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“Preliminary study of tumor size response to low and high doses cabergolina therapy in clinically non-functioning macroadenomas with different D2 receptor expression detected with 123-I-IBZM pituitary scintigraphy”
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Lack of Accuracy of Circulating Chromogranin A in the Preoperative Diagnosis of Lung Neuroendocrine Tumors
No full textSurgical treatment of neuroendocrine tumors of the lung
No full textObjective: This report reviews the pattern of neuroendocrine (NE) differentiation, lymph-node involvement, extension of surgery, and survival in 125 NE lung tumor patients. Methods: Standard diagnostic workup included CT scan, bronchoscopy, bronchial biopsy or Fine Needle Aspiration Biopsy, 111In-pentetreotide scan (OctreoScan) and mediastinoscopy in selected patients. NE differentiation was assessed based on the morphology and immunohistochemical reactivity for pan-neuroendocrine markers NSE, CGA, and Synaptophysin. For small cell carcinoma (SCC), only clinical stage I and II patients underwent surgery. Several different surgical procedures were utilized, from limited resections to lobectomy, pneumonectomy, and bronchoplastic procedures. Survival was assessed using Kaplan-Meyer method at 5 years. Results: There were 79 typical carcinoid (TC), eight atypical carcinoid (AC), 18 large cell carcinoma (LCC) and 20 SCC patients. Mean age at diagnosis was 54.6±15.2 (ranges from 16 to 77 years) for TC, 68.5±9.1 (range 53-81) for AC, 68.7±4.6 (range 58-77) for LCC, 64.6±7.9 (range 48-82) for SCC. Male/female ratio was 1/1 for TC and AC, 2.6/1 for LCC and 9/1 for SCC. Lymph-node involvement was present in 14% of TC, 0% of AC, 31.5% of LCC, and 45% of SCC. Cancer specific survival was 96% for TC, 87.5% for AC, 37.5% for LCC, and 30% for SCC at 5 years from surgery. Presenting symptoms were invariably of respiratory-related. None had the carcinoid syndrome. History of tobacco abuse ranged from 46% for TC to 100% in SCC. Survival ranged from a minimum of 1 month for SCC to a maximum of 168 months with no evidence of disease for TC. Synchronous multicentric forms were found in 14% of TC. Twenty-one percent (4/19) of the patients with SCC treated by induction therapy and surgery, and in few cases by surgery and adjuvant chemotherapy are alive without the evidence of the disease for 5 years. Conclusions: Due to the high percentage of lymph-node involvement and multicentric forms found in our series lobectomy with radical lymph-node dissection appears, in our opinion, the most appropriate surgical treatment in well-differentiated forms, while more limited resection appears sub-optimal. Also, due to the finding of recurrences many years after surgery, the follow-up must be accurate and protracted in this subgroup. Only Small Cell Lung Carcinoma patients in clinical stage I and II underwent surgery with good long-term results. © 2004 Elsevier B.V. All rights reserved
Endoscopia virtuale e tecniche di ricostruzione tridimensionali con TC nella diagnosi e nel follow-up delle lesioni tracheobronchiali - 105° Congresso Società Italiana di Chirurgia
No full text(111)In-pentetreotide SPET/CT in carcinoid tumours: is the role of hybrid systems advantageous in abdominal or thoracic lesions?
No full textOur aim was to evaluate the different clinical value of (111)In-pentetreotide hybrid SPET/CT versus SPET alone in detecting carcinoid tumours located in the thoracic and abdominal region. Twenty-four patients with carcinoid tumours histologically proven (13 of abdominal origin, 11 of thoracic origin) underwent (111)In-pentetreotide SPET/CT with hybrid system (Millennium VG with Hawkeye, G.E.M.S., USA) composed of a dual head gamma camera equipped with a low dose X-ray tube. Single photon emission tomography images were performed 4h and 24h after (111)In-pentetreotide intravenous administration, while SPET/CT co-registered images were performed at 4h. Scintigraphic images were first evaluated alone and then re-interpreted by adding transmission fused data. Nine of the 13 patients with tumours of abdominal origin showed pathological SPET images, while 4/13 were negative. Seven out of the 11 patients with tumour of thoracic origin had pathological SPET findings, while 4/11 were negative. In all, 11/24 subjects disclosed abdominal pathological uptake and 10/24 thoracic. In 6/11 abdominal cases SPET/CT allowed anatomical localization of lesions, while in 2/10 in thoracic cases. Additional data were provided by SPET/CT in 8/24 cases (6 abdominal, 2 thoracic), by transmission images characterized as lesions not expressing somatostatin receptors. Sensitivity of SPET alone in all carcinoids was 72%, negative predictive value (NPV) was 50% and accuracy was 78%. Considering abdominal lesions (independently of the origin) sensitivity of SPET alone was 64.7%, NPV was 40%, accuracy was 71.4%. For thoracic lesions sensitivity of SPET alone was 83.3%, NPV was 66.7% and accuracy was 87.5%. For SPET/CT considering together all carcinoids and also separately lesions of abdominal and of thoracic origin, sensitivity, NPV and accuracy were always 100%. In conclusion, SPET/CT imaging was more useful to anatomically detect carcinoids either in abdomen or in thorax and specifically lesions not expressing somatostatin receptors, as compared to SPET alone
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