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1.
Anticancer Res ; 41(9): 4479-4482, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34475072

RESUMO

BACKGROUND/AIM: This study determined whether computed tomography (CT) is an appropriate means by which to differentiate non-invasive and minimally invasive forms of pulmonary adenocarcinoma from the invasive variant. PATIENTS AND METHODS: A total of 64 patients (38 men and 26 women, aged 42-76, mean age 64), who underwent surgery for pulmonary adenocarcinoma and a chest CT no less than 1 month before surgery, were included in the study. Lesions exhibiting ground glass opacity or ground glass opacity with a solid component of 5 mm or smaller, were defined as minimally invasive or non-invasive adenocarcinomas. CT findings were correlated with histopathological examination. RESULTS: Distinguishing minimally invasive and non-invasive adenocarcinoma from invasive adenocarcinoma using CT was achieved with a sensitivity of 77.7%, a specificity of 97.8%, a positive predictive value of 93.3%, and a negative predictive value of 91.8%. CONCLUSION: CT can be useful in assessing the degree of invasiveness of pulmonary adenocarcinoma and is a potential tool for the individualization of treatment.


Assuntos
Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Medicina de Precisão , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
2.
J Int Med Res ; 49(9): 3000605211038137, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34486433

RESUMO

Primary pulmonary high-grade mucoepidermoid carcinoma (MEC) with a cystic airspace is uncommon, and early metastasis is extremely rare. In such cases, however, it is clinically important for clinicians to consider whether the tumor has spread to the lymph nodes through the cystic airspace. A 77-year-old man presented to our hospital with cough and hemoptysis. Chest computed tomography showed a 25-mm-diameter mass with a cystic airspace located in the upper lobe of the left lung. The possibility of malignancy was considered. Without a definitive preoperative diagnosis, left upper lobectomy and mediastinal lymphadenectomy were performed. Histopathological examination revealed the typical histological characteristics of high-grade MEC (stage IA) and no lymph node metastasis. However, lymph node metastasis was found 6 months after surgical resection, and radiochemotherapy was performed. The patient developed widespread metastatic disease 4 months following completion of radiochemotherapy and died 2 months later. Primary pulmonary MEC with a cystic airspace is a rare malignant disease with uncommon imaging findings. Complete surgical resection is the main treatment method for high-grade MEC. In this case, we hypothesize that early metastasis was caused by seeding of tumor cells through the cystic airspace.


Assuntos
Carcinoma Mucoepidermoide , Neoplasias Pulmonares , Idoso , Carcinoma Mucoepidermoide/diagnóstico por imagem , Carcinoma Mucoepidermoide/cirurgia , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Excisão de Linfonodo , Metástase Linfática , Masculino
3.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 558-562, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494526

RESUMO

Objective To investigate the application value of indocyanine green(ICG)in the localization of small pulmonary nodules in video-assisted thoracoscopic surgery(VATS). Methods We retrospectively analyzed the clinical data of 45 patients with small nodules(diameter<1 cm)who received preoperative localization with ICG and underwent VATS wedge resection from October 2020 to February 2021.The data for analysis included patients age,nodule diameter,distance from the parietal pleura,nodule density,success rate of localization,time of localization,incidence of complications,and pathological findings. Results The success rate of localization was 100%.The average nodule size was 6.3 mm,and the nodules were(10±11)mm from the parietal pleura.After localization of 59 nodules,13(22.0%)cases were found to have mild pneumothorax,and 4(6.7%)cases were found to have mild hemorrhage.The success rate of operation was 100%,and 43(72.9%)cases were confirmed adenocarcinoma by postoperative pathology. Conclusion ICG has a high success rate and good safety in the localization of small pulmonary nodules in VATS.


