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Reid MM, Amja JJ, Riestra Guiance IT, Andani RR, Vierkant RA, Goyal A, Reisenauer JS. A Retrospective External Validation of the Cleveland Clinic Malignancy Probability Prediction Model for Indeterminate Pulmonary Nodules. Mayo Clin Proc Innov Qual Outcomes 2024; 8:375-383. [PMID: 39069970 PMCID: PMC11283066 DOI: 10.1016/j.mayocpiqo.2024.05.005] [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] [Indexed: 07/30/2024] Open
Abstract
Objective To perform a retrospective, multicenter, external validation of the Cleveland Clinic malignancy probability prediction model for incidental pulmonary nodules. Patients and Methods From July 1, 2022, to May 31, 2023, we identified 296 patients who underwent tissue acquisition at Mayo Clinic (MC) (n=198) and Loyola University Medical Center (n=98) with histopathology indicating malignant (n=195) or benign (n=101). Data was collected at initial radiographic identification (point 1) and at the time of intervention (point 2). Point 3 represented the most recent data. The areas under the receiver operating characteristics were calculated for each model per time point. Calibration was evaluated by comparing the predicted and observed rates of malignancy. Results The areas under the receiver operating characteristics at time points 1, 2, and 3 for the MC model were 0.67 (95% CI, 0.61-0.74), 0.67 (95% CI, 0.58-0.77), and 0.70 (95% CI, 0.63-0.76), respectively. The Cleveland Clinic model (CCM) was 0.68 (95% CI, 0.61-0.74), 0.75 (95% CI, 0.65-0.84), and 0.72 (95% CI, 0.66-0.78), respectively. The mean ± SD estimated probability for malignant pulmonary nodules (PNs) at time points 1, 2, and 3 for the CCM was 64.2±25.9, 65.8±24.0, and 64.7±24.4, which resembled the overall proportion of malignant PNs (66%). The mean estimated probability of malignancy for the MC model at each time point was 38.3±27.4, 36.2±24.4, and 42.1±27.3, substantially lower than the observed proportion of malignancies. Conclusion The CCM found discrimination similar to its internal validation and good calibration. The CCM can be used to augment clinical and shared decision-making when evaluating high-risk PNs.
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Affiliation(s)
- Michal M. Reid
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Jack J. Amja
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL
- Division of Pulmonary, Critical Care, and Sleep Medicine, Hartford Healthcare Medical Group, Hartford, CT
| | | | - Rupesh R. Andani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert A. Vierkant
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Amit Goyal
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL
| | - Janani S. Reisenauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Division of Thoracic Surgery, Mayo Clinic, Rochester, MN
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Chang AEB, Potter AL, Yang CFJ, Sequist LV. Early Detection and Interception of Lung Cancer. Hematol Oncol Clin North Am 2024; 38:755-770. [PMID: 38724286 DOI: 10.1016/j.hoc.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Recent advances in lung cancer treatment have led to dramatic improvements in 5-year survival rates. And yet, lung cancer remains the leading cause of cancer-related mortality, in large part, because it is often diagnosed at an advanced stage, when cure is no longer possible. Lung cancer screening (LCS) is essential for intercepting the disease at an earlier stage. Unfortunately, LCS has been poorly adopted in the United States, with less than 5% of eligible patients being screened nationally. This article will describe the data supporting LCS, the obstacles to LCS implementation, and the promising opportunities that lie ahead.
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Affiliation(s)
- Allison E B Chang
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA; Department of Hematology/Oncology, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chi-Fu Jeffrey Yang
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lecia V Sequist
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Lim RS, Rosenberg J, Willemink MJ, Cheng SN, Guo HH, Hollett PD, Lin MC, Madani MH, Martin L, Pogatchnik BP, Pohlen M, Shen J, Tsai EB, Berry GJ, Scott G, Leung AN. Volumetric Analysis: Effect on Diagnosis and Management of Indeterminate Solid Pulmonary Nodules in Routine Clinical Practice. J Comput Assist Tomogr 2024:00004728-990000000-00335. [PMID: 38968327 DOI: 10.1097/rct.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To evaluate the effect of volumetric analysis on the diagnosis and management of indeterminate solid pulmonary nodules in routine clinical practice. METHODS This was a retrospective study with 107 computed tomography (CT) cases of solid pulmonary nodules (range, 6-15 mm), 57 pathology-proven malignancies (lung cancer, n = 34; metastasis, n = 23), and 50 benign nodules. Nodules were evaluated on a total of 309 CT scans (average number of CTs/nodule, 2.9 [range, 2-7]). CT scans were from multiple institutions with variable technique. Nine radiologists (attendings, n = 3; fellows, n = 3; residents, n = 3) were asked their level of suspicion for malignancy (low/moderate or high) and management recommendation (no follow-up, CT follow-up, or care escalation) for baseline and follow-up studies first without and then with volumetric analysis data. Effect of volumetry on diagnosis and management was assessed by generalized linear and logistic regression models. RESULTS Volumetric analysis improved sensitivity (P = 0.009) and allowed earlier recognition (P < 0.05) of malignant nodules. Attending radiologists showed higher sensitivity in recognition of malignant nodules (P = 0.03) and recommendation of care escalation (P < 0.001) compared with trainees. Volumetric analysis altered management of high suspicion nodules only in the fellow group (P = 0.008). κ Statistics for suspicion for malignancy and recommended management were fair to substantial (0.38-0.66) and fair to moderate (0.33-0.50). Volumetric analysis improved interobserver variability for identification of nodule malignancy from 0.52 to 0.66 (P = 0.004) only on the second follow-up study. CONCLUSIONS Volumetric analysis of indeterminate solid pulmonary nodules in routine clinical practice can result in improved sensitivity and earlier identification of malignant nodules. The effect of volumetric analysis on management recommendations is variable and influenced by reader experience.
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Affiliation(s)
| | - Jarrett Rosenberg
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Martin J Willemink
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Sarah N Cheng
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Henry H Guo
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Philip D Hollett
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Margaret C Lin
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | | | - Lynne Martin
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Brian P Pogatchnik
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Michael Pohlen
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Jody Shen
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Emily B Tsai
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA
| | | | - Ann N Leung
- From the Department of Radiology, Stanford University School of Medicine, Stanford, CA
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4
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Corcoran A, Finn L, Piccione J, Phinizy P. Computed tomography navigation guided transparenchymal nodule biopsy in pediatric patients with pulmonary lesions. Pediatr Pulmonol 2024; 59:2012-2014. [PMID: 38578145 DOI: 10.1002/ppul.26999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Aoife Corcoran
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Laura Finn
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Piccione
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Pelton Phinizy
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Husta BC, Menon A, Bergemann R, Lin IH, Schmitz J, Rakočević R, Nadig TR, Adusumilli PS, Beattie JA, Lee RP, Park BJ, Rocco G, Bott MJ, Chawla M, Kalchiem-Dekel O. The incremental contribution of mobile cone-beam computed tomography to the tool-lesion relationship during shape-sensing robotic-assisted bronchoscopy. ERJ Open Res 2024; 10:00993-2023. [PMID: 39040587 PMCID: PMC11261373 DOI: 10.1183/23120541.00993-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/16/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction This study aims to answer the question of whether adding mobile cone-beam computed tomography (mCBCT) imaging to shape-sensing robotic-assisted bronchoscopy (ssRAB) translates into a quantifiable improvement in the tool-lesion relationship. Methods Data from 102 peripheral lung lesions with ≥2 sequential mCBCT orbital spins and from 436 lesions with 0-1 spins were prospectively captured and retrospectively analysed. The primary outcome was the tool-lesion relationship status across the first and the last mCBCT spins. Secondary outcomes included 1) the change in distance between the tip of the sampling tool and the centre of the lesion between the first and the last spins and 2) the per-lesion diagnostic yield. Results Compared to lesions requiring 0-1 spins, lesions requiring ≥2 spins were smaller and had unfavourable bronchus sign and intra-operative sonographic view. On the first spin, 54 lesions (53%) were designated as non-tool-in-lesion (non-TIL) while 48 lesions (47%) were designated as TIL. Of the 54 initially non-TIL cases, 49 (90%) were converted to TIL status by the last spin. Overall, on the last spin, 96 out of 102 lesions (94%) were defined as TIL and six out of 102 lesions (6%) were defined as non-TIL (p<0.0001). The mean distance between the tool and the centre of the lesion decreased from 10.4 to 6.6 mm between the first and last spins (p<0.0001). The overall diagnostic yield was 77%. Conclusion Targeting traditionally challenging lung lesions, intra-operative volumetric imaging allowed for the conversion of 90% of non-TIL status to TIL. Guidance with mCBCT resulted in a significant decrease in the distance between the tip of the needle to lesion centre.
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Affiliation(s)
- Bryan C. Husta
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anu Menon
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Reza Bergemann
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - I-Hsin Lin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaclyn Schmitz
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rastko Rakočević
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tejaswi R. Nadig
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S. Adusumilli
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason A. Beattie
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert P. Lee
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard J. Park
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gaetano Rocco
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew J. Bott
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohit Chawla
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Or Kalchiem-Dekel
- Section of Interventional Pulmonology, Pulmonary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Lee D, Chae G, Kim JH, Ra SW, Seo KW, Jegal Y, Ahn JJ, Lee T. Diagnostic utility of adding needle aspiration (using PeriView FLEX needle) to radial endobronchial ultrasound guide sheath transbronchial lung biopsy: a single center retrospective study. J Thorac Dis 2024; 16:3818-3827. [PMID: 38983157 PMCID: PMC11228739 DOI: 10.21037/jtd-23-1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 04/30/2024] [Indexed: 07/11/2024]
Abstract
Background Radial endobronchial ultrasound (rEBUS) guide sheath (GS) transbronchial lung biopsy (TBLB) improves the diagnostic yield of peripheral lung lesions (PLL). However, its diagnostic yield is approximately 60%. We aimed to evaluate the diagnostic utility of adding rEBUS GS transbronchial needle aspiration (TBNA) using PeriView FLEX needle (Olympus, Tokyo, Japan) to rEBUS GS TBLB. Methods In this retrospective study, we initially screened 124 PLLs in 123 patients who underwent rEBUS GS procedures for PLLs from December 2020 to August 2021. The analysis was performed on 74 PLLs in 73 patients who underwent both rEBUS GS TBLB and TBNA. Results PLLs showed the following characteristics: lesion size [mean ± standard deviation (SD)], 24±12 mm; nature (solid vs. subsolid), 59 (79.7%) vs. 15 (20.3%); distance from the pleura (mean ± SD), 14±14 mm; rEBUS visualization type (probe within PLL vs. probe adjacent to PLL), 56 (75.7%) vs. 18 (24.3%). Among 74 PLLs, 47 (63.5%) were successfully diagnosed by rEBUS GS TBLB. In 27 PLLs not diagnosed by rEBUS GS TBLB, 5 (18.5%) were further diagnosed by rEBUS GS TBNA [overall diagnostic yield: 70.3% (52/74)]. EBUS visualization type of "probe adjacent to PLL" was a significant factor associated with the diagnostic yield of additional rEBUS GS TBNA. Conclusions In rEBUS GS procedures for PLLs, the diagnostic yield might be improved by implementing TBNA in addition to TBLB. In particular, additional TBNA is preferable if the probe is adjacent to the lesion rather than within the lesion on rEBUS.
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Affiliation(s)
- Donghyun Lee
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ganghee Chae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jin Hyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung Won Ra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang Won Seo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yangjin Jegal
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Joon Ahn
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taehoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Hammer MM, Hunsaker AR. Risk of Lung Cancer in Peripheral Pulmonary Nodules. Acad Radiol 2024:S1076-6332(24)00380-5. [PMID: 38945743 DOI: 10.1016/j.acra.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE To determine the risk of lung cancer and inter-observer agreement for small pulmonary nodules either touching or near the pleura. METHODS Nodules were derived from two cohorts: patients from the National Lung Screening Trial with a solid nodule measuring 6-9.5 mm; and patients with incidental pulmonary nodules in our healthcare system with a solid nodule measuring 1-8 mm. Only the dominant nodule was evaluated for each patient. All malignant nodules as well as a random sample of 200 benign nodules from each cohort were included. Two fellowship-trained thoracic radiologists independently reviewed each case to record nodule morphology (compatible with lymph node or not) and nodule location (pleural-based, septal connection to the pleura, or neither). One radiologist measured the distance to the pleura. RESULTS After exclusion criteria were applied, a total of 434 nodules were included, of which 45 were lung cancers. Considering all pleural-based nodules with lymph node morphology as benign, 0-7% of cancers were misclassified as benign, specificity 33%, and κ = 0.69. Considering subpleural nodules and those with septal connection to the pleura, 7-11% of cancers were misclassified (p = 0.16-0.25 versus pleural-based), specificity 40-52% (p < .0001), and κ = 0.60. Considering nodules with lymph node morphology ≤ 2 mm from the pleura, 2-7% of cancers were misclassified (p = 1 versus pleural-based), specificity 41-36% (p < .0001), and κ = 0.78. CONCLUSION Considering nodules with lymph node morphology with septal connection, or those ≤ 2 mm from the pleura, as benign does not lead to significant misclassification of lung cancers as benign.
