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de Groot PM, Jimenez CA, Godoy MCB, Wu CC. Pleural Effusions: Clues for Diagnosis and Characterization. Semin Roentgenol 2023; 58:431-439. [PMID: 37973272 DOI: 10.1053/j.ro.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Patricia M de Groot
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Myrna C B Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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de Groot PM, Arevalo O, Shah K, Strange CD, Shroff GS, Ahuja J, Truong MT, de Groot JF, Vlahos I. Imaging Primer on Chimeric Antigen Receptor T-Cell Therapy for Radiologists. Radiographics 2022; 42:176-194. [PMID: 34990326 DOI: 10.1148/rg.210065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy is a recently approved breakthrough treatment that has become a new paradigm in treatment of recurrent or refractory B-cell lymphomas and pediatric or adult acute lymphoid leukemia. CAR T cells are a type of cellular immunotherapy that artificially enhances T cells to boost eradication of malignancy through activation of the native immune system. The CAR construct is a synthetically created functional cell receptor grafted onto previously harvested patient T cells, which bind to preselected tumor-associated antigens and thereby activate host immune signaling cascades to attack tumor cells. Advantages include a single treatment episode of 2-3 weeks and durable disease elimination, with remission rates of over 80%. Responses to therapy are more rapid than with conventional chemotherapy or immunotherapy, with intervening short-interval edema. CAR T-cell administration is associated with therapy-related toxic effects in a large percentage of patients, notably cytokine release syndrome, immune effect cell-associated neurotoxicity syndrome, and infections related to immunosuppression. Knowledge of the expected evolution of therapy response and potential adverse events in CAR T-cell therapy and correlation with the timeline of treatment are important to optimize patient care. Some toxic effects are radiologically evident, and familiarity with their imaging spectrum is key to avoiding misinterpretation. Other clinical toxic effects may be occult at imaging and are diagnosed on the basis of clinical assessment. Future directions for CAR T-cell therapy include new indications and expanded tumor targets, along with novel ways to capture T-cell activation with imaging. An invited commentary by Ramaiya and Smith is available online. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Patricia M de Groot
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Octavio Arevalo
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Komal Shah
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Chad D Strange
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Girish S Shroff
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Jitesh Ahuja
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Mylene T Truong
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - John F de Groot
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Ioannis Vlahos
- From the Departments of Thoracic Imaging (P.M.d.G., C.D.S., G.S.S., J.A., M.T.T., I.V.), Neuroradiology (O.A., K.S.), and Neuro-oncology (J.F.d.G.), University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
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Theelen WSME, Chen D, Verma V, Hobbs BP, Peulen HMU, Aerts JGJV, Bahce I, Niemeijer ALN, Chang JY, de Groot PM, Nguyen QN, Comeaux NI, Simon GR, Skoulidis F, Lin SH, He K, Patel R, Heymach J, Baas P, Welsh JW. Pembrolizumab with or without radiotherapy for metastatic non-small-cell lung cancer: a pooled analysis of two randomised trials. Lancet Respir Med 2020; 9:467-475. [PMID: 33096027 DOI: 10.1016/s2213-2600(20)30391-x] [Citation(s) in RCA: 226] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/21/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Radiotherapy might augment systemic antitumoral responses to immunotherapy. In the PEMBRO-RT (phase 2) and MDACC (phase 1/2) trials, patients with metastatic non-small-cell lung cancer were randomly allocated immunotherapy (pembrolizumab) with or without radiotherapy. When the trials were analysed individually, a potential benefit was noted in the combination treatment arm. However, owing to the small sample size of each trial, differences in response rates and outcomes were not statistically significant but remained clinically notable. We therefore did a pooled analysis to infer whether radiotherapy improves responses to immunotherapy in patients with metastatic non-small-cell lung cancer. METHODS Inclusion criteria for the PEMBRO-RT and MDACC trials were patients (aged ≥18 years) with metastatic non-small-cell lung cancer and at least one unirradiated lesion to monitor for out-of-field response. In the PEMBRO-RT trial, patients had previously received chemotherapy, whereas in the MDACC trial, patients could be either previously treated or newly diagnosed. Patients in both trials were immunotherapy-naive. In the PEMBRO-RT trial, patients were randomly assigned (1:1) and stratified by smoking status (<10 vs ≥10 pack-years). In the MDACC trial, patients were entered into one of two cohorts based on radiotherapy schedule feasibility and randomly assigned (1:1). Because of the nature of the intervention in the combination treatment arm, blinding to radiotherapy was not feasible in either trial. Pembrolizumab was administered intravenously (200 mg every 3 weeks) with or without radiotherapy in both trials. In the PEMBRO-RT trial, the first dose of pembrolizumab was given sequentially less than 1 week after the last dose of radiotherapy (24 Gy in three fractions), whereas in the MDACC trial, pembrolizumab was given concurrently with the first dose of radiotherapy (50 Gy in four fractions or 45 Gy in 15 fractions). Only unirradiated lesions were measured for response. The endpoints for this pooled analysis were best out-of-field (abscopal) response rate (ARR), best abscopal disease control rate (ACR), ARR at 12 weeks, ACR at 12 weeks, progression-free survival, and overall survival. The intention-to-treat populations from both trials were included in analyses. The PEMBRO-RT trial (NCT02492568) and the MDACC trial (NCT02444741) are registered with ClinicalTrials.gov. FINDINGS Overall, 148 patients were included in the pooled analysis, 76 of whom had been assigned pembrolizumab and 72 who had been assigned pembrolizumab plus radiotherapy. Median follow-up for all patients was 33 months (IQR 32·4-33·6). 