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Size Measurement and Segmentectomy Resection Margin of Early-Stage Lung Adenocarcinoma Manifesting on Virtual 3D Imagery and Pathology: A Pilot Correlation Study. J Clin Med 2022; 11:jcm11206155. [PMID: 36294475 PMCID: PMC9605571 DOI: 10.3390/jcm11206155] [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: 09/06/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 12/24/2022] Open
Abstract
Background: The objective of our study was to assess if 3D reconstructed images could be extrapolated to reflect pathologies, as evaluated by early-stage lung adenocarcinoma tumor size and simulated segmentectomy resection margin. Methods: Retrospectively selected patients (n = 18) who underwent segmentectomy at Changhua Christian Hospital between 2012 and 2018 and then had pulmonary 3D reconstruction using Ziostation2 were included in our study. Tumor size and simulated segmentectomy resection distance on a 3D model were measure and compared to pathology. Results: Both tumor size and segmentectomy resection margin showed positive correlations between 3D image measurements and pathological measurements. The resection margin showed a stronger correlation and was beneficial in pre-operative planning. Conclusions: A 3D reconstructed model aided understanding of pulmonary anatomy, prompting confidence in surgical approaches and ensured segmentectomy outcome success. Regardless of age and pulmonary function, 3D simulation can accurately mimic segmentectomy, making it a simple, effective and feasible pre-operative planning tool.
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Yin J, Xi J, Liang J, Zhan C, Jiang W, Lin Z, Xu S, Wang Q. Solid Components in the Mediastinal Window of Computed Tomography Define a Distinct Subtype of Subsolid Nodules in Clinical Stage I Lung Cancers. Clin Lung Cancer 2021; 22:324-331. [PMID: 33789831 DOI: 10.1016/j.cllc.2021.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to validate the clinicopathologic characteristics and prognostic value of the presence of solid components in the mediastinal window of computed tomography scan in clinical stage I pulmonary subsolid nodules (SSNs). METHODS We retrospectively evaluated patients with pulmonary SSNs resected between 2011 and 2016. We classified SSNs into heterogeneous ground-glass nodules (HGGNs) (solid component detected only in lung window) and part-solid nodules (PSNs) (solid component detected both in lung/mediastinal windows). RESULTS A total of 487 patients (216 PSNs) were included. PSNs were associated with higher frequencies of micropapillary or solid pathologic patterns (18.1% vs. 3.3%; P < .001), epidermal growth factor receptor gene mutation (39.4% vs. 32.8%), and other types of gene mutations (2.3% vs. 1.1%; P = .043). Logistic regression analysis revealed that male sex (odds ratio [OR], 2.58; 95% confidence interval [CI], 1.20-5.57; P = .016) and higher consolidation tumor ratio (CTR) (OR, 110.04; 95% CI, 8.56-1414.39; P < .001) remained independent for invasive adenocarcinomas with poor differentiation. Receiver operating characteristic analyses revealed that solid component size in the mediastinal window (area under the curve [AUC], 0.731; 95% CI, 0.653-0.808; P < .0001) showed a better predictive ability to poor differentiation compared with solid component size in the lung window and CTR. The 5-year recurrence-free survival (RFS) rate of PSNs was worse than that of HGGNs (94.6% vs. 99.1%; P = .019). Multivariate Cox regression revealed that positive lymph node status (hazard ratio, 22.99; 95% CI, 4.52-116.86; P < .001) indicated worse RFS for PSNs. CONCLUSION SSNs with solid components in mediastinal window demonstrated clinicopathologic and prognostic features different from those without in clinical stage I lung cancer. Solid components in mediastinal window was a strong predictor of poor differentiation.