Assuntos
Neoplasias Pulmonares , Nódulo Pulmonar Solitário , Humanos , Verde de Indocianina , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X
4.
In Vivo ; 35(5): 2815-2820, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410973

RESUMO

BACKGROUND/AIM: Identification of prognostic factors is helpful in selecting optimal treatment for centrally-located non-small cell lung cancer (NSCLC). This study aimed to detect prognostic factors in patients with centrally-located NSCLC. PATIENTS AND METHODS: NSCLCs in the hilar area requiring pneumonectomy or sleeve lobectomy for complete removal are defined as centrally-located NSCLCs. We retrospectively investigated the clinical courses of 45 patients with such lesions. RESULTS: Sleeve lobectomies were performed on 33 patients and pneumonectomies on 12. Three and five-year survival rates were 72% and 62%, respectively. Presence of comorbidities (p=0.013), severe symptoms (p=0.001), high white cell count (p=0.001), and pathological T3-4 stage (p=0.004) were identified as independent predictors of poor prognosis. Operative procedures did not correlate with outcomes (p=0.722). CONCLUSION: Presence of comorbidities, severe symptoms, high white cell counts, and pathological T stage are independent predictors of poor prognosis. These data can contribute in selecting appropriate treatments for such lesions.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estadiamento de Neoplasias , Pneumonectomia , Estudos Retrospectivos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 100(32): e26901, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397918

RESUMO

ABSTRACT: This study aimed to investigate the time trend variation in the surgical volume and prognostic outcome of patients with lung cancer after the gradual prolonged implementation of a low-dose computed tomography (LDCT) lung cancer screening program.Using the hospital-based cancer registry data on number of patients with lung cancer and deaths from 2008 to 2017, we conducted a retrospective study using a hospital-based cohort to investigate the relationship between changes in lung cancer surgical volume, the proportion of lung-sparing surgery, and prolonged prognostic outcomes after the gradual implementation of the LDCT lung cancer screening program in recent years.From 2008 to 2017, 3251 patients were diagnosed with lung cancer according to the hospital-based cancer registry. The 5-year mortality rate decreased gradually from 83.54% to 69.44% between 2008 and 2017. The volume of total lung cancer surgical procedures and proportion of lung-sparing surgery performed gradually increased significantly from 2008 to 2017, especially from 2014 to 2017 after implementation of a large volume of LDCT lung cancer screening examinations. In conclusion, our real-world data suggest that there will be an increase in cases of operable early-stage lung cancers, which in turn will increase the surgical volume and proportion of lung-sparing surgery, after the gradual implementation of the LDCT lung cancer screening program in recent years. These findings suggest the importance of a successful national policy regarding LDCT screening programs, regulation of shortage of thoracic surgeons, thoracic radiologist workforce training positions, and education programs.


Assuntos
Detecção Precoce de Câncer/métodos , Mão de Obra em Saúde/estatística & dados numéricos , Neoplasias Pulmonares/diagnóstico , Pulmão/diagnóstico por imagem , Programas de Rastreamento/métodos , Pneumonectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Doses de Radiação , Estudos Retrospectivos
6.
Radiologe ; 61(9): 853-862, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34409518

RESUMO

Radiotherapy of small targets with very high single doses administered in 1 to approximately 12 fractions-carried out under image guidance and with the intention of "tumour ablation"-is called stereotactic body radiation therapy (SBRT) for extracranial tumours or metastases. Radiobiologically, besides damaging the DNA of the tumour cells, the tumour vessels are also occluded and immunological effects are triggered. The safe performance of SBRT requires a very high physical-technical effort in order to ensure sufficient protection of healthy organs. Clinically, SBRT offers a wide range of applications in curative therapy (e.g. non-small-cell lung cancer stage I). Furthermore, it is a conservative, effective and well-tolerated option for the treatment of individual metastases and an optimal combination partner in the therapy of oligometastatic tumours.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Radiocirurgia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia
7.
J Appl Clin Med Phys ; 22(9): 215-226, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34406710

