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Jing W, Li Q, Liu M, Zhang Y, Chen S, Zhang K, Li D, Zhao M, Zheng Y, Li W, Wu Y, Xu H, Zhao Z, Kang S, Lv F. CTR > 0.7 predicts the subgroup of lung adenocarcinomas ≤ 2 cm at risk of poor outcome treated by sublobar resection compared to lobar resection. Cancer Imaging 2024; 24:76. [PMID: 38886780 PMCID: PMC11181521 DOI: 10.1186/s40644-024-00717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND A standard surgical procedure for patients with small early-stage lung adenocarcinomas remains unknown. Hence, we aim in this study to assess the clinical utility of the consolidation-to-tumor ratio (CTR) when treating patients with small (2 cm) early stage lung cancers. METHODS A retrospective cohort of 298 sublobar resection and 266 lobar resection recipients for early stage lung adenocarcinoma ≤ 2 cm was assembled from the First Affiliated Hospital of Chongqing Medical University between 2016 and 2019. To compare survival rates among the different groups, Kaplan-Meier curves were calculated, and the log-rank test was used. A multivariate Cox proportional hazard model was constructed utilizing variables that were significant in univariate analysis of survival. RESULTS In the study, 564 patients were included, with 298 patients (52.8%) undergoing sublobar resection and 266 patients (47.2%) undergoing lobar resection. Regarding survival results, there was no significant difference in the 5-year overall survival (OS, P = 0.674) and 5-year recurrence-free survival (RFS, P = 0.253) between the two groups. Cox regression analyses showed that CTR ≥ 0.75(P < 0.001), age > 56 years (P = 0.007), and sublobar resection(P = 0.001) could predict worse survival. After examining survival results based on CTR categorization, we segmented the individuals into three categories: CTR<0.7, 0.7 ≤ CTR<1, and CTR = 1.The lobar resection groups had more favorable clinical outcomes than the sublobar resection groups in both the 0.7 ≤ CTR < 1(RFS: P < 0.001, OS: P = 0.001) and CTR = 1(RFS: P = 0.001, OS: P = 0.125). However, for patients with 0 ≤ CTR < 0.7, no difference in either RFS or OS was found between the lobar resection and sublobar resection groups, all of which had no positive events. Patients with a CTR between 0.7 and 1 who underwent lobar resection had similar 5-year RFS and OS rates compared to those with a CTR between 0 and 0.7 who underwent sublobar resection (100% vs. 100%). Nevertheless, a CTR of 1 following lobar resection resulted in notably reduced RFS and OS when compared to a CTR between 0.7 and 1 following lobar resection (P = 0.005 and P = 0.016, respectively). CONCLUSION Lobar resection is associated with better long-term survival outcomes than sublobar resection for small lung adenocarcinomas ≤ 2 cm and CTR ≥ 0.7.
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Affiliation(s)
- Weiwei Jing
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Mengxi Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Yi Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Sifan Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Ke Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Dan Li
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Min Zhao
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yineng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Wangjia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Yangying Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Hongbo Xu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Ziya Zhao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Shaolei Kang
- Department of Radiology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Rd, Wuhua, Kunming, 650032, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Rd, Yuanjiagang, Yuzhong District, Chongqing, 400016, People's Republic of China.
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Yang F, Sun K, Li F, Li X, Shi J, Sun X, Hong Y, Jiang G, Zhu Y, Song X. The Prognostic Impact of Epidermal Growth Factor Receptor Mutation in Clinical Stage I Lung Adenocarcinoma. Ann Thorac Surg 2024; 117:1111-1119. [PMID: 37353101 DOI: 10.1016/j.athoracsur.2023.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND This study investigated the prognostic impact of epidermal growth factor receptor (EGFR) mutation in clinical stage I lung adenocarcinoma patients. METHODS Data for 952 patients who received surgical resection and underwent detection of oncogenic driver mutations were retrospectively collected. Recurrence-free survival (RFS) and overall survival (OS) were estimated by the Kaplan-Meier method and compared using the log-rank test. The adjusted hazard ratio (aHR) with 95% CI of the prognosticator was calculated by Cox proportional hazards model, and cumulative incidence function was measured by competing risk regression model. RESULTS EGFR mutation was detected in 581 patients (61.0%) and was more frequent in women (63.9%), nonsmokers (85.5%), and those with ground-glass nodules (GGNs; 56.6%). EGFR mutation was not associated with recurrence and death in the entire cohort or GGN cohort. However, for patients with radiologic pure-solid appearance, EGFR mutation was an independent risk factor for RFS (aHR, 1.623; 95% CI, 1.192-2.210) and distant recurrence (aHR, 1.863; 95% CI, 1.311-2.650), but not OS. Subsequently, subgroup analysis based on EGFR mutation subtypes, including exon 19 deletions (19-Del), exon 21 L858R substitution (L858R), and rare mutations in patients with radiologic pure-solid appearance, revealed that all 3 subtypes have poorer RFS (19-Del: aHR, 1.424; 95% CI, 0.991-2.047; L858R: aHR, 1.708; 95% CI, 1.172-2.490; rare mutations: aHR, 2.500; 95% CI, 1.400-4.465) and higher prevalent distant recurrence (19-Del: aHR, 1.595; 95% CI, 1.061-2.400; L858R: aHR, 2.073; 95% CI, 1.371-3.140; rare mutations: aHR, 2.657; 95% CI, 1.397-5.050) compared with wild-type. CONCLUSIONS In clinical stage I lung adenocarcinoma, EGFR mutation was associated with worse RFS and higher prevalent distant recurrence in patients with radiologic pure-solid appearance but not in patients with GGN.
