Benign Pulmonary Diseases Research Articles

Relationship between CT features and high preoperative serum carcinoembryonic antigen levels in early-stage lung adenocarcinoma

To assess the relationship between thin-section computed tomography (CT) features of primary tumour and high preoperative serum carcinoembryonic antigen (CEA) levels that reportedly suggest poor prognoses in early-stage lung adenocarcinoma. Two hundred and seventy-five consecutive patients who underwent resection of pathological stage I (T1-2aN0M0) adenocarcinomas with a maximum diameter of ≤ 3 cm (144 men, 131 women; mean age 67.8 years) were enrolled. CT features of the primary tumours and clinical characteristics of these patients were statistically evaluated to identify the factors associated with high serum CEA levels (>5 ng/ml). Eighty-one patients (29.5%) had high serum CEA levels. In univariate analysis, lower ground-glass opacity ratio (p < 0.001), lower tumour shadow disappearance rate (TDR: the ratio of tumour area in mediastinal window to that of lung window, p < 0.001), presence of notch (p = 0.015), and coexistence with bullae or honeycomb cysts (p < 0.001) were observed more frequently in the group with high serum CEA levels than that of the group with normal levels. TDR [odds ratio (OR) 0.984; 95% confidence interval (CI): 0.976-0.993; p < 0.001] and coexistence with bullae or honeycomb cysts (OR = 3.08; 95% CI: 1.55-6.12; p = 0.001) remained significant, even after adjusting patients' age, gender, and smoking status. Adenocarcinomas with lower TDR and coexisting with bullae or honeycomb cysts are associated with high preoperative serum CEA levels. Although some CEA elevations may be due to benign pulmonary diseases, such tumours are suspected to have poor prognoses, even for early-stage diseases.

Evaluation of matrix metalloproteinase‐2 in lung cancer

There is an obvious need to diagnose lung cancer using novel noninvasive and sensitive biomarkers. In this regard, the aim of the present study was to evaluate and compare sputum matrix metalloproteinase 2 (MMP-2) in relation to serum MMP-2 of lung cancer patients and other nonmalignant lung diseases in order to establish a new diagnostic and prognostic biomarker with a valid noninvasive technique. Group 1 included 32 newly diagnosed lung cancer patients and group 2 included 20 patients with benign pulmonary diseases. In addition, 38 healthy subjects served as control group. MMP-2 activity levels were evaluated in serum and sputum samples of the studied groups using ELISA and zymography techniques. There was a highly significant increase in serum and sputum MMP-2 levels in malignant group in comparison with benign and control groups. In addition, there was a significant difference in the levels of serum and sputum MMP-2 as regards the different histopathological types of lung cancer and advanced stages of lung cancer. Gelatin zymography was used to confirm the enzymatic activity of MMP-2. A higher MMP-2 activity was detected in lung cancer group in comparison with benign and control groups. Serum and to a larger extent sputum MMP-2 appear to be potential noninvasive markers for detecting lung cancer.

Berstdrücke an der zentralen Pulmonalarterie nach bipolarer Gefäßversiegelung – Untersuchungen an einem Ex-vivo-Modell

