Simultaneous percutaneous microwave ablation and biopsy for highly suspected malignant pulmonary nodules: a retrospective cohort study.

Background: The conventional diagnosis and treatment for highly suspected malignant pulmonary nodules (PNs) can avoid unnecessary treatment to some extent. However, the relatively separate puncture processes may not only increase puncture-related complications, but also increase the patient's radiation exposure and hospitalization costs. The purpose of this study was to retrospectively analyze the effectiveness of simultaneous percutaneous microwave ablation (MWA) and percutaneous biopsy (PB) for PNs. Methods: From August 2015 to August 2022, 65 consecutive patients [48 solid nodules, 6 ground glass opacities (GGOs), 11 mixed nodules] with suspected single malignant PN underwent MWA and PB combination treatments at the First Affiliated Hospital of Zhengzhou University. The total of 30 patients in Group A underwent synchronous PB and MWA (strategy: low-power MWA-PB-high-power MWA), whereas 35 patients in Group B underwent asynchronous PB and MWA. The technical success, complete ablation (CA), complications, total procedure time (TPT), patient exposure dose (PED), hospitalization time, and costs were compared. An independent samples t-, χ2, or Fisher's exact tests were used. Results: The technical success (100% vs. 100%) and CA (100% vs. 97.1%) rates were not significantly different between Groups A and B. The complications of intrapulmonary hemorrhage (16.7% vs. 41.4%, P=0.02) and hemoptysis (0% vs. 8.6%, P=0.04) were significantly different between Groups A and B. TPT (41.6±7.9 vs. 57.3±8.8 min, P<0.001), PED (12.9±1.4 vs. 19.4±2.3 mSv, P<0.001), hospitalization stay (4.7±1.3 vs. 9.1±2.1 days, P<0.001) and costs (3,768.8±652.9 vs. 4,508.0±514.1 USD, P<0.001) also showed significant differences between Groups A and B. Conclusions: Synchronous PB and MWA for PNs is a safe and effective strategy that can decrease bleeding, PED, the hospitalization stay, and costs.

Percutaneous microwave ablation for lung tumors: a retrospective case-control study of conventional CT and C-arm CT guidance.

Background: Although conventional computed tomography (cCT) is the mainstream guidance equipment for lung microwave ablation (MWA), C-arm CT can provide 3-dimensional (3D) CT-like images reconstructed from 2-dimensional (2D) digital subtraction angiography (DSA) information within 8 seconds, highlighting its utility as a new guidance tool. This retrospective case-control study was performed to evaluate the clinical performance of percutaneous MWA for lung tumors using cCT and C-arm CT guidance. Methods: From April 2015 to April 2020, 101 consecutive patients with solitary lung tumors who underwent percutaneous MWA at our single center (Zhengzhou, China) were divided into 2 groups: the cCT group (n=56), with unarmed puncture, and the C-arm CT group (n=45), with iGuide navigation-assisted puncture. The primary endpoints were technical success, technical efficacy, puncture scoring (PS), and complete ablation (CA) rate. The secondary endpoints were complications, median progression-free survival (mPFS), and median overall survival (mOS). Results: The technical success rates were 100% in both the C-arm CT group and cCT group. The technical efficacies were 93.3% and 91.1% in the C-arm CT group and cCT group, respectively, with no statistical difference (P=0.67). The PS (2.9 vs. 2.5, P=0.02), total procedure time (TPT; 39.3 vs. 50.0 min, P<0.001), puncture time (PT; 12.6 vs. 15.7 min, P=0.001), and irradiation effective dose (ED; 15.2 vs. 20.9 mSV, P<0.001) showed significances between patients in the C-arm CT and those in the cCT group. The ablation time (AT; 9.1 vs. 9.6 min, P=0.36), CA rate (93.3% vs. 92.9%, P=0.93), local tumor progression (LTP) rate (11.1% vs. 8.9%, P=0.98), complications, mPFS (9.5 vs. 10.1 months, P=0.52), and mOS (37.9 vs. 38.8 months, P=0.67) showed no statistically significant difference between the 2 groups. Conclusions: C-arm CT guidance is as feasible and effective as cCT for lung tumor MWA, which can increase PS and decrease TPT.

Application of computed tomography-based radiomics in differential diagnosis of adenocarcinoma and squamous cell carcinoma at the esophagogastric junction.

