Intrathoracic lymph node enlargement is a common finding in patients with extrathoracic malignancies. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique that is commonly used for lung cancer diagnosis and staging but that has not been widely investigated for the diagnosis of enlarged mediastinal and lobar lymph nodes in patients with extrathoracic malignancies. We conducted a retrospective study of 117 patients with extrathoracic malignancies who underwent EBUS-TBNA for diagnosis of intrathoracic lymph node enlargement from October 2005 to December 2009 and compared the EBUS-TBNA findings with the final diagnoses. EBUS-TBNA diagnosed mediastinal metastases in 51 of the 117 (43.6 %) cases and gave an alternate diagnosis or ruled out the presence of malignancy in 35 (56.4 %). Fourteen of these 35 patients underwent further surgical investigation, while the remaining 21 had clinical and radiological follow-up for 18 months. No false negatives were found in the surgery group. In the follow-up group, 13 patients had stable or regressive lymphadenopathy, and eight developed clinicoradiological progression and were assumed to have been false negatives by EBUS-TBNA. The sensitivity and negative predictive value of EBUS-TBNA were 86.4 and 75 %, respectively. Immunohistochemical staining (IHC) was performed in 80.4 % of the samples obtained by EBUS-TBNA. In samples obtained from ten patients with metastatic breast cancer, estrogen receptor expression was successfully assessed in eight patients and progesterone receptor and human epidermal growth factor receptor 2 in four. EBUS-TBNA is an accurate procedure for the diagnosis of thoracic lymph node metastases in patients with extrathoracic malignancies and should be an initial diagnostic tool in these patients. Furthermore, EBUS-TBNA can obtain high-quality specimens from metastatic lymph nodes for use in molecular analyses.
clinical oncology. They are helpful in the selection of treatment; provide insights into the disease process and the therapeutic response. This study attempts to observe the survival of rectal adenocarcinoma and to find prognostic factors and other variables potentially associated with outcome of operated rectal adenocarcinoma. Methods: It's a retrospective study based on 91 patients with operated rectal adenocarcinoma collected at the Medical Oncology Department of Hassan II University Hospital for a period of 4 years between January 2014 and June 2017. Various prognostic factors had been identified through univariate (Kaplan-Meier) then multivariate (Cox) analyze, namely: age, sex, tumor localization, degree of differentiation, stage, tumor recurrence, ACE level, neoadjuvant therapy and adjuvant chemotherapy. Results: The mean age was 59 years (6 14.14) with extremes "24-86". These were 40% men and 60% women. At endoscopic examination the tumor was located: in the middle rectum in 30.8%; 36.3% in the lower rectum and 33% in the upper rectum. Histologically, the biopsy showed that liberkunian adenocarcinoma was well differentiated in 56%, moderately differentiated in 42% and in 2% poorly differentiated. The carcinoembryonic antigen revealed a rate greater than 5 ng/ml in 25% of patients. Neo-adjuvant treatment with concomitant radiochemotherapy was performed in 61.5% and radiotherapy for 24%. Histopathological examination classified the patients according to the TNM classification with: 7% of patients in stage I, 30% in stage II, 54% in stage III and 9% in stage IV. After surgery 78 patients (86%) received adjuvant chemotherapy. Average overall survival was 25 months. In addition, 23% of patients had a recurrence, median-free survival was 29month. Adjuvant therapy was the only prognostic factor influencing survival: mean survival in the group receiving adjuvant chemotherapy was 32 months vs 14 months in the surveillance group with a very significant difference (p ¼ 0.006).
Conclusion:In our series adjuvant therapy was an important prognostic factor influencing overall survival, our results correlate with those in the literature.
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