ABSTRACT
Biomarker tests in lung cancer have been traditionally ordered by the treating oncologist upon confirmation of an appropriate pathological diagnosis. The delay this introduces prolongs yet further what is already a complex, multi-stage, pre-treatment pathway and delays the start of first-line systemic treatment, which is crucially informed by the results of such analysis. Reflex testing, in which the responsibility for testing for an agreed range of biomarkers lies with the pathologist, has been shown to standardise and expedite the process. Twelve experts discussed the rationale and considerations for implementing reflex testing as standard clinical practice.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Humans , Carcinoma, Non-Small-Cell Lung/therapy , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/therapy , Lung Neoplasms/drug therapy , Consensus , Pathologists , Biomarkers, Tumor , ReflexABSTRACT
OBJECTIVE: To determine the accuracy of visual analysis and the retention index (RI) with dual-time point 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake. MATERIALS AND METHODS: A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36-83 years) referred for IPN characterization with 18F-FDG-PET/CT and maximum standard uptake value ≤ 2.5 at 60 minutes post-injection (SUVmax1). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUVmax1, SUVmax at 180 minutes post-injection (SUVmax2), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥ 2 years of follow-up. RESULTS: Twenty-four (56%) nodules were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUVmax ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75, 73.7, 78.3, 70, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1, 63.2, 73.1, 70.6, and 72.1%, respectively. SUVmax1 ≥ 2, SUVmax2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%. CONCLUSIONS: RI ≥ 10% was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUVmax1 ≥2 was highly predictive of malignancy, as well as SUVmax2 > 2.5 and FDG uptake > liver. FDG uptake < mediastinum on HD was highly predictive of benign nodules.
ABSTRACT
OBJECTIVE: Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. METHODS: We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. RESULTS: Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%-98%) and 83% (95% CI: 65%-92%), respectively. CONCLUSION: Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.
Subject(s)
Lung Neoplasms , Early Detection of Cancer , Humans , Lung Neoplasms/diagnostic imaging , Male , Retrospective Studies , Spain , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Incidental Findings , Membrane Glycoproteins , Neuroendocrine Tumors/diagnostic imaging , Organometallic Compounds , Pancreatic Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Adenocarcinoma/blood , Adenocarcinoma/pathology , Adenocarcinoma/radiotherapy , Aged, 80 and over , Gallium Isotopes , Gallium Radioisotopes , Humans , Kallikreins/blood , Male , Neuroendocrine Tumors/pathology , Pancreatic Neoplasms/pathology , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Prostatic Neoplasms/radiotherapyABSTRACT
BACKGROUND: There are limited data about the role of endoscopic ultrasound-guided tissue acquisition (EUS-TA), by fine needle aspiration (EUS-FNA) or biopsy (EUS-FNB), in the evaluation of the adrenal glands (AG). The primary aim was to assess the diagnostic yield and safety. The secondary aims were the malignancy predictors, and to create a predictive model of malignancy. METHODS: This was a retrospective nationwide study involving all Spanish hospitals experienced in EUS-TA of AGs. Inclusion period was from April-2003 to April-2016. Inclusion criteria: all consecutive cases that underwent EUS-TA of AGs. EUS and cytopathology findings were evaluated. Statistical analyses: diagnostic accuracy of echoendoscopist's suspicion using cytology by EUS-TA, as gold standard; multivariate logistic regression model to predict tumor malignancy. RESULTS: A total of 204 EUS-TA of AGs were evaluated. Primary tumor locations were lung70%, others19%, and unknown11%. AG samples were adequate for cytological diagnosis in 91%, and confirmed malignancy in 60%. Diagnostic accuracy of the endosonographer's suspicion was 68%. The most common technique was: a 22-G (65%) and cytological needle (75%) with suction-syringe (66%). No serious adverse events were described. The variables most associated with malignancy were size>30mm (OR2.27; 95%CI, 1.16-4.05), heterogeneous echo-pattern (OR2.11; 95%CI, 1.1-3.9), variegated AG shape (OR2.46; 95%CI, 1-6.24), and endosonographer suspicion (OR17.46; 95%CI, 6.2-58.5). The best variables for a predictive multivariate logistic model of malignancy were age, sex, echo-pattern, and AG-shape. CONCLUSIONS: EUS-TA of the AGs is a safe, minimally invasive procedure, allowing an excellent diagnostic yield. These results suggest the possibility of developing a pre-EUS procedure predictive malignancy model.
