Utilidad de la PET/TAC en la estadificación mediastínica del cáncer de pulmón de células no pequeñas en estadio III (N2) / Utility of PET/CT for mediastinal staging of non-small cell lung cancer in stage III (N2)

Objetivo. Evaluar la validez diagnóstica de la tomografía por emisión de positrones con 18F-fluoro-2-deoxi-D-glucosa y la tomografía computarizada (PET/TAC) en la estadificación ganglionar mediastínica (N2) en pacientes con cáncer de pulmón de células no pequeñas (CPCNP) y analizar el papel de la estadificación mediante pruebas invasivas para la verificación de los hallazgos de la tomografía por emisión de positrones (PET)/tomografía computerizada (TAC). Material y métodos. Estudio retrospectivo incluyendo a pacientes con diagnóstico histopatológico de CPCNP, estadificados como N2 mediante TAC+C y estudiados con PET/TAC. Se confirmaron mediante análisis histopatológico de la pieza quirúrgica cuando se dispuso o por consenso iconográfico en el comité de tumores torácicos. Se ha calculado la sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo del estudio PET/TAC en la correcta clasificación de los pacientes N2. Resultados. Se incluyeron 34 pacientes clasificados como N2 mediante TAC+C. El PET/TAC clasificó a 30 pacientes como estadio N2. Se encontraron discrepancias en 4 pacientes, dos clasificados como N1 y dos como N0. Los resultados fueron confirmados histológicamente en 20 pacientes. El estudio PET/TAC no mostró falsos positivos. La sensibilidad fue del 94,7%, la especificidad y el valor predictivo positivo fue del 100% y el valor predictivo negativo del 50%. Conclusiones. El estudio PET/TAC presenta una alta sensibilidad y valor predictivo positivo en la correcta clasificación de pacientes con afectación ganglionar mediastínica (N2). Nuestros resultados sugieren que en pacientes con cáncer de pulmón potencialmente resecable, candidatos a tratamiento con quimioterapia neoadyuvante, la mediastinoscopia podría reservarse para la re-estadificación(AU)

Purpose. To evaluate the accuracy of integrated positron emission tomography with 18F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. Material and methods. A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. Results. A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. Conclusions. Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy(AU)

[Utility of PET/CT for mediastinal staging of non-small cell lung cancer in stage III (N2)]. / Utilidad de la PET/TAC en la estadificación mediastínica del cáncer de pulmón de células no pequeñas en estadio III (N2).

PURPOSE: To evaluate the accuracy of integrated positron emission tomography with (18)F-fluoro-2-deoxy-D-glucose (FDG) and computed tomography (PET/CT) in mediastinal lymph node staging in patients with potentially operable (N2) non-small cell lung cancer (NSCLC) and to ascertain the role of invasive staging in verifying positron emission tomography (PET)/computed tomography (CT) results. MATERIAL AND METHODS: A retrospective study of consecutive patients with pathologically-proven NSCLC and N2 staging by enhanced CT was performed. A PET/CT scan was performed for all the patients. Lymph node staging was pathologically confirmed when it was possible or by consensus in the Thoracic Cancer Committee. Sensitivity, specificity, negative predictive value and positive predictive value of PET/CT in N2 cases were determined. RESULTS: A total of 34 patients with N2 by CT were evaluated. PET/CT showed N2 in 30 patients. Discrepancies were found in four patients, two patients were classified as N1 in PET/CT and two patients as N0. Lymph node staging was pathologically confirmed in 20 patients. No false positives were found in PET/CT study. Sensitivity was 94.7%, specificity and positive predictive values were 100% and negative predictive value was 50%. CONCLUSIONS: Our data show that integrated PET/CT provides high sensitivity and positive predictive value in mediastinal nodal staging of NSCLC patients. Therefore, in patients with potentially resectable lung cancer, neoadjuvant chemotherapy candidate, mediastinoscopy could be reserved for restaging after induction therapy.

