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Oskan F, Kornhuber C, Krause G, Vordermark D. Simultaneous stereotactic body radiation therapy of a primary non-small cell lung cancer and synchronous carcinoma in situ in a medically inoperable patient: case report. Radiat Oncol 2013; 8:213. [PMID: 24028532 PMCID: PMC3851482 DOI: 10.1186/1748-717x-8-213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/11/2013] [Indexed: 12/02/2022] Open
Abstract
The co-incidence of synchronous intraepithelial neoplasia and early stage invasive lung cancer is not a rare phenomenon. The need for curative treatment and the invasive potential of squamous cell pulmonary carcinoma in situ have been a topic of controversy. Surgical resection still remains the treatment of choice. Varieties of endoscopic techniques such as brachytherapy were developed as an alternative to surgery in selected patients. External beam radiation therapy has been used traditionally in combination with endobronchial brachytherapy in the treatment of roentgenographically occult lung cancer, and can be offered for all patients, but is handicapped, because these tumors are radiographically invisible. We report the first case of a pulmonary carcinoma in situ that was successfully treated with stereotactic body radiation therapy.
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Affiliation(s)
- Feras Oskan
- Department of Radiation Oncology, Martin-Luther University Hospital, Halle-Wittenberg, Dryanderstraße 4, 06110, Halle (Saale), Germany.
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Wisnivesky JP, Yung RCW, Mathur PN, Zulueta JJ. Diagnosis and treatment of bronchial intraepithelial neoplasia and early lung cancer of the central airways: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e263S-e277S. [PMID: 23649442 DOI: 10.1378/chest.12-2358] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Bronchial intraepithelial lesions may be precursors of central airway lung carcinomas. Identification and early treatment of these preinvasive lesions might prevent progression to invasive carcinoma. METHODS We systematically reviewed the literature to develop evidence-based recommendations regarding the diagnosis and treatment of intraepithelial lesions. RESULTS The risk and timeline for progression of bronchial intraepithelial lesions to carcinoma in situ (CIS) or invasive carcinoma are not well understood. Multiple studies show that autofluorescence bronchoscopy (AFB) is more sensitive that white light bronchoscopy (WLB) to identify these lesions. In patients with severe dysplasia or CIS in sputum cytology who have chest imaging studies showing no localizing abnormality, we suggest use of WLB; AFB may be used as an adjunct when available. Patients with known severe dysplasia or CIS of central airways should be followed with WLB or AFB, when available. WLB or AFB is also suggested for patients with early lung cancer who will undergo resection for delineation of tumor margins and assessment of synchronous lesions. However, AFB is not recommended prior to endobronchial therapy for CIS or early central lung cancer. Several endobronchial techniques are recommended for the treatment of patients with superficial limited mucosal lung cancer who are not candidates for resection. CONCLUSION Additional information is needed about the natural history and rate of progression of preinvasive central airway lesions. Patients with severe dysplasia or CIS may be treated endobronchially; however, it remains unclear if these therapies are associated with improved patient outcomes.
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Affiliation(s)
- Juan P Wisnivesky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Rex Chin-Wei Yung
- Division of Pulmonary Medicine and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Praveen N Mathur
- Division of Pulmonary, Critical Care, Allergy and Occupational Medicine, Department of Medicine, Indiana University Medical Center, Indianapolis, IN
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Vansteenkiste J, Dooms C, Mascaux C, Nackaerts K. Screening and early detection of lung cancer. Ann Oncol 2013; 23 Suppl 10:x320-7. [PMID: 22987984 DOI: 10.1093/annonc/mds303] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The greatest news of the past year in this field was the first large-scale early detection trial that could prove a 20% reduction in lung cancer-related mortality by screening high-risk individuals with low-dose computed tomography (LDCT). Several expert groups and medical societies have assessed the data and concluded that LDCT screening for lung cancer is, however, not ready for large-scale population-based implementation. Too many open questions remain, such as definition of the at-risk population, timing and intervals of screening, optimal method of acquisition and interpretation of the images, how to handle (false) positive findings, and especially cost-effectiveness in relation to other lung cancer prevention strategies, mainly smoking cessation. Further analyses and several ongoing European trials are eagerly awaited. Much hope also resides in the use of biomarkers, as their use in, e.g., blood or exhaled air may provide more easy-to-use tests to better stratify high-risk populations for screening studies. While exciting research is ongoing in this domain--e.g. with microRNAs--none of the tests has yet reached sufficient validation for clinical use. Early central lung cancers are more difficult to visualise by CT. For these patients, standard bronchoscopy, complemented by autofluoresence endoscopy, has been studied in different screening and follow-up settings.
