Diagnosis Of Bronchogenic Carcinoma Research Articles

Clinicopathological Profile of Patients with Bronchogenic Carcinoma at a Tertiary Care Center in Western India

Background: Bronchogenic carcinoma is the most common malignancy all over the globe in terms of incidence and mortality, especially in males. Its increasing incidence in nonsmokers and females is also an important concern. Objectives: The objective of this study was to study various demographic, clinical, radiological, and histopathological features of patients with confirmed diagnosis of lung cancer. Patients and Methods: Patients with confirmed histopathological diagnosis of bronchogenic carcinoma attending a tertiary care center in western India were included in the study. Results: A total of 50 patients were studied. Of 50, 45 were male and 5 were female. Average age of the patient was 59.92 years. Forty-six (92%) patients were current or ex-smokers, whereas only 4 patients were never-smokers. Cough (90%) followed by chest pain (62%) was the presenting symptom. Soft-tissue density mass lesion was the most common radiographic finding. Adenocarcinoma (36%) followed closely by squamous cell carcinoma (32%) was the diagnosed histological subtype. Of 50, 9 (18%) patients had evidence of distant metastasis at the time of diagnosis. Conclusions: This study concludes that adenocarcinoma was the most common subtype even in smokers. A high index of suspicion and prompt investigations in a patient with respiratory symptoms should be employed to diagnose patients at an early stage.

Virtual Bronchoscopy as the Guide for Fiberoptic Bronchoscopy in Evaluating Tracheobronchial Disorders in the Bronchogenic Carcinoma

Fiberoptic bronchoscopy (FOB) is one of the important modalities in helping to uphold the diagnosis and stadium of bronchogenic carcinoma. However, FOB has some limitations, namely invasive, time-consuming, requiring sedation, intolerable in patients who are critically ill, and difficult to evaluate distal airway side of severe stenosis. To identify the imaging capability of virtual bronchoscopy (VB) examinations in evaluating abnormalities in the tracheobronchial in bronchogenic carcinoma. Observational study with total sampling. Data was obtained from the histopathologic with diagnosis of bronchogenic carcinoma in 1 year. Retrospectively, the data were obtained from the archives of thoracic CT examinations in Radiology and FOB examination in Lung Operating Room. The variables assessed were the finding of mass of endobronchial based on its location, the main bronchi constriction, lobar bronchi constriction, segmental bronchi constriction, and compression/tracheal deformity. The results of VB were examined by three radiologists independently and were then compared with the results of FOB. The observation results of VB and FOB were used to analyse the degree of conformity. There is a low level of agreement on the finding of endobronchial mass, lobar bronchi and segmental bronchi constriction, sufficient level of agreement on the main bronchial constriction finding. VB has a limited capacity to evaluate abnormalities of the tracheobronchial compared with FOB, but VB has an advantage in evaluating the patency of the distal airway of severe obstruction.

Correlation of Imprint and Crush cytology with Bronchoscopic biopsy in the diagnosis of Bronchogenic carcinoma

Introduction: Lung carcinoma is the most common cancer with 2.1 million (11.6%) newly diagnosed cases in 2018. Over the years, many cytotechniques have been developed but their combination with histology is still an area of controversy. Imprint and crush cytology are considered simple, rapid and cost effective for a low resource setting in the early diagnosis and management of lung cancer. Here, we aimed to assess the diagnostic accuracy of imprint and crush cytology and compare them with histopathology. Method: A prospective study was conducted from May 2017 to April 2018 at the Pulmonary medicine unit and Department of Pathology at National Academy of Medical Sciences (NAMS), Bir Hospital. A total of 53 patients were enrolled in the study who showed visible mass on bronchoscopy. Three to five bits of tissue were obtained, imprint and crush smear were prepared from them and the tissue were then sent for histopathological examination. The level of significance selected was p < 0.005. Results: The most common age group affected was 60-69 years. 91% cases were smokers, with a male predominance. The most common location of endobronchial growth was left upper lobe. 43 cases were malignant in biopsy. The sensitivity, specificity, accuracy and positive predictive value of imprint cytology was 71.05%, 87.50%, 73.91% and 96.43% respectively while that for crush cytology was 74.36%, 75%, 74.47% and 93.55% respectively. The diagnostic yield of imprint, crush smear and forceps biopsy were 52.8%, 58.4% and 81.1% respectively. Squamous cell carcinoma was the most common carcinoma in this study. Conclusion: Imprint and crush cytology yield additional information that can be complementary to endobronchial biopsy. They are convenient, do not burden the patients and thus can be carried out wherever possible during bronchoscopy.

