Intrathoracic Lesions Research Articles

EP.11B.04 Differential Durable Responses in Intrathoracic Versus Overall Lesions of Non-Small Cell Lung Cancer Treated with Immunotherapy

EP.11B.04 Differential Durable Responses in Intrathoracic Versus Overall Lesions of Non-Small Cell Lung Cancer Treated with Immunotherapy

Comparison between Endobronchial Ultrasound-Guided Transbronchial Node Biopsy and Transbronchial Needle Aspiration: A Meta-Analysis.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be limited by the inadequacy of intact tissues, especially in patients with lymphoma, sarcoidosis, and lymph node tuberculosis. A novel technique called transbronchial node biopsy (TBNB) by forceps or cryoprobe has been proposed and studied to improve specimen quality and diagnostic yield. We performed a systematic review of studies describing the safety and sensitivity of EBUS-TBNB versus EBUS-TBNA in diagnosing intrathoracic lymphadenopathy/masses. We systematically searched MEDLINE, Embase, Cochrane, and China National Knowledge Infrastructure to identify studies focusing on the application of EBUS-TBNB for diagnosis of intrathoracic lymphadenopathy. The quality of each study was evaluated using the QUADAS-2 tool. Using inverse-variance (I-V) weighting, we performed a meta-analysis of diagnostic yield estimations. We also reviewed the complications related to the procedure. Thirteen studies were included in the final analysis. The meta-analysis yielded a pooled overall diagnostic yield of 77.80% (939/1,207) for EBUS-TBNA and 86.01% (834/958) for EBUS-TBNB, with an inverse-variance-weighted odds ratio of 3.13 (95% confidence interval [CI], 1.61-6.01; p = 0.0008) and I2 of 82%. The pooled diagnostic yield of EBUS-TBNB versus EBUS-TBNA for the diagnosis of malignancy (including primary lung cancer and extrapulmonary malignancy) was 84.53% (590/698) for EBUS-TBNA and 90.84% (476/524) for EBUS-TBNB, with an I-V-weighted OR of 2.33 (95% CI, 1.15-4.74; p = 0.02) and I2 of 64%. The pooled diagnostic yield of EBUS-TBNB versus EBUS-TBNA for the diagnosis of benignancy was 71.19% (252/354) for EBUS-TBNA and 86.62% (233/269) for EBUS-TBNB, with an I-V-weighted OR of 4.39 (95% CI, 2.00-9.65; p = 0.002) and I2 of 59%. The overall complications included bleeding (n = 11, 0.90%), pneumomediastinum (n = 6, 0.49%), pneumothorax (n = 6, 0.49%), pneumonia (n = 4, 0.33%), respiratory failure (n = 1, 0.08%), and haemoptysis (n = 1, 0.08%). The funnel plot analysis illustrated no major publication bias. EBUS-TBNB improves the overall diagnostic yield of sampling intrathoracic lymphadenopathy and mass lesions relative to EBUS-TBNA. The complication rate of EBUS-TBNB is higher than that of EBUS-TBNA but reportedly lower than that of surgical biopsies.

Retrospective evaluation of the agreement between thoracic point-of-care ultrasound and thoracic radiographs in cats with recent trauma: 111 cats.

