- Email: [email protected]
CLC045 ORAL Monitoring patients with lung cancer by cytology follow up after surgery and chemotherapy
Abstracts of the 5th International Congress on Lung Cancer, Patras, Greece, 24–27 January 2007 nancy characteristics or an average number of atypical cells suspicious for malignancy) to carcinomatous inices were 62.5% moderately high values (Ca125 up to 365U/ml, Ca19-9 up to 107U/ml, Ca15-3 up to 250U/ml, CEA up to 187ng/ml). Finally cases where cytological findings were restricted to rare atypical cells suspicious for malignancy correlate to a percentage of 75% moderately high values of carcinomatous inices (Ca125 up to 135U/ml, Ca19-9 up to 500U/ml, Ca15-3 up to 64U/ml, CEA up to 39ng/ml). Conclusion: The presence of a great number of cells in a materal raises the diagnostic efficiency of cytomorphology that is equivalent to the concentration of the carcinomatous indices in blood and serum or fluid.
CLC041
POSTER
Practical approach to early diagnosis of lung cancer in rural Achaia Arvanitis A., Skarpelos A., Chronopoulou M., Voulioti S., Giannopoulos D., Razis N. G.H. ’Saint Andreas’, Patra, Greece Aim: The early diagnosis of lung cancer (LC) remains a difficult challenge. The majority of LC cases diagnosed today are not curable at the time of diagnosis. Studies have shown that subjects who have smoked 30 or more pack-years, and who have any degree of airflow obstruction, result in four to six times more lung cancer than if airflow is normal, with all other risk factors being equal. Our aim was to find if the frontline practitioner can help with the early diagnosis of LC with an easy approach. Methods: The files of 303 adult users of 2 rural Health Centers with symptoms of cough, dyspnea and wheeze and a strong smoking history were examined over a 7-year period. Those with abnormal spirometry were recorded as AS, while those with a normal spirometry were recorded as NS. Results: AS: 167 patients (55.1%) - LC cases: 14. NS: 136 patients (44.9%) LC cases: 4. Conclusion: LC was more often in AS patients (p<0.05). As the US National Lung Health Education Program (NLHEP) proposes, the use of simple, handheld, accurate office spirometers by all primary care physicians is very useful, since the abnormal spirometry indicates higher risk of LC. Patients who should have spirometry are all smokers over the age of 45, patients with a family history of lung cancer or chronic obstructive pulmonary disease (COPD), and any patient with cough, inappropriate dyspnea, wheeze or excess mucus production.
CLC042
POSTER
Efficiency of cytodiagnostics and immunology in relation to pleural and pericardial fluids Mameletzi-Myloni E., Iconomou K., Vassilaki M., Terzoglou K., Theodoropoulou G., Zoganas L., Athanasiadis G. Red Cross Hospital, Athens, Greece Purpose of the present study is to examine the correlation between the values of carcinomatous indices and cytological diagnosis. Material and Methods: 41 pleural and 25 pericardial effusions were examined. The effusions were taken from 66 patients with diagnosed or unknown malignancy. 36 patients were females, age 27-90 years, and 30 males, age 47-93 years. The samples were configured, smeared, fixed in alcohol and air-dried. Stains: Papanicolaou, Giemsa, PAS, PAD. The determination of carcinomatous indices was done at the Immunological Laboratory and included values of CEA, AFP, Ca125, Ca19-9, Ca15-3, in bloodserum and/or fluid. Higher physiological values are: CEA 10ng/ml for smokers and 25ng/ml for non-smokers, AFP 15U/ml, Ca125 35U/ml, Ca19-9 37U/ml, Ca15-3 28U/ml. Results: From the 41 pleural effusions, 31 were cytologically positive and 10 were suspicious for malignancy, 36 were pathologically positive, 30 had high carcinomatous indices. From the 25 pericardial fluids, 19 were cytologically positive and 6 were suspicious for malignancy, 22 were pathologically positive, 24 had increased values of carcinomatous indices. The percentage of cases that presented both positive cytological diagnosis and high carcinomatous indices is 86%. The percentage of cases that were both found cytologically suspicious for malignancy and showed high carcinomatous indices is 68.75%. Conclusion: The positive cytological diagnosis is not influenced by the values of carcinomatous indices, even if they are within normal ranges. In suspicious for malignancy cytological diagnosis high values of the carcinomatous indices reinforce positivity in a percentage from 84.6 to 90.38%