Subject(s)
Adrenal Glands/pathology , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Adrenal Gland Neoplasms/pathology , Aged , Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects , Female , Humans , Male , Multivariate Analysis , Retrospective Studies , SafetyABSTRACT
Mutation analysis of epidermal growth factor receptor (EGFR) gene is essential for treatment selection in non-small cell lung cancer (NSCLC). Analysis is usually performed in tumor samples. We evaluated the clinical utility of EGFR analysis in plasma cell-free DNA (cfDNA) from patients under treatment with EGFR inhibitors. We selected 36 patients with NSCLC and EGFR-activating mutations. Blood samples were collected at baseline and during treatment with EGFR inhibitors. Wild-type EGFR, L858R, delE746-A750, and T790M mutations were quantified in cfDNA by droplet digital PCR. Stage IV patients had higher total circulating EGFR copy levels than stage I (3523 vs. 1003 copies/mL; p < 0.01). There was high agreement for activating mutations between baseline cfDNA and tumor samples, especially for L858R mutation (kappa index = 0.679; p = 0.001). In 34 % of advanced NSCLC patients, we detected mutations in cfDNA not previously detected in tumor samples and double mutations in 17 %. Patients with baseline total EGFR copy levels above the median presented decreased overall survival (OS) (341 vs. 870 days, p < 0.05) and progression-free survival (PFS) (238 vs. 783 days; p < 0.05) compared with those with total EGFR copy levels below the median. Patients with baseline concentrations of activating mutations above the median (94 copies/mL) had lower OS (317 vs. 805 days; p < 0.05) and PFS (195 vs. 724 days; p < 0.05). During follow-up, T790M resistance mutation was detected in 53 % of patients. Total and mutated EGFR analysis in cfDNA seems a relevant tool to characterize the molecular profile and prognosis of NSCLC patients harboring EGFR mutations.
Subject(s)
Biomarkers, Tumor/genetics , Carcinoma, Non-Small-Cell Lung/pathology , ErbB Receptors/genetics , Lung Neoplasms/pathology , Mutation/genetics , Protein Kinase Inhibitors/therapeutic use , Carcinoma, Non-Small-Cell Lung/classification , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , DNA Mutational Analysis/methods , Drug Resistance, Neoplasm/genetics , Female , Follow-Up Studies , Humans , Lung Neoplasms/classification , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Male , Middle Aged , Neoplasm Staging , Prognosis , Real-Time Polymerase Chain Reaction , Retrospective Studies , Survival RateABSTRACT
This consensus statement, conceived as a joint initiative of the Spanish Society of Pathology (SEAP) and the Spanish Society of Medical Oncology (SEOM), makes diagnostic and treatment recommendations for the management of patients with advanced or metastatic melanoma based on the current scientific evidence on biomarker use. This document thus provides an opportunity to improve healthcare efficiency and resource use, which will benefit these patients. Based on the data available so far, this expert group recommends routinely testing patients with metastatic melanoma for BRAF mutation status, as the result affects the subsequent therapeutic management of these patients. The analysis of genetic alterations in KIT may be reasonable in patients with primary tumours in acral or mucosal sites or on chronically sun-exposed skin, in an advanced condition, but not in patients with other types of melanomas. This panel believes that testing for other genetic alterations, such as NRAS mutation status in patients not carrying BRAF mutations, GNAQ/GNA11 mutational analysis or genetic alterations in PTEN, is not currently indicated as routine clinical practice, because the results do not influence treatment planning in these patients at the present time. Other important issues addressed in this document are the organisational requirements and quality controls needed for proper testing of these biomarkers, and the legal implications to be borne in mind.
