Multivariate Analysis Of The Diagnostic Yield Of Conventional Bronchoscopy In Peripheral Lung Adenocarcinoma

Tract creation with a 25-gauge needle for convex endobronchial ultrasound-guided core biopsy in intrapulmonary lesions adjacent to bronchi: three case reports

Background

The use of endobronchial ultrasound-guided core biopsy (EBUS-CB) using forceps or cryoprobes to obtain true histological samples has improved the diagnostic yield for mediastinal and hilar lymphadenopathy. Tract creation in the bronchial wall of the central airway is primarily performed using electrocautery devices in EBUS-CB; however, their poor maneuverability and the risk of vascular injury and damage to the tip of the bronchoscope have prevented the application of EBUS-CB for diagnosing intrapulmonary lesions beyond the central locations. This report presents three cases wherein a 25-gauge transbronchial needle aspiration (TBNA) needle with high flexibility and safety was used to create a tract in the bronchial wall for EBUS-CB of the intrapulmonary lesions adjacent to the bronchi.

Case Description

In all cases, EBUS-TBNA using a 25-gauge TBNA needle was performed on the intrapulmonary lesions adjacent to the bronchi, followed by EBUS-CB with 1.9-mm forceps in two cases and also with a 1.1-mm cryoprobe in one case. The EBUS-TBNA specimens revealed no abnormality or only a small number of tumor cells. However, subsequent EBUS-CB, through the tract created by EBUS-TBNA, enabled the collection of a sufficient amount of histological samples with well-preserved histoarchitecture. The histological diagnosis was made via immunostaining, and multigene mutation testing was also successfully analyzed.

Conclusions

The use of a 25-gauge needle for creating a tract allows EBUS-CB for the intrapulmonary lesions and may allow for the collection of sufficient histological samples for biomarker analysis and tissue diagnosis.

CT-Based Radiomic Nomogram for the Prediction of Chronic Obstructive Pulmonary Disease in Patients with Lung cancer

RATIONALE AND OBJECTIVES

To develop and validate a model for predicting chronic obstructive pulmonary disease (COPD) in patients with lung cancer based on computed tomography (CT) radiomic signatures and clinical and imaging features.

MATERIALS AND METHODS

We retrospectively enrolled 443 patients with lung cancer who underwent pulmonary function test as the primary cohort. They were randomly assigned to the training (n = 311) or validation (n = 132) set in a 7:3 ratio. Additionally, an independent external cohort of 54 patients was evaluated. The radiomic lung nodule signature was constructed using the least absolute shrinkage and selection operator algorithm, while key variables were selected using logistic regression to develop the clinical and combined models presented as a nomogram.

RESULTS

COPD was significantly related to the radiomics signature in both cohorts. Moreover, the signature served as an independent predictor of COPD in the multivariate regression analysis. For the training, internal, and external cohorts, the area under the receiver operating characteristic curve (ROC, AUC) values of our radiomics signature for COPD prediction were 0.85, 0.85, and 0.76, respectively. Additionally, the AUC values of the radiomic nomogram for COPD prediction were 0.927, 0.879, and 0.762 for the three cohorts, respectively, which outperformed the other two models.

CONCLUSION

The present study presents a nomogram that incorporates radiomics signatures and clinical and radiological features, which could be used to predict the risk of COPD in patients with lung cancer with one-stop chest CT scanning.

Long non-coding RNA 00960 promoted the aggressiveness of lung adenocarcinoma via the miR-124a/SphK1 axis

Long non-coding RNAs (lncRNAs) are closely associated with the development of lung adenocarcinoma (LADC). The present study focused on the role of LINC00960 in LADC. miRNA and mRNA expression levels were detected using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Cellular functions were evaluated by MTT, colony formation, and Transwell assays, respectively. LINC00960 Luciferase and RNA pull-down assays were performed to clarify the interaction between miR-124a and LINC00960 or Recombinant Sphingosine Kinase 1 (SphK1). We observed that LINC00960 was overexpressed in LADC tumor tissues and cell lines. LINC00960 knockdown suppressed the proliferation, migration, and invasion of LADC cells. Moreover, LINC00960 sponged miR-124a to inhibit the SphK1/S1P pathway in LADC cells. LINC00960 knockdown markedly reduced the rate of tumor growth. The luciferase reporter assay results demonstrated an interaction between miR-124a and LINC00960 or SphK1. This interaction was confirmed using the RNA pull-down assay. In addition, miR-124a downregulation or SphK1 upregulation reversed the inhibitory effects of LINC00960 knockdown on cellular functions of LADC cells, suggesting that LINC00960 may be a potential therapeutic biomarker for LADC via the miR-124a/SphK1 axis. Accordingly, LINC00960 may be a potential therapeutic biomarker for LADC.

Factors associated with lymph node metastasis upstage after resection for patients with micropapillary lung adenocarcinoma

Background

Micropapillary adenocarcinoma has a poor prognostic histological pattern. Additionally, preoperative detection of lymph node metastases by preoperative examination is difficult in some patients with micropapillary adenocarcinoma, and postoperative upstage may occur. However, clinicopathological features of patients with micropapillary adenocarcinoma with nodal upstage have not been established, therefore this study aimed to identify the factors associated with potential lymph node metastases during preoperative examination to ensure effective surgical procedures.

Methods

Between January 2011 and December 2020, 1029 patients received complete resection for primary non‐small‐cell lung cancer by lobectomy or more extensive resection with systematic lymph node dissection at this institution. One hundred and thirty‐one patients diagnosed with adenocarcinoma with micropapillary component were included in this study. The clinicopathological features of patients with nodal upstage whose postoperative N stage was more advanced than the preoperative N stage were examined.

Results

Forty patients had nodal upstage after resection. ¹⁸F‐fluorodeoxyglucose (FDG) positron emission tomography‐computed tomography (PET‐CT) revealed that a maximum standardized uptake value (SUVmax) ≥5 for the primary lesion was significantly associated with postoperative nodal upstage. There were no significant differences in terms of sex, age, smoking history, surgical procedure, and diabetes. Among 38 patients with nodal upstage, 23 patients had no significant preoperative lymphadenopathy and showed no abnormal FDG uptake in the lymph nodes on ¹⁸F‐FDG‐PET‐CT, respectively.

Conclusions

Lymph node metastases were suspected in patients preoperatively diagnosed with micropapillary adenocarcinoma with FDG SUVmax ≥5 for the primary tumor. Therefore, standard surgical resection and careful lymph node dissection should be performed for such patients.