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Fu BJ, Zhang XC, Lv FJ, Chu ZG. Potential Role of Intrapulmonary Concomitant Lesions in Differentiating Non-Neoplastic and Neoplastic Ground Glass Nodules. J Inflamm Res 2023; 16:6155-6166. [PMID: 38107382 PMCID: PMC10725751 DOI: 10.2147/jir.s437419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To determine the value of intrapulmonary concomitant lesions in differentiating non-neoplastic and neoplastic ground-glass nodules (GGNs). Patients and Methods From January 2014 to March 2022, 395 and 583 patients with confirmed non-neoplastic and neoplastic GGNs were retrospectively enrolled. Their clinical and chest CT data were evaluated. The CT features of target GGNs and intrapulmonary concomitant lesions in these two groups were analyzed and compared, and the role of intrapulmonary concomitant lesions in improving differentiation was evaluated. Results The intrapulmonary concomitant lesions were more common in patients with non-neoplastic GGNs than in those with neoplastic ones (87.88% vs 82.18%, P = 0.015). Specifically, patients with non-neoplastic GGNs had a higher incidence of multiple solid nodules (SNs), patchy ground-glass opacity/consolidation, and fibrosis/calcification in any lung fields (each P < 0.05). Logistic regression analysis indicated that patients < 44 years old, diameter < 7.35 mm, irregular shape, and coarse margin or ill-defined boundary for target GGN, pleural thickening, and concomitant SNs in the same lobe and fibrosis or calcification in any lung field were independent indicators for predicting non-neoplastic GGNs. The AUC of the model for predicting non-neoplastic GGNs increased from 0.894 to 0.926 (sensitivity, 83.10%; specificity, 87.10%) after including the concomitant lesions in the patients' clinical characteristics and CT features of target GGNs (P < 0.0001). Conclusion Besides the patients' clinical characteristics and CT features of target GGNs, the concomitant multiple SNs in the same lobe and fibrosis/calcification in any lung field should be considered in further differentiating non-neoplastic and neoplastic GGNs.
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Affiliation(s)
- Bin-Jie Fu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiao-Chuan Zhang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Department of Radiology, Chonggang General Hospital, Chongqing, People’s Republic of China
| | - Fa-Jin Lv
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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2
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Jiang J, Lv FJ, Tao Y, Fu BJ, Li WJ, Lin RY, Chu ZG. Differentiation of pulmonary solid nodules attached to the pleura detected by thin-section CT. Insights Imaging 2023; 14:146. [PMID: 37697104 PMCID: PMC10495292 DOI: 10.1186/s13244-023-01504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Pulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs. RESULTS From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients' age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037-3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235-8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161-4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567-17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847-12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526-16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001). CONCLUSION In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant. CRITICAL RELEVANCE STATEMENT The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection. KEY POINTS • The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.
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Affiliation(s)
- Jin Jiang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yang Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Udelsman BV, Blasberg JD. Using the robotic platform in the therapy of multifocal ground glass opacities. J Surg Oncol 2023; 127:262-268. [PMID: 36465021 DOI: 10.1002/jso.27154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 12/07/2022]
Abstract
Due to their association with invasive adenocarcinoma, ground glass opacities that reach 3 cm in size, develop a solid component ≥2 mm on mediastinal windows, or exhibit ≥25% annual growth warrant operative resection. Minimally invasive techniques are preferred given that approximately one third of patients will present with multifocal focal disease and may require additional operations. A robotic-assisted thoracoscopic surgical approach can be used with percutaneous or bronchoscopic localization techniques and are compatible with developing intraoperative molecular targeting techniques.
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Affiliation(s)
- Brooks V Udelsman
- Division of Thoracic Surgery, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Yale University School of Medicine, New Haven, Connecticut, USA
| | - Justin D Blasberg
- Division of Thoracic Surgery, Yale-New Haven Hospital, New Haven, Connecticut, USA.,Yale University School of Medicine, New Haven, Connecticut, USA
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Liu XL, Lv FJ, Fu BJ, Lin RY, Li WJ, Chu ZG. Correlations Between Inflammatory Cell Infiltration and Relative Density and the Boundary Manifestation of Pulmonary Non-Neoplastic Ground Glass Nodules. J Inflamm Res 2023; 16:1147-1155. [PMID: 36945317 PMCID: PMC10024903 DOI: 10.2147/jir.s399953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose To investigate the influence factors for the various boundary manifestations of pulmonary non-neoplastic ground glass nodules (GGNs) on computed tomography (CT). Materials and Methods From January 2015 to March 2022, a total of 280 patients with 318 non-neoplastic GGNs were enrolled. The correlations between degree of inflammatory cell infiltration and relative density (ΔCT) and the boundary manifestations of lesions were evaluated, respectively. Results Nongranulomatous nodules (283, 89.0%) with fibrous tissue proliferation and/or inflammatory cells as the predominant pathological findings were the most common non-neoplastic GGNs, followed by granulomatous nodules (28, 8.8%). Among nongranulomatous GGNs, cases with more and less/no inflammatory cells were 15 (10.9%) and 122 (89.1%) in 137 well-defined ones with smooth margin, 16 (24.6%) and 49 (75.4%) in 65 well-defined ones with coarse margin, 43 (91.5%) and 4 (8.5%) in 47 ill-defined ones with higher ΔCT (>151HU), and 4 (11.8%) and 30 (88.2%) in 34 ill-defined ones with lower ΔCT (< 151HU). The proportion of cases with more inflammatory cells in well-defined nodules was similar to that in ill-defined ones with lower ΔCT (P = 0.587) but significantly lower than that in ill-defined ones with higher ΔCT (P < 0.001). Among the granulomatous nodules, ill-defined cases with higher ΔCT (16, 57.1%) were the most common, and they (7/8, 87.5%) frequently had changes during short-term follow-up. Conclusion Nongranulomatous nodules are the most common non-neoplastic GGNs, their diverse boundary manifestations closely correlate with degree of inflammatory cell infiltration and density difference.
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Affiliation(s)
- Xiang-Ling Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Zhi-Gang Chu, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1# Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86 18723032809, Fax +86 23 68811487, Email
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5
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Liang X, Liu M, Li M, Zhang L. Clinical and CT Features of Subsolid Pulmonary Nodules With Interval Growth: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:929174. [PMID: 35860567 PMCID: PMC9289285 DOI: 10.3389/fonc.2022.929174] [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: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEstablishing risk-based follow-up management strategies is crucial to the surveillance of subsolid pulmonary nodules (SSNs). However, the risk factors for SSN growth are not currently clear. This study aimed to perform a systematic review and meta-analysis to identify clinical and CT features correlated with SSN growth.MethodsRelevant studies were retrieved from Web of Science, PubMed, Cochrane Library, and EMBASE. The correlations of clinical and CT features with SSN growth were pooled using a random-effects model or fixed-effects model depending on heterogeneity, which was examined by the Q test and I2 test. Pooled odds ratio (OR) or pooled standardized mean differences (SMD) based on univariate analyses were calculated to assess the correlation of clinical and CT features with SSN growth. Pooled ORs based on multivariate analyses were calculated to find out independent risk factors to SSN growth. Subgroup meta-analysis was performed based on nodule consistency (pure ground-glass nodule (pGGN) and part-solid nodule (PSN). Publication bias was examined using funnel plots.ResultsNineteen original studies were included, consisting of 2444 patients and 3012 SSNs. The median/mean follow-up duration of these studies ranged from 24.2 months to 112 months. Significant correlations were observed between SSN growth and eighteen features. Male sex, history of lung cancer, nodule size > 10 mm, nodule consistency, and age > 65 years were identified as independent risk factors for SSN growth based on multivariate analyses results. Eight features, including male sex, smoking history, nodule size > 10 mm, larger nodule size, air bronchogram, higher mean CT attenuation, well-defined border, and lobulated margin were detected to be significantly correlated with pGGNs growth. Smoking history showed no significant correlation with pGGN growth based on the multivariate analysis results.ConclusionsEighteen clinical and CT features were identified to be correlated with SSN growth, among which male sex, history of lung cancer, nodule size > 10 mm, nodule consistency and age > 65 years were independent risk factors while history of lung cancer was not correlated with pGGN growth. These factors should be considered when making risk-based follow-up plans for SSN patients.
