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1.
Albert Sánchez-Font Víctor Curull Iván Vollmer Lara Pijuan Ángel Gayete Joaquim Gea 《Archivos de bronconeumología》2009
Introduction
Transbronchial needle aspiration (TBNA) is a bronchoscopic technique that has been shown to be useful for sampling enlarged mediastinal lymph nodes. The yield of this technique can be increased by using endobronchial ultrasound (EBUS) to guide needle placement. The aim of the present study was to compare the yield of radial EBUS-guided TBNA to that of conventional TBNA in the analysis of mediastinal lymph nodes.Patients and Methods
All patients undergoing either EBUS-guided or conventional TBNA for the diagnosis of mediastinal lymph nodes between January 2006 and May 2007 were studied consecutively. Histology results were used as a reference standard in the patients treated surgically. In cases in which surgery was not indicated, the results of cytology or of clinical follow-up of at least 6 months duration were used.Results
TBNA was performed in 117 patients, and a total of 143 lymph nodes were punctured (mean shortest [SD] diameter, 17.9 [8] mm). The samples obtained were diagnostic in 58 patients (49.6%) and in 70 lymph nodes (49.0%). For paratracheal and hilar stations, the yield of radial EBUS-guided TBNA was superior to that of conventional TBNA (59.2% compared to 34.1%, P=.02).Conclusions
Radial EBUS guidance increases the diagnostic yield of TBNA in paratracheal and hilar lymph node stations. 相似文献2.
Rodrigo Alonso Moralejo Javier Sayas Catalán Ricardo García Luján Mónica Coronado Poggio Eduard Monsó Molas Ángel López Encuentra 《Archivos de bronconeumología》2010
Introduction
Positron emission tomography combined with computed axial tomography (PET/CT) is used for staging non small cell lung cancer (NSCLC). This study aims to describe PET/CT findings of unsuspected extrathoracic metastasis when used in mediastinal evaluation of patients with apparently resectable NSCLC.Patients and method
Prospective and concurrent study including all NSCLC patients between June 2004 and November 2006 who underwent PET/CT after considering them as candidates for surgery, with resectable disease after bronchoscopy, thorax and abdominal CT, brain CT and bone gammagraphy evaluation, if metastasis at these locations were suspected. Metastasis were confirmed histopathologically or assumed when they had a compatible evolution.Results
A total of 91 patients with NSCLC underwent PET/CT. In 24 of them (26%) at least one suspicious extrathoracic uptake was seen. In 7 patients (7.7%) those uptakes were NSCLC extrathoracic metastasis hidden from conventional staging. In 3 of these cases (13.1%) extrathoracic uptakes corresponded to metacrhonous tumours or pre-malignant conditions. Benign lesions were found in 12 patients (13.1%), and in 2 cases (2.2%) the uptake origins were undetermined.Conclusions
PET/CT is a complementary diagnosis method for assessing hidden metastases which could modify the therapeutical approach in patients otherwise suitable for surgery. 相似文献3.
Tamara Lourido-Cebreiro Virginia Leiro-Fernández Antoni Tardio-Baiges Maribel Botana-Rial Manuel Núñez-Delgado M. Jesús Álvarez-Martín Alberto Fernández-Villar 《Archivos de bronconeumología》2014
Background
Cell block material from puncture can be obtained with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in many cases. The aim of this study was to analyse the value of additional information from cell blocks obtained with EBUS-TBNA samples from mediastinal and hilar lymph nodes and masses.Methods
Review of pathology reports with a specific diagnosis obtained from EBUS-TBNA samples of mediastinal or hilar lesions, prospectively obtained over a two-year period. The generation of cell blocks from cytology needle samples, the contribution to morphological diagnosis, and the possible use of samples for immunohistochemistry were analysed.Results
One hundred and twenty-nine samples corresponding to 110 patients were reviewed. The diagnosis was lung cancer in 81% of cases, extrapulmonary carcinoma in 10%, sarcoidosis in 4%, lymphoma in 2.7%, and tuberculosis in 0.9%. Cell blocks could be obtained in 72% of cases. Immunohistochemistry studies on the cell blocks were significantly easier to perform than on conventional smears (52.6% vs. 14%, P < .0001). In 4 cases, the cell block provided an exclusive morphological diagnosis (3 sarcoidosis and one metastasis from prostatic carcinoma) and in 3 carcinomas, subtype and origin could be identified. Exclusive diagnoses from the cell block were significantly more frequent in benign disease than in malignant disease (25% vs 0.9%, P = .002).Conclusions
Cell blocks were obtained from 72% of EBUS-TBNA diagnostic procedures. The main contributions of cell blocks to pathology examinations were the possibility of carrying out immunohistochemical staining for the better classification of neoplasms, especially extrapulmonary metastatic tumours, and the improved diagnosis of benign lesions. 相似文献4.
