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Introduction. Patients considered for radical surgery for lung cancer need a functional evaluation to identify those at increased risk of postoperative complications. Material and methods. We performed an analysis of clinical data of 1214 patients who underwent a single lobectomy for lung cancer. To assess the risk of complications, we used the chronic obstructive pulmonary disease assessment test (CAT). Results. 254 pulmonary and 51 cardiovascular complications occurred in 216 (17.8%) patients. In 204 patients with a CAT score ≥12 complications occurred more often than in patients with a lower score (26.5% vs. 16.0%; p < 0.001). Conclusions. In patients undergoing lobectomy for lung cancer, pulmonary complications occurred much more frequently than cardiovascular complications. Patients with a CAT score ≥12 had a higher rate of postoperative complications as compared to those with a lower score.

The nodal status indicator in non-small cell lung cancer is one of the most crucial prognostic factors available. However, there are still many arguments among scientists regarding whether the currently used nodal status descriptor should be changed in the forthcoming editions of the Tumor Node Metastasis classification or whether it is precise enough and should be maintained as is. We reviewed studies concerning nodal factor classifications to evaluate their accuracy in non-small cell lung cancer patients and to address the previously mentioned challenge. We reviewed the PubMed database regarding the following classifications: ongoing 8(th) edition of the Tumor Node Metastasis classification, number of positive lymph nodes, number of negative lymph nodes, number of dissected lymph nodes, lymph node ratio, nodal chains, log odds of positive lymph nodes, zone-based classification and one that is based on the number of lymph node stations involved. Moreover, we analysed data regarding various combinations of these classifications. Our analysis showed that the present nodal staging may not accurately categorize every lung cancer patient. The number of positive lymph nodes and lymph node ratio or the log odds of positive lymph nodes (as the mathematical modification of lymph node ratio) are more legitimate, as they possess very robust data and should be considered initially as additional factors that can be incorporated in ongoing nodal staging systems. Forthcoming non-small cell lung cancer staging systems could benefit from the addition of quantitative-based parameters. Additionally, the minimal extent of lymphadenectomy should be established as staging benefits from it. International, prospective validation studies need to be performed to optimize the cut-off values and prognostic groups and to confirm the superiority of the newly suggested descriptors in non-small cell lung cancer nodal staging.

Background Pulmonary veins (PVs) are important during segmentectomy. Many case reports prove that they may be the source of bleeding during surgery, especially when anatomical variants are present. We decided to describe venous variations and prepare a computed tomography based atlas of our observations. Methods The study was conducted using 135 chest computed tomography studies with intra venous iodine contrast injection. The study population contained 86 females and 49 males, mean age was 60. Thirteen people had atrial fibrillation. Images were analysed using radiological workstation. Results The variations were divided into three categories: atypical topography of the PV, atypical venous outflow to the left atrium (LA), atypical venous vascularization of the lung bronchopulmonary segment. Retrobronchial course of the vein of the posterior segment of the right upper lobe was observed in 8.15%. The most common variant of atrial venous outflow was the direct outflow of the middle lobe vein, observed in 25.19% of cases and the long common trunk of left PVs in 11.11%. The split drainage from the middle lobe into the right superior pulmonary vein (RSPV) and the right inferior pulmonary vein (RIPV) was observed in 9.63% as the full drainage into the RIPV in 2.96%. Conclusions Long common trunk of left PVs and numerous variants of venous vascularisation of the middle lobe are the variations that may pose potential problems during thoracic surgeries. The frequency is high enough to justify the routine assessment of pulmonary vessels with computed tomography before surgery.

MicroRNAs (miRNAs), key regulators of gene expression at the post-transcriptional level, are grossly misregulated in some human cancers, including non-small-cell lung carcinoma (NSCLC). The aberrant expression of specific miRNAs results in the abnormal regulation of key components of signalling pathways in tumour cells. MiRNA levels and the activity of the gene targets, including oncogenes and tumour suppressors, produce feedback that changes miRNA expression levels and indicates the cell’s genetic activity. In this study, we measured the expression of five circulating miRNAs (miR-195, miR-504, miR-122, miR-10b and miR-21) and evaluated their association with EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) mutation status in 66 NSCLC patients. Moreover, we examined the discriminative power of circulating miRNAs for EGFR mutant‐positive and -negative NSCLC patients using two different data normalisation approaches. We extracted total RNA from the plasma of 66 non-squamous NSCLC patients (31 of whom had tumours with EGFR mutations) and measured circulating miRNA levels using quantitative reverse transcription polymerase chain reaction (RT-qPCR). The miRNA expression levels were normalised using two endogenous controls: miR-191 and miR-16. We found significant associations between the expression of circulating miR-504 and EGFR-activating mutations in NSCLC patients regardless of the normalisation approach used (p = 0.0072 and 0.0236 for miR-16 and miR-191 normalisation, respectively). The greatest discriminative power of circulating miR-504 was observed in patients with EGFR exon 19 deletions versus wild-type EGFR normalised to miR-191 (area under the curve (AUC) = 0.81, p

