INTRODUCTION: Despite many technological advances, the diagnostic yield of bronchoscopic peripheral lung nodule analysis remains limited due to frequent mispositioning. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic feedback on needle positioning, potentially improving the sampling location and diagnostic yield. Previous studies have defined and validated nCLE criteria for malignancy, airway and lung parenchyma. Larger studies demonstrating the effect of nCLE on diagnostic yield are lacking. We aim to investigate if nCLE-imaging integrated with conventional bronchoscopy results in a higher diagnostic yield compared with conventional bronchoscopy without nCLE. METHODS AND ANALYSIS: This is a parallel-group randomised controlled trial. Recruitment is performed at pulmonology outpatient clinics in universities and general hospitals in six different European countries and one hospital in the USA. Consecutive patients with a for malignancy suspected peripheral lung nodule (10-30 mm) with an indication for diagnostic bronchoscopy will be screened, and 208 patients will be included. Web-based randomisation (1:1) between the two procedures will be performed. The primary outcome is diagnostic yield. Secondary outcomes include diagnostic sensitivity for malignancy, needle repositionings, procedure and fluoroscopy duration, and complications. Pathologists will be blinded to procedure type; patients and endoscopists will not. ETHICS AND DISSEMINATION: Primary approval by the Ethics Committee of the Amsterdam University Medical Center. Dissemination involves publication in a peer-reviewed journal. SUPPORT: Financial and material support from Mauna Kea Technologies. TRIAL REGISTRATION NUMBER: NCT06079970.
- MeSH
- bronchoskopie * metody MeSH
- jehly MeSH
- konfokální mikroskopie * metody MeSH
- lidé MeSH
- multicentrické studie jako téma MeSH
- nádory plic * patologie diagnóza diagnostické zobrazování MeSH
- plíce patologie diagnostické zobrazování MeSH
- randomizované kontrolované studie jako téma MeSH
- solitární plicní uzel * patologie diagnostické zobrazování diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- protokol klinické studie MeSH
- randomizované kontrolované studie MeSH
Diagnostika a verifikace plicních malignit směřuje v poslední době hlavně cestou miniinvazivních technik. V některých případech je verifikace zatížená nedostatečným množstvím odebraného materiálu. Chirurgická verifikace je proto v některých případech nevyhnutelná. Klíč k úspěchu je kombinace vhodně zvolené zobrazovací a diagnostické techniky kombinovaná s erudicí lékaře. I v následujícím článku je místo zvolené verifikace méně tradiční, naštěstí ale s úspěšným diagnostickým závěrem.
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- MeSH
- biopsie tenkou jehlou pod endosonografickou kontrolou * metody MeSH
- bronchoskopie metody MeSH
- konfokální mikroskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů diagnostické zobrazování diagnóza MeSH
- nádory nadledvin * diagnóza MeSH
- nádory plic diagnostické zobrazování MeSH
- optická koherentní tomografie MeSH
- spektrální analýza metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
V naší kazuistice prezentujeme komplexní léčbu pacienta s metastatickým hormonálně senzitivním karcinomem prostaty (mHSPC), se vstupně symptomatickým viscerálním postižením plic. Pacient profituje z dvojkombinační terapie (androgen deprivační terapii + apalutamid) s dobrou kvalitou života.
In our case report we want to demonstrate a complex therapy of a patient with metastatic hormone-sensitive prostate cancer (mHSPC) with initially symptomatic visceral metastases of lungs. Patient profits from doublet combination (androgen deprivation therapy + apalutamid) with good quality of life.
