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Khoury LM, Sheehan KN, Mariencheck WI, Gershner KA, Maslonka M, Niehaus AG, Isom S, Bellinger CR. Endobronchial Ultrasound Guided Transbronchial Needle Aspiration and PD-L1 Yields. Lung 2024; 202:325-330. [PMID: 38637361 PMCID: PMC11143017 DOI: 10.1007/s00408-024-00692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Immunotherapy is a leading approach for treating advanced non-small cell lung cancer (NSCLC) by targeting the PD-1/PD-L1 checkpoint signaling pathway, particularly in tumors expressing high levels of PD-L1 (Jug et al. in J Am Soc Cytopathol 9:485-493, 2020; Perrotta et al. in Chest 158: 1230-1239, 2020). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method to obtain tissue for molecular studies, including PD-L1 analysis, in unresectable tumors (Genova et al. in Front Immunol 12: 799455, 2021; Wang et al. in Ann Oncol 29: 1417-1422, 2018). This study aimed to assess the adequacy of PD-L1 assessment in EBUS-TBNA cytology specimens. METHODS Data was collected retrospectively from patients who underwent EBUS-TBNA between 2017 and 2021 for suspected lung cancer biopsy. Samples positive for NSCLC were examined for PD-L1 expression. EBUS was performed by experienced practitioners, following institutional guidelines of a minimum of five aspirations from positively identified lesions. Sample adequacy for molecular testing was determined by the pathology department. RESULTS The analysis involved 387 NSCLC cases (149 squamous cell, 191 adenocarcinoma, 47 unspecified). Of the 263 EBUS-TBNA specimens tested for PD-L1, 237 (90.1%) were deemed adequate. While 84% adhered to the protocol, adherence did not yield better results. Significantly higher PD-L1 adequacy was observed in squamous cell carcinomas (93.2%) compared to adenocarcinoma (87.6%). The number of aspirations and sedation type did not correlate with PD-L1 adequacy in either cancer type, but lesion size and location had a significant impact in adenocarcinomas. Adenocarcinoma exhibited higher PD-L1 expression (68%) compared to squamous cell carcinoma (48%). CONCLUSION EBUS-TBNA offers high yields for assessing immunotherapy markers like PD-L1, with satisfactory adequacy regardless of NSCLC subtype, lesion size, or location.
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Affiliation(s)
- Lara M Khoury
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Kristin N Sheehan
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - William I Mariencheck
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Katherine A Gershner
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Matthew Maslonka
- Department of Pulmonary and Critical Care Medicine, Nebraska Pulmonary Specialties, Lincoln, NE, USA
| | - Angela G Niehaus
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Scott Isom
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christina R Bellinger
- Department of Pulmonary and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Botana-Rial M, Lojo-Rodríguez I, Leiro-Fernández V, Ramos-Hernández C, González-Montaos A, Pazos-Area L, Núñez-Delgado M, Fernández-Villar A. Is the diagnostic yield of mediastinal lymph node cryobiopsy (cryoEBUS) better for diagnosing mediastinal node involvement compared to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)? A systematic review. Respir Med 2023; 218:107389. [PMID: 37579981 DOI: 10.1016/j.rmed.2023.107389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/12/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION New tools such as cryobiopsy of mediastinal lymph nodes (cryoEBUS) have been described to improve the diagnostic usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The literature suggests that this novel procedure could be associated with greater diagnostic usefulness than conventional EBUS-TBNA. METHODS To develop a systematic analysis and meta-analysis on the diagnostic diagnostic yield and safety of cryobiopsy of hilar and mediastinal adenopathies compared to EBUS-TBNA. RESULTS Seven studies that had included a total of 555 patients were considered in this review, with 365 (65.7%) of these patients having an etiology of malignant lymph node involvement. The overall diagnostic usefulness of cryoEBUS was higher compared to EBUS-TBNA (92% vs. 80%). However, when the results were analysed according to the specific aetiologies of the adenopathies, cryoEBUS was especially useful in cases of lymphomas or non-pulmonary carcinomas (83% vs. 42%) and in cases that were benign (87% vs. 60.1%), with no significant differences being found in specific cases of lung cancer. For lymphoma, cryoEBUS was diagnostic in 87% of cases compared to 12% for EBUS-TBNA and in addition, also allowed the characterisation of every lymphoma subtype. Genetic studies and immunohistochemical determination of PD-L1 was possible in almost all (97%) of the samples obtained by cryoEBUS, while this was only possible in 79% of those obtained by EBUS-TBNA. The most frequent complication was light bleeding, which was described in up to 85% of cases in some series. CONCLUSION CryoEBUS could represent a promising technique in the diagnostic algorithm used for mediastinal and hilar involvement. Although cryoEBUS did not significantly improve the diagnosis of lung cancer compared to EBUS-TBNA, the results were significantly better in patients with benign pathologies and other tumour types, including lymphomas. In addition, it seems that the samples obtained by cryoEBUS better defined the histological subtypes of lymphoma and allowed complete molecular characterisation in cases of lung cancer. The technique has proven to be safe and no serious complications were described after the procedure.
