1. Pleural mesothelioma diagnosis for the pulmonologistAlberto Fantin, Nadia Castaldo, Ernesto Crisafulli, Giulia Sartori, Filippo Patrucco, Horiana B. Grosu, Paolo Vailati, Giuseppe Morana, Vincenzo Patruno, Stefano Kette, Avinash Aujayeb, Aleš Rozman, 2025, review article Abstract: Background/Objectives: Malignant pleural mesothelioma (MPM) is a rare, aggressive tumor with a poor prognosis and complex diagnostic pathways. Pulmonologists often play a central role in its initial recognition and investigation. This narrative review synthesizes the current evidence on the diagnostic approach to MPM, with emphasis on imaging, tissue sampling, histopathology, and emerging diagnostic innovations relevant to clinical pulmonology. Methods: English-language studies published between January 2005 and June 2025 were identified from PubMed and Scopus. International guidelines and consensus documents were also reviewed to provide an updated overview of diagnostic strategies. Results: Diagnosis of MPM relies on a stepwise integration of clinical, radiological, and pathological information. Thoracic ultrasound, computed tomography, positron emission computed tomography and magnetic resonance imaging complement each other across different stages of the diagnostic pathway. Image-guided pleural biopsy and medical thoracoscopy remain the gold standard for tissue confirmation, supported by immunohistochemistry and molecular testing. The 2021 World Health Organization classification of pleural tumors and the International Association Study of Lung Cancer 9th Edition Tumour-Node-Mestastatis system have refined histologic and staging criteria, thereby improving reproducibility and prognostic accuracy. Emerging tools, including liquid biopsy, novel serum and molecular biomarkers, artificial-intelligence-based radiomics, and breathomics, offer promise for earlier and less invasive diagnosis but require prospective validation. Conclusions: Current advances are redefining MPM diagnosis toward integrated, multidisciplinary, and precision-based models. Future priorities include standardizing diagnostic algorithms, validating minimally invasive biomarkers, and integrating AI and molecular profiling into clinical workflows to enhance patient stratification.
Published in DiRROS: 06.02.2026; Views: 653; Downloads: 227
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2. Characteristics and predictors of clinical outcome in patients with pleural effusions caused by heart, liver and renal failure: results from the ERS International Multicentre Pleural Research Collaborative (IMPACT) registryHugh Welch, Steven Walker, Jordy Kerkhoff, Julius Janssen, Silvia Bielsa, C Civit, José M. Porcel, K Fjaellegaard, J Petersen, U Bodtger, Elzbieta Magdalena Grabczak, Mohamed Ellayeh, Aleš Rozman, Mateja Marc-Malovrh, Rahul Bhatnagar, 2025, original scientific article Abstract: Introduction Pleural effusions caused by organ dysfunction are the commonest pleural disease and account for a huge healthcare burden. Previous work has demonstrated poor survival rates, but there is still uncertainty about determinants of prognosis. This study describes the characteristics and risk factors for poor outcomes in patients with pleural effusion secondary to organ failure in an international cohort. Methods The European Respiratory Society International Multicentre Pleural Research Collaborative (IMPACT) registry includes an international retrospective study of patients with effusions secondary to heart, liver or renal failure, collected from 10 countries in Europe and North and South America between 2019 and 2021. The data were analysed for associations between baseline patient characteristics and key clinical outcomes. Descriptive data were collected on treatments and complications. Results A total of 755 patients contributed data. Overall, 85.2% of effusions were classified as transudates by Light's criteria. 42% of effusions were bilateral. One-year mortality rates were 46% in renal, 35% in hepatic and 33% in cardiac effusions. Increased mortality was observed in neutrophil-predominant effusions (HR 2.001, 95% CI 1.202–3.349, p=0.008), with age (HR 1.013, 95 CI 1.002–1.024, p=0.02) and with N-terminal pro-brain natriuretic peptide >450 pg·mL−1 (HR 1.508, 95% CI 1.191–1.911) in patients with cardiac failure. Therapeutic thoracentesis was the most frequently employed pleural intervention; indwelling pleural catheter use was rare and associated with higher pleural infection rates than thoracentesis. Conclusion This study identifies prognostic factors in an international cohort of patients with transudative pleural effusions. Identification of these risk factors may support treatment approaches in a global population.