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Affiliation(s)
- Jiacheng Yin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjie Xi
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Liang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Cheng Zhan
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Jiang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zongwu Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Songtao Xu
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qun Wang
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Park CH, Kim TH, Lee S, Moon DH, Park HS. Correlation between maximal tumor diameter of fresh pathology specimens and computed tomography images in lung adenocarcinoma. PLoS One 2019; 14:e0211141. [PMID: 30682110 PMCID: PMC6347433 DOI: 10.1371/journal.pone.0211141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/08/2019] [Indexed: 02/08/2023] Open
Abstract
The authors compared maximal tumor diameters between fresh lung tissue and axial and multiplanar reformatted chest computed-tomography (CT) images in lung adenocarcinoma and investigated the factors affecting tumor-size discrepancies. This study included 135 surgically resected lung adenocarcinomas. An experienced pulmonary pathologist aimed to cut the largest tumor section and measured pathological tumor size (PTS) in fresh specimens. Radiological maximal tumor sizes (RTS) were retrospectively measured on axial (RTSax) and multiplanar reformatted (RTSre) chest CT images. Mean PTS, RTSax, and RTSre were 19.13 mm, 18.63 mm, and 20.80 mm, respectively. RTSre was significantly larger than PTS (mean difference, 1.68 mm; p<0.001). RTSax was also greater than PTS for 6−10-mm and 11−20-mm tumors. PTS and RTS were strongly positively correlated (RTSax, r2 = 0.719, p<0.001; RTSre, r2 = 0.833, p<0.001). The intraclass correlation coefficient was 0.915 between PTS and RTSax and 0.954 between PTS and RTSre. Postoperative down-staging occurred in 11.0% and 27.4% of tumors on performing radiological staging using RTSax and RTSre, respectively. Postoperative up-staging occurred in 12.3% and 1.4% of tumors on performing radiological staging using RTSax and RTSre, respectively. Multiple linear regression revealed that pleural dimpling (p = 0.024) was an independent factor affecting differences between PTS and RTSax. Specimen type (p = 0.012) and tumor location (p = 0.020) were independent factors affecting differences between PTS and RTSre. In conclusion, RTSre was significantly larger than PTS and caused postoperative down-staging in 27.4% of the tumors. Reliability analysis revealed that RTSre was more strongly correlated with PTS than RTSax. Specimen type and anatomical tumor location influenced the measured size differences between PTS and RTSre.
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Affiliation(s)
- Chul Hwan Park
- Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Radiology, Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungsoo Lee
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Duk Hwan Moon
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Heae Surng Park
- Department of Pathology, Ewha Womans University Mokdong Hospital, Seoul, Korea
- * E-mail:
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Liu L, Wu N, Tang W, Xu F, Zhou LN, Ma PQ, Li L, Liang X. The morphological changes of bronchovascular bundles within subsolid nodules on HRCT correlate with the new IASLC classification of adenocarcinoma. Clin Radiol 2018; 73:542-548. [PMID: 29329734 DOI: 10.1016/j.crad.2017.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/06/2017] [Indexed: 12/17/2022]
Abstract
AIM To observe the morphological changes of bronchovascular bundles within subsolid nodules on high-resolution (HR) computed tomography (CT) and analyse the correlation with the new adenocarcinoma classification. MATERIALS AND METHODS Two hundred and sixteen lesions (absent consolidation on mediastinal window) were reviewed retrospectively. CT features including dimensions, contour, morphological changes of the blood vessels, and bronchi/bronchioles, vacuole signs, and their correlation with histopathology were evaluated. RESULTS Excluding nine non-cancerous lesions, 34 pre-invasive lesions (PILs) including 15 atypical adenomatous hyperplasias (AAHs) and 19 adenocarcinomas in situ (AISs), 21 minimally invasive adenocarcinomas (MIAs), and 152 invasive adenocarcinomas (IACs) were analysed. Lepidic, acinar, and papillary patterns were identified in this cohort of adenocarcinomas. IACs were grouped into three types: type I (lepidic pattern ≥80%, n=47), type II (lepidic pattern ≥50%, <80%, n=67), and type III (lepidic pattern <50%, n=38). The contour of lesions, and morphological changes in vessels and bronchi/bronchioles significantly correlated with the classification of PIL, MIA, and IACs (p=0.000, p=0.000, and p=0.017, respectively). In IACs, the prevalence of vascular abnormalities on HRCT significantly correlated with (p=0.000) the proportion of non-lepidic pattern (23.40% in type I, 58.21% in type II, and 76.32% in type III); the prevalence of bronchial/bronchiolar abnormalities was higher (p=0.008) in type II/III (20.95%) compared with type I (6.38%). CONCLUSIONS The morphological changes of vessels and bronchi/bronchioles within the subsolid nodules on HRCT help to differentiate IAC from PIL and MIA, and are more common in non-lepidic predominant adenocarcinomas.
