Diagnostic accuracy of CT-guided core biopsy of ground-glass opacity pulmonary lesions

The purpose of our study was to evaluate the accuracy of CT-guided percutaneous core biopsy of ground-glass opacity (GGO) pulmonary lesions. MATERIALS AND METHODS: The study included 50 patients (24 men, 26 women; age range, 43-78 years) who had a GGO pulmonary lesion and underwent CT-guided core biopsy. Diagnostic accuracy was compared between two groups according to lesion size ( or = 2 cm) and GGO component (> 90% vs 50-90%). Each case was reviewed for complications, including pneumothorax, thoracostomy tube insertion, and hemoptysis. RESULTS: Malignancy was finally diagnosed in 33 patients, including three who underwent repeated biopsies, with 33 true-positive and three false-negative findings for an overall sensitivity of 92% (33/36). A benign lesion was finally diagnosed in 10 patients with one false-positive result, for a specificity of 90%. Two benign lesions without confirmative diagnosis because of loss of follow-up and five nondiagnostic samples were excluded from the calculations of sensitivity, specificity, and diagnostic accuracy. The overall diagnostic accuracy was 91%, with a positive predictive value of 97% and a negative predictive value of 75%. Sensitivity and accuracy were not significantly different between the two groups of lesion size and GGO components (p = 0.0491). Ten (18%) patients had pneumothorax, with one (2%) requiring placement of a thoracostomy tube. Mild hemoptysis occurred in seven (13%) patients. CONCLUSION: CT-guided core biopsy of GGO lesions can yield high diagnostic accuracy and acceptable complication rates approaching those of solid lesions

Epidermal growth factor receptor gene amplification predicts worse outcome in patients with surgically resected nonadenocarcinoma lung cancer

The epidermal growth factor receptor (EGFR) gene copy number was analyzed with fluorescent in situ hybridization (FISH) to examine the prognostic role in surgically resected nonadenocarcinoma of non-small-cell lung cancer (NA-NSCLC). Patients with EGFR gene amplification and high polysomy, who underwent curativeintent surgical resection, showed significantly shorter overall survival (hazard ratio, 1.36; 95% confidence interval, 1.040-1.782; P = .025). EGFR FISH evaluation of surgical tumor tissue, in addition to clinicopathologic factors, might better predict for the prognosis of early-stage or locally advanced NA-NSCLC patients. Purpose: The aim of the present study was to examine the prognostic role of amplification and increased expression of the epidermal growth factor receptor (EGFR) gene in surgically resected non-adenocarcinoma of non-small cell lung cancer (NA-NSCLC). Materials and Methods: The present retrospective study included 114 consecutive NA-NSCLC patients with available tumor tissue and survival data. EGFR gene copy number and protein expression were evaluated using fluorescent in situ hybridization (FISH) and immunohistochemistry in tissue microarray sections, respectively. Results: Among 114 patients, 99 (86.8%) had squamous cell carcinoma histologic features. EGFR gene amplification and high polysomy (EGFR FISH+) were observed in 7.9% and 31.6% of cases, respectively. Patients with EGFR FISH+ had significantly shorter overall survival (P = .011). A multivariate model confirmed that patients with EGFR FISH+ had a significantly greater risk of death than EGFR FISH- patients after adjusting for pathologic stage, presence of pleural invasion, venous invasion, and surgical margins (hazard ratio, 1.36; 95% CI, 1.040 to 1.782; P = .025). EGFR protein expression by immunohistochemistry was not associated with overall survival in the same group. Neither EGFR gene amplification nor EGFR immunohistochemistry expression was associated with relapse-free survival. Conclusion: An increased EGFR gene copy number in surgically resected NA-NSCLC was associated with worse survival. (C) 2018 Elsevier Inc. All rights reserved.N

The impact of multiple metastatic nodal stations on survival in patients with resectable N1 and N2 nonsmall-cell lung cancer

