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Guo CR, Han R, Xue F, Xu L, Ren WG, Li M, Feng Z, Hu BC, Peng ZM. Expression and clinical significance of CD31, CD34, and CD105 in pulmonary ground glass nodules with different vascular manifestations on CT. Front Oncol 2022; 12:956451. [PMID: 36185269 PMCID: PMC9521677 DOI: 10.3389/fonc.2022.956451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Blood vessel passage on CT exerts a vital part in early diagnosis as well as treatment of carcinoma of the lungs. Intratumoral microvascular density (iMVD) has gradually become the focus of research on biological behavior, appearance, and evolution of malignant tumors nowadays. The aim of this paper was to verify whether there is a correlation between the iMVD and the vascular morphology of ground glass nodules (GGNs). A total of 109 patients with pulmonary GGN were classified into three groups (I,II, and III) according to the vascular morphology on CT, and their expression of CD31-, CD34-, and CD105-labeled iMVD was detected by the streptoavidin–biotin method, statistically analyzing the iMVD values of each group. The expression of CD31, CD34, and CD105 in different lung tissues was significantly different, with remarkably higher iMVD in lung cancer tissues than in adjacent normal lung tissues. In the imaging sort of types I, II, and III according to the means of vascular passage, the iMVD expression of CD31, CD34, and CD105 was significantly different between groups. These data suggest that the presence and the abnormal morphology of vessels seen within GGNs indicate the occurrence and progression of lung cancer in pathology. It offers a strong theoretical foundation for early diagnosis of carcinoma of the lungs, thus providing a more precise clinical diagnosis and prognosis of early-stage lung cancer.
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Affiliation(s)
- Chen-ran Guo
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong University, Jinan, China
| | - Rui Han
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Feng Xue
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong University, Jinan, China
| | - Lin Xu
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Wan-gang Ren
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Meng Li
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Zhen Feng
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Ben-chuang Hu
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
| | - Zhong-min Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, China
- Shandong University, Jinan, China
- Shandong First Medical University (Shandong Academy Of Medical Science), Jinan, China
- *Correspondence: Zhong-min Peng,
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Ko JP, Bagga B, Gozansky E, Moore WH. Solitary Pulmonary Nodule Evaluation: Pearls and Pitfalls. Semin Ultrasound CT MR 2022; 43:230-245. [PMID: 35688534 DOI: 10.1053/j.sult.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lung nodules are frequently encountered while interpreting chest CTs and are challenging to detect, characterize, and manage given they can represent both benign or malignant etiologies. An understanding of features associated with malignancy and causes of interpretive pitfalls is helpful to avoid misdiagnoses. This review addresses pertinent topics related to the etiologies for missed lung nodules on radiography and CT. Additionally, CT imaging technical pitfalls and challenges in addition to issues in the evaluation of nodule morphology, attenuation, and size will be discussed. Nodule management guidelines will be addressed as well as recent investigations that further our understanding of lung nodules.
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Affiliation(s)
- Jane P Ko
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY.
| | - Barun Bagga
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Elliott Gozansky
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - William H Moore
- Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
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3
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Zhang T, Li X, Liu J. Prediction of the Invasiveness of Ground-Glass Nodules in Lung Adenocarcinoma by Radiomics Analysis Using High-Resolution Computed Tomography Imaging. Cancer Control 2022; 29:10732748221089408. [PMID: 35848489 PMCID: PMC9297444 DOI: 10.1177/10732748221089408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Pure ground-glass nodules (pGGNs) have been considered inert tumors due to their biological behavior; however, their prognosis is not completely consistent because of differences in internal pathological component. The aim of this study was to explore whether radiomics can be used to identify the invasiveness of pGGNs. Methods The retrospective study received the relevant ethical approval. After postoperative pathological confirmation, sixty-five patients with lung adenocarcinoma pGGNs (≤30 mm) were enrolled in this study from January 2015 to October 2018. All the cases were randomly divided into training and test groups in a 7:3 ratio. In total, 385 radiomics features were obtained from HRCT images, and then least absolute shrinkage and selection operator (LASSO) logistic regression was applied to the training group to obtain optimal features to distinguish the invasion degree of lesions. The diagnostic efficiency of the radiomics model was estimated by the area under the curve (AUC) of the receiver operating curve (ROC), and verified by the test group. Results The optimal features (“GLCMEntropy_angle135_offset1” and “Sphericity”) were selected after applying the LASSO regression to develop the proposed radiomics model. This prediction model exhibited good differentiation between pre-invasive and invasive lesions. The AUC for the test group was 0.824 (95%CI: 0.599-1.000), indicating that the radiomics model has some prediction ability. Conclusion The HRCT radiomics features can discriminate pre-invasive from invasive lung adenocarcinoma pGGNs. This non-invasive method can provide more information for surgeons before operation, and can also predict the prognosis of patients to some extent.
