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Li ZZ, Huang YL, Song HJ, Wang YJ, Huang Y. The value of 18F-FDG-PET/CT in the diagnosis of solitary pulmonary nodules: A meta-analysis. Medicine (Baltimore) 2018; 97:e0130. [PMID: 29561412 PMCID: PMC5895332 DOI: 10.1097/md.0000000000010130] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Solitary pulmonary nodules (SPNs) are common imaging findings. Many studies have indicated that F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) is an accurate test for distinguishing benign and malignant SPNs. The aim of this study was to investigate the value of F-FDG-PET/CT in the diagnosis of malignant SPNs. METHODS We systematically searched the PubMed and Embase databases up to March 2017, and published data on sensitivity, specificity, and other measures of diagnostic accuracy of F-FDG-PET/CT in the diagnosis of malignant SPNs were meta-analyzed. Statistical analyses were undertaken using Meta-DiSc 1.4 software and Stata version 12.0. The measures of accuracy of F-FDG-PET/CT in the diagnosis of malignant SPNs were pooled using random-effects models. RESULTS A total of 20 publications reporting 21 studies were identified. Pooled results indicated that F-FDG-PET/CT showed a diagnostic sensitivity of 0.89 (95% confidence interval [CI], 0.87-0.91) and a specificity of 0.70 (95% CI, 0.66-0.73). The positive likelihood ratio was 3.33 (95% CI, 2.35-4.71) and the negative likelihood ratio was 0.18 (95% CI, 0.13-0.25). The diagnostic odds ratio was 22.43 (95% CI, 12.55-40.07). CONCLUSIONS F-FDG-PET/CT showed insufficient sensitivity and specificity for diagnosing malignant SPNs; it cannot replace the "gold standard" pathology by resection or percutaneous biopsy. Larger studies are required for further evaluation.
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Affiliation(s)
- Zhen-Zhen Li
- Health Management Center, West China Hospital of Sichuan University
| | - Ya-Liang Huang
- Department of Nephrology and Rheumatology, Affiliated Hospital/Clinical Medical College of Chengdu University
| | - Hong-Jun Song
- Outpatient Department, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - You-Juan Wang
- Health Management Center, West China Hospital of Sichuan University
| | - Yan Huang
- Health Management Center, West China Hospital of Sichuan University
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Wang YXJ, Gong JS, Suzuki K, Morcos SK. Evidence based imaging strategies for solitary pulmonary nodule. J Thorac Dis 2014; 6:872-87. [PMID: 25093083 DOI: 10.3978/j.issn.2072-1439.2014.07.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/29/2014] [Indexed: 12/21/2022]
Abstract
Solitary pulmonary nodule (SPN) is defined as a rounded opacity ≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.
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Affiliation(s)
- Yi-Xiang J Wang
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Jing-Shan Gong
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Kenji Suzuki
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Sameh K Morcos
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
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Sim YT, Poon FW. Imaging of solitary pulmonary nodule-a clinical review. Quant Imaging Med Surg 2014; 3:316-26. [PMID: 24404446 DOI: 10.3978/j.issn.2223-4292.2013.12.08] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/18/2013] [Indexed: 12/11/2022]
Abstract
Current widespread use of cross-sectional imaging has led to exponential rise in detection of solitary pulmonary nodules (SPNs). Whilst large numbers of these are benign 'incidentalomas', lung cancers presenting as SPNs are often early disease, which have good prognosis. Therefore, there is rising demand and expectation for more accurate, non-invasive, diagnostic tests to characterize SPNs, aiming to avoid missed or delayed diagnosis of lung cancer. There are wide differential diagnoses of benign and malignant lesions that manifest as SPNs. On conventional imaging, the morphological features supporting benignity include stable small nodule size, smooth demarcated margins, and calcifications. Lack of significant contrast enhancement is also more suggestive of benign nodules. With improved understanding of tumor biology, for instance neo-vascularization and increased vascular permeability, imaging techniques such as dynamic contrast-enhanced computed tomography (CT) provide details on contrast uptake and wash-out kinetics, which is more closely reflecting the physiological and pathological phenomena. Positron emission tomography (PET) using 18fluorine-fluoro-deoxyglucose ((18)F-FDG) is a well-established functional imaging technique, for which one of the most common indications is differentiating between benign and malignant SPNs. Combined PET-CT integrates the anatomical, morphological and metabolic aspects in a single examination, improving overall diagnostic accuracy. Semi-quantitative analysis in FDG-PET imaging is based on measurement of maximum standardized uptake values (SUVmax). SUVmax analysis may become more useful as an assessment of tumor biology in future risk stratification models for cancers. Dual-time point FDG-PET imaging, dual-energy CT, perfusion CT, magnetic resonance (MR) imaging using dynamic contrast enhancement or diffusion-weighted imaging (DWI) techniques, are among the growing armamentarium for diagnostic imaging of SPNs. Provided there is no unacceptably high procedural or operative risk, tissue diagnosis by resection or percutaneous biopsy of SPN should be advocated in those patients identified as at moderate or high risk of malignancy, based on clinical stratification.
