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Ruan X, Wu LS, Fan ZY, Liu Q, Yan J, Li XQ. Pathological diagnosis and immunohistochemical analysis of minute pulmonary meningothelial-like nodules: A case report. World J Clin Cases 2023; 11:8022-8029. [DOI: 10.12998/wjcc.v11.i33.8022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/10/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Minute Pulmonary Meningothelial-like Nodules (MPMNs) are rare benign pulmonary nodules, which are more common in elderly women and have a higher detection rate in lung tissues of patients with lung malignant diseases. Its origin is not yet clear. At present, there are few reports on the diagnostic methods such as imaging and pathological manifestations of MPMNs. This article reports a 70-year-old female patient with pulmonary adenocarcinoma combined with MPMNs and reviews of the relevant literature.
CASE SUMMARY A 70-year-old women was admitted to our institution with feeling sour in her back and occasional cough for more than 2 mo. Computerized electronic scanning scan and 3D reconstruction images in our institution showed there were multiple ground-glass nodules in both of her two lungs. The biggest one was in the apicoposterior segment of left upper lobe, about 2.5 mm × 9 mm in size. We performed thoracoscopic resection of the left upper lung apicoposterior segment of the patient, and the final pathological report was minimally invasive adenocarcinoma. Re-examination of high resolution computed tomography 21 mo after surgery showed multiple ground-glass nodules in both lungs, and a new ground-glass nodule was found in the superior segment of the right lower lobe. We took pathological biopsy of the right upper lung and right lower lung nodules for the patient under thoracoscopy. The histomorphology of the right lower lobe nodule showed multiple lesions in the lung tissue, and the small foci in the alveolar septum were distributed in mild form of the aggregation of short spindle cells. The immunohistochemistry showed that the lesion was epithelial membrane antigen (EMA) (+), somatostatin receptor 2a (SSTR2a) (+), S-100 (-), chromogranin A (-), Syn (-), cytokeratin (-) and HMB-45 (-). The final diagnosis was minimally invasive adenocarcinoma, accompanied by MPMNs. We recommend that patients continue to receive treatment after surgery and to do regular follow-up observations.
CONCLUSION The imaging manifestations of MPMNs are atypical, histomorphology and immunohistochemistry can assist in its diagnosis. This article reviews the relevant literature of MPMNs immunohistochemistry and shows that MPMNs are positive for EMA, SSTR2a, and progesterone receptor.
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Affiliation(s)
- Xin Ruan
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
- School of Medicine, Shantou University, Shantou 515041, Guangdong Province, China
| | - Liu-Sheng Wu
- School of Medicine, Tsinghua University, Beijing 100084, China
| | - Zheng-Yang Fan
- Department of Graduate School, Xinjiang Medical University, Urumchi 830011, Xinjiang Uygur Autonomous Region, China
| | - Qi Liu
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Jun Yan
- School of Medicine, Tsinghua University, Beijing 100084, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
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Hendrix W, Rutten M, Hendrix N, van Ginneken B, Schaefer-Prokop C, Scholten ET, Prokop M, Jacobs C. Trends in the incidence of pulmonary nodules in chest computed tomography: 10-year results from two Dutch hospitals. Eur Radiol 2023; 33:8279-8288. [PMID: 37338552 PMCID: PMC10598118 DOI: 10.1007/s00330-023-09826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To study trends in the incidence of reported pulmonary nodules and stage I lung cancer in chest CT. METHODS We analyzed the trends in the incidence of detected pulmonary nodules and stage I lung cancer in chest CT scans in the period between 2008 and 2019. Imaging metadata and radiology reports from all chest CT studies were collected from two large Dutch hospitals. A natural language processing algorithm was developed to identify studies with any reported pulmonary nodule. RESULTS Between 2008 and 2019, a total of 74,803 patients underwent 166,688 chest CT examinations at both hospitals combined. During this period, the annual number of chest CT scans increased from 9955 scans in 6845 patients in 2008 to 20,476 scans in 13,286 patients in 2019. The proportion of patients in whom nodules (old or new) were reported increased from 38% (2595/6845) in 2008 to 50% (6654/13,286) in 2019. The proportion of patients in whom significant new nodules (≥ 5 mm) were reported increased from 9% (608/6954) in 2010 to 17% (1660/9883) in 2017. The number of patients with new nodules and corresponding stage I lung cancer diagnosis tripled and their proportion doubled, from 0.4% (26/6954) in 2010 to 0.8% (78/9883) in 2017. CONCLUSION The identification of incidental pulmonary nodules in chest CT has steadily increased over the past decade and has been accompanied by more stage I lung cancer diagnoses. CLINICAL RELEVANCE STATEMENT These findings stress the importance of identifying and efficiently managing incidental pulmonary nodules in routine clinical practice. KEY POINTS • The number of patients who underwent chest CT examinations substantially increased over the past decade, as did the number of patients in whom pulmonary nodules were identified. • The increased use of chest CT and more frequently identified pulmonary nodules were associated with more stage I lung cancer diagnoses.
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Affiliation(s)
- Ward Hendrix
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands.
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
| | - Matthieu Rutten
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Nils Hendrix
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, the Netherlands
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Cornelia Schaefer-Prokop
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
- Radiology Department, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Ernst T Scholten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
- Radiology Department, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
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Bartholomeus GA, van Amsterdam WAC, Harder AMD, Willemink MJ, van Hamersvelt RW, de Jong PA, Leiner T. Robustness of pulmonary nodule radiomic features on computed tomography as a function of varying radiation dose levels-a multi-dose in vivo patient study. Eur Radiol 2023; 33:7044-7055. [PMID: 37074424 PMCID: PMC10511375 DOI: 10.1007/s00330-023-09643-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/12/2022] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE Analysis of textural features of pulmonary nodules in chest CT, also known as radiomics, has several potential clinical applications, such as diagnosis, prognostication, and treatment response monitoring. For clinical use, it is essential that these features provide robust measurements. Studies with phantoms and simulated lower dose levels have demonstrated that radiomic features can vary with different radiation dose levels. This study presents an in vivo stability analysis of radiomic features for pulmonary nodules against varying radiation dose levels. METHODS Nineteen patients with a total of thirty-five pulmonary nodules underwent four chest CT scans at different radiation dose levels (60, 33, 24, and 15 mAs) in a single session. The nodules were manually delineated. To assess the robustness of features, we calculated the intra-class correlation coefficient (ICC). To visualize the effect of milliampere-second variation on groups of features, a linear model was fitted to each feature. We calculated bias and calculated the R2 value as a measure of goodness of fit. RESULTS A small minority of 15/100 (15%) radiomic features were considered stable (ICC > 0.9). Bias increased and R2 decreased at lower dose, but shape features seemed to be more robust to milliampere-second variations than other feature classes. CONCLUSION A large majority of pulmonary nodule radiomic features were not inherently robust to radiation dose level variations. For a subset of features, it was possible to correct this variability by a simple linear model. However, the correction became increasingly less accurate at lower radiation dose levels. CLINICAL RELEVANCE STATEMENT Radiomic features provide a quantitative description of a tumor based on medical imaging such as computed tomography (CT). These features are potentially useful in several clinical tasks such as diagnosis, prognosis prediction, treatment effect monitoring, and treatment effect estimation. KEY POINTS • The vast majority of commonly used radiomic features are strongly influenced by variations in radiation dose level. • A small minority of radiomic features, notably the shape feature class, are robust against dose-level variations according to ICC calculations. • A large subset of radiomic features can be corrected by a linear model taking into account only the radiation dose level.
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Affiliation(s)
| | | | | | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Pim A de Jong
- University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tim Leiner
- University Medical Center Utrecht, Utrecht, the Netherlands
- Mayo Clinic, Rochester, MN, USA
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Zhong H, Yao F, Chen QH, Guo JD, Zhang LC, Zhang Y, Han BH. [Clinical diagnosis and treatment of multiple pulmonary nodules]. Zhonghua Zhong Liu Za Zhi 2023; 45:455-463. [PMID: 37355463 DOI: 10.3760/cma.j.cn112152-20220606-00390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
CT screening has markedly reduced the lung cancer mortality in high-risk population and increased the detection of early-stage pulmonary neoplasms, including multiple pulmonary nodules, especially those with a ground-glass appearance on CT. Multiple primary lung cancer (MPLC) constitutes a specific subtype of lung cancer with indolent biological behaviors, which is predominantly early-stage adenocarcinoma. Although MPLC progresses slowly with rare lymphatic metastasis, existence of synchronous lesions and distributed location of these nodules still pose difficulty for the management of such patients. One single operation is usually insufficient to eradicate all neoplastic lesions, whereas repeated surgical procedures bring about another dilemma: whether clinical benefits of surgical treatment outweigh loss of pulmonary function following multiple operations. Therefore, despite the anxiety for treatment among MPLC patients, whether and how to treat the patient should be assessed meticulously. Currently there is a heated discussion upon the timing of clinical intervention, operation mode and the application of local therapy in MPLC. Based on clinical experience of our multiple disciplinary team, we have summarized and commented on the evaluation, surgical treatment, non-surgical local treatment, targeted therapy and immunotherapy of MPLC in this article to provide further insight into this field.
