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Naves DD, Reuling EMBP, Dickhoff C, Kortman PC, Broeckaert MAM, Plaisier PW, Daniels JMA, Thunnissen E, Radonic T. In-depth analysis of immunohistochemistry concordance in biopsy-resection pairs of bronchial carcinoids. Ann Diagn Pathol 2023; 67:152181. [PMID: 37598464 DOI: 10.1016/j.anndiagpath.2023.152181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Abstract
Primary diagnosis of bronchial carcinoids (BC) is always made on biopsies and additional immunohistochemistry (IHC) is often necessary. In the present study we investigated the concordance of common diagnostic (synaptophysin, chromogranin, CD56 and INSM-1) and potential prognostic (OTP, CD44, Rb and p16) IHC markers between the preoperative biopsies and resections of in total 64 BCs, 26 typical (41 %) and 38 atypical (59 %) carcinoid tumors. Synaptophysin and chromogranin had 100 % concordance in all resected carcinoids and paired diagnostic biopsies. Synaptophysin was not affected by variable expression in biopsies compared to chromogranin, CD56 and INSM-1. Notably, INSM-1 IHC was false negative in 8 % of biopsies. Of the novel and potential prognostic markers, only CD44 showed 100 % concordance between biopsies and resections, while OTP showed two (4 %) false negative results in paired biopsies. While Rb IHC was false negative in 8 % of biopsies, no strong and diffuse pattern of p16 expression was observed. In this study, most false negative IHC results (85 %, 22/26) were observed in small flexible biopsies. Taken together, our data suggest excellent concordance of synaptophysin and CD44 on the preoperative biopsy samples, while other neuroendocrine markers, Rb and OTP should be interpreted with caution, especially in small biopsies.
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Affiliation(s)
- Dwayne D Naves
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ellen M B P Reuling
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Pim C Kortman
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mark A M Broeckaert
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
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Dreyer HHM, van Tuyll van Serooskerken ES, Rodenburg LW, Bittermann AJN, Arets HGM, Reuling EMBP, Verweij JW, Haarman EG, van der Zee DC, Tytgat SHAJ, van der Ent CK, Beekman JM, Amatngalim GD, Lindeboom MYA. Airway Epithelial Cultures of Children with Esophageal Atresia as a Model to Study Respiratory Tract Disorders. Children (Basel) 2023; 10:1020. [PMID: 37371252 DOI: 10.3390/children10061020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Esophageal atresia (EA) is a rare birth defect in which respiratory tract disorders are a major cause of morbidity. It remains unclear whether respiratory tract disorders are in part caused by alterations in airway epithelial cell functions such as the activity of motile cilia. This can be studied using airway epithelial cell culture models of patients with EA. Therefore, the aim of this study was to evaluate the feasibility to culture and functionally characterize motile cilia function in the differentiated air-liquid interface cultured airway epithelial cells and 3D organoids derived from nasal brushings and bronchoalveolar lavage (BAL) fluid from children with EA. We demonstrate the feasibility of culturing differentiated airway epithelia and organoids of nasal brushings and BAL fluid of children with EA, which display normal motile cilia function. EA patient-derived airway epithelial cultures can be further used to examine whether alterations in epithelial functions contribute to respiratory disorders in EA.
