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PubMed1982

[Radiologic projection on the sagittal plane as a diagnostic parameter in primary lung neoplasms].

A study was carried out to evaluate the importance of location of radiological densities on lateral protection of X-ray films of the chest, as a valuable sign for the clinical diagnosis of primary neoplasms of the lung. Clinical case records of 100 patients with pneumonitis, 61 patients with active pulmonary tuberculosis and 58 cases with primary pulmonary neoplasms -- in which diagnosis was verified by hystological examination of biopsies performed during bronchoscopy or by autoptic control -- were reviewed. Radiological location in anterior or central-anterior planes was observed in only 14 per cent of patients with pneumonitis while in 86 per cent the location was in posterior or central-posterior planes. Only 10 per cent of patients with active pulmonary tuberculosis had their densities situated on anterior or central-anterior planes of the chest X-ray while in the remaining 90 per cent of cases the location was in central-posterior or posterior planes of the radiogram. In 74 per cent of patients with primary lung neoplasms we observed that radiological densities were located in the anterior or central-anterior planes; only in 26 per cent of patients the radiological location was in the posterior or central-posterior planes. Since in most instances of primary lung neoplasms the initial diagnostic approach is roentgenographic, it seems of particular importance in differential diagnosis to consider as neoplastic those lesions located in the anterior planes of an X-ray film taken in lateral projection until proven otherwise. This radiological aspect implies the opportunity to perform a bronchoscopic and hystological evaluation even in those patients in which clinical aspects should seem less suggestive of primary lung neoplasm. A posterior location does not exclude -- according to our data -- the neoplastic origin of a density but this radiological criterion does seem to justify a less aggressive diagnostic approach in all those patients which present contraindications or refuse invasive procedures.

Aged↗
PubMed2004

Radiofrequency ablation of 40 lung neoplasms: preliminary results.

OBJECTIVE: Radiofrequency thermal ablation is a minimally invasive treatment widely used for treatment of liver neoplasms and has also been tested on other types of tumor. Few studies have been published regarding the use of radiofrequency thermal ablation in the treatment of lung neoplasms. This study was performed to evaluate the technical feasibility, the safety, and the efficacy of lung radiofrequency thermal ablation. SUBJECTS AND METHODS: Between February 2002 and March 2003, 18 subjects with unresectable lung neoplasms, four of whom had primary neoplasms and 14 of whom had metastatic neoplasms, underwent lung radiofrequency ablation. The technique was performed percutaneously using a monopolar cooled-tip electrode needle under CT guidance with the patient under general anesthesia. Patients had no more than three nodules with a total diameter of 10 cm and no evidence of extrathoracic disease. A total of 40 nodules were treated in 24 therapeutic sessions. After treatment, patients underwent follow-up every 3 months by CT and nuclear MRI with gadolinium for a median time of 8 months (range, 2-14 months). RESULTS: No evidence of local relapse was discovered in 94.4% of subjects. The treatment was safe and well tolerated. Complications encountered included massive pneumothorax, which occurred in one subject, requiring pleural drainage. Other complications were moderate pneumothorax (also requiring pleural drainage), cough, fever, slight dyspnea, and pain, but these complications were short in duration and successfully treated. CONCLUSION: Radiofrequency thermal ablation is a promising technique in the treatment of patients with lung neoplasms and has been found to be both safe and technically feasible.

Adult↗
PubMed2003

[Clinical practice of 99mTc-peplimycin imaging and radio guided surgery for lung neoplasms].

