[Role of transthoracic biopsy in the modern diagnosis of tumors of organs in the thoracic cavity].

This review summarizes data of publications and meta-analyses devoted ton the use of transthoracic biopsy. It is showed that the method continues to be one of the main ways to diagnose pathological processes in the thoracic cavity's organs, especially tumors of the lungs, pleura, mediastinum and chest wall. Modern methods of navigation trepan-needles can receive sufficient volume of pathological tissue samples for subsequent full morphological study to individualize and optimize treatment algorithms.

[Role of single-photon emission-computed tomography and x-ray computed tomography in diagnosing lymphatic metastases in patients with non-small cell lung cancer].

Single photon emission tomography (SPECT) with 99mTc-MIBI was performed after conventional staging in 83 operated non-small cell lung cancer (NSCLC) patients. Diagnostic results of SPECT and conventional computerized tomography (CT) staging were validated by histological examinations of operation material. According to histological verification 35 of 83 evaluated patients had lymph node (LN) invasion by NSCLC. SPECT detected LN involvement in 28 of these 35 patients and was false positive in additional 16 patients. Pneumonia or atelectasis were detected in 12 of 16 patients with false positive SPECT results. Sensitivity (Sen), specificity (Sp), accuracy (Ac), positive (PPV) and negative (NPV) predictive values of SPECT in diagnosis of LN invasion by NSCLC was as follows: 80%, 66%, 72%, 65%, 82%. Diagnostic accuracy of CT for detection of LN involvement was inferior to SPECT: Sen--71%, Sp--62%, Ac--66%, PPV--58%, NPV--75%. Combination of SPECT and CT data offer promising solutions with Sen reached 94% or high Sp which in patients without atelectasis or pneumonia can reach 96%.

[Morphological, immunohistochemical and spectral characteristics of dysplasia, preinvasive and invasive forms of lung cancer].

An analysis of modern methods of diagnostics such as morphological, immunohistochemical and spectral, which included the bronchoscopy and spectrometry by using reflectance and autofluorescent regime, was made. The data involved the results of prospective follow-up study of 167 patients (620 biopsies). An obligatory spectrometry of suspicious area was carried out before the forceps biopsy. The microslides, which met the requirements of criteria of one of the carcinogen steps (n=201), were subjected to the in-depth morphological and immunohistochemical investigations. The tendency of angiogenesis (CD31 and CD34), proliferative activity (Ki-67), level of apoptosis (P53), EGFR expression were estimated. The sensitivity of combined endoscopic method was 94,74% by specificity 79,95% and high prognostic value of negative endoscopic diagnosis - 99,4%.

[Comparative assessment of the effectiveness of treatment for patients with lung cancer].

A total of 4218 lung cancer patients received therapy from 1965 to 2004. Patients' population analysis shows no statistically significant changes in sex, clinico-anatomical forms or morphological type structure. The first 30 years analyzed showed a gradual increase in the number of patients receiving radical treatment (46.7, 67.2 and 82.4% for each decade), in 1995-2004 this value dropped to 34,0%. For each of the decades studied was evident an increase in the number of patients over 60 years receiving radical treatment. The third decade (1985 to 1994) was characterized by statistically significant increase of 5-year overall survival among patients receiving radical treatment (49.0% compared to 36.2%, 37.6% and 46.0%) mostly due to an increase in I and IIA stage patients compared to other periods (67.9 versus 52.3, 56.5 and 51.6%). The adjuvant tele-irradiation (total focal dose 45-55 Gy, conventional fractioning) in patients receiving radical surgical treatment for metastatic lung cancer with mediastinal lymph nodes involvement (N2) lead to statistically significant increase in 5-year overall survival from 14.7 to 19.7%.

[Current problems in the combined therapy of lung cancer].

The paper describes the general experience of modern lung cancer treatment methods application. Neoadjuvant therapy was shown to improve the long-term results of stage III patients increasing the 5-year overall survival by 7,8% (p=0,012). The special diagnostic algorithm for treatment results evaluation including autofluorescence spectrometry with 97,1% sensitivity and 88,3% specificity was developed. The adjuvant external-beam radiotherapy in patients with mediastinal lymph nodes metastases was shown to increase the 5-year overall survival (14,7% versus 19,7%) (p=0,01). The combination of endotracheobronchial surgery with chemoradiotherapy allowed to increase the median survival time of patients with inoperable lung cancer to 17 months. Isolated lung chemoperfusion was shown to increase the overall (p=0,019) and relapse-free (p=0,005) survival in patients with lung metastases.

[Radical surgical treatment of the 91 year old woman with a lung cancer].

This article presents the literature data review showing an urgency of lung cancer treatment problem in elderly patients, considering that more than 40% patients are in the age category older 65. The opinion on inexpediency of baseless refusal of adequate radical operative treatment performance under condition of patient functional validity is proved. The authors demonstrate their own clinical case of the 91 year old patient with a peripheral middle lobe right lung cancer with metastasises in root lymph nodes pT2N1M0 IIB, whom upper bilobectomy with one-piece methodic ipsilateral mediastinal lymphadenectomy without any complications was made.

