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Geady C, Abbas-Aghababazadeh F, Kohan A, Schuetze S, Shultz D, Haibe-Kains B. Radiomic-based prediction of lesion-specific systemic treatment response in metastatic disease. Comput Med Imaging Graph 2024; 116:102413. [PMID: 38945043 DOI: 10.1016/j.compmedimag.2024.102413] [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: 08/11/2023] [Revised: 04/08/2024] [Accepted: 06/15/2024] [Indexed: 07/02/2024]
Abstract
Despite sharing the same histologic classification, individual tumors in multi metastatic patients may present with different characteristics and varying sensitivities to anticancer therapies. In this study, we investigate the utility of radiomic biomarkers for prediction of lesion-specific treatment resistance in multi metastatic leiomyosarcoma patients. Using a dataset of n=202 lung metastases (LM) from n=80 patients with 1648 pre-treatment computed tomography (CT) radiomics features and LM progression determined from follow-up CT, we developed a radiomic model to predict the progression of each lesion. Repeat experiments assessed the relative predictive performance across LM volume groups. Lesion-specific radiomic models indicate up to a 4.5-fold increase in predictive capacity compared with a no-skill classifier, with an area under the precision-recall curve of 0.70 for the most precise model (FDR = 0.05). Precision varied by administered drug and LM volume. The effect of LM volume was controlled by removing radiomic features at a volume-correlation coefficient threshold of 0.20. Predicting lesion-specific responses using radiomic features represents a novel strategy by which to assess treatment response that acknowledges biological diversity within metastatic subclones, which could facilitate management strategies involving selective ablation of resistant clones in the setting of systemic therapy.
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Affiliation(s)
- Caryn Geady
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Medical Biophysics, University of Toronto, Toronto, Canada
| | | | - Andres Kohan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Scott Schuetze
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - David Shultz
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Medical Biophysics, University of Toronto, Toronto, Canada; Department of Medicine, University of Michigan, Ann Arbor, MI, USA; Vector Institute for Artificial Intelligence, Toronto, Canada; Ontario Institute for Cancer Research, Toronto, Canada; Department of Computer Science, University of Toronto, Toronto, Canada; Department of Biostatistics, Dalla Lana School of Public Health, Toronto, Canada
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Medical Biophysics, University of Toronto, Toronto, Canada; Vector Institute for Artificial Intelligence, Toronto, Canada; Ontario Institute for Cancer Research, Toronto, Canada; Department of Computer Science, University of Toronto, Toronto, Canada; Department of Biostatistics, Dalla Lana School of Public Health, Toronto, Canada.
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Wang Y, Duan Y, Guo D, Lv H, Li Q, Liu X, Qiao N, Meng H, Zhang X, Lan L, Liu X, Liu X. Value of circulating tumor cell assisting low-dose computed tomography in screening pulmonary nodules based on existing liquid biopsy techniques: a systematic review with meta-analysis and trial sequential analysis. Clin Transl Oncol 2024:10.1007/s12094-024-03556-8. [PMID: 38869739 DOI: 10.1007/s12094-024-03556-8] [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: 04/11/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE This study aims to assess the diagnostic utility of circulating tumor cells (CTCs) in conjunction with low-dose computed tomography (LDCT) for differentiating between benign and malignant pulmonary nodules and to substantiate the foundation for their integration into clinical practice. METHODS A systematic literature review was performed independently by two researchers utilizing databases including PubMed, Web of Science, The Cochrane Library, Embase, and Medline, to collate studies up to September 15, 2023, that investigated the application of CTCs in diagnosing pulmonary nodules. A meta-analysis was executed employing Stata 15.0 and Revman 5.4 to calculate the pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). Additionally, trial sequential analysis was conducted using dedicated TSA software. RESULTS The selection criteria identified 16 studies, encompassing a total of 3409 patients. The meta-analysis revealed that CTCs achieved a pooled sensitivity of 0.84 (95% CI 0.80 to 0.87), specificity of 0.80 (95% CI 0.73 to 0.86), PLR of 4.23 (95% CI 3.12 to 5.72), NLR of 0.20 (95% CI 0.16 to 0.25), DOR of 20.92 (95% CI 13.52 to 32.36), and AUC of 0.89 (95% CI 0.86 to 0.93). CONCLUSIONS Circulating tumor cells demonstrate substantial diagnostic accuracy in distinguishing benign from malignant pulmonary nodules. The incorporation of CTCs into the diagnostic protocol can significantly augment the diagnostic efficacy of LDCT in screening for malignant lung diseases.
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Affiliation(s)
- Yixian Wang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Yuqing Duan
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Dingjie Guo
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Hongbo Lv
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Qiong Li
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Xuan Liu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Na Qiao
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Hengyu Meng
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Xin Zhang
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Linwei Lan
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China
| | - Xiumin Liu
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China.
| | - Xin Liu
- Department of Epidemiology and Statistics, School of Public Health, Jilin University, Changchun, Jilin, 130021, China.
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Li X, Fan F, Jia X, Yang L, He J, Tang Q, Cao W, Che J, Xu S. Prognosis of unresected versus resected early-stage pulmonary carcinoid tumors ≤3 cm in size: A population-based study. Cancer Med 2024; 13:e7311. [PMID: 38855831 PMCID: PMC11163264 DOI: 10.1002/cam4.7311] [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: 11/06/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
PURPOSE The observation-based prognosis, rather than resection, for small carcinoid tumors is still unclear. This lack of clarity has important implications for counseling elderly patients or patients for whom surgical resection poses a high risk. This study compared the outcomes of observation and surgical resection in patients with pulmonary carcinoid (PC) tumors ≤3 cm in size without metastasis. METHODS Data of patients with PC tumors with ≤3 cm in diameter and without lymph node and distant metastases were retrieved from Surveillance, Epidemiology, and End Results (SEER) registry. To reduce the inherent bias of retrospective studies, propensity score matching analysis was performed. Overall survival (OS) and lung carcinoid-specific survival (LCSS) were analyzed using Kaplan-Meier plots. Multivariate analysis was used to determine predictors of LCSS in different size subgroups. RESULTS In total, 4552 patients with early-stage PCs ≤3 cm in diameter, including 435 (9.56%) who were observed and 4117 (90.44%) treated by surgery, were recruited. Patients with surgery had significantly better OS and LCSS than those who were observed. However, patients with observation had comparable LCSS to those with surgery for PCs with tumor diameters ≤1 cm. Multivariate analysis indicated that surgical resection was an independent prognostic factor for LCSS in 1 cm < tumors ≤2 cm, and 2 cm < tumors ≤3 cm groups, but not for tumors ≤1 cm in diameter. CONCLUSION Surgical resection of small PCs is associated with a survival advantage over observation. However, for early PCs ≤1 cm in diameter, observation may be considered in patients with high risk for surgical resection.
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Affiliation(s)
- Xiongfei Li
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fanfan Fan
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuewang Jia
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lingqi Yang
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinling He
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Quanying Tang
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Weibo Cao
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ji Che
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Song Xu
- Department of Lung Cancer Surgery, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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Gaffney B, Murphy DJ. Approach to Pulmonary Nodules in Connective Tissue Disease. Semin Respir Crit Care Med 2024; 45:316-328. [PMID: 38547916 DOI: 10.1055/s-0044-1782656] [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
The assessment of pulmonary nodules is a common and often challenging clinical scenario. This evaluation becomes even more complex in patients with connective tissue diseases (CTDs), as a range of disease-related factors must also be taken into account. These diseases are characterized by immune-mediated chronic inflammation, leading to tissue damage, collagen deposition, and subsequent organ dysfunction. A thorough examination of nodule features in these patients is required, incorporating anatomic and functional information, along with patient demographics, clinical factors, and disease-specific knowledge. This integrated approach is vital for effective risk stratification and precise diagnosis. This review article addresses specific CTD-related factors that should be taken into account when evaluating pulmonary nodules in this patient group.
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Affiliation(s)
- Brian Gaffney
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - David J Murphy
- Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College, Dublin, Ireland
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Baeza S, Gil D, Sanchez C, Torres G, Carmezim J, Tebé C, Guasch I, Nogueira I, García-Reina S, Martínez-Barenys C, Mate JL, Andreo F, Rosell A. Radiomics and Clinical Data for the Diagnosis of Incidental Pulmonary Nodules and Lung Cancer Screening: Radiolung Integrative Predictive Model. Arch Bronconeumol 2024:S0300-2896(24)00192-3. [PMID: 38876917 DOI: 10.1016/j.arbres.2024.05.027] [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: 03/16/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Early diagnosis of lung cancer (LC) is crucial to improve survival rates. Radiomics models hold promise for enhancing LC diagnosis. This study assesses the impact of integrating a clinical and a radiomic model based on deep learning to predict the malignancy of pulmonary nodules (PN). METHODOLOGY Prospective cross-sectional study of 97 PNs from 93 patients. Clinical data included epidemiological risk factors and pulmonary function tests. The region of interest of each chest CT containing the PN was analysed. The radiomic model employed a pre-trained convolutional network to extract visual features. From these features, 500 with a positive standard deviation were chosen as inputs for an optimised neural network. The clinical model was estimated by a logistic regression model using clinical data. The malignancy probability from the clinical model was used as the best estimate of the pre-test probability of disease to update the malignancy probability of the radiomic model using a nomogram for Bayes' theorem. RESULTS The radiomic model had a positive predictive value (PPV) of 86%, an accuracy of 79% and an AUC of 0.67. The clinical model identified DLCO, obstruction index and smoking status as the most consistent clinical predictors associated with outcome. Integrating the clinical features into the deep-learning radiomic model achieves a PPV of 94%, an accuracy of 76% and an AUC of 0.80. CONCLUSIONS Incorporating clinical data into a deep-learning radiomic model improved PN malignancy assessment, boosting predictive performance. This study supports the potential of combined image-based and clinical features to improve LC diagnosis.
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Affiliation(s)
- Sonia Baeza
- Respiratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Debora Gil
- Computer Vision Center and Computer Science Department, UAB, Barcelona, Spain
| | - Carles Sanchez
- Computer Vision Center and Computer Science Department, UAB, Barcelona, Spain
| | - Guillermo Torres
- Computer Vision Center and Computer Science Department, UAB, Barcelona, Spain
| | - João Carmezim
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; Biostatistics Support and Research Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Cristian Tebé
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; Biostatistics Support and Research Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Ignasi Guasch
- Radiodiagnostic Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Isabel Nogueira
- Radiodiagnostic Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Samuel García-Reina
- Thoracic Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Cirugia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Martínez-Barenys
- Thoracic Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Cirugia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Luis Mate
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Felipe Andreo
- Respiratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Rosell
- Respiratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Polanco D, González J, Gracia-Lavedan E, Pinilla L, Plana R, Molina M, Pardina M, Barbé F. Multidisciplinary virtual management of pulmonary nodules. Pulmonology 2024; 30:239-246. [PMID: 35115280 DOI: 10.1016/j.pulmoe.2021.12.003] [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: 08/25/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Multidisciplinary nodule clinics provide high-quality care and favor adherence to guidelines. Virtual care has shown savings benefits along with patient satisfaction. Our aim is to describe the first year of operation of a multidisciplinary virtual lung nodule clinic, the population evaluated and issued decisions. Secondarily, among discharged patients, we aimed to analyze their follow-up prior to the existence of our consultation, evaluating its adherence to guidelines. MATERIALS AND METHODS Observational study including all patients evaluated at the Virtual Lung Nodule Clinic (VLNC) (March 2018- March 2019). Clinical and radiological data were recorded. Recommendations, based on 2017 Fleischner Society guidelines, were categorized into follow-up, discharge or referral to lung cancer consultation. Discharged patients were classified according to adherence to guidelines of their previous management, into adequate, prolonged and non-indicated follow-up. RESULTS A total of 365 patients (58.9% men; median age 64.0 years) were included. Sixty-four percent had smoking history and 23% had chronic obstructive pulmonary disease (COPD). Most nodules were solid (87.4%) and multiple (57.5%). The median diameter was 6.00 mm. 43.8% of patients were discharged following first VLNC evaluation. Among them, 27.5% had received appropriate follow-up, but 66.9% had received poor management. Patients with prolonged follow-up (33.1%) were older (67.0 vs 60.5 years) and had larger nodules (6.00 mm vs 5.00). Non-indicated follow-up patients (33.8%) were more non-smokers (77.8% vs 31.8%) and presented smaller nodules (4.00 vs 5.00 mm). CONCLUSIONS During its first year of operation, the VLNC has evaluated a population with a relevant risk profile for lung cancer development, management of which should be cautious and adhere to guidelines. After the first VLNC assessment, approximately one-half of this population was discharged. It was noticeable that previous follow-up of discharged patients was found poorly adherent to guidelines, with a marked tendency to overmanagement.
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Affiliation(s)
- D Polanco
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - J González
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - E Gracia-Lavedan
- Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - L Pinilla
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - R Plana
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain
| | - M Molina
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain
| | - M Pardina
- Department of Radiology, Arnau de Vilanova University Hospital, IRBLleida
| | - F Barbé
- Respiratory Department, University Hospital Arnau de Vilanova. Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain; Group of Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain.
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Zhang J, Zhang J, Han P, Chen XZ, Zhang Y, Li W, Qin J, He L. Path planning algorithm for percutaneous puncture lung mass biopsy procedure based on the multi-objective constraints and fuzzy optimization. Phys Med Biol 2024; 69:095006. [PMID: 38394681 DOI: 10.1088/1361-6560/ad2c9f] [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: 05/18/2023] [Accepted: 02/23/2024] [Indexed: 02/25/2024]
Abstract
Objective. The percutaneous puncture lung mass biopsy procedure, which relies on preoperative CT (Computed Tomography) images, is considered the gold standard for determining the benign or malignant nature of lung masses. However, the traditional lung puncture procedure has several issues, including long operation times, a high probability of complications, and high exposure to CT radiation for the patient, as it relies heavily on the surgeon's clinical experience.Approach.To address these problems, a multi-constrained objective optimization model based on clinical criteria for the percutaneous puncture lung mass biopsy procedure has been proposed. Additionally, based on fuzzy optimization, a multidimensional spatial Pareto front algorithm has been developed for optimal path selection. The algorithm finds optimal paths, which are displayed on 3D images, and provides reference points for clinicians' surgical path planning.Main results.To evaluate the algorithm's performance, 25 data sets collected from the Second People's Hospital of Zigong were used for prospective and retrospective experiments. The results demonstrate that 92% of the optimal paths generated by the algorithm meet the clinicians' surgical needs.Significance.The algorithm proposed in this paper is innovative in the selection of mass target point, the integration of constraints based on clinical standards, and the utilization of multi-objective optimization algorithm. Comparison experiments have validated the better performance of the proposed algorithm. From a clinical standpoint, the algorithm proposed in this paper has a higher clinical feasibility of the proposed pathway than related studies, which reduces the dependency of the physician's expertise and clinical experience on pathway planning during the percutaneous puncture lung mass biopsy procedure.