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Lin RY, Lv FJ, Fu BJ, Li WJ, Liang ZR, Chu ZG. Features for Predicting Absorbable Pulmonary Solid Nodules as Depicted on Thin-Section Computed Tomography. J Inflamm Res 2021; 14:2933-2939. [PMID: 34239316 PMCID: PMC8259943 DOI: 10.2147/jir.s318125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the clinical and computed tomography (CT) characteristics of absorbable pulmonary solid nodules (PSNs) and to clarify CT features for distinguishing absorbable PSNs from malignant ones. Materials and Methods From January 2015 to February 2021, a total of 316 patients with 348 PSNs (171 absorbable and 177 size-matched malignant) were retrospectively enrolled. Their clinical and CT data were analyzed and compared to determine CT features for predicting absorbable PSNs. Results Between absorbable and malignant PSNs, there were significant differences in patients' age, lesions' locations, shapes, homogeneity, borders, distance from the pleura, vacuoles, air bronchograms, lobulation, spiculation, halo sign, multiple concomitant nodules and pleural indentation (each P < 0.05). Multivariate analysis revealed that the independent predictors of absorbable PSNs were the following: patient age ≤55 years (OR, 2.660; 95% CI, 1.432-4.942; P = 0.002), homogeneous density (OR, 2.487; 95% CI, 1.107-5.590; P = 0.027), ill-defined border (OR, 5.445; 95% CI, 1.661-17.846; P = 0.005), halo sign (OR, 3.135; 95% CI, 1.154-8.513; P = 0.025), multiple concomitant nodules (OR, 8.700; 95% CI, 4.401-17.197; P<0.001), and abutting pleura (OR, 3.759; 95% CI, 1.407-10.044; P = 0.008). The indicators for malignant PSNs were the following: lobulation (OR, 3.904; 95% CI, 1.956-7.791; P<0.001), spiculation (OR, 4.980; 95% CI, 2.202-11.266, P<0.001), and pleural indentation (OR, 4.514; 95% CI, 1.223-16.666; P = 0.024). Conclusion In patients younger than 55 years, PSNs with homogeneous density, ill-defined border, halo sign, multiple concomitant nodules, and abutting pleura should be highly suspected as absorbable ones.
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Affiliation(s)
- Rui-Yu Lin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhang-Rui Liang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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7
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Azour L, Ko JP, Washer SL, Lanier A, Brusca-Augello G, Alpert JB, Moore WH. Incidental Lung Nodules on Cross-sectional Imaging: Current Reporting and Management. Radiol Clin North Am 2021; 59:535-549. [PMID: 34053604 DOI: 10.1016/j.rcl.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary nodules are the most common incidental finding in the chest, particularly on computed tomographs that include a portion or all of the chest, and may be encountered more frequently with increasing utilization of cross-sectional imaging. Established guidelines address the reporting and management of incidental pulmonary nodules, both solid and subsolid, synthesizing nodule and patient features to distinguish benign nodules from those of potential clinical consequence. Standard nodule assessment is essential for the accurate reporting of nodule size, attenuation, and morphology, all features with varying risk implications and thus management recommendations.
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Affiliation(s)
- Lea Azour
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA.
| | - Jane P Ko
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA
| | - Sophie L Washer
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA
| | - Amelia Lanier
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA
| | - Geraldine Brusca-Augello
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA
| | - Jeffrey B Alpert
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, Center for Biomedical Imaging, 660 First Avenue, New York, NY 10016, USA
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8
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Ye X, Fan W, Wang Z, Wang J, Wang H, Wang J, Wang C, Niu L, Fang Y, Gu S, Tian H, Liu B, Zhong L, Zhuang Y, Chi J, Sun X, Yang N, Wei Z, Li X, Li X, Li Y, Li C, Li Y, Yang X, Yang W, Yang P, Yang Z, Xiao Y, Song X, Zhang K, Chen S, Chen W, Lin Z, Lin D, Meng Z, Zhao X, Hu K, Liu C, Liu C, Gu C, Xu D, Huang Y, Huang G, Peng Z, Dong L, Jiang L, Han Y, Zeng Q, Jin Y, Lei G, Zhai B, Li H, Pan J. [Expert Consensus for Thermal Ablation of Pulmonary Subsolid Nodules (2021 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:305-322. [PMID: 33896152 PMCID: PMC8174112 DOI: 10.3779/j.issn.1009-3419.2021.101.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
局部热消融技术在肺部结节治疗领域正处在起步与发展阶段,为了肺结节热消融治疗的临床实践和规范发展,由“中国医师协会肿瘤消融治疗技术专家组”“中国医师协会介入医师分会肿瘤消融专业委员会”“中国抗癌协会肿瘤消融治疗专业委员会”“中国临床肿瘤学会消融专家委员会”组织多学科国内有关专家,讨论制定了“热消融治疗肺部亚实性结节专家共识(2021年版)”。主要内容包括:①肺部亚实性结节的临床评估;②热消融治疗肺部亚实性结节技术操作规程、适应证、禁忌证、疗效评价和相关并发症;③存在的问题和未来发展方向。
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Affiliation(s)
- Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510050, China
| | - Zhongmin Wang
- Department of Interventional Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China
| | - Hui Wang
- Interventional Center, Jilin Provincial Cancer Hospital, Changchun 170412, China
| | - Jun Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Chuntang Wang
- Department of Thoracic Surgery, Dezhou Second People's Hospital, Dezhou 253022, China
| | - Lizhi Niu
- Department of Oncology, Affiliated Fuda Cancer Hospital, Jinan University, Guangzhou 510665, China
| | - Yong Fang
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Shanzhi Gu
- Department of Interventional Radiology, Hunan Cancer Hospital, Changsha 410013, China
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Baodong Liu
- Department of Thoracic Surgery, Xuan Wu Hospital Affiliated to Capital Medical University, Beijing 100053, China
| | - Lou Zhong
- Thoracic Surgery Department, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Yiping Zhuang
- Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xichao Sun
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Nuo Yang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xiao Li
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiaoguang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, Beijing 100730, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, China
| | - Chunhai Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yan Li
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Wuwei Yang
- Department of Oncology, The Fifth Medical Center, Chinese PLA General Hospital, Beijing 100071, China
| | - Po Yang
- Interventionael & Vascular Surgery, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - Zhengqiang Yang
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yueyong Xiao
- Department of Radiology, Chinese PLA Gneral Hospital, Beijing 100036, China
| | - Xiaoming Song
- Department of Thoracic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou 277500, China
| | - Shilin Chen
- Department of Thoracic Surgery, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Weisheng Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian 350011, China
| | - Zhengyu Lin
- Department of Intervention, The First Affiliated Hospital of Fujian Medical University, Fujian 350005, China
| | - Dianjie Lin
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Zhiqiang Meng
- Minimally Invasive Therapy Center, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Kaiwen Hu
- Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - Chen Liu
- Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100161, China
| | - Cheng Liu
- Department of Radiology, Shandong Medical Imaging Research Institute, Jinan 250021, China
| | - Chundong Gu
- Department of Thoracic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, China
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China
| | - Yong Huang
- Department of Imaging, Affiliated Cancer Hospital of Shandong First Medical University, Jinan 250117, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Afliated to Shandong First Medical University, Jinan 250101, China
| | - Zhongmin Peng
- Department of Thoracic Surgery , Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Liang Dong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Lei Jiang
- Department of Radiology, The Convalescent Hospital of East China, Wuxi 214063, China
| | - Yue Han
- Department of Interventional Therapy, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qingshi Zeng
- Department of Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan 250014, China
| | - Yong Jin
- Interventionnal Therapy Department, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Guangyan Lei
- Department of Thoracic Surgery, Shanxi Provincial Cancer Hospital, Xi'an 710061, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Hailiang Li
- Department of Interventional Radiology, Henan Cancer Hospital, Zhengzhou 450003, China
| | - Jie Pan
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Li WJ, Lv FJ, Tan YW, Fu BJ, Chu ZG. Pulmonary Benign Ground-Glass Nodules: CT Features and Pathological Findings. Int J Gen Med 2021; 14:581-590. [PMID: 33679139 PMCID: PMC7930605 DOI: 10.2147/ijgm.s298517] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
Background Some pulmonary ground-glass nodules (GGNs) are benign and frequently misdiagnosed due to lack of understanding of their CT characteristics. This study aimed to reveal the CT features and corresponding pathological findings of pulmonary benign GGNs to help improve diagnostic accuracy. Patients and Methods From March 2016 to October 2019, patients with benign GGNs confirmed by operation or follow-up were enrolled retrospectively. According to overall CT manifestations, GGNs were classified into three types: I, GGO with internal high-attenuation zone; II, nodules lying on adjacent blood vessels; and other type, lesions without obvious common characteristics. CT features and pathological findings of each nodule type were evaluated. Results Among the 40 type I, 25 type II, and 14 other type GGNs, 24 (60.0%), 19 (76.0%), and 10 (71.4%) nodules were resected, respectively. Type I GGNs were usually irregular (25 of 40, 62.5%) with only one high-attenuation zone (38 of 40, 95.0%) (main pathological components: thickened alveolar walls with inflammatory cells, fibrous tissue, and exudation), which was usually centric (24 of 40, 60.0%), having blurred margin (38 of 40, 95.0%), and connecting to blood vessels (32 of 40, 80.0%). The peripheral GGO (main pathological component: a small amount of inflammatory cell infiltration with fibrous tissue proliferation) was usually ill-defined (28 of 40, 70.0%). Type II GGNs (main pathological components: focal interstitial fibrosis with or without inflammatory cell infiltration) lying on adjacent vessel branches were usually irregular (19 of 25, 76.0%) and well defined (16 of 25, 64.0%) but showed coarse margins (15 of 16, 93.8%). Other type GGNs had various CT manifestations but their pathological findings were similar to that of type II. Conclusion For subsolid nodules with CT features manifested in type I or II GGNs, follow-up should be firstly considered in further management.