- Klíčová slova
- apalutamid, degarelix, androgen deprivační terapie,
- MeSH
- hormon uvolňující gonadotropiny terapeutické užití MeSH
- kombinovaná farmakoterapie metody škodlivé účinky MeSH
- lidé MeSH
- mediastinum diagnostické zobrazování patologie MeSH
- metastázy nádorů farmakoterapie MeSH
- nádory mediastina diagnostické zobrazování sekundární MeSH
- nádory plic diagnostické zobrazování sekundární MeSH
- nádory prostaty * diagnóza farmakoterapie komplikace MeSH
- pleurální výpotek diagnostické zobrazování MeSH
- prostatický specifický antigen analýza MeSH
- senioři MeSH
- staging nádorů MeSH
- thiohydantoiny * aplikace a dávkování MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: Programmed cell death 1 (PD-1) belongs to immune checkpoint proteins ensuring negative regulation of the immune response. In non-small cell lung cancer (NSCLC), the sensitivity to treatment with anti-PD-1 therapeutics, and its efficacy, mostly correlated with the increase of tumor infiltrating PD-1+ lymphocytes. Due to solid tumor heterogeneity of PD-1+ populations, novel low molecular weight anti-PD-1 high-affinity diagnostic probes can increase the reliability of expression profiling of PD-1+ tumor infiltrating lymphocytes (TILs) in tumor tissue biopsies and in vivo mapping efficiency using immune-PET imaging. METHODS: We designed a 13 kDa β-sheet Myomedin scaffold combinatorial library by randomization of 12 mutable residues, and in combination with ribosome display, we identified anti-PD-1 Myomedin variants (MBA ligands) that specifically bound to human and murine PD-1-transfected HEK293T cells and human SUP-T1 cells spontaneously overexpressing cell surface PD-1. RESULTS: Binding affinity to cell-surface expressed human and murine PD-1 on transfected HEK293T cells was measured by fluorescence with LigandTracer and resulted in the selection of most promising variants MBA066 (hPD-1 KD = 6.9 nM; mPD-1 KD = 40.5 nM), MBA197 (hPD-1 KD = 29.7 nM; mPD-1 KD = 21.4 nM) and MBA414 (hPD-1 KD = 8.6 nM; mPD-1 KD = 2.4 nM). The potential of MBA proteins for imaging of PD-1+ populations in vivo was demonstrated using deferoxamine-conjugated MBA labeled with 68Galium isotope. Radiochemical purity of 68Ga-MBA proteins reached values 94.7-99.3% and in vitro stability in human serum after 120 min was in the range 94.6-98.2%. The distribution of 68Ga-MBA proteins in mice was monitored using whole-body positron emission tomography combined with computerized tomography (PET/CT) imaging up to 90 min post-injection and post mortem examined in 12 mouse organs. The specificity of MBA proteins was proven by co-staining frozen sections of human tonsils and NSCLC tissue biopsies with anti-PD-1 antibody, and demonstrated their potential for mapping PD-1+ populations in solid tumors. CONCLUSIONS: Using directed evolution, we developed a unique set of small binding proteins that can improve PD-1 diagnostics in vitro as well as in vivo using PET/CT imaging.
- MeSH
- antigeny CD279 * metabolismus MeSH
- HEK293 buňky MeSH
- lidé MeSH
- myši MeSH
- nádorové buněčné linie MeSH
- nádory plic diagnostické zobrazování patologie metabolismus genetika MeSH
- nemalobuněčný karcinom plic diagnostické zobrazování patologie metabolismus MeSH
- pozitronová emisní tomografie * metody MeSH
- proteinové inženýrství * MeSH
- sekvence aminokyselin MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
PURPOSE: Radiotherapy outcome modelling often suffers from class imbalance in the modelled endpoints. One of the main options to address this issue is by introducing new synthetically generated datapoints, using generative models, such as Denoising Diffusion Probabilistic Models (DDPM). In this study, we implemented DDPM to improve performance of a tumor local control model, trained on imbalanced dataset, and compare this approach with other common techniques. METHODS: A dataset of 535 NSCLC patients treated with SBRT (50 Gy/5 fractions) was used to train a deep learning outcome model for tumor local control prediction. The dataset included complete treatment planning data (planning CT images, 3D planning dose distribution and patient demographics) with sparsely distributed endpoints (6-7 % experiencing local failure). Consequently, we trained a novel conditional 3D DDPM model to generate synthetic treatment planning data. Synthetically generated treatment planning datapoints were used to supplement the real training dataset and the improvement in the model's performance was studied. Obtained results were also compared to other common techniques for class imbalanced training, such as Oversampling, Undersampling, Augmentation, Class Weights, SMOTE and ADASYN. RESULTS: Synthetic DDPM-generated data were visually trustworthy, with Fréchet inception distance (FID) below 50. Extending the training dataset with the synthetic data improved the model's performance by more than 10%, while other techniques exhibited only about 4% improvement. CONCLUSIONS: DDPM introduces a novel approach to class-imbalanced outcome modelling problems. The model generates realistic synthetic radiotherapy planning data, with a strong potential to increase performance and robustness of outcome models.