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Affiliation(s)
- Maribel Botana-Rial
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain.
| | - Irene Lojo-Rodríguez
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain
| | - Virginia Leiro-Fernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain
| | - Cristina Ramos-Hernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain
| | - Almudena González-Montaos
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain
| | - Luis Pazos-Area
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain
| | - Manuel Núñez-Delgado
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, EOXI Vigo. Pneumovigo I+I Research Group. Health Research Institute Galicia Sur (IIS Galicia Sur). Vigo, Spain
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Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
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Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Cytologic Contamination of the Sampling Needle in Endobronchial Ultrasound. Arch Bronconeumol 2022; 58:367-368. [PMID: 35312544 DOI: 10.1016/j.arbres.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
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[Translated article] Cytologic Contamination of the Sampling Needle in Endobronchial Ultrasound. Arch Bronconeumol 2022. [DOI: 10.1016/j.arbres.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The staging of mediastinal lymph nodes for lung cancer is crucial for planning treatments or reinterventions. In potentially curable patients the aim of mediastinal staging is to exclude the presence of malignancy in mediastinal lymph nodes with a high level of accuracy while also considering clinical factors and the balance of the benefits and risks of tissue sampling techniques. Mediastinal staging is based on computed tomography (CT) and positron emission tomography (PET) and can be sufficient when no mediastinal abnormalities are present and the probability of unforeseen N2 disease is low. In the case of bulky lymph nodes with a high probability of malignancy in PET-CT, tissue confirmation is not normally required. If mediastinal sampling is needed it can be achieved by endosonographic techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) or a combination of the two. Positive results do not need further confirmation. In the case of negative results, surgical techniques still play a role in the selected cases discussed by multidisciplinary lung cancer committees. New mediastinal surgical techniques including video-assisted cervical mediastinoscopy (VACM), video-assisted mediastinoscopic lymphadenectomy (VAMLA), and transcervical extended mediastinal lymphadenectomy (TEMLA) have been shown to be useful in selected patients. Final pathological staging is based on lymph node removal during surgery and can be achieved by taking one of two approaches: lymph node sampling or systematic lymph node sampling. The accuracy of PET-CT and mediastinal endosonography is lower for mediastinal restaging than it is for surgical techniques; their false positive and false negative (FN) rate is high and so, they require histological confirmation. Here we explain and revise the results from the most recent studies and current international guidelines.
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Affiliation(s)
- Virginia Leiro-Fernández
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, Vigo, Spain.,NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), Vigo, Spain
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7
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Steinhauser Motta JP, Steffen RE, Samary Lobato C, Souza Mendonça V, Lapa e Silva JR. Endobronchial ultrasound-guided transbronchial needle aspiration versus mediastinoscopy for mediastinal staging of lung cancer: A systematic review of economic evaluation studies. PLoS One 2020; 15:e0235479. [PMID: 32603376 PMCID: PMC7326228 DOI: 10.1371/journal.pone.0235479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/16/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The emergence of endobronchial ultrasound (EBUS) changed the approach to staging lung cancer. As a new method being incorporated, the use of EBUS may lead to a shift in clinical and costs outcomes. Objective The aim of this systematic review is to gather information to better understand the economic impact of implementing EBUS. Methods This review is reported according to the PRISMA statement and registered on PROSPERO (CRD42019107901). Search keywords were elaborated considering descriptors of terms related to the disease (lung cancer / mediastinal staging of lung cancer) and the technologies of interest (EBUS and mediastinoscopy) combined with a specific economic filter. The literature search was performed in MEDLINE, EMBASE, LILACS, Cochrane Library of Trials, Web of Science, Scopus and National Health System Economic Evaluation Database (NHS EED) of the Center for Reviews and Dissemination (CRD). Screening, selection of articles, data extraction and quality assessment were carried out by two reviewers. Results Seven hundred and seventy publications were identified through the database searches. Eight articles were included in this review. All publications are full economic evaluation studies, one cost-effectiveness, three cost-utility, and four cost-minimization analyses. The costs of strategies using EBUS-TBNA were lower than the ones using mediastinoscopy in all studies analyzed. Two of the best quality scored studies demonstrate that the mediastinoscopy strategy is dominated by the EBUS-TBNA strategy. Conclusion Information gathered in the eight studies of this systematic review suggest that EBUS is cost-effective compared to mediastinoscopy for mediastinal staging of lung cancer.
