The diagnostic performance of micro-RNA and metabolites in lung cancer: A meta-analysis.

BACKGROUND: The diagnosis of lung cancer is based on the microscopic exam of tissue or liquid. During the recent decade, many biomarkers have been pointed to have a potential diagnostic role. These biomarkers may be assessed in blood, pleural effusion or sputum and they could avoid biopsies or other risky procedures. The authors aimed to assess the diagnostic performances of biomarkers focusing on micro-RNA and metabolites. METHODS: This meta-analysis was conducted under the PRISMA guidelines during a nine-year-period (2013-2022). the Meta-Disc software 5.4 (free version) was used. Q test and I2 statistics were carried out to explore the heterogeneity among studies. Meta-regression was performed in case of significant heterogeneity. Publication bias was assessed using the funnel plot test and the Egger's test (free version JASP). RESULTS: According to our inclusion criteria, 165 studies from 79 articles were included. The pooled SEN, SPE and dOR accounted, respectively, for 0.76, 0.79 and 13.927. The AUC was estimated to 0.859 suggesting a good diagnostic accuracy. The heterogeneity in the pooled SEN and SPE was statistically significant. The meta-regression analysis focusing on the technique used, the sample, the number of biomarkers, the biomarker subtype, the tumor stage and the ethnicity revealed the biomarker number (p = 0.009) and the tumor stage (p = 0.0241) as potential sources of heterogeneity. CONCLUSION: Even if this meta-analysis highlighted the potential diagnostic utility of biomarkers, more prospective studies should be performed, especially to assess the biomarkers' diagnostic potential in early-stage lung cancers.

Utility of the cytological criteria in the diagnosis of malignant pleural mesothelioma: Making the bridge between theory and practice.

INTRODUCTION: The diagnosis of malignant pleural mesothelioma (MPM) depends on microscopic examination performed on pleural biopsies taken under thoracoscopy. However, it has recently been established that cytology presents a significant diagnostic contribution enabling an earlier diagnosis with a minimally invasive procedure. AIM: To assess the diagnostic value of consensual cytological features of MPM in the differentiation between adenocarcinoma, mesothelioma and reactive mesothelial cells in pleural liquid. METHODS: All available retrospective records from the computerized pathology database system and pathology reports were searched for malignant pleural effusion cytology specimens, over a 5-year period from January 2015 to February 2020. The cytological criteria based on the international Guidelines for cytopathologic diagnosis of epithelioid and mixed type of MPM were assessed. Malignant mesothelial cells, MNML and RL were considered as the gold standard. RESULTS: 189 pleural biopsies with their corresponding cytology specimens were available for review. Among the reviewed cytologies, the diagnoses of 21/189 pleural cytologies were modified. The highest sensitivities were attributed to cytoplasmic blebbing, hypercellularity and cell ball clusters. The most specific feature was the absence of extracellular granular hyaluronic acid cores in reactive cytology and the absence of intercellular openings in NMML cell clusters. Extracellular granular hyaluronic acid cores had the highest positive predictive value and the highest negative predictive value was attributed to the cytoplasmic blebbing in both reactive cytology and NMML. CONCLUSION: These results highlight the fact that no sign is pathognomonic of the diagnosis of MPM pointing out the necessity of immunocytochemical techniques in equivocal cases.

Mediastinal cysts : a 52-case retrospective study.

INTRODUCTION: mediastinal cysts are rare lesions developed from mediastinal structures. They may be acquired like thoracic duct cysts or lymphangiomas or congenital like the bronchogenic cysts, enteric cysts or celomic cysts. These cysts are rare and may cause diagnostic challenges. AIM: To assess the major characteristics of these cysts based on a single institution experience. METHODS: the authors performed a descriptive, retrospective study from January 2009 to March 2020 in a single institution. Cystic lesions taking birth from the mediastinum for which gross features, microscopic features were available were included. RESULTS: this study contained 52 mediastinal cysts that were completely resected and no patient presented complications after the surgical resection. The bronchogenic cysts were the most frequent and represented 57.69% of all lesions. Thymic cysts and pericardial cysts represented respectively 40.38% and 1.92% of the cases. The positive diagnosis was based on the microscopic exam. The final diagnosis was concordant with the radiologic findings in 15 cases reaching a rate of 28%. CONCLUSION: the diagnosis of mediastinal cysts is based on the microscopic analysis of the cystic wall. Pericardial cysts may be suspected based on their characteristic location in the cardiophrenic angle, thymic cyst may be evoked based on their location in the thymic region and bronchogenic cysts are mainly located in the middle mediastinum. Inspite of these most frequent locations, the cysts may be located in any part of the mediastinum and may be difficult to diagnose when the key diagnostic features are absent.

Prognostic impact of tumor-infiltrating lymphocytes in non-small cell lung carcinomas.

INTRODUCTION: Tumor-infiltrating lymphocytes represent a pivotal component of the host anti-tumor response. Thus, they considerably influence the evolution of cancers including non-small cell lung carcinomas. Even if, this important role is consensual, many discordant results are published in the literature about the prognostic role of the different populations of tumor-infiltrating lymphocytes. The aim of our work was to evaluate the prognostic impact of CD8+, CD4+, and forkhead box protein P3+ lymphocytes in the tumor microenvironment of non-small cell lung carcinomas. METHODS: We conducted a retrospective descriptive study, which included non-small cell lung carcinomas diagnosed in the department of pathology and followed in the medical oncology department of the same hospital between 2011 and 2015. Tumor-infiltrating lymphocytes were analyzed by the immunohistochemical method for forkhead box protein P3, CD4, and CD8. Intratumoral and stromal-labeled lymphocytes were quantified by manual counting at high magnification (×400). Forkhead box protein P3+/CD8+, forkhead box protein P3+/CD4+, and CD8+/CD4+ ratios were subsequently calculated. The prognostic value of tumor-infiltrating lymphocytes was assessed in respect of overall survival, recurrence-free survival, and relapse-free survival. RESULTS: Thirty-nine patients were included. The mean age of patients was 59.6 years. A complete surgical resection (p = 0.009), and a CD8/CD4 ratio (p = 0.008) were prognostic factors for overall survival. Complete surgical resection (p = 0.003), the forkhead box protein P3/CD8 (p = 0.005), and forkhead box protein P3/CD4 (p = 0.037) ratios were prognostic factors for recurrence-free survival. The CD8+ tumor-infiltrating lymphocytes rate (p = 0.037) was a prognostic factor for relapse-free survival with a threshold of 67.8/high power field. Microscopic subtype (p = 0.037) was a prognostic factor for relapse-free survival when only adenocarcinoma and squamous cell carcinoma were considered. In multivariate analysis, age (p = 0.004) and a CD8/CD4 ratio (p = 0.016) were independent predictors of overall survival. CONCLUSION: Despite the limitations of our study, our results confirm the prognostic value of tumor-infiltrating lymphocytes in non-small cell lung carcinomas and the importance of the combined quantification of their different subpopulations.