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Mascalchi M, Puliti D, Cavigli E, Cortés-Ibáñez FO, Picozzi G, Carrozzi L, Gorini G, Delorme S, Zompatori M, Raffaella De Luca G, Diciotti S, Eva Comin C, Alì G, Kaaks R. Large cell carcinoma of the lung: LDCT features and survival in screen-detected cases. Eur J Radiol 2024; 179:111679. [PMID: 39163805 DOI: 10.1016/j.ejrad.2024.111679] [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: 06/01/2024] [Revised: 07/17/2024] [Accepted: 08/08/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE To investigate the early radiological features and survival of Large Cell Carcinoma (LCC) cases diagnosed in low-dose computed tomography (LDCT) screening trials. METHODS Two radiologists jointly reviewed the radiological features of screen-detected LCCs observed in NLST, ITALUNG, and LUSI trials between 2002 and 2016, comprising a total of 29,744 subjects who underwent 3-5 annual screening LDCT examinations. Survival or causes of death were established according to the mortality registries extending more than 12 years since randomization. RESULTS LCC was diagnosed in 30 (4 %) of 750 subjects with screen-detected lung cancer (LC), including 15 prevalent and 15 incident cases. Three additional LCCs occurred as interval cancers during the screening period. LDCT images were available for 29 cases of screen-detected LCCs, and 28 showed a single, peripheral, and well-defined solid nodule or mass with regularly smooth (39 %), lobulated (43 %), or spiculated (18 %) margins. One case presented as hilar mass. In 9 incident LCCs, smaller solid nodules were identified in prior LDCT examinations, allowing us to calculate a mean Volume Doubling Time (VDT) of 98.7 ± 47.8 days. The overall five-year survival rate was 50 %, with a significant (p = 0.0001) difference between stages I-II (75 % alive) and stages III-IV (10 % alive). CONCLUSIONS LCC is a fast-growing neoplasm that can escape detection by annual LDCT screening. LCC typically presents as a single solid peripheral nodule or mass, often with lobulated margins, and exhibits a short VDT. The 5-year survival reflects the stage at diagnosis.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy; Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Donella Puliti
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Edoardo Cavigli
- Department of Radiology, Emergency Radiology AOU Careggi, Florence, Italy
| | - Francisco O Cortés-Ibáñez
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Giulia Picozzi
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Laura Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy; Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Giuseppe Gorini
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Stefan Delorme
- Division of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | | | - Giulia Raffaella De Luca
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Camilla Eva Comin
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Greta Alì
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy
| | - Rudolf Kaaks
- Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), the German Center for Lung Research (DZL), Heidelberg, Germany
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Mascalchi M, Cavigli E, Picozzi G, Cozzi D, De Luca GR, Diciotti S. The Azygos Esophageal Recess Is Not to Be Missed in Screening Lung Cancer With LDCT. J Thorac Imaging 2024:00005382-990000000-00151. [PMID: 39267479 DOI: 10.1097/rti.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
PURPOSE Lesion overlooking and late diagnostic workup can compromise the efficacy of low-dose CT (LDCT) screening of lung cancer (LC), implying more advanced and less curable disease stages. We hypothesized that the azygos esophageal recess (AER) of the right lower lobe (RLL) might be an area prone to lesion overlooking in LC screening. MATERIALS AND METHODS Two radiologists reviewed the LDCT examinations of all the screen-detected incident LCs observed in the active arm of 2 randomized clinical trials: ITALUNG and national lung screening trial. Those in the AER were compared with those in the remainder of the RLL for possible differences in diagnostic lag according to the Lung-RADS 1.1 recommendations, size, stage, and mortality. RESULTS Six (11.7%) of 51 screen-detected incident LCs of the RLL were located in the AER. The diagnostic lag time was significantly longer (P=0.046) in the AER LC (mean 14±9 mo) than in the LC in the remaining RLL (mean 7.3±1 mo). Size and stage at diagnosis were not significantly different. All 6 subjects with LC in the AER and 16 (35.5%) of 45 subjects with LC in the remaining RLL (P=0.004) died of LC after a median follow-up of 12 years. CONCLUSION Our retrospective study indicates that AER might represent a lung region of the RLL prone to have early LC overlooked due to detection or interpretation errors with possible detrimental consequences for the subject undergoing LC screening.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Edoardo Cavigli
- Radiology Division, Nuovo Ospedale S. Giovanni di Dio "Torregalli", Azienda Sanitaria Toscana Centro, Italy
- Department of Radiology, Emergency Radiology AOU Careggi, Florence, Italy
| | - Giulia Picozzi
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Diletta Cozzi
- Department of Radiology, Emergency Radiology AOU Careggi, Florence, Italy
| | - Giulia Raffaella De Luca
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Cesena, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Cesena, Italy
- Alma Mater Research Institute for Human-Centered Artificial Intelligence, University of Bologna, Bologna, Italy
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Li W, Chen S, Fu Y, Cheng Z, Yan S. Wolf in sheep's clothing: a case of primary lung adenosquamous carcinoma mimicking traumatic pulmonary pseudocyst. J Cardiothorac Surg 2024; 19:513. [PMID: 39227953 PMCID: PMC11370101 DOI: 10.1186/s13019-024-03005-1] [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: 05/13/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Traumatic pulmonary pseudocyst is a rare "cystlike" lung lesion that typically develops following blunt chest trauma. It differs from lung cancer associated with cystic airspaces in terms of pathogenic mechanisms, clinical manifestations, and radiological features. Furthermore, there are few reports of the diagnostic bias between traumatic pulmonary pseudocyst and lung cancer associated with cystic airspaces. Here, we present a rare case of lung cancer associated with cystic airspaces that mimicks traumatic pulmonary pseudocyst. CASE PRESENTATION A 61-year-old man with no chest medical or surgical history, no chest radiologic examination within the last five years, and no smoking history had an air-filled "cystlike" lesion surrounded by solid components and ground-glass opacities in the middle third of the right upper lobe of the lung during a computed tomography evaluation following blunt chest trauma. He was initially diagnosed with traumatic pulmonary pseudocyst and treated conservatively. On the third post-trauma day, he experienced hemoptysis, which was successfully treated with intravenous hemostatic medication. On the ninth post-trauma day, he exhibited a significant hemoptysis and a moderate dyspnea. A subsequent chest computed tomography scan demonstrated that the solid components had entered the lesion's cavity and significantly expanded, and the surrounding ground-glass opacities had slightly enlarged. A contrast-enhanced chest computed tomography scan and a three-dimensional reconstruction computed tomography image confirmed that the solid components were a hematoma caused by damage to the right upper pulmonary vein. A right upper lobectomy was performed based on the concern about severe intrapulmonary bleeding. An intraoperative frozen section analysis showed significant bleeding in the lung parenchyma. Adenosquamous carcinoma was unexpectedly identified during the postoperative pathological examination of the resected specimen. A diagnosis of primary lung adenosquamous carcinoma was made. He was discharged on the seventh postoperative day and followed up for two years without any recurrence. CONCLUSIONS The potential of lung cancer associated with cystic airspaces should be considered for "cystlike" lung lesions discovered in elderly patients after blunt chest trauma. A comprehensive review of the medical history, meticulous analysis of the radiological findings, and close monitoring can help clinicians reduce the risk of diagnostic bias.
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Affiliation(s)
- Wei Li
- Department of Cardiothoracic Surgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, China.
| | - Si Chen
- Department of Cardiothoracic Surgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, China
| | - Yao Fu
- Department of Cardiothoracic Surgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, China
| | - Zhuang Cheng
- Department of Cardiothoracic Surgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, China
| | - Sijun Yan
- Department of Cardiothoracic Surgery, General Hospital of Central Theater Command of Chinese People's Liberation Army, 627 Wuluo Road, Wuhan, 430070, China.
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Li Z, Wang X, Liu C, Ren Y. Diagnosis of contralateral rare pulmonary cavity metastasis after lung squamous cell carcinoma surgery by electromagnetic navigation: one case report and review of the literature. Front Med (Lausanne) 2024; 11:1445752. [PMID: 39238596 PMCID: PMC11375509 DOI: 10.3389/fmed.2024.1445752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/01/2024] [Indexed: 09/07/2024] Open
Abstract
Background Lung cancer associated with cystic airspaces is a rare disease, and a rare imaging performance of non-small cell lung cancer. Due to the lack of conventional diagnosis methods, it is difficult to rely on imaging diagnosis. Therefore, the definitive diagnosis of these neoplastic lesions remains challenging. Case presentation We summarize the follow-up and diagnosis of a rare cystic airspaces lung metastatic carcinoma in an elderly man with annular density shadow in the right inferior lobe 2 years after surgery for squamous cell carcinoma in the left inferior lobe. Results During the follow-up of the patient, after the lesion of the lower lobe of the right lung was enlarged, the structural and imaging characteristics were identified, and a special method was selected, namely biopsy of the lesion under the electromagnetic navigation bronchoscope, for clear diagnosis and subsequent treatment. Conclusion For pulmonary cystic airspaces, it is important to correctly identify their imaging features. Because of the possibility of malignancy, it is essential to stop the radiological study in time and to acquire the pathological diagnosis by an appropriate method.
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Affiliation(s)
- Zhengjun Li
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Xiaoge Wang
- Department of Respiratory Medicine, Shenyang Chest Hospital, Shenyang, China
| | - Chang Liu
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital, Shenyang, China
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Xu X, Zhang M, Guo J, Chen W, Dong Z, Song Q, Cai T, Sun L. The impact of cystic lesions on the postoperative prognosis of non-small cell lung cancer: a comparative study. Clin Radiol 2024:S0009-9260(24)00423-9. [PMID: 39237391 DOI: 10.1016/j.crad.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/07/2024] [Accepted: 08/08/2024] [Indexed: 09/07/2024]
Abstract
AIM Due to the rarity of lung cancer with cystic imaging manifestations, we explore the clinical features and survival prognosis of such tumors. MATERIALS AND METHODS Imaging characteristics were used to categorize 3,556 patients who underwent surgery for isolated primary lung cancer into one of three groups: those with cystic lung cancer (149), solid lung cancer (1,399), and ground-glass lung cancer (1,160). Propensity score matching by sex and age was performed to analyze the differences in clinical characteristics of lung cancer among the three groups and the correlation between clinical characteristics of cystic lesions and progression-free survival (PFS). RESULTS The three groups of patients differed in various aspects, including pathological type, smoking history, tumor stage, type of surgery, histological grading, and PFS (P < 0.05). The results of the multifactorial analysis indicated that lung cancer type, pathological type, lymph node metastasis, tumor stage, and histologic grading were independent prognostic factors for lung cancer (P < 0.05). After comparison, there was a difference in prognosis between cystic lung cancer and ground-glass lung cancer (P < 0.05). CONCLUSION The clinical features of cystic lung cancer are significantly different from those of ground-glass lung cancer and solid lung cancer. Cystic lesions are independent influencing factors affecting lung cancer, and the prognosis of cystic lung cancer is worse than that of ground-glass lung cancer.
