Search Results (94)

Background: Hypersensitivity pneumonitis (HP) is an interstitial lung disease characterized by immune-mediated inflammation and variable degrees of fibrosis. Aims: To evaluate the clinical, radiological, and hematological features of patients diagnosed with HP. Study Design: Retrospective cross-sectional study. Methods: We included 100 patients diagnosed and followed for HP between 2020 and 2024. Demographic characteristics, pulmonary function test results, diffusing capacity, six-minute walk test findings, antigen exposure history, and high-resolution computed tomography (HRCT) patterns were retrospectively analyzed. Results: The mean age was 63 ± 14 years, with equal sex distribution. Sixty-five percent of patients had identifiable antigen exposure, predominantly related to birds or bird products (86.4%). Surgical lung biopsy confirmed the diagnosis in 29% of cases. The most common HRCT findings were reticulation (87%), ground-glass opacities (84.7%), and centrilobular nodules (75%); fibrotic features were present in 48% of patients. Glucocorticoids were the main treatment (77%), and antifibrotic therapy was used in 20% of cases. Neutrophil count showed a modest positive correlation with honeycombing (r = 0.27, p = 0.025). Basophil count demonstrated a mild association with bird-related antigen exposure (r = 0.26, p = 0.035). Conclusions: Peripheral neutrophil and basophil counts showed weak but statistically significant associations with fibrotic HRCT features and exposure patterns. These exploratory findings suggest that routinely available hematologic parameters may provide supportive information alongside radiologic and clinical data. Prospective studies are needed to validate their diagnostic and prognostic relevance in HP. Full article

Spontaneous ventilation (SV) video-assisted thoracic surgery (VATS) is aimed at offering less invasive alternatives to equivalent procedures under tracheal intubation with mechanical ventilation (MV) and its benefits have shown encouraging results in lung surgery. In addition, there is also growing interest in SV-VATS in mediastinum surgery. The rationale of SV in simpler mediastinum procedures is that MV anesthesia could be considered avoidable if SV anesthesia protocols could provide similar or even better results. On the other hand, for other indications involving more delicate patient subgroups, SV-VATS is aimed at offering a more rapid recovery with less anesthesia-related risks of cardio-respiratory complications. Based on encouraging initial results, SV is also being proposed for more demanding surgical procedures, including tracheal resection and esophagectomy. However, SV mediastinum surgery also implies contraindications, potential disadvantages and peculiar physiopathologic issues which must be clearly acknowledged. This perspective is aimed at providing a critical overview of the current knowledge about SV for mediastinum surgery, with a particular emphasis on the last 10 years of data about thymectomy, biopsy of mediastinal masses, thoracic sympathectomy, tracheal resection, pericardial window and esophagectomy. Full article

Background/Objectives: This study involved an analysis of clinical data, histological types, genetic predisposition, treatment and outcomes in PPB in children. Patients and methods: We conducted a retrospective review of children treated for PPB at Polish pediatric oncology centers between 2011 and 2024. Results: A total of fifteen children (seven boys, eight girls; median age of 39 months; range: 27–64 months) were included. Type II solid/cystic PPB and type III solid PPB were diagnosed in six and eight children, respectively (one not known). Overall, 93% of patients were diagnosed at up to 4 years of age. Metastatic disease at diagnosis was confirmed in three (20%) patients, localized in bones, bone marrow and lymph nodes. Diagnosis was confirmed via central pathology review in 11 patients (73%). DICER1 pathogenic variants were identified in eight patients. All children presented with respiratory symptoms. The tumor dimensions were >10 cm (n = 7), 5–10 cm (n = 5) and <5 cm (n = 2). No bilateral lung involvement was observed. Tumor biopsy was performed in six children (40%), with subsequent resection (R0) in five patients. Primary resection (R0) was achieved in three patients (20%) with type II (n = 1) or type III (n = 2). In the other six patients, non-radical resection was performed: R1 in four (27%) children (with a tumor rupture in one patient) and R2 (subtotal resection) in two children (13%). All patients received postoperative chemotherapy. Maintenance chemotherapy was given to two patients. No patient received radiotherapy as first-line treatment. Progressive disease occurred in two patients in the CNS and lungs. Relapsed disease appeared in three patients, all with CNS involvement. Conclusions: PPB is a rare, malignant tumor of early childhood with an uncertain prognosis. Despite multimodal treatment, patients remain at risk of progression or CNS relapse. Complete surgical resection remains a key prognostic factor. Full article

