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Ospina AV, Bolufer Nadal S, Campo-Cañaveral de la Cruz JL, González Larriba JL, Macía Vidueira I, Massutí Sureda B, Nadal E, Trancho FH, Álvarez Kindelán A, Del Barco Morillo E, Bernabé Caro R, Bosch Barrera J, Calvo de Juan V, Casal Rubio J, de Castro J, Cilleruelo Ramos Á, Cobo Dols M, Dómine Gómez M, Figueroa Almánzar S, Garcia Campelo R, Insa Mollá A, Jarabo Sarceda JR, Jiménez Maestre U, López Castro R, Majem M, Martinez-Marti A, Martínez Téllez E, Sánchez Lorente D, Provencio M. Multidisciplinary approach for locally advanced non-small cell lung cancer (NSCLC): 2023 expert consensus of the Spanish Lung Cancer Group GECP. Clin Transl Oncol 2024; 26:1647-1663. [PMID: 38530556 PMCID: PMC11178633 DOI: 10.1007/s12094-024-03382-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: 10/26/2023] [Accepted: 01/03/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Recent advances in the treatment of locally advanced NSCLC have led to changes in the standard of care for this disease. For the selection of the best approach strategy for each patient, it is necessary the homogenization of diagnostic and therapeutic interventions, as well as the promotion of the evaluation of patients by a multidisciplinary oncology team. OBJECTIVE Development of an expert consensus document with suggestions for the approach and treatment of locally advanced NSCLC leaded by Spanish Lung Cancer Group GECP. METHODS Between March and July 2023, a panel of 28 experts was formed. Using a mixed technique (Delphi/nominal group) under the guidance of a coordinating group, consensus was reached in 4 phases: 1. Literature review and definition of discussion topics 2. First round of voting 3. Communicating the results and second round of voting 4. Definition of conclusions in nominal group meeting. Responses were consolidated using medians and interquartile ranges. The threshold for agreement was defined as 85% of the votes. RESULTS New and controversial situations regarding the diagnosis and management of locally advanced NSCLC were analyzed and reconciled based on evidence and clinical experience. Discussion issues included: molecular diagnosis and biomarkers, radiologic and surgical diagnosis, mediastinal staging, role of the multidisciplinary thoracic committee, neoadjuvant treatment indications, evaluation of response to neoadjuvant treatment, postoperative evaluation, and follow-up. CONCLUSIONS Consensus clinical suggestions were generated on the most relevant scenarios such as diagnosis, staging and treatment of locally advanced lung cancer, which will serve to support decision-making in daily practice.
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Affiliation(s)
- Aylen Vanessa Ospina
- Head of the Oncology Department at the Hospital Universitario Puerta de Hierro. Full Professor of Medicine, Universidad Autónoma de Madrid, C/Manuel de Falla, 1 Majadahonda, 28222, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mariano Provencio
- Head of the Oncology Department at the Hospital Universitario Puerta de Hierro. Full Professor of Medicine, Universidad Autónoma de Madrid, C/Manuel de Falla, 1 Majadahonda, 28222, Madrid, Spain.
- Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049, Madrid, Spain.
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Sun W, Qu L, Wu J, Liu X, Wang C, Jiang Y, Liu Y, Chen M, Wang X, Lin D. "Percentage" and "size" of residual viable tumor in lymph node, the performance in estimating pathologic response of lymph node in non-small cell lung cancer treated with neoadjuvant chemoimmunotherapy. Hum Pathol 2024; 149:1-9. [PMID: 38782102 DOI: 10.1016/j.humpath.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
There is no universally accepted method for evaluating lymph node metastasis (LNM) in non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy. Different protocols recommend evaluating the percentage of residual viable tumor (RVT%) and metastatic tumor size (MTS). Our aim was to determine the prognostic significance of RVT% and MTS, and identify the more effective parameter for pathological evaluating LNM. Two independent cohorts were collected (derivation, n = 84; external validation, n = 42). All patients exhibited metastatic cancer or treatment response in lymph nodes post-surgery. In the derivation cohort, we assessed the mean and largest values of MTS and RVT% in LNM, estimating their optimal cutoffs for event-free survival (EFS) using maximally selected rank statistics. Validation was subsequently conducted in the external validation cohort. The quality of prognostic factors was evaluated using the Area Under Curve (AUC). A positive association was identified between RVT% and MTS, but an absolute association could not be conclusively established. In the derivation cohort, neither the largest MTS (cutoff = 6 mm, p = 0.28), largest RVT% (cutoff = 75%, p = 0.23), nor mean RVT% (cutoff = 55%, p = 0.06) were associated with EFS. However, mean MTS (cutoff = 4.5 mm) in lymph nodes was statistically associated with EFS (p = 0.018), validated by the external cohort (p = 0.017). The prognostic value of MTS exceeded that of ypN staging in both cohorts, as evidenced by higher AUC values. The mean value of MTS can effectively serve as a parameter for the pathological evaluation of lymph nodes, with a threshold of 4.5 mm, closely linked to EFS. Its prognostic value outperforms that of ypN staging.
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Affiliation(s)
- Wei Sun
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Linlin Qu
- Department of Pathology, Peking University People's Hospital, Beijing, China
| | - Jianghua Wu
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Xinying Liu
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Chenglong Wang
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Yumeng Jiang
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Yuliang Liu
- Department of Radiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Mailin Chen
- Department of Radiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Xun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China; Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Dongmei Lin
- Department of Pathology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China.
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Huang HC, Huang YS, Chang YC, Shih JY, Chen JS, Chang YC, Wang TC. Dual-energy computed tomography for evaluating nodal staging in lung adenocarcinoma: correlation with surgical pathology. Jpn J Radiol 2024; 42:468-475. [PMID: 38311704 DOI: 10.1007/s11604-023-01525-9] [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: 10/17/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE To ascertain the performance of dual-energy CT (DECT) with iodine quantification in differentiating malignant mediastinal and hilar lymph nodes (LNs) from benign ones, focusing on patients with lung adenocarcinoma. MATERIALS AND METHODS In this study, patients with suspected lung cancer received a preoperative contrast-enhanced DECT scan from Jun 2018 to Dec 2020. Quantitative DECT parameters and the size were compared between metastatic and benign LNs. Their diagnostic performances were analyzed by the ROC curves and compared by using the two-sample t test. RESULTS 72 patients (23 men, 49 women; mean age 62.5 ± 10.1 years) fulfilled the inclusion criteria. A total of 98 LNs (67 benign, 31 metastatic) were analyzed. The iodine concentration normalized by muscle (NICmuscle) was significantly higher (P < 0.001) in metastatic LNs (4.79 ± 1.70) than in benign ones (3.00 ± 1.45). The optimal threshold of NICmuscle was 3.44, which yielded AUC: 0.798, sensitivity: 83.9%, specificity: 73.1%, accuracy: 76.5%, respectively. Applying the established size parameters with 10 mm as the threshold yielded AUC: 0.600, sensitivity: 29.0%, specificity: 91.0%, accuracy: 71.4%, respectively. The diagnostic performance of NICmuscle was significantly better (P = 0.007) than the performance obtained using the established size parameters. CONCLUSIONS For lung adenocarcinoma, the quantitative measurement of NICmuscle derived from DECT is useful for differentiating benign and metastatic mediastinal and hilar LNs before surgical intervention.
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Affiliation(s)
- Hsu-Cheng Huang
- Department of Medical Imaging, Taipei City Hospital, Yangming Branch, No. 105, Yusheng St., Shilin Dist., Taipei City, 111024, Taiwan
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan
| | - Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan
| | - Yu-Chien Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan
| | - Jin-Yuan Shih
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan
| | - Teh-Chen Wang
- Department of Medical Imaging, Taipei City Hospital, Yangming Branch, No. 105, Yusheng St., Shilin Dist., Taipei City, 111024, Taiwan.
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Jin B, Wen X, Tian H, Guo H, Hao M, Wu J, Li X, Ren Y, Wang X, Ren X. Standardized uptake value max of the primary lesion combined with tumor markers for clinically predicting distant metastasis in de novo lung adenocarcinoma. Cancer Med 2024; 13:e6961. [PMID: 38549459 PMCID: PMC10979183 DOI: 10.1002/cam4.6961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND To examine standardized uptake valuemax of the primary lesion (pSUVmax) and tumor markers (TMs) for clinically predicting distant metastasis in novo lung adenocarcinoma. METHODS The current retrospective observational study examined individuals diagnosed with de novo lung adenocarcinoma at Shanxi Cancer Hospital between February 2015 and December 2019. RESULTS Totally, 532 de novo lung adenocarcinoma cases were included. They were aged 60.8 ± 9.7 years and comprised 224 women and 268 patients with distant metastasis. The areas under the curves (AUCs) of pSUVmax, lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), cytokeratin-19 fragment (CYFRA21-1), carbohydrate antigen 125 (CA125), and Grade of TMs for predicting distant metastasis were 0.742, 0.601, 0.671, 0.700, 0.736, and 0.745, respectively. The combination of pSUVmax, LDH, CEA, CYFRA21-1, CA125, and grade of TMs in predicting distant metastasis had an AUC value of 0.816 (95%CI: 0.781-0.851), with sensitivity of 89.2%, specificity of 58.7%, positive predictive value of 73.7%, and negative predictive value of 79.7%, respectively. CONCLUSIONS pSUVmax combined with serum levels of LDH, CEA, CYFRA21-1, CA125, and the grade of TMs may have good performance in predicting distant metastasis of de novo lung adenocarcinoma.
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Affiliation(s)
- Baoli Jin
- Department of Radiation Oncology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
| | - Xiaolian Wen
- Department of Oncology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
| | - Hanji Tian
- Department of Surgery, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
| | | | - Mingyan Hao
- Department of Administration, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
| | - Jing Wu
- Department of Radiation Oncology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
| | - Xiaomin Li
- Department of Radiation Oncology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
| | - Yuejun Ren
- Department of MR/CT, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
| | - Xin Wang
- Department of SurgeryFirst Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Xiaolu Ren
- Department of Radiation Oncology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer HospitalChinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical UniversityTaiyuanChina
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Sun Y, Sun Y, Li Z, Song S, Wu K, Mao J, Cheng J. 18F-FAPI PET/CT performs better in evaluating mediastinal and hilar lymph nodes in patients with lung cancer: comparison with 18F-FDG PET/CT. Eur J Med Res 2024; 29:9. [PMID: 38173034 PMCID: PMC10763273 DOI: 10.1186/s40001-023-01494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of fluorine 18 (18F) labeled fibroblast activation protein inhibitor (FAPI) in identifying mediastinal and hilar lymph node metastases and to develop a model to quantitatively and repeatedly identify lymph node status. METHODS Twenty-seven patients with 137 lymph nodes were identified by two PET/CT images. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of lymph node status were analyzed, and the optimal cut-off value was identified by ROC analysis. RESULTS The SUVmax of metastatic lymph nodes on 18F-FAPI was higher than that on 18F-FDG PET/CT (10.87 ± 7.29 vs 6.08 ± 5.37, p < 0.001). 18F-FAPI presented much greater lymph node detection sensitivity, specificity, accuracy, PPV and NPV than 18F-FDG PET/CT (84% vs. 71%; 92% vs. 67%; 90% vs. 69%, 84% vs. 52%, and 92% vs. 83%, respectively). Additionally, the diagnostic effectiveness of 18F-FAPI in small lymph nodes was greater than that of 18F-FDG PET/CT (specificity: 96% vs. 72%; accuracy: 93% vs. 73%; PPV: 77% vs. 33%, respectively). Notably, the optimal cut-off value for specificity and PPV of 18F-FAPI SUVmax was 5.3; the optimal cut-off value for sensitivity and NPV was 2.5. CONCLUSION 18F-FAPI showed promising diagnostic efficacy in metastatic mediastinal and hilar lymph nodes from lung cancer patients, with a higher SUVmax, especially in small metastatic nodes, compared with 18F-FDG. In addition, this exploratory work recommended optimal SUVmax cutoff values to distinguish between nonmetastatic and metastatic lymph nodes, thereby advancing the development of image-guided radiation. Trial registration ClinicalTrials.gov identifier: ChiCTR2000036091.
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Affiliation(s)
- Yuyun Sun
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, 4365 Kangxin Road, Shanghai, 201321, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yun Sun
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai, 201321, China
| | - Zili Li
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Shanghai, 201321, China
| | - Shaoli Song
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, 4365 Kangxin Road, Shanghai, 201321, China
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Kailiang Wu
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
- Department of Radiotherapy, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321, China
| | - Jingfang Mao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.
- Department of Radiotherapy, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, 201321, China.
| | - Jingyi Cheng
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, 4365 Kangxin Road, Shanghai, 201321, China.
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.