In every pneumonectomy due to a malignant or benign pulmonary disease the pulmonary artery must be centrally ligated and dissected. If a thoracotomy is undertaken the vessel is usually doubly ligated with a non-absorbable suture and then dissected. Alternatively a vessel stapler can be used. In a thorascopic procedure only the stapler can be used. In the search for a cheaper alternative we investigated whether a bipolar instrument as employed in thorascopy could be used and reused. The aim of this study was to investigate the static pressure performance of the closed vessel in an ex vivo non-perfused vessel model. From freshly slaughtered pigs the heart-lung block was removed. The central pulmonary artery was exposed. For sealing the vessel we used the bipolar sealing system MARSEAL®, Brothers Martin company (Tuttlingen, Germany), consisting of an HF generator and a MARSEAL slim instrument. Two groups were formed: group A (n = 49) Stromart SealSafe®, step G5 (automatic performance regulation, duration of use depending on impedance) and group B (n = 58) bipolar Stromart "Macrocoag" (power: 120 W, constant duration of use: 15 s). At the end of the pulmonary artery a pressure probe was implanted to digitally measure the pressure at the vessel sealing suture. After sealing the end of the artery, the vessel was slowly filled via an external source in order to determine the burst pressure. The burst pressure was reached as soon as the vessel suture started to leak. The average values of the 2 groups were then compared (t test for independent variables, significance set at p < 0.05). All examined vessels (n = 107) had the same vessel diameter of 15 ± 3 mm. The average value of the burst pressure in group A was 139.3 ± 62.17 mmHg, that in group B 124.8 ± 38.46 mmHg. The ranges of burst pressures were in group A 51-297.0 mmHg und in group B 60.75-244.5 mmHg. There was no significant difference between group A and group B (p = 0.071). Satisfactory burst pressures in the central pulmonary artery can also be achieved with the bipolar sealing instrument MARSEAL® and the impedance-controlled Stromart SealSafe®. However, because of the large scattering of the measured values, further studies are required.

Correlation study and significance of the EGFR expression in serum, lymph nodes and tumor tissue of NSCLC.

This study was designed to detect the protein expression of epidermal growth factor receptor (EGFR) among serum, lymph node, and tumor tissues, and to discuss their relationship and clinical significance. We investigated whether EGFR levels in serum and lymph nodes could be used as an effective method for non-small cell lung cancer (NSCLC) to diagnose and assess clinical stage. In 56 patients with NSCLC and 10 individuals with nonmalignant thoracic disease, we measured EGFR levels in serum using an enzyme immunoassay, and EGFR mRNA levels in lymph node and NSCLC tissues by quantitative real-time-polymerase chain reaction. We examined the correlation between them and with the clinical parameters. Serum EGFR levels substantially decreased after surgical treatment (P < 0.001). Serum EGFR levels were correlated with smoking, surgery, and pathological type after surgery (all P < 0.05). EGFR mRNA levels in lymph node and tumor tissues were correlated more closely with lymph node metastasis (P = 0.015. EGFR mRNA in tissues was higher than that of benign pulmonary diseases (P = 0.020). There was an obvious positive correlation among EGFR levels of serum and lymph node tissues (r = 0.764; P < 0.001), serum and tumor tissues (r = 0.616; P < 0.001), and lymph node and tumor tissues (r = 0.904; P < 0.001) in NSCLCs. The data suggest that detecting EGFR levels in serum and lymph node tissues could be a simple and effective method to diagnose and assess the clinical stage in patients with NSCLC.

Radiofrequency ablation of the great saphenous vein in an elderly patient with co-morbid disease : online article - case report

An 86-year-old male patient with hypertension, Parkinsonism, benign prostatic hyperplasia, cataract and chronic obstructive pulmonary disease had a history of coronary bypass surgery in two veins due to anterior myocardial infarction one year earlier. He presented with pain and feelings of paresthesia below the knee of his left leg, and had fallen twice. He had used compressions and venoprotective medication for two years and had also received physiotherapy but it had not alleviated the symptoms. He had varicose dilatations in the left leg and pigmentation and a recovered venous ulcer scar were present on the medial malleolus. The patient was classed as grade 4 according to the CEAP classification. Because there was no deficiency in the superficial femoral and popliteal veins, the patient was taken for endovenous ablation. He had no pain or sensation of heaviness in the legs on postoperative day 10, and the first, third and sixth months of check up. Endovenous ablation is a procedure that increases the quality of life and comfort in elderly patients, with minimal pain. Radiofrequency catheter procedures have proven to be more successful in patients of all age groups than procedures such as standard surgery and foam therapy.

