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Hamada R, Tsukamoto Y, Odaka M, Yabe M, Shigemori R, Akiba T, Toya N, Ohtsuka T. Pulmonary metastases of a borderline ovarian tumor with multiple cystic formations: a case report. Surg Case Rep 2023; 9:36. [PMID: 36882646 PMCID: PMC9992675 DOI: 10.1186/s40792-023-01616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Metastatic lung tumors rarely present with cystic formations. This is the first report of multiple cystic formations in pulmonary metastases from mucinous borderline ovarian tumors written in English. CASE PRESENTATION A 41-year-old woman underwent left adnexectomy + partial omentectomy + para-aortic lymphadenectomy for a left ovarian tumor 4 years ago. The pathological finding was mucinous borderline ovarian tumor with a microinvasion. A chest computed tomography performed 3 years after surgery revealed multiple cystic lesions in both lungs. After 1-year follow-up, the cysts increased in size and wall thickness. Subsequently, she was referred to our department with multiple cystic lesions in both lungs. No laboratory findings indicated infectious diseases or autoimmune disorders that could cause cystic lesions in both lungs. Positron emission tomography showed slight accumulation in the cyst wall. Partial resection of the left lower lobe was performed to confirm the pathological diagnosis. The diagnosis was consistent with pulmonary metastases from a previous mucinous borderline ovarian tumor. CONCLUSIONS This is a rare case of lung metastases from a mucinous borderline ovarian tumor presenting with multiple lesions with cystic formation. Pulmonary cystic formations in patients with a borderline ovarian tumor should be considered as possible pulmonary metastases.
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Affiliation(s)
- Rintaro Hamada
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Yo Tsukamoto
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan.
| | - Makoto Odaka
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Mitsuo Yabe
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Rintaro Shigemori
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Naoki Toya
- Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita Kashiwashi, Chiba, 277-8567, Japan
| | - Takashi Ohtsuka
- Department of Surgery, The Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo, 105-8471, Japan
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Godoy MCB, Lago EAD, Pria HRFD, Shroff GS, Strange CD, Truong MT. Pearls and Pitfalls in Lung Cancer CT Screening. Semin Ultrasound CT MR 2022; 43:246-256. [PMID: 35688535 DOI: 10.1053/j.sult.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Annual LDCT lung cancer screening is recommended by the United States Preventive Services Task Force (USPSTF) for high-risk population based on the results from the National Lung Cancer Screening Trial (NLST) that showed a significant (20%) reduction in lung cancer-specific mortality rate with the use of annual low-dose computed tomography (LDCT) screening. More recently, the benefits of lung cancer screening were confirmed by the Dutch- Belgian NELSON trial in Europe. With the implementation of lung screening in large scale, knowledge of the limitations related to false positive, false negative and other potential pitfalls is essential to avoid misdiagnosis. This review outlines the most common potential pitfalls in the characterization of screen-detected lung nodules that include artifacts in LDCT, benign nodules that mimic lung cancer, and causes of false negative evaluations of lung cancer with LDCT and PET/CT studies. Awareness of the spectrum of potential pitfalls in pulmonary nodule detection and characterization, including equivocal or atypical presentations, is important for avoiding misinterpretation that can alter patient management.
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Affiliation(s)
- Myrna C B Godoy
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Eduardo A Dal Lago
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Girish S Shroff
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chad D Strange
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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Kim CH, Cha YK, Han J, Kim JH, Kim TJ, Chung MJ, Lee JH, Yoon HJ. CT findings of basaloid squamous cell carcinoma of the lung in 12 patients: A distinct category of squamous cell carcinoma in 2015 WHO classification of lung tumors. Medicine (Baltimore) 2022; 101:e29197. [PMID: 35583530 PMCID: PMC9276435 DOI: 10.1097/md.0000000000029197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/10/2022] [Indexed: 01/04/2023] Open
Abstract
Basaloid squamous cell carcinoma (SCC) is very rare subtype of SCC of the lung and it is important to distinguish basaloid to other subtypes of SCCs, since the prognosis of basaloid subtype is considered poorer than that of other non-basaloid subtypes of SCCs. Aim of this study was to assess computed tomography (CT) findings of basaloid SCC of the lung in 12 patients.From January 2016 to April 2021, 12 patients with surgically proven basaloid SCC of the lung were identified. CT findings were analyzed, and the imaging features were compared with histopathologic reports. Clinical and demographic features were also analyzed.Axial location of the tumor was central in 5 patients, while 7 was in peripheral. Of the 7 patients whose tumors were located in the peripheral, margin of the tumor were smooth (n = 2), lobulated (n = 2), or spiculated (n = 3). After contrast injection, net enhancement value ranged from 15.8 to 71.8 HU (median, 36.4 HU). Endobronchial growth were seen in 5 patients and these patients accompanied obstructive pneumonia or atelectasis. Internal profuse necrosis, cavitation, or calcifications were not seen.On CT, basaloid squamous cell presents as solitary nodule or mass with moderate enhancement. Tumor was located either peripheral or central compartment of the lung and cavitation was absent.
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Affiliation(s)
- Chu Hyun Kim
- Center for Health Promotion, Samsung Medical Center, Seoul, Republic of Korea
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon Ki Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Jung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Lee
- Department of Thoracic & Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Yoon
- Department of Radiology, Veterans Health Service Medical Center, Seoul, Republic of Korea
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Sakai T, Azuma Y, Koezuka S, Otsuka H, Sano A, Tochigi N, Iyoda A. Adenocarcinoma in situ detected on a thin-walled lung cavity: a case report. Surg Case Rep 2022; 8:60. [PMID: 35377018 PMCID: PMC8980133 DOI: 10.1186/s40792-022-01413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cavitary lesions pathologically diagnosed as adenocarcinoma in situ (AIS) have been rarely reported. The examination of these type of lesions is necessary for a better understanding of the mechanisms underlying their formation and development of more efficient diagnostic and treatment strategies. Here, we present the case of a patient with cavitary lung carcinoma, diagnosed as AIS, who underwent partial resection. CASE PRESENTATION A 72-year-old man presented with an abnormal shadow on chest radiography. Computed tomography findings showed a nodule in the right upper lobe, which was later diagnosed as an adenocarcinoma via transbronchial biopsy. A thin-walled cavity with partial thickening in the right lower lobe was also noted. We suspected that the thin-walled cavitary lesion was malignant, and performed wedge resection during a right upper lobectomy. AIS was diagnosed based on the histopathological findings of the thickened part of the thin-walled cavity. CONCLUSIONS This study highlights that, although rare, AIS may be observed in cavitary lung carcinoma cases, particularly in thin-walled lesions.
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Affiliation(s)
- Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omorinishi, Ota, Tokyo, 143-8541, Japan
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omorinishi, Ota, Tokyo, 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omorinishi, Ota, Tokyo, 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omorinishi, Ota, Tokyo, 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omorinishi, Ota, Tokyo, 143-8541, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omorinishi, Ota, Tokyo, 143-8541, Japan.
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Xie X, Li X, Tang W, Xie P, Tan X. Primary tumor location in lung cancer: the evaluation and administration. Chin Med J (Engl) 2021; 135:127-136. [PMID: 34784305 PMCID: PMC8769119 DOI: 10.1097/cm9.0000000000001802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Lung cancer continues to be the leading cause of cancer-related death in the world, which is classically subgrouped into two major histological types: Non-small cell lung cancer (NSCLC) (85% of patients) and small-cell lung cancer (SCLC) (15%). Tumor location has been reported to be associated with the prognosis of various solid tumors. Several types of cancer often occur in a specific region and are more prone to spread to predilection locations, including colorectal cancer, prostate cancer, gastric cancer, ovarian cancer, cervical cancer, bladder cancer, lung tumor, and so on. Besides, tumor location is also considered as a risk factor for lung neoplasm with chronic obstructive pulmonary disease/emphysema. Additionally, the primary lung cancer location is associated with specific lymph node metastasis. And the recent analysis has shown that the primary location may affect metastasis pattern in metastatic NSCLC based on a large population. Numerous studies have enrolled the "location" factor in the risk model. Anatomy location and lobe-specific location are both important in prognosis. Therefore, it is important for us to clarify the characteristics about tumor location according to various definitions. However, the inconsistent definitions about tumor location among different articles are controversial. It is also a significant guidance in multimode therapy in the present time. In this review, we mainly aim to provide a new insight about tumor location, including anatomy, clinicopathology, and prognosis in patients with lung neoplasm.
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Affiliation(s)
- Xueqi Xie
- School of Medicine and Life Sciences, Shandong First Medical University, Jinan, Shandong 250117, China Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China
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Xu S, Bie ZX, Li YM, Li B, Guo RQ, Li XG. A Comparative Study of Cavitary and Noncavitary Non-small Cell Lung Cancer Patients Treated with CT-Guided Microwave Ablation. J Vasc Interv Radiol 2021; 32:1170-1178. [PMID: 34033905 DOI: 10.1016/j.jvir.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/26/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To explore the outcomes of computed tomography‒guided microwave (MW) ablation in patients with cavitary non-small cell lung cancer (NSCLC) and to compare the outcomes of cavitary and noncavitary NSCLC treated with MW ablation. MATERIALS AND METHODS A total of 317 patients with NSCLC (194 men and 123 women) treated with MW ablation were include: 19 patients with cavitary NSCLC and 298 patients with noncavitary NSCLC. Complications, progression-free survival (PFS), and overall survival (OS) were evaluated and compared between the 2 groups. The Kaplan-Meier method was used to investigate the correlation of cavity and OS in patients with NSCLC. RESULTS A total of 364 MW ablation procedures were performed. Adenocarcinoma was the predominant histopathological subtype in patients with cavitary NSCLC (73.7%). Cavitary NSCLC had an incidence rate of 57.9% in overall complications, which was significantly higher than that of 34.6% for noncavitary NSCLC (P = .040). In a mean follow-up of 27.2 months ± 11.9, the median PFS and OS for cavitary NSCLC were 9.0 months ± 8.5 and 14.0 months ± 10.8, respectively, and those for noncavitary NSCLC were 13.0 months ± 10.7 and 17.0 months ± 10.9, respectively. There was no significant difference in PFS (P = .180) or OS (P = .133) between cavitary and noncavitary NSCLC. In addition, the local recurrence rates for cavitary and noncavitary NSCLC were 15.8% and 21.5%, respectively, and no significant difference was found (P = .765). The Kaplan-Meier method revealed no association between the cavity and OS in patients with NSCLC treated with MW ablation. CONCLUSIONS MW ablation was an effective and safe approach for cavitary NSCLC treatment. Compared with noncavitary NSCLC, cavitary NSCLC manifested with more complications but a comparable outcome after MW ablation.