Subject(s)
Biomarkers, Tumor/genetics , Melanoma/diagnosis , Melanoma/genetics , Genetic Testing , Humans , Neoplasm Metastasis , Proto-Oncogene Proteins B-raf/genetics , Proto-Oncogene Proteins c-kit/geneticsABSTRACT
Libro que centra su atención en dar respuesta a una serie de preguntas relacionadas con el Alzheimer y otras demencias. El modo en que funciona el cerebro del paciente, cómo afecta a la actividad intelectual, cuáles con las causas o cómo se diagnostica el Alzheimer son algunas de las cuestiones resueltas en esta guía.
Subject(s)
Alzheimer DiseaseABSTRACT
Introducción: El objetivo del presente trabajo es la valoración funcional y cinemática en pacientes con espasticidad de miembros inferiores tras lesión encefálica o medular con indicación de infiltración con toxina botulínica (TBA). Material y métodos: Diez pacientes (11 extremidades inferiores) atendidos en unidad de neurorrehabilitación. Examen clínico, funcional (functional ambulation categories, valoración marcha del Hospital de Sagunto) y biomecánico (plantillas instrumentadas Biofoot/IBV versión 5,0) antes y 3 semanas después de la infiltración con TBA. Estadísticos: prueba de la t para muestras relacionadas de las variables clínicas, funcionales y biomecánicas antes y después dela infiltración. Nivel de significación inferior a 0,05. Modo cualitativo para valorar si los cambios en las variables biomecánicas orientan a una aproximación a los parámetros de normalidad. Resultados: La infiltración con TBA mejora el tono muscular, el arco articular y la frecuencia de espasmos (p < 0,01). La población infiltrada muestra un nivel alto de satisfacción con la mejora de los síntomas. No hay cambios funcionales en habilidad para la marcha tras la infiltración. En los parámetros biomecánicos mejora de la cadencia de marcha y la presión máxima en retropié se aproxima a la significación estadística cercana a 0,1. Conclusiones: Con la disminución del tono muscular tras infiltración con TBA, mejoran los síntomas clínicos derivados de esta sin cambios funcionales en escalas de marcha. Los cambios en los parámetros biomecánicos indican la necesidad de ampliar los estudios con plantillas instrumentadas en población con espasticidad tras lesión del sistema nervioso central tratada con infiltración de TBA (AU)
Introduction: Botulinum toxin A (BTA) improves the kinematic parameters of gait in patients with spasticity of lower limbs, but there are no studies in which kinetic parameters are measured with instrumented insoles. We therefore used instrumented insoles to perform a functional assessment of therapeutic results in patients with lower limb spasticity after brain injury or spinal cord infiltration indicating BTA. Material and methods: Ten patients (11 lower limbs) seen in a Neurorehabilitation Unit. The tests carried out included clinical examination, gait assessment (Functional Ambulation Categories (FAC); Hospital de Sagunto Gait Scale), and biomechanical assessment (Biofoot / IBV version 5.0), before and three weeks after infiltration with BTA. Statistics: t-test for related samples of clinical variables, functional variables and biomechanical variables before and after infiltration. Level of significance P< .05. Qualitative method to assess whether changes in the biomechanical variables tended toward normal values. Results: BTA improves muscle tone, joint arch and frequency of spasms (P<.01). The patient sample showed a high level of satisfaction with the improvement in symptoms. There were no changes in walking ability after injection. There were no statistically significant changes inbiomechanical parameters, but there was improved gait cadence. The relatively small statistical significance close to P=.1 of the peak pressure in the heel after injection indicates the need for further studies with instrumented insoles in people with spasticity due to central nervous system injury. Conclusions: With the decrease in muscle tone after infiltration with BTA the clinical symptoms associated with muscle tone improved without any functional changes in gait scales. The changes in the biomechanical parameters show that larger studies using instrumented insoles should be performed in the population with spasticity after a central nervous system injury treated with BTA infiltration (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Gait Disorders, Neurologic/diagnosis , Muscle Spasticity/drug therapy , Botulinum Toxins/pharmacokinetics , Craniocerebral Trauma/complications , Spinal Cord Injuries/complications , Biomechanical Phenomena/physiology , Muscle TonusABSTRACT
