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Lachkar S, Guisier F, Dantoing E, Thiberville L, Salaün M. [The role of endoscopy in the management of peripheral pulmonary nodules, part 2: Treatment]. Rev Mal Respir 2024:S0761-8425(24)00172-4. [PMID: 38580585 DOI: 10.1016/j.rmr.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/26/2024] [Indexed: 04/07/2024]
Abstract
The management of peripheral lung nodules is challenging, requiring specialized skills and sophisticated technologies. The diagnosis now appears accessible to advanced endoscopy (see Part 1), which can also guide treatment of these nodules; this second part provides an overview of endoscopy techniques that can enhance surgical treatment through preoperative marking, and stereotactic radiotherapy treatment through fiduciary marker placement. Finally, we will discuss how, in the near future, these advanced endoscopic techniques will help to implement ablation strategy.
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Affiliation(s)
- S Lachkar
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France.
| | - F Guisier
- Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, 76000 Rouen, France
| | - E Dantoing
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France
| | - L Thiberville
- Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, 76000 Rouen, France
| | - M Salaün
- Department of Pneumology and Inserm CIC-CRB 1404, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, 76000 Rouen, France
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Parrot A, Canellas A, Barral M, Gibelin A, Cadranel J. [Severe hemoptysis in the onco-hematology patient]. Rev Mal Respir 2024; 41:303-316. [PMID: 38155073 DOI: 10.1016/j.rmr.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.
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Affiliation(s)
- A Parrot
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France.
| | - A Canellas
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - M Barral
- Service de radiologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| | - A Gibelin
- Service de médecine intensive et réanimation, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - J Cadranel
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
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Senot N, Pouchot J. [A swollen thumb]. Rev Med Interne 2024; 45:114-115. [PMID: 37634973 DOI: 10.1016/j.revmed.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Affiliation(s)
- N Senot
- Service de médecine interne, université Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - J Pouchot
- Service de médecine interne, université Paris-Cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Lachkar S, Guisier F, Thiberville L, Dantoing E, Salaün M. [Advanced bronchoscopic techniques for the diagnosis of peripheral lung nodule]. Rev Mal Respir 2023; 40:810-819. [PMID: 37798173 DOI: 10.1016/j.rmr.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/25/2023] [Indexed: 10/07/2023]
Abstract
The endoscopic diagnosis of peripheral lung nodules is a challenging aspect of oncological practice. More often than not inaccessible by traditional endoscopy, these nodules necessitate multiple imagery tests, as well as diagnostic surgery for benign lesions. Even though transthoracic ultrasonography has a high diagnostic yield, a sizeable complication rate renders it suboptimal. Over recent years, a number of safe and accurate navigational bronchoscopic procedures have been developed. In this first part, we provide an overview of the bronchoscopic techniques currently applied for the excision and diagnostic analysis of peripheral lung nodules; emphasis is laid on electromagnetic navigation bronchoscopy and the association of virtual bronchoscopy planner with radial endobronchial ultrasound. We conclude by considering recent innovations, notably robotic bronchoscopy.
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Affiliation(s)
- S Lachkar
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France.
| | - F Guisier
- Department of Pneumology, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, Inserm CIC-CRB 1404, 76000 Rouen, France
| | - L Thiberville
- Department of Pneumology, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, Inserm CIC-CRB 1404, 76000 Rouen, France
| | - E Dantoing
- Department of Pneumology, CHU de Rouen, 76000 Rouen, France
| | - M Salaün
- Department of Pneumology, UNIROUEN, LITIS Lab QuantIF team EA4108, CHU de Rouen, Normandie University, Inserm CIC-CRB 1404, 76000 Rouen, France
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Bessy C, Blin T, Pichon E, Marchand-Adam S, Carmier D. [Sotorasib treatment in KRAS G12C-mutated non-small cell lung cancer: Experience in the Tours university hospital]. Rev Mal Respir 2023; 40:17-23. [PMID: 36566134 DOI: 10.1016/j.rmr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022]
Abstract
Following the CodeBreak 100 study, since 2021 sotorasib has been available in France, with authorization for early access in treatment of non-small cell lung cancer with a KRAS G12C mutation. Our retrospective observational study was designed to determine the efficacy and safety of sotorasib under real-life conditions in patients treated at the Tours CHRU. Our study of 15 patients showed sotorasib to be effective in 47% of cases, with overall survival of 4 months and median progression-free survival of 5.5 months for responders. Tumor control was achieved in 7/8 (87%) of patients with PS of 0 or 1 and in 1/7 (14%) of patients with a PS of 2 or greater. Grade 3 acute hepatitis occurred in 3/15 patients (20%). While sotorasib is an interesting therapeutic option, with efficacy that seems better in patients in good general condition, it entails a possible risk of drug-induced hepatitis, which remains to be specified in dedicated studies.
