Foreign Body Reaction Mimicking Lymph Node Metastasis is Not Rare After Lung Cancer Resection.

BACKGROUND: Mediastinal lymphadenopathies with high 18-fluorodeoxyglucose uptake in patients previously operated on for lung cancer are alarming for recurrence and necessitate invasive diagnostic procedures. Peroperative placement of oxidized cellulose to control minor bleeding may lead to a metastasis-like image through a foreign body reaction within the dissected mediastinal lymph node field at postoperative examinations. In this study, we investigated clinicopathological features and the frequency of foreign body reaction mimicking mediastinal lymph node metastasis. METHODS: Patients who underwent surgery for lung cancer between January 2016 and August 2021 and who were subsequently evaluated for mediastinal recurrence with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were included. Patients were grouped according to the results of EBUS-TBNA as metastasis, foreign body, and reactive. Clinicopathological features of these patients were compared and characteristics of patients in the foreign body group were scrutinized. RESULTS: EBUS-TBNA was performed on a total of 34 patients during their postoperative follow-up due to suspicion of mediastinal recurrence. EBUS-TBNA pathological workup revealed metastasis in 18 (52.9%), foreign body reaction in 10 (29.4%) and reactive lymph nodes in 6 (17.6%) patients. Mean maximum standardized uptake value (SUVMax) for metastasis group and foreign body group were 9.39 ± 4.69 and 5.48 ± 2.54, respectively (p = 0.022). Time interval between the operation and EBUS-TBNA for the metastasis group was 23.72 ± 10.48 months, while it was 14.90 ± 12.51 months in the foreign body group (p = 0.015). CONCLUSION: Foreign body reaction mimicking mediastinal lymph node metastasis is not uncommon. Iatrogenic cause of mediastinal lymphadenopathy is related to earlier presentation and lower SUVMax compared with metastatic lymphadenopathy.

Differential Impact of Spread Through Air Spaces on Subtypes of Early-stage Lung Cancer.

OBJECTIVE: To investigate the prognostic significance of STAS (Spread through air spaces) and its effect on survival in the various types of non-small cell lung cancer (NSCLC). STUDY DESIGN: Descriptive analytical study. Place and Duration of the Study: Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkiye, between 2018 and 2021. METHODOLOGY: Early-stage lung cancer patients who underwent lobectomy were included. STAS was defined as presence of tumour cell clumps, solid nests or set of single cells located in airway spaces apart from the main tumour border and determined by pathological work-up. The clinical significance of STAS was investigated by means of histopathological subtype, tumour size, and maximum standardised uptake value (SUVmax) on PET-CT scan in early-stage lung cancer by grouping it as adenocarcinoma and non-adenocarcinoma. Five-year overall and disease-free survival, and recurrence were the outcome measures. RESULTS: A total of 165 patients were included in the study. No recurrence was observed in 125 patients, 40 patients developed recurrence. Five-year overall survival (OS) was 69.6% in STAS (+) cohort and 74.5% in STAS (-) cohort (p=0.88). Five-year disease-free survival (DFS) was 51.1% in STAS (+) cohort and 73.1% for STAS (-) cohort (p=0.034). While the absence of STAS in the adenocarcinoma group was associated with better DFS, lower SUVMax and smaller tumour size, similar results were not found to be at statistically significant level in the non-adenocarcinoma group. CONCLUSION: STAS positivity makes a difference in DFS, tumour size and SUVmax, especially in adenocarcinoma, however, it does not create a significant difference in survival or clinic pathological features in the non-adenocarcinoma. KEY WORDS: Lung Cancer, Lobectomy, Spread through air spaces, Survival, Prognosis.

Is intensive care necessary after major thoracic surgery? A propensity score-matched study.

Background: This study aims to compare the surgical results, complications, mortality rates, and inpatient costs in two patient groups followed, whether in the intensive care unit or general ward after a major thoracic procedure and to examine clinical and surgical factors related to the development of complications. Methods: Between January 2018 and June 2021, a total of 485 patients (150 males, 335 females; mean age: 58.3±13.2 years; range, 22 to 86 years) who underwent a major thoracic surgery in our clinic were retrospectively analyzed. The patients were divided into two groups as the intensive care unit patients (n=254) and general ward patients (n=231). In the former group, the patients were followed in the intensive care unit for a day, while in the general ward group, the patients were taken directly to the ward. The groups were compared after propensity score matching. All patients were analyzed for risk factors of morbidity development. Results: After propensity score matching, 246 patients were enrolled including 123 patients in each group. There was no statistically significant difference between the groups in any features except for late morbidity, and inpatient costs were higher in the intensive care unit group (p<0.05). In the multivariate analysis, age, American Society of Anesthesiologists Class 3, and secondary malignancy were found to be associated with morbidity (p<0.05). Conclusion: In experienced centers, it is both safe and costeffective to follow almost all of the major thoracic surgery patients postoperatively in the general ward.