PhD ceremony Mr. J.A. Stigt: Thoracic masses. From chest radiography and ultrasound guided biopsies to molecular biology

PhD ceremony: Mr. J.A. Stigt, 14.30 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Thoracic masses. From chest radiography and ultrasound guided biopsies to molecular biology

Promotor(s): prof. H.J.M. Groen

Faculty: Medical Sciences

This thesis describes explorative studies and case reports on diagnosing thoracic masses.

The diagnostic accuracy of endoscopic ultrasound (EUS) guided mediastinal lymph node sampling was compared with PET scintigraphy in restaging non-small cell lung cancer after treatment with concurrent chemoradiotherapy. An orthopedic application and a complication of EUS are described in case reports. The diagnostic performance of percutaneous ultrasound guided aspirations and biopsies was studied in patients suspected of having lung cancer. All lesions were detected with PET scintigraphy. The diagnostic accuracy of percutaneous ultrasound guided biopsies in the subcategory of patients with a mesothelioma (characterized by the absence of pleural effusion) was evaluated. The radiological and pathological characteristics of incidentally detected mediastinal lymphadenopathy on CT scans was described. A standardized diagnostic program for patients with an abnormal chest radiograph (suspected for lung cancer) was evaluated. Patients underwent PET scintigraphy in the morning followed by invasive diagnostics in the afternoon using bronchoscopy, EUS, EBUS and percutaneous ultrasound guided biopsies. Histological biopsies were compared with cytological samples (both obtained with EUS) for diagnosing masses as well as sub-typing malignancies and DNA analysis in case of adenocarcinoma. Two diagnostic strategies (pyrosequencing and HRM/Sanger sequencing) were compared in the mutation analysis of tumour DNA of archived EUS and EBUS samples. Finally, a review article describes all aspects relevant in diagnosing thoracic masses.