[A rare carcinoma metastasizing to the lung: Sertoli-leydig cell tumor]. / Akcigere metastaz yapan nadir bir karsinom: Sertoli-leydig hücreli tümör.

The lung is the most common site of metastasis for many malignancies. Especially the gastrointestinal system, gynecological malignancies and osteosarcomas frequently metastasize to the lung. It accounts for less than 0.5% of all ovarian neoplasms. The frequency of recurrence and metastasis is less than 5%. In most cases, they are stage I tumors, limited to the ovary and carry a good prognosis. Here, while investigating the nodules in the lung that were detected incidentally at the age of 64, the rare Sertoli-Leydig cell tumor of the lung is discussed clinically, radiologically and pathologically in the presence of a 64-year-old patient who was found to have undergone ovarian surgery 9 years ago. Since imaging methods and tumor markers did not yield significant results in terms of primary malignancy, wedge resection was performed from the left lung nodules. The histology of the lung nodule was the same as the poorly differentiated foci of the ovarian tumor. The immunohistochemical profiles of the two tumors were also similar. As a result of the evaluation of the patient's old materials belonging to the ovary and the samples taken from the lung together; The diagnosis was reached by obtaining similar results with the primary tumor in the immunohistochemical examination performed for the metastatic focus. Sex cord stromal tumors of the ovary, which rarely cause lung metastasis and have a tendency to recur and metastasis in a very long time after the first diagnosis, should also be kept in mind in the elderly woman and the patient with a gynecological history.

Relationship between 18F-FDG PET/CT radiometabolic markers and EGFR mutation, positive ALK Expression in patients with non-small cell lung cancer.

INTRODUCTION: The aim of this study was to evaluate the association between the presence of EGFR mutations, ALK rearrangement and the standardized uptake value (SUV) of 18F-fluoro-2-deoxy-glucose (18F-FDG) by PET/CT imaging in patients with NSCLC. MATERIALS AND METHODS: We retrospectively reviewed NSCLC patients, who underwent EGFR mutation, ALK rearrangement testing and pre-treatment PET/ CT. The relationships of EGFR mutation, ALK rearrangement with patient characteristics and three parameters based on 18F-FDG PET/CT, including the maximal standard uptake value (SUVmax) of the primary tumour (tSUVmax), lymph node (nSUVmax) and distant metastasis (mSUVmax) were evaluated. RESULT: EGFR mutations were found more frequently in females and nonsmokers. tSUVmax was the only PET parameter that was lower in EGFRpositive patients than in EGFR-negative patients (8.7 vs. 11), with a p value of 0.032. There were no differences between nSUVmax and mSUVmax results and EGFR mutation. tSUVmax, nSUVmax and mSUVmax were not significantly different between ALK positive and ALK negative groups in NSCLC. The presence of pleural fluid at the time of diagnosis was significantly associated with positive ALK expression. CONCLUSIONS: We showed that low tSUVmax and primary tumour diameter were associated with mutant EGFR status and could be evaluated with other clinical factors to increase the discrimination in EGFR mutation status in some NSCLC patients without EGFR testing. There is a correlation between ALK positivity and the presence of pleural fluid. We also noted that the ALK positivity might be only in the adenocarcinoma group and at a younger age.

Can LENT Prognostic score (LDH, ECOG performance score, blood neutrophil/lymphocyte ratio, tumor type) change the clinical approach in malignant pleural effusion?

