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Objective To investigate the importance of a nomogram model based on biomarkers and CT signs in the prediction of the invasive risk of ground glass nodules. Methods A total of 322 patients with ground glass nodule, including 240 and 82 patients in the model and verification groups, respectively, were retrospectively analyzed. Independent risk factors for the invasive risk of ground glass nodules were screened out after using single and multiple Logistic analysis. R software was used to construct the nomogram model, and clinical decision curve analysis (DCA), receiver operating curve (ROC), and calibration curve were used for internal and external verification of the model. Results In this study, the independent risk factors for the invasive risk of ground glass nodules included systemic immune-inflammation index (SII), CYFRA21-1, edge, vascular cluster sign, and nodular consolidation tumor ratio (CTR). The area under the ROC curve of the constructed nomogram model had a value of 0.946, and that of the external validation group reached 0.932, which suggests the good capability of the model in predicting the invasive risk of ground glass nodules. The model was internally verified through drawing of calibration curves of Bootstrap 1000 automatic sampling. The results showed that the consistency index between the model and actual curves reached 0.955, with a small absolute error and good fit. The DCA curve revealed a good clinical practicability. In addition, nodule margin, vascular cluster sign, and CTR were correlated with the grade of pathological subtype of invasive adenocarcinoma. Conclusion A nomogram model based on biomarkers and CT signs has good value and clinical practicability in the prediction of the invasive risk of ground glass nodules.
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@#Objective To explore the predictive value of CT signs of mixed ground-glass nodules in the pathological subtype and differentiation of lung adenocarcinoma. Methods The clinical data of 66 patients with mixed ground-glass nodules pathologically diagnosed as invasive adenocarcinoma (IAC) in the Second Department of Thoracic Surgery, the First Affiliated Hospital of Xiamen University from May to December 2021 were retrospectively analyzed, including 20 males and 46 females, aged 35-75 years. The CT findings were analyzed before operation, and the lesion profile was cut after operation to distinguish the ground-glass and solid components, and the pathological results of different positions were obtained. According to the postoperative pathological results, the patients were divided into a low-risk group (containing adherent type and no components of micropapillary subtype and solid subtype, n=16), a medium-risk group (containing niple or acinar type and no components of micropapillary subtype and solid subtype, n=38), and a high-risk group (containing micropapillary or solid subtype, n=12). The relationships between CT features and the pathological subtype and degree of differentiation were analyzed and compared. Results In 66 patients with IAC, the infiltration degree of solid components was greater than that of ground-glass components. When the solid component ratio (CTR) was≥25% (sensitivity 90.2%, specificity 64.0%, P=0.005), and the average CT value was>−283.95 HU (sensitivity 82.9%, specificity 64.0%, P=0.000), the histological grade was more inclined to medium and low differentiation. The CTR, Ki-67, average CT value and histological grade of IAC in the medium- and high-risk groups were higher than those of nodules in the low-risk group. Conclusion The infiltration degree of solid components is higher than that of ground-glass components in IAC mixed ground-glass nodules. The pathological subtype, Ki-67 expression and histological grade of lung adenocarcinoma can be predicted according to its CT characteristics, which has important clinical significance for determining the timing of surgery.
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Objective@#To compare the difference in somatic gene mutation of PTC subtypes between 114 patients with papillary thyroid carcinoma (PTC) and The Cancer Genome Atlas (TCGA) database.@*Methods@#Totally 114 PTC patients admitted to The First Affiliated Hospital of Nanjing Medical University were recruited. The 18 hotspot genes associated with thyroid cancer were detected in thyroidectomy specimens were using next generation sequencing. PTC data were downloaded from the TCGA database in the cBioPortal website, and the difference in the somatic gene mutation was compared between 114 PTC patients and the TCGA database@*Results@#The 114 PTC patients included 73 women (64.04%) and had a mean age of (39.23±13.18) years. The prevalence of BRAF V600E (66.67% vs. 48.68%), TERTp (3.51% vs. 0.41%), PDGFRA (1.75% vs. 0%), PTEN (3.51% vs. 0.41%) and TP53 gene mutations (4.39% vs. 0.61%) was significantly higher among the 114 PCT patients than in the TCGA database (P<0.05). The prevalence of BRAF V600E (80.88% vs. 54.99%), TP53 (7.35% vs. 0.57%) and TSHR gene mutations (2.94% vs. 0%) was significantly higher in classical PTC(CPTC) patients than in the TCGA database, and the prevalence of BRAF V600E (36.84% vs.13.86%) and TERTp gene mutations (10.53% vs. 0%) was significantly higher in follicular variant PTC (FVPTC) patients than in the TCGA database. According to the American Thyroid Association Risk Stratification of Thyroid Cancer Recurrence, the prevalence of BRAF V600E and TP53 gene mutations was 77.14% and 8.57% among moderate-risk CPTC patients, the prevalence of BRAF V600E gene mutation was 27.27% among low-risk FVPTC patients, and the prevalence of TERTp gene mutation was 33.33% among moderate-risk FVPTC patients, which were all higher than in the TCGA database (55.10%, 0%, 3.28%, and 0%, respectively; P<0.05).@*Conclusion@#There are significant differences in the type and rate of somatic gene mutations between 114 PTC patients and the TCGA database.