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Affiliation(s)
- Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Yi-Wen Tan
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Bin-Jie Fu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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10
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Hu D, Zhen T, Ruan M, Wu L. The value of percentile base on computed tomography histogram in differentiating the invasiveness of adenocarcinoma appearing as pure ground-glass nodules. Medicine (Baltimore) 2020; 99:e23114. [PMID: 33157987 PMCID: PMC7647573 DOI: 10.1097/md.0000000000023114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To investigate the value of percentile base on computed tomography (CT) histogram analysis for distinguishing invasive adenocarcinoma (IA) from adenocarcinoma in situ (AIS) or micro invasive adenocarcinoma (MIA) appearing as pure ground-glass nodules.A total of 42 cases of pure ground-glass nodules that were surgically resected and pathologically confirmed as lung adenocarcinoma between January 2015 and May 2019 were included. Cases were divided into IA and AIS/MIA in the study. The percentile on CT histogram was compared between the 2 groups. Univariate and multivariate logistic regression were used to determine which factors demonstrated a significant effect on invasiveness. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) was used to evaluate the predictive ability of individual characteristics and the combined model.The 4 histogram parameters (25th percentile, 55th percentile, 95th percentile, 97.5th percentile) and the combined model all showed a certain diagnostic value. The combined model demonstrated the best diagnostic performance. The AUC values were as follows: 25th percentile = 0.693, 55th percentile = 0.706, 95th percentile = 0.713, 97.5th percentile = 0.710, and combined model = 0.837 (all P < .05).The percentile of histogram parameters help to improve the ability to radiologically determine the invasiveness of lung adenocarcinoma appearing as pure ground-glass nodules.
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Affiliation(s)
- Dacheng Hu
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Tao Zhen
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Mei Ruan
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Linyu Wu
- Department of Radiology, the First Affiliated Hospital of Zhejiang Chinese Medical University
- The First Clinical Medical College of Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
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11
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Azour L, Ko JP, Naidich DP, Moore WH. Shades of Gray: Subsolid Nodule Considerations and Management. Chest 2020; 159:2072-2089. [PMID: 33031828 PMCID: PMC7534873 DOI: 10.1016/j.chest.2020.09.252] [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: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022] Open
Abstract
Subsolid nodules are common on chest CT imaging and may be either benign or malignant. Their varied features and broad differential diagnoses present management challenges. Although subsolid nodules often represent lung adenocarcinomas, other possibilities are common and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review highlights the similarities and differences among these algorithms, with the intent of providing a resource for comparison and aid in choosing management options.
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Affiliation(s)
- Lea Azour
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY.
| | - Jane P Ko
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
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12
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Liu B, Ye X. Computed tomography-guided percutaneous microwave ablation: A novel perspective to treat multiple pulmonary ground-glass opacities. Thorac Cancer 2020; 11:2385-2388. [PMID: 32748566 PMCID: PMC7471011 DOI: 10.1111/1759-7714.13601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Baodong Liu
- Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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13
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Huang C, Lv W, Zhou C, Mao L, Xu Q, Li X, Qi L, Xia F, Li X, Zhang Q, Zhang L, Lu G. Discrimination between transient and persistent subsolid pulmonary nodules on baseline CT using deep transfer learning. Eur Radiol 2020; 30:6913-6923. [PMID: 32696253 DOI: 10.1007/s00330-020-07071-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/17/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop and validate a deep learning model to discriminate transient from persistent subsolid nodules (SSNs) on baseline CT. METHODS A cohort of 1414 SSNs, consisting of 319 transient SSNs in 168 individuals and 1095 persistent SSNs in 816 individuals, were identified on chest CT. The cohort was assigned by examination date into a development set of 996 SSNs, a tuning set of 212 SSNs, and a validation set of 206 SSNs. Our model was built by transfer learning, which was transferred from a well-performed deep learning model for pulmonary nodule classification. The performance of the model was compared with that of two experienced radiologists. Each nodule was categorized by Lung CT Screening Reporting and Data System (Lung-RADS) to further evaluate the performance and the potential clinical benefit of the model. Two methods were employed to visualize the learned features. RESULTS Our model achieved an AUC of 0.926 on the validation set with an accuracy of 0.859, a sensitivity of 0.863, and a specificity of 0.858, and outperformed the radiologists. The model performed the best among Lung-RADS 2 nodules and maintained well performance among Lung-RADS 4 nodules. Feature visualization demonstrated the model's effectiveness in extracting features from images. CONCLUSIONS The transfer learning model presented good performance on the discrimination between transient and persistent SSNs. A reliable diagnosis on nodule persistence can be achieved at baseline CT; thus, an early diagnosis as well as better patient care is available. KEY POINTS • Deep learning can be used for the discrimination between transient and persistent subsolid nodules. • A transfer learning model can achieve good performance when it is transferred from a model with a similar task. • With the assistance of deep learning model, a reliable diagnosis on nodule persistence can be achieved at baseline CT, which can bring a better patient care strategy.
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Affiliation(s)
- Chuxi Huang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Wenhui Lv
- Department of Medical Imaging, Jinling Hospital, Southern Medical University, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Changsheng Zhou
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Li Mao
- Deepwise AI Lab, Deepwise Inc, No.8, Haidian Avenue, Beijing, 100080, China
| | - Qinmei Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Xinyu Li
- Department of Medical Imaging, Jinling Hospital, Southern Medical University, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Li Qi
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Fei Xia
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Xiuli Li
- Deepwise AI Lab, Deepwise Inc, No.8, Haidian Avenue, Beijing, 100080, China
| | - Qirui Zhang
- Department of Medical Imaging, Jinling Hospital, Southern Medical University, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, No.305, Zhongshan East Road, Nanjing, 210002, China.,Department of Medical Imaging, Jinling Hospital, Southern Medical University, No.305, Zhongshan East Road, Nanjing, 210002, China
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, No.305, Zhongshan East Road, Nanjing, 210002, China. .,Department of Medical Imaging, Jinling Hospital, Southern Medical University, No.305, Zhongshan East Road, Nanjing, 210002, China.
