Lung cancer screening by single-shot dual-energy subtraction using flat-panel detector.

PURPOSE: The purpose of this study was to evaluate the usefulness of single-shot dual-energy subtraction (DES) method using a flat-panel detector for lung cancer screening MATERIALS AND METHODS: The subjects were 13,315 residents (5801 males and 7514 females) aged 50 years or older (50-97 years, with an intermediate value of 68 years) who underwent lung cancer screening for a period of 1 year and 6 months from January 2019 to June 2020. We investigated whether the number of lung cancers detected, the detection rate, and the rate of required scrutiny changed, when DES images were added to the judgment based on conventional chest radiography. RESULTS: When DES images were added, the number and percentage of cancer detection increased from 16 (0.12%) to 23 (0.17%) (P < 0.05). Five of the newly detected 7 lung cancers were in the early stages of resectable cancer. The rate of participants requiring scrutiny increased slightly from 1.1 to 1.3%. CONCLUSION: DES method improved the detection of lung cancer in screening. The increase in the percentage of participants requiring scrutiny was negligible.

[First reported case of lung metastasis from hepatocellular carcinoma successfully treated by ultrasound-guided radiofrequency ablation using ultrasonic contrast agent].

BACKGROUND: Radiofrequency ablation (RFA) is becoming one of the useful options as a local control therapy for lung cancer. Almost all reported cases according to the RFA for lung cancer were performed by CT -guided technique. Only a limited number of articles have been published on ultrasound-guided RFA for lung cancer. CASE: An 80-year-old man underwent transcatheter arterial embolization (TAE) and RFA for hepatocellular carcinoma (HCC) in 2004. A 3.3 cm pulmonary nodule was pointed out in his right lower lobe on a chest CT examination in 2007. The nodule was diagnosed as a lung metastasis from HCC by core needle biopsy. He underwent CT-guided RFA. After three months, the lung metastasis progressed in the same location on the enhanced CT. Then an ultrasound-guided RFA using ultrasonic contrast agent (Sonazoid) was performed. We could distinguish between the necrotic lesion and the viable lesion using Sonazoid, and selective RFA for viable lesion became possible. CONCLUSION: Sonazoid has been highly evaluated in the ultrasound-guided RFA for HCC. To the best of our knowledge, this is the first report of a lung cancer case successfully treated with ultrasound-guided RFA using Sonazoid.

Detection of lung cancer using single-exposure dual-energy subtraction chest radiography.

PURPOSE: The aim of this study was to evaluate the detectability of lung cancer by chest radiography with a single-exposure dual-energy subtraction (ES) method. MATERIALS AND METHODS: Five radiologists read two sets of chest radiographs from 77 patients (66.5 +/- 9.6 years old) with histologically proven lung cancer measuring or=50 but <100%; (3) solid: TDR was <50%. RESULTS: Overall, detectability with the ES method was significantly better than that without ES (mean Az value increased from 0.7673 to 0.8265, P < 0.05). In the subgroup analysis of the nonsolid group and the solid group detectability did not change using the ES method, whereas in the partly solid group detectability with the ES method was significantly better than that without ES (mean Az value increased from 0.7162 to 0.8209, P < 0.005). CONCLUSION: The ES method improves the detectability of lung cancer by chest radiography, especially of the partly solid group.

[Prediction of pelvic control using MRI for patients with cervical carcinoma treated with radiotherapy].

PURPOSE: To investigate the usefulness of MRI for predicting pelvic control (PC) of cervical cancer treated with radiation therapy (RT). MATERIALS AND METHODS: Forty-four cervical cancer patients treated with definitive RT were retrospectively analyzed. MRIs were completed before and after RT, and the longest diameter (LD) of the residual tumor was measured on post-RT MRI. Pathologic evaluation for residual tumor was also performed. Therapeutic response was assessed using MRI. Median follow-up time for the 44 patients was 34 months. The correlations between PC rate, MRI, and pathological findings were investigated. RESULTS: The 3-year PC rates of LD = 0 cm (n = 23) after RT, 0 < LD 2 cm (n = 6) were 85%, 80%, and 0%, respectively (p < 0.0001). There was no significant difference in PC according to the presence (n = 8) or absence (n = 36) of residue in the pathologic materials (3-year PC rate: 63% vs. 77%). Three-year PC rates according to therapeutic responses were 85% in complete response (n = 23), 72% in partial response (n = 18), and 0% in stable disease or progressive disease (n = 3) (p < 0.0001). CONCLUSION: MRI is useful for predicting PC in cervical cancer treated with RT, and LD greater than 2 cm after RT is a good marker for poor PC.

