Correlation between 18-FDG standardized uptake value and tumor grade in patients with resectable non-small cell lung cancer.

Background: Positron-emission tomography (PET) is widely used for staging lung cancer. Although a correlation between the fluorodeoxyglucose standardized uptake value (SUV) and the histologic grade of the tumor has been shown in several studies, little is known about the impact of different clinical variables on this correlation. This study aimed to evaluate the correlation between tumor SUV and tumor grade in a large cohort of patients and to analyse the impact of clinical factors on this correlation. Methods: This retrospective cohort study including patients with non-small cell lung cancer age 18-90 years, with clinical stage I-IVA, who underwent curative-intent lung resection. Results: Data from 726 patients was included in this study. There was a strong correlation between SUV and primary tumor grade in the whole cohort (P<0.001), which was significant in both sexes (P<0.001) and in all selected age groups (P<0.001-0.03). There was a significant SUV-grade correlation for the right upper and left lower lobes, as well as for the central location in the right lung (P<0.001, P=0.005 and P=0.04, respectively). Moreover, a significant SUV-grade correlation was found for squamous cell cancer and adenocarcinoma (P<0.001 and P=0.01, respectively), and for T1-T3 factors (P<0.001, P=0.006, P=0.005 respectively). Conclusions: In patients with resectable lung cancer, a significant correlation was observed between the SUV of the primary tumor and its grade. This correlation was maintained for both sexes, age groups, most common histological types and T factors T1-T3.

Intrapulmonary Arteriovenous Fistula: Unusual Early Complication of Wedge Resection.

We present a case of an arteriovenous fistula that developed in the early postoperative course after wedge resection of the right upper lobe. A 57-year-old man treated for acute myeloid leukemia was referred from the hematology department because of a right upper-lobe tumor. Wedge resection was performed. A recurrent tumor was visualized 3 weeks later on chest roentgenogram. Computed tomographic angiography diagnosed an arteriovenous fistula, and the patient was scheduled for redo operation. Completion upper lobectomy was performed, and the pathologic examination confirmed an iatrogenic arteriovenous fistula, which is a rare early complication.

Influence of bilateral mediastinal lymph node dissection on survival in non-small cell lung cancer patients - Randomized study.

OBJECTIVES: This study aimed to analyze the effect of bilateral mediastinal lymphadenectomy (BML) on survival of non-small cell lung cancer (NSCLC) patients. The hypothesis was: BML offers survival benefit as compared with SLND. METHODS: A randomized clinical trial including stage I-IIIA NSCLC patients was performed. All patients underwent anatomical lung resection. BML was performed during the same operation via additional cervical incision (BML group). In the control group, standard lymphadenectomy (systematic lymph node dissection, SLND) was performed. RESULTS: In total, 102 patients were randomized. No significant difference was found in the type of lung resection, blood loss, chest tube output, air leak, pain, and complications (p = 0.188-0.959). In the BML group, the operative time was longer (318 vs 223 min, p < 0.001) with higher number of removed N2 nodes (24 vs 14, p < 0.001). The 5-year survival rate was 72 % in the BML group vs 53 % in the SLND group (OR 2.33, 95 % CI 0.95-5.69, p = 0.062). Separate comparisons for different lobar locations of the tumor have shown no significant difference in survival for the right lung tumors and left upper lobe tumors. For the left lower lobe tumors, survival time was longer in the BML group (p = 0.021), and the 5-year survival rate was 90.9 % vs 37.5 %, (OR 16.66, 95 % CI 1.36-204.04, p = 0.0277). CONCLUSIONS: In patients with NSCLC located in the left lower lobe, bilateral lymph node dissection may be associated with better survival. The invasiveness of BML is comparable to that of SLND.

Initial Polish experience of Flexible 19 gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration.

INTRODUCTION: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist's feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIAL AND METHODS: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. RESULTS: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ± 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. CONCLUSIONS: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable.

Comparison of conventional and ultrasound-guided needle biopsy techniques in the diagnosis of sarcoidosis: a randomized trial.

INTRODUCTION: Endoscopic biopsy techniques are useful in the diagnosis of sarcoidosis. There is a need for randomized trials to establish where these procedures fit in the diagnosis of sarcoidosis. OBJECTIVES: The aim of the study was to compare the diagnostic yield of conventional transbronchial needle aspiration (TBNA) with endobronchial ultrasound-guided TBNA (EBUS-TBNA) and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in stages I and II of pulmonary sarcoidosis. PATIENTS AND METHODS: Patients suspected of sarcoidosis were randomized to undergo TBNA or EBUS-TBNA or EUS-FNA. Patients with negative TBNA and EBUS-TBNA results underwent EUS-FNA and those with negative EUS-FNA results­EBUS-TBNA. If both tests were negative, patients in stage I were scheduled for mediastinoscopy (MS) and those in stage II­for transbronchial lung biopsy (TBLB). RESULTS: In 100 patients, 34 TBNA, 30 EBUS-TBNA, and 36 EUS-FNA procedures were performed at baseline. TBNA was positive in 20 patients (58.8%); EBUS-TBNA, in 23 (76.7%); and EUS-FNA, in 31 patients (86.1%). In patients with negative biopsy results, the second procedure was performed. The results of EUS-FNA were positive in 9 patients and of EBUS-TBNA­in none. Of 17 patients with negative results of both procedures, MS was performed in 6 patients and was positive in 2. In the remaining 11 patients, sarcoidosis was confirmed by TBLB. Sensitivity and accuracy of TBNA compared with EBUS-TBNA and EUS-FNA were 62.5% and 64.7%, 79.3% and 80%, and 88.6% and 88.9%, respectively. Sensitivity and accuracy of EBUS-TBNA were higher (P = 0.139) and of EUS-FNA were significantly higher compared with TBNA (P = 0.012). CONCLUSIONS: In stages I and II of pulmonary sarcoidosis, endoscopic ultrasound is a reasonable approach but EUS-FNA seems to be the method of choice.

