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21. Cytology-based treatment decision in primary lung cancer: Is it accurate enough?

Author

Roll, Patrice, Roca, Elisa, Lacroix, Romaric, Judicone, Coralie, Laroumagne, Sophie, Robert, Stéphane, Cointe, Sylvie, Muller, Alexandre, Kaspi, Elise, Brisson, Alain, Tantucci, Claudio, Astoul, Philippe, Dignat-George, Françoise, Barthélémy, Florian, Navarro, Claire, Fayek, Racha, Da Silva, Nathalie, Sigaudy, Sabine, Oshima, Junko, Bonne, Gisèle, Papadopoulou-Legbelou, Kyriaki, Evangeliou, Athanasios, Spilioti, Martha, LeMerrer, Martine, Wevers, Ron, Morava, Eva, Robaglia-Schlupp, Andrée, Lévy, Nicolas, Bartoli, Marc, De Sandre-Giovannoli, Annachiara, Hadj-Rabia, Smail, Mashiah, Jacob, Boyer, Amandine, Bourgeois, Patrice, Van Kien, Philippe Khau, Bodemer, Christine, Navarro, Claire Laure, Esteves-Vieira, Vera, Courrier, Sébastien, Duong Nguyen, Thuy, Huong, Le Thi Thanh, Meinke, Peter, Schröder, Winnie, Cormier-Daire, Valérie, Sznajer, Yves, Amor, David, Lagerstedt, Kristina, Biervliet, Martine, van den Akker, Peter, Cau, Pierre, BADENS, Catherine, Wehnert, Manfred, Sakr, Lama, Payan, Marie-José, Liprandi, Agnès, Dutau, Hervé, Loundou, Anderson, Barlesi, Fabrice, Aix Marseille Université (AMU), Assistance Publique - Hôpitaux de Marseille (APHM), Laboratoire de Biologie Cellulaire [Hôpital de la Timone - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Marseille medical genetics - Centre de génétique médicale de Marseille (MMG), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Cancer Research, medicine.medical_specialty, Pathology, Lung Neoplasms, Cytodiagnosis, [SDV]Life Sciences [q-bio], Cytological Techniques, Adenocarcinoma of Lung, Adenocarcinoma, Malignancy, 03 medical and health sciences, 0302 clinical medicine, Bronchoscopy, Carcinoma, Non-Small-Cell Lung, Biopsy, medicine, Carcinoma, Humans, Neoplasms, Squamous Cell, Lung cancer, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, 030304 developmental biology, Aged, 80 and over, 0303 health sciences, medicine.diagnostic_test, business.industry, Biopsy, Needle, Not Otherwise Specified, Middle Aged, medicine.disease, Small Cell Lung Carcinoma, respiratory tract diseases, 3. Good health, Oncology, 030220 oncology & carcinogenesis, Female, Radiology, business
Abstract

Accurate distinction of lung cancer types has become increasingly important as recent trials have shown differential response to chemotherapy among non-small cell lung carcinoma (NSCLC) subtypes. Cytological procedures are frequently used but their diagnostic accuracy has been previously questioned. However, new endoscopic and cytological techniques might have improved cytological accuracy in comparison with prior findings. The aim of this study was to reassess cytological accuracy for diagnosis of lung cancer subtypes. A retrospective chart review of subjects who underwent fiberoptic bronchoscopy (FOB) for suspicion of lung cancer in 2007–2008, was undertaken. Reports of bronchoscopically derived cytological specimens were compared to those of histological material. Endoscopic findings and specific investigational techniques were taken into account. A total of 467 FOB with both cytological and histological diagnostic techniques were performed in 449 subjects. Patients consisted of 345 men and 104 women (median age, 65 yrs). Cytology proved malignancy in 157 patients. Cytologically diagnosed carcinomas were classified into squamous cell carcinoma (SqCC) in 56, adenocarcinoma (ADC) in 6, small cell lung carcinoma (SCLC) in 12, non-small cell lung carcinoma not otherwise specified (NSCLC-NOS) in 71, and unclassified carcinoma in 12. Cytology correlated fairly with biopsy specimens, as agreement was observed in 83% of SCLC, 100% of ADC, 74% of SqCC and 8% of NSCLC-NOS. Interestingly, 61% of cytologically identified NSCLC-NOS were classified as ADC by histology. Cytological accuracy improved in case of an endobronchial lesion, mainly for SqCC. These results indicate that cytological accuracy remains fair with regard to diagnosis of squamous and non-squamous lung cancer subtypes. Improvement of cytological accuracy is expected however with novel diagnostic strategies.

