Características clínicas epidemiológicas de los pacientes con cáncer de pulmón en la provincia Camagüey 2017-2021

Introducción: El cáncer de pulmón es una de las enfermedades más graves y uno de los cánceres con mayor incidencia en las personas, responsable de los mayores índices de mortalidad oncológica a escala mundial. Objetivo: Analizar las características clínicas epidemiológicas de los pacientes con cáncer de pulmón. Métodos: Se realizó un estudio observacional descriptivo retrospectivo, con el objetivo de analizar las características clínicas epidemiológicas de los pacientes con el diagnóstico de cáncer de pulmón atendido en el Hospital Oncológico María Curie durante el quinquenio de enero de 2017 a diciembre de 2021. El universo de estudio incluyó a los 822 pacientes que fueron atendidos en el hospital durante el período antes señalado, con cáncer de pulmón. La muestra a discreción la conformaron 276 pacientes. Resultados: Predominio del cáncer de pulmón en los pacientes de 61 a 80 años de edad, sexo masculino, fumadores pasivos. La variedad cito-histológica con mayor incidencia fue el carcinoma de células pequeñas microcítico; debut de esta enfermedad en pacientes en estadio IV y con tratamiento recibido de radioterapia y quimioterapia en el 100 % de los pacientes. Conclusiones: Es un tumor predominante entre las neoplasias malignas, donde el diagnóstico oportuno permite tratar en estadios tempranos, lo cual favorece la sobrevida en pacientes.

Introduction: Lung cancer is one of the most serious diseases and one of the cancers with the highest incidence in people, responsible for the highest oncological mortality rates worldwide. Objective: To analyze the clinical-epidemiological characteristics of patients with lung cancer. Methods: A retrospective descriptive observational study was carried out, with the objective of analyzing the epidemiological clinical characteristics of patients diagnosed with lung cancer treated at the María Curie Oncological Hospital during the five-year period from January 2017 to December 2021. The universe of study included 822 patients who were treated in the hospital during the aforementioned period with lung cancer. The sample at discretion was made up of 276 patients. Results: Prevalence of lung cancer in patients between 61 and 80 years of age, male, passive smokers. The cyto-histological variety with the highest incidence was small cell microcytic carcinoma; debut of this disease in patients in stage IV and with treatment received with radiotherapy and chemotherapy in 100% of the patients. Conclusions: It is a predominant tumor among malignant neoplasms, where timely diagnosis allows treatment in early stages, which favors survival in patients.

Resultados del tratamiento quirúrgico de pacientes con cáncer pulmonar / Results of surgical treatment of patients with lung cancer

RESUMEN Fundamento: la incidencia de cáncer de pulmón en la provincia Sancti Spíritus es alta y su diagnóstico por lo general, se realiza en etapas avanzadas por lo cual el tratamiento quirúrgico no siempre es posible. Objetivo: analizar las principales características y resultados de los pacientes operados por cáncer de pulmón. Métodos: se realizó un estudio observacional descriptivo de corte transversal en el servicio de Cirugía General del Hospital Universitario General Camilo Cienfuegos en la provincia Sancti Spiritus en el período comprendido entre enero de 1996 y diciembre de 2019. El universo consistió en 83 pacientes operados con cáncer de pulmón que se sometieron a resección acompañados de muestreo de ganglios linfáticos mediastinales. Resultados: el sexo masculino predominó en el grupo estudiado. Los grupos de edades más frecuentes para ambos sexos fueron los de 51 a 60 años y los mayores de 60 años. El hábito de fumar estuvo presente en la mayoría de los pacientes. La localización tumoral más predominó fue en los lóbulos superiores y la lobectomía fue la técnica más realizada. Las etapas patológicas que predominaron fueron la lB y llB, seguidas de la lllA. El carcinoma de células escamosas fue el tipo histológico más frecuente. Las atelectasias y las infecciones respiratorias fueron las complicaciones más frecuentes. Los fallecidos fueron pocos. Conclusiones: las características demográficas de los pacientes estudiados se corresponden a otras series de pacientes con cáncer del pulmón. La localización tumoral en los lóbulos superiores, el carcinoma epidermoide, así como las etapas tempranas, predominaron en la serie estudiada. La lobectomía fue la técnica quirúrgica que se utilizó con mayor frecuencia y dentro de las complicaciones, las respiratorias fueron las más frecuentes.

ABSTRACT Background: the incidence of lung cancer in the province of Sancti Spíritus is high and its diagnosis is usually made in advanced stages, for which surgical treatment is not always possible. Objective: to analyze the main characteristics and results of patients operated on for lung cancer. Methods: a cross-sectional descriptive observational study was carried out in the General Surgery service of the Camilo Cienfuegos General University Hospital in the Sancti Spiritus province in the period between January 1996 and December 2019. The universe consisted of 83 patients operated with lung cancer who underwent resection accompanied by mediastinal lymph node sampling. Results: the male sex predominated in the studied group. The most frequent age groups for both sexes were those from 51 to 60 years old and those over 60 years old. Smoking was present in most of the patients. The most frequent tumor location was in the upper lobes and lobectomy was the most performed technique. The pathological stages that predominated were lB and llB, followed by lllA. Squamous cell carcinoma was the most frequent histological type. Atelectasis and respiratory infections were the most frequent complications. The deceased were few. Conclusions: the demographic characteristics of the patients studied correspond to other series of patients with lung cancer. Tumor location in the upper lobes, squamous cell carcinoma, as well as early stages, predominated in the series studied. Lobectomy was the most frequently used surgical technique and among complications, respiratory ones were the most frequent.