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Affiliation(s)
- Yee Ting Sim
- Radiology Department, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - Fat Wui Poon
- West of Scotland PET Centre, Beatson Oncology Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
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Lee JK, Min KJ, So KA, Kim S, Hong JH. The effectiveness of dual-phase 18F-FDG PET/CT in the detection of epithelial ovarian carcinoma: a pilot study. J Ovarian Res 2014; 7:15. [PMID: 24499648 PMCID: PMC3922340 DOI: 10.1186/1757-2215-7-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 02/03/2014] [Indexed: 11/27/2022] Open
Abstract
Background The aim of our study is to establish the potential role of dual-phase 18F-fluorodeoxyglucose positron emission tomography / computed tomography (FDG-PET/CT) in patients presenting ovarian masses with diffuse peritoneal infiltration for differentiating benign from malignant lesions. Methods Twenty patients (13 with ovarian cancers and 7 with benign lesions) were evaluated preoperatively by dual-phase 18F-FDG-PET/CT performed 1 h and 2 h after injection of 18F-FDG. The maximum standardized uptake value (SUVmax) for both time points SUVmax1 and SUVmax2 were determined, respectively, and the retention index (RI) was calculated by subtracting the SUVmax1 from the SUVmax2 and dividing by SUVmax1. Results The areas under the receiver operating characteristic curves (AUCs) of SUVmax1 and SUVmax2 were 0.753 (P = 0.062, 95% confidence interval [CI] = 0.512–0.915) and 0.835 (P = 0.001, 95% CI = 0.604–0.961), respectively. The AUC of the RI was 0.901 (P < 0.001, 95% CI = 0.684–0.988). Using pairwise comparisons, the AUC of SUVmax2 was significantly higher than that of SUVmax1 (P = 0.032). The AUC of the RI was higher than those of SUVmax1 and SUVmax2, but the difference was not statistically significant. Conclusion Dual-phase 18F-FDG PET/CT might be considered when preoperative imaging is indeterminate. A larger-scaled, prospective study is needed to verify these results.
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Affiliation(s)
| | | | | | - Sungeun Kim
- Department of Obstetrics and Gynecology, Guro Hospital, College of Medicine, Korea University, Seoul, Republic of Korea.
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Khan AN, Al-Jahdali H. Value of delayed 18F-FDG PET in the diagnosis of solitary pulmonary nodule. J Thorac Dis 2013; 5:373-4. [PMID: 23825780 DOI: 10.3978/j.issn.2072-1439.2013.06.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/05/2013] [Indexed: 11/14/2022]
Abstract
Performing dual point 18F-FDG PET scans of solitary pulmonary nodules at an initial SUV (max) <2.5 is a useful technique. However, prolonging second image acquisition from 120 to 180 min does not appear to improve accuracy. Dual time 18F-FDG PET is not useful in differentiating benign and malignant pulmonary nodules with an initial mean SUV ≤2.5 in parts of the world where granulomatous disease is prevalent. Prolonged imaging on PET scanners is expensive particularly where availability if these scanners is limited. Further prospective research is required to define the potential benefits of dual time point 18F-FDG PET imaging, before recommending routine use of the technique.