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Affiliation(s)
- Tianqi Zhang
- College of Applied Mathematics, 66445Jilin University of Finance and Economics, Changchun, China.,Department of Radiology, 12510the Second Hospital of Jilin University, Changchun, China
| | - Xiuling Li
- College of Applied Mathematics, 66445Jilin University of Finance and Economics, Changchun, China
| | - Jianhua Liu
- Department of Radiology, 12510the Second Hospital of Jilin University, Changchun, China
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Wang B, Hamal P, Sun K, Bhuva MS, Yang Y, Ai Z, Sun X. Clinical Value and Pathologic Basis of Cystic Airspace Within Subsolid Nodules Confirmed as Lung Adenocarcinomas by Surgery. Clin Lung Cancer 2021; 22:e881-e888. [PMID: 34183266 DOI: 10.1016/j.cllc.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the clinical value and pathologic basis of cystic airspace within lung adenocarcinomas manifesting as subsolid nodules. PATIENTS AND METHODS A retrospective study was conducted on a total of 541 surgically confirmed lung adenocarcinomas manifesting as subsolid nodules in computed tomography images, including 87 cases with cystic airspace and 454 cases without cystic airspace. The pathologic characteristics of the cases with and without cystic airspace were compared. The investigation of the pathologic structure of cystic airspace was attempted on the postoperative paraffin sections. RESULTS There was a significant difference in the containing of cystic airspace between preinvasive and invasive adenocarcinomas (10.5 vs 26.6%; P < .001). Multivariate analysis indicated that cystic airspace is an independent predictor of invasive adenocarcinomas (odds ratio, 3.220; 95% confidence interval, 1.822-5.687). Nodules containing multiple cystic airspaces are more likely to be invasive adenocarcinomas than nodules with a single cystic airspace (47.1 vs 72.2%; P < .05). On paraffin sections, the walls of the cystic airspace seemed to be mainly composed of atypical hyperplasia and/or tumor cells on the surface and the remaining smooth muscle cells and stroma below, which is similar to the structure of bronchi. CONCLUSIONS Cystic airspace may be a reliable predictor of invasive adenocarcinomas, the classification method based on the number of cystic airspaces might be suitable for the computed tomography-based typing of cystic airspace within subsolid nodules. Cystic airspace may derive from the destroyed and enlarged bronchi owing to the growth or infiltration of atypical hyperplasia and/or tumor cells.