124 (84%) of 148 patients had non-squamous histological features and 111 (75%) had previously received chemotherapy. Baseline variables did not differ between treatment groups, including PD-L1 status and metastatic disease volume. The most frequently irradiated sites were lung metastases (28 of 72 [39%]), intrathoracic lymph nodes (15 of 72 [21%]), and lung primary disease (12 of 72 [17%]). Best ARR was 19·7% (15 of 76) with pembrolizumab versus 41·7% (30 of 72) with pembrolizumab plus radiotherapy (odds ratio [OR] 2·96, 95% CI 1·42-6·20; p=0·0039), and best ACR was 43·4% (33 of 76) with pembrolizumab versus 65·3% (47 of 72) with pembrolizumab plus radiotherapy (2·51, 1·28-4·91; p=0·0071). Median progression-free survival was 4·4 months (IQR 2·9-5·9) with pembrolizumab alone versus 9·0 months (6·8-11·2) with pembrolizumab plus radiotherapy (hazard ratio [HR] 0·67, 95% CI 0·45-0·99; p=0·045), and median overall survival was 8·7 months (6·4-11·0) with pembrolizumab versus 19·2 months (14·6-23·8) with pembrolizumab plus radiotherapy (0·67, 0·54-0·84; p=0·0004). No new safety concerns were noted in the pooled analysis. INTERPRETATION Adding radiotherapy to pembrolizumab immunotherapy significantly increased responses and outcomes in patients with metastatic non-small-cell lung cancer. These results warrant validation in a randomised phase 3 trial. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
| | - Dawei Chen
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
| | - Vivek Verma
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Brian P Hobbs
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Heike M U Peulen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Idris Bahce
- Department of Pulmonology, VU Medical Center, Amsterdam, Netherlands
| | | | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Patricia M de Groot
- Department of Diagnostic Radiology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Nathan I Comeaux
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - George R Simon
- Department of Thoracic/Head & Neck Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Ferdinandos Skoulidis
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Kewen He
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Roshal Patel
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - John Heymach
- Department of Thoracic/Head & Neck Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
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de Groot PM, Chung JH, Ackman JB, Berry MF, Carter BW, Colletti PM, Hobbs SB, McComb BL, Movsas B, Tong BC, Walker CM, Yom SS, Kanne JP. ACR Appropriateness Criteria ® Noninvasive Clinical Staging of Primary Lung Cancer. J Am Coll Radiol 2020; 16:S184-S195. [PMID: 31054745 DOI: 10.1016/j.jacr.2019.02.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in both men and women. The major risk factor for lung cancer is personal tobacco smoking, particularly for small-cell lung cancer (SCLC) and squamous cell lung cancers, but other significant risk factors include exposure to secondhand smoke, environmental radon, occupational exposures, and air pollution. Education and socioeconomic status affect both incidence and outcomes. Non-small-cell lung cancer (NSCLC), including adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, comprises about 85% of lung cancers. SCLC accounts for approximately 13% to 15% of cases. Prognosis is directly related to stage at presentation. NSCLC is staged using the eighth edition of the tumor-node-metastasis (TNM) criteria of the American Joint Committee on Cancer. For SCLC the eighth edition of TNM staging is recommended to be used in conjunction with the modified Veterans Administration Lung Study Group classification system distinguishing limited stage from extensive stage SCLC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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5
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Cox CW, Chung JH, Ackman JB, Berry MF, Carter BW, de Groot PM, Hobbs SB, Johnson GB, Maldonado F, McComb BL, Tong BC, Walker CM, Kanne JP. ACR Appropriateness Criteria® Occupational Lung Diseases. J Am Coll Radiol 2020; 17:S188-S197. [PMID: 32370962 DOI: 10.1016/j.jacr.2020.01.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
Ordering the appropriate diagnostic imaging for occupational lung disease requires a firm understanding of the relationship between occupational exposure and expected lower respiratory track manifestation. Where particular inorganic dust exposures typically lead to nodular and interstitial lung disease, other occupational exposures may lead to isolated small airway obstruction. Certain workplace exposures, like asbestos, increase the risk of malignancy, but also produce pulmonary findings that mimic malignancy. This publication aims to delineate the common and special considerations associated with occupational lung disease to assist the ordering physician in selecting the most appropriate imaging study, while still stressing the importance of a multidisciplinary approach. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California; The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; The Society of Thoracic Surgeons
| | | | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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6
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Lee C, Colletti PM, Chung JH, Ackman JB, Berry MF, Carter BW, de Groot PM, Hobbs SB, Johnson GB, Maldonado F, McComb BL, Tong BC, Walker CM, Kanne JP. ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients. J Am Coll Radiol 2019; 16:S331-S339. [PMID: 31685101 DOI: 10.1016/j.jacr.2019.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 02/08/2023]
