ABSTRACT
INTRODUCTION: Cytological samples obtained by endobronchial ultrasound (EBUS) are capital for diagnosis, staging and molecular profile in non-small cell lung carcinoma (NSCLC). OBJECTIVE: To assess the success rate of complete, partial and individual of molecular analysis in samples obtained by EBUS-guided transbronchial needle aspiration (TBNA) and/or by oesophageal ultrasound-guided fine needle aspiration with an echobronchoscope (EUS-B-FNA) in patients with NSCLC. METHODS: Prospective study including 90 patients with non-squamous NSCLC, or non-smoking squamous. Cytological samples were classified into two groups. Group 1: PEN membrane slide and/or cell blocks for the determination of mutations of EGFR, KRAS, ERBB2 and BRAF. Group 2: silane coated slides or cell blocks for rearrangements of ALK, ROS1 and MET amplification. RESULTS: The success rate was 78.6% for 4 molecular alterations (EGFR, KRAS, ALK and ROS1), and 44% for 7 determinations. The individual success rate for EGFR was 97%, KRAS 96.3%, ALK 85%, ROS1 82.3%, ERBB2 71.4%, BRAF 67.7% and MET 81.1%. There were no significant differences (p=0.489) in the number of molecular analyses (1-3 vs. 4) in group 1, depending on the types of samples (cell block vs. PEN membrane slide vs. cell block and PEN membrane slide). CONCLUSIONS: In patients with NSCLC, the cytological material obtained by ultrasound-guided needle aspiration is sufficient for individual and partial molecular analysis in the vast majority of cases. Membrane slides such as cell blocks are valid samples for molecular analysis.
Subject(s)
Carcinoma, Non-Small-Cell Lung/genetics , Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods , Lung Neoplasms/genetics , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/pathology , DNA Mutational Analysis/methods , ErbB Receptors , Female , Gene Amplification , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/pathology , Male , Middle Aged , Polymerase Chain Reaction , Prevalence , Prospective Studies , Protein-Tyrosine Kinases/genetics , Proto-Oncogene Proteins/genetics , Proto-Oncogene Proteins B-raf , Proto-Oncogene Proteins p21(ras) , Receptor Protein-Tyrosine KinasesABSTRACT
OBJECTIVE: Retrospective analysis the immediate and long-term efficacy of embolization of bronchial and systemic arteries in the treatment of threatening or relapsing hemoptysis. MATERIALS AND METHODS: During the study period 122 arterial embolizations were performed in patients with hemoptysis over 100 ml in 24 hours, relapsing hemoptysis and/or presence of vital risk factors. Embolization was performed with polyvinyl alcohol particles, spongostan and metallic spirals. Seventy patients were included in the study and 47 were excluded as they came from other institutions. RESULTS: Angiographic changes were observed in 100% of patients. The immediate clinical success, defined as hemoptysis control, was obtained in the 70 patients. The mean follow-up time was 21.2 +/- 16.3 months. Relapsing hemoptysis occurred in 17.1% of patients (12 patients), of which 5.7% (4 cases) occurred in the first seven days and in 11.4% (8 patients) after 6 months. In five patients (7.1%) a new embolization was performed and 6 were operated after embolization (5 of them with bronchiectasis). The remarkable complications derived from the procedure included self-limited paraparesis of the lower limbs and severe chest pain. CONCLUSIONS: The embolization of bronchial arteries is an efficient technique for the treatment of threatening hemoptysis and relapses, is associated with a low morbidity rate, and the late relapse is relatively common among patiets with bronchiectasis.
Subject(s)
Embolization, Therapeutic , Hemoptysis/therapy , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Objetivo. Analizar retrospectivamente la eficacia inmediata y a largo plazo de la embolización de las arterias bronquiales y sistémicas en el tratamiento de la hemoptisis amenazante o recurrente. Material y métodos. Durante el período del estudio se realizaron 122 embolizaciones arteriales en pacientes con hemoptisis superior a 100 ml en 24 horas, recurrente y/o presencia de factores de riesgo vital. La embolización se realizó con partículas de alcohol polivinilo, espongostán y espirales metálicas. Se incluyeron en el estudio 70 pacientes y 47 fueron excluidos por pertenecer a otros centros.Resultados. Se apreciaron alteraciones angiográficas en el 100 por ciento de los pacientes. El éxito clínico inmediato, considerándose como tal el control de la hemoptisis, se consiguió en los 70 pacientes. El tiempo medio de seguimiento fue de 21,2 meses (ñ 16,3 meses). Se produjo recidiva de la hemoptisis en el 17,1 por ciento (12 pacientes), de los que el 5,7 por ciento (4 casos) fueron en los primeros 7 días y el 11,4 por ciento (8 pacientes) después de los 6 meses. En 5 pacientes (7,1 por ciento) se realizó una nueva embolización y 6 fueron intervenidos quirúrgicamente después de la embolización (5 de ellos con bronquiectasias). Las complicaciones destacables derivadas de la técnica fueron una paraparesia autolimitada de extremidades inferiores y un dolor torácico intenso. Conclusiones. La embolización de las arterias bronquiales es una técnica eficaz para el tratamiento de la hemoptisis amenazante y de las recidivas, con una baja morbilidad, siendo relativamente frecuente la recidiva tardía en los pacientes con bronquiectasias (AU)
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Subject(s)
Middle Aged , Male , Female , Humans , Embolization, Therapeutic , Retrospective Studies , HemoptysisABSTRACT
Quitting smoking is a first-line treatment for patients with bronchial diseases. Continued smoking worsens the clinical course of chronic broncho-pulmonary diseases and increases the number of exacerbations. Specialists commonly insist on the need to quit smoking. This study sought to determine whether a percentage of patients seen in a respiratory medicine clinic continued to smoke while denying doing so. One hundred twenty-five subjects were studied consecutively. At a regular visit they were first asked about smoking; later, without prior warning, exhaled carbon monoxide (CO) was measured by co-oximetry. If CO was over 10 ppm, the subject was considered to have been smoking. We defined a patient as a "liar" if he or she denied smoking but had a reading of CO in exhaled air over 10. Of the 125 cases studied, 21 (17%) smoked while denying doing so. Among men the percentage was 21%, and among ex-smokers, the figure was 27%. The highest value, 34%, was found among patients with chronic obstructive pulmonary disease (COPD). We conclude, therefore, that a substantial proportion of patients lies to their physicians. A third of COPD patients, who are particularly sensitive to the toxic effects of smoking, try to mislead their doctors.