RESUMO

BACKGROUND AND PURPOSE: When treating lung tumors with stereotactic body radiation therapy (SBRT), patient immobilization is of outmost importance. In this study, the intra-fractional shifts of the patient (based on bony anatomy) and the tumor (based on the visible target volume) are quantified, and the associated impact on the delivered dose is estimated for a frameless immobilization approach in combination with surface guided radiation therapy (SGRT) monitoring. METHODS: Cone beam computed tomographies (CBCT) were collected in free breathing prior and after each treatment for 25 patients with lung tumors, in total 137 fractions. The CBCT collected after each treatment was registered to the CBCT collected before each treatment with focus on bony anatomy to determine the shift of the patient, and with focus on the visible target volume to determine the shift of the tumor. Rigid registrations with 6 degrees of freedom were used. The patients were positioned in frameless immobilizations with their position and respiration continuously monitored by a commercial SGRT system. The patients were breathing freely within a preset gating window during treatment delivery. The beam was automatically interrupted if isocenter shifts >4 mm or breathing amplitudes outside the gating window were detected by the SGRT system. The time between the acquisition of the CBCTs was registered for each fraction to examine correlations between treatment time and patient shift. The impact of the observed shifts on the dose to organs at risk (OAR) and the gross tumor volume (GTV) was assessed. RESULTS: The shift of the patient in the CBCTs was ≤2 mm for 132/137 fractions in the vertical (vrt) and lateral (lat) directions, and 134/137 fractions in the longitudinal (lng) direction and ≤4 mm in 134/137 (vrt) and 137/137 (lat, lng) of the fractions. The shift of the tumor was ≤2 mm in 116/137 (vrt), 123/137 (lat) and 115/137 (lng) fractions and ≤4 mm in 136/137 (vrt), 137/137 (lat), and 135/137 (lng) fractions. The maximal observed shift in the evaluated CBCT data was 4.6 mm for the patient and 7.2 mm for the tumor. Rotations were ≤3.3ᵒ for all fractions and the mean/standard deviation were 0.2/1.0ᵒ (roll), 0.1/0.8ᵒ (yaw), and 0.3/1.0ᵒ (pitch). The SGRT system interrupted the beam due to intra-fractional isocenter shifts >4 mm for 21% of the fractions, but the patients always returned within tolerance without the need of repositioning. The maximal observed isocenter shift by the SGRT system during the beam holds was 8 mm. For the respiration monitoring, the beam was interrupted at least one time for 54% of the fractions. The visual tumor was within the planned internal target volume (ITV) for 136/137 fractions in the evaluated CBCT data collected at the end of each fraction. For the fraction where the tumor was outside the ITV, the D98% for the GTV decreased with 0.4 Gy. For the OARs, the difference between planned and estimated dose from the CBCT data (D2% or Dmean ) was ≤2.6% of the prescribed PTV dose. No correlation was found between treatment time and the magnitude of the patient shift. CONCLUSIONS: Using SGRT for motion management and respiration monitoring in combination with a frameless immobilization is a feasible approach for lung SBRT.


Assuntos
Neoplasias Pulmonares , Radiocirurgia , Radioterapia Guiada por Imagem , Tomografia Computadorizada de Feixe Cônico , Humanos , Pulmão , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia , Movimento , Planejamento da Radioterapia Assistida por Computador
9.
Lung Cancer ; 159: 135-144, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34340110