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Affiliation(s)
- Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | - Andetta R Hunsaker
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Nomenoğlu H, Fındık G, Çetin M, Aydoğdu K, Gülhan SŞE, Bıçakçıoğlu P. Efficiency of pulmonary nodule risk scoring systems in Turkish population. Updates Surg 2024:10.1007/s13304-024-01901-8. [PMID: 38944649 DOI: 10.1007/s13304-024-01901-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/21/2024] [Indexed: 07/01/2024]
Abstract
Malignancy risk calculation models were developed using the clinical and radiological features. It was aimed to compare pulmonary nodule risk calculation models and evaluate their effectiveness and applicability for the Turkish population. Between 2014 and 2019, 351 patients who were operated on for pulmonary nodules were evaluated with the following data: age, gender, smoking history, family history of lung cancer, extrapulmonary malignancy and granulomatous disease, nodule diameter, attenuation character, side, localization, spiculation, nodule count, presence of pulmonary emphysema, FDG uptake in PET/CT of the nodule, and definitive pathology data. Malignancy risk scores were calculated using the equations of the Brock, Mayo, and Herder models. The results were evaluated statistically. The mean age of the 351 patients (236 men, 115 women) was 57.84 ± 10.87 (range 14-79) years, and 226 malignant and 125 benign nodules were observed. Significant correlations were found between malignancy and age (p < 0.001), nodule diameter (p < 0.001), gender (p < 0.009), speculation (p < 0.001), emphysema (p < 0.05), FDG uptake (p < 0.001). All three models were found effective in the differentiation (p < 0.001). The ideal threshold value was determined for the Brock (19.5%), Mayo (23.1%), and Herder (56%) models. All models were effective for nodules of > 10 mm, but none of them were for 0-10 mm. Brock was effective in ground-glass nodules (p = 0.02) and all models were effective for semi-solid and solid nodules. None of the groups could provide AUC values as high as those achieved in the original studies. This suggests the need to optimize models and malignancy risk thresholds for Turkish population.
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Affiliation(s)
- Hakan Nomenoğlu
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Göktürk Fındık
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Mehmet Çetin
- Department of Thoracic Surgery, Ministry of Health, Nigde Omer Halisdemir Training and Research Hospital, Nigde, Turkey.
| | - Koray Aydoğdu
- Department of Thoracic Surgery, University of Health Sciences, Ankara Etlik City Hospital, Ankara, Turkey
| | - Selim Şakir Erkmen Gülhan
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | - Pınar Bıçakçıoğlu
- Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
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Sadoughi A, Synn S, Chan C, Schecter D, Hernandez Romero G, Virdi S, Sarkar A, Kim M. Ultrathin Bronchoscopy Without Virtual Navigation for Diagnosis of Peripheral Lung Lesions. Lung 2024:10.1007/s00408-024-00695-1. [PMID: 38864890 DOI: 10.1007/s00408-024-00695-1] [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: 12/24/2023] [Accepted: 03/31/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND The increasing incidence of encountering lung nodules necessitates an ongoing search for improved diagnostic procedures. Various bronchoscopic technologies have been introduced or are in development, but further studies are needed to define a method that fits best in clinical practice and health care systems. RESEARCH QUESTION How do basic bronchoscopic tools including a combination of thin (outer diameter 4.2 mm) and ultrathin bronchoscopes (outer diameter 3.0 mm), radial endobronchial ultrasound (rEBUS) and fluoroscopy perform in peripheral pulmonary lesion diagnosis? STUDY DESIGN AND METHODS This is a retrospective review of the performance of peripheral bronchoscopy using thin and ultrathin bronchoscopy with rEBUS and 2D fluoroscopy without a navigational system for evaluating peripheral lung lesions in a single academic medical center from 11/2015 to 1/2021. We used a strict definition for diagnostic yield and assessed the impact of different variables on diagnostic yield, specifically after employment of the ultrathin bronchoscope. Logistic regression models were employed to assess the independent associations of the most impactful variables. RESULTS A total of 322 patients were included in this study. The median of the long axis diameter was 2.2 cm and the median distance of the center of the lesion from the visceral pleural surface was 1.9 cm. Overall diagnostic yield was 81.3% after employment of the ultrathin bronchoscope, with more detection of concentric rEBUS views (93% vs. 78%, p < 0.001). Sensitivity for detecting malignancy also increased from 60.5% to 74.7% (p = 0.033) after incorporating the ultrathin scope into practice, while bronchus sign and peripheral location of the lesion were not found to affect diagnostic yield. Concentric rEBUS view, solid appearance, upper/middle lobe location and larger size of the nodules were found to be independent predictors of successful achievement of diagnosis at bronchoscopy. INTERPRETATION This study demonstrates a high diagnostic yield of biopsy of lung lesions achieved by utilization of thin and ultrathin bronchoscopes. Direct visualization of small peripheral airways with simultaneous rEBUS confirmation increased localization rate of small lesions in a conventional bronchoscopy setting without virtual navigational planning.
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Affiliation(s)
- Ali Sadoughi
- Division of Pulmonary, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA.
| | - Shwe Synn
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA
| | - Christine Chan
- Division of Pulmonary, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA
| | - David Schecter
- Division of Pulmonary, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, USA
| | | | - Sahil Virdi
- Division of pulmonary and critical care, United Hospital Center, West Virginia University Health System, Charleston, USA
| | - Abhishek Sarkar
- Section of Interventional Pulmonology, Department of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center / New York Medical College, Valhalla, USA
| | - Mimi Kim
- Division of Biostatistics, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, USA
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10
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Chan PS, Chang LK, Malwade S, Chung WY, Yang SM. Cone Beam CT Derived Laser-Guided Percutaneous Lung Ablation: Minimizing Needle-Related Complications Under General Anesthesia with Lung Separation. Acad Radiol 2024:S1076-6332(24)00284-8. [PMID: 38862349 DOI: 10.1016/j.acra.2024.04.049] [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: 01/23/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024]
Abstract
RATIONALE AND OBJECTIVES Percutaneous lung tumor ablations are mostly performed in computed tomography (CT) rooms under local anesthesia with conscious sedation. However, maintaining the breath-hold phase during this can be challenging, affecting image quality and increasing complications. With the advent of hybrid operating rooms (HORs), this procedure can be performed with endotracheal tube (ETGA) intubation under general anesthesia with lung separation, ensuring precise imaging in a single-stage setting. Lung separation provides surgical exposure of one lung while ensuring ample gas exchange with the other. This study evaluated tumor ablations performed in an HOR equipped with cone beam CT and laser guidance. MATERIALS AND METHODS This retrospective study included patients who underwent lung tumor ablation under general anesthesia with an ETGA in an HOR between July 2020 and May 2023. Anesthesia considerations, perioperative management, and postoperative follow-ups were evaluated. RESULTS 65 patients (78 tumors) underwent ablation using two types of lung ventilation methods including a single-lumen tube with a blocker (SLT/BL) (n = 15) and double-lumen tube (DLT) (n = 50). Most patients experienced desaturation during the apnea phase of dynamic CT and needling. The average SpO2 value was significantly lower in the DLT group than in the SLT/BL group during the procedure (81.1% versus 88.7%, P = 0.033). Five, three, and two patients developed pneumothorax, subcutaneous emphysema, and pleural effusion, respectively. CONCLUSION Percutaneous ablation under general anesthesia with endotracheal intubation and lung separation performed in HORs was feasible and safe. The setup minimized complication risks and maintained a balance between patient safety and successful procedures.
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Affiliation(s)
- Pak-Si Chan
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | | | - Wen-Yuan Chung
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
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Gieske MR, Kerns J, Schmitt GM, Kloecker G, Budhani IA, Nolan J, Williams VA, Alkapalan D, Ferguson K, Yadav R, Calhoun RF. Overcoming barriers to lung cancer screening using a systemwide approach with additional focus on the non-screened. J Med Screen 2024; 31:99-106. [PMID: 37855047 DOI: 10.1177/09691413231208160] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND The lung cancer screening program at St Elizabeth Healthcare (Kentucky, USA) began in 2013. Over 33,000 low-dose computed tomography lung cancer screens have been performed. From 2015 through 2021, 2595 lung cancers were diagnosed systemwide. A Screening Program with Impactful Results from Early Detection, reviews that experience; 342 (13.2%) were diagnosed by screening and 2253 (86.8%) were non-screened. As a secondary objective, the non-screened cohort was queried to determine how many additional individuals could have been screened, identifying barriers and failures to meet eligibility. METHODS Our QlikSense database extracted the lung cancer patients from the Cancer Patient Data and Management System, and identified and categorized them separately as screened or non-screened populations. Stage distribution was compared in screened and non-screened groups. Those meeting age criteria, with any smoking history, were further queried for screening eligibility, accessing the electronic medical record smoking history and audit trail, and determining if enough information was available to substantiate screening eligibility. The same methodology was applied to CMS 2015 and USPSTF 2021 criteria. RESULTS The screened and non-screened patients were accounted for in a stage migration chart demonstrating clear shift to early stage among screened lung cancer patients. Additionally, analysis of non-screened individuals is presented. CONCLUSION Of the St Elizabeth Healthcare eligible patients attributed to primary care providers, 49.6% were screened in 2021. Despite this level of success, this study highlighted a sizeable pool of additional individuals that could have been screened. We are shifting focus to the non-screened pool of patients that meet eligibility, further enhancing the impact on our community.
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Affiliation(s)
- Michael R Gieske
- Lung Cancer Screening, St Elizabeth Healthcare, Ft. Mitchell, KY, USA
| | - Jessica Kerns
- Lung Cancer Screening, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Gary M Schmitt
- Radiology Associates of Northern Kentucky, Crestview Hills, KY, USA
| | - Goetz Kloecker
- Thoracic Medical Oncology, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Irfan A Budhani
- Pulmonary Medicine, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Joseph Nolan
- Department of Mathematics and Statistics, Northern Kentucky University, Highland Heights, KY, USA
| | - Valerie A Williams
- Division of Thoracic Surgery, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Deema Alkapalan
- Deptartment of Pathology, St Elizabeth Healthcare, Edgewood, KY, USA
| | - Katelyn Ferguson
- University of Kentucky Medical School, Highland Heights, KY, USA
| | - Ryan Yadav
- University of Kentucky Medical School, Highland Heights, KY, USA
| | - Royce F Calhoun
- Division of Thoracic Surgery, St Elizabeth Healthcare, Edgewood, KY, USA
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12
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Azour L, Oh AS, Prosper AE, Toussie D, Villasana-Gomez G, Pourzand L. Subsolid Nodules: Significance and Current Understanding. Clin Chest Med 2024; 45:263-277. [PMID: 38816087 DOI: 10.1016/j.ccm.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Subsolid nodules are heterogeneously appearing and behaving entities, commonly encountered incidentally and in high-risk populations. Accurate characterization of subsolid nodules, and application of evolving surveillance guidelines, facilitates evidence-based and multidisciplinary patient-centered management.
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Affiliation(s)
- Lea Azour
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Box 957437, 757 Westwood Plaza, Los Angeles, CA 90095-7437, USA.
| | - Andrea S Oh
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Box 957437, 757 Westwood Plaza, Los Angeles, CA 90095-7437, USA
| | - Ashley E Prosper
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Box 957437, 757 Westwood Plaza, Los Angeles, CA 90095-7437, USA
| | - Danielle Toussie
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 1st Avenue, New York, NY 10016, USA
| | - Geraldine Villasana-Gomez
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 1st Avenue, New York, NY 10016, USA
| | - Lila Pourzand
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Box 957437, 757 Westwood Plaza, Los Angeles, CA 90095-7437, USA
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13
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Saggiante L, Biondetti P, Lanza C, Carriero S, Ascenti V, Piacentino F, Shehab A, Ierardi AM, Venturini M, Carrafiello G. Computed-Tomography-Guided Lung Biopsy: A Practice-Oriented Document on Techniques and Principles and a Review of the Literature. Diagnostics (Basel) 2024; 14:1089. [PMID: 38893616 PMCID: PMC11171640 DOI: 10.3390/diagnostics14111089] [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: 04/07/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
Computed tomography (CT)-guided lung biopsy is one of the oldest and most widely known minimally invasive percutaneous procedures. Despite being conceptually simple, this procedure needs to be performed rapidly and can be subject to meaningful complications that need to be managed properly. Therefore, knowledge of principles and techniques is required by every general or interventional radiologist who performs the procedure. This review aims to contain all the information that the operator needs to know before performing the procedure. The paper starts with the description of indications, devices, and types of percutaneous CT-guided lung biopsies, along with their reported results in the literature. Then, pre-procedural evaluation and the practical aspects to be considered during procedure (i.e., patient positioning and breathing) are discussed. The subsequent section is dedicated to complications, with their incidence, risk factors, and the evidence-based measures necessary to both prevent or manage them; special attention is given to pneumothorax and hemorrhage. After conventional CT, this review describes other available CT modalities, including CT fluoroscopy and cone-beam CT. At the end, more advanced techniques, which are already used in clinical practice, like fusion imaging, are included.
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Affiliation(s)
- Lorenzo Saggiante
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Pierpaolo Biondetti
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Velio Ascenti
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (L.S.); (C.L.); (S.C.)
| | - Filippo Piacentino
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Anas Shehab
- Interventional Radiology Fellowship, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital and Macchi Foundation, Insubria University, 21100 Varese, Italy; (F.P.); (M.V.)
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda–Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy; (P.B.); (A.M.I.); (G.C.)
