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ABSTRACT: The purpose of this study is to compare the performance of multidetector computed tomography (CT) and positron emission tomography/CT (PET/CT) with [(18)F]fluorodeoxyglucose in the diagnosis of multiple solitary lung nodules in 14 consecutive patients with suspicious lung cancer. CT and PET/CT findings were reviewed by a radiologist and nuclear medicine physician, respectively, blinded to the pathological diagnoses of lung cancer, considering nodule size, shape, and location (CT) and maximum standardized uptake value normalized to body weight (SUVbw max). Nodules were judged malignant or benign. The sensitivity, specificity, and accuracy of the two techniques were compared. CT had a sensitivity, specificity, and accuracy of 93.7, 86.7, and 90.3%, respectively, whereas PET/CT had a sensitivity, specificity, and accuracy of 75, 100, and 87.1%, respectively. Clinical management would have been erroneous in two patients by CT alone and in four patients by PET/CT alone. In one patient, the two techniques misdiagnosed the nodules (2 CT and 1 PET/CT). CT and PET/CT have complimentary roles in characterization of multiple solitary pulmonary nodules. Small nodules are poorly characterized by CT, and small-sized low-SUV malignant nodules are difficult to detect with PET/CT.
ecancermedicalscience 01/2012; 6:266.
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E Belloni,
G Veronesi,
C Micucci,
S Javan,
S P Minardi,
E Venturini,
P Maisonneuve,
S Volorio,
M Riboni,
M Bellomi,
P Scanagatta,
G Taliento,
G Pelosi,
S Pece, L Spaggiari,
P G Pelicci
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ABSTRACT: Computed tomography (CT) screening of lung cancer allows the detection of early tumors. The objective of our study was to verify whether initial asymptomatic lung cancers, identified by high-resolution low-dose CT (LD-CT) on a high-risk population, show genetic abnormalities that could be indicative of the early events of lung carcinogenesis. We analyzed 78 tumor samples: 21 (pilot population) from heavy smokers with asymptomatic non-screening detected early-stage lung cancers and 57 from 5203 asymptomatic heavy smoker volunteers, who underwent a LD-CT screening study. During surgical resection of the detected tumors, tissue samples were collected and short-term cultures were started for karyotype evaluation. Samples were classified according to the normal (NK) or aneuploid (AK) karyotype. The NK samples were further analyzed by the Affymetrix single-nucleotide polymorphisms (SNPs) technology. Metaphase spreads were obtained in 73.0% of the selected samples: 80.7% showed an AK. A statistically significant correlation was found between presence of vascular invasion and abnormal karyotype. A total of 10 NK samples were suitable for SNPs analysis. Subtle genomic alterations were found in eight tumors, the remaining two showing no evidence to date of chromosomal aberrations anywhere in the genome. Two common regions of amplification were identified at 5p and 8p11. Mutation analysis by direct sequencing was conducted for the K-RAS, TP53 and EGFR genes, confirming data already described for heavy smokers. We show that: (i) the majority of screening-detected tumors are aneuploid; (ii) early-stage tumors tend to harbor a less abnormal karyotype; (iii) whole genome analysis of NK tumors allows for the detection of common regions of copy number variation (such as amplifications at 5p and 8p11), highlighting genes that might be considered candidate markers of early events in lung carcinogenesis.
Oncogene 10/2010; 30(9):1117-26. · 6.37 Impact Factor
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G Veronesi,
P Maisonneuve, L Spaggiari,
C Rampinelli,
G Pelosi,
L Preda,
F Petrella,
A Borri,
M Casiraghi,
R Bertolotti,
N Rotmensz,
M Bellomi
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ABSTRACT: Low-dose computed tomography (CT) screening can detect early stage lung cancer in high-risk populations. However, no data on repeated annual screening over more than 5 years are available, and the impact of screening on lung cancer mortality is controversial.
We analysed outcomes in high-risk asymptomatic volunteers (smokers and former smokers, >50 years) enrolled in a pilot study over 1 year from June 2000, who received annual low-dose CT for 7 years. Cumulative lung cancer incidence and survival were represented by Kaplan-Meier curves. Standardized incidence and mortality ratios were used to estimate risks relative to the general Italian and US population.