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Affiliation(s)
- Fujun Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ke Sun
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fei Li
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiang Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinghan Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong Hong
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiao Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Adusumilli PS. Fleischner Society Glossary: The Power of Standardization of Nomenclature for Thoracic Surgical Communications. Radiology 2024; 310:e240410. [PMID: 38530187 DOI: 10.1148/radiol.240410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Prasad S Adusumilli
- From the Department of Surgery, Thoracic Service, and Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Zou Y, Mao Q, Zhao Z, Zhou X, Pan Y, Zuo Z, Zhang W. Intratumoural and peritumoural CT-based radiomics for diagnosing lepidic-predominant adenocarcinoma in patients with pure ground-glass nodules: a machine learning approach. Clin Radiol 2024; 79:e211-e218. [PMID: 38044199 DOI: 10.1016/j.crad.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023]
Abstract
AIM To develop and validate a diagnostic model utilising machine-learning algorithms that differentiates lepidic predominant adenocarcinoma (LPA) from other pathological subtypes in patients with pure ground-glass nodules (pGGNs). MATERIALS AND METHODS This bicentric study was conducted across two medical centres and included 151 patients diagnosed with lung adenocarcinoma based on histopathological confirmation of pGGNs. The training cohort consisted of 99 patients from Institution 1, while the test cohort included 52 patients from Institution 2. Radiomics features were extracted from both tumours and the 2 mm peritumoural parenchyma. The tumoural and peritumoural radiomics were designated as Modeltumoural and Modelperitumoural, respectively. The diagnostic efficacy of various models was evaluated through the receiver operating characteristic (ROC) curve analysis. Subsequently, a machine-learning-based prediction model that combined Modeltumoural, Modelperitumoural, and Modelclinical-radiological was developed to differentiate LPA from other pathological subtypes in patients with pGGNs. RESULTS Modeltumoural achieved area under the curve (AUC) values of 0.762 and 0.783 in the training and validation sets, respectively. Modelperitumoural attained AUCs of 0.742 and 0.667, and Modelclinical-radiological generated an AUC of 0.727 and 0.739 in the training and validation sets, respectively. Among the machine-learning models evaluated, gradient boosting machines demonstrated the best diagnostic efficacy, with accuracy, AUC, F1 score, and log loss values of 0.885, 0.956, 0.943, and 0.260, respectively. CONCLUSION The combined model based on machine learning that incorporated tumour and peritumoural parenchyma, as well as clinical and imaging characteristics, may offer benefits in assessing the pathological subtype of pGGNs.
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Affiliation(s)
- Y Zou
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - Q Mao
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - Z Zhao
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - X Zhou
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, 411000, China
| | - Y Pan
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China
| | - Z Zuo
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, 411000, China
| | - W Zhang
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China; Guangxi Key Clinical Specialties of Medical Imaging, Liuzhou, 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, 545006, China.
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Ng JKM, Cheung W, Li JJX, Chan KP, Yip WH, Tse GM. Detection of early (T1) lung cancers and lepidic adenocarcinomas in sputum and bronchial cytology. Ann Diagn Pathol 2023; 67:152191. [PMID: 37579536 DOI: 10.1016/j.anndiagpath.2023.152191] [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: 06/25/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The lung is an extensively epithelialized organ, producing ample exfoliated material for sputum and bronchial cytology. In view of the updates in the World Health Organization classification of early (T1/≤ 3 cm) lung cancer with respect to adenocarcinomas with lepidic pattern, this study retrospectively reviews sputum and bronchial cytology paired with resection-confirmed lung cancers. METHODS A computerized search for all lung resection specimens of carcinomas over a 20-year period was performed. Cytologic diagnoses of corresponding sputum and bronchial cytology were classified into five-tiered categories (C1-insufficient/inadequate, C2-benign, C3-atypia, C4-suspicious and C5-malignant). Reports and slides of the resection specimen were reviewed for reclassification of T1 cancers. RESULTS Totally 472 and 383 sputum and bronchial cytology specimens respectively were included. Sensitivity for T1 lesions on sputum cytology were 10.6 %, 2.1 % and 0.5 % at cutoffs of atypia/C3, suspicious/C4 and malignant/C5 categories, lower than bronchial cytology (35.1 %, 15.5 %, 8.1 %; p < 0.001). T1 lesions correlated with lower detection rates, whereas squamous cell carcinoma histology, larger size and bronchial invasion were associated with increased detection rates in sputum and bronchial cytology (p < 0.050). Detection rates for abrasive bronchial cytology (brushing) were overall higher (p = 0.018- < 0.001), but on subgroup comparison, non-abrasive (aspiration, lavage and washing) cytology demonstrated favorable trends (p = 0.063-0.088) in detecting T1 lesions. Adenocarcinomas with lepidic pattern had lower suspicious/C4 (p = 0.040) or above and malignant/C5 (p = 0.019), but not atypia/C3 or above (p = 0.517) rates. CONCLUSIONS Most adenocarcinomas with lepidic pattern are only diagnosed as atypia/C3 on cytology. With its modest sensitivity, interpretation of negative and indeterminate cytology results mandates caution.