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Affiliation(s)
- Jiayu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Jing Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Ping Han
- Urologic Surgery, Sichuan University West China Hospital, Chengdu, People's Republic of China
- Urologic Surgery, Peoples Hospital Yibin City 2, Chengdu, People's Republic of China
| | - Xin-Zu Chen
- Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Ya'an Cancer Prevention and Control Center, People's Hospital of Ya'an City, Ya'an, People's Republic of China
| | - Yu Zhang
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Wen Li
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
| | - Jing Qin
- Centre for Smart Health, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hung Hom, People's Republic of China
| | - Ling He
- College of Biomedical Engineering, Sichuan University, Chengdu, People's Republic of China
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Hardavella G, Frille A, Chalela R, Sreter KB, Petersen RH, Novoa N, de Koning HJ. How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape? Eur Respir Rev 2024; 33:230232. [PMID: 38925794 PMCID: PMC11216686 DOI: 10.1183/16000617.0232-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Implementation of lung cancer screening, with its subsequent findings, is anticipated to change the current diagnostic and surgical lung cancer landscape. This review aimed to identify and present the most updated expert opinion and discuss relevant evidence regarding the impact of lung cancer screening and lung nodule management on the diagnostic and surgical landscape of lung cancer, as well as summarise points for clinical practice. METHODS This article is based on relevant lectures and talks delivered during the European Society of Thoracic Surgeons-European Respiratory Society Collaborative Course on Thoracic Oncology (February 2023). Original lectures and talks and their relevant references were included. An additional literature search was conducted and peer-reviewed studies in English (December 2022 to June 2023) from the PubMed/Medline databases were evaluated with regards to immediate affinity of the published papers to the original talks presented at the course. An updated literature search was conducted (June 2023 to December 2023) to ensure that updated literature is included within this article. RESULTS Lung cancer screening suspicious findings are expected to increase the number of diagnostic investigations required therefore impacting on current capacity and resources. Healthcare systems already face a shortage of imaging and diagnostic slots and they are also challenged by the shortage of interventional radiologists. Thoracic surgery will be impacted by the wider lung cancer screening implementation with increased volume and earlier stages of lung cancer. Nonsuspicious findings reported at lung cancer screening will need attention and subsequent referrals where required to ensure participants are appropriately diagnosed and managed and that they are not lost within healthcare systems. CONCLUSIONS Implementation of lung cancer screening requires appropriate mapping of existing resources and infrastructure to ensure a tailored restructuring strategy to ensure that healthcare systems can meet the new needs.
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Affiliation(s)
- Georgia Hardavella
- 4th-9th Department of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Armin Frille
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany
| | - Roberto Chalela
- Department of Respiratory Medicine: Lung Cancer and Endoscopy Unit, Hospital del Mar - Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Katherina B Sreter
- Department of Pulmonology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - Rene H Petersen
- Department of Cardiothoracic Surgery, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Nuria Novoa
- Department of Thoracic Surgery, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Byrne SC, Peers C, Gargan ML, Lacson R, Khorasani R, Hammer MM. Risk of Malignancy in Incidentally Detected Lung Nodules in Patients Aged Younger Than 35 Years. J Comput Assist Tomogr 2024:00004728-990000000-00291. [PMID: 38438334 DOI: 10.1097/rct.0000000000001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND The risk of malignancy in pulmonary nodules incidentally detected on computed tomography (CT) in patients who are aged younger than 35 years is unclear. OBJECTIVE The aim of this study was to evaluate the incidence of lung cancer in incidental pulmonary nodules in patients who are 15-34 years old. METHODS This retrospective study included patients aged 15-34 years who had an incidental pulmonary nodule on chest CT from 2010 to 2018 at our hospital. Patients with prior, current, or suspected malignancy were excluded. A chart review identified patients with diagnosis of malignancy. Incidental pulmonary nodule was deemed benign if stable or resolved on a follow-up CT at least 2 years after initial or if there was a medical visit in our health care network at least 2 years after initial CT without diagnosis of malignancy.Receiver operating characteristic curve analysis was performed with nodule size. Association of categorical variables with lung cancer diagnosis was performed with Fisher exact test, and association of continuous variables was performed with logistic regression. RESULTS Five thousand three hundred fifty-five chest CTs performed on patients aged 15-34 years between January 2010 and December 2018. After excluding patients without a reported pulmonary nodule and prior or current malignancy, there were a total of 779 patients. Of these, 690 (89%) had clinical or imaging follow-up after initial imaging. Of these, 545 (70% of total patients) patients had imaging or clinical follow-up greater than 2 years after their initial imaging.A malignant diagnosis was established in 2/779 patients (0.3%; 95% confidence interval, 0.1%-0.9%). Nodule size was strongly associated with malignancy (P = 0.007), with area under the receiver operating characteristic curve of 0.97. There were no malignant nodules that were less than 10 mm in size. Smoking history, number of nodules, and nodule density were not associated with malignancy. CONCLUSIONS Risk of malignancy for incidentally detected pulmonary nodules in patients aged 15-34 years is extremely small (0.3%). There were no malignant nodules that were less than 10 mm in size. Routine follow-up of subcentimeter pulmonary nodules should be carefully weighed against the risks.
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Affiliation(s)
| | - Caroline Peers
- Department of Radiology, Center for Evidence-Based Imaging
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10
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Sugawara H, Kikkawa N, Ito K, Watanabe H, Kaku S, Akai H, Abe O, Watanabe SI, Yatabe Y, Kusumoto M. Is 18F-fluorodeoxyglucose PET recommended for small lung nodules? CT findings of 18F-fluorodeoxyglucose non-avid lung cancer. Br J Radiol 2024; 97:462-468. [PMID: 38308036 DOI: 10.1093/bjr/tqad048] [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: 07/09/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To determine the image characteristics associated with low 18F-FDG (18F-fluorodeoxyglucose) avidity among 8-15 mm solid lung cancer. METHODS Patients satisfying the following criteria were included: underwent surgery between January 2014 and December 2019 for lung cancer, presented 8-15 mm nodule without measurable ground glass component on preoperative CT, and underwent 18F-FDG PET before resection. Image characteristics, including air bronchogram, concave shape, pleural attachment, and background emphysema, were evaluated by two board-certified radiologists. The Mann-Whitney U test was used to compare maximum standardized uptake (SUVmax) values from 18F-FDG PET images. RESULTS The analysis included 235 patients. The SUVmax values of lesions with air bronchogram and concave shape were significantly lower than the SUVmax values of lesions without these features (median: 1.55 vs 2.56 and 1.66 vs 2.45, both P < .001), whereas lesions arising from emphysematous lungs had significantly higher SUVmax values than lesions arising from non-emphysematous lungs (2.90 vs 1.69, P < .001). No significant differences were detected between lesions attached and not attached to pleura. The interobserver agreement was almost perfect for air bronchograms and background emphysema (κ = 0.882 and 0.927, respectively), and 89.7% of lesions with air bronchograms and arising from non-emphysematous lungs showed SUVmax values below 2.5. CONCLUSIONS Among 8-15 mm solid lung cancer, the presence of air bronchograms and concave shape and the absence of background emphysema were associated with low 18F-FDG accumulation. ADVANCES IN KNOWLEDGE 18F-FDG PET can be misleading in differentiating certain type of small solid lung cancer.
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Affiliation(s)
- Haruto Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Nao Kikkawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Kimiteru Ito
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hirokazu Watanabe
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Sawako Kaku
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hiroyuki Akai
- Department of Radiology, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo 104-0045, Japan
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11
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He XQ, Huang XT, Luo TY, Liu X, Li Q. The differential computed tomography features between small benign and malignant solid solitary pulmonary nodules with different sizes. Quant Imaging Med Surg 2024; 14:1348-1358. [PMID: 38415140 PMCID: PMC10895103 DOI: 10.21037/qims-23-995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/20/2023] [Indexed: 02/29/2024]
Abstract
Background Computed tomography (CT) has been widely known to be the first choice for the diagnosis of solid solitary pulmonary nodules (SSPNs). However, the smaller the SSPN is, the less the differential CT signs between benign and malignant SSPNs there are, which brings great challenges to their diagnosis. Therefore, this study aimed to investigate the differential CT features between small (≤15 mm) benign and malignant SSPNs with different sizes. Methods From May 2018 to November 2021, CT data of 794 patients with small SSPNs (≤15 mm) were retrospectively analyzed. SSPNs were divided into benign and malignant groups, and each group was further classified into three cohorts: cohort I (diameter ≤6 mm), cohort II (6 mm < diameter ≤8 mm), and cohort III (8 mm < diameter ≤15 mm). The differential CT features of benign and malignant SSPNs in three cohorts were identified. Multivariable logistic regression analyses were conducted to identify independent factors of benign SSPNs. Results In cohort I, polygonal shape and upper-lobe distribution differed significantly between groups (all P<0.05) and multiparametric analysis showed polygonal shape [adjusted odds ratio (OR): 12.165; 95% confidence interval (CI): 1.512-97.872; P=0.019] was the most effective variation for predicting benign SSPNs, with an area under the receiver operating characteristic curve (AUC) of 0.747 (95% CI: 0.640-0.855; P=0.001). In cohort II, polygonal shape, lobulation, pleural retraction, and air bronchogram differed significantly between groups (all P<0.05), and polygonal shape (OR: 8.870; 95% CI: 1.096-71.772; P=0.041) and the absence of pleural retraction (OR: 0.306; 95% CI: 0.106-0.883; P=0.028) were independent predictors of benign SSPNs, with an AUC of 0.778 (95% CI: 0.694-0.863; P<0.001). In cohort III, 12 CT features showed significant differences between groups (all P<0.05) and polygonal shape (OR: 3.953; 95% CI: 1.508-10.361; P=0.005); calcification (OR: 3.710; 95% CI: 1.305-10.551; P=0.014); halo sign (OR: 6.237; 95% CI: 2.838-13.710; P<0.001); satellite lesions (OR: 6.554; 95% CI: 3.225-13.318; P<0.001); and the absence of lobulation (OR: 0.066; 95% CI: 0.026-0.167; P<0.001), air space (OR: 0.405; 95% CI: 0.215-0.764; P=0.005), pleural retraction (OR: 0.297; 95% CI: 0.179-0.493; P<0.001), bronchial truncation (OR: 0.165; 95% CI: 0.090-0.303; P<0.001), and air bronchogram (OR: 0.363; 95% CI: 0.208-0.633; P<0.001) were independent predictors of benign SSPNs, with an AUC of 0.869 (95% CI: 0.840-0.897; P<0.001). Conclusions CT features vary between SSPNs with different sizes. Clarifying the differential CT features based on different diameter ranges may help to minimize ambiguities and discriminate the benign SSPNs from malignant ones.
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Affiliation(s)
- Xiao-Qun He
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xing-Tao Huang
- Department of Radiology, the Fifth People’s Hospital of Chongqing, Chongqing, China
| | - Tian-You Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Liu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Bitter T, Seeba T, Schroeder-Richter J, Fröhlich M, Duaer W, Abidi W, Kindermann MP. [4D electromagnetic navigation bronchoscopy for the diagnosis of peripheral pulmonary nodules - An overview and preliminary clinical results]. Pneumologie 2024; 78:93-99. [PMID: 38081219 DOI: 10.1055/a-2193-0966] [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: 02/18/2024]
Abstract
BACKGROUND The diagnostic of peripheral pulmonary nodules (PPN) is a particular challenge in interventional bronchology, which is why navigation systems such as electromagnetic navigation (ENB) are increasingly being used. The 4D-ENB represents the most current development of the ENB. It utilizes inspiratory and expiratory CT scans for mapping and thus helps compensate for respiratory movements-induced CT-to-body divergence. The aim of this work was to present the first clinical data and experiences using the 4D-ENB method for diagnosis of PPNs. METHODS We retrospectively describe the results of the first nine consecutive patient cases diagnosed at Klinikum Braunschweig using 4D-ENB in a unimodal diagnostic procedure. RESULTS Of the first 9 PPNs examined by 4D-ENB, navigation and puncture of the lesion was successful in 8 patients (89%). Diagnostic biopsy was could be carried out in six out of nine patients (67%). There were no significant procedure-related complications. CONCLUSION Our preliminary data suggest that 4D-ENB is a promising new alternative for the diagnosis of PPNs. To further improve diagnostic yield, 4D-END, which lacks real-time visualization, should be embedded in a multimodal diagnostic procedure with rEBUS and/or fluoroscopy.
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Affiliation(s)
- Thomas Bitter
- Pneumology and respiratory medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Deutschland
| | - Tielko Seeba
- Pneumology and respiratory medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Deutschland
| | - Jörn Schroeder-Richter
- Pneumology and respiratory medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Deutschland
| | - Michael Fröhlich
- Pneumology and respiratory medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Deutschland
| | - Wissam Duaer
- Pneumology and respiratory medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Deutschland
| | - Wael Abidi
- Pneumology and respiratory medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Deutschland
| | - Markus Peter Kindermann
- Pneumology and respiratory medicine, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Deutschland
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13
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Wang J, Sourlos N, Heuvelmans M, Prokop M, Vliegenthart R, van Ooijen P. Explainable machine learning model based on clinical factors for predicting the disappearance of indeterminate pulmonary nodules. Comput Biol Med 2024; 169:107871. [PMID: 38154157 DOI: 10.1016/j.compbiomed.2023.107871] [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: 07/25/2023] [Revised: 11/01/2023] [Accepted: 12/17/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND During lung cancer screening, indeterminate pulmonary nodules (IPNs) are a frequent finding. We aim to predict whether IPNs are resolving or non-resolving to reduce follow-up examinations, using machine learning (ML) models. We incorporated dedicated techniques to enhance prediction explainability. METHODS In total, 724 IPNs (size 50-500 mm3, 575 participants) from the Dutch-Belgian Randomized Lung Cancer Screening Trial were used. We implemented six ML models and 14 factors to predict nodule disappearance. Random search was applied to determine the optimal hyperparameters on the training set (579 nodules). ML models were trained using 5-fold cross-validation and tested on the test set (145 nodules). Model predictions were evaluated by utilizing the recall, precision, F1 score, and the area under the receiver operating characteristic curve (AUC). The best-performing model was used for three feature importance techniques: mean decrease in impurity (MDI), permutation feature importance (PFI), and SHAPley Additive exPlanations (SHAP). RESULTS The random forest model outperformed the other ML models with an AUC of 0.865. This model achieved a recall of 0.646, a precision of 0.816, and an F1 score of 0.721. The evaluation of feature importance achieved consistent ranking across all three methods for the most crucial factors. The MDI, PFI, and SHAP methods highlighted volume, maximum diameter, and minimum diameter as the top three factors. However, the remaining factors revealed discrepant ranking across methods. CONCLUSION ML models effectively predict IPN disappearance using participant demographics and nodule characteristics. Explainable techniques can assist clinicians in developing understandable preliminary assessments.