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Affiliation(s)
| | - Ricardo E. Steffen
- Instituto de Medicina Social, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caroliny Samary Lobato
- Programa de Pós-Graduação em Clínica Médica da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa Souza Mendonça
- Biblioteca do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Avasarala SK, Aravena C, Almeida FA. Convex probe endobronchial ultrasound: historical, contemporary, and cutting-edge applications. J Thorac Dis 2020; 12:1085-1099. [PMID: 32274177 PMCID: PMC7139045 DOI: 10.21037/jtd.2019.10.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of convex-probe endobronchial ultrasound (CP-EBUS) has revolutionized bronchoscopy. It has provided the option of a relatively safe, minimally invasive approach for the assessment of various intrathoracic diseases. In current practice, its most dramatic impact has been on the diagnosing and staging of lung cancer. It has served as an invaluable tool that has replaced mediastinoscopy in a variety of clinical scenarios. Many pulmonologists and thoracic surgeons consider CP-EBUS the most significant milestone in bronchoscopy after the development of the flexible bronchoscope itself. In this review, we summarize the historical aspects, current indications, technical approach, and future direction of CP-EBUS.
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Affiliation(s)
| | - Carlos Aravena
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Delayed Presentation of Hemothorax and Mediastinal Hematoma Requiring Surgical Intervention After Linear Endobronchial Ultrasound. J Bronchology Interv Pulmonol 2020; 26:e50-e52. [PMID: 31569102 DOI: 10.1097/lbr.0000000000000589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Leiro-Fernandez V, De Chiara L, Rodríguez-Girondo M, Botana-Rial M, Valverde D, Núñez-Delgado M, Fernández-Villar A. Methylation Assessment for the Prediction of Malignancy in Mediastinal Adenopathies Obtained by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Patients with Lung Cancer. Cancers (Basel) 2019; 11:cancers11101408. [PMID: 31547177 PMCID: PMC6826358 DOI: 10.3390/cancers11101408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/13/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
Abstract
The evaluation of mediastinal lymph nodes is critical for the correct staging of patients with lung cancer (LC). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for mediastinal staging, though unfortunately lymph node micrometastasis is often missed by cytological analysis. The aim of this study was to evaluate the predictive capacity of methylation biomarkers and provide a classification rule for predicting malignancy in false negative EBUS-TBNA samples. The study included 112 patients with a new or suspected diagnosis of LC that were referred to EBUS-TBNA. Methylation of p16/INK4a, MGMT, SHOX2, E-cadherin, DLEC1, and RASSF1A was quantified by nested methylation-specific qPCR in 218 EBUS-TBNA lymph node samples. Cross-validated linear regression models were evaluated to predict malignancy. According to EBUS-TBNA and final diagnosis, 90 samples were true positives for malignancy, 110 were true negatives, and 18 were false negatives. MGMT, SHOX2, and E-cadherin were the methylation markers that better predicted malignancy. The model including sex, age, short axis diameter and standard uptake value of adenopathy, and SHOX2 showed 82.7% cross-validated sensitivity and 82.4% specificity for the detection of malignant lymphadenopathies among negative cytology samples. Our results suggest that the predictive model approach proposed can complement EBUS-TBNA for mediastinal staging.
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Affiliation(s)
- Virginia Leiro-Fernandez
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, 36312 Vigo, Spain; (M.B.-R.); (M.N.-D.); (A.F.-V.)
- NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), 36312 Vigo, Spain
- Correspondence: (L.D.C.); (V.L.-F.)
| | - Loretta De Chiara
- Department of Biochemistry, Genetics and Immunology, Biomedical Research Center (CINBIO), University of Vigo, 36310 Vigo, Spain;
- Correspondence: (L.D.C.); (V.L.-F.)
| | - Mar Rodríguez-Girondo
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
- SiDOR Research Group, Biomedical Research Center (CINBIO), University of Vigo, 36310 Vigo, Spain
| | - Maribel Botana-Rial
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, 36312 Vigo, Spain; (M.B.-R.); (M.N.-D.); (A.F.-V.)
- NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), 36312 Vigo, Spain
| | - Diana Valverde
- Department of Biochemistry, Genetics and Immunology, Biomedical Research Center (CINBIO), University of Vigo, 36310 Vigo, Spain;
| | - Manuel Núñez-Delgado
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, 36312 Vigo, Spain; (M.B.-R.); (M.N.-D.); (A.F.-V.)
- NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), 36312 Vigo, Spain
| | - Alberto Fernández-Villar
- Pulmonary Department, Hospital Álvaro Cunqueiro, Vigo Health Area, 36312 Vigo, Spain; (M.B.-R.); (M.N.-D.); (A.F.-V.)
- NeumoVigoI+i Research Group, Vigo Biomedical Research Institute (IBIV), 36312 Vigo, Spain
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Xiang Q, Wan T, Hu Q, Chen H, Li D. [Value of C-ROSE During EBUS-TBNA to Obtain the Tissue Sample
in the Diagnosis of Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:833-840. [PMID: 30454545 PMCID: PMC6247005 DOI: 10.3779/j.issn.1009-3419.2018.11.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
背景与目的 在肺及纵隔占位性病变的患者中大部分临床考虑诊断为原发性肺癌,超声支气管镜引导下的经支气管针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA)是一种常用的获取病理组织明确诊断的手术。在EBUS-TBNA过程中,快速现场细胞学评价(cytological rapid on-site evaluation, C-ROSE)是一项有用的辅助技术。本研究探讨C-ROSE在EBUS-TBNA取样诊断肺癌中的价值。 方法 对141例经胸部计算机断层扫描(computed tomography, CT)发现存在纵隔和(或)肺门病灶(包括肿大的淋巴结/肿块)且临床高度疑诊原发性肺癌而行EBUS-TBNA患者进行回顾性分析,其中术中行C-ROSE者81例,未行C-ROSE者60例,分析两组患者的穿刺情况及并发症发生率,同时分析C-ROSE联合EBUS-TBNA取样对肺癌诊断的敏感度、特异度、阳性预测值、阴性预测值。 结果 C-ROSE组与非C-ROSE组穿刺针数及穿刺部位数无统计学差异,穿刺合格率分别为98.77%和90.00%(P < 0.05),诊断率分别为88.89%和75.00%(P < 0.05),并发症发生率分别为1.23%和11.67%(P < 0.05)。C-ROSE联合EBUS-TBNA对肺癌诊断的敏感度为92.21%,特异度为100.00%,阳性预测值为100.00%,阴性预测值为40.00%。 结论 C-ROSE在疑诊肺癌行EBUS-TBNA中应用可以提高穿刺成功率及诊断率、减少并发症,值得推广。
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Affiliation(s)
- Qing Xiang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University,
Chongqing 400016, China
| | - Tao Wan
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University,
Chongqing 400016, China
| | - Qianfang Hu
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University,
Chongqing 400016, China
| | - Hong Chen
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University,
Chongqing 400016, China
| | - Dairong Li
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University,
Chongqing 400016, China
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Seides BJ, Egan JP, French KD, Kovitz KL, Desai NR. Fiducial marker placement for stereotactic body radiation therapy via convex probe endobronchial ultrasound: a case series and review of literature. J Thorac Dis 2018; 10:1972-1983. [PMID: 29707354 DOI: 10.21037/jtd.2018.03.49] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Convex probe endobronchial ultrasound (CP-EBUS) and stereotactic body radiotherapy (SBRT) are valuable tools in the diagnosis, staging, and treatment of thoracic malignancies. With widespread clinical adoption, novel uses of CP-EBUS beyond mediastinal diagnosis and staging continue to be discovered. SBRT is an attractive treatment strategy in early-stage lung cancer and oligo-metastatic disease of the chest when a surgical approach is either not feasible or desirable. Accurate application of SBRT is aided by the placement of radio-opaque fiducial markers (FM) to compensate for respiratory cycle movements. We describe eight patients with central thoracic lesions, either known or suspected to be malignant, who underwent EBUS bronchoscopy with lesion sampling and successful intralesional placement of modified FM via our technique, review the existing literature on this topic, and discuss the nuances of coding and billing aspects of FM placement.
