scholarly journals PET and Neck Ultrasound for the Detection of Cervical Lymphadenopathy in Patients with Lung Cancer and Mediastinal Lymphadenopathy

Respiration ◽  
2018 ◽  
Vol 96 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Mohammed Ahmed ◽  
Antoinette Flannery ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lung Cancer ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Neck Ultrasound

scholarly journals Routine neck ultrasound by respiratory physicians in the diagnosis and staging of patients with lung cancer and mediastinal lymphadenopathy: a prospective pilot study

2020 ◽  
Vol 6 (1) ◽  
pp. 00180-2019
Author(s):  
Mohammed Ahmed ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Second Phase ◽  
Neck Node ◽  
Neck Lymph Node ◽  
Neck Ultrasound ◽  
Respiratory Physician

IntroductionCervical lymphadenopathy in lung cancer indicates advanced disease. The presence of mediastinal lymphadenopathy is commonly associated with involvement of neck lymph nodes and some studies suggest routine neck ultrasound (NUS) in this group of patients. We conducted a two-phase study looking at training a respiratory physician to perform ultrasound-guided neck lymph node aspiration in patients with suspected lung cancer.MethodsIn the first phase of the study, one of the authors underwent training in NUS according to predetermined criteria. The adequacy of sampling was prospectively recorded. In the second phase, consecutive patients with suspected lung cancer and mediastinal lymphadenopathy underwent NUS and sampling of abnormal lymph nodes. The outcomes were the adequacy of samples for pathological analysis and molecular analysis, prevalence of cervical lymphadenopathy, and change in stage.ResultsFollowing the period of training, 35 patients underwent neck node sampling with an overall adequacy of 88.6% (95% CI 78.1–99.1%). Cervical lymph node involvement was confirmed in 13 out of 30 patients with lung cancer (43.3%, 95% CI 25.5–62.6%). Further immunohistochemistry and molecular studies were possible in all patients when it was required (nine cases). NUS led to nodal upstaging in four out of 30 (13.3%) cases.ConclusionTraining a respiratory physician to perform NUS and needle sampling to an acceptable level is feasible. Benefits of embedding this procedure in lung cancer diagnosis and pathway staging need to be explored in further studies.

Focused Neck Ultrasound and Lymph Node Sampling by Respiratory Physicians in Suspected Lung Cancer

Respiration ◽  
2021 ◽  
pp. 1-6
Author(s):  
Maged Hassan ◽  
Thomas Nicholson ◽  
Lindsey Taylor ◽  
Helen McDill ◽  
Rob Hadden ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Fast Track ◽  
Diagnostic Yield ◽  
Cervical Lymphadenopathy ◽  
Molecular Testing ◽  
Routine Practice ◽  
Neck Ultrasound ◽  
Lymph Node Sampling ◽  
Supraclavicular Fossa ◽  
Linear Probe

<b><i>Background:</i></b> Malignant cervical lymphadenopathy in the setting of lung cancer represents N3 disease, and neck ultrasound (NUS) with sampling is described in the Royal College of Radiologists ultrasound training curriculum for the non-radiologists. This study reviews the incorporation of NUS +/− biopsy in the routine practice of a lung cancer fast-track clinic in the UK. <b><i>Methods:</i></b> We retrospectively assessed 29 months of activity of a lung cancer fast-track clinic. Systematic focused NUS was conducted in suspected thoracic malignancy, sampling nodes with a ≥5-mm short axis, under real-time US using a linear probe (5–12 Mhz). Fine-needle aspirations (FNAs) with or without 18 Ga core biopsies were taken. <b><i>Results:</i></b> Between August 2017 and December 2019, of 152 peripheral lymph nodes (LNs)/deposits sampled, 98 (64.5%) were supraclavicular fossa LNs with median [IQR] size 12 [8–18] mm. Core biopsies were performed in 54/98 (55%) patients, while all patients had FNAs. No complications occurred. The representative yield was 90/95 (94.7%) in cases with suspected cancer. No difference was seen between FNA versus core biopsy (<i>p</i> = 0.44). Of the 5 non-diagnostic samples, one was FNA only. The commonest diagnosis was lung cancer in 66/98 (67.3%). PDL-1 was sufficient in 35/36 tested (97.2%). ALK-FISH was successful in 24/25 (96%) cases. EGFR mutation analysis was successful in 28/31 (90.3%) cases. Median time from clinic to initial diagnosis was 7 [5–10] days. Computed tomography (CT) scans reported no significant lymphadenopathy in 18/96 (18.7%) cases, yet 10/18 (55.5%) cases were positive for malignancy. <b><i>Conclusion:</i></b> Neck nodal sampling by respiratory physicians was safe, timely, with a high diagnostic yield and suitability for molecular testing. Neck US can provide a timely diagnosis in cases that may be missed by CT alone.