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Affiliation(s)
- Ali Nawaz Khan
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Li GL, Zhu Y, Zheng W, Guo CH, Chen C. Analysis of factors influencing skip lymphatic metastasis in pN(2) non-small cell lung cancer. Chin J Cancer Res 2013; 24:340-5. [PMID: 23358439 DOI: 10.3978/j.issn.1000-9604.2012.10.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 10/08/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Although many clinical studies on skip lymphatic metastasis in non-small cell lung cancer have been reported, the risk factors for skip lymphatic metastasis are still controversy and debatable. This study investigated, by multivariate logistic regression analysis, the clinical features of skip metastasis to mediastinal lymph nodes (N(2)) in non-small cell lung cancer (NSCLC) patients. METHODS We collected the clinicopathological data of 256 pN(2)-NSCLC patients who underwent lobectomy plus systemic lymph node dissection in Fujian Medical University Union Hospital. The cases in the present study were divided into two groups: skip metastasis (N(2) skip+) and non- skip metastasis (N(2) skip-). A retrospective analysis of clinical pathological features of two groups was performed. To determine an independent factor, multivariate logistic regression analysis was used to identify possible risk factors. RESULTS A total of 256 pN(2)-NSCLC patients were recruited. The analysis results showed that gender, pathologic types, surgery, pleural involvement, smoking history, age, tumor stages, and differentiation were not statistical significant factors impacting on skip metastasis in pN(2)-NSCLC (P>0.05), whereas tumor size was an independent factor for skip metastasis (P=0.02). CONCLUSIONS The rate of skip lymphatic metastasis increases in pN(2)-NSCLC patients, in accompany with an increased tumor size.
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Affiliation(s)
- Gui-Long Li
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
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Liu J, Liu X, Cui F, Chen G, Guan Y, He J. The efficacy of the inhalation of an aerosolized Group A streptococcal preparation in the treatment of lung cancer. Chin J Cancer Res 2013; 24:346-52. [PMID: 23359778 DOI: 10.3978/j.issn.1000-9604.2012.10.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 10/09/2012] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To observe the efficacy of the inhalation of an aerosolized group A streptococcal (GAS) preparation in treating orthotopic lung cancer in mouse models and assess the feasibility, safety, and effectiveness of this administration mode for lung cancer. METHODS Lewis lung carcinoma (LLC) cell strains were administered via intrathoracic injection to establish orthotopic lung cancer mouse models. After the tumor-bearing models were successfully established, as confirmed by computed tomography, the mice were administered by inhalation with an aerosolized GAS preparation (GAS group) or aerosolized normal saline (control group). The anti-tumor effect of the aerosolized GAS preparation was evaluated histologically; meanwhile, the survival and quality of life were compared between these two groups. RESULTS The aerosolized GAS preparation showed remarkably anti-tumor effect, causing the necrosis of the orthotopic lung cancer cells in tumor-bearing mice. Furthermore, mice in the GAS group had significantly better quality of life and longer survival than those in control group. CONCLUSIONS The inhalation of aerosolized GAS preparation may be a feasible, safe and effective solution for lung cancer.