BACKGROUND: The aim of the study was to identify common prognostic factors in nonsmall-cell lung cancer (NSCLC) with N1 and N2 nodal involvement. METHODS: A retrospective review of NSCLC patients who underwent primary surgical resection without neoadjuvant chemotherapy was performed. In all, 280 patients were included in this study, and there were 132 patients with N1 disease (N1 group) and 148 patients with N2 disease (N2 group). The median follow-up period was 26 months, and complete follow-up was possible in 269 patients (96%). RESULTS: Lobectomy was performed in 194 patients (69%), bilobectomy was performed in 43 (15%), and pneumonectomy was performed in 43 (15%). Complete resection was possible in 273 patients (98%), and operative death occurred in 5 patients (2%). The overall and disease-free 5-year survival rates were 63% and 55%, respectively, in the N1 group, and 44% and 32%, respectively, in the N2 group (p < 0.05). The prognostic factors for overall survival in both the N1 and N2 groups were age and the number of metastatic nodal stations; however, N2 metastasis was not a significant prognostic factor in the multivariate analysis. The poor prognosis of the patients in the N2 group was due to the greater incidence of multiple node involvement in comparison with the N1 group (73% versus 15%; p < 0.05). CONCLUSIONS: Multiple metastatic nodal stations was the common prognostic factor in resectable NSCLC patients with nodal metastasis, and mediastinal nodal involvement was associated with a higher chance of multiple-station metastasis in this study

Fabrication and In Vivo Evaluation of the Electrospun Small Diameter Vascular Grafts Composed of Elastin/PLGA/PCL and Heparin-VEGF

Vascular scaffolds made of synthetic materials have been successfully used for many years for the revascularization of blood vessels with inner diameters >= 6 mm. However, small diameter vascular substitutes (<5 mm) have shown poor patency rates because of the occurrence of thrombosis. In this study, we investigated small diameter(similar to 3 mm) vascular grafts composed of elastin, poly (lactic-co-glycolic acid : PLGA) and polycaprolactone (PCL) fabricated by electrospinning techniques. In addition, heparin and vascular endothelial growth factor (VEGF) were added to the scaffolds to prevent thrombosis on the target incision and promote endothelial cell growth on the surface of scaffolds. The arterial grafts of electrospun elastin/PLGA/PCL vascular prostheses in Sprague-Dawley rats were found to improve the recovery of the incised blood vessel function by promoting migration, attachment and proliferation of endothelial cells onto the vascular scaffolds, thus exploring the potential of electrospun polymer scaffold in vascular graft engineering.Sell SA, 2009, ADV DRUG DELIVER REV, V61, P1007, DOI 10.1016/j.addr.2009.07.012Zhang S, 2009, J BIOMED MATER RES A, V90A, P671, DOI 10.1002/jbm.a.32136QIU RX, 2009, BIOMED MATER, V4, P44105BRADFORD MM, 1976, ANAL BIOCHEM, V72, P248LEE SK, 1989, BIOMATERIALS, V29, P2008ITO N, 1999, ANGIOGENESIS, V3, P158Li WJ, 2002, J BIOMED MATER RES, V60, P613, DOI 10.1002/jbm.10167Cheng ZY, 2004, BIOMATERIALS, V25, P1991, DOI 10.1016/j.biomaterials.2003.08.038Jeong SI, 2005, BIOMATERIALS, V26, P1405, DOI 10.1016/j.biomaterials.2004.04.036Ma ZW, 2005, BIOMATERIALS, V26, P2527, DOI 10.1016/j.biomaterials.2004.07.026Takahashi H, 2005, CLIN SCI, V109, P227, DOI 10.1042/CS20040370Heydarkhan-Hagvall S, 2008, BIOMATERIALS, V29, P2907, DOI 10.1016/j.biomaterials.2008.03.034Choi JS, 2008, BIOMATERIALS, V29, P2899, DOI 10.1016/j.biomaterials.2008.03.031Corey JM, 2008, ACTA BIOMATER, V4, P863, DOI 10.1016/j.actbio.2008.02.020Lee SJ, 2007, J BIOMED MATER RES A, V83A, P999, DOI 10.1002/jbm.a.31287Daamen WF, 2007, BIOMATERIALS, V28, P4378, DOI 10.1016/j.biomaterials.2007.06.025Stitzel J, 2006, BIOMATERIALS, V27, P1088, DOI 10.1016/j.biomaterials.2005.07.048Lee SJ, 2006, BIOMATERIALS, V27, P3466, DOI 10.1016/j.biomaterials.2006.01.059Sell SA, 2006, BIOMED MATER, V1, P72, DOI 10.1088/1748-6041/1/2/004Olsson AK, 2006, NAT REV MOL CELL BIO, V7, P359, DOI 10.1038/nrm1911ANGST AD, 2006, MACROMOL BIOSCI, V6, P623Ashikari- Hada S, 2005, J BIOL CHEM, V280, P31508, DOI 10.1074/jbc.M414581200