- School of Radiology, Università Degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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14
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Wulaningsih W, Villamaria C, Akram A, Benemile J, Croce F, Watkins J. Deep Learning Models for Predicting Malignancy Risk in CT-Detected Pulmonary Nodules: A Systematic Review and Meta-analysis. Lung 2024:10.1007/s00408-024-00706-1. [PMID: 38782779 DOI: 10.1007/s00408-024-00706-1] [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: 01/15/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND There has been growing interest in using artificial intelligence/deep learning (DL) to help diagnose prevalent diseases earlier. In this study we sought to survey the landscape of externally validated DL-based computer-aided diagnostic (CADx) models, and assess their diagnostic performance for predicting the risk of malignancy in computed tomography (CT)-detected pulmonary nodules. METHODS An electronic search was performed in four databases (from inception to 10 August 2023). Studies were eligible if they were peer-reviewed experimental or observational articles comparing the diagnostic performance of externally validated DL-based CADx models with models widely used in clinical practice to predict the risk of malignancy. A bivariate random-effect approach for the meta-analysis on the included studies was used. RESULTS Seventeen studies were included, comprising 8553 participants and 9884 nodules. Pooled analyses showed DL-based CADx models were 11.6% more sensitive than physician judgement alone, and 14.5% more than clinical risk models alone. They had a similar pooled specificity to physician judgement alone [0.77 (95% CI 0.68-0.84) v 0.81 (95% CI 0.71-0.88)], and were 7.4% more specific than clinical risk models alone. They had superior pooled areas under the receiver operating curve (AUC), with relative pooled AUCs of 1.03 (95% CI 1.00-1.07) and 1.10 (95% CI 1.07-1.13) versus physician judgement and clinical risk models alone, respectively. CONCLUSION DL-based models are already used in clinical practice in certain settings for nodule management. Our results show their diagnostic performance potentially justifies wider, more routine deployment alongside experienced physician readers to help inform multidisciplinary team decision-making.
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Affiliation(s)
- Wahyu Wulaningsih
- The Royal Marsden, London, UK.
- Faculty of Life Sciences & Medicine, King's College London, London, UK.
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15
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Chen F, Li J, Li L, Tong L, Wang G, Zou X. Multidimensional biological characteristics of ground glass nodules. Front Oncol 2024; 14:1380527. [PMID: 38841161 PMCID: PMC11150621 DOI: 10.3389/fonc.2024.1380527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024] Open
Abstract
The detection rate of ground glass nodules (GGNs) has increased in recent years because of their malignant potential but relatively indolent biological behavior; thus, correct GGN recognition and management has become a research focus. Many scholars have explored the underlying mechanism of the indolent progression of GGNs from several perspectives, such as pathological type, genomic mutational characteristics, and immune microenvironment. GGNs have different major mutated genes at different stages of development; EGFR mutation is the most common mutation in GGNs, and p53 mutation is the most abundant mutation in the invasive stage of GGNs. Pure GGNs have fewer genomic alterations and a simpler genomic profile and exhibit a gradually evolving genomic mutation profile as the pathology progresses. Compared to advanced lung adenocarcinoma, GGN lung adenocarcinoma has a higher immune cell percentage, is under immune surveillance, and has less immune escape. However, as the pathological progression and solid component increase, negative immune regulation and immune escape increase gradually, and a suppressive immune environment is established gradually. Currently, regular computer tomography monitoring and surgery are the main treatment strategies for persistent GGNs. Stereotactic body radiotherapy and radiofrequency ablation are two local therapeutic alternatives, and systemic therapy has been progressively studied for lung cancer with GGNs. In the present review, we discuss the characterization of the multidimensional molecular evolution of GGNs that could facilitate more precise differentiation of such highly heterogeneous lesions, laying a foundation for the development of more effective individualized treatment plans.
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Affiliation(s)
- Furong Chen
- Department of Oncology, The First People’s Hospital of Shuangliu District/West China (Airport) Hospital, Sichuan University, Chengdu, China
| | - Jiangtao Li
- Department of Oncology, The First People’s Hospital of Shuangliu District/West China (Airport) Hospital, Sichuan University, Chengdu, China
| | - Lei Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of State Key Laboratory of Respiratory Health and Multimobidity, West China Hospital, Sichuan University, Chengdu, China
| | - Lunbing Tong
- Department of Respiratory Medicine, Chengdu Seventh People’s Hospital/Affiliated Cancer Hospital of Chengdu Medical College, Chengdu, China
| | - Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Department of State Key Laboratory of Respiratory Health and Multimobidity, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelin Zou
- Department of Respiratory Medicine, Chengdu Seventh People’s Hospital/Affiliated Cancer Hospital of Chengdu Medical College, Chengdu, China
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16
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Chang LK, Yang SM, Chung WY, Chen LC, Chang HC, Ho MC, Chang YC, Yu CJ. Cone-beam computed tomography image-guided percutaneous microwave ablation for lung nodules in a hybrid operating room: an initial experience. Eur Radiol 2024; 34:3309-3319. [PMID: 37926741 DOI: 10.1007/s00330-023-10360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES The experience of thermal ablation of lung lesions is limited, especially performing the procedure under localisation by cone-beam CT in the hybrid operation room (HOR). Here, we present the experience of microwave ablation (MWA) of lung nodules in the HOR. METHODS We reviewed patients who underwent image-guide percutaneous MWA for lung nodules in the HOR under general anaesthesia between July 2020 and July 2022. The workflow in the HOR including the pre-procedure preparation, anaesthesia consideration, operation methods, and postoperative care was clearly described. RESULTS Forty lesions in 33 patients who underwent MWA under general anaesthesia (GA) in the HOR were analysed. Twenty-seven patients had a single pulmonary nodule, and the remaining six patients had multiple nodules. The median procedure time was 41.0 min, and the median ablation time per lesion was 6.75 min. The median global operation room time was 115.0 min. The median total dose area product was 14881 μGym2. The median ablation volume was 111.6 cm3. All patients were discharged from the hospital with a median postoperative stay of 1 day. Four patients had pneumothorax, two patients had pleural effusion during the first month of outpatient follow-up, and one patient reported intercostal neuralgia during the 3-month follow-up. CONCLUSIONS Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if we follow the workflow provided. The procedure provides an alternative to managing pulmonary nodules in patients. CLINICAL RELEVANCE STATEMENT Thermal ablation of pulmonary nodules under GA in the HOR can be performed safely and efficiently if the provided workflow is followed. KEY POINTS • We tested the feasibility of microwave ablation of lung lesions performed in a hybrid operating room. • To this end, we provide a description of microwave ablation of the lung under cone-beam CT localisation. • We describe a workflow by which ablation of the pulmonary nodule can be performed safely under general anaesthesia.
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Affiliation(s)
- Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan.
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan.
| | - Wen-Yuan Chung
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Lun-Che Chen
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Hao-Chun Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
| | - Ming-Chih Ho
- Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, No. 2, Sec. 1, Shengyi Road, Zhubei City, Hsinchu County, 302, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Chong-Jen Yu
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Zhubei City, Taiwan
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17
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Peters AA, Solomon JB, von Stackelberg O, Samei E, Alsaihati N, Valenzuela W, Debic M, Heidt C, Huber AT, Christe A, Heverhagen JT, Kauczor HU, Heussel CP, Ebner L, Wielpütz MO. Influence of CT dose reduction on AI-driven malignancy estimation of incidental pulmonary nodules. Eur Radiol 2024; 34:3444-3452. [PMID: 37870625 PMCID: PMC11126495 DOI: 10.1007/s00330-023-10348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/10/2023] [Accepted: 09/03/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the influence of dose reduction on a commercially available lung cancer prediction convolutional neuronal network (LCP-CNN). METHODS CT scans from a cohort provided by the local lung cancer center (n = 218) with confirmed pulmonary malignancies and their corresponding reduced dose simulations (25% and 5% dose) were subjected to the LCP-CNN. The resulting LCP scores (scale 1-10, increasing malignancy risk) and the proportion of correctly classified nodules were compared. The cohort was divided into a low-, medium-, and high-risk group based on the respective LCP scores; shifts between the groups were studied to evaluate the potential impact on nodule management. Two different malignancy risk score thresholds were analyzed: a higher threshold of ≥ 9 ("rule-in" approach) and a lower threshold of > 4 ("rule-out" approach). RESULTS In total, 169 patients with 196 nodules could be included (mean age ± SD, 64.5 ± 9.2 year; 49% females). Mean LCP scores for original, 25% and 5% dose levels were 8.5 ± 1.7, 8.4 ± 1.7 (p > 0.05 vs. original dose) and 8.2 ± 1.9 (p < 0.05 vs. original dose), respectively. The proportion of correctly classified nodules with the "rule-in" approach decreased with simulated dose reduction from 58.2 to 56.1% (p = 0.34) and to 52.0% for the respective dose levels (p = 0.01). For the "rule-out" approach the respective values were 95.9%, 96.4%, and 94.4% (p = 0.12). When reducing the original dose to 25%/5%, eight/twenty-two nodules shifted to a lower, five/seven nodules to a higher malignancy risk group. CONCLUSION CT dose reduction may affect the analyzed LCP-CNN regarding the classification of pulmonary malignancies and potentially alter pulmonary nodule management. CLINICAL RELEVANCE STATEMENT Utilization of a "rule-out" approach with a lower malignancy risk threshold prevents underestimation of the nodule malignancy risk for the analyzed software, especially in high-risk cohorts. KEY POINTS • LCP-CNN may be affected by CT image parameters such as noise resulting from low-dose CT acquisitions. • CT dose reduction can alter pulmonary nodule management recommendations by affecting the outcome of the LCP-CNN. • Utilization of a lower malignancy risk threshold prevents underestimation of pulmonary malignancies in high-risk cohorts.
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Affiliation(s)
- Alan A Peters
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany.
| | - Justin B Solomon
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Oyunbileg von Stackelberg
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Njood Alsaihati
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Waldo Valenzuela
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Manuel Debic
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Christian Heidt
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
- Department of BioMedical Research, Experimental Radiology, University of Bern, Bern, Switzerland
- Department of Radiology, The Ohio State University, Columbus, OH, USA
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Claus P Heussel
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
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18
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Wang X, Cui Y, Wang Y, Liu S, Meng N, Wei W, Bai Y, Shen Y, Guo J, Guo Z, Wang M. Assessment of Lung Nodule Detection and Lung CT Screening Reporting and Data System Classification Using Zero Echo Time Pulmonary MRI. J Magn Reson Imaging 2024. [PMID: 38602245 DOI: 10.1002/jmri.29388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The detection rate of lung nodules has increased considerably with CT as the primary method of examination, and the repeated CT examinations at 3 months, 6 months or annually, based on nodule characteristics, have increased the radiation exposure of patients. So, it is urgent to explore a radiation-free MRI examination method that can effectively address the challenges posed by low proton density and magnetic field inhomogeneities. PURPOSE To evaluate the potential of zero echo time (ZTE) MRI in lung nodule detection and lung CT screening reporting and data system (lung-RADS) classification, and to explore the value of ZTE-MRI in the assessment of lung nodules. STUDY TYPE Prospective. POPULATION 54 patients, including 21 men and 33 women. FIELD STRENGTH/SEQUENCE Chest CT using a 16-slice scanner and ZTE-MRI at 3.0T based on fast gradient echo. ASSESSMENT Nodule type (ground-glass nodules, part-solid nodules, and solid nodules), lung-RADS classification, and nodule diameter (manual measurement) on CT and ZTE-MRI images were recorded. STATISTICAL TESTS The percent of concordant cases, Kappa value, intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Spearman's correlation, and Bland-Altman. The p-value <0.05 is considered significant. RESULTS A total of 54 patients (age, 54.8 ± 11.9 years; 21 men) with 63 nodules were enrolled. Compared with CT, the total nodule detection rate of ZTE-MRI was 85.7%. The intermodality agreement of ZTE-MRI and CT lung nodules type evaluation was substantial (Kappa = 0.761), and the intermodality agreement of ZTE-MRI and CT lung-RADS classification was moderate (Kappa = 0.592). The diameter measurements between ZTE-MRI and CT showed no significant difference and demonstrated a high degree of interobserver (ICC = 0.997-0.999) and intermodality (ICC = 0.956-0.985) agreements. DATA CONCLUSION The measurement of nodule diameter by pulmonary ZTE-MRI is similar to that by CT, but the ability of lung-RADS to classify nodes from MRI images still requires further research. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Xinhui Wang
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Yingying Cui
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Ying Wang
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Shuo Liu
- Department of Medical Imaging, Xinxiang Medical University and Henan Provincial People's Hospital, Zhengzhou, China
| | - Nan Meng
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Wei
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Yan Bai
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | - Yu Shen
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
| | | | - Zhiping Guo
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
- Health Management Center of Henan Province, Zhengzhou University People's Hospital and FuWai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Meiyun Wang
- Department of Medical Imaging, Zhengzhou University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, China
- Laboratory of Brain Science and Brain-Like Intelligence Technology, Biomedical Research Institute, Henan Academy of Sciences, Zhengzhou, China
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Chen Z, Zeng J, Lin Y, Zhang X, Wu X, Yong Y, Tang L, Ke M. Synchronous Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsy and Microwave Ablation for Highly Suspicious Malignant Pulmonary Ground-Glass Nodules. Respiration 2024; 103:388-396. [PMID: 38599179 DOI: 10.1159/000538743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION There is no consensus regarding the most appropriate management of suspected malignant pulmonary ground-glass nodules (GGNs). OBJECTIVE We aimed to explore the feasibility and safety of synchronous computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) and microwave ablation (MWA) for patients highly suspicious of having malignant GGNs. METHODS We retrospectively reviewed medical records between July 2020 and April 2023 from our medical center. Eligible patients synchronously underwent PTNB and MWA (either MWA immediately after PTNB [PTNB-first group] or PTNB immediately after MWA [MWA-first group]) at the the physician's discretion. We analyzed the rate of definitive diagnosis and technical success, the length of hospital stay, the postoperative efficacy, and periprocedural complications. RESULTS Of 65 patients who were enrolled, the rate of definitive diagnosis was 86.2%, which did not differ when stratified by the tumor size, the consolidation-to-tumor ratio, or the sequence of the two procedures (all p > 0.05). The diagnostic rate of malignancy was 83.1%. After the median follow-up duration of 18.5 months, the local control rate was 98.2% and the rate of completed ablation was 48.2%. The rate of perioperative minor and major complications was 44.6% and 6.2%, respectively. The most common adverse events included pain, cough, and mild hemorrhage. Mild hemorrhage took place significantly less frequently in the MWA-first group than in the PTNB-first group (16.7% vs. 45.5%, p < 0.05). CONCLUSION Synchronous PTNB and MWA are feasible and well tolerated for patients highly suspicious of having malignant GGNs, providing an alternative option for patients who are ineligible for surgical resection.