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Nigen B, Chéné AL, Liberge R, Sagan C, Blanc FX. [Immune-related pneumonitis: A differential diagnosis of SARS-CoV-2 pneumonia]. Rev Mal Respir 2022:S0761-8425(22)00258-3. [PMID: 35906150 DOI: 10.1016/j.rmr.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/04/2022] [Indexed: 12/17/2022]
Abstract
Introduction Les inhibiteurs de points de contrôle immunitaire ont révolutionné la prise en charge de nombreux cancers et ont permis d’obtenir une efficacité et une réponse durable pour certains patients. L’immunothérapie est associée à des effets secondaires en lien avec l’infiltration de cellules immunitaires dans les tissus normaux pouvant entraîner des réactions dysimmunitaires disproportionnées. Ces effets secondaires peuvent toucher n’importe quel organe, dont le poumon, pouvant parfois engager le pronostic vital. Ils peuvent ressembler à des événements de nature infectieuse, dont la COVID-19. Observations Nous rapportons le cas de 3 patients ayant présenté des toxicités pulmonaires sévères secondaires à l’immunothérapie entre mars et mai 2020 avec hypothèse initiale d’une pneumopathie à SARS-CoV-2. Après investigations approfondies, le diagnostic de toxicité pulmonaire à l’immunothérapie fut retenu, avec une évolution clinique et radiologique favorable suite à l’instauration d’une corticothérapie. Conclusion La toxicité pulmonaire secondaire à l’immunothérapie reste un effet indésirable rare, mais pouvant engager le pronostic vital. La démarche diagnostique impose d’éliminer plusieurs diagnostics différentiels. Le tableau clinique est réversible et l’évolution habituellement favorable après instauration d’une corticothérapie.
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Kirkove D, Barthelemy N, Coucke P, Mievis C, Ben Mustapha S, Jodogne S, Dardenne N, Donneau AF, Pétré B. [Feasibility study: The medical imaging as a tool for therapeutic education in radiotherapy]. Cancer Radiother 2022; 26:1034-1044. [PMID: 35843782 DOI: 10.1016/j.canrad.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/18/2022] [Accepted: 04/01/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Assess the feasibility of a randomized controlled trial (RCT) exploring the use of medical imaging as a therapeutic education (TPE) intervention in external radiation therapy. MATERIALS AND METHODS Experimental feasibility trial of "RCT" type carried out in a single-center, between November 2019 and March 2020, following adult patients treated by thoracic radiotherapy. In addition to the information usually given, the experimental group benefited from an intervention consisting in the visualization of their own medical images using the open-source software "Stone of Orthanc". RESULTS Forty-nine patients were recruited with a refusal rate of 8.16% (4/49). 20 patients were withdrawn from the study for health reasons (COVID), 10 for medical reasons. All the remaining 15 participants completed the process. Although not significant, the experimental group showed a median gain in the perception of knowledge compared to the control group (+ 1.9 (1.6 - 2.2)) vs (+ 1.4 (1.4 - 1.8)), as well as a decrease in scores related to anxiety (- 3.0 (-4.5 - (-2.0)) vs - 1.0 (-5.0 - 0.0)) and emotional distress ((- 5.0 (- 7.5 - (- 3.5)) vs (- 2.0 (- 5.0 - (- 1.0)) A significant reduction (p=0.043) is observed for the depression score ((- 2.0 (-3.0 - (-1.5)) vs (0.0 (0.0 - 0.0)). CONCLUSION This study demonstrates the feasibility of the project, with promising preliminary results. Some adaptations in order to conduct a larger-scale RCT are highlighted.