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Affiliation(s)
- Jingxuan Wang
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands.
| | - Nikos Sourlos
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Marjolein Heuvelmans
- Department of Epidemiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Mathias Prokop
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Peter van Ooijen
- Department of Radiation Oncology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands.
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14
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Rikhari H, Baidya Kayal E, Ganguly S, Sasi A, Sharma S, Dheeksha DS, Saini M, Rangarajan K, Bakhshi S, Kandasamy D, Mehndiratta A. Fully automatic deep learning-based lung parenchyma segmentation and boundary correction in thoracic CT scans. Int J Comput Assist Radiol Surg 2024; 19:261-272. [PMID: 37594684 DOI: 10.1007/s11548-023-03010-0] [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: 01/10/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE The proposed work aims to develop an algorithm to precisely segment the lung parenchyma in thoracic CT scans. To achieve this goal, the proposed technique utilized a combination of deep learning and traditional image processing algorithms. The initial step utilized a trained convolutional neural network (CNN) to generate preliminary lung masks, followed by the proposed post-processing algorithm for lung boundary correction. METHODS First, the proposed method trained an improved 2D U-Net CNN model with Inception-ResNet-v2 as its backbone. The model was trained on 32 CT scans from two different sources: one from the VESSEL12 grand challenge and the other from AIIMS Delhi. Further, the model's performance was evaluated on a test dataset of 16 CT scans with juxta-pleural nodules obtained from AIIMS Delhi and the LUNA16 challenge. The model's performance was assessed using evaluation metrics such as average volumetric dice coefficient (DSCavg), average IoU score (IoUavg), and average F1 score (F1avg). Finally, the proposed post-processing algorithm was implemented to eliminate false positives from the model's prediction and to include juxta-pleural nodules in the final lung masks. RESULTS The trained model reported a DSCavg of 0.9791 ± 0.008, IoUavg of 0.9624 ± 0.007, and F1avg of 0.9792 ± 0.004 on the test dataset. Applying the post-processing algorithm to the predicted lung masks obtained a DSCavg of 0.9713 ± 0.007, IoUavg of 0.9486 ± 0.007, and F1avg of 0.9701 ± 0.008. The post-processing algorithm successfully included juxta-pleural nodules in the final lung mask. CONCLUSIONS Using a CNN model, the proposed method for lung parenchyma segmentation produced precise segmentation results. Furthermore, the post-processing algorithm addressed false positives and negatives in the model's predictions. Overall, the proposed approach demonstrated promising results for lung parenchyma segmentation. The method has the potential to be valuable in the advancement of computer-aided diagnosis (CAD) systems for automatic nodule detection.
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Affiliation(s)
- Himanshu Rikhari
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Shuvadeep Ganguly
- All India Institute of Medical Sciences New Delhi, Medical Oncology, Dr. B.R.A. IRCH, New Delhi, India
| | - Archana Sasi
- All India Institute of Medical Sciences New Delhi, Medical Oncology, Dr. B.R.A. IRCH, New Delhi, India
| | - Swetambri Sharma
- All India Institute of Medical Sciences New Delhi, Medical Oncology, Dr. B.R.A. IRCH, New Delhi, India
| | - D S Dheeksha
- Radiodiagnosis, All India Institute of Medical Sciences New Delhi, New Delhi, India
| | - Manish Saini
- Radiodiagnosis, All India Institute of Medical Sciences New Delhi, New Delhi, India
| | - Krithika Rangarajan
- Radiodiagnosis, All India Institute of Medical Sciences New Delhi, Dr. B.R.A. IRCH, New Delhi, India
| | - Sameer Bakhshi
- All India Institute of Medical Sciences New Delhi, Medical Oncology, Dr. B.R.A. IRCH, New Delhi, India
| | | | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.
- Department of Biomedical Engineering, All India Institute of Medical Sciences New Delhi, New Delhi, India.
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15
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Fallahpoor M, Chakraborty S, Pradhan B, Faust O, Barua PD, Chegeni H, Acharya R. Deep learning techniques in PET/CT imaging: A comprehensive review from sinogram to image space. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107880. [PMID: 37924769 DOI: 10.1016/j.cmpb.2023.107880] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
Positron emission tomography/computed tomography (PET/CT) is increasingly used in oncology, neurology, cardiology, and emerging medical fields. The success stems from the cohesive information that hybrid PET/CT imaging offers, surpassing the capabilities of individual modalities when used in isolation for different malignancies. However, manual image interpretation requires extensive disease-specific knowledge, and it is a time-consuming aspect of physicians' daily routines. Deep learning algorithms, akin to a practitioner during training, extract knowledge from images to facilitate the diagnosis process by detecting symptoms and enhancing images. This acquired knowledge aids in supporting the diagnosis process through symptom detection and image enhancement. The available review papers on PET/CT imaging have a drawback as they either included additional modalities or examined various types of AI applications. However, there has been a lack of comprehensive investigation specifically focused on the highly specific use of AI, and deep learning, on PET/CT images. This review aims to fill that gap by investigating the characteristics of approaches used in papers that employed deep learning for PET/CT imaging. Within the review, we identified 99 studies published between 2017 and 2022 that applied deep learning to PET/CT images. We also identified the best pre-processing algorithms and the most effective deep learning models reported for PET/CT while highlighting the current limitations. Our review underscores the potential of deep learning (DL) in PET/CT imaging, with successful applications in lesion detection, tumor segmentation, and disease classification in both sinogram and image spaces. Common and specific pre-processing techniques are also discussed. DL algorithms excel at extracting meaningful features, and enhancing accuracy and efficiency in diagnosis. However, limitations arise from the scarcity of annotated datasets and challenges in explainability and uncertainty. Recent DL models, such as attention-based models, generative models, multi-modal models, graph convolutional networks, and transformers, are promising for improving PET/CT studies. Additionally, radiomics has garnered attention for tumor classification and predicting patient outcomes. Ongoing research is crucial to explore new applications and improve the accuracy of DL models in this rapidly evolving field.
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Affiliation(s)
- Maryam Fallahpoor
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Subrata Chakraborty
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia; School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351, Australia
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), School of Civil and Environmental Engineering, University of Technology Sydney, Ultimo, NSW 2007, Australia; Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | - Oliver Faust
- School of Computing and Information Science, Anglia Ruskin University Cambridge Campus, United Kingdom
| | - Prabal Datta Barua
- School of Science and Technology, Faculty of Science, Agriculture, Business and Law, University of New England, Armidale, NSW 2351, Australia; Faculty of Engineering and Information Technology, University of Technology Sydney, Australia; School of Business (Information Systems), Faculty of Business, Education, Law & Arts, University of Southern Queensland, Australia
| | | | - Rajendra Acharya
- School of Mathematics, Physics and Computing, University of Southern Queensland, Toowoomba, QLD, Australia
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16
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Hunter B, Argyros C, Inglese M, Linton-Reid K, Pulzato I, Nicholson AG, Kemp SV, L Shah P, Molyneaux PL, McNamara C, Burn T, Guilhem E, Mestas Nuñez M, Hine J, Choraria A, Ratnakumar P, Bloch S, Jordan S, Padley S, Ridge CA, Robinson G, Robbie H, Barnett J, Silva M, Desai S, Lee RW, Aboagye EO, Devaraj A. Radiomics-based decision support tool assists radiologists in small lung nodule classification and improves lung cancer early diagnosis. Br J Cancer 2023; 129:1949-1955. [PMID: 37932513 PMCID: PMC10703918 DOI: 10.1038/s41416-023-02480-y] [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: 01/18/2023] [Revised: 09/21/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Methods to improve stratification of small (≤15 mm) lung nodules are needed. We aimed to develop a radiomics model to assist lung cancer diagnosis. METHODS Patients were retrospectively identified using health records from January 2007 to December 2018. The external test set was obtained from the national LIBRA study and a prospective Lung Cancer Screening programme. Radiomics features were extracted from multi-region CT segmentations using TexLab2.0. LASSO regression generated the 5-feature small nodule radiomics-predictive-vector (SN-RPV). K-means clustering was used to split patients into risk groups according to SN-RPV. Model performance was compared to 6 thoracic radiologists. SN-RPV and radiologist risk groups were combined to generate "Safety-Net" and "Early Diagnosis" decision-support tools. RESULTS In total, 810 patients with 990 nodules were included. The AUC for malignancy prediction was 0.85 (95% CI: 0.82-0.87), 0.78 (95% CI: 0.70-0.85) and 0.78 (95% CI: 0.59-0.92) for the training, test and external test datasets, respectively. The test set accuracy was 73% (95% CI: 65-81%) and resulted in 66.67% improvements in potentially missed [8/12] or delayed [6/9] cancers, compared to the radiologist with performance closest to the mean of six readers. CONCLUSIONS SN-RPV may provide net-benefit in terms of earlier cancer diagnosis.
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Affiliation(s)
- Benjamin Hunter
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Christos Argyros
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Marianna Inglese
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Italy
| | - Kristofer Linton-Reid
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Ilaria Pulzato
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Andrew G Nicholson
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Histopathology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Samuel V Kemp
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
| | - Pallav L Shah
- Imperial College London, National Heart and Lung Institute, London, UK
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Respiratory Medicine, London, UK
| | - Philip L Molyneaux
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Respiratory Medicine, London, UK
| | - Cillian McNamara
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Toby Burn
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Emily Guilhem
- King's College Hospital, Department of Radiology, London, UK
| | | | - Julia Hine
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Anika Choraria
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Prashanthi Ratnakumar
- Imperial College London, National Heart and Lung Institute, London, UK
- St Mary's Hospital, Imperial College Healthcare Trust, Department of Respiratory Medicine, London, UK
| | - Susannah Bloch
- Imperial College London, National Heart and Lung Institute, London, UK
- St Mary's Hospital, Imperial College Healthcare Trust, Department of Respiratory Medicine, London, UK
| | - Simon Jordan
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Thoracic Surgery, London, UK
| | - Simon Padley
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Carole A Ridge
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Graham Robinson
- The Royal United Hospital, Bath, Department of Radiology, Bath, UK
| | - Hasti Robbie
- King's College Hospital, Department of Radiology, London, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, London, UK
| | - Mario Silva
- Section of "Scienze Radiologiche", Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sujal Desai
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
- Imperial College London, Margaret Turner-Warwick Centre for Fibrosing Lung Disease, London, UK
| | - Richard W Lee
- Imperial College London, National Heart and Lung Institute, London, UK
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- Early Diagnosis and Detection, Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Eric O Aboagye
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Anand Devaraj
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK.
- Imperial College London, National Heart and Lung Institute, London, UK.
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17
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Nguyen TC, Nguyen TP, Cao T, Dao TTP, Ho TN, Nguyen TV, Tran MT. MANet: Multi-branch attention auxiliary learning for lung nodule detection and segmentation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 241:107748. [PMID: 37598474 DOI: 10.1016/j.cmpb.2023.107748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary nodule detection and segmentation are currently two primary tasks in analyzing chest computed tomography (Chest CT) in order to detect signs of lung cancer, thereby providing early treatment measures to reduce mortality. Even though there are many proposed methods to reduce false positives for obtaining effective detection results, distinguishing between the pulmonary nodule and background region remains challenging because their biological characteristics are similar and varied in size. The purpose of our work is to propose a method for automatic nodule detection and segmentation in Chest CT by enhancing the feature information of pulmonary nodules. METHODS We propose a new UNet-based backbone with multi-branch attention auxiliary learning mechanism, which contains three novel modules, namely, Projection module, Fast Cascading Context module, and Boundary Enhancement module, to further enhance the nodule feature representation. Based on that, we build MANet, a lung nodule localization network that simultaneously detects and segments precise nodule positions. Furthermore, our MANet contains a Proposal Refinement step which refines initially generated proposals to effectively reduce false positives and thereby produce the segmentation quality. RESULTS Comprehensive experiments on the combination of two benchmarks LUNA16 and LIDC-IDRI show that our proposed model outperforms state-of-the-art methods in the tasks of nodule detection and segmentation tasks in terms of FROC, IoU, and DSC metrics. Our method reports an average FROC score of 88.11% in lung nodule detection. For the lung nodule segmentation, the results reach an average IoU score of 71.29% and a DSC score of 82.74%. The ablation study also shows the effectiveness of the new modules which can be integrated into other UNet-based models. CONCLUSIONS The experiments demonstrated our method with multi-branch attention auxiliary learning ability are a promising approach for detecting and segmenting the pulmonary nodule instances compared to the original UNet design.
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Affiliation(s)
- Tan-Cong Nguyen
- University of Science - VNUHCM, Ho Chi Minh City, Viet Nam; University of Social Sciences and Humanities - VNUHCM, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam
| | - Tien-Phat Nguyen
- University of Science - VNUHCM, Ho Chi Minh City, Viet Nam; John von Neumann Institute - VNUHCM, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam
| | - Tri Cao
- University of Science - VNUHCM, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam
| | - Thao Thi Phuong Dao
- University of Science - VNUHCM, Ho Chi Minh City, Viet Nam; John von Neumann Institute - VNUHCM, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam; Thong Nhat Hospital, Ho Chi Minh City, Viet Nam
| | - Thi-Ngoc Ho
- University of Social Sciences and Humanities - VNUHCM, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam
| | - Tam V Nguyen
- University of Dayton, Dayton, OH, United States.
| | - Minh-Triet Tran
- University of Science - VNUHCM, Ho Chi Minh City, Viet Nam; John von Neumann Institute - VNUHCM, Ho Chi Minh City, Viet Nam; Vietnam National University, Ho Chi Minh City, Viet Nam
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Geady C, Abbas-Aghababazadeh F, Kohan A, Schuetze S, Shultz D, Haibe-Kains B. Radiomic-Based Prediction of Lesion-Specific Systemic Treatment Response in Metastatic Disease. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23294942. [PMID: 37873411 PMCID: PMC10593058 DOI: 10.1101/2023.09.22.23294942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Despite sharing the same histologic classification, individual tumors in multi metastatic patients may present with different characteristics and varying sensitivities to anticancer therapies. In this study, we investigate the utility of radiomic biomarkers for prediction of lesion-specific treatment resistance in multi metastatic leiomyosarcoma patients. Using a dataset of n=202 lung metastases (LM) from n=80 patients with 1648 pre-treatment computed tomography (CT) radiomics features and LM progression determined from follow-up CT, we developed a radiomic model to predict the progression of each lesion. Repeat experiments assessed the relative predictive performance across LM volume groups. Lesion-specific radiomic models indicate up to a 5-fold increase in predictive capacity compared with a no-skill classifier, with an area under the precision-recall curve of 0.79 for the most precise model (FDR = 0.01). Precision varied by administered drug and LM volume. The effect of LM volume was controlled by removing radiomic features at a volume-correlation coefficient threshold of 0.20. Predicting lesion-specific responses using radiomic features represents a novel strategy by which to assess treatment response that acknowledges biological diversity within metastatic subclones, which could facilitate management strategies involving selective ablation of resistant clones in the setting of systemic therapy.