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Affiliation(s)
- Zhide Chen
- Department of Respiratory and Critical Care Medicine, West China Xiamen Hospital of Sichuan University, Xiamen, China
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Junli Zeng
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yan Lin
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xiaoling Zhang
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Xuemei Wu
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Yazhi Yong
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Lihua Tang
- Department of Pathology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Mingyao Ke
- Department of Respiratory Center, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
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Bodard S, Guinebert S, Petre EN, Alexander E, Marinelli B, Sarkar D, Cornelis FH. Percutaneous Lung Biopsies With Robotic Systems: A Systematic Review of Available Clinical Solutions. Can Assoc Radiol J 2024:8465371241242758. [PMID: 38581355 DOI: 10.1177/08465371241242758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
Objectives: This systematic review aims to assess existing research concerning the use of robotic systems to execute percutaneous lung biopsy. Methods: A systematic review was performed and identified 4 studies involving robotic systems used for lung biopsy. Outcomes assessed were operation time, radiation dose to patients and operators, technical success rate, diagnostic yield, and complication rate. Results: One hundred and thirteen robot-guided percutaneous lung biopsies were included. Technical success and diagnostic yield were close to 100%, comparable to manual procedures. Technical accuracy, illustrated by needle positioning, showed less frequent needle adjustments in robotic guidance than in manual guidance (P < .001): 2.7 ± 2.6 (range 1-4) versus 6 ± 4 (range 2-12). Procedure time ranged from comparable to reduced by 35% on average (20.1 ± 11.3 minutes vs 31.4 ± 10.2 minutes, P = .001) compared to manual procedures. Patient irradiation ranged from comparable to reduced by an average of 40% (324 ± 114.5 mGy vs 541.2 ± 446.8 mGy, P = .001). There was no significant difference in reported complications between manual biopsy and biopsies that utilized robotic guidance. Conclusion: Robotic systems demonstrate promising results for percutaneous lung biopsy. These devices provide adequate accuracy in probe placement and could both reduce procedural duration and mitigate radiation exposure to patients and practitioners. However, this review underscores the need for larger, controlled trials to validate and extend these findings.
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Affiliation(s)
- Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, University of Paris Cité, Necker Hospital, Paris, France
- Laboratoire d'Imagerie Biomédicale, Sorbonne University, CNRS UMR 7371, INSERM U 1146, Paris, France
| | - Sylvain Guinebert
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erica Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debkumar Sarkar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Sorbonne University, Tenon Hospital, Paris, France
- Weill Cornell Medical College, New York, NY, USA
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21
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Meng L, Zhu P, Xia K. Application value of the automated machine learning model based on modified CT index combined with serological indices in the early prediction of lung cancer. Front Public Health 2024; 12:1368217. [PMID: 38645446 PMCID: PMC11027066 DOI: 10.3389/fpubh.2024.1368217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Background and objective Accurately predicting the extent of lung tumor infiltration is crucial for improving patient survival and cure rates. This study aims to evaluate the application value of an improved CT index combined with serum biomarkers, obtained through an artificial intelligence recognition system analyzing CT features of pulmonary nodules, in early prediction of lung cancer infiltration using machine learning models. Patients and methods A retrospective analysis was conducted on clinical data of 803 patients hospitalized for lung cancer treatment from January 2020 to December 2023 at two hospitals: Hospital 1 (Affiliated Changshu Hospital of Soochow University) and Hospital 2 (Nantong Eighth People's Hospital). Data from Hospital 1 were used for internal training, while data from Hospital 2 were used for external validation. Five algorithms, including traditional logistic regression (LR) and machine learning techniques (generalized linear models [GLM], random forest [RF], gradient boosting machine [GBM], deep neural network [DL], and naive Bayes [NB]), were employed to construct models predicting early lung cancer infiltration and were analyzed. The models were comprehensively evaluated through receiver operating characteristic curve (AUC) analysis based on LR, calibration curves, decision curve analysis (DCA), as well as global and individual interpretative analyses using variable feature importance and SHapley additive explanations (SHAP) plots. Results A total of 560 patients were used for model development in the training dataset, while a dataset comprising 243 patients was used for external validation. The GBM model exhibited the best performance among the five algorithms, with AUCs of 0.931 and 0.99 in the validation and test sets, respectively, and accuracies of 0.857 and 0.955 in the validation and test groups, respectively, outperforming other models. Additionally, the study found that nodule diameter and average CT value were the most significant features for predicting lung cancer infiltration using machine learning models. Conclusion The GBM model established in this study can effectively predict the risk of infiltration in early-stage lung cancer patients, thereby improving the accuracy of lung cancer screening and facilitating timely intervention for infiltrative lung cancer patients by clinicians, leading to early diagnosis and treatment of lung cancer, and ultimately reducing lung cancer-related mortality.
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Affiliation(s)
- Leyuan Meng
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Jiangsu, Nantong, China
| | - Ping Zhu
- Department of Scientific Research, The Changshu Affiliated Hospital of Soochow University, Jiangsu, Suzhou, China
- Changshu Key Laboratory of Medical Artificial Intelligence and Big Data, Jiangsu, Suzhou, China
| | - Kaijian Xia
- Department of Scientific Research, The Changshu Affiliated Hospital of Soochow University, Jiangsu, Suzhou, China
- Changshu Key Laboratory of Medical Artificial Intelligence and Big Data, Jiangsu, Suzhou, China
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22
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Na KJ, Kim YT, Goo JM, Kim H. Clinical Utility of a CT-based AI Prognostic Model for Segmentectomy in Non-Small Cell Lung Cancer. Radiology 2024; 311:e231793. [PMID: 38625008 DOI: 10.1148/radiol.231793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Background Currently, no tool exists for risk stratification in patients undergoing segmentectomy for non-small cell lung cancer (NSCLC). Purpose To develop and validate a deep learning (DL) prognostic model using preoperative CT scans and clinical and radiologic information for risk stratification in patients with clinical stage IA NSCLC undergoing segmentectomy. Materials and Methods In this single-center retrospective study, transfer learning of a pretrained model was performed for survival prediction in patients with clinical stage IA NSCLC who underwent lobectomy from January 2008 to March 2017. The internal set was divided into training, validation, and testing sets based on the assignments from the pretraining set. The model was tested on an independent test set of patients with clinical stage IA NSCLC who underwent segmentectomy from January 2010 to December 2017. Its prognostic performance was analyzed using the time-dependent area under the receiver operating characteristic curve (AUC), sensitivity, and specificity for freedom from recurrence (FFR) at 2 and 4 years and lung cancer-specific survival and overall survival at 4 and 6 years. The model sensitivity and specificity were compared with those of the Japan Clinical Oncology Group (JCOG) eligibility criteria for sublobar resection. Results The pretraining set included 1756 patients. Transfer learning was performed in an internal set of 730 patients (median age, 63 years [IQR, 56-70 years]; 366 male), and the segmentectomy test set included 222 patients (median age, 65 years [IQR, 58-71 years]; 114 male). The model performance for 2-year FFR was as follows: AUC, 0.86 (95% CI: 0.76, 0.96); sensitivity, 87.4% (7.17 of 8.21 patients; 95% CI: 59.4, 100); and specificity, 66.7% (136 of 204 patients; 95% CI: 60.2, 72.8). The model showed higher sensitivity for FFR than the JCOG criteria (87.4% vs 37.6% [3.08 of 8.21 patients], P = .02), with similar specificity. Conclusion The CT-based DL model identified patients at high risk among those with clinical stage IA NSCLC who underwent segmentectomy, outperforming the JCOG criteria. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Kwon Joong Na
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Young Tae Kim
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Jin Mo Goo
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
| | - Hyungjin Kim
- From the Department of Thoracic and Cardiovascular Surgery (K.J.N., Y.T.K.) and Department of Radiology (J.M.G., H.K.), Seoul National University Hospital and College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea (K.J.N., Y.T.K., J.M.G.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.)
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Borg M, Rasmussen TR, Hilberg O. Introduction of the Danish Lung Nodule Registry: A part of the Danish Lung Cancer Registry. Cancer Epidemiol 2024; 89:102543. [PMID: 38364359 DOI: 10.1016/j.canep.2024.102543] [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: 11/01/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of lung cancer cases are diagnosed late, resulting in poor prognosis and high mortality rates. Early detection and management of lung cancer can improve patient outcomes and reduce mortality rates. Pulmonary nodules are key factors in the early detection of lung cancer, they are common in high-risk populations and require correct classification to determine whether they are benign or malignant. Over the last decade a steep increase in the number of thoracic CT scans has been seen in Denmark, resulting in substantial resources allocated to CT follow-up of incidentally detected pulmonary nodules. The implementation of a nationwide Danish prospective pulmonary nodule registry is to methodically record pulmonary nodules and thereby evaluate the scope of pulmonary nodule follow-up, the nature of the nodules, and the clinical progression of patients with pulmonary nodules. METHODS A prospective pulmonary nodule registry (Danish Lung Nodule Registry) will be a natural appendix to the Danish Lung Cancer Registry. Three new ICD-10 classification codes will be introduced, defining the type of nodule: /DR91.1/ Solid nodule /DR91.2/ Part-solid nodule; /DR91.3/ Non-solid nodule. Furthermore, an additional letter will describe whether the imaging exam is performed on suspicion of lung cancer (A), or the finding is incidental (B). Registration of the nodules will be performed by the departments of respiratory medicine who manage follow-up of pulmonary nodules. It is estimated that around 7000 nodules will be registered annually. DISCUSSION The registration of patients in the lung nodule registry complies with current Danish legislation. The registry will be seamlessly integrated with other nationwide Danish registries, including the Danish Lung Cancer Registry, to collect additional patient data and improve the quality and scope of the data acquired. The results from these comprehensive epidemiological studies will be of significant interest and offer valuable research opportunities.
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Affiliation(s)
- Morten Borg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark.
| | - Torben Riis Rasmussen
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
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24
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Lamb CR, Rieger-Christ KM, Reddy C, Huang J, Ding J, Johnson M, Walsh PS, Bulman WA, Lofaro LR, Wahidi MM, Feller-Kopman DJ, Spira A, Kennedy GC, Mazzone PJ. A Nasal Swab Classifier to Evaluate the Probability of Lung Cancer in Patients With Pulmonary Nodules. Chest 2024; 165:1009-1019. [PMID: 38030063 DOI: 10.1016/j.chest.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Accurate assessment of the probability of lung cancer (pCA) is critical in patients with pulmonary nodules (PNs) to help guide decision-making. We sought to validate a clinical-genomic classifier developed using whole-transcriptome sequencing of nasal epithelial cells from patients with a PN ≤ 30 mm who smoke or have previously smoked. RESEARCH QUESTION Can the pCA in individuals with a PN and a history of smoking be predicted by a classifier that uses clinical factors and genomic data from nasal epithelial cells obtained by cytologic brushing? STUDY DESIGN AND METHODS Machine learning was used to train a classifier using genomic and clinical features on 1,120 patients with PNs labeled as benign or malignant established by a final diagnosis or a minimum of 12 months of radiographic surveillance. The classifier was designed to yield low-, intermediate-, and high-risk categories. The classifier was validated in an independent set of 312 patients, including 63 patients with a prior history of cancer (other than lung cancer), comparing the classifier prediction with the known clinical outcome. RESULTS In the primary validation set, sensitivity and specificity for low-risk classification were 96% and 42%, whereas sensitivity and specificity for high-risk classification was 58% and 90%, respectively. Sensitivity was similar across stages of non-small cell lung cancer, independent of subtype. Performance compared favorably with clinical-only risk models. Analysis of 63 patients with prior cancer showed similar performance as did subanalyses of patients with light vs heavy smoking burden and those eligible for lung cancer screening vs those who were not. INTERPRETATION The nasal classifier provides an accurate assessment of pCA in individuals with a PN ≤ 30 mm who smoke or have previously smoked. Classifier-guided decision-making could lead to fewer diagnostic procedures in patients without cancer and more timely treatment in patients with lung cancer.
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Affiliation(s)
- Carla R Lamb
- Department of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA.
| | - Kimberly M Rieger-Christ
- Department of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, MA
| | - Chakravarthy Reddy
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah Health Sciences Center, Salt Lake City, UT
| | | | - Jie Ding
- Veracyte, Inc, South San Francisco, CA
| | | | | | | | | | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC
| | | | - Avrum Spira
- Department of Medicine, Boston University Medical Center, Boston, MA; Johnson & Johnson, Inc, Boston, MA
| | | | - Peter J Mazzone
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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25
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Leong TL, McWilliams A, Wright GM. Incidental Pulmonary Nodules: An Opportunity to Complement Lung Cancer Screening. J Thorac Oncol 2024; 19:522-524. [PMID: 38582541 DOI: 10.1016/j.jtho.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/02/2024] [Indexed: 04/08/2024]
Affiliation(s)
- Tracy L Leong
- Department of Respiratory Medicine, Austin Health, Heidelberg, Victoria, Australia.
