F-061 * A COMPARATIVE STUDY AMONG MINIATURIZED ULTRASOUND PROBES FOR PULMONARY NODULES DETECTION IN AN EX VIVO LUNG PERFUSION MODEL

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Case Report: Lesson learned on a case of three synchronous NSCLC\u2018S

Background: In order to raise discussion on the management of multiple pulmonary nodules, we describe the unusual case of a 70 years old man affected by three synchronous NSCLC\u2019s Methods: Past medical history was significant for 40 pack year smoking, hypertension, COPD, type II diabetes mellitus and gout arthropathy, previous gastric resection for peptic ulcer. An incidental chest CT scan revealed: 1) a 0,5 cm very small non calcified nodule in the middle lobe; 2) a 2.5 cm nodule in the apical segment of the right upper lobe presenting irregular margins, a pleural tail and a mixed density; 3) a 2.5 cm nodule, solid and rounded, with irregular borders, in the posterior segment of the right lower lobe; 4) a 2 cm nodule, solid and irregular, located in the apical-dorsal segment of the left upper lobe. Trans-bronchial biopsy of the right upper lobe nodule was positive for bronchiolar-alveolar carcinoma , PET showed ipermetabolic activity in correspondence of the three bigger nodules. The clinical staging was T1N0M1 (Stage IV). Results: Considering the impossibility to discriminate among primary or metastatic lesions on the basis of fine needle biopsies, through mid sternotomy the wedge resection of the nodules was uneventfully performed. Histology and immunohistochemistry provided diagnosis of synchronous right lung adenocarcinomas and left lung neuroendocrine carcinoma. The 0,5 cm nodule was benign. Pathological staging was pT1NXMX. After 24 months the patient is disease free. Conclusions: When radiological imaging supports the possibility of multiple synchronous NSCLC\u2019s, an aggressive surgical approach is recommended not to exclude patients from effective cure

Effectiveness of antireflux surgery (fundoplication) for the care of chronic cough \ub1 associated with GOR symptoms

Objectives The outcome of surgical therapy for atypical extra-oesophageal symptoms allegedly secondary to GORD is controversial. Aim of this study was to assess the results of antireflux surgery in patients affected by 1) typical, 2) typical + atypical, (chronic cough), in whom a dedicated preoperative work up was performed. Methods Between 1995-2010, 151 patients with GORD-related typical andtor atypical symptoms were submitted to antireflux surgery. 100% preoperatively underwent semi-quantitative evaluation of typical/atypical symptoms, chronic cough and oesophagitis, barium swallow, endoscopy and histology and oesophageal manometry, (24 hour pH-recording or intraluminal impedance/pH monitoring system in the absence of gross oesophagitis). In addition, patients with chronic cough underwent chest HRCT scan, methacholine challenge test and spirometry. Surgery was performed exclusively on patients positive for GORD and negative for pulmonary diseases. Preoperative tests for GORD were repeated at follow-up. Results Patients were ordered into two groups: A) 83 patients with typical symptoms only, B) 68 patients with typical symptoms and chronic cough. See table for preoperative clinical and instrumental assessment, type of surgery, morbidity, mortality, follow up and outcomes. In both groups, antireflux surgery demonstrated to significantly improve typical symptoms. The global score for outcome showed no significant differences between group A and B. In group B. antireflux surgery significantly improved chronic cough as well. Conclusions The preoperative work up was highly effective in selecting patients for antireflux surgery which achieved very satisfactory results in the treatment of GORD and GORD-related chronic cough. Disclosure: All authors have declared no conflicts of interest

Effectiveness of antireflux surgery (fundoplication) for the care of chronic cough ± associated with GOR symptoms

Objectives The outcome of surgical therapy for atypical extra-oesophageal symptoms allegedly secondary to GORD is controversial. Aim of this study was to assess the results of antireflux surgery in patients affected by 1) typical, 2) typical + atypical, (chronic cough), in whom a dedicated preoperative work up was performed. Methods Between 1995-2010, 151 patients with GORD-related typical andtor atypical symptoms were submitted to antireflux surgery. 100% preoperatively underwent semi-quantitative evaluation of typical/atypical symptoms, chronic cough and oesophagitis, barium swallow, endoscopy and histology and oesophageal manometry, (24 hour pH-recording or intraluminal impedance/pH monitoring system in the absence of gross oesophagitis). In addition, patients with chronic cough underwent chest HRCT scan, methacholine challenge test and spirometry. Surgery was performed exclusively on patients positive for GORD and negative for pulmonary diseases. Preoperative tests for GORD were repeated at follow-up. Results Patients were ordered into two groups: A) 83 patients with typical symptoms only, B) 68 patients with typical symptoms and chronic cough. See table for preoperative clinical and instrumental assessment, type of surgery, morbidity, mortality, follow up and outcomes. In both groups, antireflux surgery demonstrated to significantly improve typical symptoms. The global score for outcome showed no significant differences between group A and B. In group B. antireflux surgery significantly improved chronic cough as well. Conclusions The preoperative work up was highly effective in selecting patients for antireflux surgery which achieved very satisfactory results in the treatment of GORD and GORD-related chronic cough. Disclosure: All authors have declared no conflicts of interest

Efficacia della chirurgia antireflusso (fundoplicatio) nella cura della tosse cronica \ub1 associata a sintomi da RGE.