Inflammatory pseudotumor of the liver associated with malignant disease: report of two cases and a review of the literature.

Two cases of inflammatory pseudotumor (IPT) of the liver associated with gastrointestinal tract cancer are reported. In addition, the etiological correlation between IPT and abscesses of the liver in cancer patients is discussed. The first patient was a 63-year-old woman who underwent distal gastrectomy and partial hepatectomy under a diagnosis of stomach cancer with liver metastasis. The second patient was a 66-year-old man who had undergone surgery for rectal cancer 6 years previously and underwent partial hepatectomy under a diagnosis of metastasis of rectal cancer to the liver. The gastric cancer was a papillary adenocarcinoma limited to the mucosa, and the rectal cancer was a moderately differentiated adenocarcinoma limited to the subserosa. The resected liver tumor in the first case measured 5.5 x 5.0 x 4.0 cm and was 2.5 x 1.9 x 1.6 cm in the second. The cut surface showed that both masses were well circumscribed and divided into lobules by fibrous tissue. They were yellowish white in color and there was no evidence of necrosis or hemorrhage. Histologically the masses consisted of fibrous areas and cellular areas, and the cellular areas consisted of fascicles of plump spindle cells mingled with varying numbers of plasma cells, lymphocytes, and histiocytes. The masses were diagnosed as IPTs. Obliterating phlebitis suggesting infection via the portal vein was seen in the adjacent liver tissue in both cases. According to previous cases reported in the literature, there are three types of cancers associated with hepatic IPT: gastrointestinal tract cancer, biliary tract cancer, and cancers that need strong systemic chemotherapy. The underlying cancer types of IPT of the liver are almost similar to those associated with pyogenic liver abscesses suggesting the etiological correlation between IPT and abscesses of the liver.

Inflammatory pseudotumor of the liver in a patient with early gastric cancer: CT-histopathological correlation.

A case of inflammatory pseudotumor (IPT) of the liver associated with early gastric cancer is reported. Intravenous contrast-enhanced computed tomography (CT) showed a large, irregularly shaped mass lesion in the left lobe of the liver. The lesion was characterized by peripheral rim-like or septal enhancement and an internal low density area in the delayed phase. The gastric cancer was a papillary adenocarcinoma limited to the mucosa. The resected liver tumor measured 5.5 x 5.0 x 4.0 cm, and its cut surface revealed a well-circumscribed mass divided into lobules by fibrous tissue. Histologically the mass was composed of fibrous areas and cellular areas, and the cellular areas consisted of fascicles of plump spindle cells intermingled with varying numbers of plasma cells, lymphocytes and histiocytes. Thus, the higher attenuation on the enhanced CT scan corresponded to the areas of intense fibrosis, and the areas of lower attenuation corresponded to the predominantly cellular areas. The CT findings of delayed peripheral rim-like or septal enhancement of the hepatic tumor may be a specific finding of IPT.

Multiple ground-glass opacity in metastasis of malignant melanoma diagnosed by lung biopsy.

Focal ground-glass opacity (GGO) on computed tomography has been reported in several disorders including inflammatory disease and primary neoplastic lesion of the lung. We report a case of malignant melanoma of the nasal cavity metastatic to the lungs in which multiple pulmonary nodules showed GGO. Lung biopsy specimen demonstrated melanoma cells proliferating in a lepidic fashion along the thickened alveolar wall simulating bronchioloalveolar carcinoma. Metastatic lung tumor showing GGO is uncommon.

[Results of accelerated hyperfractionated radiotherapy in breast conserving therapy: a pilot study].

We performed a pilot study to evaluate the safety, tolerability and clinical usefulness of accelerated hyperfractionated radiotherapy in patients treated with breast conserving therapy (BCT). The radiotherapy was consisted of 1.5 Gy per fraction twice daily to a total dose of 51 Gy to the whole breast with or without 9 Gy boost to the tumor bed in case of positive surgical margin. Thirty-seven patients were treated with accelerated hyperfractionated radiotherapy and 178 patients with conventional radiotherapy between September 1993 and December 1997. Acute or late skin toxicity of Grade 3 or more was not observed. One case of radiation pneumonitis requiring steroid therapy occurred in the conventional group. 8-year local-relapse-free survivals were 100% in accelerated group and 97.0% in conventional group (not significant: p = 0.59). The scores in quality of life at one year after the completion of radiation therapy were not different between the conventional and the accelerated group; symptomatic scores, global QOL scores, and scores by self-estimation for therapy. Admission charges in conventional and in accelerated group were not different, either. These data suggested that accelerated hyperfractionated radiotherapy in BCT was feasible and phase III study to compare conventional with the accelerated hyperfractionated radiotherapy should be planned to evaluate its clinical usefulness in BCT.