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gavin M Wright
- Department of Cardiothoracic Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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26
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Cavion CC, Altmayer S, Forte GC, Feijó Andrade RG, Hochhegger DQDR, Zaguini Francisco M, Camargo C, Patel P, Hochhegger B. Diagnostic Performance of MRI for the Detection of Pulmonary Nodules: A Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2024; 6:e230241. [PMID: 38634743 PMCID: PMC11056753 DOI: 10.1148/ryct.230241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 02/18/2024] [Accepted: 03/07/2024] [Indexed: 04/19/2024]
Abstract
Purpose To perform a meta-analysis of the diagnostic performance of MRI for the detection of pulmonary nodules, with use of CT as the reference standard. Materials and Methods PubMed, Embase, Scopus, and other databases were systematically searched for studies published from January 2000 to March 2023 evaluating the performance of MRI for diagnosis of lung nodules measuring 4 mm or larger, with CT as reference. Studies including micronodules, nodules without size stratification, or those from which data for contingency tables could not be extracted were excluded. Primary outcomes were the per-lesion sensitivity of MRI and the rate of false-positive nodules per patient (FPP). Subgroup analysis by size and meta-regression with other covariates were performed. The study protocol was registered in the International Prospective Register of Systematic Reviews, or PROSPERO (no. CRD42023437509). Results Ten studies met inclusion criteria (1354 patients and 2062 CT-detected nodules). Overall, per-lesion sensitivity of MRI for nodules measuring 4 mm or larger was 87.7% (95% CI: 81.1, 92.2), while the FPP rate was 12.4% (95% CI: 7.0, 21.1). Subgroup analyses demonstrated that MRI sensitivity was 98.5% (95% CI: 90.4, 99.8) for nodules measuring at least 8-10 mm and 80.5% (95% CI: 71.5, 87.1) for nodules less than 8 mm. Conclusion MRI demonstrated a good overall performance for detection of pulmonary nodules measuring 4 mm or larger and almost equal performance to CT for nodules measuring at least 8-10 mm, with a low rate of FPP. Systematic review registry no. CRD42023437509 Keywords: Lung Nodule, Lung Cancer, Lung Cancer Screening, MRI, CT Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- César Campagnolo Cavion
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Stephan Altmayer
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Gabriele Carra Forte
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Rubens Gabriel Feijó Andrade
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Daniela Quinto dos Reis Hochhegger
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Martina Zaguini Francisco
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Capitulino Camargo
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Pratik Patel
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Bruno Hochhegger
- From the Department of Radiology, Pontifícia Universidade
Católica do Rio Grande do Sul, Av Ipiranga, 6681 – Partenon, Porto
Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.);
Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department
of Radiology, College of Medicine, University of Florida, Gainesville, Fla
(D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da
Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
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Ng LY, Howarth TP, Doss AX, Charakidis M, Karanth NV, Mo L, Heraganahally SS. Significance of lung nodules detected on chest CT among adult Aboriginal Australians - a retrospective descriptive study. J Med Radiat Sci 2024. [PMID: 38516966 DOI: 10.1002/jmrs.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/10/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION There are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia. METHODS Patients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules. RESULTS Of the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow-up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow-up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection. CONCLUSIONS Most lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population.
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Affiliation(s)
- Lai Yun Ng
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Timothy P Howarth
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio, Northern Savo, Finland
| | - Arockia X Doss
- Department of Medical Imaging, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Curtin Medical School, Bentley, Western Australia, Australia
| | - Michail Charakidis
- Department of Medical Oncology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Narayan V Karanth
- Department of Medical Oncology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Lin Mo
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Subash S Heraganahally
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
- Darwin Respiratory and Sleep Health, Darwin Private Hospital, Darwin, Northern Territory, Australia
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28
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Xiang Y, Chen L, Jia J, Yili F, Changwei W. The association of regional block with intraoperative opioid consumption in patients undergoing video-assisted thoracoscopic surgery: a single-center, retrospective study. J Cardiothorac Surg 2024; 19:124. [PMID: 38481337 PMCID: PMC10936020 DOI: 10.1186/s13019-024-02611-3] [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: 01/11/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Regional block, such as thoracic epidural analgesia (TEA), thoracic paravertebral block (TPVB), or serratus anterior plane block (SAPB) has been recommended to reduce postoperative opioid use in recent guidelines, but the optimal options for intraoperative opioid minimization remain unclear. The aim of this study was to evaluate the intraoperative opioids-sparing effects of three regional blocks (TEA, TPVB, and SAPB) in patients undergoing video-assisted thoracoscopic surgery (VATs). METHODS This was a retrospective study of the adults undergoing VATs at a tertiary medical center between January 2020 and February 2022. According to the type of regional block used, patients were classified into 4 groups: GA group (general anesthesia without any regional block), TEA group (general anesthesia combined with TEA), TPVB group (general anesthesia combined with TPVB), and SAPB group (general anesthesia combined with SAPB). Cases were matched with a 1:1:1:1 ratio for analysis by age, sex, ASA physical status, and operation duration. The primary outcome was the total intraoperative opioid consumption standardized to Oral Morphine Equivalents (OME). Multivariable linear regression was used to estimate the association of the three regional blocks with the OME. RESULTS A total of 2159 cases met the eligibility criteria. After matching, 168 cases (42 in each group) were included in analysis. Compared with GA without any reginal block, the use of TEA, TPVB, and SAPB reduced the median of intraoperative OME by 78.45 mg (95% confidence interval [CI], -141.34 to -15.56; P = 0.014), 94.92 mg (95% CI, -154.48 to -35.36; P = 0.020), and 11.47 mg (95% CI, -72.07 to 49.14; P = 0.711), respectively. CONCLUSIONS The use of TEA or TPVB was associated with an intraoperative opioid-sparing effect in adults undergoing VATs, whereas the intraoperative opioid-sparing effect of SAPB was not yet clear.
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Affiliation(s)
- Yan Xiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Liang Chen
- Department of Medical Statistics, Medieco Group Co., Ltd, Beijing, China
| | - Jiang Jia
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Fu Yili
- Department of Thoracic surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wei Changwei
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
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Kearney L, Bolton RE, Núñez ER, Boudreau JH, Sliwinski S, Herbst AN, Caverly TJ, Wiener RS. Tackling Guideline Non-concordance: Primary Care Barriers to Incorporating Life Expectancy into Lung Cancer Screening Decision-Making-A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-08705-x. [PMID: 38459413 DOI: 10.1007/s11606-024-08705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Primary care providers (PCPs) are often the first point of contact for discussing lung cancer screening (LCS) with patients. While guidelines recommend against screening people with limited life expectancy (LLE) who are less likely to benefit, these patients are regularly referred for LCS. OBJECTIVE We sought to understand barriers PCPs face to incorporating life expectancy into LCS decision-making for patients who otherwise meet eligibility criteria, and how a hypothetical point-of-care tool could support patient selection. DESIGN Qualitative study based on semi-structured telephone interviews. PARTICIPANTS Thirty-one PCPs who refer patients for LCS, from six Veterans Health Administration facilities. APPROACH We thematically analyzed interviews to understand how PCPs incorporated life expectancy into LCS decision-making and PCPs' receptivity to a point-of-care tool to support patient selection. Final themes were organized according to the Cabana et al. framework Why Don't Physicians Follow Clinical Practice Guidelines, capturing the influence of clinician knowledge, attitudes, and behavior on LCS appropriateness determinations. KEY RESULTS PCP referrals to LCS for patients with LLE were influenced by limited knowledge of the life expectancy threshold at which patients are less likely to benefit from LCS, discomfort estimating life expectancy, fear of missing cancer at the point of early detection, and prioritization of factors such as quality of life, patient values, clinician-patient relationship, and family support. PCPs were receptive to a decision support tool to inform and communicate LCS appropriateness decisions if easy to use and integrated into clinical workflows. CONCLUSIONS Our study suggests knowledge gaps and attitudes may drive decisions to offer screening despite LLE, a behavior counter to guideline recommendations. Integrating a LCS decision support tool that incorporates life expectancy within the electronic medical record and existing clinical workflows may be one acceptable solution to improve guideline concordance and increase confidence in selecting high benefit patients for LCS.
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Affiliation(s)
- Lauren Kearney
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA.
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
| | - Rendelle E Bolton
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Eduardo R Núñez
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Jacqueline H Boudreau
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Samantha Sliwinski
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Tanner J Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
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Wang Z, Mortani Barbosa EJ. Socio-Economic Factors and Clinical Context Can Predict Adherence to Incidental Pulmonary Nodule Follow-up via Machine Learning Models. J Am Coll Radiol 2024:S1546-1440(24)00274-6. [PMID: 38461910 DOI: 10.1016/j.jacr.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To quantify the relative importance of demographic, contextual, socio-economic, and nodule-related factors that influence patient adherence to incidental pulmonary nodule (IPN) follow-up visits and evaluate the predictive performance of machine learning models utilizing these features. METHODS We curated a 1,610-subject patient data set from electronic medical records consisting of 13 clinical and socio-economic predictors and IPN follow-up adherence status (timely, delayed, or never) as the outcome. Univariate analysis and multivariate logistic regression were performed to quantify the predictors' contributions to follow-up adherence. Three additional machine learning models (random forests, neural network, and support vector machine) were fitted and cross-validated to examine prediction performance across different model architectures and evaluate intermodel concordance. RESULTS On univariate basis, all 13 predictors except comorbidity were found to have a significant association with follow-up. In multiple logistic regression, inpatient or emergency clinical context (odds ratio favoring never following up: 7.28 and 8.56 versus outpatient, respectively) and high nodule risk (odds ratio: 0.25 versus low risk) are the most significant predictors of follow-up, and sex, race, and marital status become additionally significant if clinical context is removed from the model. Clinical context itself is associated with sex, race, insurance, employment, marriage, income, nodule risk, and smoking status, suggesting its role in mediating socio-economic inequities. On cross-validation, all four machine learning models demonstrated comparable and good predictive performances, with mean area under the curve ranging from 0.759 to 0.802, with sensitivity 0.641 to 0.660 and specificity 0.768 to 0.840. CONCLUSION Socio-economic factors and clinical context are predictive of IPN follow-up adherence, with clinical context being the most significant contributor and likely representing uncaptured socio-economic determinants.
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Affiliation(s)
- Zhuoyang Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eduardo J Mortani Barbosa
- Director of CT Modality at the Thoracic Imaging Section, Division of Cardiothoracic Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Tárnoki ÁD, Tárnoki DL, Dąbrowska M, Knetki-Wróblewska M, Frille A, Stubbs H, Blyth KG, Juul AD. New developments in the imaging of lung cancer. Breathe (Sheff) 2024; 20:230176. [PMID: 38595936 PMCID: PMC11003524 DOI: 10.1183/20734735.0176-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/25/2024] [Indexed: 04/11/2024] Open
Abstract
Radiological and nuclear medicine methods play a fundamental role in the diagnosis and staging of patients with lung cancer. Imaging is essential in the detection, characterisation, staging and follow-up of lung cancer. Due to the increasing evidence, low-dose chest computed tomography (CT) screening for the early detection of lung cancer is being introduced to the clinical routine in several countries. Radiomics and radiogenomics are emerging fields reliant on artificial intelligence to improve diagnosis and personalised risk stratification. Ultrasound- and CT-guided interventions are minimally invasive methods for the diagnosis and treatment of pulmonary malignancies. In this review, we put more emphasis on the new developments in the imaging of lung cancer.
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Affiliation(s)
- Ádám Domonkos Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, Oncologic Imaging and Invasive Diagnostic Centre, National Institute of Oncology, Budapest, Hungary
| | - Dávid László Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- National Tumour Biology Laboratory, Oncologic Imaging and Invasive Diagnostic Centre, National Institute of Oncology, Budapest, Hungary
| | - Marta Dąbrowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | | | - Armin Frille
- Department of Respiratory Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Harrison Stubbs
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Kevin G. Blyth
- Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
- School of Cancer Sciences, University of Glasgow, Glasgow, UK
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Omindo WW. Management of screening-detected ground glass nodules: a narrative review. Indian J Thorac Cardiovasc Surg 2024; 40:205-212. [PMID: 38389756 PMCID: PMC10879480 DOI: 10.1007/s12055-023-01595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 02/24/2024] Open
Abstract
Wide-scale application of low-dose computed tomography (LDCT) in lung cancer screening has led to an increased detection of ground glass nodule (GGN) lesions. However, there is still no clear management plan for these lesions after detection. Clinicians are usually faced with a dilemma in choosing the best initial management approach that not only limits overtreatment but also avoids the possibility of lesions growing into invasive carcinoma. Most current and past guidelines favor surveillance with computed tomography (CT) as the initial management approach based on the notion that the majority of GGN lesions are indolent tumors. Immediate surgery is generally considered overtreatment and is usually only recommended when the lesion grows in size, persists, or increases its solid component during follow-up CT surveillance. However, due to evolution of surgery to minimal invasive procedures, such as uniportal video-assisted thoracic surgery, and the development of enhanced recovery after thoracic surgery protocols, modern surgery is now safer and associated with less postoperative mortality. Additionally, intraoperative frozen sections can be used to guide resection, making initial management via surgery more attractive than before. Based on these developments, this review recommends that immediate surgery should be considered at the same level as follow-up CT surveillance when making multidisciplinary team decisions for screening-detected GGNs, as it provides both a diagnostic and treatment role.
