scholarly journals Does aggressive management of solitary pulmonary nodules pay off?

Breathe ◽  
2019 ◽  
Vol 15 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Stefano Elia ◽  
Serafina Loprete ◽  
Alessandro De Stefano ◽  
Georgia Hardavella
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Early Stage ◽  
Large Diameter ◽  
False Negative ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Early Stage Lung Cancer ◽  
Fdg Uptake ◽  
Negative Results

Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies.Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported.The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatmentversusonly 9% undergoing “overtreatment”.In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection.

Non-surgical management of early-stage lung cancer

2017 ◽  
Author(s):  
Jim Brown ◽  
Neal Navani
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
The Elderly ◽  
Multidisciplinary Teams ◽  
Solitary Pulmonary Nodules ◽  
Early Stage Lung Cancer ◽  
Mortality And Morbidity ◽  
Inoperable Patient ◽  
Ablative Techniques

As low-dose computed tomography screening of ‘high-risk’ smokers is occurring with increasing frequency, the incidental discovery of solitary pulmonary nodules is becoming more frequent, and lung cancer multidisciplinary teams are now often faced with balancing risk and benefit when making decisions regarding the radical treatment of patients with a clinical diagnosis of early lung cancer but borderline fitness. Surgery offers the best prospect of cure but is associated with significant mortality and morbidity; the elderly and frail experience more toxicity and a greater impact on the quality of life. This chapter reviews the criteria for assessing surgical fitness and examines the evidence for minimally invasive and ablative techniques for the treatment of early peripheral lung cancer in the medically inoperable patient.

Do minimally invasive approaches increase the survival of patients with early-stage lung cancer undergoing lobectomy

2016 ◽  
Vol 1 ◽  
pp. 18-18
Author(s):  
Benoît Bédat ◽  
Wolfram Karenovics ◽  
Samira Mercedes Sadowski ◽  
Frédéric Triponez
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Early Stage ◽  
Early Stage Lung Cancer ◽  
Stage Lung Cancer

scholarly journals Diagnosis and outcome of resected solitary pulmonary nodules after liver transplantation

2019 ◽  
Author(s):  
Mari Tone ◽  
Nobuyasu Awano ◽  
Takehiro Izumo ◽  
Hanako Yoshimura ◽  
Tatsunori Jo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Liver Transplantation ◽  
Early Stage ◽  
Lung Resection ◽  
Invasive Pulmonary Aspergillosis ◽  
Primary Lung Cancer ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Computed Tomography Scans

Abstract Objective Solitary pulmonary nodules after liver transplantation are challenging clinical problems. Herein, we report the causes and clinical courses of resected solitary pulmonary nodules in patients who underwent liver transplantation. Methods We retrospectively obtained medical records of 68 patients who underwent liver transplantation between March 2009 and June 2016. This study mainly focused on patients with solitary pulmonary nodules observed on computed tomography scans during follow-ups that were conducted until their deaths or February 2019. Results Computed tomography scans revealed solitary pulmonary nodules in 7 of the 68 patients. Definitive diagnoses were obtained using video-assisted lung resection in all seven patients. None experienced major postoperative complications. The final pathologic diagnoses were primary lung cancer in three patients, pulmonary metastases from hepatocellular carcinoma in one patient, invasive pulmonary aspergillosis in one patient, post-transplant lymphoproliferative disorder in one patient, and hemorrhagic infarction in one patient. The three patients with lung cancer were subsequently treated with standard curative resection. Conclusions Solitary pulmonary nodules present in several serious but potentially curable diseases, such as early-stage lung cancer. Patients who present with solitary pulmonary nodules after liver transplantation should be evaluated by standard diagnostic procedures, including surgical biopsy if necessary.

scholarly journals Technical Advances in Segmentectomy for Lung Cancer: A Minimally Invasive Strategy for Deep, Small, and Impalpable Tumors

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3137
Author(s):  
Takashi Eguchi ◽  
Toshihiko Sato ◽  
Kimihiro Shimizu
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Thoracic Surgery ◽  
Early Stage ◽  
Three Dimensional ◽  
Tumor Localization ◽  
Early Stage Lung Cancer ◽  
Published Evidence ◽  
Radiofrequency Identification ◽  
Technical Advances