CLC043
S11 ORAL
Simultaneous cytological diagnoses of primary lung carcinoma and relapse of Hodgkin’s disease: a case report Emmanouilidou A., Ellina E., Maounis N., Blana A., Tsiafaki X., Chorti M. Sismanoglio General Hospital, Athens, Greece Objective: Advances in the treatment of Hodgkin’s disease (HD) have made it a highly curable malignancy. However, survivors of HD, face increased risk from second malignancies, which represent the leading cause of excess mortality in these patients. Many studies have shown that lung cancer is the most common solid tumor after HD, with small cell lung carcinoma representing the predominant histologic type. Prior radiation therapy, alkylating chemotherapy and smoking, increase the risk of developing lung cancer. Material and Methods: The presented case, concerns a 60 year old man who was treated with chemotherapy (ABVD) and radiation for Hodgkin’s disease (nodular sclerosis type, stage IIa), 4 years ago and was a smoker (of >10 packyears). A year ago, the patient presented with left pleural effusion and left cervical lymph node enlargement. A chest CT revealed a left pulmonary mass. Cytologic examination of the pleural effusion demonstrated an adenocarcinoma. Bronchoscopy followed and the diagnosis was reconfirmed by cytology on the washing and brushing specimens, all prepared and stained by Papanicolaou technique. Furthermore, an FNA was performed on the cervical lymph node and relapse of the Hodgkin’s disease was established. Conclusion: HD survivors, especially those with a history of smoking, should undergo careful follow - up for second primary lung carcinoma, being aware that chest symptoms or findings on x-ray films may be misinterpreted as representing late recurrence of the first neoplastic disease.
CLC044
ORAL
Herpetic viral infection coexisting with primary lung carcinoma. Cytological diagnosis of two cases Emmanouilidou A., Maounis N., Ellina E., Blana Aik., Legaki S. Sismanoglio General Hospital, Athens, Greece Objective: Pulmonary herpes simplex virus (HSV) infections are rare in healthy adults with intact immune systems. They occur primarily in patients with underlying pulmonary disease and in association with tracheostomies and endotracheal tubes. They also occur in immunosuppressed patients or patients suffering from various chronic diseases. We report two cases with cytological diagnoses of herpetic viral infection coexisting with lung cancer. Material and Methods: First case; a 70 year old male who was admitted to our hospital with dyspnea and persistent cough. The chest CT revealed a left pulmonary mass. Second case; a 74 year old male, with known multiple sclerosis, presented with high fever, dyspnea, bronchorrhea and chest pain. The chest x-ray showed multiple nodules. Both patients underwent bronchoscopy and bronchial washings, brushings and post bronchoscopic sputum. All cytologic specimens were wet fixed in 950 alcohol and stained by the Papanicolaou technique and cytologically evaluated. Results: By examining the post bronchoscopic sputum of the first patient, the diagnosis of non-small cell lung carcinoma was achieved. Bronchial washing material of the second patient, exfoliated malignant cells morphologically consistent with BAC. Furthermore, in the above cytological samples, of both patients, evidence of HSV the characteristic multinucleation, nuclear molding, ‘ground glass’ appearance of the nuclei and peripheral margination of the chromatin- was observed. Conclusion: Even if there is a remote possibility, the knowledge of the simultaneous cytopathologic observation of a pulmonary malignancy and HSV infection, can prevent a possible false positive or negative diagnosis.
