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An J, Dong Y, Li Y, Han X, Niu H, Zou Z, Wu J, Tian Y, Chen Z. CT-guided placement of microcoil end in the pleural cavity for video-assisted thoracic surgical resection of ground-glass opacity: a retrospective study. J Cardiothorac Surg 2022; 17:316. [PMID: 36527097 PMCID: PMC9758923 DOI: 10.1186/s13019-022-02048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 11/27/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The aim of the study was to investigate and summarize the effectiveness and safety of CT-guided microcoil localization before video-assisted thoracic surgery (VATS) for the removal of ground-glass opacity (GGO). METHODS A total of 147 patients with GGO who were treated at our hospital between January 2019 and February 2021 were retrospectively analyzed. They were divided into two groups according to the final position at the end of the microcoil: intracavity (n = 78) and extracavity (n = 69), which were compared based on puncture complications and influence of the coil end position on VATS. RESULTS The proportions of supine and prone positions in the intracavity group were significantly higher than those in the extracavity group (82.1% vs. 66.7%, P < 0.05). The incidence of intrapulmonary hemorrhage, chest pain, and coil displacement in the intracavity group was significantly lower than that in the extracavity group (28.2% vs. 46.4%, 19.2% vs. 39.1%, 1.3% vs. 11.6%, P < 0.05, respectively); however, the incidence of pneumothorax was not significantly different (P > 0.05). The time of VATS and the rate of conversion to thoracotomy in the intracavity group were significantly lower than those in the extracavity group (103.4 ± 21.0 min vs. 112.2 ± 17.3 min, 0% vs. 5.8%, P < 0.05, respectively). CONCLUSION CT-guided placement of the microcoil is a practical, simple, and convenient localization method before VATS, with a high success rate and few complications. Furthermore, it is a better alternative method to place the end of the coil in the pleural cavity because of the lower complication rate, shorter VATS time, and lower rate of thoracotomy conversion.
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Affiliation(s)
- Jianli An
- Department of Interventional treatment, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province 066000 Qinhuangdao, People’s Republic of China
| | - Yanchao Dong
- Department of Interventional treatment, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province 066000 Qinhuangdao, People’s Republic of China
| | - Yanguo Li
- Department of Riadiology, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province Qinhuangdao, People’s Republic of China
| | - Xiaoyu Han
- Department of Cardiovascular, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province Qinhuangdao, People’s Republic of China
| | - Hongtao Niu
- Department of Interventional treatment, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province 066000 Qinhuangdao, People’s Republic of China
| | - Zibo Zou
- Department of Interventional treatment, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province 066000 Qinhuangdao, People’s Republic of China
| | - Jingpeng Wu
- Department of Interventional treatment, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province 066000 Qinhuangdao, People’s Republic of China
| | - Ye Tian
- Department of Interventional treatment, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province 066000 Qinhuangdao, People’s Republic of China
| | - Zhuo Chen
- Department of Interventional treatment, Qinhuangdao Municipal No. 1 Hospital, No. 258 Wenhua Road, Hebei Province 066000 Qinhuangdao, People’s Republic of China
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Zou M, Zhao Z, Zhang B, Mao H, Huang Y, Wang C. Pulmonary lesions: correlative study of dynamic triple-phase enhanced CT perfusion imaging with tumor angiogenesis and vascular endothelial growth factor expression. BMC Med Imaging 2021; 21:158. [PMID: 34717573 PMCID: PMC8556962 DOI: 10.1186/s12880-021-00692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background To investigate value of the quantitative perfusion parameters of dynamic triple-phase enhanced CT in differential diagnosis of pulmonary lesions, and explore the correlation between perfusion parameters of lung cancer with microvessel density (MVD) and vascular endothelial growth factor (VEGF). Methods 73 consecutive patients with lung lesions who successfully underwent pre-operative CT perfusion examination with dynamic triple-phase enhanced CT and received a final diagnosis by postoperative pathology or a clinical follow-up. The cases were divided into malignant and benign groups according to the pathological results. CT perfusion parameters, such as Median, Mean, Standard deviation (Std), Q10, Q25, Q50, Q75, Q90 of pulmonary artery perfusion (PAP), bronchial artery perfusion (BAP), perfusion index (PI) and arterial enhancement fraction (AEF) were obtained by performing computed tomography perfusion imaging (CTPI). Computed tomography perfusion (CTP) parameters were compared between malignant and benign lesions. The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CTP parameters in diagnosing malignant lesions. The correlations between CTP parameters with MVD and VEGF were analysed in 36 lung cancer patients who had extra sections be used for immunohistochemistry staining of CD34 and VEGF. Results BAP (Mean, Std, Q90) and PI Std of benign lesions were higher than malignant lesions (p < 0.05), and PAP (Q10, Q25), PI (Median, Mean, Q10, Q25, Q50) of malignant lesions were higher than the benign (p < 0.05). The area under the ROC curve of PI Mean, PI Q10 and PI Std was 0.722 (95% CI = [0.595–0.845]), 0.728 (95% CI = [0.612–0.844]) and 0.717 (95% CI = [0.598–0.835]) respectively. Partial perfusion parameters of BAP and AEF Q10 were positively correlated with MVD (p value range is < 0.001–0.037, ρ value range is 0.483–0.683), and partial perfusion parameters of PI were negatively correlated with MVD (p value range is 0.001–0.041,ρvalue range is − 0.523–− 0.343). Partial perfusion parameters of BAP and AEF Q10 were positively correlated with VEGF (p value range is 0.001–0.016, ρvalue range is 0.398–0.570), meanwhile some perfusion parameters of PAP and PI were negatively correlated with VEGF (p value range is 0.001–0.040, ρ value range is − 0.657–0.343). Conclusions Quantitative parameters of dynamic triple-phase enhanced CT can provide diagnostic basis for the differentiation of lung lesions, and there were connection with tumor angiogenesis and vascular endothelial growth factor expression.