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Affiliation(s)
- Henriette H M Dreyer
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, 3508 AB Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, University Medical Center, Utrecht University, 3584 CX Utrecht, The Netherlands
| | | | - Lisa W Rodenburg
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, 3508 AB Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, University Medical Center, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Arnold J N Bittermann
- Pediatric Upper Gastrointestinal and Airway Treatment Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
- Department of Pediatric Otorhinolaryngology, Pediatric Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
| | - Hubertus G M Arets
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, 3508 AB Utrecht, The Netherlands
- Pediatric Upper Gastrointestinal and Airway Treatment Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
| | - Ellen M B P Reuling
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
- Pediatric Upper Gastrointestinal and Airway Treatment Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
| | - Johannes W Verweij
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
- Pediatric Upper Gastrointestinal and Airway Treatment Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
| | - Eric G Haarman
- Department of Paediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
- Pediatric Upper Gastrointestinal and Airway Treatment Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
| | - Stefaan H A J Tytgat
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
- Pediatric Upper Gastrointestinal and Airway Treatment Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, 3508 AB Utrecht, The Netherlands
| | - Jeffrey M Beekman
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, 3508 AB Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, University Medical Center, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Gimano D Amatngalim
- Department of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center, 3508 AB Utrecht, The Netherlands
- Regenerative Medicine Center Utrecht, University Medical Center, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Maud Y A Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
- Pediatric Upper Gastrointestinal and Airway Treatment Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
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Reuling EMBP, Naves DD, Kortman PC, Broeckaert MAM, Plaisier PW, Dickhoff C, Daniels JMA, Radonic T. A Multimodal Biomarker Predicts Dissemination of Bronchial Carcinoid. Cancers (Basel) 2022; 14:cancers14133234. [PMID: 35805004 PMCID: PMC9265109 DOI: 10.3390/cancers14133234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Curatively treated bronchial carcinoid tumors have a relatively low metastatic potential. Gradation into typical (TC) and atypical carcinoid (AC) is limited in terms of prognostic value, resulting in yearly follow-up of all patients. We examined the additional prognostic value of novel immunohistochemical (IHC) markers to current gradation of carcinoids. Methods: A retrospective single-institution cohort study was performed on 171 patients with pathologically diagnosed bronchial carcinoid (median follow-up: 66 months). The risk of developing distant metastases based on histopathological characteristics (Ki-67, p16, Rb, OTP, CD44, and tumor diameter) was evaluated using multivariate regression analysis and the Kaplan−Meier method. Results: Of 171 patients, seven (4%) had disseminated disease at presentation, and 164 (96%) received curative-intent treatment with either endobronchial treatment (EBT) (n = 61, 36%) or surgery (n = 103, 60%). Among the 164 patients, 13 developed metastases at follow-up of 81 months (IQR 45−162). Univariate analysis showed that Ki-67, mitotic index, OTP, CD44, and tumor diameter were associated with development of distant metastases. Multivariate analysis showed that mitotic count, Ki-67, and OTP were independent risk factors for development of distant metastases. Using a 5% cutoff for Ki-67, Kaplan−Meier analysis showed that the risk of distant metastasis development was significantly associated with the number of risk predictors (AC, Ki-67 ≥ 5%, and loss of OTP or CD44) (p < 0.0001). Six out of seven patients (86%) with all three positive risk factors developed distant metastasis. Conclusions: Mitotic count, proliferation index, and OTP IHC were independent predictors of dissemination at follow-up. In addition to the widely used carcinoid classification, a comprehensive analysis of histopathological variables including Ki-67, OTP, and CD44 could assist in the determination of distant metastasis risks of bronchial carcinoids.
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Affiliation(s)
- Ellen M. B. P. Reuling
- Department of Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.M.B.P.R.); (C.D.)
- Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands;
| | - Dwayne D. Naves
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Pim C. Kortman
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Mark A. M. Broeckaert
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
| | - Peter W. Plaisier
- Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands;
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (E.M.B.P.R.); (C.D.)
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Johannes M. A. Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands; (D.D.N.); (P.C.K.); (M.A.M.B.)
- Cancer Center Amsterdam, Amsterdam University Medical Center, VUMC, University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Correspondence:
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Reuling EMBP, Naves DD, Daniels JMA, Dickhoff C, Kortman PC, Broeckaert MAMB, Plaisier PW, Thunnissen E, Radonic T. Correction to: Diagnosis of atypical carcinoid can be made on biopsies > 4 mm2 and is accurate. Virchows Arch 2022; 480:595. [PMID: 35129676 PMCID: PMC8989927 DOI: 10.1007/s00428-022-03294-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Dwayne D Naves
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Pim C Kortman
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Mark A M B Broeckaert
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, the Netherlands
| | - Erik Thunnissen
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Teodora Radonic
- Department of Pathology, Amsterdam University Medical Center, VU University Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
- Cancer Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
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van Tuyll van Serooskerken ES, Tytgat SHAJ, Verweij JW, Reuling EMBP, Ruiterkamp J, Witvliet MJ, Bittermann AJN, van der Zee DC, Lindeboom MYA. Thoracoscopic Repair of Esophageal Atresia. J Laparoendosc Adv Surg Tech A 2021; 31:1162-1167. [PMID: 34403593 DOI: 10.1089/lap.2021.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Esophageal atresia (EA) is a rare congenital malformation of the esophagus. Surgical treatment is required to restore the continuity of the esophagus. This can be performed through thoracotomy. However, an increasing number of hospitals is performing minimal invasive surgery (MIS). In this article, we describe the technique of thoracoscopic repair of EA in neonates in more detail and show the outcome of a patient cohort operated by young pediatric surgeons in training. Methods: Between 2014 and 2019 correction was performed in 64 EA type C patients at the UMC Utrecht, Wilhelmina Children's Hospital, mainly by young pediatric surgeons in training. Results: All patients were corrected through MIS, 3 days after birth. The median operation duration was 181 (127-334) minutes. Nasogastric tube feeding was started on the first postoperative day, and oral feeding 6 days postop. Postoperative complications included leakage (14.1%), stenosis (51.1%), and recurrent tracheoesophageal fistula (7.8%). Conclusion: Thoracoscopic repair of EA can be performed safely, with good outcome and all the benefits of MIS. However, it remains a challenging procedure and should be performed only in pediatric centers with a vast experience in MIS, especially when training young pediatric surgeons. These centers must have access to a multidisciplinary team of neonatologists, pediatric anesthesiologists, surgeons, and ENT specialists to ensure the best possible care in hemodynamic, respiratory, and cerebral monitoring and gastrointestinal and developmental outcome.