BACKGROUND & OBJECTIVE: Intraoperatively,the routine method to differentiate malignant lung neoplasms from benign lesions is by the judgment of naked eye or frozen section. It is not accurate to judge by naked eye and will take long time by frozen section. Using a gamma-detecting probe (GDP) to accurately detect the tumors and the metastases, the operators could decide the resection range and the treatment plan. This study was preliminary clinical practice of tumor imaging and radioimmunoguided surgery (RGS) using (99m)Tc-PPM (peplomycin) as a tumor tracer. METHODS: Thirty-seven patients were administered with injection of (99m)Tc-PPM. The images were taken preoperatively. Region of interest (ROI) method was performed and tumor-to- normal-tissue (T/NT) ratio was calculated on the image. The radioactivity of the specimens resected from the patients was detected using GDP at the time of surgery. T/NT ratio was obtained by comparing the radioactivity of the tumor tissue with the normal lung tissue. RESULTS: The uptake ratios (T/NT) of (99m)Tc-PPM were different between malignant and benign lesion (P< 0.01). The ratio (T/NT, x+/-2s) was regarded as the threshold for differentiation of malignant and benign lesions. The sensitivity, specificity, and accuracy of identifying malignant lesion were 90%, 87.5%, and 89.3%, respectively; GDP could be used to accurately detect the invasive range of the tumors, with the sensitivity, specificity, and accuracy of identifying lymph node metastases of 91%, 88%, and 90%, respectively. CONCLUSION: (99m)Tc-PPM is a useful agent in differentiating malignant lung neoplasm from benign lesions, and as a tumor tracer can be used in detecting tumor by GDP intraoperatively. The RGS is a simple method that can help the surgeon in the intraoperative assessment of the tumor and the lymph node metastases.

Adult↗
PubMed2004

Percutaneous radiofrequency ablation of lung neoplasms: initial therapeutic response.

PURPOSE: To evaluate the feasibility, safety, and initial therapeutic effect of radiofrequency (RF) ablation in the treatment of unresectable malignant lung tumors. MATERIALS AND METHODS: Fifty-four lung neoplasms in 31 patients were treated with RF ablation. Thirteen tumors were primary lung cancers and 41 were pulmonary metastases. Tumor sizes ranged from 0.7 to 6.0 cm, with a mean size of 2.7 +/- 1.3 cm. After the RF electrode was placed in the tumor with computed tomographic (CT) fluoroscopic guidance, RF energy was applied. Initial therapeutic response was evaluated by (18) F fluorodeoxyglucose positron emission tomography (FDG-PET) and contrast-enhanced CT. The disappearance of FDG uptake on PET images and tumor enhancement on CT images were considered to indicate complete tumor necrosis. Complete necrosis rates were evaluated according to tumor size and type (primary or secondary lung neoplasm). RESULTS: RF ablation was technically successful in all lesions. Complete necrosis was achieved in 32 of the 54 tumors (59%) after initial RF session. There was a significant difference in the rate of complete tumor necrosis between tumors 3 cm or less and tumors larger than 3 cm (69% vs. 39%; P <.05). Tumor type did not influence complete necrosis rates. Lung abscesses developed in two patients with large tumors. CONCLUSION: Lung RF ablation is a feasible, relatively safe, and promising treatment for unresectable lung neoplasms. Tumor size is an important factor in achieving complete tumor necrosis.

Aged↗
PubMed2006

Approach to the diagnosis of neuroendocrine lung neoplasms: variabilities and pitfalls.

With the publication of the spectrum of neuroendocrine proliferations and neoplasms and the features and criteria for diagnosing neuroendocrine lung neoplasms, there is more agreement in making a specific pathologic diagnosis of a neuroendocrine lung neoplasm. However, problems exist, especially in diagnosing well-differentiated neuroendocrine carcinomas (atypical carcinoids), large-cell neuroendocrine carcinomas, and even some small-cell lung cancers. Some of this disagreement has to do with a pathologist's perception of sizes and shapes of cells. Nonneuroendocrine small-cell carcinomas exist and include small-cell squamous cell carcinoma, small cell adenocarcinoma, and basaloid carcinoma. Nonneuroendocrine lung cancers, especially large-cell undifferentiated carcinoma and poorly differentiated adenocarcinoma, not infrequently express neuroendocrine markers immunohistochemically.

Adenocarcinoma↗
PubMed2002

[Positron emission-computed tomography in diagnosis and staging of lung neoplasms. Personal experience].