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Lu T, Ma J, Zou J, Jiang C, Li Y, Han J. CT-based intratumoral and peritumoral deep transfer learning features prediction of lymph node metastasis in non-small cell lung cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:597-609. [PMID: 38578874 DOI: 10.3233/xst-230326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
BACKGROUND The main metastatic route for lung cancer is lymph node metastasis, and studies have shown that non-small cell lung cancer (NSCLC) has a high risk of lymph node infiltration. OBJECTIVE This study aimed to compare the performance of handcrafted radiomics (HR) features and deep transfer learning (DTL) features in Computed Tomography (CT) of intratumoral and peritumoral regions in predicting the metastatic status of NSCLC lymph nodes in different machine learning classifier models. METHODS We retrospectively collected data of 199 patients with pathologically confirmed NSCLC. All patients were divided into training (n = 159) and validation (n = 40) cohorts, respectively. The best HR and DTL features in the intratumoral and peritumoral regions were extracted and selected, respectively. Support Vector Machine (SVM), k-Nearest Neighbors (KNN), Light Gradient Boosting Machine (Light GBM), Multilayer Perceptron (MLP), and Logistic Regression (LR) models were constructed, and the performance of the models was evaluated. RESULTS Among the five models in the training and validation cohorts, the LR classifier model performed best in terms of HR and DTL features. The AUCs of the training cohort were 0.841 (95% CI: 0.776-0.907) and 0.955 (95% CI: 0.926-0.983), and the AUCs of the validation cohort were 0.812 (95% CI: 0.677-0.948) and 0.893 (95% CI: 0.795-0.991), respectively. The DTL signature was superior to the handcrafted radiomics signature. CONCLUSIONS Compared with the radiomics signature, the DTL signature constructed based on intratumoral and peritumoral areas in CT can better predict NSCLC lymph node metastasis.
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Affiliation(s)
- Tianyu Lu
- Department of Radiology, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jianbing Ma
- Department of Radiology, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jiajun Zou
- Department of Radiology, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chenxu Jiang
- Department of Radiology, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yangyang Li
- Department of Radiology, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Jun Han
- Department of Radiology, The First Hospital of Jiaxing or The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Mirshahvalad SA, Manafi-Farid R, Fallahi B, Seifi S, Geramifar P, Emami-Ardekani A, Eftekhari M, Beiki D. Diagnostic value of [ 68 Ga]Ga-Pentixafor versus [ 18 F]FDG PET/CTs in non-small cell lung cancer: a head-to-head comparative study. Nucl Med Commun 2023; 44:803-809. [PMID: 37334548 DOI: 10.1097/mnm.0000000000001719] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVE In this study, we aimed to compare the diagnostic value of [ 68 Ga]Ga-Pentixafor and [ 18 F]FDG PET/CT in the evaluation of non-small cell lung cancer (NSCLC) patients. METHODS Patients with pathology-proven NSCLC were prospectively included. Patients underwent [ 18 F]FDG and [ 68 Ga]Ga-Pentixafor PET/CT within 1 week. All suspicious lesions were interpreted as benign or malignant, and the corresponding PET/CT semi-quantitative parameters were recorded. A two-sided P -value <0.05 was considered significant. RESULTS Twelve consecutive NSCLC patients (mean age: 60 ± 7) were included. All patients underwent both [ 18 F]FDG and [ 68 Ga]Ga-Pentixafor PET/CT scans with a median interval of 2 days. Overall, 73 abnormal lesions were detected, from which 58 (79%) were concordant between [ 18 F]FDG and [ 68 Ga]Ga-Pentixafor PET/CT. All primary tumors were clearly detectable in both scans visually. Also, [ 68 Ga]Ga-Pentixafor PET/CT demonstrated rather comparable results with [ 18 F]FDG PET/CT scan in detecting metastatic lesions. However, malignant lesions demonstrated significantly higher SUVmax and SUVmean in [ 18 F]FDG PET/CT ( P -values <0.05). Regarding the advantages, [ 68 Ga]Ga-Pentixafor depicted two brain metastases that were missed by [ 18 F]FDG PET/CT. Also, a highly suspicious lesion for recurrence on [ 18 F]FDG PET/CT scan was correctly classified as benign by subsequent [ 68 Ga]Ga-Pentixafor PET/CT. CONCLUSION [ 68 Ga]Ga-Pentixafor PET/CT was concordant with [ 18 F]FDG PET/CT in detecting primary NSCLC tumors and could visualize the majority of metastatic lesions. Moreover, this modality was found to be potentially helpful in excluding tumoural lesions when the [ 18 F]FDG PET/CT was equivocal, as well as in detecting brain metastasis where [ 18 F]FDG PET/CT suffers from poor sensitivity. However, the count statistics were significantly lower.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences
| | - Babak Fallahi
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences
| | - Sharareh Seifi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parham Geramifar
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences
| | - Alireza Emami-Ardekani
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences
| | - Mohammad Eftekhari
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences
| | - Davood Beiki
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences
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Hui WK, Charaf Z, Hendriks JMH, Van Schil PE. True Prevalence of Unforeseen N2 Disease in NSCLC: A Systematic Review + Meta-Analysis. Cancers (Basel) 2023; 15:3475. [PMID: 37444585 DOI: 10.3390/cancers15133475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with unforeseen N2 (uN2) disease are traditionally considered to have an unfavorable prognosis. As preoperative and intraoperative mediastinal staging improved over time, the prevalence of uN2 changed. In this review, the current evidence on uN2 disease and its prevalence will be evaluated. A systematic literature search was performed to identify all studies or completed, published trials that included uN2 disease until 6 April 2023, without language restrictions. The Newcastle-Ottawa Scale (NOS) was used to score the included papers. A total of 512 articles were initially identified, of which a total of 22 studies met the predefined inclusion criteria. Despite adequate mediastinal staging, the pooled prevalence of true unforeseen pN2 (9387 patients) was 7.97% (95% CI 6.67-9.27%), with a pooled OS after five years (892 patients) of 44% (95% CI 31-58%). Substantial heterogeneity regarding the characteristics of uN2 disease limited our meta-analysis considerably. However, it seems patients with uN2 disease represent a subcategory with a similar prognosis to stage IIb if complete surgical resection can be achieved, and the contribution of adjuvant therapy is to be further explored.
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Affiliation(s)
- Wing Kea Hui
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Zohra Charaf
- Department of Cardiothoracic Surgery, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
- ASTARC (Antwerp Surgical Training, Anatomy and Research Centre), University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
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Zhang X, Liu T, Zhang H, Zhang M. Measurements of target volumes and organs at risk using DW‑MRI in patients with central lung cancer accompanied with atelectasis. Mol Clin Oncol 2023; 18:45. [PMID: 37152713 PMCID: PMC10155240 DOI: 10.3892/mco.2023.2641] [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: 11/14/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Accurate imaging-based tumor delineation is crucial for guiding the radiotherapy treatments of various solid tumors. Currently, several imaging procedures, including diffusion-weighted magnetic resonance imaging (DW-MRI), intensified computed tomography and positron emission tomography are routinely used for targeted tumor delineation. However, the performance of these imaging procedures has not yet been comprehensively evaluated. In order to address this matter, the present study was conducted in an aim to assess the use of DW-MRI in guiding radiotherapy treatments, by comparing its performance to that of other imaging procedures. Specifically, the exposure dosages to organs at risk, including the lungs, heart and spinal mencord, were evaluated using various radiotherapy regimes. The findings of the present study demonstrated that DW-MRI is a non-invasive and cost-effective imaging procedure that can be used to reduce lung exposure doses, minimizing the risk of radiation pneumonitis. The data further demonstrate the immense potential of the DW-MRI procedure in the precision radiotherapy of lung cancers.
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Affiliation(s)
- Xinli Zhang
- Department of Medical Oncology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, Shandong 271000, P.R. China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan, Shandong 250117, P.R. China
| | - Tong Liu
- Department of Stomatology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, Shandong 271000, P.R. China
| | - Hong Zhang
- Department of Medical Oncology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, Shandong 271000, P.R. China
| | - Mingbin Zhang
- Department of Stomatology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, Shandong 271000, P.R. China
- Correspondence to: Dr Mingbin Zhang, Department of Stomatology, The Affiliated Tai'an City Central Hospital of Qingdao University, 29 Longtan Road, Tai'an, Shandong 271000, P.R. China
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Chen QL, Li MM, Xue T, Peng H, Shi J, Li YY, Duan SF, Feng F. Radiomics nomogram integrating intratumoural and peritumoural features to predict lymph node metastasis and prognosis in clinical stage IA non-small cell lung cancer: a two-centre study. Clin Radiol 2023; 78:e359-e367. [PMID: 36858926 DOI: 10.1016/j.crad.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
AIM To investigate the value of a radiomics nomogram integrating intratumoural and peritumoural features in predicting lymph node metastasis and overall survival (OS) in patients with clinical stage IA non-small-cell lung cancer (NSCLC). MATERIALS AND METHODS This study retrospectively enrolled 199 patients (training cohort: 71 patients from Affiliated Tumour Hospital of Nantong University; internal validation cohort: 46 patients from Affiliated Tumour Hospital of Nantong University; external validation cohort: 82 patients from the public database). CT radiomics models were constructed based on four volumes of interest: gross tumour volume (GTV), gross and 3 mm peritumoural volume (GPTV3), gross and 6 mm peritumoural volume (GPTV6), and gross and 9 mm peritumoural volume (GPTV9). The optimal radiomics signature was further combined with independent clinical predictors to develop a nomogram. Univariable and multivariable Cox regression analysis were applied to determine the relationship between factors and OS. RESULTS GPTV6 radiomics yielded better performance than GTV, GPTV3, and, GPTV9 radiomics in the training (area under the curve [AUC], 0.81), internal validation (AUC, 0.79), and external validation cohorts (AUC, 0.71), respectively. The nomogram integrating GPTV6 radiomics and spiculation improved predictive ability, with AUCs of 0.85, 0.80, and 0.74 in three cohorts, respectively. Pathological lymph node metastasis, nomogram-predicted lymph node metastasis, and pleural indentation were independent risk predictors of OS (p<0.05). CONCLUSIONS The nomogram integrating GPTV6 radiomics features and independent clinical predictors performed well in predicting lymph node metastasis and prognosis in patients with clinical stage IA NSCLC.
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Affiliation(s)
- Q-L Chen
- Department of Radiology, Affiliated Tumour Hospital of Nantong University, Nantong, Jiangsu 226001, PR China
| | - M-M Li
- Department of Radiology, Affiliated Tumour Hospital of Nantong University, Nantong, Jiangsu 226001, PR China
| | - T Xue
- Department of Radiology, Affiliated Tumour Hospital of Nantong University, Nantong, Jiangsu 226001, PR China
| | - H Peng
- Department of Radiology, Affiliated Tumour Hospital of Nantong University, Nantong, Jiangsu 226001, PR China
| | - J Shi
- Department of Radiology, Affiliated Tumour Hospital of Nantong University, Nantong, Jiangsu 226001, PR China
| | - Y-Y Li
- Department of Radiology, Affiliated Tumour Hospital of Nantong University, Nantong, Jiangsu 226001, PR China
| | - S-F Duan
- GE Healthcare China, Shanghai City 210000, China
| | - F Feng
- Department of Radiology, Affiliated Tumour Hospital of Nantong University, Nantong, Jiangsu 226001, PR China.