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@#Whether anatomical segmentectomy can replace lobectomy in the treatment of early-stage lung cancer remains controversial. A large number of studies have been conducted for decades to explore whether pulmonary segmentectomy can treat early-stage lung cancer, which is actually to explore the indications of intentional segment-ectomy. With the development of scientific researches, it is found that many characteristics affect the malignancy of lung cancer, and the different grades of each characteristic affect the prognosis of patients. It is worth exploring whether different surgical approaches can be used for early-stage lung cancer with different characteristics and different grades. This article reviews the literature and studies to discuss the advances in indications of segmentectomy for early-stage lung in terms of tumor size, consolidation-to-tumor ratio, pathological classification and tumor location, respectively. The objective of this review is to help thoracic surgeons to objectively and scientifically select the surgical method according to the clinical characteristics of early-stage lung cancer.
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Objective:To investigate the clinic diagnostic value of multi-slice CT (MSCT) imaging features in various subtypes of nodular lung adenocarcinoma.Methods:The imaging information and general clinical data of 160 patients with nodular lung adenocarcinoma who were admitted to Yantai Affiliated Hospital of Binzhou Medical University and received surgical treatment from January 2017 to May 2019 were retrospectively analyzed. Univariate analysis was used to screen statistically significant imaging features of each pathological subtype, and binary logistic regression analysis was performed. The diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, the area under the curve (AUC) was calculated, and the diagnostic efficacy was compared.Results:The age of patients with atypical adenomatous hyperplasia and adenocarcinoma in situ (AAH+ AIS), minimally invasive ademocarcinoma (MIA), invasive adenocarcinoma cancer (IAC) and variant of invasive adenocarcinoma cancer (VIAC) were (57.07±7.92), (59.37±6.96), (60.68±8.83), (63.33±6.89) years old, with no statistically significant difference ( F=1.221, P=0.304). The age of patients with VIAC, IAC, MIA and AAH+ AIS decreased in turn. The imaging features of AAH+ AIS, MIA, IAC and VIAC that exhibited statistically significant differences were as following in turn: the maximum diameter of lesion [6.85 (3.73) mm vs. 8.00 (5.00) mm vs. 16.00 (11.90) mm vs. 17.20 (9.08) mm, H=55.107, P<0.001], CT value [-563.50 (176.63) HU vs. -536.00 (293.50) HU vs. -235.50 (346.50) HU vs. -23.00 (30.50) HU, H=47.499, P<0.001], solid ratio [0 (0) vs. 0 (0) vs. 49.00% (100.00%) vs. 100.00% (0), H=44.242, P<0.001], vacuolar sign [14 (87.50%) vs. 35 (100.00%) vs. 84 (81.55%) vs. 3 (50.00%), χ2=13.925, P=0.002], inflatable bronchus sign [1 (6.25%) vs. 2 (5.71%) vs. 36 (34.95%) vs. 2 (33.33%), χ2=16.578, P=0.001], intratumoral vascular sign [13 (81.25%) vs. 28 (80.00%) vs. 64 (62.14%) vs. 1 (16.67%), χ2=11.168, P=0.009], vessel convergence sign [1 (6.25%) vs. 3 (8.57%) vs. 66 (64.08%) vs. 6 (100.00%), χ2=54.232, P<0.001], short burr sign [3 (18.75%) vs. 11 (31.43%) vs. 77 (74.76%) vs. 6 (100.00%), χ2=36.218, P<0.001], lobulation sign [4 (25.00%) vs. 18 (51.43%) vs. 93 (90.29%) vs. 6 (100.00%), χ2=43.302, P<0.001], pleural traction sign [0 (0) vs. 6 (17.14%) vs. 70 (67.96%) vs. 5 (83.33%), χ2=50.794, P<0.001]. The maximum diameter of lesion ( OR=0.858, 95% CI: 0.754-0.977, P=0.021) and pleural traction sign ( OR=0.288, 95% CI: 0.084-0.993, P=0.049) were independent influencing factors of MIA. The maximum diameter of lesion ( OR=1.131, 95% CI: 1.030-1.241, P=0.010) and pleural traction sign ( OR=3.441, 95% CI: 1.279-9.254, P=0.014) were independent influencing factors of IAC. The optimum threshold of the maximum diameter of lesion in diagnosis of MIA was 11.05 mm, AUC was 0.798 (95% CI: 0.724-0.872) sensitivity was 68.00%, and specificity was 85.70%. The AUC of pleural traction sign in diagnosis of MIA was 0.714 (95% CI: 0.623-0.806). The diagnostic efficacy exhibited no statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of MIA ( Z=1.838, P=0.066). The optimum threshold of the maximum diameter of lesion in diagnosis of IAC was 11.05 mm, AUC was 0.827 (95% CI: 0.759-0.895), sensitivity was 75.70%, and specificity was 78.90%. The AUC of pleural traction sign in diagnosis of IAC was 0.743 (95% CI: 0.663-0.823). The diagnostic efficacy exhibited statistically significant difference between the maximum diameter of lesion and pleural traction sign in diagnosis of IAC ( Z=2.114, P=0.035), and the maximum diameter of lesion > 11.05 mm was better for the diagnosis of IAC. Conclusion:The maximum diameter of lesion and pleural traction sign are independent influence factors in diagnosis of MIA and IAC, and the maximum diameter of lesion > 11.05 mm is better for the diagnosis of IAC.
