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INTRODUCCIÓN: en la actualidad no existe un consenso respecto al manejo de los nódulos pulmonares subsólidos (NPSS). OBJETIVO: describir los resultados del manejo quirúrgico de los NPSS, basados en un algoritmo local. MATERIAL Y MÉTODOS: estudio descriptivo de corte transversal. Se revisaron las fichas clínicas electrónicas de los pacientes operados por NPSS, sugerentes de ser malignos, a juicio de un equipo multidisciplinario, entre enero de 2014 y enero de 2018, en el Departamento de Cirugía de Adultos de Clínica Las Condes. RESULTADOS: se estudió un total de 35 pacientes. La edad promedio fue de 65,8 años. El tamaño promedio de los nódulos fue de 15 mm. Todos los pacientes fueron abordados por cirugía videotoracoscópica asistida. El 88,6% de las biopsias demostró la presencia de una neoplasia maligna. CONCLUSIONES: la adopción de un algoritmo local, instituido por un equipo multidisciplinario, es una alternativa para el manejo adecuado de los portadores de NPSS.
BACKGROUND: Nowadays, there is no consensus in the management of pulmonary subsolid nodules (SSNs). AIM: describe the results of surgical management of SSNs, based on institutional algorithm. MATERIAL AND METHODS: cross-sectional, descriptive study, with revision of clinical electronic records, that included all patients intervened for SSNs, suggestive of malignancy, by the judgment of a multi-disciplinary team, from January 2014 to January 2018 at the Department of Adult Surgery, Clinica Las Condes. RESULTS: 35 patients were studied. The average age was 65.8 years. The average size of the nodules was 15 mm. All patients were approached by video-assisted thoracoscopic surgery. 88.6% of biopsies turned out to be malignant neoplasm. CONCLUSIONS: the acquisition of a local algorithm established by a multidisciplinary team is an appropriate alternative for the management of the patients with SSNs.
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Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Multiple Pulmonary Nodules/surgery , Algorithms , Survival Analysis , Cross-Sectional Studies , Follow-Up Studies , Thoracic Surgery, Video-Assisted , Multiple Pulmonary Nodules/mortality , Multiple Pulmonary Nodules/diagnostic imagingABSTRACT
"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions. .
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Objective To explore the value of CT quantitative analysis in differentiating lepidicGpredominant adenocarcinoma (LPA)from invasive nonGlepidicGpredominant adenocarcinoma (INV)manifested as subsolid nodules (SSN).Methods A total of patients with lung adenocarcinoma manifested as SSNs on CT images were divided into LPA group and INV group according to their pathological results.Total volume,solid volume,solid volume percentage,total mass,solid mass,solid mass percentage and threeGdimensional mean CT value of the nodules were calculated after segmenting pulmonary nodules by a 3DGCT segmentation software,meanwhile the oneGdimensional mean CT value and maximal diameter were manually measured.SPSS 22.0 software was used for statistical analysis. Results Solid volume (0.1 6 ±0.3 6 cm3 vs 1.2 6 ±2.1 7 cm3 ,P＜0.00 1),solid volume percentage (4.7 9 ±5.40% vs 2 6.3 3 ± 1 5.6 3%, P＜0.001),total mass (1 180.64±1 751.46 mg vs 2 386.59±3 224.54 mg,P＝0.010),solid mass (151.64±337.53 mg vs 1 257.34± 2 220.9 2 mg,P＜0.00 1 ),solid mass percentage (7.9 8 ± 8.5 8% vs 3 7.2 3 ± 1 8.83%,P＜0.00 1 ),threeGdimensional mean CT value (－492.26±71.21 HU vs －350.73±94.52 HU,P＜0.001 )and oneGdimensional mean CT value (－472.29 ± 1 12.46 HU vs －282.02 ± 1 5 9.13 HU,P＜0.001)in LPA group were found significantly lower than those in INV group.There were no significant differences in the maximal diameter and total volume between LPA group and INV group.Solid volume percentage and solid mass percentage were selected according to stepwise discriminant analysis.The accuracy of Bayes modes by using substitution method and cross validation method were 84.2% and 83.3%,respectively.Conclusion Solid volume percentage and solid mass percentage were important parameters for differentiating LPA from INV.Quantitative analysis of SSN was very helpful to preoperatively evaluate the subtypes and prognosis of lung adenocarcinoma by using 3DGCT segmentation technique.