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Affiliation(s)
- Jun Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China
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Involvement of ZEB1 and E-cadherin in the invasion of lung squamous cell carcinoma. Mol Biol Rep 2012; 40:949-56. [PMID: 23065281 DOI: 10.1007/s11033-012-2136-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 10/03/2012] [Indexed: 01/08/2023]
Abstract
This study intended to investigate the expression of the ZEB1 and E-cadherin proteins in lung squamous cell carcinoma (LSCC) tissues and to examine the clinicopathological correlation between protein levels and LSCC. RT-PCR and Western blot were used to examine the expression of ZEB1 and E-cadherin mRNAs and proteins in LSCC tissues as well as in adjacent normal tissues, and then analyze the relationship between the clinicopathological characteristics and the expression changes of ZEB1 and E-cadherin mRNAs in LSCC. In addition, RNAi was used to knockdown the expression of the ZEB1 gene in Human HCC827 cells; subsequently, changes in the invasive ability of the resultant cells were studied. The positive rates of ZEB1 and E-cadherin mRNAs in LSCC tissues were 69.2 and 38.5 %, respectively. They differed significantly from the corresponding positive rates in the adjacent normal lung tissues (15.4 and 80.8 %, p < 0.05). There was a negative correlation between the protein levels of ZEB1 and E-cadherin in LSCC tissues (r = -0.714, p < 0.001); in addition, it was found that ZEB1 protein expression in LSCC tissues was significantly higher than that in the neighboring normal lung tissues (p < 0.05), and its expression was also significantly higher in patients with lymph node metastases and distant metastases compared to those patients without metastatic disease (p < 0.05). On the contrary, E-cadherin expression was significantly lower in LSCC tissues than that in the neighboring normal tissue (p < 0.05). It was lower in patients with lymph node metastasis and distant metastasis compared to patients without metastatic disease (p < 0.05). However, the expression of ZEB1 and E-cadherin was independent of gender, age, tumor size, or tumor differentiation level (p > 0.05). Transfection of ZEB1 siRNA into HCC827 cells significantly reduced the ZEB1 protein level (p < 0.01) and significantly elevated E-cadherin levels (p < 0.01). Moreover, significantly less ZEB1 siRNA-transfected cells migrated through Transwell chambers in the LSCC tissue than that in the control groups (untransfected or transfected with control siRNA, p < 0.01). The expression of the ZEB1 gene in LSCC tissues is downregulated with the expression of E-cadherin. On the other hand, the expression of siRNA against ZEB1 promotes E-cadherin expression and suppresses the invasive ability conferred by E-cadherin. In conclusion, our data suggested that overexpression of the ZEB1 gene is possibly associated with the occurrence, development, invasion of LSCC.
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PEBP4 enhanced HCC827 cell proliferation and invasion ability and inhibited apoptosis. Tumour Biol 2012; 34:91-8. [PMID: 22983920 DOI: 10.1007/s13277-012-0514-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 09/03/2012] [Indexed: 12/23/2022] Open
Abstract
The purposes of this study were to investigate the effects of phosphatidylethanolamine-binding protein 4 (PEBP4) on the cell growth, proliferation, apoptosis, and invasion of non-small cell lung cancer (NSCLC) cells and to provide evidence for future treatment options for NSCLC. Western blot assays were performed to examine PEBP4 protein expression levels in NSCLC cell lines (HCC827, A549, NCI-H661, NCI-H292, and 95-D) and a normal human bronchial epithelial (HBE) cell line. A PEBP4 shRNA expression vector was constructed and transfected into HCC827 cells. Subsequently, the effects of PEBP4 on the cell viability, cell cycle distribution, apoptosis levels, and invasion properties of HCC827 cells were analyzed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays, flow cytometry analyses, and transwell invasion assays. In addition, the effects of PEBP4 on the expression of proteins including cyclin D1, p53, Bcl-2, MMP-2, and MMP-9 were investigated. PEBP4 was highly expressed in lung cancer cells (HCC827, A549, NCI-H661, NCI-H292, and 95-D), but its expression was low in HBE cells. Cell viability, cell proliferation, and invasion of HCC827 cells in the PEBP4 knockdown group were significantly lower than that in the negative control and blank control groups (p < 0.05), and there were no significant differences between the negative and blank control groups in terms of cell viability, cell proliferation, apoptosis, and invasion. In HCC827 cells, the expression levels of cyclin D1, Bcl-2, MMP-2, and MMP-9 in the PEBP4 knockdown group were significantly lower (p < 0.05), and the expression of p53 protein was significantly higher than that in the negative and blank control groups (p < 0.05). There were no significant differences between the negative and blank control groups in the expression levels of cyclin D1, p53, Bcl-2, MMP-2, and MMP-9. In conclusion, PEBP4 enhanced HCC827 cell proliferation and invasion ability and inhibited apoptosis. Decreased PEBP4 expression may play a role in the reduced invasion ability and increased apoptosis of the human NSCLC cell line HCC827.
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