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Chiang PH, Ko KH, Peng YJ, Huang TW, Tang SE. Hyperparathyroidism presented as multiple pulmonary nodules in hemodialysis patient status post parathyroidectomy: A case report. World J Radiol 2024; 16:466-472. [PMID: 39355397 PMCID: PMC11440268 DOI: 10.4329/wjr.v16.i9.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/07/2024] [Accepted: 08/28/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Primary hyperparathyroidism is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas occur as well, with cases involving various sites, including the mediastinum, presenting in varying frequencies. Secondary hyperparathyroidism develops in the context of chronic kidney disease, primarily due to vitamin D deficiency, hypocalcemia, and hyperphosphatemia. It is frequently diagnosed in patients undergoing dialysis. This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis (HD). CASE SUMMARY The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis. Radiographic imaging revealed multiple nodules in both lungs, with the largest measuring approximately 1.35 cm. Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue. After tumor resection surgery via video-assisted thoracic surgery with wedge resection, the patient was discharged in stable condition and in follow-up her symptoms showed improvement. CONCLUSION This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing post-parathyroidectomy HD, highlighting diagnostic challenges and a positive outcome from tumor resection surgery.
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Affiliation(s)
- Ping-Han Chiang
- Department of Surgery, Tri-Service General Hospital, Taipei 114202, Taiwan
| | - Kai-Hsiung Ko
- Department of Radiology, National Defense Medical Center, Tri-Service General Hospital, Taipei 114, Taiwan
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Shih-En Tang
- Division of Thoracic Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei 114202, Taiwan
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Tracking Fluorescent Dye Dispersion from an Unmanned Aerial Vehicle. SENSORS 2021; 21:s21113905. [PMID: 34198799 PMCID: PMC8201378 DOI: 10.3390/s21113905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
Commercial unmanned aerial vehicles continue to gain popularity and their use for collecting image data and recording new phenomena is becoming more frequent. This study presents an effective method for measuring the concentration of fluorescent dyes (fluorescein and Rhodamine WT) for the purpose of providing a mathematical dispersion model. Image data obtained using a typical visible-light camera was used to measure the concentration of the dye floating on water. The reference measurement was taken using a laboratory fluorometer. The article presents the details of three extensive measurement sessions and presents elements of a newly developed method for measuring fluorescent tracer concentrations. The said method provides tracer concentration maps presented on the example of an orthophoto within a 2 × 2 m discrete grid.
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Hanaoka J, Yoden M, Hayashi K, Shiratori T, Okamoto K, Kaku R, Kawaguchi Y, Ohshio Y, Sonoda A. Dynamic perfusion digital radiography for predicting pulmonary function after lung cancer resection. World J Surg Oncol 2021; 19:43. [PMID: 33563295 PMCID: PMC7874664 DOI: 10.1186/s12957-021-02158-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/31/2021] [Indexed: 12/25/2022] Open
Abstract
Background Accurate prediction of postoperative pulmonary function is important for ensuring the safety of patients undergoing radical resection for lung cancer. Dynamic perfusion digital radiography is an excellent and easy imaging method for detecting blood flow in the lung compared with the less-convenient conventional lung perfusion scintigraphy. As such, the present study aimed to confirm whether dynamic perfusion digital radiography can be evaluated in comparison with pulmonary perfusion scintigraphy in predicting early postoperative pulmonary function and complications. Methods Dynamic perfusion digital radiography and spirometry were performed before and 1 and 3 months after radical resection for lung cancer. Correlation coefficients between blood flow ratios calculated using dynamic perfusion digital radiography and pulmonary perfusion scintigraphy were then confirmed in the same cases. In all patients who underwent dynamic perfusion digital radiography, the correlation predicted values calculated from the blood flow ratio, and measured values were examined. Furthermore, ppo%FEV1 or ppo%DLco values, which indicated the risk for perioperative complications, were examined. Results A total of 52 participants who satisfied the inclusion criteria were analyzed. Blood flow ratios measured using pulmonary perfusion scintigraphy and dynamic perfusion digital radiography showed excellent correlation and acceptable predictive accuracy. Correlation coefficients between predicted FEV1 values obtained from dynamic perfusion digital radiography or pulmonary perfusion scintigraphy and actual measured values were similar. All patients who underwent dynamic perfusion digital radiography showed excellent correlation between predicted values and those measured using spirometry. A significant difference in ppo%DLco was observed for respiratory complications but not cardiovascular complications. Conclusions Our study demonstrated that dynamic perfusion digital radiography can be a suitable alternative to pulmonary perfusion scintigraphy given its ability for predicting postoperative values and the risk for postoperative respiratory complications. Furthermore, it seemed to be an excellent modality because of its advantages, such as simplicity, low cost, and ease in obtaining in-depth respiratory functional information. Trial registration Registered at UMIN on October 25, 2017. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000033957 Registration number: UMIN000029716 Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02158-w.