Expression and clinical significance of IGF-1, IGFBP-3, and IGFBP-7 in serum and lung cancer tissues from patients with non-small cell lung cancer

The expression and clinical significance of insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), and insulin-like growth factor binding protein 7 (IGFBP-7) were investigated in serum and lung cancer tissues from 57 patients with non-small cell lung cancer (NSCLC). Lung cancer tissues at different pathologic stages (27 patients at stages I–II and 30 patients at stages III–IV), normal lung tissues from 17 patients with benign pulmonary disease, and serum samples from both lung cancer and benign pulmonary disease patients were collected during surgery. Enzyme-linked immunosorbent assay and avidin-biotin-peroxidase complex immunohistochemical staining were used to detect IGF-1, IGFBP-3, and IGFBP-7 expression in serum and tissues, respectively. The results show that expression of IGF-1 in lung cancer tissues and serum from NSCLC patients were significantly higher than in the control (P < 0.05). However, expression of IGFBP-3 and IGFBP-7 in cancer tissues and serum from NSCLC patients was significantly lower than in the control (P < 0.05). These results suggest that upregulation of IGF-1 and downregulation of IGFBP-3 and IGFBP-7 may be potential diagnostic biomarkers for NSCLC.

Gene methylation of Cyclin A1 and breast vancer dusceptibility gene 1 in non-smallcell lung cancer

Objective To explore the frequency of Cyclin A1 (CCNA1) and breast vancer dusceptibility gene 1 (BRCA1) gene methylation in patients with non-small cell lung cancer (NSCLC).Methods The methylation specific polymerase chain reaction (MSP) was used to measure the gene methylation status of CCNA1 and BRCA1 in 50 patients with clinically pathologically confirmed NSCLC (experimental group) and 20 patients with benign pulmonary diseases (control group) in order to establish the spectral type of Guangxi NSCLC related genes.Results In 50 cases of NSCLC,CCNA1 and BRCA1 methylation rate was 70.0％ (35/50) and 84.0％ (42/50) respectively.In control group,the DNA of these two genes was demethylated.Conclusion The detection of CCNA1 and BRCA1 gene DNA methylation status is beneficial for the diagnosis of Guangxi NSCLC. Key words: Non-small cell lung cancer; Cyclin A1; Breast vancer dusceptibility gene 1; Methylation

Single-Incision Thoracoscopic Lobectomy and Segmentectomy With Radical Lymph Node Dissection

Reports of single-incision thoracoscopic lobectomy and segmentectomy are rare. In this article, we present our experience with single-incision thoracoscopic lobectomy and segmentectomy and radical mediastinal lymph node dissection. Nineteen patients with early-stage malignancy or benign lung disease were treated with single-incision thoracoscopic lobectomy and segmentectomy at our institution between November 2010 and May 2012. The surgical approach began with a single incision at the fifth or sixth intercostal space at the anterior axillary line. A 10-mm video camera and working instruments were used at the same time in this incision site throughout the surgery. The perioperative variables and outcomes were collected and analyzed retrospectively. For the 19 patients included in the final analysis, 14 lobectomies and 5 segmentectomies were performed successfully without need for conversion. Among the 19 patients who underwent single-port video-assisted thoracoscopic surgery (VATS), 15 cases of cancer and 4 cases of benign pulmonary disease were noted. The mean operative time was 156±46 minutes, and the median number of lymph nodes retrieved was 22.9±9.8. Average blood loss was 38.4±25.9 mL. There were no deaths 30 days after surgery, and 2 cases of atelectasis were observed. Single-port VATS lobectomy and segmentectomy is safe and feasible for selected patients.

Tumor Markers in Patients with Benign and Malignant Pulmonary Diseases; Competitive Evaluation of ProGRP, NSE and Cyfra 21-1

