Survival and quality of life benefit after endoscopic management of malignant central airway obstruction

Although interventional management of malignant central airway obstruction (mCAO) is well established, its impact on survival and quality of life (QoL) has not been extensively studied.We prospectively assessed survival, QoL and dyspnea (using validated EORTC questionnaire) in patients with mCAO 1 day before interventional bronchoscopy, 1 week after and every following month, in comparison to patients who declined this approach. Material/Patients/Methods: 36 patients underwent extensive interventional bronchoscopic management as indicated, whereas 12 declined. All patients received full chemotherapy and radiotherapy as indicated. Patients of the 2 groups were matched for age, comorbidities, type of malignancy and level of obstruction. Follow up time was 8.0±8.7 (range 1-38) months.Mean survival for intervention and control group was 10±9 and 4±3 months respectively (p=0.04). QoL improved significantly in intervention group patients up to the 6(th) month (p<0.05) not deteriorating for those surviving up to 12 months. Dyspnea decreased in patients of the intervention group 1 month post procedure remaining reduced for survivors over the 12th month. Patients of the control group had worse QoL and dyspnea in all time points.Interventional management of patients with mCAO, may achieve prolonged survival with sustained significant improvement of QoL and dyspnea

Imaging-guided chest biopsies: techniques and clinical results

Background This article aims to comprehensively describe indications, contraindications, technical aspects, diagnostic accuracy and complications of percutaneous lung biopsy. Methods Imaging-guided biopsy currently represents one of the predominant methods for obtaining tissue specimens in patients with lung nodules; in many cases treatment protocols are based on histological information; thus, biopsy is frequently performed, when technically feasible, or in case other techniques (such as bronchoscopy with lavage) are inconclusive. Results Although a coaxial system is suitable in any case, two categories of needles can be used: fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB), with the latter demonstrated to have a slightly higher overall sensitivity, specificity and accuracy. Conclusion Percutaneous lung biopsy is a safe procedure even though a few complications are possible: pneumothorax, pulmonary haemorrhage and haemoptysis are common complications, while air embolism and seeding are rare, but potentially fatal complications

Einfluss der Art der Materialgewinnung auf die Diagnosefindung in der Lungenpathologie

Das Ziel der Arbeit ist die Darstellung der Möglichkeiten der Kryobiopsien für die Diagnostik von Lungenerkrankungen und Pleuraerkrankungen. Es wurde zunächst gezeigt, dass die transbronchialen Kryobiopsien einen deutlichen morphologischen Unterschied gegenüber den konventionellen transbronchialen Biopsien zeigen, indem sie größer sind und häufiger alveoläres Gewebe enthalten. Entnahmebedingte Artefakte des alveolären Gewebes zeigten sich nicht. Untersucht wurden Patientenkollektive mit Krebserkrankungen sowie mit interstitiellen Lungenerkrankungen. In beiden Gruppen zeigt sich eine deutliche Steigerung der diagnostischen Ausbeute. Bei den pleuralen Läsionen konnte mindestens eine Gleichwertigkeit der Methode der Kryobiopsie der Pleura mit einer flexiblen Zangenbiopsie gezeigt werden. Die letzte vorgelegte Arbeit zeigt die erste Beschreibung einer durch Kryobiopsie gesicherten diffusen idiopathischen Hyperplasie der neuroendokrinen Zellen (DIPNECH). Insgesamt zeigt sich eine gute Einsetzbarkeit der Methode bei allen Lungen- und Pleuraerkrankungen.The aim of this work is to present a variety of cryobiopsies for the diagnosis of pulmonary and pleural diseases. The first paper describes a distinct morphologic difference between cryobiopsies and traditional transbronchial biopsies. Cryobiopsies reveal to be larger, contain more common alveolar tissue, which does not show any artefacts. The following analyses included patient groups with cancer and interstitial lung diseases. Both groups show a higher diagnostic yield concerning the specific disease. For the pleural lesions it could be demonstrated that there is at least a diagnostic equivalence between cryobiopsy and flexible thoracosopy. Finally, the last paper is a first case report of a cryobiopsy-diagnosed diffuse idiopathic neuroendocrine cell hyperplasia (DIPNECH). Altogether, the method presents itself suitable for application in all groups of lung and pleural diseases

The Diagnostic Accuracy of Chest CT in the Detection of Tumor and Nodal Status in Non Small Cell Lung Carcinoma

At this time there is an increasing demand for an accurate pre operative staging in non small cell lung cancer. Chest&nbsp;Computed Tomography (CT) is one of the imaging modality of choice used for this purpose. This study evaluated the&nbsp;accuracy of the chest CT to determine the status of the tumor and nodules in non small cell lung cancer. During the&nbsp;years 1998 and 1999, a descriptive prospective study of 32 patients undergoing a contrast enhanced chest CT&nbsp;examination for non small cell lung cancer, stage I-IIIA, was conducted. Lobectomy, lymph nodes dissection and&nbsp;postoperative histo-pathological examination were done. CT findings were as follows: a sensitivity of 100%, a&nbsp;specificity of 25% and an accuracy of 60% in the detection of the nodule stage were found. In 17 patients with adenocarcinoma,&nbsp;the sensitivity, the specificity and the accuracy were 86.6%, 100% and 88.2% respectively. The diagnosis of&nbsp;all patients was confirmed histo-pathologically. Six patients with T2 and 26 patients with T3 were detected by chest CT;&nbsp;the accuracy of the tumor status was 93.7%, confirmed by surgical and histo-pathological examinations. It was&nbsp;concluded that the CT played an important role in determining the clinical stage of non small cell lung cancer. The&nbsp;specificity and accuracy were higher in adeno-carcinoma as compared with squamous cell carcinoma in detecting the&nbsp;nodal status

Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology : a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study

Background: Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology. Methods: This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders. Results: This study included 604 patients with ARF. All patients underwent noninvasive diagnostic tests, and a bronchoscopy and bronchoalveolar lavage (BAL) was performed in 155 (25.6%). Definite diagnoses were classified into four exclusive etiological categories: pneumonia (44.4%), non-infectious diagnoses (32.6%), opportunistic infection (10.1%) and undetermined (12.9%), with corresponding hospital mortality rates of 40, 35, 55 and 59%, respectively. Overall hospital mortality was 42%. By multivariable analysis, factors associated with hospital mortality were invasive pulmonary aspergillosis (OR 7.57 (95% CI 3.06-21.62); p 7 (OR 3.32 (95% CI 2.15-5.15); p < 0.005) and an undetermined ARF etiology (OR 2.92 (95% CI 1.71-5.07); p < 0.005). Conclusions: In patients with hematological malignancies and ARF, up to 13% remain with undetermined ARF etiology despite comprehensive diagnostic workup. Undetermined ARF etiology is independently associated with hospital mortality. Studies to guide second-line diagnostic strategies are warranted

Trends in bronchoscopic findings over a decade

The incidence of lung cancer in Maltese males is higher than that in females. However trends in Maltese and other foreign populations indicate a substantial recent increment in the diagnosis of lung cancer in women. In this retrospective study we report the trends seen along the last decade in bronchoscopic findings of bronchoscopies carried out by one hospital firm in order to try and reflect the practices and results of this important endoscopic investigation on the incidence, diagnosis and treatment of lung malignancies in Malta.peer-reviewe