Junichi Morimoto

Elastography for Predicting and Localizing Nodal Metastases during Endobronchial Ultrasound

Background: Elastography is a relatively new technology that can generate images reflective of tissue stiffness (elasticity). Neoplastic tissue is usually stiffer than normal structures. Objectives: The aim of this study was to evaluate the feasibility and utility of elastography when combined with convex-probe endobronchial ultrasound (CP-EBUS) for predicting and localizing metastatic lymph nodes during endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA). Methods: Consecutive results of endobronchial elastography of lymph nodes performed using EBUS- TBNA were prospectively collected and retrospectively analyzed. Elastography images were acquired as JPEG images and also recorded as video clips. Stiff area ratios [(stiff areas as blue pixels) / (lymph node areas as region of interest pixels)] for each lymph node determined by elastography were collated with the results of pathological diagnosis. We also performed elastography of surgically resected lymph nodes and compared image findings with pathological sections. Results: We evaluated 49 lymph nodes in 21 patients by CP-EBUS. There were 16 metastatic nodes (10 lung cancer metastases and 6 metastases from extrathoracic malignancies). Mean stiff area ratios were significantly greater for metastatic lymph nodes (0.478) than for benign nodes (0.216; p = 0.0002). Using a cutoff value of 0.311 for stiff area ratios, the sensitivity and specificity for predicting metastatic disease were 0.81 and 0.85, respectively. The stiff area was histologically compatible with metastatic distribution in surgically resected lymph nodes. Conclusions: Endobronchial elastography is feasible for lymph nodes when combined with CP-EBUS. Stiff area ratios are useful for predicting metastatic lymph nodes, which may be an efficient guide for TBNA.

High-grade fetal adenocarcinoma of the lung is a tumour with a fetal phenotype that shows diverse differentiation, including high-grade neuroendocrine carcinoma: a clinicopathological, immunohistochemical and mutational study of 20 cases

High‐grade fetal adenocarcinoma (H‐FLAC) is a rare variant of pulmonary adenocarcinoma; this study aims to elucidate its clinicopathological features and genetic abnormalities.

Sarcomatous Components May Predict Prognosis in Patients with Pulmonary Pleomorphic Carcinoma

OBJECTIVES AND METHODS Pulmonary pleomorphic carcinoma often presents with clinically aggressive behavior. We retrospectively reviewed 16 patients who underwent surgery from 1999 to 2013. RESULTS Sarcomatous components included spindle cell type in six (38%) patients, giant cell type in three (19%) patients, and mixed cell type in seven (44%) patients. The 5-year overall survival rate was 40.6%. On univariate analysis, spindle cell type, pN0, and small tumor diameter were associated with better prognosis. The 5-year survival of six patients with spindle cell type was 83.3%. CONCLUSIONS Despite the small sample size, we suggest that patients with spindle cell type may have favorable prognoses.

Tumor spread through air space, the clinical implications for T factor and effects on the disease recurrence and prognosis

The findings for the tumor spread through air space (STAS) in lung adenocarcinoma were reported by Kawakami et al . (1) and have attracted attention as unique clinical characteristics associated with a micropapillary pattern and nodal metastasis (1). In 2011, the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS) revised the classification of lung adenocarcinoma to include the novel findings of molecular pathology as well as the correlation with clinical outcomes (2). STAS was clearly recognized as a novel invasive morphology defined as a micropapillary clusters, solid nests, or single cells beyond the edge of the tumor into air spaces in the surrounding lung parenchyma (3). The latest WHO Classification of Tumors of The Lung, Pleura, Thymus and Heart 4th Edition in 2015 (4) basically follow the IASLC/ATS/ERS classification.

Right Lower Sleeve Lobectomy With Double-Barreled Bronchoplasty for a Centrally Located Lung Cancer

63-year-old man was evaluated for a 33 30 mm Apulmonary nodule arising in the right lower lobe (Fig 1A, arrow). Endobronchial ultrasound-guided transbronchial needle aspiration revealed small cell carcinoma without evidence of nodal metastasis. We performed an operation followed by adjuvant chemotherapy. During the operation, the tumor was noted to infiltrate the membranous part of the intermediate bronchus. We performed a right lower lobectomy with dissection of the right mainstem bronchus (RMB), upper lobe bronchus (ULB), and middle lobe bronchus (MLB) (Fig 1B). To reconstruct the bronchus, we created a new bifurcation with the right ULB and MLB using four interrupted 4-0 polydioxanone sutures. Then, we anastomosed it to the

Contents Vol. 90, 2015

I.M. Adcock, London K.E. Bloch, Zürich A. Boehler, Zürich D.E. Bouros, Athens A. Chetta, Parma V. Cottin, Lyon C. Dooms, Leuven E. Eber, Graz S. Gasparini, Ancona J. Hammer, Basel J. Johnston, Vancouver, B.C. C.F. Koegelenberg, Cape Town C. Lange, Borstel M. Lommatzsch, Rostock M. Miravitlles, Barcelona J. Müller-Quernheim, Freiburg L.P. Nicod, Lausanne D. Olivieri, Parma W. Randerath, Solingen P.L. Shah, London S. Siddiqui, Leicester T. Terashima, Ichikawa O.S. Usmani, London S. van Eeden, Vancouver, B.C. K. Yasufuku, Toronto, Ont.