超声内镜引导下经支气管针吸活检对肺部及纵隔病变的诊断价值

目的 探讨超声内镜引导下经支气管针吸活检(EBUS-TBNA)在胸内病变诊断中的应用价值.方法 对89例影像学检查提示胸内病变的患者[肺部病变者56例,确诊肺癌需进行N分期者7例,单纯纵隔和(或)肺门淋巴结肿大者21例,纵隔占位5例]行EBUS-TBNA,穿刺物行细胞及组织病理学检查.结果 89例患者均顺利完成EBUS-TBNA,无一例发生并发症.76例穿刺阳性;5例穿刺阴性;5例因穿刺标本不满意而无法统计.56例肺部病变者中诊断恶性肿瘤45例,良性疾病5例,可疑癌3例;穿刺阴性1例;标本不满意而无法统计2例.7例确诊肺癌需进行N分期者中穿刺结果提示转移5例;穿刺阴性2例.21例单纯纵隔和(或)肺门淋巴结肿大者中诊断恶性肿瘤3例,良性疾病13例;穿刺阴性2例;标本不满意而无法统计3例.5例纵隔占位者均诊断为恶性肿瘤.3例可疑癌患者中1例经CT引导下穿刺、2例经临床随访观察诊断为恶性肿瘤.确诊肺癌而穿刺阴性的2例患者中1例手术后病理证实有淋巴结转移;1例PET-CT检查未见淋巴结转移.另3例穿刺阴性者经临床随访观察均诊断为良性疾病.EBUS-TBNA的敏感性、特异性、阳性预测值及阴性预测值分别为95%、100%、100%及20%.结论 EBUS-TBNA是诊断胸内病变的一种安全、有效的方法.     

气管内超声引导下经支气管针吸活检在胸部恶性疾病诊断和肺癌个体化治疗中的价值

目的 评价气管内超声引导下经支气管针吸活检(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在胸部恶性疾病诊断和指导肺癌个体化治疗中的应用价值。 方法 回顾性分析2012年5月—2015年12月期间91例纵隔或肺门淋巴结肿大或毗邻气道的肿块的胸部恶性疾病患者EBUS-TBNA的诊断结果和24例患者EBUS标本的EGFR突变检测结果。 结果 共对227个纵隔、肺门淋巴结和23个肿块实施TBNA。4R和7组是最常受累的纵隔淋巴结;经EBUS-TBNA确诊86例,诊断恶性胸部疾病总体敏感度为94.5%,特异度为100.0%,准确度为94.5%。确诊病例中肺腺癌、小细胞癌、鳞癌和无法分型的非小细胞肺癌分别占确诊总例数的55.8%(48/86)、26.7%(23/86)、7.0%(6/86)和5.8%(5/86)。宫颈癌、结肠癌和食管癌和肾癌纵隔淋巴结转移各1例;超声图像分析表明:类圆形淋巴结[长短径之比(L/S)<1.5]、不均质回声、边界清晰、中央淋巴门结构消失和不规则血供在恶性病变中是常见征象;EBUS-TBNA标本EGFR敏感突变率为70.8%,病理标本和液基细胞标本EGFR突变阳性率差异无统计学意义(χ2=0.509 1,P=0.47);本组共17例轻微不良反应,均对症治疗后缓解或自行缓解。 结论 EBUS-TBNA操作简单、安全性高,对胸部恶性疾病的诊断和指导肺癌的个体化治疗有重要应用价值。      