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Affiliation(s)
- Willis Wasonga Omindo
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, 430030 Hubei China
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Abdelghani R, Omballi M, Abia-Trujillo D, Casillas E, Villalobos R, Badar F, Bansal S, Kheir F. Imaging modalities during navigational bronchoscopy. Expert Rev Respir Med 2024; 18:175-188. [PMID: 38794918 DOI: 10.1080/17476348.2024.2359601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Lung nodules are commonly encountered in clinical practice. Technological advances in navigational bronchoscopy and imaging modalities have led to paradigm shift from nodule screening or follow-up to early lung cancer detection. This is due to improved nodule localization and biopsy confirmation with combined modalities of navigational platforms and imaging tools. To conduct this article, relevant literature was reviewed via PubMed from January 2014 until January 2024. AREAS COVERED This article highlights the literature on different imaging modalities combined with commonly used navigational platforms for diagnosis of peripheral lung nodules. Current limitations and future perspectives of imaging modalities will be discussed. EXPERT OPINION The development of navigational platforms improved localization of targets. However, published diagnostic yield remains lower compared to percutaneous-guided biopsy. The discordance between the actual location of lung nodule during the procedure and preprocedural CT chest is the main factor impacting accurate biopsies. The utilization of advanced imaging tools with navigation-based bronchoscopy has been shown to assist with localizing targets in real-time and improving biopsy success. However, it is important for interventional bronchoscopists to understand the strengths and limitations of these advanced imaging technologies.
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Affiliation(s)
- Ramsy Abdelghani
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Mohamed Omballi
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH, USA
| | - David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ernesto Casillas
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Regina Villalobos
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Faraz Badar
- Department of Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH, USA
| | - Sandeep Bansal
- The Lung Center, Penn Highlands Healthcare, DuBois, PA, USA
| | - Fayez Kheir
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Heideman BE, Kammer MN, Paez R, Swanson T, Godfrey CM, Low SW, Xiao D, Li TZ, Richardson JR, Knight MA, Shojaee S, Deppen SA, Lentz RJ, Grogan EL, Maldonado F. The Lung Cancer Prediction Model "Stress Test": Assessment of Models' Performance in a High-Risk Prospective Pulmonary Nodule Cohort. CHEST PULMONARY 2024; 2:100033. [PMID: 38737731 PMCID: PMC11087042 DOI: 10.1016/j.chpulm.2023.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
BACKGROUND Pulmonary nodules represent a growing health care burden because of delayed diagnosis of malignant lesions and overtesting for benign processes. Clinical prediction models were developed to inform physician assessment of pretest probability of nodule malignancy but have not been validated in a high-risk cohort of nodules for which biopsy was ultimately performed. RESEARCH QUESTION Do guideline-recommended prediction models sufficiently discriminate between benign and malignant nodules when applied to cases referred for biopsy by navigational bronchoscopy? STUDY DESIGN AND METHODS We assembled a prospective cohort of 322 indeterminate pulmonary nodules in 282 patients referred to a tertiary medical center for diagnostic navigational bronchoscopy between 2017 and 2019. We calculated the probability of malignancy for each nodule using the Brock model, Mayo Clinic model, and Veterans Affairs (VA) model. On a subset of 168 patients who also had PET-CT scans before biopsy, we also calculated the probability of malignancy using the Herder model. The performance of the models was evaluated by calculating the area under the receiver operating characteristic curves (AUCs) for each model. RESULTS The study cohort contained 185 malignant and 137 benign nodules (57% prevalence of malignancy). The malignant and benign cohorts were similar in terms of size, with a median longest diameter for benign and malignant nodules of 15 and 16 mm, respectively. The Brock model, Mayo Clinic model, and VA model showed similar performance in the entire cohort (Brock AUC, 0.70; 95% CI, 0.64-0.76; Mayo Clinic AUC, 0.70; 95% CI, 0.64-0.76; VA AUC, 0.67; 95% CI, 0.62-0.74). For 168 nodules with available PET-CT scans, the Herder model had an AUC of 0.77 (95% CI, 0.68-0.85). INTERPRETATION Currently available clinical models provide insufficient discrimination between benign and malignant nodules in the common clinical scenario in which a patient is being referred for biopsy, especially when PET-CT scan information is not available.
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Affiliation(s)
- Brent E Heideman
- Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Michael N Kammer
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Rafael Paez
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Terra Swanson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Caroline M Godfrey
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - See-Wei Low
- Division of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, OH
| | - David Xiao
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Thomas Z Li
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Jacob R Richardson
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael A Knight
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Samira Shojaee
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Stephen A Deppen
- Department of Surgery, Tennessee Valley Healthcare System, Veterans Affairs, Nashville, TN; and the Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Eric L Grogan
- Department of Surgery, Tennessee Valley Healthcare System, Veterans Affairs, Nashville, TN; and the Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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Verma S, Young S, Kennedy TAC, Carvalhana I, Black M, Baer K, Churchman E, Warner A, Allan AL, Izaguirre-Carbonell J, Dhani H, Louie AV, Palma DA, Breadner DA. Detection of Circulating Tumor DNA After Stereotactic Ablative Radiotherapy in Patients With Unbiopsied Lung Tumors (SABR-DETECT). Clin Lung Cancer 2024; 25:e87-e91. [PMID: 38101984 DOI: 10.1016/j.cllc.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
For patients with stage I/IIA non-small-cell lung cancer (NSCLC), surgical resection is the standard treatment. However, some of these patients are not candidates for surgery or refuse a surgical option. Definitive stereotactic ablative radiotherapy (SABR) is a standard approach in these patients. Approximately 15% of patients undergoing SABR for localized NSCLC will experience a recurrence within 2 years. Furthermore, many of these patients are deemed appropriate for SABR without a tissue diagnosis, based on the likelihood of malignancy which can be calculated by validated models. A liquid biopsy, detecting ctDNA, would be useful in early detection of recurrences, and documenting a cancer diagnosis in patients without a biopsy. This is a multi-institutional study enrolling patients with suspected stage I/IIA NSCLC and a pretreatment likelihood of malignancy of ≥60% using the validated models for patients without a tissue diagnosis, in cohort 1 (n = 45). The second cohort will consist of biopsied patients (n = 30-60). SABR will be delivered as per risk-adapted protocol. Plasma will be collected for ctDNA analysis prior to the first fraction of SABR, 24 to 72 hours after first fraction, and at 3, 6, 9, 12, 18, and 24-months. The patients will be followed up with imaging at 3, 6, 9, 12, 18, and 24-months. The primary objective is to assess whether a cancer detection liquid biopsy platform can predict recurrence of NSCLC. The secondary objectives are to assess the impact of SABR on detection rates of ctDNA in patients undergoing SABR and to correlate ctDNA positivity and pretreatment probability of malignancy (NCT05921474).
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Affiliation(s)
- Saurav Verma
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Sympascho Young
- Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Thomas A C Kennedy
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ilda Carvalhana
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Morgan Black
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Kathie Baer
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Emma Churchman
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Alison L Allan
- London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada; Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | | | - Alexander V Louie
- Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Daniel A Breadner
- Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada.
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Zhang C, Xie F, Li R, Cui N, Herth FJF, Sun J. Robotic-assisted bronchoscopy for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis. Thorac Cancer 2024; 15:505-512. [PMID: 38286133 PMCID: PMC10912532 DOI: 10.1111/1759-7714.15229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024] Open
Abstract
Robotic-assisted bronchoscopy (RAB) is a newly developed bronchoscopic technique for the diagnosis of peripheral pulmonary lesions (PPLs). The objective of this meta-analysis was to analyze the diagnostic yield and safety of RAB in patients with PPLs. Five databases (PubMed, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov) were searched from inception to April 2023. Two independent investigators screened retrieved articles, extracted data, and assessed the study quality. The pooled diagnostic yield and complication rate were estimated. Subgroup analysis was used to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Egger test. Sensitivity analysis was also conducted to assess the robustness of the synthesized results. A total of 725 lesions from 10 studies were included in this meta-analysis. No publication bias was found. Overall, RAB had a pooled diagnostic yield of 80.4% (95% CI: 75.7%-85.1%). Lesion size of >30 mm, presence of a bronchus sign, and a concentric radial endobronchial ultrasound view were associated with a statistically significantly higher diagnostic yield. Heterogeneity exploration showed that studies using cryoprobes reported better yields than those without cryoprobes (90.0%, 95% CI: 83.2%-94.7% vs. 79.0%, 95% CI: 75.8%-82.2%, p < 0.01). The pooled complication rate was 3.0% (95% CI: 1.6%-4.4%). In conclusion, RAB is an effective and safe technique for PPLs diagnosis. Further high-quality prospective studies still need to be conducted.
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Affiliation(s)
- Chunxi Zhang
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Runchang Li
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Ningxin Cui
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, ThoraxklinikUniversity of HeidelbergHeidelbergGermany
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Department of Respiratory and Critical Care MedicineShanghai Chest Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
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Senan S, Schneiders FL, Moghanaki D. Sub-lobar resections for peripheral non-small cell lung cancer measuring ≤ 2 cm: Insights from recent clinical trials. Radiother Oncol 2024; 192:110094. [PMID: 38224918 DOI: 10.1016/j.radonc.2024.110094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/02/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024]
Abstract
The findings of two well conducted trials that randomised 1803 patients with a peripheral non-small cell lung cancer measuring ≤ 2 cm to a lobar to sub-lobar resection have established the latter as a new standard of care. It is important for non-surgical oncologists to appreciate the details of study design and outcomes of both studies, given the possible impact they have for considerations of stereotactic ablative radiotherapy (SABR) for operable patients with early-stage NSCLC. Differences in overall survival between the study populations highlight the impact of confounding factors like smoking history and comorbidities on reported outcomes. For example, despite low post-operative mortality rates in both trials, the 5-year disease-free survival rate in the CALGB 140503 trial was only approximately 60 % with either surgical procedure. Both phase III trials required guideline recommended nodal staging, which does not reflect real world surgical practice, and which may limit the generalisability of the reported findings to local institutional outcomes. Furthermore, the emergence of other malignancies was recorded in 15-18 % of study patients during follow-up, and patients who underwent sub-lobar resections had a better long-term survival associated with a higher likelihood of undergoing additional curative treatments. These findings from the JCOG0802 and the CALGB 140503 will encourage more interest in enrolling patients into ongoing trials comparing surgical resection with SABR.
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Affiliation(s)
- Suresh Senan
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1117, Postbus 7057 1007 MB, Amsterdam, the Netherlands.
| | - Famke L Schneiders
- Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1117, Postbus 7057 1007 MB, Amsterdam, the Netherlands
| | - Drew Moghanaki
- Department of Radiation Oncology, University of California Los Angeles, 200 Medical Plaza Driveway, Suite #B265, Los Angeles, CA 90095-6951 USA.
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Saad F, Frysch R, Saalfeld S, Kellnberger S, Schulz J, Fahrig R, Bhadra K, Nürnberger A, Rose G. Deformable 3D/3D CT-to-digital-tomosynthesis image registration in image-guided bronchoscopy interventions. Comput Biol Med 2024; 171:108199. [PMID: 38394801 DOI: 10.1016/j.compbiomed.2024.108199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/30/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
Traditional navigational bronchoscopy procedures rely on preprocedural computed tomography (CT) and intraoperative chest radiography and cone-beam CT (CBCT) to biopsy peripheral lung lesions. This navigational approach is challenging due to the projective nature of radiography, and the high radiation dose, long imaging time, and large footprints of CBCT. Digital tomosynthesis (DTS) is considered an attractive alternative combining the advantages of radiography and CBCT. Only the depth resolution cannot match a full CBCT image due to the limited angle acquisition. To address this issue, preoperative CT is a good auxiliary in guiding bronchoscopy interventions. Nevertheless, CT-to-body divergence caused by anatomic changes and respiratory motion, hinders the effective use of CT imaging. To mitigate CT-to-body divergence, we propose a novel deformable 3D/3D CT-to-DTS registration algorithm employing a multistage, multiresolution approach and using affine and elastic B-spline transformation models with bone and lung mask images. A multiresolution strategy with a Gaussian image pyramid and a multigrid strategy within the B-spline model are applied. The normalized correlation coefficient is included in the cost function for the affine model and a multimetric weighted cost function is used for the B-spline model, with weights determined heuristically. Tested on simulated and real patient bronchoscopy data, the algorithm yields promising results. Assessed qualitatively by visual inspection and quantitatively by computing the Dice coefficient (DC) and the average symmetric surface distance (ASSD), the algorithm achieves mean DC of 0.82±0.05 and 0.74±0.05, and mean ASSD of 0.65±0.29mm and 0.93±0.43mm for simulated and real data, respectively. This algorithm lays the groundwork for CT-aided intraoperative DTS imaging in image-guided bronchoscopy interventions with future studies focusing on automated metric weight setting.
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Affiliation(s)
- Fatima Saad
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany.
| | - Robert Frysch
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - Sylvia Saalfeld
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Jessica Schulz
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Siemens Healthcare GmbH, Forchheim, Germany
| | | | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, USA
| | - Andreas Nürnberger
- Data and Knowledge Engineering Group, Faculty of Computer Science, Otto-von-Guericke University, Magdeburg, Germany
| | - Georg Rose
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
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Zhang Y, Sun B, Yu Y, Lu J, Lou Y, Qian F, Chen T, Zhang L, Yang J, Zhong H, Wu L, Han B. Multimodal fusion of liquid biopsy and CT enhances differential diagnosis of early-stage lung adenocarcinoma. NPJ Precis Oncol 2024; 8:50. [PMID: 38409480 PMCID: PMC10897137 DOI: 10.1038/s41698-024-00551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
This research explores the potential of multimodal fusion for the differential diagnosis of early-stage lung adenocarcinoma (LUAD) (tumor sizes < 2 cm). It combines liquid biopsy biomarkers, specifically extracellular vesicle long RNA (evlRNA) and the computed tomography (CT) attributes. The fusion model achieves an impressive area under receiver operating characteristic curve (AUC) of 91.9% for the four-classification of adenocarcinoma, along with a benign-malignant AUC of 94.8% (sensitivity: 89.1%, specificity: 94.3%). These outcomes outperform the diagnostic capabilities of the single-modal models and human experts. A comprehensive SHapley Additive exPlanations (SHAP) is provided to offer deep insights into model predictions. Our findings reveal the complementary interplay between evlRNA and image-based characteristics, underscoring the significance of integrating diverse modalities in diagnosing early-stage LUAD.