Abstract
The immunocompromised patient with an acute respiratory illness (ARI) may present with fever, chills, weight loss, cough, shortness of breath, or chest pain. The number of immunocompromised patients continues to rise with medical advances including solid organ and stem cell transplantation, chemotherapy, and immunomodulatory therapy, along with the continued presence of human immunodeficiency virus and acquired immunodeficiency syndrome. Given the myriad of pathogens that can infect immunocompromised individuals, identifying the specific organism or organisms causing the lung disease can be elusive. Moreover, immunocompromised patients often receive prophylactic or empiric antimicrobial therapy, further complicating diagnostic evaluation. Noninfectious causes for ARI should also be considered, including pulmonary edema, drug-induced lung disease, atelectasis, malignancy, radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, and pulmonary thromboembolic disease. As many immunocompromised patients with ARI progress along a rapid and potentially fatal course, timely selection of appropriate imaging is of great importance in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking, or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Christopher Lee
- Research Author, University of Southern California Keck School of Medicine, Los Angeles, California
| | | | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark F Berry
- Stanford University Medical Center, Stanford, California, The Society of Thoracic Surgeons
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee, American College of Chest Physicians
| | | | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina, The Society of Thoracic Surgeons
| | | | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Jokerst C, Chung JH, Ackman JB, Carter B, Colletti PM, Crabtree TD, de Groot PM, Iannettoni MD, Maldonado F, McComb BL, Steiner RM, Kanne JP. ACR Appropriateness Criteria ® Acute Respiratory Illness in Immunocompetent Patients. J Am Coll Radiol 2019; 15:S240-S251. [PMID: 30392593 DOI: 10.1016/j.jacr.2018.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
Acute respiratory illness, defined as cough, sputum production, chest pain, and/or dyspnea (with or without fever), is a major public health issue, accounting for millions of doctor office and emergency department visits every year. While most cases are due to self-limited viral infections, a significant number of cases are due to more serious respiratory infections where delay in diagnosis can lead to morbidity and mortality. Imaging plays a key role in the initial diagnosis and management of acute respiratory illness. This study reviews the current literature concerning the appropriate role of imaging in the diagnosis and management of the immunocompetent adult patient initially presenting with acute respiratory illness. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brett Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Traves D Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; The Society of Thoracic Surgeons
| | | | - Mark D Iannettoni
- University of Iowa, Iowa City, Iowa; The Society of Thoracic Surgeons
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Robert M Steiner
- Columbia University Medical Center New York and Temple University Health System, Philadelphia, Pennsylvania
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Carter BW, Lichtenberger JP, Benveniste MK, de Groot PM, Wu CC, Erasmus JJ, Truong MT. Revisions to the TNM Staging of Lung Cancer: Rationale, Significance, and Clinical Application. Radiographics 2018. [PMID: 29528831 DOI: 10.1148/rg.2018170081] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the leading cause of cancer-related mortality worldwide. To formulate effective treatment strategies and optimize patient outcomes, accurate staging is essential. Lung cancer staging has traditionally relied on a TNM staging system, for which the International Association for the Study of Lung Cancer (IASLC) has recently proposed changes. The revised classification for this eighth edition of the TNM staging system (TNM-8) is based on detailed analysis of a new large international database of lung cancer cases assembled by the IASLC for the purposes of this project. Fundamental changes incorporated into TNM-8 include (a) modifications to the T classification on the basis of 1-cm increments in tumor size; (b) grouping of lung cancers that result in partial or complete lung atelectasis or pneumonitis; (c) grouping of tumors with involvement of a main bronchus irrespective of distance from the carina; (d) reassignment of diaphragmatic invasion in terms of T classification; (e) elimination of mediastinal pleural invasion from the T classification; and (f) subdivision of the M classification into different descriptors on the basis of the number and site of extrathoracic metastases. In response to these revisions, established stage groups have been modified, and others have been created. In addition, recommendations for classifying patterns of disease that result in multiple sites of pulmonary involvement, including multiple primary lung cancers, lung cancers with separate tumor nodules, multiple ground-glass/lepidic lesions, and consolidation, as well as recommendations for lesion measurement, are addressed. Understanding the key revisions introduced in TNM-8 allows radiologists to accurately stage patients with lung cancer and optimize therapy. ©RSNA, 2018.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - John P Lichtenberger
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Marcelo K Benveniste
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Carol C Wu
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Jeremy J Erasmus
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
| | - Mylene T Truong
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.K.B., P.M.d.G., C.C.W., J.J.E., M.T.T.); and the Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.)