With the increased detection of early-stage lung cancer and the technical advancement of minimally invasive surgery (MIS) in the field of thoracic surgery, lung segmentectomy using MIS, including video- and robot-assisted thoracic surgery, has been widely adopted. However, lung segmentectomy can be technically challenging for thoracic surgeons due to (1) complex segmental and subsegmental anatomy with frequent anomalies, and (2) difficulty in localizing deep, small, and impalpable tumors, leading to difficulty in obtaining adequate margins. In this review, we summarize the published evidence and discuss key issues related to MIS segmentectomy, focusing on preoperative planning/simulation and intraoperative tumor localization. We also demonstrate two of our techniques: (1) three-dimensional computed tomography (3DCT)-based resection planning using a novel 3DCT processing software, and (2) tumor localization using a novel radiofrequency identification technology.

scholarly journals The Role of IGF-Pathway Biomarkers in Determining Risks, Screening, and Prognosis in Lung Cancer: A Systematic Review.

2021 ◽  
Author(s):  
Alexander W. Pohlman ◽  
Hita Moudgalya ◽  
Lia Jordano ◽  
Gabriela C. Lobato ◽  
David Gerard ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Early Stage Lung Cancer ◽  
Detection Rates ◽  
Variable Expression ◽  
Igf I ◽  
Igfbp 3

Abstract Background: Detection rates of early-stage lung cancer are traditionally low, which contributes to inconsistent treatment responses and the highest rates of annual cancer deaths in the U.S. Currently, age and smoking history are the primary factors that qualify patients for low-dose computed tomography (LDCT) screening, which contributes heavily to a high false discovery rate. This limitation to the current screening paradigm has prompted research to identify biomarkers that will help more clearly define eligible patients for LDCT screening, differentiate indeterminate pulmonary nodules, and select individualized cancer therapy. Biomarkers within the Insulin-like Growth Factor (IGF) family have come to the forefront of this research. Methods: Literature available through PubMed and Google Scholar sources was cataloged using keywords: {Lung Cancer} AND {IGF} AND {Risk OR Diagnosis OR Prognosis OR Prognostication OR Treatment}. The results were summarized and provided herein.Results: Multiple biomarkers within the IGF family (or axis) have been investigated, most notably IGF-I and IGF binding protein 3 (IGFBP-3). However, newer studies seek to expand this search to other molecules within the IGF axis. Results have differed, however, due to features such as the pre-disease variable expression of IGF-I and IGFBP-3, likely promoted by factors such as obesity and smoking history. Certain studies have demonstrated these biomarkers are useful as a companion test alongside lung cancer screening, but other findings were not as conclusive, possibly owing to measurement bias from pre-analytical variables and non-standardized assay techniques. Research also has suggested IGF biomarkers may be beneficial in the prognostication and subsequent application of treatment via systemic therapy. Despite these advances, however, additional knowledge as to the intricacies of regulatory mechanisms inherent to this system are necessary to more fully harness the potential clinical utility for diagnostic tests and to identify novel targets for therapeutic intervention. Conclusions: The IGF system likely plays a role in multiple phases of lung cancer; however, there is a surplus of conflicting data, especially prior to development of the disease and during early stages of detection. IGF biomarkers may be valuable in the screening, prognosis, and treatment of lung cancer, though their exact application requires further study.

scholarly journals The Role of Minimally Invasive Surgery in the Treatment of Lung Cancer

2021 ◽  
Author(s):  
Güntuğ Batihan ◽  
Kenan Can Ceylan
Keyword(s):  
Lung Cancer ◽  
Minimally Invasive ◽  
Early Stage ◽  
Locally Advanced ◽  
Length Of Hospital Stay ◽  
Vats Lobectomy ◽  
Early Stage Lung Cancer ◽  
Oncologic Results ◽  
Stage Lung Cancer

Lobectomy plus regional lymph node dissection remains the gold standard treatment method in early-stage lung cancer. However, with the demonstration of the safety and efficacy of minimally invasive approaches, the expression of surgery in this statement, replaced by thoracoscopic anatomical lung resection. Clinical studies have demonstrated the superiority of VATS in terms of postoperative pain, drainage time, length of hospital stay, and complications, moreover, long-term oncologic results are similar or better than thoracotomy. Therefore, VATS lobectomy is the preferred surgical method in early-stage lung cancer. Different surgical techniques are available in VATS and can be modified according to the surgeon’s personal experience. Uniport can be applied as well as two or three port incisions. In this book section, I plan to focus on VATS lobectomy, technique-related tricks, complication management, and long-term oncologic results in early and locally advanced lung cancer.

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