The “polonium in vivo” study. Polonium-210 in bronchial lavages of patients with suspected lung cancer

Few studies have reported on polonium-210, a decay breakdown product of radon-222 and lead-210, in human lungs and there has been no study in patients with suspected lung cancer. The main aim of this "Polonium in vivo" study was to evaluate polonium-210 radioactivity in bronchopulmonary systems of smoker, ex-smoker and never smoker patients with suspected lung cancer. Alpha-spectrometric analyses were performed on bronchial lavage (BL) fluids from two Italian hospitals in 2013-2016. Socio-demographic, smoking, occupational and spirometric characteristics, lung cancer confirmation and histologic type and radon-222 concentration in patients' homes were collected. Seventy BL samples from never (n = 13), former (n = 35) and current smokers (n = 22) were analyzed; polonium-210 was detected in all samples from current and former smokers and in 54% of samples from never smokers (p < 0.001; median values: 1.20, 1.43 and 0.40 mBq, respectively). Polonium-210 levels were significantly higher in COPD versus no COPD patients (median value: 3.60 vs. 0.97 mBq; p = 0.007); former and current smokers, without and with COPD, had significantly increased polonium-210 levels (p = 0.012); 96% of confirmed versus 69% of non-confirmed lung cancer patients recorded detectable polonium-210 levels (p = 0.018). A polonium-210 detectable activity was measured in BL samples from all current and former smokers. Polonium-210 in the lungs could be the result of lead-210 entrapment, which, with its half-life of 22 years, could provide a continuous emission of alpha radioactivity, even many years after quitting, thus proposing a possible explanation for the onset of lung cancer, particularly in former smokers

EGFR and HER2 Gene Copy Number and Response to First-Line Chemotherapy in Patients with Advanced Non-small Cell Lung Cancer (NSCLC)

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Carinal Bronchus: A Unique Variant of the Accessory Cardiac Bronchus

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Tuberculosis-induced cartilage fractures leading to collapse of the left main stem bronchus

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The bizarre appearance of intrathoracic extramedullary hematopoiesis during an endoscopic ultrasound examination

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Transbronchial needle aspiration in sarcoidosis: Yield and predictors of a positive aspirate

ObjectiveTransbronchial needle aspiration is a useful diagnostic procedure in sarcoidosis, but widely variable yields are reported. This study determined the diagnostic contribution of standard transbronchial needle aspiration in a large series of patients with sarcoidosis and evaluated predictor variables that might influence its results.MethodsSixty-one consecutive patients with suspected sarcoidosis in a 2-year period were prospectively enrolled and underwent standard transbronchial needle aspiration with a 19-gauge needle. The following predictor variables were recorded for each patient: age; sex; sarcoidosis stage; operator; size, location, and number of sampled lymph nodes; number of needle passes per sampled node; and adequacy of both histologic and cytologic transbronchial needle aspiration specimens.ResultsSarcoidosis was diagnosed in 53 patients. Lymph node aspiration biopsy was successfully achieved in 50 of 53 cases (94%). Nonnecrotizing epithelioid granulomas were observed in 42 of 53 patients (79%), with similar results for stage I (27/33, 82%) and stage II (15/20, 75%) disease. Sampling of two lymph node stations was the only variable significantly associated with a likelihood of a sarcoidosis-positive aspirate or biopsy sample in both univariate (odds ratio 0.15, 95% confidence interval 0.02–0.79) and multivariate (odds ratio 0.12, 95% confidence interval 0.02–0.70) analyses.ConclusionStandard transbronchial needle aspiration allows successful lymph node sampling in nearly all patients with sarcoidosis and is associated with high diagnostic yield regardless of disease stage. Whenever possible, sampling of more than one nodal station is advised to increase diagnostic yield. Mediastinoscopy should be reserved for patients with negative transbronchial needle aspiration findings

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial

Studies which evaluated the role of an ultrasound-guided needle aspiration biopsy (US-NAB) of metastases from lung cancer located in "superficial" organs/tissues are scant, and none of them assessed the possible impact of rapid on-site evaluation (ROSE) on diagnostic accuracy and safety outcomes

Ultrasound-Guided Needle Aspiration Biopsy of Superficial Metastasis of Lung Cancer with and without Rapid On-Site Evaluation: A Randomized Trial