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14
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Kang S, Kim TH, Shin JM, Han K, Kim JY, Min B, Park CH. Optimization of a chest computed tomography protocol for detecting pure ground glass opacity nodules: A feasibility study with a computer-assisted detection system and a lung cancer screening phantom. PLoS One 2020; 15:e0232688. [PMID: 32442174 PMCID: PMC7244125 DOI: 10.1371/journal.pone.0232688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/19/2020] [Indexed: 12/18/2022] Open
Abstract
Objective This study aimed to optimize computed tomography (CT) parameters for detecting ground glass opacity nodules (GGNs) using a computer-assisted detection (CAD) system and a lung cancer screening phantom. Methods A lung cancer screening phantom containing 15 artificial GGNs (−630 Hounsfield unit [HU], 2–10 mm) in the left lung was examined with a CT scanner. Three tube voltages of 80, 100, and 120 kVp were used in combination with five tube currents of 25, 50, 100, 200, and 400 mA; additionally, three slice thicknesses of 0.625, 1.25, and 2.5 mm and four reconstruction algorithms of adaptive statistical iterative reconstruction (ASIR-V) of 30, 60, and 90% were used. For each protocol, accuracy of the CAD system was evaluated for nine target GGNs of 6, 8, or 10 mm in size. The cut-off size was set to 5 mm to minimize false positives. Results Among the 180 combinations of tube voltage, tube current, slice thickness, and reconstruction algorithms, combination of 80 kVp, 200 mA, and 1.25-mm slice thickness with an ASIR-V of 90% had the best performance in the detection of GGNs with six true positives and no false positives. Other combinations had fewer than five true positives. In particular, any combinations with a 0.625-mm slice thickness had 0 true positive and at least one false positive result. Conclusion Low-voltage chest CT with a thin slice thickness and a high iterative reconstruction algorithm improve the detection rate of GGNs with a CAD system in a phantom model, and may have potential in lung cancer screening.
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Affiliation(s)
- Seongmin Kang
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Shin
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology and the Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Young Kim
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Chul Hwan Park
- Department of Radiology and the Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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15
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Development and validation of a radiomics nomogram for identifying invasiveness of pulmonary adenocarcinomas appearing as subcentimeter ground-glass opacity nodules. Eur J Radiol 2019; 112:161-168. [PMID: 30777206 DOI: 10.1016/j.ejrad.2019.01.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to develop and validate a radiomics-based nomogram for differentiation of pre-invasive lesions from invasive lesions that appearing as ground-glass opacity nodules (GGNs) ≤10 mm (sub-centimeter) in diameter at CT. A total of 542 consecutive patients with 626 pathologically confirmed pulmonary subcentimeter GGNs were retrospectively studied from October 2011 to September 2017. All the GGNs were divided into a training set (n = 334) and a validation set (n = 292). Researchers extracted 475 radiomics features from the plain CT images; a radiomics signature was constructed with the least absolute shrinkage and selection operator (LASSO) based on multivariable regression in the training set. Based on the multivariable logistic regression model, a radiomics nomogram was developed in the training set. The performance of the nomogram was evaluated with respect to its calibration, discrimination, and clinical-utility and this was assessed in the validation set. The constructed radiomics signature, which consisted of 15 radiomics features, was significantly associated with the invasiveness of subcentimeter GGNs (P < 0.0001 for both training set and validation set). To build the nomogram model, radiomics signature and mean CT value were used. The nomogram model demonstrated good discrimination and calibration in both training set (C-index, 0.716 [95% CI, 0.632 to 0.801]) and validation set (C-index, 0.707 [95% CI, 0.625 to 0.788]). Decision curve analysis (DCA) indicated that radiomics-based nomogram was clinically useful. A radiomics-based nomogram that incorporates both radiomics signature and mean CT value is constructed in the study, which can be conveniently used to facilitate the preoperative individualized prediction of the invasiveness in patients with subcentimeter GGNs.
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16
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Godoy MC, Odisio EG, Erasmus JJ, Chate RC, dos Santos RS, Truong MT. Understanding Lung-RADS 1.0: A Case-Based Review. Semin Ultrasound CT MR 2018; 39:260-272. [DOI: 10.1053/j.sult.2018.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Chung K, Ciompi F, Scholten ET, Goo JM, Prokop M, Jacobs C, van Ginneken B, Schaefer-Prokop CM. Visual discrimination of screen-detected persistent from transient subsolid nodules: An observer study. PLoS One 2018; 13:e0191874. [PMID: 29438443 PMCID: PMC5810988 DOI: 10.1371/journal.pone.0191874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose To evaluate whether, and to which extent, experienced radiologists are able to visually correctly differentiate transient from persistent subsolid nodules from a single CT examination alone and to determine CT morphological features to make this differentiation. Materials and methods We selected 86 transient and 135 persistent subsolid nodules from the National Lung Screening Trial (NLST) database. Four experienced radiologists visually assessed a predefined list of morphological features and gave a final judgment on a continuous scale (0–100). To assess observer performance, area under the receiver operating characteristic (ROC) curve was calculated. Statistical differences of morphological features between transient and persistent lesions were calculated using Chi-square. Inter-observer agreement of morphological features was evaluated by percentage agreement. Results Forty-nine lesions were excluded by at least 2 observers, leaving 172 lesions for analysis. On average observers were able to differentiate transient from persistent subsolid nodules ≥ 10 mm with an area under the curve of 0.75 (95% CI 0.67–0.82). Nodule type, lesion margin, presence of a well-defined border, and pleural retraction showed significant differences between transient and persistent lesions in two observers. Average pair-wise percentage agreement for these features was 81%, 64%, 47% and 89% respectively. Agreement for other morphological features varied from 53% to 95%. Conclusion The visual capacity of experienced radiologists to differentiate persistent and transient subsolid nodules is moderate in subsolid nodules larger than 10 mm. Performance of the visual assessment of CT morphology alone is not sufficient to generally abandon a short-term follow-up for subsolid nodules.
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Affiliation(s)
- Kaman Chung
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Francesco Ciompi
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ernst T. Scholten
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Colin Jacobs
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bram van Ginneken
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelia M. Schaefer-Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands
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18
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Same-Day Computed Tomographic Chest Imaging for Pulmonary Nodule Targeting with Electromagnetic Navigation Bronchoscopy May Decrease Unnecessary Procedures. Ann Am Thorac Soc 2018; 13:2223-2228. [PMID: 27925781 DOI: 10.1513/annalsats.201607-522bc] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
RATIONALE Bronchoscopy is commonly used for the diagnosis of suspicious pulmonary nodules discovered on computed tomographic (CT) imaging of the chest. Procedural CT imaging for bronchoscopy planning is often completed weeks to months before the date of a scheduled bronchoscopy, which may not allow discovery of a decrease in nodule size or resolution before the bronchoscopic procedure. OBJECTIVES To determine whether same-day CT imaging of the chest discovers partial or total resolution of some lung nodules and thereby reduces unnecessary bronchoscopic procedures. METHODS We performed a prospective case series study of patients undergoing navigational bronchoscopy using a new technology requiring same-day preprocedural CT imaging at one university teaching hospital. Patients scheduled to undergo bronchoscopy who were found to have partial or complete resolution of their lesion on the same-day CT exam leading to the cancellation of their procedure were identified and further characterized. MEASUREMENTS AND MAIN RESULTS From January 2015 to June 2016, 116 patients were scheduled for navigational bronchoscopy for the diagnosis of a pulmonary lesion. Of the 116 patients scheduled, 8 (6.9%) had a decrease in size or resolution of their lesion, leading to the cancellation of their procedure. The number needed to screen to prevent one unnecessary procedure was 15. For cancelled cases, the average time from initial CT prompting referral for bronchoscopy to the day of procedure scan was 53 days. CONCLUSIONS Time from initial imaging to day of procedure is variable, occasionally allowing enough time for lesions to resolve, thereby obviating the need for biopsy. Same-day imaging may decrease unnecessary procedural risk.
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Li W, Wang X, Zhang Y, Li X, Li Q, Ye Z. Radiomic analysis of pulmonary ground-glass opacity nodules for distinction of preinvasive lesions, invasive pulmonary adenocarcinoma and minimally invasive adenocarcinoma based on quantitative texture analysis of CT. Chin J Cancer Res 2018; 30:415-424. [PMID: 30210221 PMCID: PMC6129571 DOI: 10.21147/j.issn.1000-9604.2018.04.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To identify the differences among preinvasive lesions, minimally invasive adenocarcinomas (MIAs) and invasive pulmonary adenocarcinomas (IPAs) based on radiomic feature analysis with computed tomography (CT). Methods A total of 109 patients with ground-glass opacity lesions (GGOs) in the lungs determined by CT examinations were enrolled, all of whom had received a pathologic diagnosis. After the manual delineation and segmentation of the GGOs as regions of interest (ROIs), the patients were subdivided into three groups based on pathologic analyses: the preinvasive lesions (including atypical adenomatous hyperplasia and adenocarcinoma in situ) subgroup, the MIA subgroup and the IPA subgroup. Next, we obtained the texture features of the GGOs. The data analysis was aimed at finding both the differences between each pair of the groups and predictors to distinguish any two pathologic subtypes using logistic regression. Finally, a receiver operating characteristic (ROC) curve was applied to accurately evaluate the performances of the regression models.