BACKGROUND: Disseminated pulmonary involvement in pediatric Hodgkin lymphoma (pHL) is indicative of Ann Arbor stage IV disease. During staging, it is necessary to assess for coexistence of non-malignant lung lesions due to infection representing background noise to avoid erroneously upstaging with therapy intensification. OBJECTIVE: This study attempts to describe new lung lesions detected on interim staging computed tomography (CT) scans after two cycles of vincristine, etoposide, prednisolone, doxorubicin in a prospective clinical trial. Based on the hypothesis that these new lung lesions are not part of the underlying malignancy but are epiphenomena, the aim is to analyze their size, number, and pattern to help distinguish true lung metastases from benign lung lesions on initial staging. MATERIALS AND METHODS: A retrospective analysis of the EuroNet-PHL-C1 trial re-evaluated the staging and interim lung CT scans of 1,300 pediatric patients with HL. Newly developed lung lesions during chemotherapy were classified according to the current Fleischner glossary of terms for thoracic imaging. Patients with new lung lesions found at early response assessment (ERA) were additionally assessed and compared to response seen in hilar and mediastinal lymph nodes. RESULTS: Of 1,300 patients at ERA, 119 (9.2%) had new pulmonary lesions not originally detectable at diagnosis. The phenomenon occurred regardless of initial lung involvement or whether a patient relapsed. In the latter group, new lung lesions on ERA regressed by the time of relapse staging. New lung lesions on ERA in patients without relapse were detected in 102 (7.8%) patients. Pulmonary nodules were recorded in 72 (5.5%) patients, the majority (97%) being<10 mm. Consolidations, ground-glass opacities, and parenchymal bands were less common. CONCLUSION: New nodules on interim staging are common, mostly measure less than 10 mm in diameter and usually require no further action because they are most likely non-malignant. Since it must be assumed that benign and malignant lung lesions coexist on initial staging, this benign background noise needs to be distinguished from lung metastases to avoid upstaging to stage IV disease. Raising the cut-off size for lung nodules to ≥ 10 mm might achieve the reduction of overtreatment but needs to be further evaluated with survival data. In contrast to the staging criteria of EuroNet-PHL-C1 and C2, our data suggest that the number of lesions present at initial staging may be less important.
- MeSH
- dítě MeSH
- doxorubicin terapeutické užití MeSH
- etoposid terapeutické užití aplikace a dávkování MeSH
- Hodgkinova nemoc * diagnostické zobrazování patologie farmakoterapie MeSH
- lidé MeSH
- mladiství MeSH
- nádory plic * diagnostické zobrazování patologie MeSH
- počítačová rentgenová tomografie * metody MeSH
- předškolní dítě MeSH
- prevalence MeSH
- prospektivní studie MeSH
- protokoly antitumorózní kombinované chemoterapie terapeutické užití MeSH
- retrospektivní studie MeSH
- staging nádorů * MeSH
- vinkristin terapeutické užití MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS: A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS: Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS: This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
- MeSH
- časná detekce nádoru metody MeSH
- exprimované sekvenční adresy MeSH
- lidé MeSH
- nádory plic * diagnostické zobrazování MeSH
- náhodný nález MeSH
- počítačová rentgenová tomografie metody MeSH
- směrnice pro lékařskou praxi jako téma * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Karcinom plic (LC) v České republice patří mezi nejčastěji diagnostikovaná nádorová onemocnění, zároveň je jednou z hlavních příčin úmrtí v rámci onkologických diagnóz a jeho prevalence setrvale mírně roste. Existují vědecké důkazy o tom, že screening LC pomocí nízkodávkového CT (LDCT) snižuje riziko úmrtí na LC. V současné době není v ČR zaveden systematický screening LC. Od začátku roku 2022 je v procesu pilotního testování metodika časného záchytu LC právě pomocí LDCT, s cílem vyhodnotit realizaci screeningového programu. Primárním cílem zaváděného postupu je časná a přesná diagnóza onemocnění, která v kombinaci s navazující léčbou povede ke snížení úmrtnosti na LC. Určitě bude na základě dat z pilotního programu následně probíhat odborná diskuse o akceptovatelnosti programu českou populací a o dopadech na zdravotnický systém. Jednoznačné je, že se zavedením screeningového programu zařadíme mezi země, které na základě vědeckých dat umožní populaci profitovat z aktivně realizované prevence tohoto nádorového onemocnění. Informovanost veřejnosti o přínosech neinvazivního vyšetření může přispět k vyšší compliance rizikových osob a jejich ochotě se do programu zapojit. Klíčovou úlohu v celém procesu mají všeobecní praktičtí lékaři, případně ambulantní pneumologové, kteří oslovují rizikové jedince, a mohou pozitivně ovlivnit jejich zapojení do programu.
