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Erasmus LT, Strange CD, Ahuja J, Agrawal R, Shroff GS, Marom EM, Truong MT. Imaging of Lung Cancer Staging: TNM 9 Updates. Semin Ultrasound CT MR 2024:S0887-2171(24)00045-3. [PMID: 39069273 DOI: 10.1053/j.sult.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Imaging plays a key role in clinical staging of lung cancer and guiding therapy. A thorough understanding of the staging system including the nomenclature and updates is necessary to tailor treatment plans and optimize patient care. The 9th edition of the Tumor, Node, Metastasis staging system for lung cancer has no changes for T classification and subdivides N2 and M1c categories. In nodal staging, N2 splits into N2a, ipsilateral mediastinal single station involvement and N2b, ipsilateral mediastinal multiple stations involvement. In the staging of multiple extrathoracic metastases, M1c splits into M1c1, multiple extrathoracic metastases in one organ system and M1c2, multiple extrathoracic metastases in multiple organ systems. Awareness of the proposed changes in TNM-9 staging classification is essential to provide methodical and accurate imaging interpretation.
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Affiliation(s)
- Lauren T Erasmus
- Department of Radiation Oncology, Baylor College of Medicine, Houston, TX
| | - Chad D Strange
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jitesh Ahuja
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rishi Agrawal
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Girish S Shroff
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel
| | - Mylene T Truong
- Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
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Tapias LF, Shen R, Cassivi SD, Reisenauer JS, Lunn BW, Lechtenberg BJ, Nichols FC, Wigle DA, Blackmon SH. Impact of FDG PET Standardized Uptake Value in Resected Clinical Stage IA Non-Small Cell Lung Cancer. Ann Thorac Surg 2024; 117:1017-1023. [PMID: 37080373 DOI: 10.1016/j.athoracsur.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/28/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND A significant proportion of patients with clinical stage IA non-small cell lung cancer (NSCLC) experience will recurrence and decreased survival after surgery. This study examined the impact of preoperative primary tumor positron emission tomography (PET) scan maximum standardized uptake value (SUVmax) on oncologic outcomes after surgery. METHODS This was a retrospective review of 251 patients who underwent surgical treatment of clinical stage IA NSCLC at an academic medical center (2005-2014). Patients were classified according to PET SUVmax level (low vs high) for analysis of upstaging, tumor recurrence, and overall survival. RESULTS Median SUVmax values were higher in squamous cell carcinoma than in adenocarcinoma (median 3.3 vs 7.2; P < .0001). There were 109 (43.4%) patients in the SUVmax low group and 142 (56.6%) in the SUVmax high group. Patients with SUVmax high had larger tumors. SUVmax high was associated with higher rates of nodal upstaging (16.2% vs 4.6% in SUVmax low; P = .004), particularly in N1 nodes. SUVmax high was independently associated with nodal upstaging (adjusted odds ratio, 3.95; 95% CI, 1.36-11.46; P = .011). SUVmax high was associated with time to recurrence (hazard ratio, 1.62; 95% CI, 1.03-2.54; P = .036), but this association was lost on multivariable analysis (hazard ratio, 1.52; 95% CI, 0.91-2.54; P = .106). SUVmax was not associated with overall survival. CONCLUSIONS Preoperative PET SUVmax level is strongly associated with nodal upstaging, particularly in N1 nodes, in patients with clinical stage IA NSCLC who undergo resection. PET SUVmax should be regarded as a risk factor when considering candidacy for sublobar resections and in future trials involving patients with stage I NSCLC.
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Affiliation(s)
- Luis F Tapias
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Robert Shen
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Brendan W Lunn
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Dennis A Wigle
- Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
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Colic N, Stevic R, Stjepanovic M, Savić M, Jankovic J, Belic S, Petrovic J, Bogosavljevic N, Aleksandric D, Lukic K, Kostić M, Saponjski D, Vasic Madzarevic J, Stojkovic S, Ercegovac M, Garabinovic Z. Correlation between Radiological Characteristics, PET-CT and Histological Subtypes of Primary Lung Adenocarcinoma-A 102 Case Series Analysis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:617. [PMID: 38674262 PMCID: PMC11051865 DOI: 10.3390/medicina60040617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Lung cancer is the second most common form of cancer in the world for both men and women as well as the most common cause of cancer-related deaths worldwide. The aim of this study is to summarize the radiological characteristics between primary lung adenocarcinoma subtypes and to correlate them with FDG uptake on PET-CT. Materials and Methods: This retrospective study included 102 patients with pathohistologically confirmed lung adenocarcinoma. A PET-CT examination was performed on some of the patients and the values of SUVmax were also correlated with the histological and morphological characteristics of the masses in the lungs. Results: The results of this analysis showed that the mean size of AIS-MIA (adenocarcinoma in situ and minimally invasive adenocarcinoma) cancer was significantly lower than for all other cancer types, while the mean size of the acinar cancer was smaller than in the solid type of cancer. Metastases were significantly more frequent in solid adenocarcinoma than in acinar, lepidic, and AIS-MIA cancer subtypes. The maximum standardized FDG uptake was significantly lower in AIS-MIA than in all other cancer types and in the acinar predominant subtype compared to solid cancer. Papillary predominant adenocarcinoma had higher odds of developing contralateral lymph node involvement compared to other types. Solid adenocarcinoma was associated with higher odds of having metastases and with higher SUVmax. AIS-MIA was associated with lower odds of one unit increase in tumor size and ipsilateral lymph node involvement. Conclusions: The correlation between histopathological and radiological findings is crucial for accurate diagnosis and staging. By integrating both sets of data, clinicians can enhance diagnostic accuracy and determine the optimal treatment plan.
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Affiliation(s)
- Nikola Colic
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruza Stevic
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
| | - Mihailo Stjepanovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Savić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Jankovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Slobodan Belic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Jelena Petrovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Center for Nuclear Medicine with PET, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nikola Bogosavljevic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Institute for Orthopedics “Banjica”, 11000 Belgrade, Serbia
| | | | - Katarina Lukic
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Marko Kostić
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dusan Saponjski
- Center for Radiology and MR, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
| | | | - Stefan Stojkovic
- Clinic for Gastroenterohepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Maja Ercegovac
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Zeljko Garabinovic
- Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia (J.J.); (M.E.)
- Clinic for Thoracic Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Zhang J, Jin F, Li C, Jiang W, Liu C, Zeng L, Jiang Y, Xu A, Fang N, Wang Y. Value of 18F-FDG PET/CT in breast cancer with second primary malignancies. Clin Imaging 2024; 108:110100. [PMID: 38341881 DOI: 10.1016/j.clinimag.2024.110100] [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: 09/18/2023] [Revised: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE To investigate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in breast cancer (BC) with second primary malignancies (SPMs). MATERIALS AND METHODS 149 BC patients (149/1419, 10.5 %) ultimately diagnosed with SPMs were included in the study. The following data were evaluated: age, location, the treatment of the first BC, the interval between the first BC and SPMs, the maximum diameter of SPMs, the maximum standardized uptake value (SUVmax) of SPMs, and SPMs metastases. The overall survival (OS) and progression-free survival (PFS) of follow-up patients were analyzed. The diagnostic efficiency of 18F-FDG PET/CT for SPMs and consistency with the pathological findings were calculated. RESULTS The most common SPMs of BC was lung cancer (81/149, 54.4 %), particularly early-stage lung adenocarcinoma. There were the shorter maximum diameter of SPMs, the lower SUVmax of SPMs, and the fewer SPMs metastases in the lung cancer group than non-lung cancer group (P<0.001). The OS and PFS of the follow-up patients in the lung cancer group were longer than non-lung cancer group (P<0.001). The SPMs metastases was independent prognostic indicator of OS. The pathological grouping and the SPMs metastases were independent prognostic indicators of PFS. 18F-FDG PET/CT efficacy in diagnosing SPMs in BC patients was high. Compared with the pathological findings, the consistency was good (P = 0.010). CONCLUSION Applying 18F-FDG PET/CT in BC patients might be helpful in detecting SPMs and partially predicting patient prognosis, in addition to its primary function in the diagnosis and staging of BC.
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Affiliation(s)
- Jing Zhang
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Fei Jin
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Chaowei Li
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Wenwen Jiang
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Cuiyu Liu
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Lei Zeng
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Yumeng Jiang
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Aodi Xu
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Na Fang
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China
| | - Yanli Wang
- Department of PET/CT, the Affiliated Qingdao Central Hospital of Qingdao University, the Qingdao Cancer Hospital, No 127. SiLiu Nan Street, Qingdao City, Shandong Province 266042, PR China.
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Yu Y, Zhu J, Sang S, Yang Y, Zhang B, Deng S. Application of 18F-FDG PET/CT imaging radiomics in the differential diagnosis of single-nodule pulmonary metastases and second primary lung cancer in patients with colorectal cancer. J Cancer Res Ther 2024; 20:599-607. [PMID: 38687930 DOI: 10.4103/jcrt.jcrt_1674_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/19/2023] [Indexed: 05/02/2024]
Abstract
OBJECTIVE It is crucially essential to differentially diagnose single-nodule pulmonary metastases (SNPMs) and second primary lung cancer (SPLC) in patients with colorectal cancer (CRC), which has important clinical implications for treatment strategies. In this study, we aimed to establish a feasible differential diagnosis model by combining 18F-fluorodeoxyglucose positron-emission tomography (18F-FDG PET) radiomics, computed tomography (CT) radiomics, and clinical features. MATERIALS AND METHODS CRC patients with SNPM or SPLC who underwent 18F-FDG PET/CT from January 2013 to July 2022 were enrolled in this retrospective study. The radiomic features were extracted by manually outlining the lesions on PET/CT images, and the radiomic modeling was realized by various screening methods and classifiers. In addition, clinical features were analyzed by univariate analysis and logistic regression (LR) analysis to be included in the combined model. Finally, the diagnostic performances of these models were illustrated by the receiver operating characteristic (ROC) curves and the area under the curve (AUC). RESULTS We studied data from 61 patients, including 36 SNPMs and 25 SPLCs, with an average age of 65.56 ± 10.355 years. Spicule sign and ground-glass opacity (GGO) were significant independent predictors of clinical features (P = 0.012 and P < 0.001, respectively) to build the clinical model. We achieved a PET radiomic model (AUC = 0.789), a CT radiomic model (AUC = 0.818), and a PET/CT radiomic model (AUC = 0.900). The PET/CT radiomic models were combined with the clinical model, and a well-performing model was established by LR analysis (AUC = 0.940). CONCLUSIONS For CRC patients, the radiomic models we developed had good performance for the differential diagnosis of SNPM and SPLC. The combination of radiomic and clinical features had better diagnostic value than a single model.