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Affiliation(s)
- J Vansteenkiste
- Respiratory Oncology Unit (Pulmonology) and Leuven Lung Cancer Group, University Hospital Gasthuisberg, Leuven, Belgium.
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Josefsen LB, Boyle RW. Unique diagnostic and therapeutic roles of porphyrins and phthalocyanines in photodynamic therapy, imaging and theranostics. Theranostics 2012; 2:916-66. [PMID: 23082103 PMCID: PMC3475217 DOI: 10.7150/thno.4571] [Citation(s) in RCA: 379] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/10/2012] [Indexed: 02/07/2023] Open
Abstract
Porphyrinic molecules have a unique theranostic role in disease therapy; they have been used to image, detect and treat different forms of diseased tissue including age-related macular degeneration and a number of different cancer types. Current focus is on the clinical imaging of tumour tissue; targeted delivery of photosensitisers and the potential of photosensitisers in multimodal biomedical theranostic nanoplatforms. The roles of porphyrinic molecules in imaging and pdt, along with research into improving their selective uptake in diseased tissue and their utility in theranostic applications are highlighted in this Review.
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TRISOLINI ROCCO, CANCELLIERI ALESSANDRA, TINELLI CARMINE, PAIOLI DANIELA, SCUDELLER LUIGIA, FORTI PARRI SERGIONICOLA, LIVI VANINA, BOARON MAURIZIO, PATELLI MARCO. Performance characteristics and predictors of yield from transbronchial needle aspiration in the diagnosis of peripheral pulmonary lesions. Respirology 2011; 16:1144-9. [DOI: 10.1111/j.1440-1843.2011.02026.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Value of autofluorescence bronchoscopy in patients with laryngeal cancer. The Journal of Laryngology & Otology 2010; 125:181-7. [PMID: 21059279 DOI: 10.1017/s002221511000229x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with squamous cell carcinoma of the head and neck constitute a high risk group for synchronous and metachronous tumours. OBJECTIVE This study aimed to investigate the usefulness of white light and autofluorescence bronchoscopy in the evaluation of pre-malignant and early neoplastic lesions in patients with laryngeal cancer, who are at high risk of concomitant lung cancer. METHODS This prospective, cross-sectional study included 30 patients who had undergone total laryngectomy for squamous cell carcinoma of the larynx. The tracheobronchial system was investigated for the presence of pre-malignant and malignant lesions, using a combination of white light and autofluorescence bronchoscopy. Biopsies were obtained from areas with a pathological appearance, and histopathological studies were performed. RESULTS All patients had a permanent tracheostomy. Light and autofluorescence bronchoscopy indicated that the tracheobronchial system was normal in 11 patients. A total of 27 biopsies was taken from the remaining 19 patients, and revealed invasive squamous cell carcinoma in one patient and pre-malignant changes in six. CONCLUSION Bronchoscopy is a valuable and practical tool for screening patients at high risk of lung cancer, and requires minimal intervention especially in patients with a permanent tracheostomy. Of the various bronchoscopic techniques becoming available, autofluorescence bronchoscopy shows promise for the detection of pre-invasive malignant changes of the tracheobronchial system in patients previously operated upon for laryngeal cancer.