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11
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Udelsman BV, Chang DC, Boffa DJ, Gaissert HA. Association of Lymph Node Sampling and Clinical Volume in Lobectomy for Non-Small Cell Lung Cancer. Ann Thorac Surg 2023; 115:166-173. [PMID: 35752354 DOI: 10.1016/j.athoracsur.2022.05.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/16/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sampling of ≥10 lymph nodes during lobectomy for non-small cell lung cancer (NSCLC) was a previous surveillance metric and potential quality metric of the American College of Surgeons Commission on Cancer. We sought to determine guideline adherence and its relationship to hospital lobectomy volume within The Society of Thoracic Surgeons General Thoracic Surgery Database. METHODS Participant centers providing elective lobectomy for NSCLC within The Society of Thoracic Surgeons General Thoracic Surgery Database (2012-2019) were divided into tertiles according to annual volume. Average hospital nodal harvest of ≥10 nodes per lobectomy defined the primary outcome. Univariable analysis compared average patient and operative characteristics between the participant centers. Multivariable logistic regression was used to determine independent factors associated with average clinical center nodal harvest of ≥10 nodes. RESULTS Median annual lobectomy volume was 6.2, 19.9, and 42.7 for low-, medium-, and high-volume participant centers. Among 305 centers and 43 597 patients, 5.6% of lobectomies occurred in low-volume centers, 24.0% in medium-volume centers, and 70.4% in high-volume centers. Average rates of ≥10 nodes per lobectomy were excised in 44.0% of low-volume centers, 70.6% of medium-volume centers, and 75.2% of high-volume centers (P < .001). On multivariable analysis, average nodal excision of ≥10 nodes was strongly associated with medium-volume (odds ratio, 2.94; CI, 1.57-5.50, P < .01) and high-volume (odds ratio, 3.82; CI, 1.95-7.46; P < .001) participant centers. CONCLUSIONS Although higher center volume and increased nodal harvest are associated, 25% of high-volume centers average a rate of <10 lymph nodes per lobectomy for NSCLC. Low nodal yield may underestimate stage, with implications for adjuvant therapy and long-term survival.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
| | - David C Chang
- Codman Center for Clinical Effectiveness, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel J Boffa
- Division of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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12
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Ohno Y, Yui M, Takenaka D, Yoshikawa T, Koyama H, Kassai Y, Yamamoto K, Oshima Y, Hamabuchi N, Hanamatsu S, Obama Y, Ueda T, Ikeda H, Hattori H, Murayama K, Toyama H. Computed DWI MRI Results in Superior Capability for N-Stage Assessment of Non-Small Cell Lung Cancer Than That of Actual DWI, STIR Imaging, and FDG-PET/CT. J Magn Reson Imaging 2023; 57:259-272. [PMID: 35753082 DOI: 10.1002/jmri.28288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Computed diffusion-weighted imaging (cDWI) is a mathematical computation technique that generates DWIs for any b-value by using actual DWI (aDWI) data with at least two different b-values and may improve differentiation of metastatic from nonmetastatic lymph nodes. PURPOSE To determine the appropriate b-value for cDWI to achieve a better diagnostic capability for lymph node staging (N-staging) in non-small cell lung cancer (NSCLC) patients compared to aDWI, short inversion time (TI) inversion recovery (STIR) imaging, or positron emission tomography with 2-[fluorine-18] fluoro-2-deoxy-d-glucose combined with computed tomography (FDG-PET/CT). STUDY TYPE Prospective. SUBJECTS A total of 245 (127 males and 118 females; mean age 72 years) consecutive histopathologically confirmed NSCLC patients. FIELD STRENGTH/SEQUENCE A 3 T, half-Fourier single-shot turbo spin-echo sequence, electrocardiogram (ECG)-triggered STIR fast advanced spin-echo (FASE) sequence with black blood and STIR acquisition and DWI obtained by FASE with b-values of 0 and 1000 sec/mm2 . ASSESSMENT From aDWIs with b-values of 0 and 1000 (aDWI1000 ) sec/mm2 , cDWI using 400 (cDWI400 ), 600 (cDWI600 ), 800 (cDWI800 ), and 2000 (cDWI2000 ) sec/mm2 were generated. Then, 114 metastatic and 114 nonmetastatic nodes (mediastinal and hilar lymph nodes) were selected and evaluated with a contrast ratio (CR) for each cDWI and aDWI, apparent diffusion coefficient (ADC), lymph node-to-muscle ratio (LMR) on STIR, and maximum standard uptake value (SUVmax ). STATISTICAL TESTS Receiver operating characteristic curve (ROC) analysis, Youden index, and McNemar's test. RESULTS Area under the curve (AUC) of CR600 was significantly larger than the CR400 , CR800 , CR2000 , aCR1000 , and SUVmax . Comparison of N-staging accuracy showed that CR600 was significantly higher than CR400 , CR2000 , ADC, aCR1000 , and SUVmax , although there were no significant differences with CR800 (P = 0.99) and LMR (P = 0.99). DATA CONCLUSION cDWI with b-value at 600 sec/mm2 may have potential to improve N-staging accuracy as compared with aDWI, STIR, and PET/CT. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan.,Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan.,Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masao Yui
- Canon Medical Systems Corporation, Otawara, Japan
| | | | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Radiology, Hyogo Cancer Center, Akashi, Japan
| | - Hisanobu Koyama
- Department of Radiology, Osaka Police Hospital, Osaka, Japan
| | | | | | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yuki Obama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
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13
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Kim K, Lee J, Lee JY, Yong SH, Kim EY, Jung JY, Kang YA, Park MS, Kim YS, Oh CM, Lee SH. Clinical features and molecular genetics associated with brain metastasis in suspected early-stage non-small cell lung cancer. Front Oncol 2023; 13:1148475. [PMID: 37139160 PMCID: PMC10150586 DOI: 10.3389/fonc.2023.1148475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Regarding whether brain magnetic resonance imaging (MRI) should be routine in patients with suspected early-stage lung cancer, guideline recommendations are inconsistent. Therefore, we performed this study to evaluate the incidence of and risk factors for brain metastasis (BM) in patients with suspected early-stage non-small-cell lung cancer (NSCLC). Methods A review of the medical charts of consecutive NSCLC patients diagnosed between January 2006 and May 2020 was performed. We identified 1,382 NSCLC patients with clinical staging of T1/2aN0M0 (excluding BM), and investigated the incidence, clinical predictors, and prognosis of BM in the cohort. We also performed RNA-sequencing differential expression analysis using transcriptome of 8 patients, using DESeq2 package (version 1.32.0) with R (version 4.1.0). Results Among 1,382 patients, nine hundred forty-nine patients (68.7%) underwent brain MRI during staging, and 34 patients (3.6%) were shown to have BM. Firth's bias-reduced logistic regression showed that tumor size (OR 1.056; 95% CI 1.009-1.106, p=0.018) was the only predictor of BM, and pathologic type was not a predictor of BM in our cohort (p>0.05). The median overall survival for patients with brain metastasis was 5.5 years, which is better than previously reported in the literature. RNA-sequencing differential expression analysis revealed the top 10 significantly upregulated genes and top 10 significantly downregulated genes. Among the genes involved in BM, Unc-79 homolog, non-selective sodium leak channel (NALCN) channel complex subunit (UNC79) was the most highly expressed gene in the lung adenocarcinoma tissues from the BM group, and an in vitro assay using A549 cells revealed that the NALCN inhibitor suppressed lung cancer cell proliferation and migration. Conclusions Given the incidence and favorable outcome of BM in patients with suspected early-stage NSCLC, selective screening with brain MRI may be considered, especially in patients with high-risk features.
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Affiliation(s)
- Kangjoon Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jibeom Lee
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Jeong-Yun Lee
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Seung Hyun Yong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Myung Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
- *Correspondence: Chang-Myung Oh, ; Sang Hoon Lee,
| | - Sang Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Chang-Myung Oh, ; Sang Hoon Lee,
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Mirmoeeni S, Azari Jafari A, Shah M, Salemi F, Hashemi SZ, Seifi A. The Clinical, Diagnostic, Therapeutic, and Prognostic Characteristics of Brain Metastases in Prostate Cancer: A Systematic Review. Prostate Cancer 2022; 2022:5324600. [PMID: 36474619 PMCID: PMC9719815 DOI: 10.1155/2022/5324600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 08/19/2023] Open
Abstract
AIM Prostate cancer (PCa) is the second most common nonskin malignancy and the second most common cause of cancer-related deaths in men. The most common site of metastasis in PCa is the axial skeleton which may lead to back pain or pathological fractures. Hematogenous spread to the brain and involvement of the central nervous system (CNS) are a rare occurrence. However, failed androgen deprivation therapy (ADT) may facilitate such a spread resulting in an advanced metastatic stage of PCa, which carries a poor prognosis. METHODS In this systematic review, we searched the PubMed, Scopus, and Web of Science online databases based on the PRISMA guideline and used all the medical subject headings (MeSH) in terms of the following search line: ("Brain Neoplasms" OR "Central Nervous System Neoplasms") and ("Prostatic Neoplasms" OR "Prostate"). Related studies were identified and reviewed. RESULTS A total of 59 eligible studies (902 patients) were included in this systematic review. In order to gain a deeper understanding, we extracted and presented the data from included articles based on clinical manifestations, diagnostic methods, therapeutic approaches, and prognostic status of PCa patients having BMs. CONCLUSION We have demonstrated the current knowledge regarding the mechanism, clinical manifestations, diagnostic methods, therapeutic approaches, and prognosis of BMs in PCa. These data shed more light on the way to help clinicians and physicians to understand, diagnose, and manage BMs in PCa patients better.
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Affiliation(s)
| | | | - Muffaqam Shah
- Deccan College of Medical Sciences, P.O. Kanchanbagh, DMRL ‘X' Road, Santhosh Nagar, Hyderabad 500058, Telangana, India
| | - Fateme Salemi
- School of Medicine, Islamic Azad University of Medical Sciences, Yazd, Iran
| | - Seyedeh Zohreh Hashemi
- Researcher at the Research Center of Tehran University of Medical Sciences, Pharmacology Department, Tehran, Iran
| | - Ali Seifi
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
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15
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Gorodetski B, Becker PH, Baur ADJ, Hartenstein A, Rogasch JMM, Furth C, Amthauer H, Hamm B, Makowski M, Penzkofer T. Inferring FDG-PET-positivity of lymph node metastases in proven lung cancer from contrast-enhanced CT using radiomics and machine learning. Eur Radiol Exp 2022; 6:44. [PMID: 36104467 PMCID: PMC9474782 DOI: 10.1186/s41747-022-00296-8] [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: 02/16/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated the role of radiomics applied to contrast-enhanced computed tomography (CT) in the detection of lymph node (LN) metastases in patients with known lung cancer compared to 18F-fluorodeoxyglucose positron emission tomography (PET)/CT as a reference. Methods This retrospective analysis included 381 patients with 1,799 lymph nodes (450 malignant, 1,349 negative). The data set was divided into a training and validation set. A radiomics analysis with 4 filters and 6 algorithms resulting in 24 different radiomics signatures and a bootstrap algorithm (Bagging) with 30 bootstrap iterations was performed. A decision curve analysis was applied to generate a net benefit to compare the radiomics signature to two expert radiologists as one-by-one and as a prescreening tool in combination with the respective radiologist and only the radiologists. Results All 24 modeling methods showed good and reliable discrimination for malignant/benign LNs (area under the curve 0.75−0.87). The decision curve analysis showed a net benefit for the least absolute shrinkage and selection operator (LASSO) classifier for the entire probability range and outperformed the expert radiologists except for the high probability range. Using the radiomics signature as a prescreening tool for the radiologists did not improve net benefit. Conclusions Radiomics showed good discrimination power irrespective of the modeling technique in detecting LN metastases in patients with known lung cancer. The LASSO classifier was a suitable diagnostic tool and even outperformed the expert radiologists, except for high probabilities. Radiomics failed to improve clinical benefit as a prescreening tool. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-022-00296-8.
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16
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Kaumanns A, König D, Hojski A, Cattaneo M, Chirindel A, Wiese M, Tamm M, Lardinois D, Rothschild SI. Role of 18F-FDG PET/CT in the postoperative follow-up in patients with stage I-III NSCLC: A retrospective single-institution study. Lung Cancer 2022; 173:14-20. [PMID: 36108578 DOI: 10.1016/j.lungcan.2022.08.020] [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: 04/16/2022] [Revised: 08/19/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The optimal surveillance strategy in patients with resected non-small cell lung cancer (NSCLC) is unknown. Early detection of recurrences by follow-up imaging might improve survival and whole-body 18F-FDG-PET/CT might be the optimal imaging modality given its high accuracy in preoperative staging. MATERIAL AND METHODS Data from a single-center cohort of 205 patients with resected stage I-III NSCLC and FDG-PET/CT surveillance was retrospectively collected. Patients had preoperative FDG-positive tumors and FDG-PET/CT at 6, 12, 24 months, chest CT at 18 months. Thereafter, annual chest CT was performed for stage I-II, annual FDG-PET/CT for stage III. RESULTS With a median follow-up of 26.3 months (range, 4.1-60.6), the rate for recurrence and secondary primary lung cancer (SPLC) was 22 % and 8 %, respectively. Associated symptoms were present in 48 % (recurrence) and 18 % (SPLC) of patients. Overall, 83 % of recurrences, and 65 % of SPLC were detected on FDG-PET/CT. 82 % of recurrences were detected in one of the first two follow-up PET/CT scans. Second curatively intended treatment (SCIT) was possible in 37 % of patients with recurrence and 100 % with SPLC. The 2-year recurrence-free survival rate after SCIT for recurrence was 53 % [95 %CI; 31-91 %]. Non-malignant FDG-positive findings occurred in 25 % of patients (71 % possible infections). CONCLUSION In our cohort of patients, more than 80% of all recurrences were identified in one of the three FDG-PET/CTs performed as part of our imaging protocol during the first two years after resection. Nearly all patients with non-distant recurrence qualified for a SCIT. Further studies are needed to identify patients who might benefit from an even more intensive surveillance strategy.
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Affiliation(s)
- Anna Kaumanns
- Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - David König
- Department of Medical Oncology, University Hospital Basel, 4031 Basel, Switzerland; Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland
| | - Aljaz Hojski
- Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland; Department of Thoracic Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Marco Cattaneo
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland
| | - Alin Chirindel
- Department of Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Mark Wiese
- Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland; Department of Thoracic Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Michael Tamm
- Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland; Department of Pulmonology, University Hospital Basel, 4031 Basel, Switzerland
| | - Didier Lardinois
- Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland; Department of Thoracic Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Sacha I Rothschild
- Department of Medical Oncology, University Hospital Basel, 4031 Basel, Switzerland; Comprehensive Cancer Center, University Hospital Basel, 4031 Basel, Switzerland.
