Related Articles

High Performance of F-Fluorodeoxyglucose Positron Emission Tomography and Contrast-Enhanced CT in a Rapid Outpatient Diagnostic Program for Patients with Suspected Lung Cancer.

Respiration. 2013 Apr 16;

Authors: Brocken P, van der Heijden HF, Dekhuijzen PN, Peters-Bax L, de Geus-Oei LF

Abstract
Background: The diagnostic evaluation of patients presenting with possible lung cancer is often complex and time consuming. A rapid outpatient diagnostic program (RODP) including (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and contrast-enhanced computed tomography (CT) as a routine diagnostic tool may improve timeliness, however the diagnostic performance of such a combined approach of RODP remains unclear. Objectives: We evaluated timeliness of care and diagnostic performance of FDG-PET and contrast-enhanced CT (FDG-PET/CT) in an RODP for all patients referred with a chest X-ray suspicious of lung cancer. Methods: Charts of patients referred to the 2-day RODP of our tertiary care university clinic after an abnormal chest X-ray between 1999 and 2009 were reviewed. Between 1999 and 2005 co-registered FDG-PET and CT imaging took place; from September 2005 onwards, a hybrid system was used. We analyzed timeliness of care and diagnostic performance of FDG-PET/CT to differentiate malignant from benign lesions. Results: In 386 patients available for analysis, 260 were diagnosed with lung cancer and 23 had another type of malignancy; in 78 patients benign disease was confirmed, and in another 45 the diagnosis was not pathologically confirmed but a median 24.5-month follow-up confirmed a benign outcome. Sensitivity, specificity, negative and positive predictive values and accuracy of FDG-PET/CT to differentiate lung cancer from benign disease were 97.7, 60.2, 92.5, 84.0 and 85.8%, respectively. Lung cancer patients had a median referral, diagnostic and therapeutic delay of 7, 2 and 19 days, respectively. Conclusions: FDG-PET/CT in an RODP setting for suspected lung cancer has high performance in detecting cancer and facilitates timely care.

PMID: 23595051 [PubMed - as supplied by publisher]

Lung Cancer in the Era of Targeted Therapy: A Cytologist's Perspective.

Arch Pathol Lab Med. 2013 Apr 18;

Authors: Zakowski MF

Abstract
Context.-The diagnosis and treatment of non-small cell lung cancer have changed dramatically in the past few years. The discovery of activating mutations in the tyrosine kinase domain of the epidermal growth factor receptor and the use of drugs that successfully target those mutations are among the key advances that have led to a shift in the practice of oncology and pathology, with perhaps the greatest effect on the field of cytology. Objectives.-To present the perspective of a practicing thoracic pathologist and cytopathologist on the developments that have changed practice and to place those changes in a broader context. Data Sources.-Literature review, studies undertaken or participated in by the author, and personal experience. Conclusions.-Cytologists are in an ideal position to influence appropriate testing and treatment in the era of targeted therapy. Lung pathology has led the way in the era of targeted therapy, in no small part due to cytology.

PMID: 23597048 [PubMed - as supplied by publisher]

[Bevacizumab in thoracic oncology: Results and practical aspects.]

Rev Pneumol Clin. 2013 Apr 15;

Authors: Dansin E, Cousin S, Lauridant G, Mennecier B

Abstract
Bevacizumab (Avastin(®)) is the first antiangiogenic therapy approved in non-small cell lung cancer (NSCLC). It is also currently the only agent in this family approved in NSCLC. This review focuses on results of clinical trials assessing bevacizumab in thoracic oncology. It also provides to clinicians practical advices for its prescription.

PMID: 23597632 [PubMed - as supplied by publisher]

Neglected evidence in idiopathic pulmonary fibrosis: from history to earlier diagnosis.

Eur Respir J. 2013 Apr 18;

Authors: Cordier JF, Cottin V

Abstract
This perspective highlights some evidence that have hitherto been neglected especially because they may not have been sufficiently explicited in the clinical respiratory medicine literature. Idiopathic pulmonary fibrosis (IPF) has appeared only in the second half of the twentieth century and may be, as lung cancer and chronic obstructive pulmonary disease, a direct consequence of the cigarette smoking epidemics. It is a disease of lung aging, with most affected patients being older than 70 years. The relationship between lung aging and pulmonary fibrosis is further illustrated in the bleomycin mouse model, in which older males develop more fibrosis than young female mice.An earlier diagnosis of IPF is a prerequisite for significant progress to be made in the long-term outcome and prognosis.The present authors consider that only two different yet complementary and realistic approaches could lead to diagnosing IPF earlier and possibly to allowing a more efficient disease management: (i) investigating any patients with early Velcro crackles at lung auscultation through proactive education of - and commitment from - primary care physicians; (ii) and using current large-scale lung cancer screening strategies with low-dose high-resolution computed tomography in smokers for the detection of subclinical interstitial lung disease and especially early IPF.

PMID: 23598958 [PubMed - as supplied by publisher]