INTRODUCTION: The aim of this study was to evaluate the predictive power of LENT (LDH in pleural fluid, Eastern Cooperative Oncology Group [ECOG] performance status, neutrophil-lymphocyte ratio in the serum, and tumor type) score which is a current prognostic score in patients with MPE and to determine its effect on survival and its status in clinical decision making. In addition, it was aimed to compare LENT score with the conventional but subjective score ECOG. MATERIALS AND METHODS: A retrospective observational study was conducted reviewing the medical records of patients managed for MPE (malign pleural effusion) between 2008 and 2018. LENT prognostic score was calculated in the patients. The ECOG score calculated for the same patients was compared in terms of mortality. RESULT: A total of 191 patients with malignant pleural effusion, 118 males (61.7%) and 73 females (38.2%), were included in the study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying overall survival were 69.8 %, 100%, 100% and 18.8%, respectively at the LENT score > 4 (p= 0.000). At ECOG PS >2, the sensitivity, specificity, PPV, NPV were as the same as the LENT score >4 for identifying overall survival. In all patients, overall median survival according to the LENT score was 662/119/33 days in low/moderate/high risk groups, respectively. Cox regression analysis indicated that having a moderate LENT score (p= 0.004, OR: 2.21, CI: 1.29 -3.78%) and high LENT score (p= 0.000, OR: 4, 50 CI: 2.57-7.89%) were predictors for overall survival in all patients due to MPE. In ROC analysis, there was no difference in mortality in erms of both LENT and ECOG at 1st, 6th and 12th months. CONCLUSIONS: LENT is a better scoring system than ECOG in predicting early mortality, while both ECOG and LENT have almost the same power in predicting mortality. However, LENT is slightly more objective but more difficult to calculate because it contains laboratory findings. Thus, both scoring systems can be used to predict mortality in patients with malignant pleural effusions. Neither of them has superiority to each other.

Clinical presentation of health care workers with symptoms of coronavirus disease 2019 at the Izmir tertiary education hospital, during an early phase of the pandemic.

INTRODUCTION: The aim of this study is to investigate and report on the data regarding the clinical characteristics and outcomes of healthcare workers with COVID-19 at tertiary education hospitals from Turkey. MATERIALS AND METHODS: This was a single center, retrospective, descriptive and observational study using cross-sectional data, which were collected from confirmed COVID-19 patients at a tertiary education hospital. Patients' demographic and clinical characteristics, mortality rates, and the factors associated with hospitalization were analyzed. RESULT: By May 15, 2020, 480 patients were diagnosed with COVID-19 in our hospital where 49 (10.2%) of whom were HCWs. The mean age was 40.0 ± 8.45 (75.5% female). The most common symptoms were cough (32.7%), fever (30.6%), and myalgia (14.3%). Comorbidities were present in 32.7% of the patients. Most of the HCWs were nurses (53.1%) and physicians (18.4%), and the remaining 14 (28.6%) were cleaning and administrative staff. The severity of the disease was mild in 65.3% and severe in 34.7% HCWs. Leukocyte, neutrophil, lymphocyte and platelet values were statistically lower in hospitalized patients. There was a statistically significant relationship between the presence of infiltration on the chest X-ray, and the patient's symptoms with the severity of the disease (respectively p= 0.002 and 0.009). CONCLUSIONS: In conclusion, the frequency of COVID-19 in healthcare workers is high. The study presents the characteristics of HCWs infected with coronavirus from a single center in Turkey.

Sociodemographic and clinical risk factors associated with in-hospital tuberculosis mortality in Türkiye, 2008-2018.

Introduction: Tuberculosis (TB) is an infectious disease that can be fatal if left untreated or poorly treated, and it is associated with many morbidities. Deaths may provide better understanding of the associated factors and help guide interventions to reduce mortality. In this study, it was aimed to reveal some of the features that predict hospital mortality in patients with TB and to present some alarming findings for clinicians. Materials and Methods: Patients who had been hospitalized with the diagnosis of TB between January 2008 and December 2018 were included and analyzed retrospectively. In-hospital mortality because of any TB disease after the initiation of treatment in patients admitted to the TB Ward and the primary cause of mortality were taken as endpoint. Result: A total of 1321 patients with a mean age of 50.1 years were examined. Total mortality was 39.4% (521 deaths) and 13.1% were in-hospital deaths (173 deaths). Of the deaths, 61.8% (n= 107) occurred during the first month after TB treatment were started. On univariate analysis, age over 48.5 years, Charlson comorbidity index, extension of radiological involvement, hypoalbuminemia and lymphopenia were most predictive variables with higher odds ratios (respectively, p<0.001 for all). Conclusions: In-hospital tuberculosis disease mortality is related with older age, cavitary or extensive pulmonary involvement, low albumin levels, unemployment, cigarette smoking and especially those with concomitant malignancy and chronic pulmonary disease.