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Affiliation(s)
- Yanwei Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beibei Sun
- Institute for Thoracic Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Jun Lu
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqing Lou
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fangfei Qian
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tianxiang Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhang
- Dianei Technology, Shanghai, China
| | - Jiancheng Yang
- Dianei Technology, Shanghai, China.
- Computer Vision Laboratory, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne, Switzerland.
| | - Hua Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ligang Wu
- State Key Laboratory of Molecular Biology, Shanghai Key Laboratory of Molecular Andrology, Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.
| | - Baohui Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Soumagne T, Dutau H, Eapen G, Guibert N, Hergott C, Maldonado F, Saka H, Fortin M. An International Survey of Practices in the Investigation and Endoscopic Treatment of Peripheral Pulmonary Lesions amongst Interventional Bronchoscopists. Respiration 2024; 103:146-154. [PMID: 38402862 DOI: 10.1159/000536271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION The investigation of peripheral pulmonary lesions (PPLs) can be challenging. Several bronchoscopic modalities have been developed to reach and biopsy PPL but the level of adoption of these techniques by interventional pulmonologists (IPs) is unknown. This international survey was conducted to describe current practices in PPL investigation among IP. METHODS This survey was sent to all members of the World Association for Bronchology and Interventional Pulmonology, Canadian Thoracic Society Procedures Assembly, AABIP, and the Groupe d'Endoscopie Thoracique et Interventionnel Francophone. The survey was composed of 48 questions and three clinical cases to establish a portrait of modalities used to investigate and treat PPL by IP around the world. RESULTS Three hundred and twelve IP responded to the survey. Most of them practice in Europe (n = 122), North America (n = 97), and Asia (n = 49). Half of responders perform more than 100 endoscopic procedures for PPL annually. General anesthesia and conscious sedation are used in similar proportions (53% and 47%, respectively). Rapid on site evaluation (ROSE) is used when sampling PPL by 42%. Radial EBUS (69%), fluoroscopy (55%), and electromagnetic navigation (27%) are the most widely used techniques. Most IP combine techniques (89%). Robotic bronchoscopy (15%) and cone-beam CT (8%) are almost exclusively used in the USA where, respectively, 60% and 37% of respondents reported using these modalities. Ten percent of IP currently had access to endoscopic treatment modalities for PPL. However, half of the remaining IP plan to acquire an endoscopic treatment modality in the next 2 years. CONCLUSION Available techniques and practices worldwide vary significantly regarding PPL investigation and treatment.
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Affiliation(s)
- Thibaud Soumagne
- Department of Pulmonology and Thoracic Surgery, Quebec Heart and Lung Institute, Laval University, Quebec, Québec, Canada
- Respiratory Medicine, Intensive Care and Bronchoscopy Department, European Hospital Georges Pompidou, APHP, Paris, France
| | - Hervé Dutau
- Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France
| | - Georgie Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolas Guibert
- Interventional Pulmonology Unit, Pulmonology Department, Hospital Larrey, Toulouse, France
| | - Christopher Hergott
- Department of Medicine, Division of Respirology University of Calgary Faculty of Medicine, Calgary, Alberta, Canada
| | - Fabien Maldonado
- Interventional Pulmonology, Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
- Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Marc Fortin
- Department of Pulmonology and Thoracic Surgery, Quebec Heart and Lung Institute, Laval University, Quebec, Québec, Canada
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Borg M, Bodtger U, Kristensen K, Alstrup G, Mamaeva T, Arshad A, Laursen CB, Hilberg O, Andersen MB, Rasmussen TR. Incidental pulmonary nodules may lead to a high proportion of early-stage lung cancer: but it requires more than a high CT volume to achieve this. Eur Clin Respir J 2024; 11:2313311. [PMID: 38379593 PMCID: PMC10878329 DOI: 10.1080/20018525.2024.2313311] [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: 09/18/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
Background The management of pulmonary nodules plays a critical role in early detection of lung cancer. Computed tomography (CT) has led to a stage-shift towards early-stage lung cancer, but regional differences in survival rates have been reported in Denmark. This study aimed to evaluate whether variations in nodule management among Danish health regions contributed to these differences. Material and Methods The Danish Health Data Authority and Danish Lung Cancer Registry provided data on CT usage and lung cancer stage distribution, respectively. Auditing of lung cancer stage IA patient referrals and nodule management of stage IV lung cancer patients was conducted in seven Danish lung cancer investigation centers, covering four of the five Danish health regions. CT scans were performed up to 2 years before the patients' diagnosis from 2019 to 2021. Results CT usage has increased steadily in Denmark over the past decade, with a simultaneous increase in the proportion of early-stage lung cancers, particularly stage IA. However, one Danish health region, Region Zealand, exhibited lower rates of early-stage lung cancer and overall survival despite a CT usage roughly similar to that of the other health regions. The audit did not find significant differences in pulmonary nodule management or a higher number of missed nodules by radiologists in this region compared to others. Conclusion This study suggests that a high CT scan volume alone is not sufficient for the early detection of lung cancer. Factors beyond hospital management practices, such as patient-related delays in socioeconomically disadvantaged areas, may contribute to regional differences in survival rates. This has implications for future strategies for reducing these differences.
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Affiliation(s)
- M. Borg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
| | - U. Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital Næstved & Roskilde, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - K. Kristensen
- Department of Internal Medicine, Gødstrup Hospital, Herning, Denmark
| | - G. Alstrup
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital Næstved & Roskilde, Næstved, Denmark
| | - T. Mamaeva
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - A. Arshad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - CB. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - O. Hilberg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - M. Brun Andersen
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- Institute of clinical medicine, Copenhagen University, Copenhagen, Denmark
| | - T Riis Rasmussen
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Yi E, Sunaguchi N, Lee JH, Seo SJ, Lee S, Shimao D, Ando M. Synchrotron Radiation Refraction-Contrast Computed Tomography Based on X-ray Dark-Field Imaging Optics of Pulmonary Malignancy: Comparison with Pathologic Examination. Cancers (Basel) 2024; 16:806. [PMID: 38398196 PMCID: PMC10886596 DOI: 10.3390/cancers16040806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Refraction-contrast computed tomography based on X-ray dark-field imaging (XDFI) using synchrotron radiation (SR) has shown superior resolution compared to conventional absorption-based methods and is often comparable to pathologic examination under light microscopy. This study aimed to investigate the potential of the XDFI technique for clinical application in lung cancer diagnosis. Two types of lung specimens, primary and secondary malignancies, were investigated using an XDFI optic system at beamline BL14B of the High-Energy Accelerator Research Organization Photon Factory, Tsukuba, Japan. Three-dimensional reconstruction and segmentation were performed on each specimen. Refraction-contrast computed tomographic images were compared with those obtained from pathological examinations. Pulmonary microstructures including arterioles, venules, bronchioles, alveolar sacs, and interalveolar septa were identified in SR images. Malignant lesions could be distinguished from the borders of normal structures. The lepidic pattern was defined as the invasive component of the same primary lung adenocarcinoma. The SR images of secondary lung adenocarcinomas of colorectal origin were distinct from those of primary lung adenocarcinomas. Refraction-contrast images based on XDFI optics of lung tissues correlated well with those of pathological examinations under light microscopy. This imaging method may have the potential for use in lung cancer diagnosis without tissue damage. Considerable equipment modifications are crucial before implementing them from the lab to the hospital in the near future.
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Affiliation(s)
- Eunjue Yi
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea;
| | - Naoki Sunaguchi
- Department of Radiological and Medical Laboratory Sciences, Graduate School of Medicine, Nagoya University, Nagoya 461-8673, Japan;
| | - Jeong Hyeon Lee
- Department of Pathology, Korea University Anam Hospital, Seoul 02841, Republic of Korea;
| | - Seung-Jun Seo
- Department of Experimental Animal Facility, Daegu Catholic University Medical Center, Daegu 42472, Republic of Korea;
| | - Sungho Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea;
| | - Daisuke Shimao
- Faculty of Health Sciences, Butsuryo College of Osaka, Osaka 593-8328, Japan;
| | - Masami Ando
- Photon Factory, Institute of Materials Structure Science, High-Energy Accelerator Research Organization, Tsukuba 300-3256, Japan;
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Kim RY. Radiomics and artificial intelligence for risk stratification of pulmonary nodules: Ready for primetime? Cancer Biomark 2024:CBM230360. [PMID: 38427470 DOI: 10.3233/cbm-230360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Pulmonary nodules are ubiquitously found on computed tomography (CT) imaging either incidentally or via lung cancer screening and require careful diagnostic evaluation and management to both diagnose malignancy when present and avoid unnecessary biopsy of benign lesions. To engage in this complex decision-making, clinicians must first risk stratify pulmonary nodules to determine what the best course of action should be. Recent developments in imaging technology, computer processing power, and artificial intelligence algorithms have yielded radiomics-based computer-aided diagnosis tools that use CT imaging data including features invisible to the naked human eye to predict pulmonary nodule malignancy risk and are designed to be used as a supplement to routine clinical risk assessment. These tools vary widely in their algorithm construction, internal and external validation populations, intended-use populations, and commercial availability. While several clinical validation studies have been published, robust clinical utility and clinical effectiveness data are not yet currently available. However, there is reason for optimism as ongoing and future studies aim to target this knowledge gap, in the hopes of improving the diagnostic process for patients with pulmonary nodules.
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Jimah BB, Amoako E, Ofori EO, Akakpo PK, Aniakwo LA, Ulzen‐Appiah K, Imbeah EG, Morna MT, Koggoh P, Akligoh H, Tackie R, Manu A, Paemka L, Sarkodie BD, Offei AK, Hutchful D, Ngoi J, Bediako Y, Rahman GA. Radiologic patterns of distant organ metastasis in advanced breast cancer patients: Prospective review of computed tomography images. Cancer Rep (Hoboken) 2024; 7:e1988. [PMID: 38351553 PMCID: PMC10864737 DOI: 10.1002/cnr2.1988] [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: 07/30/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Breast cancer (BC) metastases to the abdomen and pelvis affect the liver, mesentery, retroperitoneum, peritoneum, bladder, kidney, ovary, and uterus. The study documented the radiological pattern and features of the chest, bone, abdominal and pelvic (AP) metastases among advanced BC patients. AIM The aim is to document the radiological pattern and features of breast cancer metastasis in the chest, abdomen, pelvis and bones. MATERIALS AND RESULTS Chest, abdominal, and pelvic computed tomography scan images of 36 patients with advanced BC were collated from Cape Coast Teaching Hospital and RAAJ Diagnostics. The images were prospectively assessed for metastasis to the organs of the chest, AP soft tissues, and bones. Radiologic features of metastasis of the lungs, liver, lymph nodes (LNs), and bones were documented. Patients' demographics, clinical data, and histopathology reports were also collected. The data were captured using UVOSYO and exported to Microsoft Excel templates. The data obtained were descriptively analyzed. Only 2.8% of BCs exhibited metaplastic BC, whereas 97.2% had invasive ductal BC. Triple-negative cases were 55.6%. Of 36 patients, 31 (86.1%), 21 (58.3%), and 14(38.8%) were diagnosed of chest, AP, and bone tissues metastasis, respectively. LN involvement was reported in 26 (72.2%) patients. Majority, 21 (58.3%) were diagnosed of multiple sites metastasis with 15 (41.7%) showing single site. Lungs (77.4%, 24/31) and liver (47.6%, 10/21) were the most affected distant organs. Most bone metastases were lytic lesions (92.9%, 13/14) with the vertebrae (85.7%, 12/14) been the most affected. CONCLUSION According to the study, advanced BC patients have a higher-than-average radiologic incidence of lung, liver, bone, and LN metastases.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Patience Koggoh
- Department of SurgeryCape Coast Teaching HospitalCape CoastGhana
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He XQ, Huang XT, Luo TY, Liu X, Li Q. The differential computed tomography features between small benign and malignant solid solitary pulmonary nodules with different sizes. Quant Imaging Med Surg 2024; 14:1348-1358. [PMID: 38415140 PMCID: PMC10895103 DOI: 10.21037/qims-23-995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/20/2023] [Indexed: 02/29/2024]
Abstract
Background Computed tomography (CT) has been widely known to be the first choice for the diagnosis of solid solitary pulmonary nodules (SSPNs). However, the smaller the SSPN is, the less the differential CT signs between benign and malignant SSPNs there are, which brings great challenges to their diagnosis. Therefore, this study aimed to investigate the differential CT features between small (≤15 mm) benign and malignant SSPNs with different sizes. Methods From May 2018 to November 2021, CT data of 794 patients with small SSPNs (≤15 mm) were retrospectively analyzed. SSPNs were divided into benign and malignant groups, and each group was further classified into three cohorts: cohort I (diameter ≤6 mm), cohort II (6 mm < diameter ≤8 mm), and cohort III (8 mm < diameter ≤15 mm). The differential CT features of benign and malignant SSPNs in three cohorts were identified. Multivariable logistic regression analyses were conducted to identify independent factors of benign SSPNs. Results In cohort I, polygonal shape and upper-lobe distribution differed significantly between groups (all P<0.05) and multiparametric analysis showed polygonal shape [adjusted odds ratio (OR): 12.165; 95% confidence interval (CI): 1.512-97.872; P=0.019] was the most effective variation for predicting benign SSPNs, with an area under the receiver operating characteristic curve (AUC) of 0.747 (95% CI: 0.640-0.855; P=0.001). In cohort II, polygonal shape, lobulation, pleural retraction, and air bronchogram differed significantly between groups (all P<0.05), and polygonal shape (OR: 8.870; 95% CI: 1.096-71.772; P=0.041) and the absence of pleural retraction (OR: 0.306; 95% CI: 0.106-0.883; P=0.028) were independent predictors of benign SSPNs, with an AUC of 0.778 (95% CI: 0.694-0.863; P<0.001). In cohort III, 12 CT features showed significant differences between groups (all P<0.05) and polygonal shape (OR: 3.953; 95% CI: 1.508-10.361; P=0.005); calcification (OR: 3.710; 95% CI: 1.305-10.551; P=0.014); halo sign (OR: 6.237; 95% CI: 2.838-13.710; P<0.001); satellite lesions (OR: 6.554; 95% CI: 3.225-13.318; P<0.001); and the absence of lobulation (OR: 0.066; 95% CI: 0.026-0.167; P<0.001), air space (OR: 0.405; 95% CI: 0.215-0.764; P=0.005), pleural retraction (OR: 0.297; 95% CI: 0.179-0.493; P<0.001), bronchial truncation (OR: 0.165; 95% CI: 0.090-0.303; P<0.001), and air bronchogram (OR: 0.363; 95% CI: 0.208-0.633; P<0.001) were independent predictors of benign SSPNs, with an AUC of 0.869 (95% CI: 0.840-0.897; P<0.001). Conclusions CT features vary between SSPNs with different sizes. Clarifying the differential CT features based on different diameter ranges may help to minimize ambiguities and discriminate the benign SSPNs from malignant ones.