Virginia Pérez Dueñas Isabel Torres Sánchez Francisco García Río Emilio Valbuena Durán Blanca Vicandi Plaza Jose María Viguer García-Moreno 《Archivos de bronconeumología》2010
Objective
To evaluate the diagnostic accuracy of the percutaneous fine needle aspiration cytology (FNAC) for mediastinal lesions by using histology or follow-up clinical diagnosis as gold standard.Patients and Methods
CT-guided percutaneous FNAC was performed on 131 patients with mediastinal lesions. Helical CT was used with 3–10 mm image thickness range and low radiation dose (40 mAs, 120 kV). Samples were immediately examined by a cytologist to determine if they were representative. Histological samples were obtained by means of biopsy or resection specimens in 73 patients and clinical follow-up in 50.Results
The material was satisfactory for diagnosis in 126 patients (95.2 %), in whom 103 lesions (78.6%) were considered malignant (62 primary tumours and 41 metastases) and 23 (17.6%) benign. In the 123 patients with clinical monitoring or pathological diagnosis, using FNAC led to the identification of malignancy with a sensitivity of 95.2 % (95%CI: 89.2–97.9%), specificity 84.2% (95%CI: 62.4–94.5%), positive predictive value 97.1% (95%-CI: 91.7–99.0%), negative predictive value 76.2% (95%CI: 54.9–89.4%), likelihood-ratio positive 6.03 (95%CI: 2.13–17.05) and accuracy 93.5% (95%CI: 87.7–96.7%). Pneumothorax was the most frequent complication (3 cases). There was good agreement between the cytological findings and the histological findings, not only for malignant lesions (kappa coefficient: 0.641) but also for benign (kappa 0.607).Conclusions
CT-guided percutaneous FNAC is a safe and effective technique for the diagnosis of the mediastinal masses, with a high diagnostic yield for malignancy depicting. 相似文献5.
Introduction and Objectives
To determine the causes of death in patients operated on for stage IB non-small cell lung cancer (NSCLC) and to assess the impact on survival of the number of lymph nodes removed.Patients and Method
We studied 300 patients operated on for stage IB NSCLC. Only palpable or visible lymph nodes were excised. Kaplan-Meier survival estimates were calculated and the survival curves were compared using the log-rank test.Results
The mean (SD) age of the patients was 62.9 (9.7) years; 280 were men, 20 were women. Pneumonectomy was performed in 84 patients, lobectomy in 186, double lobectomy in 23, and segmentectomy in 7. Squamous cell carcinoma was the most common histologic type. The mean number of lymph nodes excised was 5.05 (5.01). At the time of the study 201 patients (67%) had died, 63.2% from causes related to the NSCLC. Overall 5-year survival for the patient series was 51.9% (median, 5.50 years; 95% confidence interval [CI], 4.14–6.87 years), though the 5-year survival rate was 61.87% after non-NSCLC–related deaths were excluded (median, 11.05 years; 95% CI, 7.63–14.48 years). Tumor size and the number of lymph nodes examined significantly affected survival. In the multivariate analysis, these 2 variables were also significantly correlated with the risk of death from NSCLC (P<.0001), with relative risks of 1.158 (95% CI, 1.081–1.240) and 0.387 (95% CI, 0.254–0.591), respectively.Conclusion
Besides being affected by stage and tumor size, survival in patients operated on for stage IB NSCLC is significantly influenced by the total number of lymph nodes examined. Therefore, surgical treatment of such patients should include the examination of as many lymph nodes as possible. 相似文献6.
Virginia Leiro Fernández Maribel Botana Rial Cristina Represas Represas Ana González Piñeiro Victor del Campo Pérez Alberto Fernández-Villar 《Archivos de bronconeumología》2012
Transbronchial needle aspiration (TBNA) of pulmonary lesions without endobronchial affectation in combination with transbronchial biopsy (TBB) has been shown to increase diagnostic performance. The objective of this present study was to analyze whether the combination of TBNA with conventional TBB is a cost-effective approach. 相似文献
7.
