Staging Of Lung Carcinoma Research Articles

LUNG CANCER DISEASE PREDICTION WITH CT SCAN AND HISTOPATHOLOGICAL IMAGES FEATURE ANALYSIS USING DEEP LEARNING TECHNIQUES

Research and Development on cancer detection is more on imaging than textual data. With the help of documented symptoms in the form of text and Machine Learning (ML) techniques, it is possible to predict the lung cancerstages effectively. This paper conjectures the oeuvre modelwhich is efficient in predicting the stages of lung carcinoma by applying the concepts of ML algorithms. The proposed model is combination of K-Nearest Neighbours, Decision Tree and Neural Networks modelsalong with bagging ensemble method for enhancing the accuracy of the overall prediction. The predictedresults of the suggested model are showing better accuracy compared to individual algorithms.

Retrospective study evaluating the efficacy of stereotactic body radiation therapy for the treatment of confirmed or suspected primary pulmonary carcinomas in dogs.

Canine primary pulmonary carcinomas (PCCs) are commonly treated with surgery with overall median survival times (MST) around a year; however, due to extent of disease, prognosis, or client preference, alternative treatments have been considered. Stereotactic body radiation therapy (SBRT) has been utilized in human cancer patients for local control of lung tumours as a surgical alternative. Twenty-one PCCs in 19 dogs that received SBRT for local control were retrospectively evaluated. Dogs were staged according to the canine lung carcinoma stage classification (CLCSC) system with three as Stage 1, five as Stage 2, three as Stage 3, and eight as Stage 4. Overall MST was 343 days with 38% of patients alive at 1 year. Stage did not significantly impact survival time (p = .72). Five (26%) dogs had lymphadenopathy and MST was not significantly different from dogs without lymphadenopathy (343 vs. 353 days; p = .54). Five out of 18 evaluable dogs (28%) experienced acute lung VRTOG effects and 2 of 12 dogs (17%) experienced late lung VRTOG effects. Median lung dose, V5, V20, and D30 to the lung did not correlate significantly with the development of adverse radiation events. Twelve dogs had follow-up imaging and the best response included a complete response (17%), partial response (42%), and stable disease (42%). Progressive disease was noted in seven dogs a median of 229 days after SBRT. SBRT was documented to be a safe and effective alternative to surgery and may have survival advantages for Stage 3 or 4 dogs according to the CLCSC.

Prognosis of primary pulmonary adenocarcinoma after surgical resection in small-breed dogs: 52 cases (2005-2021).

Tumor size is an important prognostic factor in lung cancer in dogs, and the canine lung carcinoma stage classification (CLCSC) recently has been proposed to subdivide tumor sizes. It is unclear if the same classification scheme can be used for small-breed dogs. To investigate whether the tumor size classification of CLCS is prognostic for survival and progression outcomes in small-breed dogs with surgically resected pulmonary adenocarcinomas (PACs). Fifty-two client-owned small-breed dogs with PAC. Single-center retrospective cohort study conducted between 2005 and 2021. Medical records of dogs weighing <15 kg with surgically resected lung masses histologically diagnosed as PAC were examined. The numbers of dogs with tumor size ≤3 cm, >3 cm to ≤5 cm, >5 cm to ≤7 cm, or >7 cm were 15, 18, 14, and 5, respectively. The median progression-free interval (PFI) and overall survival time (OST) were 754 and 716 days, respectively. In univariable analysis, clinical signs, lymph node metastasis, margin, and histologic grade were associated with PFI, and age, clinical signs, margin, and lymph node metastasis were associated with OST. Tumor size classification of CLCS was associated with PFI in all categories, and tumor size >7 cm was associated with OST. In multivariable analysis, tumor size >5 cm to ≤7 cm and margin were associated with PFI, and age was associated with OST. The tumor size classification of CLCS would be an important prognostic factor in small-breed dogs with surgically resected PACs.

