The performance of digital chest radiographs in the detection and diagnosis of pulmonary nodules and the consistency among readers / 中华肿瘤杂志

Objective: To investigate the detection and diagnostic efficacy of chest radiographs for ≤30 mm pulmonary nodules and the factors affecting them, and to compare the level of consistency among readers. Methods: A total of 43 patients with asymptomatic pulmonary nodules who consulted in Cancer Hospital, Chinese Academy of Medical Sciences from 2012 to 2014 and had chest CT and X-ray chest radiographs during the same period were retrospectively selected, and one nodule ≤30 mm was visible on chest CT images in the whole group (total 43 nodules in the whole group). One senior radiologist with more than 20 years of experience in imaging diagnosis reviewed CT images and recording the size, morphology, location, and density of nodules was selected retrospectively. Six radiologists with different levels of experience (2 residents, 2 attending physicians and 2 associate chief physicians independently reviewed the chest images and recorded the time of review, nodule detection, and diagnostic opinion. The CT imaging characteristics of detected and undetected nodules on X images were compared, and the factors affecting the detection of nodules on X-ray images were analyzed. Detection sensitivity and diagnosis accuracy rate of 6 radiologists were calculated, and the level of consistency among them was compared to analyze the influence of radiologists' seniority and reading time on the diagnosis results. Results: The number of nodules detected by all 6 radiologists was 17, with a sensitivity of detection of 39.5%(17/43). The number of nodules detected by ≥5, ≥4, ≥3, ≥2, and ≥1 physicians was 20, 21, 23, 25, and 28 nodules, respectively, with detection sensitivities of 46.5%, 48.8%, 53.5%, 58.1%, and 65.1%, respectively. Reasons for false-negative result of detection on X-ray images included the size, location, density, and morphology of the nodule. The sensitivity of detecting ≤30 mm, ≤20 mm, ≤15 mm, and ≤10 mm nodules was 46.5%-58.1%, 45.9%-54.1%, 36.0%-44.0%, and 36.4% for the 6 radiologists, respectively; the diagnosis accuracy rate was 19.0%-85.0%, 16.7%-6.5%, 18.2%-80.0%, and 0%-75.0%, respectively. The consistency of nodule detection among 6 doctors was good (Kappa value: 0.629-0.907) and the consistency of diagnostic results among them was moderate or poor (Kappa value: 0.350-0.653). The higher the radiologist's seniority, the shorter the time required to read the images. The reading time and the seniority of the radiologists had no significant influence on the detection and diagnosis results (P>0.05). Conclusions: The ability of radiographs to detect lung nodules ≤30 mm is limited, and the ability to determine the nature of the nodules is not sufficient, and the increase in reading time and seniority of the radiologists will not improve the diagnostic accuracy. X-ray film exam alone is not suitable for lung cancer diagnosis.

Cambios en la tendencia histológica del cáncer pulmonar / Changes in lung cancer's histological trend

El cáncer pulmonar se establece como la segunda causa de muerte en países desarrollados y en algunos en vías de desarrollo. Su diagnóstico es tardío, sus opciones de resección y su curación aun con terapias adyuvantes son limitadas, lo que incide en la pobre sobrevida a 5 años, es por ello que se necesitan mayores esfuerzos para combatir el hábito del tabaco, principal agente etiológico. Material y Métodos: Se trata de un estudio descriptivo transversal en pacientes adultos atendidos de 01 de enero del 2011 al 31 de diciembre del 2021, ingresados al servicio de cirugía del Hospital San Vicente de Guatemala, con diagnósticos de cáncer pulmonar, masa pulmonar, derrame pleural o nódulo pulmonar solitario. Resultados: Se atendieron 202 pacientes con diagnósticos presuntivos de cáncer pulmonar, no encontrando diferencias significativas en relación al sexo. La edad mayormente afectada se estableció entre los 50 y 70 años. Prevalecieron los estadíos IIIA, IIIB y IV basados en los hallazgos clínicos, tomográficos y transoperatorios y solo al 10% se le sometió a una cirugía de resección pulmonar mayor. Los cánceres de células no pequeñas NSCLC fueron reportados en el 68.7% y el adenocarcinoma fue la variedad más frecuente con el 54.95% sobre el 7.29% del epidermoide. La mortalidad a los treinta días se estableció en 2.97%. Conclusión: El adenocarcinoma pulmonar ocupa el primer lugar en la incidencia de los cánceres pulmonares, desplazando así al carcinoma epidermoide popularizado desde la mitad del siglo pasado. Esta tendencia en el cambio histológico está firmemente asociado a las modificaciones en los hábitos del fumar (AU)

