Publications (184) View all
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Article: Transoesophageal endoscopic ultrasound-guided fine-needle aspiration of pleural effusion for the staging of non-small cell lung cancer.
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ABSTRACT: OBJECTIVES The efficacy of endoscopic ultrasound (EUS) for evaluating mediastinal adenopathy in lung cancer is nowadays proven. However, its accuracy for detection of malignant pleural effusion per se has not been yet investigated. Herein we report our experience with EUS for detecting pleural effusion during the staging procedure of non-small cell lung cancer (NSCLC) patients.METHODS Between January 2009 and December 2011, we performed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) on 92 selected NSCLC patients to evaluate the T and N factors and to acquire bioptic material and when this was detected, to sample the pleural effusion.RESULTSIn 10 patients (8 males and 2 females, mean age 66.9 ± 9.2 years) a pleural effusion was detected and sampled. In 7 out of the 10 cases, the cytological examination of the fluid obtained by EUS-FNA tested positive for malignant cells, thereby upgrading the case to Stage IV, irrespective of T and N statuses. In 3 cases the cytology on the EUS-FNA material was proven to be negative for malignancy thereby allowing patients to be treated with curative intent without further delay.CONCLUSIONSEUS-FNA of the pleural fluid is a safe and simple procedure. Our data, albeit stemming from a limited study population, show that it can be efficient in selected NSCLC cases for obtaining useful material and information with significant impact on the staging and, therefore, on the planning of the optimum therapeutic strategy.Interactive cardiovascular and thoracic surgery 04/2013; -
Article: PREDICTING WALKING-INDUCED OXYGEN DESATURATIONS IN COPD PATIENTS: A STATISTICAL MODEL.
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ABSTRACT: Background Oxygen desaturation during walking can have important consequence on prognosis of COPD patients. However, a standard 6-minute walking test (6MWT) useful to detect walking desaturators (WD(+)), can be difficult to execute in some settings of COPD management, as in the community health care service. Aim of our study was to validate and evaluate the accuracy of a newly composed score of risk of oxygen desaturation during walking in COPD patients: the Walking Desaturation Score-WDS.Methods Data on symptomatic COPD inpatients admitted for rehabilitation (derivation cohort) and outpatients referred to the local community health service (validation cohort) were recorded. By pulse-oximetry oxygen saturation (SpO(2)) was monitored during 6MWT to obtain minimal values (SpO(2) nadir); patients were thus divided into WD(+)or non-desaturators (WD(-)). By a regression analysis model we have assigned a weighted score proportional to the measured percentage of explained variance for each variable. Risk estimate was computed by odds ratio (OR). A Receiver Operating Curve (ROC) analysis and a Hosmer-Lemeshow (HL) goodness of fit test were then performed to measure discrimination and calibration of WDS.ResultsBaseline characteristics in derivation (n=435, WD(+) 74%) and validation (n=238, WD(+) 37%) cohorts were different. Resting arterial oxygen saturation-SO(2), arterial partial pressure of oxygen-PaO(2) and forced expiratory volume in the 1(st) second-FEV(1) % pred. were the variables predicting walking desaturation. The proportion of WD(+) patients (and OR estimate) gradually increased according to WDS (range 0 to 6) and associated categories of desaturation risk (low 0-1 in total score of WDS, high 2-3, and very high 4-6) (X(2)0.001). A considerable predictive discrimination (area under curve-AUC 0.90, 95% CI 0.86 to 0.93, P< 0.001) and calibration (HL X(2) 1.31, P=0.859) values have been shown.ConclusionsWDS accurately predicts and classifies the risk of walking desaturation in COPD patients.Respiratory care 01/2013; · 2.01 Impact Factor -
Article: Long-term results in patients with pathological complete response after induction radiochemotherapy followed by surgery for locally advanced non-small-cell lung cancer.
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ABSTRACT: OBJECTIVES: The outcome of locally advanced non-small-cell lung cancer (NSCLC) patients with pathological complete response (pCR)-pT0N0 -after induction chemoradiotherapy (IT) followed by surgery has, to date, only rarely been investigated. The long-term results in this highly selected subset of patients were evaluated and reported here to identify any predictive factors associated with prognosis. METHODS: From January 1992 to December 2009, 195 consecutive locally advanced (T1-T4/N0-2/M0) NSCLC patients underwent IT, and after clinical restaging, 137 were operated upon with radical intent. Among these, 37 (19% of the overall and 27% of the surgical cohort) showed a pCR status and were included in this retrospective analysis. Survival rates and prognostic factors were analysed by the Kaplan-Meier, the log-rank and Cox regression analyses. RESULTS: The mean age and male/female ratio were 61.9 ± 9.8 years and 33/4, respectively. Before starting IT, the clinical staging was IIb in 2 (5%) patients, IIIa in 20 (54%) and IIIb in 15 (41%). Morbidity and 30-day mortality rates were 27 and 3%, respectively. The overall 3- and 5-year long-term survivals (LTSs) and disease-free survival (DFS) were 67 and 64% and 68 and 71%, respectively. Overall, 17 patients (46%) experienced a recurrence, occurring more frequently in a distant site (32%) than locally (19%). The analysis of the 5-year LTS suggests that (i) the initial single N2 station involvement (P = 0.010); (ii) the resection to a lesser extent than pneumonectomy (P = 0.005) and (iii) the adjuvant therapy (P = 0.005) are all positive prognostic factors. In particular, a 5-year hazard ratio of 8.21 (95% confidence interval 2.16-31.16, P = 0.002) was estimated by Cox regression analysis for subjects who did not undergo adjuvant therapy vs those who did. CONCLUSIONS: After induction radiochemotherapy followed by surgery in locally advanced NSCLC, a pCR is achieved in a remarkable proportion of cases (27% in our experience). In such patients, a rewarding LTS (64% at 5 years) could be expected, especially when a single N2 station is involved at diagnosis or when an adjuvant treatment is administered. Nevertheless, recurrences after surgery are quite common (46%) and this evidence deserves further investigations and deeper analysis.European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2013; · 2.40 Impact Factor -
Article: Typical bronchial carcinoid tumors: focus on surgical management.
The Annals of thoracic surgery 01/2013; 95(1):385. · 3.74 Impact Factor -
Article: EGFR-Targeted Therapy for Non-Small Cell Lung Cancer: Focus on EGFR Oncogenic Mutation.
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ABSTRACT: The two essential requirements for pathologic specimens in the era of personalized therapies for non-small cell lung carcinoma (NSCLC) are accurate subtyping as adenocarcinoma (ADC) versus squamous cell carcinoma (SqCC) and suitability for EGFR molecular testing, as well as for testing of other oncogenes such as EML4-ALK and KRAS. Actually, the value of EGFR expressed in patients with NSCLC in predicting a benefit in terms of survival from treatment with an epidermal growth factor receptor targeted therapy is still in debate, while there is a convincing evidence on the predictive role of the EGFR mutational status with regard to the response to tyrosine kinase inhibitors (TKIs).This is a literature overview on the state-of-the-art of EGFR oncogenic mutation in NSCLC. It is designed to highlight the preclinical rationale driving the molecular footprint assessment, the progressive development of a specific pharmacological treatment and the best method to identify those NSCLC who would most likely benefit from treatment with EGFR-targeted therapy. This is supported by the belief that a rationale for the prioritization of specific regimens based on patient-tailored therapy could be closer than commonly expected.International journal of medical sciences 01/2013; 10(3):320-30. · 2.24 Impact Factor