INTRODUCTION: Botulinum toxin A (BTA) improves the kinematic parameters of gait in patients with spasticity of lower limbs, but there are no studies in which kinetic parameters are measured with instrumented insoles. We therefore used instrumented insoles to perform a functional assessment of therapeutic results in patients with lower limb spasticity after brain injury or spinal cord infiltration indicating BTA. MATERIAL AND METHODS: Ten patients (11 lower limbs) seen in a Neurorehabilitation Unit. The tests carried out included clinical examination, gait assessment (Functional Ambulation Categories (FAC); Hospital de Sagunto Gait Scale), and biomechanical assessment (Biofoot / IBV version 5.0), before and three weeks after infiltration with BTA. STATISTICS: t-test for related samples of clinical variables, functional variables and biomechanical variables before and after infiltration. Level of significance P< .05. Qualitative method to assess whether changes in the biomechanical variables tended toward normal values. RESULTS: BTA improves muscle tone, joint arch and frequency of spasms (P<.01). The patient sample showed a high level of satisfaction with the improvement in symptoms. There were no changes in walking ability after injection. There were no statistically significant changes in biomechanical parameters, but there was improved gait cadence. The relatively small statistical significance close to P=.1 of the peak pressure in the heel after injection indicates the need for further studies with instrumented insoles in people with spasticity due to central nervous system injury. CONCLUSIONS: With the decrease in muscle tone after infiltration with BTA the clinical symptoms associated with muscle tone improved without any functional changes in gait scales. The changes in the biomechanical parameters show that larger studies using instrumented insoles should be performed in the population with spasticity after a central nervous system injury treated with BTA infiltration.
Subject(s)
Botulinum Toxins, Type A/therapeutic use , Foot/physiology , Gait Disorders, Neurologic/diagnosis , Gait Disorders, Neurologic/drug therapy , Muscle Spasticity/diagnosis , Muscle Spasticity/drug therapy , Neuromuscular Agents/therapeutic use , Walking/physiology , Adult , Aged , Female , Gait Disorders, Neurologic/rehabilitation , Humans , Male , Middle Aged , Muscle Spasticity/rehabilitation , Neurologic ExaminationSubject(s)
Humans , Male , Female , Adult , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/physiopathology , Prognosis , Pancreatectomy/methods , Immunohistochemistry/methods , Pancreaticoduodenectomy/methods , Retrospective Studies , Pancreas/cytology , Pancreas/pathology , Pancreatic Neoplasms , ImmunohistochemistryABSTRACT
BACKGROUND: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. AIM: To analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. MATERIAL AND METHODS: A retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. RESULTS: 6 Patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation) and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved) in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ) was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. CONCLUSIONS: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial.
Subject(s)
Pancreatic Neoplasms/pathology , Pancreatic Neoplasms/surgery , Papilloma, Intraductal/pathology , Papilloma, Intraductal/surgery , Adult , Aged , Cohort Studies , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Pancreas/pathology , Pancreas/surgery , Pancreatic Neoplasms/mortality , Pancreaticoduodenectomy , Papilloma, Intraductal/mortality , Postoperative Period , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Introducción: la neoplasia papilar mucinosa intraductal(NPMI) del páncreas comprende una serie de lesiones que evolucionandesde lesiones benignas (adenoma) hasta carcinoma ductalinvasivo.Objetivo: analizar los resultados clínicos y patológicos de 15pacientes diagnosticados de NPMI e intervenidos según las recomendacionesde conferencia de consenso.Material y métodos: análisis retrospectivo de 15 pacientescon NPMI, intervenidos entre marzo de 1993 y septiembre de2009; según pautas de conferencias de consenso internacionales.Se recogieron datos demográficos, pruebas diagnósticas, tipo deintervención, histopatología