Estadificación del cáncer de pulmón de células no pequeñas. Utilidad de la imagen estructural (TAC) y funcional (FDG-PET) / Staging of non-small cell lung cancer. Diagnosis efficacy of structural (CT) and functional (FDG-PET) imaging methods

Objetivos. Evaluar la exactitud diagnóstica de la tomografía por emisión de positrones con fluorodeoxiglucosa (FDG-PET) en el cáncer de pulmón de células no pequeñas (CPCNP) y analizar la validez diagnóstica de la tomografía axial computarizada (TAC) y la tomografía por emisión de positrones (PET) en su estadificación. Material y métodos. Se estudiaron prospectivamente 108 pacientes con sospecha clínica de CPCNP potencialmente resecable, siguiendo el protocolo de nuestro hospital y un estudio FDG-PET. El estándar de referencia ha sido la anatomía patológica de la pieza en aquellos pacientes que fueron operados y en el resto de los casos mediante técnicas de imagen específicas y biopsia. Resultados. En el 13% de los pacientes, la FDG-PET fue negativa y tampoco se evidenció tumor en el estudio histológico de la pieza. En el 22% de los pacientes, la FDG-PET detectó enfermedad metastásica (pacientes M0 por TAC). Para la afectación mediastínica, la validez diagnóstica global fue de 0,90 con FDG-PET y de 0,59 con TAC. La FDG-PET clasificó mal lesiones secundarias a fenómenos inflamatorios, de escaso tamaño o muy próximas a la lesión primaria. La estadificación mediastínica fue correcta en el 56% y en el 87% de los pacientes mediante TAC y FDG-PET, respectivamente. Conclusiones. Aunque complementarias, la evaluación funcional (FDG-PET) es significativamente superior a los métodos estructurales (TAC) en la valoración de la afectación mediastínica de pacientes con CPCNP (AU)

Purpose. To evaluate diagnostic accuracy of FDG-PET in the definition of non-small cell lung cancer (NSCLC) and analyze diagnostic validity of CT scan and FDG-PET in its staging. Methods. Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT scan and FDG-PET. Gold standard was histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. Results. In 13% of patients, the FDG-PET findings were negative and no tumor was observed in the histological study of the piece. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT scan). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT scan. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumor. Mediastinal staging by CT scan and FDG-PET was correct in 56% and 87% of patients, respectively. Conclusions. Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumor disease (AU)

[Staging of non-small cell lung cancer. Diagnosis efficacy of structural (CT) and functional (FDG-PET) imaging methods]. / Estadificación del cáncer de pulmón de células no pequeñas. Utilidad de la imagen estructural (TAC) y funcional (FDG-PET).

PURPOSE: To evaluate diagnostic accuracy of FDG-PET in the definition of non-small cell lung cancer (NSCLC) and analyze diagnostic validity of CT scan and FDG-PET in its staging. METHODS: Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT scan and FDG-PET. Gold standard was histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. RESULTS: In 13% of patients, the FDG-PET findings were negative and no tumor was observed in the histological study of the piece. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT scan). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT scan. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumor. Mediastinal staging by CT scan and FDG-PET was correct in 56% and 87% of patients, respectively. CONCLUSIONS: Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumor disease.

Diagnosis efficacy of structural (CT) and functional (FDG-PET) imaging methods in the thoracic and extrathoracic staging of non-small cell lung cancer

PURPOSE: To evaluate the efficacy of FDG-PET in the definition of tumour lung node lesions and to compare the diagnostic validity of CT and FDGPET in the staging of patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT and FDG-PET. PET images were analysed by researchers blinded to results of other imaging modalities. Definitive tumour diagnosis was by histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. Diagnostic accuracy was evaluated by comparing CT/PET results with the definitive diagnosis. RESULTS: In 13% of patients, no FDG-PET findings were observed and the histological study was negative for tumour. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumour. Mediastinal staging by CT and FDG-PET was correct in 56% and 87% of patients, respectively. CT indicated mediastinal invasion in 17% of patients with no FDG-PET finding of mediastinal involvement. Conversely, mediastinal spread was undetected by CT in 14% of patients with FDG-PET findings of mediastinal involvement. CONCLUSIONS: Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumour disease (AU)

Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia / Surgical treatment of pulmonary metastases: a study of survival