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Affiliation(s)
- X Xu
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - M Zhang
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - J Guo
- School of Public Health, Jiangxi Medical College, Nanchang University, PR China; Jiangxi Provincial Key Laboratory of Preventive Medicine, Jiangxi Medical College, Nanchang University, Nanchang 330006, PR China.
| | - W Chen
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Jiangxi Institute of Respiratory Disease, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Jiangxi Hospital of China-Japan Friendship Hospital, Nanchang, Jiangxi, 330006, PR China.
| | - Z Dong
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - Q Song
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China.
| | - T Cai
- Department of Information, The 1(st) Affiliated Hospital of Nanchang University, Jiangxi 330006 Nanchang, PR China.
| | - L Sun
- Department of Pulmonary and Critical Care Medicine, The 1(st) Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, PR China; Jiangxi Hospital of China-Japan Friendship Hospital, Nanchang, Jiangxi, 330006, PR China; Jiangxi Clinical Research Center for Respiratory Diseases, Nanchang, Jiangxi, 330006, PR China.
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Yao Y, Yang Y, Hu Q, Xie X, Jiang W, Liu C, Li X, Wang Y, Luo L, Li J. A nomogram combining CT-based radiomic features with clinical features for the differentiation of benign and malignant cystic pulmonary nodules. J Cardiothorac Surg 2024; 19:392. [PMID: 38937772 PMCID: PMC11210004 DOI: 10.1186/s13019-024-02936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/15/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Currently, the differentiation between benign and malignant cystic pulmonary nodules poses a significant challenge for clinicians. The objective of this retrospective study was to construct a predictive model for determining the likelihood of malignancy in patients with cystic pulmonary nodules. METHODS The current study involved 129 patients diagnosed with cystic pulmonary nodules between January 2017 and June 2023 at the Neijiang First People's Hospital. The study gathered the clinical data, preoperative imaging features of chest CT, and postoperative histopathological results for both cohorts. Univariate and multivariate logistic regression analyses were employed to identify independent risk factors, from which a prediction model and nomogram were developed. In addition, The model's performance was assessed through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA). RESULTS A cohort of 129 patients presenting with cystic pulmonary nodules, consisting of 92 malignant and 37 benign lesions, was examined. Logistic data analysis identified a cystic airspace with a mural nodule, spiculation, mural morphology, and the number of cystic cavities as significant independent predictors for discriminating between benign and malignant cystic lung nodules. The nomogram prediction model demonstrated a high level of predictive accuracy, as evidenced by an area under the ROC curve (AUC) of 0.874 (95% CI: 0.804-0.944). Furthermore, the calibration curve of the model displayed satisfactory calibration. DCA proved that the prediction model was useful for clinical application. CONCLUSION In summary, the risk prediction model for benign and malignant cystic pulmonary nodules has the potential to assist clinicians in the diagnosis of such nodules and enhance clinical decision-making processes.
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Affiliation(s)
- Yi Yao
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Yanhui Yang
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Qiuxia Hu
- Department of Obstetrics and Gynecology, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Xiaoyang Xie
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Wenjian Jiang
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Caiyang Liu
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Xiaoliang Li
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Yi Wang
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Lei Luo
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China
| | - Ji Li
- Department of Cardiothoracic Surgery, The First People's Hospital of Neijiang, No. 1866, West Section of Hanan Avenue, Shizhong District, Neijiang, Sichuan, 641000, China.
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Glandorf J, Vogel-Claussen J. Incidental pulmonary nodules - current guidelines and management. ROFO-FORTSCHR RONTG 2024; 196:582-590. [PMID: 38065544 DOI: 10.1055/a-2185-8714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND Due to the greater use of high-resolution cross-sectional imaging, the number of incidental pulmonary nodules detected each year is increasing. Although the vast majority of incidental pulmonary nodules are benign, many early lung carcinomas could be diagnosed with consistent follow-up. However, for a variety of reasons, the existing recommendations are often not implemented correctly. Therefore, potential for improvement with respect to competence, communication, structure, and process is described. METHODS This article presents the recommendations for incidental pulmonary nodules from the current S3 guideline for lung cancer (July 2023). The internationally established recommendations (BTS guidelines and Fleischner criteria) are compared and further studies on optimized management were included after a systematic literature search in PubMed. RESULTS AND CONCLUSION In particular, AI-based software solutions are promising, as they can be used in a support capacity on several levels at once and can lead to simpler and more automated management. However, to be applicable in routine clinical practice, software must fit well into the radiology workflow and be integrated. In addition, "Lung Nodule Management" programs or clinics that follow a high-quality procedure for patients with incidental lung nodules or nodules detected by screening have been established in the USA. Similar structures might also be implemented in Germany in a future screening program in which patients with incidental pulmonary nodules could be included. KEY POINTS · Incidental pulmonary nodules are common but are often not adequately managed. · The updated S3 guideline for lung cancer now includes recommendations for incidental pulmonary nodules. · Competence, communication, structure, and process levels offer significant potential for improvement. CITATION FORMAT · Glandorf J, Vogel-Claussen J, . Incidental pulmonary nodules - current guidelines and management. Fortschr Röntgenstr 2024; 196: 582 - 590.
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Affiliation(s)
- Julian Glandorf
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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Zheng X, Qiu L, Huang Y, Cheng R, Huang S, Xu K, Cai W, Deng Y, Wang W, Zhong X, Cui F, Hao Z, Liu J. Exploring the molecular and immune-landscape of lung cancer associated with cystic airspaces. Mol Immunol 2024; 168:75-88. [PMID: 38430689 DOI: 10.1016/j.molimm.2024.01.007] [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: 10/31/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 03/05/2024]
Abstract
To explore the molecular biological characteristics of lung cancer associated with cystic airspaces (LCCA) and its potential roles on prognosis. A total of 165 LCCAs and 201 non-LCCAs were enrolled in this study. Bulk RNA sequencing was implemented in eight LCCAs and nine non-LCCAs to explore the differentially expressed genes. TCGA data were used to analyze LCCA-specific genes that associated with overall survival (OS). The median age was 60 (IQR 53 to 65) years in LCCA cohort. We found LCCA were predominant in men and had less visceral pleura invasion (VPI) or lympho-vascular invasion (LVI). Moreover, LCCA presented with higher histological heterogeneity. Kaplan-Meier analysis showed that patients of age more than 60 and positive VPI had significantly less PFS in LCCA. Cox regression suggested that LCCA, micropapillary subtype proportion and VPI were the independent risk factors for PFS. LCCA had up-regulated pathways associated with EMT, angiogenesis and cell migration. In addition, LCCA displayed higher levels of immunosuppressor infiltration (M2 macrophages, CAFs and MDSCs) and distinct cell death and metabolic patterns. BCR/TCR repertoire analysis revealed less BCR richness, clonality and high-abundance shared clonotypes in LCCA. Finally, Cox regression analysis identified that four cystic-specific genes, KCNK3, NRN1, PARVB and TRHDE-AS1, were associated with OS of lung adenocarcinoma (LUAD). And cystic-specific risk scores (CSRSs) were calculated to construct a nomogram, which performance well. Our study for the first time indicated significantly distinct molecular biological and immune characteristics between LCCA and non-LCCA, which provide complementary prognostic values in early-stage non-small cell lung cancer (NSCLC).
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Affiliation(s)
- Xiang Zheng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China; Department of Oncology, The First Clinical Medical College of Henan University, Kaifeng, China
| | - Li Qiu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ying Huang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ran Cheng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Sihe Huang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ke Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Weipeng Cai
- Department of Thoracic Surgery, Shantou Central Hospital, Shantou, China
| | - Yu Deng
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xi Zhong
- Department of Medical Imaging, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Zhexue Hao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
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Iwamura M, Nishimori M, Iwasa H, Otani M, Nakaji K, Nitta N, Miyatake K, Yoshimatsu R, Yamanishi T, Matsumoto T, Iguchi M, Okada H, Yamagami T. A case of pulmonary pleomorphic carcinoma associated with cystic airspace. Radiol Case Rep 2023; 18:2692-2696. [PMID: 37273726 PMCID: PMC10238256 DOI: 10.1016/j.radcr.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Lung cancer associated with a cystic airspace is frequently misdiagnosed or overlooked. Adenocarcinoma, followed by squamous cell carcinoma, is the most typical histologic type of lung cancer connected to a cystic airspace. Here we present the rare case of lung pleomorphic carcinoma associated with a cystic airspace. We encountered a 74-year-old Japanese man diagnosed by computed tomography (CT) as having a nodule outside a cystic airspace in the lung. Several previous CT images showed that the cystic airspace preceded the nodule. Postsurgery, pathology indicated a diagnosis of pleomorphic carcinoma. Since pulmonary pleomorphic carcinomas pursue an aggressive clinical course, their early detection may contribute to an improved prognosis. Our case demonstrated that pleomorphic carcinoma can arise with cystic airspaces. For early diagnosis of those aggressive lung cancers, chest physicians should carefully examine the walls of cystic airspaces on CT.