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Affiliation(s)
- Bin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Preeti Hamal
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ke Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Yang Yang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zisheng Ai
- Department of Medical Statistics, Tongji University School of Medicine, Shanghai, China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Zhang BW, Zhang Y, Ye JD, Qiang JW. Use of relative CT values to evaluate the invasiveness of pulmonary subsolid nodules in patients with emphysema. Quant Imaging Med Surg 2021; 11:204-214. [PMID: 33392022 DOI: 10.21037/qims-19-998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Lung cancer is a major cause of death, and adenocarcinoma is the most common histologic subtype. Precise diagnosis and treatment of invasive adenocarcinoma (IAC) can substantially improve the survival of patients. However, early-stage adenocarcinomas frequently appear as subsolid nodules (SSN) on computed tomography (CT), and the optimal cut-off CT value for differentiating the invasiveness of SSNs in emphysematous patients is unclear. Methods High-resolution CT targeted scans of 187 pulmonary SSNs in 175 patients with emphysema as confirmed by surgery and histology were retrospectively reviewed. The mean CT value, the relative CT (rCT) values of 1 (nodule CT value - lung CT value), and 2 (nodule CT value/lung CT value), and the size of the SSNs were measured and calculated. The differentiating performance of the CT values between pre-invasive and invasive tumors was evaluated using a receiver operating characteristic (ROC) curve. Results Significant differences were found in the rCT values of 1 and 2 among pure ground-glass nodules (GGNs) with different levels of invasiveness, in the rCT values of 1 and 2 for the ground-glass component (GGC) and the mean CT value of the solid component (SC) of part-solid nodules (PSNs) between minimally invasive adenocarcinoma (MIA) and IAC (all P<<0.05). The size was significantly different among pure GGNs with different invasiveness (P<0.05). The cut-off rCT values of 1, 2 and nodule size for differentiating between pre-invasive and invasive pure GGNs were 293.82 [sensitivity 58.0%, specificity 94.7%; area under the curve (AUC) 0.783], 0.68 (sensitivity 89.5%, specificity 58.0%, AUC 0.742) and 1.10 cm (sensitivity 74.0%, specificity 79.0%, AUC 0.796), respectively. The AUCs of combining rCT values 1 and 2 with the size of nodule were 0.795 (sensitivity 62.5%, specificity 89.5%) and 0.845 (sensitivity 71.6%, specificity 89.5%) respectively. There were no significant differences in the mean CT values between pure GGNs with different levels of invasiveness and between the GGC of PSNs of MIA and IAC. Conclusions In patients with emphysema, the rCT values are more useful than the mean CT values for differentiating between SSNs with different invasiveness and can be valuable for patient management.
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Affiliation(s)
- Bo-Wei Zhang
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Zhang
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Ding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China
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6
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Zhang Y, Fu F, Chen H. Management of Ground-Glass Opacities in the Lung Cancer Spectrum. Ann Thorac Surg 2020; 110:1796-1804. [PMID: 32525031 DOI: 10.1016/j.athoracsur.2020.04.094] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/27/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Along with the popularity of low-dose computed tomography lung cancer screening, an increasing number of lung ground-glass opacity (GGO) lesions are detected. This review focuses on lung adenocarcinoma manifesting as GGO. METHODS We performed a literature search of the PubMed/MEDLINE database to identify articles reporting GGO. The following terms were used: GGO, ground-glass opacity, GGN, ground-glass nodule, part-solid nodule, and subsolid nodule. RESULTS GGO is a nonspecific radiologic finding showing a hazy opacity without blocking underlying pulmonary vessels or bronchial structures. The pathology of GGO can be benign, preinvasive, or invasive adenocarcinoma. Although radiographic features may indicate malignancy, a short period of follow-up is the optimal method to distinguish between benign and malignant GGO lesions. Pathologically, not only lepidic, but also nonlepidic growth patterns can present as GGO. Lung adenocarcinoma with a GGO component is associated with excellent survival compared with solid lesions. Moreover, there are distinct prognostic factors in patients with lung adenocarcinoma manifesting as GGO or solid lesions. For selected GGO-featured lung adenocarcinoma, sublobar resection with selective or no mediastinal lymph node dissection may be sufficient. Intraoperative frozen section is an effective method to guide resection strategy. A less intensive postoperative surveillance strategy may be more appropriate given the excellent survival. Management of multiple GGO lesions requires comprehensive considerations of GGO characteristics and patient conditions. CONCLUSIONS Lung adenocarcinoma manifesting as GGO defines a special clinical subtype with excellent prognosis. The management of GGO-featured lung adenocarcinoma should be distinct from that of solid lesions.
