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Mai S, Liu H, Zeng H, Cheng Z, Huang J, Shi G, Li Y, Wu Z. Diagnostic challenge and survival analysis of pulmonary oligometastases and primary lung cancer in breast cancer patients. Thorac Cancer 2024; 15:1017-1028. [PMID: 38494913 PMCID: PMC11045338 DOI: 10.1111/1759-7714.15285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The aim of this study was to compare breast cancer patients with pulmonary oligometastases (POM) and primary lung cancer (PLC) and to assess whether there were differences in clinical features, CT features, and survival outcomes between the two groups. METHODS From January 2010 to December 2021, the clinical records of 437 with malignant pulmonary nodules who had breast cancer patients were reviewed. POM was identified in 45 patients and PLC in 43 patients after the initial detection of pulmonary nodules. The clinicopathological characteristics, CT appearance of pulmonary nodules, and survival of the two groups were compared. RESULTS Stage II to IV breast tumors (p < 0.001), high pathological grade of breast cancer (p = 0.001), low proportion of luminal-type breast cancer (p = 0.003), and the higher serum CYFRA 21-1 level (p = 0.046) were the clinical characteristics of pulmonary nodules suggestive of POM rather than PLC. The CT features of lung nodules indicative of PLC rather than POM were the subsolid component (p < 0.001), lobulation (p = 0.010), air bronchogram (p < 0.001) and pleural indentation (p = 0.004). Ten-year survival rate for PLC was 93.2%, which was higher compared with 57.8% in those with POM (p = 0.001). CONCLUSIONS Elevated serum CYFRA 21-1 levels and late-stage breast cancer may be beneficial for the diagnosis of POM. CT imaging appearances of the subsolid component, lobulation, air bronchogram, and pleural indentation increase the likelihood of PLC. Breast cancer patients with PLC presented better survival with attentive monitoring than those with POM.
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Affiliation(s)
- Siyao Mai
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Haiqing Liu
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Hong Zeng
- Department of Pathology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Ziliang Cheng
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Jingwen Huang
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Guangzi Shi
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Yong Li
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
| | - Zhuo Wu
- Department of Radiology, Sun Yat‐Sen Memorial HospitalSun Yat‐Sen UniversityGuangzhouChina
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2
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Kanzaki R, Nagoya A, Taniguchi S, Ishida H, Kimura K, Fukui E, Kimura T, Kanou T, Ose N, Funaki S, Minami M, Morii E, Shintani Y. Surgery for pulmonary lesions in patients with a history of urinary tract transitional cell carcinoma. J Cardiothorac Surg 2024; 19:117. [PMID: 38475921 DOI: 10.1186/s13019-024-02607-z] [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: 07/12/2022] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND There has been little information on the actual diagnosis of pulmonary lesions in patients with a history of urinary tract transitional cell carcinoma (TCC) and short- and long- outcomes of pulmonary resection for these patients. METHODS In the present study, the data of 37 consecutive patients with a history of TCC who underwent pulmonary resection for solitary pulmonary lesions were reviewed, and the clinical factors and short- and long-term outcomes were analyzed. RESULTS The study population included 35 male patients, and 2 female patients. The mean age was 72.5 years. Twenty patients (80%) were smokers and showed a high incidence of chronic obstructive pulmonary disease. Pulmonary lesions and primary TCC were detected simultaneously in 5 patients and metachronously in 32 patients. The median interval between treatment for primary TCC and the detection of pulmonary lesion was 43 months. The mean tumor diameter was 23 mm. The types of resection included lobectomy (n = 19), segmentectomy (n = 8), and partial resection (n = 10). Twelve of 37 patients (32%) developed postoperative complications. The pathological diagnoses included primary lung cancer (n = 28), pulmonary metastasis from TCC (n = 7), and others (n = 2). The 5-year overall survival rate for all patients was 72%. The 5-year overall survival rate of patients with primary lung cancer was 74%, while that of patients with pulmonary metastasis from TCC was 57%. CONCLUSIONS Surgery can be proactively considered for treating pulmonary lesions in patients with a previous history of TCC, as it provides favorable long-term outcomes.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan.