RESUMO

OBJECTIVES: To compare the perioperative and oncologic outcomes following pneumonectomy performed by uniportal video-assisted thoracoscopic surgery (U-VATS) and thoracotomy in patients with centrally located non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Patients with NSCLC who underwent pneumonectomy at the Shanghai Pulmonary Hospital (SPH) and Sun Yat-sen University Cancer Center (SYUCC) with the U-VATS approach or open approach between 2011 and 2016 were selected. Propensity score matching (1:3) was performed to balance the baseline covariates. Overall survival (OS) rates and recurrence-free survival (RFS) rates were estimated and compared using the Kaplan-Meier method, respectively. RESULTS: The enrollees in the study were 579 patients in the SPH cohort, with 501 (86.5%) in the open group and 48 (13.5%) in the U-VATS group, and 271 patients in the SYUCC cohort, with 245 (90.4%) in the open group and 26 (9.6%) in the U-VATS group. After propensity score matching, morbidity rates and 30-day mortality rates were found to be similar between the U-VATS group and open group in both the SPH and SYUCC cohorts. The long-term OS rate of patients who underwent U-VATS pneumonectomy did not significantly differ compared with the patients who underwent open pneumonectomy in both cohorts (SPH, p = .900; SYUCC, p = .240). Cox regression analysis revealed that the surgical option was not a risk factor for the OS rate (SPH: hazard ratio [HR], 0.925; 95% confidence interval [CI], 0.555 to 1.542; SYUCC: HR, 1.524; 95% CI, 0.752 to 3.087). CONCLUSION: U-VATS can be used to safely perform pneumonectomy in patients with centrally located NSCLC without compromising the perioperative and oncologic outcomes compared with an open approach.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/cirurgia , China/epidemiologia , Humanos , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Pontuação de Propensão , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracotomia , Resultado do Tratamento
10.
World J Surg Oncol ; 19(1): 258, 2021 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461929

RESUMO

BACKGROUND: The standard treatment of stage III N2 small cell lung cancer (SCLC) is concurrent chemoradiation, and surgery is not recommended. This study was aimed to evaluate whether surgery has survival benefits in patients with stage III N2 SCLC and investigate the factors influencing survival of surgery. METHODS: Patients diagnosed with stage T1-4N2M0 SCLC from 2004 to 2015 were selected from the Surveillance Epidemiology End Results database. Propensity score matching (PSM) was used to balance confounders between patients who underwent surgery and those treated with radiation and/or chemotherapy. We compared overall survival (OS) of the two groups using Kaplan-Meier curves and a Cox proportional hazard model. We also identified prognostic factors in patients with surgical resection, and a nomogram was developed and validated for predicting postoperative OS. RESULTS: -A total of 5576 patients were included in the analysis; of these, 211 patients underwent surgery. PSM balanced the differences between the two groups. The median OS was longer in the surgery group than in the non-surgery group (20 vs. 15 months; p = 0.0024). Surgery was an independent prognostic factor for longer OS in the multivariate Cox regression analysis, and subgroup analysis revealed a higher survival rate in T1 stage patients treated with surgery (hazard ratio = 0.565, 95% confidence interval: 0.401-0.798; p = 0.001). In patients who underwent surgery, four prognostic factors, including age, T stage, number of positive lymph nodes, and radiation, were selected into nomogram development for predicting postoperative OS. C-index, decision curve analyses, integrated discrimination improvement, and time-dependent receiver operating characteristics showed better performance in nomogram than in the tumor-node-metastasis staging system. Calibration plots demonstrated good consistency between nomogram predicted survival and actual observed survival. The patients were stratified into three different risk groups by prognostic scores and Kaplan-Meier curves showed significant difference between these groups. CONCLUSIONS: These results indicate that surgery can prolong survival in patients with operable stage III N2 SCLC, particularly those with T1 disease. A nomogram that includes age, T stage, number of positive lymph nodes, and radiation can be used to predict their long-term postoperative survival.


