A strategy to reduce the false-positive rate after low-dose computed tomography in lung cancer screening: A multicenter prospective cohort study.

BACKGROUND: The ability of lung cancer screening to manage pulmonary nodules was limited because of the high false-positive rate in the current mainstream screening method, low-dose computed tomography (LDCT). We aimed to reduce overdiagnosis in Chinese population. METHODS: Lung cancer risk prediction models were constructed using data from a population-based cohort in China. Independent clinical data from two programs performed in Beijing and Shandong, respectively, were used as the external validation set. Multivariable logistic regression models were used to estimate the probability of lung cancer incidence in the whole population and in smokers and nonsmokers. RESULTS: In our cohort, 1,016,740 participants were enrolled between 2013 and 2018. Of 79,581 who received LDCT screening, 5165 participants with suspected pulmonary nodules were allocated into the training set, of which, 149 lung cancer cases were diagnosed. In the validation set, 1815 patients were included, and 800 developed lung cancer. The ages of patients and radiologic factors of nodules (calcification, density, mean diameter, edge, and pleural involvement) were included in our model. The area under the curve (AUC) values of the model were 0.868 (95% CI: 0.839-0.894) in the training set and 0.751 (95% CI: 0.727-0.774) in the validation set. The sensitivity and specificity were 70.5% and 70.9%, respectively, which could reduce the 68.8% false-positive rate in simulated LDCT screening. There was no substantial difference between smokers' and nonsmokers' prediction models. CONCLUSION: Our models could facilitate the diagnosis of suspected pulmonary nodules, effectively reducing the false-positive rate of LDCT for lung cancer screening.

Doppler Ultrasound Evaluation of the Efficacy of High Intensity Focused Ultrasound in Treatment of Cesarean Section Scar Pregnancy.

OBJECTIVE: To investigate the value of Doppler ultrasound in evaluating the efficacy of high intensity focused ultrasound (HIFU) in treatment of cesarean section scar pregnancy. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Ultrasonography, The Second people's Hospital of Liaocheng City Affiliated to Shandong First Medical University, China, from January 2015 to December 2017. METHODOLOGY: Forty-six patients with cesarean section scar pregnancy treated with HIFU were enrolled. Doppler ultrasound images, blood flow resistance index (RI) and ß-human chorionic gonadotropin (ß-hCG) levels were analyzed. RESULTS: Among 46 patients, 31 cases (68.89%) were embryo sac type while 15 cases (32.61%) were mass-type. After 4 weeks of HIFU treatment, among 31 cases of embryo sac type of cesarean scar pregnancy, slightly increased echogenicity and thickened walls of yolk sac were observed in 15 cases (48.39%), heart beat disappeared in 12 cases (38.71%) and fetal heart rate as still regular in four cases (12.90%). Among 15 cases of mass-type treated with 4 weeks of HIFU, echogenicity was slightly elevated at first, then echogenicity of center zone decreased, resulting in mixed echoes, finally the volumes of mass decreased to varying degrees and blood flow reduced significantly, leading to slight strong mull echoes. Compared with before treatment of HIFU, RI levels were higher after 4 weeks treatment of HIFU (p<0.001), while the blood ß-hCG levels were lower (p<0.001). CONCLUSION: Doppler ultrasound can provide accurate qualitative diagnosis of cesarean section scar pregnancy, and possess higher clinical value in evaluating the treatment efficacy of cesarean section scar pregnancy with HIFU.

Results of low-dose computed tomography as a regular health examination among Chinese hospital employees.

OBJECTIVE: Lung cancer is traditionally more prevalent in the elderly patients, men, and smokers. However, as low-dose computed tomography (LDCT) is increasingly popular, we hypothesized the disease spectrum might change. METHODS: LDCT was performed as a part of regular health examinations in 8392 of 15,686 employees from 6 hospitals in different regions of China in 2012 to 2018. Clinicopathologic characteristics, including age, sex, smoking status, radiologic features, tumor histology, and pathologic stage, were retrospectively analyzed. RESULTS: LDCT incidentally detected lung cancer (pathologically confirmed) in a total of 179 (2.1%) hospital employees. The lung cancer detection rate was significantly greater in female than male (2.5% vs 1.3%, P = .001) patients. There was also a greater detection rate among nonsmokers than smokers, although statistical significance was not reached (2.2% vs 1.4%, P = .092). The lung cancer detection rate was 1.0% in the "age ≤40 years" group, 2.6% in the "40 < age ≤55 years" group, and 2.9% in the "age >55 years" group (P < .001). Among the hospital employees with lung cancer, 171 (95.5%) presented as ground-glass opacity, 177 (98.9%) were lung adenocarcinoma, 170 (95.0%) were early stage 0/IA, and 177 (98.9%) received curative surgical resection as the initial treatment. After a median follow-up of 38 months, no disease recurrence or death was observed among these patients. CONCLUSIONS: LDCT detected lung cancer in a significant proportion of young, female, and nonsmoking employees. The vast majority of these lung cancers were early stage, with extremely good prognosis.

AKIP1 expression in tumor tissue as a new biomarker for disease monitoring and prognosis in non-small cell lung cancer: Results of a retrospective study.

BACKGROUND: A-kinase-interacting protein 1 (AKIP1) has been reported as an oncogenetic factor in multiple cancers; however, no study has reported its role in non-small cell lung cancer (NSCLC) yet. This study aimed to evaluate the expression of AKIP1, and its correlation with tumor characteristics as well as prognosis in patients with NSCLC. METHODS: Four hundred and ninety patients with NSCLC who underwent resection were reviewed, and baseline clinical data were collected. AKIP1 expression in tumor tissue/paired adjacent tissue was detected by immunohistochemistry. Disease-free survival (DFS) and overall survival (OS) were calculated. RESULTS: A-kinase-interacting protein 1 expression was elevated in tumor tissue compared with paired adjacent tissue (P < .001), and high AKIP1 tumor tissue expression was correlated with poor pathological differentiation (P < .001), tumor size >5 cm (P = .001), lymph node metastasis (P = .016), higher TNM stages (P < .001), and abnormal CEA level (>5 ng/mL) (P = .035). DFS was worse in patients with tumor tissue AKIP1 high expression compared with patients who had AKIP1 low expression in total patients (P < .001), TNM stage I (P < .001) and TNM stage III (P < .001) patients. And the OS was also decreased in patients with AKIP1 high expression in total patients (P < .001), TNM stage I patients (P = .001) and TNM stage III patients (P = .004). Moreover, multivariate Cox's proportional hazards regression model analysis revealed that AKIP1 high expression was an independent predictive factor for worse DFS (P < .001) and OS (P < .001). CONCLUSION: Tumor tissue AKIP1 expression may have the potential to be a biomarker assisting in disease monitoring and prognosis in NSCLC.