Modified inflammation-based score as an independent malignant predictor in patients with pulmonary focal ground-glass opacity: a propensity score matching analysis

Limited effect of antibiotic use on the management of pulmonary ground-glass nodules

Although pulmonary ground-glass nodules (GGNs) are encountered as common incidental findings, limited evidence exists regarding antibiotic prescriptions in managing GGNs. This study aimed to examine the clinical impact of antibiotics in treating patients presenting with GGNs. This retrospective study was conducted at West China Hospital of Sichuan University, involving 2,609 participants with incidentally detected GGNs between August 10, 2018 and July 22, 2022. Treatments were classified into antibiotic prescription versus no antibiotic prescription. Baseline characteristics and incidences of clinical outcomes (surgical resection, lung cancer diagnosis, beneficial response, and GGN growth) were evaluated. Of the 867 participants finally analyzed (184 antibiotic users; 683 antibiotic non-users), 85.2% were never smokers, and 34.7% presented with respiratory symptoms. The decision to prescribe antibiotics was correlated with the presence of symptoms and larger nodules. After propensity score matching, a higher incidence of surgical resection was observed in antibiotic users versus matched controls (40.8% vs. 29.9%, p = 0.049), whereas there was a trend toward an increased rate of lung cancer diagnosis, which was not statistically significant (32.6% vs. 22.8%, p = 0.054). Significant differences in radiographic response were not found, even among patients with suspected infection. In conclusion, limited beneficial effects of antibiotic use in the management of GGNs were observed, even among patients with suspected infection. These findings do not support empiric antibiotic administration in GGNs and call for efforts to develop outpatient antibiotic stewardship programs.

Ground-Glass Opacities in the Access Route and Biopsy in Highly Perfused Dependent Areas of the Lungs as Risk Factors for Pulmonary Hemorrhage During CT-Guided Lung Biopsy: A Retrospective Study

BACKGROUND/OBJECTIVES

The risk of hemorrhage during CT-guided lung biopsy has not been systematically studied in cases where ground-glass opacities (GGO) are present in the access route or when biopsies are performed in highly perfused, dependent lung areas. While patient positioning has been studied for pneumothorax prevention, its role in minimizing hemorrhage risk remains unexplored. This study aimed to determine whether GGOs in the access route and biopsies in dependent lung areas are risk factors for pulmonary hemorrhage during CT-guided lung biopsy.

METHODS

A retrospective analysis was conducted on 115 CT-guided lung biopsies performed at a single center (2020-2023). Patients were categorized based on post-interventional hemorrhage exceeding 2 cm (Grade 2 or higher). We evaluated the presence of GGOs in the access route and biopsy location (dependent vs. non-dependent areas) using chi square, Fisher's exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analyses were conducted to evaluate risk factors for pulmonary hemorrhage.

RESULTS

Pulmonary hemorrhage beyond 2 cm occurred in 30 of 115 patients (26%). GGOs in the access route were identified in 67% of these cases (p < 0.01), and hemorrhage occurred more frequently when biopsies were performed in dependent lung areas (63% vs. 40%, p = 0.03). Multivariable analysis showed that GGOs in the access route (OR 5.169, 95% CI 1.889-14.144, p = 0.001) and biopsies in dependent areas (OR 4.064, 95% CI 1.477-11.186, p < 0.001) independently increased hemorrhage risk.

CONCLUSIONS

GGOs in the access route and dependent lung area biopsies are independent risk factors for hemorrhage during CT-guided lung biopsy.

Advances in intelligent diagnosis methods for pulmonary ground-glass opacity nodules

Pulmonary nodule is one of the important lesions of lung cancer, mainly divided into two categories of solid nodules and ground glass nodules. The improvement of diagnosis of lung cancer has significant clinical significance, which could be realized by machine learning techniques. At present, there have been a lot of researches focusing on solid nodules. But the research on ground glass nodules started late, and lacked research results. This paper summarizes the research progress of the method of intelligent diagnosis for pulmonary nodules since 2014. It is described in details from four aspects: nodular signs, data analysis methods, prediction models and system evaluation. This paper aims to provide the research material for researchers of the clinical diagnosis and intelligent analysis of lung cancer, and further improve the precision of pulmonary ground glass nodule diagnosis.

Necessity of organized low-dose computed tomography screening for lung cancer: From epidemiologic comparisons between China and the Western nations

OBJECTIVES

To compare the proportion of stage I lung cancer and population mortality in China to those in U.S. and Europe where lung cancer screening by low-dose computed tomography (LDCT) has been already well practiced.

METHODS

The proportions of stage I lung cancer in LDCT screening population in U.S. and Europe were retrieved from NLST and NELSON trials. The general proportion of stage I lung cancer in China was retrieved from a rapid meta-analysis, based on a literature search in the China National Knowledge Infrastructure database. The lung cancer mortality and prevalence of China, U.S. and Europe was retrieved from Globocan 2012 fact sheet. Mortality-to-prevalence ratio (MPR) was applied to compare the population survival outcome of lung cancer.

RESULTS

The estimated proportion of stage I lung cancer in China is merely 20.8% among hospital-based cross-sectional population, with relative ratios (RRs) being 2.40 (95% CI 2.18-2.65) and 2.98 (95% CI 2.62-3.38) compared by LDCT-screening population in U.S. and Europe trials, respectively. MPR of lung cancer is as high as 58.9% in China, with RRs being 0.46 (95% CI 0.31-0.67) and 0.58 (95% CI 0.39-0.85) compared by U.S. and Europe, respectively.

CONCLUSIONS

By the epidemiological inference, the LDCT mass screening might be associated with increasing stage I lung cancer and therefore improving population survival outcome. How to translate the experiences of lung cancer screening by LDCT from developed counties to China in a cost-effective manner needs to be further investigated.