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Pulmonary AND Bronchogenic carcinoma [keywords]
- Enhancement of Conventional TBNA Outcome After EBUS Training. [JOURNAL ARTICLE]
- J Bronchology Interv Pulmonol 2014 Oct; 21(4):322-326.
Conventional transbronchial needle aspiration (C-TBNA) is a well-established technique for the diagnosis and staging of bronchogenic carcinoma. Because of the implementation of the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), the C-TBNA is being used less frequently. Despite its proven diagnostic utility some of the pulmonary fellowship programs have chosen to eliminate training for C-TBNA from their curriculum. The objective our study was to compare the outcomes of C-TBNA before and after the implementation of EBUS in our unit.We compared the diagnostic performance of C-TBNA in 2 groups of non-small cell lung cancer patients with mediastinal lymph nodes >10 mm in short axis as seen on the computed tomography scan of the chest. Patients underwent C-TBNA before (group A, N=147) or after (group B, N=67) implementing EBUS technology in our unit. C-TBNA technique was performed by the same bronchoscopists before and after being proficient in EBUS.The overall accuracy in group B was higher than in group A (23.9% vs. 9.5%, respectively; P=0.0001). Overall test accuracy and sensitivity of C-TBNA was 66% versus 86% and 63% versus 86% in groups A and B, respectively. The negative predictive values of C-TBNA improved after EBUS training (19% vs. 33%, P<0.001). Inadequate samples were less frequent in group B than in group A (31.1% vs. 49.7%, respectively; P=0.00001).Diagnostic performance of C-TBNA improves after EBUS training. C-TBNA should remain in the armamentarium of every bronchoscopist and on the curriculum of all pulmonary fellowship training programs even if EBUS technology is available.
- Importance of histological verification of mediastinal lymphadenopathy in exact staging of non-small cell bronchogenic carcinoma. [Journal Article]
- Bratisl Lek Listy 2014; 115(9):585-7.
ackground: Diagnostics and treatment of bronchogenic non-small cell lung carcinoma is a severe clinical problem. Radical surgery is the major treatment modality with the highest chance for a long-time survival. The aim of the study was to map metastasizing of bronchogenic non-small cell lung carcinoma into homolateral mediastinal lymph nodes and to assess the importance of histological verification of mediastinal lymphadenectomy for exact staging and treatment.Study of 29 patients with non-small cell lung carcinoma in stage IIIa, IIIb and IV (TNM classification) diagnosed from September 2006 to March 2007, with mediastinal lymph nodes invasion according to CT, and with subsequent mediastinal lymph node dissection during autopsy.50% of the right upper lobe tumors metastasized into group 1 nodes (N1-N4) and 50% into group 3 (N7). 66% of the right lower lobe tumors metastasized into group 3 nodes (N7) and 33.3% into group 1 (N1-4). 20.0% of the left upper lobe tumors metastasized into group 1 nodes (N1-4), 33.0% into group 2 (N5-6), 25.0% into group 3 (N7) and 16.7% into group 4 (N8-9). 23.5% of the left lower lobe tumors metastasized into group 1 nodes (N1-4), 23.5% into group 2 (N5-6), 23.5 % into group 4 (N8-9) and 29.5% into group 3 (N7). 27.6% of examined patients had false positivity of lymph node metastasis according to CT. Histological verification of suspect mediastinal lymph nodes via Endobronchial Ultrasound Biopsy (EBUS) or mediastinoscopy or thoracoscopy is crucial for determining the stage of the disease according to the TNM classification. False positivity of imaging methods in diagnostics of non-small cell brochogenic carcinoma can contraindicate up to quarter of potentially operable patients (Tab. 3, Ref. 11).mediastinal lymphadenopathy, bronchogenic carcinoma, lung cancer.
- Pancoast's Syndrome due to Fungal Abscess in the Apex of Lung in an Immunocompetent Individual: A Case Report and Review of the Literature. [Journal Article]
- Case Rep Pulmonol 2014.:581876.
Malignant tumours in the apices of the lungs, especially bronchogenic carcinoma (Pancoast tumours), are the most common cause of Pancoast' syndrome which presents with shoulder or arm pain radiating along the medial aspect of forearm and weakness of small muscles of hand with wasting of hypothenar eminence due to neoplastic involvement of C8 and T1 and T2 nerve roots of brachial plexus. There are a number of benign conditions which may lead to Pancoast's syndrome; fungal abscess located in the apex of lung is one of them. Oral or intravenous antifungals are the treatment of choice in this case and complete recovery is usual, whereas, surgical resection followed by chemoradiotherapy is the treatment of choice in case of Pancoast's syndrome due to lung cancers. Hence, tissue diagnosis is mandatory. Here, we report a case of apical fungal abscess causing Pancoast's syndrome in an immunocompetent individual of 35 years of age to raise the awareness among the clinicians regarding this rare clinical entity.