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Objective To investigate the clinicopathologic characteristics,immunophenotype,differential diagnosis,and prognostic factors of gonadal diffuse large B-cell lymphoma(DLBCL).Methods The clinicopathologic data of 10 patients with gonadal DLBCL including morphology and immunohistochemistry were analyzed retrospectively,then the literature was reviewed.Results Among 10 patients,9 cases were testicular DLBCL,and the median age was 67 years old(40-85 years old); 1 case was ovary DLBCL,and the age was 46 years old.Tumor cells were large to medium-sized under the optical microscope,which were characterized as diffuse infiltration around the duct and the remaining convoluted tubule of testis neoplasms.Most DLBCL(70%,7/10)immunophenotype analysis showed non-germinal center B-cell(non-GCB)type.Patients were followed up from 6 to 103 months,and 2 patients lost follow-up.The survival number of patients in 1-year,3-year,and 5-year was 4,2,2 respectively.Conclusions Primary gonadal DLBCL is an uncommon extranodal lymphoma,which mainly belongs to non-GCB type with poor prognosis.Comprehensive treatments usually take operation and chemotherapy,and the prognosis should be evaluated by multiple factors.
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Objective To investigate the clinicopathologic characteristics,immunophenotype,differential diagnosis,and prognostic factors of gonadal diffuse large B-cell lymphoma(DLBCL).Methods The clinicopathologic data of 10 patients with gonadal DLBCL including morphology and immunohistochemistry were analyzed retrospectively,then the literature was reviewed.Results Among 10 patients,9 cases were testicular DLBCL,and the median age was 67 years old(40-85 years old); 1 case was ovary DLBCL,and the age was 46 years old.Tumor cells were large to medium-sized under the optical microscope,which were characterized as diffuse infiltration around the duct and the remaining convoluted tubule of testis neoplasms.Most DLBCL(70%,7/10)immunophenotype analysis showed non-germinal center B-cell(non-GCB)type.Patients were followed up from 6 to 103 months,and 2 patients lost follow-up.The survival number of patients in 1-year,3-year,and 5-year was 4,2,2 respectively.Conclusions Primary gonadal DLBCL is an uncommon extranodal lymphoma,which mainly belongs to non-GCB type with poor prognosis.Comprehensive treatments usually take operation and chemotherapy,and the prognosis should be evaluated by multiple factors.
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Objective To evaluate the difference between nodal and extra-nodal diffuse large B-cell lymphoma (DLBCL) in clinical-pathological feature and prognosis.Methods The clinical data of 134 cases of DLBCL patients were reviewed and analyzed.Results The DLBCL patients accounted for 52.14 ％ (134/257) of non-Hodgkin lymphoma of the same period and the extra-nodal DLBCL patients accounted for 69.4 ％.The proportion of stage Ⅲ/Ⅳ disease in extra-nodal DLBCL and nodal DLBCL were 55.9 ％ (52/93) and 75.6 ％(31/41),respectively.Elevated LDH was reported in 33.3 ％ (31/93) of extra-nodal DLBCL and 58.5 ％ (24/41)of nodal DLBCL Other clinical characteristics such as B symptoms,bulky disease,elevated ESR,ECOG scores and IPI scores were not significantly different between these two groups (all P ＞ 0.05).No difference in the frequency of GCB and non-GCB subtypes was observed between extra-nodal and nodal DLBCL (P =0.623).The 3-year overall survival rates and 3-year progression free survival rates for extra-nodal and nodal DLBCL were 73.2 ％,55.2 ％ (P =0.065) and 46.3 ％,44.1％ (P =0.748).Conclusions The morbidity of extranodal DLBCL is high.Primary extra-nodal DLBCL patients present early-stage disease and normal LDH more frequently than the nodal DLBCL,while no significant difference in the frequency of pathological subtypes and 3-year OS and PFS is observed between these two groups.
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Objective To investigate the clinical characteristics of primary thyroid lymphoma(PTL) and its prognostic factors.Methods Clinical and pathological data of 7 cases diagnosed as primary thyroid lymphoma were retrospectively analyzed.Results All of the 7 patients were diagnosed on thyroidectomy and presented with thyroid nodules,of whom 6 cases were middle-aged to elderly women and some had locally oppressive symptoms.Four cases were diagnosed as diffuse large B non-Hodgkin's lymphoma (DLBCL) and 3 were mucosa-associated lymphoid tissue B-cell lymphoma (MALT).Pathological subtype of mucosa-associated lymphoid tissue B-cell lymphomas and younger patients had better prognosis.Conclusion The possibility of PTL must be kept in mind in the differential diagnosis of thyroid nodules in middle-aged to elderly women.Age and pathological subtype are important prognostic factors.