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Affiliation(s)
- Mamiko Iwamura
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Miki Nishimori
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hitomi Iwasa
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michimi Otani
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kosuke Nakaji
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Noriko Nitta
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomoaki Yamanishi
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tomohiro Matsumoto
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Mitsuko Iguchi
- Department of Diagnostic Pathology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Hironobu Okada
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, Japan
| | - Takuji Yamagami
- Department of Diagnostic and Interventional Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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10
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Mascalchi M, Picozzi G, Puliti D, Diciotti S, Deliperi A, Romei C, Falaschi F, Pistelli F, Grazzini M, Vannucchi L, Bisanzi S, Zappa M, Gorini G, Carozzi FM, Carrozzi L, Paci E. Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed. Diagnostics (Basel) 2023; 13:2197. [PMID: 37443590 DOI: 10.3390/diagnostics13132197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
The ITALUNG trial started in 2004 and compared lung cancer (LC) and other-causes mortality in 55-69 years-aged smokers and ex-smokers who were randomized to four annual chest low-dose CT (LDCT) or usual care. ITALUNG showed a lower LC and cardiovascular mortality in the screened subjects after 13 years of follow-up, especially in women, and produced many ancillary studies. They included recruitment results of a population-based mimicking approach, development of software for computer-aided diagnosis (CAD) and lung nodules volumetry, LDCT assessment of pulmonary emphysema and coronary artery calcifications (CAC) and their relevance to long-term mortality, results of a smoking-cessation intervention, assessment of the radiations dose associated with screening LDCT, and the results of biomarkers assays. Moreover, ITALUNG data indicated that screen-detected LCs are mostly already present at baseline LDCT, can present as lung cancer associated with cystic airspaces, and can be multiple. However, several issues of LC screening are still unaddressed. They include the annual vs. biennial pace of LDCT, choice between opportunistic or population-based recruitment. and between uni or multi-centre screening, implementation of CAD-assisted reading, containment of false positive and negative LDCT results, incorporation of emphysema. and CAC quantification in models of personalized LC and mortality risk, validation of ultra-LDCT acquisitions, optimization of the smoking-cessation intervention. and prospective validation of the biomarkers.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, 50121 Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giulia Picozzi
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Donella Puliti
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 47521 Cesena, Italy
| | - Annalisa Deliperi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Chiara Romei
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Fabio Falaschi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Michela Grazzini
- Division of Pneumonology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Letizia Vannucchi
- Division of Radiology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Simonetta Bisanzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Marco Zappa
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Francesca Maria Carozzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Eugenio Paci
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
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11
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Zhu H, Zhang L, Huang Z, Chen J, Sun L, Chen Y, Huang G, Chen Q, Yu H. Lung adenocarcinoma associated with cystic airspaces: Predictive value of CT features in assessing pathologic invasiveness. Eur J Radiol 2023; 165:110947. [PMID: 37392546 DOI: 10.1016/j.ejrad.2023.110947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Lung adenocarcinoma associated with cystic airspaces (LACA) is a unique entity with limited understanding. Our aim was to evaluate the radiological characteristics of LACA and to study which criteria were predictive of invasiveness. METHODS A retrospective monocentric analysis of consecutive patients with pathologically confirmed LACA was performed. The diagnosed adenocarcinomas were classified into preinvasive (atypical adenomatous hyperplasia, adenocarcinoma in situ, or minimally invasive adenocarcinoma) and invasive adenocarcinomas. Eight clinical features and twelve CT features were evaluated. Univariable and multivariable analyses were performed to analyse the correlation between invasiveness, and CT and clinical features. The inter-observer agreement was evaluated using κ statistics and intraclass correlation coefficients. The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS A total of 252 patients with 265 lesions (128 men and 124 women; mean age, 58.0 ± 11.1 years) were enrolled. Multivariable logistic regression indicated that multiple cystic airspaces (OR, 5.599; 95 % CI, 1.865-16.802), irregular shape of cystic airspace (OR, 3.236; 95 % CI, 1.073-9.761), entire tumour size (OR, 1.281; 95 % CI, 1.075-1.526), and attenuation (OR, 1.007; 95 % CI, 1.005-1.010) were independent risk factors for invasive LACA. The AUC of the logistic regression model was 0.964 (95 % CI, 0.944-0.985). CONCLUSION Multiple cystic airspaces, irregular shape of cystic airspace, entire tumour size, and attenuation were identified as independent risk factors for invasive LACA. The prediction model gives a good predictive performance, providing additional diagnostic information.
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Affiliation(s)
- Huiyuan Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian Zhang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China; Department of Radiology, Jiading Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Zike Huang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linlin Sun
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinan Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Huang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China; Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China; Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Qunhui Chen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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13
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Li M, Zhu L, Lv Y, Shen L, Han Y, Ye B. Thin-slice computed tomography enables to classify pulmonary subsolid nodules into pre-invasive lesion/minimally invasive adenocarcinoma and invasive adenocarcinoma: a retrospective study. Sci Rep 2023; 13:6999. [PMID: 37117233 PMCID: PMC10147622 DOI: 10.1038/s41598-023-33803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
The aim was to investigate the ability of thin-slice computed tomography (TSCT) to differentiate invasive pulmonary adenocarcinomas (IACs) from pre-invasive/minimally invasive adenocarcinoma (AAH-MIAs), manifesting as subsolid nodules (SSNs) of diameter less than 30 mm. The CT findings of 810 patients with single subsolid nodules diagnosed by pathology of resection specimens were analyzed (atypical adenomatous hyperplasia, n = 13; adenocarcinoma in situ, n = 175; minimally invasive adenocarcinoma, n = 285; and invasive adenocarcinoma, n = 337). According to the classification of lung adenocarcinoma published by WHO classification of thoracic tumors in 2015, TSCT features of 368 pure ground-glass nodules (pGGN) and 442 part-solid nodules (PSNs) were compared AAH-MIAs with IACs. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. In pGGNs, multivariate analysis of factors found to be significant by univariate analysis revealed that higher mean-CT values (p = 0.006, OR 1.006, 95% CI 1.002-1.010), larger tumor size (p < 0.001, OR 1.483, 95% CI 1.304-1.688) with air bronchogram and non-smooth margins were significantly associated with IACs. The optimal cut-off tumor diameter for AAH-MIAs lesions was less than 10.75 mm (sensitivity, 82.8%; specificity, 80.6%) and optimal cut-off mean-CT value - 629HU (sensitivity, 78.1%; specificity, 50.7%). In PSNs, multivariate analysis of factors found to be significant by univariate analysis revealed that smaller tumor diameter (p < 0.001, OR 0.647, 95% CI 0.481-0.871), smaller size of solid component (p = 0.001, OR 83.175, 95% CI 16.748-413.079),and lower mean-CT value of solid component (p < 0.001, OR 1.009, 95% CI 1.004-1.014) were significantly associated with AAH-MIAs (p < 0.05). The optimal cut-off tumor diameter, size of solid component, and mean-CT value of solid component for AAH-MIAs lesions were less than 14.595 mm (sensitivity, 71.1%; specificity, 83.4%), 4.995 mm (sensitivity, 97.8%; specificity, 92.3%) and - 227HU (sensitivity, 65.6%; specificity, 76.3%), respectively. In subsolid nodules, whether pGGN or PSNs, the characteristics of TSCT can help in distinguishing IACs from AAH-MIAs.
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Affiliation(s)
- Min Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
- Department of Radiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Zhu
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Yilv Lv
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, China
| | - Leilei Shen
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuchen Han
- Department of Pathology, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, China.
| | - Bo Ye
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, China.
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14
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Yang X, Zhang L, Meng F, Song W, Li D, Zhong D. Lung adenocarcinoma associated with cystic airspaces. Chronic Dis Transl Med 2023; 9:58-62. [PMID: 36926256 PMCID: PMC10011662 DOI: 10.1002/cdt3.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Xue Yang
- Department of Medical Oncology Tianjin Medical University General Hospital Tianjin China
| | - Linlin Zhang
- Department of Medical Oncology Tianjin Medical University General Hospital Tianjin China
| | - Fanlu Meng
- Department of Medical Oncology Tianjin Medical University General Hospital Tianjin China
| | - Wenjing Song
- Department of Pathology Tianjin Medical University Tianjin China.,Department of Pathology Tianjin Medical University General Hospital Tianjin China
| | - Dong Li
- Department of Radiology Tianjin Medical University General Hospital Tianjin China
| | - Diansheng Zhong
- Department of Medical Oncology Tianjin Medical University General Hospital Tianjin China
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15
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Shen YY, Jiang J, Zhao J, Song J. Lung squamous cell carcinoma presenting as rare clustered cystic lesions: A case report and review of literature. World J Clin Cases 2022; 10:13006-13014. [PMID: 36569005 PMCID: PMC9782924 DOI: 10.12998/wjcc.v10.i35.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death. Early diagnosis is critical to improving a patient’s chance of survival. However, lung cancer associated with cystic airspaces is often misdiagnosed or underdiagnosed due to the absence of clinical symptoms, poor imaging specificity, and high risk of biopsy-related complications.
CASE SUMMARY We report an unusual case of cancer in a 55-year-old man, in which the lesion evolved from a small solitary thin-walled cyst to lung squamous cell carcinoma (SCC) with metastases in both lungs. The SCC manifested as rare clustered cystic lesions, detected on chest computed tomography. There were air-fluid levels, compartments, and bronchial arteries in the cystic lesions. Additionally, there was no clear extrathoracic metastasis. After chemotherapy, the patient achieved a partial response, type I respiratory failure was relieved, and the lung lesions became a clustered thin-walled cyst.
CONCLUSION Pulmonary cystic lesions require regular imaging follow-up. Lung SCC should be a diagnostic consideration in cases of thin-walled cysts as well as multiple clustered cystic lesions.
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Affiliation(s)
- Yu-Yao Shen
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Jiang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Zhao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Song
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
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16
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Single CT Appointment for Double Lung and Colorectal Cancer Screening: Is the Time Ripe? Diagnostics (Basel) 2022; 12:diagnostics12102326. [PMID: 36292015 PMCID: PMC9601268 DOI: 10.3390/diagnostics12102326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Annual screening of lung cancer (LC) with chest low-dose computed tomography (CT) and screening of colorectal cancer (CRC) with CT colonography every 5 years are recommended by the United States Prevention Service Task Force. We review epidemiological and pathological data on LC and CRC, and the features of screening chest low-dose CT and CT colonography comprising execution, reading, radiation exposure and harm, and the cost effectiveness of the two CT screening interventions. The possibility of combining chest low-dose CT and CT colonography examinations for double LC and CRC screening in a single CT appointment is then addressed. We demonstrate how this approach appears feasible and is already reasonable as an opportunistic screening intervention in 50–75-year-old subjects with smoking history and average CRC risk. In addition to the crucial role Computer Assisted Diagnosis systems play in decreasing the test reading times and the need to educate radiologists in screening chest LDCT and CT colonography, in view of a single CT appointment for double screening, the following uncertainties need to be solved: (1) the schedule of the screening CT; (2) the effectiveness of iterative reconstruction and deep learning algorithms affording an ultra-low-dose CT acquisition technique and (3) management of incidental findings. Resolving these issues will imply new cost-effectiveness analyses for LC screening with chest low dose CT and for CRC screening with CT colonography and, especially, for the double LC and CRC screening with a single-appointment CT.
