Progress in the application of 68Ga-Pentixafor PET/CT in lung cancer: a review.

Introduction to the Third Edition: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Lung Cancer in Sudan

Lung Cancer in Germany

New American College of Chest Physicians Lung Cancer Guidelines*: An Important Addition to the Lung Cancer Guidelines Armamentarium

Size matters

Wise Choices to Improve the Quality of Lung Cancer Care.

BackgroundPTTG-1 (pituitary tumor transforming gene) is a novel oncogene that is overexpressed in tumors, such as pituitary adenoma, breast and gastrointestinal cancers as well as in leukemia. In this study, we examined the role of PTTG-1 expression in lung cancer with regard to histological subtype, the correlation of PTTG-1 to clinical parameters and relation on patients' survival.MethodsExpression of PTTG-1 was examined immunohistochemically on formalin-fixed, paraffin-embedded tissue sections of 136 patients with small cell lung cancer (SCLC) and 91 patients with non-small cell lung cancer (NSCLC), retrospectively. The intensity of PTTG-1 expression as well as the proportion of PTTG-1 positive cells within a tumor was used for univariate and multivariate analysis.ResultsPTTG-1 expression was observed in 64% of SCLC tumors and in 97.8% of NSCLC tumors. In patients with SCLC, negative or low PTTG-1 expression was associated with a shorter mean survival time compared with patients with strong PTTG-1 expression (265 ± 18 days vs. 379 ± 66 days; p = 0.0291). Using the Cox regression model for multivariate analysis, PTTG-1 expression was a significant predictor for survival next to performance status, tumor stage, LDH and hemoglobin.In contrast, in patients with NSCLC an inverse correlation between survival and PTTG-1 expression was seen. Strong PTTG-1 expression was associated with a shorter mean survival of 306 ± 58 days compared with 463 ± 55 days for those patients with no or low PTTG-1 intensities (p = 0.0386). Further, PTTG-1 expression was associated with a more aggressive NSCLC phenotype with an advanced pathological stage, extensive lymph node metastases, distant metastases and increased LDH level. Multivariate analysis using Cox regression confirmed the prognostic relevance of PTTG-1 expression next to performance status and tumor stage in patients with NSCLC.ConclusionLung cancers belong to the group of tumors expressing PTTG-1. Dependent on the histological subtype of lung cancer, PTTG-1 expression was associated with a better outcome in patients with SCLC and a rather unfavourable outcome for patients with NSCLCs. These results may reflect the varying role of PTTG-1 in the pathophysiology of the different histological subtypes of lung cancer.

Chemotherapy and Survival in Non-Small Cell Lung Cancer: The Old Vexata Questio

Association of hypoxia inducible factor-1α polymorphisms with susceptibility to non–small-cell lung cancer

Introduction Lung cancer is the leading cause of cancer related death in the Western World. 1 Accurate staging is required to identify those patients with localised Non Small Cell Lung Cancer (NSCLC) who have resectable disease. Patients with Small Cell Lung Cancer (SCLC) or T4,N2-3 or M1 NSCLC are not suitable for surgery. Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) can help obtain a tissue diagnosis where Endobronchial Ultrasound (EBUS)-FNA or CT guided biopsy is not possible. 2 Methods We performed a retrospective search of prospectively recorded data on all patients who were referred for EUS-FNA between 2012 and 2015 for the following indications: Suspicious lung mass with or without associated lymphadenopathy. This group has been subdivided into those who underwent EUS-FNA to obtain a tissue diagnosis and those who already had a tissue diagnosis and the EUS-FNA was performed for tumour staging. Suspicious mediastinal or epigastric lymph nodes alone. This group has been subdivided into those for whom EUS-FNA was performed to investigate possible recurrence of previously resected lung cancer and those who had unexplained mediastinal or epigastric lymphadenopathy. Procedure: The EUS-FNA procedures were all undertaken by AJS or SP, with a 22 g FNA needle (Cook Ltd), using a standard linear echoendoscope with ultrasound (Pentax Ltd & Hitachi Ltd). We collected data on patient demographics, EUS findings and procedures, cytology and prior pathology and radiology using our electronic clinical reporting system Results 35 patients were referred for EUS-FNA for the diagnosis or staging of lung cancer during the study period. 2 patients were unsuitable candidates. 25 patients had a suspicious lung mass and 8 had suspicious lymph nodes alone. In the group with a suspicious lung mass, EUS-FNA led to a diagnosis of lung cancer in 15 patients with 7 patients having benign pathology. 3 patients already had a diagnosis of lung cancer; EUS-FNA led to upgrading of tumour stage in 1 patient. In the group with suspicious lymph nodes alone, 3 diagnoses of lung cancer were made. Of the remaining 5 patients, 4 had benign pathology and 1 had gastric cancer. No procedural complications were encountered in any patient. EUS-FNA therefore led to a diagnosis of lung cancer in 60% (18/30) of the cases referred without a prior diagnosis. Conclusion EUS-FNA is a useful modality in the diagnosis and staging of lung cancer when EBUS and/or CT guided biopsy fail to obtain a tissue diagnosis. References 1 Ferlay J, Shin HR, Bray F, et al . Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer . 2010 ;127:2893–917. 2 Colella S, Vilmann P, Konge L, et al . Endoscopic ultrasound in the diagnosis and staging of lung cancer. Endoscopic Ultrasound . 2014; 3 (4):205–212. Disclosure of Interest None Declared