Pulmonary Tuberculosis Mimicking Lung Cancer and Metastasis Radiologically- A Case Report

2020 ◽  
Author(s):  
Harveen Kaur
Keyword(s):  
Lung Cancer ◽  
Pulmonary Tuberculosis ◽  
Diagnostic Procedures ◽  
Mediastinal Lymphadenopathy ◽  
Presumptive Diagnosis ◽  
Clinical Presentations ◽  
High Incidence ◽  
Pulmonary Infiltration ◽  
Low Incidence ◽  
Clinical Conditions

Tuberculosis (TB) is known to mimic several clinical conditions, especially malignancy. Pulmonary TB can present with pulmonary infiltration with or without mediastinal lymphadenopathy. TB often gets misdiagnosed in the countries having a low incidence of TB with a high incidence of lung cancer and varying clinical presentations, which results in delay in treatment initiation and unnecessary diagnostic procedures. We present a case of a 52-year old female, with a presumptive diagnosis of malignancy, which was subsequently proved as pulmonary tuberculosis with no evidence of malignancy instead.

Small-Cell Lung Cancer Comorbid with Pulmonary Mycobacterium avium Infection: A Case Report

Chemotherapy ◽  
2018 ◽  
Vol 63 (5) ◽  
pp. 257-261
Author(s):  
Masahiro Yamasaki ◽  
Kunihiko Funaishi ◽  
Naomi Saito ◽  
Ken-ichi Sakamoto ◽  
Sayaka Ishiyama ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Mycobacterium Avium ◽  
Cell Lung Cancer ◽  
Left Lung ◽  
Small Cell ◽  
Mediastinal Lymphadenopathy ◽  
Small Cell Lung ◽  
Before And After ◽  
Avium Infection

Background: Small-cell lung cancer (SCLC) rarely coexists with pulmonary Mycobacterium avium intracellular complex (MAC) infection. The key drug for SCLC treatment is etoposide, which is metabolized by cytochrome P-450 (CYP) 3A4. Meanwhile, the key drugs for pulmonary MAC infection are clarithromycin (CAM) and rifampicin (RFP), and their metabolism influences CYP3A4. Therefore, treatment of concurrent SCLC and pulmonary MAC infection is difficult, and to the best of our knowledge, no report of treatments for concurrent SCLC and pulmonary MAC infection has been published. Patient Concerns and Diagnoses: A 65-year-old man presented to our hospital with abnormal findings of chest computed tomography: (1) a hilar region nodule in the left lung and mediastinal lymphadenopathy and (2) a thick-walled cavity lesion in the right upper lobe of the lung. After further examinations, the former lesions were diagnosed as SCLC, cT4N3M0, stage IIIC and the latter as pulmonary MAC infection, fibrocavitary disease. Interventions and Outcomes: Concurrent treatment was conducted with discontinuation of CAM and RFP before and after etoposide administration. Specifically, intravenous cisplatin and etoposide were administered on day 1 and days 1–3, respectively, and CAM, RFP, and ethambutol (EB) were administered orally on days 6–22 every 4 weeks. Concurrent radiotherapy was added to the drug administration on days 1–27 of the first cycle. The chemotherapy was continued for 4 cycles, followed by continuation of CAM and RFP administration. EB was discontinued because of optic nerve disorder. The treatments were conducted completely and safely, and both of the SCLC lesions and the MAC lesion were improved. Conclusions: Treatments for concurrent SCLC and pulmonary MAC infection may be successfully conducted with discontinuation of CAM and RFP before and after etoposide administration.

Usefulness of CT Chest in Determining Clinically Significant Mediastinal Lymphadenopathy in Patients With Non-Small Cell Lung Cancer (NSCLC)

CHEST Journal ◽  
2003 ◽  
Vol 124 (4) ◽  
pp. 194S
Author(s):  
Mazen Alakhras ◽  
Geetha Kanajam ◽  
Damodhar Nerella ◽  
Karthikeyan Kanagarajan ◽  
Depakkumar Malli ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Mediastinal Lymphadenopathy ◽  
Small Cell Lung ◽  
Clinically Significant

scholarly journals Intramedullary thoracic spinal metastasis from small-cell lung cancer

2013 ◽  
Vol 79 (3-4) ◽  
Author(s):  
S. Katsenos ◽  
M. Nikolopoulou
Keyword(s):  
Lung Cancer ◽  
Spinal Cord ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Spinal Metastasis ◽  
Small Cell ◽  
Mediastinal Lymphadenopathy ◽  
Small Cell Lung ◽  
Intramedullary Spinal Cord ◽  
Thoracic Spinal

Intramedullary thoracic spinal metastasis from small-cell lung cancer. S. Katsenos, M. Nikolopoulou. Lung cancer with intramedullary spinal cord metastasis (ISCM) is a rare event exhibiting dismal prognosis. In the present paper, we describe a 74-year-old male who developed bilateral leg weakness with associated backache and non-productive cough. Chest imaging evaluation demonstrated pronounced bilateral mediastinal lymphadenopathy and a nodular opacity in the right lower lobe. The patient was diagnosed with small cell lung cancer through bronchoscopic procedures. Magnetic resonance imaging of the spinal cord with contrast-enhancement revealed an intramedullary lesion consistent with metastasis at the T5-T6 level. Despite chemotherapy and thoracic spine radiotherapy, he eventually succumbed to the disease 3 months after diagnosis. A brief overview of the current literature is also provided laying emphasis on the therapeutic strategies of this unusual extrathoracic metastatic disease.