| | - Akihiro Nagoya
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Seiji Taniguchi
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Hiroto Ishida
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Kenji Kimura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Toru Kimura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, L5-2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan
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3
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A Predictive Model to Differentiate Between Second Primary Lung Cancers and Pulmonary Metastasis. Acad Radiol 2022; 29 Suppl 2:S137-S144. [PMID: 34175210 DOI: 10.1016/j.acra.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a nomogram for differentiating second primary lung cancers (SPLCs) from pulmonary metastases (PMs). MATERIALS AND METHODS A total of 261 lesions from 253 eligible patients were included in this study. Among them, 195 lesions (87 SPLCs and 108 PMs) were used in the training cohort to establish the diagnostic model. Twenty-one clinical or imaging features were used to derive the model. Sixty-six lesions (32 SPLCs and 34 PMs) were included in the validation set. RESULTS After analysis, age, lesion distribution, type of lesion, air bronchogram, contour, spiculation, and vessel convergence sign were considered to be significant variables for distinguishing SPLCs from PMs. Subsequently, these variables were selected to establish a nomogram. The model showed good distinction in the training set (area under the curve = 0.97) and the validation set (area under the curve = 0.92). CONCLUSION This study found that the nomogram calculated from clinical and radiological characteristics could accurately classify SPLCs and PMs.
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4
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Kanzaki R, Fukui E, Kanou T, Ose N, Funaki S, Minami M, Shintani Y, Okumura M. Preoperative evaluation and indications for pulmonary metastasectomy. J Thorac Dis 2021; 13:2590-2602. [PMID: 34012607 PMCID: PMC8107542 DOI: 10.21037/jtd-19-3791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary metastasectomy (PM) is an established treatment that can provide improved long-term survival for patients with metastatic tumor(s) in the lung. In the current era, where treatment options other than PM such as stereotactic body radiation therapy (SBRT), immunotherapy, and molecular-targeted therapy are available, thoracic surgeons should review the approach to the preoperative evaluation and the indications. Preoperative evaluation consists of history and physical examinations, physiological tests, and radiological examinations. Radiological examinations serve to identify the differential diagnosis of the pulmonary nodules, evaluate their precise number, location, and features, and search for extra thoracic metastases. The indication of PM should be considered from both physiological and oncological points of view. The general criteria for PM are as follows; (I) the patient has a good general condition, (II) the primary malignancy is controlled, (III) there is no other extrapulmonary metastases, and (IV) the pulmonary lesion(s) are thought to be completely resectable. In addition to the general eligibility criteria of PM, prognostic factors of each tumor type should be considered when deciding the indication for PM. When patients have multiple poor prognostic factors and/or a short disease-free interval (DFI), thoracic surgeons should not hesitate to observe the patient for a certain period before deciding on the indication for PM. A multidisciplinary discussion is needed in order to decide the indication for PM.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Japan
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5
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Nicolini A, Ferrari P, Morganti R, Carpi A. Treatment of Metastatic or High-Risk Solid Cancer Patients by Targeting the Immune System and/or Tumor Burden: Six Cases Reports. Int J Mol Sci 2019; 20:ijms20235986. [PMID: 31795079 PMCID: PMC6929121 DOI: 10.3390/ijms20235986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 12/30/2022] Open
Abstract
This article summarizes the histories of six patients with different solid tumors treated with a new strategy based on tumor burden reduction and immune evasion as potential targets. All six patients were at a high risk of relapse and were likely to have a minimal residual disease following conventional therapy: biochemical recurrence (BCR) following radical prostatectomy (RP) (two prostate cancers patients), removal of distant metastases (one colorectal and one breast cancer), and complete response (CR) of distant metastases to conventional therapy (one breast cancer and one esophageal–gastric junction cancer). Four of the patients, two after RP and BCR, one after removal of a single pulmonary metastasis from breast cancer, and one after CR to chemotherapy of peritoneal metastases and ascites from an esophageal–gastric junction primary cancer, regularly received cycles of a new drug schedule with the aim of inhibiting immune suppression (IT). In these four patients, preliminary laboratory tests of peripheral blood suggested an interleukin (IL)-2/IL-12 mediated stimulation of cellular immune response with a concomitant decrease in vascular endothelial growth factor (VEGF) immune suppression. The fifth case was a breast cancer patient with distant metastases in CR, while receiving beta-interferon and interleukin-2 in addition to conventional hormone therapy. To date, all five patients are alive and doing well and they have been unexpectedly disease-free for 201 and 78 months following BCR, 28 months following the removal of a single pulmonary metastases, 32 months following CR to chemotherapy of peritoneal metastases and ascites, and 140 months following diagnosis of multiple bone metastases, respectively. The sixth patient, who had colorectal cancer and multiple synchronous liver metastases and underwent nine surgical interventions for metastatic disease, although not disease-free, is doing well 98 months after primary surgery. Our six cases reports can be interpreted with the hypothesis that immune manipulation and/or a concomitant low tumor burden favored their clinical outcome.
