Local imaging to interpret tumor size in F18 fluorodeoxyglucose positron emission tomography/CT in lung cancers

SUMMARY OBJECTIVE: This study aimed to determine the thoracic and extra-thoracic extension of the disease in patients diagnosed with lung cancer and who had whole-body F18-fluorodeoxyglucose positron emission tomography/CT imaging and to investigate whether there is a relationship between tumor size and extrathoracic spread. METHODS: A total of 308 patients diagnosed with lung cancer were included in this study. These 308 patients were first classified as group 1 (SPN 30 mm>longest lesion diameter ≥10 mm) and group 2 (lung mass (longest lesion diameter ≥30 mm), and then the same patients were classified as group 3 (nodular diameter of ≤20 mm) and group 4 (nodular size of >20 mm). Group 1 was compared with group 2 in terms of extrathoracic metastases. Similarly, group 3 was compared with group 4 in terms of frequency of extrathoracic metastases. F18 fluorodeoxyglucose positron emission tomography/CT examination was used to detect liver, adrenal, bone, and supraclavicular lymph node metastasis, besides extrathoracic metastasis. RESULTS: Liver, bone, and extrathoracic metastasis in group 1 was statistically lower than in group 2 (p<0.001, p<0.01, and p=0.03, respectively). Liver, extrathoracic, adrenal, and bone metastasis in group 3 was statistically lower than that in group 4 (p<0.001, p=0.01, and p=0.04, p<0.01, respectively). The extrathoracic extension was observed in only one patient in group 3. In addition, liver, adrenal, and bone metastases were not observed in group 3 patients. CONCLUSION: Positron emission tomography/CT may be more appropriate for cases with a nodule diameter of ≤20 mm. Performing local imaging in patients with a nodule diameter of ≤20 mm could reduce radiation exposure and save radiopharmaceuticals used in positron emission tomography/CT imaging.

Detection of subsolid nodules on chest CT scans during the COVID-19 pandemic / Detecção de nódulos subsólidos na TC de tórax durante a pandemia de COVID-19

ABSTRACT Objective: To investigate the detection of subsolid nodules (SSNs) on chest CT scans of outpatients before and during the COVID-19 pandemic, as well as to correlate the imaging findings with epidemiological data. We hypothesized that (pre)malignant nonsolid nodules were underdiagnosed during the COVID-19 pandemic because of an overlap of imaging findings between SSNs and COVID-19 pneumonia. Methods: This was a retrospective study including all chest CT scans performed in adult outpatients (> 18 years of age) in September of 2019 (i.e., before the COVID-19 pandemic) and in September of 2020 (i.e., during the COVID-19 pandemic). The images were reviewed by a thoracic radiologist, and epidemiological data were collected from patient-filled questionnaires and clinical referrals. Regression models were used in order to control for confounding factors. Results: A total of 650 and 760 chest CT scans were reviewed for the 2019 and 2020 samples, respectively. SSNs were found in 10.6% of the patients in the 2019 sample and in 7.9% of those in the 2020 sample (p = 0.10). Multiple SSNs were found in 23 and 11 of the patients in the 2019 and 2020 samples, respectively. Women constituted the majority of the study population. The mean age was 62.8 ± 14.8 years in the 2019 sample and 59.5 ± 15.1 years in the 2020 sample (p < 0.01). COVID-19 accounted for 24% of all referrals for CT examination in 2020. Conclusions: Fewer SSNs were detected on chest CT scans of outpatients during the COVID-19 pandemic than before the pandemic, although the difference was not significant. In addition to COVID-19, the major difference between the 2019 and 2020 samples was the younger age in the 2020 sample. We can assume that fewer SSNs will be detected in a population with a higher proportion of COVID-19 suspicion or diagnosis.

RESUMO Objetivo: Investigar a detecção de nódulos subsólidos na TC de tórax de pacientes ambulatoriais antes e durante a pandemia de COVID-19, bem como correlacionar os achados de imagem com dados epidemiológicos. Nossa hipótese foi a de que nódulos não sólidos (pré) malignos foram subdiagnosticados durante a pandemia de COVID-19 em virtude da sobreposição de achados de imagem de nódulos subsólidos e pneumonia por COVID-19. Métodos: Estudo retrospectivo no qual foram incluídas todas as imagens de TC de tórax realizadas em pacientes ambulatoriais adultos (com idade > 18 anos) em setembro de 2019 (antes da pandemia de COVID-19) e em setembro de 2020 (durante a pandemia de COVID-19). As imagens foram reavaliadas por um radiologista torácico, e os dados epidemiológicos foram extraídos de questionários preenchidos pelos pacientes e de encaminhamentos clínicos. Modelos de regressão foram usados para controlar fatores de confusão. Resultados: Foram reavaliadas 650 e 760 imagens de TC de tórax nas amostras de 2019 e 2020, respectivamente. Foram encontrados nódulos subsólidos em 10,6% dos pacientes que compuseram a amostra de 2019 e em 7,9% daqueles que compuseram a amostra de 2020 (p = 0,10). Nódulos subsólidos múltiplos foram encontrados em 23 e 11 dos pacientes que compuseram as amostras de 2019 e 2020, respectivamente. As mulheres constituíram a maioria da população do estudo. A média de idade foi de 62,8 ± 14,8 anos na amostra de 2019 e de 59,5 ± 15,1 anos na amostra de 2020 (p < 0,01). A COVID-19 foi responsável por 24% de todos os encaminhamentos para a realização de TC em 2020. Conclusões: Foram detectados menos nódulos subsólidos na TC de tórax de pacientes ambulatoriais durante a pandemia de COVID-19 do que antes da pandemia, embora a diferença não tenha sido significativa. Além da COVID-19, a principal diferença entre as amostras de 2019 e 2020 foi o fato de que a amostra de 2020 era mais jovem. Podemos supor que menos nódulos subsólidos serão detectados numa população com maior proporção de suspeita ou diagnóstico de COVID-19.

