DOCSLIB.ORG

A Prediction Model for N2 Disease in T1 Non-Small Cell Lung Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Prediction Model for N2 Disease in T1 Non-Small Cell Lung Cancer View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector General Thoracic Surgery Zhang et al A prediction model for N2 disease in T1 non–small cell lung cancer Yang Zhang, MD,a,b Yihua Sun, MD,a,b Jiaqing Xiang, MD,a,b Yawei Zhang, MD,a,b Hong Hu, MD,a,b and Haiquan Chen, MDa,b Objective: Controversy remains over the routine use of mediastinoscopy or positron emission tomography in T1 non–small cell lung cancer without lymph node enlargement on computed tomography because the risk of N2 GTS involvement is comparatively low. We aimed to develop a prediction model for N2 disease in cT1N0 non–small cell lung cancer to aid in the decision-making process. Methods: We reviewed the records of 530 patients with computed tomography–defined T1N0 non–small cell lung cancer who underwent surgical resection with systematic lymph node dissection. Correlations between N2 involvement and clinicopathologic parameters were assessed using univariate analysis and binary logistic regression analysis. A prediction model was built on the basis of logistic regression analysis and was internally validated using bootstrapping. Results: The incidence of N2 disease was 16.8%. Four independent predictors were identified in multivariate logistic regression analysis and included in the prediction model: younger age at diagnosis (odds ratio, 0.974; 95% confidence interval, 0.952-0.997), larger tumor size (odds ratio, 2.769; 95% confidence interval, 1.818-4.217), central tumor location (odds ratio, 3.204; 95% confidence interval, 1.512-6.790), and invasive ad- enocarcinoma histology (odds ratio, 3.537; 95% confidence interval, 1.740-7.191). This model shows good cal- ibration (Hosmer–Lemeshow test: P ¼ .784), reasonable discrimination (area under the receiver operating characteristic curve, 0.726; 95% confidence interval, 0.669-0.784), and minimal overfitting demonstrated by bootstrapping. Conclusions: We developed a 4-predictor model that can estimate the probability of N2 disease in computed tomography–defined T1N0 non–small cell lung cancer. This prediction model can help to determine the cost- effective use of mediastinal staging procedures. (J Thorac Cardiovasc Surg 2012;144:1360-4) The wide application of computed tomography (CT) has (CT-defined N0) because the risk of N2 disease is low in increased the detection of T1 (3 cm)1 lung cancers. Surgi- such patients.8,9 Although positron emission tomography cal resection is considered the optimal treatment for T1 (PET) showed superiority over CT in the mediastinal non–small cell lung cancer (NSCLC) without mediastinal staging of NSCLC10,11 and a promise to reduce the need lymph node (N2) involvement or distant metastasis. How- for invasive staging tools, its high expense is an obstacle ever, patients with T1 lung cancer with N2 involvement to the routine application in many countries.12 Moreover, should take definitive concurrent chemoradiation or induc- the benefit of PET for CT-defined clinical stage IA in pa- tion chemotherapy.2-4 Accurate mediastinal staging is a key tients also remains controversial.13 factor for the successful management of NSCLC. Some studies sought to determine the cost-effective strat- Mediastinoscopy is deemed the gold standard for medi- egies of applying invasive or expensive diagnostic proce- astinal lymph node staging.5,6 However, the risk of dures.14,15 To obtain pretest probability of N2 disease is morbidity and mortality (2% and 0.08%, respectively)7 essential for the cost-effectiveness measurement of subse- cannot be overlooked because of the invasive nature of me- quent diagnostic tests. Therefore, this study aimed to de- diastinoscopy. Controversy remains as to whether routine velop a risk prediction model of N2 disease in CT-defined mediastinoscopy should be performed in patients with T1 T1N0 NSCLC. lung cancer who have no nodal enlargement on CT scans PATIENTS AND METHODS From the Department of Thoracic Surgery,a Fudan University Shanghai Cancer Cen- Patients ter, Shanghai, China; and Department of Oncology,b Shanghai Medical College, From June 2007 to August 2011, we retrospectively reviewed our data- Fudan University, Shanghai, China. base of all patients who underwent resection with curative intention at the Disclosures: Authors have nothing to disclose with regard to commercial support. Department of Thoracic Surgery, Fudan University Shanghai Cancer Hos- Received for publication Feb 16, 2012; revisions received May 14, 2012; accepted for