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Affiliation(s)
- Jun Hanaoka
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan.
| | - Makoto Yoden
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazuki Hayashi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Takuya Shiratori
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Keigo Okamoto
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Ryosuke Kaku
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yo Kawaguchi
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Ohshio
- Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Shiga, Japan
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Miyauchi R, Yamada T, Kumano R, Aida Y, Takagi M. Recurrent hyperparathyroidism due to parathyroid and pulmonary tumors showing features of parathyroid adenoma. Radiol Case Rep 2020; 15:1289-1294. [PMID: 32595814 PMCID: PMC7306540 DOI: 10.1016/j.radcr.2020.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/25/2022] Open
Abstract
We report on a case of recurrent primary hyperparathyroidism possibly caused by parathyroid adenocarcinoma metastasizing to the lung. A 46-year-old woman with a history of parathyroid adenoma, which was extirpated 8 years ago, presented with symptoms of primary hyperparathyroidism, and was found to have a parathyroid and a lung nodule in radiographic assessments. Resections of the tumors in the parathyroid gland as well as the lung were required to improve her condition, and in pathology, both tumors demonstrated benign features consistent with adenoma. However, from the perspective of the clinical course and location of the tumors, we deduced that the tumors were malignant despite being identified as benign by conventional pathological examination. The integration of information based on clinical status and imaging studies is essential to evaluate the malignant potential of tumors if a patient with hyperparathyroidism has tumors located both inside and outside of the parathyroid gland.
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Affiliation(s)
- Ryosuke Miyauchi
- Department of Radiology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan
- Corresponding author.
| | - Takayuki Yamada
- Department of Radiology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Reiko Kumano
- Department of Radiology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasashicho, Asahi-ku, Yokohama, Kanagawa, 241-0811, Japan
| | - Yoshio Aida
- Department of Pathology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Kanagawa, Japan
| | - Masayuki Takagi
- Department of Pathology, St. Marianna University School of Medicine University Hosital, Kawasaki, Kanagawa, Japan
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Tay ZW, Chandrasekharan P, Zhou XY, Yu E, Zheng B, Conolly S. In vivo tracking and quantification of inhaled aerosol using magnetic particle imaging towards inhaled therapeutic monitoring. Theranostics 2018; 8:3676-3687. [PMID: 30026874 PMCID: PMC6037024 DOI: 10.7150/thno.26608] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/15/2018] [Indexed: 12/14/2022] Open
Abstract
Pulmonary delivery of therapeutics is attractive due to rapid absorption and non-invasiveness but it is challenging to monitor and quantify the delivered aerosol or powder. Currently, single-photon emission computed tomography (SPECT) is used but requires inhalation of radioactive labels that typically have to be synthesized and attached by hot chemistry techniques just prior to every scan. Methods: In this work, we demonstrate that superparamagnetic iron oxide nanoparticles (SPIONs) can be used to label and track aerosols in vivo with high sensitivity using an emerging medical imaging technique known as magnetic particle imaging (MPI). We perform proof-of-concept experiments with SPIONs for various lung applications such as evaluation of efficiency and uniformity of aerosol delivery, tracking of the initial aerosolized therapeutic deposition in vivo, and finally, sensitive visualization of the entire mucociliary clearance pathway from the lung up to the epiglottis and down the gastrointestinal tract to be excreted. Results: Imaging of SPIONs in the lung has previously been limited by difficulty of lung imaging with magnetic resonance imaging (MRI). In our results, MPI enabled SPION lung imaging with high sensitivity, and a key implication is the potential combination with magnetic actuation or hyperthermia for MPI-guided therapy in the lung with SPIONs. Conclusion: This work shows how magnetic particle imaging can be enabling for new imaging and therapeutic applications of SPIONs in the lung.
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Affiliation(s)
- Zhi Wei Tay
- Department of Bioengineering, University of California, Berkeley, CA 94720, United States
| | | | - Xinyi Yedda Zhou
- Department of Bioengineering, University of California, Berkeley, CA 94720, United States
| | - Elaine Yu
- Magnetic Insight, Inc., Alameda, CA 94501, United States
| | - Bo Zheng
- Department of Bioengineering, University of California, Berkeley, CA 94720, United States
| | - Steven Conolly
- Department of Bioengineering, University of California, Berkeley, CA 94720, United States
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA 94720, United States
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Zhang S, Liu Y. Diagnostic Performances of 99mTc-Methoxy Isobutyl Isonitrile Scan in Predicting the Malignancy of Lung Lesions: A Meta-Analysis. Medicine (Baltimore) 2016; 95:e3571. [PMID: 27149482 PMCID: PMC4863799 DOI: 10.1097/md.0000000000003571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We performed a meta-analysis to evaluate the value of technetium-99m methoxy isobutyl isonitrile (Tc-MIBI) single photon emission computed tomography (SPECT) in differentiating malignant from benign lung lesions.The PubMed and Embase databases were comprehensively searched for relevant articles that evaluated lung lesions suspicious for malignancy. Two reviewers independently extracted the data on study characteristics and examination results, and assessed the quality of each selected study. The data extracted from the eligible studies were assessed by heterogeneity and threshold effect tests. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and areas under the summary receiver-operating characteristic curves (SROC) were also calculated.Fourteen studies were included in this meta-analysis. The pooled sensitivity, specificity, positive and negative likelihood ratio, and DOR of Tc-MIBI scan in detecting malignant lung lesions were 0.84 (95% confidence interval [CI]: 0.81, 0.87), 0.83 (95% CI: 0.77, 0.88), 4.22 (95% CI: 2.53, 7.04), 0.20 (95% CI: 0.12, 0.31), and 25.71 (95% CI: 10.67, 61.96), respectively. The area under the SROC was 0.9062. Meta-regression analysis showed that the accuracy estimates were significantly influenced by ethnic groups (P < 0.01), but not by image analysis methods, mean lesion size, or year of publication. Deek funnel plot asymmetry test for the overall analysis did not raise suspicion of publication bias (P = 0.50).Our results indicated that Tc-MIBI scan is a promising diagnostic modality in predicting the malignancy of lung lesions.
