Asociación entre fibrosis pulmonar idiopática y neoplasia pulmonar / Association Between Idiopathic Pulmonary Fibrosis and Lung Cancer

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New TNM staging in lung cancer (8th edition) and future perspectives.

BACKGROUND: Carrying out a correct anatomical classification of lung cancer is crucial to take clinical and therapeutic decisions in each patient. AIM: TNM staging classification provides an accurate anatomical description about the extension of the disease; however, the anatomical burden of the disease is just one aspect that changes the prognosis. RELEVANCE FOR PATIENTS: TNM staging classification is a tool that predicts survival, but we must consider that TNM is just one of the factors that concern the prognosis. The impact of a factor over the prognosis is complex due to: It depends on the specific environment, the treatment strategy, among others, and our level of certainty makes difficult to include all the factors just in a group of stages. In some groups, there are difficulties to get large series due to the low frequency of cases and the small number of events (metastasis, locoregional recurrence). It does not allow to obtain evidence in a short period of time. On the other hand, in the next years, new markers will be incorporated in the coming years, which are going to be included in the new TNM classification. It could help to improve the classification giving more information about prognosis and risk of recurrence. All these aspects are being used by the International Association for the Study of Lung Cancer (IASLC) to develop a new prognosis model. This continues the evolution of TNM system, allows us to overcome the difficulties, and build a flexible framework enough to continue improving the individual prognosis of the patients.

Surgical treatment of low and intermediate grade lung net.

BACKGROUND: Carcinoids now constitute complex tumours which require a multidisciplinary approach and long-term follow-up. Surgical intervention is nowadays confirmed as the mainstay of treatment. METHODS: From 1980 to 2015, EMETNE-SEPAR collected 1,339 patients treated surgically for bronchial carcinoid (1,154 typical and 185 atypical carcinoids). Standard and conservative procedures were considered with regard to surgical approach. All the patients with carcinoid were pathologically coded following the standards of the 7th edition 2009 TNM lung cancer staging. Statistical analyses were performed in order to determine whether histology, nodal affectation and surgical technique were associated with significant differences in survival, presence of metastases and local recurrence. RESULTS: The influence of the surgical procedure on overall survival, the presence of metastases and local recurrence were demonstrated as no significant in our sample in central tumours (P>0.05). Sublobar resections in peripheral tumours are related to a decrease in survival in typical carcinoids (P=0.008) with nodal involvement and an increased number of recurrences in atypical carcinoids without nodal involvement (P=0.018). CONCLUSIONS: In central typical carcinoid, the use of lung-sparing bronchoplastic techniques could influence local recurrence in some cases. This observation demands the intraoperative pathologic verification of an adequate surgical margin by frozen section. Peripheral typical carcinoids have been surgically treated, occasionally, by sublobar resection. However, in peripheral atypical carcinoid after a limited sublobar resection the observed increase of the probability of local recurrence makes it, in our opinion, not advisable.

Tumor carcinoide bronquial como causa de neumonías de repetición en paciente joven: papel del 111In-pentetreotida en el contexto de las pruebas de imagen / Recurrent Pneumonia Due to Bronchial Carcinoid Tumour in a Young Patient: The Role of 111In-Pentetreotide in Imaging Studies

Los tumores carcinoides bronquiales son una causa infrecuente de neumonías de repetición en pacientes jóvenes. El diagnóstico se obtiene mediante pruebas de imagen, broncoscopia y confirmación histológica, y el tratamiento es fundamentalmente quirúrgico. Mediante la presentación de 2 casos, revisamos la utilidad de la gammagrafía con 111In-DTPA-Phe-octreotide (111In-pentetreotida) en la valoración de estos pacientes antes de la cirugía, apoyando el diagnóstico de tumor neuroendocrino ante una imagen sospechosa en otras pruebas (radiografía simple, TC) y descartando enfermedad regional o a distancia. Frente al reducido valor de la PET con 18F-FDG (realizada en uno de los casos), se destaca el papel de laSPECT-TC, que mejora notablemente la localización y la caracterización de los hallazgos