INTRODUCTION Tuberculosis is frequently omitted in the diagnostic workup and may be identified accidentally following thoracic surgeries, mostly those targeting lung cancer. OBJECTIVES This study aimed to assess the clinical characteristics of patients who underwent thoracic surgery that resulted in the diagnosis of tuberculosis and to review lesions initially found on chest imaging in the context of the potential presence of tuberculosis. PATIENTS AND METHODS We analyzed medical records of all patients hospitalized at the Department of Thoracic Surgery of the National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland, between the years 2014 and 2018 (n = 57) in whom tuberculosis was diagnosed. Two radiologists who knew the diagnosis retrospectively analyzed preprocedural chest computed tomography scans of the study patients. RESULTS Tuberculosis was diagnosed by culture of specimens obtained during video‑ assisted thoracoscopy (21 patients), thoracotomy (24 patients), mediastinoscopy (6 patients), transthoracic fine‑ needle biopsy (3 patients), and transbronchial biopsy (1 patient). In the remaining 2 individuals, the diagnosis was established based on the microbiological examination of drained pleural fluid. In 42 patients (73.7%), the diagnosis of tuberculosis was unexpected to thoracic surgeons. Radiological findings suggestive of tuberculosis were present in 38 patients (66.7%). The radiologists who retrospectively analyzed the imaging records suggested tuberculosis in 31 persons (54.3%), whereas those who carried out the initial preprocedural evaluation, in 11 (19.3%). CONCLUSIONS The majority of the study patients presented with radiological findings encountered in tuberculosis, which should have led to a less invasive diagnostic workup. This highlights the role of radiologists in the identification of the disease.

BACKGROUND: Video-assisted thoracic surgery (VATS) is increasingly used in the surgical treatment of early lung cancer, but the oncological benefits are still controversial. We aimed to compare video-assisted lobectomy and open thoracotomy lobectomy in terms of lymphadenectomy and long-term survival depending on the location of lobectomy. METHODS: A retrospective, multicenter study was based on the Polish Lung Cancer Study Group and included patients with stage I lung cancer who were surgically treated between 2007 and 2015. We included 1410 patients after video-assisted lobectomy and 4,855 after open thoracotomy. RESULTS: The average number of lymph nodes removed in video-assisted lobectomy was 10.9 and in open thoracotomy lobectomy was 12.9 (P

The problem of treating secondary cancer is very controversial. Huge progress in its treatment began in the 1970s with the introduction of chemotherapy. In the surgical aspect Pastorino's work published in 1997 was a milestone. To this day, most authors cite its research results.The task is to answer the question what tactics to follow in the surgical treatment of patients with secondary cancer affecting the respiratory system.Retrospective studies were conducted on a group of 577 patients. Men prevailed slightly. The average age was 56 years. Surgical access used in the vast majority of cases was anterolateral thoracotomy. Wedge resection was the most common scope of surgery. Lymph nodes were not removed as standard. Single and multifactorial statistical surveys were conducted (Kaplan-Meier estimator and multifactorial Cox regression analysis).A total of 1,058 operations were performed during which 1889 metastases were removed. Negative tissue margins were obtained in 90.4%. The median survival was 47 months. Complications occurred in 76 patients, which constituted 7.1% of performed procedures. There were 3 perioperative deaths.It was found that the factors negatively affecting survival were lack of radicalism, size of the metastasis3 cm, and number of metastases1. The factors positively influencing survival were a longer time than primary surgery and a greater number of operations. Histological diagnosis differentiated patient survival.Problem leczenia wtórnej choroby nowotworowej budzi wiele kontrowersji. Przełomem było wprowadzenie chemioterapii w latach 70. XX wieku. W aspekcie chirurgicznym kamieniem milowym była praca Pastorino opublikowana w 1997 roku. Do dzisiaj większość autorów powołuje się na wyniki jego badań.Praca ma odpowiedzieć na pytanie, jaką taktykę postępowania należy przyjąć w leczeniu chirurgicznym cierpiących na wtórną chorobę nowotworową zajmującą układ oddechowy.Badania retrospektywne przeprowadzono w grupie 577 chorych. Nieznacznie przeważali mężczyźni. Średni wiek to 56 lat. Dostępem operacyjnym stosowanym w większości przypadków była torakotomia przednio-boczna. Najczęstszym zakresem zabiegu była resekcja klinowa. Nie usuwano standardowo węzłów chłonnych. Prowadzono badania statystyczne jedno- i wieloczynnikowe (estymator Kaplana-Meyera i wieloczynnikowa analiza regresji Coksa).Przeprowadzono łącznie 1058 operacji, podczas których usunięto 1889 przerzutów. Ujemne marginesy tkankowe uzyskano w 90,4%. Mediana przeżycia wyniosła 47 miesięcy. Powikłania wystąpiły u 76 pacjentów, co stanowiło 7,1% przeprowadzonych operacji. Stwierdzono 3 zgony okołooperacyjne.Czynnikami negatywnie wpływającymi na przeżycie były brak radykalizmu, wielkość przerzutu3 cm, liczba przerzutów1, natomiast czynnikami pozytywnie wpływającymi na przeżycie – dłuższy czas od operacji pierwotnej i większa liczba operacji. Rozpoznanie histologiczne różnicował czas przeżycia pacjentów.