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Affiliation(s)
- Sheng Xu
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Xin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan-Ming Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Run-Qi Guo
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Guang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
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Tannous T, Mak A, Keating M. Small-Cell Lung Cancer Cavities: Primary or Secondary? Cureus 2021; 13:e13691. [PMID: 33824833 PMCID: PMC8012258 DOI: 10.7759/cureus.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although non-small-cell lung cancer occasionally presents as cavitary lesions, it is rare for small-cell lung cancer (SCLC) to present or progress in such a manner. If a cavitary lesion is seen in the setting of small-cell lung carcinoma, infectious etiologies must be excluded first. We present the case of a 43-year-old man with refractory SCLC that progressed despite two lines of therapy, and who was ultimately found to have recurrent adenopathy and numerous widespread cavitary lung nodules. Fine-needle aspiration of a hilar lymph node revealed extensively necrotic SCLC, while bronchoalveolar cultures grew Aspergillus fumigatus and Candida albicans. The patient was subsequently treated with voriconazole; however, despite these measures, his overall clinical course deteriorated and the patient ultimately succumbed to his illness. Aspergillosis is a major cause of cavitary lung lesions, especially in immunocompromised patients. Our patient with refractory stage four SCLC was found to have several cavitary lung lesions. Before assuming that cavitary lesions are neoplastic, evaluation for aspergillosis should be conducted, particularly in SCLC patients. Although invasive fungal infections are often missed, it may be prudent to conduct such testing because aspergillosis is a treatable condition and the treatment can improve a patient’s hospitalization and overall clinical course.
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Affiliation(s)
- Toufic Tannous
- Department of Internal Medicine, Roger Williams Medical Center, Providence, USA
| | - Andrew Mak
- Division of Hematology/Oncology, Roger Williams Medical Center, Providence, USA
| | - Matthew Keating
- Division of Hematology/Oncology, University of California, Irvine School of Medicine, Irvine, USA
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Canan A, Batra K, Saboo SS, Landay M, Kandathil A. Radiological approach to cavitary lung lesions. Postgrad Med J 2020; 97:521-531. [PMID: 32934178 DOI: 10.1136/postgradmedj-2020-138694] [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: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 11/03/2022]
Abstract
Cavitary lesions in the lung are not an uncommon imaging encounter and carry a broad differential diagnosis that includes a wide range of pathological conditions from cancers, infections/inflammatory processes to traumatic and congenital lung abnormalities. In this review article, we describe a comprehensive approach for evaluation of cavitary lung lesions and discuss the differential diagnosis in the light of radiological findings.
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Affiliation(s)
| | - Kiran Batra
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Sachin S Saboo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, 78229, USA
| | - Michael Landay
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
| | - Asha Kandathil
- Department of Radiology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 75390, USA
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Jiao H, Zhao X, Han J, Zhang J, Wang J. Synthesis of a novel 99mTc labeled GE11 peptide for EGFR SPECT imaging. Int J Radiat Biol 2020; 96:1443-1451. [PMID: 32809887 DOI: 10.1080/09553002.2020.1811419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE This study investigated a novel SPECT agent for the noninvasive imaging of EGFR-overexpressing tumors. METHODS The EGFR-targeting peptide GE11 was synthesized with the introduction of four amino acids (GGGC) to its C-terminal to act as a strong chelator and radiolabeled using 99mTc. The radiochemical yield of the 99mTc-peptide-GE11 were evaluated using RP-HPLC. Cellular assays of the probe were performed on two NSCLC cell lines: A549 (high expression) and H23 (low expression). Biodistribution and SPECT imaging were performed in BALB/c nude mice bearing A549 and H23 NSCLC xenografts. RESULTS The 99mTc-peptide-GE11 was prepared at high efficiency with radiochemical yield of 98.40 ± 1.00 % and it showed favorable stability. The cellular uptake was significantly higher in A549 than in H23 at all time points (especially at 1 h, which was 10.34 ± 0.72 and 2.04 ± 0.18, respectively). A nearly 56% reduction in probe uptake was observed after pretreatment with excess unlabeled peptides. The performance of SPECT imaging and biodistribution demonstrated higher uptake of the 99mTc-peptide-GE11 in A549 xenograft than in H23 xenografts. CONCLUSION The new SPECT tracer 99mTc-peptide-GE11 showed EGFR specificity, favorable pharmacokinetics and great potential for EGFR-targeted imaging.
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Affiliation(s)
- Honglei Jiao
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinming Zhao
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingya Han
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingmian Zhang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianfang Wang
- Department of Nuclear Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Liu Z, Feng H, Zhang Z, Sun H, Liu D. Clinicopathological characteristics of solitary cavitary lung cancer: a case-control study. J Thorac Dis 2020; 12:3148-3156. [PMID: 32642236 PMCID: PMC7330766 DOI: 10.21037/jtd-20-426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background With the emerging radiological techniques and the increasing incidence of adenocarcinoma, the composition and structure of cavitary lung cancer have been significantly changed. The aim of the study was to demonstrate clinicopathological characteristics of solitary cavitary lung cancer which was ≤3 cm. Methods A case-control study was designed through retrospective data analysis of clinicopathological data of 946 cases with solitary lung cancer smaller than 3 cm. Univariable and multivariable analysis were used to identify the risk factors of cavitation. Results Cavitary lung cancer occurred more frequently in patients who were elderly (P=0.044), male (P=0.004), who had a smoking history (P=0.018), higher carcinoembryonic antigen (CEA) level (P<0.001), peripheral lesions (P=0.017), solid nodules (P<0.001), spiculation (P=0.003), vascular convergence (P<0.001), air bronchogram (P=0.004), larger tumor size (P<0.001), advanced T stage (P<0.001), lymph node metastasis (P=0.028) and advanced pTNM stage (P=0.004). In addition, cavitary lung cancer was more common in papillary predominant tumors (P=0.017), while noncavitary lung cancer occurred more frequently in AIS/MIA (P=0.002) and lepidic predominant tumors (P<0.001). It was confirmed that cavitation was significantly associated with elderly (P=0.013), male (P=0.003), larger maximum tumor diameter (P<0.001), solid nodules (P<0.001), larger pT size (P=0.016) and advanced pN stage (P=0.036) in multivariable analysis. ROC curves showed that the AUV was greater in maximum tumor diameter than in pT size predicting cavitation (0.71 vs. 0.66). A cut off value of 20.9 mm showed a discriminatory power of cavitation with a sensitivity of 68.7% and a specificity of 71.2%. Conclusions Comparing with noncavitary lung cancer, cavitary lung cancer smaller than 3 cm may have worse prognostic clinical, radiological and pathological characteristics. Especially, cavitary lung cancer present as more solid nodules on CT images and present with more invasive on pathological findings.
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Affiliation(s)
- Zhan Liu
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Hongxiang Feng
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Zhenrong Zhang
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Hongliang Sun
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Deruo Liu
- 1Department of Thoracic Surgery, 2Department of Radiology, China-Japan Friendship Hospital, Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
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Chen C, Fu S, Ni Q, Yiyang W, Pan X, Jing J, Zhao H, Rui W. Cavity Formation is a Prognostic Indicator for Pathologic Stage I Invasive Lung Adenocarcinoma of ≥3 cm in Size. Med Sci Monit 2019; 25:9003-9011. [PMID: 31772147 PMCID: PMC6898982 DOI: 10.12659/msm.917933] [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] [Indexed: 11/10/2022] Open
Abstract
Background We investigated the correlation between cavity formation, prognosis, and tumor stage for pathologic stage I invasive lung adenocarcinomas (IADCs) ≤3 cm in size. Material/Methods 2106 candidates with pathologic stage I IADC were identified from Shanghai Chest Hospital between 2009 and 2014. There were 227 patients who were diagnosed as having cavity formation and another 1879 patients who were not (the non-cavitary lung cancer group). Kaplan-Meier analysis curves were conducted to compare the overall survival (OS) and relapse-free survival (RFS) between these 2 groups. Cox proportional hazards regression was performed to discover the independent risk factors of OS and RFS. Receiver operating characteristic (ROC) curve was done to determine the cutoff value of cavity size for predicting prognosis. Furthermore, subgroup analysis was stratified by the size of tumor and the 8th classification of T category. Results Compared with non-cavitary lung cancer group, patients with cavity formation were found to have a higher prevalence of male patients (P=0.015), older age patients (P=0.039), larger size tumors (P=0.004), and worse cancer relapse (P<0.001). Survival analysis found that patients with cavitary IADC had significantly shorter RFS than those with non-cavitary IADC (P=0.001). Further, subgroup analysis confirmed a significantly worse RFS in cavitary IADC group both in stage T1a (P=0.002) and T1b (P<0.001), but not for stage T1c (P=0.962) and T2a (P=0.364). Moreover, cavity formation was still less of a significant predictor of RFS in multivariable analysis (hazard ratio [HR] 1.810, 95% confidence level [CI] 1.229–2.665, P=0.003). The ROC curve showed that the best cutoff value of maximum diameter of the cavity for judging RFS was 5 mm (sensitivity: 0.500; specificity: 0.783). At the same time, multiple cavities were more likely to lead to recurrence (sensitivity: 0.605; specificity: 0.439). Conclusions Cavitary adenocarcinoma was a worse prognostic indicator compared with non-cavitary adenocarcinoma, especially for cavity >5 mm and multiple cavities. Thus, for stage T1a and T1b, cavitary and non-cavitary IADC should be considered separately.