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Affiliation(s)
- D Kirkove
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique.
| | - N Barthelemy
- Service Equipe mobile de soins palliatifs, Oncologie Radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - P Coucke
- Département de Physique Médicale, Service médical de radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - C Mievis
- Service Equipe mobile de soins palliatifs, Oncologie Radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - S Ben Mustapha
- Service Equipe mobile de soins palliatifs, Oncologie Radiothérapie, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman/B35, 4000 Liège, Belgique
| | - S Jodogne
- Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain School of Engineering, 1348 Louvain-la-Neuve, Belgique
| | - N Dardenne
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique; Centre Hospitalo-Universitaire Biostatistique et méthodes de recherche (B-STAT), Faculté de Médecine, Université de Liège, B23/Avenue Hippocrate, n°13, 4000 Liège, Belgique
| | - A-F Donneau
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique; Centre Hospitalo-Universitaire Biostatistique et méthodes de recherche (B-STAT), Faculté de Médecine, Université de Liège, B23/Avenue Hippocrate, n°13, 4000 Liège, Belgique
| | - B Pétré
- Département des Sciences de la Santé Publique, Université de Liège, B23/Avenue Hippocrate, n(o) 13, 4000 Liège, Belgique
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Eber J, Nannini S, Chambrelant I, Le Fèvre C, Noël G, Antoni D. [Impact of thoracic irradiation on cardiac structures]. Cancer Radiother 2021; 26:526-536. [PMID: 34728116 DOI: 10.1016/j.canrad.2021.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 12/20/2022]
Abstract
Thoracic irradiation requires protection of the heart as an organ at risk of complications. The mean heart dose is the most studied dosimetric parameter in the literature. Recent studies question its relevance in view of the multiplicity of cardiac injuries, the heterogeneity of the cardiac dose distribution and the current technical possibilities to refine cardiac dosimetric protection. The objective of this literature review is to analyze the available scientific data on the impact of the dose received by the cardiac substructures. A search of articles using the PubMed search engine was used to select the most relevant studies. A total of 19 articles were selected according to pre-established criteria to answer the issue. Several studies found significant associations between dosimetric parameters of substructures and clinical cardiological impact. Some proposed dose constraints for substructures.
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Affiliation(s)
- J Eber
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - S Nannini
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - I Chambrelant
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - C Le Fèvre
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
| | - G Noël
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France.
| | - D Antoni
- Department of radiation oncology, institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, 67200 Strasbourg, France
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Kienlen A, Mazières J, André M, Chirpaz E, Deneche I, Huchot E. [Survival and epidemiological characteristics of women with lung cancer in Reunion]. Rev Mal Respir 2021; 38:882-93. [PMID: 34565642 DOI: 10.1016/j.rmr.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/17/2021] [Indexed: 11/20/2022]
Abstract
Lung cancer is a common disease throughout the world, representing the main cause of death from cancer. Its incidence in the female population is increasing. In metropolitan France and Reunion Island, the main risk factor remains tobacco smoking. However, environmental, genetic and hormonal factors appear to play a role in bronchial oncogenesis and the survival of affected women is better than that of men. We studied retrospectively the survival and characteristics of a cohort in Reunion Island, diagnosed with lung cancer between January 2017 and December 2018. In total, 501 patients were included over the period including 166 women. The median overall survival was 23 months in women against 11 months in men (P<0.0005). Male sex has been identified as a poor prognostic factor for overall survival (HR=1.338; 95% CI=1.007-1.778) regardless of disease stage. Women smoked less often than men 85.4% of them had adenocarcinoma, with more EGFR mutations than men, and their environmental exposures were lower. The female population of Reunion Island in our study had better overall survival than the men. Smoking status, environmental exposures, histological and molecular characteristics varied by sex.