Factors associated with diagnosis of stages I and II lung cancer: a multivariate analysis

ABSTRACT OBJECTIVE To present the overall survival rate for lung cancer and identify the factors associated with early diagnosis of stage I and II lung cancer. METHODS This is a retrospective cohort study including individuals diagnosed with lung cancer, from January 2009 to December 2017, according to the cancer registry at UMass Memorial Medical Center. Five-year overall survival and its associated factors were identified by Kaplan-Meier curves and Cox's proportional hazards model. Factors associated with diagnosing clinical stage I and II lung cancer were identified by bivariate and multivariate backward stepwise logistic regression (Log-likelihood ratio (LR)) at 95% confidence interval (CI). RESULTS The study was conducted with data on 2730 individuals aged 67.9 years on average, 51.5% of whom female, 92.3% white, and 6.6% never smoked. Five-year overall survival was 21%. Individuals diagnosed with early-stage disease had a 43% five-year survival rate compared to 8% for those diagnosed at late stages. Stage at diagnosis was the main factor associated with overall survival [HR = 4.08 (95%CI: 3.62-4.59)]. Factors associated with early diagnosis included patients older than 68 years [OR = 1.23 (95%CI: 1.04-1.45)], of the female gender [OR = 1.47 (95%CI: 1.24-1.73)], white [OR = 1.63 (95%CI: 1.16-2.30)], and never-smokers [OR = 1.37 (95%CI: 1.01-1.86)]; as well as tumors affecting the upper lobe [OR = 1.46 (95%CI: 1.24-1.73)]; adenocarcinoma [OR = 1.43 (95%CI: 1.21-1.69)]; and diagnosis after 2014 [OR = 1.61 (95%CI: 1.37-1.90)]. CONCLUSIONS Stage at diagnosis was the most decisive predictor for survival. Non-white and male individuals were more likely to be diagnosed at a late stage. Thus, promoting lung cancer early diagnosis by improving access to health care is vital to enhance overall survival for individuals with lung cancer.

Multiple cavitary lung lesions on CT: imaging findings to differentiate between malignant and benign etiologies / Lesões escavadas pulmonares múltiplas em TC: achados de imagem para diferenciação entre etiologia maligna e benigna

ABSTRACT Objective: To determine the CT findings of multiple cavitary lung lesions that allow the differentiation between benign and malignant etiologies. Methods: We reviewed CT scans, including patients with two or more cavitary lung lesions. We evaluated the number of cavitary lesions, their location, cavity wall thickness, and additional findings, correlating the variables with the diagnosis of a benign or malignant lesion. Results: We reviewed the chest CT scans of 102 patients, 58 (56.9%) of whom were male. The average age was 50.5 ± 18.0 years. Benign and malignant lesions were diagnosed in 74 (72.6%) and 28 (27.4%) of the patients, respectively. On the CT scans, the mean number of cavities was 3, the mean wall thickness of the largest lesions was 6.0 mm, and the mean diameter of the largest lesions was 27.0 mm. The lesions were predominantly in the upper lobes, especially on the right (in 43.1%). In our comparison of the variables studied, a diagnosis of malignancy was not found to correlate significantly with the wall thickness of the largest cavity, lymph node enlargement, emphysema, consolidation, bronchiectasis, or bronchial obstruction. The presence of centrilobular nodules correlated significantly with the absence of malignant disease (p < 0.05). In contrast, a greater number of cavities correlated significantly with malignancy (p < 0.026). Conclusions: A larger number of cavitary lung lesions and the absence of centrilobular nodules may be characteristic of a malignant etiology. However, on the basis of our evaluation of the lesions in our sample, we cannot state that wall thickness is a good indicator of a benign or malignant etiology.

RESUMO Objetivo: Determinar os achados tomográficos de lesões escavadas pulmonares múltiplas que contribuem para a diferenciação entre etiologia benigna e maligna. Métodos: Foram revisados exames de TC, sendo incluídos pacientes com duas ou mais lesões pulmonares escavadas. Avaliaram-se a quantidade de lesões escavadas, sua localização, espessura parietal das lesões e achados adicionais, correlacionando as variáveis com a presença de diagnóstico de benignidade ou de malignidade. Resultados: Foram revisadas TCs de tórax de 102 pacientes, sendo 58 (56,9%) desses do sexo masculino. A média de idade foi de 50,5 ± 18,0 anos. Lesões benignas e malignas foram diagnosticadas em 74 pacientes (72,6%) e em 28 (27,4%), respectivamente. Quanto aos achados tomográficos, a média do número de cavidades foi 3, a da espessura média da parede da maior lesão foi de 6,0 mm, e a do diâmetro da maior lesão foi de 27,0 mm. Houve predomínio das lesões em lobos superiores, especialmente no direito (43,1%). Após a comparação das variáveis estudadas, a espessura parietal da maior escavação, assim como a presença de linfonodomegalia, enfisema, consolidação, bronquiectasias e obstrução brônquica, não apresentaram diferenças estatisticamente significativas para o diagnóstico de malignidade. A presença de nódulos centrolobulares correlacionou-se significativamente com a ausência de doença maligna (p < 0,05). Observou-se também que um número maior de cavidades se correlacionou significativamente com malignidade (p < 0,026). Conclusões: Um maior número de lesões pulmonares escavadas e a ausência de nódulos centrolobulares podem ser características relacionadas à etiologia maligna. Por outro lado, a espessura parietal não permitiu a diferenciação entre etiologia benigna e maligna das lesões em nossa amostra.