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Affiliation(s)
- Caryn Geady
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Medical Biophysics, University of Toronto, Toronto, Canada
| | | | - Andres Kohan
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Scott Schuetze
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - David Shultz
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Medical Biophysics, University of Toronto, Toronto, Canada
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Vector Institute for Artificial Intelligence, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, Toronto, Canada
| | - Benjamin Haibe-Kains
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
- Medical Biophysics, University of Toronto, Toronto, Canada
- Vector Institute for Artificial Intelligence, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
- Department of Computer Science, University of Toronto, Toronto, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, Toronto, Canada
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Kim K, Lee JH, Je Oh S, Chung MJ. AI-based computer-aided diagnostic system of chest digital tomography synthesis: Demonstrating comparative advantage with X-ray-based AI systems. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107643. [PMID: 37348439 DOI: 10.1016/j.cmpb.2023.107643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/26/2023] [Accepted: 06/03/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Compared with chest X-ray (CXR) imaging, which is a single image projected from the front of the patient, chest digital tomosynthesis (CDTS) imaging can be more advantageous for lung lesion detection because it acquires multiple images projected from multiple angles of the patient. Various clinical comparative analysis and verification studies have been reported to demonstrate this, but there is no artificial intelligence (AI)-based comparative analysis studies. Existing AI-based computer-aided detection (CAD) systems for lung lesion diagnosis have been developed mainly based on CXR images; however, CAD-based on CDTS, which uses multi-angle images of patients in various directions, has not been proposed and verified for its usefulness compared to CXR-based counterparts. BACKGROUND AND OBJECTIVE This study develops and tests a CDTS-based AI CAD system to detect lung lesions to demonstrate performance improvements compared to CXR-based AI CAD. METHODS We used multiple (e.g., five) projection images as input for the CDTS-based AI model and a single-projection image as input for the CXR-based AI model to compare and evaluate the performance between models. Multiple/single projection input images were obtained by virtual projection on the three-dimensional (3D) stack of computed tomography (CT) slices of each patient's lungs from which the bed area was removed. These multiple images result from shooting from the front and left and right 30/60∘. The projected image captured from the front was used as the input for the CXR-based AI model. The CDTS-based AI model used all five projected images. The proposed CDTS-based AI model consisted of five AI models that received images in each of the five directions, and obtained the final prediction result through an ensemble of five models. Each model used WideResNet-50. To train and evaluate CXR- and CDTS-based AI models, 500 healthy data, 206 tuberculosis data, and 242 pneumonia data were used, and three three-fold cross-validation was applied. RESULTS The proposed CDTS-based AI CAD system yielded sensitivities of 0.782 and 0.785 and accuracies of 0.895 and 0.837 for the (binary classification) performance of detecting tuberculosis and pneumonia, respectively, against normal subjects. These results show higher performance than the sensitivity of 0.728 and 0.698 and accuracies of 0.874 and 0.826 for detecting tuberculosis and pneumonia through the CXR-based AI CAD, which only uses a single projection image in the frontal direction. We found that CDTS-based AI CAD improved the sensitivity of tuberculosis and pneumonia by 5.4% and 8.7% respectively, compared to CXR-based AI CAD without loss of accuracy. CONCLUSIONS This study comparatively proves that CDTS-based AI CAD technology can improve performance more than CXR. These results suggest that we can enhance the clinical application of CDTS. Our code is available at https://github.com/kskim-phd/CDTS-CAD-P.
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Affiliation(s)
- Kyungsu Kim
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
| | - Ju Hwan Lee
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Seong Je Oh
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
| | - Myung Jin Chung
- Medical AI Research Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Republic of Korea; Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
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20
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Weckbach S, Wielpütz MO, von Stackelberg O. [Patient-centered, value-based management of incidental findings in radiology]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:657-664. [PMID: 37566128 DOI: 10.1007/s00117-023-01200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
As a byproduct of the increased use of high-resolution radiological imaging, the prevalence of incidental findings (IFs) has been increasing for years. The discovery of an incidental finding can allow early treatment of a potentially health-threatening disease and thus decisively change the course of the disease. However, many incidental findings are of low risk with little or no health impact, and yet their discovery often leads to a cascade of additional investigations. It is undisputed that incidental findings can have a direct impact on the life of the person and that not only psychosocial aspects such as worries and anxiety due to false-positive findings play a role, but that insurance, legal or professional problems can also occur under certain circumstances, which is why the correct handling of incidental findings and the accompanying ethical challenges that apply to them regularly give rise to discussions. General principles to consider when managing incidental findings are responsibility for the well-being of the patient/study participant and of society. In order to avoid overdiagnosis and overtreatment and to achieve high patient benefit, radiologists and clinicians must know how to properly deal with IFs. In recent years, various national and international societies have published important guidelines ("white papers") on how to deal with the management of IFs. It is important that radiologists are fully aware of and follow these guidelines and are also available to referring physicians for further discussions and advice. The most important fact is that the well-being of the patient must always be at the center of all decisions.
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Affiliation(s)
- Sabine Weckbach
- Research & Development, Pharmaceuticals, Radiology, Diagnostic Imaging, Data and AI Research-General Clinical Imaging Services (GCIS), Bayer AG, 13353, Berlin, Deutschland.
- University Hospital Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Deutschland.
| | - Mark O Wielpütz
- University Hospital Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Deutschland
- German Center for Lung Research (DZL), Translational Lung Research Center (TLRC) Heidelberg, Heidelberg, Deutschland
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Deutschland
| | - Oyunbileg von Stackelberg
- University Hospital Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Deutschland
- German Center for Lung Research (DZL), Translational Lung Research Center (TLRC) Heidelberg, Heidelberg, Deutschland
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Deutschland
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Baidya Kayal E, Ganguly S, Sasi A, Sharma S, DS D, Saini M, Rangarajan K, Kandasamy D, Bakhshi S, Mehndiratta A. A proposed methodology for detecting the malignant potential of pulmonary nodules in sarcoma using computed tomographic imaging and artificial intelligence-based models. Front Oncol 2023; 13:1212526. [PMID: 37671060 PMCID: PMC10476362 DOI: 10.3389/fonc.2023.1212526] [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] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
The presence of lung metastases in patients with primary malignancies is an important criterion for treatment management and prognostication. Computed tomography (CT) of the chest is the preferred method to detect lung metastasis. However, CT has limited efficacy in differentiating metastatic nodules from benign nodules (e.g., granulomas due to tuberculosis) especially at early stages (<5 mm). There is also a significant subjectivity associated in making this distinction, leading to frequent CT follow-ups and additional radiation exposure along with financial and emotional burden to the patients and family. Even 18F-fluoro-deoxyglucose positron emission technology-computed tomography (18F-FDG PET-CT) is not always confirmatory for this clinical problem. While pathological biopsy is the gold standard to demonstrate malignancy, invasive sampling of small lung nodules is often not clinically feasible. Currently, there is no non-invasive imaging technique that can reliably characterize lung metastases. The lung is one of the favored sites of metastasis in sarcomas. Hence, patients with sarcomas, especially from tuberculosis prevalent developing countries, can provide an ideal platform to develop a model to differentiate lung metastases from benign nodules. To overcome the lack of optimal specificity of CT scan in detecting pulmonary metastasis, a novel artificial intelligence (AI)-based protocol is proposed utilizing a combination of radiological and clinical biomarkers to identify lung nodules and characterize it as benign or metastasis. This protocol includes a retrospective cohort of nearly 2,000-2,250 sample nodules (from at least 450 patients) for training and testing and an ambispective cohort of nearly 500 nodules (from 100 patients; 50 patients each from the retrospective and prospective cohort) for validation. Ground-truth annotation of lung nodules will be performed using an in-house-built segmentation tool. Ground-truth labeling of lung nodules (metastatic/benign) will be performed based on histopathological results or baseline and/or follow-up radiological findings along with clinical outcome of the patient. Optimal methods for data handling and statistical analysis are included to develop a robust protocol for early detection and classification of pulmonary metastasis at baseline and at follow-up and identification of associated potential clinical and radiological markers.
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Affiliation(s)
- Esha Baidya Kayal
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Shuvadeep Ganguly
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Archana Sasi
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Swetambri Sharma
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dheeksha DS
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Manish Saini
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Krithika Rangarajan
- Radiodiagnosis, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Sameer Bakhshi
- Medical Oncology, Dr. B.R.Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, Delhi, India
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22
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Li R, Zhou L, Wang Y, Shan F, Chen X, Liu L. A graph neural network model for the diagnosis of lung adenocarcinoma based on multimodal features and an edge-generation network. Quant Imaging Med Surg 2023; 13:5333-5348. [PMID: 37581061 PMCID: PMC10423350 DOI: 10.21037/qims-23-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/09/2023] [Indexed: 08/16/2023]
Abstract
Background Lung cancer is a global disease with high lethality, with early screening being considerably helpful for improving the 5-year survival rate. Multimodality features in early screening imaging are an important part of the prediction for lung adenocarcinoma, and establishing a model for adenocarcinoma diagnosis based on multimodal features is an obvious clinical need. Through our practice and investigation, we found that graph neural networks (GNNs) are excellent platforms for multimodal feature fusion, and the data can be completed using the edge-generation network. Therefore, we propose a new lung adenocarcinoma multiclassification model based on multimodal features and an edge-generation network. Methods According to a ratio of 80% to 20%, respectively, the dataset of 338 cases was divided into the training set and the test set through 5-fold cross-validation, and the distribution of the 2 sets was the same. First, the regions of interest (ROIs) cropped from computed tomography (CT) images were separately fed into convolutional neural networks (CNNs) and radiomics processing platforms. The results of the 2 parts were then input into a graph embedding representation network to obtain the fused feature vectors. Subsequently, a graph database based on the clinical and semantic features was established, and the data were supplemented by an edge-generation network, with the fused feature vectors being used as the input of the nodes. This enabled us to clearly understand where the information transmission of the GNN takes place and improves the interpretability of the model. Finally, the nodes were classified using GNNs. Results On our dataset, the proposed method presented in this paper achieved superior results compared to traditional methods and showed some comparability with state-of-the-art methods for lung nodule classification. The results of our method are as follows: accuracy (ACC) =66.26% (±4.46%), area under the curve (AUC) =75.86% (±1.79%), F1-score =64.00% (±3.65%), and Matthews correlation coefficient (MCC) =48.40% (±5.07%). The model with the edge-generating network consistently outperformed the model without it in all aspects. Conclusions The experiments demonstrate that with appropriate data=construction methods GNNs can outperform traditional image processing methods in the field of CT-based medical image classification. Additionally, our model has higher interpretability, as it employs subjective clinical and semantic features as the data construction approach. This will help doctors better leverage human-computer interactions.
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Affiliation(s)
- Ruihao Li
- Academy for Engineering & Technology, Fudan University, Shanghai, China
| | - Lingxiao Zhou
- Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Yunpeng Wang
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Fei Shan
- Shanghai Public Health Clinical Center and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Xinrong Chen
- Academy for Engineering & Technology, Fudan University, Shanghai, China
| | - Lei Liu
- Academy for Engineering & Technology, Fudan University, Shanghai, China
- Intelligent Medicine Institute, Fudan University, Shanghai, China
- Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai, China
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23
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Salman R, Nguyen HN, Sher AC, Hallam KA, Seghers VJ, Sammer MBK. Diagnostic performance of artificial intelligence for pediatric pulmonary nodule detection in computed tomography of the chest. Clin Imaging 2023; 101:50-55. [PMID: 37301051 DOI: 10.1016/j.clinimag.2023.05.019] [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: 02/10/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE To test the performance of a commercially available adult pulmonary nodule detection artificial intelligence (AI) tool in pediatric CT chests. METHODS 30 consecutive chest CTs with or without contrast of patients ages 12-18 were included. Images were retrospectively reconstructed at 3 mm and 1 mm slice thickness. AI for detection of lung nodules in adults (Syngo CT Lung Computer Aided Detection (CAD)) was evaluated. 3 mm axial images were retrospectively reviewed by two pediatric radiologists (reference read) who determined the location, type, and size of nodules. Lung CAD results at 3 mm and 1 mm slice thickness were compared to reference read by two other pediatric radiologists. Sensitivity (Sn) and positive predictive value (PPV) were analyzed. RESULTS The radiologists identified 109 nodules. At 1 mm, CAD detected 70 nodules; 43 true positive (Sn = 39 %), 26 false positive (PPV = 62 %), and 1 nodule which had not been identified by radiologists. At 3 mm, CAD detected 60 nodules; 28 true positive (Sn = 26 %), 30 false positive (PPV = 48 %) and 2 nodules which had not been identified by radiologists. There were 103 solid nodules (47 measuring < 3 mm) and 6 subsolid nodules (5 measuring < 5 mm). When excluding 52 nodules (solid < 3 mm and subsolid < 5 mm) based on algorithm conditions, the Sn increased to 68 % at 1 mm and 49 % at 3 mm but there was no significant change in the PPV measuring 60 % at 1 mm and 48 % at 3 mm. CONCLUSION The adult Lung CAD showed low sensitivity in pediatric patients, but better performance at thinner slice thickness and when smaller nodules were excluded.