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OBJECTIVE: To determine if measurement of the diameter of the solid component in subsolid nodules (SSNs) on low-dose unenhanced chest computed tomography (CT) is as accurate as on standard-dose enhanced CT in prediction of pathological size of invasive component of lung adenocarcinoma. MATERIALS AND METHODS: From February 2012 to October 2015, 114 SSNs were identified in 105 patients that underwent low-dose unenhanced and standard-dose enhanced CT pre-operatively. Three radiologists independently measured the largest diameter of the solid component. Intraclass correlation coefficients (ICCs) were used to assess inter-reader agreement. We estimated measurement differences between the size of solid component and that of invasive component. We measured diagnostic accuracy of the prediction of invasive adenocarcinoma using a size criterion of a solid component ≥ 6 mm, and compared them using a generalized linear mixed model. RESULTS: Inter-reader agreement was excellent (ICC, 0.84.0.89). The mean ± standard deviation of absolute measurement differences between the solid component and invasive component was 4 ± 4 mm in low-dose unenhanced CT and 5 ± 4 mm in standard-dose enhanced CT. Diagnostic accuracy was 81.3% (95% confidence interval, 76.7.85.3%) in low-dose unenhanced CT and 76.6% (71.8.81.0%) in standard-dose enhanced CT, with no statistically significant difference (p = 0.130). CONCLUSION: Measurement of the diameter of the solid component of SSNs on low-dose unenhanced chest CT was as accurate as on standard-dose enhanced CT for predicting the invasive component. Thus, low-dose unenhanced CT may be used safely in the evaluation of patients with SSNs.
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Humans , Adenocarcinoma , Lung , Thorax , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To measure inter-protocol agreement and analyze interchangeability on nodule classification between low-dose unenhanced CT and standard-dose enhanced CT. MATERIALS AND METHODS: From nodule libraries containing both low-dose unenhanced and standard-dose enhanced CT, 80 solid and 80 subsolid (40 part-solid, 40 non-solid) nodules of 135 patients were selected. Five thoracic radiologists categorized each nodule into solid, part-solid or non-solid. Inter-protocol agreement between low-dose unenhanced and standard-dose enhanced images was measured by pooling κ values for classification into two (solid, subsolid) and three (solid, part-solid, non-solid) categories. Interchangeability between low-dose unenhanced and standard-dose enhanced CT for the classification into two categories was assessed using a pre-defined equivalence limit of 8 percent. RESULTS: Inter-protocol agreement for the classification into two categories {κ, 0.96 (95% confidence interval [CI], 0.94–0.98)} and that into three categories (κ, 0.88 [95% CI, 0.85–0.92]) was considerably high. The probability of agreement between readers with standard-dose enhanced CT was 95.6% (95% CI, 94.5–96.6%), and that between low-dose unenhanced and standard–dose enhanced CT was 95.4% (95% CI, 94.7–96.0%). The difference between the two proportions was 0.25% (95% CI, −0.85–1.5%), wherein the upper bound CI was markedly below 8 percent. CONCLUSION: Inter-protocol agreement for nodule classification was considerably high. Low-dose unenhanced CT can be used interchangeably with standard-dose enhanced CT for nodule classification.