Bronchial carcinoid tumours are an uncommon cause of recurrent pneumonia in young patients. Diagnosis is determined from imaging studies, bronchoscopy, and histological confirmation, and treatment is generally surgical. Two cases are reviewed in order to examine the value of 111In-DTPA-Phe-octreotide (111In-pentetreotide) scintigraphy in the pre-surgical evaluation of these patients. After a suspicious area was observed in other tests (standard X-ray, CT), a neuroendocrine tumour was diagnosed using this technique and the presence of regional or distant disease was ruled out. Comparison with the less valuable 18F-FDG PET (carried out in one of the cases) highlights the usefulness of SPECT-CT, which performs notably better in terms of the localization and characterisation of findings

Recurrent pneumonia due to bronchial carcinoid tumour in a young patient: the role of (111)in-pentetreotide in imaging studies.

Bronchial carcinoid tumours are an uncommon cause of recurrent pneumonia in young patients. Diagnosis is determined from imaging studies, bronchoscopy, and histological confirmation, and treatment is generally surgical. Two cases are reviewed in order to examine the value of (111)In-DTPA-Phe-octreotide ((111)In-pentetreotide) scintigraphy in the pre-surgical evaluation of these patients. After a suspicious area was observed in other tests (standard X-ray, CT), a neuroendocrine tumour was diagnosed using this technique and the presence of regional or distant disease was ruled out. Comparison with the less valuable (18)F-FDG PET (carried out in one of the cases) highlights the usefulness of SPECT-CT, which performs notably better in terms of the localization and characterisation of findings.

The significance of histology: typical and atypical bronchial carcinoids.

The aim of this study is to assess in bronchial carcinoid tumors, the prognostic factors in relation to the histology that would determine their most appropriate therapy. The histologic aggressiveness is a determining factor in tumor size and nodal involvement in these tumors. The knowledge of the histologic limits of typical and atypical carcinoid contributes to the recognition of a better valuation of the proportional significance that nodal involvement and histologic grade have in a tumor's prognosis.

[Detection of lymph node involvement and surgical treatment of pulmonary neoplastic processes. Current state of diagnostic and therapeutic procedures]. / Detección de la afectación ganglionar y tratamiento quirúrgico de los procesos neoplásicos pulmonares. Estado actual de distintos procederes diagnósticos y terapéuticos.

An analysis is made of different publications associated with the surgical staging and treatment of primary and metastasic pulmonary neoplastic processes. A suitable treatment program is essential to determine lymph node involvement in patients with bronchogenic carcinoma. The indication and sequence of the procedure to use (CT-PET, transbronchial puncture, videomediastinoscopic ultrasound guided transbronchial needle aspiration) is evaluated in accordance to the sensitivity, specificity and positive and negative predictive value of the different methods. Another interesting challenge is to define the criteria for indicating a sublobar resection in certain tumours and patients. Different factors, age, lung function, tumour location and type of sublobar resection, are analysed. Levels of evidence and recommendations of the procedure are also considered. Surgical resection is an accepted therapeutic option in the treatment of colorectal cancer lung metastases. Its indication is based on acceptable survival rates and knowledge of the impact of various factors (interval free of disease, number of metastases, presence of liver metastasis, presence of lymph node involvement, or increased pre-operative levels of carcinoembryonic antigen), is analysed in detail.

Detección de la afectación ganglionar y tratamiento quirúrgico de los procesos neoplásicos pulmonares. Estado actual de distintos procederes diagnósticos y terapéuticos / Detection of Lymph Node Involvement and Surgical Treatment of Pulmonary Neoplastic Processes. Current State of Diagnostic and Therapeutic Procedures