Idiopathic pulmonary fibrosis will increase the risk of lung cancer

Objective To review the studies investigating the increased risk of lung cancer in patients with idiopathic pulmonary fibrosis （IPF）.Data sources Data cited in this review were obtained mainly from PubMed and Medline from 1999 to 2013 and highly regarded older publications were also included.Study selection We identified,retrieved and reviewed the information on the frequency,risk factors,anatomical features,histological types,clinical manifestations,computed tomography findings and underlying mechanisms of lung cancer in IPF patients.Results The prevalence rates of lung cancer in patients with IPF （4.8％ to 48％） are much higher than patients without IPF （2.0％ to 6.4％）.The risk factors for lung cancer in IPF include smoking,male gender,and age.Lung cancers often occur in the peripheral lung zones where fibrotic changes are predominant.Adenocarcinoma and squamous cell carcinoma are the most common types of lung cancer in patients with IPF.Radiologic features of these patients include peripherally located,ill-defined mass mimicking air-space disease.The underlying mechanisms of the development of lung cancer in patients with IPF have not been fully understood,but may include the inflammatory response,epithelial injury and/or abnormalities,aberrant fibroblast proliferation,epigenetic and genetic changes,reduced cell-to-cell communication,and activation of specific signaling pathways.Conclusions These findings suggest that IPF is associated with increased lung cancer risk.It is necessary to raise the awareness of lung cancer risk in IPF patients among physicians and patients.     

First 30 endobronchial ultrasound-guided transbronchial needle aspirations: a single institution’s early experience

Background  A new technique developed in 2002, real time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), has been one of the most important tools in lymph nodes (LNs) staging before lung cancer surgery. EBUS-TBNA was introduced into China in 2008.

Methods  Between June 2009 and October 2009, 30 patients with mediastinal/hilar lymphadenopathy and thoracic masses previously detected with CT scan underwent EBUS-TBNA without rapid onsite cytological examination.

Results  From 30 patients, 33 samples were obtained from LNs and seven samples from intrapulmonary lesions. Twenty out of the 23 lung cancer diagnoses were clarified through the procedure, with sensitivity, specificity, positive predictive value, negative predictive value and accuracy being 87%, 100%, 100%, 70% and 90%, respectively. All three false negative cases were found in the first five procedures. Additionally, among the 33 LNs examined, three specimens that had no lymphocytes were also found within the first five procedures. There were no major complications, and the procedures were uneventful.

Conclusions  EBUS-TBNA seems a safe and effective technique in making diagnosis for mediastinal/hilar LNs and intrapulmonary masses. For pulmonologists experienced in bronchoscopy, the sensitivity of the procedure for diagnosing lung cancer should be no less than 90% after the initial five procedures .

     

Effect of cigarette smoke extraction on the expression of found in inflammatory zone 1 in rat lung epithelial L2 cells

Background Found in inflammatory zone 1 （FIZZ1） protein increased in pulmonary epithelial cells and in limited amounts of other lung cells.FIZZ1 increased in murine model of smoke induced chronic obstructive pulmonary disease.However,the direct role of FIZZ1 produced by pulmonary epithelium stimulated with cigarette smoke extraction has not been determined.We examined the expression and function of FIZZ1 in rat lung epithelial L2 cells.Methods The rat lung epithelial L2 cells （CCL 149） were exposed to cigarette smoke extraction,expression of FIZZ1 mRNA was investigated by RT-PCR.Levels of FIZZ1 protein were detected by Western blotting and laser confocal microscope.CCL 149 cells were treated with different concentrations and for different time of recombinant protein FIZZ1.After treatment,the expression levels of interleukin 8 （IL-8） were detected by enzyme-linked immunosorbent assay （ELISA）.Results When CCL 149 cells were exposed to cigarette smoke extraction,FIZZ1 mRNA and protein levels expressed significantly higher than control group.Recombinant protein FIZZ1 promoted the expression of IL-8 in a dose and time dependent manner in a certain range.Conclusions Cigarette smoke extraction activates FIZZ1 at mRNA and protein levels in CCL 149 cells.Recombinant protein FIZZ1 induces the expression of IL-8 and may thus participate in the process of chronic obstructive pulmonary disease airway inflammation and airflow obstruction.Generally,immune cells such as macrophages,neutrophils and lymphocytes are unavoidably involved in airway inflammatory and immune responses to cigarette smoke,but it is still unclear whether their involvement in the pathogenesis of chronic obstructive pulmonary disease is based on the specific expression in lung epithelial cells of FIZZ1.     