Efficacia della chirurgia antireflusso (fundoplicatio) nella cura della tosse cronica \ub1 associata a sintomi da RGE

Does anatomical segmentectomy allow an adequate lymph node (N) staging for NSCLC?

Background: Anatomical segmentectomy is again under evaluation for cure of T1 N0 NSCLC. Whether segmentectomy does permit or not an adequate resection of nodal stations for staging or cure is still pending. Methods: We compared 36 (67% male) anatomical segmentectomies (S) and 58 (76% male) lobectomies (L), performed for T 64 2cm N0 M0 at the preoperative work up. Dissection of N stations number 4/5/6/7 was identical in (S) and (L), stations number 10, 11 and 12 with the segmental 13 were also dissected carefully during (S). Results: Number and type of surgical procedures, histology, p Stage, follow up are detailed in table 1.The mean size of the resected lesions was 1.7 \ub1 0.7 cm in (S) and 1.8 \ub1 0.47 cm (p=0.409) in (L). (S) resection margins were free in 100%. Mean number of dissected lymph nodes was 9.6 \ub1 3.4 in (S) compared to 17 \ub1 7 in (L) (p=0.001), for N1 it was 5 \ub1 1.8 in (S) versus 10.2 \ub1 4.2 in (L) (p=0.001), for N2 was 5.2 \ub1 2.9 in (S) versus 6.8 \ub1 4.7 in (L) (p=0.078). In (S) 100% was N0, in (L) 86,4% was N0, 6.8% N1, 6.8%N2 (4pts ). Actuarial 24 months free from recurrence survival was 100% for (S) and 96% for (L) , p=0.889). Conclusions: If compared to standard lobectomy, anatomical segmentectomy for T 64 2cm N0, NSCLC provides a lower number of N1 and the same number of N2 nodes for pathological examination, 7% of patients may be under-staged (for N1), but the 24 months free from recurrence survival is equivalent

Ex vivo pulmonary nodule detection with miniaturized ultrasound convex probes.

Abstract BACKGROUND: The intraoperative localization of small and deep pulmonary nodules is often difficult during minimally invasive thoracic surgery. We compared the performance of three miniaturized ultrasound (US) convex probes, one of which is currently used for thoracic endoscopic diagnostic procedures, for the detection of lung nodules in an ex vivo lung perfusion model. METHODS: Three porcine cardiopulmonary blocks were perfused, preserved at 4\ub0C for 6 h and reconditioned. Lungs were randomly seeded with different patterns of echogenicity target nodules (9 water balls, 10 fat, and 11 muscles; total n = 30). Three micro-convex US probes were assessed in an open setting on the pleural surface: PROBE 1, endobronchial US 5-10 MHz; PROBE 2, laparoscopic 4-13 MHz; PROBE 3, fingertip micro-convex probe 5-10 MHz. US probes were evaluated regarding the number of nodules localized/not localized, the correlation between US and open specimen measurements, and imaging quality. RESULTS: For detecting target nodules, the sensitivity was 100% for PROBE 1, 86.6% for PROBE 2, and 78.1% for PROBE 3. A closer correlation between US and open specimen measurements of target diameter (r = 0.87; P = 0.0001) and intrapulmonary depth (r = 0.97; P = 0.0001) was calculated for PROBE 1 than for PROBES 2 and 3. The imaging quality was significantly higher for PROBE 1 than for PROBES 2 and 3 (P < 0.04). CONCLUSIONS: US examination with micro-convex probes to detect pulmonary nodules is feasible in an ex vivo lung perfusion model. PROBE 1 achieved the best performance. Clinical research with the endobronchial US micro-convex probe during minimally invasive thoracic surgery is advisable

Image enhancement technology in bronchoscopy: a prospective multicentre study in lung cancer

Contains fulltext : 193614.pdf (publisher's version ) (Open Access)Introduction: Patients with lung cancer may present with additional lesions in the central airways. Earlier studies have shown a relationship between vessel diameter, pattern and grade of malignancy. High-definition (HD+) bronchoscopy with image enhancement techniques (i-scan) detected more vascular abnormalities but correlation with pathology has not yet been established. Methods: In this investigator-initiated, randomised, controlled, crossover, multicentre study in patients with suspected lung cancer, a HD+ bronchoscopy was performed with i-scan1 and i-scan2 settings in random order. Biopsies, visual grade and vascular pattern classification were obtained by endoscopists and blinded evaluation. Results: In 107 patients, vascular patterns were classified in 48 tumours. Abrupt-ending vessels were predominantly found in squamous cell carcinoma but overall correlation between vessel pattern and histology was not significant (p=0.339). Additional lesions were detected in 35 patients (33%) with a correlation between vessel pattern and high-grade (pre-)invasive lesions (p<0.001). In 8.4% of the patients, relevant second lesions were detected which determined treatment and staging in 3% of all patients. Interobserver agreement was excellent for visual grading of the airway epithelium, but low for classifying vascular patterns. No significant detection rate difference was found by blinded and unblinded evaluation. Conclusion: HD+ bronchoscopy with i-scan image enhancement readily detects additional lesions. In one-third of all the patients, additional lesions were detected. Their vascular pattern correlates to pathology outcome, but the interobserver correlation for vascular pattern classification is low. These lesions were relevant in 8.4% and affected treatment and work-up in 3% of the cases. Trial registration number: NCT02285426; Results