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Kalvapudi S, Zubair HM, Kunadharaju R, Bhura S, Mengiste H, Saeed M, Saradna A, Grover H, Shafirstein G, Yendamuri S, Ivanick NM. Correlation of Bronchoscopy and CT in Characterizing Malignant Central Airway Obstruction. Cancers (Basel) 2024; 16:1258. [PMID: 38610936 PMCID: PMC11010868 DOI: 10.3390/cancers16071258] [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: 03/06/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Malignant Central Airway Obstruction (MCAO) presents a significant challenge in lung cancer management, with notable morbidity and mortality implications. While bronchoscopy is the established diagnostic standard for confirming MCAO and assessing obstruction subtype (intrinsic, extrinsic, mixed) and severity, Computed Tomography (CT) serves as an initial screening tool. However, the extent of agreement between CT and bronchoscopy findings for MCAO remains unclear. METHODS To assess the correlation between bronchoscopy and CT, we conducted a retrospective review of 108 patients at Roswell Park Comprehensive Cancer Center, analyzing CT and bronchoscopy results to document MCAO presence, severity, and subtype. RESULTS CT correctly identified MCAO in 99% of cases (107/108). Agreement regarding obstruction subtype (80.8%, Cohen's κ = 0.683, p < 0.001), and severity (65%, Quadratic κ = 0.657, p < 0.001) was moderate. CT tended to equally overestimate (7/19) and underestimate (7/19) the degree of obstruction. CT was also poor in identifying mucosal involvement in mixed MCAO. CONCLUSIONS CT demonstrates reasonable agreement with bronchoscopy in detecting obstruction. Nevertheless, when CT indicates a positive finding for MCAO, it is advisable to conduct bronchoscopy. This is because CT lacks reliability in determining the severity of obstruction and identifying the mucosal component of mixed disease.
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Affiliation(s)
- Sukumar Kalvapudi
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.K.); (S.Y.)
| | - Hafiz M. Zubair
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Rajesh Kunadharaju
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Sajeer Bhura
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Hiwot Mengiste
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Musa Saeed
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Arjun Saradna
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Harshwant Grover
- Department of Pulmonary and Critical Care, University at Buffalo, Buffalo, NY 14203, USA; (H.M.Z.); (R.K.); (S.B.); (H.M.); (M.S.); (A.S.); (H.G.)
| | - Gal Shafirstein
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA;
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.K.); (S.Y.)
| | - Nathaniel M. Ivanick
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (S.K.); (S.Y.)
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Khan FB, Gibson PC, Anderson S, Wagner S, Cole BF, Kaufman P, Kinsey CM. Initial Safety and Feasibility Results From a Phase 1, Diagnose-and-Treat Trial of Neoadjuvant Intratumoral Cisplatin for Stage IV NSCLC. JTO Clin Res Rep 2024; 5:100634. [PMID: 38455594 PMCID: PMC10918561 DOI: 10.1016/j.jtocrr.2024.100634] [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: 05/26/2023] [Revised: 11/29/2023] [Accepted: 01/08/2024] [Indexed: 03/09/2024] Open
Abstract
Neoadjuvant intratumoral cisplatin has the potential to generate substantial cytotoxicity and immune priming within the tumor environment, while minimizing systemic, off-target, adverse events. We initiated a phase 1A, 3+3 dose-ranging study of neoadjuvant, intratumoral cisplatin, delivered through endobronchial ultrasound bronchoscopy, in the same procedure as the initial diagnosis. There were no dose-limiting toxicity identified at the 20mg level.
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Affiliation(s)
- Farrah B. Khan
- Division of Hematology and Oncology, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Pamela C. Gibson
- Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Scott Anderson
- Department of Pathology & Laboratory Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Sarah Wagner
- Division of Pulmonary and Critical Care, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - Bernard F. Cole
- Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont
| | - Peter Kaufman
- Division of Hematology and Oncology, Larner College of Medicine at the University of Vermont, Burlington, Vermont
| | - C. Matthew Kinsey
- Division of Pulmonary and Critical Care, Larner College of Medicine at the University of Vermont, Burlington, Vermont
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DuComb EA, Collins CC, Cupak D, Wagner S, Khan FB, Budd RC, Kinsey CM. Endobronchial ultrasound-guided transbronchial needle injection of cisplatin results in dynamic changes in the tumor immune microenvironment. Respir Med Res 2023; 84:100994. [PMID: 37307616 DOI: 10.1016/j.resmer.2023.100994] [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: 10/28/2022] [Revised: 12/14/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
RATIONALE Direct intratumoral delivery of cisplatin via endobronchial ultrasound guided-transbronchial needle injections (EBUS-TBNI) is a novel approach for salvage treatment of advanced stage non-small cell lung cancer (NSCLC). The goal of this study was to evaluate changes in the tumor immune microenvironment during the course of EBUS-TBNI cisplatin therapy. METHODS Under an IRB approved protocol, patients with recurrence after radiation therapy who were not receiving other cytotoxic therapy, were prospectively enrolled, and underwent weekly treatments with EBUS-TBNI with additional biopsies obtained for research. Needle aspiration was performed prior to cisplatin delivery at each procedure. Samples were evaluated by flow cytometry for the presence of immune cell types. RESULTS Three of the six patients responded to the therapy based on RECIST criteria. Compared to the pre-treatment baseline, intratumoral neutrophils increased in 5 of the 6 patients (p = 0.041), with an average increase of 27.1%, but was not associated with response. A lower pre-treatment CD8+/CD4+ ratio at baseline was associated with response (P = 0.01). Responders demonstrated a lower final proportion of PD-1+ CD8+ T cells compared to non-responders (8.6% vs. 62.3%, respectively, P<0.001. Lower doses of intratumoral cisplatin were associated with subsequent increases in CD8+ T cells within the tumor microenvironment (P = 0.008). CONCLUSIONS EBUS-TBNI cisplatin resulted in significant alterations in the tumor immune microenvironment. Further studies are needed to determine if the changes seen here generalize to larger cohorts.
