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Because of its limited statistical power, the results of the DANTE (Detection And screening of early lung cancer with Novel imaging TEchnology) trial do not allow us to make a definitive statement about the efficacy of LDCT screening. However, they underline the importance of obtaining additional data from randomized trials with intervention-free reference arms before the implementation of population screening.

The mortality benefit from lung cancer screening by LDCT might be far smaller than anticipated.

There is a well-established link between inflammation and cancer of various organs, but little data are available on inflammation-associated markers of diagnostic and prognostic clinical utility in pulmonary malignancy. Blood samples were prospectively collected from 75 resectable lung cancer patients before surgery and in a cohort of 1,358 high-risk subjects. Serum levels of long pentraxin 3 (PTX3) were determined by high-sensitivity ELISA. PTX3 immunostaining was evaluated by immunohistochemistry in cancer tissue. Serum PTX3 levels in the high-risk population were not predictive of developing subsequent lung cancer or any other malignancy; however, serum PTX3 values in patients with lung cancer were significantly higher compared with cancer-free heavy smokers. With a cutoff of 4.5 ng/ml, specificity was 0.80, sensitivity 0.69, positive predictive value 0.15 and negative predictive value 0.98. The receiver operating curve (ROC) for serum PTX3 had an area under the curve (AUC) of 83.52%. Preoperative serum PTX3 levels in lung cancer patients did not correlate with patient outcome, but high interstitial expression of PTX3 in resected tumor specimens was a significant independent prognostic factor associated with shorter survival (p < 0.001). These results support the potential of serum PTX3 as a lung cancer biomarker in high-risk subjects. Furthermore, PTX3 immunohistochemistry findings support the role of local inflammatory mechanisms in determining clinical outcome and suggest that local expression of PTX3 may be of prognostic utility in lung cancer patients.Despite advancements in surgery, anesthesiology and the improvement of chemotherapy and radiotherapy regimens, the prognosis for clinically detected lung cancer remains dismal, with overall 5-year survival rates of 5-15%. Even with early-stage disease 30-40% of the patients ultimately relapse and die, 1 suggesting that sophisticated biological mechanisms affect their outcome that are not reflected by pathological stage alone. For such a reason, prognostic markers independent of stage are actively sought.In the last few years, leukocyte counts and blood levels of several inflammation markers have been correlated with lung cancer prognosis 2 or investigated as lung cancer risk predictors. 3,4 The role of inflammation in cancer pathogenesis and progression-that has long been investigated-includes the generation of reactive oxygen/nitrogen species and the secretion of cytokines, chemokines and proangiogenic factors. [5][6][7][8] In lung cancer, in addition to smoking-the predominant risk factor-inflammatory conditions such as chronic obstructive pulmonary disease, 9 pulmonary fibrosis and chronic lung infections 10,11 as well as polymorphisms of inflammatory genes 12 are all associated with an increased risk.

Surgery for benign lesions is a relevant issue in screening-derived patients. Local control may be achieved by minimally invasive techniques or segmentectomy; however, developing the necessary skills requires an effort by the surgical team. Long-term survivors have a noticeable chance of developing second primary cancers or resectable recurrences and may benefit from a second resection.

Single incision video-assisted thoracic surgery (VATS), better known as uniportal VATS, has taken the world of thoracic surgery by storm over the previous few years. Through advances in techniques and technology, surgeons have been able to perform increasingly complex thoracic procedures utilizing a single

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