Fluoroscopia por tomografia computadorizada - biópsia percutânea guiada de nódulos pulmonares ≤ 10 mm: análise retrospectiva de procedimentos realizados no período de pandemia de COVID-19 / Computed tomography fluoroscopy-guided percutaneous biopsy of pulmonary nodules ≤ 10 mm: retrospective analysis of procedures performed during the COVID-19 pandemic

Resumo Objetivo: Avaliar o desempenho diagnóstico da biópsia pulmonar percutânea transtorácica (BPPT) guiada por fluoroscopia associada a tomografia computadorizada (FTC) em nódulos pulmonares ≤ 10 mm no período de pandemia de COVID-19. Materiais e Métodos: No período de 1º de janeiro de 2020 a 30 de abril de 2022, 359 BPPTs guiadas por FTC foram realizadas em um centro terciário de radiologia intervencionista. As lesões pulmonares mediam entre 2 mm e 108 mm. Dessas 359 BPPTs, 27 (7,5%) foram realizadas com agulha 18G em nódulos de 2 mm a 10 mm. Resultados: Das 27 BPPTs realizadas nos nódulos ≤ 10 mm, quatro lesões tinham dimensões menores que 5 mm e 23 lesões mediam entre 5 e 10 mm. Sensibilidade e acurácia diagnóstica das BPPTs guiadas por FTC foram de 100% e 92,3%, respectivamente. A dose média de radiação ionizante para os pacientes durante o procedimento de BPPT guiada por FTC foi de 581,33 mGy*cm, variando de 303 a 1129 mGy*cm. A média de tempo dos procedimentos de biópsia foi de 6,6 minutos, variando de 2 a 12 minutos. Nas 27 BPPTs, nenhuma complicação maior foi descrita. Conclusão: A BBPT guiada por FTC resultou em alto rendimento diagnóstico e baixas taxas de complicações.

Abstract Objective: To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods: Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results: Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion: CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.

PEComa pulmonar / PEComa of the lung

Resumen Los tumores de células claras "de azúcar" (CCTL) son lesiones benignas muy infrecuentes. Forman parte de un grupo de neoplasias mesenquimales denominadas PEComas que se originan de las células epiteloides perivasculares. Por su rico estroma vascular, suelen tener avidez por los distintos tipos de contrastes utilizados en los estudios de diagnóstico por imágenes, simulando lesiones de estirpe maligna. Presentamos el caso de un paciente de 66 años con hallazgo de un nódulo pulmonar durante la estadificación oncológica por adenocarcinoma de próstata al que se le realizó una segmentectomía pulmonar anatómica. El resultado definitivo de anatomía patológica fue tumor de células epiteloides perivasculares (PEComa pulmonar o tumor de células claras "de azúcar").

Abstract Clear cell ''sugar'' tumor of the lung is a rare benign tumor arising from perivascular epithelioid cells (PECs). They belong to a group of mesenchymal neoplasms called PEComas. Although widely presumed as benign, due to their rich vascular stroma they are usually avid for the different types of contrast agents used in imaging studies, mimicking a malignant lesion. We report the case of a 66-year-old man in whom a solitary pul monary nodule was discovered during oncological staging for an adenocarcinoma of the prostate who underwent an anatomical pulmonary segmentectomy. The final pathology result was a perivascular epithelioid cell tumor (pulmonary PEComa or clear "sugar" cell tumor).

Biopsia percutánea de nódulos y masas pulmonares bajo ecografía: una alternativa a la tomografía computada / Ultrasound guided percutaneous biopsy of pulmonary nodules and masses: an alternative to CT

Resumen Los nódulos y masas pulmonares tradicionalmente son biopsiados mediante tomografía computada (TC). La ecografía está subestimada como guía para biopsias pulmonares. Las imágenes pulmonares factibles de biopsia con ecografía son aquellas en contacto pleural. Las contraindicaciones específicas incluyen ventilación mecánica asistida, neumonectomía contralateral, paciente no colaborador, tos incontrolable. En el monitoreo posbiopsia deberán controlarse los signos vitales, el dolor y la presencia de complicaciones. Por la localización de las lesiones abordables por este método, el neumotórax y el sangrado parenquimatoso como complicación son menos frecuentes que en las biopsias dirigidas por TC. En este artículo describimos los conceptos básicos para la correcta selección de paciente, planificación y ejecución segura de una biopsia de nódulo pulmonar bajo ecografía.