The aim of the study was to verify the usefulness of biomarkers in lung cancer. Thus, serum levels of tumor markers, including Pro-gastrin-releasing peptide (ProGRP), Neuron-specific enolase (NSE) and Cyfra 21-1 were evaluated competitively in benign and malignant lung diseases. Serum samples of 469 consecutive patients were investigated in two different groups. Group 1(NSE, ProGRP) contained 90 cases of benign lung diseases and 140 patients with lung cancer, including 50 cases of small cell lung cancer (SCLC) and 90 cases of non-small cell lung cancer (NSCLC). Group 2 (Cyfra 21-1) enrolled 110 cases of benign lung disorders and 129 patients with lung malignancy, containing 30 cases of SCLC and 99 cases of NSCLC. Results of group 2 were compared to a control group of 80 healthy individuals. Results demonstrated statistically significant difference between benign and malignant lung diseases using tumor markers mentioned above. Further, data analysis of evaluated tumor markers in small cell lung cancer revealed, that NSE and ProGRP are highly significant tumor markers in this histological subtype. Regarding to NSCLC, Cyfra 21-1 proved to be the marker of choice in patients with large cell lung cancer. The paper also outlines some recent patents. Keywords: Benign lung diseases, Cyfra 21-1, non-small cell lung cancer, NSE, ProGRP, small cell lung cancer, tumor markers.

Treatment of Serum Ferritin Deficiency Regardless Haemoglobin Level

AbstractAbstract 5166 IntroductionThe concentration of serum ferritin is positively correlated with the size of the total body iron stores in the absence of inflammation. [1] It is mainly concentrated in the liver, spleen and bone marrow in humans. The serum ferritin is present in all cells of the body. [ 2] Normal values are generally 12 – 300 ng/mL for men and 12 – 150 ng/mL for women. Some patients have clinical symptoms of iron deficiency anaemia as fatigue, general weakness, hair loss, depressed mode although their haemoglobin and serum ferritin are in the lower normal values [3]. MethodPatients sample are 1- females 2- aged from 15–70 years 3-who have problems with oral iron either not getting benefit from it or can’t tolerated it or not compliant with oral iron treatment. On presentation patients subjected for the following tests and then repeated after one month of intravenous iron infusion 1- complete blood count, 2- serum ferritin, 3- serum vitamin B12 and folate, 4- HPLC, 5-G6PD, 6- Coagulation profile (INR, APTT), 7 – LFT and RFT. ResultsGroup 1: responded laboratory and clinically to treatment.Group 2: responded laboratory and clinically to treatment.Group 3: responded laboratory and clinically to treatment. DiscussionThree group of patients noticed:Group 1 Low Hb and low s. ferritin where symptoms of iron deficiency are exist in this group of patients.Group 2 Hb is normal and s. ferretin where symptoms of iron deficiency are exist in this group of patients.Group 3 both Hb and s. ferretin where symptoms of iron deficiency are exist in this group of patients.Group 4 control group was just observed and reassured.Iron is essential element in all cells of human [4], so when it is low it means dysfunctions in other cells and organs like hair, muscles and brain. ConclusionLower normal level of Serum Ferritin is enough for normal Hb level but it is may be not enough for normal functions in other organs where the iron is needed. So that why it might be need to treat S. ferritin deficiency and shouldn't wait to reach to the level of IDA. According to that it might be indicated to: 1- Treat patients when s. ferritin is low even if Hb is normal. 2 - Lower normal value has to be increased to at least to 50mg to ensure that not only Hb will become normal but also other organ function.Putting in mind that the range of Hb could reach to 305ng/ml without reaching to the toxic level of iron overload. Reference1.Serum Ferritin concentrations for the assessment of iron status and iron deficiency in populations, WHO/NMH/NHD/MNM 11. 22.Ahmet E. ERBAYCU, Hayriye UÇAR, Mehmet GÜLPEK, The Contribution of Serum Ferritin, Iron, Iron Binding Capacity and Bronchoalveolar Lavage Ferritin Levels in Differential Diagnosis of Lung Cancer from Benign Pulmonary Diseases, UHOD Say○/Number: 3 Cilt/Volume: 17 Y○l/Year: 20073.Iron Deficiency Anemia, Source Medical Disadbility Advisor4.Human homeostasis, Source:1.Serum Ferritin concentrations for the assessment of iron status and iron deficiency in populations, WHO/NMH/NHD/MNM 11. 22.Ahmet E. ERBAYCU, Hayriye UÇAR, Mehmet GÜLPEK, The Contribution of Serum Ferritin, Iron, Iron Binding Capacity and Bronchoalveolar Lavage Ferritin Levels in Differential Diagnosis of Lung Cancer from Benign Pulmonary Diseases, UHOD Say○/Number: 3 Cilt/Volume: 17 Y○l/Year: 20073.Iron Deficiency Anemia, Source Medical Disadbility Advisor4.Human homeostasis, Source:1.Serum Ferritin concentrations for the assessment of iron status and iron deficiency in populations, WHO/NMH/NHD/MNM 11.2 AimIs to assess the benefit of raise up Serum Ferritin level to a new higher reference lower value as 50 ng/mL instead of the present lower values, because the present lower normal value 11 ng/mL, may be enough to get haemoglobin to the normal level and function, but it seems not enough for normal functions of other different organs as the hair, muscles, brain, which could be the reason of hair lose, general weakness, fatigue, depressed mode, . ect although haemoglobin is normal and s. ferritin is low or in lower normal value. Disclosures:No relevant conflicts of interest to declare.