Compliance was 86% at the end of the seventh year in 1035 recruited volunteers (71% men, mean age 58 years). Lung cancer was diagnosed in 54 (5.3%); radical surgery was possible in 48/54 (87%); 39/54 (72%) had stage I disease. Five-year survival was 63% overall, 89% for stage I cases. During 6308 person-years of observation, 47 participants had died versus 75 expected in the Italian general population standardised for age and sex. Fourteen lung cancer deaths were registered versus 27 expected in a standardised US smoker population.
Seventy percent of screening-diagnosed patients had stage I disease, and the survival of screen-detected cancer patients was high. Lung cancer mortality was favourable compared to age- and sex-matched population of US smokers, suggesting that mortality can be lowered by screening, although larger trials with longer follow-up are necessary to confirm these findings.
ecancermedicalscience 01/2010; 4:186.
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F Petrella,
L Monfardini,
G Musi,
G Pelosi,
G Veronesi,
F Leo,
P Solli,
A Borri,
D Galetta,
R Gasparri,
P Scanagatta, L Spaggiari
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ABSTRACT: Solitary fibrous tumors of the pleura (SFTP) are rare mesenchymal neoplasms usually originating from the visceral pleura, but sometimes found in other sites like the orbit, dura, paranasal sinus, upper respiratory tract, thyroid, sublingual gland, lung, periosteum, cauda equina, ovary, scrotum and testicular tunica vaginalis. Solitary fibrous tumor of the kidney is extremely rare with fewer than 15 reported cases in modern English literature. To the best of our knowledge, this report describes the first known case of synchronous SFTP in the left parietal pleura and left kidney. The SFTP of the pleura, widely compressing and displacing the left lower lung lobe, was resected via left thoracotomy, whereas the renal SFTP, diagnosed by echo-guided histological biopsy, was closely monitored by computed tomography scan and ultrasound. After a one-year follow-up no recurrence was detected in the left hemithorax and the renal lesion remained stable.
Minerva chirurgica 12/2009; 64(6):669-71. · 0.77 Impact Factor
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F Toffalorio,
E Giovannetti,
T De Pas,
D Radice,
G Pelosi,
M Manzotti,
D Minocci, L Spaggiari,
G Spitaleri,
C Noberasco,
C Catania,
S Boselli,
R Danesi,
F de Braud
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ABSTRACT: The aim of this study was to investigate the influence of histology and site of analysis (primary tumor versus lymph node) on the expression of genes involved in gemcitabine and cisplatin activity in non-small-cell lung cancer (NSCLC). Excision repair cross-complementing-1 (ERCC1), human equilibrative nucleoside transporter-1 (hENT1), deoxycytidine kinase (dCK), 5'-nucleotidase (5'-NT), cytidine deaminase (CDA) and ribonucleotide-reductase regulatory subunits (RRM1 and RRM2) were analyzed by quantitative-reverse transcription-PCR in 88 microdissected samples from 69 chemonaive patients. The results showed different patterns of expression for all studied genes, suggesting a possible stratification of the patients. No difference was observed between primary tumor and lymph node metastasis, as well as in adenocarcinoma and squamous-cell carcinoma specimens, while we found a correlation between the CDA-A79C polymorphism and gene expression levels. These data suggest a similar genetic susceptibility to gemcitabine-cisplatin regimens for squamous cell and adenocarcinoma and support the use of both lymph node and primary tumor for the expression profiling of NSCLC.
The Pharmacogenomics Journal 11/2009; 10(3):180-90. · 4.54 Impact Factor
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Annals of Oncology 09/2009; 20(10):1747-8. · 6.43 Impact Factor
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ABSTRACT: We report the case of a 42-year-old woman with a double vascular catheter mimicking a false persistent left superior vena cava on a chest X-ray. Physicians should be aware of the correct course of these catheters in order to avoid serious clinical consequences.
The Thoracic and Cardiovascular Surgeon 05/2009; 57(3):185-6. · 0.88 Impact Factor
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Histopathology 09/2008; 53(3):350-2. · 3.08 Impact Factor
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ABSTRACT: We report a case of a 62-year-old man affected by Pancoast's tumor who developed pneumocephalus 17 days after right upper lobectomy with en bloc resection of the first three ribs and C8-D1 branches of the brachial plexus. The patient complained of aphasia, disorientation and sphincterial release. A chest and brain-CT scan showed a right apical pneumothorax associated with a massive pneumocephalus of the ventricles and of the subarachnoidal spaces. A pneumoperitoneum was also seen. The patient was treated using pleural drainages, Trendelenburg's position and antibiotic therapy. Clinical and radiological remission was achieved after 12 days of additional hospital stay.