Motor vehicular trauma, bite wounds, high-rise syndrome, and trauma of unknown origin are common reasons cats present to the emergency service. In small animals, thoracic injuries are often associated with trauma. The objective of this retrospective study was to evaluate limits of agreement (LOA) between thoracic point-of-care ultrasound (thoracic POCUS) and thoracic radiography (TXR), and to correlate thoracic POCUS findings to animal trauma triage (ATT) scores and subscores in a population of cats suffering from recent trauma. Cats that had thoracic POCUS and TXR performed within 24 h of admission for suspected/witnessed trauma were retrospectively included. Thoracic POCUS and TXR findings were assessed as "positive" or "negative" based on the presence or absence of injuries. Cats positive on thoracic POCUS and TXR were assigned 1 to 5 tentative diagnoses: pulmonary contusions/hemorrhage, pneumothorax, pleural effusion, pericardial effusion, and diaphragmatic hernia. When available ATT scores were calculated. To express LOA between the two imaging modalities a kappa coefficient and 95% CI were calculated. Interpretation of kappa was based on Cohen values. One hundred and eleven cats were included. 83/111 (74.4%) cats were assessed as positive based on thoracic POCUS and/or TXR. Pulmonary contusion was the most frequent diagnosis. The LOA between thoracic POCUS and TXR were moderate for all combined injuries, moderate for pulmonary contusions/hemorrhage, pneumothorax, diaphragmatic hernia, and fair for pleural effusion. Cats with positive thoracic POCUS had significantly higher median ATT scores and respiratory subscores compared to negative thoracic POCUS cats. The frequency of detecting intrathoracic lesions in cats was similar between thoracic POCUS and TXR with fair to moderate LOA, suggesting thoracic POCUS is useful in cats suffering from trauma. Thoracic POCUS may be more beneficial in cats with higher ATT scores, particularly the respiratory score.

Study on Computed Tomography (CT) Guided Transthoracic Fine Needle Aspiration Cytology (FNAC) in the Diagnosis of Intrathoracic Mass Lesions - Not Approachable by USG

Background: Intrathoracic mass is a general issue encountered by the physicians in whole world including Bangladesh. Accurate diagnosis is important for proper management. Percutaneous fine needle aspiration cytology (FNAC) has been extensively utilized and widely accepted as an important means of diagnostic technique. This study was performed to know and justify the computed tomography (CT) guided FNAC as a diagnostic modality for the diagnosis of intrathoracic masses which are non-approachable by ultrasonography (USG). Methods: It was a descriptive type of cross sectional study and conducted among 30 patients having ultrasonologically non approachable intrathoracic masses during the period of Feb 2016 to July 2016 in Combined Military Hospital (CMH), Dhaka considering selection criteria and informed written consent using purposive sampling technique. FNAC was done in all the patients. After further investigation, a definitive diagnosis was made. The analysis of the surgical specimen, the biopsy, the therapeutic response, and the clinical follow-up all contributed to the ultimate diagnosis. A comparison was done between the cytological and final diagnosis for thirty cases. Ethical issues were properly addressed. Results: Initially CT guided FNAC was carried out on all patients. Conclusive cytological diagnosis was possible in 28 patients yielding 93.33% diagnostic accuracy. FNAC diagnosed 24 cases as malignant intrathoracic mass, 04 as benign lesion and 02 undiagnosed due to inadequate tissue material. In final diagnosis 25(75%) diagnosed as malignant and 05(25%) diagnosed as benign. Diagnosis of two patients was impossible by FNAC due to inadequate tissue material. Conclusion: CT guided FNAC of intrathoracic mass allow early diagnosis with lesser trauma and lower cost. This procedure avoided more invasive diagnostic surgery. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 10-16

Abstract 2576: Radiomic features of intrathoracic lesions can predict the mixed response in non-small cell lung cancer treated with immunotherapy