Role of CT in differentiation between subtypes of lung cancer; is it possible?

BackgroundContext and purpose: lung cancer is the second in the incidence rate and the first in death rate in the United States of America in 2017. Its treatment depends upon the tumor staging as well as the histological subtype of lung cancer. CT has been the modality of choice for screening as well as diagnosis of lung cancer; however, few studies tried to correlate different CT features of lung cancer to certain pathological subtypes. Our study aims to assess the CT characteristics of the subtypes of bronchogenic carcinoma.ResultsSQCC shows a higher incidence of central location compared with the rest of the lung cancers (significance level of 50%, p value of 0.5), internal cavitations (significance level of 94.9%, p value of less than 0.05) as well as more frequency of higher stage within the study population, ADC shows significant predilection to peripheral location compared with the rest of the lung cancers (significance level of 94.9%, p value of less than 0.05).ConclusionThere is an evident correlation between the MDCT diagnosis of bronchogenic carcinoma and that of histopathology/cytology. The most common types are SQCC and ADC subtypes. The SQCC type of bronchial carcinoma tends to be central with the internal cavitations are common while ADC tends to be peripheral and solid.

The Utility of Transbronchial Needle Aspiration and Conventional Diagnostic Procedures in the Diagnosis of Bronchogenic Carcinoma

The Utility of Transbronchial Needle Aspiration and Conventional Diagnostic Procedures in the Diagnosis of Bronchogenic Carcinoma

Pulmonary tuberculosis and Warthin's tumor: Is this a sign for the underlying malignancy?

The enigmatic relationship between pulmonary tuberculosis (TB) and lung cancer has long been attracted clinicians and researchers alike. Knowing the dismal prognosis of advanced bronchogenic carcinoma, efforts are always made for its early diagnosis. Here, we report an interesting case of a 57-year-old patient in which three different disease entities, namely pulmonary TB, lung cancer, and salivary gland tumor, were present concurrently. Premature diagnostic closure led to delay in the diagnosis of bronchogenic carcinoma.

Role of Computed Tomography in Diagnosis of Bronchogenic Carcinoma with Histopathological Correlation

Role of Computed Tomography in Diagnosis of Bronchogenic Carcinoma with Histopathological Correlation

Immunohistochemistry Profile in the Diagnosis of Bronchogenic Carcinoma in A Tertiary Care Hospital

Immunohistochemistry Profile in the Diagnosis of Bronchogenic Carcinoma in A Tertiary Care Hospital

“Stop Smoking!” Do We Say It Enough?

Patients who continue to smoke after the diagnosis of bronchogenic carcinoma (BC) experience increased rates of morbidity and mortality. Evidence suggests that smokers are more likely to quit if they are counseled by their physicians. However, there may be a prevailing belief among physicians that treating tobacco dependence is futile in this population. The purpose of this study was to investigate whether physicians addressed smoking cessation with patients who were diagnosed with BC. A retrospective medical record review of patients who were diagnosed with BC between 2008 and 2010 was conducted at a community medical center using the hospital cancer registry. Demographic information including age, race, sex, stage, and smoking status at the time of diagnosis was collected. Evidence of tobacco cessation counseling was sought through billing codes, physician notes, and orders surrounding the time of diagnosis. A total of 948 patients were diagnosed with lung cancer between 2008 and 2010; 438 were current smokers at diagnosis, and only 36% were counseled on smoking cessation. On average, each patient encountered three different physicians in both the inpatient and outpatient settings. Of note, patients with stage I disease were 1.7× more likely to be counseled than those with stage IV disease (P=.017). Despite evidence that smoking cessation is beneficial even after the diagnosis of BC, physicians are not counseling their patients sufficiently. With the implementation of quality improvement programs, we expect smoking cessation counseling for patients with BC will improve.

