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Guinde J, Dutau H, Astoul P. Management of Malignant Pleural Effusion: Where Are We Now? Semin Respir Crit Care Med 2022; 43:559-569. [PMID: 35613947 DOI: 10.1055/s-0042-1748185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pleural malignancies are among the most common causes of pleural disease and form the basis of our daily pleural practice. There has been significant research and increase in both diagnostic and therapeutic management of malignant pleural diseases in the last decade. Good-quality data have led to a paradigm shift in the management options of pleural malignancies, and indwelling pleural catheter is now recommended and widely used as first-line intervention. Several trials compared different treatment modalities for pleural malignancies and continue to emphasize the need to reduce hospital length of stay and unnecessary pleural intervention, and the importance of patient choice in clinical decision making. This practical review aims to summarize the current knowledge for the management of pleural malignancies, and the understanding of the steps that we still have to climb to optimize management and reduce morbidity.
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Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
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Guinde J, Bismuth J, Laroumagne S, Coiffard B, Astoul P, Thomas PA, Reynaud-Gaubert M, Dutau H. Bifurcated Silicone Stents for the Management of Anastomotic Complications in Lung Transplanted Patients: Ten Years’ Experience. Respiration 2022; 101:675-682. [DOI: 10.1159/000523755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/18/2022] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> In lung transplantation (LT), the actual surgical practice is to cut the donor bronchus as short as possible in order to reduce anastomotic complications (AC). Consequently, the anastomosis is very close to the secondary carina. If AC occur, regular straight stents may be unsatisfactory and on-site modified bifurcated stents may represent an alternative. <b><i>Objectives:</i></b> This retrospective study sought to assess the short- and long-term outcomes of patients treated with customized bifurcated stent (CBS) for the management of AC following LT. <b><i>Methods:</i></b> Data from patients with AC following LT requiring CBS placement between June 2010 and June 2020 were analyzed. <b><i>Results:</i></b> Four hundred patients underwent lung transplant. AC requiring airway stenting occurred in 32 patients (8%), and CBS were inserted in 15 patients (3.5%). Indications were stenosis (<i>n</i> = 12; 80%) and bronchial dehiscence (<i>n</i> = 3; 20%). CBS were successfully deployed in 14 patients and failed in 1 patient. No migration was recorded during the follow-up. The median number of complication was 1 per patient (0–5). CBS could be removed in 11 patients (78.6%), and 3 died with their stents in place. AC recurrence or complications requiring new stenting occurred in 4/11 patients (36.3%), with a median time of 7 days (0–29). Seven patients (63.7%) had no AC recurrence, with a median follow-up of 925 days (118–3,249). <b><i>Conclusions:</i></b> The actual surgical anastomotic technique in LT provides new endoscopic challenges. CBS seem ideally positioned to address these difficulties safely and effectively but are associated with stent related complications requiring further endoscopic management.
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Guinde J, Laroumagne S, Dutau H, Astoul P. Threatened Aorta during Right Thoracentesis: Chest Ultrasound Please. Respiration 2022; 101:619-620. [PMID: 35240659 DOI: 10.1159/000522222] [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: 06/07/2021] [Accepted: 01/25/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France.,Aix-Marseille University, Marseille, France
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Guinde J, Laroumagne S, Chollet B, Trias-Sabrià P, Dutau H, Astoul P. Saline lavage for the management of severe pleural empyema: A cohort study. Clin Respir J 2021; 15:1097-1103. [PMID: 34216522 DOI: 10.1111/crj.13415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite advances in the treatment of pleural infection, up to 20% of patients die. So far, studies assessing the role of intrapleural saline lavage for the management of all stage pleural infections are very scarce, usually excluding patients with cancer. METHODS The method used was a retrospective cohort study including pleural empyema managed with a pleural lavage of saline solution through a small-bore chest tube. The primary outcome was the rate of failure at 3 months (surgical referral or additional pleural manoeuver due to recurrent infection or all-cause mortality). Secondary outcomes were hospital stay, the change of the chest radiograph and inflammatory biomarkers, and complications. RESULTS Thirty patients with pleural empyema were included, 11 (36.7%) with an active cancer. The overall rate of failure at 3 months was 13.3% (surgical referral = 0; additional pleural manoeuver = 3; mortality = 1). Median length of pleural lavage and hospital stay were, respectively, 14 days (7-28) and 17 days (11-42). Inflammatory markers and size of the effusion on chest radiograph significantly decreased for Day 0 to Day 14. No chest tube blockade was reported, but seven (23.3%) accidentally withdrew. No other side effects were reported. CONCLUSIONS Intrapleural saline lavage is efficient and safe for the management of pleural empyema, even in severe status patients with cancer, at the cost of a prolonged hospitalization.
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Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Bertrand Chollet
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Pere Trias-Sabrià
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,Aix-Marseille University, Marseille, France
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Guinde J, Bourdages-Pageau E, Collin-Castonguay MM, Laflamme L, Lévesque-Laplante A, Marcoux S, Roy P, Ugalde PA, Lacasse Y, Fortin M. A Prediction Model to Optimize Invasive Mediastinal Staging Procedures for Non-Small Cell Lung Cancer in Patients With a Radiologically Normal Mediastinum: The Quebec Prediction Model. Chest 2021; 160:2283-2292. [PMID: 34119514 DOI: 10.1016/j.chest.2021.05.062] [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: 01/21/2021] [Revised: 05/04/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Current guideline-recommended criteria for invasive mediastinal staging in patients with a radiologically normal mediastinum fail to identify a significant proportion of patients with occult mediastinal disease (OMD), despite it leading to a large number of invasive staging procedures. RESEARCH QUESTION Which variables available before surgery predict the probability of OMD in patients with a radiologically normal mediastinum? STUDY DESIGN AND METHODS We identified all cTxN0/N1M0 non-small cell lung cancer tumors staged by CT imaging and PET with CT imaging in our institution between 2014 and 2018 who underwent gold standard surgical lymph node dissection or were demonstrated to have OMD before surgery by invasive mediastinal staging techniques and divided them into a derivation and an independent validation cohort to create the Quebec Prediction Model (QPM), which allows calculation of the probability of OMD. RESULTS Eight hundred three patients were identified (development set, n = 502; validation set, n = 301) with a prevalence of OMD of 9.1%. The developed prediction model included largest mediastinal lymph node size (P < .001), tumor centrality (P = .23), presence of cN1 disease (P = .29), and lesion standardized uptake value (P = .09). Using a calculated probability of more than 10% as a threshold to identify OMD, this model had a sensitivity, specificity, positive predictive value, and negative predictive value in the derivation cohort of 73.9% (95% CI, 58.9%-85.7%), 81.1% (95% CI, 77.2%-84.6%), 28.3% (95% CI, 23.4%-33.8%), and 96.8% (95% CI, 95.0%-98.1%), respectively. It performed similarly in the validation cohort (P = .77, Hosmer-Lemeshow test; P = .5163, Pearson χ2 and unweighted sum-of-squares statistics; and P = .0750, Stukel score test) and outperformed current guideline-recommended criteria in identifying patients with OMD (area under the receiver operating characteristic curve [AUC] for American College of Chest Physicians guidelines criteria, 0.65 [95% CI, 0.59-0.71]; AUC for European Society of Thoracic Surgeons guidelines criteria, 0.60 [95% CI, 0.54-0.67]; and AUC for the QPM, 0.85 [95% CI, 0.80-0.90]). INTERPRETATION The QPM allows the clinician to integrate available information from CT and PET imaging to minimize invasive staging procedures that will not modify management, while also minimizing the risk of unforeseen mediastinal disease found at surgery.