Added value of PET Bayesian penalized likelihood reconstruction algorithm in the diagnosis of solitary pulmonary nodules/masses / 中华核医学与分子影像杂志

Objective:To investigate the effects of silicon photomutipliers (SiPM) detector and Bayesian penalized likelihood (BPL) reconstruction algorithm on semiquantitative parameters of 18F-FDG PET/CT and diagnostic efficiency for solitary pulmonary nodules/masses compared with traditional photomultiplier tube (PMT) and ordered subsets expectation maximization (OSEM). Methods:From March 2020 to January 2022, 118 patients (76 males, 42 females, age (63.0±10.1) years) newly diagnosed with solitary pulmonary nodules/masses in First Hospital of Shanxi Medical University were prospectively enrolled and underwent 18F-FDG PET/CT imaging with two different PET/CT scanners successively. The images were divided into PMT+ OSEM, SiPM+ OSEM and SiPM+ BPL groups according to PET detector and reconstruction algorithms. The SUV max, SUV mean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of pulmonary nodules/masses were measured, then signal-to-noise ratio (SNR) and signal-to-background ratio (SBR) were calculated. One-way analysis of variance and Kruskal-Wallis rank sum test were performed to compare differences of above parameters among groups. ROC curve analysis was used to analyze the optimal threshold of SUV max for the differential diagnosis of pulmonary nodules/masses and AUCs were obtained. Results:There were 83 malignant nodules and 35 benign nodules. The image quality of SiPM+ BPL group (4.23±0.64) was better than that of SiPM+ OSEM group (3.57±0.50) or PMT+ OSEM group (3.58±0.51; F=54.85, P<0.001). There were significant differences in SUV max (7.57(3.86, 15.61) vs 4.95(2.22, 10.48)), SUV mean (4.43(2.28, 9.12) vs 2.84(1.21, 5.71)), MTV (3.54(1.57, 7.67) vs 5.09(2.83, 11.79)), SNR (28.12(12.55, 54.38) vs 20.16(8.29, 41.45)) and SBR (4.03(1.83, 7.75) vs 2.32(0.96, 5.03)) between SiPM+ BPL and SiPM+ OSEM groups ( H values: 16.63-37.05, all P<0.001). The optimal threshold values of SUV max in SiPM+ BPL, SiPM+ OSEM and PMT+ OSEM were 3.31, 2.21, 2.05 with AUCs of 0.686, 0.689, 0.615 for nodules < 2 cm, and were 10.29, 6.49, 4.33 with AUCs of 0.775, 0.782, 0.774 for nodules/masses ≥2 cm. Conclusions:Image quality and parameters of pulmonary nodules/masses are mainly affected by the reconstruction algorithms. BPL can improve SUV max, SUV mean, SBR and SNR, but reduce MTV without significant effect on liver parameters. SiPM+ BPL has a higher diagnostic threshold of SUV max than SiPM+ OSEM and PMT+ OSEM.

Application value of CT plain scan and dynamic enhanced scan in the diagnosis of solitary pulmonary nodules / 中国医师杂志

Objective:To explore the application value of computed tomography (CT) plain scan and dynamic enhanced scan in the diagnosis of solitary pulmonary nodules.Methods:The clinical data of 120 patients with solitary pulmonary nodules detected by physical examination in Baoding First Central Hospital from January 2018 to December 2020 were retrospectively reviewed. All patients were confirmed by surgery and pathology, including 77 benign lesions and 43 malignant lesions; All patients underwent CT plain scan and dynamic enhanced scan before operation. The accuracy of the two examination methods in the diagnosis of benign and malignant lesions of solitary pulmonary nodules was analyzed and compared. The detection rate of CT dynamic enhanced scan imaging characteristics (vacuole sign, ground glass sign, spinous sign, lobulation sign, hair prick sign, blood vessel cluster, pleural depression) of benign and malignant lesions of solitary pulmonary nodules was compared, and the diagnostic value of CT plain scan and dynamic enhanced scan in the differential diagnosis of benign and malignant solitary pulmonary nodules was evaluated based on the results of surgical pathological diagnosis. The manifestations and characteristic curves of CT dynamic enhanced scan of solitary pulmonary nodules was analyzed.Results:The diagnostic accuracy of CT dynamic enhanced scan for solitary pulmonary nodules was 80.00% (96/120), which was higher than that of CT plain scan (63.33%) (76/120) ( P<0.05). The sensitivity, specificity, and negative predictive value of CT dynamic enhanced scan for the diagnosis of benign and malignant lesions of solitary pulmonary nodules were higher than those of CT plain scan (all P<0.05). Among the imaging characteristics of CT dynamic enhanced scans of malignant lesions, the ground glass sign, spinous process sign, lobulation sign, spiculation sign, vascular clustering and pleural indentation were detected more frequently than those of benign lesions (all P<0.05). Benign lesions usually showed homogeneous enhancement, and a few showed heterogeneous enhancement; Malignant nodules often showed uneven enhancement, and a few had even enhancement. The time density curves of dynamic enhanced CT values in the regions of interest of benign and malignant solitary pulmonary nodules were different. Conclusions:The value of dynamic enhanced CT scan in the differential diagnosis of benign and malignant lesions of solitary pulmonary nodules is higher than that of CT plain scan, and the imaging features are obvious, with higher sensitivity and specificity, which is worthy of application.