Background and Objective: Studies which evaluated the role of an ultrasound-guided needle aspiration biopsy (US-NAB) of metastases from lung cancer located in “superficial” organs/tissues are scant, and none of them assessed the possible impact of rapid on-site evaluation (ROSE) on diagnostic accuracy and safety outcomes. Methods: Consecutive patients with suspected superficial metastases from lung cancer were randomized 1:1 to US-NAB without (US-NAB group) or with ROSE (ROSE group). The diagnostic yield for a tissue diagnosis was the primary outcome. Secondary outcomes included the diagnostic yield for cancer genotyping, the diagnostic yield for PD-L1 testing, and safety. Results: During the study period, 136 patients were randomized to receive an US-NAB with (n = 68) or without ROSE (n = 68). We found no significant differences between the ROSE group and the US-NAB group in terms of the diagnostic yields for tissue diagnosis (94.1% vs. 97%, respectively; p = 0.68), cancer genotyping (88% vs. 91.8%, respectively; p = 0.56), and PD-L1 testing (93.5% vs. 90.6%, respectively; p = 0.60). Compared to the diagnostic US-NAB procedures, the non-diagnostic procedures were characterized by less common use of a cutting needle (66.6% vs. 96.9%, respectively; p = 0.0004) and less common retrieval of a tissue core (37.5% vs. 98.5%; p = 0.0001). Only one adverse event (vasovagal syncope) was recorded. Conclusion: US-NAB of superficial metastases is safe and has an excellent diagnostic success regardless of the availability of ROSE. These findings provide a strong rationale for using US-NAB as the first-step method for tissue acquisition whenever a suspected superficial metastatic lesion is identified in patients with suspected lung cancer

Diagnosis and Molecular Profiling of Lung Cancer by Percutaneous Ultrasound-Guided Biopsy of Superficial Metastatic Sites Is Safe and Highly Effective

Background: Diagnosis, staging, and molecular profiling of lung cancer are mostly carried out with bronchoscopy or CT-guided aspiration/biopsy. However, patients with locally advanced or advanced disease often harbor "superficial" metastases for which a percutaneous, ultrasound-assisted needle aspiration/biopsy (US-NAB) might represent an equally effective yet less invasive and costly alternative. Patients and Methods: We reviewed a prospectively collected database of consecutive patients with known/suspected lung cancer who underwent a US-NAB of a suspected "superficial" metastasis. Cancer genotyping was carried out with next-generation sequencing using the Oncomine (TM) Focus DNA and RNA fusion panels. PD-L1 immunohistochemistry was performed with the SP263 antibody. Feasibility, diagnostic yield for tissue diagnosis, sensitivity for malignancy, diagnostic yield for the molecular profiling, and complications were the study endpoints. Results: A total of 98 lesions were evaluated, and 93 were biopsied (95% feasibility). The spectrum of sampled sites included lymph nodes (63 patients), bone (11), subcutaneous tissue (8), muscle (7), and the pleura (4). The diagnostic yield for a tissue diagnosis was 93% (91/98). US-NAB correctly identified 85 of the 87 patients finally diagnosed with malignancy (98% sensitivity). Cancer genotyping and PDL1 testing were successfully completed in 41/42 patients (98%) and in 40/50 patients (80%) for whom these tests were requested, respectively. No complications were observed. Conclusion: US-NAB of "superficial" metastasis of lung cancer is safe and is associated with high success for diagnosis and molecular profiling. In this clinical setting, using US-NAB as a first-step technique would significantly limit the use of more invasive and costly diagnostic procedures

TERAPIA NUTRIZIONALE PARENTERALE: APPROCCIO MULTIDISCIPLINARE, ORGANIZZATIVO E TECNOLOGICO

In diverse strutture ospedaliere, la nutrizione parenterale totale (TPN), è affidata a miscele commerciali standard. Tuttavia in alcune condizioni, quali patologie d’organo, nutrizione di neonati o pazienti compromessi che richiedono il monitoraggio dei parametri clinici e la frequente variazione dell’apporto nutizionale, non è possibile affidarsi a miscele industriali e diventa essenziale l’allestimento di miscele personalizzate da effettuarsi in farmacia ospedaliera. In questo contesto nasce il progetto ICL (Integrated Compounding Lab) nell’ambito della rete Alta tecnologia della regione Emilia Romagna che vede la collaborazione della ditta B-Braun Avitum e della ditta Lean per sviluppare un nuovo sistema automatizzato per il riempimento delle sacche. L’obiettivo del progetto consiste nel realizzare una piattaforma tecnologica, integrata e multidisciplinare, finalizzata alla produzione automatizzata in ambiente ospedaliero di composti diversamente complessi e personalizzati per TPN. In questa prima fase, sacche per TPN prescritte da alcuni reparti interni, sono state formulate presso la Camera Bianca dell’AOU Policlinico utilizzando inizialmente un sistema di riempimento automatico (Caretronic® Compounding System). Considerando la complessità di miscele personalizzate, sono stati messi a punto metodi di controllo delle formulazioni (determinazione del contenuto in nutrienti ed elettroliti, valutazione delle dimensioni delle micelle lipidiche e analisi di sterilità) con lo scopo finale di validare il sistema. La stabilità delle soluzioni (tempi, modalità di conservazione, caratteristiche di sicurezza microbiologica e particellare) è stata indagata e relazionata in conformità agli standard stabiliti dalla normativa vigente