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Affiliation(s)
- Yu Yu
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Zhu
- Department of Nuclear Medicine, Changshu No. 2 People's Hospital, Changshu, China
| | - Shibiao Sang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Yang
- Department of Nuclear Medicine, The Affiliated Suzhou Hospital of Nanjing University Medical School, Suzhou, Jiangsu, China
| | - Bin Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengming Deng
- Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, Mianyang, China
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Zhang L, Shao Y, Chen G, Tian S, Zhang Q, Wu J, Bai C, Yang D. An artificial intelligence-assisted diagnostic system for the prediction of benignity and malignancy of pulmonary nodules and its practical value for patients with different clinical characteristics. Front Med (Lausanne) 2023; 10:1286433. [PMID: 38196835 PMCID: PMC10774219 DOI: 10.3389/fmed.2023.1286433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
Objectives This study aimed to explore the value of an artificial intelligence (AI)-assisted diagnostic system in the prediction of pulmonary nodules. Methods The AI system was able to make predictions of benign or malignant nodules. 260 cases of solitary pulmonary nodules (SPNs) were divided into 173 malignant cases and 87 benign cases based on the surgical pathological diagnosis. A stratified data analysis was applied to compare the diagnostic effectiveness of the AI system to distinguish between the subgroups with different clinical characteristics. Results The accuracy of AI system in judging benignity and malignancy of the nodules was 75.77% (p < 0.05). We created an ROC curve by calculating the true positive rate (TPR) and the false positive rate (FPR) at different threshold values, and the AUC was 0.755. Results of the stratified analysis were as follows. (1) By nodule position: the AUC was 0.677, 0.758, 0.744, 0.982, and 0.725, respectively, for the nodules in the left upper lobe, left lower lobe, right upper lobe, right middle lobe, and right lower lobe. (2) By nodule size: the AUC was 0.778, 0.771, and 0.686, respectively, for the nodules measuring 5-10, 10-20, and 20-30 mm in diameter. (3) The predictive accuracy was higher for the subsolid pulmonary nodules than for the solid ones (80.54 vs. 66.67%). Conclusion The AI system can be applied to assist in the prediction of benign and malignant pulmonary nodules. It can provide a valuable reference, especially for the diagnosis of subsolid nodules and small nodules measuring 5-10 mm in diameter.
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Affiliation(s)
- Lichuan Zhang
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yue Shao
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Guangmei Chen
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Simiao Tian
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Qing Zhang
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Jianlin Wu
- Department of Respiratory Medicine, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Shanghai Respiratory Research Institution, Shanghai, China
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Shanghai Respiratory Research Institution, Shanghai, China
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Feng H, Huang G, Cao B, Zan Z, Wei Q. Maximum amplitude and mean platelet volume in the blood as biomarkers to detect lung adenocarcinoma cancer featured with ground-glass nodules. EUR J INFLAMM 2023. [DOI: 10.1177/1721727x231151530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives The development and progression of malignancies are closely linked to hypercoagulability. As an early type of lung adenocarcinoma, ground glass nodules (GGNs) have been detected increasingly. Blood Maximum amplitude (MA) and mean platelet volume (MPV) are related to various conditions of hypercoagulability. Therefore, the role of MA and MPV in diagnosing lung adenocarcinoma cancer featured with GGNs was investigated in this case-control study. Methods The analyzed data of this study is derived from GGNs patients and healthy individuals in West China (Airport) Hospital Sichuan University. The differences between GGNs patients and healthy individuals were determined by one-way ANOVA, logistic regression or chi-squared test. The accuracy of diagnostic was performed by receiver operating characteristic curve (ROC). The relative mRNA expressions were studied by RT-qPCR. Results 470 patients diagnosed with GGNs which benign lesions (BN group) are inflammatory and malignant lesions (LC group) are adenocarcinoma in stage IA, and 235 healthy subjects (HC group) were enrolled in this study. Levels of MA and MPV were increased in LC group compared with BN and HC group ( p < 0.001, p < 0.001). When we combined MA and MPV, MA and MPV presented a sensitivity (SEN) of 0.809 and a specificity (SPE) of 0.774. And the area under the curve (AUC) increased to 0.871 (0.837–0.900) when confidence interval was 95%. Conclusion This study demonstrates that there have been systemic changes in coagulation disorders in the pathogenesis of GGNs. The diagnostic ability to different lung adenocarcinoma cancer featured with GGNs from benign or healthy controls can be improved by the combination of MA and MPV. Maximum amplitude and MPV may be used as biomarkers to detect lung adenocarcinoma cancer featured with GGNs.
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Affiliation(s)
- Hao Feng
- Department of Thoracic Surgery, The First People’s Hospital of Shuangliu District, Chengdu, China
| | - Gaigai Huang
- Department of Clinical Laboratory, The First People’s Hospital of Shuangliu District, Chengdu, China
| | - Boxiong Cao
- Department of Thoracic Surgery, The First People’s Hospital of Shuangliu District, Chengdu, China
| | - Ziliang Zan
- Department of Thoracic Surgery, The First People’s Hospital of Shuangliu District, Chengdu, China
| | - Qiang Wei
- Department of Thoracic Surgery, The First People’s Hospital of Shuangliu District, Chengdu, China
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Archer JM, Mendoza DP, Hung YP, Lanuti M, Digumarthy SR. Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features. JTO Clin Res Rep 2023; 4:100605. [PMID: 38124789 PMCID: PMC10730375 DOI: 10.1016/j.jtocrr.2023.100605] [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: 08/22/2023] [Revised: 10/25/2023] [Accepted: 11/11/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Interventions and surgical procedures are common for nonmalignant lung lesions detected on lung cancer screening (LCS). Inadvertent surgical resection of benign nodules with a clinical suspicion of lung cancer can occur, can be associated with complications, and adds to the cost of screening. The objective of this study is to assess the characteristics of surgically resected benign nodules detected on LCS computed tomography which were presumed to be lung cancers. Methods This retrospective study included 4798 patients who underwent LCS between June 2014 and January 2021. The benign lung nodules, surgically resected with a presumed cancer diagnosis, were identified from the LCS registry. Patient demographics, imaging characteristics, and pathologic diagnoses of benign nodules were analyzed. Results Of the 4798 patients who underwent LCS, 148 (3.1%) underwent surgical resection of a lung nodule, and of those who had a resection, 19 of 148 (12.8%) had a benign diagnosis (median age = 64 y, range: 56-77 y; F = 12 of 19, 63.2%; M = seven of 19, 36.8%). The median nodule size was 10 mm (range: 6-31 mm). Most nodules were solid (15 of 19, 78.9%), located in the upper lobes (11 of 19; 57.9%), and were peripheral (17 of 19, 89.5%). Most nodules (13 of 17; 76.5%) had interval growth, and four of 17 (23.5%) had increased fluorodeoxyglucose uptake. Of the 19 patients, 17 (89.5%) underwent sublobar resection (16 wedge resection and one segmentectomy), whereas two central nodules (10.5%) had lobectomies. Pathologies identified included focal areas of fibrosis or scarring (n = 8), necrotizing granulomatous inflammation (n = 3), other nonspecific inflammatory focus (n = 3), benign tumors (n = 3), reactive lymphoid hyperplasia (n = 1), and organizing pneumonia (n = 1). Conclusions Surgical resections of benign nodules that were presumed malignant are infrequent and may be unavoidable given overlapping imaging features of benign and malignant nodules. Knowledge of benign pathologies that can mimic malignancy may help reduce the incidence of unnecessary surgeries.
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Affiliation(s)
- John M. Archer
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Dexter P. Mendoza
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yin P. Hung
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Lanuti
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Subba R. Digumarthy
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Erasmus LT, Strange TA, Agrawal R, Strange CD, Ahuja J, Shroff GS, Truong MT. Lung Cancer Staging: Imaging and Potential Pitfalls. Diagnostics (Basel) 2023; 13:3359. [PMID: 37958255 PMCID: PMC10649001 DOI: 10.3390/diagnostics13213359] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths in men and women in the United States. Accurate staging is needed to determine prognosis and devise effective treatment plans. The International Association for the Study of Lung Cancer (IASLC) has made multiple revisions to the tumor, node, metastasis (TNM) staging system used by the Union for International Cancer Control and the American Joint Committee on Cancer to stage lung cancer. The eighth edition of this staging system includes modifications to the T classification with cut points of 1 cm increments in tumor size, grouping of lung cancers associated with partial or complete lung atelectasis or pneumonitis, grouping of tumors with involvement of a main bronchus regardless of distance from the carina, and upstaging of diaphragmatic invasion to T4. The N classification describes the spread to regional lymph nodes and no changes were proposed for TNM-8. In the M classification, metastatic disease is divided into intra- versus extrathoracic metastasis, and single versus multiple metastases. In order to optimize patient outcomes, it is important to understand the nuances of the TNM staging system, the strengths and weaknesses of various imaging modalities used in lung cancer staging, and potential pitfalls in image interpretation.