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Affiliation(s)
- Andrea Nicolini
- Department of Oncology, Transplantation and New technologies in Medicine, University of Pisa, 56100 Pisa, Italy;
- Correspondence:
| | - Paola Ferrari
- Department of Oncology, Transplantation and New technologies in Medicine, University of Pisa, 56100 Pisa, Italy;
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56100 Pisa, Italy;
| | - Angelo Carpi
- Department of Clinical and Experimental Medicine, University of Pisa, 56100 Pisa, Italy;
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6
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Thill M, Jackisch C, Janni W, Müller V, Albert US, Bauerfeind I, Blohmer J, Budach W, Dall P, Diel I, Fasching PA, Fehm T, Friedrich M, Gerber B, Hanf V, Harbeck N, Huober J, Kolberg-Liedtke C, Kreipe HH, Krug D, Kühn T, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, Möbus V, Müller-Schimpfle M, Mundhenke C, Nitz U, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solbach C, Solomayer EF, Stickeler E, Thomssen C, Untch M, Wenz F, Witzel I, Wöckel A, Ditsch N. AGO Recommendations for the Diagnosis and Treatment of Patients with Locally Advanced and Metastatic Breast Cancer: Update 2019. Breast Care (Basel) 2019; 14:247-255. [PMID: 31558898 DOI: 10.1159/000500999] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022] Open
Abstract
Every year the Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO), a group of gynecological oncologists specialized in breast cancer and interdisciplinary members specialized in pathology, radiologic diagnostics, medical oncology, and radiation oncology, prepares and updates evidence-based recommendations for the diagnosis and treatment of patients with early and metastatic breast cancer. Every update is performed according to a documented rule-fixed algorithm, by thoroughly reviewing and scoring the recent publications for their scientific validity and clinical relevance. This current publication presents the 2019 update on the recommendations for metastatic breast cancer.
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Affiliation(s)
- Marc Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
| | - Christian Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Offenbach, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Volkmar Müller
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ute-Susann Albert
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Kassel, Germany
| | | | - Jens Blohmer
- Klinik für Gynäkologie mit Brustzentrum der Charité, Berlin, Germany
| | - Wilfried Budach
- Strahlentherapie, Radiologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Peter Dall
- Frauenklinik Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Michael Friedrich
- Klinik für Frauenheilkunde und Geburtshilfe Helios Klinikum Krefeld, Krefeld, Germany
| | - Bernd Gerber
- Universitätsfrauenklinik am Klinikum Südstadt, Rostock, Germany
| | - Volker Hanf
- Frauenklinik Nathanstift, Klinikum Fürth, Fürth, Germany
| | - Nadia Harbeck
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - David Krug
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
| | - Sherko Kümmel
- Klinik für Senologie, Kliniken Essen Mitte, Essen, Germany
| | - Sibylle Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - Diana Lüftner
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Berlin, Germany
| | - Michael Patrick Lux
- Klinik für Gynäkologie und Geburtshilfe, St. Vinzenz-Krankenhaus GmbH Paderborn, Paderborn, Germany
| | - Nicolai Maass
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Volker Möbus
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt Höchst GmbH, Frankfurt/Main, Germany
| | - Markus Müller-Schimpfle
- Klinik für Radiologie, Neuroradiologie und Nuklearmedizin, Klinikum Frankfurt Höchst GmbH, Frankfurt/Main, Germany
| | - Christoph Mundhenke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ulrike Nitz
- Senologie, Evangelisches Krankenhaus Bethesda, Mönchengladbach, Germany
| | - Kerstin Rhiem
- Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum Köln, Köln, Germany
| | - Achim Rody
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marcus Schmidt
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Schneeweiss
- Gynäkologische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Florian Schütz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Hans-Peter Sinn
- Sektion Gynäkopathologie, Pathologisches Institut, Heidelberg, Germany
| | - Christine Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - Erich-Franz Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Elmar Stickeler
- Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany
| | - Christoph Thomssen
- Universitätsfrauenklinik, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Germany