Full thoracoscopic segmentectomies for lung cancer: rational of a multiportal fissure-based approach

: Following the partial results of ongoing randomized trials, thoracoscopic anatomic sublobar resections (SLRs) may become the standard treatment of ground-glass opacities (GGO) and of some early- stage lung carcinomas. However, these procedures are challenging. The performance of closed-chest pulmonary segmentectomies, especially for complex ones, requires a meticulous dissection of bronchovascular elements. A thorough preparation facilitates the procedure. In this article, we review the different technical and technological aspects of the multiportal approach with fissure-first dissection. Prerequisites are (I) precise preoperative study of the anatomical variations, based on 3D reconstructions or 3D printing, (II) preoperative evaluation of safety margins, based on a virtual margin, (III) for small nodules, localization of the target using either preoperative or intraoperative marking, (IV) fissure-based approach to allow extensive dissection of bronchovascular elements, (V) intraoperative analysis of resection margins and intersegmental lymph nodes in order to extend resection in case on invaded margin or lymph node, (VI) accurate delineation and division of the intersegmental plane. Technical and technological helpful means are discussed in this article.

Distribution of histopathologic types of primary pulmonary neoplasia in dogs and outcome of affected dogs: 340 cases (2010–2019)

To provide updated information on the distribution of histopathologic types of primary pulmonary neoplasia in dogs and evaluate the effect of postoperative adjuvant chemotherapy in dogs with pulmonary carcinoma. 340 dogs. Medical records of dogs that underwent lung lobectomy for removal of a primary pulmonary mass were reviewed, and histopathologic type of lesions was determined. The canine lung carcinoma stage classification system was used to determine clinical stage for dogs with pulmonary carcinoma. Pulmonary carcinoma was the most frequently encountered tumor type (296/340 [87.1%]), followed by sarcoma (26 [7.6%]), adenoma (11 [3.2%]), and pulmonary neuroendocrine tumor (5 [1.5%]); there was also 1 plasmacytoma and 1 carcinosarcoma. Twenty (5.9%) sarcomas were classified as primary pulmonary histiocytic sarcoma. There was a significant difference in median survival time between dogs with pulmonary carcinomas (399 days), dogs with histiocytic sarcomas (300 days), and dogs with neuroendocrine tumors (498 days). When dogs with pulmonary carcinomas were grouped on the basis of clinical stage, there were no significant differences in median survival time between dogs that did and did not receive adjuvant chemotherapy. Results indicated that pulmonary carcinoma is the most common cause of primary pulmonary neoplasia in dogs; however, nonepithelial tumors can occur. Survival times were significantly different between dogs with pulmonary carcinoma, histiocytic sarcoma, and neuroendocrine tumor, emphasizing the importance of recognizing the relative incidence of these various histologic diagnoses. The therapeutic effect of adjuvant chemotherapy in dogs with pulmonary carcinoma remains unclear and warrants further investigation.