Introduction: Non-surgical biopsy is recommended for diagnosing solid pulmonary nodules measuring >8 mm when the probability of malignancy is low to moderate. However, currently available biopsy methods do not have a sufficient diagnostic yield for nodule size <20 mm. Previous work has shown that one-lung flooding (OLF) enables complete lung sonography and good demarcation of lung nodules. Therefore, here, we report the first experiences with ultrasound-guided transthoracic core needle biopsy (USgTTcNB) under OLF for the histological diagnosis of small pulmonary nodules. Methods: In two patients with small pulmonary nodules, a transbronchial/thoracic biopsy was not indicated due to the size and location of the nodules. Following nodule detection under OLF, the USgTTcNB was performed. The biopsy cylinder was immediately examined via the frozen section procedure. After liquid draining and re-ventilation, the patients were extubated in the operation room and monitored in the intermediate care unit. Results: In both patients, a histological diagnosis was achieved. In the case of malignancy, the patient underwent lobectomy during the same session. In the case of a benign diagnosis, a futile operation was avoided. In case two, a small apical pneumothorax occurred. The hemodynamic values during and after the intervention were in the normal range. Lung function on day 2 after the intervention increased compared with that before the intervention. Conclusions: USgTTcNB under OLF is feasible and enables a histological confirmation of small pulmonary nodules. Nevertheless, this new promising technique should be evaluated in a study with a larger cohort. Full article

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. Timely and accurate diagnosis and staging are crucial for treatment decisions. Objective: To assess the feasibility, safety, and diagnostic/staging yield of a bronchoscopy-based pathway supported by EBUS-TBNA in a regional Romanian center. Bronchoscopy combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) may reduce the need for surgical confirmation, yet its implementation in regional centers is inconsistent. Materials and Methods: This retrospective study included 67 patients with suspected lung cancer evaluated at a regional oncology center between December 2023 and February 2024. All patients underwent bronchoscopy, and EBUS-TBNA was performed in those with mediastinal lymphadenopathy on imaging, with endoscopic tissue biopsies (endobronchial/EBUS-TBNA). Demographic, clinical, histological, and molecular data were collected and analyzed using descriptive statistics and chi-square/Fisher’s exact tests. Results: Among the 67 patients, 42 (62.7%) underwent EBUS-TBNA. The majority were diagnosed in advanced stages (stage III–IV: 83.6%), with adenocarcinoma being the most frequent histological subtype. PD-L1 expression was positive in 52.2% of cases, and p63 in 67.2%. No significant procedural complications occurred, and adequate tissue sampling for histopathological and molecular analyses was achieved in all cases. Associations were found between PD-L1 and advanced TNM stage (p = 0.026), as well as between p63 status and TNM stage (p = 0.002). Conclusions: This study supports the feasibility and safety of a bronchoscopy-based diagnostic and staging algorithm supported by EBUS-TBNA, achieving reliable sampling and avoiding surgical confirmation in a regional oncology setting. Further prospective studies are warranted to validate these findings. Full article

Background: Circulating tumor DNA (ctDNA), shed into bodily fluids by cancer cells through apoptosis, necrosis, or active secretion, is currently used in the field of genomic investigation in clinical settings, primarily for advanced stages of non-small-cell lung cancer (NSCLC). However, its potential role in guiding the multi-omic approach to early-stage NSCLC is emerging as a promising area of investigation. Efforts are being made to integrate the genomics not only in surgery, but also in the definition of long-term prognosis after surgical or radiotherapy and for the prediction of recurrence. Methods: An extensive literature search was conducted on PubMed, covering publications from 2000 to 2024. Using the advanced search tool, titles and abstracts were filtered based on the following keywords: ctDNA, early stage, NSCLC. From this search, 20 studies that fulfilled all inclusion criteria were selected for analysis in this review. Results: This review highlights the growing body of evidence supporting the potential clinical use of ctDNA as a genomic biomarker in managing early-stage NSCLC. Baseline ctDNA levels offer valuable information about tumor molecular biology and histological characteristics. Beyond its prognostic value before treatment, liquid biopsy has proven useful for tracking minimal residual disease and forecasting recurrence following curative interventions such as surgery or radiotherapy. Future adjuvant treatment decisions may increasingly rely on predictive models that incorporate liquid biopsy findings alongside other clinical factors. Conclusions: The potential use of this analyte introduces new opportunities for the integration of genomic data in treatment, as well as relapse monitoring with more accurate and innovative than traditional methods, particularly in patients with early-stage NSCLC Full article