Abstract Pulmonary nodules and masses are traditionally biopsied under computed tomography (CT) guidance. Ultrasound remains underrated as lung nodule biopsy guide. Ultrasound can be employed to target pleural based lung nodules. Specific contraindications include: mechanical ventilation, contralateral pneumonectomy, non-cooperative patient and uncontrollable coughing. Post procedural care should cover vital signs check, pain assessment and complication evaluation. Due to lesion localization, complications such as pneumothorax and parenchymal bleeding are less frequent than in CT guided biopsies. In this article we provide basic concepts for patient selection, plan and safe execution of ultrasound guided pulmonary nodule biopsy.

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.

A three dimensional convolutional neural network pulmonary nodule detection algorithm based on the multi-scale attention mechanism / 生物医学工程学杂志

Early screening based on computed tomography (CT) pulmonary nodule detection is an important means to reduce lung cancer mortality, and in recent years three dimensional convolutional neural network (3D CNN) has achieved success and continuous development in the field of lung nodule detection. We proposed a pulmonary nodule detection algorithm by using 3D CNN based on a multi-scale attention mechanism. Aiming at the characteristics of different sizes and shapes of lung nodules, we designed a multi-scale feature extraction module to extract the corresponding features of different scales. Through the attention module, the correlation information between the features was mined from both spatial and channel perspectives to strengthen the features. The extracted features entered into a pyramid-similar fusion mechanism, so that the features would contain both deep semantic information and shallow location information, which is more conducive to target positioning and bounding box regression. On representative LUNA16 datasets, compared with other advanced methods, this method significantly improved the detection sensitivity, which can provide theoretical reference for clinical medicine.

Progress of radiomics in the field of lung tumors / 肿瘤研究与临床

Lung cancer is the main cause of death of patients with malignant tumors in our country, which seriously threatens people's lives and health. Therefore, improving the levels of diagnosis, treatment and management of lung cancer is a major challenge for clinicians. Radiomics is to assist doctors in making accurate diagnosis through deeper analysis and prediction of image data information. In recent years, the application of radiomics in the field of lung tumors has been promoted. This article reviews the work process of radiomics, its application in the field of lung tumors, and the prospects and challenges in its clinical application.

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.

Application and development of electromagnetic navigation bronchoscopy in the view of artificial intelligence / 中国胸心血管外科临床杂志

@#The coming out of electromagnetic navigation bronchoscopy gives exciting solution for diagnosis and even treatment of peripheral pulmonary nodules. It breaks the barriers of traditional bronchoscopy, and gives live visible imaging guidance for operators during biopsy of peripheral pulmonary nodules. The electromagnetic navigation bronchoscopy system can intelligently recognize and reconstruct the bronchial tree of the patients, and generate visible data and virtual guidance for the operators. It can perceive real-time magnetic localization of the signal, so as to precisely guide the navigational or biopsy tools. This review introduced the artificial intelligence configuration of the electromagnetic navigation bronchoscopy system based on the Veran system, and gave some improvement advices based on the defects of the system. In this way, we hope to promote the development and better clinical application of electromagnetic navigation bronchoscopy system.

