31 research outputs found
Use of the virtual slide and the dynamic real-time telepathology systems for a consultation and the frozen section intra-operative diagnosis in thoracic/pulmonary pathology.
We report the results of a study designed for assessment of the diagnostic accuracy and usability of internet-based digital microscopy: the dynamic real-time telepathology system (Coolscope) and the Virtual microscopy (Aperio Scan Scope) system, in the context of pulmonary pathology. The systems were implemented to the routine pulmonary pathology workflows and used for the intra-operative frozen-section primary diagnosis as well as for the secondary (consultative) diagnosis. The histological material presented for the teleconsultations included the samples of lung parenchyma, bronchial biopsy and resected lung/bronchi tumours. For the primary diagnosis 4 categories of material can be distinguished (304 samples): 1) the frozen sections of lung tumours, resected bronchial margins and lymph nodes; 2) fine needle aspiration [FNA] biopsies (TBNA; EBUS-TBNA, EUS-FNA; 3) oligobiopsies of bronchus, oesophagus, skin; and 4) exfoliative cytology. The telepathology diagnoses compared with conventional light microscopy diagnoses showed very high concordance for the Coolscope and Aperio Virtual Slide modality: 87.5% and 100%, respectively - within the group of teleconsultations. For the frozen sections, the primary telediagnoses were concordant with the light microscopy paraffin sections diagnoses in 100% for Aperio; and in 97.5% for Coolscope. An excellent agreement (100%) was seen in the telediagnoses and conventional slides diagnoses for FNA, oligobiopsies and cytology - for both telepathology systems. These results provide some encouragement for the implementation of Coolscope and virtual slide-based telepathology (Aperio) system to the routine histopathological diagnostics
Desmoid Tumor of lung with pleural involvement : the case of unique location of aggressive fibromatosis
Immunocytochemical analysis of the tissue location of cytokines (IL-2 and IL-12) in neuroendocrine lung cancer
The study aimed at immunocytochemical evaluation of the cellular expression of two cytokines, IL-2 and IL-12 in lung carcinoids (n = 10), following the earlier demonstration of two markers of endocrine tumours (chromogranin A and NSE-neuron-specific enolase). In the immunocytochemical studies the classical avidin-biotinylated peroxidase (ABC) technique was used. Results of the tests were semiquantitatively appraised employing the IRS scale. In 9/10 cases intense reaction (score: 6-12 points) was noted for both lung neuroendocrine markers. In all cases of carcinoma co-expression of IL-2 and IL-12 was demonstrated in cells of the tumours. The cytokines showed a cytoplasmic localisation of mean (score: 3-4 points) or high (score: 6-12 points) intensity of reaction. Our studies point to a possible role of the two cytokines in the proliferation of lung neuroendocrine carcinomas but more detailed analysis is required on a broader material
Transbronchial lung cryobiopsy guided by endobronchial ultrasound radial miniprobe in interstitial lung diseases : preliminary results of a prospective study
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Szybka diagnostyka patomorfologiczna i molekularna chorych na raka p艂uca na podstawie techniki telepatologii
