From diagnosis to therapy in lung cancer: management of CT detected pulmonary nodules, a summary of the 2015 Chinese-German Lung Cancer Expert Panel

Implementation of sodium alginate-Fe3O4 to localize undiagnosed small pulmonary nodules for surgical management in a preclinical rabbit model

Many methods are used to locate preoperative small pulmonary nodules. However, deficiencies of complications and success rates exist. We introduce a novel magnetic gel for small pulmonary nodules localization in rabbit model, and furtherly evaluate its safety and feasibility. Rabbits were used as the experimental objects. A magnetic gel was used as a tracer magnet, mixed as sodium alginate-Fe₃O₄ magnetic fluid and calcium gluconate solution. In short-term localization, a coaxial double-cavity puncture needle was applied to inject the gel into the lung after thoracotomy, and a pursuit magnet made of Nd-Fe-B permanent magnetic materials was used to attract the gel representing location of the nodule. In long-term localization, the gel was injected under X-ray guidance. Imaging changes to the lung were observed under X-ray daily. Thoracotomy was performed to excise tissue containing the gel, and hematoxylin-eosin staining was used to observe the tissue on postoperative days 1, 3, 5, and 7. Observe tissues morphology of heart, liver, spleen, and kidney in the same way. The gel was formed after injection and drew lung tissue to form a protrusion from the lung surface under the applied magnetic field. No complication was observed. The shape and position of the gel had not changed when viewed under X-ray. Pathological analysis showed the gel had a clear boundary without diffusion of magnetic fluid. All tissues retained good histologic morphology and no magnetic fluid was observed. Our study preliminarily suggested that the technique using sodium alginate-Fe₃O₄ magnetic gel to locate small pulmonary nodules with guidance of X-ray, and to search for them under an applied magnetic field during the operation is safe and feasible.

Efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules

BACKGROUND

Small pulmonary nodules are tissue shadows and thoracoscopic segmentectomy in China is still at the exploratory stage with limited application.

AIM

To evaluate the efficacy of thoracoscopic anatomical segmentectomy for small pulmonary nodules.

METHODS

Medical records of 86 patients with small pulmonary nodules treated at our hospital between August 2016 and October 2019 were retrospectively analyzed; 40 cases who underwent thoracoscopic lobectomy were set as a reference group, and 46 cases who underwent thoracoscopic anatomical segmentectomy were set as an observation group. Preoperative and postoperative parameters were measured in both groups, including the percentage of forced expiratory volume in the first second (FEV₁%), the percentage of forced vital capacity (FVC%), and the FEV₁/FVC ratio (FEV₁/FVC). Patients with positive pathological diagnosis received tests for neuron-specific enolase, carbohydrate antigen 125 (CA125), CA19-9, and squamous cell carcinoma antigen. Intraoperative bleeding volume, drainage volume, the number of dissected lymph nodes, drainage time, hospital stay, treatment cost, postoperative complications, and postoperative pain condition were compared between the two groups.

RESULTS

No significant difference was observed in the results of four serum tumor marker (CA125, CA19-9, squamous cell carcinoma antigen, and neuron-specific enolase), the number of dissected lymph nodes, treatment cost, or preoperative pulmonary ventilation index between the two groups. Intraoperative bleeding volume, drainage volume, drainage time, hospital stay, and visual analogue scale score were significantly lower in the observation group (P < 0.05). The results of FEV₁%, FVC%, and FEV₁/FVC were significantly higher in the observation group (P < 0.05).

CONCLUSION

The efficacy of thoracoscopic anatomical segmentectomy and lobectomy for small pulmonary nodules shows no significant difference in terms of lesion removal, but anatomical segmentectomy is less invasive with fewer postoperative complications and less influence on lung function.

Multicenter study of diagnostic procedures, genetic aberration analysis, and first-line treatment of lung cancer in Jiangsu Province, China

BACKGROUND

Jiangsu Province, China, is highly developed economically and culturally, and has a high prevalence of lung cancer. We aimed to evaluate the diagnostic procedures, genetic aberration analysis status, and first-line treatment models of lung cancer in Jiangsu Province.

METHODS

Lung cancer patients diagnosed in 2016 at 22 tertiary care hospitals were evaluated. Demographic characteristics, tumor histology, staging, family history of lung cancer, auxiliary examinations, genetic testing, and first-line treatment were collected on discharge. Diagnostic and treatment data were analyzed by descriptive statistics.

RESULTS

A total of 928 patients were enrolled. Chest computed tomography was the most frequently used diagnostic method; pathology diagnosis was carried out by transbronchial lung biopsy and transthoracic needle aspiration. Stage T1-2N0M0 small-cell lung cancer patients experienced surgical resection, and others received cisplatin and etoposide chemotherapy. Stage I and stage II non-small cell lung cancer patients experienced surgical resection; stage III and stage IV patients received cisplatin and pemetrexed chemotherapy as first-line treatment. Detection of epidermal growth factor receptor (EGFR) mutations occurred in 29.9% of non-selective, 36.5% of locally advanced or metastatic, and 42.1% of advanced non-squamous non-small cell lung cancer. The overall EGFR-positive rates were 49.0%, 52.5%, and 53.9%. A total 72.0% of patients with EGFR mutations were treated with tyrosine kinase inhibitors.

CONCLUSION

Chest computed tomography was the most commonly performed diagnostic method for lung cancer. First-line treatment was primarily determined by disease stages and EGFR mutation status, with few expectations.