CLC045
ORAL
Monitoring patients with lung cancer by cytology follow up after surgery and chemotherapy Emmanouilidou A., Mela A., Roussou A., Gaki E., Pappa I. Sismanoglio General Hospital, Athens, Greece Background: We evaluated 145 patients, who were treated in our hospital in the past 4 years (2003 - 2006) for pulmonary lung carcinoma. These patients underwent surgery following by adjuvant chemotherapy/radiotherapy treatment. They were followed up by series of cytologic examinations (sputum, brushing, washing, effusion, and FNA of lymph nodes. We estimated the clinical status (possible recurrences) and the response to the chemotherapy. Material and Methods: 123 (85%) from the 145 patients were men aged 5092 years (mean age 70 years) and 22 (15%) women 47-80 years (mean age years). 110 cases were respiratory cytologic specimens (sputum, brushings,
S12
Abstracts of the 5th International Congress on Lung Cancer, Patras, Greece, 24–27 January 2007
washings) 20 pleural effusions, 15 FNA of lymph nodes and subcutaneous metastasis. We observed characteristic cytomorphologic changes due to the performed chemotherapy of the obtained and examined cytologic specimens. All cytologic specimens were stained by the Papanicolaou technique. Results: From the total number of 145 patients 25 cases were diagnosed as squamous cell carcinoma, 65 as adenocarcinoma, 27 as non-small cell-Ca (NSCLC) and 28 as small-cell-lung-Ca (SCLC). Cytologic follow up evaluation recorded 63 patients free of the disease and recurrence in 82 patients (56.6%). From the 82 relapsed patients: 55 were positive for malignancy in respiratory specimens, 13 in malignant effusions and 14 were positive in FNA lymph nodes. Conclusion: Cytologic follow up is an important adjuvant examination in oncologic patients after lung cancer surgery following chemotherapy for possible recurrences or response to the chemotherapy/radiotherapy treatment.
CLC046
ORAL
Cytologic diagnosis of carcinoid tumor in pleural effusion. A rare case report Emmanouilidou A., Lyra Th. Sismanoglio General Hospital, Athens, Greece Background: Gastric carcinoid tumor is mostly a well-differentiated neuroendocrine tumor (WDNET) and grows very slowly. Type I and II are of good prognosis (enterochromafin like cells ECL cell tumors The type III is more aggressive and gives distant metastases. Carcinoid involves most organs such as lung, gastrointestinal tract, liver, kidneys, urinary bladder etc. Material and Methods: A 75 years old woman was referred to our hospital complaining of left back pain, pleuritis, fever weakness and chronic atrophic gastritis. Pleural fluid was aspirated and centrifuged. All cytologic specimens were wet fixed in 95o alcohol and stained by the Papanicolaou technique. Results: Cytological and Histological findings: The cytologic evaluation of the performed cytologic specimens revealed abundant cellularity, numerous reactive mesothelial cells and a lot of small or medium size round to oval uniform tumor cells arranged single or in clusters with slight to moderate nuclear atypia, hyperchromasia, granular or coarse chromatin pattern prominent nucleoli and occasionally with foamy cytoplasm. The cytologic diagnosis was consistent with suggestive carcinoid tumor. Findings from both cytologic (sputum, brushing, washing) and histologic material were negative for malignancy. Further investigation of the patient revealed after gastroscopy- the histologic diagnosis of chronic atrophic gastritis coexisting with carcinoid tumor of the gastric antrum of enterochromafinic type (ECL carcinoid tumor) with absence of necrosis and mitotic activity. Application of Immunocytochemistry showed: Chromogranin (+), Synaptophysin (+), Serotonin (+). Conclusion: The cytologic diagnosis for carcinoid tumor in pleural effusion is very difficult because carcinoids are present in effusions very rarely. The application of specific immunocytochemistry is necessary in the differential diagnosis from other malignant tumors presented with similar cytomorphologic features.
CLC047
POSTER
Immunocytochemical expression of matrix metalloproteinases MMP-2 and MMP-9 in fine needle aspirates of non-small cell lung carcinomas Peristeropoulou P., Mendrinou E., Kouli V. St. Andrew General Hospital, Patras, Greece Introduction and Purpose: The matrix metalloproteinases (MMPs) are proteolytic enzymes capable of degrading connective tissue components. They play an important role in tumor invasion and metastasis. In our study we evaluate the expression of MMP-2 and MMP-9 in non-small cell lung cancer. Material and Method: We used cytological specimens obtained by fine needle aspiration of lung from 20 patients suffering from non-small cell lung cancinoma (NSCLC). All cases were poorly differentiated NSCLC. The streptavidinbiotin method was performed on destained cytologic smears of previously Papanicolaou-stained slides using the commercially available monoclonal antibodies for MMP-2 and MMP-9. Results: Tumor cells from all samples were stained positive for both MMP-2 and MMP-9 and immunoreactivity was cytoplasmic. Conclusion: The immunocytochemical expression of MMP-2 and MMP-9 can be determined in non-small cell lung cancer and is possible associated with tumor progression.