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Affiliation(s)
- L Liu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - N Wu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - W Tang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - F Xu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - L-N Zhou
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - P-Q Ma
- Department of Pathology Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - L Li
- Department of Pathology Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - X Liang
- Medical Statistics Office, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Heidinger BH, Nemec U, Anderson KR, Costa DB, Gangadharan SP, VanderLaan PA, Bankier AA. "Rounding" the Size of Pulmonary Nodules: Impact of Rounding Methods on Nodule Management, as Defined by the 2017 Fleischner Society Guidelines. Acad Radiol 2017; 24:1422-1427. [PMID: 28666724 DOI: 10.1016/j.acra.2017.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/18/2017] [Accepted: 05/20/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to quantify the impact of different rounding methods on size measurements of pulmonary nodules and to determine the number of nodules that change management categories as a result of rounding. MATERIALS AND METHODS For this retrospective institutional review board-approved study, we included 503 incidental pulmonary nodules (308 solid and 195 subsolid) from a data repository. Long and short axes were measured. Average diameters were calculated using four different rounding methods (method 1: no rounding; method 2: rounding only the average diameter to the closest millimeter; method 3: rounding only short and long axes; and method 4: rounding short and long axes and the average diameter to the closest millimeter). Nodules were classified for each rounding method according to the 2017 Fleischner Society guideline management categories. Measurements were compared among the four rounding methods using analysis of variance. RESULTS Without rounding, the average nodule diameter was 15.67 ± 5.97 mm. This increased between 0.03 and 0.29 mm using rounding methods 2-4 (range: P < 0.001-0.017). The nodule size was more frequently rounded up (range: 52.1%-77.5%) than rounded down (range: 17.7%-42.5%) using rounding methods 2-4, as compared to no rounding. In the 308 solid nodules, up to 2.9% of the nodules changed management category, whereas none of the 195 subsolid nodules changed category. CONCLUSIONS Rounding methods have a small absolute but statically significant effect on nodule size, impacting management category in less than 3% of the nodules. This suggests that, in clinical practice, any rounding method can be used for determining nodule size without substantially biasing individual nodules toward given management categories.
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Affiliation(s)
- Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215.
| | - Ursula Nemec
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Kevin R Anderson
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel B Costa
- Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sidhu P Gangadharan
- Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander A Bankier
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
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Bankier AA, MacMahon H, Goo JM, Rubin GD, Schaefer-Prokop CM, Naidich DP. Recommendations for Measuring Pulmonary Nodules at CT: A Statement from the Fleischner Society. Radiology 2017. [DOI: 10.1148/radiol.2017162894] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Heidinger BH, Anderson KR, Moriarty EM, Costa DB, Gangadharan SP, VanderLaan PA, Bankier AA. Size Measurement and T-staging of Lung Adenocarcinomas Manifesting as Solid Nodules ≤30 mm on CT: Radiology-Pathology Correlation. Acad Radiol 2017; 24:851-859. [PMID: 28256438 DOI: 10.1016/j.acra.2017.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/10/2017] [Accepted: 01/12/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to compare long-axis diameter to average computed tomography (CT) diameter measurements of lung adenocarcinomas manifesting as solid lung nodules ≤30 mm on CT, as referenced to pathologic measurements, and to determine the impact of the two CT measurement approaches on tumor (T)-staging of nodules. MATERIALS AND METHODS This institutional review board-approved study included all 274 radiologic solid adenocarcinomas resected at our institution over 10 years. Two observers measured long- and short-axis diameters on pre-resection chest CT in lung and mediastinal windows. T-stages were determined. CT measurements and T-stages were compared to pathology measurements and T-stages using Wilcoxon signed rank test and McNemar test. Inter- and intraobserver variability was determined with intraclass correlation coefficients (ICC) and Bland-Altman plots. RESULTS For lung and mediastinal windows, nodule size was significantly larger using long-axis diameter rather than average diameter (16.93 vs. 14.92 mm, P <.001; and 14.02 vs. 12.17 mm, P <.001, respectively). The correlation of CT with pathologic measurements was stronger with long-axis than with average diameter (ICC 0.808 vs. 0.730; and 0.731 vs. 0.621, respectively). Lung window measurements correlated stronger with pathology than mediastinal window measurements. CT T-stages differed from pathology T-stages in more than 20% of nodules (P <.001). Inter- and intraobserver variability was small with long-axis and average diameter (ICC range 0.96-0.991, and 0.970-0.993, respectively), but long-axis diameter showed wider scatter on Bland-Altman plots. CONCLUSIONS Long-axis CT diameter is preferable for T-staging because it better reflects the pathology T-stage. Average CT diameter might be used for longitudinal nodule follow-up because it shows less measurement variability and is more conservative in size assessment.