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Affiliation(s)
- Joanna K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wing Cheung
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Ka Pang Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wing Ho Yip
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Liu M, Mu J, Song F, Liu X, Jing W, Lv F. Growth characteristics of early-stage (IA) lung adenocarcinoma and its value in predicting lymph node metastasis. Cancer Imaging 2023; 23:115. [PMID: 38041175 PMCID: PMC10691089 DOI: 10.1186/s40644-023-00631-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/01/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND We aim to compare the differences in growth characteristics between part-solid and solid lung adenocarcinoma, and to investigate the value of volume doubling time (VDT) or mass doubling time (MDT) in predicting lymph node (LN) metastasis and preoperative evaluation in patients of early-stage (IA) non-small cell lung cancer (NSCLC). METHOD We reviewed 8,653 cases of surgically resected stage IA lung adenocarcinoma between 2018 and 2022, with two follow-up visits at least 3 months apart, comparing diameter, volume, and mass growth of pSN and SN. VDT and MDT calculations for nodules with a volume change of at least 25%. Univariable or multivariable analysis was used to identify the risk factors. The area under the curve (AUC) for the receiver operating characteristic (ROC) curves was used to evaluate the diagnostic value. RESULTS A total of 144 patients were included 114 with solid nodules (SN) and 25 with part-solid nodules (pSN). During the follow-up period, the mean VDTt and MDTt of SN were shorter than those of pSN, 337 vs. 541 days (p = 0.005), 298 vs. 458 days (p = 0.018), respectively. Without considering the ground-glass component, the mean VDTc and MDTc of SN were shorter than the solid component of pSN, 337 vs. 498 days (p = 0.004) and 298 vs. 453 days (p = 0.003), respectively. 27 nodules were clinically and pathologically diagnosed as N1/N2. Logistic regression identified initial diameter (p < 0.001), consolidation increase (p = 0.019), volume increase (p = 0.020), mass increase (p = 0.021), VDTt (p = 0.002), and MDTt (p = 0.004) were independent factors for LN metastasis. The ROC curves showed that the AUC for VDTt was 0.860 (95% CI, 0.778-0.943; p < 0.001) and for MDTt was 0.848 (95% CI, 0.759-0.936; p < 0.001). CONCLUSIONS Our study showed significant differences in the growth characteristics of pSN and SN, and the application of VDT and MDT could be a valid predictor LN metastasis in patients with early-stage NSCLC.
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Affiliation(s)
- Mengxi Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junhao Mu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feipeng Song
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangling Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiwei Jing
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Sato D, Matsubara H, Matsuoka H, Kondo T, Sasanuma H, Sugimura A, Onuki Y, Uchida T, Nakajima H. Lepidic growth component as a favorable prognostic factor in non-small cell lung cancer of ≤3 cm. Thorac Cancer 2022; 13:3274-3283. [PMID: 36218004 PMCID: PMC9715824 DOI: 10.1111/1759-7714.14680] [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] [Received: 08/03/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Many non-small cell lung cancer (NSCLC) tumors present complex histology with various components. The effects of the lepidic growth component (LGC) on the prognosis of NSCLC have not been investigated. Here, we investigated whether an LGC is a relevant prognostic factor for NSCLC. METHODS This study retrospectively investigated the clinicopathologic characteristics of 379 patients with NSCLC ≤3 cm who underwent complete surgical resection between 2004 and 2016 at the University of Yamanashi Hospital. The histologic subtypes were classified into NSCLC with or without an LGC. We evaluated the effect of an LGC on the clinicopathologic features and 5-year overall survival of patients with NSCLC. RESULTS On final pathology, 214 (56%) of 379 patients had an LGC, and 165 (44%) did not. Sex, smoking history, ground-glass opacity component, pathologic invasive size, lymph node metastasis, pleural invasion, vessel invasion, pathologic stage, and histologic type were significantly different between the groups. Multivariate analysis of 5-year overall survival, identified age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.035-1.105; p < 0.001), pathologic invasive size (HR, 1.548; 95% CI, 1.088-2.202; p = 0.015) and LGC (HR, 2.11; 95% CI, 1.099-4.051; p = 0.025) as independent prognostic factors. When the pathologic invasive size was matched, the 5-year overall survival of the LGC and non-LGC groups was 93% and 77%, respectively (p = 0.006). CONCLUSIONS LGC is a significantly favorable prognostic factor for NSCLC with a pathologic invasive size of ≤3 cm.
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Affiliation(s)
- Daisuke Sato
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan,Department of Thoracic SurgeryNihon University School of MedicineTokyoJapan
| | | | | | - Tetsuo Kondo
- Department of PathologyUniversity of YamanashiYamanashiJapan
| | | | - Aya Sugimura
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
| | - Yuichiro Onuki
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
| | - Tsuyoshi Uchida
- Department of Thoracic SurgeryUniversity of YamanashiYamanashiJapan
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Shen C, Wu Q, Xia Q, Cao C, Wang F, Li Z, Fan L. Establishment of a malignancy and benignancy prediction model of sub-centimeter pulmonary ground-glass nodules based on the inflammation-cancer transformation theory. Front Med (Lausanne) 2022; 9:1007589. [PMID: 36275807 PMCID: PMC9581285 DOI: 10.3389/fmed.2022.1007589] [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] [Received: 08/01/2022] [Accepted: 09/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background In recent years, Chinese clinicians are frequently encountered by patients with multiple lung nodules and these intensity ground-glass nodules (GGNs) are usually small in size and some of them have no spicule sign. In addition, early lung cancer is diagnosed in large numbers of non-heavy smokers and individuals with no caner history. Obviously, the Mayo model is not applicable to these patients. The aim of the present study is to develop a new and more applicable model that can predict malignancy or benignancy of pulmonary GGNs based on the inflammation-cancer transformation theory. Materials and methods Included in this study were patients who underwent surgical resection or lung puncture biopsy of GGNs in Shanghai 10th People’s Hospital between January 1, 2018 and May 31, 2021 with the inclusion criterion of the maximum diameter of GGN < 1.0 cm. All the included patients had their pulmonary GGNs diagnosed by postoperative pathology. The patient data were analyzed to establish a prediction model and the predictive value of the model was verified. Results Altogether 100 GGN patients who met the inclusion criteria were included for analysis. Based on the results of logistic stepwise regression analysis, a mathematical predication equation was established to calculate the malignancy probability as follows: Malignancy probability rate (p) = ex/(1 + ex); p > 0.5 was considered as malignant and p ≤ 0.5 as benign, where x = 0.9650 + [0.1791 × T helper (Th) cell] + [0.2921 × mixed GGN (mGGN)] + (0.4909 × vascular convergence sign) + (0.1058 × chronic inflammation). According to this prediction model, the positive prediction rate was 73.3% and the negative prediction rate was 100% versus the positive prediction rate of 0% for the Mayo model. Conclusion By focusing on four major factors (chronic inflammation history, human Th cell, imaging vascular convergence sign and mGGNs), the present prediction model greatly improves the accuracy of malignancy or benignancy prediction of sub-centimeter pulmonary GGNs. This is a breakthrough innovation in this field.