Establishment of novel rat models for premalignant breast disease

Background Breast cancer has become one of the most common malignant tumors among females over the past several years.Breast carcinogenesis is a continuous process,which is featured by the normal epithelium progressing to premalignant lesions and then to invasive breast cancer （IBC）.Targeting premalignant lesions is an effective strategy to prevent breast cancer.The establishment of animal models is critical to study the mechanisms of breast carcinogenesis,which will facilitate research on breast cancer prevention and drug behaviors.In this study,we established a feasible chemically-induced rat model of premalignant breast cancer.Methods Following the administration of the drugs （carcinogen,estrogen,and progestogen） to Sprague-Dawley （SD） rats,tumors or suspicious tumors were identified by palpation or ultrasound imaging,and were surgically excised for pathological evaluation.A series of four consecutive steps were carried out in order to determine the carcinogen：7,12-dimethylbenzaanthracene （DMBA） or 1-methyl-1-nitrosourea,the route of carcinogen administration,the administration period of estrogen and progestogen,and the DMBA dosage.Results Stable premalignant lesions can be induced in SD rats on administration of DMBA （15 mg/kg,administered three times） followed by administration of female hormones 5-day cycle.Results were confirmed by ultrasound and palpation.Conclusion Under the premise of drug dose and cycle,DMBA combined with estrogen and progestogen can be used as a SD rat model for breast premalignant lesions.     

超声支气管镜引导下的经支气管针吸活检术在肺和纵隔占位性病变诊断中的应用

  目的  探讨超声支气管镜引导下的经支气管针吸活检术（EBUS-TBNA）在肺和纵隔占位性病变诊断及肺癌分期中的应用价值。  方法  90例肺和纵隔占位病变施行超声支气管镜引导下的经支气管针吸活检术，穿刺的151份标本经石蜡包埋，HE染色，细胞病理学诊断，免疫细胞化学Ki67检测，对肺癌进行淋巴结分期，以组织病理学诊断结合临床共同诊断为标准，分析细胞学诊断的符合率及敏感性。  结果  EBUS-TBNA穿刺成功率100% （151/151），诊断率91.1% （82/90），肺和纵隔占位性病变在EBUS-TBNA术后诊断率显著提高（P < 0.01）。90例中恶性肿瘤占72.22% （65/90），良性病变占18.89% （17/90），8.89%未明确诊断（8/90）。细胞学查见恶性细胞57例，诊断敏感度为 87.69%，80%的肺癌获TNM分期（44/55）。肺结核及肉芽肿性炎Ki67阳性指数0～3%，肺恶性结节ki67阳性指数20%～80%，肺良性病变与恶性肿瘤Ki67表达差异有显著统计学意义（P < 0.01）。  结论  EBUS-TBNA 是一种安全、灵敏、准确的诊断方法，可显著提高肺和纵隔占位性病变的诊断成功率，对肺癌的分类、分期、治疗和预后判断均有重要的指导意义及临床应用价值，Ki67阳性指数是判断EBUS-TBNA穿刺细胞良恶性质的重要参考指标。     

Effect of partial liquid ventilation on lung function in oleic acid-induced lung injury model of piglets

Background Pediatric patients are susceptible to lung injury that does not respond to traditional therapies.Partial liquid ventilation （PLV） has been developed as an alternative ventilatory strategy for treating severe lung injury.The aim of this study is to investigate the effect of PLV on lung function in immature piglets.Methods Acute lung injury was induced in 12 Chinese immature piglets by oleic acid （OA）.The animals were randomly assigned to two groups （n=6 each group）：（1） conventional mechanical ventilation （MV） group and （2） PLV with FC-77 （10 ml/kg） group.Mean arterial blood pressure （MAP）,mean pulmonary arterial pressure （MPAP）,central venous pressure （CVP）,left atrial pressure （LAP）,systemic vascular resistance （SVR）,pulmonary vascular resistance （PVR）,cardiac output （CO）,mean pressure of airway （Paw）,dynamic lung compliance （Cydn）,and arterial blood gases were measured during the observation period.Results No piglet died in either group with severe lung injury.After four hours of ventilation,pH in the MV group gradually decreased to lower than 7.20,while in the PLV group,pH also gradually decreased but remained higher than 7.20 （P ＜0.05）.Partial pressure of oxygen in artery （PaO2） decreased in both groups,but with a significant difference between the PLV group and MV group （P ＜0.05）.Partial pressure of carbon dioxide in artery （PaCO2） increased in both groups,but with a significant difference between the PLV group and MV group （P ＜0.05）.Paw increased in both groups,but was not significantly different （P ＞0.05）.Cydn decreased in both groups,but without a significant difference （P ＞0.05）.At four hours,heart rate （HR） and MAP in both groups decreased.MPAP in both groups increased,and there was a significant difference between the two groups （P ＜0.05）.CVP was stable in both groups.At four hours,PVR and LAP were increased in both groups.CO was decreased in both groups （P ＜0.05）.SVR was stable during the observation time.Conclusion PLV did not improve outcome in changes of lung function.     

