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Tassi V, Scarnecchia E, Ferolla P, Mete O, Manjula M, Allison F, Potenza R, Vannucci J, Ceccarelli S, Yasufuku K, De Perrot M, Pierre A, Darling G, Colella R, Ascani S, Mattioli S, Keshavjee S, Waddell TK, Puma F, Daddi N. Prognostic Significance of Pulmonary Multifocal Neuroendocrine Proliferation With Typical Carcinoid. Ann Thorac Surg 2022; 113:966-974. [PMID: 33831394 DOI: 10.1016/j.athoracsur.2021.03.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The clinical significance of multifocal pulmonary neuroendocrine proliferation (MNEP), including tumorlets and pulmonary neuroendocrine cell hyperplasia, in association with typical carcinoid (TC), is still debated. METHODS We evaluated a retrospective series of TC with long-term follow-up data prospectively collected from 2 institutions and compared the outcome between TC alone and MNEP plus TC. Several baseline covariates were imbalanced between the MNEP plus TC and TC groups; therefore, we conducted 1:1 propensity score matching and inverse probability of treatment weighting in the full sample. In the matched group, the association of clinical, respiratory, and work-related factors with the group was determined through univariable and multivariable conditional logistic regression analysis. RESULTS A total of 234 TC patients underwent surgery: 41 MNEP plus TC (17.5%) and 193 TC alone (82.5%). In the MNEP plus TC group, older age (P < .001), peripheral tumors (P = .0032), smaller tumor size (P = .011), and lymph node spread (P = .02) were observed compared with the TC group. Relapses occurred in 8 patients in the MNEP plus TC group (19.5%) and 7 in the TC group (3.6%). After matching, in 36 pairs of patients, a significantly higher 5-year progression-free rate was observed for the TC group (P < .01). Similar results were observed using inverse probability of treatment weighting in the full sample. The odds of being in the MNEP plus TC group was higher for those with work-related exposure to inhalant agents (P = .008), asthma or bronchitis (P = .002), emphysema, fibrosis, and inflammatory status (P = .032), or micronodules on the chest computed tomography scan and respiratory insufficiency (P = .036). CONCLUSIONS The association with MNEP seems to represent a clinically and prognostic relevant factor in TC. Hence, careful preoperative workup, systematic pathologic evaluation, including nontumorous lung parenchyma, and long-term postoperative follow-up should be recommended in these patients.
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Affiliation(s)
- Valentina Tassi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Elisa Scarnecchia
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Piero Ferolla
- Multidisciplinary NET Group, Umbria Regional Cancer Network and University of Perugia, Perugia, Italy
| | - Ozgur Mete
- Department of Pathology, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Maganti Manjula
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Frances Allison
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Rossella Potenza
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Jacopo Vannucci
- Thoracic Surgery Unit, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Silvia Ceccarelli
- Thoracic Surgery Unit, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Marc De Perrot
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Andrew Pierre
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Gail Darling
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Renato Colella
- Pathology Unit, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Stefano Ascani
- Pathology Unit, Department of Medicine, Medical Clinic Section and Anatomical Pathology, Terni, Italy
| | - Sandro Mattioli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Thomas Kenneth Waddell
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Francesco Puma