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Affiliation(s)
- Lauren T. Erasmus
- Department of Anatomy and Cell Biology, Faculty of Sciences, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Taylor A. Strange
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Rishi Agrawal
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Chad D. Strange
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Jitesh Ahuja
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Girish S. Shroff
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Mylene T. Truong
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
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Kawaguchi M, Kato H, Hanamatsu Y, Suto T, Noda Y, Kaneko Y, Iwata H, Hyodo F, Miyazaki T, Matsuo M. Computed Tomography and 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Imaging Biomarkers of Lung Invasive Non-mucinous Adenocarcinoma: Prediction of Grade 3 Tumour Based on World Health Organization Grading System. Clin Oncol (R Coll Radiol) 2023; 35:e601-e610. [PMID: 37587000 DOI: 10.1016/j.clon.2023.08.002] [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: 08/24/2022] [Revised: 06/02/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
AIMS To evaluate computed tomography (CT) and 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) findings of invasive non-mucinous adenocarcinoma (INMA) of the lung as a predictor of histological tumour grade according to 2021 World Health Organization (WHO) classification. MATERIALS AND METHODS This retrospective study included consecutive patients with surgically resected INMA who underwent both preoperative CT and 18F-FDG-PET/CT. A three-tiered tumour grade was performed based on the fifth edition of the WHO classification of lung tumours. CT imaging features and the maximum standardised uptake value (SUVmax) were compared among the three tumour grades. RESULTS In total, 214 patients with INMA (median age 70 years; interquartile range 65-76 years; 123 men) were histologically categorised: 36 (17%) as grade 1, 102 (48%) as grade 2 and 76 (35%) as grade 3. Pure solid appearance was more frequent in grade 3 (83%) than in grades 1 (0%) and 2 (26%) (P < 0.001). The SUVmax of the entire tumour was higher in grade 3 than in grades 1 and 2 (P < 0.001). Multivariable analysis revealed that pure solid appearance (odds ratio = 94.0; P < 0.001), round/oval shape (odds ratio = 4.01; P = 0.001), spiculation (odds ratio = 2.13; P = 0.04), air bronchogram (odds ratio = 0.40; P = 0.03) and SUVmax (odds ratio = 1.45; P < 0.001) were significant predictors for grade 3 INMAs. CONCLUSION Pure solid appearance, round/oval shape, spiculation, absence of air bronchogram and high SUVmax were associated with grade 3 INMAs. CT and 18F-FDG-PET/CT were potentially useful non-invasive imaging methods to predict the histological grade of INMAs.
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Affiliation(s)
- M Kawaguchi
- Department of Radiology, Gifu University, Gifu, Japan.
| | - H Kato
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Hanamatsu
- Department of Pathology and Translational Research, Gifu University, Gifu, Japan
| | - T Suto
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Noda
- Department of Radiology, Gifu University, Gifu, Japan
| | - Y Kaneko
- Department of Radiology, Gifu University, Gifu, Japan
| | - H Iwata
- Department of General and Cardiothoracic Surgery, Gifu University, Gifu, Japan
| | - F Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
| | - T Miyazaki
- Department of Pathology, Gifu University, Gifu, Japan
| | - M Matsuo
- Department of Radiology, Gifu University, Gifu, Japan
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11
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Chen Z, Long Y, Zhang Y, Zhang B, He Q, Zhang X. Detection efficacy of analog [ 18F]FDG PET/CT, digital [ 18F]FDG, and [ 13N]NH 3 PET/CT: a prospective, comparative study of patients with lung adenocarcinoma featuring ground glass nodules. Eur Radiol 2023; 33:2118-2127. [PMID: 36322193 DOI: 10.1007/s00330-022-09186-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This prospective study compared the detection efficacy of analog 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) (aF PET/CT), digital [18F]FDG PET/CT (dF PET/CT), and digital 13N-ammonia (13N-NH3) PET/CT (dN PET/CT) for patients with lung adenocarcinoma featuring ground glass nodules (GGNs). METHODS Eighty-seven patients with lung adenocarcinoma featuring GGNs who underwent dF and dN PET/CT were enrolled. Based on the GGN component, diameter, and solid-part size, 87 corresponding patients examined using aF PET/CT were included, with age, sex, and lesion characteristics closely matched. Images were visually evaluated, and the tumor to background ratio (TBR) was used for semi-quantitative analysis. RESULTS Ultimately, 40 and 47 patients with pure GGNs (pGGNs) and mixed GGNs (mGGNs), respectively, were included. dF PET/CT revealed more positive lesions and higher tracer uptake in GGNs than did aF PET/CT (53/87 vs. 26/87, p < 0.05; TBR: 3.08 ± 4.85 vs. 1.42 ± 0.93, p < 0.05), especially in mGGNs (44/47 vs. 26/47, p < 0.05; TBR: 4.48 ± 6.17 vs. 1.78 ± 1.16, p < 0.05). However, dN PET/CT detected more positive lesions than did dF PET/CT (71/87 vs. 53/87, p < 0.05), especially in pGGNs (24/40 vs. 9/40, p < 0.05). CONCLUSIONS dF PET/CT provides superior detection efficacy over aF PET/CT for patients with lung adenocarcinoma featuring GGNs, particularly mGGNs. dN PET/CT revealed superior detection efficacy over dF PET/CT, particularly in pGGNs. aF, dF, and dN PET/CT are valuable non-invasive examinations for lung cancer featuring GGNs, with dN PET/CT offering the best detection performance. KEY POINTS • Digital PET/CT provides superior detection efficacy over analog PET/CT in patients with lung adenocarcinoma featuring GGNs. • dN PET/CT can offer more help in the early detection of malignant GGN.
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Affiliation(s)
- Zhifeng Chen
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yali Long
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yuying Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Bing Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Qiao He
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital of Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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12
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Su Y, Zhou H, Huang W, Li L, Wang J. The value of preoperative positron emission tomography/computed tomography in differentiating the invasive degree of hypometabolic lung adenocarcinoma. BMC Med Imaging 2023; 23:31. [PMID: 36765284 PMCID: PMC9912592 DOI: 10.1186/s12880-023-00986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVES To investigate the value of preoperative positron emission tomography/computed tomography (PET/CT) in differentiating the invasive degree of hypometabolic lung adenocarcinoma. METHODS We retrospectively analyzed the data of patients who underwent PET/CT examination, high-resolution computed tomography, and surgical resection for low-metabolism lung adenocarcinoma in our hospital between June 2016 and December 2021. We also investigated the relationship between the preoperative PET/CT findings and the pathological subtype of hypometabolic lung adenocarcinoma. RESULTS A total of 128 lesions were found in 113 patients who underwent resection for lung adenocarcinoma, including 20 minimally invasive adenocarcinomas (MIA) and 108 invasive adenocarcinomas (IAC), whose preoperative PET/CT showed low metabolism. There were significant differences in the largest diameter (Dmax), lesion type, maximum standard uptake value (SUVmax), SUVindex (the ratio of SUVmax of lesion to SUVmax of contralateral normal lung paranchyma), fasting blood glucose, lobulation, spiculation, and pleura indentation between the MIA and IAC groups (p < 0.05). Multivariate logistic regression analysis showed that the Dmax (odds ratio (OR) = 1.413, 95% confidence interval (CI: 1.155-1.729, p = 0.001)) and SUVmax (OR = 12.137, 95% CI: 1.068-137.900, p = 0.044) were independent risk factors for predicting the hypometabolic IAC (p < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the Dmax ≥ 10.5 mm and SUVmax ≥ 0.85 were the cut-off values for differentiating MIA from IAC, with high sensitivity (84.3% and 75.9%, respectively) and specificity (84.5% and 85.0%, respectively), the Combined Diagnosis showed higher sensitivity (91.7%) and specificity (85.0%). CONCLUSIONS The PET/CT findings correlated with the subtype of hypometabolic lung adenocarcinoma. The parameters Dmax and SUVmax were independent risk factors for predicting IAC, and the sensitivity of Combined Diagnosis prediction is better.
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Affiliation(s)
- Yuling Su
- Department of Nuclear Medicine, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China.
| | - Hui Zhou
- grid.452930.90000 0004 1757 8087Department of Nuclear Medicine, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Wenshan Huang
- grid.452930.90000 0004 1757 8087Department of Nuclear Medicine, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Lei Li
- grid.452930.90000 0004 1757 8087Department of Nuclear Medicine, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Jinyu Wang
- grid.452930.90000 0004 1757 8087Department of Nuclear Medicine, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
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FDG-PET/CT tumor to liver SUV ratio (TLR), tumor SUVmax, and tumor size: can this help in differentiating squamous cell carcinoma from adenocarcinoma of the lung? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
PET/CT plays an essential role in the diagnosis, staging, and follow-up of lung cancer. We aimed to assess the ability of PET/CT to differentiate between adenocarcinomas (AC) and squamous cell carcinomas (SCC) of the lung using tumor size, tumor maximum standardized uptake value (SUVmax), lymph nodes SUVmax, and tumor to liver SUV ratio (TLR).
Results
A total of 60 patients pathologically proved to have non-small cell lung cancer either AC or SCC were retrospectively evaluated. The mean tumor size, SUVmax of the tumor, and TLR were significantly higher in SCC lesions compared to AC lesions. The mean SCC tumoral size was 7.96 ± 2.18 cm compared to 5.66 ± 2.57 cm in AC lesions (P = 0.008). The mean tumor SUVmax in SCC lesions was 18.95 ± 8.3 compared to 12.4 ± 7.55 in AC lesions (P = 0.04). While the mean TLR of SCC lesions was 10.32 ± 4.03 compared to 7.36 ± 4.61 in AC lesions (P = 0.028). All three parameters showed the same sensitivity (75%), while TLR showed the highest specificity (77.78%) followed by tumor size (76.47%) and then SUVmax of the tumor (72.22%).