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Affiliation(s)
- H Zhong
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - F Yao
- Department of Thoracic Surgery Department, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Q H Chen
- Department of Radiotherapy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - J D Guo
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - L C Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Y Zhang
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - B H Han
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
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Hatano H, Tsujimoto Y, Watanabe H, Tsukada A, Izumi S, Nagasaka S, Igari T, Suzuki M, Iikura M, Hojo M. A case of idiopathic multicentric Castleman disease with pulmonary hyalinizing granuloma-like multiple pulmonary nodules. Respir Investig 2023; 61:405-408. [PMID: 37099891 DOI: 10.1016/j.resinv.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023]
Abstract
A 41-year-old man presented with chronic cough and chest pain. Laboratory tests revealed anemia, inflammation, hypoalbuminemia, polyclonal hypergammaglobulinemia, and elevated interleukin-6 levels. Computed tomography revealed diffuse bilateral pulmonary nodules and multicentric lymphadenopathy. Histopathology of the pulmonary nodule resembled pulmonary hyalinizing granuloma (PHG), whereas lymph node histopathology was consistent with idiopathic multicentric Castleman disease (iMCD). The patient was diagnosed with iMCD involving PHG-like pulmonary nodules. Little is known about the association between these two diseases, and the present case provides insights regarding the relationship between PHG and iMCD.
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Affiliation(s)
- Hiroto Hatano
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Yoshie Tsujimoto
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Hiromu Watanabe
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Akinari Tsukada
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Toru Igari
- Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Tambuzzi S, Gentile G, Boracchi M, Marasciuolo L, Zoja R. Post-Mortem Diagnosis of a Rare Case of Massive Nodular Pulmonary Amyloidosis in a Forensic Setting. Acad Forensic Pathol 2023; 13:41-47. [PMID: 37091197 PMCID: PMC10119865 DOI: 10.1177/19253621231164023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/24/2023] [Indexed: 04/25/2023]
Affiliation(s)
| | - Guendalina Gentile
- Guendalina Gentile BSc, Sezione di Medicina
Legale—Dipartimento di Scienze Biomediche per la Salute—Università degli Studi, via Luigi
Mangiagalli, 37, 20133 Milano, Italy;
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Wu Z, Wang Y, Jin L, Wei J, Han L, Su J, Cao S, Liu S, Duan X, Zhao X. Case report: identification of EGFR R776H and FANCE R381H germline mutations in a patient with multiple pulmonary nodules. J Cancer Res Clin Oncol 2023; 149:921-927. [PMID: 36163560 DOI: 10.1007/s00432-022-04290-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/24/2022] [Accepted: 08/14/2022] [Indexed: 11/30/2022]
Abstract
Pulmonary nodules evaluation is clinically crucial because they may be the early predictors of lung cancer. Except for CT screening and serum tumor biomarkers testing, genetic alteration analysis by next-generation sequencing (NGS) technology can also help to find cancer earlier. In this study, we report a case of multiple pulmonary nodules patient with EGFR R776H and FANCE R381H germline mutations. Her father, paternal aunt, and elder uncle harbored either one or both two mutations and were found with multiple pulmonary ground-glass or sub-solid nodules. Her 7-year-old daughter also inherited the same two mutations.
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Affiliation(s)
- Zhenzhen Wu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yanli Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Linling Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juan Wei
- Department of Respiratory Medicine, Jiangsu Suining People's Hospital, Xuzhou, China
| | - Li Han
- ChosenMed Technology (Beijing) Co., Ltd., Beijing, China
| | - Junyan Su
- ChosenMed Technology (Beijing) Co., Ltd., Beijing, China
| | - Shuliang Cao
- ChosenMed Technology (Beijing) Co., Ltd., Beijing, China
| | - Siyao Liu
- ChosenMed Technology (Beijing) Co., Ltd., Beijing, China
| | - Xiaohong Duan
- ChosenMed Technology (Beijing) Co., Ltd., Beijing, China.
| | - Xin Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Youn S, Yang CW, Chung BH, Ko EJ. Newly diagnosed metastatic pulmonary calcification in a kidney transplantation recipient: a case report. Korean J Transplant 2022; 36:278-282. [PMID: 36704806 PMCID: PMC9832592 DOI: 10.4285/kjt.22.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 08/08/2022] [Indexed: 01/29/2023] Open
Abstract
Metastatic pulmonary calcification (MPC) is defined as calcium deposition in lung tissues. It is commonly seen in end-stage renal disease patients. However, MPC occurring in kidney transplant recipients (KTRs) is rare. We report a case of MPC in a 55-year-old female patient after successful kidney transplantation (KT). One year after KT, bisphosphonate and vitamin D were prescribed for osteoporosis. Then, 4.5 years after KT, we incidentally found multiple nodular lesions on chest X-ray (CXR) without any symptoms. Chest computed tomography showed multiple high-density nodules. A bone scan confirmed MPC in the right middle lobe and right lower lobe. A retrospective review of pretransplant blood chemistry revealed the following: serum calcium level, 11.2 mg/dL; phosphorus level, 3.2 mg/dL; intact parathyroid hormone level, lower than 2.5 pg/mL; and 24-hour urine calcium level, within normal limits (WNL). After KT, all of these parameters remained WNL. Therefore, hidden adynamic bone disease might have been aggravated by bisphosphonate and vitamin D supplementation, causing MPC. Both were discontinued. She was monitored by routine CXR, and MPC did not progress. Since MPC is commonly asymptomatic and difficult to diagnose in KTRs, caution is required when administering such medications. Patient should be followed up with routine CXR.
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Affiliation(s)
- Sojung Youn
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- Transplantation Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byung Ha Chung
- Transplantation Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Corresponding author: Byung Ha Chung Transplantation Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea, Tel: +82-2-2258-6066, Fax: +82-2-2258-6917, E-mail:
| | - Eun Jeong Ko
- Transplantation Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Co-corresponding author: Eun Jeong Ko, Transplantation Research Center, Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea, Tel: +82-2-2258-6760, Fax: +82-2-2258-6917, E-mail:
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Chen K, Lai YC, Vanniarajan B, Wang PH, Wang SC, Lin YC, Ng SH, Tran P, Lin G. Clinical impact of a deep learning system for automated detection of missed pulmonary nodules on routine body computed tomography including the chest region. Eur Radiol 2022; 32:2891-2900. [PMID: 34999920 DOI: 10.1007/s00330-021-08412-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/31/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the clinical impact of a deep learning system (DLS) for automated detection of pulmonary nodules on computed tomography (CT) images as a second reader. METHODS This single-centre retrospective study screened 21,150 consecutive body CT studies from September 2018 to February 2019. Pulmonary nodules detected by the DLS on axial CT images but not mentioned in initial radiology reports were flagged. Flagged images were scored by four board-certificated radiologists each with at least 5 years of experience. Nodules with scores of 2 (understandable miss) or 3 (should not be missed) were then categorised as unlikely to be clinically significant (2a or 3a) or likely to be clinically significant (2b or 3b) according to the 2017 Fleischner guidelines for pulmonary nodules. The miss rate was defined as the total number of studies receiving scores of 2 or 3 divided by total screened studies. RESULTS Among 172 nodules flagged by the DLS, 60 (35%) missed nodules were confirmed by the radiologists. The nodules were further categorised as 2a, 2b, 3a, and 3b in 24, 14, 10, and 12 studies, respectively, with an overall positive predictive value of 35%. Missed pulmonary nodules were identified in 0.3% of all CT images, and one-third of these lesions were considered clinically significant. CONCLUSIONS Use of DLS-assisted automated detection as a second reader can identify missed pulmonary nodules, some of which may be clinically significant. CLINICAL RELEVANCE/APPLICATION Use of DLS to help radiologists detect pulmonary lesions may improve patient care. KEY POINTS • DLS-assisted automated detection as a second reader is feasible in a large consecutive cohort. • Performance of combined radiologists and DLS was better than DLS or radiologists alone. • Pulmonary nodules were missed more frequently in abdomino-pelvis CT than the thoracic CT.
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Affiliation(s)
- Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Ying-Chieh Lai
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | | | - Pieh-Hsu Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Shao-Chung Wang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Yu-Chun Lin
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan
| | - Pelu Tran
- FerrumFerrum Health, Santa Clara, CA, USA
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
- Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Fuhsing St., Taoyuan, 33382, Guishan, Taiwan.
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10
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Tan X, Liu B, Zhang Y. [Application of CT-guided Localization with Medical Glue for Single and Two or More Small Pulmonary Nodules before Video-assisted Thoracic Surgery]. Zhongguo Fei Ai Za Zhi 2022; 25:1-6. [PMID: 35078278 DOI: 10.3779/j.issn.1009-3419.2021.102.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The localization of pulmonary nodules is related to whether the lesions can be found and removed accurately and quickly. It is an important link for the success of minimally invasive video-assisted thoracic surgery (VATS). This study investigated the feasibility of medical glue localization under VATS video-assisted thoracoscopic computed tomography (CT) guidance for single pulmonary nodule and more than two pulmonary nodules, and compared with the accuracy and safety of single nodule localization. METHODS A retrospective analysis of the clinical data of patients who underwent unilateral CT-guided medical glue localization before VATS from November 2018 to March 2021 were performed, the patients was divided into multiple pulmonary nodules group (localized nodules ≥2) and single pulmonary nodule group according to the number of localized nodules. The localization time, success rate and complication rate of the two groups were compared. RESULTS There were 126 nodules in the two groups, including 62 in single pulmonary nodule group and 64 in multiple pulmonary nodules group. The average single nodule localization time was (13.23±4.5) min in single pulmonary nodule group and (10.52±2.8) min in multiple pulmonary nodules group, the difference between the two groups is statistically significant (P<0.05). The localization success rate of single pulmonary nodule group and multiple pulmonary nodules group were 100% and 98.4% separately, the difference between the two groups was not statistically significant (P>0.05). All VATS were successfully completed after localization. The incidence of pneumothorax was higher in multiple pulmonary nodules group than in single pulmonary nodule group (P=0.07). CONCLUSIONS Compared with localization of single lung nodule, unilateral CT-guided medical glue localization for multiple pulmonary nodules before VATS is also feasible and accuracy, it is worthy of clinical application. But the higher rate of pneumothorax should be paid attention to.
