Procedure For Lung Cancer Research Articles

An analysis of the regional heterogeneity in tissue elasticity in lung cancer patients with COPD.

Recent advancements in obtaining image-based biomarkers from CT images have enabled lung function characterization, which could aid in lung interventional planning. However, the regional heterogeneity in these biomarkers has not been well documented, yet it is critical to several procedures for lung cancer and COPD. The purpose of this paper is to analyze the interlobar and intralobar heterogeneity of tissue elasticity and study their relationship with COPD severity. We retrospectively analyzed a set of 23 lung cancer patients for this study, 14 of whom had COPD. For each patient, we employed a 5DCT scanning protocol to obtain end-exhalation and end-inhalation images and semi-automatically segmented the lobes. We calculated tissue elasticity using a biomechanical property estimation model. To obtain a measure of lobar elasticity, we calculated the mean of the voxel-wise elasticity values within each lobe. To analyze interlobar heterogeneity, we defined an index that represented the properties of the least elastic lobe as compared to the rest of the lobes, termed the Elasticity Heterogeneity Index (EHI). An index of 0 indicated total homogeneity, and higher indices indicated higher heterogeneity. Additionally, we measured intralobar heterogeneity by calculating the coefficient of variation of elasticity within each lobe. The mean EHI was 0.223 ± 0.183. The mean coefficient of variation of the elasticity distributions was 51.1% ± 16.6%. For mild COPD patients, the interlobar heterogeneity was low compared to the other categories. For moderate-to-severe COPD patients, the interlobar and intralobar heterogeneities were highest, showing significant differences from the other groups. We observed a high level of lung tissue heterogeneity to occur between and within the lobes in all COPD severity cases, especially in moderate-to-severe cases. Heterogeneity results demonstrate the value of a regional, function-guided approach like elasticity for procedures such as surgical decision making and treatment planning.

Invasive Diagnostic Procedures from Bronchoscopy to Surgical Biopsy-Optimization of Non-Small Cell Lung Cancer Samples for Molecular Testing.

Background and Objectives: Treatment of advanced lung cancer (LC) has become increasingly personalized over the past decade due to an improved understanding of tumor molecular biology and antitumor immunity. The main task of a pulmonologist oncologist is to establish a tumor diagnosis and, ideally, to confirm the stage of the disease with the least invasive technique possible. Materials and Methods: The paper will summarize published reviews and original papers, as well as published clinical studies and case reports, which studied the role and compared the methods of invasive pulmonology diagnostics to obtain adequate tumor tissue samples for molecular analysis, thereby determining the most effective molecular treatments. Results: Bronchoscopy is often recommended as the initial diagnostic procedure for LC. If the tumor is endoscopically visible, the biopsy sample is susceptible to molecular testing, the same as tumor tissue samples obtained from surgical resection and mediastinoscopy. The use of new sampling methods, such as cryobiopsy for peripheral tumor lesions or cytoblock obtained by ultrasound-guided transbronchial needle aspiration (TBNA), enables obtaining adequate small biopsies and cytological samples for molecular testing, which have until recently been considered unsuitable for this type of analysis. During LC patients' treatment, resistance occurs due to changes in the mutational tumor status or pathohistological tumor type. Therefore, the repeated taking of liquid biopsies for molecular analysis or rebiopsy of tumor tissue for new pathohistological and molecular profiling has recently been mandated. Conclusions: In thoracic oncology, preference should be given to the least invasive diagnostic procedure providing a sample for histology rather than for cytology. However, there is increasing evidence that, when properly processed, cytology samples can be sufficient for both the cancer diagnosis and molecular analyses. A good knowledge of diagnostic procedures is essential for LC diagnosing and treatment in the personalized therapy era.

A look ahead to promote the early detection of lung cancer: technical and cost implications of a confirmed diagnosis before surgery

ObjectiveTo compare the costs and length of hospital stay among patients with a confirmed diagnosis of lung cancer (LC) prior to surgery versus those without confirmation. MethodsThis retrospective, single-center study was conducted in patients who underwent a surgical procedure for LC, with or without a pathologically confirmed LC diagnosis prior to surgery, between March 2017 and December 2019. The main outcomes were costs and length of hospital stay (LOS). ResultsAmong the 269 patients who underwent surgery for lung cancer between March 2017 and December 2019, 203 (75.5%) patients underwent surgery due to a histopathological diagnosis, and 66 (24.5%) because of a Multidisciplinary Cancer Committee indication. The unadjusted mean cost was significantly lower in Group II (patients with surgery based on Multidisciplinary Cancer Committee criteria) (Є2,581.80 ± Є1,002.50) than in Group I (patients with histopathological diagnosis) (Є4,244.60 ± Є2,008.80), P < 0.0001. Once adjusted for covariables, there was a mean difference of −Є1,437.20 in the costs of Group II, P < 0.0001.Unadjusted mean hospital stay was significantly longer in Group I (5.6 days) than in Group II (3.5 days). ConclusionsThe results suggest that indicating surgical resection of lung cancer based on Multidisciplinary Cancer Committee criteria, rather than performing CT-guided percutaneous lung biopsy, may result in a significant decrease in cost and length of hospital stay.