[Anesthetic management in endotracheo-bronchial surgery for central bronchial and tracheal tumors].

The article summarizes the experience of anesthetic management in rigid bronchoscopy endobronchial surgery. Induction intravenous anesthesia followed by high tidal-volume mechanical ventilation proved to be more effective, than inhalation anesthesia with injector or high-frequency ventilation, although these methods are safe and effective in patients with compensated respiratory failure. The use of controlled hypotonia with mean arterial pressure of 60-70 mm Hg leads to decrease of blood loss and hypoxemia prevention without impairment of hemodynamics.

[Optimization of treatment methods of surgical complications in lung cancer].

The present report analyses the immediate and long-term results of treatment of surgical complications in 998 patients with lung cancer. There were complications in 37,5% of the cases, with a fatality rate of 14,7%. The most frequent complications were as follows: postoperative empyema with bronchopleural fistula (41,3%), bleeding (12,0%), pneumonia (9,8%), pulmonary arteries embolism (8,1%) and heart rhythm disorders (8,1%). Adjuvant and neoadjuvant treatment does not increase the rate of surgical complications as compared to just surgery alone (p = 0,1). Postoperative empyema with bronchopleural fistula requires intensive therapy, affects the quality of life of patients but does not decrease survival rates as compared to patients at the same stages of disease with uncomplicated course (p = 0,001). Timely drainage of pleural cavity accompanied by its adequate sanation does not differ (p = 0,1) from usage thoracoplasty (MS 29,9 months to 33,2 months).

[Use of autofluorescence bronchoscopy and spectrometry in the diagnosis of central lung cancer].

The paper evaluates the available data as well as our own on use of autofluorescence bronchoscopy in conjunction with spectrometric examination. We used qualitative and quantitative assessment of images obtained by conventional and autofluorescence (ClearVu Elite) means in real time. Our double-stage study evaluated sensitivity and specificity of autofluorescence bronchoscopy in diagnosing lung cancer as well as constructed spectrometric curves (ROC) and areas under them (AUC). Endoscopy was used in 171 patients with central lung cancer. Autofluorescence bronchoscopy established high sensitivity--94.74% (95%CI: 80.9-99%) and sufficient specificity--79.95% (95%CI: 75.8-83.6%). Application of a wide range of spectrometric coefficients contributed to high specificity thus reducing the number of biopsies as well as the injury from the treatment. The AUC for a best predictive index was 0.89 (99%: 0.83-0.95).

[Application of automated quantitative cytometry in diagnosis of lung cancer].

The paper deals with evaluation of the literature data and our experience with automated quantitative cytometric examination of sputum for diagnosis of lung cancer and, in particular, early one. This novel procedure uses measurement of quantitative indices which characterise tumors-induced alterations. The LungSign computerized system was employed to scan cellular nuclei. The results were evaluated by linear discriminative analysis with the aid of ROC-curves and underlying areas. The procedures were run in 248 cases and its sensitivity was significantly higher that of a standard cytological one (36.6% and 13.3%, respectively; p = 0.033), albeit a slight decrease in specificity (93.7% and 100%, respectively; p = 0.003). Automated quantitative cytometric indices varied significantly in cohorts of patients with confirmed (-0.275871) and false (-1.24990) diagnosis of lung cancer (p = 0.0001).

[Combined endoscopic monitoring of treatment effectiveness in tracheal and/or bronchial malignancies using autofluorescence spectroscopy].

The paper presents our experience with application of a diagnostic procedure which enhanced information potential of endoscopy. Its efficiency increased due to use of an algorithm which included several stages carried out during an endoscopic procedure: routine bronchoscopy, spectroscopy in light (400-700 nm), autofluorescence spectroscopy including nearest infrared spectrum (720-800 nm). During treatment, the latter registered the dynamics of glow intensity ratios in the red (600-680 nm) and green (500-550 nm) spectra. The efficacy of our method was determinated by the precise delineation of the involvement area and its changes in the course of treatment which matched final analysis data.

[Use of hypotensive anesthesia in endotracheo-bronchial surgery for tumor-related lesion of the trachea and/or central bronchi].

The paper presents a review of the literature data and our own experience with 25 endotracheabronchial operations for tumor-related stenosis of the central bronchi and/or trachea using hypotensive anesthesia. The latter condition was induced by speeding up propofol injection and maintaining general anesthesia at 4.4-9 mg/kg x hr. Mean arterial pressure was lower than in control (60-65 vs. 70-80 mmHg, respectively). As a result, blood loss fell 138-100 +/- 11 ml whereas gas exchange indices improved (pO2 112-87 mmHg). At intubation stage, rise in mean arterial pressure and heart rate was avoided.

[Improved high-frequency flow ventilation-assisted endotracheobronchial surgery for tumors of the trachea and main bronchi].