Alfonso Fiorelli Pierfrancesco Rambaldi Giovanni Vicidomini Umberto di Serio Marina Accardo Antonio Rotondo Mario Santini 《Archivos de bronconeumología》2014
Background
To demonstrate the diagnostic accuracy of an integrated approach of blind trans-bronchial needle aspiration (TBNA) and 99mTc-2-methoxy-isobutyl-isonitrile single photon emission computed tomography (99mTc-MIBI-SPECT) in diagnosing mediastinal lymph adenopathy.Methods
Sixty one consecutive patients with mediastinal lymph adenopathy undergoing both TBNA and 99mTc-MIBI-SPECT were prospectively enrolled. Mediastinoscopy was attended in case of negative TBNA.Results
Eighty three adenopathies were sampled (73 malignant and 10 benign). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of TBNA was 74%, 100%, 100%, and 34%, respectively; and of 99mTc-MIBI-SPECT was 96%, 80%, 97%, and 73%, respectively. Combining TBNA and 99mTc-MIBI-SPECT results sensitivity, specificity, PPV, NPV of 97%, 100%, 100%, and 83%, respectively, was obtained. TBNA alone avoided medistianoscopy in 65% of cases, while an integrated approach could have potentially obviated mediastinoscopy in 76%.Conclusions
99mTc-MIBI-SPECT improved the sensitivity and the NPV of TBNA, reducing the need of mediastinoscopy. 相似文献8.
Virginia Leiro-Fernández Loretta De Chiara Maribel Botana-Rial Ana González-Piñeiro Antoni Tardio-Baiges Manuel Núñez-Delgado Diana Valverde Pérez Alberto Fernández-Villar 《Archivos de bronconeumología》2014
Introduction
The diagnosis of microscopic lymph node metastasis in lung cancer is challenging despite the constant advances in tumor staging. The analysis of the methylation status of certain genes in lymph node samples could improve the diagnostic capability of conventional cyto-histological methods. The aim of this study was to demonstrate the feasibility of methylation studies using cytological lymph node samples.Methods
Prospective study including 88 patients with a diagnosis or strong suspicion of non-small cell lung cancer, in which an echobronchoscopy was performed on mediastinal or hilar lymph nodes for diagnostic and/or staging. DNA was extracted from cytological lymph node samples and sodium bisulfite modification was performed. Methylation studies for p16/INK4a and SHOX2 were accomplished by MS-qPCR and pyrosequencing.Results
The methodology used in our study yielded optimal/good DNA quality in 90% of the cases. No differences in DNA concentration were observed with respect to the lymph node biopsied and final diagnosis. Methylation analyses using MS-qPCR and pyrosequencing were not possible in a small number of samples mainly due to low DNA concentration, inadequate purity, fragmentation and/or degradation as a consequence of bisulfite conversion.Conclusion
Methylation quantification using MS-qPCR and pyrosequencing of cytological lymph node samples obtained using echobronchoscopy is feasible if an appropriate DNA concentration is obtained, notably contributing to the identification of epigenetic biomarkers capable of improving decision-making for the benefit of potentially curable lung cancer patients. 相似文献9.
Hanaa Shafiek Federico Fiorentino Alejandro David Peralta Enrique Serra Blanca Esteban Rocío Martinez Maria Angels Noguera Pere Moyano Ernest Sala Jaume Sauleda Borja G. Cosío 《Archivos de bronconeumología》2014
Objective
To evaluate the utility of different ultrasonographic (US) features in differentiating benign and malignant lymph node (LN) by endobronchial ultrasound (EBUS) and validate a score for real-time clinical application.Methods
208 mediastinal LN acquired from 141 patients were analyzed. Six different US criteria were evaluated (short axis ≥ 10 mm, shape, margin, echogenicity, and central hilar structure [CHS], and presence of hyperechoic density) by two observers independently. A simplified score was generated where the presence of margin distinction, round shape and short axis ≥ 10 mm were scored as 1 and heterogeneous echogenicity and absence of CHS were scored as 1.5. The score was evaluated prospectively for real-time clinical application in 65 LN during EBUS procedure in 39 patients undertaken by two experienced operators. These criteria were correlated with the histopathological results and the sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated.Results
Both heterogenicity and absence of CHS had the highest sensitivity and NPV (≥ 90%) for predicting LN malignancy with acceptable inter-observer agreement (92% and 87% respectively). On real-time application, the sensitivity and specificity of the score > 5 were 78% and 86% respectively; only the absence of CHS, round shape and size of LN were significantly associated with malignant LN.Conclusions
Combination of different US criteria can be useful for prediction of mediastinal LN malignancy and valid for real-time clinical application. 相似文献10.