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de Groot PM, Shroff GS, Ahrar J, Sabloff BS, Gladish GM, Moran C, Gupta S, Gladish GW, Chang JY, Erasmus JJ. Implications for high-precision dose radiation therapy planning or limited surgical resection after percutaneous computed tomography-guided lung nodule biopsy using a tract sealant. Adv Radiat Oncol 2018; 3:139-145. [PMID: 29904738 PMCID: PMC6000068 DOI: 10.1016/j.adro.2017.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose Precision radiation therapy such as stereotactic body radiation therapy and limited resection are being used more frequently to treat intrathoracic malignancies. Effective local control requires precise radiation target delineation or complete resection. Lung biopsy tracts (LBT) on computed tomography (CT) scans after the use of tract sealants can mimic malignant tract seeding (MTS) and it is unclear whether these LBTs should be included in the calculated tumor volume or resected. This study evaluates the incidence, appearance, evolution, and malignant seeding of LBTs. Methods and materials A total of 406 lung biopsies were performed in oncology patients using a tract sealant over 19 months. Of these patients, 326 had follow-up CT scans and were included in the study group. Four thoracic radiologists retrospectively analyzed the imaging, and a pathologist examined 10 resected LBTs. Results A total of 234 of 326 biopsies (72%, including primary lung cancer [n = 98]; metastases [n = 81]; benign [n = 50]; and nondiagnostic [n = 5]) showed an LBT on CT. LBTs were identified on imaging 0 to 3 months after biopsy. LBTs were typically straight or serpiginous with a thickness of 2 to 5 mm. Most LBTs were unchanged (92%) or decreased (6.3%) over time. An increase in LBT thickness/nodularity that was suspicious for MTS occurred in 4 of 234 biopsies (1.7%). MTS only occurred after biopsy of metastases from extrathoracic malignancies, and none occurred in patients with lung cancer. Conclusions LBTs are common on CT after lung biopsy using a tract sealant. MTS is uncommon and only occurred in patients with extrathoracic malignancies. No MTS was found in patients with primary lung cancer. Accordingly, potential alteration in planned therapy should be considered only in patients with LBTs and extrathoracic malignancies being considered for stereotactic body radiation therapy or wedge resection.
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Affiliation(s)
- Patricia M. de Groot
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Corresponding author. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030.
| | - Girish S. Shroff
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Judy Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bradley S. Sabloff
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Garret M. Gladish
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cesar Moran
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory W. Gladish
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y. Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeremy J. Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract
The incidence and mortality from lung cancer is decreasing in the US due to decades of public education and tobacco control policies, but are increasing elsewhere in the world related to the commencement of the tobacco epidemic in various countries and populations in the developing world. Individual cigarette smoking is by far the most common risk factor for lung carcinoma; other risks include passive smoke inhalation, residential radon, occupational exposures, infection and genetic susceptibility. The predominant disease burden currently falls on minority populations and socioeconomically disadvantaged people. In the US, the recent legalization of marijuana for recreational use in many states and the rapid growth of commercially available electronic nicotine delivery systems (ENDS) present challenges to public health for which little short term and no long term safety data is available.