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Affiliation(s)
- Eleonora Sofie van Tuyll van Serooskerken
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefaan H A J Tytgat
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes W Verweij
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ellen M B P Reuling
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetske Ruiterkamp
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Witvliet
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arnold J N Bittermann
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David C van der Zee
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maud Y A Lindeboom
- Congenital Esophageal and Airway Team Utrecht, Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Daniels JMA, Reuling EMBP, Dickhoff C. Endobronchial Treatment of Bronchial Carcinoid in the Elderly. Curr Geri Rep 2020. [DOI: 10.1007/s13670-020-00322-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of the Review
Although surgical resection is considered the gold standard of curative treatment for bronchial carcinoid, endobronchial treatment (EBT) can serve as a less invasive curative or palliative treatment in a selection of patients. It is unclear whether elderly patients with bronchial carcinoid should be treated in the same way as younger patients. In order to study the characteristics and treatment of elderly patients with bronchial carcinoid, we analyzed data from a cohort of patients that have been treated for bronchial carcinoid with EBT, surgical resection, or a combination of both. We used our existing database of patients referred for EBT and defined two groups of patients: ≥ 65 and < 65 years. We compared the characteristics, treatment, and causes of death between these groups. Successful EBT was defined as definitive treatment without signs of recurrence during follow-up with CT and bronchoscopy.
Recent Findings
Thirty-five patients (19%) were ≥ 65 years. The incidence of atypical carcinoid was the same in both age groups (31%). Thirty-six of 184 patients (20%) were directly referred for surgical resection and 148 (80%) underwent EBT. There was no significant difference in success of EBT between patients <65 years (58/122, 48%) and patients ≥ 65 years (15/26, 58%) (p = 0.347). Complication rates were similar in both groups. After unsuccessful EBT, only 70% (14/20) of the elderly patients was operated, whereas 93% (85/91) of the patients < 65 years was operated (p = 0.001). Disease specific mortality was 6% (2/35) in the group ≥ 65 years and 2% (3/149) in the group < 65 years.
Summary
The incidence of atypical carcinoid is similar between the elderly and younger patients. Success rate and complication rate of EBT do not differ significantly between the age groups. After unsuccessful EBT, elderly patients were less likely to undergo surgical resection, which does not seem associated with excess disease specific mortality, although the number of events in this study is low.
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Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Departments of Surgery and Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Reuling EMBP, Dickhoff C, Plaisier PW, Bonjer HJ, Daniels JMA. Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review. Lung Cancer 2019; 134:85-95. [PMID: 31320001 DOI: 10.1016/j.lungcan.2019.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/31/2019] [Accepted: 04/08/2019] [Indexed: 12/26/2022]
Abstract
The treatment of pulmonary carcinoid has changed over the last decades. Although surgical resection is still the gold standard, minimally invasive endobronchial procedures have emerged as a parenchyma sparing alternative for tumors located in the central airways. This review was performed to identify the optimal treatment strategy for pulmonary carcinoid, with a particular focus on the feasibility and outcome of parenchyma sparing techniques versus surgical resection. A systematic review of the literature was carried out using MEDLINE, Embase and the Cochrane databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Two separate searches of publications in endobronchial and surgical treatment in patients with pulmonary carcinoid, were performed. Outcomes were overall survival, disease free survival, recurrence rate, complications, quality of life, and healthcare costs. Combining the two main searches for endobronchial therapy and surgical therapy yielded 3111 records. Finally, 43 studies concerning surgical treatment and 9 studies related to endobronchial treatment for pulmonary carcinoid were included. Assessment of included studies showed that lymph node involvement, histological grade, tumor location and tumor diameter were identified as poor prognostic factors and seem to be important for patients with pulmonary carcinoid. For patients with a more favorable prognosis, tumor location and tumor diameter are important factors that can help decide on the optimal treatment strategy. Centrally located small intraluminal pulmonary carcinoids, without signs of metastasis can be treated with minimally invasive alternatives such as endobronchial treatment or parenchyma sparing surgical resection. Patients with parenchyma sparing resections should be followed with long term follow up to exclude recurrence of disease. In a multidisciplinary setting, it should be determined whether individual patients are eligible for parenchyma sparing procedures or anatomical resection. Overall evidence is of low quality and future studies should focus on prospective trials in the treatment of pulmonary carcinoid.
