RESUMEN
AIM: The aim of this study is to investigate anatomical lung variations and vascular patterns using volumetric 3D computed tomography (CT) representations. METHODS & RESULTS: We considered 24 major thoracic surgery performed in our ward. In these, we discovered some interesting anatomical variations of the main pulmonary fissures. These findings were not visible on the plain x-ray or during routine examination of a preoperative CT scan. After re-examination of 3D CT scan reconstruction the anatomical variations were detected. DISCUSSION: General thoracic surgeons must familiarize themselves with anatomical variations in lungs. 3D images may aid the general thoracic surgeon in performing safer surgeries. CONCLUSION: 3D CT scan should be performed before surgery if possible.
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Imagenología Tridimensional/métodos , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Procesamiento de Imagen Asistido por Computador , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Periodo Perioperatorio , Neumonectomía/métodos , Cirugía Torácica Asistida por Video/métodosRESUMEN
AIM: As part of the Catania symposium on lung metastasectomy we reviewed our practice of computed tomography (CT)-guided percutaneous transthoracic needle biopsy of pulmonary metastatic lesions with particular emphasis on diagnostic accuracy and nature of complications lesions. MATERIALS & METHODS: 25 patients with metastatic lesions of the lung have been evaluated between May 2010 and February 2014. Inclusion criteria consisted of patients with histologically confirmed, metastatic disease of the lung, those receiving a CT-guided needle biopsy, were at least 18 years of age; and with adequate hepatic, renal and hematological function. We recorded also the size of the sampled lesions, their distance from the pleura, the complications encountered (pneumothorax and thoracostomy tube placement), the cytological diagnosis and the outcome in all the cases. RESULTS: CT-guided percutaneous transthoracic needle biopsy were performed on 23 of 25 patients with suspected lung metastases. 17 males and six females with a mean age of 71.4 years. The mean size of lesions was 4.2 cm (range: 1 to 17 cm). For CT-guided needle biopsy, an 18 gauge semi-automatic needle biopsy device was used. Of 23 biopsies, 20 (87%) yielded a correct diagnosis with specific histological typing for metastasis. Pneumothorax was the most common complication occurring in four cases (5.7%). CONCLUSION: CT-guided percutaneous transthoracic needle biopsy is a firm, useful and safe technique for the diagnosis of suspected pulmonary metastases as it avoids open biopsy in most cases.
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Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Pulmón/patología , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/métodos , Femenino , Humanos , Biopsia Guiada por Imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
Hepatocellular carcinoma (HCC) has a high incidence all over the world. Even if the primary end point of treatment of HCC is survival, radiological response could be a surrogate end point of survival, and could have a key role in clinical management. Since 1950 several radiological response criteria have been applied; however, it was not until 2000 that specific criteria for HCC were introduced by the European Association for the Study of the Liver (EASL), and these were then standardized in 2010 with the development of the modified Response Evaluation Criteria for Solid Tumors (mRECIST) for HCC. The purpose of this brief review is to compare data in literature regarding the application and the performance of mRECIST in clinical practice, and to discuss unclear and open issues.
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Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Carcinoma Hepatocelular/diagnóstico por imagen , Humanos , Pruebas de Función Hepática , Neoplasias Hepáticas/diagnóstico por imagen , Estadificación de Neoplasias , Pronóstico , Radiografía , Ensayos Clínicos Controlados Aleatorios como Asunto , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The aim of the study was to evaluate the role of contrast-enhanced ultrasound (CEUS) in the characterisation of focal liver lesions and for the selection of surgical patients. One hundred and thirty-five consecutive patients (71 women, 64 men) with 165 focal liver lesions (mean size: 3.1 cm)--89 benign (10 simple cysts, 26 haemangiomas, 29 focal nodular hyperplasia, 2 hepatocellular adenomas, 11 focal fatty sparing, 3 focal fatty areas, 5 regenerative nodules, 2 hydatid cysts, 1 abscess) and 76 malignant (47 metastases, 26 hepatocellular carcinomas and 3 peripheral cholangiocarcinomas)--underwent CEUS after the administration of SonoVue. Two radiologists reviewed baseline US and CEUS scans obtained 25-30 sec (arterial phase), 55-80 sec (portal-venous phase), and 235-260 sec (late phase) after initiating SonoVue injection, respectively. The radiologists classified each lesion as malignant or benign on the basis of clearly defined diagnostic criteria. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. CEUS correctly characterised 156/165 focal liver lesions (94.5%), 85 benign and 71 malignant. Five focal liver lesions (3%; 3 haemangiomas and 2 hepatocellular carcinomas) remained undetermined after CEUS and 4 focal liver lesions (2.4%; 3 hepatocellular carcinomas and 1 abscess) were misdiagnosed. CEUS presented sensitivity, specificity, and diagnostic accuracy values of 93.4%, 95.5% and 94.7% respectively. Positive and negative predictive values were 94.7% and 94.4%, respectively. CEUS is a useful tool in the characterisation of focal liver lesions and for selecting surgical patients.