Assuntos
Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Estadiamento de Neoplasias , Nomogramas , Prognóstico , Pontuação de Propensão , Programa de SEER , Carcinoma de Pequenas Células do Pulmão/cirurgia
11.
Medicine (Baltimore) ; 100(31): e26736, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397814

RESUMO

BACKGROUND: To explore the effects of psychological nursing on improving the mental health status of young patients with lung cancer surgery during the perioperative period. METHODS: seventy-eight young patients (From February 2018 to February 2019) underwent lung cancer operation were selected. All these patients were randomly allocated to intervention group and control group. The patients in the control group were treated with general routine care. The patients in the intervention group were treated with a comprehensive and systematic family participation psychological nursing. The mental health status of the patients in the 2 groups were compared and analyzed. RESULTS: The self-rating anxiety scale scores and self-rating depression scale scores of patients were significantly reduced in the intervention group compared with the control group (P < .05). The scores of somatization, obsessive symptoms, interpersonal relationship, depression, anxiety, hostile, phobic neurosis, stubborn, paranoia and psychosis were also significantly reduced in the intervention group compared with the control group (P < .05). CONCLUSION: the comprehensive and systematic psychological nursing intervention improved the mental health status of young patients with lung cancer surgery during the perioperative period.


Assuntos
Neoplasias Pulmonares/cirurgia , Saúde Mental/normas , Período Perioperatório/enfermagem , Adulto , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Período Perioperatório/estatística & dados numéricos , Inquéritos e Questionários
12.
Medicine (Baltimore) ; 100(34): e26681, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449453

RESUMO

RATIONALE: Recently, the number of osteosarcomas has been increasing in elderly patients due to human longevity. Lung metastases are the primary cause of death from osteosarcomas. Complete resection of lung metastases can prolong the survival. However, complete resection in elderly patients is often difficult due to high risk of operative complications. Computed tomography (CT) guided radiofrequency ablation (RFA) is a minimally invasive technique to destroy tumor nodules using heat. In this report, we present the first case older than 65 years applying RFA for lung metastases due to osteosarcoma. PATIENT CONCERNS: A 74-year-old male presented with 1-year history of heel pain. A conventional high-grade osteosarcoma in his calcaneus was diagnosed. Below-knee amputation was performed. However, lung metastases were found in both lungs 1 year after amputation. CT-guided lung RFA was chosen since surgical intervention for lung metastases was abandoned because of tumor multiplicity and medical comorbidities. A total of 18 lung metastases were treated by CT-guided RFA. The most frequent complication was pneumothoraxes in 4 of 8 (50%) procedures and chest tube drainage was required in 2 of these (2 of 8 (25%) procedures). DIAGNOSES: Six lung metastases of osteosaroma were found in both lungs at 1 year after surgery. INTERVENTIONS: CT-guided lung RFA was performed. A total of 18 lung metastases were treated in 8 lung RF procedures. OUTCOMES: The patient has been alive with disease for 5.5 years after the initial surgery. LESSONS: CT-guided lung RFA is effective for elderly patients with osteosarcoma lung metastases in spite of discouragement of lung metastasectomy due to multiplicity of metastases and medical-comorbidities.


Assuntos
Neoplasias Ósseas/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Osteossarcoma/patologia , Ablação por Radiofrequência/métodos , Idoso , Calcâneo/patologia , Humanos , Masculino , Radiografia Intervencionista , Tomografia Computadorizada por Raios X
13.
Kyobu Geka ; 74(8): 567-571, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334595

RESUMO

Thoracotomy has been preferred to video-assisted thoracoscopic surgery( VATS) for performing pulmonary pneumonectomy, and there have been no reports of complete video-assisted thoracoscopic surgery (cVATS) for such a case. We present three cases of cVATS pneumonectomy. The operation method was based on four ports, and ports were added in difficult cases. In these cases, the blood loss and length of surgery were similar to results of VATS reported previously. We experienced bleeding complications in one case but were able to manage appropriately. There were no serious postoperative complications in our cases. In addition, it was considered acceptable in terms of safety because there were no deaths within 30 days after operation in all cases. The cVATS pneumonectomy for lung cancer is one of the useful treatment option because of safety and many benefits although the long-term results are unknown at present.