NOT ALL THE ASPIRATIONS ARE COMING FROM THE OROPHARYNX

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: Aspiration is the entry of oral or gastric materials into the lungs leading to chemical pneumonitis, bacterial infection, or airway obstruction. Frequent conditions that predispose aspiration result from reduced level of consciousness without airway protection, neurologic disorders, or dysphagia from gastrointestinal tract disorders. While the most common route of aspiration is oropharyngeal, tracheoesophageal fistula (TEF) may initially present in the same manner. We present a middle-aged male with repeated aspiration pneumonia and pneumonitis secondary to TEF. CASE PRESENTATION: A 58-year-old male with history of squamous cell lung carcinoma stage IIIa in remission after chemoradiation and recurrent aspiration pneumonia with gastrostomy tube. Presented to the hospital in hypoxic respiratory failure due to sudden onset of dyspnea after attempting tube feeds. Initial evaluation was significant for leukocytosis and normal procalcitonin level. A CT of the chest showed ground glass opacities with consolidation in bilateral upper and lower lobes and tree-in-bud pattern. A bronchoscopy revealed tracheobronchial erythema with multilobar exudate and large tracheal fistula. An Upper GI series identified aspiration coating the trachea and left main bronchus. The patient was diagnosed with chemical pneumonitis and aspiration pneumonia secondary to tracheoesophageal fistula most likely from recurrent infections and radiation. He was transferred to a tertiary care center for esophageal and tracheal stent placement. DISCUSSION: TEF is an abnormal connection between the trachea and the esophagus that is mostly congenital, and in rare occasions can be acquired most commonly through esophageal malignancy, trauma, and chemoradiation. TEF is often associated with abnormal esophageal motility causing recurrent pneumonia and acute lung injury from chemical pneumonitis. Diagnosis of TEF as a result of these conditions can be challenging, but the preferred diagnosis method is direct visualization with esophagoscopy or bronchoscopy. Treatment consists of interventional procedures including airway and/or esophageal stent placement. It is the most common approach to prevent liquid leakage and help with the healing. Biological glue or thermal ablation can also be performed, as well as surgical intervention or conservative management. CONCLUSIONS: The patient presented with respiratory failure secondary to recurrent aspiration pneumonia and chemical pneumonitis who failed therapy with gastrostomy tube placement, due to tracheoesophageal fistula. TEF is a rare complication of chemoradiation that increases morbidity and mortality. It can be treated with airway/esophageal stent placement or more invasive surgical intervention. It is important to expand work up and differential diagnosis in patients with aspiration who continue failing therapy to include endoscopy for direct visualization of anatomical abnormalities. REFERENCE #1: Ke M, Wu X, Zeng J. The treatment strategy for tracheoesophageal fistula. J Thorac Dis. 2015;7(Suppl 4):S389-S397. doi:10.3978/j.issn.2072-1439.2015.12.11 REFERENCE #2: Abugroun A, Ahmed F, Singh N, Nadiri M. Late Onset Chemo/Radiation Induced Tracheoesophageal Fistula in Squamous Cell Cancer of the Lung. World J Oncol. 2017;8(5):171-173. REFERENCE #3: Lo WL, Leu HB, Yang MC, et al. Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study. J Dent Sci 2019; 14:241. DISCLOSURES: No relevant relationships by Nehal Bhatt, source=Web Response No relevant relationships by Joshuam Ruiz Vega, source=Web Response

A study of diagnostic utility of annexin A1 in bronchoalveolar lavage fluid of patients with bronchogenic carcinoma

Background Annexin A1 is implicated in multiple types of cancer, but few researches have studied its job in lung cancer. Aim The aim of the study was to enumerate annexin A1 levels in bronchoalveolar lavage fluid (BALF) and sera of lung cancer patients and patients with benign lung diseases and to evaluate its role as a diagnostic aid for lung cancer. Patients and methods This prospective analytic controlled case study was performed in Chest Department, Tanta University Hospitals, on 40 patients. The patients were split into two groups: group 1 included 20 patients with bronchogenic carcinoma, group 2 included 20 patients having nonmalignant lung diseases of known etiologies. Clinical assessment, demographic data, and routine investigations were done to all patients. Annexin A1 expression in BALF and serum was examined using enzyme-linked immunosorbent assay. Results Annexin A1 levels were higher in BALF and sera of lung carcinoma patients than those of the control group. Positive correlation was present between annexin A1 level in BALF and serum and advanced clinical stages of lung cancer and between BALF annexin A1 level and its level in serum. Conclusion High annexin A1 level in BALF was related to advanced clinical stage of lung carcinoma and in a positive correlation with serum annexin A1. High sensitivity and specificity of BALF annexin A1 for detection of lung carcinoma showed that it deemed to be a molecular biomarker for lung cancer prognosis and diagnosis.

Retrospective evaluation of a modified human lung cancer stage classification in dogs with surgically excised primary pulmonary carcinomas.

