Central Lung Carcinoma Research Articles

P1.09B.03 Ex-Situ Lung Transplantation without Heparinization: A Novel Surgical Approach for Locally Advanced and Central Lung Carcinoma

P1.09B.03 Ex-Situ Lung Transplantation without Heparinization: A Novel Surgical Approach for Locally Advanced and Central Lung Carcinoma

Patients with Pulmonary Artery Reconstruction or Double Sleeve Resection Show Inferior Survival than Patients with Bronchial Sleeve Resection for Non-small Cell Lung Cancer.

Sleeve lobectomy or resection with pulmonary artery reconstruction is a technique that allows for resection of locally advanced central lung carcinoma, preserving lung function, and is associated with lower morbidity and mortality than pneumonectomy. This survey aimed to assess the long-term survival comparing different types of sleeve lobectomy and identify risk factors affecting survival.All consecutive patients who underwent anatomical resection for primary non-small cell lung cancer with bronchial sleeve or pulmonary artery reconstruction in our department between September 2003 and September 2021 were included in this study. Cases with carinal sleeve pneumonectomy were excluded. Data were evaluated retrospectively.Bronchial sleeve resection was performed in 227 patients, double sleeve resection in 67 patients, and 45 cases underwent isolated lobectomy with pulmonary artery reconstruction. The mean follow-up was 33.5 months. The 5-year survival was 58.5% for patients after bronchial sleeve, 43.2% after double sleeve, and 36.8% after resection with vascular reconstruction. The difference in overall survival of these three groups was statistically significant (p=0.012). However, the UICC stage was higher in cases with double sleeve resection or resection with vascular reconstruction (p=0.016). Patients with lymph node metastases showed shorter overall survival (p=0.033). The 5-year survival rate was 60.1% for patients with N0 and 47% for patients with N1 and N2 status. Induction therapy, vascular sleeve resection, and double sleeve resection were independent adverse predictors for overall survival in multivariate analysis.Sleeve lobectomy and resection with vascular reconstruction are safe procedures with good long-term survival. However, double sleeve resection and vascular sleeve resection were adverse predictors of survival, possibly due to a higher UICC stage in these patients.

Incidental finding of lung carcinoma invading the left atrium

We report a clinical case of a 64-year-old male with known apical hypertrophic cardiomyopathy, who presented to the hospital with new-onset persistent atrial fibrillation. An electrical cardioversion (ECV) was planned after one month of anticoagulation therapy and transesophageal echocardiogram (TEE) was performed beforehand. During the TEE thrombus in the left atrial appendage was detected, as well as a heterogeneous, hyperechoic, vascularized and non-mobile structure in the left atrium (LA). The ECV was cancelled and the patient was sent for computerized tomography (CT) chest scan. It revealed a big mass in the right lung with macromorphology of central lung carcinoma. There was tumor infiltration of the pericardium and the LA, as well as adrenal and liver metastases. The patient was sent for bronchoscopy with biopsy.

VIRTUAL BRONCHOSCOPY FOR DETERMINING THE SIZE OF THE CHANGES IN CENTRAL LUNG CARCINOMA

Introduction: The size of the changes is important for determining the invasiveness of the process and the stage of development of the neoplastic processes of the lung. The use of the method of virtual bronchoscopy as a diagnostic method in central lung carcinoma provides non-invasive visualization, but also abilities to measure changes. Purpose: The study aims to present the results of the application of the VB method in determining the size of the changes in patients with central lung carcinoma. Methods: 130 patients, diagnosed with central carcinoma, went VB method, using 64 MDCT Siemens Definition AS. The criteria size of the changes in different localization (right or left) and sex (women, men) was considered in the work. Results: 98 men and 32 women, aged 26-83 years, diagnosed with central lung cancer were examined using the method of virtual bronchoscopy, in which the size of the changes was monitored. In central right carcinoma of men, the formations in CT ranged in average from 5 to 68 mm (36.5 ± 18.62) and the largest number of findings were of 21–43 mm (44.5 ± 14) in length. The length of the changes in men with central left carcinoma ranged from 0.45 mm to 31 mm (12.7 ± 10.59). The length of the changes in women with central right carcinoma was from 0.44 to 1.86 mm (6.45 ± 6.83), and in those with left localization - from 0.6 to 13.1 mm (10.35 ± 6.74). In men, all six groups of stenoses were presented, most of them with sizes over 20 mm, followed by those with sizes below 3 mm. In women, stenoses were presented in only 3 groups, most of which were less than 3 mm in size. A significant relation was found between the sex of the studied patients with central carcinoma and the length of the stenoses. Sex was a determining factor for the length of the stenoses (χ2 = 212.77, p = 0.0000). Conclusions: Virtual bronchoscopy allows accurate metry in all planes. The magnitude of the measured changes is important for determining the invasiveness of the process. The results obtained in VB should always be interpreted with axial and multiplanar images.