[The role of celiac disease and type 1 diabetes coexistance. Is celiac disease responsible for diabetic status?]. / Ocena znaczenia wspólwystepowania celiakii u chorych z cukrzyca typu 1. Czy celiakia moze wplywac na przebieg cukrzycy?

Celiac disease is the status of the autoimmune answer provoked by gluten ingestion in genetically predisposed people. Recently gluten entheropathy was considered as a rare clinical problem in adults. Celiac disease is an autoimmune disorder that can coexist with other diseases, such as diabetes mellitus type 1 (DMID), thyroid gland diseases. The aim of our study was evaluation of the frequency of coexistence of celiac disease with DMID using the level of anti tissue transglutaminase antibodies (IgA- tTG) and mucosal biopsy from the distal part of the duodenum. An attempt was made to estimate the influence of celiac disease on the intensity of clinical symptoms and metabolic balance in patients with DMID. Our study included 109 patients with DMID, aged 18-52 years. The frequency of the incidence of celiac disease in DMID patients was 9.71%. Gastric symptoms, such as diarrhea, abdominal pain were more frequent in patients with villous atrophy in the intestine. Hyperglycemia and problems with glucose balance in the serum were observed. Introduction of the gluten free diet led to improvement quality of life, less frequent hypoglycemic episodes and disappearance of diarrhea, increase of serum iron and decrease of IgA-tTG level in the serum. It is necessary to measure the level of IgA- tTG in patients with DMID. Diagnosis of celiac disease in patients with DMID and its treatment with gluten free diet causes the clinical, histological and biochemical improvement in these patients.

[Celiac disease and other immunomediated diseases coexistance and influence of clinical course. Case report]. / Wspólwystepowanie celiakii z chorobami autoimmunologicznymi i jej wplyw na obraz kliniczny choroby. Opis przypadku.

Celiac disease (gluten enteropathy) is chronic immunomediated disorder of gastrointestinal tract in genetically predisposed patients. We present the case of 46 years old man, with already diagnosed several autoimmune disorders, such as: diabetes mellitus LADA type, Graves-Basedow disease and vitiligo. Despite treatment of the above diseases, diarrhea and persistent abdominal pain was observed. Diagnosis of gluten enteropathy based on serology and histological evaluation of biopsies from distal part of duodenum enabled us to introduce gluten free diet, which contributed to attenuation of symptoms and better control of glucose serum levels. We think, that celiac disease should be taken into the consideration in differential diagnosis of chronic diarrhea and persistent abdominal pain, especially in patients with coexisting autoimmune diseases.

The problems with histopathological verification of breast microcalcification clusters in the stereotactic mammotome biopsy specimens.

The aim of the study was analysis of the cases, where histopathological examination failed to confirm the presence of breast microcalcifications in the SMB (stereotactic mammotome biopsy) specimens. Between 2000-2004, 242 patients underwent SMB under the guidance of digital mammography to verify breast microcalcification clusters of BI-RADS (Breast Imaging Reporting and Data System) 3-5 categories. In 39 of these patients histopathological examination did not confirm microcalcifications despite visualization on the radiograms. All such cases were additionally evaluated under polarized light microscope to detect microcalcifications containing birefringent calcium oxalate deposits. In all 39 patients only benign breast abnormalities were detected. In none of these cases breast microcalcifications were revealed in the additional evaluation under polarized light microscope. In some cases histopathological examination of the SMB specimens of breast microcalcifications may not confirm their presence despite visualization on the radiograms. The bioptates sent for the examination should he placed in the order of sampling at the same level and in such form embedded in the paraffin blocks. Radiograms confirming the location of microcalcifications should accompany the specimens. If standard assessment does not demonstrate microcalcifications, serial cutting and additional evaluation under polarized light microscope are recommended.

Primary amyloid tumors of the lungs--six cases.

Over a period of nine years, the authors followed up six cases of primary amyloid tumors of the lungs in patients at the mean age of 58.5 years. All the patients were suspected of bronchial carcinoma and they were subjected to surgical treatment. The duration of follow-up varied, but their postoperative status was satisfactory. Immunohistochemical reactions showed deposits of AL amyloid in five cases; in one of these patients, pulmonary amyloid tumors were related to marginal zone lymphoma of the lung. In one case, the accumulated amyloid was transthyretin.

Thymoma with pseudosarcomatous stroma--an unusual variant of a slowly progressing thymic neoplasm.

The authors present the first Polish case of an extremely rare thymoma in a 70-year old female surgical patient with 15-year observation before surgery.

Expression of the Na(+)/I(-) symporter in invasive ductal breast cancer.

The function of the sodium iodide symporter (Na(+)/I(-), (NIS), a membrane protein that mediates iodide transport into cells, is the best described in the thyroid cells. NIS is also found in mammary cells during lactation and in breast carcinoma cells. The aim of this study was evaluation of incidence and grade of NIS expression in invasive ductal breast cancer. Immunohistochemistry using a panel of antibodies against NIS was carried out in surgical paraffin-embedded tissue obtained from 50 patients with invasive ductal breast carcinoma. NIS expression was found in 45 (90%) cases. The demonstration of NIS expression in breast carcinoma cells may provide a novel approach to its diagnosis and treatment.