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Lin FY, Chang YC, Huang HY, Li CC, Chen YC, Chen CM. A radiomics approach for lung nodule detection in thoracic CT images based on the dynamic patterns of morphological variation. Eur Radiol 2022; 32:3767-3777. [PMID: 35020016 DOI: 10.1007/s00330-021-08456-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/26/2021] [Revised: 09/20/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To propose and evaluate a set of radiomic features, called morphological dynamics features, for pulmonary nodule detection, which were rooted in the dynamic patterns of morphological variation and needless precise lesion segmentation. MATERIALS AND METHODS Two datasets were involved, namely, university hospital (UH) and LIDC datasets, comprising 72 CT scans (360 nodules) and 888 CT scans (2230 nodules), respectively. Each nodule was annotated by multiple radiologists. Denoted the category of nodules identified by at least k radiologists as ALk. A nodule detection algorithm, called CAD-MD algorithm, was proposed based on the morphological dynamics radiomic features, characterizing a lesion by ten sets of the same features with different values extracted from ten different thresholding results. Each nodule candidate was classified by a two-level classifier, including ten decision trees and a random forest, respectively. The CAD-MD algorithm was compared with a deep learning approach, the N-Net, using the UH dataset. RESULTS On the AL1 and AL2 of the UH dataset, the AUC of the AFROC curves were 0.777 and 0.851 for the CAD-MD algorithm and 0.478 and 0.472 for the N-Net, respectively. The CAD-MD algorithm achieved the sensitivities of 84.4% and 91.4% with 2.98 and 3.69 FPs/scan and the N-Net 74.4% and 80.7% with 3.90 and 4.49 FPs/scan, respectively. On the LIDC dataset, the CAD-MD algorithm attained the sensitivities of 87.6%, 89.2%, 92.2%, and 95.0% with 4 FPs/scan for AL1-AL4, respectively. CONCLUSION The morphological dynamics radiomic features might serve as an effective set of radiomic features for lung nodule detection. KEY POINTS • Texture features varied with such CT system settings as reconstruction kernels of CT images, CT scanner models, and parameter settings, and so on. • Shape and first-order statistics were shown to be the most robust features against variation in CT imaging parameters. • The morphological dynamics radiomic features, which mainly characterized the dynamic patterns of morphological variation, were shown to be effective for lung nodule detection.
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Affiliation(s)
- Fan-Ya Lin
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Chia-Chen Li
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan
| | - Yi-Chang Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan.,Department of Medical Imaging, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Chung-Ming Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, No. 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan.
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Bartlett EC, Kemp SV, Rawal B, Devaraj A. Defining growth in small pulmonary nodules using volumetry: results from a "coffee-break" CT study and implications for current nodule management guidelines. Eur Radiol 2021. [PMID: 34580748 DOI: 10.1007/s00330-021-08302-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 12/17/2022]
Abstract
Objectives
An increase in lung nodule volume on serial CT may represent true growth or measurement variation. In nodule guidelines, a 25% increase in nodule volume is frequently used to determine that growth has occurred; this is based on previous same-day, test–retest (coffee-break) studies examining metastatic nodules. Whether results from prior studies apply to small non-metastatic nodules is unknown. This study aimed to establish the interscan variability in the volumetric measurements of small-sized non-metastatic nodules. Methods Institutional review board approval was obtained for this study. Between March 2019 and January 2021, 45 adults (25 males; mean age 65 years, range 37–84 years) with previously identified pulmonary nodules (30–150 mm3) requiring surveillance, without a known primary tumour, underwent two same-day CT scans. Non-calcified solid nodules were measured using commercial volumetry software, and interscan variability of volume measurements was assessed using a Bland–Altman method and limits of agreement. Results One hundred nodules (range 28–170 mm3; mean 81.1 mm3) were analysed. The lower and upper limits of agreement for the absolute volume difference between the two scans were − 14.2 mm3 and 12.0 mm3 respectively (mean difference 1.09 mm3, range − 33–12 mm3). The lower and upper limits of agreement for relative volume difference were − 16.4% and 14.6% respectively (mean difference 0.90%, range − 24.1–32.8%). Conclusions The interscan volume variability in this cohort of small non-metastatic nodules was smaller than that in previous studies involving lung metastases of varying sizes. An increase of 15% in nodule volume on sequential CT may represent true growth, and closer surveillance of these nodules may be warranted. Key Points • In current pulmonary nodule management guidelines, a threshold of 25% increase in volume is required to determine that true growth of a pulmonary nodule has occurred. • This test–retest (coffee break) study has demonstrated that a smaller threshold of 15% increase in volume may represent true growth in small non-metastatic nodules. • Closer surveillance of some small nodules growing 15–25% over a short interval may be appropriate.
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Martini K, Blüthgen C, Eberhard M, Schönenberger ALN, De Martini I, Huber FA, Barth BK, Euler A, Frauenfelder T. Impact of Vessel Suppressed-CT on Diagnostic Accuracy in Detection of Pulmonary Metastasis and Reading Time. Acad Radiol 2021; 28:988-94. [PMID: 32037256 DOI: 10.1016/j.acra.2020.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES To assess if vessel suppression (VS) improves nodule detection rate, interreader agreement, and reduces reading time in oncologic chest computed tomography (CT). MATERIAL AND METHODS One-hundred consecutive oncologic patients (65 male; median age 60y) who underwent contrast-enhanced chest CT were retrospectively included. For all exams, additional VS series (ClearRead CT, Riverrain Technologies, Miamisburg) were reconstructed. Two groups of three radiologists each with matched experience were defined. Each group evaluated the SD-CT as well as VS-CT. Each reader marked the presence, size, and position of pulmonary nodules and documented reading time. In addition, for the VS-CT the presence of false positive nodules had to be stated. Cohen's Kappa (k) was used to calculate the interreader-agreement between groups. Reading time was compared using paired t test. RESULTS Nodule detection rate was significantly higher in VS-CT compared to the SD-CT (+21%; p <0.001). Interreader-agreement was higher in the VS-CT (k = 0.431, moderate agreement) compared to SD-CT (k = 0.209, fair agreement). Almost all VS-CT series had false positive findings (97-99 out of 100). Average reading time was significantly shorter in the VS-CT compared to the SD-CT (154 ± 134vs. 194 ± 126; 21%, p<0.001). CONCLUSIONS Vessel suppression increases nodule detection rate, improves interreader agreement, and reduces reading time in chest CT of oncologic patients. Due to false positive results a consensus reading with the SD-CT is essential.
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Xu L, Wang J, Liu L, Shan L, Zhai R, Liu H, Yao F. Computed tomography-guided cyanoacrylate injection for localization of multiple ipsilateral lung nodules. Eur Radiol 2021; 32:184-193. [PMID: 34170364 DOI: 10.1007/s00330-021-08101-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/16/2021] [Revised: 05/09/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To retrospectively assess the clinical effectiveness of CT-guided cyanoacrylate localization for multiple ipsilateral small pulmonary nodules (SPNs) and to determine the independent predictors for pneumothorax. METHODS In total, 81 patients with 169 lesions undergoing CT-guided cyanoacrylate localization for multiple ipsilateral SPNs between September 2016 and July 2020 were enrolled (group M). Another 284 patients who received single SPN localization during the same period served as the control group (group S). Propensity score analysis was performed to minimize selection bias. Possible independent predictors for pneumothorax were evaluated using multivariate logistic regression analysis. RESULTS Multiple ipsilateral SPN localization was successfully performed in all 81 patients. The incidences of successful targeting during localization and surgery were 100% and 98.8%, respectively. Seventy-seven patients (95.1%) underwent the procedure on the day before the surgery. Propensity matching created 81 pairs of patients. There were no significant differences in the incidence of successful targeting during localization and surgery, localization-related pain score, and additional morphine use between the two groups. However, group M was associated with a significant longer localization procedural time (p < 0.001) and a higher incidence of pneumothorax (p < 0.001). In multivariate analysis, position change was significantly associated with a sevenfold increase in the risk for pneumothorax (p = 0.001). CONCLUSIONS CT-guided cyanoacrylate injection for multiple ipsilateral SPN localization was safe and reliable, and allowed a flexible surgical schedule, despite a lengthy procedure and an increased incidence of pneumothorax. Avoiding position change may help to reduce the occurrence of pneumothorax. KEY POINTS • Compared to single SPN localization, multiple ipsilateral SPN localization using cyanoacrylate injection achieved comparable safety, reliability, and comfort. • CT-guided cyanoacrylate localization for multiple ipsilateral SPNs allowed a flexible surgical schedule. • Position change was the only independent risk factor for pneumothorax during the multiple ipsilateral SPN localization.
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Affiliation(s)
- Lei Xu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, Jiangsu Province, 211100, China
| | - Jian Wang
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, Jiangsu Province, 211100, China
| | - Liang Liu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Limei Shan
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, Jiangsu Province, 211100, China
| | - Rong Zhai
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, Jiangsu Province, 211100, China
| | - He Liu
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, Jiangsu Province, 211100, China
| | - Fei Yao
- Department of Thoracic Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, No. 168, Gushan Road, Jiangning District, Nanjing, Jiangsu Province, 211100, China.