Localization and shape of stenoses in central lung carcinoma - Sensitivity and precision of MDCT VB and FB.

SummaryThe objective is to present diagnostic capabilities of virtual bronchoscopy (VB) and fiberoptic bronchoscopy (FB) for determining the localization and shape of stenoses in patients with central lung carcinoma. A systematic study was performed on 220 patients aged 11-83 (54.36±17.24) years with endobronchial disease using the FB and VB methods during the 2013-2017 period. Central carcinoma of the lung was found on VB in 130 patients and on FB in 120 patients. Other nosologic diseases were found in 22 patients. Right localization of central carcinoma prevailed over left localization in both sexes. A significant difference in the localization criterion was found in female patients examined by VB (U-test, p=0.01). VB and FB yielded 86.5% vs. 91.60% precision and 85% vs. 94.5% sensitivity. In conclusion, VB was found to be a successful noninvasive method for determining the localization of lung tumors and shape of stenoses, which are essential in the diagnosis of malignant processes.

Bronchoplasty using continuous suture in complete monitor view: a suitable method of thoracoscopic sleeve lobectomy for non-small cell lung cancer.

BackgroundOur study aims to determine the value of bronchial anastomosis using complete continuous suture.MethodsSix patients diagnosed with central lung carcinoma who were candidates for right-sided sleeve lobectomy and underwent sleeve resection of the right upper lobe by thoracoscopic surgical procedure.ResultsThe mean surgical time was 182 min (range, 110 to 260 min). The mean time of bronchial anastomosis was 49 min (range, 18 to 76 min). The mean bleeding was 110 mL (range, 50 to 260 mL). Median chest tube drainage was 305 mL (range, 200 to 600 mL). No perioperative deaths or major complications occurred. The postoperative bronchoscopy confirmed no stenosis. The mean follow-up time was 19.2 months (range, 7 to 34 months), and six patients were alive.ConclusionsBronchial anastomosis using complete continuous suture may be a suitable method in thoracoscopic sleeve lobectomy.

Clinical outcomes of photodynamic therapy in patients with central lung carcinoma in situ

Background: Bronchoscopic photodynamic therapy (PDT) is a treatment option for patients with early central lung cancer, especially ineligible for surgical resection. This study aimed to assess the clinical outcomes of curative PDT for patients with central lung carcinoma in situ (CIS). Methods: Five patients with central lung squamous CIS treated by PDT were analyzed. The PDT protocol was as followings: (1) intravenous photosensitizer (Photofrin for 1 patient or Photogem for 4 patients) 2mg/kg followed by bronchoscopic illumination 40–50h later using 630nm laser light, (2) the light dose of 100–200 J/cm with 2 cm length cylindrical type diffuser. Results: The patientswere allmalewithmedian age 70 (67–77). Five patients had each a squamous carcinoma in situ (Tis). Four lesions were synchronously detected with another main primary lung cancer (pathologic stage IA–IB). OneTiswas incidentally found during work-up for segmental lung atelectasis without other primary lung cancer. The rate of complete remission was 100% and median disease free survival (DFS) of PDT site was 74.0 months. There was no serious adverse event related to PDT. Median overall survival was not reached. 4-Year survival rate was 60%. Conclusion: PDT for central lung squamous CIS can achieve acceptable DFS and overall survival.