The Journal of cardiovascular surgery 07/2007; 48(3):385-7. · 1.56 Impact Factor
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ABSTRACT: Bronchopleural fistula (BPF) is a well recognized and potentially fatal complication of major thoracic surgery and several strategies regarding its prevention and subsequent management have been described. An immediate BPF occurring intraoperatively after bronchial closure is a rare event and is usually treated by bronchial stump reamputation and/or hand-suture reinforcement by mattress suture, or myoplasty. We report a simple and successful technique, using azygous vein flaps, to repair an intraoperative BPF associated to a small bronchial dehiscence occurred after a right pneumonectomy in a 70-year-old diabetic man receiving induction chemotherapy treatment.
Minerva chirurgica 05/2007; 62(2):137-9. · 0.77 Impact Factor
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ABSTRACT: We describe the case of a 64-year-old woman with a solitary pulmonary nodule and a previous breast carcinoma whose diagnosis of histoplasmoma was established only after surgical resection and appropriate stains. It is important not to confuse these two diseases as this will prevent inappropriate medical treatment. Limited surgery is indicated for the treatment of these circumscribed lesions.
The Thoracic and Cardiovascular Surgeon 04/2007; 55(2):123-5. · 0.88 Impact Factor
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ABSTRACT: In mediastinal dissection through a right thoracotomy, the definition of station 2 is arbitrary because no anatomical landmark indicates the line drawn tangentially to the upper margin of the aortic arch. We have developed a technique to localize it by evaluating the distance between the upper aortic arch and the azygos vein on a CT scan. This distance located intraoperatively above the azygos vein permits the surgeon to draw an imaginary line parallel to the azygos vein, which we consider to be the limit between station 2 and station 4. To verify the precision of the technique, an 8-mm clip was positioned at the intersection between the imaginary line dividing station 2 and station 4 and the superior vena cava in 38 consecutive right-sided lateral muscle-sparing thoracotomies. The definition of the station 2/4 limit was defined as "excellent" if the upper aortic arch line crossed the clips, "good" if clips were </= 5mm from it, "acceptable" if the distance was 6-10 mm, and "poor" if the distance was higher than 10 mm. Clip evaluation was possible in 37 patients. The definition of the limit between station 2 and station 4 was excellent in 26 cases (70.2%), good in 10 cases (27%), acceptable in no case and poor in 1 case (2.7%). In this latter case,the presence of a lusory artery was probably responsible for the poor clip positioning. This simple technique improves the precision of lymph node staging during mediastinal dissection,providing an excellent or good definition in more than 95% of patients submitted to lateral thoracotomy. Further studies are needed to verify whether the technique is applicable with the same precision during postero and antero-lateral thoracotomy.
The Thoracic and Cardiovascular Surgeon 04/2007; 55(3):203-4. · 0.88 Impact Factor
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ABSTRACT: Complete anastomotic dehiscence after sleeve resection is a dramatic and often fatal event requiring an extremely aggressive and risky treatment; completion pneumonectomy represents the sole effective therapeutic option to rescue the patient, but postoperative mortality after this procedure is high. We report a case successfully treated by extended redo carinal sleeve resection after full bronchial dehiscence. This option should be taken into account in such a complication, mainly in patient with compromised respiratory function.
Minerva chirurgica 09/2006; 61(4):353-5. · 0.77 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the safety of continuous nonabsorbable (3/0 polypropylene) sutures for sleeve lobectomy, and the influence of induction chemotherapy on postoperative outcome in patients with lung malignancies.
A review of a prospective database of a single surgeon identified 41 consecutive patients who underwent sleeve lobectomy from May 1998 to July 2003. Bronchial reconstruction was done placing two 3/0 polypropylene sutures at the far side of the cartilaginous wall and subsequently fixed. Afterwards, two running sutures were performed in order to obtain a telescopic anastomosis.