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Affiliation(s)
- Emily A DuComb
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington VT, United States
| | - Cheryl C Collins
- Division of Immunobiology, University of Vermont, University of Vermont College of Medicine, Burlington VT, United States
| | - Dolores Cupak
- Division of Immunobiology, University of Vermont, University of Vermont College of Medicine, Burlington VT, United States
| | - Sarah Wagner
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington VT, United States
| | - Farrah B Khan
- Division of Hematology and Oncology, University of Vermont College of Medicine, Burlington VT
| | - Ralph C Budd
- Division of Immunobiology, University of Vermont, University of Vermont College of Medicine, Burlington VT, United States
| | - C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington VT, United States.
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Ge G, Zhang J. Feature selection methods and predictive models in CT lung cancer radiomics. J Appl Clin Med Phys 2023; 24:e13869. [PMID: 36527376 PMCID: PMC9860004 DOI: 10.1002/acm2.13869] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/31/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Radiomics is a technique that extracts quantitative features from medical images using data-characterization algorithms. Radiomic features can be used to identify tissue characteristics and radiologic phenotyping that is not observable by clinicians. A typical workflow for a radiomics study includes cohort selection, radiomic feature extraction, feature and predictive model selection, and model training and validation. While there has been increasing attention given to radiomic feature extraction, standardization, and reproducibility, currently, there is a lack of rigorous evaluation of feature selection methods and predictive models. Herein, we review the published radiomics investigations in CT lung cancer and provide an overview of the commonly used radiomic feature selection methods and predictive models. We also compare limitations of various methods in clinical applications and present sources of uncertainty associated with those methods. This review is expected to help raise awareness of the impact of radiomic feature and model selection methods on the integrity of radiomics studies.
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Affiliation(s)
- Gary Ge
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| | - Jie Zhang
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
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Mori V, Bates JHT, Jantz M, Mehta HJ, Kinsey CM. A computational modeling approach for dosing endoscopic intratumoral chemotherapy for advanced non-small cell lung cancer. Sci Rep 2022; 12:44. [PMID: 34996946 PMCID: PMC8741990 DOI: 10.1038/s41598-021-03849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022] Open
Abstract
We recently developed a computational model of cisplatin pharmacodynamics in an endobronchial lung tumor following ultrasound-guided transbronchial needle injection (EBUS-TBNI). The model suggests that it is more efficacious to apportion the cisplatin dose between injections at different sites rather than giving it all in a single central injection, but the model was calibrated only on blood cisplatin data from a single patient. Accordingly, we applied a modified version of our original model in a set of 32 patients undergoing EBUS-TBNI for non-small cell lung cancer (NSCLC). We used the model to predict clinical responses and compared them retrospectively to actual patient outcomes. The model correctly predicted the clinical response in 72% of cases, with 80% accuracy for adenocarcinomas and 62.5% accuracy for squamous-cell lung cancer. We also found a power-law relationship between tumor volume and the minimal dose needed to induce a response, with the power-law exponent depending on the number of injections administered. Our results suggest that current injection strategies may be significantly over- or under-dosing the agent depending on tumor size, and that computational modeling can be a useful planning tool for EBUS-TBNI of cisplatin in lung cancer.
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Affiliation(s)
- Vitor Mori
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, 89 Beaumont Avenue, Given D208, Burlington, VT, 05401, USA
| | - Jason H T Bates
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, 89 Beaumont Avenue, Given D208, Burlington, VT, 05401, USA
| | - Michael Jantz
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, FL, USA
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care, University of Florida, Gainesville, FL, USA
| | - C Matthew Kinsey
- Division of Pulmonary and Critical Care, University of Vermont Medical Center, 89 Beaumont Avenue, Given D208, Burlington, VT, 05401, USA.
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