Outcomes of pulmonary rehabilitation after lung resection in patients with lung cancer.

Background: In this study, we aimed to examine the effectiveness of pulmonary rehabilitation applied after resection in patients with lung cancer. Methods: Between October 2017 and December 2019, a total of 66 patients (53 males, 13 females; median age: 65 years; range, 58 to 70 years) who underwent lung resection for non-small cell lung cancer and who were not administered any chemotherapy or radiotherapy regimen were included in the study. An eight-week comprehensive outpatient pulmonary rehabilitation program was applied to half of the patients, while the other half received respiratory exercise training. After the intervention, the results of both groups were compared. Results: In the pulmonary rehabilitation group, forced vital capacity value (p=0.011), six-minute walking distance (p<0.001), and Short Form-36 physical function, mental health, vitality scores increased significantly, while all scores of St. George's Respiratory Questionnaire, dyspnea (p<0.001) and anxiety score (p=0.041) significantly decreased. In the group given breathing exercise training, only dyspnea (p=0.046) and St. George's Respiratory Questionnaire symptom scores (p=0.038) were decreased. When the changes in the groups after pulmonary rehabilitation were compared, the decrease in dyspnea perception was significantly higher in the pulmonary rehabilitation group (p<0.001). Conclusion: Pulmonary rehabilitation program applied after lung resection in patients with non-small cell lung cancer reduces dyspnea and psychological symptoms, increases exercise capacity, and improves quality of life. It should be ensured that patients with lung cancer who have undergone lung resection are directed to the pulmonary rehabilitation program and benefit from this program.

FDG PET/CT signs of proven pulmonary hydatid cyst: is there any clue?

PURPOSE: Pulmonary hydatid cyst (PHC) can imitate many diseases. Sometimes, positron emission tomography/computed tomography (PET/CT) is performed in terms of malignancy exclusion for complicated cysts. Although some specific findings (doughnut sign) have been identified in hydatid cyst of the liver, there is no specific sign described for PHC. The aim of this study is to investigate the presence of a common finding in PHC patients scanned with PET/CT inadvertently. MATERIALS AND METHODS: From January 2015 to 2020, patients proven to have PHC were analyzed retrospectively. From all the patients, only 17, having a previous PET/CT, were included the study. Lesions were evaluated in three groups according to FDG uptake: A, negative; B, focal; C, doughnut sign. RESULTS: The total number of patients was 17. Nine of the patients were male and the median age was 41.94 + 14.68 (16-65) years. SUV max of the lesions ranged from 0.5 to 15.8 (mean ± SE: 4.68). According to the FDG uptake of the lesions, five were in Group A, two in Group B, and the remaining ten (58.8%) in Group C with doughnut sign. To correlate the CT findings with PET/CT findings, doughnut sign, which is a typical finding of hydatid cysts of liver, is seen in only four patients in Group 1-classified cysts which are non-complicated. But in Group 2 (n = 3) and 3(n = 4), the finding of doughnut sign is three in both groups. CONCLUSIONS: PET/CT is not a recommended imaging technique for PHC, but in cases where a definitive diagnosis is difficult, interpreting PET/CT findings is significant. This study demonstrates that previously described doughnut sign for liver hydatid cysts is also common for perforated pulmonary cysts. According to our knowledge, this is the first largest series of determining PET/CT findings of PHC. Further larger series will contribute to the literature.

Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice.

PURPOSE: The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey. METHODS: A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report. RESULTS: Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetracycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respectively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 â€‹µg/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin. CONCLUSIONS: Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 â€‹µg/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice.

Comparison of Brock University, Mayo Clinic and Herder models for pretest probability of cancer in solid pulmonary nodules.