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Affiliation(s)
- Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA; Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Kevin R Anderson
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Eoin M Moriarty
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA
| | - Daniel B Costa
- Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sidhu P Gangadharan
- Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander A Bankier
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA
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Elicin O, Terribilini D, Shelan M, Volken W, Mathier E, Dal Pra A, Aebersold DM, Fix MK, Manser P. Primary tumor volume delineation in head and neck cancer: missing the tip of the iceberg? Radiat Oncol 2017. [PMID: 28633674 PMCID: PMC5477730 DOI: 10.1186/s13014-017-0838-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background The aim was to evaluate the geometric and corresponding dosimetric differences between two delineation strategies for head and neck tumors neighboring air cavities. Methods Primary gross and clinical tumor volumes (GTV and CTV) of 14 patients with oropharynx or larynx tumors were contoured using a soft tissue window (S). In a second strategy, the same volumes were contoured with an extension to include the parts which became visible on lung window (L). For the calculation of Hausdorff-distances (HD) between contoured volumes of the two strategies, triangular meshes were exported. Two radiotherapy plans with identical goals and optimization parameters were generated for each case. Plan_S were optimized on CTV_S, and Plan_L on CTV_L. The dose coverages of CTV_L and CTV_Δ (CTV_L minus CTV_S) were evaluated in Plan_S. OAR doses were compared among Plan_S and Plan_L. Results Median three-dimensional HD for GTVs and CTVs were 5.7 (±2.6) and 9.3 (±2.8) mm, respectively. The median volume differences between structures contoured using L and S windows were 9% (±5%) and 9% (±4%) for GTV and CTV, respectively. In 13 out of 14 cases, Plan_S met the plan acceptance criteria for CTV_L. In 8 cases CTV_Δ was covered insufficiently in Plan_S. Mean and median differences in OAR dose-volume histogram parameters between Plan_S and Plan_L were within 3%. Conclusion For the current practice in radiotherapy planning for head and neck cancer, the delineation of L-based volumes seems unnecessary. However, in special settings, where smaller or no PTV margins are used, this approach may play an important role for local control. Electronic supplementary material The online version of this article (doi:10.1186/s13014-017-0838-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
| | - Dario Terribilini
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mohamed Shelan
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Werner Volken
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Etienne Mathier
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Alan Dal Pra
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michael K Fix
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Peter Manser
- Department of Radiation Oncology and Division of Medical Radiation Physics, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Bohlsen D, Talakic E, Fritz GA, Quehenberger F, Tillich M, Schoellnast H. First pass dual input volume CT-perfusion of lung lesions: The influence of the CT- value range settings on the perfusion values of benign and malignant entities. Eur J Radiol 2016; 85:1109-14. [PMID: 27161059 DOI: 10.1016/j.ejrad.2016.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/21/2016] [Accepted: 03/16/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the influence of the lower threshold for segmentation of the volume of interest on the perfusion values in first-pass dual input volume CT-perfusion of lung lesions. MATERIALS AND METHODS Dual input maximum slope volume CT-perfusion was performed in 48 patients (mean age±standard deviation [SD], 68±10years; range, 46-87 years) who underwent subsequent CT-guided biopsy to evaluate a lung lesion. Using commercial perfusion software, a lower and upper threshold was set for determination of the CT-value range, which again determined the volume of interest for perfusion calculation. The pulmonary arterial flow (PAF), bronchial