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Ducloux R, Tavernier JY, Wojewoda P, Toullet F, Romanet S, Averous V. Corticotropic insufficiency in a monocentric prospective cohort of patients with lung cancer treated with nivolumab: Prevalence and etiology. Ann Endocrinol (Paris) 2020; 82:8-14. [PMID: 33290748 DOI: 10.1016/j.ando.2020.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/22/2020] [Accepted: 11/29/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cancer therapy has greatly progressed in the past few years, due to development of immune checkpoint proteins. These immunotherapies, when applied to eligible patients, have significantly reduced mortality but are prone to induce immune side-effects, including pituitary disorder and low adreno-corticotropic hormone (ACTH) and cortisol levels. We aimed to assess the prevalence and etiology of corticotropic insufficiency through a systematic screening of cortisol and ACTH levels in patients with lung cancer treated with nivolumab perfusion. MATERIAL AND METHODS All patients from our Center with indications for nivolumab treatment for pulmonary squamous cell carcinoma or adenocarcinoma resistant to chemotherapy were successively included and underwent cortisol and ACTH assay before each nivolumab perfusion. When cortisol was below normal without ACTH elevation, we screened for pituitary metastasis, hypophysitis or corticosteroid treatment that could explain the corticotropic insufficiency. RESULTS Data from 75 patients (80.0% men, 20.0% women) showed 10.7% asymptomatic corticotropic insufficiency, with a mean cortisol level of 2.76±1.27μg/dl. Diagnosis was made during the first 2 months of nivolumab treatment in 88% of cases. Corticosteroid treatment explained the low cortisol level in 25.0% of cases. No pituitary metastases were found. Hypophysitis was suspected in 75.0% of cases. CONCLUSION In a 75-patient cohort with non-small cell lung cancer treated with the PD1 antibody nivolumab and systematically screened for cortisol abnormalities, 10.7% of patients showed asymptomatic corticotropic insufficiency. Excluding corticotropic insufficiency secondary to corticosteroid treatment, 8.0% of patients presented cortisol level<5μg/dl attributed to hypophysitis. Cortisol screening enables hydrocortisone replacement treatment to be prescribed if necessary, preventing risk of adrenal crisis.
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Affiliation(s)
- Roxane Ducloux
- Service d'Endocrinologie-Diabétologie-Nutrition, Centre Hospitalier de Douai, Route de Cambrai, 59500 Douai, France.
| | - Jean-Yves Tavernier
- Service de Pneumologie, Centre Hospitalier de Douai, Route de Cambrai, 59500 Douai, France
| | - Perrine Wojewoda
- Service d'Endocrinologie-Diabétologie-Nutrition, Centre Hospitalier de Douai, Route de Cambrai, 59500 Douai, France
| | - Flora Toullet
- Service d'Endocrinologie-Diabétologie-Nutrition, Centre Hospitalier de Douai, Route de Cambrai, 59500 Douai, France
| | - Stéphanie Romanet
- Service de Pneumologie, Centre Hospitalier de Douai, Route de Cambrai, 59500 Douai, France
| | - Véronique Averous
- Service d'Endocrinologie-Diabétologie-Nutrition, Centre Hospitalier de Douai, Route de Cambrai, 59500 Douai, France
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Lorentz E, Despreaux T, Quignette A, Chinet T, Descatha A. [Screening of occupational exposure to asbestos and silica by job-exposure matrix among patients with lung cancer and mesothelioma]. Rev Mal Respir 2019; 36:1088-95. [PMID: 31727556 DOI: 10.1016/j.rmr.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 08/01/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In the context of underreporting of occupational diseases, the aim was to study the validity of silica and asbestos job-exposure matrices in screening occupational exposure in the field of thoracic oncology. METHODS Fifty patients hospitalized with primitive lung cancer or mesothelioma in a university hospital center in the Hauts-de-Seine department of France were included between November 2016 and September 2017. For each patient 1/the job history was collected, from which data was entered single-blindly into the job-exposure matrices by a resident in occupational medicine, 2/a questionnaire (Q-SPLF) was completed similarly, and 3/the patients also had a consultation with a chief resident in occupational medicine, considered the gold standard. The main outcome was the diagnostic performance of the matrices. The Q-SPLF diagnostic performance was also studied. RESULTS The asbestos and silica matrices had sensitivities of 100%, specificities of respectively 76.1% and 87.8%, the positive likelihood ratios were at 4.19 [2.5-6] and 8.17 [3.8-10], and the negative likelihood ratios were at 0. The Q-SPLF diagnostic performance was comparable to that of the matrices. CONCLUSIONS The matrices and the questionnaire have a great diagnostic performance which seems interesting for a use as a screening tool for occupational exposures. These results have yet to be confirmed by large-scale studies.