Background
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely-accepted method for obtaining both benign and malignant mediastinal lymph node samples. We present the results obtained with a modification that simplifies sampling, known as fine-needle capillary sampling or EBUS-FNC.Methods
A prospective observational study with 44 consecutive patients who underwent EBUS at the University of Navarra Clinic in Pamplona (Spain). All samples were obtained by EBUS-FNC instead of by conventional EBUS-TBNA. No suction was used, and the internal stylus was not completely withdrawn at any time.Results
The examination of the mediastinum by means of EBUS identified the presence of lymphadenopathies or mediastinal masses in 38 patients (86.4%). Samples were taken from more than one lymph node in 23 patients (52.3%). EBUS-FNC provided adequate and representative material for interpretation in all patients, and diagnostic performance was 87%. Sensitivity for the detection of lung cancer with EBUS-FNC was 84%. Mild complications were only recorded in two patients (4.5%).Conclusions
Our study suggests that EBUS-FNC is a safe technique, comparable to EBUS-TBNA in efficacy, and is able to obtain adequate samples. 相似文献11.
Marta Ferrer Raquel Morillo Teresa Elías Luis Jara Leticia García Rosa Nieto Emmanuel Sandoval Fernando Uresandi Remedios Otero David Jiménez 《Archivos de bronconeumología》2013
Objective
The aim of this study was to compare the predictive value of two clinical prognostic models, the Spanish score and the simplified Pulmonary Embolism Severity Index (sPESI), in an independent cohort of patients diagnosed of acute symptomatic pulmonary embolism (PE).Methods
We performed a retrospective analysis of a cohort composed of 1447 patients with acute symptomatic PE. The Spanish score and the sPESI were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for 30-day mortality, and a composite of non fatal recurrent venous thromboembolism and non fatal major bleeding, using C statistic, which was obtained by means of logistic regression and ROC curves.Results
Overall, 138 patients died (9.5%) during the first month of follow-up. Both scores showed an excellent predictive value for 30-day all-cause mortality (C statistic, 0.72 and 0.74), but the performance was poor for the secondary endpoint (C statistic, 0.60 and 0.59). The sPESI classified fewer patients as low risk (32% versus 62%; P < .001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the Spanish score (1.1% versus 4.2%), while the 30-day rate of non fatal recurrent VTE or major bleeding was similar (2.2% versus 2.3%).Conclusions
Both scores provide excellent information to stratify the risk of mortality in patients treated of PE. The usefulness of these models for nonfatal adverse events is questionable. The sPESI identified low-risk patients with PE better than the Spanish score. 相似文献12.
Nuria María Novoa Jacinto Ramos Marcelo F. Jiménez José María González-Ruiz Gonzalo Varela 《Archivos de bronconeumología》2012
Objective
To quantify the degree of compliance with the recommendations of the clinical practice guidelines published in 2009 by the ERS and the ESTS regarding the preoperative assessment of risk of lung resection in daily clinical practice at a tertiary hospital.Method
A prospective, observational study of real-time data collected from consecutive patients who had been referred for evaluation from September 2009 to December 2010. We recorded the presence or absence of the recommended studies included in the algorithm, their results and, when a test was missing, the reasons why it was not performed. Hospital mortality and cardio-respiratory morbidity rates are also presented.Results
173 patients were evaluated. In 171 cases, lung resection was performed, with a mortality of 1.2% and a cardio-respiratory morbidity of 11.7%. The failure rate of the first level of the algorithm was 4.6% and for the second level (VO2max test) it was 26%. The absence of exercise tests was mainly due to hospital structural problems and the patients’ inability to perform it. Out of the patients who performed the exercise testing, 31 reached a VO2max of 20 ml/kg-min or more and underwent surgery without calculation of FEV1ppo and DCLOppo; 35 patients required the calculation to determine their operability and in 2 cases the intervention was not recommended due to functional inoperability of the patient.Conclusions
The validation process found lack of compliance with the proposed algorithm in 18.5% of the cases basically due to the absence of the exercise tests. The rate of adherence to the algorithm recommendations should be improved before performing any other validation studies. 相似文献13.
14.