The aim of this retrospective clinical study was to assess surgical duration and surgical and post-operative complications associated with Video-Assisted Thoracoscopic Surgery (VATS) and lung biopsy in horses with severe Equine Pasture Asthma (EPA) and paired control horses. Twelve horses (6 EPA-affected, 6 control) were sex, age and breed matched. Twenty-four thoracic surgeries were performed. Surgery of each matched pair (EPA-affected and healthy) was performed during asthma exacerbation (summer) and remission (winter). Surgical times were shorter with uncomplicated thoracoscopy (85 min) and significantly longer (p < 0.001) when intra-operative complications necessitated conversion to thoracotomy (156 min). The overall surgical time of EPA-affected horses during asthma exacerbation was significantly longer than control horses at any time point, predicted mean difference of 78 min (p < 0.05). When comparing EPA-affected horses to themselves during asthma exacerbation and remission, surgical times were significantly longer (p < 0.01) with a predicted mean difference of 98 min; this effect of seasonality did not occur amongst control horses. Intra-operative surgical complications (6/24) were evenly divided between EPA and control horses, however, only severe EPA horses in exacerbation were noted to have lung hyperinflation. Post-operative complications: fever, colic, hemothorax, pneumothorax, subcutaneous emphysema, surgical site infection, and/or laminitis occurred in 13/24 surgical procedures (54%). No fatalities resulted from these procedures. Full article

Background: This study aimed to develop a nomogram based on the most relevant clinical, CT, and radiomic features comprising 11 key signatures (2 clinical, 2 CT-based, and 7 radiomic) for the non-invasive prediction of the EGFR mutation status and to support the timely initiation of tyrosine kinase inhibitor (TKI) therapy in patients with non-small cell lung cancer (NSCLC) adenocarcinoma. Methods: Retrospective real-world data were collected from 521 patients with histologically confirmed NSCLC adenocarcinoma who underwent CT imaging and either surgical resection or pathological biopsy for EGFR mutation testing. Five Random Forest classification models were developed and trained on various datasets constructed by combining clinical, CT, and radiomic features extracted from CT image regions of interest (ROIs), with and without feature preselection. Results: The model trained exclusively on the most relevant clinical, CT, and radiomic features demonstrated superior predictive performance compared to the other models, with strong discrimination between EGFR-mutant and wild-type cases (AUC = 0.88; macro-average = 0.90; micro-average = 0.89; precision = 0.90; recall = 0.94; F1-score = 0.91; and accuracy = 0.87). Conclusions: A nomogram constructed using a Random Forest model trained solely on the most informative clinical, CT, and radiomic features outperformed alternative approaches in the non-invasive prediction of the EGFR mutation status, offering a promising decision-support tool for precision treatment planning in NSCLC. Full article

Background/Objectives: Lung cancer is a highly diverse disease, and reliable preclinical models that accurately reflect tumor characteristics are essential for studying lung cancer biology and testing new therapies. This study aimed to establish patient-derived tumor organoids (PDTOs) using small biopsy samples and surgical specimens to create a model system that preserves the genetic and histological features of the original tumors. Methods: PDTOs were generated from 163 lung cancer specimens, including 109 samples obtained using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) or bronchoscopy, 52 surgical specimens, and 2 pleural fluid samples. The organoid establishment rate beyond passage three was assessed, and histological subtypes and genetic profiles were analyzed using immunohistochemical staining and targeted exome sequencing. Results: The overall PDTO establishment rate was 34.4% (56/163), and 44.6% (25/56) of these organoids retained the histological and genetic features of the parental tumors. Genetic analysis identified key mutations, including KRAS G12C, EGFR L858R, MET exon 14 skipping mutation, and ROS1 fusion. PDTOs successfully formed tumors in mice while maintaining the genetic characteristics of the original tumors. Co-culture of PDTOs with cancer-associated fibroblasts (CAFs) resulted in increased resistance to paclitaxel. In the co-culture model of PDTOs with immune cells, dose-dependent growth inhibition of PDTOs was observed in response to immune checkpoint inhibitors. Conclusions: PDTOs established from small biopsy and surgical specimens serve as a valuable model for studying lung cancer biology, tumor microenvironment interactions, and drug response. This model has the potential to improve personalized treatment strategies. Full article