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Affiliation(s)
- Shuxin Zhang
- From the Department of Thoracic Surgery, Chinese PLA General Hospital (SZ, YL); and Department of Thoracic Surgery, Chinese PLA 309th Hospital (SZ), Beijing, China
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Chang SH, Chung YS, Hwang SK, Kwon JT, Minai-Tehrani A, Kim S, Park SB, Kim YS, Cho MH. Lentiviral vector-mediated shRNA against AIMP2-DX2 suppresses lung cancer cell growth through blocking glucose uptake. Mol Cells 2012; 33:553-62. [PMID: 22562359 PMCID: PMC3887752 DOI: 10.1007/s10059-012-2269-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 03/20/2012] [Accepted: 03/22/2012] [Indexed: 01/19/2023] Open
Abstract
Aminoacyl-tRNA synthetases [ARS]-interacting multifunctional protein 2 (AIMP2) has been implicated in the control of cell fate and lung cell differentiation. A variant of AIMP2 lacking exon 2 (AIMP2-DX2) is expressed in different cancer cells. We previously studied the expression level of AIMP2-DX2 in several lung cell lines and reported elevated expression levels of AIMP2-DX2 in NCI-H460 and NCI-H520. Here, we report that the suppression of AIMP2-DX2 by lentivirus mediated short hairpin (sh)RNA (sh-DX2) decreased the rate of glucose uptake and glucose transporters (Gluts) in NCI-H460 cells. Down-regulation of AIMP2-DX2 reduced glycosyltransferase (GnT)-V in the Golgi apparatus, while inducing the GnT-V antagonist GnT-III. Down-regulation of AIMP2-DX2 also suppressed the epidermal growth factor receptor/mitogen activated protein kinase (EGFR/MAPK) signaling pathway, leading to the decrease of the proliferation marker Ki-67 expression in nuclei. Furthermore, dual luciferase activity reduced capdependent protein translation in cells infected with sh-DX2. These results suggest that AIMP2-DX2 may be a relevant therapeutic target for lung cancer, and that the sh-DX2 lentiviral system can be an appropriate method for lung cancer therapy.
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Affiliation(s)
- Seung-Hee Chang
- Laboratory of Toxicology, College of Veterinary Medicine, Seoul National University, Seoul 151-742,
Korea
| | - Youn-Sun Chung
- Laboratory of Toxicology, College of Veterinary Medicine, Seoul National University, Seoul 151-742,
Korea
| | - Soon-Kyung Hwang
- Gene Regulation Section, Laboratory of Cancer Prevention, Center for Cancer Research, National Cancer Institute, Frederick, MD 21702,
USA
| | - Jung-Taek Kwon
- Laboratory of Toxicology, College of Veterinary Medicine, Seoul National University, Seoul 151-742,
Korea
- Risk Assessment Division, National Institute of Environmental Research, Incheon 404-708,
Korea
| | - Arash Minai-Tehrani
- Laboratory of Toxicology, College of Veterinary Medicine, Seoul National University, Seoul 151-742,
Korea
| | - Sunghoon Kim
- Medicinal Bioconvergence Research Center, Seoul National University, Seoul 151-742,
Korea
| | - Seung Bum Park
- Department of Chemistry, College of National Science, Seoul National University, Seoul 151-742,
Korea
| | - Yeon-Soo Kim
- Department of Smart Foods and Drugs and Indang Institute of Molecular Biology, Inje University, Seoul 100-032,
Korea
| | - Myung-Haing Cho
- Laboratory of Toxicology, College of Veterinary Medicine, Seoul National University, Seoul 151-742,
Korea
- Department of Nanofusion Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 151-742,
Korea
- Graduate Group of Tumor Biology, Seoul National University, Seoul 151-742,
Korea
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Oskoei SD, Mahmoudian B. A comparative study of lung masses with 99mTechnetium Sestamibi and pathology results. Pak J Biol Sci 2009; 10:225-9. [PMID: 19070019 DOI: 10.3923/pjbs.2007.225.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bronchial carcinoma is the leading cause of death from cancer in most countries. The aim of this prospective study was to assess the ability of 99mTechnetium Sestamibi (99mTc-MIBI) SPECT in differentiating benign from malignant pulmonary masses. 30 patients with lung mass, radiologically suspicious for malignancy were included. Planar scintigraphy was performed on all patients 10 and 120 min after intravenous injection of 99mTc-MIBI. Also SPECT was done after completion of first static image series. Images were evaluated qualitatively and quantitatively for abnormal accumulation of radiotracer corresponding to the location of the masses. Increased 99mTc-MIBI uptake was considered as positive scan result. Biopsy from lung mass was performed in all patients. Twenty patients (67%) had malignant lung lesions, which were confirmed pathologically [90% had primary lung cancer (PLC)]. 99mTc-MIBI scan had sensitivity, specificity, positive and negative predictive values of 80, 70, 84 and 64% in detection of lung malignancies, respectively. Quantitatively, malignant lesions revealed high mass/lung count ratio comparing to benign lesions (1.21 +/- 0.12 vs. 1.09 +/- 0.07, p<0.01). Small cell tumors had higher 99mTc-MIBI uptake than squamous cell tumors (p<0.05). 99mTc-MIBI scanning can be helpful in prediction of malignancy in suspicious pulmonary masses due to its high specificity and positive predictive value.