EBUS-TBNA versus surgical mediastinoscopy for mediastinal lymph node staging in potentially operable non-small cell lung cancer: a systematic review and meta-analysis / EBUS-TBNA versus mediastinoscopia cirúrgica no estadiamento linfonodal mediastinal do câncer de pulmão de células não pequenas potencialmente operável: revisão sistemática e meta-análise

ABSTRACT Objective: Lung cancer (LC) is one of the leading causes of death worldwide. Accurate mediastinal staging is mandatory in order to assess prognosis and to select patients for surgical treatment. EBUS-TBNA is a minimally invasive procedure that allows sampling of mediastinal lymph nodes (LNs). Some studies have suggested that EBUS-TBNA is preferable to surgical mediastinoscopy for mediastinal staging of LC. The objective of this systematic review and meta-analysis was to compare EBUS-TBNA and mediastinoscopy in terms of their effectiveness for mediastinal LN staging in potentially operable non-small cell lung cancer (NSCLC). Methods: This was a systematic review and meta-analysis, in which we searched various databases. We included studies comparing the accuracy of EBUS-TBNA with that of mediastinoscopy for mediastinal LN staging in patients with NSCLC. In the meta-analysis, we calculated sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. We also analyzed the risk difference for the reported complications associated with each procedure. Results: The search identified 4,201 articles, 5 of which (with a combined total of 532 patients) were selected for inclusion in the meta-analysis. There were no statistically significant differences between EBUS-TBNA and mediastinoscopy in terms of the sensitivity (81% vs. 75%), specificity (100% for both), positive likelihood ratio (101.03 vs. 95.70), or negative likelihood ratio (0.21 vs. 0.23). The area under the summary ROC curve was 0.9881 and 0.9895 for EBUS-TBNA and mediastinoscopy, respectively. Although the number of complications was higher for mediastinoscopy, the difference was not significant (risk difference: −0.03; 95% CI: −0.07 to 0.01; I2 = 76%). Conclusions: EBUS-TBNA and mediastinoscopy produced similar results for mediastinal staging of NSCLC. EBUS-TBNA can be the procedure of first choice for LN staging in patients with NSCLC.

RESUMO Objetivo: O câncer de pulmão (CP) é uma das principais causas de morte no mundo. Um estadiamento mediastinal preciso é obrigatório para avaliação do prognóstico e seleção de pacientes para tratamento cirúrgico. EBUS-TBNA é um procedimento minimamente invasivo que permite a amostragem de linfonodos mediastinais. Alguns estudos sugerem que a EBUS-TBNA é preferível que a mediastinoscopia cirúrgica no estadiamento mediastinal do CP. O objetivo desta revisão sistemática e meta-análise foi comparar a eficácia da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal do câncer de pulmão de células não pequenas (CPCNP) potencialmente operável. Métodos: Foram pesquisados diversos bancos de dados. Estudos comparando a precisão da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal em pacientes com CPCNP foram incluídos. Na meta-análise, foram calculadas sensibilidade e especificidade, bem como razões de verossimilhança positiva e negativa. A diferença de risco de complicações relatadas para cada procedimento também foi analisada. Resultados: A pesquisa identificou 4.201 artigos, dos quais 5 foram selecionados para a meta-análise (total combinado de 532 pacientes). Não houve diferenças estatisticamente significativas entre EBUS-TBNA e mediastinoscopia: sensibilidade (81% vs. 75%), especificidade (100% para ambas), razão de verossimilhança positiva (101,03 vs. 95,70) e razão de verossimilhança negativa (0,21 vs. 0,23). A área sob a curva summary ROC para EBUS-TBNA e para mediastinoscopia foi de 0,9881 e 0,9895, respectivamente. Embora o número de complicações tenha sido maior para mediastinoscopia, não foi encontrada diferença significativa (diferença de risco: −0,03; IC95%: −0,07 to 0,01; I2 = 76%). Conclusões: EBUS-TBNA e mediastinoscopia apresentaram resultados semelhantes no estadiamento mediastinal do CPCNP. EBUS-TBNA pode ser o procedimento de primeira escolha no estadiamento linfonodal em pacientes com CPCNP.