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Affiliation(s)
- Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Shijie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Qiming Ni
- Department of Image, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Wang Yiyang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Jiao Jing
- Department of Image, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
| | - Wang Rui
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (mainland)
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Choi Y, Gil BM, Chung MH, Yoo WJ, Jung NY, Kim YH, Kwon SS, Kim J. Comparing attenuations of malignant and benign solitary pulmonary nodule using semi-automated region of interest selection on contrast-enhanced CT. J Thorac Dis 2019; 11:2392-2401. [PMID: 31372276 DOI: 10.21037/jtd.2019.05.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to determine whether semi-automated region of interest (ROI) measurement of CT attenuations of solitary pulmonary nodule (SPN) is an accurate approach in differentiating malignant from benign SPN. Methods Ninety cases of pathologically proven SPN were retrospectively reviewed. CT attenuations of SPN before and after contrast injection were measured using semi-automated ROI selection method. Attenuations within a range of -100 to 200 Hounsfield units (HU) as soft tissue density range were set. The ROI included the entire SPN regardless of its internal soft tissue contents after automatic elimination of airs, calcific, or bony densities. Results There were 42 (46.7%) malignant SPN and 48 (53.3%) benign SPN, which were grouped into A (18 tuberculoma, 13 fungus), B (5 focal organizing pneumonia, 5 abscess), and C (7 other benign tumors). The malignant SPN showed significantly higher mean attenuations of enhancement and net-enhancement than all benign SPN (P<0.001). Using the area under the receiver operating characteristic curve (AUC), the cut-off net-enhancement of 15 HU gave 83% sensitivity, 65% specificity and 73% accuracy for predicting malignancy. Malignant SPN (mean 67.9 HU) had significantly higher enhancement than group A (mean 52.6 HU, P<0.001, 95% CI: 8.73, 21.81) and group B (mean 57.0 HU, P=0.025, 95% CI: -1.43, 20.34) while group C showed no significant difference (mean 68.1 HU, P=0.97). Net enhancements were higher in group B (mean 18.8 HU) than in group A (mean 8.8 HU) (P<0.001, 95% CI: 11.8, 23.18). Conclusions The semi-automated ROI measurement of SPN's attenuations on CT is an accurate approach in distinguishing indeterminate SPN.
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Affiliation(s)
- Yangsean Choi
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Bo Mi Gil
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Myung Hee Chung
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Won Jong Yoo
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Na Young Jung
- Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Yong Hyun Kim
- Division of Allergy and Pulmonary, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Soon Seog Kwon
- Division of Allergy and Pulmonary, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jeana Kim
- Department of Hospital Pathology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Jiang M, Zhang C, Liu D, Wang Y, Wang H, Li T, Hou H, Zhou N, Zhu J, Lv H, Zhang C, Fang B, Zhang X. Influence and mechanism of lung cavitation development on antiangiogenic therapy. Transl Lung Cancer Res 2019; 8:500-512. [PMID: 31555522 DOI: 10.21037/tlcr.2019.07.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Antiangiogenic agent-treated patients usually develop cavitation in their lung lesions. The clinical significance of lung cavitation development during antiangiogenic therapy has not been determined yet. Herein, we evaluated the clinical outcomes of patients who developed tumor cavitation following apatinib treatment and explored the mechanisms. Methods In this study (Clinical Trial No. NCT03629691), 187 patients (77 lung cancer and 110 gastric adenocarcinoma patients) who had progressed or relapsed after undergoing at least two lines of systemic therapy in accordance with the NCCN guidelines for primary or metastatic lung tumors were treated with apatinib at a dosage of 250 mg per day between February 1, 2015 and May 19, 2017. The effect of lung cavitation development on locoregional control (LRC), progression-free survival (PFS), and overall survival (OS) was analyzed with Kaplan-Meier estimates and compared with the log-rank test. Zebrafish experiments were used to study the anticancer mechanism of apatinib in different tumors. Western-blotting was used to analyze the expression of Cyclin D1, p53, HIF-α, and VEGFR before and after apatinib treatment in both normoxia and hypoxia. Results Cavitation development was beneficial in patients receiving apatinib therapy regardless of whether they had primary or metastatic lung cancer. Zebrafish experiments showed that apatinib inhibited tumor growth by both suppressing vascular growth and inhibiting cell proliferation. Vascular proliferation induced by the H1299 cell lines showed higher sensitivity to apatinib than that induced by the SCG-7901 cell line. However, apatinib showed weak tumor type selectivity on cell proliferation inhibition in vivo. Under hypoxic conditions, apatinib could not inhibit the protein expression of VEGFR and HIF-α in both cell lines; however, apatinib decreased the expression of cyclin D1 and P53 significantly. Conclusions Lung cavitation development is common with apatinib therapy and is a potential prognostic marker. Apatinib inhibits tumor growth by both vessel growth inhibition and proliferation inhibition.
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Affiliation(s)
- Man Jiang
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Chuantao Zhang
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Dong Liu
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Yongjie Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Hongmei Wang
- Department of Respiratory Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Tianjun Li
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Helei Hou
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Na Zhou
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Jingjuan Zhu
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Hongying Lv
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Chuanyu Zhang
- Department of Imaging, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
| | - Bingliang Fang
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiaochun Zhang
- Precision Medicine Center of Oncology, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao 266003, China
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Bashir U, Kawa B, Siddique M, Mak SM, Nair A, Mclean E, Bille A, Goh V, Cook G. Non-invasive classification of non-small cell lung cancer: a comparison between random forest models utilising radiomic and semantic features. Br J Radiol 2019; 92:20190159. [PMID: 31166787 PMCID: PMC6636267 DOI: 10.1259/bjr.20190159] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/23/2019] [Accepted: 04/04/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Non-invasive distinction between squamous cell carcinoma and adenocarcinoma subtypes of non-small-cell lung cancer (NSCLC) may be beneficial to patients unfit for invasive diagnostic procedures or when tissue is insufficient for diagnosis. The purpose of our study was to compare the performance of random forest algorithms utilizing CT radiomics and/or semantic features in classifying NSCLC. METHODS Two thoracic radiologists scored 11 semantic features on CT scans of 106 patients with NSCLC. A set of 115 radiomics features was extracted from the CT scans. Random forest models were developed from semantic (RM-sem), radiomics (RM-rad), and all features combined (RM-all). External validation of models was performed using an independent test data set (n = 100) of CT scans. Model performance was measured with out-of-bag error and area under curve (AUC), and compared using receiver-operating characteristics curve analysis on the test data set. RESULTS The median (interquartile-range) error rates of the models were: RF-sem 24.5 % (22.6 - 37.5 %), RF-rad 35.8 % (34.9 - 38.7 %), and RM-all 37.7 % (37.7 - 37.7). On training data, both RF-rad and RF-all gave perfect discrimination (AUC = 1), which was significantly higher than that achieved by RF-sem (AUC = 0.78; p < 0.0001). On test data, however, RM-sem model (AUC = 0.82) out-performed RM-rad and RM-all (AUC = 0.5 and AUC = 0.56; p < 0.0001), neither of which was significantly different from random guess ( p = 0.9 and 0.6 respectively). CONCLUSION Non-invasive classification of NSCLC can be done accurately using random forest classification models based on well-known CT-derived descriptive features. However, radiomics-based classification models performed poorly in this scenario when tested on independent data and should be used with caution, due to their possible lack of generalizability to new data. ADVANCES IN KNOWLEDGE Our study describes novel CT-derived random forest models based on radiologist-interpretation of CT scans (semantic features) that can assist NSCLC classification when histopathology is equivocal or when histopathological sampling is not possible. It also shows that random forest models based on semantic features may be more useful than those built from computational radiomic features.
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Affiliation(s)
- Usman Bashir
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Bhavin Kawa
- Department of Radiology, Maidstone Hospital, Hermitage Lane, Maidstone, UK
| | - Muhammad Siddique
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sze Mun Mak
- Department of Radiology, Guy’s Hospital, Great Maze Pond, London, UK
| | - Arjun Nair
- Department of Radiology, Guy’s Hospital, Great Maze Pond, London, UK
| | - Emma Mclean
- Department of Pathology, Guy’s Hospital and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, Lambeth, London, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Guy’s Hospital, Great Maze Pond, London, UK
| | - Vicky Goh
- Department of Radiology, Guy’s Hospital, Great Maze Pond, London, UK
| | - Gary Cook
- PET Imaging Centre and the Division of Imaging Sciences and Biomedical Engineering, King’s College London,, UK
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New insights into the impact of primary lung adenocarcinoma location on metastatic sites and sequence: A multicenter cohort study. Lung Cancer 2018; 126:139-148. [DOI: 10.1016/j.lungcan.2018.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/29/2018] [Accepted: 11/04/2018] [Indexed: 01/16/2023]
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16
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Topkan E, Selek U, Ozdemir Y, Yildirim BA, Guler OC, Ciner F, Besen AA, Findikcioglu A, Ozyilkan O. Incidence and Impact of Pretreatment Tumor Cavitation on Survival Outcomes of Stage III Squamous Cell Lung Cancer Patients Treated With Radical Concurrent Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2018; 101:1123-1132. [DOI: 10.1016/j.ijrobp.2018.04.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/12/2018] [Accepted: 04/18/2018] [Indexed: 12/17/2022]
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17
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Shinohara S, Sugaya M, Onitsuka T, Machida K, Matsuo M, Kato K, Tanaka F. Impact of the favorable prognosis of patients with lung cancer adjoining bullae. J Thorac Dis 2018; 10:3289-3297. [PMID: 30069325 DOI: 10.21037/jtd.2018.05.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Lung cancer adjoining bullae (LC-AB) is an uncommon manifestation. The clinical characteristics and prognosis of LC-AB remain unclear. The aim of this study is to investigate the clinical features and overall survival (OS) of patients with LC-AB following lung resection compared to non-LC-AB group. Methods We retrospectively investigated 291 consecutive patients with lung cancer who underwent curative resection in a single institution between April 2007 and March 2015. A total of LC-AB was 52 patients. LC-AB was determined using thin slice computed tomography (CT) imaging and pathological findings. Survival analysis was calculated using the Kaplan-Meier method. We used a Cox proportional hazards model for the univariate and multivariate analysis to identify prognostic factors. Results The LC-AB group showed a higher frequency of younger patients (P=0.017), former or current smokers (P=0.011), men (P=0.021), tumor location in the upper lobe (P=0.031), moderately or poorly differentiated tumor histology (P<0.001), pleural indentation (P=0.007), and non-adenocarcinoma histology (P=0.016) than the non-LC-AB group. The 5-year survival and recurrence-free survival (RFS) rates were significantly higher in the LC-AB group than the non-LC-AB group (88.5% vs. 74.9%, P=0.010, 75.4% vs. 61.3%, P=0.030, respectively). Multivariate analysis using a Cox proportional hazard model of OS showed that LC-AB was an independent prognostic factor [hazard ratio (HR): 0.30, 95% confidence interval (CI): 0.12-0.77, P=0.012]. Conclusions Patients with LC-AB had better OS than those with non-LC-AB. Thus, LC-AB may be an independent favorable prognostic factor following curative resection.