CLC048
ORAL
99mTc-Depreotide SPECT/low resolution CT hybrid imaging for lung cancer staging: preliminary results in operated patients Apostolopoulos D., Stamou-Koukis E., Koletsis E., Spyridonidis T., Papandrianos N., Dougenis D., Vassilakos P. University of Patras, Greece Objectives: 99mTc-Depreotide is a synthetic somatostatin analogue that binds to specific receptors, which are usually over-expressed in lung tumors. Assuming the availability and convenience of depreotide scintigraphy, we used SPECT/CT co-registered imaging in NSCLC patients for the assessment of lymph node status. Materials and Methods: 23 patients at a potentially operable stage underwent scintigraphy the day before surgery. Imaging was performed 3 hours after the administration of 740 MBq of 99mTc-depreotide, with a hybrid SPECT/CT system (Hawkey, GE Medical Systems). The concentration of the radioactive agent in the tumor site, as well as in peribronchial, hilar and mediastinal nodes was evaluated. Normal uptake in the sternum served as a reference point for nodal uptake quantification. Co-registered SPECT-CT slices were used to determine the exact location of abnormal scintigraphic findings. Imaging results were compared with the histological features of lymph nodes collected during surgery. Results: Abnormal depreotide uptake was noticed in 21/23 primary lesions. With reference to 82 examined node stations, the sensitivity, specificity, accuracy, positive and negative predictive value of the scintigraphic technique was 95%, 63%, 72%, 49% and 97% respectively. There was only one false negative nodal uptake site. 22 false positive sites were attributed to reactive lymph nodes, a fact that was particularly evident in 4 patients with concurrent pneumonitis or abscess formation. Conclusion: Preliminary results of depreotide SPECT/CT indicate a high sensitivity and negative predictive value in assessing lymph node involvement, which suggests a possible role of this technique as an adjunct method in lung cancer staging workup.
CLC049
ORAL
Extrapleural injection of normal saline for preventing pneumothorax in percutaneous lung biopsies (PLB) Kraniotis P., Kalogeropoulou Chr., Zampakis P., Tsota I., Nilas I., Koletsis E., Petsas Th. University Hospital of Patras, Greece Purpose: To evaluate the efficacy of extrapleural injection of normal saline, at the initial phase of percutaneous lung biopsy for preventing pneumothorax. Methods: Eighty patients underwent PLB for lung lesions. Patients were randomized in group A and B. In 40 patients (group A) normal saline was injected beneath the parietal pleura just before the procedure. In the remaining (group B) no saline was used. All biopsies were conducted under CT guidance, using a 19G-22G coaxial needle system. In group A, following local anesthesia, 20 to 30 mls of saline were injected extrapleurally, in the subpleural fat, in order to create a bulge of pleura, towards the lesion. All patients were evaluated with chest CT, 15 min following biopsy completion as well as 4 hs later, with chest x-ray for excluding pneumothorax. Results: The procedure was well tolerated in group A, while pneumothorax developed in 3 patients (7.5%). In group B, pneumothorax occurred in 8 patients (20%). In one case drainage was required (2.5%). The technique prolonged the procedure for 9-17min in group A. Conclusion: Our results suggest that extrapleural injection of saline reduces PLB induced pneumothorax. It is a supplementary technique, which can be used in patients who are prone to develop pneumothorax.