| | | | - Frederik Wenz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Isabell Witzel
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Achim Wöckel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Nina Ditsch
- Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany
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Zhu L, Bian H, Yang L, Liu J, Chen W, Li X, Wang J, Song X, Dai D, Ye Z, Xu W, Yu X. 18 Fluorodeoxyglucose-positron emission tomography/computed tomography features of suspected solitary pulmonary lesions in breast cancer patients following previous curative treatment. Thorac Cancer 2019; 10:1086-1095. [PMID: 30900387 PMCID: PMC6500976 DOI: 10.1111/1759-7714.13049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 12/21/2022] Open
Abstract
Background Differentiating pulmonary metastasis from primary lung cancer can be challenging in patients with breast malignancy. This study aimed to characterize the imaging features of 18fluorodeoxyglucose‐positron emission tomography/computed tomography (18F‐FDG‐PET/CT) for distinguishing between these diseases. Methods We enrolled 52 patients who received curative treatment for breast cancer but later presented with suspected solitary pulmonary lesions (SPLs) and subsequently underwent 18F‐FDG‐PET/CT to investigate. Results Subsolid lesions, ill‐defined borders, lung lesions with negative maximum standardized uptake value, and lesions without 18F‐FDG‐PET/CT‐diagnosed hilar and/or mediastinal lymph nodes and pleural metastases were more likely to be associated with primary lung cancer. Conclusions CT border, FDG uptake, hilar and/or mediastinal lymph node metastasis, and pleural metastasis are potential markers for diagnosis.
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Affiliation(s)
- Lei Zhu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haiman Bian
- Department of Radiology, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Department of Radiology, Tianjin 4th Centre Hospital, Tianjin, China
| | - Lieming Yang
- Department of Cardiovascular Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jianjing Liu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wei Chen
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaofeng Li
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jian Wang
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiuyu Song
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Dong Dai
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhaoxiang Ye
- Department of Radiology, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wengui Xu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiaozhou Yu
- Department of Molecular Imaging and Nuclear Medicine, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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8
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Almousa O, Mayo J, English J, Finley R. Microcoil-Guided Video-Assisted Thoracoscopic Excision of Nodules Suspicious for Metastasis in Patients With Extra-Thoracic Malignancies. Semin Thorac Cardiovasc Surg 2018; 31:129-134. [PMID: 30227216 DOI: 10.1053/j.semtcvs.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/07/2018] [Indexed: 12/25/2022]
Abstract
The purpose of this study is to determine the utility of preoperative CT-guided microcoil localization followed by fluoroscopy guided video-assisted thoracoscopic resection in the diagnosis and management of small peripheral pulmonary nodules in patients with extra-thoracic malignancies. This study is a retrospective analysis of prospectively collected data between August 2003 and September 2013. Fifty patients with extra-thoracic malignancies underwent preoperative localization of small indeterminate pulmonary nodules using CT-guided microcoil localization. Nodules were then resected by video-assisted thoracoscopic resection wedge excision and intraoperative fluoroscopy guidance. Univariate and multivariate logistic regression analysis were conducted. Fifty patients with a history of 14 different extra-thoracic cancers (57% female, mean age 62 years) had 55 nodules resected (mean size = 12 mm, depth from visceral pleura = 22 mm). Histology of resected nodules showed metastasis (25 of 50 patients), benign (10 of 50), and (15 of 50) early stage primary lung cancer. Smokers were found 6 times more likely to present with primary lung cancer than metastasis (P < 0.009). CT-guided microcoil localization procedure was successful in all patients with a mean time of 31(10) minutes and allowed successful wedge resection in all cases with no major complications. The mean operative time and fluoroscopy time were 27(12) minutes and 3(5) minutes, respectively. Microcoil-guided thoracoscopic wedge resection was effective in achieving early definitive diagnosis and changed management in 50% of patients with presumed metastasis with minimal morbidity.