Irradiance measurements during treatment of actinic keratosis of the scalp with conventional photodynamic therapy

Background: Bronchoscopic photodynamic therapy (PDT) is a treatment option for patients with early central lung cancer, especially ineligible for surgical resection. This study aimed to assess the clinical outcomes of curative PDT for patients with central lung carcinoma in situ (CIS). Methods: Five patients with central lung squamous CIS treated by PDT were analyzed. The PDT protocol was as followings: (1) intravenous photosensitizer (Photofrin for 1 patient or Photogem for 4 patients) 2mg/kg followed by bronchoscopic illumination 40–50h later using 630nm laser light, (2) the light dose of 100–200 J/cm with 2 cm length cylindrical type diffuser. Results: The patientswere allmalewithmedian age 70 (67–77). Five patients had each a squamous carcinoma in situ (Tis). Four lesions were synchronously detected with another main primary lung cancer (pathologic stage IA–IB). OneTiswas incidentally found during work-up for segmental lung atelectasis without other primary lung cancer. The rate of complete remission was 100% and median disease free survival (DFS) of PDT site was 74.0 months. There was no serious adverse event related to PDT. Median overall survival was not reached. 4-Year survival rate was 60%. Conclusion: PDT for central lung squamous CIS can achieve acceptable DFS and overall survival.

Differentiation of Central Lung Cancer from Atelectasis: Comparison of Diffusion-Weighted MRI with PET/CT

ObjectiveProspectively assess the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) for differentiation of central lung cancer from atelectasis.Materials and Methods38 consecutive lung cancer patients (26 males, 12 females; age range: 28–71 years; mean age: 49 years) who were referred for thoracic MR imaging examinations were enrolled. MR examinations were performed using a 1.5-T clinical scanner and scanning sequences of T1WI, T2WI, and DWI. Cancers and atelectasis were measured by mapping of the apparent diffusion coefficients (ADCs) obtained with a b-value of 500 s/mm2.ResultsPET/CT and DW-MR allowed differentiation of tumor and atelectasis in all 38 cases, but T2WI did not allow differentiation in 9 cases. Comparison of conventional T2WI and DW-MRI indicated a higher contrast noise ratio of the central lung carcinoma than the atelectasis by DW-MRI. ADC maps indicated significantly lower mean ADC in the central lung carcinoma than in the atelectasis (1.83±0.58 vs. 2.90±0.26 mm2/s, p<0.0001). ADC values of small cell lung carcinoma were significantly greater than those from squamous cell carcinoma and adenocarcinoma (p<0.0001 for both).ConclusionsDW-MR imaging provides valuable information not obtained by conventional MR and may be useful for differentiation of central lung carcinoma from atelectasis. Future developments may allow DW-MR imaging to be used as an alternative to PET-CT in imaging of patients with lung cancer.

Diffusion-weighted magnetic resonance imaging in differentiation of postobstructive consolidation from central lung carcinoma

To prospectively evaluate diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiation of postobstructive consolidation from centrally located lung carcinomas by using apparent diffusion coefficients (ADCs). An institutional review board approved this study; informed consent was obtained from patients. Forty-nine consecutive patients (3 women, 46 men; mean age, 63.6 years; age range, 42-85 years) with lung carcinoma underwent DW MR imaging. Forty patients had central and nine patients had peripheral lung carcinomas. ADC of each lung carcinoma was calculated from DW MR images obtained with two different b values (0, 1000 s/mm(2)). In the final study group including 27 patients with central lung carcinoma accompanying distal lung consolidation (mean age, 67.2 years; 3 women, 24 men), ADCs of lung carcinomas were statistically compared among cytologic/histologic types and accompanying postobstructive consolidations. Unpaired t test was used for measurable variables with normal distribution, and Kruskal-Wallis variance analysis and Mann-Whitney U tests were used for the measurable variables without normal distribution. There was no significant difference between mean ADC values of all types of carcinomas (P=.302) and also between mean ADC values of central (1.91 +/- 0.7x10(-3) mm(2)/s) and peripheral carcinomas (1.58 +/- 0. 6x10(-3) mm(2)/s) (P=.224). The mean ADC value for the masses of central lung carcinoma with postobstructive consolidations was 1.83 +/- 0.75x10(-3) mm(2)/s, and for consolidation was 2.50 +/- 0.76x10(-3) mm(2)/s. ADC of central carcinoma masses was significantly lower than that of postobstructive consolidations (P=.003). ADC values of central lung carcinoma masses appear to be lower than accompanying postobstructive consolidations. ADC values could be considered useful as a differentiating parameter among central lung carcinomas and accompanying postobstructive consolidations.