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Affiliation(s)
- Shuichi Shinohara
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Masakazu Sugaya
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Takamitsu Onitsuka
- Department of Thoracic Surgery, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Kazuhiko Machida
- Department of Pulmonary and Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Masaki Matsuo
- Department of Pulmonary and Respiratory Medicine, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Kazuo Kato
- Department of Pathology, Chubu Rosai Hospital, Nagoya, Aichi, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Gafoor K, Patel S, Girvin F, Gupta N, Naidich D, Machnicki S, Brown KK, Mehta A, Husta B, Ryu JH, Sarosi GA, Franquet T, Verschakelen J, Johkoh T, Travis W, Raoof S. Cavitary Lung Diseases. Chest 2018. [DOI: 10.1016/j.chest.2018.02.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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19
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Yang L, Wang S, Gerber DE, Zhou Y, Xu F, Liu J, Liang H, Xiao G, Zhou Q, Gazdar A, Xie Y. Main bronchus location is a predictor for metastasis and prognosis in lung adenocarcinoma: A large cohort analysis. Lung Cancer 2018; 120:22-26. [PMID: 29748011 DOI: 10.1016/j.lungcan.2018.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 02/16/2018] [Accepted: 03/10/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES In the literature, inconsistent associations between the primary locations of lung adenocarcinomas (ADCs) with patient prognosis have been reported, due to varying definitions for central and peripheral locations. In this study, we investigated the clinical characteristics and prognoses of ADCs located in the main bronchus. METHODS A total of 397,189 lung ADCs registered from 2004 to 2013 in the National Cancer Database (NCDB) were extracted and divided into main bronchus-located ADCs (2.5%, N = 10,111) and non-main bronchus ADCs (97.5%, N = 387,078). The ADCs located in the main bronchus and those not in the main bronchus were compared in terms of patient prognosis, lymph node involvement, distant metastases and other clinical features, including rate of curative-intent resection, histologic grade, and stage. RESULTS ADCs located in the main bronchus had significantly worse patient survival than those in the non-main bronchus, both for all patients (HR = 1.82, 95% CI 1.78-1.86) and for those undergoing curative-intent resection (HR = 2.49, 95% CI 2.23-2.78). Furthermore, ADCs located in the main bronchus had a significantly higher rate of lymph node involvement and distant metastasis than those not in the main bronchus, when stratified by tumor size (trend test, p < e-16). Multivariate analysis of overall survival showed that main bronchus location is a prognostic factor (HR = 1.15, 95% CI 1.08-1.23) independent of other clinical factors. CONCLUSIONS Main bronchus location is an independent predictor for metastasis and worse outcomes irrespective of stage and treatment. Tumor primary location might be considered in prognostication and treatment planning.
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Affiliation(s)
- Lin Yang
- Department of Pathology, National Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100021, China; Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Shidan Wang
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - David E Gerber
- Division of Hematology Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Yunyun Zhou
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Data Science, University of Mississippi Medical Center, MS, 39216, USA
| | - Feng Xu
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jiewei Liu
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hao Liang
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Guanghua Xiao
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Qinghua Zhou
- Lung Cancer Center/Lung Cancer Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Adi Gazdar
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Pathology, UT Southwestern Medical Center, Dallas, TX, 75390, USA; Hamon Center for Therapeutic Oncology Research, UT Southwestern Medical Center, TX, 75390, USA
| | - Yang Xie
- Quantitative Biomedical Research Center, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, 75390, USA; Department of Bioinformatics, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
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Li M, Wu N, Zhang L, Sun W, Liu Y, Lv L, Ren J, Lin D. Solid component proportion is an important predictor of tumor invasiveness in clinical stage T 1N 0M 0 (cT 1N 0M 0) lung adenocarcinoma. Cancer Imaging 2018; 18:18. [PMID: 29728140 PMCID: PMC5935978 DOI: 10.1186/s40644-018-0147-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/09/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Preoperative tumor invasiveness in clinical stage T1N0M0 lung adenocarcinoma is critical for optimal surgical procedure. The aim of the present study was to evaluate the relationship between the ground-glass opacity component (GGOc) / solid component (Sc) proportion measured using three-dimensional (3D) computer-quantified computer tomography (CT) number analysis to explore radiographic features for invasiveness prediction in cT1N0M0 lung adenocarcinomas. METHODS A total of 375 surgically resected cT1N0M0 lung adenocarcinoma patients were included. The relativity between the GGOc/Sc proportion and lepidic growth pattern percentage was assessed using Spearman's rank analysis. Multiple logistic regression analysis was used to determine independent factors from radiographic features for tumor invasiveness. Prediction probability for tumor invasiveness was analysed using a receiver operating characteristic curve (ROC). RESULTS We found that the GGOc proportion was positively correlated with lepidic growth pattern percentage (r = 0.67, P < 0.01), while the Sc proportion was negatively correlated with it (r = - 0.74, P < 0.01). Multivariate analysis showed that tumor size and Sc proportion were identified as independent predictors for tumor invasiveness. The area under the ROC curve (AUC) of Sc proportion was 0.875, which was higher than that of tumor size (0.750) (P < 0.001), and had no significant difference with that of combination of these two factors (0.884) (P = 0.28). CONCLUSIONS The GGOc/Sc proportion measured using 3D computer-quantified CT number analysis reflects the lepidic growth pattern percentage in tumors, and the Sc proportion may be an important factor for the prediction of tumor invasiveness in cT1N0M0 lung adenocarcinoma.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. .,PET-CT Center, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Sun
- Department of Pathology, Beijing Cancer Hospital, Beijing, China
| | - Ying Liu
- PET-CT Center, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lv Lv
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Ren
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongmei Lin
- Department of Pathology, Beijing Cancer Hospital, Beijing, China
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Shigefuku S, Kudo Y, Yunaiyama D, Matsubayashi J, Park J, Nagao T, Shimada Y, Saji H, Hagiwara M, Okano T, Kakihana M, Kajiwara N, Ohira T, Ikeda N. Prognostic factors for surgically resected non-small cell lung cancer with cavity formation. J Thorac Dis 2018; 10:973-983. [PMID: 29607170 DOI: 10.21037/jtd.2018.01.61] [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: 11/06/2022]
Abstract
Background Small pulmonary nodules have been detected frequently by computed tomography (CT). Lung cancers with cavity formation are also easily detected. There are a few reports focused on the cavity wall, although cancer cells exist along the cavity wall, not inside. We evaluated the impact of cavity wall thickness on prognosis and assessed the clinicopathological features in non-small cell lung cancer (NSCLC) with cavity formation. Methods Between 2005 and 2011, 1,313 patients underwent complete resection for NSCLC. Of these cases, we reviewed 65 patients (5.0%) diagnosed with NSCLC with cavity formation by chest CT. We classified the patients into three groups based on the maximum cavity wall thickness, namely, ≤4 mm (Group 1, 8 patients), >4 and ≤15 mm (Group 2, 33 patients), and >15 mm (Group 3, 24 patients). Results The number of patients with pathological whole tumor size >3 cm was 2 (25%) in Group 1, 17 (52%) in Group 2, and 23 (96%) in Group 3 (P<0.001). Cases with lymph node metastasis were 0 (0%) in Group 1, 5 (15%) in Group 2, and 10 (42%) in Group 3 (P=0.016). The 5-year overall survival (OS) rates were 100% in Group 1, 84.0% in Group 2, and 52.0% in Group 3, with significant differences between Group 1 and Group 3 (P=0.044) and between Group 2 and Group 3 (P=0.034). In univariate analysis, neither whole tumor size nor lymph node metastasis was a prognostic factor for OS (P=0.51, P=0.27). Only cavity wall thickness was a significant prognostic factor by multivariate analysis (P=0.009). Conclusions Maximum cavity wall thickness was an important prognostic factor in NSCLCs with cavity formation, comparable with other established prognostic factors.
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Affiliation(s)
| | - Yujin Kudo
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Jinho Park
- Department of Radiology, Tokyo Medical University, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | | | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tetsuya Okano
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | | | | | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
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Hwang KE, Oh SJ, Park C, Jeon SJ, Lee JM, Cha BK, Yoon KH, Jeong ET, Kim HR. Computed tomography morphologic features of pulmonary adenocarcinoma with brain/bone metastasis. Korean J Intern Med 2018; 33:340-346. [PMID: 28192888 PMCID: PMC5840592 DOI: 10.3904/kjim.2016.134] [Citation(s) in RCA: 2] [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] [Received: 04/21/2016] [Revised: 09/30/2016] [Accepted: 11/07/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND/AIMS Brain and bone metastases are common in patients with lung cancer. The development of metastasis is associated with poor survival in lung cancer patients. Although tumor morphologic features on radiographs are routinely assessed for differentiation between benign and malignant lung nodules, they are not used to predict metastasis. We assessed morphologic features of pulmonary adenocarcinomas with brain/bone metastasis on computed tomography (CT) to identify related factors for metastasis. METHODS We performed a retrospective analysis of initial chest CT findings (size, type of contour, percentage of necrosis, enhancement, presence or absence of calcification, and air cavity) from 2009 to 2010 of patients with brain or bone metastasis and compared the findings with those of patients without metastases. RESULTS In total, 128 patients were included (78 men, 52 women; mean age 69 years; range, 36 to 87). Nineteen patients had brain metastases and 32 had bone metastases. Morphologic features associated with brain metastasis included size ≥ 50 mm (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.24 to 9.17; p = 0.013), necrosis ≥ 30% (OR, 4.51; 95% CI, 1.62 to 12.55; p =0.002), and presence of calcification (OR, 3.97; 95% CI, 1.16 to 13.55; p = 0.035). Morphologic features associated with bone metastasis included necrosis ≥ 30% (OR, 4.639; 95% CI, 1.98 to 10.82; p < 0.001) and T 3 to 4 stage (OR, 2.53; 95% CI, 1.07 to 6.00; p = 0.031). CONCLUSIONS We found that necrosis ≥ 30% was associated with pulmonary adenocarcinoma with brain and bone metastasis at initial chest CT morphologic feature. To validate these results, further research should be conducted.