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Affiliation(s)
- Omamah Almousa
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - John Mayo
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John English
- Department of Anatomical Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Finley
- Division of Thoracic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Ohtaki Y, Shimizu K, Nagashima T, Nakazawa S, Obayashi K, Azuma Y, Iijima M, Kosaka T, Yajima T, Ogawa H, Tsutsumi S, Arai M, Mogi A, Kuwano H. Clinical and Radiological Discrimination of Solitary Pulmonary Lesions in Colorectal Cancer Patients. World J Surg 2018; 42:1161-1170. [PMID: 28983707 DOI: 10.1007/s00268-017-4243-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The lung is one of the most common organs of metastasis from colorectal cancer (CRC), and we have encountered lung cancer patients with a history of CRC. There have been few studies regarding methods used to discriminate between primary lung cancer (PLC) and pulmonary metastasis from CRC (PM-CRC) based only on preoperative findings. We retrospectively investigated predictive factors discriminating between these lesions in patients with a history of CRC. METHODS Between 2006 and 2015, 117 patients with a history of CRC (44 patients with 47 PLC and 73 patients with 102 PM-CRC) underwent subsequent or concurrent resection of pulmonary lesions. We compared the clinical and radiological characteristics of 100 patients with solitary lesions (43 PLC and 57 PM-CRC). Using univariate and multivariate analyses, we examined predictive factors for discrimination of these two lesions. RESULTS All tumors with findings of ground-glass opacity (GGO) were PLC (n = 19). In a multivariate analysis of 81 radiologically solid tumors, two factors were found to be significant independent predictors of PLC: a history of stage I CRC and presence of pleural indentation. All tumors in 26 patients with either GGO or both a stage I CRC history and pleural indentation were PLC, while most tumors in patients without all three factors were PM-CRC (43/44; 97.7%). CONCLUSIONS The presence or absence of GGO, pathological CRC stage, and pleural indentation could be useful factors to distinguish between PLC and PM-CRC.
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Affiliation(s)
- Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan.
| | - Toshiteru Nagashima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Kai Obayashi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Yoko Azuma
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Misaki Iijima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Takayuki Kosaka
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Toshiki Yajima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hiroomi Ogawa
- Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Soichi Tsutsumi
- Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Motohiro Arai
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Hiroyuki Kuwano
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan.,Division of Digestive Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
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10
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Hakima L, Schlesinger K, Sunkara J, Karabakhtsian RG. Differential expression of various clones of estrogen receptor in cell block preparation of lung adenocarcinoma. Diagn Cytopathol 2018; 46:390-394. [PMID: 29465823 DOI: 10.1002/dc.23910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Women treated for breast cancer are at increased risk of developing pulmonary nodules which could represent new primary lung carcinomas or metastatic breast carcinoma. The FNA biopsy is frequently the first diagnostic choice in determining the primary site of the tumor. Estrogen receptor (ER) positivity in diagnostic tissue is generally used to favor breast over lung primary. However, the recent studies have shown a wide range of ER antibody cross reactivity with lung adenocarcinoma. We studied the frequency of ER expression in cytology samples of lung adenocarcinoma using antibodies to three different ER clones. METHODS Cytology cell block preparations, including 22 lung FNAs and 19 malignant pleural effusions (PE) from 41 patients, with clinically documented primary lung adenocarcinomas were selected for this study. All cases were stained with monoclonal antibodies to ER clones 6F11 and 1D5. Twenty nine cases with remaining available material (15 FNA and 14 PE) were stained with a third antibody to ER clone SP1. The extent of ER nuclear staining was scored as 3+ (50%-100% of tumor cells), 2+ (11%-49%), and 1+ (≤10%). RESULTS Positivity for ER-6F11 clone was present in 4 of 22 lung FNAs (18.2%, 2+ staining). Two of the four 6F11 positive FNAs also co-expressed ER-1D5 (9.1%, 2+ staining). No immunoreactivity was observed for ER clones 6F11 and 1D5 in all 19 malignant PEs. In addition, none of the remaining 15 FNAs and 14 PEs showed immunoreactivity for ER-SP1 clone. CONCLUSIONS A small subset of pulmonary adenocarcinomas shows immunoreactivity for ER clones 6F11 and 1D5 in FNA samples (18.2% and 9.1%, respectively). The absence of immunoreactivity for ER-SP1 clone indicates higher specificity of this clone in non-breast tissue. The differential diagnostic value of all ER clones in malignant PEs appears to be secure. Larger studies are necessary to validate this observation.