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Liu C, Liu C, Zou X, Shao L, Sun Y, Guo Y. Next-generation sequencing facilitates differentiating between multiple primary lung cancer and intrapulmonary metastasis: a case series. Diagn Pathol 2021; 16:21. [PMID: 33706781 PMCID: PMC7953741 DOI: 10.1186/s13000-021-01083-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/03/2021] [Indexed: 01/17/2023] Open
Abstract
Background In lung cancer management, differential diagnosis between multiple primary lung cancer (MPLC) and intrapulmonary metastasis (IMP) is a critical point that is of direct therapeutic and clinical importance. However, this process often suffers from absence of a gold standard, resulting in equivocal cases. Herein, we present a series of three cases, in which genomic alteration patterns revealed by next-generation sequencing (NGS) facilitated the differential diagnosis between MPLC and IMP. Case presentation Case 1 was a 57-year-old female with two separate lesions in the upper lobe and the lower lobe of left lung, which were both histopathologically determined as T2aN0M0 adenocarcinomas. NGS identified an EGFR L858R in one lesion and an EGFR 20 exon insertion in the other one, suggestive of double primary malignancies. The patient underwent wedge resections and received an adjuvant treatment of icotinib and chemotherapy. She had a disease-free survival (DFS) of 19 months and counting. Case 2 was a 55-year-old female with multiple small lesions in both lungs. Histopathological examinations of resected lesions from right upper lobe revealed three subtypes: atypical adenomatous hyperplasia of alveolar epithelium, adenocarcinomas in situ and minimally invasive adenocarcinoma. NGS identified two different BRAF driver mutations G466E and V600_K601delinsE in two lesions of adenocarcinoma in situ, and a BRAF K601E in a lesion of minimally invasive adenocarcinoma. Case 3, a 68-year-old male, had the right upper lobe lesion histophathologically classified as a stage T3NxM0 mixed adenoneuroendocrine carcinoma and the left upper lobe lesion as a stage T1aN0M0 adenocarcinoma. NGS performed with different loci of surgical tissues revealed a rare sensitizing EGFR mutation G719A shared by the right upper lobe lesion and lymph node, and two EGFR mutations L861Q and G719S in left upper lobe lesion. The patient received icotinib treatment postoperatively and achieved a stable disease with a progression-free survival of 5 months. Conclusion Our cases provide evidence for utility of NGS in facilitating diagnosis and treatment decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-021-01083-6.
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Affiliation(s)
- Changjiang Liu
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Chengang Liu
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiao Zou
- Burning Rock Biotech, Guangzhou, 510300, China
| | - Lin Shao
- Burning Rock Biotech, Guangzhou, 510300, China
| | - Ying Sun
- Burning Rock Biotech, Guangzhou, 510300, China
| | - Yang Guo
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Hu L, Gao J, Hong N, Liu H, Chen C, Zhi X, Sui X. Simultaneous preoperative computed tomography-guided microcoil localizations of multiple pulmonary nodules. Eur Radiol 2021; 31:6539-46. [PMID: 33666697 DOI: 10.1007/s00330-021-07772-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/17/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate retrospectively the feasibility and safety of simultaneous multiple microcoil localizations of multiple pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS). METHODS This retrospective cohort study enrolled 288 consecutive patients, who underwent computed tomography (CT)-guided microcoil localization and subsequent VATS at our academic hospital between July 2017 and June 2018. Of these patients, 36 with 79 pulmonary nodules undergoing simultaneous multiple microcoil localizations in the ipsilateral lung were designated the multiple localization group; the remaining 252 with 252 pulmonary nodules undergoing single microcoil localization were designated the single localization group. The main outcomes were the technical success and complication rates of the localization procedures. The Student t test and Mann-Whitney U test were used for continuous variables. The chi-squared test and logistic regression analysis were used to assess dichotomous variables. RESULTS The localization technical success rates of the multiple and single localization groups were 96.2% (76/79) and 98.0% (247/252), respectively (p = 0.326). The rate of any complication (pneumothorax or pulmonary hemorrhage) was significantly higher in the multiple localization than in the single localization group (55.6% vs 21.8%, respectively; p < 0.001). The incidence of pneumothorax was significantly higher in the multiple localization than in the single localization group (p < 0.001). The difference between the incidence of pulmonary hemorrhage in the 2 groups was not significant (p = 0.385). CONCLUSIONS Although preoperative CT-guided simultaneous microcoil localizations of multiple pulmonary nodules produced a significantly higher incidence of pneumothorax, the localizations were clinically feasible and safe. KEY POINTS • Simultaneous preoperative CT-guided microcoil localizations of multiple pulmonary nodules are clinically feasible and safe. • Simultaneous microcoil localizations of multiple pulmonary nodules produced a significantly higher incidence of pneumothorax.
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Yu Y, Wang N, Huang N, Liu X, Zheng Y, Fu Y, Li X, Wu H, Xu J, Cheng J. Determining the invasiveness of ground-glass nodules using a 3D multi-task network. Eur Radiol 2021; 31:7162-7171. [PMID: 33665717 DOI: 10.1007/s00330-021-07794-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/30/2019] [Revised: 12/17/2020] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to determine the invasiveness of ground-glass nodules (GGNs) using a 3D multi-task deep learning network. METHODS We propose a novel architecture based on 3D multi-task learning to determine the invasiveness of GGNs. In total, 770 patients with 909 GGNs who underwent lung CT scans were enrolled. The patients were divided into the training (n = 626) and test sets (n = 144). In the test set, invasiveness was classified using deep learning into three categories: atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive pulmonary adenocarcinoma (IA). Furthermore, binary classifications (AAH/AIS/MIA vs. IA) were made by two thoracic radiologists and compared with the deep learning results. RESULTS In the three-category classification task, the sensitivity, specificity, and accuracy were 65.41%, 82.21%, and 64.9%, respectively. In the binary classification task, the sensitivity, specificity, accuracy, and area under the ROC curve (AUC) values were 69.57%, 95.24%, 87.42%, and 0.89, respectively. In the visual assessment of GGN invasiveness of binary classification by the two thoracic radiologists, the sensitivity, specificity, and accuracy of the senior and junior radiologists were 58.93%, 90.51%, and 81.35% and 76.79%, 55.47%, and 61.66%, respectively. CONCLUSIONS The proposed multi-task deep learning model achieved good classification results in determining the invasiveness of GGNs. This model may help to select patients with invasive lesions who need surgery and the proper surgical methods. KEY POINTS • The proposed multi-task model has achieved good classification results for the invasiveness of GGNs. • The proposed network includes a classification and segmentation branch to learn global and regional features, respectively. • The multi-task model could assist doctors in selecting patients with invasive lesions who need surgery and choosing appropriate surgical methods.
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Affiliation(s)
- Ye Yu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Na Wang
- SenseTime Research, Shanghai, 200233, China
| | - Ning Huang
- SenseTime Research, Shanghai, 200233, China
| | | | - Yuanjie Zheng
- School of Information Science and Engineering at Shandong Normal University, Jinan, 250358, China
| | - Yicheng Fu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Xiaoqian Li
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Huawei Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Jiejun Cheng
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
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Couraud S, Ferretti G, Milleron B, Cortot A, Girard N, Gounant V, Laurent F, Leleu O, Quoix E, Revel MP, Wislez M, Westeel V, Zalcman G, Scherpereel A, Khalil A. Intergroupe francophone de cancérologie thoracique, Société de pneumologie de langue française, and Société d'imagerie thoracique statement paper on lung cancer screening. Diagn Interv Imaging 2021; 102:199-211. [PMID: 33648872 DOI: 10.1016/j.diii.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
Following the American National Lung Screening Trial results in 2011 a consortium of French experts met to edit a statement. Recent results of other randomized trials gave the opportunity for our group to meet again in order to edit updated guidelines. After literature review, we provide here a new update on lung cancer screening in France. Notably, in accordance with all international guidelines, the experts renew their recommendation in favor of individual screening for lung cancer in France as per the conditions laid out in this document. In addition, the experts recommend the very rapid organization and funding of prospective studies, which, if conclusive, will enable the deployment of lung cancer screening organized at the national level.
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Lederlin M, de Margerie-Mellon C, Boussouar S, Bommart S, Caramella C. Lung cancer screening: French radiologists should prepare for it. Diagn Interv Imaging 2021; 102:197-198. [PMID: 33642220 DOI: 10.1016/j.diii.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Mathieu Lederlin
- Department of Radiology, University Hospital of Rennes, University of Rennes, 35033 Rennes, France.
| | - Constance de Margerie-Mellon
- Department of Radiology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France; Université de Paris, 75010 Paris, France
| | - Samia Boussouar
- Department of Radiology, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne University, 75651 Paris, France
| | - Sébastien Bommart
- Department of Medical Imaging, University Hospital of Montpellier, University of Montpellier, 34295 Montpellier, France
| | - Caroline Caramella
- Department of Radiology, Hôpital Marie Lannelongue, Institut d'Oncologie Thoracique, Paris-Saclay University, 92350 Le Plessis-Robinson, France
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Carvajal C, González F, Beltrán R, Buitrago R, de Los Reyes A, Llamas A, Beltrán J, Carreño J. Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection. Updates Surg 2021; 73:1559-1566. [PMID: 33398774 DOI: 10.1007/s13304-020-00953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/13/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
Since the introduction of lung nodule radio-guided localization, multiport video-assisted thoracoscopic surgery resection has been widely described. To date, only one series has reported the use of uniportal approach. Our objective is to describe the experience of a single institution of lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection. Retrospective cohort study based on data from medical records of patients between May 2012 and April 2019. Twenty-four patients were included, 13 were women (54.2%) with a median age of 59.5 years (range 19 and 81 years). Median nodule size was 7 mm (range 3-12 mm) and 19 (79.2%) patients had single lung nodule. The main indication was sub-centimetric nodule in 22 (91.6%) patients followed by a deep localization in 10 (41.6%) patients and sub-solid nodule in 9 (37.5%) patients. Median surgical time was 102.5 min (range 55-160 min). 4 (16.6%) patients had malignant neoplasm of the lung, 10 (41.7%) patients had lung metastases and 10 (41.7%) patients had benign lung lesions. The success rate found was 95.8%. Concordance analysis between palpation of the pulmonary nodule and the presence of the nodule in the histopathology was rated as poor, kappa value - 0.71 (P = 0.186) and between the resection of the pulmonary nodule according to the presence of the nodule in the pathology report was rated as good, Kappa value 0.625 (P = 0.001). Lung nodule radio-guided localization and uniportal video-assisted thoracoscopic surgery resection has a similar success rate and complications to those described by multiport video-assisted thoracoscopic surgery resections.
