Advancing Health Equity in Lung Cancer Screening and the Role of Humanomics.

Identifying and managing lung cancer, the leading cause of cancer-specific mortality, depend on multiple medical and sociodemographic factors. Humanomics is a model that acknowledges that negative societal stressors from systemic inequity affect individual health by altering pro-inflammatory gene expression. The same factors which may predispose individuals to lung cancer may also obstruct equitably prompt diagnosis and treatment. Increasing lung cancer screening access can lessen disparities in outcomes among disproportionately affected communities. Here, the authors describe several individual, provider, and health system-level obstacles to lung cancer screening and offer actionable solutions to increase access.

Dual-Energy Computed Tomography Applications in Lung Cancer.

This article examines the intrathoracic applications for dual-energy computed tomography (DECT), focusing on lung cancer. The topics covered include the image data sets, methods for iodine quantification, and clinical applications. The applications of DECT are to differentiate benign and malignant lung nodules, determining the grade of lung cancer and expression of ki-67 expression. Iodine quantification has role in assessment of treatment response in both the primary tumor and nodal metastases.

Microwave Ablation in the Liver: An Update.

Hepatocellular carcinoma (HCC) and secondary hepatic malignancies, most often arising from colorectal cancer, are a leading cause of morbidity and cancer-related deaths worldwide. In lieu of first-line surgical resection, which is precluded in more than 75% of cases due to underlying comorbid conditions or locally advanced disease, several minimally-invasive transarterial and thermal ablation procedures have emerged as safe and effective alternative therapies in select patients. Among the thermal ablative techniques, microwave ablation (MWA) has become the preferred treatment modality because of its operational convenience and superior heating profile, allowing for larger ablation zones and reduced treatment times while maintaining high technical success rates. To date, MWA has been demonstrated to provide equivalent, and in some cases improved, clinical outcomes compared to radiofrequency ablation (RFA) in patients with inoperable HCC or oligometastatic disease. Active areas of investigation include the comparison of MWA and transarterial therapies, such as transarterial chemoembolization (TACE), as well as combined multimodality therapies. Here we review the emerging topic of MWA for the treatment of hepatic malignancies by examining staging and treatment strategies, available technologies, procedural protocol and technique, and clinical outcomes.

The Emerging Role of Percutaneous Thermal Ablation in the Treatment of Thoracic Malignancies: A Review.

Thoracic malignancies pose a significant public health burden in the United States, with primary lung cancer accounting for nearly 25% of cancer deaths each year. Percutaneous thermal ablation (PTA) for the treatment of lung cancer has evolved from a novel oncologic strategy in the 1970s, to a limited therapeutic option in select patients through the early 2000s, into its current rapidly expanding role as an adjunct therapy, or even standalone treatment, for a diverse group of thoracic malignancies in patients with both localized and disseminated disease. Radiofrequency ablation (RFA) benefits from the largest clinical dataset and greater user experience, but its utility has been limited by a suboptimal heating mechanism in the setting of poor thermal conductive properties within the lung. As the limitations of RFA have come into sharper focus, microwave ablation (MWA) has emerged as a potentially superior ablation technique due to its ease of use and improved heating profile, allowing for larger ablation zones with reduced treatment times. Cryoablation shares many of the technical features of MWA, while targeting cancer cells via pressurized argon gas to induce cryodestruction of target tissue. In clinical practice, the need for at least two cryoprobes and prolonged freeze-thaw protocols adds to procedural time and complexity. To date, there is considerable evidence supporting the safety, tolerability, and efficacy of these minimally invasive modalities, which have been shown to be cost effective and can often be performed on an outpatient basis. Clinical outcomes continue to improve as more data is acquired for each modality, enabling clinicians to refine patient selection and tailor follow-up protocols to better reflect expected post-procedural imaging findings and potential complications. At present, combined multi-modality therapy is an exciting area of active investigation, particularly in cryoablation due to an apparent synergism with established immunotherapies. Recent data suggests PTA may also be useful in more aggressive malignancies, such as advanced NSCLC and small cell lung cancer. Looking forward, PTA remains well positioned to be a valuable therapeutic option in the treatment of patients with lung cancer.

Analysis of Abdominal Radiology fellowship website content and comprehensiveness.

PURPOSE: Fellowship programs' online content plays a key role in prospective Abdominal Radiology applicants' evaluation of programs. The purpose of this study is to examine the online accessibility of Abdominal Radiology fellowships, the comprehensiveness of the program websites' content, and evaluate whether specific program characteristics are associated with differentiated website comprehensiveness. METHODS: A list of 67 Abdominal Radiology fellowship programs was obtained from the Society of Abdominal Radiology (SAR) website. Each of the 65 publicly-available fellowship websites was scored for the presence of 19 binary variables related to the program's attributes and curriculum to assess informational comprehensiveness. Comprehensiveness scores were compared by program characteristics (accreditation status, region, and size) using Kruskal-Wallis and two-tailed t tests. RESULTS: Mean comprehensiveness score of Abdominal Radiology fellowship websites as measured by online criteria met was 52.6% (10.0 ± 3.0/19). Application requirements and information, rotation scheduling, and program director contact were found on more than 87.5% of the 65 websites, whereas salary and benefits, social information, and alumni were listed on fewer than 33.8% (22/65) of websites. Program accreditation status, region, and size were not associated with difference in mean comprehensiveness scores. CONCLUSIONS: There is a discrepancy between information commonly sought by prospective Abdominal Radiology fellowship applicants and what is available on fellowship program websites. Programs and applicants alike may benefit from programs strengthening their online material.

Percutaneous Thermal Ablation for Lung Cancer: An Update.

Lung cancer remains the leading cause of cancer death in the United States, and accounts for more deaths than breast, colon, and prostate cancer combined. Over the past decade, percutaneous thermal ablative therapy (PTA) has become a useful adjunctive therapy in combination with longer-standing methods, or as a standalone treatment. The physiologic basis of thermal ablation is that coagulative necrosis and cell death occur at temperatures above 60°C. During treatment, PTA of lung tumors routinely achieves temperatures above 70°C. Radiofrequency ablation has fallen out of favor in recent years as microwave ablation has been proven to be effective, with shorter treatment times. Pulmonary PTA is a routine outpatient procedure in which conscious sedation is used in lieu of general anesthesia. The first post-procedural follow-up imaging is CT at 4 weeks, coinciding with an office visit. In our most recent review of long-term results, which included 108 patients, all-cause survival at 1, 2, and 3 years was 83%, 59%, and 43%, respectively. When we specifically considered cancer-related survival, these numbers increased to 94%, 79%, and 57%. Percutaneous thermal ablation has been shown to be a safe and effective treatment for patients with early-stage NSCLC who are not candidates for surgery, as well as a potential treatment for local small cell lung cancers. As the field of oncology, and specifically the treatment of lung cancer, continues to evolve, PTA will represent a useful tool in the arsenal.