The stage classification for canine primary pulmonary carcinomas (PPC) was last updated in 1980. In people, the human lung cancer stage classification (HLCSC) (currently in its eighth edition) plays an integral role in diagnostic and therapeutic decision-making and is prognostic despite a heterogeneous population of tumours. The objective of this retrospective case study was to evaluate the prognostic significance of a canine lung carcinoma stage classification (CLCSC) adapted from the HLCSC by removal of substage for ease of application to canine PPC. A secondary objective was to evaluate the effect of adjuvant chemotherapy. Medical records of 71 dogs with histologically confirmed PPC were reviewed. All dogs underwent surgical excision of the primary lung tumour. Primary tumour features (referring to T1-T4 stages) and TNM stages (1-4) were assigned using the CLCSC. Canine lung carcinoma stage was I (n = 7), II (n = 32), III (n = 24) and IV (n = 8). Median survival time was 952, 658, 158 and 52 days for stages I-IV, respectively. Primary tumour features (T1-T4), incomplete surgical excision, presence of lymph node metastasis and tumour grade were independent prognostic indicators for overall survival. Twenty-six dogs received adjuvant chemotherapy; however, no statistically significant benefit was found. The CLCSC primary tumour features and stage classification were highly prognostic for survival in dogs with PPC. We propose further application and evaluation of this update to canine PPC stage classification. Given the poor prognosis of advanced stage canine PPC, novel treatments are needed.

P2.13-11 Predicting Micrometastasis in Mediastinal Lymph Nodes in Patients with Non-Small Cell Lung Cancer

Non-small-cell lung cancer staging is the most important factor affecting both the potential treatment and the prognosis. The evaluation of non-small cell lung carcinoma staging uses the TNM classification (tumor, node, metastasis). The N factor plays a more critical role in staging than T and M factors, because of its unpredictability. We know that undiagnosed micrometastatic nodal disease has a poor prognosis. Detecting micrometastasis is expensive and time consuming, so that’s why we aimed to investigate the factors predicting micrometastatic mediastinal disease. We collected all the lymph nodes from the patients that we operated between July 2012 and July 2013. We excluded all the patients who had an induction treatment and preoperatively diagnosed with mediastinal metastasis. We studied the expressions of three biomarkers; EpCAM, CEACAM5 and KRT19 using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) in lymph nodes and compared the expressions with healthy controls. If all three of them are positive, we have accepted it as micrometastasis. We compared the presence of micrometastasis with the pathological data to identify possible predictive factors. We analyzed 86 lymph nodes from 32 patients. Twenty seven out of 86 lymph nodes (%31.4) were positive for micrometastasis. Eighteen out of 32 patients (%56.3) became micrometastatic and 16 out of 32 patients are upstaged. Four of them are upstaged from N1 to N2 and 12 of them are upstaged from N0 to N2. Micrometastatic patients tend to have poorer survival compared to non-micrometastatic patients but without an statistical significance. However micrometastasis was found significantly higher in tumors with less than 2 cm (p: 0.03) and lower in tumors without lymphovasculary invasion (p: 0.03). In our study tumors with smaller than 2cm in diameter and without lymphovascular invasion have significantly higher micrometastatic potential. In order to validate these parameters as predictive markers this experiment should be performed in a larger cohort with increased control population.

Targeted Therapy With Anaplastic Lymphoma Kinase Inhibitor (Alectinib) in Adolescent Metastatic Non–Small Cell Lung Carcinoma

Primary lung adenocarcinoma is extremely rare in the pediatric age group. We report an 18-year-old man with non-small cell lung carcinoma stage IV with brain and bone metastatic. Lung biopsy showed expression of PDL1 along with rearrangement of ALK gene at chromosome 2p23. However, neither mutation of ROS1 nor epidermal growth factor receptor overexpression was seen. Second-generation anaplastic lymphoma kinase (ALK) inhibitor (alectinib) is initiated as first line of treatment. After 8 months of treatment with alectinib, F-NaF PET/CT demonstrated resolution of bone lesions. The present case show rapid and good response to alectinib in metastatic ALK-positive non-small cell lung carcinoma.

EP-1386: Impact of the stereotactic irradiation schedule for non-small-cell lung carcinoma stage I

EP-1386: Impact of the stereotactic irradiation schedule for non-small-cell lung carcinoma stage I

Analysis of haemostasis biomarkers in patients with advanced stage lung cancer during hypofractionated radiotherapy treatment.