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The prognosis of non-small cell lung cancer patients according to endobronchial metastatic lesion. Sci Rep 2022; 12:13588. [PMID: 35948652 PMCID: PMC9365769 DOI: 10.1038/s41598-022-17918-1] [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: 04/18/2022] [Accepted: 08/02/2022] [Indexed: 11/09/2022] Open
Abstract
To evaluate the prognosis of non-small cell lung cancer (NSCLC) patients according to endobronchial metastatic lesion (EML), especially those not identified on positron emission tomography or computed tomography. We evaluated progression-free survival (PFS) and overall survival (OS) according to the presence of EML in patients with NSCLC who were diagnosed at a tertiary hospital between January 2010 and December 2019. A total of 364 patients were enrolled in this study. EML was found in 69 (19.0%) patients with NSCLC. In the patients with EML versus the patients without EML, median PFS was 7.0 (3.5–13.5) and 9.5 (5.5–17.5) months (P = 0.011), and median OS was 12.0 (6.0–30.0) versus 20.0 (10.0–39.0) months (P = 0.016), respectively. Median PFS and OS rates were highest in epidermal growth factor receptor (EGFR) (+) and EML (−) patients and lowest in EGFR (−) and EML (+) patients (P < 0.001). By multivariate cox regression analysis, PFS in overall patients with NSCLC was significantly associated with EML, EGFR mutation, performance status, and pleural effusion. NSCLC patients with EML had worse prognoses of PFS and OS than patients without EML.
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18
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Husta BC, Kalchiem-Dekel O, Beattie JA, Yasufuku K. Mediastinal Staging with Endobronchial Ultrasound in Early-Stage Non-Small Cell Lung Cancer: Is It Necessary? Semin Respir Crit Care Med 2022; 43:503-511. [PMID: 36104026 DOI: 10.1055/s-0042-1748189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Herein we examine the need for minimally invasive mediastinal staging for patients with early-stage non-small cell lung cancer (NSCLC) using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Early NSCLC, stages 1 and 2, has a 5-year survival rate between 53 and 92%, whereas stages 3 and 4 have a 5-year survival of 36% and below. With more favorable outcomes in earlier stages, greater emphasis has been placed on identifying lung cancer earlier in its disease process. Accurate staging is crucial as it dictates both prognosis and therapy. Inaccurate staging can adversely impact surgical candidacy (if falsely "over-staged") or lead to inadequate treatment (if "under-staged"). Clinical staging utilizes noninvasive methods to evaluate the anatomic extent of disease; however, it remains controversial whether mediastinal staging of early NSCLC with radiological exams alone is sufficient. EBUS-TBNA has altered the landscape of invasive mediastinal staging and is a crucial component to improving confidence in lung cancer staging, specifically in early NSCLC. Radiographic occult lymph node metastasis identified upon review of surgical resection specimens of early NSCLC may support the argument to perform EBUS-TBNA in all cases of early-stage disease. Other data suggest that EBUS-TBNA could be spared in cases of peripheral cT1aN0 and cT1bN0 for which surgical resection with lymph node dissection is planned. By reviewing reported EBUS-TBNA outcomes in patients with early NSCLC, we aim to emphasize the necessity of staging with EBUS in this population.
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Affiliation(s)
- Bryan C Husta
- Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Or Kalchiem-Dekel
- Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Jason A Beattie
- Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto
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Ekinci M, Santos-Oliveira R, Ilem-Ozdemir D. Biodistribution of 99mTc-PLA/PVA/Atezolizumab Nanoparticles for Non-Small Cell Lung Cancer Diagnosis. Eur J Pharm Biopharm 2022; 176:21-31. [PMID: 35568255 DOI: 10.1016/j.ejpb.2022.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 01/17/2023]
Abstract
Lung cancer (LC) is a common type of cancer, which is a leading cause of death around the world. There is an urgency for the development of new drugs that could diagnose the LC in the early stages and in a precise manner. In this direction, the development of nanoparticles radiolabeled with the diagnostic radioisotopes represent an important advance in the field of cancer imaging. In this study were developed PLA/PVA/Atezolizumab nanoparticles which were radiolabeled with 99mTc (Technetium-99m). The radiolabeled nanoparticles were evaluated in both: in-vitro (L-929 and A-549) as in-vivo (mice). The results showed no cytotoxicity effect in the healthy cells (L-929) and cytotoxicity effect in the tumor cells (A-549). The biodistribution assay demonstrated that 99mTc-PLA/PVA/Atezolizumab could reach the tumor site 14-folds higher than the nonparticulate atezolizumab. In conclusion, 99mTc-PLA/PVA/Atezolizumab nanoparticles showed to be a new drug which is able to precisely image the lung tumor, and it must be considered for clinical trials.
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Affiliation(s)
- Meliha Ekinci
- Ege University, Faculty of Pharmacy, Department of Radiopharmacy, 35040 Bornova, Izmir, Turkey
| | - Ralph Santos-Oliveira
- Brazilian Nuclear Energy Commission, Nuclear Engineering Institute, Laboratory of Synthesis of Novel Radiopharmaceuticals and Nanoradiopharmacy, Rio de Janeiro, 21941906, Brazil; Zona Oeste State University, Laboratory of Nanoradiopharmaceuticals and Radiopharmacy, Rio de Janeiro, 23070200, Brazil
| | - Derya Ilem-Ozdemir
- Ege University, Faculty of Pharmacy, Department of Radiopharmacy, 35040 Bornova, Izmir, Turkey.
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20
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Karapınar K, Özbek M, Seyrek Y, Aker C, Akçıl AM, Cansever L, Bedirhan MA. The Diagnostic Efficiency of the Use of Non-Standard Surgical Instruments in Mediastinoscopy. ISTANBUL MEDICAL JOURNAL 2022. [DOI: 10.4274/imj.galenos.2022.64188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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21
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Zhang R, Zhang R, Luan T, Liu B, Zhang Y, Xu Y, Sun X, Xing L. A Radiomics Nomogram for Preoperative Prediction of Clinical Occult Lymph Node Metastasis in cT1-2N0M0 Solid Lung Adenocarcinoma. Cancer Manag Res 2021; 13:8157-8167. [PMID: 34737644 PMCID: PMC8560059 DOI: 10.2147/cmar.s330824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background Clinical occult lymph node metastasis (cOLNM) means that the lymph node is negatively diagnosed by preoperative computed tomography (CT), but has been proven to be positive by postoperative pathology. The aim of this study was to establish and validate a nomogram based on radiomics features for the preoperative prediction of cOLNM in early-stage solid lung adenocarcinoma patients. Methods A total of 244 patients with clinical T1-2N0M0 solid lung adenocarcinoma who underwent preoperative contrast-enhanced chest CT were divided into a primary group (n = 160) and an independent validation group from another hospital (n = 84). The records of 851 radiomics features of each primary tumor were extracted. LASSO analysis was used to reduce the data dimensionality and select features. Multivariable logistic regression was utilized to identify independent predictors of cOLNM and develop a predictive nomogram. The performance of the predictive model was assessed by its calibration and discrimination. Decision curve analysis (DCA) was performed to estimate the clinical usefulness of the nomogram. Results The predictive model consisted of a clinical factor (CT-reported tumor size) and a radiomics feature (Rad-score). The nomogram presented good discrimination, with a C-index of 0.782 (95% CI, 0.768–0.796) in the primary cohort and 0.813 (95% CI, 0.787–0.839) in the validation cohort, and good calibration. DCA showed that the radiomics nomogram was clinically useful. Conclusion This study develops and validates a nomogram that incorporates clinical and radiomics factors. It can be tailored for the individualized preoperative prediction of cOLNM in early-stage solid lung adenocarcinoma patients.
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Affiliation(s)
- Ran Zhang
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.,Tongji University, Shanghai, People's Republic of China
| | - Ranran Zhang
- Department of Medical Imaging, Linyi Cancer Hospital, Linyi, Shandong, People's Republic of China
| | - Ting Luan
- Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China.,Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Biwei Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Yimei Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Yaping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Xiaorong Sun
- Department of Nuclear Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
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Kim KY, Park HL, Kang HS, Lee HY, Yoo IR, Lee SH, Yeo CD. Clinical Characteristics and Outcome of Pathologic N0 Non-small Cell Lung Cancer Patients With False Positive Mediastinal Lymph Node Metastasis on FDG PET-CT. In Vivo 2021; 35:1829-1836. [PMID: 33910869 DOI: 10.21873/invivo.12444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM Preoperative fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) is a non-invasive and useful diagnostic tool to evaluate mediastinal lymph node (LN) metastasis in lung cancer. However, there are often false-positive LN cases in FDG PET-CT. This study aimed to explore the clinical characteristics and outcome of pathologic N0 non-small cell lung cancer patients with false-positive mediastinal LN on FDG PET-CT. PATIENTS AND METHODS We enrolled 147 patients who underwent preoperative FDG PET-CT scan and mediastinal LN dissection. These patients were re-evaluated for post-operative pathologic nodal metastasis and divided into a false-positive group and a group of others. RESULTS Among 40 patients diagnosed with clinical N1-3 on FDG PET-CT, 19 (47.5%) patients were pathologic N0, meaning false-positive LN by PET-CT. Preoperative absolute platelet count and platelet-lymphocyte ratio were significantly higher in patients with pathologic N0. The presence of lymphatic invasion was significantly lower in patients with pathologic N0 than in the group of others. Recurrence-free survival was significantly shorter in patients with false positive LN than in patients with true positive LN or true negative LN at the same pathologic stage. CONCLUSION Higher absolute platelet count and PLR, lower proportion of lymphatic invasion and shorter recurrence-free survival were associated with false positive mediastinal LN on preoperative FDG PET-CT.
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Affiliation(s)
- Kyu Yean Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Lim Park
- Division of Nuclear Medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwa Young Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ie Ryung Yoo
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;
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23
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Okubo Y, Matsumoto Y, Tanaka M, Imabayashi T, Uezono Y, Watanabe SI, Tsuchida T. Clinical validity of 25-gauge endobronchial ultrasound-guided transbronchial needle in lymph node staging of lung cancer. J Thorac Dis 2021; 13:3033-3041. [PMID: 34164194 PMCID: PMC8182540 DOI: 10.21037/jtd-20-3383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Endobronchial ultrasound-guided transbronchial needle aspiration is recommended for lymph node (LN) staging in lung cancer. Although 22-gauge needles are widely used, they may make some stations difficult to puncture owing to an acute angle. A thinner 25-gauge needle was introduced in Japan at the end of 2016 and offered structural advantages such as improved flexibility and penetrability. We aimed to validate the clinical utility of the 25-gauge needle in LN staging. Methods Patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration for LN staging of lung cancer using the 25-gauge needle at our institution between November 2016 and March 2019 were included. Patient characteristics, staging procedures, pathology findings, and genetic testing success rates were assessed. Results Data of 130 patients were included in the analysis. The sampling rate was 87.6% (589/672 lesions). In addition to stations #4R, #7, and #11, which are generally easy to puncture, multiple stations (40.1%) were sampled. The diagnostic accuracy of combined computed tomography and fluorodeoxyglucose positron emission tomography was 82.3% and that of additional endobronchial ultrasound-guided transbronchial needle aspiration was 96.9%. The overall sensitivity, specificity, and positive and negative predictive values validated using resected specimens were 97.1% (34/35), 100% (41/41), 100% (34/34), and 97.6% (41/42), respectively. The success rate of genetic testing was 100% (34/34). Conclusions The new 25-gauge needle enabled us to approach a wide range of LNs with a desirable sampling rate and diagnostic accuracy in LN staging using endobronchial ultrasound-guided transbronchial needle aspiration, while providing enough tissue for genetic testing.
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Affiliation(s)
- Yu Okubo
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan.,Department of Thoracic Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan.,Department of Comprehensive Oncology, Nagasaki University Graduate School of Biomedical Sciences, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan.,Department of Thoracic Oncology, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Midori Tanaka
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yasuhito Uezono
- Department of Comprehensive Oncology, Nagasaki University Graduate School of Biomedical Sciences, Tsukiji, Chuo-ku, Tokyo, Japan.,Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Shun-Ichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan
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Prediction of Microscopic Metastases in Patients with Metachronous Oligo-Metastases after Curative Treatment of Non-Small Cell Lung Cancer: A Microsimulation Study. Cancers (Basel) 2021; 13:cancers13081884. [PMID: 33919930 PMCID: PMC8070977 DOI: 10.3390/cancers13081884] [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: 03/02/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Many patients with metachronous oligo-metastases in non-small cell lung cancer have their recurrences surgically removed, although the 5-year recurrence-free survival of this group is 16%. This does not provide any benefit for patients with additional undetected metastases. Therefore, we aim to find patient characteristics that are predictive for having additional undetected microscopic metastases. Based on a theoretical approach, we identified the size and number of detected oligo-metastases, as well as the presence of symptoms that are the most important risk predictors. Abstract Metachronous oligo-metastatic disease is variably defined as one to five metastases detected after a disease-free interval and treatment of the primary tumour with curative intent. Oligo-metastases in non-small cell lung cancer (NSCLC) are often treated with curative intent. However additional metastases are often detected later in time, and the 5-year survival is low. Burdensome surgical treatment in patients with undetected metastases may be avoided if patients with a high versus low risk of undetected metastases can be separated. Because there is no clinical data on undetected metastases available, a microsimulation model of the development and detection of metastases in 100,000 hypothetical stage I NSCLC patients with a controlled primary tumour was constructed. The model uses data from the literature as well as patient-level data. Calibration was used for the unobservable model parameters. Metastases can be detected by a scheduled scan, or an unplanned scan when the patient develops symptoms. The observable information at time of detection is used to identify subgroups of patients with a different risk of undetectable metastases. We identified the size and number of detected oligo-metastases, as well as the presence of symptoms that are the most important risk predictors. Based on these predictors, patients could be divided into a low-risk and a high-risk group, having a model-based predicted probability of 8.1% and 89.3% to have undetected metastases, respectively. Currently, the model is based on a synthesis of the literature data and individual patient-level data that were not collected for the purpose of this study. Optimization and validation of the model is necessary to allow clinical usability. We describe the type of data that needs to be collected to update our model, as well as the design of such a validation study.