pital, Shanghai, China. We routinely performed contrast-enhanced chest publication June 18, 2012; available ahead of print July 23, 2012. CT scans at the Fudan University Shanghai Cancer Hospital before surgery, Address for reprints: Haiquan Chen, MD, Department of Thoracic Surgery, Fudan even for the patients who had received CT scans in other hospitals. Other University Shanghai Cancer Center, 270 Dong-An Rd, Shanghai 200032, China (E-mail: [email protected]). routine preoperative examinations included cardiopulmonary tests, brain 0022-5223/$36.00 magnetic resonance imaging or CT, bone scanning, and abdominal CT or Copyright Ó 2012 by The American Association for Thoracic Surgery ultrasonography. Lymph nodes were considered to be positive if the short http://dx.doi.org/10.1016/j.jtcvs.2012.06.050 axis exceeded 1 cm on chest CT images. Peripheral nodules were defined 1360 The Journal of Thoracic and Cardiovascular Surgery c December 2012 Zhang et al General Thoracic Surgery median age at diagnosis was 59 years (interquartile range, Abbreviations and Acronyms 13). Tumor size ranged from 0.4 to 3.0 cm (median, 2.0; in- CT ¼ computed tomography terquartile range, 1.0). The most common lobar location NSCLC ¼ non–small cell lung cancer was the left upper lobe (30.4%), followed by the right upper PET ¼ positron emission tomography lobe (28.7%). The majority (91.5%) of patients underwent ROC ¼ receiver operating characteristic lobectomy. The incidence of mediastinal lymph node metastasis was 16.8% (89/530). In univariate analysis (Table 1), N2-positive patients were significantly younger than as tumors with the center located within the outer one third of the lung on N2-negative patients (P ¼ .028). The mean tumor diameter GTS CT scans. Inclusion criteria included (1) NSCLC 3 cm or less in diameter of patients with mediastinal nodal involvement was signif- measured on CT scans without evidence of positive lymph nodes or distant metastasis (cT1N0M0) and (2) systematic lymph node dissection. Patients icantly larger than those without mediastinal nodal involve- who had adenocarcinoma in situ or minimally invasive adenocarcinoma ment (P <.001). The incidence of N2 disease in patients histology according to the new lung adenocarcinoma classification16 with invasive adenocarcinoma was 19.5% compared with were excluded (only invasive adenocarcinomas were included). Patients 9.6% in patients with other histology (P ¼ .006). Patients who received neoadjuvant chemotherapy or radiotherapy were excluded. with positive N2 nodes were more likely to be never- Patients with a history of malignant tumors were excluded. % % ¼ Clinicopathologic data on age, gender, smoking history, family history smokers (69.7 vs 58.0 ; P .041) and to have centrally of lung cancer, symptoms at presentation, tumor site, tumor size measured located tumors (18.0% vs 10.2%; P ¼ .036). on CT, type of surgery, histology, and lymph nodal status according to path- Finally, 4 independent predictors were included in the ologic reports were collected. prediction model after multivariate logistic regression. This study was conducted in accordance with the Helsinki Declaration Odds ratios, 95% confidence intervals, and P values of sig- and approved by the institutional review board of the Fudan University Shanghai Cancer Center, Shanghai, China. Informed consent was waived nificant predictors are listed in Table 2. Larger tumor size because this was a retrospective analysis. (P<.001), central tumor location (P ¼ .002), invasive ad- enocarcinoma histology (P<.001), and younger age at di- Statistical Analyses agnosis (P ¼ .025) were independent predictors of In univariate analyses, we used Pearson’s chi-square test or the Fisher mediastinal lymph node metastasis. exact test to evaluate the correlation between a mediastinal lymph node me- A formula was developed to estimate the probability tastasis and a categoric variable, and an independent sample t test to assess of having mediastinal lymph node metastasis on the the association between N2 involvement and a continuous variable. Vari- ables with a P value less than .2 were entered into a binary logistic regres- basis of the results of the binary logistic regression sion analysis that formed the basis of a prediction model. We used forward analysis. A score is calculated using tumor diameter, stepwise selection procedures with the likelihood-ratio test. Factors statis- tumor location, histology, and age at diagnosis: tically significant at the .05 level remained in the final model. score ¼3.449 þ (1.018 $ diameter) þ (1.164 $ location) Calibration (concordance between predicted and observed