Abstract Background: Although immunotherapy has emerged as a promising treatment for lung cancer, the decision to continue immunotherapy becomes challenging when mixed response (MR) occurs. This study is aimed to evaluate whether radiomic features from pre-treatment intrathoracic images can predict MR. Methods: 127 consecutive patients with NSCLC who received first line systemic treatment containing immunotherapy were included in this study. Chest CT scans were obtained at baseline and 1-3 times from 11 different CT scanners and harmonization method was applied to minimize scanner-related bias. The durable response of intrathoracic lesions (n=266) at least 24 weeks was evaluated based on RECIST 1.1 and irRECIST. MR was defined as the simultaneous presence of at least one lesion that increased and decreased in a single patient during immunotherapy and two different criteria of MR for the change of tumor lesions were applied: Definition-A (MR-A), Δ [baseline - first follow-up] ≥ 5 mm; Definition-B (MR-B), any change of Δ [baseline - first follow-up]. All intrathoracic lesions were identified and segmented by four different physicians. Radiomic features, including morphological, intensity, GLCM, GLRLM, GLSZM, and NGTDM, were extracted using LIFEX software (IMIV/CEA, Orsay, France). Confusion matrix was used to assess tumor responses, and area under the curve (AUC) for intrathoracic lesions was calculated. Results: Tumor responses based on irRECIST were CR (n=1, 0.8%), PR (n=33, 26.0%), SD (n=55, 43.3%), and PD (n=39, 30.7%). There were 10 cases (7.9%) of MR-A and 25 cases (19.7%) of MR-B. While the median progression-free survival (PFS) and overall survival (OS) in MR-A group were 22.9 (range, 0.5-50.6) and 23.5 (range, 1.1-42.2) months, those in MR-B group were 2.0 (range, 0.5-50.6) and 3.3 (range, 0.7-49.0) months respectively. While the overall sensitivity (SN) and specificity (SP) for MR-A in intrathoracic lesions were 0.55 and 0.87, those for MR-B were 0.52 and 0.71, respectively. The AUC for MR-A and MR-B were 0.71 and 0.62 respectively, and the AUC for durable response was 0.56. In the SD group, median PFS and OS were 3.3 (1.4-18.9) and 6.1 (4.8-26.2) in the MR-A group and 9.7 (0.7-18.9) and 23.9 (0.7-26.2) respectively in the MR-B group. Median PFS and OS were 18.2 (0.5-65.2) and 23.9 (0.9-55.3) respectively in the non-MR-A group and 18.2 (0.5-65.2) and 23.9 (0.9-55.3) respectively in the non-MR-B group. In the PD group, median PFS and OS were 23.5 (0.5-41.3) and 24.7 (1.1-42.2) respectively in the MR-A group and 5.1 (0.5-41.3) and 11.5 (1.1-49.0) respectively in the MR-B group. Median PFS and OS were 20.3 (0.7-71.4) and 37.1 (1.0-72.9) respectively in the non-MR-A group and 20.3 (0.7-71.4) and 37.1 (1.0-72.9) respectively in the non-MR-B group. Conclusion: The radiomic features in NSCLC patients who received immunotherapy may help predict MR in NSCLC patients treated with immunotherapy. Citation Format: Monica Yadav, Jeeyeon Lee, Peter Haseok Kim, Maria J. Chuchuca, Taegyu Um, Liam Il-Young Chung, Yury S. Velichko, Young Kwang Chae. Radiomic features of intrathoracic lesions can predict the mixed response in non-small cell lung cancer treated with immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2576.

Abstract 3844: Clinical implications of mixed response on prognosis of non-small cell lung cancer (NSCLC) patients treated with Immunotherapy

Abstract Background: Current methods for assessing the response of lung cancer patients to therapy (e.g. RECIST criteria) lack consideration for mixed response (MR) where some lesions increase while others decrease simultaneously. MR poses a challenge in deciding the continuation of therapy. Understanding the clinical implications of MR on patient prognosis within radiographic response categories is crucial for establishing effective treatment strategies for NSCLC. Methods: This study analyzed 177 NSCLC patients with ≥2 lesions receiving first-line systemic treatment with immunotherapy. Clinical response was evaluated by RECIST v1.1 and immune-related RECIST (irRECIST). MR was defined as the simultaneous presence of ≥1 lesion increase and ≥1 lesion decrease during therapy. Two different definitions of MR were utilized. Definition-A (MR-A): the simultaneous presence of one or more lesions increasing ≥5mm and one or more lesions decreasing ≥5mm during therapy (Δ [baseline - first follow-up] ≥ 5 mm); and Definition-B (MR-B): the simultaneous presence of one or more lesions increasing >1mm and one or more lesions decreasing >1mm during therapy (any Δ [baseline - first follow-up]). Subgroup analysis was conducted using 94 patients with only intrathoracic lesions. Results: Among the 177 patients, tumor responses based on RECIST were 3 CR (1.7%),42 PR (23.7%), 87 SD (49.2%), and 45 PD (25.4%). Based on irRECIST, responses were 3 CR (1.7%), 46 PR (26.0%), 89 SD (50.3%), and 39 PD (22.0%). MR-A and MR-B occurred in 19.8% (n=35) and 45.2% (n=80) of cases, respectively. In the irRECIST PD group, MR-A demonstrated significantly different median progression-free survival (mPFS) and median overall survival (mOS) compared to non-MR-A (p<0.020, p<0.005, respectively). The mPFS for MR-A group was 1.4 months (range 0.5-52.9) and non-MR-A group was 5.5 months (range 0.2-97.2) with the hazard ratio being 2.91 (95% CI 1.13-7.51). The mOS for MR-A and non-MR-A groups were 4.8 months (range 0.7-61.5) and 11.8 months (range 0.2-97.2), respectively, hazard ratio 4.87 (95% CI 1.43-16.56). No other significant results were found for other RECIST and irRECIST categories. Subgroup analysis of only intrathoracic lesion patients revealed no statistically significant results. Conclusion: Contrary to our hypothesis, MR did not modify prognosis within the RECIST or irRECIST category. MR-A or MR-B in the RECIST or irRECIST PD group did not show a better prognosis, indicating the complexity of mixed responses in NSCLC patients treated with immunotherapy. Further research with larger cohorts are warranted. Citation Format: Seyoung Lee, Taegyu Um, Jeeyeon Lee, Peter Haseok Kim, Monica Yadav, Maria J. Chuchuca, Liam Il-Young Chung, Young Kwang Chae. Clinical implications of mixed response on prognosis of non-small cell lung cancer (NSCLC) patients treated with Immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3844.