ObjectiveTo investigate the relationship between changes in inflammatory and coagulatory biomarkers before and after short palliative radiotherapy in patients with advanced stage lung cancer.MethodsThis prospective observational single-centre study enrolled patients with histologically- or cytologically-confirmed lung cancer who were eligible for palliative radiotherapy. Inflammatory and coagulatory biomarkers including complete blood count, D-dimer and fibrinogen levels were evaluated before and after short hypofractionated radiotherapy.ResultsSeventy-two patients with advanced stage lung carcinoma were enrolled in this study. Metastases were associated with an increase in white blood cells, neutrophils and mean platelet volume. Increased volume of the primary tumour had a borderline level of correlation with white blood cell and neutrophil counts. After radiotherapy, white blood cells, neutrophils, haemoglobin and lymphocyte counts were decreased. After radiotherapy, the change in fibrinogen and mean platelet volume were borderline significant.ConclusionThe levels of inflammatory and coagulatory biomarkers can be used to monitor treatment.

Regional lymph node sampling in lung carcinoma: a single institutional and national database comparison

Assessing regional lymph node metastasis is a key component of lung carcinoma staging and prognostication. Recent guidelines have suggested a quality metric of 10 total regional lymph nodes sampled with each stage I-II primary lung carcinoma resection. However, the extent of mediastinal lymph node sampling remains controversial. We assessed factors contributing to regional lymph node counts and effect on overall patient survival in an institutional cohort of 888 cases and the Surveillance, Epidemiology, and End Results national cancer registry (10 856 cases). The distribution of total lymph node counts in lobectomy and pneumonectomy cases was variable with a median of 10 and an interquartile range of 7 to 14. Multiple clinical and pathologic factors correlated with total regional node counts. Total lymph node counts of at least 10 in the institutional cohort did not correlate with significant differences in overall survival as compared with node counts of less than 10 (P = .38). In the Surveillance, Epidemiology, and End Results database, although 0 regional lymph nodes were correlated with reduced overall survival (hazard ratio, 1.47; P < .01), no significant difference was detected for 1 to 9 versus at least 10 nodes (P = .8). In conclusion, lymph node counts for primary lung carcinoma are driven by surgical, pathologic, and biologic variability. We find no evidence for a meaningful quality metric of 10 total regional lymph nodes at the institutional and national registry levels.

Respiratory-gated PET/CT for pulmonary lesion characterisation—promises and problems

2-deoxy-2-(18Fluorine)-fluoro-D-glucose (FDG) PET/CT is an integral part of lung carcinoma staging and frequently used in the assessment of solitary pulmonary nodules. However, a limitation of conventional three-dimensional PET/CT when imaging the thorax is its susceptibility to motion artefact, which blurs the signal from the lesion resulting in inaccurate representation of size and metabolic activity. Respiratory gated (four-dimensional) PET/CT aims to negate the effects of motion artefact and provide a more accurate interpretation of pulmonary nodules and lymphadenopathy. There have been recent advances in technology and a shift from traditional hardware to more streamlined software methods for respiratory gating which should allow more widespread use of respiratory-gating in the future. The purpose of this article is to review the evidence surrounding four-dimensional PET/CT in pulmonary lesion characterisation.

A prospective study of association of cancer stem cell marker aldehyde dehydrogenase 1 with clinicopathological profile in lung carcinoma patients.

In India, lung carcinoma is the fifth-most common tumor and second-most common tumor in the males as per the Indian Council of Medical Research registry of 2002. It has been seen that ALDH1 expression in non-small cell lung cancer (NSCLC) and the presence of marker was linked to a more tumorigenic potential in the in vivo assessment and shorter disease-free survival in NSCLC patients with platinum treatment. Hence, our objective was to detect association of cancer stem cell (CSC) marker aldehyde dehydrogenase 1 (ALDH1) with clinicopathological profile in lung carcinoma patients. This is a Pilot study. It was a Pilot study where biopsies from 55 fresh previously untreated lung cancer patients visiting the Pulmonary Medicine Department of Era's Lucknow Medical College and Hospital Lucknow and King George's Medical University were taken for 18 months November 2014-April 2016, after taking proper informed consent from them. Paraffin blocks were taken and stained by hematoxylin and eosin (Sigma) to make the histopathological diagnosis and immunohistochemistry was done for detection of CSC marker ALDH1 (Daco). The statistical analysis was done using Statistical Package for Social Sciences Version 15.0 Statistical Analysis Software. The values were represented in number (%) and mean ± standard deviation. Expression of stem cell marker ALDH1 with the staging of the tumor was observed in 62.5% of Stage I, 80% of Stage II, 94.1% of Stage III, and 100% of Stage IV cases. Statistically, there was a significant association between ALDH1expression and stage of disease (P < 0.001). Diagnostic efficacy of ALDH1 expression in the detection of any positive clinical stage, it was found to be 88.6% sensitive and 90.9% specific. Strong ALDH1 expression correlates with higher stage of lung carcinoma making it a prognostic marker needing in-depth study.