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Affiliation(s)
- Mingyue Zou
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China.
| | - Bingqian Zhang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Haijia Mao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Yanan Huang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
| | - Cheng Wang
- Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China
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Wang W, Hansen AE, Sun H, Fliedner FP, Kjaer A, Jensen AI, Andresen TL, Henriksen JR. Carbohydrate based biomarkers enable hybrid near infrared fluorescence and 64Cu based radio-guidance for improved surgical precision. Nanotheranostics 2021; 5:448-460. [PMID: 34055574 PMCID: PMC8156217 DOI: 10.7150/ntno.60295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/04/2021] [Indexed: 01/15/2023] Open
Abstract
Increasing numbers of lung tumors are identified at early disease stages by diagnostic imaging in screening programs, but difficulties in locating these during surgical intervention has prevented an improved treatment outcome. Surgical biomarkers that are visible on diagnostic images, and that provide the surgeon with real-time image guidance during the intervention are thus highly warranted to bridge diagnostic precision into enhanced therapeutic outcome. In this paper, a liquid soft tissue marker for near infrared fluorescence and radio-guidance is presented. The biocompatible marker is based on the carbohydrate ester, sucrose acetate isobutyrate, ethanol, and a multifunctional naphthalocyanine dye, which enable near infrared fluorescence image-guided resection at short, medium and long tissue depths. Naphthalocyanine dyes have high quantum yields and may further act as chelators of radionuclides. Upon injection of the liquid marker, a gel-like depot is formed in situ at the site of injection, wherein the fluorescent dye and radionuclide is retained. The radiolabeled markers were optimized for minimal fluorescence quenching and high retention of the positron emission tomography radionuclide 64Cu. The performance of the radiolabeled marker was tested in vivo in mice, where it displayed high photostability over a period of 4 weeks, and high retention of 64Cu for 48 hours. The retention and biodistribution of 64Cu was quantified via PET/CT, and the fluorescence emission by an in vivo imaging system. The presented data demonstrate proof-of-concept for naphthalocyanine markers as multimodal imaging agents that can bridge the precision of diagnostic imaging into surgical interventions.
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Affiliation(s)
- Wenbo Wang
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Anders E Hansen
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Hongmei Sun
- School of Bioengineering and Food, Key Laboratory of Fermentation Engineering, (Ministry of Education), Key Laboratory of Industrial Microbiology in Hubei, National '111' Center for Cellular Regulation and Molecular Pharmaceutic, Hubei province Cooperative Innovation Center for Industrial Fermentation, Hubei University of Technology, Wuhan 430068, China
| | - Frederikke P Fliedner
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet and University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Andreas I Jensen
- Technical University of Denmark, The Hevesy Laboratory, Department of Health Technology, 4000 Roskilde, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Thomas L Andresen
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
| | - Jonas R Henriksen
- Technical University of Denmark, Department of Health Technology, Building 423, 2800 Lyngby, Denmark.,Center for Nanomedicine and Theranostics, Technical University of Denmark, 2800 Lyngby, Denmark
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Ricciardi S, Booton R, Petersen RH, Infante M, Scarci M, Veronesi G, Cardillo G. Managing of screening-detected sub-solid nodules-a European perspective. Transl Lung Cancer Res 2021; 10:2368-2377. [PMID: 34164284 PMCID: PMC8182699 DOI: 10.21037/tlcr.2020.03.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the National Lung Screening Trial in 2011 showed a 20% reduction in lung cancer mortality using annual low-dose computed tomography (LDCT), several randomised controlled trials and studies have been started in Europe. These include the Italian lung study (ITALUNG), the Dutch-Belgian lung cancer screening trial (NELSON), the UK lung cancer screening trial (UKLS), the Detection and screening of early lung cancer with novel imaging technology (DANTE), the Danish lung cancer screening trial (DLCST), the German lung cancer screening intervention trial (LUSI), the Multicentric Italian lung detection trial (MILD) and the CT screening for lung cancer study (COSMOS). As a result of the increasing number of screening trials and the growing utilization of LDCT, the high detection of subsolid nodules is an increasingly important clinical problem. In the last few years, several guidelines have been published and providing guidance on the optimal management of subsolid nodules, but many controversies still exist. Follow-up imaging plays an important role in clinical assessment and subsequent management of this particular type of lung nodules, since they can be transient inflammatory lesions, and if persistent they can be both benign lesions or lung cancers of variable clinical behaviour. However, the vast majority of subsolid nodules retain an indolent course over many years. The aim of this review is to present a European perspective in management of screening detected subsolid nodules.