Diagnostic value of thin-layer three-dimensional reconstruction technology combined with personalized scanning for benign and malignant solid solitary pulmonary nodules / 中国基层医药

Objective:To investigate the diagnostic value of thin-layer three-dimensional reconstruction technology combined with personalized scanning for benign and malignant solid solitary pulmonary nodules.Methods:The clinical data of 140 patients with solid solitary pulmonary nodules admitted to Jiangshan People's Hospital form January 2020 to July 2021 were retrospectively analyzed. These patients consisted of 40 patients with benign solid solitary pulmonary nodules (benign group) and 100 patients with malignant solid solitary pulmonary nodules (malignant group). All patients underwent thin-layer three-dimensional reconstruction combined with personalized scanning. The pulmonary nodule signs achieved by thin-layer three-dimensional reconstruction combined with personalized scanning and the diagnostic performance of the combined technology were compared between benign and malignant groups.Results:The proportions of patients with lung cavity sign, lobular sign, vascular convergence sign, vacuole sign, emphysema distribution sign, split pleura sign, and distal perforating vascular sign in the malignant group were 11.0%, 81.0%, 77.0%, 49.0%, 6.0%, 10.0% and 31.0%, respectively, and they were 42.5%, 62.5%, 55.0%, 27.5%, 20.0%, 32.5%, and 5.0%, respectively in the benign group ( χ2 = 15.80, 5.00, 5.66, 4.55, 4.76, 8.96, 9.33, all P < 0.05). The most sensitive sign was lobular sign, which had the highest efficiency, up to 82.0%, in differentiating benign and malignant pulmonary nodules. Conclusion:Lung cavity sign, lobular sign, vascular convergence sign, vacuole sign, emphysema distribution sign, split pleura sign, and distal perforating vascular sign differ greatly between patients with benign and malignant solid solitary pulmonary nodules. Lobular sign has the highest sensitivity in differentiating benign and malignant solid solitary pulmonary nodules. Thin-layer three-dimensional reconstruction combined with personalized scanning has a diagnostic value for benign and malignant solid solitary pulmonary nodules.

Evaluation of Enhancement Pattern of Malignant Lung Lesion During Contrast Enhanced Computed Tomography - Cross Sectional Study.

Background: At present, lung cancer is a leading cause of cancer death in the world. Most of the patients are asymptomatic at the early stages of the disease and manifest at the advanced stage. It is broadly classified into two types based on histopathology, Non-small cell lung cancer (NSCLC), the predominant type, and Small cell lung cancer (SCLC). Â Our study aimed to evaluate the enhancement pattern of malignant lung lesion during contrast-enhanced computed tomography. Methodology: A cross-sectional study was conducted on 34 patients with lung cancer after clearance from the Institutional Ethical Committee. Contrast enhanced computed tomography (CECT) Thorax was performed by 16 slice Multi-Detector computed tomography (MDCT )machine, and the tumor's pre and post-contrast Hounsfield Unit (HU) value was measured in the area of highest density. Results: Out of the 34 patients, Squamous cell carcinoma and adenocarcinoma were seen in 15 patients in each group, whereas small cell carcinoma was found in 4 patients. Pre and post-contrast mean HU value was 39.5 (SD= 2.95) HU and 72.13 (SD= 4.21) HU for adenocarcinoma, 34.6 (SD=2.61) HU and 63.8(SD=2.88) HU for squamous cell carcinoma and 31.00 (SD=1.41) HU and 55.7 (SD=2.75) HU for small cell carcinoma. The significant of density difference was measured using paired t-test (p<0.05). Conclusion: All histopathological subtypes of lung cancer showed significant post-contrast enhancement (>20HU) during the CECT study. Evaluation of enhancement pattern of lung mass by measuring pre and post-contrast HU value will help the radiologist to predict the histopathological type of lung cancer.

Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review

ABSTRACT Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.

Value of 18F-FDG uptake features in differential diagnosis of benign and malignant solitary pulmonary lesions / 中华核医学与分子影像杂志

Objective:To evaluate the value of 18F-FDG uptake features in differential diagnosis of benign and malignant solitary pulmonary lesions. Methods:A total of 274 patients (181 males, 93 females, age: (61.0±10.2) years) with solitary pulmonary lesions who underwent 18F-FDG PET/CT between September 2010 and March 2017 were retrospectively analyzed. The 18F-FDG uptake features of lesions were divided into 5 types: full uptake (Group A), circular uptake (Group B), multi-focus uptake (Group C), mild uptake (Group D) and no-uptake (Group E). According to the pathology or follow-up results, the incidences of benign and malignant lesions in each group were analyzed. The diagnostic efficiencies of 18F-FDG uptake feature classification(A+ B=malignancy, C+ D+ E=benign) and SUV method (lesions with SUV max≥2.5 was taken as the malignancy) were calculated. χ2 test and ROC curve were used to analyze the data. Results:The malignant incidences of Groups A-E were 86.25%(138/160), 71.05%(27/38), 31.25%(10/32), 43.48%(10/23) and 14.29%(3/21), respectively ( χ2=79.49, P<0.001), and the rate of Group A was the highest ( χ2 values: 5.11-55.84, all P<0.05). There were significant differences in the malignancy incidence between A+ B group and C+ D+ E group (83.33%(165/198) vs 30.26%(23/76)), and between SUV max≥2.5 group and SUV max<2.5 group (76.09%(175/230) vs 29.55%(13/44); χ2 values: 71.83 and 37.15, both P<0.001). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the 18F-FDG uptake feature classification and the SUV method were 87.77%(165/188) vs 93.09%(175/188), 61.63%(53/86) vs 36.05%(31/86), 79.56%(218/274) vs 75.18%(206/274), 83.33%(165/198) vs 76.09%(175/230), 69.74%(53/76) vs 70.45%(31/44), respectively. ROC curve analysis showed that the diagnostic accuracy of the 18F-FDG uptake feature classification was higher than that of SUV method (AUCs: 0.747, 0.646; Z=4.05, P<0.001). Conclusions:18F-FDG uptake feature classification can improve the diagnostic specificity and accuracy of solitary pulmonary lesions. The multi-focus uptake feature maybe a sign of benign lesions, which still needs more researches to confirm.