The report deals with evaluation of the literature and our own data on 65 endotracheobronchial operations for tumor-related obstruction of the main bronchi using high-frequency injection flow ventilation (n = 33; 50.8%) or a combined-frequency one (n = 32; 49.2%). The latter method was significantly more efficient (p < or = 0.05%) due to more effective blood oxygenization (pO2--111.8 +/-13.8 vs. 130.6 +/-26.4 mmHg) and carbon dioxide elimination (pO2--36.1 +/-1.2 vs. 54.3 +/-6.7 mmHg). It also involved lower risk of surgical fire as oxygen concentration in inhaled air mix was monitored. Also, endoscopic examination took less time because it was continuous, while the risk of barotrauma was reduced to minimum owing to adequate selection of ventilation ratings.

[Complex endoscopy-assisted treatment for pleural malignancies with concomitant exudative pleuritis].

The paper deals with complex treatment for pleural malignancies with concomitant effusions. Cytoreduction and abatement of effusion, protein loss, inflammation, intoxication and pain syndrome were reported after argon-plasma electrocoagulation of the pleura followed by photodynamic therapy and hyperthermal intrapleural chemoperfusion. Stable effusion abatement effect was confirmed in all eight cases by X-ray examination and changes in homeostatic indices and breathing function as well as lowered severity of intoxication and pain. No emergency repeat intervention or pleural puncture was reported.

[Results of treatment of lung cancer complicated by postoperative pleural empyema].

An evaluation of the literature and our own experience with surgical and combined treatment of lung cancer complicated by postoperative pleural empyema established the following incidence rates in 2.4% of patients: postpneumonectomy (4.2%), particularly on the side (57.4%), and in tumor stage III cases (70.6%). Bronchal stump failure (89.7%) was the main cause of postoperative pleural empyema while the risk doubled (4.5-6.0%; p < or = 0.05) after neoadjuvant therapy. Both immediate and end results were worse in postoperative pleural empyema than in similar uncomplicated cases: 12 month survival--43.8% vs. 71.1%; 3-year--18.8-36.8%; 5-year--10.4-26.3%. Also, postoperative pleural empyema patients stayed in hospital longer.

[A comparison of efficacy of different modalities of treatment for locally-advanced and metastatic non-small lung cancer].

The paper evaluates the efficacy of different modalities of treatment for locally-advanced and metastatic non-small lung cancer (NSLC) (1,316 pts.). Adjuvant chemotherapy was followed by an elevation of median of survival from 14 to 21.5 months at stage III. Combined treatment appeared more effective than distant one (survival of 21 months vs. 18 at stage IIIA and 35 months vs. 21 at stage IIIB); comparatively fewer cases of complications and radiation-related injuries were reported. The highest rates of survival were characteristic of conservative therapy as a component of chemoradiation (median of survival of 15 months at stages IIIA, IIIB and IV). Survival under 3 months was registered among patients without such therapy. Survival rates for timely adequate conservative therapy at stages IIIB and IV of NSLC were similar or higher than those in surgical cases alone (median of survival of 15 months vs.14 and 12.5, respectively). All procedures of specialized antitumor treatment of locally-advanced and metastatic non-small lung cancer were followed by significant increase in quality of life (+10-50%) while the latter parameter was falling dramatically in those without such therapy (15-30% per month). "Latency of process" calls for further research in methods of treatment because it was chiefly responsible for unsatisfactory results of surgery use for NSLC.

[Use of endotracheobronchial surgery in conjunction with radiochemotherapy for advanced non-small lung cancer].

The paper deals with data on 191 endotracheobronchial surgeries (ETBS) in 153 patients with advanced non-small lung cancer involving breath obstruction (stage IIb--13.7%, III--71.9%, IV--14.4%). Difficulty in breathing either subsided or decreased significantly immediately after surgery. When followed by radiochemotherapy, ETBS was followed by survival median (over 14 months), both until tumor progression and during relapse-free survival. Complications were infrequent (8.5%); there was no lethality. End results were improved due to use of photodynamic therapy at the closing stage of treatment which pushed survival median to 17 months. In 11 cases (7.2%), combination of ETBS and radiotherapy rendered tumor operable; after radical surgery, survival median rose to 23 months, relapse-free survival--20 months. Postoperative radiotherapy was followed by 23.5 and 22 months of survival respectively. Hence, ETBS alone or carried out in conjunction with radiochemotherapy significantly improved (by 30-50%) quality of life in patients with advanced non-small lung cancer.

[Combined endoscopic treatment of malignant tumorous lesions of the pleura accompanied with exudative pleurisy].

The article is devoted to a combined method of treatment of malignant tumorous lesions of the pleura accompanied by exudative pleurisy. The main result of using the method is cytoreduction, discontinuation of exudation and loss of protein, reduction of inflammation, intoxication and pain syndrome. It results from argonoplasmic electocoagulation of the pleura followed by photodynamic therapy. The treatment was used in 10 patients with a palliative aim. In all cases persistent discontinuation of the accumulation of pleural exudates was obtained that was confirmed by better state of the patient, normalization of homeostasis indices, X-ray examination data, reestablished functions of external respiration, reduced intoxication and pain syndrome. No reoperations or pleural punctures were needed.