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Affiliation(s)
- Sara Ricciardi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, Pathology and Critical Care, University Hospital of Pisa, Pisa, Italy
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University Foundation Trust & School of Biological Sciences, The University of Manchester, Manchester UK
| | - Renè Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Maurizio Infante
- Department of Thoracic Surgery, University and Hospital Trust, Verona, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, S. Gerardo Hospital, Monza, Italy
| | - Giulia Veronesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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Ishiwata T, Ujiie H, Gregor A, Inage T, Motooka Y, Kinoshita T, Aragaki M, Chen Z, Effat A, Bernards N, Yasufuku K. Pilot study using virtual 4-D tracking electromagnetic navigation bronchoscopy in the diagnosis of pulmonary nodules: a single center prospective study. J Thorac Dis 2021; 13:2885-2895. [PMID: 34164180 PMCID: PMC8182521 DOI: 10.21037/jtd-21-141] [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] [Indexed: 01/05/2023]
Abstract
Background Electromagnetic navigation bronchoscopy (ENB) is a navigation technology intended to improve the diagnostic yield of pulmonary nodules. However, nodule displacement due to respiratory motion may compromise the accuracy of the navigation guidance. The Veran SPiNDrive ENB system employs respiratory-gating (4D-tracking) to compensate for this motion. The aim of the present study was to evaluate the diagnostic performance and safety of the Veran SPiNDrive system for biopsy of pulmonary nodules. Methods Adult patients with pulmonary nodules of ≥1 cm were enrolled at a single center. Both conventional bronchoscopy and 4D-tracking ENB were performed in one procedure session under general anesthesia, with the procedure order being randomly assigned. Radial probe endobronchial ultrasound and fluoroscopy were used in both groups. The diagnostic performance, safety, total procedure time, and total fluoroscopy time of the ENB phase were compared to the corresponding conventional bronchoscopy phase. Results The study was terminated due to poor accrual; a total of eleven patients were enrolled. The mean size of pulmonary nodules was 2.1 cm. The sensitivity for malignancy was 67% (6/9) and 56% (5/9) with conventional bronchoscopy and with 4D-tracking ENB, respectively. Two cases developed minor bleeding after conventional bronchoscopy, while no complications were observed after 4D-tracking ENB. The mean procedure time was 16.1 and 21.7 min (P=0.090), and the mean duration time for fluoroscopy use was 77 and 44 sec (P=0.056) for the conventional bronchoscopy and the 4D-tracking ENB phases, respectively. Conclusions The diagnostic performance of the Veran SPiNDrive 4D-tracking ENB did not exceed that of conventional bronchoscopy for pulmonary nodules. No complications were seen during 4D-tracking ENB. A study with a larger number of participants is required for further assessment.
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Affiliation(s)
- Tsukasa Ishiwata
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alexander Gregor
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Terunaga Inage
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Yamato Motooka
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tomonari Kinoshita
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Masato Aragaki
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Zhenchian Chen
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Andrew Effat
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nicholas Bernards
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada.,TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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6
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Sato M, Yang SM, Tian D, Jun N, Lee JM. Managing screening-detected subsolid nodules-the Asian perspective. Transl Lung Cancer Res 2021; 10:2323-2334. [PMID: 34164280 PMCID: PMC8182721 DOI: 10.21037/tlcr-20-243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The broad application of low-dose computed tomography (CT) screening has resulted in the detection of many small pulmonary nodules. In Asia, a large number of these detected nodules with a radiological ground glass pattern are reported as lung adenocarcinomas or premalignant lesions, especially among female non-smokers. In this review article, we discuss controversial issues and conditions involving these subsolid pulmonary nodules that we often face in Asia, including a lack or insufficiency of current guidelines; the roles of preoperative biopsy and imaging; the location of lesions; appropriate selection of localization techniques; the roles of dissection and sampling of frozen sections and lymph nodes; multifocal lesions; and the roles of non-surgical treatment modalities. For these complex issues, we have tried to present up-to-date evidence and our own opinions regarding the management of subsolid nodules. It is our hope that this article helps surgeons and physicians to manage the complex issues involving ground glass nodules (GGNs) in a balanced manner in their daily practice and provokes further discussion towards better guidelines and/or algorithms.