Este trabajo se basa en el análisis de distintas publicaciones relacionadas con la estadifi cación y el tratamientoquirúrgico de procesos neoplásicos pulmonares primitivos y metastásicos. En los pacientes con carcinomabroncogénico, determinar la afectación ganglionar resulta imprescindible para programar un tratamientoadecuado. La indicación y la secuencia del procedimiento a emplear (tomografía computarizada,tomografía por emisión de positrones, punción transbronquial, punción aspirativa transbronquial guiadapor ultrasonidos, videomediastinoscopia, mediastinotomía anterior, videotoracoscopia) se evalúan en razónde la sensibilidad, la especifi cidad y el valor predictivo positivo y negativo de los distintos métodos.Otro reto de interés es la defi nición del criterio de indicación de una resección sublobar en determinadostumores y pacientes. Se analizan distintos factores, como la edad, la función pulmonar, la localización tumoraly el tipo de resección sublobar. También se consideran los niveles de evidencia y los grados de recomendacióndel procedimiento.En el tratamiento de metástasis pulmonares de carcinoma colorrectal, la resección quirúrgica es una opciónterapéutica aceptada. Se analiza de forma pormenorizada su indicación, basada en la obtención de tasasaceptables de supervivencia y el conocimiento de la repercusión de distintos factores pronósticos (intervalolibre de enfermedad, número de metástasis, presencia de metástasis hepáticas, presencia deafectación ganglionar, o valores preoperatorios elevados de antígeno carcinoembrionario)(AU)

An analysis is made of different publications associated with the surgical staging and treatment of primaryand metastasic pulmonary neoplastic processes. A suitable treatment program is essential to determinelymph node involvement in patients with bronchogenic carcinoma. The indication and sequence of theprocedure to use (CT-PET, transbronchial puncture, videomediastinoscopic ultrasound guidedtransbronchial needle aspiration) is evaluated in accordance to the sensitivity, specifi city and positive andnegative predictive value of the different methods.Another interesting challenge is to defi ne the criteria for indicating a sublobar resection in certain tumoursand patients. Different factors, age, lung function, tumour location and type of sublobar resection, areanalysed. Levels of evidence and recommendations of the procedure are also considered.Surgical resection is an accepted therapeutic option in the treatment of colorectal cancer lung metastases.Its indication is based on acceptable survival rates and knowledge of the impact of various factors (intervalfree of disease, number of metastases, presence of liver metastasis, presence of lymph node involvement,or increased pre-operative levels of carcinoembryonic antigen), is analysed in detail(AU)

[Interleukin-8 expression in lung tissue during ischemia-reperfusion]. / Estudio de la expresión de interleucina-8 en el tejido pulmonar durante la isquemia-reperfusión.

OBJECTIVE: Local cytokine production is a pathogenic factor in ischemia-reperfusion injury in early graft dysfunction. This study analyzed interleukin 8 (IL-8) messenger RNA (mRNA) expression in lung tissue and the association between IL-8 mRNA levels and interstitial lung changes in an experimental model of warm lung ischemia-reperfusion. MATERIAL AND METHODS: We studied 16 New Zealand rabbits divided into 3 groups: control, ischemia (tissue taken from right lower lobe after 1, 2, or 3 hours of ischemia), and reperfusion (tissue taken from right upper and middle lobes after 1 hour of ischemia and 1, 2, or 3 hours of reperfusion). Expression of IL-8 mRNA was determined by reverse transcription and polymerase chain reaction. Interstitial infiltration by polymorphonuclear neutrophils was determined. The Mann-Whitney U-test was used for statistical comparisons, with P< .05 considered to indicate a significant result. RESULTS: During ischemia, IL-8 mRNA levels were elevated at the end of hour 1 (P=.009) with respect to the control group, but not thereafter. Interstitial changes were minimal. IL-8 mRNA levels during reperfusion were similar to those observed during ischemia, with a slight increase at the end of hour 2. There were no significant differences between hours 1, 2, and 3. Polymorphonuclear neutrophil recruitment occurred at the beginning of reperfusion (P=.014), but no significant differences were observed at hours 2 or 3. Progressive thickening of alveolar septa and edema was documented. CONCLUSIONS: Changes in IL-8 mRNA expression during ischemia precede interstitial infiltration by polymorphonuclear neutrophils during reperfusion, suggesting that the 2 processes are related. Quantification of IL-8 mRNA expression could facilitate early diagnosis of graft dysfunction.

