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BackgroundConventional smears of samples obtained by endobronchial ultrasound with real-time transbronchial needle aspiration (EBUS-TBNA) have proven useful in lung cancer staging, but the value of additional information from cell-block processing of EBUS-TBNA samples has only been marginally investigated. This study focussed on the contribution of cell block analysis to the diagnostic yield in lung cancer.MethodsPatients referred for lung cancer diagnosis and/or staging by means of EBUS-TBNA were enrolled, the adequacy of the obtained samples for preparing cell blocks was assessed, and the additional pathologic or genetic information provided from cell block analysis was examined.ResultsIn 270 lung cancer patients referred for EBUS-TBNA (mean age, 63.3 SD 10.4 years) 697 aspirations were performed. Cell blocks could be obtained from 334 aspirates (47.9%) and contained diagnostic material in 262 (37.6%) aspirates, providing information that was additional to conventional smears in 50 of the 189 samples with smears that were non-diagnostic, corresponding 21 of these blocks to malignant nodes, and allowing lung cancer subtyping of 4 samples. Overall, cell blocks improved the pathologic diagnosis attained with conventional smears in 54 of the 697 samples obtained with EBUS-TBNA (7.7%). Cell blocks obtained during EBUS-TBNA also made epithelial growth factor receptor mutation analysis possible in 39 of the 64 patients with TBNA samples showing metastatic adenocarcinoma (60.1%). Overall, cell blocks provided clinically significant information for 83 of the 270 patients participating in the study (30.7%).ConclusionsCell-block preparation from EBUS-TBNA samples is a simple way to provide additional information in lung cancer diagnosis. Analysis of cell blocks increases the diagnostic yield of the procedure by nearly seven per cent and allows for genetic analysis in a sixty per cent of the patients with metastatic adenocarcinoma.

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Anemia and previous exacerbations were independent predictors of mortality after one year in patients hospitalized for AECOPD.

The present study illustrates an exploratory spatial data analysis (ESDA) aimed at investigating changes in the distribution of built-up areas in three southern European metropolitan regions (Barcelona, Rome and Athens). An approach based on global Moran's indexes of spatial autocorrelations was proposed to assess similarities in the spatial organization of the three regions, based on land-use data for 1960 and 2010. Compact monocentric, scattered low-density and mixed polycentric structures were compared in the three regions using local Moran's indexes computed at two different scales, "urban" (5 km radius) and "regional" (20 km radius). The proposed approach identifies emerging trends in scattered monocentric or polycentric development. Our results outline the trend toward scattered urban expansion for the three cities, with signs of a modest shift toward polycentrism in Barcelona. ESDA provides basic information needed for policies promoting spatially balanced, sustainable development in originally compact and economically segmented regions

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