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Journal of Thoracic Oncology : Official... Sep 2014Anterior mediastinal masses are relatively uncommon, include a wide variety of entities, and often pose a diagnostic challenge for clinicians. In this article, available... (Review)
Review
Anterior mediastinal masses are relatively uncommon, include a wide variety of entities, and often pose a diagnostic challenge for clinicians. In this article, available data is assembled in a clinically oriented manner to develop a structured approach to evaluation of these patients. Attention to age and gender, combined with identification of certain radiographic and clinical characteristics, allows a presumptive diagnosis to be established in most patients. This structure efficiently guides what additional workup is needed.
Topics: Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mediastinum; Radiography
PubMed: 25396306
DOI: 10.1097/JTO.0000000000000294 -
Journal of Clinical Oncology : Official... Dec 2019Patients with relapsed or refractory primary mediastinal large B-cell lymphoma (rrPMBCL) have a poor prognosis, and their treatment represents an urgent and unmet need....
PURPOSE
Patients with relapsed or refractory primary mediastinal large B-cell lymphoma (rrPMBCL) have a poor prognosis, and their treatment represents an urgent and unmet need. Because PMBCL is associated with genetic aberrations at 9p24 and overexpression of programmed cell death-1 (PD-1) ligands (PD-L1), it is hypothesized to be susceptible to PD-1 blockade.
METHODS
In the phase IB KEYNOTE-013 (ClinicalTrials.gov identifier: NCT01953692) and phase II KEYNOTE-170 (ClinicalTrials.gov identifier: NCT02576990) studies, adults with rrPMBCL received pembrolizumab for up to 2 years or until disease progression or unacceptable toxicity. The primary end points were safety and objective response rate in KEYNOTE-013 and objective response rate in KEYNOTE-170. Secondary end points included duration of response, progression-free survival, overall survival, and safety. Exploratory end points included association between biomarkers and pembrolizumab activity.
RESULTS
The objective response rate was 48% (7 complete responses; 33%) among 21 patients in KEYNOTE-013 and 45% (7 complete responses; 13%) among 53 patients in KEYNOTE-170. After a median follow-up time of 29.1 months in KEYNOTE-013 and 12.5 months in KEYNOTE-170, the median duration of response was not reached in either study. No patient with complete response experienced progression, including 2 patients with complete response for at least 1 year off therapy. Treatment-related adverse events occurred in 24% of patients in KEYNOTE-013 and 23% of patients in KEYNOTE-170. There were no treatment-related deaths. Among 42 evaluable patients, the magnitude of the 9p24 gene abnormality was associated with PD-L1 expression, which was itself significantly associated with progression-free survival.
CONCLUSION
Pembrolizumab is associated with high response rate, durable activity, and a manageable safety profile in patients with rrPMBCL.
Topics: Adult; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Immunological; Disease Progression; Drug Resistance, Neoplasm; Europe; Female; Humans; Lymphoma, B-Cell; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Progression-Free Survival; Risk Assessment; Risk Factors; South America; Time Factors; United States; Young Adult
PubMed: 31609651
DOI: 10.1200/JCO.19.01389 -
European Journal of Cardio-thoracic... May 2014Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount...
Accurate preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small-cell lung cancer (NSCLC) is of paramount importance. In 2007, the European Society of Thoracic Surgeons (ESTS) published an algorithm on preoperative mediastinal staging integrating imaging, endoscopic and surgical techniques. In 2009, the International Association for the Study of Lung Cancer (IASLC) introduced a new lymph node map. Some changes in this map have an important impact on mediastinal staging. Moreover, more evidence of the different mediastinal staging technique has become available. Therefore, a revision of the ESTS guidelines was needed. In case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes, tissue confirmation is indicated. Endosonography [endobronchial ultrasonography (EBUS)/esophageal ultrasonography (EUS)] with fine-needle aspiration (FNA) is the first choice (when available), since it is minimally invasive and has a high sensitivity to rule in mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopy is preferred to mediastinoscopy. The combined use of endoscopic staging and surgical staging results in the highest accuracy. When there are no enlarged lymph nodes on CT and when there is no uptake in lymph nodes on PET or PET-CT, direct surgical resection with systematic nodal dissection is indicated for tumours ≤ 3 cm located in the outer third of the lung. In central tumours or N1 nodes, preoperative mediastinal staging is indicated. The choice between endoscopic staging with EBUS/EUS and FNA or video-assisted mediastinoscopy depends on local expertise to adhere to minimal requirements for staging. For tumours >3 cm, preoperative mediastinal staging is advised, mainly in adenocarcinoma with high standardized uptake value. For restaging, invasive techniques providing histological information are advisable. Both endoscopic techniques and surgical procedures are available, but their negative predictive value is lower compared with the results obtained in baseline staging. An integrated strategy using endoscopic staging techniques to prove mediastinal nodal disease and mediastinoscopy to assess nodal response after induction therapy needs further study.