BACKGROUND: Positron emission-computed tomography (PET) scans are obtained from the accumulation of a radiotracer in tissues with altered metabolism, such as malignant neoplasms. The authors present their experience with PET, performed in 50 selected patients with lung neoplasms in the 1998-2000 period. METHODS: The indications to PET corresponded to those most frequently reported in the literature, that is: diagnosis in solitary pulmonary nodule 8 patients; mediastinal lymph node staging, 16 patients; re-evaluation after neo-adjuvant therapy, 21 patients; increased markers blood levels in the follow-up of resected patients, 5 cases. Each indication is individually discussed and compared with the data of the literature, especially regarding the role of PET and its relationship with other noninvasive and invasive diagnostic tools. RESULTS: In 47 patients (94%) diagnostic yield was reached. A false positive (acute inflammatory lesion in solitary pulmonary nodule), a false negative (no demonstration of lymphangitic intrathoracic recurrence) and a non-diagnostic result (then pathologically proved non-neoplastic) were recorded. CONCLUSIONS: Thus the authors consider PET extremely useful in the diagnosis and staging of lung neoplasms; the high cost of PET may be compensated for the reduced need for invasive diagnostic tools and, avoiding inappropriate surgical options, with favourable cost-effectiveness.Thus, PET may be indicated in most, if not in all, patients with lung neoplasms.

Adult↗
PubMed1987

The use of electron microscopy and immunohistochemistry in the diagnosis and understanding of lung neoplasms.

This article has presented information concerning the ultrastructural features and, to a lesser degree, the immunohistochemical characteristics of lung neoplasms. Electron microscopy and immunohistochemistry are useful techniques for diagnosing and understanding common and rare lung tumors. Electron microscopy is particularly helpful in accurately diagnosing undifferentiated lung tumors such as large-cell undifferentiated and small-cell undifferentiated carcinomas. Ultrastructural studies of lung tumors have also aided in overall understanding of the histogenesis of these tumors. Electron microscopy and immunohistochemistry are techniques that can be applied to tiny specimens, including those obtained via fine-needle aspiration biopsy, and to cells obtained from pleural fluid. An intelligent use of electron microscopy and immunohistochemistry aids in the diagnosis and understanding of lung neoplasms.

Adenocarcinoma↗
PubMed2003

CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern.

OBJECTIVE: We investigated the imaging findings and progression of replacement lung neoplasms that were revealed on thin-section CT and serial CT. MATERIALS AND METHODS: We evaluated the age of patients and thin-section CT findings (lesion size; percentage of ground-glass opacity areas; and presence or absence of solid portions, lobulation, coarse spiculation, air bronchogram, cavity, multiplicity, and pleural tags) in 73 lesions (11 atypical adenomatous hyperplasias, 17 type A [Noguchi's classification], 18 type B, and 27 type C small peripheral adenocarcinomas). We compared the serial findings of 48 of 73 lesions on low-dose screening CT (n = 21) or thin-section CT (n = 27) obtained at a mean interval of 450 days (range, 85-951 days). Progression from atypical adenomatous hyperplasia through type A to type B and then to type C tumor was studied using trend tests. RESULTS: A significant linear trend was seen for lesion size (r = 0.55; p < 0.001), percentages of ground-glass opacity areas (r = 0.75; p < 0.001), and the prevalence of lobulation (p < 0.001), spiculation (p = 0.001), air bronchogram (p = 0.023), cavity (p = 0.046), pleural tag (p < 0.001), and solid portions (p < 0.001). In general from serial CT assessment, lesions were recognized first as a ground-glass opacity nodule (56% of 48 lesions) with subsequent increase in size (75%), then solid portions appeared in the nodule (17%), and finally solid portions increased (23%) with occasional augmentation of tissue contraction (6%). CONCLUSIONS: CT analysis revealed stepwise progression of replacement-type lung neoplasms.

Adenocarcinoma↗
PubMed1997

Expression of gelatinase A, tissue inhibitor of metalloproteinases-2, matrilysin, and trypsin(ogen) in lung neoplasms: an immunohistochemical study.