OBJECTIVE: Risk analysis models, which are used in the diagnostic algorithm of incidental pulmonary nodules, are based on patient data from developed countries. Mayo Clinic, Brock University and Herder are among the most known models. We aim to compare the reliability of these models in patients with indeterminate solid nodules and to investigate the contribution of the predictors used to the model. METHODS: We analysed 305 patients who performed transthoracic needle biopsy and positron emission tomography/computed tomography for solid nodules, retrospectively. For all three models, the malignancy risk probabilities of patients were calculated, and patients were classified as low (<5%), moderate (60%) and high (<60%) risk groups. Later, the malignancy rates of each model in three different risk groups were compared within each other and among the models. RESULTS: The malignancy rate is 73% in 305 patients. In the Mayo Clinic and Herder models, the difference in the low-, medium- and high-risk groups is significant (p < 0.001). In the medium-risk group, the rate of malignancy is 96.8% in the Brock model. In the high-risk group, the rate of malignancy in Herder is 88.3% and the rate of malignancy in Mayo Clinic is 28.8%. The optimal cutoff values for the Mayo Clinic, Brock University, and Herder were 29.6, 13.4 and 70 (AUC, respectively; 0.71, 0.67 and 0.73). Age, smoking, gender, size, emphysema and spiculation increase the likelihood of malignancy. CONCLUSION: Close results were obtained in all three models. In the high-risk group, the Herder model has the highest reliability rate (odds ratio 3.3, confidence interval [1.1, 10.2]). Upper lobe predilection is not a reliable predictor.

Value of Cancer Ratio plus and Cancer Ratio Formulation in Distinguishing Malignant Pleural Effusion from Tuberculosis and Parapneumonic Effusion.

Background: The aim of our study is to determine the clinical availability accessibility of cancer ratio and cancer ratio plus formulations, previously validated and reported to have clinical value in distinguishing malignant pleural effusion from tuberculosis pleurisy and parapneumonic effusion. Materials and Methods: Retrospective study of patients hospitalized with Malignant Pleural Effusion (MPE), tuberculosis (TPE) and pararapneumonic effusion (PPE) between 2009 and 2018. Results: Totally 232 patients, 101(43.5 %) having MPE, 86 (37.1 %) having PPE and 45 (19.4 %) TPE were examined. When compared with each other, "serum LDH / PS Lymphocyte %", "Cancer ratio" and "Cancer ratio plus" values were statistically different between the groups (p = 0.021, p <0.001 and p = 0.015, respectively). In multivariate logistic regression analysis, cancer ratio, serum LDH: pleural fluid lymphocyte count ratio was in positive correlation with MPE. The sensitivity and specificity of "cancer ratio", "cancer ratio plus" and "ratio of serum LDH: pleural fluid lymphocyte count" were 84.2 % (95% CI 75.6- 90.7) and 52.7 (95% CI 43.8- 61.5), and 82.2 % (95% CI 73.3- 89.1) and 45.8 (95%CI 37.1- 54.7), 53.5% (95% CI 43.3- 63.5) and 67.2% (95% CI 0.68-0.94) at the cut-off level of >14.25, >28.7, and >636, respectively. When considering only MPE and TPE patients, the specificity of cancer ratio and cancer ratio plus increased. Conclusion: The cancer ratio plus rate (the ratio of "cancer ratio"formulation to the percentage of differential pleural lymphocyte count) was almost the same as the cancer ratio in separating the malignant pleural effusion from the TPE and PPE, while it has better specificity only in differentiating malignant effusions from tuberculosis effusions.

Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR.

Objectives: The major scores associated with the mortality after COPD exacerbations were; DECAF, CURB-65, PSI and BAP-65 scores. We aimed to compare these scores in predicting 30- and 90-day mortality in patients hospitalized with exacerbation of COPD.Methods: The data of 141 patients who were hospitalized with the diagnosis of COPD exacerbation between January 2018 and March 2019 and accepted to participate in the study were prospectively recorded.Results: Age, mean modified-medical-research-council (mMRC) dyspnea score, pleural effusion, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), presence of atrial fibrillation (AF), PaCO2 pressure values were found to be significantly higher at both 30 and 90-days deceased group, while hemoglobin, albumin and pH values were significantly lower (all p < 0.05). DECAF, CURB-65, PSI and BAP-65 scores were significantly higher for both 30 and 90-days mortality (all p < 0.05). DECAF, CURB-65, PSI, BAP-65 scores, PLR, NLR predicted to 30 day and 90 day mortality. But, CURB-65 found (OR 2.968 and 2.284, respectively) superior to others in predicting 30 and 90-days mortality.Conclusions: CURB-65 score is a significant, simple and feasible score for predicting 30 and 90 days mortality in COPD exacerbation and may be routinely used in all patients hospitalized with COPD exacerbation.

