Thoracic surgery clinics
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Thoracic surgery clinics · May 2007
ReviewManagement of the peripheral small ground-glass opacities.
Pure ground-glass opacities (GGO) with a small consolidation area are mostly bronchioloalveolar carcinomas that have not yet become invasive, whereas a minority represents only inflammatory changes. Even if they are cancers, they are slow-growing and often remain unchanged for several years. ⋯ It seems that a lower-impact surgery (eg, wedge resection or segmentectomy) is curative for these lung cancers. Because high-resolution CT seems to predict noninvasive or minimally invasive GGO lung cancers with high reliability, less invasive treatments like radiofrequency ablation have greater appeal.
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Thoracic surgery clinics · May 2007
ReviewOpen lobectomy for patients with stage I non-small cell lung cancer.
Until additional multi-institutional, randomized, controlled trials provide evidence to the contrary, open lobectomy with mediastinal lymphadenectomy should be considered the gold standard for treating patients with stage I NSCLC with sufficient cardiopulmonary reserve, including older patients. It is the operation with which alternative pulmonary resections, including video-assisted thoracoscopic lobectomy and sublobar resection, should be compared. In treating stage I NSCLC patients, sublobar resection should be reserved for patients with inadequate physiologic reserve to tolerate lobectomy and for those enrolled in clinical trials.
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Thoracic surgery clinics · May 2007
ReviewBronchoscopic-directed diagnosis of peripheral lung lesions suspicious for cancer.
Bronchoscopic techniques have come a long way in diagnosing peripheral lung lesions suspicious for cancer. Following in the footsteps of gastrointestinal endoscopy. bronchoscopy has become more useful in diagnosing lesions previously thought to be unreachable. The procedure has required miniaturization of the tools used for diagnosis and, as these tools become more sophisticated, bronchoscopists are better able to reach these lesions noninvasively. ⋯ The ability to navigate through the bronchial tree in three dimensions and the locatable guide, which is steerable, allow the bronchoscopist to reach peripheral lesions with great success. This technology has great promise in not only diagnosing peripheral lung lesions with greater accuracy, but also may provide a means for therapeutic interventions through this minimally invasive technique. Patients with peripheral lung lesions may now be diagnosed more reliable through endoscopic techniques, avoiding unnecessary surgery in many cases.
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Thoracic surgery clinics · May 2007
ReviewStereotactic body radiation therapy for stage I non-small cell lung cancer.
Image-guided SBRT with the delivery of a BED greater than 100 Gy is feasible and safe in the treatment of peripherally located inoperable stage I NSCLC. The 3- to 5-year local control and overall survival rates for SBRT seem to be much better than the rates for conventional radiotherapy, and the toxicity rate is minimal. Particularly for stage Ia (T1N0M0) disease, survival rates with SBRT were comparable with rates seen with surgical resection. ⋯ Its role in operable stage I NSCLC. however. is not clear. To balance improved targeting accuracy with minimized treatment-related toxicity. a reliable immobilization device and consideration of image-guided tumor motion are crucial. The optimal dose regimen remains unclear, but a BED greater than 100 Gy seems warranted.
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Thoracic surgery clinics · May 2007
ReviewCT-directed diagnosis of peripheral lung lesions suspicious for cancer.
Small peripheral pulmonary nodules continue to be a diagnostic challenge and because of improved technology are also being identified with increased frequency. TNB, performed properly, is a highly accurate procedure and with careful attention to technical factors, nodules of any size in any location may undergo biopsy. A skilled cytologist is an essential part of the team. Continued advances in molecular diagnostics allow for an expanded role of the usefulness of this procedure.