Características clinicopatológicas de nódulos pulmonares: Experiencia en Clínica Reina Sofía, Bogotá, Colombia / Clinicopathological characteristics of pulmonary nodules: Experience at Clínica Reina Sofía, Bogotá, Colombia

Introducción. El cáncer de pulmón es la primera causa de mortalidad por cáncer a nivel mundial, lo que hace que sea considerado un problema de salud pública. Existen diferentes hallazgos imagenológicos que hacen sospechar la presencia de cáncer de pulmón, uno de los cuales son los nódulos pulmonares; sin embargo, estos también pueden verse en entidades benignas.Métodos. Se incluyeron 66 pacientes con biopsia de nódulo pulmonar en la Clínica Reina Sofía, en la ciudad de Bogotá, D.C., Colombia, entre el 1° de marzo del 2017 y el 28 de febrero del 2020. Se analizaron las características demográficas de los pacientes, las características morfológicas e histopatológicas de los nódulos pulmonares y la correlación entre sus características imagenológicas e histopatológicas. Resultados. El 69,2 % de los nódulos estudiados tenían etiología maligna, de estos el 55,5 % era de origen metástasico y el 44,5 % eran neoplasias primarias de pulmón, con patrón sólido en el 70,6 % de los casos. El patrón histológico más frecuente fue adenocarcinoma. Respecto a las características radiológicas, en su mayoría los nódulos malignos medían de 1 a 2 cm, de morfología lisa y distribución múltiple, localizados en lóbulos superiores. Conclusiones. La caracterización de los nódulos pulmonares brinda información relevante que orienta sobre los diagnósticos más frecuentes en nuestro medio, cuando se estudian nódulos sospechosos encontrados incidentalmente o en el seguimiento de otro tumor. Como el nódulo es la manifestación del cáncer temprano del pulmón, establecer programas de tamización que permitan el diagnóstico oportuno, es hoy día una imperiosa necesidad, para reducir la mortalidad.

Introduction. Lung cancer is the leading cause of cancer mortality worldwide, which makes it a public health problem. There are different imaging findings that suggest the presence of lung cancer, one of which is pulmonary nodules; however, these can also be seen in benign entities. Methods. A total of 66 patients with pulmonary nodule biopsy at Clínica Reina Sofía, in the city of Bogotá D.C. were included between March 1, 2017 and February 28, 2020. The demographic characteristics of the patients, the morphologic and histopathologic characteristics of the pulmonary nodules and their correlation with their pathological diagnosis were analyzed.Results. 69.2% of the nodules studied had malignant etiology, of these 55.5% were of metastatic origin, and 44.5% were primary lung neoplasms, with a solid pattern in 70.6% of the cases. The most frequent histological pattern was adenocarcinoma. Regarding the radiological characteristics, most of the malignant nodules measure 1 to 2 cm, of smooth morphology and had multiple distribution, located in the upper lobes. Conclusions. The characterization of pulmonary nodules provides relevant information that guides the most fre-quent diagnoses in our setting, when suspicious nodules found incidentally or in the follow-up of another tumor are studied. As the nodule is the manifestation of early lung cancer, establishing screening programs that allow timely diagnosis is an urgent need to reduce mortality.

Incidental lung findings in coronary computed tomography angiography

SUMMARY OBJECTIVE: In coronary computed tomography angiography, a part of the lung parenchyma also enters the image area which is called the field of view. The aim of this study was to evaluate the rate of pulmonary abnormalities and document their association with demographic features in subjects undergoing multislice coronary computed tomography angiography obtained for the assessment of coronary artery disease. METHODS: This was a retrospective observational study evaluating the coronary computed tomography angiography scans of 1,050 patients (58.5% males and 47.3% smokers) with a mean age of 52.2±11.2 years, obtained between January 2018 and March 2020. Pulmonary abnormalities were reported as nodules, focal consolidations, ground-glass opacities, consolidations, emphysema, cysts, bronchiectasis, atelectasis, and miscellaneous. RESULTS: In total, 274 pulmonary abnormalities were detected in 266 patients (25.3%). The distribution of incidental lung findings was as follows: pulmonary nodules: 36.4%, emphysema: 15.6%, bronchiectasis: 11%, ground-glass opacities: 7.2%, atelectasis 7.2%, focal consolidations: 5%, cysts: 6%, consolidations: 2.5%, and miscellaneous: 9.1%. The patients with pulmonary pathology were older (55.5±11.4 versus 51.0±10.9 years), and the percentage of smokers was higher (60.1 versus 43.2%). The possibility of the presence of any incidental lung findings in field of view of coronary computed tomography angiography increases significantly over the age of 40.5 years (p<0.001, AUC 0.612, 95%CI 0.573-0.651). CONCLUSION: Multislice coronary computed tomography angiography can give important clues regarding pulmonary diseases. It is essential for the reporting radiologist to review the entire scan for pulmonary pathological findings especially in patients with smoking history and over the age of 40.5 years.