arterial flow (BAF), and perfusion index (PI; PAF/(PAF+BAF)) were calculated at following pre contrast CT value range settings: -80 to 150HU (setting 1), -200 to 150HU (setting 2), -300 to 150HU (setting 3), and -500 to 150HU (setting 4). Perfusion parameters were compared between benign (n, 15) and malignant (n, 33) lesions for each setting. Intraobserver- and interobserver reliability were calculated for setting 4. RESULTS Median PAF was significantly higher in malignant lesions than in benign lesions for all settings (53-96 versus 29-62mL/min/100mL, P<0.05). There was no significant difference in BAF between malignant and benign lesions. Median PAF of all lesions was significantly influenced by the CT value range setting (P<0.05), whereas the values increased from setting 1 to 4. Intraobserver analysis as well as interobserver analysis of PAF at setting 4 showed excellent reliability (Cronbach's alpha 0.98 and 0.95, respectively, P<0.01). CONCLUSION PAF derived from first-pass dual-input maximum slope volume CT perfusion is statistically significantly higher in malignant than in benign lesion, whereas the measurements are influenced by the lower threshold of the CT value range setting. This has to be considered when using cutoff values provided in the literature for differentiation between benign and malignant lung lesions.
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Affiliation(s)
- Dennis Bohlsen
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz A-8036, Austria
| | - Emina Talakic
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz A-8036, Austria
| | - Gerald A Fritz
- Division of General Radiology, Department of Radiology, University Hospital Graz, Auenbruggerplatz 9, Graz A-8036, Austria
| | - Franz Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, Graz A-8036, Austria
| | - Manfred Tillich
- Diagnostikum Graz Süd West GmbH, Institute for Computed Tomography and Magnetic Resonance Imaging, Weblinger Gürtel 25, Graz A-8054, Austria
| | - Helmut Schoellnast
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz A-8036, Austria.
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Penn A, Ma M, Chou BB, Tseng JR, Phan P. Inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. Acta Radiol 2015; 56:1180-6. [PMID: 25293951 DOI: 10.1177/0284185114551975] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/27/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2013, the Fleischner Society published recommendations for managing subsolid pulmonary nodules. Inter-reader variability has not yet been defined and has potential implications for the ease and reproducibility of applying the guidelines to clinical practice. PURPOSE To evaluate inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. MATERIAL AND METHODS Potential nodules were identified through a systematic retrospective review of CT studies that reported a ground-glass lesion. Three radiologists decided whether these lesions fit criteria of a subsolid nodule and thus merit application of the Fleischner Society guidelines, determined if a solid component was present, and measured each component in two dimensions. Final management recommendations were based on these intermediate decisions. Inter-reader variability for management was calculated and Fleiss' kappa was used to determine significance. Logistic regression and Fisher's exact test determined whether management was contingent on each intermediate decision. RESULTS Forty-four nodules with mean diameter of 9.4 mm were evaluated by three radiologists. Final management recommendations were in agreement for 93 out of 132 cases (70.4%, kappa = 0.56). Inter-reader variability in management recommendation was contingent on disagreement over whether a pulmonary lesion fit criteria of a subsolid nodule for 24 cases (P < 0.01), whether there was a solid component for 10 cases (P = 0.01), and whether the measurement met the threshold of 5 mm for five cases (P = 0.12). CONCLUSION There is moderate inter-reader variability when applying the 2013 Fleischner Society management recommendations. Significant contributors of variability include whether the potential lesions fit subsolid nodule criteria and whether a solid component is present. Measurement variability does not significantly affect the final management decisions.