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Affiliation(s)
- Shahram Dabiri Oskoei
- Department of Nuclear Medicine, Tabriz University of Medical Sciences, Imam Hospital, Tabriz, Islamic Republic of Iran
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Rodríguez Fernández A, Bellón Guardia M, Gómez Río M, Ramos Font C, Sánchez-Palencia Ramos A, Llamas Elvira J, Pedraza Muriel V. Estadificación del cáncer de pulmón de células no pequeñas. Utilidad de la imagen estructural (TAC) y funcional (FDG-PET). Rev Clin Esp 2007; 207:541-7. [DOI: 10.1157/13111571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sharma R, Bhatnagar P, Mondal A, Sawroop K, Datta M, Kashyap R. CT-MIBI Image Fusion: Transmission and Emission Tomography for Localization of Bronchogenic Carcinoma and Nodal Metastasis. Clin Nucl Med 2006; 31:355-6. [PMID: 16714901 DOI: 10.1097/01.rlu.0000219074.75262.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Rajnish Sharma
- Department of Nuclear Medicine, Institute of Nuclear Medicine and Allied Sciences (INMAS), Delhi, India.
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Calcutt VG, Franco-Saenz R, Morrow LB, Mulrow PJ. Localization of abnormal parathyroid tissue with use of technetium-99m-sestamibi. Endocr Pract 2004; 4:184-9. [PMID: 15251730 DOI: 10.4158/ep.4.4.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the efficacy of "double-phase" technetium-99m-sestamibi scanning in the localization of abnormal parathyroid tissue in patients with hyperparathyroidism. METHODS We present a prospective review of patients with hyperparathyroidism seen at a university teaching hospital between June 1994 and May 1997. Twenty-four patients entered into the study underwent preoperative localization with double-phase technetium-99m-sestamibi. The nuclear medicine results were compared with the operative findings. RESULTS The Tc-99m-sestamibi scan correctly identified the location of single parathyroid adenomas in 22 patients (100%). Of the other two patients, both with diffuse parathyroid hyperplasia, one had a negative sestamibi scan and one had only the two inferior parathyroid glands localized on the sestamibi scan. One patient with recurrent hypercalcemia, who previously underwent total parathyroidectomy and parathyroid autotransplantation into the left forearm, had activity localized to that forearm but not to the neck. Subsequently, hyperplastic parathyroid tissue was successfully removed from the transplantation site. Another patient, who had previously undergone two unsuccessful surgical explorations prompted by hyperparathyroidism, had sestamibi localization of an adenoma inferior and medial to the right submandibular gland. The third surgical exploration disclosed a large adenoma medial to the carotid artery, just below the angle of the jaw. In two elderly, debilitated women with positive scans, adenomas were removed with use of local anesthesia. Of 22 patients in whom long-term follow-up was available, 21 remained normocalcemic for a mean period of 11.4 +/- 1.7 months postoperatively. One patient in whom hyperplastic parathyroid tissue had been removed from the left forearm had recurrence of hypercalcemia 1 year after operation. CONCLUSION Technetium-99m-sestamibi scanning is a reliable method for identifying parathyroid adenomas but not as helpful in localizing hyperplastic parathyroid glands. The precise localization of an adenoma simplifies surgical exploration and in selected patients may allow excision of the adenoma under local anesthesia. Tc-99msestamibi scanning has become the preferred method for noninvasive localization of abnormal parathyroid glands.
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Affiliation(s)
- V G Calcutt
- Department of Medicine, Medical College of Ohio, Toledo, Ohio, USA
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Hamilton D, Al-Nabulsi J. Radionuclides in Pulmonary and Extra-Pulmonary Tuberculosis. Tuberculosis (Edinb) 2004. [DOI: 10.1007/978-3-642-18937-1_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Carcinoma of the lung is one of the most frequent malignancies and a major cause of mortality. The use of positron emission tomography (PET) has been extensively investigated in patients with carcinoma of the lung and has established clinical utility and cost-effectiveness in characterization of solitary pulmonary nodules and preoperative staging of carcinoma of the lung. Evolving applications in carcinoma of the lung include detection of recurrence, assessment of treatment response, radiotherapy planning, and prognosis. In addition, there is developing interest in combined anatomic/metabolic imaging and new tracer techniques, in particular gene expression imaging. This review aims to present existing data supporting the use of PET in carcinoma of the lung and to explore the evolving indications and future prospects of PET and lung cancer.