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Affiliation(s)
- Carlos Carvajal
- Thoracic Surgeon, Thoracic Surgery Department, Instituto Nacional de Cancerología, Calle 1 No. 9-85, Bogotá, Colombia.
| | - Felipe González
- Oncologic surgeon, Surgical Oncology Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Rafael Beltrán
- Thoracic Surgeon, Thoracic Surgery Department, Instituto Nacional de Cancerología, Calle 1 No. 9-85, Bogotá, Colombia
| | - Ricardo Buitrago
- Thoracic Surgeon, Thoracic Surgery Department, Instituto Nacional de Cancerología, Calle 1 No. 9-85, Bogotá, Colombia
| | - Amelia de Los Reyes
- Nuclear Medicine Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Augusto Llamas
- Nuclear Medicine Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Julián Beltrán
- Interventional Radiologist, Radiology Department, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - José Carreño
- Research Department, Instituto Nacional de Cancerología, Bogotá, Colombia
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Xia T, Cai M, Zhuang Y, Ji X, Huang D, Lin L, Liu J, Yang Y, Fu G. Risk Factors for The Growth of Residual Nodule in Surgical Patients with Adenocarcinoma Presenting as Multifocal Ground-glass Nodules. Eur J Radiol 2020; 133:109332. [PMID: 33152625 DOI: 10.1016/j.ejrad.2020.109332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/17/2020] [Revised: 09/18/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE We aim to investigate the risk factors influencing the growth of residual nodule (RN) in surgical patients with adenocarcinoma presenting as multifocal ground-glass nodules (GGNs). METHOD From January 2014 to June 2018, we enrolled 238 patients with multiple GGNs in a retrospective review. Patients were categorized into growth group 63 (26.5%), and non-growth group 175 (73.5%). The median follow-up time was 28.2 months (range, 6.3-73.0 months). To obtain the time of RN growth and find the risk factors for growth, data such as age, gender, history of smoking, history of malignancy, type of surgery, pathology and radiological characteristics were analyzed to use Kaplan-Meier method with the log-rank test and Cox regression analysis. RESULTS The median growth time of RN was 56.0 months (95% CI, 45.0-67.0 months) in all 238 patients. Roundness (HR 4.62, 95% CI 2.20-9.68), part-solid nodule (CTR ≥ 50%) (HR 4.39, 95% CI 2.29-8.45), vascular convergence sign (HR 2.32, 95% CI 1.36-3.96) of RN, and age (HR 1.04, 95% CI 1.01-1.07) were independent predictors of further nodule growth. However, radiological characteristics and pathology of domain tumour (DT) cannot be used as indicators to predict RN growth. CONCLUSIONS RN showed an indolent growth pattern in surgical patients with multifocal GGNs. RN with a higher roundness, presence of vascular convergence sign, more solid component, and in the elder was likely to grow. However, the growth of RN showed no association with the radiological features and pathology of DT.
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Affiliation(s)
- Tianyi Xia
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Mengting Cai
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Yuandi Zhuang
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Xiaowei Ji
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Dingpin Huang
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Liaoyi Lin
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Jinjin Liu
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China
| | - Yunjun Yang
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China.
| | - Gangze Fu
- Depatment of Radiology, Wenzhou Medical University, First Affiliated Hospital, NO. 2 Fuxue Rd., Wenzhou, 325000, China.
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22
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Marušić A, Kuhtić I, Mažuranić I, Janković M, Glodić G, Sabol I, Stanić L. Nodular distribution pattern on chest computed tomography (CT) in patients diagnosed with nontuberculous mycobacteria (NTM) infections. Wien Klin Wochenschr 2020; 133:470-477. [PMID: 32617707 DOI: 10.1007/s00508-020-01701-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/13/2019] [Accepted: 06/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluated the prevalence of spreading pathways in nontuberculous mycobacteria (NTM) pulmonary infections according to nodular distribution patterns seen on chest computed tomography (CT). METHODS This study included 63 patients diagnosed with NTM lung infections who underwent CT at our institution. A retrospective analysis of CT images focused on the presence and distribution of nodules, presence of intrathoracic lymphadenopathy and the predominant side of infection in the lungs. The findings were classified into five groups; centrilobular (bronchogenic spread), perilymphatic (lymphangitic spread), random (hematogenous spread), combined pattern and no nodules present. The groups were then compared according to other CT findings. RESULTS Among 51 (81%) patients identified with a nodular pattern on chest CT, 25 (39.8%) presented with centrilobular, 7 (11.1%) with perilymphatic, 6 (9.5%) with random and 13 (20.6%) with combined nodular patterns but located in different areas of the lungs. The right side of the lungs was predominant in 38 cases (60.3%). Intrathoracic lymphadenopathy was evident in 20 patients (31.7%). Significant differences in distributions of nodular patterns were seen in patients infected with Mycoplasma avium complex (MAC) associated with centrilobular pattern (p = 0.0019) and M. fortuitum associated with random pattern (p = 0.0004). Some of the findings were related to perilymphatic nodules between other isolated species of NTM (p = 0.0379). CONCLUSION The results of this study showed a high proportion of perilymphatic nodules and right-sided predominance in the upper lobe, which, combined with intrathoracic lymphadenopathy is highly suggestive of the lymphangitic spread of lung NTM infections.
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Affiliation(s)
- Ante Marušić
- Department of Radiology, Thoracic radiology, University Hospital Center, University of Zagreb Medical School, Kišpatićeva 12, 10 000, Zagreb, Croatia.
| | - Ivana Kuhtić
- Department of Radiology, Thoracic radiology, University Hospital Center, University of Zagreb Medical School, Kišpatićeva 12, 10 000, Zagreb, Croatia
| | - Ivica Mažuranić
- Department of Radiology, Thoracic radiology, University Hospital Center, University of Zagreb Medical School, Kišpatićeva 12, 10 000, Zagreb, Croatia
| | - Mateja Janković
- Department for Respiratory Diseases, University Hospital Center, University of Zagreb Medical School, Kišpatićeva, Zagreb, Croatia
| | - Goran Glodić
- Department for Respiratory Diseases, University Hospital Center, University of Zagreb Medical School, Kišpatićeva, Zagreb, Croatia
| | - Ivan Sabol
- Division of Molecular medicine, Laboratory of Molecular Virology and Bacteriology, Ruder Boskovic Institute, Bijenička cesta, Zagreb, Croatia
| | - Lucija Stanić
- Emergency Department of Zagreb County, Matice Hrvatske, Zagreb, Croatia
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23
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Kozuka T, Matsukubo Y, Kadoba T, Oda T, Suzuki A, Hyodo T, Im S, Kaida H, Yagyu Y, Tsurusaki M, Matsuki M, Ishii K. Efficiency of a computer-aided diagnosis (CAD) system with deep learning in detection of pulmonary nodules on 1-mm-thick images of computed tomography. Jpn J Radiol 2020; 38:1052-61. [PMID: 32592003 DOI: 10.1007/s11604-020-01009-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the performance of a deep learning-based computer-aided diagnosis (CAD) system at detecting pulmonary nodules on CT by comparing radiologists' readings with and without CAD. MATERIALS AND METHODS A total of 120 chest CT images were randomly selected from patients with suspected lung cancer. The gold standard of nodules ≥ 3 mm was established by a panel of three expert radiologists. Two less experienced radiologists read the images without and afterward with CAD system. Their reading times were recorded. RESULTS The radiologists' sensitivity increased from 20.9% to 38.0% with the introduction of CAD. The positive predictive value (PPV) decreased from 70.5% to 61.8%, and the F1-score increased from 32.2% to 47.0%. The sensitivity significantly increased from 13.7% to 32.4% for small nodules (3-6 mm) and from 33.3% to 47.6% for medium nodules (6-10 mm). CAD alone showed a sensitivity of 70.3%, a PPV of 57.9%, and an F1-score of 63.5%. Reading time decreased by 11.3% with the use of CAD. CONCLUSION CAD improved the less experienced radiologists' sensitivity in detecting pulmonary nodules of all sizes, especially including a significant improvement in the detection of clinically important-sized medium nodules (6-10 mm) as well as small nodules (3-6 mm) and reduced their reading time.
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24
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Chaptal M, Gallois JC, Étienne N, Mathon G, Nicolas M, Cadelis G. [Pulmonary histoplasmosis in an immunocompetent patient]. Rev Mal Respir 2020; 37:422-426. [PMID: 32409000 DOI: 10.1016/j.rmr.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/01/2018] [Accepted: 03/25/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Acute pulmonary histoplasmosis (APH) is rare in an immunocompetent patient. We report a case of APH diagnosed by culture of broncho-alveolar lavage (BAL) in a patient presenting a pseudo-tumoral form with nodules progressing to cavitation. OBSERVATION A 41 year-old male smoker was hospitalized with a persistent fever, dry cough and dyspnoea on exertion. The first CT scan showed a reticulo-nodular interstitial infiltrate with lymphadenopathy that progressed rapidly to multiple pulmonary nodules with central cavitation. Bronchial endoscopy, with BAL culture, provided the diagnosis of Histoplasma capsulatum, variety capsulatum. The infection may have occurred during work in a hangar in Guadeloupe that was scattered with bats' guano. After two months of treatment by itraconazole, the patient's condition improved clinically and radiologically with reduction of the nodules and their cavitation. CONCLUSION This case presents an immunocompetent patient with pulmonary histoplasmosis and multiple, radiologically atypical, nodules. The diagnosis was established by BAL culture.