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Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Shun-Mao Yang
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan.,Department of Thoracic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Dong Tian
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan.,Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nakajima Jun
- Department of Thoracic Surgery, University of Tokyo Hospital, Tokyo, Japan
| | - Jang-Ming Lee
- Department of Thoracic Surgery, National Taiwan University Hospital, Taipei
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Sato M, Kuwata T, Kitamura A, Misawa K, Imashimizu K, Yamanashi K, Ikeda M, Koike T, Kobayashi M, Kosaka S, Fukai R, Isowa N, Nagayama K, Aoyama A, Date H, Nakajima J. The role of virtual-assisted lung mapping in the resection of ground glass nodules. J Thorac Dis 2018; 10:2638-2647. [PMID: 29997925 DOI: 10.21037/jtd.2018.05.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Virtual-assisted lung mapping (VAL-MAP), a bronchoscopic multi-spot dye-marking technique, was tested for its ability to resect ground glass nodules (GGNs) in sublobar lung resections. Methods All patients were prospectively registered in the multi-institutional lung mapping (MIL-MAP) study using VAL-MAP. The data were retrospectively analyzed, focusing on GGNs. GGN characteristics, pathological findings, operation type, and the surgical contribution of VAL-MAP were evaluated. Results The 370 GGNs in 299 patients included 257 pure and 113 mixed GGNs. There were 146 wedge resections (43.6%), 99 simple segmentectomies (29.6%), and 60 complex segmentectomies (18.0%). The largest number of marks were used in complex segmentectomy (4.05±0.74), followed by simple segmentectomy (3.35±0.97) and wedge resection (2.96±0.80). The overall successful resection rate was 98.6%. Multiple [2-5] GGNs were concurrently targeted by VAL-MAP in 53 patients (17.7%) with 123 GGNs. Two concurrent resections were conducted in 36 patients (12.1%), most commonly wedge resection and segmentectomies (21 patients). Among 190 sub-centimeter GGNs, 24 out of 51 GGNs ≤5 mm in diameter (47.1%) and 113 of 139 GGNs >5 mm in diameter (81.3%) were primary lung cancer (P<0.0001). Regarding the contribution of VAL-MAP to successful resection, wedge resection and pure GGNs were graded higher than both other resection types and mixed GGNs. Conclusions VAL-MAP enabled thoracoscopic limited resection of GGNs. Its multiple marks facilitated resections of multi-centric GGNs. Resected suspicious GGNs >5 mm in diameter are likely to be lung cancer. VAL-MAP may impact decision-making regarding the indications and type of surgery for suspicious small GGNs.
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Affiliation(s)
- Masaaki Sato
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.,Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Taiji Kuwata
- The Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushyu, Japan
| | - Atsushi Kitamura
- Department of Respiratory Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Misawa
- Department of Thoracic Surgery, Aizawa Hospital, Matsumoto, Japan
| | - Kota Imashimizu
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Keiji Yamanashi
- Department of Thoracic Surgery, Kitano Hospital, Osaka, Japan
| | - Masaki Ikeda
- Department of Thoracic Surgery, Nagara Medical Center, Gifu, Japan
| | - Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masashi Kobayashi
- Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinji Kosaka
- Department of Thoracic Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Ryuta Fukai
- Department of Thoracic Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Noritaka Isowa
- Department of Thoracic Surgery, Matsue Red Cross Hospital, Matsue, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University, Kyoto, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan
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Chen D, Dai C, Kadeer X, Mao R, Chen Y, Chen C. New horizons in surgical treatment of ground-glass nodules of the lung: experience and controversies. Ther Clin Risk Manag 2018; 14:203-211. [PMID: 29430182 PMCID: PMC5797461 DOI: 10.2147/tcrm.s152127] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Ground-glass nodule (GGN) is defined as a nodular shadow with ground-glass opacity that is generally associated with the early-stage lung adenocarcinoma. Nowadays, GGNs of the lung are increasingly detected with thin-section computed tomography scan. GGNs are categorized as pure GGNs and mixed GGNs according to the images from a high-resolution computed tomography. Meanwhile, it is routine to divide GGNs into different categories according to the number, solitary, or multiple, the management of which there is very different. A great number of studies have been conducted to analyze the different characteristics of GGNs in various aspects ranging from radiology, pathology, and surgery to molecular biology. However, plenty of problems still remain unsolved, ranging from the preoperative localization to intraoperative surgical resection procedure, the lymphadenectomy, and sampling of lymph nodes, as well as the accuracy of frozen sections. There has been a large volume of updated published information summarizing recently emerging and rapidly progressing aspects of surgical treatment of solitary and multiple GGNs with the unsolved problems mentioned above. However, there have been few specific reviews of surgical treatment of GGNs so far. This review presents a timely outline of advances in relevant experience and controversies of GGNs for a better understanding of this kind of lesion.