probabili- þ(1.263 $ histology)À(0.026 $ age). The units for diame- ties) of the final model was determined with the Hosmer–Lemeshow statis- tic and the calibration plot using 10 equal contiguous risk ranges showing ter and age are centimeter and year, respectively. If the observed versus predicted probabilities. The discriminative ability of the tumor is centrally located, location ¼ 1 (location ¼ 0 model was assessed with the area under the receiver operating characteris- if the tumor is peripherally located). If the tumor is ad- tic (ROC) curve, which ranges from 0.5 (no discrimination) to 1.0 (perfect enocarcinoma in histology, histology ¼ 1 (histology ¼ 0 discrimination). for other histology). The likelihood of N2 nodal A problem with a predictive model is that the performance is overesti- mated when assessed on the sample used to build the model.17 We inter- involvement is then calculated: likelihood of positive Score Score nally validated this model by bootstrapping, which is reported to be N2 nodes ¼ e /(1 þ e ).
Load more

Recommended publications
  • Airway Obstruction After Biopsy by Cervical Mediastinoscopy in a Patient with a Mediastinal Mass -A Case Report
    Korean J Anesthesiol 2012 July 63(1): 65-67 Case Report http://dx.doi.org/10.4097/kjae.2012.63.1.65 Airway obstruction after biopsy by cervical mediastinoscopy in a patient with a mediastinal mass -A case report- Yong-Cheol Lee2, Sang-Jin Park1, and In-seong Kim1 Department of Anesthesiology and Pain Medicine, 1College of Medicine, Yeungnam University, 2School of Medicine, Keimyung University, Daegu, Korea Biopsy, using mediastinoscopy is commonly employed for accurate histologic diagnosis of a mediastinal mass. However, since the mass is not removed during the procedure, it may cause compression of vital structures such as major airways, the heart, the pulmonary artery, and the superior vena cava after surgery. We observed a case of a 66-year-old man with a mediastinal mass that caused severe airway obstruction during recovery from anesthesia following mediastinoscopic biopsy, probably caused by upper airway edema which seemed to originate from compression of the superior vena cava. Therefore, we suggest that unexpected airway obstruction in a patient with a mediastinal mass can be due to superior vena cava compression. (Korean J Anesthesiol 2012; 63: 65-67) Key Words: Airway obstruction, Mediastinoscopy, Superior vena cava. Biopsies, using mediastinoscopy are commonly utilized Case Report to decide on the treatment of mediastinal masses. However, since the mass is not removed during the biopsy, it may cause A 66-year-old man visited the hospital with a one month compression of vital structures after the procedure [1]. The history of chest discomfort and sporadic swelling in the face superior vena cava has an especially low intravascular pressure and arms in the morning.
    [Show full text]
  • Update in Anaesthesia
    Update in Anaesthesia Pulmonary Function Tests and Assessment for Lung Resection David Portch*, Bruce McCormick *Correspondence Email: [email protected] INTRODUCTION Summary respectively. There are 2400 lobectomies and 500 The aim of this article is to describe the tests available This article describes the for the assessment of patients presenting for lung pneumonectomies performed in the UK each year, steps taken to evaluate resection. The individual tests are explained and we with in-hospital mortality 2-4% for lobectomy and patients’ fitness for lung 4 describe how patients may progress through a series of 6-8% for pneumonectomy. resection surgery. Examples tests to identify those amenable to lung resection. Lung resection is most frequently performed to treat are used to demonstrate interpretation of these tests. Pulmonary function testing is a vital part of the non-small cell lung cancer. This major surgery places It is vital to use these tests in assessment process for thoracic surgery. However, large metabolic demands on patients, increasing conjunction with a thorough for other types of surgery there is no evidence postoperative oxygen consumption by up to 50%. history and examination that spirometry is more effective than history and Patients presenting for lung resection are often high in order to achieve an examination in predicting postoperative pulmonary risk due to a combination of their age (median age accurate assessment of each complications in patients with known chronic lung is 70 years)5 and co-morbidities. Since non-surgical patient’s level of function. conditions. Furthermore specific spirometric values mortality approaches 100%, a thorough assessment of Much of this assessment (e.g.