- Thoracic Surgery Unit, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Niccolò Daddi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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Hurabielle C, Taillé C, Prévot G, Russier M, Didier A, Girodet PO, Colombat M, Mazières J, Guilleminault L. De-labeling severe asthma diagnosis: the challenge of DIPNECH. ERJ Open Res 2022; 8:00485-2021. [PMID: 35211620 PMCID: PMC8864625 DOI: 10.1183/23120541.00485-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pulmonary disease characterised by neuroendocrine cell hyperplasia within the bronchial epithelium [1]. The clinical presentation is characterised by nonspecific respiratory symptoms such as chronic cough, dyspnoea and bronchospasm. Given the rarity of the disease and the low specificity of symptoms, the diagnosis of DIPNECH is challenging and the time between symptom onset and diagnosis is long [1]. DIPNECH comprises a generalised proliferation of scattered neuroendocrine cells, small nodules (neuroendocrine bodies) or a linear proliferation of pulmonary neuroendocrine cells. It has been suggested that DIPNECH may mimic [2] or precede [3] asthma. The role of products of neuroendocrine cells such as substance P, which contribute to eosinophil migration, has been suggested to explain asthma symptoms in DIPNECH [3]. However, the characteristics of patients with DIPNECH who have symptoms suggestive of asthma have never been described. The aim of our study was to determine whether patients diagnosed with DIPNECH and initially referred for severe asthma management had specific characteristics. DIPNECH is a differential diagnosis of severe asthma with no specific biomarkers. Chronic cough and multiple nodules on CT should prompt clinicians to consider this diagnosis. Differentiating DIPNECH from severe asthma remains crucial.https://bit.ly/3mmFbQn
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Chung C, Bommart S, Marchand-Adam S, Lederlin M, Fournel L, Charpentier MC, Groussin L, Wislez M, Revel MP, Chassagnon G. Long-Term Imaging Follow-Up in DIPNECH: Multicenter Experience. J Clin Med 2021; 10:jcm10132950. [PMID: 34209147 PMCID: PMC8268818 DOI: 10.3390/jcm10132950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare pre-invasive disease whose pathophysiology remains unclear. We aimed to assess long-term evolution in imaging of DIPNECH, in order to propose follow-up recommendations. Patients with histologically confirmed DIPNECH from four centers, evaluated between 2001 and 2020, were enrolled if they had at least two available chest computed tomography (CT) exams performed at least 24 months apart. CT exams were analyzed for the presence and the evolution of DIPNECH-related CT findings. Twenty-seven patients, mostly of female gender (n = 25/27; 93%) were included. Longitudinal follow-up over a median 63-month duration (IQR: 31–80 months) demonstrated an increase in the size of lung nodules in 19 patients (19/27, 70%) and the occurrence of metastatic spread in three patients (3/27, 11%). The metastatic spread was limited to mediastinal lymph nodes in one patient, whereas the other two patients had both lymph node and distant metastases. The mean time interval between baseline CT scan and metastatic spread was 70 months (14, 74 and 123 months). Therefore, long-term annual imaging follow-up of DIPNECH might be appropriate to encompass the heterogeneous longitudinal behavior of this disease.
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Affiliation(s)
- Cécile Chung
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
| | - Sébastien Bommart
- Radiology Department, CHU Montpellier, Hôpital Arnaud de Villeneuve, 34090 Montpellier, France;
- Université de Montpellier, PHYMEDEXP-INSERM U1046-CNRS UMR 9214, 34000 Montpellier, France
| | - Sylvain Marchand-Adam
- Pulmonology Department, Université François Rabelais, CHU Tours, Hôpital Bretonneau, 37000 Tours, France;
| | - Mathieu Lederlin
- Department of Radiology, University of Rennes, University Hospital of Rennes, 35033 Rennes, France;
| | - Ludovic Fournel
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Thoracic Surgery Department, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
| | | | - Lionel Groussin
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Department of Endocrinology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
| | - Marie Wislez
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Oncology Thoracic Unit Pulmonology Department, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France
- Université de Paris, Centre de Recherche des Cordeliers, Inserm, «Inflammation, Complement, and Cancer», 75006 Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
| | - Guillaume Chassagnon
- Department of Radiology, AP-HP. Centre, Hôpital Cochin, 75014 Paris, France; (C.C.); (M.-P.R.)
- Université de Paris, 85 Boulevard Saint-Germain, 75006 Paris, France; (L.F.); (L.G.); (M.W.)
