He underwent thyroidectomy and unilateral cervical lymphadenectomy. Despite a negative chest X-ray, the postoperative histological examination revealed that the lymph node metastasis was actually from a lung carcinoma. Metastatic lesions in cervical lymph nodes from non-thyroidal origins must be excluded when evaluating lesions in the region, especially when thyroid nodules subjected to fine needle aspiration biopsy yield negative results, or lymph node cytological evaluations are inconsistent with thyroid cytological findings and sonographic features. Thyroid and lung adenocarcinomas share some epithelial and mesenchymal markers. Thyroglobulin helps differentiate primary thyroid tumors from lung ones, but in cases of poor differentiation, distinguishing metastatic lesions in the thyroid gland can be challenging. Lung cancer (LC) is the leading cause of cancer mortality worldwide, and survival rates have only marginally improved over the last several decades. The ongoing clinical challenge is detecting LC at earlier stages of the disease.
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Affiliation(s)
| | | | - Marco Biffoni
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Angelina Pernazza
- Department of Medico‐Surgical Sciences and BiotechnologySapienza University of RomeRomeItaly
| | - Francesca Arienzo
- Department of Radiological, Oncological and Pathological SciencesSapienza University of RomeRomeItaly
| | | | - Luca Ventrone
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Angelo Laca
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Giorgio Grani
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Cosimo Durante
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | | | - Laura Giacomelli
- Department of Surgical SciencesSapienza University of RomeRomeItaly
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Bradley SH, Bhaskaran D, Bhartia BS. How do the UK's guidelines on imaging for suspected lung cancer compare with other countries? Br J Gen Pract 2023; 73:84-86. [PMID: 36702597 PMCID: PMC9888573 DOI: 10.3399/bjgp23x731985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Stephen H Bradley
- National Institute for Health and Care Research (NIHR) Academic Clinical Lecturer, University of Leeds, Leeds
| | | | - Bobby Sk Bhartia
- Consultant Thoracic Radiologist, Leeds Teaching Hospitals NHS Trust, Leeds
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Borg M, Hilberg O, Andersen MB, Weinreich UM, Rasmussen TR. Increased use of computed tomography in Denmark: stage shift toward early stage lung cancer through incidental findings. Acta Oncol 2022; 61:1256-1262. [PMID: 36264585 DOI: 10.1080/0284186x.2022.2135134] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Computed tomography (CT) examinations are increasingly used worldwide and incidental findings are growing likewise. Lung cancer stage at diagnosis is pivotal to survival. The earliest stage of lung cancer, stage IA is in most cases asymptomatic. Potentially, increased use of clinical CTs could induce a stage shift toward earlier lung cancer diagnosis. MATERIALS AND METHODS Data on the number of CT thorax in Denmark and the stage distribution of Danish lung cancer patients 2013-2020 were acquired from, respectively, the Danish Health Data Authority and the Danish Lung Cancer Registry. Clinical auditing of stage IA lung cancer patients was performed in the period 2019-2021 in a Danish region to assess the reasons for referral. Auditing of stage IV lung cancer patients was done to see whether a CT thorax was performed in a two-year period before diagnosis. RESULTS All regions showed an increase in CTs per 1000 inhabitants. However, the number of CTs performed in 2013 differed by more than 50% among regions, and the increase per year also differed, from an increase of 1.9 to 3.4 more examinations per year. A significant correlation between CTs and fraction of stage IA lung cancers was seen in four out of the five regions. The audit of stage IA lung cancer cases revealed that 86.8% were incidental findings. Audit of stage IV lung cancer found that 4.3% had a nodule/infiltrate on a previous CT within a 2-year period prior to the diagnosis of lung cancer that was the probable origin of stage IV lung cancer. CONCLUSION The study found that the vast majority of early-stage lung cancers were incidental findings. It highlights that follow-up algorithms of incidental findings should be used in accordance with guidelines and it should be unequivocally how the CT follow-up of pulmonary infiltrates is managed.
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Affiliation(s)
- M Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - O Hilberg
- Department of Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - M B Andersen
- Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - U M Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - T R Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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