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Affiliation(s)
- Julien Guinde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada; Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Etienne Bourdages-Pageau
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Marie-May Collin-Castonguay
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Laurie Laflamme
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Alexandra Lévesque-Laplante
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Sabrina Marcoux
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Pascalin Roy
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Paula Antonia Ugalde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Yves Lacasse
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Marc Fortin
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, QC, Canada.
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Chollet B, Guinde J, Laroumagne S, Dutau H, Astoul P. Does the LENT score risk-stratify patients with malignant pleural mesothelioma? An observational study. Thorac Cancer 2021; 12:1752-1756. [PMID: 33949775 PMCID: PMC8169304 DOI: 10.1111/1759-7714.13987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 01/19/2023] Open
Abstract
Background Malignant pleural mesothelioma (MPM) is a rare, highly aggressive and deadly disease with a poor patient life expectancy. A few years ago, the main challenge was the histological diagnosis of this disease; at present, the search for the best therapeutic strategy is now a priority. However, an optimal therapeutic strategy is not yet clear, despite growing efforts in the treatment armamentarium and research, and at the era of tailored and individualized treatment, tools to predict patient survival are needed for therapeutic decision‐making. Among them, the LENT scoring system was developed to predict prognosis in patients with malignant pleural effusion. The aim of this study was to assess the performance of the LENT score in predicting prognosis in patients with MPM. Methods A retrospective observational study was conducted by analyzing the prospective collected databases of patients undergoing medical thoracoscopy in a single center with a final diagnosis of MPM confirmed by the MESOPATH National Reference Center. Results A total of 41 patients with MPM were studied. All patients underwent platinum‐based chemotherapy combined with pemetrexed ± bevacizumab. No high‐risk category patients were found using the LENT scoring system in this cohort. The median (range) LENT score at the time of medical thoracoscopy was 0 (0–3) and the median survival was 15.5 (2–54) months for the entire cohort. The median survival of low‐risk and moderate‐risk category patients was 21.4 months (2–54, 32 patients) and 6.7 months (2–19, nine patients), respectively. A total of 27 patients with MPM of epithelial subgroup had a median LENT score of 1 (0–2) with a 26 (2–54) months median survival. The median LENT score and median survival of nonepithelial mesothelioma patients (biphasic MPM subgroup, eight patients; sarcomatoid MPM subgroup, six patients) were 0 (0–3) and 11 (2–52) months, respectively. Conclusions Applied to a homogenous cohort of MPM patients, the LENT score underestimated prognosis and was not useful per se for the management of this disease, as evidenced in the epithelial mesothelioma subgroup of patients in our study.
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Affiliation(s)
- Bertrand Chollet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
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Abstract
Pleural infection and malignancy are among the most common causes of pleural disease and form the mainstay of pleural practice. There has been significant research and increase in scientific understanding in these areas in the past decade. With regard to pleural infection, the rising incidence remains worrying. An increased awareness allowing earlier diagnosis, earlier escalation of therapy and the use of validated risk stratification measures may improve outcomes. In pleural malignancy, research has enabled clinicians to streamline patient pathways with focus on reducing time to diagnosis, definitive management of malignant pleural effusion and achieving these with the minimum number of pleural interventions. Trials comparing treatment modalities of malignant pleural effusion continue to highlight the importance of patient choice in clinical decision-making. This article aims to summarise some of the most recent literature informing current practice in these two areas.
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Affiliation(s)
- Eihab O Bedawi
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
| | - Julien Guinde
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Najiib M Rahman
- Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals, Oxford, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Philippe Astoul
- Dept of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North University Hospital, Marseille, France
- Aix-Marseille University, Marseille, France
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Guinde J, Bourdages-Pageau E, Ugalde PA, Fortin M. Central location and risk of imaging occult mediastinal lymph node involvement in cN0T2-4 non-small cell lung cancer. J Thorac Dis 2020; 12:7156-7163. [PMID: 33447404 PMCID: PMC7797819 DOI: 10.21037/jtd-20-1565] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Appropriate pre-operative staging is a cornerstone in the treatment of non-small cell lung cancer (NSCLC). Central location and size greater than 3 cm are amongst indications for pre-operative invasive mediastinal staging but the quality of the evidence behind this recommendation is low. Methods We retrospectively reviewed all cases of cT2-4N0M0 NSCLCL after CT and TEP-CT which underwent surgical resection with lymph node dissection or had a positive invasive pre-operative mediastinal staging in our institution from 2014 to 2018. Results Three hundred and ten patients met inclusion criteria, 79 (25.5%) central and 231 (74.5%) peripheral tumors. Central tumor location was associated with a higher prevalence of pN2-3 disease (17.7% vs. 6.1%, P<0.001). In a multivariate analysis, central tumor location remained the only factor statistically associated with imaging occult mediastinal disease (OR 3.23, 95% CI: 1.45–7.18). NPV of PET-CT for occult mediastinal disease was 0.83 (95% CI: 0.72–0.90) in central and 0.94 (95% CI: 0.90–0.97) in peripheral tumor. Central location was also associated with a higher prevalence of occult N1 to N3 disease (43.0% vs. 15.2%, P<0.001). Conclusions This study suggests that invasive mediastinal staging is required in central cT2-4N0 NSCLC but can be questioned in peripheral one, especially in cT2N2 subgroup if the patient is a candidate for lobar resection.
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Affiliation(s)
- Julien Guinde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada.,Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Etienne Bourdages-Pageau
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Paula Antonia Ugalde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
| | - Marc Fortin
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Canada
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Guinde J, Chollet B, Laroumagne S, Dutau H, Astoul P. Prolonged survival after multimodal therapy for pleural mesothelioma: Don't give up the follow-up. A case report. Ann Med Surg (Lond) 2020; 60:442-444. [PMID: 33251003 PMCID: PMC7683176 DOI: 10.1016/j.amsu.2020.11.034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 11/01/2022] Open
Abstract
Malignant Pleural mesothelioma (MPM) is a rare disease which is associated with a poor prognosis. Front line chemotherapy represents the cornerstone in the management of MPM, and the place of radical surgery is controversial and reserve in early-stage disease. However prolonged survival (more than 24 months) can be observed in rare cases and only in the context of multimodal treatment including surgical management. We report the case of a patient suffering from an epithelial MPM with a 14-years progression-free survival after trimodal treatment including extrapleural pneumonectomy followed by chemotherapy and radiotherapy. This case illustrates that despite being an aggressive disease, multimodal management including radical surgery may allow a prolonged response in MPM but requires a whole-life surveillance.
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Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Bertrand Chollet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Marseille, France
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10
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Naud R, Guinde J, Astoul P. Pulmonary cement embolism complicating percutaneous kyphoplasty: A case report. Respir Med Case Rep 2020; 31:101188. [PMID: 32923362 PMCID: PMC7475197 DOI: 10.1016/j.rmcr.2020.101188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
Background Vertebral cement augmentation procedures, as kyphoplasty (KP) or percutaneous vertebroplasty (PVP), are commonly used for the management of pain of the vertebral column usually due to fractures related to traumatic injury, osteoporosis or metastatic lesion. It is a useful and safe technique with few complications. Among them, symptomatic pulmonary cement embolism (PCE) can happened, even rarely described in the literature, leading to severe cardio-respiratory manifestations depending on the location and size of the cement emboli. Case presentation A 55 yo woman presented with atypical chest pain and presyncope three weeks after a motor vehicle accident resulting in an L1 compression fracture treated with kyphoplasty. She was hemodynamically stable. Blood tests showed D-Dimer 0.29 μg/mL, troponin <5ng/mL, Brain Natriuretic Protein 14 ng/mL and a PaO2 of 99 mmHg on arterial blood gas analysis. A computed tomography scan of chest showed linear hyperdense foreign bodies in two segmental pulmonary arteries at the level of middle lobe and right lower lobe compatible with pulmonary cement embolism. Anticoagulation with rivaroxaban for sixth months resulted in resolution of symptoms. Conclusions In this case, the pulmonary cement embolism occurred after kyphoplasty, which is associated with less risk of PCE than vertebroplasty. The procedure was done under biplanar fluoroscopy and no leakage of cement was noted, which would raise suspicion for CPE. Repeat imagine after this procedure is not routinely done. This case demonstrates that systematic imaging post procedure should be considered. An anticoagulation with rivaroxaban seems to be effective in our patient.