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Affiliation(s)
- Alex Penn
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Mingming Ma
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Benjamin B Chou
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jeffrey R Tseng
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Peter Phan
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
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Prognostic significance of tumor size of small lung adenocarcinomas evaluated with mediastinal window settings on computed tomography. PLoS One 2014; 9:e110305. [PMID: 25365326 PMCID: PMC4217725 DOI: 10.1371/journal.pone.0110305] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/22/2014] [Indexed: 12/25/2022] Open
Abstract
Background We aimed to clarify that the size of the lung adenocarcinoma evaluated using mediastinal window on computed tomography is an important and useful modality for predicting invasiveness, lymph node metastasis and prognosis in small adenocarcinoma. Methods We evaluated 176 patients with small lung adenocarcinomas (diameter, 1–3 cm) who underwent standard surgical resection. Tumours were examined using computed tomography with thin section conditions (1.25 mm thick on high-resolution computed tomography) with tumour dimensions evaluated under two settings: lung window and mediastinal window. We also determined the patient age, gender, preoperative nodal status, tumour size, tumour disappearance ratio, preoperative serum carcinoembryonic antigen levels and pathological status (lymphatic vessel, vascular vessel or pleural invasion). Recurrence-free survival was used for prognosis. Results Lung window, mediastinal window, tumour disappearance ratio and preoperative nodal status were significant predictive factors for recurrence-free survival in univariate analyses. Areas under the receiver operator curves for recurrence were 0.76, 0.73 and 0.65 for mediastinal window, tumour disappearance ratio and lung window, respectively. Lung window, mediastinal window, tumour disappearance ratio, preoperative serum carcinoembryonic antigen levels and preoperative nodal status were significant predictive factors for lymph node metastasis in univariate analyses; areas under the receiver operator curves were 0.61, 0.76, 0.72 and 0.66, for lung window, mediastinal window, tumour disappearance ratio and preoperative serum carcinoembryonic antigen levels, respectively. Lung window, mediastinal window, tumour disappearance ratio, preoperative serum carcinoembryonic antigen levels and preoperative nodal status were significant factors for lymphatic vessel, vascular vessel or pleural invasion in univariate analyses; areas under the receiver operator curves were 0.60, 0.81, 0.81 and 0.65 for lung window, mediastinal window, tumour disappearance ratio and preoperative serum carcinoembryonic antigen levels, respectively. Conclusions According to the univariate analyses including a logistic regression and ROCs performed for variables with p-values of <0.05 on univariate analyses, our results suggest that measuring tumour size using mediastinal window on high-resolution computed tomography is a simple and useful preoperative prognosis modality in small adenocarcinoma.
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Detection and quantification of the solid component in pulmonary subsolid nodules by semiautomatic segmentation. Eur Radiol 2014; 25:488-96. [DOI: 10.1007/s00330-014-3427-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 08/30/2014] [Accepted: 09/02/2014] [Indexed: 11/26/2022]
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Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol 2014; 9:74-82. [PMID: 24346095 DOI: 10.1097/jto.0000000000000019] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION We aimed to evaluate the correlation between the size of the solid component on thin-section computed tomography (CT) and invasive component on pathology in small lung adenocarcinomas manifesting as subsolid nodules. METHODS Fifty-nine subsolid nodules in 58 patients were evaluated. The maximum diameters of subsolid nodules and the solid component on CT were measured by two radiologists in three-dimensional (3D) and two-dimensional (2D) planes using in-house software. In addition, the maximum diameters of the tumor and invasive component were measured on pathology by two pathologists. CT measurements were compared with pathologic measurements. RESULTS There was a strong correlation between the size of the solid component on CT and invasive component on pathology, as well as the size of subsolid nodules and the tumor size (r = 0.82-0.87 for 3D measurement, 0.72-0.88 for 2D measurement; p < 0.0001). The size of subsolid nodules in 3D and 2D measurements was significantly larger than tumor size (p < 0.0001). In regard to measurement of the solid component, 3D measurements tended to be larger than the size of the invasive component whereas 2D measurement tended to be similar to the size of the invasive component. By applying a size criteria of solid component that was 3 mm or lesser in maximum diameter, preinvasive and minimally invasive adenocarcinoma was predicted with a specificity of 100% (28 of 28). CONCLUSION We found a significant correlation between the size of the solid component on thin-section CT and the invasive component on pathology.