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Affiliation(s)
- Patricia M de Groot
- Department of Diagnostic Radiology at The UT MD Anderson Cancer Center, Houston, TX, USA
| | - Carol C Wu
- Department of Diagnostic Radiology at The UT MD Anderson Cancer Center, Houston, TX, USA
| | - Brett W Carter
- Department of Diagnostic Radiology at The UT MD Anderson Cancer Center, Houston, TX, USA
| | - Reginald F Munden
- Department of Radiology, Wake Forest Baptist Hospital, Winston-Salem, NC, USA
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Shroff GS, Benveniste MF, de Groot PM, Carter BW, Wu CC, Viswanathan C, Truong MT. Imaging on Lung Cancer and Treatment with Targeted Therapy. Semin Ultrasound CT MR 2018; 39:308-313. [PMID: 29807641 DOI: 10.1053/j.sult.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The identification of genetic mutations known as oncogenic driver mutations that lead to the growth and survival of cancer cells has been an important advance in the field of oncology. Treatment in advanced non-small-cell lung cancer (NSCLC) has transitioned from a more general approach to a more personalized approach based on genetic mutations of the cancer itself. Common mutations detected in patients with advanced NSCLC include mutations of epidermal growth factor receptor and anaplastic lymphoma kinase (ALK). Targeted therapies are aimed at the products of these gene mutations and include erlotinib (used in epidermal growth factor receptor mutant NSCLC) and crizotinib (used in anaplastic lymphoma kinase positive NSCLC). In this review, we discuss common genetic mutations in advanced NSCLC, the role of targeted therapies, and imaging findings that can be associated with various genetic mutations.
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Affiliation(s)
- Girish S Shroff
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX.
| | - Marcelo F Benveniste
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Patricia M de Groot
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Brett W Carter
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Chitra Viswanathan
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, Houston, TX
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Shroff GS, de Groot PM, Papadimitrakopoulou VA, Truong MT, Carter BW. Targeted Therapy and Immunotherapy in the Treatment of Non-Small Cell Lung Cancer. Radiol Clin North Am 2018; 56:485-495. [PMID: 29622080 DOI: 10.1016/j.rcl.2018.01.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The treatment strategy in advanced non-small cell lung cancer (NSCLC) has evolved from empirical chemotherapy to a personalized approach based on histology and molecular markers of primary tumors. Targeted therapies are directed at the products of oncogenic driver mutations. Immunotherapy facilitates the recognition of cancer as foreign by the host immune system, stimulates the immune system, and alleviates the inhibition that allows the growth and spread of cancer cells. The authors describes the role of targeted therapy and immunotherapy in the treatment of NSCLC, patterns of disease present on imaging studies, and immune-related adverse events encountered with immunotherapy.
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Affiliation(s)
- Girish S Shroff
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Patricia M de Groot
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Vassiliki A Papadimitrakopoulou
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mylene T Truong
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Godoy MCB, Odisio EGLC, Truong MT, de Groot PM, Shroff GS, Erasmus JJ. Pulmonary Nodule Management in Lung Cancer Screening: A Pictorial Review of Lung-RADS Version 1.0. Radiol Clin North Am 2018; 56:353-363. [PMID: 29622071 DOI: 10.1016/j.rcl.2018.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The number of screening-detected lung nodules is expected to increase as low-dose computed tomography screening is implemented nationally. Standardized guidelines for image acquisition, interpretation, and screen-detected nodule workup are essential to ensure a high standard of medical care and that lung cancer screening is implemented safely and cost effectively. In this article, we review the current guidelines for pulmonary nodule management in the lung cancer screening setting.
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Affiliation(s)
- Myrna C B Godoy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA.
| | - Erika G L C Odisio
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Mylene T Truong
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Patricia M de Groot
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Girish S Shroff
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
| | - Jeremy J Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 371, Houston, TX 77030, USA
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Ravenel JG, Chung JH, Ackman JB, de Groot PM, Johnson GB, Jokerst C, Maldonado F, McComb BL, Steiner RM, Mohammed TL. ACR Appropriateness Criteria ® Imaging of Possible Tuberculosis. J Am Coll Radiol 2018; 14:S160-S165. [PMID: 28473072 DOI: 10.1016/j.jacr.2017.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/17/2022]
Abstract
Pulmonary tuberculosis remains a major cause of disease worldwide and an important public health hazard in the United States. The imaging evaluation depends to a large degree on clinical symptoms and whether active disease is suspected or a subject is at high risk for developing active disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - James G Ravenel
- Principal Author and Panel Chair, Medical University of South Carolina, Charleston, South Carolina.
| | | | - Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Robert M Steiner
- Columbia University Medical Center New York and Temple University Health System, Philadelphia, Pennsylvania
| | - Tan-Lucien Mohammed
- Specialty Chair, University of Florida College of Medicine, Gainesville, Florida
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16
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Abstract
The chest radiograph is one of the most commonly used imaging studies and is the modality of choice for initial evaluation of many common clinical scenarios. Over the last two decades, chest computed tomography has been increasingly used for a wide variety of indications, including respiratory illnesses, trauma, oncologic staging, and more recently lung cancer screening. Diagnostic radiologists should be familiar with the common causes of missed lung cancers on imaging studies in order to avoid detection and interpretation errors. Failure to detect these lesions can potentially have serious implications for both patients as well as the interpreting radiologist.