“Stop smoking!”: Do we say it enough?

e17500 Background: There are clear benefits of smoking cessation after the diagnosis of Bronchogenic Carcinoma (BC). Patients who quit smoking after the diagnosis of BC report lower levels of pain and are less likely to develop a second primary tumor when compared to patients who continue to smoke after they are diagnosed. Persistent smoking is also associated with poor performance status and survival outcomes. Evidence suggests that smokers are more likely to quit if they are counseled by their physicians. Yet, there may be a prevailing belief among physicians that treating tobacco dependence is futile in this population. The purpose of this study was to investigate whether physicians addressed smoking cessation with patients who were diagnosed with BC. Methods: A retrospective chart review of patients who were diagnosed with BC was conducted at a community medical center between 2008 and 2010, using the hospital’s cancer registry. Demographic information including age, race, sex, AJCC stage, and smoking status at the time of diagnosis was collected. Evidence of tobacco cessation counseling was sought through billing codes, physician notes, and orders surrounding the time of diagnosis. Results: A total of 948 patients were diagnosed with lung cancer between 2008 and 2010. 438 were current smokers at diagnosis, 422 were former smokers, and 88 had never smoked. Of the 438 smokers, only 36% were counseled on smoking cessation. On average, each patient encountered 3 different physicians in both the inpatient and outpatient settings. Of note, Stage I patients were 1.7 times more likely to be counseled than those with Stage IV disease (p=0.017). There was no significant difference between the counseled group and the non counseled group in regards to age, race, or sex. Conclusions: In spite of evidence that smoking cessation is beneficial even after the diagnosis of BC, physicians are not counseling their patients sufficiently. Reasons physicians may fail to counsel include: an inability to effectively assess tobacco dependence, competing concerns during patient encounters, and reduced awareness of current quality measures. With the implementation of quality improvement programs, we suspect that smoking cessation counseling for patients with BC will improve in the community setting.

Clinical Utility and Economic Impact of Conventional Transbronchial Needle Aspiration of Mediastinal Lymphadenopathies in Bronchogenic Carcinoma

ObjectivesTo analyse the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations. Patients and methodsRetrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT. ResultsWe performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9% of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7%) that were diagnostic in 124 patients (64.6%). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1%). Staging mediastinoscopy was avoided in 67.6% of patients. The prevalence of mediastinal lymph node involvement was 74.4%, sensitivity of TBNA was 86.2% and negative predictive value was 63.6%. Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57€ per patient. ConclusionsTBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients.

“Stop smoking!” Do we say it enough?

268 Background: There are clear benefits of smoking cessation after the diagnosis of Bronchogenic Carcinoma (BC). Patients who quit smoking report lower levels of pain and are less likely to develop a second primary tumor when compared to patients who continue to smoke after they are diagnosed with BC. Persistent smoking is also associated with poor performance status and survival outcomes. Evidence suggests that smokers are more likely to quit if they are counseled by their physicians yet, there may be a prevailing belief among physicians that treating tobacco dependence is futile in this population. The purpose of this study was to investigate whether physicians addressed smoking cessation with patients who were diagnosed with BC. Methods: A retrospective chart review of patients who were diagnosed with BC was conducted at a community medical center between 2008 and 2010, using the hospital’s cancer registry. Demographic information including age, race, sex, AJCC stage, and smoking status at the time of diagnosis was collected. Evidence of tobacco cessation counseling was sought through billing codes, physician notes, and orders surrounding the time of diagnosis. Results: A total of 948 patients were diagnosed with lung cancer between 2008 and 2010. 438 were current smokers at diagnosis, 422 were former smokers, and 88 had never smoked. Of the 438 smokers, only 36% were counseled on smoking cessation. On average, each patient encountered 3 different physicians in both the inpatient and outpatient settings. Of note, stage I patients were 1.7 times more likely to be counseled than those with stage IV disease (p=0.017). There was no significant difference between the counseled group and the non-counseled group in regards to age, race, or sex. Conclusions: In spite of evidence that smoking cessation is beneficial even after the diagnosis of BC, physicians are not counseling their patients sufficiently. Reasons physicians may fail to counsel include an inability to effectively assess tobacco dependence, competing concerns during patient encounters, and reduced awareness of current quality measures. With the implementation of quality improvement programs, it will be interesting to see if smoking cessation counseling for patients with BC improves in the community setting.

Utilidad clínica e impacto económico de la punción transbronquial convencional de adenopatías mediastínicas en el carcinoma broncogénico