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Affiliation(s)
- Yang Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Institute of Thoracic Oncology, Fudan University, Shanghai, China; State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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7
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Yuan HB, Wang XY, Sun JY, Xie FF, Zheng XX, Tao GY, Pan L, Hogarth DK. Flexible bronchoscopy-guided microwave ablation in peripheral porcine lung: a new minimally-invasive ablation. Transl Lung Cancer Res 2019; 8:787-796. [PMID: 32010557 DOI: 10.21037/tlcr.2019.10.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Transbronchial lung biopsy is an important approach to diagnose peripheral lung cancer, but bronchoscopy based treatment options are limited and poorly studied. A flexible bronchoscopy-guided water-cooled microwave ablation (MWA) catheter was developed to evaluate the feasibility and safety both in ex vivo and in vivo porcine models. Methods Using direct penetration of the catheter through the surface of ex vivo porcine lung, ablations (n=9) were performed at 70, 80, 90 W for 10 minutes. Temperatures of the catheter and 10, 15, 20 mm away from the tip were measured. Under bronchoscopy conditions in porcine lung, ablations (n=18, 6 in ex vivo and 12 in vivo) were performed at 80 W for 5 minutes. Computed tomography (CT) was acquired perioperative, 24 hours, 2 weeks, and 4 weeks post ablation. Ablation zones were excised at 24 hours and 4 weeks respectively. Long-axis diameter (Dl) and short-axis diameter (Ds) were measured and tissues were sectioned for pathological examination. Results In-ex vivo lung, the temperature at 20 mm removed was over 60 °C at 80 W for 288±26 seconds. The ablations under bronchoscopic conditions were successful in-ex vivo and in vivo lung. No complications occurred during the procedures. Coagulation necrosis was visible at 24 hours, and repaired fibrous tissue was seen at 4 weeks. Conclusions The flexible bronchoscopy-guided water-cooled MWA is feasible and safe. This early animal data holds promise of MWA becoming a potential therapeutic tool for Peripheral Lung Cancers.
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Affiliation(s)
- Hai-Bin Yuan
- Department of Emergency, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiang-Yu Wang
- Department of Respiration, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 451200, China
| | - Jia-Yuan Sun
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Fang-Fang Xie
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Xiao-Xuan Zheng
- Department of Respiratory Endoscopy and Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai 200030, China
| | - Guang-Yu Tao
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Lei Pan
- Department of Respiration, Shanghai Public Health Clinic Center, Fudan University, Shanghai 201058, China
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Merrick DT. Sequencing the Events That Mediate Progression of Premalignant Lung Lesions. Cancer Res 2019; 79:4811-4813. [PMID: 31575628 DOI: 10.1158/0008-5472.can-19-2261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 11/16/2022]
Abstract
Analysis of a large group of patients with multifocal premalignant disease by Krysan and colleagues in this issue of Cancer Research provides an informative view of the processes that may underlie progression of these lesions to invasive adenocarcinoma of the lung. The identification of the type and distribution of mutational changes reveals that common processes may be occurring within individuals but that these are generally unique between patients at risk for developing lung cancer. Furthermore, predicted neoantigens are identified and associated with characteristics of immune infiltrates supporting the role of alterations in adaptive immune surveillance in progression of these premalignant lesions. These findings provide critical insights that will help establish a foundation of knowledge for developing personalized prevention strategies with the potential to significantly impact overall mortality in lung cancer.See related article by Krysan et al., p. 5022.
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Affiliation(s)
- Daniel T Merrick
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
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9
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Buckler AJ. Invited Commentary: Focus on Quantitative Imaging—Real Progress Is Being Made, but Much Is Left to Do. Radiographics 2019; 39:977-980. [DOI: 10.1148/rg.2019190063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Abstract
The incidental pulmonary nodule is commonly encountered when interpreting chest CTs. The management of pulmonary nodules requires a multidisciplinary approach entailing integration of nodule size and features, clinical risk factors, and patient preference and comorbidities. Guidelines have been issued for the management of both solid and subsolid nodules, with the Fleischner Society issuing revised guidelines in 2017. This article focuses on the CT imaging characteristics and clinical behavior of pulmonary nodules, with review of the current management guidelines that reflect this knowledge.