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Affiliation(s)
- Ki-Eun Hwang
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Su-Jin Oh
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Chul Park
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Se-Jeong Jeon
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea
| | - Jeong-Mi Lee
- Department of Public Health, Wonkwang University School of Medicine, Iksan, Korea
| | - Byong-Ki Cha
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Kwon-Ha Yoon
- Department of Radiology, Wonkwang University School of Medicine, Iksan, Korea
| | - Eun-Taik Jeong
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Hak-Ryul Kim
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
- Correspondence to Hak-Ryul Kim, M.D. Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Korea Tel: +82-63-859-2583 Fax: +82-63-855-2025 E-mail:
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23
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Al-Sheikhli J, Taqi H, Drake J, Habib A. Rare cause of pulmonary cavitation in a 75-year-old man. BMJ Case Rep 2018; 2018:bcr-2017-222792. [PMID: 29326340 DOI: 10.1136/bcr-2017-222792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 75-year-old man of Asian descent presented to the acute medical unit with signs and symptoms suggestive of a community-acquired pneumonia. He had multiple comorbidities and was relatively immunocompromised as a result. Initial investigations supported the diagnosis of community-acquired pneumonia complicated by a cavitating lung lesion, and the patient was treated as per hospital guidelines. He continued to deteriorate despite appropriate therapy and developed a hydropneumothorax, requiring the insertion of a chest drain. A diagnosis of pulmonary mucormycosis (Rhizopus microsporus) was made based on microbiology results from pleural aspirate, and patient was treated with intravenous antifungals. The patient was referred to the thoracic team for consideration of surgical intervention but was not suitable due to his multiple comorbidities. This case highlighted the importance of early consideration of fungal infection in patients with multiple risk factors and the need for aggressive therapy to ensure the best outcome.
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Affiliation(s)
- Jaffar Al-Sheikhli
- Department of General Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Hussein Taqi
- Cardiology, Nottingham City Hospital, Nottingham, UK
| | - John Drake
- Birmingham City Hospital, Birmingham, UK
| | - Ayaaz Habib
- Department of Critical Care, Queen's Medical Centre, Nottingham, UK
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24
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Li M, Wu N, Zhang L, Sun W, Wang J, Lv L, Ren J, Lin D. Pathologic N 0 Status in Clinical T 1N 0M 0 Lung Adenocarcinoma is Predictable by the Solid Component Proportion with Quantitative CT Number Analysis. Sci Rep 2017; 7:16810. [PMID: 29196627 PMCID: PMC5711838 DOI: 10.1038/s41598-017-16701-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/13/2017] [Indexed: 01/11/2023] Open
Abstract
Correctly predicting pathologic regional node-negative (pN0) disease in patients with lung cancer before operation may avoid unnecessary mediastinal lymph node dissection (MLND). In this study, we analyze the value of the radiographic and histopathological features of primary tumors for predicting pN0 status in cT1N0M0 lung adenocarcinoma and to establish an optimal surgical strategy for avoiding MLND in cT1N0M0 lung adenocarcinoma patients. We retrospectively investigated the histopathological and radiographic data of 348 surgically resected cT1N0M0 lung adenocarcinoma patients with systematic lymph node dissection from January 2005 to December 2012. Histopathological features and radiographic features were analyzed. Multivariable analysis was used to identify significant predictors of pN0 disease. Our results showed that pN0 disease was detected in 306 patients (87.9%) among the 348 patients with cT1N0M0 lung adenocarcinoma. A decreasing trend of the pN0 disease proportion was observed with both increasing histological grade and decreased differentiation (P < 0.001). In multivariable analysis, the solid component proportion was a significant predictor of pN0 disease. Among 110 patients with a solid component proportion of no more than 21.3%, mediastinal lymph node involvement was not observed. Patients who meet this criterion may be successfully managed with lung resection without MLND.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. .,PET-CT center, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Sun
- Department of Pathology, Beijing Cancer Hospital, Beijing, 100142, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lv Lv
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiansong Ren
- National Office for Cancer Prevention and Control, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dongmei Lin
- Department of Pathology, Beijing Cancer Hospital, Beijing, 100142, China
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25
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Martin MD, Kanne JP, Broderick LS, Kazerooni EA, Meyer CA. Lung-RADS: Pushing the Limits. Radiographics 2017; 37:1975-1993. [DOI: 10.1148/rg.2017170051] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Maria D. Martin
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Jeffrey P. Kanne
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Lynn S. Broderick
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Ella A. Kazerooni
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Cristopher A. Meyer
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
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26
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Tunali I, Stringfield O, Guvenis A, Wang H, Liu Y, Balagurunathan Y, Lambin P, Gillies RJ, Schabath MB. Radial gradient and radial deviation radiomic features from pre-surgical CT scans are associated with survival among lung adenocarcinoma patients. Oncotarget 2017; 8:96013-96026. [PMID: 29221183 PMCID: PMC5707077 DOI: 10.18632/oncotarget.21629] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 08/26/2017] [Indexed: 01/01/2023] Open
Abstract
The goal of this study was to extract features from radial deviation and radial gradient maps which were derived from thoracic CT scans of patients diagnosed with lung adenocarcinoma and assess whether these features are associated with overall survival. We used two independent cohorts from different institutions for training (n= 61) and test (n= 47) and focused our analyses on features that were non-redundant and highly reproducible. To reduce the number of features and covariates into a single parsimonious model, a backward elimination approach was applied. Out of 48 features that were extracted, 31 were eliminated because they were not reproducible or were redundant. We considered 17 features for statistical analysis and identified a final model containing the two most highly informative features that were associated with lung cancer survival. One of the two features, radial deviation outside-border separation standard deviation, was replicated in a test cohort exhibiting a statistically significant association with lung cancer survival (multivariable hazard ratio = 0.40; 95% confidence interval 0.17-0.97). Additionally, we explored the biological underpinnings of these features and found radial gradient and radial deviation image features were significantly associated with semantic radiological features.
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Affiliation(s)
- Ilke Tunali
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey.,Faculty of Biomedical Engineering, Namik Kemal University, Tekirdag, Turkey
| | - Olya Stringfield
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Albert Guvenis
- Institute of Biomedical Engineering, Bogazici University, Istanbul, Turkey
| | - Hua Wang
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, PR China
| | - Yoganand Balagurunathan
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Philippe Lambin
- Research Institute GROW of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
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27
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Liu Y, Wang H, Li Q, McGettigan MJ, Balagurunathan Y, Garcia AL, Thompson ZJ, Heine JJ, Ye Z, Gillies RJ, Schabath MB. Radiologic Features of Small Pulmonary Nodules and Lung Cancer Risk in the National Lung Screening Trial: A Nested Case-Control Study. Radiology 2017; 286:298-306. [PMID: 28837413 DOI: 10.1148/radiol.2017161458] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To extract radiologic features from small pulmonary nodules (SPNs) that did not meet the original criteria for a positive screening test and identify features associated with lung cancer risk by using data and images from the National Lung Screening Trial (NLST). Materials and Methods Radiologic features in SPNs in baseline low-dose computed tomography (CT) screening studies that did not meet NLST criteria to be considered a positive screening examination were extracted. SPNs were identified for 73 incident case patients who were given a diagnosis of lung cancer at either the first or second follow-up screening study and for 157 control subjects who had undergone three consecutive negative screening studies. Multivariable logistic regression was used to assess the association between radiologic features and lung cancer risk. All statistical tests were two sided. Results Nine features were significantly different between case patients and control subjects. Backward elimination followed by bootstrap resampling identified a reduced model of highly informative radiologic features with an area under the receiver operating characteristic curve of 0.932 (95% confidence interval [CI]: 0.88, 0.96), a specificity of 92.38% (95% CI: 52.22%, 84.91%), and a sensitivity of 76.55% (95% CI: 87.50%, 95.35%) that included total emphysema score (odds ratio [OR] = 1.71; 95% CI: 1.39, 2.01), attachment to vessel (OR = 2.41; 95% CI: 0.99, 5.81), nodule location (OR = 3.25; 95% CI: 1.09, 8.55), border definition (OR = 7.56; 95% CI: 1.89, 30.8), and concavity (OR = 2.58; 95% CI: 0.89, 5.64). Conclusion A set of clinically relevant radiologic features were identified that that can be easily scored in the clinical setting and may be of use to determine lung cancer risk among participants with SPNs. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Ying Liu
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Hua Wang
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Qian Li
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Melissa J McGettigan
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Yoganand Balagurunathan
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Alberto L Garcia
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Zachary J Thompson
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - John J Heine
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Zhaoxiang Ye
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Robert J Gillies
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
| | - Matthew B Schabath
- From the Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; and Tianjin's Clinical Research Center for Cancer, Tianjin, China (Y.L., H.W., Q.L., Z.Y.); and Departments of Cancer Imaging and Metabolism (Y.L., Q.L., Y.B., A.L.G., R.J.G.), Diagnostic Imaging and Interventional Radiology (M.J.M.), Biostatistics and Bioinformatics (Z.J.T.), Cancer Epidemiology (J.J.H., M.B.S.), and Thoracic Oncology (M.B.S.), H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Dr, MRC-CANCONT, Tampa, FL 33612
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28
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Tomizawa K, Shimizu S, Ohara S, Fujino T, Nishino M, Sesumi Y, Kobayashi Y, Sato K, Chiba M, Shimoji M, Suda K, Takemoto T, Mitsudomi T. Clinical significance of tumor cavitation in surgically resected early-stage primary lung cancer. Lung Cancer 2017; 112:57-61. [PMID: 29191601 DOI: 10.1016/j.lungcan.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The prognostic impact of tumor cavitation is unclear in patients with early-stage primary lung cancer. The aim of the present study was to examine the clinicopathological features and prognoses of patients with pathological stage I-IIA (p-stage I-IIA) primary lung cancers harboring tumor cavitation. This study was conducted according to the eighth edition of the TNM classification for lung cancer. MATERIALS AND METHODS We examined 602 patients with p-stage I-IIA primary lung cancer out of 890 patients who underwent pulmonary resection from January 2007 through March 2014 and searched for the presence of tumor cavitation, which is defined as the presence of air space within the primary tumor. RESULTS A total of 59 out of the 602 patients had tumor cavitation (10%). Compared with patients without tumor cavitation, those with tumor cavitation had a significantly higher frequency of the following characteristics: high serum carcinoembryonic antigen (CEA) level (≥5ng/ml, p=0.027), interstitial pneumonia (p=0.0001), high SUVmax value on FDG-PET scan (≥4.2, p=0.023), tumors located in the lower lobe (p=0.024), large tumor size (>3cm, p=0.002), vascular invasion (66% vs 17%, p<0.0001) and non-adenocarcinoma histology (p=0.025). The overall survival period of patients with tumor cavitation was significantly shorter than that of patients without tumor cavitation (log-rank test: p<0.0001, 5-year OS rate: 56% vs 81%). Tumor cavitation was found to be an independent and significant factor associated with poor prognosis in the multivariate analysis (hazard ratio: 1.76, 95% confidence interval: 1.02-3.10, p=0.042). CONCLUSIONS Tumor cavitation is an independent factor for poor prognosis in patients with resected p-stage I-IIA primary lung cancer. Based on our analyses, patients with tumor cavitation should be regarded as a separate cohort that requires more intensive follow-up.