Application of CT-guided microcoil localization in single utility port video-assisted thoracoscopic surgery for small pulmonary nodules (diameter≤15 mm): A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To explore the application value of CT-guided microcoil localization in pulmonary nodule (diameter≤15 mm) surgery. Methods    The clinical data of 175 patients with pulmonary nodules who underwent single utility port video-assisted thoracoscopic surgery at Nanjing Drum Tower Hospital from August 2018 to December 2019 were retrospectively analyzed. According to whether CT-guided coil localization was performed before operation, they were divided into a locating group and a non-locating group. There were 84 patients (34 males, 50 females, aged 57.8±8.8 years) in the locating group and 91 patients (46 males, 45 females, aged 57.6±10.8 years) in the non-locating group. The localization success rate, localization time, incidence of complications, surgical and postoperative conditions were analyzed between the two groups. Results    All 84 patients in the locating group were successfully located, and localization time was 19.0±3.6 minutes. Among them, 19 (22.6%) patients had a small pneumothorax, 4 (4.8%) pulmonary hemorrhage and 2 (2.4%) coil shift; 6 (7.1%) patients had mild pain, 3 (3.6%) moderate pain and 1 (1.2%) severe pain. Sex (P=0.181), age (P=0.673), nodule location (P=0.167), nature of lesion (P=0.244), rate of conversion to thoracotomy (P=0.414), rate of disposable resection of nodules (P=0.251) and postoperative hospital stay (P=0.207) were similar between the two groups. There were significant differences in nodule size (P<0.001), nature of nodule (P<0.001), the shortest distance from nodule to pleura (P<0.001), operation time (P<0.001), lung volume by wedge resection (P=0.031), number of staplers (P<0.001) and total hospitalization costs (P<0.001) between the two groups. Conclusion    CT-guided microcoil localization has the characteristics of high success rate, and is simple, practicable, effective, safe and minimally invasive. Preoperative CT-guided microcoil localization has important clinical application value for small pulmonary nodules, especially those with small size, deep location and less solid components. It can effectively shorten the operation time, reduce surgical trauma and lower hospitalization costs, which is a preoperative localization technique worthy of popularization.

Pulmonary nodules localization via microcoil and anchor with scaled suture guided by CT in thoracoscopic surgery: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To compare the effectiveness and safety of preoperative lung localization by microcoil and anchor with scaled suture. Methods    A total of 286 patients underwent CT-guided puncture localization consecutively between October 2019 and December 2020 in our hospital. According to the different methods of localization, they were divided into a microcoil group (n=139, including 49 males and 90 females, aged 57.92±10.51 years) and an anchor group (n=147, including 53 males and 94 females, aged 56.68±11.31 years). The clinical data of the patients were compared. Results    A total of 173 nodules were localized in the microcoil group, and 169 nodules in the anchor group. The localization success rate was similar in the two groups. However, the anchor group was significantly better than the microcoil group in the localization time (8.15±2.55 min vs. 9.53±3.08 min, P=0.001), the pathological receiving time (30.46±14.41 min vs. 34.96±19.75 min, P=0.029), and the hemoptysis rate (10.7% vs. 30.1%, P=0.001), but the pneumothorax rate was higher in the anchor group (21.3% vs. 11.0%, P=0.006). Conclusion    Preoperative localization of small pulmonary nodules using anchor with suture is practical and safe. Due to its simplicity and convenience, it is worth of promotion in the clinic.

A single-center retrospective analysis of surgical strategy and clinical outcome of pulmonary nodules using pulmonary subsegments as anatomical unit / 中国胸心血管外科临床杂志

@#Objective    To analyze the results and rationality of the lesion-focused strategy with subsegment as the pulmonary anatomical unit for pulmonary nodules with a diameter of ≤2 cm which require surgery. Methods    Clinical data of 246 patients with pulmonary nodules who underwent surgery in the Department of Thoracic Surgery of The First Affiliated Hospital of Nanjing Medical University from January 2017 to October 2018 were retrospectively analyzed, including 76 males and 170 females, with an average age of 53.30±11.82 years. The patients were divided into four groups, a single segmentectomy group, a segmentectomy combined with adjacent subsegmentectomy group, a single subsegmentectomy group and a combined subsegmentectomy group, according to the different surgical approaches, to compare preoperative, intraoperative, and postoperative related data. Results    There was no perioperative death. Among the four groups, there was no statistical difference in gender (P=0.163), age (P=0.691), diameter of the nodule (P=0.743), longitudinal position of the nodule (depth ratio, P=0.831), postoperative pulmonary leakage (P=0.752), intraoperative blood loss (P=0.135), pathological type (P=0.951) or TNM stage (P=0.995); there were statistical differences in transverse position of the nodule (P<0.001) and number of subsegments involved (P<0.001). The results of multivariate logistic regression analysis showed that compared with combined subsegmentectomy, the odds ratio (OR) of the lung nodule in segmentectomy combined with adjacent subsegmentectomy as intersegment nodules was 5.759 (95%CI 1.162 to 28.539, P=0.032). Conclusion     The surgical strategy of lesion  focused and subsegment as anatomical unit is safe and feasible for surgical treatment of pulmonary nodules with diameter ≤2 cm. The transverse position of the nodules is an important factor affecting the choice of surgical method for the middle and lateral nodules with a diameter of ≤2 cm, and the longitudinal location of the nodule is not an influencing factor. For nodules in inner zone, the diameter also is one of the factors influencing the choice of surgical method.