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Affiliation(s)
- Rydhwana Hossain
- Thoracic Imaging and Interventions, Massachusetts General Hospital, 55 Fruit Street FND 202, Boston, MA 02114, USA
| | - Carol C Wu
- Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Patricia M de Groot
- Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Brett W Carter
- Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Matthew D Gilman
- Thoracic Imaging and Interventions, Massachusetts General Hospital, 55 Fruit Street FND 202, Boston, MA 02114, USA
| | - Gerald F Abbott
- Thoracic Imaging and Interventions, Massachusetts General Hospital, 55 Fruit Street FND 202, Boston, MA 02114, USA.
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Shroff GS, Benveniste MF, Carter BW, de Groot PM, Wu CC, Viswanathan C, Sabloff BS, Truong MT. Imaging of Metastases in the Chest: Mechanisms of Spread and Potential Pitfalls. Semin Ultrasound CT MR 2017; 38:594-603. [DOI: 10.1053/j.sult.2017.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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18
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Carter BW, Benveniste MF, Madan R, Godoy MC, Groot PMD, Truong MT, Rosado-de-Christenson ML, Marom EM. IASLC/ITMIG Staging System and Lymph Node Map for Thymic Epithelial Neoplasms. Radiographics 2017; 37:758-776. [PMID: 28493800 DOI: 10.1148/rg.2017160096] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thymic epithelial neoplasms are rare malignancies that arise from the thymus and include thymoma, thymic carcinoma, and thymic neuroendocrine tumors. At least 15 different stage classifications have been proposed for thymic epithelial neoplasms and used to varying degrees in clinical practice, many of which have been constructed from small groups of patients. Traditionally, the Masaoka and Masaoka-Koga staging systems have been the schemes most commonly employed, and the latter has been recommended for use by the International Thymic Malignancy Interest Group (ITMIG). An official, consistent stage classification system has recently been recognized by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC), which are responsible for defining stage classifications for neoplasms. To establish this stage classification system, the International Association for the Study of Lung Cancer (IASLC) and ITMIG amassed a large retrospective database and evaluated this group of cases to develop proposals for the eighth edition of the stage classification manuals. For this endeavor, IASLC provided funding and statistical analysis and ITMIG provided the involvement of the clinicians and researchers actively participating in the study of thymic epithelial neoplasms. To accomplish this, a Thymic Domain of the Staging and Prognostic Factors Committee (TD-SPFC) was established to formulate the rationale, methodology, and definitions of this tumor-node-metastasis (TNM) staging system, which is presented in this article. © RSNA, 2017.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Rachna Madan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Myrna C Godoy
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Mylene T Truong
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
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Carter BW, Benveniste MF, Madan R, Godoy MC, de Groot PM, Truong MT, Rosado-de-Christenson ML, Marom EM. ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses. Radiographics 2017; 37:413-436. [PMID: 28129068 DOI: 10.1148/rg.2017160095] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Division of the mediastinum into specific compartments is beneficial for a number of reasons, including generation of a focused differential diagnosis for mediastinal masses identified on imaging examinations, assistance in planning for biopsies and surgical procedures, and facilitation of communication between clinicians in a multidisciplinary setting. Several classification schemes for the mediastinum have been created and used to varying degrees in clinical practice. Most radiology classifications have been based on arbitrary landmarks outlined on the lateral chest radiograph. A new scheme based on cross-sectional imaging, principally multidetector computed tomography (CT), has been developed by the International Thymic Malignancy Interest Group (ITMIG) and accepted as a new standard. This clinical division scheme defines unique prevascular, visceral, and paravertebral compartments based on boundaries delineated by specific anatomic structures at multidetector CT. This new definition plays an important role in identification and characterization of mediastinal abnormalities, which, although uncommon and encompassing a wide variety of entities, can often be diagnosed with confidence based on location and imaging features alone. In other scenarios, a diagnosis may be suggested when radiologic features are combined with specific clinical information. In this article, the authors present the new multidetector CT-based classification of mediastinal compartments introduced by ITMIG and a structured approach to imaging evaluation of mediastinal abnormalities. ©RSNA, 2017.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Rachna Madan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Myrna C Godoy
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Mylene T Truong
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
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20