Nódulo pulmonar / Pulmonary nodule

Introducción: El nódulo pulmonar es un hallazgo generalmente incidental. Su detección ha aumentado observándose hasta en 13 por ciento de las tomografías. El diagnóstico diferencial plantea un desafío. Objetivo: Describir el caso de un paciente con nódulos pulmonares múltiples y su abordaje a partir de recomendaciones basadas en la evidencia. Caso clínico: Se presenta el caso de un paciente de 35 años con sintomatología inespecífica y nódulos pulmonares múltiples incidentales en estudios cervicotorácicos. Se analizaron etiologías posibles según datos clínicos, epidemiológicos, radiológicos y probabilidad de malignidad. Las recomendaciones basadas en la evidencia dirigieron el manejo. Dada la probabilidad intermedia de malignidad se indicó seguimiento escanográfico en 3 a 6 meses. Conclusiones: El caso presentado pretende reforzar destrezas clínicas en el manejo de esta entidad repercutiendo favorablemente en la morbimortalidad. Busca además impulsar el desarrollo de estrategias de tamizaje en poblaciones de riesgo(AU)

Introduction: The pulmonary nodule is a generally incidental finding. Its detection has increased, being observed in up to 13 percent of CT scans. Differential diagnosis poses a challenge. Objective: To describe the case of a patient with multiple pulmonary nodules and the approach to it based on evidence-based recommendations. Clinical case report: The case of a 35-year-old patient with nonspecific symptoms and incidental multiple pulmonary nodules in cervicothoracic studies is reported. Possible etiologies were analyzed according to clinical, epidemiological, radiological data and probability of malignancy. Evidence-based recommendations guided management. Given the intermediate probability of malignancy, a scan follow-up was indicated in 3 to 6 months. Conclusions: This case aims to reinforce clinical skills in the management of this entity, favourably impacting on morbidity and mortality. It also seeks to promote the development of screening strategies in populations at risk(AU)

Influencing factors of benign and malignant diagnosis in 317 cases of solitary pulmonary nodule treated with thoracoscopic resection / 中国医师进修杂志

Objective:To retrospectively analyze the efficacy of video-assisted thoracoscopic surgery (VATS) in the treatment of solitary pulmonary nodule (SPN) and related factors affecting the diagnosis of benign and malignant SPN.Methods:The clinical data and surgical conditions of 317 patients with SPN who were resected by VATS and diagnosed by pathology in Chaoyang Central Hospital from January 2017 to December 2019 were retrospectively analyzed.The patient′s surgical efficacy and corresponding imaging features were explored.Results:Of the 317 patients, 124 (39.1%) cases underwent uniportal VATS and 193(60.9%) cases underwent multi-portal-portal VATS, 195(61.5%) cases had lobectomy, 16(5.1%) cases had anatomical segmentectomy, and 106(33.4%) cases had wedge resection. The operation time of the whole group was 50 - 210 (146.5 ± 34.7) min, intraoperative blood loss was 10 - 180 (69.3 ± 31.5) ml, thoracic drainage tube retention time was 2 - 7 (3.7 ± 1.4) d, postoperative hospital stay was 3 - 21 (6.4 ± 1.8) d, and the complication rate was 1.0%(3/317). No perioperative death occurred. Among all the nodules, 98(31.0%) cases were benign nodules and 219(69.1%) cases were malignant. Multivariate analysis showed that maximum nodule diameter, lobulated sign, burr sign, vascular bundle sign and pleural sag sign were independent related factors for the diagnosis of benign and malignant nodules ( P<0.05). Conclusions:VATS has less trauma and fewer complications, which has important clinical value for the diagnosis and treatment of benign and malignant SPN. Nodule maximum diameter, lobulated sign, burr sign, vascular bundle sign, pleural pit sign are independent related factors that affect the diagnosis of benign and malignant SPN.

Value of Combined Detection of Cytokines and Tumor Markers in the Differential Diagnosis of Benign and Malignant Solitary Pulmonary Nodules / 中国肺癌杂志

BACKGROUND@#Solitary pulmonary nodule has received increasing attention in recent years. A couple of lung nodules have been recognized as primary malignant tumors, which leads to an urgent need in enhancing the diagnosis of benign/malignant lung nodules at clinical settings. This study aims to explore the value of the combined detection of cytokines and tumor markers in differencing benign and malignant solitary pulmonary nodules in diagnose.@*METHODS@#With 81 solitary pulmonary nodules cases with a clear diagnosis, the general clinical data, nodule imaging features, pathological diagnosis data, serological index cytokine series and tumor marker expression levels were collected in groups. Both single factor and multi-factors analysis were conducted to screen out the serum influence indexes that can predict the malignant probability of lung nodules, and mean while binary logistic regression analysis was used to construct joint indexes; After receiver operating characteristic curve (ROC) was drawn, the area under the curve and the corresponding sensitivity, specificity and positive of each index predicted value, negative predicted value and accuracy could be calculated with a view to determine the statistical significance of area under the curve (AUC).@*RESULTS@#There are differences in the distribution of malignant solitary pulmonary nodules at different locations, with the highest proportion of the right upper lobe (40.4%). The serum levels of carcinoembryonic antigen (CEA), cytokeratin 19 fragment 21-1 (CYFRA21-1), interleukin-6 (IL-6), interleukin-8 (IL-8) in the malignant nodule group were higher than those in the benign nodule group. Logistic regression analysis suggests that CEA, IL-6 and IL-8 are independent risk factors for predicting malignant nodules. ROC curve analysis shows that the areas under the curve of the individual indicators CEA, IL-6 and IL-8 are 0.642, 0.684 and 0.749. The comparison result of the test efficiency of the area under the curve suggests that CEA+IL-6+IL-8 has a larger area under the curve and higher detection efficiency.@*CONCLUSIONS@#CEA, IL-6 and IL-8 are independent risk factors for malignant solitary pulmonary nodules. The combined detection of cytokines and tumor markers has played a role in the differential diagnosis of benign and malignant lung nodules. The diagnostic value of the combined detection of CEA+IL-6+IL-8 is the highest.