Introduction: Lung cancer is the most common cancer in Poland and worldwide, and the leading cause of cancer-related deaths. Compared to the present day, the annual number of new cases of lung cancer will have increased by approximately 50%, by 2030. The overall ratio of mortality to incidence totals 0.87 and is among the highest. The five-year survival rate in Poland has recently achieved 13.4%. In 2015, lung cancer screening using low-dose computed tomography (LDCT) was introduced to routine clinical practice in the United States following the publication of the largest randomised study, The National Lung Screening Trial. The implementation of screening programmes in Poland and the rest of Europe also seems unavoidable. Due to the differences, both in the socioeconomic considerations and healthcare funding, compared to that in the United States, the current approach comes down to the awaited results of the European randomised study, NELSON. Material and methods: During the meeting of an expert panel at the “Torakoneptunalia 2016” conference in Jastarnia, Poland, a decision was made to summarise and publish the current data on LDCT lung cancer screening in the form of recommendations, or a position statement. The document was prepared by a team composed of a radiologist, thoracic surgeons, pulmonologists, clinical oncologists, epidemiologists, internists, health prevention specialists and pathologists. It reflects the current body of knowledge about lung cancer, its diagnosis and treatment, and provides recommendations on early detection of lung cancer using LDCT. The recommendations address the screening procedure, the requirements for the teams conducting the screening, and the requirements for radiologists, pathologists and surgeons involved in the diagnosis and treatment of patients. Results: While awaiting the results of the NELSON study and the European position statement on lung cancer screening methodology, the multidisciplinary group of experts presents their position, laying grounds for the development of an action plan for early detection of lung cancer in the upcoming future in Poland. Conclusions: Primary and secondary prophylaxis are the principal ways to reduce lung cancer mortality. While smoking cessation is a task of utmost importance, it must be accompanied by an effective screening programme if the outcome of the disease is to be improved.

The correlation between the worse outcome of thymomas and expression of podoplanin (D2-40 antibody) in neoplastic cells has been proved in recent studies. We investigated the expression of podoplanin in thymic epithelial tumors of different histologic types and stages resected in our institution. The presence and type of reaction (membranous or cytoplasmic) with D2-40 antibody were assessed. Analyzed group consisted of 72 tumors: 3 type A, 19 type AB, 5 type B1, 24 type B2, 4 type B3, 2 micronodular, 1 metaplastic, and 9 combined B2B3 thymomas and 5 thymic carcinomas. Positive reaction with D2-40 was detected in 7 cases (37%) of AB type, 2 (40%) of B1, 28 (85%) of B2, 3 (23%) of B3, and 1 case (100%) of metaplastic thymoma. All positive B2 and 2 cases of B3 thymomas revealed membranous type of reaction, whereas other subtypes showed less conspicuous cytoplasmic reactivity. A correlation between B2 thymoma and membranous type of reaction was statistically significant (P

Background: Pulmonary sequestration (PS) is a rare congenital abnormality of lung tissue. Only few series of adult cases are reported. The aim was to describe clinical characteristics in adult cases of PS and to compare outcomes in different clinical situations. Methods: Using MSD engine we searched for cases of PS that have been diagnosed between Jan 1st, 2005 and Dec 31st, 2015. Clinical data was retrospectively gathered. Statistica v.12 (StatSoft, Inc.) was used for statistical analyses. Results: We found 25 cases (18 females, 7 males), which underwent surgery and were histologically proven. There were 22 cases of intralobar PS. 7 cases were asymptomatic, 12 had infectious history (including 3 cases of lung abscess and pleural empyema), 4 presented with hemoptysis, 2 with chest pain. The average age to undergo surgery was 38.24, in the asymptomatic group 34, in symptomatic 39.89. In the latter the symptoms preceded the surgery for 2.45-year. Great majority of sequestrations was located in lower lobes (96%), 52% on the left. Symptomatic cases were at higher than expected risk of surgical complications, comparing to asymptomatic (chi 2 , P=0.04). In most cases there were surgical and histological signs of infection, only in 9 cases etiological factor was determined: in 5 cases it was A. fumigatus . A 0.53-day longer post-surgical hospital stay was observed in the symptomatic group, no statistical significance was found (U-test, P=0.45). Conclusions: Surgical treatment of symptomatic cases of PS is characterized by slightly longer post-surgical hospital stay and higher risk of surgical complications. Fungal infections are the most likely to occur in PS.

Introduction: Molecular diagnosis of non-small-cell lung cancer (NSCLC) is commonly based on qPCR which provides sufficient sensitivity and specificity but has low sample throughput and allows parallel analysis of few amplicons only. NGS offers higher throughput with comparable diagnostic parameters. We evaluated the diagnostic utility of NGS for EGFR mutation detection in NSCLC as a part of intra-lab method validation in our center. Methods: DNA was isolated from tumor specimens (FFPET n=16, cytological smear n=4) collected from 20 advanced NSCLC patients (ADC n=17, NOS n=3) with known EGFR mutation status established using Cobas qPCR test (Roche) and Sanger sequencing. DNA libraries were sequenced on MiSeq instrument and analyzed using Variant Interpreter software (Illumina). Results: The results from Cobas/Sanger and NGS were consistent in 100% though one sample showed very low allelic frequency (AF) of L858R variant (2.44%) in NGS. Various EGFR variants were detected with mean AF of 27.32% (range 8.25-92.82%): exon (ex) 19 deletions: n=8; ex18, 20 and 21 substitutions: n=8, ex20 insertion: n=1; wild-type: n=2. A rare EGFR variant (p.(Ile706Thr) was detected by NGS while not reported by Cobas. One FFPET sample showed sequence artifacts in NGS analysis due to the cytosine deamination effect. In 16 samples, biologically meaningful mutations were found in other genes (AKT, ERBB2, FOXL2, GNA11, KIT, PIK3CA, TP53). Conclusions: NGS allows for specific detection and precise identification of multiple EGFR variants, ex19 deletion and rare mutations in particular. However, the quality of FFPET material still poses a challenge as it determines the effectiveness of NGS analysis. The study is ongoing.