Evaluation of B-lines with 2 point-of-care lung ultrasound protocols in cats with radiographically normal lungs.

To compare 2 point-of-care lung ultrasound (LUS) protocols for quantification of B-lines in cats without evidence of respiratory disease based on history, physical examination, and thoracic radiography. Prospective observational study. Single center, veterinary teaching hospital. Fifty-seven cats without respiratory disease based on history, physical examination, and thoracic radiographs. All cats had 2 point-of-care LUS protocols performed bilaterally: a regional protocol (veterinary bedside lung ultrasound evaluation [VetBLUE]) and a more comprehensive vertical sweeping (VS) protocol. The total number of B-lines per cat, number of sites with B-lines, and maximal number of B-lines at each site were recorded and compared. Ten cats (18%) had at least 1 B-line identified with VetBLUE, versus 29 (51%) with VS. Comparing protocols, VS had a statistically higher total number of B-lines per cat, higher number of sites with B-lines, and higher maximal number of B-lines per site. B-lines that were too numerous to count were identified at a single location in 1 cat with VetBLUE and 2 cats with VS. A maximum of 3 B-lines were identified at all other positive sites regardless of the protocol used. On average, it took 1.79 times longer to complete VS bilaterally compared to VetBLUE (median [interquartile range]: 140 [33] and 78 [14]s, respectively) (P=0.001). This study demonstrates it is not uncommon to identify a single or even multiple B-lines in 1 or several sites on LUS in cats deemed to be clinically free of respiratory pathology-essential knowledge when using LUS as a screening test and to monitor intrathoracic lesions. In cats asymptomatic for respiratory disease, VS generally identifies more B-lines than VetBLUE, likely because it assesses a larger lung surface area. The sonographic identification of B-lines should be interpreted considering the LUS protocol used, history, and other diagnostics to determine their clinical significance.

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This article presents a rare clinical case of sarcoidosis of the nasal septum in combination with intrathoracic (pulmonary) lesions. Clinical observation demonstrates the intranasal changes characteristic of sarcoidosis and the importance of histological examination in its diagnosis.

Video Yardımlı Göğüs Cerrahisi Cerrahi Karar Vermenin Neresinde?: 497 Olgunun Değerlendirilmesi