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Affiliation(s)
- Changxing Shen
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiong Wu
- Liangcheng Xincun Community Health Services Center, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qing Xia
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuanwu Cao
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fei Wang
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhuang Li
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lihong Fan
- Department of Integrated Traditional Chinese and Western Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Lihong Fan,
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Xie M, Gao J, Ma X, Wu C, Zang X, Wang Y, Deng H, Yao J, Sun T, Yu Z, Liu S, Zhuang G, Xue X, Wu J, Wang J. Consolidation radiographic morphology can be an indicator of the pathological basis and prognosis of partially solid nodules. BMC Pulm Med 2022; 22:369. [PMID: 36171571 PMCID: PMC9520850 DOI: 10.1186/s12890-022-02165-x] [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] [Received: 05/21/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Part-solid nodules (PSNs) have gradually shifted to defining special clinical subtypes. Commonly, the solid portions of PSNs show various radiological morphologies, of which the corresponding pathological basis and prognosis are unclear. We conducted a radiological–pathological evaluation to determine the histopathologic basis of different consolidation radiographic morphologies related to prognosis. Materials and methods A cohort of 275 patients with a surgical pathological diagnosis of lung adenocarcinoma were enrolled. Preoperative computed tomography (CT) images of the PSNs were recorded and assessed. A panel of 103 patients with complete pathological specimens was selected to examine the radiological–pathological associations, and follow-up was performed to identify the prognosis. Results Of the 275 patients, punctate consolidation was observed radiologically in 43/275 (15.7%), stripe consolidation in 68/275 (24.7%), and irregular consolidation in 164/275 (59.6%) patients. The radiological morphology of the solid components was significantly associated with the histopathological subtypes (P < 0.001). Visual punctate solid components on CT correlated with tertiary lymphoid structures, stripe solid components on CT correlated with fibrotic scar, and irregular solid components on CT correlated with invasion. PSNs with regular consolidation had a better prognosis than those with irregular consolidation. Conclusion Radiological morphology of solid components in PSNs can indicate the pathological basis and is valuable for prognosis. In particular, irregular solid components in PSNs usually indicate serious invasive growth, which should be taken with caution during assessment.
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Affiliation(s)
- Mei Xie
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, the First Medical Centre, Beijing, 100835, People's Republic of China.,Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, People's Republic of China
| | - Jie Gao
- Department of Pathology, Chinese PLA General Hospital, Beijing, 100835, People's Republic of China
| | - Xidong Ma
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, the First Medical Centre, Beijing, 100835, People's Republic of China
| | - Chongchong Wu
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100835, People's Republic of China
| | - Xuelei Zang
- Center of Clinical Laboratory Medicine, First Medical Centre, Chinese PLA General Hospital, 100835, Beijing, People's Republic of China
| | - Yuanyong Wang
- Department of Thoracic Surgery, Tangdu Hospital of Air Force Military Medical University, Xi'an, 710038, Shanxi, People's Republic of China
| | - Hui Deng
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, People's Republic of China
| | - Jie Yao
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, People's Republic of China
| | - Tingting Sun
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, People's Republic of China
| | - Zhaofeng Yu
- School of Medicine, Peking University, Beijing, 100871, People's Republic of China
| | - Sanhong Liu
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, People's Republic of China
| | - Guanglei Zhuang
- Shanghai Key Laboratory of Gynecologic Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200000, Shanghai, People's Republic of China.
| | - Xinying Xue
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, 100038, Beijing, People's Republic of China.
| | - Jianlin Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116001, People's Republic of China.
| | - Jianxin Wang
- Department of Respiratory and Critical Care, Chinese PLA General Hospital, the First Medical Centre, Beijing, 100835, People's Republic of China.
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10
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Mimae T, Miyata Y, Tsutani Y, Shimada Y, Ito H, Nakayama H, Ikeda N, Okada M. Role of ground-glass opacity in pure invasive and lepidic component in pure solid lung adenocarcinoma for predicting aggressiveness. JTCVS OPEN 2022; 11:300-316. [PMID: 36172403 PMCID: PMC9510793 DOI: 10.1016/j.xjon.2022.04.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 10/27/2022]
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11
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Tang H, Qiao C, Wang Y, Bai C. Characteristics and Prognostic Nomogram for Primary Lung Lepidic Adenocarcinoma. Can Respir J 2022; 2022:3676547. [PMID: 36091329 PMCID: PMC9453021 DOI: 10.1155/2022/3676547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/20/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Lepidic adenocarcinoma (LPA) is an infrequent subtype of invasive pulmonary adenocarcinoma (ADC). However, the clinicopathological features and prognostic factors of LPA have not been elucidated. Methods Data from the Surveillance, Epidemiology, and End Results (SEER) database of 4191 LPA patients were retrospectively analyzed and compared with non-LPA pulmonary ADC to explore the clinicopathological and prognosis features of LPA. Univariate and multivariate Cox proportional hazard models were performed to identify independent survival predictors for further nomogram development. The nomograms were validated using the concordance index, receiver operating characteristic curves, and calibration plots, as well as decision curve analysis, in both the training and validation cohorts. Results Compared with non-LPA pulmonary ADC patients, those with LPA exhibited unique clinicopathological features, including more elderly and female patients, smaller tumor size, less pleural invasion, and lower histological grade and stage. Multivariate analyses showed that age, sex, race, tumor location, primary tumor size, pleural invasion, histological grade, stage, primary tumor surgery, and chemotherapy were independently associated with overall survival (OS) and cancer-specific survival (CSS) in patients with LPA. The nomograms showed good accuracy compared with the actual observed results and demonstrated improved prognostic capacity compared with the TNM stage. Conclusions LPA is more frequently diagnosed in older people and women. LPA was inclined to be smaller in tumor size and lower in tumor grade and staging, which may indicate a favorable prognosis. The constructed nomograms accurately predict the long-term survival of LPA patients.