BACKGROUND: This study was an epidemiological analysis of all primary mediastinal neoplasms (PMNs) diagnosed between 2000 and 2016 at the National Tuberculosis and Lung Diseases Research Institute, Poland. METHODS: All patients with any mediastinal abnormality were included in the analysis. The patients’ age and gender were obtained from the institutional database. RESULTS: From a cohort of 5,108 patients, 3,691 primary mediastinal lesions were found, including 1,005 (19%) PMNs: lymphomas (533, 53% of PMNs), thymomas (215, 21%), neurogenic tumors (NTs) (100, 10%), germ cell tumors (GCTs) (62, 6%), soft tissue tumors (STTs) (47, 5%) and thymic carcinomas/thymic neuroendocrine tumors (TCs/TNETs) (37 in total, 4%). The most frequent lymphomas were classical Hodgkin lymphomas [256] and primary mediastinal large B-cell lymphomas [163]. Type AB [73] predominated in thymomas and squamous cell carcinomas [9] and carcinoids [10] in TCs/TNETs. NTs encompassed mainly schwannomas [49], ganglioneuromas [21] and neurofibromas [10]. The most frequent STTs were hemangiomas [13] and lymphangiomas [11]. Lymphomas, thymomas and NT were more often in women, TCs/TNETs in men (P70 years of age AB type and micronodular thymomas with lymphoid stroma (P0.05). CONCLUSIONS: PMNs are rare conditions thus awareness of basic epidemiology may be very helpful for final diagnosis.

OBJECTIVES The American College of Chest Physicians guidelines recommend low-technology exercise tests in the functional evaluation of patients with lung cancer considered for resectional surgery. However, the 6-min walk test (6MWT) is not included, because the data on its clinical value are inconsistent. Our goal was to evaluate the 6MWT in assessing the risk of cardiopulmonary complications in candidates for lung resection. METHODS We performed a retrospective assessment of clinical data and pulmonary function test results in 947 patients, mean age 65.3 (standard deviation 9.5) years, who underwent a single lobectomy for lung cancer. In 555 patients with predicted postoperative values ≤60%, the 6MWT was performed. The 6-min walking distance (6MWD) and the distance-saturation product (DSP), which is the product of the 6MWD in metres, and the lowest oxygen saturation registered during the test were assessed. RESULTS A total of 363 patients with predicted postoperative values CONCLUSIONS The 6MWT is useful in the assessment of operative risk in patients undergoing a single lobectomy for lung cancer. It helps to stratify the operative risk, which is lower in patients with 6MWD ≥400 m or DSP ≥350 m% than in patients with a shorter 6MWD or lower DSP values.

In recent years we see an increasing interest in applications of complex machine learning methods to medical problems. Black box models based on deep neural networks or ensembles are more and more popular in diagnostic, personalized medicine (Hamet and Tremblay 2017) or screening studies (Scheeder et al. 2018). Partially because they are accurate and easy to train. Nevertheless such models may be hard to understand and interpret. In high stake decisions, especially in medicine, the understanding of factors that drive model decisions is crucial. Lack of model understanding creates a serious risk in applications.

The International Association for the Study of Lung Cancer has proposed a new classification of N descriptor based on the number of metastatic lymph nodes (LNs) stations, including skip metastasis. The aim of the study was to determine the effect of removed LNs on the adequacy of this new classification.The material was collected retrospectively based on the database of the Polish Lung Cancer Group, including information on 8016 patients with non-small cell lung cancer operated in 23 thoracic surgery centers in Poland. The material covered the period from January 2005 to September 2015. We divided patients into two groups: ≤6LNs and6LNs removed.In the whole group, an average of 13.4 nodes and 4.54 nodal stations were removed. 5-year survivals in the6LNs group vs ≤ 6LNs group were: 62.3% and 55.1% (N0), 44.5% and 35.9% (N1a), 34.1% and 31,7% (N1b), 37.3% and 26.3% (N2a1), 32.4% and 26.7% (N2a2), 29.4% and 29.2% (N2b1), and 22.0% and 23.0% (N2b2), respectively. Comparing these groups, we detected significant differences at N0 (p 0.001) and N2a1 (p = 0.022). In the ≤6LNs group, the survival curves for N2a1, N2a2, N2b1, and N2b2 overlapped (p 0.05). In the6LNs group, the survival curves were significantly different between grades, with survival for N2a1 better than N1b (p = 0.232).The proposed classification N descriptor is potentially better at differentiating patients into different stages. The accuracy of the classification depends on the number of lymph nodes removed. Therefore, the extent of lymphadenectomy has a significant impact on the staging of surgically-treated lung cancer.