Clinical Profile and Positivity Rate of Fiber Optic Bronchoscopy (FOB) Procedures in Lung Cancer

Fiber Optic Bronchoscopy (FOB) is an invasive procedure that has been traditionally used both as diagnostic and therapeutic purposes in the field of pulmonary diseases. However, it is mainly used as diagnostic method in lung cancer diagnosis, followed by appropriate sampling procedures including needle aspiration, forceps biopsy, brushing, and washing. We aim to characterize the profile of FOB results including the positivity rate (the rate in which pathology results yield either class IV or class V cells) of each FOB procedure. This is an observational descriptive study using retrospective approach using existing FOB results from our patients. The most common FOB finding was compressive stenosis (35.4%), followed by obstructive (34.8%), and infiltrative stenosis (29.8%). Positivity rate for needle aspiration was 50% for infiltrative and 57.15% for obstructive stenosis; Positivity rate for forceps biopsy was 42.1% for infiltrative and 73.33% for obstructive stenosis; Positivity rate for brushing was 6.66% for compressive, 38.24% for infiltrative, and 25.72% for obstructive stenosis; and positivity rate of washing was 5.36% for compressive, 17.54% for infiltrative, and 6.12% for obstructive stenosis. These results showed that as the main method in lung cancer diagnosis, FOB procedures have excellent results depending on the choice of sampling procedures used based on FOB findings.

Progress and future prospective of FDG-PET/CT imaging combined with optimized procedures in lung cancer: toward precision medicine.

With a 5-year overall survival of approximately 20%, lung cancer has always been the number one cancer-specific killer all over the world. As a fusion of positron emission computed tomography (PET) and computed tomography (CT), PET/CT has revolutionized cancer imaging over the past 20years. In this review, we focused on the optimization of the function of 18F-flurodeoxyglucose (FDG)-PET/CT in diagnosis, prognostic prediction and therapy management of lung cancers by computer programs. FDG-PET/CT has demonstrated a surprising role in development of therapeutic biomarkers, prediction of therapeutic responses and long-term survival, which could be conducive to solving existing dilemmas. Meanwhile, novel tracers and optimized procedures are also developed to control the quality and improve the effect of PET/CT. With the continuous development of some new imaging agents and their clinical applications, application value of PET/CT has broad prospects in this area.

Uniportal VATS for non-small cell lung cancer.

The video-assisted thoracic surgery (VATS) technique has evolved from its multiport origins to even less invasive approaches grounded in its proven benefits over open surgery forthe treatment of early stage lung cancer. In this evolution process, the Uniportal VATS (UniVATS) strategy emerged. This technique is giving some evidence of benefits when compared to the multiport VATS and has been embraced by the surgical community spreading its geographical and surgical boundaries. Moreover, UniVATS has proven its feasibility for numerous and more complex procedures forlung cancer diagnosis and treatment, which are reviewed in this document as well as its current and future development.

