Diagnosis Of Pulmonary Carcinoma Research Articles

Exosome-mediated mechanisms in lung cancer metastasis and advancements in medical submission: A comprehensive review

Lung cancer holds a prominent position in cancer-related fatalities, contributing to a quarter of all cancer deaths, with metastasis accounting for a significant majority of these mortalities. Recent investigations have placed a growing emphasis on exosomes and their intricate role in driving the advancement of lung cancer. These investigations have shown that exosomes have a role in both the metastatic and pre-metastatic phases of cancer development by facilitating epithelial-mesenchymal transition (EMT), immune evasion, and angiogenesis. These nano-sized extracellular vesicles derived from lung tumors augment cell proliferation, angiogenesis and metastasis as well as exert control over anti-tumor immune activities and drug resistance during lung cancer. Furthermore, exosomes are investigated as valuable tools for liquid biopsy assessment, offering potential applications in the prognosis and diagnosis of pulmonary carcinoma. With their distinctive attributes of biocompatibility, stability in circulation, reduced toxicity and tumor specificity, exosomes present a promising avenue for delivering therapeutic agents. The current understanding of exosome-mediated pathways and cargoes points towards a rich source of potential therapeutic targets for managing pulmonary carcinoma metastasis and assessing prognostic significance in prognosis, diagnosis and combating resistance to tumor-targeting drugs.

Diagnosis of pulmonary carcinoma by chest ct and detection of serum CEA,SF levels

目的 探讨胸部CT和血清铁蛋白、癌胚抗原检测及联合应用诊断肺癌的价值.方法 选择肺肿瘤患者73例,均在治疗前行胸部CT检查和检测血清铁蛋白(SF)、癌胚抗原(CEA)两种肿瘤标志物浓度.分别计算两种方法单独及联合诊断肺癌的灵敏度,特异度、诊断正确率、阳性似然比和阴性似然比,并加以比较分析.结果 二法联合检测与二法单独检测相比灵敏度、诊断正确率最高,阴性似然比最低.结论 胸部CT和SF、CEA检测在肺癌诊断中具有较高价值,二者联合应用诊断肺癌具有互补作用。

An unusual cause of haemoptysis in a young male

Inflammatory myofibroblastic tumours are reported to occur in a variety of sites, including the head and neck, abdominal organs, central nervous system and urinary tract. They only rarely occur in the lung.We report a case of a 25-year-old male admitted with haemoptysis. His chest radiograph showed a peripheral right lung opacity and computed tomography revealed a right lower lobe soft tissue density mass. Bronchoscopy and fine needle aspiration were unhelpful. a diagnosis of pulmonary carcinoma was made, and the patient underwent a right lower lobectomy. On pathology, the tumor was found to be an inflammatory pseudotumor. These lesion are extremely rare, constituting less than 1% of pulmonary malignancies, but are known to occur in young patients. We believe clinicians need to retain an index of suspicion for the presence of this disease in young patients, which can masquerade as more common malignancies.

CT Bronchus Sign-Guided Bronchoscopic Multiple Diagnostic Procedures in Carcinomatous Solitary Pulmonary Nodules and Masses

CT bronchus sign (BS) designates a bronchus leading directly to a peripheral pulmonary lesion. The objective of this investigation is to determine the contribution of BS-guided bronchoscopic multiple diagnostic procedures (BMDPs) to the diagnostic yield of solitary nodules or masses (SPNMs) suspected of pulmonary carcinoma (PC). A prospective study was carried out in 92 patients with a 2–5 cm diameter SPNM at the level of third to fifth bronchial branching and without endobronchial tumors. Within 10 days after 2-mm CT scans were done, in each of 92, bronchial washing (BW), brushing (BR), transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBB) were performed respectively, via fiberoptic bronchoscopy (FB) under fluoroscopic guidance. In 40 (82%) of 49 with BS and in 19 (44%) of 43 without BS, FB established the diagnosis (p < 0.01). In 84 cases of PC, BW, BR, TBNA and TBB provided the diagnostic yields of 4% (3), 26% (22), 57% (48) and 49% (41), respectively; the combined yield reached 68% (57). A metastasis and a tuberculoma were diagnosed exclusively by TBB, and TBNA, respectively. All differences of diagnostic yield except that between TBNA and TBB (p > 0.05) were determined to be significant (p < 0.05). Thoracotomy verified diagnosis in 48 of 59 cases diagnosed and 19 of 33 undiagnosed by FB, and various tissue biopsies or clinical follow-up in 11 diagnosed and 14 undiagnosed by FB. The above data suggest that in the diagnosis of PC as a SPNM at the level of third–fifth bronchial branching, combining the guidance of CT BS, and BMDPs under fluoroscopic guidance can increase the yield considerably.

Induction of aryl hydrocarbon hydroxylase activity and pulmonary carcinoma

Aryl hydrocarbon hydroxylase activity in lymphoblasts from normal Finnish adults and from patients with pulmonary carcinomas and other types of malignancy has been studied by a modification of previously used techniques. High absolute induced aryl hydrocarbon hydroxylase activity was found in 39% of patients with untreated lung cancer but only in 15% of normal people. No increased frequency was found in the control group comprising other malignancies. The diagnosis of pulmonary carcinoma was made at a lower mean age (4.9 years younger) in the individuals with high aryl hydrocarbon hydroxylase activity than in those with low activity. High absolute aryl hydrocarbon hydroxylase activity was dominantly inherited in normal individuals, and the frequency of athe Ahb gene in the Finnish population was 8%.