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Affiliation(s)
- E M B P Reuling
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands; Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands.
| | - C Dickhoff
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands; Department of Cardiothoracic Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
| | - P W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, the Netherlands
| | - H J Bonjer
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
| | - J M A Daniels
- Department of Pulmonary Diseases, Cancer Center Amsterdam, Amsterdam University Medical Center, De Boelelaan, 1117, 1081 HV, Amsterdam, the Netherlands
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Reuling EMBP, Dickhoff C, Plaisier PW, Coupé VMH, Mazairac AHA, Lely RJ, Bonjer HJ, Daniels JMA. Author's Reply. Respiration 2018; 96:205. [PMID: 29953996 DOI: 10.1159/000489985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Statistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert H A Mazairac
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Rutger J Lely
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - H Jaap Bonjer
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
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Reuling EMBP, Dickhoff C, Plaisier PW, Coupé VMH, Mazairac AHA, Lely RJ, Bonjer HJ, Daniels JMA. Endobronchial Treatment for Bronchial Carcinoid: Patient Selection and Predictors of Outcome. Respiration 2018; 95:220-227. [PMID: 29433123 DOI: 10.1159/000484984] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditionally, surgical resection is the preferred treatment for typical carcinoids and atypical carcinoids located in the lungs. Recently however, several studies have shown excellent long-term outcome after endobronchial treatment of carcinoid tumors located in the central airways. This study investigates clinical and radiological features as predictors of successful endobronchial treatment in patients with a bronchial carcinoid tumor. OBJECTIVES To identify clinical and radiological features predictive of successful endobronchial treatment in patients with bronchial carcinoid. METHODS This analysis was performed in a cohort of patients with typical and atypical bronchial carcinoid referred for endobronchial treatment. Several patient characteristics, radiological features, and histological grade (typical or atypical carcinoid) were tested as predictors of successful endobronchial treatment. RESULTS One hundred and twenty-five patients with a diagnosis of bronchial carcinoid underwent endobronchial treatment. On multivariate analysis, a tumor diameter <15 mm (odds ratio 0.09; 95% confidence interval 0.02-0.5; p = <0.01) and purely intraluminal growth on computer tomography (CT scan) (odds ratio, 9.1; 95% confidence interval 1.8-45.8; p = <0.01) were predictive of radical endobronchial treatment. The success rate for intraluminal tumors with a diameter <20 mm was 72%. CONCLUSIONS Purely intraluminal disease and tumor diameter on CT scan seem to be independent predictors for successful endobronchial treatment in patients with bronchial carcinoid. Based on these data, patients with purely intraluminal carcinoid tumors with a diameter <20 mm on CT scan are good candidates for endobronchial treatment, regardless of histological grade. In contrast, all patients with a tumor diameter ≥20 mm should be directly referred for surgery.
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Affiliation(s)
- Ellen M B P Reuling
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.,Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Chris Dickhoff
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands.,Department of Cardiothoracic Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Peter W Plaisier
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Statistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Albert H A Mazairac
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Rutger J Lely
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - H Jaap Bonjer
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes M A Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
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van de Wall BJM, Reuling EMBP, Consten ECJ, van Grinsven JHJ, Schwartz MP, Broeders IAMJ, Draaisma WA. Endoscopic evaluation of the colon after an episode of diverticulitis: a call for a more selective approach. Int J Colorectal Dis 2012; 27:1145-50. [PMID: 22407442 DOI: 10.1007/s00384-012-1448-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE Routine colonic evaluation is advised after an episode of diverticulitis to exclude colorectal cancer. In the recent years, the possible relation between diverticulitis and colorectal cancer has been subject of debate. The aim of this study is to evaluate the benefit of routine colonic endoscopy after an episode of diverticulitis. METHODS Records of all consecutive patients presenting with a radiologically confirmed episode of diverticulitis between 2007 and 2010 were retrieved from an in-hospital database. Patients who subsequently underwent colonic evaluation were included. The endoscopic detection rate of hyperplastic polyps, adenomas and advanced colonic neoplasia was assessed. Findings were categorized on the basis of the most advanced lesion identified. RESULTS Three hundred and seven patients presented with a radiologically confirmed primary episode of diverticulitis. Two hundred and five patients underwent colonic evaluation. Hyperplastic polyps were found in15 (6.8 %), adenomas in 18 (8.8 %) and advanced neoplastic lesions in 7 (3.4 %) patients. Only two patients had a colorectal malignancy. CONCLUSION There appears to be no benefit in performing routine colonic evaluation after an episode of diverticulitis as the incidence of colorectal cancer is almost equal to that of the general population. A more selective approach might therefore be justified. Potentially, only patients with persisting abdominal complaints after an episode of diverticulitis should be offered colonic evaluation to definitively exclude causal pathology.