CLC050
ORAL
The application of a specially designed guide stylet set in thoracic biopsies Kraniotis P., Zampakis P., Kalogeropoulou Chr., Tsota I., Nilas I., Koletsis E., Petsas Th. University Hospital of Patras, Greece Purpose: To present our experience regarding the application of a guide-stylet set for performing thoracic biopsies. Materials and Methods: Seventy-nine patients, underwent chest biopsies of [lung lesions n=49, mediastinal n=16, bone (spinal and rib) lesions n=14] using this new guide stylet set. The guide stylet is made of stainless steel, has a diameter of 26 G and is combined with a 22G Chiba needle (William Cook Europe). Following the insertion of Chiba, the stylet, through the needle, is directed towards the lesion. When the stylet is correctly directed, the needle is advanced over the stylet reaching the target. The stylet serves either as a guide for the needle or as an exchange wire, when a larger needle is required. The stylet can
CLC041
POSTER
Practical approach to early diagnosis of lung cancer in rural Achaia Arvanitis A., Skarpelos A., Chronopoulou M., Voulioti S., Giannopoulos D., Razis N. G.H. ’Saint Andreas’, Patra, Greece Aim: The early diagnosis of lung cancer (LC) remains a difficult challenge. The majority of LC cases diagnosed today are not curable at the time of diagnosis. Studies have shown that subjects who have smoked 30 or more pack-years, and who have any degree of airflow obstruction, result in four to six times more lung cancer than if airflow is normal, with all other risk factors being equal. Our aim was to find if the frontline practitioner can help with the early diagnosis of LC with an easy approach. Methods: The files of 303 adult users of 2 rural Health Centers with symptoms of cough, dyspnea and wheeze and a strong smoking history were examined over a 7-year period. Those with abnormal spirometry were recorded as AS, while those with a normal spirometry were recorded as NS. Results: AS: 167 patients (55.1%) - LC cases: 14. NS: 136 patients (44.9%) LC cases: 4. Conclusion: LC was more often in AS patients (p<0.05). As the US National Lung Health Education Program (NLHEP) proposes, the use of simple, handheld, accurate office spirometers by all primary care physicians is very useful, since the abnormal spirometry indicates higher risk of LC. Patients who should have spirometry are all smokers over the age of 45, patients with a family history of lung cancer or chronic obstructive pulmonary disease (COPD), and any patient with cough, inappropriate dyspnea, wheeze or excess mucus production.
CLC042
POSTER
Efficiency of cytodiagnostics and immunology in relation to pleural and pericardial fluids Mameletzi-Myloni E., Iconomou K., Vassilaki M., Terzoglou K., Theodoropoulou G., Zoganas L., Athanasiadis G. Red Cross Hospital, Athens, Greece Purpose of the present study is to examine the correlation between the values of carcinomatous indices and cytological diagnosis. Material and Methods: 41 pleural and 25 pericardial effusions were examined. The effusions were taken from 66 patients with diagnosed or unknown malignancy. 36 patients were females, age 27-90 years, and 30 males, age 47-93 years. The samples were configured, smeared, fixed in alcohol and air-dried. Stains: Papanicolaou, Giemsa, PAS, PAD. The determination of carcinomatous indices was done at the Immunological Laboratory and included values of CEA, AFP, Ca125, Ca19-9, Ca15-3, in bloodserum and/or fluid. Higher physiological values are: CEA 10ng/ml for smokers and 25ng/ml for non-smokers, AFP 15U/ml, Ca125 35U/ml, Ca19-9 37U/ml, Ca15-3 28U/ml. Results: From the 41 pleural effusions, 31 were cytologically positive and 10 were suspicious for malignancy, 36 were pathologically positive, 30 had high carcinomatous indices. From the 25 pericardial fluids, 19 were cytologically positive and 6 were suspicious for malignancy, 22 were pathologically positive, 24 had increased values of carcinomatous indices. The percentage of cases that presented both positive cytological diagnosis and high carcinomatous indices is 86%. The percentage of cases that were both found cytologically suspicious for malignancy and showed high carcinomatous indices is 68.75%. Conclusion: The positive cytological diagnosis is not influenced by the values of carcinomatous indices, even if they are within normal ranges. In suspicious for malignancy cytological diagnosis high values of the carcinomatous indices reinforce positivity in a percentage from 84.6 to 90.38%
CLC043
S11 ORAL