BACKGROUND: The biological behavior of carcinoma of the esophagogastric junction (CEGJ) is different from that of gastric or esophageal cancer. Differentiating squamous cell carcinoma of the esophagogastric junction (SCCEG) from adenocarcinoma of the esophagogastric junction (AEG) can indicate Siewert stage and whether the surgical route for patients with CEGJ is transthoracic or transabdominal, as well as aid in determining the extent of lymph node dissection. With the development of neoadjuvant therapy, preoperative determination of pathological type can help in the selection of neoadjuvant radiotherapy and chemotherapy regimens. AIM: To establish and evaluate computed tomography (CT)-based multiscale and multiphase radiomics models to distinguish SCCEG and AEG preoperatively. METHODS: We retrospectively analyzed the preoperative contrasted-enhanced CT imaging data of single-center patients with pathologically confirmed SCCEG (n = 130) and AEG (n = 130). The data were divided into either a training (n = 182) or a test group (n = 78) at a ratio of 7:3. A total of 1409 radiomics features were separately extracted from two dimensional (2D) or three dimensional (3D) regions of interest in arterial and venous phases. Intra-/inter-observer consistency analysis, correlation analysis, univariate analysis, least absolute shrinkage and selection operator regression, and backward stepwise logical regression were applied for feature selection. Totally, six logistic regression models were established based on 2D and 3D multi-phase features. The receiver operating characteristic curve analysis, the continuous net reclassification improvement (NRI), and the integrated discrimination improvement (IDI) were used for assessing model discrimination performance. Calibration and decision curves were used to assess the calibration and clinical usefulness of the model, respectively. RESULTS: The 2D-venous model (5 features, AUC: 0.849) performed better than 2D-arterial (5 features, AUC: 0.808). The 2D-arterial-venous combined model could further enhance the performance (AUC: 0.869). The 3D-venous model (7 features, AUC: 0.877) performed better than 3D-arterial (10 features, AUC: 0.876). And the 3D-arterial-venous combined model (AUC: 0.904) outperformed other single-phase-based models. The venous model showed a positive improvement compared with the arterial model (NRI > 0, IDI > 0), and the 3D-venous and combined models showed a significant positive improvement compared with the 2D-venous and combined models (P < 0.05). Decision curve analysis showed that combined 3D-arterial-venous model and 3D-venous model had a higher net clinical benefit within the same threshold probability range in the test group. CONCLUSION: The combined arterial-venous CT radiomics model based on 3D segmentation can improve the performance in differentiating EGJ squamous cell carcinoma from adenocarcinoma.

CT-guided trans-sternal iodine-125 seeds implantation for masses in the anterior or middle mediastinum.

PURPOSE: The aim of this study was to explore the feasibility and clinical value of computed tomography (CT)-guided trans-sternal puncture to implant 125I seeds to treat masses in the anterior or middle mediastinum. MATERIAL AND METHODS: From September 2017 to December 2019, twenty patients with masses in the anterior or middle mediastinum were enrolled and treated with CT-guided trans-sternal 125I seeds implantation. Dosimetry parameters were compared between post-operative and pre-operative plans. Satisfaction rate of 125I seed distribution, complications, and local efficacy were evaluated. RESULTS: A total of 22 lesions were treated with 125I implantation in twenty patients, all procedures being successfully completed. The dosimetry parameters of the 20 patients immediately after surgery were as follows: mean D90 = 134.30 ±14.53 Gy; mean V90, V100, V150, and V200 were 96.10 ±1.55%, 92.69 ±1.93%, 66.86 ±7.53%, and 42.95 ±9.11%, respectively; mean conformity index (CI), external index (EI), and homogeneity index (HI) were 0.65 ±0.06, 40.79 ±13.72%, and 27.90 ±7.53%, respectively. The satisfaction rate of 125I seed distribution was 90%. The mean follow-up duration was 12 ±4.75 months (range, 4-24 months). The local control rates of 2 months, 6 months, and 1 year after surgery were 65.0%, 64.7%, and 53.8%, respectively. One patient had a small degree of pneumothorax, and one had hemoptysis after surgery. CONCLUSIONS: CT-guided trans-sternal puncture plant 125I seeds for the treatment of masses in the anterior or middle mediastinum might serve as an alternative approach for treating specific mediastinal metastatic tumors.