Estudio de la expresión de interleucina-8 en el tejido pulmonar durante la isquemia-reperfusión / Interleukin-8 expression in lung tissue during ischemia­ reperfusion

Objetivo: La generación local de citocinas es un factor patogénico en el daño por isquemia-reperfusión en la disfunción precoz del injerto. Este estudio analiza la expresión en tejido pulmonar de ARN mensajero de interleucina-8 (ARNm de IL-8) y su relación con los cambios intersticiales pulmonares en un modelo experimental de isquemia-reperfusión pulmonar normotérmica. Material y métodos: Se estudiaron 16 conejos de la raza Nueva Zelanda en 3 grupos de estudio: a) basal; b) isquemia (lóbulo inferior derecho tras isquemia de 1, 2 o 3 h), y c) reperfusión (lóbulos superior y medio derechos tras 1 h de isquemia y 1, 2 o 3 h de reperfusión). Se determinó la expresión del ARNm de IL-8 mediante transcripción inversa y reacción en cadena de la polimerasa y estudió la infiltración intersticial por polimorfonucleares (PMN). Para el análisis estadístico se empleó el test de la U de Mann-Whitney aceptando como significativo un valor de p < 0,05. Resultados: Durante el período de isquemia se observó respecto al basal elevación del ARNm de IL-8 al final de la primera hora (p = 0,009), pero no durante el resto del período isquémico. Los cambios intersticiales fueron mínimos. Durante la reperfusión los valores de ARNm de IL-8 fueron semejantes a los observados durante la isquemia, con una ligera elevación al final de segunda hora; no hubo diferencias significativas entre la primera, segunda y tercera horas. Hubo reclutamiento de PMN al inicio de la reperfusión (p = 0,014), sin observarse diferencias significativas en la segunda y tercera horas. Se objetivó un engrosamiento progresivo de los tabiques interalveolares y edema. Conclusiones: Los cambios en la expresión del ARNm de IL-8 durante la isquemia preceden a la infiltración intersticial de PMN durante la reperfusión, lo que señala una relación entre ambos procesos. La cuantificación del ARNm de IL-8 podría ser un procedimiento para el seguimiento diagnóstico de la disfunción precoz del injerto

Objective: Local cytokine production is a pathogenic factor in ischemia­reperfusion injury in early graft dysfunction. This study analyzed interleukin 8 (IL-8) messenger RNA (mRNA) expression in lung tissue and the association between IL-8 mRNA levels and interstitial lung changes in an experimental model of warm lung ischemia­reperfusion. Material and methods: We studied 16 New Zealand rabbits divided into 3 groups: control, ischemia (tissue taken from right lower lobe after 1, 2, or 3 hours of ischemia), and reperfusion (tissue taken from right upper and middle lobes after 1 hour of ischemia and 1, 2, or 3 hours of reperfusion). Expression of IL-8 mRNA was determined by reverse transcription and polymerase chain reaction. Interstitial infiltration by polymorphonuclear neutrophils was determined. The Mann­Whitney U-test was used for statistical comparisons, with P<.05 considered to indicate a significant result. Results: During ischemia, IL-8 mRNA levels were elevated at the end of hour 1 (P=.009) with respect to the control group, but not thereafter. Interstitial changes were minimal. IL-8 mRNA levels during reperfusion were similar to those observed during ischemia, with a slight increase at the end of hour 2. There were no significant differences between hours 1, 2, and 3. Polymorphonuclear neutrophil recruitment occurred at the beginning of reperfusion (P=.014), but no significant differences were observed at hours 2 or 3. Progressive thickening of alveolar septa and edema was documented. Conclusions: Changes in IL-8 mRNA expression during ischemia precede interstitial infiltration by polymorphonuclear neutrophils during reperfusion, suggesting that the 2 processes are related. Quantification of IL-8 mRNA expression could facilitate early diagnosis of graft dysfunction