Diagnostic Role of Tumour Markers CEA, CA15-3, CA19-9 and CA125 in Lung Cancer

The aim of this study was to assess the diagnostic yield of the tumour markers carcinoembryonic antigen, carbohydrate antigen 15-3, carbohydrate antigen 19-9 and carbohydrate antigen 125, in serum and bronchoalveolar lavage fluid in a group of patients with bronchogenic carcinoma. Serum and bronchoalveolar lavage fluid samples were collected in a group of 90 patients with benign or malignant pulmonary diseases. After appropriate processing, tumour markers were determined by enzyme immunoassay. The diagnostic yields (sensitivity, specificity and predictive values) in each environment (serum and bronchoalveolar lavage fluid) were obtained by using "Receivers operating characteristic" curve. Determined individually, carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125, showed the greatest diagnostic accuracy in bronchoalveolar lavage fluid. Carbohydrate antigen 15-3 did so in serum. Carcinoembryonic antigen was the most relevant marker in bronchoalveolar lavage fluid. For the factors evaluated in this study, determination of carcinoembryonic antigen, carbohydrate antigen 19-9 and carbohydrate antigen 125 in bronchoalveolar lavage fluid were clinically more useful markers in comparison with serum, although the latter may also be helpful in certain situations. Although there is no specific tumour marker for lung cancer, the combination of several can be used to diagnose most patients with lung cancer and also to rule out false positive and negative cases.

The significance of pro-gastrin-releasing peptide for small cell lung cancer diagnosis

Objective To evaluate the clinical value of pro-gastrin-releasing peptide (ProGRP) for small cell lung cancer (SCLC). Methods Serum levels of ProGRP and neuron-specific enolase (NSE) were measured by both chemiluminescent immunoassay and electrochemiluminescent immunoassay in 46 patients with SCLC (26 patients with limited disease, 20 patients with extensive disease),51 patients with non-small cell lung cancer (NSCLC),45 patients with benign pulmonary diseases and 56 healthy subjects.Patients were recruited by the Affiliated Hospital of Medical College, Qingdao University,from September 2010 to April 2011.The receiver operating characteristic curves (ROC) was used to set the cut-off value of ProGRP and NSE and the areas under ROC(ROC-AUC).The sensitivity and specificity of ProGRP and NSE were analyzed for diagnosing SCLC. Results Serum levels of ProGRP in healthy subjects, benign pulmonary diseases, NSCLC and SCLC groups were 22.9(19.5-28.7), 23.7(20.0-27.8), 28.9 (23.8-34.7) and 370.9(129.4-1951.6) ng/L respectively; the serum levels of NSE were 14.1 (12.5-15.7), 13.3(10.3-15.3), 16.8(11.7-22.1) and 39.9(16.1-93.9) μg/L, respectively.The Kruskal-Wallis H test showed significantly difference amoun groups of ProGRP and NSE (H=92.116 and 55.481, P 0.05).The sensitivity of ProGRP (89.1%) was statistically higher than that of NSE in the SCLC group (71.7%, χ2=4.90, P 0.05).The combining detection of ProGRP and NSE had no influence on the sensitivity and specificity compared with ProGRP itself (91.3% vs 89.1%，94.6% vs 98.2%, χ2 were all 0.00,P>0.05).Using benign pulmonary diseases group as control, the largest Youden index point of ROC was used to set the cut-off value of ProGRP and NSE (49.5 ng/L and 23.1 μg/L).The ROC-AUC of ProGRP (0.95) was statistically higher than that of NSE (0.87) in the SCLC group (Z= 1.99, P 0.05).The sensitivity of ProGRP (84.8%) was statistically higher than that of NSE in the SCLC group (69.6%, χ2=4.00, P 0.05).The combining detection of ProGRP and NSE had no obviously influence on the sensitivity and specificity compared with ProGRP itself (87.0% vs 84.8%, 95.6% vs 97.8%, χ2 were all 0.00, P>0.05).Using NSCLC group as control, the largest Youden index point of ROC was to set the cut-off value of ProGRP and NSE (49.1 ng/L and 23.0 μg/L).The ROC-AUC of ProGRP (0.90) was statistically higher than that of NSE (0.76) in the SCLC group (Z= 2.90, P 0.05).The sensitivity of ProGRP (84.8%) was higher than that of NSE in the SCLC group (69.6%, χ2=4.00, P 0.05). Conclusion ProGRP has a higher diagnostic value than NSE in SCLC.(Chin J Lab Med, 2012,35:736-741) Key words: Lung neoplasms; Carcinoma; small cell; Peptide fregments; Recombinant proteins