Objective.An analysis of subglottic stenosis (SGS) occurrence frequency in patients with granulomatosis with polyangiitis (GPA) based on the time of appearance of clinical symptoms, and an assessment of treatment effectiveness, in particular with the intratracheal dilation-injection technique (IDIT).Methods.Review and treatment with IDIT of 34 patients with SGS associated with GPA.Results.SGS developed in 34 of 250 patients with GPA (13.6%) and was not reflective of disease activity in the organs in 15 of 34 patients (44%): 11 cases after and 4 cases during immunosuppressive therapy (IST) when patients did not have organ symptoms. All patients underwent IDIT and in total, the treatment resulted in immediate improvement. In addition, in 21 cases, IST was applied because of other organ involvement or of the lack of longterm efficacy of IDIT. The median time of response was 37 months and the median interval between sessions was 5 months. None of the patients required tracheostomy after beginning IDIT in our hospital.Conclusion.SGS often occurs independently of other features of active GPA. IDIT is a safe and effective technique in the treatment of GPA-related SGS. It should be performed in all patients with GPA who develop significant SGS and in those with multiorgan disease concomitantly with IST. In patients with isolated SGS, IDIT also makes IST and tracheostomy unnecessary.

The article presents the case of a 68-year-old patient with alcohol dependence syndrome, who was admitted, in serious condition, to the Department of Surgery due to esophageal intramural lesions of unclear etiology. The imaging studies showed no signs of transmural perforation of the esophageal wall. Esophagogastroscopy revealed intramural fluid reservoirs and small oval cavities with smooth edges in the esophageal mucosa. The patient was treated conservatively with parenteral nutrition and rehabilitation. Subsequently, the patient was transferred to the intensive care unit because of cardiorespiratory failure. Despite adequate pharmacological treatment, the patient died.

Pneumopericardium is a rare disease defined as the presence of air or gas in the pericardial sac. Among the etiological factors, the following stand out: chest trauma, barotrauma, air-containing fistulas between the pericardium and the surrounding structures, secondary gas production by microorganisms growing in the pericardial sac, and iatrogenic factors. Until now, spontaneous pneumopericardium has been considered a harmless and temporary state, but a review of clinical cases indicates that the presence of air in the pericardium can lead to cardiac tamponade and life-threatening hemodynamic disturbances. We present the case of an 80-year-old patient with a chronic bronchopericardial fistula, who suffered from a cardiac arrest due to air tamponade of the heart.

Effective discrimination between lung cancer and benign tumours is a common clinical problem in the differential diagnosis of solitary pulmonary nodules. The analysis of cell-free DNA (cfDNA) in blood may greatly aid the early detection of lung cancer by evaluating cancer-related alterations. The plasma cfDNA levels and integrity were analysed in 65 non-small cell lung cancer (NSCLC) patients, 28 subjects with benign lung tumours, and 16 healthy controls using real-time PCR. The NSCLC patients demonstrated significantly higher mean plasma cfDNA levels compared with those with benign tumours (P = 0.0009) and healthy controls (P 0.0001). The plasma cfDNA integrity in healthy individuals was significantly different than that found in patients with NSCLC or benign lung tumours (P 0.0003). In ROC curve analysis, plasma cfDNA levels2.8 ng/ml provided 86.4% sensitivity and 61.4% specificity in discriminating NSCLC from benign lung pathologies and healthy controls. cfDNA integrity showed better discriminatory power (91% sensitivity, 68.2% specificity). These data demonstrate that plasma cfDNA concentration and integrity analyses can significantly differentiate between NSCLC and benign lung tumours. The diagnostic capacity of the quantitative cfDNA assay is comparable to the values presented by conventional imaging modalities used in clinical practice.

Poszczegolne grupy wezlow chlonnych zaangazowane w regionalny odplyw chlonki z pluca zostaly wyroznione na podstawie danych klinicznych na potrzeby oceny zaawansowania niedrobnokomorkowego raka pluca, a podzial ten odbiega od przedstawianego w podrecznikach klasycznej anatomii. Aktualna klasyfikacja International Association for the Study of Lung Cancer wyroznia 14 oddzielnych grup wezlow chlonnych, z czego grupy 1, 2, 4, 8–14 są wezlami parzystymi (strony prawej i lewej). Poszczegolna grupa wezlow chlonnych ma swoją szczegolową charakterystyke topograficzną. Wiekszośc pluca drenowana jest poprzez siec podoplucnowych naczyn chlonnych do wezlow grupy 10 i 11, ktore najcześciej stanowią pierwszą stacje dla szerzenia sie przerzutow. Kolejnymi grupami zaangazowanymi w odplyw chlonki są wezly środpiersia. Dane te przekladają sie na ocene zaawansowania nowotworu ( staging ) zgodnie z klasyfikacją TNM. W ponizszym artykule omawiamy szczegolową topografie poszczegolnych grup wezlowych, klasyczną oraz alternatywne drogi odplywu chlonki z pluc, przy czym tlumacząc wiele zaskakujących klinicznych obserwacji w szerzeniu sie przerzutow, prezentujemy metody obrazowania w tomografii komputerowej oraz uzytecznośc pozytonowej tomografii emisyjnej. Artykul przedstawia rowniez mozliwośc inwazyjnej diagnostyki omawianych grup wezlow — techniki mediastinoskopii oraz coraz szerzej rozpowszechnione endoskopowe metody maloinwazyjne.

