Persistent HPV infection after conization of cervical intraepithelial neoplasia-- a systematic review and meta-analysis.

OBJECTIVE: To systematically evaluate several factors of persistent human papillomavirus (HPV) infection following conization in patients with cervical intraepithelial neoplasia (CIN). METHODS: PubMed, EMBASE and the Cochrane Library were searched from January 1, 1998 to September 10, 2021. Random-effects models for meta-analyses were used and pooled relative risks with 95% confidence intervals were reported. Literature screening, data extraction, and assessment of the risk of bias in the included studies were conducted independently by two researchers. Data analysis was performed with Stata software, version 12.0. RESULTS: A total of 28 studies were included in this study. Meta-analysis revealed that surgical margin and residual disease were positively correlated with persistent HPV infection after conization. Compared with patients infected with other types of HPV, CIN patients with HPV 16 had a higher persistent infection rate (OR = 1.967, 95% CI (1.232-3.140), P < 0.05). CONCLUSIONS: CIN patients who are postmenopausal, have positive surgical margins and residual lesions, and are positive for HPV 16 are prone to persistent HPV infection after conization.

Use quantitative parameters in spectral computed tomography for the differential diagnosis of metastatic mediastinal lymph nodes in lung cancer patients.

BACKGROUND: Accurate diagnosis of mediastinal lymph node (LN) metastases is very important for the treatment and prognosis in lung cancer patients. Spectral computed tomography (CT), as a non-invasive approach, has good prospects for detecting mediastinal nodal metastasis. However, the diagnostic criteria of differentiating metastatic and nonmetastatic LNs have not been determined. METHODS: Clinical and imaging data of 64 lung cancer patients (mean age 61.3±10.3 years, 41 men) from April to December 2019 were retrospectively analyzed. The unenhanced scan and contrast enhanced arterial phase (AP) and venous phase (VP) spectral CT scans were performed. The 70 keV monochromatic image and iodine-based image in all phases were analyzed to measure the parameters of LNs. LNs were divided into the metastatic and non-metastatic groups based on confirmative pathological results, and their differences were statistically analyzed. The receiver operating characteristics curve (ROC) was used to evaluate the efficacy of the differential diagnosis. RESULTS: Seventy-four metastatic LNs and 152 non-metastatic LNs were obtained. Compared with non-metastatic LNs, metastatic LNs often had a larger size (P<0.001). In the unenhanced scans, the density of metastatic LNs was lower than that of non-metastatic LNs (P<0.001); however, there was no difference in CT value in AP and VP between metastatic and non-metastatic LNs (P=0.07, P=0.08, respectively). A statistically significant difference was found in iodine concentration (IC), normalized iodine concentration (NIC) and slope of the spectral curve (λHU) in unenhanced scan, IC and λHU in AP, as well as IC, NIC and λHU in VP between metastatic and non-metastatic LNs. There was no difference in NIC in AP between them. CONCLUSIONS: Combined with morphology, spectral CT quantitative parameters demonstrate certain diagnostic efficiency for differential diagnosis between metastatic and non-metastatic LNs in lung cancer patients.

Quantitative assessment of pulmonary function in lymphangioleiomyomatosis patients using high-resolution computed tomography and pulmonary function tests.

BACKGROUND: To explore the feasibility of using quantitative high-resolution computed tomography (HRCT) to evaluate pulmonary function in patients with pulmonary lymphangioleiomyomatosis (PLAM). METHODS: Pulmonary function tests (PFTs) were performed in 30 patients with pathologically confirmed PLAM with the use of HRCT. These results were correlated with quantitative HRCT in 21 patients. RESULTS: There were significant correlations between the HRCT parameters for lung function and PFT parameters. Among these parameters, emphysema volume (EV), pulmonary volume with a pixel index less than the trigger threshold (-950 HU) to account for a proportion of total lung volume [PI-950 (%)] and forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC (%)] had the strongest correlations, reaching values between -0.71 and -0.68. HRCT lung function might therefore also be helpful for predicting changes in lung function before and after treatment. CONCLUSIONS: HRCT is helpful for the assessment of pulmonary function in PLAM patients and can assist in the clinical evaluation of lung function and treatment response in patients with this disease.

A retrospective study analyzing missed diagnosis of lung metastases at their early stages on computed tomography.

BACKGROUND: Lungs are one of the target organs of metastases of primary lung, breast, liver, colorectal, and esophageal cancer. While computed tomography (CT) is the most widely used modality for detecting lung metastases, it is still very challenging to detect them at the earlier stages. If lung metastases could be found on CT scans at the earliest time points, patients would benefit by beginning treatment earlier. The objective of this study was to demonstrate that CT can reveal lung metastases in many cases at even earlier stages than current radiological practice may find. METHODS: One hundred patients with lung metastases were randomly selected and their surveillance CT scans were analyzed retrospectively. The patients had primary cancer in the breasts, lungs, esophagus, colorectum, and liver. All patients had multiple CT examinations of the lungs and their metastases, if any, were confirmed by subsequent CT scans. The earliest CT scans were examined to determine whether lung metastases at the same locations had been diagnosed or missed. Missed lung metastases, categorized by type of the primary cancer and adjacency to nearby blood vessels, were statistically analyzed. RESULTS: There were 36/100 (36%) cases of missed lung metastases, including 15 cases of single metastasis and 21 cases of multiple metastases. There were a total of 174 missed loci of lung metastases. Where metastases were missed, there was a statistically significant difference (P<0.001) in their distribution within the sub-regions of the lungs. Adjacency to blood vessels appeared to be a significant factor in metastases being missed during diagnosis (P<0.001). CONCLUSIONS: There was a considerable percentage of early lung metastases that were missed by radiologists but actually appeared on CT scans. The capability of CT to reveal such early metastases opens up an opportunity to move up the time points of detecting lung metastases through clinical and training improvement and technology development such as computer-aided detection.