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Humans , Classification , Tomography, X-Ray ComputedABSTRACT
Objective To investigate the predictive value of the whole nodule size and solid component size of lung adenocarcinoma manifesting as subsolid nodule(SSN) in three different dimensions for pathologic grade.Methods We evaluated retrospectively preoperative chest HRCT data of 125 patients with 127 SSNs surgically resected and pathologically conformed lung adenocarcinomas.All specimens were divided into two groups: a total of 69 SSNs in group A, including 22 AIS and 47 MIA;a total of 58 SSNs in group B, only including IAC.Computer aided diagnosis software were used to measure the one dimension maximum diameter of solid component with lung window setting(1D-SCLW),two dimension maximum diameter of solid component with lung window setting(2D-SCLW),one dimension maximum diameter of solid component with mediastinal window setting(1D-SCMW),two dimension maximum diameter of solid component with mediastinal window setting(2D-SCMW),one dimension maximum diameter of whole nodule with lung window setting (1D-WNLW), two dimension maximum diameter of whole nodule with lung window setting (2D-WNLW), and volume of solid component with threshold of-300 HU (SCT) of all SSNs.Results 1D-SCLW, 2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW,2D-WNLW and SCT of the group B were significantly larger than those of the group A(P=0.000).ROC analyses indicated that the diagnostic efficiency of SCT for the pathologic grade was the highest among 7 CT features(AUC=0.887, sensitivity:81%,specificity:93%);The cut-off values of 1D-SCLW,2D-SCLW,1D-SCMW,2D-SCMW,1D-WNLW, 2D-WNLW and SCT were 17.50 mm,14.75 mm,9.50 mm,7.75 mm,0.50 mm,1.25 mm and 139.00 mm3.Multiple Logistic regression analysis revealed that SCT was the independent predictor of pathologic grade(OR=4.978,95%CI=1.430-17.331,P=0.012).SCT of 139.00 mm3 or greater was a significant indicator of IAC.Conclusion Among the whole nodule size and solid component size of SSN in three different dimensions on preoperative HRCT, SCT is found to be the independent predictor of pathologic grade, which may provide reference for surgery.
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Objective To investigate the predictive value of whole nodule size and solid component size of pulmonary subsolid nodules (SSNs)with different window setting on preoperative HRCT for pathologic grade in lung adenocarcinoma.Methods We retrospectively evaluated preoperative chest HRCT and pathological data of 125 patients with 127 surgically resected lung adenocarcinoma manifesting as SSNs.All specimens were divided into two groups:a total of 69 SSNs in group A,including 22 adenocarcinomas in situ (AIS) and 47 minimally invasive adenocarcinoma (MIA);a total of 58 SSNs in group B,including invasive adenocarcinoma (IAC).Observer 1 used computer aided diagnosis software to measure the volume of whole nodule with lung window setting (WNLW),volume of solid component with lung window setting (SCLW),volume of solid component with mediastinal window setting (SCMW) and volume of solid component with threshold of-300 HU(SCT) of all SSNs.Observer 2 randomly selected 50 SSNs and repeated all the measurements.The interobserver agreement regarding quantitative measurements were evaluated by using intraclass correlation coefficient(ICC).The differences of all quantitative features between two groups were evaluated by Mann-Whitney U test.All the quantitative features were evaluated by using univariate logistic regression analysis,significant quantitative features identified by univariate logistic regression analysis were included in the multivariate logistic regression and independent predictors of pathological grade were obtained.Receiver operating characteristic analysis was conducted for the independent predictive factors that exhibited statistically significant differences in the multivariate logistic regression.Results The interobserver agreement regarding quantitative features were excellent (ICC＞ 0.75).The WNLW,SCLW,SCMW and SCT of group B were significantly larger than those of group A (P＜ 0.001).The univariate logistic regression analysis indicated that WNLW,SCLW,SCMW and SCT were significant (P＜0.001),the multivariate logistic regression analysis indicated that SCT was the independent predictive factor (OR=1.013,95％CI:1.006—1.020,P＜0.001).When SCT larger than 139.00 mm3,SSN was significantly associated with IACs (AUC=0.887,sensitivity=81％,specificity=93％).Conclusion SCT of SSNs on preoperative HRCT can be used to distinguish between AIS-MIA and IAC,which may provide information for choice of operation.
