The diagnostic value of narrow-band imaging for early and invasive lung cancer: a meta-analysis

This study aimed to compare the ability of narrow-band imaging to detect early and invasive lung cancer with that of conventional pathological analysis and white-light bronchoscopy. We searched the PubMed, EMBASE, Sinomed, and China National Knowledge Infrastructure databases for relevant studies. Meta-disc software was used to perform data analysis, meta-regression analysis, sensitivity analysis, and heterogeneity testing, and STATA software was used to determine if publication bias was present, as well as to calculate the relative risks for the sensitivity and specificity of narrow-band imaging vs those of white-light bronchoscopy for the detection of early and invasive lung cancer. A random-effects model was used to assess the diagnostic efficacy of the above modalities in cases in which a high degree of between-study heterogeneity was noted with respect to their diagnostic efficacies. The database search identified six studies including 578 patients. The pooled sensitivity and specificity of narrow-band imaging were 86% (95% confidence interval: 83-88%) and 81% (95% confidence interval: 77-84%), respectively, and the pooled sensitivity and specificity of white-light bronchoscopy were 70% (95% confidence interval: 66-74%) and 66% (95% confidence interval: 62-70%), respectively. The pooled relative risks for the sensitivity and specificity of narrow-band imaging vs the sensitivity and specificity of white-light bronchoscopy for the detection of early and invasive lung cancer were 1.33 (95% confidence interval: 1.07-1.67) and 1.09 (95% confidence interval: 0.84-1.42), respectively, and sensitivity analysis showed that narrow-band imaging exhibited good diagnostic efficacy with respect to detecting early and invasive lung cancer and that the results of the study were stable. Narrow-band imaging was superior to white light bronchoscopy with respect to detecting early and invasive lung cancer; however, the specificities of the two modalities did not differ significantly.

To compare the surgery indicators of early lung cancer patients between video-assisted thoracoscopic surgery and thoracotomy / 中国医学装备

Objective:To compare the surgery indicators of early lung cancer patients between video-assisted thoracoscopic surgery and thoracotomy in order to provide suggestion for surgery scheme.Methods: 126 early lung cancer patients, from March 2014 to January 2016 stayed in our hospital, were chosen as observation object. They were divided in control group (63 cases, thoracotomy) and observation group (63 cases, video-assisted thoracoscopic surgery), and to compare series of surgery indicators, IL-6 and TNF-α between the two groups.Results: The operating time and blood loss of observation group were lower, and the dissected lymph node number of observation group was higher than control group, respectively, and both of the differences were statistical significant (t=6.568,t=3.096, P<0.05;t=3.659,P<0.05); the hospital stay, catheter-retaining time and pain score of observation group were lower than control group, and the differences also were statistical significant (t=15.850,t=12.379,t=10.272;P<0.05); the differences of IL-6 and TNF-α between two groups were no statistical significant before treatment, and both of them reduced after treatment; both of the IL-6 and TNF-αof observation group were lower than control group (t=13.073, t=1.629;P<0.05); on the other hand, the total rate of complications of observation group, such as pneumonia, pulmonary atelectasis and arrhythmia, were higher than control group (x2=0.208, x2=2.800,x2=0.341;P<0.05). Conclusion: Early lung cancer patients are more suitable for video assisted thoracoscopic surgery, and its effect is better and is more conducive to the rehabilitation of patients after surgery.

Diagnostic value of combination detection of CEA,CYFR21-1,NSE in bronchoalveolar lavage fluid for early lung cancer / 国际检验医学杂志

Objective To explore the diagnostic value of combination detection of carcino‐embryonic antigen(CEA ) ,cytokeratin 19 fragment 21‐1(CYFR21‐1) ,neuron‐specific enolase(NSE) in bronchoalveolar lavage fluid (BALF) for early lung cancer and its correlation with clinical effects .Methods 69 cases of lung cancer were included into the lung cancer group and 50 cases of benign pulmonary disease were included into the lung benign disease group .All the patients were given bronchoalveolar lavage(BAL) .The chemiluminescence immunoassay was adopted to detect the levels of CEA ,CYFR21‐1 and NSE in BALF .The changes of tumor markers levels were compared between the two groups and among different clinical curative effects in the patients with lung cancer . Results The levels of CEA ,CYFR21‐1 and NSE in BALF of the lung cancer group were significantly higher than those of the be‐nign pulmonary disease group ,the difference was statistically significant (P < 0 .05) .The levels of tumor markers in the stage Ⅱ of lung cancer were higher than those in the stage Ⅰ of lung cancer ,the difference was statistically significant (P< 0 .05) ;the levels of CEA ,CYFR21‐1 and NSE in BALF were gradually increased with the decrease of clinical effect (P< 0 .05) ;the sensitivity and spe‐cificity of the combined detection of three tumor markers were 62 .3% and 82 .0% respectively ,which were significantly higher than those of any single tumor marker (P< 0 .05) .Conclusion The levels of CEA ,CYFR21‐1 and NSE in BALF of early lung cancer patients are obviously increased ,moreover which is closely correlated with the pathological stage of lung cancer ,the combined detec‐tion could contribute to improve the detection rate of early lung cancer and guide the evaluation of clinical effect .