Conclusions
SCC of the lung has a higher mean tumor size, SUVmax of the tumor, and TLR as compared to AC which can be helpful tools in differentiation between them using PET/CT.
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14
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Zeng QC, Sun Q, Su WJ, Li JC, Liu YS, Zhang K, Yang LQ. Analysis of m 6A modulator-mediated methylation modification patterns and the tumor microenvironment in lung adenocarcinoma. Sci Rep 2022; 12:20684. [PMID: 36450735 PMCID: PMC9712433 DOI: 10.1038/s41598-022-20730-6] [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: 07/14/2021] [Accepted: 02/21/2022] [Indexed: 12/02/2022] Open
Abstract
Lung adenocarcinoma (LUAD) is the most common histological subtype of lung cancer. In the development and progression of LUAD, epigenetic aberration plays a crucial role. However, the function of RNA N6-methyladenosine (m6A) modifications in the LUAD progression is unknown. The m6A regulator modification patterns in 955 LUAD samples were analyzed comprehensively. Patterns were systematically correlated with the tumor microenvironment (TME) cell-infiltration characteristics. Using principal component analysis algorithms, the m6Ascore was generated to quantify m6A modification patterns in individual tumors. Then, their values for predicting prognoses and therapeutic response in LUAD patients were assessed. Three distinct m6A modification patterns in LUAD were identified. Among them, the prognosis of m6Acluster C was the best, while the prognosis of m6Acluster A was the worst. Interestingly, the characterization of TME cell infiltration and biological behavior differed among the three patterns. To evaluate m6A modification patterns within individual tumors, an m6Ascore signature was constructed. The results showed that the high m6Ascore group was associated with a better prognosis; tumor somatic mutations and tumor microenvironment differed significantly between the high- and low- m6Ascore groups. Furthermore, in the cohort with anti-CTLA-4 treatment alone, patients with a high m6Ascore had higher ICI scores, which indicated significant therapeutic advantage and clinical benefits.
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Affiliation(s)
- Qing-Cui Zeng
- grid.410646.10000 0004 1808 0950Department of Geriatric Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China ,grid.9227.e0000000119573309Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Qin Sun
- grid.410646.10000 0004 1808 0950Department of Geriatric Intensive Care Unit, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China ,grid.9227.e0000000119573309Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Wen-Jie Su
- grid.410646.10000 0004 1808 0950Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China ,grid.9227.e0000000119573309Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jia-Cen Li
- grid.410646.10000 0004 1808 0950Department of Anesthesiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China ,grid.9227.e0000000119573309Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Yi-Sha Liu
- grid.410646.10000 0004 1808 0950Department of Pathology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China ,grid.9227.e0000000119573309Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Kun Zhang
- grid.410646.10000 0004 1808 0950Department of Chest Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China ,grid.9227.e0000000119573309Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Li-Qing Yang
- grid.410646.10000 0004 1808 0950Department of Respiratory Medicine, Eastern Hospital, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, Sichuan Province, No. 585, Honghe North Road, LongQuanYi District, Chengdu, 610000 China ,grid.9227.e0000000119573309Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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15
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Ding Y, He C, Zhao X, Xue S, Tang J. Adding predictive and diagnostic values of pulmonary ground-glass nodules on lung cancer via novel non-invasive tests. Front Med (Lausanne) 2022; 9:936595. [PMID: 36059824 PMCID: PMC9433577 DOI: 10.3389/fmed.2022.936595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Pulmonary ground-glass nodules (GGNs) are highly associated with lung cancer. Extensive studies using thin-section high-resolution CT images have been conducted to analyze characteristics of different types of GGNs in order to evaluate and determine the predictive and diagnostic values of GGNs on lung cancer. Accurate prediction of their malignancy and invasiveness is critical for developing individualized therapies and follow-up strategies for a better clinical outcome. Through reviewing the recent 5-year research on the association between pulmonary GGNs and lung cancer, we focused on the radiologic and pathological characteristics of different types of GGNs, pointed out the risk factors associated with malignancy, discussed recent genetic analysis and biomarker studies (including autoantibodies, cell-free miRNAs, cell-free DNA, and DNA methylation) for developing novel diagnostic tools. Based on current progress in this research area, we summarized a process from screening, diagnosis to follow-up of GGNs.
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Affiliation(s)
- Yizong Ding
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunming He
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Xue
- Department of Cardiovascular Surgery, Reiji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Tang
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jian Tang,
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Hino H, Shinohara S, Okano Y, Naruse K, Takeuchi E, Sakiyama S, Shinohara T. Solitary Ground-Glass Nodule Mimicking Lung Cancer due to Focal Progression of Usual Interstitial Pneumonia. Int J Surg Pathol 2022:10668969221117984. [PMID: 35946121 DOI: 10.1177/10668969221117984] [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: 11/17/2022]
Abstract
Idiopathic pulmonary fibrosis is often associated with lung cancer, but early malignant lesions mixed with fibrous lesions are not always easy to diagnose. A 78-year-old woman was referred to our hospital due to a ground-glass nodule in the left upper lobe detected on chest high resolution computed tomography during follow-up of chronic idiopathic interstitial pneumonia. Pathological examination of the resected specimen revealed that the ground-glass nodule was locally progressed usual interstitial pneumonia (UIP). It should be noted that focal progression of UIP may occur and present with ground-glass nodule mimicking lung cancer, even if lesions in other areas remain unchanged. Moreover, in such cases, recognition of nodular lesions by the gross findings on the pleural surface and palpation during surgical resection are difficult and require precise marking.
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Affiliation(s)
- Hiroyuki Hino
- Division of Thoracic Surgery, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Shizuka Shinohara
- Division of Internal Medicine, Japan Community Health Care Organization Kochi West Hospital, Kochi, Japan
| | - Yoshio Okano
- Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Keishi Naruse
- Division of Pathology, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Eiji Takeuchi
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Shoji Sakiyama
- Division of Thoracic Surgery, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Tsutomu Shinohara
- Department of Community Medicine for Respirology, 118112Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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Correlation Analysis of Computed Tomography Features and Pathological Types of Multifocal Ground-Glass Nodular Lung Adenocarcinoma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7267036. [PMID: 35928980 PMCID: PMC9345702 DOI: 10.1155/2022/7267036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
Abstract
To investigate the correlation between computed tomography (CT) image characteristics of multiple lung ground-glass nodules (GGNs) and pathological classification, the CT image data of multiple lung GGN patients confirmed by pathology (n = 132) in our hospital were collected. The imaging features of GGNs were analyzed by qualified physicians, including lesion size (diameter, volume, and mass), location, CT values (mean and relative CT values), lesion morphology (round and irregular), marginal structure (pagination and burr), internal structure (bronchial inflation sign), and adjacent structure (pleural depression). CT imaging analysis was performed for the subtype of infiltrating adenocarcinoma (IAC). In CT findings, GGNs were greatly different from adenomatous hyperplasia (AAH), pure GGN adenocarcinoma in situ (AIS), and microinvasive adenocarcinoma (MIA) in terms of marginal structure, lesion morphology, internal structure, adjacent structure, and size (P < 0.05). The mean and relative CT values of mural adenocarcinoma, acinar adenocarcinoma, and papillary adenocarcinoma of IAC subtypes were greatly different from those of AAH/AIS/MIA (P < 0.05). In summary, the CT images of GGNs can be used as the basis for the differentiation of AAH, AIS, and MIA early noninvasive types and IAC invasive types, and the CT value of the IAC subtype can be used as the basis for the classification and differentiation of IAC pathological subtypes.
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AĞABABAOĞLU İ, YİLDİZ OO, YAPAR D, ERSÖZ H, HAZER S, HELVACI Ö, GÜLHAN SŞE, KARAOGLANOGLU N. Mediastinal lymphnode positivity clinical scoring system for lung adenocarsinoma-mediastinal lymph node evaluation and staging. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1061755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The study-cohort aims to assess PET-CT's correlation with adenocarcinomas' subtypes and propose a scoring system for mediastinal lymph nodes staging.
Material and Method: The patient cohort is a multicenter, retrospective analysis of 268 patient that underwent surgery for NSCLC adenocarcinoma. Preoperative PET-CT results for mediastinal lymph node staging was pathologically confirmed on tissue specimens obtained at anatomical resection. Statistical evaluation of PET CT, radiological and pathological outcomes were performed on all subgroups.