What are the Differences Between Smoker and Non-smoker COPD Cases? Is it a Different Phenotype?

OBJECTIVE: The most important risk factor for chronic obstructive pulmonary disease (COPD) is smoking. However, more than 25% of patients do not have a history of smoking. The intent of this study is to identify characteristics of COPD patients that are non-smokers. MATERIAL AND METHODS: The records of patients with COPD were retrospectively reviewed. Smoking history, comorbidities, exacerbations, biomass, and environmental tobacco smoke (ETS) exposures were identified. Also, age, gender, pulmonary function test (PFT) values, modified Medical Research Council (mMRC) dyspnea scores were recorded. Non-smokers exposed to any of the COPD risk factors above were grouped and the data were analyzed to determine the specific characteristics of COPD that applied to them. RESULTS: A total of 706 COPD patients were analyzed with a mean age of 67.2 ± 9.4. Of these patients, 93 (13.2%) were female and 613 (86.8%) were male. Of the 706 patients, 128 (18.1%) were non-smokers. The percentage of male patients having COPD was significantly lower in the non-smoker group (P < .001). However, biomass, ETS exposure in childhood, and a history of previous respiratory infection were significantly higher in the non-smoker group (P < .001). The mean body mass index (BMI) was greater in non-smokers than smokers. CONCLUSION: Non-smokers with COPD have more biomass, ETS exposure, and infection history in childhood. They also have less impairment of airflow limitation, better symptom scores, and greater BMIs. Smoking history can be used to determine a different phenotype.

Comparison of typical and atypical computed tomography patterns regarding reversibility and fibrosis in pulmonary sarcoidosis.

PURPOSE: This study aims to investigate whether there is a significant difference between typical and atypical parenchymal patterns in the development of fibrosis, which is the most crucial factor affecting morbidity in pulmonary sarcoidosis. METHODS: In our hospital, 145 cases with Siltzbach Types 2 and 3 sarcoidoses diagnosed by clinical, radiological, and histopathologic were retrospectively investigated. Perilymphatic nodules, accompanying mosaic attenuation, and interlobular septal thickening and central peribronchovascular bunch-like thickening on high-resolution computed tomography were assessed as typical. Solid nodules, galaxy finding, consolidation, ground-glass opacity, isolated mosaic attenuation, and interlobular septal thickening, and pleural fluid were accepted as atypical findings. Findings indicating fibrosis were fine and rough reticular opacity, traction bronchiectasis, volume loss, and cystic changes. For the analysis of variables, SPSS 25.0 program was used. RESULTS: Ten (16%) of the 61 cases with typical findings and 16 (19%) of the 84 with atypical findings developed fibrosis (P = 0.827). The mean age of cases with fibrosis was higher. With the cut-off of 50 years, sensitivity was 61.5%, and specificity was 68.9%. The highest fibrosis rate was in cases with ground glass pattern (n = 7/17), whereas higher reversibility rates were in those with miliary pattern (n = 9/12) and galaxy sign (n = 5/6). CONCLUSION: The incidence of fibrosis is higher in the atypical group with no significant difference. The incidence of fibrosis differs in each atypical pattern, being highest in ground-glass opacity and lowest in the miliary pattern.

The relation between distant metastasis and genetic change type in stage IV lung adenocarcinoma patients at diagnosis.

INTRODUCTION: Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. OBJECTIVES: The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. METHODS: The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. RESULTS: A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). CONCLUSION: In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.

Effect of Rebound Thymic Hyperplasia on Survival in Chemotherapy-Treated Lung Cancer.

