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H. Jacobsson



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    P2.19 - Poster Session 2 - Imaging (ID 180)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P2.19-002 - Pulmonary tularemia: a rare disease which can be mistaken for lung cancer (ID 912)

      09:30 - 09:30  |  Author(s): H. Jacobsson

      • Abstract

      Background
      Acute infections can sometimes radiologically be suspected to be lung cancer. Only rarely are, however, the mediastinal lymph nodes enlarged. Tularemia is a disease in rodents caused by the bacterium Fransiscella tularensis but it can also infect humans if infective material is inhaled, and typically lung infiltrates and PET-positive nodes persist for a few months. We have not found any good description of this entity in the literature and therefore we describe three such cases.

      Methods
      During two years, three patients were referred for suspected lung cancer. One was a farmer and two who had cleaned out their summer house after the winter invasion of mice. PET investigation with [18]F-fluorodeoxyglycose (FDG) was strongly positive both in the "tumor" and in the enlarged mediastinal lymph nodes. Bronchoscopy showed inflammatory cells only.

      Results
      There was a spontaneous regression of the lesions during the investigations and serology proved the etiology.

      Conclusion
      Like the classical plague, there are two variants of tularemia: peripheral wounds or insect bites can cause the ulceroglandular form, with an ulceration and enlarged local lymph nodes nodes which can suppurate, and inhalation of infectious material (for example, mouse excrements) can cause a localized pulmonary infiltrate and enlarged mediastinal lymph nodes which will readily be mistaken for lung cancer. Diagnosis is by serology; treatment is mainly by tetracyclines, but by the time investigation is started the disease is usually already healing spontaneously. History is very important: has the patient has any contact with mice or other rodents or their droppings?

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    P2.20 - Poster Session 2 - Early Detection and Screening (ID 173)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P2.20-002 - Investigating suspected lung cancer: fast track in Stockholm (ID 356)

      09:30 - 09:30  |  Author(s): H. Jacobsson

      • Abstract

      Background
      Doctors´ delays can sometimes be very large in investigations of suspected lung cancer. The main problem seems to be the many steps involved, with delays at all levels. In order to speed up the process within the available limited resources we have in Stockholm constructed a “fast track”.

      Methods
      The majority of suspected lung cancers in the Northern Stockholm area are referred to the Lung Clinic in Solna from GP:s and other clinics. Patients who from this information were judged to suffer from potentially curable lung cancer were admitted to the fast track, where the first visit should occur within a week and the investigations (broncoscopy, PET-CT, spirometry etc) was planned by a special nurse within the next week.

      Results
      From December, 2009, to march, 2013, 219 patients, 109 women and 110 men, have been investigated. The mean age was 67 years (55-82). The mean time from referral to first visit was 6,1 days and 77% were seen within one week. From referral to treatment decision, the mean was 17.8 days. There were 149 primary lung cancers, thereof 105 adenocarcinomas, 18 squamous, and 13 small cell cancers. Stage I-II were 74, III 35, and IV 41. Surgery was performed on 65 patients, 17 of whom the diagnosis was made at surgery. Potentially curative radiotherapy or chemoradiotherapy was given in 44 patients. Three lymphomas, one sarcoma, and 6 metastases from earlier unknown cancers were also seen. Thus, 109 (73%) received a potentially curative therapy. Benign lesions were seen in 56 persons (26%), mostly hamartomas or infections but only one active TB. Two granulomas were operated. PET-CT also disclosed 6 concurrent and earlier unknown cancers in other organs among the cancer patients and in two with a benign diagnosis. During the period, approximately 900 primary lung cancers were diagnosed at the clinic, so about 17% went in the fast track, which was limited by available resources.

      Conclusion
      A fast track is feasible and possible even without added resources. PET-CT gives very valuable information on spread of disease but also other cancers.