We report a 26-year-old male presenting with a chronic cough and hemoptysis. Imaging revealed a large hypermetabolic mass in the left lower lung with the invasion of adjacent great vessels. A biopsy confirmed sarcomatoid carcinoma, a rare and aggressive form of primary pulmonary sarcoma. Due to vascular involvement, the patient underwent preoperative bronchial artery embolization followed by left pneumonectomy with pulmonary arterioplasty via median sternotomy. Postoperative recovery was uneventful. A two-year follow-up CT showed no recurrence. Primary pulmonary sarcomas are extremely rare, accounting for only 0.013–0.4% of lung malignancies, and are often diagnosed late due to nonspecific symptoms. This case highlights the importance of timely imaging, multidisciplinary planning, and aggressive surgical management in achieving long-term disease control, even in cases with extensive vascular invasion. Full article

Non-tuberculous mycobacteria (NTM) are saprophytes of both soil and water that may cause infection with a high risk of dissemination, mainly in immunocompromised patients. Most NTM infections occur in the lungs, while uncommon localizations are the skin, soft tissues, musculoskeletal apparatus, and lymphatic system. The possible relationship between NTM infections and dental procedures is still unclear. The authors reported a rare manifestation of NTM infection occurring in a 6-year-old girl who developed sub-mandibular swelling related to a necrotic tooth, thus mimicking an abscess of odontogenic origin. Fine-needle aspiration biopsy of the sub-mandibular swelling and the following microbiologic investigation showed infection sustained by the Mycobacterium fortuitum complex. After the medical and surgical treatment, the patient completely recovered after 8 months. A review of the relevant literature was carried out to deepen the clinical and microbiological aspects of such a rare occurrence. Full article

The diagnostic evaluation of interstitial lung diseases (ILDs) remains challenging due to their heterogeneous etiologies and overlapping clinical and radiographic patterns. A confident diagnosis often necessitates histopathological sampling, particularly when high-resolution computed tomography and serologic assessments are inconclusive. While surgical lung biopsy (SLB) has long been considered the diagnostic gold standard, its invasiveness, associated morbidity, and limited feasibility in high-risk patients have driven the pursuit of less invasive alternatives. Here, we review the current applications, diagnostic yield, procedural techniques, and complications of several bronchoscopic modalities. Bronchoalveolar lavage (BAL) aids in characterizing inflammatory profiles and differentiating among conditions such as hypersensitivity pneumonitis, sarcoidosis, and eosinophilic pneumonia. Endobronchial biopsies (EBBs) and endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) are valuable in diagnosing granulomatous diseases with lymphadenopathy. Transbronchial lung biopsy (TBLB) is effective for peribronchial and centrilobular diseases but is limited by small sample size and tissue distortion. Transbronchial lung cryobiopsy (TBC) enables acquisition of larger, well-preserved parenchymal tissue samples from the peripheral lung. Over recent years, studies have demonstrated that TBC, when interpreted within a multidisciplinary discussion (MDD), achieves diagnostic concordance rates with SLB exceeding 75%, and up to 95% in cases where high diagnostic confidence is reached. When performed in experienced centers using standardized protocols, TBC is considered a viable first-line histopathologic tool in the diagnostic evaluation of ILD. Adequate training and standardization of the TBC procedure are needed to ensure low complication rates and a high yield. Full article