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Affiliation(s)
- Romain Naud
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Aix-Marseille University, France
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Laroumagne S, Guinde J, Berdah S, Dutau H, Capel J, Astoul P. A novel pleural-bladder pump for the management of recurrent malignant pleural effusions: a feasibility animal study. Respir Res 2020; 21:184. [PMID: 32669106 PMCID: PMC7364624 DOI: 10.1186/s12931-020-01447-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/08/2020] [Indexed: 12/05/2022] Open
Abstract
Background Recurrent malignant pleural effusions (MPE) are common and associated with significant morbidity in cancer patients. A new pump connecting the pleural cavity and the bladder may have application for the management of recurrent MPE. In a pre-clinical study, we investigated the utility of this pump in healthy pigs. Methods A novel pump system (Pleurapump® system) was inserted into four pigs under general anaesthesia. A tunnelled-pleural catheter was connected to a subcutaneously implanted pump while the urinary bladder was connected by percutaneous technique. Animals were ventilated mechanically and pump functioning was tested using a range of ventilation parameters and spontaneous breathing. Fluid was added to the pleural space to mimic pleural effusion and to assess the effectiveness of the pump at removing fluid to the bladder. Results The ‘pleurapump’ system successfully transported fluid from the pleural cavity to the bladder. Pressure variations caused by respiration and variations in the amount of fluid in the pleural cavity had no impact on the pumping. Pumping stopped when the pleural cavity was drained. Conclusion This pump can be implanted into pigs and successfully removed fluid from the pleural cavity to the bladder and may represent a new treatment for management of recurrent MPE. Evaluation in humans is planned.
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Affiliation(s)
- S Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France
| | - J Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France
| | - S Berdah
- LBA-UMRT24, Aix-Marseille Université, Marseille, France
| | - H Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France
| | - J Capel
- Sequana Medical AG, Zurich, Switzerland
| | - P Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology - Hôpital Nord, Marseille, France. .,Aix-Marseille University, Marseille, France.
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Collin-Castonguay MM, Guinde J, Laflamme L, Marcoux S, Fortin M. Added value of invasive needle techniques in mediastinal and hilar nodal staging of clinical N0-N1 non-small cell lung cancer after positron emission tomography. Clin Transl Radiat Oncol 2020; 24:49-51. [PMID: 32613092 PMCID: PMC7320229 DOI: 10.1016/j.ctro.2020.06.009] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022] Open
Abstract
Previous studies evaluating staging methods of lung cancer have focused on mediastinal disease. We explored the added value of endoscopic techniques after PET scan in the evaluation of N1 nodal stations in 276 patients with a radiologically normal mediastinum demonstrating a potential stage shift in 20% of patients.
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Affiliation(s)
| | - Julien Guinde
- Department of Pulmonary Medicine and Thoracic Surgery, Quebec Heart and Lung Institute, Quebec, Canada
| | - Laurie Laflamme
- Department of Pulmonary Medicine and Thoracic Surgery, Quebec Heart and Lung Institute, Quebec, Canada
| | - Sabrina Marcoux
- Department of Pulmonary Medicine and Thoracic Surgery, Quebec Heart and Lung Institute, Quebec, Canada
| | - Marc Fortin
- Department of Pulmonary Medicine and Thoracic Surgery, Quebec Heart and Lung Institute, Quebec, Canada
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Guinde J, Roy P, Dutau H, Musani A, Quadrelli S, Stratakos G, Vergnon JM, Tremblay A, Fortin M. An International Survey of Mediastinal Staging Practices amongst Interventional Bronchoscopists. Respiration 2020; 99:508-515. [PMID: 32485718 DOI: 10.1159/000507096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/02/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In potentially curable non-small-cell lung cancer, different practice guidelines recommend invasive me-diastinal staging in tumors larger than 3 cm, central, or hy-permetabolic N1 lymph nodes. There is no consensus concerning the use of an endosonographic procedure or a mediastinoscopy in the first line in patients with a radiologically normal mediastinum, while in case of a mediastinal involvement, the latest European guidelines recommend the combination of endobronchial ultrasound (EBUS) and endoscopic ultrasound/endoscopic ultrasound with EBUS endoscope (EUS/EUS-B), using a systematic endosonographic procedure. This international survey was conducted to describe current medical practices in endoscopic mediastinal staging amongst interventional bronchoscopists. METHODS A survey was developed and sent to all members of different interventional pulmonology societies, with the purpose to describe who, when and how an endoscopic mediastinal staging was performed. RESULTS One hundred and fifty-three bronchoscopists responded to the survey. Most of them practiced in Europe (n = 84, 55%) and North America (n = 52, 34%). In the first line, EBUS alone was the most widely used endoscopic procedure for mediastinal staging. Half of the responders performed a systematic endoscopic staging procedure, including a systematic examination of all accessible nodal stations and a sampling of all lymph nodes >5 mm in the short axis at each station. A higher proportion of bronchoscopists who have completed a dedicated fellowship program performed systematic endoscopic mediastinal staging. Few endoscopists routinely perform combined EBUS/EUS(-B) for mediastinal staging and use the combination only in selected cases. CONCLUSION There are several areas of divergence between published guidelines and current practices reported by interventional bronchoscopists. EBUS alone is the most widely used endoscopic procedure for mediastinal staging in lung cancer, and a combined endoscopic approach is frequently omitted by the responders. A fellowship program appears to be associated with a higher rate of systematic endoscopic staging procedures.
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Affiliation(s)
- Julien Guinde
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Québec, Canada, .,Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France,
| | - Pascalin Roy
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Québec, Canada
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Ali Musani
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Silvia Quadrelli
- Department of Respiratory Medicine, Güemes Foundation, Buenos Aires, Argentina
| | - Grigoris Stratakos
- 1st Respiratory Medicine Department, Sotiria Hospital, University of Athens, Athens, Greece
| | | | - Alain Tremblay
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marc Fortin
- Department of Pulmonology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec, Québec, Canada
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Capron T, Guinde J, Laroumagne S, Dutau H, Astoul P. Cerebral Air Embolism After Pleural Lavage for Empyema. Ann Thorac Surg 2020; 110:e289-e291. [PMID: 32246936 DOI: 10.1016/j.athoracsur.2020.02.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 01/05/2023]
Abstract
Percutaneous pleural maneuvers are performed routinely in the management of pleural diseases with a favorable safety profile. We report a case of cerebral air embolism during a pleural lavage for the management of an empyema. This severe complication is rarely reported in the literature, although it can happen after any percutaneous thoracic procedures. Asymptomatic arterial air emboli can occur in up to 5% of percutaneous thoracic maneuvers. Diagnosis should be made upon sudden neurologic signs and confirmed with brain imaging. Standard treatment is based on hyperbaric oxygen therapy, and it can be performed safely with an intrapleural catheter.
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Affiliation(s)
- Thibaut Capron
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France.