- Clinical reasoning: an unusual cause of transverse myelitis? Author response. [Comment, Letter]
- Neurology 2014 Aug 12; 83(7):666-7.
- Tumor lysis syndrome in a nonsmall cell lung cancer. [Journal Article]
- Conn Med 2014 Aug; 78(7):421-3.
Tumor lysis syndrome (TLS) is an oncologic emergency caused by intense tumor cell destruction resulting in profound electrolyte abnormalities. It is generally recognized as a consequence of cytotoxic therapy in particularly chemotherapy-sensitive tumors such as hematologic cancers. Despite having been primarily recognized in hematologic malignancies, TLS has been reported in solid tumors as well. We present a case of a 72-year-old female who developed TLS after receiving etoposide and carboplatin for a poorly-differentiated carcinoma with areas of small-cell differentiation metastatic to her liver. She had previously undergone a thoracotomy and resection for a poorly differentiated squamous cell cancer of the lung.
- An osteolytic metastasis of humerus from an asymptomatic squamous cell carcinoma of lung: a rare clinical entity. [Journal Article]
- Case Rep Pulmonol 2014.:636017.
Advanced lung cancer is complicated by skeletal metastases either due to direct extension from adjacent primaries or, more commonly, due to haematogenous dissemination of neoplastic cells. Lumber spine is the most common site for bony metastases in bronchogenic carcinoma. Proximal lone bones, especially humerus, are unusual sites for metastases from lung primaries. Small cell and large cell varieties of lung cancer are most commonly associated with skeletal dissemination. It is also unusual that an asymptomatic squamous cell carcinoma of lung presents with painful, soft tissue swelling with osteolytic metastasis of humerus which is reported in our case. Systemic cytotoxic chemotherapy, local palliative radiotherapy, adequate analgesia, and internal fixation of the affected long bone are different modalities of treatment in this advanced stage of disease. But the prognosis is definitely poor in this stage IV disease.
- [Hyponatremia in the course of small cell lung cancer--a case report]. [English Abstract, Journal Article]
- Pol Merkur Lekarski 2014 Jul; 37(217):49-52.
Hyponatremia is a common electrolyte disorder occurring in patients with malignancy. Typically, it runs in the form of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Among malignant diseases it is often ascertained from small cell lung cancer. In the form of paraneoplastic syndrome it may precede clinical and radiological symptoms malignant disease. Hyponatremia requires special attention because of the neurological consequences and the risk of death. We present a case of a patient in whom the occurrence of hyponatremia preceded the appearance of clinical symptoms of lung cancer and has been the reason to start the diagnosis. The normalization of serum sodium was the first signal response to chemotherapy. In contrast, a statement confirmed the recurrence of hyponatremia progression of the disease in the form of metastases to the central nervous system. Speeches hyponatremia refractory symptomatic treatment should be a cause of further investigation into the neoplastic process. Recurrent hyponatremia during or after treatment may suggest its progression. Therefore, monitoring the sodium level is required not only during treatment, but also after the oncological treatment.
- Targeted therapy in lung cancer: survival, quality of life improved for some patients. [Journal Article]
- Cancer 2014 Sep 1; 120(17):2625-6.
- ACR Appropriateness Criteria® nonsurgical treatment for locally advanced non-small-cell lung cancer: good performance status/definitive intent. [Journal Article, Review]
- Oncology (Williston Park) 2014 Aug; 28(8):706-10, 712, 714 passim.
Concurrent chemotherapy/radiotherapy has been considered the standard treatment for patients with a good performance status and inoperable stage III non-small-cell lung cancer (NSCLC). Three-dimensional chemoradiation therapy and intensity-modulated radiation therapy have been reported to reduce toxicity and allow a dose escalation to 70 Gy and beyond. However, the Radiation Therapy Oncology Group 0617 trial recently showed that dose escalation from 60 Gy to 74 Gy with concurrent chemotherapy in stage III NSCLC was associated with higher toxicity and worse survival. A "one size fits all" treatment approach may need to be changed and adapted to each patient's particular disease and unique biologic/anatomic features, as well as the most appropriate radiotherapy modalities for that patient. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application, by the panel, of a well-established consensus methodology (modified Delphi technique) to rate the appropriateness of imaging and treatment procedures. In instances in which evidence is lacking or not definitive, expert opinion may be used as the basis for recommending imaging or treatment.
- Double trouble: a case of concurrent de novo T790M and L858R EGFR mutations in treatment-naive advanced non-small-cell lung cancer. [Case Reports, Journal Article]
- Oncology (Williston Park) 2014 Jun; 28(6):526, 528, 530, 534.