Malignancy Of Pulmonary Lesions Research Articles

Synergistic Effects of Omeprazole and Metformin on Glycemic Control in Type 2 Diabetic Patients. A Randomized Clinical Study

Background: Lung cancer is one of the most common malignancies worldwide. Cigarette smoking is considered as the major risk factor for bronchogenic carcinoma. The four common types namely – squamous cell; small cell; adeno and large cell carcinomas account for more than 90% cases of Bronchogenic carcinoma. Initially it is detected by plain chest radiography but it is considered as an insensitive. Computed Tomography can detect early stage disease 6-10 times more frequently than X-rays. Objective: To determine diagnostic accuracy of Contrast Enhanced Computed Tomography in detecting Bronchogenic Carcinoma taking histopathology as Gold Standard. Methods: Total 157 patients presented with pulmonary nodule or suspicious lesion on X-Ray and had history of haemoptysis, weight loss, cough and chest pain for more than two months were included. CT was performed with I/V contrast. Axial images were taken with patients lying supine. Images were analyzed. The same radiologist assessed the patient included in the study. All patients then underwent biopsy and samples were sent for histopathology. Sensitivity, specificity, and accuracy of computed tomography were calculated using histopathology as gold standard. Results: There were 101 male and 56 female patients. The mean age was 59.77±7.97 years. On CT Scan 89 patients were diagnosed with bronchogenic carcinoma. On histopathology, 90 patients were diagnosed with bronchogenic carcinoma. The sensitivity of CT Scan was 90.0%, specificity was 88.0% and diagnostic accuracy was 89.1%. Conclusion: CT scan is a sensitive imaging modality in diagnosing malignancy in pulmonary lesions

Predictors of False-Negative Results from Percutaneous Transthoracic Fine-Needle Aspiration Biopsy: An Observational Study from a Retrospective Cohort.

PurposeWe investigated factors predictive of false-negative pulmonary lesions with nonspecific benign cytology results on percutaneous transthoracic fine-needle aspiration biopsy (FNAB).Materials and MethodsWe included 222 pulmonary lesions that had a nonspecific benign result from percutaneous transthoracic FNAB between March 2005 and December 2012, and were confirmed by subsequent pathologic results or adequate clinical follow up over at least 2 years. Clinical, imaging, and biopsy procedure-related findings were compared between lesions with a final diagnosis of malignancy (false-negative) and lesions with a benign diagnosis (true-negative). Multivariate logistic regression analysis was performed to identify significant predictors of false-negatives.ResultsOf 222 lesions, 115 lesions were proved to be false-negatives, and 107 were true-negatives. Compared with the true-negatives, false-negative lesions showed significantly older age (p=0.037), higher maximum standardized uptake value (SUVmax) on positron emission tomography (p=0.001), larger lesion size (p=0.007), and lesion characteristics of a subsolid nodule (p=0.007). On multivariate logistic regression analysis, SUVmax, lesion size, and lesion characteristics were significant predictors of false-negative results.ConclusionAmong the clinical, radiologic, and procedure-related factors analyzed, high SUVmax, large lesion size, and subsolid lesions were useful for predicting malignancy in pulmonary lesions with nonspecific benign cytology results on FNAB.

Positron emission tomographic imaging with fluorodeoxyglucose is efficacious in evaluating malignant pulmonary disease

Objective: Positron emission tomography (PET), when used with the intravenously administered radiopharmaceutical F-18 fluorodeoxyglucose (FDG), has the potential to help in the evaluation of patients with lung cancer because the radiopharmaceutical is concentrated by metabolically active cells. We conducted a retrospective study of PET-FDG in 96 patients evaluated at our institution over the past 2 years for suspected primary pulmonary neoplasms. PET-FDG results were compared with the findings of computed tomographic scans on the same patients. All patients underwent surgical exploration with or without resection of the malignant tumors. Sites of potential malignancy were subjected to biopsy and/or excision, with subsequent pathologic evaluation. Results: A total of 96 patients with suspected or proven primary pulmonary malignant disease were evaluated. Sixty-six patients had histologically confirmed malignant tumors, and 30 had benign masses histologically. PET-FDG had an accuracy of detecting malignancy in pulmonary lesions of 92% (sensitivity 97%; specificity 89%). A total of 111 surgically sampled sites were from lymph nodes. PET-FDG was accurate in predicting the malignancy of nodes in 91% of instances, whereas computed tomography was correct in 64%. The sensitivity, specificity, and predictive accuracy of PET in detecting metastatic lymphadenopathy in mediastinal lymph nodes were 98%, 94%, and 95%, respectively. PET-FDG also changed the M stage in 8 (12%) patients (6 with and 2 without metastases). The 6 malignant (positive) lesions were correctly identified by PET-FDG, and the 2 without tumor were accurately predicted as benign (negative). Conclusion: These initial results suggest that PET-FDG is highly accurate in identifying and staging lung cancer. PET-FDG also appears to be more accurate in detecting metastatic mediastinal lymphadenopathy than computed tomographic scan. (J Thorac Cardiovasc Surg 1999;117:719-27)