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Affiliation(s)
- I Ho Shon
- Clinical PET Centre, Lambeth Wing, St Thomas' Hospital, London, UK
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Shiun SC, Sun SS, Hsu NY, Kao CH, Lin CC, Lee CC. Detecting mediastinal lymph node metastases in non-small-cell lung cancer using a combination of technetium-99m tetrofosmin chest single photon emission computed tomography and chest computed tomography. Cancer Invest 2002; 20:311-7. [PMID: 12025225 DOI: 10.1081/cnv-120001175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED The staging of non-small-cell lung cancer (NSCLC) to detect mediastinal lymph node (MLN) metastases is very important for determining the therapeutic strategy. METHODS Thirty-four patients with proven NSCLC were enrolled in this study. All patients underwent chest computed tomography (CT) and technetium-99m (Tc-99m) tetrofosmin chest single photon emission computed tomography (SPECT) preoperative staging. Mediastinal lymph node metastases were determined on the basis of postoperative pathologic findings to compare the diagnostic accuracy of chest CT with that of Tc-99m tetrofosmin chest SPECT. RESULTS Tc-99m tetrofosmin chest SPECT showed a diagnostic accuracy rate of 85.3% in detecting MLN metastases. Chest CT had an accuracy rate of 73.5%. If either Tc-99m tetrofosmin chest SPECT or chest CT with positive findings was considered as positive findings, the sensitivity was 94.7%. If either Tc-99m tetrofosmin chest SPECT or chest CT with negative findings was considered as negative, the specificity was 93.3%. CONCLUSION Tc-99m tetrofosmin chest SPECT was more accurate than chest CT in detecting MLN metastases in NSCLC patients. In addition, the combined use of Tc-99m tetrofosmin chest SPECT and chest CT could significantly increase the sensitivity and specificity compared with the single use of either Tc-99m tetrofosmin chest SPECT or chest CT.
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Affiliation(s)
- Shih-Chih Shiun
- Department of Chest Surgery, China Medical College Hospital, Taichung, Taiwan
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Buccheri G, Biggi A, Ferrigno D, Francini A. 99mTC-tetrofosmin scintigraphy in lung carcinoma staging and follow-up evaluations. Cancer 2002; 94:1796-807. [PMID: 11920543 DOI: 10.1002/cncr.10394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND 99mTC-tetrofosmin recently has emerged as a new radiopharmaceutical for cancer visualization. In this study, the authors have investigated, for the first time in a comprehensive way, its ability to assess lung carcinoma dissemination and progression. METHODS A 99mTC-tetrofosmin scan was incorporated into the pretreatment and posttreatment diagnostic workup of all lung carcinoma patients seen in a second referral institution for a province of 500,000 inhabitants during the years 1998 and 1999. Sixty-one patients, strongly suspected of lung carcinoma were photon-scanned; 21 of them were rescanned after completion of their front-line treatment. Eleven patients eventually underwent surgery, and 3 others underwent mediastinoscopy. Both planar and single photoemission computed tomography thoracic views were obtained. Images for the whole body also were acquired. RESULTS All 57 patients whose lung carcinoma was pathologically confirmed showed accumulation of the radiotracer (100% sensitivity). However, three of the four nonmalignant lesions were also 99mTC-tetrofosmin positive. 99mTC-tetrofosmin scan was highly sensitive for the detection of the T0-T2 disease (97% sensitivity) and highly specific for the N0-N1 disease (83% specificity). In the 16 pathologically staged mediastina, sensitivity, specificity, and accuracy rates were 73%, 100%, and 81%, respectively. 99mTC-tetrofosmin scan correctly detected most skeleton (9 of 10) and brain (5 of 7) metastases. The treatment response evaluation made with 99mTC-tetrofosmin corresponded to the clinical estimate in almost half of the sample. CONCLUSIONS This study shows that 99mTC-tetrofosmin scan is a relatively accurate method for lung carcinoma evaluation. The authors' preliminary data exclude, however, that noninvasive diagnostic efficiency might be substantially increased by a scintigraphy with 99mTC-tetrofosmin. More studies are needed for a better understanding of the real value of this technique.
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Kao A, Shiun SC, Hsu NY, Sun SS, Lee CC, Lin CC. Technetium-99m methoxyisobutylisonitrile chest imaging for small-cell lung cancer. Relationship to chemotherapy response (six courses of combination of cisplatin and etoposide) and p-glycoprotein or multidrug resistance related protein expression. Ann Oncol 2001; 12:1561-6. [PMID: 11822755 DOI: 10.1023/a:1013133801173] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This is a retrospective and adaptive randomization study. The purpose of this study was to evaluate the relationship between technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) chest-imaging results, chemotherapy response and P-glycoprotein (Pgp) or multidrug resistance related protein (MRP) expression in small-cell lung cancer (SCLC). PATIENTS AND METHODS Before chemotherapy, 30 patients (11 females, 19 males, ages: 52-69 years) with SCLC, including 14 extensive diseases without localized problems and 16 limited diseases in excess of solitary pulmonary nodule, underwent early chest imaging, including visual interpretation and quantitative analyses of tumor uptake ratio (TUR), 10 minutes after intravenous injection of Tc-99m MIBI. Immunohistochemical analyses were performed, using multiple nonconsecutive sections of the biopsy specimens, to detect Pgp and MRP expressions. Chemotherapy response was evaluated in the third month after completion of treatment by clinical and radiological methods. RESULTS All 15 (100%) of the SCLC patients with complete or partial response had positive Tc-99m MIBI chest SPECT results, but negative ones for both Pgp and MRP expression. Twelve of the 15 (80%) SCLC patients with no response or progressive disease had negative Tc-99m MIBI chest SPECT results and were positive for either Pgp or MRP expression (P < 0.05). Negative Tc-99m MIBI chest SPECT results predicted complete or partial response. The TUR of patients with complete or partial response (1.91 +/- 0.29 with a 95% confidence interval (95% CI): 1.75-2.07) was significantly higher than that of patients with no response or progressive disease (1.19 +/- 0.28 with a 95% CI: 1.04-1.35). CONCLUSION Tc-99m MIBI chest images are a potential tool for understanding Pgp and MRP expressions in SCLC and for predicting patient chemotherapy response.