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Affiliation(s)
- Rida Salman
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - HaiThuy N Nguyen
- Department of Radiology, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew C Sher
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | | | - Victor J Seghers
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Marla B K Sammer
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
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24
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Yao Y, Wang X, Guan J, Xie C, Zhang H, Yang J, Luo Y, Chen L, Zhao M, Huo B, Yu T, Lu W, Liu Q, Du H, Liu Y, Huang P, Luan T, Liu W, Hu Y. Metabolomic differentiation of benign vs malignant pulmonary nodules with high specificity via high-resolution mass spectrometry analysis of patient sera. Nat Commun 2023; 14:2339. [PMID: 37095081 PMCID: PMC10126054 DOI: 10.1038/s41467-023-37875-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
Differential diagnosis of pulmonary nodules detected by computed tomography (CT) remains a challenge in clinical practice. Here, we characterize the global metabolomes of 480 serum samples including healthy controls, benign pulmonary nodules, and stage I lung adenocarcinoma. The adenocarcinoma demonstrates a distinct metabolomic signature, whereas benign nodules and healthy controls share major similarities in metabolomic profiles. A panel of 27 metabolites is identified in the discovery cohort (n = 306) to distinguish between benign and malignant nodules. The discriminant model achieves an AUC of 0.915 and 0.945 in the internal validation (n = 104) and external validation cohort (n = 111), respectively. Pathway analysis reveals elevation in glycolytic metabolites associated with decreased tryptophan in serum of lung adenocarcinoma vs benign nodules and healthy controls, and demonstrates that uptake of tryptophan promotes glycolysis in lung cancer cells. Our study highlights the value of the serum metabolite biomarkers in risk assessment of pulmonary nodules detected by CT screening.
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Affiliation(s)
- Yao Yao
- Sate Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, 510275, Guangdong, China
| | - Xueping Wang
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Chuanbo Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Hui Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
- Metabolomics Research Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jing Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Yao Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Mingyue Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Bitao Huo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
- Metabolomics Research Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Tiantian Yu
- Metabolomics Research Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Wenhua Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Qiao Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Hongli Du
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Yuying Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Peng Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
- Metabolomics Research Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Tiangang Luan
- Sate Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-sen University, Guangzhou, 510275, Guangdong, China.
- Institute of Environmental and Ecological Engineering, Guangdong University of Technology, Guangzhou, 510006, Guangdong, China.
| | - Wanli Liu
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China.
| | - Yumin Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China.
- Metabolomics Research Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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Bianconi F, Fravolini ML, Palumbo B. Size measurement of lung nodules on CT: which diameter is most stable to inter-observer variability? Clin Imaging 2023; 99:38-40. [PMID: 37060680 DOI: 10.1016/j.clinimag.2023.03.018] [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: 11/17/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 04/17/2023]
Abstract
Indeterminate lung nodules detected on CT are common findings in the clinical practice, and the correct assessment of their size is critical for patient evaluation and management. We compared the stability of three definitions of nodule diameter (Feret's mean diameter, Martin's mean diameter and area-equivalent diameter) to inter-observer variability on a population of 336 solid nodules from 207 subjects. We found that inter-observer agreement was highest with Martin's mean diameter (intra-class correlation coefficient = 0.977, 95% Confidence interval = 0.977-0.978), followed by area-equivalent diameter (0.972, 0.971-0.973) and Feret's mean diameter (0.965, 0.964-0.966). The differences were statistically significant. In conclusion, although all the three diameter definitions achieved very good inter-observer agreement (ICC > 0.96), Martin's mean diameter was significantly better than the others. Future guidelines may consider adopting Martin's mean diameter as an alternative to the currently used Feret's (caliper) diameter for assessing the size of lung nodules on CT.
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Affiliation(s)
- Francesco Bianconi
- Department of Engineering, Università degli Studi di Perugia, Via Goffredo Duranti, 93 - 06125 Perugia, Italy.
| | - Mario Luca Fravolini
- Department of Engineering, Università degli Studi di Perugia, Via Goffredo Duranti, 93 - 06125 Perugia, Italy
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery, Università degli Studi di Perugia, Piazzale Gambuli, 1 - 06129 Perugia, Italy
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O’Hern JA, Koenen A, Janson S, Hajkowicz KM, Robertson IK, Kidd SE, Baird RW, Tong SYC, Davis JS, Carson P, Currie BJ, Ralph AP. Epidemiology, management and outcomes of Cryptococcus gattii infections: A 22-year cohort. PLoS Negl Trop Dis 2023; 17:e0011162. [PMID: 36877729 PMCID: PMC10019644 DOI: 10.1371/journal.pntd.0011162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/16/2023] [Accepted: 02/12/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Cryptococcus gattii is a globally endemic pathogen causing disease in apparently immune-competent hosts. We describe a 22-year cohort study from Australia's Northern Territory to evaluate trends in epidemiology and management, and outcome predictors. METHODS A retrospective cohort study of all C. gattii infections at the northern Australian referral hospital 1996-2018 was conducted. Cases were defined as confirmed (culture-positive) or probable. Demographic, clinical and outcome data were extracted from medical records. RESULTS 45 individuals with C. gattii infection were included: 44 Aboriginal Australians; 35 with confirmed infection; none HIV positive out of 38 tested. Multifocal disease (pulmonary and central nervous system) occurred in 20/45 (44%). Nine people (20%) died within 12 months of diagnosis, five attributed directly to C. gattii. Significant residual disability was evident in 4/36 (11%) survivors. Predictors of mortality included: treatment before the year 2002 (4/11 versus 1/34); interruption to induction therapy (2/8 versus 3/37) and end-stage kidney disease (2/5 versus 3/40). Prolonged antifungal therapy was the standard approach in this cohort, with median treatment duration being 425 days (IQR 166-715). Ten individuals had adjunctive lung resection surgery for large pulmonary cryptococcomas (median diameter 6cm [range 2.2-10cm], versus 2.8cm [1.2-9cm] in those managed non-operatively). One died post-operatively, and 7 had thoracic surgical complications, but ultimately 9/10 (90%) treated surgically were cured compared with 10/15 (67%) who did not have lung surgery. Four patients were diagnosed with immune reconstitution inflammatory syndrome which was associated with age <40 years, brain cryptococcomas, high cerebrospinal fluid pressure, and serum cryptococcal antigen titre >1:512. CONCLUSION C. gattii infection remains a challenging condition but treatment outcomes have significantly improved over 2 decades, with eradication of infection the norm. Adjunctive surgery for the management of bulky pulmonary C. gattii infection appears to increase the likelihood of durable cure and likely reduces the required duration of antifungal therapy.
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Affiliation(s)
- Jennifer A. O’Hern
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- * E-mail: (APR); (JAO)
| | - Adrian Koenen
- Department of General Surgery, Royal Darwin Hospital, Darwin, Australia
| | - Sonja Janson
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | | | - Iain K. Robertson
- College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Sarah E. Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, Australia
| | - Robert W. Baird
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Department of Health, Darwin, Australia
| | - Steven YC Tong
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joshua S. Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Phillip Carson
- Department of General Surgery, Royal Darwin Hospital, Darwin, Australia
| | - Bart J. Currie
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Anna P. Ralph
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- * E-mail: (APR); (JAO)
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Contextualizing the Role of Volumetric Analysis in Pulmonary Nodule Assessment: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 220:314-329. [PMID: 36129224 DOI: 10.2214/ajr.22.27830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pulmonary nodules are managed on the basis of their size and morphologic characteristics. Radiologists are familiar with assessing nodule size by measuring diameter using manually deployed electronic calipers. Size may also be assessed with 3D volumetric measurements (referred to as volumetry) obtained with software. Nodule size and growth are more accurately assessed with volumetry than on the basis of diameter, and the evidence supporting clinical use of volumetry has expanded, driven by its use in lung cancer screening nodule management algorithms in Europe. The application of volumetry has the potential to reduce recommendations for imaging follow-up of indeterminate solid nodules without impacting cancer detection. Although changes in scanning conditions and volumetry software packages can lead to variation in volumetry results, ongoing technical advances have improved the reliability of calculated volumes. Volumetry is now the primary method for determining size of solid nodules in the European lung cancer screening position statement and British Thoracic Society recommendations. The purposes of this article are to review technical aspects, advantages, and limitations of volumetry and, by considering specific scenarios, to contextualize the use of volumetry with respect to its importance in morphologic evaluation, its role in predicting malignancy in risk models, and its practical impact on nodule management. Implementation challenges and areas requiring further evidence are also highlighted.
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Sanchez F, Tyrrell PN, Cheung P, Heyn C, Graham S, Poon I, Ung Y, Louie A, Tsao M, Oikonomou A. Detection of solid and subsolid pulmonary nodules with lung MRI: performance of UTE, T1 gradient-echo, and single-shot T2 fast spin echo. Cancer Imaging 2023; 23:17. [PMID: 36793094 PMCID: PMC9933280 DOI: 10.1186/s40644-023-00531-4] [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: 12/19/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Although MRI is a radiation-free imaging modality, it has historically been limited in lung imaging due to inherent technical restrictions. The aim of this study is to explore the performance of lung MRI in detecting solid and subsolid pulmonary nodules using T1 gradient-echo (GRE) (VIBE, Volumetric interpolated breath-hold examination), ultrashort time echo (UTE) and T2 Fast Spin Echo (HASTE, Half fourier Single-shot Turbo spin-Echo). METHODS Patients underwent a lung MRI in a 3 T scanner as part of a prospective research project. A baseline Chest CT was obtained as part of their standard of care. Nodules were identified and measured on the baseline CT and categorized according to their density (solid and subsolid) and size (> 4 mm/ ≤ 4 mm). Nodules seen on the baseline CT were classified as present or absent on the different MRI sequences by two thoracic radiologists independently. Interobserver agreement was determined using the simple Kappa coefficient. Paired differences were compared using nonparametric Mann-Whitney U tests. The McNemar test was used to evaluate paired differences in nodule detection between MRI sequences. RESULTS Thirty-six patients were prospectively enrolled. One hundred forty-nine nodules (100 solid/49 subsolid) with mean size 10.8 mm (SD = 9.4) were included in the analysis. There was substantial interobserver agreement (k = 0.7, p = 0.05). Detection for all nodules, solid and subsolid nodules was respectively; UTE: 71.8%/71.0%/73.5%; VIBE: 61.6%/65%/55.1%; HASTE 72.4%/72.2%/72.7%. Detection rate was higher for nodules > 4 mm in all groups: UTE 90.2%/93.4%/85.4%, VIBE 78.4%/88.5%/63.4%, HASTE 89.4%/93.8%/83.8%. Detection of lesions ≤4 mm was low for all sequences. UTE and HASTE performed significantly better than VIBE for detection of all nodules and subsolid nodules (diff = 18.4 and 17.6%, p = < 0.01 and p = 0.03, respectively). There was no significant difference between UTE and HASTE. There were no significant differences amongst MRI sequences for solid nodules. CONCLUSIONS Lung MRI shows adequate performance for the detection of solid and subsolid pulmonary nodules larger than 4 mm and can serve as a promising radiation-free alternative to CT.
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Affiliation(s)
- Felipe Sanchez
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Pascal N. Tyrrell
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, Department of Statistical Sciences, Institute of Medical Science, University of Toronto, 263 McCaul Street, Toronto, Ontario M5T 1WT Canada
| | - Patrick Cheung
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Chinthaka Heyn
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Simon Graham
- grid.17063.330000 0001 2157 2938Physical Sciences Platform of Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Ian Poon
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Yee Ung
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Alexander Louie
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - May Tsao
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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Modak S, Abdel-Raheem E, Rueda L. Applications of Deep Learning in Disease Diagnosis of Chest Radiographs: A Survey on Materials and Methods. BIOMEDICAL ENGINEERING ADVANCES 2023. [DOI: 10.1016/j.bea.2023.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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He L, Meng Y, Zhong J, Tang L, Chui C, Zhang J. Preoperative path planning algorithm for lung puncture biopsy based on path constraint and multidimensional space distance optimization. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hunter B, Chen M, Ratnakumar P, Alemu E, Logan A, Linton-Reid K, Tong D, Senthivel N, Bhamani A, Bloch S, Kemp SV, Boddy L, Jain S, Gareeboo S, Rawal B, Doran S, Navani N, Nair A, Bunce C, Kaye S, Blackledge M, Aboagye EO, Devaraj A, Lee RW. A radiomics-based decision support tool improves lung cancer diagnosis in combination with the Herder score in large lung nodules. EBioMedicine 2022; 86:104344. [PMID: 36370635 PMCID: PMC9664396 DOI: 10.1016/j.ebiom.2022.104344] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Large lung nodules (≥15 mm) have the highest risk of malignancy, and may exhibit important differences in phenotypic or clinical characteristics to their smaller counterparts. Existing risk models do not stratify large nodules well. We aimed to develop and validate an integrated segmentation and classification pipeline, incorporating deep-learning and traditional radiomics, to classify large lung nodules according to cancer risk. METHODS 502 patients from five U.K. centres were recruited to the large-nodule arm of the retrospective LIBRA study between July 2020 and April 2022. 838 CT scans were used for model development, split into training and test sets (70% and 30% respectively). An nnUNet model was trained to automate lung nodule segmentation. A radiomics signature was developed to classify nodules according to malignancy risk. Performance of the radiomics model, termed the large-nodule radiomics predictive vector (LN-RPV), was compared to three radiologists and the Brock and Herder scores. FINDINGS 499 patients had technically evaluable scans (mean age 69 ± 11, 257 men, 242 women). In the test set of 252 scans, the nnUNet achieved a DICE score of 0.86, and the LN-RPV achieved an AUC of 0.83 (95% CI 0.77-0.88) for malignancy classification. Performance was higher than the median radiologist (AUC 0.75 [95% CI 0.70-0.81], DeLong p = 0.03). LN-RPV was robust to auto-segmentation (ICC 0.94). For baseline solid nodules in the test set (117 patients), LN-RPV had an AUC of 0.87 (95% CI 0.80-0.93) compared to 0.67 (95% CI 0.55-0.76, DeLong p = 0.002) for the Brock score and 0.83 (95% CI 0.75-0.90, DeLong p = 0.4) for the Herder score. In the international external test set (n = 151), LN-RPV maintained an AUC of 0.75 (95% CI 0.63-0.85). 18 out of 22 (82%) malignant nodules in the Herder 10-70% category in the test set were identified as high risk by the decision-support tool, and may have been referred for earlier intervention. INTERPRETATION The model accurately segments and classifies large lung nodules, and may improve upon existing clinical models. FUNDING This project represents independent research funded by: 1) Royal Marsden Partners Cancer Alliance, 2) the Royal Marsden Cancer Charity, 3) the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, 4) the National Institute for Health Research (NIHR) Biomedical Research Centre at Imperial College London, 5) Cancer Research UK (C309/A31316).