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Farjah F, Monsell SE, Gould MK, Smith-Bindman R, Banegas MP, Heagerty PJ, Keast EM, Ramaprasan A, Schoen K, Brewer EG, Greenlee RT, Buist DSM. Association of the Intensity of Diagnostic Evaluation With Outcomes in Incidentally Detected Lung Nodules. JAMA Intern Med 2021; 181:480-489. [PMID: 33464296 PMCID: PMC7816118 DOI: 10.1001/jamainternmed.2020.8250] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Whether guideline-concordant lung nodule evaluations lead to better outcomes remains unknown. OBJECTIVE To examine the association between the intensity of lung nodule diagnostic evaluations and outcomes, safety, and health expenditures. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study analyzed health plan enrollees at Kaiser Permanente Washington in Seattle, Washington, and Marshfield Clinic in Marshfield, Wisconsin, with an incidental lung nodule detected between January 1, 2005, and December 31, 2015. Included patients were 35 years or older, had no high suspicion of infection, had no history of malignant neoplasm, and had no evidence of advanced lung cancer on nodule detection. Data analysis was conducted from January 7 to August 19, 2020. EXPOSURES With the 2005 Fleischner Society guidelines (selected for their applicability to the time frame under investigation) as the comparator, 2 other intensities of lung nodule evaluation were defined. Guideline-concordant evaluation followed the guidelines. Less intensive evaluation was the absence of recommended testing, longer-than-recommended surveillance intervals, or less invasive testing than recommended. More intensive evaluation consisted of testing when the guidelines recommended no further testing, shorter-than-recommended surveillance intervals, or more invasive testing than recommended. MAIN OUTCOMES AND MEASURES The main outcome was the proportion of patients with lung cancer who had stage III or IV disease, radiation exposure, procedure-related adverse events, and health expenditures 2 years after nodule detection. RESULTS Among the 5057 individuals included in this comparative effectiveness research study, 1925 (38%) received guideline-concordant, 1863 (37%) less intensive, and 1269 (25%) more intensive diagnostic evaluations. The entire cohort comprised 2786 female patients (55%), and the mean (SD) age was 67 (13) years. Adjusted analyses showed that compared with guideline-concordant evaluations, less intensive evaluations were associated with fewer procedure-related adverse events (risk difference [RD], -5.9%; 95% CI, -7.2% to -4.6%), lower mean radiation exposure (-9.5 milliSieverts [mSv]; 95% CI, -10.3 mSv to -8.7 mSv), and lower mean health expenditures (-$10 916; 95% CI, -$16 112 to -$5719); no difference in stage III or IV disease was found among patients diagnosed with lung cancer (RD, 4.6%; 95% CI, -22% to +31%). More intensive evaluations were associated with more procedure-related adverse events (RD, +8.1%; 95% CI, +5.6% to +11%), higher mean radiation exposure (+6.8 mSv; 95% CI, +5.8 mSv to +7.8 mSv), and higher mean health expenditures ($20 132; 95% CI, +$14 398 to +$25 868); no difference in stage III or IV disease was observed (RD, -0.5%; 95% CI, -28% to +27%). CONCLUSIONS AND RELEVANCE This study found inconclusive evidence of an association between less intensive diagnostic evaluations and more advanced stage at lung cancer diagnosis compared with guideline-concordant care; higher intensities of diagnostic evaluations were associated with greater procedural complications, radiation exposure, and expenditures. These findings underscore the need for more evidence on better ways to evaluate lung nodules and to avoid unnecessarily intensive diagnostic evaluations of lung nodules.
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Affiliation(s)
- Farhood Farjah
- Department of Surgery, University of Washington, Seattle
| | - Sarah E Monsell
- Department of Biostatistics, University of Washington, Seattle
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Research, Pasadena, California.,Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Rebecca Smith-Bindman
- Philip R. Lee Institute for Health Policy Studies, Departments of Radiology and Biomedical Imaging, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Matthew P Banegas
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - Erin M Keast
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Kurt Schoen
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Elena G Brewer
- Department of Surgery, University of Washington, Seattle
| | | | - Diana S M Buist
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.,Kaiser Permanente Washington Health Research Institute, Seattle, Washington
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26
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Moran A, Wang Y, Dyer BA, Yip SSF, Daly ME, Yamamoto T. Prognostic Value of Computed Tomography and/or 18F-Fluorodeoxyglucose Positron Emission Tomography Radiomics Features in Locally Advanced Non-small Cell Lung Cancer. Clin Lung Cancer 2021; 22:461-468. [PMID: 33931316 DOI: 10.1016/j.cllc.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/26/2023]
Abstract
INTRODUCTION We investigated whether adding computed tomography (CT) and/or 18F-fluorodeoxyglucose (18F-FDG) PET radiomics features to conventional prognostic factors (CPFs) improves prognostic value in locally advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS We retrospectively identified 39 cases with stage III NSCLC who received chemoradiotherapy and underwent planning CT and staging 18F-FDG PET scans. Seven CPFs were recorded. Feature selection was performed on 48 CT and 49 PET extracted radiomics features. A penalized multivariate Cox proportional hazards model was used to generate models for overall survival based on CPFs alone, CPFs with CT features, CPFs with PET features, and CPFs with CT and PET features. Linear predictors generated and categorized into 2 risk groups for which Kaplan-Meier survival curves were calculated. A log-rank test was performed to quantify the discrimination between the groups and calculated the Harrell's C-index to quantify the discriminatory power. A likelihood ratio test was performed to determine whether adding CT and/or PET features to CPFs improved model performance. RESULTS All 4 models significantly discriminated between the 2 risk groups. The discriminatory power was significantly increased when CPFs were combined with PET features (C-index 0.82; likelihood ratio test P < .01) or with both CT and PET features (0.83; P < .01) compared with CPFs alone (0.68). There was no significant improvement when CPFs were combined with CT features (0.68). CONCLUSION Adding PET radiomics features to CPFs yielded a significant improvement in the prognostic value in locally advanced NSCLC; adding CT features did not.
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Affiliation(s)
- Angel Moran
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Yichuan Wang
- Department of Statistics, University of California Davis, Davis, CA
| | - Brandon A Dyer
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA
| | | | - Megan E Daly
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Tokihiro Yamamoto
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA.
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Zhang J, Jin J, Ai Y, Zhu K, Xiao C, Xie C, Jin X. Computer Tomography Radiomics-Based Nomogram in the Survival Prediction for Brain Metastases From Non-Small Cell Lung Cancer Underwent Whole Brain Radiotherapy. Front Oncol 2021; 10:610691. [PMID: 33643912 PMCID: PMC7905101 DOI: 10.3389/fonc.2020.610691] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/14/2020] [Indexed: 12/25/2022] Open
Abstract
Prognostic parameters and models were believed to be helpful in improving the treatment outcome for patients with brain metastasis (BM). The purpose of this study was to investigate the feasibility of computer tomography (CT) radiomics based nomogram to predict the survival of patients with BM from non-small cell lung cancer (NSCLC) treated with whole brain radiotherapy (WBRT). A total of 195 patients with BM from NSCLC who underwent WBRT from January 2012 to December 2016 were retrospectively reviewed. Radiomics features were extracted and selected from pretherapeutic CT images with least absolute shrinkage and selection operator (LASSO) regression. A nomogram was developed and evaluated by integrating radiomics features and clinical factors to predict the survival of individual patient. Five radiomics features were screened out from 105 radiomics features according to the LASSO Cox regression. According to the optimal cutoff value of radiomics score (Rad-score), patients were stratified into low-risk (Rad-score <= −0.14) and high-risk (Rad-score > −0.14) groups. Multivariable analysis indicated that sex, karnofsky performance score (KPS) and Rad-score were independent predictors for overall survival (OS). The concordance index (C-index) of the nomogram in the training cohort and validation cohort was 0.726 and 0.660, respectively. An area under curve (AUC) of 0.786 and 0.788 was achieved for the short-term and long-term survival prediction, respectively. In conclusion, the nomogram based on radiomics features from CT images and clinical factors was feasible to predict the OS of BM patients from NSCLC who underwent WBRT.
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Affiliation(s)
- Ji Zhang
- Department of Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Juebin Jin
- Department of Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Ai
- Department of Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kecheng Zhu
- Department of Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chengjian Xiao
- Department of Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Congying Xie
- Department of Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Radiation and Medical Oncology, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiance Jin
- Department of Radiotherapy Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Onal C, Findikcioglu A, Guler OC, Reyhan M. The use of 18F-FDG positron emission tomography to detect mediastinal lymph nodes in metastatic breast cancer. Breast 2020; 54:197-202. [PMID: 33125983 PMCID: PMC7593617 DOI: 10.1016/j.breast.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To assess the predictive value of 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) in detecting mediastinal lymph node metastasis with histopathologic verification in breast cancer (BC) patients. MATERIALS AND METHODS Between February 2012 and October 2019, 37 BC patients who underwent histopathological verification for FDG-PET positive mediastinal lymph nodes were retrospectively analyzed. Nine patients (24%) were screened before beginning treatment, while 27 (76%) were screened at the time of disease progression, an average of 39 months after completion of initial treatment. RESULTS The histopathologic diagnosis revealed lymph node metastasis from BC in 15 patients (40%) and benign disease in 22 patients (60%). The standardized uptake value (SUVmax) of mediastinal lymph nodes was significantly higher in patients with lymph node metastasis compared to those with benign histology (9.0 ± 3.5 vs. 5.9 ± 2.4; P = 0.007). The cut-off value of SUVmax after the ROC curve analysis for pathological lymph node metastasis was 6.4. Two of the 15 patients with mediastinal SUVmax ≤ 6.4 and 13 of the 22 patients with SUVmax > 6.4 had lymph node metastasis. Age and pathological findings were prognostic factors for overall survival in univariate analysis. The treatment decision was changed in 19 patients (51%) after mediastinoscopic evaluation of the entire cohort. CONCLUSIONS This is the first study to support the need for pathologic confirmation of a positive PET/CT result following evaluation of mediastinal lymph nodes for staging BC, either at initial diagnosis or at the time of progression. Treatment decisions were consequently altered for nearly half of the patients.
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Affiliation(s)
- Cem Onal
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey.
| | - Alper Findikcioglu
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Thoracic Surgery, Adana, Turkey
| | - Ozan Cem Guler
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey
| | - Mehmet Reyhan
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Nuclear Medicine, Adana, Turkey
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Bai W, Li S. Prognosis of segmentectomy in the treatment of stage IA non-small cell lung cancer. Oncol Lett 2020; 21:74. [PMID: 33365085 PMCID: PMC7716705 DOI: 10.3892/ol.2020.12335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
With improvements in detection technology, increasing numbers of patients with non-small cell lung cancer (NSCLC) are being diagnosed at an early stage. In order to treat the illness with minimal invasion and preserve lung function to the greatest possible extent, there has been an increasing tendency towards treating early-stage NSCLC by segmentectomy. However, questions remain regarding whether patients may benefit from this procedure considering the surgical and oncological outcomes. Whether adequate margin distance and lymph node dissection may be achieved is one of the most important issues associated with this procedure. The present study reviews the prognosis of segmentectomy in the treatment of stage IA NSCLC.
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Affiliation(s)
- Wenliang Bai
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
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Kalsi HS, Thakrar R, Gosling AF, Shaefi S, Navani N. Interventional Pulmonology: A Brave New World. Thorac Surg Clin 2020; 30:321-338. [PMID: 32593365 DOI: 10.1016/j.thorsurg.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Interventional pulmonology is a dynamic and evolving field in respiratory medicine. Advances have improved the ability to diagnose and manage diseases of the airways. A shift toward early detection of malignant disease has generated a focus on innovative diagnostic techniques. With patient populations living longer with malignant and benign diseases, the role for interventional bronchoscopy has grown. In cancer groups, novel immunotherapies have improved the prospects of clinical outcomes and reignited a focus on optimizing patient performance status to enable access to anticancer therapy. This review discusses current and emerging diagnostic modalities and therapeutic approaches available to manage airway diseases.