Published in DiRROS: 02.02.2026; Views: 334; Downloads: 287
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3. Fibulin-3 in plasma and pleural effusion as a biomarker of mesotheliomaKatja Adamič, Mateja Marc-Malovrh, Urška Bidovec, Aleš Rozman, 2025, original scientific article Abstract: Background: Malignant pleural mesothelioma (MPM) is a global health concern linked to asbestos exposure. In Slovenia, regions with high asbestos exposure rates make MPM a significant public health issue. Although thoracoscopic biopsy is the gold standard for MPM diagnosis, its invasiveness highlights the need for reliable, non-invasive diagnostic biomarkers. Patients and Methods: This prospective study evaluated the diagnostic potential of fibulin-3 as a biomarker for MPM, focusing on its ability to distinguish MPM from other pleural conditions, its association with disease stage and histological subtype, and its prognostic value for survival. 90 patients who underwent diagnostic thoracoscopic biopsy from January 2013 to October 2014 were included. Fibulin-3 levels in plasma and pleural effusion were measured using ELISA, and clinical data were analysed with statistical tests, including ROC analysis. Results: The study cohort comprised 32 patients with MPM, 24 with metastatic pleural carcinoma, and 34 with benign pleural diseases. Plasma fibulin-3 levels were significantly elevated (p = 0.0132) in MPM patients compared to those with benign pleural effusions due to asbestos exposure, with a cut-off of 12.31 ng/mL showing 100% specificity but low sensitivity (39.39%). Elevated fibulin-3 levels in pleural effusion correlated with advanced disease (p = 0.0463) and aggressive histological subtypes (p = 0.0324). No significant survival correlation was observed. Conclusions: While plasma fibulin-3 is a highly specific biomarker for MPM, its low sensitivity limits its standalone diagnostic utility. Its potential role in risk stratification and early detection in at-risk populations warrants further study.
Keywords: fibulin-3, asbestos, pleural effusion, mesothelioma, biomarker
Published in DiRROS: 18.06.2025; Views: 767; Downloads: 419
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4. Bronchial bacterial colonization and the susceptibility of isolated bacteria in patients with lung malignancyBojana Beović, Viktorija Tomič, Marko Bitenc, Mateja Marc-Malovrh, Vladimir Dimitrić, Dane Lužnik, Martina Miklavčič, Tamara Božič, Tina Gabrovec, Aleksander Sadikov, Aleš Rozman, 2025, original scientific article Abstract: Background Postoperative pneumonia (POP) remains a leading cause of mortality following lung surgery. Recent studies have confirmed that the respiratory tract below the vocal cords is not sterile and often harbours potentially pathogenic microorganisms (PPMs), putting patients with lung malignancies at an increased risk for pulmonary infections. Patients and methods The study analysed 149 patients who underwent bronchoscopy for lung lesions suspected to be lung cancer. Protected specimen brush (PSB) samples were obtained during bronchoscopy prior to any specific treatment. Bacterial identification and antimicrobial susceptibility testing were conducted on the isolated strains. Results Bacterial colonization was detected in 88.6% of patients, with 21.5% carrying PPMs. Notably, patients with type 2 diabetes exhibited a higher rate of PPM colonization compared to others. Antibiotic susceptibility testing showed no significant differences in efficacy between amoxicillin with clavulanic acid and first-generation cephalosporin in both colonized patients and those with PPMs. Importantly, no multidrug-resistant bacteria were identified. Conclusions Our findings indicate a slightly lower PPM colonization rate compared to previous studies, possibly due to the unique geographic characteristics of the study population. The absence of significant differences in bacterial susceptibility between the two tested antibiotics highlights the need for further research to refine perioperative infection management strategies.
Keywords: bronchial bacterial colonization, potentially pathogenic microorganisms, antibiotic prophylaxis
Published in DiRROS: 03.06.2025; Views: 806; Downloads: 489
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5. Endobronchial ultrasound elastography strain ratio for mediastinal lymph node diagnosisAleš Rozman, Mateja Marc-Malovrh, Katja Adamič, Tjaša Šubic, Viljem Kovač, Matjaž Fležar, 2015, original scientific article Keywords: cancer staging, elastography, endobronchial ultrasound, lung cancer, needle biopsy
Published in DiRROS: 23.04.2024; Views: 1576; Downloads: 829
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7. Angiogenin and vascular endothelial growth factor expression in lungs of lung cancer patientsAleš Rozman, Mira Šilar, Mitja Košnik, 2012, original scientific article Abstract: Background. Lung cancer is the leading cause of cancer deaths. Angiogenesis iscrucial process in cancer growth and progression. This prospective study evaluated expression of two central regulatory molecules: angiogenin and vascular endothelial growth factor (VEGF) in patients with lung cancer. Patients and methods. Clinical data, blood samples and broncho-alveolar lavage(BAL) from 23 patients with primary lung carcinoma were collected. BAL fluid was taken from part of the lung with malignancy, and from corresponding healthy side of the lung. VEGF and angiogenin concentrations were analysed by an enzyme-linked immunosorbent assay. Dilution of bronchial secretions in the BAL fluid was calculated from urea concentration ratio between serum and BAL fluid. Results. We found no statistical correlation between angiogenin concentrations in serum and in bronchial secretions from both parts of the lung. VEGF concentrations were greater in bronchial secretions in the affectedside of the lung than on healthy side. Both concentrations were greater than serum VEGF concentration. VEGF concentration in serum was in positive correlation with tumour size (p = 0,003) and with metastatic stage ofdisease (p = 0,041). There was correlation between VEGF and angiogenin concentrations in bronchial secretions from healthy side of the lung and between VEGF and angiogenin concentrations in bronchial secretions from part of the lung with malignancy. Conclusion. Angiogenin and VEGF concentrations insystemic, background and local samples of patients with lung cancer are affected by different mechanisms. Pro-angiogenic activity of lung cancer has an important influence on the levels of angiogenin and VEGF.