Midkine mRNA expression in peripheral blood of patients with non-small-cell lung cancer and its clinical significance

Objective To evaluate the expression of human midkine mRNA in peripheral blood of patients with uon-small-cell lung caucer (NSCLC).Methods The levels of midkine mRNA expression in 78 patients with NSCLC,35 patients with lung benign lesion and 30 healthy volunteers were evaluated by SYBR Green Ⅰ real-time reverse transcription polymerase chain reaction (PCR).Results The relative midkine mRNA expression in patients with NSCLC (6.749 ± 1.117) was significantly lower than in patients with benign pulmonary disease ( 7.988 ± 0.633 ) and healthy wolunteers ( 8.156 ± 0.525 ) ( both P ＜0.05 ),but there was no significant differenee between the latter two groups ( P ＞ 0.05 ).Moreover,higher relative midkine mRNA expression in NSCLC patients was correlated with elinic al stages,differentiation,and metastasis ( P ＜ 0.05 ),but not with sex,age,smoking habit and pathological types ( P ＞0.05).Conclusion These findings support our hypothesis that midkine mRNA is a promising biomarker in peripheral blood of patients with NSCLC. Key words: Midkine; Tumor marker; Non-small-cell lung cancer

Proteomics-based analysis of differentially expressed proteins in the sera of stage I non-small cell lung cancer patients compared with those of benign pulmonary disease and healthy subjects

Objective To identify differentially expressed proteins related to stage I non-small cell lung cancer. Methods Sera were selected from 6 patients with stage I non-small cell lung cancer, 7 pa- tients with benign lung disease confirmed surgically and pathologically, and 15 healthy volunteers. Two-di- mensional gel electrophoresis （2-DE） and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS） were employed to screen and identify differentially expressed serum pro- teins between lung cancer group and the other two groups. Results The average protein spots were （323 _＋ 11 ）. Ninety differentially expressed protein spots between lung cancer group and the other two groups were screened with PDQuest software, including 67 overexpressed protein spots and 25 underexpressed protein spots. Fifty significantly differentially expressed protein spots were excavated and 5 proteins were success- fully identified via peptide mass fingerprinting using MALDI-TOF-MS, and all of them were overexpressed in the sera of lung cancer group, including Alpha-l-acid glycoprotein, C1 inhibitor, angiotensinogen, transferrin chain A and transthyrctin. Conclusion Five overexpressed proteins can be identified in the sera of stage I non-small cell lung cancer using 2-DE and MALDI-TOF-MS, which may serve as important can- didate biomarkers for early detection of non-small cell lung cancer. Key words: Lung neoplasms ; Proteomics ; Serum