Telepathology is an emerging form of diagnostic process introducing digitalization of slides prepared from formalin-fixed paraffin-embedded materials and stained cytological smears. The use of whole slide imaging (WSI) systems could accelerate and improve the diagnosis of malignant neoplasms without the need of on-site pathologist or transporting diagnostic material in-between different locations. The implementation of endobronchial ultrasound (EBUS) and endoscopic ultrasound (EUS) with fine needle aspiration (FNA) in diagnostic process of advanced lung cancer creates a new field for telepathology utilization. In selected patients, pathomorphological and genetic diagnosis may take less than a week and therapeutic decisions can be made in a short time. There are several important issues that concern the use of telepathology and WSI in everyday clinical environment. This short review presents the pros and cons of this technology and its applicability in rapid diagnosis of lung cancer, its utilization in connection with novel sampling methods and molecular analysis.Telepatologia to nowa forma procesu diagnostycznego wprowadzaj膮ca cyfryzacj臋 preparat贸w przygotowanych z bloczk贸w parafinowych lub wybarwionych rozmaz贸w cytologicznych. Wykorzystanie systemu skanowania ca艂ych preparat贸w mo偶e polepszy膰 i znacz膮co przyspieszy膰 diagnostyk臋 nowotwor贸w z艂o艣liwych bez wymaganej obecno艣ci patomorfologa w miejscu wykonywania diagnostyki oraz bez potrzeby transportowania pobranego materia艂u pomi臋dzy r贸偶nymi lokalizacjami. Wprowadzenie biopsji aspiracyjnej cienkoig艂owej (FNA) przeprowadzanej pod kontrol膮 przezoskrzelowego lub przezprze艂ykowego USG (EBUS lub EUS) do procesu diagnostycznego zaawansowanego raka p艂uca tworzy nowe pole do zastosowania telepatologii. U wybranych chorych diagnoza patomorfologiczna i genetyczna mo偶e trwa膰 poni偶ej tygodnia, a decyzje terapeutyczne mog膮 zosta膰 podj臋te w kr贸tkim czasie. Istnieje kilka istotnych kwestii zwi膮zanych z wykorzystaniem telepatologii oraz skanowania ca艂ych preparat贸w w codziennej praktyce klinicznej. Ten kr贸tki przegl膮d ma na celu przybli偶enie wad i zalet opisanej technologii i ich mo偶liwo艣ci wykorzystania w szybkiej diagnostyce raka p艂uca w po艂膮czeniu z nowoczesnymi metodami pobierania materia艂u i konieczno艣ci膮 prowadzenia diagnostyki genetycznej
Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) for staging of non-small-cell lung cancer (NSCLC)
Wst臋p: Celem pracy jest przeanalizowanie wynik贸w nowej techniki operacyjnej — rozszerzonej limfadenektomii 艣r贸dpiersia
z dost臋pu szyjnego (TEMLA) w diagnostyce przedoperacyjnej niedrobnokom贸rkowego raka p艂uca (NDRP).
Materia艂 i metody: Operacji dokonywano z ci臋cia szyjnego o d艂ugo艣ci 5-8 cm, z uniesieniem r臋koje艣ci mostka za pomoc膮
specjalnego retraktora, z obustronnym uwidocznieniem nerw贸w krtaniowych wstecznych oraz b艂臋dnych i wypreparowaniem
wszystkich stacji w臋z艂owych 艣r贸dpiersia, z wyj膮tkiem w臋z艂贸w wi臋zad艂a p艂ucnego (stacja 9).
Wyniki: W okresie od 1 stycznia 2004 roku do 31 stycznia 2010 roku zoperowano 698 chorych (577 m臋偶czyzn i 121 kobiet)
w 艣rednim wieku 62,8 roku (41-79), w tym 501 rak贸w p艂askonab艂onkowych, 144 raki gruczo艂owe, 25 rak贸w wielokom贸rkowych
i 28 pozosta艂ych. 艢redni czas operacji wyni贸s艂 128 minut (45-330 minut) w ca艂ej grupie, za艣 w grupie ostatnich 100
pacjent贸w 艣redni czas operacji wyni贸s艂 106 minut. 艢miertelno艣膰 30-dniowa wynios艂a 0,7% (z przyczyn niezwi膮zanych
bezpo艣rednio z zabiegiem), za艣 powik艂ania wyst膮pi艂y u 6,6% chorych. 艢rednia liczba usuni臋tych w臋z艂贸w ch艂onnych wynios艂a
37,9 (15-85). Przerzutowe w臋z艂y N2 i N3 stwierdzono u odpowiednio 21,8% (152/698) i 3,7% (26/698) chorych. Torakotomii
poddano 445/513 (86,7%) chorych po ujemnym wyniku TEMLA. W czasie torakotomii przeoczone przerzutowe w臋z艂y ch艂onne
N2 stwierdzono w 7/445 (1,6%) przypadkach. Czu艂o艣膰 diagnostyczna TEMLA w wykrywaniu przerzutowych w臋z艂贸w
艣r贸dpiersia wynios艂a 96,2%, swoisto艣膰 100%, dok艂adno艣膰 99,0%, negatywna warto艣膰 predykcyjna (NPV) 98,7%, a pozytywna
warto艣膰 predykcyjna (PPV) 100%.