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Affiliation(s)
- Laleh Hakima
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Kathie Schlesinger
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jaya Sunkara
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Rouzan G Karabakhtsian
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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11
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Erkmen CP, Kaiser LR, Ehret AL. Lung cancer screening: Should we be excluding people with previous malignancy? World J Respirol 2016; 6:1-13. [DOI: 10.5320/wjr.v6.i1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
The National Lung Screening Trial (NLST) was a large, randomized, controlled study showing a 20% reduction of lung cancer mortality and 7% reduction of all cause mortality using annual low dose computed tomography (LDCT) in a high risk population. NLST excluded people with a previous history of cancer treatment within the past 5 years and all people with a history lung cancer. The aim of this work is to review how lung cancer screening trials addressed the confounding effect of previous malignancy. We also review the subsequent recommendations by the United States Preventative Task Force Services, multiple professional societies and the Center for Medicaid and Medicare Services which defer either to NLST criteria or, clinician judgment or refrain from asserting any recommendation on the topic, respectively. Implications of lung cancer screening in the setting of previous malignancies, specifically lung, head and neck, esophageal, gastric, breast, colorectal cancer and lymphoma are also discussed. With lung cancer screening, an antecedent malignancy introduces the possibility of discovering metastasis as well as lung cancer. In some circumstances diagnosis and treatment of oligometastatic disease may confer a survival benefit. The survival benefit of treating either lung cancer or oligometastatic disease as result of lung cancer screening has yet to be determined. Further studies are needed to determine the role of lung cancer screening in the setting of previous malignancy.
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12
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Michaels AY, Keraliya AR, Tirumani SH, Shinagare AB, Ramaiya NH. Systemic treatment in breast cancer: a primer for radiologists. Insights Imaging 2015; 7:131-44. [PMID: 26567115 PMCID: PMC4729711 DOI: 10.1007/s13244-015-0447-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/24/2015] [Accepted: 10/21/2015] [Indexed: 12/22/2022] Open
Abstract
Abstract Cytotoxic chemotherapy, hormonal therapy and molecular targeted therapy are the three major classes of drugs used to treat breast cancer. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), 18F-FDG positron emission tomography (PET)/CT and bone scintigraphy each have a distinct role in monitoring response and detecting drug toxicities associated with these treatments. The purpose of this article is to elucidate the various systemic therapies used in breast cancer, with an emphasis on the role of imaging in assessing treatment response and detecting treatment-related toxicities. Teaching Points • Cytotoxic chemotherapy is often used in combination with HER2-targeted and endocrine therapies. • Endocrine and HER2-targeted therapies are recommended in hormone-receptor- and HER2-positive cases. • CT is the workhorse for assessment of treatment response in breast cancer metastases. • Alternate treatment response criteria can help in interpreting pseudoprogression in metastasis. • Unique toxicities are associated with cytotoxic chemotherapy and with endocrine and HER2-targeted therapies.
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Affiliation(s)
- Aya Y Michaels
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Abhishek R Keraliya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nikhil H Ramaiya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
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