y supervivencia actuarial con un seguimientoentre mes y medio y nueve años.Resultados: se realizaron 6 duodenopancreatectomías cefálicas,4 pancreatectomías totales, 2 pancreatectomías centrales,2 pancreatectomías parciales y una pancreatectomía distal. Se registróuna morbilidad del 40%, sin mortalidad operatoria, con unaestancia media de 10 días. En 5 casos la NPMI fue de tipo mixto,en 4 afectaba al conducto pancreático y en los 6 restantes a ramasaccesorias. Dos pacientes presentaron carcinoma in situ y 3carcinoma invasivo con ganglios negativos. Un paciente, sin carcinomainvasivo, falleció a los 66 meses por adenocarcinoma depáncreas. La supervivencia actuarial hasta recidiva o muerte fuede 105,133 meses; con un rango de seguimiento entre mes y medioy 9 años.Conclusiones: la NPMI tipo ductal y mixto exige la reseccióncompleta debido a la elevada incidencia de carcinoma invasivo ode lesiones precursoras de malignidad. Por su carácter multifocallos enfermos deben ser revisados a largo plazo. Existen controversiasen las NPMI tipo accesorio asintomáticas y menores de 3 cm(AU)
Background: intraductal papillary mucinous neoplasm(IPMN) shows a series of lesions which evolve from benign lesionsadenoma to invasive carcinoma.Aim: to analyze the clinical and pathological results of 15 patientsdiagnosed of IPMN, and surgically treated according to theguidelines of International Consensus Conference.Material and method: a retrospective analysis of 15 patientssurgically treated between March 1993 and September 2009, accordingto the International Consensus recommendation. Demographic,diagnostic tools, surgical report, pathologic database andactuarial survival were analyzed with a follow-up from one and ahalf month through nine years.Results: 6 patients underwent pancreaticoduodenectomies,4 total pancreatectomies, 2 body or central pancreatectomies, 2 partialpancreatectomies (enucleation) and 1 distal pancreatectomy.A morbidity of 46 and 0% hospital mortality were assessed, witha median length hospital stay of 10 days. In five cases, the IPMNwas combined type (both main and branch pancreatic ducts involved)in four main duct-type and branch duct-type in the anothersix as well. Several atypia (IPMN carcinoma in situ) wasobserved in 2 patients and invasive carcinoma with negativelymph nodes was identified in 3 patients. A patient without invasivecarcinoma died at 66 months of follow-up for pancreas adenocarcinoma.The actuarial survival up to recurrence or deathwas 105,133 months with a range of follow-up from 1 monthand a half until 9 years.Conclusions: IPMN main duct or mixed type warrants completeresection due to its incidence of invasive carcinoma or precursorlesions of malignancy as well. Due to its multifocal pattern,patients should be followed in long-term surveillance. The managementof asymptomatic IPMN type branch less than 3 cm iscontroversial(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Neoplasms, Cystic, Mucinous, and Serous/epidemiology , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/methods , Pancreaticoduodenectomy/trends , Pancreatectomy/methods , Pancreatic Neoplasms , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Confidence IntervalsABSTRACT
Solid pseudo-papillary tumor (SPPT) is a rare cystic tumor of the pancreas (1-3% of exocrine tumors of the pancreas) which shows an "enigmatic" behavior on the clinical and molecular pattern. A retrospective analysis of the cytological studies and resected specimens of pancreatic cystic tumors from May 1996 to February 2010 was carried out. Three cases of SPPT were found, which are the objective of this study. The diagnosis was established upon occasional finding in the abdominal CT, in spite of sizing between 3 and 6 cm of diameter. In the three cases the preoperative diagnosis was confirmed by cytology and specific immunohistochemical staining. Cases 2 and 3 showed strong immunoreactivity for Beta-Catenin and E-Cadherin staining. Radical resection (R0) was carried out in the three cases. A young male -21 years of age (case 1)- who had duodenal infiltration and two lymph nodes metastases died of hepatic and peritoneal recurrence 20 months following surgery. The other two cases are free of disease. The current review of the literature reports roughly 800 cases since the first report in 1959, and shows the enigmatic character of this tumor regarding the cellular origin, molecular pathways, prognostic factors and clinical behavior.