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Affiliation(s)
- M Chaptal
- Service de pneumologie CHU de Pointe-à-pitre/Abymes, route de chauvel, BP 465, 97159 Pointe-à-Pitre, Guadeloupe, France.
| | - J-C Gallois
- Service de pneumologie CHU de Pointe-à-pitre/Abymes, route de chauvel, BP 465, 97159 Pointe-à-Pitre, Guadeloupe, France
| | - N Étienne
- Service de pneumologie CHU de Pointe-à-pitre/Abymes, route de chauvel, BP 465, 97159 Pointe-à-Pitre, Guadeloupe, France
| | - G Mathon
- Service de radiologie, CHU de Pointe-à-pitre/Abymes, route de chauvel, BP 465, 97159 Pointe-à-Pitre, Guadeloupe, France
| | - M Nicolas
- Laboratoire de mycologie-parasitologie, CHU de Pointe-à-pitre/Abymes, route de chauvel, BP 465, 97159 Pointe-à-Pitre, Guadeloupe, France
| | - G Cadelis
- Service de pneumologie CHU de Pointe-à-pitre/Abymes, route de chauvel, BP 465, 97159 Pointe-à-Pitre, Guadeloupe, France
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25
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Lacson R, Desai S, Landman A, Proctor R, Sumption S, Khorasani R. Impact of a Health Information Technology Intervention on the Follow-up Management of Pulmonary Nodules. J Digit Imaging 2019; 31:19-25. [PMID: 28664448 DOI: 10.1007/s10278-017-9989-y] [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] [Indexed: 12/21/2022] Open
Abstract
Lung cancer is the leading cause of cancer deaths in the USA. The most common abnormalities suspicious for lung cancer on CT scan include pulmonary nodules. Recommendations to improve care for patients with pulmonary nodules require follow-up management. However, transitions in care, especially for patients undergoing transitions to ambulatory care sites from the emergency department (ED) and inpatient settings, can exacerbate failures in follow-up testing and compromise patient safety. We evaluate the impact of a discharge module that includes follow-up recommendations for further management of pulmonary nodules on the study outcome and follow-up management of patients with pulmonary nodules within 1 year after discharge. After IRB approval, we collected data on all patients undergoing chest or abdominal CT exams over a 12-month baseline and 12-month intervention period at an academic medical center. The inpatient discharge module was implemented in November 2011; the ED module was implemented in May 2012. Multivariable logistic regression was performed to account for care setting, imaging modality, recommendations, and patient demographics. Implementation of a discharge module resulted in improved follow-up of patients with pulmonary nodules within 1 year after discharge (OR = 1.64, p = 0.01); the ED implementation resulted in better follow-up compared to the inpatient module (OR = 2.24, p < 0.01). Twenty-seven percent of patients with pulmonary nodules received follow-up management, which, although significantly improved from the 18% baseline, remains low. An electronic discharge module is associated with improved follow-up management of patients with pulmonary nodules, and may be combined with interventions to further improve management of these patients.
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Affiliation(s)
- Ronilda Lacson
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, 20 Kent Street, 2nd Floor, Boston, MA, 02445, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Sonali Desai
- Harvard Medical School, Boston, MA, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam Landman
- Harvard Medical School, Boston, MA, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Randall Proctor
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, 20 Kent Street, 2nd Floor, Boston, MA, 02445, USA
| | - Siobhan Sumption
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, 20 Kent Street, 2nd Floor, Boston, MA, 02445, USA
| | - Ramin Khorasani
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, 20 Kent Street, 2nd Floor, Boston, MA, 02445, USA.,Harvard Medical School, Boston, MA, USA
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26
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Wu X, Chen D, Zhu R, Wang Y, Chen C, Chen Y, Yang W. [Progress in Basic Research and Clinical Treatment of Multiple Pulmonary Nodules]. Zhongguo Fei Ai Za Zhi 2019; 22:173-177. [PMID: 30909998 PMCID: PMC6441121 DOI: 10.3779/j.issn.1009-3419.2019.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
肺癌是世界上发病率和死亡率最高的肿瘤。随着多层螺旋计算机断层扫描(computed tomography, CT)技术的发展和肺癌筛查的广泛开展,越来越多的肺结节被发现, 其中不少是多发肺结节,这些结节在病理学上常被诊断为多原发肺腺癌。对于具有不同影像学特征的多发结节,首选处理方法不尽相同,且每个肺结节的处理方法仍存在很大争议。近年来多发肺结节各病灶的演进及病灶间的相互影响机制,病灶内和病灶间肿瘤细胞在基因组学方面的同质性和异质性也备受关注。本文从组织病理学、基因组学、外科处理等多方面综合论述多发肺结节的研究进展。
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Affiliation(s)
- Xuejie Wu
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Donglai Chen
- Department of
Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Rongying Zhu
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Yifei Wang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Chang Chen
- Department of
Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Wentao Yang
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
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27
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Soliman M, Petrella T, Tyrrell P, Wright F, Look Hong NJ, Lu H, Zezos P, Jimenez-Juan L, Oikonomou A. The clinical significance of indeterminate pulmonary nodules in melanoma patients at baseline and during follow-up chest CT. Eur J Radiol Open 2019; 6:85-90. [PMID: 30805420 PMCID: PMC6374500 DOI: 10.1016/j.ejro.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 02/07/2023] Open
Abstract
Objective This study aims to determine an appropriate timeline to monitor indeterminate pulmonary nodules (IPN) in melanoma patients to confirm metastatic origin. Materials and Methods 588 clinically non-metastatic melanoma patients underwent curative intent surgery during 3 years. Patients with baseline chest CT and at least one follow-up (FU) CT were retrospectively analyzed to assess for IPN. Patients with definitely benign nodules, metastases and non-melanoma malignancies were excluded. Change in volume from first to FU CT, initial diameter (D1) and volume (V1), distance from pleura, peripheral and perifissural location, density and clinical stage were evaluated. Nodules were volumetrically measured on CTs and were considered metastases if they increased in size between two CTs or if increase was accompanied by multiple new nodules or extrapulmonary metastases. Results 148 patients were included. Two out of 243 baseline IPN detected in 70 patients, increased significantly in volume in 3 and 5 months and were proven metastases. During FU, 86% of 40 interval IPN detected in 28 patients, were proven metastases. Interval nodule (p < 0.0001, HR:243,CI:[57.32,1033.74]), 3-month volume change (OR:1.023,CI:[1.014,1.033]), V1 (OR:1.006,CI:[1.003,1.009]), D1 (OR:1.424,CI:[1.23,1.648]), distance from pleura (OR:1.03,CI:[1.003,1.059]), and combined stage IIC + III (OR:11.29,CI:[1.514,84.174]), were associated with increased risk for metastasis. 43%, 72% and 94% of patients with IPN were confirmed with metastases in the first FU CT at 3, 6 and 12 months respectively. Conclusion Baseline IPN are most likely benign, while interval IPN are high risk for metastasis. Absence of volume increase of IPN within 6 months excluded metastasis in most patients.
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Affiliation(s)
- Magdy Soliman
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, M4N 3M5, Toronto, ON, Canada
| | - Teresa Petrella
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, M4N 3M5, Toronto, ON, Canada
| | - Pascal Tyrrell
- Department of Medical Imaging, University of Toronto, M5T 1W7, Toronto, ON, Canada
| | - Frances Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, M4N 3M5, Toronto, ON, Canada
| | - Nicole J Look Hong
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, M4N 3M5, Toronto, ON, Canada
| | - Hua Lu
- Department of Medical Imaging, University of Toronto, M5T 1W7, Toronto, ON, Canada
| | - Petros Zezos
- Department of Medicine, North Ontario School of Medicine, ON P7B 5E1, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, M4N 3M5, Toronto, ON, Canada
| | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, M4N 3M5, Toronto, ON, Canada
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28
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Ding YL, Zhu H, Yang W, Liu BB, Zhu X, Li MJ, He B. [Diffuse pulmonary meningotheliomatosis: a case report and literature review]. Zhonghua Jie He He Hu Xi Za Zhi 2019; 42:24-29. [PMID: 30630245 DOI: 10.3760/cma.j.issn.1001-0939.2019.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the clinical features, diagnosis and differential diagnosis of diffuse pulmonary meningotheliomatosis (DPM), a rare subtype of minute pulmonary meningothelial-like nodules (MPMN), so as to improve the understanding of this disorder. Methods: The clinical data of a patient diagnosed as DPM admitted in department of Respiratory Medicine, Peking University Third Hospital in August 2016 were reported and the related literatures were reviewed. With "pulmonary meningothelial-like nodules" , "minute pulmonary meningothelial-like nodules" or "diffuse pulmonary meningotheliomatosis" as the search terms, and the search time before November 1st 2017 for Wanfangdata, China National Knowledge Infrastructure (CNKI), and PubMed.Twenty-five articles were retrieved, among which 6 English (all case reports) articles were found with the search term "diffuse pulmonary meningotheliomatosis" involving 10 cases, and the other 19 articles (1 Chinese, 18 English) about MPMN mainly discussed non-DPM cases,including 13 case reports and 6 pathological/genetic studies. Results: A 68-year old female was admitted to the hospital because of intermittent cough and expectoration for more than 3 years and aggravation for 3 weeks. Her pulmonary CT showed diffuse minute nodules distributed randomly throughout both lungs, and did not improve after treatment with oral Moxifloxacin for 2 weeks. A video-assisted thoracoscopic biopsy was performed. The specimens showed MPMN and no other lesions, which confirmed the final diagnosis of DPM. She was followed without any medication therapy and her pulmonary CT showed stabilization of the lesions one year later. DPM was considered as a rare type of MPMN. A total of 11 cases were analyzed, including 10 cases reported in the literature. The patients included 1man and 10 women, aged 51 to 75 years, with an average age of (64±8) years. Among the 11 patients, 8 denied a history of smoking or of occupational exposure, 7 presented with dyspnea, shortness of breath, or fatigue, and 8 had mild abnormalities of pulmonary function test. The pulmonary CT of all the patients showed randomly distributed, diffuse bilateral small solid or ground-glass nodules, with the diameters less than 5 millimeters, some of which were cavitated. Only 1 patient had pulmonary thromboembolism, while the other 10 did not have any other lung diseases. All the patients were histologically diagnosed, 8 by open lung biopsies, 2 by transbronchial lung biopsy, and 1 by CT-guided fine needle aspiration. Three patients were followed for 12-92 months and the lung lesions were all stable. Conclusions: As a rare subtype of MPMN, DPM lacks specificity of clinical manifestations, and presents with diffuse bilateral small solid or ground-glass nodules, distributed randomly throughout both lungs. An early correct diagnosis depends on biopsy.