Objetivos: Estudiar los resultados del tratamiento quirúrgico de las metástasis pulmonares realizado en nuestra unidad. Pacientes y métodos: Analizamos retrospectivamente los pacientes intervenidos entre 1986 y 1999. Se incluyeron 44 pacientes a los que se practicó resecciones completas de las metástasis pulmonares, con tumor primario controlado, ausencia de metástasis extrapulmonares y capacidad funcional respiratoria suficiente. Los pacientes fueron distribuidos en grupos pronósticos según criterios del registro internacional de metástasis pulmonares. Resultados: Se practicaron 48 metastasectomías a 44 pacientes, 21 varones y 23 mujeres, con una edad media de 58 años (rango, 31-74). La histología del tumor primario más frecuente fue epitelial, con un 80 por ciento, sarcomas en un 9 por ciento, tumores germinales en un 2,2 por ciento, melanomas en un 2,2 por ciento y otros en un 6,4 por ciento. El intervalo libre de enfermedad medio fue de 37,3 (rango, 0-168), con una mediana de 30 meses. El 66,7 por ciento de los casos presentaron metástasis única y el 33,3 por ciento múltiples (17,9 por ciento bilaterales). La toracotomía posterolateral (66,7 por ciento) fue la vía de acceso más empleada. Se realizaron resecciones atípicas (86,6 por ciento) y lobectomías (11,1 por ciento). La mortalidad perioperatoria fue del 4,4 por ciento. La supervivencia media de la serie fue de 70 meses, del 87 por ciento al año, y del 29 por ciento a los 10 años. Para el grupo I (resecables sin factores de riesgo) (n = 13) fue del 100 por ciento al año y del 75 por ciento a los 10 años. El grupo II (resecables con un factor de riesgo) (n = 16) tuvo un supervivencia al año del 78 por ciento y a los 10 años del 12 por ciento. El grupo III (resecables con dos factores de riesgo) (n = 8) la supervivencia al año fue del 87 por ciento, del 62 por ciento a los 3 años, del 15 por ciento a los 4 años y nula a los 5 años. Log-rank *2 9,8 (2 df), p = 0,0097. Conclusiones: La cirugía de las metástasis pulmonares en pacientes seleccionados constituye un procedimiento terapéutico y diagnóstico con baja mortalidad y buena supervivencia. La clasificación por grupos pronósticos según el número de metástasis, intervalo libre de enfermedad y resecabilidad se correlaciona significativamente con la expectativa de supervivencia de los pacientes, con independencia de la histología del tumor primario. (AU)

[Surgical treatment of pulmonary metastasis: survival study]. / Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia.

OBJECTIVE: To study the results of surgical treatment of pulmonary metastases in our department. PATIENTS AND METHODS: We retrospectively studied 44 patients undergoing surgery between 1986 and 1999 for complete resection of pulmonary metastases. Primary tumors had been eradicated, no metastasis to other organs was evident, and functional respiratory capacity was adequate. The patients were assigned to different prognostic groups based on the criteria of the International Registry of Lung Metastases. RESULTS: Forty-eight operations were performed on the 44 patients (21 men and 23 women) whose mean age was 58 years (31-74 years). The most frequent type of primary tumor was epithelial (82%); other types in order of frequency were sarcoma (9%), thyroid gland (4.4%), germ cell (2.2%) and melanoma (2.2%). The mean disease-free interval was 37.7 months (0.168) and the median was 30 months. A single site of metastasis was seen in 66.7% of the cases whereas 33.3% had multiple metastases (17.9% of them bilateral). Posterolateral thoracotomy was the surgical approach in over half the cases (66.7%). We performed wedge resections in 86.6% and lobectomies in 11.1%. Perioperative mortality was 4.4%. Mean survival was 70 months, with 87% alive at one year and 29% at 10 years. For group I (resectable, no risk factors; n = 13) survival was 100% at one year and 75% at 10 years. For group II (resectable, one risk factor; n = 16) the actuarial survival was 78% at one year and 12% at 10 years. For group III (resectable, two risk factors; n = 8), survival was 87% at one year, 62% at three years, 15% at four years and 0% at five years (Log-rank chi 2 9.8 [df = 2)], p = 0.0097). CONCLUSIONS: Surgical resection of pulmonary metastasis is a treatment and diagnostic procedure associated with low mortality and good survival. Prognostic grouping that takes into account number of metastases, disease-free interval and resectability correlates significantly with expected survival regardless of histological typing of the primary tumor.