Topics: Algorithms; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Lymph Nodes; Mediastinal Neoplasms; Neoplasm Staging; Thoracoscopy
PubMed: 24578407
DOI: 10.1093/ejcts/ezu028 -
The Lancet. Digital Health Sep 2023Mediastinal neoplasms are typical thoracic diseases with increasing incidence in the general global population and can lead to poor prognosis. In clinical practice, the...
BACKGROUND
Mediastinal neoplasms are typical thoracic diseases with increasing incidence in the general global population and can lead to poor prognosis. In clinical practice, the mediastinum's complex anatomic structures and intertype confusion among different mediastinal neoplasm pathologies severely hinder accurate diagnosis. To solve these difficulties, we organised a multicentre national collaboration on the basis of privacy-secured federated learning and developed CAIMEN, an efficient chest CT-based artificial intelligence (AI) mediastinal neoplasm diagnosis system.
METHODS
In this multicentre cohort study, 7825 mediastinal neoplasm cases and 796 normal controls were collected from 24 centres in China to develop CAIMEN. We further enhanced CAIMEN with several novel algorithms in a multiview, knowledge-transferred, multilevel decision-making pattern. CAIMEN was tested by internal (929 cases at 15 centres), external (1216 cases at five centres and a real-world cohort of 11 162 cases), and human-AI (60 positive cases from four centres and radiologists from 15 institutions) test sets to evaluate its detection, segmentation, and classification performance.
FINDINGS
In the external test experiments, the area under the receiver operating characteristic curve for detecting mediastinal neoplasms of CAIMEN was 0·973 (95% CI 0·969-0·977). In the real-world cohort, CAIMEN detected 13 false-negative cases confirmed by radiologists. The dice score for segmenting mediastinal neoplasms of CAIMEN was 0·765 (0·738-0·792). The mediastinal neoplasm classification top-1 and top-3 accuracy of CAIMEN were 0·523 (0·497-0·554) and 0·799 (0·778-0·822), respectively. In the human-AI test experiments, CAIMEN outperformed clinicians with top-1 and top-3 accuracy of 0·500 (0·383-0·633) and 0·800 (0·700-0·900), respectively. Meanwhile, with assistance from the computer aided diagnosis software based on CAIMEN, the 46 clinicians improved their average top-1 accuracy by 19·1% (0·345-0·411) and top-3 accuracy by 13·0% (0·545-0·616).
INTERPRETATION
For mediastinal neoplasms, CAIMEN can produce high diagnostic accuracy and assist the diagnosis of human experts, showing its potential for clinical practice.
FUNDING
National Key R&D Program of China, National Natural Science Foundation of China, and Beijing Natural Science Foundation.
Topics: Humans; Mediastinal Neoplasms; Mediastinum; Artificial Intelligence; Cohort Studies; Diagnosis, Computer-Assisted
PubMed: 37625894
DOI: 10.1016/S2589-7500(23)00106-1 -
Journal of Thoracic Oncology : Official... Sep 2014
Topics: Humans; Mediastinal Neoplasms; Thymus Neoplasms
PubMed: 25396313
DOI: 10.1097/JTO.0000000000000289 -
The Canadian Journal of Cardiology Jun 2007Pseudocoarctation, also known as kinking or buckling of the aorta, is an uncommon anomaly. Its recognition is important, because it may be mistaken for true coarctation,...