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Arenas-Jiménez J. Measurement of Solid Component in Part-Solid Lesions with a Mediastinal Window Setting? Radiology 2013; 268:305-6. [DOI: 10.1148/radiol.13130209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Travis WD, Brambilla E, Riely GJ. New pathologic classification of lung cancer: relevance for clinical practice and clinical trials. J Clin Oncol 2013; 31:992-1001. [PMID: 23401443 DOI: 10.1200/jco.2012.46.9270] [Citation(s) in RCA: 375] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We summarize significant changes in pathologic classification of lung cancer resulting from the 2011 International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) lung adenocarcinoma classification. The classification was developed by an international core panel of experts representing IASLC, ATS, and ERS with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. Because 70% of patients with lung cancer present with advanced stages, a new approach to small biopsies and cytology with specific terminology and criteria focused on the need for distinguishing squamous cell carcinoma from adenocarcinoma and on molecular testing for EGFR mutations and ALK rearrangement. Tumors previously classified as non-small-cell carcinoma, not otherwise specified, because of the lack of clear squamous or adenocarcinoma morphology should be classified further by using a limited immunohistochemical workup to preserve tissue for molecular testing. The terms "bronchioloalveolar carcinoma" and "mixed subtype adenocarcinoma" have been discontinued. For resected adenocarcinomas, new concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma define patients who, if they undergo complete resection, will have 100% disease-free survival. Invasive adenocarcinomas are now classified by predominant pattern after using comprehensive histologic subtyping with lepidic, acinar, papillary, and solid patterns; micropapillary is added as a new histologic subtype with poor prognosis. Former mucinous bronchioloalveolar carcinomas are now called "invasive mucinous adenocarcinoma." Because the lung cancer field is now rapidly evolving with new advances occurring on a frequent basis, particularly in the molecular arena, this classification provides a much needed standard for pathologic diagnosis not only for patient care but also for clinical trials and TNM classification.
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Affiliation(s)
- William D Travis
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Filosso PL, Sandri A, Oliaro A, Filippi AR, Cassinis MC, Ricardi U, Lausi PO, Asioli S, Ruffini E. Emerging treatment options in the management of non-small cell lung cancer. LUNG CANCER-TARGETS AND THERAPY 2011; 2:11-28. [PMID: 28210115 DOI: 10.2147/lctt.s8618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lung cancer (LC) has become the leading cancer-related cause of death in the US and in developed European countries in the last decade. Its incidence is still growing in females and in smokers. Surgery remains the treatment of choice whenever feasible, but unfortunately, many patients have an advanced LC at presentation and one-third of potentially operable patients do not receive a tumor resection because of their low compliance for intervention due to their compromised cardiopulmonary functions and other comorbidities. For these patients the alternative therapeutic options are stereotactic radiotherapy or percutaneous radiofrequency. When surgery is planned, an anatomical resection (segmentectomy, lobectomy, bilobectomy, pneumonectomy, sleeve lobectomy) is usually performed; wedge resection (considered as a nonanatomical one) is generally the accepted option for unfit patients. The recent increase in discovering small and peripheral LCs and/or ground-glass opacities with screening programs has dramatically increased surgeons' interest in limited resections. The role of these resections is discussed. Also, recent improvements in molecular biology techniques have increased the chemotherapic options for neoadjuvant LC treatment. The role and the importance of targeted chemotherapy is also discussed.
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Affiliation(s)
| | | | | | | | | | - Umberto Ricardi
- Department of Medical and Surgical Disciplines, Radiation Therapy Division
| | | | - Sofia Asioli
- Department of Oncology and Biomedical Sciences, University of Torino, Torino, Italy
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