Integrated positron emission tomography and computed tomography in preoperative lymph node staging of non-small cell lung cancer

Background Integrated positron emission tomography and computed tomography （PET/CT） is increasingly used for the preoperative nodal staging of non-smail cell lung cancer （NSCLC）.The aim of this study was to evaluate the accuracy of PET/CT in comparison with CT in detection of nodal metastasis and preoperative nodal staging in patients with NSCLC,and to analyze the causes of the PET/CT false-negative and false-positive results.Methods Consecutive patients with pathologically proven NSCLC who underwent staging using PET/CT from July 2008 to February 2012 were evaluated retrospectively.Nodal staging was pathologically confirmed on tissue specimens obtained at thoracotomy.The accuracy of PET/CT and CT in the assessment of intrathoracic nodal involvement was determined using histological results as the reference standard.Logistic regression was used to define the causes of the false-negative and false-positive results.Results A total of 528 lymph node stations were evaluated in 101 patients.Lymph nodes were positive for malignancy in 43 out of 101 patients （42.6%）,and 101 out of 528 nodal stations （19.2%）.PET/CT was significantly more accurate for nodal staging than CT.The sensitivity,specificity,positive and negative predictive values,and accuracy of PET/CT for detecting nodal metastasis were 51.5%,95.8%,74.3%,89.3%,and 87.3% and the corresponding data by CT were 45.5%,87.1%,45.5%,87.1%,and 79.2%,respectively.PET/CT confers significantly higher specificity,positive predictive value,and accuracy than CT in detecting nodal metastasis.False-negative results by PET/CT are significantly associated with smaller lymph node size,whereas false-positive results are related to a combination of inflammatory disorders and larger lymph node size.Conclusion PET/CT confers significantly higher accuracy than CT in nodal staging,and is more specific and accurate than CT in detecting nodal metastasis but has a low sensitivity and high false-negative rate.     

Bedside chest radiography of novel influenza A （H7N9） virus infections and follow-up findings after short-time treatment

Background Influenza A （H7Ng） virus infections were first observed in China in March 2013.This type virus can cause severe illness and deaths,the situation raises many urgent questions and global public health concerns.Our purpose was to investigate bedside chest radiography findings for patients with novel influenza A （H7Ng） virus infections and the followup appearances after short-time treatment.Methods Eight hospitalized patients infected with the novel influenza A （H7Ng） virus were included in our study.All of the patients underwent bedside chest radiography after admission,and all had follow-up bedside chest radiography during their first ten days,using AXIOM Aristos MX and/or AMX-Ⅳ portable X-ray units.The exposure dose was generally 90 kV and 5 mAs,and was slightly adjusted according to the weight of the patients.The initial radiography data were evaluated for radiological patterns （ground glass opacity,consolidation,and reticulation）,distribution type （focal,multifocal,and diffuse）,lung zones involved,and appearance at follow-up while the patients underwent therapy.Results All patients presented with bilateral multiple lung involvement.Two patients had bilateral diffuse lesions,three patients had unilateral diffuse lesions of the right lobe with multifocal lesions of the left lobe,and the remaining three had bilateral multifocal lung lesions.The lesions were present throughout bilateral lung zones in three patients,the whole right lung zone in three patients with additional involvement in the left middle and/or lower lung zone（s）,both lower and middle lung zones in one patient,and the right middle and lower in combination with the left lower lung zones in one patient.The most common abnormal radiographic patterns were ground glass opacity （8/8）,and consolidation （8/8）.In three cases examined by CT we also found the pattern of reticulation in combination with CT images.Four patients had bilateral and four had unilateral pleural effusion.After a short period of treatment the pneumonia in one patient had significantly improved and three cases demonstrated disease progression.In four cases the severity of the pneumonia fluctuated.Conclusions In patients with influenza A （H7N9） virus infection,the distribution of the lung lesions are extensive,and the disease usually involves both lung zones.The most common imaging findings are a mixture of ground glass opacity and consolidation.Pleural effusion is common.Most cases have a poor short-time treatment response,and seem to have either rapid progressive radiographic deterioration or fluctuating radiographic changes.Chest radiography is helpful for evaluating patients with severe clinical symptoms and for follow-up evaluation.     