Assuntos
Neoplasias Pulmonares , Pneumonectomia , Humanos , Pulmão , Neoplasias Pulmonares/cirurgia , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Toracotomia
14.
Kyobu Geka ; 74(8): 635-639, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334610

RESUMO

We experienced two cases of primary pulmonary amyloidosis with a localized consolidation. Case 1 is a 80-year-old man, who was found to have an abnormal chest nodular shadow with blurred margin at a medical examination. Chest computed tomography( CT) showed a localized consolidation on the periphery of the upper lobe of the right lung. A CT-guided biopsy was performed. Case 2 is a 66-year-old woman, who was found to have an abnormal chest opacity at a medical examination. Chest CT showed a localized gathering of small nodules in the right lower lobe. Gradual enlargement was noted by follow up CT and the accumulation of fluorodeoxyglucose (FDG) was shown by PET/CT. In consideration of primary lung cancer or malignant lymphoma, right lower lobectomy was performed. Both cases were pathologically diagnosed as pulmonary amyloidosis. Since no findings of amyloid deposits in other organs or of existence of any blood disorders, a diagnosis of primary pulmonary amyloidosis was made.


Assuntos
Amiloidose , Amiloidose de Cadeia Leve de Imunoglobulina , Pneumopatias , Neoplasias Pulmonares , Idoso , Idoso de 80 Anos ou mais , Amiloidose/diagnóstico por imagem , Amiloidose/cirurgia , Feminino , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Pneumopatias/diagnóstico por imagem , Pneumopatias/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
15.
Gan To Kagaku Ryoho ; 48(8): 1057-1060, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34404076

RESUMO

The patient was a 66-year-old male who had undergone an operation for lung cancer and solitary brain metastases. Follow- up PET-CT after 1 year detected FDG accumulation in the stomach. We performed esophagogastroscopy and found an approximately 20 mm-sized Type 2 tumor on the greater curvature of the upper stomach. A pathological diagnosis of lung adenocarcinoma metastasis in the stomach was made. Laparoscopic surgery was performed on the metastatic lesion to prevent bleeding and perforation, and resection was achieved with minimal invasion. The current development of chemotherapy, including immunotherapy, has contributed to the improved prognosis of cancer patients, including those with lung metastasis in the stomach. Considering these backgrounds, preventive surgical resection under laparoscopy may be an effective approach for improving prognosis and preventing acute life-threatening adverse events. We report this case along with a literature review.


Assuntos
Laparoscopia , Neoplasias Pulmonares , Neoplasias Gástricas , Idoso , Gastrectomia , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/cirurgia , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
16.
Zhonghua Bing Li Xue Za Zhi ; 50(8): 882-890, 2021 Aug 08.
Artigo em Chinês | MEDLINE | ID: mdl-34344071