Objectives To assess the results of surgical treatment of T-ALI (adjacent lobe invasion) tumours in patients with non-small-cell lung carcinoma. Methods Multicentric retrospective analysis of a prospectively maintained database of 13 065 patients, aged 32-89 years (mean 52.9, median 63 years), who underwent resection between January 2009 and September 2014. Results In the whole study group, T-ALI was observed in 324 patients (2.5%): 201 patients (62.0%) with a tumour invading the pleura in the inter-lobar fissure (T-ALI-A), and 123 patients (38.0%) with a tumour in the adjacent lobe but without pleural invasion in the fissure (T-ALI-D). With regard to N0 patients, the 3- and 5-year survival rates in the T2 group were significantly higher than that of the T-ALI group (76.1 and 68.4%, P = 0.002 vs 58.3 and 51.0%, P = 0.008, respectively). On the other hand, when the N1 group was analysed, the 5-year survival rates were 54.3 and 48%, respectively (P = 0.041). In the N2 group, the 5-year survival rates in the T2 and T-ALI groups were 40.2 and 35.0%, respectively (P = 0.241). The comparison of the T-ALI and T3 groups for stages N0, N1 and N2 revealed differences in 5-year survival rates as follows: 68.4 vs 62.9% (P = 0.048), 48.0 vs 37.6% (P = 0.08) and 35.0 vs 27.6% (P = 0.121), respectively. In the whole group, the difference in survival rate between T-ALI N0 and T2N0 was statistically significant (P = 0.008) and statistically significant for the T3N0 group (P = 0.048). The 3-year survival rate in the T-ALI N0 group was statistically lower following pneumonectomy than following lobectomy (56.4 vs 61.3%, P = 0.03). The best survival rate was observed following bilobectomy (75.6%). Conclusions In our study, a tumour with ALI (T-ALI) represented a separate stage of cancer between T2 and T3. The survival rate in the T-ALI-A group was significantly poorer than that in the T-ALI-D group. Overall treatment results were similar for stage T3, suggesting that it may be necessary to divide this group into T3a and T3b. We would suggest that all tumours between 5 and 7 cm be classified as T3b, and any tumour smaller than 5 cm but with ALI be classified as T3a. Treatment of choice should include lobectomy or bilobectomy. Pneumonectomy should be performed only in a selected group of patients.

Powszechna dostepnośc charakteryzujących sie wysoką jakością badan wielorzedowych aparatow do tomografii komputerowej przyniosla znaczący wzrost wykrywania pojedynczych guzkow pluca. Zwazywszy na wysoką zapadalnośc na raka pluca i stale niezadowalające wyniki leczenia, mozliwośc wykrywania zmian malo zaawansowanych, poddających sie doszczetnej resekcji, budzily duze nadzieje. Wykorzystywana w badaniach przesiewowych nisko­dawkowa tomografia komputerowa klatki piersiowej wskazuje na obecnośc pojedynczych guzkow pluca nawet u 50% palących papierosy osob powyzej 50 roku zycia. Biorąc pod uwage istotnośc problemu klinicznego, kluczowe jest ustalenie optymalnego sposobu diagnostyki pojedynczych guzkow pluca. Pomocne w tym zakresie mogą byc wytyczne American College of Chest Physcians. Wskazują one, iz w dokladnym oszacowaniu prawdopodobienstwa zlośliwości zmiany nalezy oprzec sie na doświadczeniu klinicznym bądź tez uzyc jednego ze zweryfikowanych modeli typu Bayesian analysis . W ponizszej pracy przedstawiamy przypadek chorego z pojedynczym guzkiem pluca, wskazując na rozbiezności decyzji diagnostycznych i terapeutycznych opartych na doświadczeniu diagnostow i klinicystow oraz wytycznych opartych na badaniach „kohortowych”.

Background: In recent years, liquid biopsy based on plasma circulating tumor DNA (ctDNA) analysis has emerged as an auxiliary tool in the molecular diagnosis of NSCLC patients from whom sufficient tumor tissue/cells specimens cannot be obtained. We compared the robustness of the two most common commercial kits for detection of EGFR mutations in liquid biopsy. Methods:EGFR mutations were analyzed in plasma ctDNA collected from 107 NSCLC patients (non-SQC type, stages I-IV) before treatment (n=80) or at the time of progression on EGFR-TKIs (n=27) using two IVD-marked tests: ‘Cobas EGFR Mutation Test v2’ (Roche) and ‘Therascreen EGFR Plasma RGQ PCR Kit’ (Qiagen). Results: the overall concordance between EGFR mutation status in liquid biopsy and paired tumor tissue was 62% for all patients (46% for Cobas and 32% for Therascreen test). In advanced NSCLC patients the concordance increased to 88% (83% for Cobas and to 56% for Therascreen). Accordingly, the Cobas test showed higher positive percent agreement between plasma ctDNA and tissue results (PPA=83%) than did the Therascreen test (PPA=56%) in advanced NSCLC. Both tests showed 100% negative percent agreement. T790 mutation was detected in 26% liquid biopsy samples from patients upon progression on EGFR-TKIs. Conclusions: in our laboratory setting, the Cobas test showed superior diagnostic performance over Therascreen assay in detection of EGFR mutations in plasma ctDNA from advanced NSCLC patients. Since analysis of EGFR mutations in liquid biopsy is still a troublesome laboratory procedure, we recommend to validate the true diagnostic performance of each commercial test despite its IVD certification.