Herramienta para la detección automática de nódulos pulmonares solitarios en series de imágenes de tomografía computarizada multicorte / A tool for automated detection of solitary pulmonary nodules in series of multicut computerized tomography images

Introducción: el nódulo pulmonar solitario es uno de los problemas más frecuentes en la práctica del radiólogo, que constituye un hallazgo incidental habitual en los estudios torácicos realizados durante el ejercicio clínico diario. Objetivo: implementar un sistema de diagnóstico asistido por computadora que facilite la detección del nódulo pulmonar solitario en las series de imágenes de tomografía computarizada multicorte. Métodos: se utilizó Matlab para el desarrollo y evaluación de un conjunto de algoritmos que constituyen elementos necesarios de un sistema de diagnóstico asistido por computadora. En orden: un algoritmo para la extracción de las regiones de interés, algoritmo para la extracción de características y un algoritmo de detección de nódulo pulmonar solitario para el cual se probaron varios clasificadores. La evaluación de los algoritmos fue efectuada en base a las anotaciones realizada por especialistas a la colección de imágenes LIDC-IDRI (Lung Image Database Consortium). Resultados: el método de segmentación empleado para extracción de las regiones de interés permitió generar la adecuada división de las imágenes originales en regiones significativas. El algoritmo utilizado en la detección mostró para el conjunto de prueba además de buena exactitud (de 96,4 por ciento), un buen balance de sensibilidad (91,5 por ciento) para una tasa de 0,84 falsos positivos por imagen. Conclusiones: el trabajo de investigación y la implementación realizada se reflejan en la construcción de una interfaz gráfica en Matlab como prototipo del sistema de diagnóstico asistido por computadora, con el que se puede contribuir a detectar más fácilmente el NPS(AU)

Introduction: solitary pulmonary nodules are one of the most frequent problems in radiographic practice. They are a common incidental finding in chest studies conducted during routine clinical work. Objective: implement a computer-assisted diagnostic system facilitating detection of solitary pulmonary nodules in multicut computerized tomography image series. Methods: Matlab was used to develop and evaluate a set of algorithms constituting necessary components of a computer-assisted diagnostic system. The order was the following: an algorithm to extract regions of interest, another to extract characteristics, and another to detect solitary pulmonary nodules, for which several classifiers were tested. Evaluation of the algorithms was based on notes taken by specialists on the LIDC-IDRI (Lung Image Database Consortium) image collection. Results: the segmentation method used for extraction of regions of interest made it possible to create a suitable division of the original images into significant regions. The algorithm used for detection found that the test set exhibited good accuracy (96.4%), a good sensitivity balance (91.5%), and a 0.84 rate of false positives per image. Conclusions: the research and implementation work done is reflected in the construction of a Matlab graphic interface serving as a prototype for a computer-assisted diagnostic system which may facilitate detection of SPNs.

Etiología de nódulos pulmonares en pacientes con cáncer mamario / Etiology of pulmonary nodules in patients with breast cancer

Resumen Objetivo: Describir los diagnósticos histopatológicos a partir de los casos de las pacientes con cáncer de mama que fueron llevadas a resección de nódulos pulmonares en el Instituto Nacional de Cancerología (INC). Materiales y métodos: Se desarrolló un estudio tipo serie de casos donde se describen las características clínicas, histológicas y anatomopatológicas de un grupo de pacientes con diagnóstico confirmado de cáncer de mama de novo o que durante su enfermedad presentaron nódulos pulmonares que requirieron resección quirúrgica mediante cuña pulmonar o lobectomía en el INC, entre el 1 de enero de 2015 y el 30 de abril de 2018. Resultados: En el periodo de estudio se realizaron 225 resecciones en cuña pulmonar y lobectomías, 55 de estos pacientes tenían diagnóstico de cáncer de mama, de los cuales el 69,1% fueron de origen neoplásico, 26 pacientes fueron metástasis de cáncer mama (47,3%), 9 pacientes tenían segundo primario pulmonar (16,4%) y un paciente tenía concomitantemente cáncer primario pulmonar y una metástasis de mama (1,8%). Otras 2 pacientes tenían metástasis de otros órganos, uno de recto y uno de tiroides (3,6%), mientras que las 17 pacientes restantes presentaron reporte de lesiones pulmonares benignas en la anatomía patológica (30,9%). Conclusión: La presencia de nódulos pulmonares en pacientes con cáncer de mama no siempre son secundarias a enfermedad metastásica en pulmón; pueden existir otras etiologías como cáncer primario pulmonar, metástasis de otros órganos, tumores benignos o infecciones. Conocer la etiología de los nódulos pulmonares en pacientes con cáncer de mama es determinante para evaluar las opciones terapéuticas que pueden variar desde el manejo quirúrgico hasta el manejo sistémico.