Lung cancer is established as the second cause of death in developed countries and in some developing ones. Its diagnosis is late, its resection options and its cure even with adjuvant therapies are limited, which affects the poor survival at 5 years, which is why greater efforts are needed to combat the tobacco habit, the main etiological agent. Material and Methods: This is a cross-sectional descriptive study in adult patients treated from January 1, 2011 to December 31, 2021, admitted to the surgery service of the Hospital San Vicente de Guatemala, with diagnoses of lung cancer, lung mass, effusion pleural or solitary pulmonary nodule. Results: 202 patients with presumptive diagnoses of lung cancer were treated, finding no significant differences in relation to sex and the most affected age was established between 50 and 70 years. Stages IIIA, IIIB, and IV prevailed based on clinical, tomographic, and intraoperative findings, and only 10% underwent major lung resection surgery. NSCLC non-small cell cancers were reported in 68.7% and adenocarcinoma was the most frequent variety with 54.95% over 7.29% of epidermoid. Thirty-day mortality was established at 2.97%. Conclusion: Pulmonary adenocarcinoma occupies the first place in the incidence of lung cancers, thus displacing squamous cell carcinoma popularized since the middle of the last century. This trend in histological change is strongly associated with changes in smoking habits.

Analysis of lung cancer screening through low-dose spiral computed tomography among petroleum company staffs in Sichuan-Chongqing Area in 2020 / 中华劳动卫生职业病杂志

Objective: To provide scientific evidence for early lung cancer screening, to analyze the incidence of pulmonary nodules among petroleum company staffs in Sichuan-Chongqing Area. Methods: In January 2021 , 6002 petroleum company staffs in Sichuan-Chongqing Area which scanned by low-dose spiral computed tomography (LDCT) of chest in medical examination center in 2020 were retrospectively collected as objects. Their imaging and clinical data were collected. χ(2) test was used to analyze the differences in the detection rates of lung nodules and suspected lung cancer nodules among workers in petroleum company staffs of different genders, ages and types of work. Results: Among the 6002 objects, 3853 (64.2%) were male and 2149 (35.8%) were female, with an average age of (47.25±12.13) years old. A total of 431 cases (7.2%) of pulmonary nodules and 57 cases (0.9%) of suspected lung cancer nodules were detected. 45 cases were followed up with surgical treatment, and 41 cases (91.1%) of lung cancer were diagnosed by postoperative pathology. There were significant differences in the detection rates of pulmonary nodules and suspected lung cancer nodules between different age groups (χ(2)=51.23, 18.81 , P<0.001). The detection rates of pulmonary nodules in the age groups 51-60 years old and ≥61 years old were higher than those in the age groups≤40 years old and 41-50 years old (P<0.05). The detection rate of suspected lung cancer nodules in the age group≥ 61 years old was higher than those in the age groups≤40 years old, 41-50 years old and 51-60 years old (P< 0.05) . And the detection rate of suspected lung cancer pulmonary nodules in oil workers was higher than that of ordinary workers (P<0.05) . Among female objects, the detection rate of pulmonary nodules in oil workers was higher than that in ordinary workers (χ(2)=8.09, P=0.004) . The detection rate of pulmonary nodules in oil workers aged ≥61 years old was higher than ordinary workers (χ(2)=37.94, P<0.001) . Among male objects, the detection rate of suspected lung cancer pulmonary nodules in oil workers was higher than that in ordinary workers (χ(2)=8.42, P=0.004) . The detection rates of suspected lung cancer pulmonary nodules in oil workers aged 51-60 years old and ≥61 years old groups were higher than those of ordinary workers (χ(2)=4.70, 8.74; P=0.030, 0.003) . Conclusion: LDCT is suitable for early lung cancer screening for petroleum company staffs. During the clinical screening process, LDCT should be used as a routine physical examination item for petroleum workers older than 51 years old.

Evaluación de nódulos pulmonares con TC mediante el sistema Lung-RADS. Valor clínico / Evaluation of pulmonary nodules on CT using the LUNG-RADS system. Clinical assessment