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Mansuet-Lupo A, Filaire M, Chaffanjon P, Alifano M, Forest F, Gibault L, Vignaud JM, Brevet M, Hofman V, Rouquette I, Antoine M, Cazes A, Damotte D, Lantuejoul S. [Guidelines for the macroscopic management of surgically resected lung carcinoma]. Ann Pathol 2019; 39:425-432. [PMID: 31604575 DOI: 10.1016/j.annpat.2019.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/30/2019] [Indexed: 12/25/2022]
Abstract
Gross examination is an essential step for pathological report of a surgical sample. It includes the description of the surgical specimen and their disease(s), the precise and exhaustive sampling of tumoral and adjacent tumoral tissue areas. This examination requires a good knowledge of the updated pTNM classification. Pathologists from the PATTERN group have collaborated with thoracic surgeons, under the auspices of the Sociéte française de pathologie, to propose guidelines for resected specimen management. This approach fits into the context of the elaboration of structured pathological report proposed by the société française de pathologie, which is necessary for a standardized management of patients.
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Affiliation(s)
- Audrey Mansuet-Lupo
- Service d'anatomie pathologique, département de pathologie, HUPC, université Paris Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du faubourg Saint-Jacques, 74014 Paris, France.
| | - Marc Filaire
- Département de chirurgie thoracique, unité de Nutrition Humaine (UNH), centre Jean-Perrin, UMR 1019 INRA-UCA, université de Clermont-Auvergne, 63011 Clermont-Ferrand, France
| | - Philippe Chaffanjon
- Département de chirurgie thoracique, CHU Grenoble-Alpes, 38700 La Tronche, France
| | - Marco Alifano
- Département de chirurgie thoracique, HUPC, université Paris Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du faubourg Saint-Jacques, 74014 Paris, France
| | - Fabien Forest
- Département de pathologie, CHU de Saint-Étienne, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Laure Gibault
- Département de pathologie, HEGP, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 75015 Paris, France
| | - Jean-Michel Vignaud
- Département de pathologie, hôpital Central, CHRU de Nancy, 54000 Nancy, France
| | - Marie Brevet
- Département de pathologie, hospices civils de Lyon, 69677 Bron, France
| | - Véronique Hofman
- Département de pathologie, laboratoire de pathologie clinique et expérimentale, hôpital Pasteur, CHU de Nice, 30, voie Romaine, 06001 Nice cedex 1, France
| | - Isabelle Rouquette
- Département de pathologie, IUCT Oncopôle, CHU de Toulouse, 31059 Toulouse, France
| | - Martine Antoine
- Département de pathologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Aurélie Cazes
- Département de pathologie, université Paris Diderot, hôpital Bichat, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - Diane Damotte
- Service d'anatomie pathologique, département de pathologie, HUPC, université Paris Descartes, hôpital Cochin, Assistance publique-Hôpitaux de Paris, 27, rue du faubourg Saint-Jacques, 74014 Paris, France
| | - Sylvie Lantuejoul
- Département de biopathologie et département de recherche translationnelle et d'innovations, centre Léon-Bérard UNICANCER, université Grenoble-Alpes, 28, rue Laennec, 69008 Lyon, France
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Giraud P, Kreps S, Tournat H, Bibault JE, Fabiano E, Feutren T, Dautruche A, Durdux C. [Stereotactic pulmonary radiotherapy: Which machine?]. Cancer Radiother 2019; 23:658-661. [PMID: 31471252 DOI: 10.1016/j.canrad.2019.07.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 07/03/2019] [Indexed: 11/29/2022]
Abstract
Stereotactic radiotherapy represents a fundamental change in the practice of radiotherapy of lung cancers. Despite the great heterogeneity of sites, techniques, and doses, most studies found a high local control rate, around 70 to 90% at 2 years, and reduced toxicity, around 5% of grade 3 at 2 years. Stereotactic radiotherapy can be realized either by a dedicated accelerator (CyberKnife®) or by a conventional accelerator associated with specific systems. The two modalities deliver a very precise irradiation whose very good results published to date are similar. Some technical characteristics specific to each type of linear accelerator could guide the choice according to the target volume treated.