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17
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Xie Y, Zhang D, Zhao H, Lei S, Zhang H, Zhang S. Case Report: Misdiagnosis of Lung Carcinoma in Patients with Shrunken Lung Cyst After High Altitude Travel. Cancer Manag Res 2022; 14:2373-2377. [PMID: 35967751 PMCID: PMC9371466 DOI: 10.2147/cmar.s373068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Lung cancer associated with cystic airspace is a rare disease, and the imaging understanding of lung cancer with cystic cavity is still unclear. Little is known in the literature on whether cystic lung cancer is caused by emphysema or ruptured bullae. Case Reports We report the case of a 50-year-old female patient after finishing a business trip in November 2021, when another chest CT demonstrated an unexpected reduction in the cyst, with a solid mural nodule on the posterior wall. The airspace of the cyst is only about 13 mm × 12 mm × 6 mm in size. The size of the mural nodule in the posterior wall is about 10 mm × 6 mm × 5 mm. The patient felt anxious due to suspicion of lung cancer. 2.5 months after the last chest CT, she accepted minimally invasive thoracoscopic surgery on the posterior basal segment of the left lower lobe. The postoperative pathology showed benign lesions. Conclusion For radiologists, it is important to recognize the process from lung cysts or bullae to LC-CAS, especially the morphological changes of the cyst airspace and the cyst wall, in order to identify the malignant features of lung cysts in time.
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Affiliation(s)
- Yibing Xie
- Department of Graduate School, Hebei North University, Zhangjiakou, People’s Republic of China
- Department of Radiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Dongmei Zhang
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Huanfen Zhao
- Department of Pathology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Shaoyang Lei
- Department of Radiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Hua Zhang
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Shuqian Zhang
- Department of Radiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China
- Correspondence: Shuqian Zhang, Department of Radiology, Hebei General Hospital, 348 Heping West Road, Shijiazhuang, 050051, People’s Republic of China, Tel +8615930153668, Email
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18
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Bello AM, Anselmi C, Frau M, Berman KG, Novellas R, Espada Y, Longley MJ, Dhumeaux MP. Pulmonary carcinoma associated with cystic airspaces in two dogs. J Small Anim Pract 2021; 63:486-491. [PMID: 34913482 DOI: 10.1111/jsap.13451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/10/2021] [Accepted: 10/31/2021] [Indexed: 12/17/2022]
Abstract
Malignant pulmonary neoplasia associated with cystic airspaces is a well-recognised disease entity in humans. Two elderly dogs, previously diagnosed with a solitary emphysematous bulla, presented with non-specific clinical signs. At presentation, pulmonary auscultation was unremarkable. In both cases, thoracic CT demonstrated the transformation of the cystic airspace lesions characterised by a progressive increase of the solid component and reduction of the air component. Cytological evaluation and subsequent surgical excision followed by histopathology confirmed pulmonary carcinoma in both cases. These two cases represent the first demonstration of possible malignant transformation of pulmonary cystic airspace in dogs. Veterinarians should consider neoplastic transformation as a differential diagnosis in cases of cystic airspaces, particularly cases with features including thickening or irregularity of the wall, associated soft-tissue nodules or solid and non-solid tissue intermixed within clusters of multiple cystic airspaces. Ongoing monitoring of cystic airspace lesions through diagnostic imaging is recommended.
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Affiliation(s)
- A M Bello
- Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - C Anselmi
- Pride Veterinary Centre, Derby, DE24 8HX, UK
| | - M Frau
- Departament de Medicina i Cirurgia Animals, and Fundació Hospital Clínic Veterinari, Autonomous University of Barcelona, College of Veterinary Medicine, Barcelona, 08193, Spain
| | - K G Berman
- Synlab, VPG Histology, Bristol, BS7 0BJ, UK
| | - R Novellas
- Departament de Medicina i Cirurgia Animals, and Fundació Hospital Clínic Veterinari, Autonomous University of Barcelona, College of Veterinary Medicine, Barcelona, 08193, Spain
| | - Y Espada
- Departament de Medicina i Cirurgia Animals, and Fundació Hospital Clínic Veterinari, Autonomous University of Barcelona, College of Veterinary Medicine, Barcelona, 08193, Spain
| | - M J Longley
- Pride Veterinary Centre, Derby, DE24 8HX, UK
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Carroll MB, Shroff GS, Truong MT, Walker CM. Pearls and Pitfalls in Lung Cancer Imaging. Semin Ultrasound CT MR 2021; 42:524-534. [PMID: 34895608 DOI: 10.1053/j.sult.2021.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging plays an essential role in the diagnosis and staging of pulmonary malignancy. Familiarity of less common manifestations of lung cancer including subsolid nodule, consolidation, and cyst associated lung cancer is important to avoid delayed diagnosis and improve patient outcomes. In this article, we review the staging of multifocal lung cancer, PET negative lung cancers (carcinoid and indolent lung adenocarcinoma), and false positive lymph nodes on PET due to infectious and inflammatory etiologies. Knowledge of these potential pitfalls and pearls in lung cancer imaging and correlation with patients' clinical history are essential to prevent misinterpretation.
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Affiliation(s)
- Melissa B Carroll
- University of Kansas Medical Center, Department of Radiology, Kansas City, KS.
| | - Girish S Shroff
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Serial CT changes in different components of lung cancer associated with cystic airspace in patients treated with neoadjuvant chemotherapy. Sci Rep 2021; 11:23544. [PMID: 34876610 PMCID: PMC8651644 DOI: 10.1038/s41598-021-02897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/18/2021] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to observe changes in different components (solid, cystic airspace, or entire tumor) in lung cancer associated with cystic airspace following treatment with neoadjuvant chemotherapy (NC), using computerized tomography (CT). We analyzed serial (baseline, first-time follow-up, and last-time follow-up) clinical data and CT imaging in six patients treated with NC. The diameters, areas, and volumes of different tumor components (solid, cystic airspace, and entire tumor) were measured. Delta (Δ) was used to represent changes in these parameters between two examinations: Δ1(%) represents the change from baseline to first follow-up after NC, and Δ2(%) represents the change from baseline to last follow-up after NC. We used the intra-group correlation coefficient (ICC) to test for consistency between parameters as measured by two radiologists. The diameter of solid components in all lesions showed a trend of continuous reduction compared with baseline (Δ1 ranged from − 8.3 to − 46.0%, Δ2 from − 30.8 to − 69.2%). For cystic airspace and entire tumors, different lesions showed different trends over the course of treatment. For diameter, area, and volume, Δ1 of changes in the solid component ranged from − 8.3 to − 46.9%, − 19.4 to − 70.8%, and − 19.1 to − 94.7%, respectively; Δ2 ranged from − 30.8 to − 69.2%, − 50.8 to − 92.1%, and − 32.7 to − 99.8% in diameter, area, and volume, respectively. Results were inconsistent between different components of lung cancer associated with cystic airspace that was treated with NC, but the diameter, area, and volume of solid components were continuously reduced during treatment. Furthermore, area and volume measurements showed more-significant variation than diameter measurements.
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21
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Tang X, Liu G, Tan X, Liu C, Xiang J, Jiang Y. Solitary multicystic lesion lung cancer: two case reports and review of the literature. BMC Pulm Med 2021; 21:368. [PMID: 34775945 PMCID: PMC8591847 DOI: 10.1186/s12890-021-01729-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background Lung cancer associated with cystic airspaces, especially solitary multicystic lesion lung cancer, is a rare disease (a rare imaging performance of non-small cell lung cancer). It is difficult to diagnose owing to the lack of a clear definition; therefore, diagnosis of these neoplastic lesions remains challenging. Case presentation We outlined two cases of elderly Chinese men who were admitted to the hospital with a solitary multicystic lesion of the lung and subsequent surgical resection, confirming a diagnosis of adenocarcinoma. Conclusions For solitary pulmonary cystic airspaces (especially solitary multicystic lung lesions), it is important to properly recognise their imaging features. Due to the possibility of malignancies, timely surgery is an effective treatment strategy for early diagnosis.
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Affiliation(s)
- Xi Tang
- Department of Respiratory and Critical Care Medicine, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Gang Liu
- Department of Critical Care Medicine, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Xianglan Tan
- Department of Respiratory and Critical Care Medicine, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Chengjun Liu
- Department of Thoracic Surgery Department, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Jin Xiang
- Department of Respiratory and Critical Care Medicine, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China
| | - Yu Jiang
- Department of Respiratory and Critical Care Medicine, University-Town Hospital of Chongqing Medical University, Chongqing, 401331, China.
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22
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Byrne D, English JC, Atkar-Khattra S, Lam S, Yee J, Myers R, Bilawich AM, Mayo JR, Mets OM. Cystic Primary Lung Cancer: Evolution of Computed Tomography Imaging Morphology Over Time. J Thorac Imaging 2021; 36:373-381. [PMID: 34029281 DOI: 10.1097/rti.0000000000000594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Primary lung cancers associated with cystic airspaces are increasingly being recognized; however, there is a paucity of data on their natural history. We aimed to evaluate the prevalence, pathologic, and imaging characteristics of cystic lung cancer in a regional thoracic surgery center with a focus on the evolution of computed tomography morphology over time. MATERIALS AND METHODS Consecutive patients referred for potential surgical management of primary lung cancer between January 2016 and December 2018 were included. Clinical, imaging, and pathologic data were collected at the time of diagnosis and at the time of the oldest computed tomography showing the target lesion. Descriptive analysis was carried out. RESULTS A total of 441 cancers in 431 patients (185 males, 246 females), median age 69.6 years (interquartile range: 62.6 to 75.3 y), were assessed. Overall, 41/441 (9.3%) primary lung cancers were cystic at the time of diagnosis. The remaining showed solid (67%), part-solid (22%), and ground-glass (2%) morphologies. Histopathology of the cystic lung cancers at diagnosis included 31/41 (76%) adenocarcinomas, 8/41 (20%) squamous cell carcinomas, 1/41 (2%) adenosquamous carcinoma, and 1/41 (2%) unspecified non-small cell lung carcinoma. Overall, 8/34 (24%) cystic cancers at the time of diagnosis developed from different morphologic subtype precursor lesions, while 8/34 (24%) cystic precursor lesions also transitioned into part-solid or solid cancers at the time of diagnosis. CONCLUSIONS This study demonstrates that cystic airspaces within lung cancers are not uncommon, and may be seen transiently as cancers evolve. Increased awareness of the spectrum of cystic lung cancer morphology is important to improve diagnostic accuracy and lung cancer management.