Results We found that the voxel count feature (P<0.001) could be used as a predictor for distinguishing IPAs from preinvasive lesions. However, the surface area feature (P=0.040) and the extruded surface area feature (P=0.013) could be predictors of IPAs compared with MIAs. In addition, the correlation feature (P=0.046) could distinguish preinvasive lesions from MIAs better. Conclusions Preinvasive lesions, MIAs and IPAs can be discriminated based on texture features within CT images, although the three diseases could all appear as GGOs on CT images. The diagnoses of these three diseases are very important for clinical surgery.
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Affiliation(s)
- Wei Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xuexiang Wang
- Department of Radiology, Tianjin Hongqiao Hospital, Tianjin 300130, China
| | - Yuwei Zhang
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xubin Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Affiliation(s)
- Julien G Cohen
- Pôle Imagerie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.,Grenoble Alpes Université, Grenoble, France
| | - Gilbert R Ferretti
- Pôle Imagerie, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.,Grenoble Alpes Université, Grenoble, France
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21
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Miller AR. Multiple sub-solid nodules: Different or just more? Respirology 2017; 22:1493-1494. [DOI: 10.1111/resp.13110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Alistair R. Miller
- Monash Lung and Sleep, Monash Health; Monash University; Melbourne Victoria Australia
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22
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Hutchinson BD, Moreira AL, Ko JP. Spectrum of Subsolid Pulmonary Nodules and Overdiagnosis. Semin Roentgenol 2017; 52:143-155. [PMID: 28734396 DOI: 10.1053/j.ro.2017.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Barry D Hutchinson
- Department of Radiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY.
| | - Andre L Moreira
- Department of Pathology, NYU Langone Medical Center, NYU School of Medicine, New York, NY
| | - Jane P Ko
- Department of Radiology, NYU Langone Medical Center, NYU School of Medicine, New York, NY
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23
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Malignancy estimation of Lung-RADS criteria for subsolid nodules on CT: accuracy of low and high risk spectrum when using NLST nodules. Eur Radiol 2017; 27:4672-4679. [PMID: 28439653 PMCID: PMC5635094 DOI: 10.1007/s00330-017-4842-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 12/19/2022]
Abstract
Purpose Lung-RADS proposes malignancy probabilities for categories 2 (<1%) and 4B (>15%). The purpose of this study was to quantify and compare malignancy rates for Lung-RADS 2 and 4B subsolid nodules (SSNs) on a nodule base. Methods We identified all baseline SSNs eligible for Lung-RADS 2 and 4B in the National Lung Screening Trial (NLST) database. Solid cores and nodule locations were annotated using in-house software. Malignant SSNs were identified by an experienced radiologist using NLST information. Malignancy rates and percentages of persistence were calculated. Results Of the Lung-RADS 2SSNs, 94.3% (1790/1897) could be located on chest CTs. Likewise, 95.1% (331/348) of part-solid nodules ≥6 mm in diameter could be located. Of these, 120 had a solid core ≥8 mm, corresponding to category 4B. Category 2 SSNs showed a malignancy rate of 2.5%, exceeding slightly the proposed rate of <1%. Category 4B SSNs showed a malignancy rate of 23.9%. In both categories one third of benign lesions were transient. Conclusion Malignancy probabilities for Lung-RADS 2 and 4B generally match malignancy rates in SSNs. An option to include also category 2 SSNs for upgrade to 4X designed for suspicious nodules might be useful in the future. Integration of short-term follow-up to confirm persistence would prevent unnecessary invasive work-up in 4B SSNs. Key points • Malignancy probabilities for Lung-RADS 2/4B generally match malignancy risks in SSNs. • Transient rate between low-risk Lung-RADS 2 and high-risk 4B lesions were similar. • Upgrade of highly suspicious Lung-RADS 2 SSNs to Lung-RADS 4X might be useful. • Up to one third of the benign high-risk Lung-RADS 4B lesions were transient. • Short-term follow-up confirming persistence would avoid unnecessary invasive work-up of 4B lesions.
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Wang T, Yan T, Wan F, Ma S, Wang K, Wang J, Song J, He W, Bai J, Jin L. [Surgical Treatment of Small Pulmonary Nodules Under Video-assisted Thoracoscopy
(A Report of 129 Cases)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:35-40. [PMID: 28103971 PMCID: PMC5973285 DOI: 10.3779/j.issn.1009-3419.2017.01.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
背景与目的 影像技术的发展导致肺部微小结节尤其是肺磨玻璃结节(ground-glass opacity, GGO)检出逐年增多,但术前定性困难。本研究探讨肺部微小结节的临床诊断及微创手术治疗的必要性和可行性、病理诊断,微创切除及淋巴结切除的手术方式。 方法 对2013年12月-2016年11月接受电视胸腔镜手术(video-assisted thoracic surgery, VATS)治疗并有明确病理诊断的共129例患者的临床资料回顾性分析。所有患者术前行薄层计算机断层扫描(computed tomography, CT)扫描,其中21个微小结节术前行CT引导下Hook-wire定位,并根据病理性质及患者身体状况采用不同手术方式。 结果 共129个微小结节,实性结节(solid pulmonary nodule, SPN)37个,恶性比例是24.3%(9/37),术后病理结果为:肺原发性鳞状细胞癌3个,浸润性腺癌(invasive adenocarcioma, IA)3个,转移癌2个,小细胞肺癌(small cell lung cancer, SCLC)1个,错构瘤16个,其他炎症等良性病变12个;49个混合性GGO(mixed ground-glass opacity, mGGO)的恶性比例是63.3%(31/49),术后病理结果为:IA 19个,微浸润腺癌(micro invasive adenocarcioma, MIA)6个,原位腺癌(adenocarcioma in situ, AIS)4个,非典型性腺瘤样增生(atipical adenomatous hyperplasia, AAH)1个,SCLC 1个,炎症等良性病变18个;43个纯GGO(pure ground-glass opacity, pGGO)的恶性比例是86.0%(37/43),术后病理结果为:AIS 19个,MIA 6个,IA 6个,AAH 6个,炎症等良性病变6个;GGO总的恶性比例是73.9%(68/92)。52个良性病变均采用VATS肺楔形切除;原发性非小细胞肺癌(non-small cell lung cancer, NSCLC)共73例,VATS肺叶切除和淋巴结清扫33例,VATS肺楔形切除和选择性淋巴结切除6例,VATS肺段切除和选择性淋巴结切除6例,VATS肺楔形切除28例;2个转移癌和2个SCLC,采用VATS肺楔形切除术。另有6例患者术中冰冻病理存在误差,其中2例选择二次手术行肺叶切除和淋巴结清扫。45例有淋巴结病理结果NSCLC只有两例以SPN为表现的IA出现纵隔淋巴结转移,其余均未出现淋巴结转移。术后随访1个月-35个月,平均(15.1±10.2)个月,无复发及转移。 结论 肺部微小结节尤其是GGO,是恶性病灶的概率大,应积极外科处理;围手术期应与患者及家属充分告知冰冻病理结果存在误差可能性,避免医疗纠纷。
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Affiliation(s)
- Tong Wang
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Feng Wan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Shaohua Ma
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Keyi Wang
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jingdi Wang
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jintao Song
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Wei He
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jie Bai
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Liang Jin
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
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Abstract
Ground glass opacity (GGO) is a good prognostic indicator for lung cancer and is useful for physicians to predict prognosis. Due to recent advances in computed tomography (CT), the chance to encounter GGO is rapidly increasing in clinical practice. Based on the studies on radiological pathological correlation, GGO represents pathological lepidic growth and consolidation on CT represents pathologically invasive components. Thus, consolidation tumor ratio 0.5 or less means pathological less invasiveness for lung cancer. Not a few studies have shown that sublobar resection is equivalent to lobectomy for radiological early lung cancers. Additionally, observation of GGO is one of the options for physicians. Indication of surgical intervention remains unclear. Physician observing GGO in practice should know the natural history of GGO to reach an optimal treatment decision. For multifocal GGO lesions clinical management is surely challenging. Whack-a-mole strategy, which means sublobar resection for radiological invasive cancer is one of the most promising strategies for such lesions.