Simultaneous cytological diagnoses of primary lung carcinoma and relapse of Hodgkin’s disease: a case report Emmanouilidou A., Ellina E., Maounis N., Blana A., Tsiafaki X., Chorti M. Sismanoglio General Hospital, Athens, Greece Objective: Advances in the treatment of Hodgkin’s disease (HD) have made it a highly curable malignancy. However, survivors of HD, face increased risk from second malignancies, which represent the leading cause of excess mortality in these patients. Many studies have shown that lung cancer is the most common solid tumor after HD, with small cell lung carcinoma representing the predominant histologic type. Prior radiation therapy, alkylating chemotherapy and smoking, increase the risk of developing lung cancer. Material and Methods: The presented case, concerns a 60 year old man who was treated with chemotherapy (ABVD) and radiation for Hodgkin’s disease (nodular sclerosis type, stage IIa), 4 years ago and was a smoker (of >10 packyears). A year ago, the patient presented with left pleural effusion and left cervical lymph node enlargement. A chest CT revealed a left pulmonary mass. Cytologic examination of the pleural effusion demonstrated an adenocarcinoma. Bronchoscopy followed and the diagnosis was reconfirmed by cytology on the washing and brushing specimens, all prepared and stained by Papanicolaou technique. Furthermore, an FNA was performed on the cervical lymph node and relapse of the Hodgkin’s disease was established. Conclusion: HD survivors, especially those with a history of smoking, should undergo careful follow - up for second primary lung carcinoma, being aware that chest symptoms or findings on x-ray films may be misinterpreted as representing late recurrence of the first neoplastic disease.
CLC044
ORAL
Herpetic viral infection coexisting with primary lung carcinoma. Cytological diagnosis of two cases Emmanouilidou A., Maounis N., Ellina E., Blana Aik., Legaki S. Sismanoglio General Hospital, Athens, Greece Objective: Pulmonary herpes simplex virus (HSV) infections are rare in healthy adults with intact immune systems. They occur primarily in patients with underlying pulmonary disease and in association with tracheostomies and endotracheal tubes. They also occur in immunosuppressed patients or patients suffering from various chronic diseases. We report two cases with cytological diagnoses of herpetic viral infection coexisting with lung cancer. Material and Methods: First case; a 70 year old male who was admitted to our hospital with dyspnea and persistent cough. The chest CT revealed a left pulmonary mass. Second case; a 74 year old male, with known multiple sclerosis, presented with high fever, dyspnea, bronchorrhea and chest pain. The chest x-ray showed multiple nodules. Both patients underwent bronchoscopy and bronchial washings, brushings and post bronchoscopic sputum. All cytologic specimens were wet fixed in 950 alcohol and stained by the Papanicolaou technique and cytologically evaluated. Results: By examining the post bronchoscopic sputum of the first patient, the diagnosis of non-small cell lung carcinoma was achieved. Bronchial washing material of the second patient, exfoliated malignant cells morphologically consistent with BAC. Furthermore, in the above cytological samples, of both patients, evidence of HSV the characteristic multinucleation, nuclear molding, ‘ground glass’ appearance of the nuclei and peripheral margination of the chromatin- was observed. Conclusion: Even if there is a remote possibility, the knowledge of the simultaneous cytopathologic observation of a pulmonary malignancy and HSV infection, can prevent a possible false positive or negative diagnosis.
CLC045
ORAL
Monitoring patients with lung cancer by cytology follow up after surgery and chemotherapy Emmanouilidou A., Mela A., Roussou A., Gaki E., Pappa I. Sismanoglio General Hospital, Athens, Greece Background: We evaluated 145 patients, who were treated in our hospital in the past 4 years (2003 - 2006) for pulmonary lung carcinoma. These patients underwent surgery following by adjuvant chemotherapy/radiotherapy treatment. They were followed up by series of cytologic examinations (sputum, brushing, washing, effusion, and FNA of lymph nodes. We estimated the clinical status (possible recurrences) and the response to the chemotherapy. Material and Methods: 123 (85%) from the 145 patients were men aged 5092 years (mean age 70 years) and 22 (15%) women 47-80 years (mean age years). 110 cases were respiratory cytologic specimens (sputum, brushings,
S12
Abstracts of the 5th International Congress on Lung Cancer, Patras, Greece, 24–27 January 2007
washings) 20 pleural effusions, 15 FNA of lymph nodes and subcutaneous metastasis. We observed characteristic cytomorphologic changes due to the performed chemotherapy of the obtained and examined cytologic specimens. All cytologic specimens were stained by the Papanicolaou technique. Results: From the total number of 145 patients 25 cases were diagnosed as squamous cell carcinoma, 65 as adenocarcinoma, 27 as non-small cell-Ca (NSCLC) and 28 as small-cell-lung-Ca (SCLC). Cytologic follow up evaluation recorded 63 patients free of the disease and recurrence in 82 patients (56.6%). From the 82 relapsed patients: 55 were positive for malignancy in respiratory specimens, 13 in malignant effusions and 14 were positive in FNA lymph nodes. Conclusion: Cytologic follow up is an important adjuvant examination in oncologic patients after lung cancer surgery following chemotherapy for possible recurrences or response to the chemotherapy/radiotherapy treatment.