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Affiliation(s)
- P Giraud
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France.
| | - S Kreps
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - H Tournat
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - J-E Bibault
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - E Fabiano
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - T Feutren
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Dautruche
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - C Durdux
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université Paris-Descartes, 75006 Paris, France
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Abstract
CONTEXT Lung cancer is the most common cancer in men and the leading cause of cancer death worldwide. This cancer, often diagnosed at an advanced stage, mainly affects smokers and survival could increase with early detection. Screening by chest x-ray has not shown its effectiveness, then several randomized trials have been carried out about screening by thoracic low-dose computed tomography in smokers. METHODS A systematic review of these trials was conducted according to the PRISMA criteria as well as a point of the difficulties of setting up screening following these trials. RESULTS Among five trials that published mortality results, only the US one, the National Lung Screening Trial (NLST) was showed a 20% decrease in lung cancer mortality in smokers screened by low-dose computed tomography compared to chest x-ray. However, besides the lack of power of the other trials, a great heterogeneity of the methods makes the synthesis of the results difficult. While many expert groups are in favor of testing, only the United States has implemented a screening program, whose adherence remains low. CONCLUSION Many persistent questions about the eligible population, the organization, the side effects, and finally the cost-benefit, need additional research around these issues.
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Affiliation(s)
- Gaëlle Coureau
- Université Bordeaux, Epicene, centre Inserm U1219, 33000 Bordeaux, France; CHU de Bordeaux, service d'information médicale, 33000 Bordeaux, France.
| | - Fleur Delva
- Université Bordeaux, Epicene, centre Inserm U1219, 33000 Bordeaux, France; CHU de Bordeaux, service de médecine du travail et de pathologies professionnelles, 33000 Bordeaux, France
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Agrafiotis AC, Prieto M, Siat J, Grosdidier G. [Staple line presenting as a suspicious pulmonary nodule]. Rev Pneumol Clin 2016; 72:204-206. [PMID: 27113616 DOI: 10.1016/j.pneumo.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 01/18/2016] [Accepted: 01/26/2016] [Indexed: 06/05/2023]
Abstract
The case reported herein concerns a 47-year-old female patient with a right apical pulmonary nodule, which was hypermetabolic on positron emission tomography scan. Eighteen years ago, she underwent a right axillary thoracotomy with apical blebectomy and pleurectomy for a recurrent primary spontaneous pneumothorax. Percutaneous transthoracic needle biopsy was unsuccessful. Surgical exploration revealed that the lesion was in fact the reinforcement material of the staple line that was used in the previous operation. Even though it is a rare presentation, previous use of surgical staples should alert the care team, especially when a new nodule is located near the ancient staple line, in order to avoid unnecessary invasive procedures.