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Objective To investigate the relationships and types between pulmonary subsolid nodules and bronchi and vessels,and their diagnostic values in differentiating subsolid nodules.Methods MSCT images of 40 subsolid nodules were retrospectively reviewed.The relationships between subsolid nodules and bronchi were divided into five types.Type Ⅰ:the bronchi were “cutoff”in the solid part of nodules.Type Ⅱ:the bronchi were distortion and extension in the solid parts of nodules.Type Ⅲ:the bronchi were distortion and extension in the GGO parts of nodules.Type Ⅳ:the bronchi were normal course in the GGO parts of nodules.Type Ⅴ:the bronchi were circumvent nodule lesions.The relationships between subsolid nodules and vessels were categorized into four types.Type Ⅰ:vessels passing by SSNs;Type Ⅱ:intact vessels passing through SSNs;Type Ⅲ:distorted,dilated or tortuous vessels seen within SSNs;Type Ⅳ:more complicated vessels other than described above.The relationship types were correlated to pathologic and/or clinical findings of subsolid nodules.Results Of 40 subsolid nodules,4 were preinvasive nodules,6 micro infiltrating adeocarcinomas and 30 invasive ones that were pathologically proven.Types Ⅰ,Ⅱ,Ⅲ and Ⅳ vascular relationships were observed in 0,8,21 and 11 subsolid nodules,respectively.Type Ⅲ relationship was the dominating one.All 11 subsolid nodules were invasive adenocarcinomas,when the relationship between subsolid nodules and vessle was type Ⅳ.There were 17 invasive adenocarcinomas,2 preinvasive ones,and 2 infiltrating ones when the relationship between subsolid nodules and vessel was type Ⅲ.Correlation analysis showed strong correlation between invasive adenocarcinoma and type Ⅲ and Ⅳ relationships.There was significantly statistical significance among 3 groups of relationships between subsolid nodule and vessels(χ2 =1 5.1 90,P =0.004).Types Ⅰ,Ⅱ,Ⅲ,Ⅳ and V brochi relationships were observed in 20,5,6,9 and 0 subsolid nodules,respectively.Type I relationship was the dominating relationship.There were 1 7 invasive adenocarcinomas, 1 preinvasive one,2 micro invasive ones when the relationship between subsolid nodules and bronchi were typeⅠ.There was significantly statistical significance among 3 groups of relationships between subsolid nodule and bronchi (χ2 =23.81 1,P =0.001 ).Conclusion Different subsolid nodules have different relationships with bronchi and vessels.Understanding and recognizing the characteristic subsolid nodule-bronchi and subsolid nodule-vessel relationships may help to identify which nodules are more likely to be malignant.
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Background and purpose: With characteristic but non-specific features, subsolid pulmonary nodules (SSPN) is closely associated with early lung cancer. This study aimed to estimate the imaging value of SSPN in stageⅠA lung cancer, and summarized the radiological features of various SSPNs, retrospectively. Methods:The clinical data and imaging data of 405 patients with solitary pulmonary nodules (SPNs) from Apr. 2008 to Apr. 2014 at Fudan University Shanghai Cancer Center were collected. According to ground-glass opacity (GGO) proportion, SPNs were divided into 3 groups:pure ground-glass opacity (pGGO), mixed ground-glass opacity (mGGO) and solid nodule (SN). The malignant ratios were calculated based on the postoperatively pathological results. Besides, SSPNs were classiifed into stageⅠA lung cancer group and benign lesions group aiming at identifying the differentiating computed tomography (CT) features. Results:Of the enrolled 405 SPN patients, there were 367 SSPNs (including 124 pGGOs and 243 mGGOs) whose incidence in stageⅠA lung cancer group was signiifcantly higher than those in benign group [95.9%(257/268) vs 80.3%(110/137), P<0.001]. The total malignant ratio of SSPN was 70.0%(257/367), mGGO had a higher malignant ratio (72.0%) than those of pGGO (66.1%) and SN (28.9%). The malignant SSPNs were frequently detected in upper lobe of middle-aged women with a higher incidence of irregular edge, spiculation, lobulation and pleural retraction than benign group (P<0.05). Conclusion:SSPN is one of the signiifcantly malignant indicators, and mGGO has the highest malignant tendency. Senility, female, irregular edge, spiculation, lobulation, pleural retraction and pulmonary upper lobe distribution are demonstrated the signiifcant discriminators from benign lesions.