Wnioski: Technika TEMLA jest now膮, minimalnie inwazyjn膮 metod膮 chirurgiczn膮, zapewniaj膮c膮 wyj膮tkow膮 mo偶liwo艣膰
wykonania bardzo rozleg艂ej, obustronnej limfadenektomii 艣r贸dpiersia i charakteryzuj膮c膮 si臋 bardzo wysok膮 warto艣ci膮 diagnostyczn膮.
Pneumonol. Alergol. Pol. 2011; 79, 3: 196-206Introduction: The aim of the study is to analyze diagnostic yield of the new surgical technique - the Transcervical
Extended Mediastinal Lymphadenectomy (TEMLA) in preoperative staging of Non-Small-Cell Lung Cancer (NSCLC)
Material and methods: Operative technique included 5-8 cm collar incision in the neck, elevation of the sternal manubrium
with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves and dissection of all mediastinal
nodal stations except of the pulmonary ligament nodes (station 9).
Results: 698 patients (577 men, 121 women), of mean age 62.8 (41-79) were operated on from 1.1.2004 to 31.1.2010,
including 501 squamous-cell carcinomas, 144 adenocarcinomas, 25 large cell carcinomas and 28 others. Mean operative
time was 128 min. (45 to 330 min) and 106.5 min. in the last 100 patients. 30-day mortality was 0.7 % (unrelated causes)
and morbidity 6.6%. The mean number of dissected nodes during TEMLA was 37.9 (15 to 85). Metastatic N2 and N3 nodes
were found in 152/698 (21.8%) and 26/698 patients (3.7%), respectively. Subsequent thoracotomy was performed in 445/513 patients (86.7%) after negative result of TEMLA. During thoracotomy, omitted N2 was found in 7/445 (1.6%) patients.
Sensitivity of TEMLA in discovery of metastatic N2-3 nodes was 96.2 %, specificity was 100%, accuracy was 99,0%,
Negative Predictive Value (NPV) was 98.7 % and Positive Predictive Value (PPV) was 100%.
Conclusions: TEMLA is a new minimally invasive surgical procedure providing unique possibility to perform very extensive,
bilateral mediastinal lymphadenectomy with very high diagnostic yield in staging of NSCLC
Pneumonol. Alergol. Pol. 2011; 79, 3: 196-20
Initial Polish experience of Flexible 19 gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration
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INTRODUCTION: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist鈥檚 feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
MATERIAL AND METHODS: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data.
RESULTS: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 卤 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details.
CONCLUSIONS: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable.
Initial Polish experience of flexible 19 gauge endobronchial ultrasound-guided transbronchial needle aspiration
Introduction: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist鈥檚 feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Material and methods: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. Results: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 卤 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. Conclusions: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable
Endoscopic ultrasound-guided needle aspiration in lung cancer
Introduction: The aim of the study was to assess the diagnostic yield of transoesophageal endoscopic ultrasound-guided
needle aspiration (EUS-NA) in lung cancer (LC).
Material and methods: Real time EUS-NA was performed under local anaesthesia and sedation in consecutive LC patients. All
negative EUS-NA results in NSCLC patients were verified by transcervical extended bilateral mediastinal lymphadenectomy (TEMLA).
