Could new reconstruction CT techniques challenge MRI for the detection of brain metastases in the context of initial lung cancer staging?

State of the Art: Lung Cancer Staging Using Updated Imaging Modalities

Lung cancer is among the most common mortality causes worldwide. This scientific article is a comprehensive review of current knowledge regarding screening, subtyping, imaging, staging, and management of treatment response for lung cancer. The traditional imaging modality for screening and initial lung cancer diagnosis is computed tomography (CT). Recently, a dual-energy CT was proven to enhance the categorization of variable pulmonary lesions. The National Comprehensive Cancer Network (NCCN) recommends usage of fluorodeoxyglucose positron emission tomography (FDG PET) in concert with CT to properly stage lung cancer and to prevent fruitless thoracotomies. Diffusion MR is an alternative to FDG PET/CT that is radiation-free and has a comparable diagnostic performance. For response evaluation after treatment, FDG PET/CT is a potent modality which predicts survival better than CT. Updated knowledge of lung cancer genomic abnormalities and treatment regimens helps to improve the radiologists’ skills. Incorporating the radiologic experience is crucial for precise diagnosis, therapy planning, and surveillance of lung cancer.

The Application Value of Magnetic Resonance Imaging (MRI) in the Clinical Diagnosis in Hospital Management

Background & Objective

To evaluate the application value of dynamic enhanced magnetic resonance imaging (DCE-MRI) in the clinical diagnosis in hospital based on the fuzzy C-means clustering algorithm and conduct its cost-benefit analysis in practice.

Methods

This study was conducted from October 11th 2020 to November 25, 2020. Eighteen patients with lung cancer confirmed by pathology were collected and examined by DCE-MRI one day before and one month after surgery using a fuzzy C-means clustering algorithm. And then, taking Guang'an District People's Hospital as an example, the present paper conducts the cost-benefit analysis with the utilization of net present value (NPV).

Results

After 1-month review, eleven patients with effective treatment, four numerical Ktrans, Kep, Ve, Vp compared with preoperative decreased, which Ktrans, Kep, the change of the Ve was statistically significant (P < 0.05), the Vp of decline has no statistical significance (P > 0.05), the experimental and ineffective group after an operation, compared to four numerical Ktrans and Vp difference was statistically significant (P < 0.05), the corresponding AUC (area under the curve) to 1 and 0.818, the sensitivity of 100% and 85.7%, a specific degree of 100% and 72.7%. The NPV analysis results showed that the hospital could achieve profit and loss balance in the third year after purchasing MRI equipment and then gradually obtain positive cash inflow.

Conclusion

The application of MRI in the Clinical Diagnosis helps hospital promote the therapeutic effect, thus having great practical value, and also contributes to increasing benefits in the long run.

Multidisciplinary consensus statement on the clinical management of patients with stage III non-small cell lung cancer

Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.

Lung cancer staging: a concise update

Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.