RESUMO
BACKGROUND: Complete pulmonary metastasectomy for sarcoma metastases provides patients an opportunity for long-term survival and possible cure. Intraoperative localization of preoperatively identified metastases and identification of occult lesions can be challenging. In this trial, we evaluated the efficacy of near-infrared (NIR) intraoperative imaging using second window indocyanine green during metastasectomy to identify known metastases and to detect occult nodules. METHODS: Thirty patients with pulmonary nodules suspicious for sarcoma metastases were enrolled in an open-label, feasibility study (NCT02280954). All patients received intravenous indocyanine green (5 mg/kg) 24 hours before metastasectomy. Patients 1 through 10 (cohort 1) underwent metastasectomy via thoracotomy to assess fluorescence patterns of nodules detected by traditional methods (preoperative imaging and intraoperative visualization/bimanual palpation). After confirming reliability within cohort 1, patients 11 through 30 (cohort 2) underwent video-assisted thoracic surgery metastasectomy with NIR imaging. RESULTS: In cohort 1, 14 out of 16 preoperatively identified pulmonary metastases (87.5%) displayed tumor fluorescence. Nonfluorescent metastases were deeper than fluorescent metastases (2.1 cm vs 1.3 cm; P = .03). Five out of 5 metastases identified during thoracotomy displayed fluorescence. NIR imaging identified 3 additional occult lesions in this cohort. In cohort 2, 33 out of 37 known pulmonary metastases (89.1%) displayed fluorescence. Nonfluorescent tumors were deeper than 2.0 cm (P = .007). NIR imaging identified 24 additional occult lesions. Of 24 occult lesions, 21 (87.5%) were confirmed metastases and the remaining 3 nodules were lymphoid aggregates. CONCLUSIONS: NIR intraoperative imaging with indocyanine green (5 mg/kg and 24 hours before surgery) localizes known sarcoma pulmonary metastases and identifies otherwise occult lesions. This approach may be a useful intraoperative adjunct to improve metastasectomy.
Assuntos
Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Nódulos Pulmonares Múltiplos/cirurgia , Imagem Óptica/métodos , Pneumonectomia , Sarcoma/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Espectroscopia de Luz Próxima ao Infravermelho , Cirurgia Torácica Vídeoassistida , Toracotomia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Corantes Fluorescentes/administração & dosagem , Humanos , Verde de Indocianina/administração & dosagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Metastasectomia/efeitos adversos , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/secundário , Pneumonectomia/efeitos adversos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sarcoma/diagnóstico por imagem , Sarcoma/secundário , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/secundário , Cirurgia Torácica Vídeoassistida/efeitos adversos , Toracotomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Adulto JovemAssuntos
Neoplasias Ósseas/patologia , Neoplasias Pulmonares/secundário , Nódulos Pulmonares Múltiplos/secundário , Osteossarcoma/secundário , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Osteossarcoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
We report the case of a 45-year-old man who initially presented with chondrosarcoma of the left femur that was treated surgically. Follow-up chest computed tomography (CT) performed 3 years later showed multiple small nodules with a tree-in-bud branching pattern and larger elongated opacities with beaded contours. These findings raised the suspicion of intravascular tumor embolism. Pulmonary CT angiography demonstrated intravascular thrombosis and dilated and beaded peripheral pulmonary arteries. The tumoral origin of the thrombus was confirmed by lung biopsy.
Assuntos
Condrossarcoma/secundário , Neoplasias Femorais/patologia , Neoplasias Pulmonares/secundário , Nódulos Pulmonares Múltiplos/secundário , Células Neoplásicas Circulantes/patologia , Artéria Pulmonar/patologia , Biópsia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/tratamento farmacológico , Condrossarcoma/cirurgia , Neoplasias Femorais/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/tratamento farmacológico , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Surgical resection is currently a standard approach for isolated lung metastases from different primary tumours. The aim of the present analysis is to evaluate the outcome of patients submitted to complete resection of pulmonary metastases and to determine prognostic factors for long-term survival. A group of 440 consecutive patients previously diagnosed with primary malignant solid tumours and submitted to complete surgical resection of lung nodules with suspected or diagnosed metastatic lesion were retrospectively reviewed. The average follow-up time was 43.2 months (range: 0-192) and the 60-month O.S. was 43.7%. Univariate analysis: patients with adenocarcinoma presented the highest 5-year survival rates (53.4%, P = 0.0001); DFI >36 months (P < 0.0001), number of nodules on CT scan (P = 0.0052), number of malignant nodules resected (P = 0.0252) and the size of the largest resected nodule (P < 0.0001) were also significant. Multivariate analysis: number of malignant nodules resected (P = 0.01), size of the largest nodule resected (P = 0.001), DFI >36 months (P < 0.001) and histology of the primary tumour (P = 0.017) had significant impact on survival. The benefit of such an aggressive surgical approach is only limited to selected subgroups of patients. The decision to consider a patient for resection of metastastic disease should include factors beyond the feasibility of complete removal.
Assuntos
Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Nódulos Pulmonares Múltiplos/cirurgia , Pneumonectomia , Adolescente , Adulto , Idoso , Brasil , Quimioterapia Adjuvante , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Masculino , Metastasectomia/efeitos adversos , Metastasectomia/mortalidade , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/mortalidade , Nódulos Pulmonares Múltiplos/secundário , Análise Multivariada , Seleção de Pacientes , Pneumonectomia/efeitos adversos , Pneumonectomia/mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
Se presenta un caso de leiomioma pulmonar metastizante en una mujer de 48 años. El estudio histológico reveló múltiples nódulos pulmonares de musculatura lisa de aspecto benigno. El seguimiento a 8 años mostró una paciente en buenas condiciones generales sin síntomas respiratorios. La historia clínica reveló antecedentes de histerectomía cuatro años antes debido a múltiples leiomiomas. Se hace una revisión clínico patológica de los tumores musculares lisos uterinos en sus formas clásicas y en sus presentaciones inusuales.
A case of pulmonary benign metastasizing leiomyoma in a 48 years old female is presented. The histological study showed pulmonary nodules formed by smooth muscle cell of benign appearance. The 8 years follow up revealed a patient in a good fashion without respiratory symptoms. There was a 4 years history of previous hysterectomy due to multiple uterine leiomyomas. A clinico pathological review of the classical and unusual forms of smooth muscle tumors of the uterus is also presented.