RESUMO

Objective: To reveal the current status and problem of surgical pathological diagnosis and to construct a structured pathological database of lung cancer in China, and to further improve the level of pathological standards and scientific data. Methods: Case report form (CRF) was made according to the diagnostic criteria of radical resection specimens of lung cancer, including general information, smoking history, pathological report (including molecular data), treatment and prognosis, etc. The original clinicopathological data of patients with primary lung cancer who underwent surgical resection in 23 centers from January 2013 to December 2017 were retrospectively collected. After desensitization, filtering and natural language processing, combined with domain knowledge base, and the raw data in the form of continuous text were structured. Results: A total of 153 817 non-structured pathological reports, 57 748 molecular reports and 13 295 pieces of treatment and/or follow-up information were collected. Finally, 75 941 effective structured documents (including 86 979 primary lesions) were obtained. The quality of treatment and follow-up data was not satisfactory; Number of CRF index involved showed an increasing trend with time coursing, and had no significant difference between general hospitals and cancer hospitals (P<0.05). The indexes with low use rate until 2017 were peripheral lung disease, pTNM stage, spread though air space, and pathological evaluation of neoadjuvant treatment response. The ratio of male to female was 1.2∶1.0; 8 648 cases (11.39%) had smoking history, and the ratio of smokers to non-smokers was 0.92∶1.00. Age group of the highest incidence was 60-69 years, accounting for 38.76%. The top five common pathological subtypes were adenocarcinoma (74.58%), squamous cell carcinoma (18.01%), small cell carcinoma (2.18%), adenosquamous carcinoma (1.71%) and sarcomatoid carcinoma (0.82%); histological subtypes were significantly correlated with gender, age and smoking status (P<0.05): adenocarcinoma (58.5%) and squamous cell carcinoma (31.6%) were the main pathological types in male patients, while adenocarcinoma (91.6%) and squamous cell carcinoma (3.4%) were the main pathological types in female patients; adenocarcinoma (85.6%) was the main type of non-smoking patients, adenocarcinoma and squamous cell carcinoma accounted for 50.6% and 37.7% respectively in smoking patients; the proportion of adenocarcinoma decreased with age, while squamous cell carcinoma and small cell carcinoma increased. The top five common immunohistochemical (IHC) markers were TTF1, CK7, ALK-Ventana, Napsin A and p63 and the most common panel included 7-9 IHC markers. The overall EGFR mutation rate was 51.32% (all 10 335/20 139 by PCR), the total ALK positive rate was 6.18% (2 084/33 726, PCR, FISH and IHC-Ventana platform positive rates were 3.01%, 8.93% and 6.58%, respectively), the KRAS mutation rate was 7.01% (all 662/9 441 by PCR). The positive rates of EGFR, ALK and KRAS were 58.14% (9 986/17 175), 6.59% (1 791/27 176) and 7.52% (607/8 068) in adenocarcinoma, 5.83% (113/1 939), 0.40% (1/251) and 1.76% (15/852) in squamous cell carcinoma, respectively. Due to the poor quality of prognostic data, it was difficult to obtain effective survival analysis. Conclusions: The standardization of pathological reports (including molecular detection) of lung cancer in China is generally fine, but most of the models are still in the state of unstructured continuous text. The postoperative pathological staging, pathological evaluation of neoadjuvant therapy response and high-quality prognosis data need paying more attention and improvement. Panel of IHC markers is balanced although further precision. The use of lung cancer structured report template and intelligent structured database management mode to improve the degree of the pathologic diagnosis standardization and data quality is recommended.


Assuntos
Big Data , Neoplasias Pulmonares , Idoso , China/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Mutação , Estadiamento de Neoplasias , Estudos Retrospectivos
18.
Br J Radiol ; 94(1125): 20201208, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34319810

RESUMO

OBJECTIVE: To compare the efficacy of medical adhesive and hookwire as CT-guided non-palpable pulmonary nodule (NPN) localization methods before video-assisted thoracoscopic surgery (VATS) resection, and determine the risk factors for common complications during localization. METHODS: This was a single-center non-randomized retrospective study. 102 consecutive patients with 109 NPNs were divided into Group A (medical adhesive, 66 patients, 72 nodules) and Group B (hookwire, 36 patients, 37 nodules) before VATS. Patient- and nodule-based characteristics were compared. Logistic regression was performed to identify the risk factors for complications. RESULTS: Localization was successfully performed in all the NPNs. For Group A, the rate of pneumothorax immediately after localization was lower (p = 0.049) and the localization-to-surgery interval was longer (p = 0.011) than Group B. There was no significant difference in rates of hemorrhage after needle withdrawal between the two groups (p = 0.198). Hookwire ( vs medical adhesive) (ß = 1.12, p = 0.018), total insertion depth (ß = -0.41, p = 0.013), pleura-needle angle (ß = -0.04, p = 0.025) and grade of hemorrhage after needle withdrawal (ß = -0.96, p = 0.030) were independently associated with pneumothorax, while age (ß = -0.94, p = 0.018), tumor size (ß = 0.29, p = 0.007) and its distance from the pleural surface (ß = 0.14, p = 0.004) were associated with higher grade hemorrhage after needle withdrawal. CONCLUSION: Compared with hookwire, localization with medical adhesive excelled in lower risk of pneumothorax, a more flexible localization-to-surgery interval, and had similar rates of hemorrhage after needle withdrawal. Hookwire is an independent risk factor of pneumothorax immediately after localization. ADVANCES IN KNOWLEDGE: This study added new clinical evidence to the efficacy of medical adhesive in pre-operative CT-guided NPN localization.


