False-positive 18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) scans mimicking malignancies.

AIM: 18-Fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) is an imaging modality that is often used to help differentiate benign from malignant pulmonary lesions and it has been shown to be more efficacious than conventional chest computed tomography (CT). However, some benign lesions may also show increased metabolic activity which can lead to false-positive PET findings. We aim to illustrate false positive findings of PET scan that simulate lung cancer in a variety of diseases. METHODS: Patients referred to Yedikule Chest Diseases and Surgery Teaching and Research Hospital with increased FDG uptake for which histological results were available over a 2-year period (2013-2014) were reviewed. Seven patients with false-positive PET/CT findings were reported in this study. RESULTS: The majority of lesions showing increased metabolic activity were due to malignant diseases. However, increased 18 F-FDG uptake was also seen in benign lesions such as active pulmonary inflammation or infection, granulomatous processes and fibrotic lesions. CONCLUSION: The integration of clinical history, morphologic findings of lesions on the CT component, and metabolic activities of PET/CT scan can help reduce false interpretations. Interventional procedures may be needed for tissue confirmation for differential diagnosis.

Efficacy of convex probe endobronchial ultrasound (CP-EBUS) assisted transbronchial needle aspiration for mediastinal staging in non-small cell lung cancer cases with mediastinal lymphadenopathy.

BACKGROUND AND OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a sampling method for the patients with non-small cell lung cancer (NSCLC) that have enlarged mediastinal lymph nodes that are detected with computed tomography (CT). We aimed to investigate the value of EBUS-TBNA in sampling enlarged mediastinal lymph nodes in the patient with NSCLC. PATIENTS AND METHOD: From January 2007 to May 2009, patients were diagnosed NSCLC with CT scans showing enlarged lymph nodes (node >1 cm) or a positron emission tomography (PET/CT) finding of the mediastinum underwent EBUS-TBNA. RESULTS: EBUS-TBNA was successfully performed in all 52 patients (mean age, 52 years; 45 men) from 93 mediastinal lymph nodes. EBUS detected lymph node metastasis in 40 patients (77%). 12 patients (23%) with negative lymph node samples were underwent mediastinoscopy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EBUS-TBNA in the detection of mediastinal metastasis were 95 %, 100%, 100%, 83%, and 96%, respectively. EBUS-TBNA was uneventful, and there were no complications. CONCLUSION: EBUS-TBNA is an effective, safe and minimally invasive procedure following PET/CT or CT scanning in the mediastinal staging of potentially operable NSCLC.

Value of real-time endobronchial ultrasound-guided transbronchial needle aspiration.

AIM: The diagnostic value of real-time convex-probe endobronchial ultrasound (CP-EBUS)-guided transbronchial needle aspiration (TBNA) in mediastinal pathologies, and the factors influencing it are not clearly known. This study has been designed to examine factors affecting the efficacy and diagnostic value of CP-EBUS-TBNA. METHODS: Patients (n = 321) with mediastinal mass or enlarged lymph node in the mediastinum, participated in this study, conducted between April 2007 and May 2009. Samples were obtained from the lesions using the TBNA method, with the guidance of CP-EBUS. Histopathologic (in all samples) and microbiologic (in 151 patients' samples) evaluations were carried out. Biopsy using an appropriate surgical method was taken when the result of the TBNA procedure was nondiagnostic. Thirty-four patients were excluded from the analysis due to several reasons. The diagnostic efficacy of the procedure was analyzed in the remaining 287 patients. RESULTS: The diagnostic rate was 92% (89.7% for the benign diseases and 92.6% for the malignant diseases (P = 0.59)). In granulomatous diseases, the rate was 96% for sarcoidosis and 79% for tuberculosis (P = 0.002). Patients in whom only one lymph node was sampled and in whom two or more lymph nodes were sampled had a diagnostic rate of 85% and 95%, respectively (P = 0.03). When left hilar nodes were sampled, a higher diagnostic rate was achieved (P = 0.01). CONCLUSIONS: CP-EBUS-guided TBNA has a high diagnostic rate. Sampling of at least two separate lymph nodes and the discovery of left hilar station in these lymph nodes increase the rate of diagnosis.

Treatment of endoluminal typical carcinoid tumor with bronchoscopic techniques.

Surgical treatment of typical bronchial carcinoid tumors varies from bronkoskopic excision to major resective procedures. Typical carcinoid tumor was detected in 29 year old man patient who were admitted to our clinic with hemoptysis and dyspnea. Typical carcinoid tumor was treated with exsicion after argon plasma coagulation by bronchoscopic techniques. It should not be forgotten that bronchoscopic approach and simple excision is an effective and safe procedure for the treatment of typical bronchial carcinoid tumors in selected cases like polypoid type lesions.

Primary pulmonary teratoma: Report of a case and the proposition of "bronchotrichosis" as a new term.

Primary pulmonary teratoma is a very rare disease. Most follow a benign course and are incidental findings during routine chest X-rays. Hair found in sputum or in bronchus detected during bronchoscopy is also a rare condition and is usually caused by mediastinal teratoma. This case report is of a 36-year-old man who presented with halitosis. A fiber-optic bronchoscopy revealed coarse hair originated from the right upper lobe. The patient was successfully treated by right upper lobectomy, and pathology confirmed primary pulmonary teratoma. We recommend that "bronchotrichosis" could be used as a new term for such a sign.