Clinicopathological significance of lymphatic vessel density marked by D2-40 and E-cadherin expression in non-small-cell lung cancer

The aim of our study is to investigate the relationship between lymphatic vessel density (LVD) marked by D2-40 and E-cadherin expression and the clinicopathological characteristics of patients with non-small-cell lung cancer (NSCLC). Immunohistochemical analysis was used to detect the expression of D2-40 and E-cadherin in 46 archival surgical specimens of human NSCLC and 10 cases of benign pulmonary disease. The LVD positively stained with D2-40 was observed and counted. The LVD was mainly distributed in the tumor borderline. The LVD in NSCLC tissues was significantly higher than in benign lesions (p < 0.001), and the LVD marked by D2-40 was significantly associated with lymph node metastasis (p < 0.001). The reduced expression of E-cadherin was present in NSCLC tissues. The positive rate of E-cadherin expression was negatively correlated with TNM stage (p = 0.027), pathological grade (p = 0.032), and lymph node metastasis (p = 0.014), and not significantly correlated with histologic classification (p = 0.714) in NSCLC tissues. A correlation analysis showed that high LVD marked by D2-40 was correlated with reduced E-cadherin expression in NSCLC tissues (t = 36.476, p < 0.001). The new monoclonal antibody D2-40 can specifically recognize lymphatic endothelial cells in NSCLC tissue. The relationship between LVD marked by D2-40 and the reduced expression of E-cadherin and lymph node metastasis in NSCLC was demonstrated. The detection of D2-40 and E-cadherin may be used as an indicator of lymph node metastasis in NSCLC.

Endobronchial Ultrasonography With a Guide Sheath in the Diagnosis of Benign Peripheral Diseases

For appropriate treatment, such as the selection of antibiotics or initiation of steroid therapy, correctly diagnosing benign pulmonary diseases located at the periphery is vital. This study assessed the usefulness of bronchoscopy using endobronchial ultrasonography with a guide sheath (EBUS-GS) in the diagnosis of benign pulmonary diseases, especially those presenting peripheral nodular lesions. We retrospectively reviewed 159 patients with 171 peripheral pulmonary lesions (PPLs) that were subsequently diagnosed as benign diseases. To examine the role of bronchoscopy with EBUS-GS, the contribution of bronchoscopy was classified into 4 categories. We also retrospectively reviewed 24 patients with 25 PPLs that were subsequently diagnosed as benign diseases by bronchoscopy without EBUS-GS (historical control). The ultimate diagnosis of 171 PPLs included 45 cases of mycobacteriosis, 45 cases of bronchiolitis obliterans organizing pneumonia/chronic organized pneumonia (BOOP), 23 cases of bacterial pneumonia, 13 abscesses, 11 cases of sarcoidosis, and 34 other benign diseases. Among them, a definitive diagnosis was obtained by bronchoscopy with EBUS-GS in 99 lesions (58%). Lesions in which the probe was positioned within the lesion had a higher diagnostic yield (64%) than did lesions in which the probe was positioned adjacent to the lesion (52%) or outside the lesion (20%; P=0.01). The diagnostic yield of bronchoscopy with EBUS-GS was higher compared with that of the historical control (58% versus 28%; P=0.04). Bronchoscopy using EBUS-GS is a reasonable option as a diagnostic procedure for PPLs, even if they are suspected to be benign in nature.

Intralobar Pulmonary Sequestration Showing Increased Serum CA19-9

Carbohydrate antigen 19-9 (CA19-9) is a specific tumor marker of the biliary, pancreatic and gastrointestinal tracts. CA19-9 is occasionally elevated in serum in patiens with benign pulmonary diseases such as bronchiectasis, idiopathic interstitial pneumonia or collagen disease-associated pulmonary fibrosis. Intralobar pulmonary sequestration is an uncommon congenital lung anomaly. It is dissociated from the normal tracheobronchial tree and is supplied by an anomalous systemic artery. There have been some reports of elevation of CA19-9 in this lesion. We report a case of intralobar pulmonary sequestration with elevated serum CA19-9 in a 29-year-old man who was diagnosed with bronchiectasia of left lower lung field on general check up. He had no evidence of any malignant disease in pancreatobiliary or gastrointestinal tracts. Elevated serum CA19-9 level might be encountered with benign pulmonary disease such as pulmonary sequestration.