CLC046
ORAL
Cytologic diagnosis of carcinoid tumor in pleural effusion. A rare case report Emmanouilidou A., Lyra Th. Sismanoglio General Hospital, Athens, Greece Background: Gastric carcinoid tumor is mostly a well-differentiated neuroendocrine tumor (WDNET) and grows very slowly. Type I and II are of good prognosis (enterochromafin like cells ECL cell tumors The type III is more aggressive and gives distant metastases. Carcinoid involves most organs such as lung, gastrointestinal tract, liver, kidneys, urinary bladder etc. Material and Methods: A 75 years old woman was referred to our hospital complaining of left back pain, pleuritis, fever weakness and chronic atrophic gastritis. Pleural fluid was aspirated and centrifuged. All cytologic specimens were wet fixed in 95o alcohol and stained by the Papanicolaou technique. Results: Cytological and Histological findings: The cytologic evaluation of the performed cytologic specimens revealed abundant cellularity, numerous reactive mesothelial cells and a lot of small or medium size round to oval uniform tumor cells arranged single or in clusters with slight to moderate nuclear atypia, hyperchromasia, granular or coarse chromatin pattern prominent nucleoli and occasionally with foamy cytoplasm. The cytologic diagnosis was consistent with suggestive carcinoid tumor. Findings from both cytologic (sputum, brushing, washing) and histologic material were negative for malignancy. Further investigation of the patient revealed after gastroscopy- the histologic diagnosis of chronic atrophic gastritis coexisting with carcinoid tumor of the gastric antrum of enterochromafinic type (ECL carcinoid tumor) with absence of necrosis and mitotic activity. Application of Immunocytochemistry showed: Chromogranin (+), Synaptophysin (+), Serotonin (+). Conclusion: The cytologic diagnosis for carcinoid tumor in pleural effusion is very difficult because carcinoids are present in effusions very rarely. The application of specific immunocytochemistry is necessary in the differential diagnosis from other malignant tumors presented with similar cytomorphologic features.
CLC047
POSTER
Immunocytochemical expression of matrix metalloproteinases MMP-2 and MMP-9 in fine needle aspirates of non-small cell lung carcinomas Peristeropoulou P., Mendrinou E., Kouli V. St. Andrew General Hospital, Patras, Greece Introduction and Purpose: The matrix metalloproteinases (MMPs) are proteolytic enzymes capable of degrading connective tissue components. They play an important role in tumor invasion and metastasis. In our study we evaluate the expression of MMP-2 and MMP-9 in non-small cell lung cancer. Material and Method: We used cytological specimens obtained by fine needle aspiration of lung from 20 patients suffering from non-small cell lung cancinoma (NSCLC). All cases were poorly differentiated NSCLC. The streptavidinbiotin method was performed on destained cytologic smears of previously Papanicolaou-stained slides using the commercially available monoclonal antibodies for MMP-2 and MMP-9. Results: Tumor cells from all samples were stained positive for both MMP-2 and MMP-9 and immunoreactivity was cytoplasmic. Conclusion: The immunocytochemical expression of MMP-2 and MMP-9 can be determined in non-small cell lung cancer and is possible associated with tumor progression.