Clinical Study of Artificial Intelligence-assisted Diagnosis System in Predicting the Invasive Subtypes of Early-stage Lung Adenocarcinoma Appearing as Pulmonary Nodules / 中国肺癌杂志

BACKGROUND@#Lung cancer is the cancer with the highest mortality at home and abroad at present. The detection of lung nodules is a key step to reducing the mortality of lung cancer. Artificial intelligence-assisted diagnosis system presents as the state of the art in the area of nodule detection, differentiation between benign and malignant and diagnosis of invasive subtypes, however, a validation with clinical data is necessary for further application. Therefore, the aim of this study is to evaluate the effectiveness of artificial intelligence-assisted diagnosis system in predicting the invasive subtypes of early‑stage lung adenocarcinoma appearing as pulmonary nodules.@*METHODS@#Clinical data of 223 patients with early-stage lung adenocarcinoma appearing as pulmonary nodules admitted to the Lanzhou University Second Hospital from January 1st, 2016 to December 31th, 2021 were retrospectively analyzed, which were divided into invasive adenocarcinoma group (n=170) and non-invasive adenocarcinoma group (n=53), and the non-invasive adenocarcinoma group was subdivided into minimally invasive adenocarcinoma group (n=31) and preinvasive lesions group (n=22). The malignant probability and imaging characteristics of each group were compared to analyze their predictive ability for the invasive subtypes of early-stage lung adenocarcinoma. The concordance between qualitative diagnostic results of artificial intelligence-assisted diagnosis of the invasive subtypes of early-stage lung adenocarcinoma and postoperative pathology was then analyzed.@*RESULTS@#In different invasive subtypes of early-stage lung adenocarcinoma, the mean CT value of pulmonary nodules (P<0.001), diameter (P<0.001), volume (P<0.001), malignant probability (P<0.001), pleural retraction sign (P<0.001), lobulation (P<0.001), spiculation (P<0.001) were significantly different. At the same time, it was also found that with the increased invasiveness of different invasive subtypes of early-stage lung adenocarcinoma, the proportion of dominant signs of each group gradually increased. On the issue of binary classification, the sensitivity, specificity, and area under the curve (AUC) values of the artificial intelligence-assisted diagnosis system for the qualitative diagnosis of invasive subtypes of early-stage lung adenocarcinoma were 81.76%, 92.45% and 0.871 respectively. On the issue of three classification, the accuracy, recall rate, F1 score, and AUC values of the artificial intelligence-assisted diagnosis system for the qualitative diagnosis of invasive subtypes of early-stage lung adenocarcinoma were 83.86%, 85.03%, 76.46% and 0.879 respectively.@*CONCLUSIONS@#Artificial intelligence-assisted diagnosis system could predict the invasive subtypes of early‑stage lung adenocarcinoma appearing as pulmonary nodules, and has a certain predictive value. With the optimization of algorithms and the improvement of data, it may provide guidance for individualized treatment of patients.

Chinese Experts Consensus on Artificial Intelligence Assisted Management for Pulmonary Nodule (2022 Version) / 中国肺癌杂志

Low-dose computed tomography (CT) for lung cancer screening has been proven to reduce lung cancer deaths in the screening group compared with the control group. The increasing number of pulmonary nodules being detected by CT scans significantly increase the workload of the radiologists for scan interpretation. Artificial intelligence (AI) has the potential to increase the efficiency of pulmonary nodule discrimination and has been tested in preliminary studies for nodule management. As more and more artificial AI products are commercialized, the consensus statement has been organized in a collaborative effort by Thoracic Surgery Committee, Department of Simulated Medicine, Wu Jieping Medical Foundation to aid clinicians in the application of AI-assisted management for pulmonary nodules.
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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.