Biomarkers in the Lung Cancer Diagnosis: A Clinical Perspective

The propensity for tumor biomarkers to be detected in serum at an early disease stage has become an area of interest for clinicians. This study aimed to evaluate the efficiency of 7 tumor biomarkers, namely, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin 19 (CYFRA-21-1), alpha-fetoprotein, carbohydrate antigen-125 (CA-125), carbohydrate antigen-19.9 (CA-19.9), and ferritin, independently or in combination for the diagnosis of lung cancer. Electrochemiluminescence immunization was used to determine biomarker levels expressed in 530 patients with pulmonary disease and 229 healthy subjects. The observed levels of CEA, NSE, CYFRA-21-1, CA-125, and CA-19.9 in patients with pathologically confirmed lung cancer were significantly higher than those in patients with benign pulmonary disease or control subjects. Adenocarcinoma, squamous cell carcinoma, and small cell carcinoma of the lung were associated with the highest observed levels of CA-125, CYFRA-21-1, and NSE, respectively. Combining biomarkers successfully led to the diagnosis of lung cancer. CEA + NSE + CA-125 showed the highest sensitivity for small cell carcinoma, at 83.33%, whereas CEA + NSE + CYFRA-21-1 + CA-125 showed 94.11% sensitivity for squamous cell carcinoma. The combination of 6 biomarkers, namely, CEA + NSE + CYFRA-21-1 + CA-125 + ferritin + CA-19.9, showed 80.49% sensitivity for adenocarcinoma. Combining biomarkers significantly aided in the diagnosis of lung cancer. However, this increased sensitivity on combination was accompanied by a decreased specificity for lung cancer subtypes. Combining biomarkers appropriately increases their sensitivity and helps with the diagnosis of lung cancer.

Usefulness of Serum Anti-p53 Antibody Assay for Lung Cancer Diagnosis

Some tumor markers, including carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA 21-1), are used for the detection of lung cancer; however, their use is limited because of low sensitivities and high false-positive rates. To investigate the usefulness of an anti-p53 assay in detecting lung cancer and to compare the anti-p53 to CEA and CYFRA 21-1 tumor markers. Serum samples were collected from 82 patients with lung cancer. Sera were also collected from 79 patients with or without benign pulmonary disease for the control group. All 161 specimens were assayed for CEA, CYFRA 21-1, and anti-p53. The diagnostic performances of these markers were compared using receiver operating characteristic analysis. The receiver operating characteristic area under the curve values of CYFRA 21-1, CEA, and anti-p53 for discriminating lung cancers from benign or healthy conditions were 0.79, 0.81, and 0.79, respectively. Area under the curve for the 3 markers in combination was 0.90. The sensitivities of those markers for lung cancer detection were respectively 39.0%, 53.7%, and 34.1% at 94.9% specificity, and the cutoff levels at those sensitivities and specificities were 4.5 ng/mL for CYFRA 21-1, 5.4 ng/mL for CEA, and 2.7 U/mL for anti-p53. We found 79.3% positive results for patients with lung cancer by any of the 3 markers, and 12.2% were positive only for anti-p53. All patients without cancer had negative results for 2 or all 3 markers. Anti-p53 combined with other conventional markers is helpful in increasing the sensitivity and specificity for detecting lung cancer.

Molecular Imaging in Pulmonary Diseases

In this article, we consider a multitude of the latest techniques used for evaluating benign and malignant pulmonary diseases. Our review will include mostly clinically pertinent studies, but we have also included breakthrough basic science research that has potentially significant clinical implications. Molecular imaging enables noninvasive visualization and measurement of the dynamic molecular processes within living organisms. Early recognition of molecular and cellular malfunctions can help optimize diagnostic and therapeutic strategies.