Subject(s)
Carcinoma, Papillary/pathology , Pancreatic Neoplasms/pathology , Adolescent , Adult , Fatal Outcome , Female , Humans , Immunohistochemistry , Liver Neoplasms/secondary , Lymphatic Metastasis , Magnetic Resonance Imaging , Male , Pancreatectomy , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Tomography, X-Ray Computed , Treatment Outcome , Young AdultABSTRACT
The European Early Lung Cancer (EUELC) project aims to determine if specific genetic alterations occurring in lung carcinogenesis are detectable in the respiratory epithelium. In order to pursue this objective, nonsmall cell lung cancer (NSCLC) patients with a very high risk of developing progressive lung cancer were recruited from 12 centres in eight European countries: France, Germany, southern Ireland, Italy, the Netherlands, Poland, Spain and the UK. In addition, NSCLC patients were followed up every 6 months for 36 months. A European Bronchial Tissue Bank was set up at the University of Liverpool (Liverpool, UK) to optimise the use of biological specimens. The molecular-pathological investigations were subdivided into specific work packages that were delivered by EUELC Partners. The work packages encompassed mutational analysis, genetic instability, methylation profiling, expression profiling utilising immunohistochemistry and chip-based technologies, as well as in-depth analysis of FHIT and RARbeta genes, the telomerase catalytic subunit hTERT and genotyping of susceptibility genes in specific pathways. The EUELC project engendered a tremendous collaborative effort, and it enabled the EUELC Partners to establish protocols for assessing molecular biomarkers in early lung cancer with the view to using such biomarkers for early diagnosis and as intermediate end-points in future chemopreventive programmes.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnosis , Lung Neoplasms/diagnosis , Aged , Carcinoma, Non-Small-Cell Lung/metabolism , DNA Methylation , DNA Mutational Analysis , Epithelium/metabolism , Europe , Female , Humans , Immunohistochemistry/methods , Lung Neoplasms/metabolism , Male , Middle Aged , Oligonucleotide Array Sequence Analysis , Receptors, Retinoic Acid/metabolism , Telomerase/metabolismABSTRACT
La Hiperplasia adenomatosa atípica (HAA) es una entidad infrecuente en la población general. Se manifi esta en TC como un nódulo pulmonar en vidrio deslustrado sin componente sólido y persistente a pesar detratamiento antibiótico. Se presenta un caso de HAA, descubierto a raíz del programa de detección precoz de cáncer de pulmón de la Clínica Universitaria de Navarra. Se muestran los hallazgos en TC y AnatomíaPatológica, así como la correlación radio patológica. Se plantea el diagnóstico diferencial con otras entidades incluidas lesiones con potencial maligno (carcinoma bronquioloalveolar y adenocarcinoma de bajo grado). Se comenta el método empleado en el manejo de laslesiones nodulares en vidrio deslustrado en el contexto de este programa de detección precoz
Atypical adenomatose hyperplasia (HAA) is an infrequent pathology in general population. The CT fi ndings are ground glass opacity without solid component and persistent regardless antibiotic treatment. Wepresent a case of HAA, detected on program of early detection of lung cancer program of the Clínica Universitaria de Navarra. We show the CTand histology fi ndings, and radiopathologic correlation. The differential diagnosis must include other lesions with potential malignity (bronquioalveolarcarcinoma and low grade adenocarcinoma). We show themethod applied in ground glass opacities management in an early lung detection program context
Subject(s)
Humans , Male , Aged , Solitary Pulmonary Nodule/diagnosis , Lung Neoplasms/diagnosis , Diagnosis, Differential , Hyperplasia/diagnosisABSTRACT
La Hiperplasia adenomatosa atípica (HAA) es una entidad infrecuenteen la población general. Se manifi esta en TC como un nódulo pulmonaren vidrio deslustrado sin componente sólido y persistente a pesar detratamiento antibiótico. Se presenta un caso de HAA, descubierto a raízdel programa de detección precoz de cáncer de pulmón de la ClínicaUniversitaria de Navarra. Se muestran los hallazgos en TC y AnatomíaPatológica, así como la correlación radio patológica. Se planteael diagnóstico diferencial con otras entidades incluidas lesiones conpotencial maligno (carcinoma bronquioloalveolar y adenocarcinomade bajo grado). Se comenta el método empleado en el manejo de laslesiones nodulares en vidrio deslustrado en el contexto de este programade detección precoz(AU)