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Affiliation(s)
- Benjamin J Seides
- Division of Pulmonary, Critical Care, and Allergy, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John P Egan
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kim D French
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA
| | - Kevin L Kovitz
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Neeraj R Desai
- Chicago Chest Center, Chicago, IL, USA.,Suburban Lung Associates, Chicago, IL, USA.,Section of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, USA
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Pereiro T, Golpe A, Martínez de Alegría-Alonso A, Valdés L. Mediastinitis as a complication of minimally invasive diagnostic and mediastinal staging techniques. Pulmonology 2017; 24:S2173-5115(17)30160-4. [PMID: 29254905 DOI: 10.1016/j.rppnen.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- T Pereiro
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Spain.
| | - A Golpe
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Spain
| | | | - L Valdés
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Spain; Grupo Interdisciplinar de Investigación en Neumología, Instituto de Investigaciones Sanitarias de Santiago (IDIS), Spain
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Gullón Blanco JA, Villanueva Montes MÁ, Rodríguez López J, Sánchez Antuña A. Negative Endobronchial Ultrasound in Lung Cancer Staging. Arch Bronconeumol 2017; 53:646-647. [PMID: 28438344 DOI: 10.1016/j.arbres.2017.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Juan Rodríguez López
- Unidad de Gestión Clínica Neumología, Hospital Universitario San Agustín, Avilés, Asturias, España
| | - Andrés Sánchez Antuña
- Unidad de Gestión Clínica Neumología, Hospital Universitario San Agustín, Avilés, Asturias, España
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Barreiro E, Bustamante V, Curull V, Gea J, López-Campos JL, Muñoz X. Relationships between chronic obstructive pulmonary disease and lung cancer: biological insights. J Thorac Dis 2016; 8:E1122-E1135. [PMID: 27867578 DOI: 10.21037/jtd.2016.09.54] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung cancer (LC) has become one of the leading causes of preventable death in the last few decades. Cigarette smoking (CS) stays as the main etiologic factor of LC despite that many other causes such as occupational exposures, air pollution, asbestos, or radiation have also been implicated. Patients with chronic obstructive pulmonary disease (COPD), which also represents a major cause of morbidity and mortality in developed countries, exhibit a significantly greater risk of LC. The study of the underlying biological mechanisms that may predispose patients with chronic respiratory diseases to a higher incidence of LC has also gained much attention in the last few years. The present review has been divided into three major sections in which different aspects have been addressed: (I) relevant etiologic agents of LC; (II) studies confirming the hypothesis that COPD patients are exposed to a greater risk of developing LC; and (III) evidence on the most relevant underlying biological mechanisms that support the links between COPD and LC. Several carcinogenic agents have been described in the last decades but CS remains to be the leading etiologic agent in most geographical regions in which the incidence of LC is very high. Growing evidence has put the line forward the implications of COPD and especially of emphysema in LC development. Hence, COPD represents a major risk factor of LC in patients. Different avenues of research have demonstrated the presence of relevant biological mechanisms that may predispose COPD patients to develop LC. Importantly, the so far identified biological mechanisms offer targets for the design of specific therapeutic strategies that will further the current treatment options for patients with LC. Prospective screening studies, in which patients with COPD should be followed up for several years will help identify biomarkers that may predict the risk of LC among these patients.
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Affiliation(s)
- Esther Barreiro
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Víctor Bustamante
- Pneumology Department, Basurto University Hospital, Osakidetza, Department of Medicine, EHU-University of the Basque Country, Bilbao, Bizkaia, Spain
| | - Víctor Curull
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Joaquim Gea
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - José Luis López-Campos
- Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain; ; Medical-Surgery Unit of Respiratory Disease, Sevilla Biomedicine Institute (IBIS), Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Xavier Muñoz
- Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain; ; Pulmonology Service, Medicine Department, Vall d'Hebron University Hospital, Barcelona Autonomous University (UAB), Barcelona, Spain
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