Published
2012
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24. Interstitial lung disease is associated with an increased risk of lung cancer in systemic sclerosis: Longitudinal data from the Canadian Scleroderma Research Group

Author

Sakr, Lama, Hudson, Marie, Wang, Mianbo, Younanian, Elie, Baron, Murray, and Bernatsky, Sasha

Abstract

Objective: The literature supports an increased risk of malignancy in systemic sclerosis, including lung cancer. Our objective was to identify potential independent predictors of lung cancer risk in systemic sclerosis.Methods: We used a cohort of 1560 systemic sclerosis patients from the Canadian Scleroderma Research Group, enrolled from 2004 and followed for a maximum of 11 years. Time to lung cancer was calculated from the onset of the first non-Raynaud’s symptoms. Baseline demographic, clinical, and serological characteristics of patients with and without lung cancer were compared. Cox proportional hazards models were used to estimate the effects of demographic variables, exposure to smoking, disease duration, disease subset (diffuse vs limited), immunosuppressant drug exposure, and presence of interstitial lung disease on the risk of lung cancer.Results: Over the 5519 total person-years of follow-up, 18 SSc patients were diagnosed with lung cancer after cohort entry (3.2 cancers per 1000 person-years). In univariate comparisons, cancer cases were more likely to be male, to have a smoking history, and to have interstitial lung disease than non-cases. In multivariate analysis, interstitial lung disease was independently associated with the risk of lung cancer (hazard ratio: 2.95, 95% confidence interval: 1.10–7.87).Conclusion: In addition to known demographic (male sex) and lifestyle risk factors (smoking), interstitial lung disease is an independent risk factor for lung cancer in systemic sclerosis. These results have implications for lung cancer screening in systemic sclerosis.

Published
2018
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28. Tracheal Glomus Tumor: A Multidisciplinary Approach to Management.

Author

Sakr, Lama, Palaniappan, Ramanathan, Payan, Marie-José, Doddoli, Christophe, and Dutau, Hervé

Subjects
BIOPSY, BRONCHOSCOPY, CHEST X rays, MEDICAL lasers, STAINS & staining (Microscopy), RESPIRATORY organ tumors, TOMOGRAPHY, SYMPTOMS, TRACHEAL diseases, DIAGNOSIS, TUMOR treatment, THERAPEUTICS
Abstract

A 66-year-old man presented with acute respiratory distress due to a tracheal tumor involving the posterior wall of the upper trachea, with nearly complete airway obstruction. Partial debulking of the tumor's endoluminal component, via rigid bronchoscopy and yttrium-aluminum-perovskite laser, allowed timely and effective airway restoration. The diagnosis was benign tracheal glomus tumor. Two weeks later, elective tracheal sleeve resection with end-to-end anastomosis allowed complete resection of the lesion. No tumor recurrence was found at 21-month follow-up. We describe the multidisciplinary management of this extremely rare tracheal tumor, and review its features. [ABSTRACT FROM AUTHOR]

Published
2011
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29. Systemic sarcoidosis mimicking metastatic renal cell carcinoma with subsequent cardiac involvement.

Author

Frohlich, Michael, Buhlaiga, Najwa, Wang, Hangjun, Patenaude, Francois, Sirois, Christian, and Sakr, Lama

Abstract

There exists a well-established association between sarcoidosis and many solid and hematologic malignancies however it is a less frequently described phenomenon in patients with renal cell carcinoma. Moreover the majority of described cases presented with local sarcoid-like reactions in close proximity to the tumor with comparatively few reports of more distant disease. Given the relatively low number of cases there remains a great deal of uncertainty surrounding the clinical behaviour of sarcoidosis in the setting of renal cell carcinoma. We report the case of a patient with surgically resected renal cell carcinoma who, several years later, developed bilateral pulmonary nodules, intra-thoracic lymphadenopathy as well as splenic, hepatic and osseous lesions. After extensive investigation, culminating in video-assisted thoracoscopic surgical resection, he was found to have sarcoidosis. He remained asymptomatic for many years before being diagnosed with cardiac sarcoidosis, which was found to be inactive and did not require any treatment. Both his sarcoidosis and underlying renal cell carcinoma have remained in remission to date. This case highlights the variable behaviour of sarcoidosis in these patients and underscores the importance of obtaining an accurate tissue diagnosis in the setting of suspected metastatic disease. Additionally, it underscores the importance of close monitoring and long-term follow up as these patients may develop significant organ involvement, even many years after diagnosis. Interestingly the patient's renal cell carcinoma remained in remission, raising questions about whether the development of sarcoidosis portends a better prognosis in patients with an underlying solid malignancy. [ABSTRACT FROM AUTHOR]

Published
2020
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