Background: Video-assisted thoracic surgery (VATS) exploration is a frequently performed surgical intervention in thoracic surgery in cases such as pleural biopsy, mediastinal and hilar lymphadenopathy biopsies, hemothorax, air leak control. In this study, 497 patients were reviewed and extended indications of VATS exploration were revealed. Methods: All of the patients with radiologically detected intrathoracic pathology between 2009-2019 were included in the study. Preoperative, intraoperative and postoperative findings were evaluated retrospectively. Results: The clinical indications for VATS exploration were pleural effusion, intrapulmonary mass, cystic lesion, mediastinal lymphadenopathy or mass that has been investigated with a pre-diagnosis of malignancy or developed secondary to previously known malignancy, prolonged air leakage and / or lung expansion problems, mediastinal mass, hemothorax, pleural thickening or pleural nodule, chest wall tumor, pericardial cyst or effusion, chylothorax, and intrathoracic cavitary lesion. All patients with these indications were managed mainly with VATS exploration. Conclusion: Evaluation of operability criteria, and subtype determination for targeted therapies in the diagnosed patient, definitive diagnosis can be made and over-treatments can be prevented due to the precise biopsies can be taken with VATS exploration. We recommend the VATS exploration as a key step for all intrathoracic pathologies.

Transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration for diagnostic and staging purposes: a narrative review.

Transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) is a feasible and well-tolerated modality that is increasingly used to diagnose intrathoracic lesions. This narrative review summarizes the current application of EUS-B-FNA for diagnosing lung cancer, thoracic sarcoidosis, and metastases from extrathoracic malignancies. A comprehensive and systematic online literature search via Medline/PubMed for the period January 2005 to December 2022 was conducted for articles published using the keywords "EUS-B-FNA", "endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA)", "endoscopic ultrasound fine-needle aspiration (EUS-FNA)", "lung cancer", "staging", and "sarcoidosis". Recent data prove the efficacy and safety of EUS-B-FNA for providing complete lung cancer staging, when combined with EBUS-TBNA, and in the evaluation of para-esophageal lesions. EUS-B-FNA allows access to inferior mediastinal lymph nodes and para-esophageal masses that are not accessible by EBUS-TBNA. Additional advantages of using EUS-B-FNA include significantly lower doses of anesthetics and sedatives, a shorter procedural time, fewer incidents of oxygen desaturation due to a poor respiratory reserve, significantly less cough, and higher operator satisfaction. Moreover, this procedure can be performed sequentially in the same setting with EBUS-TBNA by one operator. Other benefits include a lower cost, a single setting, and scope use. As EUS-B-FNA and EBUS-TBNA have complementary access to the mediastinum, the diagnostic yield of EUS-B-FNA combined with EBUS-TBNA is higher than that of endosonographic techniques alone in the diagnostic workup of intrathoracic lesions.

USG and CT-guided cytomorphological profile of FNAC in deep-seated lesions

Abstract Introduction: Ultrasound and computed tomography-guided fine needle aspiration cytology play an important role in the diagnosis of deep-seated lesions such as intra-abdominal and intrathoracic diseases. Objective: To evaluate the efficacy of ultrasound (USG) and computed tomography (CT)-guided FNAC in the diagnosis of abdominal and intrathoracic lesions for one year, from January 2021 to December 2021. Materials And Methods: The study included 58 intraabdominal and 45 intrathoracic lesions. Cytological findings were correlated to clinical and radiographic data to arrive at a definitive diagnosis. Results: Fine needle aspiration cytology was performed at various anatomical sites: liver (24 patients), colon (9 patients), gallbladder (5 patients), ovary (6 cases), spleen (3 cases), mesentery (3 cases), omentum ( 3 cases), cecum (2 cases), pancreas (1 case), subhepatic lesions (1 case), lung (43 cases), mediastinum (2 cases). The most common intra-abdominal disease was metastatic adenocarcinoma of the liver (14 patients), and the most common intrathoracic disease was lung adenocarcinoma (18 patients). Conclusion: Ultrasound and computed tomography-guided fine needle cytology is an excellent method for deep diagnosis in the abdominal and thoracic cavity.

