So you’ve referred your patient with stage III non-small cell lung cancer (N2 or N3 mediastinal nodes) to receive neoadjuvant chemoradiation therapy in the hopes of eliminating cancer from the mediastinal nodes, “downstaging” her to a resectable N0 status. How do you re-evaluate the lymph nodes to ensure resection may be curative? von Bartheld et [… read more]
Deppen et al report that PET-CT’s specificity for lung cancer was only 40% among 211 patients undergoing resection for presumed lung cancer at Vanderbilt in Nashville, TN, an area endemic for histoplasmosis. Twenty-two of 43 benign nodules were granulomas; most were positive on PET-CT (~60%). Ann Thorac Surg 2011;92:428-433.
37 Canadian oncologists got together in a consensus panel to talk about biomarkers and histologic subtypes of non-small cell lung cancer. The take-home: All NSCLC should be tested for the EGFR mutation, as tyrosine kinase inhibitors can prolong survival for eligible patients. There is insufficient evidence to recommend routine testing for other mutations (KRAS, p53, [… read more]
In 161 patients with known extrathoracic malignancy and enlarged hilar/mediastinal lymph nodes, endobronchial ultrasound FNA was very helpful at identifying metastasis to the chest. EBUS found lymph node mets in 44% of the patients and a new lung cancer in 12%. Sarcoidosis was discovered in 9%. Neal et al followed-up these 161 patients for 6 months [… read more]
If air trapping causes symptoms and limitation in people with emphysema, why not un-trap the air? Say, by poking holes in bronchi leading to areas of severe emphysema, and putting paclitaxel-eluting stents in place to maintain patency? The air should naturally become freed, flow out, and improve respiratory mechanics. Only, it didn’t. Shah et al [… read more]
Sun et al pooled 21 studies (n=3,266) over 20 years. Autofluorescence added to traditional white light bronchoscopy appeared to possibly improve the sensitivity of detecting intraepithelial neoplasia, but not invasive lung cancer. J Thorac Oncol 2011;6(8):1336-1344. Review.
Wisnivesky et al crunched through the SEER data on 3,399 people who underwent resection for N1 non-small cell lung cancer. They found that the number of cancerous lymph nodes predicted survival: 1 positive N1 lymph node: 8.8 years mean lung cancer-specific survival 2-3 positive N1 lymph nodes: 8.2 years 4-8 positive N1 lymph nodes: 6.0 [… read more]
Darling et al report findings from the Early Lung PET trial for non-small cell lung cancer. PET-CT had 70% sensitivity and 94% specificity for identifying cancerous mediastinal lymph nodes (with invasive staging as the reference standard). Sounds good. However, among the 22 patients with PET-CT scans positive for mediastinal nodes, 8 did not have cancer [… read more]
Anraku et al report a series of 40 patients previously treated for lung cancer who underwent endobronchial ultrasound guided transbronchial needle aspiration for new mediastinal or hilar abnormalities between 2008-2010 at University of Toronto. After EBUS-TBNA of mediastinal/hilar lymph nodes, 28 of 40 were found to have lung cancer. In 21, an identical cell type [… read more]
In severe congestive heart failure, lymphatic drainage can increase 10-fold. Pastis et al hypothesize this could result in enlarged mediastinal lymph nodes. They retrospectively examined chest CT scans for 118 patients undergoing heart transplantation. Fifty-three had mediastinal LNs > 1 cm. In the 9 who had post-transplant CT scans available, mediastinal lymph nodes shrank after [… read more]
Trouillet et al randomized patients requiring mechanical ventilation 4 days after cardiac surgery to either immediate perc-trach, or delayed percutaneous tracheostomy at 15 days. There were no differences in ventilator-free days at 60 days, nor in survival at 28, 60, or 90 days, nor in rates of VAP; however, the early-trach group had a lower [… read more]
In a retrospective review of 418 tunneled pleural catheters placed over 2 years, 91% of patients did not require any other drainage procedure. Spontaneous pleurodesis occurred in one-quarter, in whom the catheter was taken out at a median 44 days. More patients with catheters placed in the operating room achieved pleurodesis (36%). Complication rate overall [… read more]
Survival varies widely among people with N1 non-small cell lung cancer. Examining SEER data on 1,682 patients age > 65, who had a median 8 lymph nodes resected between 1992 and 2005, Wisnivesky et al observe that the ratio of positive-to-negative sampled lymph nodes independently predicted survival. Having more than 50% positive LNs foretold a median survival [… read more]
Establishing mediastinal spread of non-small cell lung cancer (N2-3 disease) precludes surgery and worsens prognosis; whether PET-CT imaging can improve overall accuracy or safely prevent mediastinoscopies is still unknown. Fischer et al re-heat the data from their 2009 NEJM randomized trial in Denmark, with EUS-FNA and mediastinoscopy on 189 NSCLC patients, in which they concluded that the [… read more]
Ashraf et al selected people with lung nodules from the Danish Lung Cancer Screening Trial, referring them for PET. Having a suspicious PET scan, or a volume-doubling time (VDT) of < 1 year, each separately had a sensitivity of 71% and a specificity of 91% for lung cancer. Combining PET data with VDT improved sensitivity [… read more]
A retrospective look at 447 patients with stage I non-small cell lung cancer by Inoue et al suggests yes, but without affecting survival. When cancer recurred in those initially diagnosed by CT-guided needle biopsy, pleural dissemination was more likely (8 of 13 recurrences). However, 5-year disease free survival was 89% in the CT-biopsy group and [… read more]
In 173 patients free of bronchiolitis obliterans syndrome at least 6 months post-transplant, having 10 or more colony-forming units of mesenchymal cells in bronchoalveolar lavage fluid carried a >5.0 hazard ratio for subsequently developing BOS. The relation persisted after multivariate analysis, report Badri et al. AJRCCM 2011;183:1062-1070.
Transtracheal oxygen therapy: Christopher KL, Schwartz MD
In 186 patients who underwent transbronchial needle aspiration at an experienced center, followed by endoscopic biopsy or surgery as a gold standard, the positive predictive value of FNA cytology for adenocarcinoma was 92% and for squamous cell carcinoma, 82%. J Thorac Oncol 2011;6:489-493.
THIS STUDY HAS BEEN RETRACTED. Kupfer et al looked retrospectively at 168 vented patients with transudative pleural effusions at Maimonides in Brooklyn. The half that got chest tubes (with an average of 1,200 mL drained) spent 3.8 days on the vent, vs 6.5 days for the group that got only thoracentesis, with no complications reported. [… read more]