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Assistance Publique, Hôpitaux de Marseille, Hôpital Nord, Marseille, France; Aix-Marseille University, Marseille, France
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15
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Thiam K, Guinde J, Laroumagne S, Bourinet V, Berbis J, Touré NO, Dutau H, Astoul P. Lateral decubitus chest radiography or chest ultrasound to predict pleural adhesions before medical thoracoscopy: a prospective study. J Thorac Dis 2019; 11:4292-4297. [PMID: 31737314 DOI: 10.21037/jtd.2019.09.54] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medical thoracoscopy (MT) is the gold-standard to investigate unexplained pleural exudates. However, the major prerequisite is an easy pleural access obtained by creating an artificial pneumothorax at the beginning of the procedure which can be a challenge in case of pleural adhesions and make the procedure unsafe. The detection of pleural adhesions prior to MT is necessary. Nowadays chest ultrasonography (CUS) is considered the best procedure to detect pleural adhesions. However, this technique is not available in all countries where the assessment of the pleural cavity is only based on chest radiography. Therefore, we conducted this study to compare the performance of lateral decubitus chest radiography (LDCR) and CUS to predict pleural adhesions. METHODS LDCR and CUS were performed prior MT in consecutive patients presenting exudative pleural effusion to detect pleural adhesions. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each pre thoracoscopy procedure were calculated. RESULTS Data analysis for the sixty-six enrolled patients showed a higher superiority to detect pleural adhesions for CUS in comparison to LDCR for all the parameters analyzed. CONCLUSIONS These results confirm that pre-MT CUS is the cornerstone to evaluate the access to the pleural cavity and justify educational program in this field in all centers which intends to develop interventional pulmonology.
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Affiliation(s)
- Khady Thiam
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,Department of Pulmonology and Phtisiology, NUHC Fann, Dakar, Senegal
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France
| | - Valerian Bourinet
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Julie Berbis
- EA 3279, Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, Marseille, France
| | | | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France.,School of Medicine, Aix-Marseille University, Marseille, France
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16
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Fortin M, Cabon E, Berbis J, Laroumagne S, Guinde J, Elharrar X, Dutau H, Astoul P. Diagnostic Value of Computed Tomography Imaging Features in Malignant Pleural Mesothelioma. Respiration 2019; 99:28-34. [PMID: 31655816 DOI: 10.1159/000503239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/19/2019] [Accepted: 09/06/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical history, thoracentesis, and imaging features are usually the first steps in the investigation of a possible malignant pleural effusion (MPE). Unfortunately, the diagnostic yield of thoracentesis in this situation is suboptimal even if the procedure is repeated, especially in the context of malignant pleural mesothelioma (MPM). The next step for confirming the diagnosis, if clinically appropriate, is thoracoscopy, but not all patients are fit to undergo this procedure, so the diagnosis is then based on the medical history and imaging features only. OBJECTIVES Our objective was to evaluate the diagnostic value of the medical history and imaging features in MPM. METHODS We reviewed the imaging and medical charts of 92 patients with a final diagnosis of MPE included in our prospective medical thoracoscopy database. The clinical characteristics and imaging features of patients with primary MPE were compared with those of patients with secondary MPE. RESULTS Male sex (82 vs. 59%, p = 0.02), asbestos exposure (58 vs. 10%, p < 0.001), and mediastinal (68 vs. 33%, p = 0.04), diaphragmatic (75 vs. 31%, p = 0.001) and circumferential pleural thickening (55 vs. 19% p = 0.001) were significantly more frequent in MPM patients. In a multivariate linear regression model, only asbestos exposure (OR 11.2; 95% CI 3.4-36.9) and circumferential pleural thickening (OR 4.7; 95% CI 1.6-13.9) were significantly associated with a diagnosis of MPM. CONCLUSION In situations where it is impossible to obtain adequate pleural samples to differentiate MPM from a secondary pleural malignancy, the combination of circumferential pleural thickening and a history of asbestos exposure may be sufficient to make a clinical diagnosis.
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Affiliation(s)
- Marc Fortin
- Department of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada,
| | - Emmanuelle Cabon
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonary Medicine, Hôpital Nord, Marseille, France
| | - Julie Berbis
- Public Health, Chronic Diseases and Quality of Life Research Unit, Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonary Medicine, Hôpital Nord, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonary Medicine, Hôpital Nord, Marseille, France
| | - Xavier Elharrar
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonary Medicine, Hôpital Nord, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonary Medicine, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonary Medicine, Hôpital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
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Plante A, Guinde J, Boudreau C, Maltais F, Martel S, Delage A, Fortin M. A Rare Complication: Development of an Aspergilloma after Endobronchial Coil Placement in a COPD Patient. Respiration 2019; 99:423-425. [PMID: 31622972 DOI: 10.1159/000503363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/05/2019] [Accepted: 09/14/2019] [Indexed: 11/19/2022] Open
Abstract
Endobronchial coils are a relatively novel endoscopic lung volume reduction modality that aims to increase functional capacity in chronic obstructive pulmonary disease (COPD) patients. Two major trials have studied the safety and efficacy of this therapy, but long-term safety has not been studied. Adverse events reported are mainly periprocedural pneumothoraces and early bacterial infectious complications. We report the case of a patient with severe emphysema (Global Initiative for Chronic Obstructive Lung Disease stage IV COPD) who developed endobronchial coil-associated aspergillomas 3 years after coil placement.
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Affiliation(s)
- Alexandre Plante
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Julien Guinde
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada.,Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France
| | - Christine Boudreau
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Simon Martel
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Antoine Delage
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Marc Fortin
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada,
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Brun C, Giusiano S, Thiam K, Guinde J, Froudarakis M, Astoul P. The necessity of a more aggressive initial surgical treatment in patients with mesothelioma of the testicular tunica vaginalis. Ann Med Surg (Lond) 2019; 47:57-60. [PMID: 31692693 PMCID: PMC6806379 DOI: 10.1016/j.amsu.2019.10.012] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 11/25/2022] Open
Abstract
Mesothelioma of the tunica vaginalis of the testis (MTVM) is a rare tumor encountering for less than 1% of mesothelioma. Patients suffering from these tumors have poor survival due to local and distant metastasis despite treatment. Actually, no specific treatment recommendations exist for this tumor, yet radical orchidectomy is the gold standard in limited disease. We herein report the case of a 71 patient with MTVM who underwent radical orchidectomy without inguinal lymph node dissection and recurred 2 years later with metastasis in pelvic and mediastinal lymph nodes. Despite systemic chemotherapy combining pemetrexed, bevacizumab and Cisplatinum, the disease relapsed eight months later with multiple metastatic lung nodules leading to a treatment shift. We believe that systematic inguinal-iliac lymph node resection should be included in the initial treatment of this tumor.