Abstract Objectives: To describe the histopathological diagnoses of patients with breast cancer who underwent resection of pulmonary nodules at the National Cancer Institute (INC) of Bogotá. Materials and methods: A case-series study was developed to describe the clinical, histological and anatomopathological characteristics of a sample of patients with a diagnosis of de novo metastatic breast cancer or whom presented with pulmonary nodules during their disease that required surgical resection by wedge pulmonary or lobectomy in the INC, between January 1, 2015 and April 30, 2018. Results: During the study period, 225 resections were performed in lung wedge and lobectomies, 55 of these patients had a diagnosis of breast cancer, of which 69.1% were of neoplastic origin, 26 (47.3%) were metastatic of breast cancer, 9 (16.4%) second primary pulmonary and 1 (1.8%) patient had concomitantly primary lung cancer and a breast metastasis. Another 2 (3.6%) patients had metastases from other organs, one from the rectum and one from the thyroid, while the remaining 17 (30.9%) patients presented a report of benign lung lesions in the pathology. Conclusion: The presence of pulmonary nodules in patients with breast cancer are not always secondary to metastatic disease. Other etiologies may exist, such as primary pulmonary cancer, metastasis from other cancers, benign lung tumors or infections. Knowing the etiology of pulmonary nodules in patients with breast cancer is crucial to evaluate the therapeutic options that can vary from surgical management to systemic management.

Use of PET/CT to aid clinical decision-making in cases of solitary pulmonary nodule: a probabilistic approach / Uso da PET/CT no auxílio à decisão de tomada clínica no nódulo pulmonar solitário: uma abordagem probabilística

Abstract Objective: To determine the frequency with which 18F-FDG-PET/CT findings change the probability of malignancy classification of solitary pulmonary nodules. Materials and Methods: This was a retrospective analysis of all 18F-FDG-PET/CT examinations performed for the investigation of a solitary pulmonary nodule between May 2016 and May 2017. We reviewed medical records and PET/CT images to collect the data necessary to calculate the pre-test probability of malignancy using the Swensen model and the Herder model. The probability of malignancy was classified as low if < 5%, intermediate if 5-65%, and high if > 65%. Cases classified as intermediate in the Swensen model were reclassified by the Herder model. Results: We reviewed the records for 33 patients, of whom 17 (51.5%) were male. The mean age was 68.63 ± 12.20 years. According to the Swensen model, the probability of malignancy was intermediate in 23 cases (69.7%). Among those, the application of the Herder model resulted in the probability of malignancy being reclassified as low in 6 (26.1%) and as high in 8 (34.8%). Conclusion: 18F-FDG-PET/CT was able to modify the probability of malignancy classification of a solitary pulmonary nodule in more than 50% of the cases evaluated.

Resumo Objetivo: Determinar a frequência em que a PET/CT com FDG-18F muda a classificação de probabilidade de malignidade do nódulo pulmonar solitário. Materiais e Métodos: Foi realizada análise retrospectiva de todas as PET/CTs com FDG-18F realizadas entre maio/2016 e maio/2017 num serviço de medicina nuclear, cuja indicação era a avaliação de nódulo pulmonar solitário. Foram analisados os prontuários e os exames de PET/CT para coleta das informações necessárias para o cálculo da probabilidade pré-teste de malignidade pelo modelo de Swensen e pelo modelo de Herder. Probabilidade menor que 5% foi considerada como baixa, maior que 65% foi definida como alta, e os casos restantes, como intermediária. Os casos classificados como intermediários pelo modelo de Swensen foram reclassificados de acordo com o modelo de Herder. Resultados: Trinta e três pacientes foram incluídos neste estudo, 17 (51,5%) deles eram do gênero masculino, e a média de idade foi 68,63 anos (± 12,20 anos). Em relação à classificação da probabilidade de malignidade pelo modelo de Swensen, 23 (69,7%) apresentaram probabilidade intermediária de malignidade. Destes, o modelo de Herder classificou 6 casos (26,1%) como probabilidade baixa e 8 casos (34,8%) como probabilidade alta de malignidade. Conclusão: A PET/CT com FDG-18F foi capaz de modificar a classificação probabilística do nódulo pulmonar solitário em mais da metade dos casos.

Preoperative Pulmonary Nodule Localization Methods:A Comparison of Microcoil and Sclerosing Agent / 中国肺癌杂志

BACKGROUND@#Small pulmonary nodules are usually difficult to identify during thoraco-scopic resection, and preoperative computed tomography (CT)-guided percutaneous puncture assisted localization can be helpful. The purpose of this study is to compare the localization effect and complication rates of two different methods by microcoil placement and sclerosing agent injection (Lauromacrogol).@*METHODS@#A retrospective analysis of the clinical data of 371 patients with preoperative pulmonary nodules percutane us puncture localization was performed. According to the use of different materials, they were divided into the microcoil group (167 cases with 196 localized nodules ) and the sclerosing agent group (204 cases with 239 localized nodules). The localization effect, complication, pathological results and operation relates data were statistically analyzed.@*RESULTS@#The localization failure rate (2.4%) was higher in the microcoil group than in the sclerosing agent group (0.5%) (P=0.011), and the localization time of sclerosing agent group was significantly shorter than the microcoil group [(18.78±6.91) min vs (11.99±3.77) min, P=0.000], but the distance between the selected localized nodules and the pleura was deeper in the microcoil group than in the sclerosing agent group [(9.59±8.62) mm vs (8.13±6.49)mm, P=0.002]. The overall complications in the microcoil group were significantly higher than those in the sclerosing agent group (P=0.000), in which pneumothorax was the most common. Through the analysis of related risk factors, we revealed that different positioning methods was independent risk factors. Wedge resection was the main type of surgical method and non-invasive carcinomas were the majority of postoperative pathological results.@*CONCLUSIONS@#Our study suggests that both microcoil placement and sclerosing agent injection are suitable for preoperative pulmonary nodule localization equivalently, however, compared with microcoils placement, injection of lauromacrogol, the sclerosing agent, had lower failure rate, less complications, shorter localization time and it is worthy of promotion also by easy operation and low cost.