scholarly journals EBUS in optimizing non-small cell lung cancer diagnosis and treatment

2020 ◽  
Author(s):  
Antonia Haranguș ◽  
Ioana Berindan-Neagoe ◽  
Lăcrămioara Toma ◽  
Ioan Șimon ◽  
Ovidiu Pop ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Molecular Analysis ◽  
Cancer Diagnosis ◽  
Predictive Value ◽  
Small Cell ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Small Cell Lung ◽  
Anaplastic Lymphoma ◽  
Lung Cancer Diagnosis

Background. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly used minimally invasive method for the diagnosis and staging of lung cancer. In order to improve its diagnostic accuracy, rapid on-site cytologic evaluation (ROSE) is being utilized in some institutions. ROSE, performed by a cytopathologist in the examination room, allows the assessment of the adequacy of the collected samples, identifies malignant cells and sometimes establishes diagnosis on the spot, thus improving diagnostic sensitivity. As non-small cell lung carcinomas (NSCLC) require not only pathological subtyping, but also molecular characterization, obtaining the adequate amount of tissue is crucial. Only a limited number of studies have analyzed the suitability of EBUS-TBNA samples for assessment of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and programmed death-ligand 1 (PD-L1) status. Aim. We intended to examine the diagnostic yield of ROSE in NSCLC and the results and feasibility of molecular analysis performed on EBUS-TBNA small samples. Methods. 100 patients with lung tumors and hilar and/or mediastinal lymphadenopathy on CT or PET/CT scans were retrospectively identified over a 3-year period, from a prospectively maintained EBUS-TBNA database. All examinations were accompanied by on-site cytological exam - ROSE, histopathological exam (HPE) and, in the case of NSCLC, molecular testing. After the sampling of the lymph nodes, specimens were Diff-Quik stained and a rapid preliminary diagnosis was established. Immunohistochemistry and mutational testing were performed using cell blocks. Results. Adenocarcinoma was the most frequent diagnosis in both ROSE (34%) and histopathology (53%). Overall sensitivity and positive predictive value of ROSE in NSCLC, considering HPE the gold standard, were 92.18% and 93.65%, respectively, with a specificity and negative predictive value of 75% and 70.58%, respectively. All samples that were tested for EGFR mutation and ALK rearrangement were adequate for analysis. The adequacy ratio for PD-L1 was 91.66%; 37.5% of patients showed a high PD-L1 expression level, with a tumor proportion score TPS≥50%. Conclusion. EBUS-TBNA is a valuable method for lung cancer diagnosis. ROSE proved to have a moderate prediction of the final diagnosis in NSCLC. Molecular analysis of EGFR, ALK and PD-L1 can be successfully accomplished on EBUS-TBNA small tissue samples.

Mediastinal Lymphadenopathy in the National Lung Screening Trial (NLST) Is Associated with Interval Lung Cancer

Radiology ◽  
2021 ◽  
Author(s):  
Hamid Chalian ◽  
Holman Page McAdams ◽  
Youkyung Lee ◽  
Fenghai Duan ◽  
Yanning Wu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Mediastinal Lymphadenopathy ◽  
National Lung Screening Trial ◽  
Lung Screening ◽  
Screening Trial

scholarly journals Ultrasound-Guided Cervical Lymph Node Sampling Performed by Respiratory Physicians

2019 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Mohammed Ahmed ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lymph Node ◽  
Cervical Lymph Node ◽  
Diagnostic Yield ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Competency Assessment ◽  
Neck Lymph Node ◽  
Lymph Node Sampling ◽  
Significant Difference ◽  
Respiratory Physician

Background: A variety of disease processes investigated by respiratory physicians can lead to cervical lymphadenopathy. Ultrasound (US) has revolutionised respiratory investigations, and neck ultrasound (NUS) is increasingly recognised as an additional important skill for respiratory physicians. Objectives: We aimed to assess the feasibility of NUS performed by respiratory physicians in the workup of patients with mediastinal lymphadenopathy. Methods: This is a single-centre retrospective cohort study. All patients that underwent US-guided cervical lymph node sampling were included. The diagnostic yield is reported, and specimen adequacy is compared for respiratory physicians and radiologists. Results: Over 5 years, 106 patients underwent NUS-guided lymph node sampling by respiratory physicians compared to 35 cases performed by radiologists. There was no significant difference in the adequacy of sampling between the two groups (respiratory physicians 91.5% [95% CI 84.5–96%] compared to 82.9% [95% CI 66.4–93.4%] for radiologists [p = 0.2]). In the respiratory physician group, a diagnosis was achieved based on lymph node sampling in 89 cases (84%). Neck lymph node sampling was the only procedure performed to obtain tissue in 48 cases (45.3%). Conclusion: NUS and sampling performed by respiratory physicians are feasible and associated with an adequacy rate comparable to that of radiologists. It can reduce the number of invasive procedures performed in a selected group of patients. Guidelines for training and competency assessment are required.

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