8 research outputs found

    Szybka diagnostyka patomorfologiczna i molekularna chorych na raka p艂uca na podstawie techniki telepatologii

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    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

    Transbronchial lung cryobiopsy guided by radial mini-probe endobronchial ultrasound in interstitial lung diseases 鈥 a multicenter prospective study

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    Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). A聽general anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it鈥檚 safety could result in wider use.Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without a聽guide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5鈥8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels.Results: From March 2017 to September 2019 鈥 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring a聽chest tube drainage and a聽minor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers.Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

    Transbronchial lung cryobiopsy guided by radial "mini-probe" endobronchial ultrasound in interstitial lung diseases - a multicenter prospective study

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    Introduction: Transbronchial lung cryobiopsy (TBLC) is commonly used in diagnosing interstitial lung diseases (ILDs). Ageneral anesthesia with endotracheal intubation, balloon blockers and fluoroscopy control is the most common modality. Simplifying the procedure without decreasing it鈥檚 safety could result in wider use. Prospective, observational study was conducted in three Polish pulmonology centers to evaluate safety and diagnostic yield of TBLC under conscious sedation, without intubation and bronchial blockers and with radial-EBUS guidance instead of fluoroscopy. Material and methods: In patients suspected of ILD, in accordance with high resolution computer tomography (HRCT) selected lung segments were examined with radial-EBUS mini probe without aguide sheath. If the lung infiltrations were visible this locations were preferred. If not, specimens were taken from two different segments of the same lobe. Two to five biopsies with freezing time 5鈥8 seconds were performed. Moreover ultrasound examination was used to avoid injury of lung vessels. Results: From March 2017 to September 2019 鈥 114 patients (M: 59, F: 55) of mean (SD) age 54 (14) years were included to the study on the basis of medical history and HRCT. Histopathology was conclusive in 90 (79%) patients and included 16 different diagnoses (sarcoidosis, EAA, COP predominantly). 24 inconclusive biopsies of unclassifiable pulmonary fibrosis were followed up. Complications included five cases (4.4%) of pneumothorax requiring achest tube drainage and aminor and moderate bleeding in few cases. There was no need for use of balloon bronchial blockers. Conclusions: TBLC under conscious sedation guided by radial EBUS mini-probe is novel, reasonable and safe technique for histological diagnosis of ILDs

    The Delayed Risk Stratification System in the Risk of Differentiated Thyroid Cancer Recurrence.

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    CONTEXT:There has been a marked increase in the detection of differentiated thyroid carcinoma (DTC) over the past few years, which has improved the prognosis. However, it is necessary to adjust treatment and monitoring strategies relative to the risk of an unfavourable disease course. MATERIALS AND METHODS:This retrospective study examined data from 916 patients with DTC who received treatment at a single centre between 2000 and 2013. The utility of the American Thyroid Association (ATA) and the European Thyroid Association (ETA) recommended systems for early assessment of the risk of recurrent/persistent disease was compared with that of the recently recommended delayed risk stratification (DRS) system. RESULTS:The PPV and NPV for the ATA (24.59% and 95.42%, respectively) and ETA (24.28% and 95.68%, respectively) were significantly lower than those for the DRS (56.76% and 98.5%, respectively) (p<0.0001). The proportion of variance for predicting the final outcome was 15.8% for ATA, 16.1% for ETA and 56.7% for the DRS. Recurrent disease was rare (1% of patients), and was nearly always identified in patients at intermediate/high risk according to the initial stratification (9/10 cases). CONCLUSIONS:The DRS showed a better correlation with the risk of persistent disease than the early stratification systems and allows personalisation of follow-up. If clinicians plan to alter the intensity of surveillance, patients at intermediate/high risk according to the early stratification systems should remain within the specialized centers; however, low risk patients can be referred to endocrinologists or other appropriate practitioners for long-term follow-up, as these patients remained at low risk after risk re-stratification
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