    [Show full text]
  • Consider a Minor Surgery As a Major Surgery and Order Preoperative Tests Accordingly (I.E
    ROUTINE PREOPERATIVE LAB TEST GUIDELINES For adult patients (≥ 16 years) undergoing elective surgery TESTS WITHIN 6 MONTHS OF SURGERY CLINICAL JUDGEMENT IS REQUIRED EXCLUSIONS are valid, provided there has been no interim change as additional tests may be appropriate for patients with this guideline does not apply to patients in the patient’s condition. complex or uncommon surgical or medical conditions. undergoing cardiac surgery or cesarean section. MINOR SURGERY MAJOR SURGERY Associated with an expected blood loss of Associated with an expected blood loss of >500mL, significant fluid shifts and typically, at least one night in <500mL, minimal fluid shifts and is typically hospital*. Includes laparoscopic surgery (except cholecystectomy and tubal ligation); open resection of organs; done on an ambulatory basis (day surgery/ large joint replacements; mastectomy with reconstruction; and spine, thoracic, vascular, or intracranial surgery. same day discharge)*. It includes cataract * If the surgery is typically ambulatory but the patient has a medical or social reason for overnight admission (i.e. OSA, no support surgery; breast surgery without reconstruction; at home), still consider the surgery minor in determining which lab tests to order. laparoscopic cholecystectomy and tubal ligation; and most cutaneous, superficial, All Major Age: 16-49 years old Age: 50+ years old endoscopic and arthroscopic procedures. or Order • add ECG for patients with DM, HTN, Renal, • add ECG + + – DO NOT ORDER PREOP TESTS CBC Cardiovascular or severe Respiratory disease. + + – • add Na , K , Cl , TCO2 including: chest x-rays, Na , K , Cl , TCO , + + – 2 Na K Cl TCO & Cr/ eGFR serum glucose, CBC, ECG, INR, urinalysis, • add , , , 2 for patients with • add Cr/ eGFR renal, liver or thyroid function tests in DM; HTN; Malnutrition; BMI > 40; Renal, Liver or asymptomatic** patients.
    [Show full text]
  • Mediastinoscopy: a Clinical Evaluation of 400 Consecutive Cases
    Thorax: first published as 10.1136/thx.24.5.585 on 1 September 1969. Downloaded from Thorax (1969), 24, 585. Mediastinoscopy: A clinical evaluation of 400 consecutive cases C. L. SARIN1 AND H. C. NOHL-OSER From the Thoracic Surgical Unit, Harefield Hospital, Harefield, Middlesex Mediastinoscopy was carried out in 400 cases, including 296 of bronchogenic carcinoma. At the time of presentation the new growth had already spread to involve the mediastinal lymph nodes in slightly more than 50% of these. The incidence of involvement was 76% in oat-cell and 35% in squamous-cell carcinoma. Non-resectability at thoracotomy was encountered in seven out of 120 patients. We advocate this procedure in every case of bronchogenic carcinoma which is considered operable on other counts. In patients in whom the mediastinal lymph nodes are invaded by growth we prefer radical radiotherapy to surgery, as the long-term survival of the two methods is comparable. This procedure may be the only source of positive histological proof of diagnosis, not only in carcinoma but in other types of intrathoracic disease. We believe that this procedure reduces the number of unnecessary exploratory thoracotomies. Carlens (1959) introduced diagnostic exploration sible. Biopsy in such cases can be obtained from tissues inside the thoracic inlet. in the of the superior mediastinum. The space explored just Bleeding, copyright. is part of the superior mediastinum which is presence of incipient or developed superior vena caval of the obstruction, or dense fibrosis of the pre-tracheal situated around tihe intrathoracic part fascia, can make the procedure difficult or impossible.