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Affiliation(s)
- Jane P Ko
- Department of Radiology, NYU Langone Health, New York, NY.
| | - Lea Azour
- Department of Radiology, NYU Langone Health, New York, NY
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11
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Can we differentiate minimally invasive adenocarcinoma and non-invasive neoplasms based on high-resolution computed tomography features of pure ground glass nodules? PLoS One 2017; 12:e0180502. [PMID: 28683126 PMCID: PMC5500348 DOI: 10.1371/journal.pone.0180502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 06/18/2017] [Indexed: 12/18/2022] Open
Abstract
Objective The purpose of our study was to assess the differentially diagnostic value of radiographic characteristics of pure ground glass nodules (GGNs) between minimally invasive adenocarcinoma and non-invasive neoplasm. Methods Sixty-seven pure GGNs (28 minimally invasive adenocarcinomas (MIA) and 39 pre-invasive lesions) were analyzed from June 2012 to June 2015. Pre-invasive lesions consisted of 15 atypical adenomatous hyperplasia (AAH) and 24 adenocarcinomas in situ (AIS). High-resolution computed tomography (HRCT) features and volume of MIA and pre-invasive lesions were assessed. Fisher exact test, independent sample t test, Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were performed. Results Inter-observer agreement indexes for the diameter, mean HRCT attenuations and volume of pure GGNs were all high (ICC>0.75). Univariate analyses showed that lesion diameter, mean HRCT attenuation, and volume value differed significantly between two groups. Among HRCT findings, GGN shape as round or oval (F = 13.456, P = 0.002) and lesion borders as smooth or notched (F = 15.742, P = 0.001) frequently appeared in pre-invasive lesions in comparison with MIA. Type II and type III of the relationship between blood vessels and pure GGNs suggested higher possibility of malignancy than type I. Conclusions HRCT features of pure GGNs can help to differentiate MIA from non-invasive neoplasms.
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12
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Hutchinson BD, Moreira AL, Ko JP. Spectrum of Subsolid Pulmonary Nodules and Overdiagnosis. Semin Roentgenol 2017; 52:143-155. [PMID: 28734396 DOI: 10.1053/j.ro.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Barry D Hutchinson
- Department of Radiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
| | - Andre L Moreira
- Department of Pathology, NYU Langone Medical Center, NYU School of Medicine, New York, NY
| | - Jane P Ko
- Department of Radiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY
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13
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Xu X, Wu K, Zhao Y, Mei L. Stage I lung adenocarcinoma: the value of quantitative CT in differentiating pathological subtypes and predicting growth of subsolid nodules. Medicine (Baltimore) 2017; 96:e6595. [PMID: 28422852 PMCID: PMC5406068 DOI: 10.1097/md.0000000000006595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The aim of this study was to investigate feasibility of quantitative computed tomography (CT) measurements in predicting invasiveness and growth of nodular ground glass opacities (nGGOs).A set of 203 patients (group A) with nGGOs that were confirmed stage-I adenocarcinomas and 79 patients (group B) with nGGOs that were completely followed up were included. Lesions diameters, volume (VOL), maximum (MAX), mean (MEN), and standard deviation (STD) of CT attenuation were measured. P53 labeling index (LI) was evaluated through immunohistochemistry in group-A patients. Multivariate linear stepwise regressions were performed based on group-A lesions to calculate P53-LI prediction from CT measurements. The receiver operating characteristic (ROC) curve analyses were performed to assess the performance of P53-LI prediction in predicting invasiveness and growth of nGGOs. The Cox regression analysis was conducted to identify correlation between P53-LI Prediction and volume doubling time (VDT) of lesions in group B.Diameter, VOL, MEN, STD, and the P53 LI showed significant differences between lesions of different pathological invasiveness (P < .01). By multivariate linear regressions, MEN and STD were identified as independent variables indicating P53 LI (P < .001); thus, an equation was established to calculate P53-LI Prediction as: P53LI Prediction = 0.013 × MEN + 0.024 × STD + 9.741 (R square = 0.411, P < .001). The P53-LI Prediction showed good performance, similar as the actual one, in differentiating pathological invasiveness of nGGOs. In addition, the P53-LI Prediction demonstrated excellent performance in predicting growth of nGGOs (AUC = 0.833, P < .001) and independently forecasted VDT of nGGOs (β = 1.773, P < .001).The P53-LI Prediction that was calculated from preoperative quantitative CT measurements of nGGOs indicates lesions' invasiveness and allows for predicting growth of nGGOs.