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Affiliation(s)
- Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Chenyang Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Xiermaimaiti Kadeer
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Rui Mao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
| | - Yongbing Chen
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai
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Watanabe H, Uruma T, Seita I, Oishi T, Watanabe Y, Tsukimori A, Haga Y, Fukushima S, Sato A, Nakamura I, Matsumoto T. Solitary pulmonary caseating granulomas: A 5-year retrospective single-center analysis. Mol Clin Oncol 2017; 6:839-845. [PMID: 28588774 PMCID: PMC5451854 DOI: 10.3892/mco.2017.1244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/10/2017] [Indexed: 11/06/2022] Open
Abstract
Solitary pulmonary caseating granulomas (SPCGs) are a characteristic type of tuberculomas associated with infection with non-tuberculous mycobacteria (NTM) and other microbes; however, their significance remains unclear. The aim of the present study was to describe the clinical characteristics of patients with SPCGs in terms of diagnosis, presence of lung cancer and treatment status. A retrospective analysis of 17 immunocompetent patients with histopathologically confirmed caseating granulomas after undergoing video-assisted thoracoscopic surgery (VATS) was conducted at our center between 2011 and 2015. The patients comprised 10 men and 7 women with a mean age of 59.1±14.4 years. Of the 17 patients, 14 (82.4%) were asymptomatic and the lesions were discovered incidentally. In 2 patients the SPCGs were accompanied by a small satellite nodule (SPCG mean diameter, 16.2±5.1 mm). Mycobacteria, including Mycobacterium tuberculosis (11.8%), Mycobacterium avium (11.8%) Mycobacterium kansasii (23.5%) and other Mycobacterium spp. (5.9%), were isolated from 9 of the patients (52.9%). Concurrent lung cancer was present in 3 patients (17.6%). When microbial agents could not be isolated, the interferon-γ release assay was useful for diagnosis. Positron emission tomography was not found to be useful for differentiating SPCGs from lung cancer, or for differentiating tuberculomas from NTM pulmonary nodules (NTMPNs). NTMPNs in cases of SPCGs were diagnosed more frequently in men. The findings indicate that a course of observation may be sufficient for patients in whom an SPCG from NTM (NTMPN) is identified by VATS. However, the presence of concurrent lung cancer in certain cases indicates that malignancy should not necessarily be excluded, particularly in NTMPNs, and highlights the necessity of aggressive diagnosis by VATS.
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Affiliation(s)
- Hidehiro Watanabe
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Tomonori Uruma
- Department of Infection Control and Prevention, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki 300-0395, Japan
| | - Ikuo Seita
- Department of Infection Control and Prevention, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki 300-0395, Japan
| | - Tsuyoshi Oishi
- Department of Infection Control and Prevention, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki 300-0395, Japan
| | - Yusuke Watanabe
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Ayaka Tsukimori
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Yoshiteru Haga
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Shinji Fukushima
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Akihiro Sato
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Itaru Nakamura
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Tetsuya Matsumoto
- Department of Microbiology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
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Wang FL, Tan YY, Gu XM, Li TR, Lu GM, Liu G, Huo TL. Comparison of Positron Emission Tomography Using 2-[18F]-fluoro-2-deoxy-D-glucose and 3-deoxy-3-[18F]-fluorothymidine in Lung Cancer Imaging. Chin Med J (Engl) 2017; 129:2926-2935. [PMID: 27958224 PMCID: PMC5198527 DOI: 10.4103/0366-6999.195468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The detection of solitary pulmonary nodules (SPNs) that may potentially develop into a malignant lesion is essential for early clinical interventions. However, grading classification based on computed tomography (CT) imaging results remains a significant challenge. The 2-[18F]-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET)/CT imaging produces both false-positive and false-negative findings for the diagnosis of SPNs. In this study, we compared 18F-FDG and 3-deoxy-3-[18F]-fluorothymidine (18F-FLT) in lung cancer PET/CT imaging. Methods: The binding ratios of the two tracers to A549 lung cancer cells were calculated. The mouse lung cancer model was established (n = 12), and micro-PET/CT analysis using the two tracers was performed. Images using the two tracers were collected from 55 lung cancer patients with SPNs. The correlation among the cell-tracer binding ratios, standardized uptake values (SUVs), and Ki-67 proliferation marker expression were investigated. Results: The cell-tracer binding ratio for the A549 cells using the 18F-FDG was greater than the ratio using 18F-FLT (P < 0.05). The Ki-67 expression showed a significant positive correlation with the 18F-FLT binding ratio (r = 0.824, P < 0.01). The tumor-to-nontumor uptake ratio of 18F-FDG imaging in xenografts was higher than that of 18F-FLT imaging. The diagnostic sensitivity, specificity, and the accuracy of 18F-FDG for lung cancer were 89%, 67%, and 73%, respectively. Moreover, the diagnostic sensitivity, specificity, and the accuracy of 18F-FLT for lung cancer were 71%, 79%, and 76%, respectively. There was an obvious positive correlation between the lung cancer Ki-67 expression and the mean maximum SUV of 18F-FDG and 18F-FLT (r = 0.658, P < 0.05 and r = 0.724, P < 0.01, respectively). Conclusions: The 18F-FDG uptake ratio is higher than that of 18F-FLT in A549 cells at the cellular level. 18F-FLT imaging might be superior for the quantitative diagnosis of lung tumor tissue and could distinguish lung cancer nodules from other SPNs.