OBJECTIVES: Thymus is a lymphoepithelial system in which cells responsible for the immune system are produced and directed. The aim of this study is to determine the overall survival effect of rebound thymic hyperplasia (RTH) in patients with non-small cell lung cancer (NSCLC) treated with systemic chemotherapy (CT). MATERIALS AND METHODS: The study was designed as retrospective case series. One hundred and thirty patients who met the inclusion criteria were evaluated. Demographic data, type of tumor, and treatments administered were recorded. The frequency of RTH development and the relationship between RTH development and survival was investigated. RESULTS: The median age of the patients was 59, and nine of 13 patients (69.4%) with RTH were iden-tified as stable disease, two patients had a partial response (15.3%), and two were evaluated as progres-sive disease (15.3%). Of the remaining 117 patients, 78 (66.6%) had stable disease, 11 (9.4%) had com-plete response, 21 (17.9%) had partial response, and seven patients were evaluated as having progressive disease (5.9%). The patients were categorized into two groups: Group 1 - without RTH and group 2 - with RTH. Thirteen (10%) of 130 patients developed RTH (group 2), while the remaining 117 (90%) patients did not have RTH (group 1). There was no difference between the two groups (59.1 years) in terms of age (p = 0.933). The RTH developed after a median time of 4.5 months (2-7 months) after CT had been administered. Overall survival was longer in patients with RTH than in patients without RTH (20.04 months) (95% CI, 4.79-35.29) vs. 10.05 months (95% CI, 8.74-11.36; p=0.049). CONCLUSION: The developing of RTH during systemic CT may be a prognostic marker in stage 4 non-small cell lung cancer.

Diagnostic success of transthoracic needle biopsy and PET-CT for 1 to 2 cm solid indeterminate pulmonary nodules.

OBJECTIVES: Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET-CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET-CT and TTNB. MATERIALS AND METHODS: 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET-CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. RESULTS: The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P < .001). The 2.5 SUVmax cutoff value had sensitivity of 91%, specificity of 35.6%, accuracy of 75% (P = .034). The cutoff value of 49 years of age, nodule size of 16.4 mm, gender and 2.5 SUVmax value had high accuracy for benign-malignant differentiation. No statistically significant difference was found in the upper lobe localization of nodule. CONCLUSION: A positive result from TTNB is a reliable finding; however, a negative result is not definitive. The high negative predictive value of PET-CT is effective in preventing the unnecessary biopsies and surgical procedures.

Contribution of Cell Block Obtained by Thoracentesis in the Diagnosis of Malignant Pleural Effusion.

AIM: The aim of this study wass to compare the cytological features of pleural exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of the combined approach for cytodiagnosis of these effusions. MATERIALS AND METHODS: In all, 113 pleural exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features, and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of malignancy were calculated for both the methods, using histology as a gold standard. RESULTS: CB method provided higher cellularity, better architectural patterns, and additional yield for malignancy when compared with CS method. For 22 (40%) patients, histologic subtype was determined with CB especially for adenocarcinoma. The sensitivity, specificity, positive, and negative predictive values of cytology and CB were 48%, 100%, 100%, 67.8% and 59.2%, 100%, 100%, 72.8%, respectively. CONCLUSION: CB technique definitively increased detection of malignancy in pleural fluid effusion when used as an adjunct to CSs. Also, CB provides material suitable for molecular genetic analysis for targeted therapies especially in the treatment of adenocarcinoma.

[Investigation of pyrazinamide resistance in multidrug-resistant tuberculosis cases in Hospital of Pulmonary Diseases, Izmir, Turkey]. / Izmir Gögüs Hastaliklari Hastanesinde çok ilaca dirençli tüberküloz olgularinda pirazinamid direncinin arastirilmasi.

Pyrazinamide (PZA) is one of primary drugs for antituberculous treatment. The aim of this study was to determine the rates of PZA resistance in multidrug-resistant (MDR) and susceptible Mycobacterium tuberculosis (MTB) strains isolated from patients who were admitted to our hospital. MDR strains have been isolated between 2005-2007 years, and susceptible strains were chosen randomly among the collection of the strains of the same period. MTB isolates were grown in BACTEC 960 full automatized broth system (Becton Dickinson, Sparks, MD) and Lowenstein-Jensen solid medium. Identification was done by radiometric BACTEC 460 NAP procedure. Antibiotic susceptibility testing against conventional anti-tuberculous drugs (streptomycin, isoniazide, rifampisin, etambutol) was performed by the radiometric BACTEC 460 system and PZA susceptibility was worked out by BD MGIT 960 PZA Kit (Becton Dickinson, Sparks, MD) with the use of 100.0 microg/ml critical concentrations of PZA. As a result, two of the 65 (3.1%) MTB susceptible strains and 16 of 63 (25.4%) MDR-MTB isolates were found resistant to PZA. In conclusion, due to the high PZA resistance rate in MDR-MTB isolates, susceptibility testing against PZA should be done in MDR-TB cases; however, since PZA resistance rate was low in new susceptible cases, it was thought that testing susceptibility of PZA is not necessary as a routine procedure in our region.