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Affiliation(s)
- Hardeep S Kalsi
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Ricky Thakrar
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Andre F Gosling
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK.
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Tekchandani H, Verma S, Londhe N. Performance improvement of mediastinal lymph node severity detection using GAN and Inception network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 194:105478. [PMID: 32447144 DOI: 10.1016/j.cmpb.2020.105478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/21/2020] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE In lung cancer, the determination of mediastinal lymph node (MLN) status as benign or malignant influence treatment planning and survival rate. Invasive pathological tests for the classification of MLNs into benign and malignant have various shortcomings like painfulness, the risk associated with anesthesia, and depends to a large extent on skillset and preferences of the surgeon performing the test. Hence, computer-aided system for MLNs severity detection has been explored widely by the researchers. Very recently, in our earlier concluded work on non-invasive method for MLNs differential diagnosis in computed tomography (CT) images, combination of different data augmentation approaches and state-of-art fully convolutional network (FCN) were implemented to enhance the performance of malignancy detection. However, the performance of FCN network were highly depended on the selection of appropriate data augmentation approach and control of their hyperparameters. Moreover, a standard practice to get hierarchical features in convolutional neural network (CNN) models requires deeper stacking of layers. This leads to an increase in number of trainable parameters which prone to overfitting of the network. METHODS In view of the above mention limitations, in this paper, authors have proposed an approach that includes: 1) Generative Adversarial Network (GAN) for data augmentation, and 2) Inception network for malignancy detection. Unlike conventional data augmentation strategy, GAN based augmentation approach generates data that correlates to original data distribution. In the case of Inception based model, it uses multiple size kernels with factorized convolution for hierarchical feature extraction. This helps to a significant reduction in trainable parameters and the problem of overfitting. RESULTS In this paper, experiments with different GAN approaches, as well as with different Inception architectures, are conducted to evaluate and justify the selection of appropriate GAN and Inception architecture, respectively for MLNs severity detection. The proposed approach achieves superior results with an average accuracy, sensitivity, specificity, and area under curve of 94.95%, 93.65%, 96.67%, and 95%, respectively. CONCLUSION The obtained results validate the usefulness of GANs for data augmentation in the differential diagnosis of benign and malignant MLNs. The proposed Inception network based classifier for malignancy detection shows promising results compared to all investigated methods presented in various literature.
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Affiliation(s)
- Hitesh Tekchandani
- Electronics and Communication Engineering, National Institute of Technology Raipur, NIT Raipur, G E Road, Raipur, Chhattisgarh 492010, India
| | - Shrish Verma
- Electronics and Communication Engineering, National Institute of Technology Raipur, NIT Raipur, G E Road, Raipur, Chhattisgarh 492010, India
| | - Narendra Londhe
- Electrical Engineering, National Institute of Technology Raipur, NIT Raipur,G E Road, Raipur, Chhattisgarh 492010, India.
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Zhang J, Jin J, Ai Y, Zhu K, Xiao C, Xie C, Jin X. Differentiating the pathological subtypes of primary lung cancer for patients with brain metastases based on radiomics features from brain CT images. Eur Radiol 2020; 31:1022-1028. [PMID: 32822055 DOI: 10.1007/s00330-020-07183-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES It is of high clinical importance to identify the primary lesion and its pathological types for patients with brain metastases (BM). The purpose of this study is to investigate the feasibility and accuracy of differentiating the primary adenocarcinoma (AD) and squamous cell carcinoma (SCC) of non-small-cell lung cancer (NSCLC) for patients with BM based on radiomics from brain contrast-enhanced computer tomography (CECT) images. METHODS A total of 144 BM patients (94 male, 50 female) were enrolled in this study with 102 with primary lung AD and 42 with SCC, respectively. Radiomics features from manually contoured tumors were extracted using python. Mann-Whitney U test and the least absolute shrinkage and selection operator (LASSO) logistic regression were applied to select relative radiomics features. Binary logistic regression and support vector machines (SVM) were applied to build models with radiomics features alone and with radiomics features plus age and sex. RESULTS Fourteen features were selected from a total of 105 radiomics features for the final model building. The area under the curves (AUCs) and accuracy of SVM and binary logistic regression models were 0.765 vs. 0.769, 0.795 vs.0.828, and 0.716 vs. 0.726, 0.768 vs. 0.758, respectively, for models with radiomics features alone and models with radiomics features plus sex and age. CONCLUSIONS Brain CECT radiomics are promising in differentiating primary AD and SCC to achieve optimal therapeutic management in patients with BM from NSCLC. KEY POINTS • It is of high clinical importance to identify the primary lesion and its pathological types for patients with brain metastases (BM) to define the prognosis and treatment. • Few studies had investigated the feasibility and accuracy of differentiating the pathological subtypes of primary non-small-cell lung cancer between adenocarcinoma (AD) and squamous cell carcinoma (SCC) for patients with BM based on radiomics from brain contrast-enhanced CT (CECT) images, although CECT images are often the initial imaging modality to screen for metastases and are recommended on equal footing with MRI for the detection of cerebral metastases. • Brain CECT radiomics are promising in differentiating primary AD and SCC to achieve optimal therapeutic management in patients with BM from NSCLC with a highest area under the curve (AUC) of 0.828 and an accuracy of 0.758, respectively.
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Affiliation(s)
- Ji Zhang
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Juebin Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yao Ai
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kecheng Zhu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chengjian Xiao
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China. .,Department of Radiation and Medical Oncology, The Second Affiliated Hospital of Wenzhou Medical University, No. 109 West Xueyuan Road, Wenzhou, 325000, China.
| | - Xiance Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Feller‐Kopman D. Interventional pulmonology: There is no going back, only forward. Respirology 2020; 25:909-910. [DOI: 10.1111/resp.13896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 12/14/2022]
Affiliation(s)
- David Feller‐Kopman
- Director, Bronchoscopy and Interventional Pulmonology, Professor of Medicine, Anesthesiology, Otolaryngology – Head and Neck SurgeryJohns Hopkins Hospital Baltimore MD USA
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Xu CC, Lei W, Jiang JH, Wang ZR, Ni CJ, Huang JA. Endobronchial ultrasound-guided transbronchial needle aspiration can improve the diagnostic accuracy of positron emission tomography/computed tomography in hilar and/or mediastinal lymphadenopathy. J Cancer Res Ther 2020; 15:1490-1495. [PMID: 31939427 DOI: 10.4103/jcrt.jcrt_17_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and positron emission tomography/computed tomography (PET/CT) are the two most extensively used methods for the diagnosis and staging of lung cancer. Aims The present study was designed to compare the diagnostic performance of EBUS-TBNA with that of PET/CT in patients with hilar and/or mediastinal lymphadenopathy. Settings and Design We compared the accuracy of EBUS-TBNA with that of PET/CT in the diagnosis of hilar and/or mediastinal lymphadenopathy and evaluated the diagnostic utility of EBUS-TBNA in patients with PET/CT false-positive and false-negative findings. Methods This study retrospectively analyzed 85 patients with hilar and/or mediastinal lymphadenopathy who underwent EBUS-TBNA and PET/CT between January 2014 and December 2017. The accuracy of EBUS-TBNA histopathology and cytopathology was evaluated and compared with PET/CT scan findings. Results The diagnostic accuracy of EBUS-TBNA combined with PET/CT was significantly higher than that of the single diagnostic method (P < 0.001). Among PET/CT-negative lymph nodes, 4 of 9 (44.4%) malignant lymph nodes were identified by EBUS-TBNA. Among PET/CT-positive lymph nodes, 43 of 47 (91.5%) benign lymph nodes were diagnosed by EBUS-TBNA. Conclusions EBUS-TBNA combined with PET/CT could effectively reduce false-positive and false-negative rates in the diagnosis of hilar and mediastinal lymphadenopathy, which might provide accurate staging, determine optimum therapeutic strategy and improve survival in patients with lung cancer.
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Affiliation(s)
- Chuan-Cai Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Lei
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun-Hong Jiang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zi-Rui Wang
- Department of Respiratory Medicine, The Fifth People's Hospital of Suzhou Wujiang, Suzhou, China
| | - Chong-Jun Ni
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian-An Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
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Wasp GT, Del Prete C, Farrell JAD, Dragnev KH, Russo G, Atkins GT, Phillips JD, Brooks GA. Impact of neuroimaging in the pretreatment evaluation of early stage non-small cell lung cancer. Heliyon 2020; 6:e04319. [PMID: 32637704 PMCID: PMC7330068 DOI: 10.1016/j.heliyon.2020.e04319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/06/2019] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
Background There are limited data and conflicting guideline recommendations regarding the role of neuroimaging in the pretreatment evaluation of non-small cell lung cancer (NSCLC). Methods We performed a retrospective, pragmatic cohort study of patients with NSCLC diagnosed between January 1 and December 31, 2015. Eligible patients were identified from an institutional tumor registry. We collected all records of pretreatment neuroimaging within 12 weeks of diagnosis, including CT head (CT) and MRI brain (MRI). We abstracted the indication for neuroimaging, presence of central neurologic symptoms and cancer stage (with and without neuroimaging findings) from the tumor registry and the electronic health record. Results We identified 216 evaluable patients with newly diagnosed NSCLC. 157 of 216 patients (72.7%) underwent neuroimaging as part of initial staging, and 41 (26%) were found to have brain metastases. Of 43 patients with central neurologic symptoms at the time of neuroimaging, 28 (67%) had brain metastasis. In patients without central neurologic symptoms, brain metastases were discovered in 0 of 33 patients with clinical stage I or II, 4 of 36 (11%) with clinical stage III and 9 of 45 (20%) with clinical stage IV disease. Conclusions In patients with early stage NSCLC (i.e. clinical stage I and II) without central neurologic symptoms, brain metastases are unlikely. The continued use of neuroimaging in the pretreatment evaluation of clinical stage I patients without central neurologic symptoms is not needed.
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Affiliation(s)
- Garrett T Wasp
- Department of Internal Medicine, Section of Medical Oncology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03765, USA
| | - Christopher Del Prete
- Department of Medicine, Division of Hematology/Oncology, Warren Alpert School of Medicine at Brown University, 222 Richmond St, Providence, RI, 02903, USA
| | | | - Konstantin H Dragnev
- Department of Internal Medicine, Section of Medical Oncology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03765, USA
| | - Gregory Russo
- Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, USA
| | - Graham T Atkins
- Department of Internal Medicine, Section of Pulmonology, Dartmouth-Hitchcock Medical Center, USA
| | - Joseph D Phillips
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, USA
| | - Gabriel A Brooks
- Department of Internal Medicine, Section of Medical Oncology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03765, USA
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Kezeminasab S, Emamalizadeh B, Khoubnasabjafari M, Jouyban A. Exhaled Breath Condensate: A Non-Invasive Source for Tracking of Genetic and Epigenetic Alterations in Lung Diseases. PHARMACEUTICAL SCIENCES 2020. [DOI: 10.34172/ps.2020.46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Lung diseases have been recognized as an extensive cause of morbidity and mortality in the worldwide. The high degree of clinical heterogeneity and nonspecific initial symptoms of lung diseases contribute to a delayed diagnosis. So, the molecular and genomic profiling play a pivotal role in promoting the pulmonary diseases. Exhaled breath condensate (EBC) as a novel and potential method for sampling the respiratory epithelial lining fluid is to assess the inflammatory and oxidative stress biomarkers, drugs and genetic alterations in the pathophysiologic processes of lung diseases. The recent studies on the analysis of EBC from both a genetic and epigenetic point of view were searched from database and reviewed. This review provides an overview of the current findings in the tracking of genomic and epigenetic alterations which are potentially effective in better management of cancer detection. In addition, respiratory microbiota DNA using EBC samples in association with pulmonary disease especially lung cancer were investigated. Various studies have concluded that EBC has a great potential for analysis of nuclear and mitochondrial DNA alterations as well as epigenetic modifications and identification of respiratory microbiome. Next-generation sequencing (NGS) based genomic profiling of EBC samples is recommended as a promising approach to establish personalized based prevention, diagnosis, treatment and post-treatment follow-ups for patients with lung diseases especially lung cancer.