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Affiliation(s)
- Kenji Tomizawa
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Shigeki Shimizu
- Department of Pathology, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Shuta Ohara
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Toshio Fujino
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Masaya Nishino
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Yuichi Sesumi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Yoshihisa Kobayashi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Katsuaki Sato
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Masato Chiba
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Masaki Shimoji
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Kenichi Suda
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Toshiki Takemoto
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan
| | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Japan.
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29
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Survival and central photopenia detected by fluorine-18 fluoro-deoxy-glucose positron emission tomography (FDG-PET) in patients with locoregional non-small cell lung cancer treated with radiotherapy. Radiother Oncol 2017; 124:25-30. [DOI: 10.1016/j.radonc.2017.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/26/2017] [Accepted: 06/05/2017] [Indexed: 11/19/2022]
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30
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Yip SSF, Liu Y, Parmar C, Li Q, Liu S, Qu F, Ye Z, Gillies RJ, Aerts HJWL. Associations between radiologist-defined semantic and automatically computed radiomic features in non-small cell lung cancer. Sci Rep 2017; 7:3519. [PMID: 28615677 PMCID: PMC5471260 DOI: 10.1038/s41598-017-02425-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/11/2017] [Indexed: 12/26/2022] Open
Abstract
Tumor phenotypes captured in computed tomography (CT) images can be described qualitatively and quantitatively using radiologist-defined "semantic" and computer-derived "radiomic" features, respectively. While both types of features have shown to be promising predictors of prognosis, the association between these groups of features remains unclear. We investigated the associations between semantic and radiomic features in CT images of 258 non-small cell lung adenocarcinomas. The tumor imaging phenotypes were described using 9 qualitative semantic features that were scored by radiologists, and 57 quantitative radiomic features that were automatically calculated using mathematical algorithms. Of the 9 semantic features, 3 were rated on a binary scale (cavitation, air bronchogram, and calcification) and 6 were rated on a categorical scale (texture, border definition, contour, lobulation, spiculation, and concavity). 32-41 radiomic features were associated with the binary semantic features (AUC = 0.56-0.76). The relationship between all radiomic features and the categorical semantic features ranged from weak to moderate (|Spearmen's correlation| = 0.002-0.65). There are associations between semantic and radiomic features, however the associations were not strong despite being significant. Our results indicate that radiomic features may capture distinct tumor phenotypes that fail to be perceived by naked eye that semantic features do not describe and vice versa.
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Affiliation(s)
- Stephen S F Yip
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, 02115, USA.
| | - Ying Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin, PR China
| | - Chintan Parmar
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, 02115, USA
| | - Qian Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin, PR China
| | - Shichang Liu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin, PR China
| | - Fangyuan Qu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin, PR China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin, PR China
| | - Robert J Gillies
- Department of Cancer Imaging and Metabolism, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Hugo J W L Aerts
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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Toyokawa G, Takada K, Okamoto T, Shimokawa M, Kozuma Y, Matsubara T, Haratake N, Takamori S, Akamine T, Katsura M, Shoji F, Oda Y, Maehara Y. Computed Tomography Features of Lung Adenocarcinomas With Programmed Death Ligand 1 Expression. Clin Lung Cancer 2017; 18:e375-e383. [PMID: 28385373 DOI: 10.1016/j.cllc.2017.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/07/2017] [Accepted: 03/07/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The development of immune checkpoint inhibitors against programmed death 1 has paved the way for a new era of treatment of lung cancer. Programmed death-ligand 1 (PD-L1) is expected to predict the response of immune checkpoint inhibitors in lung cancer. Predicting PD-L1 expression using a noninvasive method before immunotherapy would, therefore, help identify patients for whom immunotherapy can be successful. PATIENTS AND METHODS A total of 394 patients with resected lung adenocarcinoma who had undergone preoperative thin-section computed tomography (CT) were analyzed for PD-L1 expression by immunohistochemistry and evaluated to determine the association between PD-L1 expression and CT characteristics, including convergence, surrounding ground glass opacity (GGO), air bronchogram, notching, pleural indentation, spiculation, and cavitation. RESULTS Of the 394 patients, 78 (19.8%) were positive and 316 (80.2%) were negative for PD-L1 expression. Univariate analysis demonstrated that PD-L1+ adenocarcinoma was significantly associated with the presence of convergence (P < .01), notching (P < .01), spiculation (P < .01), and cavitation (P < .01) and the absence of surrounding GGO (P < .01) compared with PD-L1- cases. On multivariate analysis, the presence of convergence (P < .01) and cavitation (P < .01) and the absence of surrounding GGO (P = .02) and air bronchogram (P = .03) were significantly associated with PD-L1 expression. CONCLUSION PD-L1+ adenocarcinoma cases showed convergence and cavitation more frequently than did PD-L1- cases. In contrast, surrounding GGO and air bronchogram were observed less frequently in PD-L1+ cases than in PD-L1- cases. These results will prove helpful in identifying PD-L1-expressing adenocarcinoma by CT before immunotherapy.
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Affiliation(s)
- Gouji Toyokawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Kazuki Takada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Yuka Kozuma
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taichi Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Haratake
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinkichi Takamori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takaki Akamine
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masakazu Katsura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumihiro Shoji
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Cheng Z, Shan F, Yang Y, Shi Y, Zhang Z. CT characteristics of non-small cell lung cancer with epidermal growth factor receptor mutation: a systematic review and meta-analysis. BMC Med Imaging 2017; 17:5. [PMID: 28068946 PMCID: PMC5223577 DOI: 10.1186/s12880-016-0175-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/23/2016] [Indexed: 12/21/2022] Open
Abstract
Background To systematically investigate the relationship between CT morphological features and the presence of epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC). Methods All studies about the CT morphological features of NSCLC with EGFR mutations published between January 1, 2000 and March 15, 2015 were searched in the PubMed and EMBASE databases. Qualified studies were selected according to inclusion criteria. The frequency of EGFR mutations and CT features of ground-glass opacity (GGO) content, tumor size, cavitation, air-bronchogram, lobulation, and spiculation were extracted. The relationship between EGFR mutations and each of these CT features was tested based upon the weighted mean difference or inverse variance in the form of an odds ratio at a 95% confidence interval using Forest Plots. The publication bias was examined using Egger’s test. Results A total of 13 studies, consisting of 2146 NSCLC patients, were included, and 51.12% (1097/2146) of patients had EGFR mutations. The EGFR mutations were present in NSCLC with part-solid GGO in contrast to nonsolid GGO (OR = 0.49, 95% CI = 0.25–0.96, P = 0.04). Other CT features such as tumor size, cavitation, air-bronchogram, lobulation and spiculation did not demonstrate statistically significant correlation with EGFR mutations individually (P = 0.91; 0.67; 0.12; 0.45; and 0.36, respectively). No publication bias among the selected studies was noted in this meta-analysis (Egger’s tests, P > 0.05 for all). Conclusion This meta-analysis demonstrated that NSCLC with CT morphological features of part-solid GGO tended to be EGFR mutated, which might provide an important clue for the correct selection of patients treated with molecular targeted therapies. Electronic supplementary material The online version of this article (doi:10.1186/s12880-016-0175-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zenghui Cheng
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, NO.2901 Caolang Road, Jinshan, Shanghai, 201508, China.,Department of Radiology, Qingpu branch of Zhongshan Hospital, Fudan University, Shanghai, 201700, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, NO.2901 Caolang Road, Jinshan, Shanghai, 201508, China
| | - Yuesong Yang
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, NO.2901 Caolang Road, Jinshan, Shanghai, 201508, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, NO.2901 Caolang Road, Jinshan, Shanghai, 201508, China.
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Sun W, Yang X, Liu Y, Yuan Y, Lin D. Primary Tumor Location Is a Useful Predictor for Lymph Node Metastasis and Prognosis in Lung Adenocarcinoma. Clin Lung Cancer 2017; 18:e49-e55. [DOI: 10.1016/j.cllc.2016.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 01/14/2023]
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Cavity Wall Thickness in Solitary Cavitary Lung Adenocarcinomas Is a Prognostic Indicator. Ann Thorac Surg 2016; 102:1863-1871. [PMID: 27663793 DOI: 10.1016/j.athoracsur.2016.03.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 01/28/2016] [Accepted: 03/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although cavitary lung cancers typically show thick-walled cavities on radiology, thin-walled cancers have recently been reported. However, the prognostic and pathologic differences between thin-walled and thick-walled variants are unclear. We reviewed detailed histologic features and survival outcomes of cavitary pulmonary adenocarcinomas to assess pathologic attributes, focusing particularly on cavity wall thickness. METHODS We studied 132 patients diagnosed with lung adenocarcinoma involving cavitary formation, as determined with high-resolution computed tomography or histology, between 1998 and 2007. Using receiver-operating characteristics curve analysis, we established a cutoff value for cavity wall thickness based on disease-specific survival. Cavitary adenocarcinomas were grouped into thick-walled or thin-walled types according to this cutoff, as measured by computed tomography. RESULTS The thick-walled group comprised lung adenocarcinoma patients with a cavity wall thickness of greater than 4 mm (n = 65); the thin-walled group comprised patients with a cavity wall thickness of 4 mm or less (n = 67). The thick-walled group had a higher frequency of solid predominant tumors (p < 0.01), vascular invasion (p < 0.001), lymphatic invasion (p < 0.01), necrosis (p < 0.001), obstructive pneumonia (p < 0.01), intracavity abscess (p < 0.01), and bronchiolar obstruction (p = 0.02). Lepidic predominant (p = 0.09) and papillary predominant patterns (p = 0.08) were more common in the thin-walled group. Multivariate analysis revealed cavity wall thickness to be an independent prognostic factor (p = 0.022). CONCLUSIONS The pathologic and prognostic implications of thick-walled cavities versus thin-walled cavities in lung carcinoma patients, defined according to our cutoff, were found to be distinct.