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Affiliation(s)
- Xiao-Qun He
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xing-Tao Huang
- Department of Radiology, the Fifth People’s Hospital of Chongqing, Chongqing, China
| | - Tian-You Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Liu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Wang J, Sourlos N, Heuvelmans M, Prokop M, Vliegenthart R, van Ooijen P. Explainable machine learning model based on clinical factors for predicting the disappearance of indeterminate pulmonary nodules. Comput Biol Med 2024; 169:107871. [PMID: 38154157 DOI: 10.1016/j.compbiomed.2023.107871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/01/2023] [Accepted: 12/17/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND During lung cancer screening, indeterminate pulmonary nodules (IPNs) are a frequent finding. We aim to predict whether IPNs are resolving or non-resolving to reduce follow-up examinations, using machine learning (ML) models. We incorporated dedicated techniques to enhance prediction explainability. METHODS In total, 724 IPNs (size 50-500 mm3, 575 participants) from the Dutch-Belgian Randomized Lung Cancer Screening Trial were used. We implemented six ML models and 14 factors to predict nodule disappearance. Random search was applied to determine the optimal hyperparameters on the training set (579 nodules). ML models were trained using 5-fold cross-validation and tested on the test set (145 nodules). Model predictions were evaluated by utilizing the recall, precision, F1 score, and the area under the receiver operating characteristic curve (AUC). The best-performing model was used for three feature importance techniques: mean decrease in impurity (MDI), permutation feature importance (PFI), and SHAPley Additive exPlanations (SHAP). RESULTS The random forest model outperformed the other ML models with an AUC of 0.865. This model achieved a recall of 0.646, a precision of 0.816, and an F1 score of 0.721. The evaluation of feature importance achieved consistent ranking across all three methods for the most crucial factors. The MDI, PFI, and SHAP methods highlighted volume, maximum diameter, and minimum diameter as the top three factors. However, the remaining factors revealed discrepant ranking across methods. CONCLUSION ML models effectively predict IPN disappearance using participant demographics and nodule characteristics. Explainable techniques can assist clinicians in developing understandable preliminary assessments.
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Affiliation(s)
- Jingxuan Wang
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands.
| | - Nikos Sourlos
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Marjolein Heuvelmans
- Department of Epidemiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Mathias Prokop
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Peter van Ooijen
- Department of Radiation Oncology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands.
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Yamashita T, Matsubayashi Y, Mochizuki T. Traumatic tumor hemorrhage of inflammatory myofibroblastic tumor of the lung. Respir Med Case Rep 2024; 47:101981. [PMID: 38288137 PMCID: PMC10823134 DOI: 10.1016/j.rmcr.2024.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024] Open
Abstract
A 23-year-old female with a history of idiopathic epilepsy was found to have a right chest cavity shadow in a school health checkup 5 years before. CT revealed a thin-walled cavity lesion in the right middle lobe containing a ball-like mass, showing air crescent sign. After falling due to a seizure, she was transported by ambulance and admitted. CT revealed diffuse ground-glass opacities throughout the right lung field. Bronchoscopy revealed bloody bronchial alveolar lavage fluid. Due to the tumor hemorrhage, an elective simple right middle lobe resection was performed without complications. The initial immunohistochemical staining was negative for ALK using ALK1 clone; however, subsequent staining of ALK by D5F3 and 5A4 clone was positive. Immunostaining findings led to a diagnosis of inflammatory myofibroblastic tumor. The patient remains under regular observation and has experienced no recurrence over the 6-year postoperative period. This case contains two different points: the first is that a cavity lesion of inflammatory myofibroblastic tumor may cause traumatic bleeding and should be treated with caution; the second is that attention should be paid to differences in stainability among clones when diagnosing inflammatory myofibroblastic tumor.
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Affiliation(s)
- Takashi Yamashita
- Department of Thoracic Surgery, Iwata City Hospital, 512-3, Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Yuta Matsubayashi
- Department of Thoracic Surgery, Iwata City Hospital, 512-3, Ohkubo, Iwata, Shizuoka, 438-8550, Japan
| | - Takahiro Mochizuki
- Department of Thoracic Surgery, Iwata City Hospital, 512-3, Ohkubo, Iwata, Shizuoka, 438-8550, Japan
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Tai DT, Nhu NT, Tuan PA, Sulieman A, Omer H, Alirezaei Z, Bradley D, Chow JCL. A user-friendly deep learning application for accurate lung cancer diagnosis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:611-622. [PMID: 38607727 DOI: 10.3233/xst-230255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Accurate diagnosis and subsequent delineated treatment planning require the experience of clinicians in the handling of their case numbers. However, applying deep learning in image processing is useful in creating tools that promise faster high-quality diagnoses, but the accuracy and precision of 3-D image processing from 2-D data may be limited by factors such as superposition of organs, distortion and magnification, and detection of new pathologies. The purpose of this research is to use radiomics and deep learning to develop a tool for lung cancer diagnosis. METHODS This study applies radiomics and deep learning in the diagnosis of lung cancer to help clinicians accurately analyze the images and thereby provide the appropriate treatment planning. 86 patients were recruited from Bach Mai Hospital, and 1012 patients were collected from an open-source database. First, deep learning has been applied in the process of segmentation by U-NET and cancer classification via the use of the DenseNet model. Second, the radiomics were applied for measuring and calculating diameter, surface area, and volume. Finally, the hardware also was designed by connecting between Arduino Nano and MFRC522 module for reading data from the tag. In addition, the displayed interface was created on a web platform using Python through Streamlit. RESULTS The applied segmentation model yielded a validation loss of 0.498, a train loss of 0.27, a cancer classification validation loss of 0.78, and a training accuracy of 0.98. The outcomes of the diagnostic capabilities of lung cancer (recognition and classification of lung cancer from chest CT scans) were quite successful. CONCLUSIONS The model provided means for storing and updating patients' data directly on the interface which allowed the results to be readily available for the health care providers. The developed system will improve clinical communication and information exchange. Moreover, it can manage efforts by generating correlated and coherent summaries of cancer diagnoses.
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Affiliation(s)
- Duong Thanh Tai
- Department of Medical Physics, Faculty of Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Nguyen Tan Nhu
- School of Biomedical Engineering, Ho Chi Minh City International University (VNU-HCM), Ho Chi Minh City, Vietnam
- Vietnam National University Ho Chi Minh City, Vietnam
| | - Pham Anh Tuan
- Nuclear Medicine and Oncology Centre, Bach Mai Hospital, Ha Noi, Vietnam
| | - Abdelmoneim Sulieman
- Radiology and Medical Imaging Department Prince Sattam Bin Abdulaziz University College of Applied Medical Sciences, Al-Kharj, Saudi Arabia
- Radiological Science Department, College of Applied Medical Sciences, Al Ahsa, Saudi Arabia, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hiba Omer
- Department of Basic Sciences, Deanship of Preparatory Year and Supporting Studies, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zahra Alirezaei
- Radiology Department, Paramedical School, Bushehr University of Medical Sciences, Bushehr, Iran
| | - David Bradley
- Applied Physics and Radiation Technologies Group, CCDCU, Sunway University, Subang Jaya, PJ, Malaysia
- School of Mathematics and Physics, University of Surrey, Guildford, UK
| | - James C L Chow
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Mohakud S, Das R, Bag ND, Mohapatra PR, Mishra P, Naik S. A Prospective Observational Study of Diagnostic Reliability of Semiquantitative and Quantitative High b-Value Diffusion-Weighted MRI in Distinguishing between Benign and Malignant Lung Lesions at 3 Tesla. Indian J Radiol Imaging 2024; 34:6-15. [PMID: 38106852 PMCID: PMC10723977 DOI: 10.1055/s-0043-1771530] [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] [Indexed: 12/19/2023] Open
Abstract
Aim The aim of this study was to evaluate the usefulness of high b-value diffusion-weighted imaging (DWI) to differentiate benign and malignant lung lesions in 3 Tesla magnetic resonance imaging (MRI). Materials and Methods Thirty-one patients with lung lesions underwent a high b-value (b= 1000 s/mm 2 ) DW MRI in 3 Tesla. Thirty lesions were biopsied, followed by histopathological analysis, and one was serially followed up for 2 years. Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of different DWI parameters in distinguishing benign and malignant lesions. Receiver operating characteristic (ROC) curves were used to determine the cutoff values of different parameters. Results The qualitative assessment of signal intensity on DWI based on a 5-point rank scale had a mean score of 2.71 ± 0.75 for benign and 3. 75 ± 0.60 for malignant lesions. With a cutoff of 3.5, the sensitivity, specificity, and accuracy were 75, 86, and 77.6%, respectively. The mean ADC min (minimum apparent diffusion coefficient) value of benign and malignant lesions was 1. 49 ± 0.38 × 10-3 mm 2 /s and 1.11 ± 0.20 ×10-3 mm 2 /s, respectively. ROC curve analysis showed a cutoff value of 1.03 × 10-3 mm 2 /s; the sensitivity, specificity, and accuracy were 87.5, 71.4, and 83.3%, respectively. For lesion to spinal cord ratio and lesion to spinal cord ADC ratio with a cutoff value of 1.08 and 1.38, the sensitivity, specificity, and accuracy were 83.3 and 87.5%, 71.4 and 71.4%, and 80.6 and 83.8%, respectively. The exponential ADC showed a low accuracy rate. Conclusion The semiquantitative and quantitative parameters of high b-value DW 3 Tesla MRI can differentiate benign from malignant lesions with high accuracy and make it a reliable nonionizing modality for characterizing lung lesions.
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Affiliation(s)
- Sudipta Mohakud
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rasmibala Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari D. Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta R. Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pritinanda Mishra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Dun Y, Cui N, Wu S, Fu S, Ripley-Gonzalez JW, Zhou N, Zeng T, Li D, Chen M, Ren Y, Yee Lau W, Du Y, Thomas RJ, Squires RW, Olson TP, Liu S. Cardiorespiratory fitness and morbidity and mortality in patients with non-small cell lung cancer: a prospective study with propensity score weighting. Ann Med 2023; 55:2295981. [PMID: 38128485 PMCID: PMC10763904 DOI: 10.1080/07853890.2023.2295981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the association between cardiorespiratory fitness (CRF) and perioperative morbidity and long-term mortality in operable patients with early-stage non-small cell lung cancer (NSCLC). PATIENTS AND METHODS This prospective study included consecutive patients with early-stage NSCLC who underwent presurgical cardiopulmonary exercise testing between November 2014 and December 2019 (registration number: ChiCTR2100048120). Logistic and Cox proportional hazards regression were applied to evaluate the correlation between CRF and perioperative complications and long-term mortality, respectively. Propensity score overlap weighting was used to adjust for the covariates. We performed sensitivity analyses to determine the stability of our results. RESULTS A total of 895 patients were followed for a median of 40 months [interquartile range 25]. The median age of the patients was 59 years [range 26-83], and 62.5% were male. During the study period, 156 perioperative complications and 146 deaths were observed. Low CRF was associated with a higher risk of death (62.9 versus 33.6 per 1000 person-years; weighted incidence rate difference, 29.34 [95% CI, 0.32 to 58.36] per 1000 person-years) and perioperative morbidity (241.6 versus 141.9 per 1000 surgeries; weighted incidence rate difference, 99.72 [95% CI, 34.75 to 164.70] per 1000 surgeries). A CRF of ≤ 20 ml/kg/min was significantly associated with a high risk of long-term mortality (weighted hazard ratio, 1.98 [95% CI, 1.31 to 2.98], p < 0.001) and perioperative morbidity (weighted odds ratio, 1.93 [1.28 to 2.90], p = 0.002) compared to higher CRF. CONCLUSION The study found that low CRF is significantly associated with increased perioperative morbidity and long-term mortality in operable patients with early-stage NSCLC.
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Affiliation(s)
- Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
- School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King’s College London, United Kingdom
| | - Ni Cui
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shaoping Wu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Siqian Fu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jeffrey W. Ripley-Gonzalez
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Nanjiang Zhou
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tanghao Zeng
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dezhao Li
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Mi Chen
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yu Ren
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - Yang Du
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Randal J. Thomas
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ray W. Squires
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas P. Olson
- Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine and Rehabilitation, Xiangya Hospital of Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, China
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