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Affiliation(s)
- Fu-Li Wang
- Department of Hospital Management, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China
| | - Ye-Ying Tan
- Department of Radiology, Xuzhou Center Hospital, Xuzhou, Jiangsu 221000, China
| | - Xiang-Min Gu
- Department of Hospital Management, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China
| | - Tian-Ran Li
- Department of Radiology, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048; Department of Radiology, Nanjing General Hospital of Chinese PLA, Nanjing, Jiangsu 210000, China
| | - Guang-Ming Lu
- Department of Radiology, Nanjing General Hospital of Chinese PLA, Nanjing, Jiangsu 210000, China
| | - Gang Liu
- Department of Radiology, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China
| | - Tian-Long Huo
- Department of Radiology, Peking University People's Hospital, Beijing 100048, China
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Yang W, Jiang H, Khan AN, Allen C, Bertolaccini L, Lv T, Song Y. Transthoracic needle aspiration in solitary pulmonary nodule. Transl Lung Cancer Res 2017; 6:76-85. [PMID: 28331827 DOI: 10.21037/tlcr.2017.02.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With improved awareness of public health and the recent advances in various imaging technologies, the detection rate of solitary pulmonary nodules (SPN) is continuously increasing. Transthoracic needle aspiration (TTNA) has represented a major approach for the diagnosis and differential diagnosis of pulmonary masses, owing to its simplicity and minimal invasiveness. This paper demonstrates the role of TTNA in SPN.
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Affiliation(s)
- Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Hongli Jiang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Ali Nawaz Khan
- Department of Radiology, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsall, Manchester M8 6RB, UK
| | - Carolyn Allen
- Department of Radiology, North Manchester General Hospital, Acute Pennine NHS Trust, Crumpsall, Manchester M8 6RB, UK
| | - Luca Bertolaccini
- Thoracic Surgery - AUSL Romagna, Santa Maria delle Croci Teaching Hospital, Viale Vincenzo Randi 5, 48121 Ravenna, Italy
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing 210002, China
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12
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Zhan P, Zhu QQ, Miu YY, Liu YF, Wang XX, Zhou ZJ, Jin JJ, Li Q, Sasada S, Izumo T, Tu CY, Cheng WC, Evison M, Lv TF, Song Y. Comparison between endobronchial ultrasound-guided transbronchial biopsy and CT-guided transthoracic lung biopsy for the diagnosis of peripheral lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2017; 6:23-34. [PMID: 28331821 DOI: 10.21037/tlcr.2017.01.01] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND With the release of the National Lung Screening Trial results, the detection of peripheral pulmonary lesions (PPLs) is likely to increase. Computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) and radial probe endobronchial ultrasound (r-EBUS)-guided transbronchial lung biopsy (TBLB) are recommended for tissue diagnosis of PPLs. METHODS A systematic review of published literature evaluating the accuracy of r-EBUS-TBLB and CT-PTNB for the diagnosis of PPLs was performed to determine point sensitivity and specificity, and to construct a summary receiver-operating characteristic curve. RESULTS This review included 31 publications dealing with EBUS-TBLB and 14 publications dealing with CT-PTNB for the diagnosis of PPLs. EBUS-TBLB had point sensitivity of 0.69 (95% CI: 0.67-0.71) for the diagnosis of peripheral lung cancer (PLC), which was lower than the sensitivity of CT-PTNB (0.94, 95% CI: 0.94-0.95). However, the complication rates observed with EBUS-TBLB were lower than those reported for CT-PTNB. CONCLUSIONS This meta-analysis showed that EBUS-TBLB is a safe and relatively accurate tool in the investigation of PLC. Although the yield remains lower than that of CT-PTNB, the procedural risks are lower.
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Affiliation(s)
- Ping Zhan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qing-Qing Zhu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ying-Ying Miu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ya-Fang Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Xiao-Xia Wang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ze-Jun Zhou
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jia-Jia Jin
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Shinji Sasada
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Minato-ku, Tokyo 108-0073, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya-ku, Tokyo 150-8935, Japan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, China
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, China
| | - Matthew Evison
- North West Lung Centre, University Hospital of South Manchester, Wythenshawe M23 9LT, UK
| | - Tang-Feng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
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Perandini S, Soardi GA, Motton M, Augelli R, Dallaserra C, Puntel G, Rossi A, Sala G, Signorini M, Spezia L, Zamboni F, Montemezzi S. Enhanced characterization of solid solitary pulmonary nodules with Bayesian analysis-based computer-aided diagnosis. World J Radiol 2016; 8:729-734. [PMID: 27648166 PMCID: PMC5002503 DOI: 10.4329/wjr.v8.i8.729] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/12/2016] [Accepted: 07/13/2016] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to prospectively assess the accuracy gain of Bayesian analysis-based computer-aided diagnosis (CAD) vs human judgment alone in characterizing solitary pulmonary nodules (SPNs) at computed tomography (CT). The study included 100 randomly selected SPNs with a definitive diagnosis. Nodule features at first and follow-up CT scans as well as clinical data were evaluated individually on a 1 to 5 points risk chart by 7 radiologists, firstly blinded then aware of Bayesian Inference Malignancy Calculator (BIMC) model predictions. Raters’ predictions were evaluated by means of receiver operating characteristic (ROC) curve analysis and decision analysis. Overall ROC area under the curve was 0.758 before and 0.803 after the disclosure of CAD predictions (P = 0.003). A net gain in diagnostic accuracy was found in 6 out of 7 readers. Mean risk class of benign nodules dropped from 2.48 to 2.29, while mean risk class of malignancies rose from 3.66 to 3.92. Awareness of CAD predictions also determined a significant drop on mean indeterminate SPNs (15 vs 23.86 SPNs) and raised the mean number of correct and confident diagnoses (mean 39.57 vs 25.71 SPNs). This study provides evidence supporting the integration of the Bayesian analysis-based BIMC model in SPN characterization.