Lung cancer is a heterogeneous tumor in terms of clinical and biological behavior, and its aggressiveness depends on its invasive and metastatic properties. Matrix metalloproteinases and serine proteinases are believed to play a crucial role in invasion and metastasis of malignant tumor cells. In the present study, the authors evaluated immunohistochemically the expression of gelatinase A; tissue inhibitor of metalloproteinases-2 (TIMP-2), an inhibitor of gelatinase A; matrilysin; and trypsin(ogen) in 67 lung tumors from a variety of histological types including 17 squamous cell carcinomas, 16 adenocarcinomas, 15 small cell carcinomas, and 12 carcinoids. Interestingly, normal bronchial, bronchiolar, and alveolar epithelial cells expressed gelatinase A, TIMP-2, matrilysin, and trypsin(ogen) at varying frequencies and intensities. Bronchial smooth muscle cells and cartilage cells expressed gelatinase A alone, whereas endothelial cells, fibroblasts, and macrophages expressed gelatinase A and TIMP-2. Gelatinase A was expressed at high levels in most lung tumors examined (47% to 80%). TIMP-2 was also expressed at high levels except in the small cell carcinomas, which showed TIMP-2 expression at a lower frequency (60%) compared with other types of lung tumors (80% to 100%). Although matrilysin was expressed by tumor cells of all the histological types at various frequencies (13% to 63%), its expression was most common in adenocarcinomas. Expression of trypsin(ogen) was observed almost exclusively in adenocarcinomas (56%); other types of lung tumors expressed trypsin(ogen) far less frequently (0% to 12%). The present results, taken together with those of previous studies, suggest that gelatinase A is associated with malignant behavior of all the types of lung tumors, whereas its activity may be controlled by the endogenous inhibitor TIMP-2. The aggressive clinical behavior of small cell carcinoma may be attributable, at least in part, to a loss of the inhibitory effect of TIMP-2, as a significant proportion of these tumors showed negative or low levels of TIMP-2 expression. Matrilysin and trypsin(ogen) expressions are unlikely to be correlated with the aggressiveness of lung tumors. The expression of trypsin (ogen) may rather reflect the differentiation of adenocarcinoma cells toward normal airway epithelial cells.

Adult↗
PubMed2004

The significance of associated pre-invasive lesions in patients resected for primary lung neoplasms.

OBJECTIVE: To evaluate the prevalence and clinico/prognostic significance of the presence of pre-invasive lesions in patients resected for primary lung neoplasm. METHODS: From 1993 to 2002, 1090 patients received resection for primary lung carcinomas. Of these, 73 presented an associated pre-invasive lesion in the surgical specimen distant from the primary tumour. Classification of pre-invasive lesions included Atypical Adenomatous Hyperplasia (AAH); Carcinoma In Situ (CIS) either diffuse or at the bronchial resection margin; Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH). Correlation between the presence of pre-invasive lesion and the following variables were calculated by logistic regression analysis: sex, age, median tumour size, histology, histologic differentiation, histologic evidence of invasiveness (vascular and perineural invasion), peritumoural lymphocytic infiltrate, pTNM, lobe location, history of previous malignancy. Survival rates were computed using Kaplan-Meier method and survival differences with the total patient population of resected lung carcinomas were tested using the log-rank method. RESULTS: There were 28 AAH, 42 CIS (5 at the bronchial resection margin) and 3 DIPNECH. Histology of the primary tumor included bronchioloalveolar carcinoma (9 patients), adenocarcinoma (19), squamous cell carcinoma (39), typical carcinoid tumour (3) and adenosquamous carcinoma (3). Overall prevalence of pre-invasive lesion was 6.7%. A strong correlation was found between the presence of AAH and the co-existence of either adenocarcinoma, bronchioloalveolar carcinoma or mixed adenocarcinoma-containing tumours (P = 0.00002) between CIS and squamous cell carcinoma (P = 0.009) and between DIPNECH and carcinoid tumours (P = 0.001). No significant correlation was found between the presence of any type of pre-invasive lesion and sex, age, median tumour size, histologic differentiation, histologic evidence of invasiveness, pTNM, lobe location and history of previous malignancy or the probability to develop a second primary lung carcinoma in the remaining lobe(s) after resection. Survival rates in the patients with AAH and CIS were not significantly different from those of patients without pre-invasive lesion (P = 0.3 and P = 0.1). CONCLUSIONS: Associated pre-invasive lesions in patients resected for primary lung neoplasms are not infrequent. AAH is associated with adenocarcinoma, CIS with squamous cell carcinoma, DIPNECH with typical carcinoid tumours. Our experience indicates that in these patients histology, stage distribution and survival do not differ from the total population of resected patients with lung tumors.