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Affiliation(s)
- A C Agrafiotis
- Service de chirurgie générale, urgences et chirurgie thoracique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Prieto
- Service de chirurgie générale, urgences et chirurgie thoracique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - J Siat
- Service de chirurgie générale, urgences et chirurgie thoracique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
| | - G Grosdidier
- Service de chirurgie générale, urgences et chirurgie thoracique, CHU de Nancy, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France
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Fiogbe AA, Liistro G, Hoton D, Pieters T. [Mycobacterium avium tumoral infection mimicking a lung adenocarcinoma: A potential diagnostic pitfall]. Rev Pneumol Clin 2016; 72:147-151. [PMID: 26651929 DOI: 10.1016/j.pneumo.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 07/31/2015] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The incidence of atypical mycobacterial infection in Europe is estimated at one case per 100,000 persons/year. Despite the low incidence of Mycobacterium avium infection, it can result in a nodular lesion simulating lung cancer. We report a case of atypical mycobacteriosis, mimicking lung cancer, which led to a lobectomy. CASE REPORT It was a right pulmonary upper lobe nodule found in a 63-year-old COPD patient, partially nephrectomized for renal carcinoma, and weekly treated by methotrexate for rheumatoid arthritis. FDG uptake was weakly positive on PET-CT (SUV=2.2) in the upper fissure. Bronchoscopy yielded no lesions and no bacteriological findings. Percutaneous transthoracic lung biopsy revealed lung adenocarcinoma stage T1 (a) N0M0. An upper lobectomy with lymphadenectomy was performed. Histological examination revealed epithelioid granuloma surrounded by giant cells suggestive of tuberculomas. The bronchial washing fluid culture was positive for Mycobacterium avium after 7 weeks. CONCLUSION In pseudo-neoplastic forms of atypical mycobacteriosis, the presence of alveolar, inflammatory cytonuclear abnormalities can mimic an adenocarcinoma. Making the difference between the cytonuclears defects related to inflammation or neoplasia remains a daily challenge in histopathology.
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Affiliation(s)
- A A Fiogbe
- Service de pneumologie, cliniques universitaires Saint-Luc, université catholique de Louvain (UCL), 10, avenue Hippocrate, 1200 Bruxelles, Belgique.
| | - G Liistro
- Service de pneumologie, cliniques universitaires Saint-Luc, université catholique de Louvain (UCL), 10, avenue Hippocrate, 1200 Bruxelles, Belgique
| | - D Hoton
- Laboratoire d'anatomie pathologique, université catholique de Louvain (UCL), 10, avenue Hippocrate, 1200 Bruxelles, Belgique
| | - T Pieters
- Service de pneumologie, cliniques universitaires Saint-Luc, université catholique de Louvain (UCL), 10, avenue Hippocrate, 1200 Bruxelles, Belgique
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Cadelis G, Ehret N. [Concomitant discovery of lung cancer and tuberculosis in a cannabis smoker]. Rev Pneumol Clin 2015; 71:301-305. [PMID: 25725601 DOI: 10.1016/j.pneumo.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/09/2014] [Accepted: 12/31/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The coexistence of lung cancer and active tuberculosis is relatively rare. We report a case of concomitant discovery of lung cancer and tuberculosis in the context of addiction to tobacco and cannabis. OBSERVATION A 50-year-old man, smoking tobacco and cannabis since the age of 18, was hospitalized for hemoptysis. Physical examination revealed cachexia, hyperthermia and decreased breath sounds on auscultation of the left lung field. The chest X-ray objectified atelectasis of the left upper lobe. The CT scan revealed a left upper lobe atelectasis and a cavity surrounded opacities taking a tree in bud appearance located at the apex of the left lower lobe. Endoscopy showed an obstruction by a bud located at the upper left lobe. Histology of bronchial biopsy revealed squamous cell carcinoma. Direct examination of bacteriological samples found BAAR and culture confirmed tuberculosis. The contamination could occur via a close relative, smoking cannabis and being treated for tuberculosis. After a 6-month treatment for tuberculosis, the patient underwent a course of chemotherapy, but refused further treatment. Death occurred 3months later. CONCLUSION This observation relates the concomitant discovery of lung cancer and tuberculosis. It also highlights the possible role of cannabis addiction in the transmission of tuberculosis and the occurrence of lung cancer in combination with tobacco.