ObjectivesTo analyze the clinical utility and economic impact of conventional transbronchial needle aspiration (TBNA) in patients with diagnosis of bronchogenic carcinoma (BC) and mediastinal lymphadenopathies in thoracic computed tomography (CT). To assess the predictive factors of valid aspirations. Patients and methodsRetrospective observational study between 2006 and 2011 of all TBNA performed in patients with final diagnosis of BC and accessible hilar or mediastinal lymphadenopathies on thoracic CT. ResultsWe performed TBNA on 267 lymphadenopathies of 192 patients. In 34.9% of patients, two or more lymph nodes were biopsied. Valid aspirations were obtained in 153 patients (79.7%) that were diagnostic in 124 (64.6%). Multivariate analysis showed that factors associated with valid or diagnostic results are the diameter of the lymph node and the number of lymph nodes explored. TBNA was the only endoscopic technique that provided the diagnosis of BC in 54 patients (28.1%). Staging mediastinoscopy was avoided in 67.6% of patients. The prevalence of mediastinal lymph node involvement was 74.4%, sensitivity of TBNA was 86.2% and negative predictive value was 63.6%. Including mediastinoscopy and other avoided diagnostic techniques, TBNA saved 451.57 € per patient. ConclusionsTBNA is a clinically useful, cost-effective technique in patients with BC and mediastinal or hilar lymphadenopathies. It should therefore be performed on a regular basis during diagnostic bronchoscopy of these patients.

Pulmonary tuberculosis masquerading as bronchogenic carcinoma with lymphangitic spread of tumor

Pulmonary tuberculosis may present as a mass like lesion, which may mimic neoplasm. We report the case of a middle-aged lady presenting with cough, intermittent fever, hemoptysis and weight loss. A large non-cavitating mass lesion with thickening of the surrounding interlobular septa and adjacent right major fissure was demonstrated on CT scan. A diagnosis of bronchogenic carcinoma with lymphangitic spread of tumor was made on imaging appearance. Image guided biopsy confirmed tuberculosis. We reviewed the existing literature.

Abstract 5541: Molecular diagnostic tests to augment cytomorphologic diagnosis of lung cancer

Abstract Morphologic analysis of cytology samples obtained by transthoracic needle aspiration (TTNA) is one of the primary methods for diagnosing bronchogenic carcinoma. However, across multiple studies the false negative rate for cytomorphological analysis ranges from 0.2-0.3, and among those diagnosed with lung cancer, the false positive rate for diagnosing the sub-class of small cell carcinoma averages 0.09. These false results lead to additional invasive diagnostic studies and delay treatment. In an effort to augment accuracy and utility of cytopathologic evaluation of TTNA lung samples, we measured the previously reported c-myc x E2F-1/p21WAF1/CIP1 (p21 hereafter) gene expression index in cDNA samples from 78 non-malignant lung tissues and 57 lung cancer tissues. Using the optimal cut-off value, this test correctly classified 72/78 non-malignant and 50/57 malignant samples for a correct classification rate of 90% (95% CI 83.6% - 94.3%), sensitivity of 88%, and specificity of 92%. A CDKN2C/FOSL1 test for distinguishing non-small cell lung cancer (NSCLC) from small cell lung cancer (SCLC) had a PPV of 100% with 63% sensitivity. In order to optimize the robustness and utility of these tests, we developed qPCR methods that enable simultaneous measurement of each target gene and reference gene transcript relative to a known number of internal standard competitive template (CT) molecules using two-color flurometric analysis on real-time platform. For each gene, the native template was quantified with a sequence-specific FAM-labeled probe and the CT was quantified with a sequence-specific Quasar670 labeled probe. Results for each gene thus far demonstrate excellent linearity (R2 > 0.99, slope 1.0 +/- 0.05), relative accuracy (variance < 0.2), signal-to-analyte response (1.0 +/- 0.05) and precision (CV < 30%) over six orders of magnitude, and reliable detection of as few as 10 molecules. Assessing both the c-myc x E2F-1/p21 index and the CDKN2C/FOSL1 test promises to augment cytomorphologic diagnosis of bronchogenic carcinoma in TTNA samples biopsy samples. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5541. doi:1538-7445.AM2012-5541

Role of EBUS-TBNA in the diagnosis of bronchogenic carcinoma.

e17534 Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique of minimally invasive endoscopic staging and of great interest for the identification and staging of mediastinal and hilar lymph nodes in patients with suspected and/or known bronchopulmonary neoplasm. This study was to evaluate diagnostic yield and the safety of EBUS-TBNA in the diagnosis of bronchogenic carcinoma. Methods: Between July, 2009 and Feb, 2010, 95 patients with mediastinal / hilar lymphadenopathy and /or intrathoracic peritracheal or peribronchial masses previously detected with CT scan underwent EBUS-TBNA. No rapid onsite cytology was performed. Results: In all 95 patients, 60 cases of patients were newly diagnosed lung cancer through the pathological examination and clinical follow-up certification. In 60 lung cancer cases, 112 samples were obtained from lymph nodes (LNs) and 11 samples were obtained from intrapulmonary lesions. 58 cases of patients were diagnosed in 60 lung cancer cases, false negative in 2 cases. Sensitivity and specificity of EBUS-guided TBNA method in distinguishing benign from malignant LNs or thoracic masses was 96.67% and 100%, respectively. In absence of any major complication, the procedure was uneventful. Conclusions: EBUS-TBNA seemed a safe and effective technique in making bronchogenic carcinoma diagnosis for mediastinal/hilar LNs and intrapulmonary masses.