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Affiliation(s)
- Clement Brun
- Service de Pneumologie et d'Oncologie Thoracique, Hôpital Nord, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Sophie Giusiano
- Service d'Anatomie et Cytologie Pathologiques, Centre Hospitalier Universitaire Nord - Centre de Recherche en Cancérologie de Marseille (CRCM), INSERM U1068/CNRS U7258, Aix-Marseille Université, Marseille, France
| | - Khady Thiam
- Service de Pneumo-Oncologie, CHU Fann, Université Cheikh Anta Diop, Dakar, Senegal.,Service d'Oncologie Thoracique, Maladies de la Plèvre et Pneumologie Interventionnelle, Centre Hospitalier Universitaire Nord, and, Aix-Marseille University, Marseille, France
| | - Julien Guinde
- Service d'Oncologie Thoracique, Maladies de la Plèvre et Pneumologie Interventionnelle, Centre Hospitalier Universitaire Nord, and, Aix-Marseille University, Marseille, France
| | - Marios Froudarakis
- Service de Pneumologie et d'Oncologie Thoracique, Hôpital Nord, Centre Hospitalier Universitaire de Saint Etienne, France
| | - Philippe Astoul
- Service d'Oncologie Thoracique, Maladies de la Plèvre et Pneumologie Interventionnelle, Centre Hospitalier Universitaire Nord, and, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Marseille, France
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19
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Guinde J, Georges S, Bourinet V, Laroumagne S, Dutau H, Astoul P. Recent developments in pleurodesis for malignant pleural disease. Clin Respir J 2019; 12:2463-2468. [PMID: 30252207 DOI: 10.1111/crj.12958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/18/2018] [Accepted: 08/28/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Metastatic pleural effusion (MPE) is one of the most frequent causes of pleural effusion. The aims of the therapeutic management are palliation of symptoms and improvement in patient's quality of life. The first step is a therapeutic thoracentesis. In case of a recurrent MPE, pleural maneuvers can be used to manage symptoms based on either ambulatory pleural drainage or pleurodesis to prevent fluid accumulation. The aim of this review is to describe recent advances, according to the best available evidence, in the field of pleurodesis for the management of MPE. DATA SOURCE AND STUDY SELECTION Three different searches of the most clinically relevant articles and up-to-date results in the field of pleurodesis for the management of MPE were performed using PubMed. Different indexing terms and time restriction were chosen. From these PubMed searches, 322 articles were respectively found. After cross-checking these three lists and the selection of articles published after January 2010 specially dedicated to the management of MPE by pleurodesis, the abstracts of 106 articles were extracted to feed the corpus of this review. RESULTS AND CONCLUSION Treatment approaches of recurrent MPE should take into account multiple factors in particular patient's life expectancy and preference. If talc is the best sclerosing agent alone or in combination with indwelling pleural catheter which is a promising strategy, the pathophysiology of MPE has to be revisited in order to propose a personalized management targeting intrapleural key molecules involved in the genesis of malignant process.
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Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Samer Georges
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Department of Pulmonology, Hôpital du Sacré Coeur, Montreal, Canada
| | - Valerian Bourinet
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Herve Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Aix-Marseille University, Marseille, France
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Sow A, Delliaux S, Guinde J, Finance J, Rey F, Boussuges A, Palot A, Reynaud-Gaubert M, Bregeon F. Le test d’hyperoxie (100 % oxygène) a-t-il un intérêt en première intention dans la recherche d’un shunt ? Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Bourinet V, Thiam K, Guinde J, Laroumagne S, Dutau H, Astoul P. [Trans-vocal cord prostheses - preliminary experience treating benign laryngotracheal stenosis in adults]. Rev Mal Respir 2018; 36:49-56. [PMID: 30337136 DOI: 10.1016/j.rmr.2018.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/15/2017] [Accepted: 01/25/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Benign laryngotracheal stenosis is a rare pathology with multiple etiologies, the management of which is complex. This is because of the configuration and proximity of the larynx and the difficulty with surgical approaches, which are potentially mutilating, especially for the management of a benign disease. When surgery is challenging, iterative dilatations of the stricture or the fashioning of a definitive tracheotomy are therapeutic alternatives. Advances in rigid bronchoscopy and the evolution of prosthetic silicone material allow a new approach in the management of benign laryngotracheal stenosis, by placing flexible silicone prostheses which cover all the stenosis from the arytenoids to the trachea. This preliminary work aims to evaluate the feasibility, effectiveness, tolerance and complications of the implementation of this type of prosthesis. PATIENTS AND METHODS This is a retrospective single-centre study which analyzed the records of patients with symptomatic benign laryngotracheal stenosis who underwent placement of a transcordial prosthesis over a period of three years. The prosthesis used, inserted under general anesthesia during a rigid tube interventional bronchoscopy, was either a straight silicone prosthesis or a Montgomery T-tube for those with a pre-existing tracheotomy. RESULTS Six patients were included. Five are still alive, one patient died from a cause unrelated to the placement of the prosthesis. Four have no tracheostomy and two now have no transcordal prosthesis. The data collected on tolerance found, for three patients, two cases of minor aspiration and one case of transient cough. All patients had whispered voice dysphonia. We did not observe prosthesis migration or obstruction. CONCLUSION These preliminary results are encouraging. Transcordal prostheses in benign laryngotracheal stenosis have a complementary or alternative role compared to surgery with a palliative or even curative objective.
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Affiliation(s)
- V Bourinet
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - K Thiam
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France; Service de pneumo-oncologie, université Cheikh-Anta-Diop, CHU Fann, Dakar, Sénégal
| | - J Guinde
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - S Laroumagne
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France
| | - H Dutau
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France.
| | - P Astoul
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord Aix-Marseille université, 13000 Marseille, France; Aix-Marseille université, 13000 Marseille, France
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Guinde J, Frankel D, Perrin S, Delecourt V, Lévy N, Barlesi F, Astoul P, Roll P, Kaspi E. Lamins in Lung Cancer: Biomarkers and Key Factors for Disease Progression through miR-9 Regulation? Cells 2018; 7:E78. [PMID: 30012957 PMCID: PMC6071028 DOI: 10.3390/cells7070078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 02/08/2023] Open
Abstract
Lung cancer represents the primary cause of cancer death in the world. Malignant cells identification and characterization are crucial for the diagnosis and management of patients with primary or metastatic cancers. In this context, the identification of new biomarkers is essential to improve the differential diagnosis between cancer subtypes, to select the most appropriate therapy, and to establish prognostic correlations. Nuclear abnormalities are hallmarks of carcinoma cells and are used as cytological diagnostic criteria of malignancy. Lamins (divided into A- and B-types) are localized in the nuclear matrix comprising nuclear lamina, where they act as scaffolding protein, involved in many nuclear functions, with regulatory effects on the cell cycle and differentiation, senescence and apoptosis. Previous studies have suggested that lamins are involved in tumor development and progression with opposite results concerning their prognostic role. This review provides an overview of lamins expression in lung cancer and the relevance of these findings for disease diagnosis and prognosis. Furthermore, we discuss the link between A-type lamins expression in lung carcinoma cells and nuclear deformability, epithelial to mesenchymal transition, and metastatic potential, and which mechanisms could regulate A-type lamins expression in lung cancer, such as the microRNA miR-9.
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Affiliation(s)
- Julien Guinde
- Aix Marseille Université, INSERM, MMG, 13385 Marseille, France.
- APHM, Hôpital Nord, Department of Thoracic Oncology-Pleural Diseases-Interventional Pulmonology, CEDEX 5, 13385 Marseille, France.
| | - Diane Frankel
- Aix Marseille Université, APHM, INSERM, MMG, Hôpital la Timone, Service de Biologie Cellulaire, 13385 Marseille, France.
| | - Sophie Perrin
- Aix Marseille Université, INSERM, MMG, 13385 Marseille, France.
- ProGeLife, 13385 Marseille, France.
| | | | - Nicolas Lévy
- Aix Marseille Université, APHM, INSERM, MMG, Hôpital la Timone, Département de Génétique Médicale, 13385 Marseille, France.
| | - Fabrice Barlesi
- Aix Marseille Université, APHM, CNRS, INSERM, CRCM, Multidisciplinary Oncology & Therapeutic Innovations Department, 13385 Marseille, France.
| | - Philippe Astoul
- APHM, Hôpital Nord, Department of Thoracic Oncology-Pleural Diseases-Interventional Pulmonology, CEDEX 5, 13385 Marseille, France.
| | - Patrice Roll
- Aix Marseille Université, APHM, INSERM, MMG, Hôpital la Timone, Service de Biologie Cellulaire, 13385 Marseille, France.
| | - Elise Kaspi
- Aix Marseille Université, APHM, INSERM, MMG, Hôpital la Timone, Service de Biologie Cellulaire, 13385 Marseille, France.