Comparison of curative and palliative radiotherapy efficacy in unresectable advanced non-small cell lung cancer patients with or without metastasis.

OBJECTIVE: To evaluate the efficacy of curative and palliative radiotherapy in inoperable advanced non-small cell lung cancer (NSCLC) patients with a performance status (PS) equal or greater than 2, and to compare the therapy effect on survival with or without metastatic disease. METHODS: From January 1998 through December 2004, 797 patients with inoperable stage III and IV NSCLC were treated with radiotherapy alone because of older age, cardiovascular disease, insufficient respiratory reserve or general frailty. Radical radiotherapy, consisting of approximately 60 Gy, given in 30 fractions was performed in 363 (45.5 %) of these patients. The other 434 patients (54.5%) were treated with palliative dose radiotherapy. Conventional follow-up of the patients was conducted at Izmir Oncology Center. All results were evaluated statistically. RESULTS: Seven hundred and sixty-three patients (95.7%) were male. The mean age was 61.02 years (+/- 9.678), ranging from 30-88 years. The prominent histology was squamous cell carcinoma (70.7%). Sixty-five patients (8.2%) have been staged IIIA, 419 (52.6%) IIIB, and 313 (39.3%) IV. The median follow up of patients was 274.19 days. One-year survival rate was 37%, and 2-year survival rate was 11% in the radical radiotherapy group, while these rates were 20% and 5% in the others. CONCLUSION: Although radical thoracic radiotherapy for metastatic NSCLC has not been adopted universally, this study shows that curative radiotherapy for the primary tumor provides additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This result raises the question of whether treatment with radical radiotherapy alone might be the most beneficial and cost-effective treatment of advanced stage NSCLC.

Evaluation of curative and palliative radiotherapy efficacy in extensive stage small cell lung cancer.

OBJECTIVE: To evaluate the efficacy of curative and palliative radiotherapy in the treatment of extensive stage small cell lung cancer (E-SCLC), and compare therapy effect on survival with or without metastatic disease. METHODS: From January 1998 through December 2004, 128 patients with E-SCLC were treated with radiotherapy and concomitants combined chemotherapy. Radical radiotherapy, consisting of approximately 60 Gy given in up to 30 fractions was performed in 53 (41.4%) of these patients. Others (58.6%) were treated with palliative dose radiotherapy. In all patients, chemotherapy was planned with cisplatin (80 mg/m2) intravenously (i.v.) on day 1, and etoposide (120 mg/m2) i.v. on days 1, 2 and 3, every 3 weeks for 3-6 cycles. Conventional follow-up of patients was conducted at Izmir Oncology Center, Izmir, Turkey. All results were evaluated statistically. RESULTS: One hundred and twenty-four patients (96.9%) were males. The mean age was 58.49 (+/- 9.01), ranging from 37-78 years. Metastases were initially determined in 64 patients (50%). The median follow up of patients was 287.41 days and median survival was 354.87 days. One year survival rate was 35.8%, and 2-year survival rates was 16.9% in the radical radiotherapy group, while these rates were 26.6% and 8% in the others. According to the statistical findings; the gains in duration of median survival with the curative thoracic irradiation are 151.97 days in all 128 patients. CONCLUSION: This study shows that curative radiotherapy at the primary tumor provides an additional survival benefit in patients with metastatic disease compared with palliative radiotherapy. This finding raises the question of whether treatment with radical thoracic radiotherapy with concomitant chemotherapy, consisting of first-line drugs, might be more beneficial and cost-effective as well as a less toxic treatment of E-SCLC.