El cáncer del pulmón: algunas consideraciones epidemiológicas, del diagnóstico y el tratamiento / Lung cancer: some epidemiologic, diagnoses and treatment considerations

RESUMEN Fundamento: el cáncer es una de las causas principales de muerte alrededor del mundo. En el año 2012 hubo 14 millones de casos nuevos, así como 8,2 millones de muertes relacionadas. Dentro de todas las localizaciones del cáncer, es el pulmón el de mayor incidencia y mortalidad para el hombre y en el caso de la mujer ocupa el segundo lugar. Objetivos: realizar una actualización en aspectos epidemiológicos, del diagnóstico, así como del tratamiento del cáncer pulmonar a nivel global, regional y local. Métodos: se realizó una búsqueda en las bases de datos Pub Med, SciELO, Medline, Cochrane, Lilacs, mediante EndNote y Clinical Key, en un período desde el primero de septiembre al 15 de diciembre de 2017. Se emplearon las palabras claves: lung cancer, epidemiology, diagnostic, treatment, screening. Se realizó una revisión bibliográfica de un total 302 artículos de ellos se utilizaron 40 citas la mayoría de ellas de los últimos tres y cinco años. Se consideraron para la revisión, artículos originales, revisiones a texto completo, así como artículos de opinión. Desarrollo: se abordaron aspectos del cáncer pulmonar relacionados con estadísticas globales, regionales y locales, así como de los indicadores de impacto, aspectos relacionados con el diagnóstico precoz a través del tamizaje y elementos novedosos de ensayos clínicos relacionados con la aplicación de la vacuna CIMAvax-EGF. Conclusiones: con el elevado aporte del cáncer de pulmón a la morbilidad y mortalidad general en Cuba y en particular en la provincia de Camagüey, así como el consecuente impacto negativo en la duración y calidad de vida de la población, se considera pertinente y necesario el diseño de un programa integral asistencial organizacional para atender a pacientes con esta terrible y letal enfermedad.

ABSTRACT Background: cancer is one of the leading causes of death around the world. In 2012, there were 14 million of new cases, as well as 8.2 million related deaths. Within all cancer locations, the lung is the one with the highest incidence and mortality for men and in the case of women, it occupies the second place. Objectives: to carry out an update on epidemiological aspects of diagnosis, as well as the treatment of lung cancer at a global, regional and local level. Methods: a search on Pub Med, SciELO, Medline, Cochrane, Lilacs databases using EndNote and Clinical Key was carried out, from September 1 to December 15, 2017. The following keywords were used: lung cancer, epidemiology, diagnostic, treatment, screening. A bibliographic review of a total of 302 articles was made, of them 40 citations were used, most of them from the last three and five years. Original articles, full-text reviews, as well as opinion articles were considered for the review. Development: aspects of lung cancer, related to global, regional and local statistics, as well as impact indicators, aspects related to early diagnosis through screening and novel elements of clinical trials related to the application of the vaccine CIMAvax-EGF were addressed. Conclusions: with the high contribution of lung cancer to morbidity and general mortality in Cuba and in particular in Camagüey province, as well the negative consequent impact on the duration and quality of life of the population, it is considered necessary to design a comprehensive organizational assistance program to care for patients with this terrible and lethal disease.

Lung cancer in Brazil / Câncer de pulmão no Brasil

ABSTRACT Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

RESUMO O câncer de pulmão é um dos tipos de câncer com maior incidência e uma das principais causas de mortalidade por câncer no Brasil. Revisamos a situação atual do câncer de pulmão por meio de pesquisa de dados relevantes a respeito de prevenção, diagnóstico e tratamento no país. Esta revisão mostra várias questões que precisam de atenção, tais como controle do tabagismo, educação dos pacientes, desconhecimento por parte dos pacientes, diagnóstico tardio e desigualdade de acesso ao tratamento de câncer no Brasil. Propomos estratégias para ajudar a superar essas limitações e desafiamos os profissionais de saúde, a sociedade e os representantes do governo a trabalhar em conjunto e dar um passo à frente na luta contra o câncer de pulmão.

Impacto do 18F-FDG PET/CT no estadiamento de pacientes com câncer de pulmão: chave para melhorar o tratamento / The impact of 18F-FDG PET/CT in staging of non-small cell lung cancer patients: the key to improve patient treatment strategy

O câncer de pulmão lidera a causa de mortes relacionadas ao câncer em homens e mulheres em todo o mundo. O mais comum é o câncer do pulmão de células não pequenas (NSCLC), sendo essencial o seu estadiamento preciso para a escolha do tratamento. A tomografia por emissão de pósitrons (PET) com 18F-fluorodeoxiglicose (18F-FDG) pode fornecer informações molecular e metabólica que, quando adquiridas simultaneamente com tomografia computadorizada (TC), constituemse instrumento muito útil no diagnóstico e no estadiamento do câncer. O estadiamento do câncer de pulmão é importante para evitar cirurgias desnecessárias, e reduzir a morbidade e os custos do tratamento. Este estudo objetivou analisar o impacto da 18F-FDG PET/TC na avaliação de pacientes com NSCLC na realidade brasileira. Foram incluídos 26 pacientes com diagnóstico histopatológico de NSCLC que foram submetidos a estadiamento em dois momentos com: 1. Imagens morfológicas (raios-x e TC); 2. 18F-FDG PET/CT. A 18F-FDG PET/CT mudou 30% o estadiamento linfonodal classificado como operável com alta sensibilidade e valor preditivo negativo. Em relação ao estádio de metástase, a 18F-FDG PET/CT aumentou em 11,5% a detecção de metástases não detectadas. A 18F-FDG PET/CT reduziu significativamente o número de pacientes classificados como operáveis, evitando a realização de toracotomia desnecessária em 19,2% dos casos. A informação metabólica obtida pela 18F-FDG PET/CT demonstrou melhor precisão quando comparada com métodos anatômicos na detecção de linfonodos e metástases à distância. Assim, demonstra impacto importante na estratégia e nos custos relacionados com o tratamento.