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Affiliation(s)
| | | | | | - Liejun Mei
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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14
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Ma X, Siegelman J, Paik DS, Mulshine JL, St Pierre S, Buckler AJ. Volumes Learned: It Takes More Than Size to "Size Up" Pulmonary Lesions. Acad Radiol 2016; 23:1190-8. [PMID: 27287713 DOI: 10.1016/j.acra.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to review the current understanding and capabilities regarding use of imaging for noninvasive lesion characterization and its relationship to lung cancer screening and treatment. MATERIALS AND METHODS Our review of the state of the art was broken down into questions about the different lung cancer image phenotypes being characterized, the role of imaging and requirements for increasing its value with respect to increasing diagnostic confidence and quantitative assessment, and a review of the current capabilities with respect to those needs. RESULTS The preponderance of the literature has so far been focused on the measurement of lesion size, with increasing contributions being made to determine the formal performance of scanners, measurement tools, and human operators in terms of bias and variability. Concurrently, an increasing number of investigators are reporting utility and predictive value of measures other than size, and sensitivity and specificity is being reported. Relatively little has been documented on quantitative measurement of non-size features with corresponding estimation of measurement performance and reproducibility. CONCLUSIONS The weight of the evidence suggests characterization of pulmonary lesions built on quantitative measures adds value to the screening for, and treatment of, lung cancer. Advanced image analysis techniques may identify patterns or biomarkers not readily assessed by eye and may also facilitate management of multidimensional imaging data in such a way as to efficiently integrate it into the clinical workflow.
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Affiliation(s)
- Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984.
| | - Jenifer Siegelman
- Department of Radiology, Brigham and Women's Hospital, Boston Massachusetts; Department of Radiology (hospital-based), Harvard Medical School, Boston, Massachusetts
| | - David S Paik
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
| | - James L Mulshine
- Department of Internal Medicine, Rush University, Chicago, Illinois
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15
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Yamaguchi M, Furuya A, Edagawa M, Taguchi K, Shimamatsu S, Toyokawa G, Toyozawa R, Nosaki K, Hirai F, Seto T, Takenoyama M, Ichinose Y. How should we manage small focal pure ground-glass opacity nodules on high-resolution computed tomography? A single institute experience. Surg Oncol 2015; 24:258-63. [PMID: 26298200 DOI: 10.1016/j.suronc.2015.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/24/2015] [Accepted: 08/09/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the detection of pure ground-glass opacity (p-GGO) nodules on high-resolution chest computed tomography (HRCT) often implies a diagnosis of lung adenocarcinoma, the management of p-GGO nodules remains under discussion. OBJECTIVE To assess the correlation between the radiological and pathological diagnoses of small p-GGO on HRCT. PATIENTS AND METHODS This is a single-institution retrospective study. We analyzed 89 consecutive patients, including 33 patients with resected p-GGO nodule(s) equal or less than 20 mm in maximal diameter on axial images of HRCT. RESULTS Thirty-nine patients underwent locoregional treatment (Treatment group), including surgical resection in 33 and stereotactic body radiation therapy in six. The remaining 50 patients were observed (Observation group) using periodic chest HRCT. The median follow-up time was 30.4 (4.9-102.5) months in the Treatment group and 44.8 (0.4-1125.8) months in the Observation group. During the follow-up period, the p-GGO nodules increased in size in eight patients over a median of 20.6 (12.1-50.6) months, with increased attenuation in three patients over a median of 20.6 (12.1-50.6) months, and either decreased in size or disappeared in four patients over a median of 6.9 (2.0-11.2) months. Thirty-three patients with 47 nodules underwent surgical resection, including 41 adenocarcinomas, one neuroendocrine tumor, three cases of atypical adenomatous hyperplasia and two benign lesions. The frequency of invasive adenocarcinoma was higher among the larger p-GGO nodules. CONCLUSIONS Careful observation and decision making with respect to the timing of intervention in cases of p-GGO nodules are warranted.
