Evaluation of the utility of vibration response imaging device and Operation Planning Software in the assessment of patients before lung resection surgery.

BACKGROUND AND OBJECTIVES: A variety of methods have been used to evaluate patients with lung cancer to define a patient cohort at high risk for postoperative mortality and respiratory complications associated with lung resection surgery. Our aim was to evaluate the utility of vibration response imaging (VRI(XP)) Operation Planning Software (O-Plan) in assessing suitability for surgical resection and for the prediction of postoperative forced expiratory volume in 1s (ppoFEV(1)). METHODS: A total of 58 subjects with lung cancer underwent evaluation prior to lung resection surgery and postoperative lung function after surgery. RESULTS: Preoperative pulmonary function tests and quantitative breath sound measurements by VRI were performed in all patients to estimate postoperative lung function. In addition, 20 patients underwent perfusion scan prior to surgery. VRI(XP) O-Plan predictions (12 pneumonectomies and 46 lobectomies) showed good correlation and concordance (Lin's coefficient) with postoperative FEV(1) (l) (r=0.865, Lin's coefficient 0.858) and FEV(1) (%) (r=0.877, Lin's coefficient 0.861) 4-6 weeks after surgery. Predicted and postoperative measured FEV(1) showed no significant differences (p>0.05). Average lung function predicted postoperative values were similar for perfusion and VRI(XP) O-Plan calculations with a correlation of 0.74 and concordance of 0.700. CONCLUSIONS: VRI(XP) O-Plan has shown high accuracy in predicting postoperative FEV(1) after lung resection surgery. Given its simplicity of operation and the non-invasive nature of VRI(XP) and O-Plan, it could be a good alternative to perfusion scan in pre-surgery assessment.

[Endobronchial lipoma. Therapeutic considerations]. / Lipoma endobronquial. Consideraciones terapéuticas.

Endobronchial lipoma is a very rare benign tumor. The most frequent clinical presentation is caused by airway obstruction. A computed tomography finding of a homogeneous mass with fat density not enhanced by intravenous contrast material is considered diagnostic of this kind of tumor. The definitive diagnosis is given by bronchoscopy and biopsy. The treatment of choice is endoscopic resection, although open resection is sometimes required. We present a case of endobronchial lipoma that involved the left main bronchus and extended through the bronchial carina. Endoscopic treatment was initially attempted. However, open resection through superior lobectomy with carinal resection and a bronchoplastic procedure were required to avoid left pneumonectomy.

Clinical value of p53, c-erbB-2, CEA and CA125 regarding relapse, metastasis and death in resectable non-small cell lung cancer.

The prognostic value of p53 and c-erbB-2 immunostaining and preoperative serum levels of CEA and CA125 was investigated in a prospective multicentric study including 465 consecutive non-small cell lung cancer (NSCLC) patients with resectable tumors. Four end-points were used: lung cancer death, first relapse (either locoregional or metastasis), loco-regional recurrence and metastasis development. Standard statistical survival methods (Kaplan-Meier and Cox regression) were used. The specificity of the prognostic effect across different types of tumors was also explored, as had been planned in advance. Our results showed, once again, that pathological T and N classifications continue to be the strongest predictors regarding either relapse or mortality. Three of the studied markers seemed to add further useful information, however, but in a more specific context. For example, increased CEA concentration defined a higher risk population among adenocarcinomas but not among people with squamous tumors; and p53 overexpression implied a worse prognosis mainly in patients with well differentiated tumors. The analysis of type of relapse proved to be very informative. Thus, CA125 level was associated with a worse prognosis mainly related with metastasis development. Another interesting result was the influence of smoking, which showed a clear dose-response relationship with the probability of metastasis. For future studies, we recommend the inclusion of different endpoints, namely considering the relationship of markers with the type of relapse involved in lung-cancer recurrence. They can add useful information regarding the complex nature of prognosis.