Lung cancer leads the cause of cancer-related deaths in men and women around the world. The most common is non-small cell lung cancer (NSCLC). Fast and accurate staging is essential for choosing treatment for NSCLC. The positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) can provide molecular and metabolic information, which acquired simultaneously with computed tomography (CT), has proved to be a very useful tool in the cancer diagnosis and staging. Identifying the stage of lung cancer is important to avoid unnecessary surgeries, reducing morbidity and treatment costs. This study aims to examine the impact of 18F-FDG PET/CT in the initial evaluation of patients with NSCLC in the Brazilian reality. Twenty-six patients with histopathologic diagnosis of NSCLC were included. They underwent staging in two separated moments: first with morphological images (x-ray and computed tomography scan) and after with 18F-FDG PET/CT. The performance of 18F-FDG PET/CT changed lymph node staging in around 30% of the patients initially classified as potentially operable, with high sensitivity and negative predictive values. Regarding the stage of metastasis, 18F-FDG PET/CT increased by 11.5% the detection of metastasis not previously detected. About the clinical staging, using the 18F-FDG PET/CT significantly reduced the number of patients classified as potentially operable in the early stages, avoiding the use of unnecessary thoracotomies in 19.2% of patients. The metabolic information obtained by 18F-FDG PET/CT demonstrated better accuracy when comparated to anatomic methods in the detection of lymph node and distant metastases. Thus, having important impact on therapeutic strategy and treatment cost related.

Rendimento diagnóstico de câncer de pulmão por intermédio de fibrobroncoscopia e tomografia / Diagnostic efficiency of lung cancer by fiberoptic bronchoscopy and tomography

JUSTIFICATIVA E OBJETIVO: Analisar a tomografia computadorizada e a broncoscopia, no diagnóstico da neoplasia pulmonar, e avaliar a acurácia dessas técnicas diante da presença de carcinoma. Correlacionar dados epidemiológicos, como idade, gênero, hábitos tabágicos e tipos histológicos. A justificativa implica na necessidade da correlação entre o método de imagem e broncoscópico para o diagnóstico preciso de carcinoma pulmonar, doença esta que apresenta elevada mortalidade. MÉTODOS: Estudo documental, observacional, transversal e retrospectivo. Foram analisados, entre junho de 2009 a junho de 2011, os prontuários de 234 pacientes internados que realizaram fibrobroncoscopia nesse período. Destes, foram excluídos164 pacientes que não foram submetidos ao exame histopatológico (exame padrão-ouro para o diagnóstico de câncer de pulmão). Preencheram os critérios de inclusão 70 pacientes do serviço analisado, tendo sido realizadas as duas técnicas estudadas,as quais foram correlacionadas com a confirmação ou não de câncer de pulmão. RESULTADOS: Foram diagnosticadas 32 neoplasias por biópsia endobrônquica, 26 do gênero masculino e 6 do feminino. O tipo histológico mais frequente foi o carcinoma epidermoide, com 53,1%, seguido do carcinoma de pequenas células, com 18,8%. A sensibilidade da tomografia foi de 75%, a especificidade de 81,6% e acurácia de 78,6%. A sensibilidade da fibrobroncoscopia foi de 81,3%, especificidade foi de 76,3%, o valor preditivo-positivo foi de 74,3%, o preditivo--negativo foi de 82,9% e a acurácia de 78,6%. CONCLUSÃO: A tomografia e a broncoscopia são muito importantes para auxílio diagnóstico do câncer de pulmão. O carcinoma epidermoide foi o mais encontrado, predominando em lobos superiores, com aspecto endobrônquico de lesão tumescente. O rendimento da broncoscopia foi maior quando associado a biópsia, escovado e lavado broncoalveolar.

BACKGROUND AND OBJECTIVE: To analyze the tomography and bronchoscopy in the diagnosis of lung cancer and to evaluate the accuracy of these techniques in the presence of carcinoma. Also, to correlate epidemiological data, such as age, gender, smoking habits, and histological types. The justification implies the necessity of correlation between imaging and bronchoscopic methods for accurate diagnosis of lung cancer, adisease that has a high mortality. METHODS: Documentary, observational, cross-sectional and retrospective study. We analyzed 234 in patients who underwent bronchoscopy between June 2009 and June 2011. Of these, we excluded 164 patients who were not submitted to histopathological examination (goldstandard test for the diagnosis of lung cancer). Seventy patients met the inclusion criteria. We performed both techniques and correlated them with the confirmation or not of lung cancerin the studied service. RESULTS: We found that 32 tumors were diagnosed by endobronchial biopsy - 26 males and 6females. The most common histological type was squamous cell carcinoma with 53.1%, followed by small cell carcinoma with 18.8%. The sensitivity of computed tomography was 75%, specificity of 81.6%, and accuracy of 78.6%. The sensitivity of bronchoscopy was 81.3%, specificity of 76.3%,positive predictive value of 74.3%, negative predictive value of 82.9% and accuracy of 78.6%. CONCLUSION: Computed tomography and bronchoscopy are very important to aid in the diagnosis of lung cancer. Squamous cell carcinoma was the most frequently found, predominantly in the upper lobeswith endobronchial aspect of tumescent lesion. The yield of bronchoscopy was higher when associated with biopsy, brushbiopsy, and bronchoalveolar lavage.