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Affiliation(s)
- Benjamin Hunter
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK; Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Mitchell Chen
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Prashanthi Ratnakumar
- Department of Respiratory Medicine, Charing Cross Hospital, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Esubalew Alemu
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Andrew Logan
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Kristofer Linton-Reid
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Daniel Tong
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Nishanthi Senthivel
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Amyn Bhamani
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK
| | - Susannah Bloch
- Department of Respiratory Medicine, Charing Cross Hospital, Imperial College Healthcare Trust, Fulham Palace Road, London, W6 8RF, UK
| | - Samuel V Kemp
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Foundation Trust, Hucknall Road, Nottingham, NG5 1PB, UK
| | - Laura Boddy
- Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Sejal Jain
- Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - Shafick Gareeboo
- Department of Respiratory Medicine, Queen Elizabeth Hospital, Stadium Road, Woolwich, London, SE18 4QH, UK
| | - Bhavin Rawal
- Department of Radiology, The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK
| | - Simon Doran
- CRUK Cancer Imaging Centre, The Institute of Cancer Research, Cotswold Road, Sutton, SM2 5NG, UK
| | - Neal Navani
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospitals NHS Foundation Trust, Euston Road, London, NW1 2BU, UK
| | - Catey Bunce
- Clinical Trials Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Stan Kaye
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
| | - Matthew Blackledge
- Computational Imaging Group, The Institute of Cancer Research, Cotswold Road, Sutton, SM2 5NG, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Anand Devaraj
- Department of Radiology, The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK
| | - Richard W Lee
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK; Early Diagnosis and Detection Centre, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK.
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Computer-Aided Diagnosis of Pulmonary Nodules in Rheumatoid Arthritis. Life (Basel) 2022; 12:life12111935. [PMID: 36431070 PMCID: PMC9697803 DOI: 10.3390/life12111935] [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: 11/03/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Rheumatoid arthritis (RA) is considered a systemic inflammatory pathology characterized by symmetric polyarthritis associated with extra-articular manifestations, such as lung disease. The purpose of the present study is to use CAD in the detection of rheumatoid pulmonary nodules. In addition, we aim to identify the characteristics and associations between clinical, laboratory and imaging data in patients with rheumatoid arthritis and lung nodules. (2) Methods: The study included a number of 42 patients diagnosed with rheumatoid arthritis according to the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria, examined from January 2017 to November 2022 in the Departments of Rheumatology and Radiology and Medical Imaging of the University of Medicine and Pharmacy of Craiova. Medical records were reviewed. A retrospective blinded review of CT for biopsy-proven pulmonary nodules in RA using Veolity LungCAD software was performed (MeVis Medical Solutions AG, Bremen, Germany). Imaging was also reviewed by a senior radiologist. (3) Results: The interobserver agreement proved to be moderate (κ = 0.478) for the overall examined cases. CAD interpretation resulted in false positive results in the case of 12 lung nodules, whereas false negative results were reported in the case of 8 lung nodules. The mean time it took for the detection of lung nodules using CAD was 4.2 min per patient, whereas the detection of lung nodules by the radiologist was 8.1 min per patient. This resulted in a faster interpretation of lung CT scans, almost reducing the detection time by half (p < 0.001). (4) Conclusions: The CAD software is useful in identifying lung nodules, in shortening the interpretation time of the CT examination and also in aiding the radiologist in better assessing all the pulmonary lung nodules. However, the CAD software cannot replace the human eye yet due to the relative high rate of false positive and false negative results.
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Schmid-Bindert G, Vogel-Claussen J, Gütz S, Fink J, Hoffmann H, Eichhorn ME, Herth FJ. Incidental Pulmonary Nodules - What Do We Know in 2022. Respiration 2022; 101:1024-1034. [PMID: 36228594 PMCID: PMC9945197 DOI: 10.1159/000526818] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
Lung cancer (LC) is the leading cause of cancer-related mortality worldwide, and early LC diagnosis can significantly improve outcomes and survival rates in affected patients. Implementation of LC screening programs using low-dose computed tomography CT in high-risk subjects aims to detect LC as early as possible, but so far, adoption of screening programs into routine clinical care has been very slow. In recent years, the use of CT has significantly increased the rate of incidentally detected pulmonary nodules. Although most of those incidental pulmonary nodules (IPNs) are benign, some of them represent early-stage LC. Given the large number of IPNs detected in the range of several millions each year, this represents an additional, maybe even larger, opportunity to drive stage shift in LC diagnosis, next to LC screening programs. Comprehensive evaluation and targeted work-up of IPNs are mandatory to identify the malignant nodules from the crowd, and several guidelines provide radiologists and physicians' guidance on IPN assessment and management. However, IPNs still seem to be inadequately processed due to various reasons including insufficient reporting in the radiological report, missing communication between stakeholders, absence of patient tracking systems, and uncertainty regarding responsibilities for the IPN management. In recent years, several approaches such as lung nodule programs, patient tracking software, artificial intelligence, and communication software were introduced into clinical practice to address those shortcomings. This review evaluates the current situation of IPN management and highlights recent developments in process improvement to achieve first steps toward stage shift in LC diagnosis.
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Affiliation(s)
- Gerald Schmid-Bindert
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany,AstraZeneca GmbH, Hamburg, Germany,*Gerald Schmid-Bindert,
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover, Germany
| | - Sylvia Gütz
- Department of Pneumology, Cardiology, Endocrinology, Diabetology and General Internal Medicine, Sankt Elisabeth Hospital, Leipzig, Germany
| | | | - Hans Hoffmann
- Section for Thoracic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Martin E. Eichhorn
- Department of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Felix J.F. Herth
- Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany,Department of Pulmonology, and Critical Care Medicine, Thoraxklinik Universitätsklinikum Heidelberg, Heidelberg, Germany
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Russ DH, Barta JA, Evans NR, Stapp RT, Kane GC. Volume Doubling Time of Pulmonary Carcinoid Tumors Measured by Computed Tomography. Clin Lung Cancer 2022; 23:e453-e459. [PMID: 35922364 DOI: 10.1016/j.cllc.2022.06.006] [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: 03/21/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Pulmonary carcinoid tumor (PCT) is a rare neuroendocrine lung neoplasm comprising approximately 2% of lung cancer diagnoses. It is classified as either localized low-grade (typical) or intermediate-grade (atypical) subtypes. PCT is known clinically to be a slow-growing cancer, however few studies have established its true growth rate when followed over time by computed tomography (CT). Therefore, we sought to determine the volume doubling time for PCTs as visualized on CT imaging. MATERIALS AND METHODS We conducted a retrospective analysis of all PCTs treated at our institution between 2006 and 2020. Nodule dimensions were measured using a Picture Archiving and Communication System or retrieved from radiology reports. Volume doubling time was calculated using the Schwartz formula for PCTs followed by successive CT scans during radiographic surveillance. Consistent with Fleischner Society guidelines, tumors were considered to have demonstrated definitive growth by CT only when the interval change in tumor diameter was greater than or equal to 2 mm. RESULTS The median volume doubling time of 13 typical PCTs was 977 days, or 2.7 years. Five atypical PCTs were followed longitudinally, with a median doubling time of 327 days, or 0.9 years. CONCLUSIONS Typical pulmonary carcinoid features a remarkably slow growth rate as compared to more common lung cancers. Our analysis of atypical pulmonary carcinoid included too few cases to offer definitive conclusions. It is conceivable that clinicians following current nodule surveillance guidelines may mistake incidentally detected typical carcinoids for benign non-growing lesions when followed for less than 2 years in low-risk patients.
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Affiliation(s)
- Douglas H Russ
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Julie A Barta
- Division of Pulmonary, Allergy and Critical Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Nathaniel R Evans
- Division of Thoracic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Robert T Stapp
- Department of Pathology, Anatomy, and Cell Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Gregory C Kane
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Philadelphia, PA
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Prediction of Lung Nodule Progression with an Uncertainty-Aware Hierarchical Probabilistic Network. Diagnostics (Basel) 2022; 12:diagnostics12112639. [DOI: 10.3390/diagnostics12112639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Predicting whether a lung nodule will grow, remain stable or regress over time, especially early in its follow-up, would help doctors prescribe personalized treatments and better surgical planning. However, the multifactorial nature of lung tumour progression hampers the identification of growth patterns. In this work, we propose a deep hierarchical generative and probabilistic network that, given an initial image of the nodule, predicts whether it will grow, quantifies its future size and provides its expected semantic appearance at a future time. Unlike previous solutions, our approach also estimates the uncertainty in the predictions from the intrinsic noise in medical images and the inter-observer variability in the annotations. The evaluation of this method on an independent test set reported a future tumour growth size mean absolute error of 1.74 mm, a nodule segmentation Dice’s coefficient of 78% and a tumour growth accuracy of 84% on predictions made up to 24 months ahead. Due to the lack of similar methods for providing future lung tumour growth predictions, along with their associated uncertainty, we adapted equivalent deterministic and alternative generative networks (i.e., probabilistic U-Net, Bayesian test dropout and Pix2Pix). Our method outperformed all these methods, corroborating the adequacy of our approach.
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Zaharudin N, Jailaini MFM, Abeed NNN, Ng BH, Ban AYL, Imree M, Zakaria R, Zakaria SZS, Hamid MFA. Prevalence and clinical characteristics of malignant lung nodules in tuberculosis endemic area in a single tertiary centre. BMC Pulm Med 2022; 22:328. [PMID: 36038853 PMCID: PMC9422142 DOI: 10.1186/s12890-022-02125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung nodule management remains a challenge to clinicians, especially in endemic tuberculosis areas. Different guidelines are available with various recommendations; however, the suitability of these guidelines for the Asian population is still unclear. Our study described the prevalence of malignant lung nodules among nodules measuring 2-30 mm, the demographic and characteristics of lung nodules between benign and malignant groups, and the clinician's clinical practice in managing lung nodules. METHOD Retrospective review of lung nodules from the computed tomography archiving and communication system (PACS) database and clinical data from January 2019 to January 2022. The data was analysed by using chi square, mann whitney test and simple logistic regression. RESULTS There were 288 nodules measuring 2-30 mm identified; 49 nodules underwent biopsy. Twenty-seven (55%) biopsied nodules were malignant, (prevalence of 9.4%). Among the malignant lung nodules, 74% were adenocarcinoma (n = 20). The commonest benign nodules were granuloma n = 12 (55%). In nodules > 8 mm, the median age of malignant and benign was 72 ± 12 years and 66 ± 16 years, respectively (p = 0.024). There was a significant association of benign nodules (> 8 mm) in subjects with previous or concurrent tuberculosis (p = 0.008). Benign nodules are also associated with nodule size ≤ 8 mm, without spiculation (p < 0.001) and absence of emphysema (p = 0.007). The nodule size and the presence of spiculation are factors to make the clinicians proceed with tissue biopsy. Spiculated nodules and increased nodule size had 11 and 13 times higher chances of undergoing biopsy respectively (p < 0.001).) Previous history of tuberculosis had a 0.874 reduced risk of progression to malignant lung nodules (p = 0.013). These findings implied that these three factors are important risk factors for malignant lung nodules. There was no mortality association between benign and malignant. Using Brock's probability of malignancy, nodules ≤ 8 mm had a low probability of malignancy. CONCLUSION The prevalence of malignant lung nodules in our centre was comparatively lower than non-Asian countries. Older age, the presence of emphysema, and spiculation are associated with malignancy. Clinical judgment is of utmost importance in managing these patients. Fleishner guideline is still being used as a reference by our clinician.
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Affiliation(s)
- Norsyuhada Zaharudin
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mas Fazlin Mohamad Jailaini
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Nik Nuratiqah Nik Abeed
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Boon Hau Ng
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Andrea Yu-Lin Ban
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mohd Imree
- Radiology Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Rozman Zakaria
- Radiology Department, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Mohamed Faisal Abdul Hamid
- Respiratory Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
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Liu F, Dai L, Wang Y, Liu M, Wang M, Zhou Z, Qi Y, Chen R, OuYang S, Fan Q. Derivation and validation of a prediction model for patients with lung nodules malignancy regardless of mediastinal/hilar lymphadenopathy. J Surg Oncol 2022; 126:1551-1559. [PMID: 35993806 DOI: 10.1002/jso.27072] [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: 03/05/2022] [Revised: 06/15/2022] [Accepted: 08/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Clinical prediction models to classify lung nodules often exclude patients with mediastinal/hilar lymphadenopathy, although the presence of mediastinal/hilar lymphadenopathy does not always indicate malignancy. Herein, we developed and validated a multimodal prediction model for lung nodules in which patients with mediastinal/hilar lymphadenopathy were included. METHODS A single-center retrospective study was conducted. We developed and validated a logistic regression model including patients with mediastinal/hilar lymphadenopathy. Discrimination of the model was assessed by area under the operating curve. Goodness of fit test was performed via the Hosmer-Lemeshow test, and a nomogram of the logistic regression model was drawn. RESULTS There were 311 cases included in the final analysis. A logistic regression model was developed and validated. There were nine independent variables included in the model. The aera under the curve (AUC) of the validation set was 0.91 (95% confidence interval [CI]: 0.85-0.98). In the validation set with mediastinal/hilar lymphadenopathy, the AUC was 0.95 (95% CI: 0.90-0.99). The goodness-of-fit test was 0.22. CONCLUSIONS We developed and validated a multimodal risk prediction model for lung nodules with excellent discrimination and calibration, regardless of mediastinal/hilar lymphadenopathy. This broadens the application of lung nodule prediction models. Furthermore, mediastinal/hilar lymphadenopathy added value for predicting lung nodule malignancy in clinical practice.
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Affiliation(s)
- Fenghui Liu
- Department of Respiratory and Sleep Medicine in the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Liping Dai
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Yulin Wang
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Man Liu
- Henan Institute of Medical and Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Meng Wang
- Department of Imaging and Nuclear Medicine in the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhigang Zhou
- Department of Imaging and Nuclear Medicine in the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Yu Qi
- Department of Thoracic Surgery in the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Ruiying Chen
- Department of Respiratory and Sleep Medicine in the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Songyun OuYang
- Department of Respiratory and Sleep Medicine in the First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China
| | - Qingxia Fan
- Department of Oncology in the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Gao Z, Wang X, Zuo T, Zhang M, Zhang Z. A predictive nomogram for lymph node metastasis in part-solid invasive lung adenocarcinoma: A complement to the IASLC novel grading system. Front Oncol 2022; 12:916889. [PMID: 36046052 PMCID: PMC9423719 DOI: 10.3389/fonc.2022.916889] [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: 04/10/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background The International Association for the Study of Lung Cancer (IASLC) proposed a novel grading system for invasive lung adenocarcinoma, but lymphatic invasion was not evaluated. Meanwhile, the scope of lymph node dissection in part-solid invasive lung adenocarcinoma (PSILA) is still controversial. Therefore, this study aims to explore preoperative risk factors for lymph node metastasis in PSILA, to provide reference for intraoperative dissection of lymph nodes. Methods From 2018 to 2020, clinical data of patients (stage cN0) consecutively diagnosed as PSILA were retrospectively analyzed and classified according to the novel grading system. Logistic regression was conducted to screen the clinicopathological factors of lymph node metastasis in PSILA. Results A large cohort of 960 patients with PSILA who underwent lobectomy or sub-lobectomy were enrolled. By logistic regression analyses, solid part size, bronchial cutoff sign, spiculation, and carbohydrate antigen 199 (CA199) were eventually identified as independent risk factors for lymph node metastasis, based on which a nomogram was built to preoperatively predict the risk of lymph node metastasis [area under the receiver operating characteristic curve (AUC)=0.858; concordance index = 0.857; best cutoff, 0.027]. This suggests that intraoperative systematic lymph node dissection is recommended when the predicted risk value exceeds 0.027. Reproducibility of the novel grading system was verified. Conclusions The novel IASLC grading system was applicative in real world. The nomogram for preoperative prediction of lymph node metastasis may provide reference for the lymph node dissection strategy during PSILA surgeries.