Apneic oxygenation in thoracic surgery in patients with previous pneumonectomy

Introduction Anaesthetic management of patients undergoing thoracic surgical procedures for lung cancer poses unique challenges to the anaesthesiologist, including patients’ comorbidities, lateral decubitus position, the need for lung isolation, and the associated pathophysiology during and after these procedures. Anaesthetic management is even more challenging in patients with previous pneumonectomy. In this case report we present two patients, who had a previous history of left pneumonectomy and were scheduled for surgical resection of a tumor in the remaining right lung. Methods Apneic oxygenation was used in both patients (patients A and B) intraoperatively, initially by oxygen insufflation via a thin catheter advanced to the level of the carina through a single lumen endotracheal tube. After the development of hypoxemia apneic oxygenation was continued via a Mapleson C circuit. Results For a significant period of time, oxygenation was preserved in both patients. Patients A and B showed time to oxygen desaturation of 30min and 25min respectively. Hypoxemia was recognized immediately by SpO2 decline below 90% and was confirmed via blood gas samples. Apneic oxygenation via a Mapleson C circuit was applied successfully for hypoxemia management in both patients. Oxygen levels improved immediately and remained stable until the end of apneic oxygenation. Total duration of apneic oxygenation was 90min and 50min in patients A and B, respectively. Increase of arterial carbon dioxide tension (PaCO2) and subsequent respiratory acidosis were predictable results of apneic oxygenation that were corrected quickly by mechanical ventilation (MV). After the end of surgery, both patients were admitted intubated to the ICU, where weaning from MV was successful after 2hrs. Patients A and B were discharged from the ICU on first postoperative day after an uncomplicated postoperative course. Discussion Apneic oxygenation is an acceptable oxygenation technique during thoracic surgery, especially in patients with previous pneumonectomy, which is able to keep sufficient oxygenation for a significant period of time, and does not deserve any special equipment. The expected hypercapnia and respiratory acidosis limit the duration of its application. PaCO2 values are related with the total time of apneic oxygenation and the only effective way for its decrease is mechanical ventilation. In the absence of pulmonary hypertension or pathology of the brain, mechanical ventilation normalises PaCO2 and pH quickly, without any complications.

Developments in Diagnostic and Interventional Procedures in Lung Cancer

Worldwide around 1.8 million cases of lung cancer are diagnosed each year [1]. The overall 5year survival is poor at around 4% mainly due to the fact that only approximately 15% of the cases are diagnosed with the early stages of lung cancer [1].

Diagnostic Yield of Various Procedures in Lung Cancer

Diagnostic Yield of Various Procedures in Lung Cancer

Palliative Procedures in Lung Cancer

Palliative care aims to optimize comfort and function when cure is not possible. Image-guided interventions for palliative treatment of lung cancer is aimed at local control of advanced disease in the affected lung, adjacent mediastinal structures, or distant metastatic sites. These procedures include endovascular therapy for superior vena cava syndrome, bronchial artery embolization for hemoptysis associated with lung cancer, and ablation of osseous metastasis. Pathophysiology, clinical presentation, indications of these palliative treatments, procedural techniques, complications, and possible future interventions are discussed in this article.

The role of molecular profiling to differentiate multiple lung primary adenocarcinomas from intrapulmonary metastases from a lung primary.

7555 Background: In the case of patients with multiple lung adenocarcinomas (ADCs) (whether synchronous or metachronous), the distinction of intrapulmonary metastases from independent primaries is clinically important as it impacts staging and thus therapeutic strategy. Currently the distinction is made based principally on histology of the tumor. Molecular profiling is becoming a routine diagnostic procedure for lung cancer to help treatment decision-making. Thus, we sought the role of mutation assays to differentiate multiple primaries from metastases. Methods: 45 synchronous and 37 metachronous cases of multiple tumors were obtained at 103 surgeries in 68 patients. Each of the resultant 156 tumors was tested with the SNaPshot multiplex PCR genotyping assay and each case, based on molecular profiling, was classified as synchronous multiple primaries (SP), metachronous primaries (MP), synchronous intrapulmonary metastases (SM), or metachronous metastases (MM). Each case was also classified into 4 groups by a comprehensive histologic analysis. Clinical outcomes were compared between multiple primaries (SP and MP) and metastases (SM and MM) in the molecular and histologic analyses using Log-rank test. Results: Based on histology alone, SP were present in 37 cases, MP in 32, SM in 8 and MM in 5. The molecular results were interpreted as SP in 25, MP in 21, SM in 10 and MM in 11. 15 of the 82 cases were non-informative, since no mutations were identified in any lesions. Of the 67 cases harboring mutations, 21 (31%) showed discordant results consisting of 16 with SP or MP by histology and SM or MM by molecular profiling. 5 cases showed the opposite results. Molecular profiling showed a trend toward the 5-year survival of the patients with metastases being shorter than those with multiple primaries (57 months vs. 87 months, P=0.068), which was not observed by histology (P=0.84). Conclusions: Although its performance is limited by non-informative results in 18% of cases of multiple ADCs, SNaPshot profiling for clinical use appears to be useful in determining whether multiple ADCs are primaries or metastases. Thus, it may allow for more accurate staging and optimal therapeutic management.