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Affiliation(s)
- Y L Ding
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - H Zhu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - W Yang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - B B Liu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
| | - X Zhu
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - M J Li
- Department of Radiology, Peking University Third Hospital, Beijing 100191, China
| | - B He
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China
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29
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Koslow M, Young JR, Yi ES, Baqir M, Decker PA, Johnson GB, Ryu JH. Rheumatoid pulmonary nodules: clinical and imaging features compared with malignancy. Eur Radiol 2018; 29:1684-1692. [PMID: 30288558 DOI: 10.1007/s00330-018-5755-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/05/2018] [Revised: 07/28/2018] [Accepted: 09/11/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The objective of this study was to identify clinical and imaging features that distinguish rheumatoid lung nodules from malignancy. METHODS We conducted a retrospective review of 73 rheumatoid patients with histologically-proven rheumatoid and malignant lung nodules encountered at Mayo Clinic, Rochester, MN (2001-2016). Medical records and imaging were reviewed including a retrospective blinded review of CT and PET/CT studies. RESULTS The study cohort had a mean age of 67 ± 11 years (range 45-86) including 44 (60%) women, 82% with a smoking history, 38% with subcutaneous rheumatoid nodules, and 78% with rheumatoid factor seropositivity. Subjects with rheumatoid lung nodules compared to malignancy were younger (59 ± 12 vs 71 ± 9 years, p < 0.001), more likely to manifest subcutaneous rheumatoid nodules (73% vs 20%, p < 0.001) and rheumatoid factor seropositivity (93% vs 68%, p = 0.034) but a history of smoking was common in both groups (p = 0.36). CT features more commonly associated with rheumatoid lung nodules compared to malignancy included multiplicity, smooth border, cavitation, satellite nodules, pleural contact, and a subpleural rind of soft tissue. Optimal sensitivity (77%) and specificity (92%) (AUC 0.85, CI 0.75-0.94) for rheumatoid lung nodule were obtained with ≥ 3 CT findings (≥ 4 nodules, peripheral location, cavitation, satellite nodules, smooth border, and subpleural rind). Key 18FDG-PET/CT features included low-level metabolism (SUVmax 2.7 ± 2 vs 7.2 ± 4.8, p = 0.007) and lack of 18F-fluorodeoxyglucose (FDG)-avid draining lymph nodes. CONCLUSION Rheumatoid lung nodules have distinct CT and PET/CT features compared to malignancy. Patients with rheumatoid lung nodules are younger and more likely to manifest subcutaneous rheumatoid nodules and seropositivity. KEY POINTS • Rheumatoid lung nodules have distinct clinical and imaging features compared to lung malignancy. • CT features of rheumatoid lung nodules include multiplicity, cavitation, satellite nodules, smooth border, peripheral location, and subpleural rind. • Key PET/CT features include low-level metabolism and lack of FDG-avid draining lymph nodes.
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Affiliation(s)
- Matthew Koslow
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Gonda 18 South, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Jason R Young
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Gonda 18 South, 200 First St. SW, Rochester, MN, 55905, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Gonda 18 South, 200 First St. SW, Rochester, MN, 55905, USA
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30
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Mun JM, Kim JI, Ko TY, Park SD. Surgical Treatment of Primary Pulmonary Myopericytoma. Korean J Thorac Cardiovasc Surg 2018; 51:220-222. [PMID: 29854670 PMCID: PMC5973222 DOI: 10.5090/kjtcs.2018.51.3.220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 11/21/2022]
Abstract
Myopericytoma is a benign tumor that occurs in soft tissues. Myopericytoma in the lungs is very rare. We report the case of a 63-year-old woman presenting with cavitary masses in the left lung and multiple tiny nodules in both lungs. She underwent surgery, and a histological examination revealed primary pulmonary myopericytoma.
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Affiliation(s)
- Jeong Min Mun
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine
| | - Jong In Kim
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine
| | - Taek Yong Ko
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine
| | - Sung Dal Park
- Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine
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Heraudeau A, Ricordel C, Sale A, Lederlin M, Kerjouan M, De Latour B, Llamas-Guttierez F, Desrues B, Jouneau S. [Interstitial lung disease and pancreatic cancer: Series of two cases]. Rev Mal Respir 2018; 35:78-82. [PMID: 29398155 DOI: 10.1016/j.rmr.2017.10.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 07/25/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pancreatic cancer is often not diagnosed until at a metastatic stage at which point the prognosis is very poor. Pulmonary metastases are pleomorphic, often present at the time of diagnosis and can lead to the discovery of an asymptomatic primary disease. CASE REPORT We describe two cases aged 60 and 74 years, where imaging identified what was thought to be an interstitial lung disease but which was actually metastasis from pancreatic cancer. In the first case, CT showed multiple excavated pulmonary nodules but the presentation with medullary compression led rapidly to pathological diagnosis on bone lesions. In the second patient, a history of rheumatoid arthritis and the lack of abdominal symptoms led to an initial search for disease related to the rheumatoid disease. Histopathology, from lung and bone biopsies, enabled a correct diagnosis to be achieved. CONCLUSION Where atypical interstitial lung disease occurs, biopsy should be considered in order not to delay a diagnosis of cancer, especially pancreatic cancer.
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Affiliation(s)
- A Heraudeau
- Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - C Ricordel
- Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - A Sale
- Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - M Lederlin
- Service de radiologie, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - M Kerjouan
- Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - B De Latour
- Service de chirurgie thoracique et cardiovasculaire, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - F Llamas-Guttierez
- Service d'anatomopathologie, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - B Desrues
- Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - S Jouneau
- Service de pneumologie, hôpital Pontchaillou, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; IRSET UMR 1085, université de Rennes 1, 2, avenue du Pr-Léon-Bernard, 35043 Rennes, France
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Abstract
Benign Metastasizing Leiomyoma (BML) is a rare disease which represents with multiple leiomyomatous lesions in many tissues and organs especially in lungs. These patients have been operated for leiomyoma of the uterus. Here we report a case of a 41-year-old woman who was evaluated in a thoracic surgery hospital for dyspnea and bilateral nodules in chest roentgenogram. She had no history of neoplasm, only myomectomy history of uterine leiomyoma 10 years ago. Biopsy and histopathological examination were consistent with pulmonary leiomyoma. The patient was reffered to our clinic and we performed a total abdominal hysterectomy for her multiple uterine leiomyomas. The final diagnosis was 'benign pulmonary metastasizing leiomyoma'. After this diagnosis, surgical castration was performed but two years later, repeat imaging showed progression in pulmonary lesions and progesterone therapy was administered to the patient. Patient has continued on this hormonal therapy to date and during the 5-years follow-up, the persisting lesions in both lungs regressed.
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Affiliation(s)
- Nurettin Aka
- Associate Professor, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
| | - Reyyan Iscan
- Faculty, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
| | - Gültekin Köse
- Faculty, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
| | - Isik Kaban
- Faculty, Department of Obstetrics and Gynecology, Haydarpasa Numune Teaching Hospital , Istanbul, Turkey
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Abstract
BACKGROUND The presence of multiple symptomatic pulmonary nodules and one cardiac tumour in a child requires urgent diagnosis and treatment. Until a few decades ago, the diagnosis of a cardiac tumour was difficult and was based on a high index of suspicion from indirect signs, and required angiocardiography for confirmation. Echocardiography and other imaging techniques have also helped in the detection of cardiac neoplasms. However, it is not always easy to make the correct diagnosis. CLINICAL CASE The case is presented of a 12 year-old boy with pulmonary symptoms, and diagnosed with a cardiac tumour with lung metastases. The presence of numerous pulmonary nodules was confirmed in our hospital. The echocardiogram detected a solid cardiac nodule in the right ventricle. Magnetic resonance imaging confirmed the findings and the diagnosis. Puncture-aspiration of a lung nodule gave the diagnosis of hydatidosis. He underwent open-heart surgery with cardiac cyst resection and treated with anthelmintics. The lung cysts were then excised, and he recovered uneventfully. DISCUSSION This child had multiple pulmonary nodules and a solid cardiac nodule, and was suspected of having a cardiac tumour with pulmonary metastases. However, given the clinical history, background and morphology of pulmonary nodules, another possible aetiology for consideration is echinococcosis. The clinical picture of cardiac hydatidosis and its complications is highly variable. The clinical history is essential in these cases, as well as having a high index of suspicion. CONCLUSION Hydatidosis should be included in the differential diagnosis of a solid, echogenic, cardiac nodule. The treatment for cardiopulmonary hydatid cysts is surgical, followed by anthelmintics.
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Affiliation(s)
- Marta Martín-Izquierdo
- Servicio de Pediatría y Puericultura, Clínica San Miguel, Igualatorio Médico Quirúrgico de Navarra, Pamplona, España
| | - Alejandro Martín-Trenor
- Departamento de Cardiología y Cirugía Cardíaca, Sección de Cirugía Cardíaca, Clínica Universidad de Navarra, Pamplona, España.
