RESUMEN
BACKGROUND: Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers. RESEARCH QUESTION: Are the HAL and HOMER models valid across multiple centers? STUDY DESIGN AND METHODS: This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. HOMER was used to predict the probability of N0 vs N1 vs N2 or N3 (N2|3) disease, and HAL was used to predict the probability of N2|3 (vs N0 or N1) disease. Model discrimination was assessed using the area under the receiver operating characteristics curve (ROC-AUC), and calibration was assessed using the Brier score, calibration plots, and the Hosmer-Lemeshow test. RESULTS: Thirteen centers enrolled 1,799 patients. HAL and HOMER demonstrated good discrimination: HAL ROC-AUC = 0.873 (95%CI, 0.856-0.891) and HOMER ROC-AUC = 0.837 (95%CI, 0.814-0.859) for predicting N1 disease or higher (N1|2|3) and 0.876 (95%CI, 0.855-0.897) for predicting N2|3 disease. Brier scores were 0.117 and 0.349, respectively. Calibration plots demonstrated good calibration for both models. For HAL, the difference between forecast and observed probability of N2|3 disease was +0.012; for HOMER, the difference for N1|2|3 was -0.018 and for N2|3 was +0.002. The Hosmer-Lemeshow test was significant for both models (P = .034 and .002), indicating a small but statistically significant calibration error. INTERPRETATION: HAL and HOMER demonstrated good discrimination and calibration in multiple centers. Although calibration error was present, the magnitude of the error is small, such that the models are informative.
Asunto(s)
Biopsia con Aguja Fina/métodos , Carcinoma de Pulmón de Células no Pequeñas/patología , Endosonografía/métodos , Biopsia Guiada por Imagen/métodos , Neoplasias Pulmonares/patología , Metástasis Linfática , Estadificación de Neoplasias/métodos , Broncoscopía/métodos , Calibración , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Femenino , Humanos , Neoplasias Pulmonares/epidemiología , Metástasis Linfática/diagnóstico por imagen , Metástasis Linfática/patología , Masculino , Mediastino/diagnóstico por imagen , Persona de Mediana Edad , Selección de Paciente , Valor Predictivo de las Pruebas , Pronóstico , Estados Unidos/epidemiologíaRESUMEN
Mucous membrane pemphigoid (MMP) is a rare variant of the skin disease pemphigoid, which predominantly involves the mucous membranes. This rare autoimmune disease that infrequently affects the respiratory tract is characterized by subepithelial blister formation that may result in scarring. Immunopathologic examination of mucous membranes reveals the deposition of immunoglobulins and complement within the subepithelial basement membrane. We describe a patient with undiagnosed MMP, with a near-fatal presentation of central airway obstruction causing acute respiratory distress. The patient was successfully treated with emergent rigid bronchoscopic resection of a ball valve-like endotracheal mass, and diagnosed with a rare variant of pemphigoid disease, MMP. The patient was treated with mycophenolate and was clinically in remission, with bronchoscopically stable lesions at 1 year of follow-up.
Asunto(s)
Obstrucción de las Vías Aéreas/etiología , Ácido Micofenólico/uso terapéutico , Penfigoide Benigno de la Membrana Mucosa/complicaciones , Tráquea/cirugía , Obstrucción de las Vías Aéreas/patología , Obstrucción de las Vías Aéreas/cirugía , Antibióticos Antineoplásicos/uso terapéutico , Broncoscopía/métodos , Femenino , Humanos , Membrana Mucosa/patología , Ácido Micofenólico/administración & dosificación , Penfigoide Benigno de la Membrana Mucosa/tratamiento farmacológico , Penfigoide Benigno de la Membrana Mucosa/patología , Penfigoide Benigno de la Membrana Mucosa/cirugía , Penfigoide Ampolloso/patología , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , Tráquea/inmunología , Tráquea/patología , Traqueostomía/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
Solitary fibrous tumor of the pleura (SFTP) is a rare tumor of fibroblastic origin. It can be quite vascular, and its surgical management carries the risk of a major intra-operative bleed. The pre-operative use of endobronchial ultrasound (EBUS) to visualize the vascular supply of the tumor has not been reported.We report a case of a patient presenting with progressive shortness of breath and cough who was found to have a very large pleural-based tumor. We describe the use of medical thoracoscopy and EBUS to establish the diagnosis of SFTP and to characterize the blood supply of the tumor.In the future, EBUS may provide an alternative to conventional angiography for both mapping and embolizing tumor blood supply.