Magnetic resonance imaging for the study of mediastinal adenopathies in lung cancer: Comparison with standard tests.

BACKGROUND: Lung cancer is the second most common cancer in both men and women. Mediastinal lymph node involvement in these patients, determined by imaging tests, indicates prognosis and modifies therapeutic attitude. PURPOSE: The aim of this study was to analyze the diagnostic capacity of magnetic resonance imaging (MRI) in the study of the mediastinum in comparison with conventional tests (computed tomography [CT] and positron-emission tomography [PET] or PET/CT scans), taking histology as the gold standard. MATERIALS AND METHODS: An observational study was conducted on 16 patients with suspicion of primary lung cancer (June 2016 through December 2018). We studied their demographic characteristics and used CT, PET, or PET/CT scans and MRI (diffusion-weighted imaging-MRI sequence) to examine mediastinal disease and compare MRIs diagnostic yield and percentage agreement to that of conventional tests. RESULTS: As compared to CT and PET scanning, MRI displayed a very low sensitivity and a specificity of 90 and 88%, respectively; positive predictive value was 0.67 (both) and negative predictive value (NPV) was 0.28 and 0.22, respectively. MRI showed a high degree of agreement in lymph node diagnosis when compared with histology (91.2%; P = 0.001): specificity in this case was high (E = 0.94), as was the NPV (NPV = 0.97). CONCLUSIONS: The results of this study would appear to indicate that MRI could play a relevant role in mediastinal staging of lung cancer. More prospective, multicenter studies are, however, needed to be able to draw up firm recommendations about the role of MRI and its place in lung cancer staging.

Epidemiology of stage III lung cancer: frequency, diagnostic characteristics, and survival.

Stage III non-small cell lung cancer (NSCLC) includes a highly heterogeneous group of patients with differences in the extent and localization of disease. Many aspects of stage III disease are controversial. The data supporting treatment approaches are often subject to a number of limitations, due to the heterogeneous patient populations involved in the trials. Furthermore, the definition of stage III disease has changed over time, and early studies were frequently inadequately powered to detect small differences in therapeutic outcome, were not randomized, or had a limited follow-up times. Major improvements in therapy, including the use of more active chemotherapy agents and refinements in radiation and surgical techniques, also limit the interpretation of earlier clinical trials. Lastly, improvements in pretreatment staging have led to reclassification of patients with relatively minimal metastatic disease as stage IV rather than stage III, leading to an apparent increase in the overall survival of both stage III and IV patients. Median overall stage III NSCLC survival ranges from 9 to 34 months. Higher survival rates are observed in younger Caucasian women with good performance status, adenocarcinoma, mutations, stage IIIA, and in patients with multidisciplinary-team-based diagnoses.

Usefulness of Positron Emission Tomography in the Examination of Hilar and Mediastinal Lymphadenopathies in Patients with Suspicion of Lung Cancer.

Introduction: Lung cancer is a major health problem. Mediastinal staging performed with the aid of imaging techniques is essential for appropriate disease treatment and prognosis. Accordingly, this study aimed to ascertain the usefulness of positron emission tomography (PET) in mediastinal staging, establish the best maximum standardized uptake value (SUVmax) cutoff point, compare its usefulness to that of computed tomography (CT), and determine the influence of histological tumour subtype. Methods: We conducted a retrospective study across a period of 3 years on 128 patients with suspicion of lung cancer and analyzed their demographic and radiological characteristics using CT and PET to perform the mediastinal examination. Histology was regarded as the gold standard. Results: PET displayed a high sensitivity (95%) and negative predictive value (NPV) (92%), outperforming CT (89% and 85%, respectively). Percentage agreement with histology was also higher (0.207 and 0.241 for CT and PET, respectively; p < 0.001). Taking an SUVmax value of 0.5 as that which would ensure greatest diagnostic accuracy, S and NPV were 100%, though percentage agreement did not increase (0.189; p < 0.001). PET discriminatory power was not affected by histological tumour subtype. Conclusions: The results of our study indicate that PET might be a useful test for examination of the mediastinum in lung cancer patients. Its high NPV suggests that the absence of mediastinal uptake could be used to proceed to surgical treatment without the need for further tests or examinations. Nevertheless, studies directly aimed to answer this specific question are needed.

P. TYR1381X: Are We Facing a New Mutation of CFTR in a Patient With Severe Cystic Fibrosis? / P. TYR1381X: ¿Nos enfrentamos a una nueva mutación de CFTR en un paciente con fibrosis quística grave?