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Affiliation(s)
- A Kao
- Department of Nuclear Medicine, China Medical College Hospital, Taichung, Taiwan.
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Abstract
The clinical nature of sport-related concussion is discussed in this paper. Particularly highlighted are the difficulties with definition, injury severity grading, classification, and understanding of clinical symptoms. In addition, the well-recognized sequelae of concussion including the motor and convulsive manifestations are discussed in detail. Where possible, an evidence-based approach is adopted to assist the understanding of the literature in this complex area.
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Affiliation(s)
- K M Johnston
- Department of Neurosurgery, McGill University, Montreal, Quebec, Canada
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Xia J, Wu H, Zhao M, Xianyu Z. Monitoring of biological responses of tumor cells after irradiation with 99mTc-MIBI--an in vitro study. Curr Med Sci 2001; 21:152-5. [PMID: 11523224 DOI: 10.1007/bf02888083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2000] [Indexed: 10/19/2022]
Abstract
To explore the possibility to employ 99mTc-MIBI to monitor biological response of tumor cells after irradiation and to observe the relation between the radiation doses and the uptake levels of 99mTc-MIBI in tumor cells, the cells were irradiated with a single dose of 2 Gy, 10 Gy and 20 Gy respectively. The uptake of 99mTc-MIBI in each dosage group was determined before and 24, 48, 72 h after irradiation respectively. Apoptosis index (AI), plating efficiency (PE) of tumor cells was simultaneously determined. There was a positive correlation between uptake levels of 99mTc-MIBI and AI(r = -0.91, P < 0.05). A negative correlation was noted between the uptake levels and PE (r = -0.86, P < 0.05). It is suggested that 99mTc-MIBI may be used as a tracer to monitor the change of viability state of tumor cells after being irradiated with different doses.
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Affiliation(s)
- J Xia
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030
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Tatsumi M, Yutani K, Nishimura T. Evaluation of lung cancer by 99mTc-tetrofosmin SPECT: comparison with [18F]FDG-PET. J Comput Assist Tomogr 2000; 24:574-80. [PMID: 10966189 DOI: 10.1097/00004728-200007000-00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to clarify the validity of (99m)Tc-tetrofosmin SPECT (TF-SPECT) in the evaluation of lung cancer in comparison with [18F]fluorodeoxyglucose ([18F]FDG-PET). METHOD Twenty-one patients with biopsy-proven non-small cell lung cancer were examined by both TF-SPECT (early and delayed images) and FDG-PET within a week of each study. Lung cancers were analyzed visually and semiquantitatively using the ratio of lesion to background counts (L/B ratio). Mediastinal lymph node metastases were analyzed only visually. RESULTS Both early and delayed TF images could detect 18 of 21 lung cancers on visual analysis (85.7%), whereas FDG-PET could detect all the lesions (100%). The L/B ratio of TF-SPECT was significantly higher in delayed than in early images (1.79 +/- 0.55 vs. 1.56 +/- 0.40; p < 0.001). However, the L/B ratio of FDG-PET was 8.85 +/- 3.05, significantly higher than those of both TF images (p < 0.0001). In the assessment of mediastinal involvement, TF-SPECT was 40.0% sensitive, 100% specific, and 71.4% accurate, whereas FDG-PET was 80.0% sensitive, 81.8% specific, and 81.0% accurate. CONCLUSION Although the detection sensitivity was far better than expected, TF-SPECT is not considered to be an alternative to FDG-PET in the evaluation of malignant pulmonary lesions because of its significantly low L/B ratio. TF-SPECT has poor sensitivity for mediastinal lymph node metastases and is useless for staging patients with lung cancer.
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Affiliation(s)
- M Tatsumi
- Division of Tracer Kinetics, Biomedical Research Center, Osaka University Graduate School of Medicine, Japan.