Application of immunohistochemistry in biopsy specimen for differential diagnosis of small cell lung carcinoma and non-small cell lung carcinoma / 中国医师杂志

Objective To investigate the role of immunohistochemistry in the differential diagnosis between small cell lung carcinoma (SCLC) and non-small cell lung carcinoma (NSCLC).Methods The protein expressions of CD56, Syn, TTF1, CK5/6, CK14, P63, CK7, and NapsinA in percutaneous lung biopsy and bronchoscopic biopsy specimens which were suspected as SCLC were examined by immunohistological streptavidin-peroxidase ( SP) method to analyze the pathological characteristics , immunological pheno-typical features , and differential diagnosis between SCLC and NSCLC .Results Among 72 cases of lung cancer patients ,there were 27 cases of SCLC,17 cases of low differentiated squamous cell carcinoma ( SCC) and 28 cases of low differentiated adenocarcinoma ( ADC) .Conclusions It is the different therapy between SCLC and NSCLC , immunohistochemistry analysis of biopsy can provide ac-curate diagnosis of SCLC and NSCLC , which will result in less misdiagnosis and provide an important valuable in the selection of clini -cal treatment protocols for lung cancer patients .

Pulmonary tuberculosis and lung cancer: simultaneous and sequential occurrence / Tuberculose pulmonar e cancer de pulmao: ocorrencia simultanea ou sequencial

OBJECTIVE: Lung cancer (LC) is the leading cause of cancer-related death and represents a major public health problem worldwide. Another major cause of morbidity and mortality, especially in developing countries, is tuberculosis. The simultaneous or sequential occurrence of pulmonary tuberculosis and LC in the same patient has been reported in various case series and case-control studies. The objective of this study was to describe the characteristics of patients developing tuberculosis and LC, either simultaneously or sequentially. METHODS: This was a cross-sectional study based on the review of medical charts. RESULTS: The study involved 24 patients diagnosed with tuberculosis and LC between 2009 and 2012. The diagnoses of tuberculosis and LC occurred simultaneously in 10 patients, whereas tuberculosis was diagnosed prior to LC in 14. The median time between the two diagnoses was 5 years (interquartile range: 1-30 years). Fourteen patients (58.3%) were male, 20 (83.3%) were White, and 22 (91.7%) were smokers or former smokers. The most common histological type was adenocarcinoma, identified in 14 cases (58.3%), followed by epidermoid carcinoma, identified in 6 (25.0%). Seven patients (29.2%) presented with distant metastases at diagnosis; of those 7 patients, 5 (71%) were diagnosed with LC and tuberculosis simultaneously. CONCLUSIONS: In the present study, most of the patients with tuberculosis and LC were smokers or former smokers, and tuberculosis was diagnosed either before or simultaneously with LC. Non-small cell lung cancer, especially adenocarcinoma, was the most common histological type. .

OBJETIVO: O câncer de pulmão (CP) é o tipo mais letal de câncer na população mundial e representa um importante problema de saúde pública. A tuberculose é outra causa significativa de morbidade e mortalidade, especialmente em países em desenvolvimento. A ocorrência de tuberculose pulmonar e CP no mesmo paciente, simultaneamente ou não, tem sido descrita em diversas séries de casos e estudos de caso-controle. O objetivo deste estudo foi descrever as características de pacientes com tuberculose e CP, com apresentação simultânea ou sequencial. MÉTODOS: Estudo transversal, realizado através de revisão de prontuários. RESULTADOS: Foram incluídos no estudo 24 pacientes com diagnósticos de tuberculose e CP no período entre 2009 e 2012. Os diagnósticos de tuberculose e CP ocorreram simultaneamente em 10 pacientes, enquanto a tuberculose foi diagnosticada antes do CP em 14. A mediana do tempo entre os diagnósticos foi de 5 anos (variação interquartil: 1-30 anos). Quatorze pacientes (58,3%) eram do sexo masculino, 20 (83,3%) eram brancos, e 22 (91,7%) eram tabagistas ativos ou ex-tabagistas. O tipo histológico mais comum foi o adenocarcinoma, em 14 casos (58,3%), seguido de carcinoma epidermoide, em 6 (25,0%). Sete pacientes (29,2%) já apresentavam metástases à distância no momento do diagnóstico; desses 7, 5 (71%) tiveram o diagnóstico de CP e TB simultaneamente. CONCLUSÕES: Neste estudo, a maioria dos pacientes com tuberculose e CP eram tabagistas ou ex-fumantes e a tuberculose foi diagnosticada tanto antes quanto simultaneamente ao diagnóstico de CP. O carcinoma ...