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Affiliation(s)
- Somayeh Kezeminasab
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Emamalizadeh
- Department of Medical Genetics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Khoubnasabjafari
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abolghasem Jouyban
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Kimia Idea Pardaz Azerbaijan (KIPA) Science-Based Company, Tabriz University of Medical Sciences, Tabriz, Iran
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Usefulness of Positron Emission Tomography in the Examination of Hilar and Mediastinal Lymphadenopathies in Patients with Suspicion of Lung Cancer. Can Respir J 2020; 2020:7909543. [PMID: 32587645 PMCID: PMC7294363 DOI: 10.1155/2020/7909543] [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: 02/20/2020] [Accepted: 05/08/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Lung cancer is a major health problem. Mediastinal staging performed with the aid of imaging techniques is essential for appropriate disease treatment and prognosis. Accordingly, this study aimed to ascertain the usefulness of positron emission tomography (PET) in mediastinal staging, establish the best maximum standardized uptake value (SUVmax) cutoff point, compare its usefulness to that of computed tomography (CT), and determine the influence of histological tumour subtype. Methods We conducted a retrospective study across a period of 3 years on 128 patients with suspicion of lung cancer and analyzed their demographic and radiological characteristics using CT and PET to perform the mediastinal examination. Histology was regarded as the gold standard. Results PET displayed a high sensitivity (95%) and negative predictive value (NPV) (92%), outperforming CT (89% and 85%, respectively). Percentage agreement with histology was also higher (0.207 and 0.241 for CT and PET, respectively; p < 0.001). Taking an SUVmax value of 0.5 as that which would ensure greatest diagnostic accuracy, S and NPV were 100%, though percentage agreement did not increase (0.189; p < 0.001). PET discriminatory power was not affected by histological tumour subtype. Conclusions The results of our study indicate that PET might be a useful test for examination of the mediastinum in lung cancer patients. Its high NPV suggests that the absence of mediastinal uptake could be used to proceed to surgical treatment without the need for further tests or examinations. Nevertheless, studies directly aimed to answer this specific question are needed.
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Zhai X, Guo Y, Qian X. Combination of Fluorine-18 Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography (¹⁸F-FDG PET/CT) and Tumor Markers to Diagnose Lymph Node Metastasis in Non-Small Cell Lung Cancer (NSCLC): A Retrospective and Prospective Study. Med Sci Monit 2020; 26:e922675. [PMID: 32483109 PMCID: PMC7291785 DOI: 10.12659/msm.922675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The early diagnosis of lymph node (LN) metastasis is crucial for patients with non-small cell lung cancer (NSCLC). However, the diagnosis of LN metastasis mainly dependent on 18F-FDG PET/CT (fluorine-18 fluorodeoxyglucose positron-emission tomography/computed tomography) which exhibited high false positive/negative rate. Material/Methods In retrospective analysis, 135 patients with NSCLC from February 2014 to March 2017 were enrolled. Based on the pathological examination, 71 patients were distributed to the LN Metastasis Group while 64 patients were distributed to the No LN Metastasis Group. Data from 18F-FDG PET/CT and tumor marker (TM) examination were collected to establish a logistic model. The receiver operating characteristic (ROC) curve analysis set the threshold of diagnostic factors. Finally, the diagnostic values of these factors were verified in a prospective analysis that included 78 patients with NSCLC from July 2017 to April 2019. Results In our retrospective analysis, compared with the No LN Metastasis Group, the maximum standardized uptake value (SUVmax)/size of primary lesion, the CT value/SUVmax/short diameter of LN, the level of TM were all significantly different than the LN Metastasis Group (All P<0.05). Our logistic model showed that SUVmax of primary lesion (odds ratio [OR]=1.491), short diameter of LN (OR=1.310) and grade of TM (OR=2.927) were significant variables. The ROC curve analysis showed the specificity and sensitivity of our logistic model was 90.6% and 90.1%, respectively. In our prospective analysis, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the logistic model were calculated as 85.7%, 90.9%, 87.2%, 96.0%, and 71.4%, respectively. Conclusions Our study found that combining 18F-FDG PET/CT data and TM to establish a logistic model performed better in the diagnosis of LN metastasis with low false positive/negative rates in patients with NSCLC.
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Affiliation(s)
- Xiaoli Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yuehong Guo
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xiaojun Qian
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
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Cong M, Yao H, Liu H, Huang L, Shi G. Development and evaluation of a venous computed tomography radiomics model to predict lymph node metastasis from non-small cell lung cancer. Medicine (Baltimore) 2020; 99:e20074. [PMID: 32358390 PMCID: PMC7440109 DOI: 10.1097/md.0000000000020074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to develop a venous computed tomography (CT)-based radiomics model to predict the lymph node metastasis (LNM) in patients with non-small cell lung cancer (NSCLC). A total of 411 consecutive patients with NSCLC underwent tumor resection and lymph node (LN) dissection from January 2018 to September 2018 in our hospital. A radiologist with 20 years of diagnostic experience retrospectively reviewed all CT scans and classified all visible LNs into LNM and non-LNM groups without the knowledge of pathological diagnosis. A logistic regression model (radiomics model) in classification of pathology-confirmed NSCLC patients with and without LNM was developed on radiomics features for NSCLC patients. A morphology model was also developed on qualitative morphology features in venous CT scans. A training group included 288 patients (99 with and 189 without LNM) and a validation group included 123 patients (42 and 81, respectively). The receiver operating characteristic curve was performed to discriminate LNM (+) from LNM (-) for CT-reported status, the morphology model and the radiomics model. The area under the curve value in LNM classification on the training group was significantly greater at 0.79 (95% confidence interval [CI]: 0.77-0.81) by use of the radiomics model (build by best 10 features in predicting LNM) compared with 0.51 by CT-reported LN status (P < .001) or 0.66 (95% CI: 0.64-0.68) by morphology model (build by tumor size and spiculation) (P < .001). Similarly, the area under the curve value on the validation group was 0.73 (95% CI: 0.70-0.76) by the radiomics model, compared with 0.52 or 0.63 (95% CI: 0.60-0.66) by the other 2 (both P < .001). A radiomics model shows excellent performance for predicting LNM in NSCLC patients. This predictive radiomics model may benefit patients to get better treatments such as an appropriate surgery.
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Affiliation(s)
- Mengdi Cong
- Department of Computed Tomography and Magnetic Resonance, Children's Hospital of Hebei Province
| | - Haoyue Yao
- Department of Computed Tomography and Magnetic Resonance, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei Province
| | - Hui Liu
- Cooperate Research Center, United Imaging Healthcare, Shanghai, China
| | - Liqiang Huang
- Department of Computed Tomography and Magnetic Resonance, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei Province
| | - Gaofeng Shi
- Department of Computed Tomography and Magnetic Resonance, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Shijiazhuang, Hebei Province
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Preoperative CT features for prediction of ALK gene rearrangement in lung adenocarcinomas. Clin Radiol 2020; 75:562.e21-562.e29. [PMID: 32307109 DOI: 10.1016/j.crad.2020.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 03/11/2020] [Indexed: 11/20/2022]
Abstract
AIM To identify preoperative features on computed tomography (CT) associated with ALK rearrangement in lung adenocarcinomas presenting as a nodule. MATERIALS AND METHODS This retrospective analysis included 56 patients with ALK rearrangement and 57 that were ALK-negative. All patients had surgically resected lung adenocarcinomas <3 cm. Univariate and multivariate analyses were conducted to analyse clinicopathological and CT features associated with ALK rearrangement. Receiver operating characteristic (ROC) analyses were performed to quantify the performance status of the model. RESULTS ALK rearrangement was associated with lymph node metastases (p=0.004), later pathological stage (p=0.005), lower lobe (p=0.019), lobulation (p=0.006), thickened adjacent bronchovascular bundles (p=0.006), homogeneous tumour (p=0.008), absence of ground-glass opacity (GGO; p<0.001), absence of air bronchogram (p=0.010), smaller relative enhancement (p=0.019), and larger short axis of the largest lymph node (p=0.012). Cavity larger than 1 cm was found in 3 ALK-positive tumours while not in ALK-negative tumours. Multivariate analysis revealed a single predictive model with an AUC of 0.794 that lobulation (OR=4.50, p=0.026), GGO (OR=0.19, p=0.003), and short axis of the largest lymph node (OR=12.49, p=0.047) were independent predictors of ALK rearrangement status. CONCLUSIONS This study identified a modestly predictive radiological model to identify ALK rearrangement in small lung adenocarcinomas.
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Lymph node assessment in early stage non-small cell lung cancer lymph node dissection or sampling? Gen Thorac Cardiovasc Surg 2020; 68:716-724. [PMID: 32266699 DOI: 10.1007/s11748-020-01345-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 12/25/2022]
Abstract
Lymph node assessment is an essential component of the treatment of lung cancer. Identification of the correct "N" stage is important for staging which in turn determines treatment. Assessment of lymph nodes may be accomplished using imaging with CT scan and PET-CT, invasive techniques such as mediastinoscopy, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) or endoscopic ultrasound fine needle aspiration (EUS-FNA). Ultimately, regardless of any pre-resection assessment, lymph nodes must be assessed at the time of resection. The question to be addressed in this report is the role of mediastinal lymph node dissection versus lymph node sampling. However, the issues surrounding lymph node assessment in NSCLC are complex, depending on clinical stage, imaging and histology.
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Sha X, Gong G, Qiu Q, Duan J, Li D, Yin Y. Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging. BMC Med Imaging 2020; 20:12. [PMID: 32024469 PMCID: PMC7003415 DOI: 10.1186/s12880-020-0416-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to develop radiomic models based on different phases of computed tomography (CT) imaging and to investigate the efficacy of models for diagnosing mediastinal metastatic lymph nodes (LNs) in non-small cell lung cancer (NSCLC). Methods Eighty-six NSCLC patients were enrolled in this study, and we selected 231 mediastinal LNs confirmed by pathology results as the subjects which were divided into training (n = 163) and validation cohorts (n = 68). The regions of interest (ROIs) were delineated on CT scans in the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images in each phase. A least absolute shrinkage and selection operator (LASSO) algorithm was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders 1–6) based on the radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV). Results A total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1–6, respectively. All of the models showed excellent discrimination, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 and 0.925; 0.860 and 0.769; 0.871 and 0.882; and 0.906 and 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879 and 0.919 to 0.949 and 0979 and the NPV increased from 0.821 and 0.789 to 0.878 and 0.900 in the training group, respectively. Conclusions All of the CT radiomic models based on different phases all showed high accuracy and precision for the diagnosis of LN metastasis (LNM) in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model was be further improved.
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Affiliation(s)
- Xue Sha
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan, 250358, China
| | - Guanzhong Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingtao Qiu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China
| | - Jinghao Duan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China
| | - Dengwang Li
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan, 250358, China
| | - Yong Yin
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan, 250358, China. .,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China.
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Ehrlich K, Parker HE, McNicholl DK, Reid P, Reynolds M, Bussiere V, Crawford G, Deighan A, Garrett A, Kufcsák A, Norberg DR, Spennati G, Steele G, Szoor-McElhinney H, Jimenez M. Demonstrating the Use of Optical Fibres in Biomedical Sensing: A Collaborative Approach for Engagement and Education. SENSORS (BASEL, SWITZERLAND) 2020; 20:E402. [PMID: 31936827 PMCID: PMC7014119 DOI: 10.3390/s20020402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 12/29/2022]
Abstract
This paper demonstrates how research at the intersection of physics, engineering, biology and medicine can be presented in an interactive and educational way to a non-scientific audience. Interdisciplinary research with a focus on prevalent diseases provides a relatable context that can be used to engage with the public. Respiratory diseases are significant contributors to avoidable morbidity and mortality and have a growing social and economic impact. With the aim of improving lung disease understanding, new techniques in fibre-based optical endomicroscopy have been recently developed. Here, we present a novel engagement activity that resembles a bench-to-bedside pathway. The activity comprises an inexpensive educational tool (<$70) adapted from a clinical optical endomicroscopy system and tutorials that cover state-of-the-art research. The activity was co-created by high school science teachers and researchers in a collaborative way that can be implemented into any engagement development process.
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Affiliation(s)
- Katjana Ehrlich
- EPSRC IRC Hub in Optical Molecular Sensing & Imaging, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.K.); (D.R.N.); (H.S.-M.)
| | - Helen E. Parker
- EPSRC IRC Hub in Optical Molecular Sensing & Imaging, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.K.); (D.R.N.); (H.S.-M.)
| | - Duncan K. McNicholl
- Scottish Universities Physics Alliance (SUPA), Institute of Photonics and Quantum Science, Heriot-Watt University, Edinburgh EH14 4AS, UK;
| | - Peter Reid
- College of Science and Engineering Engagement Team, King’s Buildings, University of Edinburgh, Edinburgh EH9 3BF, UK; (P.R.); (M.R.)
| | - Mark Reynolds
- College of Science and Engineering Engagement Team, King’s Buildings, University of Edinburgh, Edinburgh EH9 3BF, UK; (P.R.); (M.R.)
| | - Vincent Bussiere
- James Watt School of Engineering, Biomedical Engineering Division, University of Glasgow, Glasgow G12 8LT, UK; (V.B.); (A.G.); (G.S.); (M.J.)
| | | | | | - Alice Garrett
- James Watt School of Engineering, Biomedical Engineering Division, University of Glasgow, Glasgow G12 8LT, UK; (V.B.); (A.G.); (G.S.); (M.J.)
| | - András Kufcsák
- EPSRC IRC Hub in Optical Molecular Sensing & Imaging, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.K.); (D.R.N.); (H.S.-M.)
| | - Dominic R. Norberg
- EPSRC IRC Hub in Optical Molecular Sensing & Imaging, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.K.); (D.R.N.); (H.S.-M.)
| | - Giulia Spennati
- James Watt School of Engineering, Biomedical Engineering Division, University of Glasgow, Glasgow G12 8LT, UK; (V.B.); (A.G.); (G.S.); (M.J.)
| | - Gregor Steele
- Scottish Schools Education Research Centre (SSERC), Dunfermline KY11 8UU, UK;
| | - Helen Szoor-McElhinney
- EPSRC IRC Hub in Optical Molecular Sensing & Imaging, Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.K.); (D.R.N.); (H.S.-M.)
| | - Melanie Jimenez
- James Watt School of Engineering, Biomedical Engineering Division, University of Glasgow, Glasgow G12 8LT, UK; (V.B.); (A.G.); (G.S.); (M.J.)