Published in DiRROS: 22.03.2024; Views: 1624; Downloads: 412
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8. Priporočila za obravnavo bolnikov s pljučnim rakomMartina Vrankar, Nina Boc, Izidor Kern, Aleš Rozman, Karmen Stanič, Tomaž Štupnik, Mojca Unk, Maja Ebert Moltara, Vesna Zadnik, Katja Adamič, Jernej Benedik, Marko Bitenc, Jasna But-Hadžić, Anton Crnjac, Marina Čakš, Dominik Časar, Eva Ćirić, Tanja Čufer, Ana Demšar, Rok Devjak, Goran Gačevski, Marta Globočnik Kukovica, Kristina Gornik-Kramberger, Maja Ivanetič Pantar, Marija Ivanović, Urška Janžič, Staša Jelerčič, Veronika Kloboves-Prevodnik, Mile Kovačević, Luka Ležaič, Mateja Marc-Malovrh, Katja Mohorčič, Loredana Mrak, Igor Požek, Nina Turnšek, Bogdan Vidmar, Dušanka Vidovič, Gregor Vlačić, Ana Lina Vodušek, Rok Zbačnik, Ivana Žagar, 2023, professional article Abstract: Leta 2019 so bila objavljena Priporočila za obravnavo bolnikov s pljučnim rakom, ki so v slovenski prostor vnesla prepotrebno poenotenje diagnostike in zdravljenja z namenom izboljšanja preživetja bolnikov s pljučnim rakom. Posodobitev Priporočil tri leta po izidu izvirnika prinaša največ novosti v poglavju o sistemskem zdravljenju bolnikov s pljučnim rakom. To kaže na izjemen napredek na področju razumevanja onkogeneze in biologije pljučnega raka ter s tem razvoja novih zdravil. Breme pljučnega raka ostaja veliko, saj je pljučni rak pri nas in v svetu še vedno najpogostejši vzrok smrti zaradi raka. Za vsako peto smrt zaradi raka je odgovoren pljučni rak. Skoraj tretjina bolnikov s pljučnim rakom ne prejme specifičnega onkološkega zdravljenja, bodisi zaradi slabega stanja zmogljivosti, spremljajočih bolezni ali obsega bolezni. Polovica bolnikov ima ob diagnozi razsejano bolezen, zaradi česar izboljšanje preživetja z malimi koraki sledi napredku v zdravljenju bolnikov s pljučnim rakom. Ti podatki nas opominjajo, da se bomo morali za velike premike v obravnavi bolnikov s pljučnim rakom lotiti drugačnih pristopov. Kot najbolj obetavno se ponuja zgodnje odkrivanje bolezni, ko so možnosti ozdravitve pljučnega raka najboljše. Zapisana Priporočila so usmeritev za obravnavo bolnikov s pljučnim rakom. Le s sodobnim multidisciplinarnim pristopom obravnave lahko bolniku ponudimo zdravljenje, ki mu omogoča najboljši izhod prognostično neugodne bolezni.
Keywords: pljučni rak, priporočila
Published in DiRROS: 27.07.2023; Views: 2421; Downloads: 981
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9. Priporočila za obravnavo bolnikov s pljučnim rakomMartina Vrankar, Nina Boc, Izidor Kern, Aleš Rozman, Karmen Stanič, Tomaž Štupnik, Mojca Unk, Maja Ebert Moltara, Vesna Zadnik, Katja Adamič, Jernej Benedik, Marko Bitenc, Jasna But-Hadžić, Anton Crnjac, Eva Ćirić, Tanja Čufer, Goran Gačevski, Marta Globočnik Kukovica, Kristina Gornik-Kramberger, Maja Ivanetič Pantar, Staša Jelerčič, Veronika Kloboves-Prevodnik, Mile Kovačević, Luka Ležaič, Mateja Marc-Malovrh, Katja Mohorčič, Bogdan Vidmar, Dušanka Vidovič, Gregor Vlačić, Ana Lina Vodušek, Rok Zbačnik, Ivana Žagar, 2022, not set Keywords: elektronske knjige
Published in DiRROS: 24.11.2022; Views: 2395; Downloads: 1086
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