The carinal resection is still considered a real challenge, both for a thoracic surgeon and an anesthesiologist. Depending on the indications and the degree of local advancement of the neoplasm, there are 2 techniques of carinal resection and reconstruction. The first one consists of the isolated resection with formation of a new bifurcation, whereas the second one is a combination of anatomic resection of lung parenchyma together with the bifurcation and the subsequent reconstruction. Long-term outcomes after carinal resection procedures, with clear postoperative margins, depend to a large extent on the stage of advancement of the primary disease.

Background and Aims Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate and minimally invasive technique that has been shown to have excellent diagnostic yield in the diagnosis of mediastinal and hilar lymphadenopathy. However, endoscopic bronchial biopsy (EBB) and transbronchial lung biopsy (TBLB) are still the standard method for making a pathologic diagnosis of sarcoidosis. The aim of this study was to compare the diagnostic yield of EBUS-TBNA and TBLB through a flexible bronchoscope in patients with stage I and II sarcoidosis. Methods A total of 653 patients with suspected stage I and II sarcoidosis were included in this retrospective study. After radiological assessment, patients were qualified to bronchoscopy. Patients underwent sequential EBUS-TBNA followed by TBLB and/or EBB. In all patients, 1056 biopsies from mediastinal lymph nodes group were taken. Results In all of the biopsied lymph nodes, positive results were obtained in 549 patients (84%). In 180 patients with stage II TBLB, a biopsy was taken from affected part of the lung. Positive results were found in 79 patients (43.9%). EBB was performed in 340 patients, with a positive result in 101 (29.7%). Mediastinoscopy was performed in 60 patients (9.2%) with a negative result in EBUS-TBNA, TBLB and/or EBB. Non-caseating granulomas were found in 48 patients. The sensitivity of TBLB technique alone was significantly lower at 43.9% (79/180) (P

Background: Alpha-1 antitrypsin (AAT) is encoded by the highly polymorphic SERPINA1 gene. Mutations in this gene cause AAT deficiency (AATD) - a risk factor for a number of chronic lung diseases. The causative link between AATD and non-small cell lung cancer (NSCLC) is still controversial due to insufficient or inconsistent research data. Objective: We evaluated the frequency of the major pathogenic SERPINA1 gene alleles among Polish NSCLC patients. Methods: blood samples were collected from 468 NSCLC patients (ADC, SQC, LCC, NOS, stages I-IV). The serum AAT concentration was measured by nephelometry and the phenotype was analyzed by isoelectric focusing in polyacrylamide gel. The SERPINA1 gene variants were identified by DNA sequencing. The frequency of SERPINA1 gene alleles was estimated by means of Hardy-Weinberg equilibrium. Results: 446 out of 468 (95.2%) NSCLC patients presented normal Pi*MM phenotype. AATD alleles were found in 22 patients. 10 (2.1%) carried Pi*S allele, 10 (2.1%) - Pi*Z allele, and 3 (0.6%) – Pi*F allele. Accordingly, the frequency of major AATD alleles was: Pi*S 10.7/1000 (95%CI: 4.1-17.3) and Pi*Z 10.7/1000 (95%CI: 4.1-17.3). The mean serum AAT concentration in NSCLC patients was 180 mg/dL in Pi*MM individuals and 148 mg/dL in AATD allele carriers. Conclusions: The frequency of Pi*S and Pi*Z alleles in NSCLC patients differ noticeably from the general Polish population (Pi*Z 13.7/1000 and Pi*S 7.6/1000): the frequency of Pi*Z allele is lower whereas the frequency of Pi*S is higher. The NSCLC patients who carry AATD allele do not present reduced AAT concentration in blood as compared to the reference values from population studies. The study is on-going.

Wstep: Pierwotne nowotwory z komorek rozrodczych o lokalizacji środpiersiowej stanowią 1–6% guzow środpiersia oraz 2–5% wszystkich nowotworow z komorek rozrodczych wystepujących u doroslych. Rozpoznawane są najcześciej w 3. dekadzie zycia, w 90% u mezczyzn. Najczestsze objawy to: dusznośc, bole w klatce piersiowej, kaszel, stany podgorączkowe i utrata masy ciala. Celem pracy byla ocena wynikow leczenia pierwotnych nowotworow z komorek rozrodczych o lokalizacji środpiersiowej i przegląd piśmiennictwa poświeconego tej tematyce. Material i metody: W okresie od 1999 do 2009 roku w Klinice Nowotworow Pluca i Klatki Piersiowej Centrum Onkologii-Instytut im. Marii Sklodowskiej-Curie w Warszawie leczono 5 chorych z nowotworem z komorek rozrodczych o pierwotnej lokalizacji środpiersiowej, 4 mezczyzn i 1 kobiete. Średnia wieku wyniosla 27,8 roku (zakres 23–30). Wyniki: U wszystkich chorych zastosowano chemioterapie wedlug schematu BEP. U wszystkich chorych uzyskano obiektywną odpowiedź na leczenie. Dwoch chorych zmarlo z powodu progresji choroby pomimo stosowania chemioterapii II i III linii. Trzech chorych nadal pozostaje w obserwacji. Mediana czasu przezycia wyniosla 55,8 miesiąca (zakres 8,0–120,0). Wnioski: Pierwotne nowotwory z komorek rozrodczych o lokalizacji środpiersiowej są nowotworami o rokowaniu gorszym niz w lokalizacji gonadalnej. Na podstawie obserwacji wlasnych i przeglądu piśmiennictwa mozna stwierdzic, ze wyniki leczenia pierwotnych nienasieniakow w lokalizacji środpiersiowej pozostają niezadowalające. Szczegolnie niekorzystne są wyniki leczenia chorych, u ktorych dochodzi do wczesnej wznowy lub progresji w trakcie chemioterapii I linii. Określenie nowych standardow postepowania w nowotworach opornych na cisplatyne wymaga dalszych badan oceniających skutecznośc cytostatykow nowych generacji.