Diagnostic value of endobronchial ultrasound elastography in differentiating between benign and malignant hilar and mediastinal lymph nodes: a retrospective study.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a first-line approach for diagnosing hilar and mediastinal lymph node metastasis. Endobronchial ultrasound (EBUS) elastography is an imaging technique for describing the elasticity of intrathoracic lesions. However, the reported accuracy of EBUS elastography needs to be improved. In this study, we aimed to explore the diagnostic value of EBUS elastography for differentiating between benign and malignant hilar and mediastinal lymph nodes. We conducted a single-center, retrospective study enrolling consecutive patients who received EBUS elastography followed by EBUS-TBNA at the Chinese PLA General Hospital from October 2015 to October 2022. The pathological results of EBUS-TBNA confirmed by 6-month follow-up were used as the gold standard. The ultrasound elastography parameters of lymph nodes included strain rate, stiff area ratio, and elasticity score, along with the conventional ultrasound characteristics such as short axis diameter, shape, margin, echogenicity distribution and intensity, and blood flow. The diagnostic performance of these parameters was compared, and conjointly analyzed using multivariate logistic regression. Bootstrapping resampling was applied for internal validation of the regression model. A total of 83 patients were enrolled with an average age of 57 years, and 66.3% of patients were male. In total, 131 lymph nodes were punctured, among which 79 (60.3%) were malignant. All the conventional ultrasound characteristics were significantly different between benign and malignant lymph nodes. All the ultrasound elastography parameters of malignant lymph nodes were markedly higher than those of benign lymph nodes. Multivariate logistic regression analysis showed that the margin, echogenicity intensity, blood flow, short axis diameter, and stiff area ratio were the main factors affecting the lymph node property. The diagnostic accuracy, sensitivity, and specificity were 91.8% [95% confidence interval (CI): 85.4-96.0%], 94.4% (95% CI: 86.4-98.5%), and 88.0% (95% CI: 75.7-95.5%), respectively. Bootstrap resampling validation showed a concordance index (C-index) of 0.949. The calibration plot indicated good agreement between the predicted and observed results. EBUS elastography is a promising approach for differentiating between benign and malignant lymph nodes. The combination of conventional EBUS and elastography can improve diagnostic efficacy, provide reliable complementary information, and guide the implementation of EBUS-TBNA more accurately.

Hypertrophic Osteopathy Associated with Lung Adenocarcinoma in a Cat: An Overview

Abstract Hypertrophic osteopathy (HO) is a pathological condition characterized by progressive, bilateral and symmetrical periosteal bone hyperostosis. Hypertrophic osteopathy is considered a secondary disease that occurs as a consequence of many chronic processes, which are primarily localized in the thoracic cavity (intrathoracic lesions), and less as a result of changes in the abdominal cavity (extrathoracic lesions). We describe a case of a 3.5-year-old female unneutered short-haired cat with a history of chronic weight loss, decreased appetite, dyspnea, and wet cough. During the native X-ray examination of the thoracic cavity, a clearly limited homogeneous radiopaque shadow which covered the entire thoracic cavity was found, as well as periostitis of the front limbs, mainly on the humeri, radii and ulnae. After euthanizing the cat, a control X-ray examination and necropsy of the body was performed. The necropsy revealed a soft-tissue proliferation measuring 13 x 5 x 4 cm and weighing 228 g, and a pronounced ossified periostosis of the long bones, while the histopathological findings revealed adenocarcinoma of the lung with metastasis to the mediastinal lymph nodes. The outcome of hypertrophic osteopathy mostly depends on the primary cause. If the initial lesion had been identified and removed on time, the condition would have also receded spontaneously. The primary tool in determining hypertrophic osteopathy is X-ray diagnosis. Considering the determination of this condition is an indicator of ongoing severe disease, especially in the thoracic cavity, its early diagnosis would lead to prolongation of the animal's life.

The upper airway parameters: the potential diagnostic clues for congenital intrathoracic lesions