Establishing the Diagnosis of Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

IntroductionHistologic classification of lung cancer plays an important role in clinical practice. Two main histological subtype of lung cancer: small-cell lung cancer (SCLC) and nonsmall-cell lung cancer (NSCLC) differ in terms of invasiveness, response to treatment, and risk factors, among others.AimsTo evaluate differences in acceptance of illness, level of perceived pain, and quality of life (QoL) between patients with SCLC and NSCLC.Materials and methodsTwo hundred and fifty-seven lung cancer patients, who were treated in 2015, completed Acceptance of Illness Scale, Visual Analog Scale for pain, and European Organization for Research and Treatment of Cancer 30-item Core Quality of Life Questionnaire and European Organization for Research and Treatment of Cancer 13-item Lung Cancer specific Quality of Life Questionnaire. Clinical and sociodemographic data were collected. For statistical analysis, the Student t-test and the Mann–Whitney U test were used. For comparisons among three or more groups, analysis of variance was employed.ResultsPatients with SCLC had significantly worse health as measured with the presence of metastases, parameters of lung function, comorbidities, and number of previous hospitalizations. The Acceptance of Illness Scale score and Visual Analog Scale score were significantly worse in patients with SCLC than in those with NSCLC (24.58±8.73 vs 27.05±9.06; p=0.046 and 4.81±2.01 vs 4.17±1.97; p=0.003). Patients with SCLC achieved worse scores of all aspects of QoL than patients with NSCLC. Comparison with the reference values showed that all dimensions of functioning are impaired in patients with lung cancer regardless of its type; only the role functioning in patients with NSCLC remains unaffected.ConclusionMonitoring of QoL, personalized approach to treatment, and interventions for symptom management should be conducted in a tailored manner. Socioeconomic status in lung cancer patients, especially those suffering from SCLC, needs to be addressed.

Sec62 Bridges the Gap from 3q Amplification to Molecular Cell Biology in Non–Small Cell Lung Cancer

From the Authors: We thank Drs. Maturu, Agarwal, and Rossi for their interest in our article (1). Drs. Maturu and Agarwal question the cost effectiveness of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) compared with standard bronchoscopy in the diagnosis of lung cancer. None of the patients included in our study had endobronchial disease, and we cannot agree with their statement that the vast majority of patients with lung cancer have abnormal endobronchial findings. Drs. Maturu and Agarwal also miss an important point regarding the utility of EBUS-TBNA in patients with lung cancer. Not only can EBUS-TBNA provide a lung cancer phenotype and genotype, but it also provides a highly accurate nodal stage, critical to determining the treatment options. EBUS-TBNA, therefore, provides considerable information in addition to that provided by bronchoscopy and may prevent the need for further investigations such as integrated positron emission tomography–computed tomography, endoscopic ultrasound–guided fine needle aspiration, and mediastinoscopy. We are currently investigating the clinical efficacy and cost effectiveness of EBUS-TBNA as an initial investigation after staging computed tomography scan in patients with suspected lung cancer (2). We agree with Dr. Rossi that the personalization of advanced non–small cell lung cancer (NSCLC) management has adjusted the spotlight onto tissue acquisition techniques and their interpretation. A paradox currently exists whereby patients with metastatic disease (in whom cancer phenotyping and genotyping is mandatory for best outcomes) have the smallest biopsies, whereas patients with considerably larger surgically resected specimens currently do not have systemic treatment tailored to their tumor. Dr. Rossi highlights the key role that the pathologist plays in deciding treatment options for patients with advanced NSCLC as well as the demands now placed on small biopsy samples. As well as the pathologist requiring more dedicated lung cancer expertise, the same may apply to pulmonologists. Evidence already exists that the presence of dedicated thoracic surgeons may result in better lung cancer outcomes (3). The number of centers using EBUS-TBNA as a diagnostic and staging tool continues to increase internationally. Although the learning curve to reach competency in the procedure may be short (4), the focus has been on procedure sensitivity, whereas the assessment of quality of samples generated has not yet been built into competency assessment. The centers included in our study are recognized for their expertise in lung cancer management, and it is unclear whether the results seen in our study may be generalizable to centers without specific expertise in lung cancer. Dr. Rossi calls for pathologists dedicated to lung cancer in each laboratory that receives lung cancer samples. However, given current progress and the prospect of further genetic targets in NSCLC reaching clinical utility in the very near future, perhaps the time has come to consider centers dedicated to lung cancer imaging and tissue acquisition as well as pathological diagnostics. This model may optimize the patient experience for lung cancer diagnosis and staging, raise standards of diagnostics to a more uniform level, be cost effective, and facilitate recruitment to clinical trials.

Present and Past Smoking History and Other Predisposing Factors in 100 Lung Cancer Patients