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Affiliation(s)
- Kenji Suzuki
- General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Chung K, Jacobs C, Scholten ET, Goo JM, Prosch H, Sverzellati N, Ciompi F, Mets OM, Gerke PK, Prokop M, van Ginneken B, Schaefer-Prokop CM. Lung-RADS Category 4X: Does It Improve Prediction of Malignancy in Subsolid Nodules? Radiology 2017; 284:264-271. [PMID: 28339311 DOI: 10.1148/radiol.2017161624] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Purpose To evaluate the added value of Lung CT Screening Reporting and Data System (Lung-RADS) assessment category 4X over categories 3, 4A, and 4B for differentiating between benign and malignant subsolid nodules (SSNs). Materials and Methods SSNs on all baseline computed tomographic (CT) scans from the National Lung Cancer Trial that would have been classified as Lung-RADS category 3 or higher were identified, resulting in 374 SSNs for analysis. An experienced screening radiologist volumetrically segmented all solid cores and located all malignant SSNs visible on baseline scans. Six experienced chest radiologists independently determined which nodules to upgrade to category 4X, a recently introduced category for lesions that demonstrate additional features or imaging findings that increase the suspicion of malignancy. Malignancy rates of purely size-based categories and category 4X were compared. Furthermore, the false-positive rates of category 4X lesions were calculated and observer variability was assessed by using Fleiss κ statistics. Results The observers upgraded 15%-24% of the SSNs to category 4X. The malignancy rate for 4X nodules varied from 46% to 57% per observer and was substantially higher than the malignancy rates of categories 3, 4A, and 4B SSNs without observer intervention (9%, 19%, and 23%, respectively). On average, the false-positive rate for category 4X nodules was 7% for category 3 SSNs, 7% for category 4A SSNs, and 19% for category 4B SSNs. Of the falsely upgraded benign lesions, on average 27% were transient. The agreement among the observers was moderate, with an average κ value of 0.535 (95% confidence interval: 0.509, 0.561). Conclusion The inclusion of a 4X assessment category for lesions suspicious for malignancy in a nodule management tool is of added value and results in high malignancy rates in the hands of experienced radiologists. Proof of the transient character of category 4X lesions at short-term follow-up could avoid unnecessary invasive management. © RSNA, 2017.
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Affiliation(s)
- Kaman Chung
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Colin Jacobs
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Ernst T Scholten
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Jin Mo Goo
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Helmut Prosch
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Nicola Sverzellati
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Francesco Ciompi
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Onno M Mets
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Paul K Gerke
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Mathias Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Bram van Ginneken
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
| | - Cornelia M Schaefer-Prokop
- From the Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, the Netherlands (K.C., C.J., E.T.S., F.C., P.K.G., M.P., B.v.G., C.M.S.P.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (H.P.); Division of Radiology, Department of Clinical Sciences, University of Parma, Parma, Italy (N.S.); Department of Radiology, University Medical Center Utrecht, the Netherlands (O.M.M.); and Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.P.)
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Silva M, Bankier AA, Centra F, Colombi D, Ampollini L, Carbognani P, Sverzellati N. Longitudinal evolution of incidentally detected solitary pure ground-glass nodules on CT: relation to clinical metrics. Diagn Interv Radiol 2016; 21:385-90. [PMID: 26140697 DOI: 10.5152/dir.2015.14457] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE We aimed to assess the relation between basic clinical parameters and evolution of solitary pure ground-glass nodules (pGGN) in the lungs. METHODS Baseline and follow-up computed tomography (CT) of patients with solitary pGGN were selected and two radiologists independently reviewed CTs for nodule characterization. CT features of solitary pGGN were manually measured maximum diameter (D1) and its orthogonal diameter (D2), mean diameter (mD), D1 to D2 ratio as surrogate of roundness, and location according to lobar anatomy. Longitudinal changes were assessed and solitary pGGNs were classified as resolved or persisting. Persisting nodules were further classified as stable or grown according to an increase in mD of ≥2 mm or appearance of solid component. Baseline CT features of solitary pGGNs and clinical metrics of patients were compared between resolved and persisting nodules and, thereafter, between stable and grown lesions. RESULTS A total of 95 subjects with solitary pGGN were included. After a median 16-month follow-up, 20 nodules resolved, while 75 persisted. Among persisting nodules, 18 were grown and 57 were stable. Grown nodules showed larger D1 and mD compared with stable pGGNs (P < 0.001). Subjects with grown nodules were older (P = 0.021). Logistic regression analyses showed higher likelihood of growth for nodules ≥10 mm (odds ratio [OR], 8.355; P = 0.001) and subjects older than 67 years (OR, 3.656; P = 0.034). CONCLUSION Nodules ≥10 mm in subjects older than 67 years showed higher likelihood of growth. These data could contribute to a more individual approach to the management of solitary pGGN.
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Affiliation(s)
- Mario Silva
- Section of Radiology, Department of Surgery, University Hospital of Parma, Italy; Section of Cardiothoracic Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Cohen JG, Reymond E, Jankowski A, Brambilla E, Arbib F, Lantuejoul S, Ferretti GR. Lung adenocarcinomas: correlation of computed tomography and pathology findings. Diagn Interv Imaging 2016; 97:955-963. [PMID: 27639313 DOI: 10.1016/j.diii.2016.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Abstract
Adenocarcinoma is the most common histologic type of lung cancer. Recent lung adenocarcinoma classifications from the International Association for the Study of Lung cancer, the American Thoracic Society and the European Respiratory Society (IASLC/ETS/ERS, 2011) and World Health Organization (WHO, 2015) define a wide range of adenocarcinoma types and subtypes featuring different prognosis and management. This spectrum of lesions translates into various CT presentations and features, which generally show good correlation with histopathology, stressing the key role of the radiologist in the diagnosis and management of those patients. This review aims at helping radiologists to understand the basics of the up-to-date adenocarcinoma pathological classifications, radio-pathological correlations and how to use them in the clinical setting, as well as other imaging-related correlations (radiogenomics, quantitative analysis, PET-CT).
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Affiliation(s)
- J G Cohen
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France.
| | - E Reymond
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - A Jankowski
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - E Brambilla
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - F Arbib
- Clinique universitaire de pneumologie, pôle d'oncologie, CHU A.-Michallon, 38043 Grenoble, France.
| | - S Lantuejoul
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - G R Ferretti
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France.
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Wang T, Ma S, Yan T, Song J, Wang K, He W, Bai J. [Computed Tomography Guided Hook-wire Precise Localization and Minimally Invasive Resection of Pulmonary Nodules]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2016; 18:680-5. [PMID: 26582223 PMCID: PMC6000314 DOI: 10.3779/j.issn.1009-3419.2015.11.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
背景与目的 肺小结节尤其是磨玻璃结节(ground glass opacity, GGO)病灶的定位是微创手术切除的难点,报道的方法很多但均有不足。本研究旨在探讨计算机断层扫描(computed tomography, CT)引导下Hook-wire术前定位在胸腔镜下(video-assisted thoracoscopic surgery, VATS)肺结节切除术中的临床应用价值,并初步探讨GGOs积极微创手术治疗的必要性和可行性。 方法 2013年5月-2015年6月共25例患者的26枚肺结节于术前行CT引导下Hook-wire定位,然后施行胸腔镜楔形切除术。统计Hook-wire定位时间、成功率、并发症及楔形切除时间、住院时间等,计算病灶组织学分型中的恶性几率,讨论肺部GGOs积极手术治疗的必要性。 结果 共25例患者26个结节(男性10例,女性15例,6个实性结节,20个GGOs),病灶直径5 mm-20 mm(平均8 mm),病灶距离胸膜垂直距离5 mm-30 mm(平均14 mm),CT引导下Hook-wire定位成功率为100%。VATS楔形切除术成功率为100%。CT定位时间平均10 min(5 min-15 min),微创切除病灶所需时间平均20 min(15 min-40 min),平均住院时间为4 d(3 d-6 d)。4例患者定位后发生微量气胸,但无需闭式引流处理。术中定位针脱落1例,但仍于胸腔镜下观察到穿刺点脏层胸膜下血肿后,准确定位并成功切除。20个GGOs术后组织学诊断结果为:16个混合性GGOs(mixed GGO, mGGO)中,微浸润腺癌2例,腺癌5例,小细胞肺癌(small cell lung cancer, SCLC)1例,炎性病灶8例;4个纯GGOs(pure GGO, pGGO)中原位腺癌1例,非典型性腺瘤样增生(atypical adenomatoid hyperplasia, AAH)1例,炎性病灶2例。 结论 CT引导下Hook-wire肺结节尤其是GGOs术前定位准确率高,相关并发症轻微,是一种安全、有效的方法,能快速确定下一步诊疗方案,值得临床推广;肺部mGGOs是恶性病灶的几率很大,积极微创手术治疗是非常必要的。
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Affiliation(s)
- Tong Wang
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Shaohua Ma
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jintao Song
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Keyi Wang
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Wei He
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jie Bai
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China
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Quantitative Computed Tomography Imaging Biomarkers in the Diagnosis and Management of Lung Cancer. Invest Radiol 2016; 50:571-83. [PMID: 25811833 DOI: 10.1097/rli.0000000000000152] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tumor diameter has traditionally been used as a standard metric in terms of diagnosis and prognosis prediction of lung cancer. However, recent advances in imaging techniques and data analyses have enabled novel quantitative imaging biomarkers that can characterize disease status more comprehensively and/or predict tumor behavior more precisely. The most widely used imaging modality for lung tumor assessment is computed tomography. Therefore, we focused on computed tomography imaging biomarkers such as tumor volume and mass, ground-glass opacities, perfusion parameters, as well as texture features in this review. Herein, we first appraised the conventional 1- or 2-dimensional measurement with brief discussion on their limits and then introduced the potential imaging biomarkers with emphasis on the current understanding of their clinical usefulness with respect to the malignancy differentiation, treatment response monitoring, and patient outcome prediction.