Comparative study of efficacy of brush cytology and transthoracic fine needle aspiration cytology in the diagnosis of bronchogenic carcinoma

Online: 20 July 2010DOI: http://dx.doi.org/10.3329/bmrcb.v36i1.4251 Bangladesh Med Res Counc Bull 2010; 36: 37-39

Role of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma

背景与目的本研究旨在评价超声支气管镜引导下的经支气管针吸活检（endobronchial ultrasoundguided transbronchial needle aspiration, EBUS-TBNA）对肺癌的诊断价值和安全性。方法于2009年7月-2010年2月，对95例胸部CT检查显示纵隔/肺门淋巴结肿大和/或胸内气管或支气管旁肿块患者进行EBUS-TBNA，并未采取现场细胞学方法进行检测。结果95例患者中，其中经病理学检查和临床随访验证新发肺癌患者60例。60例肺癌患者共穿刺112组淋巴结，肺内肿块11例。60例肺癌患者中通过EBUS-TBNA明确诊断58例，假阴性2例，敏感性为96.67%、特异性100%。EBUS-TBNA过程安全，全部病例无并发症发生。结论EBUS-TBNA是诊断肺癌安全、有效的方法。

Role of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma: Experience of a single institution in China.

To evaluate diagnostic yield and the safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal/hilar lymph nodes and intrapulmonary masses. Between July 2009 and February 2010, 95 patients with mediastinal/hilar lymphadenopathy and/or intrathoracic peritracheal or peribronchial masses detected with computed tomography underwent EBUS-TBNA. One hundred and twelve samples were obtained from lymph nodes (LNs) and 11 samples were obtained from intrapulmonary lesions. All patients had cytological evaluation by smears and/or tissue evaluation of aspiration specimens. Out of the 95 patients, 60 had lung cancer, 58 of these patients were diagnosed using EBUS-TBNA without onsite cytology assistance, false negative in 2 cases. Sensitivity the of convex probe EBUS-TBNA method in distinguishing benign from malignant lymph nodes or thoracic mass was 96.67%. In the absence of any major complications the procedure was uneventful. EBUS-TBNA seems a safe and effective technique in the diagnosis making bronchogenic carcinoma for mediastinal/hilar lymph nodes (LNs) and intrapulmonary masses.

Carcinoma broncogénico en pacientes con trasplante de órgano sólido. Papel de la cirugía

Background The incidence of neoplastic diseases is higher in patients undergoing solid organ transplant. However, the incidence of bronchogenic carcinoma (BC) is controversial. The objective of our study was to determine the incidence of BC in a large cohort of transplant patients and the role of surgery. Material and methods Until December 2006, 3596 patients underwent solid organ transplant at our institution; 24 (0.7%) patients subsequently developed BC, of which 6 (24%) were classified as clinical stage I and submitted to surgical treatment. Survival was estimated by the Kaplan-Meier method. Results Three patients received a liver transplant, two a kidney transplant and one a heart transplant. All were male and all had a smoking history. Mean age was 58.6 years. Two patients had cough, one accompanied by bloody expectoration, and BC was an incidental finding in the remaining cases. The interval between transplant and diagnosis of BC was 38.1 months. Epidermoid carcinoma was the most frequent histological type. Mean tumour size was 3.6 cm (range, 1.3–6). One tumour was classified as pathological stage IA, four as stage IB and one as IIB due to parietal pleural invasion. No patient died during the perioperative period and only one had a haemothorax which resolved with chest tube drainage. Mean hospital stay was 8.5 days (range, 7–11). The immunosuppression regimen was maintained continuously. In subsequent follow-up, one patient died from BC metastasis, one from sepsis, one from chronic renal failure, and three remained alive. The probability of survival at 5 years was 40%, and median survival was established at 5 years. Conclusions The incidence of BC in patients undergoing solid organ transplant and the proportion of patients diagnosed in early stages does not differ from non-transplant patients diagnosed with BC, which questions the role of immunosuppression in the genesis and aggressiveness of BC in transplant patients. Surgery may offer acceptable results in early stages, with acceptable rates of perioperative morbidity and mortality.