BackgroundThe diagnosis of congenital intrathoracic lesions still has limitations. The airway development was influenced by intrathoracic factors. Whether the diagnostic value of the upper airway parameters in congenital intrathoracic lesions has not been confirmed.ObjectivesWe aimed to compare fetal upper airway parameters between normal fetuses and fetuses with intrathoracic lesions, and we tried to verify its diagnostic value in intrathoracic lesions.MethodsThis was an observational case–control study. In the control group, 77 women were screened at 20–24 weeks’ gestational age, 23 were screened at 24–28 weeks’ gestational age, and 27 were screened at 28–34 weeks’ gestational age. In the case group, 41 cases were enrolled (6 cases of intrathoracic bronchopulmonary sequestration, 22 of congenital pulmonary airway malformations, and 13 of congenital diaphragmatic hernia). Fetal upper airway parameters (tracheal width, the narrowest lumen width, and width of the subglottic cavity and laryngeal vestibule) were measured using ultrasound equipment. The correlations between fetal upper airway parameters and gestational age, and the differences in fetal upper airway parameters between cases and controls, were analyzed. The standardized airway paraments were acquired, and their potential diagnostic value for congenital intrathoracic lesions were analyzed.ResultsThe fetal upper airway parameters of both groups were positively correlated with the gestational age: The control group, tracheal width (R2 = 0.569, p < 0.001), narrowest lumen width (R2 = 0.429, p < 0.001), subglottic cavity width (R2 = 0.551, p < 0.001), laryngeal vestibule width (R2 = 0.349, p < 0.001). The case group (tracheal width R2 = 0.474, p < 0.001) narrowest lumen width (R2 = 0.425, p < 0.001), subglottic cavity width (R2 = 0.623, p < 0.001), laryngeal vestibule width (R2 = 0.347, p < 0.001). Fetal upper airway parameters of the cases group were smaller than those of the controls group. The tracheal width in fetuses with congenital diaphragmatic hernia was the smallest among the other case groups studied. The standardized tracheal width has the best diagnostic value for congenital intrathoracic lesions in the standardized airway paraments (the area under the ROC curve was 0.894), and has a high diagnostic value for congenital pulmonary airway malformations and congenital diaphragmatic hernia (the area under the ROC curve was 0.911 and 0.992, respectively).ConclusionFetal upper airway parameters differ between normal fetuses and fetuses with intrathoracic lesions, and might offer potential diagnostic clues for congenital intrathoracic lesions.

EBUS ROSE‐guided cytological evaluations of intrathoracic lesions. Assessments of the pathological material adequacy and the diagnostic efficacy

Several clinical groups consider cytological assessment under EBUS (Endobronchial Ultrasonography)-ROSE (Rapid Onsite Evaluation) as the golden standard for diagnosis and staging of intrathoracic lesions. On the other hand, some investigators proposed that EBUS-TBNA (Transbronchial Needle Aspiration) has considerably high false-negative rates for diagnosis. In this study, we analyzed our patient cohort (n = 152) with intrathoracic lesions and suspected malignancies evaluated by EBUS-ROSE. Our specific aims were: (i) to determine whether EBUS-ROSE could provide sufficient pathologic material for diagnosis and staging; (ii) to determine the fidelity of EBUS-ROSE-guided initial diagnoses in comparison to paraffin block diagnoses; (iii) to evaluate whether anatomical localization of sampled lymph nodes associate with material adequacy and final diagnoses. NCSS (Number Cruncher Statistical System) 2020 Statistical Software (Utah, USA) was used for statistical analysis. In EBUS-ROSE cytological assessment, material adequacy was determined in 50,7% (n = 77) of the cases. Considering the paraffin block pathology as the golden standart, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates of EBUS-ROSE were 90,2%, 93,1%, 94,8%, 87,1%, and 91,4%, respectively. There was no statistically significant difference between the final pathology and EBUS cytology results (p > .05) with a non-random Kappa agreement rate as 82.9%. There were differences in material adequacy and diagnoses according to the localization of sampled lymph node stations. EBUS-ROSE is efficient to decide for the adequacy of the pathological specimen and provides diagnoses with reliable fidelity.

Combination of Endobronchial Ultrasound and Modern Cytological Diagnosis in Patients With Intrathoracic Lesions