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Watanabe H, Uruma T, Seita I, Chikasawa Y, Kikuchi R, Itoh M, Aoshiba K, Nakamura H, Oishi T. Successful desensitization therapy involving fluoroquinolone for the treatment of a solitary tuberculoma: A case report and literature review. Mol Clin Oncol 2016; 5:117-120. [PMID: 27330780 DOI: 10.3892/mco.2016.881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 04/19/2016] [Indexed: 11/05/2022] Open
Abstract
The patient was a 31-year-old female with no previous health problems; however, during a health checkup in 2013, a nodule (2.5 cm in diameter) was identified in the S10 area of the left lung. No clinical symptoms were apparent. Positron emission tomography/computed tomography revealed an accumulation in the same region. The patient was suspected of having lung cancer, and video-assisted thoracoscopic surgery was performed. A histopathological examination of the resected specimen revealed epithelioid granulomas accompanied by caseous necrosis in the lesion. The culture was positive for Mycobacterium tuberculosis, which led to the final diagnosis of tuberculoma. Initially, the patient underwent anti-M.tuberculosis treatment [isoniazid (INH) + rifampicin (RFP) + ethambutol (EB) + pyrazinamide (PZA)]. However, two weeks later, the development of epatic dysfunction necessitated suspension of the medication. Treatment was resumed following improvement of the hepatic function. However, this relapsed two weeks later, resulting in discontinuation of the treatment. The patient was negative for each of the four drugs in the drug-induced lymphocyte stimulation test (DLST), and drug-induced hepatotoxicity (DIH) attributable to the anti-tuberculous drugs that were administered. Therefore, desensitization therapy was initiated. EB + PZA were changed to levofloxacin (LVFX) at an initial dose of 250 mg/day (dose level increased to the maintenance dose). Subsequently, desensitization therapy with RFP and INH was applied in accordance with the Japanese Society for Tuberculosis protocol. After each drug dose level reached the maintenance dose level, the therapy was completed following administration of the drugs for the recommended duration of 6 months. There were no signs of relapse 6 months following completion of the therapy. Therefore, the patient responded well to the substitute therapy with LVFX and desensitization therapy, and the present case report provided information regarding the treatment of tuberculoma.
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Affiliation(s)
- Hidehiro Watanabe
- Department of Infection Control and Infectious Disease, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan; Department of Respiratory Medicine, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Tomonori Uruma
- Department of Infection Control and Infectious Disease, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan; Department of Respiratory Medicine, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Ikuo Seita
- Department of Infection Control and Infectious Disease, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Yushi Chikasawa
- Department of Infection Control and Infectious Disease, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Ryota Kikuchi
- Department of Respiratory Medicine, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Masayuki Itoh
- Department of Respiratory Medicine, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Kazutetsu Aoshiba
- Department of Respiratory Medicine, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Hiroyuki Nakamura
- Department of Respiratory Medicine, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
| | - Tsuyoshi Oishi
- Department of Infection Control and Infectious Disease, Ibaraki Medical Center, Tokyo Medical University, Inashiki, Ibaraki 300-0395, Japan
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15
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Transthoracic Needle Biopsy (TNB) under Different Guiding Methods - the Experience of the Thoracic Surgery Clinic of Craiova after the First 235 Cases. CURRENT HEALTH SCIENCES JOURNAL 2015; 41:239-245. [PMID: 30534428 PMCID: PMC6246991 DOI: 10.12865/chsj.41.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/15/2015] [Indexed: 11/29/2022]
Abstract
ABSTRACT: Transthoracic needle biopsy (TNB) is a fast and safe method used to establish definitive diagnosis for most thoracic lesions, whether the lesion is located in the pleura, the lung parenchyma, or the mediastinum. Diffuse disease and solitary lesions are equally approachable.TNB can avoid (when technically possible) more complex diagnostic interventions such asmediastinoscopy, thoracoscopy and exploratory thoracotomy. This article focuses on the advantages of TNB which is a safe, affordable and quick method to obtain histopathological confirmation of intrathoracic tumors. Material and MethodsThe study included a total of 235 cases over a period of 4 and a half years (01.01.2011-30.04.2015). We investigated the demographic and clinical parameters, the guiding methods, the histological results and the complications of the procedure. ResultsThe median age of the patients was 62 years and the predominent sex was male. We could obtain a tissue biopsy in 99% with a histopathological confirmation of 88%. The most frequently used guiding method was the previous CT scan of the patient and the anathomical landmarks (53%). The main histopathological result was squamous cell carcinoma.ConclusionsTNB is generally a safe procedure with limited morbidity and extremely rare mortality. It is an affordable and quick method to obtain histopathological confirmation of intrathoracic tumors.Most TNBs can be performed by using local anesthesia without conscious sedation and virtually any location in the chest can be safely addressed.