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20
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Abstract
The authors evaluated the ability of dual SPECT with Tc-99m MIBI and Tl-201 chloride to differentiate malignant and benign solitary pulmonary nodules smaller than 3 cm in diameter. Forty-three patients had solitary pulmonary nodules smaller than 3 cm in diameter based on the findings of chest CT. All patients underwent dual-isotope SPECT with Tc-99m MIBI and Tl-201 chloride. Regions of interest were placed over the tumors (T) and contralateral normal lung tissue (N) on one coronal SPECT view, and T:N ratios and retention indices were calculated. The sensitivities of early and delayed Tc-99m MIBI SPECT and early and delayed Tl-201 chloride SPECT for differentiating malignant and benign lesions were 44%, 48%, 56%, and 52%, respectively. The corresponding specificity rates were 44%, 56%, 25%, and 31%, respectively, and corresponding accuracy rates were 44%, 51%, 44%, and 44%, respectively. There were no statistically significant differences between malignant and benign lesions in the early and delayed T:N ratios for Tc-99m MIBI and Tl-201 chloride and the retention index for Tc-99m MIBI. However, the retention index using Tl-201 chloride in malignant lesions was significantly higher (P < 0.01) than that in benign lesions. Analysis of semiquantitative parameters of the T:N ratio and retention index from Tc-99m MIBI SPECT appears to have little or no value for differentiating malignant from benign solitary pulmonary nodules smaller than 3 cm in diameter. However, the retention index using Tl-201 chloride seems to be a better parameter for differentiating between these malignant and benign lesions.
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21
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Basoglu T, Bernay I, Coskun C, Canbaz F, Talu A, Erkan L. Pulmonary Tc-99m tetrofosmin imaging: clinical experience with detecting malignant lesions and monitoring response to therapy. Clin Nucl Med 1998; 23:753-7. [PMID: 9814563 DOI: 10.1097/00003072-199811000-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors prospectively investigated the uptake and kinetics of Tc-99m tetrofosmin (Tetro) in benign and malignant lung lesions and the effect of radiotherapy, chemotherapy, or both on Tc-99m Tetro uptake in malignant lung tumors. Dynamic and planar Tetro imaging were performed in 45 patients with pulmonary lesions during a period of 28 months (34 untreated malignant tumors, 11 benign lesions). Tetro uptake was visibly increased in 26 of 34 malignant tumors, with a mean lesion to contralateral normal tissue ratio of 1.44 +/- 0.29 and a tumor washout rate of 28.4 +/- 6.6% 30 minutes after injection. In 3 of 11 benign lesions, Tetro uptake was observed. Of the 26 patients with malignant tumors and positive Tetro uptake, nine had repeated imaging 6 to 8 weeks after therapy. The patients were treated with radiotherapy, chemotherapy, or both. Reduction in radiological tumor size was used as the clinical response parameter. In five of nine patients, the course of Tetro uptake in follow-up imaging was in accordance with that of radiological tumor size. Two of four remaining patients had only slight discordance between the alteration of Tetro uptake and radiological tumor size. The sensitivity of Tetro to detect malignant lung lesions in our patients was 77%. The specificity and accuracy of the method were 73% and 76%, respectively. Tetro has limited diagnostic value in detecting lung cancer. It may be useful to monitor the response to therapy in malignant lung tumors with initial tracer uptake. Broader trials on this matter are needed for further clarification.
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Affiliation(s)
- T Basoglu
- Department of Nuclear Medicine, Ondokuz Mayis University Hospital, Samsun, Turkey
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22
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Kao CH, ChangLai SP, Chieng PU, Yen TC. Technetium-99m methoxyisobutylisonitrile chest imaging of small cell lung carcinoma: relation to patient prognosis and chemotherapy response--a preliminary report. Cancer 1998; 83:64-8. [PMID: 9655294 DOI: 10.1002/(sici)1097-0142(19980701)83:1<64::aid-cncr9>3.0.co;2-e] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The purpose of this preliminary study was to evaluate retrospectively the relation between chemotherapy response and survival time, using technetium-99m methoxyisobutylisonitrile (Tc-99m MIBI) uptake in small cell lung carcinoma (SCLC) to detect the expression of multidrug resistance (mdr)-mediated 170-kDa P-glycoprotein (PgP). METHODS Before the administration of chemotherapy (which consisted of cisplatin 25 mg and etoposide 125 mg every day per 3-day course), 15 male patients (ages 54-64 years) with SCLC were enrolled in this study to undergo Tc-99m MIBI chest imaging, including single photon emission computed tomography (SPECT) and planar imaging, for qualitative and quantitative assessments of PgP in their SCLC. RESULTS In 12 of 15 cases (80%), SCLC could be detected by visual interpretation of the Tc-99m MIBI chest SPECT images. In 13 of 15 cases (87%), Tc-99m MIBI chest SPECT images (either positive SPECT with good response or negative SPECT with poor response) correctly predicted chemotherapy response. The correlation between tumor uptake ratios obtained by planar images (total counts in the region of interest [ROI] of the tumor divided by total counts in the same size ROI of the contralateral normal lung) and survival days (from the time of SCLC diagnosis to the time of the patient's death) was both positive and good (correlation coefficient=0.83). CONCLUSIONS Tc-99m MIBI chest images have the potential to demonstrate mdr-PgP expression in SCLC and to predict patient prognosis and chemotherapy response.
