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The purpose of this study is to evaluate cytokine expression by peripheral blood mononuclear cells (PBMC) from stage I lung cancer patients and to confirm these expression patterns by exposing PBMCs to lung cancer cells in vitro. Five altered cytokines in stage I lung cancer patients (CCL3, IL8, IL1β, CXCL10, sIL2Rα) were identified in plasma from subjects (n = 15) before and after resection using a 30-plex panel protein assay. Gene expression studies using quantitative RT-qPCR were performed on PBMCs from stage I lung cancer patients (n = 62) before and after resection, and compared to non-cancer patients (n = 32) before and after surgery for benign disease. Co-culture experiments that exposed healthy donor PBMCs to lung cancer cells in vitro were performed to evaluate the effect on PBMC cytokine expression. PBMC gene expression of CCL3, IL8 and IL1β was higher in lung cancer patients compared to the same patients at each of four sequential timepoints after removal of their tumors, while CXCL10 and IL2Rα were essentially unchanged. This pattern was also detected when lung cancer patients were compared to non-cancer patients. When non-cancer patients underwent surgery for benign diseases, these cytokine expression changes were not demonstrable. Lung cancer cell lines, but not benign bronchial epithelial cells, induced similar changes in cytokine gene and protein expression by healthy donor PBMCs in an in vitro co-culture system. We conclude that PBMCs from stage I lung cancer patients possess distinct cytokine expression patterns compared to both non-cancer patients, and lung cancer patients following tumor removal. These expression patterns are replicated by healthy donor PBMCs exposed to lung cancer cell lines, but not benign bronchial epithelial cells in vitro. These findings have implications for understanding the immune response to lung cancer. [ABSTRACT FROM AUTHOR]

Objective: Invasive mediastinal biopsy is often necessary in the evaluation of non–small cell lung cancer (NSCLC), and mediastinoscopy has long been considered the reference standard. However, the emergence of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has resulted in controversy regarding it represents a suitable replacement for mediastinoscopy. We chose to determine the utility of EBUS-TBNA in evaluating the mediastinum in patients with NSCLC. Methods: The present study was a retrospective review of a prospective database of consecutive patients with NSCLC who underwent EBUS-TBNA for mediastinal evaluation from 2009 to 2011. The sensitivity, specificity, negative predictive value, and accuracy of EBUS-TBNA are reported. Also reported are the size of the lymph nodes biopsied and the number of instances in which EBUS-TBNA obviated the need for cervical mediastinoscopy. Results: A total of 73 patients had a total of 140 mediastinal stations biopsied using EBUS-TBNA. Of the 73 patients, 30 had benign findings and underwent surgical resection, 1 of whom was found to have stage N2 disease. Of the remaining patients, 42 had a positive result and 1 had nondiagnostic biopsy findings for which malignancy was confirmed by mediastinoscopy. Mediastinoscopy would have changed the tumor stage and treatment planning in only 2 (2.7%) of the 73 patients. Overall, EBUS-TBNA had a sensitivity of 95%, a specificity of 100%, a negative predictive value of 94%, and an accuracy of 97%. Conclusions: EBUS-TBNA might be a feasible option for most patients with NSCLC for whom histologic assessment of the mediastinum is necessary. The rates of nondiagnostic and false-negative biopsy findings using EBUS-TBNA were low, small subcentimeter nodes could be routinely biopsied, and most patients with a radiographically positive mediastinum had their disease pathologically confirmed. [Copyright &y& Elsevier]

Objective: Our objectives were 3-fold: to define the correlation between automated volumetric and 2-dimensional measurements of pulmonary nodule growth and prospectively; to determine whether volumetric growth analysis represents a useful addition to 2-dimensional measurements; and to evaluate growth rates over time of biopsy-proven lung cancers using automated volumetric software. Methods: Nodule growth on consecutive 2-dimensional computed tomographic scans was measured, and a decision regarding nodule biopsy was made. Automated volumetric software was then used to determine nodule growth, growth rates obtained from the 2 techniques were correlated, and the decision to perform a biopsy was reassessed. Biopsy-proven lung cancer growth rates were then documented over time. Results: Growth rates measured using volumetric software were highly correlated with 2-dimensional measurements (r = 0.69; P < .00001). This correlation was affected by nodule type (irregular [r = .63] versus smooth [r = 0.84]; P = .02) as well as the interval between scans (<100 days [r = .5] versus >100 days [r = 0.76]; P = .02). The addition of volumetric growth analysis changed the decision to perform a biopsy after only a minority (6.2%) of scan comparisons; however, lung cancer was diagnosed in 43% of these cases. Growth curves for individual cancers were highly variable, with 45% of tumors showing at least 1 period of shrinkage. Conclusions: Automated volumetric software influences biopsy decisions in only a minority of cases in a dedicated pulmonary nodule clinic, but seems to be useful in detecting lung cancer in this minority. Radiographically determined nodule growth rates, in general, need to be questioned as the sole determinate of the need to perform a biopsy. [ABSTRACT FROM AUTHOR]