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Tazi-Mezalek R, Frankel D, Fortin M, Kaspi E, Guinde J, Assolen A, Laroumagne S, Robaglia A, Dutau H, Roll P, Astoul P. Chest ultrasonography to assess the kinetics and efficacy of talc pleurodesis in a model of pneumothorax: an experimental animal study. ERJ Open Res 2018; 4:00158-2017. [PMID: 29900179 PMCID: PMC5994484 DOI: 10.1183/23120541.00158-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/27/2018] [Indexed: 12/28/2022] Open
Abstract
Talc pleurodesis is used to avoid recurrences in malignant pleural effusions or pneumothorax. The lack of lung sliding detected by chest ultrasonography (CUS) after talc application is indicative of the effectiveness of pleurodesis. The objective of our study was to explore, in an animal model, the capacity of CUS to predict the quality of a symphysis induced by talc poudrage (TP) and talc slurry (TS). We induced an artificial pneumothorax in six healthy pigs prior to talc application. TP was performed on one hemithorax, followed by TS on the other side 1 week later. 108 points on the chest were marked and evaluated by ultrasonography during the study. TP showed higher sonographic scores compared to TS starting from 72 h after talc administration. At autopsy, a higher grade of symphysis was observed for TP, and a high correlation rate was registered between CUS and macroscopic findings. Histological analysis also showed a higher grade of pleural symphysis for TP. CUS is a reliable tool to assess talc pleurodesis. The quality and kinetics of the pleural symphysis are also evaluable by ultrasonography. Pleurodesis by TP is more effective than TS in this experimental model of pneumothorax. Quality of talc pleurodesis and kinetics of pleural symphysis can be evaluated by chest ultrasonographyhttp://ow.ly/8Ejt30jVTjn
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Affiliation(s)
- Rachid Tazi-Mezalek
- AP-HM, Hôpital Nord, Dept of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France
| | - Diane Frankel
- Aix-Marseille University, INSERM, GMGF, Marseille, France.,AP-HM, Hôpital de la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Marc Fortin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Ville de Québec, Canada
| | - Elise Kaspi
- Aix-Marseille University, INSERM, GMGF, Marseille, France.,AP-HM, Hôpital de la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Julien Guinde
- AP-HM, Hôpital Nord, Dept of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France.,AP-HM, Hôpital de la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Alexandra Assolen
- AP-HM, Hôpital de la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Sophie Laroumagne
- AP-HM, Hôpital Nord, Dept of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France
| | - Andree Robaglia
- Aix-Marseille University, INSERM, GMGF, Marseille, France.,AP-HM, Hôpital de la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Herve Dutau
- AP-HM, Hôpital Nord, Dept of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France
| | - Patrice Roll
- Aix-Marseille University, INSERM, GMGF, Marseille, France.,AP-HM, Hôpital de la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Philippe Astoul
- AP-HM, Hôpital Nord, Dept of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France.,Aix-Marseille University, Marseille, France
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24
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Thiam K, Berbis J, Laroumagne S, Guinde J, Chollet B, Dutau H, Touré NO, Astoul P. Diagnostic Accuracy of Lateral Decubitus Chest Radiography before Pleural Maneuvers for the Management of Pleurisies in the Era of Chest Ultrasound. Respiration 2018; 95:449-453. [PMID: 29723854 DOI: 10.1159/000487999] [Citation(s) in RCA: 2] [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: 12/02/2017] [Accepted: 02/26/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chest ultrasound (CUS) is the gold standard to detect pleural adhesions before pleural maneuvers. However, the CUS technique is not available in all countries where the assessment is only based on clinical examination and chest radiography. OBJECTIVE To assess the value of lateral decubitus chest radiography (LDCR) to detect pleural adhesions. METHODS Consecutive patients with pleural effusions undergoing LCDR followed by medical thoracoscopy the day after were identified from an institutional database. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for LDCR were calculated. RESULTS Eighty-six patients were included in the study. The sensitivity, specificity, PPV, and NPV of LDCR for the presence of adhesions taking into account the shape of the horizontal level were 71.2% (56.7-82.5), 44.1% (27.6-61.9), 66.1% (52.1-77.8), and 50% (31.7-68.3), respectively. The accuracy to predict pleural adhesions for the sign "incomplete horizontal level" was 60.5 (49.3-70.7). The accuracy to predict pleural adhesions in case of irregular aspect of the horizontal level was 53.5 (42.5-64.2). CONCLUSIONS The accuracy of LDCR for the detection of pleural adhesions is low in patients with pleural effusion and LDCR is not sufficient before pleural maneuvers. This has to be taken into account in countries with a high prevalence of pleural tuberculosis which usually lead to loculated pleural effusions. CUS has to be urgently included in dedicated educational programs in these areas in order to decrease the complications related to unexpected pleural adhesions and achieve better planning for the management of pleural effusions.
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Affiliation(s)
- Khady Thiam
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France.,Department of Pulmonology and Phthisiology, CHNU Fann, Dakar, Senegal
| | - Julie Berbis
- Aix-Marseille University, EA 3279, Public Health, Chronic Diseases and Quality of Life, Research Unit, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Bertrand Chollet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | | | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France.,G-Echo, French National Group for Chest Ultrasonography, Paris, France.,Aix-Marseille University, Marseille, France
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25
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Guinde J, Georges S, Bourinet V, Laroumagne S, Astoul P, Dutau H. "Kissing Nodules" in Saber-Sheath Trachea. Respiration 2018; 95:464. [PMID: 29694986 DOI: 10.1159/000488246] [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: 01/29/2018] [Accepted: 03/06/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Samer Georges
- Department of Adult Respirology, Sacred Heart Hospital of Montreal, University of Montreal, Montreal, Québec, Canada
| | - Valerian Bourinet
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
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26
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Frankel D, Nanni-Metellus I, Robaglia-Schlupp A, Tomasini P, Guinde J, Barlesi F, Astoul P, Ouafik L, Amatore F, Secq V, Kaspi E, Roll P. Detection of EGFR, KRAS and BRAF mutations in metastatic cells from cerebrospinal fluid. Clin Chem Lab Med 2018; 56:851-856. [PMID: 29306909 DOI: 10.1515/cclm-2017-0527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/15/2017] [Accepted: 12/04/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND In lung adenocarcinoma, molecular profiling of actionable genes has become essential to set up targeted therapies. However, the feasibility and the relevance of molecular profiling from the cerebrospinal fluid (CSF) in the context of meningeal metastasis have been poorly assessed. METHODS We selected patients with stage IV lung adenocarcinoma harbouring metastatic cells in the CSF after cytological analysis. Seven samples from six patients were eligible for molecular testing of epidermal growth factor receptor (EGFR), V-Ki-ras2 Kirsten rat sarcoma viral oncogene homologue (KRAS), v-Raf murine sarcoma viral oncogene homologue B1 (BRAF) and human epidermal growth factor receptor 2 (HER2) mutations using quantitative polymerase chain reaction (PCR) high-resolution melting curve analysis and Sanger sequencing after DNA extraction from the cell pellets of the CSF. RESULTS Five patients showed mutations in one or two actionable genes, two harboured an EGFR mutation (exons 19 and 21), one only a KRAS mutation, one both EGFR and KRAS mutations and one a BRAF mutation. In all cases, the results of mutation testing provided new major information for patient management, leading to therapeutic adaptation. CSF molecular analysis identified mutations not detected in other neoplastic sites for two patients. In one case, the EGFR p.Thr790Met was identified. CSF was also the only sample available for genetic testing for almost all patients at the time of disease progression. CONCLUSIONS When cancer cells are present in the CSF, the molecular profiling from the cell pellets is relevant, as it can detect supplemental or different mutations compared to a previous analysis of the primitive tumour or plasma cell-free DNA and allows the adaptation of the treatment strategy.