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Affiliation(s)
- C H Kao
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taiwan
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23
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Affiliation(s)
- V J Mansberg
- Department of Nuclear Medicine, Prince of Wales Hospital, Sydney, Australia
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Giordano A, Calcagni ML, Meduri G, Valente S, Galli G. Perfusion lung scintigraphy for the prediction of postlobectomy residual pulmonary function. Chest 1997; 111:1542-7. [PMID: 9187171 DOI: 10.1378/chest.111.6.1542] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
STUDY OBJECTIVES Scintigraphic prediction of the residual pulmonary function following a lobectomy is not widely employed; its accuracy is poorly known. This study aims at determining the accuracy and the clinical value of the scintigraphic prediction of postlobectomy residual function. PATIENTS AND INTERVENTIONS In this study, 41 patients with bronchial carcinoma underwent a perfusion lung scintigraphy before lobectomy; the functional contribution of each single lobe was computed by an indirect method proposed by Wernly et al.; the results of the scintigraphic prediction were compared with those of the pulmonary function tests performed 1 month after surgery. MEASUREMENTS AND RESULTS The linear regression analyses of predicted and observed values of FVC and FEV1 showed significant correlations (R2=0.607 and 0.749, respectively); however, an evident scatter of data was obtained, as quantified by the values of imprecision (20.70% and 18.11%, respectively) and global inaccuracy (25.50% and 22.90%, respectively). The estimates of both FVC and FEV1 were significantly better in right lung lobectomies than in left lung lobectomies (mean imprecision and global inaccuracy: 15.43% and 14.94% for the right lung, and 27.27% and 29.00% for the left lung). CONCLUSIONS The scintigraphic prediction of postlobectomy residual function is easily implemented by the method herein employed; it has a greater margin of uncertainty than that of pneumonectomy, especially for left lobectomies; however, the use of some safety thresholds for predicted values of FEV1 (1.2 L for upper lobectomies and 1 L for lower lobectomies) guarantees a safe clinical use of the test.
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Affiliation(s)
- A Giordano
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
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25
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Wang H, Maurea S, Mainolfi C, Fiore F, Gravina A, Panico MR, Bazzicalupo L, Salvatore M. Tc-99m MIBI scintigraphy in patients with lung cancer. Comparison with CT and fluorine-18 FDG PET imaging. Clin Nucl Med 1997; 22:243-9. [PMID: 9099482 DOI: 10.1097/00003072-199704000-00008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tc-99m MIBI imaging has been used to evaluate patients with different neoplastic disorders, but its role in nuclear oncology has not been definitely established. In this study, we compared the results of Tc-99m MIBI (planar and SPECT imaging) with those of F-18 FDG PET radionuclide studies in 19 patients who had proven lung cancer. One patient was studied in follow-up. All patients underwent chest CT scans. MIBI and FDG images were qualitatively and quantitatively analyzed using region of interest analysis. Quantitative evaluation of MIBI and FDG activities in lung-tumor lesions was performed calculating tumor/nontumor ratios. On CT, 18 lung tumors were detected, while one patient was disease free. For lung lesions, the diagnostic sensitivity of planar MIBI imaging was 83%, while those of MIBI SPECT and FDG PET were both 100%. The quantitative analysis of lung-tumor MIBI and FDG activities showed that FDG uptake was significantly (P < 0.001) higher compared with MIBI uptake (5.5 +/- 3.1 vs 2.1 +/- 0.6); concordant MIBI and FDG images were found in 4 lesions in terms of central activity defect showing central necrotic tumor tissue. For lymph node abnormalities, planar MIBI scan only detected 3 lesions in 3 patients, whereas MIBI SPECT identified 9 lesions in 5 patients. FDG PET showed 13 lymph node abnormalities in 5 patients. This study shows similar results of Tc-99m MIBI SPECT and F-18 FDG PET in the diagnostic evaluation of patients with lung tumors. However, FDG lung tumor uptake was significantly higher compared with MIBI accumulation, suggesting a high glucose tumor metabolism. Thus, MIBI SPECT imaging may be useful to evaluate such patients and may be considered an alternative when PET is not available.
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Affiliation(s)
- H Wang
- Department of Nuclear Medicine, Università Federico II, Napoli, Italy
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26
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Ishibashi M, Hayashi A, Takamori S, Ohzono H, Morita S, Hayabuchi N. 99mTc tetrofosmin uptake in lung cancer. A case report. Acta Radiol 1996; 37:763-6. [PMID: 8915290 DOI: 10.1177/02841851960373p267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This case report describes a 71-year-old man with a lung tumor in the posterior inferior segment of the right lung, detected on a screening chest radiograph. The patient underwent myocardial imaging with 99mTc tetrofosmin and 201Tl, using single photon emission CT (SPECT), and the tumor showed intense focal uptake of the radiotracer. This observation supports the recent suggestion that 99mTc tetrofosmin may be useful for oncologic imaging of lung carcinoma, and further studies may be warranted.
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Affiliation(s)
- M Ishibashi
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
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27
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Mira ML, Popa N, Huysmans E, Lenaers A, Schoutens A. Tc-99m sestamibi SPECT imaging of a brain metastasis in a man with lung tumor and increased sexual activity. Clin Nucl Med 1996; 21:745-6. [PMID: 8879886 DOI: 10.1097/00003072-199609000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M L Mira
- Department of Cardiology, Free University of Brussels, Belgium
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Clarke CP. The emerging role of video-assisted thoracoscopic surgery in thoracic oncology. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1995; 21:422-3. [PMID: 7664911 DOI: 10.1016/s0748-7983(95)92780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- C P Clarke
- Thoracic Surgical Unit, Austin & Repatriation Medical Centre, Melbourne, Australia
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