Diagnostic value of CEA, CA125, CYFRA21-1, and NSE in lung cancer / 中国医师杂志

Objective To explore the diagnostic value of four tumor markers analyzed with Logistic regression and receiver operator characteristic (ROC) curve in patients with lung cancer.Methods The serum levels of carcinoembryonic antigen (CEA) 、carbohydrate antigen 125 (CA125),cytokeratin 19 fragment (CYFRA21-1) and neuron specific enolase (NSE) were determined by radioimmunoassay in 112 patients with lung cancer and 74 patients with benign pulmonary disease.Four tumor markers were analyzed by Logistic regression and ROC curve.Results The serum levels of CEA,CA125,CYFRA21-1 and NSE in lung cancer patients were [4.53(2.22-11.53)ng/ml,28.97 (11.39-62.10) U/ml,4.05(2.29-8.18)ng/ml,14.11 (11.35-24.12) ng/ml],respectively,which were significantly higher than those in health adults[2.08 (1.45-2.52) ng/ml,12.90 (9.80-19.44) U/ml,1.53 (1.21-2.17) ng/ml,11.38 (9.07-12.80) ng/ml] (all P ＜ 0.01).According to regression equation Y =1/[1 + EXP (4.902-0.394X1-0.627X2-0.165X3)],the area under the ROC curve (AUC),sensitivity,specificity,and accuracy of new variable Y were 0.915 ± 0.020,79.46％,93.24％,and 84.95％,respectively.Conclusions Application of logistic regression and ROC curve increases diagnostic accuracy in lung cancer.

Solitary Pulmonary Nodule on Helical Dynamic CT Scans: Analysis of the Enhancement Patterns Using a Computer-Aided Diagnosis (CAD) System

OBJECTIVE: We wanted to investigate the usefulness of a computer-aided diagnosis (CAD) system in assisting radiologists to diagnosis malignant solitary pulmonary nodules (SPNs), as compared with diagnosing SPNs with using direct personal drawing. MATERIALS AND METHODS: Forty patients with SPNs were analyzed. After the pre-contrast scan was performed, an additional ten series of post-contrast images were obtained at 20-second intervals. Two investigators measured the attenuation values of the SPNs: a radiologist who drew the regions of interest (ROIs), and a technician who used a CAD system. The Bland and Altman plots were used to compare the net enhancement between a CAD system and direct personal drawing. The diagnostic characteristics of the malignant SPNs were calculated by considering the CAD and direct personal drawing and with using Fisher's exact test. RESULTS: On the Bland and Altman plot, the net enhancement difference between the CAD system and direct personal drawing was not significant (within +/- 2 standard deriation). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of diagnosing malignant SPNs using CAD was 92%, 85%, 75%, 96% and 88%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of diagnosing malignant SPNs using direct drawing was 92%, 89%, 79%, 92% and 88%, respectively. CONCLUSION: The CAD system was a useful tool for diagnosing malignant SPNs.

Nodular Ground-Glass Opacities on Thin-section CT: Size Change during Follow-up and Pathological Results

OBJECTIVE: To evaluate the inter-group differences in growth and the pathological results of nodular ground-glass opacities (GGOs) according to their size and focal solid portions. MATERIALS AND METHODS: Ninety-six nodular GGOs in 55 individuals followed by CT for at least one month from an initial chest CT were included. Forty nodular GGOs in 30 individuals were pathologically confirmed to be: adenocarcinoma (n = 15), bronchioloalveolar carcinoma (BAC) (n = 11), atypical adenomatous hyperplasia (AAH) (n = 8), focal interstitial fibrosis (n = 5) and aspergillosis (n = 1). Lesions were categorized based on high-resolution CT findings: pure nodular GGO (PNGGO) 10 mm, mixed nodular GGO (MNGGO) 10 mm. In each group, the change in size during the follow-up period, the pathological results and the rate of malignancy were evaluated. RESULTS: Three MNGGO lesions, and none of the PNGGO, grew during the follow-up period. Resected PNGGOs 10 mm were focal interstitial fibrosis (n = 4), AAH (n = 2), BAC (n = 2), and adenocarcinoma (n = 2). Resected MNGGOs 10 mm were adenocarcinoma (n = 11), BAC (n = 3), and aspergillosis (n = 1). CONCLUSION: Mixed nodular GGOs (MNGGOs) had the potential for growth; most were pathologically adenocarcinoma or BAC. By contrast, PNGGOs were stable for several months to years; most were AAH, BAC, or focal interstitial fibrosis.