Adenocarcinoma↗
PubMed1993

[Correlation between C219 and drug resistance in lung neoplasms].

The authors take into consideration 19 cases of lung neoplasm to see the relationship of clinical behaviour and C219. They found a cutoff (25%) to separate drug resistant by drug sensibility. Marker sensitivity was 84.2% and relation with PCNA was negative (-0.384).

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1991

Expression of transforming growth factor alpha in plutonium-239-induced lung neoplasms in dogs: investigations of autocrine mechanisms of growth.

We have previously shown that 47% of radiation-induced lung neoplasms in dogs exhibit increased expression of epidermal growth factor receptor (EGFR). In this study, we investigated the expression of transforming growth factor alpha (TGF-alpha), a ligand for EGFR, to determine if an autocrine mechanism for growth stimulation was present in these tumors. As determined by immunohistochemistry, 59% (26/44) of the lung neoplasms examined had increased expression of TGF-alpha. Expression of TGF-alpha was not related to the etiology of the tumor, e.g., spontaneous or plutonium-induced; however, it was related to the phenotype of the tumor. Statistical analysis of the correlation of EGFR and TGF-alpha expression within the same tumor did not show a positive association; however, specific phenotypes did have statistically significant expression of EGFR or TGF-alpha, suggesting that overexpression of either the ligand or its receptor conferred a growth advantage to the neoplasm. Twenty-seven percent (32/117) of radiation-induced proliferative epithelial foci expressed TGF-alpha, and a portion of those foci (8/32) expressed both EGFR and TGF-alpha. This supports the hypothesis that these foci represent preneoplastic lesions, and suggests that those foci exhibiting increased expression of the growth factor or its receptor are at greater risk for progressing to neoplasia.

Administration, Inhalation↗
PubMed2006

Pneumothorax as a complication of percutaneous radiofrequency ablation for lung neoplasms.

PURPOSE: The present study was performed to determine the frequency of the complication of pneumothorax after radiofrequency (RF) ablation for lung neoplasms and risk factors affecting such pneumothoraces. MATERIALS AND METHODS: The study was based on 129 consecutive sessions of percutaneous RF ablation of lung neoplasms under real-time computed tomographic fluoroscopic guidance performed in a single institution between May 2003 and November 2005 in 41 patients (17 women, 24 men; mean age, 63 years; age range, 29-82 y). Correlation was determined between the incidence of pneumothorax after RF ablation and multiple factors: sex, age, presence of emphysema, lesion size, lesion depth, contact of tumor with pleura, number of punctures, maximum power of RF generator, period of ablation, tissue temperature at the end of the RF ablation session, and patient position during the procedure. Management of each case of iatrogenic pneumothorax was reviewed. RESULTS: Pneumothorax after RF ablation occurred in 38 of 129 RF ablation sessions (29.5%). Fourteen of the 38 cases were treated by manual aspiration, and 24 were simply observed. In five cases (3.9%), chest tube placement was required as therapy for pneumothorax. The risk of pneumothorax was significantly increased in patients with pulmonary emphysema. CONCLUSIONS: The frequency of pneumothorax after RF ablation in our experience is similar to the frequency of pneumothorax after lung biopsy reported in the literature. Various conditions for RF ablation did not influence the incidence of pneumothorax. Emphysema was the only individual factor that correlated significantly with the development of iatrogenic pneumothorax.

Adult↗