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Affiliation(s)
- Hui Tang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caixia Qiao
- Department of Medical Oncology, Liaocheng Third People's Hospital, Liaocheng, China
| | - Yingyi Wang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunmei Bai
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Ono Y, Tagawa T, Kinoshita F, Haratake N, Takada K, Kohno M, Takenaka T, Kamitani T, Shimokawa M, Oda Y, Mori M, Yoshizumi T. Relationship between consolidation tumor ratio and tumor-infiltrating lymphocytes in small-sized lung adenocarcinoma. Thorac Cancer 2022; 13:2134-2141. [PMID: 35791738 PMCID: PMC9346188 DOI: 10.1111/1759-7714.14524] [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] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Consolidation tumor ratio (CTR) is associated with cancer progression and histological invasiveness in lung adenocarcinoma (LAD). However, little is known about the association between CTR and immune‐related factors, including tumor‐infiltrating lymphocytes (TILs) density or tumor expression of programmed death ligand 1 (PD‐L1) and indoleamine 2,3‐dioxygenase 1 (IDO1) in small‐sized LAD. Methods This study included 258 patients with LAD (<3 cm) who underwent surgery. Patients were assigned to four groups: CTR = 0; 0 < CTR <0.5; 0.5 ≤ CTR <1 (ground‐glass opacity [GGO] group); and CTR = 1 (pure‐solid group). CD4+, CD8+, and FoxP3+ TIL density and PD‐L1 and IDO1 tumor expression were assessed by immunohistochemistry. Results Among the GGO group, CD8+ and FoxP3+ TIL density increased significantly with increasing CTR (p < 0.001 and p < 0.001, respectively). Moreover, PD‐L1 and IDO1 expression was significantly higher in the pure‐solid group than in the GGO group (p < 0.001 and p < 0.001, respectively). Conclusions CTR was correlated with the abundance of CD8+ and FoxP3+ TILs in the GGO group. PD‐L1 and IDO1 positivity rates were significantly higher in the pure‐solid group than in the GGO group. Increased CTR may be correlated with immunosuppressive condition.
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Affiliation(s)
- Yuki Ono
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuzo Tagawa
- Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Japan
| | - Fumihiko Kinoshita
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Naoki Haratake
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuki Takada
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Mikihiro Kohno
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoyoshi Takenaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Tokai University School of Medicine, Tokyo, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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13
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Huang X, Sun Y, Tan M, Ma W, Gao P, Qi L, Lu J, Yang Y, Wang K, Chen W, Jin L, Kuang K, Duan S, Li M. Three-Dimensional Convolutional Neural Network-Based Prediction of Epidermal Growth Factor Receptor Expression Status in Patients With Non-Small Cell Lung Cancer. Front Oncol 2022; 12:772770. [PMID: 35186727 PMCID: PMC8848731 DOI: 10.3389/fonc.2022.772770] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/10/2022] [Indexed: 12/16/2022] Open
Abstract
Objectives EGFR testing is a mandatory step before targeted therapy for non-small cell lung cancer patients. Combining some quantifiable features to establish a predictive model of EGFR expression status, break the limitations of tissue biopsy. Materials and Methods We retrospectively analyzed 1074 patients of non-small cell lung cancer with complete reports of EGFR gene testing. Then manually segmented VOI, captured the clinicopathological features, analyzed traditional radiology features, and extracted radiomic, and deep learning features. The cases were randomly divided into training and test set. We carried out feature screening; then applied the light GBM algorithm, Resnet-101 algorithm, logistic regression to develop sole models, and fused models to predict EGFR mutation conditions. The efficiency of models was evaluated by ROC and PRC curves. Results We successfully established Modelclinical, Modelradiomic, ModelCNN (based on clinical-radiology, radiomic and deep learning features respectively), Modelradiomic+clinical (combining clinical-radiology and radiomic features), and ModelCNN+radiomic+clinical (combining clinical-radiology, radiomic, and deep learning features). Among the prediction models, ModelCNN+radiomic+clinical showed the highest performance, followed by ModelCNN, and then Modelradiomic+clinical. All three models were able to accurately predict EGFR mutation with AUC values of 0.751, 0.738, and 0.684, respectively. There was no significant difference in the AUC values between ModelCNN+radiomic+clinical and ModelCNN. Further analysis showed that ModelCNN+radiomic+clinical effectively improved the efficacy of Modelradiomic+clinical and showed better efficacy than ModelCNN. The inclusion of clinical-radiology features did not effectively improve the efficacy of Modelradiomic. Conclusions Either deep learning or radiomic signature-based models can provide a fairly accurate non-invasive prediction of EGFR expression status. The model combined both features effectively enhanced the performance of radiomic models and provided marginal enhancement to deep learning models. Collectively, fusion models offer a novel and more reliable way of providing the efficacy of currently developed prediction models, and have far-reaching potential for the optimization of noninvasive EGFR mutation status prediction methods.