Results: The low FDG affinity in the lepidic pattern was statistically significant in the study (p
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Affiliation(s)
| | | | | | | | - Seray HAZER
- UNIVERSITY OF HEALTH SCIENCES, ANKARA ATATÜRK HEALTH RESEARCH CENTER FOR PULMONOLOGY AND THORACIC SURGERY
| | - Özant HELVACI
- Yıldırım Beyazıt Üniversitesi Yenimahalle Eğitim ve Araştırma Hastanesi
| | - Selim Şakir Erkmen GÜLHAN
- UNIVERSITY OF HEALTH SCIENCES, ANKARA ATATÜRK HEALTH RESEARCH CENTER FOR PULMONOLOGY AND THORACIC SURGERY
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Tissue Fraction Correction and Visual Analysis Increase Diagnostic Sensitivity in Predicting Malignancy of Ground-Glass Nodules on [ 18F]FDG PET/CT: A Bicenter Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12051292. [PMID: 35626447 PMCID: PMC9140844 DOI: 10.3390/diagnostics12051292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 01/15/2023] Open
Abstract
We investigated the role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in evaluating ground-glass nodules (GGNs) by visual analysis and tissue fraction correction. A total of 40 pathologically confirmed ≥1 cm GGNs were evaluated visually and semiquantitatively. [18F]FDG uptake of GGN distinct from background lung activity was considered positive in visual analysis. In semiquantitative analysis, we performed tissue fraction correction for the maximum standardized uptake value (SUVmax) of GGN. Of the 40 GGNs, 25 (63%) were adenocarcinomas, 9 (23%) were minimally invasive adenocarcinomas (MIAs), and 6 (15%) were adenocarcinomas in situ (AIS). On visual analysis, adenocarcinoma showed the highest positivity rate among the three pathological groups (88%, 44%, and 17%, respectively). Both SUVmax and tissue-fraction−corrected SUVmax (SUVmaxTF) were in the order of adenocarcinoma > MIA > AIS (p = 0.033 and 0.018, respectively). SUVmaxTF was significantly higher than SUVmax before correction (2.4 [1.9−3.0] vs. 1.3 [0.8−1.8], p < 0.001). When using a cutoff value of 2.5, the positivity rate of GGNs was significantly higher in SUVmaxTF than in SUVmax (50% vs. 5%, p < 0.001). The diagnostic sensitivity of [18F]FDG PET/CT in predicting the malignancy of lung GGN was improved by tissue fraction correction and visual analysis.
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Sun X, Chen T, Xie C, Liu L, Lei B, Wang L, Ruan M, Yan H, Zhang Q, Chang C, Xie W. Relationships between SUVmax of lung adenocarcinoma and different T stages, histological grades and pathological subtypes: a retrospective cohort study in China. BMJ Open 2022; 12:e056804. [PMID: 35580966 PMCID: PMC9114855 DOI: 10.1136/bmjopen-2021-056804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cancer cell has aberrant metabolism. The purpose of this study aimed to investigate relationships between maximum standard uptake value (SUVmax)of 18fluoro-2-deoxy-d-glucose and T stages, histological grades and pathological subtypes of lung adenocarcinoma. DESIGN Retrospective cohort study, employing the Kruskal-Wallis, Bonferroni-Dunn and Mann-Whitney tests to compare SUVmax of different T stages, histological grades and pathological subtypes of lung adenocarcinoma. SETTING The outpatients who had aberrant positron emission tomography/CT (PET/CT) images in chest were enrolled this study from August 2016 to November 2018 in Shanghai, China. PARTICIPANT Initial 11 270 patients with suspected lung cancer who underwent PET/CT examinations were surveyed. A total of 1454 patients who were diagnosed as lung adenocarcinoma by pathologist were included in this project. PRIMARY OUTCOME MEASURES SUVmax value at different tumour-node-metastasis stages of lung adenocarcinoma before surgery. RESULTS The mean SUVmax of patients with lung adenocarcinoma was significantly elevated with the increase in T stages. There were significant evident differences in SUVmax among T1a-T1c (p<0.05). However, after the staging of patients was more than T1 stage, SUVmax of T2a, T2b, T2 visceral pleural invasion, T3 and T4 had not dramatic changes. SUVmax value of lung adenocarcinoma in the same T stage group was the highest in patients with the high grade of malignancy and solid-predominant invasive adenocarcinoma. CONCLUSIONS SUVmax value was significantly associated with T stages, grades of malignancy and pathological subtypes of lung adenocarcinoma.
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Affiliation(s)
- Xiaoyan Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tianxiang Chen
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China, Shanghai, China
| | - Chun Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Maomei Ruan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Yan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Zhang
- Department of Nuclear Medicine, Anhui Chest Hospital, Anhui, China
| | - Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Bu L, Tu N, Wang K, Zhou Y, Xie X, Han X, Lin H, Feng H. Relationship between 18F-FDG PET/CT Semi-Quantitative Parameters and International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society Classification in Lung Adenocarcinomas. Korean J Radiol 2022; 23:112-123. [PMID: 34983098 PMCID: PMC8743143 DOI: 10.3348/kjr.2021.0455] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the relationship between 18F-FDG PET/CT semi-quantitative parameters and the International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histopathologic classification, including histological subtypes, proliferation activity, and somatic mutations. Materials and Methods This retrospective study included 419 patients (150 males, 269 females; median age, 59.0 years; age range, 23.0–84.0 years) who had undergone surgical removal of stage IA–IIIA lung adenocarcinoma and had preoperative PET/CT data of lung tumors. The maximum standardized uptake values (SUVmax), background-subtracted volume (BSV), and background-subtracted lesion activity (BSL) derived from PET/CT were measured. The IASLC/ATS/ERS subtypes, Ki67 score, and epidermal growth factor/anaplastic lymphoma kinase (EGFR/ALK) mutation status were evaluated. The PET/CT semi-quantitative parameters were compared between the tumor subtypes using the Mann–Whitney U test or the Kruskal–Wallis test. The optimum cutoff values of the PET/CT semi-quantitative parameters for distinguishing the IASLC/ATS/ERS subtypes were calculated using receiver operating characteristic curve analysis. The correlation between the PET/CT semi-quantitative parameters and pathological parameters was analyzed using Spearman’s correlation. Statistical significance was set at p < 0.05. Results SUVmax, BSV, and BSL values were significantly higher in invasive adenocarcinoma (IA) than in minimally IA (MIA), and the values were higher in MIA than in adenocarcinoma in situ (AIS) (all p < 0.05). Remarkably, an SUVmax of 0.90 and a BSL of 3.62 were shown to be the optimal cutoff values for differentiating MIA from AIS, manifesting as pure ground-glass nodules with 100% sensitivity and specificity. Metabolic-volumetric parameters (BSV and BSL) were better potential independent factors than metabolic parameters (SUVmax) in differentiating growth patterns. SUVmax and BSL, rather than BSV, were strongly or moderately correlated with Ki67 in most subtypes, except for the micropapillary and solid predominant groups. PET/CT parameters were not correlated with EGFR/ALK mutation status. Conclusion As noninvasive surrogates, preoperative PET/CT semi-quantitative parameters could imply IASLC/ATS/ERS subtypes and Ki67 index and thus may contribute to improved management of precise surgery and postoperative adjuvant therapy.
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Affiliation(s)
- Lihong Bu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Tu
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Wang
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ying Zhou
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinli Xie
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xingmin Han
- Department of Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huiqin Lin
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyan Feng
- PET/CT/MRI and Molecular Imaging Center, Renmin Hospital of Wuhan University, Wuhan, China.
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22
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Niu R, Gao J, Shao X, Wang J, Jiang Z, Shi Y, Zhang F, Wang Y, Shao X. Maximum Standardized Uptake Value of 18F-deoxyglucose PET Imaging Increases the Effectiveness of CT Radiomics in Differentiating Benign and Malignant Pulmonary Ground-Glass Nodules. Front Oncol 2022; 11:727094. [PMID: 34976790 PMCID: PMC8718929 DOI: 10.3389/fonc.2021.727094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
To investigate whether the maximum standardized uptake value (SUVmax) of 18F-deoxyglucose (FDG) PET imaging can increase the diagnostic efficiency of CT radiomics-based prediction model in differentiating benign and malignant pulmonary ground-glass nodules (GGNs). We retrospectively collected 190 GGNs from 165 patients who underwent 18F-FDG PET/CT examination from January 2012 to March 2020. Propensity score matching (PSM) was performed to select GGNs with similar baseline characteristics. LIFEx software was used to extract 49 CT radiomic features, and the least absolute shrinkage and selection operator (LASSO) algorithm was used to select parameters and establish the Rad-score. Logistic regression analysis was performed combined with semantic features to construct a CT radiomics model, which was combined with SUVmax to establish the PET + CT radiomics model. Receiver operating characteristic (ROC) was used to compare the diagnostic efficacy of different models. After PSM at 1:4, 190 GGNs were divided into benign group (n = 23) and adenocarcinoma group (n = 92). After texture analysis, the Rad-score with three CT texture features was constructed for each nodule. Compared with the Rad-score and CT radiomics model (AUC: 0.704 (95%CI: 0.562-0.845) and 0.908 (95%CI: 0.842-0.975), respectively), PET + CT radiomics model had the best diagnostic efficiency (AUC: 0.940, 95%CI: 0.889-0.990), and there was significant difference between each two of them (P = 0.001-0.030). SUVmax can effectively improve CT radiomics model performance in the differential diagnosis of benign and malignant GGNs. PET + CT radiomics might become a noninvasive and reliable method for differentiating of GGNs.
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Affiliation(s)
- Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Jianxiong Gao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Zhenxing Jiang
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yunmei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Feifei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
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Prognostic Analysis of Lung Adenocarcinoma Based on DNA Methylation Regulatory Factor Clustering. JOURNAL OF ONCOLOGY 2021; 2021:1557968. [PMID: 34484331 PMCID: PMC8413078 DOI: 10.1155/2021/1557968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/16/2021] [Accepted: 08/14/2021] [Indexed: 12/03/2022]
Abstract
There is a known link between DNA methylation and cancer immunity/immunotherapy; however, the effect of DNA methylation on immunotherapy in lung adenocarcinoma (LUAD) remains to be elucidated. In the current study, we aimed to screen key markers for prognostic analysis of LUAD based on DNA methylation regulatory factor clustering. We classified LUAD using the NMF clustering method, and as a result, we obtained 20 DNA methylation regulatory genes. These 20 regulatory genes were used to determine the pattern of DNA methylation regulation, and patients were grouped for further analysis. The risk score model was analyzed in the TCGA dataset and an external validation set, and the correlation between the risk score and DNA methylation regulatory gene expression was explored. We analyzed the correlation between the prognostic model and immune infiltration and checkpoints. Finally, we analyzed the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes functions of the prognosis model and established the nomogram model and decision tree model. The survival analyses of ClusterA and ClusterB were significantly different. Survival analysis showed that patients with a high risk score had a poor prognosis. Survival models (tobacco, T, N, M, stage, sex, age, status, and risk score) were abnormally correlated with T cells and macrophages. The higher the risk score associated with smoking was and the higher the stage was, the more severe the LUAD and the more maladjusted the immune system were. Immune infiltration and abnormal expression of immune checkpoint genes in the prognostic model of LUAD were associated with the risk score. The prognostic models were mainly enriched in the cell cycle and DNA replication. Characterization of DNA methylation regulatory patterns is helpful to improve our understanding of the immune microenvironment in LUAD and to guide the development of a more personalized immunotherapy strategy in the future.