Protective effects of penehyclidine hydrochloride on acute lung injury caused by severe dichlorvos poisoning in swine

Background Organophosphate poisoning is an important health problem in developing countries which causes death mainly by inducing acute lung injury. In this study, we examined the effects of penehyclidine hydrochloride （PHC）, a selective M-receptor inhibitor, on dichlorvos-induced acute lung injury in swine. Methods Twenty-two female swines were randomly divided into control （n=5）, dichlorvos （n=6）, atropine （n=6）, and PHC （n=5） groups. Hemodynamic data, extravascular lung water index （EVLWI）, and pulmonary vascular permeability index （PVPI） were monitored; blood gas analysis and acetylcholinesterase （AchE） levels were measured. PaO2/FiO2, cardiac index （CI）, and pulmonary vascular resistance indices （PVRI） were calculated. At termination of the study, pulmonary tissue was collected for ATPase activity determination and wet to dry weight ratio （W/D） testing 6 hours post-poisoning. TUNEL assay, and Bax, Bcl-2, and caspase-3 expression were applied to pulmonary tissue, and histopathology was observed. Results After poisoning, PHC markedly decreased PVRI, increased CI more effectively than atropine. Anticholinergic treatment reduced W/D, apoptosis index （AI）, and mitigated injury to the structure of lung; however, PHC reduced AI and caspase-3 expression and improved Bcl-2/Bax more effectively than atropine. Atropine and PHC improved ATPase activities; a significant difference between groups was observed in Ca2＋-ATPase activity, but not Na＋-K＋-ATPase activity. Conclusions The PHC group showed mild impairment in pathology, less apoptotic cells, and little impact on cardiac function compared with the atropine group in dichlorvos-induced acute lung injury.     

Clinicopathological classification and individualized treatment of breast cancer

Background The clinicopathological classification was proposed in the St. Gallen Consensus Report 2011. We conducted a retrospective analysis of breast cancer subtypes, tumor-nodal-metastatic （TNM） staging, and histopathological grade to investigate the value of these parameters in the treatment strategies of invasive breast cancer.     

Current practice for pulmonary hypertension

Objective To investigate the current practice of pulmonary hypertension including current epidemiology, diagnosis and treatment. Data sources The review was based on data obtained from the published articles and guidelines. Study selection Articles with high level of evidence or current best evidence in each issue were selected to be reviewed. Results Overall prevalence of pulmonary hypertension was 0.3% to 6% with left heart disease occupying the most proportion, followed by pulmonary disease, pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. In diagnosis, a flow diagram of diagnosis of pulmonary hypertension, differential diagnosis of pulmonary hypertension and how to determine the severity of pulmonary hypertension are explained including recent development of magnetic resonance imaging and gene abnormality study on bone morphogenetic protein receptor ll. In treatment, newly- developed pulmonary vasodilators and the way to use them are shown to treat pulmonary hypertension. Conclusion Safer and more effective treatment algorithm and basic researches and clinical trials are warranted to be explored.     