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Affiliation(s)
- Xuemei Huang
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Yingli Sun
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Mingyu Tan
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Weiling Ma
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Pan Gao
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Lin Qi
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Jinjuan Lu
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Yuling Yang
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Kun Wang
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Wufei Chen
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Liang Jin
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | | | - Shaofeng Duan
- Precision Health Institution, GE Healthcare, Shanghai, China
| | - Ming Li
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
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HATTORI ARITOSHI, SUZUKI KENJI. Latest Clinical Evidence and Operative Strategy for Small-Sized Lung Cancers. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:52-59. [PMID: 38911012 PMCID: PMC11189789 DOI: 10.14789/jmj.jmj21-0030-ot] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 06/25/2024]
Abstract
Many thoracic surgeons revealed that consolidation tumor ratio or solid component size on thin-section computed tomography has been considered more prognostic than maximum tumor size in non-small cell lung cancer (NCSLC). According to the results, the 8th TNM classification drastically changed the staging system, i.e., clinical T category was determined based on the invasive or solid component size excluding a ground-glass opacity (GGO). However, several debates are arising over the application of radiological solid size for the clinical T staging. Meanwhile, recent several institutional reports have noticed a significantly simple fact that the presence of a GGO denotes an influence on the favorable prognosis of NSCLC. More important, radiologic pure-solid lung cancers without a GGO exhibit more malignant behaviors with regard to both the clinical and pathological aspects, and show several histologic types that have a poorer prognosis than radiologic part-solid lung cancer. In contrast, favorable prognostic impact of the presence of a GGO component was demonstrated, which was irrespective of the solid component size in cases in which the tumor showed a GGO component. Recently, this concept has been gradually noticed on a nationwide level. Obvious distinctions regarding the several baseline characteristics between the tumor with/without GGO component is a fundamental biological feature of early-stage lung cancer, which would result in a big difference in prognosis, modes of recurrence, overall behavior, and appropriate operative strategies. As a future perspective, the presence or absence of a GGO should be considered as an important parameter in the next clinical T classification.
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Affiliation(s)
- ARITOSHI HATTORI
- Corresponding author: Aritoshi Hattori, Department of General Thoracic Surgery, Juntendo University School of Medicine 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan, TEL: +81-3-3813-3111 FAX: +81-3-5800-0281 E-mail:
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15
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Shao X, Shao X, Niu R, Jiang Z, Xu M, Wang Y. Investigating the association between ground-glass nodules glucose metabolism and the invasive growth pattern of early lung adenocarcinoma. Quant Imaging Med Surg 2021; 11:3506-3517. [PMID: 34341727 DOI: 10.21037/qims-20-1189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/26/2021] [Indexed: 01/11/2023]
Abstract
Background To explore the association between the glucose metabolism level of lung ground-glass nodules (GGNs), as revealed by 18F-flurodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging, and the invasive pathological growth pattern of early lung adenocarcinoma. Methods We retrospectively analyzed patients who underwent PET/CT examination and surgical resection due to persistent GGNs, which were confirmed to be early lung adenocarcinoma by postoperative pathology examination. After adjusting for confounding factors and performing stratified analysis, we explored the association between the maximum standard uptake value of PET (SUVmax) and the invasive pathological growth pattern of early stage lung adenocarcinoma. Results The proportions of invasive adenocarcinoma (INV) in the SUVmax of Tertile 1, Tertile 2, and Tertile 3 were 52.7%, 73.3%, and 87.1%, respectively. After adjusting for potential confounding factors, the risk of INV gradually increased as the GGN SUVmax increased [odds ratio (OR): 1.520, 95% confidence interval (CI): 1.044-2.213, P=0.029]. This trend was statistically significant (OR: 1.678, 95% CI: 1.064-2.647, P=0.026), especially in Tertile 3 vs. Tertile 1 (OR: 4.879, 95% CI: 1.349-17.648, P=0.016). Curve fitting showed that the SUVmax and INV risk were linearly and positively associated. The association was consistent in different subgroups based on GGN number, type, shape, edge, bronchial sign, vacuole sign, pleural depression sign, diameters, and consolidation-to-tumor ratio, suggesting that there was no significant interaction between different grouping parameters and the association (P for interaction range = 0.129-0.909). Conclusions In FDG PET, the glucose metabolism level (SUVmax) of lung GGNs is independently associated with INV risk, and this association is linear and positive.
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Affiliation(s)
- Xiaoliang Shao
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Xiaonan Shao
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Rong Niu
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Zhenxing Jiang
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Mei Xu
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Yuetao Wang
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
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16
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Lai J, Li Q, Fu F, Zhang Y, Li Y, Liu Q, Chen H. Subsolid Lung Adenocarcinomas: Radiological, Clinical and Pathological Features and Outcomes. Semin Thorac Cardiovasc Surg 2021; 34:702-710. [PMID: 34087379 DOI: 10.1053/j.semtcvs.2021.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
Lung adenocarcinomas manifesting as subsolid nodules usually have a favorable prognosis. This study aimed to have a comprehensive investigation of the radiological and clinicopathologic features and oncological outcomes of subsolid nodules. Between March 2010 and December 2015, 865 patients with surgically resected clinical IA subsolid lung adenocarcinoma were retrospectively reviewed. Patients were classified into the pure ground-glass nodules (GGN) (pGGN [n = 358], without solid component on lung and mediastinal windows), heterogeneous GGN (hGGN [n = 65], only with solid components on lung window), and real part-solid nodule (rPSN [n = 442], with solid component on both lung and mediastinal windows) groups. The clinicopathological features and survival time of the three groups were compared between groups. There was a significant increase in median tumor size (P < 0.001), solid component size measured at lung window (LW-SCS) (P < 0.001), and the proportion of invasive adenocarcinoma subtypes (P < 0.001) from pGGNs to hGGNs to rPSNs. After adjustment for LW-SCS, adenocarcinomas with predominant lepidic patterns were still more common in hGGNs than in rPSNs (P = 0.009). Patients with rPSNs had a significantly worse recurrence-free survival (RFS) than those with pGGNs and hGGNs (5-year: 91.9% versus 100% versus 100%, P < 0.001). Multivariate Cox analyses revealed that gender (both P < 0.05) and clinical T category (based on lung window [LW-cT] [P = 0.002] or mediastinal window [MW-cT] [P < 0.001]) were independent prognostic factors of RFS in the rPSN group. HGGNs represented as an intermediate subtype between pGGNs and rPSNs. Both pGGNs and hGGNs had excellent outcomes, while rPSNs exhibited a worse prognosis than them. Clinical T category and gender had prognostic implications for rPSNs.