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Affiliation(s)
- G Cadelis
- Service de pneumologie, CHU de Pointe-à-Pitre, 97159 Pointe-à-Pitre cedex, Guadeloupe.
| | - N Ehret
- Service de pneumologie, CHU de Pointe-à-Pitre, 97159 Pointe-à-Pitre cedex, Guadeloupe
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Caidi M, Zouidia F, Bouchikh M, Benosman A. [Amelanotic pulmonary melanoma]. Rev Mal Respir 2015; 33:257-60. [PMID: 26073103 DOI: 10.1016/j.rmr.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 03/15/2015] [Indexed: 11/20/2022]
Abstract
We report a case of amelanotic pulmonary melanoma in a 52-year-old man. Histological diagnosis was established after right lower lobectomy. The primary source was not found. We describe the diagnosis, treatment and surgical follow-up of this type of pulmonary tumour.
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Affiliation(s)
- M Caidi
- Service de chirurgie thoracique, hôpital Ibn Sina, CHU, Rabat-Salé, Maroc.
| | - F Zouidia
- Service d'anatomie pathologique, hôpital Ibn Sina, CHU, Rabat-Salé, Maroc
| | - M Bouchikh
- Service de chirurgie thoracique, hôpital Ibn Sina, CHU, Rabat-Salé, Maroc
| | - A Benosman
- Service de chirurgie thoracique, hôpital Ibn Sina, CHU, Rabat-Salé, Maroc
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Folliet L, Perpoint T, Pignat JC, Laurent F, Devouassoux M, Perol M, Nesme P, Guerin JC, Ernesto S, Odier L, Arpin D. [Tumor-bronchial actinomycosis simulating a recurrence of lung cancer 14 years after initial treatment: A case report]. Rev Mal Respir 2015; 32:524-9. [PMID: 26024827 DOI: 10.1016/j.rmr.2014.10.732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 10/29/2014] [Indexed: 11/20/2022]
Abstract
A patient with a history of squamous cell carcinoma of the right upper lung lobe treated 14 years before by concomitant chemo-radiotherapy was referred on account of dyspnea. Bronchial endoscopy revealed complete obstruction of the right main bronchus highly suggestive of a tumor recurrence. However, biopsy samples only showed inflammatory and necrotic tissue with no evidence of malignancy. Despite complete tissue resection by rigid bronchoscopy, a rapid and complete recurrence occurred requiring the placement of a Y-shaped bronchial prosthesis. Repeat histological, bacteriological and mycological analyses were negative. The patient was soon readmitted to hospital for a lung infection due to recurrence of obstruction inside and around the prosthesis. Bacterial examination of biopsy samples identified Actinomyces meyeri. Appropriate antibiotic therapy led to a complete regression of the bronchial obstruction. Unfortunately, the patient died a few months later due to massive hemoptysis after the removal of the prosthesis. Autopsy examination showed a fistula between the right main bronchus and pulmonary artery, with no evidence of neoplastic recurrence nor the persistence of lesions associated with actinomycosis.
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Vincent M, Catinon M, Chemarin C. [Contribution of mineralogical analysis in thoracic oncology: The example of asbestos]. Rev Mal Respir 2014; 31:874-5. [PMID: 25433596 DOI: 10.1016/j.rmr.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022]
Affiliation(s)
- M Vincent
- Laboratoire d'analyses minéralogiques, centre hospitalier St-Joseph et St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France; Service de pneumologie, centre hospitalier St-Joseph et St-Luc, 69000 Lyon, France.
| | - M Catinon
- Laboratoire d'analyses minéralogiques, centre hospitalier St-Joseph et St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France
| | - C Chemarin
- Laboratoire d'analyses minéralogiques, centre hospitalier St-Joseph et St-Luc, 20, quai Claude-Bernard, 69007 Lyon, France
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