Predictors of mediastinal staging and usefulness of pet in patients with stage IIIA (N2) or IIIB (N3) lung cancer.

OBJECTIVE: To analyze which factors predict mediastinal N2/N3 lymph node staging and diagnostic accuracy of PET and CT to determine it. PATIENTS AND METHODS: We analyzed data collected prospectively in a database that included patients with non-small cell lung cancer (NSCLC) who underwent EBUS-TBNA. Prior to EBUS-TBNA, CT and PET were used to define the radiographic N stage and lymph nodes with short axis ≥ 1 cm by CT or with ratio between maximum standardized uptake value (maxSUV), by PET, of lymph node and primary tumor greater than 0.56, were considered pathological. Definitive lymph node staging was established through EBUS-TBNA, mediastinoscopy or surgical lymph node dissection. RESULTS: One hundred and thirty four patients were included, in 88 of whom (65.6%), definitive lymph node staging was N2 or N3. Primary tumor of central location, lymph node size, maxSUV of lymph node and radiographic N stage by CT or PET were associated with N2/N3 in univariate analysis, but in logistic regression model it was only independently related with N stage by CT or PET. Negative predictive value and positive predictive value of CT were 0.81 and 0.74, respectively, and for PET 0.78 and 0.68. CONCLUSION: In NSCLC, in locoregional disease radiographic staging by CT or PET predict the existence of N2/N3 mediastinal disease, but negative and positive predictive values of both imaging techniques are not adequate, so EBUS-TBNA samples should be taken in all lymph nodes with a diameter greater than 5 mm, regardless of PET findings.

[Chronic pulmonary histoplasmosis diagnosed in a nonimmunosuppressed patient 10 years after returning from an endemic area]. / Histoplasmosis pulmonar crónica en un paciente no inmunodeprimido, residente 10 años antes en una zona endémica.

We report the case of a Spanish nonimmunosuppressed patient who was a chronic alcoholic and who developed chronic cavitary pulmonary histoplasmosis. He had been living in Venezuela until 10 years ago. The diagnosis was established when Histoplasma capsulatum was cultured from bronchoscopy samples. The patient was treated with itraconazole and progressed favorably until cure. This case suggests that histoplasmosis can reactivate years after exposure, even when significant immunodeficiency is not present. In the absence of another immunosuppressive factor, alcoholism may have played a role in the development of the condition.

Histoplasmosis pulmonar crónica en un paciente no inmunodeprimido, residente 10 años antes en una zona endémica / Chronic pulmonary histoplasmosis diagnosed in a non immunosuppressed patient 10 years after returning from an endemic area

Se presenta el caso de un paciente español, no inmunodeprimido,con alcoholismo crónico e histoplasmosis pulmonarcavitaria, crónica, que había residido 10 años antes en Venezuela.El diagnóstico se estableció por cultivo de Histoplasmacapsulatum en muestras de broncoscopia y el tratamientoconsistió en itraconazol, con buena evolución y curación.Este caso apoya la posibilidad de que la histoplasmosis puedareactivarse años después de la exposición y sin que hayainmunodepresión clínicamente importante. Se plantea que,en ausencia de otro factor inmunodepresor, el alcoholismopodría haber desempeñado algún papel en el desarrollo delcuadro

We report the case of a Spanish non immunosuppressed patient who was a chronic alcoholic and who developed chronic cavitary pulmonary histoplasmosis. He had beenliving in Venezuela until 10 years ago. The diagnosis wasestablished when Histoplasma capsulatum was cultured frombronchoscopy samples. The patient was treated withitraconazole and progressed favorably until cure. This casesuggests that histoplasmosis can reactivate years afterexposure, even when significant immunodeficiency is notpresent. In the absence of another immunosuppressivefactor, alcoholism may have played a role in the development of the condition