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Affiliation(s)
- Diane Frankel
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Isabelle Nanni-Metellus
- APHM, Faculté de Médecine Nord, Laboratoire de Transfert d'Oncologie Biologique, Marseille, France
| | - Andrée Robaglia-Schlupp
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Pascale Tomasini
- APHM, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Julien Guinde
- Aix Marseille Univ, INSERM, MMG, Marseille, France.,APHM, Hôpital Nord, Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France
| | - Fabrice Barlesi
- APHM, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Philippe Astoul
- APHM, Hôpital Nord, Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Marseille, France.,Aix Marseille Univ, Marseille, France
| | - L'Houcine Ouafik
- APHM, Faculté de Médecine Nord, Laboratoire de Transfert d'Oncologie Biologique, Marseille, France.,Aix Marseille Univ, INSERM, CRO2, Marseille, France
| | - Florent Amatore
- APHM, Hôpital Nord, Département de Dermatologie, Marseille, France
| | - Véronique Secq
- APHM, Hôpital Nord, Service Hospitalier d'Anatomie et Cytologie Pathologiques, Marseille, France.,Aix Marseille Univ, CNRS, INSERM, Institut Paoli-Calmette, CRCM, Marseille, France
| | - Elise Kaspi
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
| | - Patrice Roll
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France.,Aix Marseille Univ, INSERM, MMG, Marseille, France
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27
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Bourinet V, Raguin T, Fortin M, Chetrit E, Guinde J, Laroumagne S, Fakhry N, Astoul P, Debry C, Dutau H. Experience with Transcordal Silicone Stents in Adult Laryngotracheal Stenosis: A Bicentric Retrospective Study. Respiration 2018; 95:441-448. [PMID: 29621756 DOI: 10.1159/000487242] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 09/18/2017] [Accepted: 01/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Benign stenosis involving laryngeal and upper tracheal structures represents a therapeutic challenge. Open surgery and endoscopic management have to be discussed by a multidisciplinary board in order to evaluate the risk and benefit for each patient. OBJECTIVE The objective of this retrospective study was to report the experience of two French centers with transcordal silicone stents (TSS) in the endoscopic management of benign laryngotracheal stenosis (BLTS) in adults, with focus on efficacy, safety, and tolerability. METHODS We performed a retrospective chart review of all cases of BLTS treated with TSS between January 2001 and June 2017 at two tertiary centers in France: the Centre Hospitalier Régional Universitaire de Strasbourg and the Hôpital Nord de Marseille. RESULTS A total of 17 patients were included. Eleven had a tracheostomy at initial management which consisted of 8 T-tubes and 9 strictly endoluminal stents placements. The main complications were minor aspirations in 5 patients (29%), granulation in 3 patients (18%), migration in 2 patients (12%), and severe dysphonia in 3 patients (18%). After a mean duration of 18.3 months, 11 patients (65%) had had their TSS definitely removed, 13 patients were tracheostomy free (76%), and a TSS remained in place in 4 patients (24%). CONCLUSIONS Adult BLTS treatment with TSS placement is associated with low morbidity and excellent clinical outcomes, with a large proportion of patients free of airway instrumentation on long-term follow-up.
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Affiliation(s)
- Valerian Bourinet
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Thibaut Raguin
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Marc Fortin
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Elsa Chetrit
- Department of Radiology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
| | - Nicolas Fakhry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Marseille, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France.,Aix-Marseille University, Marseille, France
| | - Christian Debry
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France
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Guinde J, Kaspi E, Frankel D, Perrin S, Laroumagne S, Robaglia-Schlupp A, Ostacolo K, Harhouri K, Tazi-Mezalek R, Micallef J, Dutau H, Tomasini P, De Sandre-Giovannoli A, Levy N, Cau P, Astoul P, Roll P. Lamine A comme marqueur pronostique dans les adénocarcinomes bronchiques métastatiques : étude in vivo à partir d’épanchements pleuraux métastatiques. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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Guinde J, Carron R, Tomasini P, Greillier L, Régis J, Barlesi F. Bevacizumab Plus Radiosurgery for Nonsquamous Non–Small Cell Lung Cancer Patients with Brain Metastases: Safe Combination? World Neurosurg 2017; 107:1047.e1-1047.e4. [DOI: 10.1016/j.wneu.2017.07.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/20/2017] [Accepted: 07/31/2017] [Indexed: 11/27/2022]
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30
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Kaspi E, Frankel D, Guinde J, Perrin S, Laroumagne S, Robaglia-Schlupp A, Ostacolo K, Harhouri K, Tazi-Mezalek R, Micallef J, Dutau H, Tomasini P, De Sandre-Giovannoli A, Lévy N, Cau P, Astoul P, Roll P. Low lamin A expression in lung adenocarcinoma cells from pleural effusions is a pejorative factor associated with high number of metastatic sites and poor Performance status. PLoS One 2017; 12:e0183136. [PMID: 28806747 PMCID: PMC5555706 DOI: 10.1371/journal.pone.0183136] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/31/2017] [Indexed: 11/29/2022] Open
Abstract
The type V intermediate filament lamins are the principal components of the nuclear matrix, including the nuclear lamina. Lamins are divided into A-type and B-type, which are encoded by three genes, LMNA, LMNB1, and LMNB2. The alternative splicing of LMNA produces two major A-type lamins, lamin A and lamin C. Previous studies have suggested that lamins are involved in cancer development and progression. A-type lamins have been proposed as biomarkers for cancer diagnosis, prognosis, and/or follow-up. The aim of the present study was to investigate lamins in cancer cells from metastatic pleural effusions using immunofluorescence, western blotting, and flow cytometry. In a sub-group of lung adenocarcinomas, we found reduced expression of lamin A but not of lamin C. The reduction in lamin A expression was correlated with the loss of epithelial membrane antigen (EMA)/MUC-1, an epithelial marker that is involved in the epithelial to mesenchymal transition (EMT). Finally, the lamin A expression was inversely correlated with the number of metastatic sites and the WHO Performance status, and association of pleural, bone and lung metastatic localizations was more frequent when lamin A expression was reduced. In conclusion, low lamin A but not lamin C expression in pleural metastatic cells could represent a major actor in the development of metastasis, associated with EMT and could account for a pejorative factor correlated with a poor Performance status.