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Affiliation(s)
- Zhaoming Gao
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Thoracic Surgery, Binzhou People’s Hospital Affiliated to Shandong First Medical University, Binzhou, China
| | - Xiaofei Wang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Tao Zuo
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Thoracic Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, China
| | - Mengzhe Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhenfa Zhang
- Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- *Correspondence: Zhenfa Zhang,
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Possible Bias in Supervised Deep Learning Algorithms for CT Lung Nodule Detection and Classification. Cancers (Basel) 2022; 14:cancers14163867. [PMID: 36010861 PMCID: PMC9405732 DOI: 10.3390/cancers14163867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Artificial Intelligence (AI) algorithms can assist clinicians in their daily tasks by automatically detecting and/or classifying nodules in chest CT scans. Bias of such algorithms is one of the reasons why implementation of them in clinical practice is still not widely adopted. There is no published review on the bias that these algorithms may contain. This review aims to present different types of bias in such algorithms and present possible ways to mitigate them. Only then it would be possible to ensure that these algorithms work as intended under many different clinical settings. Abstract Artificial Intelligence (AI) algorithms for automatic lung nodule detection and classification can assist radiologists in their daily routine of chest CT evaluation. Even though many AI algorithms for these tasks have already been developed, their implementation in the clinical workflow is still largely lacking. Apart from the significant number of false-positive findings, one of the reasons for that is the bias that these algorithms may contain. In this review, different types of biases that may exist in chest CT AI nodule detection and classification algorithms are listed and discussed. Examples from the literature in which each type of bias occurs are presented, along with ways to mitigate these biases. Different types of biases can occur in chest CT AI algorithms for lung nodule detection and classification. Mitigation of them can be very difficult, if not impossible to achieve completely.
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Bianconi F, Palumbo I, Fravolini ML, Rondini M, Minestrini M, Pascoletti G, Nuvoli S, Spanu A, Scialpi M, Aristei C, Palumbo B. Form Factors as Potential Imaging Biomarkers to Differentiate Benign vs. Malignant Lung Lesions on CT Scans. SENSORS (BASEL, SWITZERLAND) 2022; 22:5044. [PMID: 35808538 PMCID: PMC9269784 DOI: 10.3390/s22135044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 06/15/2023]
Abstract
Indeterminate lung nodules detected on CT scans are common findings in clinical practice. Their correct assessment is critical, as early diagnosis of malignancy is crucial to maximise the treatment outcome. In this work, we evaluated the role of form factors as imaging biomarkers to differentiate benign vs. malignant lung lesions on CT scans. We tested a total of three conventional imaging features, six form factors, and two shape features for significant differences between benign and malignant lung lesions on CT scans. The study population consisted of 192 lung nodules from two independent datasets, containing 109 (38 benign, 71 malignant) and 83 (42 benign, 41 malignant) lung lesions, respectively. The standard of reference was either histological evaluation or stability on radiological followup. The statistical significance was determined via the Mann-Whitney U nonparametric test, and the ability of the form factors to discriminate a benign vs. a malignant lesion was assessed through multivariate prediction models based on Support Vector Machines. The univariate analysis returned four form factors (Angelidakis compactness and flatness, Kong flatness, and maximum projection sphericity) that were significantly different between the benign and malignant group in both datasets. In particular, we found that the benign lesions were on average flatter than the malignant ones; conversely, the malignant ones were on average more compact (isotropic) than the benign ones. The multivariate prediction models showed that adding form factors to conventional imaging features improved the prediction accuracy by up to 14.5 pp. We conclude that form factors evaluated on lung nodules on CT scans can improve the differential diagnosis between benign and malignant lesions.
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Affiliation(s)
- Francesco Bianconi
- Department of Engineering, Università degli Studi di Perugia, Via Goffredo Duranti 93, 06125 Perugia, Italy;
| | - Isabella Palumbo
- Section of Radiation Oncology, Department of Medicine and Surgery, Università degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (I.P.); (C.A.)
| | - Mario Luca Fravolini
- Department of Engineering, Università degli Studi di Perugia, Via Goffredo Duranti 93, 06125 Perugia, Italy;
| | - Maria Rondini
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, Università degli Studi di Sassari, Viale San Pietro 8, 07100 Sassari, Italy; (M.R.); (S.N.); (A.S.)
| | - Matteo Minestrini
- Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery, Università degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (M.M.); (B.P.)
| | - Giulia Pascoletti
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Torino, Italy;
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, Università degli Studi di Sassari, Viale San Pietro 8, 07100 Sassari, Italy; (M.R.); (S.N.); (A.S.)
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, Università degli Studi di Sassari, Viale San Pietro 8, 07100 Sassari, Italy; (M.R.); (S.N.); (A.S.)
| | - Michele Scialpi
- Division of Diagnostic Imaging, Department of Medicine and Surgery, Piazza Lucio Severi 1, 06132 Perugia, Italy;
| | - Cynthia Aristei
- Section of Radiation Oncology, Department of Medicine and Surgery, Università degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (I.P.); (C.A.)
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery, Università degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy; (M.M.); (B.P.)
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Antunes MDS, Hochhegger B, Alves GRT, Gazzoni FF, Forte GC, Andrade RGF, Felicetti JC. Postoperative computed tomography of insufflated lung specimens obtained by video-assisted thoracic surgery: detection and margin assessment of pulmonary nodules. Radiol Bras 2022; 55:151-155. [PMID: 35795601 PMCID: PMC9254709 DOI: 10.1590/0100-3984.2021.0046] [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: 07/18/2021] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the utility of computed tomography (CT) scans to detect and
assess the margin status of pulmonary nodules that were insufflated after
being resected by video-assisted thoracic surgery. Materials and Methods This was a novel multicenter study conducted at two national referral centers
for thoracic diseases. Patients suspected of having lung cancer underwent
video-assisted thoracic surgery for the resection of pulmonary nodules,
which were submitted to postoperative CT. Measurements from the CT scans
were compared with the results of the histopathological analysis. Results A total of 37 pulmonary nodules from 37 patients were evaluated. The mean age
of the patients was 65 years (range, 36-84 years), and 27 (73%) were female.
A CT analysis of insufflated specimens identified all 37 nodules, and 33 of
those nodules were found to have tumor-free margins. The histopathological
analysis revealed lung cancer in 30 of the nodules, all with tumor-free
margins, and benign lesions in the seven remaining nodules. Conclusion Postoperative CT of insufflated suspicious lung lesions provides real-time
detection of pulmonary nodules and satisfactory assessment of tumor margins.
This initial study shows that CT of insufflated lung lesions can be a
valuable tool at centers where intraoperative histopathological analysis is
unavailable.
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Affiliation(s)
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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A Cost-Effective and Non-Invasive pfeRNA-Based Test Differentiates Benign and Suspicious Pulmonary Nodules from Malignant Ones. Noncoding RNA 2021; 7:ncrna7040080. [PMID: 34940762 PMCID: PMC8709422 DOI: 10.3390/ncrna7040080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 12/19/2022] Open
Abstract
The ability to differentiate between benign, suspicious, and malignant pulmonary nodules is imperative for definitive intervention in patients with early stage lung cancers. Here, we report that plasma protein functional effector sncRNAs (pfeRNAs) serve as non-invasive biomarkers for determining both the existence and the nature of pulmonary nodules in a three-stage study that included the healthy group, patients with benign pulmonary nodules, patients with suspicious nodules, and patients with malignant nodules. Following the standards required for a clinical laboratory improvement amendments (CLIA)-compliant laboratory-developed test (LDT), we identified a pfeRNA classifier containing 8 pfeRNAs in 108 biospecimens from 60 patients by sncRNA deep sequencing, deduced prediction rules using a separate training cohort of 198 plasma specimens, and then applied the prediction rules to another 230 plasma specimens in an independent validation cohort. The pfeRNA classifier could (1) differentiate patients with or without pulmonary nodules with an average sensitivity and specificity of 96.2% and 97.35% and (2) differentiate malignant versus benign pulmonary nodules with an average sensitivity and specificity of 77.1% and 74.25%. Our biomarkers are cost-effective, non-invasive, sensitive, and specific, and the qPCR-based method provides the possibility for automatic testing of robotic applications.
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Balagurunathan Y, Beers A, McNitt-Gray M, Hadjiiski L, Napel S, Goldgof D, Perez G, Arbelaez P, Mehrtash A, Kapur T, Yang E, Moon JW, Bernardino G, Delgado-Gonzalo R, Farhangi MM, Amini AA, Ni R, Feng X, Bagari A, Vaidhya K, Veasey B, Safta W, Frigui H, Enguehard J, Gholipour A, Castillo LS, Daza LA, Pinsky P, Kalpathy-Cramer J, Farahani K. Lung Nodule Malignancy Prediction in Sequential CT Scans: Summary of ISBI 2018 Challenge. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:3748-3761. [PMID: 34264825 PMCID: PMC9531053 DOI: 10.1109/tmi.2021.3097665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Lung cancer is by far the leading cause of cancer death in the US. Recent studies have demonstrated the effectiveness of screening using low dose CT (LDCT) in reducing lung cancer related mortality. While lung nodules are detected with a high rate of sensitivity, this exam has a low specificity rate and it is still difficult to separate benign and malignant lesions. The ISBI 2018 Lung Nodule Malignancy Prediction Challenge, developed by a team from the Quantitative Imaging Network of the National Cancer Institute, was focused on the prediction of lung nodule malignancy from two sequential LDCT screening exams using automated (non-manual) algorithms. We curated a cohort of 100 subjects who participated in the National Lung Screening Trial and had established pathological diagnoses. Data from 30 subjects were randomly selected for training and the remaining was used for testing. Participants were evaluated based on the area under the receiver operating characteristic curve (AUC) of nodule-wise malignancy scores generated by their algorithms on the test set. The challenge had 17 participants, with 11 teams submitting reports with method description, mandated by the challenge rules. Participants used quantitative methods, resulting in a reporting test AUC ranging from 0.698 to 0.913. The top five contestants used deep learning approaches, reporting an AUC between 0.87 - 0.91. The team's predictor did not achieve significant differences from each other nor from a volume change estimate (p =.05 with Bonferroni-Holm's correction).
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Affiliation(s)
| | | | | | | | - Sandy Napel
- Dept. of Radiology, School of Medicine, Stanford University (SU), CA
| | | | - Gustavo Perez
- Biomedical computer vision lab (BCV), Universidad de los Andes, Colombia
| | - Pablo Arbelaez
- Biomedical computer vision lab (BCV), Universidad de los Andes, Colombia
| | - Alireza Mehrtash
- Robotics and Control Laboratory (RCL), Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC
- Surgical Planning Laboratory (SPL), Radiology Department, Brigham and Women’s Hospital, Boston, MA, 02130
| | - Tina Kapur
- Surgical Planning Laboratory (SPL), Radiology Department, Brigham and Women’s Hospital, Boston, MA, 02130
| | - Ehwa Yang
- Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Won Moon
- Human Medical Imaging & Intervention Center, Seoul 06524, Korea
| | - Gabriel Bernardino
- Centre Suisse d’Électronique et de Microtechnique, Neuchâtel, Switzerland
| | | | - M. Mehdi Farhangi
- Medical Imaging Laboratory, University of Louisville, Louisville, KY. USA
- Computer Engineering and Computer Science, University of Louisville
| | - Amir A. Amini
- Medical Imaging Laboratory, University of Louisville, Louisville, KY. USA
- Electrical and Computer Engineering Department, University of Louisville, Louisville, KY. USA
| | | | - Xue Feng
- Spingbok Inc
- Department of Biomedical Engineering, University of Virginia, Charlottesville
| | | | | | - Benjamin Veasey
- Medical Imaging Laboratory, University of Louisville, Louisville, KY. USA
- Electrical and Computer Engineering Department, University of Louisville, Louisville, KY. USA
| | - Wiem Safta
- Computer Engineering and Computer Science, University of Louisville
| | - Hichem Frigui
- Computer Engineering and Computer Science, University of Louisville
| | - Joseph Enguehard
- Department of Radiology, Boston Children’s Hospital, and Harvard Medical School
| | - Ali Gholipour
- Department of Radiology, Boston Children’s Hospital, and Harvard Medical School
| | | | - Laura Alexandra Daza
- Department of Biomedical Engineering, Universidad de los Andes, Bogota, Colombia
| | - Paul Pinsky
- Divsion of Cancer Prevention, National Cancer Institute (NCI), Washington DC
| | | | - Keyvan Farahani
- Center for Biomedical Informatics and Information Technology, National Cancer Institute (NCI), Washington DC
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Lian KH, Liu WD, Lin MW, Hsu HH, Tsai TM, Tsou KC, Chen YC, Chen JS. Undiagnosed solitary caseating granulomas: Is lung resection surgery a feasible method for diagnosis and treatment? J Formos Med Assoc 2021; 121:896-902. [PMID: 34740492 DOI: 10.1016/j.jfma.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 06/01/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In many patients, low-dose computed tomography (CT) screening for lung cancer reveals asymptomatic pulmonary nodules. Lung resection surgery may be indicated in these patients; however, distinguishing malignancies from benign lesions preoperatively can be challenging. METHODS From 2013 to 2018, 4181 patients undergoing surgery for pulmonary nodules were reviewed at National Taiwan University Hospital, and 837 were diagnosed with benign pathologies. Only patients with pathological diagnosis as caseating granulomatous inflammation were included, sixty-nine patients were then analyzed for preoperative clinical and imaging characteristics, surgical methods and complications, pathogens, medical treatment and outcomes. Mycobacterial evidence was obtained from the culture of respiratory or surgical specimen. RESULTS Overall, 68% of the patients were asymptomatic before surgery. More than half of the nodules were in the upper lobes, and all patients underwent video-assisted thoracoscopic surgery (VATS). Some patients (14.5%) developed grade I complications, and the mean postoperative hospital stay was 4 days. The final pathology reports of 20% benign entities postoperatively, and caseating granulomatous inflammation accounted for a significant part. MTB and NTM were cultured from one-fourth of the patients respectively. All patients with confirmed MTB infection received antimycobacterial treatment, while the medical treatment in NTM-infected patients was decided by the infectious disease specialists. The mean follow-up period was 736 days, and no recurrence was found. CONCLUSION Lung resection surgery is an aggressive but safe and feasible method for diagnosing MTB- or NTM-associated pulmonary nodules, and, potentially, an effective therapeutic tool for patients with undiagnosed MTB- or NTM-associated pulmonary nodules.