Efficacy of low-dose landiolol, an ultrashort-acting β-blocker, on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer

Postoperative atrial fibrillation is the most common complication encountered during the early postoperative period following a pulmonary resection procedure. Landiolol is a newly developed, ultrashortacting, β-adrenoceptor antagonist. The objective of the present study was to evaluate the efficacy and safety of low-dose landiolol for postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer. Of 553 patients who underwent an elective pulmonary resection procedure for lung cancer at National Toneyama Hospital from January 2005 to December 2009, this analysis involved 30 consecutive patients who developed atrial fibrillation after surgery and needed treatment. These patients were divided into two groups: the landiolol group (n = 15) and the historical control group (treated with a combination of verapamil and digoxin, n = 15). Hemodynamic changes before and 30 min, 2 h, and 12 h after medication, the time required to restore sinus rhythm, and adverse events were evaluated. There were no significant differences between the two groups regarding blood pressure before and after medication. Heart rate was reduced immediately in both groups after medication and was significantly lower in the landiolol group than in the control group. The time to restore sinus rhythm was significantly shorter in the landiolol group than in the control group (8.1 ± 11.0 h vs. 23.0 ± 26.0 h, P < 0.05). In none of the subjects with the landiolol infusion was it discontinued because of side effects. Low-dose landiolol can be effective quickly and used safely in patients who develop atrial fibrillation after pulmonary resection for lung cancer.

Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy

There is increasing awareness of minimally invasive endoscopic techniques for mediastinal staging in lung cancer. Traditionally, cervical mediastinoscopy has been utilized. Endobronchial ultrasound-guided fine needle aspiration (EBUS) has recently emerged as a potential alternative. EBUS has sensitivity for lung cancer which is at least equivalent (if not superior) to cervical mediastinoscopy. However, cervical mediastinoscopy remains superior to EBUS and other techniques in its high negative predictive value. More recent data suggest EBUS may have a role in presurgical staging of radiologically normal subcentimetre nodes and its negative predictive value may be equivalent to surgical staging. Ongoing comparative studies between EBUS and cervical mediastinoscopy may well clarify relative performance and cost analyses. Currently, insufficient data are present to recommend replacing cervical mediastinoscopy with EBUS for lung cancer staging; the negative predictive value of EBUS requires validation. However, EBUS can be recommended for initial staging as a minimally invasive option provided negative results are followed by cervical mediastinoscopy. This would also allow cervical mediastinoscopy to be reserved for re-staging. Conventional transbronchial needle aspiration has a limited role only as a first-line staging procedure but may aid diagnosis. In the future, EBUS may have a role in presurgical staging of the radiologically normal mediastinum and re-staging if prior staging is done by cervical mediastinoscopy.

Evaluating cancer patient satisfaction before and after daily multidisciplinary care for thoracic surgery inpatients

9605 Background: Significant subpopulations of cancer inpatients in the SUPPORT trial were dissatisfied with their pain control. (Desbiens, Wu et al. 1996) The hospitalized thoracic surgical patient is a person at risk for uncontrolled symptoms and burdens due to advanced cancer at time of presentation. Methods: This is a retrospective, observational, study of 1188 thoracic surgery patients undergoing elective surgical procedures for lung cancer at an NCI-approved cancer hospital over a 3-year period. Patients with primary and secondary lung cancer, undergoing elective thoracic surgery procedures were evaluated before (n=660, “Period 1”) and after (n=528, “Period 2”) an 8-month, daily, collaborative multidisciplinary Intervention Period to improve pain control and to facilitate transition for discharge. The collaborative process also identified thoracic surgical patients who needed more complex symptom management and additional support for advanced disease. Patient satisfaction with pain therapy and referrals to hospice were analyzed before and after the intervention period. Results: Pain satisfaction scores improved from baseline in each sequential period (Period 1 = 9.0 SD 1.71, Intervention Period = 9.4 SD 1.37, and Period 2 = 9.5 SD 1.03, p&lt;0.0001). The percentage of patients referred to hospice increased from 0.15% to 1.7% (p&lt;0.0001). Conclusions: Innovative collaboration between thoracic surgery specialists and a palliative medicine service improved patients’ satisfaction with pain control. The collaborative relationship resulted in an increase in referrals to hospice for patients with advanced cancer. These improvements were sustained by the thoracic surgery service after a daily collaborative intervention period ceased. No significant financial relationships to disclose.

Successful thoracoscopic lobectomy for lung cancer in a patient with anatomic variation of the left inferior pulmonary vein.