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Affiliation(s)
| | - Akio Furuya
- Department of Diagnostic Imaging and Nuclear Medicine, National Kyushu Cancer Center, Japan
| | - Makoto Edagawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Kyushu Cancer Center, Japan
| | | | - Gouji Toyokawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Japan
| | - Ryo Toyozawa
- Department of Thoracic Oncology, National Kyushu Cancer Center, Japan
| | - Kaname Nosaki
- Department of Thoracic Oncology, National Kyushu Cancer Center, Japan
| | - Fumihiko Hirai
- Department of Thoracic Oncology, National Kyushu Cancer Center, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Kyushu Cancer Center, Japan
| | | | - Yukito Ichinose
- Department of Thoracic Oncology, National Kyushu Cancer Center, Japan
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Abstract
The development of widespread lung cancer screening programs has the potential to dramatically increase the number of thoracic computed tomography (CT) examinations performed annually in the United States, resulting in a greater number of newly detected, indeterminate solitary pulmonary nodules (SPNs). Additional imaging studies, such as fluorodeoxyglucose F 18 (FDG)-positron emission tomography (PET), have been shown to provide valuable information in the assessment of indeterminate SPNs. Newer technologies, such as contrast-enhanced dual-energy chest CT and FDG-PET/CT, also have the potential to facilitate diagnosis of potentially malignant SPNs.
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17
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Truong MT, Ko JP, Rossi SE, Rossi I, Viswanathan C, Bruzzi JF, Marom EM, Erasmus JJ. Update in the Evaluation of the Solitary Pulmonary Nodule. Radiographics 2014; 34:1658-79. [DOI: 10.1148/rg.346130092] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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18
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Zhang Y, Qiang JW, Ye JD, Ye XD, Zhang J. High resolution CT in differentiating minimally invasive component in early lung adenocarcinoma. Lung Cancer 2014; 84:236-41. [DOI: 10.1016/j.lungcan.2014.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 01/13/2014] [Accepted: 02/12/2014] [Indexed: 11/28/2022]
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Lee SW, Leem CS, Kim TJ, Lee KW, Chung JH, Jheon S, Lee JH, Lee CT. The long-term course of ground-glass opacities detected on thin-section computed tomography. Respir Med 2013; 107:904-10. [PMID: 23514949 DOI: 10.1016/j.rmed.2013.02.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/19/2013] [Accepted: 02/21/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Focal ground-glass opacity (GGO) is becoming a major concern because of its possible association with lung cancer. In this study, we analyzed the long-term progression of GGOs that persisted for more than 2 years. METHODS We reviewed focal GGOs identified by thin-section computed tomography that persisted for more than 2 years. RESULTS We enrolled a total of 114 patients with 175 GGO lesions. The median patient age was 61 years (range, 37-92 years) and 42 (36.8%) patients were male. Mean initial GGO size was 7.8 ± 4.4 mm. Median follow-up duration was 45 months. Forty-six (26.3%) GGOs had significant size increases (≥2 mm in the longest diameter) with a mean volume doubling time of 1041 days. In a multivariate analysis, large size (≥10 mm), the presence of a solid portion (mixed GGO) and old age (≥65 years) were risk factors for significant size increase, with odds ratios (95% CI) of 6.46 (2.69-15.6), 2.69 (1.11-6.95) and 2.55 (1.13-5.77), respectively. GGOs with character changes from pure to mixed or mixed to solid showed more rapid volume expansion. CONCLUSIONS GGOs which persisted for several years showed an indolent course. Large lesions with a solid portion and GGOs in male or elderly individuals may be cause for more concern, as these factors were associated with size increase. Resection should be considered if GGOs show character changes, as these may be associated with rapid size progression.
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Affiliation(s)
- Sei Won Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
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