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Affiliation(s)
- Kuan-Hsun Lian
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Wang-Da Liu
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Hsao-Hsun Hsu
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Tung-Ming Tsai
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan, No. 57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan
| | - Kuan-Chuan Tsou
- National Taiwan University College of Medicine Graduate Institute of Clinical Medicine, No. 7, Chung-Shan South Road, Taipei, Taiwan; Department of Surgery, Taipei City Hospital, Zhongxiao Branch, No.145, Zhengzhou Rd., Datong Dist., Taipei, Taiwan.
| | - Yee-Chun Chen
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Cancer Center, Taipei, Taiwan, No. 57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan
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Cha MJ, Ahn HS, Choi H, Park HJ, Benkert T, Pfeuffer J, Paek MY. Accelerated Stack-of-Spirals Free-Breathing Three-Dimensional Ultrashort Echo Time Lung Magnetic Resonance Imaging: A Feasibility Study in Patients With Breast Cancer. Front Oncol 2021; 11:746059. [PMID: 34692529 PMCID: PMC8529215 DOI: 10.3389/fonc.2021.746059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the clinical feasibility of accelerated free-breathing stack-of-spirals (spiral) three-dimensional (3D) ultrashort echo time (UTE) lung magnetic resonance imaging (MRI) using iterative self‐consistent parallel imaging reconstruction from arbitrary k‐space (SPIRiT) algorithm in patients with breast cancer. Methods The institutional review board approved this prospective study and patients’ informed consents were obtained. Between June and August 2018, 29 female patients with breast cancer underwent 3-T MRI including accelerated free-breathing spiral 3D UTE (0.98-mm isotropic spatial resolution; echo time, 0.05 msec) of the lungs and thin-section chest computed tomography (CT). Two radiologists evaluated the image quality and pulmonary nodules on MRI were assessed and compared, CT as a reference. Results The pulmonary vessels and bronchi were visible consistently up to the sub-sub-segmental and sub-segmental branch levels, respectively, on accelerated spiral 3D UTE. The overall image quality was evaluated as good and excellent for 70.7% of accelerated spiral 3D UTE images (reviewer [R]1, 72.4% [21/29]; R2, 69.0% [20/29]) and acceptable for 20.7% (both R1 and R2, 20.7% [6/29]). Five patients on CT revealed 141 pulmonary metastatic nodules (5.3 ± 2.6 mm); the overall nodule detection rate of accelerated spiral 3D UTE was sensitivity of 90.8% (128/141), accuracy of 87.7%, and positive predictive value of 96.2%. In the Bland-Altman plot analysis comparing nodule size between CT and MRI, 132/141 nodules (93.6%) were inside the limits of agreement. Conclusion Accelerated free-breathing spiral 3D UTE using the SPIRiT algorithm could be a potential alternative to CT for oncology patients.
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Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyewon Choi
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyun Jeong Park
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
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Franck C, Snoeckx A, Spinhoven M, El Addouli H, Nicolay S, Van Hoyweghen A, Deak P, Zanca F. PULMONARY NODULE DETECTION IN CHEST CT USING A DEEP LEARNING-BASED RECONSTRUCTION ALGORITHM. RADIATION PROTECTION DOSIMETRY 2021; 195:158-163. [PMID: 33723584 DOI: 10.1093/rpd/ncab025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 06/12/2023]
Abstract
This study's aim was to assess whether deep learning image reconstruction (DLIR) techniques are non-inferior to ASIR-V for the clinical task of pulmonary nodule detection in chest computed tomography. Up to 6 (range 3-6, mean 4.2) artificial lung nodules (diameter: 3, 5, 8 mm; density: -800, -630, +100 HU) were inserted at different locations in the Kyoto Kagaku Lungman phantom. In total, 16 configurations (10 abnormal, 6 normal) were scanned at 7.6, 3, 1.6 and 0.38 mGy CTDIvol (respectively 0, 60, 80 and 95% dose reduction). Images were reconstructed using 50% ASIR-V and a deep learning-based algorithm with low (DL-L), medium (DL-M) and high (DL-H) strength. Four chest radiologists evaluated 256 series by locating and scoring nodules on a five-point scale. No statistically significant difference was found among the reconstruction algorithms (p = 0.987, average across readers AUC: 0.555, 0.561, 0.557, 0.558 for ASIR-V, DL-L, DL-M, DL-H).
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Affiliation(s)
- C Franck
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - A Snoeckx
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - M Spinhoven
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - H El Addouli
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - S Nicolay
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - A Van Hoyweghen
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- mVISION, Faculty of Medicine and Health Sciences, University of Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - P Deak
- GE Healthcare, Glattbrugg, Switzerland
| | - F Zanca
- Palindromo Consulting, Leuven, Belgium
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Horry M, Chakraborty S, Pradhan B, Paul M, Gomes D, Ul-Haq A, Alamri A. Deep Mining Generation of Lung Cancer Malignancy Models from Chest X-ray Images. SENSORS 2021; 21:s21196655. [PMID: 34640976 PMCID: PMC8513105 DOI: 10.3390/s21196655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/28/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
Lung cancer is the leading cause of cancer death and morbidity worldwide. Many studies have shown machine learning models to be effective in detecting lung nodules from chest X-ray images. However, these techniques have yet to be embraced by the medical community due to several practical, ethical, and regulatory constraints stemming from the “black-box” nature of deep learning models. Additionally, most lung nodules visible on chest X-rays are benign; therefore, the narrow task of computer vision-based lung nodule detection cannot be equated to automated lung cancer detection. Addressing both concerns, this study introduces a novel hybrid deep learning and decision tree-based computer vision model, which presents lung cancer malignancy predictions as interpretable decision trees. The deep learning component of this process is trained using a large publicly available dataset on pathological biomarkers associated with lung cancer. These models are then used to inference biomarker scores for chest X-ray images from two independent data sets, for which malignancy metadata is available. Next, multi-variate predictive models were mined by fitting shallow decision trees to the malignancy stratified datasets and interrogating a range of metrics to determine the best model. The best decision tree model achieved sensitivity and specificity of 86.7% and 80.0%, respectively, with a positive predictive value of 92.9%. Decision trees mined using this method may be considered as a starting point for refinement into clinically useful multi-variate lung cancer malignancy models for implementation as a workflow augmentation tool to improve the efficiency of human radiologists.
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Affiliation(s)
- Michael Horry
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Sydney, NSW 2007, Australia;
- IBM Australia Ltd., Sydney, NSW 2000, Australia
| | - Subrata Chakraborty
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Sydney, NSW 2007, Australia;
- Correspondence: (S.C.); (B.P.)
| | - Biswajeet Pradhan
- Centre for Advanced Modelling and Geospatial Information Systems (CAMGIS), Faculty of Engineering and IT, University of Technology Sydney, Sydney, NSW 2007, Australia;
- Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia
- Correspondence: (S.C.); (B.P.)
| | - Manoranjan Paul
- Machine Vision and Digital Health (MaViDH), School of Computing and Mathematics, Charles Sturt University, Bathurst, NSW 2795, Australia; (M.P.); (D.G.); (A.U.-H.)
| | - Douglas Gomes
- Machine Vision and Digital Health (MaViDH), School of Computing and Mathematics, Charles Sturt University, Bathurst, NSW 2795, Australia; (M.P.); (D.G.); (A.U.-H.)
| | - Anwaar Ul-Haq
- Machine Vision and Digital Health (MaViDH), School of Computing and Mathematics, Charles Sturt University, Bathurst, NSW 2795, Australia; (M.P.); (D.G.); (A.U.-H.)
| | - Abdullah Alamri
- Department of Geology and Geophysics, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
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Hou H, Yu S, Xu Z, Zhang H, Liu J, Zhang W. Prediction of malignancy for solitary pulmonary nodules based on imaging, clinical characteristics and tumor marker levels. Eur J Cancer Prev 2021; 30:382-388. [PMID: 33284149 PMCID: PMC8322042 DOI: 10.1097/cej.0000000000000637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To establish a prediction model of malignancy for solitary pulmonary nodules (SPNs) on the basis of imaging, clinical characteristics and tumor marker levels. METHODS Totally, 341 cases of SPNs were enrolled in this retrospective study, in which 70% were selected as the training group (n = 238) and the rest 30% as the verification group (n = 103). The imaging, clinical characteristics and tumor marker levels of patients with benign and malignant SPNs were compared. Influencing factors were identified using multivariate logistic regression analysis. The model was assessed by the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS Differences were evident between patients with benign and malignant SPNs in age, gender, smoking history, carcinoembryonic antigen (CEA), neuron-specific enolase, nodule location, edge smoothing, spiculation, lobulation, vascular convergence sign, air bronchogram, ground-glass opacity, vacuole sign and calcification (all P < 0.05). Influencing factors for malignancy included age, gender, nodule location, spiculation, vacuole sign and CEA (all P < 0.05). The established model was as follows: Y = -5.368 + 0.055 × age + 1.012 × gender (female = 1, male = 0) + 1.302 × nodule location (right upper lobe = 1, others = 0) + 1.208 × spiculation (yes = 1, no = 0) + 2.164 × vacuole sign (yes = 1, no = 0) -0.054 × CEA. The AUC of the model with CEA was 0.818 (95% confidence interval, 0.763-0.865), with a sensitivity of 64.80% and a specificity of 84.96%, and the stability was better through internal verification. CONCLUSIONS The prediction model established in our study exhibits better accuracy and internal stability in predicting the probability of malignancy for SPNs.
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Affiliation(s)
- Hongjun Hou
- Imaging Department, Weihai Central Hospital, Weihai, Shandong, China
| | - Shui Yu
- Imaging Department, Weihai Central Hospital, Weihai, Shandong, China
| | - Zushan Xu
- Imaging Department, Weihai Central Hospital, Weihai, Shandong, China
| | - Hongsheng Zhang
- Imaging Department, Weihai Central Hospital, Weihai, Shandong, China
| | - Jie Liu
- Imaging Department, Weihai Central Hospital, Weihai, Shandong, China
| | - Wenjun Zhang
- Imaging Department, Weihai Central Hospital, Weihai, Shandong, China
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Zhang X, Cheung C, Cheng K, Yang Z, Zhu W, Chao W, Lam S, Cao Y, Li M. [Lung Cancer Screening Study in Macao Smoking Individuals]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:548-556. [PMID: 34412767 PMCID: PMC8387649 DOI: 10.3779/j.issn.1009-3419.2021.101.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
背景与目的 中国澳门肺癌发病率逐年上升,吸烟人群是肺癌的高发人群,本研究旨在了解中国澳门长期吸烟人群的肺癌发病情况及胸部低剂量计算机断层扫描(low-dose computed tomography, LDCT)肺结节特点。 方法 通过澳门中华医学会会员私家医生推荐及宣传招募中国澳门无症状长期吸烟人士,行胸部LDCT检查,分析肺癌、肺部结节检出率及影像学特点。 结果 符合纳入条件者291例,检出肺癌10例,检出率3.44%(95%CI: 2.78%-4.01%),其中,肺腺癌5例,鳞癌、小细胞肺癌各2例,腺鳞癌1例。早期肺癌4例,占40%。212例检出肺结节,肺结节总检出率72.9%(95%CI: 67.8%-78.0%); 疑似肺癌结节44例,检出率15.1%(95%CI: 11.0%-19.2%)。单发结节51例,无肺癌检出; 多发结节161例,检出肺癌9例,两组肺癌检出率无统计学差异(P > 0.05)。 < 6 mm实性结节与 < 5 mm非实性结节组168例,未检出肺癌; ≥6 mm实性结节与≥5 mm非实性结节组44例,检出肺癌9例,两组比较有统计学差异(P < 0.05)。 结论 长期吸烟人群中肺癌检出率高,类型以腺癌为主,肺部结节发生率高,当实性结节≥6 mm或非实性结节≥5 mm时,肺癌检出率增高。建议在符合高危因素的男性吸烟人群中推行胸部LDCT筛查肺癌,女性肺癌筛查,应重新界定高危因素。
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Affiliation(s)
| | | | - Kun Cheng
- Respiratory Medicine, Kiangwu Hospital, Macao, China
| | | | - Weiguo Zhu
- Thoracic Surgery, Kiangwu Hospital, Macao, China
| | - Waiman Chao
- Health Management Center, Kiangwu Hospital, Macao, China
| | | | - Yabing Cao
- Oncology Department, Kiangwu Hospital, Macao, China
| | - Mu Li
- Respiratory Medicine, Kiangwu Hospital, Macao, China
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Park YJ, Choi D, Choi JY, Hyun SH. Performance Evaluation of a Deep Learning System for Differential Diagnosis of Lung Cancer With Conventional CT and FDG PET/CT Using Transfer Learning and Metadata. Clin Nucl Med 2021; 46:635-640. [PMID: 33883488 DOI: 10.1097/rlu.0000000000003661] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to evaluate the performance of a deep learning system for differential diagnosis of lung cancer with conventional CT and FDG PET/CT using transfer learning (TL) and metadata. METHODS A total of 359 patients with a lung mass or nodule who underwent noncontrast chest CT and FDG PET/CT prior to treatment were enrolled retrospectively. All pulmonary lesions were classified by pathology (257 malignant, 102 benign). Deep learning classification models based on ResNet-18 were developed using the pretrained weights obtained from ImageNet data set. We propose a deep TL model for differential diagnosis of lung cancer using CT imaging data and metadata with SUVmax and lesion size derived from PET/CT. The area under the receiver operating characteristic curve (AUC) of the deep learning model was measured as a performance metric and verified by 5-fold cross-validation. RESULTS The performance metrics of the conventional CT model were generally better than those of the CT of PET/CT model. Introducing metadata with SUVmax and lesion size derived from PET/CT into baseline CT models improved the diagnostic performance of the CT of PET/CT model (AUC = 0.837 vs 0.762) and the conventional CT model (AUC = 0.877 vs 0.817). CONCLUSIONS Deep TL models with CT imaging data provide good diagnostic performance for lung cancer, and the conventional CT model showed overall better performance than the CT of PET/CT model. Metadata information derived from PET/CT can improve the performance of deep learning systems.
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Affiliation(s)
| | - Dongmin Choi
- Department of Computer Science, Yonsei University, Seoul, South Korea
| | - Joon Young Choi
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Seung Hyup Hyun
- From the Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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