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Affiliation(s)
- Danielle Byrne
- Departments of Cardiothoracic Radiology
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | | | - Sukhinder Atkar-Khattra
- Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Stephen Lam
- Respiratory Medicine
- Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, BC, Canada
| | - John Yee
- Thoracic Surgery, Vancouver General Hospital and University of British Columbia
| | - Renelle Myers
- Respiratory Medicine
- Department of Integrative Oncology, The British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Ana-Maria Bilawich
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - John R Mayo
- Department of Radiology, St James Hospital and Trinity College, Dublin, Ireland
| | - Onno M Mets
- Departments of Cardiothoracic Radiology
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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23
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Shen Y, Zhang Y, Guo Y, Li W, Huang Y, Wu T, Jiang G, Dai J. Prognosis of lung cancer associated with cystic airspaces: A propensity score matching analysis. Lung Cancer 2021; 159:111-116. [PMID: 34325317 DOI: 10.1016/j.lungcan.2021.07.003] [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: 12/08/2020] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The association between the morphological characteristics and survival outcome of lung cancer associated with cystic airspaces (LCCAs) is unclear due to rarity of this disease. The current study attempted to compare the survival outcome between LCCAs and non-LCCAs and investigate the correlation between imaging features and prognosis of LCCA. METHOD Of 10,835 patients diagnosed with non-small cell lung carcinoma (NSCLC) between January 2015 and December 2016, 123 patients with LCCA were included. The non-LCCA group comprised 3136 patients with primary solitary adenocarcinoma or squamous cell lung cancer. Propensity score matching (PSM) was performed for age, sex, tumor size, tumor stage, and lymph node involvement in a 1:1 ratio between the LCCAs and non-LCCAs, and the correlation between radiological features and recurrence-free survival (RFS) was analyzed. RESULT The computed tomography (CT) lesion size was found to be higher in all LCCA subtypes, particularly in Type III (a cystic airspace with a mural nodule) and Type IV (mixed) LCCAs (3.09 and 3.65 cm, respectively), than in non-LCCAs (2 cm) after PSM. Three-year RFS in the LCCA group was higher than in the non-LCCA group (Type I- IV LCCAs: 100%, 84%, 77% and 83%, respectively vs. non-LCCAs: 77%). However, statistically significant difference was only found in comparison between LCCA Type I (thin-walled) and non-LCCA groups (P = 0.026). Type III lung cancer exhibited the worst survival among all four LCCA subtypes. CONCLUSIONS The CT lesion size and pathologic tumor size varied significantly across LCCAs. Type I LCCAs exhibited better survival than non-LCCAs, whereas Type III LCCAs exhibited the worst survival rate among the four LCCA subtypes.
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Affiliation(s)
- Yingran Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Yunfei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Yanhua Guo
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Weitong Li
- Department of Medical Imaging, Shishi Hospital, Fujian 362700, China
| | - Yan Huang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Tong Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China.
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24
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Munden RF, Black WC, Hartman TE, MacMahon H, Ko JP, Dyer DS, Naidich D, Rossi SE, McAdams HP, Goodman EM, Brown K, Kent M, Carter BW, Chiles C, Leung AN, Boiselle PM, Kazerooni EA, Berland LL, Pandharipande PV. Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2021; 18:1267-1279. [PMID: 34246574 DOI: 10.1016/j.jacr.2021.04.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022]
Abstract
The ACR Incidental Findings Committee presents recommendations for managing incidentally detected lung findings on thoracic CT. The Chest Subcommittee is composed of thoracic radiologists who endorsed and developed the provided guidance. These recommendations represent a combination of current published evidence and expert opinion and were finalized by informal iterative consensus. The recommendations address commonly encountered incidental findings in the lungs and are not intended to be a comprehensive review of all pulmonary incidental findings. The goal is to improve the quality of care by providing guidance on management of incidentally detected thoracic findings.
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Affiliation(s)
- Reginald F Munden
- Professor, Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina; Chair, Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - William C Black
- Professor of Radiology, Emeritus, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Heber MacMahon
- Professor of Radiology, Section of Thoracic Imaging, Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Jane P Ko
- Professor of Radiology, Department of Radiology, NYU Langone Health, New York, New York; Fellowship Director, Cardiothoracic Imaging, Department of Radiology, NYU Langone Health, New York, New York
| | - Debra S Dyer
- Professor, Department of Radiology, National Jewish Health, Denver, Colorado; Chair, Department of Radiology, National Jewish Health, Denver, Colorado
| | - David Naidich
- Professor, Emeritus, NYU-Langone Health, New York, New York; Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Santiago E Rossi
- Chairman, Centro Rossi, Buenos Aires, Argentina; Chest Section Head, Hospital Cetrángolo, Buenos Aires, Argentina
| | - H Page McAdams
- Professor of Radiology, Duke University Health System, Durham, North Carolina
| | - Eric M Goodman
- Assistant Professor, Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York; Associate Program Director, Diagnostic Radiology, Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Kathleen Brown
- Professor, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Section Chief, Thoracic Imaging, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California; Assistant Dean, Equity and Diversity Inclusion, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michael Kent
- Associate Professor of Surgery, Harvard Medical School, Boston, Massachusetts; Director, Minimally Invasive Thoracic Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Brett W Carter
- Associate Professor, Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas; Director of Clinical Operations, University of Texas MD Anderson Cancer Center, Houston, Texas; Chief Patient Safety and Quality Officer, Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chiles
- Professor, Department of Radiology, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Ann N Leung
- Professor, Clinical Affairs, Stanford University Medical Center, Stanford, California; Associate Chair, Clinical Affairs, Stanford University Medical Center, Stanford, California; Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Phillip M Boiselle
- Professor, Quinnipiac's Frank H. Netter MD School of Medicine, North Haven, Connecticut; Dean, Quinnipiac's Frank H. Netter MD School of Medicine, William and Barbara Weldon Dean's Chair of Medicine, North Haven, Connecticut
| | - Ella A Kazerooni
- Professor of Radiology, Division of Cardiothoracic Radiology and Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lincoln L Berland
- Professor Emeritus, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Director, MGH Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts; Associate Chair, Integrated Imaging & Imaging Sciences, MGH Radiology, Massachusetts General Hospital, Boston, Massachusetts; Executive Director, Clinical Enterprise Integration, Mass General Brigham (MGB) Radiology, Massachusetts General Hospital, Boston, Massachusetts; Associate Professor of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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25
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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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Clinicopathologic and Longitudinal Imaging Features of Lung Cancer Associated With Cystic Airspaces: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2020; 216:318-329. [PMID: 32755209 DOI: 10.2214/ajr.20.23835] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND. Lung cancer (LC) associated with cystic airspaces is an uncommon presentation that is underrecognized on imaging. Additionally, understanding of its underlying pathology and risk factors is limited, which can contribute to delays in diagnosis. OBJECTIVE. The purpose of this analysis was to systematically review, analyze, and synthesize the medical literature to determine the imaging features of LC associated with cystic airspaces. EVIDENCE ACQUISITION. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we included published research reporting the clinical, pathologic, and imaging features of LC associated with cystic airspaces. We then performed a pooled analysis of continuous and categoric data with respect to patient clinical characteristics, tumor pathologic features, underlying driver mutation, CT features, and evolution of these features over time. EVIDENCE SYNTHESIS. The analysis included eight original observational studies with a combined total of 341 patients with LC associated with cystic airspaces (weighted mean age, 61.8 years; range, 30-87 years; 135 women and 206 men). Most patients were current or previous smokers (127/192 [66.1%]). The most common histologic finding was adenocarcinoma (289/328 [88.1%]) followed by squamous cell carcinoma (30/328 [9.1%]). The most common driver mutations were EGFR (46/122 [37.7%]) and KRAS (21/122 [17.2%]). The cysts in LC associated with cystic airspaces commonly had nonuniform (104/114 [91.2%]) and thick (83/222 [37.4%]) walls, irregular margins (53/142 [37.3%]), and were unilocular (173/272 [63.6%]). Most cysts had a nodular component (210/328 [64.0%]). Over time, most cysts showed development or enlargement of the nodular component (61/89 [68.5%]), approximately half showed wall thickening (43/89 [48.3%]), and a minority evolved into completely solid lesions (11/89 [12.4%]). The size of the cystic component increased in 36 of 89 patients (40.4%), decreased in 28 (31.5%), and remained stable in 24 (27.0%). CONCLUSION. LC associated with cystic airspaces occurs most commonly as adeno-carcinoma and is seen in both smokers and nonsmokers. The cysts associated with LC show wall thickening and mural nodularity, which may evolve over time. LC associated with cystic airspaces can be indolent, and long-term surveillance with imaging should be considered if cysts are not resected. CLINICAL IMPACT. Familiarity with the imaging features and temporal evolution of LC associated with cystic airspaces can minimize delays in LC diagnosis. Future management guidelines should include protocols for follow-up and management of cystic lung lesions identified during diagnostic and LC screening CT.