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16
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Yang W, Sun W, Li Q, Yao Y, Lv T, Zeng J, Liang W, Zhou X, Song Y. Diagnostic Accuracy of CT-Guided Transthoracic Needle Biopsy for Solitary Pulmonary Nodules. PLoS One 2015; 10:e0131373. [PMID: 26110775 PMCID: PMC4482532 DOI: 10.1371/journal.pone.0131373] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/31/2015] [Indexed: 11/18/2022] Open
Abstract
To evaluate the diagnostic accuracy of computed tomography (CT)-guided percutaneous lung biopsy for solitary pulmonary nodules. Three hundred and eleven patients (211 males and 100 females), with a mean age of 59.6 years (range, 19-87 years), who were diagnosed with solitary pulmonary nodules and underwent CT-guided percutaneous transthoracic needle biopsy between January 2008 and January 2014 were reviewed. All patients were confirmed by surgery or the clinical course. The overall diagnostic accuracy and incidence of complications were calculated, and the factors influencing these were statistically evaluated and compared. Specimens were successfully obtained from all 311 patients. A total of 217 and 94 cases were found to be malignant and benign lesions, respectively, by biopsy. Two hundred and twenty-five (72.3%) carcinomas, 78 (25.1%) benign lesions, and 8 (2.6%) inconclusive lesions were confirmed by surgery and the clinical course. The diagnostic accuracy, sensitivity, and specificity of CT-guided percutaneous transthoracic needle biopsy were 92.9%, 95.3%, and 95.7%, respectively. The incidences of pneumothorax and self-limiting bleeding were 17.7% and 11.6%, respectively. Taking account of all evidence, CT-guided percutaneous lung biopsy for solitary pulmonary nodules is an efficient, and safe diagnostic method associated with few complications.
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Affiliation(s)
- Wen Yang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Wenkui Sun
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Yanwen Yao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Junli Zeng
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Wenjun Liang
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Xiaojun Zhou
- Department of pathology, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China
- * E-mail:
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Callahan J, Kron T, Schneider ME, Hicks RJ. A prospective investigation into the clinical impact of 4D-PET/CT in the characterisation of solitary pulmonary nodules. Cancer Imaging 2014; 14:24. [PMID: 25608679 PMCID: PMC4331829 DOI: 10.1186/1470-7330-14-24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/22/2014] [Indexed: 12/26/2022] Open
Abstract
Background While the effects of respiratory motion on measuring metabolic signal in PET/CT scanning are well known, it is still standard practice in most centres to scan patients while breathing freely with no correction for the effects of respiratory motion. The aim of this study was to investigate the impact of 4D-PET/CT in classifying lesions in patients with a radiologically-indeterminate solitary pulmonary nodule. Methods Twenty consecutive patients with a solitary pulmonary nodule for investigation were prospectively recruited and completed a whole-body (WB)-PET/CT and 4D-PET/CT in the same session. The reporting physician initially classified the nodule using a 5-point scale (Definitely Malignant, Probably Malignant, Indeterminate, Probably benign, Definitely Benign) on the WB-PET/CT. The physician was then shown the 4D-PET/CT and asked if they would re-classify the lesion. Frequency, sensitivity, specificity and accuracy values were calculated for WB-PET/CT alone and then with the addition of the 4D-PET/CT. Results There were no changes in the classification for nodules initially classed as either benign or malignant with the addition of a 4D-PET/CT. However changes were observed between WB and 4D-PET/CT scans in lesions initially classified as indeterminate. When indeterminate lesions were defined as malignant there was a minor increase in sensitivity (from 73% to 75%), in specificity (56%-63%) and in accuracy (65%-70%) but these results do not reach statistical significance. When the Indeterminate lesions were defined as benign there was an increase in sensitivity (from 55% to 67%) but there was a reduction in the specificity (100%-75%) and accuracy (75%-70%) with the addition of the 4D-PET/CT but again the results did not reach statistical significance. Conclusion The addition of 4D-PET/CT is most likely to have an impact on those nodules initially classified as indeterminate on standard WB-PET/CT. In lesions classified as benign or malignant on standard WB-PET/CT the addition of a 4D-PET/CT is less likely to impact lesion classification. While 4D-PET/CT does improve the measurement of the metabolic signal, it does not overcome inherent limitations of FDG in differentiating a malignant lesion from inflammatory processes, correct for partial volume effects or compensate for the low intrinsic FDG-avidity of some malignancies.
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