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Affiliation(s)
- Jinglei Lai
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiao Li
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Quan Liu
- Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China; Institution of Thoracic Oncology, Fudan University, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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17
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Watanabe Y, Hattori A, Nojiri S, Matsunaga T, Takamochi K, Oh S, Suzuki K. Clinical impact of a small component of ground-glass opacity in solid-dominant clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2020; 163:791-801.e4. [PMID: 33516459 DOI: 10.1016/j.jtcvs.2020.12.089] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Non-small cell lung cancers with a ground-glass opacity component have better prognosis than those with solid nodules of equivalent consolidation size. However, the impact of small ground-glass opacity components on prognosis is unknown. Therefore, we aimed to evaluate the significance of a small ground-glass opacity component in solid-dominant clinical stage IA non-small cell lung cancers. METHODS We reviewed the cases of 543 surgically resected solid-dominant c-stage IA non-small cell lung cancers, which was defined as a tumor with consolidation tumor ratio of 0.75 or more on computed tomography. The patients were classified into 2 groups: 0.75 or less consolidation tumor ratio less than 1 (n = 126) and consolidation tumor ratio of 1 (n = 417). The prognoses were compared between the 2 groups. RESULTS Among the 543 cases, multivariable analyses revealed that pure-solid appearance was a predictor of worse overall survival (hazard ratio, 2.051; 95% confidence interval, 1.044-4.028). Compared with the part-solid group, the pure-solid group was associated with poor survival in c-stages IA2 (5-year overall survival: 91.5% vs 76.8%, hazard ratio, 2.942; 95% confidence interval, 1.402-6.173; recurrence-free survival: 89.0% vs 68.8%, hazard ratio, 3.439; 95% confidence interval, 1.776-6.669) and IA3 (5-year overall survival: 93.5% vs 63.0%, hazard ratio, 5.110; 95% confidence interval, 1.607-16.241; recurrence-free survival: 80.5% vs 54.1%, hazard ratio, 2.789; 95% confidence interval, 1.290-6.027). The T categories significantly affected 5-year overall survival only in the pure-solid group (cT1a, 89.3%; cT1b, 76.8%; cT1c, 63.0%). CONCLUSIONS A small ground-glass opacity component has an impact on the prognosis of patients with solid-dominant c-stage IA non-small cell lung cancer. Therefore, c-stage IA non-small cell lung cancers should be evaluated separately for tumors with ground-glass opacity and pure-solid tumors.
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Affiliation(s)
- Yukio Watanabe
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Wang YH, Chen CF, Lin YK, Chiang C, Tzao C, Yen Y. Predicting malignancy: subsolid nodules detected on LDCT in a surgical cohort of East Asian patients. J Thorac Dis 2020; 12:4315-4326. [PMID: 32944344 PMCID: PMC7475597 DOI: 10.21037/jtd-20-659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Due to widespread use of low-dose computed tomography (LDCT) screening, increasing number of patients are found to have subsolid nodules (SSNs). The management of SSNs is a clinical challenge and primarily depends on CT imaging. We seek to identify risk factors that may help clinicians determine an optimal course of management. Methods We retrospectively reviewed the characteristics of 83 SSN lesions, including 48 pure ground-glass nodules and 35 part-solid nodules, collected from 83 patients who underwent surgical resection. Results Of the 83 SSNs, 16 (19.28%) were benign and 67 (80.72%) were malignant, including 23 adenocarcinomas in situ (AIS), 16 minimally invasive adenocarcinomas (MIA), and 28 invasive adenocarcinomas (IA). Malignant lesions were found to have significantly larger diameters (P<0.05) with an optimal cut-off point of 9.24 mm. Significant indicators of malignancy include female sex (P<0.05), air bronchograms (P<0.001), spiculation (P<0.05), pleural tail sign (P<0.05), and lobulation (P<0.05). When compared with AIS/MIA combined, IA lesions were found to be larger (P<0.05) with an optimal cut-off of 12 mm, and have a higher percentage of part-solid nodules (P<0.001), pleural tail sign (P<0.001), air bronchograms (P<0.05), and lobulation (P<0.05). Further multivariate analysis found that lesion size and spiculation were independent factors for malignancy while part-solid nodules were associated with IA histology. Conclusions East Asian females are at risk of presenting with a malignant lesion even without history of heavy smoking or old age. Nodule features associated with malignancy include larger size, air bronchograms, lobulation, pleural tail sign, spiculation, and solid components. A combination of patient characteristic and LDCT features can be effectively used to guide management of patients with SSNs.