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27
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Parisi C, Lamberti G, Zompatori M, Gelsomino F, Salvagni S, Sperandi F, Ardizzoni A. Evolution of cystic airspaces lung lesions on immune checkpoint inhibition in non-small cell lung cancer. J Immunother Cancer 2020; 8:jitc-2019-000502. [PMID: 33004540 PMCID: PMC7534725 DOI: 10.1136/jitc-2019-000502] [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] [Accepted: 04/18/2020] [Indexed: 11/25/2022] Open
Abstract
Non-small cell lung cancer (NSCLC) can be associated with pulmonary cystic airspaces (pCAs). pCAs are radiologically classified into four types based on whether the nodule or mass extrudes the wall of the pCAs. In most cases, response evaluation of these lesions by Response Evaluation Criteria in Solid Tumors (RECIST) V.1.1 is challenging. Based on the observation of a case of morphological evolution of pCAs associated with NSCLC in a patient receiving immune checkpoint inhibitor (ICI), we reviewed retrospectively imaging scans of 92 consecutive advanced patients with NSCLC treated at our institution. Overall, three cases of pCAs associated with NSCLC obtained a remarkable change following ICI. Of note, these changes were not always seen in the context of a clear radiological objective response. The morphological changes observed may reflect a novel pattern of response to immunotherapy agents that clinicians should be aware of. This pattern of response, not reported before, warrants further investigation and, if confirmed, we believe that it should be considered in future version of immune RECIST.
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Affiliation(s)
- Claudia Parisi
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Giuseppe Lamberti
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Maurizio Zompatori
- Radiology Department, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Francesco Gelsomino
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Stefania Salvagni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Francesca Sperandi
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
| | - Andrea Ardizzoni
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni - 15, Bologna, Italy
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28
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Penha D, Pinto E, Taborda-Barata L, Irion K, Marchiori E. Lung cancer associated with cystic airspaces: a new radiological presentation of lung cancer. J Bras Pneumol 2020; 46:e20200156. [PMID: 32965296 PMCID: PMC7567613 DOI: 10.36416/1806-3756/e20200156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Diana Penha
- . Universidade da Beira Interior, Covilhã, Portugal
| | - Erique Pinto
- . Universidade da Beira Interior, Covilhã, Portugal
| | | | - Klaus Irion
- . Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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29
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Sung YE, Cho U, Lee KY. Peripheral type squamous cell carcinoma of the lung: clinicopathologic characteristics in comparison to the central type. J Pathol Transl Med 2020; 54:290-299. [PMID: 32544984 PMCID: PMC7385267 DOI: 10.4132/jptm.2020.05.04] [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] [Received: 12/24/2019] [Revised: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Squamous cell carcinomas (SqCCs) of the lung are known to arise more often in a central area but reports of peripheral SqCCs have increased, with a pathogenesis that is obscured. In this study, the clinicopathologic characteristics of peripheral lung SqCCs were studied and compared with those of the central type. METHODS This study included 63 peripheral lung SqCCs and 48 randomly selected central cases; hematoxylin and eosin-stained slides of surgically resected specimens were reviewed in conjunction with radiologic images and clinical history. Cytokeratin-7 immunohistochemical staining of key slides and epidermal growth factor receptor (EGFR)/KRAS mutations tested by DNA sequencing were also included. RESULTS Stages of peripheral SqCCs were significantly lower than central SqCCs (p=.016). Cystic change of the mass (p=.007), presence of interstitial fibrosis (p=0.007), and anthracosis (p=.049) in the background lung were significantly associated with the peripheral type. Cytokeratin-7 positivity was also higher in peripheral SqCCs with cutoffs of both 10% and 50% (p=.011). Pathogenic mutations in EGFR and KRAS were observed in only one case out of the 72 evaluated. The Cox proportional hazard model indicated a significantly better disease-free survival (p=.009) and the tendency of better overall survival (p=.106) in the peripheral type. CONCLUSIONS In peripheral type, lower stage is a favorable factor for survival but more frequent interstitial fibrosis and older age are unfavorable factors. Multivariate Cox analysis revealed that peripheral type is associated with better disease-free survival. The pathogenesis of peripheral lung SqCCs needs further investigation, together with consideration of the background lung conditions.
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Affiliation(s)
- Yeoun Eun Sung
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Uiju Cho
- Department of Hospital Pathology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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30
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Liu Z, Feng H, Zhang Z, Sun H, Liu D. Clinicopathological characteristics of solitary cavitary lung cancer: a case-control study. J Thorac Dis 2020; 12:3148-3156. [PMID: 32642236 PMCID: PMC7330766 DOI: 10.21037/jtd-20-426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background With the emerging radiological techniques and the increasing incidence of adenocarcinoma, the composition and structure of cavitary lung cancer have been significantly changed. The aim of the study was to demonstrate clinicopathological characteristics of solitary cavitary lung cancer which was ≤3 cm. Methods A case-control study was designed through retrospective data analysis of clinicopathological data of 946 cases with solitary lung cancer smaller than 3 cm. Univariable and multivariable analysis were used to identify the risk factors of cavitation. Results Cavitary lung cancer occurred more frequently in patients who were elderly (P=0.044), male (P=0.004), who had a smoking history (P=0.018), higher carcinoembryonic antigen (CEA) level (P<0.001), peripheral lesions (P=0.017), solid nodules (P<0.001), spiculation (P=0.003), vascular convergence (P<0.001), air bronchogram (P=0.004), larger tumor size (P<0.001), advanced T stage (P<0.001), lymph node metastasis (P=0.028) and advanced pTNM stage (P=0.004). In addition, cavitary lung cancer was more common in papillary predominant tumors (P=0.017), while noncavitary lung cancer occurred more frequently in AIS/MIA (P=0.002) and lepidic predominant tumors (P<0.001). It was confirmed that cavitation was significantly associated with elderly (P=0.013), male (P=0.003), larger maximum tumor diameter (P<0.001), solid nodules (P<0.001), larger pT size (P=0.016) and advanced pN stage (P=0.036) in multivariable analysis. ROC curves showed that the AUV was greater in maximum tumor diameter than in pT size predicting cavitation (0.71 vs. 0.66). A cut off value of 20.9 mm showed a discriminatory power of cavitation with a sensitivity of 68.7% and a specificity of 71.2%. Conclusions Comparing with noncavitary lung cancer, cavitary lung cancer smaller than 3 cm may have worse prognostic clinical, radiological and pathological characteristics. Especially, cavitary lung cancer present as more solid nodules on CT images and present with more invasive on pathological findings.
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Affiliation(s)
- Zhan Liu
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Hongxiang Feng
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Zhenrong Zhang
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Hongliang Sun
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Deruo Liu
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
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31
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Jung W, Cho S, Yum S, Chung JH, Lee KW, Kim K, Lee CT, Jheon S. Stepwise Disease Progression Model of Subsolid Lung Adenocarcinoma with Cystic Airspaces. Ann Surg Oncol 2020; 27:4394-4403. [PMID: 32363512 DOI: 10.1245/s10434-020-08508-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Subsolid lung adenocarcinoma with cystic airspaces (LACA) is a unique manifestation of lung cancer. This study was conducted to establish a radiologic disease progression model of LACA and to explore its association with the clinical course and clinicopathologic features of LACA. MATERIALS AND METHODS Sixty patients with LACA who underwent surgery at our center between 2004 and 2017 were retrospectively reviewed. The morphological changes of LACA over time on 98 serial computed tomography scans from 27 of 60 patients were tracked to establish a radiologic disease progression model. Associations between this model and the clinicopathologic characteristics of LACA were investigated. RESULTS The following stepwise progression model of LACA was developed: in phase I, cystic airspaces (CAs) appear in the middle of non-solid nodules; in phase II, the CAs grow; in phase III, a solid component appears on the border of the CAs; and in phase IV, the solid component gradually surrounds the CAs and becomes thicker, and the CAs shrink. In total, 10 (17%), 33 (55%), and 17 (28%) LACA patients were classified as belonging to phases II, III, and IV at the time of surgery, respectively. More advanced phases were associated with higher pathologic T and N staging, lymphovascular invasion, visceral pleural invasion, spread through air spaces, and solid/micropapillary subtype. In the multivariate analysis, our model demonstrated a good discrimination capability for cancer recurrence risk. CONCLUSIONS The stepwise disease progression model of LACA based on radiologic findings developed in this study represented its natural clinical course and clinicopathologic features well.
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Affiliation(s)
- Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Sungwon Yum
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choon Taek Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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32
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Jung W, Cho S. ASO Author Reflections: Understanding Subsolid Lung Adenocarcinoma with Cystic Airspaces (LACA). Ann Surg Oncol 2020; 27:4404. [PMID: 32356268 DOI: 10.1245/s10434-020-08528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Woohyun Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea. .,Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Gui X, Ding J, Li Y, Yu M, Chen T, Huang M, Xiao Y. Lung carcinoma with diffuse cystic lesions misdiagnosed as pulmonary langerhans cell histocytosis: a case report. BMC Pulm Med 2020; 20:30. [PMID: 32019517 PMCID: PMC7001302 DOI: 10.1186/s12890-020-1066-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/28/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cystic airspace is an uncommon imaging manifestation involved in non-small lung cancer (NSCLC). Diffuse cystic lesion is even rarer as pulmonary manifestation of NSCLC. In the present study, we reported a rare case of NSCLC associated with progressive diffusion of cystic lesions misdiagnosed as Pulmonary langerhans cell histocytosis (PLCH), finally diagnosed by transbronchial cryobiopsy (TBCB). CASE PRESENTATION A 52-year-old woman was admitted to our hospital due to cough and dyspnea. High-resolution computed tomography (HRCT) presented diffuse cystic shadow mostly, concomitantly with nodular densities in bilateral lungs. A lung biopsy revealed poorly differentiated adenocarcinoma with vascular tumor emboli. The epidermal growth factor receptor (EGFR) mutation on exon 18 (G719X, G719) was detected by mutation test. The patient received treatment of tyrosine kinase inhibitor (afatinib). CONCLUSIONS Diffuse cystic lesion can be a rare manifestation of lung cancer. It was important to improve the recognition of diffuse cystic lung diseases to avoid misdiagnosis.