Long-Term Oncologic Outcomes, Opioid Use, and Complications after Esophageal Cancer Surgery

Effective and adequate opioid use and prevention of postoperative complications are important for enhanced recovery after surgery. We examined the effects of postoperative opioid use and postoperative complications on overall survival and recurrence-free survival after esophageal cancer surgery. This retrospective cohort study analyzed the records of patients diagnosed with esophageal cancer who underwent the Ivor Lewis operation between January 2005 and December 2011. We collected data on total opioid use for 8 days postoperatively, as well as information on postoperative complications (Clavien-Dindo classification). One hundred and twenty-one patients were included in the final analysis. Total opioid use was not significantly associated with overall survival (p = 0.520) and recurrence-free survival (p = 0.818). In contrast, the hazard ratio of postoperative overall survival was significantly higher with respect to Clavien-Dindo classification 1–2 (hazard ratio: 2.009, p = 0.046), 3a–3b (hazard ratio: 5.759, p &lt; 0.001), and 4a–5 (hazard ratio: 3.982, p = 0.020) complications compared to no complications. Additionally, the hazard ratio of the recurrence-free survival was significantly higher in class 1–2 complications (hazard ratio: 2.336, p = 0.028) compared to none. Our study demonstrates that postoperative opioid use is not associated with survival and recurrence-free survival after esophageal cancer surgery, while postoperative complications may increase the hazard ratio for survival and recurrence-free survival

Impact of idiopathic pulmonary fibrosis on recurrence after surgical treatment for stage I-III non-small cell lung cancer.

BackgroundIdiopathic pulmonary fibrosis (IPF) is an independent risk factor for lung cancer (LC) development; however, its effect on recurrence after curative surgery remains unclear.ObjectivesThis study aimed to determine the impact of IPF on recurrence-free survival following curative surgical resection of stage I-III non-small cell lung cancer (NSCLC) and investigate the effects of patient and surgical factors on the risk of recurrence.MethodsWe reviewed retrospectively collected data of patients with surgically resected stage I-III NSCLC from two tertiary care hospitals in South Korea. By propensity score matching, patients with IPF (LC with IPF) were matched to those without IPF (LC without IPF).ResultsIn total, 3416 patients underwent surgical resection, and 96 were diagnosed with underlying IPF. In the LC with IPF group, 89.6% patients were men, and the average age was 69.7 years. Sublobar resection was performed more frequently in the LC with IPF group than in the LC without IPF group, while the rate of mediastinal lymph node dissection and dissected node number were lower in the former group. The 5-year recurrence-free survival rate was significantly lower in the LC with IPF group (49.2%) than in the LC without IPF group (69.1%; PConclusionsIPF may increase the risk of recurrence after curative surgical treatment for NSCLC. Close surveillance for recurrence is mandatory for patients with underlying IPF