- Correspondence:
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A 68-year-old woman with a diagnosis of asthma and multiple fleeting pulmonary nodules- a case report. Respir Med Case Rep 2020; 31:101250. [PMID: 33294353 PMCID: PMC7683343 DOI: 10.1016/j.rmcr.2020.101250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 12/02/2022] Open
Abstract
Diffuse idiopathic pulmonary neuroendocrine cell (DIPNECH syndrome) remains unfamiliar to most clinicians even though it was first described almost 30 years ago. Diagnosis is usually confirmed histopathologically after lung biopsy, but often, a diagnosis or suspected diagnosis can be made radiographically. In this paper, we present a case report of a 68-year-old female with shortness of breath and fleeting pulmonary nodules observed on chest CT scan. She was initially misdiagnosed with asthma based on an abnormal pulmonary function test which revealed an obstructive ventilatory defect. The classic radiographic findings of DIPNECH syndrome and the typical patient demographics that should arouse suspicion of a DIPNECH diagnosis were also illustrated. DIPNECH syndrome is a clinicopathological syndrome whereas focal NECH is a pathological diagnosis that is often made incidentally on histological examination and is encountered in a variety of settings, including in resected carcinoid tumors, in the context of reactive changes concomitant with infection, in metastatic cancer, radiation pneumonitis, intra-lobar sequestration, smokers, interstitial lung disease, and lung adenocarcinoma. There are no proven treatments for DIPNECH syndrome. In patients with obstructive ventilatory symptoms, bronchodilators with inhaled steroids are usually prescribed. Some severe cases may require parenteral steroids. Somatostatin analogs (SSA) have also been used in some cases with mixed results. Rapamycin has been used in several cases based on the purported activation of the mammalian target of rapamycin (mTOR) in DIPNECH. Some patients with large carcinoid tumors may benefit from resection. DIPNECH syndrome is a clinicopathological diagnosis and should not be confused with incidental findings of reactive NECH after surgical lung biopsy. DIPNECH syndrome should be suspected in any non-smoking females that present with symptoms of obstructive lung disease and mosaic attenuation on the expiratory film of HRCT of the chest. DIPNECH syndrome has a favorable natural course with good prognosis in most patients. Most patients with symptoms of dyspnea and cough will respond to bronchodilators and ICS. Occasionally, parenteral steroids might be needed in those with severe symptoms. Octreotide scans can be used to identify patients that might benefit from SSA. Sirolimus has also been tried in a few cases with an excellent response.
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Pedro J, Cunha FM, Neto V, Hespanhol V, Martins DF, Guimarães S, Varela A, Carvalho D. Coexistence of DIPNECH and carotid body paraganglioma: is it just a coincidence? Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190141. [PMID: 32408270 PMCID: PMC7274547 DOI: 10.1530/edm-19-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023] Open
Abstract
SUMMARY We describe the case of a 56 year-old woman with the almost simultaneous appearance of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) and a carotid body paraganglioma. Of interest, 6 years earlier, the patient underwent total thyroidectomy due to papillary thyroid carcinoma and, in the meantime, she was submitted to mastectomy to treat an invasive ductal carcinoma of the breast. In order to explain these lesions, an extensive genetic study was performed. Results showed positivity for the presence of the tumor suppressor gene PALB2, whose presence had already been detected in a niece with breast cancer. The patient underwent different procedures to treat the lesions and currently she is symptom-free over 2 years of follow-up. LEARNING POINTS The presence of two rare neoplasms in a single person should raise the suspicion of a common etiology. To the best of our knowledge, this is the first case that shows the coexistence of DIPNECH and paraganglioma. The contribution of the PALB2 gene in the etiology of these rare neoplasms is a possibility.