Twenty-four patients (59%) underwent induction chemotherapy. There were 31 right upper, 3 left lower ''reverse'', and 7 left upper sleeve lobectomies with radical lymph node dissection. Eight patients underwent reconstruction of the pulmonary artery. There were 34 non-small cell lung cancers, 3 limited small cell lung cancers, 1 neuroendocrine large cell carcinoma, and 3 bronchial carcinoid tumors. N2, N1, and N0 diseases were found in 13, 12 and 16 patients, respectively. Post-operative morbidity and mortality were 14.5% (n=6) and 4.8% (n=2) (1 patient, 4%, after induction chemotherapy). The rate of postoperative anastomotic complications was 2.4% (n=1). Late bronchial stenosis developed in 3 cases, but all were successfully medically treated. Twenty-nine patients are still alive, 27 without evidence of disease. The overall 2-year probability of survival (Kaplan-Meier) was 59%. Induction chemotherapy did not influence postoperative morbidity/mortality (chi2 test: P=0.64/P=0.56).
Continuous nonabsorbable suture for sleeve lobectomy is quick and technical easy to perform, with low postoperative morbidity/mortality; induction chemotherapy does not influence postoperative outcome in these patients.
Minerva chirurgica 09/2006; 61(4):307-13. · 0.77 Impact Factor
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N Fazio,
T De Pas,
F de Braud, L Spaggiari,
G Mazzarol,
R Biffi,
B Andreoni,
M Zampino,
G Curigliano,
K Lorizzo,
G Di Meglio,
A Goldhirsch
Annals of Oncology 01/2005; 15(12):1850. · 6.43 Impact Factor
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ABSTRACT: Surgical treatment of lung metastasis has become common, but extended pulmonary metastasectomy is not accepted worldwide. We report a case of huge apical pulmonary metastasis of renal cancer with involvement of the subclavian vessels associated to two additional lesions of the lower lobe. All lung deposits were successfully removed through a combination of a transmanubrial cervicothoracic approach for the apical lesion and a videothoracoscopic technique for the nodules of the lower lobe.
The Thoracic and Cardiovascular Surgeon 05/2004; 52(2):113-4. · 0.88 Impact Factor
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U Pastorino,
G Veronesi,
C Landoni,
M Leon,
M Picchio,
P G Solli,
F Leo, L Spaggiari,
G Pelosi,
M Bellomi,
F Fazio
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ABSTRACT: F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is now a procedure of proven clinical value in the staging of primary lung cancer. This study evaluated the role of PET in the preoperative assessment of resectable lung metastases.
Eighty-six patients with previously treated malignancy and proven or suspected lung metastases, deemed resectable at computed tomography scan, were investigated with 89 preoperative PET procedures. Primary tumor sites were: gastrointestinal in 32 cases, sarcoma in 13, urologic in 14, breast in 8, head and neck in 7, gynecologic in 5, thymus in 5, other in 5. Seventy lung resections were performed in 68 patients of whom only 54 proved to be lung metastasis, 7 were primary lung tumors, and 9 were benign lesions.
In 19 cases (21%) lung surgery was excluded on the basis of PET scan results due to extrapulmonary metastases (11 cases), primary site recurrence (2), mediastinal adenopathy (2), or benign disease (4). All mediastinal node metastases (7 cases) were detected by PET with a sensitivity, accuracy, and negative predictive value for mediastinal staging of 100%, 96%, and 100%, respectively, versus 71%, 92%, and 95% of the computed tomography scan. In the group of patients who underwent lung resection, PET sensitivity for detection of lung metastasis was 87%.
PET scan proved to be a valuable staging procedure in patients with clinically resectable lung metastasis and changed the therapeutic management in a high proportion of cases.
Journal of Thoracic and Cardiovascular Surgery 01/2004; 126(6):1906-10. · 3.41 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 12/2003; 126(5):1670-1; author reply 1671. · 3.41 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 03/2003; 125(2):428-9. · 3.41 Impact Factor
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ABSTRACT: Postpneumonectomy syndrome (PPS) is a rare complication of pneumonectomy due to an excessive mediastinal shift producing compression of the main bronchus or a lobe bronchus on the aorta or the spine. We report an exceptional case in which an extreme mediastinal shift was due to fibrosis and complete atelectasis of the left lung, as a complication of chemoradiation treatment for recurrent mediastinal Hodgkin's lymphoma. This condition, associated with a further recurrence of the disease, indicated a postpneumonectomy-like syndrome.
Annals of Oncology 01/2003; 13(12):1945-7. · 6.43 Impact Factor