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Zhang L, Li M, Wu N, Chen Y. Time Trends in Epidemiologic Characteristics and Imaging Features of Lung Adenocarcinoma: A Population Study of 21,113 Cases in China. PLoS One 2015; 10:e0136727. [PMID: 26317971 PMCID: PMC4552856 DOI: 10.1371/journal.pone.0136727] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/08/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study aims to describe time trends of epidemiologic characteristics and imaging features over 14 years among histologically confirmed lung adenocarcinoma (ADC) in China and to discuss the possible reasons for these changes. MATERIALS AND METHODS Data of 21,113 pathologically confirmed lung cancer patients from January 1999 to December 2012 were analyzed retrospectively. Preoperative high-resolution computer tomography (HRCT) images were available and reviewed in 5,439 lung ADC patients since 2005. Time trends of the ADC proportion of lung cancer cases, gender distribution, age at diagnosis, the proportion of early-stage ADC and imaging features were investigated. RESULTS The proportion of ADC increased during the 14 years (P = 0.000). The ratio of female to male ADC cases was higher than both squamous cell carcinoma (SQCC) and total lung cancer cases (P = 0.000). The median age at diagnosis of ADC patients was younger than that of both SQCC and total lung cancer during the 14 years (P = 0.000). The proportion of age group 45-59 years increased in total lung cancer cases (P = 0.000). When stratified by lung cancer histopathologic subtypes, this trend was also observed in ADC (P = 0.001) and SQCC (P = 0.007). The proportion of early-stage cases of ADC increased from 2008 to 2012 (P < 0.001). The proportion of subsolid nodules (SSN) in ADC increased (P = 0.001) from 2005 to 2012. CONCLUSION The data suggests that the proportion of ADC increased from 1999 to 2012 especially in middle-aged, female patients; early-stage ADC and SSN on HRCT images gradually increased, which may have been caused by a change in smoking habits and increased application of HRCT.
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Affiliation(s)
- Li Zhang
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Meng Li
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- PET-CT Center, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- * E-mail:
| | - Yuheng Chen
- Cancer Foundation of China, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Jin X, Zhao SH, Gao J, Wang DJ, Wu J, Wu CC, Chang RP, Ju HY. CT characteristics and pathological implications of early stage (T1N0M0) lung adenocarcinoma with pure ground-glass opacity. Eur Radiol 2015; 25:2532-40. [PMID: 25725775 DOI: 10.1007/s00330-015-3637-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To analyze the CT characteristics and pathological classification of early lung adenocarcinoma (T1N0M0) with pure ground-glass opacity (pGGO). METHODS Ninety-four lesions with pGGO on CT in 88 patients with T1N0M0 lung adenocarcinoma were selected from January 2010 to December 2012. All lesions were confirmed by pathology. CT appearances were analyzed including lesion location, size, density, uniformity, shape, margin, tumour-lung interface, internal and surrounding malignant signs. Lesion size and density were compared using analysis of variance, lesion size also assessed using ROC curves. Gender of patients, lesion location and CT appearances were compared using χ²-test. RESULTS There were no significant differences in gender, lesion location and density with histological invasiveness (P > 0.05). The ROC curve showed that the possibility of invasive lesion was 88.73% when diameter of lesion was more than 10.5 mm. There was a significant difference between lesion uniformity and histological invasiveness (P = 0.01). There were significant differences in margin, tumour-lung interface, air bronchogram with histological invasiveness ( P = 0.02,P = 0.00,P = 0.048). The correlation index of lesion size and uniformity was r = 0.45 (P = 0.00). CONCLUSIONS The lesion size and uniformity, tumour-lung interface and the air bronchogram can help predict invasive extent of early stage lung adenocarcinoma with pGGO. KEY POINTS • CT characteristics and pathological classification of pGGO lung adenocarcinoma smaller than 3 cm • The optimal cut-off value for discriminating preinvasive from invasive lesions was 10.5 mm • Uniformity was significant difference between histological subtypes and correlated with lesion size • Tumour margin, tumour-lung interface and air bronchogram showed different between histological types • No significant difference in gender, lesion location and density with histological subtypes.
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Affiliation(s)
- Xin Jin
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China
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Marshall HM, Bowman RV, Yang IA, Fong KM, Berg CD. Screening for lung cancer with low-dose computed tomography: a review of current status. J Thorac Dis 2014; 5 Suppl 5:S524-39. [PMID: 24163745 DOI: 10.3978/j.issn.2072-1439.2013.09.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 09/10/2013] [Indexed: 12/19/2022]
Abstract
Screening using low-dose computed tomography (CT) represents an exciting new development in the struggle to improve outcomes for people with lung cancer. Randomised controlled evidence demonstrating a 20% relative lung cancer mortality benefit has led to endorsement of screening by several expert bodies in the US and funding by healthcare providers. Despite this pivotal result, many questions remain regarding technical and logistical aspects of screening, cost-effectiveness and generalizability to other settings. This review discusses the rationale behind screening, the results of on-going trials, potential harms of screening and current knowledge gaps.
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Affiliation(s)
- Henry M Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia; ; University of Queensland Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
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Manos D, Seely JM, Taylor J, Borgaonkar J, Roberts HC, Mayo JR. The Lung Reporting and Data System (LU-RADS): A Proposal for Computed Tomography Screening. Can Assoc Radiol J 2014; 65:121-34. [DOI: 10.1016/j.carj.2014.03.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 03/12/2014] [Indexed: 02/08/2023] Open
Abstract
Despite the positive outcome of the recent randomized trial of computed tomography (CT) screening for lung cancer, substantial implementation challenges remain, including the clear reporting of relative risk and suggested workup of screen-detected nodules. Based on current literature, we propose a 6-level Lung-Reporting and Data System (LU-RADS) that classifies screening CTs by the nodule with the highest malignancy risk. As the LU-RADS level increases, the risk of malignancy increases. The LU-RADS level is linked directly to suggested follow-up pathways. Compared with current narrative reporting, this structure should improve communication with patients and clinicians, and provide a data collection framework to facilitate screening program evaluation and radiologist training. In overview, category 1 includes CTs with no nodules and returns the subject to routine screening. Category 2 scans harbor minimal risk, including <5 mm, perifissural, or long-term stable nodules that require no further workup before the next routine screening CT. Category 3 scans contain indeterminate nodules and require CT follow up with the interval dependent on nodule size (small [5-9 mm] or large [≥10 mm] and possibly transient). Category 4 scans are suspicious and are subdivided into 4A, low risk of malignancy; 4B, likely low-grade adenocarcinoma; and 4C, likely malignant. The 4B and 4C nodules have a high likelihood of neoplasm simply based on screening CT features, even if positron emission tomography, needle biopsy, and/or bronchoscopy are negative. Category 5 nodules demonstrate frankly malignant behavior on screening CT, and category 6 scans contain tissue-proven malignancies.