    [Show full text]
  • Thoracic Surgery Institution: Nashville VA Medical Center & Duration: 6 Weeks Vanderbilt University Medical Center Supervising Physician: Eric L
    Thoracic Surgery Institution: Nashville VA Medical Center & Duration: 6 weeks Vanderbilt University Medical Center Supervising Physician: Eric L. Grogan, M.D. Contact Information: 615-300-2900 Year of Training: PGY-4 Educational Objectives: During this rotation, the resident will better understand the pathophysiology of thoracic diseases including lung, esophagus, and chest wall diseases. The resident will identify the general risks and complications of thoracic surgery operations, and learn the preoperative and postoperative care of patients undergoing thoracic surgery operations Evaluation of the resident's understanding of the patient and disease process will be reviewed (in part) at the time of operation and through resident-faculty interaction. Feedback will be verbal and timely; residents are encouraged to establish a dialogue with the faculty to facilitate feedback. Residents are expected to notify Dr. Grogan and meet with him when starting the service. Other Comments and Responsibilities Daily rounds will include the General Care Wards and the Intensive Care Unit at the VA. Medical Knowledge and Patient Care: I. CHEST WALL A. Anatomy, Physiology and Embryology Learner Objectives: • Understands the anatomy and physiology of the cutaneous, muscular, and bony components of the chest wall and their anatomic and physiologic relationships to adjacent structures; • Knows various operative approaches to the chest wall. Clinical Skills: • Recognizes the normal and abnormal anatomy of the chest wall. B. Acquired Abnormalities and Neoplasms Learner Objectives: • Evaluates and diagnoses primary and metastatic chest wall tumors, knows their histologic appearance, and understands the indications for incisional versus excisional biopsy; • Knows the radiologic characteristics of tumors. Clinical Skills: • Performs a variety of surgical incisions to expose components of the chest wall and interior thoracic organs.
    [Show full text]
  • Chapter I GENERAL CORRECT CODING POLICIES for NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL for MEDICARE SERVICES
    CHAP1-gencorrectcodingpolicies Revision Date: 1/1/2021 Chapter I GENERAL CORRECT CODING POLICIES FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2020 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, prospective payment systems, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Revision Date (Medicare): 1/1/2021 Table of Contents LIST OF ACRONYMS ............................................ I-2 Chapter I ................................................... I-4 General Correct Coding Policies ............................ I-4 A. Introduction ..........................................I-4 B. Coding Based on Standards of Medical/Surgical Practice I-8 C. Medical/Surgical Package .............................I-11 D. Evaluation & Management (E&M) Services ...............I-16 E. Modifiers and Modifier Indicators ....................I-18 F. Standard Preparation/Monitoring Services for Anesthesia .................................................. I-26 G. Anesthesia Service Included in the Surgical Procedure I-26 H. HCPCS/CPT
    [Show full text]
  • A Late Complication of a Diagnostic Mediastinoscopy
    Thorax: first published as 10.1136/thx.33.1.115 on 1 February 1978. Downloaded from Thorax, 1978, 33, 115-116 A late complication of a diagnostic mediastinoscopy H. F. W. HOITSMA1, E. T. T. TJHO2, AND M. A. CUESTA' From the Departments of General Surgery' and Thoracic Medicine2, Het Academisch Ziekenhuis der Vrije Universiteit, Amsterdam, The Netherlands Hoitsma, H. F. W., Tjho, E. T. T., and Cuesta, M. A. (1978). Thorax, 33, 115-116. A late complication of a diagnostic mediastinoscopy. A 69-year-old man with a moderately well differentiated squamous-cell carcinoma of the lung, underwent a mediastinoscopy. All histological examinations of the mediastinal nodes were negative. The patient was treated with a curative left pneumonectomy. Three months after this negative mediastinoscopy the patient developed a metastasis in the mediastinoscopy scar. A report of this case and a review of the literature are presented. In 1959, Carlens wrote the article, which has since all of them at biopsy. Histological investigation of become famous, entitled 'Mediastinoscopy: a the biopsy specimens showed fragmented and com- method for inspection and tissue biopsy in the plete lymph nodes with an intact structure. Besides superior mediastinum'. He described a method anthracotic infiltration there was a firm, histiocytic which he had developed in order to assess the reaction. No tumour cells were found. copyright. stage of lymphatic metastasis of carcinoma of the Ten days later the patient underwent a left lung. Since its introduction it has become a much pneumonectomy. All visible nodes in the hilus and used method to avoid unnecessary thoracotomies.