Resumen Introducción: Inspirado en el sistema BI-RADS (Breast Imaging Reporting), el American College of Radiology (ACR) desarrolló el sistema Lung-RADS, con la intención de realizar informes estandarizados sobre los nódulos pulmonares detectados en el En Argentina y en muchos lugares del mundo, no se realiza el Lung Cancer Screening (LCS) debido a los altos costos; sin embargo, en las TC de tórax los hallazgos incidentales de nódulos pulmonares, es frecuente. Para evaluarlos, existen diversos sistemas basados en caracte rísticas que permiten establecer un seguimiento. Entre ellos, Guía Fleischner, British Thoracic Society Guidelines y Lung-RADS, siendo este último el único que posee una categorización numérica. En este artículo se estudia la utilidad del Lung-RADS, como método de diagnóstico y seguimiento en la clasificación de los nódulos pulmonares. Objetivo: Evaluación del nódulo pulmonar diagnosticado en la TC de Tórax, mediante el uso del Lung-RADS para determinar su valor clínico, comparando la correlación entre esta clasificación y la malignidad o benignidad en el examen histopatológico. Material y Método: Estudio descriptivo, estadístico, observacional, retrospectivo y prospectivo.Se estudiaron un total de 100 pacientes adultos, de ambos sexos, con diagnóstico de nódulo pulmonar, comprendidos entre Enero del año 2017 hasta Diciembre del 2019, de los cuales se excluyeron aquellos que no tuvieron un seguimiento. Estudio tomográfico realizado en tomógrafo de 128 hileras de detectores. Las variables estudiadas incluyeron: sexo y edad de los pacientes, tamaño y densidad del nódulo, malignidad de la lesión en el estudio anatomopatológico, categoría del Lung-RADS y terapéutica realizada y sugerida. Para el análisis descriptivo, se utilizaron frecuencias relativas (porcentajes) y absolutas (número de casos) para las variables cualitativas; y para las variables cuantitativas se utilizó media y desvío estándar, y rango de valores mínimomáximo. Para las pruebas de hipótesis, se realizaron pruebas de Chi cuadrado para las variables cualitativas. Para las variables cuantitativas se realizaron, en primer lugar, pruebas de Shapiro Wilks y de Kolmogorov. Resultados: En 100 pacientes en los que se aplicó el Lung-RADS para determinar seguimiento y tratamiento, se identificaron diferentes tipos de escenarios tanto en el comportamiento como en el seguimiento de los mismos, algunos con necesidad de recategorización y cambios en conducta diagnóstica y tratamiento. En cuanto al análisis estadístico se analizó la asociación entre la Clasificación Lung- RADS obtenida y la presencia o ausencia de malignidad en el examen anatomopatológico obteniendo resultados estadísticamente significativos (p-valor <0,0001) para esta asociación. Discusión: Actualmente se utiliza en sistema Lung-RADS y las guías de recomendaciones de los nódulos pulmonares de la Sociedad Fleischner. Ambas tienen criterios similares y se basan en la sospecha morfológica de malignidad, que incluye la densidad del nódulo (sólido, parcialmente sólido o en vidrio esmerilado), tamaño y, cuando está disponible, el crecimiento o evolución, que se aplican en distintos grupos de pacientes. La determinación del puntaje Lung-RADS ha demostrado su utilidad en este estudio, dada la correlación patológica del nódulo, con resultado estadísticamente aceptable y buena correlación con la decisión de seguimiento y tratamiento. Conclusión: La aplicación del sistema Lung-RADS en serie ha demostrado un buen manejo de seguimiento de los mismos posibilitando, en algunos casos, la realización de resecciones quirúrgicas y, en otros, una conducta expectante con cierta seguridad evitando, en muchas oportunidades, la adopción de tratamientos agresivos innecesarios.

Evaluation of pulmonary nodules on CT using the Lung-RADS system. Clinical value

Abstract Introduction: Inspired by the BI-RADS system (Breast Imaging Reporting and Data System), the American College of Radiology (ACR) developed the Lung-RADS system, for the purpose of making standardized reports on lung nodules detected in lung cancer screening (LCS). In Argentina and in many other parts of the world the LCS is not performed due to high costs; however, in chest CT scans pulmonary nodules frequently appear as incidental findings. There are multiple systems to evaluate them based on a series of features that allow subsequent follow-up. Some of them are the Fleischner Guidelines, the British Thoracic Society Guidelines and the Lung-RADS system, the latter being the only one with numerical categorization. In this article we study the usefulness of the Lung- RADS, as a diagnostic, follow-up method for the classification of pulmonary nodules. Objective: Evaluation of the pulmonary nodule diagnosed on chest CT scan, using the Lung-RADS system to determine its clinical importance, comparing the correlation between this classification and the malignancy or benignancy in the histopathological examination. Material and Method: Descriptive, statistical, observational, retrospective and prospective study. A total of 100 adult patients, both men and women, with a diagnosis of pulmonary nodule were studied between January 2017 and December 2019. Patients without follow-up were excluded. Studies were performed with a 128-slice scanner. The variables under evaluation were: patients' sex and age, size and density of the nodule, malignancy of the lesion found in the anatomopathological study, Lung-RADS category and treatment performed and suggested. For the descriptive analysis we used relative frequencies (percentages) and absolute frequencies (number of cases) for qualitative variables; and mean and standard deviation as well as range of minimum-maximum values for the quantitative variables. For hypothesis tests, Chi-Square tests were performed for qualitative variables. For quantitative variables, Shapiro Wilks and Kolmogorov tests were performed. Results: In 100 patients in whom Lung-RADS was applied to determine follow-up and treatment, different types of scenarios could be identified regarding the approach and follow-up: some needed recategorization and changes in the diagnostic approach and treatment. As for the statistical analysis, we analyzed the association between the Lung-RADS classification obtained and the presence or absence of malignancy in the anatomopathological examination, and obtained statistically significant results (p-value <0.0001) for this association. Discussion: The Lung-RADS system and the Fleischner Society Guidelines on pulmonary nodules are used at present. Both have similar criteria and are based on the morphological suspicion of malignancy that includes the density of the nodule (solid, partially solid or ground-glass), the size and, when available, growth or evolution, which can be applied in different groups of patients. Determining the Lung-RADS score has proven its usefulness in this study, based on the pathological correlation of the nodule, with a statistically acceptable result and a good correlation with the treatment and follow-up decision. Conclusion: The application of the Lung-RADS system to this series of patients has shown a good management of patients' follow-up, with surgical resections in some cases and an expectant approach in others, providing certain security and mostly avoiding the use of unnecessary aggressive treatments.

Resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol: experiencia en dos centros universitarios / Videotoracoscopy resection of pulmonary nodules marked with lipiodol: experience in two university centers

INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.

BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.

Manejo de los nódulos pulmonares subsólidos: resultados quirúrgicos basados en algoritmo local / Pulmonary subsolid nodules: surgical outcomes based on institutional algorithm

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.

Effect of the High-Pitch Mode in Dual-Source Computed Tomography on the Accuracy of Three-Dimensional Volumetry of Solid Pulmonary Nodules: A Phantom Study

OBJECTIVE: To evaluate the influence of high-pitch mode (HPM) in dual-source computed tomography (DSCT) on the accuracy of three-dimensional (3D) volumetry for solid pulmonary nodules. MATERIALS AND METHODS: A lung phantom implanted with 45 solid pulmonary nodules (n = 15 for each of 4-mm, 6-mm, and 8-mm in diameter) was scanned twice, first in conventional pitch mode (CPM) and then in HPM using DSCT. The relative percentage volume errors (RPEs) of 3D volumetry were compared between the HPM and CPM. In addition, the intermode volume variability (IVV) of 3D volumetry was calculated. RESULTS: In the measurement of the 6-mm and 8-mm nodules, there was no significant difference in RPE (p > 0.05, respectively) between the CPM and HPM (IVVs of 1.2 +/- 0.9%, and 1.7 +/- 1.5%, respectively). In the measurement of the 4-mm nodules, the mean RPE in the HPM (35.1 +/- 7.4%) was significantly greater (p < 0.01) than that in the CPM (18.4 +/- 5.3%), with an IVV of 13.1 +/- 6.6%. However, the IVVs were in an acceptable range (< 25%), regardless of nodule size. CONCLUSION: The accuracy of 3D volumetry with HPM for solid pulmonary nodule is comparable to that with CPM. However, the use of HPM may adversely affect the accuracy of 3D volumetry for smaller (< 5 mm in diameter) nodule.

Cryoablation of a Small Pulmonary Nodule with Pure Ground-Glass Opacity: A Case Report

Treatments for pure ground-glass nodules (GGNs) include limited resection; however, surgery is not always possible in patients with limited pulmonary functional reserve. In such patients, cryoablation may be a suitable alternative to treat a pure GGN. Here, we report our initial experience with cryoablation of a pure GGN that remained after repeated surgical resection in a patient with multiple GGNs. A 5-mm-sized pure GGN in the left lower lobe was cryoablated successfully without recurrence at the 6-month follow-up.

Case of Pulmonary Cryptococcosis Mimicking Hematogeneous Metastases in an Immuocompetent Patient: Value of Absent 18F-Fluorodeoxylucose Uptake on Positron Emission Tomography/CT Scan

The radiologic appearance of multiple discrete pulmonary nodules in immunocompetent patients, with cryptococcal infection, has been rarely described. We describe a case of pulmonary cryptococcosis, presenting with bilaterally and randomly distributed nodules on a computed tomography, mimicking hematogeneous metastases. Positron emission tomography does not demonstrate 18F-fluorodeoxyglucose (FDG) uptake, suggesting a low probability for malignancy, which is a crucial piece of information for clinicians when making a management decision. We find the absence of FDG uptake correlates with the pathologic finding of an infectious nodule, composed of fibrosis and necrosis.