Atypical adenomatose hyperplasia (HAA) is an infrequent pathology ingeneral population. The CT fi ndings are ground glass opacity withoutsolid component and persistent regardless antibiotic treatment. Wepresent a case of HAA, detected on program of early detection of lungcancer program of the Clínica Universitaria de Navarra. We show the CTand histology fi ndings, and radiopathologic correlation. The differentialdiagnosis must include other lesions with potential malignity (bronquioalveolarcarcinoma and low grade adenocarcinoma). We show themethod applied in ground glass opacities management in an early lungdetection program context(AU)
Subject(s)
Humans , Male , Middle Aged , Hyperplasia/complications , Hyperplasia/physiopathology , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Diagnosis, Differential , Hyperplasia , Lung Neoplasms/physiopathology , Lung Neoplasms , Adenocarcinoma/diagnosis , Carcinoma/diagnosisABSTRACT
The computed tomography (CT)-based early lung cancer diagnostic technologies allow the detection of very small stage I lung tumors. As part of these screening protocols any suspicious nodule has to be diagnosed morphologically, which requires CT-guided Fine Needle Aspiration, open biopsy or surgery. Fine Needle Aspiration (FNA) cytology is a well-recognised method for a rapid and accurate diagnosis of small lung tumors. Molecular analysis of the FNA specimens could complement cytology diagnosis by the characterization of the biological traits at the preoperative stage. In this study, we aimed to characterize the biological profile of 33 paraffin-embedded transthoracic FNA samples obtained from three groups of lung cancer patients: two groups of small early-detected lung adenocarcinomas (radiologically subsolid and solid nodules) and a third group of small metastatic adenocarcinomas. Genetic analysis was performed by fluorescence in situ hybridization using the four-color LAVysion probe. p53 and Ki-67 protein expression was also evaluated by immunocytochemistry. The samples showed gains for all targets analyzed; two cases had EGFR gene amplification and two cases had MYC amplification. There were no significant differences in the percentage of genetically malignant cells and the expression of Ki-67 among the three groups. However, p53 accumulation was significantly higher in the metastatic group compared to the subsolid early-detected group (P = 0.001). In conclusion, molecular analysis of FNA specimens may provide useful information at preoperative stages. In our series, a good prognostic profile in subsolid early detected adenocarcinomas is suggested.
Subject(s)
Adenocarcinoma/pathology , Biopsy, Fine-Needle/methods , Lung Neoplasms/pathology , Adenocarcinoma/metabolism , Adult , Aged , Aged, 80 and over , ErbB Receptors/metabolism , Female , Humans , Immunohistochemistry/methods , In Situ Hybridization, Fluorescence/methods , Ki-67 Antigen/metabolism , Lung Neoplasms/metabolism , Male , Middle Aged , Neoplasm Staging , Paraffin Embedding/methods , Proto-Oncogene Proteins c-myc/metabolism , Tumor Suppressor Protein p53/metabolismABSTRACT
Presentamos un caso de carcinoma adenoide quístico de tráquea demostrado mediante TC multidetector de 64 coronas, PET-TC, y correlación anatomopatológica, en un paciente con hemoptisis. En este artículo revisamos el diagnóstico diferencial de las lesiones traqueales únicas focales mediante tomografía computarizada (TC). Las técnicas de imagen permitieron el diagnóstico e infravaloraron la invasión de la pared traqueal en este caso, confi rmada con posterioridad mediante el estudio histológico
We present a case of adenoid cystic tracheal carcinoma detected by computerized tomography (64-MDCT) with cyto-histological correlation in a patient with hemoptysis. In this article we review the differential diagnosis of solitary focal tracheal lesions as they appear in computerized tomography (CT). In this case, image methods suggested the diagnosis but underestimated the tracheal wall invasion, which was established by histologycal examination of the resected tumor