Radiomic feature analysis of computed tomography images for the diagnosis of invasive pulmonary adenocarcinoma appearing as ground-glass nodules / 中国基层医药

Objective:To investigate the value of radiomic features of computed tomography (CT) images in the diagnosis of invasive pulmonary adenocarcinoma appearing as part-solid ground-glass nodules.Methods:The clinical data of 100 part-solid ground-glass nodules from 88 patients with pulmonary adenocarcinoma confirmed by pathological diagnosis who received surgical treatment in Taizhou Tumor Hospital, China between February 2016 and April 2019 were retrospectively analyzed. Among these 100 part-solid ground-glass nodules, 56 from 53 patients were diagnosed as invasive pulmonary adenocarcinoma and 44 from 35 patients as non-invasive pulmonary adenocarcinoma. A set of regular risk factors and visually-assessed qualitative CT imaging features were compared with the radiomic features using logistic regression analysis. Three diagnostic models, i.e., a basis model using the clinical risk factors and qualitative CT features, a radiomics model using significant radiomic features, and a nomogram model combining all significant features, were established and their diagnostic efficacy was compared based on receiver operating characteristic (ROC) curves. Decision curve analysis was performed for the nomogram model to explore its potential clinical benefit.Results:Multiple logistic regression analysis showed that three qualitative CT imaging features (pleural traction ( P = 0.006), solid component size ( P = 0.045) and solid component proportion ( P = 0.020)) and quantitative Rad score ( P = 0.046) were significantly correlated with invasive pulmonary adenocarcinoma. The adjusted ratios were 7.189, 0.075, 194.786 and 2.016, respectively. The diagnostic nomogram model based on these four features showed that the area under the ROC curve (AUC) was 0.903 (95% CI: 0.845, 0.975). The diagnostic nomogram model showed a significantly higher performance (AUC = 0.903) in differentiating invasive pulmonary adenocarcinoma from non-invasive pulmonary adenocarcinoma than either the basis model (AUC = 0.853, P = 0.000) or the radiomics model (AUC = 0.769, P < 0.001). Decision curve analysis indicated a potential benefit of using such a nomogram model in clinical diagnosis. Conclusion:Quantitative radiomic features provide additional information regarding clinically-assessed qualitative features for differentiating invasive pulmonary adenocarcinoma from non-invasive pulmonary adenocarcinoma appearing as ground-glass nodules, and a diagnostic nomogram model including all these significant features may be clinically useful in preoperative strategy planning.

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.

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)

Clinical application of artificial intelligence to lung nodules diagnosis in regional medical center / 中国胸心血管外科临床杂志

@#Objective    To explore the efficacy of artificial intelligence (AI) detection on pulmonary nodule compared with multidisciplinary team (MDT) in regional medical center. Methods    We retrospectively analyzed the clinical data of 102 patients with lung nodules in the Xiamen Fifth Hospital from April to December 2020. There were 57 males and 45 females at age of 36-90 (48.8±11.6) years. The preoperative chest CT was imported into AI system to record the detected lung nodules. The detection rate of pulmonary nodules by AI system was calculated, and the sensitivity, specificity of AI in the different diagnosis of benign and malignant pulmonary was calculated and compared with manual film reading by MDT. Results    A total of 322 nodules were detected by AI software system, and 305 nodules were manually detected by physicians (P<0.05). Among them, 113 pulmonary nodules were diagnosed by pathologist. Thirty-eight of 40 lung cancer nodules were AI high-risk nodules, the sensitivity was 95.0%, and 25 of 73 benign nodules were AI high-risk nodules, the specificity was 65.8%. Lung cancer nodules were correctly diagnosed by MDT, but  benign nodules were still considered as  lung cancer at the first diagnosis in 10 patients. Conclusion    AI assisted diagnosis system has strong performance in the detection of pulmonary nodules, but it can not content itself with clinical needs in the differentiation of benign and malignant pulmonary nodules. The artificial intelligence system can be used as an auxiliary tool for MDT to detect pulmonary nodules in regional medical center.

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.