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Vansteenkiste J, Dooms C, De Leyn P. Early stage non-small-cell lung cancer: challenges in staging and adjuvant treatment: evidence-based staging. Ann Oncol 2010; 21 Suppl 7:vii189-95. [DOI: 10.1093/annonc/mdq424] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Colt HG, Murgu SD. Interventional bronchoscopy from bench to bedside: new techniques for early lung cancer detection. Clin Chest Med 2010; 31:29-37, Table of Contents. [PMID: 20172430 DOI: 10.1016/j.ccm.2009.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lung cancer is a leading cause of cancer-related death in the world, and it accounts for more deaths than breast, colon, and prostate cancer combined in the United States. From a historical perspective, the premise behind early lung cancer detection strategy is that early detection of lung cancer is justified if early treatment improves the outcome. New optical technologies such as those presented in this article allow dynamic study of these processes at the cellular level, and it is hoped that opportunities for targeted therapy will be provided in the future. Investigators are on the verge of discovering a multidimensional bronchoscopic platform that can be used to narrow in on airway structures, explore vascular flow and angiogenesis, and discover new features of bronchogenic carcinogenesis.
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Affiliation(s)
- Henri G Colt
- Department of Medicine, Pulmonary and Critical Care Medicine, University of California School of Medicine, 101 The City Drive, Irvine, Orange, CA 92868, USA.
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Collaud S, Bongiovanni M, Pache J, Fioretta G, Robert JH. Survival according to the site of bronchial microscopic residual disease after lung resection for non–small cell lung cancer. J Thorac Cardiovasc Surg 2009; 137:622-6. [DOI: 10.1016/j.jtcvs.2008.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 10/08/2008] [Accepted: 10/13/2008] [Indexed: 11/30/2022]
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Current indications and future perspective of fluorescence bronchoscopy: A review study. Photodiagnosis Photodyn Ther 2008; 5:238-46. [DOI: 10.1016/j.pdpdt.2009.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 01/27/2009] [Accepted: 01/27/2009] [Indexed: 11/20/2022]
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Kwon MH, Kang MI, Jeong JH, Won HK, Park HW, Park JH, Kim ST, Kwon SJ, Choi E, Na MJ, Cho HM, Kim YJ, Kim YM, Cho YJ, Son JW. Synchronous Roentgenographically Occult Lung Carcinoma Treated with Argon Plasma Coagulation in a Patient with Resectable Primary Lung Cancer. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Mi-Hye Kwon
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Mi-Il Kang
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Ji-Hyun Jeong
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Hee-Kwan Won
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Hyun-Woong Park
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Jung-Ho Park
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Sung-Tae Kim
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Sun-Jung Kwon
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Eugene Choi
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Moon-Jun Na
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
| | - Hyun-Min Cho
- Department of Chest Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Young-Jin Kim
- Department of Chest Surgery, Konyang University College of Medicine, Daejon, Korea
| | - Yoon-Mee Kim
- Department of Pathology, Konyang University College of Medicine, Daejon, Korea
| | - Young-Jun Cho
- Department of Diagnostic Radiology, Konyang University College of Medicine, Daejon, Korea
| | - Ji-Woong Son
- Department of Internal Medicine, Konyang University College of Medicine, Daejon, Korea
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Kennedy TC, McWilliams A, Edell E, Sutedja T, Downie G, Yung R, Gazdar A, Mathur PN. Bronchial Intraepithelial Neoplasia/Early Central Airways Lung Cancer. Chest 2007; 132:221S-233S. [PMID: 17873170 DOI: 10.1378/chest.07-1377] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND An evidence-based approach is necessary for the localization and management of intraepithelial and microinvasive non-small cell lung cancer in the central airways. METHODS Material appropriate to this topic was obtained by literature search of a computerized database. Recommendations were developed by the writing committee and then reviewed by the entire guidelines panel. The final recommendations were made by the Chair and were voted on by the entire committee. RESULTS White light bronchoscopy has diagnostic limitations in the detection of microinvasive lesions. Autofluorescence bronchoscopy (AFB) is a technique that has been shown to be a sensitive method for detecting these lesions. In patients with moderate dysplasia or worse on sputum cytology and normal chest radiographic findings, bronchoscopy should be performed. If moderate/severe dysplasia or carcinoma in situ (CIS) is detected in the central airways, then bronchoscopic surveillance is recommended. The use of AFB is preferred if available. In a patient being considered for curative endobronchial therapy to treat microinvasive lesions, AFB is useful. A number of endobronchial techniques as therapeutic options are available for the management of CIS and can be recommended to patients with inoperable disease. In patients with operable disease, surgery remains the mainstay of treatment, although patients may be counseled about these techniques. CONCLUSIONS AFB is a useful tool for the localization of microinvasive neoplasia. A number of endobronchial techniques available for the curative treatment can be considered first-line therapy in inoperable cases. For operable cases, the techniques may be considered and discussed with the patients.