Interstitial lung disease (ILD) is a group of diffuse parenchymal disorders, which are diagnosed in many cases by multidisciplinary discussion (MDD). In some cases, diagnosis can be challenging, and the addition of histopathology can increase diagnostic confidence. The tools to obtain a histopathological sample to diagnose ILD are expanding. In this review, we will discuss the various modalities, their sensitivities and specificities, and procedural complication rates. In this review, we conducted a comprehensive review of literature focusing on emerging and established diagnostic tools for ILD. A systematic search of peer-reviewed publications was performed using PubMed with a focus on clinical trials, retrospective and prospective cohort studies, and systematic reviews. The key diagnostic modalities in focus were genomic classifier (GC), transbronchial cryobiopsy (TBLC), surgical lung biopsy (SLB), endobronchial ultrasound cryobiopsy (EBUS-C), genetic testing, and speckled transthoracic echocardiography (STE). Data extracted from these studies focused on diagnostic yield, specificity, sensitivity, and procedural complication rate. Genomic classifier, a gene-based molecular diagnostic tool, has a high specificity for histological usual interstitial pneumonia (UIP). However, in cases of a negative result, it often results in a need for further invasive sampling by TBLC or SLB. TBLC results in a larger histological sample, which can increase diagnostic yield and increase diagnostic confidence at MDD. Recent prospective trials have compared this modality with SLB and found 63–77% interobserver agreement between pathologists. SLB remains the gold standard with diagnostic yields reported to be more than 90%. EBUS-C has shown promising results increasing diagnostic yield in patients with suspected sarcoidosis or lymphoma. All diagnostic modalities have procedural complications with most common being pneumothorax, bleeding and, rarely, death. Advancements in diagnostic tools for interstitial lung disease (ILD) have significantly improved accuracy. Even though surgical lung biopsy remains the gold standard, the alternative modalities are promising and provide a promising yield with a lower procedural risk. Full article

Objectives: Despite continuous advances in diagnosis, such as the “Two week wait” policy for hospital specialist referral and fast-track diagnostic pathways, lung cancers are detected mostly at advanced stages. Our aim was to evaluate the fast-track diagnostic pathway in a tertiary hospital. Methods: Between March and September 2022, 114 consecutive patients with respiratory symptoms or radiology suspicions of lung cancer were referred to our “Pulmonary Point” outpatient clinic. The time intervals to take in the charges and conduct biopsy and ^18FDGPET-CT were prospectively collected. Furthermore, the patients’ experiences were evaluated by means of a six-item questionnaire investigating the outpatient clinic environment and accessibility, the kindness and professional approach of the healthcare professionals, the psychological support provided and an overall evaluation. The data were compared with those of 79 patients observed in the Thoracic Surgery Ambulatory in the pre-COVID-19 pandemic period of March–September 2019 before the fast-track diagnostic pathway for lung cancer was established. Results: The patients were referred to the “Pulmonary Point” outpatient clinic by a General Practitioner in 44 cases (38.5%), by other Specialists in 56 (49.1%) and by an Emergency Department in 14 (12.2%). Among the 114 patients, 104 (91.2%) were visited within 3 working days. Biopsies (FNAB, EBUS, bronchoscopy or surgical) were performed at a median period of 18 days (IQR: 9–26), and ^18FDGPET-CT was carried out at a median period of 16 days (IQR: 7–25). The patients referred to the Thoracic Surgery Ambulatory in the period of March–September 2019 were characterized by longer times to biopsy [26 days (IQR: 12–54), p < 0.001] and to ^18FDGPET-CT [25 days (IQR: 15–38), p = 0.003]. The patients referred in 2022 reported higher scores in the clinic environment (p < 0.001), psychological support provided (p < 0.001) and overall evaluation (p = 0.02) domains of the questionnaire. Conclusions: The establishment of a dedicated diagnostic pathway improves time to diagnosis and patients’ satisfaction. Full article

Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality worldwide. Advances in tissue-based biomarkers have significantly enhanced diagnostic and therapeutic approaches in NSCLC, enabling precision medicine strategies. This review provides a comprehensive analysis of the molecular pathologist’s practical approach to assessing NSCLC biomarkers across various specimen types (liquid biopsy, broncho–alveolar lavage, transbronchial biopsy/endobronchial ultrasound-guided biopsy, and surgical specimen), including challenges such as biological heterogeneity and preanalytical variability. We discuss the role of programmed death ligand 1 (PD-L1) immunohistochemistry in predicting immunotherapy response, the practice of histopathological tumor regression grading after neoadjuvant chemoimmunotherapy, and the application of DNA- and RNA-based techniques for detecting actionable molecular alterations. Finally, we emphasize the critical need for quality management to ensure the reliability and reproducibility of biomarker testing in NSCLC. Full article