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Carter BW, Benveniste MF, Betancourt SL, de Groot PM, Lichtenberger JP, Amini B, Abbott GF. Imaging Evaluation of Malignant Chest Wall Neoplasms. Radiographics 2016; 36:1285-306. [PMID: 27494286 DOI: 10.1148/rg.2016150208] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Neoplasms of the chest wall are uncommon lesions that represent approximately 5% of all thoracic malignancies. These tumors comprise a heterogeneous group of neoplasms that may arise from osseous structures or soft tissues, and they may be malignant or benign. More than 50% of chest wall neoplasms are malignancies and include tumors that may arise as primary malignancies or secondarily involve the chest wall by way of direct invasion or metastasis from intrathoracic or extrathoracic neoplasms. Although 20% of chest wall tumors may be detected at chest radiography, chest wall malignancies are best evaluated with cross-sectional imaging, principally multidetector computed tomography (CT) and magnetic resonance (MR) imaging, each of which has distinct strengths and limitations. Multidetector CT is optimal for depicting bone, muscle, and vascular structures, whereas MR imaging renders superior soft-tissue contrast and spatial resolution and is better for delineating the full extent of disease. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is not routinely performed to evaluate chest wall malignancies. The primary functions of PET/CT in this setting include staging of disease, evaluation of treatment response, and detection of recurrent disease. Ultrasonography has a limited role in the evaluation and characterization of superficial chest wall lesions; however, it can be used to guide biopsy and has been shown to depict chest wall invasion by lung cancer more accurately than CT. It is important that radiologists be able to identify the key multidetector CT and MR imaging features that can be used to differentiate malignant from benign chest lesions, suggest specific histologic tumor types, and ultimately guide patient treatment. (©)RSNA, 2016.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Sonia L Betancourt
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - John P Lichtenberger
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Behrang Amini
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
| | - Gerald F Abbott
- From the Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., S.L.B., P.M.d.G., B.A.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (J.P.L.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (G.F.A.)
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Carter BW, de Groot PM, Godoy MC, Marom EM, Wu CC. Imaging of the Mediastinum: Vascular Lesions as a Potential Pitfall. Semin Roentgenol 2015; 50:241-50. [DOI: 10.1053/j.ro.2015.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rotman JA, Plodkowski AJ, Hayes SA, de Groot PM, Shepard JAO, Munden RF, Ginsberg MS. Postoperative complications after thoracic surgery for lung cancer. Clin Imaging 2015; 39:735-49. [PMID: 26117564 DOI: 10.1016/j.clinimag.2015.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Lung cancer is the leading cause of cancer-related deaths in the United States. Several surgical techniques are currently used as part of the standard of care for early-stage lung cancer. Differentiating normal postoperative changes from complications is essential in the management of these patients. This article will review the various surgical approaches used, ranging from wedge resection to pneumonectomy, and will outline their expected postsurgical changes. Early and late postsurgical complications will be described, some of which are unique to the type of surgery performed. In addition, local tumor recurrence is a form of postoperative complication and must be distinguished from typical postoperative or postradiation change. Knowledge of both common and uncommon postoperative complications is crucial in the follow-up of lung cancer patients. SUMMARY STATEMENT Familiarity with the appearance of postoperative complications in lung cancer patients is vital to distinguish it from the normal postoperative or postradiation appearance in follow-up imaging.
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Affiliation(s)
- Jessica A Rotman
- Department of Radiology, NY Presbyterian/Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Sara A Hayes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
| | - Patricia M de Groot
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030.
| | - Jo-Anne O Shepard
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114.
| | - Reginald F Munden
- Department of Radiology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030.
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065.
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Abstract
Primary lung cancer is the leading cause of cancer mortality in the world. Thorough clinical staging of patients with lung cancer is important, because therapeutic options and management are to a considerable degree dependent on stage at presentation. Radiologic imaging is an essential component of clinical staging, including chest radiography in some cases, computed tomography, MRI, and PET. Multiplanar imaging modalities allow assessment of features that are important for surgical, oncologic, and radiation therapy planning, including size of the primary tumor, location and relationship to normal anatomic structures in the thorax, and existence of nodal and/or metastatic disease.
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Affiliation(s)
- Patricia M de Groot
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA.
| | - Brett W Carter
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Sonia L Betancourt Cuellar
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Jeremy J Erasmus
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
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Affiliation(s)
- Patricia M de Groot
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gerald F Abbott
- Division of Thoracic Imaging and Interventions, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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de Groot PM, Carter BW, Godoy MCB, Munden RF. Lung cancer screening-why do it? Tobacco, the history of screening, and future challenges. Semin Roentgenol 2014; 50:72-81. [PMID: 25770337 DOI: 10.1053/j.ro.2014.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Patricia M de Groot
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston TX.