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Affiliation(s)
- Timothy C Kennedy
- MBBS, 550 W University Blvd, Suite 4903, Indianapolis IN 46202, USA.
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Moghissi K, Dixon K, Thorpe JAC, Stringer M, Oxtoby C. Photodynamic therapy (PDT) in early central lung cancer: a treatment option for patients ineligible for surgical resection. Thorax 2006; 62:391-5. [PMID: 17090572 PMCID: PMC2117198 DOI: 10.1136/thx.2006.061143] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To review the Yorkshire Laser Centre experience with bronchoscopic photodynamic therapy (PDT) in early central lung cancer in subjects not eligible for surgery and to discuss diagnostic problems and the indications for PDT in such cases. METHODS Of 200 patients undergoing bronchoscopic PDT, 21 had early central lung cancer and were entered into a prospective study. Patients underwent standard investigations including white light bronchoscopy in all and autofluorescence bronchoscopy in 12 of the most recent cases. Indications for bronchoscopic PDT were recurrence/metachronous endobronchial lesions following previous treatment with curative intent in 10 patients (11 lesions), ineligibility for surgery because of poor cardiorespiratory function in 8 patients (9 lesions) and declined consent to operation in 3 patients. PDT consisted of intravenous administration of Photofrin 2 mg/kg followed by bronchoscopic illumination 24-48 h later. RESULTS 29 treatments were performed in 21 patients (23 lesions). There was no procedure-related or 30 day mortality. One patient developed mild skin photosensitivity. All patients expressed satisfaction with the treatment and had a complete response of variable duration. Six patients died at 3-103 months (mean 39.3), three of which were not as a result of cancer. Fifteen patients were alive at 12-82 months. CONCLUSION Bronchoscopic PDT in early central lung cancer can achieve long disease-free survival and should be considered as a treatment option in those ineligible for resection. Autofluorescence bronchoscopy is a valuable complementary investigation for identification of synchronous lesions and accurate illumination in bronchoscopic PDT.
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Trisolini R, Paioli D, Patelli M. Is bronchoscopy dangerous in the pretreatment workup of non-small cell lung cancer patients? Chest 2006; 130:1284. [PMID: 17035478 DOI: 10.1378/chest.130.4.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kwon SJ, Lee YS, Joung MK, Lee YJ, Jang PS, Lee JE, Chung CU, Park HS, Jung SS, Kim SY, Kim JO. Primary Synchronous Lung Cancer Detected using Autofluorescence Bronchoscopy. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.60.6.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sun Jung Kwon
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yun Seun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Mi Kyong Joung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Yu Jin Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Pil Soon Jang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Jeung Eyun Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Chae Uk Chung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hee Sun Park
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sung Soo Jung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sun Young Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Ju Ock Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
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Muraoka M, Oka T, Akamine S, Tagawa T, Hashizume S, Matsumoto K, Tagawa Y, Hayashi T, Nagayasu T. Surgical Treatment for Multiple Primary Lung Cancer. ACTA ACUST UNITED AC 2005. [DOI: 10.2482/haigan.45.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Zeng H, McWilliams A, Lam S. Optical spectroscopy and imaging for early lung cancer detection: a review. Photodiagnosis Photodyn Ther 2004; 1:111-22. [DOI: 10.1016/s1572-1000(04)00042-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thomas PA. [Non-small cell multifocal lung cancer: should it be surgically treated or not?]. Rev Mal Respir 2004; 21:227-8. [PMID: 15260078 DOI: 10.1016/s0761-8425(04)71277-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- P A Thomas