[Thoracic wounds: review of 90 cases]. / Heridas torácicas: revisión de 90 casos.

Our aim in reviewing all cases of chest wounds (CW) treated in our unit to analyze their causes, clinical characteristics and treatment. We performed a retrospective study of all CW patients admitted and/or treated by us between January 1986 and August 1997, studying causes, history, number and type of wounds, location, the association of chest and non-chest lesions, treatment, complications and length of hospital stay. The 90 CW patients treated in our unit accounted for 10.6% of all CW patients admitted during the study period. Eighty-five (94.4%) were men and five were women (5.6%) and mean age was 33.87 years. Physical attack was the most common cause of CW, accounting for 74 cases (82.2%) and stab wounds (77 cases, 85.6%) were more common than gunshot wounds (13 cases, 14.4%). Sixty-one (67.%) were deep and most were to the left hemithorax (46 cases, 51.1%). Besides damage to skin and soft tissues of the chest wall, lesions most often affected the pleura (59 cases, 65.5%) and parenchyma (27 cases, 30%). Local treatment of the wound was sufficient for 31 patients (34.4%) but 29 (32.3%) also required drainage and 30 (33.3%) required surgery. Complications developed in 8 cases (8.9%) and one patient died while in surgery. Mean duration of hospital stay was 8.64 days. CW in our practice is seen most commonly in young men and is caused by physical aggression, usually involving knives. Most wounds are stabs, usually to the left hemithorax. The prognosis for firearm wounds is poorer. One third of patients require thoracic drains and another third require chest surgery in addition to local treatment of CW and other wounds. The patient's hemodynamic status was the parameter that indicated need for surgical treatment.

[Evolution of resected bronchogenic carcinoma: 5-year survival. Our experience]. / Evolución del carcinoma broncogénico resecado: supervivencia a los 5 años. Nuestra experiencia.

To review the causes of non-small cell bronchogenic carcinoma treated surgically with the intention to cure, in order to determine and analyze the course of disease in our patients, particularly regarding survival after five years, and to compare our outcomes with those reported in the literature. Retrospective study of all patients resected in our unit from September 1984 through December 1990. We also analyze sex, age, and course of disease over a period of 60 months, emphasizing surgically related mortality, TNM stage, type of resection and tissue type. We calculated five year actuarial survival globally and for each variable studied, excluding patients who died as a result of surgery and those who were lost to follow-up. We identified 115 cases (13.62% of all patients under-going surgery during this period). Nine patients (7.82%) died after surgery. Six patients were lost to follow-up and for three patients data were incomplete. Fifty-three patients died within five years of surgery. Forty-four lived at least five years. Overall actuarial survival was 56.05%. Analyzing by TNM stages, 54.9% were stage I, 50% were stage II and 32.09% were stage IIIa. Pneumonectomy was performed on 43.59%, single or double lobectomy on 50.29%, and infralobar resection on 33.33% Histology revealed 54.56% to be epidermoid versus 33.01% for all other tissue types. The outcomes for bronchogenic carcinomas resected in our department are comparable to those in the literature, survival after five postoperative years being similar to the rate reported for other series.

Experimental study of a new porous tracheal prosthesis.

We studied the efficacy of a new tracheal prosthesis made of expanded polytetrafluorethylene reinforced with spiral silicone rings to repair circumferential tracheal defects in rabbits. Results showed an adequate consistency of prosthesis, adequate tolerance without producing tracheal stenoses, and impermeability to air, allowing a correct invasion by granulation tissue. This process was faster than any found in any other porous tracheal implant so far tested. We proved that epithelialization results from capillary invasion through the prosthetic pores and from growth from both tracheal ends. We conclude that this prosthetic material can be useful in repairing tracheal defects and may be the optimal tracheal graft for humans.