Assuntos
Adesivos/administração & dosagem , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Cuidados Pré-Operatórios/métodos , Radiografia Intervencionista/métodos , Nódulo Pulmonar Solitário/cirurgia , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Nódulo Pulmonar Solitário/diagnóstico por imagem , Cirurgia Torácica Vídeoassistida/métodos
19.
Gen Thorac Cardiovasc Surg ; 69(10): 1432-1437, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34283387

RESUMO

Situs inversus totalis (SIT) is an extremely uncommon congenital disease where the major organs of the body are transposed through the sagittal plane. Kartagener syndrome is a complication of SIT with immotility of bronchial cilia, bronchiectasis, and chronic sinusitis. There is no report describing patients with Kartagener syndrome who accept uni-portal segmentectomies for lung cancer in past studies. Here we report a 74-year-old female patient with both Kartagener syndrome and a small early-stage lung cancer lesion located in the apical segment of the left upper lobe (LS1). The pulmonary segment anatomy of the left upper lobe in this case, which had very rare variants, was presented and interpreted in detail. This patient underwent an anatomic segmentectomy to the LS1 and a partial excision to the left middle lobe with bronchiectasis through a single 3 cm length incision. We believe that the case can give surgeons some experience and inspiration.


Assuntos
Síndrome de Kartagener , Neoplasias Pulmonares , Idoso , Feminino , Humanos , Síndrome de Kartagener/complicações , Síndrome de Kartagener/cirurgia , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Mastectomia Segmentar , Pneumonectomia
20.
BMC Infect Dis ; 21(1): 629, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210287

RESUMO

BACKGROUND: Along with the medical development, organ transplant patients increase dramatically. Since these transplant patients take immunosuppressants for a long term, their immune functions are in a suppressed state, prone to all kinds of opportunistic infections and cancer. However, it is rarely reported that the kidney transplant recipients (KTRs) have pulmonary tuberculosis and lung cancer simultaneously. CASE PRESENTATION: A 60-year-old male was admitted because of persistent lung shadow for 2 years without any obvious symptom 8 years after renal transplant. T-SPOT test was positive but other etiological examinations for Mycobacterium tuberculosis were negative. Chest CT scan revealed two pulmonary lesions in the right upper and lower lobe respectively. 18F-fluorodesoxyglucose positron-emission tomography (FDG-PET) CT found FDG intake increased in both pulmonary consolidation lesions. CT-guided percutaneous transthoracic needle biopsy revealed lung adenocarcinoma and tuberculosis. The video-assisted thoracoscopic surgery was operated to resect the malignancy lesions. The patient received specific anti-tuberculosis therapy and was discharged. At the follow-up of 6 months post drug withdrawal, the patient was recovered very well. CONCLUSIONS: We for the first time reported co-existence of smear-negative pulmonary TB and lung adenocarcinoma in a KTR, which highlighted the clinical awareness of co-occurrence of TB and malignancy after renal transplant and emphasized the value of biopsy and 18F-FDG-PET in early diagnosis of TB and cancer.


Assuntos
Adenocarcinoma/complicações , Transplante de Rim , Neoplasias Pulmonares/complicações , Tuberculose Pulmonar/complicações , Adenocarcinoma/cirurgia , China/epidemiologia , Etambutol/uso terapêutico , Fluordesoxiglucose F18 , Humanos , Biópsia Guiada por Imagem , Isoniazida/uso terapêutico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Moxifloxacina/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Cirurgia Torácica Vídeoassistida , Resultado do Tratamento , Tuberculose Pulmonar/tratamento farmacológico
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