Stereotactic body radiotherapy in early stage non-small cell lung cancer: First experience from an Indian Centre.

BACKGROUND: Surgery is the standard of care for early stage (T1-2, N0, M0) non-small cell lung cancer. A considerable number of these patients are ineligible for surgery due to age and comorbidities. Hypo fractionated high-dose stereotactic body radiotherapy (SBRT) is being performed for these group of patients. There is paucity of literature regarding this novel technique from the Indian subcontinent. AIMS AND OBJECTIVES: We hereby report the dosimetry, response and outcome of our small cohort of early stage non-small cell lung cancer patients treated with SBRT. MATERIALS AND METHODS: Between December 2007 and December 2010, 8 patients of early stage (T1-2N0M0) underwent SBRT at our centre. All the patients had undergone whole body PET-CT scan, MRI brain and pulmonary function test (PFT with DLCO). The SBRT schedules included 48 Gy in 6 fractions for peripherally located and 48 Gy in 8 fractions for centrally located tumors. Response and toxicity were assessed in 3 monthly follow up visits. RESULTS: The median duration of follow up was 18 months (range 8-44 months). The median age of the patients was 70 years (range 63-82 years) and the median tumor diameter was 4 cm (range 2.8-5.0 cm). The mean PTV volume was 165 cc(range 127.3- 193.9 cc). The mean dose to the PTV was 99.5% (range 97.7- 102.1%). After 3 months, 7 patients had complete metabolic response and 1 patient had partial metabolic response. Overall survival at 1.5 years was 87.5%. One patient had grade 2 pneumonitis. No toxicities of grade 3 or higher were identified. CONCLUSION: SBRT for early stage NSCLC resulted in excellent local control with minimal toxicity and can be considered as a treatment option in properly selected patients.

Histopathologic Findings, and p53 and K-ras Mutational Analysis in Biopsy Specimens Using Fluorescence Bronchoscopy

A fluorescence bronchoscope system has been developed for detecting early lung cancer including dysplasia and carcinoma in situ. To determine the histologic findings and genetic alterations of the lung tissues, which were biopsied by the fluorescence bronchoscope, we analyzed 104 specimens from 62 heavy smokers for their histopathology, cell proliferation index, and genetic mutations of p53 and K-ras. We used immunohistochemistry for MIB-1 and p53, and PCR-SSCP and direct DNA sequencing for p53 and K-ras. The histology was variable from reactive conditions to invasive cancers, and consisted of basal cell hyperplasia (26.9%), dysplasia (4.8%), carcinoma in situ (1.9%), squamous cell carcinoma (7.7%), adenocarcinoma (4.8%), and small cell carcinoma (10.6%). The cellular proliferation index of the lesions increased as their aggressiveness increased. p53 and K-ras mutations were detected in 33.7% and 14.4% of all tissues, respectively. In dysplasia, p53 and K-ras mutations were observed in 3 of 5 and in 2 of 5 tissues, respectively. However, these genetic alterations were not found in carcinoma in situ. Interestingly, 28.6% of basal cell hyperplasia showed p53 mutations. In conclusion, these data suggest that the biopsy specimens using fluorescence bronchoscopy show variable histologic findings, ranging from reactive conditions to invasive cancers. In addition, some of the dysplastic lesions are related to p53 and K-ras mutations, although these genetic alterations are also seen in basal cell hyperplasia.

A Case of Visceral Botryomycosis Accompanied by Early Lung Cancer / 대한내과학회지

Botryomycosis is a rare, chronic and suppurative di- sease that is often mistaken clinically and histologically for a fungal infection, because the histologic feature shows a cluster of bacteria found within an eosinophilic matrix or capsule, giving the appearance of granules mimicking the sulfur granules of actinomycosis. Staphy- lococcus aureus is the most common organism cultured from lesions of botryomycosis, but other bacteria have also been isolated and implicated, including Psudomonas aeruginosa, E. coli, Proteus spp., Bacillus spp.. In some case, multiple pathogenic bacteria were found on cul ture. This disease has two patterns of organ involve ment. The more common type is cutaneous type, which involves the skin, subcutaneous soft tissue, muscle and bone. The other is visceral type which involves the lungs, liver, tongue, orbit, bowel, brain, kidney or pros tate. We report a case of brain and pulmonary botry omycosis in a 60 year-old man, who have early lung cancer. Botryomycosis was diagnosed by brain mass removal, PCNA and bronchoscopy, and lung cancer was detected incidentally by bronchoscope. The patient was treated with the Penicillin G after operation of brain mass, and right pneumonectomy was done.