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Ko RB, Abelson JA, Fleischmann D, Louie JD, Hwang GL, Sze DY, Schüler E, Kielar KN, Maxim PG, Le QT, Hara WH, Diehn M, Kothary N, Loo BW. Pulmonary interstitial lymphography: A prospective trial with potential impact on stereotactic ablative radiotherapy planning for early-stage lung cancer. Radiother Oncol 2024; 191:110079. [PMID: 38163486 DOI: 10.1016/j.radonc.2023.110079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/29/2023] [Indexed: 01/03/2024]
Abstract
This prospective feasibility trial investigated pulmonary interstitial lymphography to identify thoracic primary nodal drainage (PND). A post-hoc analysis of nodal recurrences was compared with PND for patients with early-stage lung cancer; larger studies are needed to establish correlation. Exploratory PND-inclusive stereotactic ablative radiotherapy plans were assessed for dosimetric feasibility.
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Affiliation(s)
- Ryan B Ko
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA.
| | - Jonathan A Abelson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Coastal Radiation Oncology, San Luis Obispo, CA, USA.
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - John D Louie
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gloria L Hwang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel Y Sze
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Emil Schüler
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Kayla N Kielar
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Varian Medical Systems, Stanford, CA, USA
| | - Peter G Maxim
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiation Oncology, University of California, Irvine, CA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Wendy H Hara
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Nishita Kothary
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
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Carroll MB, Shroff GS, Truong MT, Walker CM. Pearls and Pitfalls in Lung Cancer Imaging. Semin Ultrasound CT MR 2021; 42:524-534. [PMID: 34895608 DOI: 10.1053/j.sult.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging plays an essential role in the diagnosis and staging of pulmonary malignancy. Familiarity of less common manifestations of lung cancer including subsolid nodule, consolidation, and cyst associated lung cancer is important to avoid delayed diagnosis and improve patient outcomes. In this article, we review the staging of multifocal lung cancer, PET negative lung cancers (carcinoid and indolent lung adenocarcinoma), and false positive lymph nodes on PET due to infectious and inflammatory etiologies. Knowledge of these potential pitfalls and pearls in lung cancer imaging and correlation with patients' clinical history are essential to prevent misinterpretation.
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Affiliation(s)
- Melissa B Carroll
- University of Kansas Medical Center, Department of Radiology, Kansas City, KS.
| | - Girish S Shroff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Xia X, Li K, Wu R, Lv Q, Deng X, Fei Z, Zou C, Yang X. Predictive value of neuron-specific enolase, neutrophil-to-lymphocyte-ratio and lymph node metastasis for distant metastasis in small cell lung cancer. CLINICAL RESPIRATORY JOURNAL 2020; 14:1060-1066. [PMID: 32750207 DOI: 10.1111/crj.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the value of neuron-specific enolase (NSE), neutrophil-to-lymphocyte ratio (NLR) and lymph node metastasis in predicating distant metastasis in patients with limited-stage small cell lung cancer (LD-SCLC). METHODS Clinical pathological data of LD-SCLC patients in the First Affiliated Hospital of Wenzhou Medical University between August 2009 and October 2017 were retrospectively analyzed. The age, gender, smoking, TNM, NSE, NLR, chemotherapy cycle, radiotherapy, surgery and new metastasis of lymph nodes of 47 cases with distant metastasis and 47 cases without distant metastasis in 1 year were compared. Finally, factors influencing distant metastasis were determined as the predictors. The receiver operating characteristic (ROC) curve model was established based on logistic regression analysis of the factors obtained. RESULTS Distant metastasis mainly involved brain (17/47), liver (17/47) and bone (17/47). Univariate analysis showed that patients with new lymph node metastasis, high NSE, pretreatment hilar lymph node metastasis and NLR were more prone to have distant metastasis. Multivariate analysis showed that new lymph node metastasis, high NSE, NLR and pretreatment hilar lymph node metastasis were independent predictors. The predictive model established using these predictors had an AUC of 0.872 (95%CI: 0.803-0.941), a sensitivity of 76.60% and a speciality of 80.85%. CONCLUSION The new lymph node metastasis, NLR and NSE are predictors of distant metastasis, and thus, may have a profound impact on treatment decision making. Patients with lower NLR and NSE expression levels and less new metastasis of lymph nodes have a lower distant metastasis rate.
