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Mediastinum (Hong Kong, China) 2019The staging of mediastinal lymph nodes is essential for planning the most adequate treatment for patients with non-small cell lung cancer (NSCLC). For this reason, the... (Review)
Review
The staging of mediastinal lymph nodes is essential for planning the most adequate treatment for patients with non-small cell lung cancer (NSCLC). For this reason, the current American and European guidelines recommend obtaining tissue confirmation of any mediastinal abnormality seen on chest computed tomography (CT) and positron emission tomography (PET). This can be done by endoscopic techniques, such as endobronchial ultrasonographic fine-needle aspiration (EBUS-FNA), esophageal ultrasonographic FNA (EUS-FNA), or a combination of the two (CUS). Traditionally, surgical methods have been reserved to validate the negative results of minimally invasive endoscopic techniques. However, based on the latest evidence, cervical mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy (VAMLA) have demonstrated their superiority over minimally invasive methods in terms of performance for those tumors with normal mediastinum [clinical (c) N0-1 by CT and PET]. Therefore, cervical mediastinoscopy and VAMLA should be considered in the staging algorithms of this particular subset of NSCLC, and in the other well-established indications.
PubMed: 35118259
DOI: 10.21037/med.2019.07.01 -
BMJ (Clinical Research Ed.) Oct 2019Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis... (Review)
Review
Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.
Topics: Biomarkers; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Fluorodeoxyglucose F18; Glucocorticoids; Humans; Hypertension, Pulmonary; Immunosuppressive Agents; Incidence; Lung; Positron-Emission Tomography; Prognosis; Pulmonary Fibrosis; Sarcoidosis, Pulmonary; Treatment Outcome
PubMed: 31641045
DOI: 10.1136/bmj.l5553 -
Respiratory Medicine Case Reports 2020A 60-year-old female was evaluated for significant weight loss, nausea, vomiting, and dysphagia. A computed tomography (CT) of the chest showed a 3 cm mass in the middle...
A 60-year-old female was evaluated for significant weight loss, nausea, vomiting, and dysphagia. A computed tomography (CT) of the chest showed a 3 cm mass in the middle mediastinum. CT scan of the abdomen and pelvis revealed no abnormality. Positron emission tomography (PET) of the whole body revealed tracer uptake in the pre-carinal nodal mass. There were no other suspicious foci of tracer uptake. Mediastinoscopy and biopsy revealed a well-differentiated low-grade neuroendocrine tumor. She underwent sternotomy, and after careful mobilization of the great vessels, the middle mediastinal mass was successfully resected. Final pathology revealed a paraganglioma with no morphological signs to suggest malignancy. The right lower paratracheal lymph node did not show any tumor cells. She did well postoperatively.
PubMed: 32953448
DOI: 10.1016/j.rmcr.2020.101211 -
Surgical Laparoscopy, Endoscopy &... Aug 2023The objective of the current study was to investigate the safety and feasibility of mediastinoscopy-assisted esophagectomy (MAE). (Meta-Analysis)
Meta-Analysis
BACKGROUND
The objective of the current study was to investigate the safety and feasibility of mediastinoscopy-assisted esophagectomy (MAE).
METHODS
A meta-analysis was conducted between MAE and traditional transthoracic esophagectomy (TTE). For a comparative analysis of MAE and TTE, we searched PubMed, the Cochrane Library, Embase, and Web of Science databases. We identified the relevant literature and extracted the relevant data. Finally, RevMan 5.3 software was applied to conduct a meta-analysis of the data.
RESULTS
A total of 1256 people were enrolled in 16 studies, comprising 575 patients with MAE and 681 with TTE. The findings revealed that the pulmonary complications, cardiac complications, and postoperative hospital stay in the MAE group were significantly better than those in the TTE group. No significant differences were found between the 2 groups in postoperative chylothorax, anastomotic fistula, and postoperative mortality. But the incidence of recurrent laryngeal nerve injury in the MAE group was higher than that in the TTE group (odds ratio=1.64, 95% CI, 1.15 to 2.35, P =0.006). The MAE group had less lymph node dissection than the TTE group (mean difference=-4.62, 95% CI, -5.97 to 3.45, P <0.00001).
CONCLUSIONS
This meta-analysis presented that MAE was safe and feasible, reduced postoperative pulmonary and cardiac complications, and shortened hospital stay, but lymph node dissection was less, recurrent laryngeal nerve injury was higher, and the impact of long-term survival prognosis required more randomized controlled trials.