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24
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Shao X, Shao X, Niu R, Jiang Z, Xu M, Wang Y. Investigating the association between ground-glass nodules glucose metabolism and the invasive growth pattern of early lung adenocarcinoma. Quant Imaging Med Surg 2021; 11:3506-3517. [PMID: 34341727 DOI: 10.21037/qims-20-1189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 03/26/2021] [Indexed: 01/11/2023]
Abstract
Background To explore the association between the glucose metabolism level of lung ground-glass nodules (GGNs), as revealed by 18F-flurodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging, and the invasive pathological growth pattern of early lung adenocarcinoma. Methods We retrospectively analyzed patients who underwent PET/CT examination and surgical resection due to persistent GGNs, which were confirmed to be early lung adenocarcinoma by postoperative pathology examination. After adjusting for confounding factors and performing stratified analysis, we explored the association between the maximum standard uptake value of PET (SUVmax) and the invasive pathological growth pattern of early stage lung adenocarcinoma. Results The proportions of invasive adenocarcinoma (INV) in the SUVmax of Tertile 1, Tertile 2, and Tertile 3 were 52.7%, 73.3%, and 87.1%, respectively. After adjusting for potential confounding factors, the risk of INV gradually increased as the GGN SUVmax increased [odds ratio (OR): 1.520, 95% confidence interval (CI): 1.044-2.213, P=0.029]. This trend was statistically significant (OR: 1.678, 95% CI: 1.064-2.647, P=0.026), especially in Tertile 3 vs. Tertile 1 (OR: 4.879, 95% CI: 1.349-17.648, P=0.016). Curve fitting showed that the SUVmax and INV risk were linearly and positively associated. The association was consistent in different subgroups based on GGN number, type, shape, edge, bronchial sign, vacuole sign, pleural depression sign, diameters, and consolidation-to-tumor ratio, suggesting that there was no significant interaction between different grouping parameters and the association (P for interaction range = 0.129-0.909). Conclusions In FDG PET, the glucose metabolism level (SUVmax) of lung GGNs is independently associated with INV risk, and this association is linear and positive.
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Affiliation(s)
- Xiaoliang Shao
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Xiaonan Shao
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Rong Niu
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Zhenxing Jiang
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Mei Xu
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Yuetao Wang
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
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25
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Minato H, Katayanagi K, Kurumaya H, Tanaka N, Fujimori H, Tsunezuka Y, Kobayashi T. Verification of the eighth edition of the UICC-TNM classification on surgically resected lung adenocarcinoma: Comparison with previous classification in a local center. Cancer Rep (Hoboken) 2021; 5:e1422. [PMID: 34169671 PMCID: PMC8789611 DOI: 10.1002/cnr2.1422] [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: 01/30/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The UICC 8th TNM classification of lung cancer has been changed dramatically, especially in measuring methods of T-desriptors. Different from squamous- or small-cell carcinomas, in which the solid- and the invasive-diameter mostly agree with each other, the diameter of the radiological solid part and that of pathological invasive part in adenocarcinomas often does not match. AIM We aimed to determine radiological and pathological tumor diameters of pulmonary adenocarcinomas with clinicopathological factors and evaluate the validity of the 8th edition in comparison with the 7th edition. METHODS AND RESULTS We retrospectively analyzed clinicopathological factors of 429 patients with surgically resected pulmonary adenocarcinomas. The maximum tumor and their solid-part diameters were measured using thin-sectioned computed tomography and compared with pathological tumor and invasive diameters. Overall survival (OS) rate was determined using the Kaplan-Meier method for different subgroups of clinicopathological factors. Akaike's information criteria (AIC) was used as a discriminative measure for the univariate Cox model for the 7th and 8th editions. Multivariate Cox regression analysis was performed to explore independent prognostic factors. Correlation coefficients between radiological and pathological diameters in the 7th and 8th editions were 0.911 and 0.888, respectively, without a significant difference. The major reasons for the difference in the 8th edition were the presence of intratumoral fibrosis and papillary growth pattern. The weighted kappa coefficients in the 8th edition were superior those in the 7th edition for both the T and Stage classifications. In the univariate Cox model, AIC levels were the lowest in the 8th edition. Multivariate analysis revealed that age, lymphovascular invasion, pT(8th), and stage were the most important determinants for OS. CONCLUSION The UICC 8th edition is a more discriminative classification than the 7th edition. For subsolid nodules, continuous efforts are necessary to increase the universality of the measurement of solid and invasive diameters.
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Affiliation(s)
- Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroshi Kurumaya
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Nobuhiro Tanaka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hideki Fujimori
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Yoshio Tsunezuka
- Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Takeshi Kobayashi
- Department of Diagnostic and Interventional Radiology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
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26
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Bertoglio P, Ventura L, Aprile V, Cattoni MA, Nachira D, Lococo F, Rodriguez Perez M, Guerrera F, Minervini F, Gnetti L, Bacchin D, Franzi F, Querzoli G, Rindi G, Bellafiore S, Femia F, Viti A, Kestenholz P, Ruffini E, Paci M, Margaritora S, Imperatori AS, Lucchi M, Carbognani P, Terzi AC. Prognostic role of standard uptake value according to pathologic features of lung adenocarcinoma. TUMORI JOURNAL 2021; 108:461-469. [PMID: 34039110 DOI: 10.1177/03008916211018515] [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: 11/16/2022]
Abstract
OBJECTIVE To evaluate the influence of lung adenocarcinoma second predominant pattern on the maximal standard uptake value (SUVmax) and its prognostic effect in different histologic groups. METHODS We retrospectively collected surgically resected pathologic stage I and II lung adenocarcinoma from nine European institutions. Only patients who underwent preoperative PET-CT and with available information regarding SUVmax of T (SUVmaxT) and N1 (SUVmaxN1) component were included. RESULTS We enrolled 344 patients with lung adenocarcinoma. SUVmaxT did not show any significant relation according to the second predominant pattern (p = 0.139); this relationship remained nonsignificant in patients with similar predominant pattern. SUVmaxT influenced the disease-free survival in the whole cohort (p = 0.002) and in low- and intermediate-grade predominant pattern groups (p = 0.040 and p = 0.008, respectively). In the high-grade predominant pattern cohort and in the pathologic N1 cases, SUVmaxT lost its prognostic power. SUVmaxN1 did not show any significant correlation with predominant and second predominant patterns and did not have any prognostic impact on DFS. CONCLUSIONS SUVmaxT is influenced only by the adenocarcinoma predominant pattern, but not by second predominant pattern. Concurrently, in high-grade predominant pattern and pN1 group the prognostic power of SUVmaxT becomes nonsignificant.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Luigi Ventura
- Division of Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | | | - Dania Nachira
- Department of General Thoracic Surgery, Fondazione Policlinico "A. Gemelli"-Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Lococo
- Department of General Thoracic Surgery, Fondazione Policlinico "A. Gemelli"-Catholic University of Sacred Heart, Rome, Italy
| | | | | | - Fabrizio Minervini
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Letizia Gnetti
- Division of Pathological Anatomy, University Hospital of Parma, Parma, Italy
| | - Diana Bacchin
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Francesca Franzi
- Division of Pathological Anatomy, University of Insubria, Varese, Italy
| | - Giulia Querzoli
- Division of Pathological Anatomy, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy
| | - Guido Rindi
- Division of Pathological Anatomy, Fondazione Policlinico "A.Gemelli"-Catholic University of Sacred Heart, Rome, Italy
| | - Salvatore Bellafiore
- Division of Pathological Anatomy, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Federico Femia
- Division of Thoracic Surgery, University of Torino, Torino, Italy
| | - Andrea Viti
- Division of Thoracic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy
| | - Peter Kestenholz
- Division of Thoracic Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Enrico Ruffini
- Division of Thoracic Surgery, University of Torino, Torino, Italy
| | - Massimiliano Paci
- Division of Thoracic Surgery, Azienda USL di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Stefano Margaritora
- Department of General Thoracic Surgery, Fondazione Policlinico "A. Gemelli"-Catholic University of Sacred Heart, Rome, Italy
| | | | - Marco Lucchi
- Division of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Paolo Carbognani
- Division of Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Alberto Claudio Terzi
- Division of Thoracic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Verona, Italy
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Editorial Comment: Metabolic Tumor Volume on FDG PET/CT for Predicting Lymphovascular Invasion of Non-Small Cell Lung Cancer-Proceed With Caution. AJR Am J Roentgenol 2021; 217:1443. [PMID: 34009004 DOI: 10.2214/ajr.21.26193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Niu R, Shao X, Shao X, Jiang Z, Wang J, Wang Y. Establishment and verification of a prediction model based on clinical characteristics and positron emission tomography/computed tomography (PET/CT) parameters for distinguishing malignant from benign ground-glass nodules. Quant Imaging Med Surg 2021; 11:1710-1722. [PMID: 33936959 DOI: 10.21037/qims-20-840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background To develop and verify a prediction model for distinguishing malignant from benign ground-glass nodules (GGNs) combined with clinical characteristics and 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) parameters. Methods We retrospectively analyzed 170 patients (56 males and 114 females) with GGNs who underwent PET/CT and high-resolution CT examination in our hospital from November 2011 to December 2019. The clinical and imaging data of all patients were collected, and the nodules were randomly divided into a derivation set and a validation set. For the derivation set, we used multivariate logistic regression to develop a prediction model for distinguishing benign from malignant GGNs. A receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of the model, and the data in the validation set were used to verify the prediction model. Results Among the 170 patients, 197 GGNs were confirmed via postoperative pathological examination or clinical follow-up. There were 21 patients with 27 GGNs in the benign group and 149 patients with 170 GGNs in the adenocarcinoma group. A total of five parameters, including the patient's sex, nodule location, margin, pleural indentation, and standardized uptake value (SUV) index (the ratio of nodule SUVmax to liver SUVmean), were selected to develop a prediction model for distinguishing benign from malignant GGNs. The area under the curve (AUC) of the model was 0.875 in the derivation set, with a sensitivity of 0.702 and a specificity of 0.923. The positive likelihood ratio was 9.131, and the negative likelihood ratio was 0.322. In the validation set, the AUC of the model was 0.874, which was not significantly different from the derivation set (P=0.989). Conclusions This study developed and validated a prediction model based on 18F-FDG PET/CT imaging and clinical characteristics for distinguishing malignant from benign GGNs. The model showed good diagnostic efficacy and high specificity, which can improve the preoperative diagnosis of high-risk GGNs.