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Evolución tras la retirada de la oxigenoterapia domiciliaria. Perfil del paciente en el que hay que reintroducirla / Progress After the Withdrawal of Home Oxygen Therapy. The Profile of Patients Requiring Reintroduction

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Necesidad de titular el oxígeno portátil mediante pruebas de marcha de 6 minutos / Need for Portable Oxygen Titration During 6-Minute Walk Tests

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El juul. Posiblemente una de las formas más peligrosas de tabaquismo en la actualidad / Juul. It may be one of the most dangerous forms of smoking at present

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Use of Magnetic Resonance Imaging for N-Staging in Patients with Non-Small Cell Lung Cancer. A Systematic Review / Uso de las imágenes por resonancia magnética para la estadificación ganglionar (N) del cáncer de pulmón de no microcítico. Revisión sistemática

Introduction: The aim of this study is to assess the diagnostic value of the magnetic resonance imaging (MRI) in differentiating metastasic from non-metastatic lymph nodes in NSCLC patients compared with computed tomography (CT) and fluorodeoxyglucose (FDG) - positron emission tomography (PET) or both combined. Methods: Twenty-three studies (19 studies and 4 meta-analysis) with sample size ranging between 22 and 250 patients were included in this analysis. MRI, regardless of the sequence obtained, where used for the evaluation of N-staging of NSCLC. Histopathology results and clinical or imaging follow-up were used as the reference standard. Studies were excluded if the sample size was less than 20 cases, if less than 10 lymph nodes assessment were presented or studies where standard reference was not used. Papers not reporting sufficient data were also excluded. Results: As compared to CT and PET, MRI demonstrated a higher sensitivity, specificity and diagnostic accuracy in the diagnosis of metastatic or non-metastatic lymph nodes in N-staging in NSCLC patients. No study considered MRI inferior than conventional techniques (CT, PET or PET/CT). Other outstanding results of this review are fewer false positives with MRI in comparison with PET, their superiority over PET/CT to detect non-resectable lung cancer, to diagnosing infiltration of adjacent structures or brain metastasis and detecting small nodules. Conclusion: MRI has shown at least similar or better results in diagnostic accuracy to differentiate metastatic from non-metastatic mediastinal lymph nodes. This suggests that MRI could play a significant role in mediastinal NSCLC staging

Introducción: El objetivo de este trabajo es evaluar el potencial diagnóstico de las imágenes por resonancia magnética (RM) para identificar nódulos linfáticos metastásicos frente aquellos no metastásicos en pacientes con cáncer de pulmón no microcítico (CPNM) en comparación con la tomografía computarizada (TC), la tomografía por emisión de positrones con 18F-fluorodesoxiglucosa (PET-FDG) o ambas técnicas combinadas. Métodos: En el análisis se incluyeron 23 estudios (19 estudios y 4 metaanálisis) con tamaños de muestra entre 22 y 250 pacientes. Para la estadificación ganglionar (N) del CPNM se utilizaron imágenes de RM independientemente de la secuencia obtenida. Como estándar de referencia se usaron los resultados histopatológicos y el seguimiento clínico o por imagen. Se excluyeron aquellos estudios con tamaños muestrales menores de 20 casos, aquellos con menos de 10 nódulos linfáticos evaluados o estudios en los que no se usó un estándar de referencia. También se excluyeron los artículos que no presentaron suficientes datos. Resultados: Se observó que la RM presentaba mayor sensibilidad, especificidad y precisión en la estadificación ganglionar (N) y el diagnóstico de nódulos linfáticos metastásicos o no metastásicos en pacientes con CPNM en comparación con la TC y el PET. Ningún estudio consideró a la RM inferior con respecto a otras técnicas convencionales (TC, PET y PET/TC). Otros resultados destacables de esta revisión son que con la RM se originaron menos falsos positivos en comparación con el PET, y su superioridad respecto al PET/TC en la detección de tumores de pulmón no operables, en el diagnóstico de infiltración en estructuras adyacentes o metástasis cerebrales, así como en la detección de nódulos de pequeño tamaño. Conclusión: La RM dio lugar a mejores resultados o, al menos comparables, relacionados con la precisión diagnóstica para diferenciar nódulos linfáticos metastásicos de no metastásicos. Esto sugiere que la RM podría jugar un papel importante en la estadificación mediastinal en pacientes con CPNM