Current Issue : October-December Volume : 2025 Issue Number : 4 Articles : 5 Articles
Background/Objectives: While the genomic landscape of primary lung carcinomas is well characterized, there is a relative scarcity of fusion data on corresponding central nervous system (CNS) metastases. This study aimed to elucidate the molecular profiles of CNS metastases to (1) assess the significance of a combined DNA–reflex RNA fusion testing approach and (2) compare the mutational landscape between patients who present initially [early (≤2 months)] with CNS metastases and those who develop CNS metastases thereafter [late (>2 months)]. Methods: We performed a retrospective search of CNS metastases of adenocarcinoma of probable lung origin interrogated by targeted DNA–reflex RNA next-generation sequencing (NGS). The DNA NGS panel included the driver mutations EGFR, BRAF, KRAS, MET, and ERBB2. RNA NGS included ALK, RET, ROS1, and MET. Additionally, mutational profiles were examined between those with early versus late CNS metastases. Results: Of the 58 patients, 44 (75.9%) had mutations or alterations, including 34 identified by DNA NGS [EGFR (n = 17; 50.0%), KRAS (n = 15; 44.1%), MET (n = 2; 5.9%)] and 10/24 by RNA NGS [ALK (n = 7; 70%), MET (n = 2; 20%), ROS1 (n = 1; 10%)]. Of all patients, 32 (55%) presented with early and 26 (45%) with late CNS metastases. Although patients with early metastases had worse survival compared to those with late metastases (p < 0.001), there were no statistically significant differences in the mutational profiles between the two cohorts. Conclusions: A significant proportion of CNS metastases without driver mutations identified by DNA NGS had targetable alterations identified by RNA NGS (10/24, 41.7%). In summary, a combined DNA with reflex RNA fusion testing approach plays a significant role in detecting and potentially managing CNS metastases. Comprehensive prospective studies are essential to elucidate the differences between early and late CNS metastases....
Goals of medical management of individuals with chronic obstructive pulmonary disease (COPD) should be to live better and live longer—in other words, improve healthrelated quality of life (HRQL) and survival. This narrative review summarizes the literature in these areas, with an emphasis on pulmonary rehabilitation (PR). Treatments that increase HRQL include pharmacologic agents, exercise training, physical activity promotion, lung volume reduction, PR, self-management training, and supplemental oxygen. Additionally, anything that reduces the frequency or impact of exacerbations substantially increases HRQL. With respect to survival in COPD, the list of beneficial interventions for this outcome is considerably more limited. Supplemental oxygen therapy for hypoxemic patients, smoking cessation interventions, influenza vaccination, and lung volume reduction procedures have the strongest evidence in survival benefit. PR, especially when provided following discharge for exacerbations, may improve survival. A nihilistic view of COPD treatment is unwarranted, as multiple interventions are available that improve HRQL, and likely increase survival for selected patients....
Background: Pneumoconiosis is a group of lung diseases characterized by the deposition and accumulation of dust or mineral fibers in the lung interstitium, primarily caused by occupational exposure. Methods: The aim of this study was to identify cases of pneumoconiosis induced by occupational exposure in patients living on the island of Sicily (South Italy), through the retrospective analysis of pneumoconiosis cases registered by the Reference Center for the Prevention, Diagnosis and Treatment of Interstitial Lung Diseases and Rare Lung Diseases (RCLD) of University of Catania, during the decade 2012–2022. Furthermore, the results of a screening conducted in the same 10-year period (2012–2022) on cohorts of workers potentially exposed to RCS generated by Etna’s volcanic dust are reported. Results: From the consultation of the RCLD database, there does not appear to be any correlation between pulmonary fibrosis and exposure to dust of basaltic origin. Conclusions: These data seem to be confirmed by the data of the health monitoring conducted over 10 years on 200 workers involved in different processes of working with lava stone....
Aims: To investigate sociodemographic associations with medicated health conditions, general practitioner (GP) contacts, and computed tomography (CT) scans of the lung, as 12-month precursors of diagnosis of lung cancer at a local stage (cancers localized to the primary site of bronchus and lung). Methods: Cancer Registry data for New South Wales (NSW) adults diagnosed with lung cancer (ICD-10 C33-34) since the Census of August 2016 (n = 6160) were linked at person level with census and other administrative data. These included residents diagnosed with lung cancer from September 2016 to December 2018. Structural equation modelling indicated adjusted measures of associations with lung cancer, including adjusted odds ratios (aORs), in stepped analyses. Results: The first part of the multivariate modelling showed age, major city residence, and other sociodemographic characteristics that were associated with numbers of medicated conditions. The second part showed the numbers of medicated conditions and other sociodemographic characteristics that were associated with the number of GP consultations. The third part of the modelling showed the numbers of GP consultations and other sociodemographic characteristics that were associated with having CT lung scans. Modelling showed that having CT scans and being female were the main predictors of lung cancer diagnosis at a local stage, with aORs of 2.30, 95%CI 2.01–2.63 and 1.39, and 95%CI 1.23–1.58, respectively. The modelling also showed age, GP consultations, residence in a major city, and other sociodemographic characteristics to be associated with having CT scans. Conclusions: The findings of the study indicate the main precursors of lung cancer diagnosis at a local stage after multivariate adjustment. Irrespective of causal significance, results reveal population-wide characteristics for targeting screening for early detection. They demonstrate the potential value of person-level linkage of cancer-registry data with census and other administrative data for this purpose. Our study of linked cancer-registry and census data revealed broad descriptive features of pathways to early diagnosis of relevance to service screening and planning....
The diagnostic evaluation of interstitial lung diseases (ILDs) remains challenging due to their heterogeneous etiologies and overlapping clinical and radiographic patterns. A confident diagnosis often necessitates histopathological sampling, particularly when high-resolution computed tomography and serologic assessments are inconclusive. While surgical lung biopsy (SLB) has long been considered the diagnostic gold standard, its invasiveness, associated morbidity, and limited feasibility in high-risk patients have driven the pursuit of less invasive alternatives. Here, we review the current applications, diagnostic yield, procedural techniques, and complications of several bronchoscopic modalities. Bronchoalveolar lavage (BAL) aids in characterizing inflammatory profiles and differentiating among conditions such as hypersensitivity pneumonitis, sarcoidosis, and eosinophilic pneumonia. Endobronchial biopsies (EBBs) and endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) are valuable in diagnosing granulomatous diseases with lymphadenopathy. Transbronchial lung biopsy (TBLB) is effective for peribronchial and centrilobular diseases but is limited by small sample size and tissue distortion. Transbronchial lung cryobiopsy (TBC) enables acquisition of larger, well-preserved parenchymal tissue samples from the peripheral lung. Over recent years, studies have demonstrated that TBC, when interpreted within a multidisciplinary discussion (MDD), achieves diagnostic concordance rates with SLB exceeding 75%, and up to 95% in cases where high diagnostic confidence is reached. When performed in experienced centers using standardized protocols, TBC is considered a viable first-line histopathologic tool in the diagnostic evaluation of ILD. Adequate training and standardization of the TBC procedure are needed to ensure low complication rates and a high yield....
Loading....