    [Show full text]
  • Cervical Mediastinal L SUSAN ALEXANDER L for STAGING of LUNG CANCER
    Cervical Mediastinal l SUSAN ALEXANDER l FOR STAGING OF LUNG CANCER ervical mediastinal exp- bronchogenic lung cancer by sam- loration (CME), or pling selected lymph nodes in and mediastinoscopy, is a around the trachea, its major surgical procedure to bifurcation and the great vessels. C explore and sample Lymph nodes are removed and lymph nodes in the space between sent to pathology for tissue diag- the lungs, (the mediastinum), nosis to determine the histology when diagnostic imaging studies of the tumor. CME is performed (X-ray, CT scan, etc) suggest a primarily to stage lung cancer growth in the lungs or mediasti- and determine the extent of the nal region. The most common pur- disease and establish treatment pose of the CME is to diagnose options. DECEMBER 2002 The Surgical Technologist 9 224 DECEMBER 2002 CATEGORY 1 If cancer exists in the lymph nodes, the cell type nodes that are not accessible through CME. In (histology) identifies the type of cancer and one series of 100 patients with tumors in this extent of the lymph nodes involved. If tumor area, 22 were found to be inoperable despite hav­ involvement in the mediastinal area is demon­ ing a negative mediastinoscopy.5 Left anterior strated in the pathology review of the speci- mediastinotomy through the second intercostal men(s) (lymph nodes), the patient may be space is the preferred method to assess the oper­ spared an unnecessary thoracotomy; however, ability of these patients, as suggested by Pearson this means that the tumor is inoperable.5 and coworkers.5 Less than 50% of patients undergoing cura­ History tive resection for bronchogenic carcinoma sur­ CME was originally described by Harken and vive five years.
    [Show full text]
  • Physicians As Assistants at Surgery: 2016 Update
    Physicians as Assistants at Surgery: 2016 Update Participating Organizations: American College of Surgeons American Academy of Ophthalmology American Academy of Orthopaedic Surgeons American Academy of Otolaryngology – Head and Neck Surgery American Association of Neurological Surgeons American Pediatric Surgical Association American Society of Colon and Rectal Surgeons American Society of Plastic Surgeons American Society of Transplant Surgeons American Urological Association Congress of Neurological Surgeons Society for Surgical Oncology Society for Vascular Surgery Society of American Gastrointestinal Endoscopic Surgeons The American College of Obstetricians and Gynecologists The Society of Thoracic Surgeons Physicians as Assistants at Surgery: 2016 Update INTRODUCTION This is the seventh edition of Physicians as Assistants at Surgery, a study first undertaken in 1994 by the American College of Surgeons and other surgical specialty organizations. The study reviews all procedures listed in the “Surgery” section of the 2016 American Medical Association’s Current Procedural Terminology (CPT TM). Each organization was asked to review new codes since 2013 that are applicable to their specialty and determine whether the operation requires the use of a physician as an assistant at surgery: (1) almost always; (2) almost never; or (3) some of the time. The results of this study are presented in the accompanying report, which is in a table format. This table presents information about the need for a physician as an assistant at surgery. Also, please note that an indication that a physician would “almost never” be needed to assist at surgery for some procedures does NOT imply that a physician is never needed. The decision to request that a physician assist at surgery remains the responsibility of the primary surgeon and, when necessary, should be a payable service.