Topics: Humans; Mediastinoscopy; Esophagectomy; Feasibility Studies; Recurrent Laryngeal Nerve Injuries; Esophageal Neoplasms; Lymph Node Excision; Postoperative Complications
PubMed: 37505923
DOI: 10.1097/SLE.0000000000001182 -
Diagnostics (Basel, Switzerland) Jun 2023Lung cancer represents the second most common malignancy worldwide and lymph node (LN) involvement serves as a crucial prognostic factor for tailoring treatment... (Review)
Review
Lung cancer represents the second most common malignancy worldwide and lymph node (LN) involvement serves as a crucial prognostic factor for tailoring treatment approaches. Invasive methods, such as mediastinoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), are employed for preoperative LN staging. Among the preoperative non-invasive diagnostic methods, computed tomography (CT) and, recently, positron emission tomography (PET)/CT with fluorine-18-fludeoxyglucose ([F]FDG) are routinely recommended by several guidelines; however, they can both miss pathologically proven LN metastases, with an incidence up to 26% for patients staged with [F]FDG PET/CT. These undetected metastases, known as occult LN metastases (OLMs), are usually cases of micro-metastasis or small LN metastasis (shortest radius below 10 mm). Hence, it is crucial to find novel approaches to increase their discovery rate. Radiomics is an emerging field that seeks to uncover and quantify the concealed information present in biomedical images by utilising machine or deep learning approaches. The extracted features can be integrated into predictive models, as numerous reports have emphasised their usefulness in the staging of lung cancer. However, there is a paucity of studies examining the detection of OLMs using quantitative features derived from images. Hence, the objective of this review was to investigate the potential application of PET- and/or CT-derived quantitative radiomic features for the identification of OLMs.
PubMed: 37443547
DOI: 10.3390/diagnostics13132153 -
American Family Physician May 2022Lung cancer is the second most common cancer in men and women in the United States; however, it remains the leading cause of cancer-related death in the United States...
Lung cancer is the second most common cancer in men and women in the United States; however, it remains the leading cause of cancer-related death in the United States and worldwide. The most common but nonspecific symptom of lung cancer is cough. Associated symptoms, including hemoptysis or shortness of breath, or systemic symptoms, including anorexia or weight loss, greatly increase the likelihood of having lung cancer. Referral to a multidisciplinary lung cancer team, imaging, and confirmation through sputum cytology, thoracentesis, fine-needle aspiration, or mediastinoscopy are recommended. If lung cancer is confirmed, treatment options vary based on staging, histology, immunotherapy biomarker testing, and patient health status. Treatments include surgical resection, immunotherapy, chemotherapy, and/or radiotherapy. Family physicians should focus on primary prevention of lung cancer by encouraging tobacco cessation and early recognition by screening at-risk individuals and following guidelines for pulmonary nodules. As of 2021, the U.S. Preventive Services Task Force recommends annual lung cancer screening using low-dose computed tomography starting at 50 years of age in patients with a 20 pack-year history.
Topics: Advisory Committees; Early Detection of Cancer; Female; Humans; Lung Neoplasms; Male; Mass Screening; Tomography, X-Ray Computed; United States
PubMed: 35559635
DOI: No ID Found -
Journal of Cardiothoracic and Vascular... Apr 2018Tumor staging is critical for the treatment of lung malignancies. Invasive techniques of lung tumor staging can be accomplished via mediastinoscopy, endobronchial... (Review)
Review
Tumor staging is critical for the treatment of lung malignancies. Invasive techniques of lung tumor staging can be accomplished via mediastinoscopy, endobronchial ultrasound, and video-assisted thoracoscopy. Anesthesiologists taking care of patients undergoing mediastinal staging procedures might face different challenges. In this narrative review, the authors summarize the literature on the anesthetic considerations for mediastinal staging procedures.
Topics: Anesthesia; Humans; Lung Neoplasms; Mediastinoscopy; Mediastinum; Neoplasm Staging; Thoracic Surgery, Video-Assisted; Ultrasonography, Interventional
PubMed: 29174661
DOI: 10.1053/j.jvca.2017.08.041 -
International Journal of Clinical... Jun 2023Although the transmediastinal approach as a radical esophagectomy for esophageal carcinoma patients has attracted attention, its advantages over the transthoracic... (Review)
Review
BACKGROUND
Although the transmediastinal approach as a radical esophagectomy for esophageal carcinoma patients has attracted attention, its advantages over the transthoracic approach remain unclear. This study aimed to evaluate the efficacy of transmediastinal esophagectomy (TME) in terms of postoperative respiratory complications compared to that of open transthoracic esophagectomy (TTE).
METHODS
We reviewed patients with thoracic and abdominal esophageal carcinoma who underwent TME or TTE between February 2014 and November 2021. We compared postoperative respiratory complications as the primary outcome. The secondary outcomes included perioperative operation time, blood loss, postoperative complications, and the number of harvested mediastinal lymph nodes.