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Affiliation(s)
- Yung-Hsien Wang
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei
| | - Chieh-Feng Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Public Health, College of Medicine, Taipei Medical University, Taipei.,Cochrane Taiwan, Taipei Medical University, Taipei.,Division of Plastic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei.,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei
| | - Yen-Kuang Lin
- Biostatistics Research Center, College of Nursing, Taipei Medical University, Taipei.,School of Nursing, College of Nursing, Taipei Medical University, Taipei
| | - Caleb Chiang
- Trinity College of Arts & Sciences, Duke University, Durham, USA
| | - Ching Tzao
- Division of Thoracic Surgery, Kuang Tien General Hospital, Taichung
| | - Yun Yen
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei.,PhD Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei.,Graduate Institute of Cancer Biology and Drug Discovery, Taipei Medical University, Taipei.,Cancer Center, Taipei Municipal Wan Fang Hospital, Taipei
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Miyoshi T, Aokage K, Katsumata S, Tane K, Ishii G, Tsuboi M. Ground-Glass Opacity Is a Strong Prognosticator for Pathologic Stage IA Lung Adenocarcinoma. Ann Thorac Surg 2019; 108:249-255. [DOI: 10.1016/j.athoracsur.2019.01.079] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/26/2018] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
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Hattori A, Takamochi K, Oh S, Suzuki K. New revisions and current issues in the eighth edition of the TNM classification for non-small cell lung cancer. Jpn J Clin Oncol 2019; 49:3-11. [PMID: 30277521 DOI: 10.1093/jjco/hyy142] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022] Open
Abstract
In the eighth edition of the TNM classification of lung cancer, the prognostic impact of tumor size is emphasized as a descriptor of all T categories. Especially in lung cancer where tumor size is 5 cm or less, the 1-cm cutoff point significantly differentiated the survival outcome. In addition, the new staging categories were assigned, namely, Tis (adenocarcinoma in situ) and T1mi (minimally invasive adenocarcinoma). Furthermore, the measurement of a radiological solid component size excluding the ground glass opacity component or pathological invasive size without a lepidic component was proposed for deciding the cT/pT categories for lung adenocarcinoma. The N descriptors were kept the same as in the eventh edition on the whole, however, quantification of nodal disease had a prognostic impact based on the number of nodal stations involved in the eighth edition, i.e. N1a as a single N1 station, N1b as a multiple N1 station, N2a1 as a single N2 station without N1 (skip metastasis), N2a2 as a single N2 station with N1 disease, and N2b as a multiple N2 station. In the M descriptors, subclassification was performed based on the location or numbers of distantly metastatic lesions, i.e. M1a as any intrathoracic metastases, M1b as a single distant metastatic lesion in one organ, and M1c as multiple distant metastases in either a single organ or multiple organs. Survival analysis of the eighth edition of the TNM classification clearly separated the distinct groups, however, unsolved issues still remain that should be discussed and further revised for the forthcoming TNM staging system.
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Radonic T, Dickhoff C, Mino-Kenudson M, Lely R, Paul R, Thunnissen E. Gross handling of pulmonary resection specimen: maintaining the 3-dimensional orientation. J Thorac Dis 2019; 11:S37-S44. [PMID: 30775026 PMCID: PMC6353737 DOI: 10.21037/jtd.2018.12.36] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/06/2018] [Indexed: 01/10/2023]
Abstract
There is limited literature on the gross handling of lung resection specimens. Microscopic examination of the specimen, TNM staging and predictive biomarker testing are fully dependent on an adequate gross handling. In this paper, we present a 3-dimensional (3D) grossing method of oncological lung resection specimens, which ensures proper fixation of the tumor tissue, but also enables accurate correlation with the pre-surgical imaging.
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Affiliation(s)
- Teodora Radonic
- Department of Pathology Amsterdam University Medical Centers, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Surgery, Amsterdam University Medical Centers, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Rutger Lely
- Department of Radiology, Amsterdam University Medical Centers, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Rick Paul
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Erik Thunnissen
- Department of Pathology Amsterdam University Medical Centers, VU University Medical Center, De Boelelaan 1117, Amsterdam, The Netherlands
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22
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Jiménez-Zarazúa O, Vélez-Ramírez LN, Padilla-López JC, García-Ramírez JR, González-Carillo PL, Mondragón JD. Invasive Pulmonary Adenocarcinoma with Lepidic Growth Pattern in a Pregnant Patient. Case Rep Oncol 2018; 11:822-834. [PMID: 30687058 PMCID: PMC6341323 DOI: 10.1159/000495460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/13/2018] [Indexed: 12/01/2022] Open
Abstract
Among the differential diagnoses that should be considered in acute respiratory failure (ARF) are infectious processes, autoimmune diseases, interstitial pulmonary fibrosis, and pulmonary neoplasia. Timely diagnosis of lung neoplasia is complicated in the early stages. An opportune diagnosis, as well as the specific treatment, decrease mortality. ARF occurs 1 in 500 pregnancies and is most common during the postpartum period. Among the specific etiologies that cause ARF during pregnancy that must be considered are: (1) preeclampsia; (2) embolism of amniotic fluid; (3) peripartum cardiomyopathy; and (4) trophoblastic embolism. The case of a 36-year-old patient with a 33-week pregnancy and ARF is presented. The patient presented dyspnea while exerting moderate effort that progressed to orthopnea and type 1 respiratory insufficiency. Imaging studies showed bilateral alveolar infiltrates and predominantly right areas of consolidation. Blood cultures, a galactomannan assay and IgG antibodies against mycoplasma pneumoniae, were reported as negative. Autoimmune etiology was ruled out through an immunoassay. A percutaneous pulmonary biopsy was performed and an invasive pulmonary adenocarcinoma with lepidic growth pattern (i.e. lepidic pulmonary adenocarcinoma, LPA) result was reported. This etiology is rare and very difficult to recognize in acute respiratory failure cases. After infectious, autoimmune and interstitial lung fibrosis have been excluded the clinician must suspect of lung cancer in a patient with acute respiratory failure and chest imaging compatible with the presence of ground-glass nodular opacities, a solitary nodule or mass with bronchogram, and lung consolidation. In the presence of acute respiratory failure, the suspicion of pulmonary neoplasia in an adult of reproductive age must be timely. Failure to recognize this etiology can lead to fatal results.
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Affiliation(s)
- Omar Jiménez-Zarazúa
- Hospital General León, Department of Internal Medicine, León, Mexico.,Universidad de Guanajuato, Department of Medicine and Nutrition, León, Mexico
| | | | | | - Juana R García-Ramírez
- Universidad de Guanajuato, Department of Medicine and Nutrition, León, Mexico.,Hospital General León, Department of Pathology, León, Mexico
| | | | - Jaime D Mondragón
- University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Alzheimer Research Center, Groningen, The Netherlands
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Rizzo S, Savoldi F, Rossi D, Bellomi M. Radiogenomics as association between non-invasive imaging features and molecular genomics of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:447. [PMID: 30603635 DOI: 10.21037/atm.2018.11.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stefania Rizzo
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, IT, Italy
| | - Filippo Savoldi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, IT, Italy
| | - Duccio Rossi
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, IT, Italy
| | - Massimo Bellomi
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, IT, Italy.,Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, IT, Italy
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