Pseudocoarctation, also known as kinking or buckling of the aorta, is an uncommon anomaly. Its recognition is important, because it may be mistaken for true coarctation, aneurysm or mediastinal neoplasm. A case of pseudocoarctation associated with left cervical aorta is reported. The present case is unique in the demonstration of obvious tortuosity and kink formation of the cervical aorta and main branches without frank aneurysm formation. Magnetic resonance angiography as a noninvasive imaging modality was suggested for the definitive diagnosis of cervical aortic arch and its accompanying anomalies.
Topics: Aorta; Aortic Aneurysm; Aortic Coarctation; Child; Diagnosis, Differential; Female; Humans; Magnetic Resonance Angiography; Mediastinal Neoplasms
PubMed: 17593995
DOI: 10.1016/s0828-282x(07)70232-5 -
European Respiratory Review : An... Dec 2021The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently... (Review)
Review
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years.
Topics: Diagnostic Imaging; Humans; Mediastinal Neoplasms; Mediastinum
PubMed: 34615701
DOI: 10.1183/16000617.0309-2020 -
Blood Aug 2018The World Health Organization now recognizes primary mediastinal B-cell lymphoma (PMBCL) as a unique clinical and biologic entity. PMBCL is distinct from other B-cell... (Review)
Review
The World Health Organization now recognizes primary mediastinal B-cell lymphoma (PMBCL) as a unique clinical and biologic entity. PMBCL is distinct from other B-cell non-Hodgkin lymphoma subtypes and has features that overlap with classical Hodgkin lymphoma, including a peak incidence in the adolescent and young adult population, mediastinal presentation of disease, and molecular alterations in JAK2 and programmed death ligands. Because PMBCL is rare, there are few prospective clinical trials to guide therapy, resulting in no single standard of care. Given the long life expectancy of survivors of PMBCL, treatment approaches must balance maximizing cure while minimizing long-term toxicity. In this article, I review my approach to the treatment of PMBCL, incorporating data from adult and pediatric studies, as well as recent advances in our understanding of the molecular basis of PMBCL.
Topics: Humans; Lymphoma, B-Cell; Mediastinal Neoplasms
PubMed: 29976557
DOI: 10.1182/blood-2018-04-791566 -
Cancer Imaging : the Official... Nov 2012Anterior mediastinal tumours include primary and secondary tumours. Patients may be asymptomatic or present with symptoms related to local tumour invasion or systemic... (Review)
Review
Anterior mediastinal tumours include primary and secondary tumours. Patients may be asymptomatic or present with symptoms related to local tumour invasion or systemic symptoms due to release of hormones/cytokines or antibodies. The most common symptoms at presentation include chest pain, dyspnoea, cough, fever and chills. Despite rapid developments in imaging techniques, accurate staging of anterior mediastinal tumours remains a diagnostic quandary. Multimodality imaging plays an important role in determining surgical resectability and/or impact on subsequent management. This article briefly discusses the epidemiology and incidence of anterior mediastinal tumours and describes the role of imaging in tumour characterization and staging in detail. We focus on the more commonly encountered anterior mediastinal tumours.
Topics: Diagnostic Imaging; Humans; Mediastinal Neoplasms; Neoplasm Staging
PubMed: 23131900
DOI: 10.1102/1470-7330.2012.0039 -
Revista Medica de Chile Sep 2017In the last years, several techniques have been developed to obtain a prompt diagnosis or rule out lung cancer. Endobronchial ultrasound- guided transbronchial needle... (Review)
Review
In the last years, several techniques have been developed to obtain a prompt diagnosis or rule out lung cancer. Endobronchial ultrasound- guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield for mediastinal and central pulmonary lesions. This procedure is especially useful for lung cancer diagnosis and mediastinal staging. Two different types of EBUS are currently available: Radial EBUS and lineal EBUS. Each one has technical differences together with a range of clinical indications. The aim of this review is to discuss about EBUS-TBNA and its current clinical indications, evidence about the accuracy of the procedure for lung cancer diagnosis and staging, and evaluation of the pathological and molecular studies (EGFR, ALK, and ROS1) obtained through EBUS-TBNA and rapid on-site evaluation (ROSE).
Topics: Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Lung; Lung Neoplasms; Mediastinal Neoplasms; Medical Illustration; Neoplasm Staging; Reproducibility of Results
PubMed: 29424404
DOI: 10.4067/s0034-98872017000901165