[The Significance of Surgical Biopsy in Case of the Resistance to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors for the Treatment of Postoperative Recurrence of Lung Cancer].

To evaluate the clinical features of patients who developed resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) administered for postoperative recurrence of lung cancer, we assessed eight patients who underwent surgical biopsy or sampling for the detection of T790M mutation under general anesthesia from 2017 to 2019 in our hospital. All 8 patients had undergone lobectomy with nodal dissection for lung cancer of pathological stageⅠB/Ⅲ/Ⅳa (4/3/1 patients). The median disease-free survival was 29 months (range:11~110 months). The recurrence site was the lung in six patients including malignant pleural effusion in one of six, and two pleural disseminations. All eight patients received gefitinib as first-line treatment. The median age at surgical biopsy was 75 years (range:66~86 years). We performed pleural biopsy in 2 patients, partial lung resection in 5 patients, and pleural effusion sampling in 1 patient in whom our attempt to perform partial lung resection failed because of severe adhesion between the lung and chest wall. T790M mutation was observed in 7 patients( 85.7%) and the treatment by osimertinib in 6 patients was effective in 5 patients( 83.3%). Surgical biopsy is useful for detecting gene mutations in patients resistant to EGFR-TKIs.

[Lung Cancer Accompanied by Sarcoidosis with Mediastinal and Bilateral Hilar Lymphadenopathy;Report of a Case].

A 64-year-old woman with complete atrioventricular block caused by sarcoidosis was emergently placed a pacemaker. A 10 mm nodule in the left upper lobe of the lung and the mediastinal and bilateral hilar lymphadenopathy was detected through chest computed tomography. To establish the diagnosis, resection of the tumor and #4L was performed. By intraoperative pathology, the nodule was diagnosed as an adenocarcinoma and #4L was found to be a granuloma without metastasis of carcinoma. Subsequently, left upper lobectomy and lymph node dissection (ND2a-2) was conducted. Pathological stage was stageⅠA1 lung cancer. No recurrence has been noted for a year postoperatively and lymphadenopathy has improved by administering prednisolone medication.

Successful step-by-step diagnosis and management of expiratory central airway collapse.

A 45-year-old woman with recurrent dyspnea for 40 years was previously diagnosed with bronchial asthma and spasmodic dysphonia. On admission, the patient was diagnosed with expiratory central airway collapse (ECAC) due to expiratory dynamic airway collapse based on radiographic examination, chest computed tomography, and bronchoscopy. After continuous positive airway pressure and temporal airway stenting, surgical tracheobronchoplasty and tracheal membranous portion reinforcement using polypropylene mesh successfully relieved the respiratory symptoms. In patients with airway obstructive disease refractory to conventional therapies, ECAC should be considered.

Virtual-assisted lung mapping using dual staining with indocyanine green and indigo carmine enhanced marking detectability.

Background: Virtual-assisted lung mapping (VAL-MAP) is a preoperative bronchoscopic multispot dye-marking procedure to facilitate sublobar lung resection for unidentifiable lung nodules. To increase detectable markings, we performed VAL-MAP using dual staining (VAL-MAP DS) with indocyanine green (ICG) and indigo carmine. This study was designed to evaluate the efficacy and safety of the modified technique. Methods: We retrospectively reviewed the records of patients who underwent VAL-MAP DS. Twenty patients with 27 lesions underwent 72 VAL-MAP DS markings. We investigated the overall detectable marking rate, visible marking rate, successful resection rate, and complications. Results: The overall detectable marking rate, thanks to both ICG and indigo carmine, tended to be higher than the indigo carmine visible marking rate (95.7% vs. 85.5%, P=0.08). The successful resection rate with sufficient margins was 92.0%. There were no adverse events related to the use of ICG. ICG markings of the lungs of patients with a history of smoking more than 50 pack-years tended to be visible, but the staining was too extensive compared with the staining in patients who smoked less or not at all (58.8% vs. 0.0%, P<0.001). Conclusions: VAL-MAP DS is likely be efficacious and safe in enhancing the detectability of markings. This bronchoscopic technique should be considered as one of the optimal preoperative marking methods in thoracic surgery.