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Kim KY, Jin GY, Han YM, Lee YC, Jung MJ. Cryoablation of a small pulmonary nodule with pure ground-glass opacity: a case report. Korean J Radiol 2015; 16:657-61. [PMID: 25995697 PMCID: PMC4435997 DOI: 10.3348/kjr.2015.16.3.657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/10/2015] [Indexed: 11/15/2022] Open
Abstract
Treatments for pure ground-glass nodules (GGNs) include limited resection; however, surgery is not always possible in patients with limited pulmonary functional reserve. In such patients, cryoablation may be a suitable alternative to treat a pure GGN. Here, we report our initial experience with cryoablation of a pure GGN that remained after repeated surgical resection in a patient with multiple GGNs. A 5-mm-sized pure GGN in the left lower lobe was cryoablated successfully without recurrence at the 6-month follow-up.
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Affiliation(s)
- Kun Yung Kim
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Young Min Han
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Yong Chul Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Myung Ja Jung
- Department of Pathology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
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Al-Ameri A, Malhotra P, Thygesen H, Plant PK, Vaidyanathan S, Karthik S, Scarsbrook A, Callister MEJ. Risk of malignancy in pulmonary nodules: A validation study of four prediction models. Lung Cancer 2015; 89:27-30. [PMID: 25864782 DOI: 10.1016/j.lungcan.2015.03.018] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [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: 11/26/2014] [Revised: 02/24/2015] [Accepted: 03/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Clinical prediction models assess the likelihood of malignancy in pulmonary nodules detected by computed tomography (CT). This study aimed to validate four such models in a UK population of patients with pulmonary nodules. Three models used clinical and CT characteristics to predict risk (Mayo Clinic, Veterans Association, Brock University) with a fourth model (Herder et al. [4]) additionally incorporating (18)Fluorine-Fluorodeoxyglucose (FDG) avidity on positron emission tomography-computed tomography (PET-CT). MATERIALS AND METHODS The likelihood of malignancy was calculated for patients with pulmonary nodules (4-30mm diameter) and data used to calculate the area under the receiver operating characteristic curve (AUC) for each model. The models were used in a restricted cohort of patients based on each model's exclusion criteria and in the total cohort of all patients. RESULTS Two hundred and forty-four patients were studied, of whom 139 underwent FDG PET-CT. Ninety-nine (40.6%) patients were subsequently confirmed to have malignant nodules (33.2% primary lung cancer, 7.4% metastatic disease). The Mayo and Brock models performed similarly (AUC 0.895 and 0.902 respectively) and both were significantly better than the Veterans Association model (AUC 0.735, p<0.001 and p=0.002 respectively). In patients undergoing FDG PET-CT, the Herder model had significantly higher accuracy than the other three models (AUC 0.924). When the models were tested on all patients in the cohort (i.e. including those outside the original model inclusion criteria) AUC values were reduced, yet remained high especially for the Herder model (AUC 0.916). For sub-centimetre nodules, AUC values for the Mayo and Brock models were 0.788 and 0.852 respectively. CONCLUSIONS The Mayo and Brock models showed good accuracy for determining likelihood of malignancy in nodules detected on CT scan. In patients undergoing FDG PET-CT for nodule evaluation, the highest accuracy was seen for the model described by Herder et al. incorporating FDG avidity.
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Affiliation(s)
- Ali Al-Ameri
- Department of Respiratory Medicine, Pinderfields General Hospital, Wakefield, UK
| | - Puneet Malhotra
- Department of Respiratory Medicine, Whiston Hospital, Liverpool, UK
| | - Helene Thygesen
- Department of Biostatistical Support, Cancer Research UK Leeds Centre, Leeds, UK
| | - Paul K Plant
- Department of Respiratory Medicine, North Cumbria University Hospitals, Carlisle, UK
| | | | - Shishir Karthik
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK
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Lee CH, Tzao C, Chang TH, Chang WC, Huang GS, Lin CK, Lin HC, Hsu HH. Case of pulmonary cryptococcosis mimicking hematogeneous metastases in an immunocompetent patient: value of absent 18F-fluorodeoxyglucose uptake on positron emission tomography/CT scan. Korean J Radiol 2013; 14:540-3. [PMID: 23690726 PMCID: PMC3655313 DOI: 10.3348/kjr.2013.14.3.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/16/2012] [Indexed: 11/30/2022] Open
Abstract
The radiologic appearance of multiple discrete pulmonary nodules in immunocompetent patients, with cryptococcal infection, has been rarely described. We describe a case of pulmonary cryptococcosis, presenting with bilaterally and randomly distributed nodules on a computed tomography, mimicking hematogeneous metastases. Positron emission tomography does not demonstrate 18F-fluorodeoxyglucose (FDG) uptake, suggesting a low probability for malignancy, which is a crucial piece of information for clinicians when making a management decision. We find the absence of FDG uptake correlates with the pathologic finding of an infectious nodule, composed of fibrosis and necrosis.
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Affiliation(s)
- Chiao-Hua Lee
- Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan, Republic of China
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Patout M, Declercq PL, Pestel-Caron M, Louvel JP, Lamia B, Muir JF, Cuvelier A. [Acute respiratory failure due to Mycoplasma pneumonia]. Rev Mal Respir 2013; 30:780-4. [PMID: 24267769 DOI: 10.1016/j.rmr.2013.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2012] [Accepted: 02/16/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Respiratory infections due to Mycoplasma pneumoniae are typically mild and subacute. We report the case of a 40-year-old man hospitalized for acute respiratory distress in the context of an acute infection with Mycoplasma pneumoniae. Radiological and pulmonary function test were consistent with an acute infectious bronchiolitis. CASE REPORT The patient presented with isolated respiratory failure with profound hypoxemia requiring oxygen delivered at high concentration by face mask. The CT appearance of the lesions corresponded to a spread of bilateral micro-connected pulmonary nodules (a "tree-in-bud" pattern) associated with obstructive ventilatory disorder. The only pathogen identified by PCR on BAL and serology was Mycoplasma pneumoniae. The evolution was favorable with antibiotic therapy combined with corticosteroids. CONCLUSION Mycoplasma pneumoniae may be responsible for severe respiratory illness in the form of bronchiolitis. In the setting of severe acute community pneumoniae antibiotic treatment which is also effective against Mycoplasma pneumonia should be considered. In this case, corticosteroids may be an effective adjunct by their action on the small airways.
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Affiliation(s)
- M Patout
- UPRES EA 3830, service de pneumologie et soins intensifs respiratoires, institut hospitalo-universitaire de recherche biomédicale et d'innovation, université de Rouen, centre hospitalier universitaire de Rouen, 76031 Rouen, France
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Kim SJ, Lee JH, Lee ES, Kim IH, Park HJ, Shin C, Kim JH. A case of secondary syphilis presenting as multiple pulmonary nodules. Korean J Intern Med 2013; 28:231-5. [PMID: 23526483 PMCID: PMC3604614 DOI: 10.3904/kjim.2013.28.2.231] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/12/2011] [Accepted: 06/22/2011] [Indexed: 11/27/2022] Open
Abstract
Syphilis is a sexually transmitted disease caused by Treponema pallidum. The prevalence of this disease has recently increased worldwide. However, pulmonary involvement in secondary syphilis is extremely rare. A 51-year-old heterosexual male patient presented with multiple pulmonary nodules with reactive serology from the Venereal Disease Research Laboratory test and positive fluorescent treponemal antibody absorption testing. A hematogenous metastatic malignancy was suspected and an excisional lung biopsy was performed. Histopathological examination showed only central necrosis with abscess and plasma cell infiltration, but no malignant cells. The patient reported sexual contact with a prostitute 8 weeks previously and a penile lesion 6 weeks earlier. Physical examination revealed an erythematous papular rash on the trunk. Secondary syphilis with pulmonary nodules was suspected, and benzathine penicillin G, 2.4 million units, was administered. Subsequently, the clinical signs of syphilis improved and the pulmonary nodules resolved. The final diagnosis was secondary syphilis with pulmonary nodular involvement.
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Affiliation(s)
- Se Joong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Ju-Han Lee
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
| | - Eung-Seok Lee
- Department of Pathology, Korea University Ansan Hospital, Ansan, Korea
| | - Il-Hwan Kim
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
| | - Hyung Joo Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chol Shin
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Je Hyeong Kim
- Division of Pulmonary, Sleep and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
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Liu T, Kyrollos M, Kravcik S. Pulmonary hyalinizing granuloma in HIV/AIDS. Can J Infect Dis Med Microbiol 2007; 18:305-7. [PMID: 18923729 DOI: 10.1155/2007/208140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 07/18/2007] [Indexed: 11/17/2022]
Abstract
A 55-year-old man who was recently diagnosed with HIV/AIDS developed multiple bilateral pulmonary nodules after starting highly active antiretroviral therapy. Workup confirmed the diagnosis of pulmonary hyalinizing granuloma. This is the first described case of pulmonary hyalinizing granuloma in HIV/AIDS, and may represent a rare form of immune reconstitution inflammatory syndrome.
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Bauer S, Kim JE, La KS, Yoo Y, Lee KH, Park SH, Choung JT, Kim CW. Isolated pulmonary cryptococcosis in an immunocompetent boy. Korean J Pediatr 2011; 53:971-4. [PMID: 21218020 PMCID: PMC3012278 DOI: 10.3345/kjp.2010.53.11.971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 07/14/2010] [Accepted: 08/04/2010] [Indexed: 11/27/2022]
Abstract
Pulmonary cryptococcosis is rare in immunocompetent subjects. Here, we present the case of a 16-year-old boy who was referred to our pediatric department for the management of multiple consolidations detected on chest radiography, which was routinely performed when the patient was being evaluated for an ankle fracture. Fine needle aspiration biopsy was performed, and the definitive diagnosis was established as cryptococcal pneumonia. After 8 weeks of antifungal treatment, the pulmonary nodules on the chest radiographs disappeared.
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Affiliation(s)
- Siegfried Bauer
- Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea
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