We present a case of primary lung cancer with a rare distribution pattern of left inferior pulmonary vein (PV), encountered in the thoracoscopic left lower lobectomy. Thoracoscopic observation revealed 2 trunks of inferior PV (ventral and dorsal branch) at the stem level. The ventral trunk consisted of a branch of vein (V(5)) from the lingular segment and venous ramifications (V(8)a, V(9) and V(10)a) from the basal segment. On the other hand, a branch of vein (V(6)) from the superior segment in the lower lobe and other veins (V(8)b and V(10)b + c) from the basal segment emptied together into the dorsal trunk. We successfully carried out a thoracoscopic left lower lobectomy without excision of the aberrant vein (V(5)). Retrospective review of the preoperative chest CT demonstrates the double trunk inferior PV and the aberrant lingular branch emptying with V(8)a into the ventral trunk. Knowledge of the branching variations of PV from preoperative evaluations leads to appropriate thoracoscopic procedures for lung cancer.

CLC057 ORAL Bronchoplastic procedures for lung cancer

CLC057 ORAL Bronchoplastic procedures for lung cancer

Parenchymal-Sparing Procedures in Lung Cancer: Sleeve Resection of the Lung for Proximal Lesions

Parenchymal-Sparing Procedures in Lung Cancer: Sleeve Resection of the Lung for Proximal Lesions

Nuclear medicine procedures in lung cancer.

Although radiography, computed tomography and magnetic resonance imaging are still the methods of choice for the study of lung cancer, they have certain limitations in the determination of the nature of suspicious lung nodules, the evaluation of mediastinal involvement, the assessment of the viability of previously treated lesions and the diagnosis of tumour relapse. There is a wide range of current oncological requirements related to lung cancer: detection of malignant lesions at the earliest stage and in the most effective way; the definition of the biological characteristics of a lesion (proliferation, aggressiveness, differentiation, etc.); the need to define the operability of the patient (function of residual lung and staging); and the need to evaluate the behaviour of the tumour (response to therapy, early detection of recurrences, metastatic spread). Most of the efforts of the nuclear medicine community have been focussed on diagnosis, staging, restaging and therapy monitoring of lung cancer. Many radiopharmaceuticals have been employed for this, including gallium, monoclonal antibodies, somatostatin analogues, lipophilic cations and positron emission tracers. There is ample evidence that nuclear medicine techniques may provide complementary information with respect to anatomical imaging, for example in the assessment of preoperative function by means of ventilation and perfusion scintigraphy, or in tumour localisation by means of specific tumour-seeking agents. However, clinical data suggest that, when properly used, nuclear medicine procedures in some cases may be not only complementary to radiology but essential for the clinical management of lung cancer. An example of such a procedure is fluorodeoxyglucose positron emission tomography (FDG PET) the introduction of which has greatly contributed to confirmation of the clinical value of nuclear medicine in this field. FDG PET has proved of great help in lung cancer management and its cost-effectiveness in lung cancer staging is firmly established. In this review the results of the most important nuclear medicine techniques are summarised and their value in clinical practice is discussed. General, updated information is provided about the epidemiology, biology and clinical management of lung cancer, and about the role of nuclear medicine in these areas.

385 Bronchoplastic procedures for lung cancer

385 Bronchoplastic procedures for lung cancer

Five Year Audit of Operative Procedures in Lung Cancer in the Elderly from One Region in England

Journal Article Five Year Audit of Operative Procedures in Lung Cancer in the Elderly from One Region in England Get access F Lesley, F Lesley Cardiothoracic Centre, Thomas Drive, Liverpool & Department of Geriatric Medicine, University of Liverpool Search for other works by this author on: Oxford Academic PubMed Google Scholar CIA Jack, CIA Jack Cardiothoracic Centre, Thomas Drive, Liverpool & Department of Geriatric Medicine, University of Liverpool Search for other works by this author on: Oxford Academic PubMed Google Scholar G Wilson, G Wilson Cardiothoracic Centre, Thomas Drive, Liverpool & Department of Geriatric Medicine, University of Liverpool Search for other works by this author on: Oxford Academic PubMed Google Scholar RJ Donnelly, RJ Donnelly Cardiothoracic Centre, Thomas Drive, Liverpool & Department of Geriatric Medicine, University of Liverpool Search for other works by this author on: Oxford Academic PubMed Google Scholar CRK Hind CRK Hind Cardiothoracic Centre, Thomas Drive, Liverpool & Department of Geriatric Medicine, University of Liverpool Search for other works by this author on: Oxford Academic PubMed Google Scholar Age and Ageing, Volume 23, Issue suppl_2, 1994, Pages P8-c–P8, https://doi.org/10.1093/ageing/23.suppl_2.P8-c Published: 01 June 1994