Results: In 146 patients there were 206 biopsies performed in lymph node stations: subcarinal (7):124, left lower paratracheal (4L):70,
paraoesophageal (8):9 and pulmonary ligament (9):3. A mean short axis of punctured node was 10 ± 6.3 (95% CI) mm. Lymph node
biopsy was technically successful in 95.6% and was diagnostic in 40.1% of LC patients. In NSCLC staging, the sensitivity of EUS-NA
calculated on the per-patient basis was 85.5%, specificity 100%, accuracy 93.6% and negative predictive value (NPV) 89.7% in stations
accessible for EUS-NA, but in all mediastinal stations it was 70.7%, 100%, 84.3% and 74.7, respectively (p = 0.009). The sensitivity of
EUS-NA in NSCLC staging patients, calculated on the per-biopsy basis was 88.6%, specificity 100%, accuracy 95.4% and NPV 91.4%.
A diagnostic yield of EUS-NA on the per-biopsy basis was higher for station 4L than 7, but the difference was not significant (χ2 p = 0.4).
Conclusions: The diagnostic value of EUS-NA in LC is high. In NSCLC staging EUS-NA is insufficient and should be complemented
by other invasive techniques, especially those that give access to the right paratracheal region.Wst臋p: Celem pracy by艂a ocena skuteczno艣ci diagnostycznej przezprze艂ykowej biopsji w臋z艂贸w ch艂onnych 艣r贸dpiersia pod
kontrol膮 ultrasonografii wewn膮trzprze艂ykowej w czasie rzeczywistym (EUS-NA) w diagnostyce raka p艂uca.
Materia艂 i metody: U kolejnych chorych na raka p艂uca wykonywano EUS-NA w znieczuleniu miejscowym i p艂ytkiej sedacji.
U chorych na niedrobnokom贸rkowego raka p艂uca (NSCLC) i z ujemnym wynikiem EUS-NA wykonywano weryfikuj膮c膮
operacyjn膮 obustronn膮 rozszerzon膮 limfadenektomi臋 艣r贸dpiersiow膮.
Wyniki: U 146 chorych wykonano 206 EUS-NA w臋z艂贸w ch艂onnych 艣r贸dpiersia: w grupie 7 - 124, grupie 4L - 70, grupie 8
- 9 i grupie 9 - 3. Wymiar poprzeczny bioptowanych w臋z艂贸w ch艂onnych wynosi艂 10 ± 6,3 (95% CI) mm. Materia艂
diagnostyczny uzyskano w 95,6% nak艂u膰, a przerzuty raka p艂uca stwierdzono u 40,1% chorych. Czu艂o艣膰 metody EUS-NA w ustalaniu stopnia zaawansowania NSCLC w przeliczeniu na pacjenta (bior膮c pod uwag臋 wszystkie stacje w臋z艂贸w ch艂onnych
艣r贸dpiersia) wynios艂a 70,7%, swoisto艣膰 100%, dok艂adno艣膰 84,3%, a warto艣膰 predykcyjna wyniku ujemnego (NPV)
- 74,7%; natomiast w stacjach w臋z艂贸w ch艂onnych 艣r贸dpiersia osi膮galnych metod膮 EUS-NA wynios艂y odpowiednio: 85,5%, 100%, 93,6% i 89,7%. R贸偶nice pomi臋dzy obydwiema grupami by艂y znamienne statystycznie (p = 0,009). Czu艂o艣膰 metody
EUS-NA w ustalaniu stopnia zaawansowania NSCLC w przeliczeniu na biopsj臋 wynios艂a 88,6%, swoisto艣膰 100%, dok艂adno艣膰
95,4%, a NPV - 91,4%. Skuteczno艣膰 diagnostyczna metody EUS-NA by艂a wi臋ksza w grupie 4L ni偶 w grupie 7, jednak
r贸偶nice nie by艂y znamienne (p = 0,4).
Wnioski: Skuteczno艣膰 diagnostyczna metody EUS-NA w diagnostyce raka p艂uca jest du偶a. W ocenie stopnia zaawansowania
niedrobnokom贸rkowego raka p艂uca EUS-NA mo偶e nie by膰 wystarczaj膮ca i nale偶y j膮 uzupe艂ni膰 o inne metody eksploracji
艣r贸dpiersia, zw艂aszcza umo偶liwiaj膮ce dost臋p do okolicy przytchawiczej prawej