Prospective study of thoracoscopic limited resection for ground-glass opacity selected by computed tomography.

BACKGROUND: With recent advances in low-dose helical computed tomography (CT), detection of ground-glass opacity (GGO) has increased. The aim of this study was to correlate high-resolution CT (HRCT) findings with pathologic features and to evaluate the efficacy of thoracoscopic limited resection for focal GGO, which were selected based on HRCT findings. METHODS: Focal GGO lesions were classified into two subtypes based on HRCT findings: pure type and mixed type. Ninety-six patients with persistent GGO 2 cm or less in diameter underwent pulmonary resection from January 1997 to December 2001. Among these, thoracoscopic wedge resection was performed prospectively between June 2000 and December 2001 in 33 patients with pure GGO lesions that were 1 cm or less. RESULTS: Thoracoscopic wedge resection was completed with complete safety. The histologic diagnoses of these 33 lesions were adenocarcinoma in 1, bronchioloalveolar carcinoma (BAC) in 23, and atypical adenomatous hyperplasia (AAH) in 9. No patients have had any evidence of tumor recurrence to date. Of the total 96 GGO lesions, 93.0% (53/57) of pure GGO 1 cm or less were BAC or AAH, whereas 38.5% (15/39) of pure GGO larger than 1 cm or mixed GGO were adenocarcinoma. CONCLUSIONS: Pure GGO 1 cm or less was characteristic of noninvasive lesions. Thoracoscopic limited resection for small GGO lesions selected by HRCT was valid.

Measurement of localized ground-glass attenuation on thin-section computed tomography images: correlation with the progression of bronchioloalveolar carcinoma of the lung.

RATIONALE AND OBJECTIVE: This study was to measure localized ground-glass attenuation (GGA) in the peripheral lung on thin-section computed tomography (CT) and to assess any relationship between the attenuation and lesion. MATERIALS AND METHODS: Twenty-eight surgically resected tumors with localized GGA at thin-section CT were studied. The tumors were histologically diagnosed as 8 atypical adenomatous hyperplasia (AAH), 11 bronchioloalveolar carcinoma (BAC), and 9 BAC with fibrosis. We assumed three concentric circles, which were 0.8, 1.0, and 1.2 times the diameter of each tumor and measured the average CT values corresponding to inside each circle. We calculated a difference in CT value between 0.8 and 1.2 times the diameter of the tumor and defined as the contrast index. RESULTS: The contrast index for tumors with AAH, BAC, and BAC with fibrosis were 19.8 +/- 8.3, 42.5 +/- 16.0 (P < 0.05 vs. group with AAH), and 111.4 +/- 32.6 (P < 0.0001 vs. Group with BAC), respectively. The contrast index became greater in the stepwise progression from AAH to BAC and from BAC to BAC with fibrosis. CONCLUSION: The contrast index correlated histologic findings of the tumor growth in BAC. The contrast index may be a useful and objective measurement for determining surgical treatment for localized GGA in preoperative diagnosis.

Focal ground-glass opacity detected by low-dose helical CT.

OBJECTIVE: Focal ground-glass opacity (GGO) has been detected increasingly by low-dose helical CT. Although focal GGO suggests in situ neoplastic lesion in the peripheral lung, it remains controversial how to manage these lesions. The purpose of this study was to evaluate the pathologic and radiologic characteristics of focal GGO in order to develop a standard of treatment for these lesions. PATIENTS: Forty-three patients with persistent focal GGO < or = 2 cm in size from January 1998 to September 2000 were studied. Thoracoscopic lung biopsy was performed consecutively for persistent focal GGO following a several-month observation period (mean, 3.7 months). RESULTS: The histologic diagnoses were bronchioloalveolar carcinoma (BAC) in 23 patients, adenocarcinoma with mixed subtypes in 11 patients, and atypical adenomatous hyperplasia (AAH) in 9 patients. None of 34 carcinoma patients had lymph node involvement. All of 17 lesions > or = 1 cm in size were malignant. GGO with solid components on high-resolution CT were highly associated with adenocarcinoma (malignant rate, 93.3%). CONCLUSIONS: Persistent focal GGO after observation for several months was a finding of early adenocarcinoma or its precursor. Especially, lesions > or = 1 cm in size or GGO with solid component were significant signs of malignancy. We concluded lung biopsy should be attempted for persistent focal GGO.