Heliox as a driving gas to atomize inhaled drugs on acute exacerbation of chronic obstructive pulmonary disease: a prospective clinical study

Background Acute exacerbation of chronic obstructive pulmonary disease （AECOPD） is a common condition,which affects not only the quality of life of patients but also their prognosis.The purpose of this study was to explore the effects of an inhaled salbutamol sulfate solution and an inhalation suspension of the glucocorticoid budesonide that were atomized with heliox to treat patients with AECOPD.Methods Twenty-three patients with AECOPD were divided into a treatment group （He/O2=70％/30％） and a control group （N2/O2=70％/30％）.The salbutamol sulfate and budesonide were administered by inhalation twice a day for 7 days.Vital signs,arterial blood gas levels,pulmonary function and the levels of serum myostatin （sMSTN） were measured and lung vibration imaging was performed.Results We found that the PaO2 and PaCO2 values were not significantly different between the two groups at the various time points （P ＞0.05）.There were also no significant differences in any of the parameters of pulmonary function between the two groups.However,after baseline correction,the increase rate of the forced expiratory volume in one second （FEV1）,the forced vital capacity （FVC）,and the maximum minute ventilation （MW） appeared to be significantly increased at some time points compared with the baseline （before treatment） in both groups （P ＜0.05）.Although the values of quantitative lung distribution （QLD） for different regions and the levels of sMSTN were slightly different between the two groups,the repeated measures analysis of variance （ANOVA） revealed that there were no significant differences between the two groups or within any group （P ＞0.05）.Conclusion Although the use of heliox as a driving gas can improve symptoms and benefit patients with AECOPD,the heliox treatment group did not have significant differences in arterial blood gases,lung function,lung vibration response imaging or the levels of sMSTN compared with the control group.（Chinese Clinical Trial Register Center ChiCTR-TRC-00000273）     

Ischemic postconditioning alleviates lung injury and maintains a better expression of aquaporin-1 during cardiopulmonary bypass

Background It has found that ischemic postconditioning （IPO） might decrease pulmonary ischemia/reperfusion （I/ R） injury,which is one of the main reasons of lung injury caused by cardiopulmonary bypass （CPB）.It was found that aquaporins （AQPs） play a role in the maintenance of fluid homeostasis.But it is still unclear whether IPO influences the expression of aquaporin-1 （AQP1）.This study was designed to investigate whether IPO can reduce CPB-related lung injury and affect the expression of AQP1 of lungs.Methods Twelve healthy dogs were divided into control group （C group） and ischemia postconditioning group （IPO group）.CPB procedures were implemented.Ten minutes later,the left pulmonary artery was separated and blocked.Postconditioning consisted of two cycles of 5-minute pulmonary artery reperfusion/5-minute reocclusion starting at the beginning of reperfusion.The 2×4 cm tissues of both sides of pulmonary apex,superior,middle and inferior lobe were taken before CPB （T1）,before occlusion and reopening of left pulmonary artery （T2,T3）,and 2 hours after CPB （T4）.Samples were used to evaluate lung injury degrees and to detect the expression of AQP1.At T1 and T4,blood was collected from femoral artery to calculate pulmonary function.Results At T4,each pulmonary function showed significant deterioration compared with T1.Lung injury could be found at the onset of CPB.However,the expression of AQP1 decreased and wet to dry weight ratio （W/D） increased after T2.In the left lung of C group,the worst pulmonary function and structures were detected.The slightest changes were discovered in the right lung of C group.A close relationship between W/D and lung injury score was found.The lung injury score was negatively related with the expression of AQP1.It was found that the expression of AQP1 was negatively connected with W/D.Conclusions In dog CPB models,lung injury induced by CPB was related with down regulated expression of AQP1.AQP1 is believed to be involved in the mechanisms of     

Is surgical treatment of cancer of the gastric cardia or esophagus associated with a concurrent major pulmonary operation feasible? One center’s experience

Background  Pulmonary complications are a major cause of mortality after operation for cancer of the gastric cardia or esophagus. Although the risk involved in gastric cardiectomy or esophagectomy associated with a concurrent major pulmonary operation is expected to be much higher, it has seldom been evaluated on the basis of clinical experience. The aim of this study was to investigate the possibility and feasibility of the gastric cardiectomy or esophagectomy associated with a major pulmonary operation.