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Affiliation(s)
- Daria Manos
- Department of Diagnostic Radiology, QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean M. Seely
- Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jana Taylor
- McGill Health Center, Montreal General Site, McGill University, Montreal, Quebec, Canada
| | - Joy Borgaonkar
- Department of Diagnostic Radiology, QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heidi C. Roberts
- Department of Medical Imaging, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John R. Mayo
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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Godoy MCB, Truong MT, Sabloff B, Naidich DP. Subsolid pulmonary nodule management and lung adenocarcinoma classification: state of the art and future trends. Semin Roentgenol 2014; 48:295-307. [PMID: 24034262 DOI: 10.1053/j.ro.2013.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Myrna C B Godoy
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX.
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Zhao YR, Heuvelmans MA, Dorrius MD, van Ooijen PMA, Wang Y, de Bock GH, Oudkerk M, Vliegenthart R. Features of resolving and nonresolving indeterminate pulmonary nodules at follow-up CT: the NELSON study. Radiology 2013; 270:872-9. [PMID: 24475806 DOI: 10.1148/radiol.13130332] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively identify features that allow prediction of the disappearance of solid, indeterminate, intraparenchymal nodules detected at baseline computed tomographic (CT) screening of individuals at high risk for lung cancer. MATERIALS AND METHODS The study was institutional review board approved. Participants gave informed consent. Participants with at least one noncalcified, solid, indeterminate, intraparenchymal nodule (volume range, 50-500 mm(3)) at baseline were included (964 nodules in 750 participants). According to protocol, indeterminate nodules were re-examined at a 3-month follow-up CT examination. Repeat screening was performed at years 2 and 4. A nodule was defined as resolving if it did not appear at a subsequent CT examination. Nodule resolution was regarded as spontaneous, not the effect of treatment. CT features of resolving and nonresolving (stable and malignant) nodules were compared by means of generalized estimating equations analysis. RESULTS At subsequent screening, 10.1% (97 of 964) of the nodules had disappeared, 77.3% (n = 75) of these at the 3-month follow-up CT and 94.8% (n = 92) at the second round of screening. Nonperipheral nodules were more likely to resolve than were peripheral nodules (odds ratio: 3.16; 95% confidence interval: 1.76, 5.70). Compared with smooth nodules, nodules with spiculated margins showed the highest probability of disappearance (odds ratio: 4.36; 95% confidence interval: 2.24, 8.49). CONCLUSION Approximately 10% of solid, intermediate-sized, intraparenchymal pulmonary nodules found at baseline screening for lung cancer resolved during follow-up, three-quarters of which had disappeared at the 3-month follow-up CT examination. Resolving pulmonary nodules share CT features with malignant nodules.
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Affiliation(s)
- Ying Ru Zhao
- From the Center for Medical Imaging-North East Netherlands (Y.R.Z., M.A.H., M.D.D., P.M.A.v.O., Y.W., M.O., R.V.), Department of Radiology (Y.R.Z., M.A.H., M.D.D., P.M.A.v.O., R.V.), and Department of Epidemiology (G.H.d.B.), University of Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, 9700RB Groningen, the Netherlands
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Lederlin M, Revel MP, Khalil A, Ferretti G, Milleron B, Laurent F. Management strategy of pulmonary nodule in 2013. Diagn Interv Imaging 2013; 94:1081-94. [PMID: 24034970 DOI: 10.1016/j.diii.2013.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M Lederlin
- Service d'imagerie médicale, Université Bordeaux Segalen, CHU Bordeaux Groupe Sud, avenue de Magellan, 33600 Pessac, France.
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Abstract
In this review, we focus on the radiologic, clinical, and pathologic aspects primarily of solitary subsolid pulmonary nodules. Particular emphasis will be placed on the pathologic classification and correlative computed tomography (CT) features of adenocarcinoma of the lung. The capabilities of fluorodeoxyglucose positron emission tomography-CT and histologic sampling techniques, including CT-guided biopsy, endoscopic-guided biopsy, and surgical resection, are discussed. Finally, recently proposed management guidelines by the Fleischner Society and the American College of Chest Physicians are reviewed.
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Affiliation(s)
- Roy A Raad
- Department of Radiology, NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
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Attinà D, Niro F, Stellino M, Ciccarese F, Mineo G, Sverzellati N, Zompatori M. Evolution of the subsolid pulmonary nodule: a retrospective study in patients with different neoplastic diseases in a nonscreening clinical context. Radiol Med 2013; 118:1269-80. [DOI: 10.1007/s11547-013-0926-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/17/2012] [Indexed: 10/26/2022]
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Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143:e93S-e120S. [PMID: 23649456 PMCID: PMC3749714 DOI: 10.1378/chest.12-2351] [Citation(s) in RCA: 880] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 11/30/2012] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. METHODS We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. RESULTS We formulated recommendations for evaluating solid pulmonary nodules that measure > 8 mm in diameter, solid nodules that measure ≤ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefits and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. CONCLUSIONS Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management.
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Affiliation(s)
- Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | | | - William R Lynch
- Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI
| | | | | | | | - Renda Soylemez Wiener
- The Pulmonary Center, Boston University School of Medicine, Boston, MA; Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA
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Silva M, Mario S, Sverzellati N, Nicola S, Manna C, Carmelinda M, Negrini G, Giulio N, Marchianò A, Alfonso M, Zompatori M, Maurizio Z, Rossi C, Cristina R, Pastorino U, Ugo P. Long-term surveillance of ground-glass nodules: evidence from the MILD trial. J Thorac Oncol 2013; 7:1541-6. [PMID: 22968185 DOI: 10.1097/jto.0b013e3182641bba] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the natural evolution of ground-glass nodules (GGNs) in the Multicentric Italian Lung Detection (MILD) trial, which adopted a nonsurgical approach to this subset of lesions. METHODS From September 2005 to August 2007, 56 consecutive MILD participants with 76 GGNs were identified from 1866 individuals who underwent baseline low-dose computed tomography. The features of GGNs were assessed and compared with the corresponding repeat low-dose computed tomographies after a mean time of 50.26 ± 7.3 months. The GGNs were classified as pure (pGGN) or part-solid (psGGN) GGNs. The average of the maximum and the minimum diameters for both pGGNs and psGGNs and the maximum diameter of the solid portion of psGGNs were manually measured. At follow-up, GGNs were classified as follows: resolved, decreased, stable, or progressed (according to three defined growth patterns). RESULTS A total of 15 of 48 pGGNs (31.3%) resolved, 4 of 48 (8.3%) decreased in size, 21 of 48 (43.8%) remained stable, and 8 of 48 (16.7%) progressed. Among the psGGNs with a solid component smaller than 5 mm, 3 of 26 (11.5%) resolved, 11 of 26 (42.3%) remained stable, and 12 of 26 (46.2%) progressed. One of the two psGGNs with a solid component larger than 5 mm remained stable, and the other decreased in size. Four lung cancers were detected among the GGN subjects, but only one arose from a psGGN, and was resected in stage Ia. CONCLUSIONS The progression rate of the GGNs toward clinically relevant disease was extremely low in the MILD trial and supports an active surveillance attitude.
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Affiliation(s)
- Mario Silva
- Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma, Italy
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Abstract
PURPOSE OF REVIEW Given the higher rate of malignancy of subsolid pulmonary nodules and the considerably lower growth rate of ground-glass nodules (GGNs), dedicated standardized guidelines for management of these nodules have been proposed, including long-term low-dose computed tomography (CT) follow-up (≥3 years). Physicians must be familiar with the strategic management of subsolid pulmonary nodules, and should be able to identify imaging features that suggest invasive adenocarcinoma requiring a more aggressive management. RECENT FINDINGS Low-dose CT screening studies for early detection of lung cancer have increased our knowledge of pulmonary nodules, and in particular our understanding of the strong although imperfect correlation of the subsolid pulmonary nodules, including pure GGNs and part-solid nodules, with the spectrum of preinvasive to invasive lung adenocarcinoma. Serial CT imaging has shown stepwise progression in a subset of these nodules, characterized by increase in size and density of pure GGNs and development of a solid component, the latter usually indicating invasive adenocarcinoma. SUMMARY There is close correlation between the CT features of subsolid nodules (SSNs) and the spectrum of lung adenocarcinoma. Standardized guidelines are suggested for management of SSNs.
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