Lung cancer (LC) is one of the most frequently diagnosed cancers and one of the leading causes of cancer deaths in the Czech Republic, the prevalence of which is steadily increasing. There is scientific evidence that LC screening through low-dose computed tomography (LDCT) reduces the risk of death from LC. No systematic LC screening strategy has been currently in place in the Czech Republic. Since the beginning of 2022, the methodology of early detection of LC using LDCT has been piloted to test the feasibility of the screening program. The primary purpose of the project is an early and accurate diagnosis of the disease, which, in combination with follow-up treatment, will lead to a reduction in LC mortality. The pilot data will definitely serve as a basis for an expert discussion of the acceptability of the program to the Czech population and its impact on the healthcare system. It is clear that by introducing such a screening program, we will join the countries that, based on scientific data, enable the population to profit from an actively implemented LC prevention strategy. Public awareness of the benefits of early non-invasive LC detection can contribute to higher compliance of at-risk persons and their willingness to participate in the program. The key role in the entire process is played by general practitioners and/or outpatient pulmologists who address at-risk individuals and can positively influence their involvement in the program.
- MeSH
- časná detekce nádoru MeSH
- lidé MeSH
- nádory plic * diagnostické zobrazování prevence a kontrola MeSH
- počítačová rentgenová tomografie MeSH
- sekundární prevence * MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
Článok referuje troch pacientov so solitárnym fibróznym tumorom hrudníka. Prvý pacient mal nádor v oblasti kupoly pravej pohrudnicovej dutiny, ktorý bol radikálne resekovaný spolu s hrudníkovou stenou v okolí jeho origa. V druhom prípade išlo o nádor fixovaný cievnou stopkou k dolnému laloku pravých pľúc. Tento nádor bol resekovaný atypicky, cestou torakotómie, spolu s bezpečnostným lemom zdravého pľúcneho tkaniva v oblasti bázy jeho stopky. Posledný pacient mal nádor dolného laloka pravých pľúc, ktorý obklopoval dolnú pľúcnu žilu a miestami nemal zreteľnú hranicu so zdravým pľúcnym tkanivom. Nález si vyžiadal dolnú lobektómiu pravých pľúc cestou posterolaterálnej torakotómie. Kazuistiky poukazujú na zriedkavý typ nádorov v oblasti hrudníka, ktoré v čase zistenia dosahujú často veľké rozmery, nútiace k rozsiahlym operačným výkonom. Vzhľadom k biologickej povahe týchto nádorov, je vhodné daných pacientov dlhodobo dispenzarizovať.
The article reports on three patients with a solitary fibrous tumor of the chest. The first patient had a tumor in the area of the dome of the right pleural cavity which was radically resected together with the chest wall around its origin. In the second case, the tumor was attached by a vascular pedicle to the lower lobe of the right lung. This tumor was resected atypically, via thoracotomy, along with a margin of healthy lung tissue at the base of its pedicle. The last patient had a tumor of the lower lobe of the right lung, surrounding the lower pulmonary vein, which did not have a clear margin of healthy lung tissue. This finding required right lower lobectomy via posterolateral thoracotomy. The presented cases describe rare types of tumors in the chest area which at the time of detection often reach large dimensions, necessitating extensive surgical procedures. Due to the biological nature of these tumors, long-term patient follow-up is advisable.
- MeSH
- dospělí MeSH
- dyspnoe etiologie MeSH
- hrudník diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory pleury chirurgie diagnostické zobrazování patologie MeSH
- nádory plic chirurgie diagnostické zobrazování patologie MeSH
- pleurální dutina chirurgie diagnostické zobrazování patologie MeSH
- počítačová rentgenová tomografie MeSH
- senioři MeSH
- solitární fibrózní tumory * chirurgie diagnostické zobrazování patologie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
- Geografické názvy
- Slovenská republika MeSH