Clinical value of pulmonary needle biopsy in diagnosis of pulmonary carcinoma.

In 92 consecutive pulmonary needle biopsies, preliminary diagnoses on the basis of radiological and clinical data were compared with cytological reports. Three groups emerged. In the first, of 43 cases with radiological changes typical for primary lung carcinoma and no clinical data making other diagnosis a plausible alternative, the cytologist found carcinoma cells in 37 and malignant lymphoma cells in one. A further 3 cases proved to be carcinomas at the histological examination. Two cases were not carcinomas. In the second group, where 30 patients displayed radiological changes less typical for primary diagnoses, or clinical/anamnestical data also supported alternative diagnoses, the cytologist found malignancies in 8 cases, carcinoid in one and no signs of malignancy in 21 cases. In 19 cases the patients were considered radiologically to have no malignancies. Malignant cells were found in none. It is concluded that in a certain group of patients, the diagnosis of pulmonary carcinoma can be made with reasonable accuracy from radiological and clinical data alone. Needle aspiration biopsy and similar techniques are of questionable value as routine procedures when the probability of this diagnosis is already very high on other grounds. Their use should be reserved for cases where plausible diagnostic alternatives are present.

Gallium-67 as a diagnostic tool in the evaluation of peripheral pulmonary lesions.

<b>le Roux, B. T., and Houlder, A. E. (1974).</b><i>Thorax</i>, <b>29</b>, 355-358. <b>Gallium-67 as a diagnostic tool in the evaluation of peripheral pulmonary lesions.</b> While Gallium-67 shows a high affinity for primary pulmonary tumours, benign pulmonary lesions also concentrate the isotope. In 50 consecutive patients in whom the diagnosis of pulmonary carcinoma was not achieved by other means, the exhibition of ⁶⁷Ga showed a positive scan in 36, of whom three, on histological evidence, certainly did not have a pulmonary carcinoma, and in three others radiographic diminution in the extent of the peripheral pulmonary lesion makes most unlikely the diagnosis of carcinoma. In seven of 14 patients in whom the scan was negative it was judged necessary to undertake surgical management. Scanning with ⁶⁷Ga may modify the extent of surgical resection in some with a negative scan but does not establish the diagnosis of carcinoma in those with a positive scan, is unsafe as a screening test on which to base the decision on the need for referral to a thoracic surgeon, and in particular does not distinguish between the three common causes of `chronic lung abscess9—chronic destructive pneumonia, cavitated carcinoma, and tuberculosis with cavitation and without tubercle bacilli in the sputum.

Planigraphy in the differential diagnosis of the pulmonary nodule, with particular reference to the notch sign of malignancy.

The detection of nodular lesions in the periphery of the lung by roentgen examination is now a common occurrence. Lesions as small as 3 mm. in diameter can be found when in a favorable position, and primary bronchogenic carcinomas, as well as metastases, as small as this have been reported. The major problem involved in the consideration of such lesions is the differential diagnosis as to the nature of the process producing what is commonly designated as a “coin” lesion. It has been estimated by some authors (2, 6, 12, 16) that there may be as many as thirty different causes responsible for the production of such a shadow. In 1948, one of us (L. G. R.) first observed a curious irregularity or, as it was then called, an umbilication, on the margin of a shadow in a lateral roentgenogram of the lung, in a case later proved to be undifferentiated carcinoma. The repeated observation of a similar finding in planigraphic studies of spheroidal nodules in the lung, which later proved to be malignant tumors, has led to a more extensive study and to a preliminary report of this finding as indicative of malignancy (14). With this particular sign in mind, we have reviewed all our cases of pulmonary disease found during the past five years in which planigraphic studies were made. Our object was to determine the value of such studies in the differential diagnosis of the peripheral lung nodule and to evaluate the significance of this “notch” sign in the diagnosis of pulmonary carcinoma. There were available to us some 550 cases in which lesions in the lung were suspected and more or less adequate planigraphic studies had been undertaken. Many of the studies proved to be insignificant; others were made for clear-cut tuberculosis and for similar reasons. We were able, however, to find some 132 cases in which planigrams were made to determine more clearly the nature of a peripheral nodule. In order to define the cases considered, we would clarify the term “peripheral nodule.” As used by us, it refers to what is commonly miscalled a “coin” shadow but actually represents a spheroidal nodule in the lung. Cases have been selected in which a density can be seen in the lung almost completely surrounded by air, so that it is clearly not a part of the mediastinal structures or the major bronchi and has a general, although not necessarily clear-cut, spheroidal form. The size has varied from 1 to 10 cm. in diameter. In 50 of the 132 cases the diagnosis was verified histologically. Of the proved cases, 24 were primary carcinomas of the lung and 8 metastases from various sources. There were 11 granulomas and 4 hamartomas. In 1 case the histologic evidence did not establish the diagnosis; in 2, exceedingly small lesions were actually not found at autopsy although the examination was not intensive enough to exclude them.