Global lipidomics identified plasma lipids as novel biomarkers for early detection of lung cancer.

PurposeLipids play roles in membrane structure, energy storage, and signal transduction as well as in human cancers. Here we adopt lipidomics to identify plasma lipid markers for early screening and detection of lung cancer.Experimental DesignUsing mass spectrometry, we profiled 390 individual lipids using training and validation strategy in a total of 346 plasma samples from 199 early NSCLC patients, including 113 adenocacinoma and 86 squamous cell cancers (SqCC), and from 147 healthy controls.ResultsIn the training stage, we found distinct lipid groups that were significantly distributed between NSCLC cases and healthy controls. We further defined a panel of four lipid markers (LPE(18:1), ePE(40:4), C(18:2)CE and SM(22:0)) for prediction of early cancer with a accuracy of 82.3% AUC (Area under ROC curve), sensitivity of 81.9% and specificity of 70.7% at the training stage and yielded the predictive power with accuracy (AUC,80.8%), sensitivity 78.7%, specificity 69.4% and in the validation stage.ConclusionsUsing lipidomics we identified several lipid markers capable of discerning early stage lung carcinoma from healthy individuals, which might be further developed as a quick, safe blood test for early diagnosis of this disease.

Relationship with lung carcinoma in the patients with Anthracosis by detection of expression of P16 and MUC1 genes.

Introduction and objective: Anthracosis is a pneumoconiosis caused by coal dust. The term “pneumoconiosis” refers to an occupational lung disease caused by long-term inhalation of dust. To achieve more efficient diagnosis and treatment methods, changes in the expression of MUC1 and P16 genes in the patients with anthracosis and their relationship with none-small cells lung carcinoma were examined.&#x0D; Methodology: Thirty anthracosis samples (center of lesion) and thirty healthy samples (edges of lesion) were collected from anthracosis patients diagnosed by a specialist. The patients signed a written letter of consent beforehand. The expression of MUC1 and P19 biomarkers was measured through Real-Time PCR. The relationship of the expression of biomarkers with tumor staging and lung carcinoma stage was examined.&#x0D; Results: The two groups in the study were compared using t-test. P16 marker was positive at the center and edges of lesions in seven (out of 30) and 18 (out of 30) cases respectively. There was a significant difference between positive P16 markers at the center and edges of the lesions (p-value&lt;0.001). MUC1 marker was positive at the center of lesions in 21 cases out of 30 (sensitivity = 70%) and it was positive at the edges of lesions in seven cases out of 30. In terms&#x0D; lesions (p-value&lt;0.001).&#x0D; Conclusion: The results indicated a relationship between anthracosis and lung carcinoma. Clearly, the positive cases of P16 genes at the edges of lesions were higher than that at the center; while, the positive cases of MCU1 gene at the center of lesions were higher than that at the edges. Further studies with larger sample groups are needed to provide more evidences.

The intersegmental plane: an emerging concern for the thoracoscopic surgeon

The profile of patients who are operated on for lung cancer is evolving. More and more ground glass opacities and early stage lung carcinomas are discovered, either because lung cancer screening programs are being set up or because patients or their physician ask more easily for a CT-scan than in the past. Until recently, many of these patients—when a non-small cell lung carcinoma (NCSLC) was suspected - underwent a lobectomy whatever the size and clinical stage of the tumor. Although the results of ongoing trials comparing survivals of lobectomy and sublobar resections (SLR) for early NSCLC are pending, most pulmonologists, oncologists and surgeons agree that many of these patients should rather have a SLR than a lobectomy.