Rak płuca jest w Polsce najczęstszą przyczyną zgonów nowotworowych. Około 85% wszystkich nowotworów płuca stanowi rak niedrobnokomórkowy (NDRP), w którym leki cytotoksyczne i ukierunkowane molekularnie odgrywają coraz większą rolę. W pracy przedstawiono oparte na obecnej wiedzy zalecenia dotyczące stosowania tych metod w praktyce klinicznej u chorych na NDRP oraz na złośliwego międzybłoniaka opłucnej.

BACKGROUND Invasive pulmonary aspergillosis (IPA) occurs in 1% to 8% of liver transplant recipients. It is one of the most frequent life-threatening fungal infections in immunocompromised patients, with a reported mortality rate of approximately 60%. CASE REPORT We present the case of an 18-year-old man who underwent liver transplantation (LT) in January 2004 due to multifocal hepatoblastoma (HBL) and was diagnosed with IPA 3 years after LT. Because of a single pulmonary nodule of the left lung found in chest computed tomography (CT) 4 weeks after LT, the patient received adjuvant chemotherapy. A control chest CT performed in September 2004 did not reveal any pathological changes. A subsequent examination in May 2006 demonstrated a pulmonary lesion situated in the 10th segment of the left lung, which was confirmed by PET in October 2006. In March 2007 the patient underwent videothoracoscopic complete resection of the lesion. Histopathological examination revealed IPA and subsequent 3-month antifungal treatment with voriconazole resulted in 5 years of recurrence-free survival. CONCLUSIONS We conclude that any stable solitary pulmonary lesion in a transplant recipient needs to be resected in order to allow a definitive diagnosis and prevent disease dissemination such as IPA in our patient.

OBJECTIVES Anatomical lobar resection and mediastinal lymphadenectomy remain the standard for the treatment of early stage non-small-cell lung cancer (NSCLC) and are preferred over procedures such as segmentectomy or wedge resection. However, there is an ongoing debate concerning the influence of the extent of the resection on overall survival. The aim of this article was to assess the overall survival for different types of resection for Stage I NSCLC. METHODS We performed a retrospective analysis of the results of the surgical treatment of Stage I NSCLC. Between 1 January 2007 and 31 December 2013, the data from 6905 patients who underwent Stage I NSCLC operations were collected in the Polish National Lung Cancer Registry (PNLCR) and overall survival was assessed. A propensity score-matched analysis was used to compare 3 groups of patients, each consisting of 231 patients who underwent lobectomy, segmentectomy, or wedge resection. RESULTS In the unmatched and matched patient groups, lobectomy and segmentectomy were associated with a significant benefit compared to wedge resection regarding overall survival (log-rank P

The paper aimed to compare the efficacy of log odds (LODDS) compared to a classification based on the distribution of involved lymph nodes (pN) and lymph node ratio (LNR).Material was collected retrospectively from an online survey-based database of the Polish Lung Cancer Group and included a group of 17,369 patients who received radical surgical treatment (R0) due to lung cancer.In the whole group the median survival for N0, N1 and N2 was 76.1, 41.7 and 24.2 months, respectively. The median survival for individual LODDS categories (-6,-4], (-4,-3], (-3,-2], (-2,-1], (-1,0], (0,1] and (1,2] was 76.5, 76.3, 71.7, 45.4, 25.0, 19.1 and 17.7 months, respectively. The median survival for LNR in individual categories (0), (0,0.25], (0.25,05], (0.5075] and (0.75,1.0] was 75.6, 40.3, 24.1, 18.8 and 16.4 months, respectively. A multi-variant analysis demonstrated that each LODDS category is an independent prognostic factor: (-4,-3] (HR = 0.982; 95% CI 0.867-1.112; P = 0.775), (-3,-2] (HR = 1.114; 95% CI 0.984-1.262; P = 0.089), (-2,-1] (HR = 1.241; 95% CI 1.080-1.425; P = 0.002), (-1,0] (HR = 1.617; 95% CI 1.385-1.887; P 0.0001), (0,1] (HR = 1.918; 95% CI 1.579-2.329; P 0.0001) and (1,2] (HR = 2.016; 95% CI 1.579-2.573; P 0.0001).Based on LODDS it is possible to discriminate patients with regard to lung cancer stage more effectively compared to pN and LNR classification, and it is also a better classification system.