Ignasi Garcia-Olivé Eduard Xavier Valverde Forcada Felipe Andreo García José Sanz-Santos Eva Castellà Mariona Llatjós Julio Astudillo Eduard Monsó 《Archivos de bronconeumología》2009
Background and Objective
Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has proven useful for sampling mediastinal masses and nodes and for staging lung cancer. The aim of this study was to assess the usefulness of this diagnostic tool in patients with indications of mediastinal disease that could not be diagnosed by noninvasive methods or white light bronchoscopy.Patients and Methods
All patients undergoing linear EBUS-TBNA for the diagnosis of mediastinal masses and/or adenopathy at our endoscopy unit were included in the study. Diagnoses obtained by linear EBUS-TBNA or any surgical technique performed after a nondiagnostic EBUS-TBNA were considered as final.Results
In the study population of 128 patients with a mean (SD) age of 62.0 (11.2) years, a total of 294 TBNAs were performed on 12 masses and 282 nodes. Satisfactory samples were obtained in 11 cases (91.7%) from masses and in 233 cases (82.6%) from nodes. Linear EBUS-TBNA was diagnostic, obviating the need for mediastinoscopy in 115 patients (diagnostic sensitivity, 89.8%). The technique confirmed the diagnosis in 85 of the 94 patients with cancer (90.4%), in 8 of the 10 patients with tuberculosis (80.0%), and in the 5 patients with sarcoidosis.Conclusions
Linear EBUS-TBNA is a useful diagnostic tool in patients with mediastinal disease for whom a pathologic diagnosis is not achieved by noninvasive methods or white light bronchoscopy. 相似文献15.
Helmut Baumgartner Philipp Bonhoeffer Natasja M.S. De Groot Fokko de Haan John Erik Deanfield Nazzareno Galie Michael A. Gatzoulis Christa Gohlke-Baerwolf Harald Kaemmerer Philip Kilner Folkert Meijboom Barbara J.M. Mulder Erwin Oechslin Jose M. Oliver Alain Serraf Andras Szatmari Erik Thaulow Pascal R. Vouhe Edmond Walma 《Revista espa?ola de cardiología》2010
16.
Virginia Leiro-Fernández Cecilia Mouronte-Roibás Cristina Ramos-Hernández Maribel Botana-Rial Ana González-Piñeiro Esmeralda García-Rodríguez Cristina Represas-Represas Alberto Fernández-Villar 《Archivos de bronconeumología》2014
Introduction
Important clinical and epidemiological changes have been observed in lung cancer (LC) in our healthcare area compared to the previous decade. In the last 10 years, specific LC care circuits have been implemented and the active search for cases has been stepped up. The aim of this study was to analyze the progress of these changes over the last 20 years.Methods
This is a retrospective study comparing clinical and epidemiological changes between 2 historical cohorts of LC patients (1992-1994 [group 1, 164 patients] and 2004-2006 [group 2, 250 patients]) and a current group from the period 2011-2012 (group 3, 209 patients)Results
Two hundred and nine (209) LC patients were included in group 3 (2011-2012 period). After comparing groups 3 and 2, a non-significant rise in smoking was observed in women (59% vs 41%, p = .25), while the prevalence of adenocarcinoma was unchanged (45% vs 44%, p = .9). The main changes observed were the increase in cases with previous malignancies (23% vs 16%, p = .04), the rise in patients with no associated LC symptoms (33% vs 16%, p < .001), and an increased number of localized NSCLC (non-small cell LC) diagnoses (42% vs 24% in series 2, p < .001 and 14.2% in series 1, p < .001).Conclusions
The number of LC patients diagnosed in localized stages has increased significantly. Furthermore, the number of patients with no symptoms associated with LC and with a history of previous malignancy were significantly increased. 相似文献17.
18.
19.
Bienvenida Carpe-Carpe Lauro Hernando-Arizaleta M. Carmen Ibáñez-Pérez Joaquín A. Palomar-Rodríguez Antonio M. Esquinas-Rodríguez 《Archivos de bronconeumología》2013
Introduction
Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).Subjects and methods
A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.Results
We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.Conclusions
The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay. 相似文献20.
Laura Florén-Zabala Francisco Javier Chamizo-López Alicia Eisman-Maraver Carmen Pérez-González Fernando de Ory-Marchón Gloria Trallero-Maso María Cabrerizo María José Pena-López 《Enfermedades infecciosas y microbiología clínica》2012