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Reuling EMBP, Sierevelt IN, van den Bekerom MPJ, Hilverdink EF, Schnater JM, van Dijk CN, Goslings JC, Raaymakers ELFB. Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score. Arch Orthop Trauma Surg 2012; 132:249-56. [PMID: 22113433 PMCID: PMC3261383 DOI: 10.1007/s00402-011-1424-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Indexed: 12/26/2022]
Abstract
INTRODUCTION To study the association between potential prognostic factors and functional outcome at 1 and 5 year follow-up in patients with femoral neck fractures treated with an arthroplasty. To analyze the reliability of the Harris hip score (HHS). MATERIALS AND METHODS A multicenter analysis which included 252 patients who sustained a femoral neck fracture treated with an arthroplasty. Functional outcome after surgery was assessed using a modified HHS and was evaluated after 1 (HHS1) and 5 (HHS5) years. Several prognostic factors were analyzed and reliability of the HHS was assessed. RESULTS After 1 year the presence of co-morbidities was a significant (p = 0.002) predictor for a poor functional outcome (mean HHS1 71.8 with co-morbidities, and 80.6 without co-morbidities). After 5 years none of the potential prognostic factors had significant influence on functional outcome. Internal consistency testing of the HHS showed that when pain and function of the HHS were analyzed together, the internal consistency was poor (HHS1 0.38 and HHS5 0.20). The internal consistency of the HHS solely in function (without pain) improved to 0.68 (HHS1) and 0.46 (HHS5). Analyzing the functional aspect exclusively, age and the existence of co-morbidities could be defined as predictors for functional outcome of femoral neck fractures after 1 and 5 years. CONCLUSION After using the HHS in a modification, age and the existence of pre-operative co-morbidities appeared to be predictors of the functional outcome after 1 and 5 years. The HHS, omitting pain, is a more reliable score to estimate the functional outcome, than HHS analyzing pain and function in one scoring system.
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Affiliation(s)
| | - Inger N. Sierevelt
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ Amsterdam, The Netherlands
| | | | - Elsa F. Hilverdink
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ Amsterdam, The Netherlands
| | - J. Marco Schnater
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - C. Niek van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ Amsterdam, The Netherlands
| | - J. Carel Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Ernst L. F. B. Raaymakers
- Department of Orthopaedic Surgery, Academic Medical Center, P.O. Box 22660, 1105 AZ Amsterdam, The Netherlands
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van den Bekerom MPJ, Hilverdink EF, Sierevelt IN, Reuling EMBP, Schnater JM, Bonke H, Goslings JC, van Dijk CN, Raaymakers ELFB. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. ACTA ACUST UNITED AC 2010; 92:1422-8. [PMID: 20884982 DOI: 10.1302/0301-620x.92b10.24899] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to analyse the functional outcome after a displaced intracapsular fracture of the femoral neck in active patients aged over 70 years without osteoarthritis or rheumatoid arthritis of the hip, randomised to receive either a hemiarthroplasty or a total hip replacement (THR). We studied 252 patients of whom 47 (19%) were men, with a mean age of 81.1 years (70.2 to 95.6). They were randomly allocated to be treated with either a cemented hemiarthroplasty (137 patients) or cemented THR (115 patients). At one- and five-year follow-up no differences were observed in the modified Harris hip score, revision rate of the prosthesis, local and general complications, or mortality. The intra-operative blood loss was lower in the hemiarthroplasty group (7% > 500 ml), THR group (26% > 500 ml) and the duration of surgery was longer in the THR group (28% > 1.5 hours versus 12% > 1.5 hours). There were no dislocations of any bipolar hemiarthroplasty than in the eight dislocations of a THR during follow-up. Because of a higher intra-operative blood loss (p < 0.001), an increased duration of the operation (p < 0.001) and a higher number of early and late dislocations (p = 0.002), we do not recommend THR as the treatment of choice in patients aged ≥ 70 years with a fracture of the femoral neck in the absence of advanced radiological osteoarthritis or rheumatoid arthritis of the hip.
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Affiliation(s)
- M P J van den Bekerom
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
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