- Service de Chirurgie Thoracique, Hôpital Sainte Marguerite, CHU Sud, Marseille, France
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Tomić I, Mrda V, Karlicić V, Bokun R, Tatomirović Z. [Phonation bronchoscopy]. VOJNOSANIT PREGL 2003; 60:161-6. [PMID: 12852158 DOI: 10.2298/vsp0302161t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fluorescence bronchoscopy is one of the methods of the early detection of lung cancer that involves the large airways. The method is based on the detection of the altered autofluorescence of malignantly transformed tissue, and confirmed by biopsy and histopathologic examination. METHOD Fluorescence bronchoscopy was performed in 18 patients, mean age of 51.2 years (male n = 12, female n = 6) due to the suspected lung cancer. Fluorescence bronchoscopy was performed using the Xillix LIFE-Lung System, Vancouver, Canada. After conventional white-light bronchoscopy, the tracheobronchial tree was illuminated by blue light (442 nm) using helium-cadmium laser, and the results of autofluorescence were classified into three classes. Normal mucosa was of green fluorescence (Class I), abnormal mucosa was red or dark brown fluorescence (Class II and II), which was the indication for performing biopsy. RESULTS Normal endoscopy findings were established in 15 patients by conventional bronchoscopy. In the same group, by fluorescence bronchoscopy, Class I of fluorescence (normal finding) was found in 9 patients, while Class II changes occurred in 6 patients. Histopathologic analysis of bronchial mucosa with Class II changes was performed detecting planocellular carcinoma in situ in one patient. Tumor-like changes were detected in 3 patients by conventional bronchoscopy, and were determined as Class III changes by fluorescence bronchoscopy. By the biopsy of these chages carcinoma was documented in 2 patients while in one patient metaplasia of epithelium and granulation tissue around aspirated foreign body was detected. CONCLUSION Fluorescence bronchoscopy is one of the methods for detecting metaplasia, carcinoma in situ and cancerous changes of bronchial epithelium in the large airways. However, the high rate of falsely positive findings represents a limitation of this method.
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Affiliation(s)
- Ilija Tomić
- Vojnomedicinska akademija, Klinika za plućne bolesti, ZPSM, Beograd
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Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study. Lung Cancer 2003; 39:49-53. [PMID: 12499094 DOI: 10.1016/s0169-5002(02)00309-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bronchoscopic treatment (BT) has a curative potential for patients with intraluminal microinvasive radiographically occult lung cancer (ROLC). We report the long-term follow-up in a group of 32 patients, ineligible for surgery, in whom ROLC was diagnosed and treated with BT. Tumors were strictly <or=1 cm in size, intraluminally located in the central airways, with no bronchial wall invasion or extraluminal tumor growth on high resolution CT (HRCT), with visible distal margin under conventional and autofluorescence bronchoscopy (AFB). BT was given with curative intent and consecutive patients were treated with photodynamic therapy (five patients), Nd-YAG laser therapy (one patient), electrocautery (24 patients) and argon plasma coagulation (two patients). Follow-up evaluation at 3-4 months interval included HRCT scans, both conventional and AFB, including biopsies and brush cytology for histological evaluation. The average follow-up period was 5 years (range: 2-10 years). In three patients local recurrence was again successfully treated with electrocautery. Sixteen patients died during follow-up. Eight of the nine patients who died due to lung cancer had a previous resection of a more advanced stage lung cancer up to 5 years before BT of the ROLC. The remaining seven patients cause of death was not related to lung cancer. Sixteen patients are still alive without any tumor recurrence. These data showed that BT is an effective treatment modality for high-risk patients with ROLC, who are not eligible for surgical resection.