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Medios de Contraste , Hepatopatías/diagnóstico por imagen , Hepatopatías/cirugía , Selección de Paciente , Ultrasonografía Doppler en Color/métodos , Adenoma de Células Hepáticas/diagnóstico por imagen , Adenoma de Células Hepáticas/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/diagnóstico por imagen , Carcinoma/cirugía , Colangiocarcinoma/diagnóstico por imagen , Colangiocarcinoma/cirugía , Quistes/diagnóstico por imagen , Quistes/cirugía , Diagnóstico Diferencial , Equinococosis Hepática/diagnóstico por imagen , Equinococosis Hepática/cirugía , Hígado Graso/diagnóstico por imagen , Hígado Graso/cirugía , Femenino , Hiperplasia Nodular Focal/diagnóstico por imagen , Hiperplasia Nodular Focal/cirugía , Hemangioma/diagnóstico por imagen , Hemangioma/cirugía , Humanos , Hepatopatías/patología , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento , Ultrasonografía Intervencional/métodosRESUMEN
Hepatocellular carcinoma is a major health problem. It is the sixth most common cancer worldwide and the third most common cause of cancer-related death. Despite the availability of several treatment opportunities, diagnosis is still made in an advanced phase, limiting application of most therapeutic choices that currently are based on the Barcelona Clinic Cancer Liver Classification and include surgical resection, orthotopic liver transplantation and ablative methods for very early and early disease, arterial chemoembolization for intermediate stages and systemic therapy with sorafenib for advanced hepatocellular carcinoma. Thanks to novel advancements in knowledge of molecular pathogenesis of this tumor, many new systemic agents and locoregional treatments are in different stages of clinical development and they represent an important promise of further improvements in patients' survival.
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Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Animales , Terapia Combinada , HumanosRESUMEN
BACKGROUND: Radio-frequency ablation (RFA) has been employed in the treatment of Barcelona Clinic Liver Cancer (BCLC) early stage hepatocellular carcinoma (HCC) as curative treatments. AIM: To assess the effectiveness and the safety of RFA in patients with early HCC and compensated cirrhosis. METHODS: A cohort of 151 consecutive patients with early stage HCC (122 Child-Pugh class A and 29 class B patients) treated with RFA were enrolled. Clinical, laboratory and radiological follow-up data were collected from the time of first RFA. A single lesion was observed in 113/151 (74.8%), two lesions in 32/151 (21.2%), and three lesions in 6/151 (4%) of patients. RESULTS: The overall survival rates were 94%, 80%, 64%, 49%, and 41% at 12, 24, 36, 48 and 60 months, respectively. Complete response (CR) at 1 month (p<0.0001) and serum albumin levels (pâ=â0.0004) were the only variables indipendently linked to survival by multivariate Cox model. By multivariate analysis, tumor size (pâ=â0.01) is the only variable associated with an increased likehood of CR. The proportion of major complications after treatment was 4%. CONCLUSIONS: RFA is safe and effective for managing HCC with cirrhosis, especially for patients with HCC ≤3 cm and higher baseline albumin levels. Complete response after RFA significantly increases survival.