RESULTS
Overall, 60 and 54 patients underwent TME and TTE, respectively. The baseline characteristics were similar between the two groups, except for age and histological type. There were no intraoperative lethal complications in either group. The incidence of respiratory complications was significantly lower in the TME group than in the TTE group (6.7 vs. 22.2%, p = 0.03). The TME group had a shorter operation time (403 vs. 451 min, p < 0.01), less blood loss (107 vs. 253 mL, p < 0.01), and slightly higher anastomotic leakage (11.7 vs. 5.6%, p = 0.33). The number of harvested lymph nodes was similar in both groups (24 vs. 26, p = 0.10). Multivariate analysis revealed that TME is an independent factor in reducing respiratory complications (odds ratio = 0.27, p = 0.04).
CONCLUSIONS
TME for esophageal carcinoma was performed safely. TME was superior to TTE in terms of postoperative respiratory complications; however, the relatively higher frequency of anastomotic leakage should be considered and requires further evaluation.
Topics: Humans; Lymph Node Excision; Anastomotic Leak; Esophagectomy; Postoperative Complications; Esophageal Neoplasms; Carcinoma; Retrospective Studies
PubMed: 36928515
DOI: 10.1007/s10147-023-02328-8 -
Oncology Letters Jun 2023Bronchogenic carcinoma comprises >90% of primary lung tumors. The present study aimed to estimate the profile of patients with bronchogenic carcinoma and assess the...
Bronchogenic carcinoma comprises >90% of primary lung tumors. The present study aimed to estimate the profile of patients with bronchogenic carcinoma and assess the cancer resectability in newly diagnosed patients. This is a single-center retrospective review conducted over a period of 5 years. A total of 800 patients with bronchogenic carcinoma were included. The diagnoses were mostly proven with either cytological examination or histopathological diagnosis. Sputum analysis, cytological examination of pleural effusion and bronchoscopic examination were performed. Lymph node biopsy, minimally invasive procedures (mediastinoscopy and video-assisted thoracoscopic surgery), tru-cut biopsy or fine-needle aspiration was used to obtain the samples for diagnosis. The masses were removed by lobectomy and pneumonectomy. The age range was between 22 and 87 years, with a mean age of 62.95 years. Males represented the predominant sex. Most of the patients were smokers or ex-smokers. The most common symptom was a cough, followed by dyspnea. Chest radiography revealed abnormal findings in 699 patients. A bronchoscopic evaluation was performed for the majority of patients (n=633). Endobronchial masses and other suggestive malignancy findings were present in 473 patients (83.1%) of the 569 who underwent fiberoptic bronchoscopy. Cytological and/or histopathological samples of 581 patients (91.8%) were positive. Small cell lung cancer (SCLC) occurred in 38 patients (4.75%) and non-SCLC was detected in 762 patients (95.25%). Lobectomy was the main surgical procedure, followed by pneumonectomy. A total of 5 patients developed postoperative complications without any mortality. In conclusion, bronchogenic carcinoma is rapidly increasing without a predilection for sex in the Iraqi population. Advanced preoperative staging and investigation tools are required to determine the rate of resectability.
PubMed: 37153056
DOI: 10.3892/ol.2023.13805 -
Mediastinum (Hong Kong, China) 2019Mediastinal lymph node staging is crucial in deciding the treatment strategy for lung carcinoma. The diagnosis rate of computed tomography is not high; however, it is a... (Review)
Review
Mediastinal lymph node staging is crucial in deciding the treatment strategy for lung carcinoma. The diagnosis rate of computed tomography is not high; however, it is a standard examination. Although the contrast computed tomography is necessary for an accurate diagnosis, images from the positron emission tomography are excellent, and these two technologies are independent and complementary. Positron emission tomography has a disadvantage of false positives and false negatives, but it should also be used in cases where lymph node diameters are 1 cm or more. However, image-based diagnostic methods are not an alternative to histological examination. The results of a transbronchial needle biopsy are extremely dependent on the inspection method, the diagnostic ability of the physician, and the staging of the case. The transesophageal ultrasound endoscope is useful for reaching parts inaccessible by a mediastinoscope. Although its employment requires technical training, it is becoming popular as a minimally invasive method of obtaining cell and the tissue samples. A thoracoscopic biopsy is considered as a last resort for mediastinal lymph node diagnosis. Carefully-chosen invasive procedures are necessary to diagnose swollen lymph nodes. Although mediastinoscopy is still considered as the gold standard, most procedures will be replaced by a comparatively minimally invasive method in the future.
PubMed: 35118261
DOI: 10.21037/med.2019.07.04