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Affiliation(s)
- Anton Vonk-Noordegraaf
- Department of Pulmonary Medicine, Vrije Universiteit Medical Center, P O Box 7057, 1007 MB, Amsterdam, The Netherlands
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van Rens MT, Schramel FM, Elbers JR, Lammers JW. The clinical value of lung imaging fluorescence endoscopy for detecting synchronous lung cancer. Lung Cancer 2001; 32:13-8. [PMID: 11282424 DOI: 10.1016/s0169-5002(00)00201-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Some patients with non-small cell lung cancer (NSCLC) will also have a synchronous malignant lesion. The lung imaging fluorescence endoscopy (LIFE) has proven better than conventional white light bronchoscopy (WLB) for visualizing premalignant lesions or early stages of lung cancer. In this study, the additional value of LIFE in diagnosing synchronous lung cancers as well as the impact of these findings on definite therapy was analyzed. Seventy-two patients with recently diagnosed NSCLC or pulmonary lesions highly suspect of lung cancer were studied. Patients underwent WLB, followed by LIFE. Apart from the primary lesions, additional abnormal and suspicious lesions seen at WLB and LIFE were scored separately and biopsied. Sixty-nine patients had NSCLC and three patients had small cell lung carcinoma. Apart from the primary lesion, one up to six additional endobronchial lesions were visualized in 48 patients by WLB and/or LIFE. High-grade dysplastic lesions were detected in ten patients, three of whom were eligible for surgery of the primary tumor after completion of the investigations. Three other patients (4.3%) had synchronous cancers (NSCLC). In one patient, the lesion was visualized by LIFE and by WLB. The other two malignant lesions were detected only by LIFE. In these three latter patients, diagnostic work-up and definite treatment was changed, as a result of detection of synchronous lesions. In conclusion, LIFE has additional value in detecting synchronous malignant lesions in patients with primary lung cancer. The detection of these lesions changed diagnostic work-up and definite treatment plan. Therefore, LIFE should be used in the work-up of patients with primary lung cancer.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Bronchoscopy/methods
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/therapy
- Female
- Fluorescence
- Humans
- Light
- Lung Neoplasms/diagnosis
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Sensitivity and Specificity
- Treatment Outcome
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Affiliation(s)
- M T van Rens
- Department of Pulmonary Diseases, Sint Antonius Hospital, EM, Nieuwegein, The Netherlands.
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Weigel TL, Kosco PJ, Dacic S, Rusch VW, Ginsberg RJ, Luketich JD. Postoperative fluorescence bronchoscopic surveillance in non-small cell lung cancer patients. Ann Thorac Surg 2001; 71:967-70. [PMID: 11269482 DOI: 10.1016/s0003-4975(00)02523-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Second lung primaries occur at a rate of 1% to 3% per patient-year after complete resections for non-small cell lung carcinoma (NSCLC). Fluorescence bronchoscopy appears to be a sensitive tool for surveillance of the tracheobronchial tree for early neoplasias. METHODS Patients who were disease-free after complete resection of a NSCLC were entered into a fluorescence bronchoscopy surveillance program. All suspicious lesions were biopsied along with two areas of normal mucosa to serve as negative controls. RESULTS A total of 73 fluorescence bronchoscopies were performed after conventional bronchoscopy in 51 patients at a median of 13 months postresection. The majority (46 of 51) of patients had stage I or II NSCLC, whereas 10% (5 of 51) had stage IIIA. Three intraepithelial neoplasias and one invasive carcinoma were identified in 3 of 51 patients (6%), all current or former smokers. Of the four lesions identified, three were in the 20 patients with prior squamous cell carcinomas. No intraepithelial neoplasias were identified by white-light bronchoscopy, whereas two of three were detected by fluorescence examination. The one invasive cancer detected was apparent on both white-light and fluorescence bronchoscopic examinations. CONCLUSIONS Surveillance with fluorescence bronchoscopy identified lesions in 6% of postoperative NSCLC patients thought to be disease-free. Patients with prior squamous cell carcinomas appear to be a population that may warrant future prospective study of postoperative fluorescence bronchoscopic surveillance.
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Affiliation(s)
- T L Weigel
- Thoracic Surgery Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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