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Affiliation(s)
- Xianhua Gui
- Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Jingjing Ding
- Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yan Li
- Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Min Yu
- Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Tingting Chen
- Department of Pathology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Mei Huang
- Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
| | - Yonglong Xiao
- Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
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Utrera Pérez E, Trinidad López C, González Carril F, Delgado Sánchez-Gracián C, Villanueva Campos A, Jurado Basildo C. Can pseudocavitation in lung tumors predict the diagnosis of adenocarcinoma with lepidic growth? RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Lung cancer associated with cystic airspaces: Characteristic morphological features on CT in a series of 11 cases. Clin Imaging 2019; 56:102-107. [DOI: 10.1016/j.clinimag.2019.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 02/10/2019] [Accepted: 02/19/2019] [Indexed: 12/17/2022]
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36
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Giant Secondary Overgrowth of Type-1 Pulmonary Cystic Airway Malformation Upon Development of Anaplastic Lymphoma Kinase-Rearranged Adenocarcinoma. J Thorac Oncol 2019; 14:2019-2022. [PMID: 31228624 DOI: 10.1016/j.jtho.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/01/2019] [Accepted: 06/04/2019] [Indexed: 11/22/2022]
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37
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Utrera Pérez E, Trinidad López C, González Carril F, Delgado Sánchez-Gracián C, Villanueva Campos A, Jurado Basildo C. Can pseudocavitation in lung tumors predict the diagnosis of adenocarcinoma with lepidic growth? RADIOLOGIA 2019; 61:396-404. [PMID: 31078301 DOI: 10.1016/j.rx.2019.03.004] [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: 01/22/2019] [Revised: 03/04/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the prevalence of pseudocavitation in lung tumors and whether its presence makes it possible to predict the diagnosis of adenocarcinoma with lepidic growth. MATERIAL AND METHODS We retrospectively reviewed chest CT studies for 212 consecutive lung tumors included in a CT perfusion database and for 351 consecutive adenocarcinomas diagnosed between July 2007 and September 2017. Two radiologists blinded to the pathology report determined whether air cysts were present in the tumors, excluding lesions with necrosis and those surrounded by bullae or emphysema. We analyzed whether the presence of pseudocavitation was associated with the histologic type, size, or EGFR positivity of the tumor as well as with the age or sex of the patient. We also evaluated the relationship with the histologic subtype of the tumor in patients who underwent surgery. We used the chi-square test for categorical variables and logistic regression for continuous variables. RESULTS Pseudocavitation was present in 15% of the tumors and was significantly more common in adenocarcinomas (24.1%), p=0.003, although it was also observed in 9.8% of the epidermoid carcinomas and in 3% of the microcytic carcinomas. For the diagnosis of adenocarcinoma, the presence of pseudocavitation yielded 92.4% specificity, 24% sensitivity, 73.3% PPV, 58.4% NPV, and 37.6% accuracy. In the resected adenocarcinomas, 65% of the tumors with pseudocavitation had lepidic growth; the prevalence of pseudocavitation was 40.6% in tumors with lepidic growth, 31.5% in those with acinar growth, and 33% in those with papillary growth. Pseudocavitation was significantly more common in women (29%); no differences were found with respect to age, size, or EGFR positivity. CONCLUSIONS Pseudocavitation is more common in adenocarcinomas with lepidic growth and in women.
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Affiliation(s)
- E Utrera Pérez
- Residente, Servicio de Radiología, Povisa, Vigo, Pontevedra, España.
| | - C Trinidad López
- Médico adjunto, Servicio de Radiología, Povisa, Vigo, Pontevedra, España
| | - F González Carril
- Médico adjunto, Servicio de Anatomía Patológica, Povisa, Vigo, Pontevedra, España
| | | | | | - C Jurado Basildo
- Residente, Servicio de Radiología, Povisa, Vigo, Pontevedra, España
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Shen Y, Xu X, Zhang Y, Li W, Dai J, Jiang S, Wu T, Cai H, Sihoe A, Shi J, Jiang G. Lung cancers associated with cystic airspaces: CT features and pathologic correlation. Lung Cancer 2019; 135:110-115. [PMID: 31446982 DOI: 10.1016/j.lungcan.2019.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/23/2019] [Accepted: 05/06/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Lung cancer associated with cystic airspaces (LCCA) is a rare entity. The diagnosis and treatment is often delayed due to lack of comprehension of this disease. We aimed to elucidate LCCA's clinicopathological characteristics and investigate imaging features correlated with pathological invasiveness. METHOD The preoperative computed tomographic (CT) scans of 10,835 patients diagnosed with NSCLC between January 2015 and December 2016 were reviewed by two thoracic radiologists for association with a cystic airspace. A clinicopathological and radiological feature analysis was done. RESULT A total number of 123 LCCA patients were identified and four morphologic patterns were recognized: I, thin-walled type (n = 23, 18.7%); II, thick-walled type (n = 34, 27.6%); III, a cystic airspace with a mural nodule (CWN) type (n = 43, 35.0%); and IV, mixed type (n = 23, 18.7%). A solid component in the cyst wall predicted histological invasiveness in all four types of LCCA. The proportion of moderately/poorly (M/P)-differentiated subtype in type III (85.0%) was higher than in other three patterns (which were 50.0%, 50.0%, and 69.6%, respectively). Multivariate analysis revealed that type III pattern (odds ratio [OR], 6.5; 95% confidence interval [CI], 1.1-36.4; P = 0.035), part-solid/solid component in wall (part-solid: OR, 27.2; 95% CI, 5.6-3131.6; P < 0.001; solid: OR 614.6; 95% CI, 36.4-10,368.6; P < 0.001), and irregular inner surface of cyst (OR 7.0; 95% CI 1.9-26.2; P = 0.004) were independent risk factors for the M/P-differentiated subtype. EGFR mutations were the predominant genetic alterations in each type of LCCAs, but no significant difference was found among them. CONCLUSIONS In LCCA, morphological patterns and wall components were two important predictors for determining pathological invasiveness.
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Affiliation(s)
- Yingran Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Xinnan Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Yunfei Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Weitong Li
- Department of Medical Imaging, Shishi Hospital, Fujian, 362700, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Siming Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Tong Wu
- Department of Medical Imaging, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Haomin Cai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Alan Sihoe
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China
| | - Jingyun Shi
- Department of Medical Imaging, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China.
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai, 200433, China.
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Inter-observer agreement on the morphology of screening-detected lung cancer: beyond pulmonary nodules and masses. Eur Radiol 2019; 29:3862-3870. [DOI: 10.1007/s00330-019-06243-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
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40
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Mergo PJ, Rojas CA. CT Characteristics and Pathologic Basis of Solitary Cystic Lung Cancer. Radiology 2019; 291:502-503. [DOI: 10.1148/radiol.2019190329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Patricia J. Mergo
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Carlos A. Rojas
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
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41
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Snoeckx A, Reyntiens P, Carp L, Spinhoven MJ, El Addouli H, Van Hoyweghen A, Nicolay S, Van Schil PE, Pauwels P, van Meerbeeck JP, Parizel PM. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis 2019; 11:987-1004. [PMID: 31019789 DOI: 10.21037/jtd.2019.02.91] [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] [Indexed: 12/18/2022]
Abstract
"Lung cancer associated with cystic airspaces" is an uncommon manifestation, in which lung cancer presents on imaging studies with a cystic area with associated consolidation and/or ground glass. With the widespread use of computed tomography (CT), both in clinical practice and for lung cancer screening, these tumors are being more frequently recognized. An association of this entity with smoking has been established with the majority of cases reported being in former and current smokers. The true pathogenesis of the cystic airspace is not yet fully understood. Different causes of this cystic airspace have been described, including a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma on emphysematous lung parenchyma, cyst formation of tumor and tumor growth along the wall of a pre-existing bulla. Adenocarcinoma is the commonest histological type, followed by squamous cell carcinoma. Two classification systems have been described, based on morphological features of the lesion, taking into account both the cystic airspace as well as the morphology of the surrounding consolidation or ground glass. The cystic component may mislead radiologists to a benign etiology and the many different faces on imaging can make early diagnosis challenging. Special attention should be made to focal or diffuse wall thickening and consolidation or ground glass abutting or interspersed with cystic airspaces. Despite their atypical morphology, staging and management currently are still similar to that of other lung cancer types. Although the rarity of this entity will hamper larger studies, numerous aspects regarding this particular lung cancer type still need to be unraveled. This manuscript reviews the CT-imaging findings and gives an overview of available data in the English literature on pathogenesis, histopathology and clinical findings. Differential diagnosis and pitfalls are discussed as well as future directions regarding staging and management.
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Affiliation(s)
- Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maarten J Spinhoven
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Astrid Van Hoyweghen
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Patrick Pauwels
- Department of Pathology Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Mets OM, Schaefer-Prokop CM, de Jong PA. Cyst-related primary lung malignancies: an important and relatively unknown imaging appearance of (early) lung cancer. Eur Respir Rev 2018; 27:27/150/180079. [PMID: 30567934 DOI: 10.1183/16000617.0079-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
It is well known that lung cancer can manifest itself in imaging as solid and subsolid nodules or masses. However, in this era of increased computed tomography use another morphological computed tomography appearance of lung cancer is increasingly being recognised, presenting as a malignancy in relation to cystic airspaces. Despite the fact that it seems to be a relatively common finding in daily practice, literature on this entity is scarce and presumably the overall awareness is limited. This can lead to misinterpretation and delay in diagnosis and, therefore, increased awareness is urgently needed. This review aims to illustrate the imaging appearances of cyst-related primary lung malignancies, demonstrate its mimickers and potential pitfalls, and discuss the clinical implications based on the available literature and our own experience in four different hospitals.
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Affiliation(s)
- Onno M Mets
- Dept of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelia M Schaefer-Prokop
- Diagnostic Imaging Analysis Groups, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Dept of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Pim A de Jong
- Dept of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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43
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Bueno J, Landeras L, Chung JH. Updated Fleischner Society Guidelines for Managing Incidental Pulmonary Nodules: Common Questions and Challenging Scenarios. Radiographics 2018; 38:1337-1350. [PMID: 30207935 DOI: 10.1148/rg.2018180017] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The new guidelines for managing incidental pulmonary nodules published by the Fleischner Society in 2017 reflect an improved understanding of the risk factors and biologic features of lung cancer. Specific topics emphasized in the updated guidelines include a new threshold size for follow-up, the importance of the morphologic features of nodules, accurate nodule measurements, recognition of subsolid components, understanding interval growth or change in nodule morphology, and knowledge of patient risk factors. The updated guidelines enable greater personal flexibility in the decision-making process and encourage individualized management of pulmonary nodules. These factors may introduce new challenges for radiologists, who previously used solely nodule size to make management recommendations. The authors describe eight scenarios that illustrate the challenges potentially encountered when applying the new guidelines to pulmonary nodule management. ©RSNA, 2018.