Simple Pulmonary Eosinophilia Detected at Low-dose CT for Lung Cancer Screening

PURPOSE: The aim of this study was to evaluate the frequency, radiologic findings and clinical significance of the simple pulmonary eosinophilia (SPE) that was diagnosed among the asymptomatic patients who underwent low-dose CT scans for the early detection of lung cancer. MATERIALS AND METHODS: From June 2003 to May 2005, 1,239 asymptomatic patients (1,275 examinations) who visited the health promotion center in our hospital and who underwent low-dose CT were enrolled in this study. SPE was defined as the presence of > 500 eosinophils per microliter of peripheral blood and the presence of abnormal parenchymal lesions such as nodules, airspace consolidation or areas of ground-glass attenuation (GGA) on CT, and there was spontaneous resolution or migration of the lesions on the follow-up examination. We analyzed the CT findings of SPE and we investigated the relationship between the occurrence of SPE and the season, smoking and the presence of parasite infestation. RESULTS: 36 patients were finally diagnosed as having SPE; this was 24% of the 153 patients who were diagnosed with parasite infestation and 2.8% of the total low-dose CT scans. These 36 patients consisted of 31 men and 5 women with a mean age 45.7 years. There was no significant relationship between SPE and the presence of parasite infestation, smoking or gender. Among the patients with peripheral blood eosinophilia, the eosinophil count was significantly higher in the patients with SPE than that in the patients without pulmonary infiltration (p < 0.05). SPE more frequently occurred in winter and spring than in summer and autumn (p < 0.05). The CT findings were single or multiple nodules in 18 patients, nodules and focal GGA in 9 patients and GGA only in 9 patients. Most of the nodules were less than 10 mm (88%, 49/56) in diameter and they showed an ill-defined margin (82%, n = 46); 30% of the nodules (n = 17) showed a halo around them. CONCLUSION: Simple pulmonary eosinophilia can be suggested as the cause if single or multiple ill-defined nodules or focal GGA are found on the low-dose CT performed in asymptomatic patients with peripheral blood eosinophilia. Short interval follow-up should be recommended to avoid invasive procedures or unnecessary aggressive treatment due to mistaking these lesions as lung cancer or metastatic malignancy.

Clinical values of serum neuron-specific enolase in lung cancer / 吉林大学学报(医学版)

Objective To study the clinical values of neuron-specific enolase(NSE) as serum tumor marker in lung cancer.Methods The serum NSE levels in 96 patients with lung cancer,60 patients with begnign pulmonary disease and 60 healthy controls were measured by using enzyme-linked immunosorbent assay.Results The levels of NSE in serum in patients with lung cancer was significantly higher than those in healthy subjects and patients with begnign lung disease(P0.05).The effective rate of chemotherapy were 87.10%,40.00% and 66.67%, 33.33% in patients with SCLC and NSCLC,respective for NSE positive and negative ones(P

Malignant Solitary Pulmonary Nodule: Enhancement Patterns on Contrast-enhanced Dynamic CT with the Histopathologic Evaluation

PURPOSE: We wanted to evaluate the potential role of dynamic incremental computed tomography (CT) for making the diagnosis of malignant solitary pulmonary nodule (SPN) by investigating the dynamic enhancement patterns. MATERIALS AND METHODS: Forty patients with presumed malignant SPN (diameter 0.05). CONCLUSION: Dynamic incremental chest CT was useful for making the diagnosis of malignant SPN that showed an established dynamic contrast enhancement pattern regardless of the histopatholgic subtypes.

Clinical application of image processing and neural network in cytopathological diagnosis of lung cancer / 中华胸心血管外科杂志

Objective To study a new technique (lung cancer diagnossing system, LCDS) based on the computer imaging and artificial neural network for early diagnosis of lung cancer, and evaluate it's value in early cytopathological diagnosis of lung cancer. Methods The cytological smears from the specimens obtained by Percutaneous Aspiration Lung Biopsy (PALB) in 512 cases were synthetically analyzed by LCDS. Among them, 362 cases received operations. The diagnoses by LCDS were compared with postoperative histopathological diagnosis. Results In cytopathological diagnoses for the 512 specimens, LCDS can judge between cancer cells and non-cancer cells from lung lesions with its image analysis and expert system. Moreover, it can distinguish squamous carcinoma, adenocarcinoma and small cell carcinoma in cytopathological diagnosis with built-in neural network. The total coincident rate of LCDS diagnosis was 91.80% compared with the pathological diagnosis. In the 362 cases, the sensitivity of LCDS diagnosis was 94.79% (291/307), the specificity was 90.91%(50/55), and the consistent rate was 94.20%(341/362). Conclusion The diagnostic pattern of LCDS was practical and effective. It has applicable value in cytopathological diagnosis of lung cancer and may be an efficient means for early diagnosis of lung cancer.

Focal Organizing Pneumonia: CT and Pathologic Findings

The purpose of this study was to describe the CT findings of focal organizing pneumonia and to compare the findings with pathology. CT findings of histologically proven focal organizing pneumonias in 26 consecutive patients were analyzed. In 17 patients who had undergone surgical resections, the findings were correlated with pathology. Focal organizing pneumonias appeared as a nodule (n= 13) or a mass (n=13), ranging from 9 mm to 66 mm in diameter. Ground-glass opacity was seen in 6/13 (46%) nodules and 6.5/13 (50%) masses (k=.48) with an extent ranging from 5% to 75% (mean, 16%). In 4/26 (15%) patients, the extent was more than 50% of the lesion. They showed smooth (n=4), lobulated (n=8), spiculated (n=1), or lobulated and spiculated margin (n=13). On correlative analysis, nodule or mass on CT consisted histologically of intraalveolar exudate or microabscess, chronic inflammatory cell infiltration, fibrotic nodules, and polypoid granulation tissue in the alveolar or bronchiolar spaces. Ground-glass opacity consisted of interstitial fibrosis and chronic inflammatory cell infiltration and intraalveolar polypoid granulation tissue. Focal organizing pneumonia may simulate a lung cancer with variable appearances on CT and the findings reflect underlying histopathology of the disease.