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Affiliation(s)
- Rong Niu
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Xiaonan Shao
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Zhenxing Jiang
- Department of Radiology, the Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
| | - Yuetao Wang
- Department of Nuclear Medicine, the Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
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29
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Ye X, Fan W, Wang Z, Wang J, Wang H, Wang J, Wang C, Niu L, Fang Y, Gu S, Tian H, Liu B, Zhong L, Zhuang Y, Chi J, Sun X, Yang N, Wei Z, Li X, Li X, Li Y, Li C, Li Y, Yang X, Yang W, Yang P, Yang Z, Xiao Y, Song X, Zhang K, Chen S, Chen W, Lin Z, Lin D, Meng Z, Zhao X, Hu K, Liu C, Liu C, Gu C, Xu D, Huang Y, Huang G, Peng Z, Dong L, Jiang L, Han Y, Zeng Q, Jin Y, Lei G, Zhai B, Li H, Pan J. [Expert Consensus for Thermal Ablation of Pulmonary Subsolid Nodules (2021 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:305-322. [PMID: 33896152 PMCID: PMC8174112 DOI: 10.3779/j.issn.1009-3419.2021.101.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
局部热消融技术在肺部结节治疗领域正处在起步与发展阶段,为了肺结节热消融治疗的临床实践和规范发展,由“中国医师协会肿瘤消融治疗技术专家组”“中国医师协会介入医师分会肿瘤消融专业委员会”“中国抗癌协会肿瘤消融治疗专业委员会”“中国临床肿瘤学会消融专家委员会”组织多学科国内有关专家,讨论制定了“热消融治疗肺部亚实性结节专家共识(2021年版)”。主要内容包括:①肺部亚实性结节的临床评估;②热消融治疗肺部亚实性结节技术操作规程、适应证、禁忌证、疗效评价和相关并发症;③存在的问题和未来发展方向。
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Affiliation(s)
- Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510050, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Interventional Center, Jilin Provincial Cancer Hospital, Changchun 170412, China
| | - Jun Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Chuntang Wang
- Department of Thoracic Surgery, Dezhou Second People's Hospital, Dezhou 253022, China
| | - Lizhi Niu
- Department of Oncology, Affiliated Fuda Cancer Hospital, Jinan University, Guangzhou 510665, China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shanzhi Gu
- Department of Interventional Radiology, Hunan Cancer Hospital, Changsha 410013, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Baodong Liu
- Department of Thoracic Surgery, Xuan Wu Hospital Affiliated to Capital Medical University, Beijing 100053, China
| | - Lou Zhong
- Thoracic Surgery Department, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yiping Zhuang
- Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xichao Sun
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Nuo Yang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xiao Li
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaoguang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, Beijing 100730, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, China
| | - Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yan Li
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Wuwei Yang
- Department of Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China
| | - Po Yang
- Interventionael & Vascular Surgery, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhengqiang Yang
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yueyong Xiao
- Department of Radiology, Chinese PLA Gneral Hospital, Beijing 100036, China
| | - Xiaoming Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Shilin Chen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Weisheng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian 350011, China
| | - Zhengyu Lin
- Department of Intervention, The First Affiliated Hospital of Fujian Medical University, Fujian 350005, China
| | - Dianjie Lin
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Zhiqiang Meng
- Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Kaiwen Hu
- Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - Chen Liu
- Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100161, China
| | - Cheng Liu
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan 250021, China
| | - Chundong Gu
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China
| | - Yong Huang
- Department of Imaging, Affiliated Cancer Hospital of Shandong First Medical University, Jinan 250117, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Zhongmin Peng
- Department of Thoracic Surgery , Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Liang Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Lei Jiang
- Department of Radiology, The Convalescent Hospital of East China, Wuxi 214063, China
| | - Yue Han
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qingshi Zeng
- Department of Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Yong Jin
- Interventionnal Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Guangyan Lei
- Department of Thoracic Surgery, Shanxi Provincial Cancer Hospital, Xi'an 710061, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Hailiang Li
- Department of Interventional Radiology, Henan Cancer Hospital, Zhengzhou 450003, China
| | - Jie Pan
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Niu R, Wang Y, Shao X, Jiang Z, Wang J, Shao X. Association Between 18F-FDG PET/CT-Based SUV Index and Malignant Status of Persistent Ground-Glass Nodules. Front Oncol 2021; 11:594693. [PMID: 33842310 PMCID: PMC8024639 DOI: 10.3389/fonc.2021.594693] [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: 08/14/2020] [Accepted: 03/02/2021] [Indexed: 11/14/2022] Open
Abstract
To explore the association between 18F-FDG PET/CT-based SUV index and malignant risk of persistent ground-glass nodules (GGNs). We retrospectively analyzed a total of 166 patients with GGN who underwent PET/CT examination from January 2012 to October 2019. There were 113 women and 53 men, with an average age of 60.8 ± 9.1 years old. A total of 192 GGNs were resected and confirmed by pathology, including 22 in benign group and 170 in adenocarcinoma group. They were divided into three groups according to SUV index tertiles: Tertile 1 (0.14–0.54), Tertile 2 (0.55–1.17), and Tertile 3 (1.19–6.78), with 64 GGNs in each group. The clinical and imaging data of all patients were collected and analyzed. After adjusting for the potential confounding factors, we found that the malignancy risk of GGN significantly decreased as the SUV index increased (OR, 0.245; 95%CI, 0.119–0.504; P <0.001), the average probability of malignant GGN was 89.1% (95% CI, 53.1–98.3%), 80.5% (95% CI, 36.7–96.7%), and 34.3% (95%CI, 9.5–72.2%) for Tertile 1 to Tertile 3. And the increasing trend of SUV index was significantly correlated with the reduction of malignant risk (OR, 0.099; 95%CI, 0.025–0.394; P = 0.001), especially between Tertile 3 versus Tertile 1 (OR, 0.064; 95%CI, 0.012–0.356; P = 0.002). Curve fitting showed that the SUV index was linearly and negatively correlated with the malignant risk of GGN. SUV index is an independent correlation factor for malignancy risk of GGN, the higher the SUV index, the lower the probability of GGN malignancy.
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Affiliation(s)
- Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhenxing Jiang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianfeng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, The Third Affiliated Hospital of Soochow University, Changzhou, China
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31
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Chen K, Nie Y, Park S, Zhang K, Zhang Y, Liu Y, Hui B, Zhou L, Wang X, Qi Q, Li H, Kang G, Huang Y, Chen Y, Liu J, Cui J, Li M, Park IK, Kang CH, Shen H, Yang Y, Guan T, Zhang Y, Yang F, Kim YT, Wang J. Development and Validation of Machine Learning-based Model for the Prediction of Malignancy in Multiple Pulmonary Nodules: Analysis from Multicentric Cohorts. Clin Cancer Res 2021; 27:2255-2265. [PMID: 33627492 DOI: 10.1158/1078-0432.ccr-20-4007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/08/2020] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Nodule evaluation is challenging and critical to diagnose multiple pulmonary nodules (MPNs). We aimed to develop and validate a machine learning-based model to estimate the malignant probability of MPNs to guide decision-making. EXPERIMENTAL DESIGN A boosted ensemble algorithm (XGBoost) was used to predict malignancy using the clinicoradiologic variables of 1,739 nodules from 520 patients with MPNs at a Chinese center. The model (PKU-M model) was trained using 10-fold cross-validation in which hyperparameters were selected and fine-tuned. The model was validated and compared with solitary pulmonary nodule (SPN) models, clinicians, and a computer-aided diagnosis (CADx) system in an independent transnational cohort and a prospective multicentric cohort. RESULTS The PKU-M model showed excellent discrimination [area under the curve; AUC (95% confidence interval (95% CI)), 0.909 (0.854-0.946)] and calibration (Brier score, 0.122) in the development cohort. External validation (583 nodules) revealed that the AUC of the PKU-M model was 0.890 (0.859-0.916), higher than those of the Brock model [0.806 (0.771-0.838)], PKU model [0.780 (0.743-0.817)], Mayo model [0.739 (0.697-0.776)], and VA model [0.682 (0.640-0.722)]. Prospective comparison (200 nodules) showed that the AUC of the PKU-M model [0.871 (0.815-0.915)] was higher than that of surgeons [0.790 (0.711-0.852), 0.741 (0.662-0.804), and 0.727 (0.650-0.788)], radiologist [0.748 (0.671-0.814)], and the CADx system [0.757 (0.682-0.818)]. Furthermore, the model outperformed the clinicians with an increase of 14.3% in sensitivity and 7.8% in specificity. CONCLUSIONS After its development using machine learning algorithms, validation using transnational multicentric cohorts, and prospective comparison with clinicians and the CADx system, this novel prediction model for MPNs presented solid performance as a convenient reference to help decision-making.