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Affiliation(s)
- Xiaofang Xia
- Department of Radiotherapy, The Fifth Affiliated Hospital of Wenzhou Medical University, Affiliated Lishui Hospital of Zhejiang University, The Central Hospital of Zhejiang Lishui, Lishui, China
| | - Kejie Li
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ruoqi Wu
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiyuan Lv
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xia Deng
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenghua Fei
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Changlin Zou
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xujing Yang
- Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Huang T, Sun H, Luo X, Zhang X, Jin K, Wang F, Sun L, Cheng N, Wu S, Lou Q, Li B. Correlation study between flash dual source CT perfusion imaging and regional lymph node metastasis of non-small cell lung cancer. BMC Cancer 2020; 20:547. [PMID: 32532248 PMCID: PMC7291763 DOI: 10.1186/s12885-020-07032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background To explore the correlation of flash dual source computed tomography perfusion imaging (CTPI) and regional lymph node metastasis of non-small cell lung cancer (NSCLC), and to evaluate the value of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC. Methods 120 consecutive patients with NSCLC confirmed by postoperative histopathology were underwent flash dual source CT perfusion imaging in pre-operation. The CT perfusion parameters of NSCLC, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability (PMB) were obtained by the image post-processing. Then microvessel density (MVD), luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP) of NSCLC were counted by immunohistochemistry. These cases were divided into group A (patients with lymph node metastasis, 58 cases) and group B (patients without lymph node metastasis, 62 cases) according to their pathological results. The CT perfusion parameters and the microvessel parameters were contrastively analysed between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC in pre-operation. Results Group A presented significantly lower LVA, BF and higher MTT, PMB than Group B (P < 0.05), while BV, LVN, LVP and MVD were no significant difference (P > 0.05). Correlation analysis showed that BF was correlated with LVA and LVP (P < 0.05), while BV, MTT and PMB were not correlated with LVN, LVA and LVP (P > 0.05). All the perfusion parameters were not correlated with MVD. According to the ROC curve analysis, when BF < 85.16 ml/100 ml/min as a cutoff point to predict regional lymph node metastasis of NSCLC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 60.8, 81.7, 71.5, 75.6 and 69.5% respectively. Conclusion Flash dual source CT perfusion imaging can non-invasively indicate the luminal vascular structure of tumor and BF can be used as one of the important indexes in predicting regional lymph node metastasis of NSCLC in pre-operation.
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Affiliation(s)
- Tingting Huang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Hui Sun
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Xianli Luo
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Xuemei Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China
| | - Kaiyuan Jin
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Feng Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Lv Sun
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Nianlan Cheng
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Shuo Wu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Qin Lou
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Bangguo Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.
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Lasnon C, Salomon T, Desmonts C, Dô P, Oulkhouir Y, Madelaine J, Aide N. Generating harmonized SUV within the EANM EARL accreditation program: software approach versus EARL-compliant reconstruction. Ann Nucl Med 2016; 31:125-134. [PMID: 27812791 DOI: 10.1007/s12149-016-1135-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/23/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Evolutions in hardware and software PET technology, such as point spread function (PSF) reconstruction, have been shown to improve diagnostic performance, but can also lead to important device-dependent and reconstruction-dependent variations in standardized uptake values (SUVs). This may preclude the multicentre use of SUVs as a prognostic or diagnostic tool or as a biomarker of the early response to antineoplastic treatments. This study compared two SUV harmonization strategies using a newer reconstruction algorithm that improves lesion detection while maintaining comparability with older systems: (1) the use of a second reconstruction compliant with harmonization standards and (2) the use of a proprietary software tool (EQ.PET). METHODS PET data from 50 consecutive non-small cell lung cancer patients were reconstructed with PSF reconstruction for optimal tumor detection and an ordered subset expectation maximization (OSEM3D) reconstruction to mimic a former generation PET. An additional PSF reconstruction was performed with a 7 mm Gaussian filter (PSF7, first method), and, post-reconstruction, the EQ filter (same Gaussian filter) was applied to the PSF data (PSFEQ, second method) for harmonization purposes. The 7 mm kernel filter was chosen to comply with the European Association of Nuclear Medicine (EANM) standards. SUVs for all reconstructions were compared with regression analyses and/or Bland-Altman plots. RESULTS Overall, 171 lesions were analyzed: 55 lung lesions (32.2%), 87 lymph nodes (50.9%), and 29 metastases (16.9%). In these lesions, the mean PSF7/OSEM3D ratios for SUVmax and SUVpeak were 1.02 (95% CI: 0.93-1.11) and 1.04 (95% CI: 0.95-1.14), respectively. The mean PSFEQ/OSEM3D ratios for SUVmax and SUVpeak were 1.01 (95% CI: 0.91-1.11) and 1.04 (95% CI: 0.94-1.14), respectively. When comparing PSF7 and PSFEQ, Bland-Altman analysis showed that the mean PSF7/PSFEQ ratios for SUVmax and SUVpeak were 1.01 (95% CI: 0.96-1.06) and 1.01 (95% CI: 0.97-1.04), respectively. CONCLUSION The issue of reconstruction dependency in SUV values that hampers the comparison of data between different PET systems can be overcome using two reconstructions for harmonized quantification and optimal diagnosis or using the EQ.PET technology. Both technologies produce similar results, EQ.PET sparing reconstruction and interpretation time. Other manufacturers are encouraged to either emulate this solution or to produce a vendor-neutral approach.
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Affiliation(s)
- Charline Lasnon
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France.,INSERM 1199, François Baclesse Cancer Centre, Caen, France.,Normandie University, Caen, France
| | - Thibault Salomon
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Cédric Desmonts
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Pascal Dô
- Thoracic Oncology, François Baclesse Cancer Centre, Caen, France
| | | | | | - Nicolas Aide
- Nuclear Medicine Department, Caen University Hospital, Avenue Côte de Nacre, 14000, Caen, France. .,INSERM 1199, François Baclesse Cancer Centre, Caen, France. .,Normandie University, Caen, France.
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