Methods  From August 2003 to January 2011, 14 patients underwent concurrent gastric cardiectomy or esophagectomy and a major pulmonary operation in our hospital. This included eight for pulmonary invasion of esophageal carcinoma, and six for synchronous lung tumor. All patients underwent systematic lymph node dissection for cardiac or esophageal cancer. To prevent postoperative complications, the operative approach and dissection procedures for cardiac or esophageal carcinoma were modified according to the associated pulmonary operation and the extent of cancer invasion. All thoracotomies for cardiectomy or esophagectomy were performed on the same side as the major pulmonary operation.

Results  All patients underwent a curative operation. There were no deaths or postoperative complications in the six synchronous lung tumor patients. In the eight pulmonary invasion patients, one patient died of respiratory failure 11 days after operation, and postoperative complications developed in four of them, but none was fatal. Six patients were still alive.

Conclusions  Curative gastric cardiectomy or esophagectomy associated with concurrent major pulmonary operation is not contraindicated in patients in good condition. In selected patients, when the operative procedures for cardiectomy or esophagectomy are appropriately modified to minimize the effect of the associated pulmonary operation, the treatment is associated with a low operative morbidity and mortality with an acceptable long-term survival.

     

Initial computed tomography findings of invasive pulmonary aspergillosis in non-hematological patients

Background  The computed tomography (CT) findings of invasive pulmonary aspergillosis (IPA) are unclear in non- hematological patients. The present study was a retrospective evaluation of CT images in non-hematological patients with IPA.

Methods  All adult patients who met the 2008 European Organization for Research and Treatment of Cancer/ Mycoses Study Group (EORTC/MSG) criteria for proven or probable IPA were included during a 5-year study at our institutions. Initial CT findings in our cohort were retrospectively reviewed by two independent thoracic radiologists blinded to patient demographics and clinical outcomes. The presence, pattern, and distribution of abnormalities were recorded.

Results  Twenty-three non-hematological patients with pathologically confirmed IPA were included in our study. Areas of ground-glass opacities were present in 14 patients (61%), which were bilateral in 10 patients and unilateral in four. This pattern mainly involved the middle and upper lung zones. Air-space consolidation was identified in 12 patients (52%), and the areas were distributed along the bronchus or subpleura in most cases. Other findings, including five small nodules (22%), three macronodules (13%), and one halo sign (4%), were less common.

Conclusions  CT findings of IPA in non-hematological patients frequently manifested as acute bronchopneumonia, and ground-glass opacities and air-space consolidations were the most common CT findings of IPA in these patients.

     

Value of frozen section examination in diagnosis and treatment of high-grade cervical intraepithelial neoplasia

Background  Invasive cancer of the cervix is considered a preventable disease because it has a long pre-invasive state, cervical cytology screening programs are currently available, and treatment of pre-invasive lesions is effective. We tested the accuracy of frozen section examination (FSE) of cone specimens to identify the endocervical margin and rule out invasion in patients with high-grade cervical intraepithelial neoplasia (CIN).

Methods  For 320 consecutive patients with a preoperative biopsy result of CIN stage 2/3, cold-knife conization (CKC) was performed followed by FSE. The results from analyses of permanent paraffin sections (PS) were compared with the FSE findings.

Results  The accuracy of FSE was 87% (278/320). For all of the seven patients with an invasive squamous cell carcinoma of the cervix identified by FSE, the diagnosis was confirmed by PS analysis. For one patient, the FSE result was cervicitis, whereas PS ananlysis showed microinvasive carcinoma. Appropriate surgery was performed for all patients based on the FSE and biopsy results. The FSE and PS results were not significantly different (P=0.000). Definitive examination of margin status using PS was concordant with FSE findings in all cases.

Conclusions  FSE is a rapid and reliable method for evaluating CKC specimens. It can identify frank invasion, permit adequate treatment in a one-stage procedure, and reliably detect clear resection margins. Since discrepancies do exist and may result in inappropriate treatment, further research is required to decrease these discrepancies and avoid missing even one case.