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Affiliation(s)
- Elise Kaspi
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Diane Frankel
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France
| | - Julien Guinde
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
- APHM, Hôpital Nord, Department of Thoracic Oncology–Pleural diseases–Interventional pulmonology, Marseille, France
| | | | - Sophie Laroumagne
- APHM, Hôpital Nord, Department of Thoracic Oncology–Pleural diseases–Interventional pulmonology, Marseille, France
| | - Andrée Robaglia-Schlupp
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France
- APHM, Hôpital la Timone, Département de Génétique Médicale et Centre de Ressources Biologiques, Marseille, France
| | | | | | - Rachid Tazi-Mezalek
- APHM, Hôpital Nord, Department of Thoracic Oncology–Pleural diseases–Interventional pulmonology, Marseille, France
| | - Joelle Micallef
- APHM, Hôpital la Timone, Service de Pharmacologie Clinique & Centre d’Investigation Clinique—CPCET, Marseille, France
- Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | - Hervé Dutau
- APHM, Hôpital Nord, Department of Thoracic Oncology–Pleural diseases–Interventional pulmonology, Marseille, France
| | - Pascale Tomasini
- Aix Marseille Univ, APHM, Marseille Early Phases Cancer Trials Center CLIP, Marseille, France
| | - Annachiara De Sandre-Giovannoli
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
- APHM, Hôpital la Timone, Département de Génétique Médicale et Centre de Ressources Biologiques, Marseille, France
| | - Nicolas Lévy
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
- APHM, Hôpital la Timone, Département de Génétique Médicale et Centre de Ressources Biologiques, Marseille, France
| | - Pierre Cau
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
| | - Philippe Astoul
- APHM, Hôpital Nord, Department of Thoracic Oncology–Pleural diseases–Interventional pulmonology, Marseille, France
- Aix Marseille Univ, Marseille, France
| | - Patrice Roll
- Aix Marseille Univ, INSERM, GMGF, Marseille, France
- APHM, Hôpital la Timone, Service de Biologie Cellulaire, Marseille, France
- * E-mail:
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Dutau H, Bourru D, Guinde J, Laroumagne S, Deslée G, Astoul P. Successful Late Removal of Endobronchial Coils. Chest 2017; 150:e143-e145. [PMID: 27938769 DOI: 10.1016/j.chest.2016.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 01/18/2016] [Revised: 03/07/2016] [Accepted: 03/18/2016] [Indexed: 11/16/2022] Open
Abstract
Although endobronchial coils for the treatment of severe emphysema are associated with an acceptable safety profile, adverse events such as pneumothorax and thoracic pain may occur. The coils are indicated as a permanent implant and are deemed very difficult to remove. We describe the first successful removal of two coils 10 months after placement in a patient who experienced persistent thoracic pain. This case report highlights that very distal (subpleural) coil placement may induce pneumothorax and subsequent thoracic pain and that nonsurgical removal of coils up to 10 months after implantation is feasible.
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Affiliation(s)
- Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France.
| | - David Bourru
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Julien Guinde
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, INSERM U903, University Hospital, Reims, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France
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32
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Fortin M, Lacasse Y, Elharrar X, Tazi-Mezalek R, Laroumagne S, Guinde J, Astoul P, Dutau H. Safety and Efficacy of a Fully Covered Self-Expandable Metallic Stent in Benign Airway Stenosis. Respiration 2017; 93:430-435. [PMID: 28448981 DOI: 10.1159/000472155] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 11/24/2016] [Accepted: 03/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of self-expandable metallic stents (SEMS) in benign airway disease was the object of a boxed warning from the United States Food and Drug Administration in 2005 due to the risk of stent-related complications and difficulties associated with their removal. Third-generation fully covered SEMS have been commercialized since this warning and theoretically should not present the same difficulties associated with removal as they cannot become embedded in the airway mucosa. OBJECTIVES We aimed to examine the safety and efficacy of a specific third-generation SEMS, the Silmet stent. METHODS We reviewed the records of all patients treated for benign airway stenosis with third-generation Silmet SEMS from January 2011 to December 2015 at the North Hospital of Marseilles, France. RESULTS Forty SEMS were inserted in 30 patients over this period. Twenty (50.0%) stents were removed because of stent-related complications after a median of 77.0 ± 96.6 days (migration 32.5%, granulation tissue formation 7.5%, subjective intolerance 5.0%, mucus plugging 2.5%, laryngeal edema 2.5%). There were no cases of stent-related mortality. All complications were managed successfully endoscopically. Thirty-six stents (90.0%) were removed successfully after a median of 122.0 ± 113.2 days without any complications. The clinical success rate of stent treatment was 40.7%. CONCLUSION Third-generation SEMS are a safe treatment option for complex benign airway stenosis, but complications requiring stent removal are frequent. Further studies are needed to compare the performance of third-generation SEMS and silicone stents in benign airway stenosis.
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Affiliation(s)
- Marc Fortin
- Department of Thoracic Oncology, Pleural Disease, and Interventional Pulmonology, North Hospital, Marseilles, France
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33
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Guinde J, Elharrar X, Laroumagne S, Dutau H, Astoul P. [Not Available]. Rev Prat 2016; 66:e445-e452. [PMID: 30512487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Julien Guinde
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Xavier Elharrar
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Sophie Laroumagne
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Hervé Dutau
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Philippe Astoul
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
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Guinde J, Elharrar X, Laroumagne S, Dutau H, Astoul P. [Not Available]. Rev Prat 2016; 66:e444. [PMID: 30512486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Julien Guinde
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Xavier Elharrar
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Sophie Laroumagne
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Hervé Dutau
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - Philippe Astoul
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
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Arroyo B, Guinde J, Gouitaa M, Tummino C, Charpin D, Chanez P, Palot A. Exacerbation de BPCO secondaire à l’inhalation accidentelle de liquide de cigarette électronique. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Guinde J, Laroumagne S, Kaspi E, Martinez S, Tazi-Mezalek R, Astoul P, Dutau H. [Endobronchial ultrasound in the diagnosis of malignant pleural mesothelioma]. Rev Mal Respir 2015; 32:750-4. [PMID: 26071130 DOI: 10.1016/j.rmr.2014.12.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/29/2014] [Indexed: 11/29/2022]
Abstract
The diagnosis of malignant pleural mesothelioma relies mostly on the pathological examination of pleural samples, validated by a panel of experts and generally obtained during medical or surgical thoracoscopy performed for the management of an exudative pleural effusion. In the absence of pleural effusion (dry-type mesothelioma), the diagnostic approach depends on the features of the lesions (pleural thickness, nodules and/or masses) and their pleural location. Ultrasound and CT-guided needle aspiration represent recognized alternative diagnostic techniques in these situations. We present the case of a patient, presenting a dry-type mesothelioma, whose diagnosis was obtained by endobronchial ultrasound (EBUS)-guided needle aspiration of a pleural mediastinal mass and confirmed by a CT-guided needle aspiration of another pleural mass in close contact with the chest wall. The samples have been compared and show quantitative and qualitative similarities. EBUS represents a minimally invasive alternative diagnostic technique for dry-type mesothelioma, showing thickness of the mediastinal pleura in contact with a central airway or when thoracoscopy, which remains the "gold standard" diagnostic approach, is not feasible.
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Affiliation(s)
- J Guinde
- Service d'oncologie thoracique, maladie de la plèvre et pneumologie interventionnelle, hôpital Nord, chemin des Bourrely, 13000 Marseille, France
| | - S Laroumagne
- Service d'oncologie thoracique, maladie de la plèvre et pneumologie interventionnelle, hôpital Nord, chemin des Bourrely, 13000 Marseille, France
| | - E Kaspi
- Service de biologie cellulaire, hôpital La Timone, 13000 Marseille, France; Université d'Aix-Marseille, 13000 Marseille, France
| | - S Martinez
- Service d'oncologie thoracique, maladie de la plèvre et pneumologie interventionnelle, hôpital Nord, chemin des Bourrely, 13000 Marseille, France
| | - R Tazi-Mezalek
- Service d'oncologie thoracique, maladie de la plèvre et pneumologie interventionnelle, hôpital Nord, chemin des Bourrely, 13000 Marseille, France
| | - P Astoul
- Service d'oncologie thoracique, maladie de la plèvre et pneumologie interventionnelle, hôpital Nord, chemin des Bourrely, 13000 Marseille, France; Université d'Aix-Marseille, 13000 Marseille, France
| | - H Dutau
- Service d'oncologie thoracique, maladie de la plèvre et pneumologie interventionnelle, hôpital Nord, chemin des Bourrely, 13000 Marseille, France.
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Guinde J, Secq V, Nanni-Metellus I, Fina F, Goupil-Vastra A, Garcia S, Barlési F, Greillier L. Caractéristiques génomiques des cancers bronchiques non à petites cellules non-épidermoïdes (CBNPC-NE) chez les sujets jeunes. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2014.10.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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