Results in mediastinal lymph node staging of surgical lung cancer: Data from the prospective cohort of the Spanish Video-Assisted Thoracic Surgery Group.

OBJECTIVES: The objective of this study was to assess the diagnostic performance of combined computerised tomography (CT) and positron emission tomography (PET) in mediastinal staging of surgical lung cancer based on data obtained from the prospective cohort of the Spanish Group for Video-Assisted Thoracic Surgery (GEVATS). METHODS: A total of 2782 patients underwent surgery for primary lung carcinoma. We analysed diagnostic success in mediastinal lymph node staging (cN2) using CT and PET. Bivariate and multivariate analyses were performed of the factors involved in this success. The risk of unexpected pN2 disease was analysed for cases in which an invasive testing is recommended: cN1, the tumour centrally located or the tumour diameter >3 cm. RESULTS: The overall success of CT together with PET was 82.9% with a positive predictive value of 0.21 and negative predictive value of 0.93. If the tumour was larger than 3 cm and for each unit increase in mediastinal SUVmax, the probability of success was lower with OR 0.59 (0.44-0.79) and 0.71 (0.66-0.75), respectively. In the video-assisted thoracic surgery (VATS) approach, the probability of success was higher with OR 2.04 (1.52-2.73). The risk of unexpected pN2 increased with the risk factors cN1, the tumour centrally located or the tumour diameter >3 cm: from 4.5% (0 factors) to 18.8% (3 factors) but did not differ significantly as a function of whether invasive testing was performed. CONCLUSIONS: CT and PET together have a high negative predictive value. The overall success of the staging is lower in the case of tumours >3 cm and high mediastinal SUVmax, and it is higher when VATS is performed. The risk of unexpected pN2 is higher if the disease is cN1, the tumour centrally located or the tumour diameter >3 cm but does not vary significantly as a function of whether patients have undergone invasive testing.

Local recurrence and metastatic disease in a typical N1 carcinoid bronchial tumour.

Typical carcinoid bronchial tumour is a well-known disease that, for years, was considered benign. Currently, it is classified within the group of neuro-endocrine lung tumours. It is a low-grade malignancy tumour with a capability of local and distant recurrence. Complete resection with mediastinal lymphadenectomy is the treatment-of-choice. There are, usually, long-term survivors, even in cases of recurrence or mediastinal node invasion. These patients could benefit from removal of recurrent or metastatic disease. We present, here, a case of a 19-years-old female diagnosed as having N1-bronchial typical carcinoid tumour. She underwent radical surgery, but with mediastinal recurrence and hepatic metastases. A new radical lung resection was performed, and a liver transplant was the therapy-of-choice for the metastatic lesion.

Extraction of airway foreign bodies in adults: experience from 1987-2008.

To determine the incidence and the clinical, radiographic, and endoscopic characteristics of adult patients in our area diagnosed with tracheobronchial foreign bodies (FBs), we have performed a descriptive retrospective study analysing rigid and flexible bronchoscopies practised at our department between 1987 and 2008 in patients older than 14 years. Of the 9781 bronchoscopies performed, 32 involved cases of bronchoaspiration of FBs. The mean age of the patients was 43.81 years (S.D. 21.43); 65.6% were male and 34.4% were female. Acute or recurrent infection was the most frequent clinical presentation. Chest radiographs provided data for diagnosis in 68% of the cases. The most common FB aspirated were inorganic (pins and plastic devices 21.4%, respectively). In conclusion, we can state that in our area tracheobronchial aspiration of FBs by adults is not common. The clinical symptoms are highly variable and the FBs are usually lodged in the right bronchial tree.

[Liposarcomas of the mediastinum in atypical locations: report of two cases]. / Liposarcomas mediastínicos de localización atípica. Aportación de 2 casos.

Liposarcomas of the mediastinum are unusual tumors characterized by compression of neighboring structures and frequent recurrence. Computed tomography and magnetic resonance imaging provide useful data for diagnosis. According to a review of the literature, surgical resection is the most effective treatment. We report two cases of mediastinal liposarcoma: the first was a liposarcoma that was a recurrence of an atypical lipoma of the neck, and the second was a giant mediastinal liposarcoma involving both hemithoraces.

Liposarcomas mediastínicos de localización atípica. Aportación de 2 casos / Liposarcomas of the mediastinum in atypical locations: reports of two cases

El liposarcoma mediastínico es un tumor raro que se caracteriza clínicamente por la compresión de las estructuras vecinas y la tendencia a la recidiva. La tomografía computarizada y la resonancia magnética aportan información relevante para su diagnóstico. La resección quirúrgica es la mejor opción terapéutica en estos tumores, según la bibliografía revisada. A continuación presentamos 2 casos de liposarcoma mediastínico: 1 liposarcoma recidivado de un lipoma atípico cervical y 1 liposarcoma gigante de mediastino posterior con extensión a ambos hemitórax (AU)

Liposarcomas of the mediastinum are unusual tumors characterized by compression of neighboring structures and frequent recurrence. Computed tomography and magnetic resonance imaging provide useful data for diagnosis. According to a review of the literature, surgical resection is the most effective treatment. We report two cases of mediastinal liposarcoma: the first was a liposarcoma that was a recurrence of an atypical lipoma of the neck, and the second was a giant mediastinal liposarcoma involving both hemithoraces (AU)

Local recurrence and metastatic disease in a typical N1 carcinoid bronchial tumour

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Typical carcinoid bronchial tumour is a wellknown disease that, for years, was considered benign. Currently, it is classified within the group of neuro-endocrine lung tumours. It is a low-grade malignancy tumour with a capability of local and distant recurrence. Complete resection with mediastinal lymphadenectomy is the treatment-ofchoice. There are, usually, long-term survivors, even in cases of recurrence or mediastinal node invasion. These patients could benefit from removal of recurrent or metastatic disease. We present, here, a case of a 19-years-old female diagnosed as having N1-bronchial typical carcinoid tumour. She underwent radical surgery, but with mediastinal recurrence and hepatic metastases. A new radical lung resection was performed, end a liver transplant was the therapy-of-choice for the metastatic lesion