IA01.04 Does Cytological Material Fit All - Lessons from EBUS/Bronchoscopy

In the diagnosis of lung cancer the primary diagnostic approach is microscopic evaluation of tissue biopsy. However, in many cases the only material for microscopic evaluation is cytological one. There are numerous types of cytological material in evaluation of lung tumors including sputum, bronchial brush, bronchial washing, transthoracic and transbronchial fine needle aspirates. Historically sputum was the most common diagnostic material but at present the most common types of cytological specimen are bronchial brush, and transthoracic or transbronchial FNAB. Nowadays worked out and recognized cytological criteria allows not only to diagnose carcinoma but in majority of cases to specify the histologic type of a tumor. This approach to microscopic diagnosis of lung carcinoma was incorporated to the latest WHO classification of lung tumors (ref). The key reason that cytodiagnosic criteria and terminology were included into WHO classification was that in about 30% cases of lung tumors the cytological specimen is the only material for microscopic evaluation. Similarly to evaluation of small tissue biopsies in cytopathology, in doubtful cases, immunocytochemistry may be implemented to determine histologic type of tumor. Most useful in evaluation of cytological specimen are IHC antibodies with nuclear presentation (e.g. p40 for squamous cell carcinoma and TTF1 for adenocarcinoma). Cytological material may be utilized in evaluation and in differential diagnosis between primary and metastatic lung tumor. The panel of the antibodies (e.g. CDX2, PSA, Melan A) may be used to indicate location of primary tumors mainly adenocarcinomas. Since cytological smears are of limited diagnostic value for immunocytochemistry, the so-called cell blocs technique is recommended. This technique allows to use larger panel of antibodies for immunohistochemical evaluation. Cytology become very useful for clinical staging of lung carcinoma routinely utilizing EBUS and EUS technique for obtaining material from parahilar and mediastinal lymph nodes. Cytological criteria are similar to that used for specimens obtained by transthoracic FNAB. In our center practice cooperation with adequately trained thorax surgeons provides adequate material for microscopic evaluation from EBUS and EUS obtained specimens in 94% cases. Currently one of the important task for pathologist in evaluating material from lung carcinoma is adequate selection of the material for molecular test. In case of lung carcinoma or to be specific lung adenocarcinoma â material is selected for evaluation of EGFR and K-RAS mutation. In our experience cytological material particularly fine needle aspirates - fulfill such demands. Percentages of tumors cells in the sample is often even higher than in tissue sections especially in fine needles of peripherally location lesions. Cytological material may be useful in evaluation of EGFR and K-RAS mutation as well as in determination of presence of translocations of ALK and ROS1 using FISH technique. Evaluation of ALK and ROS1 translocation remained in the hands of cytopathologists since the crucial point is the location of translocation in nuclei of tumors cells. Latest challenge for pathologists evaluating lung carcinoma specimen is to determine predictive criteria for immunotherapy in those tumors. At the moment it seems that cytological material may be not satisfactory for adequate evaluation of immunocytochemical expression of PD-L1 and PD-1. In summary cytological material from lung carcinoma is useful in establishing the firm microscopic diagnosis of malignancy, to determine histologic type and to be used for molecular tests. It also allows to differentiated between primary and metastatic lung malignancies as well as determined primary location of metastatic lung carcinoma. Cytological specimens obtained by EBUS and EBUS techniques are very useful in clinical staging of lung carcinoma. Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG eds. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. 4th ed. Lyon, France: IARC Press; 2015. cytology, lung carcinoma, molecular testing

43 Quality standards for invasive tests for diagnosis and staging of lung carcinoma: a retrospective review at a tertiary referral hospital

43 Quality standards for invasive tests for diagnosis and staging of lung carcinoma: a retrospective review at a tertiary referral hospital