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Affiliation(s)
- J Pedro
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
| | - F M Cunha
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - V Neto
- Department of Pneumology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - V Hespanhol
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Department of Pneumology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - D F Martins
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S Guimarães
- Department of Pathology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - A Varela
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - D Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine of Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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Malczewska A, Oberg K, Bodei L, Aslanian H, Lewczuk A, Filosso PL, Wójcik-Giertuga M, Rydel M, Zielińska-Leś I, Walter A, Suarez AL, Kolasińska-Ćwikła A, Roffinella M, Jamidar P, Ziora D, Czyżewski D, Kos-Kudła B, Ćwikła J. NETest Liquid Biopsy Is Diagnostic of Lung Neuroendocrine Tumors and Identifies Progressive Disease. Neuroendocrinology 2019; 108:219-231. [PMID: 30654372 PMCID: PMC7472425 DOI: 10.1159/000497037] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/22/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND There are no effective biomarkers for the management of bronchopulmonary carcinoids (BPC). We examined the utility of a neuroendocrine multigene transcript "liquid biopsy" (NETest) in BPC for diagnosis and monitoring of the disease status. AIM To independently validate the utility of the NETest in diagnosis and management of BPC in a multicenter, multinational, blinded study. MATERIAL AND METHODS The study cohorts assessed were BPC (n = 99), healthy controls (n = 102), other lung neoplasia (n = 101) including adenocarcinomas (ACC) (n = 41), squamous cell carcinomas (SCC) (n = 37), small-cell lung cancer (SCLC) (n = 16), large-cell neuroendocrine carcinoma (LCNEC) (n = 7), and idiopathic pulmonary fibrosis (IPF) (n = 50). BPC were histologically classified as typical (TC) (n = 62) and atypical carcinoids (AC) (n = 37). BPC disease status determination was based on imaging and RECIST 1.1. NETest diagnostic metrics and disease status accuracy were evaluated. The upper limit of normal (NETest) was 20. Twenty matched tissue-blood pairs were also evaluated. Data are means ± SD. RESULTS NETest levels were significantly increased in BPC (45 ± 25) versus controls (9 ± 8; p < 0.0001). The area under the ROC curve was 0.96 ± 0.01. Accuracy, sensitivity, and specificity were: 92, 84, and 100%. NETest was also elevated in SCLC (42 ± 32) and LCNEC (28 ± 7). NETest accurately distinguished progressive (61 ± 26) from stable disease (35.5 ± 18; p < 0.0001). In BPC, NETest levels were elevated in metastatic disease irrespective of histology (AC: p < 0.02; TC: p = 0.0006). In nonendocrine lung cancers, ACC (18 ± 21) and SCC (12 ± 11) and benign disease (IPF) (18 ± 25) levels were significantly lower compared to BPC level (p < 0.001). Significant correlations were evident between paired tumor and blood samples for BPC (R: 0.83, p < 0.0001) and SCLC (R: 0.68) but not for SCC and ACC (R: 0.25-0.31). CONCLUSIONS Elevated -NETest levels are indicative of lung neuroendocrine neoplasia. NETest levels correlate with tumor tissue and imaging and accurately define clinical progression.
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Affiliation(s)
- Anna Malczewska
- Yale University School of Medicine, New Haven, Connecticut, USA
- Medical University of Silesia, Katowice, Poland
| | | | - Lisa Bodei
- Memorial Sloan Kettering Cancer Center, New York, New York, USA,
| | - Harry Aslanian
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | | | | | | | | | | - Priya Jamidar
- Yale University School of Medicine, New Haven, Connecticut, USA
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Martin-Deleon R, Llabrés de Prada M, López-Giraldo A. Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia Causing Chronic Cough. Arch Bronconeumol 2018; 54:577. [PMID: 29880314 DOI: 10.1016/j.arbres.2018.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/23/2018] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Roberto Martin-Deleon
- Departamento de Neumología, Instituto Respiratorio, Hospital Clínic de Barcelona, Barcelona, España
| | - Marta Llabrés de Prada
- Departamento de Neumología, Instituto Respiratorio, Hospital Clínic de Barcelona, Barcelona, España
| | - Alejandra López-Giraldo
- Departamento de Neumología, Instituto Respiratorio, Hospital Clínic de Barcelona, Barcelona, España.
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Diffuse Idiopathic Pulmonary Neuroendocrine Cell Hyperplasia (DIPNECH) Syndrome and Carcinoid Tumors With/Without NECH. Am J Surg Pathol 2018; 42:646-655. [PMID: 29438170 DOI: 10.1097/pas.0000000000001033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Winningham PJ, Martínez-Jiménez S, Rosado-de-Christenson ML, Betancourt SL, Restrepo CS, Eraso A. Bronchiolitis: A Practical Approach for the General Radiologist. Radiographics 2017; 37:777-794. [DOI: 10.1148/rg.2017160131] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peter J. Winningham
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Santiago Martínez-Jiménez
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Melissa L. Rosado-de-Christenson
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Sonia L. Betancourt
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Carlos S. Restrepo
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
| | - Andrés Eraso
- From the Division of Thoracic Imaging, Department of Radiology, University of Missouri-Kansas City, St Luke’s Hospital, 4401 Wornall Rd, Kansas City, MO 64111 (P.J.W., S.M.J., M.L.R.d.C.); Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex (S.L.B.); Department of Cardiothoracic Radiology, University of Texas Health Science Center at
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