Objective: To evaluate the effectiveness of endobronchial (EBUS) and endoscopic ultrasound (EUS) in cytomorphological verification of a malignant process using the transbronchial needle aspiration (TBNA) of the lymph nodes and mediastinal organs.Materials and methods: In 2017–2019 we analyzed the cytological samples (standard and cell block) of 172 patients (115 males and 57 females) with an average age of 61 years (25–82 years) in the clinical diagnostic laboratory of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). Of them 111 were used for immunocytochemical analysis. The majority of the studies (77) were performed in patients with lung cancer in order to identify the stage of the disease. We used combined bronchoscopy under general anesthesia in the operating room with high-frequency ventilation and a rapid on-site evaluation (ROSE).Results: We found the lymph node and mediastinal invasion in 140 (81%) patients who underwent EBUS-EUS TBNA. The non-diagnostic results were obtained in 32 (19%) patients. The combination of EUS and EBUS with TBNA showed the highest effectiveness in the mentioned clinical cases. The sensitivity, specificity, and accuracy of the cytologic analysis during EBUS and EUS with TBNA and no ROSE were 89%, 100%, and 90%, respectively. ROSE reduced the rate of non-diagnostic results and increased the sensitivity (96%), specificity (100%), and accuracy (97%) of the cytologic evaluation.Conclusions: According to the obtained results, we recommend using EBUS-EUS TBNA modalities for morphological verification of the mediastinal lymph nodes as a routine invasive diagnosis component of the preoperative evaluation in patients with lung cancer.

Factors Influencing Diagnostic Success of Computed Tomography-guided Transthoracic Needle Biopsy in Intrathoracic Lesions: An Experience of a Reference Chest Disease Hospital

Factors Influencing Diagnostic Success of Computed Tomography-guided Transthoracic Needle Biopsy in Intrathoracic Lesions: An Experience of a Reference Chest Disease Hospital

Prediction factors in surgical treatment of intragrawn kidney cancer metastasis

Background . The incidence of distant metastases of intrathoracic localization in kidney cancer, including intrathoracic lymph nodes, makes the problem of identifying and introducing knowledge about prognostic factors into clinical practice when using the surgical treatment of this disease urgent. Aim . To identify prognostic factors in the surgical treatment of intrathoracic metastases of renal cancer. Materials and methods . In this work, a retrospective analysis was carried out of a group of 100 patients with intrathoracic cancer metastases, almost who underwent surgical treatment in the form of removal of distant metastases. We analyzed the clinically significant factors associated with the prevalence of the tumor process in the lungs, which could affect the long-term results of treatment, as well as the influence of various instrumental research methods on the frequency of detection of intrathoracic lesions. In addition, the influence of the choice of surgical approach and the volume of surgery on the long-term survival of this group of patients was analyzed. Results . 40 (40 %) patients had synchronous and 60 (60 %) had metachronous lung metastases. 63 (63 %) had open and 36 (36 %) – thoracoscopic surgery, 1 (1 %) patient underwent a transdiaphragmatic resection. 70 (70 %) patients had atypical lung resections. 5-year overall survival was 53.4 %, 5-year progression-free survival – 43.1 %. There was no postoperative mortality and no grade 3–4 morbidity. Following factors were associated with an overall survival during a single-factor analysis: bilateral lung lesions (р &lt;0.0001), R0 resection (р = 0.002), Munich scale (р = 0.007). Only bilateral lung lesion were associated with an overall survival during a multifactor analysis (р = 0.001). Conclusions . Removal of intrathoracic metastases of kidney cancer in the lung can lead to long-term survival in a significant number of patients. Achieving R0 resection is the main goal of surgical treatment.

Increased Nuchal Translucency Without Aneuploidy in a Fetus: Abnormal Postnatal Radiograph and a Novel Mutation.

Increased Nuchal Translucency Without Aneuploidy in a Fetus: Abnormal Postnatal Radiograph and a Novel Mutation.

The diagnostic value of magnetic resonance imaging compared to computed tomography in the evaluation of fat-containing thoracic lesions.

Intrathoracic fat-containing lesions may arise in the mediastinum, lungs, pleura, or chest wall. While CT can be helpful in the detection and diagnosis of these lesions, it can only do so if the lesions contain macroscopic fat. Furthermore, because CT cannot demonstrate microscopic or intravoxel fat, it can fail to identify and diagnose microscopic fat-containing lesions. MRI, employing spectral and chemical shift fat suppression techniques, can identify both macroscopic and microscopic fat, with resultant enhanced capability to diagnose these intrathoracic lesions non-invasively and without ionizing radiation. This paper aims to review the CT and MRI findings of fat-containing lesions of the chest and describes the fat-suppression techniques utilized in their assessment.