    [Show full text]
  • Icd-9-Cm (2010)
    ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
    [Show full text]
  • A Novel Prediction Model for the Probability Of
    Editorial Page 1 of 7 A novel prediction model for the probability of mediastinal lymph node metastases detected by endobronchial ultrasound-transbronchial needle aspiration in non-small cell lung cancer: possible applications in clinical decision-making Aldo Carnevale1, Gianluca Milanese2,3, Nicola Sverzellati2, Mario Silva2,3 1Section of Radiology, Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy; 2Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy; 3bioMILD Lung Cancer Screening Trial, IRCCS Istituto Nazionale Tumori, Milan, Italy Correspondence to: Mario Silva. Section of Radiology, Pad. Barbieri, via Gramsci 14, 43126, Parma, Italy. Email: [email protected]. Comment on: O’Connell OJ, Almeida FA, Simoff MJ, et al. A Prediction Model to Help with the Assessment of Adenopathy in Lung Cancer: HAL. Am J Respir Crit Care Med 2017;195:1651-60. Received: 17 March 2018; Accepted: 08 May 2018; Published: 01 June 2018. doi: 10.21037/med.2018.05.02 View this article at: http://dx.doi.org/10.21037/med.2018.05.02 Surgery is the most successful radical approach to non-small and address the most appropriate therapy (e.g., surgery, cell lung cancer (NSCLC), provided accurate preoperative radiation therapy, or medical treatment) (6). systemic and mediastinal staging for stratification of patients Each of CT and PET show limitations in N staging, with potentially resectable disease (1). In particular, pre- especially with smaller lymph nodes (7). As a consequence, surgical mediastinal nodal staging (N staging) is performed the American College of Chest Physicians (ACCP) issued by a combination of diagnostic tests with different levels of guidelines with four main categories on the basis of thoracic accuracy and invasiveness (2,3), as well as cumulative costs radiographic appearance to drive the most appropriate use of and risks.
    [Show full text]
  • Bronchoscopic Needle Aspiration in the Diagnosis of Mediastinal Lymphadenopathy and Staging of Lung Cancer
    Free full text available from Review Article www.cancerjournal.net Bronchoscopic needle aspiration in the diagnosis of mediastinal lymphadenopathy and staging of lung cancer ABSTRACT Vikas Punamiya1, 2 Transbronchial needle aspiration (TBNA) has the potential to allow adequate mediastinal staging of non-small cell lung cancer with Ankur Mehta , Prashant N. Chhajed1,2 enlarged lymph nodes in most patients without the need for mediastinoscopy. Metastasis to the mediastinal lymph nodes is one of the most important factors in determining resectability and prognosis in non-small cell lung cancer. The importance of TBNA as a tool for 1Institute of Pulmonology, diagnosing intrathoracic lymphadenopathy as well as in the staging of lung cancer has been reported in various studies. We performed Medical Research & Development, Mumbai, a literature search in PubMed and Journal of Bronchology using the keyword transbronchial needle aspiration. TBNA is a safe and 2Fortis Hiranandani effective procedure to diagnose mediastinal lymphadenopathy. Real-time bronchoscopic ultrasound-guided TBNA is the new kid on Hospitals, Mumbai, India the block, which can further enhance the sensitivity of bronchoscopy in the diagnosis of mediastinal lesions. For correspondence: Dr. Prashant N. Chhajed, B/24, Datta Apartments, KEY WORDS: Bronchoscopy, lung cancer, mediastinoscopy, transbronchial needle aspiration Ramkrishna Mission Marg, 15th Road, Khar - West, Mumbai - 400 052, INTRODUCTION Transbronchial needle aspiration (TBNA) can be India. E-mail: pchhajed@gmail. performed at bronchoscopy to sample mediastinal com Differential diagnosis of mediastinal and hilar lymph nodes or mass lesions. We DOI: 10.4103/0973- lymphadenopathy ranges from lymph node performed a literature search in PubMed using 1482.65231 metastases, malignant lymphomas, infectious, the keyword transbronchial needle aspiration.
    [Show full text]