CLC048
ORAL
99mTc-Depreotide SPECT/low resolution CT hybrid imaging for lung cancer staging: preliminary results in operated patients Apostolopoulos D., Stamou-Koukis E., Koletsis E., Spyridonidis T., Papandrianos N., Dougenis D., Vassilakos P. University of Patras, Greece Objectives: 99mTc-Depreotide is a synthetic somatostatin analogue that binds to specific receptors, which are usually over-expressed in lung tumors. Assuming the availability and convenience of depreotide scintigraphy, we used SPECT/CT co-registered imaging in NSCLC patients for the assessment of lymph node status. Materials and Methods: 23 patients at a potentially operable stage underwent scintigraphy the day before surgery. Imaging was performed 3 hours after the administration of 740 MBq of 99mTc-depreotide, with a hybrid SPECT/CT system (Hawkey, GE Medical Systems). The concentration of the radioactive agent in the tumor site, as well as in peribronchial, hilar and mediastinal nodes was evaluated. Normal uptake in the sternum served as a reference point for nodal uptake quantification. Co-registered SPECT-CT slices were used to determine the exact location of abnormal scintigraphic findings. Imaging results were compared with the histological features of lymph nodes collected during surgery. Results: Abnormal depreotide uptake was noticed in 21/23 primary lesions. With reference to 82 examined node stations, the sensitivity, specificity, accuracy, positive and negative predictive value of the scintigraphic technique was 95%, 63%, 72%, 49% and 97% respectively. There was only one false negative nodal uptake site. 22 false positive sites were attributed to reactive lymph nodes, a fact that was particularly evident in 4 patients with concurrent pneumonitis or abscess formation. Conclusion: Preliminary results of depreotide SPECT/CT indicate a high sensitivity and negative predictive value in assessing lymph node involvement, which suggests a possible role of this technique as an adjunct method in lung cancer staging workup.
CLC049
ORAL
Extrapleural injection of normal saline for preventing pneumothorax in percutaneous lung biopsies (PLB) Kraniotis P., Kalogeropoulou Chr., Zampakis P., Tsota I., Nilas I., Koletsis E., Petsas Th. University Hospital of Patras, Greece Purpose: To evaluate the efficacy of extrapleural injection of normal saline, at the initial phase of percutaneous lung biopsy for preventing pneumothorax. Methods: Eighty patients underwent PLB for lung lesions. Patients were randomized in group A and B. In 40 patients (group A) normal saline was injected beneath the parietal pleura just before the procedure. In the remaining (group B) no saline was used. All biopsies were conducted under CT guidance, using a 19G-22G coaxial needle system. In group A, following local anesthesia, 20 to 30 mls of saline were injected extrapleurally, in the subpleural fat, in order to create a bulge of pleura, towards the lesion. All patients were evaluated with chest CT, 15 min following biopsy completion as well as 4 hs later, with chest x-ray for excluding pneumothorax. Results: The procedure was well tolerated in group A, while pneumothorax developed in 3 patients (7.5%). In group B, pneumothorax occurred in 8 patients (20%). In one case drainage was required (2.5%). The technique prolonged the procedure for 9-17min in group A. Conclusion: Our results suggest that extrapleural injection of saline reduces PLB induced pneumothorax. It is a supplementary technique, which can be used in patients who are prone to develop pneumothorax.
CLC050
ORAL
The application of a specially designed guide stylet set in thoracic biopsies Kraniotis P., Zampakis P., Kalogeropoulou Chr., Tsota I., Nilas I., Koletsis E., Petsas Th. University Hospital of Patras, Greece Purpose: To present our experience regarding the application of a guide-stylet set for performing thoracic biopsies. Materials and Methods: Seventy-nine patients, underwent chest biopsies of [lung lesions n=49, mediastinal n=16, bone (spinal and rib) lesions n=14] using this new guide stylet set. The guide stylet is made of stainless steel, has a diameter of 26 G and is combined with a 22G Chiba needle (William Cook Europe). Following the insertion of Chiba, the stylet, through the needle, is directed towards the lesion. When the stylet is correctly directed, the needle is advanced over the stylet reaching the target. The stylet serves either as a guide for the needle or as an exchange wire, when a larger needle is required. The stylet can