Value of preoperative localization techniques for solitary pulmonary nodules in singleport thoracoscopic surgery / 南方医科大学学报

To evaluate the value and clinical effect of different preoperative localization techniques for solitary pulmonary nodules (SPN) before single-port thoracoscopic surgery.From January 2018 to June 2019, 54 patients diagnosed with solitary pulmonary nodules received single-port thoracoscopic surgery in Thoracic Department of General Hospital of Southern Theater Command of PLA. Based on the location methods of the nodules, the patients were divided into group A (34 cases) with preoperative CT-guided Hook-wire (a common positioning needle usually using in mammary gland) positioning and group B (20 cases) with preoperative CT-guided methylene blue location.The success rate of localization in group A was 94.18% (32/34), significantly higher than that in group B [85% (17/20), < 0.05). No intraoperative conversion to thoracotomy occurred in group A, while the conversion rate was 10% (2/20) in group B ( < 0.05). The average positioning cost was significantly higher in group A than in group B (1715±109 1021±86 RMB yuan, < 0.05), but the total hospitalization cost was similar between the two groups (50 114±3788 47871±5902 RMB yuan, >0.05). The length of hospital stay was significantly shorter in group A than in group B (6.71±1.23 8.19±2.61 days, < 0.05).Compared with the traditional methylene blue localization method, Hook-wire localization positioning can significantly increase the success rate of localization, and can be used as the standard preoperative localization method in patients undergoing single-port thoracoscopic pulmonary nodule resection, especially in those with deep nodule location from the visceral pleura.

Clinicopathological features of minute meningothelial-like nodules in the lung / 中华病理学杂志

Objective@#To study the clinicopathological features of minute meningothelial-like nodule (MMLN) in the lung and its histological origin.@*Methods@#Clinicopathological data of 93 patients diagnosed with MMLN in Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University) from September 2016 to September 2018 were collected and analyzed retrospectively, and the related literature was reviewed.@*Results@#Ninety-three MMLNs were identified from 5 239 patients undergoing pulmonary resection. There were 18(19.6%) males and 75(80.6%) females; age ranged 38-81 years, with mean age 58 years. The frequency of MMLNs was related to the site of origin, and single lesion most commonly (43%) arose in right lobe. There was no significant relationship with patients′ age, gender and the co-existing malignant tumors. Receiver operating characteristic (ROC) curve analysis showed that the area under curve (AUC) was 0.584 (P<0.05), and the best cut-off point was 11.5, indicating an appropriate increase in the number of slides to at least 12 would facilitate the discovery of MMLN. Histologically, MMLN cells showed bland morphology, located around the normal alveolar cavity or form nests or whorls centered on small veins. Immunohistochemistry was done in 55 cases, and all cells expressed vimentin; and a high proportion of cells expressed EMA, PR, CD56 and Calponin. They were all negative for TTF1, Syn, CgA, CKpan, SMA and CD34. The Ki-67 index was low in all cases (<2%). In addition odds ratio analysis showed that MMLN was not a risk factor for invasive carcinoma (including other malignant tumors in the lung, P=0.100).@*Conclusions@#MMLN closely resembles meningothelioma morphologically and immunophenotypically, although its origin remains uncertain. In the study, MMLN is considered as a reactive benign lesion around pulmonary pathology, functioning as an effector regulating small blood vessels caliber. MMLN probably provides nutritional support to the surrounding disease and affords a suitable environment for the development of tumor cells.

Risk factors presented as mathematical models for predicting malignancy in solitary pulmonary nodules: a meta?analysis / 中华健康管理学杂志

Objective To evaluate the risk factors of malignant solitary pulmonary nodules (SPNs). Methods A literature search was conducted was performed using the Chinese CNKI, VIP, Wanfang, PubMed, and Embase databases to identify studies on the prediction model for differentiating benign and malignant SPNs, up to December 2018 A literature search was conducted using the Chinese CNKI, VIP, Wanfang, PubMed, and Embase databases to identify studies on the prediction model for differentiating benign and malignant SPNs, up to December 2018. The meta?analysis was performed using the Stata 15 software. The various factors were analyzed using a fixed? or random?effect model, pooled odds ratio (OR), and 95% confidence interval (CI). A sensitivity analysis was used to evaluate the influence of each study on the strength and stability of the meta?analysis results. The Begg rank correlation test was conducted to assess publication bias. Results Eighteen studies met our inclusion criteria. The meta?analysis revealed that 19 factors, including 4 demographic characteristic?related factors (patient age, family history of cancer, and histories of cancer and smoking), 10 imaging characteristic?related factors (spiculation, SPN diameter, lobulation, calcification, ground?glass nodule, clear boundary, obscure boundary, pleural indentation sign, short spiculation, and SUVmax), and 1 biomarker (CYFRA21?1; all P<0.05), influenced the development of malignant SPN. The sensitivity analysis revealed that the study was stable and reliable, and no publication biases for all the variables. Age, spiculation, SPN diameter, and lobulation were chosen as prediction models in ≥9 studies (50%), and the other factors only existed in<30% studies. Conclusions Numerous factors can affect the development of malignant SPNs, with age, spiculation, SPN diameter, and lobulation being the main influencing factors.