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Abstract
Molecular imaging with positron emission tomography (PET) using tumour-seeking radiopharmaceuticals has gained wide acceptance in oncology with many clinical applications. The hybrid imaging modality PET/CT (computed tomography) allows assessing molecular as well as morphologic information at the same time. Therefore, PET/CT represents an efficient tool for whole-body staging and re-staging within one imaging modality. In oncology, the glucose analogue 18-F-fluorodeoxyglucose (FDG) is the most widely used PET/CT radiopharmaceutical in clinical routine. FDG PET and FDG PET/CT have been used for staging and re-staging of tumour patients in numerous studies. This chapter will discuss the use and the main indications of FDG PET/CT in oncology with special emphasis on lung cancer, lymphoma, head and neck cancer, melanoma and breast cancer (among other tumour entities). A review of the current literature is given with respect to primary diagnosis, staging and diagnosis of recurrent disease. Besides its integral role in diagnosis, staging and re-staging of disease in oncology, there is increasing evidence that FDG PET/CT can be used for therapy response assessment (possibly influencing therapeutic management and treatment planning) by evaluating tumour control, which will also be discussed in this chapter.
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Affiliation(s)
- Juliane Becker
- Department of Nuclear Medicine, University Medicine Rostock, Gertrudenplatz 1, 18057, Rostock, Germany
| | - Sarah M Schwarzenböck
- Department of Nuclear Medicine, University Medicine Rostock, Gertrudenplatz 1, 18057, Rostock, Germany
| | - Bernd J Krause
- Department of Nuclear Medicine, University Medicine Rostock, Gertrudenplatz 1, 18057, Rostock, Germany.
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Panunzio A, Sartori P. Lung Cancer and Radiological Imaging. Curr Radiopharm 2020; 13:238-242. [PMID: 32445458 PMCID: PMC8206195 DOI: 10.2174/1874471013666200523161849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/16/2019] [Accepted: 11/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lung cancer is the neoplasm with the highest prevalence and mortality rates in the world. Most patients with lung cancer that are symptomatic have hemoptysis, coughing, shortness of breath, chest pain and persistent infections. Less than 10% of patients are asymptomatic when the tumor is detected as an incidental finding. OBJECTIVE The present expert review aims to describe the use of radiological imaging modalities for the diagnosis of lung cancer. METHODS Some papers were selected from the international literature, by using mainly Pubmed as a source. RESULTS Chest x-ray (CXR) is the first investigation performed during the workup of suspected lung cancer. In the absence of a rib erosion, CXR cannot distinguish between benign and malignant masses, therefore computed tomography (CT) with contrast enhancement should be performed in order to obtain a correct staging. Magnetic resonance imaging of the chest is considered a secondary approach as the respiratory movement affects the overall results. CONCLUSION Radiological imaging is essential for the management of patients affected by lung cancer.
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Affiliation(s)
- Annalori Panunzio
- UO Radiodiagnostica, Presidio Ospedaliero di Ostuni, ASL Brindisi, Brindisi, Italy
| | - Paolo Sartori
- Ospedale San Giovanni e Paolo, ULSS 3 Veneziana, Venezia, Italy
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Sheha AS, Elia RZ, Ghoneim NMFH. The added value of18F-FDG PET/CT in staging non-small cell lung cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Non-small cell lung cancer (NSCLC) accounts for about 80% of all lung cancers. The current criteria for its staging are based on the TNM system that determines treatment options and predicts survival rate in patients. The aim of the study was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography PET/CT in staging of NSCLC patients.
Methods
A retrospective study was conducted. We reviewed the CT and PET/CT examinations done in our institution on pathologically proven patients of NSCLC, in the period between October 2018 and end of July 2019.
Results
A total of 40 patients were evaluated with the age ranging from 37 to 77 years old, and the mean was 55.63 years (SD ± 10.29). There were 31 male cases and 9 female cases. When we compared contrast enhanced CT (CECT) to PET-CT for staging, PET-CT helped upstage disease in 10 of 40 patients (25%) and downstage in 3 of 40 patients (7.5%).
Conclusion
PET/CT is a useful imaging tool in initial staging of the newly diagnosed patients with NSCLC. It is better thаn СT alone fоr detection of malignant lesions for accurate staging. It can change the strategy of treatment according to its findings.
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47
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Vella M, Meyer CS, Zhang N, Cohen BE, Whooley MA, Wang S, Hope MD. Association of Receipt of Positron Emission Tomography-Computed Tomography With Non-Small Cell Lung Cancer Mortality in the Veterans Affairs Health Care System. JAMA Netw Open 2019; 2:e1915828. [PMID: 31747036 PMCID: PMC6902817 DOI: 10.1001/jamanetworkopen.2019.15828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Positron emission tomography-computed tomography (PET-CT) has been increasingly used in the management of lung cancer, but its association with survival has not been convincingly documented. OBJECTIVE To examine the association of the use of PET-CT with non-small cell lung cancer (NSCLC) mortality in the US Department of Veterans Affairs (VA) health care system from 2000 to 2013. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 64 103 veterans receiving care in the VA health care system who were diagnosed with incident NSCLC between September 2000 and December 2013. Data analysis took place in October 2018. EXPOSURE Use of PET-CT before and/or after diagnosis. MAIN OUTCOMES AND MEASURES All-cause and NSCLC-specific 5-year mortality; secondary outcome was receipt of stage-appropriate treatment. RESULTS A total of 64 103 veterans with the diagnosis of NSCLC were evaluated; 62 838 (98.0%) were men, and 50 584 (78.9%) were white individuals. Among these, 51 844 (80.9%) had a PET-CT performed: 25 735 (40.1%) in the 12 months before diagnosis and 41 242 (64.3%) in the 5 years after diagnosis. Increased PET-CT use (597 of 978 veterans [59.2%] in 2000 vs 3649 of 3915 [93.2%] in 2013) and decreased NSCLC-specific 5-year mortality (879 of 978 veterans [89.9%] in 2000 vs 3226 of 3915 veterans [82.4%] in 2013) were found over time. Increased use of stage-appropriate therapy was also seen over time, from 346 of 978 veterans (35.4%) in 2000 to 2062 of 3915 (52.7%) in 2013 (P < .001). Increased PET-CT use was associated with higher-complexity level VA facilities (26 127 veterans [82.3%] at level 1a vs 1289 [75.2%] at level 3 facilities; P < .001) and facilities with on-site PET-CT compared with facilities without on-site PET-CT (33 081 [82.2%] vs 17 443 [80.3%]; P < .001). Use of PET-CT before diagnosis was associated with increased likelihood of stage-appropriate treatment for all stages of NSCLC (eg, veterans with stage 1 disease: 4837 of 7870 veterans [61.5%] who received PET-CT underwent surgical resection vs 4042 of 7938 veterans [50.9%] who did not receive PET-CT; P < .001) and decreased mortality in a risk-adjusted model among all participants and among veterans undergoing stage-appropriate treatment (all-cause mortality: hazard ratio [HR], 0.78; 95% CI, 0.77-0.79; NSCLC-specific mortality: HR, 0.78; 95% CI, 0.76-0.80). Facilities with on-site PET-CT and higher-complexity level facilities were associated with a mortality benefit, with 16% decreased mortality at level 1a vs level 3 facilities (HR, 0.84; 95% CI, 0.80-0.89) and a 3% decrease in all-cause mortality in facilities with on-site PET-CT (HR, 0.97; 95% CI, 0.96-0.99). CONCLUSIONS In this study, the use of PET-CT among veterans with NSCLC significantly increased from 2000 to 2013, coinciding with decreased 5-year mortality and an increase in stage-appropriate treatment. Variation in use of PET-CT was found, with the highest use at higher-complexity level facilities and those with PET-CT on-site. These facilities were associated with reduced all-cause and NSCLC-specific mortality.
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Affiliation(s)
- Maya Vella
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Craig S. Meyer
- Department of Medicine, University of California, San Francisco
| | - Ning Zhang
- Department of Medicine, University of California, San Francisco
| | - Beth E. Cohen
- Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Mary A. Whooley
- Department of Medicine, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sunny Wang
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- Division of Hematology and Oncology, University of California, San Francisco
| | - Michael D. Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System, San Francisco, California
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Walter MA. The Role of Positron Emission Tomography-Computed Tomography in the Workup of Non-Small Cell Lung Cancer. JAMA Netw Open 2019; 2:e1915873. [PMID: 31747028 DOI: 10.1001/jamanetworkopen.2019.15873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Martin A Walter
- Service of Nuclear Medicine, Diagnostic Department, University Hospital, University of Geneva, Geneva, Switzerland
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Ost DE, Niu J, Zhao H, Grosu HB, Giordano SH. Quality Gaps and Comparative Effectiveness in Lung Cancer Staging and Diagnosis. Chest 2019; 157:1322-1345. [PMID: 31610159 DOI: 10.1016/j.chest.2019.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guidelines recommend mediastinal sampling first for patients with mediastinal lymphadenopathy with suspected lung cancer. The objective of this study was to describe practice patterns and outcomes of diagnostic strategies in patients with lung cancer. METHODS This study included a retrospective cohort of 15,914 patients with lung cancer with T1-3N1-3M0 disease diagnosed from 2004 to 2013 in the National Cancer Institute's Surveillance, Epidemiology, and End Results or Texas Cancer Registry Medicare-linked databases. Patients who had mediastinal sampling as their first invasive test were classified as guideline consistent; all others were guideline inconsistent. Propensity matching was used to compare the number of tests performed, and multivariable logistic regression was used to compare the incidence of complications. RESULTS Guideline-consistent care increased from 23% to 34% of patients from 2004 to 2013 (P < .001). Use of endobronchial ultrasound-guided transbronchial needle aspiration increased from 0.1% to 25% of all patients (P < .001), and mediastinal sampling increased from 54% to 64% (P < .0001). Guideline-consistent care was associated with fewer thoracotomies (38% vs 71%; P < .001) and CT scan-guided biopsies (10% vs 75%; P < .001) than guideline-inconsistent care but more transbronchial needle aspirations (59% vs 12%; P < .001). Guideline-consistent care was associated with fewer pneumothoraxes (5.1% vs 22%; P < .001), chest tubes (0.9% vs 4.4%; P < .001), hemorrhages (3.5% vs 5.8%; P < .001), and respiratory failure events (2.7% vs 3.7%; P = .047) than guideline-inconsistent care. Bronchoscopic mediastinal sampling was associated with fewer complications than surgical mediastinal sampling. CONCLUSIONS Guideline-consistent care with mediastinal sampling first was associated with fewer tests and complications. Quality gaps decreased with the introduction of endobronchial ultrasound-guided transbronchial needle aspiration but persist. Gaps include failure to sample the mediastinum first, failure to sample the mediastinum at all, and overuse of thoracotomy.
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Affiliation(s)
- David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Jiangong Niu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hui Zhao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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[Lung cancer and elective nodal irradiation: A solved issue?]. Cancer Radiother 2019; 23:701-707. [PMID: 31501024 DOI: 10.1016/j.canrad.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/27/2019] [Indexed: 12/25/2022]
Abstract
Lung cancer treatment is a heavy workload for radiation oncologist and that field showed many evolutions over the last two decades. The issue about target volume was raised when treatment delivery became more precise with the development of three-dimensional conformal radiotherapy. Initially based upon surgical series, numerous retrospective and prospective studies aimed to evaluate the risk of elective nodal failure of involved-field radiotherapy compared to standard large field elective nodal irradiation. In every setting, locally advanced non-small cell lung cancer, localized non-small cell lung cancer, localized small cell lung cancer, exclusive chemoradiation or postoperative radiotherapy, most of the studies showed no significant difference between involved-field radiotherapy or elective nodal irradiation with elective nodal failure rate under 5% at 2 years, provided staging had been done with modern imaging and diagnostic techniques (positron emission tomography scan, endoscopy, etc.). Moreover, if reducing irradiated volumes are safe regarding recurrences, involved-field radiotherapy allowed dose escalation while reducing acute and late oesophageal, cardiac and pulmonary toxicities. Consequently, major clinical trials involving radiotherapy initiated in the last two decades and international clinical guidelines recommended omission of elective nodal irradiation in favour of in-field radiotherapy.
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