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Affiliation(s)
- Kezhong Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
| | - Yuntao Nie
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kai Zhang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yangming Zhang
- Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yuan Liu
- Synthetic and Functional Biomolecules Center, Beijing National Laboratory for Molecular Sciences, Key Laboratory of Bioorganic Chemistry and Molecular Engineering of Ministry of Education, College of Chemistry and Molecular Engineering, Peking University, Beijing, China
| | - Bengang Hui
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Lixin Zhou
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Xun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Qingyi Qi
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Hao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Guannan Kang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yuqing Huang
- Department of Thoracic Surgery, Beijing Haidian Hospital, Beijing, China
| | - Yingtai Chen
- Department of Thoracic Surgery, Beijing Aerospace General Hospital, Beijing, China
| | - Jiabao Liu
- Department of Thoracic Surgery, First Hospital of Shijiazhuang, Shijiazhuang, China
| | - Jian Cui
- Department of Thoracic Surgery, Beijing Chuiyangliu Hospital, Beijing, China
| | - Mingru Li
- Department of Thoracic Surgery, Aerospace 731 Hospital, Beijing, China
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Haifeng Shen
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yingshun Yang
- Department of Thoracic Surgery, Beijing Haidian Hospital, Beijing, China
| | - Tian Guan
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yaxiao Zhang
- Department of Thoracic Surgery, First Hospital of Shijiazhuang, Shijiazhuang, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
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Cheng B, Deng H, Zhao Y, Zhu F, Liang H, Li C, Zhong R, Li J, Xiong S, Chen Z, Liang W, He J. Management for Residual Ground-Glass Opacity Lesions After Resection of Main Tumor in Multifocal Lung Cancer: A Case Report and Literature Review. Cancer Manag Res 2021; 13:977-985. [PMID: 33568943 PMCID: PMC7868271 DOI: 10.2147/cmar.s290830] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/13/2021] [Indexed: 12/26/2022] Open
Abstract
There are increasing numbers of synchronous multiple primary lung cancer (SMPLC) patients in clinical practice, with most lesions presenting as ground-glass opacity (GGO). For SMPLC patients, surgical resection should be a prior option for all lesions suspected of being malignant, if medically and technically feasible. However, it is frequently a dilemma for the management of residual GGO lesions that were unresected simultaneously with the main tumor in SMPLC patients. We report a case of SMPLC, in which the patient underwent surgical resection of the major lesion with EGFR mutation and then received compelling EGFR-TKI treatment for one enlarging residual GGO lesion after 12 months since operation. Furthermore, a comprehensive literature review about the risk for the progress of GGOs unresected simultaneously with the main lesion and the management of these residual GGOs was also summarized. With the treatment of EGFR-TKI gefitinib for 3 months, the biggest residual GGO lesion (more than 10mm) achieved a complete response (CR), three lesions reduced in size, and the other three lesions remained stable in this case. Surgical resection for major lesion and EGFR-TKI treatment on unresected GGOs might bring favorable outcome for patients with EGFR-mutated multifocal lung cancer. This strategy is safe and effective, which could be a promising therapeutic approach for unresectable GGO lesions in EGFR-mutated SMPLC patients after primary surgery. Notably, folate receptor-positive circulating tumor cell (FR+-CTC) for therapeutic monitoring was more sensitive for GGO-featured lung adenocarcinoma than serum markers.
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Affiliation(s)
- Bo Cheng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Hongsheng Deng
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Yi Zhao
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Feng Zhu
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Jianfu Li
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Shan Xiong
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Zhuxing Chen
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, 510120, People's Republic of China
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Yang T, Chen C, Chen Z. The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis. BMC Pulm Med 2021; 21:34. [PMID: 33472612 PMCID: PMC7816324 DOI: 10.1186/s12890-020-01374-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/14/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND It is necessary to analyze the CT pulmonary vascular parameters and disease severity in chronic obstructive pulmonary disease (COPD) patients to provide evidence support for the management of COPD. METHODS COPD patients on acute exacerbation admitted to our hospital from COPD patients from January 2019 to March 2020 was selected. The characteristics and ratio of the cross-sectional area (CSA) of small pulmonary vessels to the total area of the lung field, and the ratio of pulmonary artery and aorta (PA/A) cross-sectional diameter in patients with COPD were analyzed. RESULTS A total of 128 COPD patients were included. There were significant differences in the duration of COPD, smoking history, the PaO2, PaCO2, pH, and FEV1, FVC and FEV1/FVC among COPD patients with different severity (all p < 0.05). The duration of COPD, smoking, PaO2, PaCO2, CSA and PA/A were correlated with the COPD severity (all p < 0.05). Both CSA, PA/A were correlated with post BD FEV1 (all p < 0.05). The cutoff value of CSA and PA/A for the diagnosis of severe COPD was 0.61 and 0.87 respectively, and the AUC of CSA and PA/A for the diagnosis of severe COPD was 0.724 and 0.782 respectively. CONCLUSIONS Patients with CSA ≤ 0.61 and PA/A ≥ 0.87 may have higher risks for severe COPD, and more studies are needed in the future to further elucidate the management of COPD.
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Affiliation(s)
- Tao Yang
- Imaging Department, Linyi Central Hospital, Linyi, 276400, Shandong, China
| | - Chihua Chen
- Radiology Department, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan, 430015, Hubei, China
| | - Zhongyuanlong Chen
- Department of Radiology, Chest Hospital of Xinjiang Uygur Autonomous Region of the PRC, No. 106, Yan'an road, Urumqi, 830049, Xinjiang, China.
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34
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Zhang Q, Cui Q. Biodistribution of andrographolide to assess the interior-exterior relationship between the lung and intestine using microPET. Thorac Cancer 2020; 11:3365-3374. [PMID: 33017514 PMCID: PMC7606023 DOI: 10.1111/1759-7714.13682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 01/23/2023] Open
Abstract
Background One classic traditional Chinese medicine theory is that the “lung and intestine are exterior‐interiorly related”; however, this has not been confirmed experimentally. The aim of this study was to provide a biological basis for the theory by measuring the tissue distribution of andrographolide. Methods Acute pneumonia was induced in a mouse model by repeated stimulation with lipopolysaccharide. The distribution of andrographolide in mice was observed by positron emission tomography (PET) imaging with [18F]‐labeled andrographolide, and changes in the in vivo distribution before and after modeling were compared. Subsequently, the consistency of pathological changes in lung and intestine was confirmed by observation of pathological sections. Finally, the results were verified by cytokine detection. Results The value of organ uptake, pathological changes and inflammatory factor expression of the lung and intestine were consistent. The concentration of andrographolide in the lung and intestine increased significantly, and was confirmed by pathology and enzyme‐linked immunosorbent assays (ELISA). Conclusions Micro‐positron emission tomography (microPET) can be used to visually observe the distribution of medicinal ingredients in vivo, and [18F]‐andrographolide can be used as a tool to assess the interior‐exterior relationship between the lung and intestine.
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Affiliation(s)
- Qi Zhang
- College of Pharmacy, State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin, China
| | - Qingxin Cui
- College of Pharmacy, State Key Laboratory of Medicinal Chemical Biology, Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin, China
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35
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Shao X, Niu R, Shao X, Jiang Z, Wang Y. Value of 18F-FDG PET/CT-based radiomics model to distinguish the growth patterns of early invasive lung adenocarcinoma manifesting as ground-glass opacity nodules. EJNMMI Res 2020; 10:80. [PMID: 32661639 PMCID: PMC7359213 DOI: 10.1186/s13550-020-00668-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/02/2020] [Indexed: 11/12/2022] Open
Abstract
Background To establish and validate 18F-fluorodeoxyglucose (18F-FDG) PET/CT-based radiomics model and use it to predict the intermediate-high risk growth patterns in early invasive adenocarcinoma (IAC). Methods Ninety-three ground-glass nodules (GGNs) from 91 patients with stage I who underwent a preoperative 18F-FDG PET/CT scan and histopathological examination were included in this study. The LIFEx software was used to extract 52 PET and 49 CT radiomic features. The least absolute shrinkage and selection operator (LASSO) algorithm was used to select radiomic features and develop radiomics signatures. We used the receiver operating characteristics curve (ROC) to compare the predictive performance of conventional CT parameters, radiomics signatures, and the combination of these two. Also, a nomogram based on conventional CT indicators and radiomics signature score (rad-score) was developed. Results GGNs were divided into lepidic group (n = 18) and acinar-papillary group (n = 75). Four radiomic features (2 for PET and 2 for CT) were selected to calculate the rad-score, and the area under the curve (AUC) of rad-score was 0.790, which was not significantly different as the attenuation value of the ground-glass opacity component on CT (CTGGO) (0.675). When rad-score was combined with edge (joint model), the AUC increased to 0.804 (95% CI [0.699–0.895]), but which was not significantly higher than CTGGO (P = 0.109). Furthermore, the decision curve of joint model showed higher clinical value than rad-score and CTGGO, especially under the purpose of screening for intermediate-high risk growth patterns. Conclusion PET/CT-based radiomics model shows good performance in predicting intermediate-high risk growth patterns in early IAC. This model provides a useful method for risk stratification, clinical management, and personalized treatment.
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Affiliation(s)
- Xiaonan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Xiaoliang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China
| | - Zhenxing Jiang
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China. .,Changzhou Key Laboratory of Molecular Imaging, Changzhou, 213003, China.
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