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Affiliation(s)
- Juliana Bueno
- From the Department of Radiology and Medical Imaging, University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908 (J.B.); and Department of Radiology, University of Chicago, Chicago, Ill (L.L., J.H.C.)
| | - Luis Landeras
- From the Department of Radiology and Medical Imaging, University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908 (J.B.); and Department of Radiology, University of Chicago, Chicago, Ill (L.L., J.H.C.)
| | - Jonathan H Chung
- From the Department of Radiology and Medical Imaging, University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908 (J.B.); and Department of Radiology, University of Chicago, Chicago, Ill (L.L., J.H.C.)
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Wang X, Tao YX, Zhang M, Wu WB, Yang DP, Wang M. Solitary thin-walled cystic lung cancer with extensive extrapulmonary metastasis: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e12950. [PMID: 30412112 PMCID: PMC6221603 DOI: 10.1097/md.0000000000012950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Asymptomatic, isolated, and thin-walled cystic lung cancer with extensive extrapulmonary metastasis is rare, and the risk of pulmonary cyst developing into lung cancer is poorly understood. The efficacy of apatinib for end-stage pulmonary adenosquamous carcinoma has not been clarified yet. PATIENT CONCERNS We herein report a rare case of primary lung cancer that appeared as an isolated thin-walled cystic lesion on computed tomography (CT) image, who was initially misdiagnosed as having pulmonary cyst empirically. DIAGNOSES Fluorine-18-fluorodeoxyglucose-positron emission tomography and CT-guided liver biopsy of the patient revealed extra-pulmonary metastasis of lung cancer. INTERVENTIONS Eight cycles of cisplatin-based chemotherapy were administered, followed by oral apatinib for 6 months. Thereafter, best supportive care was given for this patient. OUTCOMES The pulmonary cystic lesion indicated stable disease through the therapy, but the hepatic tumors were progressed gradually after anticancer treatment. The patient died 16 months after the correct diagnosis. LESSONS Solitary thin-walled cystic lung cancer should be kept in mind during the differential diagnosis of pulmonary cavitary lesions. Chest CT alone is insufficient for surveillance of these cystic diseases. Timely biopsy and resection are essential to avoid delayed management. Besides, apatinib may play a role in the treatment of end-stage pulmonary adenosquamous carcinoma.
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Affiliation(s)
| | | | | | | | | | - Min Wang
- Department of Respiratory Medicine, Xuzhou Central Hospital of Southeast University, Xuzhou, China
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Vlahos I, Stefanidis K, Sheard S, Nair A, Sayer C, Moser J. Lung cancer screening: nodule identification and characterization. Transl Lung Cancer Res 2018; 7:288-303. [PMID: 30050767 DOI: 10.21037/tlcr.2018.05.02] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The accurate identification and characterization of small pulmonary nodules at low-dose CT is an essential requirement for the implementation of effective lung cancer screening. Individual reader detection performance is influenced by nodule characteristics and technical CT parameters but can be improved by training, the application of CT techniques, and by computer-aided techniques. However, the evaluation of nodule detection in lung cancer screening trials differs from the assessment of individual readers as it incorporates multiple readers, their inter-observer variability, reporting thresholds, and reflects the program accuracy in identifying lung cancer. Understanding detection and interpretation errors in screening trials aids in the implementation of lung cancer screening in clinical practice. Indeed, as CT screening moves to ever lower radiation doses, radiologists must be cognisant of new technical challenges in nodule assessment. Screen detected lung cancers demonstrate distinct morphological features from incidentally or symptomatically detected lung cancers. Hence characterization of screen detected nodules requires an awareness of emerging concepts in early lung cancer appearances and their impact on radiological assessment and malignancy prediction models. Ultimately many nodules remain indeterminate, but further imaging evaluation can be appropriate with judicious utilization of contrast enhanced CT or MRI techniques or functional evaluation by PET-CT.
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Affiliation(s)
- Ioannis Vlahos
- St George's NHS Foundation Hospitals Trust and School of Medicine, London, UK
| | | | | | - Arjun Nair
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Charles Sayer
- Brighton and Sussex University Hospitals Trust, Haywards Heath, UK
| | - Joanne Moser
- St George's NHS Foundation Hospitals Trust and School of Medicine, London, UK
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Shinohara S, Sugaya M, Onitsuka T, Machida K, Matsuo M, Kato K, Tanaka F. Impact of the favorable prognosis of patients with lung cancer adjoining bullae. J Thorac Dis 2018; 10:3289-3297. [PMID: 30069325 DOI: 10.21037/jtd.2018.05.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Lung cancer adjoining bullae (LC-AB) is an uncommon manifestation. The clinical characteristics and prognosis of LC-AB remain unclear. The aim of this study is to investigate the clinical features and overall survival (OS) of patients with LC-AB following lung resection compared to non-LC-AB group. Methods We retrospectively investigated 291 consecutive patients with lung cancer who underwent curative resection in a single institution between April 2007 and March 2015. A total of LC-AB was 52 patients. LC-AB was determined using thin slice computed tomography (CT) imaging and pathological findings. Survival analysis was calculated using the Kaplan-Meier method. We used a Cox proportional hazards model for the univariate and multivariate analysis to identify prognostic factors. Results The LC-AB group showed a higher frequency of younger patients (P=0.017), former or current smokers (P=0.011), men (P=0.021), tumor location in the upper lobe (P=0.031), moderately or poorly differentiated tumor histology (P<0.001), pleural indentation (P=0.007), and non-adenocarcinoma histology (P=0.016) than the non-LC-AB group. The 5-year survival and recurrence-free survival (RFS) rates were significantly higher in the LC-AB group than the non-LC-AB group (88.5% vs. 74.9%, P=0.010, 75.4% vs. 61.3%, P=0.030, respectively). Multivariate analysis using a Cox proportional hazard model of OS showed that LC-AB was an independent prognostic factor [hazard ratio (HR): 0.30, 95% confidence interval (CI): 0.12-0.77, P=0.012]. Conclusions Patients with LC-AB had better OS than those with non-LC-AB. Thus, LC-AB may be an independent favorable prognostic factor following curative resection.
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Affiliation(s)
- Shuichi Shinohara
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Masakazu Sugaya
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Takamitsu Onitsuka
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Kazuhiko Machida
- Department of Pulmonary and Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Masaki Matsuo
- Department of Pulmonary and Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Kazuo Kato
- Department of Pathology, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Deng H, Zhang J, Zhao S, Zhang J, Jiang H, Chen X, Wang D, Gao J, Wu C, Pan L, Wang Y, Xue X. Thin-wall cystic lung cancer: A study of 45 cases. Oncol Lett 2018; 16:755-760. [PMID: 29963142 PMCID: PMC6019975 DOI: 10.3892/ol.2018.8707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/22/2018] [Indexed: 12/19/2022] Open
Abstract
Thin-wall cystic lung cancer is uncommon. Consequently, there is a lack of knowledge concerning the features of this type of lung cancer, which may lead to misdiagnosis and delayed treatment. The aim of the present study is to understand the invasiveness and metastasis of thin-wall cystic lung cancer. The prognosis of this type of cancer will also be discussed. The present study attempted to determine the pathological interpretation of the imaging results. A total of 45 patients with this specific type of lung cancer were analyzed retrospectively based on the review of medical records, radiological findings, pathological changes and treatment strategies. Certain patients were also telephoned in order to learn about their recent physical conditions. Thin-wall cystic lung cancer displayed suspected malignant signs. The majority of these cases are adenocarcinoma, but certain cases of squamous cell carcinoma may also display cysts on their images. Although thin-wall cystic lung cancer is often thought to progress slowly, certain cases may progress rapidly. Distant metastasis, which is relatively rare, occurred in three cases. Cancer cells proliferate along the terminal bronchioles and destroy the lung tissues exposing the bronchial arteries and adjacent bronchi. Therefore, separation in cysts on the images was observed. In the majority of cases, the thin-wall cystic lung cancer proliferates slowly, but in a few cases it may be very aggressive.
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Affiliation(s)
- Hui Deng
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Jingyuan Zhang
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Sheng Zhao
- Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Jie Zhang
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Hong Jiang
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Xiaolan Chen
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Dongxu Wang
- Department of Medical Imaging, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang 161006, P.R. China
| | - Jie Gao
- Department of Pathology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Chongchogn Wu
- Department of Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Lei Pan
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Yong Wang
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Xinying Xue
- Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
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Sheard S, Moser J, Sayer C, Stefanidis K, Devaraj A, Vlahos I. Lung Cancers Associated with Cystic Airspaces: Underrecognized Features of Early Disease. Radiographics 2018; 38:704-717. [DOI: 10.1148/rg.2018170099] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sarah Sheard
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Joanna Moser
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Charlie Sayer
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Konstantinos Stefanidis
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Anand Devaraj
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
| | - Ioannis Vlahos
- From the Department of Radiology, St George’s Hospitals NHS Trust, Blackshaw Rd, London SW17 0QT, England (S.S., J.M., K.S., I.V.); Department of Radiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, England (C.S.); and Department of Radiology, Royal Brompton and Harefield NHS Trust, London, England (A.D.)
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Yankelevitz DF. Invited Commentary: Early Lung Cancer and Cystic Airspaces. Radiographics 2018; 38:717-718. [DOI: 10.1148/rg.2018180092] [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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Abstract
The chest radiograph is one of the most commonly used imaging studies and is the modality of choice for initial evaluation of many common clinical scenarios. Over the last two decades, chest computed tomography has been increasingly used for a wide variety of indications, including respiratory illnesses, trauma, oncologic staging, and more recently lung cancer screening. Diagnostic radiologists should be familiar with the common causes of missed lung cancers on imaging studies in order to avoid detection and interpretation errors. Failure to detect these lesions can potentially have serious implications for both patients as well as the interpreting radiologist.
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Affiliation(s)
- Rydhwana Hossain
- Thoracic Imaging and Interventions, Massachusetts General Hospital, 55 Fruit Street FND 202, Boston, MA 02114, USA
| | - Carol C Wu
- Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Patricia M de Groot
- Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brett W Carter
- Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Matthew D Gilman
- Thoracic Imaging and Interventions, Massachusetts General Hospital, 55 Fruit Street FND 202, Boston, MA 02114, USA
| | - Gerald F Abbott
- Thoracic Imaging and Interventions, Massachusetts General Hospital, 55 Fruit Street FND 202, Boston, MA 02114, USA.
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