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Myrna C B Godoy
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston TX
| | - Reginald F Munden
- Department of Radiology, The Houston Methodist Hospital, Houston, TX
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Carter BW, Wu CC, Khorashadi L, Godoy MCB, de Groot PM, Abbott GF, Lichtenberger JP. Multimodality imaging of cardiothoracic lymphoma. Eur J Radiol 2014; 83:1470-82. [PMID: 24935137 DOI: 10.1016/j.ejrad.2014.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 04/02/2014] [Accepted: 05/09/2014] [Indexed: 01/15/2023]
Abstract
Lymphoma is the most common hematologic malignancy and represents approximately 5.3% of all cancers. The World Health Organization published a revised classification scheme in 2008 that groups lymphomas by cell type and molecular, cytogenetic, and phenotypic characteristics. Most lymphomas affect the thorax at some stage during the course of the disease. Affected structures within the chest may include the lungs, mediastinum, pleura, and chest wall, and lymphomas may originate from these sites as primary malignancies or secondarily involve these structures after arising from other intrathoracic or extrathoracic sources. Pulmonary lymphomas are classified into one of four types: primary pulmonary lymphoma, secondary pulmonary lymphoma, acquired immunodeficiency syndrome-related lymphoma, and post-transplantation lymphoproliferative disorders. Although pulmonary lymphomas may produce a myriad of diverse findings within the lungs, specific individual features or combinations of features can be used, in combination with secondary manifestations of the disease such as involvement of the mediastinum, pleura, and chest wall, to narrow the differential diagnosis. While findings of thoracic lymphoma may be evident on chest radiography, computed tomography has traditionally been the imaging modality used to evaluate the disease and effectively demonstrates the extent of intrathoracic involvement and the presence and extent of extrathoracic spread. However, additional modalities such as magnetic resonance imaging of the thorax and (18)F-FDG PET/CT have emerged in recent years and are complementary to CT in the evaluation of patients with lymphoma. Thoracic MRI is useful in assessing vascular, cardiac, and chest wall involvement, and PET/CT is more accurate in the overall staging of lymphoma than CT and can be used to evaluate treatment response.
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Affiliation(s)
- Brett W Carter
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA.
| | - Carol C Wu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114, USA
| | - Leila Khorashadi
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA 02138, USA
| | - Myrna C B Godoy
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA
| | - Patricia M de Groot
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Section of Thoracic Imaging, 1515 Holcombe Blvd., Unit 1478, Houston, TX 77030, USA
| | - Gerald F Abbott
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, FND-202, Boston, MA 02114, USA
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Mathieu KB, Ai H, Fox PS, Godoy MCB, Munden RF, de Groot PM, Pan T. Radiation dose reduction for CT lung cancer screening using ASIR and MBIR: a phantom study. J Appl Clin Med Phys 2014; 15:4515. [PMID: 24710436 PMCID: PMC5875473 DOI: 10.1120/jacmp.v15i2.4515] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 12/03/2013] [Accepted: 11/05/2013] [Indexed: 01/14/2023] Open
Abstract
The purpose of this study was to reduce the radiation dosage associated with computed tomography (CT) lung cancer screening while maintaining overall diagnostic image quality and definition of ground‐glass opacities (GGOs). A lung screening phantom and a multipurpose chest phantom were used to quantitatively assess the performance of two iterative image reconstruction algorithms (adaptive statistical iterative reconstruction (ASIR) and model‐based iterative reconstruction (MBIR)) used in conjunction with reduced tube currents relative to a standard clinical lung cancer screening protocol (51 effective mAs (3.9 mGy) and filtered back‐projection (FBP) reconstruction). To further assess the algorithms' performances, qualitative image analysis was conducted (in the form of a reader study) using the multipurpose chest phantom, which was implanted with GGOs of two densities. Our quantitative image analysis indicated that tube current, and thus radiation dose, could be reduced by 40% or 80% from ASIR or MBIR, respectively, compared with conventional FBP, while maintaining similar image noise magnitude and contrast‐to‐noise ratio. The qualitative portion of our study, which assessed reader preference, yielded similar results, indicating that dose could be reduced by 60% (to 20 effective mAs (1.6 mGy)) with either ASIR or MBIR, while maintaining GGO definition. Additionally, the readers' preferences (as indicated by their ratings) regarding overall image quality were equal or better (for a given dose) when using ASIR or MBIR, compared with FBP. In conclusion, combining ASIR or MBIR with reduced tube current may allow for lower doses while maintaining overall diagnostic image quality, as well as GGO definition, during CT lung cancer screening. PACS numbers: 87.57.Q‐, 87.57.nf
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Halabi RS, Miller KB, Grossman CE, de Groot PM, Brath LK. A Fatal Case of Pulmonary Kaposi Sarcoma-Associated Immune Reconstitution Syndrome in the Absence of Mucocutaneous Lesions. Chest 2010. [DOI: 10.1378/chest.10915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Affiliation(s)
| | | | | | - Jane P. Ko
- New York University Langone Medical Center
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