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Kunihiro Y, Kobayashi T, Tanaka N, Matsumoto T, Okada M, Kamiya M, Ueda K, Kawano H, Matsunaga N. High-resolution CT findings of primary lung cancer with cavitation: a comparison between adenocarcinoma and squamous cell carcinoma. Clin Radiol 2016; 71:1126-31. [PMID: 27394062 DOI: 10.1016/j.crad.2016.06.110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/21/2016] [Accepted: 06/09/2016] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the high-resolution computed tomography (CT) findings of primary lung cancer with cavitation and compare the findings in adenocarcinoma and squamous cell carcinoma. MATERIALS AND METHODS The high-resolution CT findings of tumours with cavitation were retrospectively evaluated in 60 patients. Forty-seven of the lesions were diagnosed as adenocarcinomas; 13 were diagnosed as squamous cell carcinomas. The diameters of the tumour and cavity, the maximum thickness of the cavity wall, shape of the cavity wall, the number of cavities, and the presence of ground-glass opacity, bronchial obstruction, intratumoural bronchiectasis, emphysema, and honeycombing were evaluated. The mechanisms of cavity formation were examined according to the pathological features. RESULTS The maximum thickness of the cavity wall was significantly greater in squamous cell carcinomas than in adenocarcinomas (p=0.002). Ground-glass opacity and intratumoural bronchiectasis were significantly more common in adenocarcinomas than in squamous cell carcinomas (p<0.001 and p=0.040, respectively). Regarding the pathological findings, intratumoural bronchiectasis with or without alveolar wall destruction contributed to a significant difference between adenocarcinoma and squamous cell carcinoma (p<0.001; odds ratio [OR], 20.35; 95% confidence interval [CI], 3.87-107.10). CONCLUSION The cavity wall tends to be thicker in squamous cell carcinomas than in adenocarcinomas. The presence of ground-glass opacity and intratumoural bronchiectasis is strongly suggestive of adenocarcinoma.
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Affiliation(s)
- Y Kunihiro
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
| | - T Kobayashi
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - N Tanaka
- Department of Radiology, Saiseikai Yamaguchi General Hospital, 2-11, Midori-town, Yamaguchi-city, Yamaguchi 755-8517, Japan
| | - T Matsumoto
- Department of Radiology, National Hospital Organization, Yamaguchi Ube Medical Center, 685, Higashikiwa, Ube, Yamaguchi 755-0241, Japan
| | - M Okada
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - M Kamiya
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - K Ueda
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - H Kawano
- Department of Molecular Pathology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - N Matsunaga
- Department of Radiology, Yamaguchi University Graduate School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi 755-8505, Japan
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Hasegawa M, Sakai F, Ishikawa R, Kimura F, Ishida H, Kobayashi K. CT Features of Epidermal Growth Factor Receptor–Mutated Adenocarcinoma of the Lung: Comparison with Nonmutated Adenocarcinoma. J Thorac Oncol 2016; 11:819-26. [DOI: 10.1016/j.jtho.2016.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/17/2016] [Accepted: 02/17/2016] [Indexed: 11/25/2022]
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Tan M, Li Z, Qiu Y, McMeekin SD, Thai TC, Ding K, Moore KN, Liu H, Zheng B. A New Approach to Evaluate Drug Treatment Response of Ovarian Cancer Patients Based on Deformable Image Registration. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:316-325. [PMID: 26336119 PMCID: PMC5161344 DOI: 10.1109/tmi.2015.2473823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although Response Evaluation Criteria in Solid Tumors (RECIST) is the current clinical guideline to assess size change of solid tumors after therapeutic treatment, it has a relatively lower association to the clinical outcome of progression free survival (PFS) of the patients. In this paper, we presented a new approach to assess responses of ovarian cancer patients to new chemotherapy drugs in clinical trials. We first developed and applied a multi-resolution B-spline based deformable image registration method to register two sets of computed tomography (CT) image data acquired pre- and post-treatment. The B-spline difference maps generated from the co-registered CT images highlight the regions related to the volumetric growth or shrinkage of the metastatic tumors, and density changes related to variation of necrosis inside the solid tumors. Using a testing dataset involving 19 ovarian cancer patients, we compared patients' response to the treatment using the new image registration method and RECIST guideline. The results demonstrated that using the image registration method yielded higher association with the six-month PFS outcomes of the patients than using RECIST. The image registration results also provided a solid foundation of developing new computerized quantitative image feature analysis schemes in the future studies.
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Affiliation(s)
| | - Zheng Li
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 USA
| | - Yuchen Qiu
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 USA
| | - Scott D. McMeekin
- Health Science Center of University of Oklahoma, Oklahoma City, OK 73104 USA
| | - Theresa C. Thai
- Health Science Center of University of Oklahoma, Oklahoma City, OK 73104 USA
| | - Kai Ding
- Health Science Center of University of Oklahoma, Oklahoma City, OK 73104 USA
| | - Kathleen N. Moore
- Health Science Center of University of Oklahoma, Oklahoma City, OK 73104 USA
| | - Hong Liu
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 USA
| | - Bin Zheng
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019 USA
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Correlation between EGFR mutation status and computed tomography features in patients with advanced pulmonary adenocarcinoma. J Thorac Imaging 2015; 29:357-63. [PMID: 25303964 DOI: 10.1097/rti.0000000000000116] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To correlate computed tomography (CT) imaging features and epidermal growth factor receptor (EGFR) mutation status in patients with advanced lung adenocarcinoma. MATERIALS AND METHODS Patients with advanced pulmonary adenocarcinoma who were diagnosed between January 1, 2009 and December 31, 2011 and who had available chest CT and their tumors analyzed for EGFR mutations at a university hospital were enrolled in this retrospective study. Two radiologists independently evaluated the CT images and recorded the target lesion's size, shape, margin, density, and the presence or absence of an air bronchogram and calcification. RESULTS One hundred and forty-nine patients were enrolled into this study (66 men, 83 women), with a mean age of 63±11 years (range 32 to 89 y). Seventy-eight (52.3%) patients had EGFR mutations. The tumors in the patients harboring no EGFR mutations (EGFR wild type) were larger than in those whose tumors harbored EGFR mutations (P=0.01). An irregular shape was more common in the tumors with wild-type EGFR (P=0.01), and an oval shape was more common in tumors with EGFR mutations. Tumors with exon 21 mutations were larger than those with exon 19 deletions (P=0.02). Air bronchograms were more common in tumors with exon 19 deletions than in those with wild-type EGFR or exon 21 mutations (P=0.004 and 0.01, respectively). Calcification was more common in the tumors with wild-type EGFR than in those with EGFR mutations (P=0.03). CONCLUSIONS Adenocarcinomas with wild-type EGFR were significantly associated with larger tumors and an irregular shape. In particular, calcification was more common in the tumors with wild-type EGFR than in those with EGFR mutations. In addition, air bronchograms were more common in the tumors with exon 19 deletions.
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Surgically Resected Solitary Cavitary Lung Adenocarcinoma: Association Between Clinical, Pathologic, and Radiologic Findings and Prognosis. Ann Thorac Surg 2015; 99:968-74. [DOI: 10.1016/j.athoracsur.2014.10.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/14/2014] [Accepted: 10/21/2014] [Indexed: 12/17/2022]
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40
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Mortensen KH, Babar JL, Balan A. Multidetector CT of pulmonary cavitation: filling in the holes. Clin Radiol 2015; 70:446-56. [PMID: 25623513 DOI: 10.1016/j.crad.2014.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/03/2014] [Accepted: 12/11/2014] [Indexed: 12/17/2022]
Abstract
Pulmonary cavitation causes significant morbidity and mortality. Early diagnosis of the presence and aetiology of a cavity is therefore crucial in order to avoid further demise in both the localized pulmonary and systemic disorders that may manifest with pulmonary cavity formation. Multidetector CT has become the principal diagnostic technique for detecting pulmonary cavitation and its complications. This review provides an overview of the aetiologies and their imaging findings using this technique. Combining a literature review with case illustration, a synopsis of the different imaging features and constellations is provided, which may suggest a particular cause and aid the differentiation from diseases with similar findings.
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Affiliation(s)
- K H Mortensen
- University Department of Radiology, Cambridge University, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
| | - J L Babar
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A Balan
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
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Xue XY, Liu YX, Wang KF, Zang XF, Sun JP, Zhang MY, Yang B, Ao T, Wang JX. Computed tomography for the diagnosis of solitary thin-walled cavity lung cancer. CLINICAL RESPIRATORY JOURNAL 2014; 9:392-8. [PMID: 24931383 DOI: 10.1111/crj.12172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/09/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Lung cancer is the most commonly diagnosed neoplasm and the leading cause of cancer-related death worldwide. Despite the high incidence of lung cancer, the diagnosis of solitary thin-walled cavity lung cancer is rare. The aim of this review is to explore the potentials of computed tomography (CT) as diagnostic tool for solitary thin-walled cavity lung cancer. METHOD The literature search was made in electronic databases including PudMed, Ovid SP, Embase, Web of Sciences, EBSCO and Wiley online by using relevant key terms. Because of the rarity of the subject, no precise exclusion or inclusion criteria were used for article selection and the outcome dissemination was decided to be more descriptive rather than quantitative. RESULTS The detection of cavitation in lungs is frequently done utilizing chest radiographs CT scans. However, the diagnostic challenge remains the accurate detection of solitary thin-walled cavity lung cancer among the prevalence of cavitary lung lesions in multiple thoracic disorders including benign disorders, infectious disease and malignant tumors. Moreover, an accurate diagnosis of solitary thin-walled cavity lung cancer is further complicated by its subjective classification within the literature. In order to facilitate early diagnosis of this disease and circumvent the need for more invasive tests that may not be warranted, the overarching goal is to establish definitive radiological features of lung cavities that are indicative of malignancy. Herein, we describe the benefits of using CT to identify and diagnose solitary thin-walled cavity lung cancer, as well as explore the underlying mechanisms that contribute to thin-walled cavity formation in oncology patients. CONCLUSION CT is the best modality for the noninvasive differentiation between malignant and nonmalignant cavities as it provides reliable information regarding the morphology and density of lesions. Besides, CT densitometry can efficiently detect the calcifications in lesions.
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Affiliation(s)
- Xin-Ying Xue
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China.,Department of Special Medical Treatment-Respiratory Disease, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yu-Xia Liu
- Research Department, Peking Union Medical College Hospital, Beijing, China
| | - Kai-Fei Wang
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xue-Feng Zang
- Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jun-Ping Sun
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ming-Yue Zhang
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bing Yang
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China
| | - Ting Ao
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jian-Xin Wang
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China
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Koenigkam Santos M, Muley T, Warth A, de Paula WD, Lederlin M, Schnabel PA, Schlemmer HP, Kauczor HU, Heussel CP, Puderbach M. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: Impact on prognosis and comparison with adenocarcinomas. Eur J Radiol 2014; 83:1275-1281. [DOI: 10.1016/j.ejrad.2014.04.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/19/2014] [Accepted: 04/19/2014] [Indexed: 12/31/2022]
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Mama N, Dhifallah M, Ben Aicha S, Kadri K, Arifa N, Hasni I, Tlili-Graiess K. Imagerie tomodensitométrique des lésions pulmonaires excavées. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.frad.2014.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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44
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Zhao F, Yan SX, Wang GF, Wang J, Lu PX, Chen B, Yuan J, Zhang SZ, Wang YXJ. CT features of focal organizing pneumonia: An analysis of consecutive histopathologically confirmed 45 cases. Eur J Radiol 2014; 83:73-8. [DOI: 10.1016/j.ejrad.2013.04.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/21/2013] [Accepted: 04/10/2013] [Indexed: 02/02/2023]
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Singh N, Mootha VK, Madan K, Aggarwal AN, Behera D. Tumor cavitation among lung cancer patients receiving first-line chemotherapy at a tertiary care centre in India: association with histology and overall survival. Med Oncol 2013; 30:602. [PMID: 23673987 DOI: 10.1007/s12032-013-0602-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 05/03/2013] [Indexed: 12/19/2022]
Abstract
Clinical significance of tumor cavitation (TC) prior to and following first-line chemotherapy of lung cancer is unclear. An evaluation of the incidence and prognostic role of TC among treatment naive lung cancer patients undergoing chemotherapy at a tertiary care institute in North India was undertaken. Retrospective data analysis and radiological review of newly diagnosed lung cancer patients initiated on chemotherapy over a 2-year period were carried out. Demographic characteristics and overall survival (OS) were compared between patients with and without TC at baseline. Patients who received 3 or more cycles of chemotherapy were included in analysis for response rates and new onset TC. Overall, 27 (7.8 %) of 347 patients had baseline TC. Among 271 non-small cell lung cancer (NSCLC) patients with (n = 26) and without (n = 245) baseline TC, histology was the only demographic characteristic that differed significantly [squamous 76.9 vs. 46.9 %; p = 0.004]. Majority (82.7 %) of NSCLC patients had advanced (stage IIIB/IV) disease. NSCLC patients with and without baseline TC alive at 6 months, 1 and 2 years were 34.6 versus 53.9 %, 11.5 versus 25.7 % and 3.8 versus 7.8 %, respectively. NSCLC patients with baseline TC had shorter median OS than those without (174 days [95 % confidence interval (CI) 106-242 days] vs. 235 days [95 % CI 207-263 days]). On multivariate Cox proportional hazard analysis, age [hazard ratio (HR) = 1.02, 95 % CI 1.01-1.04] and baseline TC [HR = 1.66, 95 % CI 1.03-2.69] were found significant. Response rates were similar between the two groups. Patients with TC after chemotherapy differed from those without in frequency of squamous histology (77.8 vs. 38.9 %; p < 0.001) and presence of metastatic disease (19.4 vs. 40.9 %; p = 0.016). Squamous histology has a significant association with presence of baseline TC and of new onset TC after chemotherapy. Presence of baseline TC has an independent association with shorter OS among NSCLC patients undergoing first-line chemotherapy.
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Affiliation(s)
- Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh 160012, India.
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Abstract
Orbital cavitary rhabdomyosarcoma has been previously reported in 2 cases. The case presented here was a 15-year-old boy who had proptosis, pain, periorbital hyperemia, and visual loss in his OD, which progressed in 6 weeks. Radiologic studies demonstrated a well-demarcated, multilobulated, large mass with cavities, extending from the anterior orbit to the apex, suggesting a diagnosis of venolymphatic malformation with an intrinsic hemorrhage. On surgery, a multilobular, hemorrhagic cystic mass was almost completely excised. Histologic examination revealed a diagnosis of embryonal rhabdomyosarcoma. After postoperative chemotherapy and radiotherapy, the tumor did not recur during a follow-up period of 45 months. This case, together with the previous ones, suggests that cavitary orbital rhabdomyosarcomas may have some distinct clinical, radiologic, and surgical characteristics.
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Lee Y, Lee HJ, Kim YT, Kang CH, Goo JM, Park CM, Paeng JC, Chung DH, Jeon YK. Imaging characteristics of stage I non-small cell lung cancer on CT and FDG-PET: relationship with epidermal growth factor receptor protein expression status and survival. Korean J Radiol 2013; 14:375-83. [PMID: 23483676 PMCID: PMC3590355 DOI: 10.3348/kjr.2013.14.2.375] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/10/2012] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To identify CT and FDG-PET features associated with epidermal growth factor receptor (EGFR) protein overexpression, and to evaluate whether imaging features and EGFR-overexpression can help predict clinical outcome. MATERIALS AND METHODS In 214 patients (M : F = 129 : 85; mean age, 63.2) who underwent curative resection of stage I non-small cell lung cancer, EGFR protein expression status was determined through immunohistochemical analysis. Imaging characteristics on CT and FDG-PET was assessed in relation to EGFR-overexpression. Imaging features and EGFR-overexpression were also evaluated for clinical outcome by using the Cox proportional hazards model. RESULTS EGFR-overexpression was found in 51 patients (23.8%). It was significantly more frequent in tumors with an SUV(max) > 5.0 (p < 0.0001), diameter > 2.43 cm (p < 0.0001), and with ground glass opacity ≤ 50% (p = 0.0073). SUV(max) > 5.0 (OR, 3.113; 95% CI, 1.375-7.049; p = 0.006) and diameter > 2.43 cm (OR, 2.799; 95% CI, 1.285-6.095; p = 0.010) were independent predictors of EGFR overexpression. Multivariate analysis showed that SUV(max) > 4.0 (hazard ratio, 10.660; 95% CI, 1.370-82.966; p = 0.024), and the presence of cavitation within a tumor (hazard ratio, 3.122; 95% CI, 1.143-8.532; p = 0.026) were factors associated with poor prognosis. CONCLUSION EGFR-overexpression is associated with high SUV(max), large tumor diameter, and small GGO proportion. CT and FDG-PET findings, which are closely related to EGFR overexpression, can be valuable in the prediction of clinical outcome.
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Affiliation(s)
- Youkyung Lee
- Department of Radiology, Seoul National University Hospital, Seoul 110-744, Korea
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Raissouni S, Ghizlane R, Mouzount H, Saoussane K, Khadija S, Zouaidia F, Latib R, Mrabti H, Errihani H. Unusual case of cavitary lung metastasis from squamous cell carcinoma of the uterine cervix. Pan Afr Med J 2013; 14:37. [PMID: 23560120 PMCID: PMC3612870 DOI: 10.11604/pamj.2013.14.37.1420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 05/03/2012] [Indexed: 01/15/2023] Open
Abstract
Spontaneous excavation of primary lung cancer is common; however cavitation of metastatic lung lesions is rare and usually confused with benign lesions. In Moroccan context tuberculosis is the first suspected diagnosis of lung excavations. We report a rare case of cavitary lung metastasis of a uterine cervix cancer, treated initially as tuberculosis. A 40-year old non-smoking woman with a known history of squamous cell carcinoma of the uterine cervix since August 2005; presented on September 2008 with right chest pain without fever, hemoptysis or weight loss. CT scan showed a thin walled cavity. Empirical Antibiotic therapy was conducted 15 days with poor outcome. Then antibacillary treatment was started with no proof of mycobacterial infection. A month later, the patient presented with gynecological bleeding and a pneumothorax. Bronchoscopy with transbronchial biopsy of the cavitary mass was performed. Pathology demonstrated a metastatic squamous cell carcinoma. Pelvic examination and MRI showed a subsequent local cervix recurrence. Patient underwent 3 courses of systemic chemotherapy. She died on June 2009 due to progressive disease. Even cavitary lung metastases are rare and benign differential diagnosis are more common, clinician should be careful in neoplastic context and investigation should be done to eliminate a recurrence.
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Affiliation(s)
- Soundouss Raissouni
- Department of medical oncology, National Institute of Oncology, Rabat, Morocco
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Kim NR, Han J. Pathologic review of cystic and cavitary lung diseases. KOREAN JOURNAL OF PATHOLOGY 2012; 46:407-14. [PMID: 23136566 PMCID: PMC3490124 DOI: 10.4132/koreanjpathol.2012.46.5.407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 06/04/2012] [Accepted: 06/08/2012] [Indexed: 12/19/2022]
Abstract
Pulmonary cystic and cavitary lesions caused by diverse etiologies are commonly encountered in chest imaging. The terms "cyst" and "cavity" are used to describe air-filled regions in the center of a nodule or consolidation of the lung. To date, only radiologic aspects of these lesions have been addressed. The morphologies of pulmonary cystic and cavitary lesions exhibit a broad spectrum, ranging from benign to malignant pulmonary diseases of acquired or congenital origin, including variable infectious diseases. In this review, we summarized the differential diagnosis of pathological entities to provide pathologists and radiologists with an overview of the diseases most commonly associated with pulmonary cystic and cavitary lesions in adults and children. The results showed slightly different patterns in the distribution of the diseases in the two groups. The most common causes of cavitary lesions include malignancy and infection in adults, and congenital malformation in children. Therefore, identification of pathologic entities correlating with the radiologic findings, clinical course, and location of the lesion is important in the evaluation of cystic and cavitary lung lesions in order to avoid unnecessary surgical procedures or delayed treatment.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
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Hodnett PA, Ko JP. Evaluation and Management of Indeterminate Pulmonary Nodules. Radiol Clin North Am 2012; 50:895-914. [DOI: 10.1016/j.rcl.2012.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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